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Pubblicazioni recenti - cardiac magnetic resonance
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Change in Physical Activity and Cardiac Structure over 10 Years: The Multi-Ethnic Study of Atherosclerosis.
Med Sci Sports Exerc2019 Oct;51(10):2033-2040. doi: 10.1249/MSS.0000000000002027.
Florido Roberta, Zhao D I, Ndumele Chiadi E, Bluemke David A, Heckbert Susan R, Allison Matthew A, Ambale-Venkatesh Bharath, Liu Chia-Ying, Lima Joao, Michos Erin D,
Abstract
INTRODUCTION:
Physical activity (PA) is inversely associated with risk of heart failure and cardiovascular disease (CVD), whereas increased left ventricular (LV) mass and mass to volume (m:v) ratio are unfavorable CVD risk factors. We assessed whether changes in leisure time PA were associated with longitudinal changes in cardiac structure in a community-based population.
METHODS:
We included 2779 Multi-Ethnic Study of Atherosclerosis participants, free of baseline CVD, who had available data on PA and cardiac magnetic resonance imaging at examinations 1 (2000-2002) and 5 (2010-2012). Physical activity was measured by a Typical Week PA Survey and converted to MET-minutes per week of moderate+vigorous activity. We used linear mixed effect models to estimate the associations of baseline and change in PA with baseline and change in cardiac structure, adjusting for CVD risk factors and body size.
RESULTS:
At baseline, the mean age was 59 yr, 53% were women, and 58% of nonwhite race/ethnicity. During average 10-yr follow-up, and after accounting for baseline PA levels, the highest quintiles of PA increase were significantly associated with increases in LV mass (2.3 g; 95% confidence interval [CI], 0.4-4.2), LV end-diastolic volume (4.7 mL; 95% CI, 2.4-7.0), and stroke volume (3.3 mL; 95% CI, 1.6-5.1), but lower M:V ratio (-2.9; 95% CI, -5.0 to -0.8) compared with the lowest quintiles. Increasing exercise PA was associated with increases in LV diameter and reductions in M:V ratio, whereas occupational PA was associated with increases in m:v ratio. Increasing PA over 10 yr was also associated with greater risk of eccentric dilated LV hypertrophy at examination 5.
CONCLUSIONS:
After accounting for baseline PA, greater positive changes in leisure-time PA levels were associated with a more eccentric-type of LV remodeling pattern over 10 yr. The clinical implications of such findings remain to be determined.
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New Diagnosis of Non-compaction Cardiomyopathy in a 43-Year-Old Man Presenting with Syncope.
Cureus2019 Jul;11(7):e5107. doi: 10.7759/cureus.5107.
Musmar Ahmad, Hammami Muhammad B, Alzaraq Saleh, Aboushaar Reem, Levine Eli,
Abstract
Non-compaction cardiomyopathy (NCM) is rare congenital cardiomyopathy characterized on cardiac imaging by a two-layered ventricular wall with prominent trabeculations and intertrabecular recesses. This case highlights a patient in his fifth decade who presented from an outpatient setting for abnormal findings found on a transthoracic echocardiogram for syncopal workup. Cardiac MRI was consistent with non-compaction cardiomyopathy. A loop recorder then inserted, and he was placed on guideline-directed therapy for heart failure with reduced ejection fraction (HFrEF) and discharged with life vest since left ventricular ejection fraction (LVEF) > 35%. There are many areas of controversies in NCM, such as prevalence, diagnostic criteria, clinical features, prognosis, and management strategy. We will discuss the etiology, diagnostic criteria, and management. Physicians should be aware of NCM diagnosis when a patient presents with heart failure and structural heart changes on imaging despite the age. Cardiac magnetic resonance imaging (CMRI) is the best diagnostic modality. Patients should be recognized and started on proper management to prevent complications.
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Cardiovascular magnetic resonance: Stressing the future.
World J Cardiol2019 Aug;11(8):195-199. doi: 10.4330/wjc.v11.i8.195.
Merinopoulos Ioannis, Gunawardena Tharusha, Eccleshall Simon C, Vassiliou Vassilios S,
Abstract
Non-invasive cardiac stress imaging plays a central role in the assessment of patients with known or suspected coronary artery disease. The current guidelines suggest estimation of the myocardial ischaemic burden as a criterion for revascularisation on prognostic grounds despite the lack of standardised reporting of the magnitude of ischaemia on various non-invasive imaging methods. Future studies should aim to accurately describe the relationship between myocardial ischaemic burden as assessed by cardiovascular magnetic resonance imaging and mortality.
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Authors' response to 'Cardiovascular magnetic resonance: a promising method for detecting myocardial scar in patients with cardiac implantable devices'.
Int J Cardiol -
Most of the patients classified under "Myocardial infarction with non-obstructive coronary arteries (MI-NOCA)" have either no MI or no NOCA.
Int J Cardiol -
Assessment of the regional distribution of normalized circumferential strain in the thoracic and abdominal aorta using DENSE cardiovascular magnetic resonance.
J Cardiovasc Magn Reson2019 Sep;21(1):59. doi: 10.1186/s12968-019-0565-0.
Wilson John S, Taylor W Robert, Oshinski John,
Abstract
BACKGROUND:
Displacement Encoding with Stimulated Echoes (DENSE) cardiovascular magnetic resonance (CMR) of the aortic wall offers the potential to improve patient-specific diagnostics and prognostics of diverse aortopathies by quantifying regionally heterogeneous aortic wall strain in vivo. However, before regional mapping of strain can be used to clinically assess aortic pathology, an evaluation of the natural variation of normal regional aortic kinematics is required.
METHOD:
Aortic spiral cine DENSE CMR was performed at 3?T in 30 healthy adult subjects (range 18 to 65?years) at one or more axial locations that are at high risk for aortic aneurysm or dissection: the infrarenal abdominal aorta (IAA, n?=?11), mid-descending thoracic aorta (DTA, n?=?17), and/or distal aortic arch (DAA, n?=?11). After implementing custom noise-reduction techniques, regional circumferential Green strain of the aortic wall was calculated across 16 sectors around the aortic circumference at each location and normalized by the mean circumferential strain for comparison between individuals.
RESULTS:
The distribution of normalized circumferential strain (NCS) was heterogeneous for all locations evaluated. Despite large differences in mean strain between subjects, comparisons of NCS revealed consistent patterns of strain distribution for similar groupings of patients by axial location, age, and/or mean displacement angle. NCS at local systole was greatest in the lateral/posterolateral walls in the IAAs (1.47?±?0.27), medial wall in anteriorly displacing DTAs (1.28?±?0.20), lateral wall in posteriorly displacing DTAs (1.29?±?0.29), superior curvature in DAAs ?50?years (2.29?±?0.58). The distribution of strain was strongly influenced by the location of the vertebra and other surrounding structures unique to each location.
CONCLUSIONS:
Regional in vivo circumferential strain in the adult aorta is unique to each axial location and heterogeneous around its circumference, but can be grouped into consistent patterns defined by basic patient-specific metrics following normalization. The heterogeneous strain distributions unique to each group may be due to local peri-aortic constraints (particularly at the aorto-vertebral interface), heterogeneous material properties, and/or heterogeneous flow patterns. These results must be carefully considered in future studies seeking to clinically interpret or computationally model patient-specific aortic kinematics.
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Superiority of Out-of-Office Blood Pressure for Predicting Hypertensive Heart Disease in Non-Hispanic Black Adults.
Hypertension2019 Sep;():HYPERTENSIONAHA11913542. doi: 10.1161/HYPERTENSIONAHA.119.13542.
Rader Florian, Franklin Stanley S, Mirocha James, Vongpatanasin Wanpen, Haley Robert W, Victor Ronald G,
Abstract
Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Global Nature of Incipient Chamber Remodeling and Dysfunction in Diabetic Individuals Living in the Community: Potential Mechanisms.
Circ Cardiovasc Imaging2019 Sep;12(9):e009729. doi: 10.1161/CIRCIMAGING.119.009729.
Xie Eric, Lima João A C,
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Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy.
Circ Cardiovasc Imaging2019 Sep;12(9):e009476. doi: 10.1161/CIRCIMAGING.119.009476.
Jensen Magnus T, Fung Kenneth, Aung Nay, Sanghvi Mihir M, Chadalavada Sucharitha, Paiva Jose M, Khanji Mohammed Y, de Knegt Martina C, Lukaschuk Elena, Lee Aaron M, Barutcu Ahmet, Maclean Edd, Carapella Valentina, Cooper Jackie, Young Alistair, Piechnik Stefan K, Neubauer Stefan, Petersen Steffen E,
Abstract
BACKGROUND:
Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging.
METHODS:
Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ?50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status.
RESULTS:
A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: -0.86% [-1.8 to 0.5]; =0.065), LV mass (-0.13 g/m [-1.6 to 1.3], =0.86), or right ventricular ejection fraction (-0.23% [-1.2 to 0.8], =0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m: -3.46 mL/m [-5.8 to -1.2], =0.003, right ventricular end-diastolic volume/m: -4.2 mL/m [-6.8 to -1.7], =0.001, LV stroke volume/m: -3.0 mL/m [-4.5 to -1.5], <0.001; right ventricular stroke volume/m: -3.8 mL/m [-6.5 to -1.1], =0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, =0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: -6.2% [-10.2 to -2.1], =0.003; left atrial emptying fraction:-3.5% [-6.9 to -0.1], =0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], =0.045).
CONCLUSIONS:
In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally.
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Quantification of intramyocardial hemorrhage volume using magnetic resonance imaging with three-dimensional T1-weighted sequence in patients with ischemia-reperfusion injury: a semi-automated image processing technique.
Int J Cardiovasc Imaging2019 Sep;():. doi: 10.1007/s10554-019-01697-4.
Arai Hideo, Kawakubo Masateru, Abe Ko, Hatashima Hikaru, Sanui Kenichi, Nishimura Hiroshi, Kadokami Toshiaki,
Abstract
Although intramyocardial hemorrhage (IMH) is a poor prognostic factor caused by ischemia reperfusion injury, little evidence is available regarding the association between IMH volume and biomarkers. In the present study, we measured IMH volume using three-dimensional (3D) T1-weighted magnetic resonance imaging (T1-MRI) and investigated its association with biomarkers. Moreover, the accuracy of semi-automatic measurement of IMH volume was validated. We retrospectively enrolled 33 consecutive patients (mean age 67?±?11 years) who underwent cardiac MRI after reperfusion therapy for acute myocardial infarction. IMH was observed in 4 patients (12.1%). Receiver operating characteristics (ROC) analysis of creatine kinase (CK) and CK-muscle/brain (CK-MB) tests for detecting IMH were performed. IMH volume measured using semi-automatic methods by a 2 standard deviation (SD) threshold was compared to manual measurements using the Spearman's correlation coefficient (?) and Bland-Altman analyses. ROC analysis revealed optimal cutoff values of CK: 2460 IU/l and CK-MB: 231 IU/l (area under the curve: 0.95 and 0.91; sensitivity: 86% and 79%; specificity: 100% for both). IMH volume with the 2SD threshold correlated with that of the manual measurement [5.84 g (3.30 to 9.00) g vs. 8.07 g (5.37 to 9.33); ?: 0.85, p?
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Multiscale Modeling of Superior Cavopulmonary Circulation: Hemi-Fontan And Bidirectional Glenn Are Equivalent.
Semin Thorac Cardiovasc Surg2019 Sep;():. doi: S1043-0679(19)30276-X.
Kung Ethan, Corsini Chiara, Marsden Alison, Vignon-Clementel Irene, Pennati Giancarlo, Figliola Richard, Hsia Tain-Yen, ,
Abstract
Superior cavopulmonary circulation (SCPC) can be achieved by either the Hemi-Fontan (hF) or Bidirectional Glenn (bG) connection. Debate remains as to which results in best hemodynamic results. Adopting patient-specific multiscale computational modeling, we examined both the local dynamics and global physiology to determine if surgical choice can lead to different hemodynamic outcomes. Six patients (age: 3-6 months) underwent cardiac magnetic resonance imaging and catheterization prior to SCPC surgery. For each patient: 1) a finite 3-dimensional (3D) volume model of the preoperative anatomy were constructed to include detailed definition of the distal branch pulmonary arteries, 2) virtual hF and bG operations were performed to create two SCPC 3D models, and 3) a specific lumped network representing each patient's entire cardiovascular circulation was developed from clinical data. Using a previously validated multiscale algorithm that couples the 3D models with lumped network, both local flow dynamics, i.e. power loss, and global systemic physiology can be quantified. In two patients whose preoperative imaging demonstrated significant left pulmonary artery (LPA) stenosis, we performed virtual pulmonary arterioplasty to assess its effect. In one patient, the hF model showed higher power loss (107%) than the bG, while in 3 the power losses were higher in the bG models (18 to 35%). In the remaining two patients, the power loss differences were minor. Despite these variations, for all patients, there were no significant differences between the hF and bG models in hemodynamic or physiologic outcomes, including cardiac output, superior vena cava pressure, right-left pulmonary flow distribution, and systemic oxygen delivery. In the two patients with LPA stenosis, arterioplasty led to better LPA flow (5-8%) while halving the power loss, but without important improvements in SVC pressure or cardiac output. Despite power loss differences, both hF and bG result in similar SCPC hemodynamics and physiology outcome. This suggests that for SCPC, the pre-existing patient-specific physiology and condition, such as pulmonary vascular resistance, are more deterministic in the hemodynamic performance than the type of surgical palliation. Multiscale modeling can be a decision assist tool to assess whether an extensive LPA reconstruction is needed at the time of SCPC for LPA stenosis.
Copyright © 2019. Published by Elsevier Inc.
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Differentiation between Fabry disease and hypertrophic cardiomyopathy with cardiac T1 mapping.
Diagn Interv Imaging2019 Sep;():. doi: S2211-5684(19)30201-3.
Deborde E, Dubourg B, Bejar S, Brehin A-C, Normant S, Michelin P, Dacher J-N,
Abstract
PURPOSE:
To evaluate the potential of non-contrast myocardial T1 mapping on cardiovascular magnetic resonance examination (CMR) in differentiating patients with Fabry disease (FD) from those with hypertrophic cardiomyopathy (HCM) and healthy control subjects.
MATERIALS AND METHODS:
Seventeen patients with FD (8 men, 9 women; mean age, 48 ±18 [SD] years; [range: 19-73 years]; 53% with left ventricular hypertrophy [LVH]) were matched with 36 patients with hypertrophic cardiomyopathy (HCM) (22 men, 14 women; mean age, 57±16 [SD] years; [range: 22-85 years]) and 70 healthy control subjects (34 men, 36 women; mean age, 38 ±15 [SD] years; [range: 18-65 years]). Cardiac T1 mapping was performed using the modified Look-Locker inversion (MOLLI®) sequence on a 1.5-T magnet. T1 values were calculated, on midventricular section, for septal left ventricular segments (S8-S9) and all mid-ventricular ones (global T1 values; S7-S12). Statistical analysis included unpaired Mann-Whitney test, receiver operating characteristic curve and likelihood ratios.
RESULTS:
Septal native T1 values were significantly decreased in patients with FD (889±61 [SD] ms; range: 784-980ms) compared to those with HCM (995±48 [SD] ms; range: 935-1125ms) (P<0.001) and versus healthy controls (965±29 [SD] ms; range: 910-1028ms) (P<0.001). Global native T1 values were also significantly decreased in patients with FD (891±49 [SD] ms; range 794-970ms) compared to those with HCM (995±34 [SD] ms; range: 952-1086ms) (P<0.001) and versus healthy controls (966±27 [SD] ms; range: 920-1042ms) (P<0.001). A septal left ventricular native T1 cutoff value of 940ms could distinguish FD from HCM with 88% sensitivity (95% CI: 73-100%) and 92% specificity (95% CI: 83-100%). Positive likelihood ratio was 11, negative likelihood ratio was 0.12. Compared to controls, the same threshold could distinguish FD with 88% sensitivity (95% CI: 73-100%) and 86% specificity (95% CI: 78-94%). Positive likelihood ratio was 6.3, negative likelihood ratio was 0.14. T1 value was abnormal in 4 of 8 (50%) of FD patients who did not have LVH.
CONCLUSION:
Native T1 values are significantly lower in patients with FD by comparison with those with HCM and healthy volunteers.
Copyright © 2019 Société française de radiologie. Published by Elsevier Masson SAS. All rights reserved.
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Impact of the type of electroanatomic mapping system on the incidence of cerebral embolism after radiofrequency catheter ablation of left atrial tachycardias.
Heart Rhythm2019 Sep;():. doi: S1547-5271(19)30830-6.
Nakamura Kohki, Sasaki Takehito, Take Yutaka, Minami Kentaro, Inoue Mitsuho, Kishi Shohei, Yoshimura Shingo, Sasaki Wataru, Okazaki Yoshinori, Motoda Hiroyuki, Niijima Katsura, Miki Yuko, Goto Koji, Yamashita Eiji, Koyama Keiko, Funabashi Nobusada, Naito Shigeto,
Abstract
BACKGROUND:
Left atrial tachycardias (ATs) often occur after left atrial ablation. The incidence of symptomatic and silent cerebral embolism after radiofrequency catheter ablation of left ATs and the impact of the type of 3-dimesional electroanatomic mapping (3D-EAM) system on the incidence of cerebral embolism remain unclear.
OBJECTIVE:
This study aimed to investigate the incidence of cerebral embolism after a 3D-EAM system-guided left AT ablation, and compare that between the different 3D-EAM systems.
METHODS:
We prospectively enrolled 59 patients who underwent a left AT ablation and brain magnetic resonance imaging after the procedure: 30 were guided by the Rhythmia? system and 29 by the CARTO® system (Groups R and C).
RESULTS:
One transient ischemic attack occurred in Group R and no symptomatic embolism occurred in Group C. Silent cerebral ischemic lesions (SCILs) were observed in 35 patients (59.3%), and Group R had a significantly higher incidence of SCILs than Group C (86.2% vs. 33.3%; P<0.001). In a multivariate analysis, Group R and a left atrial linear ablation were independent positive predictors of SCILs (odds ratios, 12.822 and 8.668; P=0.001 and 0.005). The incidence of bleeding complications was comparable between Groups R and C (0% vs. 3.3%, P=0.508).
CONCLUSIONS:
Group R exhibited a higher incidence of post-ablation cerebral embolism than Group C. The use of the high resolution 3D-EAM system with a mini-basket catheter to guide radiofrequency ablation of left atrial macroreentrant tachycardias may markedly increase the risk of silent cerebral embolism. The present results require further validation in a randomized study.
Copyright © 2019. Published by Elsevier Inc.
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Cross-Sectional Magnetic Resonance and Modeling Comparison From Just After Fontan To The Teen Years.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31355-4.
Fogel Mark A, Trusty Phillip M, Nicolson Susan, Spray Thomas, Gaynor J William, Whitehead Kevin K, Yoganathan Ajit P,
Abstract
BACKGROUND:
Little is known of baseline anatomic, hemodynamic and fluid dynamic cardiac magnetic resonance data in single ventricle patients immediately after Fontan. A comparison from that timepoint to the teen years can demonstrate clinical course, potentially predict future events and may shed some light regarding how to optimize outcome. This cross-sectional study is meant to characterize these parameters from just after Fontan to the teenage years.
METHODS:
The anatomy, flows and computational fluid dynamic modeling of 22 patients 3-9 months after Fontan (age 3+1.1 years) and 25 teens (age 16+1.8 years) were compared. Significance was P<0.05.
RESULTS:
The % Fontan pathway stenosis was greater with cardiac index, fenestration flow and caval return lower in teens than younger patients (for Fontan pathway stenosis, 43% vs 21%, P=0.009), however, hepatic flow distribution (HFD) was more evenly distributed in older patients. Pulmonary artery size kept up with somatic growth. In the teen group, indexed powerloss (R=0.39), % Fontan pathway stenosis (R=0.62) and particle resident time (PRT) (R=0.42) deteriorated as time from Fontan increased (P<0.04 for all).
CONCLUSIONS:
There are mostly aspects of deterioration with a few bright spots of stability in anatomy, blood flow and fluid dynamic parameters in Fontan patients from the post-operative period to the teenage years. Most notably, Fontan pathway stenosis increases with decreasing flows while pulmonary artery size and HFD remain stable or improved. These data may be aid in designing improved Fontan reconstruction to optimize clinical outcome and to understand future complications.
Copyright © 2019. Published by Elsevier Inc.
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Determinants and prognostic value of cardiac magnetic resonance imaging-derived infarct characteristics in non-ST-elevation myocardial infarction.
Eur Heart J Cardiovasc Imaging2019 Jun;():. doi: jez165.
Feistritzer Hans-Josef, Nanos Michael, Eitel Ingo, Jobs Alexander, de Waha-Thiele Suzanne, Meyer-Saraei Roza, Freund Anne, Stiermaier Thomas, Abdel-Wahab Mohamed, Lurz Philipp, Reinstadler Sebastian J, Reindl Martin, Klug Gert, Metzler Bernhard, Desch Steffen, Thiele Holger,
Abstract
AIMS:
The prognostic significance of cardiac magnetic resonance (CMR)-derived infarct characteristics has been demonstrated in ST-elevation myocardial infarction (STEMI) cohorts but is undefined in non-ST-elevation myocardial infarction (NSTEMI) patients. We aimed to investigate determinants and the long-term prognostic impact of CMR imaging-derived infarct characteristics in patients with NSTEMI.
METHODS AND RESULTS:
Infarct size (IS), myocardial salvage index (MSI), and microvascular obstruction were assessed using CMR imaging in 284 NSTEMI patients undergoing percutaneous coronary intervention (PCI) in three centres. CMR imaging was performed 3 [interquartile range (IQR) 2-4] days after admission. The primary clinical endpoint was defined as major adverse cardiac events during median follow-up of 4.4 (IQR 3.6-4.9) years. Median IS was 7.2% (IQR 2.2-13.7) of left ventricular (LV) myocardial mass (%LV) and MSI was 65.7 (IQR 39.3-84.9). Age (P???0.003), heart rate (P???0.02), the number of diseased coronary arteries (P???0.01), and Thrombolysis In Myocardial Infarction (TIMI) flow grade before PCI (P?
CONCLUSION:
In this prospective, multicentre NSTEMI cohort reperfused by PCI, age, heart rate, the number of diseased coronary arteries, and TIMI flow grade before PCI were independent predictors of IS and MSI assessed by CMR. However, in contrast to STEMI patients there was no additional long-term prognostic value of CMR-derived infarct characteristics over and above LV ejection fraction.
CLINICALTRIALS.GOV:
NCT03516578.
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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Paradigm of Sudden Death Prevention in Hypertrophic Cardiomyopathy.
Circ Res2019 Aug;125(4):370-378. doi: 10.1161/CIRCRESAHA.119.315159.
Maron Barry J, Rowin Ethan J, Maron Martin S,
Abstract
Hypertrophic cardiomyopathy (HCM) is a worldwide genetic heart disease and a common cause of sudden death in the young. Penetration of the implantable cardioverter-defibrillator (ICD) into this patient population over the past 20 years has made accurate selection of patients for primary prevention ICDs a priority. Consequently, a new paradigm has emerged in the management of this complex disease with ICD therapy responsible for a substantial decrease in overall HCM-related mortality (to 0.5%/y) and independent of patient age. Selection of candidates for ICDs has matured substantially with the formulation of an enhanced risk stratification algorithm. One or more contemporary risk markers judged major within a given patient's clinical profile, in association with physician judgment and shared decision-making, is sufficient to consider a primary prevention ICD implant. An enhanced American College of Cardiology/American Heart Association risk factor model (including new contrast-magnetic resonance-based markers, such as left ventricular apical aneurysm) used prospectively to make ICD decisions proved to be 95% sensitive for identifying patients who would experience ?1 appropriate device therapies terminating ventricular tachycardia/fibrillation. The number of HCM patients required to treat with ICDs to save 1 patient with abolition of lethal ventricular tachyarrhythmias was 6:1, similar to randomized defibrillator trials in other cardiomyopathies. In contrast to patients with ischemic heart disease, after ICD shock HCM patients rarely experience transformation to heart failure deterioration or sudden arrhythmic death. The mathematically derived risk score model proposed by the European Society of Cardiology was inferior for identifying high-risk patients susceptible to arrhythmic sudden death with a sensitivity of only 33%, leaving many patients exposed to the possibility of sudden death without ICDs. In conclusion, introduction of the ICD associated with a matured risk stratification algorithm has altered management strategy and clinical course of many HCM patients, making the likelihood of sudden death prevention a reality and fulfilling the aspiration of preservation of life and reduced mortality for this vulnerable patient population.
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Right heart failure in pulmonary hypertension: Diagnosis and new perspectives on vascular and direct right ventricular treatment.
Br J Pharmacol2019 Sep;():. doi: 10.1111/bph.14866.
Tello Khodr, Seeger Werner, Naeije Robert, Vanderpool Rebecca, Ghofrani Hossein Ardeschir, Richter Manuel, Tedford Ryan J, Bogaard Harm J,
Abstract
Adaptation of right ventricular (RV) function to increased afterload - known as RV-arterial coupling - is a key determinant of prognosis in pulmonary hypertension. However, measurement of RV-arterial coupling is a complex, invasive process involving analysis of the RV pressure-volume relationship during preload reduction over multiple cardiac cycles. Simplified methods have therefore been proposed, including echocardiographic and cardiac MRI approaches. This review describes the available methods for assessment of RV function and RV-arterial coupling, and the effects of pharmacotherapy on these parameters. Overall, pharmacotherapies for pulmonary hypertension have shown beneficial effects on various measures of RV function, but it is often unclear if these are direct RV effects or indirect results of afterload reduction. Studies of the effects of pharmacotherapies on RV-arterial coupling are limited and mostly restricted to experimental models. Simplified methods to assess RV-arterial coupling should be validated and incorporated into routine clinical follow-up and future clinical trials.
This article is protected by copyright. All rights reserved.
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Effects of CHADS2 score, echocardiographic and haematologic parameters on stroke severity and prognosis in patients with stroke due to nonvalvular atrial fibrillation.
Ideggyogy Sz2019 Jul;72(7-8):241-256. doi: 10.18071/isz.72.0241.
Aynaci Ozer, Tekata? Aslan, Aynaci Gülden, Kehaya Sezgin, Utku Ufuk,
Abstract
Background and purpose:
The aim of this study is to evaluate utility of CHADS2 score to estimate stroke severity and prognosis in patients with ischemic stroke due to non-valvular atrial fibrillation (AF) in addition to evaluate effects of hematologic and echocardiographic findings on stroke severity and prognosis.
Methods:
This prospective study included 156 ischemic stroke cases due to non-valvular AF in neurology ward of Trakya University Medical School between March 2013-March 2015. National Institute of Health Stroke (NIHS) score was used to evaluate severity of stroke at admission. Carotid and vertebral Doppler ultrasonography findings, brain computed tomography (CT) and magnetic resonance imaging (MRI) of the cases were evaluated. Left atrial diameter and ejection fraction (EF) values were measured. CHADS2 score was calculated. Modified Rankin Scale was used to rate the degree of dependence. Effects of age and sex of the patients, presence of diabetes mellitus (DM), Congestive Heart Failure (CHF), Cerebrovascular Disease (CVD) and C-reactive protein (CRP) levels on CHADS2, NIHS, and mRS were evaluated.
Results:
In patients with age ?75, mean NIHS score was 3.3 points and mean mRS score was 1.02 points higher, than in patient below 75 years of age. Compared with the mild risk group, cases in the high risk group had older age, higher serum D-dimer, fibrinogen and CRP levels and lower EF. A positive relation was detected between stroke severity and Hemorrhagic Transformation (HT), previous CVD history, and presence of CHF. A significant association was found between increased stroke severity and Early Neurological Deterioration (END) development. Older age, higher serum fibrinogen, D-dimer, CRP and lower EF values were associated with poor prognosis. History of CVD and presence of CHF were associated with poor prognosis. END development was found to be associated with poor prognosis. In the high-risk group, 30.3% (n = 33) had END. Among those in the high-risk group according to the CHADS2 score, END development rate was found to be significantly higher than in the moderate risk group (p <0.05). There was a strong positive correlation between CHADS2 and NIHS scores. mRS score increased with increasing CHADS2 score and there was a strong correlation between them. Effect of stroke severity on prognosis was assessed and a positive correlation was found between NIHS score and mRS value.
Conclusion:
Our study demonstrated the importance of CHADS2 score, haemostatic activation and echocardiographic findings to assess stroke severity and prognosis. Knowing factors which affect stroke severity and prognosis in patients with ischemic stroke may be directive to decide primary prevention and stroke management.
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Native T1 time and extracellular volume fraction in differentiation of normal myocardium from non-ischemic dilated and hypertrophic cardiomyopathy myocardium: A systematic review and meta-analysis.
Int J Cardiol Heart Vasc2019 Dec;25():100422. doi: 10.1016/j.ijcha.2019.100422.
Minegishi Shintaro, Kato Shingo, Takase-Minegishi Kaoru, Horita Nobuyuki, Azushima Kengo, Wakui Hiromichi, Ishigami Tomoaki, Kosuge Masami, Kimura Kazuo, Tamura Kouichi,
Abstract
Background:
Both native T1 time and extracellular volume (ECV) fraction have been shown to be important measures for the detection of myocardial fibrosis. However, ECV determination requires the administration of an intravenous contrast agent, whereas native T1 mapping can be performed without a contrast agent.
Methods:
Here, we conducted a meta-analysis of myocardial native T1 data obtained for non-ischemic cardiomyopathy (NIC) patients and controls. A literature review included studies that applied T1 mapping using modified Look-Locker inversion recovery to measure myocardial fibrosis, and the results were validated by comparing datasets for dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) patients and healthy controls (HCs).
Results:
We identified 16 eligible studies. Pooled mean differences (MDs) and 95% confidence intervals (CIs) were estimated as follows. Native T1 at 1.5-T, DCM vs. HC: MD?=?45.26 (95% CI: 30.92-59.59); HCM vs. HC: MD?=?47.09 (95% CI: 32.42-61.76). Native T1 at 3.0-T, DCM vs. HC: MD?=?82.52 (95% CI: 47.60-117.44); HCM vs. HC: MD?=?115.87 (95% CI: 50.71-181.04). ECV at 1.5-T, DCM vs. HC: MD?=?4.26 (95% CI: 3.06-5.46); HCM vs. HC: MD?=?1.49 (95% CI: -1.45-4.43). ECV at 3.0-T, DCM vs. HC: MD?=?8.40 (95% CI: 2.94-13.86); HCM vs. HC: MD?=?8.02 (95% CI: 5.45-1-0.59).
Conclusion:
In conclusion, native T1 values were significantly different between NIC patients and controls. Native T1 mapping may be a useful noninvasive method to detect diffuse myocardial fibrosis in NIC patients.
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Echocardiographic global longitudinal strain is associated with infarct size assessed by cardiac magnetic resonance in acute myocardial infarction.
Echo Res Pract2019 Dec;6(4):81-89. doi: 10.1530/ERP-19-0026.
Joseph Gowsini, Zaremba Tomas, Johansen Martin Berg, Ekeloef Sarah, Heiberg Einar, Engblom Henrik, Jensen Svend Eggert, Sogaard Peter,
Abstract
The aim of this study was to investigate if there was an association between infarct size (IS) measured by cardiac magnetic resonance (CMR) and echocardiographic global longitudinal strain (GLS) in the early stage of acute myocardial infarction in patients with preserved left ventricular ejection fraction (LVEF). Patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were assessed with CMR and transthoracic echocardiogram within 1 week of hospital admission. Two-dimensional speckle tracking was performed using a semi-automatic algorithm (EchoPac, GE Healthcare). Longitudinal strain curves were generated in a 17-segment model covering the entire left ventricular myocardium. GLS was calculated automatically. LVEF was measured by auto-LVEF in EchoPac. IS was measured by late gadolinium enhancement CMR in short-axis views covering the left ventricle. The study population consisted of 49 patients (age 60.4?±?9.7 years; 92% male). The study population had preserved echocardiographic LVEF with a mean of 45.8?±?8.7%. For each percent increase of IS, we found an impairment in GLS by 1.59% (95% CI 0.57-2.61), ?=?0.02, after adjustment for sex, age and LVEF. No significant association between IS and echocardiographic LVEF was found: -0.25 (95% CI: -0.61 to 0.11), ?=?0.51. At the segmental level, the strongest association between IS and longitudinal strain was found in the apical part of the LV: impairment of 1.69% (95% CI: 1.14-2.23), ?
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