bluuebunny/crossref_metadata_2025 huggingface dataset:
CMR derived ventricular arterial coupling in hypertrophic cardiomyopathy
Authors: Kharabish A , Eid M , Elmozy W , Elguindy A , Yacoub M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Ventriculoarterial coupling (VAC) is an important surrogate measurement of global cardiovascular efficiency. However, up till recently, this measurement has been rarely used in clinical practice. This could be due to its invasive nature, and the relatively complex methods required for acquisition and interpretation. We here describe a noninvasive method of measuring VA coupling using cardiac magnetic resonance (CMR) in a cohort of hypertrophic cardiomyopathy (HCM).

Methods

 

Cardiac MRI was performed in 61 patients with hypertrophic obstructive cardiomyopathy (HOCM) before and after undergoing extended surgical myectomy. Cardiac MRIs from 15 patients with non-obstructive HCM were also included for comparison. Hypertensive patients were excluded from this study. Vitals signs were recorded during each MRI study. Arterial end-systolic pressure (AESP) was determined non-invasively as previously described (0.9x brachial blood pressure). Left ventricular end-systolic pressure (LVESP) was calculated by adding the echo-derived peak systolic gradient across the left ventricular outflow tract to the arterial end-systolic pressure. Indexed stroke volume (SVI) in the ascending aorta as well as indexed end systolic volume (ESVI) were calculated from CMR. Indexed arterial (Ea) and ventricular (Ev) elastance were calculated as AESP/SVI and LVESP/ESVI. VA coupling was then calculated as Ea/Ev. 

Results

Compared to the baseline measurements, VAC increased significantly post myectomy (mean VAC pre-myectomy and post-myectomy 0.38 vs. versus 0.62 respectively, p= 0.00001). VAC in non-obstructive HCM patients (mean = 0.64) was statistically similar to that in post-myectomy (p = 0.82) and statistically different from pre-myectomy (p = 0.00016). The mean of LVOTO gradients post- and pre-myectomy were significantly different (p = 0.00001). Significant correlation of the delta-VAC with the delta gradient in the LVOTO was found (r= 0.35, p = 0.005). 

Conclusion

Non-invasive assessment of VA coupling using CMR is feasible and could be a useful tool in the evaluation of patients with various cardiovascular disorders. Further studies with larger numbers of patients are required to establish the utility of this method in clinical practice.
EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study
Authors: Rios-Navarro C , Gavara J , Nunez J , Bonanad Lozano C , Revuelta-Lopez E , Monmeneu JV , Lopez-Lereu MP , De Dios E , Perez-Sole N , Vila JM , Oltra R , Chorro FJ , Bayes-Genis A , Bodi V
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER”

Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting.

Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI.

Methods. We prospectively included 106 patients with a first STEMI treated with primary percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours post-reperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction (LVEF) was evaluated.

Results. The mean age of the sample was 59 ± 13 years and 76% were male. Patients were dichotomized according to EpCAM median (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (p-value = 0.02) and greater infarct size (p-value = 0.02). At presentation, only EpCAM values were significantly associated with the presence of MVO in univariate (Odds Ratio [95% confidence interval] (OR [95% CI]): 0.58 [0.38-0.88], p-value = 0.01) and multivariate logistic regression models (OR [95% CI]: 0.54 [0.34-0.85], p-value = 0.007). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: depressed LVEF (p-value = 0.009) and higher left ventricular end-systolic volume (p-value = 0.04).

Conclusions. EpCAM is associated with occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI. Future studies are needed to confirm EpCAM as biomarker, and eventually biotarget in STEMI pathophysiology.
Effect of weight loss on early left atrial myopathy in obese patients without known cardiovascular disease
Authors: Deal O , Rayner J , Stracquadanio A , Wijesurendra R , Neubauer S , Casadei B , Rider O , Spartera M
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): BHF & NIHR BRC

Introduction

Obesity is strongly associated with increased risk of heart failure and ischaemic stroke independently of associated co-morbidities. Left atrial (LA) reservoir dysfunction, a marker of atrial distensibility and compliance, is an early pathophysiological change which precedes the onset of cardiovascular disease in patients with obesity. It is unclear whether a weight loss intervention may be sufficient to reverse LA reservoir dysfunction.

Purpose

To longitudinally assess whether a weight loss intervention normalizes LA reservoir function by cardiac magnetic resonance (CMR) feature-tracking in patients with obesity and only subclinical cardiovascular disease and compared this age and sex matched non-obese normal weight controls.

Methods

A total of 45 patients with severe obese (age = 45 ± 11 years, body mass index = 39.1 ± 6.7 kg/m2, 51 ± 18 kg of excess body weight [EBW], 67% female) underwent CMR for quantification of LA and left ventricular (LV) size and function before and a median of 373 days following weight loss intervention. Weight loss was achieved by means of a very-low calorie diet (N = 28; 800 kcal/day) or by bariatric surgery (N = 17). A total of N = 27 non-obese healthy controls (age = 41 ± 12 years, body mass index = 22.3 ± 2.4 kg/m2, 75% female) underwent the same CMR protocol once.

Results

At baseline, patients with obesity displayed signs of atrial myopathy with increased LA volume and reduced LA reservoir function as compared to normal-weight controls (both P < 0.05, Figure 1) alongside increased LV mass and hyper-normal LV ejection fraction [LVEF] (both p < 0.01). As expected, weight loss led to a significant reduction of LA volume and LV mass with normalization of LVEF regardless of the degree of weight loss achieved (all P < 0.05, Figure 2). By contrast, only a large weight loss (>46.6% EBW, in red in Figure 2) was sufficient to improve and normalize the LA reservoir function (P < 0.05, Figure 2).  On the other hand, moderate or milder weight loss (in orange and red) had no significant effect on LA reservoir function (both P > 0.05).

Conclusion

Successful weight loss can completely revert early LA myopathic phenotype in obese patients without known cardiovascular disease although this can be achieved only with larger weight loss targets.
Diffuse myocardial fibrosis precedes impairment of myocardial strain in patients with systemic sclerosis
Authors: Gotschy A , Jordan S , Stoeck CT , Von Deuster C , Gastl M , Vishnevskiy V , Wissmann L , Dobrota R , Mihai C , Becker MO , Maurer B , Kozerke S , Ruschitzka F , Distler O , Manka R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background - Myocardial involvement is common in patients with systemic sclerosis (SSc) and causes myocardial fibrosis and subtle ventricular dysfunction. However, the temporal onset of myocardial involvement during the progression of the disease is yet unknown.

Purpose - To investigated the presence of subclinical functional impairment and diffuse myocardial fibrosis in patients with very early diagnosis of SSc (VEDOSS) and to compared the findings to patients with established SSc and healthy controls.

Methods - 110 SSc patients (86 with established SSc and 24 with VEDOSS) and 15 healthy controls were prospectively recruited. The study subjects underwent cardiovascular magnetic resonance on a clinical 1.5T system. Pre- and post-contrast T1 mapping was performed using a MOLLI (Modified Look-Locker Inversion Recovery) sequence. For extracellular volume (ECV) measurements, a single bolus protocol with image acquisition 15-20 min. post-contrast injection was used. For the assessment of subtle functional impairment, global longitudinal (GLS) and circumferential (GCS) myocardial strain were evaluated.

Results - Native T1 values and ECV were elevated in VEDOSS and in patients with established SSc compared to controls (p < 0.001; Figure 1 A & B). GLS was similar in VEDOSS and controls but significantly reduced in patients with established SSc (p < 0.001; Figure 1 C). GCS was similar over all groups (p = 0.88). Patients with clinical evidence of pulmonary or gastrointestinal involvement had higher ECV or T1 values, respectively. Patients with clinical signs of cardiac involvement had lower absolute GLS. SSc subtype, classification or disease duration were not associated with the extent of myocardial fibrosis or impaired strain.

Conclusion - Subclinical myocardial involvement first manifests as diffuse myocardial fibrosis identified by expansion of ECV and increased native T1 in VEDOSS patients while subtle functional impairment as measured by GLS only occurs in established SSc. No single clinical feature of SSc shows a strong association with subtle myocardial involvement.
Cardiac magnetic resonance strain as a predictor of clinical events in hypertrophic cardiomyopathy
Authors: Martinez Vives P , Cecconi A , Vera A , Nogales-Romo T , Lopez-Melgar B , Rojas-Gonzalez A , Jimenez-Borreguero LJ , Alfonso F
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hypertrophic cardiomyopathy (HCM) is a relatively prevalent condition associated with cardiovascular death and heart failure. Several tools are currently available to identify which HCM patients are at risk of developing these events.

Purpose

We aimed to evaluate the association of new Tissue Tracking strain analysis by cardiac magnetic resonance (CMR) and the development of clinical events in patients with HCM.

Methods

We prospectively analyzed 136 consecutive patients with HCM diagnosis (established according to current clinical practice guidelines) from January 2006 to October 2017. Heart failure hospital admissions and death on follow-up were included in a combined clinical outcome. CMR studies were performed following our predefined CMR protocol for HCM with 1.5T magnets. Cine images were obtained with standard, retrospectively gated, steady-state free-precession (SSFP) sequences in 2, 3 and 4 chambers views and in 10–15 contiguous short-axis slices covering the ventricles from the base to the apex, with breath holding.  The strain evaluation was performed by a commercially available Tissue Tracking analysis software, manually defining the endocardial border in short axis, 4, 3 and 2 chambers views and, after verifying adequate identification of the different structures, running the strain analysis (Figure 1, displaying myocardium identification by the strain analysis software).

Results

Mean follow-up was 49 ± 45 months. Mean age was 61 ± 15.33 years old (p 0.024) and 31% of patients were women (p 0.01). 20% had atrial fibrillation (p 0.154). Mean ejection fraction was 69 ± 9.21% (p 0.762) and mean HCM-SCD (hypertrophic cardiomyopathy sudden cardiac death) risk score was 2.20 ± 1.35 (p 0.885).

Mean global radial systolic strain rate (GRSsr) was -1,33 ± 0.59 s-1 (p 0.083). During follow-up, 12 heart failure hospital admissions and 14 death from any cause were registered.

GRSsr showed an area under de ROC curve of 0.63 (95% confidence interval -CI- 0.51 – 0.75) predicting clinical events. The value of 1.40 s−1 was selected as the best sensitivity/specificity cutoff point. Three variables (sex, age, and previous history of atrial fibrillation) were chosen (through the allsets method) and included as adjusting variables together with <1,40 s−1/≥1.40 s−1 in a multivariate Cox’s regression model (p 0.002; AIC 99.7; Harrell C index 0.82). Patients with GRSsr <1.40 s−1 showed more clinical evens on follow-up vs those with GRSsr ≥1.40 s−1 (adjusted HR 6.57; 95% CI 2.01 – 21.49; p 0.002; Figure 2, displaying Kaplan-Meier survival estimates).

Conclusions

A GRSsr <1.40 s−1 emerges as a novel independent predictor of worse clinical outcomes in patients with HCM and preserved ejection fraction.
Myocardial strain overrules left ventricular ejection fraction and late gadolinium enhancement extent in predicting MACE in CMR-proven acute myocarditis
Authors: Vos JL , Raafs AG , Van Der Velde N , Germans T , Biesbroek PS , Hirsch A , Heymans SRB , Nijveldt R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac magnetic resonance (CMR) plays a major role in both the diagnostic process and prognostic stratification in acute myocarditis. Presence of late gadolinium enhancement (LGE) and left ventricular (LV) ejection fraction (EF) are known predictors of major adverse cardiovascular events (MACE). However, in daily clinical practice it remains challenging to distinguish ‘the good from the bad’. The prognostic value of CMR feature tracking (FT) derived strain, with respect to LGE and LVEF, remains unclear.

Purpose

To evaluate the incremental prognostic value of left atrial (LA) phasic function, LV and right ventricular (RV) strain using CMR-FT in patients with CMR-proven acute myocarditis.

Methods

In this multicenter observational study, patients with CMR-proven acute myocarditis were included and followed with regard to MACE including all-cause mortality (ACM), heart-failure hospitalizations (HFH), and life-threatening arrhythmias (LTA). Using FT-derived strain, LV global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS), RV GLS and LA phasic function were measured. Uni- and multivariable analysis including clinical and CMR parameters were performed to assess the association with MACE.

Results

A total of 162 patients were included (75% male, 41 ±17 years). MACE occurred in 29 patients (18%, ACM n = 18, HFH n = 7, LTA n = 11) during a median follow-up of 5.5 (2.2-8.3) years. Forty-six percent had a STEMI-like presentation (combination of chest pain, elevated troponin, and ST-elevation, n = 74). LGE was present in 90% of patients and mean LVEF was 51 ± 12%. Patients with LVEF <50% had a significantly worse prognosis compared to patients with LVEF ≥50% (p < 0.0001, Figure A). When we categorized the study population into subgroups of quartile values of LV GLS, patients with LV GLS worse than 18% had a significant worse outcome compared to the other subgroups (p < 0.05, Figure B). Subgroups of LGE extent did not show significantly different associations with outcome (p = 0.458, Figure C). Cox regression analysis showed that LV strain and LA phasic function were univariably associated with MACE, whereas RV GLS and LGE extent were not. All univariable associated strain parameters were separately included in a multivariable model, including age, sex, STEMI-like presentation, and LVEF. LV GLS (HR 1.08, p = 0.01), LV GCS (HR 1.15, p = 0.02), and LV GRS (HR 0.98, p = 0.02) were independent predictors of MACE.

Conclusions

LV strain parameters are independent and incremental predictors of prognosis in patients with acute myocarditis, while RV strain and LA phasic function are not. Therefore, LV strain is a promising novel parameter for risk stratification in acute myocarditis.
Aortic rotational flow patterns and stiffness by 4D flow CMR in patients with Loeys-Dietz syndrome compared to healthy volunteers and patients with Marfan syndrome
Authors: Ruiz Munoz A , Guala A , Rodriguez-Palomares JF , Dux-Santoy L , Servato L , Lopez-Sainz A , La Mura L , Gonzalez-Alujas T , Galian-Gay L , Gutierrez L , Johnson K , Wieben O , Ferreira I , Evangelista A , Teixido-Tura G
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): La Marató de TV3, Instituto de Salud Carlos III through the project and Spanish Ministry of Science, Innovation and Universities.

BACKGROUND

Loeys-Dietz (LDS) and Marfan (MFS) syndromes are rare genetic connective tissue disorders associated with progressive aortic dilation, however, aortic dissections have been observed at lower aortic root diameters in LDS than in MFS. Recent CMR studies in MFS patients reported increased aortic stiffness (1–3) and altered rotational flow (4), but research on aortic flow dynamics and biomechanics in LDS is lacking.

PURPOSE

The aim of this study was to assess rotational aortic flow and aortic stiffness in LDS compared to healthy volunteers (HV) and MFS patients, using 4Dflow CMR.

METHODS

Twenty-one LDS and 44 MFS patients, without previous aortic dissection or surgery, and 43 HV underwent a non-contrast-enhanced 4D flow CMR. Aortic stiffness was quantified at the AAo and DAo using pulse wave velocity (PWV). In-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) (5) and local aortic diameters were obtained at 20 equidistant planes from the ascending (AAo) to the proximal descending aorta (DAo).

RESULTS

LDS patients had lower IRF at the distal AAo and proximal DAo compared to HV (p = 0.053 and 0.004, respectively), once adjusted for age, stroke volume and local aortic diameter; but no differences were found with respect to MFS (Figure). Although SFRR at the proximal DAo was increased in LDS patients compared to both HV (p = 0.037) and MFS populations (p = 0.015), once adjusted for age and aortic diameter, the difference in magnitude was small (Figure). On the other hand, AAo and DAo PWV revealed stiffer aortas in LDS patients compared to HV but no differences versus MFS patients (Table).

CONCLUSIONS

Patients with Loeys-Dietz syndrome showed decreased in-plane rotational flow and abnormally-high regional aortic stiffness compared to healthy controls, and similar hemodynamics and aortic stiffness with respect to patients with Marfan syndrome.
Feasibility and prognostic value of adenosine stress perfusion cardiovascular magnetic resonance in patient with implantable device
Authors: Pavon A , Porretta AP , Arangalage D , Rutz T , Hugelshofer S , Domenichini G , Pruvot E , Muller O , Monney P , Pascale P , Schwitter J
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

stress CMR has a limited use in patients with implantable device, in order to the possible artefacts due to the metallic component and to the risk of adenosine interaction with cardiac pacing. The aim of the study was to assess the global feasibility and to assess the prognostic value of stress perfusion CMR in patients with implantable device.

Materials and Methods

we conducted a retrospective single-center longitudinal analysis of consecutive patients with an implantable device referred for stress CMR, performed using a 1.5 Tesla unit (Siemens Healthcare,MAGNETOM Aera, Erlangen-Germany). Protocol was adapted according to current guidelines. Cardiac follow-up [6 months to 7 years] was obtained by medical records of direct contact with patient’s cardiologist referral. 

Results

44 patients were enrolled. 34 patients needed a continuous pacing during adenosine stress, that was settled in DOO in 14 (32%) and in VOO in 20 (45%). Device integrity was not compromised by CMR and not competitive atrial or ventricular stimulation was observed during examination. Image quality was good in 95% cases. 26% cases had a perfusion deficit corresponding to a previous scar, while 12% of patients had a positive stress test. All of them needed continuous pacing during stress test and underwent to a coronary angiography who confirmed the coronary stenosis.  In patients without inducible ischemia 2 patients experienced a Non-ST-elevation Myocardial Infarction after 6 and 2 years while no other cardiac symptoms or cardiac hospitalisation was remarkable during follow up.

Conclusion

adenosine stress CMR in patient who are pacemaker dependent during scanner is feasible, with an overall good image quality, proving an excellent diagnostic and prognostic value in a long term follow up even. Adenosine administration is safe and no the magnetic field interference with the correct functioning of the device have been shown in short or long term follow-up.
Microstructural characteristics of chronic infarct segments assessed using diffusion tensor imaging
Authors: Das A , Kelly C , Teh I , Stoeck C , Kozerke S , Chowdhary A , Jex N , Thiranavukarasu S , Sharrack N , Ben-Arzi H , Aldred M , Greenwood JP , Plein S , Schneider JE , Dallarmellina E
Published: July 2021

Funding Acknowledgements

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

Background

The microstructural changes following myocardial infarction (MI) can be characterised in-vivo with cardiac diffusion tensor imaging (cDTI) imaging, using mean diffusivity (MD), fractional anisotropy (FA), secondary eigenvector angle (E2A) and helix angle (HA) maps. In this study, we use cDTI to explore the microstructural differences between subendocardial and transmural chronic infarct segments.

Method

Twenty STEMI patients (15 men, 5 women, mean age 59) underwent 3T CMR scan at 3 months following presentation (mean interval 107 ± 18 days). Scan protocol included: second order motion compensated (M012) free-breathing spin echo DTI (3 slices, 18 diffusion directions at b-values 100s/mm2[3], 200s/mm2[3] and 500s/mm2[12], acquired resolution was 2.20x2.27x8mm3; cine gradient echo and LGE imaging. Average MD, FA, E2A and HA parameters were calculated on a 16-AHA-segmental level. HA maps were described by dividing values into left-handed HA (LHM, -90° < HA < -30°), circumferential HA (CM, -30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) and reported as relative proportions. Infarct segments were identified using LGE; patients were categorised according to the maximal transmurality of their infarct segments, into subendocardial (<50% LGE) or transmural (>50% LGE) MI.

Results

DTI acquisition was successful in all patients (acquisition time 13 ± 5mins). Ten patients had transmural MI. The results are shown in table 1. Transmurally infarcted segments had significantly lower FA (FA subendocardial MI = 0.27 ± 0.04, FA transmural MI = 0.23 ± 0.02, p < 0.01), lower E2A (E2A subendocardial MI = 47 ± 7°, E2A transmural MI = 38 ± 6°, p < 0.01) and lower proportions of right-handed cardiomyocytes (RHM subendocardial MI = 21 ± 5%, RHM transmural MI = 14 ± 5%, p < 0.01) than subendocardial infarct segments. 

Conclusion

Compared to subendocardial MI segments, the diffusion of water molecules is more isotropic in transmurally infarcted myocardium as evidenced by lower FA values, signifying increased structural disarray. The significantly lower E2A values suggest that laminar sheetlets of transmural infarct segments remain fixed at shallower angles during systole and are unable to reach their usual contractile configuration. The lower proportions of RHM on HA maps highlight the significantly greater loss of subendocardial cardiomyocytes in transmural infarct segments. Further studies are required to assess if these segmental changes can be predictive of long-term LV remodelling.
Left ventricular four-dimensional blood flow energetics and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus
Authors: Demirkiran A , Hassell M ECJ , Garg P , Elbaz M SM , Delewi R , Greenwood JP , Piek JJ , Plein S , Van Der Geest RJ , Nijveldt R
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation [FS/10/62/28409] and Dutch ZonMw [104003001].

Background

Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls.

Methods

In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n= 9 and MI-LVT(-), n= 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak KE values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape).

Results

The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p < 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean vorticity at the basal level was significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p < 0.01). The vortex ring core during E-wave in MI-LVT(-) group was located closer to the mitral annulus and in a less tilted orientation to the LV compared to MI-LVT(+) group (p = 0.05, p < 0.01, respectively).

Conclusion

Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate these initial observations.
RV function by cardiac magnetic resonance and its relationship with neutrophil/lymphocyte ratio in patients with acute inferior STEMI undergoing PPCI
Authors: Taha S , Kelany SH , D"ascenzo F , Hasan-Ali H , Ghzally Y , Abdel-Ghany M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) carries an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI.Cardiac Magnetic resonance (CMR) is ideal for assessing the RV because it allows a comprehensive assessment of cardiovascular morphology and physiology without most of the limitations that hinder alternative imaging modalities.

Objectives

To evaluate the sensitivity of other parameters;the neutrophil/ lymphocyte ratio (NLR) and RV function using 2D speckle tracking echo compared to (CMR) among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PPCI).

Methodology

 40 Patients with inferior MI who had PPCI were included in the study; two groups were highlighted according to the CMR derived RVEF RV dysfunction (RVD and non-RVD). NLR  and 2D speckle tracking echo were done in comparison to RVEF.

Results

out of the 40 patients, 18 (45%) patients had RVD. ST segment elevation in the right leads was significantly higher (P-value =0.03) in patients with RV dysfunction (55.6%) in comparison with patients (22.7%) who had no RV dysfunction.When comparing groups according to the complications, heart block was significantly higher in patients with RV dysfunction (P-value= 0.008) as it occurred in 5 (27.8%) patients.Echocardiography was done for all patients, and it was found that fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (P-value =0.03). RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of -19.5 ±3.9 % in the RV dysfunction group P value 0.008.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 ± 15.8) ml and (35.4 ± 6.9) % respectively, with large RV systolic volume, with the highly statistically significant difference in comparison to the other group (p value = 0.000). Mean N/L ratio was higher (7.3 ± 5.2 (10^3/uL)) in the group with RV dysfunction compared to (6.4 ± 4.1(10^3/uL)) in the group with non RV dysfunction group. N/L ratio for predicting RV dysfunction by CMR had a cutoff value of >7.7 with low sensitivity (38.89%) and high specificity (77.27 %), while LS for predicting RV dysfunction by CMR had both high sensitivity (83.33%) and high specificity (63.64%) with P-value =0.005.

Conclusion

Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting  RVD when measured by cardiac MRI.
Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse
Authors: Pavon A , Arangalage D , Hugelshofer S , Rutz T , Porretta AP , Le Bloa M , Muller O , Pruvot E , Schwitter J , Monney P
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Background

In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events

Methods

Thirty patients with MVP and MAD (MVP-MAD) underwent Cardiac Magnetic Resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECV). The control group included 14 patients with mitral regurgitation but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24h-Holter monitoring.

Results

LGE was observed in 47% of MVP-MAD patients and absent in controls. ECV was higher in MVP-MAD (30 ± 3% vs 24 ± 3% MR-NoMAD, p < 0.0001 and vs 24 ± 2% NoMR-NoMAD, p < 0.0001), even in MVP-MAD patients without LGE (29 ± 3% vs 24 ± 3%, p < 0.0001 and vs 24 ± 2%, p < 0.0001, respectively), Fig.1. MAD length was correlated with ECV (rho = 0.61, p = 0.0003), but not with LGE extent. Four patients had history of OHCA; LGE and ECV were equally performant to identify those high-risk patients (area under the ROC curve 0.81 vs 0.83, p = 0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECV was above the cut-off value in all while only 53% had LGE.

Conclusion

Increase in ECV, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and OHCA. ECV should be part of the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.
Aortic regurgitation and left ventricle remodeling in cardiac magnetic resonance and transthoracic echocardiography
Authors: Haberka M , Balys M , Gasior Z
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Medical University of SIlesia

Background

Transthoracic echocardiography (TTE) is the main imaging modality used to assess patients with chronic aortic regurgitation (AR). However, it is not possible to provide a precise quantification in all patients. Our aim was to compare TTE and cardiovascular magnetic resonance (CMR) measurements in grading AR and left ventricle (LV) remodeling.

Methods

A total of 51 consecutive patients with isolated AR in TTE were enrolled into the study and finally forty nine individuals (age: 57.1 (14); 61% males) underwent a non-contrast CMR (2 pts excluded for CMR contraindications). AR severity grading and LV remodeling were assessed according to the current ASE guidelines, including a semi-quantitative and quantitative parameters. All CMR studies were obtained on ecg-gated cine images acquired on 1.5T system (GE Optima MR450w, GE Healthcare, Wisconsin, USA) with a dedicated cardiac coil using a non-contrast protocol, including a quantitative approach (phase-contrast velocity  encoded imaging).

Results

Most of the study patients showed mild symptoms (NYHA I/II/III – 55%/38%/7%; CCS 0/I/II/III/IV – 79%/2%/12%/6%) and typical cardiovascular risk factors: hypertension (83%), dyslipidemia (91%), diabetes (12%) and obesity (16%). Twenty patients (40%) showed combined AV disease and 14 patients (28,5%) had a bicuspid AV. The AR jets were central (53%) or eccentric (47%) and multiple in 7 cases (14%). The inter-modality agreement (TTE-CMR) in AR grading was high in mild AR (91%) and low in mild-to-moderate (12%), moderate-to-severe (10%) and severe (20%) AR. The comprehensive quantitative grading with AR volume (AR vol) and regurgitant fraction (RF) were measurable in TTE in 24 cases and showed a significant association with CMR parameters (AR vol: r = 0.75; p < 0.001 and RF: r = 0.55; p < 0.01). Moreover, CMR revealed significantly larger LV end-diastolic volumes (EDV) (185,5 ± 61ml vs 158,4 ± 61ml; p = 0.03) and a trend towards higher left ventricle ejection fraction (59 ± 8 vs 56 ± 8%; p = 0.08). The association of AR vol and LV EDV was stronger in CMR (r = 0.85; p < 0.0001) compared to TTE (r = 0.6; p = 0.001).

Conclusions

CMR provides a comprehensive assessment of AR severity and LV remodeling with a moderate agreement with TTE.
Cardiac magnetic resonance in COVID-19 positive and probable cases: A report from a high volume CMR centre in Ireland
Authors: James SI , Fallon A , Waterhouse DF , O" Hanlon R
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Coronavirus disease 2019 (COVID-19) infection can have multisystem involvements. The inflammation sequelae can cause myocarditis. The COVID-19 pandemic has impacted Ireland significantly. Understanding of myocardial involvement in COVID-19 is not fully elucidated but has been reported. The Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic in Ireland is a high volume CMR centre with approximately 4500 cases per year and accepting referral from all hospital in Ireland. These analyses are to describe the CMR findings in COVID-19 positive and probable cases attending the centre.

Methods

Consecutive 65 referrals with mention of "COVID-19" from March 2020 to December 2020 was assessed. 56 cases were included in this analysis. Cases were categorised as COVID-19 positive cases or probable (viral illness like symptoms) cases. The demography and CMR parameters were collected. Serial imaging of selected cases was included. Descriptive analyses methods were applied.

Results

In the period of 10 months, there was 49 COVID-19 positive cases (65.3% male; median age 49 [32 : 61] years) and 7 COVID-19 probable cases (42.9% male; median age 39 [37 : 59] years). In the COVID-19 positive cases, 25 had normal CMR, 11 has evidence of myocarditis, 1 with pericarditis, 2 with infarction/ischaemia, 3 with dilated cardiomyopathy, 2 with hypertrophic cardiomyopathy and 5 with other findings. There were 3 COVID-19 positive cases with serial imaging showing resolving myocarditis (100% female; median age 41 [30 : 47] years). 2 professional athletes with COVID-19 positive test showed no evidence of myocarditis. There are no significant differences in the age of male COVID-19 positive versus female group (p= 0.0752). Different demography and CMR parameters and tissue characterisation are described in Table 1 and Table 2.

Conclusions

The prevalence of myocarditis in this cohort is approximately 1 in 5 (21.4%). Within the COVID-19 positive cases, the prevalence is 22.4%. These observations may reflect selection bias for CMR referral in those with cardiac symptoms or cardiac enzymes leak.
Cardiac injury after 4 months of coronavirus infection disease 2019 in mildly symptomatic patients
Authors: Rajewska-Tabor J , Elikowski W , Janus M , Rozmiarek S , Lesiak M , Pyda M
Published: July 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular involvement during SARS-CoV-2 infection has been described previously in hospitalized patients mainly. The percentage of patients vulnerable after coronavirus infection disease 2019 (COVID-19) is still being under discussion. What remains unknown is the impact of coronary virus on heart on mildly symptomatic patients. 

Aim of the study

The aim of the study was to evaluate cardiac injury 4 months after COVID-19 in mildly symptomatic patients.

Material and methods

80 patients successfully cured from COVID-19 were evaluated between 3-4 months after the disease. The study group consisted of 30 males (37.5%) and 50 females (62.5%) with the mean (SD) age 45 (11) years. All patients had laboratory tests, electrocardiogram (ECG) and cardiac magnetic resonance (CMR) done. Cardiac magnetic resonance was performed on 1,5T scanner (Aera, Siemens, Germany). During the CMR study cine imagines, T2-mapping, T1-mapping before and after gadolinium, extracellular volume (ECV) assumption and late gadolinium enhancement were done. Additionally global longitudinal strain was examined. Dedicated software (QMass, Medis, Holland) was used.

Results

During SARS-CoV-2 infection 31 patients (39%) had comorbidities, 16 patients (20%) were hospitalized for 3-5 days. 64 (80%) recovered at home, from whom 10 (12.5%) were asymptomatic. At the time of CMR, high-sensitivity troponin I (hs TnI) was in the normal range in all subjects, while 8 (10%) subjects showed slightly elevated NT pro-BNP and 11 (14%) subjects showed elevated D-dimers. Based on myocardial injury detected during CMR the patients were divided into 2 groups. CMR examination showed myocardial injury in 34 (42.5%) patients. The patients with myocardial injury had significant higher native T1 (1011ms in injured group vs 967ms in group without injury; p = 0.006) and ECV (29.5% vs 27% respectively; p = 0.003). NT pro-BNP levels were elevated in 9 patients with myocardial injury on CMR. None of the patients without myocardial injury had NT pro-BNP elevated (p = 0.007).

Conclusions

This study indicates that even in mildly symptomatic patients there are occurrences of myocardial injury. The cardiac magnetic resonance is a useful tool for diagnosing myocardial injury after COVID-19.
Stress cardiovascular magnetic resonance and mortality in a registry of 2496 elderly patients with chronic coronary syndrome. Prognosis and decision-making
Authors: Bonanad Lozano C , Gabaldon-Perez A , Garcia-Blas S , Gavara J , Rios-Navarro C , Perez-Sole N , De Dios E , Marcos-Garces V , Merenciano-Gonzalez H , Monmeneu-Menadas JV , Lopez-Lereu MP , Nunez J , Chorro FJ , Bodi V
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Fondo Europeo de Desarrollo Regional (FEDER)

Introduction and objectives. Management of the elderly with chronic coronary syndrome (CCS) is challenging. We explore the prognostic value and the usefulness for decision-making of the ischemic burden determined by vasodilator stress cardiac magnetic resonance (CMR) imaging in elderly patients with known or suspected CCS.

Methods. The study group was made up of 2496 patients older than 70 years submitted to vasodilator stress CMR for known or suspected CCS. The ischemic burden (number of segments with stress-induced perfusion deficit) was calculated following the 17-segment model. Its association with all-cause mortality and the effect of CMR-guided revascularization were analyzed retrospectively.

Results. During a median follow-up of 4.58 years, 430 deaths (17.2%) were recorded. A larger ischemic burden was an independent predictor of mortality: hazard ratio [95% confidence intervals]: 1.04 [1.01-1.07] for each additional ischemic segment, p = 0.006). This association also occurred in patients over 80 years of age and in women (p < 0.001). Compared to non-revascularized patients, revascularization associated with worse outcomes at low ischemic burden and exerted protective prognostic effect in patients with extensive ischemia both in the whole group (p for interaction = 0.003) and in 496 patients matched 1:1 by a propensity score (p = 0.06).

Conclusions. Vasodilator stress CMR represents a valuable tool to stratify risk in elderly patients with CCS and might be helpful to guide decision-making in this scenario.
Determinants of quality of life in acute heart failure patients with and without comorbidities: a prospective, observational study
Authors: van den Berge Jan C , van Vark Laura C , Postmus Douwe , Utens Elisabeth M W J , Hillege Hans L , Boersma Eric , Lesman-Leegte Ivonne , Akkerhuis K Martijn
Published: July 2021

Aims

The relation between non-cardiac comorbidities and health-related quality of life (HRQoL) in patients with heart failure (HF) has been studied to a limited extent. To investigate the HRQoL and their determinants among HF patients with and without comorbidities.

Methods and results

TRIUMPH (TRanslational Initiative on Unique and novel strategies for Management of Patients with Heart failure) is a Dutch prospective, multicentre study enrolling 496 acute HF patients between 2009 and 2014. We included 334 patients who had completed the HRQoL questionnaires at baseline. The HRQoL was measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ) en EuroQuality-of-life five Dimensions (EQ-5D). Comorbidity was defined as having a history of at least one of the following comorbidities: chronic kidney disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and/or cerebrovascular accident. Patients with comorbidity (n = 205, 61%) had lower scores on the physical limitation scale and clinical summary score of the KCCQ (P = 0.03 and P = 0.01, respectively). Female sex, COPD, previous HF, increasing body mass index (BMI), elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP), high systolic blood pressure, and the presence of anxiety and/or depression negatively influenced the HRQoL among HF patients with comorbidity. Besides anxiety and depression, we hardly found any other determinant of HRQoL in patients without comorbidity.

Conclusion

Heart failure patients without comorbidity had better HRQoL than patients with comorbidity. Sex, previous HF, BMI, COPD, systolic blood pressure, NT-proBNP levels, and also anxiety and depression were determinants of HRQoL in patients with comorbidity. In those without comorbidity, apart from anxiety and depression, no further determinants of HRQoL were found.
Insights from the first genome assembly of Onion (Allium cepa)
Authors: Finkers Richard , van Kaauwen Martijn , Ament Kai , Burger-Meijer Karin , Egging Raymond , Huits Henk , Kodde Linda , Kroon Laurens , Shigyo Masayoshi , Sato Shusei , Vosman Ben , van Workum Wilbert , Scholten Olga
Published: July 2021

Onion is an important vegetable crop with an estimated genome size of 16 Gb. We describe the de novo assembly and ab initio annotation of the genome of a doubled haploid onion line DHCU066619, which resulted in a final assembly of 14.9 Gb with an N50 of 464 Kb. Of this, 2.4 Gb was ordered into eight pseudomolecules using four genetic linkage maps. The remainder of the genome is available in 89.6 K scaffolds. Only 72.4% of the genome could be identified as repetitive sequences and consist, to a large extent, of (retro) transposons. In addition, an estimated 20% of the putative (retro) transposons had accumulated a large number of mutations, hampering their identification, but facilitating their assembly. These elements are probably already quite old. The ab initio gene prediction indicated 540,925 putative gene models, which is far more than expected, possibly due to the presence of pseudogenes. Of these models, 47,066 showed RNASeq support. No gene rich regions were found, genes are uniformly distributed over the genome. Analysis of synteny with Allium sativum (garlic) showed collinearity but also major rearrangements between both species. This assembly is the first high-quality genome sequence available for the study of onion and will be a valuable resource for further research.
Noncanonical outcomes of break-induced replication produce complex, extremely long-tract gene conversion events in yeast
Authors: Stewart Joseph A , Hillegass Michael B , Oberlitner Joseph H , Younkin Ellen M , Wasserman Beth F , Casper Anne M
Published: July 2021

Long-tract gene conversions (LTGC) can result from the repair of collapsed replication forks, and several mechanisms have been proposed to explain how the repair process produces this outcome. We studied LTGC events produced from repair collapsed forks at yeast fragile site FS2. Our analysis included chromosome sizing by contour-clamped homogeneous electric field electrophoresis, next-generation whole-genome sequencing, and Sanger sequencing across repair event junctions. We compared the sequence and structure of LTGC events in our cells to the expected qualities of LTGC events generated by proposed mechanisms. Our evidence indicates that some LTGC events arise from half-crossover during BIR, some LTGC events arise from gap repair, and some LTGC events can be explained by either gap repair or “late” template switch during BIR. Also based on our data, we propose that models of collapsed replication forks be revised to show not a one-end double-strand break (DSB), but rather a two-end DSB in which the ends are separated in time and subject to gap repair.
The whole-genome sequence of the novel yeast species Metschnikowia persimmonesis isolated from medicinal plant Diospyros kaki Thunb
Authors: Rahmat Endang , Park Inkyu , Kang Youngmin
Published: July 2021

The new yeast Metschnikowia persimmonesis KCTC 12991BP (KIOM G15050 strain) exhibits strong antimicrobial activity against some pathogens. This activity may be related to the medicinal profile of secondary metabolites that could be found in the genome of this species. Therefore, to explore its future possibility of producing some beneficial activities, including medicinal ability, we report high-quality whole-genome assembly of M. persimmonesis produced by PacBio RS II sequencer. The final draft assembly consisted of 16 scaffolds with GC content of 45.90% and comprised a fairly complete set (82.8%) of BUSCO result using Saccharomycetales lineage data set. The total length of the genome was 16.473 Mb, with a scaffold N50 of 1.982 Mb. Annotation of the M. persimmonesis genome revealed presence of 7029 genes and 6939 functionally annotated proteins. Based on the analysis of phylogenetic relationship and the average nucleotide identities, M. persimmonesis was proved to a novel species within the Metschnikowia genus. This finding is expected to significantly contribute to the discovery of high-value natural products from M. persimmonesis as well as for genome biology and evolution comparative analysis within Metschnikowia species.