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Pubblicazioni recenti - cardiac magnetic resonance
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Early detection of obstructive coronary artery disease in the asymptomatic high-risk population: objectives and study design of the EARLY-SYNERGY trial.
Am Heart J2022 Jan;():. doi: S0002-8703(22)00005-9.
Ties Daan, van Dorp Paulien, Pundziute Gabija, van der Aalst Carlijn M, Gratama Jan Willem C, Braam Richard L, Kuijpers Dirkjan, Lubbers Daniël D, van der Bilt Ivo A C, Westenbrink B Daan, Wolcherink Martijn J Oude, Doggen Carine J M, I?gum Ivana, Nijveldt Robin, de Koning Harry J, Vliegenthart Rozemarijn, Oudkerk Matthijs, van der Harst Pim,
Abstract
BACKGROUND:
Coronary artery disease (CAD) burden for society is expected to steeply increase over the next decade. Improved feasibility and efficiency of preventive strategies is necessary to flatten the curve. Acute myocardial infarction (AMI) is the main determinant of CAD-related mortality and morbidity, and predominantly occurs in individuals with more advanced stages of CAD causing subclinical myocardial ischemia (obstructive CAD; OCAD). Unfortunately, OCAD can remain subclinical until its destructive presentation with AMI or sudden death. Current primary preventive strategies are not designed to differentiate between non-OCAD and OCAD and the opportunity is missed to treat individuals with OCAD more aggressively.
METHODS:
ARLY-SYNERGY is a multicenter, randomized-controlled clinical trial in individuals with coronary artery calcium (CAC) presence to study (1.) the diagnostic yield of cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) for early OCAD diagnosis and (2) whether early OCAD diagnosis improves outcomes. Individuals with CAC score ?300 objectified in two population-based trials (ROBINSCA; ImaLife) are recruited for study participation. Eligible candidates are randomized 1:1 to cardiac magnetic resonance stress myocardial perfusion imaging (CMR-MPI) or no additional functional imaging. In the CMR-MPI arm, feedback on imaging results is provided to primary care provider and participant in case of guideline-based actionable findings. Participants are followed-up for clinical events, healthcare utilizationand quality of life.
CONCLUSIONS:
EARLY-SYNERGY is the first randomized-controlled clinical trial designed to test the hypothesis that subclinical OCAD is widely present in the general at-risk population and that early differentiation of OCAD from non-OCAD followed by guideline-recommended treatment improves outcomes.
Copyright © 2022. Published by Elsevier Inc.
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Saturated and Unsaturated Bone Marrow Lipids Have Distinct Effects on Bone Density and Fracture Risk in Older Adults.
J Bone Miner Res2022 Jan;():. doi: 10.1002/jbmr.4504.
Woods Gina N, Ewing Susan K, Schafer Anne L, Gudnason Vilmundur, Sigurdsson Sigurdur, Lang Thomas, Hue Trisha F, Kado Deborah M, Vittinghoff Eric, Rosen Clifford, Li Xiaojuan, Schwartz Ann V,
Abstract
Greater bone marrow adiposity (BMAT) is associated with lower bone mineral density (BMD) and vertebral fractures; less is known about BMAT composition and bone. We studied BMAT composition and bone outcomes in 465 participants from the Age Gene/Environment Susceptibility (AGES)-Reykjavik study. BMAT saturation and unsaturation, measured with magnetic resonance spectroscopy, were defined as the ratio of saturated (1.3 ppm peak) or unsaturated (5.3 ppm peak) lipid to total marrow contents, respectively. At baseline and follow-up visits, spine and hip BMD were assessed with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA) and vertebral fractures were identified with DXA. Incident clinical fractures were identified through medical records for up to 8.8?years of follow-up. Associations between BMAT composition and BMD, bone loss, and fractures were evaluated in adjusted regression models. At baseline, mean participant age was 81.7 (SD 4.3) years, mean BMAT unsaturation was 3.5% (SD 1.0) and mean saturation was 46.3% (SD 7.2) in the full cohort (47.7% women). Each SD increase in BMAT saturation was associated with lower trabecular BMD: -23.6% (spine), -13.0% (total hip) (all p
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Peripheral blood natural killer cells in sarcoidosis are associated with early cardiac involvement.
Eur J Clin Invest2022 Jan;():e13742. doi: 10.1111/eci.13742.
Vakrakou Aigli G, Kolilekas Lykourgos, Lama Niki, Katsanos Spiros, Stratakos Grigorios, Tsougos Ilias, Manali Effrosyni, Grigoriou Eirini, Psarra Katherina, Kilidireas Constantinos, Papiris Spiros, Kelekis Nikolaos L, Gialafos Elias J,
Abstract
AIM:
To evaluate the distribution of circulating immune cell subsets in peripheral blood of patients with sarcoidosis and investigate if there is an association with an underlying cardiac involvement.
METHODS AND RESULTS:
Eighty-five newly diagnosed treatment-naïve patients with sarcoidosis (50 women) were included in the study. All patients underwent a thorough cardiac investigation, including cardiac magnetic resonance imaging (CMR). Of all patients, 19 (23.53%) had myocardial involvement, and the NK subpopulation in these patients in peripheral blood was significantly decreased compared to patients without (n = 63, p = 0.001 and p = 0.003 respectively). The absolute number of NKT cells (CD3+CD16/56 ) in patients with cardiac involvement was highly correlated with T2 map increased values in MRI (r = -686, p = 0.041) showing that low NKT cell count correlates with the inflammatory process of the heart. No difference in CD19, CD3, CD4, CD8 and CD3 NK cell counts was found between groups. Lung severity was not found to correlate with the number of NK cells.
CONCLUSION:
We found that low NK cell count in peripheral blood of patients with sarcoidosis is associated with cardiac involvement, and the number of NK-T cells correlates with CMR findings indicative of myocardial inflammation. This finding might have a potential clinical application in detecting clinically silent cardiac involvement in sarcoidosis and may also suggest potential targets for therapeutic interventions.
© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.
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Left ventricular trabeculations and cardiac magnetic resonance imaging.
J Anat2022 Jan;():. doi: 10.1111/joa.13624.
Stöllberger Claudia, Gerger Daniel, Finsterer Josef,
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Atrial Giant Cell Myocarditis as a Cause of Heart Failure: Diagnostic Pathway and Successful Treatment.
JACC Case Rep2022 Jan;4(1):66-71. doi: 10.1016/j.jaccas.2021.11.007.
Paitazoglou Christina, Bergmann Martin W, Tiemann Katharina, Wiese Andrea, Schäfer Ulrich, Schwarz Arne, Eitel Ingo, Montenbruck Moritz,
Abstract
We present a patient with acute heart failure and new onset atrial fibrillation secondary to giant cell myocarditis with lone atrial involvement. The diagnosis was managed with cardiac magnetic resonance and confirmed by interventionally guided biopsy. In the future, diagnosis could be managed noninvasively for this rare entity as the gold standard. ().
© 2022 The Authors.
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Episodic Myocarditis in Arrhythmogenic Cardiomyopathy: A Novel Treatment Target?
JACC Case Rep -
Toxin-Mediated Myocarditis From a Brown Recluse Spider Bite.
JACC Case Rep2022 Jan;4(1):49-53. doi: 10.1016/j.jaccas.2021.10.003.
Sims Richard A, Fish-Trotter Hannah L, Clark Daniel E, Gayle Kathryn A, Hughes Sean G, Brittain Evan L,
Abstract
We describe a case of myocarditis associated with a brown recluse spider bite in a 31-year-old man. Cardiac magnetic resonance revealed late gadolinium enhancement in the lateral wall and inferior wall. There was also regional elevation of the myocardial T2 and extracellular volume indicative of myocardial edema. ().
© 2022 The Authors.
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Dissecting Into the 2021 Chest Pain Guidelines.
JACC Case Rep2022 Jan;4(1):21-26. doi: 10.1016/j.jaccas.2021.10.019.
Dong Tiffany, Jaber Wael A,
Abstract
Although acute coronary syndromes remain crucial diagnoses of chest pain that cannot be missed, there are several other potentially fatal diagnoses that can manifest similarly. This case report applies the 2021 chest pain guidelines emphasizing the importance of considering alternative nonischemic but still serious presentations under the umbrella of chest pain. ().
© 2022 The Authors.
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A case of a small-sized cavernous hemangioma in the right ventricle - an incidental finding.
Radiol Case Rep2022 Mar;17(3):856-862. doi: 10.1016/j.radcr.2021.12.038.
Vu Thu Thuy, Nguyen Van Thach, Tran Quang Thai, Ngo Thi Minh Hanh, Do Thanh Hoa, Le Hai Son, Nguyen Ngoc Trang, Nguyen Van Thuy, Lam Khanh,
Abstract
A cardiac cavernous hemangioma is a rare, primary, benign tumor that is usually diagnosed in young or middle-aged patients. In this article, we report the case of a 71-year-old male patient whose doctors incidentally discovered a heart tumor on his transthoracic echocardiography. Triple-phase computed tomography (CT) (pre-contrast, arterial and portal venous) missed the lesion, and magnetic resonance imaging (MRI) revealed a small, oval tumor attached to the wall of the right ventricle. The tumor was successfully removed surgically, and the patient recovered after 2 weeks. A histopathological examination resulted in the diagnosis of a benign cavernous hemangioma.
© 2021 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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Myocardial Energy Response to Glyceryl Trinitrate: Physiology Revisited.
Front Physiol2021 ;12():790525. doi: 10.3389/fphys.2021.790525.
Watson William D, Green Peregrine G, Valkovi? Ladislav, Herring Neil, Neubauer Stefan, Rider Oliver J,
Abstract
Although intravenous nitrates are commonly used in clinical medicine, they have been shown to increase myocardial oxygen consumption and inhibit complex IV of the electron transport chain. As such we sought to measure whether myocardial energetics were impaired during glyceryl trinitrate (GTN) infusion. 10 healthy volunteers underwent cardiac magnetic resonance imaging to assess cardiac function and phosphorus magnetic resonance spectroscopy to measure Phosphocreatine/ATP (PCr/ATP) ratio and creatine kinase forward rate constant (CK ) before and during an intravenous infusion of GTN. During GTN infusion, mean arterial pressure (78?±?7 vs. 65?±?6?mmHg, ?0.001), left ventricular (LV) stroke work (7,708?±?2,782 vs. 6,071?±?2,660?ml?mmHg, ?0.001), and rate pressure product (7,214?±?1,051 vs. 6,929?±?976?mmHg?bpm, ?=?0.06) all fell. LV ejection fraction increased (61?±?3 vs. 66?±?4%, ?0.001), with cardiac output remaining constant (6.2?±?1.5 vs. 6.5?±?1.4?l/min, ?=?0.37). Myocardial PCr/ATP fell during GTN infusion (2.17?±?0.2 vs. 1.99?±?0.22, ?=?0.03) with an increase in both CK (0.16?±?0.07 vs. 0.25?±?0.1?s, ?=?0.006) and CK flux (1.8?±?0.8 vs. 2.6?±?1.1??mol/g/s, ?=?0.03). During GTN infusion, despite reduced LV stroke work and maintained cardiac output, there was a 44% increase in myocardial ATP delivery through CK. As PCr/ATP fell, this increase in ATP demand coincided with GTN-induced impairment of mitochondrial oxidative phosphorylation. Overall, this suggests that while GTN reduces cardiac work, it does so at the expense of increasing ATP demand beyond the capacity to increase ATP production.
Copyright © 2021 Watson, Green, Valkovi?, Herring, Neubauer and Rider.
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Reproducibility of Cardiac Magnetic Resonance Imaging in Patients With Cardiac Implantable Electrical Devices: Multicenter CONCERT-HF Trial.
JACC Cardiovasc Imaging2022 Jan;():. doi: S1936-878X(21)00894-9.
Ostovaneh Mohammad R, Ward Caroline, Ambale-Venkatesh Bharath, Chamera Elzbieta, Kato Yoko, Bolli Roberto, Mitrani Raul, Perin Emerson C, Henry Timothy D, Hare Joshua M, Moyé Lem, Nazarian Saman, Lima João A C,
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Alterations in pain processing circuitries in episodic migraine.
J Headache Pain2022 Jan;23(1):9. doi: 10.1186/s10194-021-01381-w.
Mungoven Tiffani J, Marciszewski Kasia K, Macefield Vaughan G, Macey Paul M, Henderson Luke A, Meylakh Noemi,
Abstract
BACKGROUND:
The precise underlying mechanisms of migraine remain unknown. Although we have previously shown acute orofacial pain evoked changes within the brainstem of individuals with migraine, we do not know if these brainstem alterations are driven by changes in higher cortical regions. The aim of this investigation is to extend our previous investigation to determine if higher brain centers display altered activation patterns and connectivity in migraineurs during acute orofacial noxious stimuli.
METHODS:
Functional magnetic resonance imaging was performed in 29 healthy controls and 25 migraineurs during the interictal and immediately (within 24-h) prior to migraine phases. We assessed activation of higher cortical areas during noxious orofacial heat stimulation using a thermode device and assessed whole scan and pain-related changes in connectivity.
RESULTS:
Despite similar overall pain intensity ratings between all three groups, migraineurs in the group immediately prior to migraine displayed greater activation of the ipsilateral nucleus accumbens, the contralateral ventrolateral prefrontal cortex and two clusters in the dorsolateral prefrontal cortex (dlPFC). Reduced whole scan dlPFC [Z?+?44] connectivity with cortical/subcortical and brainstem regions involved in pain modulation such as the putamen and primary motor cortex was demonstrated in migraineurs. Pain-related changes in connectivity of the dlPFC and the hypothalamus immediately prior to migraine was also found to be reduced with brainstem pain modulatory areas such as the rostral ventromedial medulla and dorsolateral pons.
CONCLUSIONS:
These data reveal that the modulation of brainstem pain modulatory areas by higher cortical regions may be aberrant during pain and these alterations in this descending pain modulatory pathway manifests exclusively prior to the development of a migraine attack.
© 2022. The Author(s).
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Quantitative assessment of right ventricular size and function with multiple parameters from artificial intelligence-based three-dimensional echocardiography: A comparative study with cardiac magnetic resonance.
Echocardiography2022 Jan;():. doi: 10.1111/echo.15292.
Zhu Ying, Bao Yuwei, Zheng Kangchao, Zhou Wei, Zhang Jun, Sun Ruiying, Deng Youbin, Xia Liming, Liu Yani,
Abstract
AIMS:
This study aimed to explore the validation and the diagnostic value of multiple right ventricle (RV) volumes and functional parameters derived from a novel artificial intelligence (AI)-based three-dimensional echocardiography (3DE) algorithm compared to cardiac magnetic resonance (CMR).
METHODS AND RESULTS:
A total of 51 patients with a broad spectrum of clinical diagnoses were finally included in this study. AI-based RV 3DE was performed in a single-beat HeartModel mode within 24 hours after CMR. In the entire population, RV volumes and right ventricular ejection fraction (RVEF) measured by AI-based 3DE showed statistically significant correlations with the corresponding CMR analysis (p
CONCLUSION:
AI-based 3DE could provide rapid and accurate quantitation of the RV volumes and function with multiple parameters. Both volumetric and non-volumetric measurements derived from AI-based 3DE contributed to the identification of the RV dysfunction.
© 2022 Wiley Periodicals LLC.
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An Explainable Machine Learning Approach Reveals Prognostic Significance of Right Ventricular Dysfunction in Nonischemic Cardiomyopathy.
JACC Cardiovasc Imaging2022 Jan;():. doi: S1936-878X(21)00902-5.
Fahmy Ahmed S, Csecs Ibolya, Arafati Arghavan, Assana Salah, Yankama Tuyen T, Al-Otaibi Talal, Rodriguez Jennifer, Chen Yi-Yun, Ngo Long H, Manning Warren J, Kwong Raymond Y, Nezafat Reza,
Abstract
OBJECTIVES:
We implemented an explainable machine learning (ML) model to gain insight into the association between cardiac magnetic resonance markers and adverse outcomes of cardiovascular hospitalization and all-cause death (composite endpoint) in patients with nonischemic dilated cardiomyopathy (NICM).
BACKGROUND:
Risk stratification of patients with NICM remains challenging. An explainable ML model has the potential to provide insight into the contributions of different risk markers in the prediction model.
METHODS:
An explainable ML model based on extreme gradient boosting (XGBoost) machines was developed using cardiac magnetic resonance and clinical parameters. The study cohorts consist of patients with NICM from 2 academic medical centers: Beth Israel Deaconess Medical Center (BIDMC) and Brigham and Women's Hospital (BWH), with 328 and 214 patients, respectively. XGBoost was trained on 70% of patients from the BIDMC cohort and evaluated based on the other 30% as internal validation. The model was externally validated using the BWH cohort. To investigate the contribution of different features in our risk prediction model, we used Shapley additive explanations (SHAP) analysis.
RESULTS:
During a mean follow-up duration of 40 months, 34 patients from BIDMC and 33 patients from BWH experienced the composite endpoint. The area under the curve for predicting the composite endpoint was 0.71 for the internal BIDMC validation and 0.69 for the BWH cohort. SHAP analysis identified parameters associated with right ventricular (RV) dysfunction and remodeling as primary markers of adverse outcomes. High risk thresholds were identified by SHAP analysis and thus provided thresholds for top predictive continuous clinical variables.
CONCLUSIONS:
An explainable ML-based risk prediction model has the potential to identify patients with NICM at risk for cardiovascular hospitalization and all-cause death. RV ejection fraction, end-systolic and end-diastolic volumes (as indicators of RV dysfunction and remodeling) were determined to be major risk markers.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Cost-Minimization Analysis for Cardiac Revascularization in 12 Health Care Systems Based on the EuroCMR/SPINS Registries.
JACC Cardiovasc Imaging2022 Jan;():. doi: S1936-878X(21)00836-6.
Moschetti Karine, Kwong Raymond Y, Petersen Steffen E, Lombardi Massimo, Garot Jerome, Atar Dan, Rademakers Frank E, Sierra-Galan Lilia, Mavrogeni Sophie, Li Kuncheng, Fernandes Juliano Lara, Schneider Steffen, Pinget Christophe, Ge Yin, Antiochos Panagiotis, Deluigi Christina, Bruder Oliver, Mahrholdt Heiko, Schwitter Juerg,
Abstract
OBJECTIVES:
The aim of this study was to compare the costs of a noninvasive cardiac magnetic resonance (CMR)-guided strategy vs 2 invasive strategies with and without fractional flow reserve (FFR).
BACKGROUND:
Coronary artery disease (CAD) is a major contributor to the public health burden. Stress perfusion CMR has excellent accuracy to detect CAD. International guidelines recommend as a first step noninvasive testing of patients in stable condition with known or suspected CAD. However, nonadherence in routine clinical practice is high.
METHODS:
In the EuroCMR (European Cardiovascular Magnetic Resonance) registry (n = 3,647, 59 centers, 18 countries) and the U.S.-based SPINS (Stress-CMR Perfusion Imaging in the United States) registry (n = 2,349, 13 centers, 11 states), costs were calculated for 12 health care systems (8 in Europe, the United States, 2 in Latin America, and 1 in Asia). Costs included diagnostic examinations (CMR and x-ray coronary angiography [CXA] with and without FFR), revascularizations, and complications during 1-year follow-up. Seven subgroup analyses covered low- to high-risk cohorts. Patients with ischemia-positive CMR underwent CXA and revascularization at the treating physician's discretion (CMR+CXA strategy). In the hypothetical invasive CXA+FFR strategy, costs were calculated for initial CXA and FFR in vessels with ?50% stenoses, assuming the same proportion of revascularizations and complications as with the CMR+CXA strategy and FFR-positive rates as given in the published research. In the CXA-only strategy, costs included CXA and revascularizations of ?50% stenoses.
RESULTS:
Consistent cost savings were observed for the CMR+CXA strategy compared with the CXA+FFR strategy in all 12 health care systems, ranging from 42% ± 20% and 52% ± 15% in low-risk EuroCMR and SPINS patients with atypical chest pain, respectively, to 31% ± 16% in high-risk SPINS patients with known CAD (P
CONCLUSIONS:
In 12 health care systems, a CMR+CXA strategy yielded consistent moderate to high cost savings compared with a hypothetical CXA+FFR strategy over the entire spectrum of risk. Cost savings were consistently high compared with CXA only for all risk groups.
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
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Understanding and Improving Risk Assessment After Myocardial Infarction Using Automated Left Ventricular Shape Analysis.
JACC Cardiovasc Imaging2022 Jan;():. doi: S1936-878X(21)00899-8.
Corral Acero Jorge, Schuster Andreas, Zacur Ernesto, Lange Torben, Stiermaier Thomas, Backhaus Sören J, Thiele Holger, Bueno-Orovio Alfonso, Lamata Pablo, Eitel Ingo, Grau Vicente,
Abstract
OBJECTIVES:
This study aimed to identify novel 3-dimensional (3D) imaging end-systolic (ES) shape and contraction descriptors toward risk-related features and superior prognosis in acute myocardial infarction (AMI).
BACKGROUND:
Left ventricular ejection fraction (LVEF) and end-systolic volume (ESV) remain the main imaging biomarkers for post-AMI risk stratification. However, they are limited to global systolic function and fail to capture functional and anatomical regional abnormalities, hindering their performance in risk stratification.
METHODS:
A multicenter cohort of AMI survivors (n = 1,021; median age 63 years; 74.5% male) who underwent cardiac magnetic resonance (CMR) at a median of 3 days after infarction were considered for this study. The clinical end point was the 12-month rate of major adverse cardiac events (MACE; n = 73), consisting of all-cause death, reinfarction, and new congestive heart failure. A fully automated pipeline was developed to segment CMR images, build 3D statistical models of shape and contraction in AMI, and find the 3D patterns related to MACE occurrence.
RESULTS:
The novel ES shape markers proved to be superior to ESV (median cross-validated area under the receiver-operating characteristic curve 0.681 [IQR 0.679-0.684] vs 0.600 [0.598-0.602]; P
CONCLUSIONS:
The quantification of 3D differences in ES shape and contraction, enabled by a fully automated pipeline, improves post-AMI risk prediction and identifies shape and contraction patterns related to MACE occurrence.
Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.
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Prevalence and Prognostic Significance of Microvascular Dysfunction in Heart Failure With Preserved Ejection Fraction.
JACC Cardiovasc Imaging2022 Jan;():. doi: S1936-878X(21)00893-7.
Arnold Jayanth R, Kanagala Prathap, Budgeon Charley A, Jerosch-Herold Michael, Gulsin Gaurav S, Singh Anvesha, Khan Jamal N, Chan Daniel C S, Squire Iain B, Ng Leong L, McCann Gerry P,
Abstract
OBJECTIVES:
The aim of this study was to use cardiovascular magnetic resonance to 1) quantify coronary microvascular function; 2) examine the relationship between perfusion and fibrosis; and 3) evaluate the impact of microvascular dysfunction (MVD) and fibrosis on long-term clinical outcomes.
BACKGROUND:
The pathophysiological and clinical significance of MVD in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain.
METHODS:
In a prospective, observational study, patients with HFpEF and control subjects underwent multiparametric cardiovascular magnetic resonance (comprising assessment of left ventricular volumetry, perfusion, and fibrosis [focal by late gadolinium enhancement and diffuse by extracellular volume]). The primary endpoint was the composite of death or hospitalization with heart failure.
RESULTS:
One hundred and one patients with HFpEF (mean age 73 ± 9 years, mean ejection fraction 56% ± 5%) and 43 control subjects (mean age 73 ± 5 years, mean ejection fraction 58% ± 5%) were studied. Myocardial perfusion reserve (MPR) was lower in patients with HFpEF versus control subjects (1.74 ± 0.76 vs 2.22 ± 0.76; P = 0.001). MVD (defined as MPR
CONCLUSIONS:
MVD is highly prevalent among patients with HFpEF and is an independent predictor of prognosis. The lack of correlation between MVD and fibrosis may challenge the assertion of a direct causal link between these entities. (Developing Imaging and Plasma Biomarkers in Describing Heart Failure With Preserved Ejection Fraction [DIAMONDHFpEF]; NCT03050593).
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Non-contact whole-chamber charge density mapping of the left ventricle: preclinical evaluation in a sheep model.
Heart Rhythm2022 Jan;():. doi: S1547-5271(22)00017-0.
Ramirez F Daniel, Winterfield Jeffrey R, Shi Xinwei, Chou Derrick, Robinson Dave, Angel Nathan, Shah Pratik, Sorrell Tim, Ghafoori Elyar, Vanderper Annelies, Mariappan Leo, Soré Bruno, Peyrat Jean-Marc, Loyer Virginie, Nakatani Yosuke, Cochet Hubert, Jaïs Pierre,
Abstract
BACKGROUND:
Conventional contact-based electroanatomic mapping is poorly suited for rapid or dynamic ventricular arrhythmias. Whole-chamber charge density (CD) mapping could efficiently characterize complex ventricular tachyarrhythmias and yield insights into their underlying mechanisms.
OBJECTIVE:
This study sought to evaluate the feasibility and accuracy of non-contact whole-chamber left ventricular (LV) CD mapping, and to characterize CD activation patterns during sinus rhythm, ventricular pacing, and ventricular fibrillation (VF).
METHODS:
Ischemic scar as defined by CD amplitude thresholds was compared to late gadolinium enhancement criteria on magnetic resonance imaging using an iterative closest point algorithm. Electrograms recorded at sites of tissue contact were compared to the nearest non-contact CD-derived electrograms to calculate signal morphology cross-correlations and time differences. Regions of consistently slow conduction were examined relative to areas of scar and to localized irregular activation (LIA) during VF.
RESULTS:
Areas under receiver operating characteristic curves (AUCs) of CD-defined dense and total LV scar were 0.92 ± 0.03 and 0.87 ± 0.06, with accuracies of 0.86±0.03 and 0.80±0.05, respectively. Morphology cross-correlation between 8,677 contact and corresponding non-contact electrograms was 0.93±0.10, with a mean time difference of 2.5±5.6 msec. Areas of consistently slow conduction tended to occur at scar borders and exhibited spatial agreement with LIA during VF (AUC 0.90±0.02).
CONCLUSION:
Non-contact LV CD mapping can accurately delineate ischemic scar. CD-derived ventricular electrograms correlate strongly with conventional contact-based electrograms. Regions with consistently slow conduction are often at scar borders and tend to harbor LIA during VF.
Copyright © 2022. Published by Elsevier Inc.
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The effect of dietary patterns on non-alcoholic fatty liver disease diagnosed by biopsy or magnetic resonance in adults: a systematic review of randomised controlled trials.
Metabolism2022 Jan;():155136. doi: S0026-0495(22)00014-2.
Angelidi Angeliki M, Papadaki Angeliki, Nolen-Doerr Eric, Boutari Chrysoula, Mantzoros Christos S,
Abstract
Adhering to specific dietary patterns might hold promise as a lifestyle modification treatment of non-alcoholic fatty liver disease (NAFLD). The aim of this systematic review was to examine the effect of dietary patterns on changes in hepatic fat content, liver enzymes and metabolic syndrome components. We searched Pubmed, Embase, CINAHL and Web of Science for randomised controlled trials published in English until April 2020, comparing a specific dietary pattern with no treatment, usual care, or a different diet in adults with NAFLD. Studies were included if NAFLD had been diagnosed using biopsy, magnetic resonance imaging, or proton magnetic resonance spectroscopy. Data from three trials in adults with NAFLD but without diabetes (n?=?128; mean age 49.9?±?5.0?years, range 42-55?years) were included in the qualitative synthesis; across them, risk of bias was considered low, unclear and high for 33%, 38% and 29% of domains, respectively. There was moderate evidence that a low-carbohydrate, compared to a low-calorie diet (-27%, P?=?0.008, one study, n?=?18) and the Mediterranean, compared to a low-fat, high-carbohydrate diet (-4.4%, P?=?0.030, one study, n?=?12) result in greater reductions in hepatic fat content, but no such evidence was found for the Fatty Liver in Obesity dietary pattern (based on the principles of the Mediterranean diet), compared to the American Heart Association diet (-0.6%, P?=?0.706, one study, n?=?98). No between-group differences were reported for other outcomes across studies. A post hoc analysis, including two eligible studies assessing the effect of the Mediterranean, compared to a low-fat diet, irrespective of baseline presence of diabetes, showed strong evidence that the Mediterranean diet reduces hepatic fat content (-4.1%, 95% CI?=?-5.8 to -2.3, P?0.001; I?=?0%) and triglyceride concentrations (-16.9?mg/dL, 95% CI?=?-26.3 to -7.7, P?0.001; I?=?0%). Well-designed, adequately powered and rigorous randomised controlled trials are needed to provide robust evidence on the effect of these dietary patterns, but also other whole dietary approaches, on NAFLD progression.
Copyright © 2021. Published by Elsevier Inc.
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Initial experience with intensity distribution analysis of hemodynamic parameters in the thoracic aorta using four-dimensional magnetic resonance imaging: A comparison between groups with different ejection fractions.
Medicine (Baltimore)2022 Jan;101(2):e28563. doi: 10.1097/MD.0000000000028563.
Nishimura Takamasa, Sueyoshi Eijun, Koike Hirofumi, Uetani Masataka,
Abstract
ABSTRACT:
The purpose of this study was to investigate whether there were significant differences in the intensity distributions of thoracic aorta hemodynamic parameters between groups with different ejection fractions (EF) using four-dimensional flow magnetic resonance imaging and to investigate the relationships between each parameter.A total of 26 patients, 13 each with EF of >60% and 60%: mean age: 54?±?11.6?years, EF 60% group, these intensity distributions showed higher values in the greater curvature of the AAo, whereas in the EF
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
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