Long term cardiovascular magnetic resonance phenotyping of anthracycline cardiomyopathy

Introduction: This cardiovascular magnetic resonance (CMR) study aims to determine whether changes in systemic vascular resistance (SVR), obtained from CMR flow sequences, might explain the significant long-term changes in left ventricular (LV) ejection fraction (EF) observed in subjects with no cardiac disease history.Methods: Cohort subjects without any known cardiac disease but with high rates of hypertension and obesity, underwent CMR with phase-contrast sequences both at baseline and at a median follow-up of 5.2 years. Longitudinal changes in EF were analyzed for any concomitant changes in blood pressure and vascular function, notably the indexed SVR given by the formula: mean brachial blood pressure / cardiac output x body surface area.Results: A total of 118 subjects (53 ± 12 years, 52% women) were included, 26% had hypertension, and 52% were obese. Eighteen (15%) had significant EF variations between baseline and follow-up (7 increased EF and 11 decreased EF). Longitudinal changes in EF were inversely related to concomitant changes in mean and diastolic blood pressures (p = 0.030 and p = 0.027, respectively) and much more significantly to SVR (p < 0.001). On average, these SVR changes were −8.08 ± 9.21 and +8.14 ± 8.28 mmHg.min.m2.L−1, respectively, in subjects with significant increases and decreases in EF, and 3.32 ± 7.53 mmHg.min.m2.L−1 in subjects with a stable EF (overall p < 0.001).Conclusions: Significant EF variations are not uncommon during the long-term CMR follow-up of populations with no evident health issues except for uncomplicated hypertension and obesity. However, most of these variations are linked to SVR changes and may therefore be unrelated to any intrinsic change in LV contractility. This underscores the benefits of specifically assessing LV afterload when EF is monitored in populations at risk of vascular dysfunction.Clinical Trial Registration:ClinicalTrials.gov, identifier: NCT01716819 and NCT02430805.

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Predictors of Mortality in Patients With Biopsy‐Proven Viral Myocarditis: 10‐Year Outcome Data

Journal of the American Heart Association ◽

10.1161/jaha.119.015351 ◽

2020 ◽

Vol 9 (16) ◽

Author(s):

Simon Greulich ◽

Andreas Seitz ◽

Karin A. L. Müller ◽

Stefan Grün ◽

Peter Ong ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Cardiac Death ◽

Prognostic Value ◽

Viral Myocarditis ◽

Outcome Data ◽

Risk Of Death ◽

Long Term Mortality

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 P ≤0.009. Specifically, midwall, (antero‐) septal LGE, and extent of LGE were highly associated with death, all P <0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38–15.24; P =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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Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging

International Journal of Cardiology ◽

10.1016/j.ijcard.2021.11.088 ◽

2021 ◽

Author(s):

Rajiv Ananthakrishna ◽

Zach Liang ◽

Betty Raman ◽

John L. Moran ◽

Benita Rajvi ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Myocardial Infarction ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Clinical Outcomes ◽

Coronary Arteries ◽

Cardiovascular Magnetic Resonance Imaging ◽

Resonance Imaging

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Long-term prognostic value of ischaemia and cardiovascular magnetic resonance-related revascularization for stable coronary disease, irrespective of patient’s sex: a large retrospective study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab186 ◽

2021 ◽

Author(s):

Théo Pezel ◽

Philippe Garot ◽

Marine Kinnel ◽

Thomas Hovasse ◽

Stéphane Champagne ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Prognostic Value ◽

Cox Regression ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Major Adverse Cardiovascular Events ◽

Ventricular Ejection Fraction ◽

Inducible Ischaemia

Abstract Aims To assess the sex-specific, long-term prognostic value of myocardial ischaemia induced by stress cardiovascular magnetic resonance (CMR) and early CMR-related revascularization in consecutive patients from a large registry. Methods and results Between 2008 and 2010, all consecutive patients referred for stress CMR were followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Early CMR-related revascularization was defined as any revascularization within 90 days after CMR. Among 3664 patients (56.9% male, mean age 69.9 ± 11.8 years), 472 (12.9%) had MACE (163 women and 309 men) after a median follow-up of 8.8 (IQR 6.9-9.5) years. Inducible ischaemia and late gadolinium enhancement (LGE) by CMR were associated with MACE in women and men (all P < 0.001). In multivariable Cox regression, inducible ischaemia, LGE, and CMR-related revascularization were independent predictors of MACE both in women [heart rate (HR) 4.79, 95% confidence interval (CI) 2.17–9.10; HR 1.82, 95% CI 1.22–2.71; HR 0.71, 95% CI 0.54–0.92, respectively; all P < 0.001] and men (HR 3.88, 95% CI 2.33–5.98; HR 1.48, 95% CI 1.16–1.89; HR 0.78, 95% CI 0.65–0.97, respectively; all P < 0.001). The addition of CMR-parameters led to improved model discrimination for MACE (C-statistic 0.61 vs. 0.71; NRI = 0.212; IDI = 0.032) for both women and men. CMR-related revascularization was associated with a lower incidence of MACE in patients with left ventricular ejection fraction (LVEF)<50%. Conclusion Inducible ischaemia and early CMR-related revascularization were good long-term predictors of MACE irrespective of sex. CMR-related revascularization was associated with a lower MACE incidence in the sole sub-set of patients with LVEF < 50%.

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