Elevated T2 Research Articles

A dyadic analysis of financial toxicity and health-related quality of life among bone marrow transplant patients and their caregivers.

Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads. Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM). Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not. Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients.

Non-invasive assessment and visualization of Phytophthora cactorum infection in strawberry crowns using quantitative magnetic resonance imaging

Phytophthora cactorum is an oomycete species that causes enormous losses on horticultural crops, including strawberries. The purpose of this work was to investigate the alterations caused by P. cactorum inoculation in hydroponically grown strawberry plantlets (Fragaria × ananassa Duch.) using quantitative magnetic resonance imaging (qMRI). It was observed that with MRI, spatial and temporal progression of the infection could be observed in the crown using quantitative MR parameters, namely relaxation time maps. Relaxation times are numeric subject-specific properties that describe the MR signal behavior in an examined anatomical region. Elevated T2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T_{2}$$\\end{document} relaxation time values were observed inside the infected plant crowns with respect to the healthy references. The T2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T_{2}$$\\end{document} and T2∗\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T_{2}^{*}$$\\end{document} values of healthy plants were small in the crown region and further diminished during the development of the plant. Furthermore, elevated T1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$T_{1}$$\\end{document} relaxation time values were seen in regions where P. cactorum progression was observed in corresponding plant dissection photographs. Quantitative susceptibility maps (QSM) were calculated to estimate the local magnetic field inhomogeneities. The QSM suggests magnetic susceptibility differences near the center of the pith. This study provides novel non-invasive information on the structure and development of strawberry plants and the effects caused by the P. cactorum infection.

IL-13 and IL-13–induced periostin levels are specifically decreased in patients following endoscopic sinus surgery for chronic rhinosinusitis

BackgroundType 2 (T2) inflammation plays a pathogenic role in chronic rhinosinusitis (CRS) effects of endoscopic sinus surgery (ESS) on T2 inflammation are unknown. ObjectiveTo compare T2 inflammatory biomarkers from middle meatal (MM) mucus for distinguishing CRS from non-CRS patients, identifying major phenotypes (CRS without (CRSsNP) and with nasal polyps (CRSwNP)), assessing endotypic change and establishing cross-sectional and longitudinal outcomes in patients undergoing ESS. MethodsMM mucus samples were collected from CRSsNP and CRSwNP patients before and 6-12 months after ESS and compared to non-CRS control patients. T2 biomarkers were evaluated continuously, using threshold-based definitions of T2 endotype, and for relationships with patient-reported (SNOT-22 and CRS-PRO) and clinician-reported (radiographic and endoscopic) severity. Linear mixed models were developed to analyze clinical variables associated with T2 biomarker levels. Results154 CRS patients (89 CRSsNP, 65 CRSwNP) were enrolled with a mean 9-month interval between ESS and follow-up. Pre-ESS MM mucus analysis revealed elevated T2 mediators in CRSwNP vs. CRSsNP and non-CRS controls. Temporally stable correlations between IL-13 and IL-5; periostin and C5a; and ECP and CCL26 was observed. On this basis and pathologic significance, IL-13, periostin and ECP were further analyzed. Post-ESS, IL-13 and periostin levels decreased significantly, ECP levels remained unchanged. Across pre- and post-ESS evaluation, the T2 endotype was associated with radiographic severity but did not predict outcomes. CRSwNP status and African American race were associated with higher levels of IL-13 and periostin, whereas ECP was higher in patients undergoing extensive surgery. ConclusionESS decreased IL-13 and periostin in MM. T2 inflammation post-ESS correlated with patient- and clinician-reported severity across phenotypes. Pre-ESS T2 inflammation did not predict post-ESS outcomes.

Cardiac magnetic resonance assessment of acute rejection and cardiac allograft vasculopathy in pediatric heart transplant

In pediatric heart transplant (PHT), cardiac catheterization with endomyocardial biopsy (EMB) is standard for diagnosing acute rejection (AR) and cardiac allograft vasculopathy (CAV) but is costly and invasive. To evaluate the ability of cardiac magnetic resonance (CMR) to noninvasively identify differences in PHT patients with AR and CAV. Patients were enrolled at three children's hospitals. Data were collected from surveillance EMB or EMB for-cause AR. Patients were excluded if they had concurrent diagnoses of AR and CAV, CMR obtained >7days from AR diagnosis, they had EMB negative AR, or could not undergo contrasted, unsedated CMR. Kruskal-Wallis test was used to compare groups: (1) No AR or CAV (Healthy), (2) AR, (3) CAV. Wilcoxon rank-sum test was used for pairwise comparisons. Fifty-nine patients met inclusion criteria (median age 17years [IQR 15-19]) 10 (17%) with AR, and 11 (19%) with CAV. AR subjects had worse left ventricular ejection fraction compared to Healthy patients (p=0.001). Global circumferential strain (GCS) was worse in AR (p=0.054) and CAV (p=0.019), compared to Healthy patients. ECV, native T1, and T2 z-scores were elevated in patients with AR. CMR was able to identify differences between CAV and AR. CAV subjects had normal global function but abnormal GCS which may suggest subclinical dysfunction. AR patients have abnormal function and tissue characteristics consistent with edema (elevated ECV, native T1 and T2 z-scores). Characterization of CMR patterns is critical for the development of noninvasive biomarkers for PHT and may decrease dependence on EMB.

Multiparametric Cardiovascular MRI Assessment of Post-COVID Syndrome in Children in Comparison to Matched Healthy Individuals.

Post-COVID syndrome (PCS) can adversely affect the quality of life of patients and their families. In particular, the degree of cardiac impairment in children with PCS is unknown. The aim of this study was to identify potential cardiac inflammatory sequelae in children with PCS compared with healthy controls. This single-center, prospective, intraindividual, observational study assesses cardiac function, global and segment-based strains, and tissue characterization in 29 age- and sex-matched children with PCS and healthy children using a 3 T magnetic resonance imaging (MRI). Cardiac MRI was carried out over 36.4 ± 24.9 weeks post-COVID infection. The study cohort has an average age of 14.0 ± 2.8 years, for which the majority of individuals experience from fatigue, concentration disorders, dyspnea, dizziness, and muscle ache. Children with PSC in contrast to the control group exhibited elevated heart rate (83.7 ± 18.1 beats per minute vs 75.2 ± 11.2 beats per minute, P = 0.019), increased indexed right ventricular end-diastolic volume (95.2 ± 19.2 mlm -2 vs 82.0 ± 21.5 mlm -2 , P = 0.018) and end-systolic volume (40.3 ± 7.9 mlm -2 vs 34.8 ± 6.2 mlm -2 , P = 0.005), and elevated basal and midventricular T1 and T2 relaxation times ( P < 0.001 to P = 0.013). Based on the updated Lake Louise Criteria, myocardial inflammation is present in 20 (69%) children with PCS. No statistically significant difference was observed for global strains. Cardiac MRI revealed altered right ventricular volumetrics and elevated T1 and T2 mapping values in children with PCS, suggestive for a diffuse myocardial inflammation, which may be useful for the diagnostic workup of PCS in children.

Cognitive decline in thrombotic thrombocytopenic purpura survivors: The role of white matter health as assessed by MRI.

Immune-mediated thrombotic thrombocytopenic purpura (iTTP) is a rare condition caused by severe ADAMTS13 deficiency, leading to platelet aggregation and thrombosis. Despite treatment, patients are prone to cognitive impairment and depression. We investigated brain changes in iTTP patients during remission using advanced magnetic resonance imaging (MRI) techniques, correlating these changes with mood and neurocognitive tests. Twenty iTTP patients in remission (30 days post-haematological remission) were compared with six healthy controls. MRI scans, including standard and specialized sequences, were conducted to assess white matter health. Increased T1 relaxation times were found in the cingulate cortex (p < 0.05), and elevated T2 relaxation times were observed in the cingulate cortex, frontal, parietal and temporal lobes (p < 0.05). Pathological changes in these areas are correlated with impaired cognitive and depressive scores in concentration, short-term memory and verbal memory. This study highlights persistent white matter damage in iTTP patients, potentially contributing to depression and cognitive impairment. Key regions affected include the frontal lobe and cingulate cortex. These findings have significant implications for the acute and long-term management of iTTP, suggesting a need for re-evaluation of treatment approaches during both active phases and remission. Further research is warranted to enhance our understanding of these complexities.

Investigating the cardiac manifestations of IgG4-related disease using cardiac magnetic resonance imaging

Abstract Introduction IgG4-related disease (IgG4-RD) is a relapsing-remitting immune-mediated condition that affects multiple organ systems. Case reports of suspected cardiovascular involvement in IgG4-RD have emerged though no study has systematically assessed the cardiovascular phenotype of IgG4-RD using cardiac magnetic resonance (CMR) imaging. Purpose We systematically assessed patients with IgG4-RD using CMR to identify the cardiovascular manifestations, and compared them to controls. Methods We recruited 11 patients with histologically-confirmed IgG4-RD (6 female, 61±11 years, 9 with active disease (8 with pancreatic involvement, 3 parotid, 5 bile ducts, 5 kidneys and 3 cardiovascular)). Patients underwent CMR at 1.5T including cine, myocardial tagging, native T1-mapping, late gadolinium enhancement (LGE), extracellular volume (ECV) and quantitative stress perfusion mapping. Results were compared to 10 healthy controls with no cardiac disease (50% female, 35±8 years). Results are presented as mean ± standard deviation (SD) unless otherwise stated. Results Patients with IgG4-RD had similar cardiac geometry to the reference group (Table 1), with similar biventricular and bi-atrial volumes. However, despite similar biventricular ejection fractions compared to controls (patient LVEF: 55-67%, RVEF: 51-65%), IgG4-RD patients showed significantly reduced global longitudinal strain (GLS) (-16.8 ± 2.3% vs -18.7 ± 1.6%, p=0.045). Furthermore, 64% (7/11) of IgG4-RD patients showed LGE, 6 of whom showed non-ischaemic patterns (Figure 1). Male IgG4-RD patients (n=5) as a group showed a significantly higher average myocardial T1 value relative to the reference group, with 3/5 male patients having an abnormally high myocardial T1 (above the 2SD limit of normal). Female IgG4-RD patients (n=6) had similar and normal myocardial T1 values to the reference group. ECV did not significantly differ between the two groups. IgG4-RD patients showed a significantly reduced global myocardial perfusion reserve (MPR), including two patients with a qualitative inducible perfusion defect. Only 3 out of the 11 IgG4-RD patients had a completely normal CMR. Conclusion Patients with IgG4-RD show frequent cardiac abnormalities as revealed by advanced CMR phenotyping. These include subclinical systolic dysfunction, ischaemic and non-ischaemic myocardial fibrosis, reduced myocardial perfusion reserve, and elevated myocardial T1 times. These abnormalities have been described in inflammatory cardiovascular diseases, supporting a plausible pathophysiological link with IgG4-RD. Future work in larger and multicentre cohorts is warranted, to systematically define the novel cardiovascular phenotype of IgG4-RD.Table 1Figure 1

Myocardial edema measured by T2 mapping is an independent predictor of ventricular arrhythmias in hypertrophic cardiomyopathy

Abstract Introduction Clinical outcome of patients with hypertrophic cardiomyopathy (HCM) largely depends on ventricular arrhythmias. Parametric T2 mapping from Cardiac MRI (CMR) was found to be a measure of myocardial edema. We sought to study whether elevated T2 values on CMR in patients with hypertrophic cardiomyopathy (HCM) might predict ventricular arrhythmias (VA) and adverse clinical outcome. Methods Consecutive patients with HCM (n = 59) and healthy volunteers (n = 21) underwent 3 Tesla CMR. T2 mapping values were independently analyzed by 2 independent readers and presented using a 16-segment AHA model. VA was recorded by 24-hour Holter monitoring and/or during exercise stress test. Composite outcome was defined as ventricular tachycardia (VT) per Holter and/or ergometry, admission due to arrhythmias, ICD insertion and all-cause mortality. Statistical analysis was a t-test for VA and multi-variant logistic regression model adjusted for age and gender. Results Septal and apical variants of HCM were found in 42 and 17 patients, respectively. We found good interobserver agreement in T2 values (ICC=0.92, 95% CI 0.86 - 0.96, p value &amp;lt;0.001). The 3rd tertile of T2 values (48 ± 8 msec) was significantly associated with VA 92% vs. 57 and 40% in lower tertiles, p = 0.02. Logistic regression analysis showed the 3rd tertile was an independent predictor of composite outcome (VT per Holter and/or ergometry, admission due to arrhythmias, ICD and all-cause mortality) OR 95% CI = 22.8 (1.4 - 361.6), p = 0.026. ROC analysis to find best cut-off of T2 for prediction of outcome showed AUC 0.7 (Figure 1). Conclusion Elevated T2 is an independent predictor of VA and adverse outcome in HMC patients. These results suggest the impact of myocardial edema in myocardial disease activity in HCM.ROC analysis to find best cut-off of T2

Abstract 16260: Children With Increased Native T1, Extracellular Volume and T2 Values on Initial Cardiac Magnetic Resonance Imaging for Acute Myocarditis Have Less Improvement in Late Gadolinium Enhancement on Follow Up Imaging: Risk Factor for Adverse Events?

Introduction: Late gadolinium enhancement (LGE) in pediatric patients with acute myocarditis has been shown to be a risk factor for adverse events. On follow up cardiac magnetic resonance imaging (CMR), some patients show improvement and/or resolution of LGE but others do not. Factors associated with residual LGE have not been described. Hypothesis: Measurements on initial CMR would be associated with degree of improvement of LGE on follow up CMR. Methods: We conducted a retrospective cohort study of patients &lt;21 years with acute myocarditis who underwent initial CMR within 14 days of presentation and returned for follow up CMR. Those who suffered cardiac arrest or with autoimmune disease, known cardiomyopathy or congenital heart disease were excluded. LGE was defined as tissue with signal intensity 5 standard deviations above mean signal intensity of unaffected myocardium on viability imaging; this mass was measured and indexed to total left ventricular mass. Strain was measured using CMR feature tracking. Spearman’s correlation was used to determine associations between change in indexed LGE mass on follow up CMR to values from initial CMR. Results: We enrolled 36 patients aged 16.4 years (IQR 14.9-17.2 years) with median time to follow up CMR 229 days (IQR 171, 407). Native T1 (Figure 1), T2, peak T2 relaxation times and ECV on initial CMR inversely correlated with change in indexed LGE mass on follow up CMR while indexed right ventricular end diastolic volume (RVEDVi) on initial CMR positively correlated. (Table 1) Strain and ventricular function did not correlate with change in LGE mass on follow up CMR. Conclusions: Elevated T1 and T2 values and ECV on initial CMR in patients with acute myocarditis are associated with less improvement of LGE on follow up CMR; increased RVEDVi was associated with greater improvement. Further work is needed to determine which are the most useful predictors of residual LGE following myocarditis in children.

Abstract 13651: Pembrolizumab Associated Myocarditis, Myasthenia Gravis, and Myositis

Case: A 71 year old man presented with acute generalized muscle weakness, double vision, sagging eye lids, weakness with swallowing, shortness of breath, and dark urine. History was notable for stage IV non-small cell lung cancer with second dose of pembrolizumab therapy completed 12 days earlier. Exam showed bilateral ptosis and muffled speech. He had increased work of breathing, tachypnea, 3/5 strength in the bilateral lower extremities, and 5/5 strength in the upper extremities. His initial NIF was -25. Labs were notable for troponin of 1532, CK 16229, ESR 100, CRP 8.8, ALT 225, and AST 648. EKG revealed a new right bundle branch block and left posterior fascicular block. TTE showed EF of 65% without regional wall motion abnormalities. Cardiac MRI showed mildly elevated T1 and T2 relaxation times, suggestive of diffuse myocardial edema and inflammation without delayed gadolinium enhancement. He was treated with high dose steroids, fluid resuscitation, IVIG, and briefly pyridostigmine. On hospital day 8, he was found to have complete AV block with junctional escape rhythm. He had urgent placement of a temporary pacemaker. He was started on abatacept, ruxolitinib, and oral prednisone. Over the next 14 days he made gradual improvement. Discussion: While ICI-associated myocarditis is rare, it is worth investigating due to the high mortality. The clinical presentation can range from asymptomatic troponin elevations to cardiogenic shock and ventricular arrhythmias/AV block. Diagnosis requires a high index of suspicion and multiple diagnostic modalities, including ECG, echocardiography, serum biomarkers, and often cardiac MRI and endomyocardial biopsy. There is a large overlap between myocarditis and myositis. The mainstay treatments of ICI-induced myocarditis include holding the offending immune-checkpoint inhibitor, high-dose corticosteroids, and guideline-directed medical therapy for associated heart failure or arrhythmias. Abatacept, a cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) immunoglobulin fusion protein, and ruxolitinib, a JAK 1/2 inhibitor, have recently been suggested as a novel combination to reduce mortality from ICI-associated myocarditis with concomitant myositis.

Abstract 18714: Myocardial Infarction With Non-Obstructive Coronary Artery Disease in a Young Woman - The Cardinal Role of Coronary Reactivity Testing in Unveiling the Underlying Etiology

43-year old female presented to the emergency department with substernal chest pain. She had similar symptoms years ago without obstructive CAD on coronary angiogram and was diagnosed with myocarditis. Presenting ECG revealed new anterolateral T wave inversions (Fig 1), and high-sensitivity troponins peaked at 322 ng/L consistent with NSTEMI. TTE was significant for global hypokinesis of the left ventricle with a reduced ejection fraction of 35 to 40%. Invasive coronary angiogram showed no obstructive CAD or spontaneous coronary artery dissection however there was reduced flow in the mid to distal LAD raising suspicion for endothelial and microvascular dysfunction. Contrast-enhanced cardiac MRI showed myocardial edema in the anterior and anteroseptal walls with elevated myocardial T1 and T2 values, and early enhancement post gadolinium administration showed an acute LAD territorial infarct (Fig 2). Findings were consistent with myocardial infarction with non-obstructive coronary artery disease (MINOCA). She was started on carvedilol for empiric treatment of coronary artery spasm and microvascular dysfunction, along with aspirin and atorvastatin. Losartan was added for heart failure management. Outpatient invasive coronary reactivity testing showed severe epicardial (70% vasoconstriction) and microvascular (80% decrease in coronary blood flow) endothelial dysfunction in response to acetylcholine (Fig 3 and Fig 4) as underlying etiology of recent MINOCA. CFR was normal. L-arginine (NO precursor) was added to the medical regimen. Patient has not had recurrence of chest pain or ACS at 1 year follow-up and LVEF normalized on repeat echocardiogram. This case shows the importance of cardiac MRI in confirming the diagnosis of MINOCA in patients with no obstructive CAD, and the crucial role of coronary reactivity testing in diagnosing and treating severe coronary endothelial dysfunction, which is aligned with the AHA/ACC MINOCA consensus document.

Abstract 15484: Heart Transplantation in a Light-Chain Amyloidosis Patient at Mayo Stage IIIa After Anti-Plasma Cell Chemotherapy With Complete Remission

A 42-year-old female patient was admitted for lower limb edema. Laboratory tests showed nephrotic proteinuria (2.76g/24h). Serum-free λ light chains were 84.9 mg/L, with a κ/λ ratio of 0.12. Bone marrow examination detected 6% immature clonal plasma cells. Amyloid deposition was identified in a renal biopsy. Cardiac magnetic resonance (CMR) revealed normal left ventricular ejection fraction (LVEF), left ventricular circumferential late gadolinium enhancement (LGE), and elevated myocardial T1 value (1459ms) and extracellular volume (47.4%). She was diagnosed with AL amyloidosis and classed as IIIa by the Mayo Stage 2004. A hematologic complete response (CR) was achieved and sustained after treatment with sequencing cyclophosphamide, bortezomib, dexamethasone (CyBorD) and daratumumab regimen. The follow-up CMRs were underwent at 6, 12, and 18 months after starting chemotherapy, which monitored cardiac changes in reponse to CR. Unfortunately, there was no alleviation of cardiac involvement. CMR re-examination (at 42 months) revealed severe cardiac function impairment (LVEF 28%), and dramatically increased extracellular volume (66.2%). Then, she underwent heart transplantation (HTx) evaluated by the heart transplantation multidisciplinary team. Three months later, she was doing well, CMR demonstrated stable cardiac allograft function. Repeated endomyocardial biopsies showed no amyloid deposits. This case illustrates that cardiac amyloid deposition might be a dynamic process in AL amyloidosis and highlights the value of CMR in long-term monitoring and identifying the patients reached CR who need HTx.

Abstract 16396: A Tale of Two Maladies: An Interplay of Mendelian Principles

A 22-year-old male with no medical history presented in acute decompensated heart failure and cardiogenic shock. Physical exam showed a thin body habitus, reduced muscle bulk, bilateral ptosis, limited extraocular motion, and upper extremity weakness. An echocardiogram revealed severe biventricular dilation and systolic dysfunction. Invasive hemodynamics revealed elevated cardiac filling pressures and low cardiac output. Coronary angiography excluded coronary artery disease and anatomical variants. He was initiated on dobutamine and eventually milrinone given persistently low index and elevated lactate. An evaluation for the etiology of his cardiomyopathy focused on nutritional deficiencies (e.g., Wet Beriberi), myocarditis, genetic mutations, infiltrative cardiomyopathy (e.g., Friedrich’s ataxia), and mitochondrial and myopathy-related cardiomyopathy. CMR had globally elevated T1 and normal T2 values ruling out acute myocarditis or infiltrative processes. Serum thiamine, TSH and B12 were within normal range. Muscle biopsy and mitochondrial genetic testing revealed a pathogenic deletion (m.7416_14556) and 70% heteroplasmy. Physical exam, biopsy and mitochondrial genetics were diagnostic of Kearns-Sayre Syndrome (KSS). Notably KSS does not typically cause severe cardiomyopathy suggesting an alternative cause. A genetic cardiomyopathy panel was sent revealing a pathologic mutation in the plakophilin 2 gene which was the suspected cause of his cardiomyopathy. A heart transplant evaluation was initiated as he developed refractory shock requiring mechanical support via an Impella 5.5, placed via the right innominate artery due to his small body and vessel size. He underwent an uncomplicated heart transplantation and is doing well. This case underscores the significance of a broad differential diagnosis, multidisciplinary collaboration, and a detailed physical examination in diagnosing and managing complex cardiac conditions.

Accuracy of free-breathing multi-parametric SASHA in identifying T1 and T2 elevations in pediatric orthotopic heart transplant patients.

T1/T2 parametric mapping may reveal patterns of elevation ("hotspots") in myocardial diseases, such as rejection in orthotopic heart transplant (OHT) patients. This study aimed to evaluate the diagnostic accuracy of free-breathing (FB) multi-parametric SAturation recovery single-SHot Acquisition (mSASHA) T1/T2 mapping in identifying hotspots present on conventional Breath-held Modified Look-Locker Inversion recovery (BH MOLLI) T1 and T2-prepared balanced steady-state free-precession (BH T2p-bSSFP) maps in pediatric OHT patients. Pediatric OHT patients underwent noncontrast 1.5T CMR with BH MOLLI T1 and T2p-bSSFP and prototype FB mSASHA T1/T2 mapping in 8 short-axis slices. FB and BH T1/T2 hotspots were segmented using semi-automated thresholding (ITK-SNAP) and their 3D coordinate locations were collected (3-Matic, Materialise, Leuven, Belgium). Receiver operator characteristic curve analysis and measures of central tendency were utilized. 40 imaging datasets from 23 pediatric OHT patients were obtained. FB mSASHA yielded a sensitivity of 82.8% for T1 and 80% for T2 maps when compared to the standard BH MOLLI, as well as 100% specificity for both T1 and T2 maps. When identified on both FB and BH maps, hotspots overlapped in all cases, with an average long axis offset between FB and BH hotspot centers of 5.8mm (IQR 3.5-8.2) on T1 and 5.9mm (IQR 3.5-8.2) on T2 maps. FB mSASHA T1/T2 maps can identify hotspots present on conventional BH T1/T2 maps in pediatric patients with OHT, with high sensitivity, specificity, and overlap in 3D space. Free-breathing mapping may improve patient comfort and facilitate OHT assessment in younger patient populations.

Validation of a deep learning-based software for automated analysis of T2 mapping in cardiac magnetic resonance imaging.

The reliability and diagnostic performance of deep learning (DL)-based automated T2 measurements on T2 map of 3.0-T cardiac magnetic resonance imaging (MRI) using multi-institutional datasets have not been investigated. We aimed to evaluate the performance of a DL-based software for measuring automated T2 values from 3.0-T cardiac MRI obtained at two centers. Eighty-three subjects were retrospectively enrolled from two centers (42 healthy subjects and 41 patients with myocarditis) to validate a commercial DL-based software that was trained to segment the left ventricular myocardium and measure T2 values on T2 mapping sequences. Manual reference T2 values by two experienced radiologists and those calculated by the DL-based software were obtained. The segmentation performance of the DL-based software and the non-inferiority of automated T2 values were assessed compared with the manual reference standard per segment level. The software's performance in detecting elevated T2 values was assessed by calculating the sensitivity, specificity, and accuracy per segment. The average Dice similarity coefficient for segmentation of myocardium on T2 maps was 0.844. The automated T2 values were non-inferior to the manual reference T2 values on a per-segment analysis (45.35 vs. 44.32 ms). The DL-based software exhibited good performance (sensitivity: 83.6-92.8%; specificity: 82.5-92.0%; accuracy: 82.7-92.2%) in detecting elevated T2 values. The DL-based software for automated T2 map analysis yields non-inferior measurements at the per-segment level and good performance for detecting myocardial segments with elevated T2 values compared with manual analysis.

Prevalence, Predictors and Diagnosis of Cardiac Amyloidosis in Patients with Aortic Stenosis

Cardiac amyloidosis and aortic stenosis often share a common clinical phenotype, and are associated with morbidity and mortality if untreated. Cardiac amyloidosis is present in ~15% of patients with aortic stenosis. Clinical suspicion for cardiac amyloidosis in aortic stenosis is often raised based on history (bilateral carpal tunnel syndrome, severe lumbar spinal stenosis, spontaneous biceps rupture), chronic troponin elevation, electrocardiographic features (low-voltage criteria, pseudoinfarct pattern), echocardiogram (bilateral ventricular hypertrophy, abnormal longitudinal strain) and magnetic resonance imaging (late gadolinium enhancement, elevated T1 and T2). Eventual diagnosis of cardiac amyloidosis is based either on pyrophosphate nuclear scintigraphy or tissue biopsy depending on which subtype of cardiac amyloidosis is suspected.

Examining Maternal Cardiometabolic Markers in Pregnancy on Child Emotional and Behavior Trajectories: Using Growth Curve Models on a Cohort Study

BackgroundPoor maternal cardiometabolic health in pregnancy is associated with negative effects on child health outcomes, but there is limited literature on child and adolescent socioemotional outcomes. The study aimed to investigate associations between maternal cardiometabolic markers during pregnancy with child and adolescent socioemotional trajectories. MethodsGrowth curve models were run to examine how maternal cardiometabolic markers in pregnancy affected child socioemotional trajectories from ages 4 to 16. Models were adjusted for all pregnancy trimesters and maternal, child, and socioeconomic covariates. This study used the Avon Longitudinal Study of Parents and Children (United Kingdom) cohort. Participants consisted of mother-child pairs (N = 15,133). Maternal predictors of fasting glucose, triglycerides, high-density lipoprotein, low-density lipoprotein, and body mass index were taken from each pregnancy trimester (T1, T2, T3). Child outcomes included emotional problems, conduct problems, and hyperactivity problems from the Strengths and Difficulties Questionnaire. ResultsFully adjusted models showed significant associations between elevated T1 fasting glucose and increased conduct problems, higher T1 body mass index and increased hyperactivity problems, lowered T1 high-density lipoprotein and decreased hyperactivity problems, and elevated T2 triglycerides and increased hyperactivity problems. ConclusionsMaternal cardiometabolic risk is associated with conduct and hyperactivity outcomes from ages 4 to 16. This study suggests that maternal markers of fasting glucose, low-density lipoprotein, high-density lipoprotein, and triglycerides during pregnancy could be added as supplements for clinical measures of risk when predicting child and adolescent socioemotional trajectories.

Probing muscle recovery following downhill running using precise mapping of MRI T2 relaxation times.

Postexercise recovery rate is a vital component of designing personalized training protocols and rehabilitation plans. Tracking exercise-induced muscle damage and recovery requires sensitive tools that can probe the muscles' state and composition noninvasively. Twenty-four physically active males completed a running protocol consisting of a 60-min downhill run on a treadmill at -10% incline and 65% of maximal heart rate. Quantitative mapping of MRI T2 was performed using the echo-modulation-curve algorithm before exercise, and at two time points: 1 h and 48 h after exercise. T2 values increased by 2%-4% following exercise in the primary mover muscles and exhibited further elevation of 1% after 48 h. For the antagonist muscles, T2 values increased only at the 48-h time point (2%-3%). Statistically significant decrease in the SD of T2 values was found following exercise for all tested muscles after 1 h (16%-21%), indicating a short-term decrease in the heterogeneity of the muscle tissue. MRI T2 relaxation time constitutes a useful quantitative marker for microstructural muscle damage, enabling region-specific identification for short-term and long-term systemic processes, and sensitive assessment of muscle recovery following exercise-induced muscle damage. The variability in T2 changes across different muscle groups can be attributed to their different role during downhill running, with immediate T2 elevation occurring in primary movers, followed by delayed elevation in both primary and antagonist muscle groups, presumably due to secondary damage caused by systemic processes.

Hepatic t1 mapping: a new easily obtained biomarker for heart failure patients undergoing cardiac magnetic resonance

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Hepatic venous pressure overload and subsequent liver damage are frequent in patients with Chronic Heart Failure (CHF) but are difficult to quantify except in the late stages of disease. Myocardial T1 mapping is now commonly performed in patients undergoing cardiac magnetic resonance (CMR), with short axis images usually intercepting the liver, therefore allowing the opportunistic measurement of hepatic T1 values. Purpose The aim of this study was to quantify hepatic T1 values in HF patients undergoing CMR, and to assess its clinical and prognostic significance as a biomarker in this setting. Methods Consecutive patients with CHF (LVEF ≤ 50%) who underwent CMR at a single centre since Jan2019 were retrospectively identified. Those with known chronic liver disease, cardiac amyloidosis or suspected alcoholic cardiomyopathy were excluded. Native myocardial T1 mapping [MOLLI 5(3)3 sequence] basal short axis images were used to measure hepatic T1, with the region of interest drawn in the liver, avoiding organ vessels. A control group of subjects without known cardiovascular disease (n=57) was used to define the limits of normality for hepatic T1 values. The clinical significance of hepatic T1 values was assessed by its relationship with markers of right-sided CHF, and its prognostic value by the association with cardiovascular mortality. Results A total of 267 patients (mean age 62±15 years, 69% men, 38% with ischemic cardiomyopathy) were included. Median LVEF was 35% (IQR 26 – 44%) and median RVEF was 51% (IQR 40 – 59%). Overall, 46 patients (17%) had hepatic T1 values above 684 ms (the upper limit of normal for controls). Patients with elevated hepatic T1 had significantly higher RV volumes and lower RVEF (all p values &amp;lt;0.03). Hepatic T1 values were significantly higher in patients with RVEF&amp;lt;45% and in those with moderate or severe tricuspid regurgitation (Figure 1), and were also inversely correlated with RVEF (Spearman R −0.20, p&amp;lt;0.001). During a median follow-up period of 17 months (IQR 11–24), there were 11 cardiovascular deaths. Elevated hepatic T1 was associated with an increased risk of this endpoint (HR 3.04, 95%CI 1.02 – 9.11, p = 0.047). Conclusions Hepatic T1 values can be easily measured in standard myocardial T1 maps, are associated with markers of right-sided heart failure, and have prognostic value in patients with HF. Further studies are warranted to assess the potential clinical usefulness of this new biomarker.

Non-infarcted myocardium inflammation predicts outcomes after myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background ST segment elevated myocardial infarction (STEMI) is associated with a systemic inflammatory response. In animal model of STEMI, a sustained inflammatory response has also been described in the non-infarcted myocardium (NIM) with potential detrimental consequences for the left ventricular (LV) remodelling. Purpose to characterize inflammation of the NIM in relation with infarct size (IS) and other inflammatory markers and its prognostic role after STEMI. Methods 171 consecutive patients with STEMI who underwent CMR after primary angioplasty were analysed in terms of standard infarct characteristics. Inflammation of the NIM was assessed based on T2 mapping. The primary endpoint was major adverse cardiac events (MACE), defined as deaths, myocardial infarction (MI), unplanned non-infarct-related artery revascularization or re-hospitalization for heart failure at follow-up. Results NIM T2 values were directly correlated with IS (r=0.610; p&amp;lt;0.001), area at risk (r = 0.503, p &amp;lt;0.001) and inversely correlated with LVEF (−0.397, p &amp;lt;0.001). T2 values of NIM followed a bimodal distribution with a mean and median values of 45 ms. A total of 78 patients (46%) presented high, defined as above the median, T2 values. Patients with high, compared with non-high NIM T2 values, had lower LVEF (46.04±12.29% vs 54.63±10.99%, p &amp;lt; 0.001), larger IS (median value: 19.9 vs 9.0 gr p value &amp;lt; 0.001), greater AAR (median value: 25.00 vs 18.61 gr, p-value &amp;lt; 0.001), higher T2 values in the infarcted area (64.31±7.18 vs 61.53±5.44 ms, p 0.028), and more frequent MVO (60.3% vs 32.3%, p &amp;lt; 0.001). At logistic multivariable analyses, IS (OR 1.116, 95%CI 1.080 – 1.258, p &amp;lt; 0.001) and T2 values in the infarcted area (OR 1.102, 95%CI 1.007 – 1.206, p = 0.035), were the only independent predictors of high NIM T2 values. At median follow-up of 30 [27–34] months, patients with high (&amp;gt;45 ms) T2 values in the non-infarcted area incurred greater MACE risk (21.5% vs 7.7% for T2 values &amp;lt;45 ms, p &amp;lt;0.001). Multivariable Cox regression analysis showed that elevated NIM T2 values (HR 2.768, 95%CI 1.262 – 6.073, p = 0.011), LVEF&amp;lt;50% % (HR 2.182, 95%CI 1.058–4.497, p = 0.035) and larger IS (HR 2.830, 95%CI 1.303–6.149, p = 0.009) were independently associated with MACE occurrence (HR 2.126, 95%CI 1.023 – 4.417, p = 0.043) and myocardial re-infarction (HR 10.928, 95%CI 1.441 – 83.686, p = 0.021) after correction for the main CMR parameters. Conclusions High NIM T2 values after STEMI are independently associated with worse outcomes, mainly owing to higher MI risk. Importantly, the prognostic information of NIM T2 values was incremental in addition to established CMR outcome markers, including IS. Additional studies are needed to validate weather therapeutic interventions that influence remote zone native T2 improve event-free survival after revascularized STEMI or not.