Tissue tracking MR to evaluate left ventricular global myocardial deformation in patients with cardiac amyloidosis of transmural late gadolinium enhancement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Li ◽  
H Jin ◽  
H Yun ◽  
Z Wei ◽  
M.S Zeng
Keyword(s):  
Late Gadolinium Enhancement ◽  
Cardiac Amyloidosis ◽  
Contractile Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Cine Mri ◽  
Gadolinium Enhancement ◽  
Deformation Parameters ◽  
Tissue Tracking

Abstract Purpose Cardiac amyloidosis (CA) is a major cause of mortality in patients with amyloidosis because it leads to heart failure and lethal arrhythmia. The present study was aimed to evaluate left ventricular (LV) global myocardial deformation in patients with CA of transmural late gadolinium enhancement (LGE) using tissue tracking MRI. Materials and methods Thirty-nine patients with CA, confirmed by cardiac MRI, and a biopsy of at least one involved organ were enrolled. According to LV ejection fraction (LVEF), they were divided into reduced LVEF (CArEF) and preserved EF (CApEF) groups. Thirty-nine normal controls were recruited (NC). Tissue tracking analysis was done based on cine MRI sequences. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were computed. Results GLS [CArEF vs. CApEF vs. NC: (−5.82±2.42) % vs. (−8.44±4.15) % vs. (−14.74±2.93)%], GCS [CArEF vs. CApEF vs. NC: (−9.47±2.96) % vs. (−15.01±1.81) % vs. (−19.86±2.30) %], and GRS [CArEF vs. CApEF vs. NC: (11.37±4.68) % vs. (20.61±6.27) % vs. (39.02±8.98) %] were all reduced in the CArEF and CApEF groups compared with healthy control subjects (all P<0.01). GCS and GRS in the CArEF group were reduced compared with the CApEF group (P<0.01). GLS, GCS, and GRS were also strongly correlated with LVEF (r=−0.77, −0.88, and 0.83, respectively; P<0.01). Furthermore, the optimal cutoff values to predict LVEF reduction were −9.31% (sensitivity 88%, specificity 97%) for GLS, −14.13% (sensitivity 96%, specificity 97%) for GCS, and 20.11% (sensitivity 90%, specificity 97%) for GRS. Conclusion MRI-based LV global deformation parameters could be a useful method to assess LV myocardial systolic function and predict LVEF reduction in patients with CA of transmural enhancement on LGE. The differences of GCS and GRS between the CArEF and CApEF groups may also reflect preserved contractile function of the mid- or/and subepicardial myocardium. Figure 1. LV deformation parameters Funding Acknowledgement Type of funding source: None

scholarly journals Myocardial deformation techniques as potential tools to detect arrhythmogenic cardiomyopathy in early stages of the disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Segura Rodriguez ◽  
F J Bermudez-Jimenez ◽  
L Gonzalez Camacho ◽  
J M Oyonarte-Ramirez ◽  
E Moreno Escobar ◽  
...  
Keyword(s):  
Global Longitudinal Strain ◽  
Regional Wall Motion ◽  
Pathogenic Mutation ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Control Group ◽  
Arrhythmogenic Cardiomyopathy ◽  
Early Stages ◽  
Mechanical Dispersion ◽  
Deformation Parameters

Abstract Introduction Arrhythmogenic Cardiomyopathy (ACM) is a life-threatening entity which predispose to malignant arrhythmias and sudden cardiac death even in early stages of the disease. Deformation techniques obtained by echocardiography are promising tools which can identify subtle pathologic changes in the myocardial wall. Our aim is to investigate how myocardial deformation parameters may be affected throughout ACM spectrum. Methods A cohort of ACM 45 subjects, was characterized using advanced transthoracic echocardiography and divided into groups according to left ventricle ejection fraction (LVEF). Twenty-three healthy volunteers were also included as control group (CG). We analyzed regional wall motion abnormalities and left ventricular myocardial deformation parameters by 2D Speckle Tracking, such as global longitudinal strain (GLS), mechanical dispersion (MD) [standard deviation (SD) and range (delta)]. Results 23 (51,1%) of the ACM cohort were men, with a mean age of 43,13±16,55 years. Next-generation sequencing identified a potential pathogenic mutation in 37 (82,2%) of the patients. Those ACM subjects with low LVEF (ACM-L) presented lower GLS values when compared to those with normal LVEF (ACM-N) (−16,17±2,68% vs. ACM-N −19,39±2,97%; p<0.001) with no significant differences in MD parameters. ACM-N showed no differences in GLS regarding to CG, but significant differences were found when analyzing MD values, with pathological dispersion times in the ACM-N group (ACM-N DMSD 50,50±20,39ms vs. CG 37,35±17,15ms; p=0,016; ACM-N DMDelta 167,4583±75,07ms vs CG 125±49,13ms; p=0,033). Conclusions MD may be an additive tool for identifying ACM patients in early stages of the disease when LVEF is still preserved. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis

2016 ◽  
Vol 2016 ◽  
pp. 1-7
Author(s):  
Nina P. Hofmann ◽  
Sorin Giusca ◽  
Karin Klingel ◽  
Peter Nunninger ◽  
Grigorios Korosoglou
Keyword(s):  
Heart Disease ◽  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Endomyocardial Biopsy ◽  
Cardiac Amyloidosis ◽  
Hypertensive Heart Disease ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Lv Mass ◽  
Small Pericardial Effusion

Left ventricular (LV) hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG), echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2), severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%), accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR). Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease.

scholarly journals The prognostic value of novel myocardial deformation parameters for sudden events in hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Zegkos ◽  
D Parcharidou ◽  
T Panagiotidis ◽  
D Ntelios ◽  
S Katranas ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Predictive Value ◽  
Speckle Tracking ◽  
Prognostic Value ◽  
Global Longitudinal Strain ◽  
Radial Strain ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
Deformation Parameters ◽  
2D Speckle Tracking

Abstract Background Data about the implications of two-dimensional (2D) speckle tracking myocardial deformation parameter for predicting sudden arrhythmic events in hypertrophic cardiomyopathy (HCM) are limited. Purpose The aim of our study was to prospectively evaluate the predictive value of novel myocardial deformation parameters with regard to 2D speckle tracking echocardiography in patients with HCM. Methods This was a prospective study that included HCM patients without concomitant severe valvular heart disease, without prior myocardial infarction and with sinus rhythm at index evaluation. A total of 317 patients were screened and 67 subjects were excluded. Finally, the study sample consisted of 250 patients (mean age 50.8±15.8, 67.2% male). Global longitudinal strain (GLS), left atrial (LA) strain, radial strain, circumferential strain, and mechanical dispersion of the left ventricle ((MD)-the standard deviation of time to peak negative strain in 18 left ventricular segments) were examined. The primary outcome of the study was sudden arrhythmic events including sudden cardiac death, sustained ventricular tachycardia, resuscitated cardiac arrest and appropriate impantable cardioverter defibrillator discharges. Results During a mean follow-up of 2.4±1.2 years, 19 patients suffered a sudden arrhythmic event. GLS, LA strain, MD and radial strain significantly predicted sudden events among our cohort. The optimal cut-off values obtained from receiver-operator characteristic curves were for GLS >−14%, for LA strain <12%, for radial strain <21% and for MD >67ms. However, only GLS >−14% and LA strain <12% displayed a significant additive predictive value on top of the European Society Of Cardiology risk score (HCMRisk-SCD) (C statistic from 0.757 to 0.831, p=0.03 including GLS >−14% in the survival model and to 0.839, p=0.009 including LA strain <12% in the model). (Table) Conclusion GLS and LA strain conferred a significant additional prognostic value to HCMRisc-SCD score for predicting sudden arrhythmic events in HCM patients. Funding Acknowledgement Type of funding source: None

scholarly journals Patients with acute myocarditis and preserved systolic left ventricular function: comparison of global and regional longitudinal strain imaging by echocardiography with quantification of late gadolinium enhancement by CMR

2021 ◽  
Author(s):  
Christine Meindl ◽  
Michael Paulus ◽  
Florian Poschenrieder ◽  
Florian Zeman ◽  
Lars S. Maier ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Longitudinal Strain ◽  
Acute Myocarditis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction ◽  
Group 2 ◽  
Group 1

Abstract Background Conventional transthoracic echocardiography (TTE) does often not accurately reveal pathologies in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEEF). Therefore, we investigated the diagnostic value of two-dimensional (2D) speckle tracking echocardiography compared to late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) imaging in patients with acute myocarditis and normal global LVEF. Methods and results 31 patients (group 1) with the diagnosis of acute myocarditis confirmed by CMR according to the Lake Louise criteria and 20 healthy controls (group 2) were analyzed including global longitudinal strain (GLS) and regional longitudinal strain (RLS) derived by the bull’s eye plot. Although preserved LVEF was present in both groups, GLS was significantly lower in patients with acute myocarditis (group 1: GLS − 19.1 ± 1.8% vs. group 2: GLS − 22.1 ± 1.7%, p < 0.001). Compared to controls, lower RLS values were detected predominantly in the lateral, inferolateral, and inferior segments in patients with acute myocarditis. Additionally RLS values were significantly lower in segments without LGE. Conclusion In patients with acute myocarditis and preserved LVEF, a significant reduction of GLS compared to healthy subjects was detected. Further RLS adds important information to the localization and extent of myocardial injury. Graphic abstract

scholarly journals Implications of multiple late gadolinium enhancement lesions on the frequency of left ventricular reverse remodeling and prognosis in patients with non‐ischemic cardiomyopathy

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shingo Ota ◽  
Makoto Orii ◽  
Tsuyoshi Nishiguchi ◽  
Mao Yokoyama ◽  
Ryoko Matsushita ◽  
...  
Keyword(s):  
Heart Failure ◽  
Late Gadolinium Enhancement ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Cardiac Events ◽  
Gadolinium Enhancement ◽  
Systolic Volume ◽  
Linear Pattern ◽  
Multiple Lesions

Abstract Background Non-ischemic cardiomyopathy (NICM) is a heterogeneous disease, and its prognosis varies. Although late gadolinium enhancement (LGE)-cardiovascular magnetic resonance (CMR) demonstrates a linear pattern in the mid-wall of the septum or multiple LGE lesions in patients with NICM, the therapeutic response and prognosis of multiple LGE lesions have not been elucidated. This study aimed to investigate the frequency of left ventricular (LV) reverse remodeling (LVRR) and prognosis in patients with NICM who have multiple LGE lesions. Methods This single-center retrospective study included 101 consecutive patients with NICM who were divided into 3 groups according to LGE-CMR results: patients without LGE (no LGE group = 48 patients), patients with a typical mid-wall LGE pattern (n = 29 patients), and patients with multiple LGE lesions (n = 24 patients). LVRR was defined as an increase in LV ejection fraction (LVEF) ≥ 10 % and a final value of LVEF > 35 %, which was accompanied by a decrease in LV end-systolic volume ≥ 15 % at 12-month follow-up using echocardiography. The frequency of composite cardiac events, defined as sudden cardiac death (SCD), aborted SCD (non-fatal ventricular fibrillation, sustained ventricular tachycardia, or adequate implantable cardioverter-defibrillator therapies), and heart failure death or hospitalization for worsening heart failure, were summarized and compared between the groups. Results Among the 3 groups, the frequency of LVRR was significantly lower in the multiple lesions group than in the no LGE and mid-wall groups (no LGE vs. mid-wall vs. multiple lesions: 49 % vs. 52 % vs. 19 %, p = 0.03). There were 24 composite cardiac events among the patients: 2 in patients without LGE (hospitalization for worsening heart failure; 2), 7 in patients of the mid-wall group (SCD; 1, aborted SCD; 1 and hospitalization for worsening heart failure; 5), and 15 in patients of the multiple lesions group (SCD; 1, aborted SCD; 8 and hospitalization for worsening heart failure; 6). The multiple LGE lesions was an independent predictor of composite cardiac events (hazard ratio: 11.40 [95 % confidence intervals: 1.49−92.01], p = 0.020). Conclusions Patients with multiple LGE lesions have a higher risk of cardiac events and poorer LVRR. The LGE pattern may be useful for an improved risk stratification in patients with NICM.

scholarly journals Effects of candesartan on left ventricular hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Maqsood ◽  
H.A Shakeel ◽  
H.F Shoukat ◽  
M.D Khan ◽  
S.A.Y Shah ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Interstitial Fibrosis ◽  
Angiotensin Receptor Blockers ◽  
Left Ventricular ◽  
Funding Source ◽  
Gadolinium Enhancement ◽  
Percent Change ◽  
Lv Mass ◽  
Significant Difference

Abstract Introduction Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular (LV) hypertrophy in the absence of pressure overload. Manifestations of the disease include heart failure associated with diastolic dysfunction and atrial and ventricular tachyarrhythmias. Pathological features of HCM include myocyte hypertrophy, interstitial fibrosis, and myocyte disarray and are mediated by angiotensin II. Purpose This study aimed to evaluate the effects of candesartan on left ventricular (LV) hypertrophy and fibrosis in patients with hypertrophic cardiomyopathy (HCM). Methods In double-blind fashion, 30 patients (6 women, 24 men; age: 55±11 years) with HCM were randomly assigned to receive placebo (n=13) or candesartan 50 mg twice a day (n=17) for 1 year. To measure LV mass and extent of fibrosis, cardiac magnetic resonance imaging was performed at baseline and 1 year as assessed by late gadolinium enhancement. Results There was a trend toward a significant difference in the percent change in LV mass (median: +5% with placebo vs. −5% with candesartan; p=0.06). There was a significant difference in the percent change in the extent of late gadolinium enhancement, with the placebo group experiencing a larger increase (+30±27% with placebo vs. −22±44% with candesartan; p=0.03). Conclusion Our study concludes reduction of the progression of myocardial hypertrophy and fibrosis with candesartan in patients with hypertrophic cardiomyopathy. Our study population was limited so we warrant larger trials to confirm a place for angiotensin receptor blockers in the management of patients with hypertrophic cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): Self funding

scholarly journals Can myocardial work indices contribute to the exploration of patients with cardiac amyloidosis?

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001346
Author(s):  
Aénora Roger-Rollé ◽  
Eve Cariou ◽  
Khailène Rguez ◽  
Pauline Fournier ◽  
Yoan Lavie-Badie ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Characteristic Curve ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Peak Oxygen Consumption ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Echocardiographic Parameters ◽  
Global Work ◽  
Better Than

BackgroundCardiac amyloidosis (CA) is a life-threatening restrictive cardiomyopathy. Identifying patients with a poor prognosis is essential to ensure appropriate care. The aim of this study was to compare myocardial work (MW) indices with standard echocardiographic parameters in predicting mortality among patients with CA.MethodsClinical, biological and transthoracic echocardiographic parameters were retrospectively compared among 118 patients with CA. Global work index (GWI) was calculated as the area of left ventricular pressure–strain loop. Global work efficiency (GWE) was defined as percentage ratio of constructive work to sum of constructive and wasted works. Sixty-one (52%) patients performed a cardiopulmonary exercise.ResultsGWI, GWE, global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and myocardial contraction fraction (MCF) were correlated with N-terminal prohormone brain natriuretic peptide (R=−0.518, R=−0.383, R=−0.553, R=−0.382 and R=−0.336, respectively; p<0.001). GWI and GLS were correlated with peak oxygen consumption (R=0.359 and R=0.313, respectively; p<0.05). Twenty-eight (24%) patients died during a median follow-up of 11 (4–19) months. The best cut-off values to predict all-cause mortality for GWI, GWE, GLS, LVEF and MCF were 937 mm Hg/%, 89%, 10%, 52% and 15%, respectively. The area under the receiver operator characteristic curve of GWE, GLS, GWI, LVEF and MCF were 0.689, 0.631, 0.626, 0.511 and 0.504, respectively.ConclusionIn CA population, MW indices are well correlated with known prognosis markers and are better than LVEF and MCF in predicting mortality. However, MW does not perform better than GLS.

Sign in / Sign up

Export Citation Format

Share Document