RPS 603b - Connecting the heart with the lungs and the rest of the body

Purpose:

To explore the feasibility of a CMR-derived feature tracking algorithm for assessing left ventricular myocardial deformation in patients having Takayasu's arteritis with pulmonary artery involvement (PTA), and to determine if these parameters are correlated to clinical assessments.

Methods and materials:

Patients with PTA (n = 25) and healthy controls (n=17) were enrolled and underwent CMR examination. Feature tracking of CMR cine imaging was used to obtain left ventricular global, segmental longitudinal, circumferential, radial strain, and their respective strain rates. Clinical assessments were performed concurrently. ROC curve was performed to detect patients with PTA.

Results:

PTA patients had significantly reduced global peak longitudinal strain (GLS) (-12.7± 3.9%,-14.9± 2.5%), a peak longitudinal diastolic strain rate (GLDSR) (0.65± 0.57%,0.94± 0.28%), and a peak radial diastolic strain rate (GRDSR) (-2.08±1.22,-2.85±0.87%). The basal peak circumferential strain (CS), peak radial diastolic strain rate (RDSR), mid-ventricular CS, peak circumferential diastolic strain rate, LDSR, and RDSR were also decreasing (P<0.05). GLS was correlated to ESRs (r=-0.48, P=0.02). GLS had the highest sensitivity (84%), specificity (53%), and accuracy (75%) for the identification of PTA patients.

Conclusion:

The abnormal LV myocardial deformation of PTA patients with preserved LVEF can be detected early using feature tracking CMR. GLS is associated with ESR and had a high sensitivity for PTA patients.

Limitations:

The patients included in our study were limited to PTA. Most patients in our study were enrolled later into the disease course. This likely influences the strength of associations between clinical and imaging assessments. There was an insufficient sample size and this may affect the strength of our results.

Ethics committee approval

The study protocol was approved by the Beijing Chao-Yang Hospital Ethics Committee (2017-K-127).

Funding:

This study was supported by the National Natural Science Foundation of China (81871328).

Purpose:

To evaluate left ventricular (LV) global myocardial strain in newly diagnosed primary aldosteronism (PA) patients compared with healthy controls.

Methods and materials:

Form May 2018 to April 2019, 33 significant hypertension patients with newly diagnosed PA and 20 healthy controls were enrolled retrospectively. Cardiac magnetic resonance (CMR) was used to determine LV feature-tracking parameters. Global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PSDR) were measured and compared among patients and controls. Clinical variables, medication, and other cardiovascular risk factors were obtained through patient questionnaires or medical records.

Results:

PA patients had a higher LV mass than normal controls (71.74 ± 16.87 vs. 94.44 ± 24, p=0.002). A decrease in global circumferential PSSR, longitudinal, and radial PSDR were found in PA patients compared to healthy individuals (all p<0.05). Systolic blood pressure and serum aldosterone concentration (SAC) was closely related to LV mass index and LV deformation (all p < 0.05).

Conclusion:

Our findings may indicate that in PA patients, CMR-feature tracking could quantify LV deformation effectively. Further, systolic blood pressure and SAC may induce LV hypertrophy and functional impairment.

Limitations:

Our study is single-centred and retrospective, based on a small sample size, which may cause bias. Patients with subclinical coronary heart disease and kidney disease may affect the outcome.

Ethics committee approval

This study was approved by the Institutional Review Board of West China Hospital, Sichuan University (Chengdu, Sichuan, China) with a waiver of informed consent due to the retrospective nature of this investigation.

Funding:

No funding was received for this work.

Purpose:

We evaluated the effects of LV geometry, myocardial microcirculation, and tissue characteristics on cardiac deformation in silent type 2 diabetes mellitus (T2DM) patients, utilising multiparametric cardiac magnetic resonance (CMR) imaging.

Methods and materials:

A total of 55 clinically diagnosed T2DM patients and 29 healthy controls were evaluated. CMR-derived parameters including cardiac geometry, function, microvascular perfusion, T1 mapping, T2 mapping, and strain were analysed and compared between T2DM patients and controls.

Results:

Compared with the controls, those with T2DM presented a higher remodelling index, decreased perfusion function, higher extracellular volume (ECV), higher T2 values, and decreased cardiac strain. Additional univariable and multivariable analysis revealed that a longer duration of diabetes was associated with a decreased longitudinal peak systolic strain rate (PSSR-L) (β = 0.195, p = 0.013), and remodelling index, and ECV tended to correlate with a longitudinal peak diastolic strain rate (PDSR-L) (remodelling index, β = −0.339, p = 0.000; ECV, β = −0.172, p = 0.026), while microvascular perfusion index and T2 value affected both PSSR-L (perfusion index, β = −0.328, p = 0.000; T2 value, β = 0.306, p = 0.000) and PDSR-L (perfusion index, β = 0.209, p = 0.004; T2 value, β = −0.275, p = 0.000) simultaneously.

Conclusion:

T2DM patients demonstrated LV concentric remodelling, microvascular injury, myocardial fibrosis, myocardial oedema, and deformation dysfunction. In addition, the existing pathological changes have diverse effects on cardiac systolic and diastolic functions.

Limitations:

A single-centre study. The studied variables are weakly correlated with LV deformation.

Ethics committee approval

The study was approved by the institutional ethics committee of our hospital (No. 2016-24).

Funding:

1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYGD18013).

Purpose:

To determine the association between atrial size and adverse events (AE) in patients with acute PE.

Methods and materials:

Left (LA) and right atrial (RA) volume (Image 1), area (largest axial), and diameter (perpendicular to interatrial septum), along with ventricular diameters and pulmonary artery (PA) diameter, were retrospectively measured in 493 patients with acute PE. Interventricular septal bowing and reflux of contrast into the inferior vena cava was also assessed. Tricuspid annular plane systolic excursion (TAPSE) was measured as a representative echocardiography parameter and ECG evidence of right-heart strain documented. AE was defined as 30-day PE-related mortality or the need for advanced therapy i.e. thrombolysis, thrombectomy, or vasopressors. Mann-Whitney and Chi-squared tests were used to compare those with and without AE. The area under the curve values and multivariate logistic regression were used for prediction analysis.

Results:

There was 62/493 patients with AE. There was no significant sex (p=0.6) or age (p=0.2) difference between the groups. Decreased LA volume, area, and diameter, along with increased RA/LA volume, area, and diameter ratios, septal bowing, and contrast reflux were associated with AE. PA diameter was not associated.

LA volume was the best atrial predictor of AE (AUC=0.67) and was an equivocal predictor compared to the combination of RV/LV diameter ratio, TAPSE, and ECG (AUC=0.71)(P=0.07).

Conclusion:

Decreased LA measurements along with septal bowing and contrast reflux are associated with acute PE-related adverse events. LA volume is of similar predictive value compared to a combination of ventricular diameter ratio, TAPSE, and ECG.

Limitations:

A retrospective study with selection bias as only patients with acute PE and echo were included. Non-gated images were degraded by motion.

Ethics committee approval

IRB waived informed consent(#2015P000425).

Funding:

No funding was received for this work.

Purpose:

The relationship between the occurrence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and the cardiac magnetic resonance (CMR) changes in people without clinically overt heart disease.

Methods and materials:

The study group consisted of 74 people (48.81±11.35 years): 29 patients with RA, 23 patients with AS, and 22 people from a control group. Blood samples were taken to assess laboratory parameters, disease activity was determined using activity scales, and CMR was performed.

Results:

It was shown that the factors independently related to higher left ventricular mass index are AS occurrence, human B27 leukocyte antigen occurrence, higher neutrophil gelatinase-associated lipocalin concentration (NGAL), and higher body mass index (BMI). The lower right ventricular ejection fraction is a result of an independent effect of RA, AS, and higher NGAL. RA presence, methotrexate use, higher rheumatoid factor titer, higher NGAL, older age, and higher BMI should be considered independent risk factors for greater left ventricular myocardium hydration. RA occurrence, AS occurrence, type 2 diabetes occurrence, and a higher C-reactive protein concentration can be independently associated with a higher probability of non-ischaemic left ventricular myocardium injury. A larger volume of fluid in the pericardial sac is a result of an independent effect of higher NGAL, higher anti-cyclic citrullinated peptide antibodies titre, and higher DAS28 disease activity index. The use of steroids is a protective factor against larger volumes of pericardial fluid.

Conclusion:

RA and AS in people without clinically apparent myocardial injury are associated with the occurrence of adverse changes in CMR. NGAL is the most useful clinical parameter for the purpose of predicting the risk of adverse changes in CMR in the studied group of patients with RA and AS.

Limitations:

A small study group size. Only standard CMR sequences.

Ethics committee approval

Local Bioethics Committee.

Funding:

No funding was received for this work.

Purpose:

Within the last decade, balloon pulmonary angioplasty (BPA) has grown as a valuable therapy option for inoperable CTEPH, accompanied by invasive right heart catheterisation as the gold standard in therapy monitoring. The purpose of this study was to investigate the ventricular mass index as a non-invasive parameter to monitor BPA treatment success.

Methods and materials:

26 patients with CTEPH who underwent BPA received cardiac MRI and right heart catheterisation (RHC) prior to and 6 months after treatment. Ventricular mass index (VMI) was evaluated by two experienced radiologists and the mean pulmonary arterial pressure (mPAP) was derived from RHC. Paired testing of the pre- and post-interventional values was performed with a Wilcoxon signed-rank test. The Spearman-Rho correlation coefficient was used to correlate invasive and non-invasive parameters. Univariate linear regression analysis was performed to show the impact of mPAP on VMI.

Results:

VMI and mPAP both showed a mean decrease by 20% 6 months after BPA (VMI -19.0% vs mPAP -23.4%). The VMI ratio (postBPA/preBPA) correlated significantly with the mPAP ratio (r=0,403*) and the ratio of brain natriuretic peptide (r=0,577**), whereas the ratio of right or left ventricular mass showed only mediocre correspondence. In addition, the total decrease in VMI also correlated significantly with the total change in mPAP (r=0,457*) and NT-proBNP (r=0,452*). Univariate linear regression analysis between VMI and mPAP showed significant interrelation (R=0,401; p=0,042 and R=0,474; p=0,014).

Conclusion:

Cardiac MRI allows for non-invasive assessment of therapy outcomes in BPA treated CTEPH. Thereby, VMI is a better parameter than right or left ventricular mass only.

Limitations:

The study comprises only a small number of patients.

Ethics committee approval

Institutional Review Board approval was obtained.

Funding:

No funding was received for this work.

Purpose:

To assess the occult cardiac involvement in asymptomatic SSc participants of recent onset by strain imaging derived from cardiac magnetic resonance (CMR) for very early identification of myocardial involvement associated with a poor prognosis

Methods and materials:

16 consecutive SSc participants of recent onset were included. We considered SSc of recent onset, all those participants fulfilling the ACR/EULAR 2013 classification criteria, in less than 1 year from the onset of Raynaud’s phenomenon. All the participants underwent pharmacological stress, rest perfusion, and late enhancement (LE) CMR. Strain evaluations of the left ventricle were performed on cine-images and the values were compared with 15 healthy controls (HCs). All 2-d radial, circumferential, and longitudinal strain values were analysed

Results:

No SSc participant showed internal organs or skin involvement, “traditional” cardiovascular risk factors, episodes of chest pain, and all were naïve to any medication. Perfusions defects were detected in 5 SSc participants and LE in 1 participant. By analysing strain values, we observed a significant reduction of radial (SSc: 29.47% ±4.41 vs HCs: 40.43% ± 13.24, p= 0.006) and longitudinal (SSc: -15.36% ± 1.72 vs HCs: -17.94% ±1.84, p= 0.002) values in SSc. Conversely, the comparison of circumferential values did not result in statistical difference (SSc: -19.17% ± 2.52 vs HCs: -20.30% ± 3.32, p= 0.348).

Conclusion:

The decreased radial and longitudinal strain values could unmask an early sub-endocardial involvement in asymptomatic SSc participants, which is independent from traditional cardiovascular risk factors and seems to be a specific hallmark of recent onset of the disease.

Limitations:

A small sample size.

Ethics committee approval

The study was conducted in accordance with Helsinki declaration.

Funding:

No funding was received for this work.

Purpose:

Pulmonary hypertension (PH) is associated with left (LV) and right ventricular (RV) myocardial alterations, which should be reflected in alterations of LV and RV strain parameters. The aim of the current study was to analyse if global myocardial strain parameters derived from cine realtime feature-tracking predict the presence of PH.

Methods and materials:

65 patients with known or suspected PH underwent right heart catheterisation and free-breathing cardiac MR cine realtime imaging at 3T (Skyra, Siemens Healthcare) within 1±3 days (mPAP=43.47±11.07mmHg in PH; mPAP=18.97±3.7mmHg in non-PH, n=34 and 31, respectively). LV and RV global radial (GRS), circumferential (GCS), and longitudinal (GLS) strains and strain rates (GRS_rate, GCS_rate, and GLS_rate, respectively) were evaluated by cvi42 (Circle Cardiovascular Imaging, Canada) using a two-dimensional approach. Group differences of resulting strain parameters and their association with PH were analysed employing t-test, correlation, and receiver operating characteristic curve analysis.

Results:

Apart from RV diastolic GRS_rate and GCS_rate, all RV strains and strain rates, as well as LV diastolic GRS_rate and GCS_rate, differed significantly between PH and non-PH subjects and correlated significantly with mPAP.

The strongest correlation with mPAP (r=0.59) was found for RV-GLS (-21±4% vs. -15±4%, p<0.0001, in PH and non-PH, respectively). RV-GLS also demonstrated the highest area under the curve (AUC) for the prediction of PH (AUC=0.86, 95% confidence interval: 0.75-0.94). A cut-off RV-GLS>-17.6% resulted in a sensitivity of 79% (95% confidence interval: 62-91%) and a specificity of 86% (95% confidence interval: 67-96%) for the diagnosis of PH.

Conclusion:

Despite the significant association of global LV and RV strains and strain rates derived from cine realtime feature-tracking with PH, the prediction of PH from global myocardial strain parameters is limited.

Limitations:

A single-centre study.

Ethics committee approval

NCT01725763.

Funding:

OeNB-Anniversary-FundNr.17934.