Myocardial Edema without Fibrosis by Magnetic Resonance T2 Mapping in Acute Chagas' Myocarditis

Introduction: Athletic cardiac adaptation is associated with structural changes that can overlap with disease states, unnecessarily limiting sports participation. Cardiovascular magnetic resonance (CMR) is useful in athlete’s heart and provides myocardial tissue characterization by T1 and T2 mapping. Hypothesis: CMR in competitive athletes will show abnormal T1 and T2 mapping due to intense exercise induced myocardial edema that can overlap with myocarditis. Methods: CMR data including left ventricular ejection fraction (LVEF) and T1/T2 maps were collected using standardized protocols on a 1.5 T scanner and compared between competitive athletes (N = 18, 83% male, median age 20 years), clinical myocarditis (N = 42, 71% male, median age 23 years) and controls (N = 35, 86% male, median age 22 years) between 2016-2020. T2 values of <59 ms and native T1 <1080 ms were defined as normal per institutional data. Extracellular volume fraction (ECV) and late gadolinium enhancement (LGE) were compared between athlete and myocarditis groups. Results: Figure 1 (panel A) shows participating sport and indications for CMR in athletes. There were 11 athletes (61%) with elevated T2 values (>59 ms), of which 9 (82%) were without clinical myocarditis. Average T2, native T1, ECV, and LVEF are shown in panels B-E. T2 values were highest in myocarditis, followed by athletes and controls (p = 0.001). ECV was higher in myocarditis compared to athletes (p = 0.002). LGE was present in 8/18 athletes and 41/42 myocarditis patients. 6 athletes had follow-up CMR after a period of deconditioning, with 3 (50%) demonstrating an improvement in T2 values and LGE. Conclusions: To conclude, we demonstrate abnormalities on T2 mapping in athletes consistent with myocardial edema or inflammation. Changes in T2 may be related to intense training. Additional studies are required to prospectively evaluate athletes for normative T1 and T2 mapping values, relationship to training, and their correlation with LGE.

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Myocardial edema, interstitial expansion and clinical correlates in takotsubo syndrome: a cardiac magnetic resonance tissue mapping study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab090.029 ◽

2021 ◽

Vol 22 (Supplement_2) ◽

Author(s):

L Arcari ◽

G Camastra ◽

F Ciolina ◽

M Danti ◽

R Semeraro ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

T2 Mapping ◽

Interventricular Septum ◽

Extracellular Volume ◽

Myocardial Edema ◽

Takotsubo Syndrome ◽

Native T1 ◽

Tissue Mapping ◽

Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Background takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by transient systolic dysfunction, widespread myocardial edema and not trivial rate of in-hospital complications. Tissue mapping by cardiac magnetic resonance (CMR) imaging provides measure of myocardial interstitial expansion. Few studies to date comprehensively examined native T1, T2 and extracellular volume (ECV) quantification by CMR in TTS. Purpose to describe T1 and T2 mapping findings by cardiac magnetic resonance (CMR) imaging in a cohort of TTS patients and control subjects. Methods we performed CMR imaging with native T1 and T2 mapping assessment as well as ECV and late gadolinium enhancement (LGE) imaging in n = 14 TTS patients at a median of 4 (3, 7) days after the acute event. Control group consisted of n = 14 healthy individuals with no known prior acute cardiac events. Extracellular-volume (ECV) fraction estimate was derived from native and post-contrast T1 of myocardium and blood pool corrected for hematocrit as reported in literature. All mapping measurements were performed in the interventricular septum from the mid-short-axis view. Results median age of the study population was 72 years, 84% female. Typical apical ballooning was present in 72% of the patients, atypical in 28%, with median left ventricular ejection fraction (LVEF) of 45%; mid interventricular septum was involved in all patients based on the presence of wall motion abnormalities at hospital admission. Median native T1, T2 and ECV were 1078 msec vs 965 msec, 55 msec vs 47 msec and 29% vs 25% in TTS and controls respectively (p < 0.001 for all). A significant direct correlation was found between T2 and both native T1 and ECV in TTS (r = 0.759, p = 0.002 and r = 0.630, p = 0.018 respectively) but not in controls. Moreover, in TTS patients, native T2 inversely correlated with LVEF as assessed at hospital admission (r=-0.563, p = 0.037), whereas non-significant trends were observed between admission LVEF and both native T1 and ECV. No LGE was detected neither in TTS patients nor in controls. Conclusions myocardial edema, as signified by increased T2, is a prominent feature of TTS, likely driving interstitial expansion and increase of native T1 and ECV in the acute phase. Correlation of T2 with LVEF on admission suggests that CMR-based parametric assessment of myocardial edema could contribute to better characterize disease severity in TTS.

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PREVALENCE OF MYOCARDIAL EDEMA WITH T2 MAPPING IN HYPERTROPHIC CARDIOMYOPATHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02661-9 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1303

Author(s):

Mirza Baig ◽

Patrycja Galazka ◽

Omar Dakwar ◽

Sameh A. Syed ◽

Rahul Sawlani ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

T2 Mapping ◽

Myocardial Edema

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POS0886 COULD BE INTERSTITIAL MYOCARDITIS A FEATURE OF THE ANTISYNTHETASE SYNDROME?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3696 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 699.1-699

Author(s):

A. Gil-Vila ◽

G. Burcet ◽

A. Anton-Vicente ◽

D. Gonzalez-Sans ◽

A. Nuñez-Conde ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Late Gadolinium Enhancement ◽

Magnetic Resonance ◽

Interstitial Lung Disease ◽

Cardiac Involvement ◽

T2 Mapping ◽

Extracellular Volume ◽

Interstitial Tissue ◽

Antisynthetase Syndrome ◽

Gadolinium Enhancement

Background:Antisynthetase syndrome (ASS) is characterized by inflammatory myopathy, interstitial lung disease, arthritis, mechanical hands and Raynaud phenomenon, among other features. Recent studies have shown that idiopathic inflammatory myopathies (IIM) may develop cardiac involvement, either ischemic (coronary artery disease) or inflammatory (myocarditis). We wonder if characteristic lung interstitial involvement (interstitial lung disease) that appears in patients with the ASS may also affect the myocardial interstitial tissue. New magnetic resonance mapping techniques could detect subclinical myocardial involvement, mainly as edema (increase extracellular volume in interstitium and extracellular matrix), even in the absence of visible late Gadolinium enhancement (LGE).Objectives:Our aim was to describe the presence of interstitial myocarditis in a group of patients with ASS.Methods:Cross-sectional, observational study performed in a tertiary care center. We included 13 patients diagnosed with ASS (7 male, 53%, mean (SD) age at diagnosis 56,8 years (±11,8)). The patients were consecutively selected from our outpatient myositis clinic. Myositis specific and associated antibodies were performed by means of line immunoblot (EUROIMMUN©). Cardiac magnetic resonance (CMR) was performed on all patients. The study protocol includes functional cine magnetic resonance and standard late gadolinium enhancement (LGE), as well as novel parametric T1 and T2 mapping sequences (modified look locker inversion recovery sequences - MOLLI) with extracellular volume (ECV) calculation 20 minutes after the injection of a gadolinium-based contrast material.Results:CMR could not be performed in one patient due to anxiety. All patients studied (12) had a normal biventricular function, without alteration of segmental contraction. A third (4 out of 12, 33%) of the studied patients showed elevated T2 myocardial values without focal LGE, half of them (2/4) with an elevated ECV, consistent with myocardial edema. Two patients with normal T2 values showed unspecific LGE focal patterns, one in the right ventricle union points and another with mild interventricular septum enhancement (Figure 1). None of the patients studied refer any cardiac symptomatology. All the four patients with T2 mapping alterations (100%) had interstitial lung involvement, but only 4 out of 8 (50%) of the rest ASS patients without T2 mapping positivity. The autoimmune profile was as follows: 10 anti-Jo1/Ro52, 1 anti-EJ/Ro52, 2 anti-PL12.Conclusion:Myocarditis, although subclinical, appears to be a feature in ASS patients. T1 and T2 mapping sequences might be valuable to detect and monitor subclinical cardiac involvement in these patients. The possibility that the same etiopathogenic mechanism may be involved in the interstitial tissue in lung and myocardium is raised. More studies must be done in order to assert the prevalence of myocarditis in ASS.References:[1]Dieval C et al. Myocarditis in Patients With Antisynthetase Syndrome: Prevalence, Presentation, and Outcomes. Medicine (Baltimore). 2015 Jul;94(26):e798.[2]Myhr KA, Pecini R. Management of Myocarditis in Myositis: Diagnosis and Treatment. Curr Rheumatol Rep. 2020 Jul 22; 22:49.[3]Sharma K, Orbai AM, Desai D, Cingolani OH, Halushka MK, Christopher-Stine L, Mammen AL, Wu KC, Zakaria S. Brief report: antisynthetase syndrome-associated myocarditis. J Card Fail. 2014 Dec;20(12):939-45.Figure 1.Cardiac magnetic resonance images from ASS patients.Disclosure of Interests:None declared

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ORAL AB QUICK FIRE I1496Myocardial substrates underlyng early ventricular arrhythmias in st-elevation acute myocardial infarction: the role of cardiac magnetic resonance1416Cardiac magnetic resonance predicts atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy1469T1 and T2 mapping cardiovascular magnetic resonance to monitor inflammatory activity in patients with myocarditis1480Impact of electronic coaching on cardiovascular risk reduction in a high-risk primary prevention population – A cardiovascular magnetic resonance sub-study1598Anatomical and functional evaluation of postinterventional pulmonary vein stenosis by magnetic resonance imaging1364Reduced infarct-adjacent wall thickening and impaired restperfusion in the area at risk of successfully reperfused acute myocardial infarction1580Correlation between circulating microRNA 29 and diffuse myocardial fibrosis, assessed by T1 mapping, in patients affected by non ischemic dilative cardiomyopathy1435Association of Smoking with Myocardial Injury and Clinical Outcome in Patients Undergoing Mechanical Reperfusion for ST-Elevation Myocardial Infarction1640Assessing the risk of late cardiotoxicity in low risk breast cancer survivors receiving contemporary anthracycline treatment: a 6 year 100 patient study1511Risk stratification in sarcoidosis: Incidence of cardiac sarcoidosis in individuals diagnosed with extra-cardiac disease by cardiovascular magnetic resonance1334Patterns of late gadolinium enhancement in Brugada syndrome1591Detailed Left Atrial Assessment in Anderson Fabry Disease1634Role of cardiac magnetic resonance in the diagnosis of ARVC/D mimics1321Comparison of transtlioracic ecliocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patients: Table 1.

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jew179 ◽

2016 ◽

Vol 17 (suppl 1) ◽

pp. i4-i9

Author(s):

Susana Angela ◽

Claudia Camaioni ◽

S. Bohnen ◽

Mohammed Y. Khanji ◽

Sebastian Hilbert ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Primary Prevention ◽

Magnetic Resonance ◽

T2 Mapping ◽

Pulmonary Vein Stenosis ◽

Wall Thickening ◽

Circulating Microrna ◽

Functional Evaluation ◽

Late Cardiotoxicity ◽

St Elevation

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Abstract 10378: Characterization of Changes in Cardiac Structure and Function in Mice Treated With Anthracyclines Using Serial Cardiac Magnetic Resonance Imaging

Circulation ◽

10.1161/circ.132.suppl_3.10378 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Pedro V Staziaki ◽

Hoshang Farhad ◽

Otávio Coelho-Filho ◽

Ravi V Shah ◽

Richard N Mitchell ◽

...

Keyword(s):

Cardiac Magnetic Resonance ◽

Magnetic Resonance ◽

Myocardial Fibrosis ◽

Myocardial Edema ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Post Contrast ◽

Cardiac Edema ◽

Early Increase ◽

Acute Increase

Introduction: Anthracyclines are a standard chemotherapeutic agent. However, the anthracyclines are associated with a late reduction in left ventricular ejection fraction (LVEF) and heart failure. Pathologically, anthracycline-induced cardiotoxicity (AIC) is characterized by the development of cardiac edema and fibrosis and cardiac magnetic resonance (CMR) is the gold-standard imaging technique for edema and fibrosis. Hypothesis: We hypothesized that a) cardiac edema and fibrosis would be detected by CMR after anthracyclines and b) edema and fibrosis would provide prognostic information. Methods: We performed a longitudinal CMR and histological study of 45 wild-type mice randomized to doxorubicin (DOX, n=30, 5 mg/kg/week for 5 weeks) or placebo (n=15). Measurements were performed at baseline, 5, 10, and 20 weeks after DOX or placebo. Measures of interest were LVEF, myocardial edema and fibrosis. Edema was assessed by T2 mapping, fibrosis by calculating the extracellular volume (ECV) from pre- and post-contrast T1 measurements. Results: In DOX-treated mice vs. placebo, myocardial edema at 5 weeks was increased (T2 values of 32±4 vs. 21±3 ms, P<0.05, Fig. A), while LVEF was unchanged. At 10 weeks, there was a reduction in LVEF (54±6 vs. 63±5% μL, P<0.05) and an increase in myocardial fibrosis (ECV of 0.34±0.03 vs. 0.27±0.03, P<0.05, Fig. B). There was a correlation between T2 measures and cardiac water weight (r=0.79, P=0.007, Fig. C) and between the ECV and histological myocardial fibrosis (r=0.90, P<0.001; Fig. D). Both the early increase in edema and the sub-acute increase in fibrosis predicted the late DOX-induced mortality (P<0.001, Fig. E and F). Conclusions: Our data suggest that, in mice, CMR can detect the early increase in edema and sub-acute increase in fibrosis after anthracyclines, that an increase in edema precedes a reduction in LVEF, that the increase in edema and fibrosis are linked and both are predictive of late animal mortality.

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