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2.
Hypertension ; 74(5): 1192-1199, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31522619

RESUMO

Black Americans suffer disproportionately from hypertension and hypertensive heart disease. Out-of-office blood pressure (BP) is more predictive for cardiovascular complications than clinic BP; however, the relative abilities of clinic and out-of-office BP to predict left ventricular hypertrophy in black and white adults have not been established. Thus, we aimed to compare associations of out-of-office and clinic BP measurement with left ventricular hypertrophy by cardiac magnetic resonance imaging among non-Hispanic black and white adults. In this cross-sectional study, 1262 black and 927 white participants of the Dallas Heart Study ages 30 to 64 years underwent assessment of standardized clinic and out-of-office (research staff-obtained) BP and left ventricular mass index. In multivariable-adjusted analyses of treated and untreated participants, out-of-office BP was a stronger determinant of left ventricular hypertrophy than clinic BP (odds ratio per 10 mm Hg, 1.48; 95% CI, 1.34-1.64 for out-of-office systolic BP and 1.15 [1.04-1.28] for clinic systolic BP; 1.71 [1.43-2.05] for out-of-office diastolic BP, and 1.03 [0.86-1.24] for clinic diastolic BP). Non-Hispanic black race/ethnicity, treatment status, and lower left ventricular ejection fraction were also independent determinants of hypertrophy. Among treated Blacks, the differential association between out-of-office and clinic BP with hypertrophy was more pronounced than in treated white or untreated participants. In conclusion, protocol-driven supervised out-of-office BP monitoring provides important information that cannot be gleaned from clinic BP assessment alone. Our results underscore the importance of hypertension management programs outside the medical office to prevent hypertensive heart disease, especially in high-risk black adults. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00344903.


Assuntos
Afro-Americanos/estatística & dados numéricos , Monitorização Ambulatorial da Pressão Arterial/métodos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Imagem Cinética por Ressonância Magnética/métodos , Adulto , Fatores Etários , Anti-Hipertensivos/uso terapêutico , Teorema de Bayes , Determinação da Pressão Arterial/métodos , Estudos Transversais , Eletrocardiografia/métodos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/etnologia , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/etnologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Texas
3.
Hypertension ; 74(2): 295-304, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31291149

RESUMO

Subendocardial damage is among the first cardiac manifestations of hypertension and is already present in asymptomatic disease states. Accordingly, markers of subendocardial impairment may facilitate early detection of cardiac damages and risk stratification under these conditions. This study aimed to investigate the impact of subendocardial damage on myocardial microstructure and function to elucidate early pathophysiologic processes and to identify corresponding diagnostic measures. Mice (n=38) were injected with isoproterenol to induce isolated subendocardial scarring or saline as corresponding control. Cardiac function and myocardial deformation were determined by high-frequency echocardiography. The cardiac stress response was assessed in a graded exercise test and during dobutamine stress echocardiography. Myocardial microstructure was studied ex vivo by 7 T diffusion tensor magnetic resonance imaging at a spatial resolution of 100×100×100 µm 3 . Results were correlated with histology and biomarker expression. Subendocardial fibrosis was accompanied by diastolic dysfunction, impaired longitudinal deformation (global peak longitudinal strain [LS]: -12.5±0.5% versus -15.6±0.5%; P<0.001) and elevated biomarker expression (ANP [atrial natriuretic peptide], Galectin-3, and ST2). Systolic function and cardiac stress response remained preserved. Diffusion tensor magnetic resonance imaging revealed a left-shift in helix angle towards lower values in isoproterenol-treated animals, which was mainly determined by subepicardial myofibers (mean helix angle: 2.2±0.8° versus 5.9±1.0°; P<0.01). Longitudinal strain and subepicardial helix angle were highly predictive for subendocardial fibrosis (sensitivity, 82%-92% and specificity, 89%-90%). The results indicate that circumscribed subendocardial damage alone can cause several hallmarks observed in cardiovascular high-risk patients. Microstructural remodeling under these conditions involves also remote regions, and corresponding changes in longitudinal strain and helix angle might serve as diagnostic markers.


Assuntos
Endocárdio/patologia , Interpretação de Imagem Assistida por Computador , Isoproterenol/efeitos adversos , Imagem Cinética por Ressonância Magnética/métodos , Disfunção Ventricular Esquerda/diagnóstico por imagem , Animais , Biópsia por Agulha , Modelos Animais de Doenças , Ecocardiografia/métodos , Endocárdio/diagnóstico por imagem , Endocárdio/lesões , Fibrose/diagnóstico por imagem , Fibrose/patologia , Alemanha , Humanos , Imuno-Histoquímica , Injeções Subcutâneas , Isoproterenol/administração & dosagem , Modelos Lineares , Camundongos , Camundongos Endogâmicos , Curva ROC , Distribuição Aleatória , Valores de Referência , Volume Sistólico/fisiologia , Análise de Sobrevida , Disfunção Ventricular Esquerda/patologia
4.
Int Heart J ; 60(4): 938-943, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308320

RESUMO

The literature on malignant cardiac tumors is relatively limited because they are rare, especially among the Chinese population. We analyzed 14 patients diagnosed with malignant cardiac tumors in Fuwai Hospital and present the results of surgical treatments on the tumors. The mean age at tumor diagnosis was 47 years in a male-dominated cohort. There was a high frequency of pericardial effusion and coronary artery involvement in our group. We compared the survival times of patients who received different treatments and found that surgery improved prognosis of tumors, especially for patients who underwent orthotopic heart transplantation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia/métodos , Neoplasias Cardíacas/diagnóstico , Imagem Cinética por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Biomarcadores Tumorais/análise , China/epidemiologia , Feminino , Neoplasias Cardíacas/mortalidade , Neoplasias Cardíacas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências
5.
J Comput Assist Tomogr ; 43(3): 410-415, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31082946

RESUMO

OBJECTIVE: Marfan syndrome is an autosomal-dominant genetic disorder caused by mutations in the fibrillin-1 gene. The condition is a connective tissue disease that frequently involves the cardiovascular system. The existence of a primary cardiomyopathy in Marfan syndrome, however, is controversial. The aims of this study were to investigate the prevalence of left ventricular dysfunction with both transthoracic echocardiography and cardiovascular magnetic resonance (CMR) in a cohort of Marfan syndrome patients and to investigate patterns of myocardial strain across the cohort. METHODS: We used an institutional database to identify all patients with a firm diagnosis of Marfan syndrome based on Ghent criteria. Inclusion required left ventricular ejection fraction (LVEF) to have been measured by both CMR and transthoracic echocardiography within 12 months of each other. Normal LVEF was defined as a value of >55% when measured by CMR. Velocity vector imaging was used to measure left ventricular longitudinal strain patterns by application of feature tracking to cine magnetic resonance images. Results were compared with data from 20 age-matched control subjects. RESULTS: Sixty-nine Marfan syndrome patients met the inclusion criteria. The mean age was 35.4 ± 15.0 years, and 56.5% were male. The mean LVEF was 59.0% ± 7.0% by CMR and 59.1% ± 5.8% by echo. One-fifth of Marfan syndrome patients (15/69; 21.7%) had reduced function with LVEF ≤55% by CMR, but only 5 of these were identified by echo. Furthermore, echo identified 5 Marfan syndrome patients as having reduced LVEF in the presence of a normal LVEF by CMR. Some Marfan syndrome patients had abnormal longitudinal strain patterns even with LVEF within the reference range. CONCLUSIONS: These data provide support for a primary cardiomyopathy in some Marfan syndrome patients. Cardiovascular magnetic resonance is more sensitive than echo for identifying cases with mild systolic dysfunction. Strain analysis may be more sensitive than simple LVEF assessment for identifying at-risk individuals.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Síndrome de Marfan/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Adulto , Cardiomiopatias/etiologia , Estudos de Coortes , Ecocardiografia , Feminino , Humanos , Masculino , Síndrome de Marfan/diagnóstico por imagem , Síndrome de Marfan/fisiopatologia , Pessoa de Meia-Idade , Adulto Jovem
6.
Bone Joint J ; 101-B(5): 540-546, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31039002

RESUMO

AIMS: Cardiac magnetic resonance (CMR) was used to assess whether cardiac function or tissue composition was affected in patients with well-functioning metal-on-metal hip resurfacing arthroplasties (MoMHRA) when compared with a group of controls, and to assess if metal ion levels correlated with any of the functional or structural parameters studied. PATIENTS AND METHODS: In all, 30 participants with no significant cardiac history were enrolled: 20 patients with well-functioning MoMHRA at mean follow-up of 8.3 years post-procedure (ten unilateral, ten bilateral; 17 men, three women) and a case-matched control group of ten non-MoM total hip arthroplasty patients (six men, four women). The mean age of the whole cohort (study group and controls) at the time of surgery was 50.6 years (41.0 to 64.0). Serum levels of cobalt and chromium were measured, and all patients underwent CMR imaging, including cine, T2* measurements, T1 and T2 mapping, late gadolinium enhancement, and strain measurements. RESULTS: None of the MoMHRA patients showed clinically significant cardiac functional abnormality. The MoMHRA patients had larger indexed right and left end diastolic volumes (left ventricular (LV): 74 ml/m2 vs 67 ml/m2, p = 0.045; right ventricular: 80 ml/m2 vs 71 ml/m2, p = 0.02). There was a small decrease in T2 time in the MoMHRA patients (median 49 ms vs 54 ms; p = 0.0003). Higher metal ion levels were associated with larger LV volumes and with shorter T2 time. CONCLUSION: Although cardiac function is not clinically adversely affected in patients with well-functioning MoMHRA, modern imaging is able to demonstrate subtle changes in structure and function of the heart. As these changes correlate with systemic ion measurements, they may be consequences of wear debris deposition. Longer, longitudinal studies are necessary to determine whether cardiac function will become affected. Cite this article: Bone Joint J 2019;101-B:540-546.


Assuntos
Artroplastia de Quadril/efeitos adversos , Coração/diagnóstico por imagem , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Imagem Cinética por Ressonância Magnética/métodos , Próteses Articulares Metal-Metal/efeitos adversos , Adulto , Idoso , Estudos de Casos e Controles , Cromo/sangue , Cobalto/sangue , Feminino , Coração/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia
7.
Eur Radiol ; 29(7): 3686-3695, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31041566

RESUMO

OBJECTIVES: To assess the incidence of acute adverse events (AAEs) in gadolinium-enhanced cardiac magnetic resonance (CMR) imaging. METHODS: Gadolinium-based contrast agent (GBCA)-enhanced CMR data from the multinational, multicenter European Society of Cardiovascular Radiology MRCT Registry was included. AAE severity was classified according to the American College of Radiology Manual on Contrast Media (mild, moderate, severe). Multivariable generalized linear mixed effect models were used to assess the likelihood of AAEs in various GBCA, adjusting for pharmacological stressor, main indications (i.e., suspected or known coronary artery disease or myocarditis), age, sex, and submitting center as a random effect. RESULTS: In the study population of 72,839 GBCA-enhanced CMRs, a total of 260 AAEs were reported (0.36%), with a minority of severe AAEs (n = 24, 0.033%). Allergic-like AAEs were less likely than physiologic AAEs (29% versus 71%). Patients without pharmacological stress imaging had a lower AAE rate (0.22%) compared to stress imaging (0.75%), with the highest AAE rates for regadenoson (2.95%). AAE rates also varied by GBCA subtype (overall p < 0.001). There was significant interaction between GBCA and pharmacological stressor (interaction p = 0.025), with AAE rates ranging between 0 and 10% for certain GBCA/stressor combinations. There was further marginal evidence that higher GBCA volume was associated with higher AAE incidence (OR = 1.02, p = 0.05). CONCLUSION: GBCA-enhanced CMR imaging demonstrates low AAE rates comparable to those of other body regions. AAE likelihood correlates with GBCA subtype, pharmacological stressor, and imaging indication. Intravenous fluid administration in patients with cardiac impairment might contribute to these findings. KEY POINTS: • Acute adverse event rates in cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents (GBCAs) are low (0.36%), especially for severe adverse events (0.033%). • Mild and moderate adverse events are more frequent during stress CMR imaging. • Physiologic AAEs are more common than allergic AAEs in CMR imaging.


Assuntos
Doenças Cardiovasculares/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Imagem Cinética por Ressonância Magnética/efeitos adversos , Compostos Organometálicos/efeitos adversos , Radiologia , Sistema de Registros , Sociedades Médicas , Doença Aguda , Administração Intravenosa , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Estudos Retrospectivos
8.
Int J Cardiovasc Imaging ; 35(9): 1683-1689, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31037474

RESUMO

The acquisition of short-axis (SA) cine magnetic resonance (MR) images after the administration of contrast agent (CA) is a common, time-saving technique, but a decreased difference in the blood-myocardium contrast on these steady-state free precession (SSFP) cine scans could change the calculated parameters when using threshold-based papillary and trabecular muscle (PTM) quantification. We studied the effect of CA on the parameters calculated from pre- and post-CA SA cine images in noncompaction cardiomyopathy (NC-CMP) and healthy (H) participants using a threshold-based module. A total of 39 individuals (20 patients and 19 healthy) were included prospectively in this study. After the pre-CA SA images were acquired, i.v. gadobutrol (GA) or gadobenate dimeglumine (GD) (GA vs. GD: NC-CMP = 12 vs. 8; C = 12 vs. 7) was administered, and SA scans were repeated after two minutes. A threshold-based PTM software was used for postprocessing. Pre-CA and post-CA SA images were analyzed, and the parameters were compared in both the NC-CMP and H groups. The left ventricular volumes were significantly larger, while the left ventricular myocardial (LVmass) and trabecular mass (LVtrab) values were significantly smaller on the post-CA scans (NC-CMP: pre-CA vs. post-CA, EDV: 74.0 ± 13.6 vs. 81.1 ± 16.3 ml/m2, ESV: 25.3 ± 7.3 vs. 30.1 ± 11.2 ml/m2, LVmass-ED: 82.5 ± 17.5 vs. 75.7 ± 15.9 g/m2, LVtrab-ED: 25.0 ± 6.6 vs. 18.9 ± 4.7 g/m2; Healthy: preCA vs. post-CA, EDV: 69.7 ± 11.9 vs. 72.2 ± 10.7 ml/m2, ESV: 22.6 ± 5.7 vs. 23.9 ± 6.3 ml/m2, LVmass-ED: 71.3 ± 13.6 vs. 68.7 ± 13.9 g/m2, LVtrab-ED: 19.4 ± 2.6 vs. 16.2 ± 3.0 g/m2; p < 0.05). The decreased blood-myocardium contrast difference on post-CA SSFP SA cine images leads to altered cardiac parameters when using threshold-based software for evaluation.


Assuntos
Meios de Contraste/administração & dosagem , Ventrículos do Coração/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Miocárdio Ventricular não Compactado Isolado/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética/métodos , Meglumina/análogos & derivados , Compostos Organometálicos/administração & dosagem , Software , Volume Sistólico , Função Ventricular Esquerda , Adulto , Fenômenos Biomecânicos , Estudos de Casos e Controles , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Miocárdio Ventricular não Compactado Isolado/fisiopatologia , Masculino , Meglumina/administração & dosagem , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Adulto Jovem
9.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088894

RESUMO

Cardiac rhabdomyoma is the most common neonatal cardiac tumor and is typically associated with tuberous sclerosis complex (TSC). Although these tumors may naturally regress, some patients require surgical resection because of cardiac instability. If not fully resected, patients may also require medical therapy to improve their hemodynamics. Everolimus, a mammalian target of rapamycin inhibitor, has shown promise in reducing rhabdomyoma in patients with TSC, but the drug's impact in patients without TSC has not been reported. Monitoring of tumor response has typically been limited to echocardiograms, which is not ideal given inherent difficulties in three-dimensional measurements. We report a case of sporadic cardiac rhabdomyoma in a neonate treated with everolimus resulting in tumor regression as documented by cardiac MRI. While on everolimus, our patient had an increased incidence of a preexisting arrhythmia, which resolved with planned cessation of therapy, suggesting that close monitoring is imperative in patients with arrhythmia.


Assuntos
Everolimo/administração & dosagem , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/tratamento farmacológico , Imagem Cinética por Ressonância Magnética , Rabdomioma/diagnóstico por imagem , Rabdomioma/tratamento farmacológico , Administração Intravenosa , Antineoplásicos/administração & dosagem , Humanos , Lactente , Imagem Cinética por Ressonância Magnética/métodos , Resultado do Tratamento
10.
Int J Cardiovasc Imaging ; 35(10): 1913-1924, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31144257

RESUMO

Hypertrophic cardiomyopathy (HCM) is characterized by myocardial disarray, hypertrophy, and fibrosis. Reduced global longitudinal strain and presence of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) have been associated with an adverse prognosis. This study evaluated 3D principal and conventional strain characteristics of non-enhanced myocardium in patients with HCM. 3D principal and conventional strain analysis was conducted in 51 HCM patients and 38 healthy controls. Principal strain was reduced within the non-enhanced myocardium of HCM as compared with controls (maximum principal: 51.5 ± 23.7 vs. 75.1 ± 21.4%, P < 0.0001; minimum principal: - 18.4 ± 4.0 vs. - 20.1 ± 2.9%, P < 0.05). Principal strain within the non-enhanced myocardium was incrementally reduced in HCM patients with extensive global LGE ( ≥ 15%) (maximum principal: 41.6 ± 17.5 vs. 56.9 ± 25.9%, P < 0.05; minimum principal: - 16.9 ± 3.9 vs. - 19.1 ± 4.0%, P = 0.1), as was longitudinal ( - 10.5 ± 2.6 vs. - 12.7 ± 2.6%, P < 0.05) and circumferential strain ( - 11.0 ± 2.7 vs. - 14.0 ± 2.9%, P < 0.01). Principal strain within non-enhanced myocardium was significantly correlated with indexed LV mass (P < 0.0001), maximum (P = 0.0008), and mean wall thickness (P < 0.0001), but not LGE (P = 0.0841). In adjusted analysis, all strain measures within non-enhanced myocardium were independently associated with indexed LV mass (maximum principal: P = 0.0003; minimum principal: P = 0.0039; longitudinal: P = 0.0015; circumferential: P = 0.0002; radial: P = 0.0023). 3D principal strain of non-enhanced myocardium was significantly reduced in HCM patients as compared with controls, and was incrementally reduced among patients with more extensive global LGE. Comprehensive strain assessment may be considered in routine CMR assessment of HCM patients.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico por imagem , Imagem Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Contração Miocárdica , Adulto , Idoso , Fenômenos Biomecânicos , Cardiomiopatia Hipertrófica/fisiopatologia , Estudos de Casos e Controles , Meios de Contraste/administração & dosagem , Estudos Transversais , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , Valor Preditivo dos Testes
11.
Int J Cardiovasc Imaging ; 35(6): 1101-1109, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30929101

RESUMO

To explore the potential role of two- (2D) and three-dimensional (3D) cardiac magnetic resonance (CMR) feature tracking (FT) myocardial strain analysis in identifying sub-clinical myocardial systolic and diastolic dysfunction in acute myocarditis patients with preserved ejection fraction (EF). Prospective two centre study-control study. Thirty patients (9 female, 37.2 ± 11.8 years.) with a CMR diagnosis of acute myocarditis according to the Lake Louise Criteria and preserved EF (≥ 55%) were included in the analysis. CMR data from 24 healthy volunteers (11 female, 36.2 ± 12.5 years.) served as control. 2D and 3D LV tissue tracking analysis were performed in a random fashion by two double-blinded operators. Variables were checked for normality and analysed with parametric test. The baseline characteristics of myocarditis patients with preserved EF and the healthy volunteers were perfectly comparable, except for the LV mass index and T1 and T2 mapping values (p < 0.001). The results of the interobserver variability in the 2D and 3D LV CMR FT myocardial strain analysis were p > 0.42, ICC > 0.80 and η2 > 0.98. There was no statistical difference in 2D and 3D global radial, circumferential and longitudinal strain peak (%) and both systolic and diastolic strain rate (1/s) between acute myocarditis with preserved EF and healthy volunteers (all p = ns). There were no difference in 2D and 3D global radial, circumferential and longitudinal strain peak and both systolic and diastolic strain rate of the LV between acute myocarditis patients with preserved ejection fraction and healthy volunteers.


Assuntos
Imagem Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Contração Miocárdica , Miocardite/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Doença Aguda , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Itália , Masculino , Pessoa de Meia-Idade , Miocardite/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Disfunção Ventricular Esquerda/fisiopatologia , Adulto Jovem
12.
Eur J Radiol ; 113: 217-224, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927950

RESUMO

INTRODUCTION: T1 and T2 mapping have been shown to be reliable markers of interstitial myocardial fibrosis, edema, and inflammation. The aim of this study was to evaluate myocardial involvement in acute phase Takotsubo syndrome using native and post-contrast T1 mapping, ECV fraction, and T2 mapping. MATERIAL AND METHODS: We investigated 14 patients with acute Takotsubo syndrome and 14 healthy controls. CMR included cine imaging, black-blood STIR imaging, early and late gadolinium enhancement imaging, native and post-contrast T1 mapping, and T2 mapping. Wall motion, T2 ratio, early gadolinium enhancement ratio, extracellular volume fraction, T1 and T2 relaxation times were analyzed. RESULTS: Patients had significantly impaired left ventricular function (46 ± 10%) and acute wall motion abnormalities compared with controls (62 ± 2%). Native T1 and T2 values, T2 ratio, and ECV fraction were significantly higher in patients compared with controls. In patients, native T1 and T2 values as well as T2 ratio were significantly higher in segments with abnormal wall motion compared with normokinetic segments. Native T1 values, T2 relaxation times, T2 ratio, and ECV fraction were significantly higher, post-contrast T1 relaxation times significantly lower in segments with abnormal wall motion compared with segments of controls; except for T2 ratio and post-contrast T1 relaxation times this also held true for patients' segments with normal wall motion. CONCLUSIONS: Native T1 and T2 mapping, as well as ECV fraction, discriminate between visually affected vs. unaffected segments in patients with acute Takotsubo syndrome and reveal significant T1 and T2 tissue changes even in visually unaffected segments. Thus, mapping may allow for better detection in convalescent stages of disease and additionally may have the potential to serve as a marker of disease progress. These preliminary findings warrant further investigation in a larger patient cohort.


Assuntos
Cardiomiopatia de Takotsubo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cardiomiopatias/patologia , Meios de Contraste , Feminino , Fibrose/patologia , Gadolínio , Humanos , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Valor Preditivo dos Testes , Estudos Prospectivos , Cardiomiopatia de Takotsubo/fisiopatologia , Função Ventricular Esquerda/fisiologia
13.
Eur J Radiol ; 113: 51-58, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927959

RESUMO

BACKGROUND: Systolic strain and peak-early diastolic strain rate (PEDSR) measure subclinical cardiac dysfunction. These parameters can be derived from cardiovascular magnetic resonance (CMR) cine images using new software packages, but the comparative test-retest reproducibility of these software in disease states is unknown. This study compared the test-retest reproducibility of strain measures derived from two software packages (feature-tracking software (FT) and tissue-tracking (TT)) in disease populations with preserved ejection fractions. METHODS: This was a prospective study of 10 patients with aortic stenosis (AS), 10 haemodialysis patients and 10 diabetic patients at 1.5 and 3-Tesla. 30 subjects underwent test-retest reproducibility scans of global circumferential strain (GCS), global longitudinal strain (GLS), circumferential-PEDSR and longitudinal-PEDSR calculated using TT and FT software. RESULTS: Test-retest reproducibility of GCS and GLS were similar for FT and TT across patient groups. Coefficient of variability (CoV) for FT-derived GCS 8.1%, 5% and 7.9% for AS, diabetic and haemodialysis patients, compared to 3.3%, 9.2% and 5.4% for TT-derived GCS, with CoV for FT-derived GLS 8%, 6.4% and 8.2% for AS, diabetic and haemodialysis patients, compared to 5.3%, 4.8% and 7% for TT-derived GLS). Reproducibility of FT-derived circumferential and longitudinal-PEDSR was worse than TT-derived circumferential and longitudinal-PEDSR (CoV for FT-derived circumferential-PEDSR 18.2%, 18% and 17.4% for AS, diabetic and haemodialysis patients, compared to 6.1%, 11.7% and 11% for TT-derived circumferential-PEDSR with CoV for FT-derived longitudinal PEDSR 18.2%, 18.9%, 18.3% for AS, diabetic and haemodialysis patients, compared to 8.9%, 9.1% and 11.4% for TT-derived longitudinal-PEDSR). Bland-Altman analysis revealed no systematic bias with tighter limits of agreement for TT-derived strain measures. CONCLUSIONS: Reproducibility of GCS and GLS are excellent with FT and TT software across diseases. TT had superior test-retest reproducibility for quantification of longitudinal and circumferential-PEDSR than FT-derived PEDSR across diseases.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Software , Idoso , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Estresse Fisiológico/fisiologia , Volume Sistólico/fisiologia
14.
Int J Cardiovasc Imaging ; 35(7): 1339-1346, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30949869

RESUMO

To describe a novel time-resolved magnetic resonance angiography (TR-MRA) postprocessing technique using the time-resolved angiography with interleaved stochastic trajectories (TWIST) method to evaluate the pulmonary veins and left atrium in adults with congenital heart disease undergoing cardiac MRI. Institutional ethics committee approved the study. 21 consecutive adult patients (14 female, 7 male patients, mean age 28 years) with known congenital heart disease who underwent a cardiac MRI were included. Post-processing of the TR-MRA sequences created novel "subtracted" datasets. Two independent observers reviewed the conventional TWIST and novel subtracted TWIST data sets in source and maximum intensity projection (MIP) coronal reformats to assess visualization of the pulmonary veins and left atrium based on a 5-point scale. Quantitative signal to noise (SNR) comparison was performed. TR-MRA yielded diagnostic image data in 20/21 patients (95.2%). The novel "subtracted" TR-MRA technique improved visualization of the pulmonary veins and left atrium compared to the source TR-MRA sequence in 16/20 patients (mean scores 3.34 ± 0.69 vs. 2.92 ± 0.69, p < 0.008). Further improved visualization of the pulmonary veins and left atrium was observed in the subtracted MIP TWIST sequences compared to the MIP TWIST images (mean scores 4.43 ± 0.80 vs. 3.02 ± 0.87 vs., p < 0.001). No significant SNR difference between the source and novel subtracted group was observed (85.4 vs. 70.4, p = 0.57). Compared to source TR-MRA images, subtraction of TR-MRA images is a novel postprocessing technique that improves visualization of the pulmonary veins and left atrium in a substantial number of patients.


Assuntos
Átrios do Coração/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Flebografia/métodos , Veias Pulmonares/diagnóstico por imagem , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Átrios do Coração/anormalidades , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Veias Pulmonares/anormalidades , Processos Estocásticos , Fatores de Tempo , Adulto Jovem
15.
J Clin Neurosci ; 64: 141-144, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31000330

RESUMO

The ventriculoperitoneal (VP) shunt is a gold standard procedure to treat hydrocephalus. However, shunt malfunction is the common complications after surgery. In this study, we utilize phase-contrast cine magnetic resonance imaging (PC cine MRI) to improve the diagnosis of VP shunt malfunction. In in vitro and in vivo experiment results demonstrate the cerebrospinal fluid (CSF) flow velocities in the shunt tube are significantly decreased in the shunt malfunction group, which indicated PC cine MRI could evaluate the CSF flow dynamics of VP shunt effectively. This method is noninvasive and simple, also can improve the diagnosis of shunt malfunction.


Assuntos
Falha de Equipamento , Imagem Cinética por Ressonância Magnética/métodos , Neuroimagem/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Derivação Ventriculoperitoneal/efeitos adversos , Feminino , Humanos , Hidrocefalia/cirurgia , Masculino
16.
Diabetes Res Clin Pract ; 150: 72-80, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30844469

RESUMO

AIM: The aim of the study was to assess the extracellular volume fraction (ECV) in type 2 diabetes mellitus (T2DM) patients with different level of hemoglobin A1c (HbA1c) by cardiac magnetic resonance (CMR), and the ability of HbA1c to predict myocardial fibrosis. METHODS: In total, 80 T2DM patients and 20 age- and sex-matched controls were prospective enrolled and underwent CMR to obtain ECV value and LV function parameters. We divided all patients into a group of HbA1c < 7.0% and a group of HbA1c ≥ 7.0%. RESULTS: In the higher HbA1c group the ECV value (all p < 0.001) was higher than both lower HbA1c group (36.23% vs. 32.19%, p < 0.001) and controls (36.23% vs. 29.73%, p < 0.001). HbA1c was positively associated (ß = 0.36, p = 0.004) with ECV, and it was also an independent predictor of myocardial fibrosis (OR = 2.00, P = 0.014). The ROC analysis showed that 7.1% was the optimal cutoff value of HbA1c that predicted the risk of myocardial fibrosis with high diagnostic accuracy (area under the curve = 0.78). CONCLUSION: T1 mapping provided myocardial fibrosis information in T2DM patients. HbA1c is positively correlated with myocardial fibrosis and can be an independently predictor of myocardial fibrosis, which may be helpful for the clinical decision-making of blood glucose control.


Assuntos
Cardiomiopatias/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Fibrose/diagnóstico , Hemoglobina A Glicada/análise , Imagem Cinética por Ressonância Magnética/métodos , Cardiomiopatias/sangue , Cardiomiopatias/diagnóstico por imagem , Cardiomiopatias/etiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Fibrose/sangue , Fibrose/diagnóstico por imagem , Fibrose/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Curva ROC
17.
Future Cardiol ; 15(2): 119-126, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30848669

RESUMO

This review examined the relevance of chest pain, pericardial friction rub, pericardial effusion and ECG changes in regard to the diagnosis of acute pericarditis. It also assessed the evidence for the management and therapeutic guidelines, specifically nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine and corticosteroids. Overall, there appears to be a lack of research into pericarditis. The bulk of high-quality research seems to have been carried out prior to the publication of the European Society of Cardiology guidelines of 2015. Diagnostically, the current combination of symptoms, clinical signs and investigations offer reasonable criteria for diagnosis, but they are not a gold standard. Research into its therapeutic treatment options is required to address the effects of specific nonsteroidal anti-inflammatory drugs (NSAIDs).


Assuntos
Anti-Inflamatórios/uso terapêutico , Gerenciamento Clínico , Eletrocardiografia/métodos , Imagem Cinética por Ressonância Magnética/métodos , Pericardite/diagnóstico , Pericardite/terapia , Guias de Prática Clínica como Assunto , Doença Aguda , Biomarcadores/sangue , Diagnóstico Diferencial , Humanos , Troponina/sangue
18.
Pediatr Cardiol ; 40(4): 857-864, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30840104

RESUMO

Children with myocarditis have increased risk of ventricular tachycardia (VT) due to myocardial inflammation and remodeling. There is currently no accepted method for VT risk stratification in this population. We hypothesized that personalized models developed from cardiac late gadolinium enhancement magnetic resonance imaging (LGE-MRI) could determine VT risk in patients with myocarditis using a previously-validated protocol. Personalized three-dimensional computational cardiac models were reconstructed from LGE-MRI scans of 12 patients diagnosed with myocarditis. Four patients with clinical VT and eight patients without VT were included in this retrospective analysis. In each model, we incorporated a personalized spatial distribution of fibrosis and myocardial fiber orientations. Then, VT inducibility was assessed in each model by pacing rapidly from 26 sites distributed throughout both ventricles. Sustained reentrant VT was induced from multiple pacing sites in all patients with clinical VT. In the eight patients without clinical VT, we were unable to induce sustained reentry in our simulations using rapid ventricular pacing. Application of our non-invasive approach in children with myocarditis has the potential to correctly identify those at risk for developing VT.


Assuntos
Ventrículos do Coração/diagnóstico por imagem , Imagem Tridimensional/métodos , Imagem Cinética por Ressonância Magnética/métodos , Miocardite/complicações , Taquicardia Ventricular/diagnóstico por imagem , Adolescente , Criança , Simulação por Computador , Feminino , Gadolínio , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Projetos Piloto , Estudos Retrospectivos , Medição de Risco/métodos , Taquicardia Ventricular/etiologia
19.
Heart Fail Clin ; 15(2): 205-217, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30832812

RESUMO

A comprehensive multi-imaging evaluation of the right heart structure, function, and pressures represents an essential step in the diagnostic and prognostic algorithm of patients with heart failure. Furthermore, it provides important information for detecting early signs of right ventricular unfavorable remodeling, and consequently, guiding appropriate therapeutic interventions.


Assuntos
Insuficiência Cardíaca/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Direita/fisiologia , Doença Crônica , Ecocardiografia/métodos , Feminino , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Prognóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
20.
Heart Fail Clin ; 15(2): 219-227, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30832813

RESUMO

Secondary regurgitation caused by the remodeling and dysfunction of the left or right heart chamber may complicate heart failure, worsening both symptoms and prognosis. Outcome studies have shown that patients' prognosis worsened as the severity of secondary regurgitation increases. Imaging and more specifically echocardiography plays a central role for diagnosis and serial assessment of secondary regurgitation as well as for timing the intervention and guiding the procedure.


Assuntos
Insuficiência Cardíaca/complicações , Doenças das Valvas Cardíacas/etiologia , Ecocardiografia/métodos , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Prognóstico , Remodelação Ventricular
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