Pubblicazioni recenti - cardiac mri
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Obesity blunts amelioration of cardiac hypertrophy and fibrosis by human mesenchymal stem/stromal cell-derived extracellular vesicles.
Am J Physiol Heart Circ Physiol2023 Jun;():. doi: 10.1152/ajpheart.00676.2022.
Hong Siting, Huang Weijun, Zhu Xiangyang, Tang Hui, Krier James D, Xing Li, Lu Bo, Gandhi Deep, Jordan Kyra L, Saadiq Ishran M, Lerman Amir, Eirin Alfonso, Lerman Lilach O,
Abstract
Renovascular hypertension (RVH) can induce cardiac damage that is reversible using adipose tissue-derived mesenchymal stromal/stem cells (A-MSC). However, A-MSCs isolated from obese patients are less effective than lean-A-MSC in blunting hypertensive cardiomyopathy in mice with RVH. We tested the hypothesis that this impairment extends to their obese-A-MSC-extracellular vesicles (EVs) progeny. MSCs were harvested from the subcutaneous fat of obese and lean human subjects, and their EVs were collected and injected into the aorta of mice two weeks after renal artery stenosis or sham surgery. Cardiac left ventricular (LV) function was studied with MRI two weeks later, and myocardial tissue ex-vivo. Blood pressure, LV myocardial wall thickness, mass, and fibrosis that were elevated in RVH mice were suppressed only by lean-EVs. Hence, human A-MSC-derived lean-EVs are more effective than obese-EVs in blunting hypertensive cardiac injury in RVH mice. These observations highlight impaired paracrine repair potency of endogenous MSC in obese patients.
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Automated inversion time selection for black-blood late gadolinium enhancement cardiac imaging in clinical practice.
MAGMA2023 Jun;():. doi: 10.1007/s10334-023-01101-2.
Maillot Aurélien, Sridi Soumaya, Pineau Xavier, André-Billeau Amandine, Hosteins Stéphanie, Maes Jean-David, Montier Géraldine, Nuñez-Garcia Marta, Quesson Bruno, Sermesant Maxime, Cochet Hubert, Stuber Matthias, Bustin Aurélien,
Abstract
OBJECTIVE:
To simplify black-blood late gadolinium enhancement (BL-LGE) cardiac imaging in clinical practice using an image-based algorithm for automated inversion time (TI) selection.
MATERIALS AND METHODS:
The algorithm selects from BL-LGE TI scout images, the TI corresponding to the image with the highest number of sub-threshold pixels within a region of interest (ROI) encompassing the blood-pool and myocardium. The threshold value corresponds to the most recurrent pixel intensity of all scout images within the ROI. ROI dimensions were optimized in 40 patients' scans. The algorithm was validated retrospectively (80 patients) versus two experts and tested prospectively (5 patients) on a 1.5 T clinical scanner.
RESULTS:
Automated TI selection took?~?40 ms per dataset (manual:?~?17 s). Fleiss' kappa coefficient for automated-manual, intra-observer and inter-observer agreements were [Formula: see text]= 0.73, [Formula: see text] = 0.70 and [Formula: see text] = 0.63, respectively. The agreement between the algorithm and any expert was better than the agreement between the two experts or between two selections of one expert.
DISCUSSION:
Thanks to its good performance and simplicity of implementation, the proposed algorithm is a good candidate for automated BL-LGE imaging in clinical practice.
© 2023. The Author(s).
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Automatic right ventricular segmentation for cine cardiac magnetic resonance images based on a new deep atlas network.
Med Phys2023 Jun;():. doi: 10.1002/mp.16547.
Wang Lijia, Su Hanlu, Liu Peng,
Abstract
BACKGROUND:
The high morbidity and mortality of heart disease present a significant threat to human health. The development of methods for the quick and accurate diagnosis of heart diseases, enabling their effective treatment, has become a key issue of concern. Right ventricular (RV) segmentation from cine cardiac magnetic resonance (CMR) images plays a significant role in evaluating cardiac function for clinical diagnosis and prognosis. However, due to the complex structure of the RV, traditional segmentation methods are ineffective for RV segmentation.
PURPOSE:
In this paper, we propose a new deep atlas network to improve the learning efficiency and segmentation accuracy of a deep learning network by integrating multi-atlas.
METHODS:
First, a dense multi-scale U-net (DMU-net) is presented to acquire transformation parameters from atlas images to target images. The transformation parameters map the atlas image labels to the target image labels. Second, using a spatial transformation layer, the atlas images are deformed based on these parameters. Finally, the network is optimized by backpropagation with two loss functions where the mean squared error function (MSE) is used to measure the similarity of the input images and transformed images. Further, the Dice metric (DM) is used to quantify the overlap between the predicted contours and the ground truth. In our experiments, 15 datasets are used in testing, and 20 cine CMR images are selected as atlas.
RESULTS:
The mean values and standard deviations for the DM and Hausdorff distance are 0.871 and 4.67 mm, 0.104 and 2.528 mm, respectively. The correlation coefficients of endo-diastolic volume, endo-systolic volume, ejection fraction, and stroke volume are 0.984, 0.926, 0.980, and 0.991, respectively, and the mean differences between all of the mentioned parameters are 3.2, -1.7, 0.02, and 4.9, respectively. Most of these differences are within the allowable range of 95%, indicating that the results are acceptable and show good consistency. The segmentation results obtained in this method are compared with those obtained by other methods that provide satisfactory performance. The other methods provide better segmentation effects at the base, but either no segmentation or the wrong segmentation at the top, which demonstrate that the deep atlas network can improve top-area segmentation accuracy.
CONCLUSION:
Our results indicate that the proposed method can achieve better segmentation results than the previous methods, with both high relevance and consistency, and has the potential for clinical application.
© 2023 American Association of Physicists in Medicine.
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Case report: Multimodality imaging revealing ruptured giant coronary artery aneurysm presenting with hemoptysis.
Front Cardiovasc Med2023 ;10():1185089. doi: 1185089.
Gong Xiangfeng, Zhang Hongwei, Peng Wanlin, Yang Gang, Xiao Zhenghua,
Abstract
Giant coronary artery aneurysm (CAA) is a relatively uncommon disease that is defined by a focal dilation of at least 20?mm and characterized by various clinical symptoms. However, cases presenting primarily with hemoptysis have not been reported. A man in his late 20?s suffering from persistent chest pain for over 2 months was transferred to our emergency department for intermittent hemoptysis lasting for 12?h. Bronchoscopy detected fresh blood in the left upper lobe bronchus without a definite bleeding source. Magnetic resonance imaging (MRI) demonstrated a heterogeneous mass and the high-intensity signals suggested active bleeding. coronary computed tomography (CT) angiography demonstrated a giant ruptured CAA wrapped in a large mediastinal mass Coronary angiography confirmed the CAA originating from the left anterior descending artery. The patient underwent an emergency sternotomy and an enormous hematoma arising from a ruptured CAA densely adhering to the left lung was identified. The patient recovered uneventfully and was discharged on the 7th day later. The ruptured CAA masquerading as hemoptysis highlights the indispensability of multimodality imaging for accurate diagnosis. Urgent surgical intervention is desirable in such life-threatening conditions.
© 2023 Gong, Zhang, Peng, Yang and Xiao.
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[Anti-HMGCR immune-mediated necrotizing myopathy: A case report].
Beijing Da Xue Xue Bao Yi Xue Ban2023 Jun;55(3):558-562.
Zhang Y J, Ma J Y, Liu X Y, Zheng D F, Zhang Y S, Li X G, Fan D S,
Abstract
The patient was a 55-year-old man who was admitted to hospital with "progressive myalgia and weakness for 4 months, and exacerbated for 1 month". Four months ago, he presented with persistent shoulder girdle myalgia and elevated creatine kinase (CK) at routine physical examination, which fluctuated from 1 271 to 2 963 U/L after discontinuation of statin treatment. Progressive myalgia and weakness worsened seriously to breath-holding and profuse sweating 1 month ago. The patient was post-operative for renal cancer, had previous diabetes mellitus and coronary artery disease medical history, had a stent implanted by percutaneous coronary intervention and was on long-term medication with aspirin, atorvastatin and metoprolol. Neurological examination showed pressure pain in the scapularis and pelvic girdle muscles, and V- grade muscle strength in the proximal extremities. Strongly positive of anti-HMGCR antibody was detected. Muscle magnetic resonance imaging (MRI) T2-weighted image and short time inversion recovery sequences (STIR) showed high signals in the right vastus lateralis and semimembranosus muscles. There was a small amount of myofibrillar degeneration and necrosis, CD4 positive inflammatory cells around the vessels and among myofibrils, MHC-? infiltration, and multifocal lamellar deposition of C5b9 in non-necrotic myofibrils of the right quadriceps muscle pathological manifestation. According to the clinical manifestation, imageological change, increased CK, blood specific anti-HMGCR antibody and biopsy pathological immune-mediated evidence, the diagnosis of anti-HMGCR immune-mediated necrotizing myopathy was unequivocal. Methylprednisolone was administrated as 48 mg daily orally, and was reduced to medication discontinuation gradually. The patient's complaint of myalgia and breathlessness completely disappeared after 2 weeks, the weakness relief with no residual clinical symptoms 2 months later. Follow-up to date, there was no myalgia or weakness with slightly increasing CK rechecked. The case was a classical anti-HMGCR-IMNM without swallowing difficulties, joint symptoms, rash, lung symptoms, gastrointestinal symptoms, heart failure and Raynaud's phenomenon. The other clinical characters of the disease included CK as mean levels >10 times of upper limit of normal, active myogenic damage in electromyography, predominant edema and steatosis of gluteus and external rotator groups in T2WI and/or STIR at advanced disease phase except axial muscles. The symptoms may occasionally improve with discontinuation of statins, but glucocorticoids are usually required, and other treatments include a variety of immunosuppressive therapies such as methotrexate, rituximab and intravenous gammaglobulin.
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Native T1 high region and left ventricular ejection fraction recovery in patients with dilated cardiomyopathy.
Int J Cardiovasc Imaging2023 Jun;():. doi: 10.1007/s10554-023-02888-w.
Yazaki Mayu, Nabeta Takeru, Takigami Yu, Eda Yuko, Maemura Kenji, Oki Takumi, Fujita Teppei, Iida Yuichiro, Ikeda Yuki, Ishii Shunsuke, Inoue Yusuke, Ako Junya,
Abstract
Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of >?5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of ??45% and an LVEF increase of ??10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P?=?0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P?=?0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM.
© 2023. The Author(s).
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Association of Baseline Metabolomic Profiles With Incident Stroke and Dementia and With Imaging Markers of Cerebral Small Vessel Disease.
Neurology2023 Jun;():. doi: 10.1212/WNL.0000000000207458.
Harshfield Eric L, Markus FMed Sci Hugh S,
Abstract
BACKGROUND AND OBJECTIVES:
Cerebral small vessel disease is a major cause of stroke and dementia. Metabolomics can help identify novel risk factors to better understand pathogenesis and predict disease progression and severity.
METHODS:
We analysed baseline metabolomics profiles from 118,021 UK Biobank participants. We examined cross-sectional associations of 325 metabolites with MRI markers of small vessel disease, evaluated longitudinal associations with incident stroke and dementia, and ascertained causal relationships using Mendelian randomization.
RESULTS:
In cross-sectional analyses, lower levels of apolipoproteins, free cholesterol, cholesteryl esters, fatty acids, lipoprotein particle concentrations, phospholipids, and triglycerides were associated with increased white matter microstructural damage on diffusion tensor MRI. In longitudinal analyses, lipoprotein subclasses of very large HDL were associated with increased risk of stroke, and acetate and 3-hydroxybutyrate were associated with increased risk of dementia. Mendelian randomization analyses identified strong evidence supporting causal relationships for many findings. A few metabolites had consistent associations across multiple analysis types. Increased total lipids in very large HDL and increased HDL particle size were associated with increased white matter damage (Lower FA: OR: 1.44, 95% CI: 1.07-1.95, and OR: 1.19, 95% CI: 1.06-1.34, respectively; MD: OR: 1.49, 95% CI: 1.11-2.01, and OR: 1.24, 95% CI: 1.11-1.40, respectively) and increased risk of incident all stroke (HR: 4.04, 95% CI: 2.13-7.64, and HR: 1.54, 95% CI: 1.20-1.98, respectively) and ischaemic stroke (HR: 3.12, 95% CI: 1.53-6.38; HR: 1.37, 95% CI: 1.04-1.81). Valine was associated with decreased MD (OR: 0.51, 95% CI: 0.30-0.88) and had a protective association with all-cause dementia (HR: 0.008, 95% CI: 0.002-0.035). Cholesterol in small HDL had an inverse association with incident all stroke (HR: 0.17, 95% CI: 0.08-0.39) and ischaemic stroke (HR: 0.19, 95% CI: 0.08-0.46) that was supported by evidence of a causal association with MRI-confirmed lacunar stroke (OR: 0.96, 95% CI: 0.93-0.99).
DISCUSSION:
In this large-scale metabolomics study, we found multiple metabolites associated with stroke, dementia, and MRI markers of small vessel disease. Further studies may help inform development of personalised prediction models and provide insights into mechanistic pathways and future treatment approaches.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
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Molecular Imaging of Myocardial Fibroblast Activation in Patients with Advanced Aortic Stenosis Before Transcatheter Aortic Valve Replacement: A Pilot Study.
J Nucl Med2023 Jun;():. doi: jnumed.122.265147.
Diekmann Johanna, Neuser Jonas, Röhrich Manuel, Derlin Thorsten, Zwadlo Carolin, Koenig Tobias, Weiberg Desiree, Jäckle Felix, Kempf Tibor, Ross Tobias L, Tillmanns Jochen, Thackeray James T, Widder Julian, Haberkorn Uwe, Bauersachs Johann, Bengel Frank M,
Abstract
Using multimodal imaging, we investigated the extent and functional correlates of myocardial fibroblast activation in patients with aortic stenosis (AS) scheduled for transcatheter aortic valve replacement (TAVR). AS may cause myocardial fibrosis, which is associated with disease progression and may limit response to TAVR. Novel radiopharmaceuticals identify upregulation of fibroblast activation protein (FAP) as a cellular substrate of cardiac profibrotic activity. Twenty-three AS patients underwent Ga-FAP inhibitor 46 (Ga-FAPI) PET, cardiac MRI, and echocardiography within 1-3 d before TAVR. Imaging parameters were correlated and then were integrated with clinical and blood biomarkers. Control cohorts of subjects without a history of cardiac disease and with ( = 5) and without ( = 9) arterial hypertension were compared with matched AS subgroups. Myocardial FAP volume varied significantly among AS subjects (range, 1.54-138 cm, mean ± SD, 42.2?±?35.6 cm) and was significantly higher than in controls with (7.42?±?8.56 cm, = 0.007) and without (2.90?±?6.67 cm;
© 2023 by the Society of Nuclear Medicine and Molecular Imaging.
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Imaging Early Life Cardiovascular Phenotype.
Circ Res2023 Jun;132(12):1607-1627. doi: 10.1161/CIRCRESAHA.123.322054.
Varadarajan Vinithra, Gidding Samuel S, Wu Colin, Carr J Jeffrey, Lima Joao A C,
Abstract
The growing epidemics of obesity, hypertension, and diabetes, in addition to worsening environmental factors such as air pollution, water scarcity, and climate change, have fueled the continuously increasing prevalence of cardiovascular diseases (CVDs). This has caused a markedly increasing burden of CVDs that includes mortality and morbidity worldwide. Identification of subclinical CVD before overt symptoms can lead to earlier deployment of preventative pharmacological and nonpharmacologic strategies. In this regard, noninvasive imaging techniques play a significant role in identifying early CVD phenotypes. An armamentarium of imaging techniques including vascular ultrasound, echocardiography, magnetic resonance imaging, computed tomography, noninvasive computed tomography angiography, positron emission tomography, and nuclear imaging, with intrinsic strengths and limitations can be utilized to delineate incipient CVD for both clinical and research purposes. In this article, we review the various imaging modalities used for the evaluation, characterization, and quantification of early subclinical cardiovascular diseases.
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Dynamic lung water MRI during exercise stress.
Magn Reson Med2023 Jun;():. doi: 10.1002/mrm.29716.
Seemann Felicia, Javed Ahsan, Khan Jaffar M, Bruce Christopher G, Chae Rachel, Yildirim Dursun Korel, Potersnak Amanda, Wang Haiyan, Baute Scott, Ramasawmy Rajiv, Lederman Robert J, Campbell-Washburn Adrienne E,
Abstract
PURPOSE:
Exercise-induced dyspnea caused by lung water is an early heart failure symptom. Dynamic lung water quantification during exercise is therefore of interest to detect early stage disease. This study developed a time-resolved 3D MRI method to quantify transient lung water dynamics during rest and exercise stress.
METHODS:
The method was evaluated in 15 healthy subjects and 2 patients with heart failure imaged in transitions between rest and exercise, and in a porcine model of dynamic extravascular lung water accumulation through mitral regurgitation (n?=?5). Time-resolved images were acquired at 0.55T using a continuous 3D stack-of-spirals proton density weighted sequence with 3.5?mm isotropic resolution, and derived using a motion corrected sliding-window reconstruction with 90-s temporal resolution in 20-s increments. A supine MRI-compatible pedal ergometer was used for exercise. Global and regional lung water density (LWD) and percent change in LWD (?LWD) were automatically quantified.
RESULTS:
A ?LWD increase of 3.3?±?1.5% was achieved in the animals. Healthy subjects developed a ?LWD of 7.8?±?5.0% during moderate exercise, peaked at 16?±?6.8% during vigorous exercise, and remained unchanged over 10?min at rest (-1.4?±?3.5%, p?=?0.18). Regional LWD were higher posteriorly compared the anterior lungs (rest: 33?±?3.7% vs 20?±?3.1%, p?0.0001; peak exercise: 36?±?5.5% vs 25?±?4.6%, p?0.0001). Accumulation rates were slower in patients than healthy subjects (2.0?±?0.1%/min vs 2.6?±?0.9%/min, respectively), whereas LWD were similar at rest (28?±?10% and 28?±?2.9%) and peak exercise (?LWD 17?±?10% vs 16?±?6.8%).
CONCLUSION:
Lung water dynamics can be quantified during exercise using continuous 3D MRI and a sliding-window image reconstruction.
Published 2023. This article is a U.S. Government work and is in the public domain in the USA. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
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Prediction of experimental cardiac magnetostimulation thresholds using pig-specific body models.
Magn Reson Med2023 Jun;():. doi: 10.1002/mrm.29717.
Klein Valerie, Davids Mathias, Vendramini Livia, Ferris Natalie G, Schad Lothar R, Sosnovik David E, Nguyen Christopher T, Wald Lawrence L, Guérin Bastien,
Abstract
PURPOSE:
Modern high-amplitude gradient systems can be limited by the International Electrotechnical Commission 60601-2-33 cardiac stimulation (CS) limit, which was set in a conservative manner based on electrode experiments and E-field simulations in uniform ellipsoidal body models. Here, we show that coupled electromagnetic-electrophysiological modeling in detailed body and heart models can predict CS thresholds, suggesting that such modeling might lead to more detailed threshold estimates in humans. Specifically, we compare measured and predicted CS thresholds in eight pigs.
METHODS:
We created individualized porcine body models using MRI (Dixon for the whole body, CINE for the heart) that replicate the anatomy and posture of the animals used in our previous experimental CS study. We model the electric fields induced along cardiac Purkinje and ventricular muscle fibers and predict the electrophysiological response of these fibers, yielding CS threshold predictions in absolute units for each animal. Additionally, we assess the total modeling uncertainty through a variability analysis of the 25 main model parameters.
RESULTS:
Predicted and experimental CS thresholds agree within 19% on average (normalized RMS error), which is smaller than the 27% modeling uncertainty. No significant difference was found between the modeling predictions and experiments (p?0.05, paired t-test).
CONCLUSION:
Predicted thresholds matched the experimental data within the modeling uncertainty, supporting the model validity. We believe that our modeling approach can be applied to study CS thresholds in humans for various gradient coils, body shapes/postures, and waveforms, which is difficult to do experimentally.
© 2023 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
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Cardiovascular Measures of All-Cause Mortality in Duchenne Muscular Dystrophy.
Circ Heart Fail2023 Jun;():e010040. doi: 10.1161/CIRCHEARTFAILURE.122.010040.
Soslow Jonathan H, Xu Meng, Slaughter James C, Crum Kimberly, Kaslow Jacob A, George-Durrett Kristen, Raucci Frank J, Wilkinson James D, Cripe Linda H, Hor Kan N, Spurney Christopher F, Markham Larry W,
Abstract
BACKGROUND:
Cardiopulmonary failure is the leading cause of death in Duchenne muscular dystrophy (DMD). Research into DMD-specific cardiovascular therapies is ongoing, but there are no Food and Drug Administration-approved cardiac end points. To adequately power a therapeutic trial, appropriate end points must be chosen and the rate of change for these end points reported. The objective of this study was to evaluate rate of change for cardiac magnetic resonance and blood biomarkers and to determine which measures associate with all-cause mortality in DMD.
METHODS:
Seventy-eight DMD subjects underwent 211 cardiac magnetic resonance studies analyzed for left ventricular (LV) ejection fraction, indexed LV end diastolic and systolic volumes, circumferential strain, late gadolinium enhancement presence and severity (global severity score, and full width half maximum), native T1 mapping, T2 mapping, and extracellular volume. Blood samples were analyzed for BNP (brain natriuretic peptide), NT-proBNP (N-terminal pro-B-type natriuretic peptide), and troponin I. Cox proportional hazard regression modeling was performed with all-cause mortality as the outcome.
RESULTS:
Fifteen subjects (19%) died. LV ejection fraction, indexed end systolic volumes, global severity score, and full width half maximum worsened at 1 and 2 years while circumferential strain and indexed LV end diastolic volumes worsened at 2 years. LV ejection fraction, indexed LV end diastolic and systolic volumes, late gadolinium enhancement full width half maximum, and circumferential strain associated with all-cause mortality (
CONCLUSIONS:
LV ejection fraction, indexed LV volumes, circumferential strain, late gadolinium enhancement full width half maximum, and NT-proBNP are associated with all-cause mortality in DMD and may be the best end points for use in cardiovascular therapeutic trials. We also report change over time of cardiac magnetic resonance and blood biomarkers.
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Imaging and Serum Biomarkers for Cardiomyopathy in Duchenne Muscular Dystrophy.
Circ Heart Fail2023 Jun;():e010700. doi: 10.1161/CIRCHEARTFAILURE.123.010700.
McNally Elizabeth M, Chhabria Karisma R, Fullenkamp Dominic E,
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Advanced imaging of fetal cardiac function.
Front Cardiovasc Med2023 ;10():1206138. doi: 1206138.
Kühle Henriette, Cho Steven K S, Barber Nathaniel, Goolaub Datta Singh, Darby Jack R T, Morrison Janna L, Haller Christoph, Sun Liqun, Seed Mike,
Abstract
Over recent decades, a variety of advanced imaging techniques for assessing cardiovascular physiology and cardiac function in adults and children have been applied in the fetus. In many cases, technical development has been required to allow feasibility in the fetus, while an appreciation of the unique physiology of the fetal circulation is required for proper interpretation of the findings. This review will focus on recent advances in fetal echocardiography and cardiovascular magnetic resonance (CMR), providing examples of their application in research and clinical settings. We will also consider future directions for these technologies, including their ongoing technical development and potential clinical value.
© 2023 Kühle, Cho, Barber, Goolaub, Darby, Morrison, Haller, Sun and Seed.
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Single coronary artery presenting dilated cardiomyopathy and hyperlipidemia with the and gene mutation: A case report and review of the literature.
Front Cardiovasc Med2023 ;10():1113886. doi: 1113886.
Hu Xiaoxia, Kong Jing, Niu Tingting, Chen Liang, Yang Jingjing,
Abstract
We present a 55-year-old man with chest tightness and dyspnoea after activity lasting for 2 months who was diagnosed with single coronary artery (SCA) and presented with dilated cardiomyopathy (DCM) with the c.1858C?>?T mutation in the gene. The computed tomography coronary angiogram (CTCA) showed congenital absence of the right coronary artery (RCA), and the right heart was nourished by the left coronary artery branch with no apparent stenosis. Transthoracic echocardiography (TTE) revealed enlargement of the left heart and cardiomyopathy. Cardiac magnetic resonance imaging (CMR) revealed DCM. Genetic testing showed that the c.1858C?>?T variant of the gene could lead to Brugada syndrome and DCM. SCA is a rare congenital anomaly of the coronary anatomy, and this case reported as SCA accompanied by DCM is even rarer. We present a rare case of a 55-year-old man with DCM with the c.1858C?>?T (p. Arg620Cys)/c.1008G?>?A (p.(Pro336=) variant of the gene, congenital absence of RCA, and c.990_993delAACA (p. Asp332Valfs*5) variant of the gene. To our knowledge, this is the first report of DCM combined with the gene mutation in SCA after searching the PubMed, CNKI and Wanfang databases.
© 2023 Hu, Kong, Niu, Chen and Yang.
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Type I Spontaneous Coronary Artery Dissection in a 33-Year-Old Male With Clinically Suspected Myopericarditis.
Cureus2023 May;15(5):e38570. doi: e38570.
Nisson Cullen, Hernandez Mato Yeily, Lingappa Nimisha, Abraham James,
Abstract
We report a 33-year-old male with uncontrolled type II diabetes, and tobacco and marijuana use who presented with chest pain after a night of binge drinking and vomiting. ECG changes were consistent with acute pericarditis. Troponin levels were found to be significantly elevated and rising. The patient was immediately treated with acetylsalicylic acid (ASA), morphine, nitroglycerin drip, and heparin drip. Echocardiogram showed preserved ejection fraction (EF) without effusion. Coronary angiography demonstrated a type I spontaneous coronary artery dissection (SCAD) of the mid-left anterior descending artery (LAD) without significant coronary artery disease. Diagnostic intravenous ultrasound (IVUS) confirmed a type I SCAD with penumbra and a minimal luminal area of 10 mm of the mid-LAD without significant luminal narrowing. Percutaneous intervention was performed with ultrasound-guided penumbra aspiration thrombectomy. Medical therapy was started with aspirin and ticagrelor, high-intensity statin, metoprolol tartrate, lisinopril, colchicine, and insulin. A biopsy or cardiac MRI was not performed due to the resolution of the patient's symptoms. We conclude that the development of a type I SCAD in this patient was multifactorial in nature, including clinically suspected acute myopericarditis, uncontrolled type II diabetes mellitus, and binge drinking associated with vomiting.
Copyright © 2023, Nisson et al.
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Cardiac Arrest Associated With Psilocybin Use and Hereditary Hemochromatosis.
Cureus2023 May;15(5):e38669. doi: e38669.
Bae Suhwoo, Vaysblat Michael, Bae Edward, Dejanovic Ilja, Pierce Matthew,
Abstract
Recreational drug use is a significant public health concern in various countries. It is well understood that usage of psychedelics/hallucinogens, such as lysergic acid diethylamide (LSD), ecstasy, phencyclidine (PCP), and psilocybin-containing mushrooms, has increased significantly over the last few decades, particularly in adolescents and young adults, yet the effects of these recreational drugs are poorly understood. Psilocybin has recently been studied as an alternative to traditional antidepressant therapies with potentially benign side effects. Here, we present the case of a 48-year-old male with a past medical history of attention-deficit/hyperactivity disorder on lisdexamfetamine who presented after a syncopal episode witnessed by his wife at home. He was found to be in ventricular fibrillation and subsequently had an extensive workup with cardiac magnetic resonance imaging (MRI), ischemic evaluation, and electrophysiology, which were unrevealing. He then received an automatic implantable cardiac defibrillator and was incidentally found to have hereditary hemochromatosis on outpatient follow-up. His polypharmacy may have potentially led to catecholamine release, leading to ventricular arrhythmia.
Copyright © 2023, Bae et al.
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Left Ventricular Systolic Dysfunction in Aortic Stenosis: Pathophysiology, Diagnosis, Management, and Future Directions.
Struct Heart2022 Oct;6(5):100089. doi: 100089.
Spilias Nikolaos, Martyn Trejeeve, Denby Kara J, Harb Serge C, Popovic Zoran B, Kapadia Samir R,
Abstract
Degenerative calcific aortic stenosis (AS) is the most common valvular heart disease and often co-exists with left ventricular (LV) systolic dysfunction at the time of diagnosis. Impaired LV systolic function has been associated with worse outcomes in the setting of AS, even after successful aortic valve replacement (AVR). Myocyte apoptosis and myocardial fibrosis are the 2 key mechanisms responsible for the transition from the initial adaptation phase of LV hypertrophy to the phase of heart failure with reduced ejection fraction. Novel advanced imaging methods, based on echocardiography and cardiac magnetic resonance imaging, can detect LV dysfunction and remodeling at an early and reversible stage, with important implications for the optimal timing of AVR especially in patients with asymptomatic severe AS. Furthermore, the advent of transcatheter AVR as a first-line treatment for AS with excellent procedural outcomes, and evidence that even moderate AS portends worse prognosis in heart failure with reduced ejection fraction patients, has raised the question of early valve intervention in this patient population. With this review, we describe the pathophysiology and outcomes of LV systolic dysfunction in the setting of AS, present imaging predictors of LV recovery after AVR, and discuss future directions in the treatment of AS extending beyond the traditional indications defined in the current guidelines.
© 2022 The Author(s).
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Multimodality hemodynamic evaluation for optimizing management of anomalous origin of the right pulmonary artery from the aorta in an adolescent.
Ann Pediatr Cardiol2023 ;16(1):65-70. doi: 10.4103/apc.apc_98_22.
Gupta Saurabh Kumar, Choubey Mrigank, Kumar Sanjeev, Patel Chetan, Airan Balram,
Abstract
The hemodynamics of anomalous origin of the pulmonary artery (PA) from the aorta is challenging. Different sources of blood supply to the lungs lead to a unique state of differential flow, pressure, and pulmonary vascular resistance in each lung. The decision for surgical reimplantation of the anomalous PA during infancy is easy. The assessment of operability beyond infancy, however, is perplexing. In this report, we describe stepwise multimodal hemodynamic evaluation and successful surgical management in a 15-year-old boy with an isolated anomalous origin of the right PA from the aorta. We also report 5-year hemodynamic data confirming sustained benefit over the long term, thus providing much-needed clinical validation of often cited Poiseuille's and Ohm's laws.
Copyright: © 2023 Annals of Pediatric Cardiology.
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Cardiac rhabdomyomas and cerebral lesions in 4 pediatric patients with tuberous sclerosis.
Radiol Case Rep2023 Aug;18(8):2645-2648. doi: 10.1016/j.radcr.2023.04.041.
Fogante Marco, Ventura Fiammetta, Schicchi Nicolò, Regnicolo Luana, Potente Chiara, Argalia Giulio, Polonara Gabriele,
Abstract
Rhabdomyoma is the most common primary cardiac tumor in pediatric patients. A strong association exists between cardiac rhabdomyomas and tuberous sclerosis (TS), an autosomal dominant disease, characterized by diffuse lesions in the nervous system, such as cortical-subcortical tubers and subependymal nodules. In TS, cardiac rhabdomyomas typically are diagnosed in childhood, but they could be detected in the neonatal period with echocardiography and magnetic resonance imaging and may precede cerebral lesions. Therefore, the precocious detection of cardiac rhabdomyomas in pediatric patients can suggest the diagnosis of TS and the early detection of cerebral lesions, improving the management of the related symptoms. We reported the cases of 4 pediatric patients, in which the detection of cardiac rhabdomyomas lead to the early discovery of cerebral lesions and the diagnosis of the TS.
© 2023 The Authors.
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