Background and AimsPatients with repaired tetralogy of Fallot remain at risk of life-threatening ventricular tachycardia related to slow-conducting anatomical isthmuses (SCAIs). Preventive ablation... Show moreBackground and AimsPatients with repaired tetralogy of Fallot remain at risk of life-threatening ventricular tachycardia related to slow-conducting anatomical isthmuses (SCAIs). Preventive ablation of SCAI identified by invasive electroanatomical mapping is increasingly performed. This study aimed to non-invasively identify SCAI using 3D late gadolinium enhancement cardiac magnetic resonance (3D-LGE-CMR).MethodsConsecutive tetralogy of Fallot patients who underwent right ventricular electroanatomical mapping (RV-EAM) and 3D-LGE-CMR were included. High signal intensity threshold for abnormal myocardium was determined based on direct comparison of bipolar voltages and signal intensity by co-registration of RV-EAM with 3D-LGE-CMR. The diagnostic performance of 3D-LGE-CMR to non-invasively identify SCAI was determined, validated in a second cohort, and compared with the discriminative ability of proposed risk scores.ResultsThe derivation cohort consisted of 48 (34 ± 16 years) and the validation cohort of 53 patients (36 ± 18 years). In the derivation cohort, 78 of 107 anatomical isthmuses (AIs) identified by EAM were normal-conducting AI, 22 were SCAI, and 7 blocked AI. High signal intensity threshold was 42% of the maximal signal intensity. The sensitivity and specificity of 3D-LGE-CMR for identifying SCAI or blocked AI were 100% and 90%, respectively. In the validation cohort, 85 of 124 AIs were normal-conducting AI, 36 were SCAI, and 3 blocked AI. The sensitivity and specificity of 3D-LGE-CMR were 95% and 91%, respectively. All risk scores showed an at best modest performance to identify SCAI (area under the curve ≤ .68).Conclusions3D late gadolinium enhancement cardiac magnetic resonance can identify SCAI with excellent accuracy and may refine non-invasive risk stratification and patient selection for invasive EAM in tetralogy of Fallot. Show less
Yazaki, M.; Nabeta, T.; Takigami, Y.; Eda, Y.; Maemura, K.; Oki, T.; ... ; Ako, J. 2023
Native T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to... Show moreNative T1 mapping is used to assess myocardial tissue characteristics without gadolinium contrast agents. The focal T1 high-intensity region can indicate myocardial alterations. This study aimed to identify the association between the native T1 mapping including the native T1 high region and left ventricular ejection fraction (LVEF) recovery in patients with dilated cardiomyopathy (DCM). Patients with newly diagnosed DCM (LVEF of < 45%) who underwent cardiac magnetic resonance imaging with native T1 mapping were included in the analysis. Native T1 high region was defined as a signal intensity of > 5 SD in the remote myocardium. Recovered EF was defined as a follow-up LVEF of >= 45% and an LVEF increase of >= 10% after 2 years from baseline. Seventy-one patients met the inclusion criteria for this study. Forty-four patients (61.9%) achieved recovered EF. Logistic regression analysis showed that the native T1 value (OR: 0.98; 95% CI: 0.96-0.99; P = 0.014) and the native T1 high region (OR: 0.17; 95% CI: 0.05-0.55; P = 0.002), but not late gadolinium enhancement, were independent predictors of recovered EF. Compared with native T1 value alone, combined native T1 high region and native T1 value improved the area under the curve from 0.703 to 0.788 for predicting recovered EF. Myocardial damage, which was quantified using native T1 mapping and the native T1 high region were independently associated with recovered EF in patients with newly diagnosed DCM. Show less
Zeppenfeld, K.; Tfelt-Hansen, J.; Riva, M. de; Winkel, B.G.; Behr, E.R.; Blom, N.A.; ... ; ESC Scientific Document Group 2022
Purpose: To develop and validate a new myocardial T-1 mapping sequence (MOSHA) which is based on a combination of the modified Look-Locker inversion recovery (MOLLI) and the saturation recovery... Show morePurpose: To develop and validate a new myocardial T-1 mapping sequence (MOSHA) which is based on a combination of the modified Look-Locker inversion recovery (MOLLI) and the saturation recovery single-shot acquisition (SASHA) sequences. Methods: Prior studies have shown that myocardial T-1 & nbsp;mapping by SASHA is more accurate but less precise than MOLLI. A new myocardial T1 mapping technique (MOSHA) based on single-shot acquisitions is developed by combining the MOLLI and SASHA sequences. Phantom and patient studies on 15 patients (9 males, median age 21 years) were performed to validate and compare MOSHA with the MOLLI and SASHA sequences in terms of accuracy and precision. Results: In the phantom study, MOSHA was as accurate as SASHA (P-value = 0.88) and as precise as MOLLI (P value = 0.59). Similar trends were observed in the patient study. Compared to SASHA, MOSHA accuracy was comparable for blood pre-contrast (P-value > 0.10) and post-contrast (P-value > 0.70), and for myocardium pre contrast (P-value = 0.70) and post-contrast (P-value = 0.09). Compared to MOLLI, MOSHA precision was lower for blood pre-contrast (P-value < 0.01) and higher for blood post-contrast (P-value < 0.01), and comparable for myocardium pre-contrast (P-value = 0.24) and post-contrast (P-value = 0.07). Synthetic Extracellular volume fraction (ECV) calculated by MOSHA was more precise than those of SASHA and MOLLI (P-value < 0.01). Conclusion: In phantom studies and patients, MOSHA has comparable accuracy as SASHA and nearly similar precision as MOLLI for T1 mapping. Precision of MOSHA was better than MOLLI and SASHA in synthetic ECV measurements. Therefore, it may be a superior choice in clinical practice for a precise and accurate calculation of T1 and ECV. Show less
Cardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta... Show moreCardiovascular magnetic resonance (CMR) enables assessment and quantification of morphological and functional parameters of the heart, including chamber size and function, diameters of the aorta and pulmonary arteries, flow and myocardial relaxation times. Knowledge of reference ranges ("normal values") for quantitative CMR is crucial to interpretation of results and to distinguish normal from disease. Compared to the previous version of this review published in 2015, we present updated and expanded reference values for morphological and functional CMR parameters of the cardiovascular system based on the peer-reviewed literature and current CMR techniques. Further, databases and references for deep learning methods are included. Show less
Takotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious... Show moreTakotsubo syndrome (TTS) is a complex and still poorly recognized heart disease with a wide spectrum of possible clinical presentations. Despite its reversibility, it is associated with serious adverse in-hospital events and high complication rates during follow-up. Multimodality imaging is helpful for establishing the diagnosis, guiding therapy, and stratifying prognosis of TTS patients in both the acute and post-acute phase. Echocardiography plays a key role, particularly in the acute care setting, allowing for the assessment of left ventricular (LV) systolic and diastolic function and the identification of the typical apical-midventricular ballooning pattern, as well as the circumferential pattern of wall motion abnormalities. It is also useful in the early detection of complications (i.e. LV outflow tract obstruction, mitral regurgitation, right ventricular involvement, LV thrombi, and pericardial effusion) and monitoring of systolic function recovery. Left ventriculography allows the evaluation of LV function and morphology, identifying the typical TTS patterns when echocardiography is not available or wall motion abnormalities cannot be properly assessed with ultrasound. Cardiac magnetic resonance provides a more comprehensive depiction of cardiac morphology and function and tissue characterization and offers additional value to other imaging modalities for differential diagnosis (myocardial infarction and myocarditis). Coronary computed tomography angiography has a substantial role in the diagnostic workup of patients with acute chest pain and a doubtful TTS diagnosis to rule out other medical conditions. It can be considered as a non-invasive appropriate alternative to coronary angiography in several clinical scenarios. Although the role of nuclear imaging in TTS has not yet been well established, the combination of perfusion and metabolic imaging may provide useful information on myocardial function in both the acute and post-acute phase. Show less
Cardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement... Show moreCardiovascular (CV) imaging is an important tool in baseline risk assessment and detection of CV disease in oncology patients receiving cardiotoxic cancer therapies. This position statement examines the role of echocardiography, cardiac magnetic resonance, nuclear cardiac imaging and computed tomography in the management of cancer patients. The Imaging and Cardio-Oncology Study Groups of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) in collaboration with the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the ESC have evaluated the current evidence for the value of modern CV imaging in the cardio-oncology field. The most relevant echocardiographic parameters, including global longitudinal strain and three-dimensional ejection fraction, are proposed. The protocol for baseline pre-treatment evaluation and specific surveillance algorithms or pathways for anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor tyrosine kinase inhibitors, BCr-Abl tyrosine kinase inhibitors, proteasome inhibitors and immune checkpoint inhibitors are presented. The indications for CV imaging after completion of oncology treatment are considered. The typical consequences of radiation therapy and the possibility of their identification in the long term are also summarized. Special populations are discussed including female survivors planning pregnancy, patients with carcinoid disease, patients with cardiac tumours and patients with right heart failure. Future directions and ongoing CV imaging research in cardio-oncology are discussed. Show less
Pulmonary artery aneurysm (PAA) is a common finding in patients with long-term pulmonary arterial hypertension (PAH). The influence of PAH severity in the development of PAA remains unclear. We... Show morePulmonary artery aneurysm (PAA) is a common finding in patients with long-term pulmonary arterial hypertension (PAH). The influence of PAH severity in the development of PAA remains unclear. We sought to determine whether PAA development is related to PAH severity and whether treatment optimization based on risk profile estimation is effective to stop pulmonary artery (PA) enlargement. This is a retrospective study of 125 PAH patients who underwent an imaging test (computed tomography or magnetic resonance) combined with a right heart catheterization within a six-month period. A multivariate analysis was performed to identify independent risk factors for PAA. Patients who underwent an additional imaging-test and RHC during follow-up were analyzed to evaluate changes on PA dimensions. PAA was diagnosed in 42 (34%) patients. PAA was more frequent in patients with congenital heart disease and toxic oil syndrome. PAH time-course showed to be an independent risk factor for PAA (HR 1.051, 95% CI 1.013-1.091, p = 0.008) whereas PAH severity did not. Twenty-six patients underwent a follow-up imaging-test and catheterization. After treatment optimization, a non-significant reduction of mean PA pressure was observed (58.5 mmHg [43.5-70.8] vs. 55.5 mmHg [47.5-66.3], p = 0.115) and a higher proportion of patients achieved a low-risk profile (19% vs. 35%, p = 0.157). However, the PA diameter significantly increased (40.4 +/- 10.1 mm vs. 42.1 +/- 9.6 mm; p = 0.003). PAA is a common condition in long-standing PAH but its development is not necessarily related to PAH severity. Despite stabilization after treatment optimization, a progressive PA dilatation was observed. Show less
Sramko, M.; Hoogendoorn, J.C.; Glashan, C.A.; Zeppenfeld, K. 2019
Over the last decades, substrate-based approaches to ventricular tachycardia (VT) ablation have evolved into an important therapeutic option for patients with various structural heart diseases (SHD... Show moreOver the last decades, substrate-based approaches to ventricular tachycardia (VT) ablation have evolved into an important therapeutic option for patients with various structural heart diseases (SHD) and unmappable VT. The well-recognized limitations of conventional electroanatomical mapping (EAM) to delineate the complex 3D architecture of scar, and the potential capability of advanced cardiac imaging technologies to provide adjunctive information, have stimulated electrophysiologists to evaluate the role of imaging to improve safety and efficacy of catheter ablation. In this review, we summarize the histological differences between SHD aetiologies related to monomorphic sustained VT and the currently available data on the histological validation of cardiac imaging modalities and EAM to delineate scar and the arrhythmogenic substrate. We review the current evidence of the value provided by cardiac imaging to facilitate VT ablation and to ultimately improve outcome. Show less
Bijl, P. van der; Podlesnikar, T.; Bax, J.J.; Delgado, V. 2018
Advanced echocardiographic techniques permit assessment of left ventricular dyssynchrony in overt heart failure patients and provide important prognostic data. These techniques may guide patients__... Show moreAdvanced echocardiographic techniques permit assessment of left ventricular dyssynchrony in overt heart failure patients and provide important prognostic data. These techniques may guide patients__ selection for cardiac resynchronization therapy and device optimization. Global left ventricular longitudinal 2-dimensional strain may help detect early stages of myocardial dysfunction in diabetic patients with preserved left ventricular ejection fraction. Novel cardiac magnetic resonance imaging sequence analysis may allow tissue characterization, quantification of diffuse fibrosis and detection of early alterations in ventriculo-arterial coupling. Advanced cardiac imaging provides invaluable information at every stage of the heart failure syndrome. It may help identify an earlier stage of the disease, help to select patients for cardiac resynchronization therapy, tailor therapies in selected individuals and offer important prognostic information. Show less
