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Pubblicazioni recenti - cardiac magnetic resonance
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Prognostic value of cardiac magnetic resonance imaging parameters in left ventricular noncompaction with left ventricular dysfunction.
BMC Cardiovasc Disord2022 Dec;22(1):526. doi: 10.1186/s12872-022-02963-5.
Bai Wei, Xu Rong, Li Xiao, Xu Huayan, Fu Hang, Hou Ruilai, Zhou Ziqi, Huang Wei, Wang Yining, Guo Yingkun,
Abstract
BACKGROUND:
Cardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF).
METHODS:
A total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7?±?16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias.
RESULTS:
After a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p?=?0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p?=?0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p?=?0.411) in the multivariate model.
CONCLUSIONS:
The combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
© 2022. The Author(s).
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The sex-specific metabolic signature of C57BL/6NRj mice during aging.
Sci Rep2022 Dec;12(1):21050. doi: 10.1038/s41598-022-25396-8.
Bresilla Doruntina, Habisch Hansjoerg, Priti?anac Iva, Zarse Kim, Parichatikanond Warisara, Ristow Michael, Madl Tobias, Madreiter-Sokolowski Corina T,
Abstract
Due to intact reactive oxygen species homeostasis and glucose metabolism, C57BL/6NRj mice are especially suitable to study cellular alterations in metabolism. We applied Nuclear Magnetic resonance spectroscopy to analyze five different tissues of this mouse strain during aging and included female and male mice aged 3, 6, 12, and 24 months. Metabolite signatures allowed separation between the age groups in all tissues, and we identified the most prominently changing metabolites in female and male tissues. A refined analysis of individual metabolite levels during aging revealed an early onset of age-related changes at 6 months, sex-specific differences in the liver, and a biphasic pattern for various metabolites in the brain, heart, liver, and lung. In contrast, a linear decrease of amino acids was apparent in muscle tissues. Based on these results, we assume that age-related metabolic alterations happen at a comparably early aging state and are potentially associated with a metabolic switch. Moreover, identified differences between female and male tissues stress the importance of distinguishing between sexes when studying age-related changes and developing new treatment approaches. Besides, metabolomic features seem to be highly dependent on the genetic background of mouse strains.
© 2022. The Author(s).
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Gastroenteropancreatic Neuroendocrine Tumor Metastasis to the Heart: Evaluation of Imaging Manifestations.
Curr Probl Diagn Radiol2022 Nov;():. doi: S0363-0188(22)00154-2.
Wang Yuxiang, Ayoub Chadi, Yang Aaron F, Sonbol Mohamad B, Butterfield Richard, Halfdanarson Thorvardur R, Arsanjani Reza, Zhu Wuqiang, Yang Ming,
Abstract
Neuroendocrine tumors (NET) may affect the heart by cardiac metastasis or carcinoid heart disease. NET metastasis to the heart is rare, with limited data characterizing it. We sought to evaluate Ga-DOTATATE PET scan imaging features and associated cardiac imaging characteristics where available in those with NET cardiac metastases. Ga-DOTATATE positron emission tomography (PET)/CT scans performed on patients with gastroenteropancreatic (GEP) NET at our institution were reviewed for cardiac involvement. Those identified with cardiac metastases had their electronic medical record, transthoracic echocardiogram (TTE) and cardiac magnetic resonance imaging (MRI) reviewed for characterization. From a total of 1426 Ga-DOTATATE PET/CT scans performed on patients with GEP-NET, 25 (1.75%) had cardiac uptake consistent with metastasis. Of these, 22 had myocardial metastases (29 distinct myocardial lesions: left ventricle - 16, right ventricle - 6, and ventricular septum -7) and 3 had periradial lymph node involvement only. NET patients with cardiac metastases as identified by DOTATATE scan did not appear to have any hemodynamically significant TTE features, aside from those (2/25) who had concomitant carcinoid heart disease. Of the 14 patients who had available TTE for review, only one with high metastatic cardiac tumor burden had detectable cardiac mass. Of the 6 cases who had available MRI, all had metastatic cardiac lesions seen with excellent correlation with tumor localization on Ga-DOTATATE PET scan. Ga-DOTATATE PET has excellent capability for the diagnosis of cardiac NET metastasis. Cardiac MRI may provide further anatomic and tissue characterization evaluation. Those with myocardial NET metastases without carcinoid heart disease did not have significant hemodynamic effect based on echocardiographic criteria.
Copyright © 2022 Elsevier Inc. All rights reserved.
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A Case of Isolated Cardiac Burkitt Lymphoma Causing Right-Sided Heart Failure.
Tex Heart Inst J2022 Nov;49(6):. doi: e217575.
Rector Graham, Koh Stephanie J, Tabbaa Rashed,
Abstract
Primary cardiac tumors are rare, as the most common cause of cardiac masses is from metastatic disease. In this article, a unique case of isolated cardiac Burkitt lymphoma causing right-sided heart failure in a 70-year-old man who presented to the emergency department with abdominal distension and lower-extremity swelling is described. The right ventricular mass was initially identified via computed tomographic scans of the abdomen and pelvis. Further workup included transthoracic echocardiogram and cardiac magnetic resonance imaging that showed extension of the mass into the right atrium and pericardium. Staging imaging and bone marrow biopsy revealed no evidence of metastatic disease. Cytology of the peritoneal fluid and biopsy of the right ventricular mass confirmed Burkitt lymphoma. The cardiac mass substantially decreased in size and the right-sided heart failure resolved after the initiation of chemotherapy, which highlights the importance of prompt diagnosis and treatment of Burkitt lymphoma.
© 2022 by the Texas Heart® Institute, Houston.
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Heart Failure as the Initial Clinical Manifestation of Becker Muscular Dystrophy in an Adult.
Tex Heart Inst J2022 Nov;49(6):. doi: e217634.
Del Rio-Pertuz Gaspar, Morataya Cristina, Ratheal Kelly, Rios Steven R, Sethi Pooja, Argueta-Sosa Erwin,
Abstract
Congestive heart failure is an uncommon initial presentation for dystrophin-deficient muscular dystrophies. Cardiac manifestations may appear in late disease stages, although they classically present after musculoskeletal symptoms develop. This case report describes a patient who presented with heart failure and was newly diagnosed with Becker muscular dystrophy. The objective is to recognize Becker muscular dystrophy as a potential cause of dilated cardiomyopathy in young patients, even in the absence of clinically overt musculoskeletal symptoms.
© 2022 by the Texas Heart® Institute, Houston.
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Single breath-hold MR T1 mapping in the heart: Hybrid MOLLI combining saturation and inversion recovery.
Magn Reson Imaging2022 Dec;():. doi: S0730-725X(22)00210-7.
Yu Chun-Yang, Huang Teng-Yi, Chung Hsiao-Wen,
Abstract
The native T1 values of the myocardium provide valuable information for tissue characterization and assessment of cardiomyopathies. In this study, we proposed a novel hybrid MOLLI sequence for myocardial T1 mapping. Unlike the two groups of inversion-recovery sampling of the conventional MOLLI5(3?s)3 sequence, the hybrid MOLLI sequence consisted of an inversion-recovery block followed by a saturation-recovery block. Since the second block employed a saturation pulse to spoil the longitudinal magnetization, it did not require a waiting period as MOLLI5(3?s)3 did. As a result, the hybrid MOLLI required less acquisition time leading to a practical application for patients with breath-hold difficulties. Phantom and healthy subject experiments were performed to evaluate the proposed sequence against the MOLLI5(3?s)3 sequence. The phantom study showed that the heart-rate dependency of one variant of the hybrid MOLLI sequences, hbMOLLI4, was comparable to that of MOLLI5(3?s)3. In addition, both hbMOLLI4 and MOLLI53 derived T1 values under 2% variations with simulated heart rates from 50 to 90 beats-per-minute within the range of T1 values for myocardium and blood before contrast administration. Simulation results suggested slightly reduced T1 fitting precision in hbMOLLI4 compared with MOLLI5(3?s)3, but prominently better than saturation recovery. Bland-Altman analysis on accuracy assessment revealed that hbMOLLI4 partially reduced the T1 underestimation of MOLLI5(3?s)3. In the human study, The T1 values of both methods were consistent (hbMOLLI4 vs. MOLLI5(3?s)3, slope?=?1.14, R?>?0.97), with equal reproducibility. The results supported that hybrid MOLLI produced comparable T1 mapping results in terms of accuracy, reproducibility, and heart-rate dependency, at the expense of slightly reduced precision. We concluded that the hybrid MOLLI sequence presents a competitive alternative to the MOLLI5(3?s)3 sequence when a speedy acquisition is required.
Copyright © 2022. Published by Elsevier Inc.
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Prolonged smoldering Douglas fir smoke inhalation augments respiratory resistances, stiffens the aorta, and curbs ejection fraction in hypercholesterolemic mice.
Sci Total Environ2022 Dec;():160609. doi: 10.1016/j.scitotenv.2022.160609.
Eden Matthew J, Matz Jacqueline, Garg Priya, Gonzalez Mireia Perera, McElderry Katherine, Wang Siyan, Gollner Michael J, Oakes Jessica M, Bellini Chiara,
Abstract
While mounting evidence suggests that wildland fire smoke (WFS) inhalation may increase the burden of cardiopulmonary disease, the occupational risk of repeated exposure during wildland firefighting remains unknown. To address this concern, we evaluated the cardiopulmonary function in mice following a cumulative exposure to lab-scale WFS equivalent to a mid-length wildland firefighter (WLFF) career. Dosimetry analysis indicated that 80 exposure hours at a particulate concentration of 22?mg/m yields in mice the same cumulative deposited mass per unit of lung surface area as 3600?h of wildland firefighting. To satisfy this condition, male Apoe mice were whole-body exposed to either air or smoldering Douglas fir smoke (DFS) for 2?h/day, 5?days/week, over 8 consecutive weeks. Particulate size in DFS fell within the respirable range for both mice and humans, with a count median diameter of 110?±?20?nm. Expiratory breath hold in mice exposed to DFS significantly reduced their minute volume (DFS: 27?±?4; Air: 122?±?8?mL/min). By the end of the exposure time frame, mice in the DFS group exhibited a thicker (DFS: 109?±?3; Air: 98?±?3??m) and stiffer (DFS: 23?±?1; Air: 28?±?1?MPa) aorta with reduced diastolic blood augmentation capacity (DFS: 53?±?2; Air: 63?±?2?kPa). Cardiac magnetic resonance imaging further revealed larger end-systolic volume (DFS: 14.6?±?1.1; Air: 9.9?±?0.9??L) and reduced ejection-fraction (DFS: 64.7?±?1.0; Air: 75.3?±?0.9 %) in mice exposed to DFS. Consistent with increased airway epithelium thickness (DFS: 10.4?±?0.8; Air: 7.6?±?0.3??m), airway Newtonian resistance was larger following DFS exposure (DFS: 0.23?±?0.03; Air: 0.20?±?0.03 cmHO-s/mL). Furthermore, parenchyma mean linear intercept (DFS: 36.3?±?0.8; Air: 33.3?±?0.8??m) and tissue thickness (DFS: 10.1?±?0.5; Air: 7.4?±?0.7??m) were larger in DFS mice compared to air controls. Collectively, mice exposed to DFS manifested early signs of cardiopulmonary dysfunction aligned with self-reported events in mid-career WLFFs.
Copyright © 2022. Published by Elsevier B.V.
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Yield of Cardiac Magnetic Resonance Imaging in a Preparticipation Cohort of Young Asian Males With T Wave Inversion.
Circulation2022 Dec;146(23):1802-1804. doi: 10.1161/CIRCULATIONAHA.122.061271.
Thiagarajan Nishanth, Ho Wilbert H H, Lim Daniel Y Z, Loo Wesley T W, Shen Goy, Sundar Vahul, Lim Huai Yang, Lim Lian Kiat, Chua Terrance S J, Lim Paul C Y, Tang Hak Chiaw, Koh Choong Hou, Yeo Tee Joo, Chong Daniel T T,
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Myopericarditis After COVID-19 mRNA Vaccination Among Adolescents and Young Adults: A Systematic Review and Meta-analysis.
JAMA Pediatr2022 Dec;():. doi: 10.1001/jamapediatrics.2022.4768.
Yasuhara Jun, Masuda Kaihei, Aikawa Tadao, Shirasu Takuro, Takagi Hisato, Lee Simon, Kuno Toshiki,
Abstract
IMPORTANCE:
Published data on COVID-19 mRNA vaccine-associated myopericarditis in adolescents and young adults have been derived from small case series, national population-based studies, or passive reporting systems. Pooled evidence from a larger, international cohort is scarce.
OBJECTIVE:
To investigate the clinical features and early outcomes associated with myopericarditis after COVID-19 mRNA vaccination in a heterogeneous population of adolescents and young adults.
DATA SOURCES:
PubMed and EMBASE were searched through August 2022. Language restrictions were not applied.
STUDY SELECTION:
Observational studies and case series describing COVID-19 vaccine-associated myopericarditis in adolescents and young adults aged 12 to 20 years and reporting clinical characteristics and early outcomes were included.
DATA EXTRACTION AND SYNTHESIS:
Two independent investigators extracted relevant data from each study. One-group meta-analysis in a random effects model was performed. The Preferred Reporting Items for Systematic Reviews and Meta-analysis and Meta-analysis of Observational Studies in Epidemiology reporting guidelines were followed.
MAIN OUTCOMES AND MEASURES:
The primary outcomes were clinical features and early outcomes for COVID-19 mRNA vaccine-associated myopericarditis, including incident rate, cardiac findings, hospitalization, intensive care unit (ICU) admission, and in-hospital mortality.
RESULTS:
A total of 23 observational studies were identified, including 854 individuals (mean age, 15.9 [95% CI, 15.5-16.2] years) with COVID-19 vaccine-associated myopericarditis. Male sex was predominant, at 90.3% (95% CI, 87.3%-93.2%) of individuals. The incident rate was higher after the second dose than the first dose, with 74.4% (95% CI, 58.2%-90.5%) of events occurring after the second dose. Most patients (84.4% [95% CI, 80.5%-88.3%] of patients) had preserved left ventricular (LV) function. Of the 15.6% (95% CI, 11.7%-19.5%) of patients with LV systolic dysfunction (LV ejection fraction [LVEF]
CONCLUSIONS AND RELEVANCE:
This systematic review and meta-analysis found low incidence rate and largely favorable early outcomes of COVID-19 mRNA vaccine-associated myopericarditis in adolescents and young adults from a wide range of populations. These findings are reassuring but continued follow-up is warranted.
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The Impact of Bariatric Surgery on Cardiac Structure, and Systolic and Diastolic Function in Patients with Obesity: A Systematic Review and Meta-analysis.
Obes Surg2022 Dec;():. doi: 10.1007/s11695-022-06396-z.
Esparham Ali, Shoar Saeed, Kheradmand Hamid Reza, Ahmadyar Soheil, Dalili Amin, Rezapanah Alireza, Zandbaf Tooraj, Khorgami Zhamak,
Abstract
The purpose of this study was to provide pooled data from all studies on the impact of bariatric surgery on cardiac structure, and systolic and diastolic function evaluated by either echocardiography or cardiac magnetic resonance. PubMed, Web of Science, Embase, and Scopus databases were searched. Almost all of cardiac left-side structural indices improved significantly after bariatric surgery. However, right-side structural indices did not change significantly. Left ventricular ejection fraction and most of the diastolic function indices improved significantly after the bariatric surgery. The subgroup analysis showed that the left ventricular mass index decreased more in long-term follow-up (??12 months). In addition, subgroup analysis of studies based on surgery type did not reveal any difference in outcomes between gastric bypass and sleeve gastrectomy groups.
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Adults with small, unrepaired atrial septal defects have reduced cardiac index during exercise.
Cardiol Young2022 Dec;():1-11. doi: 10.1017/S1047951122003742.
Maagaard Marie, Boutrup Nicolai, Udholm Sebastian, Ahlstrup Mathias, Nielsen-Kudsk Jens Erik, Ringgaard Steffen, Hjortdal Vibeke,
Abstract
OBJECTIVES:
Small, unrepaired atrial septal defects are considered a benign lesion with good prognosis. Recently, clinical and register-based studies discovered increased long-term mortality and morbidity. The nature of these findings is not fully understood. Therefore, MRI was performed to evaluate cardiac function at rest and during exercise.
METHODS:
Adults with open or spontaneously closed atrial septal defects and healthy, matched controls underwent MRI for evaluation of cardiac chamber volume. Quantitative flow scans measured blood flow in the ascending aorta and the proximal pulmonary artery at rest and during increasing supine exercise.
RESULTS:
In total, 15 open defects (39 ± 11 years) and 15 matched controls (38 ± 12 years) were included, along with 20 spontaneously closed (36 ± 13 years) and 20 controls (36 ± 11 years). Cardiac chamber volumes and flow measurements at rest were comparable between groups, as were heart rates and workloads during exercise. At maximal exercise, open defects reached 31% lower cardiac index and had 38% higher retrograde flow in the pulmonary artery than their controls, p
CONCLUSION:
Adults with a small, open or spontaneously closed atrial septal defects exhibit markedly lower exercise capacity compared with healthy peers. Moreover, open defects exhibit higher retrograde flows with increasing exercise. Finally, increasing age is related to poorer results in patients but not healthy controls. Longitudinal studies are necessary in order to determine potential accelerated worsening of physical capacity along with age-related changes in patients.
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Treatment decision in a 4-year-old-boy with left ventricular outpouching after advanced hemodynamical flow evaluation with 4Dflow CMR: A case report.
Front Pediatr2022 ;10():953770. doi: 953770.
Lagerstrand Kerstin, Svensson Par-Arne, Andersson Linnea, Synnergren Mats, Öhman Annika, Petersson Magnus, Sunnegardh Jan, Dangardt Frida,
Abstract
BACKGROUND:
The present study presents a diagnostic course for the characterization of a congenital left ventricular outpouching (LVO) in a 4-year-old boy with severe neonatal heart failure, evaluating the added value of cardiac magnetic resonance (CMR) 4Dflow.
CASE PRESENTATION:
A boy, born at full term, presented with heart failure immediately after birth. Echocardiography showed dilated left ventricle with poor function and LVO was initially interpreted as an aneurysm. No infection, inflammation, or other cause for heart failure was found. With intensive medical treatment, the heart function returned to normal, and eventually, all medication was terminated. At follow-up, surgical treatment of the LVO was discussed but after CMR 4Dflow, a thorough evaluation of the function of the left ventricle as well as the LVO was possible and the LVO was determined a double-chambered left ventricle with a good prognosis.
CONCLUSIONS:
The present case demonstrates the clinical usability of CMR 4Dflow for improved decision-making and risk assessment, revealing advanced hemodynamic flow patterns with no need for operation.
© 2022 Lagerstrand, Svensson, Andersson, Synnergren, Öhman, Petersson, Sunnegardh and Dangardt.
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Myocardial fibrosis in congenital heart disease.
Front Pediatr2022 ;10():965204. doi: 965204.
Gordon Blanca, González-Fernández Víctor, Dos-Subirà Laura,
Abstract
Myocardial fibrosis resulting from the excessive deposition of collagen fibers through the myocardium is a common histopathologic finding in a wide range of cardiovascular diseases, including congenital anomalies. Interstitial fibrosis has been identified as a major cause of myocardial dysfunction since it distorts the normal architecture of the myocardium and impairs the biological function and properties of the interstitium. This review summarizes current knowledge on the mechanisms and detrimental consequences of myocardial fibrosis in heart failure and arrhythmias, discusses the usefulness of available imaging techniques and circulating biomarkers to assess this entity and reviews the current body of evidence regarding myocardial fibrosis in the different subsets of congenital heart diseases with implications in research and treatment.
© 2022 Gordon, González-Fernández and Dos-Subirà.
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Clinical factors associated with microstructural connectome related brain dysmaturation in term neonates with congenital heart disease.
Front Neurosci2022 ;16():952355. doi: 952355.
Votava-Smith Jodie K, Gaesser Jenna, Harbison Anna Lonyai, Lee Vince, Tran Nhu, Rajagopalan Vidya, Del Castillo Sylvia, Kumar S Ram, Herrup Elizabeth, Baust Tracy, Johnson Jennifer A, Gabriel George C, Reynolds William T, Wallace Julia, Meyers Benjamin, Ceschin Rafael, Lo Cecilia W, Schmithorst Vanessa J, Panigrahy Ashok,
Abstract
OBJECTIVE:
Term congenital heart disease (CHD) neonates display abnormalities of brain structure and maturation, which are possibly related to underlying patient factors, abnormal physiology and perioperative insults. Our primary goal was to delineate associations between clinical factors and postnatal brain microstructure in term CHD neonates using diffusion tensor imaging (DTI) magnetic resonance (MR) acquisition combined with complementary data-driven connectome and seed-based tractography quantitative analyses. Our secondary goal was to delineate associations between mild dysplastic structural brain abnormalities and connectome and seed-base tractography quantitative analyses. These mild dysplastic structural abnormalities have been derived from prior human infant CHD MR studies and neonatal mouse models of CHD that were collectively used to calculate to calculate a brain dysplasia score (BDS) that included assessment of subcortical structures including the olfactory bulb, the cerebellum and the hippocampus.
METHODS:
Neonates undergoing cardiac surgery for CHD were prospectively recruited from two large centers. Both pre- and postoperative MR brain scans were obtained. DTI in 42 directions was segmented into 90 regions using a neonatal brain template and three weighted methods. Clinical data collection included 18 patient-specific and 9 preoperative variables associated with preoperative scan and 6 intraoperative (e.g., cardiopulmonary bypass and deep hypothermic circulatory arrest times) and 12 postoperative variables associated with postoperative scan. We compared patient specific and preoperative clinical factors to network topology and tractography alterations on a preoperative neonatal brain MRI, and intra and postoperative clinical factors to network topology alterations on postoperative neonatal brain MRI. A composite BDS was created to score abnormal findings involving the cerebellar hemispheres and vermis, supratentorial extra-axial fluid, olfactory bulbs and sulci, hippocampus, choroid plexus, corpus callosum, and brainstem. The neuroimaging outcomes of this study included (1) connectome metrics: cost (number of connections) and global/nodal efficiency (network integration); (2) seed based tractography methods of fractional anisotropy (FA), radial diffusivity, and axial diffusivity. Statistics consisted of multiple regression with false discovery rate correction (FDR) comparing the clinical risk factors and BDS (including subcortical components) as predictors/exposures and the global connectome metrics, nodal efficiency, and seed based- tractography (FA, radial diffusivity, and axial diffusivity) as neuroimaging outcome measures.
RESULTS:
A total of 133 term neonates with complex CHD were prospectively enrolled and 110 had analyzable DTI. Multiple patient-specific factors including d-transposition of the great arteries (d-TGA) physiology and severity of impairment of fetal cerebral substrate delivery (i.e., how much the CHD lesion alters typical fetal circulation such that the highest oxygen and nutrient rich blood from the placenta are not directed toward the fetal brain) were predictive of preoperative reduced cost (
CONCLUSION:
Patient-specific (d-TGA anatomy, preoperative impairment of fetal cerebral substrate delivery) and postoperative (e.g., seizures, need for ECMO, or CPR) clinical factors were most predictive of diffuse postnatal microstructural dysmaturation in term CHD neonates. Anthropometric measurements (weight, length, and head size) predicted tractography outcomes. In contrast, subcortical components (cerebellum, hippocampus, olfactory) of a structurally based BDS (derived from CHD mouse mutants), predicted more localized and regional postnatal microstructural differences. Collectively, these findings suggest that brain DTI connectome and seed-based tractography are complementary techniques which may facilitate deciphering the mechanistic relative contribution of clinical and genetic risk factors related to poor neurodevelopmental outcomes in CHD.
Copyright © 2022 Votava-Smith, Gaesser, Harbison, Lee, Tran, Rajagopalan, del Castillo, Kumar, Herrup, Baust, Johnson, Gabriel, Reynolds, Wallace, Meyers, Ceschin, Lo, Schmithorst and Panigrahy.
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Work-up for Incidentally Detected NAFLD: How Far is It Worth?
Euroasian J Hepatogastroenterol2022 Jul;12(Suppl 1):S26-S36. doi: 10.5005/jp-journals-10018-1364.
Mishra Saurabh, Bhujade Harish, Butt Amna Subhan, Kamani Lubna, Premkumar Madhumita,
Abstract
UNLABELLED:
The incidence of nonalcoholic fatty liver disease (NAFLD) has seen a steep rise in parallel with the global obesity and metabolic syndrome epidemic. The presence of NAFLD contributes to significant socioeconomic burden due to healthcare costs, progression of liver disease as non-alcoholic steatohepatitis (NASH), and later cirrhosis and hepatocellular carcinoma (HCC). With the advent of widely available imaging, it is also being detected as an incidental diagnosis in individuals with systemic disease like metabolic syndrome, diabetes, chronic cardiac disease, polycystic ovarian syndrome, etc. or in asymptomatic persons on presurgical evaluation or even annual health assessments. Gastroenterologists, hepatologists, physicians and surgeons need to be updated about the new diagnostic criteria of Metabolic (dysfunction)-associated fatty liver disease, noninvasive tests (NITs) of liver fibrosis, new tools of elastography, and identification of those with high-risk disease. In this review, we appraise the relevance of new diagnostic definitions, steatosis and fibrosis estimation tests, advanced imaging like magnetic resonance elastography and proton density fat fraction and discuss the diagnostic algorithm for incidentally detected NAFLD.
HOW TO CITE THIS ARTICLE:
Mishra S, Bhujade H, Butt AS, . Work-up for Incidentally Detected NAFLD: How Far is It Worth? Euroasian J Hepato-Gastroenterol 2022;12(Suppl 1):S26-S36.
Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.
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Cardiac magnetic resonance imaging parameters show association between myocardial abnormalities and severity of chronic kidney disease.
Front Cardiovasc Med2022 ;9():1053122. doi: 1053122.
Jia Xi, Han Xiaoyu, Wang Yuqin, He Fangfang, Zhou Xiaoyue, Zheng Yuting, Guo Yingkun, Xu Rong, Liu Jia, Li Yumin, Gu Jin, Cao Yukun, Zhang Chun, Shi Heshui,
Abstract
BACKGROUND:
Chronic kidney disease patients have increased risk of cardiovascular abnormalities. This study investigated the relationship between cardiovascular abnormalities and the severity of chronic kidney disease using cardiac magnetic resonance imaging.
METHODS:
We enrolled 84 participants with various stages of chronic kidney disease (group I: stages 1-3, = 23; group II: stages 4-5, = 20; group III: hemodialysis patients, = 41) and 32 healthy subjects. The demographics and biochemical parameters of the study subjects were evaluated. All subjects underwent non-contrast cardiac magnetic resonance scans. Myocardial strain, native T1, and T2 values were calculated from the scanning results. Analysis of covariance was used to compare the imaging parameters between group I-III and the controls.
RESULTS:
The left ventricular ejection fraction (49 vs. 56%, = 0.021), global radial strain (29 vs. 37, = 0.019) and global circumferential strain (-17.4 vs. -20.6,
CONCLUSIONS:
Our study showed that myocardial strain, native T1, and T2 values progressively got worse with advancing chronic kidney disease stage. The increased T1 values and decreased T2 values of hemodialysis patients might be due to increasing myocardial fibrosis but with reduction in oedema following effective fluid management.
TRIAL REGISTRATION NUMBER:
ChiCTR2100053561 (http://www.chictr.org.cn/edit.aspx?pid=139737&htm=4).
Copyright © 2022 Jia, Han, Wang, He, Zhou, Zheng, Guo, Xu, Liu, Li, Gu, Cao, Zhang and Shi.
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Assessment of right ventricular remodeling in chronic thromboembolic pulmonary hypertension by 2D-speckle tracking echocardiography: A comparison with cardiac magnetic resonance.
Front Cardiovasc Med2022 ;9():999389. doi: 999389.
Wang Yeqing, Guo Dichen, Liu Mingxi, Zhang Xinyuan, Hu Huimin, Yang Hao, Yang Yuanhua, Lv Xiuzhang, Li Yidan, Guo Xiaojuan,
Abstract
BACKGROUND:
Right heart remodeling occurs in a substantial proportion of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and significantly affects their prognosis. Two-dimensional speckle-tracking echocardiography (2D-STE) can be used to evaluate myocardial deformation under physiological and pathological conditions. This study aimed to assess the feasibility of 2D-STE for evaluating right ventricular (RV) remodeling in CTEPH patients.
METHODS:
This retrospective study included 21 CTEPH patients who underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR). Data for the following parameters that can reflect RV function were collected: tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), right ventricular index of myocardial performance (RIMP), peak systolic velocity of the tricuspid annulus (S'), and CMR-right ventricular ejection fraction (CMR-RVEF). The following strain parameters were calculated using post-processing software: STE-RV global longitudinal strain (STE-RVGLS), STE-RV free wall longitudinal strain (STE-RVFWLS), and CMR-RVGLS.
RESULTS:
As CMR-RVEF deteriorated, RV remodeling in CTEPH patients became more apparent and was mainly characterized by significant enlargement of the RV, weakening of myocardial deformation, and a decrease in RV contractility (RV area, STE-RVFWLS, STE-RVGLS: mild vs. severe and moderate vs. severe,
CONCLUSIONS:
For the measurement of RVGLS, 2D-STE is similarly feasible to CMR-FT and could sensitively identify right heart remodeling.
Copyright © 2022 Wang, Guo, Liu, Zhang, Hu, Yang, Yang, Lv, Li and Guo.
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'TAVR Infected Pseudomonas Endocarditis': a case report.
Ther Adv Infect Dis2022 ;9():20499361221138459. doi: 20499361221138459.
Essien Francis, Patterson Shane, Estrada Fernando, Wall Timothy, Madden John, McGarvey Michael,
Abstract
UNLABELLED:
() rarely causes infective endocarditis (IE), previously reported for approximately 3% of all patients with IE. Most commonly, the infection occurs in intravenous drug users (IVDU) as right-sided endocarditis, noting presentations IE without history of intravenous drug to be extremely rare, finding only a few cases reported in the literature. However there are increasing reports of cardiovascular implantable electronic device-related and prosthetic heart valve infections caused by this pathogen in non-IVDUs. This report will focus on the clinical presentation, management, and outcome of endocarditis in an 89-year-old patient with a transcatheter aortic valve replacement (TAVR). Medical management was pursued due to the patient's underlying comorbidities. Long-term suppressive antibiotic therapy with delafloxacin was successful in maintaining negative blood cultures, despite an allergy to levofloxacin and ciprofloxacin.
PLAIN LANGUAGE SUMMARY:
An 89-year-old male was admitted to our hospital after he was diagnosed with a blood stream infection. The initial identification noted gram-negative organisms consistent with so the patient was started on intravenous (IV) antibiotics. He improved after the antibiotics started and was discharged to a nursing facility to complete his antibiotics course. While at the facility, after he had finished his antibiotics, he started to become ill again. He was brought back to the hospital to be evaluated. His repeat blood cultures again grew This suggested that his infection had not been cleared the first time and most likely he had a source of bacterial growth. A few years prior, a transcatheter aortic valve replacement (TAVR) had been performed for the patient. This was suspected as the source of continued infection and so a transthoracic echocardiogram was obtained, which revealed vegetation on the TAVR. We also obtained a magnetic resonance imaging (MRI) of the brain, which demonstrated infarcts of several portions of the brain consistent with emboli. Due to his age and additional medical issues, the patient was not a candidate for surgical valve replacement. We decided to try medical therapy with a fluoroquinolone antibiotic since the bacteria was susceptible to it. Unfortunately, he had demonstrated allergies to the usual choices to include Levaquin and ciprofloxacin. Therefore, we elected to start him on a new fluoroquinolone agent that had recently been FDA approved and obtained by our facility called delafloxacin. The patient tolerated this well and his repeat blood cultures remain clear. After discussion with the infectious disease specialist, he requires a lifelong suppression with the medication since the TAVR cannot be removed. This case is meant to illustrate the effectiveness of medical therapy when surgical options are not available.
© The Author(s), 2022.
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Society for cardiovascular magnetic resonance recommendations for training and competency of CMR technologists.
J Cardiovasc Magn Reson2022 Dec;24(1):68. doi: 10.1186/s12968-022-00900-1.
Darty Stephen, Jenista Elizabeth, Kim Raymond J, Dyke Christopher, Simonetti Orlando P, Radike Monika, Bryant Jen, Lawton Chris Benny, Freitag Nicole, Shah Dipan J, Bucciarelli-Ducci Chiara, Raman Subha, Plein Sven, Elliott Michael D,
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) recommendations for training and competency of cardiovascular magnetic resonance (CMR) technologists document will define the knowledge, experiences and skills required for a technologist to be competent in CMR imaging. By providing a framework for CMR training and competency the overarching goal is to promote the performance of high-quality CMR and to foster the increased adoption of CMR into clinical care.
© 2022. The Author(s).
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Feasibility of monitoring the resolution of acute pulmonary embolism with non-contrast-enhanced magnetic resonance imaging at one day, one week, one, three, and six months.
Acta Radiol2022 Sep;():2841851221122449. doi: 10.1177/02841851221122449.
Medson Koshiar, Westerlund Eli, Paris Roberto Vargas, Fyrdahl Alexander, Vidovic Nina, Nyren Sven, Lindholm Peter,
Abstract
BACKGROUND:
Pulmonary embolism (PE) is a common cause of death with an incidence of approximately 1-2 cases per 1000 inhabitants in Europe and the United States. Treatment for PE is the administration of anticoagulants for at least three months.
PURPOSE:
To assess the feasibility of following the resolution rate of PE over time using repeated imaging with a non-contrast-enhanced magnetic resonance imaging (MRI) protocol.
MATERIAL AND METHODS:
Patients (n?=?18) diagnosed with acute PE via computed tomography pulmonary angiography (CTPA) underwent non-contrast-enhanced MRI at two tertiary hospitals. The first MRI was performed within 36 h of CTPA, with follow-up at one week, one, three, and six months. The MRI sequence used was a non-contrast-enhanced standard two-dimensional steady-state free precession under free-breathing and without respiratory or cardiac gating. All MRI scans were then compared to the initial CTPA. The emboli were assessed visually for location and size, and clot burden was calculated using the Qanadli score.
RESULTS:
MRI revealed complete resolution in seven cases at one week, in five cases at one month, and in three cases at three months. The most significant resolution of emboli occurred within the first few weeks, with only 10% of the diagnosed emboli persisting at the one-month examination.
CONCLUSION:
The use of MRI imparts the ability to visualize PE without radiation and thus allows multiple examinations to be made, for example in studies investigating the resolution of PE or the evaluation of drug effect in clinical trials.
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