Browsing by Subject "Late gadolinium enhancement"

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    Cardiac Imaging and Biomarkers for Assessing Myocardial Fibrosis in Children with Hypertrophic Cardiomyopathy
    (Elsevier, 2023) Kirmani, Sonya; Woodard, Pamela K.; Shi, Ling; Hamza, Taye H.; Canter, Charles E.; Colan, Steven D.; Pahl, Elfriede; Towbin, Jeffrey A.; Webber, Steven A.; Rossano, Joseph W.; Everitt, Melanie D.; Molina, Kimberly M.; Kantor, Paul F.; Jefferies, John L.; Feingold, Brian; Addonizio, Linda J.; Ware, Stephanie M.; Chung, Wendy K.; Ballweg, Jean A.; Lee, Teresa M.; Bansal, Neha; Razoky, Hiedy; Czachor, Jason; Lunze, Fatima I.; Marcus, Edward; Commean, Paul; Wilkinson, James D.; Lipshultz, Steven E.; Pediatrics, School of Medicine
    Background: Myocardial fibrosis, as diagnosed on cardiac magnetic resonance imaging (cMRI) by late gadolinium enhancement (LGE), is associated with adverse outcomes in adults with hypertrophic cardiomyopathy (HCM), but its prevalence and magnitude in children with HCM have not been established. We investigated: (1) the prevalence and extent of myocardial fibrosis as detected by LGE cMRI; (2) the agreement between echocardiographic and cMRI measurements of cardiac structure; and (3) whether serum concentrations of N-terminal pro hormone B-type natriuretic peptide (NT-proBNP) and cardiac troponin-T are associated with cMRI measurements. Methods: A cross-section of children with HCM from 9 tertiary-care pediatric heart centers in the U.S. and Canada were enrolled in this prospective NHLBI study of cardiac biomarkers in pediatric cardiomyopathy (ClinicalTrials.gov Identifier: NCT01873976). The median age of the 67 participants was 13.8 years (range 1-18 years). Core laboratories analyzed echocardiographic and cMRI measurements, and serum biomarker concentrations. Results: In 52 children with non-obstructive HCM undergoing cMRI, overall low levels of myocardial fibrosis with LGE >2% of left ventricular (LV) mass were detected in 37 (71%) (median %LGE, 9.0%; IQR: 6.0%, 13.0%; range, 0% to 57%). Echocardiographic and cMRI measurements of LV dimensions, LV mass, and interventricular septal thickness showed good agreement using the Bland-Altman method. NT-proBNP concentrations were strongly and positively associated with LV mass and interventricular septal thickness (P < .001), but not LGE. Conclusions: Low levels of myocardial fibrosis are common in pediatric patients with HCM seen at referral centers. Longitudinal studies of myocardial fibrosis and serum biomarkers are warranted to determine their predictive value for adverse outcomes in pediatric patients with HCM.
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    The Society for Cardiovascular Magnetic Resonance Registry at 150,000
    (Elsevier, 2024-07-04) Tong, Matthew S.; Slivnick, Jeremy A.; Sharif, Behzad; Kim, Han W.; Young, Alistair A.; Sierra-Galan, Lilia M.; Mukai, Kanae; Farzaneh-Far, Afshin; Al-Kindi, Sadeer; Chan, Angel T.; Dibu, George; Elliott, Michael D.; Ferreira, Vanessa M.; Grizzard, John; Kelle, Sebastian; Lee, Simon; Malahfji, Maan; Petersen, Steffen E.; Polsani, Venkateshwar; Toro-Salazar, Olga H.; Shaikh, Kamran A.; Shenoy, Chetan; Srichai, Monvadi B.; Stojanovska, Jadranka; Tao, Qian; Wei, Janet; Weinsaft, Jonathan W.; Wince, W. Benjamin; Chudgar, Priya D.; Judd, Matthew; Judd, Robert M.; Shah, Dipan J.; Simonetti, Orlando P.; Medicine, School of Medicine
    Background: Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The Society for Cardiovascular Magnetic Resonance (SCMR) Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine images. The goal of this study is to summarize the status of the SCMR Registry at 150,000 exams. Methods: The processes for data security, data submission, and research access are outlined. We interrogated the Registry and presented a summary of its contents. Results: Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (∼100 terabytes of storage). Across reported values, the human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% (63,070/145,275) female, 72% (69,766/98,008) Caucasian, and had a mortality rate of 8% (9,962/132,979). The most common indication was cardiomyopathy (35,369/131,581, 27%), and most frequently used current procedural terminology code was 75561 (57,195/162,901, 35%). Macrocyclic gadolinium-based contrast agents represented 89% (83,089/93,884) of contrast utilization after 2015. Short-axis cines were performed in 99% (76,859/77,871) of tagged scans, short-axis late gadolinium enhancement (LGE) in 66% (51,591/77,871), and stress perfusion sequences in 30% (23,241/77,871). Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction <35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct LGE, compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years. Conclusion: The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility.
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    T‐wave and its association with myocardial fibrosis on cardiovascular magnetic resonance examination
    (Wiley, 2021-03) Zareba, Karolina M.; Truong, Vien T.; Mazur, Wojciech; Smart, Suzanne M.; Xia, Xiaojuan; Couderc, Jean-Philippe; Raman, Subha V.; Medicine, School of Medicine
    Background: Risk stratification in non-ischemic myocardial disease poses a challenge. While cardiovascular magnetic resonance (CMR) is a comprehensive tool, the electrocardiogram (ECG) provides quick impactful clinical information. Studying the relationships between CMR and ECG can provide much-needed risk stratification. We evaluated the electrocardiographic signature of myocardial fibrosis defined as presence of late gadolinium enhancement (LGE) or extracellular volume fraction (ECV) ≥29%. Methods: We evaluated 240 consecutive patients (51% female, 47.1 ± 16.6 years) referred for a clinical CMR who underwent 12-lead ECGs within 90 days. ECG parameters studied to determine association with myocardial fibrosis included heart rate, QRS amplitude/duration, T-wave amplitude, corrected QT and QT peak, and Tpeak-Tend. Abnormal T-wave was defined as low T-wave amplitude ≤200 µV or a negative T wave, both in leads II and V5. Results: Of the 147 (61.3%) patients with myocardial fibrosis, 67 (28.2%) had ECV ≥ 29%, and 132 (54.6%) had non-ischemic LGE. An abnormal T-wave was more prevalent in patients with versus without myocardial fibrosis (66% versus 42%, p < .001). Multivariable analysis demonstrated that abnormal T-wave (OR 1.95, 95% CI 1.09-3.49, p = .03) was associated with myocardial fibrosis (ECV ≥ 29% or LGE) after adjustment for clinical covariates (age, gender, history of hypertension, and heart failure). Dynamic nomogram for predicting myocardial fibrosis using clinical parameters and the T-wave was developed: https://normogram.shinyapps.io/CMR_Fibrosis/. Conclusion: Low T-wave amplitude ≤ 200 µV or negative T-waves are independently associated with myocardial fibrosis. Prospective evaluation of T-wave amplitude may identify patients with a high probability of myocardial fibrosis and guide further indication for CMR.