scholarly journals Prognostic Value of Myocardial Scar In Ischemic And Non-Ischemic Cardiomyopathy Using Cardiac Magnetic Resonance Imaging

2021 ◽  
Author(s):  
Reem Laymouna ◽  
Eman El-Sharkawy ◽  
Salah El-Tahan ◽  
Mohamed El-Fiky
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Myocardial Scar ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ischaemic Cardiomyopathy ◽  
Group I ◽  
Scar Size ◽  
Group Ii

Abstract Purpose is to evaluate the prognostic value of myocardial scar/fibrosis using cardiac magnetic resonance (CMR) in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM).Methods; 156 patients with either ICM or NICM underwent CMR with late gadolinium enhancement (LGE) sequences for assessment of left ventricular ejection fraction (EF), detection and quantification of any myocardial scar/fibrosis using three methods; a) manual, b) number of segments involved, c) percentage of scarred myocardium (segment based). Patients were followed up for at least 6 months for any clinical cardiac event.Results: Males were 56% (mean age 61 years), with minimal follow up (FU) of 6 months. Patients were divided into; group I; ICM (58%) and group II; NICM (36%). Clinical presentation was ranging from eventless (10%), chest pain (18%), heart failure (15%), hospitalization (35%), syncope (1%), ventricular tachycardia (<1%) and cardiac arrest (<1%). The scar mass was more in size in group I (17% ± 15) than in group II (8 % ± 13). Direct linear relationship was observed between scar size and event severity (P value < 0.001). Inverted relationship between LVEF and event severity in group I (P value of < 0.001) was detected, however, no significant correlation between LVEF and event severity in group II (P value 0.128).Conclusion: Myocardial scar size is a strong predictor for the clinical outcome in both ICM and NICM. EF is less reliable to predict morbidity in cardiomyopathy patients. Segments dependent methods for quantification of myocardial scar is comparable to the manual LGE quantifications.

scholarly journals EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
C Rios-Navarro ◽  
J Gavara ◽  
J Nunez ◽  
C Bonanad Lozano ◽  
E Revuelta-Lopez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Microvascular Obstruction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting. Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods. We prospectively included 106 patients with a first STEMI treated with primary percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours post-reperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction (LVEF) was evaluated. Results. The mean age of the sample was 59 ± 13 years and 76% were male. Patients were dichotomized according to EpCAM median (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (p-value = 0.02) and greater infarct size (p-value = 0.02). At presentation, only EpCAM values were significantly associated with the presence of MVO in univariate (Odds Ratio [95% confidence interval] (OR [95% CI]): 0.58 [0.38-0.88], p-value = 0.01) and multivariate logistic regression models (OR [95% CI]: 0.54 [0.34-0.85], p-value = 0.007). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: depressed LVEF (p-value = 0.009) and higher left ventricular end-systolic volume (p-value = 0.04). Conclusions. EpCAM is associated with occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI. Future studies are needed to confirm EpCAM as biomarker, and eventually biotarget in STEMI pathophysiology.

Cardiac magnetic resonance derived left atrial function after ST-elevation myocardial infarction: an important prognostic indicator

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Nayyar ◽  
T Nguyen ◽  
F Pathan ◽  
T Vo ◽  
D Richards ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Left Atrial ◽  
Prognostic Value ◽  
Cox Regression ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Kaplan Meier

Abstract Background The prognostic value of cardiac magnetic resonance (CMR) derived left atrial (LA) strain, ejection fraction (LAEF) and volumes (LAVImax and LAVImin) after STEMI is controversial. Aim To assess the relationship between LA function and major adverse cardiovascular events (MACE) within 2 years after STEMI. Methods We prospectively recruited 213 consecutive STEMI patients who underwent CMR at median day 4. 202 patients had complete CMR data for feature tracking assessment. LA reservoir and booster strain were quantified by one blinded observer based on the average of three independently repeated measurements from two- and four-chamber views. MACE was a composite of all-cause mortality, reinfarction, new or worsening heart failure, stroke and sustained ventricular arrhythmias. Results The cohort included 174 (86.1%) males, median age 56 years (IQR 50–65 years). MACE occurred in 35 (17.3%) patients. Patients with MACE had lower median reservoir strain (18.9 vs 29.4%, p&lt;0.001), booster strain (9.4 vs 13.0%, p=0.002) and LAEF (41.5 vs 49.2%, p&lt;0.001), and higher LAVImax (43.5 vs 38.6ml/m2, p=0.019) and LAVImin (23.7 vs 19.3ml/m2, p&lt;0.001) than patients without MACE. Patients with reduced left ventricular ejection fraction (LVEF≤40%) had lower median reservoir strain (22.5 vs 30.1%, p&lt;0.001), booster strain (11.3 vs 12.9%, p=0.021) and LAEF (43.3 vs 50.3%, p&lt;0.001) than patients with LVEF&gt;40%. AUC analyses showed reservoir strain (AUC 0.769; 95% CI 0.676–0.861, p&lt;0.001), booster strain (AUC 0.684; 95% CI 0.558–0.810, p=0.002) and LAEF (AUC 0.698; 95% CI 0.596–0.800, p&lt;0.001) predicted MACE. Kaplan Meier analyses showed a difference in MACE between high- and low-risk groups for reservoir strain (cutoff 21%, p&lt;0.001), booster strain (cutoff 9.6%, p&lt;0.001) and LAEF (cutoff 41%, p&lt;0.001). Univariate Cox regression analyses showed all LA parameters had a significant effect on MACE, while multivariate analyses found additional prognostic utility using reservoir strain. Conclusion LA reservoir strain provided incremental prognostic value beyond established clinical and CMR parameters for predicting MACE after STEMI. Kaplan Meier analyses Funding Acknowledgement Type of funding source: None

scholarly journals The role of cardiac magnetic resonance for arrhythmic risk stratification in a patient with myocarditis

2021 ◽  
Author(s):  
Giuseppe Fede ◽  
◽  
Giuseppe Abate ◽  
Giovanni Tasca ◽  
Nicoletta Guccione ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Risk Stratification ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Myocardial Scar ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Life Threatening

Myocarditis is an inflammatory disease of cardiac muscle with a variable clinical presentation, ranging from asymptomatic cases to different degrees of left ventricular systolic dysfunction up to heart failure and dilated heart disease. Ventricular arrhythmias (VA) can occur in patients with myocarditis and implantable cardioverter defibrillator (ICD) may be indicated in patients with life-threatening VA who are not in the acute phase of myocarditis and who are receiving optimal medical therapy. Reduced left ventricular ejection fraction (LVEF) below 35%, which is used as the main criterion for stratifying the risk of sudden cardiac death (SCD), has low sensitivity and low specificity for arrhythmic risk stratification in patients with myocarditis. Myocardial scar is the main determinant for VA in these patients. Cardiac magnetic resonance imaging (CMR), using late gadolinium enhancement(LGE), has an excellent ability to determinate the extension and characterization of myocardial scar, indeed CMR can potentially improve SCD risk stratification and indication for ICD implantation in patients with myocarditis. We present a case of a 36 years-old male presenting to the Emergency Department with a monomorphic sustained ventricular tachycardia in whom MRI revealed myocardial-pericardial recurrent inflammatory involvement and worsening disease progression. ICD was implanted in consideration of the high risk of life-threatening arrhythmias.

scholarly journals The value of cardiovascular magnetic resonance in myocarditis with different clinical presentation

2019 ◽  
Vol 91 (4) ◽  
pp. 28-36
Author(s):  
O V Stukalova ◽  
E M Gupalo ◽  
P V Chumachenko ◽  
A N Samko ◽  
E A Butorova ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Structural Changes ◽  
Morphological Changes ◽  
Resonance Imaging ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Objective: to assess the diagnostic meaning of cardiac magnetic resonance imaging (CMR) in various clinical forms of myocarditis. Materials and methods. 11 (8 men, mean age 32.8±11.1 years) patients (pts), hospitalized with suspected acute coronary syndrome, while an acute myocardial infarction was excluded during the examination (group I); 48 pts (31 men, 43.1±12.7 years), with clinical and instrumental signs of dilated cardiomyopathy (DCM) - group II; and 20 patients (12 men, 39.5±14 years), with episodes of ventricular tachycardia (group III) underwent cardiac magnetic resonance imaging (CMRI). In 38 patients endomyocardial biopsy (EMB) was performed. Results and discussion. According to EMB, signs of active myocarditis were revealed in 10 (34.5%) group II pts and in 3 (37.5%) group III pts; signs of resolved myocarditis - in 8 (27.6%) patients in group II and in 3 (37.5%); minimal morphological changes - in 11 (37.9%) patients of group II and in 2 (25%) patients of group III. In 9 (81.9%) patients of group I MRI data allowed to establish the diagnosis of acute myocarditis. Signs of active inflammation from MRI data were detected in myocardium 5 (10.4%) in group II pts and 7 (35%) in group III pts. In 22 (45.8%) pts in group II and 10 (50%), CMR data corresponded to the picture of resolved myocarditis. In 21 (43.8%) cases of group II and 3 (15%) of group III, MRI revealed minimal structural changes. In pts with clinical and instrumental signs of DCM and/or ventricular tachycardia MRI allows to identify signs of "active myocarditis" with a sensitivity of 37.5% with a specificity of 83.4%. At the same time, in cases of resolved myocarditis and minimal morphological changes MRI has high sensitivity (70 and 71.5%) and specificity (71.5 and 75%, respectively). Conclusion. CMR has high diagnostic significance in patients with infarct-like course of myocarditis. In patients with clinical syndrome of dilated cardiomyopathy or arrhythmias, the sensitivity of MRI in detecting active myocarditis is low (37.5%) with high specificity (83.4%). In cases of minimal structural changes in the myocardium and resolved inflammation, CMR is a good alternative to EMB.

scholarly journals Measuring lung water adds prognostic value in heart failure patients undergoing cardiac magnetic resonance

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bruno M. L. Rocha ◽  
Gonçalo J. L. Cunha ◽  
Pedro Freitas ◽  
Pedro M. D. Lopes ◽  
Ana C. Santos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Primary Endpoint ◽  
Prognostic Value ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lung Water ◽  
Signal Ratio ◽  
Ventricular Ejection Fraction

AbstractTo assess whether a simplified cardiac magnetic resonance (CMR)–derived lung water density (LWD) quantification predicted major events in Heart Failure (HF). Single-centre retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) < 50% who underwent CMR. All measurements were performed on HASTE sequences in a parasagittal plane at the right midclavicular line. LWD was determined by the lung-to-liver signal ratio multiplied by 0.7. A cohort of 102 controls was used to derive the LWD upper limit of normal (21.2%). The primary endpoint was a composite of time to all-cause death or HF hospitalization. Overall, 290 patients (mean age 64 ± 12 years) were included. LWD measurements took on average 35 ± 4 s, with good inter-observer reproducibility. LWD was increased in 65 (22.4%) patients, who were more symptomatic (NYHA ≥ III 29.2 vs. 1.8%; p = 0.017) and had higher NT-proBNP levels [1973 (IQR: 809–3766) vs. 802 (IQR: 355–2157 pg/mL); p < 0.001]. During a median follow-up of 21 months, 20 patients died and 40 had ≥ 1 HF hospitalization. In multivariate analysis, NYHA (III–IV vs. I–II; HR: 2.40; 95%-CI: 1.30–4.43; p = 0.005), LVEF (HR per 1%: 0.97; 95%-CI: 0.94–0.99; p = 0.031), serum creatinine (HR per 1 mg/dL: 2.51; 95%-CI: 1.36–4.61; p = 0.003) and LWD (HR per 1%: 1.07; 95%-CI: 1.02–1.12; p = 0.007) were independent predictors of the primary endpoint. These findings were mainly driven by an association between LWD and HF hospitalization (p = 0.026). A CMR-derived LWD quantification was independently associated with an increased HF hospitalization risk in HF patients with LVEF < 50%. LWD is a simple, reproducible and straightforward measurement, with prognostic value in HF.

scholarly journals Prognostic Value of Late Enhanced Cardiac Magnetic Resonance Imaging Derived Texture Features in Dilated Cardiomyopathy Patients With Severely Reduced Ejection Fractions

2021 ◽  
Vol 8 ◽  
Author(s):  
Shenglei Shu ◽  
Cheng Wang ◽  
Ziming Hong ◽  
Xiaoyue Zhou ◽  
Tianjng Zhang ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Adverse Events ◽  
Dilated Cardiomyopathy ◽  
Prognostic Value ◽  
Systolic Dysfunction ◽  
Texture Features ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection

Background: Late enhanced cardiac magnetic resonance (CMR) images of the left ventricular myocardium contain an enormous amount of information that could provide prognostic value beyond that of late gadolinium enhancements (LGEs). With computational postprocessing and analysis, the heterogeneities and variations of myocardial signal intensities can be interpreted and measured as texture features. This study aimed to evaluate the value of texture features extracted from late enhanced CMR images of the myocardium to predict adverse outcomes in patients with dilated cardiomyopathy (DCM) and severe systolic dysfunction.Methods: This single-center study retrospectively enrolled patients with DCM with severely reduced left ventricular ejection fractions (LVEFs &lt; 35%). Texture features were extracted from enhanced late scanning images, and the presence and extent of LGEs were also measured. Patients were followed-up for clinical endpoints composed of all-cause deaths and cardiac transplantation. Cox proportional hazard regression and Kaplan–Meier analyses were used to evaluate the prognostic value of texture features and conventional CMR parameters with event-free survival.Results: A total of 114 patients (37 women, median age 47.5 years old) with severely impaired systolic function (median LVEF, 14.0%) were followed-up for a median of 504.5 days. Twenty-nine patients experienced endpoint events, 12 died, and 17 underwent cardiac transplantations. Three texture features from a gray-level co-occurrence matrix (GLCM) (GLCM_contrast, GLCM_difference average, and GLCM_difference entropy) showed good prognostic value for adverse events when analyzed using univariable Cox hazard ratio regression (p = 0.007, p = 0.011, and p = 0.007, retrospectively). When each of the three features was analyzed using a multivariable Cox regression model that included the clinical parameter (systolic blood pressure) and LGE extent, they were found to be independently associated with adverse outcomes.Conclusion: Texture features related LGE heterogeneities and variations (GLCM_contrast, GLCM_difference average, and GLCM_difference entropy) are novel markers for risk stratification toward adverse events in DCM patients with severe systolic dysfunction.

scholarly journals Cardiac magnetic resonance derived global longitudinal strain outperfoms established functional parameters in prognostication after ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Holzknecht ◽  
M Reindl ◽  
C Tiller ◽  
I Lechner ◽  
T Hornung ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Independent Predictor ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
St Elevation

Abstract Background Left ventricular ejection fraction (LVEF) is the parameter of choice for left ventricular (LV) function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI); however, its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far. Purpose We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in the acute stage post-STEMI for the occurrence of major adverse cardiac events (MACE). Methods This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2–4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure. Results During a follow-up of 21 [IQR: 12–50] months, 40 (10%) patients experienced MACE. LVEF (p=0.005), MAPSE (p=0.001) and GLS (p&lt;0.001) were significantly related to MACE. GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63–0.79; p&lt;0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58–0.75; p=0.001) and LVEF (AUC: 0.64, 95% CI 0.54–0.73; p=0.005). After multivariable analysis, GLS emerged as sole independent predictor of MACE (HR: 1.22, 95% CI 1.11–1.35; p&lt;0.001). Of note, GLS remained associated with MACE (p&lt;0.001) even after adjustment for infarct size and microvascular obstruction. Conclusion CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage. Funding Acknowledgement Type of funding source: None

scholarly journals Assessment of Cerebrospinal Fluid Hydrodynamics Using Magnetic Resonance Imaging in Postcraniospinal Surgery Patients

2021 ◽  
Author(s):  
Pankaj Arora ◽  
Kanica Rawat ◽  
Rajiv Azad ◽  
Kehkashan Chouhan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Phase Contrast ◽  
Flow Dynamics ◽  
Resonance Imaging ◽  
Csf Flow ◽  
Group I ◽  
Group Ii

Abstract Objective Aim of this study is to evaluate the effect of craniospinal interventions on cerebrospinal fluid (CSF) flow hydrodynamics and study the correlation of postoperative changes in flow alteration with clinical outcome. Materials and Methods Fifty patients who underwent various craniospinal procedures were studied using conventional and phase-contrast magnetic resonance imaging (PCMRI) protocol. CSF flow quantification was performed at cerebral aqueduct, foramen magnum, C2–3, and D12–L1 vertebral levels with site showing maximal alteration of CSF flow dynamics considered as the region of interest. Velocity encoding was kept at 20 cm/s. Patients with pathology atcraniovertebral junction were considered separately (group I) from others (group II) due to different flow dynamics. Follow-up scans were performed after an interval of 1 month for temporal evaluation of changes in CSF flow dynamics. Results Patients in both groups showed a significant change in peak CSF velocity postoperatively (mean change of 1.34 cm/s in group I and 0.28 cm/s in group II) with bidirectional improvement in flow on cine-phase-contrast qualitative images. Regional pain (82%) and headache (46%) were seen in most of the patients preoperatively. Postoperatively clinical symptoms improved in 59.5%, static in 26.2%, and worsened in 14.3%. In both the groups, an improvement in clinical symptomatology had significant correlation with mean changes in peak CSF velocity postoperatively (p = 0.04 in both groups). Conclusion PCMRI can effectively evaluate changes in CSF flow noninvasively both pre- and postoperatively. This may have potential role in determining clinical outcome and prognosis of patients undergoing procedures in craniospinal axis.

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