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Pubblicazioni recenti - cardiac magnetic resonance
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Magnetic resonance imaging-guided laser-induced thermal therapy for functional hemispherotomy in a child with refractory epilepsy and multiple medical comorbidities.
J Neurosurg Pediatr2020 Oct;():1-6. doi: 10.3171/2020.6.PEDS20455.
Chua Melissa M J, Bushlin Ittai, Stredny Coral M, Madsen Joseph R, Patel Archana A, Stone Scellig,
Abstract
Magnetic resonance imaging-guided laser-induced thermal therapy (MRgLITT) is a minimally invasive surgical approach increasingly employed for precise targeted ablation of epileptogenic brain foci. Recent reports have described corpus callosotomy using MRgLITT, though its application in more extensive functional disconnections has not been documented. Here, the authors detail its use in achieving a palliative hemispherotomy in a 5-year-old with medically refractory hemiclonic seizures following a hemispheric infarction, highlighting a novel use of this surgical technique. In this particular case, open craniotomy was deemed high risk given the multiple medical comorbidities including congenital cardiac disease and end-stage renal failure. MRgLITT was considered an alternative approach with a lower risk for periprocedural hemodynamic perturbations. The patient tolerated the procedure well, attaining an Engel class IB outcome at 16 months' follow-up. This suggests that MRgLITT may be an alternative approach to an open hemispherectomy, particularly in cases in which multiple comorbidities pose significant risks and preclude an open procedure.
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Standardization of T1-mapping in cardiovascular magnetic resonance using clustered structuring for benchmarking normal ranges.
Int J Cardiol2020 Oct;():. doi: S0167-5273(20)33994-2.
Popescu Iulia A, Werys Konrad, Zhang Qiang, Puchta Henrike, Hann Evan, Lukaschuk Elena, Ferreira Vanessa M, Piechnik Stefan K,
Abstract
BACKGROUND:
Cardiovascular magnetic resonance T1-mapping is increasingly used for tissue characterization, commonly based on Modified Look-Locker Inversion recovery (MOLLI). However, there are numerous MOLLI variants with differing normal ranges. This lack of standardization presents confusion and difficulty in inter-center comparisons, hindering widespread adoption of T1-mapping.
METHODS:
To address this, we performed a structured literature search for native left ventricular myocardial T1-mapping in healthy humans measured using MOLLI variants at 1.5 and 3 Tesla, across scanner vendors. We then used k-means clustering to structure normal MOLLI-T1 values according to magnetic field strength, and investigated correlations between common imaging parameters: repetition time (TR), echo time (TE), flip angle (FA).
RESULTS:
We analyzed data from 2207 healthy controls in 76 independent reports. Normal MOLLI-T1 standard deviations varied by 11-fold, and dependencies on TE, TR, and FA differed between 1.5?T and 3?T, thwarting meaningful T1 standardization even within a single field strength, including the use of Z-score. However, divergent MOLLI-T1 norms may be structured using data clustering. For 1.5?T, two clusters emerged: Cluster1: T1?=?958?±?16?ms (n?=?1272); Cluster2: T1?=?1027?±?19?ms (n?=?386). For 3?T, three clusters emerged: Cluster1: T1?=?1160?±?21?ms (n?=?330); Cluster2: T1?=?1067?±?18?ms (n?=?178); Cluster3: T1?=?1227?±?19?ms (n?=?41). We then propose the concept of an online calculator for assigning local norms to a known MOLLI-T1 cluster, allowing benchmarking against published norms.
CONCLUSIONS:
Clustered structuring allows T1 standardization of widely-divergent MOLLI variants, benchmarking local norms (usually based on smaller samples) against published norms (larger samples). This may increase confidence and quality control in method implementation, facilitating wider clinical adoption of T1-mapping.
Copyright © 2020. Published by Elsevier B.V.
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Assessment of left and right ventricular functional parameters using dynamic dual-tracer [N]NH3 and [F]FDG PET/MRI.
J Nucl Cardiol2020 Oct;():. doi: 10.1007/s12350-020-02391-y.
Rasul Sazan, Beitzke Dietrich, Wollenweber Tim, Rausch Ivo, Lassen Martin Lyngby, Stelzmüller Marie Elisabeth, Mitterhauser Markus, Pichler Verena, Beyer Thomas, Loewe Christian, Hacker Marcus,
Abstract
BACKGROUND:
Cardiac positron emission tomography/magnetic resonance imaging (PET/MRI) can assess various cardiovascular diseases. In this study, we intra-individually compared right (RV) and left ventricular (LV) parameters obtained from dual-tracer PET/MRI scan.
METHODS:
In 22 patients with coronary heart disease (69 ± 9 years) dynamic [N]NH (NH) and [F]FDG (FDG) PET scans were acquired. The first 2 minutes were used to calculate LV and RV first-pass ejection fraction (FPEF). Additionally, LV end-systolic (LVESV) and end-diastolic (LVEDV) volume and ejection fraction (LVEF) were calculated from the early (EP) and late-myocardial phases (LP). MRI served as a reference.
RESULTS:
RVFPEF and LVFPEF from FDG and NH as well as RVEF and LVEF from MRI were (28 ± 11%, 32 ± 15%), (32 ± 11%, 41 ± 14%) and (42 ± 16%, 45 ± 19%), respectively. LVESV, LVEDV and LVEF from EP FDG and NH in 8 and 16 gates were [71 (15 to 213 mL), 98 (16 to 241 mL), 32 ± 17%] and [50 (17 to 206 mL), 93 (13 to 219 mL), 36 ± 17%] as well as [60 (19 to 360 mL), 109 (56 to 384 mL), 41 ± 22%] and [54 (16 to 371 mL), 116 (57 to 431 mL), 46 ± 24%], respectively. Moreover, LVESV, LVEDV and LVEF acquired from LP FDG and NH were (85 ± 63 mL, 138 ± 63 mL, 47 ± 19%) and (79 ± 56 mL, 137 ± 63 mL, 47 ± 20%), respectively. The LVESV, LVEDV from MRI were 93 ± 66 mL and 153 ± 71 mL, respectively. Significant correlations were observed for RVFPEF and LVFPEF between FDG and MRI (R = .51, P = .01; R = .64, P = .001), respectively. LVESV, LVEDV, and LVEF revealed moderate to strong correlations to MRI when they acquired from EP FDG and NH in 16 gates (all R > .7, P = .000). Similarly, all LV parameters from LP FDG and NH correlated good to strongly positive with MRI (all R > .7, and P < .001), except EDV from NH3 weakly correlated to EDV of MRI (R = .54, P < .05). Generally, Bland-Altman plots showed good agreements between PET and MRI.
CONCLUSIONS:
Deriving LV and RV functional values from various phases of dynamic NH and FDG PET is feasible. These results could open a new perspective for further clinical applications of the PET examinations.
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Cardiac Imaging in Dialysis Patients.
Kidney Med;2(5):629-638. doi: 10.1016/j.xkme.2020.05.010.
Kott Jeff, Reichek Nathaniel, Butler Javed, Arbeit Leonard, Mallipattu Sandeep K,
Abstract
There is a well-established yet unexplained high prevalence of cardiovascular morbidity and mortality in individuals with end-stage kidney disease receiving dialysis. Potential causes include changes in cardiac structure and function, with increased left ventricular mass index as the best established cardiac structural change associated with this increase in mortality. However, in recent years, new echocardiographic and cardiac magnetic resonance imaging techniques have emerged that may provide novel markers that may better explain the mechanisms underlying the cardiovascular morbidity and mortality observed in end-stage kidney disease. This review outlines advances in cardiac imaging and the current status of imaging modalities, including echocardiography, cardiac magnetic resonance imaging, and cardiac positron emission tomography, to identify dialysis patients at high risk for cardiovascular mortality.
© 2020 The Authors.
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Left Ventricular Mass Assessment by 1- and 2-Dimensional Echocardiographic Methods in Hemodialysis Patients: Changes in Left Ventricular Volume Using Echocardiography Before and After a Hemodialysis Session.
Kidney Med;2(5):578-588.e1. doi: 10.1016/j.xkme.2020.06.006.
Kristensen Charlotte Burup, Steensgaard-Hansen Frank, Myhr Katrine Aagaard, Løkkegaard Niels Jørgen, Finsen Stine Høyer, Hassager Christian, Møgelvang Rasmus,
Abstract
Rationale & Objective:
Left ventricular (LV) mass (LVM) is a predictor of cardiovascular morbidity and mortality and commonly calculated using 1-dimensional (1D) echocardiographic methods. These methods are vulnerable to small measurement errors and LVM may wrongly change according to changes in LV volume (LVV). Less commonly used 2-dimensional (2D) methods can accommodate to the changes in LVV and may be a better alternative among patients receiving hemodialysis (HD) with large fluid fluctuations.
Study Design:
Observational study.
Setting & Participants:
Patients with end-stage kidney disease receiving HD.
Exposure:
One HD session.
Analytical Approach:
Transthoracic echocardiography was performed right before and after HD. LVM was calculated using 1D (Devereux, Penn, and Teichholz) and 2D methods (truncated ellipsoid and area-length).
Outcomes:
Significant differences in LVM after HD.
Results:
We compared dimensions, LVV and LVM, in 53 patients (mean age, 63 ± 15 years; 66% men). For each 1-L increase in ultrafiltration volume (UFV), LV internal diameter decreased 1.1 mm (95% CI, 0.5-1.7 mm; = 0.001). Patients were divided into 2 groups by the median UFV of 1.6 L. Patients with UFV > 1.6 L had significant smaller LVV and LV internal diameter after HD. LVM calculated using 1D methods decreased according to changes in LVV. Conversely, LVM calculated using 2D methods was not significantly different after HD. No significant change in differences between diastolic - systolic myocardial thickness or LVM as assessed using 1D and 2D methods was observed before and after HD, indicating that LVM remained constant despite HD.
Limitations:
We did not use contrast enhancement, 3-dimensional methods, or cardiac magnetic resonance.
Conclusions:
LVM calculated using 2D methods, truncated ellipsoid and area-length, is less affected by fluctuations in fluid and LVV, in contrast to 1D methods. Complementary LVM calculation using 2D methods is encouraged, especially in patients with large fluid fluctuations in which increased LVM using a 1D method has been detected.
© 2020 The Authors.
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NT-proBNP Level Predicts Extent of Myonecrosis and Clinical Adverse Outcomes in Patients with ST-Elevation Myocardial Infarction: A Pilot Study.
Med Res Arch2020 Feb;8(2):. doi: 10.18103/mra.v8i2.2039.
Mathbout Mohammad, Asfour Ahmed, Leung Steve, Lolay Georges, Idris Amr, Abdel-Latif Ahmed, Ziada Khaled M,
Abstract
Background and Hypothesis:
The initial assessment of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) reflects cardiac damage and is an important prognostic factor in patients with acute ST-elevation myocardial infarction (STEMI). N-Terminal prohormone of brain natriuretic peptide (NT-proBNP) is released following cardiomyocytes injury. However, the relationship between NT-proBNP levels, myocardial damage and clinical outcomes after STEMI has not been well defined.
Methods:
Plasma levels of NT-proBNP, troponin I and creatinine kinase (CK) were assessed in 75 patients with STEMI. Echocardiography and CMR were performed prior to hospital discharge. Cardiac damage was quantified using peak biomarker levels and LGE. Patients were followed for a median of 975 days (IQR 823-1098 days) for major adverse cardiac events (MACE) (all-cause mortality, recurrent myocardial infraction, unplanned recurrent revascularization and recurrent hospitalization for heart failure).
Results:
Plasma levels of NT-proBNP increased following STEMI to peak at 24 hours. The dynamic changes in plasma NT-proBNP were similar to those noted with troponin I and its delayed peak but not those observed with plasma CK levels. Peak NT-proBNP levels correlated positively with indices of myocardial damage such as peak troponin I (R =0.38, <0.001), peak CK (R =0.22, = 0.01) and LGE examination (R = 0.46, <0.001). Peak plasma level of NT- proBNP was strongly predictive of MACE during the follow-up period.
Conclusions:
Peak levels of NT-proBNP following STEMI are predictive of the extent of myocardial damage and clinical outcomes. These results suggest an important prognostic role for NT-proBNP assessment in STEMI patients.
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Seeded fibrils of the germline variant of human ?-III immunoglobulin light chain FOR005 have a similar core as patient fibrils with reduced stability.
J Biol Chem2020 Oct;():. doi: jbc.RA120.016006.
Pradhan Tejaswini, Annamalai Karthikeyan, Sarkar Riddhiman, Huhn Stephanie, Hegenbart Ute, Schönland Stefan, Fändrich Marcus, Reif Bernd,
Abstract
Systemic antibody light chains (AL) amyloidosis is characterized by deposition of amyloid fibrils derived from a particular antibody light chain. Cardiac involvement is a major risk factor for mortality. Using MAS solid-state NMR, we studied the fibril structure of a recombinant light chain fragment corresponding to the fibril protein from patient FOR005, together with fibrils formed by protein sequence variants that are derived from the closest germline (GL) sequence. Both analyzed fibril structures were seeded with ex-vivo amyloid fibrils purified from the explanted heart of this patient. We find that residues 11-42 and 69-102 adopt ?-sheet conformation in patient protein fibrils. We identify arginine-49 as a key residue that forms a salt bridge to aspartate-25 in the patient protein fibril structure. In the germline sequence, this residue is replaced by a glycine. Fibrils from the GL protein and from the patient protein harboring the single point mutation R49G can be both heterologously seeded using patient ex-vivo fibrils. Seeded R49G fibrils show an increased heterogeneity in the C-terminal residues 80-102, which is reflected by the disappearance of all resonances of these residues. By contrast, residues 11-42 and 69-77, which are visible in the MAS solid-state NMR spectra, show 13C? chemical shifts that are highly similar to patient fibrils. The mutation R49G thus induces a conformational heterogeneity at the C-terminus in the fibril state, while the overall fibril topology is retained. These findings imply that patient mutations in FOR005 can stabilize the fibril structure.
Published under license by The American Society for Biochemistry and Molecular Biology, Inc.
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Cardiac Resynchronization Therapy Guided by Echocardiography, MRI, and CT Imaging: A Randomized Controlled Study.
JACC Clin Electrophysiol2020 Oct;6(10):1300-1309. doi: S2405-500X(20)30382-0.
Borgquist Rasmus, Carlsson Marcus, Markstad Hanna, Werther-Evaldsson Anna, Ostenfeld Ellen, Roijer Anders, Bakos Zoltan,
Abstract
OBJECTIVES:
This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT).
BACKGROUND:
LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated.
METHODS:
This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ?15% at 6 months post-implantation.
RESULTS:
Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ?1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07).
CONCLUSIONS:
Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321).
Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Validation of left ventricular volume and ejection fraction measurements by high-definition blood flow imaging: Comparisons with cardiac magnetic resonance imaging and contrast echocardiography.
Echocardiography2020 Oct;():. doi: 10.1111/echo.14904.
Ahmad Masood, Wu Geru, Frank Luba, Dimaano Meneleo M,
Abstract
BACKGROUND:
We recently reported the efficacy of High-definition blood flow imaging (HDI) in the assessment of left ventricular (LV) function and demonstrated that the results are comparable to those obtained by contrast echocardiography (CE). The present study validates HDI in measurements of LV volumes and ejection fraction (EF) by simultaneous comparisons with CE and cardiac magnetic resonance imaging (CMR).
METHODS:
Eighteen patients (age range 25-79 years) with limited echocardiographic images had measurements of LV end-diastolic volume (EDV, mL), end-systolic volume (ESV, mL), and EF (%) by HDI, CE, and CMR.
RESULTS:
Using the three techniques, measurements of EDV, ESV, and EF correlated well with correlation coefficients (r) ranging from .91 to .98 in comparisons between HDI and CMR, and .89 to .97 in comparisons between CE and CMR. The limits of agreement for the inter-methods comparisons by Bland-Altman analysis (mean ± 1.96 SD) between HDI and CMR were 4.92 ± 16.87% for EF, 21.53 ± 32.18 mL for EDV, and 10.69 ± 36.12 mL for ESV, between CE and CMR, the agreement limits were 2.48 ± 18.52% (LVEF), 24.58 ± 47.41 mL (EDV), and 14.09 ± 43.55 mL (ESV).
CONCLUSIONS:
Measurements of LV volumes and EF by HDI and CE correlated well with CMR. Using CMR as the gold standard, the agreements in measurements of LV volumes were superior for HDI compared to CE. In measurements of EF, CE showed less mean difference when compared to HDI. HDI measurements compared well with those obtained by CMR.
© 2020 Wiley Periodicals LLC.
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Breathing Freely During Nitrogen Washout.
J Appl Physiol (1985)2020 Oct;():. doi: 10.1152/japplphysiol.00847.2020.
Motta-Ribeiro Gabriel C, Winkler Tilo,
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Effects of contrast agents on relaxation properties of P metabolites.
Magn Reson Med2020 Oct;():. doi: 10.1002/mrm.28541.
Valkovi? Ladislav, Lau Justin Y C, Abdesselam Ines, Rider Oliver J, Frollo Ivan, Tyler Damian J, Rodgers Christopher T, Miller Jack J J,
Abstract
PURPOSE:
Phosphorous MR spectroscopy (P-MRS) forms a powerful, non-invasive research tool to quantify the energetics of the heart in diverse patient populations. P-MRS is frequently applied alongside other radiological examinations, many of which use various contrast agents that shorten relaxation times of water in conventional proton MR, for a better characterisation of cardiac function, or following prior computed tomography (CT). It is, however, unknown whether these agents confound P-MRS signals, for example, 2,3-diphosphoglycerate (2,3-DPG).
METHODS:
In this work, we quantitatively assess the impact of non-ionic, low osmolar iodinated CT contrast agent (iopamidol/Niopam), gadolinium chelates (linear gadopentetic acid dimeglumine/Magnevist and macrocyclic gadoterate meglumine/Dotarem) and superparamagnetic iron oxide nanoparticles (ferumoxytol/Feraheme) on the nuclear T and T of P metabolites (ie, 2,3-DPG), and H in water in live human blood and saline phantoms at 11.7 T.
RESULTS:
Addition of all contrast agents led to significant shortening of all relaxation times in both H and P saline phantoms. On the contrary, the T relaxation time of 2,3-DPG in blood was significantly shortened only by Magnevist (P = .03). Similarly, the only contrast agent that influenced the T relaxation times of 2,3-DPG in blood samples was ferumoxytol (P = .02).
CONCLUSION:
Our results show that, unlike conventional proton MR, phosphorus MRS is unconfounded in patients who have had prior CT with contrast, not all gadolinium-based contrast agents influence P-MRS data in vivo, and that ferumoxytol is a promising contrast agent for the reduction in P-MRS blood-pool signal.
© 2020 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.
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CDR132L improves systolic and diastolic function in a large animal model of chronic heart failure.
Eur Heart J2020 Oct;():. doi: ehaa791.
Batkai Sandor, Genschel Celina, Viereck Janika, Rump Steffen, Bär Christian, Borchert Tobias, Traxler Denise, Riesenhuber Martin, Spannbauer Andreas, Lukovic Dominika, Zlabinger Katrin, Ha?imbegovi? Ena, Winkler Johannes, Garamvölgyi Rita, Neitzel Sonja, Gyöngyösi Mariann, Thum Thomas,
Abstract
AIMS:
Cardiac miR-132 activation leads to adverse remodelling and pathological hypertrophy. CDR132L is a synthetic lead-optimized oligonucleotide inhibitor with proven preclinical efficacy and safety in heart failure (HF) early after myocardial infarction (MI), and recently completed clinical evaluation in a Phase 1b study (NCT04045405). The aim of the current study was to assess safety and efficacy of CDR132L in a clinically relevant large animal (pig) model of chronic heart failure following MI.
METHODS AND RESULTS:
In a chronic model of post-MI HF, slow-growing pigs underwent 90?min left anterior descending artery occlusion followed by reperfusion. Animals were randomized and treatment started 1-month post-MI. Monthly intravenous (IV) treatments of CDR132L over 3 or 5 months (3× or 5×) were applied in a blinded randomized placebo-controlled fashion. Efficacy was evaluated based on serial magnetic resonance imaging, haemodynamic, and biomarker analyses. The treatment regime provided sufficient tissue exposure and CDR132L was well tolerated. Overall, CDR132L treatment significantly improved cardiac function and reversed cardiac remodelling. In addition to the systolic recovery, diastolic function was also ameliorated in this chronic model of HF.
CONCLUSION:
Monthly repeated dosing of CDR132L is safe and adequate to provide clinically relevant exposure and therapeutic efficacy in a model of chronic post-MI HF. CDR132L thus should be explored as treatment for the broad area of chronic heart failure.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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COVID-19 fulminant myocarditis: a case report.
Eur Heart J Case Rep2020 Oct;4(FI1):1-6. doi: 10.1093/ehjcr/ytaa212.
Bernal-Torres Wikler, Herrera-Escandón Álvaro, Hurtado-Rivera Manuel, Plata-Mosquera Carlos Andrés,
Abstract
Background:
Fulminant myocarditis is a catastrophic disease with high mortality and complications. A viral aetiology is frequent and the implication of SARS-CoV-2 is not yet known.
Case summary:
A 38-year-old woman who recently arrived from Spain presented with palpitations that started suddenly 3 days prior to presentation and were associated with haemodynamic instability, without dyspnoea or chest pain. We found features of myopericarditis on the electrocardiogram and severe systolic dysfunction on the echocardiogram. The chest tomography showed findings which suggested COVID-19 infection, and PCR for SARS-CoV-2 was positive. The cardiac magnetic resonance image showed Lake Louise criteria for myocarditis. The patient was treated with immunomodulatory, steroid, and immunoglobulin therapy, with a favourable clinical response.
Discussion:
The importance of this case lies in highlighting the severe cardiac involvement in a young patient, without previous risk factors, positive for COVID-19, and the favourable response to the medical treatment given.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Fulminant type 1 diabetes: recent research progress and future prospects.
Diabetol Int2020 Oct;11(4):336-341. doi: 10.1007/s13340-020-00466-2.
Imagawa Akihisa, Tachibana Megumi,
Abstract
To clarify the clinical and etiological characteristics of fulminant type 1 diabetes, we reviewed data from patients who had developed type 1 diabetes following anti-programmed cell death 1/programmed cell death ligand 1 (anti-PD-1/PD-L1) therapy, and research on pancreatic beta cells derived from induced pluripotent stem (iPS) cells from patients with fulminant type 1 diabetes. As determined from the disease classifications and clinical and genetic characteristics, anti-PD-1/PD-L1 therapy-related type 1 diabetes includes both fulminant type 1 diabetes and acute-onset type 1 diabetes. Using insulin-positive cells derived from iPS cells, beta-cell fragility to inflammatory cytokines, but not its regeneration failure, was observed in fulminant type 1 diabetes. Moreover, severe hyperglycemia was reported as a risk factor of sudden death or cardiac arrest at disease onset, diffusion-weighted magnetic resonance imaging was suggested as an additional tool for making a diagnosis, and the locus was genetically associated with fulminant type 1 diabetes. To fully understand fulminant type 1 diabetes, it is important to clarify the molecular mechanisms step by step through multifaceted approaches such as through analyses of the genetic factors, clinical features, histological findings, and cell biology. The careful and detailed study of patients is a great means for clarifying the etiology and pathophysiology of the disease.
© The Japan Diabetes Society 2020.
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Galactin-3 and soluble ST2 as complementary tools to cardiac MRI for sudden cardiac death risk stratification in heart failure: A review.
JRSM Cardiovasc Dis;9():2048004020957840. doi: 10.1177/2048004020957840.
Shah Niel N, Ayyadurai Puvanalingam, Saad Muhammad, Kosmas Constantine E, Dogar Muhammad U, Patel Upen, Vittorio Timothy J,
Abstract
Heart failure (HF) is recognized as one of the leading causes of morbidity and mortality worldwide. Every year about 500,000 new cases of HF are diagnosed in the United States. The predominant etiology of death in HF patients include sudden cardiac death (SCD) and pump failure. Prediction of mode of death may help in devising management decisions. In patients with HF, the presence of myocardial fibrosis has been a known risk factor for SCD and thus it could be used as a criterion in risk stratification for SCD. However, the underlying pathophysiology of SCD is uncertain and controversial, which makes it necessary to develop newer tools to enhance SCD risk stratification. The newer tools should be innovative enough either to complement or to replace the currently available tools. In this scoping review, we highlighted the utilization of novel biomarkers galectin-3 (gal-3) and soluble ST2 (sST2) and discussed that how they might complement currently available tools such as, cardiac MRI (CMR) for SCD risk stratification in HF patients.
© The Author(s) 2020.
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Right ventriculo-pulmonary arterial uncoupling and poor outcomes in pulmonary arterial hypertension.
Pulm Circ;10(3):2045894020957223. doi: 10.1177/2045894020957223.
Nakaya Toshitaka, Ohira Hiroshi, Sato Takahiro, Watanabe Taku, Nishimura Masaharu, Oyama-Manabe Noriko, Kato Masaru, Ito Yoichi M, Tsujino Ichizo,
Abstract
Right ventricular function critically affects the prognosis of patients with pulmonary arterial hypertension. We aimed to analyze the prognostic value of right ventricular indices calculated using magnetic resonance imaging and right heart catheterization metrics in pulmonary arterial hypertension. We retrospectively collected data from 57 Japanese patients with pulmonary arterial hypertension and 18 controls and calculated six indices of right ventricular function: two indices of contractility (end-systolic elastance calculated with right ventricular maximum pressure and with magnetic resonance imaging metrics); two indices of right ventricular-pulmonary arterial coupling (end-systolic elastance/arterial elastance calculated with the pressure method (end-systolic elastance/arterial elastance (P)) and with the volume method (end-systolic elastance/arterial elastance (V)); and two indices of right ventricular diastolic function (stiffness (?) and end-diastolic elastance). We compared the indices between controls and patients with pulmonary arterial hypertension and examined their prognostic role. In patients with pulmonary arterial hypertension, end-systolic elastance (right ventricular maximum pressure) was higher (pulmonary arterial hypertension 0.94 (median) vs control 0.42 (mmHg/mL), ?
© The Author(s) 2020.
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The outcome in patients with brain stroke: A deep learning neural network modeling.
J Res Med Sci2020 ;25():78. doi: 10.4103/jrms.JRMS_268_20.
Someeh Nasrin, Asghari Jafarabadi Mohammad, Shamshirgaran Seyed Morteza, Farzipoor Farshid,
Abstract
Background:
The artificial intelligence field is obtaining ever-increasing interests for enhancing the accuracy of diagnosis and the quality of patient care. Deep learning neural network (DLNN) approach was considered in patients with brain stroke (BS) to predict and classify the outcome by the risk factors.
Materials and Methods:
A total of 332 patients with BS (mean age: 77.4 [standard deviation: 10.4] years, 50.6% - male) from Imam Khomeini Hospital, Ardabil, Iran, during 2008-2018 participated in this prospective study. Data were gathered from the available documents of the BS registry. Furthermore, the diagnosis of BS was considered based on computerized tomography scans and magnetic resonance imaging. The DLNN strategy was applied to predict the effects of the main risk factors on mortality. The quality of the model was measured by diagnostic indices.
Results:
The finding of this study for 81 selected models demonstrated that ranges of accuracy, sensitivity, and specificity are 90.5%-99.7%, 83.8%-100%, and 89.8%-99.5%, respectively. Based on the optimal model (tangent hyperbolic activation function with the minimum-maximum hidden units of 10-20, max epochs of 400, momentum of 0.5, and learning rate of 0.1), the most important predictors for BS mortality were time interval after 10 years (accuracy = 92.2%), age category (75.6%), the history of hyperlipoproteinemia (66.9%), and education level (66.9%). The other independent variables are at moderate importance (66.6%) which include sex, employment status, residential place, smoking habits, history of heart disease, cerebrovascular accident type, blood pressure, diabetes, oral contraceptive pill use, and physical activity.
Conclusion:
The best means for dropping the BS load is effective BS prevention. DLNN strategy showed a surprising presentation in the prediction of BS mortality based on the main risk factors with an excellent diagnostic accuracy. Moreover, the time interval after 10 years, age, the history of hyperlipoproteinemia, and education level are the most important predictors for BS.
Copyright: © 2020 Journal of Research in Medical Sciences.
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Ventricular Arrhythmias in Cardiac Amyloidosis: A Review of Current Literature.
Clin Med Insights Cardiol2020 ;14():1179546820963055. doi: 10.1177/1179546820963055.
Khanna Shaun, Lo Phillip, Cho Kenneth, Subbiah Rajesh,
Abstract
Cardiac Amyloidosis is an infiltrative cardiomyopathy which occurs secondary to deposition of mis-folded protein in the myocardium, with the two most common subtypes being AL amyloidosis and TTR amyloidosis. The pathogenesis of the disease is multifaceted and involves a variety of mechanisms including an inflammatory response cascade, oxidative stress and subsequent separation of myocyte fibrils. Cardiac Amyloidosis frequently results in congestive cardiac failure and arrhythmias, from a disruption in cardiac substrate with subsequent electro-mechanical remodelling. Disease progression is usually demonstrated by development of progressive pump failure, which may be seen with a high arrhythmic burden, usually portending a poor prognosis. There is a paucity of literature on the clinical implications of ventricular arrhythmias in the context of cardiac amyloidosis. The important diagnostic investigations for these patients include transthoracic echocardiography, cardiac magnetic resonance imaging and an electrophysiology study. Whilst there are no robust management guidelines, studies have indicated benefits from contemporary pharmacological therapy and case-by-case catheter ablation. There are novel directed therapies available for TTR amyloidosis that have shown to improve overall survival. The role of ICD therapy in cardiac amyloidosis is controversial, with benefits seen predominantly in early phases of the disease process. The only definitive surgical therapy includes heart transplantation, but is largely indicated for progressive decompensated heart failure (Figure 1). Further large-scale studies are required to better outline management paradigms for treating ventricular arrhythmias in cardiac amyloidosis.
© The Author(s) 2020.
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Coexistence of acute poststreptococcal glomerulonephritis and acute rheumatic fever in a Japanese girl with primary Sjögren's syndrome.
Mod Rheumatol Case Rep2020 Jul;4(2):262-266. doi: 10.1080/24725625.2020.1728060.
Kobayashi Ichiro, Takezaki Shunichiro, Tozawa Yusuke, Ueki Masahiro, Hayashi Asako, Yamazaki Takeshi, Sato Yasuyuki, Okamoto Takayuki, Yamada Masafumi, Ariga Tadashi,
Abstract
Although acute poststreptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are well-known complications of group A streptococcus infection, concomitant occurrence of both diseases is rare. We report an 11-year-old Japanese girl with primary Sjögren's syndrome complicated by acute renal failure about 2?weeks after the onset of pharyngitis. Although histopathological findings of the kidney were not confirmative, APSGN was suggested by the spontaneous recovery of her renal function, typical latent period with high levels of antistreptolysin O and low serum levels of C3 but not of C4. In addition, cardiac hypomotility and regurgitation of the 4 valves progressed in the convalescent phase of APSGN, which was accompanied by elevation of serum C-reactive protein and plasma brain natriuretic peptide (BNP) levels. Myocarditis was suggested by delayed gadolinium-enhancement of cardiac walls on cardiac magnetic resonance imaging. She was diagnosed with APSGN and ARF and was treated with a combination of short course prednisolone and prophylactic penicillin G. There is no relapse of renal or cardiac symptoms during 6?years follow-up. Unexpected elevation of plasma BNP in a convalescent stage of APSGN suggests the development of ARF. Underlying Sjögren's syndrome (SS) may modify the histopathological findings and make it difficult to differentiate APSGN from CTD-associated nephritis such as lupus nephritis (LN) even by renal biopsy.
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High-resolution MRI assessment of optic nerve sheath diameter in adults: optic nerve sheath variation and a new diagnostic tool for intracranial hypertension.
Acta Radiol2020 Oct;():284185120966715. doi: 10.1177/0284185120966715.
Zheng Ying-Mei, Hao Da-Peng, Tang Guo-Zhang, Zhou Rui-Zhi, Pang Jing, Dong Cheng,
Abstract
BACKGROUND:
Assessment of optic nerve sheath diameter (ONSD) is a non-invasive measure of intracranial pressure (ICP). However, it is not clear whether healthy individuals exhibit ONSD variation or whether factors other than ICP affect the ONSD.
PURPOSE:
To investigate whether ONSD was correlated with age, sex, height, weight, eyeball transverse diameter (ETD), or body mass index (BMI), and to develop a new diagnostic model to increase the diagnostic accuracy of intracranial hypertension (IH).
MATERIAL AND METHODS:
A total of 145 relatively healthy adults and 40 patients with acute IH who underwent high-resolution magnetic resonance imaging (MRI) were enrolled in this study. Linear regression analyses were used to determine the relationship between ONSD and these variables. If correlations were identified, an index ONSD removing variables effects was calculated. ROC analysis was used to assess the IH predictive value of ONSD in terms of sensitivity and specificity.
RESULTS:
In relatively healthy adults, there was a correlation between ONSD and BMI (?=?0.002), which can be presented as an index ONSD. The ONSD model better predicted IH than the ONSD model (?=?0.035), with a sensitivity of 70.00%, a specificity of 71.72%, and an AUC of 0.755.
CONCLUSION:
A correlation between ONSD and body mass index (BMI) was found using high-resolution MRI. This result indicates that the effects of BMI should be considered along with the ONSD during ICP monitoring. Meanwhile, the index ONSD was better than the ONSD in predicting IH and could be used to obtain a more precise estimation of ICP.
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