Pubblicazioni recenti - cardiac magnetic resonance

• Strain Tensor Imaging: Cardiac-induced brain tissue deformation in humans quantified with high-field MRI.
  Neuroimage

  2021 Apr;():118078. doi: S1053-8119(21)00355-4.
  
  Sloots Jacob-Jan, Biessels Geert Jan, de Luca Alberto, Zwanenburg Jaco J M,
  
  Abstract
  
  The cardiac cycle induces blood volume pulsations in the cerebral microvasculature that cause subtle deformation of the surrounding tissue. These tissue deformations are highly relevant as a potential source of information on the brain's microvasculature as well as of tissue condition. Besides, cyclic brain tissue deformations may be a driving force in clearance of brain waste products. We have developed a high-field magnetic resonance imaging (MRI) technique to capture these tissue deformations with full brain coverage and sufficient signal-to-noise to derive the cardiac-induced strain tensor on a voxel by voxel basis, that could not be assessed non-invasively before. We acquired the strain tensor with 3mm isotropic resolution in 9 subjects with repeated measurements for 8 subjects. The strain tensor yielded both positive and negative eigenvalues (principle strains), reflecting the Poison effect in tissue. The principle strain associated with expansion followed the known funnel shaped brain motion pattern pointing towards the foramen magnum. Furthermore, we evaluate two scalar quantities from the strain tensor: the volumetric strain and octahedral shear strain. These quantities showed consistent patterns between subjects, and yielded repeatable results: the peak systolic volumetric strain (relative to end-diastolic strain) was 4.19?10 ± 0.78?10 and 3.98?10 ± 0.44?10 (mean ± standard deviation for first and second measurement, respectively), and the peak octahedral shear strain was 2.16?10 ± 0.31?10 and 2.31?10 ± 0.38?10, for the first and second measurement, respectively. The volumetric strain was typically highest in the cortex and lowest in the periventricular white matter, while anisotropy was highest in the subcortical white matter and basal ganglia. This technique thus reveals new, regional information on the brain's cardiac-induced deformation characteristics, and has the potential to advance our understanding of the role of microvascular pulsations in health and disease.
  
  Copyright © 2021. Published by Elsevier Inc.
  
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• Identification of a novel presumed cardiac sarcoidosis category for patients at high risk of disease.
  Int J Cardiol

  2021 Apr;():. doi: S0167-5273(21)00658-6.
  
  Rosenbaum Andrew N, Kolluri Nikhil, Elwazir Mohamed Y, Kapa Suraj, Abou Ezzeddine Omar F, Bois John P, Chareonthaitawee Panithaya, Schmidt Tyler J, Cooper Leslie T,
  
  Abstract
  
  BACKGROUND:
  Histologic evidence is required for a definitive diagnosis of cardiac sarcoidosis (CS) by published guidelines; however, the sporadic nature of the disease may produce false negative biopsy results, causing CS to be underdiagnosed. We sought to establish a clinical category of CS absent histologic findings.
  
  METHODS:
  Patients evaluated for CS were stratified into 3 groups: probable CS and definite CS based on Heart Rhythm Society (HRS) criteria and presumed CS, ie, patients without any histologic evidence of sarcoidosis, but with unexplained high-grade atrioventricular block or ventricular arrhythmia and findings suggestive of CS on either cardiac magnetic resonance imaging or positron emission tomography. The primary end point was hospitalization-free and overall survival at 10?years.
  
  RESULTS:
  A total of 383 patients were included in the study: 59, definite CS; 223, probable CS; and 101, presumed CS (62, isolated CS and 39, systemic CS). Compared with patients meeting HRS criteria for CS, patients with presumed CS had lower odds of New York Heart Association class III or IV symptoms (odds ratio [OR], 0.44 [95% CI, 0.23-0.83]; P?=?.01) but greater odds of previous ventricular tachycardia (OR, 2.4 [95% CI, 1.4-4.0]; P?=?.001) or history of resuscitated sudden cardiac arrest (OR, 2.9 [95% CI, 1.0-8.6]; P?=?.05). Hospitalization-free and overall survival were similar among groups (P?=?.51 and P?=?.71, respectively).
  
  CONCLUSIONS:
  Clinical categorization of patients with presumed CS identified a high-risk cohort comparable to patients with histologic evidence of disease, although caution should be exercised in reaching this diagnosis without paying due diligence to the differential diagnosis.
  
  Copyright © 2021. Published by Elsevier B.V.
  
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• Four-Dimensional Magnetic Resonance After Ross Procedure for Unicuspid Aortic Valve.
  Circ Cardiovasc Imaging

  2021 Apr;14(4):e011500. doi: 10.1161/CIRCIMAGING.120.011500.
  
  Drullinsky David, Mehta Christopher K, Scott Michael B, Crawford Erin, Markl Michael, Bonow Robert O, Mendelson Marla A, El-Hamamsy Ismail, Malaisrie S Chris,
  
  
  
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• Fully Automatic Scar Segmentation for Late Gadolinium Enhancement MRI Images in Left Ventricle with Myocardial Infarction.
  Curr Med Sci

  2021 Apr;41(2):398-404. doi: 10.1007/s11596-021-2360-z.
  
  Wu Zheng-Hong, Sun Li-Ping, Liu Yun-Long, Dong Dian-Dian, Tong Lv, Deng Dong-Dong, He Yi, Wang Hui, Sun Yi-Bo, Dong Jian-Zeng, Xia Ling,
  
  Abstract
  
  Numerous methods have been published to segment the infarct tissue in the left ventricle, most of them either need manual work, post-processing, or suffer from poor reproducibility. We proposed an automatic segmentation method for segmenting the infarct tissue in left ventricle with myocardial infarction. Cardiac images of a total of 60 diseased hearts (55 human hearts and 5 porcine hearts) were used in this study. The epicardial and endocardial boundaries of the ventricles in every 2D slice of the cardiac magnetic resonance with late gadolinium enhancement images were manually segmented. The subsequent pipeline of infarct tissue segmentation is fully automatic. The segmentation results with the automatic algorithm proposed in this paper were compared to the consensus ground truth. The median of Dice overlap between our automatic method and the consensus ground truth is 0.79. We also compared the automatic method with the consensus ground truth using different image sources from different centers with different scan parameters and different scan machines. The results showed that the Dice overlap with the public dataset was 0.83, and the overall Dice overlap was 0.79. The results show that our method is robust with respect to different MRI image sources, which were scanned by different centers with different image collection parameters. The segmentation accuracy we obtained is comparable to or better than that of the conventional semi-automatic methods. Our segmentation method may be useful for processing large amount of dataset in clinic.
  
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• Cardiac manifestations in Finnish gelsolin amyloidosis patients.
  Amyloid

  2021 Apr;():1-5. doi: 10.1080/13506129.2021.1911798.
  
  Mustonen Tuuli, Holkeri Arttu, Holmström Miia, Atula Sari, Pakarinen Sami, Lehmonen Lauri, Kiuru-Enari Sari, Aro Aapo L,
  
  Abstract
  
  INTRODUCTION:
  Finnish gelsolin amyloidosis (AGel amyloidosis) is an inherited systemic amyloidosis with well-known ophthalmological, neurological and cutaneous symptoms. Additionally, cardiomyopathies, conduction disorders and need of cardiac pacemakers occur in some patients. This study focuses on electrocardiographic (ECG) findings in AGel amyloidosis and their relation to cardiac magnetic resonance (CMR) changes. We also assessed whether ECG abnormalities were associated with pacemaker implantation and mortality.
  
  MATERIALS AND METHODS:
  In this cohort study, 51 genetically verified AGel amyloidosis patients (mean age 66?years) without cardiac pacemakers underwent 12-lead ECG and CMR imaging with contrast agent in 2017. Patients were followed-up for 3?years.
  
  RESULTS:
  Conduction disturbances were found in 22 patients (43%). Nine (18%) presented with first-degree atrioventricular block, six (12%) with left anterior hemiblock, seven (14%) with left or right bundle branch block and two (4%) with non-specific intraventricular conduction delay. Low QRS voltage was present in two (4%) patients. Late gadolinium enhancement (LGE) concentrating on the interventricular septum and inferior parts of the heart was present in 19 (86%) patients with conduction abnormalities. During the follow-up, only one patient received a pacemaker, and one patient died.
  
  DISCUSSION:
  Conduction disorders and septal LGE are common in AGel amyloidosis, whereas other ECG and CMR findings typically observed in most common cardiac amyloidosis types were rare. Septal pathology seen in CMR may interfere with the cardiac conduction system in AGel amyloidosis, explaining conduction disorders, although pacemaker therapy is rarely required.
  
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• Cardiac Magnetic Resonance-Derived Extracellular Volume Mapping for the Quantification of Hepatic and Splenic Amyloid.
  Circ Cardiovasc Imaging

  2021 Apr;():CIRCIMAGING121012506. doi: 10.1161/CIRCIMAGING.121.012506.
  
  Chacko Liza, Boldrini Michele, Martone Raffaele, Law Steven, Martinez-Naharrro Ana, Hutt David F, Kotecha Tushar, Patel Rishi K, Razvi Yousuf, Rezk Tamer, Cohen Oliver C, Brown James T, Srikantharajah Mukunthan, Ganesananthan Sharmananthan, Lane Thirusha, Lachmann Helen J, Wechalekar Ashutosh D, Sachchithanantham Sajitha, Mahmood Shameem, Whelan Carol J, Knight Daniel S, Moon James C, Kellman Peter, Gillmore Julian D, Hawkins Philip N, Fontana Marianna,
  
  Abstract
  
  BACKGROUND:
  Systemic amyloidosis is characterized by amyloid deposition that can involve virtually any organ. Splenic and hepatic amyloidosis occurs in certain types, in some patients but not others, and may influence prognosis and treatment. SAP (serum amyloid P component) scintigraphy is uniquely able to identify and quantify amyloid in the liver and spleen, thus informing clinical management, but it is only available in 2 centers globally. The aims of this study were to examine the potential for extracellular volume (ECV) mapping performed during routine cardiac magnetic resonance to: (1) detect amyloid in the liver and spleen and (2) estimate amyloid load in these sites using SAP scintigraphy as the reference standard.
  
  METHODS:
  Five hundred thirty-three patients referred to the National Amyloidosis Centre, London, between 2015 and 2017 with suspected systemic amyloidosis who underwent SAP scintigraphy and cardiac magnetic resonance with T1 mapping were studied.
  
  RESULTS:
  The diagnostic performance of ECV to detect splenic and hepatic amyloidosis was high for both organs (liver: area under the curve, -0.917 [95% CI, 0.880-0.954]; liver ECV cutoff, 0.395; sensitivity, 90.7%; specificity, 77.7%; <0.001; spleen: area under the curve, -0.944 [95% CI, 0.925-0.964]; spleen ECV cutoff, 0.385; sensitivity, 93.6%; specificity, 87.5%; <0.001). There was good correlation between liver and spleen ECV and amyloid load assessed by SAP scintigraphy (r=0.504, <0.001; r=0.693, <0.001, respectively). There was high interobserver agreement for both the liver and spleen (ECV liver intraclass correlation coefficient, 0.991 [95% CI, 0.984-0.995]; <0.001; ECV spleen intraclass correlation coefficient, 0.995 [95% CI, 0.991-0.997]; <0.001) with little bias across a wide range of ECV values.
  
  CONCLUSIONS:
  Our study demonstrates that ECV measurements obtained during routine cardiac magnetic resonance scans in patients with suspected amyloidosis can identify and measure the magnitude of amyloid infiltration in the liver and spleen, providing important clues to amyloid type and offering a noninvasive measure of visceral amyloid burden that can help guide and track treatment.
  
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• Post-mortem CMR in a model of sudden death due to myocardial ischemia: validation with connexin-43.
  Eur Radiol

  2021 Apr;():. doi: 10.1007/s00330-021-07890-1.
  
  Aquaro Giovanni Donato, Di Paolo Marco, Guidi Benedetta, Ghabisonia Khatia, Pucci Angela, Aringheri Giacomo, Gorgodze Nikoloz, Veronica Musetti, Chiti Enrica, Burchielli Silvia, Turillazzi Emanuela, Emdin Michele, Caramella Davide, Recchia Fabio A,
  
  Abstract
  
  OBJECTIVES:
  We sought to evaluate the effectiveness of post-mortem cardiac magnetic resonance (PM-CMR) for the identification of myocardial ischemia as cause of sudden cardiac death (SCD) when the time interval between the onset of ischemia and SCD is ? 90 min.
  
  METHODS:
  PM-CMR was performed in 8 hearts explanted from pigs with spontaneous death caused by occlusion of the left anterior descending coronary artery: 4 with SCD after ? 40 min of coronary occlusion and 4 between 40 and 90 min. PM-CMR included conventional T1 and T2-weighted image and T1, T2, and T2* mapping techniques. Imaging data were compared and validated with immunohistochemical evaluation of the altered proportion and redistribution of phosphorylated versus non-phosphorylated connexin 43 (CX43 and npCX43, respectively), an established molecular marker of myocardial ischemia.
  
  RESULTS:
  At T2-weighted images, the ischemic core was hypointense (core/remote ratio 0.67 ± 0.11) and surrounded by and hyperintense border zone. Compared to remote myocardium, the ischemic core had higher T1 (p = 0.0008), and lower T2 (p = 0.007) and T2* (p = 0.002). Cytoplasmatic npX43 and the npCX43/CX43 ratio were significantly higher in animals deceased > 40 min than in others.
  
  CONCLUSION:
  PM-CMR can reliably detect early signs of myocardial damage induced by ischemia, based on conventional pulse sequences complemented by a novel ad hoc application of quantitative mapping techniques.
  
  KEY POINTS:
  ? Post-mortem MRI may help to understand cause of sudden cardiac death. ? Post-mortem MRI allows detection of signs of myocardial ischemia as cause of sudden cardiac death within 90 and 40 min following coronary occlusion as demonstrated in a pig model of myocardial ischemia. ? Signs of myocardial ischemia using conventional and mapping MRI technique are associated with the immunohistochemical changes of phosphorylated and dephosphorylated connexin-43 which is an established molecular marker of myocardial ischemia.
  
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• Atrial fibrillation and left atrial size and function: a Mendelian randomization study.
  Sci Rep

  2021 Apr;11(1):8431. doi: 10.1038/s41598-021-87859-8.
  
  van de Vegte Yordi J, Siland Joylene E, Rienstra Michiel, van der Harst Pim,
  
  Abstract
  
  Atrial fibrillation (AF) patients have enlarged left atria (LA), but prior studies suggested enlarged atria as both cause and consequence of AF. The aim of this study is to investigate the causal association between AF and LA size and function. In the UK Biobank, all individuals with contoured cardiovascular magnetic resonance data were selected. LA maximal volume (LA max), LA minimal volume (LA min), LA stroke volume and LA ejection fraction were measured and indexed to body surface area (BSA). Two-sample Mendelian randomization analyses were performed using 84 of the known genetic variants associated with AF to assess the association with all LA size and function in individuals without prevalent AF. A total of 4274 individuals (mean age 62.0?±?7.5 years, 53.2% women) were included. Mendelian randomization analyses estimated a causal effect between genetically determined AF and BSA-indexed LA max, LA min, and LA ejection fraction, but not between AF and LA stroke volume. Leave-one-out analyses showed that the causal associations were attenuated after exclusion of rs67249485, located near PITX2 gene. Our results suggest that AF causally increases LA size and decreases LA ejection fraction. The AF risk allele of rs67249485, located near the PITX2 gene, contributes strongly to these associations.
  
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• Is biventricular vascular coupling a better indicator of ventriculo-ventricular interaction in congenital heart disease?
  Cardiol Young

  2021 Apr;():1-6. doi: 10.1017/S1047951121001426.
  
  Yang Emily L, Kutty Shelby, Soriano Brian D, Mallenahalli Sathish, Ferguson Mark R, Lewin Mark B, Buddhe Sujatha,
  
  Abstract
  
  BACKGROUND:
  Ventriculo-ventricular interactions are known to exist, though not well quantified. We hypothesised that the ventricular-vascular coupling ratio assessed by cardiovascular MRI would provide insight into this relationship. We also sought to compare MRI-derived ventricular-vascular coupling ratio to echocardiography and patient outcomes.
  
  METHODS:
  Children with cardiac disease and biventricular physiology were included. Sanz's and Bullet methods were used to calculate ventricular-vascular coupling ratio by MRI and echocardiography, respectively. Subgroup analysis was performed for right and left heart diseases. Univariate and multivariate regressions were performed to determine associations with outcomes.
  
  RESULTS:
  A total of 55 patients (age 14.3 ± 2.5 years) were included. Biventricular ventricular-vascular coupling ratio by MRI correlated with each other (r = 0.41; p = 0.003), with respect to ventricle's ejection fraction (r = -0.76 to -0.88; p < 0.001) and other ventricle's ejection fraction (r = -0.42 to -0.47; p < 0.01). However, biventricular ejection fraction had only weak correlation with each other (r = 0.31; p = 0.02). Echo underestimated ventricular-vascular coupling ratio for the left ventricle (p < 0.001) with modest correlation to MRI-derived ventricular-vascular coupling ratio (r = 0.43; p = 0.002). There seems to be a weak correlation between uncoupled right ventricular-vascular coupling ratio with the need for intervention and performance on exercise testing (r = 0.33; p = 0.02).
  
  CONCLUSION:
  MRI-derived biventricular ventricular-vascular coupling ratio provides a better estimate of ventriculo-ventricular interaction in children and adolescents with CHD. These associations are stronger than traditional parameters and applicable to right and left heart conditions.
  
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• Left Ventricular Assist Device Implantation in Patients with Left Ventricular Thrombus.
  Artif Organs

  2021 Apr;():. doi: 10.1111/aor.13963.
  
  Dogan Günes, Mariani Silvia, Hanke Jasmin S, Deniz Ezin, Merzah Ali, Li Tong, Haverich Axel, Schmitto Jan D,
  
  Abstract
  
  An intra-cavitary left ventricular (LV) thrombus is a relative contraindication to LV assist device (LVAD) implantation based on increased thromboembolic risks. Herein, we present our experience with LVAD patients with or without preoperative diagnosis of LV-thrombus. We retrospectively investigated 563 patients who received LVAD implantation between 2004 and 2018. Diagnosis of LV-thrombus was verified with computed tomography scan, magnetic resonance imaging, echocardiography or intraoperative LV inspection. The primary endpoint was 30-day survival free of stroke and pump thrombosis. Overall, 72 patients (12.8%) had a diagnosis of LV-thrombus. They were younger (51 years; IQR:41-59), affected by severely reduced ejection fraction (15%; IQR:10-20), more often presenting with dilated cardiomyopathy (61.8%) and INTERMACS profile 1 (33.3%). Preoperative atrial fibrillation was frequent in patients without LV-thrombus (38.9%). Conventional sternotomy was the preferred approach in LV-thrombus patients (77.8%), based on more HMII implantations in these patients (41.7%). Survival free of strokes and pump thrombosis at 30 days was comparable (p=0.5751) between patients with (83.3%) or without LV-thrombus (80.9%). LVAD implantation in patients with preoperative LV-thrombus is safe and feasible. When managed through correct diagnostic and intraoperative strategies including accurate inspection of the LV cavity, these patients show similar 30-day outcomes compared to patients without LV-thrombus.
  
  This article is protected by copyright. All rights reserved.
  
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• Rotigaptide Infusion for the First 7 Days After Myocardial Infarction-Reperfusion Reduced Late Complexity of Myocardial Architecture of the Healing Border-Zone and Arrhythmia Inducibility.
  J Am Heart Assoc

  2021 Apr;():e020006. doi: 10.1161/JAHA.120.020006.
  
  Chowdhury Rasheda A, Debney Michael T, Protti Andrea, Handa Balvinder S, Patel Kiran H K, Lyon Alexander R, Shah Ajay M, Ng Fu Siong, Peters Nicholas S,
  
  Abstract
  
  Background Survivors of myocardial infarction are at increased risk of late ventricular arrhythmias, with infarct size and scar heterogeneity being key determinants of arrhythmic risk. Gap junctions facilitate the passage of small ions and morphogenic cell signaling between myocytes. We hypothesized that gap junctions enhancement during infarction-reperfusion modulates structural and electrophysiological remodeling and reduces late arrhythmogenesis. Methods and Results Infarction-reperfusion surgery was carried out in male Sprague-Dawley rats followed by 7 days of rotigaptide or saline administration. The in vivo and ex vivo arrhythmogenicity was characterized by programmed electrical stimulation 3 weeks later, followed by diffusion-weighted magnetic resonance imaging and Masson's trichrome histology. Three weeks after 7-day postinfarction administration of rotigaptide, ventricular tachycardia/ventricular fibrillation was induced on programmed electrical stimulation in 20% and 53% of rats, respectively (rotigaptide versus control), resulting in reduction of arrhythmia score (3.2 versus 1.4, =0.018), associated with the reduced magnetic resonance imaging parameters fractional anisotropy (fractional anisotropy: -5% versus -15%; =0.062) and mean diffusivity (mean diffusivity: 2% versus 6%, =0.042), and remodeling of the 3-dimensional laminar structure of the infarct border zone with reduction of the mean (16° versus 19°, =0.013) and the dispersion (9° versus 12°, =0.015) of the myofiber transverse angle. There was no change in ECG features, spontaneous arrhythmias, or mortality. Conclusions Enhancement of gap junctions function by rotigaptide administered during the early healing phase in reperfused infarction reduces later complexity of infarct scar morphology and programmed electrical stimulation-induced arrhythmias, and merits further exploration as a feasible and practicable intervention in the acute myocardial infarction management to reduce late arrhythmic risk.
  
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• Feature tracking myocardial strain analysis in patients with bileaflet mitral valve prolapse: relationship with LGE and arrhythmias.
  Eur Radiol

  2021 Apr;():. doi: 10.1007/s00330-021-07876-z.
  
  Gatti Marco, Palmisano Anna, Esposito Antonio, Fiore Stefano, Monti Caterina Beatrice, Andreis Alessandro, Pistelli Lorenzo, Vergara Pasquale, Bergamasco Laura, Giustetto Carla, De Cobelli Francesco, Fonio Paolo, Faletti Riccardo,
  
  Abstract
  
  OBJECTIVES:
  Anatomical substrate and mechanical trigger co-act in arrhythmia's onset in patients with bileaflet mitral valve prolapse (bMVP). Feature tracking (FT) may improve risk stratification provided by cardiac magnetic resonance (CMR). The aim was to investigate differences in CMR and FT parameters in bMVP patients with and without complex arrhythmias (cVA and no-cVA).
  
  METHODS:
  In this retrospective study, 52 patients with bMVP underwent 1.5 T CMR and were classified either as no-cVA (n = 32; 12 males; 49.6 ± 17.4 years) or cVA (n = 20; 3 males; 44.7 ± 11.2 years), the latter group including 6 patients (1 male; 45.7 ± 12.7 years) with sustained ventricular tachycardia or ventricular fibrillation (SVT-FV). Twenty-four healthy volunteers (11 males, 36.2 ± 12.5 years) served as control. Curling, prolapse distance, mitral annulus disjunction (MAD), and late gadolinium enhancement (LGE) were recorded and CMR-FT analysis performed. Statistical analysis included non-parametric tests and binary logistic regression.
  
  RESULTS:
  LGE and MAD distance were associated with cVA with an odds ratio (OR) of 8.51 for LGE (95% CI 1.76, 41.28; p = 0.008) and of 1.25 for MAD (95% CI 1.02, 1.54; p = 0.03). GLS 2D (- 11.65 ± 6.58 vs - 16.55 ± 5.09 1/s; p = 0.04), PSSR longitudinal 2D (0.04 ± 1.62 1/s vs - 1.06 ± 0.35 1/s; p = 0.0001), and PSSR radial 3D (3.95 ± 1.97 1/s vs 2.64 ± 1.03 1/s; p = 0.0001) were different for SVT-VF versus the others. PDSR circumferential 2D (1.10 ± 0.54 vs. 0.84 ± 0.34 1/s; p = 0.04) and 3D (0.94 ± 0.42 vs. 0.69 ± 0.17 1/s; p = 0.04) differed between patients with and without papillary muscle LGE.
  
  CONCLUSIONS:
  CMR-FT allowed identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT-VF. LGE and MAD distance were associated with cVA.
  
  KEY POINTS:
  ? CMR-FT allows identifying several subtle myocardial deformation abnormalities in bMVP patients, especially those involving the papillary muscle. ? CMR-FT allows identifying subtle myocardial deformation abnormalities in bMVP patients at risk of SVT and VF. ? In patients with bMVP, the stronger predictor of cVA is LGE (OR = 8.51; 95% CI 1.76, 41.28; p = 0.008), followed by MAD distance (OR = 1.25; 95% CI 1.02, 1.54; p = 0.03).
  
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• The Effects of a 6-Week Controlled, Hypocaloric Ketogenic Diet, With and Without Exogenous Ketone Salts, on Body Composition Responses.
  Front Nutr

  2021 ;8():618520. doi: 10.3389/fnut.2021.618520.
  
  Buga Alex, Kackley Madison L, Crabtree Christopher D, Sapper Teryn N, Mccabe Lauren, Fell Brandon, LaFountain Rich A, Hyde Parker N, Martini Emily R, Bowman Jessica, Pan Yue, Scandling Debbie, Brownlow Milene L, O'Connor Annalouise, Simonetti Orlando P, Kraemer William J, Volek Jeff S,
  
  Abstract
  
  Ketogenic diets () that elevate beta-hydroxybutyrate () promote weight and fat loss. Exogenous ketones, such as ketone salts (), also elevate BHB concentrations with the potential to protect against muscle loss during caloric restriction. Whether augmenting ketosis with KS impacts body composition responses to a well-formulated KD remains unknown. To explore the effects of energy-matched, hypocaloric KD feeding (<50 g carbohydrates/day; 1.5 g/kg/day protein), with and without the inclusion of KS, on weight loss and body composition responses. Overweight and obese adults were provided a precisely defined hypocaloric KD (~75% of energy expenditure) for 6 weeks. In a double-blind manner, subjects were randomly assigned to receive ~24 g/day of a racemic BHB-salt (KD + KS; = 12) or placebo (KD + PL; = 13). A matched comparison group ( = 12) was separately assigned to an isoenergetic/isonitrogenous low-fat diet (LFD). Body composition parameters were assessed by dual x-ray absorptiometry and magnetic resonance imaging. The KD induced nutritional ketosis (>1.0 mM capillary BHB) throughout the study ( < 0.001), with higher fasting concentrations observed in KD + KS than KD + PL for the first 2 weeks ( < 0.05). There were decreases in body mass, whole body fat and lean mass, mid-thigh muscle cross-sectional area, and both visceral and subcutaneous adipose tissues ( < 0.001), but no group differences between the two KDs or with the LFD. Urine nitrogen excretion was significantly higher in KD + PL than LFD ( < 0.01) and trended higher in KD + PL compared to KD + KS ( = 0.076), whereas the nitrogen excretion during KD + KS was similar to LFD ( > 0.05). Energy-matched hypocaloric ketogenic diets favorably affected body composition but were not further impacted by administration of an exogenous BHB-salt that augmented ketosis. The trend for less nitrogen loss with the BHB-salt, if manifested over a longer period of time, may contribute to preserved lean mass.
  
  Copyright © 2021 Buga, Kackley, Crabtree, Sapper, Mccabe, Fell, LaFountain, Hyde, Martini, Bowman, Pan, Scandling, Brownlow, O'Connor, Simonetti, Kraemer and Volek.
  
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• Diagnosis of Primary Cardiac T-cell Lymphoma: Feasibility and Safety of Endomyocardial Biopsy Guided by Pre-acquired Cardiovascular Magnetic Resonance.
  Eur J Case Rep Intern Med

  2021 ;8(3):002427. doi: 10.12890/2021_002427.
  
  Avella Andrea, Giordano Carla, Buffa Vitaliano, De Girolamo Piergiuseppe, Uguccioni Massimo,
  
  Abstract
  
  Background:
  Multimodality imaging of a cardiac mass lesion may raise suspicion of a primitive cardiac lymphoma (PCL). However, a definitive diagnosis requires histopathological confirmation.
  
  Methods:
  This report describes the methodology we used to perform biopsy sampling of a cardiac mass lesion affecting a 45-year-old man. In order to increase endomyocardial biopsy diagnostic accuracy, we used pre-acquired cardiac magnetic resonance (CMR) images to guide the bioptome on a cardiac site overtly infiltrated by the suspected tumour. The right ventricular outflow tract was identified as the target site for biopsy sampling. To reduce the risk of the procedure, the biopsy was performed at a safe distance from the tip of a diagnostic quadripolar catheter positioned at the level of the pulmonary valve, previously identified by pacing manoeuvres. The reported approach demonstrated safety and diagnostic accuracy, allowing the identification of an extremely rare PCL subtype of T-cell origin.
  
  Conclusion:
  Biopsy sampling of a suspected tumour may be safely and accurately performed using pre-acquired CMR images to guide the bioptome on the target site.
  
  LEARNING POINTS:
  Multimodal imaging techniques capable of tissue characterization may raise suspicion of a primary cardiac lymphoma (PCL).However, the final diagnosis of PCL can be confirmed only by histological examination of a tissue sample.Biopsy sampling of the mass lesion may be accurately guided by previously acquired cardiac magnetic resonance images.
  
  © EFIM 2021.
  
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• Cardiac Amyloidosis Presenting as Biventricular Systolic Heart Failure.
  Case Rep Cardiol

  2021 ;2021():6671469. doi: 10.1155/2021/6671469.
  
  Oye Monique, Richardson Aaron, Sadic Edin, Alkhasawneh Ahmad, Velarde Gladys,
  
  Abstract
  
  A previously healthy octogenarian presented with new onset heart failure symptoms. Comprehensive multimodality imaging including complete echocardiography with longitudinal strain analysis, cardiac magnetic resonance imaging (cMRI), nuclear medicine pyrophosphate (99-mcTcPYP) scan along with biomarker, monoclonal protein analysis, and fat pad biopsy confirmed diagnosis of transthyretin cardiac amyloidosis.
  
  Copyright © 2021 Monique Oye et al.
  
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• Study Protocol: The Heart and Brain Study.
  Front Physiol

  2021 ;12():643725. doi: 10.3389/fphys.2021.643725.
  
  Suri Sana, Bulte Daniel, Chiesa Scott T, Ebmeier Klaus P, Jezzard Peter, Rieger Sebastian W, Pitt Jemma E, Griffanti Ludovica, Okell Thomas W, Craig Martin, Chappell Michael A, Blockley Nicholas P, Kivimäki Mika, Singh-Manoux Archana, Khir Ashraf W, Hughes Alun D, Deanfield John E, Jensen Daria E A, Green Sebastian F, Sigutova Veronika, Jansen Michelle G, Zsoldos Enik?, Mackay Clare E,
  
  Abstract
  
  Background:
  It is well-established that what is good for the heart is good for the brain. Vascular factors such as hypertension, diabetes, and high cholesterol, and genetic factors such as the apolipoprotein E4 allele increase the risk of developing both cardiovascular disease and dementia. However, the mechanisms underlying the heart-brain association remain unclear. Recent evidence suggests that impairments in vascular phenotypes and cerebrovascular reactivity (CVR) may play an important role in cognitive decline. The combines state-of-the-art vascular ultrasound, cerebrovascular magnetic resonance imaging (MRI) and cognitive testing in participants of the long-running Whitehall II Imaging cohort to examine these processes together. This paper describes the study protocol, data pre-processing and overarching objectives.
  
  Methods and Design:
  The 775 participants of the Whitehall II Imaging cohort, aged 65 years or older in 2019, have received clinical and vascular risk assessments at 5-year-intervals since 1985, as well as a 3T brain MRI scan and neuropsychological tests between 2012 and 2016 (Whitehall II Wave MRI-1). Approximately 25% of this cohort are selected for the , which involves a single testing session at the University of Oxford (Wave MRI-2). Between 2019 and 2023, participants will undergo ultrasound scans of the ascending aorta and common carotid arteries, measures of central and peripheral blood pressure, and 3T MRI scans to measure CVR in response to 5% carbon dioxide in air, vessel-selective cerebral blood flow (CBF), and cerebrovascular lesions. The structural and diffusion MRI scans and neuropsychological battery conducted at Wave MRI-1 will also be repeated. Using this extensive life-course data, the will examine how 30-year trajectories of vascular risk throughout midlife (40-70 years) affect vascular phenotypes, cerebrovascular health, longitudinal brain atrophy and cognitive decline at older ages.
  
  Discussion:
  The study will generate one of the most comprehensive datasets to examine the longitudinal determinants of the heart-brain association. It will evaluate novel physiological processes in order to describe the optimal window for managing vascular risk in order to delay cognitive decline. Ultimately, the will inform strategies to identify at-risk individuals for targeted interventions to prevent or delay dementia.
  
  Copyright © 2021 Suri, Bulte, Chiesa, Ebmeier, Jezzard, Rieger, Pitt, Griffanti, Okell, Craig, Chappell, Blockley, Kivimäki, Singh-Manoux, Khir, Hughes, Deanfield, Jensen, Green, Sigutova, Jansen, Zsoldos and Mackay.
  
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• Seg-CapNet: A Capsule-Based Neural Network for the Segmentation of Left Ventricle from Cardiac Magnetic Resonance Imaging.
  J Comput Sci Technol

  2021 ;36(2):323-333. doi: 10.1007/s11390-021-0782-5.
  
  Cao Yang-Jie, Wu Shuang, Liu Chang, Lin Nan, Wang Yuan, Yang Cong, Li Jie,
  
  Abstract
  
  Deep neural networks (DNNs) have been extensively studied in medical image segmentation. However, existing DNNs often need to train shape models for each object to be segmented, which may yield results that violate cardiac anatomical structure when segmenting cardiac magnetic resonance imaging (MRI). In this paper, we propose a capsule-based neural network, named Seg-CapNet, to model multiple regions simultaneously within a single training process. The Seg-CapNet model consists of the encoder and the decoder. The encoder transforms the input image into feature vectors that represent objects to be segmented by convolutional layers, capsule layers, and fully-connected layers. And the decoder transforms the feature vectors into segmentation masks by up-sampling. Feature maps of each down-sampling layer in the encoder are connected to the corresponding up-sampling layers, which are conducive to the backpropagation of the model. The output vectors of Seg-CapNet contain low-level image features such as grayscale and texture, as well as semantic features including the position and size of the objects, which is beneficial for improving the segmentation accuracy. The proposed model is validated on the open dataset of the Automated Cardiac Diagnosis Challenge 2017 (ACDC 2017) and the Sunnybrook Cardiac Magnetic Resonance Imaging (MRI) segmentation challenge. Experimental results show that the mean Dice coefficient of Seg-CapNet is increased by 4.7% and the average Hausdorff distance is reduced by 22%. The proposed model also reduces the model parameters and improves the training speed while obtaining the accurate segmentation of multiple regions.
  
  Supplementary Information:
  The online version contains supplementary material available at 10.1007/s11390-021-0782-5.
  
  © Institute of Computing Technology, Chinese Academy of Sciences 2021.
  
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• SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes.
  Circulation

  2021 Apr;():. doi: 10.1161/CIRCULATIONAHA.121.054824.
  
  Moulson Nathaniel, Petek Bradley J, Drezner Jonathan A, Harmon Kimberly G, Kliethermes Stephanie A, Patel Manesh R, Baggish Aaron L, ,
  
  Abstract
  
  Cardiac involvement among hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is common and associated with adverse outcomes. The objective of this study was to determine the prevalence and clinical implications of SARS-CoV-2 cardiac involvement in young competitive athletes. In this prospective multicenter observational cohort study with data from 42 colleges/universities, we assessed the prevalence, clinical characteristics, and outcomes of SARS-CoV-2 cardiac involvement among collegiate athletes in the United States. Data were collected from September 1, 2020 to December 31, 2020. The primary outcome was the prevalence of definite, probable, or possible SARS-CoV-2 cardiac involvement based on imaging definitions adapted from the Updated Lake Louise Criteria. Secondary outcomes included the diagnostic yield of cardiac testing, predictors for cardiac involvement, and adverse cardiovascular events or hospitalizations. Among 19,378 athletes tested for SARS-CoV-2 infection, 3018 (mean age 20 years [SD,1 year]; 32% female) tested positive and underwent cardiac evaluation. A total of 2820 athletes underwent at least one element of cardiac 'triad' testing [12-lead electrocardiography (ECG), troponin, and/or transthoracic echocardiography(TTE)] followed by cardiac magnetic resonance (CMR) if clinically indicated. In contrast, primary screening CMR was performed in 198 athletes. Abnormal findings suggestive of SARS-CoV-2 cardiac involvement were detected by ECG (21/2999,0.7%), cardiac troponin (24/2719,0.9%), and TTE (24/2556,0.9%). Definite, probable, or possible SARS-COV-2 cardiac involvement was identified in 21/3018 (0.7%) athletes, including 15/2820 (0.5%) who underwent clinically indicated CMR (n=119) and 6/198 (3.0%) who underwent primary screening CMR. Accordingly, the diagnostic yield of CMR for SARS-COV-2 cardiac involvement was 4.2 times higher for a clinically indicated CMR (15/119,12.6%) versus a primary screening CMR (6/198,3.0%). After adjustment for race and sex, predictors of SARS-CoV-2 cardiac involvement included cardiopulmonary symptoms (OR:3.1,95% CI:1.2,7.7) or at least one abnormal triad test (OR:37.4,95% CI:13.3,105.3). Five (0.2%) athletes required hospitalization for non-cardiac complications of SARS-CoV-2. During clinical surveillance (median follow-up 113 days [IQR=90,146]), there was one (0.03%) adverse cardiac event likely unrelated to SARS-CoV-2 infection. SARS-CoV-2 infection among young competitive athletes is associated with a low prevalence of cardiac involvement and a low risk of clinical events in short term follow-up.
  
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• Contributions of Cerebral Blood Flow to Associations Between Blood Pressure Levels and Cognition: The Age, Gene/Environment Susceptibility-Reykjavik Study.
  Hypertension

  2021 Apr;():HYPERTENSIONAHA12016894. doi: 10.1161/HYPERTENSIONAHA.120.16894.
  
  Moonen Justine E, Sabayan Behnam, Sigurdsson Sigurdur, van Buchem Mark A, Gudnason Vilmundur, Meirelles Osorio, Launer Lenore J,
  
  Abstract
  
  Cerebral hypoperfusion leads to adverse sequalae including dementia. Midlife higher blood pressure (BP) can lead to low cerebral blood flow (CBF), but older persons may need higher BP to maintain cerebral perfusion. We investigated the associations among late-life BP, CBF, and cognition. Data are from 2498 participants with a mean age of 79.8 (SD, 4.7) years of the second exam of the AGES (Age, Gene/Environment Susceptibility)-Reykjavik Study. BP was measured, and phase-contrast (PC) magnetic resonance imaging was acquired to estimate total brain CBF. Cognitive outcomes included verbal and working memory, processing speed, mild cognitive impairment, and all-cause dementia. Relationships among late-life BP, CBF, and cognition were assessed with regression models, controlling for socio-demographics, BP level at midlife (at a mean age of 49.6 [SD, 5.9] years), cardiovascular factors, and total brain volume. In fully adjusted models, each mm Hg increase in late-life diastolic BP was associated with a -0.082 mL/min per 100 mL (95% CI -0.123 to -0.041) lower CBF. In contrast, each mm Hg increase in late-life systolic BP or pulse pressure was associated with a 0.027 mL/min per 100 mL (95% CI, 0.0065-0.048) and 0.061 mL/min per 100 mL (95% CI, 0.038-0.084) higher late-life CBF, respectively. Higher CBF was significantly related to higher cognitive scores for psychomotor speed, verbal, and working memory and to a lower odd of mild cognitive impairment or dementia, irrespective of late-life BP level. Higher late-life diastolic BP and systolic BP were differentially associated with CBF. Our findings suggest CBF is an important correlate of late-life cognition, independent of BP level.
  
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• Intracerebral electrical stimulation to understand the neural basis of human face identity recognition.
  Eur J Neurosci

  2021 Apr;():. doi: 10.1111/ejn.15235.
  
  Jonas Jacques, Rossion Bruno,
  
  Abstract
  
  Recognizing people's identity by their faces is a key function in the human species, supported by regions of the ventral occipito-temporal cortex (VOTC). In the last decade, there have been several reports of perceptual face distortion during direct electrical stimulation (DES) with subdural electrodes positioned over a well-known face-selective VOTC region of the right lateral middle fusiform gyrus (LatMidFG; i.e., the "Fusiform Face Area", FFA). However, transient impairments of face identity recognition (FIR) have been extremely rare and only behaviorally quantified during DES with intracerebral (i.e., depth) electrodes in stereo-electroencephalography (SEEG). The three detailed cases reported so far, summarized here, were specifically impaired at FIR during DES inside different anatomical VOTC regions of the right hemisphere: the inferior occipital gyrus (IOG) and the LatMidFG, as well as a region that lies at the heart of a large magnetic susceptibility artifact in functional magnetic resonance imaging (fMRI): the anterior fusiform gyrus (AntFG). In the first two regions, the eloquent electrode contacts were systematically associated with the highest face-selective and (unfamiliar) face individuation responses as measured with intracerebral electrophysiology. Stimulation in the right AntFG did not lead to perceptual changes but also caused an inability to remember even having been presented face pictures, as if the episode was never recorded in memory. These observations support the view of an extensive network of face-selective VOTC regions subtending human FIR, with at least three critical nodes in the right hemisphere associated with differential intrinsic and extrinsic patterns of reentrant connectivity.
  
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