The International Journal of Cardiovascular Imaging

Gräni, Christoph

doi: 10.1007/s10554-024-03060-8pmid: 38345662

Spampinato, Ricardo A.; Marin-Cuartas, Mateo; van Kampen, Antonia; Fahr, Florian; Sieg, Franz; Strotdrees, Elfriede; Jahnke, Cosima; Klaeske, Kristin; Wiesner, Karoline; Morningstar, Jordan E.; Nagata, Yasufumi; Izquierdo-Garcia, David; Dieterlen, Maja-Theresa; Norris, Russell A.; Levine, Robert A.; Paetsch, Ingo; Borger, Michael A.

doi: 10.1007/s10554-023-02985-wpmid: 37891450

PurposeMitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies.MethodsMVP patients with indication for surgery due to severe mitral regurgitation (n = 19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings.ResultsMVP patients (54 ± 10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096 ± 78ms vs. 994 ± 54ms and 33.9 ± 5.6% vs. 25.9 ± 3.1%, respectively, p < 0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE + in LV and PM was identified in 5 (26.3%) patients, while DB-LGE + was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE + in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs. 36.8%, p = 0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p = 0.029).ConclusionsCMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.

Kersten, Johannes; Fink, Visnja; Kersten, Maria; May, Lisa; Nunn, Samuel; Tadic, Marijana; Huober, Jens; Bekes, Inga; Radermacher, Michael; Hombach, Vinzenz; Rottbauer, Wolfgang; Buckert, Dominik

doi: 10.1007/s10554-023-02996-7pmid: 38001273

BackgroundBreast cancer is a common and increasingly treatable disease. However, survivors have a significantly elevated risk of cardiac events afterwards. This study aimed to characterise cardiac changes during cardiotoxic cancer therapy using cardiovascular magnetic resonance (CMR) imaging.MethodsThis study involved 34 patients with histologically proven breast cancer and planned cardiotoxic therapy. All patients underwent CMR before starting therapy, and 6 and 12 months thereafter. The CMR protocol included volumetric and functional analyses, parametric mapping, and deformation analysis using feature tracking. As the control group, 10 healthy female volunteers were scanned using the same protocol.ResultsWith therapy, there was a significant reduction of left ventricular and right ventricular ejection fractions (both p < 0.05) without reaching pathologic values. Left ventricular radial (p = 0.008), circumferential (p = 0.010), and longitudinal strain (p = 0.036) were also reduced at follow-up. In the parametric mapping, there was a significant increase in native T1 time (start: 1037 ± 41 ms vs. 6 months: 1068 ± 51 ms vs. 12 months: 1017 ± 57 ms, p < 0.001) and T2 time (start: 55 ± 4 ms vs. 6 months: 59 ± 3 ms vs. 12 months: 57 ± 3 ms, p = 0.001), with unchanged extracellular volume and relative late gadolinium enhancement. Twelve months after cancer diagnosis, the breast cancer patients exhibited significant impairments in left ventricular global radial (p = 0.001), circumferential (p = 0.001), and longitudinal strain (p = 0.002) and T2 time (p = 0.008) compared to the healthy controls.DiscussionBreast cancer patients receiving cardiotoxic chemotherapy show persistent deterioration in left ventricular strain values. This is accompanied by inflammatory changes in non-invasive tissue characterisation. Larger studies with longer follow-up periods are needed to identify patients at risk and establish preventive and therapeutic approaches.

Wang, Chaofan; Wang, Lili; Yin, Jie; Xuan, Haochen; Chen, Junhong; Li, Dongye; Hou, Xiancun; Xu, Tongda

doi: 10.1007/s10554-023-02998-5pmid: 37953371

PurposeLayer-specific speckle tissue echocardiography (LS-STE) is a unique technique used to assess coronary microvascular obstruction (CMVO) that may offer more information on the myocardial anatomy of patients with ST-elevation myocardial infarction (STEMI). Cardiovascular magnetic resonance feature tracking (CMR-FT) has also been gaining popularity as a way to evaluate CMVO. The aim of the present study was to directly compare CMVO assessment in STEMI patients using CMR-FT and LS-STE.Patients and methodsA total of 105 STEMI patients with LS-STE, CMR-FT, and primary percutaneous coronary intervention (PPCI) were included in the study. Longitudinal peak systolic strain (LS), circumferential peak systolic strain (CS), and radial peak systolic strain (RS) were each used to evaluate CMVO using CMR-FT and LS-STE.ResultsCorrelation coefficients were 0.56, 0.53, and 0.55 for CMR-FT CS vs. endocardial CS, midcardial CS, and epicardial CS comparisons, respectively, and 0.87, 0.51, and 0.32 for CMR-FT LS vs. endocardial LS, midcardial LS, and epicardial LS comparisons, respectively. Bland-Altman analysis revealed strong inter-modality agreement and little bias in endocardial LS, while the absolute of limited of agreement (LOA) value was 2.28 ± 4.48. The absolutes LOA values were 1.26 ± 11.16, -0.02 ± 12.21, and − 1.3 ± 10.27 for endocardial, midcardial, and epicardial respectively. Intraclass correlation coefficient value of 0.87 showed good reliability in endocardial LS, and moderate reliability with values of 0.71, 0.70, and 0.64 in endocardial, midcardial, and epicardial CS, respectively (all p < 0.001).ConclusionsCMR-FT is a viable technique for CMVO evaluation in STEMI patients. Endocardial LS showed good reliability for CMR-FT. STEMI patients can undergo LS-STE to assess the CMVO before PPCI.

Zhuang, Baiyan; Cui, Chen; He, Jian; Xu, Jing; Wang, Xin; Li, Li; Jia, Liujun; Wu, Weichun; Sun, Xiaoxin; Li, Shuang; Zhou, Di; Yang, Wenjing; Wang, Yining; zhu, leyi; Sirajuddin, Arlene; Zhao, Shihua; Lu, Minjie

Pan, Yue; Varghese, Juliet; Tong, Matthew S.; Yildiz, Vedat O.; Azzu, Alessia; Gatehouse, Peter; Wage, Rick; Nielles-Vallespin, Sonia; Pennell, Dudley J.; Jin, Ning; Bacher, Mario; Hayes, Carmel; Speier, Peter; Simonetti, Orlando P.

Cecere, Annagrazia; Cipriani, Alberto; De Lazzari, Manuel; Graziano, Francesca; Brunetti, Giulia; De Conti, Giorgio; Motta, Raffaella; Ravagnin, Alberto; Lorenzoni, Giulia; Gregori, Dario; Basso, Cristina; Tona, Francesco; Lee, Yoo Jin; Delling, Francesca Nesta; Iliceto, Sabino; Marra, Martina Perazzolo

Lin, Kai; Sarnari, Roberto; Gordon, Daniel Z.; Markl, Michael; Carr, James C.

doi: 10.1007/s10554-023-03007-5pmid: 37968429

Although cine MRI-derived radiomics features in the cardiac blood pool have been used to represent cardiac function and motion, the clinical relevance of radiomics features in the great vessels is still unknown. The aim of the present study was to test the hypothesis that cine MRI-derived radiomics features of the pulmonary artery (PA) can represent hemodynamic abnormalities in pulmonary hypertension (PH). With the approval of the institutional review board (IRB), 50 PH patients (21 males, 36–89 years old, diagnosed with right heart catheterization [RHC]) and 23 healthy volunteers (14 males, 26–80 years old) were retrospectively enrolled in this study. All participants underwent cardiac 4D flow and cine MRI (25 retrospective phases) at the right ventricular (RV) outflow tract (RVOT). A total of 93 radiomics features were extracted from RVOT cine images through a fixed size region of interest (ROI) at the proximal part of the PA. The peak values of the 6 first order features were different between the PH patients and controls. 4D flow-derived mean velocity in PA was related to ‘Kurtosis’ (r = 0.452,), ‘Range’ (r = 0.426), ‘Autocorrelation’ (r = 0.407), ‘Joint Average’ (r = 0.459), ‘Sum Average’ (r = 0.459), ‘High Gray Level Emphasis’ (r = 0.41), ‘Large Dependence High Gray Level Emphasis’ (r = 0.44), ‘High Gray Level Run Emphasis’ (r = 0.422), ‘Gray Level Variance’ (r = 0.419), ‘High Gray Level Zone Emphasis’ (r = 0.451), and ‘Small Area High Gray Level Emphasis’ (r = 0.415). Mean RV pressure was related to ‘Inverse Variance’ (r = 0.43) and ‘Run Percentage’ (r = 0.403). All p values < 0.05. Cine MRI-derived PA radiomics features have the potential to serve as novel imaging biomarkers for representing hemodynamic changes in pulmonary circulation.

Aliaga, Francisca; Alegría, Julia; Díaz, Juan Carlos

doi: 10.1007/s10554-023-03016-4pmid: 38038812

Left ventricular apical hypoplasia is a rare congenital condition. It can cause nonspecific symptoms and can be accompanied by cardiac conduction system alterations such as bundle branch block, atrial flutter (AF) or atrial fibrillation. The diagnosis mostly is made by imaging.

Fulop, Pavol; Valocik, Gabriel; Barbierik Vachalcova, Marianna; Zenuch, Pavol; Filipova, Lenka

doi: 10.1007/s10554-023-02986-9pmid: 37950827

At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn’t any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = − 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.