Pubblicazioni recenti - cardiac magnetic resonance

• The impact of visceral and general obesity on vascular and left ventricular function and geometry: a cross-sectional magnetic resonance imaging study of the UK Biobank.
  Eur Heart J Cardiovasc Imaging

  2019 Nov;():. doi: jez279.
  
  van Hout Max J P, Dekkers Ilona A, Westenberg Jos J M, Schalij Martin J, Scholte Arthur J H A, Lamb Hildo J,
  
  Abstract
  
  AIMS :
  We aimed to evaluate the associations of body fat distribution with cardiovascular function and geometry in the middle-aged general population.
  
  METHODS AND RESULTS :
  Four thousand five hundred and ninety participants of the UK Biobank (54% female, mean age 61.1?±?7.2?years) underwent cardiac magnetic resonance for assessment of left ventricular (LV) parameters [end-diastolic volume (EDV), ejection fraction (EF), cardiac output (CO), and index (CI)] and magnetic resonance imaging for body composition analysis [subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT)]. Body fat percentage (BF%) was assessed by bioelectrical impedance. Linear regressions were performed to assess the impact of visceral (VAT) and general (SAT and BF%) obesity on cardiac function and geometry. Visceral obesity was associated with a smaller EDV [VAT: ? -1.74 (-1.15 to -2.33)], lower EF [VAT: ? -0.24 (-0.12 to -0.35), SAT: ? 0.02 (-0.04 to 0.08), and BF%: ? 0.02 (-0.02 to 0.06)] and the strongest negative association with CI [VAT: ? -0.05 (-0.06 to -0.04), SAT: ? -0.02 (-0.03 to -0.01), and BF% ? -0.01 (-0.013 to -0.007)]. In contrast, general obesity was associated with a larger EDV [SAT: ? 1.01 (0.72-1.30), BF%: ? 0.37 (0.23-0.51)] and a higher CO [SAT: ? 0.06 (0.05-0.07), BF%: ? 0.02 (0.01-0.03)]. In the gender-specific analysis, only men had a significant association between VAT and EF [? -0.35 (-0.19 to -0.51)].
  
  CONCLUSION :
  Visceral obesity was associated with a smaller LV EDV and subclinical lower LV systolic function in men, suggesting that visceral obesity might play a more important role compared to general obesity in LV remodelling.
  
  © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Self-calibrated interpolation of non-Cartesian data with GRAPPA in parallel imaging.
  Magn Reson Med

  2019 Nov;():. doi: 10.1002/mrm.28033.
  
  Chieh Seng-Wei, Kaveh Mostafa, Akçakaya Mehmet, Moeller Steen,
  
  Abstract
  
  PURPOSE:
  To develop a non-Cartesian k-space reconstruction method using self-calibrated region-specific interpolation kernels for highly accelerated acquisitions.
  
  METHODS:
  In conventional non-Cartesian GRAPPA with through-time GRAPPA (TT-GRAPPA), the use of region-specific interpolation kernels has demonstrated improved reconstruction quality in dynamic imaging for highly accelerated acquisitions. However, TT-GRAPPA requires the acquisition of a large number of separate calibration scans. To reduce the overall imaging time, we propose Self-calibrated Interpolation of Non-Cartesian data with GRAPPA (SING) to self-calibrate region-specific interpolation kernels from dynamic undersampled measurements. The SING method synthesizes calibration data to adapt to the distinct shape of each region-specific interpolation kernel geometry, and uses a novel local k-space regularization through an extension of TT-GRAPPA. This calibration approach is used to reconstruct non-Cartesian images at high acceleration rates while mitigating noise amplification. The reconstruction quality of SING is compared with conjugate-gradient SENSE and TT-GRAPPA in numerical phantoms and in vivo cine data sets.
  
  RESULTS:
  In both numerical phantom and in vivo cine data sets, SING offers visually and quantitatively similar reconstruction quality to TT-GRAPPA, and provides improved reconstruction quality over conjugate-gradient SENSE. Furthermore, temporal fidelity in SING and TT-GRAPPA is similar for the same acceleration rates. G-factor evaluation over the heart shows that SING and TT-GRAPPA provide similar noise amplification at moderate and high rates.
  
  CONCLUSION:
  The proposed SING reconstruction enables significant improvement of acquisition efficiency for calibration data, while matching the reconstruction performance of TT-GRAPPA.
  
  © 2019 International Society for Magnetic Resonance in Medicine.
  
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• Safe guidewire visualization using the modes of a PTx transmit array MR system.
  Magn Reson Med

  2019 Nov;():. doi: 10.1002/mrm.28069.
  
  Godinez Felipe, Scott Greig, Padormo Francesco, Hajnal Joseph V, Malik Shaihan J,
  
  Abstract
  
  PURPOSE:
  MRI-guided cardiovascular intervention using standard metal guidewires can produce focal tissue heating caused by induced radiofrequency guidewire currents. It has been shown that safe operation is made possible by using parallel transmit radiofrequency coils driven in the null current mode, which does not induce radiofrequency currents and hence allows safe tissue visualization. We propose that the maximum current modes, usually considered unsafe, be used at very low power levels to visualize conductive wires, and we investigate pulse sequences best suited for this application.
  
  METHODS:
  Spoiled gradient echo, balanced steady-state free precession, and turbo spin echo sequences were evaluated for their ability to visualize a conductive guidewire embedded in a gel phantom when run in maximum current modes at very low power level. Temperature at the guidewire tip was monitored for safety assessment.
  
  RESULTS:
  Excellent guidewire visualization could be achieved using maximum current modes excitation, with the turbo spin echo sequence giving the best image quality. Although turbo spin echo is usually considered to be a high-power sequence, our method reduced all pulses to 1% amplitude (0.01% power), and heating was not detected. In addition, visualization of background tissue can be achieved using null current mode, also with no recorded heating at the guidewire tip even when running at 100% (reported) specific absorption rate.
  
  CONCLUSION:
  Parallel transmit is a promising approach for both guidewire and tissue visualization using maximum and null current modes, respectively, for interventional cardiac MRI. Such systems can switch excitation mode instantaneously, allowing for flexible integration into interactive sequences.
  
  © 2019 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine.
  
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• Serum Exosome MicroRNAs Predict Multiple Sclerosis Disease Activity after Fingolimod Treatment.
  Mol Neurobiol

  2019 Nov;():. doi: 10.1007/s12035-019-01792-6.
  
  Ebrahimkhani Saeideh, Beadnall Heidi N, Wang Chenyu, Suter Catherine M, Barnett Michael H, Buckland Michael E, Vafaee Fatemeh,
  
  Abstract
  
  We and others have previously demonstrated the potential for circulating exosome microRNAs to aid in disease diagnosis. In this study, we sought the possible utility of serum exosome microRNAs as biomarkers for disease activity in multiple sclerosis patients in response to fingolimod therapy. We studied patients with relapsing-remitting multiple sclerosis prior to and 6 months after treatment with fingolimod. Disease activity was determined using gadolinium-enhanced magnetic resonance imaging. Serum exosome microRNAs were profiled using next-generation sequencing. Data were analysed using univariate/multivariate modelling and machine learning to determine microRNA signatures with predictive utility. Accordingly, we identified 15 individual miRNAs that were differentially expressed in serum exosomes from post-treatment patients with active versus quiescent disease. The targets of these microRNAs clustered in ontologies related to the immune and nervous systems and signal transduction. While the power of individual microRNAs to predict disease status post-fingolimod was modest (average 77%, range 65 to 91%), several combinations of 2 or 3 miRNAs were able to distinguish active from quiescent disease with greater than 90% accuracy. Further stratification of patients identified additional microRNAs associated with stable remission, and a positive response to fingolimod in patients with active disease prior to treatment. Overall, these data underscore the value of serum exosome microRNA signatures as non-invasive biomarkers of disease in multiple sclerosis and suggest they may be used to predict response to fingolimod in future clinical practice. Additionally, these data suggest that fingolimod may have mechanisms of action beyond its known functions.
  
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• Contrast-enhanced echocardiographic measurement of longitudinal strain: accuracy and its relationship with image quality.
  Int J Cardiovasc Imaging

  2019 Nov;():. doi: 10.1007/s10554-019-01732-4.
  
  Karagodin Ilya, Genovese Davide, Kruse Eric, Patel Amit R, Rashedi Nina, Lang Roberto M, Mor-Avi Victor,
  
  Abstract
  
  The importance of left ventricular (LV) global longitudinal strain (GLS) is increasingly recognized in multiple clinical scenarios. However, in patients with poor image quality, strain is difficult or impossible to measure without contrast enhancement. The feasibility of contrast-enhanced GLS measurement was recently demonstrated. We sought to determine: (1) whether contrast enhancement improves the accuracy of GLS measurements against cardiac magnetic resonance (CMR) reference, (2) their reproducibility compared to non-enhanced GLS, and (3) the dependence of accuracy and reproducibility on image quality. We prospectively enrolled 25 patients undergoing clinically indicated CMR imaging who subsequently underwent transthoracic echocardiography (TTE) with and without low-dose contrast injection (1-2 mL Optison/3-5 mL saline IV, GE Healthcare). GLS was measured from both non-contrast and contrast-enhanced images using speckle tracking (EchoInsight, Epsilon Imaging). These measurements were compared to each other and to CMR reference values obtained using feature tracking (SuiteHEART, NeoSoft). Inter-technique comparisons included linear regression and Bland-Altman analyses. A random subgroup of 15 patients was used to assess inter- and intra-observer variability using intra-class correlation (ICC). Contrast-enhanced GLS was in close agreement with non-enhanced GLS (r?=?0.95; bias: -?0.2?±?1.5%). Both inter-observer (ICC?=?0.88 vs. 0.82) and intra-observer variability (ICC?=?0.91 vs. 0.88) were improved by contrast enhancement. The agreement with CMR was better for contrast-enhanced GLS (r?=?0.87; bias: 1.1?±?2.2%) than for non-enhanced GLS (r?=?0.80; bias: 1.3?±?2.7%). In 12/25 patients with suboptimal TTE images that rendered GLS difficult to measure, contrast-enhanced GLS showed better agreement with CMR than non-enhanced GLS (r?=?0.88 vs. 0.83) and also improved inter-observer (ICC?=?0.83 vs. 0.76) and intra-observer variability (ICC?=?0.88 vs. 0.82). In conclusion, contrast enhancement of TTE images improves the accuracy and reproducibility of GLS measurements, resulting in better agreement with CMR, even in patients with suboptimal acoustic windows. This approach may aid in the assessment of LV function in this patient population.
  
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• Cardiac magnetic resonance imaging to detect ischemia in chronic coronary syndromes - state of the art.
  Kardiol Pol

  2019 Nov;():. doi: 10.33963/KP.15057.
  
  Sokolska Justyna Maria, von Spiczak Jochen, Gotschy Alexander, Kozerke Sebastian, Manka Robert,
  
  Abstract
  
  The new '2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes' emphasize the role of non-invasive functional imaging of myocardial ischemia in diagnosing coronary artery disease to guide decision regarding revascularization. Cardiac magnetic resonance (CMR) stands out relative to other imaging modalities given its high safety profile, absence of ionizing radiation and its versatility in encoding various image contrasts. CMR allows to assess myocardial function, ischemia, viability and permits tissue characterization including detection of edema in a single examination. In recent years a number of meta-analyses and studies considering the role of CMR for detecting ischemia has been published. The recent multi-center, randomized MR-INFORM trial has demonstrated the clinical utility of CMR in patients with stable angina and cardiovascular risk factors. This landmark study has proven that perfusion CMR- based strategy leads to lower numbers of revascularizations while being non-inferior to an invasive coronary angiography with fractional flow reserve- guided therapy in terms of major adverse cardiac events at 1 year. In light of recent and future technical improvements, CMR will further extend its importance in the assessment of myocardial ischemia in patients with chronic coronary syndromes.
  
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• Improved Biomarker and Imaging Analysis for Characterizing Progressive Cardiac Fibrosis in a Mouse Model of Chronic Chagasic Cardiomyopathy.
  J Am Heart Assoc

  2019 Nov;8(22):e013365. doi: 10.1161/JAHA.119.013365.
  
  Hoffman Kristyn A, Reynolds Corey, Bottazzi Maria Elena, Hotez Peter, Jones Kathryn,
  
  Abstract
  
  Background Chronic chagasic cardiomyopathy (CCC), caused by infection, is an important public health problem attributable to progressive cardiomyopathy in patients, for which there is no cure. Chronic chagasic cardiomyopathy is characterized by myocarditis and cardiac fibrosis, which leads to life-threatening arrhythmogenic and circulatory abnormalities. This study aimed to investigate cardiac fibrosis progression in a mouse model of chronic chagasic cardiomyopathy. Methods and Results Cardiac cells infected with produced significantly higher concentrations of transforming growth factor-? (TGF-?), connective tissue growth factor, endothelin-1, and platelet-derived growth factor-D than noninfected controls. Female Balb/c mice infected with were compared with naïve mice. TGF-? genes and other TGF-? superfamily genes, as well as connective tissue growth factor, endothelin-1, and platelet-derived growth factor, were upregulated in infected mouse hearts. Serum concentrations of TGF-?, connective tissue growth factor, and platelet-derived growth factor-D were higher in infected mice and correlated with cardiac fibrosis. Strain analysis performed on magnetic resonance images at 111 and 140 days postinfection and echocardiography images at 212 days postinfection revealed significantly elevated left ventricular strain and cardiac fibrosis and concomitantly significantly decreased cardiac output in infected mice. Conclusions TGF-?, connective tissue growth factor and platelet-derived growth factor-D are potentially useful biomarkers of cardiac fibrosis, as they correlate with cardiac fibrosis. Strain analysis allows for use of noninvasive methods to measure fibrosis in the chronic stages of chagasic cardiomyopathy in a mouse model. These findings can be applied as noninvasive tools to study the effects of interventions and/or therapeutics on cardiac fibrosis development when using a mouse model of chronic chagasic cardiomyopathy.
  
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• Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate: rationale and design of the CENS study.
  Blood Press

  2019 Nov;():1-12. doi: 10.1080/08037051.2019.1684817.
  
  Blom Kjersti Benedicte, Bergo Kaja Knudsen, Espe Emil Knut Stenersen, Rosseland Vigdis, Grøtta Ole Jørgen, Mjøen Geir, Åsberg Anders, Bergan Stein, Sanner Helga, Bergersen Tone Kristin, Bjørnerheim Reidar, Skauby Morten, Seljeflot Ingebjørg, Waldum-Grevbo Bård, Dahle Dag Olav, Sjaastad Ivar, Birkeland Jon Arne,
  
  Abstract
  
  Until recently, it has been believed that donating a kidney not represents any risk for development of cardiovascular disease. However, a recent Norwegian epidemiological study suggests that kidney donors have an increased long-term risk of cardiovascular mortality. The pathophysiological mechanisms linking reduced kidney function to cardiovascular disease are not known. Living kidney donors are screened for cardiovascular morbidity before unilateral nephrectomy, and are left with mildly reduced glomerular filtration rate (GFR) after donation. Therefore, they represent an unique model for investigating the pathogenesis linking reduced GFR to cardiovascular disease and cardiovascular remodelling. We present the study design of Cardiovascular rEmodelling in living kidNey donorS with reduced glomerular filtration rate (CENS), which is an investigator-initiated prospective observational study on living kidney donors. The hypothesis is that living kidney donors develop cardiovascular remodelling due to a reduction of GFR. 60 living kidney donors and 60 age and sex matched healthy controls will be recruited. The controls will be evaluated to fulfil the Norwegian transplantation protocol for living kidney donors. Investigations will be performed at baseline and after 1, 3, 6 and 10 years in both groups. The investigations include cardiac magnetic resonance imaging, echocardiography, bone density scan, flow mediated dilatation, laser Doppler flowmetry, nailfold capillaroscopy, office blood pressure, 24-h ambulatory blood pressure, heart rate variability and investigation of microbiota and biomarkers for inflammation, cardiovascular risk and the calcium-phosphate metabolism. The present study seeks to provide new insight in the pathophysiological mechanisms linking reduced kidney function to cardiovascular disease. In addition, we aim to enlighten predictors of adverse cardiovascular outcome in living kidney donors. The study is registered at Clinical-Trials.gov (identifier: NCT03729557).
  
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• Multimodality Imaging Assessment of Fabry Disease.
  Circ Cardiovasc Imaging

  2019 Nov;12(11):e009013. doi: 10.1161/CIRCIMAGING.119.009013.
  
  Tower-Rader Albree, Jaber Wael A,
  
  Abstract
  
  Fabry disease is a lysosomal storage disease with a variety of cardiac manifestations. Although not specific for a diagnosis of Fabry disease, certain cardiac imaging findings may be highly suggestive of the diagnosis of Fabry disease in previously undiagnosed patients or cardiac involvement for patients with a known diagnosis of Fabry disease. In this review, we explore the current applications of multimodality cardiac imaging in the diagnosis and monitoring of patients with Fabry disease. Additionally, data regarding tissue characterization by cardiac magnetic resonance imaging and novel nuclear imaging techniques and their role in evaluating phenotype development is discussed.
  
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• All-Suture Anchor Settling After Arthroscopic Repair of Small and Medium Rotator Cuff Tears.
  Am J Sports Med

  2019 Nov;():363546519886547. doi: 10.1177/0363546519886547.
  
  Ro Kyunghan, Rhee Sung-Min, Kim Jung Youn, Kim Myung Seo, Kim Jong Dae, Lee Hojin, Rhee Yong Girl,
  
  Abstract
  
  BACKGROUND:
  All-suture anchors are increasingly being used in rotator cuff repair. However, there are debates on the micromotion of all-suture anchors.
  
  PURPOSE:
  To perform rotator cuff repair on patients with rotator cuff tears and different shoulder bone mineral densities (BMDs) and investigate (1) where the anchor is located under the cortex, (2) if there is any anchor migration settling during follow-up, and (3) if structural outcome differs according to shoulder BMD.
  
  STUDY DESIGN:
  Cohort study; Level of evidence, 3.
  
  METHODS:
  We retrospectively investigated 88 patients who underwent arthroscopic single-row repair for small- to medium-sized rotator cuff tears (age [mean ± SD], 58.8 ± 7.1 years) from 712 cases of rotator cuff tendon repair between November 2015 and February 2018. Inclusion criteria were as follows: use of an all-suture anchor; preoperative shoulder BMD; and magnetic resonance imaging (MRI) conducted preoperatively, 2 days after surgery, and 10 months after surgery. Patients were excluded from the study if they underwent open rotator cuff repair (n = 118), got surgery with a double-row technique (n = 178), underwent surgery with anchors other than the all-suture type (n = 273), received anchor insertion in sites other than the greater tuberosity owing to concomitant procedures such as biceps tenodesis and subscapularis repair (n = 29), did not take preoperative shoulder BMD (n = 15), had more than a large-size tear (n = 6), and were lost to follow-up (n = 5). After compression of the all-suture anchor during surgery, the strands were pulled multiple times to ensure that the anchor was fixed onto the bone with appropriate tension. BMD was measured before surgery. Depth to anchor (DA), anchor settling, and repaired rotator cuff integrity were measured with MRI. Patients were categorized into 3 groups: group A (BMD, <0.4 g/cm; n = 31), group B (BMD, 0.4-0.6 g/cm; n = 32), and group C (BMD, >0.6 g/cm; n = 25). A total of 65 patients had follow-up MRI. On the basis of rotator cuff tendon integrity, patients were categorized into either a sufficient thickness group (group S, Sugaya classification grade II or lower; n = 44) or an insufficient thickness group (group I, Sugaya classification grade III or higher; n = 21).
  
  RESULTS:
  On time-zero MRI, the DA differed significantly among groups (group A, 3.62 ± 2.02 mm; group B, 5.18 ± 2.13 mm; group C, 6.30 ± 3.34 mm) ( = .001). The DA was deeper in patients with a higher BMD at time zero ( = 0.374; = .001), but the DA did not differ at follow-up MRI (mean, 10.3 months after surgery). On follow-up MRI, anchor settling tended to increase with deeper time-zero DA ( = 0.769; < .001). Anchor settling was significantly different among groups (group A, 1.33 ± 1.08 mm; group B, 2.78 ± 1.99 mm; group C, 3.81 ± 2.19 mm) ( = .001). The proportion of patients with sufficient thickness in each group did not show a statistical difference (group A, 70.8%; group B, 72.7%; group C, 57.9%) ( = .550).
  
  CONCLUSION:
  In conclusion, this study confirmed that the postoperative site of anchor insertion in arthroscopic single-row rotator cuff repair with all-suture anchors was located farther from the cortex in patients with higher shoulder BMD and closer to the subcortical bone in patients with lower BMD. On follow-up MRI, no further settling occurred past a certain distance from the cortex, and there was no significant difference in anchor depth or integrity of the rotator cuff tendon based on shoulder BMD. Therefore, minimal settling in the all-suture anchor did not show clinical significance.
  
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• Non-contrast enhanced diagnosis of acute myocarditis based on the 17-segment heart model using 2D-feature tracking magnetic resonance imaging.
  Magn Reson Imaging

  2019 Nov;():. doi: S0730-725X(19)30517-X.
  
  Ravesh Mona Salehi, Eden Matthias, Langguth Patrick, Piesch Tim-Christian, Lehmann Johanna Karolin, Lebenatus Annett, Hauttemann David, Graessner Joachim, Frey Norbert, Jansen Olav, Both Marcus,
  
  Abstract
  
  PURPOSE:
  The aim of this study was to investigate the diagnostic value of myocardial deformation analysis based on the 17-segment heart model using non-contrast enhanced (CE) 2D tissue feature tracking (2D-FT) technique.
  
  MATERIAL AND METHODS:
  Seventy patients with suspected myocarditis underwent a cardiovascular magnetic resonance (CMR) examination at 1.5 Tesla. A contrast-agent-free part of this CMR protocol was additionally performed in forty healthy volunteers (HV). Besides standard CMR data sets, 2D-FT derived segmental and global longitudinal, radial, and circumferential deformation parameters were analyzed. The 2D-FT results were compared to the combined findings from CMR imaging and endomyocardial biopsy (EMB).
  
  RESULTS:
  Patients were assigned to three groups depending on their ejection fraction (EF) (<40%, 40-55%, ?55%). Compared to HV, impaired EF (<55%) was significantly correlated to reduced segmental and global strain and strain rate values. The circumferential deformation analysis was more sensitive to myocardial changes than longitudinal and radial analysis. The segmental strain/strain rate had an accuracy of 84.3%/70.0% for the diagnosis of an acute myocarditis, stated by EMB and CMR in 42 of 70 patients. In patients with preserved EF, acute myocarditis could be ruled out using only segmental strain analysis with a negative predictive value of 87.5%.
  
  CONCLUSION:
  In patients with suspected myocarditis, the deformation analysis based on the 17-segment heart model provides valuable information about functional myocardial inhomogeneity. This quantitative approach could be used in addition to the clinical standard CMR protocol and represents a promising tool in the framework of a prospective automatized multiparametric CMR imaging analysis.
  
  Copyright © 2019. Published by Elsevier Inc.
  
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• Biventricular pacing during cardiac magnetic resonance imaging.
  Europace

  2019 Nov;():. doi: euz289.
  
  Vago Hajnalka, Czimbalmos Csilla, Papp Roland, Szabo Liliana, Toth Attila, Dohy Zsofia, Csecs Ibolya, Suhai Ferenc, Kosztin Annamaria, Molnar Levente, Geller Laszlo, Merkely Bela,
  
  Abstract
  
  AIMS:
  We aimed to assess the effect of cardiac resynchronization on left ventricular (LV) function, volumes, geometry, and mechanics in order to demonstrate reverse remodelling using cardiac magnetic resonance (CMR) with resynchronization on.
  
  METHODS AND RESULTS:
  New York Heart Association (NYHA) Class II-III patients on optimal medical therapy with LV ejection fraction (LVEF) ?35%, and complete LBBB with broad QRS (>150 ms) were prospectively recruited. Cardiac magnetic resonance examination was performed at baseline and at 6-month follow-up, applying both biventricular and AOO pacing. The following data were measured: conventional CMR parameters, remodelling indices, global longitudinal, circumferential, radial strain, global dyssynchrony [mechanical dispersion (MD) defined as the standard deviation of time to peak longitudinal/circumferential strain in 16 LV segments], and regional dyssynchrony (maximum differences in time between peak septal and lateral transversal displacement). Thirteen patients (64?±?7?years, 38% male) were enrolled. Comparing the baseline and follow-up CMR parameters measured during biventricular pacing, significant increase in LVEF, and decrease in LV end-diastolic volume index (LVEDVi) and LV end-systolic volume index (LVESVi) were found. Left ventricular remodelling indices, global longitudinal, circumferential, and radial strain values showed significant improvement. Circumferential MD decreased (20.5?±?5.5 vs. 13.4?±?3.4, P?
  CONCLUSION:
  Cardiac magnetic resonance imaging during biventricular pacing is feasible and enables a more precise quantification of LV function, morphology, and mechanics. As a result, it may contribute to a better understanding of the effects of resynchronization therapy and might improve responder rate in the future.
  
  © The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Atrial fibrillation and cardiac fibrosis.
  Eur Heart J

  2019 Nov;():. doi: ehz786.
  
  Sohns Christian, Marrouche Nassir F,
  
  Abstract
  
  The understanding of atrial fibrillation (AF) evolved from a sole rhythm disturbance towards the complex concept of a cardiomyopathy based on arrhythmia substrates. There is evidence that atrial fibrosis can be visualized using late gadolinium enhancement cardiac magnetic resonance imaging and that it is a powerful predictor for the outcome of AF interventions. However, a strategy of an individual and fibrosis guided management of AF looks promising but results from prospective multicentre trials are pending. This review gives an overview about the relationship between cardiac fibrosis and AF focusing on translational aspects, clinical observations, and fibrosis imaging to emphasize the concept of personalized paths in AF management taking into account the individual amount and distribution of fibrosis.
  
  Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
  
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• Structural and Functional Properties of the Left Atrium in Healthy Volunteers and Patients With Atrial Fibrillation: Data of Magnetic Resonance Imaging.
  Kardiologiia

  2018 Nov;57(9):5-13. doi: 10.18087/cardio.2017.9.10029.
  
  Aparina Olga P, Stukalova O V, Parkhomenko D V, Mironova N A, Strazdenj E Yu, Ternovoy S K ', Golitsyn S P,
  
  Abstract
  
  BACKGROUND:
  In the recent years, there has been an increasing number of publications postulating that data on left atrial (LA) structure obtained by late gadolinium enhancement magnetic resonance imaging (LGE MRI) can improve the management of patients with atrial fibrillation (AF). At the same time, similar data regarding healthy LA myocardium is limited.
  
  AIM:
  To assess structural and functional properties of LA in healthy volunteers (HV) using cardiac magnetic resonance (CMR) (including LGE MRI); to compare these properties in patients with AF and HV.
  
  MATERIALS AND METHODS:
  We included in this study 53 patients with AF (28 without signs of cardiovascular disease, 28 with hypertension) and 23 HV of similar age. All enrolled persons underwent MRI. Cine-MRI was used to assess end diastolic volume of LA (LA EDV), LA ejection fraction (LA EF), left ventricular diastolic index (LV DI). High resolution LGE MRI was performed 15-20 min after gadoversetamide injection using IR 3D gradient echo pulse sequence with fat saturation (TI 290-340 ms, TE 2.44 ms, TR 610-1100ms). On obtained images LA was segmented semiautomatically. LA fibrosis quantification was performed using developed software LGE Heart Analyzer. The extent of fibrosis was represented as percent of LA myocardium volume. Fibrosis location was determined on reconstructed rotating 3D LA model.
  
  RESULTS:
  Compared with patients HV had lower LA EDV (59 [54; 78] ml and 79 [65.5; 86.6] ml, ?=0.043, respectively), higher LA EF (56.1 [49; 63.2] % and 44.5 [34.5, 54.5] %, ?=0.03, respectively), and lower extent of LA fibrosis (0.7 [0.05; 3.5] % and 9.1 [1.7; 18] %, ?.
  
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• Magnetic resonance imaging of patients with epicardial leads: in vitro evaluation of temperature changes at the lead tip.
  J Interv Card Electrophysiol

  2019 Nov;():. doi: 10.1007/s10840-019-00627-7.
  
  Balmer Christian, Gass Matthias, Dave Hitendu, Duru Firat, Luechinger Roger,
  
  Abstract
  
  PURPOSE:
  The aim of this study was to systematically investigate the potential heating effects of magnetic resonance imaging (MRI) in the presence of epicardial leads, which are connected to a device or abandoned, using a series of in vitro measurements.
  
  METHODS:
  The heating effects of MRI in a 1.5-T scanner were measured at the lead tip in a gel-filled tank. First, a transvenous lead (5086-45 cm, Medtronic) was compared with an epicardial lead (4968-35 cm, Medtronic) with and without connection to an MR-conditional pacemaker. Then, experiments were conducted using various lengths of epicardial leads exposed to MRI.
  
  RESULTS:
  (1) A temperature rise of +?2.5 °C was observed for the transvenous lead attached to an MRI-conditional pacemaker. The epicardial lead attached to the same pacemaker showed four times higher heating. (2) The transvenous lead without pacemaker showed four times higher heating, and the epicardial lead without pacemaker showed 30 times higher heating. (3) The epicardial lead coiled to 20 cm length without pacemaker showed 9 times higher heating. (4) Experiments with various lengths of epicardial leads showed that the shorter the leads were, the smaller was the heating effect.
  
  CONCLUSION:
  Standard clinical MRI investigations may result in pronounced heating at the tip of epicardial electrodes. Epicardial leads, which are not connected to a pacemaker and thus mimicking abandoned leads, may even result in a more pronounced rise in temperature at the lead tip. Therefore, current epicardial pacing systems may carry a substantial risk of inducing thermal damage of the neighboring tissue during MRI scanning.
  
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• Range Variability in CMR Feature Tracking Multilayer Strain across Different Stages of Heart Failure.
  Sci Rep

  2019 Nov;9(1):16478. doi: 10.1038/s41598-019-52683-8.
  
  Tanacli Radu, Hashemi Djawid, Lapinskas Tomas, Edelmann Frank, Gebker Rolf, Pedrizzetti Gianni, Schuster Andreas, Nagel Eike, Pieske Burkert, Düngen Hans-Dirk, Kelle Sebastian,
  
  Abstract
  
  Heart failure (HF) is associated with progressive ventricular remodeling and impaired contraction that affects distinctly various regions of the myocardium. Our study applied cardiac magnetic resonance (CMR) feature tracking (FT) to assess comparatively myocardial strain at 3 distinct levels: subendocardial (Endo-), mid (Myo-) and subepicardial (Epi-) myocardium across an extended spectrum of patients with HF. 59 patients with HF, divided into 3 subgroups as follows: preserved ejection fraction (HFpEF, N?=?18), HF with mid-range ejection fraction (HFmrEF, N?=?21), HF with reduced ejection fraction (HFrEF, N?=?20) and a group of age- gender- matched volunteers (N?=?17) were included. Using CMR FT we assessed systolic longitudinal and circumferential strain and strain-rate at Endo-, Myo- and Epi- levels. Strain values were the highest in the Endo- layer and progressively lower in the Myo- and Epi- layers respectively, this gradient was present in all the patients groups analyzed but decreased progressively in HFmrEF and further on in HFrEF groups. GLS decreased with the severity of the disease in all 3 layers: Normal?>?HFpEF?>?HFmrEF?>?HFrEF (Endo-: -23.0?±?3.5?>?-20.0?±?3.3?>?-16.4?±?2.2?>?-11.0?±?3.2, p??-17.5.0?±?2.6?>?-14.5?±?2.1?>?-9.6?±?2.7, p??-12.2?±?2.1?>?-10.6?±?2.3?>?-7.7?±?2.3, p??HFmrEF?>?HFrEF (Endo-: -34.5?±?6.2?>?-20.0?±?4.2?>?12.3?±?4.2, p??-13.0?±?3.4?>?-8.0?±?2.7. p??-7.9?±?2.3?>?-4.5?±?1.9. p?
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• Real-time hyperpolarized C magnetic resonance detects increased pyruvate oxidation in pyruvate dehydrogenase kinase 2/4-double knockout mouse livers.
  Sci Rep

  2019 Nov;9(1):16480. doi: 10.1038/s41598-019-52952-6.
  
  Sharma Gaurav, Wu Cheng-Yang, Wynn R Max, Gui Wenjun, Malloy Craig R, Sherry A Dean, Chuang David T, Khemtong Chalermchai,
  
  Abstract
  
  The pyruvate dehydrogenase complex (PDH) critically regulates carbohydrate metabolism. Phosphorylation of PDH by one of the pyruvate dehydrogenase kinases 1-4 (PDK1-4) decreases the flux of carbohydrates into the TCA cycle. Inhibition of PDKs increases oxidative metabolism of carbohydrates, so targeting PDKs has emerged as an important therapeutic approach to manage various metabolic diseases. Therefore, it is highly desirable to begin to establish imaging tools for noninvasive measurements of PDH flux in rodent models. In this study, we used hyperpolarized (HP) C-magnetic resonance spectroscopy to study the impact of a PDK2/PDK4 double knockout (DKO) on pyruvate metabolism in perfused livers from lean and diet-induced obese (DIO) mice and validated the HP observations with high-resolution C-nuclear magnetic resonance (NMR) spectroscopy of tissue extracts and steady-state isotopomer analyses. We observed that PDK-deficient livers produce more HP-bicarbonate from HP-[1-C]pyruvate than age-matched control livers. A steady-state C-NMR isotopomer analysis of tissue extracts confirmed that flux rates through PDH, as well as pyruvate carboxylase and pyruvate cycling activities, are significantly higher in PDK-deficient livers. Immunoblotting experiments confirmed that HP-bicarbonate production from HP-[1-C]pyruvate parallels decreased phosphorylation of the PDH E1? subunit (pE1?) in liver tissue. Our findings indicate that combining real-time hyperpolarized C NMR spectroscopy and C isotopomer analysis provides quantitative insights into intermediary metabolism in PDK-knockout mice. We propose that this method will be useful in assessing metabolic disease states and developing therapies to improve PDH flux.
  
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• Severity Scores for Ebstein Anomaly: Credibility and Usefulness of Echocardiographic vs Magnetic Resonance Assessments of the Celermajer Index.
  Can J Cardiol

  2019 Aug;():. doi: S0828-282X(19)31149-3.
  
  Cieplucha Aleksandra, Trojnarska Olga, Bartczak-Rutkowska Agnieszka, Kociemba Anna, Rajewska-Tabor Justyna, Kramer Lucyna, Pyda Malgorzata,
  
  Abstract
  
  BACKGROUND:
  The severity score of Ebstein anomaly (EA) that corresponds to clinical status is still under research, with the Celermajer index (Cel-ind) being one of those. The agreement between echocardiographic and cardiac magnetic resonance (CMR) assessment of Cel-ind is not known. We determined the agreement between echocardiography- and CMR-derived Cel-ind and its relationship with heart failure markers.
  
  METHODS:
  A total of 37 unoperated adults with EA (mean age, 43.0 ± 14.4 years) underwent echocardiography, CMR, and cardiopulmonary tests. For the Cel-ind, end-diastolic areas in echocardiography or end-diastolic volumes in CMR were used according to the following formula: Cel-ind = (right atrium + atrialized right ventricle)/(functional right ventricle + left atrium + left ventricle). On the basis of this assumption, patients were classified as follows: grade 1 = Cel-ind < 0.5, grade 2 = 0.5 to 0.99, grade 3 = 1.0 to 1.49, grade 4 > 1.5. The agreement between echocardiographic and CMR was determined with the intraclass correlation coefficient or Cohen's kappa (<0.2 poor agreement; 0.2-0.4 fair agreement; 0.4-0.6 moderate agreement; 0.6-0.8 good agreement; 0.8-1.0 very good agreement).
  
  RESULTS:
  The median echoCel-ind was 0.9 (range, 0.4-2.3), and the median cmrCel-ind was 0.7 (range, 0.3-5.3). Grade 1 or 2 was found in 19 patients (51.3%) by echocardiography and in 27 patients (72.9%) by CMR. The agreement between imaging methods was only fair (kappa = 0.39, P = 0.002) for the 4-grade classification and moderate (intra-class correlation coefficient = 0.43; 95% confidence interval, 0.13-0.66) for Cel-ind calculation. Significant correlations between Cel-ind in CMR and cardiopulmonary parameters were found (for peak oxygen uptake: R = -0.35, P = 0.034; for the ventilation/carbon dioxide slope: R = 0.46, P = 0.005). Neither of them correlated with echocardiographic severity score.
  
  CONCLUSIONS:
  The agreement between echocardiographic and CMR assessment of the Cel-ind is at most moderate; echocardiography usually overestimates, but rarely underestimates, EA severity. Cel-ind by CMR seems to be more valuable, because it is associated with heart failure markers.
  
  Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
  
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• Usefulness of Cardiac Magnetic Resonance for Recurrent Pericarditis.
  Am J Cardiol

  2019 Oct;():. doi: S0002-9149(19)31094-X.
  
  Imazio Massimo, Pivetta Emanuele, Palacio Restrepo Sara, Sormani Paola, Pedrotti Patrizia, Quarta Giovanni, Brucato Antonio, Bubbico Elisa, Dal Corso Maria, Milazzo Angela, Quattrocchi Giuseppina, Andriani Monica, Lobetti Bodoni Luisa, Davini Ottavio, Sironi Sandro, Giannattasio Cristina, Giustetto Carla, Bogaert Jan, Adler Yehuda, Bucciarelli Ducci Chiara, De Ferrari Gaetano Maria,
  
  Abstract
  
  Cardiac magnetic resonance (CMR) offers the capability to objectively detect pericarditis by identifying pericardial thickening, edema/inflammation by Short-TI Inversion Recovery-T2 weighted (STIR-T2w) imaging, edema/inflammation or fibrosis by late gadolinium enhancement (LGE), and presence of pericardial effusion. This is especially helpful for the diagnosis of recurrent pericarditis. Aim of the present paper is to assess the diagnostic accuracy of CMR findings as well as their potential prognostic value for the diagnosis of recurrent pericarditis. Multicenter cohort study of consecutive patients with recurrent pericarditis evaluated by CMR. We included 128 consecutive cases (60 males, 47%; mean age 48 ± 14 years). CMR was performed at a mean time of 12 days (95% confidence interval 15 to 21) after the clinical diagnosis. We evaluated the diagnostic accuracy and areas under the receiver operating characteristic (ROC) curve for CMR diagnostic criteria and complications (additional recurrences, cardiac tamponade, and constrictive pericarditis). Areas under the ROC curve were respectively 64% for pericardial thickening, 84% for pericardial edema, 82% for pericardial LGE, and 71% for pericardial effusion. After a mean follow-up of 34 months, recurrences occurred in 52% of patients, tamponade in 6%, and constrictive pericarditis in 11%. Using a multivariable Cox model, elevation of CRP and presence of CMR pericardial thickening were predictors of adverse events, whereas the presence of CMR LGE was associated with a lower risk. The prognostic model for adverse events using gender, age, CRP level, and all CMR variables showed a C-index of 0.84. In conclusion, CMR findings show high diagnostic accuracy and may help identifying patients at higher risk of complications.
  
  Copyright © 2019 Elsevier Inc. All rights reserved.
  
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• Prognostic Value of Late Gadolinium Enhancement in Predicting Life-Threatening Arrhythmias in Heart Failure Patients With Implantable Cardioverter-Defibrillators: A Systematic Review and Meta-Analysis.
  J Magn Reson Imaging

  2019 Nov;():. doi: 10.1002/jmri.26982.
  
  Yue Ting, Chen Bing-Hua, Wu Lian-Ming, Xu Jian-Rong, Pu Jun,
  
  Abstract
  
  BACKGROUND:
  The presence of late gadolinium enhanced (LGE), which may enable better evaluation of myocardial impairment, would help predict the occurrence of life-threatening arrhythmias and major adverse cardiovascular events (MACE) in patients suffering from ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) patients and who underwent a process of implantable cardioverter-defibrillator (ICD).
  
  PURPOSE:
  To evaluate the prognostic value of cardiac MR-LGE for ICM and NICM patients with ICD.
  
  STUDY TYPE:
  Systematic review and meta-analysis.
  
  POPULATION:
  A total of 33 studies of 3457 patients were included.
  
  FIELD STRENGTH:
  1. 5T and 3.0T, LGE.
  
  ASSESSMENT:
  PubMed, Cochrane Library, EMBASE, and Web of Science were systematically searched for studies reporting LGE in ICM or NICM patients with ICD implantation with several kinds of endpoints: MACE, life-threatening arrhythmia, cardiovascular mortality, and all-cause mortality.
  
  STATISTICAL TESTS:
  A meta-analysis was performed using a random-effects model to calculate odds ratios or standard mean differences (SMDs) for binary and continuous data.
  
  RESULTS:
  MR-LGE was positive in 1923 (55.6%) of ICM and NICM patients. LGE-present patients were more likely to have life-threatening arrhythmia (odds ratio [OR]: 5.1; 95% confidence interval [CI]: 3.8-6.8), MACE (OR: 5.2; 95% CI: 3.8-6.9), cardiovascular mortality (OR: 2.4; 95% CI: 1.2-4.6), and all-cause mortality (OR: 2.1; 95% CI: 1.3-3.4) compared with those without LGE. Moreover, ICM and NICM patients with LGE both had increased life-threatening arrhythmia (OR: 4.6; 95% CI: 2.7-8.0; OR: 5.2; 95% CI: 3.6-7.8, respectively) and MACE (OR: 4.7; 95% CI: 2.8-7.9; OR: 4.7; 95% CI: 2.7-8.1, respectively).
  
  DATA CONCLUSION:
  The presence of MR-LGE may worsen the prognosis for adverse cardiovascular events in both ICM and NIMC patients who benefit more from ICDs.
  
  LEVEL OF EVIDENCE:
  3 TECHNICAL EFFICACY STAGE: 3.
  
  © 2019 International Society for Magnetic Resonance in Medicine.
  
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