bluuebunny/crossref_metadata_2025_split huggingface dataset:
Septal late gadolinium enhancement on Cardiac MRI predicts failure to achieve left bundle pacing
Authors: Ali NADINE , Arnold AD , Miyazawa AA , Keene D , Peters NS , Kanagaratnam P , Qureshi N , Ng FS , Linton N , Lefroy D , Francis D , Lim PB , Whinnett ZI , Kellman P , Cole GD 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
Background; Left bundle area pacing is a novel technique that provides direct stimulation of cardiac conduction tissue in order to deliver physiological ventricular activation. The approach for left bundle area pacing is transseptal lead implantation, where the lead is advanced from the right ventricular side of the septum to the left ventricular side to capture the proximal left bundle. Observational data suggests that whilst this is a safe and feasible method, implant success rate is not 100%, and appears to be lower in patients with a cardiac resynchronization therapy (CRT) indication rather than a bradycardia indication for pacing. The mechanisms for failure to advance the lead through the ventricular septum are not well understood.
Purpose; We used pre-procedural CMR to determine whether there are features which can help identify patients where lead implantation may be challenging. We assessed whether the extent and location of septal late gadolinium enhancement identified patients in whom left bundle area pacing will be challenging. We hypothesized that the presence of extensive scar in the septum impedes advancing the lead to the left ventricular septum and prevents capture of the left bundle.
Methods; Patients underwent cardiac MRI including motion corrected free-breathing late gadolinium enhancement imaging1 before implantation. Scar was quantified using the full height half maximum method and expressed as the overall proportion of myocardial mass in the basal anteroseptal and basal inferoseptal segments, as shown in Figure 1. Left bundle area pacing was then attempted in patients with a CRT indication for pacing. We compared the extent of septal scar between patients in whom left bundle area pacing was achieved and those where there was failure to advance the lead deep into the septum.
Results; 12 patients (11 male, 1 female), with average age 72 (IQR 63 to 78) and LVEF 30% (IQR 26 to 33) were studied. There was failure to advance the lead deep into the septum in 4 patients. There was a significantly higher basal septal scar burden in those patients where there was failure to advance the left bundle lead compared to those in which left bundle capture was achieved as shown in Figure 2 (median 55% and 5% respectively, p-value 0.02 by Wilcoxon signed rank test).
Conclusion; The presence and extent of late gadolinium enhancement in the basal septum appears to be an important determinant of successful implantation of left bundle pacing lead using current implant technology. This may be because extensive septal scar prevents advancement of the pacing lead through the septum. Cardiac MRI before left bundle area pacing is likely to be useful in procedural planning.
Myocardial T2 values by a segmental approach with healthy ageing and gender
Authors: Pepe A , Martini N , Positano V , D"angelo G , Barison A , Todiere G , Grigoratos C , Keilberg P , Pistoia L , Gargani L , Ripoli A , Meloni A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. No data are available in literature about normal ranges for T2 in human myocardium using GE scanners.
Aims. Our aims were to obtain myocardial regional and global T2 values as a reference for normality for the first time using a GE scanner and to assess their association with physiological variables.
Methods. A stratified approach was adopted for healthy volunteers recruitment, ensuring the presence of 10 participants for both genders in each age decile: 20–30, 30–40, 40-50, 50-60, 60-70 years. Basal, medium, and apical short-axis slices of the left ventricle were acquired by a multi-echo fast-spin-echo (MEFSE) sequence. Image analysis was performed with a commercially available software package. T2 value was assessed in all 16 myocardial segments and global value was the mean.
Results. The global T2 value averaged across all subjects was 52.2 ± 2.5 ms (range: 47.0-59.9 ms).
Inter-study, intra-observer, and inter-observer reproducibility was good (coefficient of variation &lt; 5%).
The 3.6% of segments was excluded because of artifacts and/or partial-volume effects. Segmental T2 values differed significantly (P &lt; 0.0001), with the lowest value in the basal anterolateral segment (50.0 ± 3.5 ms) and the highest in the apical lateral segment (54.9 ± 5.1 ms). Mean T2 was significantly lower in the basal slice compared to both medium (51.0 ± 2.4 vs 51.8 ± 2.6 ms; P &lt; 0.0001) and apical slices (51.0 ± 2.4 vs 54.2 ± 3.7 ms; P &lt; 0.0001), and in the medium slice than in the apical slice (51.8 ± 2.6 vs 54.2 ± 3.7 ms; P &lt; 0.0001).
Aging was associated with increased segmental and global T2 values. Females showed higher T2 values than males. T2 values were not correlated to heart rate.
Mean T2 values, standard deviation, and lower and upper limits of normal for all 16 myocardial segments are shown in Figure 1 for males and in Figure 2 for females, considering separately each age group.
Conclusion. The optimized MEFSE sequence allows for robust, reliable, and reproducible quantification of segmental T2 values. T2 values differ among myocardial slices and are influenced by age and gender, making mandatory to define gender- and age-specific segmental reference values for distinguishing between healthy and diseased myocardium. The normal ranges defined in this study on a large cohort of healthy subjects could be used as reference by other sites using the same sequence, allowing them to recruit a smaller population and accelerating the spread of myocardial T2 mapping in the clinical arena.
Influence of cardiac phase on myocardial native T1 values by a segmental approach
Authors: Pepe A , Martini N , Positano V , D"angelo G , Barison A , Todiere G , Grigoratos C , Barra V , Pistoia L , Gargani L , Ripoli A , Meloni A 
Published: July 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Native T1 values are usually assessed in the end-diastole to minimize motion artifacts while the systolic data acquisition offers the advantage of a thicker myocardium, with reduced partial-volume effects. Higher myocardial T1 values have been detected in diastole at both 1.5T and 3T but the dependence of this difference on myocardial segments or gender has not been fully explored.
Aim. We provided a systematic comparison of myocardial native T1 values in diastole and systole, by considering separately myocardial segments and dividing males and females.
Methods. Sixty-one healthy subjects (46.0 ± 14.1 years, 32 males) underwent CMR at 1.5T (Signa Artist; GE Healthcare). Three short-axis slices of the left ventricle acquired in diastole and systole using a Modified Look–Locker Inversion Recovery sequence. Image analysis was performed with a commercially available software package. T1 value was assessed in all 16 myocardial segments and global value was the mean.
Results. Table 1 shows the comparison between T1 values calculated from maps obtained in diastole and systole. Systolic T1 values were significantly lower in the basal anterolateral segment, in all medium segments except for the medium inferior segment, and in all apical segments. The percentage difference between diastolic and systolic T1 values was considered to compensate for the higher T1 values in females, and a significantly higher value was detected in females for the majority of medium segments, for all apical segments, and for the global value.
Conclusion. The diastolic-systolic discrepancy was more pronounced for the females and at the apical level, supporting the hypothesis that, besides the physiologic variations in myocardial blood volume during the cardiac cycle, the partial volume-effect may be a strong additional contributing factor. Native T1 values should be obtained always in the same cardiac phase to avoid a potential bias in the discrimination between healthy and pathologically affected myocardium.
Fully automated CMR derived stroke volume correlates with right heart catheter measurements in patients with suspected pulmonary hypertension
Authors: Alabed S , Karunasaagarar K , Alandejani F , Garg P , Uthoff J , Metherall P , Sharkey M , Lu H , Wild JM , Kiely DG , Van Der Geest RJ , Swift AJ 
Published: July 2021

Abstract

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

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

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

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

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

Abstract

Funding Acknowledgements
Type of funding sources: None.

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

Methods

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

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

Conclusion

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

Abstract

Funding Acknowledgements
Type of funding sources: None.
Diastolic function assessed my CMR feature tracking is a predictor for outcomes in patients with suspected myocarditis and preserved left ventricular ejection fraction

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

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

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

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

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

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

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

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): 1. Tehran University of Medical Sciences 2. Iran University of Medical Sciences
Assessment of early cardiotoxic adverse effects of Doxorubicin-containing regimens in breast cancer patients.

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

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

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

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

Conclusion
We demonstrated a significant difference in ventricular ejection fraction and global strain values early after Doxorubicin chemotherapy. Exclusive CMR parameters can aid in the early initiation of preventive cardiac strategies.