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Pubblicazioni recenti - cardiac magnetic resonance
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Myocardial Tissue Characterization and Fibrosis by Imaging.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30711-9.
Karamitsos Theodoros D, Arvanitaki Alexandra, Karvounis Haralambos, Neubauer Stefan, Ferreira Vanessa M,
Abstract
Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Coronary Flow Reserve by Cardiac Magnetic Resonance Imaging in Patients With Diabetes Mellitus.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30703-X.
Kato Shingo, Fukui Kazuki, Saigusa Yusuke, Kubota Kazumi, Kodama Sho, Asahina Naoki, Hayakawa Keigo, Iguchi Kohei, Fukuoka Masahiro, Iwasawa Tae, Utsunomiya Daisuke, Kosuge Masami, Kimura Kazuo, Tamura Kouichi,
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Myocardial T1 and ECV Measurement: Underlying Concepts and Technical Considerations.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30715-6.
Robinson Austin A, Chow Kelvin, Salerno Michael,
Abstract
Myocardial native T1 and extracellular volume fraction (ECV) mapping have emerged as cardiac cardiac magnetic resonance biomarkers providing unique insight into cardiac pathophysiology. Single breath-hold acquisition techniques, available on clinical scanners across multiple vendor platforms, have made clinical T1 and ECV mapping a reality. Although the relationship between changes in native T1 and alterations in cardiac microstructure is complex, an understanding of how edema, blood volume, myocyte and interstitial expansion, lipids, and paramagnetic substances affect T1 and ECV can provide insight into how and why these parameters change in various cardiac pathologies. The goals of this state-of-the-art review will be to review factors influencing native T1 and ECV, to describe how native T1 and ECV are measured, to discuss potential challenges and pitfalls in clinical practice, and to describe new T1 mapping techniques on the horizon.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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The Interstitium in the Hypertrophied Heart.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30714-4.
Halliday Brian P, Prasad Sanjay K,
Abstract
Pathological left ventricular hypertrophy is a common feature of many cardiac diseases. It results from both myocyte hypertrophy and interstitial expansion. Interstitial expansion is most commonly secondary to the accumulation of mature cross-linked collagen fibers due to dysregulated metabolism, known as interstitial fibrosis. This occurs secondary to a variety of stimuli including ischemic, toxic, metabolic, infective, genetic, and hemodynamic factors. Less commonly, interstitial expansion may occur because of the accumulation of misfolded amyloid protein or interstitial edema. It is now well recognized that the presence and extent of interstitial disease are associated with adverse outcomes. There is therefore interest in the development of novel therapies that target the pathways that drive these disease processes. With the emergence of such therapies, it is becoming increasingly important to be able to characterize the type and extent of interstitial disease to enable the use of such targeted therapies in a personalized manner.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cardiac Magnetic Resonance for Evaluating Nonculprit Lesions After Myocardial Infarction: Comparison With Fractional Flow Reserve.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30731-4.
Everaars Henk, van der Hoeven Nina W, Janssens Gladys N, van Leeuwen Maarten A, van Loon Ramon B, Schumacher Stefan P, Demirkiran Ahmet, Hofman Mark B M, van der Geest Rob J, van de Ven Peter M, Götte Marco J, van Rossum Albert C, van Royen Niels, Nijveldt Robin,
Abstract
OBJECTIVES:
This study sought to determine the agreement between cardiac magnetic resonance (CMR) imaging and invasive measurements of fractional flow reserve (FFR) in the evaluation of nonculprit lesions after ST-segment elevation myocardial infarction (STEMI). In addition, we investigated whether fully quantitative analysis of myocardial perfusion is superior to semiquantitative and visual analysis.
BACKGROUND:
The agreement between CMR and FFR in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease is unknown.
METHODS:
Seventy-seven patients with STEMI with at least 1 intermediate (diameter stenosis 50% to 90%) nonculprit lesion underwent CMR and invasive coronary angiography in conjunction with FFR measurements at 1 month after primary intervention. The imaging protocol included stress and rest perfusion, cine imaging, and late gadolinium enhancement. Fully quantitative, semiquantitative, and visual analysis of myocardial perfusion were compared against a reference of FFR. Hemodynamically obstructive was defined as FFR ?0.80.
RESULTS:
Hemodynamically obstructive nonculprit lesions were present in 31 (40%) patients. Visual analysis displayed an area under the curve (AUC) of 0.74 (95% confidence interval [CI]: 0.62 to 0.83), with a sensitivity of 73% and a specificity of 70%. For semiquantitative analysis, the relative upslope of the stress signal intensity time curve and the relative upslope derived myocardial flow reserve had respective AUCs of 0.66 (95% CI: 0.54 to 0.77) and 0.71 (95% CI: 0.59 to 0.81). Fully quantitative analysis did not augment diagnostic performance (all p > 0.05). Stress myocardial blood flow displayed an AUC of 0.76 (95% CI: 0.64 to 0.85), with a sensitivity of 69% and a specificity of 77%. Similarly, MFR displayed an AUC of 0.82 (95% CI: 0.71 to 0.90), with a sensitivity of 82% and a specificity of 71%.
CONCLUSIONS:
CMR and FFR have moderate-good agreement in the evaluation of nonculprit lesions in patients with STEMI with multivessel disease. Fully quantitative, semiquantitative, and visual analysis yield similar diagnostic performance.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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EX-UTERO EXTRACORPOREAL SUPPORT AS A MODEL FOR FETAL HYPOXIA AND BRAIN DYSMATURITY.
Ann Thorac Surg2019 Sep;():. doi: S0003-4975(19)31405-5.
McGovern Patrick E, Lawrence Kendall, Baumgarten Heron, Rossidis Avery, Mejaddam Ali, Licht Daniel J, Grinspan Judith, Schupper Alexander, Rychik Jack, Didier Ryne A, Vossough Arastoo, Spray Thomas L, Peranteau William H, Davey Marcus G, Flake Alan W, Gaynor J William,
Abstract
BACKGROUND:
Congenital heart disease (CHD) is associated with abnormal fetal brain development, a phenomenon that may be related to decreased cerebral oxygen delivery in utero. We utilized an artificial womb model to test the hypothesis that decreasing fetal oxygen delivery would reproduce physiological changes identified in fetuses with CHD.
METHODS:
Experimental (hypoxemic) fetal lambs (mean gestational age 111±3 days, n=4) and controls (112 days, n=5) were maintained in the artificial womb for a mean of 22±6 days. Oxygen delivery was reduced to 15.6±1.0mL/kg/min in the hypoxemia animals versus 21.6±2.0mL/kg/min in controls. Blood chemistry analysis and sonographic evaluation were performed daily. An additional control group (n=7) was maintained in-utero and harvested for analysis at gestational age 134±4 days.
RESULTS:
Physiological parameters were monitored continuously, and no statistical differences between the groups were identified. Fetal oxygen delivery and arterial pO2 were significantly lower in the experimental group longitudinally. Increased umbilical artery and decreased middle cerebral artery resistance resulted in a lower cerebral to umbilical resistance ratio, similar to the 'brain sparing' effect observed in human fetuses with CHD. Experimental brains were smaller than controls in relation to the calvarium on magnetic resonance.
CONCLUSIONS:
Sustained hypoxemia in fetal sheep leads to altered cerebrovascular resistances and loss of brain mass, similar to human fetuses with CHD. This unique model provides opportunities to investigate the pathology underlying CHD associated brain dysmaturity, as well as to evaluate potential fetal neuroprotective therapies.
Copyright © 2019. Published by Elsevier Inc.
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Characteristics of Cardiovascular Magnetic Resonance Imaging and Outcomes in Adults With Repaired Truncus Arteriosus.
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30944-0.
Robinson Vimala Leena, Hanneman Kate, Thavendiranathan Paaladinesh, Nguyen Elsie T, Silversides Candice K, Wald Rachel M,
Abstract
The cardiovascular magnetic resonance imaging (CMR) features of adults with repaired truncus arteriosus (rTA) are largely undefined. We sought to explore CMR characteristics in rTA and to identify associations between imaging findings and cardiovascular outcomes. Adults with rTA and CMR were identified and anatomic subtypes (1-4) were assigned (Collett and Edwards classification). CMR characteristics, clinical data at last follow-up and adverse cardiovascular outcome were recorded. Twenty-seven adults (19% male) were studied (median age at cardiovascular magnetic resonance 26 years [interquartile range 18 to 40]) over 5.2-year duration [interquartile range 2.5 to 7.5]. With the exception of mildly increased RV mass (30 ± 12 g/m), cardiac chamber measurements were within the normal range. In CMR measurements, only pulmonary artery peak velocity differed in subtypes (highest in subtype 3, 318 ± 26 cm/s, p?=?0.029). Number of cardiovascular interventions in adulthood was moderately correlated with left ventricular end-diastolic volume (r?=?0.463, p?=?0.015), left ventricular ejection fraction (r?=?0.425, p?=?0.027) and neoaortic root size (r?=?0.398, p?=?0.039). Cardiovascular events (nonmutually exclusive) in 5 of 27 patients (19%) included death (n?=?1), heart failure (n?=?1), ventricular tachycardia (n?=?1), and atrial tachycardia (n?=?3). Increased cardiovascular risk was associated with decreased right ventricular ejection fraction (odds ratio 1.153, confidence interval 1.003 to 1.326, p?=?0.046) and smaller ascending aorta diameter (odds ratio 1.758, confidence interval 1.037 to 2.976, p?=?0.036). In conclusion, decreased right ventricular ejection fraction and smaller ascending aorta on cardiovascular magnetic resonance were associated with adverse events in rTA.
Copyright © 2019. Published by Elsevier Inc.
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[The Case of Fulminant Myocarditis].
Kardiologiia2019 Sep;59(9):91-96. doi: 10.18087/cardio.2019.9.n461.
Titov V A, Shishkova A A, Mitrofanova L B, Ivanova S V, Zverev D A, Marichev A O, Moiseeva O M,
Abstract
Fulminant myocarditis (FM) is a severe form of inflammatory myocardial injury rapidly developing as acute heart failure, cardiogenic shock, or life-threatening disturbances of cardiac rhythm. FM requires intensive treatment including drug therapy, mechanical circulatory support, and in some cases - heart transplantation. Echocardiography can be used as a screening method of diagnostics. Magnetic resonance imaging of the heart often cannot be performed because of hemodynamic instability of a patient, therefore endomyocardial biopsy with histological and immunohistochemical studies as well as molecular-genetic analysis of obtained samples is required for final diagnosis. Prognosis of the disease is determined by histological picture. In most cases, after cessation of acute stage of the inflammatory process, FM has a favorable long-term prognosis. In this article we present a clinical case of FM and review of current literature on diagnosis and treatment of this disease.
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Cardiac MRI Evaluation of Neonatal Bronchopulmonary Dysplasia Associated Pulmonary Hypertension.
Am J Respir Crit Care Med2019 Sep;():. doi: 10.1164/rccm.201904-0826OC.
Critser Paul J, Higano Nara S, Tkach Jean A, Olson Emilia S, Spielberg David R, Kingma Paul S, Fleck Robert J, Lang Sean M, Moore Ryan A, Taylor Michael D, Woods Jason C,
Abstract
RATIONALE:
Patients with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH) have increased morbidity and mortality. Noninvasive assessment relies on echocardiograms (echo), which is technically challenging in this population. Improved assessment could augment decisions regarding PH therapies.
OBJECTIVES:
We hypothesized that neonatal cardiac magnetic resonance imaging (MRI) will correlate with BPD severity and predict short term clinical outcomes, including need for PH therapies for infants with BPD.
METHODS:
52 infants (31 severe BPD, 9 moderate BPD, and 12 with either mild or no BPD) were imaged between 39 and 47 weeks post-menstrual age on a neonatal-sized, NICU-sited 1.5T MR scanner. MR left-ventricular eccentricity index (MR-EI), main pulmonary artery to aorta diameter (PA/AO) ratio, and pulmonary arterial blood flow (PBF) were determined. Echos obtained for clinical indications were reviewed. MRI and echo indices were compared to BPD severity and clinical outcomes including length of stay (LOS), duration of respiratory support, respiratory support at discharge, and PH therapy.
MEASUREMENTS AND MAIN RESULTS:
PA/AO increased with BPD severity. Increased PA/AO, MR-EI, and echo-EIs were associated with increased LOS and duration of respiratory support. No correlation was seen between PBF and BPD outcomes. Controlling for gestational age, birth weight, and BPD severity, MR-EI was associated with LOS and duration of respiratory support. Increased PA/AO and MR-EI were associated with PH therapy during hospitalization and at discharge.
CONCLUSIONS:
MRI can provide important image-based measures of cardiac morphology that relate to disease severity and clinical outcomes in neonates with BPD.
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Elastomeric cardiopatch scaffold for myocardial repair and ventricular support.
Eur J Cardiothorac Surg2019 Sep;():. doi: ezz252.
Chachques Juan Carlos, Lila Nermine, Soler-Botija Carolina, Martinez-Ramos Cristina, Valles Ana, Autret Gwennhael, Perier Marie-Cecile, Mirochnik Nicolas, Monleon-Pradas Manuel, Bayes-Genis Antoni, Semino Carlos E,
Abstract
OBJECTIVES:
Prevention of postischaemic ventricular dilatation progressing towards pathological remodelling is necessary to decrease ventricular wall deterioration. Myocardial tissue engineering may play a therapeutic role due to its capacity to replace the extracellular matrix, thereby creating niches for cell homing. In this experimental animal study, a biomimetic cardiopatch was created with elastomeric scaffolds and nanotechnologies.
METHODS:
In an experimental animal study in 18 sheep, a cardiopatch was created with adipose tissue-derived progenitor cells seeded into an engineered bioimplant consisting of 3-dimensional bioabsorbable polycaprolactone scaffolds filled with a peptide hydrogel (PuraMatrix?). This patch was then transplanted to cover infarcted myocardium. Non-absorbable poly(ethyl) acrylate polymer scaffolds were used as controls.
RESULTS:
Fifteen sheep were followed with ultrasound scans at 6?months, including echocardiography scans, tissue Doppler and spectral flow analysis and speckle-tracking imaging, which showed a reduction in longitudinal left ventricular deformation in the cardiopatch-treated group. Magnetic resonance imaging (late gadolinium enhancement) showed reduction of infarct size relative to left ventricular mass in the cardiopatch group versus the controls. Histopathological analysis at 6?months showed that the cardiopatch was fully anchored and integrated to the infarct area with minimal fibrosis interface, thereby promoting angiogenesis and migration of adipose tissue-derived progenitor cells to surrounding tissues.
CONCLUSIONS:
This study shows the feasibility and effectiveness of a cardiopatch grafted onto myocardial infarction scars in an experimental animal model. This treatment decreased fibrosis, limited infarct scar expansion and reduced postischaemic ventricular deformity. A capillary network developed between our scaffold and the heart. The elastomeric cardiopatch seems to have a positive impact on ventricular remodelling and performance in patients with heart failure.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Development and prognostic validation of partition values to grade right ventricular dysfunction severity using 3D echocardiography.
Eur Heart J Cardiovasc Imaging2019 Sep;():. doi: jez233.
Muraru Denisa, Badano Luigi P, Nagata Yasufumi, Surkova Elena, Nabeshima Yosuke, Genovese Davide, Otsuji Yutaka, Guida Valentina, Azzolina Danila, Palermo Chiara, Takeuchi Masaaki,
Abstract
AIMS:
Transthoracic 3D echocardiography (3DE) has been shown to be feasible and accurate to measure right ventricular (RV) ejection fraction (EF) when compared with cardiac magnetic resonance (CMR). However, RV EF, either measured with CMR or 3DE, has always been reported as normal (RV EF > 45%) or abnormal (RV EF???45%). We therefore sought to identify the partition values of RV EF to stratify RV dysfunction in mildly, moderately, or severely reduced as we are used to do with the left ventricle.
METHODS AND RESULTS:
We used 3DE to measure RV EF in 412 consecutive patients (55?±?18?years, 65% men) with various cardiac conditions who were followed for 3.7?±?1.4?years to obtain the partition values which defined mild, moderate, and severe reduction of RV EF (derivation cohort). Then, the prognostic value of these partition values was tested in an independent population of 446 patients (67?±?14?years, 58% men) (validation cohort). During follow-up, we recorded 59 cardiac deaths (14%) in the derivation cohort. Using K-Adaptive partitioning for survival data algorithm we identified four groups of patients with significantly different mortality according to RV EF: very low?>?46%, 40.9%?
CONCLUSION:
Our study confirms the independent prognostic value of RV EF in patients with heart diseases, and identifies the partition values of RV EF to stratify the risk of cardiac death and MACE.
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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Association of trans-myocardial repolarisation parameters with size of the diffusion limitation area in acute ischaemic stroke.
Neurol Neurochir Pol2019 Sep;():. doi: 10.5603/PJNNS.a2019.0041.
Uzunosmano?lu Hüseyin, Korucu Osman, Emektar Emine, Çorbac?o?lu ?eref Kerem, Hac?fazl?o?lu Çi?dem, Çevik Yunsur,
Abstract
OBJECTIVES:
This study aimed to evaluate the relationship between transmyocardial repolarisation parameters and the size of the diffusion limitation area measured using diffusion weighted magnetic resonance imaging (DWMRI) in patients diagnosed with ischaemic stroke without known cardiac diseases.
MATERIAL AND METHODS:
The study was a prospective, observational clinical study. Patients without cardiac disease with acute ischaemic stroke were included in the study. Electrocardiography (ECG) was received from the patients. P, QT, QTc and Tp-e dispersions were calculated. All the patients had computerised brain tomography (CT) and then DWMRI carried out so as to calculate infarct areas.
RESULTS:
Seventy ischaemic stroke patients and 30 control patients were included in the study. All parameters except for QTc dispersion (p = 0.88) were higher in the stroke group than in the control group (p < 0.05 for all values). The infarct area calculated with DWMRI was divided into four groups according to quartiles, and QT, QTc, P, and Tp-e dispersions of patients were evaluated. Patients were found to have a prolonged dispersion as the infarct area expanded, and this difference was statistically significant (p < 0.05 for all values).
CONCLUSIONS:
When we compared the patients with ischaemic stroke who had no known cardiac disease to those in the control group we found an increase in transmyocardial repolarisation parameters. As diffusion limitation areas grew larger, QT, QTc, P, and Tp-e dispersions increased. Physicians should be aware of dysrhythmias and sudden cardiac death in acute stroke and should observe these patients, especially those with larger stroke lesions.
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Cardiac abnormalities in patients with nonalcoholic fatty liver disease : Insights from auxiliary examinations.
Herz2019 Sep;():. doi: 10.1007/s00059-019-04855-5.
Dong Yu, Li Guangsen,
Abstract
Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease in developed countries and is associated with type 2 diabetes mellitus, obesity, hypertension, dyslipidemia, and metabolic syndrome. It is defined as steatosis in over 5% of hepatocytes. The disease spectrum of NAFLD ranges from simple fatty liver to nonalcoholic steatohepatitis, liver fibrosis, even hepatic cirrhosis. The disease affects various extra-hepatic systems such as the cardiovascular system and urinary system. Heart-related disease is identified as the leading cause of mortality in NAFLD patients rather than liver-related disease. In this review, we summarize the cardiac abnormalities (structural, functional, arrhythmic cardiac complications etc.) seen in NAFLD patients with the assistance of auxiliary examinations, such as electrocardiography, echocardiography, computed tomography, magnetic resonance imaging etc. In addition, the epidemiology of NAFLD and how NAFLD affects the myocardium are also discussed.
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Marked variation in heritability estimates of left ventricular mass depending on modality of measurement.
Sci Rep2019 Sep;9(1):13556. doi: 10.1038/s41598-019-49961-w.
Nethononda Richard M, McGurk Kathryn A, Whitworth Polly, Francis Jane, Mamasoula Chysovalanto, Cordell Heather J, Neubauer Stefan, Keavney Bernard D, Mayosi Bongani M, Farrall Martin, Watkins Hugh,
Abstract
Left ventricular (LV) hypertrophy is a strong risk factor for heart failure and cardiovascular death. ECG measures of LV mass are estimated as heritable in twin and family-based analyses and heritability estimates of LV mass measured by echocardiography are lower. We hypothesised that CMR-derived measurements, being more precise than echocardiographic measurements, would advance our understanding of heritable LV traits. We phenotyped 116 British families (427 individuals) by CMR and ECG, and undertook heritability analyses using variance-components (QTDT) and GWAS SNP-based (GCTA-GREML) methods. ECG-based traits such as LV mass and Sokolow-Lyon duration showed substantial estimates of heritability (60%), whereas CMR-derived LV mass was only modestly heritable (20%). However, the ECG LV mass was positively correlated with the lateral diameter of the chest (rho?=?0.67), and adjustment for this attenuated the heritability estimate (42%). Finally, CMR-derived right ventricular mass showed considerable heritability (44%). Heritability estimates of LV phenotypes show substantial variation depending on the modality of measurement, being greater when measured by ECG than CMR. This may reflect the differences between electrophysiological as opposed to anatomical hypertrophy. However, ECG LV hypertrophy traits are likely to be influenced by genetic association with anthropometric measures, inflating their overall measured heritability.
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[Assessment of the hemodynamics of pulmonary artery and right ventricular function in chronic obstructive pulmonary disease with pulmonary hypertension using cardiac magnetic resonance imaging].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue2019 Aug;31(8):972-977. doi: 10.3760/cma.j.issn.2095-4352.2019.08.012.
Fan Yuchun, Guo Xiaotong, Sun Xiao, Cao Xia, He Jinxi, Zhu Li, Chen Juan,
Abstract
OBJECTIVE:
To investigate the role of cardiac magnetic resonance imaging (CMRI) in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PAH); and the relationship between CMRI parameters and pulmonary function parameters, blood gas analysis parameters and 6-minute walk test (6MWT) parameters in patients with COPD complicated with PAH.
METHODS:
Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016, who underwent transthoracic echocardiography (TTE) to measure pulmonary arterial systolic pressure (PASP), and were divided into COPD group and COPD+PAH group according to whether there was PAH [PASP > 40 mmHg (1 mmHg = 0.133 kPa) was defined as PAH]. All patients completed pulmonary function tests [1 second forced expiratory volume to forced vital capacity ratio (FEV1/FVC), FEV1 predicted value (FEV1pred)], blood gas analysis [arterial blood oxygen partial pressure (PaO), arterial blood carbon dioxide partial pressure (PaCO)], CMRI examination [relative dilatation of the main pulmonary artery (mPAD), mean pulmonary artery pressure (mPAP), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), right ventricular end-diastolic myocardial mass (RVMED), right ventricular end-systolic myocardial mass (RVMES)], and 6MWD [6-minute walk distance (6MWD)] within 1 week. The obtained clinical parameters had been compared between the groups, and correlation was analyzed.
RESULTS:
Among the 37 patients with COPD, 16 patients were complicated with PAH. There were no significant differences in FEV1/FVC, FEV1pred, PaO, PaCO and other baseline indicators between the two groups. In the COPD group, TTE obtained PASP of 2 patients were normal (PSAP < 40 mmHg), while CMRI measured mPAP were higher than the normal limit (> 25 mmHg). Compared with the COPD group, mPAD, RVEF and 6MWD were significantly decreased in the COPD+PAH group [mPAD: (25.64±5.01)% vs. (44.00±22.52)%, RVEF: 0.525±0.054 vs. 0.592±0.071, 6MWD (m): 319.3±116.5 vs. 408.2±38.0, all P < 0.01], mPAP, RVMED and RVMES were significantly increased [mPAP (mmHg): 28.89±3.16 vs. 20.18±2.43, RVMED (g): 57.19±15.46 vs. 40.71±15.44, RVMES (g): 45.99±11.16 vs. 33.71±13.39, all P < 0.01], and there was no significant differences in LVEF (0.663±0.082 vs. 0.699±0.075, P > 0.05). Correlation analysis showed that mPAD was positively correlated with FEV1/FVC and FEV1pred (r = 0.538, P = 0.021; r = 0.448, P = 0.049); RVMED was negatively correlated with PaO (r = -0.581, P = 0.015), and positively correlated with PaCO (r = 0.592, P = 0.014); 6MWD was positively correlated with RVEF (r = 0.485, P = 0.041), and had no correlation with LVEF (r = 0.271, P = 0.104).
CONCLUSIONS:
Compared with COPD patients, changes in pulmonary hemodynamics and right ventricular function in COPD patients with PAH are related to the severity of airflow limitation. CMRI can early monitor pulmonary hemodynamics and right heart function changes in patients with COPD. Once PAH appears, pulmonary hemodynamics, right heart function and exercise tolerance have changed.
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Preoperative Physiology, Imaging, and Management of Coarctation of Aorta in Children.
Semin Cardiothorac Vasc Anesth2019 Sep;():1089253219873004. doi: 10.1177/1089253219873004.
Ganigara Madhusudan, Doshi Arpan, Naimi Iman, Mahadevaiah Guru Prasad, Buddhe Sujatha, Chikkabyrappa Sathish M,
Abstract
Coarctation of the aorta (CoA) is a narrowing of the proximal thoracic aorta typically located at the junction of the aorta with the ductus arteriosus. While it is a simple lesion to understand, considerable variation exists in the anatomy and pathophysiology, leading to varied clinical presentation, management options, and prognosis. On the one hand critical CoA manifests in the neonatal period as a duct-dependent lesion, while less severe forms of obstruction present later in childhood or adulthood as hypertension or incidentally noted precordial murmurs. While transthoracic echocardiography is usually adequate, older children and adults may need more advanced imaging modalities like computed tomography and magnetic resonance imaging prior to intervention. Depending on the type of lesion, management options currently available include surgery and percutaneous balloon angioplasty and stenting. Even after successful interventions, these patients need life-long surveillance for residual aortic obstruction and systemic hypertension with variable long-term clinical outcomes.
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Increased prevalence of cerebral microbleeds in patients with low left ventricular systolic function.
Heart Vessels2019 Sep;():. doi: 10.1007/s00380-019-01503-0.
Watanabe Tomohiko, Kanzaki Yumiko, Yamauchi Yohei, Ito Takahide, Nishida Yusuke, Yamamura Kenichiro, Komori Tsuyoshi, Sohmiya Koichi, Hoshiga Masaaki,
Abstract
Gradient-echo T2-star (T2*)-weighted magnetic resonance imaging (MRI) is a sensitive method to detect cerebral microbleeds (CMBs). The presence of CMBs was reported to be a marker of future cardiovascular mortality and is associated with various cardiovascular risk factors, use of antithrombotic drugs, and cognitive dysfunction. However, the relationship between cardiac function and CMBs remains unclear. We investigated the association between cardiac function and presence of CMBs in patients with cardiovascular diseases. This single-center retrospective study included a total of 424 participants (mean age 70?±?12 years; men 286 (67%); mean left ventricular ejection fraction (LVEF) 61%?±?12%] who underwent echocardiography and brain T2*-weighted MRI within 1 month without neurologic abnormality. CMBs were found in 118 (28%) patients. There was no significant relationship between CMBs and anticoagulant or antiplatelet therapy. LVEF was significantly lower in patients with CMBs than in those without CMBs (59%?±?13% vs. 62%?±?11%, P?
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Abnormal aortic flow conduction is associated with increased viscous energy loss in patients with repaired tetralogy of Fallot.
Eur J Cardiothorac Surg2019 Sep;():. doi: ezz246.
Schäfer Michal, Barker Alex J, Jaggers James, Morgan Gareth J, Stone Matthew L, Truong Uyen, Browne Lorna P, Malone Ladonna, Ivy D Dunbar, Mitchell Max B,
Abstract
OBJECTIVES:
Aortopathy in tetralogy of Fallot (TOF) is characterized by increased aortic stiffness, dilation and reduced left ventricular (LV) function. Repair in infancy normalizes aortic dimensions in early childhood. Our prior work demonstrated that early TOF repair does not normalize aortic compliance and that abnormal ascending aortic flow patterns are prevalent. The objectives of this study were to: (i) determine whether proximal aortic flow-mediated viscous energy loss (EL') is elevated in patients with early TOF repair compared with healthy controls, and (ii) determine whether the degree of EL' is associated with LV function.
METHODS:
Forty-one patients post TOF repair with normalized aortic size and 15 healthy controls underwent 4-dimenisonal-flow magnetic resonance imaging flow analysis and EL' assessment. Correlations between EL', aortic size, and LV function were assessed.
RESULTS:
The TOF group had increased peak systolic thoracic aorta EL' (3.8 vs 1.5 mW, P?=?0.004) and increased averaged EL' throughout the cardiac cycle (1.2 vs 0.5 mW, P?=?0.003). Peak and mean systolic EL' in the ascending aorta was increased 2-fold in the TOF group compared with control (peak: 2.0 vs 0.9 mW, P?=?0.007). Peak EL' measured along the entire thoracic aortic length correlated with LV ejection fraction (R = -0.45, P?=?0.009), indexed LV end-systolic volume (R = -0.40, P?=?0.010), and right ventricular end-systolic volume (R = -0.37, P?=?0.034).
CONCLUSIONS:
Patients with repaired TOF exhibit abnormal aortic flow associated with increased EL' in the thoracic aorta. The magnitude of EL' is associated with LV function and volumes. Increased aortic EL' in TOF is likely due to inherently abnormal LV outflow geometry and or right ventricular interaction. Reduced aortic flow efficiency in TOF increases cardiac work and may be an important factor in long-term cardiac performance.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Cardiac Arrest due to Butane Gas Inhalation in an 18 Years Old Boy.
Case Rep Emerg Med2019 ;2019():2461346. doi: 10.1155/2019/2461346.
AlRabiah Abdulaziz A, AlShamrani Abdulmalik M, AlMass Afnan A,
Abstract
An 18-year-old male smoker inhaled butane gas out of a pocket lighter with his friend for the purpose of changing his voice. He suddenly collapsed and lost his consciousness. Upon arrival to the Emergency Department, he was found pulseless with a rhythm of ventricular fibrillation. Cardiopulmonary resuscitation (CPR) was initiated according to the advanced cardiac life support (ACLS) protocol for three cycles until return of spontaneous circulation archived. After extubation, the patient was ataxic and had significant memory loss and severe confusion. Days later he improved and was discharged with walking aid for his ataxia and a plan to followup with the neurology team for magnetic resonance imaging (MRI) of the brain and electroencephalogram (EEG) as an outpatient.
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Model-based myocardial T1 mapping with sparsity constraints using single-shot inversion-recovery radial FLASH cardiovascular magnetic resonance.
J Cardiovasc Magn Reson2019 Sep;21(1):60. doi: 10.1186/s12968-019-0570-3.
Wang Xiaoqing, Kohler Florian, Unterberg-Buchwald Christina, Lotz Joachim, Frahm Jens, Uecker Martin,
Abstract
BACKGROUND:
This study develops a model-based myocardial T1 mapping technique with sparsity constraints which employs a single-shot inversion-recovery (IR) radial fast low angle shot (FLASH) cardiovascular magnetic resonance (CMR) acquisition. The method should offer high resolution, accuracy, precision and reproducibility.
METHODS:
The proposed reconstruction estimates myocardial parameter maps directly from undersampled k-space which is continuously measured by IR radial FLASH with a 4?s breathhold and retrospectively sorted based on a cardiac trigger signal. Joint sparsity constraints are imposed on the parameter maps to further improve T1 precision. Validations involved studies of an experimental phantom and 8 healthy adult subjects.
RESULTS:
In comparison to an IR spin-echo reference method, phantom experiments with T1 values ranging from 300 to 1500?ms revealed good accuracy and precision at simulated heart rates between 40 and 100?bpm. In vivo T1 maps achieved better precision and qualitatively better preservation of image features for the proposed method than a real-time CMR approach followed by pixelwise fitting. Apart from good inter-observer reproducibility (0.6% of the mean), in vivo results confirmed good intra-subject reproducibility (1.05% of the mean for intra-scan and 1.17, 1.51% of the means for the two inter-scans, respectively) of the proposed method.
CONCLUSION:
Model-based reconstructions with sparsity constraints allow for single-shot myocardial T1 maps with high spatial resolution, accuracy, precision and reproducibility within a 4?s breathhold. Clinical trials are warranted.
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