Incidence Of Late Gadolinium Enhancement Research Articles

Additive effect of metabolic dysfunction-associated fatty liver disease on left ventricular function and global strain in type 2 diabetes mellitus patients: a 3.0 T cardiac magnetic resonance feature tracking study

BackgroundType 2 diabetes mellitus (T2DM) and metabolic-associated fatty liver disease (MAFLD) are both metabolic disorders that negatively impact the cardiovascular system. This study comprehensively analyzed the additive effect of MAFLD on left ventricular function and global strain in T2DM patients by cardiac magnetic resonance (CMR).MethodsData of 261 T2DM patients, including 109 with and 152 without MAFLD, as well as 73 matched normal controls from our medical center between June 2015 and March 2022 were retrospectively analyzed. CMR-derived parameters, including LV function and global strain parameters, were compared among different groups. Univariate and multivariate linear regression analyses were conducted to investigate the impact of various factors on LV function and global strain.ResultsOur investigation revealed a progressive deterioration in LV functional parameters across three groups: control subjects, T2DM patients without MAFLD, and T2DM patients with MAFLD. Statistically significant increases in left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), left ventricular mass index (LVMI) were observed, along with decreases in left ventricular ejection fraction (LVEF) and left ventricular global function index (LVGFI). Among these three groups, significant reductions were also noted in the absolute values of LV global radial, circumferential, and longitudinal peak strains (GRPS, GCPS, and GLPS), as well as in peak systolic (PSSR) and peak diastolic strain rates (PDSR). MAFLD was identified as an independent predictor of LVEF, LVMI, LVGFI, GRPS, GCPS, and GLPS in multivariate linear analysis. Besides, the incidence of late gadolinium enhancement was higher in MAFLD patients than in non-MAFLD patients (50/109 [45.9%] vs. 42/152 [27.6%], p = 0.003). Furthermore, escalating MAFLD severity was associated with a numerical deterioration in both LV function parameters and global strain values.ConclusionsThis study thoroughly compared CMR parameters in T2DM patients with and without MAFLD, uncovering MAFLD’s adverse impact on LV function and deformation in T2DM patients. These findings highlight the critical need for early detection and comprehensive management of cardiac function in T2DM patients with MAFLD.

Prognostic value of cardiovascular magnetic resonance in immune checkpoint inhibitor-associated myocarditis: A systematic review and meta-analysis.

Immune checkpoint inhibitors (ICI)are increasingly used in the first-line treatment of malignant tumors. There is increasing recognition of their cardiotoxicity and, in particular, their potential to lead to myocarditis. Cardiovascular magnetic resonance (CMR)can quantify pathological changes, such as myocardial edema and fibrosis. The purpose of this systematic review and meta-analysis was to examine the evidence for the roles of CMR in predicting prognosis in ICI-associated myocarditis. PubMed, Cochrane Library, and Web of Science databases were searched until October 2023 for published works investigating the relationship between CMR parameters and adverse events in patients with ICI-associated myocarditis. The analysis included studies reporting the incidence of late gadolinium enhancement (LGE),T1 values, T2 values, and CMR-derived left ventricular ejection fraction (LVEF).Odds ratios (OR)and weighted mean differences (WMD)were combined for binary and continuous data, respectively. Newcastle-Ottawa Scale was used to assess the methodological quality of the included studies. Five cohort studies were included (average age 65-68 years; 25.4% female). Of these, four studies were included in the meta-analysis of LGE-related findings. Patients with major adverse cardiovascular events (MACE)had a higher incidence of LGE compared with patients without MACE (OR = 4.18, 95% CI: 1.72-10.19, p = 0.002). A meta-analysis, incorporating data from two studies, showed that patients who developed MACE exhibited significantly higher T1 value (WMD = 36.16 ms, 95% CI: 21.43-50.89, p < 0.001) and lower LVEF (WMD = - 8.00%, 95% CI: -13.60 to -2.40, p = 0.005). Notably, T2 value (WMD = -0.23 ms, 95% CI: -1.86 to -1.39, p = 0.779) was not associated with MACE in patients with ICI-related myocarditis. LGE, T1 value, and LVEF measured by CMR imaging have potential prognostic value for long-term adverse events in patients with ICI-related myocarditis.

The effect of eplerenone on the disease onset and progression of phospholamban cardiomyopathy in presymptomatic mutation carriers: results of the i-PHORECAST trial

Abstract Background A pathogenic variant in the gene encoding phospholamban (PLN; p.Arg14del) may cause cardiomyopathy, the pathophysiologic hallmark of which is cardiac fibrosis that may cause malignant ventricular arrhythmias and severe heart failure. There is no evidence-based therapy to modify disease progression in presymptomatic pathogenic variant carriers. Eplerenone is a selective mineralocorticoid receptor antagonist with established antifibrotic properties, and may be a potentially interesting treatment in PLN p.Arg14del mutation carriers. Purpose To investigate if preventive therapy with eplerenone attenuates disease onset and progression in PLN cardiomyopathy. Methods 84 presymptomatic PLN p.Arg14del mutation carriers (median age 39 [27–50] years, 44% males) were randomized 1:1 to receive eplerenone (50mg once daily) or no treatment, and endpoints were adjudicated in a blinded fashion (PROBE design). Baseline values were acquired including demographics, cardiac magnetic resonance imaging (CMR) parameters (ventricular volumes, systolic function, late gadolinium enhancement (LGE)), and electrocardiographic parameters (QRS voltages and ventricular ectopy per 24 hour). Subjects were re-evaluated every year and CMR was performed at baseline and after three years. The composite endpoint included LVEDV/RVEDV increase (&amp;gt;10%), LVEF/RVEF decrease (5%), newly developed LGE on CMR, increase in ventricular ectopy (&amp;gt;100% PVCs/24h if &amp;gt;1000 PVCs/24h), decrease in QRS voltage (&amp;gt;25%), non-sustained ventricular tachycardia, symptoms or arrhythmias necessitating treatment, and cardiovascular death. Results Two out of 84 subjects (2%) were lost to follow up. 49 out of 82 remaining subjects (60%) reached the composite end point, 25 (60%) in the control group, 24 (60%) in the treatment group (p=0.825). There was no significant difference between the groups when considering the individual end points, see Table 1. Baseline and follow up CMR was performed on 76 subjects, 39 in the control group, 37 in the treatment group. In total there were 10 (13%) cases of newly developed LGE, 6 (18%) in the control group, 4 (12%) in the treatment group (p=0.556), see Figure 1. Conclusions Eplerenone did not significantly attenuate disease onset and progression in presymptomatic PLN p.Arg14del mutation carriers. There was no significant difference in new incidence of LGE between the treatment and control groups. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was financially supported by the Netherlands Cardiovascular Research Initiative, an initiative supported by the Dutch Heart Foundation (The Hague, Netherlands).

Abstract 13478: Cardiac Magnetic Resonance Imaging Identifies Cardiac Disease in Limb-Girdle Muscular Dystrophy in Previously Low Risk Mutations

Introduction: Limb-Girdle Muscular Dystrophies (LGMD) are an inheritable group of genetic disorders primarily involving progressive weakening and atrophy of the pelvic or shoulder girdle musculature with potential cardiac dysfunction. Prior reports stratified frequency of cardiac disease based on genetic mutations. The general incidence of cardiac muscle involvement in LGMD is variable depending on genetic factors and carry important indications for clinical management. Cardiac magnetic resonance imaging (CMR) is increasingly used in dystrophinopathies and determining management. There is limited CMR data in adult LGMD patients and fewer reports in younger patients. Hypothesis: Therefore, we sought to determine the extent of cardiac involvement based on genetic risk of cardiomyopathy. Methods: This is a retrospective review of LGMD patients followed at our institution who underwent CMR assessment. Patients stratified into Group A (high incidence of cardiomyopathy; LGMDs 1B, 2E, 2F and 2I) and Group B (rare or no reported cardiomyopathy; LGMDs 1A, 1C, 2A, 2B, 2C, 2D, 2G, 2H, 2J) with CMR studies were assessed for presence of cardiac scar defined as late gadolinium enhancement (LGE) and LVEF for each subject. Results: 41 subjects were identified with average age of 21.3±11.5 years (range 6-50) with normal LVEF 58±12.1% and 12/41 (29.3%) with LGE with the youngest patient age 12.4 years. Group A included 14/41 (34%) and 27/41 (66%) were in Group B. Group A had higher incidence of LGE 6/14(42.9%) with preserved LVEF of 58.2±11% compared to Group B with 6/27 (22.2%) with no difference in LVEF of 55.7±16.4% (p = 0.5). When stratified by LGE status, the LGE-positive group was older at 26.4±11.9 years and had preserved LVEF of 61.9±11.1% versus LGE-negative group of 19.1±10.9 years (p = 0.03) with abnormal LVEF of 49.4±9.5% (p =0.0008). Conclusions: This is the largest study of CMR in LGMD patients, confirming presence of cardiac disease by LGE in the high risk group. Surprisingly, nearly 25% of the low risk mutations have evidence of LGE. Abnormal LGE predicted abnormalities in LVEF in both Group A and Group B. Management of LGMD patients should include CMR even in low risk population. Ongoing data collection may reveal disease cluster in previous low risk groups.

Characterisation of ventricular premature beats during exercise testing in masters athletes

Abstract Background Exercise induced ventricular premature beats (VPBs) are associated with an adverse outcome in patients with cardiac disease and the general population. The incidence and significance of exercise induced VPBs in masters athletes remains unknown. Methods 237 masters athletes (54.6±8 years of age, 42% male) and 50 controls of similar age and sex were assessed with a 12-lead ECG, echocardiogram, cardiopulmonary exercise test, 24-hour holter, cardiovascular magnetic resonance imaging and a CT coronary angiogram. Athletes had participated in endurance exercise for a meanof 32±12 years. Results Athletes achieved a higher VO2 max (43.2 ml/min/kg vs 28 ml/min/kg) compared with controls and on average weighed 12kg less (63kg vs 75kg). VPBs were common in master athletes during exercise but are no more common than in age matched sedentary controls (39.3% vs 33.3% &amp;gt;1 VPB, and 8.9% vs 5.9% complex or frequent VPBs). There were no sex differences in terms of VPB number (40% vs 39%) or complex morphology (10% vs 8%) between male and female athletes. Athletes demonstrating complex ectopy during ETT had similar age (54.8±9 and 54.6±8), years of competition (34±9 and 32±12), VO2 max (40±6 and 43±7ml/min/kg), left ventricular mass (142±36g and 148±35g), end diastolic volume (160±35ml and 157±32ml) and incidence of late gadolinium enhancement (14% and 10%) compared with athletes who did not reveal complex VPBs. Conclusion VPBs are common during exercise testing in both masters athletes and sedentary age matched controls. Exercise-induced complex ectopy in an asymptomatic, low risk masters athlete represents a poor marker of significant structural heart disease. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cardiac Risk in the Young

Reverse Myocardial Remodeling Following Valve Repair in Patients With Chronic Severe Primary Degenerative Mitral Regurgitation

ObjectivesThe aims of this study were to quantify preoperative myocardial fibrosis using late gadolinium enhancement (LGE), extracellular volume fraction (ECV%), and indexed extracellular volume (iECV) on cardiac magnetic resonance; determine whether this varies following surgery; and examine the impact on postoperative outcomes. BackgroundMyocardial fibrosis complicates chronic severe primary mitral regurgitation and is associated with left ventricular dilatation and dysfunction. It is not known if this nonischemic fibrosis is reversible following surgery or if it affects ventricular remodeling and patient outcomes. MethodsA multicenter prospective study was conducted among 104 subjects with primary mitral regurgitation undergoing mitral valve repair. Cardiac magnetic resonance and cardiopulmonary exercise stress testing were performed preoperatively and ≥6 months after surgery. Symptoms were assessed using the Minnesota Living With Heart Failure Questionnaire. ResultsMitral valve repair was performed for Class 2a indications in 65 patients and Class 1 indications in 39 patients. Ninety-three patients were followed up at 8.8 months (IQR: 7.4 months-10.6 months). Following surgery, there were significant reductions in both ECV% (from 27.4% to 26.6%; P = 0.027) and iECV (from 17.9 to 15.4 mL/m2; P < 0.001), but the incidence of LGE was unchanged. Neither preoperative ECV% nor LGE affected postoperative function, but iECV predicted left ventricular end-systolic volume index (β = 1.04; 95% CI: 0.49 to 1.58; P < 0.001) and left ventricular ejection fraction (β = −0.61; 95% CI: −1.05 to −0.18; P = 0.006). Patients with above-median iECV of ≥17.6 mL/m2 had significantly larger postoperative values of left ventricular end-systolic volume index (30.5 ± 12.7 mL/m2 vs 23.9 ± 8.0 mL/m2; P = 0.003), an association that remained significant in subcohort analyses of patients in New York Heart Association functional class I. ConclusionsMitral valve surgery results in reductions in ECV% and iECV, which are surrogates of diffuse myocardial fibrosis, and preoperative iECV predicts the degree of postoperative remodeling irrespective of symptoms. (The Role of Myocardial Fibrosis in Degenerative Mitral Regurgitation; NCT02355418)

Diagnostic and Prognostic Value of Cardiovascular Magnetic Resonance in Neuromuscular Cardiomyopathies.

Neuromuscular diseases (NMD) encompass a broad spectrum of diseases with variable type of cardiac involvement and there is lack of clinical data on Cardiovascular Magnetic Resonance (CMR) phenotypes or even prognostic value of CMR in NMD. We explored the diagnostic and prognostic value of CMR in NMD-related cardiomyopathies. The study included retrospective analysis of a cohort of 111 patients with various forms of NMD; mitochondrial: n = 14, Friedreich's ataxia (FA): n = 27, myotonic dystrophy: n = 27, Becker/Duchenne's muscular dystrophy (BMD/DMD): n = 15, Duchenne's carriers: n = 6, other: n = 22. Biventricular volumes and function and myocardial late gadolinium enhancement (LGE) pattern and extent were assessed by CMR. Patients were followed-up for the composite clinical endpoint of death, heart failure development or need for permanent pacemaker/intracardiac defibrillator. The major NMD subtypes, i.e. FA, mitochondrial, BMD/DMD, and myotonic dystrophy had significant differences in the incidence of LGE (56%, 21%, 62% & 30% respectively, chi2 = 9.86, p = 0.042) and type of cardiomyopathy phenotype (chi2 = 13.8, p = 0.008), extent/pattern (p = 0.006) and progression rate of LGE (p = 0.006). In survival analysis the composite clinical endpoint differed significantly between NMD subtypes (p = 0.031), while the subgroup with LGE + and LVEF < 50% had the worst prognosis (Log-rank p = 0.0034). We present data from a unique cohort of NMD patients and provide evidence on the incidence, patterns, and the prognostic value of LGE in NMD-related cardiomyopathy. LGE is variably present in NMD subtypes and correlates with LV remodelling, dysfunction, and clinical outcomes in patients with NMD.

Left Atrial Fibrosis Assessed with Cardiac MRI in Patients with Paroxysmal and Those with Persistent Atrial Fibrillation.

Background Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the χ2 test and logistic regression analysis. Results Of the 195 patients (mean age, 55 years ± 10 [standard deviation], 161 men), 74 (38%) had PAF and 121 (62%) had PeAF. Of all patients, 114 (58.4%) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 ± 1.1 vs 0.6 ± 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2% [29 of 74] vs 7.4% [nine of 121]; P < .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95% confidence interval: 1.7, 10.5; P < .001). Conclusion The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.

Absence of late gadolinium enhancement on cardiac magnetic resonance imaging in ventricular fibrillation and nonischemic cardiomyopathy.

Cardiac magnetic resonance (CMR)-identified late gadolinium enhancement (LGE), representing regional fibrosis, is often used to predict ventricular arrhythmia risk in nonischemic cardiomyopathy (NICM). However, LGE is more closely correlated with sustained monomorphic ventricular tachycardia (SMVT) than ventricular fibrillation (VF). We characterized CMR findings of ventricular LGE in VF survivors. We examined consecutively resuscitated VF survivors undergoing contrast-enhanced 1.5T CMR between 9/2007 and 7/2016. We excluded coronary artery disease, hypertrophic cardiomyopathy, amyloid, sarcoid, arrhythmogenic right ventricular cardiomyopathy, and channelopathy. Preexisting implantable cardioverter-defibrillator (ICD) was a CMR contraindication. VF patients were divided into three groups: (1) NICM, (2) left ventricular (LV) dilatation with normal LV ejection fraction (LVEF), and (3) normal LV size and LVEF. Two groups of NICM patients with and without SMVT were examined for comparison. We analyzed 87VF patients, and found that LGE was seen in 8/22 (36%) with NICM (LVEF 38±11%, LV end-diastolic volume index [LVEDVI] 134±68mL/BSA), 11/40 (28%) with LV dilatation and normal LVEF (LVEDVI 103±17mL/BSA), 4/25 (16%) with normal LV size and LVEF. Incidence of LGE in NICM patients without prior ventricular tachycardia/VF (LVEF 36±12%, LVEDVI 141±46mL/body surface area [BSA]) was 117/277 and was not lower than those with VF and NICM (42%vs 36%; P=0.59). By contrast, 22/37 NICM patients with SMVT (LVEF 42±11%, LVEDVI 123±48mL/BSA) were LGE-positive (59% NICM-SMVT vs 36% NICM-VF; P=0.04). Most VF survivors with a diagnosis of NICM did not have LGE on CMR and would not have met primary prevention ICD criteria based on LVEF. Absence of LGE may not portend a benign prognosis in NICM. Novel strategies for determining SCD risk in this cohort are required.

Abstract 13490: Cardiac Progenitor Cell Therapy in Right Heart Failure With Preserved Ejection Fraction

Background: Hear failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome characterized by normal EF with abnormal relaxation. Although the significance of HFpEF in right ventricle (RV) remains elusive as well as cell therapy responses in HFpEF patients with single ventricular heart diseases (SHD) have not yet clarified. Purpose: We investigated the underlying mechanisms and potential benefits of cardiosphere-derived cell (CDC) therapy in HFpEF includes rat models and human SHD. Methods: Pulmonary artery banding (PAB) was created in rats for 4 weeks as RV failure models. In human study, 40 patients, aged 2.2±1.4 years, 91% diagnosed as RV type SHD, were analyzed. Both rat and human studies were defined as follows (HFpEF; EF≧40%, HFrEF; EF&lt;40%), and intracoronary CDC infusion responses were assessed. Results: Rats received PAB showed RV dysfunction with significant cardiac fibrosis those were addressed by increased expression of heart failure or fibrosis related genes in both HFpEF and HFrEF rats rather than controls. CDC infusion led to marked increase in EF in rats with HFrEF but not HFpEF. Although CDC infusion did not augment EF in HFpEF, this treatment significantly decreased interstitial fibrosis and improved myocardial elastance in both HFpEF and HFrEF compared with baseline. Furthermore, CDC treatment markedly reduced Col1, Col3, NPPA and MMP2 expressions in both groups, whereas inflammatory cytokine such as Ccl2 and IL6 decreased only in HFrEF. Notably, CDC infusion did not affect the expression of MMP9, TIMP1 and TIMP2 in both groups. In human study, there was no difference in the incidence of late gadolinium enhancement detected by cMRI in two groups (20% in HFrEF and 15% in HFpEF); however, HFrEF but not HFpEF patients demonstrated a marked improvement in EF and reduced ventricular volumes and mass one year after CDC infusion. In contrast, the beneficial effects of CDC therapy could be observed by improved myocardial strain, elastance, and diastolic function in both groups. Conclusions: Our translational and clinical research of HFpEF in RV suggests that CDC infusion may have significant impact on diastolic relaxation and myocardial stiffening improvements to reverse ventricular fibrosis and remodeling leading to RV failure.

Abstract 13881: Cardiac Progenitor Cell Infusion in Patients With Univentricular Heart Diseases in Heart Failure With Preserved Ejection Fraction

Backgrounds: The clinical outcomes of heart failure with reduced and preserved ejection fraction (HFrEF and HFpEF) after staged palliations in patients with univentricular heart disease remain unknown as is the question whether cardiosphere-derived cell (CDC) transfer may have impact on either type of cardiac dysfunction. Purpose: We sought to characterize the heart failure patients, include HFrEF and HFpEF, with single ventricular physiology and investigate the clinical responsiveness after CDC therapy. Methods: Forty-three patients, aged 2.2±1.4 years, undergoing staged shunt procedures were divided into two groups by cardiac function based on cMRI (HFrEF: EF&lt;40%, n=30; HFpEF: EF&gt;40%, n=13). Results: Compared with HFpEF patients, HFrEF patients showed increased cardiac volume (P=0.02) and mass index (P=0.04), those were associated with reduced global circumferential strain in HFrEF compared with HFpEF (P=0.0004). There was no difference in the incidence of late gadolinium enhancement detected by cMRI in both groups (20% in HFrEF and 15% in HFpEF). When patients underwent staged shunt procedures, HFpEF group had significant reduction in EF (P=0.03) and atrial strain (P=0.047), resulting in increase in Tei index 1 month after palliation (P=0.02). To investigate whether CDC infusion may affect the cardiac function in these two types of HF, patients were subjected to receive CDC injection 1 month post palliation. In contrast to HFpEF group, HFrEF patients demonstrated a marked improvement in EF (P=0.0006), right ventricular elastance (P=0.0005) 3 months after CDC infusion. Similarly, diastolic function improvements were found in CDC-treated HFrEF group but HFpEF patients as shown by increased atrial fractional area change (P=0.01) and reduced E-wave/e’sr (P=0.049). However, patients with HFpEF showed no improvement in diastolic function but significantly reduced dP/dt at 3 months (P=0.04). These beneficial effects by CDCs could not be seen in remaining 20 patients who were assigned to treat as palliation alone without CDC injection. Conclusions: HFpEF is common in univentricular heart diseases and that may have early perioperative right ventricular dysfunction and could be CDC therapy-resistant leading to latent heart failure.