43 results on '"Shenoy, Chetan"'
Search Results
2. Large-scale 3D non-Cartesian coronary MRI reconstruction using distributed memory-efficient physics-guided deep learning with limited training data.
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Zhang C, Piccini D, Demirel OB, Bonanno G, Roy CW, Yaman B, Moeller S, Shenoy C, Stuber M, and Akçakaya M
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- Humans, Algorithms, Physics, Deep Learning, Imaging, Three-Dimensional methods, Coronary Vessels diagnostic imaging, Magnetic Resonance Imaging methods, Image Processing, Computer-Assisted methods, Neural Networks, Computer
- Abstract
Object: To enable high-quality physics-guided deep learning (PG-DL) reconstruction of large-scale 3D non-Cartesian coronary MRI by overcoming challenges of hardware limitations and limited training data availability., Materials and Methods: While PG-DL has emerged as a powerful image reconstruction method, its application to large-scale 3D non-Cartesian MRI is hindered by hardware limitations and limited availability of training data. We combine several recent advances in deep learning and MRI reconstruction to tackle the former challenge, and we further propose a 2.5D reconstruction using 2D convolutional neural networks, which treat 3D volumes as batches of 2D images to train the network with a limited amount of training data. Both 3D and 2.5D variants of the PG-DL networks were compared to conventional methods for high-resolution 3D kooshball coronary MRI., Results: Proposed PG-DL reconstructions of 3D non-Cartesian coronary MRI with 3D and 2.5D processing outperformed all conventional methods both quantitatively and qualitatively in terms of image assessment by an experienced cardiologist. The 2.5D variant further improved vessel sharpness compared to 3D processing, and scored higher in terms of qualitative image quality., Discussion: PG-DL reconstruction of large-scale 3D non-Cartesian MRI without compromising image size or network complexity is achieved, and the proposed 2.5D processing enables high-quality reconstruction with limited training data., (© 2024. The Author(s), under exclusive licence to European Society for Magnetic Resonance in Medicine and Biology (ESMRMB).)
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- 2024
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3. Evaluation of Stress Cardiac Magnetic Resonance Imaging in Risk Reclassification of Patients With Suspected Coronary Artery Disease.
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Antiochos P, Ge Y, Steel K, Chen YY, Bingham S, Abdullah S, Mikolich JR, Arai AE, Bandettini WP, Patel AR, Farzaneh-Far A, Heitner JF, Shenoy C, Leung SW, Gonzalez JA, Shah DJ, Raman SV, Ferrari VA, Schulz-Menger J, Stuber M, Simonetti OP, Murthy VL, and Kwong RY
- Subjects
- Aged, Cohort Studies, Coronary Artery Disease physiopathology, Exercise Test, Female, Humans, Male, Middle Aged, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia physiopathology, Retrospective Studies, Risk Assessment, Coronary Artery Disease diagnostic imaging, Magnetic Resonance Imaging
- Abstract
Importance: The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline-recommended categories has not been established., Objective: To examine the utility of stress CMR imaging for risk reclassification in patients without a history of coronary artery disease (CAD) who presented with suspected myocardial ischemia., Design, Setting, and Participants: A retrospective, multicenter cohort study with median follow-up of 5.4 years (interquartile range, 4.6-6.9) was conducted at 13 centers across 11 US states. Participants included 1698 consecutive patients aged 35 to 85 years with 2 or more coronary risk factors but no history of CAD who presented with suspected myocardial ischemia to undergo stress CMR imaging. The study was conducted from February 18, 2019, to March 1, 2020., Main Outcomes and Measures: Cardiovascular (CV) death and nonfatal myocardial infarction (MI). Major adverse CV events (MACE) including CV death, nonfatal MI, hospitalization for heart failure or unstable angina, and late, unplanned coronary artery bypass graft surgery., Results: Of the 1698 patients, 873 were men (51.4%); mean (SD) age was 62 (11) years, accounting for 67 CV death/nonfatal MIs and 190 MACE. Clinical models of pretest risk were constructed and patients were categorized using guideline-based categories of low (<1% per year), intermediate (1%-3% per year), and high (>3% year) risk. Stress CMR imaging provided risk reclassification across all baseline models. For CV death/nonfatal MI, adding stress CMR-assessed left ventricular ejection fraction, presence of ischemia, and late gadolinium enhancement to a model incorporating the validated CAD Consortium score, hypertension, smoking, and diabetes provided significant net reclassification improvement of 0.266 (95% CI, 0.091-0.441) and C statistic improvement of 0.086 (95% CI, 0.022-0.149). Stress CMR imaging reclassified 60.3% of patients in the intermediate pretest risk category (52.4% reclassified as low risk and 7.9% as high risk) with corresponding changes in the observed event rates of 0.6% per year for low posttest risk and 4.9% per year for high posttest risk. For MACE, stress CMR imaging further provided significant net reclassification improvement (0.361; 95% CI, 0.255-0.468) and C statistic improvement (0.092; 95% CI, 0.054-0.131), and reclassified 59.9% of patients in the intermediate pretest risk group (48.7% reclassified as low risk and 11.2% as high risk)., Conclusions and Relevance: In this multicenter cohort of patients with no history of CAD presenting with suspected myocardial ischemia, stress CMR imaging reclassified patient risk across guideline-based risk categories, beyond clinical risk factors. The findings of this study support the value of stress CMR imaging for clinical decision-making, especially in patients at intermediate risk for CV death and nonfatal MI.
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- 2020
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4. Right Ventricular Abnormalities on Cardiovascular Magnetic Resonance Imaging in Patients With Sarcoidosis.
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Velangi PS, Chen KA, Kazmirczak F, Okasha O, von Wald L, Roukoz H, Farzaneh-Far A, Markowitz J, Nijjar PS, Bhargava M, Perlman D, Akçakaya M, and Shenoy C
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- Adult, Aged, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac mortality, Arrhythmias, Cardiac physiopathology, Death, Sudden, Cardiac etiology, Female, Heart Ventricles physiopathology, Humans, Male, Middle Aged, Predictive Value of Tests, Prevalence, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Sarcoidosis complications, Sarcoidosis mortality, Sarcoidosis physiopathology, Systole, Time Factors, Ventricular Dysfunction, Right etiology, Ventricular Dysfunction, Right mortality, Ventricular Dysfunction, Right physiopathology, Heart Ventricles diagnostic imaging, Magnetic Resonance Imaging, Sarcoidosis diagnostic imaging, Stroke Volume, Ventricular Dysfunction, Right diagnostic imaging, Ventricular Function, Right
- Abstract
Objectives: This study aimed to determine the prevalence on cardiac magnetic resonance (CMR) of right ventricular (RV) systolic dysfunction and RV late gadolinium enhancement (LGE), their determinants, and their influences on long-term adverse outcomes in patients with sarcoidosis., Background: In patients with sarcoidosis, RV abnormalities have been described on many imaging modalities. On CMR, RV abnormalities include RV systolic dysfunction quantified as an abnormal right ventricular ejection fraction (RVEF), and RV LGE., Methods: Consecutive patients with biopsy-proven sarcoidosis who underwent CMR for suspected cardiac involvement were studied. They were followed for 2 endpoints: all-cause death, and a composite arrhythmic endpoint of sudden cardiac death or significant ventricular arrhythmia., Results: Among 290 patients, RV systolic dysfunction (RVEF <40% in men and <45% in women) and RV LGE were present in 35 (12.1%) and 16 (5.5%), respectively. The median follow-up time was 3.2 years (interquartile range [IQR]: 1.6 to 5.7 years) for all-cause death and 3.0 years (IQR: 1.4 to 5.5 years) for the arrhythmic endpoint. On Cox proportional hazards regression multivariable analyses, only RVEF was independently associated with all-cause death (hazard ratio [HR]: 1.05 for every 1% decrease; 95% confidence interval [CI]: 1.01 to 1.09; p = 0.022) after adjustment for left ventricular EF, left ventricular LGE extent, and the presence of RV LGE. RVEF was not associated with the arrhythmic endpoint (HR: 1.01; 95% CI: 0.96 to 1.06; p = 0.67). Conversely, RV LGE was not associated with all-cause death (HR: 2.78; 95% CI: 0.36 to 21.66; p = 0.33), while it was independently associated with the arrhythmic endpoint (HR: 5.43; 95% CI: 1.25 to 23.47; p = 0.024)., Conclusions: In this study of patients with sarcoidosis, RV systolic dysfunction and RV LGE had distinct prognostic associations; RV systolic dysfunction but not RV LGE was independently associated with all-cause death, whereas RV LGE but not RV systolic dysfunction was independently associated with sudden cardiac death or significant ventricular arrhythmia. These findings may indicate distinct implications for the management of RV abnormalities in sarcoidosis., (Copyright © 2020 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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5. Myocardial Fibrosis and Prognosis in Heart Transplant Recipients.
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Hughes A, Okasha O, Farzaneh-Far A, Kazmirczak F, Nijjar PS, Velangi P, Akçakaya M, Martin CM, and Shenoy C
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- Contrast Media, Female, Fibrosis, Humans, Male, Middle Aged, Minnesota epidemiology, Prevalence, Prognosis, Cardiomyopathies diagnostic imaging, Cardiomyopathies epidemiology, Heart Transplantation, Magnetic Resonance Imaging methods
- Abstract
Background: Myocardial fibrosis is a well-described histopathologic feature in heart transplant recipients. Whether myocardial fibrosis in heart transplant recipients is independently associated with clinical outcomes is unclear. We sought to determine whether myocardial fibrosis on late gadolinium enhancement cardiovascular magnetic resonance imaging in heart transplant recipients was independently associated with all-cause death or major adverse cardiac outcomes in the long-term., Methods: Using a cohort of consecutive heart transplant recipients that had cardiovascular magnetic resonance imaging, we determined the prevalence and the patterns of myocardial fibrosis and analyzed associations between myocardial fibrosis and a composite end point of all-cause death or major adverse cardiac events: retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization., Results: One hundred and fifty-two heart transplant recipients (age, 54±15 years; 29% women; 5.0±5.4 years after heart transplantation) were included. Myocardial fibrosis was present in 18% (37% infarct pattern, 41% noninfarct pattern, and 22% both). Its prevalence was positively associated with cardiac allograft vasculopathy grade. With a median follow-up of 2.6 years, myocardial fibrosis was independently associated with all-cause death or major adverse cardiac events (hazard ratio, 2.88; 95% CI, 1.59-5.23; P <0.001) after adjustment for cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume. Every 1% increase in myocardial fibrosis was independently associated with a 6% higher hazard for all-cause death or major adverse cardiac events (hazard ratio, 1.06; 95% CI, 1.03-1.09; P <0.001). The addition of myocardial fibrosis variables to models with cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume resulted in significant improvements in model fit, suggesting incremental prognostic value., Conclusions: In heart transplant recipients, myocardial fibrosis is seen on late gadolinium enhancement cardiovascular magnetic resonance imaging in 18%. Both the presence and the extent of myocardial fibrosis are independently associated with the long-term risk of all-cause death or major adverse cardiac events.
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- 2019
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6. Neoplastic Arrhythmogenic Right Ventricular Cardiomyopathy.
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Bawaskar P, Chaurasia A, Nawale J, Nalawade D, and Shenoy C
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- Adult, Female, Heart Ventricles diagnostic imaging, Humans, Arrhythmogenic Right Ventricular Dysplasia diagnostic imaging, Magnetic Resonance Imaging methods
- Published
- 2019
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7. Prognostic Value of Vasodilator Stress Cardiac Magnetic Resonance Imaging: A Multicenter Study With 48 000 Patient-Years of Follow-up.
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Heitner JF, Kim RJ, Kim HW, Klem I, Shah DJ, Debs D, Farzaneh-Far A, Polsani V, Kim J, Weinsaft J, Shenoy C, Hughes A, Cargile P, Ho J, Bonow RO, Jenista E, Parker M, and Judd RM
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- Aged, Body Mass Index, Coronary Artery Disease drug therapy, Coronary Artery Disease physiopathology, Exercise Test mortality, Female, Follow-Up Studies, Heart physiopathology, Humans, Magnetic Resonance Imaging mortality, Male, Middle Aged, Myocardial Infarction mortality, Predictive Value of Tests, Risk Factors, Stroke Volume physiology, Survival Analysis, Ventricular Function, Left physiology, Coronary Artery Disease diagnosis, Exercise Test methods, Heart diagnostic imaging, Magnetic Resonance Imaging methods, Myocardial Infarction diagnostic imaging, Vasodilator Agents administration & dosage
- Abstract
Importance: Stress cardiac magnetic resonance imaging (CMR) is not widely used in current clinical practice, and its ability to predict patient mortality is unknown., Objective: To determine whether stress CMR is associated with patient mortality., Design, Setting, and Participants: Real-world evidence from consecutive clinically ordered CMR examinations. Multicenter study of patients undergoing clinical evaluation of myocardial ischemia. Patients with known or suspected coronary artery disease (CAD) underwent clinical vasodilator stress CMR at 7 different hospitals. An automated process collected data from the finalized clinical reports, deidentified and aggregated the data, and assessed mortality using the US Social Security Death Index., Main Outcomes and Measures: All-cause patient mortality., Results: Of the 9151 patients, the median (interquartile range) patient age was 63 (51-70) years, 55% were men, and the median (interquartile range) body mass index was 29 (25-33) (calculated as weight in kilograms divided by height in meters squared). The multicenter automated process yielded 9151 consecutive patients undergoing stress CMR, with 48 615 patient-years of follow-up. Of these patients, 4408 had a normal stress CMR examination, 4743 had an abnormal examination, and 1517 died during a median follow-up time of 5.0 years. Using multivariable analysis, addition of stress CMR improved prediction of mortality in 2 different risk models (model 1 hazard ratio [HR], 1.83; 95% CI, 1.63-2.06; P < .001; model 2: HR, 1.80; 95% CI, 1.60-2.03; P < .001) and also improved risk reclassification (net improvement: 11.4%; 95% CI, 7.3-13.6; P < .001). After adjustment for patient age, sex, and cardiac risk factors, Kaplan-Meier survival analysis showed a strong association between an abnormal stress CMR and mortality in all patients (HR, 1.883; 95% CI, 1.680-2.112; P < .001), patients with (HR, 1.955; 95% CI, 1.712-2.233; P < .001) and without (HR, 1.578; 95% CI, 1.235-2.2018; P < .001) a history of CAD, and patients with normal (HR, 1.385; 95% CI, 1.194-1.606; P < .001) and abnormal left ventricular ejection fraction (HR, 1.836; 95% CI, 1.299-2.594; P < .001)., Conclusions and Relevance: Clinical vasodilator stress CMR is associated with patient mortality in a large, diverse population of patients with known or suspected CAD as well as in multiple subpopulations defined by history of CAD and left ventricular ejection fraction. These findings provide a foundational motivation to study the comparative effectiveness of stress CMR against other modalities.
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- 2019
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8. Safety and prognostic value of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients.
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Kazmirczak F, Nijjar PS, Zhang L, Hughes A, Chen KA, Okasha O, Martin CM, Akçakaya M, Farzaneh-Far A, and Shenoy C
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- Adult, Coronary Artery Disease etiology, Coronary Artery Disease mortality, Coronary Artery Disease therapy, Female, Heart Transplantation mortality, Humans, Male, Middle Aged, Myocardial Infarction etiology, Myocardial Infarction mortality, Myocardial Infarction therapy, Percutaneous Coronary Intervention, Predictive Value of Tests, Purines adverse effects, Pyrazoles adverse effects, Reoperation, Retrospective Studies, Risk Factors, Treatment Outcome, Vasodilator Agents adverse effects, Coronary Artery Disease diagnostic imaging, Heart Transplantation adverse effects, Magnetic Resonance Imaging adverse effects, Myocardial Infarction diagnostic imaging, Purines administration & dosage, Pyrazoles administration & dosage, Vasodilator Agents administration & dosage
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Background: There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients., Methods: To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive heart transplant recipients who underwent regadenoson stress CMR matched in a 2:1 ratio to age- and gender-matched non-heart transplant patients. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, retransplantation or death., Results: For the safety analysis, 234 regadenoson stress CMR studies were included - 78 performed in 57 heart transplant recipients and 156 performed in non-heart transplant patients. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMR studies were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and non-heart transplant patients. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034)., Conclusions: Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events.
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- 2019
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9. Impact of Cardiovascular Magnetic Resonance Imaging on Identifying the Etiology of Cardiomyopathy in Patients Undergoing Cardiac Transplantation.
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Lin LQ, Kazmirczak F, Chen KA, Okasha O, Nijjar PS, Martin CM, Akçakaya M, Farzaneh-Far A, and Shenoy C
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- Adult, Aged, Biopsy, Cardiomyopathies therapy, Echocardiography, Female, Heart Failure diagnosis, Heart Failure etiology, Heart Failure therapy, Heart Transplantation adverse effects, Humans, Immunohistochemistry, Male, Middle Aged, Retrospective Studies, Cardiomyopathies diagnosis, Cardiomyopathies etiology, Magnetic Resonance Imaging methods
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Errors in identifying the etiology of cardiomyopathy have been described in patients undergoing cardiac transplantation. There are increasing data that cardiovascular magnetic resonance imaging (CMR) provides unique diagnostic information in heart failure. We investigated the association of the performance of CMR prior to cardiac transplantation with rates of errors in identifying the etiology of cardiomyopathy. We compared pre-transplantation clinical diagnoses with post-transplantation pathology diagnoses obtained from the explanted native hearts. Among 338 patients, there were 23 (7%) errors in identifying the etiology of cardiomyopathy. Of these, 22 (96%) occurred in patients with pre-transplantation clinical diagnoses of non-ischemic cardiomyopathy (NICM). Only 61/338 (18%) had CMRs prior to transplantation. There was no significant association between the performance of CMR and errors in the entire study cohort (p = 0.093). Among patients with pre-transplantation clinical diagnoses of NICM, there was a significant inverse association between the performance of CMR and errors (2.4% vs. 14.6% in patients with and without CMR respectively; p = 0.030). In conclusion, CMR was underutilized prior to cardiac transplantation. In patients with pre-transplantation clinical diagnoses of NICM - in whom 96% of errors in identifying the etiology of cardiomyopathy occurred - the performance of CMR was associated with significantly fewer errors.
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- 2018
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10. Temporally resolved parametric assessment of Z-magnetization recovery (TOPAZ): Dynamic myocardial T 1 mapping using a cine steady-state look-locker approach.
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Weingärtner S, Shenoy C, Rieger B, Schad LR, Schulz-Menger J, and Akçakaya M
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- Adult, Algorithms, Computer Simulation, Humans, Image Interpretation, Computer-Assisted, Male, Middle Aged, Models, Theoretical, Phantoms, Imaging, Reproducibility of Results, Systole, Young Adult, Heart diagnostic imaging, Image Processing, Computer-Assisted methods, Magnetic Resonance Imaging, Myocardium pathology
- Abstract
Purpose: To develop and evaluate a cardiac phase-resolved myocardial T
1 mapping sequence., Methods: The proposed method for temporally resolved parametric assessment of Z-magnetization recovery (TOPAZ) is based on contiguous fast low-angle shot imaging readout after magnetization inversion from the pulsed steady state. Thereby, segmented k-space data are acquired over multiple heartbeats, before reaching steady state. This results in sampling of the inversion-recovery curve for each heart phase at multiple points separated by an R-R interval. Joint T1 and B1+ estimation is performed for reconstruction of cardiac phase-resolved T1 and B1+ maps. Sequence parameters are optimized using numerical simulations. Phantom and in vivo imaging are performed to compare the proposed sequence to a spin-echo reference and saturation pulse prepared heart rate-independent inversion-recovery (SAPPHIRE) T1 mapping sequence in terms of accuracy and precision., Results: In phantom, TOPAZ T1 values with integrated B1+ correction are in good agreement with spin-echo T1 values (normalized root mean square error = 4.2%) and consistent across the cardiac cycle (coefficient of variation = 1.4 ± 0.78%) and different heart rates (coefficient of variation = 1.2 ± 1.9%). In vivo imaging shows no significant difference in TOPAZ T1 times between the cardiac phases (analysis of variance: P = 0.14, coefficient of variation = 3.2 ± 0.8%), but underestimation compared with SAPPHIRE (T1 time ± precision: 1431 ± 56 ms versus 1569 ± 65 ms). In vivo precision is comparable to SAPPHIRE T1 mapping until middiastole (P > 0.07), but deteriorates in the later phases., Conclusions: The proposed sequence allows cardiac phase-resolved T1 mapping with integrated B1+ assessment at a temporal resolution of 40 ms. Magn Reson Med 79:2087-2100, 2018. © 2017 International Society for Magnetic Resonance in Medicine., (© 2017 International Society for Magnetic Resonance in Medicine.)- Published
- 2018
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11. Simultaneous multislice imaging for native myocardial T 1 mapping: Improved spatial coverage in a single breath-hold.
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Weingärtner S, Moeller S, Schmitter S, Auerbach E, Kellman P, Shenoy C, and Akçakaya M
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- Adult, Algorithms, Female, Humans, Male, Middle Aged, Myocardium, Phantoms, Imaging, Young Adult, Breath Holding, Heart diagnostic imaging, Image Processing, Computer-Assisted methods, Magnetic Resonance Imaging methods
- Abstract
Purpose: To develop a saturation recovery myocardial T
1 mapping method for the simultaneous multislice acquisition of three slices., Methods: Saturation pulse-prepared heart rate independent inversion recovery (SAPPHIRE) T1 mapping was implemented with simultaneous multislice imaging using FLASH readouts for faster coverage of the myocardium. Controlled aliasing in parallel imaging (CAIPI) was used to achieve minimal noise amplification in three slices. Multiband reconstruction was performed using three linear reconstruction methods: Slice- and in-plane GRAPPA, CG-SENSE, and Tikhonov-regularized CG-SENSE. Accuracy, spatial variability, and interslice leakage were compared with single-band T1 mapping in a phantom and in six healthy subjects., Results: Multiband phantom T1 times showed good agreement with single-band T1 mapping for all three reconstruction methods (normalized root mean square error <1.0%). The increase in spatial variability compared with single-band imaging was lowest for GRAPPA (1.29-fold), with higher penalties for Tikhonov-regularized CG-SENSE (1.47-fold) and CG-SENSE (1.52-fold). In vivo multiband T1 times showed no significant difference compared with single-band (T1 time ± intersegmental variability: single-band, 1580 ± 119 ms; GRAPPA, 1572 ± 145 ms; CG-SENSE, 1579 ± 159 ms; Tikhonov, 1586 ± 150 ms [analysis of variance; P = 0.86]). Interslice leakage was smallest for GRAPPA (5.4%) and higher for CG-SENSE (6.2%) and Tikhonov-regularized CG-SENSE (7.9%)., Conclusion: Multiband accelerated myocardial T1 mapping demonstrated the potential for single-breath-hold T1 quantification in 16 American Heart Association segments over three slices. A 1.2- to 1.4-fold higher in vivo spatial variability was observed, where GRAPPA-based reconstruction showed the highest homogeneity and the least interslice leakage. Magn Reson Med 78:462-471, 2017. © 2017 International Society for Magnetic Resonance in Medicine., (© 2017 International Society for Magnetic Resonance in Medicine.)- Published
- 2017
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12. Association of Feature-Tracking Cardiac Magnetic Resonance Imaging Left Ventricular Global Longitudinal Strain With All-Cause Mortality in Patients With Reduced Left Ventricular Ejection Fraction.
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Romano S, Judd RM, Kim RJ, Kim HW, Klem I, Heitner J, Shah DJ, Jue J, White BE, Shenoy C, and Farzaneh-Far A
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- Aged, Female, Humans, Longitudinal Studies, Male, Middle Aged, Risk Factors, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Magnetic Resonance Imaging, Stroke Volume, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left mortality, Ventricular Dysfunction, Left physiopathology, Ventricular Dysfunction, Left therapy
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- 2017
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13. Cardiovascular magnetic resonance imaging before catheter ablation for atrial fibrillation: much more than left atrial and pulmonary venous anatomy.
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Yarmohammadi H and Shenoy C
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- Heart Atria surgery, Humans, Pulmonary Veins surgery, Atrial Fibrillation pathology, Atrial Fibrillation surgery, Catheter Ablation methods, Magnetic Resonance Imaging
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- 2015
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14. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR.
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Weinsaft JW, Kim HW, Crowley AL, Klem I, Shenoy C, Van Assche L, Brosnan R, Shah DJ, Velazquez EJ, Parker M, Judd RM, and Kim RJ
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- Aged, Chi-Square Distribution, Contrast Media, Female, Heart Diseases diagnostic imaging, Heart Diseases physiopathology, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Humans, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Registries, Thrombosis diagnostic imaging, Thrombosis physiopathology, Ventricular Dysfunction, Left diagnostic imaging, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left, Echocardiography, Heart Diseases diagnosis, Magnetic Resonance Imaging, Thrombosis diagnosis, Ventricular Dysfunction, Left diagnosis
- Abstract
Objectives: This study sought to evaluate performance characteristics of routine echo for left ventricular thrombus (LVT)., Background: Although the utility of dedicated echocardiography (echo) for LVT is established, echo is widely used as a general test for which LVT is rarely the primary indication. We used delayed-enhancement cardiac magnetic resonance (DE-CMR) as a reference to evaluate LVT detection by routine echo., Methods: Dedicated LVT assessment using DE-CMR was prospectively performed in patients with left ventricular systolic dysfunction. Echoes were done as part of routine clinical care. Echo and CMR were independently read for LVT and related indexes of LVT size, shape, and image quality/diagnostic confidence. Follow-up was done for embolic events and pathology validation of LVT., Results: In this study, 243 patients had routine clinical echo and dedicated CMR within 1 week without intervening events. Follow-up supported DE-CMR as a reference standard, with >5-fold difference in endpoints between patients with versus without LVT by DE-CMR (p = 0.02). LVT prevalence was 10% by DE-CMR. Echo contrast was used in 4% of patients. Echo sensitivity and specificity were 33% and 91%, with positive and negative predictive values of 29% and 93%. Among patients with possible LVT as the clinical indication for echo, sensitivity and positive predictive value were markedly higher (60%, 75%). Regarding sensitivity, echo performance related to LVT morphology and mirrored cine-CMR, with protuberant thrombus typically missed when small (p ≤ 0.02). There was also a strong trend to miss mural thrombus irrespective of size (p = 0.06). Concerning positive predictive value, echo performance related to image quality, with lower diagnostic confidence scores for echoes read positive for LVT in discordance with DE-CMR compared with echoes concordant with DE-CMR (p < 0.02)., Conclusions: Routine echo with rare contrast use can yield misleading results concerning LVT. Echo performance is improved when large protuberant thrombus is present and when the clinical indication is specifically for LVT assessment., (Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
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15. Identifying the etiology: a systematic approach using delayed-enhancement cardiovascular magnetic resonance.
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Senthilkumar A, Majmudar MD, Shenoy C, Kim HW, and Kim RJ
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- Algorithms, Cardiomyopathies classification, Cardiomyopathies etiology, Cardiomyopathies physiopathology, Coronary Artery Disease complications, Coronary Artery Disease diagnosis, Humans, Myocardial Ischemia complications, Myocardial Ischemia diagnosis, Cardiomyopathies diagnosis, Magnetic Resonance Imaging methods
- Abstract
In patients who have heart failure, treatment and survival are directly related to the cause. Clinically, as a practical first step, patients are classified as having either ischemic or non-ischemic cardiomyopathy, a delineation usually based on the presence or absence of epicardial coronary artery disease. However, this approach does not account for patients with non-ischemic cardiomyopathy who also have coronary artery disease, which may be either incidental or partly contributing to myocardial dysfunction (mixed cardiomyopathy). By allowing direct assessment of the myocardium, delayed-enhancement cardiovascular magnetic resonance (DE-CMR) may aid in addressing these conundrums. This article explores the use of DE-CMR in identifying ischemic and non-ischemic myopathic processes and details a systematic approach to determine the cause of cardiomyopathy.
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- 2009
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16. Gadolinium-induced nephrogenic systemic fibrosis in patients with kidney and liver disease.
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Shenoy C
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- Fibrosis, Humans, Magnetic Resonance Imaging adverse effects, Risk Factors, Contrast Media adverse effects, Gadolinium adverse effects, Liver Failure diagnosis, Magnetic Resonance Imaging methods, Renal Insufficiency diagnosis, Skin Diseases chemically induced, Skin Diseases pathology
- Published
- 2008
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17. Utilization of cardiovascular magnetic resonance (CMR) imaging for resumption of athletic activities following COVID-19 infection: an expert consensus document on behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention (CVRI) Leadership and endorsed by the Society for Cardiovascular Magnetic Resonance (SCMR)
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Ruberg, Frederick L., Baggish, Aaron L., Hays, Allison G., Jerosch-Herold, Michael, Kim, Jiwon, Ordovas, Karen G., Reddy, Gautham, Shenoy, Chetan, Weinsaft, Jonathan W., and Woodard, Pamela K.
- Published
- 2022
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18. Large-scale 3D non-Cartesian coronary MRI reconstruction using distributed memory-efficient physics-guided deep learning with limited training data.
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Zhang, Chi, Piccini, Davide, Demirel, Omer Burak, Bonanno, Gabriele, Roy, Christopher W., Yaman, Burhaneddin, Moeller, Steen, Shenoy, Chetan, Stuber, Matthias, and Akçakaya, Mehmet
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CARDIAC magnetic resonance imaging ,CONVOLUTIONAL neural networks ,MAGNETIC resonance imaging ,CARDIOLOGISTS ,DEEP learning - Abstract
Object: To enable high-quality physics-guided deep learning (PG-DL) reconstruction of large-scale 3D non-Cartesian coronary MRI by overcoming challenges of hardware limitations and limited training data availability. Materials and methods: While PG-DL has emerged as a powerful image reconstruction method, its application to large-scale 3D non-Cartesian MRI is hindered by hardware limitations and limited availability of training data. We combine several recent advances in deep learning and MRI reconstruction to tackle the former challenge, and we further propose a 2.5D reconstruction using 2D convolutional neural networks, which treat 3D volumes as batches of 2D images to train the network with a limited amount of training data. Both 3D and 2.5D variants of the PG-DL networks were compared to conventional methods for high-resolution 3D kooshball coronary MRI. Results: Proposed PG-DL reconstructions of 3D non-Cartesian coronary MRI with 3D and 2.5D processing outperformed all conventional methods both quantitatively and qualitatively in terms of image assessment by an experienced cardiologist. The 2.5D variant further improved vessel sharpness compared to 3D processing, and scored higher in terms of qualitative image quality. Discussion: PG-DL reconstruction of large-scale 3D non-Cartesian MRI without compromising image size or network complexity is achieved, and the proposed 2.5D processing enables high-quality reconstruction with limited training data. [ABSTRACT FROM AUTHOR]
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- 2024
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19. Right Ventricular Function on Cardiovascular Magnetic Resonance Imaging and Long-Term Outcomes in Stable Heart Transplant Recipients.
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Barrett, Collin M., Bawaskar, Parag, Hughes, Andrew, Singh Athwal, Pal Satyajit, Guo, Yugene, Alexy, Tamas, and Shenoy, Chetan
- Abstract
BACKGROUND: In heart transplant recipients, right ventricular (RV) dysfunction may occur for a variety of reasons. Whether RV dysfunction in the stable phase after heart transplantation is associated with long-term adverse outcomes is unknown. We aimed to determine the long-term prognostic significance of RV dysfunction identified on cardiovascular magnetic resonance imaging (CMR) at least 1 year after heart transplantation. METHODS: In consecutive heart transplant recipients who underwent CMR for surveillance, we assessed 2 CMR measures of RV function: RV ejection fraction and RV global longitudinal strain (RVGLS). We investigated associations between RV dysfunction and a composite end point of death or major adverse cardiac events, including retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS: A total of 257 heart transplant recipients (median age, 59 years; 75% men) who had CMR at a median of 4.3 years after heart transplantation were included. Over a median follow-up of 4.4 years after the CMR, 108 recipients experienced death or major adverse cardiac events. In a multivariable Cox regression analysis adjusted for age, time since transplantation, indication for transplantation, cardiac allograft vasculopathy, history of rejection, and CMR covariates, RV ejection fraction was not associated with the composite end point, but RVGLS was independently associated with the composite end point with a hazard ratio of 1.08 per 1% worsening in RVGLS ([95% CI, 1.00-1.17]; P=0.046). RVGLS provided incremental prognostic value over other variables in multivariable analyses. The association was replicated in subgroups of recipients with normal RV ejection fraction and recipients with late gadolinium enhancement imaging. A similar association was seen with a composite end point of cardiovascular death or major adverse cardiac events. CONCLUSIONS: CMR feature tracking-derived RVGLS assessed at least 1 year after heart transplantation was independently associated with the long-term risk of death or major adverse cardiac events. Future studies should investigate its role in guiding clinical decision-making in heart transplant recipients. [ABSTRACT FROM AUTHOR]
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- 2024
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20. Cardiac magnetic resonance in histologically proven eosinophilic myocarditis.
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Pöyhönen, Pauli, Rågback, Johanna, Mäyränpää, Mikko I., Nordenswan, Hanna-Kaisa, Lehtonen, Jukka, Shenoy, Chetan, and Kupari, Markku
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BIOPSY ,CARDIOMYOPATHIES ,PERICARDIAL effusion ,MAGNETIC resonance imaging ,MANN Whitney U Test ,T-test (Statistics) ,DESCRIPTIVE statistics ,CHI-squared test ,RESEARCH funding - Abstract
Background: Eosinophilic myocarditis (EM) is a life-threatening acute heart disease. Cardiac magnetic resonance (CMR) excels in the assessment of myocardial diseases but CMR studies of EM are limited. We aimed to describe CMR findings in histologically proven EM. Methods: Patients with histologically proven EM seen at an academic center from 2000 through 2020 were identified. Of the 28 patients ascertained, 15 had undergone CMR for diagnosis and constitute our study cohort. Results: The patients, aged 51 ± 17 years, presented with fever (53%), dyspnea (47%), chest pain (53%), heart block (20%), and blood eosinophilia (60%). On CMR, all 15 patients had myocardial edema with 10 of them (67%) having abnormally high left ventricular (LV) mass as well. LV ejection fraction measured < 50% in 11 patients (73%) and < 30% in 2 (13%), but only 6 (40%) had dilated LV size. Eight patients (53%) had pericardial effusion. LV late gadolinium enhancement (LGE) was found in all but one patient (13/14; 93%). LGE was always multifocal and subendocardial but could involve any myocardial layer. Patients with necrotizing EM by histopathology (n = 6) had higher LGE mass (32.1 ± 16.6% vs 14.5 ± 7.7%, p = 0.050) and more LV segments with LGE (15 ± 2 vs 9 ± 3 out of 17, p = 0.003) than patients (n = 9) without myocyte necrosis. Two patients had LV thrombosis accompanying widespread subendocardial LGE. Conclusions: In EM, CMR shows myocardial edema and LGE that is typically subendocardial but can involve any myocardial layer. The left ventricle is often non-dilated with moderate-to-severe systolic dysfunction. Pericardial effusion is common. Necrotizing EM presents with extensive myocardial LGE on CMR. [ABSTRACT FROM AUTHOR]
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- 2023
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21. The primary cardiomyopathy of systemic sclerosis on cardiovascular magnetic resonance imaging.
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Chhikara, Sanya, Kanda, Adinan, Ogugua, Fredrick M, Rouf, Rejowana, Nouraee, Cyrus, Bawaskar, Parag, Molitor, Jerry A, and Shenoy, Chetan
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HEART physiology ,LEFT heart ventricle ,HEART transplantation ,CONFIDENCE intervals ,CARDIOMYOPATHIES ,SYSTEMIC scleroderma ,MAGNETIC resonance imaging ,RETROSPECTIVE studies ,CONTRAST media ,DISEASE incidence ,HEART assist devices ,CARDIOVASCULAR system ,CHEMICAL elements ,RISK assessment ,HOSPITAL care ,STROKE volume (Cardiac output) ,ODDS ratio ,LONGITUDINAL method ,DISEASE complications - Abstract
Aims Cardiac disease in systemic sclerosis (SSc) may be primary or secondary to other disease manifestations of SSc. The prevalence of the primary cardiomyopathy of SSc is unknown. Cardiovascular magnetic resonance (CMR) imaging can help accurately determine the presence and cause of cardiomyopathy. We aimed to investigate the prevalence, the CMR features, and the prognostic implications of the primary cardiomyopathy of SSc. Methods and results We conducted a retrospective cohort study of consecutive patients with SSc who had a clinical CMR for suspected cardiac involvement. We identified the prevalence, the CMR features of the primary cardiomyopathy of SSc, and its association with the long-term incidence of death or major adverse cardiac events (MACEs): heart failure hospitalization, ventricular assist device implantation, heart transplantation, and sustained ventricular tachycardia. Of 130 patients with SSc, 80% were women, and the median age was 58 years. On CMR, 22% had an abnormal left ventricular ejection fraction, and 40% had late gadolinium enhancement (LGE). The prevalence of the primary cardiomyopathy of SSc was 21%. A third of these patients had a distinct LGE phenotype. Over a median follow-up of 3.6 years after the CMR, patients with the primary cardiomyopathy of SSc had a greater incidence of death or MACE (adjusted hazard ratio 2.01; 95% confidence interval 1.03–3.92; P = 0.041). Conclusion The prevalence of the primary cardiomyopathy of SSc was 21%, with a third demonstrating a distinct LGE phenotype. The primary cardiomyopathy of SSc was independently associated with a greater long-term incidence of death or MACE. [ABSTRACT FROM AUTHOR]
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- 2023
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22. Cardiac magnetic resonance in giant cell myocarditis: a matched comparison with cardiac sarcoidosis.
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Pöyhönen, Pauli, Nordenswan, Hanna-Kaisa, Lehtonen, Jukka, Syväranta, Suvi, Shenoy, Chetan, and Kupari, Markku
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TREATMENT of cardiomyopathies ,TROPONIN ,SARCOIDOSIS ,MAGNETIC resonance imaging ,COMPARATIVE studies ,CHEMICAL elements ,PEPTIDE hormones - Abstract
Aims Giant cell myocarditis (GCM) is an inflammatory cardiomyopathy akin to cardiac sarcoidosis (CS). We decided to study the findings of GCM on cardiac magnetic resonance (CMR) imaging and to compare GCM with CS. Methods and results CMR studies of 18 GCM patients were analyzed and compared with 18 CS controls matched for age, sex, left ventricular (LV) ejection fraction and presenting cardiac manifestations. The analysts were blinded to clinical data. On admission, the duration of symptoms (median) was 0.2 months in GCM vs. 2.4 months in CS (P = 0.002), cardiac troponin T was elevated (>50 ng/L) in 16/17 patients with GCM and in 2/16 with CS (P < 0.001), their respective median plasma B-type natriuretic propeptides measuring 4488 ng/L and 1223 ng/L (P = 0.011). On CMR imaging, LV diastolic volume was smaller in GCM (177 ± 32 mL vs. 211 ± 58 mL, P = 0.014) without other volumetric or wall thickness measurements differing between the groups. Every GCM patient had multifocal late gadolinium enhancement (LGE) in a distribution indistinguishable from CS both longitudinally, circumferentially, and radially across the LV segments. LGE mass averaged 17.4 ± 6.3% of LV mass in GCM vs 25.0 ± 13.4% in CS (P = 0.037). Involvement of insertion points extending across the septum into the right ventricular wall, the "hook sign" of CS, was present in 53% of GCM and 50% of CS. Conclusion In GCM, CMR findings are qualitatively indistinguishable from CS despite myocardial inflammation being clinically more acute and injurious. When matched for LV dysfunction and presenting features, LV size and LGE mass are smaller in GCM. [ABSTRACT FROM AUTHOR]
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- 2023
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23. Signal intensity informed multi‐coil encoding operator for physics‐guided deep learning reconstruction of highly accelerated myocardial perfusion CMR.
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Demirel, Omer Burak, Yaman, Burhaneddin, Shenoy, Chetan, Moeller, Steen, Weingärtner, Sebastian, and Akçakaya, Mehmet
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DEEP learning ,CARDIAC magnetic resonance imaging ,PERFUSION ,MAGNETIC resonance imaging ,CONTRAST media ,SPEECH processing systems - Abstract
Purpose: To develop a physics‐guided deep learning (PG‐DL) reconstruction strategy based on a signal intensity informed multi‐coil (SIIM) encoding operator for highly‐accelerated simultaneous multislice (SMS) myocardial perfusion cardiac MRI (CMR). Methods: First‐pass perfusion CMR acquires highly‐accelerated images with dynamically varying signal intensity/SNR following the administration of a gadolinium‐based contrast agent. Thus, using PG‐DL reconstruction with a conventional multi‐coil encoding operator leads to analogous signal intensity variations across different time‐frames at the network output, creating difficulties in generalization for varying SNR levels. We propose to use a SIIM encoding operator to capture the signal intensity/SNR variations across time‐frames in a reformulated encoding operator. This leads to a more uniform/flat contrast at the output of the PG‐DL network, facilitating generalizability across time‐frames. PG‐DL reconstruction with the proposed SIIM encoding operator is compared to PG‐DL with conventional encoding operator, split slice‐GRAPPA, locally low‐rank (LLR) regularized reconstruction, low‐rank plus sparse (L + S) reconstruction, and regularized ROCK‐SPIRiT. Results: Results on highly accelerated free‐breathing first pass myocardial perfusion CMR at three‐fold SMS and four‐fold in‐plane acceleration show that the proposed method improves upon the reconstruction methods use for comparison. Substantial noise reduction is achieved compared to split slice‐GRAPPA, and aliasing artifacts reduction compared to LLR regularized reconstruction, L + S reconstruction and PG‐DL with conventional encoding. Furthermore, a qualitative reader study indicated that proposed method outperformed all methods. Conclusion: PG‐DL reconstruction with the proposed SIIM encoding operator improves generalization across different time‐frames /SNRs in highly accelerated perfusion CMR. [ABSTRACT FROM AUTHOR]
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- 2023
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24. Long-term prognostic value of right ventricular dysfunction on cardiovascular magnetic resonance imaging in anthracycline-treated cancer survivors.
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Chhikara, Sanya, Hooks, Matthew, Athwal, Pal Satyajit Singh, Hughes, Andrew, Ismail, Mohamed F, Joppa, Stephanie, Velangi, Pratik S, Nijjar, Prabhjot S, Blaes, Anne H, and Shenoy, Chetan
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MORTALITY risk factors ,HEART failure risk factors ,HEART transplantation ,CARDIOTOXICITY ,ANTHRACYCLINES ,VENTRICULAR ejection fraction ,MAJOR adverse cardiovascular events ,MAGNETIC resonance imaging ,HEART assist devices ,CANCER patients ,TREATMENT effectiveness ,RIGHT ventricular dysfunction ,HOSPITAL care ,CARDIAC arrest ,VENTRICULAR arrhythmia ,KAPLAN-Meier estimator ,DISEASE prevalence ,TUMORS ,RESUSCITATION ,PROPORTIONAL hazards models ,DISEASE risk factors - Abstract
Aims We aimed to determine the prevalence of right ventricular (RV) systolic dysfunction on cardiovascular magnetic resonance imaging (CMR) and its impact on long-term adverse outcomes in a large cohort of cancer survivors treated with anthracycline-based chemotherapy. Methods and results Consecutive cancer survivors treated with anthracyclines who underwent clinical CMR for suspected anthracycline-related cardiomyopathy were studied. The primary endpoint was a composite of all-cause death or major adverse cardiac events (MACE): heart failure hospitalization, heart transplantation, ventricular assist device implantation, resuscitated cardiac arrest, or life-threatening ventricular arrhythmia. The secondary endpoints were all-cause death, and cardiac death or MACE. Among 249 survivors who underwent CMR at a median of 2.9 years after cancer treatment, RV systolic dysfunction was present in 54 (21.7%). Of these, 50 (92.6%) had an abnormal left ventricular ejection fraction (LVEF). At a median follow-up time after the CMR of 2.7 years, 105 survivors experienced the primary endpoint. On Kaplan–Meier analyses, the cumulative incidence of the primary endpoint was significantly higher in survivors with abnormal RVEF compared with those with normal RVEF (P = 0.002). However, on Cox multivariable analyses, RVEF was not associated with the primary endpoint (HR 1.04 per 5% decrease; 95% CI 0.93–1.17; P = 0.46) after adjustment for non-imaging variables and LVEF. RVEF was also not associated with the secondary endpoints. Conclusion Among anthracycline-treated cancer survivors undergoing CMR for suspected cardiotoxicity, RV systolic dysfunction was present in one in five cases, accompanied by LV systolic dysfunction in nearly all cases, and was not independently associated with long-term outcomes. [ABSTRACT FROM AUTHOR]
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- 2022
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25. Feature-Tracking Global Longitudinal Strain Predicts Mortality in Patients With Preserved Ejection Fraction: A Multicenter Study
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Romano, Simone, Judd, Robert M, Kim, Raymond J, Heitner, John F, Shah, Dipan J, Shenoy, Chetan, Evans, Kaleigh, Romer, Benjamin, Salazar, Pablo, and Farzaneh-Far, Afshin
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Adult ,Male ,Magnetic Resonance Spectroscopy ,Time Factors ,Heart Diseases ,cardiac magnetic resonance imaging ,feature-tracking ,Left ,Magnetic Resonance Imaging, Cine ,Risk Assessment ,Article ,Ventricular Function, Left ,left ventricular function ,Predictive Value of Tests ,Risk Factors ,Ventricular Function ,Humans ,Aged ,Retrospective Studies ,Stroke Volume ,Reference Standards ,Middle Aged ,Prognosis ,mortality ,Magnetic Resonance Imaging ,United States ,Cine ,Female ,global longitudinal strain - Abstract
The goal of this study was to evaluate the prognostic value of global longitudinal strain (GLS) derived from cardiac magnetic resonance (CMR) feature-tracking in a large multicenter population of patients with preserved ejection fraction.Ejection fraction is the principal parameter used clinically to assess cardiac mechanics and provides prognostic information. However, significant abnormalities of myocardial deformation can be present despite preserved ejection fraction. CMR feature-tracking techniques now allow assessment of strain from routine cine images, without specialized pulse sequences. Whether abnormalities of strain measured by using CMR feature-tracking have prognostic value in patients with preserved ejection fraction is unknown.Consecutive patients with preserved ejection fraction (≥50%) and a clinical indication for CMR at 4 U.S. medical centers were included in this retrospective study. Feature-tracking GLS was calculated from 3 long-axis cine views. The primary endpoint was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between GLS and death. The incremental prognostic value of GLS was assessed in nested models.Of the 1,274 patients in this study, 115 died during a median follow-up of 6.2 years. By Kaplan-Meier analysis, patients with GLS ≥ median (-20%) had significantly reduced event-free survival compared with those with GLS median (log-rank test, p 0.001). By Cox multivariable regression modeling, each 1% worsening in GLS was associated with a 22.8% increased risk of death after adjustment for clinical and imaging risk factors (hazard ratio: 1.228 per percent; p 0.001). Addition of GLS in this model resulted in significant improvement in the global chi-square test (94 to 183; p 0.001) and Harrell's C-statistic (0.75 to 0.83; p 0.001).GLS derived from CMR feature-tracking is a powerful independent predictor of mortality in patients with preserved ejection fraction, incremental to common clinical and imaging risk factors.
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- 2019
26. Left ventricular thrombus on cardiovascular magnetic resonance imaging in non-ischaemic cardiomyopathy.
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Hooks, Matthew, Okasha, Osama, Velangi, Pratik S, Nijjar, Prabhjot S, Farzaneh-Far, Afshin, and Shenoy, Chetan
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THROMBOSIS diagnosis ,LEFT heart ventricle ,ECHOCARDIOGRAPHY ,VENTRICULAR ejection fraction ,CARDIOMYOPATHIES ,MYOCARDIAL ischemia ,MAGNETIC resonance imaging ,EMBOLISMS ,DESCRIPTIVE statistics - Abstract
Aims Case reports have described left ventricular (LV) thrombus in patients with non-ischaemic cardiomyopathy (NICM). We aimed to systematically study the characteristics, predictors, and outcomes of LV thrombus in NICM. Methods and results Forty-eight patients with LV thrombus detected on late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE CMR) in NICM were compared with 124 patients with LV thrombus in ischaemic cardiomyopathy (ICM), and 144 matched patients with no LV thrombus in NICM. The performance of echocardiography for the detection of LV thrombus was compared between NICM and ICM. The 12-month incidence of embolism was compared between the three study groups. Independent predictors of LV thrombus in NICM were LV ejection fraction (LVEF) [hazard ratio (HR) 1.36 per 5% decrease; P = 0.002], LGE presence (HR 6.30; P < 0.001), and LGE extent (HR 1.33 per 5% increase; P = 0.001). Compared with patients with LV thrombus in ICM, those with LV thrombus in NICM had a 10-fold higher prevalence of thrombi in other cardiac chambers. The performance of echocardiography for the detection of LV thrombus was not different between NICM and ICM. The 12-month incidence of embolism associated with LV thrombus was not different between NICM and ICM (8.7% vs. 6.8%; P = 0.69) but both were higher compared with no LV thrombus in NICM (1.5%). Conclusion Independent predictors of LV thrombus in NICM were lower LVEF, LGE presence, and greater LGE extent. The 12-month incidence of embolism associated with LV thrombus in NICM was not different compared with LV thrombus in ICM. [ABSTRACT FROM AUTHOR]
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- 2021
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27. Sex Differences in Patients With Suspected Cardiac Sarcoidosis Assessed by Cardiovascular Magnetic Resonance Imaging.
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Kalra, Rajat, Malik, Shray, Ko-Hsuan Amy Chen, Ogugua, Fredrick, Athwal, Pal Satyajit Singh, Elton, Andrew C., Velangi, Pratik S., Ismail, Mohamed F., Chhikara, Sanya, Markowitz, Jeremy S., Nijjar, Prabhjot S., von Wald, Lisa, Roukoz, Henri, Bhargava, Maneesh, Perlman, David, Shenoy, Chetan, and Chen, Ko-Hsuan Amy
- Abstract
Background: There are few data on sex differences in suspected cardiac sarcoidosis. Methods: Consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement were studied. We investigated sex differences in presenting features, cardiac involvement, and the long-term incidence of a primary composite end point of all-cause death or significant ventricular arrhythmia and secondary end points of all-cause death and significant ventricular arrhythmia. Results: Among 324 patients, 163 (50.3%) were female and 161 (49.7%) were male patients. Female patients had a greater prevalence of chest pain (37.4% versus 23.6%; P=0.010) and palpitations (39.3% versus 26.1%; P=0.016) than male patients but not dyspnea, presyncope, syncope, or arrhythmias at presentation. Female patients had a lower prevalence of late gadolinium enhancement on cardiovascular magnetic resonance imaging (20.2% versus 35.4%; P=0.003) and less often met criteria for a clinical diagnosis of cardiac sarcoidosis (Heart Rhythm Society consensus criteria, 22.7% versus 36.0%; P=0.012 and 2016 Japanese Circulation Society guideline criteria, 8.0% versus 19.3%; P=0.005), indicating lesser cardiac involvement. However, the long-term incidence of all-cause death or significant ventricular arrhythmia was not different between female and male patients (23.2% versus 23.2%; P=0.46). Among the secondary end points, the incidence of all-cause death was not different between female and male patients (20.7% versus 14.3%; P=0.51), while female patients had a lower incidence of significant ventricular arrhythmia compared with male patients (4.3% versus 13.0%; P=0.022). On multivariable analyses, sex was not associated with the primary end point (hazard ratio for female patients, 1.36 [95% CI, 0.77–2.43]; P=0.29). Conclusions: We observed distinct sex differences in patients with suspected cardiac sarcoidosis. A paradox was identified wherein female patients had a greater prevalence of chest pain and palpitations than male patients, but lesser cardiac involvement, and a similar long-term incidence of all-cause death or significant ventricular arrhythmia. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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28. Stress CMR in patients with obesity: insights from the Stress CMR Perfusion Imaging in the United States (SPINS) registry.
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Ge, Yin, Steel, Kevin, Antiochos, Panagiotis, Bingham, Scott, Abdullah, Shuaib, Mikolich, J Ronald, Arai, Andrew E, Bandettini, W Patricia, Shanbhag, Sujata M, Patel, Amit R, Farzaneh-Far, Afshin, Heitner, John F, Shenoy, Chetan, Leung, Steve W, Gonzalez, Jorge A, Shah, Dipan J, Raman, Subha V, Nawaz, Haseeb, Ferrari, Victor A, and Schulz-Menger, Jeanette
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OBESITY complications ,CORONARY heart disease risk factors ,CARDIOVASCULAR disease related mortality ,PREDICTIVE tests ,CONFIDENCE intervals ,MAGNETIC resonance imaging ,CORONARY disease ,MYOCARDIAL infarction ,REGRESSION analysis ,MEDICAL care costs ,RISK assessment ,DESCRIPTIVE statistics ,BODY mass index - Abstract
Aims Non-invasive assessment and risk stratification of coronary artery disease in patients with large body habitus is challenging. We aim to examine whether body mass index (BMI) modifies the prognostic value and diagnostic utility of stress cardiac magnetic resonance imaging (CMR) in a multicentre registry. Methods and results The SPINS Registry enrolled consecutive intermediate-risk patients who presented with a clinical indication for stress CMR in the USA between 2008 and 2013. Baseline demographic data including BMI, CMR indices, and ratings of study quality were collected. Primary outcome was defined by a composite of cardiovascular death and non-fatal myocardial infarction. Of the 2345 patients with available BMI included in the SPINS cohort, 1177 (50%) met criteria for obesity (BMI ≥ 30) with 531 (23%) at or above Class 2 obesity (BMI ≥ 35). In all BMI categories, >95% of studies were of diagnostic quality for cine, perfusion, and late gadolinium enhancement (LGE) sequences. At a median follow-up of 5.4 years, those without ischaemia and LGE experienced a low annual rate of hard events (<1%), across all BMI strata. In patients with obesity, both ischaemia [hazard ratio (HR): 2.14; 95% confidence interval (CI): 1.30–3.50; P = 0.003] and LGE (HR: 3.09; 95% CI: 1.83–5.22; P < 0.001) maintained strong adjusted association with the primary outcome in a multivariable Cox regression model. Downstream referral rates to coronary angiography, revascularization, and cost of care spent on ischaemia testing did not significantly differ within the BMI categories. Conclusion In this large multicentre registry, elevated BMI did not negatively impact the diagnostic quality and the effectiveness of risk stratification of patients referred for stress CMR. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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29. Myocardial damage assessed by late gadolinium enhancement on cardiovascular magnetic resonance imaging in cancer patients treated with anthracyclines and/or trastuzumab.
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Modi, Kalpit, Joppa, Stephanie, Chen, Ko-Hsuan Amy, Athwal, Pal Satyajit Singh, Okasha, Osama, Velangi, Pratik S, Hooks, Matthew, Nijjar, Prabhjot S, Blaes, Anne H, and Shenoy, Chetan
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ANTHRACYCLINES ,MYOCARDIUM ,TRASTUZUMAB ,CARDIOMYOPATHIES ,MAGNETIC resonance imaging ,CHEMICAL elements ,DIAGNOSTIC imaging ,CANCER patients ,DISEASE prevalence ,TUMORS ,LONGITUDINAL method - Abstract
Aims In cancer patients with cardiomyopathy related to anthracyclines and/or trastuzumab, data regarding late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging are confusing. The prevalence ranges from 0% to 30% and the patterns are ill-defined. Whether treatment with anthracyclines and/or trastuzumab is associated with LGE is unclear. We aimed to investigate these topics in a large cohort of consecutive cancer patients with suspected cardiotoxicity from anthracyclines and/or trastuzumab. Methods and results We studied 298 patients, analysed the prevalence, patterns, and correlates of LGE, and determined their causes. We compared the findings with those from 100 age-matched cancer patients who received neither anthracyclines nor trastuzumab. Amongst those who received anthracyclines and/or trastuzumab, 31 (10.4%) had LGE. It had a wide range of extent (3.9–34.7%) and locations. An ischaemic pattern was present in 20/31 (64.5%) patients. There was an alternative explanation for the non-ischaemic LGE in 7/11 (63.6%) patients. In the age-matched patients who received neither anthracyclines nor trastuzumab, the prevalence of LGE was higher at 27.0%, while the extent of LGE and the proportion with ischaemic pattern were not different. Conclusion LGE was present in only a minority. Its patterns and locations did not fit into a single unique profile. It had alternative explanations in virtually all cases. Finally, LGE was also present in cancer patients who received neither anthracyclines nor trastuzumab. Therefore, treatment with anthracyclines and/or trastuzumab is unlikely to be associated with LGE. The absence of LGE can help distinguish anthracycline- and/or trastuzumab-related cardiomyopathy from unrelated cardiomyopathies. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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30. Kiosk 5R-FB-06 - Prognostic Value of Stress CMR Perfusion in Diabetes: Insights FBom the SPINS Registry.
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Topriceanu, Constantin-Cristian, Bernhard, Benedikt, Ge, Yin, Antiochos, Panagiotis, Heydari, Bobak, Steel, Kevin, Bingham, Scott, Ronald Mikolich, J, E Arai, Andrew, Bandettini, W Patricia, Patel, Amit, Shanbhag, Sujata M, Farzaneh-Far, Afshin, Heitner, John F, Shenoy, Chetan, Leung, Steve W, Gonzalez, Jorge A, Raman, Subha V, Ferrari, Victor A, and Shah, Dipan
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HEART function tests ,MAGNETIC resonance imaging ,CONFERENCES & conventions ,PERFUSION imaging ,CARDIOVASCULAR disease diagnosis ,PERFUSION ,DIABETES - Published
- 2024
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31. CMR 3-86 - Stress CMR Perfusion Imaging in the Medicare Eligible Population: Insights from the Stress CMR Perfusion Imaging in the United States (SPINS) Study.
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Ge, Yin, Antiochos, Panagiotis, Heydari, Bobak, Bernhard, Benedikt, Steel, Kevin, Bingham, Scott, Abdullah, Shuaib M., Mikolich, J Ronald, Arai, Andrew, Shanbhag, Sujata M, Bandettini, W Patricia, Patel, Amit, Farzaneh-Far, Afshin, Heitner, John F, Shenoy, Chetan, Leung, Steve W, Gonzalez, Jorge A, Shah, Dipan, Raman, Subha V, and Ferrari, Victor A
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INSURANCE ,MEDICARE ,MAGNETIC resonance imaging ,CONFERENCES & conventions ,PERFUSION imaging ,CARDIOVASCULAR disease diagnosis ,PERFUSION - Published
- 2024
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32. CMR 2-48 - Periinfarct Ischemia Provides Strong Risk Prognostication Incremental to Ischemic Markers: The Multicenter Stress CMR Perfusion Imaging in the United States (SPINS) Study of the CMR Registry.
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Bernhard, Benedikt, Ge, Yin, Antiochos, Panagiotis, Heydari, Bobak, Santiuste, Natalia Sanchez, Steel, Kevin, Bingham, Scott, Ronald Mikolich, J, Arai, Andrew E, Bandettini, W Patricia, Patel, Amit, Shanbhag, Sujata M, Farzaneh-Far, Afshin, Heitner, John F, Shenoy, Chetan, Leung, Steve W, Gonzalez, Jorge A, Raman, Subha V, Ferrari, Victor A, and Shah, Dipan
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RISK assessment ,ISCHEMIA ,MAGNETIC resonance imaging ,CONFERENCES & conventions ,PERFUSION imaging ,PERFUSION ,BIOMARKERS ,DISEASE complications - Published
- 2024
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33. Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance.
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Hans Huang, Nijjar, Prabhjot S., Misialek, Jeffrey R., Blaes, Anne, Derrico, Nicholas P., Kazmirczak, Felipe, Klem, Igor, Farzaneh-Far, Afshin, and Shenoy, Chetan
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TUMOR diagnosis ,HEART ventricle diseases ,CARDIOVASCULAR diseases ,COMPARATIVE studies ,STATISTICAL correlation ,LEFT heart ventricle ,CARDIAC radionuclide imaging ,MAGNETIC resonance imaging ,RESEARCH funding ,STATISTICAL hypothesis testing ,STATISTICS ,T-test (Statistics) ,LOGISTIC regression analysis ,CROSS-sectional method ,VENTRICULAR ejection fraction - Abstract
Background: Multiple gated acquisition scanning (MUGA) is a common imaging modality for baseline and serial assessment of left ventricular ejection fraction (LVEF) for cardiotoxicity risk assessment prior to, surveillance during, and surveillance after administration of potentially cardiotoxic cancer treatment. The objective of this study was to compare the accuracy of left ventricular ejection fractions (LVEF) obtained by contemporary clinical multiple gated acquisition scans (MUGA) with reference LVEFs from cardiovascular magnetic resonance (CMR) in consecutive patients with cancer. Methods: In a cross-sectional study, we compared MUGA clinical and CMR reference LVEFs in 75 patients with cancer who had both studies within 30 days. Misclassification was assessed using the two most common thresholds of LVEF used in cardiotoxicity clinical studies and practice: 50 and 55%. Results: Compared to CMR reference LVEFs, MUGA clinical LVEFs were only lower by a mean of 1.5% (48.5% vs. 50.0%, p = 0.17). However, the limits of agreement between MUGA clinical and CMR reference LVEFs were wide at -19.4 to 16. 5%. At LVEF thresholds of 50 and 55%, there was misclassification of 35 and 20% of cancer patients, respectively. Conclusions: MUGA clinical LVEFs are only modestly accurate when compared with CMR reference LVEFs. These data have significant implications on clinical research and patient care of a population with, or at risk for, cardiotoxicity. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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34. Utilization of Cardiovascular Magnetic Resonance Imaging for Resumption of Athletic Activities Following COVID-19 Infection: An Expert Consensus Document on Behalf of the American Heart Association Council on Cardiovascular Radiology and Intervention...
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Ruberg, Frederick L., Baggish, Aaron L., Hays, Allison G., Jerosch-Herold, Michael, Kim, Jiwon, Ordovas, Karen G., Reddy, Gautham, Shenoy, Chetan, Weinsaft, Jonathan W., and Woodard, Pamela K.
- Abstract
The global pandemic of COVID-19 caused by infection with SARS-CoV-2 is now entering its fourth year with little evidence of abatement. As of December 2022, the World Health Organization Coronavirus (COVID-19) Dashboard reported 643 million cumulative confirmed cases of COVID-19 worldwide and 98 million in the United States alone as the country with the highest number of cases. Although pneumonia with lung injury has been the manifestation of COVID-19 principally responsible for morbidity and mortality, myocardial inflammation and systolic dysfunction though uncommon are well-recognized features that also associate with adverse prognosis. Given the broad swath of the population infected with COVID-19, the large number of affected professional, collegiate, and amateur athletes raises concern regarding the safe resumption of athletic activity (return to play) following resolution of infection. A variety of different testing combinations that leverage ECG, echocardiography, circulating cardiac biomarkers, and cardiovascular magnetic resonance imaging have been proposed and implemented to mitigate risk. Cardiovascular magnetic resonance in particular affords high sensitivity for myocarditis but has been employed and interpreted nonuniformly in the context of COVID-19 thereby raising uncertainty as to the generalizability and clinical relevance of findings with respect to return to play. This consensus document synthesizes available evidence to contextualize the appropriate utilization of cardiovascular magnetic resonance in the return to play assessment of athletes with prior COVID-19 infection to facilitate informed, evidence-based decisions, while identifying knowledge gaps that merit further investigation. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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35. Cardiovascular magnetic resonance imaging for bicuspid aortic valve syndrome: the time is now.
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Shenoy, Chetan, Maron, Martin S., and Pandian, Natesa G.
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HEART disease diagnosis ,ANGIOGRAPHY ,AORTIC valve insufficiency ,CARDIOLOGY ,DIAGNOSTIC imaging ,MAGNETIC resonance imaging - Abstract
The authors reflect on a study by R. Wassmuth and colleagues on cardiovascular magnetic resonance imaging for bicuspid aortic valve syndrome, published within the issue. Topics discussed include the components of congenital abiscupid aortic valve, such as aortic valve stenosis, ascending aortic dilation and aortic coarctation, the use of cardiovascular magnetic resonance (CMR) as a modality, and factors affecting the role of CMR.
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- 2014
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36. Long-Term Embolic Outcomes After Detection of Left Ventricular Thrombus by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging: A Matched Cohort Study.
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Velangi, Pratik S., Choo, Christopher, Chen, Ko-Hsuan A., Kazmirczak, Felipe, Nijjar, Prabhjot S., Farzaneh-Far, Afshin, Okasha, Osama, Akçakaya, Mehmet, Weinsaft, Jonathan W., and Shenoy, Chetan
- Abstract
Supplemental Digital Content is available in the text. Background: Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique ability to identify thrombus based on tissue characteristics related to avascularity. The long-term prognostic significance of left ventricular (LV) thrombus detected by LGE CMR is unknown. Methods: We performed a matched cohort study of consecutive adult patients with LV thrombus detected by LGE CMR who were matched on the date of CMR, age, and LV ejection fraction to up to 3 patients without LV thrombus. We investigated the long-term incidence of a composite of embolic events: stroke, transient ischemic attack, or extracranial systemic arterial embolism. We also compared outcomes among patients with LV thrombus detected by LGE CMR stratified by whether the LV thrombus was also detected by echocardiography or not. Results: Of 157 LV thrombus patients, 155 were matched to 400 non-LV thrombus patients. During a median follow-up of 3.3 years, the cumulative incidence of embolism was significantly higher in LV thrombus patients compared with the matched non-LV thrombus patients (P <0.001), with annualized rates of 3.7% and 0.8% for LV thrombus and matched non-LV thrombus patients, respectively. LV thrombus was the only independent predictor of the composite embolic end point (hazard ratio, 3.99 [95% CI, 1.54–10.35]; P =0.004). The cumulative incidence of embolism was not different in patients with LV thrombus that was also detected by echocardiography versus patients with LV thrombus not detected by echocardiography (P =0.25). Conclusions: Despite contemporary antithrombotic treatment, LV thrombus detected by LGE CMR is associated with a 4-fold higher long-term incidence of embolism compared with matched non-LV thrombus patients. LV thrombus detected by LGE CMR but not by echocardiography is associated with a similar risk of embolism as that detected by both LGE CMR and echocardiography. [ABSTRACT FROM AUTHOR]
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- 2019
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37. Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis.
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Kazmirczak, Felipe, Chen, Ko-Hsuan Amy, Adabag, Selcuk, von Wald, Lisa, Roukoz, Henri, Benditt, David G., Okasha, Osama, Farzaneh-Far, Afshin, Markowitz, Jeremy, Nijjar, Prabhjot S., Velangi, Pratik S., Bhargava, Maneesh, Perlman, David, Duval, Sue, Akçakaya, Mehmet, and Shenoy, Chetan
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SARCOIDOSIS diagnosis ,TREATMENT of cardiomyopathies ,SARCOIDOSIS treatment ,SARCOIDOSIS ,BIOPSY ,CARDIOMYOPATHIES ,IMPLANTABLE cardioverter-defibrillators ,PROGNOSIS ,MAGNETIC resonance imaging ,RETROSPECTIVE studies ,MEDICAL protocols ,CARDIAC arrest ,RESEARCH funding ,MEDICAL societies ,LONGITUDINAL method ,DISEASE complications - Abstract
Background: Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them.Methods: We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index.Results: In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point.Conclusions: We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research. [ABSTRACT FROM AUTHOR]- Published
- 2019
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38. Desmoplakin Variant-Associated Arrhythmogenic Cardiomyopathy Presenting as Acute Myocarditis.
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Reichl, Kaitlyn, Kreykes, Sarah E., Martin, Cindy M., and Shenoy, Chetan
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- 2018
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39. Left Ventricular Noncompaction and Cardiogenic Shock.
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Kazmirczak, Felipe, Martin, Cindy M., and Shenoy, Chetan
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CARDIOGENIC shock , *ARRHYTHMOGENIC right ventricular dysplasia , *ARRHYTHMIA , *CONGENITAL heart disease - Abstract
Keywords: clinical decision-making; diagnostic tests; fibrosis; heart failure; imaging; magnetic resonance imaging; myocardium EN clinical decision-making diagnostic tests fibrosis heart failure imaging magnetic resonance imaging myocardium 696 701 6 04/20/20 20200225 NES 200225 I Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs i I Shenoy and Martin), who respond to the information, sharing their reasoning with the reader (regular type). I Dr Shenoy: i In patients with a history of congenital heart disease and those presenting with heart failure, echocardiography is the first-line imaging test but cardiovascular magnetic resonance imaging (CMR) often provides incremental information. Identifying 1 or a few possible causes of nonischemic cardiomyopathies also helps to guide clinical management, such as endomyocardial biopsy in cases of suspected infiltrative or inflammatory cardiomyopathies, or genetic testing in cases of suspected genetic cardiomyopathies. Discussion The Current Status of LVNC LVNC is a term used to describe excessive trabeculations and deep intertrabecular recesses in the LV on imaging.[2] LVNC cardiomyopathy was first classified as a specific type of cardiomyopathy by an expert consensus panel in 2006. [Extracted from the article]
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- 2020
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40. Nonischemic or Dual Cardiomyopathy in Patients With Coronary Artery Disease.
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Bawaskar, Parag, Thomas, Nicholas, Ismail, Khaled, Guo, Yugene, Chhikara, Sanya, Athwal, Pal Satyajit Singh, Ranum, Alison, Jadhav, Achal, Hooker Mendez, Abel, Nadkarni, Ishan, Frerichs, Dominic, Velangi, Pratik, Ergando, Tesfatsiyon, Akram, Hassan, Kanda, Adinan, and Shenoy, Chetan
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CARDIAC magnetic resonance imaging , *MAGNETIC resonance imaging , *CORONARY artery disease , *CARDIOMYOPATHIES , *STRESS echocardiography , *CORONARY angiography , *CONTRAST-enhanced magnetic resonance imaging - Abstract
BACKGROUND: Randomized trials in obstructive coronary artery disease (CAD) have largely shown no prognostic benefit from coronary revascularization. Although there are several potential reasons for the lack of benefit, an underexplored possible reason is the presence of coincidental nonischemic cardiomyopathy (NICM). We investigated the prevalence and prognostic significance of NICM in patients with CAD (CAD-NICM). METHODS: We conducted a registry study of consecutive patients with obstructive CAD on coronary angiography who underwent contrast-enhanced cardiovascular magnetic resonance imaging for the assessment of ventricular function and scar at 4 hospitals from 2004 to 2020. We identified the presence and cause of cardiomyopathy using cardiovascular magnetic resonance imaging and coronary angiography data, blinded to clinical outcomes. The primary outcome was a composite of all-cause death or heart failure hospitalization, and secondary outcomes were all-cause death, heart failure hospitalization, and cardiovascular death. RESULTS: Among 3023 patients (median age, 66 years; 76% men), 18.2% had no cardiomyopathy, 64.8% had ischemic cardiomyopathy (CAD+ICM), 9.3% had CAD+NICM, and 7.7% had dual cardiomyopathy (CAD+dualCM), defined as both ICM and NICM. Thus, 16.9% had CAD+NICM or dualCM. During a median follow-up of 4.8 years (interquartile range, 2.9, 7.6), 1116 patients experienced the primary outcome. In Cox multivariable analysis, CAD+NICM or dualCM was independently associated with a higher risk of the primary outcome compared with CAD+ICM (adjusted hazard ratio, 1.23 [95% CI, 1.06–1.43]; P =0.007) after adjustment for potential confounders. The risks of the secondary outcomes of all-cause death and heart failure hospitalization were also higher with CAD+NICM or dualCM (hazard ratio, 1.21 [95% CI, 1.02–1.43]; P =0.032; and hazard ratio, 1.37 [95% CI, 1.11–1.69]; P =0.003, respectively), whereas the risk of cardiovascular death did not differ from that of CAD+ICM (hazard ratio, 1.15 [95% CI, 0.89–1.48]; P =0.28). CONCLUSIONS: In patients with CAD referred for clinical cardiovascular magnetic resonance imaging, NICM or dualCM was identified in 1 of every 6 patients and was associated with worse long-term outcomes compared with ICM. In patients with obstructive CAD, coincidental NICM or dualCM may contribute to the lack of prognostic benefit from coronary revascularization. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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41. Asymptomatic Progression of an Atherosclerotic Giant Right Coronary Artery Aneurysm Over 12 Years.
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Tamene, Ashenafi M., Saxena, Retu, Grizzard, John D., and Shenoy, Chetan
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CARDIAC aneurysms , *DISEASE progression , *ATHEROSCLEROSIS , *MAGNETIC resonance imaging , *CARDIAC imaging , *COMPUTED tomography , *ETIOLOGY of diseases - Abstract
The article discusses a case study of 91-year-old male with asymptomatic progression of an atherosclerotic giant right coronary artery aneurysm (CAA). The patient was referred for cardiovascular magnetic resonance imaging (MRI) after a diagnosis of paracardiac mass on computed tomography (CT) of the abdomen and pelvis. A discussion on CAAs including the common causes in children and adults and the growth rate is provided.
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- 2015
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42. Abstract 15984: Rapid Visual Pathology-Based Late Gadolinium Enhancement Phenotyping on Cardiovascular Magnetic Resonance Imaging Improves Risk Stratification of Patients With Suspected Cardiac Sarcoidosis.
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Kazmirczak, Felipe, Chen, Ko-Hsuan A, Okasha, Osama, Farzaneh-Far, Afshin, Duval, Sue, von Wald, Lisa, Roukoz, Henri, Bhargava, Maneesh, Perlman, David, Markowitz, Jeremy, Nijjar, Prabhjot, Cogswell, Rebecca, Akcakaya, Mehmet, and Shenoy, Chetan
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- *
CARDIAC magnetic resonance imaging , *SARCOIDOSIS , *CARDIAC patients , *GADOLINIUM - Abstract
Background: In patients with suspected cardiac sarcoidosis (CS), the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) identifies patients with an increased risk for mortality. While the prevalence of LGE is typically 30%, only 10% of patients with LGE die of cardiovascular causes. We, therefore, postulated that characteristics of LGE would explain variations in cardiovascular outcomes. We aimed to improve risk stratification of patients with suspected CS by identifying high- and low-risk CS phenotypes on LGE CMR. Methods: We analyzed gross pathology images from the published literature of CS patients that underwent necropsy or heart explantation after cardiac transplantation and identified high-risk features. Using these, we defined a high-risk CS phenotype on LGE CMR in a cohort of patients with a histological diagnosis of sarcoidosis and suspected CS. The high-risk CS phenotype was defined by the presence of epicardial and either multifocal and/or septal LGE - E&M/S(+). We analyzed associations of the presence and the absence of the high-risk CS phenotype with a composite endpoint of CS-related major adverse cardiac events (CS-MACE) and all-cause death. Results: Of 286 patients, 85 (29.7%) had LGE. The LGE(+) E&M/S(-) phenotype, seen in 70.6% of patients with LGE, was associated with a significantly lower cumulative incidence of CS-MACE compared with the LGE(+) E&M/S(+) phenotype (log rank p<0.0001). LGE(+) E&M/S(-) patients had a similar survival free of CS-MACE as the LGE(-) patients (log rank p=0.91). On multivariable analyses, the only independent markers of CS-MACE were LGE(+) E&M/S(+) phenotype (HR 33.55; 95% CI 3.99-282.37; p=0.0012) and LGE extent (HR 1.07 for every 1% increase in LGE; 95% CI 1.01-1.14; p=0.031). LGE extent expressed as a dichotomous variable (< or >5.3%) was not independently associated with CS-MACE. Conclusions: In patients with suspected CS, LGE(+) E&M/S(+) is a rapid and reproducible, visual LGE phenotype that is associated with a high risk of CS-MACE. The absence of this phenotype is associated with a low risk of CS-MACE, even in the presence of LGE. Risk stratification of patients with suspected CS by LGE phenotype could improve management decisions regarding implantable cardioverter-defibrillator implantation and immunosuppression. [ABSTRACT FROM AUTHOR]
- Published
- 2018
43. Abstract 12322: Safety and Prognostic Value of Regadenoson Stress Cardiac Magnetic Resonance Imaging in Heart Transplant Recipients.
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Kazmirczak, Felipe, Nijjar, Prabhjot, Zhang, Lei, Hughes, Andrew, Chen, Ko-Hsuan A, Okasha, Osama, Martin, Cindy M, Akcakaya, Mehmet, and Shenoy, Chetan
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CARDIAC magnetic resonance imaging , *HEART transplant recipients , *HEART transplantation , *SINOATRIAL node , *PSYCHOLOGICAL stress testing - Abstract
Background: There is a critical need for non-invasive methods to detect coronary allograft vasculopathy and to risk stratify heart transplant recipients. Vasodilator stress testing using cardiovascular magnetic resonance imaging (CMR) is a promising technique for this purpose. We aimed to evaluate the safety and the prognostic value of regadenoson stress CMR in heart transplant recipients. Methods: To evaluate the safety, we assessed adverse effects in a retrospective matched cohort study of consecutive regadenoson stress CMRs in heart transplant recipients matched in a 2:1 ratio to age- and gender-matched non-heart transplant recipient controls. To evaluate the prognostic value, we compared the outcomes of patients with abnormal vs. normal regadenoson stress CMRs using a composite endpoint of myocardial infarction, percutaneous intervention, cardiac hospitalization, redo heart transplantation or death. Results: For the safety analysis, 234 regadenoson stress CMRs were included - 78 performed in 57 heart transplant recipients and 156 performed in controls. Those in heart transplant recipients were performed at a median of 2.74 years after transplantation. Thirty-four (44%) CMRs were performed in the first two years after heart transplantation. There were no differences in the rates of adverse effects between heart transplant recipients and controls. To study the prognostic value of regadenoson stress CMRs, 20 heart transplant recipients with abnormal regadenoson stress CMRs were compared to 37 with normal regadenoson stress CMRs. An abnormal regadenoson stress CMR was associated with a significantly higher incidence of the composite endpoint compared with a normal regadenoson stress CMR (3-year cumulative incidence estimates of 32.1% vs. 12.7%, p = 0.034; Figure). Conclusions: Regadenoson stress CMR is safe and well tolerated in heart transplant recipients, with no incidence of sinus node dysfunction or high-degree atrioventricular block, including in the first two years after heart transplantation. An abnormal regadenoson stress CMR identifies heart transplant recipients at a higher risk for major adverse cardiovascular events. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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