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Pubblicazioni recenti - cardiac magnetic resonance
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Evaluating Biventricular Myocardial Velocity and Interventricular Dyssynchrony in Adult Patients During the First Year After Heart Transplantation.
J Magn Reson Imaging2020 Feb;():. doi: 10.1002/jmri.27091.
Sarnari Roberto, Blake Allison M, Ruh Alexander, Abbasi Muhannad A, Pathrose Ashitha, Blaisdell Julie, Dolan Ryan S, Ghafourian Kambiz, Wilcox Jane E, Khan Sadiya S, Vorovich Esther E, Rich Jonathan D, Anderson Allen S, Yancy Clyde W, Carr James C, Markl Michael,
Abstract
BACKGROUND:
Magnetic resonance tissue phase mapping (TPM) measures three-directional myocardial velocities of the left and right ventricle (LV, RV). This noninvasive technique may supplement endomyocardial biopsy (EMB) in monitoring grafts post-heart transplantation (HTx).
PURPOSE:
To assess biventricular myocardial velocity alterations in grafts and investigate the relationship between velocities and acute cellular rejection (ACR) episodes.
STUDY TYPE:
Prospective.
SUBJECTS:
Twenty-seven patients within 1?year post-HTx (49?±?13?years, 19?M) and 18 age-matched controls (49?±?15?years, 12?M).
FIELD STRENGTH/SEQUENCE:
1.5T, 2D balanced steady-state free precession, and TPM.
ASSESSMENT:
Ventricular function: end-diastolic and end-systolic volumes, stroke volumes, ejection fraction (EF), and myocardial mass. TPM velocities: peak-systolic and peak-diastolic velocities, cardiac twist, and interventricular dyssynchrony. ACR rejection episodes: International Society for Heart and Lung Transplantation grading of EMB specimens.
STATISTICAL TESTS:
The Lilliefors test for normality, unpaired t-tests, and Wilcoxon rank-sum tests for normally and nonnormally distributed data, respectively, were used, as well as multivariate regression for confounding variables and Pearson's correlation for associations between TPM velocities and global function.
RESULTS:
Compared to controls, HTx patients demonstrated reduced biventricular systolic longitudinal velocities (LV: 5.2?±?2.1 vs. 4.0?±?1.5?cm/s, P?4 preceding ACR episodes showed globally reduced RV and LV systolic radial velocity, and segmentally reduced radial and longitudinal systolic velocities.
DATA CONCLUSION:
Biventricular global and segmental velocities were reduced in HTx patients. Patients with >4 rejection episodes showed reduced myocardial velocities. The TPM sequence may add functional information for monitoring graft dysfunction.
LEVEL OF EVIDENCE:
2 TECHNICAL EFFICACY STAGE: 2.
© 2020 International Society for Magnetic Resonance in Medicine.
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Extending the Role of Cardiac Magnetic Resonance in Sarcoidosis Risk Stratification: Editorial for "Regional Myocardial Remodeling Characteristics Correlates With Cardiac Events in Sarcoidosis".
J Magn Reson Imaging -
Recovery of hibernating myocardium using stem cell patch with coronary bypass surgery.
J Thorac Cardiovasc Surg2020 Jan;():. doi: S0022-5223(20)30055-6.
Hocum Stone Laura L, Swingen Cory, Wright Christin, Qi Steven S, Rassette Matt, McFalls Edward O, Kelly Rosemary F,
Abstract
OBJECTIVE:
This study aims to investigate the utility of mesenchymal stem cells (MSCs) applied as an epicardial patch during coronary artery bypass graft (CABG) to target hibernating myocardium; that is, tissue with persistently decreased myocardial function, in a large animal model.
METHODS:
Hibernating myocardium was induced in juvenile swine (n = 12) using a surgically placed constrictor on the left anterior descending artery, causing stenosis without infarction. After 12 weeks, single-vessel CABG was performed using left internal thoracic artery to left anterior descending artery graft. During CABG, an epicardial patch was applied to the hibernating myocardium region consisting either of MSCs grown onto a polyglactin mesh (n = 6), or sham polyglactin mesh without MSCs (n = 6). Four weeks after CABG and patch placement, cardiac magnetic resonance imaging was performed and cardiac tissue was examined by gross inspection, including coronary dilators for vessel stenosis and patency, electron microscopy, protein assays, and proteomic analysis.
RESULTS:
CABG + MSC myocardium showed improvement in contractile function (78.24% ± 19.6%) compared with sham patch (39.17% ± 5.57%) during inotropic stimulation (P < .05). Compared with sham patch control, electron microscopy of CABG + MSC myocardium showed improvement in mitochondrial size, number, and morphology; protein analysis similarly showed increases in expression of the mitochondrial biogenesis marker peroxisome proliferator-activated receptor gamma coactivator 1-alpha (0.0022 ± 0.0009 vs 0.023 ± 0.009) (P < .01) along with key components of the electron transport chain, including succinate dehydrogenase (complex II) (0.06 ± 0.02 vs 0.14 ± 0.03) (P < .05) and adenosine triphosphate synthase (complex V) (2.7 ± 0.4 vs 4.2 ± 0.26) (P < .05).
CONCLUSIONS:
In hibernating myocardium, placement of a stem cell patch during CABG shows promise in improving myocardial function by improving mitochondrial morphology and function.
Copyright © 2020 The American Association for Thoracic Surgery. All rights reserved.
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Role of surgeon intuition and computer-aided design in Fontan optimization: A computational fluid dynamics simulation study.
J Thorac Cardiovasc Surg2020 Jan;():. doi: S0022-5223(20)30050-7.
Loke Yue-Hin, Kim Byeol, Mass Paige, Opfermann Justin D, Hibino Narutoshi, Krieger Axel, Olivieri Laura,
Abstract
OBJECTIVE:
Customized Fontan designs, generated by computer-aided design (CAD) and optimized by computational fluid dynamics simulations, can lead to novel, patient-specific Fontan conduits unconstrained by off-the-shelf grafts. The relative contributions of both surgical expertise and CAD to Fontan optimization have not been addressed. In this study, we assessed hemodynamic performance of Fontans designed by both surgeon's unconstrained modeling (SUM) and by CAD.
METHODS:
Ten cardiac magnetic resonance imaging datasets were used to create 3-dimensional (3D) models of Fontans. Baseline computational fluid dynamics simulations assessed Fontan indexed power loss (iPL), hepatic flow distribution, and percentage of conduit surface area with abnormally low wall shear stress for venous flow (<1 dyne/cm). Fontans not meeting thresholds were redesigned using 2 methods: SUM (ie, original venous anatomy without the Fontan was 3D printed and sent to surgeon for Fontan redesign with clay modeling) and CAD (ie, the same 3D geometry was sent to engineers for iterative Fontan redesign guided by computational fluid dynamics). Both groups were blinded to each other's results.
RESULTS:
Eight Fontans were redesigned by SUM and CAD methods. Both SUM and CAD redesigns met iPL thresholds. SUM had lower iPL, whereas CAD demonstrated balanced hepatic flow distribution and lower wall shear stress percentage. Wall shear stress percentage shared an inverse relationship with iPL, preventing oversized Fontan designs.
CONCLUSIONS:
Customized Fontan conduits with low iPL can be created by either a surgeon or CAD. CAD can also improve hepatic flow distribution and prevent oversized Fontan designs. Future studies should investigate workflows that combine SUM and CAD to optimize Fontan conduits.
Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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Prevalence and determinants of elevated D-dimer in patients with hypertrophic cardiomyopathy.
Biomark Med2020 Feb;():. doi: 10.2217/bmm-2019-0225.
Yang Chengzhi, Zhang Changlin, Yuan Jiansong, Cui Jingang, Qiao Shubin,
Abstract
To evaluate D-dimer levels in patients with hypertrophic cardiomyopathy (HCM). A total of 346 patients with HCM were recruited. Plasma D-dimer was determined by clinical laboratory of our hospital. Left ventricular mass, stroke volume, cardiac output and cardiac index were assessed with cardiovascular magnetic resonance. A total of 36 (10.4%) patients had elevated D-dimer levels. Age, female patients and statin therapy were independently associated with increasing D-dimer levels, and predictors of elevated D-dimer. Patients with HCM may have higher plasma D-dimer levels than subjects without HCM. D-dimer levels in patients with HCM are influenced by age, sex, atrial fibrillation, statin therapy and diastolic blood pressure.
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Breaking hearts and taking names: A case of sarcoidosis related effusive-constrictive pericarditis.
Respir Med2020 Jan;163():105879. doi: S0954-6111(20)30019-6.
Valentin Ramon, Keeley Ellen C, Ataya Ali, Gomez-Manjarres Diana, Petersen John, Arnaoutakis George J, Drew Peter, Barnes Matt, Patel Divya C,
Abstract
INTRODUCTION:
Pericardial involvement of sarcoidosis is a rare cause for acute heart failure, and usually occurs as a result of the development of a pericardial effusion leading to cardiac tamponade. Even rarer still, is the manifestation of constrictive pericarditis. We report a case of sarcoidosis with lung, pleural, and pericardial involvement with effusive-constrictive pericarditis leading to cardiac tamponade.
CASE PRESENTATION:
A 34-year-old Caucasian man presented for evaluation of a history of worsening exertional dyspnea, edema, and weight loss. A high-resolution chest computed tomography showed diffuse pulmonary nodules with upper lobe predominance and in a perilymphatic distribution; large right pleural effusion; and large pericardial effusion with pericardial thickening. A transthoracic echocardiogram demonstrated early tamponade physiology for which a pericardial drain was placed. After removal of the drain he developed cardiogenic shock from cardiac tamponade attributed to the reaccumulation of a pericardial effusion and urgent pericardial window was performed. Serial echocardiography was concerning for organization and localization of the pericardial fluid. Cardiac magnetic resonance imaging demonstrated a significant reduction in pericardial slippage between the parietal and visceral layers around the heart collectively suggestive of constrictive pericarditis. Confirmation of effusive-constrictive pericarditis was noted on right heart catheterization. He then underwent pericardiectomy, which on histopathologic evaluation demonstrated non-necrotizing granulomas, thus confirming pericardial involvement of sarcoidosis.
CONCLUSIONS:
We report a case demonstrating unique manifestations of sarcoidosis; effusive-constrictive pericarditis presenting with acute congestive heart failure.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Predictors of left ventricular remodelling in patients with dilated cardiomyopathy - a cardiovascular magnetic resonance study.
Eur J Heart Fail2020 Feb;():. doi: 10.1002/ejhf.1734.
Tayal Upasana, Wage Ricardo, Newsome Simon, Manivarmane Ramasamy, Izgi Cemil, Muthumala Amal, Dungu Jason N, Assomull Ravi, Hatipoglu Suzan, Halliday Brian P, Lota Amrit S, Ware James S, Gregson John, Frenneaux Michael, Cook Stuart A, Pennell Dudley J, Scott Andrew D, Cleland John G F, Prasad Sanjay K,
Abstract
AIMS:
There is an important need for better biomarkers to predict left ventricular (LV) remodelling in dilated cardiomyopathy (DCM). We undertook a comprehensive assessment of cardiac structure and myocardial composition to determine predictors of remodelling.
METHODS AND RESULTS:
Prospective study of patients with recent-onset DCM with cardiovascular magnetic resonance (CMR) assessment of ventricular structure and function, extracellular volume (T1 mapping), myocardial strain, myocardial scar (late gadolinium enhancement) and contractile reserve (dobutamine stress). Regression analyses were used to evaluate predictors of change in LV ejection fraction (LVEF) over 12?months. We evaluated 56 participants (34 DCM patients, median LVEF 43%; 22 controls). Absolute LV contractile reserve predicted change in LVEF (1% increase associated with 0.4% increase in LVEF at 12?months, P = 0.02). Baseline myocardial strain (P = 0.39 global longitudinal strain), interstitial myocardial fibrosis (P = 0.41), replacement myocardial fibrosis (P = 0.25), and right ventricular contractile reserve (P = 0.17) were not associated with LV reverse remodelling. There was a poor correlation between contractile reserve and either LV extracellular volume fraction (r = -0.22, P = 0.23) or baseline LVEF (r = 0.07, P = 0.62). Men were more likely to experience adverse LV remodelling (P = 0.01) but age (P = 0.88) and disease-modifying heart failure medication (beta-blocker, P = 0.28; angiotensin-converting enzyme inhibitor, P = 0.92) did not predict follow-up LVEF.
CONCLUSIONS:
Substantial recovery of LV function occurs within 12?months in most patients with recent-onset DCM. Women had the greatest improvement in LVEF. A low LV contractile reserve measured by dobutamine stress CMR appears to identify patients whose LVEF is less likely to recover.
© 2020 The Authors. European Journal of Heart Failure © 2020 European Society of Cardiology.
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A multi-vendor, multi-center study on reproducibility and comparability of fast strain-encoded cardiovascular magnetic resonance imaging.
Int J Cardiovasc Imaging2020 Feb;():. doi: 10.1007/s10554-020-01775-y.
Erley Jennifer, Zieschang Victoria, Lapinskas Tomas, Demir Aylin, Wiesemann Stephanie, Haass Markus, Osman Nael F, Simonetti Orlando P, Liu Yingmin, Patel Amit R, Mor-Avi Victor, Unal Orhan, Johnson Kevin M, Pieske Burkert, Hansmann Jochen, Schulz-Menger Jeanette, Kelle Sebastian,
Abstract
Myocardial strain is a convenient parameter to quantify left ventricular (LV) function. Fast strain-encoding (fSENC) enables the acquisition of cardiovascular magnetic resonance images for strain-measurement within a few heartbeats during free-breathing. It is necessary to analyze inter-vendor agreement of techniques to determine strain, such as fSENC, in order to compare existing studies and plan multi-center studies. Therefore, the aim of this study was to investigate inter-vendor agreement and test-retest reproducibility of fSENC for three major MRI-vendors. fSENC-images were acquired three times in the same group of 15 healthy volunteers using 3 Tesla scanners from three different vendors: at the German Heart Institute Berlin, the Charité University Medicine Berlin-Campus Buch and the Theresien-Hospital Mannheim. Volunteers were scanned using the same imaging protocol composed of two fSENC-acquisitions, a 15-min break and another two fSENC-acquisitions. LV global longitudinal and circumferential strain (GLS, GCS) were analyzed by a trained observer (Myostrain 5.0, Myocardial Solutions) and for nine volunteers repeatedly by another observer. Inter-vendor agreement was determined using Bland-Altman analysis. Test-retest reproducibility and intra- and inter-observer reproducibility were analyzed using intraclass correlation coefficient (ICC) and coefficients of variation (CoV). Inter-vendor agreement between all three sites was good for GLS and GCS, with biases of 0.01-1.88%. Test-retest reproducibility of scans before and after the break was high, shown by ICC- and CoV values of 0.63-0.97 and 3-9% for GLS and 0.69-0.82 and 4-7% for GCS, respectively. Intra- and inter-observer reproducibility were excellent for both parameters (ICC of 0.77-0.99, CoV of 2-5%). This trial demonstrates good inter-vendor agreement and test-retest reproducibility of GLS and GCS measurements, acquired at three different scanners from three different vendors using fSENC. The results indicate that it is necessary to account for a possible bias (
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Emerging concepts in arrhythmogenic dilated cardiomyopathy.
Heart Fail Rev2020 Feb;():. doi: 10.1007/s10741-020-09933-z.
Zegkos Thomas, Panagiotidis Theofilos, Parcharidou Despoina, Efthimiadis Georgios,
Abstract
Dilated cardiomyopathy (DCM) represents one of the primary cardiomyopathies and may lead to heart failure and sudden death. Until recently, ventricular arrhythmias were considered to be a direct consequence of the systolic dysfunction of the left ventricle (LV) and guidelines for implantable cardioverter defibrillator implantation were established on this basis. However, the identification of heritable dilated cardiomyopathy phenotypes that presented with mildly impaired or moderate LV dysfunction, with or without chamber dilatation, and ventricular arrhythmias exceeding the degree of the underlying morphological abnormalities lead to the identification of the arrhythmogenic phenotypes and genotypes of DCM. This subset of DCM patients presents phenotypic and in many cases genotypic overlaps with left dominant arrhythmogenic cardiomyopathy (LDAC). LMNA, SCN5A, FLNC, TTN, and RBM20 are the main genes responsible for arrhythmogenic DCM. Moreover, desmosomal genes such as DSP and other non-desmosomal such as DES and PLN have been associated with both LDAC and arrhythmogenic DCM. The aim of this review is to highlight the importance of genetic profiling among DCM patients with disproportionate arrhythmic burden and the significance of the electrocardiogram, cardiac magnetic resonance, Holter monitoring, detailed family history, and other assays in order to identify red flags for arrhythmogenic DCM and proceed to an early preventive approach for sudden cardiac death. A special consideration was given to the phenotypic and genotypic overlap with LDAC. The role of myocarditis as a common disease expression of LDAC and arrhythmogenic DCM is also analyzed supporting the premise of their phenotypic overlap.
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Assessment of knee pain from MR imaging using a convolutional Siamese network.
Eur Radiol2020 Feb;():. doi: 10.1007/s00330-020-06658-3.
Chang Gary H, Felson David T, Qiu Shangran, Guermazi Ali, Capellini Terence D, Kolachalama Vijaya B,
Abstract
OBJECTIVES:
It remains difficult to characterize the source of pain in knee joints either using radiographs or magnetic resonance imaging (MRI). We sought to determine if advanced machine learning methods such as deep neural networks could distinguish knees with pain from those without it and identify the structural features that are associated with knee pain.
METHODS:
We constructed a convolutional Siamese network to associate MRI scans obtained on subjects from the Osteoarthritis Initiative (OAI) with frequent unilateral knee pain comparing the knee with frequent pain to the contralateral knee without pain. The Siamese network architecture enabled pairwise learning of information from two-dimensional (2D) sagittal intermediate-weighted turbo spin echo slices obtained from similar locations on both knees. Class activation mapping (CAM) was utilized to create saliency maps, which highlighted the regions most associated with knee pain. The MRI scans and the CAMs of each subject were reviewed by an expert radiologist to identify the presence of abnormalities within the model-predicted regions of high association.
RESULTS:
Using 10-fold cross-validation, our model achieved an area under curve (AUC) value of 0.808. When individuals whose knee WOMAC pain scores were not discordant were excluded, model performance increased to 0.853. The radiologist review revealed that about 86% of the cases that were predicted correctly had effusion-synovitis within the regions that were most associated with pain.
CONCLUSIONS:
This study demonstrates a proof of principle that deep learning can be applied to assess knee pain from MRI scans.
KEY POINTS:
? Our article is the first to leverage a deep learning framework to associate MR images of the knee with knee pain. ? We developed a convolutional Siamese network that had the ability to fuse information from multiple two-dimensional (2D) MRI slices from the knee with pain and the contralateral knee of the same individual without pain to predict unilateral knee pain. ? Our model achieved an area under curve (AUC) value of 0.808. When individuals who had WOMAC pain scores that were not discordant for knees (pain discordance?
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A Neurofunctional Domains Approach to Evaluate D1/D5 Dopamine Receptor Partial Agonism on Cognition and Motivation in Healthy Volunteers With Low Working Memory Capacity.
Int J Neuropsychopharmacol2020 Feb;():. doi: pyaa007.
Balice-Gordon Rita, Honey Garry D, Chatham Christopher, Arce Estibaliz, Duvvuri Sridhar, Naylor Melissa Graham, Liu Wenlei, Xie Zhiyong, DeMartinis Nicholas, Harel Brian T, Braley Gabriel H, Kozak Rouba, Park Lovingly, Gray David L,
Abstract
BACKGROUND:
Dopamine D1 receptor (D1R) signaling plays key roles in core domains of neural function, including cognition and reward processing; however, many questions remain about the functions of circuits modulated by D1R, largely because clinically viable, selective agonists have yet to be tested in humans.
METHODS:
Using a novel, exploratory neurofunctional domains study design, we assessed the safety, tolerability, pharmacodynamics, and pharmacokinetics of PF-06412562, a selective D1/D5R partial agonist, in healthy male volunteers who met pre-specified criteria for low working memory capacity. Functional magnetic resonance imaging, electrophysiologic endpoints, and behavioral paradigms were used to assess working memory, executive function, and motivation/reward processing following multiple-dose administration of PF-06412562. A total of 77 subjects were assigned PF-06412562 (3 mg twice daily [BID] and 15 mg BID) or placebo, administered for 5 to 7 days. Due to the exploratory nature of the study, it was neither powered for any specific treatment effect nor corrected for multiple comparisons.
RESULTS:
Nominally significant improvements from baseline in cognitive endpoints were observed in all 3 groups; however, improvements in PF-06412562-treated subjects were less than in placebo-treated subjects. Motivation/reward processing endpoints were variable. PF-06412562 was safe and well tolerated, with no serious adverse events (AEs), severe AEs, or AEs leading to dose reduction or temporary discontinuation, except for 1 permanent discontinuation due to increased orthostatic heart rate.
CONCLUSIONS:
PF-06412562, in the dose range and patient population explored in this study, did not improve cognitive function or motivation/reward processing more than placebo over the 5- to 7-day treatment period.ClinicalTrials.gov Identifier: NCT02306876.
© The Author(s) 2020. Published by Oxford University Press on behalf of CINP.
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Emergency embolectomy for acute middle cerebral artery occlusion with chronic common carotid artery occlusion.
Radiol Case Rep2020 Apr;15(4):375-378. doi: 10.1016/j.radcr.2020.01.013.
Yanagawa Taro, Harada Yoichi, Kiyomoto Masaru, Yamashita Keiichi, Hatayama Toru,
Abstract
Occurrence of acute middle cerebral artery occlusion with common carotid artery occlusion is rare, and its treatment may be complicated. If the approach route cannot be secured because of carotid artery occlusion, endovascular embolectomy may not be indicated. The best treatment approach for such cases remains controversial. A woman in her 70s was transferred to our hospital in ambulance following a sudden onset of dysarthria and left hemiparesis. Magnetic resonance imaging revealed an ischemic lesion in the right basal ganglia and occlusion of the right common carotid and intracranial middle cerebral arteries. Emergency embolectomy was performed for acute middle cerebral artery occlusion. Postoperative magnetic resonance imaging revealed complete recovery of the right middle cerebral artery blood flow. Emergency embolectomy can effectively treat acute middle cerebral artery occlusion with common carotid artery occlusion.
© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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Distinct pressure half-time values by transthoracic echocardiography for grading of paravalvular regurgitation after transcatheter aortic valve replacement.
Sci Rep2020 Feb;10(1):2549. doi: 10.1038/s41598-020-59211-z.
Schröder Joerg, Almalla Mohammad, Saad Mohammed, Mezger Matthias, Keszei Andras, Frick Michael, Lotfi Shahram, Hoffmann Rainer, Becker Michael, Altiok Ertunc,
Abstract
Postprocedural aortic regurgitation (AR) has negative impact on patient outcome after transcatheter aortic valve replacement (TAVR). Standard assessment of AR severity by echocardiography is hampered after TAVR. Measurement of pressure half-time (PHT) by echocardiography is not limited in these patients but it may be affected by concomitant left ventricular hypertrophy (LVH). This study sought to evaluate distinct cut-off values of PHT differentiating between patients without and with more than mild LVH for grading of AR after TAVR with cardiac magnetic resonance (CMR) as the reference method for comparison. 71 patients (age 81?±?6 years) with severe aortic stenosis undergoing TAVR were included into the study. Transthoracic echocardiography (TTE) and CMR were performed after TAVR. Left ventricular mass index was calculated by TTE. PHT was measured by continuous-wave Doppler echocardiography of aortic regurgitation jet. In 18 patients (25%) PHT could not be obtained due to no or very faint Doppler signal. Aortic regurgitant volume and regurgitant fraction were calculated by CMR by flow analysis of the ascending aorta. In 14 of 53 patients (26%) AR after TAVR was moderate or severe as categorized by CMR analysis. More than mild LVH was present in 27 of 53 patients (51%). PHT correlated inversely less to regurgitant fraction by CMR analysis in patients with LVH (r?=?-0.293; p?=?0.138) than in patients without LVH (r?=?-0.455; p?=?0.020). In patients without relevant LVH accuracy of PHT to predict moderate or severe paravalvular regurgitation AUC was 0.813 using a cut-off value of 347?ms and AUC was 0.729 in patients with more than mild LVH using a cut-off value of 420?ms. Analysis of PHT by TTE with distinct cut-off values for patients without and with more than mild LVH allows detection of moderate or severe AR after TAVR as defined by CMR. In none of the patients in which PHT could not be measured AR was categorized as more than trace by CMR analysis.
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Diagnostic Dilemma of Recurrent Pulmonary Embolism.
Diagnostics (Basel)2020 Feb;10(2):. doi: E96.
Dadarlat-Pop Alexandra, Burian Irina, Cadis Laura, Tomoaia Raluca, Oprea Alexandru,
Abstract
Popliteal venous aneurysms are rare vascular disorders associated with a high risk of pulmonary embolism. We present the case of a 56-year-old woman hospitalized for a third episode of unprovoked pulmonary embolism. Venous ultrasonography identified a popliteal aneurysm, repeatedly missed by two-point compression venous ultrasonography, which was eventually confirmed by a magnetic resonance examination. Because of its highly symptomatic nature despite optimal anticoagulant treatment, the decision was made to undergo surgery, consisting of aneurysmectomy followed by patch angioplasty. The goal of this paper is to report a rare case of popliteal venous aneurysm and its treatment strategies and postoperative evolution.
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Prognostic value of the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction: A systematic review and meta-regression analysis.
PLoS One2020 ;15(2):e0228736. doi: 10.1371/journal.pone.0228736.
Kendziora Benjamin, Dewey Marc,
Abstract
In all patients with ST-segment elevation myocardial infarction, risk stratification should be performed before discharge. The measurement of therapy efficiency with magnetic resonance imaging has been proposed as part of the risk assessment, but it has not been adopted widely. This meta-analysis was conducted to summarize published data on the prognostic value of the proportion of salvaged myocardium inside previously ischemic myocardium (myocardial salvage index) measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging after ST-segment elevation myocardial infarction. Random and mixed effects models were used for analyzing the data of 10 studies with 2,697 patients. The pooled myocardial salvage index, calculated as the proportion of non-necrotic myocardium inside edematous myocardium measured by T2-weighted and T1-weighted late gadolinium enhancement MRI, was 43.0% (95% confidence interval: 37.4, 48.6). The pooled length of follow-up was 12.3 months (95% confidence interval: 7.0, 17.6). The pooled incidence of major cardiac events during follow-up, defined as cardiac death, nonfatal myocardial infarction, or admission for heart failure, was 10.6% (95% confidence interval: 5.7, 15.5). The applied mixed effects model showed an absolute decrease of 1.7% in the incidence of major cardiac events during follow-up (95% confidence interval: 1.6, 1.9) with every 1% of increase in the myocardial salvage index. The heterogeneity between studies was considerable (? = 21.3). Analysis of aggregated follow-up data after ST-segment elevation myocardial infarction suggests that the myocardial salvage index measured by T2-weighted and T1-weighted late gadolinium enhancement magnetic resonance imaging provides prognostic information on the risk of major cardiac events, but considerable heterogeneity exists between studies.
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Ventricular arrhythmia ablation lesions detectability and temporal changes on cardiac magnetic resonance.
Pacing Clin Electrophysiol2020 Feb;():. doi: 10.1111/pace.13886.
Vunnam Rama, Maheshwari Varun, Jeudy Jean, Ghzally Yousra, Imanli Hasan, Abdulghani Mohammed, Mahat Jagat B, Timilsina Saroj, Restrepo Alejandro, See Vincent, Shorofsky Stephen, Dickfeld Timm,
Abstract
BACKGROUND:
Cardiac magnetic resonance (CMR) characteristics of ventricular radiofrequency ablation (RFA) lesions have only been incompletely defined.
AIM:
To determine the detectability and imaging characteristics of ventricular RFA lesions in an unselected patient cohort undergoing ventricular arrhythmia ablation.
METHODS AND RESULTS:
A retrospective chart review (n = 249) identified 36 patients with either pre-/post-ablation CMR (n = 14) or only post-ablation CMR (n = 22). Ablation lesions could be identified in 50% (n = 18) of patients. Non-visualized lesions had more preexisting transmural late gadolinium enhancement >75% at the ablation sites (21% vs. 0.0%, p = 0.042), more prevalent ICD artifact (50% vs. 0%, p = 0.001), and lower ejection fraction (35.8±14.2% vs 45.3±13.4%, p = 0.048). Early CMR imaging demonstrated a central "black" signal void (microvascular obstruction/MVO, n = 12, 67%) up to 32 days post-RFA, while late imaging showed a homogenously "white" gadolinium enhancement pattern (n = 6, 33%). MVO was only observed in non-fibrotic myocardium without preexisting LGE (n = 12) but was not observed in the scar with preexisting LGE (n = 3, p = 0.002) suggesting different wash-in/wash-out kinetics in scar/non-scar myocardium. Signal intensity (1909 vs. 2534, p = 0.009) and contrast-to-noise ratio (-7.8 vs. 16.3, p = 0.009) were significantly different between MVO and LGE lesions, respectively.
CONCLUSION:
Ventricular ablation lesions visualization is negatively affected by preexisting transmural scar, ICD artifact and low EF. The transition of "black" MVO appearance to "white" LGE appearance on CMR occurs around 1 month following ablation, suggesting a change in histological characteristics of ablation lesions. This may affect the utility of CMR in the evaluation of the ventricular lesions, when undergoing real-time or repeat VT ablations. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
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CMR for myocardial iron overload quantification: calibration curve from the MIOT Network.
Eur Radiol2020 Feb;():. doi: 10.1007/s00330-020-06668-1.
Meloni Antonella, Maggio Aurelio, Positano Vincenzo, Leto Filippo, Angelini Annalisa, Putti Maria Caterina, Maresi Emiliano, Pucci Angela, Basso Cristina, Marra Martina Perazzolo, Pistoia Laura, De Marchi Daniele, Pepe Alessia,
Abstract
OBJECTIVES:
R2* cardiac magnetic resonance (CMR) allows the non-invasive measurement of myocardial iron. We calibrated cardiac R2* values against myocardial tissue-measured iron concentration by using a segmental approach and we assessed the iron distribution.
METHODS:
Five hearts of thalassemia patients were donated after death/transplantation to the CoreLab of the Myocardial Iron Overload in Thalassemia Network. A multislice multiecho R2* approach was adopted. After CMR, used as guidance, the heart was cut in three short-axis slices and each slice was cut into different equiangular segments according to AHA segmentation and differentiated into endocardial and epicardial layers. Tissue iron concentration was measured by atomic absorption spectrometer technique.
RESULTS:
Fifty-five samples were used since only for two hearts all the 16 samples were analyzed. Mean iron concentration was 4.71?±?4.67 mg/g dw. Segmental iron levels ranged from 0.24 to 13.78 mg/g dw. The coefficient of variability of iron for myocardial segments ranged from 8.08 to 24.54% (mean 13.49?±?6.93%). Iron concentration was significantly higher in the epicardial than in the endocardial layer (5.99?±?6.01 vs 4.84?±?4.87 mg/g dw; p?=?0.042). Four different circumferential regions (anterior, septal, inferior, and lateral) were defined. A circumferential heterogeneity was noted, with more iron in the anterior region, followed by the inferior region. The direct nonlinear fitting of R2* and [Fe] data led to the calibration curve: [Fe]?=?0.0022 ? (R2*-ROI) (R-square?=?0.956).
CONCLUSIONS:
Our data further validate R2* CMR using a segmental approach as a sensitive and early technique for quantifying iron distribution in the current clinical practice.
KEY POINTS:
? Calibration in humans for cardiovascular magnetic resonance R2* against myocardial iron concentration was provided. ? A circumferential heterogeneity in cardiac iron distribution was detected: more iron was observed in the anterior region, followed by the inferior region. This finding corroborates the use of a segmental T2* CMR approach in the clinical practice to detect a heterogeneous iron distribution. ? The comparison between the cardiac T2* values obtained with the region-based and the pixel-wise approaches showed a significant correlation and no significant difference but, in presence of significant iron load, the region-based approach resulted in significantly higher T2* values.
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Cardiac Myxoma with Cerebral Metastases and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Case Report and Review.
J Neurol Surg Rep2020 Jan;81(1):e1-e6. doi: 10.1055/s-0039-3399570.
Maas Jared A, Menes Manuel, Siomin Vitaly,
Abstract
?Cardiac myxomas, the most common primary cardiac tumors, are generally benign neoplasms. Primary cardiac lymphoma is a rare cardiac malignancy with a very poor prognosis. Here we present a case of a cardiac myxoma with cerebral metastases and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) arising within the cerebral metastases. ?A 62-year-old man, who presented with symptoms of multiple transient ischemic attacks, was found to have a left atrial myxoma. Twelve months after excision of the myxoma, the patient experienced a recurrence of neurologic symptoms. Brain magnetic resonance imaging revealed multiple hemorrhagic masses. Craniotomy was performed to resect the lesions. Histopathologic examination confirmed cardiac myxoma metastases and a small lymphocytic infiltrate within the tumor consistent with CLL/SLL. ?Including the present case, there are 27 cases of cardiac myxoma cerebral metastases and 22 cases of lymphomas arising within myxomas. The present case is the first known instance of both entities in the same patient. There is no standard management for either cardiac myxoma metastases or lymphoma within a myxoma. For both diseases, surgical excision is the primary treatment modality, but postoperative chemotherapy and/or radiation have been attempted. Myxomas may create a chronic inflammatory state that could lead to the development of CLL/SLL.
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Cardiac Metastases in Neuroendocrine Tumors: 68Ga-DOTATATE PET/CT With Cardiac Magnetic Resonance Correlation.
Clin Nucl Med2020 Feb;():. doi: 10.1097/RLU.0000000000002944.
Polk Stuart Lane, Montilla-Soler Jaime, Gage Kenneth L, Parsee Arthur, Jeong Daniel,
Abstract
Neuroendocrine tumor (NET) cardiac metastases can be associated with complications including ventricular outflow obstruction, arrhythmias, heart failure, and cardiac arrest, warranting intervention. Anatomical characterization of these lesions via cardiac magnetic resonance (CMR) is helpful to assess and predict the risk of complications and guide therapy. Images of 2 patients with small bowel NET related cardiac metastases are described on Ga-DOTATATE PET/CT and CMR. The lesions were significantly smaller and more obscure on CMR compared with PET/CT. On CMR, T2-weighted dark blood images and late gadolinium enhancement images offered the most conspicuous detection of the NET myocardial metastases in these cases.
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Combined transepicardial and transseptal implantation of autologous CD 133+ bone marrow cells during bypass grafting improves cardiac function in patients with low ejection fraction.
J Card Surg2020 Feb;():. doi: 10.1111/jocs.14454.
Soetisna Tri Wisesa, Sukmawan Renan, Setianto Budhi, Mansyur Muchtaruddin, Murni Tri Wahyu, Listiyaningsih Erlin, Santoso Anwar,
Abstract
OBJECTIVES:
Autologous CD133+ bone marrow stem cells may improve cardiac function. This randomized, single-blind clinical trial inquired whether a combined transepicardial and transseptal implantation of CD133+ stem cells during coronary artery bypass grafting (CABG) improve cardiac function with ejection fraction (EF) changes as a primary endpoint in patients with low EF.
METHODS:
Thirty patients with coronary heart disease and EF <35% were randomized to undergo CABG alone or CABG with transseptal and transepicardial implantation of CD133+. Cardiac function was evaluated using cardiac magnetic resonance imaging (MRI) before and 6 months after CABG.
RESULTS:
Preoperative EF was lower in the intervention group (25.88%?±?5.66%) than in the control group (30.18%?±?3.85%; P?=?.04). The adverse event incidence was similar between both groups. At 6 months, EF changes were significantly higher (8.69%?±?9.49; P?=?.04) in the CD133+ group than in the CABG-only group. Compared to the control group, significant improvements were seen in the wall motion score index (P?=?.003) and scar size proportion (P?=?.047) in the CD133+ group. The quality of life (QOL), assessed by a 6-minute walking test, showed considerable improvement in the CD133+ group compared to that in the control group (P?=?.03). The Minnesota Living with Heart Failure Questionnaire (MLHFQ) scale did not show improvement in the intervention group (P?=?.09, vs control).
CONCLUSION:
Combined transepicardial and transseptal autologous CD133+ BMC implantation during bypass grafting improved cardiac function in low EF coronary artery disease patients.
© 2020 The Authors. Journal of Cardiac Surgery Published by Wiley Periodicals, Inc.
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