Measurement Of Ventricular Mass Research Articles

Clinical utility of a rapid two-dimensional balanced steady-state free precession sequence with deep learning reconstruction

BackgroundCardiovascular magnetic resonance (CMR) cine imaging is still limited by long acquisition times. This study evaluated the clinical utility of an accelerated two-dimensional (2D) cine sequence with deep learning reconstruction (Sonic DL) to decrease acquisition time without compromising quantitative volumetry or image quality. MethodsA sub-study using 16 participants was performed using Sonic DL at two different acceleration factors (8x and 12x). Quantitative left-ventricular volumetry, function and mass measurements were compared between the two acceleration factors against a standard cine method. Following this sub-study, 108 participants were prospectively recruited and imaged using a standard cine method and the Sonic DL method with the acceleration factor that more closely matched the reference method. Two experienced clinical readers rated images based on their diagnostic utility and performed all image contouring. Quantitative contrast difference and endocardial border sharpness were also assessed. Left- and right-ventricular volumetry, left-ventricular mass and myocardial strain measurements were compared between cine methods using Bland-Altman plots, Pearson’s correlation, and paired t-tests. Comparative analysis of image quality was measured using Wilcoxon-signed-rank tests and visualized using bar graphs. ResultsSonic DL at an acceleration factor of 8 more closely matched the reference cine method. There were no significant differences found across left ventricular volumetry, function, or mass measurements. In contrast, an acceleration factor of 12 resulted in a 6% reduction of measured ejection fraction when compared to the standard cine method and a 4% reduction of measured ejection fraction when compared to Sonic DL at an acceleration factor of 8. Thus, Sonic DL at an acceleration factor of 8 was chosen for downstream analysis. In the larger cohort, this accelerated cine sequence was successfully performed in all participants and significantly reduced the acquisition time of cine images compared to the standard 2D method (reduction of 40%, p < 0.0001). Diagnostic image quality ratings and quantitative image quality evaluations were statistically not different between the two methods (p > 0.05). Left- and right-ventricular volumetry and circumferential and radial strain were also similar between methods (p > 0.05) but left-ventricular mass and longitudinal strain were over-estimated using the proposed accelerated cine method (mass over-estimated by 3.36g/m2, p < 0.0001; longitudinal strain over-estimated by 1.97%, p = 0.001). ConclusionsThis study found that an accelerated 2D cine method with DL reconstruction at an acceleration factor of 8 can reduce CMR cine acquisition time by 40% without significantly affecting volumetry or image quality. Given the increase of scan time efficiency, this undersampled acquisition method using deep learning reconstruction should be considered for routine clinical CMR.

Whole blood viscosity is associated with reduced myocardial mechano-energetic efficiency in nondiabetic individuals.

This cross-sectional study aimed to investigate the association between myocardial mechano-energetic efficiency (MEE) and whole blood viscosity (WBV) in nondiabetic adults participating in the CATAnzaro MEtabolic RIsk factors (CATAMERI) study. 1143 participants underwent an oral glucose tolerance test and an echocardiogram for myocardial MEE per gram of left ventricular mass (MEEi) measurement. WBV was measured as: [0.12 × h] + [0.17 × (p-2.07)], where h is haematocrit and p is plasma protein levels. Study population includes 595 males and 548 females with a mean age of 46 ± 12 years and a mean BMI of 30.0 ± 6.2 kg/m2 . Individuals with normal glucose tolerance were 63%, while those with impaired fasting glucose, impaired glucose tolerance and or the combination of both were 14.3%, 13% and 9.7%, respectively. A univariate analysis showed that MEEi was significantly associated with sex, age, smoking, BMI, waist circumference, total cholesterol, HDL, triglycerides, fasting glucose, fasting insulin, HOMA-IR index, glucose tolerance, C-reactive protein, haematocrit, haemoglobin, plasma protein and WBV. In a multivariable regression model including variables that were significantly associated with MEEi in univariate analysis, MEEi was associated with HOMA-IR (β = -0.144, p < .001), age (β = -0.140, p < .001), WBV (β = -0.129, p < .001) and glucose tolerance (β = -0.064, p = .04). The independent association between WBV and MEEi remained statistically significant (β = -0.122, p < .001) when antihypertensive therapy and lipid-lowering therapy were included in the model. WBV is associated with decreased myocardial MEE independently of other cardiovascular risk factors.

Evaluation of cardiac biomarkers, electrocardiogram changes and echocardiography findings before and after exercise in paediatric athletes

Purpose: The aim of this study was to investigate the structural and electrical changes in the heart associated with exercise in young athletes under 18 years of age and to examine the relationship between these changes and biochemical markers.&#x0D; Materials and Methods: In this study, 32 male paediatric athletes (five rowers, five kayakers and 22 footballers) were prospectively evaluated. Dynamic exercise training for 75 minutes was applied to all athletes. An echocardiographic evaluation was performed on the athletes at rest. An electrocardiogram (ECG) was taken before and after the exercise. Blood samples were taken from all athletes before the exercise, during the first hour of exercise and after the fourth hour of the training session to analyse the serum levels of creatine kinase myocardial band, troponin T(cTnT) and pro-brain natriuretic peptide.&#x0D; Results: The mean age of all athletes was 15.3±0.9 years. In the echocardiography examination, end-diastolic thickness, left ventricular end-diastolic diameter, posterior wall end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass measurements (LVM) and left ventricular mass indices (LVMI) were higher among the rowers than in the remaining groups. In the post-exercise ECG, T-wave peaks were observed in 16 individuals, including all rowers, all kayakers, and six footballers. The cTnT values in the first hour and after the fourth were 0.31–0.71 ng/ml in football players, 0.10–0.27 ng/ml in rowers, and 0.04–0.15 ng/ml kayakers. An increase in cTnT levels was detected after the fourth hour of exercise in all groups. There was a correlation between T-wave peaks in the ECG taken after exercise and age, cTnT serum level and increased LVM. &#x0D; Conclusion: In this study, we found T-wave peaks in half of the athletes after exercise. The serum cTnT levels of young athletes may be elevated by exercise and that LVM and LVMI may be higher in athletes. Echocardiography and ECG evaluations should be performed in paediatric athletes.

Heart ventricles of the dromedary camel (Camelus dromedarius): new insights from sectional anatomy, 3D computed tomography, and morphometry

BackgroundDromedary camel heart morphology is a crucial research topic with clinical applications. The study aims to understand the dromedary camel anatomy, morphology, and architecture of the ventricular mass. Results: Sagittal and transverse gross sections were compared to sagittal, transverse, and 3D render volume reconstruction computed tomography (CT) scans. The subepicardial fat, which covered the heart base, the coronary groove (sulcus coronarius), the left longitudinal interventricular groove (sulcus interventricularis paraconalis), and the right longitudinal interventricular groove (sulcus interventricularis subsinuosus), had a relatively low density with a homogeneous appearance in the 3D render volume CT. The pericardium in the color cardiac window was identified better than the black and white window (ghost). Transverse and sagittal CT scans demonstrated the internal structures of the heart, including the right atrioventricular orifice (ostium atrioventriculare dextrum), right atrioventricular orifice (ostium atrioventriculare sinistrum), and aortic orifice (ostium aortae), chordae tendineae, the cusps of the valves (cuspis valvae), and the papillary muscles (musculi papillares). The papillary muscle (musculi papillares) was presented with a more moderate density than the rest of the heart, and the cusps of the valves (cuspis valvae) had a lower density. The ventricular wall (margo ventricularis) exhibited different densities: the outer part was hyperdense, while the inner part was hypodense. The thicknesses of the ventricular mural wall and the interventricular septum (septum atrioventriculare) were highest at the midpoint of the ventricular mass, and the lowest value was present toward the apical part. The coronary groove (sulcus coronarius) circumference measured 51.14 ± 0.72 cm, and the fat in the coronary groove (sulcus coronarius) (56 ± 6.55 cm2) represented 28.7% of the total cross-sectional area. Conclusion: The current study provided more information about ventricular mass measurements by gross and CT analysis on the heart, which provides a valuable guide for future cardiac CT investigations in camels in vivo.

Cardiac Magnetic Resonance Derived Left Ventricular Eccentricity Index and Right Ventricular Mass Measurements Predict Outcome in Children with Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) is associated with increased right ventricular (RV) afterload, affecting RV remodeling and RV performance, a major determinant of outcome in PAH-patients. In children with PAH, treatment strategy is guided by risk stratification where noninvasive prognosticators are highly needed. The prognostic value of RV characteristics derived by cardiac magnetic resonance (CMR) has been scarcely studied in pediatric PAH. We aimed to identify CMR-derived morphometric and functional RV characteristics prognostic for outcome in children with PAH. From the Dutch National cohort, thirty-eight children with either idiopathic/heritable PAH (IPAH/HPAH) or PAH associated with congenital heart disease (PAH-CHD), who underwent CMR, were included (median (interquartile range) [IQR] age 13.0 years (10.8-15.0), 66% females). Patients had severe PAH, characterized by their World Health Organization Functional Class, increased N-terminal pro-B-type natriuretic peptide and high pulmonary arterial pressure and pulmonary vascular resistance index at time of CMR. RV-ejection fraction (RVEF), indexed RV-mass (RVMi), the ratio between RV and LV mass (RVM/LVM-ratio) and left ventricular eccentricity index (LVEI) all correlated with transplant-free survival from time of CMR. These correlations could not be confirmed in the PAH-CHD group. This study shows that CMR-derived measures reflecting RV function and remodeling (LVEI, RVMi, RVM/LVM-ratio, RVEF) predict transplant-free survival in children with IPAH/HPAH and may be included in risk stratification scores in pediatric PAH.

Ultrasonic Measurement of Left Ventricular Mass Index of Hypertensive and Normotensive Adults in a Tertiary Hospital in South-South Nigeria

Background: Hypertension is a known cause of heart disease which may manifest as an increase in left ventricular mass index. Echocardiography is a painless, safe and reliable test using sound waves for measuring Left Ventricular Mass (LVM) from which Left Ventricular Mass Index (LVMI) can be derived.&#x0D; Aims and Objectives: This study was aimed at evaluating and comparing the ultrasonic measurement of the left ventricular mass index of hypertensive patients and normotensive participants and correlating the Left Ventricular Mass Index (LVMI) to the Body Mass Index (BMI) and Gender in the study populations.&#x0D; Methodology: This was a prospective hospital-based case-control study of adult hypertensive participants and normotensive controls. Echocardiography was done with measurements of the Left Ventricular Mass (LVM) obtained. The LVMI of the study groups was correlated to their BMI and gender.&#x0D; Results: The mean BMI was statistically higher in the hypertensive group (25.98 4.40 kg/m2) (p-value=0.001).The mean Left Ventricular Mass Index (LVMI) was significantly higher in the hypertensive group (79.5961.67g/m2.7) than in normotensive group (55.36 34.77g/m2.7) (p-value 0.0001). In this study, the high BMI category (obese/overweight) was the strongest predictors of LVMI above 51g/m2.7 (p-value= 0.0001) and females were almost 1.8 times more likely to have increased LVMI than men&#x0D; Conclusion: This study revealed that the female gender, BMI and hypertension were significant predictors of increased left ventricular mass index. High BMI category (obese/overweight) was the strongest predictors of LVMI above 51g/m2.7. Periodic ultrasonic measurement of the ventricular mass index will help in early detection and reducing this common and potentially modifiable risk that leads to increased morbidity and mortality.

Ameliorative Role of Fluconazole Against Abdominal Aortic Constriction-Induced Cardiac Hypertrophy in Rats.

Cytochrome P450 1B1 (CYP1B1) is known to be involved in the pathogenesis of several cardiovascular diseases, including cardiac hypertrophy and heart failure, through the formation of cardiotoxic metabolites named as mid-chain hydroxyeicosatetraenoic acids (HETEs). Recently, we have demonstrated that fluconazole decreases the level of mid-chain HETEs in human liver microsomes, inhibits human recombinant CYP1B1 activity, and protects against angiotensin II-induced cellular hypertrophy in H9c2 cells. Therefore, the overall purpose of this study was to elucidate the potential cardioprotective effect of fluconazole against cardiac hypertrophy induced by abdominal aortic constriction (AAC) in rats. Male Sprague-Dawley rats were randomly assigned into 4 groups such as sham control rats, fluconazole-treated (20 mg/kg daily for 4 weeks, intraperitoneal) sham rats, AAC rats, and fluconazole-treated (20 mg/kg) AAC rats. Baseline and 5 weeks post-AAC echocardiography were performed. Gene and protein expressions were measured using real-time PCR and Western blot analysis, respectively. The level of mid-chain HETEs was determined using liquid chromatography-mass spectrometry. Echocardiography results showed that fluconazole significantly prevented AAC-induced left ventricular hypertrophy because it ameliorated the AAC-mediated increase in left ventricular mass and wall measurements. In addition, fluconazole significantly prevented the AAC-mediated increase of hypertrophic markers. The antihypertrophic effect of fluconazole was associated with a significant inhibition of CYP1B1, CYP2C23, and 12-LOX and a reduction in the formation rate of mid-chain HETEs. This study demonstrates that fluconazole protects against left ventricular hypertrophy, and it highlights the potential repurposing of fluconazole as a mid-chain HETEs forming enzymes' inhibitor for the protection against cardiac hypertrophy.

Determination of sources of error and improvement in accuracy of left ventricular mass measurement by echocardiography.

Abnormal Left ventricular mass (LVM) prognosticates adverse cardiovascular events. Conventionally, LVM measured by echo assumes a prolate ellipsoid (PE) shape; however, it poorly correlates with reference standard of cardiac magnetic resonance imaging (CMR) derived LVM. PE model assumes LVL = 2 × LVID. We developed a new echo LVM formula based on LV length and tested for accuracy against CMR. A retrospective study of consecutive patients with an echocardiogram and CMR within 3months. Derivation (n = 170) and validation cohorts (n = 54) were used to test the new formula. Following analysis of correlation of interventricular septum (IVS), LV internal dimension (LVID), posterior wall (PW) and LVL between echo and CMR, a novel paraboloid-shape linear regression (PLR) model was derived. LVM by both models were compared to CMR. Poor correlation observed between actual and assumed LVL (0.52 with CMR; 0.44 with echo). Strong correlation was noted between echo and CMR measured LVL, LVID, IVS (r > 0.80) and a moderate correlation with PW (r = 0.62). Strong correlation of LVL was harnessed to develop PLR model, which significantly decreased paired error in derivation cohort (from 64 ± 42 to 22 ± 21 gm) and validation cohort (from 63 ± 46 to 25 ± 18 gm). Furthermore, it demonstrates significant reduction in absolute, relative errors and variability along with superior correlation in both cohorts. Between echo and CMR, LVL demonstrates one of the best correlation among LV dimensions. The assumption, LVL = 2 × LVID appears inaccurate. PLR model incorporates LVL and significantly improves accuracy, reduces variability of LVM.

Left ventricular dimensions and mass measurement from 3D echocardiography: are we there yet?

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Health Research Council (HRC) of New Zealand and National Heart Foundation (NHF) of New Zealand Introduction—Echocardiographic measures of left ventricular (LV) structure and size, including LV wall thickness and LV end-diastolic dimension (LVID), provide important information in the assessment of patients with heart disease. For example, LV mass is a predictor of outcome for patients with hypertension and LVID is a predictor of cardiac resynchronisation response in patients with heart failure. Advances in 3D echocardiography (3DE) have enabled full-volume acquisitions, which overcome geometric assumptions present in conventional 2D echocardiography (2DE), providing a more accurate representation of cardiac geometry. Although numerous validation studies have been performed for 3DE-derived LV volumes, comparisons of LV dimension by 3DE against established methods are limited. Purpose—We sought to compare routine LV dimension measurements between 3DE and 2DE, with validation using cardiac magnetic resonance (CMR) imaging. Methods—Transthoracic echocardiography (2D and 3D) and cine CMR imaging were performed in 62 prospectively recruited participants (47 healthy controls, 9 patients with LVH, 6 patients with aortic regurgitation), &amp;lt;1 h apart. 2DE LV dimension measurements (interventricular septum [IVS], posterior wall thickness [PWT], and LVID) were taken at end-diastole from the parasternal long axis, and mass was calculated using the linear method based on ASE/EACVI guidelines. For 3DE, 3D geometric models of the LV were constructed by interactively fitting surfaces to the endocardium and epicardium using previously validated software, from which corresponding LV dimension measurements and mass were extracted. Measurements were obtained from CMR by a similar 3D geometric modelling process. Results—Differences (mean ± SD) in LV dimension measurements between the three modalities and intraclass correlation coefficients (ICC) are presented in Table I. When compared with CMR, 3DE exhibited higher agreement in terms of LVID and mass than 2DE, but lower agreement in wall thickness measurements. Statistically significant differences were found between 2DE and 3DE for PWT, LVID, and mass, as well as 2DE and CMR for LVID and mass (where P &amp;lt; 0.01 for a paired sample t­-test, marked with an asterisk). Meanwhile, there were no statistically significant differences between 3DE and CMR for IVS, PWT, LVID, or mass. Conclusions—Our results demonstrate that 3DE is superior to 2DE in terms of LVID and mass quantification, exhibiting good agreement with CMR. 3DE exhibited moderate and poor agreement for IVS and PWT, respectively, with both 2DE and CMR, likely due to the lower spatial resolution of 3DE. Further advances in 3DE image quality and analysis tools are therefore needed to improve accuracy of wall thickness measurements. Since 2DE imaging plane and probe positioning can result in oblique measurement and underestimation of LVID, the assessment of LVID and mass by 3DE is likely to lead to more accurate diagnostic and prognostic outcomes. Abstract Table 1

AI Based CMR Assessment of Biventricular Function: Clinical Significance of Intervendor Variability and Measurement Errors

ObjectivesThe aim of this study was to determine whether left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) and left ventricular mass (LVM) measurements made using 3 fully automated deep learning (DL) algorithms are accurate and interchangeable and can be used to classify ventricular function and risk-stratify patients as accurately as an expert. BackgroundArtificial intelligence is increasingly used to assess cardiac function and LVM from cardiac magnetic resonance images. MethodsTwo hundred patients were identified from a registry of individuals who underwent vasodilator stress cardiac magnetic resonance. LVEF, LVM, and RVEF were determined using 3 fully automated commercial DL algorithms and by a clinical expert (CLIN) using conventional methodology. Additionally, LVEF values were classified according to clinically important ranges: <35%, 35% to 50%, and ≥50%. Both ejection fraction values and classifications made by the DL ejection fraction approaches were compared against CLIN ejection fraction reference. Receiver-operating characteristic curve analysis was performed to evaluate the ability of CLIN and each of the DL classifications to predict major adverse cardiovascular events. ResultsExcellent correlations were seen for each DL-LVEF compared with CLIN-LVEF (r = 0.83-0.93). Good correlations were present between DL-LVM and CLIN-LVM (r = 0.75-0.85). Modest correlations were observed between DL-RVEF and CLIN-RVEF (r = 0.59-0.68). A >10% error between CLIN and DL ejection fraction was present in 5% to 18% of cases for the left ventricle and 23% to 43% for the right ventricle. LVEF classification agreed with CLIN-LVEF classification in 86%, 80%, and 85% cases for the 3 DL-LVEF approaches. There were no differences among the 4 approaches in associations with major adverse cardiovascular events for LVEF, LVM, and RVEF. ConclusionsThis study revealed good agreement between automated and expert-derived LVEF and similarly strong associations with outcomes, compared with an expert. However, the ability of these automated measurements to accurately classify left ventricular function for treatment decision remains limited. DL-LVM showed good agreement with CLIN-LVM. DL-RVEF approaches need further refinements.

Indicaciones e interpretación de la resonancia magnética cardíaca

Cardiac magnetic resonance is a fundamental technique in the study of cardiomyopathies. Its main value lies in the great precision and reproducibility of ventricular volumes, ejection fraction, parietal thickness, and myocardial mass measurements as well as its ability to characterize tissue, which allows for refining the etiological diagnosis. The group that most benefits from a cardiac magnetic resonance study is patients suspected of having cardiomyopathy, whose diagnosis cannot be established via echocardiogram due to technique limitations (poor window). This technique would be indicated in the etiological study of dilated cardiomyopathies and in hypertrophic phenotypes. Another strength of cardiac magnetic resonance is the demonstrated prognostic value of its findings in this group of patients.

Fluconazole Protects against Abdominal Aortic Constriction‐Induced Cardiac Hypertrophy

Purpose: Cytochrome P450 1B1 (CYP1B1) is known to be involved in the pathogenesis of several cardiovascular diseases such as cardiac hypertrophy and heart failure, through the formation of cardiotoxic metabolites named as midchain hydroxyeicosatetraenoic acids (HETEs). Recently, we have demonstrated that fluconazole, an antifungal agent, decreases the level of mid-chain HETEs in human liver microsomes, inhibits human recombinant CYP1B1 activity and protects against angiotensin II-induced cellular hypertrophy in H9c2 cells. Therefore, the overall objectives of the present study were to elucidate the potential cardioprotective effect of fluconazole against cardiac hypertrophy induced by abdominal aortic constriction (AAC) and unravel the mechanism(s) involved. Methods: Male Sprague-Dawley rats were randomly assigned into four groups; sham control rats, fluconazole-treated (20 mg/kg daily for 4 weeks, intraperitoneal) sham rats, AAC rats and fluconazole-treated (20 mg/kg) AAC rats. Baseline and 5 weeks post-AAC echocardiography were performed. Gene and protein expression were measured using real-time PCR and Western blot analysis, respectively. The level of mid-chain HETEs was determined using liquid chromatography–mass spectrometry (LC/MS). Results: Echocardiography results showed that fluconazole significantly reversed the AAC-induced left ventricular hypertrophy, as it was able to ameliorate the AAC-mediated increase in left ventricular mass and several wall measurements. In addition, fluconazole significantly prevented the AAC-mediated increase of hypertrophic markers, β-myosin heavy chain (MHC)/α-MHC and atrial natriuretic peptide (ANP). The antihypertrophic effect of fluconazole was associated with a significant inhibition of CYP1B1 at the gene and protein levels as well as a reduction in the formation rate of midchain HETEs. Conclusion: The current study demonstrates a strong evidence that fluconazole protects against left ventricular hypertrophy. The findings of the present work highlight the potential repurposing of fluconazole as a CYP1B1 inhibitor for the protection against cardiac hypertrophy and a possible treatment for heart failure.

META-ANALYSIS ASSESSING THE EFFECTS OF ALLOPURINOL ON LEFT VENTRICULAR MASS AND OTHER INDICES OF LEFT VENTRICULAR REMODELING AS EVALUATED BY CARDIAC MAGNETIC RESONANCE IMAGING

Objective: Hyperuricemia is a relatively common morbidity, featuring a close relationship with cardiovascular disease, hypertension, heart failure and chronic kidney disease, while it is also related to the development of type 2 diabetes mellitus. Allopurinol remains the mainstay of treatment. We sought to determine whether allopurinol affects left ventricular (LV) mass and other measures of LV remodeling, as assessed by cardiac magnetic resonance imaging (cMRI). Design and method: We performed a systematic search in two major electronic databases, PubMed and Cochrane Central Register of Controlled Trials (CENTRAL), for eligible randomized controlled trials (RCTs), from their inception to September 2020, along with grey literature sources. Results: Our search yielded 84 results in total. Finally, 4 records were included in our quantitative synthesis. Our analysis in a total of 225 patients showed that allopurinol treatment produced a non-significant decrease in LV mass by 1.42 g (MD = -1.42, 95% CI -6.34 to 3.50, I2 = 90%), and a non-significant decrease in LV mass index by 1.47 g/m2 (MD = -1.47, 95% CI -3.91 to 0.96, I2 = 91%). In addition, allopurinol did not decrease significantly neither LV end systolic volume (MD = -0.45 mL, 95% CI -5.53 to 4.64, I2 = 56%) nor LV end diastolic volume (MD = -2.98 mL, 95% CI –9.39 to 3.43, I2 = 35%). Finally, allopurinol did not affect significantly LV stroke volume (MD = 2.06 mL, 95% CI –2.02 to 6.14, I2 = 0%). We consider as major limitations of the present meta-analysis the small number of included RCTs and enrolled participants, which did not permit us to perform subgroup analyses in order to investigate the sources of heterogeneity. Conclusions: Conclusion: Allopurinol does not exert a significant effect on LV mass and other indices of LV remodeling, as quantified by cMRI, in a broad population with significant cardiovascular co-morbidities.

Tissue characteristics of the athlete"s heart: differentiation of physiological and pathological hypertrophy using parametric T1 and T2 mapping

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Fund of Hungary Background Intensive physical exercise leads to structural and functional cardiac adaptation termed athlete’s heart. Cardiac magnetic resonance (CMR) has an important role in the differentiation of physiological adaptation and pathological conditions. Beside the precise measurement of the ventricular volumes, mass, and function, it provides tissue specific information. Recently, native T1 mapping technique has been applied as a non-contrast method to detect myocardial fibrosis. Previous studies suggested that native T1 mapping can identify myocardial pathology before other CMR imaging techniques. T2 mapping values are elevated in case of myocardial edema. Purpose The aim of our study was to investigate the differences in CMR characteristics especially the native T1 and T2 mapping values of highly trained healthy athletes, healthy controls and patients with hypertrophic cardiomyopathy (HCM). Methods A total of 43 healthy athletes (water polo, swimming, football, 22 ± 8 training hours/week), 27 non-athlete healthy control and 25 HCM patients were involved in the study. Our inclusion criteria were: age &amp;gt;18 years, in the athlete group &amp;gt;7 training hours per week . We evaluated the left ventricular (LV) end-systolic, end-diastolic (EDVi) and stroke volume (SVi) index, mass index (LVMi), ejection fraction (EF) and maximal end-diastolic wall thickness (EDWT). In a basal short axis slice the native T1 and T2 mapping values were evaluated. Results Athletes had significantly higher LV volumes compared to the control and HCM group (LVEDVi 114 ± 13 vs. 86 ± 11; 84 ± 15 ml/m2, LVSVi 64 ± 7 vs. 51 ± 7; 54 ± 10 ml/m2, respectively, p &amp;lt; 0.0001). HCM patients had the highest LVMi (72 ± 14 g/m2) and EDWT (18 ± 4 mm) compared to athletes and controls, athletes had higher LVMi (60 ± 11 vs. 42 ± 8 g/m2) and EDWT (10 ± 2 vs. 8 ± 1 mm) compared to the controls (p &amp;lt; 0.001). The native T1 mapping values differed significantly in the three groups, athletes had the lowest, HCM patients had the highest T1 values (athletes: 956 ± 19 ms, controls: 971 ± 20 ms, HCM patients: 993 ± 39 ms; p &amp;lt; 0.0001). There was no difference in the T2 mapping values between athletes and controls (44 ± 2 vs. 43 ± 2 ms), HCM patients had higher T2 values (45 ± 2 ms) compared to the other two groups (p &amp;lt; 0.01). Conclusion Intensive and regular training may lead to tissue specific changes of the myocardium. T1 and T2 mapping are potentially useful tools for differentiating between athlete"s heart and patients with hypertrophic cardiomyopathy. Abstract Figure. T1 mapping in HCM and athlete

Cardiovascular System Radio Waves Description and MRI Scanning Importance

Cardiovascular attractive reverberation imaging (MRI) has advanced from a powerful examination instrument into a clinically demonstrated, protected and thorough imaging methodology. It gives anatomic and utilitarian data in gained and inborn coronary illness and is the most exact strategy for measurement of ventricular volumes, capacity, and mass. Inferable from its incredible interstudy reproducibility, cardiovascular MRI is the ideal technique for appraisal of changes in ventricular boundaries after remedial intercession.

Mid- to Late-Life Time-Averaged Cumulative Blood Pressure and Late-Life Cardiac Structure, Function, and Heart Failure.

Limited data exist regarding systolic blood pressure (SBP) through mid- to late-life and late-life cardiac function and heart failure (HF) risk. Among 4578 HF-free participants in the ARIC study (Atherosclerosis Risk in Communities) attending the fifth visit (2011-2013; age 75±5 years), time-averaged cumulative SBP was calculated as the sum of averaged SBPs from adjacent consecutive visits (visits 1-5) indexed to total observation time (24±1 years). Calculations were performed using measured SBPs and also incorporating antihypertensive medication specific effect constants (underlying SBP). Outcomes included comprehensive echocardiography at visit 5 and post-visit 5 incident HF, HF with preserved ejection fraction, and reduced ejection fraction. Higher cumulative SBP was associated with greater left ventricular mass and worse diastolic measures (all P<0.001), associations that were stronger with underlying compared with cumulative SBP (all P<0.05). At 5.6±1.2 years follow-up post-visit 5, higher cumulative measured and underlying SBP were associated with incident HF (hazard ratio per 10 mm Hg for measured: 1.12 [1.01-1.24]; underlying: 1.19 [95% CI, 1.10-1.30]) and HF with preserved ejection fraction (measured: 1.15 [1.00-1.33]; underlying: 1.28 [1.14-1.45]), but not HF with reduced ejection fraction (measured: 1.11 [0.94-1.32]; underlying: 1.11 [0.96-1.24]). Associations with HF and HF with preserved ejection fraction were more robust with cumulative underlying compared with measured SBP (all P<0.05). Time-averaged cumulative SBP in mid to late life is associated with worse cardiac function and risk of incident HF, especially HF with preserved ejection fraction, in late life. These associations were stronger considering underlying as opposed to measured SBP, highlighting the importance of prevention and effective treatment of hypertension to prevent late-life cardiac dysfunction and HF.

Left Ventricular Mass and Wall Thickness Measurements Using Echocardiography and Cardiac MRI in Patients with Fabry Disease: Clinical Significance of Discrepant Findings.

To compare transthoracic echocardiography (TTE) and cardiac MRI measurements of left ventricular mass (LVM) and maximum wall thickness (MWT) in patients with Fabry disease and evaluate the clinical significance of discrepancies between modalities. Seventy-eight patients with Fabry disease (mean age, 46 years ± 14 [standard deviation]; 63% female) who underwent TTE and cardiac MRI within a 6-month interval between 2008 and 2018 were included in this retrospective cohort study. The clinical significance of measurement discrepancies was evaluated with respect to diagnosis of left ventricular hypertrophy (LVH), eligibility for disease-specific therapy, and prognosis. Statistical analysis included paired-sample t test, Cox proportional hazard models, Akaike information criterion (AIC), and intraclass correlation coefficients. LVM indexed to body surface area (LVMI) and MWT were significantly higher at TTE compared with MRI (105 g/m2 ± 48 vs 78 g/m2 ± 36, P < .001 and 14 mm ± 4 vs 13 mm ± 5, P = .008, respectively). LVH classification was discordant between modalities in 23 patients (29%) (P < .001). Eligibility for disease-specific therapy based on MWT was discordant between modalities in 20 patients (26%) (P < .001). LVMI assessed with MRI was a better predictor of the combined endpoint compared with LVMI assessed with TTE (AIC, 127 vs 131). Interobserver agreement for LVMI and MWT was higher for MRI (intraclass correlation coefficient, 0.951 and 0.912, respectively) compared with TTE (intraclass correlation coefficient, 0.940 and 0.871; respectively). TTE overestimates LVM and MWT and has lower reproducibility compared with cardiac MRI in Fabry disease. Measurement discrepancies between modalities are clinically significant with respect to diagnosis of LVH, prognosis, and treatment decisions.© RSNA, 2020.

Influence of observer-dependency on left ventricular hypertrabeculation mass measurement and its relationship with left ventricular volume and ejection fraction - comparison between manual and semiautomatic CMR image analysis methods.

Recent studies concerning left ventricular noncompaction (LVNC) suggest that the extent of left ventricular (LV) hypertrabeculation has no impact on prognosis. The variety of methods of LV noncompacted myocardial mass (NCM) assessment may influence the results. Hence, we compared two methods of NCM estimation: largely observer-independent Hautvast's(H) computed algorithm-based approach and commonly used Jacquier's(J) method, and their associations with LV end-diastolic volume (EDV) and ejection fraction (EF). Cardiac magnetic resonance images of 77 persons (45±17yo) - 42 LVNC, 15 non-ischemic dilative cardiomyopathy, 20 control group were analyzed. LVNC patients were divided into the subgroup with normal (LVNCN) and high EDV (LVNCDCM). NCM and total left ventricular mass (LVM) were estimated by Hautvast's [excluding intertrabecular blood (ITB) and including papillary muscles (PMs) into NCM] and Jacquier's approach (including ITB and PMs, if unclearly distinguished, into NCM). The cut-off value of NCM for LVNC diagnosis was 22% (AUC 0.933) for NCMH/LVMH and 26% (AUC 0.883) for NCMJ/LVMJ. Inter- and intra-observer variability (estimated by coefficient of variation [CoV] and intraclass correlation coefficient [ICC]) of NCMH/LVMH appeared better than of NCMJ/LVMJ (CoV 4.3%, ICC 0.981 and CoV 4.9%, ICC 0.978; respectively for NCMH/LVMH, while for NCMJ/LVMJ: CoV 19.7%, ICC 0.15 and CoV 12.9%, ICC 0.504). In LVNCN subgroup, the correlation between EDV and NCMH was stronger than NCMJ (r = 0.677, p<0.001 vs. r = 0.480, p = 0.038; respectively). In LVNC the EDV correlated with NCMH/LVMH (r = 0.391, p<0.01), but not with NCMJ/LVMJ. In the overall group a relationship was present between EF and NCMH/LVMH (r = -0.449, p<0.001), but not NCMJ/LVMJ. Only NCMH/LVMH explained the variability of EDV (b 0.434, p<0.001). Choosing a method of NCM assessment that is less observer-dependent might increase the reliability of results. The impact of method selection on the LV parameters and cut-off values for hypertrabeculation should be further investigated.

Risk of cardiovascular involvement in pediatric patients with X-linked hypophosphatemia.

To find out if cardiovascular alterations are present in pediatric patients with X-linked hypophosphatemia (XLH). Multicentre prospective clinical study on pediatric patients included in the RenalTube database ( www.renaltube.com ) with genetically confirmed diagnosis of XLH by mutations in the PHEX gene. The study's protocol consisted of biochemical work-up, 24-h ambulatory blood pressure monitoring (ABPM), carotid ultrasonography, and echocardiogram. All patients were on chronic treatment with phosphate supplements and 1-hydroxy vitamin D metabolites. Twenty-four patients (17 females, from 1 to 17years of age) were studied. Serum concentrations (X ± SD) of phosphate and intact parathyroid hormone were 2.66 ± 0.60mg/dl and 58.3 ± 26.8pg/ml, respectively. Serum fibroblast growth factor 23 (FGF23) concentration was 278.18 ± 294.45pg/ml (normal < 60pg/ml). Abnormally high carotid intima media thickness was found in one patient, who was obese and hypertensive as revealed by ABPM, which disclosed arterial hypertension in two other patients. Z scores for echocardiographic interventricular septum end diastole and left ventricular posterior wall end diastole were + 0.77 ± 0.77 and + 0.94 ± 0.86, respectively. Left ventricular mass index (LVMI) was 44.93 ± 19.18g/m2.7, and four patients, in addition to the obese one, had values greater than 51g/m2.7, indicative of left ventricular hypertrophy. There was no correlation between these echocardiographic parameters and serum FGF23 concentrations. XLH pediatric patients receiving conventional treatment have echocardiographic measurements of ventricular mass within normal reference values, but above the mean, and 18% have LVMI suggestive of left ventricular hypertrophy without correlation with serum FGF23 concentrations. This might indicate an increased risk of cardiovascular involvement in XLH.

High sensitivity C-reactive protein, left ventricular mass, and systolic function in obese adolescents

Background Obesity has been associated with structural and functional cardiac muscle defects. High sensitivity C-reactive protein (hs-CRP) has been utilized as an independent predictor of future cardiovascular disease.Objective To assess for correlations between hs-CRP, left ventricular mass, and systolic function in obese adolescents.Methods This cross-sectional study was conducted from August 2013 to February 2014. Subjects were obese adolescents aged 13-18 years with a body mass index (BMI) &gt;95th percentile, according to the 2000 Centers for Disease Control and Prevention Growth Chart. Subjects underwent laboratory testing of serum hs-CRP levels, as well as left ventricular mass and function measurements by echocardiography. Descriptive analysis was performed on patients’ characteristics and correlation analysis was done by Pearson’s test with a significance level of P&lt;0.05.Results Subjects were 40 obese adolescents. There was no statistically significant correlation between hs-CRP and left ventricular mass (r=0.083; P=0.305). There was a moderate correlation between hs-CRP with ejection fraction (EF) (r=0.372 and P=0.009 ) and fractional shortening (FS) of the left ventricle (r=0.420 and P=0.003).Conclusion In obese adolescents, we find no correlation between hs-CRP and left ventricular mass. However, hs-CRP is moderately correlated with left ventricular EF and FS.