bluuebunny/crossref_metadata_2025 huggingface dataset:
Reciprocal communication of perivascular epicardial adipose tissue and coronary atherogenesis
Authors: Wildauer M , Honold S , Beyer C , Senoner T , Stuehlinger M , Friedrich G , Feuchtner G , Plank F
Published: November 2020

Purpose

Perivascular epicardial adipose tissue (PEAT) has been linked to underlying coronary artery disease (CAD) and proposed to modulate adjacent atherosclerotic plaque formation. In vitro and ex vivo studies support bilateral influence of adipose tissue and vessel wall. Therefore, we quantified PEAT volume and composition and its dynamics in a low coronary risk patient cohort with a semi-automate software in serial CT exams.

Methods and materials

We retrospectively included 120 patients (27% females) from a tertiary care hospital who underwent serial cardiac CT angiographies with a low cardiovascular risk profile. All coronary CTs were evaluated in a standardized approach: epicardial adipose tissue (EAT) volume and attenuation was quantified in total, in the atrioventricular (RCA, LCX) or interventricular (LAD) sulcus and in a 5mm radius for each coronary artery (PEAT). Coronary plaques were quantified using a semi-automated software and compared to progression, stability of regression between the two scans. The measurements were compared on a per-patient and per-vessel basis between plaque-naïve and diseased vessels.

Results

Of 120 patients (32% female), 59.2%) had atherosclerotic plaque formation. After 36 months mean follow-up, 22 (18.3%) showed a CAD regression plaques, 39 (32.5%) had stable coronary arteries and 49 (40.8%) progressive CAD. Total EAT volume decreased by −15.6±37.2 mm3 in the regressive group, increased by 2.7±30.6mm3 in the stable group and by 24.3±37.1mm3 in the progressive CAD group (p=0.003).

Per-vessel analysis showed a significant decrease of perivascular EAT attenuation in patients with CAD regression (−3.8±7.6 HU) compared to CAD stable (1.2±9.1 HU) and CAD progressive patients (3.5±8.2 HU, p<0.0001). Mean sulcus EAT attenuation did not show a significant change at follow-up (p=0.135)

Conclusion

Epicardial adipose tissue volume is mutually changing with the progression or regression of coronary artery disease. Perivascular but not epicardial attenuation levels correlated to adjacent plaque and support a direct bilateral influence.

Change per-vessel-basis (n=360)

Funding Acknowledgement

Type of funding source: None
Prognostic value of noninvasive combined anatomic/functional assessment by cardiac ct in patients with suspected coronary heart disease
Authors: Dewey M , Rochitte C , Ostovaneh M , Chen M , George R.T , Niinuma H , Kitagawa K , Laham R , Kofoed K , Nomura C , Sakuma H , Yoshioka K , Mehra V , Jinzaki M , Arbab-Zadeh A
Published: November 2020

Background

Noninvasive evaluation of patients with stable angina is preferable over invasive testing if it leads to similar patient outcome. The combination of coronary angiography and vasodilator challenge myocardial perfusion imaging by computed tomography allows fast, comprehensive assessment of patients with suspected coronary heart disease.

Purpose

To compare the long-term prognostic value of combined computed tomography angiography (CTA) and myocardial CT perfusion imaging (CTP) with invasive coronary angiography (ICA) and single photon emission tomography (SPECT) in patients with suspected hemodynamically significant coronary heart disease.

Methods

At 16 centres, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC).

Results

Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA/CTP findings compared to ICA/SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: 0.03, 0.36). Abnormal results by combined CTA/CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA/SPECT (95% CI for difference: 0.05, 0.39, CI −1.0, 11.1) (Figure). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI: −4.6, 4.9). When MACE was restricted to death, myocardial infarction, or stroke, AUC for CTA/CTP was 66 vs. 61 by ICA/SPECT (difference 5.1; 95% CI: −7.1, 12.9).

Conclusions

Combined CTA/CTP yield similar 5-year prognostic performance as joined ICA/SPECT assessment in patients presenting with suspected coronary heart disease and thus may represent a fast, non-invasive alternative to the traditional diagnostic approach.

Figure 1. 5-year event-free survival

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): National Institutes of Health
Left ventricular remodeling after transcatheter mitral valve replacement with Tendyne
Authors: Fukui M , Sorajja P , Goessl M , Bae R , Sun B , Duncan A , Muller D , Cavalcante J
Published: November 2020

Background

Data on changes in left atrial (LA) and left ventricular (LV) volumes after transcatheter mitral valve replacement (TMVR) are limited.

Purpose

This study sought to describe the anatomical and functional changes in left-sided cardiac chambers by computed tomography angiography (CTA) from baseline to 1-month after TMVR with Tendyne prosthesis.

Methods

We analyzed patients who underwent TMVR with Tendyne prosthesis (Abbott Structural, Menlo Park, CA) between 2015 and 2018. Changes in LV end-diastolic volume (LVEDV), ejection fraction (LVEF), mass (LV mass), LA volume and global longitudinal strain (GLS) were assessed at baseline and at 1-month after TMVR with CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes.

Results

A total of 36 patients (mean age 73±8 years, 78% men, 86% secondary MR) were studied. There were significant decreases in LVEDV (268±68 vs. 240±66ml, p<0.001), LVEF (38±10 vs. 32±11%, p<0.001), LV mass (126±37 vs. 117±32g, p<0.001), LA volume (181±74 vs. 174±70 ml, p=0.027) and GLS (−12.6±5.1 vs. −9.5±4.0%, p<0.001) from baseline to 1-month follow-up. Favorable LVEDV reverse-remodeling occurred in the majority (30 of 36 patients, or 83%). Closer proximity of the Tendyne apical pad to the true apex was predictive of favorable remodeling (pad distance: 25.0±7.7 vs. 33.5±8.8mm, p=0.02 for those with and without favorable remodeling).

Conclusions

TMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1-month after implantation. CTA identifies the favorable post-TMVR changes, which could be related to specific characteristics of the device implantation.

Funding Acknowledgement

Type of funding source: None
Comparison between echocardiography and cardiac magnetic resonance for differential diagnosis of left ventricular hypertrophy
Authors: Corsi E , Todiere G , Barison A , Grigoratos C , Aquaro G.D
Published: November 2020

Background

Left ventricular hypertrophy (LVH) may be due to different causes, ranging from, benign secondary forms (athlete's heart) to severe prognosis cardiomyopathies (i.e. cardiac amyloidosis). Early and accurate differential diagnosis is important to proper patient management. LVH may be detected by echocardiography signs of hypertrophy or other abnormalities often associated to hypertrophic phenotypes. Cardiac magnetic resonance (CMR) is often used to confirm the initial diagnostic suspicion. On the best of our knowledge, there are no study specifically designed to evaluate the final impact of CMR in changing or confirming the initial diagnostic echocardiographic suspicion.

Aim

To evaluate the clinical prognostic correlates of CMR in patients with echocardiographic or ECG suspicion of LVH (or cardiomyopathies with hypertrophic phenotype).

Methods and results

We enrolled 275 pts with echocardiographic evidence of LVH. Using current guidelines, the initial echocardiographic diagnostic suspicion was: hypertrophic cardiomyopathy (HCM) in 46.9% of pts; cardiac amyloidosis in 14.5%; hypertensive LVH in 17%; aortic stenosis in 1.5%; athlete's heart in 0.3%; undetermined LVH in 17%. CMR changed the diagnosis in 42% cases: the diagnosis of HCM increased from 44% to 72% of pts; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). Finally, the change in diagnostic suspicion was associated to reclassification of risk of patients: Kaplan-Meier curves demonstrated that HCM and cardiac amyloidosis had worst prognosis than undetermined or hypertensive LVH.

Conclusions

CMR changed the echocardiographic suspicion in almost half of patients with LVH. This study highlights the indication of CMR in patient with ECG or echocardiographic suspicion of LVH.

Kaplan-Meier curves

Funding Acknowledgement

Type of funding source: None
Diffusion tensor cardiovascular magnetic resonance detects altered myocardial microstructure in patients with acute st-elevation myocardial infarction
Authors: Rajakulasingam R , Nielles-Vallespin S , Ferreira P.F , Scott A.D , Khalique Z , Rogers P , Barnes G , Tindale A , Prendergast C , Cantor E , Wage R , Dalby M , Firmin D.N , Pennell D.J , De Silva R
Published: November 2020

Background

Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) can quantify metrics of tissue integrity (mean diffusivity [MD] and fractional anisotropy [FA]) and changes in laminar microstructures (sheetlets), which reorientate from more wall-parallel in diastole (DIA) towards wall-perpendicular in systole (SYS) as the myocardium thickens, quantified by E2 angle [E2A]. Microstructural changes after STEMI may provide new insights into adverse LV remodelling and risk stratification.

Methods

In vivo DT-CMR was performed 3–5 days after PPCI for first presentation STEMI (N=19, mean age 57±9, 79% male). DT-CMR was acquired in 2 short-axes (SYS & DIA) using a STEAM-EPI sequence. 12 segment analysis of MD, FA, E2A and E2A mobility (ΔE2A = E2ASYS − E2ADIA) was performed. Infarct (INF) segments were defined as >25% LGE, adjacent (ADJ, located contiguous to INF) and remote (REM, all other segments). Wilcoxon signed rank tests were used with threshold P<0.017 (Bonferroni corrected).

Results

See Table.

MD in both SYS and DIA was significantly higher in INF and ADJ regions compared to REM. FA in both SYS and DIA was lower in the INF and ADJ compared to REM. E2ADIA was higher in INF, indicating a more wall-perpendicular orientation of sheetlets, compared to ADJ and REM zones. E2ASYS in INF was significantly reduced, indicating a more wall-parallel orientation of sheetlets, compared to ADJ and REM regions, resulting in significantly reduced sheetlet mobility (ΔE2A).

Conclusions

Microstructural changes can be detected after acute STEMI by in vivo DT-CMR. Zonal changes in MD and FA may suggest loss of barriers to water diffusion and altered cardiomyocyte organisation, respectively. We provide the first report of reduced sheetlet mobility after acute STEMI in INF. Ongoing work is evaluating the mechanisms and prognostic importance of altered sheetlet mobility after STEMI.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis
Authors: Andreini D , Conte E , Casella M , Mushtaq S , Pontone G , Dello Russo A , Nicoli F , Catto V , Vettor G , Sommariva E , Rizzo S , Basso C , Tondo C , Pepi M
Published: November 2020

Objectives

To identify potential imaging features at cardiac magnetic resonance (CMR) specific for left-dominant arrhythmogenic cardiomyopathy (LDAC) diagnosis.

Materials and methods

Between January 2011 and May 2016, we considered 36 consecutive stable patients with a recent diagnosis of significant VA and ECG morphology consistent with a LV origin, detection of potential LV arrhythmic substrate at CMR, undergoing a clinically-indicated LV endomyocardial biopsy. Exclusion criteria were history of known cardiac disease, contraindications to CMR and impaired CMR image quality. After application of these criteria, in 9 patients endomyocardial biopsy showed tissue abnormalities consistent with the diagnosis of LDAC. From the same CMR-endomyocardial biopsy registry, a second group of 9 consecutive patients with a histological diagnosis of previous myocarditis were identified.

Results

Mid-wall LGE in the interventricular septum was detected in 5 myocarditis, without findings in LDAC group (p=0.03), whereas subepicardial LGE at the level of posterolateral wall of LV was detected in 8 cases of LDAC vs. 2 cases of myocarditis (p=0.02). Fat infiltration, and particularly subepicardial posterolateral fat infiltration, was found in all LDAC patients vs. one myocarditis only (p<0.01). No differences in other CMR findings or in any clinical or echocardiographic parameters were found between patients with a biopsy consistent with LDAC vs. patients in whom biopsy suggested myocarditis.

Conclusions

In patients with significant VA and ECG morphology consistent with a LV origin, identification of morpho-functional involvement of the subepicardial layer of LV posterolateral wall at CMR (LGE, fat infiltration, wall dyskinesis) is consistent with a diagnosis of LDAC.

Funding Acknowledgement

Type of funding source: None
The prevalence and natural progress of myocardial fibrosis in Duchenne muscular dystrophy patients
Authors: Xu R , Xu H , Liu H , Guo Y
Published: November 2020

Purpose

The cardiac disease is now as the leading cause of morbidity and mortality in DMD patients. The early detection of cardiac involvement is challenging and the frequency and presence of the cardiac involvement in the first decade is uncertain. The aim of the current study was to characterize the frequency, pattern and extent of LGE in the first decade in DMD patients, and identify a set of prognosis factors that portend the presence and extent of LGE in those patients.

Methods

There are 93 DMD patients (mean age: 8.31±2.30 years, rang: 3–13 years) with a biopsy showing absent dystrophin and/or DNA analysis demonstrating a characteristic dystrophin mutation enrolled. All patients underwent a complete cine imaging and LGE imaging. The left ventricular function and tissue characteristic were analyzed and statistic.

Results

There were 42% patients presented LGE-positive. Six years old was the youngest age onset myocardial fibrosis, and after 7 years old, the frequency of LGE positive rising fast. Moreover, all LGE positive patients showed complex patterns with non-ischaemic pattern, including septum, papillary muscle and right ventricular involvement. The free wall, inferior, apical and septum were the most common position. The papillary and right ventricular were rarely common. And all patients presented right ventricular involvement associated with septum involvement. Moreover, compared with younger patients (<7 years), the presence and extent of LGE in older patients (≥7 years) were significant higher. And the logistic analysis showed that the age is a strong predictor of presence of LGE (OR: 1.61, 95% CI: 1.26–2.05, P<0.000).

Conclusion

The myocardial fibrosis could onset in DMD patients in the first decade with a rapid rising and presented with complex patterns. The early CMR examination is necessary for the assessment of cardiac involvement and should consider to complete in younger age in DMD patients.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): The National Natural Science Foundation
Cardiac diastolic function of 8–9-year-old singletons following fresh or frozen embryo transfer compared to naturally conceived – a cardiac magnetic resonance study
Authors: Mizrak I , Asserhoej L.L , Jensen R.B , Lund M.A.V , Heldarskard G.F , Kjaer A.S.L , Greisen G , Vejlstrup N , Madsen P.L , Pinborg A
Published: November 2020

Background

Epigenetics may alter the cardiovascular system of children conceived after assisted reproductive technology (ART). Singletons born after frozen embryo transfer (FET) are more likely to be large for gestational age and fresh embryo transfer (ET) are at risk of being small for gestational age. Children conceived after ART may have endothelial dysfunction, and high body mass index and arterial blood pressure (ABP). Such changes may be associated with cardiac diastolic dysfunction.

Purpose

We investigate whether children conceived after fresh ET and FET are at risk of cardiac changes including left ventricular (LV) diastolic dysfunction.

Methods

150 9-year-old singletons have been recruited in a cardiac magnetic resonance imaging study (all scanned by April 2020). 50 children were born after natural conception (NC); 50 children after FET; and 50 children after fresh ET. Left atrium (LA) maximal volume, LA early emptying fraction (LAEEF), LV peak filling rates (PFR) and the peak ejection rate (PER)/PFR ratio are reported to assess the diastolic function.

Results

Preliminary data analyzed in a blinded manner from 59 children show no differences in ambulatory ABP, LV and right ventricular ejection fraction, end-diastolic and end-systolic volumes, stroke volumes and LV mass between the groups. With respect to LV diastolic function, no differences were seen in LA maximal volume and LAEEF; but the Fresh ET group tended to have lower PFR with a resultant PER/PFR ratio now increasing above unity compared to the other groups.

Conclusion

Preliminary data suggest a possible trend towards diastolic dysfunction in children born after fresh ET. If the lack of significant difference in heart function between NC and FET can be ascertained in the full cohort, this is reassuring.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Foundation
Cardiac magnetic resonance derived global longitudinal strain outperfoms established functional parameters in prognostication after ST-elevation myocardial infarction
Authors: Holzknecht M , Reindl M , Tiller C , Lechner I , Hornung T , Plappert D , Klug G , Reinstadler S.J , Bauer A , Mayr A , Metzler B
Published: November 2020

Background

Left ventricular ejection fraction (LVEF) is the parameter of choice for left ventricular (LV) function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI); however, its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far.

Purpose

We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in the acute stage post-STEMI for the occurrence of major adverse cardiac events (MACE).

Methods

This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2–4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure.

Results

During a follow-up of 21 [IQR: 12–50] months, 40 (10%) patients experienced MACE. LVEF (p=0.005), MAPSE (p=0.001) and GLS (p<0.001) were significantly related to MACE. GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63–0.79; p<0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58–0.75; p=0.001) and LVEF (AUC: 0.64, 95% CI 0.54–0.73; p=0.005). After multivariable analysis, GLS emerged as sole independent predictor of MACE (HR: 1.22, 95% CI 1.11–1.35; p<0.001). Of note, GLS remained associated with MACE (p<0.001) even after adjustment for infarct size and microvascular obstruction.

Conclusion

CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.

Funding Acknowledgement

Type of funding source: None
Risk stratification of patients with Brugada syndrome (BrS): the impact of myocardial strain analysis using cardiac magnetic resonance myocardial feature tracking (CMR-FT)
Authors: Hohneck A.L , Overhoff D , Rutsch M , Rudic B , Tueluemen E , Wolpert C , Akin I , Borggrefe M , Papavassiiu T
Published: November 2020

Objectives

This study evaluated the prognostic significance of cardiac magnetic resonance myocardial feature racking (CMR-FT) in patients with Brugada syndrome (BrS) to detect subclinical alterations and predict major adverse events (MAE).

Methods and results

CMR was performed in 106 patients (pts) with BrS. Biventricular global strain analysis was assessed using CMR-FT. Pts were followed for a mean of 11.1±3.5 years.

The study cohort was subdivided according to the presence of a spontaneous type 1 ECG (sECG), into sBrS (BrS with sECG, n=34 (32.1%)) and diBrS (BrS with drug-induced type 1 ECG, n=72 (67.9%)). Both left and right ventricular (RV) ejection fraction were reduced within the normal range in sBrS pts. CMR-FT revealed morphological differences between sBrS and diBrS pts regarding RV strain (circumferential (%) (sBrS 7.9±2.9 vs diBrS −9.5±3.1, p=0.02) and radial strain (%) (sBrS 12.0±4.3 vs diBrS 15.4±5.4, p<0.01)). During follow up, MAE were noted in 12 pts (11.3%). The presence of a sECG was the strongest predictor for MAE (OR 0.70, 95% CI 0.53–0.90; p=0.008). RV global circumferential strain (GCS) was also associated with MAE (OR 0.16, 95% CI 0.03–0.82; p=0.03). A risk model which combined these two identified predictors showed a substantial risk increase for patients with both sECG and reduced RV-GCS.

Conclusion

Myocardial strain analysis detected early subclinical alterations, prior to apparent changes in myocardial function, in patients with BrS. Moreover, RV-GCS provided additional prognostic information on the occurrence of MAE during follow-up.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), German Centre for Cardiovascular Research
CMR markers for early right ventricular dysfunction in precapillary pulmonary hypertension
Authors: Vos J , Leiner T , Van Dijk A.P.J , Meijboom F.J , Sieswerda G.T , Snijder R.J , Post M.C , Nijveldt R , Driessen M.M.P
Published: November 2020

Introduction

Precapillary pulmonary hypertension (pPH) causes right ventricular (RV) pressure overload inducing RV remodeling, often resulting in dysfunction and dilatation, heart failure, and ultimately death. The ability of the right ventricle to adequately adapt to increased pressure loading is key for patients' prognosis. RV ejection fraction (RVEF) by cardiac magnetic resonance (CMR) is related to outcome in pPH patients, but this global measurement is not ideal for detecting early changes in RV function. Strain analysis on CMR using feature tracking (FT) software provides a more detailed assessment, and might therefore detect early changes in RV function.

Aim

1) To compare RV strain parameters in pPH patients and healthy controls, and 2) to compare strain parameters in a subgroup of pPH patients with preserved RVEF (pRVEF) and healthy controls.

Methods

In this prospective study, a CMR was performed in pPH patients and healthy controls. Using FT-software on standard cine images, the following RV strain parameters were analyzed: global, septal, and free wall longitudinal strain (GLS, sept-LS, free wall-LS), time to peak strain (TTP, as a % of the whole cardiac cycle), the fractional area change (FAC), global circumferential strain (GCS), global longitudinal and global circumferential strain rate (GLSR and GCSR, respectively). A pRVEF is defined as a RVEF >50%. To compare RV strain parameters in pPH patients to healthy controls, the Mann-Whitney U test was used.

Results

33 pPH-patients (55 [45–63] yrs; 10 (30%) male) and 22 healthy controls (40 [36–48] yrs; 15 (68%) male) were included. All RV strain parameters were significantly reduced in pPH patients compared to healthy controls (see table), except for GCS and GCSR. Most importantly, in pPH patients with pRVEF (n=8) GLS (−26.6% [−22.6 to −27.3] vs. −28.1% [−26.2 to −30.6], p=0.04), sept-LS (−21.2% [−19.8 to −23.2] vs. −26.0% [−24.0 to −27.9], p=0.005), and FAC (39% [35–44] vs. 44% [42–47], p=0.02) were still significantly impaired compared to healthy controls. The RV TTP was significantly increased in pPH patients compared to healthy controls (47% [44–57] vs. 40% [33–43], p≤0.001).

Conclusions

Several CMR-FT strain parameters of the right ventricle are impaired in pPH patients when compared to healthy controls. Moreover, even in pPH patients with a preserved RVEF multiple RV strain parameters (GLS, sept-LS, and FAC) remained significantly impaired, and TTP significantly prolonged, in comparison to healthy controls. This suggests that RV strain parameters may be used as an early marker of RV dysfunction in pPH patients.

Funding Acknowledgement

Type of funding source: None
The role of descending aorta diastolic reverse flow in the quantification of aortic regurgitation by CMR
Authors: La Mura L , Teixido-Tura G , Guala A , Ruiz-Munoz A , Servato M.L , Fassano N , Valente F , Lopez-Sainz A , Galian-Gay L , Gonzalez-Alujas T , Cinque A , Ferreira I , Evangelista A , Galderisi M , Rodriguez-Palomares J.F
Published: November 2020

Background

EACVI recommends the use of an “integrative approach”, using several parameters, in aortic regurgitation (AR) quantification. This approach is easily achieved by echocardiography although cardiovascular magnetic resonance (CMR) remains the gold standard for the quantification of regurgitant fraction (RF).

Purpose

The aim of the study was to analyze the accuracy of descending aorta (DA) diastolic reverse flow in the assessment of chronic AR severity by CMR to identify an additional parameter.

Methods

188 patients (34% female, 54.6±15.6 years) with different severity grades of chronic AR were enrolled. All patients underwent a CMR study. Aortic regurgitation was considered as absent (≤1%), mild (≤15%), moderate (≤15%) or severe (≥30%) depending on RF value at valve level. Furthermore, cine-sequences were used to estimate aortic diameters and distensibilities using Art Fun software. Velocity-time integral (VTI) of reverse flow in DA was calculated from maximum velocity curves by an in-house MatLab code.

Results

AR was absent in 21 (12%) patients, mild in 114 (62.9%), moderate in 23 (12.7%) and severe in 21 (11.6%).DA VTI reverse flow was significantly higher as was the RF at valve level (r=0.805, p<0.001) (IMG, Table). It also positively correlated withaortic root diameter (r=0.347, p<0.001) and DA distensibility (r=0.279, p<0.001). It did not correlate with age (r=−0.91, p=0.22). In a statistically significant multiple regression model (p<0.001, R2 = 0.697), although VTI reverse flow in DA correlated strongly with RF at valve level (p<0.001; beta = 0.733), it was also influenced by DA distensibility (p<0.001; beta = 0.197) and aortic root diameter (p<0.001; beta= 0.140).

Conclusions

VTI reverse flow in DA correlates strongly with the degree of AR and may be useful in the assessment of its severity. Neverthless, owing to the influence of other factors (aortic distensibility and aortic root diameter), it cannot be used as a single parameter in the quantification of AR severity by CMR.

Scatter Plot graphs

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): research grant provided by the Cardiopath PhD program
Texture-based machine learning in LGE-CMRI for automatic scar assessment
Authors: Froysa V.F , Jansson G.J.B , Eftestol T.E , Woie L.W , Orn S.O
Published: November 2020

Background

Conventional methods for the estimation of infarct size by late-enhanced cardiac magnetic resonance imaging use analyzes from each slice which in turn is added to generate a volume. We present a novel method based on machine learning, called texture based probability mapping (TPM). TPM is based upon expressing the probability of scarring in a pixel based upon analysing textural information in patches around each pixel.

Purpose

To explore our method and assess its utility as a tool to scar size and compare it with four established methods.

Methods

In 54 patients with ischemic scars, our method was compared with four 2D methods. 2 patients were excluded due to low image quality and artefacts. The most basal and apical short axis image slices were exclude due to partial volume artefacts. Myocardial infarction (MI) size was estimated manually, and TPM performed. Cardiac segments were defined as myocardial regions with pixel probabilities within a specified range. By varying the lower probability threshold while keeping the upper threshold fixed at 1, different cardiac segments were defined. Using the Sørensen-Dice coefficient the optimal probability range with the highest correlation to manual estimation of infarct size was identified.

Results

TPM-range 0.341–1.0 is best correlated to manual demarcation (median Dice 0.70). The method demonstrated stronger correlations between scar size and left ventricular remodeling parameters (LV ejection fraction: r=−0.731, p<0.0005; LV end-diastolic volume: r=0.641, p<0.0005; LV end-systolic volume: r=0.672, p<0.0005) compared with manual method.

Conclusion

Using TPM, infarct size can be measured automatically without using signal intensity as a reference value. It is without the need for manual demarcation of the scar and is less time consuming and less vulnerable to interobserver variability. It has a strong correlation with left ventricular remodeling parameters crucial in guiding further medical therapy. The use of this method is however not primarily dedicated for scar size estimation, but a tool to evaluate different properties of the tissue that cannot be visualized by the naked eye. It's an important step towards better understanding of myocardial damage pattern causing ventricular arrhythmia and SCD.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): Helse Vest
Myocardial fibrosis and inflammation are predictors of heart failure outcomes in people living with HIV
Authors: Arendt C , De Leuw P , Haberl A , Stephan C , Vasquez M , Arcari L , Zhou H , Zainal H , Albrecht M , Vogl T , Zeiher A , Nagel E , Puntmann V
Published: November 2020

Background

People living with HIV (PLWH) have higher prevalence of heart failure (HF), which cannot be fully related to traditional cardiovascular disease (CVD) risk factor< or coronary artery disease. Tissue characterisation by cardiac magnetic resonance (CMR), such as with T1 and T2 mapping, is a unique diagnostic approach to provide non-invasive insights into the underlying myocardial pathophysiology.

Purpose

To examine prognostic associations of CMR measures, conventional and modified CVD risk scores with HF outcome in PLWH on long-term highly active antiretroviral therapy (HAART).

Methods

Consecutive PLWH underwent prospectively standardized evaluation of HF using CMR, risk scores and blood markers. CMR protocol included T1 and T2 mapping, perfusion and scar imaging. MAGGIC, Framingham and D:A:D risk scores were collected. Primary HF endpoint was defined as hospitalization or mortality due to HF, and time-to-even analysis from the index CMR to the first event per patient was performed.

Results

141 PLWH (61% males, 48.0 [40.1–54.6] years, CD4 count 655 [411–909] cells/μl) were included. 16 HF events were observed (12 hospitalizations and 4 deaths) during a median follow-up of 13 [9–16] months. Baseline myocardial native T1, T2, left ventricular volumes and troponin were significant univariate predictors of the HF endpoint. The only signifcant (p<0.001) independent predictor in the multivariate analysis was myocardial native T1 (T1 ≥4 SD, HR (95% CI): 5.0 [1.8–13.4]). Conventional and modified CVD risk scores showed no prognostic association with HF outcomes.

Conclusions

Our results show that presence and severity of myocardial inflammation and predominantly diffuse fibrosis detected by T2 and T1 mapping strongly relates to HF events in contrast to conventional and traditional CVD risk scores.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Centre for Cardiovascular Research (DZHK)
Adenosine stress native T1 mapping demonstrates impaired myocardial perfusion reserve in non-ischemic dilated cardiomyopathy
Authors: Nucifora G , Tsoumani Z , Miller C , Schmitt M
Published: November 2020

Background

Impaired myocardial perfusion reserve has been demonstrated in non-ischemic dilated cardiomyopathy (NIDCM) by positron emission tomography (PET) and adenosine-stress first-pass perfusion cardiac magnetic resonance (CMR) imaging. Adenosine stress native T1 mapping is a novel CMR technique able to assess myocardial perfusion without the use of contrast agents. The aim of the present study was to determine the clinical utility of this novel CMR technique in NIDCM.

Methods

A total of 20 consecutive patients (mean age 61±12 years, 80% males) with diagnosis of NIDCM who consented to be enrolled in the UHSM CMR registry were included in the present study. CMR at 3T including 1. cine imaging for the assessment of LV volumes, mass and global longitudinal strain (GLS) by tissue-tracking imaging; 2. rest and stress (adenosine 140 mcg/kg/min) MOLLI T1 mapping of mid-ventricular slice for the assessment of rest and stress T1 values and T1 reactivity (ΔT1%); 3. first-pass perfusion imaging for the assessment of myocardial perfusion reserve index (MPRI) and 4. late gadolinium enhancement (LGE) imaging for the assessment of myocardial replacement fibrosis, was performed. Twenty control patients without history of known coronary artery disease and evidence of reversible ischemia or previous myocardial infarct on CMR imaging were included for comparison purposes.

Results

NIDCM patients had significantly higher native T1 value (1263±47 ms vs. 1234±38 ms, p=0.031), significantly lower ΔT1% (3.2±1.5% vs. 5.7±1.7%, p<0.001, Figure A), significantly lower MPRI (1.32±0.18 vs. 1.67±0.13, p<0.001) and significantly impaired GLS (−10±4% vs. −16±2%, p<0.001) as compared to controls. A significant strong relation between ΔT1% and MPRI (β=0.76, p<0.001, Figure B) and significant moderate relation between ΔT1% and GLS (β=−0.54, p<0.001) were observed.

Conclusion

T1 reactivity, myocardial perfusion reserve and GLS are significantly reduced in NIDCM patients compared to controls. Adenosine stress T1 mapping holds promise for detection of impaired myocardial perfusion reserve in NIDCM without the requirement for contrast agents.

Funding Acknowledgement

Type of funding source: None
Cardiac magnetic resonance using T1 mapping for assessment of late cancer therapeutics-related cardiotoxicity in childhood cancer survivors
Authors: Panovsky R , Kepak T , Opatril L , Masarova L , Holecek T , Feitova V , Mojica-Pisciotti M.L , Machal J , Kincl V
Published: November 2020

Introduction

Due to cardiotoxic treatment, childhood cancer survivors (CCS) are at 15-fold increased risk of developing chronic heart failure and are at 7-fold higher risk of premature death due to cardiac causes compared with the general population. Cardiac magnetic resonance (CMR) has the potential to detect early cardiac involvement with consecutive possibilities of preventive steps against the development of advanced stages of heart failure. So far, only a few studies using T1mapping in CCS monitoring have been published.

Purpose

This study aimed to assess early cardiac involvement in a population of CCS using T1 mapping.

Methods

One hundred five CCS of age 24,9±5,4 years were included, mean time since the end of cancer-therapeutics treatment was 12,2±5,8 years. One hundred of them underwent complete CMR examination at 1,5T scanner. Cine images for assessment of left ventricular (LV) volumetric and functional parameters, pre- and post-contrast Modified Look-Locker Inversion recovery (MOLLI) images were acquired for assessment of native T1 relaxation time and extracellular volume (ECV), and delayed postcontrast images for evaluation of late gadolinium enhancement (LGE). The measured parameters were compared between CCS patients and 50 healthy controls.

Results

CCS patients had not enlarged LV (end-diastolic volume 128±30ml vs 124±30ml, p=NS) and normal, although lower systolic LV function than the controls – LV ejection fraction 59±6% vs 67±5% (p<0,05). In CCS group, only 3 (3%) patients had LV ejection fraction <50%, four (4%) patients had regional LV hypokinesia, and small non-ischemic LGE was found in 4 (4%) patients. Mean native T1 relaxation time was not prolonged - 987±31 msec vs 986±24msec (p=NS), and mean ECV value was not increased – 24,6±5,3% vs 23,8±2,3% (p=NS).

Conclusion

In this study, the late cancer therapeutics-related cardiotoxicity was quite low. Native and postcontrast T1mapping did not show any significant subclinical myocardial involvement.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): Supported by the European Regional Development Fund - Project ENOCH (no. CZ.02.1.01/0.0/0.0/16_019/0000868)
Role of 18F-FDG PET/CT in diagnosis of cardiovascular infection in patients after cardiac surgery
Authors: Pursanova D , Aslanidis I.P , Mukhortova O.V , Shurupova I.V , Trifonova T.A , Katunina T.A , Muratov R.M , Serguladze S.Y.U , Mironenko V.A , Arakelyan V.S , Popov D.A
Published: November 2020

Purpose

To investigate the diagnostic performance of 18F-FDG PET/CT in patients with suspected prosthetic valve infective endocarditis (IE), prosthetic aortic and intracardiac device infection.

Methods

The prospective analysis included results of PET/CT examinations performed in 60 patients with fever of unknown origin after cardiac surgery (median time 29 months): valve replacement (n=26), intracardiac device implantation (n=19), both procedures (n=8), Bentall-de-Bono surgery (n=7). According to the Duke criteria most patients – 90% (54/60) – had possible (n=42) and rejected (n=12) diagnosis of IE; 6 patients had definite IE. PET/CT scan was performed 90 min after intravenous injection of 18F-FDG (175–200MBq). All patients underwent strict carbohydrate-free diet and fasted for at least 15–18 hours. Final diagnosis was based on clinical, laboratory, instrumental and intraoperative (n=41) data: confirmed in 40 and ruled out in 20 patients.

Results

PET/CT results correctly confirmed the infectious process in the prosthetic valve area, aortic prosthesis or along the intracardiac device in 93% (37/40) and ruled it out in 75% (15/20) patients. False results were obtained in 13% (8/60) – positive (n=5) and negative (n=3). Thus, in the analyzed group of patients (n=60), the sensitivity, specificity and diagnostic accuracy of PET/CT with 18F-FDG in the diagnosis of IE were 93%, 75% and 83%, respectively; positive and negative predictive value – 88% and 83%.

In patients with possible IE according to the Duke criteria, true PET/CT results were obtained in 86% (36/42) – positive (n=28) and negative (n=8). In 7% (4/60) of patients – the diagnosis was based only on PET/CT, while initially, according to the Duke criteria, it was rejected.

In addition, in 40% (24/60) of patients of the analyzed group, whole body PET/CT revealed other than valve and device, previously unknown foci of inflammation: in the lungs (n=6), in the sternum (n=6), in the area of the native valve (n=3), in the mediastinum (n=4), other (n=13).

Conclusions

18F-FDG PET/CT proved to be highly informative for the diagnosis of infectious processes in the heart and vessels in patients after cardiac surgery. The inclusion of PET/CT in the diagnostic algorithm for this category of patients reduces the number of patients with possible IE according to the Duke criteria.

Funding Acknowledgement

Type of funding source: None
Tissue tracking MR to evaluate left ventricular global myocardial deformation in patients with cardiac amyloidosis of transmural late gadolinium enhancement
Authors: Li Z , Jin H , Yun H , Wei Z , Zeng M.S
Published: November 2020

Purpose

Cardiac amyloidosis (CA) is a major cause of mortality in patients with amyloidosis because it leads to heart failure and lethal arrhythmia. The present study was aimed to evaluate left ventricular (LV) global myocardial deformation in patients with CA of transmural late gadolinium enhancement (LGE) using tissue tracking MRI.

Materials and methods

Thirty-nine patients with CA, confirmed by cardiac MRI, and a biopsy of at least one involved organ were enrolled. According to LV ejection fraction (LVEF), they were divided into reduced LVEF (CArEF) and preserved EF (CApEF) groups. Thirty-nine normal controls were recruited (NC). Tissue tracking analysis was done based on cine MRI sequences. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were computed.

Results

GLS [CArEF vs. CApEF vs. NC: (−5.82±2.42) % vs. (−8.44±4.15) % vs. (−14.74±2.93)%], GCS [CArEF vs. CApEF vs. NC: (−9.47±2.96) % vs. (−15.01±1.81) % vs. (−19.86±2.30) %], and GRS [CArEF vs. CApEF vs. NC: (11.37±4.68) % vs. (20.61±6.27) % vs. (39.02±8.98) %] were all reduced in the CArEF and CApEF groups compared with healthy control subjects (all P<0.01). GCS and GRS in the CArEF group were reduced compared with the CApEF group (P<0.01). GLS, GCS, and GRS were also strongly correlated with LVEF (r=−0.77, −0.88, and 0.83, respectively; P<0.01). Furthermore, the optimal cutoff values to predict LVEF reduction were −9.31% (sensitivity 88%, specificity 97%) for GLS, −14.13% (sensitivity 96%, specificity 97%) for GCS, and 20.11% (sensitivity 90%, specificity 97%) for GRS.

Conclusion

MRI-based LV global deformation parameters could be a useful method to assess LV myocardial systolic function and predict LVEF reduction in patients with CA of transmural enhancement on LGE. The differences of GCS and GRS between the CArEF and CApEF groups may also reflect preserved contractile function of the mid- or/and subepicardial myocardium.

Figure 1. LV deformation parameters

Funding Acknowledgement

Type of funding source: None
The imortance of hyperemic contrast velocity assessment on image-based fractional flow reserve calculation
Authors: Tar B , Uveges A , Koszegi Z
Published: November 2020

Aims

Image-based fractional flow reserve (FFR) calculations reported good agreement with FFR measured invasively.

The purpose of this study was to perform a retrospective analysis of the cases of a previous study on less invasive FFR calculation (simple FFR: FFRsim) as a simple calculation from hyperemic contrast flow data and three-dimensional coronary parameters.

Methods and results

We aimed to analyze the relations between the pressure wire-based FFR (FFRmeas) and fixed FFRsim: calculated from the fixed hyperemic velocity, rest FFRsim: calculated using the non-hyperemic frame count data to extrapolate the hyperemic velocity (based on the database used in the FAVOR1 study) hyp FFRsim: the hyperemic velocity derived from the frame count assessment during vasodilation.To calculate the frame count reserve (CFRFC) the resting frame count was divided by the hyperemic frame count; this value was then used to determine the CFRFC/FFRmeas ratio as an indicator of microvascular function in the corresponding myocardial area of the measured coronary vessel.

A total of 50 lesions with intermediate stenosis were investigated. Correlation between rest FFRsim (from the resting frame count extrapolated to the hyperemic velocity) and FFRmeas was lower than the correlation between hyp FFRsim and FFRmeas (r=0.761 vs. 0.824).

Based on ROC curve analysis for predicting the abnormal FFR of ≤0.80 the AUC were significantly higher for the hyperemia-based parameter than those calculated from resting frame counts. Significantly higher AUC were detected by the hyp FFRsim than by the rest FFRsim: 0.936 (95% CI: 0.828 to 0.985) vs. 0.862 (CI: 0.734 to 0.943); p=0.011.

Linear regression analyses between the FFRsim (either by fixed FFRsim or by rest FFRsim or by hyp FFRsim methods) and the FFRmeas showed higher intercepts and less steep of the slopes in the subgroups with presence of microvascular disease defined as CFRFC/FFRmeas <2 than in those without microvascular disease (CFRFC/FFRmeas >2); the difference reached significant level (p=0.019) when calculated by rest FFRsim.

Conclusions

Hyperemic challenge either by adenosine or regadenoson is required for exact image-based FFR calculation especially in cases of suspicion for microvascular coronary disease.

Funding Acknowledgement

Type of funding source: None
Risk stratification in patients discharged for STEMI. Ejection fraction by echocardiography as the gatekeeper for a selective use of cardiac magnetic resonance
Authors: Marcos Garces V , Gavara J , Lopez-Lereu M.P , Monmeneu J.V , Rios-Navarro C , De Dios E , Merenciano-Gonzalez H , Gabaldon-Perez A , Bonanad C , Chorro F.J , Valente F , Lorenzatti D , Rodriguez-Palomares J.F , Ortiz J.T , Bodi V
Published: November 2020

Background

CMR permits robust risk stratification of discharged STEMI patients but an indiscriminate use in all cases is unfeasible.

Purpose

We evaluated the usefulness of left ventricular ejection fraction (LVEF) by echocardiography (Echo) as the gatekeeper for identifying those patients discharged for ST-segment elevation myocardial infarction (STEMI) who benefit most from cardiac magnetic resonance (CMR) for prognostic purposes.

Methods

Echo and CMR were performed in 1119 patients discharged for STEMI included in a multicenter registry. The prognostic power of CMR beyond Echo-LVEF was assessed using C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI).

Results

During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 re-admissions for acute heart failure). Lesser Echo-LVEF and CMR-LVEF associated with the occurrence of MACE but only CMR-LVEF and microvascular obstruction were independent predictors. The MACE rate significantly increased only in patients with CMR-LVEF <40% (≥50%: 7%, 40–49%: 9%, <40%: 27%, p<0.001). The majority of patients (629, 56%) displayed Echo-LVEF ≥50% and most of them (94%) were at the “safe zone” (CMR-LVEF >40%). On the other hand, 490 patients (44%) exhibited Echo-LVEF <50% and 33% of them were incorrectly classified either in the “safe zone” (CMR-LVEF ≥40%) or in the “risk zone” (CMR-LVEF <40%). C-statistic, NRI and IDI demonstrated potent reclassification for MACE prediction by CMR in patients with Echo-LVEF <50% but not in those with Echo-LVEF ≥50%.

Conclusions

Echo-LVEF <50% identifies the subset of discharged STEMI patients who may benefit most from CMR in terms of long-term risk prediction.

Figure 1. LVEF reclassification

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants).