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14 pages, 1243 KiB

Open AccessArticle

Acute and Chronic Cardiopulmonary Effects of High Dose Interleukin-2 Therapy: An Observational Magnetic Resonance Imaging Study

by Jakub Lagan, Josephine H. Naish, Christien Fortune, Christopher Campbell, Shien Chow, Manon Pillai, Joshua Bradley, Lenin Francis, David Clark, Anita Macnab, Gaetano Nucifora, Rebecca Dobson, Erik B. Schelbert, Matthias Schmitt, Robert Hawkins and Christopher A. Miller

Diagnostics 2022, 12(6), 1352; https://doi.org/10.3390/diagnostics12061352 - 30 May 2022

Cited by 1 | Viewed by 1494

Abstract

High dose interleukin-2 (IL-2) is known to be associated with cardiopulmonary toxicity. The goal of this study was to evaluate the effects of high dose IL-2 therapy on cardiopulmonary structure and function. Combined cardiopulmonary magnetic resonance imaging (MRI) was performed in 7 patients [...] Read more.

High dose interleukin-2 (IL-2) is known to be associated with cardiopulmonary toxicity. The goal of this study was to evaluate the effects of high dose IL-2 therapy on cardiopulmonary structure and function. Combined cardiopulmonary magnetic resonance imaging (MRI) was performed in 7 patients in the acute period following IL-2 therapy and repeated in 4 patients in the chronic period. Comparison was made to 10 healthy volunteers. IL-2 therapy was associated with myocardial and pulmonary capillary leak, tissue oedema and cardiomyocyte injury, which resulted in acute significant left ventricular (LV) dilatation, a reduction in LV ejection fraction (EF), an increase in LV mass and a prolongation of QT interval. The acute effects occurred irrespective of symptoms. In the chronic period many of the effects resolved, but LV hypertrophy ensued, driven by focal replacement and diffuse interstitial myocardial fibrosis and increased cardiomyocyte mass. In conclusion, IL-2 therapy is ubiquitously associated with acute cardiopulmonary inflammation, irrespective of symptoms, which leads to acute LV dilatation and dysfunction, increased LV mass and QT interval prolongation. Most of these effects are reversible but IL-2 therapy is associated with chronic LV hypertrophy, driven by interstitial myocardial fibrosis and increased cardiomyocyte mass. The findings have important implications for the monitoring and long term impact of newer immunotherapies. Future studies are needed to improve risk stratification and develop cardiopulmonary-protective strategies. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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18 pages, 1803 KiB

Open AccessArticle

Comparison of Nonclassic and Classic Phenotype of Hypertrophic Cardiomyopathy Focused on Prognostic Cardiac Magnetic Resonance Parameters: A Single-Center Observational Study

by Magdalena Stachera, Paweł Przybyło, Katarzyna Sznajder and Marek Gierlotka

Diagnostics 2022, 12(5), 1104; https://doi.org/10.3390/diagnostics12051104 - 28 Apr 2022

Viewed by 1921

Abstract

Patients with nonclassic phenotypes (NCP)—more advanced stages of hypertrophic cardiomyopathy (HCM)—constitute an intriguing and heterogeneous group that is difficult to diagnose, risk-stratify, and treat, and often neglected in research projects. We aimed to compare cardiac magnetic resonance (CMR) parameters in NCP versus classic [...] Read more.

Patients with nonclassic phenotypes (NCP)—more advanced stages of hypertrophic cardiomyopathy (HCM)—constitute an intriguing and heterogeneous group that is difficult to diagnose, risk-stratify, and treat, and often neglected in research projects. We aimed to compare cardiac magnetic resonance (CMR) parameters in NCP versus classic phenotypes (CP) of HCM with special emphasis given to the parameters of established and potential prognostic importance, including numerous variables not used in everyday clinical practice. The CMR studies of 88 patients performed from 2011 to 2019 were postprocessed according to the study protocol to obtain standard and non-standard parameters. In NCP, the late gadolinium enhancement extent expressed as percent of left ventricular mass (%LGE) and left ventricular mass index (LVMI) were higher, left atrium emptying fraction (LAEF) was lower, minimal left atrial volume (LAV min) was greater, and myocardial contraction fraction (MCF) and left ventricular global function index (LVGFI) were lower than in CP (p < 0.001 for all). In contrast, HCM risk score and left ventricular maximal thickness (LVMT) were similar in NCP and CP patients. No left ventricular outflow tract obstruction (LVOTO) was observed in the NCP group. Left ventricular outflow tract diameter (LVOT), aortic valve diameter (Ao), and LVOT/Ao ratio were significantly higher and anterior mitral leaflet (AML)/LVOT ratio was lower in the NCP compared to the CP group. In conclusion, significant differences in nonstandard CMR parameters were noted between the nonclassic and classic HCM phenotypes that may contribute to future studies on disease stages and risk stratification in HCM. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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11 pages, 870 KiB

Open AccessArticle

The Diagnostic and Prognostic Utility of Contemporary Cardiac Magnetic Resonance in Suspected Acute Myocarditis

by Jakub Lagan, Christien Fortune, David Hutchings, Joshua Bradley, Josephine H. Naish, Richard Timoney, Daniel Prescott, Hamish D. C. Bain, Tasneem Bangi, Jerome McIntosh, Robin Egdell, R. Bruce Irwin, David Clark, Erik B. Schelbert, Gaetano Nucifora, Matthias Schmitt and Christopher A. Miller

Diagnostics 2022, 12(1), 156; https://doi.org/10.3390/diagnostics12010156 - 10 Jan 2022

Cited by 4 | Viewed by 1885

Abstract

Cardiovascular magnetic resonance (CMR) is used to investigate suspected acute myocarditis, however most supporting data is retrospective and few studies have included parametric mapping. We aimed to investigate the utility of contemporary multiparametric CMR in a large prospective cohort of patients with suspected [...] Read more.

Cardiovascular magnetic resonance (CMR) is used to investigate suspected acute myocarditis, however most supporting data is retrospective and few studies have included parametric mapping. We aimed to investigate the utility of contemporary multiparametric CMR in a large prospective cohort of patients with suspected acute myocarditis, the impact of real-world variations in practice, the relationship between clinical characteristics and CMR findings and factors predicting outcome. 540 consecutive patients we recruited. The 113 patients diagnosed with myocarditis on CMR performed within 40 days of presentation were followed-up for 674 (504–915) days. 39 patients underwent follow-up CMR at 189 (166–209) days. CMR provided a positive diagnosis in 72% of patients, including myocarditis (40%) and myocardial infarction (11%). In multivariable analysis, male sex and shorter presentation-to-scan interval were associated with a diagnosis of myocarditis. Presentation with heart failure (HF) was associated with lower left ventricular ejection fraction (LVEF), higher LGE burden and higher extracellular volume fraction. Lower baseline LVEF predicted follow-up LV dysfunction. Multiparametric CMR has a high diagnostic yield in suspected acute myocarditis. CMR should be performed early and include parametric mapping. Patients presenting with HF and reduced LVEF require closer follow-up while those with normal CMR may not require it. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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12 pages, 8754 KiB

Open AccessArticle

Early Myocardial Changes in Patients with Rheumatoid Arthritis without Known Cardiovascular Diseases—A Comprehensive Cardiac Magnetic Resonance Study

by Ewa Malczuk, Witold Tłustochowicz, Elżbieta Kramarz, Bartłomiej Kisiel, Magdalena Marczak, Małgorzata Tłustochowicz and Łukasz A. Małek

Diagnostics 2021, 11(12), 2290; https://doi.org/10.3390/diagnostics11122290 - 7 Dec 2021

Cited by 8 | Viewed by 2390

Abstract

Clinically silent cardiac disease is frequently observed in rheumatoid arthritis (RA), and cardiovascular complications are the leading cause of mortality in RA. We sought to evaluate the myocardium of young RA patients without known cardiac disease using cardiac magnetic resonance (CMR), including T1/T2 [...] Read more.

Clinically silent cardiac disease is frequently observed in rheumatoid arthritis (RA), and cardiovascular complications are the leading cause of mortality in RA. We sought to evaluate the myocardium of young RA patients without known cardiac disease using cardiac magnetic resonance (CMR), including T1/T2 mapping sequences. Eighteen RA patients (median age 41 years, 83% females) mainly with low disease activity or in remission and without any known cardiovascular disease were prospectively included to undergo CMR. A control group consisted of 10 sex- and age-matched patients without RA or any known structural cardiovascular disease. Heart chambers size and left/right ventricular systolic function were similar in patients with RA and controls. Signs of myocardial oedema were present in up to 39% of RA patients, including T2 time above cut-off value in 7 patients (39%) in comparison to none of the controls (p = 0.003) and T2 signal intensity ratio above the cut-off value in 6 patients (33%) and in none of the controls (p = 0.06). Extracellular volume was similar in both groups signifying a lack of diffuse fibrosis in studied group of RA patients. There were also no signs of late gadolinium enhancement (LGE) in either group except for one patient with RA who was found to have prior silent myocardial infarction. No correlation was found between markers of disease severity and markers of oedema observed on CMR in patients with RA. Nevertheless, patients with increased T2 time (≥50 ms) were more likely to have X-ray erosions (p = 0.02) and a longer duration between symptom onset and diagnosis (p = 0.02). Finally, there were no significant arrhythmias on 24-h ECG Holter monitoring in RA patients. CMR features of myocardial oedema without signs of myocardial fibrosis were found in 39% of young RA patients without known heart disease or cardiac symptoms. Presence of myocardial oedema was associated with X-ray erosions and a longer duration between symptom onset and diagnosis. The clinical significance of the observed early myocardial changes accompanying RA requires additional studies. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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12 pages, 1553 KiB

Open AccessArticle

Deformation Parameters of the Heart in Endurance Athletes and in Patients with Dilated Cardiomyopathy—A Cardiac Magnetic Resonance Study

by Łukasz A. Małek, Łukasz Mazurkiewicz, Mikołaj Marszałek, Marzena Barczuk-Falęcka, Jenny E. Simon, Jacek Grzybowski, Barbara Miłosz-Wieczorek, Marek Postuła and Magdalena Marczak

Diagnostics 2021, 11(2), 374; https://doi.org/10.3390/diagnostics11020374 - 22 Feb 2021

Cited by 12 | Viewed by 2729

Abstract

A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete’s heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance [...] Read more.

A better understanding of the left ventricle (LV) and right ventricle (RV) functioning would help with the differentiation between athlete’s heart and dilated cardiomyopathy (DCM). We aimed to analyse deformation parameters in endurance athletes relative to patients with DCM using cardiac magnetic resonance feature tracking (CMR-FT). The study included males of a similar age: 22 ultramarathon runners, 22 patients with DCM and 21 sedentary healthy controls (41 ± 9 years). The analysed parameters were peak LV global longitudinal, circumferential and radial strains (GLS, GCS and GRS, respectively); peak LV torsion; peak RV GLS. The peak LV GLS was similar in controls and athletes, but lower in DCM (p < 0.0001). Peak LV GCS and GRS decreased from controls to DCM (both p < 0.0001). The best value for differentiation between DCM and other groups was found for the LV ejection fraction (area under the curve (AUC) = 0.990, p = 0.0001, with 90.9% sensitivity and 100% specificity for ≤53%) and the peak LV GRS diastolic rate (AUC = 0.987, p = 0.0001, with 100% sensitivity and 88.4% specificity for >−1.27 s⁻¹). The peak LV GRS diastolic rate was the only independent predictor of DCM (p = 0.003). Distinctive deformation patterns that were typical for each of the analysed groups existed and can help to differentiate between athlete’s heart, a nonathletic heart and a dilated cardiomyopathy. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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Review

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19 pages, 4199 KiB

Open AccessReview

Anatomical-MRI Correlations in Adults and Children with Hypertrophic Cardiomyopathy

by Radu Ovidiu Rosu, Ana Lupsor, Alexandru Necula, Gabriel Cismaru, Simona Sorana Cainap, Daniela Iacob, Cecilia Lazea, Andrei Cismaru, Alina Gabriela Negru, Dana Pop and Gabriel Gusetu

Diagnostics 2022, 12(2), 489; https://doi.org/10.3390/diagnostics12020489 - 14 Feb 2022

Cited by 1 | Viewed by 4179

Abstract

Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the [...] Read more.

Hypertrophic Cardiomyopathy (HCM) is the most frequent hereditary cardiovascular disease and the leading cause of sudden cardiac death in young individuals. Advancements in CMR imaging have allowed for earlier identification and more accurate prognosis of HCM. Interventions aimed at slowing or stopping the disease’s natural course may be developed in the future. CMR has been validated as a technique with high sensitivity and specificity, very few contraindications, a low risk of side effects, and is overall a good tool to be employed in the management of HCM patients. The goal of this review is to evaluate the magnetic resonance features of HCM, starting with distinct phenotypic variants of the disease and progressing to differential diagnoses of athlete’s heart, hypertension, and infiltrative cardiomyopathies. HCM in children has its own section in this review, with possible risk factors that are distinct from those in adults; delayed enhancement in children may play a role in risk stratification in HCM. Finally, a number of teaching points for general cardiologists who recommend CMR for patients with HCM will be presented. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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17 pages, 954 KiB

Open AccessReview

Cardiovascular Magnetic Resonance in Myocarditis

by Christian L. Polte, Emanuele Bobbio, Entela Bollano, Niklas Bergh, Christina Polte, Jakob Himmelman, Kerstin M. Lagerstrand and Sinsia A. Gao

Diagnostics 2022, 12(2), 399; https://doi.org/10.3390/diagnostics12020399 - 3 Feb 2022

Cited by 28 | Viewed by 6276

Abstract

Myocarditis is an inflammatory disease of the myocardium, and its diagnosis remains challenging owing to a varying clinical presentation and broad spectrum of underlying aetiologies. In clinical practice, cardiovascular magnetic resonance has become an invaluable non-invasive imaging tool in the evaluation of patients [...] Read more.

Myocarditis is an inflammatory disease of the myocardium, and its diagnosis remains challenging owing to a varying clinical presentation and broad spectrum of underlying aetiologies. In clinical practice, cardiovascular magnetic resonance has become an invaluable non-invasive imaging tool in the evaluation of patients with clinically suspected myocarditis, mainly thanks to its unique multiparametric tissue characterization ability. Although considered as useful, the method also has its limitations. This review aims to provide an up-to-date overview of the strengths and weaknesses of cardiovascular magnetic resonance in the diagnostic work-up of patients with clinically suspected myocarditis in a broad clinical context. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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19 pages, 8940 KiB

Open AccessReview

Anatomical-MRI Correlations in Adults and Children with Arrhythmogenic Right Ventricular Cardiomyopathy

by Simona-Sorana Cainap, Ilana Kovalenko, Edoardo Bonamano, Niclas Crousen, Alexandru Tirpe, Andrei Cismaru, Daniela Iacob, Cecilia Lazea, Alina Negru and Gabriel Cismaru

Diagnostics 2021, 11(8), 1388; https://doi.org/10.3390/diagnostics11081388 - 31 Jul 2021

Cited by 2 | Viewed by 4712

Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare disease in which the right ventricular myocardium is replaced by islands of fibro-adipose tissue. Therefore, ventricular re-entry circuits can occur, predisposing the patient to ventricular tachyarrhythmias, as well as dilation of the right ventricle that [...] Read more.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare disease in which the right ventricular myocardium is replaced by islands of fibro-adipose tissue. Therefore, ventricular re-entry circuits can occur, predisposing the patient to ventricular tachyarrhythmias, as well as dilation of the right ventricle that eventually leads to heart failure. Although it is a rare disease with low prevalence in Europe and the United States, many patients are addressed disproportionately for cardiac magnetic resonance imaging (MRI). The most severe consequence of this condition is sudden cardiac death at a young age due to untreated cardiac arrhythmias. The purpose of this paper is to revise the magnetic resonance characteristics of ARVC, including the segmental contraction abnormalities, fatty tissue replacement, decrease of the ejection fraction, and the global RV dilation. Herein, we also present several recent improvements of the 2010 Task Force criteria that are not included within the ARVC diagnosis guidelines. In our opinion, these features will be considered in a future Task Force Consensus. Full article

(This article belongs to the Special Issue Clinical Applications of Cardiac Magnetic Resonance in Adults and Children)

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