Abnormalities in serum biomarkers correlate with lower cardiac index in the Fontan population

2016 ◽  
Vol 27 (1) ◽  
pp. 59-68 ◽  
Author(s):  
Bradley S. Marino ◽  
David J. Goldberg ◽  
Adam L. Dorfman ◽  
Eileen King ◽  
Heidi Kalkwarf ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Index ◽  
Mean Corpuscular Volume ◽  
Operating Characteristic ◽  
Risk Group ◽  
Area Under The Curve ◽  
Total Alkaline Phosphatase ◽  
Fontan Patients ◽  
Total Alkaline

BackgroundFontan survivors have depressed cardiac index that worsens over time. Serum biomarker measurement is minimally invasive, rapid, widely available, and may be useful for serial monitoring. The purpose of this study was to identify biomarkers that correlate with lower cardiac index in Fontan patients.Methods and resultsThis study was a multi-centre case series assessing the correlations between biomarkers and cardiac magnetic resonance-derived cardiac index in Fontan patients ⩾6 years of age with biochemical and haematopoietic biomarkers obtained ±12 months from cardiac magnetic resonance. Medical history and biomarker values were obtained by chart review. Spearman’s Rank correlation assessed associations between biomarker z-scores and cardiac index. Biomarkers with significant correlations had receiver operating characteristic curves and area under the curve estimated. In total, 97 cardiac magnetic resonances in 87 patients met inclusion criteria: median age at cardiac magnetic resonance was 15 (6–33) years. Significant correlations were found between cardiac index and total alkaline phosphatase (−0.26, p=0.04), estimated creatinine clearance (0.26, p=0.02), and mean corpuscular volume (−0.32, p<0.01). Area under the curve for the three individual biomarkers was 0.63–0.69. Area under the curve for the three-biomarker panel was 0.75. Comparison of cardiac index above and below the receiver operating characteristic curve-identified cut-off points revealed significant differences for each biomarker (p<0.01) and for the composite panel [median cardiac index for higher-risk group=2.17 L/minute/m2versus lower-risk group=2.96 L/minute/m2, (p<0.01)].ConclusionsHigher total alkaline phosphatase and mean corpuscular volume as well as lower estimated creatinine clearance identify Fontan patients with lower cardiac index. Using biomarkers to monitor haemodynamics and organ-specific effects warrants prospective investigation.

scholarly journals Segmentation of Scarred Myocardium in Cardiac Magnetic Resonance Images

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Lasya Priya Kotu ◽  
Kjersti Engan ◽  
Karl Skretting ◽  
Stein Ørn ◽  
Leik Woie ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Operating Characteristic ◽  
Texture Feature ◽  
Texture Features ◽  
Magnetic Resonance Images ◽  
Bayes Classifier ◽  
Limited Data ◽  
Local Mean ◽  
Local Average

The segmentation of scarred and nonscarred myocardium in Cardiac Magnetic Resonance (CMR) is obtained using different features and feature combinations in a Bayes classifier. The used features are found as a local average of intensity values and the underlying texture information in scarred and nonscarred myocardium. The segmentation classifier was trained and tested with different experimental setups and parameter combinations and was cross validated due to limited data. The experimental results show that the intensity variations are indeed an important feature for good segmentation, and the average area under the Receiver Operating Characteristic (ROC) curve, that is, the AUC, is 91.58 ± 3.2%. The segmentation using texture features also gives good segmentation with average AUC values at 85.89 ± 5.8%, that is, lower than the direct current (DC) feature. However, the texture feature gives robust performance compared to a local mean (DC) feature in a test set simulated from the original CMR data. The segmentation of scarred myocardium is comparable to manual segmentation in all the cross validation cases.

scholarly journals Cardiac Magnetic Resonance–Derived Extracellular Volume Mapping for the Quantification of Hepatic and Splenic Amyloid

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Liza Chacko ◽  
Michele Boldrini ◽  
Raffaele Martone ◽  
Steven Law ◽  
Ana Martinez-Naharrro ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Intraclass Correlation ◽  
Extracellular Volume ◽  
Area Under The Curve ◽  
Systemic Amyloidosis ◽  
Amyloid Load ◽  
Hepatic Amyloidosis

Background: Systemic amyloidosis is characterized by amyloid deposition that can involve virtually any organ. Splenic and hepatic amyloidosis occurs in certain types, in some patients but not others, and may influence prognosis and treatment. SAP (serum amyloid P component) scintigraphy is uniquely able to identify and quantify amyloid in the liver and spleen, thus informing clinical management, but it is only available in 2 centers globally. The aims of this study were to examine the potential for extracellular volume (ECV) mapping performed during routine cardiac magnetic resonance to: (1) detect amyloid in the liver and spleen and (2) estimate amyloid load in these sites using SAP scintigraphy as the reference standard. Methods: Five hundred thirty-three patients referred to the National Amyloidosis Centre, London, between 2015 and 2017 with suspected systemic amyloidosis who underwent SAP scintigraphy and cardiac magnetic resonance with T1 mapping were studied. Results: The diagnostic performance of ECV to detect splenic and hepatic amyloidosis was high for both organs (liver: area under the curve, −0.917 [95% CI, 0.880–0.954]; liver ECV cutoff, 0.395; sensitivity, 90.7%; specificity, 77.7%; P <0.001; spleen: area under the curve, −0.944 [95% CI, 0.925–0.964]; spleen ECV cutoff, 0.385; sensitivity, 93.6%; specificity, 87.5%; P <0.001). There was good correlation between liver and spleen ECV and amyloid load assessed by SAP scintigraphy (r=0.504, P <0.001; r=0.693, P <0.001, respectively). There was high interobserver agreement for both the liver and spleen (ECV liver intraclass correlation coefficient, 0.991 [95% CI, 0.984–0.995]; P <0.001; ECV spleen intraclass correlation coefficient, 0.995 [95% CI, 0.991–0.997]; P <0.001) with little bias across a wide range of ECV values. Conclusions: Our study demonstrates that ECV measurements obtained during routine cardiac magnetic resonance scans in patients with suspected amyloidosis can identify and measure the magnitude of amyloid infiltration in the liver and spleen, providing important clues to amyloid type and offering a noninvasive measure of visceral amyloid burden that can help guide and track treatment.

Cardiac index after acute ST-segment elevation myocardial infarction measured with phase-contrast cardiac magnetic resonance imaging

2015 ◽  
Vol 26 (7) ◽  
pp. 1999-2008 ◽  
Author(s):  
Gert Klug ◽  
Sebastian Johannes Reinstadler ◽  
Hans-Josef Feistritzer ◽  
Christian Kremser ◽  
Johannes P. Schwaiger ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Index ◽  
Phase Contrast ◽  
Resonance Imaging ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy—A Cardiac Magnetic Resonance Study

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 374
Author(s):  
Łukasz A. Małek ◽  
Łukasz Mazurkiewicz ◽  
Mikołaj Marszałek ◽  
Marzena Barczuk-Falęcka ◽  
Jenny E. Simon ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Area Under The Curve ◽  
Athlete’S Heart ◽  
Endurance Athletes ◽  
Deformation Parameters ◽  
Best Value ◽  
Deformation Patterns ◽  
Athlete's Heart

A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete’s heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance feature tracking (CMR-FT). The study included males of a similar age: 22 ultramarathon runners, 22 patients with DCM and 21 sedentary healthy controls (41 ± 9 years). The analysed parameters were peak LV global longitudinal, circumferential and radial strains (GLS, GCS and GRS, respectively); peak LV torsion; peak RV GLS. The peak LV GLS was similar in controls and athletes, but lower in DCM (p < 0.0001). Peak LV GCS and GRS decreased from controls to DCM (both p < 0.0001). The best value for differentiation between DCM and other groups was found for the LV ejection fraction (area under the curve (AUC) = 0.990, p = 0.0001, with 90.9% sensitivity and 100% specificity for ≤53%) and the peak LV GRS diastolic rate (AUC = 0.987, p = 0.0001, with 100% sensitivity and 88.4% specificity for >−1.27 s−1). The peak LV GRS diastolic rate was the only independent predictor of DCM (p = 0.003). Distinctive deformation patterns that were typical for each of the analysed groups existed and can help to differentiate between athlete’s heart, a nonathletic heart and a dilated cardiomyopathy.

scholarly journals Can shear wave imaging distinguish between diffuse interstitial and replacement myocardial fibrosis?

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
ANIELA Petrescu ◽  
M Cvijic ◽  
S Bezy ◽  
P Santos ◽  
J Duchenne ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Shear Wave ◽  
Myocardial Fibrosis ◽  
Propagation Velocity ◽  
Area Under The Curve ◽  
Diffuse Fibrosis ◽  
Valve Closure ◽  
Replacement Fibrosis

Abstract Funding Acknowledgements Type of funding sources: None. Background   Diffuse interstitial or myocardial replacement fibrosis are common features of a large variety of cardiomyopathies. These alterations contribute to functional changes, particularly to an increased myocardial stiffness (MS). Histological examination is the gold standard for myocardial fibrosis quantification, however, it requires endomyocardial biopsy which is invasive and not without risks. Cardiac magnetic resonance (CMR) can characterize the extent of both diffuse and replacement fibrosis and may have prognostic value in various cardiomyopathies. Echocardiographic shear wave (SW) elastography is an emerging approach for measuring MS in vivo. SWs occur after mechanical excitation of the myocardium, e.g. after mitral valve closure (MVC), and their propagation velocity is directly related to MS, thus providing an opportunity to assess stiffness at end-diastole. Purpose The aim was to investigate if velocities of natural SW can distinguish between interstitial and replacement fibrosis.  Methods We prospectively enrolled 47 patients (22 patients after heart transplant [54.2 ± 15.8 years, 82.6% male] and 25 patients with established hypertrophic cardiomyopathy [54.0 ± 13.5 years, 80.0% male]) undergoing CMR during their check-up. We performed SW elastography in parasternal long axis views of the LV using a fully programmable experimental scanner (HD-PULSE) equipped with a clinical phased array transducer (Samsung Medison P2-5AC) at 1100 ± 250 frames per second. Tissue acceleration maps were extracted from an anatomical M-mode line along the midline of the LV septum. The SW propagation velocity at MVC was measured as the slope in the M-mode image. All patients underwent T1 mapping as well as late gadolinium enhancement (LGE) cardiac magnetic resonance at 1.5 T to assess the presence of diffuse or replacement fibrosis (Figure A). Therefore, patients were divided in three groups: no fibrosis, diffuse fibrosis and replacement fibrosis. Results Mechanical SW’s were observed in 46 subjects starting immediately after MVC and propagating from the LV base to the apex. SW propagation velocity at MVC correlated well with native myocardial T1 values (r = 0.65, p &lt; 0.0001) and differed significantly among groups (p &lt; 0.0001), with a significant post-test between any pair of groups (Figure B). SW velocities below a cut-off of 6.01 m/s showed the highest accuracy to identify patients without any type of fibrosis (sensitivity 88 %, specificity 89%, area under the curve = 0.93) (Figure C). A cut-off of 8.11 m/s could distinguish replacement fibrosis from diffuse fibrosis with a sensitivity and specificity of 59% and 92 %, respectively (area under the curve = 0.80) (Figure D). Conclusions   Shear wave velocities after mitral valve closure can distinguish between normal and pathological myocardium and can detect differences between diffuse and replacement fibrosis. Abstract Figure.

Abstract 2122: ECG Quantification of Myocardial Scar in Cardiomyopathy Patients with or without Conduction Defects: Correlation with Cardiac Magnetic Resonance and Arrhythmogenesis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
David G Strauss ◽  
Ronald H Selvester ◽  
João A Lima ◽  
Håkan Arheden ◽  
Julie M Miller ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Area Under The Curve ◽  
Left Ventricular ◽  
List Type ◽  
Operating Characteristics ◽  
S Wave ◽  
Icd Implantation ◽  
Arrhythmogenic Substrate ◽  
Scar Size

Background : Myocardial scarring from infarction (MI) or nonischemic fibrosis forms an arrhythmogenic substrate. The Selvester QRS-score estimates MI size by quantifying changes in Q-, R- and S-wave durations, amplitudes and morphologies from the 12-lead electrocardiogram (ECG). It provides 32 possible points with each point reflecting scarring of 3% of the left ventricle (LV). Although QRS scoring has been extensively validated for estimating MI scar size in the absence of ECG confounders, it has not been validated in patients with left ventricular hypertrophy (LVH), fascicular/bundle branch blocks or nonischemic scar. We assessed the hypotheses that QRS-scores (modified for each conduction type) correctly identify and quantify both ischemic and nonischemic scar as compared to the reference standard of Cardiac Magnetic Resonance - Late Gadolinium Enhancement (CMR-LGE) and QRS-estimated scar size is associated with inducible sustained monomorphic ventricular tachycardia (MVT) during electrophysiologic (EP) testing. Methods and Results: A prospective 162 patient cohort with LV dysfunction (95 ischemic, 67 nonischemic) received 12-lead ECG and CMR-LGE before defibrillator (ICD) implantation for primary prevention of sudden cardiac death. QRS-scores correctly diagnosed CMR-scar presence with receiver operating characteristics (ROC) area under the curve (AUC)=0.91 and correlation for scar quantification of r=0.74, p<0.0001, for all patients. Performance within the LVH, bundle branch/fascicular block and nonischemic subgroups ranged from AUC 0.81– 0.94, r=0.60 – 0.80, p<0.001 for all. Of the 137 patients undergoing EP or device testing, 37/82 (45%) of ischemic and 7/55 (13%) of nonischemic patients had inducible MVT. For each 3 QRS point increase (9% LV scarring), the odds ratio for inducing MVT was 2.2 [95% CI: 1.5–3.2, p<0.001] for all patients; 1.7 [1.0 –2.7, p=0.04)] for ischemics; and 2.2 [1.0 –5.0, p=0.05] for nonischemics. Conclusions : Compared to CMR, QRS-scores identify and quantify MI and nonischemic scar despite ECG confounders. Higher QRS-estimated scar size is associated with increased arrhythmogenic potential and warrants further study as a risk-stratifying tool for patients with left ventricular dysfunction.

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