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Pubblicazioni recenti - cardiac magnetic resonance
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[Suspected cardiac amyloidosis - diagnostic steps for evaluation].
Dtsch Med Wochenschr2020 Aug;145(16):1162-1168. doi: 10.1055/a-1019-2072.
Feldmann Korinna, Hamm Christian W, Aßmus Birgit,
Abstract
Cardiac amyloidosis is a rare cause of cardiomyopathy, however, it is part of an underdiagnosed underlying systemic disease. For transthyretin (ATTR) amyloidosis, which is caused by the deposition of incorrectly folded transthyretin, either as the wild-type (wtATTR) or mutated (mATTR) form, novel evidence-based treatment options were recently shown to reduce disease progression as well as hospitalisation rates for heart failure. Thus, it is important to establish early and reliable diagnosis of cardiac involvement with ATTR amyloidosis.Modern non-invasive imaging (cardio magnetic resonance (CMR) and scintigraphic methods) together with immune fixation with determination of free light chains allow fast and reliable clinical screening for cardiac amyloidosis, whereas endomyocardial biopsy and genetics are used for confirmation of the underlying diagnosis. Interdisciplinary teams including hemato-oncology, neurology, nephrology in addition to cardiology are essential to enable personalized targeted treatment strategies.
© Georg Thieme Verlag KG Stuttgart · New York.
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T1 and T2 mapping to detect chronic inflammation in cardiac magnetic resonance imaging in heart failure with reduced ejection fraction.
ESC Heart Fail2020 Aug;():. doi: 10.1002/ehf2.12830.
Emrich Tilman, Hahn Felix, Fleischmann David, Halfmann Moritz C, Düber Christoph, Varga-Szemes Akos, Escher Felicitas, Pefani Evgenia, Münzel Thomas, Schultheiss Heinz-Peter, Kreitner Karl-Friedrich, Wenzel Philip,
Abstract
AIMS:
The purpose of this retrospective single-centre study was to evaluate the non-invasive detection of endomyocardial biopsy (EMB)-established chronic myocardial inflammation in patients with heart failure with reduced ejection fraction (HFrEF) using T1 and T2 mapping.
METHODS AND RESULTS:
The study population consisted of 52 retrospectively identified HFrEF patients who underwent EMB and cardiac magnetic resonance imaging at 3 Tesla. EMB was defined according to the position statement of the European Society of Cardiology and served as reference to identify inflammation in all patients. A control group of healthy volunteers with prior cardiac magnetic resonance imaging studies (n = 58) was also identified. Global and segmental T1 and T2 values as well as septal measurements and tissue heterogeneity parameters were calculated. Out of the 52 patients with HFrEF, 33 patients had myocardial inflammation detected by EMB, while 19 patients were EMB negative for inflammation. Mean left ventricular ejection fraction was 31% in both groups (P = 0.97). Global T1 and T2 values in HFrEF patients were significantly higher compared with healthy controls (T1 1275 ± 69 ms vs. 1,175 ± 44 ms, P < 0.001; T2 40.0 ± 3.4 ms vs. 37.9 ± 1.6 ms, P < 0.001). The distribution of T1 and T2 values between patients with and without EMB-proven chronic myocardial inflammation was not statistically different when regarding global (T1 1292 ± 71 ms vs. 1266 ± 67 ms, P = 0.26; T2 40.0 ± 2.6 ms vs. 40.0 ± 3.9 ms, P = 1.0), septal (T1 1299 ± 63 ms vs. 1289 ± 76 ms, P = 0.76; T2 40.1 ± 3.5 ms vs 40.0 ± 6.4 ms, P = 0.49) or maximum segmental values (T1 1414 ± 111 ms vs. 1363 ± 88 ms, P = 0.15; T2 47.3 ± 5.2 ms vs. 48.8 ± 11.8 ms, P = 0.53). Mean absolute deviation of segmental T1 and T2 values and log-transformed pixel-wise standard deviation as parameters of tissue heterogeneity did not reveal statistical significant differences between inflammation-positive and inflammation-negative HFrEF patients (all P > 0.4).
CONCLUSIONS:
Conventionally performed quantitative T1 and T2 mapping values significantly correlated with prevalence of HFrEF but did not discriminate HFrEF patients with or without chronic myocardial inflammation in our cohort. This suggests that EMB is the preferred method to detect chronic myocardial inflammation in HFrEF.
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
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A rare case of a pulmonary valve papillary fibroelastoma.
J Card Surg2020 Aug;():. doi: 10.1111/jocs.14944.
Ahern Shane, Khan Muhammad E A, McLoughlin Joseph, Mellerick Lisa, Burke Louise, Hinchion John,
Abstract
CASE:
A 67-year-old female presented with an exceedingly rare cardiac neoplasm - papillary fibroelastoma. This is made rarer still as it occurred on the pulmonary valve. The patient complained of a prolonged history of chest discomfort. Magnetic resonance imaging and echocardiography revealed a pulmonary valve papillary fibroelastoma. Surgical excision proved curative and the patient remains asymptomatic to date.
DISCUSSION:
The literature surrounding papillary fibroelastomas is discussed. Primary cardiac tumours are uncommon. Papillary fibroelastomas occurring the right side of the heart comprise less than 0.05% of these. They have a characteristic macroscopic appearance which allow them to be easily identified with echocardiography and at surgical excision. They can present in a variety of ways including classical cardiac symptoms, embolic complications or as an incidental finding. Surgical excision is the definitive treatment.
© 2020 Wiley Periodicals LLC.
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Myocarditis and intracardiac thrombus due to Henoch-Schönlein purpura: case report and literature review.
Clin Rheumatol2020 Aug;():. doi: 10.1007/s10067-020-05317-8.
Y?lmaz Neslihan, Yüksel Selçuk, Becerir Tülay, Giri?gen ?lknur, Ufuk Furkan, Gürses Dolunay, Y?lmaz Münevver, Yalç?n Nagihan,
Abstract
Cardiac involvement is very rare in patients with Henoch-Schönlein purpura (HSP). In this case study, we present an 8-year-old girl presenting with HSP-induced myocarditis and thrombus in the right atrium and HSP nephritis. To date, 15 cases of HSP-related cardiac involvement have been reported in the PubMed/MEDLINE, Scopus, and Google Scholar databases. These cases, together with our case, are included in this review. We excluded those patients with other rheumatologic diseases (acute rheumatic fever, acute post-streptococcal glomerulonephritis, Kawasaki disease) accompanied by HSP. Three were children and 13 were adults and all were male except our case. This review revealed tachyarrhythmia, chest pain, dyspnea, murmur, and heart failure as the major signs. Cardiac tests, electrocardiogram (ECG), and imaging methods (echocardiography in all patients, cardiac magnetic resonance imaging (MRI) in three, cardiac biopsy in one, and post-mortem necropsy in three) showed that the cardiac involvements were pericardial effusion, intra-atrial thrombus, myocarditis, coronary artery changes, myocardial ischemia, infarction and necrosis, subendocardial hemorrhage, and left ventricular dilatation. Kidney involvement was not observed in three patients. As the treatment, high-dose prednisolone and cyclophosphamide, oral corticosteroid, azathioprine, nadroparin calcium, ACE inhibitors, calcium antagonists, beta-blockers, and diuretics were used. Eleven patients (all three children and eight of the adults) had a complete cardiac recovery. Cardiac involvement in adults was more likely to be fatal. Death (three patients), ischemia, and infarct have been reported only in adults. We suggested that early and aggressive treatment can be life-saving. MRI examination is effective at identifying cardiac involvement.
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3D hybrid printed models in complex congenital heart disease: 3D echocardiography and cardiovascular magnetic resonance imaging fusion.
Eur Heart J2020 Aug;():. doi: ehaa654.
Gomez Alberto, Gomez Gorka, Simpson John, Valverde Israel,
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Breast cancer diagnosis is associated with relative left ventricular hypertrophy and elevated endothelin-1 signaling.
BMC Cancer2020 Aug;20(1):751. doi: 10.1186/s12885-020-07217-1.
Maayah Zaid H, Takahara Shingo, Alam Abrar S, Ferdaoussi Mourad, Sutendra Gopinath, El-Kadi Ayman O S, Mackey John R, Pituskin Edith, Paterson D Ian, Dyck Jason R B,
Abstract
BACKGROUND:
The survival rates of women with breast cancer have improved significantly over the last four decades due to advances in breast cancer early diagnosis and therapy. However, breast cancer survivors have an increased risk of cardiovascular complications following chemotherapy. While this increased risk of later occurring structural cardiac remodeling and/or dysfunction has largely been attributed to the cardiotoxic effects of breast cancer therapies, the effect of the breast tumor itself on the heart prior to cancer treatment has been largely overlooked. Thus, the objectives of this study were to assess the cardiac phenotype in breast cancer patients prior to cancer chemotherapy and to determine the effects of human breast cancer cells on cardiomyocytes.
METHODS:
We investigated left ventricular (LV) function and structure using cardiac magnetic resonance imaging in women with breast cancer prior to systemic therapy and a control cohort of women with comparable baseline factors. In addition, we explored how breast cancer cells communicate with the cardiomyocytes using cultured human cardiac and breast cancer cells.
RESULTS:
Our results indicate that even prior to full cancer treatment, breast cancer patients already exhibit relative LV hypertrophy (LVH). We further demonstrate that breast cancer cells likely contribute to cardiomyocyte hypertrophy through the secretion of soluble factors and that at least one of these factors is endothelin-1.
CONCLUSION:
Overall, the findings of this study suggest that breast cancer cells play a greater role in inducing structural cardiac remodeling than previously appreciated and that tumor-derived endothelin-1 may play a pivotal role in this process.
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Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data.
J Am Heart Assoc2020 Aug;():e015351. doi: 10.1161/JAHA.119.015351.
Greulich Simon, Seitz Andreas, Müller Karin A L, Grün Stefan, Ong Peter, Ebadi Nawid, Kreisselmeier Klaus Peter, Seizer Peter, Bekeredjian Raffi, Zwadlo Carolin, Gräni Christoph, Klingel Karin, Gawaz Meinrad, Sechtem Udo, Mahrholdt Heiko,
Abstract
Background There is scarce data about the long-term mortality as well as the prognostic value of cardiovascular magnetic resonance and late gadolinium enhancement (LGE) in patients with biopsy-proven viral myocarditis. We sought to investigate: (1) mortality and (2) prognostic value of LGEcardiovascular magnetic resonance (location, pattern, extent, and distribution) in a >10-year follow-up in patients with biopsy-proven myocarditis. Methods and Results Two-hundred three consecutive patients with biopsy-proven viral myocarditis and cardiovascular magnetic resonance were enrolled; 183 patients were eligible for standardized follow-up. The median follow-up was 10.1 years. End points were all-cause death, cardiac death, and sudden cardiac death (SCD). We found substantial long-term mortality in patients with biopsy-proven myocarditis (39.3% all cause, 27.3% cardiac, and 10.9% SCD); 101 patients (55.2%) demonstrated LGE. The presence of LGE was associated with a more than a doubled risk of death (hazard ratio [HR], 2.40; 95% CI], 1.30-4.43), escalating to a HR of 3.00 (95% CI, 1.41-6.42) for cardiac death, and a HR of 14.79 (95% CI, 1.95-112.00) for SCD; all ?0.009. Specifically, midwall, (antero-) septal LGE, and extent of LGE were highly associated with death, all <0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38-15.24; =0.01). Conclusions In patients with biopsy-proven viral myocarditis, the presence of midwall LGE in the (antero-) septal segments is associated with a higher rate of mortality (including SCD) compared with absent LGE or other LGE patterns, underlining the prognostic benefit of a distinct LGE analysis in these patients.
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Novel Imaging Strategies in Systemic Sclerosis.
Curr Rheumatol Rep2020 Aug;22(9):57. doi: 10.1007/s11926-020-00926-3.
Wolf Molly, Montesi Sydney B,
Abstract
PURPOSE OF REVIEW:
Imaging modalities such as computed tomography, ultrasound, magnetic resonance imaging, and molecular imaging are being used to evaluate for disease in systemic sclerosis (SSc) patients. Here, we review novel imaging strategies to detect organ and vascular complications of SSc and novel imaging techniques for assessing interstitial lung disease and pulmonary hypertension in other conditions that may have further applicability to SSc.
RECENT FINDINGS:
Imaging techniques can be used to identify disease in the lungs, pulmonary vascular system, heart, skin, vascular tissue, and gastrointestinal tract of SSc patients. These show promise in detecting early disease, many without the use of ionizing radiation. Novel imaging techniques in patients with SSc can be used to detect disease in multiple susceptible organs. These imaging strategies have potential for early disease detection, as well as potential for incorporation into clinical trials to accelerate the development of SSc therapies.
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Velocity Pulsatility and Arterial Distensibility Along the Internal Carotid Artery.
J Am Heart Assoc2020 Aug;():e016883. doi: 10.1161/JAHA.120.016883.
van Tuijl Rick J, Ruigrok Ynte M, Velthuis Birgitta K, van der Schaaf Irene C, Rinkel Gabriël J E, Zwanenburg Jaco J M,
Abstract
Background Attenuation of velocity pulsatility along the internal carotid artery (ICA) is deemed necessary to protect the microvasculature of the brain. The role of the carotid siphon within the whole ICA trajectory in pulsatility attenuation is still poorly understood. This study aims to assess arterial variances in velocity pulsatility and distensibility over the whole ICA trajectory, including effects of age and sex. Methods and Results We assessed arterial velocity pulsatility and distensibility using flow-sensitized 2-dimensional phase-contrast 3.0 Tesla magnetic resonance imaging in 118 healthy participants. Velocity pulsatility index (vPI=(V-V)/V) and arterial distensibility defined as area pulsatility index (A-A)/A) were calculated at C1, C3, and C7 segments of the ICA. vPI increased between C1 and C3 (0.85±0.13 versus 0.93±0.13, <0.001 for averaged right+left ICA) and decreased between C3 and C7 (0.93±0.13 versus 0.84±0.13, <0.001) with overall no effect (C1-C7). Conversely, the area pulsatility index decreased between C1 and C3 (0.18±0.06 versus 0.14±0.04, <0.001) and increased between C3 and C7 (0.14±0.04 versus 0.31±0.09, <0.001). vPI in men is higher than in women and increases with age (<0.015). vPI over the carotid siphon declined with age but remained stable over the whole ICA trajectory. Conclusions Along the whole ICA trajectory, vPI increased from extracranial C1 up to the carotid siphon C3 with overall no effect on vPI between extracranial C1 and intracranial C7 segments. This suggests that the bony carotid canal locally limits the arterial distensibility of the ICA, increasing the vPI at C3 which is consequently decreased again over the carotid siphon. In addition, vPI in men is higher and increases with age.
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Histological Validation of Cardiovascular Magnetic Resonance T1 Mapping for Assessing the Evolution of Myocardial Injury in Myocardial Infarction: An Experimental Study.
Korean J Radiol2020 Aug;():. doi: 10.3348/kjr.2020.0107.
Zhang Lu, Yang Zhi Gang, Xu Huayan, Yang Meng Xi, Xu Rong, Chen Lin, Sun Ran, Miao Tianyu, Zhao Jichun, Zhou Xiaoyue, Fu Chuan, Guo Yingkun,
Abstract
OBJECTIVE:
To determine whether T1 mapping could monitor the dynamic changes of injury in myocardial infarction (MI) and be histologically validated.
MATERIALS AND METHODS:
In 22 pigs, MI was induced by ligating the left anterior descending artery and they underwent serial cardiovascular magnetic resonance examinations with modified Look-Locker inversion T1 mapping and extracellular volume (ECV) computation in acute (within 24 hours, n = 22), subacute (7 days, n = 13), and chronic (3 months, n = 7) phases of MI. Masson's trichrome staining was performed for histological ECV calculation. Myocardial native T1 and ECV were obtained by region of interest measurement in infarcted, peri-infarct, and remote myocardium.
RESULTS:
Native T1 and ECV in peri-infarct myocardium differed from remote myocardium in acute (1181 ± 62 ms vs. 1113 ± 64 ms, = 0.002; 24 ± 4% vs. 19 ± 4%, = 0.031) and subacute phases (1264 ± 41 ms vs. 1171 ± 56 ms, < 0.001; 27 ± 4% vs. 22 ± 2%, = 0.009) but not in chronic phase (1157 ± 57 ms vs. 1120 ± 54 ms, = 0.934; 23 ± 2% vs. 20 ± 1%, = 0.109). From acute to chronic MI, infarcted native T1 peaked in subacute phase (1275 ± 63 ms vs. 1637 ± 123 ms vs. 1471 ± 98 ms, < 0.001), while ECV progressively increased with time (35 ± 7% vs. 46 ± 6% vs. 52 ± 4%, < 0.001). Native T1 correlated well with histological findings (R² = 0.65 to 0.89, all < 0.001) so did ECV (R² = 0.73 to 0.94, all < 0.001).
CONCLUSION:
T1 mapping allows the quantitative assessment of injury in MI and the noninvasive monitoring of tissue injury evolution, which correlates well with histological findings.
Copyright © 2020 The Korean Society of Radiology.
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Troponin-Positive Non-Obstructive Coronary Arteries and Myocardial Infarction with Non-Obstructive Coronary Arteries: Definition, Etiologies, and Role of CT and MR Imaging.
Korean J Radiol2020 Aug;():. doi: 10.3348/kjr.2020.0064.
Yoo Seung Min, Jang Sowon, Kim Jeong A, Chun Eun Ju,
Abstract
In approximately 10% of patients with acute myocardial infarction (MI), angiography does not reveal an obstructive coronary stenosis. This is known as myocardial infarction with non-obstructive coronary arteries (MINOCA), which has complex and multifactorial causes. However, this term can be confusing and open to dual interpretation, because MINOCA is also used to describe patients with acute myocardial injury caused by ischemia-related myocardial necrosis. Therefore, with regards to this specific context of MINOCA, the generic term for MINOCA should be replaced with troponin-positive with non-obstructive coronary arteries (TpNOCA). The causes of TpNOCA can be subcategorized into epicardial coronary (causes of MINOCA), myocardial, and extracardiac disorders. Cardiac magnetic resonance imaging can confirm MI and differentiate various myocardial causes, while cardiac computed tomography is useful to diagnose the extracardiac causes.
Copyright © 2020 The Korean Society of Radiology.
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Effect of Preoperative Frozen Shoulder on Clinical Outcomes After Arthroscopic Rotator Cuff Repair.
Orthop J Sports Med2020 Jul;8(7):2325967120934449. doi: 10.1177/2325967120934449.
Jeong Jeung Yeol, Shim Seung Bo, Hong Jin Ho, Im Wooyoung, Lee Sang Min, Yoo Jae Chul,
Abstract
Background:
A concomitant rotator cuff tear (RCT) with frozen shoulder is a common but challenging clinical scenario. The effect of frozen shoulder on clinical outcomes is open to discussion.
Purpose/Hypothesis:
This study aimed to evaluate the effect of preoperative frozen shoulder on postoperative clinical outcomes of an RCT. We hypothesized that the treatment results of an RCT concomitant with preoperative frozen shoulder would be comparable with those of an isolated RCT.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
A total of 212 patients were divided into 2 groups: 154 in the non-frozen shoulder (NFS) group and 58 in the preoperative frozen shoulder (FS) group. All patients underwent a thorough preoperative evaluation that included range of motion (ROM) and the pain visual analog scale, functional visual analog scale, Constant score, and American Shoulder and Elbow Surgeons (ASES) score. The same evaluation was performed at 6 months and 1 and 2 years postoperatively. The healing status of the repaired RCT of all patients was evaluated by postoperative magnetic resonance imaging.
Results:
The FS group showed statistically significantly worse functional outcomes than the NFS group at 6 months and 1 year postoperatively ( < .05). At 2 years postoperatively, active assisted ROM was equivalent between the groups, although the ASES and Constant scores were significantly lower for the FS group ( < .033 and < .001, respectively). The retear rates were 5.3% and 12.3% for the FS and NFS groups, respectively ( = .013).
Conclusion:
Preoperative frozen shoulder positively affected rotator cuff healing but negatively affected most functional outcomes, including ROM, at 6 months and 1 year postoperatively. At 2 years after surgery, there was no significant difference in active motion, but outcome scores remained lower in the FS group. For patients with preoperative frozen shoulder, a delay in surgery for additional physical therapy might not be necessary. The retear rate for the NFS group was more than double that for the FS group in the current study, which indicates that surgery for an RCT combined with frozen shoulder might provide better results in the long term because of an intact, healed rotator cuff.
© The Author(s) 2020.
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Atlas-based measures of left ventricular shape may improve characterization of adverse remodeling in anthracycline-exposed childhood cancer survivors: a cross-sectional imaging study.
Cardiooncology2020 ;6():13. doi: 10.1186/s40959-020-00069-5.
Narayan Hari K, Xu Ronghui, Forsch Nickolas, Govil Sachin, Iukuridze David, Lindenfeld Lanie, Adler Eric, Hegde Sanjeet, Tremoulet Adriana, Ky Bonnie, Armenian Saro, Omens Jeffrey, McCulloch Andrew D,
Abstract
Background:
Adverse cardiac remodeling is an important precursor to anthracycline-related cardiac dysfunction, however conventional remodeling indices are limited. We sought to examine the utility of statistical atlas-derived measures of ventricular shape to improve the identification of adverse anthracycline-related remodeling in childhood cancer survivors.
Methods:
We analyzed cardiac magnetic resonance imaging from a cross-sectional cohort of 20 childhood cancer survivors who were treated with low (
Results:
Compared with the reference population, survivors had differences in conventional measures (lower volume and mass) and shape modes (corresponding to lower overall size and lower sphericity; all ?
Conclusions:
Compared with a reference population, heart size is smaller in anthracycline-exposed childhood cancer survivors. Atlas-based measures of left ventricular shape may improve the detection of anthracycline dose-related remodeling differences.
© The Author(s) 2020.
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Prospective cross-sectional study using Poisson renewal theory to study phase singularity formation and destruction rates in atrial fibrillation (RENEWAL-AF): Study design.
J Arrhythm2020 Aug;36(4):660-667. doi: 10.1002/joa3.12363.
Quah Jing, Dharmaprani Dhani, Lahiri Anandaroop, Schopp Madeline, Mitchell Lewis, Selvanayagam Joseph B, Perry Rebecca, Chahadi Fahd, Tung Matthew, Ahmad Waheed, Stoyanov Nikola, Joseph Majo X, Singleton Cameron, McGavigan Andrew D, Ganesan Anand N,
Abstract
Background:
Unstable functional reentrant circuits known as rotors have been consistently observed in atrial fibrillation and are mechanistically believed critical to the maintenance of the arrhythmia. Recently, using a Poisson renewal theory-based quantitative framework, we have demonstrated that rotor formation (?) and destruction rates (?) can be measured using in vivo electrophysiologic data. However, the association of ? and ? with clinical, electrical, and structural markers of atrial fibrillation phenotype is unknown.
Methods:
RENEWAL-AF is a multicenter prospective cross-sectional study recruiting adult patients with paroxysmal or persistent atrial fibrillation undergoing clinically indicated catheter ablation. Patients will undergo intraprocedural electrophysiologic atrial fibrillation mapping, with ? and ? to be determined from 2-minute unipolar electrogram recordings acquired before ablation. The primary objective will be to determine the association of ? and ? as markers of fibrillatory dynamics with clinical, electrical, and structural markers of atrial fibrillation clinical phenotype, measured by preablation transthoracic echocardiogram and cardiac magnetic resonance imaging. An exploratory objective is the noninvasive assessment of ? and ? using surface ECG characteristics via a machine learning approach.
Results:
Not applicable.
Conclusion:
This pilot study will provide insight into the correlation between ?/? with clinical, electrophysiological, and structural markers of atrial fibrillation phenotype and provide a foundation for the development of noninvasive assessment of ?/? using surface ECG characteristics will help expand the use of ?/? in clinical practice.
© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.
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Updates in Spontaneous Coronary Artery Dissection.
Curr Cardiol Rep2020 Aug;22(10):123. doi: 10.1007/s11886-020-01378-y.
Krittanawong Chayakrit, Saw Jacqueline, Olin Jeffrey W,
Abstract
PURPOSE OF REVIEW:
To review the epidemiology, pathogenesis, diagnosis using emerging imaging modalities, management strategy, and prevention of recurrent spontaneous coronary artery dissection (SCAD) and provide a more extensive review of the current data.
RECENT FINDINGS:
SCAD generally affects women without conventional cardiovascular risk factors. Diagnosis and management of SCAD are challenging due to heterogeneity, undefined mechanisms, differing phenotypes, and a lack of strong clinical evidence. After reviewing the current evidence to date, we recommend conservative management, including cardiac rehabilitation for SCAD with low-risk features, while coronary revascularization should be considered in SCAD with high-risk features. Non-invasive imaging (e.g., coronary computed tomography angiography, cardiac magnetic resonance, myocardial perfusion imaging) should be considered in diagnosing specific SCAD phenotypes. The standard guideline-based medical therapy for acute coronary syndrome, in the absence of contraindications, should be considered along with appropriate SCAD phenotypes. Discharge counseling and follow-up using emerging imaging modalities should be based on individuals' profiles and approached on a case by case basis.
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SS-31 and NMN: Two paths to improve metabolism and function in aged hearts.
Aging Cell2020 Aug;():e13213. doi: 10.1111/acel.13213.
Whitson Jeremy A, Bitto Alessandro, Zhang Huiliang, Sweetwyne Mariya T, Coig Rene, Bhayana Saakshi, Shankland Eric G, Wang Lu, Bammler Theo K, Mills Kathryn F, Imai Shin-Ichiro, Conley Kevin E, Marcinek David J, Rabinovitch Peter S,
Abstract
The effects of two different mitochondrial-targeted drugs, SS-31 and NMN, were tested on Old mouse hearts. After treatment with the drugs, individually or Combined, heart function was examined by echocardiography. SS-31 partially reversed an age-related decline in diastolic function while NMN fully reversed an age-related deficiency in systolic function at a higher workload. Metabolomic analysis revealed that both NMN and the Combined treatment increased nicotinamide and 1-methylnicotinamide levels, indicating greater NAD turnover, but only the Combined treatment resulted in significantly greater steady-state NAD(H) levels. A novel magnetic resonance spectroscopy approach was used to assess how metabolite levels responded to changing cardiac workload. PCr/ATP decreased in response to increased workload in Old Control, but not Young, hearts, indicating an age-related decline in energetic capacity. Both drugs were able to normalize the PCr/ATP dynamics. SS-31 and NMN treatment also increased mitochondrial NAD(P)H production under the higher workload, while only NMN increased NAD in response to increased work. These measures did not shift in hearts given the Combined treatment, which may be owed to the enhanced NAD(H) levels in the resting state after this treatment. Overall, these results indicate that both drugs are effective at restoring different aspects of mitochondrial and heart health and that combining them results in a synergistic effect that rejuvenates Old hearts and best recapitulates the Young state.
© 2020 The Authors. Aging Cell published by Anatomical Society and John Wiley & Sons Ltd.
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Significant role of magnetic resonance imaging for the diagnosis and evaluation of cardiac amyloidosis in primary light chain amyloidosis.
J Clin Exp Hematop2020 Aug;():. doi: 10.3960/jslrt.19040.
Sekiguchi Yasunobu, Wakabayashi Mutsumi, Iizuka Hiroko, Takizawa Haruko, Sugimoto Keiji, Sakajiri Sakura, Inano Tadaaki, Fukuda Yasutaka, Hamano Yasuharu, Tomita Shigeki, Izumi Hiroshi, Isogai Hiroyuki, Okubo Mitsuo, Nakamura Noriko, Sawada Tomohiro, Matsumoto Kimihiro, Noguchi Masaaki,
Abstract
A 47-year-old male with macroglossia presented with dyspnea on effort and chest pain at rest. Cardiac MRI revealed diffuse global subendocardial late gadolinium enhancement below the left ventricular endocardium and a dark blood pool of intracardiac contrast medium. Tongue biopsy revealed amyloid deposition, which was limited in the myocardium. He was diagnosed with primary light chain amyloidosis. His condition was stage I according to the Mayo Clinic staging system. He underwent autologous peripheral blood stem cell transplantation. On Day 10, he developed chest pain and died suddenly on Day 11. Postmortem examination revealed amyloid deposition throughout the heart.
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Impact of biological treatment on left ventricular dysfunction determined by global circumferential, longitudinal and radial strain values using cardiac magnetic resonance imaging in patients with rheumatoid arthritis.
Int J Rheum Dis2020 Aug;():. doi: 10.1111/1756-185X.13942.
Yokoe Isamu, Kobayashi Hitomi, Kobayashi Yasuyuki, Nishiwaki Atsuma, Sugiyama Kaita, Nagasawa Yousuke, Ikumi Natsumi, Karasawa Hiromi, Okumura Yasuo, Kitamura Noboru, Takei Masami,
Abstract
AIM:
To evaluate left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA) and to determine the impact of biological treatment on LV function in these patients using global circumferential strain (GCS), global longitudinal strain (GLS) and global radial strain (GRS) values assessed by feature tracking cardiac magnetic resonance (FT-CMR) imaging.
METHODS:
Eighty patients with RA and 20 controls without cardiovascular disease underwent non-contrast CMR imaging. Patients with RA received conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or biologic DMARDs (bDMARDs). Global strains were calculated in 16 LV segments.
RESULTS:
No significant differences in cardiovascular risk factors were found between the RA group and controls. GCS was 21% lower in the RA group compared with controls (P < 0.001) and was 14% lower in the csDMARDs group compared with the bDMARDs group (P = 0.002), whereas, there was no significant difference in GLS and GRS between the RA group and the controls. In regard to strain rates, diastolic GCS and GRS rates were significantly lower in the RA group (P < 0.001, 0.011, respectively). In univariate analyses, GCS was significantly associated with the Simplified Disease Activity Index, bDMARDs, swollen joint count, anti-cyclic citrullinated peptides antibodies and matrix metalloproteinase-3, but in multivariable analysis, only bDMARDs was significantly associated with GCS (P = 0.021).
CONCLUSION:
Global circumferential strain, GLS and GRS assessed by FT-CMR can reveal subclinical LV dysfunction in patients with RA. Furthermore, they can be used to determine the normalization of LV regional dysfunction induced by bDMARDs possibly related to disease activity reduction.
© 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.
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Design, Implementation, and Validation of a Pulsatile Heart Phantom Pump.
J Digit Imaging2020 Aug;():. doi: 10.1007/s10278-020-00375-5.
Tuncay Volkan, Zijlstra Jan, Oudkerk Matthijs, van Ooijen Peter M A,
Abstract
The developments in Computed Tomography (CT) and Magnetic Resonance allow visualization of blood flow in vivo using these techniques. However, validation tests are needed to determine a gold standard. For the validation tests, controllable systems that can generate pulsatile flow are needed. In this study, we aimed to develop an affordable pulsatile pump and an artificial circulatory system to simulate the blood flow for validation purposes. Initially, the prerequisites for the phantom were pulsating flow output equal to that of the human cardiac pulse pattern; the flow pattern of the mimicked cardiac output should be equal to that of a human, a variable stroke volume (40-120 ml/beat), and a variable heart rate (60-170 bpm). The developed phantom setup was tested with CT scanner. A washout profile was created based on the image intensity of the selected slice. The test was successful for a heart rate of 70 bpm and a stroke volume of 68 ml, but the system failed to work at various heartbeats and stroke volumes. This was due to the problems with software of the microcontroller. As conclusion in this study, we present a proof of concept for a pulsatile heart phantom pump that can be used in validation tests.
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Changes in left atrial function, left ventricle remodeling, and fibrosis after septal myectomy for obstructive hypertrophic cardiomyopathy.
J Thorac Cardiovasc Surg2020 Jul;():. doi: S0022-5223(20)31551-8.
Tang Bing, Song Yunhu, Yang Qiulan, Cui Hao, Ji Keshan, Zhao Shihua, Wang Shuiyun,
Abstract
BACKGROUND:
This study aimed to investigate the impact of septal myectomy on left atrial function, left ventricle remodeling, and fibrosis in patients with obstructive hypertrophic cardiomyopathy.
METHOD:
From May 2012 to September 2016, preoperative cardiac magnetic resonance imaging of 507 adult patients who underwent septal myectomy at Fuwai Hospital was retrospectively collected. Until October 2019, 57 patients were followed up with postoperative cardiac magnetic resonance imaging at 11.9 months (interquartile range, 6.4-25.3). Preoperative and postoperative left atrium and left ventricle changes, as well as late gadolinium enhancement as a surrogate of myocardial fibrosis, were analyzed.
RESULTS:
Patients with hypertrophic cardiomyopathy requiring myectomy showed increased left atrium volume, stroke volume, left ventricular ejection fraction, and left ventricle mass, as well as decreased left ventricle end-systolic volume. Echocardiography demonstrated that myectomy decreased the left ventricle outflow tract gradient, left atrium diameter, left ventricular ejection fraction, and posterior wall thickness. Postoperative cardiac magnetic resonance imaging showed that the minimal left atrium volume (P < .001), stroke volume (P = .009), left ventricle ejection fraction (P < .001), and left ventricle mass (166.9 [interquartile range, 135.8] vs 149.3 [interquartile range, 100.5] g, P < .001) decreased, whereas the left ventricle end-systolic volume (P = .001) and left atrium ejection fraction (37.9% ± 14.6% vs 47.8% ± 14%, P < .001) increased. However, left ventricle myocardial fibrosis, as detected by late gadolinium enhancement, still progressed after myectomy in patients with obstructive hypertrophic cardiomyopathy (15.2% ± 9.6% vs 18.6% [interquartile range, 21.6], P = .009).
CONCLUSIONS:
Septal myectomy alleviated left ventricle hypertrophy and reversed left atrium and left ventricle remodeling in patients with obstructive hypertrophic cardiomyopathy. Late gadolinium enhancement in the left ventricle increased despite myectomy in patients with obstructive hypertrophic cardiomyopathy.
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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