Pulmonary circulation biomarkers acquired by cardiovascular magnetic resonance in population after heart transplant

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was supported by the European Regional Development Fund - Project ENOCH. This study was conducted at Masaryk University as part of the project "New Methods in Diagnostic and Stratification of Cardiovascular Diseases" MUNI/A/1393/2019 with the support of the Specific University Research Grant, as provided by the Ministry of Education, Youth and Sports of the Czech Republic in 2019. Introduction Right heart catheterization still remains the golden standard in measuring pulmonary circulation parameters, although its clinical use is limited due to it being an invasive examination. Pulmonary circulation biomarkers acquired by cardiovascular magnetic resonance (CMR) could provide a non-invasive alternative for assuming congestion in patients. Biomarkers such as pulmonary transit time (PTT), pulmonary transit beats (PTB) and pulmonary blood volume index (PBVI) are not new themselves, however, data on cut-off values of these biomarkers and on different populations are limited. To our knowledge, these biomarkers have never been measured in patients after heart transplant (HT) before and PTT from stress perfusion has only been acquired by a single study, which makes the data on this relatively new marker very limited. Purpose The purpose of this study was to calculate PTT stress/rest ratio and provide more evidence about pulmonary circulation biomarkers in HT patients. Methods In this retrospective study, 38 patients after HT who had undergone a CMR examination including contrast methods and stress CMR perfusion were enrolled. PTT values in both rest and stress perfusion were measured as peak-to-peak time in main contrast bolus of dual-bolus stress CMR examination. PTB was calculated by dividing PTT by RR interval obtained from heart rate and PBVI from PTB and right ventricle systolic volume. PTT under stress and rest condition was afterwards compared and PTT ratio was calculated dividing stress values by rest values. Obtained results were further compared to a healthy group as published previously. PTT ratio of HT patients was then compared to measurements conducted on a control group consisting of 10 patients after anthracycline treatment. Results Patients after HT showed biomarker values as follows PBVI 250 ± 59 mL/m2, PTT 6,26 ± 1,05 s, PTT stress 5,66 ± 1,09 s, PTB 7,39 ± 1,31 and PTT ratio 0,91 ± 0,14. These results resemble previously published healthy group values (PBVI 308 ± 92 ml/m2, PTT 6,8 s, PTB 7) and none of the patients enrolled in our study crossed the presented cut-off value of PBVI 492 mL/m2 for hemodynamic congestion. PTT ratio in our control group was 0,77 ± 0,14. In both the populations, PTT values under stress were lower than in rest condition and therefore PTT ratio values were below 1. Conclusions The study provided more evidence about pulmonary circulation biomarkers acquired by CMR in HT patients and presented PTT ratio as a new biomarker. Patients 1 year after HT have comparable values to those of healthy population. PTT stress values were shorter than PTT rest values in both HT group and control group.

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Impairment in Quantitative Microvascular Function in Non-Ischemic Cardiomyopathy as Demonstrated Using Cardiovascular Magnetic Resonance

10.21203/rs.3.rs-496006/v1 ◽

2021 ◽

Author(s):

Jeremy A. Slivnick ◽

Karolina M. Zareba ◽

Vien T. Truong ◽

Ellen Liu ◽

Alexis Barnes ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Ischemic Cardiomyopathy ◽

Systolic Function ◽

Univariate Analysis ◽

Myocardial Perfusion Reserve ◽

Microvascular Function ◽

Stress Perfusion ◽

Visual Evaluation ◽

Stress Cmr

Abstract Purpose Microvascular dysfunction (MVD)—defined as impaired augmentation of the microcirculation in response to stress—is present in various cardiovascular diseases and portends worse outcomes. We aimed to evaluate the relationship between MVD and non-ischemic cardiomyopathy (NICM) utilizing stress cardiovascular magnetic resonance (CMR) as compared to a cohort of control patients. Methods We retrospectively studied 41 consecutive patients with NICM (mean age 51 ± 14, 59% male) and 58 controls with preserved systolic function (mean age 51 ± 13, 31% male) who underwent adenosine stress CMR exams between 2011–2016. Microvascular function was assessed visually and with myocardial perfusion reserve index (MPRI), quantified using first pass perfusion imaging by comparing perfusion slopes of myocardium and blood pool at rest/stress. MVD was defined visually as presence of subendocardial stress perfusion defect and quantitatively by MPRI < 1.51. MPRI was compared between NICM and controls using univariate analysis and multivariable linear regression. Results Impaired MPRI was noted in 37 patients (23 in NICM and 14 in control cohorts). In patients with NICM, 23 (56%) had MVD by quantitative assessment, while 11 (27%) by visual evaluation. No differences in comorbidities were noted between cohorts. Compared with controls, NICM patients had lower rest perfusion slope (3.9 vs 4.9, p = 0.05), stress perfusion slope (8.8 vs 11.7, p < 0.001), and MPRI (1.41 vs 1.74, p = 0.02). MPRI remained associated with NICM after controlling for age, gender, hypertension, diabetes, and late gadolinium enhancement (log MPR, β coefficient = -0.17, p = 0.009). Conclusions MVD assessed with stress CMR is highly prevalent in NICM as compared to control patients with preserved systolic function. Quantitative MPRI assessment identities more NICM patients with MVD as compared to visual evaluation. NICM remains independently associated with an impaired MPRI after controlling for covariates. Further studies are needed to determine whether targeted therapies to treat MVD are beneficial in NICM.

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Vasodilatation stress cardiovascular magnetic resonance: feasibility and safety in a monocentric prospective study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.293 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

T Pezel ◽

P Garot ◽

T Hovasse ◽

S Toupin ◽

T Unterseeh ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Demographic Data ◽

Obstructive Coronary Artery Disease ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Funding Sources ◽

Artery Disease ◽

Stress Cmr ◽

Inducible Ischaemia

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. PURPOSE The aim of our study was to assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated. METHODS Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded. RESULTS Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p < 0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%). CONCLUSION Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications. Abstract Table. Final results after stress CMR

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Prognostic value of dipyridamole stress perfusion cardiovascular magnetic resonance in elderly patients >75 years with suspected coronary artery disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa193 ◽

2020 ◽

Author(s):

Théo Pezel ◽

Francesca Sanguineti ◽

Marine Kinnel ◽

Thomas Hovasse ◽

Philippe Garot ◽

...

Keyword(s):

Coronary Artery Disease ◽

Cardiovascular Magnetic Resonance ◽

Coronary Artery ◽

Magnetic Resonance ◽

Prognostic Value ◽

Stress Perfusion ◽

Artery Disease ◽

Stress Cmr ◽

Dipyridamole Stress

Abstract Aims There are only very few data on the prognostic value of stress cardiovascular magnetic resonance (CMR) in elderly people, while life expectancy of the general population is steadily increasing. Therefore, this study aims to assess the prognostic value of vasodilator stress perfusion CMR in elderly >75 years. Methods and results Between 2008 and 2017, we included consecutive elderly >75 years without known coronary artery disease (CAD) referred for dipyridamole stress CMR. They were followed for the occurrence of major adverse cardiovascular events (MACE) including cardiac death or non-fatal myocardial infarction. Univariate and multivariate analyses were performed to determine the prognostic value of ischaemia or late gadolinium enhancement. Of 754 elderly individuals (82.0 ± 3.9 years, 48.4% men), 659 (87.4%) completed the follow-up with median follow-up of 4.7 years. Using Kaplan–Meier analysis, the presence of myocardial ischaemia was associated with the occurrence of MACE [hazard ratio (HR) 5.38, 95% confidence interval (CI): 3.56–9.56; P < 0.001]. In a multivariable Cox regression including clinical characteristics and CMR indexes, inducible ischaemia was an independent predictor of a higher incidence of MACE (HR 4.44, 95% CI: 2.51–7.86; P < 0.001). In patients without ischaemia, the occurrence of MACE was lower in women when compared with men (P < 0.01). Conclusion Stress CMR is safe and has discriminative prognostic value in elderly, with a significantly lower event rate of future cardiovascular event or death in subjects without ischaemia or infarction.

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Abstract 13465: Prognostic Value of Vasodilator Stress Perfusion Cardiovascular Magnetic Resonance in Patients With Known Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.13465 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Theo Pezel ◽

Philippe Garot ◽

Marine Kinnel ◽

Thomas Hovasse ◽

Solenn Toupin ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Prognostic Value ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Inducible Ischemia ◽

Perfusion Cardiovascular Magnetic Resonance ◽

Stress Cmr

Introduction: Several studies have demonstrated the consistently high prognostic value of stress perfusion cardiovascular magnetic resonance (CMR). This prognostic value in patients with known myocardial infarction (MI) is poorly described. Hypothesis: To assess the prognostic value of vasodilator stress perfusion CMR in patients with known MI. Methods: We prospectively included consecutive patients with known MI referred for vasodilator stress CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Results: Of 1602 patients with known MI (68 ± 17 years, 78% men), 1556 (97%) completed the CMR protocol, and among those 1401 (90%) completed the follow-up (median follow-up 5.7 (3.9-7.6) years). Reasons for failure to complete CMR included ECG-gating problems (n=13), intolerance to stress agent (n=12), renal failure (n=12), declining participation (n=4) and claustrophobia (n=5). Stress CMR was well tolerated without occurrence of death or severe adverse event. Patients without inducible ischemia experienced a substantially lower annual event rate of MACE (3.1%) than those with 1 or 2 segments of ischemia (4.5%), than those with 3 to 5 segments of ischemia (21.5%), than those with 6 or more segments of ischemia (45.7%, for all p<0.01). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 3.52; 95% confidence interval CI: 2.67 - 4.65; p <0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 2.84; 95% CI: 2.14 to 3.78; p <0.001). Conclusions: Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI.

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Abstract 13467: Vasodilatation Stress Cardiovascular Magnetic Resonance: Feasibility and Safety in a Monocentric Prospective Study

Circulation ◽

10.1161/circ.142.suppl_3.13467 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Theo Pezel ◽

Philippe Garot ◽

Thomas Hovasse ◽

Thierry Unterseeh ◽

Solenn Toupin ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Demographic Data ◽

Obstructive Coronary Artery Disease ◽

Vasodilator Stress ◽

Stress Perfusion ◽

Cardiovascular Center ◽

Artery Disease ◽

Stress Cmr ◽

Inducible Ischaemia

Introduction: Cardiovascular magnetic resonance imaging (CMR) has emerged as an accurate technique that can assess ventricular function, stress myocardial perfusion, and viability, without radiation. Recent studies have shown that stress CMR would be the best test to predict obstructive coronary artery disease (CAD) with a good safety. Hypothesis: To assess the feasibility and incidence of immediate complications of stress CMR in a tertiary Cardiovascular Center with CMR Laboratory dedicated. Methods: Prospective registry of vasodilator stress CMR in a French center with CMR expertise included all consecutive patients referred for vasodilator stress perfusion CMR to detect an obstructive CAD between 2008 and 2020. Stress CMR was performed at 1.5 T using dipyridamole. The clinical and demographic data, quality of test, CMR findings, haemodynamic data, and complications were prospectively recorded. Results: Stress CMR was performed in 35,157 patients (98.2% of requested). The study could not be performed due to claustrophobia in 0.3%. Quality was optimal in 93.1%, suboptimal in 6.4%, and poor in 0.5% of studies. Images were diagnostic in 97.9% of patients. No patient died or had acute myocardial infarction during the test. Moreover, 56 patients (0.16%) had severe immediate complications, and one anaphylactic shock post-gadolinium. The only factor significantly associated with higher incidence of serious complications was the detection of inducible ischaemia (p<0.001). Incidence of non-severe complications was low (1.5%), severe controlled chest pain being the most frequent. Minor symptoms occurred frequently (35.5%). Conclusions: Performance of stress CMR is safe with very high image rate of satisfactory quality to perform the diagnosis in a referral population. Inducible ischaemia was the only factor identified which was associated with serious complications.

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P5285Pressure-volume relationship by cardiovascular magnetic resonance: feasibility and clinical implications

European Heart Journal ◽

10.1093/eurheartj/ehz746.0256 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A De Luca ◽

A Meloni ◽

C Nugara ◽

C Cappelletto ◽

G Aquaro ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Systolic Pressure ◽

Peak Stress ◽

Left Ventricular ◽

Volume Index ◽

Roc Curve Analysis ◽

Prognostic Information ◽

Stress Cmr ◽

Dipyridamole Stress

Abstract Background The variation between rest and peak stress end-systolic pressure-volume relation (ESPVR; the Suga index) is easily obtained during routine stress echocardiography and has been established as a reasonably load-independent index of myocardial contractile performance that provides prognostic information above and beyond regional wall motion. Purpose This is the first study assessing the delta rest-stress ESPVR (DESPVR) by stress Cardiovascular Magnetic Resonance (CMR). Methods Eighty-five consecutive patients (19 females, main age 62.99±9.26 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson method. Results Mean ESPVR index at rest and peak stress was, respectively, 4.52±2.26 mmHg/mL/m2 and 4.62±2.32 mmHg/mL/m2 and mean DESPVR was 0.11±1.19 mmHg/mL/m2. DESPVR was not associated to age or sex. An inverse relationship between rest left ventricular end-diastolic volume index (LVEDVI) and both rest and peak ESPVR was present (R=-0.805 P<0.0001 and R=-0.795 P<0.0001, respectively), but it was absent when the DESPVR was considered (R=0.170 P=0.121). An abnormal stress CMR was found in 22 patients and the DESPVR was comparable between patients with normal and abnormal stress exam. During a median follow-up of 60.62 months (IQ range 36.78 months), 27 cardiovascular events occurred: 3 deaths, 1 ventricular arrhythmias, 9 coronary syndromes, 14 heart failure hospitalization. At receiver-operating characteristic (ROC) curve analysis, a DESPVR<0.009 predicted the presence of future cardiac events with a sensitivity of 0.70 and a specificity of 0.64 (P=0.049). Conclusions We showed for the first time that dipyridamole stress CMR can be used for the assessment of DESPVR. DESPVR was shown to be independent from chamber size and, as a consequence, can be used for a comparative assessment of patients with different diseases. DESPVR by CMR can provide a prognostic stratification and the optimal cutoff for relevant events was 0.009.

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Long-term prognostic value of stress perfusion cardiovascular magnetic resonance in patients without known coronary artery disease

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00737-0 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Théo Pezel ◽

Thierry Unterseeh ◽

Marine Kinnel ◽

Thomas Hovasse ◽

Francesca Sanguineti ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Magnetic Resonance ◽

Coronary Artery ◽

Magnetic Resonance ◽

Prognostic Value ◽

Stress Perfusion ◽

Artery Disease ◽

Stress Cmr

Abstract Background To assess the incremental long-term prognostic value of vasodilator stress perfusion cardiovascular magnetic resonance (CMR) in patients without known coronary artery disease (CAD). Methods Between 2010 and 2011, consecutive patients with cardiovascular risk factors without known CAD referred for stress CMR were followed for the occurrence of major adverse cardiac events (MACE), defined by cardiovascular mortality or recurrent non-fatal myocardial infarction (MI). Uni- and multivariable Cox regressions were performed to determine the prognostic value of ischemia and unrecognized MI defined by sub-endocardial or transmural late gadolinium enhancement (LGE). Results Among 2,295 patients without known CAD, 2058 (89.7%) (71.2 ± 12.5 years; 37.5% males) completed the follow-up (median [IQR]: 8.3 [7.3–8.7] years), and 203 had MACE (9.9%). Using Kaplan–Meier analysis, ischemia and unrecognized MI were associated with MACE (hazard ratio, HR: 4.64 95% CI: 3.69–6.17 and HR: 2.88; 95% CI: 2.08–3.99, respectively; both p < 0.001). In multivariable stepwise Cox regression, ischemia and unrecognized MI were independent predictors of MACE (HR = 3.71; 95% CI 2.73–5.05, p < 0.001 and HR = 1.73; 95% CI 1.22–2.45, p = 0.002; respectively) and cardiovascular mortality (HR: 3.13; 95% CI: 2.17–4.51, p < 0.001 and HR = 1.73; 95% CI 1.15–2.62, p = 0.009; respectively). The addition of ischemia and unrecognized MI led to an improved model discrimination for MACE (change in C statistic from 0.61 to 0.72; NRI = 0.431; IDI = 0.053). Conclusions Inducible ischemia and unrecognized MI identified by stress CMR have incremental long term prognostic value for the incidence of MACE in patients without known CAD over traditional risk factors and left ventricular ejection fraction.

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