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Pubblicazioni recenti - cardiac magnetic resonance
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Practical recommendations for the diagnosis and management of transthyretin cardiac amyloidosis.
Heart Fail Rev2021 Jan;():. doi: 10.1007/s10741-020-10062-w.
Bistola Vasiliki, Parissis John, Foukarakis Emmanouil, Valsamaki Pipitsa N, Anastasakis Aris, Koutsis Georgios, Efthimiadis Georgios, Kastritis Efstathios,
Abstract
Cardiac amyloidosis (CA) is an infiltrative restrictive cardiomyopathy caused by accumulation in the heart interstitium of amyloid fibrils formed by misfolded proteins. Most common CA types are light chain amyloidosis (AL) caused by monoclonal immunoglobulin light chains and transthyretin amyloidosis (ATTR) caused by either mutated or wild-type transthyretin aggregates. Previously considered a rare disease, CA is increasingly recognized among patients who may be misdiagnosed as undifferentiated heart failure with preserved ejection fraction (HFPEF), paradoxical low-flow/low-gradient aortic stenosis, or otherwise unexplained left ventricular hypertrophy. Progress in diagnosis has been due to the refinement of cardiac echocardiographic techniques (speckle tracking imaging) and magnetic resonance (T1 mapping) and mostly due to the advent of bone scintigraphy that has enabled noninvasive diagnosis of ATTR, limiting the need for endomyocardial biopsy. Importantly, proper management of CA starts from early recognition of suspected cases among high prevalence populations, followed by advanced diagnostic evaluation to confirm diagnosis and typing, preferentially in experienced amyloidosis centers. Differentiating ATTR from other types of amyloidosis, especially AL, is critical. Emerging targeted ATTR therapies offer the potential to improve outcomes of these patients previously treated only palliatively.
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A novel rabbit fixator made of a thermoplastic mask for awake imaging experiments.
Sci Rep2021 Jan;11(1):1546. doi: 10.1038/s41598-021-81358-6.
Lu Rencai, Hou Li, Wang Siyu, She Bo, He Hong, Gao Wentao, Wang Sidang, Xv Dongdong, Ji Yunhai, Yang Shasha, Yang Zhaohui, Wang Shaobo,
Abstract
This study aimed to develop and validate a novel rabbit fixator made from a thermoplastic mask for awake imaging experiments. When heated in a hot-water bath at 65-70 °C for 2-5 min, the thermoplastic mask became soft and could be molded to fit over the entire body of an anesthetized rabbit (4 ml of 3% pentobarbital sodium solution by intramuscular injection). Twenty rabbits were randomly divided into fixator (n?=?10) and anesthesia (n?=?10) groups. The animals' vital signs, stress hormones (cortisol and adrenaline), and subjective image quality scores for the computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) scanning were measured and compared. Phantom CT, MRI and PET studies were performed to assess the performance with and without the thermoplastic mask by using image agents at different concentrations or with different radioactivity. The respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), peripheral capillary oxygen saturation (SpO) and body temperature (T) decreased after anesthesia (all P??0.05). The heart rate (HR), cortisol and adrenaline did not significantly decrease after either anesthesia or fixation (all P?>?0.05). The subjective image quality scores for the CT and MRI images of the head, thorax, liver, kidney, intestines and pelvis and the subjective image quality scores for the PET images did not significantly differ between the two groups (all P?>?0.05). For all examined organs except the muscle, F-FDG metabolism was lower after fixation than after anesthesia, and was almost identical of liver between two groups. The phantom study showed that the CT values, standard uptake values and MR T2 signal values did not differ significantly with or without the mask (all P?>?0.05). A novel rabbit fixator created using a thermoplastic mask could be used to obtain high-quality images for different imaging modalities in an awake and near-physiological state.
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Instantaneous wave-free ratio guided multivessel revascularisation during percutaneous coronary intervention for acute myocardial infarction: study protocol of the randomised controlled iMODERN trial.
BMJ Open2021 Jan;11(1):e044035. doi: 10.1136/bmjopen-2020-044035.
Beijnink Casper W H, Thim Troels, van der Heijden Dirk Jan, Klem Igor, Al-Lamee Rasha, Vos Jacqueline L, Koop Yvonne, Dijkgraaf Marcel G W, Beijk Marcel A M, Kim Raymond J, Davies Justin, Raposo Luis, Baptista Sérgio B, Escaned Javier, Piek Jan J, Maeng Michael, van Royen Niels, Nijveldt Robin,
Abstract
INTRODUCTION:
Recent randomised clinical trials showed benefit of non-culprit lesion revascularisation in ST-elevation myocardial infarction (STEMI) patients. However, it remains unclear whether revascularisation should be performed at the index procedure or at a later stage.
METHODS AND ANALYSIS:
The instantaneous wave-free ratio (iFR) Guided Multivessel Revascularisation During Percutaneous Coronary Intervention for Acute Myocardial Infarction trial is a multicentre, randomised controlled prospective open-label trial with blinded evaluation of endpoints. After successful primary percutaneous coronary intervention (PCI), eligible STEMI patients with residual non-culprit lesions are randomised, to instantaneous wave-free ratio guided treatment of non-culprit lesions during the index procedure versus deferred cardiac MR-guided management within 4 days to 6 weeks. The primary endpoint of the study is the combined occurrence of all-cause death, recurrent myocardial infarction and hospitalisation for heart failure at 12 months follow-up. Clinical follow-up includes questionnaires at 3 months and outpatient visits at 6 months and 12 months after primary PCI. Furthermore, a cost-effectiveness analysis will be performed.
ETHICS AND DISSEMINATION:
Permission to conduct this trial has been granted by the Medical Ethical Committee of the Amsterdam University Medical Centres (loc. VUmc, ID NL60107.029.16). The primary results of this trial will be shared in a main article and subgroup analyses or spin-off studies will be shared in secondary papers.
TRIAL REGISTRATION NUMBER:
NCT03298659.
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Effusive-constrictive pericarditis in the spectrum of pericardial compressive syndromes.
Heart2021 Jan;():. doi: heartjnl-2020-316664.
Janus Scott E, Hoit Brian D,
Abstract
When pericardial fluid accumulates and exceed the reserve volume of the pericardium or when the pericardium becomes scarred and inelastic, one of three pericardial compressive syndromes may ensue, namely, cardiac tamponade (CT), characterised by the accumulation of pericardial fluid under pressure; constrictive pericarditis (CP), the result of scarring and loss of the normal elasticity of the pericardial sac; and effusive-constrictive pericarditis (ECP), characterised by the concurrence of a tense pericardial effusion and constriction of the heart by the visceral pericardium. Although relatively uncommon, prevalence estimates vary widely and depend on the nature of the cohorts studied, the methods used to diagnose ECP and the manner in which ECP is defined. Most cases of ECP are idiopathic, reflecting the frequency of idiopathic pericardial disease in general, and other causes include radiation, malignancy, chemotherapy, infection and postsurgical/iatrogenic pericardial disease. The diagnosis of ECP often becomes apparent when pericardiocentesis fails to decrease the right atrial pressure by 50% or to a level below 10?mm Hg. Important non-invasive diagnostic modalities include echocardiography, cardiac magnetic resonance and, to a lesser extent, cardiac CT. In cases with clear evidence of pericardial inflammation, a trial of an anti-inflammatory regimen is warranted. A complete pericardiectomy should be reserved for refractory symptoms or clinical evidence of chronic CP.
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.
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Commentary: Planning ahead: Fetal magnetic resonance imaging may predict brain injury before surgery for congenital heart disease.
J Thorac Cardiovasc Surg -
Identification of a Multiplex Biomarker Panel for Hypertrophic Cardiomyopathy Using Quantitative Proteomics and Machine Learning.
Mol Cell Proteomics2020 Jan;19(1):114-127. doi: S1535-9476(20)30009-8.
Captur Gabriella, Heywood Wendy E, Coats Caroline, Rosmini Stefania, Patel Vimal, Lopes Luis R, Collis Richard, Patel Nina, Syrris Petros, Bassett Paul, O'Brien Ben, Moon James C, Elliott Perry M, Mills Kevin,
Abstract
Hypertrophic cardiomyopathy (HCM) is defined by pathological left ventricular hypertrophy (LVH). It is the commonest inherited cardiac condition and a significant number of high risk cases still go undetected until a sudden cardiac death (SCD) event. Plasma biomarkers do not currently feature in the assessment of HCM disease progression, which is tracked by serial imaging, or in SCD risk stratification, which is based on imaging parameters and patient/family history. There is a need for new HCM plasma biomarkers to refine disease monitoring and improve patient risk stratification. To identify new plasma biomarkers for patients with HCM, we performed exploratory myocardial and plasma proteomics screens and subsequently developed a multiplexed targeted liquid chromatography-tandem/mass spectrometry-based assay to validate the 26 peptide biomarkers that were identified. The association of discovered biomarkers with clinical phenotypes was prospectively tested in plasma from 110 HCM patients with LVH (LVH+ HCM), 97 controls, and 16 HCM sarcomere gene mutation carriers before the development of LVH (subclinical HCM). Six peptides (aldolase fructose-bisphosphate A, complement C3, glutathione S-transferase omega 1, Ras suppressor protein 1, talin 1, and thrombospondin 1) were increased significantly in the plasma of LVH+ HCM compared with controls and correlated with imaging markers of phenotype severity: LV wall thickness, mass, and percentage myocardial scar on cardiovascular magnetic resonance imaging. Using supervised machine learning (ML), this six-biomarker panel differentiated between LVH+ HCM and controls, with an area under the curve of ? 0.87. Five of these peptides were also significantly increased in subclinical HCM compared with controls. In LVH+ HCM, the six-marker panel correlated with the presence of nonsustained ventricular tachycardia and the estimated five-year risk of sudden cardiac death. Using quantitative proteomic approaches, we have discovered six potentially useful circulating plasma biomarkers related to myocardial substrate changes in HCM, which correlate with the estimated sudden cardiac death risk.
Copyright © 2020 © 2020 Captur et al. Published by Elsevier Inc. All rights reserved.
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Characterizing the protracted neurobiological and neuroanatomical effects of paraquat in a murine model of Parkinson's disease.
Neurobiol Aging2020 Nov;100():11-21. doi: S0197-4580(20)30395-X.
Dwyer Zach, Rudyk Chris, Farmer Kyle, Beauchamp Sheryl, Shail Pragya, Derksen Alexa, Fortin Teresa, Ventura Katelyn, Torres Carlos, Ayoub Kiara, Hayley Shawn,
Abstract
The primary motor symptoms of Parkinson's disease (PD) result from the degeneration of dopamine-producing neurons of the substantia nigra pars compacta (SNc), and often, the loss is asymmetrical, resulting in unilateral tremor presentation. Notably, age is the primary risk factor for PD, and it is likely that the disease ultimately stems from the impact of environmental factors, which interact with the aging process. Recent research has focused on the role of microglia and pro-oxidative responses in dopaminergic neuronal death. In this study, we sought to examine the neurodegenerative, inflammatory, and stress effects of exposure to the etiologically relevant pesticide, paraquat, over time (up to 6 months after injections). We also were interested in whether a high-resolution, 7-Tesla animal magnetic resonance imaging would be sensitive enough to detect the degenerative impact of paraquat. We found that paraquat induced a loss of dopaminergic SNc neurons and activation of microglia that surprisingly did not change over 6 months after the last injection. A long-lasting reduction was evident for body weight, and alterations in organ (lung and heart) weight were evident, which reflect the peripheral impact of the toxicant. The microglial proinflammatory actin-remodeling factor, WAVE2, along with the inflammatory transcription factor, nuclear factor kappa B were also elevated within the brain. Remarkably, the stress hormone, corticosterone, was still significantly elevated 1 month after paraquat, whereas the inflammasome factor, caspase-1, and antigen presentation factor, MFG-E8, both displayed delayed rises after the 6-month time. Using high-resolution magnetic resonance imaging, we detected no striatal changes but modest hemispheric differences in the SNc and time-dependent volumetric enlargement of the ventricles in paraquat-treated mice. These data suggest that paraquat induces long-term nigrostriatal pathology (possibly asymmetric) and inflammatory changes and stress and trophic/apoptotic effects that appear to either increase with the passage of time or are evident for at least 1 month. In brief, paraquat may be a useful nonspecific means to model widespread stress and inflammatory changes related to PD or age-related disease in general, but not the progressive nature of such diseases.
Copyright © 2020. Published by Elsevier Inc.
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Late gadolinium enhancement in patients with Tetralogy of Fallot: A systematic review.
Eur J Radiol2021 Jan;136():109521. doi: S0720-048X(21)00001-2.
Secchi Francesco, Lastella Giulia, Monti Caterina Beatrice, Barbaro Ugo, Capra Davide, Zanardo Moreno, Sardanelli Francesco,
Abstract
PURPOSE:
The aim of this study is to review the literature concerning myocardial late gadolinium enhancement (LGE) with cardiac magnetic resonance in patients with Tetralogy of Fallot (ToF), with regards to its prevalence, characteristics and clinical relevance.
METHODS:
We performed a systematic search, aiming to retrieve original articles that evaluated LGE in ToF, running a search string on MEDLINE and EMBASE in November 2019 and November 2020. Papers were then selected by two independent, blinded readers based on title and abstract, and then on full-text reading, and articles which did not include LGE evaluation were excluded. From each included paper two readers extracted descriptive data concerning technical parameters of LGE acquisition, LGE description and clinical significance.
RESULTS:
18 articles were eventually included in our review. The included studies observed that a higher amount of right ventricular LGE relates with higher right ventricular volumes, lower ejection fraction and a higher pulmonary regurgitant fraction, thus acting as a marker of progressive impairment of myocardial function. Moreover, LGE in ToF patients correlated with the onset of arrhythmias, and with serum biomarkers indicative of myocardial stress and fibrosis.
CONCLUSIONS:
LGE could be used in the follow-up repaired ToF patients as its appraisal can provide information concerning cardiac dysfunction. Moreover, it may be ideal to aim towards a common framework for standardizing assessment and quantification of LGE in ToF patients.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Safety, effectiveness, and quality of life following pulmonary vein isolation with a multi-electrode radiofrequency balloon catheter in paroxysmal atrial fibrillation: 1-year outcomes from SHINE.
Europace2020 Jan;():. doi: euaa382.
Schilling Richard, Dhillon Gurpreet Singh, Tondo Claudio, Riva Stefania, Grimaldi Massimo, Quadrini Federico, Neuzil Petr, Chierchia Gian-Battista, de Asmundis Carlo, Abdelaal Ahmed, Vanderlinden Liesbeth, Tan Tiffany, Ding Wern Yew, Gupta Dhiraj, Reddy Vivek Y,
Abstract
AIMS:
To evaluate the safety and effectiveness of a compliant multi-electrode radiofrequency balloon catheter (RFB) used with a multi-electrode diagnostic catheter for pulmonary vein isolation (PVI).
METHODS AND RESULTS:
This prospective, multicentre, single-arm study was conducted at six European sites and enrolled patients with symptomatic paroxysmal atrial fibrillation. The primary effectiveness endpoint was entrance block in treated pulmonary veins (PVs) after adenosine/isoproterenol challenge. The primary safety endpoint was the occurrence of primary adverse events (PAEs) within 7?days. Cerebral magnetic resonance imaging and neurological assessments were performed pre- and post-ablation in a subset of patients. Atrial arrhythmia recurrence was assessed over 12?months via transtelephonic and Holter monitoring. Quality of life was assessed by the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. Of 85 patients undergoing ablation per study protocol, PV entrance block was achieved in all (one PV required touch-up with a focal catheter). Acute reconnection of ?1 PVs after adenosine/isoproterenol challenge was observed in 9.3% (30/324) of PVs ablated. Post-ablation, silent cerebral lesions were detected in 9.7% (3/31) of patients assessed, all of which was resolved at 1-month follow-up. One patient experienced a PAE (retroperitoneal bleed). Freedom from documented symptomatic and all arrhythmia was 72.2% and 65.8% at 12?months. Four patients (4.7%) underwent repeat ablation. Significant improvements in all AFEQT subscale scores were seen at 6 and 12?months.
CONCLUSION:
PVI with the novel RFB demonstrated favourable safety and effectiveness, with low repeat ablation rate and clinically meaningful improvement in quality of life.
CLINICALTRIALS.GOV REGISTRATION NUMBER:
NCT03437733.
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology.
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FRESH 3D Bioprinting a Full-Size Model of the Human Heart.
ACS Biomater Sci Eng2020 Nov;6(11):6453-6459. doi: 10.1021/acsbiomaterials.0c01133.
Mirdamadi Eman, Tashman Joshua W, Shiwarski Daniel J, Palchesko Rachelle N, Feinberg Adam W,
Abstract
Recent advances in embedded three-dimensional (3D) bioprinting have expanded the design space for fabricating geometrically complex tissue scaffolds using hydrogels with mechanical properties comparable to native tissues and organs in the human body. The advantage of approaches such as Freeform Reversible Embedding of Suspended Hydrogels (FRESH) printing is the ability to embed soft biomaterials in a thermoreversible support bath at sizes ranging from a few millimeters to centimeters. In this study, we were able to expand this printable size range by FRESH bioprinting a full-size model of an adult human heart from patient-derived magnetic resonance imaging (MRI) data sets. We used alginate as the printing biomaterial to mimic the elastic modulus of cardiac tissue. In addition to achieving high print fidelity on a low-cost printer platform, FRESH-printed alginate proved to create mechanically tunable and suturable models. This demonstrates that large-scale 3D bioprinting of soft hydrogels is possible using FRESH and that cardiac tissue constructs can be produced with potential future applications in surgical training and planning.
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Prognostic value of myocardial extracellular volume fraction evaluation based on cardiac magnetic resonance T1 mapping with T1 long and short in hypertrophic cardiomyopathy.
Eur Radiol2021 Jan;():. doi: 10.1007/s00330-020-07650-7.
Li Yuancheng, Liu Xiuming, Yang Fuyao, Wang Jie, Xu Yuanwei, Fang TingTing, Pu LuTong, Zhou XiaoYue, Han Yuchi, Chen Yucheng,
Abstract
OBJECTIVE:
To investigate the prognostic significance of T1 mapping using T1 long and short in hypertrophic cardiomyopathy (HCM) patients.
METHODS:
A total of 263 consecutive patients with HCM referred for cardiovascular magnetic resonance (CMR) imaging were enrolled in this study. The imaging protocol consisted of cine, late gadolinium enhancement (LGE), and T1 mapping with T1 long and short. All patients were followed up prospectively. Outcome events were divided into the primary and secondary endpoint events. Primary endpoint events included cardiac death, heart transplant, aborted sudden death, and cardiopulmonary resuscitation after syncope. The secondary endpoint event was defined as unplanned rehospitalization for heart failure.
RESULT:
The average follow-up duration was 28.3 ± 12.1 (range: 1-78) months. In all, 17 patients (7.0%) experienced a primary endpoint including 13 cardiovascular deaths, three aborted sudden deaths, and one resuscitation after syncope, and 34 patients experienced a secondary endpoint. Patients with primary endpoints showed a trend towards more extensive LGE (p < 0.001), significantly higher ECV (p < 0.001), and native T1 (p = 0.028) than those without events. In multivariate Cox regression analysis, ECV was independently associated with primary and secondary endpoints (p < 0.001 and p = 0.047, respectively). For every 3% increase, ECV portended a 1.374-fold increase risk of a primary endpoint occurring (p < 0.001). In the Kaplan-Meier survival analysis, the incidence of primary and secondary endpoint events was significantly higher in HCM with increased ECV (p < 0.001 and p = 0.009, respectively).
CONCLUSION:
In patients with HCM, ECV is a strong imaging marker for predicting adverse outcome.
KEY POINTS:
? ECV is a potent imaging index which has a strong correlation with LVEF and LVEDVI and can evaluate myocardial tissue structure and function. ? ECV and LGE can provide a prognostic value in patients with hypertrophic cardiomyopathy. ? ECV has stronger predictive effectiveness than LGE; even in the subgroup with LGE, ECV shows independent predictive significance for adverse events.
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Prognostic implications of cardiac magnetic resonance feature tracking derived multidirectional strain in patients with chronic aortic regurgitation.
Eur Radiol2021 Jan;():. doi: 10.1007/s00330-020-07651-6.
Fernández-Golfín Covadonga, Hinojar-Baydes Rocío, González-Gómez Ariana, Monteagudo Juan Manuel, Esteban Amparo, Alonso-Salinas Gonzalo, Fernández Maria Angeles, García-Martín Ana, Santoro Ciro, Pascual-Izco Marina, Jiménez-Nacher Jose Julio, Zamorano Jose Luis,
Abstract
OBJECTIVE:
Speckle-tracking echocardiography (STE) deformation parameters detect latent LV dysfunction in chronic aortic regurgitation (AR) and are associated with outcomes. The aim of the study was to evaluate cardiac magnetic resonance (CMR) feature tracking (FT) deformation parameters in asymptomatic patients with AR and implications in outcomes.
METHODS:
Fifty-five patients with AR and 54 controls were included. Conventional functional CMR parameters, aortic regurgitant volume, and fraction were assessed. CMR-FT analysis was performed with a dedicated software. Clinical data was obtained from hospital records. A combined endpoint included all-cause mortality, cardiovascular mortality, aortic valve surgery, or cardiovascular hospital admission due to heart failure.
RESULTS:
Left ventricular (LV) mechanics is impaired in patients with significant AR. Significant differences were noted in global longitudinal strain (GLS) between controls and AR patients (- 19.1 ± 2.9% vs - 16.5 ± 3.2%, p < 0.001) and among AR severity groups (- 18.3 ± 3.1% vs - 16.2 ± 1.6% vs - 15 ± 3.5%; p = 0.02 for AR grades I-II, III, and IV). In univariate and multivariate analyses, circumferential strain (GCS) and global radial strain (GRS) but not GLS were associated with and increased risk of the end point with a HR of 1.26 (p = 0.016, 1.04-1.52) per 1% worsening for GCS and 0.90 (p = 0.012, 0.83-0.98) per 1% worsening for GRS.
CONCLUSIONS:
CMR-FT myocardial deformation parameters are impaired in patients with AR not meeting surgical criteria. GLS decreases early in the course of the disease and is a marker of AR severity while GCS and GRS worsen later but predict a bad prognosis, mainly the need of aortic valve surgery.
KEY POINTS:
? CMR feature tracking LV mechanic parameters may be reduced in significant chronic AR with normal EF. ? LV mechanics, mainly global longitudinal strain, worsens as AR severity increases. ? LV mechanics, specially global radial and circumferential strain, is associated with a worse prognosis in AR patients.
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Predictors of moderate to severe ischemic mitral regurgitation after myocardial infarction: a cardiac magnetic resonance study.
Eur Radiol2021 Jan;():. doi: 10.1007/s00330-020-07658-z.
Zhang Chen, Zhao Lei, Zhu Enjun, Schoenhagen Paul, Tian Jie, Lai Yong-Qiang, Ma Xiaohai,
Abstract
OBJECTIVES:
The purpose of this study is to explore the predictors of moderate to severe ischemic mitral regurgitation (IMR) after myocardial infarction with cardiovascular magnetic resonance (CMR).
METHODS:
From January 2016 to September 2018, 109 patients (mean age 60?±?8 years) with IMR were studied retrospectively. All patients underwent CMR-cine with True-FISP sequence and late gadolinium enhancement (LGE) with a phase-sensitive inversion recovery sequence. The presence of papillary muscle infarction (PMI), global left ventricular (LV) infarcted extent, LV functional parameters, and LV myocardial strain were assessed. Univariate and multivariate analyses were performed to identify factors in the development of moderate to severe IMR.
RESULTS:
Mild IMR was present in 61 patients (56%), and moderate to severe IMR was present in 48 patients (44%). PMI was identified in 22 patients (20.1%); 14 of them (63.63%) showed a moderate or severe IMR. Global LV infarcted extent was increased in patients with moderate to severe IMR (p
CONCLUSIONS:
The incidence of PMI was higher in patients with moderate-to-severe IMR. The extent of global LV infarcted extent and GLS were independent predictors of moderate-to-severe IMR.
KEY POINTS:
? Cardiovascular magnetic resonance late gadolinium enhancement and feature-tracking imaging provide reliable information on LV function, myocardial viability, and papillary muscle morphology. ? Papillary muscle infarction is not an independent predictor of moderate-to-severe IMR. ? The extent of global LV infarction and LV global longitudinal strain were independent predictors of moderate-to-severe chronic IMR.
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Perfusion strategy using axillary or femoral cannulation for minimally invasive cardiac surgery: experience in 270 patients with computed tomography-based criteria.
Eur J Cardiothorac Surg2021 Jan;():. doi: ezaa469.
Nakamura Yoshitsugu, Nishijima Shuhei, Kuroda Miho, Nakayama Taisuke, Tsuruta Ryo, Yoshiyama Daiki, Yasumoto Yuto, Ito Yujiro,
© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Catecholaminergic polymorphic ventricular tachycardia complicated by dilated cardiomyopathy: a case report.
Eur Heart J Case Rep2020 Dec;4(6):1-6. doi: 10.1093/ehjcr/ytaa299.
Christina Granitz, Peter Jirak, Bernhard Strohmer, Gerhard Pölzl,
Abstract
Background :
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a severe genetic arrhythmogenic disorder characterized by adrenergically induced ventricular tachycardia manifesting as stress-induced syncope and sudden cardiac death. While CPVT is not associated with dilated cardiomyopathy (DCM) in most cases, the combination of both disease entities poses a major diagnostic and therapeutic challenge.
Case summary :
We present the case of a young woman with CPVT. The clinical course since childhood was characterized by repetitive episodes of exercise-induced ventricular arrhythmias and a brady-tachy syndrome due to rapid paroxysmal atrial fibrillation and sinus bradycardia. Medical treatment included propranolol and flecainide until echocardiography showed a dilated left ventricle with severely depressed ejection fraction when the patient was 32?years old. Cardiac magnetic resonance imaging revealed non-specific late gadolinium enhancement. Myocardial inflammation, however, was excluded by subsequent endomyocardial biopsy. Genetic analysis confirmed a mutation in the cardiac ryanodine receptor but no pathogenetic variant associated with DCM. Guideline-directed medical therapy for HFrEF was limited due to symptomatic hypotension. Over the next months, the patient developed progressive heart failure symptoms that were finally managed by heart transplantation.
Discussion :
Management in patients with CPVT and DCM is challenging, as Class I antiarrhythmic drugs are not recommended in structural heart disease and prophylactic internal cardioverter-defibrillator implantation without adjuvant antiarrhythmic therapy can be detrimental. Regular echocardiographic screening for DCM is recommendable in patients with CPVT. A multidisciplinary team of heart failure specialists, electrophysiologists, geneticists, and imaging specialists is needed to collaborate in the delivery of clinical care.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Acute heart and brain failure: a case report.
Eur Heart J Case Rep2020 Dec;4(6):1-8. doi: 10.1093/ehjcr/ytaa352.
Stuetz Magdalena, Templin Christian, Templin-Ghadri Jelena-Rima, Ruschitzka Frank, Pohl Heiko, Hofer Daniel,
Abstract
Background:
Takotsubo syndrome (TTS) is characterized by often reversible but acute heart failure occurring after an emotional or physical trigger event. The 'brain failure' counterpart is posterior reversible encephalopathy syndrome (PRES) characterized by often reversible but acute neurological symptoms. This case report elaborates on a complex clinical scenario with co-existence of coronary artery disease, TTS and PRES and discusses the pathophysiology, differential diagnosis, and management.
Case summary:
An 82-year-old woman presented with acute heart failure and generalized tonic-clonic seizures following an acute exacerbation of her chronic back pain. Brain magnetic resonance imaging demonstrated vasogenic oedema consistent with the diagnosis of PRES. Focal wall motion abnormalities on echocardiography without causal coronary stenoses on angiography were consistent with the diagnosis of TTS. After an interdisciplinary approach to differential diagnosis and treatment, the patient was discharged to geriatric rehabilitation without heart failure or neurological defects 4 weeks later.
Discussion:
TTS and PRES share significant similarities in proposed pathogenesis, epidemiology, management, and clinical outcome. This case report highlights the need for early recognition of this rare association and multidisciplinary approach to diagnosis and treatment as both heart and brain disease may require early intervention up to rapid intensive care support.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Two zebras and a cardiac arrest: a case report of concomitant Brugada syndrome and an anomalous coronary artery.
Eur Heart J Case Rep2020 Dec;4(6):1-6. doi: 10.1093/ehjcr/ytaa425.
Bates Alexander, Ullah Waqas, Wilkinson James, Shambrook James,
Abstract
Background:
Discovering concomitant diagnoses results in a challenge to determine the true cause of a patient's presentation. Evaluating this fully is vital to plan appropriate and avoid inappropriate therapy.
Case summary:
A 55-year-old gentleman presents in cardiac arrest whilst watching an unusual occurrence of England dominating a Football World Cup game vs. Panama in 2018. Diagnostic coronary angiography discovered an anomalous right coronary artery from the opposite sinus (R-ACAOS), but clinical suspicion this was incidental lead to a further diagnosis of Type 1 Brugada Syndrome (BrS) following a positive Ajmaline provocation challenge. Risk stratification of these two zebras using computed tomography coronary angiography (CTCA), Cardiac magnetic resonance imaging (CMRI), Exercise Stress Echocardiography was performed and following a multi-disciplinary meeting, BrS was felt to be the primary diagnosis. The patient received a secondary prevention implantation of a cardiac defibrillator and avoided cardiac surgery.
Discussion:
Diagnosing a rare condition does not necessarily mean it is the cause of a patient's presentation and should not end the investigative process. Right coronary artery from the opposite sinus rarely causes cardiac arrest in middle age and is typically associated with peak exercise. Type 1 BrS is associated with cardiac arrest with vagal activity, perhaps such as England winning a World Cup game! Clinical correlation and risk stratification is required for suspected incidental findings.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Follow-up magnetic resonance imaging of Löffler endocarditis: a case report.
Eur Heart J Case Rep2020 Dec;4(6):1-4. doi: 10.1093/ehjcr/ytaa381.
Ito Shinya, Isotani Akihiro, Yamaji Kyohei, Ando Kenji,
Abstract
Background :
Löffler endocarditis is a condition characterized by cardiac infiltration of eosinophils. Cardiac magnetic resonance imaging (MRI) is a modality for the diagnosis of myocardial damage.
Case summary :
This is the case of a 77-year-old man with acute decompensated heart failure who was admitted. Transthoracic echocardiography showed preserved left ventricular (LV) systolic function along with LV thrombi attached to the septo-apical wall and the posterior wall, consistent with Löffler endocarditis. Cardiac MRI revealed obliteration of the LV apex and partial filling of the LV cavity, as well as near circumferential subendocardial late gadolinium enhancement (LGE) in the mid- and apical segments. T2-weighted images showed a near circumferential high-intensity area of the LV subendocardial muscle in the mid- and apical segments. High-dose corticosteroids and intravenous heparin were initiated, followed by maintenance warfarin therapy. At 18?months, follow-up cardiac MRI revealed the disappearance of the LV thrombi, and a reduction of LGE, as well as high-intensity areas in the T2-weighted images.
Discussion :
The high-intensity area of T2-weighted images indicate the presence of subendocardial oedema. Eosinophil-mediated heart damage evolves through three stages: (i) acute necrotic, (ii) thrombotic, and (iii) fibrotic stages. Since the deposition of toxic eosinophil granule proteins and eosinophil infiltration injured the endocardium, the first-line treatment for Löffler endocarditis is corticosteroid therapy. In this case, LGE in the subendocardium and the high-intensity area in the T2-weighted images were reduced at 18?months. High-intensity areas of T2-weighted images in the acute phase might indicate the possibility of therapeutic response to corticosteroid therapy.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Non-Obstructive Coronary Artery Disease in Women: Current Evidence and Future Directions.
Int J Clin Res Trials2020 ;5(2):. doi: 152.
Smith Leanna R, Salifu Moro O, McFarlane Isabel M,
Abstract
Background:
Over half of women who present with angina are found to have negative coronary angiographic assessments. Of these patients, up to 50% are diagnosed with coronary microvascular dysfunction (CMD), which refers to pathologic changes within the small vessels of the coronary circulation. The hallmark of the pathophysiology of CMD is that endothelial damage, which occurs due to a multitude of conditions and risk factors, is the inciting event for the development and progression of CMD. CMD leads to a mismatch in myocardial demand and perfusion, leading to signs and symptoms of cardiac ischemia in the absence of obstructive lesions in the major vessels. CMD can be diagnosed through a variety of both invasive methods that allow a more specific evaluation of the microvasculature and non-invasive imaging techniques, such as cardiac positron emission tomography (PET) and magnetic resonance imaging (MRI). Risk factors for CMD overlap significantly with those of obstructive coronary artery disease (CAD) - hypertension, hypercholesterolemia, and diabetes remain salient predictors. However, these conditions only account for 20% of CMD cases in females.
Findings:
Women have sex-specific risk factors such as menopause, pregnancy, polycystic ovarian syndrome (PCOS), and a higher proclivity toward chronic inflammatory disorders. Estrogen has a cardioprotective effect by increasing production of nitric oxide, a potent vasodilator released by endothelial cells. As a result, the hormonal changes of menopause may accelerate endothelial damage, and in turn, CMD. Current treatments focus on addressing the risk factors of cardiovascular disease, such as anti-hypertensive drugs, weight loss, and glucose control.
Conclusion:
Given the multifactorial nature of CMD in women, and the extensive atypical risk factors for cardiac disease, a more nuanced approach is needed that addresses the varied pathophysiology of CMD.
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Apical Hypertrophic Cardiomyopathy Masked by Takotsubo Syndrome.
J Cardiovasc Echogr;30(3):174-176. doi: 10.4103/jcecho.jcecho_46_20.
Gherbesi Elisa, Paiocchi Vera Lucia, Leo Laura Anna, Schlossbauer Susanne Anna, Chiarello Giuseppina, Faletra Francesco Fulvio,
Abstract
We describe the case of a 66-year-old female presented to our emergency department (ER) with acute chest pain and diagnosed with Takotsubo syndrome that initially prevented from suspecting an apical hypertrophic cardiomyopathy at echocardiography.
Copyright: © 2020 Journal of Cardiovascular Echography.
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