Pubblicazioni recenti - cardiac mri
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A Rare Case of Congenital Left Ventricular Diverticulum With Apical Thrombus: Diagnostic Challenges and Management Insights.
Cureus2024 Mar;16(3):e56662. doi: e56662.
Alsallamin Isaac, Ahmed Eman N, Wazir Maha, Mtour Sameer M,
Abstract
A myocardial diverticulum is a rare congenital anomaly characterized by pouch-like protrusions within the myocardial wall, which can potentially lead to various cardiac complications. This case report describes a unique presentation of a left ventricular diverticulum (LVD) with an associated apical thrombus, highlighting the diagnostic and management challenges posed by this condition. A 58-year-old man presented to the emergency department with left arm weakness, wrist drop, and chest pain, initially raising concerns for a stroke. Diagnostic evaluations, including echocardiography and magnetic resonance imaging (MRI), revealed a small focal outpouching at the left ventricular apex, consistent with a congenital LVD containing a thrombus. This diagnosis was supported by the patient's historical imaging dating back to 2007, which had similarly identified this outpouching. The patient was managed with anticoagulation therapy, transitioning from heparin to warfarin, alongside standard cardiac care. This case underscores the importance of considering myocardial diverticulum in the differential diagnosis of patients presenting with cardiac symptoms that might initially suggest more common conditions, such as stroke. It also highlights the essential role of echocardiography and MRI in diagnosing and managing myocardial diverticula.
Copyright © 2024, Alsallamin et al.
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Complete remission of giant cell myocarditis by prednisolone monotherapy: A case with mild inflammation demonstrated by mismatch between T2-high intensity areas and late gadolinium enhancement.
J Cardiol Cases2024 Apr;29(4):182-185. doi: 10.1016/j.jccase.2023.12.007.
Soma Takanobu, Kinjo Takahiko, Goto Shintaro, Sasaki Shingo, Tomita Hirofumi,
Abstract
UNLABELLED:
Giant cell myocarditis (GCM) is a potentially lethal subtype of myocarditis. Herein, we report a case of a 22-year-old woman with GCM who was successfully treated with prednisolone monotherapy. The patient had a fever and shortness of breath and was referred to our hospital. Laboratory test results revealed elevated troponin I levels. Cardiac magnetic resonance (CMR) showed high intensity in the inferoseptal segment of the left ventricle on T2-weighted short tau inversion recovery imaging without late gadolinium enhancement (LGE), suggesting predominant edema rather than necrosis. The patient was diagnosed with GCM based on an endomyocardial biopsy, which revealed lymphocyte infiltration and multinucleated giant cells in the absence of granuloma formation. Subsequently, the patient received intravenous methylprednisolone at 1000?mg/day for 3?days followed by oral prednisolone at 30?mg/day, which normalized troponin levels. Follow-up CMR revealed improved cardiac inflammation; therefore, the patient was discharged without prescribing another immunosuppressive agent. Prednisolone was tapered and terminated three years after discharge. The patient went one year without medication and had no recurrence of GCM on follow-up. This case highlights the presence of mild GCM, successfully treated by steroid monotherapy, in which the mismatch between high-intensity T2 areas and LGE suggests mild inflammation.
LEARNING OBJECTIVE:
Giant cell myocarditis (GCM) is potentially lethal and usually requires multiple immunosuppressive agents. Here, we report a patient with GCM with preserved left ventricular ejection fraction. Cardiac magnetic resonance revealed focal high T2 signal intensity areas without late gadolinium enhancement, indicating myocardial edema without necrosis. The patient remained in remission with prednisolone monotherapy for 2?years. Our report indicates that "mild" GCM may be treated with prednisolone monotherapy.
© 2024 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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Paradoxical septic embolism in an Ebstein's anomaly patient leading to brain abscess: A case report.
J Cardiol Cases2024 Apr;29(4):161-164. doi: 10.1016/j.jccase.2023.12.001.
Singla Ankur, Gautam Archana, Goyal Amandeep, Dalia Tarun,
Abstract
UNLABELLED:
Ebstein's anomaly (EA), a congenital cardiac anomaly, is characterized by apical displacement of the tricuspid valve leaflet(s) into the right ventricle. We present the case of a 61-year-old female with a history of EA, Wolff-Parkinson-White syndrome, and patent foramen ovale (PFO), who presented with worsening hypoxia and confusion, in the setting of left lower extremity cellulitis and abscess. The computed tomography (CT) scan of the head showed a cerebellar infarct with hemorrhagic conversion. Magnetic resonance imaging of the head showed a satellite lesion raising concern for the embolic nature of infarcts. After ruling out cardioembolic causes of cerebellar infarction, her presenting symptoms were attributed to paradoxical septic emboli from the left leg abscess (demonstrated on CT scan of the leg). She was deemed a poor candidate for surgical closure of PFO due to contraindication to use heparin (due to the presence of hemorrhagic stroke) and underlying comorbidities. Septic embolization is a rare but dreaded complication in EA patients with PFO.
LEARNING OBJECTIVE:
?Paradoxical emboli can occur in patients with Ebstein's anomaly (EA) and patent foramen ovale (PFO).?The mainstay of management in case of paradoxical embolism lies with the identification and treatment of the underlying cause, such as infective endocarditis, deep vein thrombosis, or infectious source, as in the present case.?The surgical correction of PFO in EA patients should be considered when the patient becomes symptomatic with cyanosis, hypoxia, or manifestations of paradoxical emboli.
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd.
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Non-invasive pressure-volume loops using the elastance model and CMR: a porcine validation at transient pre-loads.
Eur Heart J Imaging Methods Pract2024 Jan;2(1):qyae016. doi: qyae016.
Seemann Felicia, Heiberg Einar, Bruce Christopher G, Khan Jaffar M, Potersnak Amanda, Ramasawmy Rajiv, Carlsson Marcus, Arheden Håkan, Lederman Robert J, Campbell-Washburn Adrienne E,
Abstract
AIMS:
Pressure-volume (PV) loops have utility in the evaluation of cardiac pathophysiology but require invasive measurements. Recently, a time-varying elastance model to derive PV loops non-invasively was proposed, using left ventricular (LV) volume by cardiovascular magnetic resonance (CMR) and brachial cuff pressure as inputs. Validation was performed using CMR and pressure measurements acquired on the same day, but not simultaneously, and without varying pre-loads. This study validates the non-invasive elastance model used to estimate PV loops at varying pre-loads, compared with simultaneous measurements of invasive pressure and volume from real-time CMR, acquired concurrent to an inferior vena cava (IVC) occlusion.
METHODS AND RESULTS:
We performed dynamic PV loop experiments under CMR guidance in 15 pigs ( = 7 naïve, = 8 with ischaemic cardiomyopathy). Pre-load was altered by IVC occlusion, while simultaneously acquiring invasive LV pressures and volumes from real-time CMR. Pairing pressure and volume signals yielded invasive PV loops, and model-based PV loops were derived using real-time LV volumes. Haemodynamic parameters derived from invasive and model-based PV loops were compared. Across 15 pigs, 297 PV loops were recorded. Intra-class correlation coefficient (ICC) agreement was excellent between model-based and invasive parameters: stroke work (bias = 0.007 ± 0.03?J, ICC = 0.98), potential energy (bias = 0.02 ± 0.03?J, ICC = 0.99), ventricular energy efficiency (bias = -0.7 ± 2.7%, ICC = 0.98), contractility (bias = 0.04 ± 0.1?mmHg/mL, ICC = 0.97), and ventriculoarterial coupling (bias = 0.07 ± 0.15, ICC = 0.99). All haemodynamic parameters differed between naïve and cardiomyopathy animals (
CONCLUSION:
An elastance model-based estimation of PV loops and associated haemodynamic parameters provided accurate measurements at transient loading conditions compared with invasive PV loops.
Published by Oxford University Press on behalf of the European Society of Cardiology 2024.
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A hidden pathophysiology of endolymphatic hydrops: case report of a patient with spontaneous intracranial hypotension presenting with sudden sensorineural hearing loss with vertigo.
Front Neurol2024 ;15():1394534. doi: 1394534.
Kim Jong Kwan, Lee Ho Yun, Kim Ha Youn, Kwak Min Young,
Abstract
Spontaneous intracranial hypotension (SIH) is characterized by decreased cerebrospinal fluid (CSF) volume due to leakage through the dural membrane. We present the case of a patient with SIH manifested by fluctuating low-frequency hearing loss, tinnitus, and vertigo. In this patient, endolymphatic hydrops in the cochlea and saccule were visualized by means of a special sequence of inner ear magnetic resonance imaging scans, with a gadolinium-based contrast agent administered intravenously. Endolymphatic hydrops is a potential underlying pathophysiology of SIH-associated hearing impairment. We hypothesize that SIH may be a rare cause of endolymphatic hydrops.
Copyright © 2024 Kim, Lee, Kim and Kwak.
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Recurrent angina and cardiac ischaemia as a presentation of pheochromocytoma: a case report.
Eur Heart J Case Rep2024 Apr;8(4):ytae153. doi: ytae153.
van de Bovenkamp Arno A, Kalkman Deborah N, Beijk Marcel A M, van de Veerdonk Mariëlle C,
Abstract
BACKGROUND:
We present a case of a pregnant patient with recurrent angina, in which her symptoms were initially attributed to coronary artery spasm. However, during follow-up, she was diagnosed as having pheochromocytoma, a rare neuroendocrine tumour.
CASE SUMMARY:
The 35-year-old patient was admitted to the hospital because of chest pain and elevated cardiac troponins after the use of MDMA. Physical examination, electrocardiogram, echocardiography, coronary angiogram, and cardiac MRI were normal. Symptoms were attributed to coronary spasm, and a calcium antagonist was started. Ten months later, when 36 weeks pregnant, her symptoms returned. One week later, the patient was readmitted to the hospital with signs of acute left ventricular (LV) failure, highly elevated troponins, and severe global LV dysfunction. Urgent section caesarean was performed due to maternal morbidity and foetal tachycardia. During section, flushes and marked variability in blood pressure were noted. Laboratory metanephrines testing was performed. LV function recovered within 3 days without any therapeutic intervention. However, chest pain reoccurred, now accompanied with headaches, malignant hypertension, and accelerated idiopathic ventricular rhythms. (Nor)metanephrines tests were positive. A solid lesion in the right adrenal on CT scan confirmed the diagnosis of pheochromocytoma. Fluid repletion and alpha-blocker therapy were started. Due to persistent symptoms, urgent laparoscopic adrenalectomy was performed. Hereafter, the patient remained without symptoms.
DISCUSSION:
A pheochromocytoma may present with recurrent angina and can result in a catecholamine-induced cardiomyopathy. It is important to timely recognize this diagnosis in order to minimize morbidity and mortality.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Characterization of spatial integrity with active and passive implants in a low-field magnetic resonance linear accelerator scanner.
Phys Imaging Radiat Oncol2024 Apr;30():100576. doi: 100576.
Pouymayou Bertrand, Perez-Haas Yoel, Allemann Florin, Saguner Ardan M, Andratschke Nicolaus, Guckenberger Matthias, Tanadini-Lang Stephanie, Wilke Lotte,
Abstract
BACKGROUND AND PURPOSE:
Standard imaging protocols can guarantee the spatial integrity of magnetic resonance (MR) images utilized in radiotherapy. However, the presence of metallic implants can significantly compromise this integrity. Our proposed method aims at characterizing the geometric distortions induced by both passive and active implants commonly encountered in planning images obtained from a low-field 0.35 T MR-linear accelerator (LINAC).
MATERIALS AND METHODS:
We designed a spatial integrity phantom defining 1276 control points and covering a field of view of 20x20x20 cm. This phantom was scanned in a water tank with and without different implants used in hip and shoulder arthroplasty procedures as well as with active cardiac stimulators. The images were acquired with the clinical planning sequence (balanced steady-state free-precession, resolution 1.5x1.5x1.5 mm). Spatial integrity was assessed by the Euclidian distance between the control point detected on the image and their theoretical locations. A first plane free of artefact (FPFA) was defined to evaluate the spatial integrity beyond the larger banding artefact.
RESULTS:
In the region extending up to 20 mm from the largest banding artefacts, the tested passive and active implants could cause distortions up to 2 mm and 3 mm, respectively. Beyond this region the spatial integrity was recovered and the image could be considered as unaffected by the implants.
CONCLUSIONS:
We characterized the impact of common implants on a low field MR-LINAC planning sequence. These measurements could support the creation of extra margin while contouring organs at risk and target volumes in the vicinity of implants.
© 2024 The Authors.
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Pulsative venous return from the branchial vessels to the heart of the Mytilus galloprovincialis supports the constant-volume mechanism.
J Exp Biol2024 Apr;():. doi: jeb.247345.
Seo Eriko, Seo Yoshiteru,
Abstract
In bivalves and gastropods, ventricle contraction causes a negative pressure in the auricles, and increases venous return from the afferent oblique vein (AOV): the constant-volume (CV) mechanism. The flow in the AOV should be a pulsative flow synchronized with the ventricular contraction. The flow in the heart and adjacent vessels of the Mytilus galloprovincialis were measured by magnetic resonance imaging to confirm this hypothesis. Under a regular heartbeat, pulsative flows in the AOV and branchial vessels (BVs) were almost completely synchronized with the flow in the aorta, while filling in the ventricle was in the opposite phase. Flows in the BVs were directed to the posterior direction, and a pair of BVs in the gill axes (the efferent BVs) were connected to the AOV. Based on the images of the whole pathway of the AOV in an oblique slice, we confirmed that haemolymph flow was evoked from the efferent BVs, and flow into the ventricle via the auricle was completed in a single heartbeat. Therefore, the walls of the AOV and BVs could resist negative transmural pressure caused by the ventricular contraction. In conclusion, the auricle, the AOV and the BVs, including the gill filaments, act as a suction pump. The pulsative venous return is driven by the negative pressure of the AOV as in the CV mechanism, and the negative pressure in the efferent BVs could draw haemolymph from the sinus via the gill and the afferent BVs. Therefore, the Mytilus can start and stop its heartbeat ad libitum.
© 2024. Published by The Company of Biologists Ltd.
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Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study.
Arch Cardiovasc Dis2024 Apr;():. doi: S1875-2136(24)00057-3.
Hulot Jean-Sébastien, Janiak Philip, Boutinaud Philippe, Boutouyrie Pierre, Chézalviel-Guilbert Frédérique, Christophe Jean-Joseph, Cohen Ariel, Damy Thibaud, Djadi-Prat Juliette, Firat Hüseyin, Hervé Pierre-Yves, Isnard Richard, Jondeau Guillaume, Mousseaux Elie, Pernot Mathieu, Prot Pierre, Tyl Benoit, Soulat Gilles, Logeart Damien, ,
Abstract
BACKGROUND:
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome that is poorly defined, reflecting an incomplete understanding of its pathophysiology.
AIM:
To redefine the phenotypic spectrum of HFpEF.
METHODS:
The PACIFIC-PRESERVED study is a prospective multicentre cohort study designed to perform multidimensional deep phenotyping of patients diagnosed with HFpEF (left ventricular ejection fraction?50%), patients with heart failure with reduced ejection fraction (left ventricular ejection fraction?40%) and subjects without overt heart failure (3:2:1 ratio). The study proposes prospective investigations in patients during a 1-day hospital stay: physical examination; electrocardiogram; performance-based tests; blood samples; cardiac magnetic resonance imaging; transthoracic echocardiography (rest and low-level exercise); myocardial shear wave elastography; chest computed tomography; and non-invasive measurement of arterial stiffness. Dyspnoea, depression, general health and quality of life will be assessed by dedicated questionnaires. A biobank will be established. After the hospital stay, patients are asked to wear a connected garment (with digital sensors) to collect electrocardiography, pulmonary and activity variables in real-life conditions (for up to 14 days). Data will be centralized for machine-learning-based analyses, with the aim of reclassifying HFpEF into more distinct subgroups, improving understanding of the disease mechanisms and identifying new biological pathways and molecular targets. The study will also serve as a platform to enable the development of innovative technologies and strategies for the diagnosis and stratification of patients with HFpEF.
CONCLUSIONS:
PACIFIC-PRESERVED is a prospective multicentre phenomapping study, using novel analytical techniques, which will provide a unique data resource to better define HFpEF and identify new clinically meaningful subgroups of patients.
Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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RAS Dataset: A 3D Cardiac LGE-MRI Dataset for Segmentation of Right Atrial Cavity.
Sci Data2024 Apr;11(1):401. doi: 401.
Zhu Jinwen, Bai Jieyun, Zhou Zihao, Liang Yaqi, Chen Zhiting, Chen Xiaoming, Zhang Xiaoshen,
Abstract
The current challenge in effectively treating atrial fibrillation (AF) stems from a limited understanding of the intricate structure of the human atria. The objective and quantitative interpretation of the right atrium (RA) in late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) scans relies heavily on its precise segmentation. Leveraging the potential of artificial intelligence (AI) for RA segmentation presents a promising solution. However, the successful implementation of AI in this context necessitates access to a substantial volume of annotated LGE-MRI images for model training. In this paper, we present a comprehensive 3D cardiac dataset comprising 50 high-resolution LGE-MRI scans, each meticulously annotated at the pixel level. The annotation process underwent rigorous standardization through crowdsourcing among a panel of medical experts, ensuring the accuracy and consistency of the annotations. Our dataset represents a significant contribution to the field, providing a valuable resource for advancing RA segmentation methods.
© 2024. The Author(s).
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Challenging diagnosis of resistance to thyroid hormone in a patient with COVID-19, pituitary microadenoma and unusual response to octreotide long-acting release test.
Endocrinol Diabetes Metab Case Rep2024 Apr;2024(2):. doi: 23-0146.
Petolicchio Cristian, Brasili Sara, Gay Stefano, Cocchiara Francesco, Campi Irene, Persani Luca, Vera Lara, Ferone Diego, Gatto Federico,
Abstract
SUMMARY:
The resistance to thyroid hormone syndrome (RTH?) occurs uncommonly and requires a high level of clinical suspicion and specific investigations to reach a precise diagnosis and to avoid unnecessary and potentially harmful therapies. We report a case of a young male patient referred to our unit for SARS-CoV-2 infection and atrial fibrillation with elevated thyroid hormones and non-suppressed thyroid-stimulating hormone (TSH), for which antithyroid therapy was prescribed. A mood disorder was reported in the medical history. The family history was unknown as the patient was adopted. Thyroid-specific antibodies were undetectable, and thyroid ultrasound revealed a normal thyroid gland without nodules. After the resolution of SARS-CoV-2 infection, the diagnostic workup continued, and the pituitary MRI revealed a small area ascribable to a microadenoma. Due to atrial fibrillation, the execution of the T3 test was contraindicated. The octreotide long-acting release (LAR) test showed an initial reduction of free thyroid hormones levels at first administration, which was consistent with the presence of a TSH-secreting pituitary tumour, although an escape from the response was observed after the following two injections of octreotide LAR. Indeed, the genetic investigation revealed a variant in heterozygosity of the THR? gene (Pro453Ser), thus leading to an RTH? diagnosis, and, therefore, medical treatment with triiodothyroacetic acid was initiated. After 2 years from the SARS-CoV-2 infection, the patient continues the follow-up at our outpatient clinic, and no other medical interventions are needed.
LEARNING POINTS:
RTH? is a rare genetic syndrome characterised by discrepant thyroid function tests and by a dissociation between the observed hormone levels and the expected patient signs and symptoms. Features of thyroid hormone deficiency in TR-ß dependent tissues (pituitary gland, hypothalamus, liver and neurosensitive epithelia), as well as thyroid hormone excess in TR-?-dependent tissues (heart, bone, skeletal muscle and brain), may coexist in the same individual. Clinical pictures can be different even when the same variant occurs, suggesting that other genetic and/or epigenetic factors may play a role in determining the patient's phenotype. Differentiating RTH? from a TSH-secreting pituitary tumour is very difficult, especially when a concomitant pituitary adenoma is detected during diagnostic workup. The injection of long-acting somatostatin analogues can help differentiate the two conditions, but it is important to detect any interference in the dosage of thyroid hormones to avoid an incorrect diagnosis. Genetic testing is fundamental to prevent unnecessary and potentially harmful therapies. Medical treatment with triiodothyroacetic acid was demonstrated to be effective in reducing thyroid hormone excess and controlling symptoms.
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Epicardial Adipose Tissue Thickness and Preserved Ejection Fraction Heart Failure.
Curr Hypertens Rep2024 Apr;():. doi: 10.1007/s11906-024-01302-7.
Dhore-Patil Aneesh, Urina-Jassir Daniela, Samson Rohan, Le Jemtel Thierry H, Oparil Suzanne,
Abstract
PURPOSE OF THE REVIEW:
Preserved ejection fraction heart failure and obesity frequently coexist. Whether obesity plays a consistent role in the pathogenesis of preserved ejection fraction heart failure is unclear. Accumulation of visceral adiposity underlies the pathogenic aftermaths of obesity. However, visceral adiposity imaging is assessed by computed tomography or magnetic resonance and thus not routinely available. In contrast, epicardial adiposity thickness is assessed by echocardiography and thus routinely available. We review the rationale for assessing epicardial adiposity thickness in patients with preserved ejection fraction heart failure and elevated body mass index.
RECENT FINDINGS:
Body mass index correlates poorly with visceral, and epicardial adiposity. Visceral and epicardial adiposity enlarges as preserved ejection fraction heart failure progresses. Epicardial adiposity may hasten the progression of coronary artery disease and impairs left ventricular sub-endocardial perfusion and diastolic function. Epicardial adiposity thickness may help monitor the therapeutic response in patients with preserved ejection failure heart failure and elevated body mass index.
© 2024. The Author(s).
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Chiral Pyclen-Based Heptadentate Chelates as Highly Stable MRI Contrast Agents.
Inorg Chem2024 Apr;():. doi: 10.1021/acs.inorgchem.4c01028.
Jian Yong, Mo Gengshen, Xu Weiyuan, Liu Yao, Zhang Zhichao, Ding Yinghui, Gao Ruonan, Xu Jiao, Zhu Jiang, Shu Kun, Yan Zhihan, Carniato Fabio, Platas-Iglesias Carlos, Ye Fangfu, Botta Mauro, Dai Lixiong,
Abstract
In recent years, pyclen-based complexes have attracted a great deal of interest as magnetic resonance imaging (MRI) contrast agents (CAs) and luminescent materials, as well as radiopharmaceuticals. Remarkably, gadopiclenol, a Gd(III) bishydrated complex featuring a pyclen-based heptadentate ligand, received approval as a novel contrast agent for clinical MRI application in 2022. To maximize stability and efficiency, two novel chiral pyclen-based chelators and their complexes were developed in this study. showed significant enhancements in both thermodynamic and kinetic stabilities compared to those of the achiral parent derivative . H NMRD profiles reveal that both chiral gadolinium complexes ( and ) have a higher relaxivity than , while variable-temperature O NMR studies show that the two inner-sphere water molecules have distinct residence times ? and ?. Furthermore, imaging demonstrates that enhances the signal in the heart and kidneys of the mice, and the chiral Gd complexes exhibit the ability to distinguish between tumors and normal tissues in a 4T1 mouse model more efficiently than that of the clinical agent gadobutrol. Biodistribution studies show that and are primarily cleared by a renal pathway, with 24 h residues of in the liver and kidney being lower than those of .
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CardSegNet: An adaptive hybrid CNN-vision transformer model for heart region segmentation in cardiac MRI.
Comput Med Imaging Graph2024 Apr;115():102382. doi: 10.1016/j.compmedimag.2024.102382.
Aghapanah Hamed, Rasti Reza, Kermani Saeed, Tabesh Faezeh, Banaem Hossein Yousefi, Aliakbar Hamidreza Pour, Sanei Hamid, Segars William Paul,
Abstract
Cardiovascular MRI (CMRI) is a non-invasive imaging technique adopted for assessing the blood circulatory system's structure and function. Precise image segmentation is required to measure cardiac parameters and diagnose abnormalities through CMRI data. Because of anatomical heterogeneity and image variations, cardiac image segmentation is a challenging task. Quantification of cardiac parameters requires high-performance segmentation of the left ventricle (LV), right ventricle (RV), and left ventricle myocardium from the background. The first proposed solution here is to manually segment the regions, which is a time-consuming and error-prone procedure. In this context, many semi- or fully automatic solutions have been proposed recently, among which deep learning-based methods have revealed high performance in segmenting regions in CMRI data. In this study, a self-adaptive multi attention (SMA) module is introduced to adaptively leverage multiple attention mechanisms for better segmentation. The convolutional-based position and channel attention mechanisms with a patch tokenization-based vision transformer (ViT)-based attention mechanism in a hybrid and end-to-end manner are integrated into the SMA. The CNN- and ViT-based attentions mine the short- and long-range dependencies for more precise segmentation. The SMA module is applied in an encoder-decoder structure with a ResNet50 backbone named CardSegNet. Furthermore, a deep supervision method with multi-loss functions is introduced to the CardSegNet optimizer to reduce overfitting and enhance the model's performance. The proposed model is validated on the ACDC2017 (n=100), M&Ms (n=321), and a local dataset (n=22) using the 10-fold cross-validation method with promising segmentation results, demonstrating its outperformance versus its counterparts.
Copyright © 2024 Elsevier Ltd. All rights reserved.
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Retinal Ischemic Perivascular Lesion Reflects Cerebral Small Vessel Disease Burden in Single Subcortical Infarction.
J Am Heart Assoc2024 Apr;():e033081. doi: 10.1161/JAHA.123.033081.
Kwapong William R, Yan Yuying, Cao Le, Wang Hang, Ye Chen, Jiang Shuai, Tao Wendan, Wu Bo,
Abstract
BACKGROUND:
Retinal ischemic perivascular lesions (RIPLs) are an indicator of ischemia in the middle retina. We aimed to determine the relationship between RIPLs and single subcortical infarction (SSI). We also investigated the differences in cerebral small vessel disease imaging burden between groups with and without RIPLs in SSI.
METHODS AND RESULTS:
In this case-control study, we enrolled 82 patients with SSI and 72 nonstroke controls. All participants underwent magnetic resonance imaging and swept-source optical coherence tomography/optical coherence tomography angiography. Small vessel disease markers such as lacunes, cerebral microbleeds, white matter hyperintensity, and perivascular spaces were rated on brain imaging. RIPLs were assessed via swept-source optical coherence tomography. Optical coherence tomography angiography was used to measure the superficial vascular complex and deep vascular complex of the retina. After adjusting for risk factors, the presence of RIPLs was significantly associated with SSI (odds ratio [OR], 1.506 [95% CI, 1.365-1.662],
CONCLUSIONS:
RIPLs are associated with SSI independent of underlying risk factors. The relationship between the presence of RIPLs and small vessel disease markers provides evidence that RIPLs might be an additional indicator of cerebral ischemic changes.
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Rationale and design of the ELEANOR trial early aortic valve surgery versus watchful waiting strategy in severe asymptomatic aortic regurgitation, ACRONYM: ELEANOR.
Heliyon2024 Apr;10(8):e29470. doi: e29470.
Ko?ková Radka, Vojá?ek Jan, Bedá?ová Helena, Fila Petr, Skalský Ivo, ?áková Daniela, Klán Michal, Míková Barbora, M?dílek Karel, Tuna Martin, Fialová Monika, Dvo?áková Radka, Hlubocká Zuzana, Panovský Roman, Slabý Kry?tof, Kelen de Oliveira Elayne, Casselman Filip, P?ni?ka Martin,
Abstract
BACKGROUND:
The optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimodality imaging has brought new tools for the accurate selection of asymptomatic patients at risk of early clinical deterioration, however, prospective and randomized data are pending. Cardiac magnetic resonance (CMR)-derived AR quantification along with LV remodeling assessment appears to be the most accurate tool for a selection of such patients at risk.
TRIAL DESIGN:
The objective of our prospective and multicenter study is to determine whether patients at risk of early clinical deterioration as per CMR assessment will benefit from early surgical treatment. The study is designed as a superiority trial to demonstrate that early surgical treatment is safe and more effective than the standard treatment. A total of 217 asymptomatic patients with severe AR, but without current guidelines-based surgical indication, will be enrolled across all centers. We expect 24 % of patients identified as high clinical risk and therefore eligible for 1:1 randomization to early surgical treatment within 3 months or a watchful waiting strategy. Follow-up will be annual. We expect a complete restoration of LV size and function along with improved quality of life and physical performance in a short-term follow-up of 12 months. The primary endpoint will be a composite safety and efficacy with all criteria mandatory: 15 % or larger reduction of baseline CMR-derived LV end-diastolic volume index, LV ejection fraction >50 %, and no major adverse cardiovascular events. The annual follow-up will continue for a minimum of 4 years until the required number of endpoints is achieved to show a statistically significant difference in cardiovascular morbidity and mortality in early surgically treated patients.
CONCLUSION:
The ELEANOR trial is the first multicenter randomized controlled study to compare early surgical treatment with a watchful waiting strategy in asymptomatic patients with chronic severe AR at high risk of early clinical deterioration as per CMR assessment but without guidelines-based indications for surgical treatment.
© 2024 The Authors. Published by Elsevier Ltd.
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Recurrent immunosuppressive-responsive myocarditis in a patient with desmoplakin cardiomyopathy: a case report.
Eur Heart J Case Rep2024 Mar;8(3):ytae129. doi: ytae129.
McColl Hayden, Cordina Rachael, Lal Sean, Parker Matthew, Hunyor Imre, Medi Caroline, Gray Belinda,
Abstract
BACKGROUND:
Desmoplakin (DSP) cardiomyopathy is a rare genetic condition characterized by repeated inflammatory myocardial injury and is associated with ventricular arrhythmia and sudden cardiac death. Diagnosis is challenging and requires a combination of genetic testing and advanced imaging techniques.
CASE SUMMARY:
We present the case of a 38-year-old woman with recurrent episodes of subclinical myocarditis. Investigation using cardiac magnetic resonance imaging (cMRI) and genetic testing revealed a diagnosis of DSP cardiomyopathy. Her disease was initially responsive to corticosteroid therapy but quickly relapsed when treatment was tapered. Management of her condition required significant immunosuppression and the subsequent insertion of an implantable cardiac defibrillator due to her risk of sudden cardiac death.
DISCUSSION:
Cardiac MRI and genetic testing are key diagnostic techniques in the assessment of patients with recurrent myocarditis and cardiomyopathy. The management of cardiomyopathies with an inflammatory component is not completely understood; however, there is likely a key role for immune suppression therapies. Furthermore, there are several cardiomyopathy genetic variants including DSP which require careful risk stratification due to an increased risk of sudden cardiac death.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Comprehensive characterization of cardiac contraction for improved post-infarction risk assessment.
Sci Rep2024 Apr;14(1):8951. doi: 8951.
Corral Acero Jorge, Lamata Pablo, Eitel Ingo, Zacur Ernesto, Evertz Ruben, Lange Torben, Backhaus Sören J, Stiermaier Thomas, Thiele Holger, Bueno-Orovio Alfonso, Schuster Andreas, Grau Vicente,
Abstract
This study aims at identifying risk-related patterns of left ventricular contraction dynamics via novel volume transient characterization. A multicenter cohort of AMI survivors (n?=?1021) who underwent Cardiac Magnetic Resonance (CMR) after infarction was considered for the study. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE, n?=?73), consisting of all-cause death, reinfarction, and new congestive heart failure. Cardiac function was characterized from CMR in 3 potential directions: by (1) volume temporal transients (i.e. contraction dynamics); (2) feature tracking strain analysis (i.e. bulk tissue peak contraction); and (3) 3D shape analysis (i.e. 3D contraction morphology). A fully automated pipeline was developed to extract conventional and novel artificial-intelligence-derived metrics of cardiac contraction, and their relationship with MACE was investigated. Any of the 3 proposed directions demonstrated its additional prognostic value on top of established CMR indexes, myocardial injury markers, basic characteristics, and cardiovascular risk factors (P?0.001). The combination of these 3 directions of enhancement towards a final CMR risk model improved MACE prediction by 13% compared to clinical baseline (0.774 (0.771-0.777) vs. 0.683 (0.681-0.685) cross-validated AUC, P?0.001). The study evidences the contribution of the novel contraction characterization, enabled by a fully automated pipeline, to post-infarction assessment.
© 2024. The Author(s).
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Electrophysiological cardiovascular MR: procedure-ready mesh model generation for interventional guidance based on non-selective excitation compressed sensing whole heart imaging.
Sci Rep2024 Apr;14(1):8974. doi: 8974.
Jahnke Cosima, Darma Angeliki, Lindemann Frank, Oebel Sabrina, Hilbert Sebastian, Bode Kerstin, Stehning Christian, Smink Jouke, Paetsch Ingo,
Abstract
Fully CMR-guided electrophysiological interventions (EP-CMR) have recently been introduced but data on the optimal CMR imaging protocol are scarce. This study determined the clinical utility of 3D non-selective whole heart steady-state free precession imaging using compressed SENSE (nsWHcs) for automatic segmentation of cardiac cavities as the basis for targeted catheter navigation during EP-CMR cavo-tricuspid isthmus ablation. Fourty-two consecutive patients with isthmus-dependent right atrial flutter underwent EP-CMR radiofrequency ablations. nsWHcs succeeded in all patients (nominal scan duration, 98?±?10 s); automatic segmentation/generation of surface meshes of right-sided cavities exhibited short computation times (16?±?3 s) with correct delineation of right atrium, right ventricle, tricuspid annulus and coronary sinus ostium in 100%, 100%, 100% and 95%, respectively. Point-by-point ablation adhered to the predefined isthmus line in 62% of patients (26/42); activation mapping confirmed complete bidirectional isthmus block (conduction time difference, 136?±?28 ms). nsWHcs ensured automatic and reliable 3D segmentation of targeted endoluminal cavities, multiplanar reformatting and image fusion (e.g. activation time measurements) and represented the basis for precise real-time active catheter navigation during EP-CMR ablations of isthmus-dependent right atrial flutter. Hence, nsWHcs can be considered a key component in order to advance EP-CMR towards the ultimate goal of targeted substrate-based ablation procedures.
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Regional conduction velocities determined by non-invasive mapping are associated with arrhythmia-free survival after atrial fibrillation ablation.
Heart Rhythm2024 Apr;():. doi: S1547-5271(24)02390-7.
Invers-Rubio Eric, Hernández-Romero Ismael, Reventos-Presmanes Jana, Ferro Elisenda, Guichard Jean-Baptiste, Regany-Closa Mariona, Pellicer-Sendra Berta, Borras Roger, Prat-Gonzalez Susanna, Tolosana Jose Maria, Porta-Sanchez Andreu, Arbelo Elena, Guasch Eduard, Sitges Marta, Brugada Josep, Guillem Maria S, Roca-Luque Ivo, Climent Andreu M, Mont Lluís, Althoff Till F,
Abstract
BACKGROUND:
Atrial arrhythmogenic substrate is a key determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI), and reduced conduction-velocities have been linked to adverse outcome. However, a non-invasive method to assess such electrophysiological substrate is not available to date.
OBJECTIVE:
This study aimed to non-invasively assess regional conduction-velocities and their association with arrhythmia-free survival following PVI.
METHODS:
52 consecutive patients scheduled for AF ablation (PVI-only) and 19 healthy controls were prospectively included and received electrocardiographic imaging (ECGi) to non-invasively determine regional atrial conduction-velocities in sinus rhythm. A novel ECGi technology obviating the need of additional CT- or CMR-imaging was applied and validated using invasive mapping.
RESULTS:
Mean ECGi-determined atrial conduction-velocities were significantly lower in AF-patients than in healthy controls (1.45±0.15 versus 1.64±0.15m/s; p
CONCLUSIONS:
This is the first study to investigate regional atrial conduction velocities non-invasively. The absence of ECGi-determined slow-conduction areas well discriminates PVI-responders from non-responders. Such non-invasive assessment of electrical arrhythmogenic substrate may guide treatment strategies and be a step towards personalised AF therapy.
Copyright © 2024. Published by Elsevier Inc.
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