Tissue Characterization by Mapping and Strain Cardiac MRI to Evaluate Myocardial Inflammation in Fulminant Myocarditis

2020 ◽  
Vol 52 (3) ◽  
pp. 930-938 ◽  
Author(s):  
Haojie Li ◽  
Hui Zhu ◽  
Zhaoxia Yang ◽  
Dazhong Tang ◽  
Lu Huang ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Tissue Characterization ◽  
Fulminant Myocarditis ◽  
Myocardial Inflammation

Role of myocardial inflammation and fibrosis in the development of ventricular arrythmias in patients with inflammatory cardiomyopathy (results of 1-year follow-up)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Kovalenko ◽  
E Nesukay ◽  
S Cherniuk ◽  
R Kirichenko ◽  
A Kozliuk ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Cardiac Mri ◽  
Inflammatory Process ◽  
Delayed Enhancement ◽  
Myocardial Inflammation ◽  
Inflammatory Cardiomyopathy ◽  
Initial Examination ◽  
Inflammatory Lesions ◽  
Clinical Onset

Abstract Background Myocardial inflammatory and fibrotic changes are the most frequent and significant causes of ventricular rhythm disorders that could result in development of life threatening arrythmias and increase the risk of sudden cardiac death, especially in young patients with inflammatory cardiomyopathy (ICM). The purpose – to estimate association of myocardial inflammation and fibrosis with development of ventricular arrythmias in patients with ICM during 12-months of follow-up. Material and methods The study was performed on 70 patients with ICM, average age was (35,2±2,7) years. Initially all patients had cardiomegaly with reduced left ventricular (LV) ejection fraction - <40% and absolute value of longitudinal global systolic strain <9,0%. By 24-hour ECG monitoring we studied frequency of ventricular premature beats (VPB) and incidence of non-sustained ventricular tachycardia (NSVT) paroxysms. All patients underwent for cardiac MRI with evaluation of early T1- and T2-weighted images for the detection of inflammatory changes and T1-weighted delayed images for detection of myocardial fibrosis. Results of cardiac MRI were estimated by Lake Louise criteria and also we performed quantification of segments involved according to standard 17-segment LV model. Initial examination was carried out within the 1st month from the clinical onset of disease and subsequent evaluation of studied parameters was performed after 12 months of follow-up. Results After 12 months of follow-up average frequency of VPB reduced to (1,42±0,14) % from (2,32±0,27) % on initial examination (p<0,01), similarly reduced the incidence of NSVT paroxysms – to 11,4% after 12 months from 28,6% initially. Mean quantity of LV segments, affected by inflammatory process and characterized by presence of edema and/or hyperemia, reduced to (2,12±0,22) segm. after 12 months of follow up from (6,12±0,71) segm. on the 1st month (p<0,01). Also we observed increase of LV segments amount with the presence of delayed enhancement which indicates myocardial fibrosis – from (2,04±0,21) segm. on initial examination to (4,79±0,38) segm. after 12 months (p<0,01). Using binary regression analysis we defined that initial presence of inflammatory lesions in ≥5,0 LV segments was associated with frequent VPB (≥1,0%) and NSVT paroxysms. Wherein, after 12 months presence of inflammatory lesions had no association with ventricular rhythm disorders but the same relation was observed between the presence of delayed enhancement in ≥4,0 LV segments and frequent VPB (≥1,0%) as also with NSVT paroxysms. Conclusion At the time of clinical onset of inflammatory cardiomyopathy ventricular rhythm disorders (particularly VPB and NSVT paroxysms) were associated with larger quantity of LV segments involved into inflammatory process. After 12 months of follow-up ventricular rhythm disorders were associated predominantly with the presence of fibrotic lesions in several (≥4,0) segments of LV. Funding Acknowledgement Type of funding source: None

scholarly journals Myocardial Tissue Characterization By T2 Mapping in Thalassemia Major

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 27-28
Author(s):  
Alessia Pepe ◽  
Nicola Martini ◽  
Rita Borrello ◽  
Vincenzo Positano ◽  
Laura Pistoia ◽  
...  
Keyword(s):  
Tissue Characterization ◽  
Spin Echo ◽  
T2 Mapping ◽  
Relaxation Times ◽  
Thalassemia Major ◽  
Fast Spin Echo ◽  
Myocardial Inflammation ◽  
Healthy Population ◽  
Myocardial Iron ◽  
Magnetic Resonance Imaging Mri

Introduction.The presence of iron deposits results in a significant reduction in all magnetic resonance imaging (MRI) relaxation times (T1, T2 and T2*). In the clinical setting the T2* technique is the method of choice for cardiac iron quantification and it has revolutionized the management of patients with hemoglopinopathies. Purpose.To compare myocardial T2 against T2* in patients with thalassemia major (TM) for myocardial iron characterization. Methods.133 TM patients (79 females, 38.4±11.3 years) enrolled in the Extension Myocardial Iron Overload in Thalassemia (eMIOT) Network were considered. T2 and T2* images were acquired, respectively, with multi-echo fast-spin-echo and gradient-echo sequences. Global heart T2 and T2* values were obtained by averaging the values in all 16 myocardial segments. The normal T2 range was established as mean±2 standard deviations on data acquired on 80 healthy volunteers (males: 48-56 ms and females: 50-57 ms). The lower limit of normal for global heart T2*, established on the same healthy population, was 32 ms. Results.A significant correlation was detected between global heart T2 and T2* values (R=0.577; P<0.0001) (Figure). Out of the 113 (84.9%) patients with a normal global heart T2* value, none had a decreased global heart T2 value, while 58 (51.3%) had an increased T2 value. Out of the 20 patents with a decreased global heart T2* value, only 10 (50%) had also a reduced T2 value. Conversely, 9 (45.0%) had a normal global heart T2 value and one (4.5) showed an increased T2 value. The 59 patients with increased global heart T2 value were significantly older than the remaining patients (40.8±10.5 vs 36.4±11.6 years; P=0.019) Conclusion.All patients with decreased T2 value had also a decreased T2* value and in half of the patients iron load was undetected by T2, suggesting that T2 mapping does not offer any advantage in terms of sensitivity for MIO assessment. However, more than half of TM patients had an increased T2 value, thus may be caused by the presence of myocardial inflammation and/or edema. So, T2 mapping could reveal subclinical myocardial involvement in TM patients. Figure Disclosures Pistoia: Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

scholarly journals CARDIAC MRI TISSUE CHARACTERIZATION AND MYOCARDIAL MECHANICS IN PEDIATRIC PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

2018 ◽  
Vol 71 (11) ◽  
pp. A1642
Author(s):  
Sudeep Sunthankar ◽  
David Parra ◽  
Kristen George-Durrett ◽  
Jason Christensen ◽  
Jonathan Soslow
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Cardiac Mri ◽  
Tissue Characterization ◽  
Pediatric Patients ◽  
Myocardial Mechanics

scholarly journals Fulminant Myocarditis: Brief Review

2021 ◽  
Vol 3 (3) ◽  
pp. 01-04
Author(s):  
Ezra A Amsterdam ◽  
Muhammad Majid
Keyword(s):  
Heart Transplantation ◽  
Cardiac Imaging ◽  
Ventricular Arrhythmias ◽  
Early Recognition ◽  
Standard Test ◽  
Fulminant Myocarditis ◽  
Myocardial Inflammation ◽  
Aggressive Management ◽  
Hemodynamic Impairment ◽  
Malignant Arrhythmias

Fulminant myocarditis (FM) is a rare disease characterized by acute hemodynamic impairment and ventricular arrhythmias due to severe myocardial inflammation. It is typically preceded by a viral infection but any of multiple other toxic and infective agents may also be the inciting agent. Diagnosis is based on biomarkers and/or cardiac imaging, but endomyocardial biopsy is the standard test for confirming the diagnosis. FM usually requires therapeutic support of cardiac function and treatment of malignant arrhythmias. Contrary to prior concepts, recent evidence has revealed that patients with FM are more likely to die or need heart transplantation than those with the nonfulminant form of the disease. Early recognition and aggressive management are essential for favorable outcomes.

scholarly journals CMR Tissue Characterization in Patients with HFmrEF

2019 ◽  
Vol 8 (11) ◽  
pp. 1877 ◽  
Author(s):  
Patrick Doeblin ◽  
Djawid Hashemi ◽  
Radu Tanacli ◽  
Tomas Lapinskas ◽  
Rolf Gebker ◽  
...  
Keyword(s):  
Cardiac Mri ◽  
Tissue Characterization ◽  
Statistical Significance ◽  
Systolic Dysfunction ◽  
Extracellular Volume ◽  
Relaxation Times ◽  
Healthy Controls ◽  
T2 Relaxation ◽  
Reduced Ejection Fraction ◽  
T1 Relaxation

The characteristics and optimal management of heart failure with a moderately reduced ejection fraction (HFmrEF, LV-EF 40–50%) are still unclear. Advanced cardiac MRI offers information about function, fibrosis and inflammation of the myocardium, and might help to characterize HFmrEF in terms of adverse cardiac remodeling. We, therefore, examined 17 patients with HFpEF, 18 with HFmrEF, 17 with HFrEF and 17 healthy, age-matched controls with cardiac MRI (Phillips 1.5 T). T1 and T2 relaxation time mapping was performed and the extracellular volume (ECV) was calculated. Global circumferential (GCS) and longitudinal strain (GLS) were derived from cine images. GLS (−15.7 ± 2.1) and GCS (−19.9 ± 4.1) were moderately reduced in HFmrEF, resembling systolic dysfunction. Native T1 relaxation times were elevated in HFmrEF (1027 ± 40 ms) and HFrEF (1033 ± 54 ms) compared to healthy controls (972 ± 31 ms) and HFpEF (985 ± 32 ms). T2 relaxation times were elevated in HFmrEF (55.4 ± 3.4 ms) and HFrEF (56.0 ± 6.0 ms) compared to healthy controls (50.6 ± 2.1 ms). Differences in ECV did not reach statistical significance. HFmrEF differs from healthy controls and shares similarities with HFrEF in cardiac MRI parameters of fibrosis and inflammation.

P607Myocardial injury in systemic lupus erythematosus defined by cardiac magnetic resonance imaging: clinical and echocardiographic characteristics

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Du Toit ◽  
P G Herbst ◽  
A J K Pecoraro ◽  
C Ackerman ◽  
A Du Plessis ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Renal Disease ◽  
Lupus Erythematosus ◽  
Tissue Characterization ◽  
Clinical Laboratory ◽  
Myocardial Dysfunction ◽  
Myocardial Inflammation ◽  
Systemic Lupus

Abstract Background Lupus myocarditis (LM) occurs in 5–10% of patients with systemic lupus erythematosus (SLE). Subclinical myocardial inflammation is detected in 37% at post mortem. Echocardiographic strain analyses (speckle tracking [STE]) supports subclinical myocardial dysfunction in SLE. Tissue characterization by cardiac magnetic resonance (CMR) identifies myocardial inflammation, necrosis/fibrosis, detecting clinical and subclinical myocardial injury (MIN). It is the non-invasive diagnostic modality of choice for myocarditis (all types) based on the Lake Louise criteria (LLC). The utility of CMR is limited by cost (in resource limited settings) as well as intolerance of / contra-indications to CMR. Purpose Determine prevalence of MIN in SLE (as per LLC). Compare clinical and echocardiographic features of patients with and without MIN. Identify echocardiographic predictors of MIN. Methods A prospective crossectional study was done at Tygerberg Hospital, Western Cape, South Africa. Adult inpatients, fulfilling the 2012 classification criteria for SLE were screened for inclusion. Echocardiography (echo) included strain analyses (segmental and global [GLS]) through STE and regional function assessment (wall motion score (WMS)). Patients were grouped according to CMR evidence of MIN (absent LLC [AC]; single criterion [SC]; fulfilling LLC). Clinical, laboratory and echo parameters were compared between groups. Logistic regression and ROC were used to determine predictors of MIN. Results 49/106 SLE patients screened were included (Figure 1). The median age was 27 years (IQR: 22–35) and 88% were female. 46.9% of patients had MIN (≥1 criterion): 12.2% fulfilled LLC and 34.7% had a SC. Demographic features, cardiac risk factors (including antiphospholipid syndrome) and renal disease were similar among groups. Compared to the AC group, SLE disease activity was higher in patients fulfilling LLC (p=0.022), but not in the SC group (p=0.813). A clinical and echo diagnosis of LM was made in all patients fulfilling LLC (p<0.001), in 17.6% of patients in the SC group (p=0.026) vs none in the AC group. Anti-DsDNA (p=0.054) and anti-B2GP1 (p=0.081) were more frequently positive in the SC vs AC group. The WMS was higher in LLC and SC groups (p=0.006; p=0.083) with mid and basal strain more impaired in patients with MIN (p=0.043; p=0.047). LVID and mid STE score (number of segments with impaired STE) combined was the best predictor of MIN (OR: 2.1; 95% CI: 1.2–3.5; p=0.008). The predictive model had an AUC of 0.791 (PPV: 81.8%; NPV: 86.4%). Figure 1 Conclusion CMR is limited by a high exclusion rate in SLE, mainly due to renal disease. CMR evidence of MIN is common in SLE, even in the absence of clinical myocardial dysfunction or high lupus activity. Impaired echo regional and global function occurs more frequently in patients with MIN. STE combined with LVID predicts the presence of MIN detected by CMR and has potential as a cost effective screening tool.

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