216 results on '"Pier Giorgio Masci"'
Search Results
2. Prognostic Value of Cardiovascular Magnetic Resonance in Aortic Regurgitation: A Network Meta-analysis
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Georgios Georgiopoulos, MD, PhD, MSc, Kamil Stankowski, MD, Silvana Di Maio, MD, Stefano Figliozzi, MD, and Pier Giorgio Masci, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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3. Prevalence and Clinical Significance of Mitral Annulus Disjunction in a Large Cohort of Consecutive Patients Undergoing Cardiovascular Magnetic Resonance
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Stefano Figliozzi, MD, Kamil Stankowski, MD, Costanza Lisi, MD, Mauro Gitto, MD, Marzia Olivieri, MD, Elena Locatelli, Federica Catapano, MD, Lara Tondi, MD, Francesco Cannata, MD, Fabio Fazzari, MD, Renato M Bragato, MD, Georgios Georgiopoulos, MD, PhD, MSc, Pier Giorgio Masci, MD, Lorenzo Monti, MD, Gianluigi Condorelli, MD, PhD, and Marco Francone, MD, PhD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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4. Acute Marginal Losses: An Interesting Case of Isolated Right Ventricular Myocardial Infarction
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Michelle Swinburne, BSc, Richard Crawley, MD, BSc, Hadeer Hasaneen, MSc, MB, Amedeo Chiribiri, PhD, MB, FSCMR, Hannah Sinclair, MD, and Pier Giorgio Masci, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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5. Arrhythmic Mitral Valve Prolapse Phenotype: An Unsupervised Machine-learning Analysis Using a Multi-center Registry
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Stefano Figliozzi, MD, Ralph Kwame Akyea, PhD, Pedro M Lopes, MD, Sara Moura-Ferreira, MD, Lara Tondi, MD, Saima Mushtaq, MD, Stefano Censi, Anna Giulia Pavon, MD, Ilaria Bassi, Laura Galian, Arco J Teske, Domenico Filomena, Camilla Torlasco, Pierre Monney, MD, Viviana Maestrini, MD, PhD, Patrizia Pedrotti, MD, Bert Vandenberk, Angelo Squeri, MD, Massimo Lombardi, MD, Juerg Schwitter, MD, PhD, Giovanni Donato Aquaro, Amedeo Chiribiri, PhD, MB, FSCMR, José F Rodríguez Palomares, Lorenzo Monti, MD, Ali Yilmaz, Daniele Andreini, Anca Florian, Marco Francone, MD, PhD, Gianluca Pontone, MD, PhD, Joao Abecassis, MD, Tim Leiner, MD, PhD, Luigi P Badano, Jan Bogaert, MD, PhD, Georgios Georgiopoulos, MD, PhD, MSc, and Pier Giorgio Masci, MD
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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6. T1 and Extracellular Volume Measurements. Normal Values at 0.55T and Validation in Comparison with 1.5T
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Anmol Kaushal, Sami Jeljeli, Tiago Sequeiros, BSc, Filippo Bosio, BSc, Rosemarie Bolla, Karl P. Kunze, Daniel Giese, Sharon Giles, Pier Giorgio Masci, MD, Reza Razavi, MD, Sebastien Ourselin, Tevfik Ismail, MD, PhD, BSc, FSCMR, and Amedeo Chiribiri, PhD, MB, FSCMR
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2024
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7. Corrigendum to 'Machine learning outcome prediction using stress perfusion cardiac magnetic resonance reports and natural language processing of electronic health records' [Inform. Med. Unlocked (2024) 1–7/101418]
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Ebraham Alskaf, Simon M. Frey, Cian M. Scannell, Avan Suinesiaputra, Dijana Vilic, Vlad Dinu, Pier Giorgio Masci, Divaka Perera, Alistair Young, and Amedeo Chiribiri
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Computer applications to medicine. Medical informatics ,R858-859.7 - Published
- 2024
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8. Machine learning outcome prediction using stress perfusion cardiac magnetic resonance reports and natural language processing of electronic health records
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Ebraham Alskaf, Simon M. Frey, Cian M. Scannell, Avan Suinesiaputra, Dijana Vilic, Vlad Dinu, Pier Giorgio Masci, Divaka Perera, Alistair Young, and Amedeo Chiribiri
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Machine learning ,Coronary artery disease ,Cardiac magnetic resonance ,Electronic health records ,Outcome prediction ,Natural language processing ,Computer applications to medicine. Medical informatics ,R858-859.7 - Published
- 2024
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9. Serial Cardiac Magnetic Resonance Imaging in Patients with Mitral Valve Prolapse—A Single-Center Retrospective Registry
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Maarten Blondeel, Wouter L’Hoyes, Tomas Robyns, Peter Verbrugghe, Pieter De Meester, Tom Dresselaers, Pier Giorgio Masci, Rik Willems, Jan Bogaert, and Bert Vandenberk
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mitral valve prolapse ,mitral annular disjunction ,cardiac magnetic resonance imaging ,sudden cardiac death ,ventricular arrhythmias ,implantable cardioverter-defibrillator ,Medicine - Abstract
Background: Mitral valve prolapse (MVP) and mitral annular disjunction (MAD) are common valvular abnormalities that have been associated with ventricular arrhythmias (VA). Cardiac magnetic resonance imaging (CMR) has a key role in risk stratification of VA, including assessment of late gadolinium enhancement (LGE). Methods: Single-center retrospective analysis of patients with MVP or MAD who had >1 CMR and >1 24 h Holter registration available. Data are presented in detail, including evolution of VA and presence of LGE over time. Results: A total of twelve patients had repeated CMR and Holter registrations available, of which in four (33%) patients, it was conducted before and after minimal invasive mitral valve repair (MVR). After a median of 4.7 years, four out of eight (50%) patients without surgical intervention had new areas of LGE. New LGE was observed in the papillary muscles and the mid to basal inferolateral wall. In four patients, presenting with syncope or high-risk non-sustained ventricular tachycardia (VT), programmed ventricular stimulation was performed and in two (50%), sustained monomorphic VT was easily inducible. In two patients who underwent MVR, new LGE was observed in the basal inferolateral wall of which one presented with an increased burden of VA. Conclusions: In patients with MVP and MAD, repeat CMR may show new LGE in a small subset of patients, even shortly after MVR. A subgroup of patients who presented with an increase in VA burden showed new LGE upon repeat CMR. VA in patients with MVP and MAD are part of a heterogeneous spectrum that requires further investigation to establish risk stratification strategies.
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- 2024
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10. High-resolution non-contrast free-breathing coronary cardiovascular magnetic resonance angiography for detection of coronary artery disease: validation against invasive coronary angiography
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Muhummad Sohaib Nazir, Aurélien Bustin, Reza Hajhosseiny, Momina Yazdani, Matthew Ryan, Vittoria Vergani, Radhouene Neji, Karl P. Kunze, Edward Nicol, Pier Giorgio Masci, Divaka Perera, Sven Plein, Amedeo Chiribiri, René Botnar, and Claudia Prieto
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Coronary imaging ,Cardiovascular magnetic resonance angiography ,Coronary artery disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Coronary artery disease (CAD) is the single most common cause of death worldwide. Recent technological developments with coronary cardiovascular magnetic resonance angiography (CCMRA) allow high-resolution free-breathing imaging of the coronary arteries at submillimeter resolution without contrast in a predictable scan time of ~ 10 min. The objective of this study was to determine the diagnostic accuracy of high-resolution CCMRA for CAD detection against the gold standard of invasive coronary angiography (ICA). Methods Forty-five patients (15 female, 62 ± 10 years) with suspected CAD underwent sub-millimeter-resolution (0.6 mm3) non-contrast CCMRA at 1.5T in this prospective clinical study from 2019–2020. Prior to CCMR, patients were given an intravenous beta blockers to optimize heart rate control and sublingual glyceryl trinitrate to promote coronary vasodilation. Obstructive CAD was defined by lesions with ≥ 50% stenosis by quantitative coronary angiography on ICA. Results The mean duration of image acquisition was 10.4 ± 2.1 min. On a per patient analysis, the sensitivity, specificity, positive predictive value and negative predictive value (95% confidence intervals) were 95% (75–100), 54% (36–71), 60% (42–75) and 93% (70–100), respectively. On a per vessel analysis the sensitivity, specificity, positive predictive value and negative predictive value (95% confidence intervals) were 80% (63–91), 83% (77–88), 49% (36–63) and 95% (90–98), respectively. Conclusion As an important step towards clinical translation, we demonstrated a good diagnostic accuracy for CAD detection using high-resolution CCMRA, with high sensitivity and negative predictive value. The positive predictive value is moderate, and combination with CMR stress perfusion may improve the diagnostic accuracy. Future multicenter evaluation is now required.
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- 2022
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11. Efficient non-contrast enhanced 3D Cartesian cardiovascular magnetic resonance angiography of the thoracic aorta in 3 min
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Anastasia Fotaki, Camila Munoz, Yaso Emanuel, Alina Hua, Filippo Bosio, Karl P. Kunze, Radhouene Neji, Pier Giorgio Masci, René M. Botnar, and Claudia Prieto
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Undersampled Cartesian MRA ,iNAV ,Thoracic aortic disease ,Non-rigid motion correction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The application of cardiovascular magnetic resonance angiography (CMRA) for the assessment of thoracic aortic disease is often associated with prolonged and unpredictable acquisition times and residual motion artefacts. To overcome these limitations, we have integrated undersampled acquisition with image-based navigators and inline non-rigid motion correction to enable a free-breathing, contrast-free Cartesian CMRA framework for the visualization of the thoracic aorta in a short and predictable scan of 3 min. Methods 35 patients with thoracic aortic disease (36 ± 13y, 14 female) were prospectively enrolled in this single-center study. The proposed 3D T2-prepared balanced steady state free precession (bSSFP) sequence with image-based navigator (iNAV) was compared to the clinical 3D T2-prepared bSSFP with diaphragmatic-navigator gating (dNAV), in terms of image acquisition time. Three cardiologists blinded to iNAV vs. dNAV acquisition, recorded image quality scores across four aortic segments and their overall diagnostic confidence. Contrast ratio (CR) and relative standard deviation (RSD) of signal intensity (SI) in the corresponding segments were estimated. Co-axial aortic dimensions in six landmarks were measured by two readers to evaluate the agreement between the two methods, along with inter-observer and intra-observer agreement. Kolmogorov–Smirnov test, Mann–Whitney U (MWU), Bland–Altman analysis (BAA), intraclass correlation coefficient (ICC) were used for statistical analysis. Results The scan time for the iNAV-based approach was significantly shorter (3.1 ± 0.5 min vs. 12.0 ± 3.0 min for dNAV, P = 0.005). Reconstruction was performed inline in 3.0 ± 0.3 min. Diagnostic confidence was similar for the proposed iNAV versus dNAV for all three reviewers (Reviewer 1: 3.9 ± 0.3 vs. 3.8 ± 0.4, P = 0.7; Reviewer 2: 4.0 ± 0.2 vs. 3.9 ± 0.3, P = 0.4; Reviewer 3: 3.8 ± 0.4 vs. 3.7 ± 0.6, P = 0.3). The proposed method yielded higher image quality scores in terms of artefacts from respiratory motion, and non-diagnostic images due to signal inhomogeneity were observed less frequently. While the dNAV approach outperformed the iNAV method in the CR assessment, the iNAV sequence showed improved signal homogeneity along the entire thoracic aorta [RSD SI 5.1 (4.4, 6.5) vs. 6.5 (4.6, 8.6), P = 0.002]. BAA showed a mean difference of
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- 2022
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12. Multimodality Imaging in Valvular Structural Interventions
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Karine Grigoryan, Camelia Demetrescu, Ioannis Kasouridis, Olukayode Abiola, Pier Giorgio Masci, Didem Oguz, Giulia Benedetti, Sze Mun Mak, Purvi Parwani, Rebecca Preston, Amedeo Chiribiri, Jane Hancock, Tiffany Patterson, Simon Redwood, Bernard Prendergast, and Julia Grapsa
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Structural valvular interventions have skyrocketed in the past decade with new devices becoming available and indications for patients who would previously have been deemed inoperable. Furthermore, while echocardiography is the main imaging tool and the first line for patient screening, cardiac magnetic resonance and CT are now essential tools in pre-planning and post-procedural follow-up. This review aims to address imaging modalities and their scope in aortic, mitral and tricuspid structural valvular interventions, including multimodality imaging. Pulmonary valve procedures, which are mostly carried out in patients with congenital problems, are discussed. This article presents a guide on individualised imaging approaches on each of the available interventional procedures.
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- 2022
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13. Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial
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Reza Hajhosseiny, Imran Rashid, Aurélien Bustin, Camila Munoz, Gastao Cruz, Muhummad Sohaib Nazir, Karine Grigoryan, Tevfik F. Ismail, Rebecca Preston, Radhouene Neji, Karl Kunze, Reza Razavi, Amedeo Chiribiri, Pier Giorgio Masci, Ronak Rajani, Claudia Prieto, and René M. Botnar
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Coronary artery disease ,Coronary magnetic resonance angiography ,CMRA ,Atherosclerosis ,High resolution ,Coronary angiography ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time. Objectives To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD. Methods Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter. Results The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively. Conclusions The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.
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- 2021
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14. 3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging
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Giorgia Milotta, Camila Munoz, Karl P. Kunze, Radhouene Neji, Stefano Figliozzi, Amedeo Chiribiri, Reza Hajhosseiny, Pier Giorgio Masci, Claudia Prieto, and René M. Botnar
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3D whole-heart ,Respiratory motion correction ,Late gadolinium enhancement ,Dixon water/fat separation ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Purpose To develop a free-breathing whole-heart isotropic-resolution 3D late gadolinium enhancement (LGE) sequence with Dixon-encoding, which provides co-registered 3D grey-blood phase-sensitive inversion-recovery (PSIR) and complementary 3D fat volumes in a single scan of 0.99) were obtained with the 2D and 3D PSIR LGE approaches with comparable total acquisition time (p = 0.29). Similar agreement in intra and inter-observer variability were obtained for the 2D and 3D acquisition respectively. Conclusion The proposed approach enabled the acquisition of free-breathing motion-compensated isotropic-resolution 3D grey-blood PSIR LGE and fat volumes. The proposed approach showed good agreement with conventional 2D LGE in terms of CR, scar depiction and scan time, while enabling free-breathing acquisition, whole-heart coverage, reformatting in arbitrary views and visualization of both water and fat information.
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- 2021
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15. Probing the intravascular and interstitial compartments of remodeled myocardium in heart failure patients with preserved and reduced ejection fraction: a CMR study
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Pier Giorgio Masci, Anna Giulia Pavon, Gregoire Berchier, and Juerg Schwitter
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Medical technology ,R855-855.5 - Abstract
Abstract Background Recent autopsy studies found microvascular rarefaction in remodeled myocardium of patients who died of heart failure with preserved ejection-fraction (HFpEF). This condition has not been investigated so far by non-invasive methods in patients with HFpEF. The aim was to quantify the intravascular volume (IVV) compartment by CMR in HFpEF patients. Methods In two separate CMR examinations, HFpEF patients (n = 6; 12 examinations) and post-myocardial infarction patients (post-MI; n = 6; 12 examinations) were studied with T1-mapping (MOLLI-sequence) before and after IV bolus of 0.03 mmol/Kg of the intravascular contrast-medium (CM) Gadofosveset and 0.2 mmol/Kg of the extravascular CM Gadobutrol yielding IVV and extracellular volume (ECV), respectively. Healthy controls (n = 10 with Gadofosveset only, n = 10 with Gadobutrol only) were also studied with the same protocol. IVV and ECV were measured in the basal septum (without ischemic scar in post-MI patients). In post-MI patients, ECV and IVV were also measured in the ischemic scar. Left ventricular (LV) volumes, mass, and ejection-fraction were measured by standard protocol. LV global longitudinal strain (GLS) was calculated by feature tracking on long-axis cine acquisitions. Results LV mass to end-diastolic volume ratio and GLS in HFpEF were higher and lower, respectively, than in healthy controls and post-MI patients, whereas the post-MI patients showed lower LV ejection-fraction. Compared to healthy myocardium of controls, IVV in scar was reduced (0.135 ± 0.018 vs 0.109 ± 0.008, respectively, p = 0.005), while ECV was increased (0.244 ± 0.037 vs 0.698 ± 0.106, respectively, p
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- 2019
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16. Multi-Modality Imaging in Dilated Cardiomyopathy: With a Focus on the Role of Cardiac Magnetic Resonance
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Panagiota Mitropoulou, Georgios Georgiopoulos, Stefano Figliozzi, Dimitrios Klettas, Flavia Nicoli, and Pier Giorgio Masci
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cardiac imaging ,dilated cardiomyopathy ,cardiac magnetic resonance ,non-ischemic cardiomyopathy ,heart failure ,sudden cardiac death ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Heart failure (HF) is recognized as a leading cause of morbidity and mortality worldwide. Dilated cardiomyopathy (DCM) is a common phenotype in patients presenting with HF. Timely diagnosis, appropriate identification of the underlying cause, individualized risk stratification, and prediction of clinical response to treatment have improved the prognosis of DCM over the last few decades. In this article, we reviewed the current evidence on available imaging techniques used for DCM patients. In this direction, we evaluated appropriate scenarios for the implementation of echocardiography, nuclear imaging, and cardiac computed tomography, and we focused on the primordial role that cardiac magnetic resonance (CMR) holds in the diagnosis, prognosis, and tailoring of therapeutic options in this population of special clinical interest. We explored the predictive value of CMR toward left ventricular reverse remodeling and prediction of sudden cardiac death, thus guiding the decisions for device therapy. Principles underpinning the use of state-of-the-art CMR techniques such as parametric mapping and feature-tracking strain analysis are also provided, along with expectations for the anticipated future advances in this field. We also attempted to correlate the evidence with clinical practice, with the intent to address questions on selecting the optimal imaging method for different indications and clinical needs. Overall, we recommend a comprehensive assessment of DCM patients at baseline and at follow-up intervals depending on the clinical status, with the addition of CMR as a second-line modality to other imaging techniques. We also provide an algorithm to guide the detailed imaging approach of the patient with DCM. We expect that future guidelines will upgrade their clinical recommendations for the utilization of CMR in DCM, which is expected to further improve the quality of care and the outcomes. This review provides an up-to-date perspective on the imaging of dilated cardiomyopathy patients and will be of clinical value to training doctors and physicians involved in the area of heart failure.
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- 2020
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17. Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study
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Gabriella Vincenti, Pier Giorgio Masci, Tobias Rutz, Jonathan De Blois, Milan Prša, Xavier Jeanrenaud, Juerg Schwitter, and Pierre Monney
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Mitral regurgitation ,Mitral valve ,Prolapse ,Barlow ,Cardiac magnetic resonance ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson’s method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson’s method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR. Methods In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSVuncorr was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESVcorr was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5–29% regurgitant fraction (RF)), moderate (30–49% RF), or severe (≥50% RF). Results In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p
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- 2017
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18. Leiomyosarcoma of the inferior vena cava in a patient with Budd-Chiari syndrome
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Andrea Barison, Luigi Emilio Pastormerlo, Gianluca Mirizzi, Elisa Castelluccio, Pier Giorgio Masci, and Claudio Passino
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Published
- 2014
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19. Automatic Detection of Extra-Cardiac Findings in Cardiovascular Magnetic Resonance.
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Dewmini Hasara Wickremasinghe, Natallia Khenkina, Pier-Giorgio Masci, Andrew P. King, and Esther Puyol-Antón
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- 2021
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20. Long-Range Decoder Skip Connections: Exploiting Multi-Context Information for Cardiac Image Segmentation.
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Nicolás Gutierrez-Castilla, Ricardo da Silva Torres, Alexandre X. Falcão, Sebastian Kozerke, Jürg Schwitter, Pier-Giorgio Masci, and Javier A. Montoya-Zegarra
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- 2019
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21. Comparison of Demographic, Clinical, Biochemical, and Imaging Findings in Hypertrophic Cardiomyopathy Prognosis
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Georgios Georgiopoulos, Stefano Figliozzi, Konstantinos Pateras, Flavia Nicoli, Dimitrios Bampatsias, Matteo Beltrami, Gherardo Finocchiaro, Amedeo Chiribiri, Pier Giorgio Masci, and Iacopo Olivotto
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Cardiology and Cardiovascular Medicine - Published
- 2023
22. Comparative effects of fentanyl versus morphine on platelet inhibition induced by ticagrelor in patients with ST-segment elevation myocardial infarction: Full results of the PERSEUS randomized trial
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Juan F, Iglesias, Marco, Valgimigli, Federico, Carbone, Nathalie, Lauriers, Pier-Giorgio, Masci, and Sophie, Degrauwe
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Fentanyl ,Ticagrelor ,Percutaneous Coronary Intervention ,Treatment Outcome ,Morphine ,Platelet Function Tests ,Purinergic P2Y Receptor Antagonists ,Humans ,ST Elevation Myocardial Infarction ,Prospective Studies ,General Medicine ,Cardiology and Cardiovascular Medicine ,Platelet Aggregation Inhibitors - Abstract
Morphine reduces absorption and delays action onset of potent oral P2Y₁₂ receptor inhibitors in patients with ST-segment elevation myocardial infarction (STEMI). We sought to determine the differential effects of fentanyl compared to morphine on the pharmacodynamics and pharmacokinetics of ticagrelor in STEMI patients undergoing primary percutaneous coronary intervention (PCI).PERSEUS (NCT02531165) was a prospective, single-center, open-label, randomized controlled study. Patients with STEMI who required analgesia were randomly assigned in a 1:1 ratio to treatment with intravenous fentanyl or morphine after ticagrelor loading dose (LD) administration. The primary endpoint was platelet reactivity at 2 hours after ticagrelor LD assessed by P2Y₁₂ reaction units (PRU).The study was prematurely stopped in June 2017 after enrolment of 38 out of 56 planned patients. PRU at 2 hours following ticagrelor LD was 173.3 ± 89.7 in the fentanyl group and 210.3 ± 76.4 in the morphine group (p = 0.179). At 4 hours, PRU was significantly lower among patients treated with fentanyl as compared to those treated with morphine (90.1 ± 97.4 vs. 168.0 ± 72.2; p = 0.011). Maximal plasma concentrations of ticagrelor and its active metabolite AR-C124910XX tended to be delayed and numerically lower among patients treated with morphine compared to fentanyl. Total exposures to ticagrelor and AR-C124910XX within 6 hours after ticagrelor LD were numerically greater among patients treated with fentanyl compared to those treated with morphine.In patients with STEMI undergoing primary PCI, fentanyl did not improve platelet inhibition at 2 hours after ticagrelor pre-treatment compared with morphine. Fentanyl may, however, accelerate ticagrelor absorption and increase platelet inhibition at 4 hours compared to morphine.
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- 2022
23. Causal Relationship Between Average Alcohol Consumption and Risk of Atrial Fibrillation: A Mendelian Randomization Study
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Andrea Georgiou, Georgios Georgiopoulos, Dimitrios Delialis, Eleni Maneta, Pier Giorgio Masci, Onisiphoros Neophytou, Dimitrios Tsiachris, and Evangelos Evangelou
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General Medicine - Published
- 2023
24. Cardiac Magnetic Resonance for Prophylactic Implantable-Cardioverter Defibrillator Therapy in Ischemic Cardiomyopathy
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Gianluca Pontone, Andrea Igoren Guaricci, Laura Fusini, Andrea Baggiano, Marco Guglielmo, Giuseppe Muscogiuri, Alessandra Volpe, Raffaele Abete, Giovanni Aquaro, Andrea Barison, Jan Bogaert, Giovanni Camastra, Samuela Carigi, Nazario Carrabba, Grazia Casavecchia, Stefano Censi, Gloria Cicala, Carlo N. De Cecco, Manuel De Lazzari, Gabriella Di Giovine, Mauro Di Roma, Monica Dobrovie, Marta Focardi, Nicola Gaibazzi, Annalaura Gismondi, Matteo Gravina, Chiara Lanzillo, Massimo Lombardi, Valentina Lorenzoni, Jordi Lozano-Torres, Chiara Martini, Francesca Marzo, Ambra Masi, Riccardo Memeo, Claudio Moro, Alberto Nese, Alessandro Palumbo, Anna Giulia Pavon, Patrizia Pedrotti, Martina Perazzolo Marra, Silvia Pica, Silvia Pradella, Cristina Presicci, Mark G. Rabbat, Claudia Raineri, José F. Rodriguez-Palomares, Stefano Sbarbati, U. Joseph Schoepf, Angelo Squeri, Nicola Sverzellati, Rolf Symons, Emily Tat, Mauro Timpani, Giancarlo Todiere, Adele Valentini, Akos Varga-Szemes, Pier-Giorgio Masci, and Juerg Schwitter
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2023
25. AI Cardiac MRI Scar Analysis Aids Prediction of Major Arrhythmic Events in the Multicenter DERIVATE Registry
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Fahime Ghanbari, Thomas Joyce, Valentina Lorenzoni, Andrea I. Guaricci, Anna-Giulia Pavon, Laura Fusini, Daniele Andreini, Mark G. Rabbat, Giovanni Donato Aquaro, Raffaele Abete, Jan Bogaert, Giovanni Camastra, Samuela Carigi, Nazario Carrabba, Grazia Casavecchia, Stefano Censi, Gloria Cicala, Carlo N. De Cecco, Manuel De Lazzari, Gabriella Di Giovine, Mauro Di Roma, Marta Focardi, Nicola Gaibazzi, Annalaura Gismondi, Matteo Gravina, Chiara Lanzillo, Massimo Lombardi, Jordi Lozano-Torres, Ambra Masi, Claudio Moro, Giuseppe Muscogiuri, Alberto Nese, Silvia Pradella, Stefano Sbarbati, U. Joseph Schoepf, Adele Valentini, Gérard Crelier, Pier Giorgio Masci, Gianluca Pontone, Sebastian Kozerke, Juerg Schwitter, Institut Català de la Salut, [Ghanbari F] Cardiovascular Department, CMR Center, University Hospital Lausanne–CHUV, Lausanne, Switzerland. Faculty of Biology and Medicine, Lausanne University, UniL, Lausanne, Switzerland. [Joyce T] Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland. [Lorenzoni V] Institute of Management, Scuola Superiore Sant’Anna, Pisa, Italy. [Guaricci AI] Institute of Cardiovascular Disease, Department of Emergency and Organ Transplantation, University Hospital Policlinico of Bari, Bari, Italy. [Pavon AG] Cardiovascular Department, CMR Center, University Hospital Lausanne–CHUV, Lausanne, Switzerland. [Fusini L] Centro Cardiologico Monzino IRCCS, Milan, Italy. Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy. [Lozano-Torres J] Servei de Cardiologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain. Universitat Autònoma de Barcelona, Bellaterra, Spain. Centro de Investigación Biomédica en Red-CV, CIBER CV, Madrid, Spain, and Vall d'Hebron Barcelona Hospital Campus
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conceptos matemáticos::algoritmos::inteligencia artificial [FENÓMENOS Y PROCESOS] ,Male ,Intel·ligència artificial ,enfermedades cardiovasculares::enfermedades cardíacas::arritmias cardíacas [ENFERMEDADES] ,Mathematical Concepts::Algorithms::Artificial Intelligence [PHENOMENA AND PROCESSES] ,Arrítmia ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Stroke Volume ,Gadolinium ,Magnetic Resonance Imaging ,Ventricular Function, Left ,Cicatrix ,Artificial Intelligence ,Predictive Value of Tests ,Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Tomography::Magnetic Resonance Imaging [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,Imatgeria per ressonància magnètica ,Humans ,diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::tomografía::imagen por resonancia magnética [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,Radiology, Nuclear Medicine and imaging ,Registries ,Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac [DISEASES] ,Aged ,Retrospective Studies - Abstract
Background Scar burden with late gadolinium enhancement (LGE) cardiac MRI (CMR) predicts arrhythmic events in patients with postinfarction in single-center studies. However, LGE analysis requires experienced human observers, is time consuming, and introduces variability. Purpose To test whether postinfarct scar with LGE CMR can be quantified fully automatically by machines and to compare the ability of LGE CMR scar analyzed by humans and machines to predict arrhythmic events. Materials and Methods This study is a retrospective analysis of the multicenter, multivendor CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry. Patients with chronic heart failure, echocardiographic left ventricular ejection fraction (LVEF) of less than 50%, and LGE CMR were recruited (from January 2015 through December 2020). In the current study, only patients with ischemic cardiomyopathy were included. Quantification of total, dense, and nondense scars was carried out by two experienced readers or a Ternaus network, trained and tested with LGE images of 515 and 246 patients, respectively. Univariable and multivariable Cox analyses were used to assess patient and cardiac characteristics associated with a major adverse cardiac event (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare model performances. Results In 761 patients (mean age, 65 years ± 11, 671 men), 83 MACEs occurred. With use of the testing group, univariable Cox-analysis found New York Heart Association class, left ventricle volume and/or function parameters (by echocardiography or CMR), guideline criterion (LVEF of ≤35% and New York Heart Association class II or III), and LGE scar analyzed by humans or the machine-learning algorithm as predictors of MACE. Machine-based dense or total scar conferred incremental value over the guideline criterion for the association with MACE (AUC: 0.68 vs 0.63, P = .02 and AUC: 0.67 vs 0.63, P = .01, respectively). Modeling with competing risks yielded for dense and total scar (AUC: 0.67 vs 0.61, P = .01 and AUC: 0.66 vs 0.61, P = .005, respectively). Conclusion In this analysis of the multicenter CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry, fully automatic machine learning-based late gadolinium enhancement analysis reliably quantifies myocardial scar mass and improves the current prediction model that uses guideline-based risk criteria for implantable cardioverter defibrillator implantation. ClinicalTrials.gov registration no.: NCT03352648 Published under a CC BY 4.0 license. Supplemental material is available for this article. ispartof: Radiology vol:307 issue:3 pages:e222239- ispartof: location:United States status: published
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- 2023
26. Prevalence and significance of relative apical sparing in aortic stenosis: insights from an echo and cardiovascular magnetic resonance study of patients referred for surgical aortic valve replacement
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João Abecasis, Pedro Lopes, Rita Reis Santos, Sérgio Maltês, Sara Guerreiro, António Ferreira, Pedro Freitas, Regina Ribeiras, Maria João Andrade, Rita Theias Manso, Sancia Ramos, Victor Gil, Pier Giorgio Masci, and Nuno Cardim
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Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
AimsThis study aims to assess the prevalence of relative apical sparing pattern (RASP) in patients with severe symptomatic aortic stenosis (AS), referred for surgical aortic valve replacement (AVR), to evaluate its significance, possible relation to amyloid deposition, and persistence after surgery.Methods and resultsProspective study of 150 consecutive patients [age 73 (interquartile range: 68–77), 51% women], with severe symptomatic AS referred to surgical AVR. All patients underwent cardiac magnetic resonance (CMR) before surgery. RASP was defined by [average apical longitudinal strain (LS)/(average basal LS + average mid LS)] > 1 by echocardiography. AVR was performed in 119 (79.3%) patients. Both Congo red and sodium sulphate-Alcian blue (SAB) stain were used to exclude amyloid on septal myocardial biopsy. LV remodelling and tissue characterization parameters were compared in patients with and without RASP. Deformation pattern was re-assessed at 3–6 months after AVR.RASP was present in 23 patients (15.3%). There was no suspicion of amyloid at pre-operative CMR [native T1 value 1053 ms (1025–1076 ms); extracellular volume (ECV) 28% (25–30%)]. None of the patients had amyloid deposition at histopathology. Patients with RASP had significantly higher pre-operative LV mass and increased septal wall thickness. They also had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels [1564 (766–3318) vs. 548 (221–1440) pg/mL, P = 0.010], lower LV ejection fraction (53.7 ± 10.5 vs. 60.5 ± 10.2%, P = 0.005), and higher absolute late gadolinium enhancement (LGE) mass [9.7 (5.4–14.1) vs. 4.8 (1.9–8.6) g, P = 0.016] at CMR. Follow-up evaluation after AVR revealed RASP disappearance in all except two of the patients.ConclusionRASP is not specific of cardiac amyloidosis. It may also be found in severe symptomatic AS without amyloidosis, reflecting advanced LV disease, being mostly reversible after surgery.
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- 2023
27. Causal Relationship Between Average Alcohol Consumption and Risk of Atrial Fibrillation: A Mendelian Randomization Study
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Andrea Georgiou Georgios Georgiopoulos Dimitrios Delialis Eleni Maneta Pier Giorgio Masci Onisiphoros Neophytou Dimitrios Tsiachris Evangelos Evangelou
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Health Sciences ,Επιστήμες Υγείας - Published
- 2023
28. Simultaneous multislice steady‐state free precession myocardial perfusion with full left ventricular coverage and high resolution at 1.5 T
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Sarah McElroy, Giulio Ferrazzi, Muhummad Sohaib Nazir, Carl Evans, Joana Ferreira, Filippo Bosio, Nabila Mughal, Karl P. Kunze, Radhouene Neji, Peter Speier, Daniel Stäb, Tevfik F. Ismail, Pier Giorgio Masci, Adriana D. M. Villa, Reza Razavi, Amedeo Chiribiri, and Sébastien Roujol
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Perfusion ,Heart Ventricles ,Image Interpretation, Computer-Assisted ,Humans ,Reproducibility of Results ,Radiology, Nuclear Medicine and imaging ,Image Enhancement - Abstract
To implement and evaluate a simultaneous multi-slice balanced SSFP (SMS-bSSFP) perfusion sequence and compressed sensing reconstruction for cardiac MR perfusion imaging with full left ventricular (LV) coverage (nine slices/heartbeat) and high spatial resolution (1.4 × 1.4 mmA preliminary study was performed to evaluate the performance of blipped controlled aliasing in parallel imaging (CAIPI) and RF-CAIPI with gradient-controlled local Larmor adjustment (GC-LOLA) in the presence of fat. A nine-slice SMS-bSSFP sequence using RF-CAIPI with GC-LOLA with high spatial resolution (1.4 × 1.4 mmFat signal leakage was significantly higher for blipped CAIPI than for RF-CAIPI with GC-LOLA (7.9% vs. 1.2%, p = 0.010). All 10 SMS-bSSFP perfusion datasets resulted in 16/16 diagnostic myocardial segments. There were no significant differences between the SMS and conventional acquisitions in terms of image quality (2.6 ± 0.6 vs. 2.7 ± 0.2, p = 0.8) or perceived SNR (2.8 ± 0.3 vs. 2.7 ± 0.3, p = 0.3). Inter-reader variability was good for both image quality (ICC = 0.84) and perceived SNR (ICC = 0.70). Myocardial sharpness was improved using the SMS sequence compared to the conventional sequence (0.37 ± 0.08 vs 0.32 ± 0.05, p 0.001). There was no significant difference between measurements of upslope index for the SMS and conventional sequences (0.11 ± 0.04 vs. 0.11 ± 0.03, p = 0.84).SMS-bSSFP with multiband factor 3 and compressed sensing reconstruction enables cardiac MR perfusion imaging with three-fold increased spatial coverage and improved myocardial sharpness compared to a conventional sequence, without compromising perceived SNR, image quality, upslope index or number of diagnostic segments.
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- 2022
29. Left atrial adaptation in ischemic heart disease: insights from a cardiovascular magnetic resonance study
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Anna Giulia Pavon, Pier Giorgio Masci, Lorenzo Pucci, Antonio Landi, Amit Bermano, Amir Vaxman, Craig Gotsman, Tobias Rutz, Pierre Monney, Rita Godihno, David Saraiva Rodrigues, Olivier Muller, Marco Valgimigli, and Juerg Schwitter
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Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Abstract
Left atrium (LA) plays a key role in the overall cardiac performance. However, it remains unclear how LA adapts, in terms of function and volumes, to left ventricular dysfunction in the acute and post-acute phases of myocardial infarction. LA volumes and function were evaluated in patients in the acute phase of ST-segment elevation myocardial infarction (acute-STEMI group) and in the post-acute phase after STEMI (post-acute STEMI group). Ten age and sex-matched healthy controls served as control group. In all subjects LA was assessed by a compressed-sensing cine pulse sequence and by a 3D non-model-based reconstruction. LV infarct size and microvascular obstruction were determined on late-gadolinium-enhancement data and LV myocardial oedema and myocardial haemorrhage were measured on T
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- 2022
30. 983 COMPARISON OF DEMOGRAPHIC, CLINICAL, BIOCHEMICAL AND IMAGING AND IMAGING FINDINGS IN HYPERTROPHIC CARDIOMYOPATHY PROGNOSIS: A NETWORK META-ANALYSES
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Matteo Beltrami, Iacopo Olivotto, Stefano Figliozzi, Kostantinos Pateras, Flavia Niccoli, Dimitrios Bampatsias, Gherardo Finocchiaro, Amedeo Chiribiri, Pier Giorgio Masci, and Georgios Georgiopoulos
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Cardiology and Cardiovascular Medicine - Abstract
Background Despite hypertrophic cardiomyopathy (HCM) being the most common inherited heart disease and conferring increased risk for heart failure (HF) and sudden cardiac death (SCD), risk assessment in HCM patients is still largely unresolved. Objective To synthesize and compare the prognostic impact of demographic, clinical, biochemical, and imaging findings in patients with HCM. Methods We searched PubMed, Embase, and Cochrane Library for studies published from inception to November 2020, and the endpoints were: i) all-cause death; ii) an arrhythmic endpoint including SCD, sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; iii) a composite endpoint including i) or ii) plus hospitalization for HF or cardiac transplantation. We performed a pairwise meta-analysis obtaining the pooled estimate separately for the association between baseline variables and study endpoints. A random-effects network meta-analysis (NMA) was subsequently used to comparatively assess the prognostic value of outcome predictors. Results One-hundred-eleven studies with 56,792 HCM patients were included. Among others, increased BNP/NT-proBNP, late-gadolinium-enhancement (LGE), positive genotype, impaired global longitudinal strain and presence of apical aneurysm conferred increased risk for the composite endpoint. At NMA, LGE showed the highest prognostic value for all endpoints and was superior to all other predictors except NYHA class≥II. A multiparametric imaging-based model was superior in predicting the composite endpoint compared to a pre-specified model based on conventional risk factors. Conclusions This network meta-analysis supports the development of multiparametric risk prediction algorithms, including advanced imaging markers additively to conventional risk factors, for refined risk stratification in HCM.
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- 2022
31. Clinical Risk Prediction in Patients With Left Ventricular Myocardial Noncompaction
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Josep Ramon Marsal, Laura Gutierrez-Garcia, Juan Ramón Gimeno-Blanes, Pier Giorgio Masci, Juan Jiménez-Jáimez, Gisela Teixido-Tura, Marta Codina-Solà, Gerard Oristrell, Coloma Tiron, Ignacio Ferreira-González, Andrea Guala, Pablo García-Pavía, Paula Fernández-Álvarez, Juan José Santos-Mateo, Esther Zorio, José Luis de la Pompa, Artur Evangelista, José Manuel García-Pinilla, Daniele Andreini, Eduardo Villacorta, Tomás Ripoll-Vera, Ángela López-Sainz, José Rodríguez-Palomares, José Antonio Sorolla-Romero, Gianluca Pontone, Lucia La Mura, Javier Limeres, Jan Bogaert, Mar Borregan, Augusto Sao Avilés, Julián Palomino-Doza, Rafaela Soler-Fernandez, Aida Ribera, Josefa González-Carrillo, José M. Larrañaga-Moreira, Guillem Casas, Giovanni Donato Aquaro, Roberto Barriales-Villa, Antoni Bayes-Genis, Sociedad Catalana de Cardiología, Hospital Universitario Virgen de la Arrixaca, Fundación La Marató TV3, Hospital Universitario y Politécnico La Fe, Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF), Instituto de Salud Carlos III, Ministerio de Ciencia, Innovación y Universidades (España), and Centro de Investigación Biomédica en Red - CIBERCV (Enfermedades Cardiovasculares)
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Patient-Specific Modeling ,Adult ,Male ,Noncompaction cardiomyopathy ,medicine.medical_specialty ,Embolism ,Risk Assessment ,Young Adult ,noncompaction cardiomyopathy ,Internal medicine ,medicine ,Humans ,In patient ,Longitudinal Studies ,cardiovascular diseases ,Aged ,Retrospective Studies ,Heart Failure ,late gadolinium enhancement ,Isolated Noncompaction of the Ventricular Myocardium ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Arrhythmias, Cardiac ,Magnetic resonance imaging ,Middle Aged ,major adverse cardiovascular events ,medicine.disease ,physiologic hypertrabeculation ,Spain ,left ventricular ejection fraction ,Heart failure ,Cardiology ,Left ventricular noncompaction ,Female ,genotype ,Cardiology and Cardiovascular Medicine ,business ,Mace ,Cohort study - Abstract
Left ventricular noncompaction (LVNC) is a heterogeneous entity with uncertain prognosis. This study sought to develop and validate a prediction model of major adverse cardiovascular events (MACE) and to identify LVNC cases without events during long-term follow-up. This is a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by echocardiography or cardiovascular magnetic resonance. MACE were defined as heart failure (HF), ventricular arrhythmias (VAs), systemic embolisms, or all-cause mortality. A total of 585 patients were included (45 ± 20 years of age, 57% male). LV ejection fraction (LVEF) was 48% ± 17%, and 18% presented late gadolinium enhancement (LGE). After a median follow-up of 5.1 years, MACE occurred in 223 (38%) patients: HF in 110 (19%), VAs in 87 (15%), systemic embolisms in 18 (3%), and 34 (6%) died. LVEF was the main variable independently associated with MACE (P < 0.05). LGE was associated with HF and VAs in patients with LVEF >35% (P < 0.05). A prediction model of MACE was developed using Cox regression, composed by age, sex, electrocardiography, cardiovascular risk factors, LVEF, and family aggregation. C-index was 0.72 (95% confidence interval: 0.67-0.75) in the derivation cohort and 0.72 (95% confidence interval: 0.71-0.73) in an external validation cohort. Patients with no electrocardiogram abnormalities, LVEF ≥50%, no LGE, and negative family screening presented no MACE at follow-up. LVNC is associated with an increased risk of heart failure and ventricular arrhythmias. LVEF is the variable most strongly associated with MACE; however, LGE confers additional risk in patients without severe systolic dysfunction. A risk prediction model is developed and validated to guide management. The project was partially funded by a grant from the Catalan Society of Cardiology (Barcelona, Spain). Hospital Universitario Virgen de la Arrixaca (Murcia, Spain) was supported by a grant from the Foundation Marató TV3 (218/C/2015) (Barcelona, Spain). Hospital Universitario y Politécnico La Fe (Valencia, Spain) was partially supported by Fondo Europeo de Desarrollo Regional (“Unión Europea, Una forma de hacer Europa”) (Madrid, Spain) and the Instituto de Salud Carlos III (La Fe Biobank PT17/0015/ 0043) (Madrid, Spain). Dr Guala was supported by funding from the Spanish Ministry of Science, Innovation and Universities (IJC2018-037349-I) (Madrid, Spain). Dr La Mura was supported by a research grant from the Cardiopath PhD program (Naples, Italy). Prof de la Pompa was supported by grants PID2019-104776RB-I00 and CB16/11/00399 (CIBER CV) from the Spanish Ministry of Science, Innovation and Universities. Dr Bayes-Genis was supported by grants from CIBER Cardiovascular (CB16/11/00403 and 16/11/00420) (Madrid, Spain) and AdvanceCat 2014-2020 (Barcelona, Spain); and has received advisory board and lecture fees from Novartis, Boehringer Ingelheim, Vifor, Roche Diagnostics, and Critical Diagnostics. Dr Pontone has received speaker honorarium and/or institutional research grants from GE Healthcare, Bracco, Boehringer Ingelheim, and HeartFlow. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sí
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- 2021
32. Left ventricular remodelling in mitral valve prolapse patients: implications of apical papillary muscle insertion
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Tom Dresselaers, Rolf Symons, Jan Bogaert, Rik Willems, Bert Vandenberk, Sara Moura-Ferreira, Pier Giorgio Masci, and Christophe Garweg
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medicine.medical_specialty ,Cardiomyopathy ,Diastole ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Humans ,Medicine ,Mitral valve prolapse ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Systole ,Papillary muscle ,Mitral regurgitation ,Mitral Valve Prolapse ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Mitral Valve Insufficiency ,General Medicine ,Papillary Muscles ,medicine.disease ,medicine.anatomical_structure ,Cardiology ,Mitral Valve ,Cardiology and Cardiovascular Medicine ,business ,Apical four chamber view - Abstract
Aims Mitral valve prolapse (MVP) causes left ventricular (LV) remodelling even in the absence of significant mitral regurgitation. To evaluate whether apical insertion of the papillary muscle (PM) influences the pattern and severity of MVP-related LV remodelling. Methods and results All MVP patients who underwent CMR at our institution between December 2008 and December 2019 were included, thoroughly reviewed and grouped according to apical/non-apical PM insertion. Apical PM insertion was found in 53/92 patients (58%) and associated with mitral leaflet thickening (P 5%) and non-sustained ventricular tachyarrhythmias was found in patients with apical PM insertion: 53% vs. 25% (P = 0.04) and 38% vs. 18% (P = 0.04), respectively. Conclusion Apical PM insertion is part of the phenotypic spectrum of MVP, impacts significantly LV remodelling, and potentially may be related to increased ventricular arrhythmogenicity.
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- 2021
33. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse
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Stefano Figliozzi, Georgios Georgiopoulos, Pedro M. Lopes, Klemens B. Bauer, Sara Moura-Ferreira, Lara Tondi, Saima Mushtaq, Stefano Censi, Anna Giulia Pavon, Ilaria Bassi, Maria Luz Servato, Arco J. Teske, Federico Biondi, Domenico Filomena, Silvia Pica, Camilla Torlasco, Denisa Muraru, Pierre Monney, Giuseppina Quattrocchi, Viviana Maestrini, Luciano Agati, Lorenzo Monti, Patrizia Pedrotti, Bert Vandenberk, Angelo Squeri, Massimo Lombardi, António M. Ferreira, Juerg Schwitter, Giovanni Donato Aquaro, Amedeo Chiribiri, José F. Rodríguez Palomares, Ali Yilmaz, Daniele Andreini, Anca Florian, Tim Leiner, João Abecasis, Luigi Paolo Badano, Jan Bogaert, Pier-Giorgio Masci, Figliozzi, S, Georgiopoulos, G, Lopes, P, Bauer, K, Moura-Ferreira, S, Tondi, L, Mushtaq, S, Censi, S, Pavon, A, Bassi, I, Servato, M, Teske, A, Biondi, F, Filomena, D, Pica, S, Torlasco, C, Muraru, D, Monney, P, Quattrocchi, G, Maestrini, V, Agati, L, Monti, L, Pedrotti, P, Vandenberk, B, Squeri, A, Lombardi, M, Ferreira, A, Schwitter, J, Aquaro, G, Chiribiri, A, Rodríguez Palomares, J, Yilmaz, A, Andreini, D, Florian, A, Leiner, T, Abecasis, J, Badano, L, Bogaert, J, and Masci, P
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Radiology, Nuclear Medicine and imaging ,myocardial fibrosis ,MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE ,mitral valve prolapse ,cardiac magnetic resonance - Abstract
Background: Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose: To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods: In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results: A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence (P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; P = .03). Conclusion: In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction.
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- 2022
34. 3D whole-heart grey-blood late gadolinium enhancement cardiovascular magnetic resonance imaging
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Camila Munoz, Stefano Figliozzi, Giorgia Milotta, Amedeo Chiribiri, Claudia Prieto, Reza Hajhosseiny, René M. Botnar, Karl P. Kunze, Radhouene Neji, and Pier Giorgio Masci
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medicine.medical_specialty ,Contrast Media ,Gadolinium ,030204 cardiovascular system & hematology ,Dixon water/fat separation ,Late gadolinium enhancement ,030218 nuclear medicine & medical imaging ,Respiratory motion correction ,Scan time ,03 medical and health sciences ,0302 clinical medicine ,Imaging, Three-Dimensional ,Predictive Value of Tests ,3D whole-heart ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Radiology, Nuclear Medicine and imaging ,Single scan ,Angiology ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Research ,Reproducibility of Results ,Magnetic resonance imaging ,Image Enhancement ,Magnetic Resonance Imaging ,RC666-701 ,Acquisition time ,Cardiology and Cardiovascular Medicine ,business ,Nuclear medicine - Abstract
Purpose To develop a free-breathing whole-heart isotropic-resolution 3D late gadolinium enhancement (LGE) sequence with Dixon-encoding, which provides co-registered 3D grey-blood phase-sensitive inversion-recovery (PSIR) and complementary 3D fat volumes in a single scan of Methods A free-breathing 3D PSIR LGE sequence with dual-echo Dixon readout with a variable density Cartesian trajectory with acceleration factor of 3 is proposed. Image navigators are acquired to correct both inversion recovery (IR)-prepared and reference volumes for 2D translational respiratory motion, enabling motion compensated PSIR reconstruction with 100% respiratory scan efficiency. An intermediate PSIR reconstruction is performed between the in-phase echoes to estimate the signal polarity which is subsequently applied to the IR-prepared water volume to generate a water grey-blood PSIR image. The IR-prepared water volume is obtained using a water/fat separation algorithm from the corresponding dual-echo readout. The complementary fat-volume is obtained after water/fat separation of the reference volume. Ten patients (6 with myocardial scar) were scanned with the proposed water/fat grey-blood 3D PSIR LGE sequence at 1.5 T and compared to breath-held grey-blood 2D LGE sequence in terms of contrast ratio (CR), contrast-to-noise ratio (CNR), scar depiction, scar transmurality, scar mass and image quality. Results Comparable CRs (p = 0.98, 0.40 and 0.83) and CNRs (p = 0.29, 0.40 and 0.26) for blood-myocardium, scar-myocardium and scar-blood respectively were obtained with the proposed free-breathing 3D water/fat LGE and 2D clinical LGE scan. Excellent agreement for scar detection, scar transmurality, scar mass (bias = 0.29%) and image quality scores (from 1: non-diagnostic to 4: excellent) of 3.8 ± 0.42 and 3.6 ± 0.69 (p > 0.99) were obtained with the 2D and 3D PSIR LGE approaches with comparable total acquisition time (p = 0.29). Similar agreement in intra and inter-observer variability were obtained for the 2D and 3D acquisition respectively. Conclusion The proposed approach enabled the acquisition of free-breathing motion-compensated isotropic-resolution 3D grey-blood PSIR LGE and fat volumes. The proposed approach showed good agreement with conventional 2D LGE in terms of CR, scar depiction and scan time, while enabling free-breathing acquisition, whole-heart coverage, reformatting in arbitrary views and visualization of both water and fat information.
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- 2021
35. Clinical comparison of sub-mm high-resolution non-contrast coronary CMR angiography against coronary CT angiography in patients with low-intermediate risk of coronary artery disease: a single center trial
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Karine Grigoryan, Reza Razavi, Camila Munoz, Reza Hajhosseiny, Amedeo Chiribiri, Muhummad Sohaib Nazir, Karl P. Kunze, Ronak Rajani, René M. Botnar, Imran Rashid, Radhouene Neji, Aurelien Bustin, Rebecca Preston, Claudia Prieto, Gastao Cruz, Tevfik F Ismail, and Pier Giorgio Masci
- Subjects
Male ,medicine.medical_specialty ,Computed Tomography Angiography ,Coronary angiography ,High resolution ,030204 cardiovascular system & hematology ,Single Center ,Coronary artery disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,CMRA ,Predictive Value of Tests ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Radiology, Nuclear Medicine and imaging ,In patient ,Angiology ,Coronary magnetic resonance angiography ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Research ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Atherosclerosis ,RC666-701 ,Angiography ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Intermediate risk ,Magnetic Resonance Angiography - Abstract
Background The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm3) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time. Objectives To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD. Methods Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter. Results The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively. Conclusions The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.
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- 2021
36. High-Resolution Cardiac Magnetic Resonance Imaging Techniques for the Identification of Coronary Microvascular Dysfunction
- Author
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Howard Ellis, Pier Giorgio Masci, Haseeb Rahman, Divaka Perera, Amedeo Chiribiri, Hannah McConkey, Matthew Ryan, Cian M. Scannell, and Ozan M. Demir
- Subjects
Male ,medicine.medical_specialty ,Ischemia ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Coronary artery disease ,Angina ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Cardiac magnetic resonance imaging ,Coronary Circulation ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Area under the curve ,Coronary flow reserve ,Blood flow ,medicine.disease ,Magnetic Resonance Imaging ,Angiography ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives This study assessed the ability to identify coronary microvascular dysfunction (CMD) in patients with angina and nonobstructive coronary artery disease (NOCAD) using high-resolution cardiac magnetic resonance (CMR) and hypothesized that quantitative perfusion techniques would have greater accuracy than visual analysis. Background Half of all patients with angina are found to have NOCAD, while the presence of CMD portends greater morbidity and mortality, it now represents a modifiable therapeutic target. Diagnosis currently requires invasive assessment of coronary blood flow during angiography. With greater reliance on computed tomography coronary angiography as a first-line tool to investigate angina, noninvasive tests for diagnosing CMD warrant validation. Methods Consecutive patients with angina and NOCAD were enrolled. Intracoronary pressure and flow measurements were acquired during rest and vasodilator-mediated hyperemia. CMR (3-T) was performed and analyzed by visual and quantitative techniques, including calculation of myocardial blood flow (MBF) during hyperemia (stress MBF), transmural myocardial perfusion reserve (MPR: MBFHYPEREMIA / MBFREST), and subendocardial MPR (MPRENDO). CMD was defined dichotomously as an invasive coronary flow reserve Results A total of 75 patients were enrolled (57 ± 10 years of age, 81% women). Among the quantitative perfusion indices, MPRENDO and MPR had the highest accuracy (area under the curve [AUC]: 0.90 and 0.88) with high sensitivity and specificity, respectively, both superior to visual assessment (both p Conclusions High-resolution CMR has good accuracy at detecting CMD but only when analyzed quantitatively. Although omission of rest imaging and stress-only protocols make for quicker scans, this is at the cost of accuracy compared with integrating rest and stress perfusion. Quantitative perfusion CMR has an increasingly important role in the management of patients frequently encountered with angina and NOCAD.
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- 2021
37. Is heart failure with preserved ejection fraction a ‘dementia’ of the heart?
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Mauro Giacca, Matteo Pardini, Gianfranco Sinagra, Marco Canepa, Niccolò Marchionni, Iacopo Olivotto, Federica del Monte, Giacomo Tini, Antonio Cannatà, Pier Giorgio Masci, James E. Udelson, Tini, G., Cannata, A., Canepa, M., Masci, P. G., Pardini, M., Giacca, M., Sinagra, G., Marchionni, N., Del Monte, F., Udelson, J. E., and Olivotto, I.
- Subjects
Cardiac function curve ,medicine.medical_specialty ,Diastole ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Myocardial fibrosis ,Internal medicine ,Humans ,Medicine ,Dementia ,Calcium handling ,030212 general & internal medicine ,Cardiac aging ,HFpEF ,Pathological ,Heart Failure ,business.industry ,Heart ,Stroke Volume ,medicine.disease ,Physiological Aging ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,Heart failure with preserved ejection fraction ,business - Abstract
Heart failure with preserved ejection fraction (HFpEF) remains an elusive entity, due to its heterogeneous clinical profile and an arbitrarily defined nosology. Several pathophysiological mechanisms recognized as central for the development of HFpEF appear to be in common with the process of physiological aging of the heart. Both conditions are characterized by progressive impairment in cardiac function, accompanied by left ventricular hypertrophy, diastolic dysfunction, sarcomeric, and metabolic abnormalities. The neurological paradigm of dementia-intended as a progressive, multifactorial organ damage with decline of functional reserve, eventually leading to irreversible dysfunction-is well suited to represent HFpEF. In such perspective, certain phenotypes of HFpEF may be viewed as a maladaptive response to environmental modifiers, causing premature and pathological aging of the heart. We here propose that the 'HFpEF syndrome' may reflect the interplay of adverse structural remodelling and erosion of functional reserve, mirroring the processes leading to dementia in the brain. The resulting conceptual framework may help advance our understanding of HFpEF and unravel potential therapeutical targets.
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- 2021
38. From the Epicardial Vessels to the Microcirculation
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Amedeo Chiribiri and Pier Giorgio Masci
- Subjects
Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine - Published
- 2021
39. Quantitative susceptibility mapping (QSM) of the cardiovascular system: challenges and perspectives
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Alberto Aimo, Li Huang, Andrew Tyler, Andrea Barison, Nicola Martini, Luigi F. Saccaro, Sébastien Roujol, and Pier-Giorgio Masci
- Subjects
Radiological and Ultrasound Technology ,Predictive Value of Tests ,Iron ,Brain ,Humans ,Radiology, Nuclear Medicine and imaging ,Heart ,Cardiology and Cardiovascular Medicine ,Magnetic Resonance Imaging - Abstract
Quantitative susceptibility mapping (QSM) is a powerful, non-invasive, magnetic resonance imaging (MRI) technique that relies on measurement of magnetic susceptibility. So far, QSM has been employed mostly to study neurological disorders characterized by iron accumulation, such as Parkinson’s and Alzheimer’s diseases. Nonetheless, QSM allows mapping key indicators of cardiac disease such as blood oxygenation and myocardial iron content. For this reason, the application of QSM offers an unprecedented opportunity to gain a better understanding of the pathophysiological changes associated with cardiovascular disease and to monitor their evolution and response to treatment. Recent studies on cardiovascular QSM have shown the feasibility of a non-invasive assessment of blood oxygenation, myocardial iron content and myocardial fibre orientation, as well as carotid plaque composition. Significant technical challenges remain, the most evident of which are related to cardiac and respiratory motion, blood flow, chemical shift effects and susceptibility artefacts. Significant work is ongoing to overcome these challenges and integrate the QSM technique into clinical practice in the cardiovascular field.
- Published
- 2022
40. Comparison of Demographic, Clinical, Biochemical, and Imaging Findings in Hypertrophic Cardiomyopathy Prognosis: A Network Meta-Analysis
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Georgios, Georgiopoulos, Stefano, Figliozzi, Konstantinos, Pateras, Flavia, Nicoli, Dimitrios, Bampatsias, Matteo, Beltrami, Gherardo, Finocchiaro, Amedeo, Chiribiri, Pier Giorgio, Masci, and Iacopo, Olivotto
- Subjects
Heart Failure ,Death, Sudden, Cardiac ,Risk Factors ,Network Meta-Analysis ,Humans ,Contrast Media ,Gadolinium ,Cardiomyopathy, Hypertrophic ,Prognosis ,Magnetic Resonance Imaging ,Risk Assessment ,Demography - Abstract
Despite hypertrophic cardiomyopathy (HCM) being the most common inherited heart disease and conferring increased risk for heart failure (HF) and sudden cardiac death (SCD), risk assessment in HCM patients is still largely unresolved.This study aims to synthesize and compare the prognostic impact of demographic, clinical, biochemical, and imaging findings in patients with HCM.The authors searched PubMed, Embase, and Cochrane Library for studies published from 1955 to November 2020, and the endpoints were: 1) all-cause death; 2) an arrhythmic endpoint including SCD, sustained ventricular tachycardia, ventricular fibrillation, or aborted SCD; and 3) a composite endpoint including (1) or (2) plus hospitalization for HF or cardiac transplantation. The authors performed a pairwise meta-analysis obtaining the pooled estimate separately for the association between baseline variables and study endpoints. A random-effects network meta-analysis was subsequently used to comparatively assess the prognostic value of outcome associates.A total of 112 studies with 58,732 HCM patients were included. Among others, increased brain natriuretic peptide/N-terminal pro-B-type natriuretic peptide, late gadolinium enhancement (LGE), positive genotype, impaired global longitudinal strain, and presence of apical aneurysm conferred increased risk for the composite endpoint. At network meta-analysis, LGE showed the highest prognostic value for all endpoints and was superior to all other associates except New York Heart Association functional classclass II. A multiparametric imaging-based model was superior in predicting the composite endpoint compared to a prespecified model based on conventional risk factors.This network meta-analysis supports the development of multiparametric risk prediction algorithms, including advanced imaging markers additively to conventional risk factors, for refined risk stratification in HCM. (Long-term prognosis of hypertrophic cardiomyopathy according to genetic, clinical, biochemical and imaging findings: a systemic review and meta-analysis; CRD42020185219).
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- 2022
41. Acute chest pain with ST-segment elevation in lead V1–V3: when you hear hoofbeats, also look for zebras
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Anna Giulia Pavon, Johan Bennett, Pier Giorgio Masci, Pierre Monney, Olivier Muller, Jan Bogaert, Patrizio Pascale, and Juerg Schwitter
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endocrine system ,medicine.medical_specialty ,business.industry ,Infarction ,Anterior myocardial infarction ,General Medicine ,medicine.disease ,Elevation (emotion) ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,medicine ,Acute chest pain ,Cardiology ,ST segment ,cardiovascular diseases ,Myocardial infarction ,Right Ventricular Free Wall ,Cardiology and Cardiovascular Medicine ,business - Abstract
ST-segment elevation (STE) in the anterior precordial leads is the hallmark of anterior myocardial infarction. In rare cases, this ECG pattern may be due to isolated infarction of the right ventricle since leads V1-V3 directly overlie the right ventricular free wall. Herein, we aimed to provide clues to recognize and understand this diagnostic pitfall through a series of 4 patients presenting with STE in the anterior leads.
- Published
- 2021
42. 67 Echocardiography vs. computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis
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Dimitrios Delialis, Kimon Stamatelopoulos, Dimitrios Klettas, Georgios Ntritsos, Stefano Figliozzi, Michele Emdin, Georgios Georgiopoulos, Pier-Giorgio Masci, and Alberto Aimo
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Diastole ,Computed tomography ,medicine.disease ,Thrombosis ,Meta-analysis ,medicine ,Echocardiography transthoracic ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
Aims Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi (either in the left ventricle [LV] or in the left atrial appendage [LAA]) and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events. Methods and results We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi. Six studies were included in the first meta-analysis. Pooled sensitivity and specificity values were 62% (95% confidence interval [CI], 37-81%) and 97% (95% CI, 94-99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the meta-analysis of the diagnostic accuracy of CT vs. TEE. The pooled values of sensitivity and specificity were 97% (95% CI, 77-100%) and 94% (95% CI, 87-98%). The pooled DOR was 500 (95% CI, 52-4810), and the pooled LR+ and LR- values were 17% (95% CI, 7-40%) and 3% (95% CI, 0-28%). The shape of the HSROC curve and the 0.99 AUC suggested a high accuracy of CT vs. TEE. Conclusion TTE is a valid alternative to DE-CMR for the identification of LV thrombi, and CT has a good accuracy compared to TEE for the detection of LAA thrombosis.
- Published
- 2020
43. Imaging predictors of incident heart failure: a systematic review and meta-analysis
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Nikolaos Magkas, Michele Emdin, Alberto Aimo, Pier Giorgio Masci, Andrea Barison, and Georgios Georgiopoulos
- Subjects
medicine.medical_specialty ,Diastole ,heart failure ,030204 cardiovascular system & hematology ,Left ventricular hypertrophy ,Asymptomatic ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,030212 general & internal medicine ,Subclinical infection ,Ejection fraction ,business.industry ,Hazard ratio ,imaging ,General Medicine ,medicine.disease ,Confidence interval ,meta-analysis ,predictors ,Heart failure ,Cardiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. Methods This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. Results Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). Conclusion LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure.
- Published
- 2020
44. <scp>T1</scp> , <scp>T2,</scp> and Fat Fraction Cardiac MR Fingerprinting: Preliminary Clinical Evaluation
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Pier Giorgio Masci, Peter Koken, Sohaib Nazir, Reza Hajhosseiny, Daniel Rueckert, Gastao Cruz, Claudia Prieto, René M. Botnar, Olivier Jaubert, Mariya Doneva, Torben Schneider, and Aurelien Bustin
- Subjects
education.field_of_study ,Wilcoxon signed-rank test ,Phantoms, Imaging ,business.industry ,Population ,Reproducibility of Results ,Heart ,Repeatability ,Magnetic Resonance Imaging ,Imaging phantom ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Statistical significance ,Spin echo ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,education ,business ,Nuclear medicine ,Clinical evaluation ,Fat fraction - Abstract
BACKGROUND Dixon cardiac magnetic resonance fingerprinting (MRF) has been recently introduced to simultaneously provide water T1 , water T2 , and fat fraction (FF) maps. PURPOSE To assess Dixon cardiac MRF repeatability in healthy subjects and its clinical feasibility in a cohort of patients with cardiovascular disease. POPULATION T1MES phantom, water-fat phantom, 11 healthy subjects and 19 patients with suspected cardiovascular disease. STUDY TYPE Prospective. FIELD STRENGTH/SEQUENCE 1.5T, inversion recovery spin echo (IRSE), multiecho spin echo (MESE), modified Look-Locker inversion recovery (MOLLI), T2 gradient spin echo (T2 -GRASE), 6-echo gradient rewound echo (GRE), and Dixon cardiac MRF. ASSESSMENT Dixon cardiac MRF precision was assessed through repeated scans against conventional MOLLI, T2 -GRASE, and PDFF in phantom and 11 healthy subjects. Dixon cardiac MRF native T1 , T2 , FF, postcontrast T1 and synthetic extracellular volume (ECV) maps were assessed in 19 patients in comparison to conventional sequences. Measurements in patients were performed in the septum and in late gadolinium enhanced (LGE) areas and assessed using mean value distributions, correlation, and Bland-Altman plots. Image quality and diagnostic confidence were assessed by three experts using 5-point scoring scales. STATISTICAL TESTS Paired Wilcoxon rank signed test and paired t-tests were applied. Statistical significance was indicated by *(P
- Published
- 2020
45. The Additive Value of Cardiovascular Magnetic Resonance in Convalescent COVID-19 Patients
- Author
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Alessandra Borlotti, Helena Thomaides-Brears, Georgios Georgiopoulos, Rajarshi Banerjee, Matthew D. Robson, Dahlene N. Fusco, and Pier-Giorgio Masci
- Subjects
Cardiology and Cardiovascular Medicine - Abstract
In COVID-19 the development of severe viral pneumonia that is coupled with systemic inflammatory response triggers multi-organ failure and is of major concern. Cardiac involvement occurs in nearly 60% of patients with pre-existing cardiovascular conditions and heralds worse clinical outcome. Diagnoses carried out in the acute phase of COVID-19 rely upon increased levels of circulating cardiac injury biomarkers and transthoracic echocardiography. These diagnostics, however, were unable to pinpoint the mechanisms of cardiac injury in COVID-19 patients. Identifying the main features of cardiac injury remains an urgent yet unmet need in cardiology, given the potential clinical consequences. Cardiovascular magnetic resonance (CMR) provides an unparalleled opportunity to gain a deeper insight into myocardial injury given its unique ability to interrogate the properties of myocardial tissue. This endeavor is particularly important in convalescent COVID-19 patients as many continue to experience chest pain, palpitations, dyspnea and exertional fatigue, six or more months after the acute illness. This review will provide a critical appraisal of research on cardiovascular damage in convalescent adult COVID-19 patients with an emphasis on the use of CMR and its value to our understanding of organ damage.
- Published
- 2022
46. Head-to-head comparison of multiple cardiovascular magnetic resonance techniques for the detection and quantification of intramyocardial haemorrhage in patients with ST-elevation myocardial infarction
- Author
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Juerg Schwitter, Georgios Georgiopoulos, Gabriella Vincenti, Olivier Muller, Eric Eeckhout, Gregoire Berchier, Pierre Monney, Pier Giorgio Masci, Anna Giulia Pavon, and Chiara Cirillo
- Subjects
Male ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Myocardial ischemic reperfusion injury ,Magnetic Resonance Imaging, Cine ,Hemorrhage ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,St elevation myocardial infarction ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,In patient ,Myocardial infarction ,Neuroradiology ,Reproducibility ,medicine.diagnostic_test ,business.industry ,Myocardium ,Ultrasound ,Reproducibility of Results ,Magnetic resonance imaging ,Interventional radiology ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,ST Elevation Myocardial Infarction ,Female ,Radiology ,business ,Cardiac - Abstract
Objectives T2*-weighted (T2*w) is deemed as a reference standard for post-infarction intramyocardial haemorrhage (IMH). However, high proportion of T2* images is affected by off-resonance artefacts hampering image interpretation. Diagnostic accuracy and precision of alternative techniques for IMH diagnosis and quantification have been seldomly investigated. Methods and results Between April 2016 and May 2017, 50 ST-segment elevation myocardial infarction patients (66% male, 57 ± 17 years) and 15 healthy controls (60% male, 58 ± 13) were consecutively enrolled. Subjects underwent head-to-head comparison of single mid-infarct slice acquired on black-blood T2-weighted short-TI-inversion recovery (T2w-STIR), bright-blood T2prep-steady-state-free precession (T2prep-SSFP), and T2/T1 maps for IMH diagnosis and quantification against T2*w. All images were graded for quality (grade 1: very poor; grade 4: excellent) and diagnostic confidence (Likert scale, 1: very unsure and 5: highly confident). Reduced relaxation time/hypointense region (hypocore) embedded in infarct-related oedema on T2 map, T1 map, and T2w-STIR had the best overall diagnostic accuracy (per-subject: 91%, 86%, and 86%, respectively; per segment: 95%, 93%, and 93%, respectively). By mixed-effects analysis, image quality, and diagnostic confidence were higher for T2 map and T1 maps than T2*w (p r > 0.7, p Conclusion Hypocore on T2/T1 map is the best alternative technique to T2*w for diagnosing and quantifying IMH in post-STEMI patients. Key Point • Mapping techniques are the best alternatives for diagnosing post-infarction intramyocardial haemorrhage. • Mapping techniques are valuable tools for imaging intramyocardial haemorrhage.
- Published
- 2020
47. Echocardiography versus computed tomography and cardiac magnetic resonance for the detection of left heart thrombosis: a systematic review and meta-analysis
- Author
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Pier Giorgio Masci, Kimon Stamatelopoulos, Eleni Kollia, Georgios Ntritsos, Georgios Georgiopoulos, Dimitrios Delialis, Alberto Aimo, Andrea Barison, Dimitrios Klettas, Stefano Figliozzi, and Michele Emdin
- Subjects
medicine.medical_specialty ,Receiver operating characteristic ,business.industry ,Area under the curve ,General Medicine ,030204 cardiovascular system & hematology ,medicine.disease ,Thrombosis ,Confidence interval ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Ventricle ,Internal medicine ,Meta-analysis ,medicine ,Diagnostic odds ratio ,Cardiology ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
Accurate and reproducible diagnostic techniques are essential to detect left-sided cardiac thrombi [either in the left ventricle (LV) or in the left atrial appendage (LAA)] and to guide the onset and duration of antithrombotic treatment while minimizing the risk for thromboembolic and hemorrhagic events. We conducted a systematic review and meta-analysis aiming to compare the diagnostic performance of transthoracic echocardiography (TTE) vs. cardiac magnetic resonance (CMR) for the detection of LV thrombi, and transesophageal echocardiography (TEE) vs. computed tomography (CT) for the detection of LAA thrombi. Six studies were included in the first meta-analysis (TTE vs. CMR for LV thrombosis). Pooled sensitivity and specificity values were 62% [95% confidence interval (CI), 37–81%] and 97% (95% CI, 94–99%). The shape of the hierarchical summary receiver operating characteristic (HSROC) curve and the area under the curve (AUC) of 0.96 suggested a high accuracy. Ten studies were included in the second meta-analysis (CT versus TEE for LAA thrombosis). The pooled values of sensitivity and specificity were 97% (95% CI, 77–100%) and 94% (95% CI, 87–98%). The pooled diagnostic odds ratio (DOR) was 500 (95% CI, 52–4810), and the pooled likelihood ratios (LR + and LR−) were 17% (95% CI, 7–40%) and 3% (95% CI, 0–28%). The shape of the HSROC curve and 0.99 AUC suggested a high accuracy of CT vs. TEE. TTE is a fair alternative to DE-CMR for the identification of LV thrombi, while CT has a good accuracy compared to TEE for the detection of LAA thrombosis. CRD42020185842.
- Published
- 2020
48. CINENet: deep learning-based 3D cardiac CINE MRI reconstruction with multi-coil complex-valued 4D spatio-temporal convolutions
- Author
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René M. Botnar, Thomas Küstner, Reza Hajhosseiny, Kerstin Hammernik, Daniel Rueckert, Haikun Qi, Radhouene Neji, Pier Giorgio Masci, Claudia Prieto, Niccolo Fuin, Aurelien Bustin, and Engineering & Physical Science Research Council (EPSRC)
- Subjects
0301 basic medicine ,Male ,Computer science ,Image quality ,lcsh:Medicine ,Breath Holding ,0302 clinical medicine ,Multi coil ,Computational models ,Computer vision ,Prospective Studies ,lcsh:Science ,Multidisciplinary ,Ejection fraction ,medicine.diagnostic_test ,Computational science ,Healthy subjects ,Complex valued ,Middle Aged ,Cine mri ,Cine imaging ,Cardiovascular Diseases ,Three-dimensional imaging ,Female ,Biomedical engineering ,Adult ,Cardiology ,Magnetic Resonance Imaging, Cine ,Article ,03 medical and health sciences ,Magnetic resonance imaging ,Deep Learning ,Imaging, Three-Dimensional ,Spatio-Temporal Analysis ,Image processing ,Machine learning ,Image Interpretation, Computer-Assisted ,medicine ,Humans ,business.industry ,Deep learning ,lcsh:R ,Data acquisition ,030104 developmental biology ,Case-Control Studies ,lcsh:Q ,Artificial intelligence ,business ,030217 neurology & neurosurgery - Abstract
Cardiac CINE magnetic resonance imaging is the gold-standard for the assessment of cardiac function. Imaging accelerations have shown to enable 3D CINE with left ventricular (LV) coverage in a single breath-hold. However, 3D imaging remains limited to anisotropic resolution and long reconstruction times. Recently deep learning has shown promising results for computationally efficient reconstructions of highly accelerated 2D CINE imaging. In this work, we propose a novel 4D (3D + time) deep learning-based reconstruction network, termed 4D CINENet, for prospectively undersampled 3D Cartesian CINE imaging. CINENet is based on (3 + 1)D complex-valued spatio-temporal convolutions and multi-coil data processing. We trained and evaluated the proposed CINENet on in-house acquired 3D CINE data of 20 healthy subjects and 15 patients with suspected cardiovascular disease. The proposed CINENet network outperforms iterative reconstructions in visual image quality and contrast (+ 67% improvement). We found good agreement in LV function (bias ± 95% confidence) in terms of end-systolic volume (0 ± 3.3 ml), end-diastolic volume (− 0.4 ± 2.0 ml) and ejection fraction (0.1 ± 3.2%) compared to clinical gold-standard 2D CINE, enabling single breath-hold isotropic 3D CINE in less than 10 s scan and ~ 5 s reconstruction time.
- Published
- 2020
49. Multi‐parametric liver tissue characterization using MR fingerprinting: Simultaneous T 1 , T 2 , T 2 *, and fat fraction mapping
- Author
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Gastao Cruz, Torben Schneider, Cristobal Arrieta, Claudia Prieto, René M. Botnar, Pier Giorgio Masci, Aurelien Bustin, Carlos Sing-Long, Olivier Jaubert, and Georgios Georgiopoulos
- Subjects
Multi parametric ,medicine.disease ,Radial trajectory ,Imaging phantom ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Liver disease ,0302 clinical medicine ,Liver tissue ,medicine ,Radiology, Nuclear Medicine and imaging ,Golden angle ,030217 neurology & neurosurgery ,Gradient echo ,Fat fraction ,Biomedical engineering ,Mathematics - Abstract
Purpose Quantitative T1 , T2 , T2 *, and fat fraction (FF) maps are promising imaging biomarkers for the assessment of liver disease, however these are usually acquired in sequential scans. Here we propose an extended MR fingerprinting (MRF) framework enabling simultaneous liver T1 , T2 , T2 *, and FF mapping from a single ~14 s breath-hold scan. Methods A gradient echo (GRE) liver MRF sequence with nine readouts per TR, low flip angles (5-15°), varying magnetisation preparation and golden angle radial trajectory is acquired at 1.5T to encode T1 , T2 , T2 *, and FF simultaneously. The nine-echo time-series are reconstructed using a low-rank tensor constrained reconstruction and used to fit T2 *, B0 and to separate the water and fat signals. Water- and fat-specific T1 , T2, and M0 are obtained through dictionary matching, whereas FF estimation is extracted from the M0 maps. The framework was evaluated in a standardized T1 /T2 phantom, a water-fat phantom, and 12 subjects in comparison to reference methods. Preliminary clinical feasibility is shown in four patients. Results The proposed water T1 , water T2 , T2 *, and FF maps in phantoms showed high coefficients of determination (r2 > 0.97) relative to reference methods. Measured liver MRF values in vivo (mean ± SD) for T1 , T2 , T2 *, and FF were 671 ± 60 ms, 43.2 ± 6.8 ms, 29 ± 6.6 ms, and 3.2 ± 2.6% with biases of 92 ms, -7.1 ms, -1.4 ms, and 0.63% when compared to conventional methods. Conclusion A nine-echo liver MRF sequence allows for quantitative multi-parametric liver tissue characterization in a single breath-hold scan of ~14 s. Future work will aim to validate the proposed approach in patients with liver disease.
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- 2020
50. Isotropic 3D Cartesian single breath‐hold CINE MRI with multi‐bin patch‐based low‐rank reconstruction
- Author
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Thomas Küstner, Radhouene Neji, Reza Hajhosseiny, René M. Botnar, Aurelien Bustin, Pier Giorgio Masci, Olivier Jaubert, and Claudia Prieto
- Subjects
Ejection fraction ,business.industry ,Magnetic Resonance Imaging, Cine ,Reproducibility of Results ,030218 nuclear medicine & medical imaging ,Breath Holding ,03 medical and health sciences ,Imaging, Three-Dimensional ,0302 clinical medicine ,Compressed sensing ,Sampling (signal processing) ,Temporal resolution ,Image Interpretation, Computer-Assisted ,Humans ,Radiology, Nuclear Medicine and imaging ,Multislice ,Golden angle ,Nuclear medicine ,business ,030217 neurology & neurosurgery ,Spiral ,Mathematics ,Volume (compression) - Abstract
Purpose To develop a novel acquisition and reconstruction framework for isotropic 3D Cartesian cardiac CINE within a single breath-hold for left ventricle (LV) and whole-heart coverage. Methods A variable-density Cartesian acquisition with spiral profile ordering, out-inward sampling, and acquisition-adaptive alternating tiny golden/golden angle increment between spiral arms is proposed to provide incoherent and nonredundant sampling within and among cardiac phases. A novel multi-bin patch-based low-rank reconstruction, named MB-PROST, is proposed to exploit redundant information on a local (within a patch), nonlocal (similar patches within a spatial neighborhood), and temporal (among all cardiac phases) scale with an implicit motion alignment among patches. The proposed multi-bin patch-based low-rank reconstruction reconstruction is compared against compressed sensing reconstruction, whereas LV function parameters derived from the proposed 3D CINE framework are compared against those estimated from conventional multislice 2D CINE imaging in 10 healthy subjects and 15 patients. Results The proposed framework provides 3D cardiac CINE images with high spatial (1.9 mm3 ) and temporal resolution (˜50 ms) in a single breath-hold of ˜20 s for LV and ˜26 s for whole-heart coverage in healthy subjects. Shorter breath-hold durations of ˜13 to 15 s are feasible for LV coverage with slightly anisotropic resolution (1.9 × 1.9 × 2.5 mm) in patients. LV function parameters derived from 3D CINE were in good agreement with 2D CINE, with a bias of -0.1 mL/0.1 mL, -0.9 mL/-1.0 mL, -0.1%/-0.8%; and confidence intervals of ±1.7 mL/±3.7 mL, ±1.2 mL/±2.6 mL, and ±1.2%/±3.6% (10 healthy subjects/15 patients) for end-systolic volume, end-diastolic volume, and ejection fraction, respectively. Conclusion The proposed framework enables 3D isotropic cardiac CINE in a single breath-hold scan of ˜20 s/˜26 s for LV/whole-heart coverage, showing good agreement with clinical 2D CINE scans in terms of LV functional assessment.
- Published
- 2020
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