scholarly journals Evaluation of Extracellular Volume by Computed Tomography is Useful for Prediction of Prognosis in Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Satomi Yashima ◽  
Hiroyuki Takaoka ◽  
Manami Takahashi ◽  
Makiko Kinoshita ◽  
Haruka Sasaki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Dilated Cardiomyopathy ◽  
Cardiac Ct ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cox Proportional Hazards Model ◽  
Left Ventricular Myocardium ◽  
Operating Characteristics

Abstract Purpose: Dilated cardiomyopathy (DCM) is commonly encountered in daily clinical practice, and screening for coronary artery disease and other cardiomyopathies is necessary for its diagnosis. Cardiac CT is useful for the screening of coronary artery stenosis, and extracellular volume fraction (ECV) analysis by CT has become available using new specific software. Here, we evaluated the utility of ECV analysis using cardiac CT to predict patient prognosis in cases with DCM. Methods: We analyzed 70 cases with DCM and coronary computed tomography (CT) with available late-phase images. We evaluated the ECV of the left ventricular myocardium (LVM) using commercially available software (Ziostation 2, Ziosoft Inc, Japan). Results: ECV on LVM was 34.5±4.9%. Major adverse cardiac events (MACE) occurred in 20 cases (29%). ECV of the LVM on CT and the presence of significant valvular disease were significantly higher in cases with MACE than in those without (37.6±5.9 vs 33.2±3.9% and 55% vs 24%, P=0.0057 and P=0.013). LVEF was significantly lower in cases with MACE than in those without (22.3±7.6 vs 30.8±11.8%, P=0.0008). The best cut-off value of ECV on LVM for prediction of MACE was 32.7% based on receiver operating characteristics analysis. Cases with ECV ≥32.7% had significantly higher MACE based on Kaplan-Meier analysis (P=0.012). Only ECV on LVM was an independent predictor of MACE based on a Cox proportional hazards model (P=0.028). Conclusion: Evaluation of ECV on LVM by CT is useful for predicting MACE in patients with DCM.

Abstract 16663: Importance of Assessment for Diffuse Ventricular Fibrosis in Atrial Fibrillation Using Cardiac Ct-Derived Myocardial Extracellular Volume Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hisanori Kanazawa ◽  
Miwa Ito ◽  
Yusei Kawahara ◽  
Tadashi Hoshiyama ◽  
Kenichi Tsujita
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Ct ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Volume Index ◽  
Characteristic Analysis ◽  
Recurrence Group ◽  
Af Recurrence

Introduction: Previous cardiac MRI studies reported that the baseline diffuse LV fibrosis status should be evaluated before performing catheter ablation (CA) to identify the responders early and triage them with appropriate treatment. However, no study has been conducted to evaluate diffuse LV fibrosis in conjunction with pre-ablation planning cardiac CT. Objectives: The purpose of this study was to quantify diffuse left ventricular (LV) fibrosis by the CT-derived extracellular volume fraction (CT-ECV%) in conjunction with cardiac CT performed for CA planning and evaluate its determinants in patients with atrial fibrillation (AF). Methods: Prior to AF ablation, 98 patients (50 patients with paroxysmal AF and 48 patients with persistent AF) underwent pre-ablation planning cardiac CT. Additionally, delayed cardiac CT was performed to measure CT-ECV% as an index of diffuse myocardial fibrosis. Results: Persistent AF patients more frequently had a history of heart failure. Left atrial (LA) volume index was greater in persistent AF patients compared with paroxysmal AF patients. CT-ECV% of persistent AF patients was significantly higher than that of paroxysmal AF patients (30 ± 5 % vs. 26 ± 5 %, p < 0.001). Univariate and multivariate analysis revealed that only persistent AF was independent associated with CT-ECV%. Furthermore, CT-ECV% in recurrence group after CA for AF was higher than that in non-recurrence group (29 ± 4 % vs. 26 ± 5 %, p = 0.013). Multivariate logistic regression analysis revealed that CT-ECV% was significantly correlated with AF recurrence after CA for AF. Receiver operating characteristic analysis showed that more than 28 % in the CT-ECV% was a significant predictor of AF recurrence (area under the curve 0.692, log-rank test: p < 0.001). Conclusions: The quantification of diffuse LV fibrosis by CT-ECV% in conjunction with pre-ablation planning cardiac CT is feasible in AF patients, and persistent AF is independently associated with increasing diffuse LV fibrosis. Furthermore, CT-ECV% was significantly associated with AF recurrence after CA for AF. These findings suggested that it was more important to evaluate cardiac remodeling using CT and intervene early in AF.

scholarly journals The importance of cardiac tomography in the evaluation of cardiac changes and coronary atherosclerosis in patients with betathalassemia major

2020 ◽  
Vol 11 ◽  
pp. 602-611
Author(s):  
Stancă Ionut ◽  
Rizea Ileana Olguta ◽  
Popescu Andreea Caterina ◽  
Albu Alice ◽  
Rus Mihaela ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Arterial Stiffness ◽  
Coronary Atherosclerosis ◽  
Cardiac Ct ◽  
Calcium Score ◽  
Left Ventricular ◽  
Beta Thalassemia ◽  
Control Group ◽  
Atherosclerotic Lesions

Betathalassemic patients demonstrate an increased rate of extracardiac vascular complications, but very low prevalence for coronary artery disease. Computed tomography (CT) achieves excellent tissue characterization, with high spatial resolution and has developed as a gold standard for noninvasive angiography and calcium score assessment.  Methods.  We examined 7 patients with major beta-thalassemia and 7 patients who had an indication for cardiac CT for resting ECG changes, without symptoms of angina pectoris. We investigated the coronary atherosclerosis by assessing the coronary artery calcium (CAC) and arterial stifness. Usual tests and echocardiography measurement were performed. Cardiac computed tomography determined left ventricular mass, left ventricular ejection fraction  (LVEF), coronary calcium score and coronary anatomy. An analysis of myocardial density was also performed. Artery stiffness was assessed by the cardio ankle vascular index  (CAVI). Results. Arterial stiffness index in betathallasemic group was higher than control group, R-CAVI index was 6.21± 0.49 vs 5.65±0.37 and L-CAVI index was 6.21± 0.38 vs 5.71±0.31. The assessment of systolic function by echocardiography and cardiac CT examination in the 2 groups, shows that the LVEF in the betathallasemic group was significantly lower than in the control group, which means that some patients already had cardiomyopathy. LV myocardial mass was significantly higher in the group with beta-thalassemia, which is explained by the appearance of myocardial remodeling. The calcium score in patients with major beta-thalassemia was 0 and 8,5± 5,9  in the control group. Only 3 patients (42,8%) in the control group had a calcium score > 10U. No atherosclerotic lesions were observed in patients with major beta-thalassemia, whereas the control group showed mild coronary atherosclerotic lesions. If myocardial density can be determined, calcium or iron deposits can be detected in the myocardium. In patients with beta-thalassemia, the density of the myocardium was higher, both in the left ventricle (49.29 8.87±HU) and in the septum (56.71± 8.1 HU). Calculation of Pearson’s correlation coefficient revealed a good association between CT and echocardiography, reproducibility of CT was significantly higher on an intra-observer level for LVEF and LV Mass. Conclusions: Patients with β–thalassemia major have a similar calcium score compared to control subjects, but they have an increase in arterial stiffness. However, zero frequencie of coronary heart disease,  denotes coronary protection mechanisms in thalassemia, so future research should focus on the anti-atherogenic potential of blood lipids at these patients. The ability of cardiac tomography to detect calcifications and changes in myocardial density should be valued, as it can be a good tool for establishing the diagnosis of cardiomyopathy by iron loading.

scholarly journals Quantification of extracellular volume fraction by cardiac computed tomography for noninvasive assessment of myocardial fibrosis in hemodialysis patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Akimasa Yamada ◽  
Kakuya Kitagawa ◽  
Satoshi Nakamura ◽  
Masafumi Takafuji ◽  
Yoshitaka Goto ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Myocardial Fibrosis ◽  
Cardiac Ct ◽  
Cardiac Computed Tomography ◽  
Extracellular Volume ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Volume Index ◽  
Stress Perfusion ◽  
Control Group

Abstract Extent of myocardial fibrosis in hemodialysis patients has been associated with poor prognosis. Myocardial extracellular volume (ECV) quantification using contrast enhanced cardiac computed tomography (CT) is a novel method to determine extent of myocardial fibrosis. Cardiac CT-based myocardial ECV in hemodialysis patients with those of propensity-matched non-hemodialysis control subjects were compared. Twenty hemodialysis patients (mean age, 67.4 ± 9.6 years; 80% male) and 20 propensity-matched non-hemodialysis controls (mean age, 66.3 ± 9.1 years; 85% male) who underwent comprehensive cardiac CT consisted of calcium scoring, coronary CT angiography, stress perfusion CT and delayed enhancement CT were evaluated. Myocardial ECV was significantly greater in the hemodialysis group than in the control group (33.8 ± 4.7% versus 26.6 ± 2.9%; P < 0.0001). In the hemodialysis group, modest correlation was evident between myocardial ECV and left atrial volume index (r = 0.54; P = 0.01), while there was no correlation between myocardial ECV and other cardiac parameters including left ventricular mass index and severity of myocardial ischemia. Cardiac CT-based myocardial ECV may offer a potential imaging biomarker for myocardial fibrosis in HD patients.

scholarly journals Effects of left atrial function on pulmonary arterial pressure in acute myocardial infarction, hypertrophic and dilated cardiomyopathy

2021 ◽  
Author(s):  
Minjeong Kim ◽  
Hyemoon Chung ◽  
In-Soo Kim ◽  
Chul Hwan Park ◽  
Se-Joong Rim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Dilated Cardiomyopathy ◽  
Left Atrial ◽  
Volume Fraction ◽  
Global Longitudinal Strain ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Pulmonary Arterial

Abstract Aims: To investigate the differential contribution of the left atrial (LA) function and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure (PASP) in reperfused acute myocardial infarction (AMI), hypertrophic cardiomyopathy (HCM), and dilated cardiomyopathy (DCM). Methods and Results: Data of 370 patients with HCM (n=133), reperfused AMI (n=123), and DCM (n=114) who underwent both echocardiography and cardiovascular magnetic resonance (CMR) were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), and extracellular volume fraction (ECV) of LV were measured using CMR. E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The E/e’/LA-GLS was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e', but not in AMI. In DCM, ECV was significantly related to PASP (p<0.001) independent of LA volume index and E/e’. When subdivided according to the linear regression between PASP and E/e’, patients in the discrepantly high PASP group had lower total emptying fraction and reservoir fraction of left atrium in HCM and DCM but not in AMI compared to the good correlation group. Conclusions: The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e’ and LA size, contrary to that in AMI. These results suggest the presence of atrial myopathy in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function.

scholarly journals Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248306
Author(s):  
Yoav Hammer ◽  
Yeela Talmor-Barkan ◽  
Aryeh Abelow ◽  
Katia Orvin ◽  
Yaron Aviv ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Extracellular Volume ◽  
Normal Subjects ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Galectin 3

Background The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Methods Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Results Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65–0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. Conclusion In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.

scholarly journals The link between left ventricular extracellular volume determined by T1 myocardial mapping and gut microbiota composition in individuals with heart failure and preserved ejection fraction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N Kaburova ◽  
O.M Drapkina ◽  
S.M Uydin ◽  
M.V Vishnyakova ◽  
M.S Pokrovskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Gut Microbiota ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Diffuse Myocardial Fibrosis ◽  
Rrna Gene ◽  
Preserved Ejection Fraction

Abstract Introduction Heart failure with preserved ejection fraction (HFpEF) represents a major challenge in modern cardiology. As described previously, in HFpEF comorbidities promote a systemic inflammatory state, leading to diffuse myocardial fibrosis resulting in myocardial stiffening. Gut dysbiosis which is considered as the novel source of chronic systemic inflammation has been actively investigated as the risk factor for the development and aggravation of cardiovascular diseases including heart failure. Cardiac magnetic resonance T1-mapping is a novel tool, which allows noninvasive quantification of the extracellular space and diffuse myocardial fibrosis. Moreover, the extracellular volume (ECV) fraction can be calculated, providing information on the relative expansion of the extracellular matrix, thus being a noninvasive alternative to myocardial biopsy studies. Purpose The research was aimed at investigating the correlation between the left ventricular ECV and gut microbial genera in patients with HFpEF. Methods 42 patients with confirmed HF-pEF (mediana and interquartile range of age 67 [64; 72] years, 47% men, body mass index &lt;35 kg/m2 with no history of myocardial infarction or diabetes mellitus) were enrolled in the study. The patients underwent transthoracic echocardiography with Doppler study, HF-pEF was confirmed according to the recent ESC guidelines (based on E/e' ratio, N-terminal pro-B type natriuretic peptide &gt;125 pg/ml and symptoms of heart failure). The intestinal microbiome was investigated using high-throughput sequencing of bacterial 16S rRNA gene. As the last step of research T1-myocardial mapping with the modified look-locker inversion-recovery protocol (MOLLI) sequence at 1.5 Tesla was performed to assess left ventricular extracellular volume fraction. Results The mean±std in ECV was 31.02±4.4%. The relative abundance (%) of the most prevalent phyla in gut microbiota was 48±22.5 for Firmicutes, 47.4±22.8 for Bacteroidetes and 1.5 [1.5; 2.5] for Proteobacteria. The analysis showed significant negative correlations between ECV and the following bacterial genera: Faecalibacterium (r=−0.35), Blautia (r=−0.43), Lachnoclostridium (r=−0.32). Moreover ECV positively correlated with Holdemania (r=0.4), Victivallis (r=0.38), Dehalobacterium (r=0.38), Enterococcus (r=0.33) and Catabacter (r=0.32). All correlation values with p&lt;0.05. Conclusion We discovered both negative and positive significant correlations between ECV – the non-invasive marker of myocardial fibrosis and several bacterial genera, which may have negative impact on myocardial remodeling in HF-pEF. Funding Acknowledgement Type of funding source: None

Transmural heterogeneity of diffusion anisotropy in the sheep myocardium characterized by MR diffusion tensor imaging

2007 ◽  
Vol 293 (4) ◽  
pp. H2377-H2384 ◽  
Author(s):  
Yi Jiang ◽  
Julius M. Guccione ◽  
Mark B. Ratcliffe ◽  
Edward W. Hsu
Keyword(s):  
Diffusion Tensor Imaging ◽  
Volume Fraction ◽  
Diffusion Tensor ◽  
Extracellular Volume ◽  
Extracellular Volume Fraction ◽  
Left Ventricular ◽  
Fiber Direction ◽  
Significant Difference ◽  
Mr Diffusion ◽  
Mr Diffusion Tensor Imaging

The orientation of MRI-measured diffusion tensor in the myocardium has been directly correlated to the tissue fiber direction and widely characterized. However, the scalar anisotropy indexes have mostly been assumed to be uniform throughout the myocardial wall. The present study examines the fractional anisotropy (FA) as a function of transmural depth and circumferential and longitudinal locations in the normal sheep cardiac left ventricle. Results indicate that FA remains relatively constant from the epicardium to the midwall and then decreases (25.7%) steadily toward the endocardium. The decrease of FA corresponds to 7.9% and 12.9% increases in the secondary and tertiary diffusion tensor diffusivities, respectively. The transmural location of the FA transition coincides with the location where myocardial fibers run exactly circumferentially. There is also a significant difference in the midwall-endocardium FA slope between the septum and the posterior or lateral left ventricular free wall. These findings are consistent with the cellular microstructure from histological studies of the myocardium and suggest a role for MR diffusion tensor imaging in characterization of not only fiber orientation but, also, other tissue parameters, such as the extracellular volume fraction.

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