End-diastolic Left Ventricular Mass Research Articles

Central Actions of Leptin Induce an Atrophic Pattern and Improves Heart Function in Lean Normoleptinemic Rats via PPARβ/δ Activation.

Leptin, acting centrally or peripherally, has complex effects on cardiac remodeling and heart function. We previously reported that central leptin exerts an anti-hypertrophic effect in the heart via cardiac PPARβ/δ activation. Here, we assessed the impact of central leptin administration and PPARβ/δ inhibition on cardiac function. Various cardiac properties, including QRS duration, R wave amplitude, heart rate (HR), ejection fraction (EF), end-diastolic left ventricular mass (EDLVM), end-diastolic volume (EDV), and cardiac output (CO) were analyzed. Central leptin infusion increased cardiac PPARβ/δ protein content and decreased HR, QRS duration, and R wave amplitude. These changes induced by central leptin suggested a decrease in the ventricular wall growth, which was confirmed by MRI. In fact, the EDLVM was reduced by central leptin while increased in rats co-treated with leptin and GSK0660, a selective antagonist of PPARβ/δ activity. In summary, central leptin plays a dual role in cardiac health, potentially leading to ventricular atrophy and improving heart function when PPARβ/δ signaling is intact. The protective effects of leptin are lost by PPARβ/δ inhibition, underscoring the importance of this pathway. These findings highlight the therapeutic potential of targeting leptin and PPARβ/δ pathways to combat cardiac alterations and heart failure, particularly in the context of obesity.

A retrospective study on the clinical significance of cardiac computed tomography in heart failure patients with preserved ejection fraction.

This study investigated the correlation between cardiac function parameters by cardiac computed tomography (CT) and the clinical outcomes of heart failure patients with preserved ejection fraction (HFpEF) to provide experimental data for the diagnosis of HFpEF. A total of 157 HFpEF patients admitted to our hospital from January 2017 to January 2019 were retrospectively analyzed. The patients were divided into event and non-event groups according to the occurrence or absence of adverse events. Cardiac function parameters, such as the left ventricular (LV) end-diastolic volume (LVEDV) and LV end-diastolic volume index (LVEDVI), were obtained via CT scan. Also, the N-terminal-pro hormone b-type natriuretic peptide (NT-proBNP) levels in patients' serum were measured using an enzyme linked immunosorbent assay (ELISA) kit, and echocardiographic parameters such as LV posterior wall thickness (LVPWT) were also recorded. Further, Cox regression was employed to analyze factors associated with the clinical outcomes. Compared with patients in the non-event group, the left ventricular end-diastolic mass (LVM), LVEDVI, left ventricular end-systolic volume index (LVESVI), left atrial end-diastolic volume index (LAEDVI), and left atrial end-systolic volume index (LAESVI) were significantly increased, and the left ventricular total emptying fraction (LVTEF) and left atrial total emptying fraction (LATEF) were markedly decreased in the event group patients. Also, the E/e' and LAEDVI were related factors affecting the clinical outcomes of HFpEF patients. The above indicators displayed a significant predictive for the clinical outcomes of HFpEF patients. Several cardiac function measures, including LAEDVI, are factors associated with the clinical outcomes of HFpEF patients.

Speckle tracking imaging combined with myocardial comprehensive index to evaluate left ventricular function changes in patients with systemic lupus erythematosus

AbstractObjectiveTo evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three‐dimensional speckle tracking imaging (3D‐STI).MethodsA total of 30 SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA‐SLEDAI) score: ≤ 12: mild‐to‐moderate group; > 12: severe group. All participants were examined using 3D‐STI, the 3D‐STI parameters were obtained. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among 3D‐STI parameters and high sensitivity‐TropT (hs‐TropT).ResultsCompared with the control group, the absolute values of left ventricular end‐diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist angle (LVtw), torsion (Tor) and myocardial comprehensive index (MCI) decreased, left ventricular end diastolic mass (LV EDmass), left ventricular end systolic mass (LV ESmass) and peak strain dispersion (PSD) increased in the mild‐to‐moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of 3D‐STI parameters between the mild‐to‐moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs‐TropT (r = − 0.677).Conclusion3D‐STI technology may help detect early changes in left ventricular systolic function in patients with SLE.

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs.

The development of heart failure is the most powerful predictor of long-term mortality in patients surviving acute myocardial infarction (MI). There is an unmet clinical need for prevention and therapy of post-myocardial infarction heart failure (post-MI HF). Clinically relevant pig models of post-MI HF are prerequisites for final proof-of-concept studies before entering into clinical trials in drug and medical device development. Here we aimed to characterize a closed-chest porcine model of post-MI HF in adult Göttingen minipigs with long-term follow-up including serial cardiac magnetic resonance imaging (CMRI) and to compare it with the commonly used Landrace pig model. MI was induced by intraluminal balloon occlusion of the left anterior descending coronary artery for 120 min in Göttingen minipigs and for 90 min in Landrace pigs, followed by reperfusion. CMRI was performed to assess cardiac morphology and function at baseline in both breeds and at 3 and 6 months in Göttingen minipigs and at 2 months in Landrace pigs, respectively. Scar sizes were comparable in the two breeds, but MI resulted in a significant decrease of left ventricular ejection fraction (LVEF) only in Göttingen minipigs, while Landrace pigs did not show a reduction of LVEF. Right ventricular (RV) ejection fraction increased in both breeds despite the negligible RV scar sizes. In contrast to the significant increase of left ventricular end-diastolic (LVED) mass in Landrace pigs at 2 months, Göttingen minipigs showed a slight increase in LVED mass only at 6 months. In summary, this is the first characterization of post-MI HF in Göttingen minipigs in comparison to Landrace pigs, showing that the Göttingen minipig model reflects post-MI HF parameters comparable to the human pathology. We conclude that the Göttingen minipig model is superior to the Landrace pig model to study the development of post-MI HF.

Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs

The development of heart failure is the most powerful predictor of long-term mortality in patients surviving acute myocardial infarction (MI). There is an unmet clinical need for prevention and therapy of post-myocardial infarction heart failure (post-MI HF). Clinically relevant pig models of post-MI HF are prerequisites for final proof-of-concept studies before entering into clinical trials in drug and medical device development. Here we aimed to characterize a closed-chest porcine model of post-MI HF in adult Göttingen minipigs with long-term follow-up including serial cardiac magnetic resonance imaging (CMRI) and to compare it with the commonly used Landrace pig model. MI was induced by intraluminal balloon occlusion of the left anterior descending coronary artery for 120 min in Göttingen minipigs and for 90 min in Landrace pigs, followed by reperfusion. CMRI was performed to assess cardiac morphology and function at baseline in both breeds and at 3 and 6 months in Göttingen minipigs and at 2 months in Landrace pigs, respectively. Scar sizes were comparable in the two breeds, but MI resulted in a significant decrease of left ventricular ejection fraction (LVEF) only in Göttingen minipigs, while Landrace pigs did not show a reduction of LVEF. Right ventricular (RV) ejection fraction increased in both breeds despite the negligible RV scar sizes. In contrast to the significant increase of left ventricular end-diastolic (LVED) mass in Landrace pigs at 2 months, Göttingen minipigs showed a slight increase in LVED mass only at 6 months. In summary, this is the first characterization of post-MI HF in Göttingen minipigs in comparison to Landrace pigs, showing that the Göttingen minipig model reflects post-MI HF parameters comparable to the human pathology. We conclude that the Göttingen minipig model is superior to the Landrace pig model to study the development of post-MI HF.

Association between oral contraceptive use and incident heart failure.

AimsOral contraceptives (OCs) are widely used in women of reproductive age, but their influences on heart failure (HF) development have yet to be reported. This study was performed to assess HF risk associated with OC use.Methods and resultsWe studied women participating in the Multi‐Ethnic Study of Atherosclerosis with available data on OC use. Inverse probability of treatment weighting analyses were used to reduce baseline imbalances. Cox proportional hazards models were applied to evaluate the associations of OC use and HF risk. The primary analysis comprised a total of 3594 participants [average age 62.10 (10.24) years]. During an average follow‐up of 12.45 (3.75) years, 138 incident HF occurred. In unadjusted Cox model, OC use was associated with a decreased risk of HF [hazard ratio (HR) = 0.45, 95% confidence interval (CI) 0.31–0.64, P < 0.001]. However, in multivariable‐adjusted and inverse probability of treatment weighting models, the results were attenuated and became non‐significant (HR = 0.96, 95% CI 0.63–1.48, P = 0.86 and HR = 0.79, 95% CI 0.45–1.40, P = 0.43, respectively). Duration of OC use was not related to increased risks of HF. When stratifying HF into subtypes, similar associations were observed. In multivariable–adjusted regression models, OC use was positively associated with left ventricular end‐diastolic mass [coefficient (β) = 3.04, P = 0.006] and stroke volume (β = 1.76, P = 0.01 for the left ventricle; β = 2.17, P = 0.005 for the right ventricle) but had no impact on left ventricular ejection fraction (β = 0.09, P = 0.75) and right ventricular ejection fraction (β = 0.33, P = 0.25).ConclusionsOral contraceptive use in women of reproductive age does not portend increased risk of HF. However, whether the formulations or dosages differently impact this association should be further investigated.

Automated left and right ventricular chamber segmentation in cardiac magnetic resonance images using dense fully convolutional neural network

Background and objectiveSegmentation of the left ventricular (LV) myocardium (Myo) and RV endocardium on cine cardiac magnetic resonance (CMR) images represents an essential step for cardiac-function evaluation and diagnosis. In order to have a common reference for comparing segmentation algorithms, several CMR image datasets were made available, but in general they do not include the most apical and basal slices, and/or gold standard tracing is limited to only one of the two ventricles, thus not fully corresponding to real clinical practice. Our aim was to develop a deep learning (DL) approach for automated segmentation of both RV and LV chambers from short-axis (SAX) CMR images, reporting separately the performance for basal slices, together with the applied criterion of choice. MethodA retrospectively selected database (DB1) of 210 cine sequences (3 pathology groups) was considered: images (GE, 1.5 T) were acquired at Centro Cardiologico Monzino (Milan, Italy), and end-diastolic (ED) and end-systolic frames (ES) were manually segmented (gold standard, GS). Automatic ED and ES RV and LV segmentation were performed with a U-Net inspired architecture, where skip connections were redesigned introducing dense blocks to alleviate the semantic gap between the U-Net encoder and decoder. The proposed architecture was trained including: A) the basal slices where the Myo surrounded the LV for at least the 50% and all the other slice; B) all the slices where the Myo completely surrounded the LV. To evaluate the clinical relevance of the proposed architecture in a practical use case scenario, a graphical user interface was developed to allow clinicians to revise, and correct when needed, the automatic segmentation. Additionally, to assess generalizability, analysis of CMR images obtained in 12 healthy volunteers (DB2) with different equipment (Siemens, 3T) and settings was performed. ResultsThe proposed architecture outperformed the original U-Net. Comparing the performance on DB1 between the two criteria, no significant differences were measured when considering all slices together, but were present when only basal slices were examined. Automatic and manually-adjusted segmentation performed similarly compared to the GS (bias±95%LoA): LVEDV -1±12 ml, LVESV -1±14 ml, RVEDV 6±12 ml, RVESV 6±14 ml, ED LV mass 6±26 g, ES LV mass 5±26 g). Also, generalizability showed very similar performance, with Dice scores of 0.944 (LV), 0.908 (RV) and 0.852 (Myo) on DB1, and 0.940 (LV), 0.880 (RV), and 0.856 (Myo) on DB2. ConclusionsOur results support the potential of DL methods for accurate LV and RV contours segmentation and the advantages of dense skip connections in alleviating the semantic gap generated when high level features are concatenated with lower level feature. The evaluation on our dataset, considering separately the performance on basal and apical slices, reveals the potential of DL approaches for fast, accurate and reliable automated cardiac segmentation in a real clinical setting.

Changes in left ventricular function induced by carboplatin combined with paclitaxel in patients with ovarian cancer identified using three-dimensional spot tracking imaging technology.

To investigate the clinical value of three-dimensional speckle tracking imaging (3D-STI) in evaluating left ventricular (LV) systolic function in patients with ovarian cancer (OC) treated with paclitaxel and carboplatin. We studied 30 patients with OC treated with paclitaxel combined with carboplatin chemotherapy. Two-dimensional echocardiography and 3D-STI were performed in the patients before they underwent 2- and 6-cycle chemotherapies, and in 30 normal control subjects. Were measured LV end-diastolic volume (EDV), end-systolic volume (ESV), three-dimensional LV ejection fraction (3D-LVEF), stroke volume (SV), spherical index (SPI), LV end-diastolic mass (LV EDmass), LV end-systolic mass (LV ESmass), LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), global area strain (GAS) and cardiac troponin T(cTnT). At the end of chemotherapy, magnetic resonance imaging (MRI) was also performed. The 3D conventional strain values (3D-LVEF, SV, LV EDV) after the 2- and 6-cycle chemotherapy were lower than before chemotherapy. LV Edmass, LV ESmass and cTnT were higher while LV GLS, GCS, GRS, GAS were lower after 2- and after 6-cycle chemotherapy than before chemotherapy. There was no significant difference in ESV and EDV between the 3D-STI and MRI parameters. GAS showed a significant negative correlation with cTnT. MRI and 3D-STI variables were significantly correlated, and the receiver operating characteristic curves showed the greater area under the curve for GAS after 2- and after 6-cycle chemotherapy. After 2-cycle chemotherapy, the highest specificity for GAS was 93.3%, and the highest sensitivity for GLS was 70.0%. After 6-cycle chemotherapy, the highest specificity for GAS was 96.7%, and the highest sensitivity for GLS was 96.7%. The LV systolic function decreased in OC patients treated with paclitaxel and carboplatin, showing that 3D-STI may detect early LV systolic dysfunction.

P5274Characterization of cardiac involvement in patients with MELAS syndrome in comparison to HCM patients by conventional LGE imaging and novel T1-mapping

Abstract Background MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) is a rare clinical subtype of mitochondrial myopathy. Cardiovascular magnetic resonance (CMR) images of MELAS-patients at an advanced state of the disease often show characteristic patterns: septal pronounced left ventricular (LV) hypertrophy and distinct focal myocardial scars in late-gadolinium-enhancement (LGE) images. This specific pattern is different from those seen in patients with hypertrophic cardiomyopathy (HCM) due to sarcomere protein mutations. Besides LGE imaging another method for the assessment of myocardial integrity, T1-mapping, has been established recently. This is the first study comparing native and enhanced T1-mapping (T1-na/en) as well as extracellular volume (ECV) values in HCM and MELAS. Methods 12 patients with confirmed MELAS syndrome at different states of the disease, 13 HCM patients and 15 controls were included. All CMR studies were performed on a 1.5T MR scanner (Ingenia, Philips) using bSSFP cine sequences for the assessment of LV-function and MOLLI sequences for T1-na/en mapping. 15min after IV injection of 0.1mmol/kg BW Gadobutrol for LGE imaging, T1-en maps were acquired. For comparison of groups T1-na/en and ECV values in a basal short axis slice were used. Results Median and interquartile ranges of LV function, T1 and ECV are shown in the table. There was no difference in LV ejection fraction (LVEF) between the groups, but end-diastolic LV-mass was increased in HCM- and MELAS-patients vs. controls (p&lt;0.001, p=0.028). In MELAS-patients, myocardial fibrosis was detected in focal spots clearly defined in both septum and free lateral wall. In HCM patients there was a rather diffuse LGE pattern in the hypertrophic septum and the RV insertion points. Here T1-na/en and ECV significantly differed from those measured in healthy controls (p&lt;0.001, p&lt;0.001, p=0.002). In the MELAS group T1-na values were significantly higher compared to controls (p=0.004) and significantly lower compared to HCM patients (p=0.003). LV-function and mapping parameters of compared groups LV-EF, % LV-EDV, ml/m2 LV-mass, g/m2 T1-na, ms T1-en, ms ECV, % MELAS 57 (44–63) 86 (81–122) 80 (50–131) 969 (940–1033) 409 (381–465) 27 (24–35) HCM 60 (57–65) 50 (73–94) 94 (72–102) 1041 (1021–1074) 362 (346–430) 31 (28–36) Controls 61 (58–65) 72 (67–89) 53 (42–60) 937 (894–951) 464 (446–513) 26 (24–27) Conclusion Compared to healthy controls and HCM-patients, cardiac involvement in MELAS-patients is not only reliably visualized by conventional LGE imaging but also detected without the use of contrast agent by native T1-mapping. MELAS vs. HCM-patients show a different pattern of LGE and higher native T1 values, respectively.

Strain-encoded cardiac magnetic resonance imaging: a new approach for fast estimation of left ventricular function

BackgroundRecently introduced fast strain-encoded (SENC) cardiac magnetic resonance (CMR) imaging (fast-SENC) provides real-time acquisition of myocardial performance in a single heartbeat. We aimed to test the ability and accuracy of real-time strain-encoded CMR imaging to estimate left ventricular volumes, ejection fraction and mass.MethodsThirty-five subjects (12 healthy volunteers and 23 patients with known or suspected coronary artery disease) were investigated. All study participants were imaged at 1.5 Tesla MRI scanner (Achieva, Philips) using an advanced CMR study protocol which included conventional cine and fast-SENC imaging. A newly developed real-time free-breathing SENC imaging technique based on the acquisition of two images with different frequency modulation was employed.ResultsAll parameters were successfully derived from fast-SENC images with total study time of 105 s (a 15 s scan time and a 90 s post-processing time). There was no significant difference between fast-SENC and cine imaging in the estimation of LV volumes and EF, whereas fast-SENC underestimated LV end-diastolic mass by 7%.ConclusionThe single heartbeat fast-SENC technique can be used as a good alternative to cine imaging for the precise calculation of LV volumes and ejection fraction while the technique significantly underestimates LV end-diastolic mass.

Compressed SENSE single-breath-hold and free-breathing cine imaging for accelerated clinical evaluation of the left ventricle

To assess the accuracy of compressed SENSE (CS-SENSE) cine cardiac magnetic resonance imaging (CMR) with and without breath-hold in comparison to standard cine CMR with breath-hold for the assessment of left ventricular (LV) function. Thirty-three healthy volunteers underwent balanced turbo field-echo cine CMR with breath-hold (BTFE-BH; reference standard), single breath-hold CS-SENSE (csBTFE-BH) cine CMR, and free-breathing (FB) CS-SENSE (csBTFE-FB) cine CMR on a 3 T MRI system. All images were acquired in stacks of eight short-axis sections. Image quality was assessed and compared by the Wilcoxon matched-pairs signed-rank test. End-diastolic volume, end-systolic volume, stroke volume, ejection fraction, LV end-diastolic (LVED) mass, regional myocardial wall motion, and scan time were compared by paired t-test, linear regression, and Bland-Altman analyses. All techniques provided acceptable image quality (score ≥3) for LV volumetric analysis in all participants (BTFE-BH [reference standard]: 5.00±0.00; csBTFE-BH: 4.03±0.17 [p<0.001]; csBTFE-FB: 3.76±0.44 [p<0.001]), with good agreement in LV function assessment; however, there was a slight but significant underestimation of LVED mass by csBTFE-FB (csBTFE-FB: 73.63±17.31 g versus BTFE-BH [reference standard]: 75.12±18.18 g, p=0.037). All methods showed a strong correlation with quantitative regional myocardial wall motion. Acquisition times for both csBTFE-BH and csBTFE-FB were significantly shorter than that for BTFE-BH (BTFE-BH [reference standard]: 89.3±5.70 seconds; csBTFE-BH: 24.42±2.18 seconds [p<0.001]; csBTFE-FB: 22.48±1.85 seconds [p<0.001]). LV function assessment with the novel CS-SENSE cine CMR is not inferior to standard cine CMR, irrespective of BH; however, LVED mass is underestimated by csBTFE-FB.

Left ventricular remodeling in hypertrophic cardiomyopathy patients with atrial fibrillation

BackgroundAtrial fibrillation (AF) is the most common complication in hypertrophic cardiomyopathy (HCM). The mechanisms of AF is associated with left atrial (LA) structural remodeling in HCM patients. However, the impact of left ventricular (LV) remodeling on the presence of AF in HCM patients has not been evaluated yet. We sought to investigate effect of LV remodeling on the presence of AF assessed by cardiovascular magnetic resonance (CMR) in HCM patients.MethodsA total of 394 HCM patients were enrolled into this study, including HOCM patients (n = 293) and NOHCM patients (n = 101). Patients were divided into HCM with AF (50) and HCM without AF (n = 344). Data were collected from hospital records.ResultsLA diameter and LV remodeling index (LVRI) were significantly higher in HCM patients with AF than that of HCM patients without AF (46.6 ± 7.4 mm versus 39.9 ± 8.0 mm, p < 0.001, and 1.46 ± 0.6 versus 1.2 ± 0.4, p = 0.002, respectively). HCM patients with AF were older than HCM patients without AF (53.6 ± 11.7 years versus 47.7 ± 13.6 years, p = 0.002). Additionally, LVRI positively correlated to LA size (r = 0.12, p = 0.02). In a multivariable logistic regression analysis, when adjusting for age and LV end diastolic mass index, LVRI and LA size remained an independent determinant of AF in HCM patients (OR = 4.7, p = 0.001 and OR = 1.13, P < 0.001).ConclusionHCM patients with AF showed significantly more LA diameter, LVRI and age than HCM patients without AF. LVRI and LA size were strong independent predictor of AF in HCM, suggesting LV remodeling may contribute to the occurrence of AF in HCM patients.

Systolic function evaluated with cardiovascular magnetic resonance imaging in HIV-infected patients

Background: Of all areas worldwide, sub-Saharan Africa is worst affected by the HIV and/or AIDS epidemic. Cardiovascular manifestations are very common and are a powerful contributor to mortality, but often go undetected. Cardiovascular magnetic resonance (CMR) is the most reliable method of assessing cardiac function and morphology and, with this in mind, we initiated a cross-sectional study comparing CMR-determined morphological and functional parameters in asymptomatic HIV-infected patients who were not yet on treatment and early in the disease, with HIV-uninfected control patients.Objectives: To ascertain whether there were any morphological abnormalities or systolic functional impairments on CMR in untreated asymptomatic HIV-infected patients, compared with HIV-uninfected control individuals.Methods: The CMR studies were performed using a 1.5-T whole-body clinical magnetic resonance 16-channel scanner (Achieva, Philips Medical Systems, Best, The Netherlands), using a cardiac five-element phased-array receiver coil (SENSE coil). Functional assessment was performed on 36 HIV-infected patients and the findings compared with 35 HIV-uninfected control patients who were matched for age and sex.Results: There was no significant difference in systolic function between the HIV-uninfected and the HIV-infected patients. The left ventricular end diastolic mass (LVEDM) was slightly higher in the HIV-infected group, but this was statistically insignificant.Conclusion: No significant differences were found regarding the CMR systolic functional analysis and morphological parameters between the HIV-infected and the healthy volunteers.

Relation of Left Ventricular Mass and Infarct Size in Anterior Wall ST-Segment Elevation Acute Myocardial Infarction (from the EMBRACE STEMI Clinical Trial)

Biomarker measures of infarct size and myocardial salvage index (MSI) are important surrogate measures of clinical outcomes after a myocardial infarction. However, there is variability in infarct size unaccounted for by conventional adjustment factors. This post hoc analysis of Evaluation of Myocardial Effects of Bendavia for Reducing Reperfusion Injury in Patients With Acute Coronary Events (EMBRACE) ST-Segment Elevation Myocardial Infarction (STEMI) trial evaluates the association between left ventricular (LV) mass and infarct size as assessed by areas under the curve for creatine kinase-MB (CK-MB) and troponin I release over the first 72hours (CK-MB area under the curve [AUC] and troponin I [TnI] AUC) and the MSI. Patients with first anterior STEMI, occluded left anterior descending artery, and available LV mass measurement in EMBRACE STEMI trial were included (n= 100) (ClinicalTrials.govNCT01572909). MSI, end-diastolic LV mass on day 4 cardiac magnetic resonance, and CK-MB and troponin I concentrations were evaluated by a core laboratory. After saturated multivariate analysis, dominance analysis was performed to estimate the contribution of each independent variable to the predicted variance of each outcome. In multivariate models that included age, gender, body surface area, lesion location, smoking, and ischemia time, LV mass remained independently associated with biomarker measures of infarct size (CK-MB AUC p= 0.02, TnI AUC p= 0.03) and MSI (p= 0.003). Dominance analysis demonstrated that LV mass accounted for 58%, 47%, and 60% of the predicted variances for CK-MB AUC, TnI AUC, and MSI, respectively. In conclusion, LV mass accounts for approximately half of the predicted variance in biomarker measures of infarct size. It should be considered as an adjustment variable in studies evaluating infarct size.

Assessment of myocardial changes in athletes with native T1 mapping and cardiac functional evaluation using 3T MRI.

Intensive physical exercise leads to increases in left ventricular muscle mass and wall thickness. Cardiac magnetic resonance imaging allows the assessment of functional and morphological changes in an athlete's heart. In addition, a native T1 mapping technique has been suggested as a non-contrast method to detect myocardial fibrosis. The aim of this study was to show the correlation between athletes' cardiac modifications and myocardial fibrosis with a native T1 mapping technique. A total of 41 healthy non-athletic control subjects and 46 athletes underwent CMR imaging. After the functional and morphological assessments, native T1 mapping was performed in all subjects using 3.0T magnetic resonance imaging. Most of the CMR findings were significantly higher in athletes who had ≥5years of sports activity when compared with non-athletic controls and athletes who had <5years of sports activity. Significantly higher results were shown in native T1 values in athletes who had <5years of sports activity, but there were no significant differences in the left ventricular end-diastolic volume, left ventricular end-diastolic mass, or interventricular septal wall thickness between non-athletic controls and athletes who had <5years of sports activity. The native T1 mapping technique has the potential to discriminate myocardial fibrotic changes in athletes when compared to a normal myocardium. The T1 mapping method might be a feasible technique to evaluate athletes because it does not involve contrast, is non-invasive and allows for easy evaluation of myocardial remodeling.

Abstract 17468: Left Ventricular Remodeling Index (LVRI) in patients after breast cancer therapy in the long-term follow-up

Introduction: Cardiotoxic side effects are of concern in long-term survivors of left-sided breast cancer therapy. 3-dimensional conventional radiotherapy (3DCRT) deposits high doses in defined regions of the heart. Intensity modulated radiotherapy (IMRT) reduces local high-dose exposition at the expense of exposing more heart tissue to lower doses. Cardio-MRI was performed in this study to assess MRI-morphologic and functional alterations after 3DCRT and IMRT/ additional chemotherapy, with IMRT only performed in patients that would have been exposed to unacceptably high heart doses with 3DCRT. Methods: 49 patients with left-sided breast cancer (38 3DCRT and 11 IMRT; 20 patients with additional adjuvant chemotherapy (ACH) (13 3DCRT, 7 IMRT) were included prospectively. Baseline (pre-treatment) and 24 months post-treatment MRI was performed. With MRI, enddiastolic left ventricular mass (LVM), enddiastolic left ventricular volume (LVEDV) and stroke volume (SV) were assessed. LVRI was calculated with the formula LVM/LVEDV. Results: Mean dose for the whole heart was higher in IMRT than in 3DCRT patients (12.9±3.9 vs. 4.5 ±2.4 Gy). Larger regions received a higher radiation dose (&gt;40Gy) in 3DCRT than in IMRT patients (3.3% vs. 1.3% of the whole heart). High local radiation dose &gt; 50 Gy only occurred in the 3DCRT group (0.74% of the heart volume). After 24 months LVRI decreased significantly in patients with ACH (0.80 vs. 0.70, p=0.028). Non-significant decrease of LVRI was observed in the whole cohort (0.85 vs. 0.79), after IMRT (0.74 vs. 0.71), after 3DCRT (0.88 vs. 0.82) and without ACH (0.87 vs. 0.84). Decrease of LVRI in patients with ACH was caused by significant decrease of LVM (102.4 vs. 89.7 g, p=0.028) whereas LVEDV was stable (128.3 vs. 128.1g). In all groups, no significant decrease of SV could be assessed after 24 months. Conclusions: 24 months after therapy, significant decrease of LVRI due to decreased LVM could be found only in patients with additional chemotherapy. Radiotherapy alone did not have a significant impact on LVRI, LVM and SV. Low doses to the whole heart with IMRT did not cause significant decreases in LVRI, LVM and SV. LVM and LVRI are to be assessed in larger cohorts in patients with cancer therapy especially with additional chemotherapy.

Interstitial Fibrosis, Left Ventricular Remodeling, and Myocardial Mechanical Behavior in a Population-Based Multiethnic Cohort

Background— Tagged cardiac magnetic resonance provides detailed information on regional myocardial function and mechanical behavior. T1 mapping by cardiac magnetic resonance allows noninvasive quantification of myocardial extracellular expansion (ECE), which has been related to interstitial fibrosis in previous clinical and subclinical studies. We assessed sex-associated differences in the relation of ECE to left ventricular (LV) remodeling and myocardial systolic and diastolic deformation in a large community-based multiethnic population. Methods and Results— Midventricular midwall peak circumferential shortening and early diastolic strain rate and LV torsion and torsional recoil rate were determined using cardiac magnetic resonance tagging. Midventricular short-axis T1 maps were acquired in the same examination pre- and postcontrast injection using Modified Look-Locker Inversion-Recovery sequence. Multivariable linear regression (estimated regression coefficient, B ) was used to adjust for risk factors and subclinical disease measures. Of 1230 participants, 114 had a visible myocardial scar by late gadolinium enhancement. Participants without a visible myocardial scar (n=1116) had no history of previous clinical events. In the latter group, multivariable linear regression demonstrated that lower postcontrast T1 times, reflecting greater ECE, were associated with lower circumferential shortening ( B =−0.1; P =0.0001), lower LV end-diastolic volume index ( B =0.6; P =0.0001), and lower LV end-diastolic mass index ( B =0.4; P =0.0001). In addition, lower postcontrast T1 times were associated with lower early diastolic strain rate ( B =0.01; P =0.03) in women only and lower LV torsion ( B =0.005; P =0.03) and lower LV ejection fraction (B=0.2, P =0.01) in men only. Conclusions— Greater ECE is associated with reduced LV end-diastolic volume index and LV end-diastolic mass index in a large multiethnic population without history of previous cardiovascular events. In addition, greater ECE is associated with reduced circumferential shortening, lower early diastolic strain rate, and a preserved ejection fraction in women, whereas in men, greater ECE is associated with greater LV dysfunction manifested as reduced circumferential shortening, reduced LV torsion, and reduced ejection fraction.

Epicardial adipose tissue assessed by cardiac magnetic resonance imaging in patients with heart failure due to dilated cardiomyopathy

We sought to investigate the association of the EAT with CMR parameters of ventricular remodelling and left ventricular (LV) dysfunction in patients with non-ischemic dilated cardiomyopathy (DCM). One hundred and fifty subjects (112 consecutive patients with DCM and 48 healthy controls) underwent CMR examination. Function, volumes, dimensions, the LV remodelling index (LVRI), the presence of late gadolinium enhancement (LGE) and the amount of EAT were assessed. Compared to healthy controls, patients with DCM revealed a significantly reduced indexed EAT mass (31.7 ± 5.6 g/m(2) vs 24.0 ± 7.5 g/m(2) , p<0.0001). There was no difference in the EAT mass between DCM patients with moderate and severe LV dysfunction (23.5 ± 9.8 g/m(2) vs 24.2 ± 6.6 g/m(2) , P = 0.7). Linear regression analysis in DCM patients showed that with increasing LV end-diastolic mass index (LV-EDMI) (r = 0.417, P < 0.0001), increasing LV end-diastolic volume index (r = 0.251, P = 0.01) and increasing LV end-diastolic diameter (r = 0.220, P = 0.02), there was also a significantly increased amount of EAT mass. However, there was no correlation between the EAT and the LV ejection fraction (r = 0.0085, P = 0.37), right ventricular ejection fraction (r = 0.049, P = 0.6), LVRI (r = 0.116, P = 0.2) and the extent of LGE % (r = 0.189, P = 0.1). Among the healthy controls, the amount of EAT only correlated with increasing age (r = 0.461, P = 0.001), BMI (r = 0.426, P = 0.003) and LV-EDMI (r = 0.346, P = 0.02). In patients with DCM the amount of EAT is decreased compared to healthy controls irrespective of LV function impairment. However, an increase in LV mass and volumes is associated with a significantly increase in EAT in patients with DCM.

Sport category is an important determinant of cardiac adaptation: an MRI study

BackgroundPhysiological cardiac adaptation in athletes is influenced by body surface area, gender, age, training intensity and sport type. This study assesses the influence of sport category and provides a physiological...

Impact of Functional, Morphological and Clinical Parameters on Epicardial Adipose Tissue in Patients With Coronary Artery Disease

Because a close relationship between epicardial adipose tissue (EAT) and coronary artery disease (CAD) has been shown, the impact of functional, morphological and clinical parameters to identify potential determinants of EAT was investigated. Clinical and cardiac magnetic resonance parameters were determined and correlated to the amount of EAT in 158 patients with CAD and 40 healthy subjects. Patients with CAD and left ventricular function (LVEF) ≥50% revealed significantly elevated EAT (36±11g/m²) compared to healthy controls (31±8g/m²) and to patients with LVEF <50% (26±8.0g/m²). In the whole study population, only LVEF (P=0.003), body mass index (BMI) (P=0.004) and left ventricular end diastolic diameter (LV-EDD) (P=0.004) remained significantly associated with EAT after multivariate analysis. Subgroup analysis in patients with CAD and LVEF ≥50% showed that BMI (P=0.03) was the only correlate of EAT. However, in patients with CAD and LVEF <50%, indexed LV end diastolic mass (LV-EDMI) (P=0.003) and the extent of late gadolinium enhancement (LGE %) (P=0.03) remained significantly correlated with EAT in multivariate analysis. The amount and the determinants of EAT differ according to the LVEF in patients with CAD. Thus, different amounts of EAT reflect different stages of CAD underlining the complex interaction of EAT in the pathogenesis and progression of ischemic cardiomyopathy.