bluuebunny/crossref_metadata_2025 huggingface dataset:
Septal late gadolinium enhancement on Cardiac MRI predicts failure to achieve left bundle pacing
Authors: Ali NADINE , Arnold AD , Miyazawa AA , Keene D , Peters NS , Kanagaratnam P , Qureshi N , Ng FS , Linton N , Lefroy D , Francis D , Lim PB , Whinnett ZI , Kellman P , Cole GD
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background; Left bundle area pacing is a novel technique that provides direct stimulation of cardiac conduction tissue in order to deliver physiological ventricular activation. The approach for left bundle area pacing is transseptal lead implantation, where the lead is advanced from the right ventricular side of the septum to the left ventricular side to capture the proximal left bundle. Observational data suggests that whilst this is a safe and feasible method, implant success rate is not 100%, and appears to be lower in patients with a cardiac resynchronization therapy (CRT) indication rather than a bradycardia indication for pacing. The mechanisms for failure to advance the lead through the ventricular septum are not well understood.

Purpose; We used pre-procedural CMR to determine whether there are features which can help identify patients where lead implantation may be challenging.  We assessed whether the extent and location of septal late gadolinium enhancement identified patients in whom left bundle area pacing will be challenging.  We hypothesized that the presence of extensive scar in the septum impedes advancing the lead to the left ventricular septum and prevents capture of the left bundle.

Methods; Patients underwent cardiac MRI including motion corrected free-breathing late gadolinium enhancement imaging1 before implantation.  Scar was quantified using the full height half maximum method and expressed as the overall proportion of myocardial mass in the basal anteroseptal and basal inferoseptal segments, as shown in Figure 1.  Left bundle area pacing was then attempted in patients with a CRT indication for pacing.  We compared the extent of septal scar between patients in whom left bundle area pacing was achieved and those where there was failure to advance the lead deep into the septum.

Results; 12 patients (11 male, 1 female), with average age 72 (IQR 63 to 78) and LVEF 30% (IQR 26 to 33) were studied.  There was failure to advance the lead deep into the septum in 4 patients.  There was a significantly higher basal septal scar burden in those patients where there was failure to advance the left bundle lead compared to those in which left bundle capture was achieved as shown in Figure 2 (median 55% and 5% respectively, p-value 0.02 by Wilcoxon signed rank test).

Conclusion; The presence and extent of late gadolinium enhancement in the basal septum appears to be an important determinant of successful implantation of left bundle pacing lead using current implant technology. This may be because extensive septal scar prevents advancement of the pacing lead through the septum. Cardiac MRI before left bundle area pacing is likely to be useful in procedural planning.
Myocardial T2 values by a segmental approach with healthy ageing and gender
Authors: Pepe A , Martini N , Positano V , D"angelo G , Barison A , Todiere G , Grigoratos C , Keilberg P , Pistoia L , Gargani L , Ripoli A , Meloni A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. No data are available in literature about normal ranges for T2 in human myocardium using GE scanners.

Aims. Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables.

Methods. A stratified approach was adopted for healthy volunteers recruitment, ensuring the presence of 10 participants for both genders in each age decile:  20–30, 30–40, 40-50, 50-60, 60-70 years. Basal, medium, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. T2 value was assessed in all 16 myocardial segments and global value was the mean.

Results. The global T2 value averaged across all subjects was 52.2 ± 2.5 ms (range: 47.0-59.9 ms).

Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation < 5%).

The 3.6% of segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (P < 0.0001), with the lowest value in the basal anterolateral segment (50.0 ± 3.5 ms) and the highest in the apical lateral segment (54.9 ± 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both medium (51.0 ± 2.4  vs 51.8 ± 2.6 ms; P < 0.0001) and apical slices (51.0 ± 2.4  vs 54.2 ± 3.7 ms; P < 0.0001), and in the medium slice than in the apical slice (51.8 ± 2.6  vs 54.2 ± 3.7 ms; P < 0.0001).

Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate.

Mean T2 values, standard deviation, and lower and upper limits of normal for all 16 myocardial segments are shown in Figure 1 for males and in Figure 2 for females, considering separately each age group.

Conclusion. The optimized MEFSE sequence allows for robust, reliable, and reproducible quantification of segmental T2 values. T2 values differ among myocardial slices and are influenced by age and gender, making mandatory to define gender- and age-specific segmental reference values for distinguishing between healthy and diseased myocardium. The normal ranges defined in this study on a large cohort of healthy subjects could be used as reference by other sites using the same sequence, allowing them to recruit a smaller population and accelerating the spread of myocardial T2 mapping in the clinical arena.
Influence of cardiac phase on myocardial native T1 values by a segmental approach
Authors: Pepe A , Martini N , Positano V , D"angelo G , Barison A , Todiere G , Grigoratos C , Barra V , Pistoia L , Gargani L , Ripoli A , Meloni A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Native T1 values are usually assessed in the end-diastole to minimize motion artifacts while the systolic data acquisition offers the advantage of a thicker myocardium, with reduced partial-volume effects. Higher myocardial T1 values have been detected in diastole at both 1.5T and 3T but the dependence of this difference on myocardial segments or gender has not been fully explored.

Aim. We provided a systematic comparison of myocardial native T1 values in diastole and systole, by considering separately myocardial segments and dividing males and females.

Methods. Sixty-one healthy subjects (46.0 ± 14.1 years, 32 males) underwent CMR at 1.5T (Signa Artist; GE Healthcare). Three short-axis slices of the left ventricle acquired in diastole and systole using a Modified Look–Locker Inversion Recovery sequence. Image analysis was performed with a commercially available software package. T1 value was assessed in all 16 myocardial segments and global value was the mean.

Results. Table 1 shows the comparison between T1 values calculated from maps obtained in diastole and systole. Systolic T1 values were significantly lower in the basal anterolateral segment, in all medium segments except for the medium inferior segment, and in all apical segments. The percentage difference between diastolic and systolic T1 values was considered to compensate for the higher T1 values in females, and a significantly higher value was detected in females for the majority of medium segments, for all apical segments, and for the global value.

Conclusion. The diastolic-systolic discrepancy was more pronounced for the females and at the apical level, supporting the hypothesis that, besides the physiologic variations in myocardial blood volume during the cardiac cycle, the partial volume-effect may be a strong additional contributing factor. Native T1 values should be obtained always in the same cardiac phase to avoid a potential bias in the discrimination between healthy and pathologically affected myocardium.
Fully automated CMR derived stroke volume correlates with right heart catheter measurements in patients with suspected pulmonary hypertension
Authors: Alabed S , Karunasaagarar K , Alandejani F , Garg P , Uthoff J , Metherall P , Sharkey M , Lu H , Wild JM , Kiely DG , Van Der Geest RJ , Swift AJ
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Welcome Trust (UK), NIHR (UK)

Introduction

Cardiac magnetic resonance (CMR) assessment plays a significant role in the diagnosis, prognosis and monitoring of patients with pulmonary hypertension (PH). We developed a deep learning model to automatically generate biventricular contours and validated its result in a prospective cohort of patients with suspected PH who underwent right heart catheterization (RHC).

Methods

A deep learning CMR contouring model was developed in a retrospective multi-vendor (Siemens and General Electric), multi-pathology cohort of patients, predominantly with heart failure, lung disease and PH (n = 400, ASPIRE registry). Biventricular segmentations were made on all CMR studies across cardiac phases. A prospective validation cohort of 102 suspected PH patients was recruited and they had RHC within 24 hours  of the CMR. To test the accuracy of the automatic segmentation, the RHC-thermodilution and CMR-derived measures of stroke volume (SV) were compared for manual and automated measurements. 

Results

The mean and standard deviation for the derived SV was 59 ml ± 21 measured by RHC and 75 ml ± 25 for automated and 79 ml ± 26 for manual CMR measurements. Automatic and manual CMR measurement correlated strongly with RHC derived SV; 0.73, 95% CI [0.62, 0.81] and 0.78, 95% CI [0.69, 0.85], respectively (figure 1).  The agreement between automatic and manual SV was high; interclass correlation coefficient (ICC) = 0.88, 95% CI [0.83, 0.92] and Bland-Altman plots showed a narrow spread of mean differences between manual and automatic measurements (figure 2).

Conclusion

In a prospective cohort, fully automatic CMR assessments corresponded accurately to invasive hemodynamics performed within 24 hours of a CMR study.
A practical approach to cardiac imaging in adults with Duchenne muscular dystrophy - echocardiography or cardiac MRI?
Authors: Hewitt K , Carron J , Quinn S , Sheahan R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The incidence of cardiomyopathy in Duchenne muscular dystrophy (DMD) increases with age, accounting for up to 20% of mortality in the third decade of life. As patients are frequently asymptomatic until advanced stages of disease, imaging plays an essential role in screening for cardiac involvement and monitoring progression. Guidelines recommend annual transthoracic echocardiography assessment, with periodic use of cardiac magnetic resonance imaging (CMR). However, some studies suggest that CMR should be the gold standard imaging in DMD. This study aimed to review the use echo and CMR in adult patients with DMD, with particular focus on practical utility and real-world limitations.

Methods

 

A retrospective chart review of 24 patients attending our DMD cardiomyopathy clinic was undertaken. Demographic data including age, genotyping and medical therapy were noted. Results of cardiac imaging, as well as discussions regarding referral for CMR were recorded.

Results

All patients had echocardiography performed in our facility (table 1) and all had a documented discussion regarding referral for CMR in their medical notes. 15 patients (60%) were unsuitable for CMR and were not referred. Reasons were inability to lie flat due to breathing/claustrophobia (n = 12) and difficulty with positioning due to contractures (n = 9). 2 patients (8%) attended for CMR but were unable to proceed due to difficulty with positioning in the scanner. 4 patients (16.5%) had CMR performed, 3 additional patients were referred and awaited CMR. Results outlined in table 1 and image 1 show correlation between measurement of left ventricular ejection fraction (LVEF) on echo and CMR. Wall motion abnormalities and fibrosis were better detected with CMR. 

Conclusion

 

Significant limitations were seen with both imaging techniques. Accessibility of CMR for adults with DMD is poor, related primarily to the severity of underlying musculoskeletal and respiratory disease. Echocardiography is easily accessible, but images are frequently suboptimal. Despite this, strong correlation was seen in assessment of LV function in those who underwent both echocardiography and CMR, with indication that echocardiography can accurately guide intensification of medications and cardiac device therapy. CMR remains the optimal modality for the assessment of myocardial fibrosis. Improving accessibility of CMR for patients with DMD should be prioritised for the future of this modality.
Diastolic function assessed my CMR feature tracking is a predictor for outcomes in patients with suspected myocarditis and preserved left ventricular ejection fraction
Authors: Bernhard B , Fischer K , Stark AW , Erne SA , Obrist SJ , Guensch DP , Kwong RY , Graeni C
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Diastolic function assessed my CMR feature tracking is a predictor for outcomes in patients with suspected myocarditis and preserved left ventricular ejection fraction

Background

Impairment of left ventricular (LV) systolic function was reported to be a valuable predictor for outcomes in patients with myocarditis. However, in patients with myocarditis and preserved LV systolic function, prediction of outcomes remains challenging. So far, minimal data exists about the prognostic role of diastolic function, as assessed by cardiac magnetic resonance imaging (CMR) in the clinical setting of suspected myocarditis.

Purpose

To determine the predictive value of LV diastolic function in patients with suspected myocarditis and preserved LV ejection fraction (LVEF).

Methods

In patients referred for CMR with clinically suspected myocarditis and LVEF≥50%, diastolic function was assessed by CMR feature tracking (FT). The primary endpoint was defined as a composite of major adverse cardiovascular events (MACE) including hospitalization for heart failure, recurrent myocarditis, sustained ventricular tachycardia and all-cause death.

Results

Of 381 patients included with clinically suspected myocarditis (216, 56.7% male, mean age 45.7 ± 16.4 years) late gadolinium enhancement (LGE) was present in 124 (32.4 %) of patients (mean LGE extent 4.9 ± 5.0 g). MACE occurred in 25 (6.6%) individuals at a median follow-up time of 4.5 years. In a univariate cox-regression model, radial, circumferential and longitudinal early diastolic strain rate (EDSR) and circumferential late diastolic strain rate were significantly associated with MACE. After adjustment for age, gender and extent of LGE, radial EDSR remained an independent predictor for MACE (HR = 2.26, 95% CI 1.06 to 4.8; p = 0.034).

Conclusion

Diastolic strain rate, as assessed by CMR-FT, can be useful in the prediction of outcomes in patients with myocarditis and preserved LVEF.
Evolution of myocardial tissue injury over a decade after ST-elevation myocardial infarction: a cardiac magnetic resonance study
Authors: Mayr A , Klug G , Reindl M , Tiller C , Holzknecht M , Lechner I , Pamminger M , Troger F , Bauer A , Reinstadler SJ , Metzler B
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Austrian Society of Cardiology

Background

In patients with first ST-elevation myocardial infarction (STEMI), the evolution of myocardial tissue injury parameters over a decade as assessed by cardiac magnetic resonance (CMR) has not yet been described.

Purpose

This study examined long-term myocardial tissue injury dynamics in STEMI patients treated with primary percutaneous coronary intervention (PCI), as well as its association with patient characteristics.

Methods

A total of 104 patients with STEMI were included in this observational study. Sequential late gadolinium enhanced CMR studies (after 3 days [interquartile ranges (IQR) 2-4], 4 months [IQR 4-5] and 9 years [IQR 8-10]) were conducted to assess left ventricular (LV) dimensions and function, infarct size and microvascular obstruction (MVO). T2* mapping was added at 9 year scan to assess the presence of persistent iron within the infarct core.

Results

Infarct size decreased progressively from 13% of LV myocardial mass [IQR 7-21] to 10.2% [IQR 5.2-16.1] to 8% [IQR 2.4-12.3] (p < 0.001), with an average reduction rate of 6.4% ± 3.4 per year. Relative reduction of infarct size from baseline to 9y follow-up was 43% [IQR 18-66], 21% [IQR 3-42] during the first 4m and 33% [IQR 8-54] between 4m and 9y after STEMI. Decrease of infarct size was associated with greater baseline infarct size (p < 0.004) and extent of MVO (p = 0.01). MVO was present in 60% (60/104) of patients at baseline, but in none of the follow-up examinations. Sixteen patients had persistent iron within the infarct core at 9 year CMR. Clinical and imaging associates of persistent iron included younger age at study inclusion (p = 0.036), higher peak hs troponin T (p < 0.001), higher peak creatine kinase (p < 0.001) and higher peak CRP (p = 0.036) as well as greater infarct size at any occasion (all p < 0.001) and greater MVO (p < 0.001). Patients with persistent iron showed less relative infarct size regression (51% [IQR 41-79] versus 46% [IQR 32-54], p = 0.009).

Conclusion

In patients with STEMI, the evolution of infarct size is a dynamic process that extends well beyond the first few months after the acute event. MVO vanishes in the first few weeks after the index event in all patients. However, persistence of iron within the infarct core occurs up to a decade after reperfused STEMI, reflecting its irreversibility and is associated with the initial infarct severity and worse infarct healing.
Feature tracking cardiovascular magnetic resonance in asymptomatic patients with extracardiac sarcoidosis
Authors: Panovsky R , Doubkova M , Mojica-Pisciotti ML , Holecek T , Machal J , Feitova V , Masarova L , Opatril L , Kincl V , Viskova J
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Regional Development Fund - Project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868) and the Specific University Research (MUNI/A/1685/2020) provided by the Ministry of Education, Youth and Sports of the Czech Republic (MEYS CR) in the year 2020.

Introduction

Sarcoidosis is a systemic granulomatous disease affecting many organs including heart. Myocardial strain analysis could potentially detect early stadia of cardiac dysfunction in sarcoidosis patients.

Purpose

The study aims to assess use cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis.

Methods

One hundred thirteen CMR studies of patients with extracardiac sarcoidosis without pre-existing known cardiovascular disease were included into the study and analysed using FT and compared to 22 age and gender matched controls.  Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of left ventricle (LV) were measured.

Results

The sarcoidosis patients did not significantly differ from controls in basic demographic data and had normal global and regional systolic LV function – LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (-13.9 ± 3.1 vs. -14.2 ± 2.5), GCS (-23.4 ± 4.0 vs. -22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS).

Conclusion

Asymptomatic patients with extracardiac sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain.
Assessment of early cardiotoxic adverse effects of doxorubicin-containing regimens in breast cancer patients
Authors: Rezaeian N , Maddah Safaei AFSANE , Asadian SANAZ , Molanaie Kamangar TARA , Hosseini LEILA
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): 1. Tehran University of Medical Sciences 2. Iran University of Medical Sciences

Assessment of early cardiotoxic adverse effects of Doxorubicin-containing regimens in breast cancer patients.

Abstract: Introduction

BC is the most prevalent cancer among women and comprises about 30% of cancers in this population group1. Numerous patients with breast cancer (BC) require cardiotoxic anthracycline-based chemotherapy.

Purpose

We intended to assess the early cardiotoxic effects of doxorubicin utilizing cardiac magnetic resonance (CMR) imaging.

Methods

Frothy-nine patients including 21 otherwise healthy females with BC at a mean age (±SD) of 47.62 ± 9.07 years and 28 normal controls at a mean age (±SD) of 45.18 ± 4.29 years were recruited. BC cases underwent both CMR and TTE at baseline and seven days after four biweekly cycles of Doxorubicin and Cyclophosphamide. Functional, volumetric, and strain parameters, including global longitudinal (GLS), circumferential (GCS), and radial strain (GRS), were analyzed.  The findings compared with those of 28 controls. 

Results

In post-chemotherapy CMR, four patients (19.04%) displayed evidence of drug cardiotoxicity. Ventricular ejection fraction, left ventricular end-systolic volume index, and strain values significantly changed after chemotherapy (all Ps < 0.05). One patient (4.76%) had myocardial edema in post-chemotherapy CMR, and three patients (14.28%) had evidence of myocardial fibrosis. In the follow-up time of 4 to 10 months (mean: seven months) after chemotherapy, eight patients (38.09%) complained of dyspnea on exertion and fatigue. None of the CMR parameters had any correlation with the evolution of symptoms. 

Conclusion

We demonstrated a significant difference in ventricular ejection fraction and global strain values early after Doxorubicin chemotherapy. Exclusive CMR parameters can aid in the early initiation of preventive cardiac strategies.
Cardiac MRI-guided pulmonary vein isolation for atrial fibrillation: a time-driven-activity-based costing analysis
Authors: Eijkenduijn J , Van Den Nieuwenhof HB , Bannink LS , Feenstra L , Nijhof WH , Vreemann S , Hamans BC , Rier M , Van Driel VJHM , Van Der Bilt IAC
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Aims

The number of people suffering from atrial fibrillation (AF) is increasing drastically, leading to a greater burden on the financial budget due to increased treatment. Fluoroscopy-guided pulmonary vein isolation (PVI) has become first-line treatment. However, long-term outcomes of PVI for AF are frequently unsuccessful, causing recurrences of AF and the need for redo procedures. Magnetic Resonance Imaging (MRI) guided catheter ablation might reduce subsequent ablation procedures and associated costs.

Purpose

The aim of this study was to perform a Value-Based Healthcare analysis using a Time-Driven Activity-Based Costing (TDABC) approach. As secondary endpoint, the percentage of redo procedures for MRI-guided ablation at which this treatment becomes equally costly was calculated.

Methods

The TDABC method was implemented for the MRI-guided and fluoroscopically-guided  catheter ablations. The costs and time estimates for the resources (personnel and equipment) were allocated to each activity performed in the entire Care-Delivery Value Chain (CDVC) and aggregated to establish a complete cost overview.

Results: The ablation procedure was most substantial within the cost overview

69% versus 77% for fluoroscopically-guided and MRI-guided ablation, respectively. The percentage of redo procedures for fluoroscopically-guided ablation was established to be 26%. For the MRI-guided ablation a virtual percentage of 15% redo was calculated to be equally costly.

Conclusion

A detailed in-house cost assessment with a refined understanding of the distribution of the costs was developed. The catheter ablation procedure was the main contributor to total cost. This was mainly due to the high costs of the single use ablation catheters.
Left ventricular remodeling in mitral valve prolapse patients: implications of apical papillary muscle implantation
Authors: Moura-Ferreira S , Vandenberk B , Masci PG , Dresselaers T , Garweg C , Symons R , Willems R , Bogaert J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Mitral valve prolapse (MVP) causes left ventricle (LV) remodeling even in the absence of significant mitral regurgitation.

PURPOSE

We sought to evaluate whether apical implantation of the papillary muscle (PM) has an influence on the pattern and severity of MVP-related LV remodeling.

METHODS

All MVP patients who underwent Cardiovascular Magnetic Resonance at our institution between December 2008 and December 2019 were included, thoroughly reviewed and grouped according to apical/non-apical PM implantation.

RESULTS

Apical PM implantation was found in 53/92 patients (58%) and associated with mitral leaflet thickening (p < 0.01) and a trend toward higher prevalence of mitral annular disjunction (p = 0.05). Whereas there were no differences between groups concerning ventricular volumes and ejection fraction, mitral valve prolapse location or severity of mitral valve insufficiency, patients with apical PM implantation showed more lateral wall remodeling with mid lateral wall thinning (2.1 [1.8-2.5]mm vs. 4.0 [3.5-5.0]mm, p < 0.01), increased LV eccentricity and a lower Global Circumferential Strain at this level (15 ± 3% vs. 20 ± 3%, p < 0.01). In long-axis direction, increased end-diastolic mid lateral wall angulation was found (i.e., angle <155° measured in the thinnest point of the mid lateral wall in 4-chamber view) with a higher angle variation during systole (25 ± 11° vs. 17 ± 8° p < 0.01). Remarkably, PM fibrosis was significantly more frequent in patients with apical PM implantation (i.e., 66% vs. 28%, p < 0.01). Importantly, PM fibrosis was observed in the apically implanted PM in the vast majority of cases (86%), showing a strong association between PM fibrosis and its apical implantation. Finally, a higher burden of premature ventricular complexes (>5%) and non-sustained ventricular tachyarrhythmias was found in patients with apical PM implantation: 53% vs. 25% (p = 0.04) and 38% vs. 18% (p = 0.04), respectively.

CONCLUSIONS

Apical PM implantation is part of the phenotypic spectrum of MVP, significantly impacts LV remodeling and potentially may be related to increased ventricular arrhythmogenicity.
Race, gender and clinical presentation in apical hypertrophic cardiomyopathy
Authors: Khoury S , Bhatia R , Marwaha S , Bunce N , Papadakis M , Sharma S , Tome M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The apical variant of hypertrophic cardiomyopathy (ApHCM) has male predominance and is a relatively rare phenotype in Western population. Characteristics of female and black patients diagnosed with ApHCM are very limited in the existing literature.

Purpose

We aimed to investigate whether gender and race are associated with a different clinical presentation and CMR findings in apical HCM.

Methods

We retrospectively analysed 150 patients (113 males and 37 females) with a diagnosis of apical HCM who have been followed in our inherited cardiac conditions (ICC) clinic between 2010 and 2020. Only patients with a CMR study and apical hypertrophy defined as ≥ 13mm at the time of diagnosis were included.

Demographics and clinical characteristics were obtained from electronic records. Volumetric CMR data were taken from confirmed reports while other parameters were measured by standard protocol. "Pure" ApHCM was defined as isolated apical hypertrophy and "mixed" with both apical and septal hypertrophy but with the apex thickest (1). Apical displacement of papillary muscles (PM) was defined when the base of PM originated from the apical one-third of the left ventricle (LV) in the apical 4- or 2-chamber views. Giant T-wave inversion was defined as T-wave inversion that is equal or greater than 10 mm (1 mV) in any electrocardiogram lead.

Results

Our study population included patients of White (55, 37%), Black (37, 25%), Asian (36, 24%) and Mixed/Others (22, 15%) ethnicity.  Black patients were more likely to have a diagnosis of hypertension at presentation when compared to White (70% vs 40%, p = 0.01) and to Asian and Mixed/Other patients (70% vs 48%, p = 0.03). Similarly, they were more likely to have "mixed" ApHCM than White (49% vs 20%, p = 0.003) and Asian and Mixed/Other (49% vs 26%, p = 0.02) patients.

Females were diagnosed at an older age (63 ± 12 vs 52 ± 14, p < 0.001) and were less likely to have deep T-wave inversion on their ECG at presentation (14% vs 32%, p = 0.03) compared to their male counterparts. Females in this cohort also had higher representation of black ethnicity and were more likely to have hypertension (68% vs 47%, p = 0.03). Apart from the expected gender related differences in volumes and LV mass, there were no differences in cardiomyopathy-specific parameters we investigated.

Conclusions

In our cohort, females with ApHCM presented at an older age and were less likely to have giant T-wave inversion on ECG. Black patients with ApHCM were more likely to have hypertension and the "mixed" type of the disease.
Prevalence of cardiac magnetic resonance myocarditis after SARS-CoV-2 infection
Authors: Klincheva MK , Zafirovska PZ , Veljanovska-Kiridzievska LV , Rozalia RR , Mitrev ZM
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Myocarditis and myocardial inflammation constitute an important complication after viral infection. The frequency of myocardial involvement in seasonal influenza virus varies from 0 to 10%.

The prevalence of myocardial injury among patients with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear.

The purpose of this study is to estimate the prevalence of myocarditis among unselected patients that recovered recently from SARS-CoV-2 by cardiac magnetic resonance.

Methods

We evaluated 153 consequent cardiac magnetic resonance findings that were performed from 1st of June 2020 until 15th of February 2021. Out of them, 35 patients (23%) underwent cardiac magnetic resonance due to persistent symptoms from SARS-CoV -2 infection. A conventional CMR protocol to rule out myocarditis was performed. Lake Louise Criteria were used for diagnosis of myocarditis. All scans were performed by Phillips Medical Systems Ingenia 1.5T. T1 native values were estimated elevated when mapping values measured above 1000ms, T2 mapping values were estimated elevated when greater than 55 ms. Mid wall or subepicardial late gadolinium enhancement were detected.

Results

 Seven out of 35 patients (20%) fulfilled the Lake Louise criteria for myocarditis. The most prevalent symptoms were effort intolerance and palpitations (51% and 43% respectively). Mean age was 42 ± 14 years, 68% were males. T1 mapping values were increased in 31% of the patients. All patients with increased native T1, had symptoms of COVID for not more than 3 months from the symptom onset. Three out of seven patients had acute myocarditis (42%). Only 25% of this group of patients needed hospitalization due to COVID infection. All 7 patients with cardiac magnetic resonance signs for myocarditis also had X-Ray and/or multi-slice computer tomography signs for atypical pneumonia.  None of these patients had signs of fulminant myocarditis.

Conclusion

The prevalence of myocardial involvement after SARS-CoV-2 infection is higher than influenza virus. Myocardial inflammation in any form presents in the first three months after the first symptoms. Myocarditis after SARS-CoV-2infection develops regardless of the severity of the symptoms.
T1-mapping and extracellular volume in patients with hypertrophic cardiomyopathy without focal myocardial injury in late gadolinium enhancement sequence
Authors: Gac P , Kedzierski B , Truszkiewicz K , Poreba R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The LGE (late gadolinium enhancement) sequence is a recognized classic tool for imaging focal myocardial injury. The T1-mapping sequence to assess native T1 myocardial time, post-contrast T1 time, and myocardial extracellular volume (ECV) is a widely studied tool for imaging focal and diffused myocardial injury.

Purpose

The aim of the study was to evaluate the native T1 time, the post-contrast T1 time and the myocardial extracellular volume in the T1-mapping sequence in patients with hypertrophic cardiomyopathy without focal LGE myocardial injury.

Methods

The study group consisted of 28 consecutive patients who met the criteria for diagnosis of hypertrophic cardiomyopathy without focal LGE myocardial injury (HCM group; mean age 52.17 ± 6.35 years). 28 patients without cardiomyopathy (CON group; mean age 51.76 ± 6.49 years) with similar anthropometric parameters were selected by the case-to-case method as a control group. All patients underwent 1.5 T cardiac magnetic resonance, including cinematographic sequences (CINE), LGE sequence and T1-mapping sequences before (native) and 20-minutes after intravenous administration of a paramagnetic agent (post-contrast). In the T1-mapping sequences, the mean T1 time of the whole myocardium (T1 whole myocardium) was assessed, as well as the T1 time in the basal layers (T1 basal), middle layers (T1 middle) and apical layers (T1 apical) of the myocardium. Moreover, the mean T1 time was assessed in the 16-segment myocardial AHA model (T1 segment 1-16). The extracellular volume of the myocardium was estimated in an analogous way.

Results

In CINE sequences, in the HCM group compared to the CON group, the end-diastolic thickness of the anterior part of interventricular septum, the end-diastolic thickness of the left ventricular posterior wall and the left ventricular mass index were significantly higher. The studied groups did not differ in left ventricular ejection fraction. In both groups, no foci of myocardial injury in the LGE sequence were found. There were no statistically significant differences in T1 times between the study groups. In the HCM group as compared to the CON group, the ECV whole myocardium, ECV basal, ECV apical and ECV segments 1-3, 8, 13-16 were statistically significantly higher.

Conclusion

Patients with hypertrophic cardiomyopathy without myocardium focal injury in the LGE sequence are characterized by higher myocardial ECV values, assessed in the T1-mapping sequence.
Adverse remodeling of the subpulmonary left ventricle in patient with systemic right ventricle is associated with clinical outcome
Authors: Santens B , Helsen F , Van De Bruaene A , De Meester P , Budts A , Troost E , Moons P , Claus P , Rega F , Bogaert J , Budts W
Published: July 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This research received project funding by KU Leuven

Background – Early recognition of adverse remodeling is important since outcome is unfavorable once patients with a systemic right ventricle (sRV) become symptomatic. We aimed assessing prognostic markers linked to short-term clinical evolution in this population. 

Purpose - We aimed assessing short-term clinical evolution and early prognostic markers of cardiac complications in adults with sRV (atrial switch repair for D-transposition of the great arteries (D-TGA) and congenitally corrected transposition of the great arteries (ccTGA)) based on detailed phenotyping. 

Methods– Thirty-three patients with sRV underwent detailed phenotyping including exercise CMR. Adverse outcome was a composite of heart failure episode and tachyarrhythmia. Descriptive statistics and univariate cox regression analyses were performed. 

Results - Thirty-three patients (76% male) with sRV were followed over mean follow-up time of 3 years. Mean age was 40 ± 8 (range 26-57) years at latest follow-up. When compared to baseline, (I) most patients remained in NYHA functional class I (76%),  (II) the degree of severity of the SAVV regurgitation rose and (III) more electrical instability was documented at latest follow-up. Six (18%) of a total of nine events were counted as first cardiovascular events (9% heart failure, 9% arrhythmia). NTproBNP (HR 11.02 (95%CI 1.296-93.662), p= 0.028), oxygen pulse (HR 1.202 (95% CI 1.012-1.428), p = 0.037), left ventricle end diastolic volume index (LVEDVi) in rest (HR 1.046 (95% CI 1.002-1.092), p = 0.041) and during exercise (HR 1.035 (95% CI 1.002-1.069), p = 0.038), stroke volume index (SVi) of the subpulmonary left ventricle (LV) in rest (HR 1.154 (95% CI 1.005-1.322), p = 0.038) and at peak exercise (HR 1.065 (95% CI 1.007-1.125), p = 0.026) were significantly associated with the first cardiovascular event (Figure 1A and B). 

Conclusion – NTproBNP was by far the best prognostic marker for clinical outcome. Adverse remodelling with increase of LVEDVi and SVi of the subpulmonary LV at rest and during exercise were associated with worse clinical outcome. We theorize that remodeling of the subpulmonary ventricle might be an early sign of a failing sRV circulation (Figure 2).
Prognostic implications of longitudinal strain in hypertensive patients
Authors: Taleb Bendiab N , Benkhedda S , Meziane Tani A , Henaoui L
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Tlemcen

Introduction

Hypertension is a well-established risk factor for cardiovascular disease. It causes left ventricular (LV) pressure overload, and, in turn, changes in cardiac geometry and LV hypertrophy (LVH).

Early impairment of LV function, detected by a reduced GLS, is associated with long-lasting, uncontrolled HBP, overweight, related metabolic changes, and is more pronounced in patients with LVH.

This decline in longitudinal function may be a determining factor in the occurrence of cardiovascular complications and therefore an increase in cardiovascular morbidity and mortality.

Purpose :

This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events  in hypertensive patients.

Methods

We retrospectively studied 400 asymptomatic patients with hypertension of which, 182 patients had abnormal global longitudinal strain(GLS) and 218 patients had normal GLS, between 2016 and 2019. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for  admission because of heart failure, myocardial infarction, atrial fibrillation and strokes, over median of 4 years.

At the start of study, all patients had preserved LV ejection fraction.

Résultats :

 The control of patients noted 25 cases (6.25%) of attacks of heart failure in the arm hypertension with low GLS against only 4 cases (1%) in the arm hypertension + normal GLS (P <0.001).

The same, 19 ( 4.75%) hypertensive patients with low GLS had a stroke compared to only 5 (1.25%) hypertensive patients with normal GLS. A significant difference in the incidence of onset of acute coronary syndromes was also noted in the hypertension arm with abnormal GLS (P = 0.002).

As for rhythmic complications, 26 (6.5%) hypertensive patients with  abnormal GLS developed atrial fibrillation compared to only 9 (2.25%) hypertensive patients with normal GLS (P <0.0001).

Conclusion : 

GLS and its deterioration are associated with cardiovascular complications in asymptomatic hypertensive heart disease. Although LVEF will remain a cornerstone of LV function assessment, the addition of GLS enables detailed phenotyping and improved risk assessment and is a tool for present and future therapeutic advancement.

A risk score incorporating strain was useful for predicting risk of cardiac events.
Longer sustained Fontan circulation is associated with prolonged hepatic T1 relaxation time on T1 mapping
Authors: Yanovskiy A , Ojala T , Kivisaari R , Martelius L
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with single ventricle defects may develop Fontan-associated liver disease. T1 mapping has been successfully used for evaluating chronic liver disease in adults. Liver T1 mapping has been also studied in the pediatric patients with single ventricles, and these patients show higher T1 relaxation times compared to the healthy controls.

Purpose

Our objective was to study the relationship between the cardiac MRI (CMR) T1 mapping relaxation time of the liver and 1) CMR derived hemodynamic parameters, 2) peripheral venous pressure (PVP) measured from a cubital cannula 3) systemic ventricle morphology [LV vs. RV], 4) the age of patient, and 5) alanine transaminase (P-ALAT) levels.

Methods

This retrospective study included 46 patients with functional single ventricle, which underwent routine CMR at our hospital. Table 1 shows demographic and clinical data of the study population. Statistical analysis were performed with IBM SPSS Statistics v.25 software using independent samples t test, Mann-Whitney U-test or Pearson correlation as appropriate. A p-value less than 0.05 was considered significant.

Results

The average T1 relaxation time of the liver was longer in patients with RV morphology (p = 0.004). There was a significant moderate positive correlation between the age of the patients and hepatic T1 relaxation time (r = 0.45, p = 0.002), and between hepatic T1 relaxation time and P-ALAT levels (r = 0.5, p = 0.016) (Fig.1).  No significant correlations were detected between the T1 times of the liver and hemodynamic parameters of the heart (all tested parameters are listed in the Table1). Ejection fraction and PVP showed a non-significant weak correlation with a hepatic T1 relaxation times (r=-0.3, p = 0,056 and r = 0.3, p = 0,070, respectively).

Conclusions

 T1 mapping times of the liver may reflect Fontan-associated liver disease. We observed connections between the hepatic T1 relaxation times and 1) patients age, 2) systemic ventricle morphology and 3) P-ALAT levels.
Cardiovascular magnetic resonance for early detection of late cardiotoxicity in asymptomatic survivors of hodgkin and non-hodgkin lymphoma
Authors: Van Der Velde N , Janus CPM , Bowen DJ , Hassing HC , Kardys I , Van Leeuwen FE , So-Osman C , Nout RA , Manintveld OC , Hirsch A
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Long-term survivors of Hodgkin (HL) and non-Hodgkin (NHL) lymphomas experience late adverse effects of mediastinal radiotherapy and/or anthracycline containing chemotherapy, which lead to premature cardiovascular morbidity and mortality. It is unknown whether early stages of myocardial dysfunction and heart failure in these survivors can be detected by cardiovascular magnetic resonance imaging (CMR).

Purpose

To identify early sensitive markers for the detection of subclinical late cardiotoxicity using CMR in asymptomatic survivors of HL and (primary mediastinal large B-cell lymphoma) NHL.

Methods

For this prospective observational study, we included 80 HL or selected NHL survivors, who have been free of disease for ≥5 years and were treated with mediastinal radiotherapy (RT) with/without chemotherapy. Patients with known cardiac disease were excluded. Included patients were compared to 40 age- and sex matched healthy controls. CMR included 1) cine imaging for assessment of left ventricular (LV) and right ventricular (RV) dimensions, systolic function and strain; 2) 2-dimensional late gadolinium enhancement (LGE) imaging; 3) T2 mapping and 4) pre- and post-contrast T1 mapping (MOLLI) for assessment of native T1 values and extracellular volume (ECV).

Results

Of the 80 patients, 78 (98%) had a history of HL and 2 (2%) of NHL with a mean age of 47 ± 11 years (46% male). All patients were treated with mediastinal RT which was combined with anthracycline containing chemotherapy in 68 (85%) patients. The median interval between diagnosis and CMR was 20 [14 – 26] years. Differences in CMR characteristics between patients and healthy controls are shown in the table. LV end-systolic volume was statistically significantly higher, but LV ejection fraction and mass were significantly lower in patients compared to healthy controls. RV volumes were significantly lower in patients, but RV ejection fraction was preserved. Strain parameters of the LV, i.e. global longitudinal strain, global circumferential strain and global radial strain, were slightly but significantly reduced in patients. No significant differences were found in myocardial T2 times and ECV; however, native myocardial T1 time was significantly higher in patients compared to healthy controls. LGE was detected in 25% of the patients and in the majority of patients with LGE this was classified as hinge point fibrosis.

Conclusion

Asymptomatic survivors of HL and NHL are not exempt of late cardiotoxicity, which can be detected by subtle changes in LV myocardial function, strain and native T1 value with CMR. Furthermore, late gadolinium enhancement was present in 25% of the patients. Further longitudinal studies are needed to assess the implication of these changes in relation to clinical outcome.
The Economic Incentives of Cultural Transmission: Spatial Evidence from Naming Patterns Across France
Authors: Algan Yann , Malgouyres Clément , Mayer Thierry , Thoenig Mathias
Published: July 2021

This paper studies how economic incentives influence cultural transmission, using a crucial expression of cultural identity: child naming decisions. Our focus is on Arabic versus non-Arabic names given in France over the 2003–2007 period. Our model of cultural transmission features three determinants: (i) vertical (parental) cultural transmission culture; (ii) horizontal (neighbourhood) influence; (iii) information on the economic penalty associated with Arabic names. We find that economic incentives largely influence naming choices: if the parental expectation on the economic penalty was zero, the annual number of babies born with an Arabic name would be more than 50% larger.