Pubblicazioni recenti - cardiac magnetic resonance
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Cardiac MRI T1 and T2 Mapping as a Quantitative Imaging Biomarker in Transthyretin Amyloid Cardiomyopathy.
Acad Radiol2023 Sep;():. doi: S1076-6332(23)00466-X.
Yamaguchi Shinpei, Oda Seitaro, Kidoh Masafumi, Hayashi Hidetaka, Takashio Seiji, Usuku Hiroki, Nagayama Yasunori, Nakaura Takeshi, Tsujita Kenichi, Hirai Toshinori, Aoki Takatoshi,
Abstract
RATIONALE AND OBJECTIVES:
This study aimed to assess the utility of cardiac magnetic resonance imaging (MRI) T1 and T2 mapping as quantitative imaging biomarkers in transthyretin amyloid cardiomyopathy (ATTR-CM).
MATERIALS AND METHODS:
This study retrospectively evaluated 74 patients with confirmed wild-type ATTR-CM who underwent cardiac MRI, Tc-labeled pyrophosphate (Tc-PYP) scintigraphy, and echocardiography. We assessed the quantitative disease parameters, for example, left ventricular ejection fraction (LVEF), and global longitudinal strain (GLS) by echocardiography, native T1, extracellular volume fraction (ECV), and native T2 value by cardiac MRI, heart-to-contralateral ratio (H/CL) by Tc-PYP, and high-sensitive cardiac troponin T. Myocardial native T2 of ?50 ms was defined as myocardial edema. Correlations between the disease's quantitative parameters were evaluated, and the ECV was compared to other parameters in ATTR-CM with/without myocardial edema.
RESULTS:
ECV in all patients with ATTR-CM revealed a strong correlation with native T1 (r = 0.62), a moderate correlation with hs-TnT (r = 0.59), LVEF (r = -0.48), GLS (r = 0.58), and H/CL (r = 0.48). Correlations between ECV and other quantitative parameters decreased in ATTR-CM with myocardial edema except for H/CL. Meanwhile, the correlations increased in ATTR-CM without myocardial edema.
CONCLUSION:
The presence of myocardial edema affected the interpretation of ECV assessment, although ECV can be a comprehensive imaging biomarker for ATTR-CM. ECV showed a significant correlation with various quantitative disease parameters and can be a reliable disease monitoring marker in patients with ATTR-CM when myocardial edema was excluded.
Copyright © 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
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Mitral annular disjunction and Pickelhaube sign in children with mitral valve prolapse: A prospective cohort study.
Arch Cardiovasc Dis2023 Sep;():. doi: S1875-2136(23)00168-7.
Vaksmann Guy, Bouzguenda Ivan, Guillaume Marie-Paule, Gras Pauline, Silvestri Valentina, Richard Adélaïde,
Abstract
BACKGROUND:
Mitral annular disjunction (MAD) and the Pickelhaube sign are identified as risk factors for malignant ventricular arrhythmias (VAs) and sudden cardiac death in adults with mitral valve prolapse (MVP); their prevalence and consequences in children have never been studied.
OBJECTIVES:
To determine the proportion of MAD in children with MVP, and its potential link with VAs.
METHODS:
A cohort of 49 consecutive children (mean age 12.8±3.0 years; 33 females) with MVP and comprehensive clinical arrhythmia (24-hour monitoring) and Doppler echocardiographic characterization, including pulsed-wave tissue Doppler (PWTD) of the lateral mitral annulus, was identified. The relationship between clinical and echocardiographic data and presence of VAs was studied.
RESULTS:
MAD was common (n=25; 51%). Only five patients had significant VAs (Lown grade>2) characterized by polymorphic premature ventricular contractions or couplets. MAD was not associated with VAs on 24-hour Holter monitoring, but an association was found between VAs and spiked high-velocity midsystolic signal>16cm/s on PWTD (Pickelhaube sign) (P=0.004), myxomatous mitral valve (P=0.004) and left ventricular dilatation (P=0.01). T-wave inversion in inferolateral leads on electrocardiogram was more frequent in patients with versus without the Pickelhaube sign (P=0.03). No difference was found between patients with or without MAD regarding sex, history of palpitation, severity of mitral regurgitation, aortic root diameter and incidence of connective tissue disorders. Myocardial fibrosis was detected in two of three patients who underwent a complementary cardiac magnetic resonance examination.
CONCLUSIONS:
MAD is common in children with MVP; its presence was not associated with significant VAs on 24-hour Holter monitoring, but the Pickelhaube sign and presence of myxomatous mitral valve may help to detect patients prone to significant VAs. Myocardial fibrosis can be detected by cardiac magnetic resonance in children with significant VAs.
Copyright © 2023 Elsevier Masson SAS. All rights reserved.
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Colchicine added to standard therapy further reduces fibrosis in pigs with myocardial infarction.
J Cardiovasc Med (Hagerstown)2023 Nov;24(11):840-846. doi: 10.2459/JCM.0000000000001554.
Aimo Alberto, Martinez-Falguera Daina, Barison Andrea, Musetti Veronica, Masotti Silvia, Morfino Paolo, Passino Claudio, Martinelli Giulia, Pucci Angela, Crisostomo Veronica, Sanchez-Margallo Francisco, Blanco-Blazquez Virginia, Galvez-Monton Carolina, Emdin Michele, Bayes-Genis Antoni,
Abstract
BACKGROUND:
The anti-inflammatory drug colchicine improves the outcome of patients with myocardial infarction (MI). As an intense inflammatory and fibrotic response after MI may lead to scar expansion and left ventricular (LV) remodeling, the clinical benefit of colchicine could be related to a positive effect on the infarct scar and LV remodeling.
METHODS:
Pigs underwent left anterior descending artery occlusion through an angioplasty balloon for 90?min and were then randomized into two groups: standard therapy [ACE inhibitor, beta blocker, mineralocorticoid receptor antagonist (MRA), aspirin] plus colchicine (n?=?14) or standard therapy alone (n?=?13). The pigs were treated for 30?days and underwent two cardiac magnetic resonance (CMR) scans at 72?h and 30?days. The pigs were then sacrificed the day after the second CMR. The primary efficacy end point was the extent of fibrosis in the infarct zone (calculated on eight samples from this zone and averaged).
RESULTS:
In the hearts explanted after 31?days, pigs in the colchicine group had less fibrosis in the infarct zone than the other animals [41.6% (20.4-51.0) vs. 57.4% (42.9-66.5); P?=?0.022]. There was a trend toward a higher myocardial salvage index (MSI; an index of the efficacy of revascularization) in pigs on colchicine (P?=?0.054). Conversely, changes in LV volumes, ejection fraction and mass did not differ between groups.
CONCLUSION:
Colchicine therapy for 1?month after reperfused MI further reduces myocardial fibrosis when added to standard therapy, while it does not have additional effects on LV remodeling.
Copyright © 2023 Italian Federation of Cardiology - I.F.C. All rights reserved.
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Central Venous Waveform Patterns in the Fontan Circulation Independently Contribute to the Prediction of Composite Survival.
Pediatr Cardiol2023 Sep;():. doi: 10.1007/s00246-023-03268-w.
Ferrari Margaret R, Schäfer Michal, Hunter Kendall S, Di Maria Michael V,
Abstract
It is well appreciated that the Fontan circulation perturbs central venous hemodynamics, with elevated pressure being the clearest change associated with Fontan comorbidities, such as Fontan-associated liver disease (FALD) and protein-losing enteropathy (PLE). Our group has better quantity of these venous perturbations through single- and multi-location analyses of flow waveforms obtained from magnetic resonance imaging of Fontan patients. Here, we determine if such analyses, which yield principal components (PC) that describe flow features, are associated with Fontan survival. Patients with a Fontan circulation (N?=?140) that underwent free-breathing and mechanically ventilated cardiac MRI were included in this study. Standard volumetric and functional hemodynamics, as well as flow analysis principal components, were subjected to univariate and bivariate Cox regression analyses to determine composite clinical outcome, including plastic bronchitis, PLE, and referral and receipt of transplant. Unsurprisingly, ventricular function measures of ejection fraction (EF; HR?=?0.88, p?0.0001), indexed end-systolic volume (ESVi; HR 1.02, p?0.0001), and indexed end-diastolic volume (EDVi; HR?=?1.02, p?=?0.0007) were found as specific predictors of clinical events, with specificities uniformly?>?0.75. Additionally a feature of IVC flow (PC2) indicating increased flow in systole was found as a highly sensitive predictor (HR?=?0.851, p?=?0.027, sensitivity 0.93). In bivariate prediction, combinations of ventricular function (EF, ESVi, EDVi) with this IVC flow feature yielded best overall prediction of composite outcome. This suggests that central venous waveform analysis relays additional information about Fontan patient survival and that coupling sensitive and specific measures in bivariate analysis is a useful approach for obtaining superior prediction of survival.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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The Right Heart in Congenital Heart Disease.
Curr Heart Fail Rep2023 Sep;():. doi: 10.1007/s11897-023-00629-7.
Arvanitaki Alexandra, Diller Gerhard, Giannakoulas George,
Abstract
PURPOSE OF REVIEW:
To analyze the pathophysiologic importance of the right heart in different types of congenital heart disease (CHD), summarize current diagnostic modalities, and discuss treatment options.
RECENT FINDINGS:
The right ventricle (RV) plays a key role in disease progression and prognosis, either as the subpulmonary or as the systemic ventricle. Volume and/or pressure overload as well as intrinsic myocardial disease are the main factors for RV remodeling. Echocardiography and cardiac magnetic resonance imaging are important noninvasive modalities for assessing anatomy, size, and function of the right heart. Timely repair of related lesions is essential for preventing RV dysfunction. Few inconclusive data exist on conventional pharmacotherapy in CHD-related RV dysfunction. Cardiac resynchronization therapy and ventricular assist devices are an option in patients with advanced systemic RV failure. Right heart disease is highly related with adverse clinical outcomes in CHD. Research should focus on early identification of patients at risk and development of medical and interventional treatments that improve RV function.
© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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Territorial Post-Revascularization Remodeling of Chronic Coronary Syndromes: Cardiac Magnetic Resonance Feature Tracking Study.
J Magn Reson Imaging2023 Sep;():. doi: 10.1002/jmri.29026.
Elzoghby Mohamed M, Salama Mai M A, Elsetiha Mohamed A, El Ahwal Hanan M, Romeih Soha A, Shaaban Mahmoud N, Elmozy Wesam E,
Abstract
BACKGROUND:
MRI feature-tracking (MRI-FT) can accurately assess ventricular myocardial deformation and regional function and may be a better predictor of mortality than ejection fraction and infarct extension. However, role of MRI-FT in assessing coronary revascularization is unclear.
PURPOSE:
To assess coronary revascularization effect on territorial left ventricle (LV) function of chronic coronary syndrome (CCS) patients by MRI-FT.
STUDY TYPE:
Prospective.
SUBJECTS:
50 CCS patients (age: 62.22?±?8.70?years) scheduled for elective percutaneous coronary intervention (PCI), and 30 healthy controls (age: 35.33?±?11.57?years).
FIELD STRENGTH/SEQUENCE:
1.5T with balanced steady-state free precession cine sequence.
ASSESSMENT:
Global and segmental peak systolic longitudinal, circumferential, and radial myocardial strains were quantified in both patient and healthy control groups by an experienced operator using dedicated software. Patients were studied both pre-PCI and 6-month post-PCI and LV territorial myocardial strain values were calculated by averaging the segmental values of each revascularized territory.
STATISTICAL TESTS:
Student's t-test, paired t-test, Mann Whitney test, and Wilcoxon signed ranks test. Significance was judged at the 5% level.
RESULTS:
Territorial longitudinal strain showed significant 6-month post-PCI improvement in the left anterior descending (LAD) and right coronary artery (RCA) territories, but there was not in the left circumflex (LCX) territory (LAD: mean?-?11.41%?±?3.45% pre, -13.01%?±?3.53% post; RCA: mean?-?11.11%?±?2.65% pre, -13.25%?±?2.81% post; and LCX: mean?-?15.43%?±?3.97% pre, -16.17%?±?4.38% post, P?=?0.215). Territorial circumferential strain showed significant post-PCI improvement in all revascularized territories (LAD: mean?-?13.73%?±?6.56% pre, -16.98%?±?6.01% post; LCX: mean?-?13.23%?±?4.23% pre, -16.34%?±?3.45% post; and RCA: mean?-?11.24%?±?3.36% pre, -13.80%?±?3.51% post). Territorial radial strain showed no significant post-PCI improvement (LAD: mean 22.73%?±?12.38% pre, 21.79%?±?11.55% post, P?=?0.541; LCX: mean 27.73%?±?7.95% pre, 29.0%?±?7.25% post, P?=?0.264; and RCA: mean 36.68%?±?11.10% pre, 31.75%?±?10.95% post, P?=?0.208).
DATA CONCLUSION:
Territorial LV systolic function was significantly improved by coronary revascularization in CCS patients.
LEVEL OF EVIDENCE:
1 TECHNICAL EFFICACY: Stage 4.
© 2023 International Society for Magnetic Resonance in Medicine.
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The silent invader: a case of intrapericardial hydatid cyst with exceptional pulmonary artery involvement.
Oxf Med Case Reports2023 Sep;2023(9):omad099. doi: omad099.
Soufiani Aida, El-Mhadi Samah, Chraibi Hamza, Agoumy Zineb, Fehri Zineb Fassi, Es-Sebbani Sanae, Leghlimi Hasnaa, El Kettani Omar Ech-Cherif, Lachhab Fadoua, Tribak Mohammed, Fellat Rokya, Bendagha Nesma, Moughil Said,
Abstract
A 70-year-old woman was referred to our cardiology department for the management of dyspnoea. Cardiovascular examination revealed a loud P2, with no sign of right-sided heart failure. Chest X-ray showed a convex left medium cardiac border and a double contour along the right cardiac border. Transthoracic echocardiogram revealed a cystic mass attached to the right ventricle apex. Computed tomography scan showed cyst with fluid density on the apex of the right ventricle; and a honeycomb-like aspect cyst with partial occlusion in the left pulmonary artery. Cardiac magnetic resonance imaging revealed the presence of hydatic intrapericardial cyst that compresses the right ventricular apex; associated with intraluminal left pulmonary artery cyst. Hydatic serology was positive. The patient refused surgery and was discharged on a regimen of Albendazole. She has been followed up closely with a good outcome.
© The Author(s) 2023. Published by Oxford University Press.
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Irregular anatomical features can alter hemodynamics in Takayasu arteritis.
JVS Vasc Sci2023 ;4():100125. doi: 100125.
Zhu Yu, Xu Xiao Yun, Mason Justin, Mirsadraee Saeed,
Abstract
OBJECTIVE:
Takayasu arteritis (TA) is a difficult disease to deal with because there are neither reliable clinical signs, laboratory biomarkers, nor a single noninvasive imaging technique that can be used for early diagnosis and disease activity monitoring. Knowledge of aortic hemodynamics in TA is lacking. This study aimed to fill this gap by assessing hemodynamics in patients with TA using image-based computational fluid dynamics (CFD) simulations.
METHODS:
Eleven patients with TA were included in the present study. Patient-specific geometries were reconstructed from either clinical aortic computed tomography angiography or magnetic resonance angiography studies and coupled with physiological boundary conditions for CFD simulations. Key anatomical and hemodynamic parameters were compared with a control group consisting of 18 age- and sex-matched adults without TA who had healthy aortas.
RESULTS:
Compared with controls, patients with TA had significantly higher aortic velocities (0.9 m/s [0.7, 1.1 m/s] vs 0.6 m/s [0.5, 0.7 m/s]; = .002), maximum time-averaged wall shear stress (14.2 Pa [9.8, 20.9 Pa] vs 8.0 Pa [6.2, 10.3 Pa]; = .004), and maximum pressure drops between the ascending and descending aorta (36.9 mm Hg [29.0, 49.3 mm Hg] vs 28.5 mm Hg [25.8, 31.5 mm Hg]; = .004). These significant hemodynamic alterations in patients with TA might result from abnormal anatomical features including smaller arch diameter (20.0 mm [13.8, 23.3 mm] vs 25.2 mm [23.3, 26.8 mm]; = .003), supra-aortic branch diameters (21.9 mm [18.5, 24.6 mm] vs 25.7 mm [24.3, 28.3 mm]; = .003) and descending aorta diameter (14.7 mm [12.2, 16.8 mm] vs 22.5 mm [19.8, 24.0 mm];
CONCLUSIONS:
CFD analysis reveals hemodynamic changes in the aorta of patients with TA. The applicability of CFD technique coupled with standard imaging assessments in predicting disease progression of such patients will be explored in future studies. Future large cohort study with outcome correlation is also warranted.
CLINICAL RELEVANCE:
Based on patient-specific computational fluid dynamics simulations, the present retrospective study revealed significant difference in aortic hemodynamics between the patients with and without Takayasu arteritis (TA). To the best of our knowledge, this study is the first to evaluate hemodynamic conditions within TA, demonstrating the potential of computational flow modeling in capturing abnormal hemodynamic forces, such as high wall shear stress, resulted from irregular morphological changes. In the future, assessing the hemodynamic parameters within patients with TA during the prestenotic period, together with longitudinal computational fluid dynamics studies may allow better monitoring and management of TA.
Crown Copyright © 2023 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery.
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255th ENMC workshop: Muscle imaging in idiopathic inflammatory myopathies. 15th January, 16th January and 22nd January 2021 - virtual meeting and hybrid meeting on 9th and 19th September 2022 in Hoofddorp, The Netherlands.
Neuromuscul Disord2023 Sep;():. doi: S0960-8966(23)00709-5.
de Visser Marianne, Carlier Pierre, Vencovský Ji?í, Kubínová Kate?ina, Preusse Corinna, ,
Abstract
The 255th ENMC workshop on Muscle Imaging in Idiopathic Inflammatory myopathies (IIM) aimed at defining recommendations concerning the applicability of muscle imaging in IIM. The workshop comprised of clinicians, researchers and people living with myositis. We aimed to achieve consensus on the following topics: a standardized protocol for the evaluation of muscle images in various types of IIMs; the exact parameters, anatomical localizations and magnetic resonance imaging (MRI) techniques; ultrasound as assessment tool in IIM; assessment methods; the pattern of muscle involvement in IIM subtypes; the application of MRI as biomarker in follow-up studies and clinical trials, and the place of MRI in the evaluation of swallowing difficulty and cardiac manifestations. The following recommendations were formulated: In patients with suspected IIM, muscle imaging is highly recommended to be part of the initial diagnostic workup and baseline assessment. MRI is the preferred imaging modality due to its sensitivity to both oedema and fat accumulation. Ultrasound may be used for suspected IBM. Repeat imaging should be considered if patients do not respond to treatment, if there is ongoing diagnostic uncertainty or there is clinical or laboratory evidence of disease relapse. Quantitative MRI is established as a sensitive biomarker in IBM and could be included as a primary or secondary outcome measure in early phase clinical trials, or as a secondary outcome measure in late phase clinical trials. Finally, a research agenda was drawn up.
Copyright © 2023.
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Recurrent Cardiac Sarcoidosis and Giant Cell Myocarditis After Heart Transplant: A Case Report and Systematic Literature Review.
Am J Cardiol2023 Sep;207():271-279. doi: 10.1016/j.amjcard.2023.08.005.
Stein Andrew P, Stewart Brian D, Patel Divya C, Al-Ani Mohammad, Vilaro Juan, Aranda Juan M, Ahmed Mustafa M, Parker Alex M,
Abstract
Recurrence of cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) after heart transplant is rare, with rates of 5% in CS and 8% in GCM. We aim to identify all reported cases of recurrence in the literature and to assess clinical course, treatments, and outcomes to improve understanding of the conditions. A systematic review, utilizing Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was conducted by searching MEDLINE/PubMed and Embase of all available literature describing post-transplant recurrent granulomatous myocarditis, CS, or GCM. Data on demographics, transplant, recurrence, management, and outcomes data were collected from each publication. Comparison between the 2 groups were made using standard statistical approaches. Post-transplant GM recurrence was identified in 39 patients in 33 total publications. Reported cases included 24 GCM, 12 CS, and 3 suspected cases. Case reports were the most frequent form of publication. Mean age of patients experiencing recurrence was 42 years for GCM and 48 years for CS and favored males (62%). Time to recurrence ranged from 2 weeks to 9 years post-transplant, occurring earlier in GCM (mean 1.8 vs 3.0 years). Endomyocardial biopsies (89%) were the most utilized diagnostic method over cardiac magnetic resonance and positron emission tomography. Recurrence treatment regimens involved only steroids in 40% of CS, whereas other immunomodulatory regimens were utilized in 70% of GCM. In conclusion, GCM and CS recurrence after cardiac transplantation holds associated risks including concurrent acute cellular rejection, a higher therapeutic demand for GCM recurrence compared with CS, and mortality. New noninvasive screening techniques may help modify post-transplant monitoring regimens to increase both early detection and treatment of recurrence.
Published by Elsevier Inc.
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Report of a Rare Case of Primary Pericardial Malignancy.
West Afr J Med2023 Sep;40(9):1003-1006.
Folorunso T O, Adedeji E A, Folorunso A E, Oluwarotimi I V,
Abstract
BACKGROUND:
Primary pericardial malignancy is rare and often clinically silent until the late stage when survival is abysmally poor.
OBJECTIVES:
To emphasize the need for a high index of suspicion and accessibility as well as affordability of cardiac magnetic resonance imaging in our clinical practice.
CASE REPORT:
68years old male sawmiller who presented with a history of progressive weight loss and recurrent fever and 3 months history of generalized body swelling and dyspnea. Examination revealed an elderly man, wasted with cold clammy extremities and anasarca, Blood pressure was 100/60mmHg, elevated JVP, and distant heart sound S1, S2, S3. Grossly distended abdomen but no palpable organomegaly and ascites demonstrable by fluid thrill. Tachypnea with dull percussion note with reduced tactile fremitus and breath sound bilaterally. A plain chest radiograph revealed cardiomegaly while electrocardiography revealed ventricular tachycardia. The diagnosis was confirmed by both echocardiography and computerized tomography which revealed a circumferential pericardial mass. The patient's response to treatment was poor and died 9th day of admission.
CONCLUSION:
There is a need for a high index of suspicion, accessible and affordable cardiac resonance imaging for accurate and prompt diagnosis of rare condition.
Copyright © 2023 by West African Journal of Medicine.
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The Diagnostic Value of the 12-Lead ECG in Arrhythmogenic Left Ventricular Cardiomyopathy: Novel ECG Signs.
JACC Clin Electrophysiol2023 Sep;():. doi: S2405-500X(23)00671-0.
Calò Leonardo, Crescenzi Cinzia, Martino Annamaria, Casella Michela, Romeo Fabiana, Cappelletto Chiara, Bressi Edoardo, Panattoni Germana, Stolfo Davide, Targetti Mattia, Toso Elisabetta, Musumeci Maria Beatrice, Tini Giacomo, Ciabatti Michele, Stefanini Matteo, Silvetti Elisa, Stazi Alessandra, Danza Maria Ludovica, Rebecchi Marco, Canestrelli Stefano, Fedele Elisa, Lanzillo Chiara, Fusco Armando, Sangiuolo Federica Carla, Oliviero Giada, Radesich Cinzia, Perotto Maria, Pieroni Maurizio, Golia Paolo, Mango Ruggiero, Gasperetti Alessio, Autore Camillo, Merlo Marco, de Ruvo Ermenegildo, Russo Antonio Dello, Olivotto Iacopo, Sinagra Gianfranco, Gaita Fiorenzo,
Abstract
BACKGROUND:
Electrocardiographic (ECG) findings in arrhythmogenic left ventricular cardiomyopathy (ALVC) are limited to small case series.
OBJECTIVES:
This study aimed to analyze the ECG characteristics of ALVC patients and to correlate ECG with cardiac magnetic resonance and genotype data.
METHODS:
We reviewed data of 54 consecutive ALVC patients (32 men, age 39 ± 15 years) and compared them with 84 healthy controls with normal cardiac magnetic resonance.
RESULTS:
T-wave inversion was often noted (57.4%), particularly in the inferior and lateral leads. Low QRS voltages in limb leads were observed in 22.2% of patients. The following novel ECG findings were identified: left posterior fascicular block (LPFB) (20.4%), pathological Q waves (33.3%), and a prominent R-wave in V with a R/S ratio ?0.5 (24.1%). The QRS voltages were lower in ALVC compared with controls, particularly in lead I and II. At receiver-operating characteristic analysis, the sum of the R-wave in I to II ?8 mm (AUC: 0.909; P
CONCLUSIONS:
Pathological Q waves, LPFB, and a prominent R-wave in V were common ECG signs in ALVC. A R-wave sum in I to II ?8 mm and SV+RV ?12 mm were specific findings for ALVC phenotypes compared with controls.
Copyright © 2023 American College of Cardiology Foundation. All rights reserved.
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Unveiling the gothic aortic arch and cardiac mechanics: insights from young patients after arterial switch operation for d-transposition of the great arteries.
Monaldi Arch Chest Dis2023 Sep;():. doi: 10.4081/monaldi.2023.2712.
Pergola Valeria, Avesani Martina, Reffo Elena, Da Pozzo Stefano, Cavaliere Annachiara, Padalino Massimo, Vida Vladimiro, Motta Raffaella, Di Salvo Giovanni,
Abstract
The arterial switch operation (ASO) has become the standard surgical treatment for patients with d-transposition of the great arteries (d-TGA). While ASO has significantly improved survival rates, a subset of patients develops a unique anatomical anomaly known as the gothic aortic arch (GAA). Understanding cardiac mechanics in this population is crucial as altered mechanics can have profound consequences on cardiac function and exercise capacity. The GAA has been associated with changes in ventricular function, hemodynamic, and exercise capacity. Studies have shown a correlation between the GAA and decreased ascending aorta distensibility, loss of systolic wave amplitude across the aortic arch, and adverse cardiovascular outcomes. Various imaging techniques, including echocardiography, cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (CCT), play a crucial role in assessing cardiac mechanics and evaluating the GAA anomaly. Despite significant advancements, gaps in knowledge regarding the prognostic implications and underlying mechanisms of the GAA anomaly remain. This review aims to explore the implications of the GAA anomaly on cardiac mechanics and its impact on clinical outcomes in young patients after ASO. Advancements in imaging techniques, such as computational modeling, offer promising avenues to enhance our understanding of cardiac mechanics and improve clinical management.
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[An unexpected case of right heart dilation in the elderly].
G Ital Cardiol (Rome)2023 Oct;24(10):831-833. doi: 10.1714/4100.40984.
Pagliaccia Michele, Conti Serenella, Bufi Alessandro, Borghetti Valentino, De Paolis Marcella, Dominici Marcello,
Abstract
Atrial septal defects (ASD) represent the most common congenital heart defect diagnosed in adulthood. Adults with an ASD are often asymptomatic, but sometimes may present with non-specific symptoms such as dyspnea on exertion or exercise intolerance. Isolated sinus venosus atrial defect is an extremely rare anomaly. Sinus venosus defects occur more commonly in the superior (rather than inferior) portion of the embryologic sinus venosus and commonly occur with partial anomalous pulmonary venous return, particularly of the right upper pulmonary vein. We describe the case of an 80-year-old man with an undiagnosed, hemodynamically significant superior sinus venosus type of ASD who presented with persistent dyspnea and hypoxia after COVID-19 disease. Although cardiac magnetic resonance represents the gold standard for the morpho-functional evaluation of ASDs, transesophageal echocardiography is an accessible method for diagnosing the superior sinus venosus type of ASD and three-dimensional transesophageal echocardiography is useful for obtaining an "en face" view of the ASD and important surrounding structures.
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[West Nile virus and myocarditis, a rare event: case report].
G Ital Cardiol (Rome)2023 Oct;24(10):827-830. doi: 10.1714/4100.40983.
Laurito Andrea, Rodella Luca, Vizzardi Enrico, Metra Marco,
Abstract
We present a rare case of a 77-year-old Italian woman, admitted to the neurology unit with the diagnosis of West Nile virus encephalitis. Twenty days after the onset of the neurological symptoms, new negative T-waves appeared on the ECG in association with serum elevation of myocardial necrosis enzymes and regional cardiac wall motion abnormalities on echocardiography, so that a coronary angiography was performed. The exam showed significant stenosis on the left circumflex artery, treated with percutaneous coronary intervention. In addition, a cardiovascular magnetic resonance was performed for further investigation: the T2-weighted images revealed edema in the anterior wall and mid-wall late gadolinium enhancement, significant findings of acute myocardial inflammation. Because of the recent diagnosis of West Nile virus encephalitis and the high serum level of specific IgM antibody, the clinical presentation was suggestive of West Nile myocarditis.
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A double-tuned H/ P coil for rabbit heart metabolism detection at 3 T.
NMR Biomed2023 Sep;():e5049. doi: 10.1002/nbm.5049.
Quan Zhiyan, Yang Zhaoxia, Tang Xiaocui, Fu Caixia, Zhou Xiaoyue, Huang Lu, Xia Liming, Zhang Xiaotong,
Abstract
Magnetic resonance imaging (MRI)/magnetic resonance spectroscopy (MRS) employing proton nuclear resonance has emerged as a pivotal modality in clinical diagnostics and fundamental research. Nonetheless, the scope of MRI/MRS extends beyond protons, encompassing nonproton nuclei that offer enhanced metabolic insights. A notable example is phosphorus-31 ( P) MRS, which provides valuable information on energy metabolites within the skeletal muscle and cardiac tissues of individuals affected by diabetes. This study introduces a novel double-tuned coil tailored for H and P frequencies, specifically designed for investigating cardiac metabolism in rabbits. The proposed coil design incorporates a butterfly-like coil for P transmission, a four-channel array for P reception, and an eight-channel array for H reception, all strategically arranged on a body-conformal elliptic cylinder. To assess the performance of the double-tuned coil, a comprehensive evaluation encompassing simulations and experimental investigations was conducted. The simulation results demonstrated that the proposed P transmit design achieved acceptable homogeneity and exhibited comparable transmit efficiency on par with a band-pass birdcage coil. In vivo experiments further substantiated the coil's efficacy, revealing that the rabbit with experimentally induced diabetes exhibited a lower phosphocreatine/adenosine triphosphate ratio compared with its normal counterpart. These findings emphasize the potential of the proposed coil design as a promising tool for investigating the therapeutic effects of novel diabetes drugs within the context of animal experimentation. Its capability to provide detailed metabolic information establishes it as an indispensable asset within this realm of research.
© 2023 John Wiley & Sons, Ltd.
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Late-onset MELAS syndrome in a 46-year-old man with initial symptom of chest tightness: a case report.
Eur Heart J Case Rep2023 Sep;7(9):ytad441. doi: ytad441.
Wang Ai, Zhao Ji, Zhao Yun, Yan Yan,
Abstract
BACKGROUND:
Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes (MELAS) syndrome is a rare mitochondrial disorder caused by mutations in mitochondrial DNA, resulting in impaired energy production and affecting multiple organs. We present a suspected MELAS syndrome case with the initial symptom of chest tightness.
CASE SUMMARY:
A 46-year-old man sought medical attention due to progressively worsening chest tightness during physical activity. He had been receiving treatment for type 2 diabetes for 15 years. One year ago, he presented with symptoms of hearing impairment. Transthoracic echocardiography revealed increased thickness of the left ventricular wall. Serum protein electrophoresis showed no evidence of light-chain amyloidosis, and the 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scan showed no definite uptake in the heart muscle. The patient's head magnetic resonance imaging (MRI) indicated lacunar infarcts. The lactate threshold test was positive. The biopsy of the skeletal muscle showed broken red fibre infiltration on modified Gomori trichrome staining, and electron microscopy revealed signs of mitochondrial cardiomyopathy, including mild mitochondrial swelling, lipid accumulation, and myofibril damage. A whole-exome genetic test was used to detect the m.3243A>G mutation in the MT-TL1 gene. Based on these findings, MELAS syndrome was the most probable diagnosis.
DISCUSSION:
The patient presented with chest tightness in adulthood, without any accompanying psychoneurological symptoms. However, the patient presented with other symptoms, including diabetes mellitus, hearing loss, abnormal lactate levels, ischaemic lesions on head MRI, and left ventricular hypertrophy. By identifying a mutation in the MT-TL1 gene and conducting a muscle biopsy, the diagnosis of MELAS syndrome was definitively confirmed.
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Tricuspid atresia 1c accompanying neonatal encephalopathy treated with pulmonary trunk banding and therapeutic hypothermia.
Ann Pediatr Cardiol2023 ;16(2):138-140. doi: 10.4103/apc.apc_115_22.
Cao Yuchen, Shibasaki Jun, Tachibana Tsuyoshi,
Abstract
The influence of therapeutic hypothermia, known to improve neurodevelopmental outcomes in neonatal encephalopathy, remains unknown in newborns with severe congenital heart diseases. We report a neonate with tricuspid atresia type 1c suffering from moderate neonatal encephalopathy. A burst suppression pattern on amplitude-integrated electroencephalography recovered after inducing moderate therapeutic hypothermia, but exacerbated pulmonary overcirculation still persisted even after the rewarming. Since the medical treatment for pulmonary overcirculation had reached the limit, semi-urgent pulmonary trunk banding was performed on the 4 day of life. Postoperative brain magnetic resonance imaging showed no apparent brain injuries; the patient was discharged uneventfully. We share our perioperative management experience of a patient with tricuspid atresia type Ic who required therapeutic hypothermia for neonatal encephalopathy.
Copyright: © 2023 Annals of Pediatric Cardiology.
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[Incidental Cardiac Uptake in Bone Scintigraphy Establishing a Diagnosis of Transthyretin Amyloid Cardiomyopathy: A Case Report].
Nihon Hoshasen Gijutsu Gakkai Zasshi2023 Sep;():. doi: 10.6009/jjrt.2023-1403.
Chono Taiki, Harada Kohei, Asanuma Osamu,
Abstract
This is a case of a male patient in his 70s undergoing endocrine therapy for castration-resistant prostate cancer. On follow-up, he underwent whole-body bone scintigraphy for bone metastasis surveillance, and incidental cardiac uptake was identified. The findings were reported by the radiologist to the urologist, which was followed by a cardiac consultation. Late gadolinium enhancement magnetic resonance imaging did not detect typical patterns suggestive of cardiac amyloidosis. However, pyrophosphate scintigraphy identified cardiac uptake. These findings were indicative of transthyretin amyloid cardiomyopathy, and we confirmed the diagnosis by endomyocardial biopsy. In about 0.4-2.0 percentage of elderly patients, incidental cardiac uptake in bone scintigraphy has been reported. Bone scintigraphy is the most commonly utilized techniques among all scintigraphies. Thus, it is crucial that radiologists recognize and report the findings to establish a diagnosis of transthyretin amyloid cardiomyopathy.
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Nocturnal Blood Pressure Estimation from Sleep Plethysmography Using Machine Learning.
Sensors (Basel)2023 Sep;23(18):. doi: 7931.
Yilmaz Gizem, Lyu Xingyu, Ong Ju Lynn, Ling Lieng Hsi, Penzel Thomas, Yeo B T Thomas, Chee Michael W L,
Abstract
BACKGROUND:
Elevated nocturnal blood pressure (BP) is a risk factor for cardiovascular disease (CVD) and mortality. Cuffless BP assessment aided by machine learning could be a desirable alternative to traditional cuff-based methods for monitoring BP during sleep. We describe a machine-learning-based algorithm for predicting nocturnal BP using single-channel fingertip plethysmography (PPG) in healthy adults.
METHODS:
Sixty-eight healthy adults with no apparent sleep or CVD (53% male), with a median (IQR) age of 29 (23-46 years), underwent overnight polysomnography (PSG) with fingertip PPG and ambulatory blood pressure monitoring (ABPM). Features based on pulse morphology were extracted from the PPG waveforms. Random forest models were used to predict night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP).
RESULTS:
Our model achieved the highest out-of-sample performance with a window length of 7 s across window lengths explored (60 s, 30 s, 15 s, 7 s, and 3 s). The mean absolute error (MAE ± STD) was 5.72 ± 4.51 mmHg for SBP and 4.52 ± 3.60 mmHg for DBP. Similarly, the root mean square error (RMSE ± STD) was 6.47 ± 1.88 mmHg for SBP and 4.62 ± 1.17 mmHg for DBP. The mean correlation coefficient between measured and predicted values was 0.87 for SBP and 0.86 for DBP. Based on Shapley additive explanation (SHAP) values, the most important PPG waveform feature was the stiffness index, a marker that reflects the change in arterial stiffness.
CONCLUSION:
Our results highlight the potential of machine learning-based nocturnal BP prediction using single-channel fingertip PPG in healthy adults. The accuracy of the predictions demonstrated that our cuffless method was able to capture the dynamic and complex relationship between PPG waveform characteristics and BP during sleep, which may provide a scalable, convenient, economical, and non-invasive means to continuously monitor blood pressure.
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