scholarly journals EXPRESS: Cardiac biomarkers as indicators of right ventricular dysfunction and recovery in CTEPH patients after BPA therapy – a cardiac magnetic resonance imaging cohort study

2021 ◽  
pp. 204589402110565
Author(s):  
Steffen Kriechbaum ◽  
Julia M Vietheer ◽  
CB Wiedenroth ◽  
Felix Rudolph ◽  
Marta A. Barde ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cohort Study ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Right Heart Failure ◽  
Cardiac Biomarkers ◽  
Resonance Imaging ◽  
Right Heart

BACKGROUND: In chronic thromboembolic pulmonary hypertension (CTEPH), right heart failure determines outcome. Balloon pulmonary angioplasty (BPA) therapy allows right heart recovery, which can be monitored by cardiac magnetic resonance imaging (CMR). This study evaluates whether cardiac biomarkers (NT-proBNP, MR-proANP, sST2, PAPP-A) are associated with CMR findings prior to and after BPA therapy. METHODS: This observational cohort study enrolled 22 CTEPH patients who underwent BPA therapy and completed a 6-month follow-up including CMR. Biomarker levels were compared with findings for right heart morphology and function derived from CMR. RESULTS: Pulmonary hemodynamics improved after BPA therapy [PVR: 7.7 (6.0-9.0) vs. 4.7 (3.5-5.5) WU, p<0.001; meanPAP 41 (38-47) vs. 32 (28-37) mmHg, p<0.001]. CMR findings indicated right heart maladaptation at baseline and recovery after therapy [RVEDV 192 (141-229) ml vs. 143 (128-172) ml, p=0.002; RVESV 131 (73-157) ml vs. 77 (61-99) ml (p<0.001); RVEF 34 (28-41) % vs. 52 (41-54) %; p<0.001]. Biomarker level cut-offs [NT-proBNP 347 ng/L (AUC 0.91), MR-proANP 230 pg/L (AUC 0.78), PAPP-A 14.5 mU/L (AUC 0.81), sST2 48.0 ng/ml (AUC 0.88)] indicated a RVEF ≤35% at baseline. The dynamics of NT-proBNP (rs =-0.79; p<0.001), MR-proANP (rs =-0.80; p<0.001), and sST2 (rs =-0.49; p=0.02) correlated inversely with the improvement in RVEF after therapy. A relative decrease of NT-proBNP <53% (AUC 0.86) and MR-proANP <24% (AUC 0.82) indicated a limited RVEF response. CONCLUSIONS: In CTEPH patients, CMR findings illustrate right heart failure and recovery after BPA therapy. Cardiac biomarker levels correlate with right heart parameters at baseline and their dynamics after therapy.

scholarly journals A case report: multiple right ventricular diverticula with constrictive pericarditis and right heart failure

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Sohail Iqbal ◽  
Nik Abidin ◽  
Richard Bruce Irwin ◽  
Matthias Schmitt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Computed Tomography ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Right Ventricular ◽  
Constrictive Pericarditis ◽  
Right Heart Failure ◽  
Resonance Imaging ◽  
Right Heart

Abstract Background Right ventricular diverticula (RVD) are very rare congenital anomalies and their association with constrictive pericarditis is even rarer. So far, only one case has been published in literature. Case summary We report a case of multiple congenital RVD with constrictive pericarditis and right heart failure which was incidentally identified on surveillance computed tomography (CT) for abdominal lymphangioma. Interval CT, echocardiography, and cardiac magnetic resonance imaging (CMR) studies were performed and reviewed. Computed tomography abdomen showed hepatic congestion with features of portal hypertension, increasing size of the RVD on review of serial CTs, and eccentric foci of pericardial calcification. Echocardiography performed for breathlessness demonstrated supranormal early diastolic tissue velocities with average of 19.8 cms−1 and a septal bounce phenomenon on m-mode imaging suggesting constrictive physiology, which triggered a CMR referral. Cardiac magnetic resonance imaging HASTE and right ventricular (RV) outflow tract imaging showed four outpouchings along RV free wall, the largest measuring 4.5 × 2 cm with a sizeable neck. These outpouchings displayed a trabecular network and/or were contractile aiding the diagnosis of diverticula as opposed to aneurysms. Right ventricular function was moderately compromised, whereas left ventricular function was preserved. Discussion Right ventricular diverticula can be associated with, and potentially be causative of, pericardial thickening and calcification eventually leading to constrictive pericarditis and heart failure.

Abstract MP31: Left Ventricular Hypertrophy by Electrocardiogram versus Cardiac Magnetic Resonance Imaging as a Predictor for Heart Failure: The MESA Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Abdullahi O Oseni ◽  
Waqas T Qureshi ◽  
Mohammed F Almahmoud ◽  
Alain Bertoni ◽  
David A Bluemke ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Hypertrophy ◽  
Cardiac Magnetic Resonance Imaging ◽  
Ventricular Hypertrophy ◽  
Predictive Ability ◽  
Left Ventricular ◽  
Resonance Imaging

Background: Left ventricular hypertrophy (LVH) is an established risk factor for heart failure (HF). However, it is unknown whether LVH detected by electrocardiogram (ECG-LVH) is equivalent to LVH ascertained by cardiac magnetic resonance imaging (MRI-LVH) in terms of prediction of incident HF using risk prediction models like the Framingham Heart Failure Risk Score (FHFRS). Methods: This analysis included 4745 (mean age 61+10 years, 53.5% women, 61.7% non-whites) from the Multi-Ethnic Study of Atherosclerosis who were free of cardiovascular disease at the time of enrollment. ECG-LVH was defined using Cornell’s criteria while MRI-LVH was derived from left ventricular (LV) mass measured by cardiac MRI. Cox proportional hazard regression was used to examine the association between ECG-LVH and MRI-LVH with incident HF. Harrell’s concordance C-index was used to estimate the predictive ability of the FHFRS when either ECG-LVH or MRI-LVH were included as one of its components. The added predictive ability of ECG-LVH and MRI-LVH were investigated using integrated discrimination improvement (IDI) index and relative IDI. Results: ECG-LVH was present in 291(6.1%) while MRI-LVH was present in 499 (10.5%) of the participants. Over a median follow up of 10.4 years, 140 participants developed HF. Both ECG-LVH [HR (95% CI): 2.25(1.38-3.69)] and MRI-LVH [HR (95% CI): 3.80(1.56-5.63)] were associated with an increased risk of HF in multivariable adjusted models (Table 1). The ability of FHFRS to predict HF was improved with MRI-LVH (C-index 0.871, 95% CI: 0.842-0.899) when compared with ECG-LVH (C-index 0.860, 95% CI: 0.833-0.888) (p < 0.0001). To assess the potential clinical utility of using LVH-MRI instead of ECG-LVH, we calculated several measures of reclassification (Table 1), which were consistent with the statistically significantly improved C-statistic with MRI-LVH. Conclusion: Both ECG-LVH and MRI-LVH are predictive of HF when used in the FHFRS. Substituting MRI-LVH for ECG-LVH improves the predictive ability of the FHFRS.

Role of Cardiac Magnetic Resonance Imaging in Heart Failure

2021 ◽  
Author(s):  
Carla Contaldi ◽  
Santo Dellegrottaglie ◽  
Ciro Mauro ◽  
Francesco Ferrara ◽  
Luigia Romano ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Resonance Imaging

Optimisation of cardiac resynchronisation therapy device selection guided by cardiac magnetic resonance imaging: Cost-effectiveness analysis

2019 ◽  
Vol 27 (6) ◽  
pp. 622-632 ◽  
Author(s):  
Carlos Crespo ◽  
Markus Linhart ◽  
Juan Acosta ◽  
David Soto-Iglesias ◽  
Mikel Martínez ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Quality Adjusted Life Years ◽  
Life Years ◽  
Cardiac Resynchronisation ◽  
Quality Adjusted Life

Background A recent study showed that the presence and characteristics of myocardial scar could independently predict appropriate implantable cardioverter-defibrillator therapies and the risk of sudden cardiac death in patients receiving a de novo cardiac resynchronisation device. Design The aim was to evaluate the cost-effectiveness of cardiac magnetic resonance imaging-based algorithms versus clinical practice in the decision-making process for the implantation of a cardiac resynchronisation device pacemaker versus cardiac resynchronisation device implantable cardioverter-defibrillator device in heart failure patients with indication for cardiac resynchronisation therapy. Methods An incidental Markov model was developed to simulate the lifetime progression of a heart failure patient cohort. Key health variables included in the model were New York Heart Association functional class, hospitalisations, sudden cardiac death and total mortality. The analysis was done from the healthcare system perspective. Costs (€2017), survival and quality-adjusted life years were assessed. Results At 5-year follow-up, algorithm I reduced mortality by 39% in patients with a cardiac resynchronisation device pacemaker who were underprotected due to misclassification by clinical protocol. This approach had the highest quality-adjusted life years (algorithm I 3.257 quality-adjusted life years; algorithm II 3.196 quality-adjusted life years; clinical protocol 3.167 quality-adjusted life years) and the lowest lifetime costs per patient (€20,960, €22,319 and €28,447, respectively). Algorithm I would improve results for three subgroups: non-ischaemic, New York Heart Association class III–IV and ≥65 years old. Furthermore, implementing this approach could generate an estimated €702 million in health system savings annually in European Society of Cardiology countries. Conclusion The application of cardiac magnetic resonance imaging-based algorithms could improve survival and quality-adjusted life years at a lower cost than current clinical practice (dominant strategy) used for assigning cardiac resynchronisation device pacemakers and cardiac resynchronisation device implantable cardioverter-defibrillators to heart failure patients.

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