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In-vivo assessment of myocardial calcium uptake using manganese-enhanced cardiovascular magnetic resonance in aortic stenosis. 利用锰增强核磁共振成像对主动脉瓣狭窄患者的心肌钙摄取进行体内评估
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-02 DOI: 10.1016/j.jocmr.2024.101074
Abhishek Dattani, Saadia Aslam, Gaurav S Gulsin, Aseel Alfuhied, Trisha Singh, Shruti S Joshi, Lucy E Kershaw, David E Newby, Gerry P McCann, Anvesha Singh

Background: Dysregulated myocardial calcium handling has been demonstrated in ischemic, non-ischemic and diabetic cardiomyopathy. Manganese-enhanced MRI (MEMRI) provides a unique method to quantify in-vivo myocardial calcium uptake but no studies have so far utilized MEMRI in patients with aortic stenosis (AS). We sought to: 1) determine whether myocardial calcium uptake is perturbed in people with severe AS, and 2) assess change in calcium uptake following aortic valve replacement (AVR).

Methods: In this prospective, pilot, case-control study, adults with severe AS underwent MEMRI before and after AVR. A group of healthy controls were also recruited. The primary outcome was the rate of manganese uptake (Ki) as assessed by Patlak modeling to act as a surrogate of myocardial calcium uptake. Comparison of Ki between groups was adjusted for age, body mass index (BMI) and systolic blood pressure.

Results: Twenty-eight controls and ten subjects with severe AS (age 72 [61-75] years, 8 male, 7 symptomatic, valve area 0.81 [0.74-1.0] cm2) were recruited, with seven returning for repeat scans post-AVR. AS patients had higher BMI and blood pressure, and a greater incidence of hyperlipidemia compared to controls. Baseline left ventricular (LV) volumes were similar between the groups, but the AS patients had higher indexed left ventricular mass. Global longitudinal strain and peak early diastolic strain rate were lower in the AS group. There was no significant difference in Ki between patients with severe AS and controls (7.09 [6.33-8.99] vs. 8.15 [7.54-8.78] mL/100g of tissue/min, P=0.815). Following AVR, there was regression in indexed LV mass (68 [51-79] to 49 [47-65] g/m2, P=0.018) and mass-volume ratio (0.94 [0.80-1.13] to 0.74 [0.71-0.82] g/mL, P=0.028) but no change in Ki was seen (7.35 [6.81-8.96] to 7.11 [6.16-8.01] mL/100 g of tissue/min, P=0.499).

Conclusions: Despite clear features of adverse LV remodeling and systolic dysfunction, patients with severe AS demonstrated no alteration in calcium uptake at baseline compared to controls. Moreover, AVR led to reverse LV remodeling but no notable change in calcium uptake was seen. This may suggest that altered myocardial calcium handling does not play a significant pathophysiological role in AS.

背景:缺血性、非缺血性和糖尿病性心肌病均可导致心肌钙处理失调。锰增强磁共振成像(MEMRI)提供了一种独特的方法来量化体内心肌钙摄取,但迄今为止还没有研究将 MEMRI 用于主动脉瓣狭窄(AS)患者。我们试图1)确定严重 AS 患者的心肌钙摄取是否受到干扰;2)评估主动脉瓣置换术(AVR)后钙摄取的变化:在这项前瞻性试点病例对照研究中,患有严重 AS 的成人在主动脉瓣置换术前后接受了 MEMRI 检查。同时还招募了一组健康对照者。主要结果是帕特拉克模型评估的锰摄取率(Ki),作为心肌钙摄取的替代指标。组间 Ki 的比较根据年龄、体重指数(BMI)和收缩压进行了调整:共招募了 28 名对照组和 10 名重度 AS 患者(年龄 72 [61-75] 岁,8 名男性,7 名有症状,瓣膜面积 0.81 [0.74-1.0] 平方厘米),其中 7 名患者在做完 AVR 后返回重复扫描。与对照组相比,强直性脊柱炎患者的体重指数(BMI)和血压更高,高脂血症的发病率也更高。两组患者的基线左心室(LV)容积相似,但AS患者的指数左心室质量更高。AS组的整体纵向应变和舒张早期峰值应变率较低。重度AS患者的Ki与对照组无明显差异(7.09 [6.33-8.99] vs. 8.15 [7.54-8.78] mL/100g组织/分钟,P=0.815)。AVR术后,指数左心室质量(68 [51-79] g/m2降至49 [47-65] g/m2,P=0.018)和质容比(0.94 [0.80-1.13] g/mL降至0.74 [0.71-0.82] g/mL,P=0.028)有所下降,但Ki无变化(7.35 [6.81-8.96] mL/100g组织/分钟降至7.11 [6.16-8.01] mL/100g组织/分钟,P=0.499):结论:尽管重度强直性脊柱炎患者具有明显的左心室重塑和收缩功能障碍的不良特征,但与对照组相比,其基线钙摄取量没有变化。此外,AVR导致左心室重塑逆转,但钙摄取量未见明显变化。这可能表明,心肌钙处理的改变在强直性脊柱炎中并不扮演重要的病理生理角色。
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引用次数: 0
Interval changes in four-dimensional flow-derived in vivo hemodynamics stratify aortic growth in type B aortic dissection patients. B 型主动脉夹层患者主动脉生长的四维血流推导活体血流动力学分层变化
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-02 DOI: 10.1016/j.jocmr.2024.101078
Joshua Engel, Ozden Kilinc, Elizabeth Weiss, Justin Baraboo, Christopher Mehta, Andrew Hoel, S Chris Malaisrie, Michael Markl, Bradley D Allen

Background: Aortic diameter growth in type B aortic dissection (TBAD) is associated with progressive aortic dilation, resulting in increased mortality in patients with both de novo TBAD (dnTBAD) and residual dissection after type A dissection repair (rTAAD). Preemptive thoracic endovascular aortic repair may improve mortality in patients with TBAD, although it is unclear which patients may benefit most from early intervention. In vivo hemodynamic assessment using four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has been used to characterize TBAD patients with growing aortas. In this longitudinal study, we investigated whether changes over time in 4D flow-derived true and false lumen (TL and FL) hemodynamic parameters correlate with aortic growth rate, which is a marker of increased risk.

Methods: We retrospectively identified TBAD patients with baseline and follow-up 4D flow CMR at least 120 days apart. Patients with TBAD intervention before baseline or between scans were excluded. 4D flow CMR data analysis included segmentation of the TL and FL, followed by voxel-wise calculation of TL and FL total kinetic energy (KE), maximum velocity (MV), mean forward flow (FF), and mean reverse flow (RF). Changes over time (Δ) were calculated for all hemodynamic parameters. Maximal diameter in the descending aorta was measured from magnetic resonance angiogram images acquired at the time of 4D flow. Aortic growth rate was defined as the change in diameter divided by baseline diameter and standardized to scan interval.

Results: Thirty-two patients met inclusion criteria (age: 56.9 ± 14.1 years, female: 13, n = 19 rTAAD, n = 13 dnTBAD). Mean follow-up time was 538 days (range: 135-1689). Baseline aortic diameter did not correlate with growth rate. In the entire cohort, Δ FL MV (Spearman's rho [rho] = 0.37, p = 0.04) and Δ FL RF (rho = 0.45, p = 0.01) correlated with growth rate. In rTAAD only, Δ FL MV (rho = 0.48, p = 0.04) and Δ FL RF (rho = 0.51, p = 0.03) correlated with growth rate, while in dnTBAD only, Δ TL KE (rho = 0.63, p = 0.02) and Δ TL MV (rho = 0.69, p = 0.01) correlated with growth rate.

Conclusion: 4D flow-derived longitudinal hemodynamic changes correlate with aortic growth rate in TBAD and may provide additional prognostic value for risk stratification. 4D flow MRI could be integrated into existing imaging protocols to allow for the identification of TBAD patients who would benefit from preemptive surgical or endovascular intervention.

背景:B 型主动脉夹层(TBAD)的主动脉直径增长与主动脉逐渐扩张有关,导致新发 TBAD(dnTBAD)和 A 型夹层修复后残余夹层(rTAAD)患者的死亡率增加。先发制人的胸腔内血管主动脉修复术可能会改善 TBAD 患者的死亡率,但目前还不清楚哪些患者可以从早期干预中获益最多。利用四维(4D)血流磁共振成像(MRI)进行的体内血流动力学评估已被用于描述主动脉正在生长的 TBAD 患者的特征。在这项纵向研究中,我们调查了四维血流得出的真腔和假腔(TL、FL)血流动力学参数随时间的变化是否与作为风险增加标志的主动脉生长率相关:我们回顾性地确定了基线和随访 4D 血流 MRI 相隔至少 120 天的 TBAD 患者。基线前或两次扫描之间进行过 TBAD 干预的患者被排除在外。四维血流 MRI 数据分析包括对 TL 和 FL 进行分割,然后按体素计算 TL 和 FL 的总动能 (KE)、最大速度 (MV)、平均正向血流 (FF) 和平均反向血流 (RF)。计算所有血液动力学参数随时间的变化(Δ)。降主动脉的最大直径是根据 4D 血流时采集的 MR 血管造影图像测量的。主动脉增长率定义为直径变化除以基线直径,并根据扫描间隔进行标准化:32名患者符合纳入标准(年龄:56.9±14.1岁,女性:13人,n=19 rTAAD,n=13 dnTBAD)。平均随访时间为 538 天(范围:135-1689)。主动脉基线直径与生长速度无关。在整个队列中,ΔFL MV(rho=0.37,p=.04)和ΔFL RF(rho=0.45,p=0.01)与生长速度相关。仅在 rTAAD 中,Δ FL MV(rho=0.48,p=.04)和 Δ FL RF(rho=0.51,p=0.03)与生长速度相关,而仅在 dnTBAD 中,Δ TL KE(rho=0.63,p=.02)和 Δ TL MV(rho=0.69,p=.01)与生长速度相关:结论:4D血流得出的纵向血流动力学变化与TBAD的主动脉生长速度相关,可为风险分层提供额外的预后价值。四维血流 MRI 可以整合到现有的成像方案中,以便识别哪些 TBAD 患者可以从先期手术或血管内介入治疗中获益。
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引用次数: 0
Respiratory-resolved five-dimensional flow cardiovascular magnetic resonance : In-vivo validation and respiratory-dependent flow changes in healthy volunteers and patients with congenital heart disease. 呼吸分辨 5D 血流 MRI:健康志愿者和先天性心脏病患者的体内验证和呼吸相关血流变化。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-02 DOI: 10.1016/j.jocmr.2024.101077
Elizabeth K Weiss, Justin Baraboo, Cynthia K Rigsby, Joshua D Robinson, Liliana Ma, Mariana B L Falcão, Christopher W Roy, Matthias Stuber, Michael Markl

Background: This study aimed to validate respiratory-resolved five-dimensional (5D) flow cardiovascular magnetic resonance (CMR) against real-time two-dimensional (2D) phase-contrast MRI, assess the impact of number of respiratory states, and measure the impact of respiration on hemodynamics in congenital heart disease (CHD) patients.

Methods: Respiratory-resolved 5D flow MRI-derived net and peak flow measurements were compared to real-time 2D phase-contrast MRI-derived measurements in 10 healthy volunteers. Pulmonary-to-systemic flow ratios (Qp:Qs) were measured in 19 CHD patients and aortopulmonary collateral burden was measured in 5 Fontan patients. Additionally, the impact of number of respiratory states on measured respiratory-driven net flow changes was investigated in 10 healthy volunteers and 19 CHD patients (shunt physiology, n = 11, single ventricle disease [SVD], n = 8).

Results: There was good agreement between 5D flow MRI and real-time 2D phase-contrast-derived net and peak flow. Respiratory-driven changes had a good correlation (rho = 0.64, p < 0.001). In healthy volunteers, fewer than four respiratory states reduced measured respiratory-driven flow changes in veins (5.2 mL/cycle, p < 0.001) and arteries (1.7 mL/cycle, p = 0.05). Respiration drove substantial venous net flow changes in SVD (64% change) and shunt patients (57% change). Respiration had significantly greater impact in SVD patients compared to shunt patients in the right and left pulmonary arteries (46% vs 15%, p = 0.003 and 59% vs 20%, p = 0.002). Qp:Qs varied by 37 ± 24% over respiration in SVD patients and 12 ± 20% in shunt patients. Aortopulmonary collateral burden varied by 118 ± 84% over respiration in Fontan patients. The smallest collateral burden was measured during active inspiration in all patients and the greatest burden was during active expiration in four of five patients. Reduced respiratory resolution blunted measured flow changes in the caval veins of shunt and SVD patients (p < 0.005).

Conclusions: Respiratory-resolved 5D flow MRI measurements agree with real-time 2D phase contrast. Venous measurements are sensitive to number of respiratory states, whereas arterial measurements are more robust. Respiration has a substantial impact on caval vein flow, Qp:Qs, and collateral burden in CHD patients.

背景:本研究旨在验证呼吸分辨 5D 血流 MRI 与实时 2D 相位对比 MRI 的比较,评估呼吸状态数量的影响,并测量呼吸对先天性心脏病(CHD)患者血液动力学的影响:方法:在 10 名健康志愿者中,将呼吸分辨 5D 流量 MRI 得出的净流量和峰值流量测量值与实时 2D 相位对比 MRI 得出的测量值进行比较。在 19 名先天性心脏病患者中测量了肺血流与全身血流的比率(Qp:Qs),在 5 名丰坦患者中测量了主动脉-肺侧支负担。此外,还研究了 10 名健康志愿者和 19 名 CHD 患者(分流生理,11 人;单心室疾病(SVD),8 人)的呼吸状态数量对测量的呼吸驱动净血流变化的影响:结果:5D血流磁共振成像与实时二维相位对比得出的净血流和峰值血流之间有很好的一致性。呼吸驱动的变化具有良好的相关性(rho=0.64,p结论:呼吸分辨 5D 血流 MRI 测量结果与实时 2D 相位对比结果一致。静脉测量对呼吸状态的数量很敏感,而动脉测量则更稳健。呼吸对冠心病患者的腔静脉血流、Qp:Qs 和侧支负担有很大影响。
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引用次数: 0
Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy. 肥厚型心肌病中青年患者心肌加速纤维化
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-02 DOI: 10.1016/j.jocmr.2024.101072
Shiro Nakamori, Ethan J Rowin, Jennifer Rodriguez, Long H Ngo, Warren J Manning, Martin Maron, Reza Nezafat

Background: The extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death events. However, the clinical significance of age-specific longitudinal changes in LGE is not well characterized in HCM. We sought to assess whether the risk of LGE progression diverges between young to middle-aged (ages 20-59 years) and older (≥ 60) adults with HCM.

Methods: A total of 102 HCM patients (age <60 years; n=75, age ≥60 years; n=27) undergoing serial CMR studies from two tertiary medical centers were evaluated. The median time interval between initial and follow-up CMR scans was 3.7 years. LGE was semiautomatically quantified by measuring regions with signal intensity >6 SD above the nulled remote myocardium and manually adjusting a grayscale threshold.

Results: LGE was identified at baseline in 61 of the 102 HCM patients (60%), occupying 4.8 ± 3.9% of the left ventricular (LV) mass. At the end of the follow-up period, 53 of the 61 patients (87%) demonstrated an increase in the extent of LGE to 7.7 ± 5.4%, and 8 patients had no change. In 5 patients (5%), LGE increased to extensive with >15% of the LV mass. The rate of LGE progression was 0.7 ± 1.0%/year, including 21 patients (21%) with particularly accelerated progression of ≥1%/year. The risk of LGE progression ≥1%/year was significantly higher in patients <60 years than those ≥ 60 years (25% vs. 7%, p=0.03). The odds of LGE progression ≥1%/year was almost 4 times greater for patients <60 years compared with those ≥ 60 years (odds ratio, 4.2; 95%CI, 1.1-27.9). Age <60 years and LGE extent ≥ 10% were significant baseline predictors for future LGE progression ≥1%/year, even after adjustment for other potential risk factors.

Conclusion: In HCM, progressive fibrosis occurs more frequently in young to middle-aged patients, underscoring the importance of repeating CMR to re-evaluate for potential LGE progression in this age group.

背景:肥厚型心肌病(HCM)患者心血管磁共振(CMR)上的晚期钆增强(LGE)程度与心脏性猝死事件的风险增加有关。然而,LGE 的年龄特异性纵向变化在 HCM 中的临床意义尚不明确。我们试图评估中青年(20-59 岁)和老年(≥ 60 岁)HCM 患者的 LGE 进展风险是否存在差异:共有 102 名 HCM 患者(年龄在 6 SD 以上)对远端心肌进行了归零,并手动调整了灰度阈值:102 例 HCM 患者中有 61 例(60%)在基线时发现 LGE,占左心室(LV)质量的 4.8 ± 3.9%。在随访期结束时,61 名患者中有 53 名(87%)的 LGE 扩大到 7.7 ± 5.4%,8 名患者没有变化。有 5 名患者(5%)的 LGE 扩大到 LV 质量的 15%以上。LGE 的进展速度为 0.7 ± 1.0%/年,其中 21 例患者(21%)的进展速度特别快,≥1%/年。结论:在 HCM 患者中,进展性纤维化更多发生在中青年患者中,这就强调了重复 CMR 的重要性,以重新评估这一年龄组患者潜在的 LGE 进展。
{"title":"Accelerated myocardial fibrosis in young to middle-aged patients with hypertrophic cardiomyopathy.","authors":"Shiro Nakamori, Ethan J Rowin, Jennifer Rodriguez, Long H Ngo, Warren J Manning, Martin Maron, Reza Nezafat","doi":"10.1016/j.jocmr.2024.101072","DOIUrl":"10.1016/j.jocmr.2024.101072","url":null,"abstract":"<p><strong>Background: </strong>The extent of late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM) is associated with an increased risk of sudden cardiac death events. However, the clinical significance of age-specific longitudinal changes in LGE is not well characterized in HCM. We sought to assess whether the risk of LGE progression diverges between young to middle-aged (ages 20-59 years) and older (≥ 60) adults with HCM.</p><p><strong>Methods: </strong>A total of 102 HCM patients (age <60 years; n=75, age ≥60 years; n=27) undergoing serial CMR studies from two tertiary medical centers were evaluated. The median time interval between initial and follow-up CMR scans was 3.7 years. LGE was semiautomatically quantified by measuring regions with signal intensity >6 SD above the nulled remote myocardium and manually adjusting a grayscale threshold.</p><p><strong>Results: </strong>LGE was identified at baseline in 61 of the 102 HCM patients (60%), occupying 4.8 ± 3.9% of the left ventricular (LV) mass. At the end of the follow-up period, 53 of the 61 patients (87%) demonstrated an increase in the extent of LGE to 7.7 ± 5.4%, and 8 patients had no change. In 5 patients (5%), LGE increased to extensive with >15% of the LV mass. The rate of LGE progression was 0.7 ± 1.0%/year, including 21 patients (21%) with particularly accelerated progression of ≥1%/year. The risk of LGE progression ≥1%/year was significantly higher in patients <60 years than those ≥ 60 years (25% vs. 7%, p=0.03). The odds of LGE progression ≥1%/year was almost 4 times greater for patients <60 years compared with those ≥ 60 years (odds ratio, 4.2; 95%CI, 1.1-27.9). Age <60 years and LGE extent ≥ 10% were significant baseline predictors for future LGE progression ≥1%/year, even after adjustment for other potential risk factors.</p><p><strong>Conclusion: </strong>In HCM, progressive fibrosis occurs more frequently in young to middle-aged patients, underscoring the importance of repeating CMR to re-evaluate for potential LGE progression in this age group.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101072"},"PeriodicalIF":4.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Late gadolinium enhancement and the diagnosis of arrhythmogenic right ventricular cardiomyopathy. 晚期钆增强与 ARVC 诊断。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.1016/j.jocmr.2024.101075
David A Bluemke
{"title":"Late gadolinium enhancement and the diagnosis of arrhythmogenic right ventricular cardiomyopathy.","authors":"David A Bluemke","doi":"10.1016/j.jocmr.2024.101075","DOIUrl":"10.1016/j.jocmr.2024.101075","url":null,"abstract":"","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101075"},"PeriodicalIF":4.2,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11415338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141874865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reduced response to regadenoson with increased weight: An artificial intelligence-based quantitative myocardial perfusion study. 体重增加会降低对雷公藤多苷的反应:基于人工智能的定量心肌灌注研究。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-25 DOI: 10.1016/j.jocmr.2024.101066
Emmanouil Androulakis, Georgios Georgiopoulos, Alessia Azzu, Elena Surkova, Adam Bakula, Panagiotis Papagkikas, Alexandros Briasoulis, Ranil De Silva, Peter Kellman, Dudley Pennell, Francisco Alpendurada

Background: There is conflicting evidence regarding the response to a fixed dose of regadenoson in patients with high body weight. The aim of this study was to evaluate the effectiveness of regadenoson in patients with varying body weights using novel quantitative cardiovascular magnetic resonance (CMR) perfusion parameters in addition to standard clinical markers.

Methods: Consecutive patients with typical angina and/or risk factors for coronary artery disease (N = 217) underwent regadenoson stress CMR perfusion imaging using a dual-sequence quantitative protocol with perfusion parameters generated from an artificial intelligence (AI)-based algorithm. CMR was performed on 1.5T scanners using a standard 0.4 mg injection of regadenoson. A cohort of consecutive patients undergoing adenosine stress perfusion (N = 218) was used as a control group.

Results: An inverse association of myocardial perfusion reserve and weight (mean decrease -0.05 per 10 kg increase, 95% confidence interval [CI] -0.009/-0.0001, P = 0.045) was noted in the regadenoson group but not in patients stressed with adenosine (P = 0.77). Adjusted logistic regression analysis revealed a 10 kg increase resulted in 36% increased odds for inadequate stress response (odds ratio [OR] = 1.36, 95% CI 1.10-1.69, P = 0.005). Moreover, a significant interaction (OR = 1.09, 95% CI 1.02-1.16, P = 0.012) between stressor type (regadenoson vs adenosine) and weight was noted. This was also confirmed in the propensity-matched subgroup (P = 0.024) and was not attenuated after adjustment (P = 0.041). Body surface area (BSA) (P = 0.006) but not body mass index (P = 0.055) was differentially associated with inadequate response conditional to the stressor used, and this association remained significant after adjustment for confounders (P = 0.025). Patients in the highest quartile of weight (>93 kg) or BSA (>2.06 m2) had substantially increased odds for inadequate response with regadenoson (OR = 8.19, 95% CI 2.04-32.97, P = 0.003 for increased weight and OR = 7.75, 95% CI 1.93-31.13, P = 0.004 for increased BSA). Both weight and BSA had excellent discriminative ability for inadequate regadenoson response (receiver operating characteristic area under curves 0.84 and 0.83, respectively).

Conclusion: Using quantitative perfusion CMR in patients undergoing pharmacological stress with regadenoson, we found an inverse relationship between patient weight and both clinical response and myocardial perfusion parameters. A fixed-dose bolus approach may not be adequate to induce maximal hyperemia in patients with increased weight. Weight-adjusted stressors, such as adenosine, may be considered instead in patients with body weight >93 kg and BSA >2.06 m2.

背景:关于高体重患者对固定剂量瑞格列奈松的反应,存在相互矛盾的证据。本研究旨在评估雷加地诺松对不同体重患者的疗效,除了使用标准临床指标外,还使用了新型定量 CMR 灌注参数:具有典型心绞痛和/或冠状动脉疾病危险因素的连续患者(217 人)接受了雷加地诺松应激 CMR 灌注成像,该成像采用双序列定量方案,灌注参数由基于人工智能(AI)的算法生成。CMR 在 1.5T 扫描仪上进行,使用标准的 0.4 毫克瑞格列酮注射液。一组连续接受腺苷应激灌注的患者(N=218)作为对照组:结果:雷加登罗松组的心肌灌注储备与体重呈反向关系(体重每增加 10 千克平均下降-0.05,95% CI -0.009/-0.0001,P=0.045),但在接受腺苷应激灌注的患者中则没有这种关系(P=0.77)。调整后的逻辑回归分析显示,体重增加 10 千克导致应激反应不足的几率增加 36%(OR= 1.36,95% CI 1.10-1.69,P=0.005)。此外,应激源类型(雷公藤多苷与腺苷)与体重之间存在明显的交互作用(OR=1.09,95% CI 1.02-1.16,P=0.012)。这在倾向匹配亚组中也得到了证实(P=0.024),并且在调整后也没有减弱(P=0.041)。BSA(P=0.006)而非 BMI(P=0.055)与所使用的应激源条件下的反应不足有不同程度的相关性,在对混杂因素进行调整后,这种相关性仍然显著(P=0.025)。体重(>93 千克)或BSA(>2.06 平方米)最高四分位数的患者对雷公藤多苷反应不充分的几率大大增加(体重增加时,OR=8.19,95% CI 2.04-32.97,P=0.003;BSA 增加时,OR=7.75,95% CI 1.93-31.13,P=0.004)。体重和 BSA 对雷公藤多苷反应不足都有很好的判别能力(ROC 曲线下面积分别为 0.84 和 0.83):通过对接受瑞格列酮药物应激的患者进行定量灌注 CMR,我们发现患者体重与临床反应和心肌灌注参数之间存在反比关系。在体重增加的患者中,固定剂量的栓剂方法可能不足以诱导最大充血。对于体重大于 93 千克且 BSA 大于 2.06 平方米的患者,可以考虑使用腺苷等调整体重的压力源。
{"title":"Reduced response to regadenoson with increased weight: An artificial intelligence-based quantitative myocardial perfusion study.","authors":"Emmanouil Androulakis, Georgios Georgiopoulos, Alessia Azzu, Elena Surkova, Adam Bakula, Panagiotis Papagkikas, Alexandros Briasoulis, Ranil De Silva, Peter Kellman, Dudley Pennell, Francisco Alpendurada","doi":"10.1016/j.jocmr.2024.101066","DOIUrl":"10.1016/j.jocmr.2024.101066","url":null,"abstract":"<p><strong>Background: </strong>There is conflicting evidence regarding the response to a fixed dose of regadenoson in patients with high body weight. The aim of this study was to evaluate the effectiveness of regadenoson in patients with varying body weights using novel quantitative cardiovascular magnetic resonance (CMR) perfusion parameters in addition to standard clinical markers.</p><p><strong>Methods: </strong>Consecutive patients with typical angina and/or risk factors for coronary artery disease (N = 217) underwent regadenoson stress CMR perfusion imaging using a dual-sequence quantitative protocol with perfusion parameters generated from an artificial intelligence (AI)-based algorithm. CMR was performed on 1.5T scanners using a standard 0.4 mg injection of regadenoson. A cohort of consecutive patients undergoing adenosine stress perfusion (N = 218) was used as a control group.</p><p><strong>Results: </strong>An inverse association of myocardial perfusion reserve and weight (mean decrease -0.05 per 10 kg increase, 95% confidence interval [CI] -0.009/-0.0001, P = 0.045) was noted in the regadenoson group but not in patients stressed with adenosine (P = 0.77). Adjusted logistic regression analysis revealed a 10 kg increase resulted in 36% increased odds for inadequate stress response (odds ratio [OR] = 1.36, 95% CI 1.10-1.69, P = 0.005). Moreover, a significant interaction (OR = 1.09, 95% CI 1.02-1.16, P = 0.012) between stressor type (regadenoson vs adenosine) and weight was noted. This was also confirmed in the propensity-matched subgroup (P = 0.024) and was not attenuated after adjustment (P = 0.041). Body surface area (BSA) (P = 0.006) but not body mass index (P = 0.055) was differentially associated with inadequate response conditional to the stressor used, and this association remained significant after adjustment for confounders (P = 0.025). Patients in the highest quartile of weight (>93 kg) or BSA (>2.06 m<sup>2</sup>) had substantially increased odds for inadequate response with regadenoson (OR = 8.19, 95% CI 2.04-32.97, P = 0.003 for increased weight and OR = 7.75, 95% CI 1.93-31.13, P = 0.004 for increased BSA). Both weight and BSA had excellent discriminative ability for inadequate regadenoson response (receiver operating characteristic area under curves 0.84 and 0.83, respectively).</p><p><strong>Conclusion: </strong>Using quantitative perfusion CMR in patients undergoing pharmacological stress with regadenoson, we found an inverse relationship between patient weight and both clinical response and myocardial perfusion parameters. A fixed-dose bolus approach may not be adequate to induce maximal hyperemia in patients with increased weight. Weight-adjusted stressors, such as adenosine, may be considered instead in patients with body weight >93 kg and BSA >2.06 m<sup>2</sup>.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101066"},"PeriodicalIF":4.2,"publicationDate":"2024-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11490868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Free-breathing three-dimensional simultaneous myocardial T1 and T2 mapping based on multi-parametric SAturation-recovery and Variable-flip-Angle. 基于多参数饱和恢复和可变翻转角度(mSAVA)的自由呼吸三维同步心肌 T1 和 T2 图谱。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-24 DOI: 10.1016/j.jocmr.2024.101065
Dongyue Si, Rui Guo, Lan Cheng, Xiangchuang Kong, Daniel A Herzka, Haiyan Ding

Background: Quantitative myocardial tissue characterization with T1 and T2 parametric mapping can provide an accurate and complete assessment of tissue abnormalities across a broad range of cardiomyopathies. However, current clinical T1 and T2 mapping tools rely predominantly on two-dimensional (2D) breath-hold sequences. Clinical adoption of three-dimensional (3D) techniques is limited by long scan duration. The aim of this study is to develop and validate a time-efficient 3D free-breathing simultaneous T1 and T2 mapping sequence using multi-parametric SAturation-recovery and Variable-flip-Angle (mSAVA).

Methods: mSAVA acquires four volumes for simultaneous whole-heart T1 and T2 mapping. We validated mSAVA using simulations, phantoms, and in-vivo experiments at 3T in 11 healthy subjects and 11 patients with diverse cardiomyopathies. T1 and T2 values by mSAVA were compared with modified Look-Locker inversion recovery (MOLLI) and gradient and spin echo (GraSE), respectively. The clinical performance of mSAVA was evaluated against late gadolinium enhancement (LGE) imaging in patients.

Results: Phantom T1 and T2 by mSAVA showed a strong correlation to reference sequences (R2 = 0.98 and 0.99). In-vivo imaging with an imaging resolution of 1.5 × 1.5 × 8 mm3 could be achieved. Myocardial T1 and T2 of healthy subjects by mSAVA were 1310 ± 46 and 44.6 ± 2.0 ms, respectively, with T1 standard deviation higher than MOLLI (105 ± 12 vs 60 ± 16 ms) and T2 standard deviation lower than GraSE (4.5 ± 0.8 vs 5.5 ± 1.0 ms). mSAVA T1 and T2 maps presented consistent findings in patients undergoing LGE. Myocardial T1 and T2 of all patients by mSAVA were 1421 ± 79 and 47.2 ± 3.3 ms, respectively.

Conclusion: mSAVA is a fast 3D technique promising for clinical whole-heart T1 and T2 mapping.

背景:利用 T1 和 T2 参数图谱对心肌组织进行定量表征,可准确、全面地评估各种心肌病的组织异常。然而,目前的临床 T1 和 T2 映像学工具主要依赖于二维屏气序列。由于扫描时间较长,三维技术的临床应用受到限制。本研究的目的是利用多参数饱和恢复和可变翻转角度(mSAVA),开发并验证一种省时的三维自由呼吸同时 T1 和 T2 绘图序列。我们在 11 名健康受试者和 11 名不同心肌病患者中使用模拟、模型和 3T 体外实验对 mSAVA 进行了验证。mSAVA 的 T1 和 T2 值分别与改良 Look-Locker 反转恢复(MOLLI)和梯度自旋回波(GraSE)进行了比较。还评估了 mSAVA 与患者晚期钆增强(LGE)成像的临床表现:通过 mSAVA 进行的幻影 T1 和 T2 与参考序列显示出很强的相关性(R2=0.98 和 0.99)。体内成像的成像分辨率可达 1.5×1.5×8 mm3。健康受试者的心肌T1和T2分别为1310±46和44.6±2.0ms,T1标准偏差高于MOLLI(105±12 vs. 60±16ms),T2标准偏差低于GraSE(4.5±0.8 vs. 5.5±1.0ms)。结论:mSAVA 是一种快速三维技术,有望用于临床全心 T1 和 T2 地图绘制。
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引用次数: 0
Society for Cardiovascular Magnetic Resonance guidelines for reporting cardiovascular magnetic resonance examinations in patients with congenital heart disease. 心血管磁共振学会《先天性心脏病患者心血管磁共振检查报告指南》。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-23 DOI: 10.1016/j.jocmr.2024.101062
Lars Grosse-Wortmann, Rachel M Wald, Israel Valverde, Emanuela Valsangiacomo-Buechel, Karen Ordovas, Francesca Raimondi, Lorna Browne, Sonya V Babu-Narayan, Rajesh Krishnamurthy, Deane Yim, Rahul H Rathod
{"title":"Society for Cardiovascular Magnetic Resonance guidelines for reporting cardiovascular magnetic resonance examinations in patients with congenital heart disease.","authors":"Lars Grosse-Wortmann, Rachel M Wald, Israel Valverde, Emanuela Valsangiacomo-Buechel, Karen Ordovas, Francesca Raimondi, Lorna Browne, Sonya V Babu-Narayan, Rajesh Krishnamurthy, Deane Yim, Rahul H Rathod","doi":"10.1016/j.jocmr.2024.101062","DOIUrl":"10.1016/j.jocmr.2024.101062","url":null,"abstract":"","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101062"},"PeriodicalIF":4.2,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11543539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiovascular magnetic resonance imaging. 临床心脏磁共振成像显示,远端心肌纤维化可预测心肌梗死患者的不良预后。
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-23 DOI: 10.1016/j.jocmr.2024.101064
Nicholas Black, Joshua Bradley, Erik B Schelbert, Laura J Bonnett, Gavin A Lewis, Jakub Lagan, Christopher Orsborne, Pamela F Brown, Fardad Soltani, Fredrika Fröjdh, Martin Ugander, Timothy C Wong, Miho Fukui, Joao L Cavalcante, Josephine H Naish, Simon G Williams, Theresa McDonagh, Matthias Schmitt, Christopher A Miller

Background: Heart failure (HF) most commonly occurs in patients who have had a myocardial infarction (MI), but factors other than MI size may be deterministic. Fibrosis of myocardium remote from the MI is associated with adverse remodeling. We aimed to 1) investigate the association between remote myocardial fibrosis, measured using cardiovascular magnetic resonance (CMR) extracellular volume fraction (ECV), and HF and death following MI, 2) identify predictors of remote myocardial fibrosis in patients with evidence of MI and determine the relationship with infarct size.

Methods: Multicenter prospective cohort study of 1199 consecutive patients undergoing CMR with evidence of MI on late gadolinium enhancement. Median follow-up was 1133 (895-1442) days. Cox proportional hazards modeling was used to identify factors predictive of the primary outcome, a composite of first hospitalization for HF (HHF) or all-cause mortality, post-CMR. Linear regression modeling was used to identify determinants of remote ECV.

Results: Remote myocardial fibrosis was a strong predictor of primary outcome (χ2: 15.6, hazard ratio [HR]: 1.07 per 1% increase in ECV, 95% confidence interval [CI]: 1.04-1.11, p < 0.001) and was separately predictive of both HHF and death. The strongest predictors of remote ECV were diabetes, sex, natriuretic peptides, and body mass index, but, despite extensive phenotyping, the adjusted model R2 was only 0.283. The relationship between infarct size and remote fibrosis was very weak.

Conclusion: Myocardial fibrosis, measured using CMR ECV, is a strong predictor of HHF and death in patients with evidence of MI. The mechanisms underlying remote myocardial fibrosis formation post-MI remain poorly understood, but factors other than infarct size appear to be important.

背景:心力衰竭(HF)最常见于心肌梗死(MI)患者,但除心肌梗死大小外,其他因素也可能起决定作用。远离心肌梗死的心肌纤维化与不良重塑有关。我们的目的是:i)调查使用心血管磁共振(CMR)测量的远端心肌纤维化细胞外体积(ECV)与心肌梗死后的高房颤和死亡之间的关系;ii)确定有证据表明发生心肌梗死的患者中远端心肌纤维化的预测因素,并确定其与心肌梗死大小的关系:多中心前瞻性队列研究:对 1,199 名连续接受 CMR 检查并有晚期钆增强心肌梗死证据的患者进行研究。中位随访 1,133 (895-1,442) 天。采用 Cox 比例危险模型确定主要结果的预测因素,即 CMR 后首次因 HF(HHF)住院或全因死亡的复合结果。线性回归模型用于确定远端ECV的决定因素:结果:远端心肌纤维化是主要结果的有力预测因素(χ2:15.6,ECV 每增加 1%,HR:1.07,95% CI:1.04-1.11,P2 仅为 0.283)。梗死面积与远端纤维化之间的关系非常微弱:结论:使用 CMR ECV 测量的心肌纤维化是有证据表明发生过心肌梗死的患者出现 HHF 和死亡的有力预测因素。心肌梗死后远端心肌纤维化形成的机制仍不甚明了,但梗死面积以外的其他因素似乎也很重要。
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引用次数: 0
Can cardiovascular magnetic resonance enhance our understanding of coronary involvement in immunoglobulin subclass 4-related disease? CMR 能否加深我们对 IgG4 相关疾病冠状动脉受累情况的了解?
IF 4.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-21 DOI: 10.1016/j.jocmr.2024.101063
Tevfik F Ismail
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引用次数: 0
期刊
Journal of Cardiovascular Magnetic Resonance
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