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1. SCMR expert consensus statement for cardiovascular magnetic resonance of patients with a cardiac implantable electronic device

Author

Daniel Kim, Jeremy D. Collins, James A. White, Kate Hanneman, Daniel C. Lee, Amit R. Patel, Peng Hu, Harold Litt, Jonathan W. Weinsaft, Rachel Davids, Kanae Mukai, Ming-Yen Ng, Julian A. Luetkens, Ariel Roguin, Carlos E. Rochitte, Pamela K. Woodard, Charlotte Manisty, Karolina M. Zareba, Lluis Mont, Frank Bogun, Daniel B. Ennis, Saman Nazarian, Gregory Webster, and Jadranka Stojanovska

Subjects
Cardiac implantable electronic device, MR safety, Cardiovascular magnetic resonance, Guidelines, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Cardiovascular magnetic resonance (CMR) is a proven imaging modality for informing diagnosis and prognosis, guiding therapeutic decisions, and risk stratifying surgical intervention. Patients with a cardiac implantable electronic device (CIED) would be expected to derive particular benefit from CMR given high prevalence of cardiomyopathy and arrhythmia. While several guidelines have been published over the last 16 years, it is important to recognize that both the CIED and CMR technologies, as well as our knowledge in MR safety, have evolved rapidly during that period. Given increasing utilization of CIED over the past decades, there is an unmet need to establish a consensus statement that integrates latest evidence concerning MR safety and CIED and CMR technologies. While experienced centers currently perform CMR in CIED patients, broad availability of CMR in this population is lacking, partially due to limited availability of resources for programming devices and appropriate monitoring, but also related to knowledge gaps regarding the risk-benefit ratio of CMR in this growing population. To address the knowledge gaps, this SCMR Expert Consensus Statement integrates consensus guidelines, primary data, and opinions from experts across disparate fields towards the shared goal of informing evidenced-based decision-making regarding the risk-benefit ratio of CMR for patients with CIEDs.

Published
2024
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2. Cardiovascular magnetic resonance imaging and clinical follow-up in patients with clinically suspected myocarditis after COVID-19 vaccination

Author

Norain Talib, Matteo Fronza, Constantin Arndt Marschner, Paaladinesh Thavendiranathan, Gauri Rani Karur, and Kate Hanneman

Subjects
CMR, Myocarditis, Vaccination, COVID-19, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

ABSTRACT: Background: The purpose of this study was to evaluate cardiovascular magnetic resonance (CMR) findings and their relationship to longer-term clinical outcomes in patients with suspected myocarditis following coronavirus disease 2019 (COVID-19) vaccination. Methods: Consecutive adult patients who underwent clinically indicated CMR for evaluation of suspected myocarditis following messenger ribonucleic acid (mRNA)-based COVID-19 vaccination at a single center between 2021 and 2022 were retrospectively evaluated. Patients were classified based on the revised Lake Louise criteria for T1-based abnormalities (late gadolinium enhancement [LGE] or high T1 values) and T2-based abnormalities (regional T2-hyperintensity or high T2 values). Results: Eighty-nine patients were included (64% [57/89] male, mean age 34 ± 13 years, 38% [32/89] mRNA-1273, and 62% [52/89] BNT162b2). On baseline CMR, 42 (47%) had at least one abnormality; 25 (28%) met both T1- and T2-criteria; 17 (19%) met T1-criteria but not T2-criteria; and 47 (53%) did not meet either. The interval between vaccination and CMR was shorter in those who met T1- and T2-criteria (28 days, IQR 8–69) compared to those who met T1-criteria only (110 days, IQR 66–255, p

Published
2024
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10. Cardiovascular magnetic resonance for evaluation of cardiac involvement in COVID-19: recommendations by the Society for Cardiovascular Magnetic Resonance

Author

Vanessa M. Ferreira, Sven Plein, Timothy C. Wong, Qian Tao, Zahra Raisi-Estabragh, Supriya S. Jain, Yuchi Han, Vineeta Ojha, David A. Bluemke, Kate Hanneman, Jonathan Weinsaft, Mahesh K. Vidula, Ntobeko A. B. Ntusi, Jeanette Schulz-Menger, and Jiwon Kim

Subjects
Cardiovascular magnetic resonance, COVID-19, SARS-CoV-2, Cardiac complications, Myocarditis, Myocardial infarction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic that has affected nearly 600 million people to date across the world. While COVID-19 is primarily a respiratory illness, cardiac injury is also known to occur. Cardiovascular magnetic resonance (CMR) imaging is uniquely capable of characterizing myocardial tissue properties in-vivo, enabling insights into the pattern and degree of cardiac injury. The reported prevalence of myocardial involvement identified by CMR in the context of COVID-19 infection among previously hospitalized patients ranges from 26 to 60%. Variations in the reported prevalence of myocardial involvement may result from differing patient populations (e.g. differences in severity of illness) and the varying intervals between acute infection and CMR evaluation. Standardized methodologies in image acquisition, analysis, interpretation, and reporting of CMR abnormalities across would likely improve concordance between studies. This consensus document by the Society for Cardiovascular Magnetic Resonance (SCMR) provides recommendations on CMR imaging and reporting metrics towards the goal of improved standardization and uniform data acquisition and analytic approaches when performing CMR in patients with COVID-19 infection.

Published
2023
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11. Predefined and data driven CT densitometric features predict critical illness and hospital length of stay in COVID-19 patients

Author

Tamar Shalmon, Pascal Salazar, Miho Horie, Kate Hanneman, Mini Pakkal, Vahid Anwari, and Jennifer Fratesi

Subjects
Medicine, Science
Abstract

Abstract The aim of this study was to compare whole lung CT density histograms to predict critical illness outcome and hospital length of stay in a cohort of 80 COVID-19 patients. CT chest images on segmented lungs were retrospectively analyzed. Functional Principal Component Analysis (FPCA) was used to find the main modes of variations on CT density histograms. CT density features, the CT severity score, the COVID-GRAM score and the patient clinical data were assessed for predicting the patient outcome using logistic regression models and survival analysis. ROC analysis predictors of critically ill status: 87.5th percentile CT density (Q875)—AUC 0.88 95% CI (0.79 0.94), F1-CT—AUC 0.87 (0.77 0.93) Standard Deviation (SD-CT)—AUC 0.86 (0.73, 0.93). Multivariate models combining CT-density predictors and Neutrophil–Lymphocyte Ratio showed the highest accuracy. SD-CT, Q875 and F1 score were significant predictors of hospital length of stay (LOS) while controlling for hospital death using competing risks models. Moreover, two multivariate Fine-Gray regression models combining the clinical variables: age, NLR, Contrast CT factor with either Q875 or F1 CT-density predictors revealed significant effects for the prediction of LOS incidence in presence of a competing risk (death) and acceptable predictive performances (Bootstrapped C-index 0.74 [0.70 0.78]).

Published
2022
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12. Interpretable machine learning for automated left ventricular scar quantification in hypertrophic cardiomyopathy patients.

Author

Zeinab Navidi, Jesse Sun, Raymond H Chan, Kate Hanneman, Amna Al-Arnawoot, Alif Munim, Harry Rakowski, Martin S Maron, Anna Woo, Bo Wang, and Wendy Tsang

Subjects
Computer applications to medicine. Medical informatics, R858-859.7
Abstract

Scar quantification on cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) images is important in risk stratifying patients with hypertrophic cardiomyopathy (HCM) due to the importance of scar burden in predicting clinical outcomes. We aimed to develop a machine learning (ML) model that contours left ventricular (LV) endo- and epicardial borders and quantifies CMR LGE images from HCM patients.We retrospectively studied 2557 unprocessed images from 307 HCM patients followed at the University Health Network (Canada) and Tufts Medical Center (USA). LGE images were manually segmented by two experts using two different software packages. Using 6SD LGE intensity cutoff as the gold standard, a 2-dimensional convolutional neural network (CNN) was trained on 80% and tested on the remaining 20% of the data. Model performance was evaluated using the Dice Similarity Coefficient (DSC), Bland-Altman, and Pearson's correlation. The 6SD model DSC scores were good to excellent at 0.91 ± 0.04, 0.83 ± 0.03, and 0.64 ± 0.09 for the LV endocardium, epicardium, and scar segmentation, respectively. The bias and limits of agreement for the percentage of LGE to LV mass were low (-0.53 ± 2.71%), and correlation high (r = 0.92). This fully automated interpretable ML algorithm allows rapid and accurate scar quantification from CMR LGE images. This program does not require manual image pre-processing, and was trained with multiple experts and software, increasing its generalizability.

Published
2023
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13. Combined simultaneous FDG-PET/MRI with T1 and T2 mapping as an imaging biomarker for the diagnosis and prognosis of suspected cardiac sarcoidosis

Author

Edward Cheung, Sarah Ahmad, Matthew Aitken, Rosanna Chan, Robert M. Iwanochko, Meyer Balter, Ur Metser, Patrick Veit-Haibach, Filio Billia, Yasbanoo Moayedi, Heather J. Ross, and Kate Hanneman

Subjects
Cardiac sarcoidosis, Sarcoidosis, FDG PET, Cardiac MRI, CMR, PET/MRI, Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

Abstract Purpose To evaluate the diagnostic and prognostic significance of combined cardiac 18F-fluorodeoxyglucose (FDG) PET/MRI with T1/T2 mapping in the evaluation of suspected cardiac sarcoidosis. Methods Patients with suspected cardiac sarcoidosis were prospectively enrolled for cardiac 18F-FDG PET/MRI, including late gadolinium enhancement (LGE) and T1/T2 mapping with calculation of extracellular volume (ECV). The final diagnosis of cardiac sarcoidosis was established using modified JMHW guidelines. Major adverse cardiac events (MACE) were assessed as a composite of cardiovascular death, ventricular tachyarrhythmia, bradyarrhythmia, cardiac transplantation or heart failure. Statistical analysis included Cox proportional hazard models. Results Forty-two patients (53 ± 13 years, 67% male) were evaluated, 13 (31%) with a final diagnosis of cardiac sarcoidosis. Among patients with cardiac sarcoidosis, 100% of patients had at least one abnormality on PET/MRI: FDG uptake in 69%, LGE in 100%, elevated T1 and ECV in 100%, and elevated T2 in 46%. FDG uptake co-localized with LGE in 69% of patients with cardiac sarcoidosis compared to 24% of those without, p = 0.014. Diagnostic specificity for cardiac sarcoidosis was highest for FDG uptake (69%), elevated T2 (79%), and FDG uptake co-localizing with LGE (76%). Diagnostic sensitivity was highest for LGE, elevated T1 and ECV (100%). After median follow-up duration of 634 days, 13 patients experienced MACE. All patients who experienced MACE had LGE, elevated T1 and elevated ECV. FDG uptake (HR 14.7, p = 0.002), elevated T2 (HR 9.0, p = 0.002) and native T1 (HR 1.1 per 10 ms increase, p = 0.044) were significant predictors of MACE even after adjusting for left ventricular ejection fraction and immune suppression treatment. The presence of FDG uptake co-localizing with LGE had the highest diagnostic performance overall (AUC 0.73) and was the best predictor of MACE based on model goodness of fit (HR 14.9, p = 0.001). Conclusions Combined cardiac FDG-PET/MRI with T1/T2 mapping provides complementary diagnostic information and predicts MACE in patients with suspected cardiac sarcoidosis.

Published
2021
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14. Cardiovascular signatures of COVID-19 predict mortality and identify barrier stabilizing therapies

Author

Dakota Gustafson, Michelle Ngai, Ruilin Wu, Huayun Hou, Alice Carvalhal Schoffel, Clara Erice, Serena Mandla, Filio Billia, Michael D. Wilson, Milica Radisic, Eddy Fan, Uriel Trahtemberg, Andrew Baker, Chris McIntosh, Chun-Po S. Fan, Claudia C. dos Santos, Kevin C. Kain, Kate Hanneman, Paaladinesh Thavendiranathan, Jason E. Fish, and Kathryn L. Howe

Subjects
COVID-19, MicroRNA, Biomarkers, Endothelium, Cardiovascular risk, Inflammation, Medicine, Medicine (General), R5-920
Abstract

Summary: Background: Endothelial cell (EC) activation, endotheliitis, vascular permeability, and thrombosis have been observed in patients with severe coronavirus disease 2019 (COVID-19), indicating that the vasculature is affected during the acute stages of SARS-CoV-2 infection. It remains unknown whether circulating vascular markers are sufficient to predict clinical outcomes, are unique to COVID-19, and if vascular permeability can be therapeutically targeted. Methods: Prospectively evaluating the prevalence of circulating inflammatory, cardiac, and EC activation markers as well as developing a microRNA atlas in 241 unvaccinated patients with suspected SARS-CoV-2 infection allowed for prognostic value assessment using a Random Forest model machine learning approach. Subsequent ex vivo experiments assessed EC permeability responses to patient plasma and were used to uncover modulated gene regulatory networks from which rational therapeutic design was inferred. Findings: Multiple inflammatory and EC activation biomarkers were associated with mortality in COVID-19 patients and in severity-matched SARS-CoV-2-negative patients, while dysregulation of specific microRNAs at presentation was specific for poor COVID-19-related outcomes and revealed disease-relevant pathways. Integrating the datasets using a machine learning approach further enhanced clinical risk prediction for in-hospital mortality. Exposure of ECs to COVID-19 patient plasma resulted in severity-specific gene expression responses and EC barrier dysfunction, which was ameliorated using angiopoietin-1 mimetic or recombinant Slit2-N. Interpretation: Integration of multi-omics data identified microRNA and vascular biomarkers prognostic of in-hospital mortality in COVID-19 patients and revealed that vascular stabilizing therapies should be explored as a treatment for endothelial dysfunction in COVID-19, and other severe diseases where endothelial dysfunction has a central role in pathogenesis. Funding Information: This work was directly supported by grant funding from the Ted Rogers Center for Heart Research, Toronto, Ontario, Canada and the Peter Munk Cardiac Center, Toronto, Ontario, Canada.

Published
2022
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15. Cardiovascular magnetic resonance based diagnosis of left ventricular non-compaction cardiomyopathy: impact of cine bSSFP strain analysis

Author

John G. Dreisbach, Shobhit Mathur, Christian P. Houbois, Erwin Oechslin, Heather Ross, Kate Hanneman, and Bernd J. Wintersperger

Subjects
Isolated noncompaction of the ventricular myocardium, Cardiovascular magnetic resonance, Myocardial strain, Feature tracking, Ventricular dysfunction, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Investigation of the myocardial strain characteristics of the left ventricular non-compaction (LVNC) phenotype with cardiovascular magnetic resonance (CMR) feature tracking. Methods CMR cine balanced steady-state free precession data sets of 59 retrospectively identified LVNC phenotype patients (40 years, IQR: 28–50 years; 51% male) and 36 healthy subjects (39 years, IQR: 30–47 years; 44% male) were evaluated for LV volumes, systolic function and mass. Hypertrabeculation in patients and healthy subjects was evaluated against established CMR diagnostic criteria. Global circumferential strain (GCS), global radial strain (GRS) and global longitudinal strain (GLS) were evaluated with feature-tracking software. Subgroup analyses were performed in patients (n = 25) and healthy subjects (n = 34) with normal LV volumetrics, and with healthy subjects (n = 18) meeting at least one LVNC diagnostic criteria. Results All LVNC phenotype patients, as well as a significant proportion of healthy subjects, met morphology-based CMR diagnostic criteria: non-compacted (NC): compacted myocardial diameter ratio > 2.3 (100% vs. 19.4%), NC mass > 20% (100% vs. 44.4%) and > 25% (100% vs. 13.9%), and NC mass indexed to body surface area > 15 g/m2 (100% vs. 41.7%). LVNC phenotype patients demonstrated reduced GRS (26.4% vs. 37.1%; p

Published
2020
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16. Loss of base-to-apex circumferential strain gradient assessed by cardiovascular magnetic resonance in Fabry disease: relationship to T1 mapping, late gadolinium enhancement and hypertrophy

Author

Shobhit Mathur, John G. Dreisbach, Gauri R. Karur, Robert M. Iwanochko, Chantal F. Morel, Syed Wasim, Elsie T. Nguyen, Bernd J. Wintersperger, and Kate Hanneman

Subjects
Cardiomyopathy, Fabry disease, Cardiovascular magnetic resonance, Magnetic resonance imaging, T1 mapping, Myocardial strain, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Cardiac involvement is common and is the leading cause of mortality in Fabry disease (FD). We explored the association between cardiovascular magnetic resonance (CMR) myocardial strain, T1 mapping, late gadolinium enhancement (LGE) and left ventricular hypertrophy (LVH) in patients with FD. Methods In this prospective study, 38 FD patients (45.0 ± 14.5 years, 37% male) and 8 healthy controls (40.1 ± 13.7 years, 63% male) underwent 3 T CMR including cine balanced steady-state free precession (bSSFP), LGE and modified Look-Locker Inversion recovery (MOLLI) T1 mapping. Global longitudinal (GLS) and circumferential (GCS) strain and base-to-apex longitudinal strain (LS) and circumferential strain (CS) gradients were derived from cine bSSFP images using feature tracking analysis. Results Among FD patients, 8 had LVH (FD LVH+, 21%) and 17 had LGE (FD LGE+, 45%). Nineteen FD patients (50%) had neither LVH nor LGE (FD LVH- LGE-). None of the healthy controls had LVH or LGE. FD patients and healthy controls did not differ significantly with respect to GLS (− 15.3 ± 3.5% vs. − 16.3 ± 1.5%, p = 0.45), GCS (− 19.4 ± 3.0% vs. -19.5 ± 2.9%, p = 0.84) or base-to-apex LS gradient (7.5 ± 3.8% vs. 9.3 ± 3.5%, p = 0.24). FD patients had significantly lower base-to-apex CS gradient (2.1 ± 3.7% vs. 6.5 ± 2.2%, p = 0.002) and native T1 (1170.2 ± 37.5 ms vs. 1239.0 ± 18.0 ms, p

Published
2019
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17. Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation

Author

Sean Robison, Gauri Rani Karur, Rachel M. Wald, Paaladinesh Thavendiranathan, Andrew M. Crean, and Kate Hanneman

Subjects
Cardiovascular magnetic resonance (CMR), T1 mapping, Extracellular volume (ECV), Noninvasive hemoglobin monitoring, Hematocrit, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Background Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard. Methods One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7® Pulse CO-Oximeter®, Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC). Results There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p = 0.106), with minimal bias and modest precision (bias − 0.18%, 95%CI [− 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [− 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]). Conclusions Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.

Published
2018
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18. Hypertrophic Cardiomyopathy Complicated by Pulmonary Edema in the Postpartum Period

Author

Kate Hanneman, Elsie T. Nguyen, and Andrew M. Crean

Subjects
Medical physics. Medical radiology. Nuclear medicine, R895-920
Abstract

We report the case of a 42-year-old patient with hypertrophic cardiomyopathy (HCM) who presented to the emergency department with severe shortness of breath one week following uneventful cesarean delivery. Thoracic CT ruled out pulmonary embolus and confirmed pulmonary edema. Asymmetric interventricular septal thickening was clearly identified, demonstrating that the heart may be evaluated even on a non-ECG gated study. Acute pulmonary edema in the postpartum period is an unusual clinical presentation of HCM.

Published
2013
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21. Cardiac Link: a retrospective cohort study evaluating a clinical pathway for expedited cardiology referral

Author

Fahmeen J. Afgani, Connor T.A. Brenna, Kate Hanneman, Stephen Holzapfel, Corwin Burton, Paula J. Harvey, and Elsie T. Nguyen

Subjects
Male, Ontario, Chest Pain, Critical Pathways, Cardiology, Humans, Female, Coronary Artery Disease, General Medicine, Middle Aged, Referral and Consultation, Retrospective Studies
Abstract

Outpatients presenting with chest pain often face long wait times for cardiology consultation and subsequent investigation for obstructive coronary artery disease (CAD), during which adverse cardiovascular events may occur. Our objective was to describe the design of Cardiac Link, a coronary computed tomography angiogram (CCTA)-guided rapid-access program, and evaluate its effect on cardiology consultation wait times in patients who present to primary care physicians with stable chest pain.We conducted a retrospective cohort study at Women's College Hospital, Toronto, Ontario, Canada, between 2017 and 2020 involving eligible patients from the Family Practice Health Centre who underwent CCTA after presenting with stable chest pain or equivalent symptoms. Referring primary care physicians decided on a patient-by-patient basis to opt into the Cardiac Link program when requesting CCTA. Our primary outcome was measure of time from CCTA to cardiology consultation, and our secondary outcomes were measures of time to diagnosis from primary care consultation and CCTA booking time.Our analysis included 148 patients (Cardiac LinkWe determined that the Cardiac Link program reduced cardiology consultation wait times for symptomatic patients who were suspected of having CAD. Our study shows the viability of CCTA-guided rapid-access programs to expedite specialist consultation and reduce unnecessary referral for patients presenting to primary care physicians with stable chest pain.

Published
2022

22. Visual Ordinal Scoring of Coronary Artery Calcium on Contrast-Enhanced and Noncontrast Chest CT: A Retrospective Study of Diagnostic Performance and Prognostic Utility

Author

Camila Urzua, Fresno, Felipe Sanchez, Tijmes, Paaladinesh, Thavendiranathan, Shadi, Akhtari, Gauri Rani, Karur, Felipe Soares, Torres, Jaydeep, Halankar, Elsie T, Nguyen, and Kate, Hanneman

Subjects
Male, Contrast Media, Coronary Artery Disease, General Medicine, Middle Aged, Coronary Angiography, Prognosis, Coronary Vessels, Risk Factors, Humans, Calcium, Female, Radiology, Nuclear Medicine and imaging, Tomography, X-Ray Computed, Vascular Calcification, Aged, Retrospective Studies
Published
2022

24. Cardiac Imaging in Myocarditis: Current Evidence and Future Directions

Author

Camila Urzua Fresno, Felipe Sanchez Tijmes, Kirsten E. Shaw, Flora Huang, Paaladinesh Thavendiranathan, Sharmila Khullar, Michael A. Seidman, and Kate Hanneman

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine
Abstract

Myocarditis is defined as a non-ischemic inflammatory disease of the myocardium. It remains a challenge to diagnose given non-specific symptoms and lack of specific blood biomarkers. Cardiac imaging plays an important role in the evaluation of myocarditis with unique strengths and limitations of different imaging modalities, including cardiac magnetic resonance imaging, echocardiography, cardiac computed tomography, and positron emission tomography. The purpose of this review is to discuss the strengths and limitations of various cardiac imaging techniques in the evaluation of myocarditis, review imaging findings in specific causes of myocarditis including COVID-19 and after vaccination, evaluate the role of imaging in differentiating myocarditis from potential mimics and differential considerations, identify current gaps in knowledge, and propose future directions.

Published
2022

25. Statin Use for Primary Cardiovascular Disease Prevention Is Low in Inflammatory Arthritis

Author

Bindee Kuriya, Shadi Akhtari, Mohammad Movahedi, Jacob A. Udell, Patrick R. Lawler, Michael E. Farkouh, Edward C. Keystone, Kate Hanneman, Elsie Nguyen, Paula J. Harvey, and Lihi Eder

Subjects
Male, Canada, Arthritis, Middle Aged, Atherosclerosis, Primary Prevention, Cross-Sectional Studies, Cardiovascular Diseases, Risk Factors, Humans, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine, Apolipoproteins B, Dyslipidemias
Abstract

Patients with inflammatory arthritis (IA) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet management of dyslipidemia is infrequently prioritized. We applied Canadian dyslipidemia guidelines to determine how many patients with IA would be eligible for primary prevention with statins.We conducted a cross-sectional study of patients with IA in a cardio-rheumatology clinic, with no known CVD and without statin therapy at cohort entry. We stratified patients by Framingham Risk Score (FRS) and summarized the proportion meeting guideline statin-indicated criteria. Multivariable logistic regression analyses determined the association of variables with statin indication after adjustment for age, sex, traditional ASCVD risk factors, and arthritis characteristics.Among 302 patients, most had rheumatoid arthritis (59%). Mean age was 58 years, and 71% were female. Overall, 50% of the cohort was eligible for statin therapy. The majority was low FRS risk category (68%), and the most frequent qualifier for statins was elevated apolipoprotein B (ApoB) levels or low-density lipoprotein cholesterol (LDL-c) levels. In the intermediate FRS group, 91% met criteria for statin therapy based on the presence of a coronary artery calcification (CAC) score0 or an elevated high-sensitivity C-reactive protein. Male sex, hypertension, elevated ApoB, and a CAC score0 were the factors most strongly associated with indication for statin therapy.Statin therapy is suboptimal in IA despite a significant number of patients meeting indication based on lipoprotein thresholds or CAC scores. Understanding the barriers and potential facilitators of implementing and interpreting these CVD screening tools in IA is needed.

Published
2022

26. Letter to the Editor: Radiology Action for Climate Change

Author

Jessica R. Leschied, Katherine E. Maturen, Maura Brown, Kate Hanneman, Julia H. Schoen, Beth Zigmund, Benjamin E. Northrup, Jonathan S. Gross, Priya Dave, Sean A. Woolen, Cameron Henry, Cody R. Quirk, Tarek A. Hijaz, Michael E. Zalis, and John R. Scheel

Subjects
Radiology, Nuclear Medicine and imaging
Published
2023

27. Climate Change and Sustainability

Author

Kate Hanneman, Jose Arimateia Batista Araujo-Filho, Cesar Higa Nomura, Jenna Jakubisin, and Linda Moy

Subjects
Radiology, Nuclear Medicine and imaging
Published
2023

29. Statins to prevent early cardiac dysfunction in cancer patients at increased cardiotoxicity risk receiving anthracyclines

Author

Paaladinesh Thavendiranathan, Christian Houbois, Thomas H Marwick, Tiffanie Kei, Sudipta Saha, Kyle Runeckles, Flora Huang, Tamar Shalmon, Kevin E Thorpe, Rossanna C Pezo, Anca Prica, Dawn Maze, Husam Abdel-Qadir, Kim A Connelly, Joyce Chan, Filio Billia, Coleen Power, Kate Hanneman, Bernd J Wintersperger, Christine Brezden-Masley, and Eitan Amir

Subjects
Pharmacology (medical), Cardiology and Cardiovascular Medicine
Abstract

Background and aims Anthracyclines can cause cancer therapy-related cardiac dysfunction (CTRCD). We aimed to assess whether statins prevent decline in left ventricular ejection fraction (LVEF) in anthracycline-treated patients at increased risk for CTRCD. Methods In this multicenter double-blinded, placebo-controlled trial, patients with cancer at increased risk of anthracycline-related CTRCD (per ASCO guidelines) were randomly assigned to atorvastatin 40 mg or placebo once-daily. Cardiovascular magnetic resonance (CMR) imaging was performed before and within 4 weeks after anthracyclines. Blood biomarkers were measured at every cycle. The primary outcome was post-anthracycline LVEF, adjusted for baseline. CTRCD was defined as a fall in LVEF by >10% to Results We randomized 112 patients (56.9 ± 13.6 years, 87 female, and 73 with breast cancer): 54 to atorvastatin and 58 to placebo. Post-anthracycline CMR was performed 22 (13–27) days from last anthracycline dose. Post-anthracycline LVEF did not differ between the atorvastatin and placebo groups (57.3 ± 5.8% and 55.9 ± 7.4%, respectively) when adjusted for baseline LVEF (P = 0.34). There were no significant between-group differences in post-anthracycline LV end-diastolic (P = 0.20) or end-systolic volume (P = 0.12), CMR myocardial edema and/or fibrosis (P = 0.06–0.47), or peak hsTnI (P ≥ 0.99) and BNP (P = 0.23). CTRCD incidence was similar (4% versus 4%, P ≥ 0.99). There was no difference in adverse events. Conclusions In patients at increased risk of CTRCD, primary prevention with atorvastatin during anthracycline therapy did not ameliorate early LVEF decline, LV remodeling, CTRCD, change in serum cardiac biomarkers, or CMR myocardial tissue changes. Trial registration NCT03186404.

Published
2023

30. Comprehensive Cardiovascular Magnetic Resonance Tissue Characterization and Cardiotoxicity in Women With Breast Cancer

Author

Paaladinesh Thavendiranathan, Tamar Shalmon, Chun-Po Steve Fan, Christian Houbois, Eitan Amir, Yobiga Thevakumaran, Emily Somerset, Julia M. Malowany, Camila Urzua-Fresno, Paul Yip, Chris McIntosh, Marshall S. Sussman, Christine Brezden-Masley, Andrew T. Yan, C. Anne Koch, Neil Spiller, Husam Abdel-Qadir, Coleen Power, Kate Hanneman, and Bernd J. Wintersperger

Subjects
Cardiology and Cardiovascular Medicine
Abstract

ImportanceThere is a growing interest in understanding whether cardiovascular magnetic resonance (CMR) myocardial tissue characterization helps identify risk of cancer therapy–related cardiac dysfunction (CTRCD).ObjectiveTo describe changes in CMR tissue biomarkers during breast cancer therapy and their association with CTRCD.Design, Setting, and ParticipantsThis was a prospective, multicenter, cohort study of women with ERBB2 (formerly HER2)–positive breast cancer (stages I-III) who were scheduled to receive anthracycline and trastuzumab therapy with/without adjuvant radiotherapy and surgery. From November 7, 2013, to January 16, 2019, participants were recruited from 3 University of Toronto–affiliated hospitals. Data were analyzed from July 2021 to June 2022.ExposuresSequential therapy with anthracyclines, trastuzumab, and radiation.Main Outcomes and MeasuresCMR, high-sensitivity cardiac troponin I (hs-cTnI), and B-type natriuretic peptide (BNP) measurements were performed before anthracycline treatment, after anthracycline and before trastuzumab treatment, and at 3-month intervals during trastuzumab therapy. CMR included left ventricular (LV) volumes, LV ejection fraction (EF), myocardial strain, early gadolinium enhancement imaging to assess hyperemia (inflammation marker), native/postcontrast T1 mapping (with extracellular volume fraction [ECV]) to assess edema and/or fibrosis, T2 mapping to assess edema, and late gadolinium enhancement (LGE) to assess replacement fibrosis. CTRCD was defined using the Cardiac Review and Evaluation Committee criteria. Fixed-effects models or generalized estimating equations were used in analyses.ResultsOf 136 women (mean [SD] age, 51.1 [9.2] years) recruited from 2013 to 2019, 37 (27%) developed CTRCD. Compared with baseline, tissue biomarkers of myocardial hyperemia and edema peaked after anthracycline therapy or 3 months after trastuzumab initiation as demonstrated by an increase in mean (SD) relative myocardial enhancement (baseline, 46.3% [16.8%] to peak, 56.2% [18.6%]), native T1 (1012 [26] milliseconds to 1035 [28] milliseconds), T2 (51.4 [2.2] milliseconds to 52.6 [2.2] milliseconds), and ECV (25.2% [2.4%] to 26.8% [2.7%]), with P Conclusions and RelevanceIn women with ERBB2-positive breast cancer receiving sequential anthracycline and trastuzumab therapy, CMR tissue biomarkers suggest inflammation and edema peaking early during therapy and were associated with ventricular remodeling and BNP elevation. However, the increases in CMR biomarkers were transient, were not associated with LVEF or myocardial strain, and were not useful in identifying traditional CTRCD risk.

Published
2023

31. Cardiovascular Considerations in the Management of People With Suspected Long COVID

Author

Kieran L. Quinn, Grace Y. Lam, Jillian F. Walsh, Anne Bhéreur, Adam D. Brown, Chung Wai Chow, Kit Yan Christie Chung, Juthaporn Cowan, Noah Crampton, Simon Décary, Emilia L. Falcone, Lorraine Graves, Douglas P. Gross, Kate Hanneman, Paula J. Harvey, Sheila Holmes, Gabrielle M. Katz, Parinaz Parhizgar, Abdu Sharkawy, Karen C. Tran, Susan Waserman, Vanessa E. Zannella, and Angela M. Cheung

Subjects
Cardiology and Cardiovascular Medicine
Published
2023

34. NASCI young investigator awards 2022

Author

Stefan L, Zimmerman, Kate, Hanneman, Quynh A, Truong, Phillip M, Young, and Gregory A, Kicska

Abstract

Each year, the North American Society of Cardiovascular Imaging (NASCI) selects the Young Investigator Awards, which are amongst the top abstracts presented at the NASCI annual meeting. All residents, postdoctoral students, medical students and fellows are eligible for these awards.The International Journal of Cardiovascular Imaging proudly publishes the following abstracts from the fnalists that were presented in full at the Annual Meeting in Cleveland, Ohio on September 10-13, 2022.The 2023 Meeting will be held on September 9-12 in Scottsdale, Arizona. Learn more at https://www.nasci.org/future-meetings .For information about NASCI, and to register to attend the annual meeting, go to www.nasci.org .

Published
2022

36. Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) in Uncomplicated Type B Aortic Dissection: Study Design and Rationale

Author

Domenico Mastrodicasa, Martin J. Willemink, Valery L. Turner, Virginia Hinostroza, Marina Codari, Kate Hanneman, Maral Ouzounian, Daniel Ocazionez Trujillo, Rana O. Afifi, Sandeep Hedgire, Nicholas S. Burris, Bo Yang, Joan M. Lacomis, Thomas G. Gleason, Davide Pacini, Gianluca Folesani, Luigi Lovato, Ricarda Hinzpeter, Hatem Alkadhi, Arthur E. Stillman, Edward P. Chen, Sander M. J. van Kuijk, Geert W. H. Schurink, Anna M. Sailer, Kathrin Bäumler, D. Craig Miller, Michael P. Fischbein, Dominik Fleischmann, Epidemiologie, MUMC+: KIO Kemta (9), MUMC+: MA Vaatchirurgie CVC (3), Vascular Surgery, RS: Carim - V03 Regenerative and reconstructive medicine vascular disease, University of Zurich, and Fleischmann, Dominik

Subjects
10042 Clinic for Diagnostic and Interventional Radiology, 2741 Radiology, Nuclear Medicine and Imaging, Radiology, Nuclear Medicine and imaging, 610 Medicine & health, Original Research
Abstract

PURPOSE: To describe the design and methodological approach of a multicenter, retrospective study to externally validate a clinical and imaging-based model for predicting the risk of late adverse events in patients with initially uncomplicated type B aortic dissection (uTBAD).MATERIALS AND METHODS: The Registry of Aortic Diseases to Model Adverse Events and Progression (ROADMAP) is a collaboration between 10 academic aortic centers in North America and Europe. Two centers have previously developed and internally validated a recently developed risk prediction model. Clinical and imaging data from eight ROADMAP centers will be used for external validation. Patients with uTBAD who survived the initial hospitalization between January 1, 2001, and December 31, 2013, with follow-up until 2020, will be retrospectively identified. Clinical and imaging data from the index hospitalization and all follow-up encounters will be collected at each center and transferred to the coordinating center for analysis. Baseline and follow-up CT scans will be evaluated by cardiovascular imaging experts using a standardized technique.RESULTS: The primary end point is the occurrence of late adverse events, defined as aneurysm formation (≥6 cm), rapid expansion of the aorta (≥1 cm/y), fatal or nonfatal aortic rupture, new refractory pain, uncontrollable hypertension, and organ or limb malperfusion. The previously derived multivariable model will be externally validated by using Cox proportional hazards regression modeling.CONCLUSION: This study will show whether a recent clinical and imaging-based risk prediction model for patients with uTBAD can be generalized to a larger population, which is an important step toward individualized risk stratification and therapy.Keywords: CT Angiography, Vascular, Aorta, Dissection, Outcomes Analysis, Aortic Dissection, MRI, TEVAR© RSNA, 2022See also the commentary by Rajiah in this issue.

Published
2022

38. Association of Thoracic Computed Tomographic Measurements and Outcomes in Patients with Hematologic Malignancies Requiring Mechanical Ventilation

Author

Ewan C. Goligher, Laveena Munshi, Michael E Detsky, Dmitry Rozenberg, Michael C. Sklar, Bruno L. Ferreyro, Kate Hanneman, Sangeeta Mehta, Michael D. Elfassy, Santhosh Thyagu, Sunita Mathur, Anca Prica, and Sophia Kerzner

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, medicine.medical_treatment, Computed tomography, Subcutaneous fat, Computed tomographic, 03 medical and health sciences, 0302 clinical medicine, medicine, Hematologic malignancy, Humans, In patient, Acute respiratory failure, Letters, 030212 general & internal medicine, Mechanical ventilation, medicine.diagnostic_test, business.industry, Middle Aged, Respiration, Artificial, Intensive Care Units, 030228 respiratory system, Hematologic Neoplasms, Body Composition, Female, Radiology, Tomography, X-Ray Computed, business
Abstract

Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes.Objectives: We aimed to determine whether body composition characteris...

Published
2021

39. Association of Pectus Excavatum With Ventricular Remodelling and Mitral Valve Abnormalities in Marfan Syndrome

Author

Dalia Abdulmonem L Hashem, Victor Siang Hua Chan, Kate Hanneman, Rachel M. Wald, Paaladinesh Thavendiranathan, Maral Ouzounian, Erwin Oechslin, and Gauri R. Karur

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine
Abstract

Background: Marfan syndrome (MFS) is an inherited connective tissue disorder. Pectus excavatum (PEX) is common in MFS. The purpose was to evaluate the association of PEX with cardiovascular manifestations of MFS, biventricular size and function. Methods: MFS adults undergoing cardiac MRI were retrospectively evaluated. Exclusion criteria were incomplete cardiac MRI, significant artifacts, co-existent ischaemic or congenital heart disease. Haller Index (HI) ≥3.25 classified patients as PEX positive (PEX+) and PEX negative (PEX−). Cardiac MRI analysis included assessment of mitral valve prolapse (MVP), mitral annular disjunction (MAD), biventricular volumetry and aortic dimensions. Results: 212 MFS patients were included, 76 PEX+ and 136 PEX− (HI 8.3 ± 15.2 vs 2.3 ± 0.5, P < .001). PEX+ were younger (33.4 ± 12.0 vs 38.1 ± 14.3 years, P = .02) and similar in sex distribution (55% vs 63% male, P = .26) compared to PEX−. MVP and MAD were more frequent in PEX+ vs PEX− (43/76 [57%] vs 37/136 [27%], P < .001; 44/76 [58%] vs 50/136[37%], P = .003, respectively). PEX+ had higher right ventricular end-diastolic and end-systolic volumes (RVEDVi 92 ± 17mL/m2 vs 84 ± 22mL/m2, P = .04; RVESVi 44 ± 10 mL/m2 vs 39 ± 14 mL/m2, P = .02), lower RV ejection fraction (RVEF 52 ± 5% vs 55 ± 6%, P = .01) compared to PEX−. Left ventricular (LV) volumes, LVEF and aortic dimensions were similar. Conclusion: MFS adults with PEX have higher frequency of cardiac manifestations including MV abnormalities, increased RV volumes and lower RVEF compared to those without PEX. Awareness of this association is important for all radiologists who interpret aortic CT or MRI, where HI can be easily measured. PEX in MFS may suggest more severe disease expression necessitating careful screening for MV abnormalities and outcomes surveillance.

Published
2022

40. Myocarditis Following COVID-19 Vaccination

Author

Constantin A. Marschner, Kirsten E. Shaw, Felipe Sanchez Tijmes, Matteo Fronza, Sharmila Khullar, Michael A. Seidman, Paaladinesh Thavendiranathan, Jacob A. Udell, Rachel M. Wald, and Kate Hanneman

Subjects
Male, Myocarditis, Young Adult, COVID-19 Vaccines, Adolescent, Incidence, Vaccination, COVID-19, Humans, General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Myocarditis is an established but rare adverse event following administration of messenger RNA-based coronavirus disease 2019 (COVID-19) vaccines and is most common in male adolescents and young adults. Symptoms typically develop within a few days of vaccine administration. Most patients have mild abnormalities on cardiac imaging with rapid clinical improvement with standard treatment. However, longer term follow-up is needed to determine whether imaging abnormalities persist, to evaluate for adverse outcomes, and to understand the risk associated with subsequent vaccination. The purpose of the review is to evaluate the current literature related to myocarditis following COVID-19 vaccination, including the incidence, risk factors, clinical course, imaging findings, and proposed pathophysiologic mechanisms.

Published
2022

41. Clinical Impact of Cardiac MRI T1 and T2 Parametric Mapping in Patients with Suspected Cardiomyopathy

Author

William Warnica, Amna Al-Arnawoot, Aleksandra Stanimirovic, Paaladinesh Thavendiranathan, Rachel M. Wald, Mini Pakkal, Gauri Rani Karur, Bernd J. Wintersperger, Valeria Rac, and Kate Hanneman

Subjects
Male, Radiography, Myocarditis, Humans, Radiology, Nuclear Medicine and imaging, Heart, Middle Aged, Magnetic Resonance Imaging, Retrospective Studies
Abstract

Background There are limited data on the incremental value of parametric mapping compared with core cardiac MRI protocols for suspected cardiomyopathy in routine clinical practice. Purpose To evaluate the impact of cardiac MRI T1 and T2 mapping in routine clinical practice with respect to diagnostic accuracy, reader diagnostic confidence, and downstream cardiac imaging utilization. Materials and Methods In this retrospective single-center study, consecutive clinical cardiac MRI scans obtained with and without T1 and T2 mapping for evaluation of suspected cardiomyopathy between January 2017 and October 2019 were evaluated. Diagnostic accuracy and reader diagnostic confidence were evaluated in a random subset. Downstream cardiac imaging utilization was analyzed in patients with a minimum of 1 year of clinical follow-up ending before January 2020. Results A total of 1876 patients (mean age, 51 years ± 17 [SD]; 1113 men) were evaluated. Of these, 751 (40%) underwent cardiac MRI with the core protocol and 1125 (60%) with the core protocol plus T1 and T2 mapping. In the mapping group, T1 and T2 were high in 280 (25%) and 47 patients (4%), respectively. In the subset evaluated for diagnostic utility (

Published
2022

42. Disparities in Radiologist Fee-For-Service Payments by Gender in Canada

Author

Hayley McKee, Cynthia Walsh, Mana Modares, Wan Wan Yap, Natalia Gorelik, Maura Brown, Charlotte J Yong-Hing, and Kate Hanneman

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine
Abstract

Objective: To examine differences in fee-for-service (FFS) payments to men and women radiologists in Canada and evaluate potential contributors. Methods: Publicly available FFS radiology billing data was analyzed from British Columbia (BC), Ontario (ON), Prince-Edward Island (PEI) and Nova Scotia (NS) between 2017 and 2021. Data was analyzed by gender on a per-province and national level. Variables evaluated included year, province, procedure billings, and days worked (BC and ON only). The gender pay gap was expressed as the difference in mean billing payments between men and women divided by mean payments to men. Results: Data points from 8478 radiologist years were included (2474 [29%] women and 6004 [71%] men). The unadjusted difference in annual FFS billings between men and women was $126,657. Overall, payments to women were 81% of payments to men with a 19% gender pay gap. The difference in billings between men and women did not change significantly between 2017 and 2021 (range in gender pay gap, 17–21%) but did vary by province (highest gap NS). Compared to men, women worked fewer days per year (weighted mean 218 ± 29 vs 236 ± 25 days/year, P < .001, 8% difference). Conclusion: In an analysis of fee-for-service payments to radiologists in 4 Canadian provinces between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap. Payments were lower to women across all years evaluated. Women worked 8% fewer days per year on average than men, which did not fully account for the difference in FFS billing payments between men and women. Summary Statement: In an analysis of fee-for-service payments to Canadian radiologists between 2017 and 2021, payments to women were 81% of payments to men with a 19% gender pay gap which is not fully accounted for by time spent working.

Published
2023

43. 2021 Update on Safety of Magnetic Resonance Imaging: Joint Statement From Canadian Cardiovascular Society/Canadian Society for Cardiovascular Magnetic Resonance/Canadian Heart Rhythm Society

Author

Christine Villemaire, James A. White, Matthew T. James, D. Ian Paterson, Michael D. Hill, Secondary Panel, Laurence D. Sterns, Kate Hanneman, Douglas Wan, Atul Verma, Carmen Lydell, Jonathan Windram, Craig Butler, Idan Roifman, Anish Kirpalani, Primary Panel, L. Grosse-Wortmann, Rachel M. Wald, Kim A. Connelly, Jonathon Leipsic, Andrew M. Crean, Elsie T Nguyen, Jaimie Manlucu, Bradley Sarak, Roopinder K. Sandhu, and Peter G. Guerra

Subjects
Canada, Pacemaker, Artificial, medicine.medical_specialty, MEDLINE, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Clinical Protocols, Inventions, medicine, Humans, In patient, 030212 general & internal medicine, Practice Patterns, Physicians', Intensive care medicine, medicine.diagnostic_test, business.industry, Magnetic resonance imaging, Canadian Cardiovascular Society, Image Enhancement, medicine.disease, Magnetic Resonance Imaging, Quality Improvement, Defibrillators, Implantable, Structure and function, Heart Rhythm, Safety profile, Cardiovascular Diseases, Nephrogenic systemic fibrosis, Risk Adjustment, Patient Safety, Cardiology and Cardiovascular Medicine, business
Abstract

Magnetic resonance imaging (MRI) is often considered the gold-standard test for characterizing cardiac as well as noncardiac structure and function. However, many patients with cardiac implantable electronic devices (CIEDs) and/or severe renal dysfunction are unable to undergo this test because of safety concerns. In the past 10 years, newer-generation CIEDs and gadolinium-based contrast agents (GBCAs) as well as coordinated care between imaging and heart rhythm device teams have mitigated risk to patients and improved access to MRI at many hospitals. The purpose of this statement is to review published data on safety of MRI in patients with conditional and nonconditional CIEDs in addition to patient risks from older and newer GBCAs. This statement was developed through multidisciplinary collaboration of pan-Canadian experts after a relevant and independent literature search by the Canadian Agency for Drugs and Technologies in Health. All recommendations align with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Key recommendations include: (1) the development of standardized protocols for patients with a CIED undergoing MRI; (2) patients with MRI nonconditional pacemakers and pacemaker dependency should be programmed to asynchronous mode and those with MRI nonconditional transvenous defibrillators should have tachycardia therapies turned off during the scan; and (3) macrocyclic or newer linear GBCAs should be used in preference to older GBCAs because of their better safety profile in patients at higher risk of nephrogenic systemic fibrosis.

Published
2021

44. The impact of pulmonary valve replacement on pregnancy outcomes in women with tetralogy of Fallot

Author

Valeria E. Duarte, Kate Hanneman, Tal Geva, Rachel M. Wald, Kenichiro Yamamura, Anne Marie Valente, Julia A. Graf, and Gauri R. Karur

Subjects
medicine.medical_specialty, Population, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Pulmonary Valve Replacement, Internal medicine, medicine, Humans, 030212 general & internal medicine, education, Retrospective Studies, Tetralogy of Fallot, Heart Valve Prosthesis Implantation, Pulmonary Valve, Fetus, education.field_of_study, Ejection fraction, medicine.diagnostic_test, business.industry, Infant, Newborn, Pregnancy Outcome, Magnetic resonance imaging, medicine.disease, Pulmonary Valve Insufficiency, eye diseases, 3. Good health, Treatment Outcome, Cohort, Ventricular Function, Right, Cardiology, Female, sense organs, Cardiology and Cardiovascular Medicine, business
Abstract

Background Pregnant women with repaired tetralogy of Fallot (rTOF) are at increased risk of adverse outcomes. Although pre-pregnancy pulmonary valve replacement (PVR) may be considered in some women to attenuate risk, published data to support this practice are lacking. Our objective was to explore the impact of pre-pregnancy PVR on pregnancy outcomes in rTOF. Methods Women with rTOF and cardiovascular magnetic resonance imaging (CMR) before and after pregnancy were included if CMR studies were completed within 3 years of pregnancy. Subjects were compared according to presence (+) or absence (−) of PVR at pre-pregnancy CMR. Pregnancy outcomes (cardiovascular, obstetric, and fetal/neonatal) were documented. Results Of the 29 study women identified, 7 were PVR+ and 22 were PVR-. Post-pregnancy, the PVR- group demonstrated interval increase in indexed right ventricular end-diastolic volumes (RVEDVi) (157 ± 28 versus 166 ± 33 ml/m2, p = 0.003) and end-systolic volumes (RVESVi) (82 ± 17 versus 89 ± 20 ml/m2, p = 0.003) as compared with pre-pregnancy, but no significant change in RV ejection fraction, RV mass, or left ventricular measurements. In the PVR+ group, there were no interval changes in RV measurements pre-versus post pregnancy. Interval rate of change in RVESVi of PVR- exceeded PVR+ women (+3.7 ± 5.0 versus −2.2 ± 5.0 ml/m2/year, p = 0.03). Pregnancy outcomes did not differ in PVR+ versus PVR- women. Conclusions Pregnancy outcomes did not differ according to PVR status in our cohort. While RV volumes remained unchanged in PVR+ women, interval RV dilation was observed in PVR- women. Additional study of a larger population with longer follow-up may further inform clinical practice regarding pre-pregnancy PVR.

Published
2021

45. ACR Appropriateness Criteria® Nonischemic Myocardial Disease with Clinical Manifestations (Ischemic Cardiomyopathy Already Excluded)

Author

Todd C. Villines, Jacobo Kirsch, Daniel C. Lee, Joao R. Inacio, Kate Hanneman, Prabhakar Rajiah, Christopher J. François, Amer M. Johri, Mauricio S Galizia, Juan C Batlle, Suhny Abbara, Richard K J Brown, Satinder Singh, Stefan L. Zimmerman, Samuel Wann, and Michael A. Bolen

Subjects
medicine.medical_specialty, Ischemic cardiomyopathy, business.industry, Ischemia, Cardiomyopathy, Restrictive cardiomyopathy, Hypertrophic cardiomyopathy, Dilated cardiomyopathy, Myocardial Disorder, medicine.disease, Appropriate Use Criteria, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, 030220 oncology & carcinogenesis, Internal medicine, medicine, Cardiology, Radiology, Nuclear Medicine and imaging, business
Abstract

Nonischemic cardiomyopathies encompass a broad spectrum of myocardial disorders with mechanical or electrical dysfunction without evidence of ischemia. There are five broad variants of nonischemic cardiomyopathies; hypertrophic cardiomyopathy (Variant 1), restrictive or infiltrative cardiomyopathy (Variant 2), dilated or unclassified cardiomyopathy (Variant 3), arrhythmogenic cardiomyopathy (Variant 4), and inflammatory cardiomyopathy (Variant 5). For variants 1, 3, and 4, resting transthoracic echocardiography, MRI heart function and morphology without and with contrast, and MRI heart function and morphology without contrast are the usually appropriate imaging modalities. For variants 2 and 5, resting transthoracic echocardiography and MRI heart function and morphology without and with contrast are the usually appropriate imaging modalities. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Published
2021

46. Progression of Myocardial Fibrosis in Hypertrophic Cardiomyopathy

Author

Raymond H. Chan, Barry J. Maron, Harry Rakowski, Kimia Fardfini, Arnon Adler, Manhal Habib, Kate Hanneman, Martin S. Maron, Sara Hoss, and Ethan J. Rowin

Subjects
medicine.medical_specialty, business.industry, Hypertrophic cardiomyopathy, Patient characteristics, 030204 cardiovascular system & hematology, medicine.disease, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, 0302 clinical medicine, Fibrosis, Internal medicine, Heart failure, cardiovascular system, Cardiology, Medicine, Late gadolinium enhancement, Radiology, Nuclear Medicine and imaging, Myocardial fibrosis, In patient, cardiovascular diseases, Cardiology and Cardiovascular Medicine, business, Cardiac magnetic resonance
Abstract

Objectives This study examined fibrosis progression in hypertrophic cardiomyopathy (HCM) patients, as well as its relationship to patient characteristics, clinical outcomes, and its effect on clinical decision making. Background Myocardial fibrosis, as quantified by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR), provides valuable prognostic information in patients with HCM. Methods A total of 157 patients with HCM were enrolled in this study, with 2 sequential CMR scans separated by an interval of 4.7 ± 1.9 years. Results At the first CMR session (CMR-1), 70% of patients had LGE compared with 85% at CMR-2 (p = 0.001). The extent of LGE extent increased between the 2 CMR procedures, from 4.0 ± 5.6% to 6.3 ± 7.4% (p 8% of LV mass, indexed LV mass >100 g/m2, maximal wall thickness ≥20 mm, LVEF ≤60%, and apical aneurysm. There was a significant correlation between the magnitude of LGE progression and future implantation of insertable cardioverter-defibrillators (p = 0.004), EF deterioration to ≤50% (p Conclusions Myocardial fibrosis in patients with HCM is a slowly progressive process. Progression of LGE is significantly correlated with a number of clinical outcomes such as progression to EF ≤50% and heart failure admission. Judicious use of serial CMR with LGE can provide valuable information to help patient management.

Published
2021

47. Inter-observer variability of expert-derived morphologic risk predictors in aortic dissection

Author

Martin J. Willemink, Domenico Mastrodicasa, Mohammad H. Madani, Marina Codari, Leonid L. Chepelev, Gabriel Mistelbauer, Kate Hanneman, Maral Ouzounian, Daniel Ocazionez, Rana O. Afifi, Joan M. Lacomis, Luigi Lovato, Davide Pacini, Gianluca Folesani, Ricarda Hinzpeter, Hatem Alkadhi, Arthur E. Stillman, Anna M. Sailer, Valery L. Turner, Virginia Hinostroza, Kathrin Bäumler, Anne S. Chin, Nicholas S. Burris, D. Craig Miller, Michael P. Fischbein, and Dominik Fleischmann

Subjects
Radiology, Nuclear Medicine and imaging, General Medicine, Article
Abstract

Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning.Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow. A second inter-observer variability assessment on 30 out of the 47 CTA scans compared observers 3 and 4 with a constrained, standardized workflow. A third inter-observer variability assessment was done after specialized training and tested between observers 3 and 4 in an external population of 25 CTA scans. Inter-observer agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots.Pre-training ICCs of the four morphologic features ranged from 0.04 (-0.05 to 0.13) to 0.68 (0.49-0.81) between observer 1 and observers 2-4 and from 0.50 (0.32-0.69) to 0.89 (0.78-0.95) between observers 3 and 4. ICCs improved after training ranging from 0.69 (0.52-0.87) to 0.97 (0.94-0.99), and Bland-Altman analysis showed decreased bias and limits of agreement.Manual morphologic feature measurements on CTA images can be optimized resulting in improved inter-observer reliability. This is essential for robust ground-truth determination for machine learning models.• Clinical fashion manual measurements of aortic CTA imaging features showed poor inter-observer reproducibility. • A standardized workflow with standardized training resulted in substantial improvements with excellent inter-observer reproducibility. • Robust ground truth labels obtained manually with excellent inter-observer reproducibility are key to develop reliable machine learning models.

Published
2022

48. Worldwide Disparities in Recovery of Cardiac Testing 1 Year Into COVID-19

Author

Andrew J. Einstein, Cole Hirschfeld, Michelle C. Williams, Joao V. Vitola, Nathan Better, Todd C. Villines, Rodrigo Cerci, Leslee J. Shaw, Andrew D. Choi, Sharmila Dorbala, Ganesan Karthikeyan, Bin Lu, Valentin Sinitsyn, Alexey A. Ansheles, Takashi Kudo, Chiara Bucciarelli-Ducci, Bjarne Linde Nørgaard, Pál Maurovich-Horvat, Roxana Campisi, Elisa Milan, Lizette Louw, Adel H. Allam, Mona Bhatia, Lorenzo Sewanan, Eli Malkovskiy, Yosef Cohen, Michael Randazzo, Jagat Narula, Olga Morozova, Thomas N.B. Pascual, Yaroslav Pynda, Maurizio Dondi, Diana Paez, Gerd Hinterleitner, Yao Lu, Zhuoran Xu, Cole B. Hirschfeld, Ikenna Erinne, Mrinali Shetty, Andrew Choi, Juan Lopez-Mattei, Purvi Parwani, Artan Goda, Ervina Shirka, Salah Bouyoucef, Lydia Chelghoum, Farouk Mansouri, Abdelkader Medjahedi, Qais Naili, Mokhtar Ridouh, Diego Alasia, Lucia Alberghina, Natalia Aramayo, Diego Buchara, Franco Gabriel Busso, Jose Javier Bustos Rivadero, Jorge Camilletti, Hugo Campanelli, Ricardo Belisario Castro, Mariana Daicz, Horacio del Riego, Laura Dragonetti, Diego Echazarreta, Juan Erriest, Fernando Faccio, Adolfo Facello, Hugo Gallegos, Ricardo Geronazzo, Horacio Glait, Victor Hasbani, Victor Jäger, Julio Manuel Lewkowicz, Jose Lotti, Neiva Maciel, Osvaldo Masoli, Edgardo Mastrovito, Maria Medus, Maria Fernanda Merani, Susana Molteni, Marcos Montecinos, Gustavo Parisi, Claudio Pereyra Sueldo, Diego Perez de Arenaza, Luis Quintana, Alejandro Radzinschi, Marcela Redruello, Marina Rodríguez, Horacio Rojas, Arturo Romero Acuña, Daniel Schere, Sonia Traverso, Gustavo Vazquez, Susana Zeffiro, Mari Sakanyan, Scott Beuzeville, Raef Boktor, Michael Crowley, D'Arne Downie, Girish Dwivedi, Barry Elison, Omar Farouque, Kim Jasper, Subodh Joshi, Joseph Lee, Kenneth Lee, Elaine Lui, Peter Mcconachie, Joanne Meaker, Dee Nandurkar, Johanne Neill, Edward O'Rourke, Patricia O'Sullivan, George Pandos, Manuja Premaratne, David Prior, Natalie Rutherford, Connor Saunders, Kim Taubman, Andrew Tauro, Andrew Taylor, James Theuerle, Paul Thomas, Jonathan Tow, Anthony Upton, Shankar Vamadevan, Victor Wayne, Eva Alina Wegner, David Wong, John Younger, Dietrich Beitzke, Gudrun Feuchtner, Oliver Sommer, Konrad Weiss, Natallia Maroz-Vadalazhskaya, Uladzimir Tserakhau, Filip Homans, Caroline M. Van De Heyning, Raúl Araujo, Valentina Soldat-Stankovic, Sinisa Stankovic, Augusto Almeida, Carlos Anselmi, Guilherme S.A. 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Strickland, Suliman Suliman, Naghmeh Tebyanian, Dustin Thomas, Randall Thompson, Seth Uretsky, Srikanth Vallurupalli, Marian Vandyck-Acquah, Vikas Verma, Todd Villines, Joseph Weinstein, David Wolinsky, Karolina Zareba, Michael Zgaljardic, Mario Beretta, Rodolfo Ferrando, Miguel Kapitan, Fernando Mut, Omoa Djuraev, Gulnora Rozikhodjaeva, Luisa Vera, Binh Duong Duc, Xuan Canh Nguyen, Phuoc Minh Hiep Nguyen, Translational Immunology Groningen (TRIGR), Cardiovascular Centre (CVC), ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Molecular Pharmacology, Drug Design, Einstein, A, Hirschfeld, C, Williams, M, Vitola, J, Better, N, Villines, T, Cerci, R, Shaw, L, Choi, A, Dorbala, S, Karthikeyan, G, Lu, B, Sinitsyn, V, Ansheles, A, Kudo, T, Bucciarelli-Ducci, C, Norgaard, B, Maurovich-Horvat, P, Campisi, R, Milan, E, Louw, L, Allam, A, Bhatia, M, Sewanan, L, Malkovskiy, E, Cohen, Y, Randazzo, M, Narula, J, Morozova, O, Pascual, T, Pynda, Y, Dondi, M, 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Rutherford, N, Saunders, C, Taubman, K, Tauro, A, Taylor, A, Theuerle, J, Thomas, P, Tow, J, Upton, A, Vamadevan, S, Wayne, V, Wegner, E, Wong, D, Younger, J, Beitzke, D, Feuchtner, G, Sommer, O, Weiss, K, Maroz-Vadalazhskaya, N, Tserakhau, U, Homans, F, Van De Heyning, C, Araujo, R, Soldat-Stankovic, V, Stankovic, S, Almeida, A, Anselmi, C, Azevedo, G, Bittencourt, M, Pianta, D, Cabeda, E, Carreira, L, Coelho, I, de Amorim Fernandes, F, de Lorenzo, A, Delgado, R, Erthal, F, Fernandes, F, Fernandes, J, Ferreira de Souza, T, Foppa, M, Matos Alves, W, Gontijo, C, Gottlieb, I, Grossman, G, Albernaz Siqueira, M, Nomura, C, Koga, K, Lima, R, Lopes, R, Marcal Filho, H, Masiero, P, Mastrocola, L, Menezes de Siqueira, M, Mesquita, C, Naves, D, Penna, F, Pinto, I, Rocha, T, Rocha, J, Rodrigues, A, Salioni, L, Sanches, A, Santos, M, Da Silva, L, Schvartzman, P, Matushita, C, Senra, T, Silva, M, Soares, C, Spiro, B, Suaide Silva, C, Torres, R, Monte, G, Vilela, A, Villa, A, Voss, T, Waltrick, R, 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Sewanan, Lorenzo, Malkovskiy, Eli, Cohen, Yosef, Randazzo, Michael, Narula, Jagat, Morozova, Olga, Pascual, Thomas N B, Pynda, Yaroslav, Dondi, Maurizio, Paez, Diana, and Cuocolo, Alberto

Subjects
cardiac testing, Health Personnel, delivery of health care, coronavirus, COVID-19, global health, 610 Medicine & health, cardiovascular disease, health personnel, humans, pandemics, surveys and questionnaires, coronaviru, Surveys and Questionnaires, Humans, Cardiology and Cardiovascular Medicine, Delivery of Health Care, Pandemics, COVID-19/epidemiology
Abstract

BACKGROUND: The extent to which health care systems have adapted to the COVID-19 pandemic to provide necessary cardiac diagnostic services is unknown.OBJECTIVES: The aim of this study was to determine the impact of the pandemic on cardiac testing practices, volumes and types of diagnostic services, and perceived psychological stress to health care providers worldwide.METHODS: The International Atomic Energy Agency conducted a worldwide survey assessing alterations from baseline in cardiovascular diagnostic care at the pandemic's onset and 1 year later. Multivariable regression was used to determine factors associated with procedure volume recovery.RESULTS: Surveys were submitted from 669 centers in 107 countries. Worldwide reduction in cardiac procedure volumes of 64% from March 2019 to April 2020 recovered by April 2021 in high- and upper middle-income countries (recovery rates of 108% and 99%) but remained depressed in lower middle- and low-income countries (46% and 30% recovery). Although stress testing was used 12% less frequently in 2021 than in 2019, coronary computed tomographic angiography was used 14% more, a trend also seen for other advanced cardiac imaging modalities (positron emission tomography and magnetic resonance; 22%-25% increases). Pandemic-related psychological stress was estimated to have affected nearly 40% of staff, impacting patient care at 78% of sites. In multivariable regression, only lower-income status and physicians' psychological stress were significant in predicting recovery of cardiac testing.CONCLUSIONS: Cardiac diagnostic testing has yet to recover to prepandemic levels in lower-income countries. Worldwide, the decrease in standard stress testing is offset by greater use of advanced cardiac imaging modalities. Pandemic-related psychological stress among providers is widespread and associated with poor recovery of cardiac testing.

Published
2022

50. Abstract 111: Multiparametric Circulating Cardiovascular Biomarkers Elucidate A Molecular Signature Of Coronavirus Disease 2019 Mortality And Identify Vascular Barrier Stabilizing Therapies

Author

Dakota Gustafson, Michelle Ngai, Ruilin Wu, Huayun Hou, Clara Erice, Michael Wilson, Kevin Kain, Kate Hanneman, Paaladinesh Thavendiranathan, Jason Fish, and Kathryn Howe

Subjects
Cardiology and Cardiovascular Medicine
Abstract

Background: Endothelial cell (EC) activation, endotheliitis, vascular permeability, and thrombosis have been observed in patients with severe COVID-19, indicating that the vasculature is affected during the acute stages of SARS-CoV-2 infection. It remains unknown whether circulating vascular markers are sufficient to predict clinical outcomes, unique to COVID-19 related pathology, and if vascular permeability can be therapeutically targeted. Methods: This is a secondary analysis of a prospectively recruited longitudinal multicenter cohort study enrolling 241 patients with suspected SARS-CoV-2 infection. The prevalence of circulating inflammatory, cardiac, EC activation, and the entirety of the microRNA transcriptome was evaluated, and the prognostic value assessed using a Random Forest model machine learning approach. Ex vivo experiments were performed to assess EC permeability responses to patient plasma and to derive modulated gene regulatory networks from which rational therapeutic selection could be inferred. Results: Multiple inflammatory and EC activation biomarkers were associated with mortality in COVID-19 patients and in severity-matched SARS-CoV-2-negative patients. In contrast, dysregulation of particular microRNAs at presentation was specific for poor COVID-19-related outcomes and revealed disease-relevant pathways. Integrating datasets (i.e., clinical, protein, and microRNA) using a machine learning approach further enhanced clinical risk prediction for in-hospital mortality. Exposure of ECs to COVID-19 patient plasma resulted in severity-specific gene expression responses and EC barrier dysfunction. ECs treated with patient plasma showed increased vascular permeability, which was ameliorated by treatment with the vascular stabilizing molecules angiopoietin-1 mimetic or recombinant Slit2-N, but not nangibotide or dexamethasone. Conclusions: Integration of multi-omics data identified microRNA and vascular biomarkers prognostic of in-hospital mortality in COVID-19 patients and revealed that vascular stabilizing therapies should be explored as a treatment for endothelial dysfunction in COVID-19, and other severe diseases where endothelial dysfunction has a central role in pathogenesis.

Published
2022

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