Journal of Cardiovascular Magnetic Resonance最新文献

{"title":"Design and Rationale of MYOFLAME-19 RCT: MYOcardial protection to reduce inFLAMmatory heart disease due to COVID-19 Infection using CMR Endpoints.","authors":"Valentina O Puntmann, Dietrich Beitzke, Andreas Kammerlander, Inga Voges, Dominik D Gabbert, Marcus Doerr, Bishwas Chamling, Biykem Bozkurt, Juan Carlos Kaski, Erica Spatz, Eva Herrmann, Gernot Rohde, Philipp DeLeuw, Lenka Taylor, Christine Windemuth-Kieselbach, Cornelia Harz, Marta Santiuste, Laura Schoeckel, Juliana Hirayama, Peter C Taylor, Colin Berry, Eike Nagel","doi":"10.1016/j.jocmr.2024.101121","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101121","url":null,"abstract":"<p><strong>Background: </strong>Cardiac symptoms due to postacute inflammatory cardiac involvement affect a broad segment of previously well people with only mild acute COVID-19 illness and without overt structural heart disease. Cardiac magnetic resonance (CMR) imaging can identify the underlying subclinical disease process, which is associated with chronic cardiac symptoms. Specific therapy directed at reducing postacute cardiac inflammatory involvement prior to development of myocardial injury and impairment is missing.</p><p><strong>Trial design: </strong>Prospective multicentre randomised placebo-controlled study of myocardial protection therapy (combined immunosuppressive/antiremodelling) of low-dose prednisolone and losartan. Consecutive symptomatic individuals with a prior COVID-19 infection, no preexisting significant comorbidities or structural heart disease, undergo standardised assessments with questionnaires, CMR imaging and cardiopulmonary exercise testing (CPET). Eligible participants fulfilling the criteria of subclinical Post-COVID inflammatory involvement on baseline CMR examination are randomised to treatment with either verum or placebo for a total of 16 weeks (W16). Participants and investigators remain blinded to the group allocation throughout the study duration. The primary efficacy endpoint is the absolute change of left ventricular ejection fraction (LVEF) to baseline at W16, measured by CMR, between the verum treatment and placebo group by absolute difference, using unpaired t-test confirmatively at the 5% significance level. Secondary endpoints include assessment of changes of symptoms, CMR parameters, and CPET after W16, and frequency of major adverse cardiac events after 1 year. Safety data will be analysed for frequency, severity and types of adverse events (AEs) for all treatment groups. The proportion of AEs related to the contrast agent gadobutrol will also be analysed. A calculated sample size is a total of 280 participants (accounting for 8% drop-out), randomised in 1:1 fashion to 140 in the verum and 140 placebo group.</p><p><strong>Conclusion: </strong>Myoflame-19 study will examine the efficacy of a myocardial protection therapy in symptomatic participants with post-COVID inflammatory cardiac involvement determined by CMR. The aim of the intervention is to reduce the symptoms and inflammatory myocardial injury, to improve exercise tolerance and preclude the development of cardiac impairment.</p><p><strong>Clinical trial identifier: </strong>NCT05619653.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Subclinical Right Ventricular Alterations and Aerobic Exercise Capacity in Type 2 Diabetes.","authors":"Abhishek Dattani, Jian L Yeo, Emer M Brady, Alice Cowley, Anna-Marie Marsh, Manjit Sian, Joanna M Bilak, Matthew P M Graham-Brown, Anvesha Singh, Jayanth R Arnold, David Adlam, Thomas Yates, Gerry P McCann, Gaurav S Gulsin","doi":"10.1016/j.jocmr.2024.101120","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101120","url":null,"abstract":"<p><strong>Background: </strong>Type 2 Diabetes (T2D) leads to cardiovascular remodeling, and heart failure has emerged as a major complication of T2D. There is a limited understanding of the impact of T2D on the right heart. This study aimed to assess subclinical right heart alterations and their contribution to aerobic exercise capacity (peak VO₂) in adults with T2D.</p><p><strong>Methods: </strong>Single center, prospective, case-control comparison of adults with and without T2D, and no prevalent cardiac disease. Comprehensive evaluation of the left and right heart was performed using transthoracic echocardiography and stress cardiovascular magnetic resonance. Cardiopulmonary exercise testing on a bicycle ergometer with expired gas analysis was performed to determine peak VO₂. Between group comparison was adjusted for age, sex, race and body mass index using ANCOVA. Multivariable linear regression including key clinical and left heart variables, was undertaken in people with T2D to identify independent associations between measures of right ventricular (RV) structure and function with peak VO₂.</p><p><strong>Results: </strong>340 people with T2D (median age 64 years, 62% male, mean HbA1c 7.3%) and 66 controls (median age 58 years, 58% male, mean HbA1c 5.5%) were included. T2D participants had markedly lower peak VO₂ (adjusted mean 20.3(95% CI: 19.8-20.9) vs. 23.3(22.2-24.5) mL/kg/min, P<0.001) than controls and had smaller left ventricular (LV) volumes and LV concentric remodeling. Those with T2D had smaller RV volumes (indexed RV end-diastolic volume: 84(82-86) vs. 100(96-104) mL/m, P<0.001) with evidence of hyperdynamic RV systolic function (global longitudinal strain: 26.3(25.8-26.8) vs. 23.5(22.5-24.5) %, P<0.001) and impaired RV relaxation (longitudinal peak early diastolic strain rate: 0.77(0.74-0.80) vs. 0.92(0.85-1.00) s^-1, P<0.001). Multivariable linear regression demonstrated that RV end-diastolic volume (β=-0.342, P=0.004) and RV cardiac output (β=0.296, P=0.001), but not LV parameters, were independent determinants of peak VO₂.</p><p><strong>Conclusions: </strong>In T2D, markers of RV remodeling are associated with aerobic exercise capacity, independent of left heart alterations.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interstitial Fibrosis and Arrhythmic Mitral Valve Prolapse: Unravelling Sex-Based Differences.","authors":"Lionel Tastet, Shalini Dixit, Rohit Jhawar, Thuy Nguyen, Mohammad Al-Akchar, Rdcs Dwight Bibby, Farzin Arya, Luca Cristin, Shafkat Anwar, Satoshi Higuchi, Henry Hsia, Yoo Jin Lee, Francesca N Delling","doi":"10.1016/j.jocmr.2024.101117","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101117","url":null,"abstract":"<p><strong>Background: </strong>Interstitial fibrosis as quantified by cardiac magnetic resonance (CMR) has been demonstrated in arrhythmic mitral valve prolapse (AMVP), a condition with known female predominance. Prior studies of interstitial fibrosis in AMVP have only included cases with significant mitral regurgitation (MR) or mitral annular disjunction (MAD), limiting our understanding of alternative arrhythmic mechanisms in MVP. We sought to evaluate the association between interstitial fibrosis and AMVP, regardless of MAD and without severe MR, while also investigating the contribution of sex to this association.</p><p><strong>Methods: </strong>We performed research-based contrast CMR in consecutive individuals with MVP between 2019 and 2022. Extracellular volume fraction (ECV%), a surrogate marker for interstitial fibrosis, was quantified using T₁ mapping in the basal and mid-LV slices. Replacement fibrosis was assessed using late gadolinium enhancement (LGE). AMVP was defined as MVP with frequent premature ventricular contractions and/or non-sustained/sustained ventricular tachycardia (VT) or fibrillation (VF).</p><p><strong>Results: </strong>We identified 65 MVP cases without severe MR (46% women, 34% no/trace, 44% mild, and 21% moderate MR) and with adequate ECV% measurement. Among these, 38% were classified as AMVP, including two cases of aborted VF arrest, both in premenopausal females. Global ECV% was significantly higher in AMVP versus non-AMVP (31%[27-33] vs 27%[23-30], p=0.002). In the AMVP group, higher segmental ECV% was not limited to the inferolateral/inferior walls, typically subject to myocardial traction by the prolapsing leaflets/MAD but was more diffuse and involved atypical segments such as the anterior/anterolateral walls (p<0.05). The association between AMVP and global ECV% was driven by female sex (32%[30-34] vs 27%[25-30], p=0.002 in females; 28%[23-32] vs 26%[23-30], p=0.41 in males). ECV% remained independently associated with an increased risk of arrhythmic events, including VT/VF (p<0.01), even after adjustment for cardiovascular risk factors, MAD, and LGE (p<0.01).</p><p><strong>Conclusion: </strong>In MVP without significant MR, interstitial fibrosis by CMR is associated with an increased risk of arrhythmic events, suggesting a primary myopathic process. The selective association between interstitial fibrosis and AMVP in females may explain why severe arrhythmic complications are more prevalent among women.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biventricular longitudinal strain analysis using CMR feature-tracking: prognostic value in Eisenmenger syndrome.","authors":"Chao Gong, Chen Chen, Xuhan Liu, Ke Wan, Jiajun Guo, Juan He, Lidan Yin, Bi Wen, Shoufang Pu, Yucheng Chen Md","doi":"10.1016/j.jocmr.2024.101116","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101116","url":null,"abstract":"<p><strong>Background: </strong>Evidence to support risk stratification in Eisenmenger syndrome (ES) is still very limited. We hypothesized that biventricular longitudinal strain analysis could have potential prognostic value in ES.</p><p><strong>Methods: </strong>We prospectively enrolled fifty-seven consecutive ES patients with post-tricuspid shunt who underwent both cardiovascular magnetic resonance (CMR) and right heart catheterization between June 2013 and March 2022. Biventricular longitudinal strains were evaluated by CMR feature-tracking analysis. The composite endpoint included all-cause mortality and re-admission for heart failure or hemoptysis. Cox regression analysis, Kaplan-Meier curves, and C-index were employed to assess the relationship between biventricular longitudinal strain and prognosis.</p><p><strong>Results: </strong>During a median follow-up of 33 months (interquartile range: 12-50), 20 (35.1%) patients reached the composite endpoint. Patients with composite endpoints had significantly lower absolute values of left ventricular global longitudinal strain (LV GLS) and right ventricular free wall longitudinal strain (RV FWLS) than patients without composite endpoints (p < 0.05). Multivariate Cox regression analysis demonstrated that LV GLS and RV FWLS were independent predictors for composite endpoints (hazard ratio [HR]: 1.37, 95% confidence interval [CI]: 1.08-1.75, p = 0.010 and HR: 1.19, 95% CI: 1.01-1.41, p = 0.042). Kaplan-Meier analysis indicated that patients with both lower absolute values of LV GLS and RV FWLS were more likely to be at an even higher risk of composite endpoints (p < 0.001). Furthermore, the combined addition of LV GLS and RV FWLS provided incremental value for the prognostic model including clinical parameters and biventricular ejection fraction (C-index increased from 0.75 to 0.86, p = 0.004).</p><p><strong>Conclusion: </strong>Impaired biventricular longitudinal strains improved prognostic prediction of ES patients with post-tricuspid shunt.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Cardiac Magnetic Resonance-Derived Right Ventricular Ejection Fraction on Adverse Outcomes: A Robust Bayesian Model-Averaged Meta-Analysis.","authors":"Tetsuji Kitano, František Bartoš, Yosuke Nabeshima, Alex Ali Sayour, Attila Kovacs, Masaaki Takeuchi","doi":"10.1016/j.jocmr.2024.101118","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101118","url":null,"abstract":"<p><strong>Background: </strong>There are few meta-analyses examining the prognostic value of right ventricular ejection fraction (RVEF) for a specific type of cardiovascular disease (CVD). The aim of this study was to compare the association of cardiac magnetic resonance (CMR)-derived RVEF with adverse outcomes for several specific types of CVD, using a robust Bayesian model-averaged meta-analysis.</p><p><strong>Methods: </strong>Three databases were searched for CMR articles reporting hazard ratios (HRs) of RVEF restricted to a specific type of CVD. For each specific type of CVD, Bayesian model-averaged meta-analyses with and without publication bias adjustments were conducted to evaluate the strength of evidence for RVEF according to the Bayes Factor (BF).</p><p><strong>Results: </strong>Among 108 articles (21,166 patients) analyzing 11 CVD types, pooled HR for 5% reduction in RVEF assessed by publication bias-unadjusted, Bayesian model-averaged meta-analysis offered moderate or strong evidence of an association with outcomes for all types of CVD (HR: 1.07-1.37, BF₁₀: 4.3-9.6*10⁷). In contrast, a robust Bayesian model-averaged meta-analysis, adjusted for publication bias, found moderate or strong evidence in favor of an association of RVEF with outcomes only in hypertrophic cardiomyopathy (HR: 1.19, 95% CrI: 0.98-1.42, BF₁₀: 5.0), dilated cardiomyopathy (HR: 1.16, 95% CrI: 1-1.22, BF₁₀: 23.3), pulmonary hypertension (HR: 1.05, 95% CrI: 1-1.12, BF₁₀: 3.0), and aortic stenosis (HR: 1.15, 95% CrI: 0.97-1.34, BF₁₀: 4.2). There was weak evidence for an association of RVEF with adverse outcomes in seven other CVDs.</p><p><strong>Conclusions: </strong>In a Bayesian meta-analysis adjusted for publication bias, there was moderate or strong evidence for an association of RVEF with outcomes for only four CVDs. Additional data may strengthen evidence regarding other CVDs.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of dobutamine stress cardiovascular magnetic resonance in patients with prior coronary artery bypass grafting.","authors":"Jannick Heins, Janek Salatzki, Anne Köhrer, Andreas Ochs, Lukas D Weberling, Hauke Hund, Evangelos Giannitsis, Norbert Frey, Dirk Loßnitzer, Florian André, Henning Steen","doi":"10.1016/j.jocmr.2024.101119","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101119","url":null,"abstract":"<p><strong>Background and purpose: </strong>Patients with coronary artery bypass grafts (CABG) face an elevated risk of major adverse cardiac events (MACE). High-dose dobutamine stress cardiovascular magnetic resonance imaging (DCMR) is a well-established technique to detect hemodynamically significant coronary artery disease (CAD). However, there is a lack of data regarding the safety of DCMR in patients with CABG. This study aims to evaluate the safety of DCMR in patients with CABG.</p><p><strong>Methods: </strong>We retrospectively studied patients after CABG who subsequently underwent DCMR between November 2008 and July 2018. Side effects, defined as adverse events and minor symptoms, during DCMR were analyzed and compared to 200 individuals matched for age, sex and BMI without prior CABG undergoing DCMR.</p><p><strong>Results: </strong>336 patients (70±9 years, 85% men) were identified. Adverse events occurred in 35 CABG patients (10%) and 18 controls (9%, p=0.595). A drop of systolic blood pressure (SBP) >40mmHg (12 patients), non-sustained ventricular tachycardia (6 patients), increase in SBP >200mmHg (5 patients), monomorphic premature ventricular contractions (PVC) (2 patients), bigeminy (2 patients), left bundle-branch block (2 patients), as well as tachycardiac paroxysmal atrial fibrillation, bradycardia, supraventricular tachycardia, couplets/triplets, and sinus arrhythmia in one patient each occurred in the study group. In addition, one patient was hospitalized due to tachycardiac paroxysmal atrial fibrillation and transient ischemic attack. 29 (8.7%) examinations in the study group were aborted because of either chest pain, dyspnea, nausea, dizziness, a drop of SBP, arrhythmias, tachycardiac paroxysmal atrial fibrillation, monomorphic PVCs, or non-sustained ventricular tachycardia. The rate of aborted examination was comparable to the control group (15 (7.5%), p=0.631). Univariable logistic regression analysis revealed that female sex (OR 2.21, 95% CI 1.2 - 4.3, p=0.017) and inducible ischemia (OR 3.50, 95% CI 2.0 - 6.0, p<0.001) were associated with an increased risk of side effects during DCMR.</p><p><strong>Conclusion: </strong>Dobutamine stress CMR did not show a relevant increase of adverse events in patients with prior CABG compared to patients without prior CABG. Female sex and dobutamine-induced myocardial ischemia are associated with side effects during DCMR.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Easing the Strain of Fetal CMR: Editorial for \"Fetal Cardiovascular Magnetic Resonance Feature Tracking Myocardial Strain Analysis in Congenital Heart Disease\".","authors":"Alex J Barker, Lorna P Browne, Richard M Friesen","doi":"10.1016/j.jocmr.2024.101115","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101115","url":null,"abstract":"","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase-contrast Magnetic Resonance Angiography of Foot at Ultra-high field 5T System: Visualization of Distal Small Vessels and Enhancement by Warm Water Immersion.","authors":"Zhang Shi, Hao Li, Xiyin Miao, Bei Wang, Dong Wang, He Wang, Mengsu Zeng","doi":"10.1016/j.jocmr.2024.101114","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101114","url":null,"abstract":"<p><strong>Background: </strong>Ultra-high field strength MR system has been proved to offer improved visualization of the distal intracranial vessels and branches, but its effectiveness on peripheral vasculatures was not investigated. We aim to assess the visualization of lower-extremity vessels using three-dimensional phase contrast MR angiography (3D PC-MRA) at 5T field-strength through the feet with warm water immersion (WWI).</p><p><strong>Methods: </strong>Participants were prospectively recruited and underwent 3T, 5T 3D PC-MRA on feet with and without WWI (water temperature between 40 to 45 ℃ for a duration of 10minutes). Patients with suspected lower-extremity vessel diseases underwent CTA for lesion identification. Signal-to-noise ratio (SNR), subjective scoring, quantitative vessel segmentation and flow velocity were performed to assess vessel visualization before and after WWI. Friedman's test was conducted to determine statistical significance.</p><p><strong>Results: </strong>Out of thirty participants (mean age, 46.2±5.9; males, 20; lower-extremity vessel disease, 10), 900 vessel segments were available for evaluation. 5T images showed significantly higher scores of image quality and foot vessel visualization than 3T (all P <.05). WWI further improved the visualizing scores (percentage of score 3: 40.2% vs 66.2%, P =.008), SNR (44.27 vs 67.78, P <.001), total branch count (151.92 ± 29.17 vs 225.63 ± 16.76; P <.001), and the flow velocity (0.72 ± 0.03 vs 0.48 ± 0.11cm/s; P <.001).</p><p><strong>Conclusion: </strong>3D PC-MRA at 5T effectively visualizes foot vessels in patients with lower-extremity disease. Furthermore, WWI can significantly enhance the depiction of distal and small vessels.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed 3D IR FLASH for airway imaging in children: more than myocardial fibrosis assessment.","authors":"Laura Acosta Izquierdo, Romina Dsouza, Ankavipar Saprungruang, Afsaneh Amirabadi, Mike Seed, Shi-Joon Yoo, Christopher Z Lam","doi":"10.1016/j.jocmr.2024.101110","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101110","url":null,"abstract":"<p><strong>Background: </strong>To investigate the ability of a delayed respiratory-navigated, electrocardiographically-gated three-dimensional inversion recovery-prepared flash low angle shot (3D IR FLASH) sequence to evaluate the lower airways in children undergoing routine cardiovascular magnetic resonance (CMR).</p><p><strong>Methods: </strong>This retrospective study included pediatric patients (0-18 years) who underwent clinical CMR where a delayed 3D IR FLASH sequence was performed between July 2020 and April 2021. The airway image quality and extent of lower airway visibility was graded by two blinded readers using a four-point ordinal scale (0-3). Lower airway anatomical variants and abnormalities were recorded.</p><p><strong>Results: </strong>180 patients were included with a median age of 11.7 (4.6-15.3) years. 51/180 (28%) were under general anesthesia (GA). Overall, the median grading of airway image quality was 3 (2-3) and extent of lower airway visibility was 3 (3-3). Interrater agreement was almost perfect (κ = 0.867 and κ = 0.956, respectively). Image quality correlated with extent of lower airway visibility (r = 0.62, p < 0.01). Delayed 3D IR FLASH was able to characterize the segmental bronchi in 137/180 (76%) and lobar bronchi in 172/180 (96%) of patients. Lower airway abnormalities were identified in 37/180 (21%) of patients and in 33/129 (26%) with congenital heart disease (CHD). Identified abnormalities included tracheobronchial branching anomalies in 6/180 (3%), abnormal tracheobronchial situs in 6/180 (3%), and extrinsic vascular compression in 25/180 (14%).</p><p><strong>Conclusions: </strong>Delayed 3D IR FLASH has excellent performance for evaluation of the lower airway anatomy and can simultaneously assess for myocardial late gadolinium enhancement. Lower airway abnormalities are not infrequently seen in children undergoing routine CMR for CHD.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histological Validation of 3D Variable Flip Angle TSE Multi-Contrast Magnetic Resonance Vessel Wall Imaging in Characterizing Carotid Vulnerable Atherosclerotic Plaques.","authors":"Jiachen Liu, Zihan Ning, Chenlin Du, Shuo Chen, Tao Wang, Jingli Cao, Ran Huo, Dongye Li, Dandan Yang, Rui Shen, Shuwan Yu, Chunjiang Hu, Shuhao Wang, Huiyu Qiao, Xihai Zhao","doi":"10.1016/j.jocmr.2024.101112","DOIUrl":"https://doi.org/10.1016/j.jocmr.2024.101112","url":null,"abstract":"<p><strong>Background: </strong>Accurate assessment of the vulnerability of carotid atherosclerotic plaques is crucial for stroke prevention. The three-dimensional (3D) magnetic resonance (MR) vessel wall imaging (VWI) has been increasingly employed to evaluate carotid plaques due to its extensive coverage and isotropic high spatial resolution. However, the accuracy of such technique lacks validation by histology.</p><p><strong>Objective: </strong>This study aims to validate the accuracy of 3D multi-contrast MR VWI used variable-flip-angle (VFA) and turbo spin echo (TSE) readout in identifying vulnerable carotid plaques, using histological analysis as a reference.</p><p><strong>Methods: </strong>Twenty-one male patients (mean age: 64.4 ± 7.2 years) scheduled for carotid endarterectomy (CEA) were recruited for this study. All patients underwent carotid multi-contrast MR VWI, including 3D T1- and T2-weighted variable flip angle-based turbo spin echo (VFA-TSE) sequences, as well as 3D time of flight (TOF) MR angiography (MRA), using a 3.0T MR system. Histological processing was performed for carotid plaque specimens. The presence or absence, along with the area measurements, of lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and calcifications (CA) were independently evaluated on both MR images and histological sections. Cohen's kappa (κ) analysis was utilized to determine the agreement between 3D multi-contrast MR VWI and histology in identifying carotid plaque compositions before and after excluding compositions bellow certain size threshold. Spearman's correlation analysis was also conducted to assess the agreement in quantifying plaque compositions.</p><p><strong>Results: </strong>A total of 81 slices of MR images were successfully matched with histological sections. Moderate to almost perfect agreements were observed between 3D MR VWI and histology in the identification of LRNC (κ: 0.85 and 0.89), IPH (κ: 0.65 and 0.69), and CA (κ: 0.46 and 0.62) before and after excluding compositions smaller than 0.79 mm². Strong to very strong correlations were found in the quantification of plaque compositions including LRNC (r=0.88), IPH (r=0.80), and CA (r=0.74) between MR imaging and histology.</p><p><strong>Conclusion: </strong>The 3D VFA-TSE multi-contrast MR VWI is capable of accurately characterizing vulnerable carotid atherosclerotic plaques.</p>","PeriodicalId":15221,"journal":{"name":"Journal of Cardiovascular Magnetic Resonance","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}