Pub Date : 2024-08-02DOI: 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。
{"title":"In-vivo assessment of myocardial calcium uptake using manganese-enhanced cardiovascular magnetic resonance in aortic stenosis.","authors":"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","doi":"10.1016/j.jocmr.2024.101074","DOIUrl":"10.1016/j.jocmr.2024.101074","url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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] cm<sup>2</sup>) 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/m<sup>2</sup>, 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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101074"},"PeriodicalIF":4.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889369","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}
Pub Date : 2024-08-02DOI: 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.
{"title":"Interval changes in four-dimensional flow-derived in vivo hemodynamics stratify aortic growth in type B aortic dissection patients.","authors":"Joshua Engel, Ozden Kilinc, Elizabeth Weiss, Justin Baraboo, Christopher Mehta, Andrew Hoel, S Chris Malaisrie, Michael Markl, Bradley D Allen","doi":"10.1016/j.jocmr.2024.101078","DOIUrl":"10.1016/j.jocmr.2024.101078","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101078"},"PeriodicalIF":4.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11421234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889368","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}
Pub Date : 2024-08-02DOI: 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.
{"title":"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.","authors":"Elizabeth K Weiss, Justin Baraboo, Cynthia K Rigsby, Joshua D Robinson, Liliana Ma, Mariana B L Falcão, Christopher W Roy, Matthias Stuber, Michael Markl","doi":"10.1016/j.jocmr.2024.101077","DOIUrl":"10.1016/j.jocmr.2024.101077","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101077"},"PeriodicalIF":4.2,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11417305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889372","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}
Pub Date : 2024-08-02DOI: 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.
{"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}
Pub Date : 2024-07-31DOI: 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}
Pub Date : 2024-07-25DOI: 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}
Pub Date : 2024-07-24DOI: 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.
{"title":"Free-breathing three-dimensional simultaneous myocardial T<sub>1</sub> and T<sub>2</sub> mapping based on multi-parametric SAturation-recovery and Variable-flip-Angle.","authors":"Dongyue Si, Rui Guo, Lan Cheng, Xiangchuang Kong, Daniel A Herzka, Haiyan Ding","doi":"10.1016/j.jocmr.2024.101065","DOIUrl":"10.1016/j.jocmr.2024.101065","url":null,"abstract":"<p><strong>Background: </strong>Quantitative myocardial tissue characterization with T<sub>1</sub> and T<sub>2</sub> parametric mapping can provide an accurate and complete assessment of tissue abnormalities across a broad range of cardiomyopathies. However, current clinical T<sub>1</sub> and T<sub>2</sub> 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 T<sub>1</sub> and T<sub>2</sub> mapping sequence using multi-parametric SAturation-recovery and Variable-flip-Angle (mSAVA).</p><p><strong>Methods: </strong>mSAVA acquires four volumes for simultaneous whole-heart T<sub>1</sub> and T<sub>2</sub> mapping. We validated mSAVA using simulations, phantoms, and in-vivo experiments at 3T in 11 healthy subjects and 11 patients with diverse cardiomyopathies. T<sub>1</sub> and T<sub>2</sub> 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.</p><p><strong>Results: </strong>Phantom T<sub>1</sub> and T<sub>2</sub> by mSAVA showed a strong correlation to reference sequences (R<sup>2</sup> = 0.98 and 0.99). In-vivo imaging with an imaging resolution of 1.5 × 1.5 × 8 mm<sup>3</sup> could be achieved. Myocardial T<sub>1</sub> and T<sub>2</sub> of healthy subjects by mSAVA were 1310 ± 46 and 44.6 ± 2.0 ms, respectively, with T<sub>1</sub> standard deviation higher than MOLLI (105 ± 12 vs 60 ± 16 ms) and T<sub>2</sub> standard deviation lower than GraSE (4.5 ± 0.8 vs 5.5 ± 1.0 ms). mSAVA T<sub>1</sub> and T<sub>2</sub> maps presented consistent findings in patients undergoing LGE. Myocardial T<sub>1</sub> and T<sub>2</sub> of all patients by mSAVA were 1421 ± 79 and 47.2 ± 3.3 ms, respectively.</p><p><strong>Conclusion: </strong>mSAVA is a fast 3D technique promising for clinical whole-heart T<sub>1</sub> and T<sub>2</sub> mapping.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101065"},"PeriodicalIF":4.2,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141766129","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}
Pub Date : 2024-07-23DOI: 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}
Pub Date : 2024-07-23DOI: 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.
{"title":"Remote myocardial fibrosis predicts adverse outcome in patients with myocardial infarction on clinical cardiovascular magnetic resonance imaging.","authors":"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","doi":"10.1016/j.jocmr.2024.101064","DOIUrl":"10.1016/j.jocmr.2024.101064","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Remote myocardial fibrosis was a strong predictor of primary outcome (χ<sup>2</sup>: 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 R<sup>2</sup> was only 0.283. The relationship between infarct size and remote fibrosis was very weak.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101064"},"PeriodicalIF":4.2,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11347049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141758954","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}
Pub Date : 2024-07-21DOI: 10.1016/j.jocmr.2024.101063
Tevfik F Ismail
{"title":"Can cardiovascular magnetic resonance enhance our understanding of coronary involvement in immunoglobulin subclass 4-related disease?","authors":"Tevfik F Ismail","doi":"10.1016/j.jocmr.2024.101063","DOIUrl":"10.1016/j.jocmr.2024.101063","url":null,"abstract":"","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":" ","pages":"101063"},"PeriodicalIF":4.2,"publicationDate":"2024-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751757","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}