18 results on '"Piechnik, Stefan K."'
Search Results
2. Diffuse Myocardial Fibrosis and Inflammation in Rheumatoid Arthritis: Insights From CMR T1 Mapping.
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Ntusi NAB, Piechnik SK, Francis JM, Ferreira VM, Matthews PM, Robson MD, Wordsworth PB, Neubauer S, and Karamitsos TD
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- Adult, Arthritis, Rheumatoid diagnosis, Biomechanical Phenomena, Cardiomyopathies etiology, Cardiomyopathies physiopathology, Contrast Media, Edema, Cardiac etiology, Edema, Cardiac physiopathology, England, Female, Fibrosis, Humans, Male, Meglumine, Middle Aged, Myocardial Contraction, Myocarditis etiology, Myocarditis physiopathology, Organometallic Compounds, Predictive Value of Tests, Prospective Studies, Stroke Volume, Ventricular Function, Left, Ventricular Function, Right, Arthritis, Rheumatoid complications, Cardiomyopathies pathology, Edema, Cardiac pathology, Magnetic Resonance Imaging, Cine, Myocarditis pathology, Myocardium pathology
- Abstract
Objectives: The goal of this study was to assess the diffuse myocardial fibrosis and edema in rheumatoid arthritis (RA) using multiparametric cardiac magnetic resonance (CMR) and the association of myocardial T1 and extracellular volume (ECV) with disease activity, duration, and cardiac function., Background: RA is a connective tissue disorder, with frequent cardiovascular disease. Myocardial inflammation and diffuse fibrosis can be detected noninvasively by using native T1 mapping and ECV quantification on CMR., Methods: Thirty-nine RA patients (28 women; mean age 50 ± 12 years) and 39 matched control subjects (28 women; mean age 49 ± 12 years) underwent CMR at 1.5-T, including cine, tagging, T2-weighted, native T1 mapping (shortened modified Look-Locker inversion recovery), late gadolinium enhancement (LGE), and ECV imaging., Results: Focal fibrosis on LGE was found in 46% of RA patients compared with none of the control subjects. Patients with RA had larger areas of focal myocardial edema (10% vs. 0%), higher native T1 values (973 ± 27 ms vs. 961 ± 18 ms; p = 0.03), larger areas of involvement as detected by native T1 >990 ms (35% vs. 2%; p < 0.001), and expansion of ECV (30.3 ± 3.4% vs. 27.9 ± 2.0%; p < 0.001) compared with control subjects. Left ventricular volumes, mass, and ejection fraction were similar between RA patients and control subjects. Peak systolic circumferential strain (-16.9 ± 1.3 vs. -18.7 ± 1.2; p < 0.001) and peak diastolic circumferential strain rate (83 ± 21 s(-1) vs. 112 ± 20 s(-1); p < 0.001) were impaired in RA patients. Myocardial T1 and ECV were correlated with myocardial strain and RA disease activity., Conclusions: Subclinical cardiovascular disease is frequent in RA, including focal and diffuse myocardial fibrosis and inflammation, which are associated with impaired strain and RA disease activity. CMR T1 mapping provides potential added value as a biomarker for disease monitoring and study of therapies aimed at reducing diffuse myocardial fibrosis in RA., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2015
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3. T1 mapping and survival in systemic light-chain amyloidosis.
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Banypersad SM, Fontana M, Maestrini V, Sado DM, Captur G, Petrie A, Piechnik SK, Whelan CJ, Herrey AS, Gillmore JD, Lachmann HJ, Wechalekar AD, Hawkins PN, and Moon JC
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- Amyloid metabolism, Amyloidosis pathology, Biomarkers metabolism, Cardiomyopathies pathology, Contrast Media, Female, Gadolinium, Heart Failure metabolism, Heart Failure mortality, Humans, Immunoglobulin Light Chains metabolism, Kaplan-Meier Estimate, Magnetic Resonance Angiography, Male, Middle Aged, Prognosis, Amyloidosis mortality, Cardiomyopathies mortality
- Abstract
Aims: To assess the prognostic value of myocardial pre-contrast T1 and extracellular volume (ECV) in systemic amyloid light-chain (AL) amyloidosis using cardiovascular magnetic resonance (CMR) T1 mapping., Methods and Results: One hundred patients underwent CMR and T1 mapping pre- and post-contrast. Myocardial ECV was calculated at contrast equilibrium (ECV(i)) and 15 min post-bolus (ECVb). Fifty-four healthy volunteers served as controls. Patients were followed up for a median duration of 23 months and survival analyses were performed. Mean ECV(i) was raised in amyloid (0.44 ± 0.12) as was ECV(b) (mean 0.44 ± 0.12) compared with healthy volunteers (0.25 ± 0.02), P < 0.001. Native pre-contrast T1 was raised in amyloid (mean 1080 ± 87 ms vs. 954 ± 34 ms, P < 0.001). All three correlated with pre-test probability of cardiac involvement, cardiac biomarkers, and systolic and diastolic dysfunction. During follow-up, 25 deaths occurred. An ECV(i) of >0.45 carried a hazard ratio (HR) for death of 3.84 [95% confidence interval (CI): 1.53-9.61], P = 0.004 and pre-contrast T1 of >1044 ms = HR 5.39 (95% CI: 1.24-23.4), P = 0.02. Extracellular volume after primed infusion and ECVb performed similarly. Isolated post-contrast T1 was non-predictive. In Cox regression models, ECV(i) was independently predictive of mortality (HR = 4.41, 95% CI: 1.35-14.4) after adjusting for E:E', ejection fraction, diastolic dysfunction grade, and NT-proBNP., Conclusion: Myocardial ECV (bolus or infusion technique) and pre-contrast T1 are biomarkers for cardiac AL amyloid and they predict mortality in systemic amyloidosis., (© The Author 2014. Published by Oxford University Press on behalf of the European Society of Cardiology.)
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- 2015
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4. Subclinical myocardial inflammation and diffuse fibrosis are common in systemic sclerosis--a clinical study using myocardial T1-mapping and extracellular volume quantification.
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Ntusi NA, Piechnik SK, Francis JM, Ferreira VM, Rai AB, Matthews PM, Robson MD, Moon J, Wordsworth PB, Neubauer S, and Karamitsos TD
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- Aged, Cardiomyopathies etiology, Cardiomyopathies pathology, Cardiomyopathies physiopathology, Case-Control Studies, Contrast Media, Diastole, Edema, Cardiac etiology, Edema, Cardiac pathology, Edema, Cardiac physiopathology, England, Female, Fibrosis, Humans, Male, Middle Aged, Myocarditis etiology, Myocarditis pathology, Myocarditis physiopathology, Predictive Value of Tests, Prospective Studies, Severity of Illness Index, Ventricular Function, Left, Ventricular Function, Right, Cardiomyopathies diagnosis, Edema, Cardiac diagnosis, Magnetic Resonance Imaging, Cine, Myocarditis diagnosis, Myocardium pathology, Scleroderma, Diffuse complications
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Background: Systemic sclerosis (SSc) is characterised by multi-organ tissue fibrosis including the myocardium. Diffuse myocardial fibrosis can be detected non-invasively by T1 and extracellular volume (ECV) quantification, while focal myocardial inflammation and fibrosis may be detected by T2-weighted and late gadolinium enhancement (LGE), respectively, using cardiovascular magnetic resonance (CMR). We hypothesised that multiparametric CMR can detect subclinical myocardial involvement in patients with SSc., Methods: 19 SSc patients (18 female, mean age 55 ± 10 years) and 20 controls (19 female, mean age 56 ± 8 years) without overt cardiovascular disease underwent CMR at 1.5T, including cine, tagging, T1-mapping, T2-weighted, LGE imaging and ECV quantification., Results: Focal fibrosis on LGE was found in 10 SSc patients (53%) but none of controls. SSc patients also had areas of myocardial oedema on T2-weighted imaging (median 13 vs. 0% in controls). SSc patients had significantly higher native myocardial T1 values (1007 ± 29 vs. 958 ± 20 ms, p < 0.001), larger areas of myocardial involvement by native T1 >990 ms (median 52 vs. 3% in controls) and expansion of ECV (35.4 ± 4.8 vs. 27.6 ± 2.5%, p < 0.001), likely representing a combination of low-grade inflammation and diffuse myocardial fibrosis. Regardless of any regional fibrosis, native T1 and ECV were significantly elevated in SSc and correlated with disease activity and severity. Although biventricular size and global function were preserved, there was impairment in the peak systolic circumferential strain (-16.8 ± 1.6 vs. -18.6 ± 1.0, p < 0.001) and peak diastolic strain rate (83 ± 26 vs. 114 ± 16 s-1, p < 0.001) in SSc, which inversely correlated with diffuse myocardial fibrosis indices., Conclusions: Cardiac involvement is common in SSc even in the absence of cardiac symptoms, and includes chronic myocardial inflammation as well as focal and diffuse myocardial fibrosis. Myocardial abnormalities detected on CMR were associated with impaired strain parameters, as well as disease activity and severity in SSc patients. CMR may be useful in future in the study of treatments aimed at preventing or reducing adverse myocardial processes in SSc.
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- 2014
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5. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveal a high burden of myocardial disease in HIV patients.
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Holloway CJ, Ntusi N, Suttie J, Mahmod M, Wainwright E, Clutton G, Hancock G, Beak P, Tajar A, Piechnik SK, Schneider JE, Angus B, Clarke K, Dorrell L, and Neubauer S
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- Adult, Anti-Retroviral Agents therapeutic use, Cardiomyopathies pathology, Case-Control Studies, Cross-Sectional Studies, Female, Fibrosis, HIV Infections drug therapy, Heart physiopathology, Humans, Lipid Metabolism physiology, Male, Middle Aged, Myocardium metabolism, Myocardium pathology, Prevalence, Cardiomyopathies diagnosis, Cardiomyopathies epidemiology, HIV Infections complications, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy
- Abstract
Background: HIV infection continues to be endemic worldwide. Although treatments are successful, it remains controversial whether patients receiving optimal therapy have structural, functional, or biochemical cardiac abnormalities that may underlie their increased cardiac morbidity and mortality. The purpose of this study was to characterize myocardial abnormalities in a contemporary group of HIV-infected individuals undergoing combination antiretroviral therapy., Methods and Results: Volunteers with HIV who were undergoing combination antiretroviral therapy and age-matched control subjects without a history of cardiovascular disease underwent cardiac magnetic resonance imaging and spectroscopy for the determination of cardiac function, myocardial fibrosis, and myocardial lipid content. A total of 129 participants were included in this analysis. Compared with age-matched control subjects (n=39; 30.23%), HIV-infected subjects undergoing combination antiretroviral therapy (n=90; 69.77%) had 47% higher median myocardial lipid levels (P <0.003) and 74% higher median plasma triglyceride levels (both P<0.001). Myocardial fibrosis, predominantly in the basal inferolateral wall of the left ventricle, was observed in 76% of HIV-infected subjects compared with 13% of control subjects (P<0.001). Peak myocardial systolic and diastolic longitudinal strain were also lower in HIV-infected individuals than in control subjects and remained statistically significant after adjustment for available confounders., Conclusions: Comprehensive cardiac imaging revealed cardiac steatosis, alterations in cardiac function, and a high prevalence of myocardial fibrosis in a contemporary group of asymptomatic HIV-infected subjects undergoing combination antiretroviral therapy. Cardiac steatosis and fibrosis may underlie cardiac dysfunction and increased cardiovascular morbidity and mortality in subjects with HIV.
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- 2013
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6. Noncontrast T1 mapping for the diagnosis of cardiac amyloidosis.
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Karamitsos TD, Piechnik SK, Banypersad SM, Fontana M, Ntusi NB, Ferreira VM, Whelan CJ, Myerson SG, Robson MD, Hawkins PN, Neubauer S, and Moon JC
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- Aged, Amyloidosis physiopathology, Aortic Valve Stenosis pathology, Cardiomyopathies physiopathology, Case-Control Studies, Chi-Square Distribution, Contrast Media, Female, Humans, Hypertrophy, Left Ventricular pathology, Male, Meglumine, Middle Aged, Myocardial Contraction, Organometallic Compounds, Predictive Value of Tests, Prognosis, Stroke Volume, Ventricular Function, Left, Amyloidosis pathology, Cardiomyopathies pathology, Magnetic Resonance Imaging, Cine, Myocardium pathology
- Abstract
Objectives: This study sought to explore the potential role of noncontrast myocardial T1 mapping for detection of cardiac involvement in patients with primary amyloid light-chain (AL) amyloidosis., Background: Cardiac involvement carries a poor prognosis in systemic AL amyloidosis. Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is useful for the detection of cardiac amyloid, but characteristic LGE patterns do not always occur or they appear late in the disease. Noncontrast characterization of amyloidotic myocardium with T1 mapping may improve disease detection. Furthermore, quantitative assessment of myocardial amyloid load would be of great value., Methods: Fifty-three AL amyloidosis patients (14 with no cardiac involvement, 11 with possible involvement, and 28 with definite cardiac involvement based on standard biomarker and echocardiographic criteria) underwent CMR (1.5-T) including noncontrast T1 mapping (shortened modified look-locker inversion recovery [ShMOLLI] sequence) and LGE imaging. These were compared with 36 healthy volunteers and 17 patients with aortic stenosis and a comparable degree of left ventricular hypertrophy as the cardiac amyloid patients., Results: Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients (1,140 ± 61 ms) compared to normal subjects (958 ± 20 ms, p < 0.001) and patients with aortic stenosis (979 ± 51 ms, p < 0.001). Myocardial T1 was increased in AL amyloid even when cardiac involvement was uncertain (1,048 ± 48 ms) or thought absent (1,009 ± 31 ms). A noncontrast myocardial T1 cutoff of 1,020 ms yielded 92% accuracy for identifying amyloid patients with possible or definite cardiac involvement. In the AL amyloidosis cohort, there were significant correlations between myocardial T1 time and indices of systolic and diastolic dysfunction., Conclusions: Noncontrast T1 mapping has high diagnostic accuracy for detecting cardiac AL amyloidosis, correlates well with markers of systolic and diastolic dysfunction, and is potentially more sensitive for detecting early disease than LGE imaging. Elevated myocardial T1 may represent a direct marker of cardiac amyloid load. Further studies are needed to assess the prognostic significance of T1 elevation., (Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
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- 2013
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7. Ultrafast Magnetic Resonance Imaging for Iron Quantification in Thalassemia Participants in the Developing World
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Abdel-Gadir, Amna, Vorasettakarnkij, Yongkasem, Ngamkasem, Hataichanok, Nordin, Sabrina, Ako, Emmanuel A., Tumkosit, Monravee, Sucharitchan, Pranee, Uaprasert, Noppacharn, Kellman, Peter, Piechnik, Stefan K., Fontana, Marianna, Fernandes, Juliano L., Manisty, Charlotte, Westwood, Mark, Porter, John B., Walker, J. Malcolm, and Moon, James C.
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cardiomyopathies ,Adult ,Male ,Iron Overload ,Time Factors ,diagnosis ,International Cooperation ,Iron ,Transfusion Reaction ,Heart ,Middle Aged ,Thailand ,Magnetic Resonance Imaging ,United Kingdom ,Young Adult ,Liver ,Correspondence ,Research Letter ,Humans ,Thalassemia ,Female - Published
- 2016
8. T1 mapping and survival in systemic light-chain amyloidosis
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Banypersad, Sanjay M., Fontana, Marianna, Maestrini, Viviana, Sado, Daniel M., Captur, Gabriella, Petrie, Aviva, Piechnik, Stefan K., Whelan, Carol J., Herrey, Anna S., Gillmore, Julian D., Lachmann, Helen J., Wechalekar, Ashutosh D., Hawkins, Philip N., and Moon, James C.
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Heart Failure ,Male ,Amyloid ,Cardiomyopathy ,Contrast Media ,amyloid ,cardiomyopathy ,CMR ,ECV ,heart failure ,T1 mapping ,amyloidosis ,biomarkers ,cardiomyopathies ,contrast media ,female ,gadolinium ,humans ,immunoglobulin light chains ,kaplan-meier estimate ,magnetic resonance angiography ,male ,middle aged ,prognosis ,cardiology and cardiovascular medicine ,medicine (all) ,Gadolinium ,Amyloidosis ,Kaplan-Meier Estimate ,Middle Aged ,Prognosis ,Imaging ,Clinical Research ,Humans ,Female ,Immunoglobulin Light Chains ,Cardiomyopathies ,Biomarkers ,Magnetic Resonance Angiography - Abstract
Aims To assess the prognostic value of myocardial pre-contrast T1 and extracellular volume (ECV) in systemic amyloid light-chain (AL) amyloidosis using cardiovascular magnetic resonance (CMR) T1 mapping. Methods and results One hundred patients underwent CMR and T1 mapping pre- and post-contrast. Myocardial ECV was calculated at contrast equilibrium (ECVi) and 15 min post-bolus (ECVb). Fifty-four healthy volunteers served as controls. Patients were followed up for a median duration of 23 months and survival analyses were performed. Mean ECVi was raised in amyloid (0.44 ± 0.12) as was ECVb (mean 0.44 ± 0.12) compared with healthy volunteers (0.25 ± 0.02), P < 0.001. Native pre-contrast T1 was raised in amyloid (mean 1080 ± 87 ms vs. 954 ± 34 ms, P < 0.001). All three correlated with pre-test probability of cardiac involvement, cardiac biomarkers, and systolic and diastolic dysfunction. During follow-up, 25 deaths occurred. An ECVi of >0.45 carried a hazard ratio (HR) for death of 3.84 [95% confidence interval (CI): 1.53–9.61], P = 0.004 and pre-contrast T1 of >1044 ms = HR 5.39 (95% CI: 1.24–23.4), P = 0.02. Extracellular volume after primed infusion and ECVb performed similarly. Isolated post-contrast T1 was non-predictive. In Cox regression models, ECVi was independently predictive of mortality (HR = 4.41, 95% CI: 1.35–14.4) after adjusting for E:E′, ejection fraction, diastolic dysfunction grade, and NT-proBNP. Conclusion Myocardial ECV (bolus or infusion technique) and pre-contrast T1 are biomarkers for cardiac AL amyloid and they predict mortality in systemic amyloidosis.
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- 2014
9. Measurement of myocardial native T1 in cardiovascular diseases and norm in 1291 subjects.
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Liu, Joanna M., Liu, Alexander, Leal, Joana, McMillan, Fiona, Francis, Jane, Greiser, Andreas, Rider, Oliver J., Myerson, Saul, Neubauer, Stefan, Ferreira, Vanessa M., and Piechnik, Stefan K.
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CARDIOMYOPATHIES ,CARDIAC hypertrophy ,MYOCARDIUM ,BODY surface mapping ,CARDIOVASCULAR diseases ,REPORTING of diseases ,REFERENCE values ,CONTRAST media ,DATA analysis software ,DESCRIPTIVE statistics ,ANATOMY ,DIAGNOSIS - Abstract
Background: Native T1-mapping provides quantitative myocardial tissue characterization for cardiovascular diseases (CVD), without the need for gadolinium. However, its translation into clinical practice is hindered by differences between techniques and the lack of established reference values. We provide typical myocardial T1-ranges for 18 commonly encountered CVDs using a single T1-mapping technique - Shortened Look-Locker Inversion Recovery (ShMOLLI), also used in the large UK Biobank and Hypertrophic Cardiomyopathy Registry study. Methods: We analyzed 1291 subjects who underwent CMR (1.5-Tesla, MAGNETOM-Avanto, Siemens Healthcare, Erlangen, Germany) between 2009 and 2016, who had a single CVD diagnosis, with mid-ventricular T1-map assessment. A region of interest (ROI) was placed on native T1-maps in the "most-affected myocardium", characterized by the presence of late gadolinium enhancement (LGE), or regional wall motion abnormalities (RWMA) on cines. Another ROI was placed in the "reference myocardium" as far as possible from LGE/RWMA, and in the septum if no focal abnormality was present. To further define normality, we included native T1 of healthy subjects from an existing dataset after sub-endocardial pixelerosions. Results: Native T1 of patients with normal CMR (938 ± 21 ms) was similar compared to healthy subjects (941 ± 23 ms). Across all patient groups (57 ± 19 yrs., 65% males), focally affected myocardium had significantly different T1 value compared to reference myocardium (all p < 0.001). In the affected myocardium, cardiac amyloidosis (1119 ± 61 ms) had the highest native T1 compared to normal and all other CVDs, while iron-overload (795 ± 58 ms) and Anderson-Fabry disease (863 ± 23 ms) had the lowest native reference T1 (all p < 0.001). Future studies designed to detect the large T1 differences between affected and reference myocardium are estimated to require small sample-sizes (n < 50). However, studies designed to detect the small T1 differences between reference myocardium in CVDs and healthy controls can require several thousand of subjects. Conclusions: We provide typical T1-ranges for common clinical cardiac conditions in the largest cohort to-date, using ShMOLLI T1-mapping at 1.5 T. Sample-size calculations from this study may be useful for the design of future studies and trials that use T1-mapping as an endpoint. [ABSTRACT FROM AUTHOR]
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- 2017
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10. Native T1-mapping detects the location, extent and patterns of acute myocarditis without the need for gadolinium contrast agents.
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Ferreira, Vanessa M., Piechnik, Stefan K., Dall¿Armellina, Erica, Karamitsos, Theodoros D., Francis, Jane M., Ntusi, Ntobeko, Holloway, Cameron, Choudhury, Robin P., Kardos, Attila, Robson, Matthew D., Friedrich, Matthias G., and Neubauer, Stefan
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MAGNETIC resonance imaging , *ANALYSIS of variance , *LONGITUDINAL method , *CARDIOMYOPATHIES , *STATISTICS , *T-test (Statistics) , *U-statistics , *DATA analysis , *CONTRAST media , *RECEIVER operating characteristic curves , *DATA analysis software , *DESCRIPTIVE statistics , *DIAGNOSIS - Abstract
Background Acute myocarditis can be diagnosed on cardiovascular magnetic resonance (CMR) using multiple techniques, including late gadolinium enhancement (LGE) imaging, which requires contrast administration. Native T1-mapping is significantly more sensitive than LGE and conventional T2-weighted (T2W) imaging in detecting myocarditis. The aims of this study were to demonstrate how to display the non-ischemic patterns of injury and to quantify myocardial involvement in acute myocarditis without the need for contrast agents, using topographic T1-maps and incremental T1 thresholds. Methods We studied 60 patients with suspected acute myocarditis (median 3 days from presentation) and 50 controls using CMR (1.5 T), including:(1) dark-blood T2W imaging; (2) native T1-mapping (ShMOLLI); (3) LGE. Analysis included: (1) global myocardial T2 signal intensity (SI) ratio compared to skeletal muscle; (2) myocardial T1 times; (3) areas of injury by T2W, T1-mapping and LGE. Results Compared to controls, patients had more edema (global myocardial T2 SI ratio 1.71 ± 0.27 vs.1.56 ± 0.15), higher mean myocardial T1 (1011 ± 64 ms vs. 946 ± 23 ms) and more areas of injury as detected by T2W (median 5% vs. 0%), T1 (median 32% vs. 0.7%) and LGE (median 11% vs. 0%); all p < 0.001. A threshold of T1 > 990 ms (sensitivity 90%, specificity 88%) detected significantly larger areas of involvement than T2W and LGE imaging in patients, and additional areas of injury when T2W and LGE were negative. T1-mapping significantly improved the diagnostic confidence in an additional 30% of cases when at least one of the conventional methods (T2W, LGE) failed to identify any areas of abnormality. Using incremental thresholds, T1-mapping can display the non-ischemic patterns of injury typical of myocarditis. Conclusion Native T1-mapping can display the typical non-ischemic patterns in acute myocarditis, similar to LGE imaging but without the need for contrast agents. In addition, T1-mapping offers significant incremental diagnostic value, detecting additional areas of myocardial involvement beyond T2W and LGE imaging and identified extra cases when these conventional methods failed to identify abnormalities. In the future, it may be possible to perform gadolinium-free CMR using cine and T1-mapping for tissue characterization and may be particularly useful for patients in whom gadolinium contrast is contraindicated. [ABSTRACT FROM AUTHOR]
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- 2014
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11. Non-contrast T1-mapping detects acute myocardial edema with high diagnostic accuracy: a comparison to T2-weighted cardiovascular magnetic resonance.
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Ferreira, Vanessa M, Piechnik, Stefan K, Dall'Armellina, Erica, Karamitsos, Theodoros D, Francis, Jane M, Choudhury, Robin P, Friedrich, Matthias G, Robson, Matthew D, and Neubauer, Stefan
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EDEMA , *MYOCARDIAL infarction , *TAKOTSUBO cardiomyopathy , *MAGNETIC resonance , *CORONARY disease , *MYOCARDITIS , *TROPONIN , *DIAGNOSIS of edema , *MAGNETIC resonance imaging , *MYOCARDIUM , *CARDIOMYOPATHIES , *PROBABILITY theory , *RECEIVER operating characteristic curves , *SKELETAL muscle , *DESCRIPTIVE statistics - Abstract
Background: T2w-CMR is used widely to assess myocardial edema. Quantitative T1-mapping is also sensitive to changes in free water content. We hypothesized that T1-mapping would have a higher diagnostic performance in detecting acute edema than dark-blood and bright-blood T2w-CMR. Methods: We investigated 21 controls (55 ± 13 years) and 21 patients (61 ± 10 years) with Takotsubo cardiomyopathy or acute regional myocardial edema without infarction. CMR performed within 7 days included cine, T1-mapping using ShMOLLI, dark-blood T2-STIR, bright-blood ACUT2E and LGE imaging. We analyzed wall motion, myocardial T1 values and T2 signal intensity (SI) ratio relative to both skeletal muscle and remote myocardium. Results: All patients had acute cardiac symptoms, increased Troponin I (0.15-36.80 ug/L) and acute wall motion abnormalities but no LGE. T1 was increased in patient segments with abnormal and normal wall motion compared to controls (1113 ± 94 ms, 1029 ± 59 ms and 944 ± 17 ms, respectively; p<0.001). T2 SI ratio using STIR and ACUT2E was also increased in patient segments with abnormal and normal wall motion compared to controls (all p<0.02). Receiver operator characteristics analysis showed that T1-mapping had a significantly larger area-under-the-curve (AUC = 0.94) compared to T2-weighted methods, whether the reference ROI was skeletal muscle or remote myocardium (AUC = 0.58-0.89; p<0.03). A T1 value of greater than 990 ms most optimally differentiated segments affected by edema from normal segments at 1.5 T, with a sensitivity and specificity of 92 %. Conclusions: Non-contrast T1-mapping using ShMOLLI is a novel method for objectively detecting myocardial edema with a high diagnostic performance. T1-mapping may serve as a complementary technique to T2-weighted imaging for assessing myocardial edema in ischemic and non-ischemic heart disease, such as quantifying area-at-risk and diagnosing myocarditis. [ABSTRACT FROM AUTHOR]
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- 2012
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12. Comparison of T1 mapping techniques for ECV quantification. Histological validation and reproducibility of ShMOLLI versus multibreath-hold T1 quantification equilibrium contrast CMR.
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Fontana, Marianna, White, Steve K., Banypersad, Sanjay M., Sado, Daniel M., Maestrini, Viviana, Flett, Andrew S., Piechnik, Stefan K., Neubauer, Stefan, Roberts, Neil, and Moon, James C.
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CARDIOMYOPATHIES ,HEART diseases ,AORTIC stenosis ,AORTIC valve diseases ,STENOSIS ,FIBROSIS ,BIOPSY ,COLLAGEN ,CONFIDENCE intervals ,EXTRACELLULAR space ,CARDIAC hypertrophy ,HEMATOCRIT ,MAGNETIC resonance imaging ,MYOCARDIUM ,PROBABILITY theory ,RESEARCH evaluation ,STATISTICAL reliability ,BREATH holding ,PRE-tests & post-tests ,CONTRAST media ,DESCRIPTIVE statistics ,INTRACLASS correlation ,DIAGNOSIS - Abstract
Background: Myocardial extracellular volume (ECV) is elevated in fibrosis or infiltration and can be quantified by measuring the haematocrit with pre and post contrast T1 at sufficient contrast equilibrium. Equilibrium CMR (EQ-CMR), using a bolus-infusion protocol, has been shown to provide robust measurements of ECV using a multibreath-hold T1 pulse sequence. Newer, faster sequences for T1 mapping promise whole heart coverage and improved clinical utility, but have not been validated.Methods: Multibreathhold T1 quantification with heart rate correction and single breath-hold T1 mapping using Shortened Modified Look-Locker Inversion recovery (ShMOLLI) were used in equilibrium contrast CMR to generate ECV values and compared in 3 ways. Firstly, both techniques were compared in a spectrum of disease with variable ECV expansion (n=100, 50 healthy volunteers, 12 patients with hypertrophic cardiomyopathy, 18 with severe aortic stenosis, 20 with amyloid). Secondly, both techniques were correlated to human histological collagen volume fraction (CVF%, n=18, severe aortic stenosis biopsies). Thirdly, an assessment of test:retest reproducibility of the 2 CMR techniques was performed 1 week apart in individuals with widely different ECVs (n=10 healthy volunteers, n=7 amyloid patients). Results: More patients were able to perform ShMOLLI than the multibreath-hold technique (6% unable to breath-hold). ECV calculated by multibreath-hold T1 and ShMOLLI showed strong correlation (r
2 =0.892), little bias (bias -2.2%, 95%CI -8.9% to 4.6%) and good agreement (ICC 0.922, range 0.802 to 0.961, p<0.0001). ECV correlated with histological CVF% by multibreath-hold ECV (r2 = 0.589) but better by ShMOLLI ECV (r2 = 0.685). Inter-study reproducibility demonstrated that ShMOLLI ECV trended towards greater reproducibility than the multibreath-hold ECV, although this did not reach statistical significance (95%CI -4.9% to 5.4% versus 95%CI -6.4% to 7.3% respectively, p=0.21). Conclusions: ECV quantification by single breath-hold ShMOLLI T1 mapping can measure ECV by EQ-CMR across the spectrum of interstitial expansion. It is procedurally better tolerated, slightly more reproducible and better correlates with histology compared to the older multibreath-hold FLASH techniques. [ABSTRACT FROM AUTHOR]- Published
- 2012
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13. Changes in Cardiac Morphology and Function in Individuals With Diabetes Mellitus: The UK Biobank Cardiovascular Magnetic Resonance Substudy.
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Jensen, Magnus T., Fung, Kenneth, Aung, Nay, Sanghvi, Mihir M., Chadalavada, Sucharitha, Paiva, Jose M., Khanji, Mohammed Y., de Knegt, Martina C., Lukaschuk, Elena, Lee, Aaron M., Barutcu, Ahmet, Maclean, Edd, Carapella, Valentina, Cooper, Jackie, Young, Alistair, Piechnik, Stefan K., Neubauer, Stefan, and Petersen, Steffen E.
- Abstract
Background: Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease. Detection of early cardiac changes before manifest disease develops is important. We investigated early alterations in cardiac structure and function associated with DM using cardiovascular magnetic resonance imaging. Methods: Participants from the UK Biobank Cardiovascular Magnetic Resonance Substudy, a community cohort study, without known cardiovascular disease and left ventricular ejection fraction ≥50% were included. Multivariable linear regression models were performed. The investigators were blinded to DM status. Results: A total of 3984 individuals, 45% men, (mean [SD]) age 61.3 (7.5) years, hereof 143 individuals (3.6%) with DM. There was no difference in left ventricular (LV) ejection fraction (DM versus no DM; coefficient [95% CI]: −0.86% [−1.8 to 0.5]; P =0.065), LV mass (−0.13 g/m
2 [−1.6 to 1.3], P =0.86), or right ventricular ejection fraction (−0.23% [−1.2 to 0.8], P =0.65). However, both LV and right ventricular volumes were significantly smaller in DM, (LV end-diastolic volume/m2 : −3.46 mL/m2 [−5.8 to −1.2], P =0.003, right ventricular end-diastolic volume/m2 : −4.2 mL/m2 [−6.8 to −1.7], P =0.001, LV stroke volume/m2 : −3.0 mL/m2 [−4.5 to −1.5], P <0.001; right ventricular stroke volume/m2 : −3.8 mL/m2 [−6.5 to −1.1], P =0.005), LV mass/volume: 0.026 (0.01 to 0.04) g/mL, P =0.006. Both left atrial and right atrial emptying fraction were lower in DM (right atrial emptying fraction: −6.2% [−10.2 to −2.1], P =0.003; left atrial emptying fraction:−3.5% [−6.9 to −0.1], P =0.043). LV global circumferential strain was impaired in DM (coefficient [95% CI]: 0.38% [0.01 to 0.7], P =0.045). Conclusions: In a low-risk general population without known cardiovascular disease and with preserved LV ejection fraction, DM is associated with early changes in all 4 cardiac chambers. These findings suggest that diabetic cardiomyopathy is not a regional condition of the LV but affects the heart globally. [ABSTRACT FROM AUTHOR]- Published
- 2019
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14. Inflammatory bowel disease andmyocarditis: T1-mapping the heart of the problem.
- Author
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Carande, Elliott J., Piechnik, Stefan K., Myerson, Saul G., and Ferreira, Vanessa M.
- Subjects
INFLAMMATORY bowel disease treatment ,CARDIOMYOPATHIES ,ANTICOAGULANTS ,CORONARY arteries ,EDEMA ,GASTROINTESTINAL hemorrhage ,INFLAMMATION ,INFLAMMATORY bowel diseases ,MAGNETIC resonance imaging ,ULCERATIVE colitis ,DISEASE exacerbation ,PLATELET aggregation inhibitors ,ACUTE coronary syndrome ,SKELETAL muscle ,DISEASE complications ,DIAGNOSIS - Published
- 2017
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15. The diagnostic performance of novel techniques for the detection of acute myocarditis: a clinical study using cardiovascular magnetic resonance imaging.
- Author
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Ferreira, Vanessa, Piechnik, Stefan K., Dall'Armellina, Erica, Karamitsos, Theodoros, Francis, Jane M., Ntusi, Ntobeko, Holloway, Cameron, Choudhury, Robin P., Kardos, Attila, Robson, Matthew D., Friedrich, Matthias G., and Neubauer, Stefan
- Subjects
- *
CARDIOMYOPATHIES , *CARDIOVASCULAR disease diagnosis , *CONFERENCES & conventions , *MAGNETIC resonance imaging , *DIAGNOSIS - Abstract
An abstract of the article "The diagnostic performance of novel techniques for the detection of acute myocarditis: a clinical study using cardiovascular magnetic resonance imaging," by Vanessa Ferreira and colleagues is presented.
- Published
- 2013
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16. Non-contrast T1 mapping characterizes the myocardium beyond that achieved by late gadolinium enhancement in both hypertrophic and dilated cardiomyopathy.
- Author
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Dass, Sairia, Suttie, Joseph, Piechnik, Stefan K., Ferreira, Vanessa, Holloway, Cameron, Robson, Matthew D., Watkins, Hugh, Karamitsos, Theodoros, and Neubauer, Stefan
- Subjects
CARDIOMYOPATHIES - Abstract
An abstract of the conference paper "Non-contrast T1 mapping characterizes the myocardium beyond that achieved by late gadolinium enhancement in both hypertrophic and dilated cardiomyopathy," by Sairia Dass and colleagues is presented.
- Published
- 2012
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17. Comprehensive cardiac magnetic resonance imaging and spectroscopy reveals a high burden of myocardial disease in HIV infection.
- Author
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Holloway, Cameron, Ntusi, Ntobeko, Suttie, Joseph, Mahmod, Masliza, Wainwright, Emma, Clutton, Genevieve, Hancock, Gemma, Beak, Philip, Tajar, Abdelouahid, Piechnik, Stefan K., Schneider, Jurgen E., Clarke, Kieran, Dorrell, Lucy, and Neubauer, Stefan
- Subjects
CARDIOMYOPATHIES ,CONFERENCES & conventions ,HIV-positive persons ,MAGNETIC resonance imaging ,SPECTRUM analysis ,DIAGNOSIS - Abstract
An abstract of the article "Comprehensive cardiac magnetic resonance imaging and spectroscopy reveals a high burden of myocardial disease in HIV infection," by Cameron Holloway and colleagues is presented.
- Published
- 2013
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18. Pheochromocytoma Is Characterized by Catecholamine-Mediated Myocarditis, Focal and Diffuse Myocardial Fibrosis, and Myocardial Dysfunction.
- Author
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Ferreira, Vanessa M., Marcelino, Mafalda, Piechnik, Stefan K., Marini, Claudia, Karamitsos, Theodoros D., Ntusi, Ntobeko A.B., Francis, Jane M., Robson, Matthew D., Arnold, J. Ranjit, Mihai, Radu, Thomas, Julia D.J., Herincs, Maria, Hassan-Smith, Zaki K., Greiser, Andreas, Arlt, Wiebke, Korbonits, Márta, Karavitaki, Niki, Grossman, Ashley B., Wass, John A.H., and Neubauer, Stefan
- Subjects
- *
PHEOCHROMOCYTOMA , *CATECHOLAMINES , *MYOCARDITIS , *CARDIAC contraction , *CARDIOTOXICITY , *COHORT analysis , *HEART ventricle diseases , *ADRENAL tumors , *DIASTOLE (Cardiac cycle) , *HEART , *LEFT heart ventricle , *LONGITUDINAL method , *MAGNETIC resonance imaging , *MYOCARDIUM , *CARDIOMYOPATHIES , *RESEARCH funding , *FIBROSIS , *CASE-control method , *STROKE volume (Cardiac output) , *PERICARDIAL effusion , *DISEASE complications - Abstract
Background: Pheochromocytoma is associated with catecholamine-induced cardiac toxicity, but the extent and nature of cardiac involvement in clinical cohorts is not well-characterized.Objectives: This study characterized the cardiac phenotype in patients with pheochromocytoma using cardiac magnetic resonance (CMR).Methods: A total of 125 subjects were studied, including patients with newly diagnosed pheochromocytoma (n = 29), patients with previously surgically cured pheochromocytoma (n = 31), healthy control subjects (n = 51), and hypertensive control subjects (HTN) (n = 14), using CMR (1.5-T) cine, strain imaging by myocardial tagging, late gadolinium enhancement, and native T1 mapping (Shortened Modified Look-Locker Inversion recovery [ShMOLLI]).Results: Patients who were newly diagnosed with pheochromocytoma, compared with healthy and HTN control subjects, had impaired left ventricular (LV) ejection fraction (<56% in 38% of patients), peak systolic circumferential strain (p < 0.05), and diastolic strain rate (p < 0.05). They had higher myocardial T1 (974 ± 25 ms, as compared with 954 ± 16 ms in healthy and 958 ± 23 ms in HTN subjects; p < 0.05), areas of myocarditis (median 22% LV with T1 >990 ms, as compared with 1% in healthy and 2% in HTN subjects; p < 0.05), and focal fibrosis (59% had nonischemic late gadolinium enhancement, as compared with 14% in HTN subjects). Post-operatively, impaired LV ejection fraction typically normalized, but systolic and diastolic strain impairment persisted. Focal fibrosis (median 5% LV) and T1 abnormalities (median 12% LV) remained, the latter of which may suggest some diffuse fibrosis. Previously cured patients demonstrated abnormal diastolic strain rate (p < 0.001), myocardial T1 (median 12% LV), and small areas of focal fibrosis (median 1% LV). LV mass index was increased in HTN compared with healthy control subjects (p < 0.05), but not in the 2 pheochromocytoma groups.Conclusions: This first systematic CMR study characterizing the cardiac phenotype in pheochromocytoma showed that cardiac involvement was frequent and, for some variables, persisted after curative surgery. These effects surpass those of hypertensive heart disease alone, supporting a direct role of catecholamine toxicity that may produce subtle but long-lasting myocardial alterations. [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
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