Diagnostics

Editorial

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Open AccessEditorial

The Multi-Faceted Utility of Cardiovascular Magnetic Resonance Imaging: Editorial on Special Issue “Advances in Cardiovascular Magnetic Resonance”

by Minjie Lu and Arlene Sirajuddin

Diagnostics 2023, 13(23), 3501; https://doi.org/10.3390/diagnostics13233501 - 22 Nov 2023

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Abstract

Cardiovascular magnetic resonance (CMR) imaging has emerged as a versatile tool for evaluating and managing a variety of cardiovascular diseases [...] Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

Research

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12 pages, 3025 KiB

Open AccessArticle

Dark-Blood Late Gadolinium Enhancement MRI Is Noninferior to Bright-Blood LGE in Non-Ischemic Cardiomyopathies

by Jan M. Brendel, Robert J. Holtackers, Jan N. Geisel, Jens Kübler, Florian Hagen, Meinrad Gawaz, Konstantin Nikolaou, Simon Greulich and Patrick Krumm

Diagnostics 2023, 13(9), 1634; https://doi.org/10.3390/diagnostics13091634 - 5 May 2023

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Abstract

(1) Background and Objectives: Dark-blood late gadolinium enhancement has been shown to be a reliable cardiac magnetic resonance (CMR) method for assessing viability and depicting myocardial scarring in ischemic cardiomyopathy. The aim of this study was to evaluate dark-blood LGE imaging compared with [...] Read more.

(1) Background and Objectives: Dark-blood late gadolinium enhancement has been shown to be a reliable cardiac magnetic resonance (CMR) method for assessing viability and depicting myocardial scarring in ischemic cardiomyopathy. The aim of this study was to evaluate dark-blood LGE imaging compared with conventional bright-blood LGE for the detection of myocardial scarring in non-ischemic cardiomyopathies. (2) Materials and Methods: Patients with suspected non-ischemic cardiomyopathy were prospectively enrolled in this single-centre study from January 2020 to March 2023. All patients underwent 1.5 T CMR with both dark-blood and conventional bright-blood LGE imaging. Corresponding short-axis stacks of both techniques were analysed for the presence, distribution, pattern, and localisation of LGE, as well as the quantitative scar size (%). (3) Results: 343 patients (age 44 ± 17 years; 124 women) with suspected non-ischemic cardiomyopathy were examined. LGE was detected in 123 of 343 cases (36%) with excellent inter-reader agreement (κ 0.97–0.99) for both LGE techniques. Dark-blood LGE showed a sensitivity of 99% (CI 98–100), specificity of 99% (CI 98–100), and an accuracy of 99% (CI 99–100) for the detection of non-ischemic scarring. No significant difference in total scar size (%) was observed. Dark-blood imaging with mean 5.35 ± 4.32% enhanced volume of total myocardial volume, bright-blood with 5.24 ± 4.28%, p = 0.84. (4) Conclusions: Dark-blood LGE imaging is non-inferior to conventional bright-blood LGE imaging in detecting non-ischemic scarring. Therefore, dark-blood LGE imaging may become an equivalent method for the detection of both ischemic and non-ischemic scars. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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11 pages, 7023 KiB

Open AccessArticle

Evaluation of Cardiac Function in Young Mdx Mice Using MRI with Feature Tracking and Self-Gated Magnetic Resonance Cine Imaging

by Junpei Ueda and Shigeyoshi Saito

Diagnostics 2023, 13(8), 1472; https://doi.org/10.3390/diagnostics13081472 - 19 Apr 2023

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Abstract

This study aimed to evaluate cardiac function in a young mouse model of Duchenne muscular dystrophy (mdx) using cardiac magnetic resonance imaging (MRI) with feature tracking and self-gated magnetic resonance cine imaging. Cardiac function was evaluated in mdx and control mice (C57BL/6JJmsSlc mice) [...] Read more.

This study aimed to evaluate cardiac function in a young mouse model of Duchenne muscular dystrophy (mdx) using cardiac magnetic resonance imaging (MRI) with feature tracking and self-gated magnetic resonance cine imaging. Cardiac function was evaluated in mdx and control mice (C57BL/6JJmsSlc mice) at 8 and 12 weeks of age. Preclinical 7-T MRI was used to capture short-axis, longitudinal two-chamber view and longitudinal four-chamber view cine images of mdx and control mice. Strain values were measured and evaluated from cine images acquired using the feature tracking method. The left ventricular ejection fraction was significantly less (p < 0.01 each) in the mdx group at both 8 (control, 56.6 ± 2.3% mdx, 47.2 ± 7.4%) and 12 weeks (control, 53.9 ± 3.3% mdx, 44.1 ± 2.7%). In the strain analysis, all strain value peaks were significantly less in mdx mice, except for the longitudinal strain of the four-chamber view at both 8 and 12 weeks of age. Strain analysis with feature tracking and self-gated magnetic resonance cine imaging is useful for assessing cardiac function in young mdx mice. Full article

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11 pages, 1907 KiB

Open AccessArticle

Cardiac MRI: An Alternative Method to Determine the Left Ventricular Function

by Kerstin Michler, Christopher Hessman, Marcus Prümmer, Stephan Achenbach, Michael Uder and Rolf Janka

Diagnostics 2023, 13(8), 1437; https://doi.org/10.3390/diagnostics13081437 - 17 Apr 2023

Cited by 1 | Viewed by 1946

Abstract

(1) Background: With the conventional contour surface method (KfM) for the evaluation of cardiac function parameters, the papillary muscle is considered to be part of the left ventricular volume. This systematic error can be avoided with a relatively easy-to-implement pixel-based evaluation method (PbM). [...] Read more.

(1) Background: With the conventional contour surface method (KfM) for the evaluation of cardiac function parameters, the papillary muscle is considered to be part of the left ventricular volume. This systematic error can be avoided with a relatively easy-to-implement pixel-based evaluation method (PbM). The objective of this thesis is to compare the KfM and the PbM with regard to their difference due to papillary muscle volume exclusion. (2) Material and Methods: In the retrospective study, 191 cardiac-MR image data sets (126 male, 65 female; median age 51 years; age distribution 20–75 years) were analysed. The left ventricular function parameters: end-systolic volume (ESV), end-diastolic volume (EDV), ejection fraction (EF) and stroke volume (SV) were determined using classical KfW (syngo.via and cvi42 = gold standard) and PbM. Papillary muscle volume was calculated and segmented automatically via cvi42. The time required for evaluation with the PbM was collected. (3) Results: The size of EDV was 177 mL (69–444.5 mL) [average, [minimum–maximum]], ESV was 87 mL (20–361.4 mL), SV was 88 mL and EF was 50% (13–80%) in the pixel-based evaluation. The corresponding values with cvi42 were EDV 193 mL (89–476 mL), ESV 101 mL (34–411 mL), SV 90 mL and EF 45% (12–73%) and syngo.via: EDV 188 mL (74–447 mL), ESV 99 mL (29–358 mL), SV 89 mL (27–176 mL) and EF 47% (13–84%). The comparison between the PbM and KfM showed a negative difference for end-diastolic volume, a negative difference for end-systolic volume and a positive difference for ejection fraction. No difference was seen in stroke volume. The mean papillary muscle volume was calculated to be 14.2 mL. The evaluation with PbM took an average of 2:02 min. (4) Conclusion: PbM is easy and fast to perform for the determination of left ventricular cardiac function. It provides comparable results to the established disc/contour area method in terms of stroke volume and measures “true” left ventricular cardiac function while omitting the papillary muscles. This results in an average 6% higher ejection fraction, which can have a significant influence on therapy decisions. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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12 pages, 1160 KiB

Open AccessArticle

Cardiovascular Magnetic Resonance Imaging Findings in Africans with Idiopathic Dilated Cardiomyopathy

by Nqoba Tsabedze, Andre du Plessis, Dineo Mpanya, Anelia Vorster, Quinn Wells, Leonie Scholtz and Pravin Manga

Diagnostics 2023, 13(4), 617; https://doi.org/10.3390/diagnostics13040617 - 8 Feb 2023

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Abstract

In sub-Saharan Africa, idiopathic dilated cardiomyopathy (IDCM) is a common yet poorly investigated cause of heart failure. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for tissue characterisation and volumetric quantification. In this paper, we present CMR findings obtained from a cohort [...] Read more.

In sub-Saharan Africa, idiopathic dilated cardiomyopathy (IDCM) is a common yet poorly investigated cause of heart failure. Cardiovascular magnetic resonance (CMR) imaging is the gold standard for tissue characterisation and volumetric quantification. In this paper, we present CMR findings obtained from a cohort of patients with IDCM in Southern Africa suspected of having a genetic cause of cardiomyopathy. A total of 78 IDCM study participants were referred for CMR imaging. The participants had a median left ventricular ejection fraction of 24% [interquartile range, (IQR): 18–34]. Late gadolinium enhancement (LGE) was visualised in 43 (55.1%) participants and localised in the midwall in 28 (65.0%) participants. At the time of enrolment into the study, non-survivors had a higher median left ventricular end diastolic wall mass index of 89.4 g/m² (IQR: 74.5–100.6) vs. 73.6 g/m² (IQR: 51.9–84.7), p = 0.025 and a higher median right ventricular end-systolic volume index of 86 mL/m² (IQR:74–105) vs. 41 mL/m² (IQR: 30–71), p < 0.001. After one year, 14 participants (17.9%) died. The hazard ratio for the risk of death in patients with evidence of LGE from CMR imaging was 0.435 (95% CI: 0.259–0.731; p = 0.002). Midwall enhancement was the most common pattern, visualised in 65% of participants. Prospective, adequately powered, and multi-centre studies across sub-Saharan Africa are required to determine the prognostic significance of CMR imaging parameters such as late gadolinium enhancement, extracellular volume fraction, and strain patterns in an African IDCM cohort. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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Graphical abstract

12 pages, 1395 KiB

Open AccessArticle

Predictive Value of Cardiac Magnetic Resonance for Left Ventricular Remodeling of Patients with Acute Anterior Myocardial Infarction

by Wenkun Ma, Xinni Li, Chengjie Gao, Yajie Gao, Yuting Liu, Sang Kang and Jingwei Pan

Diagnostics 2022, 12(11), 2780; https://doi.org/10.3390/diagnostics12112780 - 14 Nov 2022

Cited by 3 | Viewed by 1599

Abstract

Background: Heart failure is a serious complication resulting from left ventricular remodeling (LVR), especially in patients experiencing acute anterior myocardial infarction (AAMI). It is crucial to explore the predictive parameters for LVR following primary percutaneous coronary intervention (PPCI) in patients with AAMI. Methods: [...] Read more.

Background: Heart failure is a serious complication resulting from left ventricular remodeling (LVR), especially in patients experiencing acute anterior myocardial infarction (AAMI). It is crucial to explore the predictive parameters for LVR following primary percutaneous coronary intervention (PPCI) in patients with AAMI. Methods: A total of 128 AAMI patients who were reperfused successfully by PPCI were enrolled sequentially from June 2018 to December 2019. Cardiovascular magnetic resonance (CMR) was performed at the early stage (<7 days) and after the 6-month follow-up. The patients were divided into LVR and non-LVR groups according to the increase of left ventricular end diastolic volume (LVEDV) measured by the second cardiac magnetic resonance examination ≥20% from baseline. (3) Results: The left ventricular ejection fraction (LVEF), the global longitudinal strain (GLS), the peak circumferential strain in infarcted segments, and the infarct size (IS) remained significantly different in the multivariate logistic regression analysis (all p < 0.05). The area under the receiver operating characteristic curve of Model 1, wherein the GLS was added to the LVEF, was 0.832 (95% CI 0.758–0.907, p < 0.001). The C-statistics for Model 2, which included the infarct-related regional parameters (IS and the peak circumferential strain in infarcted segments)was 0.917 (95% CI 0.870–0.965, p < 0.001). Model 2 was statistically superior to Model 1 in predicting LVR (IDI: 0.190, p = 0.002). (4) Conclusions: Both the global and regional CMR parameters were valuable in predicting LVR in patients with AAMI following the PPCI. The local parameters of the infarct zones were superior to those of the global ones. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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11 pages, 1270 KiB

Open AccessArticle

Prognostic Value of Late Gadolinium Enhancement in Left Ventricular Noncompaction: A Multicenter Study

by Wei Huang, Ran Sun, Wenbin Liu, Rong Xu, Ziqi Zhou, Wei Bai, Ruilai Hou, Huayan Xu, Yingkun Guo, Li Yu and Lu Ye

Diagnostics 2022, 12(10), 2457; https://doi.org/10.3390/diagnostics12102457 - 11 Oct 2022

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Abstract

Current diagnostic criteria for left ventricular noncompaction (LVNC) may be poorly related to adverse prognosis. Late gadolinium enhancement (LGE) is a predictor of major adverse cardiovascular events (MACE), but risk stratification of LGE in patients with LVNC remains unclear. We retrospectively analyzed the [...] Read more.

Current diagnostic criteria for left ventricular noncompaction (LVNC) may be poorly related to adverse prognosis. Late gadolinium enhancement (LGE) is a predictor of major adverse cardiovascular events (MACE), but risk stratification of LGE in patients with LVNC remains unclear. We retrospectively analyzed the clinical and cardiovascular magnetic resonance (CMR) data of 75 patients from three institutes and examined the correlation between different LGE types and MACE based on the extent, pattern (including a specific ring-like pattern), and locations of LGE in LVNC. A total of 51 patients (68%) presented LGE. A specific ring-like pattern was observed in 9 (12%). MACE occurred in 29 (38.7%) at 4.3 years of follow-up (interquartile range: 2.1–5.7 years). The adjusted hazard ratio (HR) for patients with ring-like LGE were 6.10 (95% CI, 1.39–26.75, p < 0.05). Free-wall or mid-wall LGE was associated with an increased risk of MACE after adjustment (HR 2.85, 95% CI, 1.31–6.21; HR 4.35, 95% CI, 1.23–15.37, respectively, p < 0.05). The risk of MACE in LVNC significantly increased when the LGE extent was greater than 7.5% and ring-like, multiple segments, and free-wall LGE were associated with MACE. These results suggest the value of LGE risk stratification in patients with LVNC. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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14 pages, 1700 KiB

Open AccessArticle

Clinical Application of Cardiac Magnetic Resonance in ART-Treated AIDS Males with Short Disease Duration

by Keke Hou, Hang Fu, Wei Xiong, Yueqin Gao, Liqiu Xie, Jianglin He, Xianbiao Feng, Tao Zeng, Lin Cai, Lei Xiong, Nan Jiang, Min Jiang, Bin Kang, Haiyan Zheng, Na Zhang and Yingkun Guo

Diagnostics 2022, 12(10), 2417; https://doi.org/10.3390/diagnostics12102417 - 6 Oct 2022

Cited by 2 | Viewed by 1366

Abstract

Cardiac complications are common in antiretroviral therapy-treated (ART-treated) acquired immune deficiency syndrome (AIDS) patients, and the incidence increases with age. Myocardial injury in ART-treated AIDS patients with a relatively longer disease duration has been evaluated. However, there is no relevant study on whether [...] Read more.

Cardiac complications are common in antiretroviral therapy-treated (ART-treated) acquired immune deficiency syndrome (AIDS) patients, and the incidence increases with age. Myocardial injury in ART-treated AIDS patients with a relatively longer disease duration has been evaluated. However, there is no relevant study on whether patients with a short AIDS duration have cardiac dysfunction. Thirty-seven ART-treated males with AIDS and eighteen healthy controls (HCs) were prospectively included for CMR scanning. Clinical data and laboratory examination results were collected. The ART-treated males with AIDS did not have significantly reduced biventricular ejection fraction, myocardial edema, or late gadolinium enhancement. Compared with the HCs, the biventricular volume parameters and left ventricle myocardial strain indices in ART-treated males with AIDS were not significantly reduced (all p > 0.05). ART-treated males with AIDS were divided into subgroups according to their CD4+ T-cell counts (<350 cells/μL and ≥350 cells/μL) and duration of disease (1–12 months, 13–24 months, and 25–36 months). There was no significant decrease in left or right ventricular volume parameters or myocardial strain indices among the subgroups (all p > 0.05). In Pearson correlation analysis, CD4+ T-cell counts were not significantly correlated with biventricular volume parameters or left ventricular myocardial strain indices. In conclusion, ART-treated males with AIDS receiving ART therapy with a short disease duration (less than 3 years) might not develop obvious cardiac dysfunction as evaluated by routine CMR, so it is reasonable to appropriately extend the interval between cardiovascular follow-ups to more than 3 years. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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12 pages, 2797 KiB

Open AccessArticle

Differential Expression of microRNAs in Hypertrophied Myocardium and Their Relationship to Late Gadolinium Enhancement, Left Ventricular Hypertrophy and Remodeling in Hypertrophic Cardiomyopathy

by Chen Zhang, Hongbo Zhang, Lei Zhao, Zhipeng Wei, Yongqiang Lai and Xiaohai Ma

Diagnostics 2022, 12(8), 1978; https://doi.org/10.3390/diagnostics12081978 - 16 Aug 2022

Cited by 5 | Viewed by 1754

Abstract

Background: Differential expression has been found in a variety of circulating miRNAs in patients with hypertrophic cardiomyopathy (HCM). However, study on myocardial miRNAs is limited and a lot of miRNAs were not studied in previous studies. Methods: Twenty-one HCM patients and four patients [...] Read more.

Background: Differential expression has been found in a variety of circulating miRNAs in patients with hypertrophic cardiomyopathy (HCM). However, study on myocardial miRNAs is limited and a lot of miRNAs were not studied in previous studies. Methods: Twenty-one HCM patients and four patients who died from non-cardiovascular diseases were prospectively recruited for our study. A total of 26 myocardial tissues were collected, which were stored in liquid nitrogen immediately for miRNA detection using the Agilent Human miRNA Microarray Kit. All HCM patients underwent cardiovascular magnetic resonance (CMR) examination before surgery and cvi42 software was used to analyze cardiac function and myocardial fibrosis. Results: Compared with the control group, the expression of 22 miRNAs was found to be significantly increased in the HCM group, while 46 miRNAs were found to be significantly decreased in the HCM group. The expression levels of hsa-miR-3960 and hsa-miR-652-3p were significantly correlated with left ventricular mass index (r = 0.449 and 0.474, respectively). Meanwhile, Hsa-miR-642a-3p expression was positively correlated to the quantification of late gadolinium enhancement (r = 0.467). Conclusions: Our study found that 68 myocardial miRNAs were significantly increased or decreased in the HCM group. Myocardial miRNA levels could be used as potential biomarkers for LV hypertrophy, fibrosis and remodeling. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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14 pages, 1836 KiB

Open AccessArticle

The Variation in the Diastolic Period with Interventricular Septal Displacement and Its Relation to the Right Ventricular Function in Pulmonary Hypertension: A Preliminary Cardiac Magnetic Resonance Study

by Fan Yang, Wen Ren, Dan Wang, Yan Yan, Yuan-Lin Deng, Zhen-Wen Yang, Tie-Lian Yu, Dong Li and Zhang Zhang

Diagnostics 2022, 12(8), 1970; https://doi.org/10.3390/diagnostics12081970 - 15 Aug 2022

Cited by 1 | Viewed by 1697

Abstract

Background: Pulmonary hypertension (PH) is known to alter the biventricular shape and temporal phases of the cardiac cycle. The presence of interventricular septal (IVS) displacement has been associated with the severity of PH. There has been limited cardiac magnetic resonance (CMR) data regarding [...] Read more.

Background: Pulmonary hypertension (PH) is known to alter the biventricular shape and temporal phases of the cardiac cycle. The presence of interventricular septal (IVS) displacement has been associated with the severity of PH. There has been limited cardiac magnetic resonance (CMR) data regarding the temporal parameters of the cardiac cycle in PH. This study aimed to quantify the temporal changes in the cardiac cycle derived from CMR in PH patients with and without IVS displacement and sought to understand the mechanism of cardiac dysfunction in the cardiac cycle. Methods: Patients with PH who had CMR and right heart catheterization (RHC) examinations were included retrospectively. Patients were divided into an IVS non-displacement (IVS_ND) group and an IVS displacement (IVS_D) group according to IVS morphology, as observed on short-axis cine CMR images. Additionally, age-matched healthy volunteers were included as the health control (HC). Temporal parameters, IVS displacement, ventricular volume and functional parameters were obtained by CMR, and pulmonary hemodynamics were obtained by RHC. The risk stratification of the PH patients was also graded according to the guidelines. Results: A total of 70 subjects were included, consisting of 33 IVS_D patients, 15 IVS_ND patients, and 22 HC patients. In the IVS_ND group, only the right ventricle ejection fraction (RVEF) was decreased in the ventricular function, and no temporal change in the cardiac cycle was found. A prolonged isovolumetric relaxation time (IRT) and shortened filling time (FT) in both ventricles, along with biventricular dysfunction, were detected in the IVS_D group (p < 0.001). The IRT of the right ventricle (IRT_RV) and FT of the right ventricle (FT_RV) in the PH patients were associated with pulmonary vascular resistance, right cardiac index, and IVS curvature, and the IRT_RV was also associated with the RVEF in a multivariate regression analysis. A total of 90% of the PH patients in the IVS_D group were stratified into intermediate- and high-risk categories, and they showed a prolonged IRT_RV and a shortened FT_RV. The IRT_RV was also the predictor of the major cardiovascular events. Conclusions: The temporal changes in the cardiac cycle were related to IVS displacement and mainly impacted the diastolic period of the two ventricles in the PH patients. The IRT and FT changes may provide useful pathophysiological information on the progression of PH. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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16 pages, 3141 KiB

Open AccessArticle

The Role of Circulating Collagen Turnover Biomarkers and Late Gadolinium Enhancement in Patients with Non-Ischemic Dilated Cardiomyopathy

by Radu Revnic, Bianca Olivia Cojan-Minzat, Alexandru Zlibut, Rares-Ilie Orzan, Renata Agoston, Ioana Danuta Muresan, Dalma Horvat, Carmen Cionca, Bogdan Chis and Lucia Agoston-Coldea

Diagnostics 2022, 12(6), 1435; https://doi.org/10.3390/diagnostics12061435 - 10 Jun 2022

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Abstract

Background: Myocardial scarring is a primary pathogenetic process in nonischemic dilated cardiomyopathy (NIDCM) that is responsible for progressive cardiac remodeling and heart failure, severely impacting the survival of these patients. Although several collagen turnover biomarkers have been associated with myocardial fibrosis, their clinical [...] Read more.

Background: Myocardial scarring is a primary pathogenetic process in nonischemic dilated cardiomyopathy (NIDCM) that is responsible for progressive cardiac remodeling and heart failure, severely impacting the survival of these patients. Although several collagen turnover biomarkers have been associated with myocardial fibrosis, their clinical utility is still limited. Late gadolinium enhancement (LGE) determined by cardiac magnetic resonance imaging (CMR) has become a feasible method to detect myocardial replacement fibrosis. We sought to evaluate the association between collagen turnover biomarkers and replacement myocardial scarring by CMR and, also, to test their ability to predict outcome in conjunction with LGE in patients with NIDCM. Method: We conducted a prospective study on 194 patients (48.7 ± 14.3 years of age; 74% male gender) with NIDCM. The inclusion criteria were similar to those for the definition of NIDCM, performed exclusively by CMR: (1) LV dilation with an LV end-diastolic volume (LVEDV) of over 97 mL/m²; (2) global LV dysfunction, expressed as a decreased LVEF of under 45%. CMR was used to determine the presence and extent of LGE. Several collagen turnover biomarkers were determined at diagnosis, comprising galectin-3 (Gal3), procollagen type I carboxy-terminal pro-peptide (PICP) and N-terminal pro-peptide of procollagen type III (PIIINP). A composite outcome (all-cause mortality, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. Results: Gal3, PICP and PIIINP were considerably increased in those with LGE+ (p < 0.001), also being directly correlated with LGE mass (r² = 0.42; r² = 0.44; r² = 0.31; all p < 0.001). Receiver operating characteristic (ROC) analysis revealed a significant ability to diagnose LGE, with an area under the ROC of 0.816 for Gal3, 0.705 for PICP, and 0.757 for PIIINP (all p < 0.0001). Kaplan–Meier analysis showed that at a threshold of >13.8 ng/dL for Gal3 and >97 ng/dL for PICP, they were able to significantly predict outcome (HR = 2.66, p < 0.001; HR = 1.93, p < 0.002). Of all patients, 17% (n = 33) reached the outcome. In multivariate analysis, after adjustment for covariates, only LGE+ and Gal3+ remained independent predictors for outcome (p = 0.008; p = 0.04). Nonetheless, collagen turnover biomarkers were closely related to HF severity, providing incremental predictive value for severely decreased LVEF of under 30% in patients with NIDCM, beyond that with LGE alone. Conclusions: In patients with NIDCM, circulating collagen turnover biomarkers such as Gal3, PICP and PIIINP are closely related to the presence and extent of LGE and can significantly predict cardiovascular outcome. The joint use of LGE with Gal3 and PICP significantly improved outcome prediction. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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15 pages, 981 KiB

Open AccessArticle

Stress Perfusion Cardiac Magnetic Resonance in Long-Standing Non-Infarcted Chronic Coronary Syndrome with Preserved Systolic Function

by Pierpaolo Palumbo, Ester Cannizzaro, Annamaria Di Cesare, Federico Bruno, Francesco Arrigoni, Alessandra Splendiani, Antonio Barile, Carlo Masciocchi and Ernesto Di Cesare

Diagnostics 2022, 12(4), 786; https://doi.org/10.3390/diagnostics12040786 - 23 Mar 2022

Cited by 5 | Viewed by 2869

Abstract

(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a [...] Read more.

(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (heart failure) and all major cardiac events (MACE) including death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, or resuscitated cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and ischemia, respectively, were considered. Higher ischemic burden was predictive of disease progression (OR: 1.59, 95%CI: 1.18–2.14; p-value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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Review

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20 pages, 1335 KiB

Open AccessReview

Cardiac Magnetic Resonance Imaging in Appraising Myocardial Strain and Biomechanics: A Current Overview

by Alexandru Zlibut, Cosmin Cojocaru, Sebastian Onciul and Lucia Agoston-Coldea

Diagnostics 2023, 13(3), 553; https://doi.org/10.3390/diagnostics13030553 - 2 Feb 2023

Cited by 10 | Viewed by 3088

Abstract

Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. [...] Read more.

Subclinical alterations in myocardial structure and function occur early during the natural disease course. In contrast, clinically overt signs and symptoms occur during late phases, being associated with worse outcomes. Identification of such subclinical changes is critical for timely diagnosis and accurate management. Hence, implementing cost-effective imaging techniques with accuracy and reproducibility may improve long-term prognosis. A growing body of evidence supports using cardiac magnetic resonance (CMR) to quantify deformation parameters. Tissue-tagging (TT-CMR) and feature-tracking CMR (FT-CMR) can measure longitudinal, circumferential, and radial strains and recent research emphasize their diagnostic and prognostic roles in ischemic heart disease and primary myocardial illnesses. Additionally, these methods can accurately determine LV wringing and functional dynamic geometry parameters, such as LV torsion, twist/untwist, LV sphericity index, and long-axis strain, and several studies have proved their utility in prognostic prediction in various cardiovascular patients. More recently, few yet important studies have suggested the superiority of fast strain-encoded imaging CMR-derived myocardial strain in terms of accuracy and significantly reduced acquisition time, however, more studies need to be carried out to establish its clinical impact. Herein, the current review aims to provide an overview of currently available data regarding the role of CMR in evaluating myocardial strain and biomechanics. Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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15 pages, 1439 KiB

Open AccessReview

Nephrogenic Systemic Fibrosis in Patients with Chronic Kidney Disease after the Use of Gadolinium-Based Contrast Agents: A Review for the Cardiovascular Imager

by Sebastian Gallo-Bernal, Nasly Patino-Jaramillo, Camilo A. Calixto, Sergio A. Higuera, Julian F. Forero, Juliano Lara Fernandes, Carlos Góngora, Michael S. Gee, Brian Ghoshhajra and Hector M. Medina

Diagnostics 2022, 12(8), 1816; https://doi.org/10.3390/diagnostics12081816 - 28 Jul 2022

Cited by 14 | Viewed by 4929

Abstract

Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic [...] Read more.

Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic renal dysfunction in patients with cardiovascular conditions, the risk of nephrogenic systemic fibrosis (NSF) after gadolinium exposure has been a permanent concern. Even though the newer macrocyclic agents have proven to be much safer in patients with chronic kidney disease and end-stage renal failure, clinicians must fully understand the clinical characteristics and risk factors of this devastating pathology and maintain a high degree of suspicion to prevent and recognize it. This review aimed to summarize the existing evidence regarding the physiopathology, clinical manifestations, diagnosis, and prevention of NSF related to the use of gadolinium-based contrast agents. Full article

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5 pages, 1430 KiB

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Loeffler Endocarditis Causing Heart Failure with Preserved Ejection Fraction (HFpEF): Characteristic Images and Diagnostic Pathway

by Silvia Lupu, Marian Pop and Adriana Mitre

Diagnostics 2022, 12(9), 2157; https://doi.org/10.3390/diagnostics12092157 - 5 Sep 2022

Cited by 6 | Viewed by 1638

Abstract

We report the case of a 69-year-old female patient in which echocardiography and cardiac magnetic resonance imaging were used to diagnose a patient presenting with heart failure with preserved ejection fraction (HFpEF) due to Loeffler endocarditis. Loeffler endocarditis is an uncommon cause of [...] Read more.

We report the case of a 69-year-old female patient in which echocardiography and cardiac magnetic resonance imaging were used to diagnose a patient presenting with heart failure with preserved ejection fraction (HFpEF) due to Loeffler endocarditis. Loeffler endocarditis is an uncommon cause of heart failure with preserved ejection fraction, triggered by eosinophil and lymphocyte infiltration of the endomyocardium, followed by the formation of thrombus in the afflicted area, and eventually fibrosis. This condition is due to an increased number of eosinophils associated with allergies, infections, systemic conditions, as well as malignancies and hypereosinophilic syndrome. Loeffler endocarditis can lead to serious complications, such as progressive heart failure, systemic thromboembolic events, or arrhythmias (including sudden cardiac death). Full article

(This article belongs to the Special Issue Advances in Cardiovascular Magnetic Resonance)

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