scholarly journals Prognostic Impact of Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance in Myocarditis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Georgios Georgiopoulos ◽  
Stefano Figliozzi ◽  
Francesca Sanguineti ◽  
Giovanni Donato Aquaro ◽  
Gianluca di Bella ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Gadolinium Enhancement ◽  
End Point ◽  
Hazard Ratios ◽  
Increased Risk

Background: Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance in patients with AM plays an important diagnostic role, but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of cardiovascular magnetic resonance-derived LGE in patients with AM. Methods: Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: Myocarditis, CMR, Magnetic Resonance Imaging, Magnetic Resonance . From 2422 articles retrieved, we selected 11 studies reporting baseline cardiovascular magnetic resonance assessment and long-term clinical follow-up in patients with AM. Hazard ratios and CIs for a combined clinical end point were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal versus non-anteroseptal). A combined end point comprised all-cause mortality, cardiac mortality, and major adverse cardiovascular events. Hartung and Knapp correction improved robustness of the results. Prespecified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Results: LGE presence (pooled hazard ratios, 3.28 [95% CIs, 1.69–6.39], P <0.001 [95% CIs, 1.33–8.11] after Hartung and Knapp correction) and anteroseptal LGE (pooled-hazard ratios, 2.58 [95% CIs, 1.87–3.55], P <0.001 [95% CIs, 1.64–4.06] after Hartung and Knapp correction) were associated with an increased risk of the combined end point. Extensive LGE was associated with worse outcomes (pooled-hazard ratios, 1.96 [95% CIs, 1.08–3.56], P =0.027), but this association was not confirmed after Hartung and Knapp correction (95% CIs, 0.843–4.57). Conclusions: LGE presence and anteroseptal location at baseline cardiovascular magnetic resonance are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619.

scholarly journals Cardiovascular magnetic resonance for early detection of late cardiotoxicity in asymptomatic survivors of hodgkin and non-hodgkin lymphoma

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
N Van Der Velde ◽  
CPM Janus ◽  
DJ Bowen ◽  
HC Hassing ◽  
I Kardys ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
B Cell Lymphoma ◽  
Left Ventricular ◽  
Healthy Controls ◽  
Gadolinium Enhancement ◽  
Native T1 ◽  
Late Cardiotoxicity

Abstract Funding Acknowledgements Type of funding sources: None. Background Long-term survivors of Hodgkin (HL) and non-Hodgkin (NHL) lymphomas experience late adverse effects of mediastinal radiotherapy and/or anthracycline containing chemotherapy, which lead to premature cardiovascular morbidity and mortality. It is unknown whether early stages of myocardial dysfunction and heart failure in these survivors can be detected by cardiovascular magnetic resonance imaging (CMR). Purpose To identify early sensitive markers for the detection of subclinical late cardiotoxicity using CMR in asymptomatic survivors of HL and (primary mediastinal large B-cell lymphoma) NHL. Methods For this prospective observational study, we included 80 HL or selected NHL survivors, who have been free of disease for ≥5 years and were treated with mediastinal radiotherapy (RT) with/without chemotherapy. Patients with known cardiac disease were excluded. Included patients were compared to 40 age- and sex matched healthy controls. CMR included 1) cine imaging for assessment of left ventricular (LV) and right ventricular (RV) dimensions, systolic function and strain; 2) 2-dimensional late gadolinium enhancement (LGE) imaging; 3) T2 mapping and 4) pre- and post-contrast T1 mapping (MOLLI) for assessment of native T1 values and extracellular volume (ECV). Results Of the 80 patients, 78 (98%) had a history of HL and 2 (2%) of NHL with a mean age of 47 ± 11 years (46% male). All patients were treated with mediastinal RT which was combined with anthracycline containing chemotherapy in 68 (85%) patients. The median interval between diagnosis and CMR was 20 [14 – 26] years. Differences in CMR characteristics between patients and healthy controls are shown in the table. LV end-systolic volume was statistically significantly higher, but LV ejection fraction and mass were significantly lower in patients compared to healthy controls. RV volumes were significantly lower in patients, but RV ejection fraction was preserved. Strain parameters of the LV, i.e. global longitudinal strain, global circumferential strain and global radial strain, were slightly but significantly reduced in patients. No significant differences were found in myocardial T2 times and ECV; however, native myocardial T1 time was significantly higher in patients compared to healthy controls. LGE was detected in 25% of the patients and in the majority of patients with LGE this was classified as hinge point fibrosis. Conclusion Asymptomatic survivors of HL and NHL are not exempt of late cardiotoxicity, which can be detected by subtle changes in LV myocardial function, strain and native T1 value with CMR. Furthermore, late gadolinium enhancement was present in 25% of the patients. Further longitudinal studies are needed to assess the implication of these changes in relation to clinical outcome.

scholarly journals Cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis

2020 ◽  
Vol 41 (18) ◽  
pp. 1733-1743 ◽  
Author(s):  
Lili Zhang ◽  
Magid Awadalla ◽  
Syed S Mahmood ◽  
Anju Nohria ◽  
Malek Z O Hassan ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Immune Checkpoint ◽  
Cardiovascular Events ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction

Abstract Aims Myocarditis is a potentially fatal complication of immune checkpoint inhibitors (ICI). Sparse data exist on the use of cardiovascular magnetic resonance (CMR) in ICI-associated myocarditis. In this study, the CMR characteristics and the association between CMR features and cardiovascular events among patients with ICI-associated myocarditis are presented. Methods and results From an international registry of patients with ICI-associated myocarditis, clinical, CMR, and histopathological findings were collected. Major adverse cardiovascular events (MACE) were a composite of cardiovascular death, cardiogenic shock, cardiac arrest, and complete heart block. In 103 patients diagnosed with ICI-associated myocarditis who had a CMR, the mean left ventricular ejection fraction (LVEF) was 50%, and 61% of patients had an LVEF ≥50%. Late gadolinium enhancement (LGE) was present in 48% overall, 55% of the reduced EF, and 43% of the preserved EF cohort. Elevated T2-weighted short tau inversion recovery (STIR) was present in 28% overall, 30% of the reduced EF, and 26% of the preserved EF cohort. The presence of LGE increased from 21.6%, when CMR was performed within 4 days of admission to 72.0% when CMR was performed on Day 4 of admission or later. Fifty-six patients had cardiac pathology. Late gadolinium enhancement was present in 35% of patients with pathological fibrosis and elevated T2-weighted STIR signal was present in 26% with a lymphocytic infiltration. Forty-one patients (40%) had MACE over a follow-up time of 5 months. The presence of LGE, LGE pattern, or elevated T2-weighted STIR were not associated with MACE. Conclusion These data suggest caution in reliance on LGE or a qualitative T2-STIR-only approach for the exclusion of ICI-associated myocarditis.

Abstract 17442: Myocardial Damage Assessed by Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance Imaging in Cancer Patients Treated With Anthracyclines and/or Trastuzumab

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kalpit Modi ◽  
Ko-hsuan Chen ◽  
Osama Okasha ◽  
Pratik Velangi ◽  
Matthew Hooks ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Cancer Patients ◽  
Cardiovascular Magnetic Resonance Imaging ◽  
Myocardial Damage ◽  
Left Ventricular ◽  
Resonance Imaging ◽  
Gadolinium Enhancement

Aims: In cancer patients with cardiomyopathy related to anthracyclines and/or trastuzumab, data on late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) are conflicting, with a prevalence of 0-100%. The patterns of LGE are also poorly described. We aimed to investigate these topics in a large cohort of consecutive cancer patients with suspected cardiotoxicity from anthracyclines and/or trastuzumab. Methods and Results: We studied 298 patients, analyzed the prevalence, patterns, and correlates of LGE, and identified their causes. We compared the findings with those from 100 age-matched cancer patients who received neither anthracyclines nor trastuzumab. Overall, 31 (10.4%) patients who received anthracyclines and/or trastuzumab had LGE. The LGE had widely varying extents (3.9-34.7%) and locations (all 17 left ventricular segments were involved). It was in an ischemic pattern in 20/31 (64.5%) patients. There was an alternative explanation for the non-ischemic LGE in 7/11 (63.6%) patients. In the patients who received neither anthracyclines nor trastuzumab, the prevalence of LGE was higher at 27.0%, while the extent of LGE and the proportion with ischemic LGE were not different. Conclusions: Treatment with anthracyclines and/or trastuzumab is unlikely to be associated with LGE because LGE was present in only a minority, the LGE did not fit into a single profile that could be attributed to cancer treatment-related cardiotoxicity, the LGE had alternative explanations in almost all cases, and LGE was also present in cancer patients who received neither anthracyclines nor trastuzumab. Absence of LGE can differentiate anthracycline- or trastuzumab-related cardiomyopathy from unrelated cardiomyopathies.

scholarly journals Cardiovascular Magnetic Resonance for the Differentiation of Left Ventricular Hypertrophy

2020 ◽  
Vol 17 (5) ◽  
pp. 192-204
Author(s):  
Matthew K. Burrage ◽  
Vanessa M. Ferreira
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Tissue Characterisation ◽  
Gadolinium Enhancement ◽  
Parametric Mapping ◽  
Morphological Assessment

Abstract Purpose of Review Left ventricular hypertrophy (LVH) is a common presentation encountered in clinical practice with a diverse range of potential aetiologies. Differentiation of pathological from physiological hypertrophy can be challenging but is crucial for further management and prognostication. Cardiovascular magnetic resonance (CMR) with advanced myocardial tissue characterisation is a powerful tool that may help to differentiate these aetiologies in the assessment of LVH. Recent Findings The use of CMR for detailed morphological assessment of LVH is well described. More recently, advanced CMR techniques (late gadolinium enhancement, parametric mapping, diffusion tensor imaging, and myocardial strain) have been used. These techniques are highly promising in helping to differentiate key aetiologies of LVH and provide valuable prognostic information. Summary Recent advancements in CMR tissue characterisation, such as parametric mapping, in combination with detailed morphological assessment and late gadolinium enhancement, provide a powerful resource that may help assess and differentiate important causes of LVH.

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