RPS 1703 - Cardiac imaging: interactions with other organs and systemic diseases

Author Block: J. Qin, Y. Xu; Nanjing, Jiangsu/CN
Purpose: To explore the association between coronary computed tomography angiography (CCTA)- derived pericoronary fat attenuation index (pFAI), fractional flow reserve (CT-FFR) and degree of white matter hyperintensities (WMH).
Methods or Background: Clinical, CCTA and brain magnetic resonance imaging (MRI) data of 561 participants were retrospectively analyzed. WMH were assessed in periventricular (PVWMH) and deep (DWMH) locations, and a total Fazekas score was calculated by summing the scores for PVWMH and DWMH. The study cohort was classified into mild WMH group (score 0-2) and moderate-to-severe WMH group (score 3-6). Coronary artery disease (CAD) was defined as one or more coronary arteries with diameter stenosis of ≥50%. The threshold value of CT-FFR was set as 0.80. Clinical data, pFAI, CT-FFR and other coronary parameters were compared between two groups, and independent variables associated with moderate-to-severe WMH were identified using multiple logistic regression analysis.
Results or Findings: Compared with patients with mild WMH, those with moderate-to-severe WMH showed larger volume of plaque (total, calcified, noncalcified palque), higher plaque burden, longer plaque length, higher Agatston Score, higher value of pFAI and higher proportion of CT-FFR≤ 0.80, higher proportion of patients with CAD and aortic ulcers (all p<0.05). Multiple logistic regression indicated that age [odds ratio (OR), 1.028; p=0.025], CAD (OR, 5.282; p=0.004), plaque burden (OR, 4.101; p=0.004) , noncalcified plaque burden (OR, 2.850; p<0.001) and pFAI (OR, 1.109; p<0.001) were independently associated with moderate-to-severe WMH.
Conclusion: Besides the well-known factors including age, CAD and plaque burden, pFAI was also found to be associated with moderate-to-severe WMH.
Limitations: As a cross-sectional study, the progression of WMH was not analyzed. Future research exploring the progression of CCTA- derived parameters including CT-FFR and pFAI and the progression of WMH would be more valuable.
Funding for this study: This work was supported by the grants from the Natural Scientific Foundation of China (Grant Nos. 82302163 for Yunfei Wang) and Young Scholars Fostering Fund fo the First Affiliated Hospital of Nanjing Medical University (Grant Nos. PY2022036 for Yunfei Wang).
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The requirement of written informed consent was waived due to the retrospective nature.

Author Block: G. Prencipe, I. Notarangelo, P. Mangano, L. Marinelli, L. Macarini, G. Guglielmi, M. Gravina; Foggia/IT
Purpose: The aim of this study was to evaluate the efficacy of cardiac T1 mapping MRI sequences in assessing myocardial iron overload in patients with Hereditary Hemochromatosis, in comparison to the more commonly employed T2* sequences.
Methods or Background: A total of 28 cardiac MRI scans, conducted between 2019 and 2023, were analyzed. All patients had Hereditary Hemochromatosis and elevated serum ferritin levels. The MRI scans were performed using a Philips Achieva dStream 1.5T scanner with cardiac gating and included T2* and native T1 mapping sequences, without the use of contrast agents. Quantitative T2* analysis was conducted by placing regions of interest (ROIs) in the interventricular septum (IVS), and these results were compared with the corresponding native T1 mapping findings.
Results or Findings: Out of the 28 patients, 25 had T2* values over 20 msec, indicating no significant iron deposition. The remaining three patients exhibited T2* values between 15 and 20 msec, suggesting mild iron overload. None of the patients demonstrated T2* values below 15 msec. In the three patients with mild iron overload, T1 mapping showed correspondingly low values, consistent with their T2* measurements. However, 5 of the 25 patients with normal T2* values had T1 values below the expected range (980-1080 msec for the our scanner).
Conclusion: Native T1 values were reduced in patients with myocardial iron accumulation and correlated well with T2* measurements. T1 mapping provides the added benefit of detecting early-stage iron overload that might be missed by T2* alone, making it a valuable tool for the early diagnosis of iron deposition and for monitoring the effectiveness of chelation therapy
Limitations: The study is retrospective. Single center study. Few patients with low T2*.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: The study is retrospective

Author Block: E. Norton, J. M. Brendel, I. Hadzic, T. Mayrhofer, I. L. Langenbach, M. C. Langenbach, M. T. Lu, H. Aerts, B. Foldyna; Boston, MA/US
Purpose: To evaluate the prognostic value of epicardial adipose tissue (EAT) volume and density between women and men (who often present with different body fat distribution) eligible for lung cancer screening, a group with an unmet need for better risk stratification.
Methods or Background: Using a validated deep-learning algorithm, we measured EAT volume (indexed to body-surface-area; cm³/m²) and density (HU) on baseline non-contrast, low-dose chest CTs from the National Lung Screening Trial. Associations with 12-year all-cause and cardiovascular mortality were assessed using multivariable Cox regression models, stratified by sex, and adjusted for age, race/ethnicity, smoking status (current vs. former), pack-years, history of heart disease or stroke, diabetes mellitus, hypertension, educational status, and body-mass-index.
Results or Findings: Among 24,090 participants, 9,886 were women (41%; 61±5 years), and 14,204 were men (59%; 62±5 years). Women presented lower EAT volumes and higher densities than men (65.7±23.2cm³/m² and -77.2±5.1HU vs. 73.5±25.0cm³/m² and -78.0±5.2HU; p<0.001 for sex differences). A 10 cm³/m² EAT volume increase revealed similar prognostic values in women and men (all-cause mortality: aHR:1.10 [95%-CI: 1.07–1.13] in women vs. aHR:1.11 [95%CI: 1.08–1.13] in men; cardiovascular mortality: aHR:1.13 [95%-CI: 1.06–1.20] in women vs. aHR:1.16 [95%-CI: 1.11–1.21] in men). EAT density demonstrated a stronger association with all-cause mortality in men than in women (aHR:1.41 [95%-CI: 1.28–1.56] in men vs. aHR:1.28 [95%-CI: 1.10–1.47] in women; p=0.010 for sex as interaction term). The associations were similar with cardiovascular death (aHR:1.76 [95%-CI: 1.29–2.41] in women vs. aHR:1.78 [95%-CI: 1.45–2.19] in men).
Conclusion: Opportunistic EAT volume and density quantification may improve risk stratification in women and men eligible for lung cancer screening, with EAT density being a stronger predictor of all-cause death in men than women.
Limitations: Exclusively heavy smokers were included, precluding comparison with non-smokers and lower-risk smokers.
Funding for this study: Original data collection for NLST was funded by NIH.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Insight IRB protocol #: 2017P002400

Author Block: J. Arenja, D. G. Aydemir, L. Naimi, I. Molwitz, M. Sterneck, G. Adam, P. Bannas, E. Tahir, J. Erley; Hamburg/DE
Purpose: A transjugular intrahepatic portosystemic shunt (TIPS) results in blood flow from the splanchnic to the venous circulation. We aimed to evaluate if a TIPS impacts cardiovascular magnetic resonance (CMR) features in patients with liver cirrhosis.
Methods or Background: In this retrospective, monocentric study, 60 patients with liver cirrhosis received a CMR exam (3T, Ingenia, Philips or Siemens). Left ventricular (LV) mass, volumes (indexed to the body mass index [BMI]), and ejection fraction (EF) were analyzed. Strain was measured by feature tracking using Cvi42 (Circle Vascular Imaging). For statistics, mixed linear models were conducted.
Results or Findings: 30 patients with TIPS (40% females, age 56±11 years, BMI 26.8±5.2 kg/m2, hepatic venous pressure gradient (HVPG) pre-TIPS 27.9±6.7 and post-TIPS 11.2±4.1 mmHg) were compared to 30 matched patients without TIPS (47% females, age 53±14 years, BMI 26.1±5.1 kg/m2). Patients with TIPS showed a -14.8% attenuated LV global radial strain [95% confidence interval (CI): -28.1 to -1.5%] compared to patients without TIPS (p = 0.037). LV mass, volumes, and longitudinal/circumferential strain were not significantly different between the groups. In patients with TIPS, LV end-diastolic mass (regression coefficient = 1.5 ml/m2 [95%-CI: 0.1 to 3%], p = 0.040) and LV global longitudinal strain (0.6% [95%-CI: 0.1 to 1.2%], p = 0.035) were associated with HPVG post-TIPS.
Conclusion: Cirrhotic patients with TIPS show attenuated LV radial strain compared to patients without TIPS, possibly reflecting subclinical LV dysfunction due to TIPS-induced increase in preload. A higher post-TIPS HPVG is associated with increased LV end-diastolic mass and attenuated LV global longitudinal strain, indicating LV hypertrophy and subclinical dysfunction with persistent portal hypertension.
Limitations: This is a retrospective study with a small sample size, warranting validation in a larger cohort.
Funding for this study: Not applicable.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the local ethics committee of the medical association in Hamburg.

Author Block: E. Moliterno¹, L. Giarletta¹, G. Rovere¹, S. L. Bosello¹, G. De Luca², A. Tonutti³, M. A. D'Agostino¹, L. Natale¹, R. Marano¹; ¹Rome/IT, ²Milan/IT, ³Rozzano/IT
Purpose: Cardiac involvement in Systemic Sclerosis (SSc) is widely recognized as heterogeneous and, when clinically evident, it is associated with a poor prognosis. Recently, 5 cardiac magnetic resonance (CMR) phenotypes in SSc have been identified (Knight DS et al. European Heart Journal 2023). These phenotypes do not align with the existing clinical subgroup classifications or autoantibody statuses, yet each has a distinct 5-year prognosis. Our objective is to test the long-term prognostic significance of this classification system in an external cohort and to compare ECG Holter monitor parameters, NT-proBNP and troponin T levels and 10-year survival outcomes across these groups.
Methods or Background: CMR assessments were conducted in 3 Italian tertiary centers on 143 consecutive SSc patients who presented symptoms of dyspnea, palpitations or chest pain. Based on the CMR findings, patients were categorized into 5 distinct groups: dilated right hearts with right ventricular failure (RVF); biventricular failure with dilatation and dysfunction (BVF), normal function with average cavity (NF-AC), small cavity (NF-SC), and large cavity (NF-LC).
Results or Findings: The distributions for NF-AC, NF-SC, NF-LC, BVF, and RVF were 46.2%, 22.4%, 14.0%, 14.0%, and 3.5%, respectively. Proportions of male patients and pulmonary function tests showed statistically significant differences across the subsets. Troponin T and NT-proBNP values were similar across all subsets. The NF-LC and RVF groups exhibited Left Bundle Branch Block (LBB) and ventricular ectopic beats (VEB) more frequently compared to other groups. There was a variation in 10-year survival rates across the groups, with patients in the RVF, NF-LC, and BVF categories showing poorer prognosis.
Conclusion: This data confirms the prognostic value of the proposed CMR subsets in an another European SSc cohort, highlighting that subsets with poorer prognosis are associated with a higher arrhythmic burden.
Limitations: No
Funding for this study: None
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information: No additional information

Author Block: I. T. Rakıcı, K. F. Kaldırımoğlu, A. S. Mahmutoğlu; Istanbul/TR
Purpose: Atherosclerosis is the main cause of coronary artery disease, with inflammation as a key factor. Studies link SII (SII=PlateletxNeutrophil/Lymphocyte) and SIRI (SIRI=NeutrophilxMonocyte/Lymphocyte) to inflamatory diseases and cardiovascular outcomes. This study examines the relationship between these markers, Ca scoring, and ASCVD.
Methods or Background: Images of 460 patients who underwent coronary CTA and calcium scoring were analyzed and divided into five groups: normal calcium score, calcium score 1-100, calcium score >100, calcium score of 0 with hypodense plaques, and calcium score of 0 with myocardial bridging. The SIRI and SII were calculated to assess significant differences and establish cutoff values.
Results or Findings: In the group with a calcium score greater than 100, the SIRI value was significantly higher than in all other groups, indicating an inflammatory process in ASCVD. A notable difference in SIRI values was observed between calcium scores of 1-100 and above 100, suggesting a correlation between higher scores and elevated inflammatory markers. In cases with a calcium score of 0 and myocardial bridging, no significant differences in inflammatory markers were found, suggesting no increase in the inflammatory process.
The SII value showed no significant differences (p>0.05) among the other groups, except that it was significantly higher (p<0.05) in the calcium score > 100 and 1-100 groups compared to the calcium score 0 group with myocardial bridging. No significant differences in SIRI and SII values were observed in cases with a calcium score of 0 and hypodense plaques, indicating SIRI and SII values were insufficient to detect inflammation in these cases.
Conclusion: SIRI effectively discriminates between calcium score levels, whereas SII is not a reliable indicator. Future research is needed to determine clinically relevant cutoff values in this area.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by the University of Health Sciences Istanbul Training and Research Hospital Clinical Research Ethics Committee (Decision number: 91).

Author Block: H. Xu, X. Ting; Cheng du/CN
Purpose: This study aims to explore the relationship between Myocardial strain trajectories and myocardial fibrosis by cardiac magnetic resonance (CMR) in Duchenne Muscular Dystrophy (DMD).
Methods or Background: DMD is a severe, X-linked genetic disorder characterized by progressive degeneration of skeletal muscle due to mutations in the dystrophin gene. And cardiomyopathy is becoming the leading cause of death. Cardiac magnetic resonance (CMR) and late gadolinium enhancement (LGE) are important tools in recognizing myocardial involvement, myocardial strain assessed by CMR feature tracking imaging (FT) may demonstrate early functional changes. Trajectories is a new method used to explore the dynamic changes of disease progression. Dynamic changes of myocardial strain using trajectories and myocardial tissue characteristics has not been investigated.
We obtained myocardial strain parameters of more than 2 times by CMR FT method on 110 DMD patients. Global circumferential strain data was used to construct trajectory model. Late gadolinium enhancement progression was measured. Group-based trajectory modeling (GBTM) was performed to detect the trajectories of FT. Data t tests or one-way ANOVA adjusting for multiple comparisons.
Results or Findings: Three circumferential strain FT trajectory groups were identified as: up-down FT trajectory group(N=14), FT trajectory group(N=32), the steady FT trajectory group (N= 64). The occurrence rate of adverse cardiac event in the three trajectory analysis groups were significantly different(P=0.03).
Conclusion: This study is the first to analyze the myocardial strain trajectory of DMD patients. It provides further evidence of the correlation between FT and progression of myocardial fibrosis.
Limitations: The relatively small number of patients assigned to the 3 groups may result in insufficient statistical power.
Funding for this study: National funding of china
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Ethics committee of west china second university hospital