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Mehrnia M, Kholmovski E, Katsaggelos A, Kim D, Passman R, Elbaz MSM. Novel Self-Calibrated Threshold-Free Probabilistic Fibrosis Signature Technique for 3D Late Gadolinium Enhancement MRI. IEEE Trans Biomed Eng 2025; 72:856-869. [PMID: 39383069 PMCID: PMC11875924 DOI: 10.1109/tbme.2024.3476930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
Myocardial fibrosis is a crucial marker of heart muscle injury in several heart disease like myocardial infarction, cardiomyopathies, and atrial fibrillation (AF). Fibrosis and associated scarring (dense fibrosis) are also vital for assessing heart muscle pre- and post-intervention, such as evaluating left atrial (LA) fibrosis/scarring in patients undergoing catheter ablation for AF. Although cardiac MRI is the gold standard for fibrosis assessment, current quantification methods are unreliable due to their reliance on variable thresholding and sensitivity to MRI uncertainties, lacking standardization and reproducibility. Importantly, current methods focus solely on quantifying fibrosis volume ignoring the unique MRI characteristics of fibrosis density and unique distribution, that could better inform on disease severity. To address these issues, we propose a novel threshold-free self-calibrating probabilistic method called "Fibrosis Signatures." This method efficiently encodes ∼9 billion MRI intensity co-disparities per scan into standardized probability density functions, deriving a unique MRI fibrosis signature index (FSI). The FSI index quantitatively encodes fibrosis/scar extent, density, and distribution patterns simultaneously, providing a detailed assessment of burden/severity. Our self-calibrating design mitigates impacts of MRI uncertainties, ensuring robust evaluations pre- and post-intervention under varying MRI qualities. Extensively validated using a novel numerical phantom and 143 in vivo LA 3D MRIs of AF patients (pre- and post- ablation and serial post-ablation scans) and compared to 5 existing methods, our FSI index demonstrated strong correlations with traditional fibrosis measures and was able to quantify density and distribution pattern beyond entropy. FSI was up to 9 times more reliable and reproducible to MRI uncertainties (noise, segmentation, spatial resolution), highlighting its potential to improve cardiac MRI reliability and clinical utility.
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Affiliation(s)
- Mehri Mehrnia
- Radiology Department, Northwestern University, Chicago, IL, USA
- Biomedical Engineering, Northwestern University
| | - Eugene Kholmovski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | | | - Daniel Kim
- Radiology Department, Northwestern University, Chicago, IL, USA
| | - Rod Passman
- Cardiology, Northwestern University, Chicago, IL, USA
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Santoro F, Vitale E, Ragnatela I, Cetera R, Leopzzi A, Mallardi A, Matera A, Mele M, Correale M, Brunetti ND. Multidisciplinary approach in cardiomyopathies: From genetics to advanced imaging. Heart Fail Rev 2024; 29:445-462. [PMID: 38041702 DOI: 10.1007/s10741-023-10373-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Cardiomyopathies are myocardial diseases characterized by mechanical and electrical dysfunction of the heart muscle which could lead to heart failure and life-threatening arrhythmias. Certainly, an accurate anamnesis, a meticulous physical examination, and an ECG are cornerstones in raising the diagnostic suspicion. However, cardiovascular imaging techniques are indispensable to diagnose a specific cardiomyopathy, to stratify the risk related to the disease and even to track the response to the therapy. Echocardiography is often the first exam that the patient undergoes, because of its non-invasiveness, wide availability, and cost-effectiveness. Cardiac magnetic resonance imaging allows to integrate and implement the information obtained with the echography. Furthermore, cardiomyopathies' genetic basis has been investigated over the years and the list of genetic mutations deemed potentially pathogenic is expected to grow further. The aim of this review is to show echocardiographic, cardiac magnetic resonance imaging, and genetic features of several cardiomyopathies: dilated cardiomyopathy (DMC), hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), left ventricular noncompaction cardiomyopathy (LVNC), myocarditis, and takotsubo cardiomyopathy.
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Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Rosa Cetera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | | | | | - Annalisa Matera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Marco Mele
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
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Zhou Z, Wang R, Wang H, Liu Y, Lu D, Sun Z, Yang G, Xu L. Myocardial extracellular volume fraction quantification in an animal model of the doxorubicin-induced myocardial fibrosis: a synthetic hematocrit method using 3T cardiac magnetic resonance. Quant Imaging Med Surg 2021; 11:510-520. [PMID: 33532252 DOI: 10.21037/qims-20-501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Visualization of diffuse myocardial fibrosis is challenging and mainly relies on histology. Cardiac magnetic resonance (CMR), which uses extracellular contrast agents, is a rapidly developing technique for measuring the extracellular volume (ECV). The objective of this study was to evaluate the feasibility of the synthetic myocardial ECV fraction based on 3.0 T CMR compared with the conventional ECV fraction. Methods This study was approved by the local animal care and ethics committee. Fifteen beagle models with diffuse myocardial fibrosis, including 12 experimental and three control subjects, were generated by injecting doxorubicin 30 mg/m2 intravenously every three weeks for 24 weeks. Short-axis (SAX) and 4-chamber long-axis (LAX) T1 maps were acquired for both groups. The association between hematocrit (Hct) and native T1blood was derived from 9 non-contrast CMR T1 maps of 3 control beagles using regression analysis. Synthetic ECV was then calculated using the synthetic Hct and compared with conventional ECV at baseline and the 16th and 24th week after doxorubicin administration. The collagen volume fraction (CVF) value was measured on digital biopsy samples. Bland-Altman plots were used to analyze the agreement between conventional and synthetic ECV. Correlation analyses were performed to explore the association among conventional ECV, synthetic ECV, CVF, and left ventricular ejection fraction (LVEF). Results The regression model synthetic Hct = 816.46*R1blood - 0.01 (R2=0.617; P=0.012) was used to predict the Hct from native T1blood values. The conventional and synthetic ECV fractions of experimental animals at the 16th and 24th week after modeling were significantly higher than those measured at the baseline (31.4%±2.2% and 36.3%±2.1% vs. 22.9%±1.7%; 29.9%±2.4% and 36.1%±2.6% vs. 22.0%±2.4%; all with P<0.05). Bland-Altman plots showed a bias (1.0%) between conventional and synthetic ECV with 95% limits of agreement of -2.5% to 4.4% in the per-subject analysis (n=21) and a bias (1.0%) between conventional and synthetic ECV with 95% limits of agreement of -2.4% to 4.3% in the per-segment analysis (n=294). Conventional and synthetic ECV were well correlated with CVF (r=0.937 and 0.925, all with P<0.001, n=10). Conclusions Our study showed promising results for using synthetic ECV compared with the conventional ECV for providing accurate quantification of myocardial ECV without the need for blood sampling.
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Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yi Liu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Dongxu Lu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, WA, Australia
| | - Guang Yang
- Cardiovascular Research Centre, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Zhou Z, Gao Y, Wang H, Wang W, Zhang H, Wang S, Sun Z, Xu L. Myocardial extracellular volume fraction analysis in doxorubicin-induced beagle models: comparison of dual-energy CT with equilibrium contrast-enhanced single-energy CT. Cardiovasc Diagn Ther 2021; 11:102-110. [PMID: 33708482 DOI: 10.21037/cdt-20-798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Dual-energy CT (DECT) permits the simultaneous operation of two different kV levels, providing a potential method toward the assessment of diffuse myocardial fibrosis. The purpose of this study was to determine the accuracy of DECT for evaluation of the myocardial extracellular volume (ECV) fraction in comparison with single-energy CT (SECT). Methods Myocardial ECV was quantified in fifteen dogs using DECT and dynamic equilibrium SECT before and after doxorubicin administration. Cardiac magnetic resonance imaging (CMRI) was used to assess myocardial function. The histological collagen volume fraction (CVF) was calculated as the gold standard. The Bland-Altman analysis was performed to compare the agreement between DECT-ECV and SECT-ECV. The association among ECV values derived from DECT and SECT, CVF, and left ventricular ejection fraction (LVEF) were determined by correlation analysis. The variations of these values were evaluated using repeated ANOVA. Results The DECT- and SECT-ECV were increased with the elongation of modeling time (pre-modeling vs. 16-week models vs. 24-week models: DECT-ECV 24.1%±1.1%, 35.1%±1.3% and 37.6%±1.4%; SECT-ECV 22.9%±0.8%, 33.6%±1.2% and 36.3%±1.0%; n=30 in per-subject analysis, all P<0.05). Both ECV values of DECT and SECT correlated well with the histological CVF results (R=0.935 and 0.952 for the DECT-ECV and SECT-ECV; all P<0.001; n=13). Bland-Altman plots showed no significant differences between DECT- and SECT-ECV. Conclusions DECT-ECV correlated well with both SECT-ECV and histology, showing the feasibility of DECT in evaluating doxorubicin-induced diffuse myocardial interstitial fibrosis.
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Affiliation(s)
- Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yifeng Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongwei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenjing Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | - Zhonghua Sun
- Discipline of Medical Radiation Sciences, Curtin Medical School, Curtin University, Perth, Australia
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Muser D, Nucifora G, Castro SA, Enriquez A, Chahal CAA, Magnani S, Kumareswaran R, Arkles J, Supple G, Schaller R, Hyman M, Dixit S, Lin D, Zado ES, Tschabrunn C, Callans DJ, Nazarian S, Frankel DS, Marchlinski FE, Santangeli P. Myocardial Substrate Characterization by CMR T 1 Mapping in Patients With NICM and No LGE Undergoing Catheter Ablation of VT. JACC Clin Electrophysiol 2021; 7:831-840. [PMID: 33516709 DOI: 10.1016/j.jacep.2020.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The goal of this study was to characterize the relationship between DF, the electroanatomic mapping (EAM) substrate, and outcomes of catheter ablation of VT in NICM. BACKGROUND A substantial proportion of patients with nonischemic dilated cardiomyopathy (NICM) and ventricular tachycardia (VT) do not have scar detectable by cardiac magnetic resonance late gadolinium enhancement (LGE) imaging. In these patients, the significance of diffuse fibrosis (DF) detected with T1 mapping has not been previously investigated. METHODS This study included 51 patients with NICM and VT undergoing catheter ablation (median age 55 years; 77% male subjects) who had no evidence of LGE on pre-procedural cardiac magnetic resonance. Post-contrast T1 relaxation time determined on the septum was assessed as a surrogate of DF burden. The extent of endocardial low-voltage areas (LVAs) at EAM was correlated with T1 mapping data. RESULTS Bipolar LVAs were present in 22 (43%) patients (median extent 15 cm2 [8 to 29 cm2]) and unipolar LVA in all patients (median extent 48 cm2 [26 to 120 cm2]). A significant inverse correlation was found between T1 values and both unipolar-LVA (R2 = 0.64; β = -0.85; p < 0.01) and bipolar-LVA (R2 = 0.16; β = -1.63; p < 0.01). After a median follow-up of 45 months (22 to 57 months), 2 (4%) patients died, 3 (6%) underwent heart transplantation, and 8 (16%) experienced VT recurrence. Shorter post-contrast T1 time was associated with an increased risk of VT recurrence (hazard ratio: 1.16; 95% confidence interval: 1.03 to 1.33 per 10 ms decrease; p = 0.02). CONCLUSIONS In patients with NICM and no evidence of LGE undergoing catheter ablation of VT, DF estimated by using post-contrast T1 mapping correlates with the voltage abnormality at EAM and seems to affect post-ablation outcomes.
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Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaetano Nucifora
- Cardiac Imaging Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Simon A Castro
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andres Enriquez
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C Anwar A Chahal
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Silvia Magnani
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jeffrey Arkles
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory Supple
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Schaller
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Lin
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cory Tschabrunn
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Taron J, Foldyna B, Eslami P, Hoffmann U, Nikolaou K, Bamberg F. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. ROFO-FORTSCHR RONTG 2019; 191:817-826. [PMID: 31250415 PMCID: PMC6839890 DOI: 10.1055/a-0924-5883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Rapid improvement of scanner and postprocessing technology as well as the introduction of minimally invasive procedures requiring preoperative imaging have led to the broad utilization of cardiac computed tomography (CT) beyond coronary CT angiography (CTA). METHOD This review article presents an overview of recent literature on cardiac CT. The goal is to summarize the current guidelines on performing cardiac CT and to list established as well as emerging techniques with a special focus on extracoronary applications. RESULTS AND CONCLUSION Most recent guidelines for the appropriate use of cardiac CT include the evaluation of coronary artery disease, cardiac morphology, intra- and extracardiac structures, and functional and structural assessment of the myocardium under certain conditions. Besides coronary CTA, novel applications such as the calculation of a CT-derived fractional flow reserve (CT-FFR), assessment of myocardial function and perfusion imaging, as well as pre-interventional planning in valvular heart disease or prior pulmonary vein ablation in atrial fibrillation are becoming increasingly important. Especially these extracoronary applications are of growing interest in the field of cardiac CT and are expected to be gradually implemented in the daily clinical routine. KEY POINTS · Coronary artery imaging remains the main indication for cardiac CT. · Novel computational fluid dynamics allow the calculation of a CT-derived fractional flow reserve in patients with known or suspected coronary artery disease. · Cardiac CT delivers information on left ventricular volume as well as myocardial function and perfusion. · CT is the cardinal element for pre-interventional planning in transcatheter valve implantation and pulmonary vein isolation. CITATION FORMAT · Taron J, Foldyna B, Eslami P et al. Cardiac Computed Tomography - More Than Coronary Arteries? A Clinical Update. Fortschr Röntgenstr 2019; 191: 817 - 826.
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Affiliation(s)
- Jana Taron
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Borek Foldyna
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Parastou Eslami
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Massachusetts General-Hospital – Harvard Medical School, Boston, United States
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University-Hospital Tübingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Pontecorboli G, Figueras I Ventura RM, Carlosena A, Benito E, Prat-Gonzales S, Padeletti L, Mont L. Use of delayed-enhancement magnetic resonance imaging for fibrosis detection in the atria: a review. Europace 2018; 19:180-189. [PMID: 28172967 DOI: 10.1093/europace/euw053] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/02/2016] [Indexed: 11/13/2022] Open
Abstract
This paper presents a review of the different approaches existing in the literature to detect and quantify fibrosis in contrast-enhanced magnetic resonance images of the left atrial wall. The paper provides a critical analysis of the different methods, stating their advantages and limitations, and providing detailed analysis on the possible sources of variability in the final amount of detected fibrosis coming from the use of different techniques.
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Affiliation(s)
| | | | | | - Eva Benito
- Hospital Clinic, Universitat de Barcelona, Catalonia, Spain
| | | | - Luigi Padeletti
- Department of Heart and Vessels, University of Florence, Florence, Italy.,IRCCS Multimedica, Milan, Italy
| | - Lluís Mont
- Hospital Clinic, Universitat de Barcelona, Catalonia, Spain
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Hu C, Sinusas AJ, Huber S, Thorn S, Stacy MR, Mojibian H, Peters DC. T1-refBlochi: high resolution 3D post-contrast T1 myocardial mapping based on a single 3D late gadolinium enhancement volume, Bloch equations, and a reference T1. J Cardiovasc Magn Reson 2017; 19:63. [PMID: 28821300 PMCID: PMC5563030 DOI: 10.1186/s12968-017-0375-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High resolution 3D T1 mapping is important for assessment of diffuse myocardial fibrosis in left atrium or other thin-walled structures. In this work, we investigated a fast single-TI 3D high resolution T1 mapping method that directly transforms a 3D late gadolinium enhancement (LGE) volume to a 3D T1 map. METHODS The proposed method, T1-refBlochi, is based on Bloch equation modeling of the LGE signal, a single-point calibration, and assumptions that proton density and T2* are relatively uniform in the heart. Several sources of error of this method were analyzed mathematically and with simulations. Imaging was performed in phantoms, eight swine and five patients, comparing T1-refBlochi to a standard spin-echo T1 mapping, 3D multi-TI T1 mapping, and 2D ShMOLLI, respectively. RESULTS The method has a good accuracy and adequate precision, even considering various sources of error. In phantoms, over a range of protocols, heart-rates and T1 s, the bias ±1SD was -3 ms ± 9 ms. The porcine studies showed excellent agreement between T1-refBlochi and the multi-TI method (bias ±1SD = -6 ± 22 ms). The proton density and T2* weightings yielded ratios for scar/blood of 0.94 ± 0.01 and for myocardium/blood of 1.03 ± 0.02 in the eight swine, confirming that sufficient uniformity of proton density and T2* weightings exists among heterogeneous tissues of the heart. In the patients, the mean T1 bias ±1SD in myocardium and blood between T1-refBlochi and ShMOLLI was -9 ms ± 21 ms. CONCLUSION T1-refBlochi provides a fast single-TI high resolution 3D T1 map of the heart with good accuracy and adequate precision.
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Affiliation(s)
- Chenxi Hu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Albert J. Sinusas
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Stephanie Thorn
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Mitchel R. Stacy
- Department of Internal Medicine (Cardiology), Yale School of Medicine, New Haven, CT 06520 USA
| | - Hamid Mojibian
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
| | - Dana C. Peters
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT 06520 USA
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9
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Höke U, Khidir MJ, van der Geest RJ, Schalij MJ, Bax JJ, Delgado V, Ajmone Marsan N. Relation of Myocardial Contrast-Enhanced T 1 Mapping by Cardiac Magnetic Resonance to Left Ventricular Reverse Remodeling After Cardiac Resynchronization Therapy in Patients With Nonischemic Cardiomyopathy. Am J Cardiol 2017; 119:1456-1462. [PMID: 28274575 DOI: 10.1016/j.amjcard.2017.01.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/31/2022]
Abstract
Myocardial scar is known to be associated with limited left ventricular (LV) reverse remodeling after cardiac resynchronization therapy (CRT). However, the impact of diffuse myocardial interstitial fibrosis, as assessed with myocardial T1 mapping cardiac magnetic resonance (CMR), has not been studied in patients with CRT. Therefore, we aimed at evaluating the association between diffuse myocardial interstitial fibrosis, in nonischemic cardiomyopathy patients, and LV reverse remodeling after CRT. A total of 40 patients (61 ± 11 years) with nonischemic cardiomyopathy who underwent CMR before CRT implantation were included. Myocardial T1 mapping was performed using an inversion-recovery Look-Locker sequence after gadolinium injection. Myocardial contrast-enhanced T1 time values were assessed from segments without delayed contrast enhancement and normalized for heart rate. At 6-month follow-up, LV reverse remodeling was assessed by the reduction in LV end-systolic volume. Before CRT implantation, mean myocardial contrast-enhanced T1 time was 351 ± 46 ms. At 6-month follow-up, LV end-systolic volume decreased by 24 ± 21%. Myocardial contrast-enhanced T1 time showed a significant correlation with LV reverse remodeling (r = 0.5, p = 0.001) together with hemoglobin level, renal function, LV dyssynchrony, and presence of delayed contrast enhancement. Multivariate regression analysis identified myocardial contrast-enhanced T1 time (β -0.160, p = 0.022), LV dyssynchrony (β -0.267, p = 0.002), and renal function (β -0.334, p = 0.021) as independent associates of LV reverse remodeling. In conclusion, in nonischemic cardiomyopathy, diffuse interstitial myocardial fibrosis quantified with T1 mapping CMR is independently associated with LV reverse remodeling after CRT and might, therefore, be used to optimize patient selection.
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10
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Wang Y, Li M, Xu L, Liu J, Wang D, Li Q, Wang L, Li P, Chen S, Liu T. Expression of Bcl-2 and microRNAs in cardiac tissues of patients with dilated cardiomyopathy. Mol Med Rep 2016; 15:359-365. [PMID: 27922664 DOI: 10.3892/mmr.2016.5977] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 11/01/2016] [Indexed: 12/28/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is associated with sudden cardiac death and heart failure, resulting in a significant medical burden. The mechanisms underlying the pathogenesis of DCM remain elusive. In the present study, human cardiac tissues from patients with DCM and healthy donors were collected and their pathology was examined. The expression levels of apoptosis regulator Bcl-2 and fibrosis-associated microRNAs were also evaluated. Extensive myocardial fibrosis and apoptosis in DCM cardiac tissues was observed. As demonstrated by western blotting, reverse transcription-quantitative polymerase chain reaction and immunohistochemistry, the expression of Bcl‑2 was significantly increased in the apex, and the left and right ventricle of the heart in patients with DCM. In the specified locations, it was identified that miR‑21 was upregulated, while members of miR‑29 family (miR‑29a, miR‑29b and miR‑29c) and miR‑133 family (miR-133a and miR-133b) were downregulated. The present study suggested that Bcl‑2 and specific microRNAs may be involved in DCM pathogenesis, with a potential implication as therapeutic targets.
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Affiliation(s)
- Yong Wang
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Min Li
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Li Xu
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Ju Liu
- Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Dong Wang
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Quan Li
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Lili Wang
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Peijie Li
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Shanliang Chen
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
| | - Tianqi Liu
- Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R. China
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Tachi M, Amano Y, Inui K, Takeda M, Yamada F, Asai K, Kumita S. Relationship of postcontrast myocardial T1 value and delayed enhancement to reduced cardiac function and serious arrhythmia in dilated cardiomyopathy with left ventricular ejection fraction less than 35. Acta Radiol 2016; 57:430-6. [PMID: 25900838 DOI: 10.1177/0284185115580840] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dilated cardiomyopathy (DCM) is often associated with progressive heart failure or ventricular arrhythmia. Look-Locker magnetic resonance imaging (MRI) allows quantitative evaluation of interstitial fibrosis by measuring the myocardial T1 value, and delayed enhancement (DE) MRI visualizes myocardial scar. PURPOSE To determine the relationship of postcontrast myocardial T1 value or DE to reduced cardiac function or sustained ventricular tachycardia (SVT) in DCM patients with a left ventricular ejection fraction (LVEF) <35%. MATERIAL AND METHODS We enrolled 41 patients with DCM. Correlations between the cardiac function parameters and postcontrast myocardial T1 value or extent of DE were evaluated. The relationship between SVT and the T1 values or extent of DE was assessed. The correlation between the extent of DE and the T1 value was also examined. RESULTS The postcontrast myocardial T1 value was significantly correlated with the LVEF (P < 0.05; r = 0.31) and end-diastolic volume (P < 0.01; r = -0.40) in 40 patients with LVEF <35%. DE was not correlated with the cardiac function, but provided a high negative predictive value of 94.7% for SVT. No correlation was found between the myocardial T1 value and extent of DE. CONCLUSION In DCM patients with LVEF <35%, the postcontrast myocardial T1 value correlated with the severity of cardiac dysfunction, and the absence of DE indicated the low risk of SVT. Both MRI parameters should be estimated because they may reflect discrete forms of myocardial damages in patients with DCM.
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Affiliation(s)
- Masaki Tachi
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Yasuo Amano
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Kensuke Inui
- Department of Cardiology, Nippon Medical School, Tokyo, Japan
| | - Minako Takeda
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Fumi Yamada
- Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiology, Nippon Medical School, Tokyo, Japan
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Everett RJ, Stirrat CG, Semple SIR, Newby DE, Dweck MR, Mirsadraee S. Assessment of myocardial fibrosis with T1 mapping MRI. Clin Radiol 2016; 71:768-78. [PMID: 27005015 DOI: 10.1016/j.crad.2016.02.013] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 11/18/2022]
Abstract
Myocardial fibrosis can arise from a range of pathological processes and its presence correlates with adverse clinical outcomes. Cardiac magnetic resonance (CMR) can provide a non-invasive assessment of cardiac structure, function, and tissue characteristics, which includes late gadolinium enhancement (LGE) techniques to identify focal irreversible replacement fibrosis with a high degree of accuracy and reproducibility. Importantly the presence of LGE is consistently associated with adverse outcomes in a range of common cardiac conditions; however, LGE techniques are qualitative and unable to detect diffuse myocardial fibrosis, which is an earlier form of fibrosis preceding replacement fibrosis that may be reversible. Novel T1 mapping techniques allow quantitative CMR assessment of diffuse myocardial fibrosis with the two most common measures being native T1 and extracellular volume (ECV) fraction. Native T1 differentiates normal from infarcted myocardium, is abnormal in hypertrophic cardiomyopathy, and may be particularly useful in the diagnosis of Anderson-Fabry disease and amyloidosis. ECV is a surrogate measure of the extracellular space and is equivalent to the myocardial volume of distribution of the gadolinium-based contrast medium. It is reproducible and correlates well with fibrosis on histology. ECV is abnormal in patients with cardiac failure and aortic stenosis, and is associated with functional impairment in these groups. T1 mapping techniques promise to allow earlier detection of disease, monitor disease progression, and inform prognosis; however, limitations remain. In particular, reference ranges are lacking for T1 mapping values as these are influenced by specific CMR techniques and magnetic field strength. In addition, there is significant overlap between T1 mapping values in healthy controls and most disease states, particularly using native T1, limiting the clinical application of these techniques at present.
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Affiliation(s)
- R J Everett
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK.
| | - C G Stirrat
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S I R Semple
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - D E Newby
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
| | - M R Dweck
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK
| | - S Mirsadraee
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, UK; Clinical Research Imaging Centre, University of Edinburgh, UK
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13
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Gensler D, Mörchel P, Fidler F, Ritter O, Quick HH, Ladd ME, Bauer WR, Ertl G, Jakob PM, Nordbeck P. Myocardial T1: Quantification by Using an ECG-triggered Radial Single-Shot Inversion-Recovery MR Imaging Sequence. Radiology 2015; 274:879-87. [DOI: 10.1148/radiol.14131295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Saeed M, Hetts SW, Jablonowski R, Wilson MW. Magnetic resonance imaging and multi-detector computed tomography assessment of extracellular compartment in ischemic and non-ischemic myocardial pathologies. World J Cardiol 2014; 6:1192-1208. [PMID: 25429331 PMCID: PMC4244616 DOI: 10.4330/wjc.v6.i11.1192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 08/15/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Myocardial pathologies are major causes of morbidity and mortality worldwide. Early detection of loss of cellular integrity and expansion in extracellular volume (ECV) in myocardium is critical to initiate effective treatment. The three compartments in healthy myocardium are: intravascular (approximately 10% of tissue volume), interstitium (approximately 15%) and intracellular (approximately 75%). Myocardial cells, fibroblasts and vascular endothelial/smooth muscle cells represent intracellular compartment and the main proteins in the interstitium are types I/III collagens. Microscopic studies have shown that expansion of ECV is an important feature of diffuse physiologic fibrosis (e.g., aging and obesity) and pathologic fibrosis [heart failure, aortic valve disease, hypertrophic cardiomyopathy, myocarditis, dilated cardiomyopathy, amyloidosis, congenital heart disease, aortic stenosis, restrictive cardiomyopathy (hypereosinophilic and idiopathic types), arrythmogenic right ventricular dysplasia and hypertension]. This review addresses recent advances in measuring of ECV in ischemic and non-ischemic myocardial pathologies. Magnetic resonance imaging (MRI) has the ability to characterize tissue proton relaxation times (T1, T2, and T2*). Proton relaxation times reflect the physical and chemical environments of water protons in myocardium. Delayed contrast enhanced-MRI (DE-MRI) and multi-detector computed tomography (DE-MDCT) demonstrated hyper-enhanced infarct, hypo-enhanced microvascular obstruction zone and moderately enhanced peri-infarct zone, but are limited for visualizing diffuse fibrosis and patchy microinfarct despite the increase in ECV. ECV can be measured on equilibrium contrast enhanced MRI/MDCT and MRI longitudinal relaxation time mapping. Equilibrium contrast enhanced MRI/MDCT and MRI T1 mapping is currently used, but at a lower scale, as an alternative to invasive sub-endomyocardial biopsies to eliminate the need for anesthesia, coronary catheterization and possibility of tissue sampling error. Similar to delayed contrast enhancement, equilibrium contrast enhanced MRI/MDCT and T1 mapping is completely noninvasive and may play a specialized role in diagnosis of subclinical and other myocardial pathologies. DE-MRI and when T1-mapping demonstrated sub-epicardium, sub-endocardial and patchy mid-myocardial enhancement in myocarditis, Behcet’s disease and sarcoidosis, respectively. Furthermore, recent studies showed that the combined technique of cine, T2-weighted and DE-MRI technique has high diagnostic accuracy for detecting myocarditis. When the tomographic techniques are coupled with myocardial perfusion and left ventricular function they can provide valuable information on the progression of myocardial pathologies and effectiveness of new therapies.
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Abstract
Cardiovascular magnetic resonance using late gadolinium enhancement (LGE) provides a unique opportunity to assess myocardial tissue in vivo. LGE enables tissue characterization in ischemic and nonischemic cardiomyopathies and other cardiac diseases. LGE is associated with adverse clinical outcomes across a range of different cardiac conditions and may improve risk stratification for death, sudden cardiac death, or serious adverse events beyond traditional prognostic markers. Generally, matching data for the prognostic impact of LGE are frequently reached in cardiac disorders. In other diseases, only a limited number of trials are available, but it is anticipated that the prognostic impact of delayed enhancement will become evident. The development and validation of new cardiovascular magnetic resonance methods for diffuse myocardial fibrosis measurements would even improve the prognostic impact of LGE. The evaluation of diffuse myocardial fibrosis has a great potential in large-scale diseases, including their initial phases, with the possibility to identify patients at risk for subsequent development of clinical heart failure, to assess repeatedly the stage and progression of cardiac diseases, and to monitor the effect of treatment.
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Jablonowski R, Wilson MW, Do L, Hetts SW, Saeed M. Multidetector CT measurement of myocardial extracellular volume in acute patchy and contiguous infarction: validation with microscopic measurement. Radiology 2014; 274:370-8. [PMID: 25247406 DOI: 10.1148/radiol.14140131] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To provide proof of concept that expansion of myocardial extracellular volume (MECV), measured at contrast material-enhanced multidetector computed tomography (CT), can be used as a (a) marker for viability based on histologic confirmation and (b) predictor of severity of myocardial injury. MATERIALS AND METHODS Animals cared for in compliance with Institutional Animal Care and Use Committee served as controls (group 1, n = 6) or were subjected to microinfarction by using 16-mm(3) (60 000 count) microemboli (group 2) and 32-mm(3) (120 000 count) microemboli (group 3), contiguous infarct with left anterior descending artery (LAD) occlusion followed by reperfusion (group 4), or the combination of LAD occlusion and 32-mm(3) microemboli followed by reperfusion (group 5) (n = 7 per group). MECV calculations were based on regional measurements of signal attenuation at contrast-enhanced multidetector CT and counterstaining of infarct at microscopy. Two-way analysis of variance and Student t tests were used to determine significant differences (P < .05). Data were presented as means ± standard deviations. RESULTS Mean signal attenuation at equilibrium state of contrast media distribution (10 minutes) was significantly different among blood (137 HU ± 10), myocardial muscle (77 HU ± 12, P < .05), and skeletal muscle (35 HU ± 12, P < .05). Patchy microinfarct, contiguous infarct, and microinfarct with preexisting contiguous infarct can be differentiated on the basis of mean MECV (24% ± 3 [group 1] vs 36% ± 3 [group 2], P < .01, and 55% ± 5 [group 4], 56% ± 4 [group 5] vs 41% ± 3 [group 3], P < .05). Microscopy measurements confirmed multidetector CT quantitative measurements and differences in patterns of infarct caused by obstruction of major and minor coronary arteries. Regression analysis revealed excellent correlation between regional MECV using multidetector CT and microscopy (r(2) = 0.92). CONCLUSION Contrast-enhanced multidetector CT is a suitable noninvasive imaging technique for assessing MECV in acute patchy and contiguous infarct caused by obstruction of major and minor coronary vessels.
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Affiliation(s)
- Robert Jablonowski
- From the Department of Radiology and Biomedical Imaging, School of Medicine, University of California-San Francisco, 185 Berry St, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705
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18
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Francone M. Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance. ISRN RADIOLOGY 2014; 2014:365404. [PMID: 24967294 PMCID: PMC4045555 DOI: 10.1155/2014/365404] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 01/07/2023]
Abstract
Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.
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Affiliation(s)
- Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Viale Regina Elena, 324 00161 Rome, Italy
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19
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Carballeira Pol L, Deyell MW, Frankel DS, Benhayon D, Squara F, Chik W, Kohari M, Deo R, Marchlinski FE. Ventricular premature depolarization QRS duration as a new marker of risk for the development of ventricular premature depolarization-induced cardiomyopathy. Heart Rhythm 2013; 11:299-306. [PMID: 24184787 DOI: 10.1016/j.hrthm.2013.10.055] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frequent ventricular premature depolarizations (VPDs) can cause cardiomyopathy (CMP). The mechanisms underlying its development remain unclear, with VPD burden being only a weak predictor of risk. OBJECTIVE To determine whether VPD QRS duration at the time of initial presentation could predict risk for the subsequent development of CMP in patients with normal left ventricular ejection fraction (LVEF). METHODS From consecutive patients referred for ablation between January 1, 2006, and April 2, 2013, with ≥10% VPDs on 24-hour Holter monitoring, we identified 45 patients with normal LVEF and an electrocardiogram of the targeted VPD, who were then followed for at least 6 months (median 14 months; interquartile range [IQR] 8-32 months) before intervention. We excluded patients with structural or genetic heart disease. RESULTS Of the 45 patients, 28 (62%) maintained normal LVEF and 17(38%) developed VPD-induced CMP. VPD burden was similar (26.5% [IQR 19.3%-39.5%] vs 26.0% [IQR 16.4%-41.0%]; P = 0.4) between the 2 groups. Patients who developed VPD-induced CMP had significantly longer VPD QRS duration (159 ms vs 142 ms; P < .001) and a longer sinus QRS duration (97 ms vs 89 ms; P = .04). A VPD QRS duration of ≥153 ms best predicted development of VPD CMP (82% sensitivity and 75% specificity). Longer VPD QRS duration and a non-outflow tract site of VPD origin were independent risk factors for left ventricular dysfunction after multivariate analysis. CONCLUSION VPD QRS duration longer than 153 ms and a non-outflow tract site of origin might be useful predictors of the subsequent development of VPD-induced CMP.
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Affiliation(s)
- Lidia Carballeira Pol
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc W Deyell
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Benhayon
- Cardiology Department, Pasteur University Hospital, Nice, France
| | - Fabien Squara
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Cardiology Department, Pasteur University Hospital, Nice, France
| | - William Chik
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maria Kohari
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rajat Deo
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Electrophysiology Section, Cardiovascular Division, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Tachi M, Amano Y, Kobayashi Y, Mizuno K, Kumita S. Evaluation of nonscarred myocardial T1 value using contrast-enhanced look-locker cardiac MRI and its relationship to cardiac function in dilated cardiomyopathy: Comparison of 1.5 and 3.0 Tesla MRI. J Magn Reson Imaging 2013; 38:1395-401. [PMID: 23852918 DOI: 10.1002/jmri.24131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 02/22/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess relationship between nonscarred myocardial T1 value measured using contrast-enhanced Look-Locker MRI and cardiac function in dilated cardiomyopathy (DCM) at 1.5 Tesla (T) and 3.0T MRI. MATERIALS AND METHODS Contrast-enhanced Look-Locker MRI was performed in 35 DCM patients. Nonscarred myocardial and blood T1 values were calculated from the signal intensity values and the delay time obtained on Look-Locker MRI. We assessed the correlation between the myocardial T1 value or myocardial T1 minus blood T1 value and cardiac function estimated using cine MRI (e.g., end-diastolic volume: EDV, left ventricular ejection fraction: LVEF) or brain natriuretic peptide (BNP). RESULTS With 1.5T MRI (n = 16), the myocardial T1 value correlated negatively with the EDV(r = -0.66) and end-systolic volume (ESV; r = -0.68), and positively with the LVEF (r = 0.51); the myocardial T1 minus blood T1 value correlated inversely with EDV (r = -0.70), ESV (r = -0.62), and brain natriuretic peptide (BNP; r = -0.56). With 3.0T MRI (n = 17), the myocardial T1 value correlated negatively with ESV (r = -0.44), septal thickness (r = -0.60), and BNP (r = -0.51), and positively with LVEF (r = 0.61); the myocardial T1 minus blood T1 value negatively correlated with BNP (r = -0.50) and positively with LVEF (r = 0.54). CONCLUSION The nonscarred myocardial T1 value measured with either 1.5T or 3.0T contrast-enhanced Look-Locker MRI is significantly related to cardiac dysfunction in DCM.
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Affiliation(s)
- Masaki Tachi
- Departments of Radiology, Nippon Medical School, Tokyo, Japan
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21
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Beinart R, Khurram IM, Liu S, Yarmohammadi H, Halperin HR, Bluemke DA, Gai N, van der Geest RJ, Lima JAC, Calkins H, Zimmerman SL, Nazarian S. Cardiac magnetic resonance T1 mapping of left atrial myocardium. Heart Rhythm 2013; 10:1325-31. [PMID: 23643513 DOI: 10.1016/j.hrthm.2013.05.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) T1 mapping is an emerging tool for objective quantification of myocardial fibrosis. OBJECTIVES To (a) establish the feasibility of left atrial (LA) T1 measurements, (b) determine the range of LA T1 values in patients with atrial fibrillation (AF) vs healthy volunteers, and (c) validate T1 mapping vs LA intracardiac electrogram voltage amplitude measures. METHODS CMR imaging at 1.5 T was performed in 51 consecutive patients before AF ablation and in 16 healthy volunteers. T1 measurements were obtained from the posterior LA myocardium by using the modified Look-Locker inversion-recovery sequence. Given the established association of reduced electrogram amplitude with fibrosis, intracardiac point-by-point bipolar LA voltage measures were recorded for the validation of T1 measurements. RESULTS The median LA T1 relaxation time was shorter in patients with AF (387 [interquartile range 364-428] ms) compared to healthy volunteers (459 [interquartile range 418-532] ms; P < .001) and was shorter in patients with AF with prior ablation compared to patients without prior ablation (P = .035). In a generalized estimating equations model, adjusting for data clusters per participant, age, rhythm during CMR, prior ablation, AF type, hypertension, and diabetes, each 100-ms increase in T1 relaxation time was associated with 0.1 mV increase in intracardiac bipolar LA voltage (P = .025). CONCLUSIONS Measurement of the LA myocardium T1 relaxation time is feasible and strongly associated with invasive voltage measures. This methodology may improve the quantification of fibrotic changes in thin-walled myocardial tissues.
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Affiliation(s)
- Roy Beinart
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland MD 21287, USA.
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Comparison between (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement in evaluating cardiac involvement in patients with transthyretin familial amyloid polyneuropathy. AJR Am J Roentgenol 2013; 200:W256-65. [PMID: 23436870 DOI: 10.2214/ajr.12.8737] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Cardiac involvement is not rare in systemic amyloidosis and is associated with poor prognosis. Both (99m)Tc-diphosphonate imaging and cardiac MRI with late gadolinium enhancement are considered valuable tools in revealing amyloid deposition in the myocardium; however, to our knowledge, no comparative study between the two techniques exists. We compared findings of these two techniques in patients with transthyretin-familial amyloid polyneuropathy (FAP). SUBJECTS AND METHODS Eighteen patients with transthyretin-FAP underwent (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement. Images were visually evaluated by independent readers to determine the presence of radiotracer accumulation or late gadolinium enhancement-positive areas at the level of cardiac chambers. RESULTS Interobserver agreement ranged from moderate to very good for (99m)Tc-diphosphonate imaging findings and was very good for findings of MRI with late gadolinium enhancement. Left ventricle (LV) radiotracer uptake was found in 10 of 18 patients, whereas LV late gadolinium enhancement-positive areas were found in eight of 18 patients (χ(2) = 0.9; p = 0.343). One hundred fifty-nine LV segments showed (99m)Tc-diphosphonate accumulation, and 57 LV segments were late gadolinium enhancement positive (p < 0.0001). Radiotracer uptake was found in the right ventricle (RV) in eight patients and in both atria in five patients, whereas MRI showed that RV was involved in three patients and both atria in six patients; the differences were not statistically significant (RV, p = 0.07; atria, p = 1). Intermodality agreement between (99m)Tc-diphosphonate imaging and MRI ranged from fair to good. CONCLUSION Our study shows that, although (99m)Tc-diphosphonate imaging and MRI with late gadolinium enhancement have similar capabilities to identify patients with myocardial amyloid deposition, cardiac amyloid infiltration burden can be significantly underestimated by visual analysis of MRI with late gadolinium enhancement compared with (99m)Tc-diphosphonate imaging.
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Nacif MS, Kawel N, Lee JJ, Chen X, Yao J, Zavodni A, Sibley CT, Lima JAC, Liu S, Bluemke DA. Interstitial myocardial fibrosis assessed as extracellular volume fraction with low-radiation-dose cardiac CT. Radiology 2012; 264:876-83. [PMID: 22771879 DOI: 10.1148/radiol.12112458] [Citation(s) in RCA: 164] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To develop a cardiac computed tomographic (CT) method with which to determine extracellular volume (ECV) fraction, with cardiac magnetic resonance (MR) imaging as the reference standard. MATERIALS AND METHODS Study participants provided written informed consent to participate in this institutional review board-approved study. ECV was measured in healthy subjects and patients with heart failure by using cardiac CT and cardiac MR imaging. Paired Student t test, linear regression analysis, and Pearson correlation analysis were used to determine the relationship between cardiac CT and MR imaging ECV values and clinical parameters. RESULTS Twenty-four subjects were studied. There was good correlation between myocardial ECV measured at cardiac MR imaging and that measured at cardiac CT (r = 0.82, P < .001). As expected, ECV was higher in patients with heart failure than in healthy control subjects for both cardiac CT and cardiac MR imaging (P = .03, respectively). For both cardiac MR imaging and cardiac CT, ECV was positively associated with end diastolic and end systolic volume and inversely related to ejection fraction (P < .05 for all). Mean radiation dose was 1.98 mSv ± 0.16 (standard deviation) for each cardiac CT acquisition. CONCLUSION ECV at cardiac CT and that at cardiac MR imaging showed good correlation, suggesting the potential for myocardial tissue characterization with cardiac CT.
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Affiliation(s)
- Marcelo Souto Nacif
- Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10, Room 1C355, Bethesda, MD 20892-1182, USA
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Corbetti F, Razzolini R, Bettini V, Marshall JD, Naggert J, Tona F, Milan G, Maffei P. Alström syndrome: cardiac magnetic resonance findings. Int J Cardiol 2012; 167:1257-63. [PMID: 22498418 DOI: 10.1016/j.ijcard.2012.03.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/08/2012] [Accepted: 03/18/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Alström Syndrome (ALMS) is an extremely rare multiorgan disease caused by mutations in ALMS1. Dilated cardiomyopathy (DCM) is a common finding but only one series has been investigated by Cardiac Magnetic Resonance (CMR). METHODS Eight genetically proven ALMS patients (ages 11-41) underwent CMR performed by standard cine steady state, T1, T2 and late gadolinium enhancement (LGE) sequences. Ejection fraction (EF), Diastolic Volume (EDV) and Systolic Volume normalized for body surface area (ESV), and mass indices were determined, as well as EDV/Mass ratio, an index expressing the adequacy of cardiac mass to heart volume. Regional fibrosis was assessed by LGE; diffuse fibrosis was measured by a TI scout sequence acquired at 5, 10 and 15 min after gadolinium by comparing inversion time values (TI) at null time in ALMS and control group. RESULTS In one patient severe DCM was present with diffuse LGE. There were seven cases without clinical DCM. In these patients, EF was at lower normal limits or slightly reduced and ESV index increased; six patients had decreased mass index and EDV/Mass ratio. Mild regional non ischemic fibrosis was detected by LGE in three cases; diffuse fibrosis was observed in all cases, as demonstrated by shorter TI values in ALMS in comparison with controls (5 min: 152 ± 12 vs 186 ± 16, p 0.0002; 10 min: 175 ± 8 vs 204 ± 18, p 0.0012; 15 min: 193 ± 9 vs 224 ± 16, p 0.0002). CONCLUSIONS Cardiac involvement in ALMS is characterized by progressive DCM, associated with systolic dysfunction, myocardial fibrosis and reduced myocardial mass.
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Slavich M, Florian A, Bogaert J. The emerging role of magnetic resonance imaging and multidetector computed tomography in the diagnosis of dilated cardiomyopathy. Insights Imaging 2012; 2:453-469. [PMID: 22347967 PMCID: PMC3259418 DOI: 10.1007/s13244-011-0101-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/25/2011] [Accepted: 05/02/2011] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance imaging and multidetector computed tomography are new imaging methods that have much to offer clinicians caring for patients with dilated cardiomyopathy. In this article we briefly describe the clinical, pathophysiological and histological aspects of dilated cardiomyopathy. Then we discuss in detail the use of both imaging methods for measurement of chamber size, global and regional function, for myocardial tissue characterisation, including myocardial viability assessment, and determination of arrhythmogenic substrate, and their emerging role in cardiac resynchronisation therapy.
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Affiliation(s)
- Massimo Slavich
- Department of Radiology and Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
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Sado DM, Flett AS, Moon JC. Novel imaging techniques for diffuse myocardial fibrosis. Future Cardiol 2012; 7:643-50. [PMID: 21929344 DOI: 10.2217/fca.11.45] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diffuse myocardial fibrosis (DMF) is an important marker in many cardiac diseases, but its utility has been limited by the need for biopsy for its assessment. An accurate noninvasive method for DMF assessment could transform cardiology. This review explores the basic biology of DMF and then discusses the ability of various cardiac imaging modalities to evaluate this variable, speculating on how this area of research may develop over the next few years.
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Affiliation(s)
- Daniel M Sado
- Department of Inherited Cardiac Disease, The Heart Hospital, 16-18 Westmoreland Street, London, W1G 8PH, UK
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Nacif MS, Turkbey EB, Gai N, Nazarian S, van der Geest RJ, Noureldin RA, Sibley CT, Ugander M, Liu S, Arai AE, Lima JAC, Bluemke DA. Myocardial T1 mapping with MRI: comparison of look-locker and MOLLI sequences. J Magn Reson Imaging 2011; 34:1367-73. [PMID: 21954119 PMCID: PMC3221792 DOI: 10.1002/jmri.22753] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 07/22/2011] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To evaluate the relationship between "Look-Locker" (LL) and modified Look-Locker Inversion recovery (MOLLI) approaches for T1 mapping of the myocardium. MATERIALS AND METHODS A total of 168 myocardial T1 maps using MOLLI and 165 maps using LL were obtained in human subjects at 1.5 Tesla. The T1 values of the myocardium were calculated before and at five time points after gadolinium administration. All time and heart rate normalizations were done. The T1 values obtained were compared to determine the absolute and bias agreement. RESULTS The precontrast global T1 values were similar when measured by the LL and by MOLLI technique (mean, 1004.9 ms ± 120.3 versus 1034.1 ms ± 53.1, respectively, P = 0.26). Postcontrast myocardial T1 time from LL was significantly longer than MOLLI from 5 to 25 min (mean difference, LL - MOLLI was +61.8 ± 46.4 ms, P < 0.001). No significant differences in T1 values were noted between long and short axis measurements for either MOLLI or LL. CONCLUSION Postcontrast LL and MOLLI showed very good agreement, although LL values are higher than MOLLI. Precontrast T1 values showed good agreement, however LL has greater limits of agreement. Short and long axis planes can reliably assess T1 values.
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Affiliation(s)
- Marcelo Souto Nacif
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA; Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Radiology Department, Universidade Federal Fluminense, Niterói, Brazil
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Mavrogeni S, Bratis K, Kolovou G. Cardiac magnetic resonance in myocarditis. What we know and what we have to learn. Eur J Heart Fail 2011; 13:1381. [PMID: 22037387 DOI: 10.1093/eurjhf/hfr145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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