Measuring lung water adds prognostic value in heart failure patients undergoing cardiac magnetic resonance.
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ABSTRACT:
SUBMITTER: Rocha BML
PROVIDER: S-EPMC8505633 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:PURPOSE:Cardiac magnetic resonance fingerprinting (cMRF) has been recently introduced to simultaneously provide T1 , T2 , and M0 maps. Here, we develop a 3-point Dixon-cMRF approach to enable simultaneous water specific T1 , T2 , and M0 mapping of the heart and fat fraction (FF) estimation in a single breath-hold scan. METHODS:Dixon-cMRF is achieved by combining cMRF with several innovations that were previously introduced for other applications, including a 3-echo GRE acquisition with golden angle radial readout and a high-dimensional low-rank tensor constrained reconstruction to recover the highly undersampled time series images for each echo. Water-fat separation of the Dixon-cMRF time series is performed to allow for water- and fat-specific T1 , T2 , and M0 estimation, whereas FF estimation is extracted from the M0 maps. Dixon-cMRF was evaluated in a standardized T1 -T2 phantom, in a water-fat phantom, and in healthy subjects in comparison to current clinical standards: MOLLI, SASHA, T2 -GRASE, and 6-point Dixon proton density FF (PDFF) mapping. RESULTS:Dixon-cMRF water T1 and T2 maps showed good agreement with reference T1 and T2 mapping techniques (R2 > 0.99 and maximum normalized RMSE ~5%) in a standardized phantom. Good agreement was also observed between Dixon-cMRF FF and reference PDFF (R2 > 0.99) and between Dixon-cMRF water T1 and T2 and water selective T1 and T2 maps (R2 > 0.99) in a water-fat phantom. In vivo Dixon-cMRF water T1 values were in good agreement with MOLLI and water T2 values were slightly underestimated when compared to T2 -GRASE. Average myocardium septal T1 values were 1129 ± 38 ms, 1026 ± 28 ms, and 1045 ± 32 ms for SASHA, MOLLI, and the proposed water Dixon-cMRF. Average T2 values were 51.7 ± 2.2 ms and 42.8 ± 2.6 ms for T2 -GRASE and water Dixon-cMRF, respectively. Dixon-cMRF FF maps showed good agreement with in vivo PDFF measurements (R2 > 0.98) and average FF in the septum was measured at 1.3%. CONCLUSION:The proposed Dixon-cMRF allows to simultaneously quantify myocardial water T1 , water T2 , and FF in a single breath-hold scan, enabling multi-parametric T1 , T2 , and fat characterization. Moreover, reduced T1 and T2 quantification bias caused by water-fat partial volume was demonstrated in phantom experiments.
| S-EPMC7064906 | biostudies-literature
Project description:BackgroundCardiac magnetic resonance (CMR) has been used to diagnose and risk-stratify patients with left ventricular noncompaction (LVNC). The prognostic value of CMR parameters for LVNC, especially feature tracking (CMR-FT), is not well known in LVNC patients with left ventricular dysfunction. The present study aimed to investigate whether the combination of CMR-FT with traditional CMR parameters can increase the prognostic value of CMR for LVNC patients with reduced left ventricular ejection fraction (LVEF).MethodsA total of 123 candidates were retrospectively included in this multicenter study and 55 LVNC patients (mean age, 45.7 ± 16.2 years; 61.8% men) remained after applying the exclusion criteria. Clinical features, left ventricular (LV) function parameters, global and segment myocardial strain, and late gadolinium enhancement (LGE) were evaluated. The outcomes include the composite events of cardiovascular death, heart transplantation, hospitalization for heart failure, thromboembolic events, and ventricular arrhythmias.ResultsAfter a median follow-up of 5.17 years (interquartile range: 0.17 to 10.58 years), 24 (36.8%) patients experienced at least one major adverse cardiovascular event (MACE). The myocardial strain parameters of patients with events were lower than those of patients without events. In the univariable Cox analysis, LVEF, the presence of LGE, global longitudinal strain (GLS) and segmental strains, including longitudinal strain at the apical level and radial and circumferential strain at the basal level, were significantly associated with MACEs. In the multivariate analysis, LGE (hazard ratio (HR) 3.452, 95% CI 1.133 to 10.518, p = 0.029) was a strong predictor of MACEs and significantly improved the predictive value (chi-square of the model after adding LGE: 7.51 vs. 13.47, p = 0.009). However, myocardial strain parameters were not statistically significant for the prediction of MACEs after adjusting for age, body mass index, LVEF and the presence of LGE and did not increase the prognostic value (chi-square of the model after adding GLS: 13.47 vs. 14.14, p = 0.411) in the multivariate model.ConclusionsThe combination of CMR-FT with traditional CMR parameters may not increase the prognostic value of CMR in LVNC patients with reduced LVEF, while the presence of LGE was a strong independent predictor of MACEs and significantly improved the predictive value.
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Project description:Blood and cerebrospinal fluid (CSF) pulse and flow throughout the brain, driven by the cardiac cycle. These fluid dynamics, which are essential to healthy brain function, are characterized by several noninvasive magnetic resonance imaging (MRI) methods. Recent developments in fast MRI, specifically simultaneous multislice acquisition methods, provide a new opportunity to rapidly and broadly assess cardiac-driven flow, including CSF spaces, surface vessels and parenchymal vessels. We use these techniques to assess blood and CSF flow dynamics in brief (3.5 min) scans on a conventional 3 T MRI scanner in five subjects. Cardiac pulses are measured with a photoplethysmography (PPG) on the index finger, along with functional MRI (fMRI) signals in the brain. We, retrospectively, align the fMRI signals to the heartbeat. Highly reliable cardiac-gated fMRI temporal signals are observed in CSF and blood on the timescale of one heartbeat (test-retest reliability within subjects R2 > 50%). In blood vessels, a local minimum is observed following systole. In CSF spaces, the ventricles and subarachnoid spaces have a local maximum following systole instead. Slower resting-state scans with slice timing, retrospectively, aligned to the cardiac pulse, reveal similar cardiac-gated responses. The cardiac-gated measurements estimate the amplitude and phase of fMRI pulsations in the CSF relative to those in the arteries, an estimate of the local intracranial impedance. Cardiac aligned fMRI signals can provide new insights about fluid dynamics or diagnostics for diseases where these dynamics are important.
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Project description:BackgroundThe timing of surgery for aortic stenosis (AS) is imperfect, and the management of moderate AS and asymptomatic severe AS is still challenging. Myocardial fibrosis (MF) is the main pathological basis of cardiac decompensation in patients with AS and can be detected by cardiovascular magnetic resonance (CMR). The aim of this study was to evaluate the prognostic value of MF measured by CMR in patients with AS, which can provide a reference for the timing of aortic valve replacement (AVR).MethodsWe searched Medline, Embase, and Web of Science to include all studies that investigated the prognostic value of CMR in patients with AS. The search deadline is March 31, 2021. The pooled relative risk (RR) or hazard ratio (HR) and 95% confidence intervals (CI) of the biomarkers including late gadolinium enhancement (LGE), Native T1 or extracellular volume (ECV) were calculated to evaluate the prognostic value.Results13 studies and 2,430 patients with AS were included in this study, the mean or medium follow-up duration for each study was ranged from 6 to 67.2 months. Meta-analysis showed the presence of LGE was associated with an increased risk for all-cause mortality (pooled RR: 2.14, 95% CI: 1.67-2.74, P < 0.001), cardiac mortality (pooled RR: 3.50, 95% CI: 2.32-5.30, P < 0.001), and major adverse cardiovascular events (MACEs) (pooled RR: 1.649, 95% CI: 1.23-2.22, P = 0.001). Native T1 was significantly associated with MACEs (pooled RR: 2.23, 95% CI: 1.00-4.95; P = 0.049), and higher ECV was associated with a higher risk of cardiovascular events (pooled HR: 1.69, 95% CI: 1.11-2.58; P = 0.014).ConclusionThe use of CMR to detect MF has a good prognostic value in patients with AS. LGE, Native T1 and ECV measured by CMR can contribute to risk stratification of AS, thereby helping to optimize the timing of AVR.
| S-EPMC8812989 | biostudies-literature
Project description:BACKGROUND:End-stage renal disease (ESRD) patients are at high cardiovascular risk, and myocardial fibrosis (MF) accounts for most of their cardiac events. The purpose of this study is to investigate the prognostic value and risk stratification of MF as measured by extracellular volume (ECV) on cardiac magnetic resonance (CMR) for heart failure (HF) in patients with hemodialysis-dependent ESRD. METHODS:Sixty-six hemodialysis ESRD patients and 25 matched healthy volunteers were prospectively enrolled and underwent CMR to quantify multiple parameters of MF by T1 mapping and late gadolinium enhancement (LGE). All ESRD patients were followed up for 11-30?months, and the end-point met the 2016 ESC guidelines for the definition of HF. RESULTS:Over a median follow-up of 18?months (range 11-30?months), there were 26 (39.39%) guideline-diagnosed HF patients in the entire cohort of ESRD subjects. The native T1 value was elongated, and ECV was enlarged in the HF cohort relative to the non-HF cohort and normal controls (native T1, 1360.10?±?50.14?ms, 1319.39?±?55.44?ms and 1276.35?±?56.56?ms; ECV, 35.42?±?4.42%, 31.85?±?3.01% and 26.97?±?1.87%; all p<0.05). In the cardiac strain analysis, ECV was significantly correlated with global radial strain (GRS) (r?=?-?0.501, p?=?0.009), global circumferential strain (GCS) (r?=?0.553, p?=?0.005) and global longitudinal strain (GLS) (r?=?0.507, p?=?0.008) in ESRD patients with HF. Cox proportional hazard regression models revealed that ECV (hazard ratio [HR]?=?1.160, 95% confidence interval: 1.022 to 1.318, p?=?0.022) was the only independent predictor of HF in ESRD patients. It also had a higher diagnostic accuracy for detecting MF (area under the curve [AUC]?=?0.936; 95% confidence interval: 0.864 to 0.976) than native T1 and post T1 (all p???0.002). Kaplan-Meier analysis revealed that the high-ECV group had a shorter median overall survival time than the low-ECV group (18?months vs. 20?months, log-rank p?=?0.046) and that ESRD patients with high ECV were more likely to have HF. CONCLUSIONS:Myocardial fibrosis quantification by ECV on CMR T1 mapping was shown to be an independent risk factor of heart failure, providing incremental prognostic value and risk stratification for cardiac events in ESRD patients. TRIAL REGISTRATION:Chinese Clinical Trial Registry ChiCTR-DND-17012976, 13/12/2017, Retrospectively registered.
| S-EPMC6954545 | biostudies-literature
Project description:Background Left ventricular (LV) involvement is frequently observed in arrhythmogenic cardiomyopathy (ACM). We investigated the association of LV myocardial assessment using cardiac magnetic resonance (CMR) with clinical outcomes including heart failure (HF)-related events in ACM. Methods and Results We retrospectively analyzed 60 patients with ACM between 2005 and 2020 according to the 2010 Task Force Criteria and assessed HF-related events (HF hospitalization, heart transplantation, and cardiac death) and ventricular tachycardia events. We analyzed CMR findings including late gadolinium enhancement (LGE) in all subjects and obtained mapping values (native T1, extracellular volume, and T2) on 30 (50%) patients out of them. Among the study population (mean age 49 years, 77% male), 41 (68%) patients had LV LGE. During a median follow-up of 34 months, there were 13 (22%) HF-related events, and 20 (30%) ventricular tachycardia events. Kaplan-Meier survival analysis revealed that HF-related events occurred only in patients with LV LGE (+) (versus LV LGE (-), log-rank P=0.006), and the events were not significantly different regarding right ventricular LGE (log-rank P>0.999). When categorized by median value for each mapping parameter, HF-related events occurred more in patients with higher native T1 (versus lower native T1, log-rank P=0.002), and higher T2 (versus lower T2, log-rank P=0.002), higher extracellular volume (versus lower extracellular volume, log-rank P=0.002). However, regarding ventricular tachycardia events, there were no significant differences according to these CMR markers. Conclusions LV myocardial assessment using CMR with LGE imaging and native T1, T2, and extracellular volume markers were significantly associated with HF-related event risk in patients with ACM.
| S-EPMC9075293 | biostudies-literature
Project description:Background This study aimed to evaluate the prognostic value of hyperemic coronary sinus flow (h-CSF) and global coronary flow reserve (g-CFR) obtained by phase-contrast cine-magnetic resonance imaging in patients with acute myocardial infarction (MI). Methods and Results This retrospective study analyzed patients with acute MI (n=523) who underwent primary (ST-segment-elevation MI) or urgent (non-ST-segment-elevation MI) percutaneous coronary intervention. Absolute coronary sinus blood flow (CSF) at rest and during vasodilator stress hyperemia was quantified at 30 days (24-36 days) after the index infarct-related lesion percutaneous coronary intervention and revascularization of functionally significant non-infarct-related lesions. We used Cox proportional hazards regression modeling to examine the association between h-CSF, g-CFR, and major adverse cardiac events defined as all-cause death, nonfatal MI, hospitalization for congestive heart failure, and stroke. Finally, 325 patients with ST-segment-elevation MI (62.1%) and 198 patients with non-ST-segment-elevation MI (37.9%) were studied over a median follow-up of 2.5 years. The rest CSF, h-CSF, and g-CFR were 0.94 (0.68-1.26) mL/min per g, 2.05 (1.42-2.73) mL/min per g, and 2.17 (1.54-3.03), respectively. Major adverse cardiac events occurred in 62 patients, and Cox proportional hazards analysis showed that h-CSF and g-CFR were independent predictors of major adverse cardiac events (h-CSF: hazard ratio [HR], 0.64; 95% CI, 0.47-0.88; P=0.005; g-CFR: HR, 0.62; 95% CI, 0.47-0.82; P=0.001). When stratified by h-CSF and g-CFR, cardiac event-free survival was the worst in patients with concordantly impaired h-CSF (<1.6 mL/min per g) and g-CFR (<1.7) (P<0.001). Conclusions Global coronary sinus flow quantification using phase-contrast cine-magnetic resonance imaging provided significant prognostic information independent of infarction size and conventional risk factors in patients with acute MI undergoing revascularization.
| S-EPMC9075062 | biostudies-literature
Project description:BackgroundCoronary magnetic resonance angiography (CMRA) allows non-ionizing visualization of luminal narrowing in coronary artery disease (CAD). Although a prior study showed the usefulness of CMRA for risk stratification in short-term follow-up, the long-term prognostic value of CMRA remains unclear. The purpose of this study was to evaluate the long-term prognostic value of CMRA.MethodsA total of 506 patients without history of myocardial infarction or prior coronary artery revascularization underwent free-breathing whole-heart CMRA between 2009 and 2015. Images were acquired using a 1.5 T or 3 T scanner and visually evaluated as the consensus decisions of two observers. Obstructive CAD on CMRA was defined as luminal narrowing of ≥ 50% in at least one coronary artery. Major adverse cardiac events (MACE) comprised cardiac death, nonfatal myocardial infarction, and unstable angina.ResultsObstructive CAD on CMRA was observed in 214 patients (42%). During follow-up (median, 5.6 years), 31 MACE occurred. Kaplan-Meier curve analysis revealed a significant difference in event-free survival between patients with and without obstructive CAD for MACE (log-rank, p = 0.003) and cardiac death (p = 0.012). Annualized event rates for MACE in patients with no obstructive CAD, 1-vessel disease, 2-vessel disease, and left-main or 3-vessel disease were 0.6%, 1.5%, 2.3%, and 3.6%, respectively (log-rank, p = 0.003). Cox proportional hazard regression analysis showed that, among obstructive CAD on CMRA and clinical risk factors (age, sex, hypertension, diabetes, dyslipidemia, smoking, and family history of CAD), obstructive CAD and diabetes were significant predictors of MACE (hazard ratios, 2.9 [p = 0.005] and 2.2 [p = 0.034], respectively). In multivariate analysis, obstructive CAD remained an independent predictor (adjusted hazard ratio, 2.6 [p = 0.010]) after adjusting for diabetes. Addition of obstructive CAD to clinical risk factors significantly increased the global chi-square result from 8.3 to 13.8 (p = 0.022).ConclusionsIn long-term follow-up, free breathing whole heart CMRA allows non-invasive risk stratification for MACE and cardiac death and provides incremental prognostic value over conventional risk factors in patients without a history of myocardial infarction or prior coronary artery revascularization. The presence and severity of obstructive CAD detected by CMRA were associated with worse prognosis. Importantly, patients without obstructive CAD on CMRA displayed favorable prognosis.
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