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The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 25978

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Dr. Sophie I. Mavrogeni

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University Research Institute of Maternal and Child Health and Precision Medicine and UNESCO Chair in Adolescent Health Care, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
Interests: clinical cardiology; autoimmune diseases; non-ischemic cardiomyopathy; cardiovascular magnetic resonance imaging (CMR)
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Dear Colleagues,

The contribution of imaging is of paramount important for diagnosis, risk stratification, and treatment follow-up of cardiovascular diseases.

It is well documented that many systemic and/or neurologic diseases may affect the cardiovascular system. Autoimmune rheumatic, endocrine, gastroenterologic diseases, and genetic musculoskeletal or endocrine diseases are between the commonest causes that may involve the cardiovascular system.

Recently, cardiology has presented a miraculous development in both early diagnosis and treatment of cardiovascular involvement in systemic diseases. To achieve this target, the contribution of imaging is of paramount importance for early diagnosis, risk stratification, and treatment follow-up of cardiovascular diseases in this target group. The currently used diagnostic imaging tools include:

(a) Echocardiography, which is the most widely available modality, without radiation that offers valuable information about systolic and diastolic function of both ventricles in rest–stress. However, it is an operator and acoustic window depended modality;
(b) Nuclear techniques (SPECT-PET) that provide information about both myocardial function and perfusion. However, they use radioactive materials to acquire images;
(c) Cardiovascular computed tomography that gives information about biventricular function and coronary arteries anatomy non-invasively, but with the use of radiation;
(d) Cardiovascular magnetic resonance, which can perform biventricular function, flow evaluation, and tissue characterization and also great vessels/coronary arteries assessment without using radiation.

In this Special Issue of JCM, we will present the role of these noninvasive imaging modalities in the early diagnosis, risk stratification, and treatment follow-up of cardiovascular involvement in autoimmune and/or genetic systemic diseases.

Dr. Sophie I. Mavrogeni
Guest Editor

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Keywords

cardiovascular disease
autoimmune rheumatic diseases
autoimmune endocrine diseases
autoimmune gastroenterologic diseases
genetic neuromuscular diseases
genetic endocrine diseases
ischemic cardiac disease
nonischemic cardiac disease
valvular heart disease
echocardiography
nuclear techniques
cardiac computed tomography
cardiovascular magnetic resonance

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Published Papers (7 papers)

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Editorial

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2 pages, 142 KiB

Open AccessEditorial

The Role of Cardiovascular Imaging in the Evaluation of Rheumatic and Neuromuscular Disorders

by Sophie I. Mavrogeni

J. Clin. Med. 2020, 9(11), 3614; https://doi.org/10.3390/jcm9113614 - 10 Nov 2020

Viewed by 1193

Abstract

Autoimmune rheumatic diseases (ARD) and neuromuscular disorders can affect a number of organs [...] Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

Research

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14 pages, 982 KiB

Open AccessArticle

Combined Brain-Heart Magnetic Resonance Imaging in Autoimmune Rheumatic Disease Patients with Cardiac Symptoms: Hypothesis Generating Insights from a Cross-Sectional Study

by George Markousis-Mavrogenis, Dimos D. Mitsikostas, Loukia Koutsogeorgopoulou, Theodoros Dimitroulas, Gikas Katsifis, Panayiotis Argyriou, Dimitrios Apostolou, Stella Velitsista, Vasiliki Vartela, Dionysia Manolopoulou, Maria G. Tektonidou, Genovefa Kolovou, George D. Kitas, Petros P. Sfikakis and Sophie I. Mavrogeni

J. Clin. Med. 2020, 9(2), 447; https://doi.org/10.3390/jcm9020447 - 6 Feb 2020

Cited by 13 | Viewed by 3604

Abstract

Background: Autoimmune rheumatic diseases (ARDs) may affect both the heart and the brain. However, little is known about the interaction between these organs in ARD patients. We asked whether brain lesions are more frequent in ARD patients with cardiac symptoms compared with non-ARD patients with cardiovascular disease (CVD). Methods: 57 ARD patients with mean age of 48 ± 13 years presenting with shortness of breath, chest pain, and/or palpitations, and 30 age-matched disease-controls with non-autoimmune CVD, were evaluated using combined brain–heart magnetic resonance imaging (MRI) in a 1.5T system. Results: 52 (91%) ARD patients and 16 (53%) controls had white matter hyperintensities (p < 0.001) in at least one brain area (subcortical/deep/periventricular white matter, basal ganglia, pons, brainstem, or mesial temporal lobe). Only the frequency and number of subcortical and deep white matter lesions were significantly greater in ARD patients (p < 0.001 and 0.014, respectively). ARD vs. control status was the only independent predictor of having any brain lesion. Specifically for deep white matter lesions, each increase in ECV independently predicted a higher number of lesions [odds ratio (95% confidence interval): 1.16 (1.01–1.33), p = 0.031] in ordered logistic regression. Penalized logistic regression selected only ARD vs. control status as the most important feature for predicting whether brain lesions were present on brain MRI (odds ratio: 5.46, marginal false discovery rate = 0.011). Conclusions: Subclinical brain involvement was highly prevalent in this cohort of ARD patients and was mostly independent of the severity of cardiac involvement. However, further research is required to determine the clinical relevance of these findings. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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17 pages, 877 KiB

Open AccessArticle

More Impaired Dynamic Ventilatory Muscle Oxygenation in Congestive Heart Failure than in Chronic Obstructive Pulmonary Disease

by Ming-Lung Chuang, I-Feng Lin and Meng-Jer Hsieh

J. Clin. Med. 2019, 8(10), 1641; https://doi.org/10.3390/jcm8101641 - 7 Oct 2019

Cited by 11 | Viewed by 3092

Abstract

Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) often have dyspnea. Despite differences in primary organ derangement and similarities in secondary skeletal muscle changes, both patient groups have prominent functional impairment. With similar daily exercise performance in patients with CHF and COPD, we hypothesized that patients with CHF would have worse ventilatory muscle oxygenation than patients with COPD. This study aimed to compare differences in tissue oxygenation and blood capacity between ventilatory muscles and leg muscles and between the two patient groups. Demographic data, lung function, and maximal cardiopulmonary exercise tests were performed in 134 subjects without acute illnesses. Muscle oxygenation and blood capacity were measured using frequency-domain near-infrared spectroscopy (fd-NIRS). We enrolled normal subjects and patients with COPD and CHF. The two patient groups were matched by oxygen-cost diagram scores, New York Heart Association functional classification scores, and modified Medical Research Council scores. COPD was defined as forced expired volume in one second and forced expired vital capacity ratio ≤0.7. CHF was defined as stable heart failure with an ejection fraction ≤49%. The healthy subjects were defined as those with no obvious history of chronic disease. Age, body mass index, cigarette consumption, lung function, and exercise capacity were different across the three groups. Muscle oxygenation and blood capacity were adjusted accordingly. Leg muscles had higher deoxygenation (HHb) and oxygenation (HbO₂) and lower oxygen saturation (S_mO₂) than ventilatory muscles in all participants. The S_mO₂ of leg muscles was lower than that of ventilatory muscles because S_mO₂ was calculated as HbO₂/(HHb+HbO₂), and the HHb of leg muscles was relatively higher than the HbO₂ of leg muscles. The healthy subjects had higher S_mO₂, the patients with COPD had higher HHb, and the patients with CHF had lower HbO₂ in both muscle groups throughout the tests. The patients with CHF had lower S_mO₂ of ventilatory muscles than the patients with COPD at peak exercise (p < 0.01). We conclud that fd-NIRS can be used to discriminate tissue oxygenation of different musculatures and disease entities. More studies on interventions on ventilatory muscle oxygenation in patients with CHF and COPD are warranted. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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10 pages, 2364 KiB

Open AccessArticle

Biatrial Remodeling in Patients with Cystic Fibrosis

by Aleksandar Dordevic, Martin Genger, Carsten Schwarz, Cesare Cuspidi, Elvis Tahirovic, Burkert Pieske, Hans-Dirk Düngen and Marijana Tadic

J. Clin. Med. 2019, 8(8), 1141; https://doi.org/10.3390/jcm8081141 - 31 Jul 2019

Cited by 4 | Viewed by 2272

Abstract

Background: Previous studies have focused on left and right ventricular remodeling in cystic fibrosis (CF), whereas atrial function has not been assessed in detail so far. We sought to investigate left and right atrial (LA and RA) function in patients with CF. Methods: This retrospective investigation included 82 CF patients (64 survivors and 18 non-survivors) who were referred to CF department over the period of four years, as well as 32 control subjects matched by age and gender. All participants underwent an echocardiographic examination including a strain analysis, which was performed offline and blinded for groups. Results: LA and RA volume indexes were significantly higher in CF patients than in controls and were particularly high in CF non-survivors. LA conduit and reservoir functions were significantly worse in CF survivors and non-survivors, compared with control subjects. RA phasic function was not different between controls, CF survivors and non-survivors. The parameters of lung function (forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1)) and the LA and RA volume indexes were predictors of mortality in CF patients. However, in a multivariate analysis, only FVC was an independent predictor of mortality in CF patients. Conclusions: Our results suggest that both atria are enlarged, but only LA function is impaired in CF patients. LA reservoir and conduit function is particularly deteriorated in CF patients. Though statistical significance was not reached due to our limited sample size, there was a trend of deterioration of LA and RA function from controls across CF survivors to CF non-survivors. LA and RA enlargement represented predictors of mortality in CF patients. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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15 pages, 1647 KiB

Open AccessArticle

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

by Sophie I. Mavrogeni, George Markousis-Mavrogenis, Olga Karapanagiotou, Konstantinos Toutouzas, Panagiotis Argyriou, Stella Velitsista, George Kanoupakis, Dimitrios Apostolou, David Hautemann, Petros P. Sfikakis and Maria G. Tektonidou

J. Clin. Med. 2019, 8(7), 1084; https://doi.org/10.3390/jcm8071084 - 23 Jul 2019

Cited by 23 | Viewed by 3928

Abstract

Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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18 pages, 1279 KiB

Open AccessArticle

Effects of Different Antidiabetic Medications on Endothelial Glycocalyx, Myocardial Function, and Vascular Function in Type 2 Diabetic Patients: One Year Follow–Up Study

by Vaia Lambadiari, George Pavlidis, Foteini Kousathana, Eirini Maratou, Dimitrios Georgiou, Ioanna Andreadou, Aikaterini Kountouri, Maria Varoudi, Konstantinos Balampanis, John Parissis, Helen Triantafyllidi, Konstantinos Katogiannis, Dionysia Birba, John Lekakis, George Dimitriadis and Ignatios Ikonomidis

J. Clin. Med. 2019, 8(7), 983; https://doi.org/10.3390/jcm8070983 - 5 Jul 2019

Cited by 27 | Viewed by 3573

Abstract

Background: Poor glycaemic control affects myocardial function. We investigated changes in endothelial function and left ventricular (LV) myocardial deformation in poorly controlled type 2 diabetics before and after glycaemic control intensification. Methods: In 100 poorly-controlled diabetic patients (age: 51 ± 12 years), we measured at baseline and at 12 months after intensified glycaemic control: (a) Pulse wave velocity (PWV, Complior); (b) flow-mediated dilatation (FMD, %) of the brachial artery; (c) perfused boundary region (PBR) of the sublingual arterial micro-vessels (side-view dark-field imaging, Glycocheck); (d) LV global longitudinal strain (GLS), peak twisting (pTw), peak twisting velocity (pTwVel), and peak untwisting velocity (pUtwVel) using speckle tracking echocardiography, where the ratio of PWV/GLS was used as a marker of ventricular-arterial interaction; and (e) Malondialdehyde (MDA) and protein carbonyls (PCs) plasma levels. Results: Intensified 12-month antidiabetic treatment reduced HbA1c (8.9 ± 1.8% (74 ± 24 mmol/mol) versus 7.1 ± 1.2% (54 ± 14 mmol/mol), p = 0.001), PWV (12 ± 3 versus 10.8 ± 2 m/s), PBR (2.12 ± 0.3 versus 1.98 ± 0.2 μm), MDA, and PCs; meanwhile, the treatment improved GLS (−15.2 versus −16.9%), PWV/GLS, and FMD% (p < 0.05). By multi-variate analysis, incretin-based agents were associated with improved PWV (p = 0.029), GLS (p = 0.037), PBR (p = 0.047), and FMD% (p = 0.034), in addition to a reduction of HbA1c. The patients with a final HbA1c ≤ 7% (≤ 53 mmol/mol) had greater reduction in PWV, PBR, and markers of oxidative stress, with a parallel increase in FMD and GLS, compared to those who had HbA1c > 7% (> 53 mmol/mol). Conclusions: Intensified glycaemic control, in addition to incretin-based treatment, improves arterial stiffness, endothelial glycocalyx, and myocardial deformation in type 2 diabetes after one year of treatment. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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Review

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19 pages, 3165 KiB

Open AccessReview

Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives

by Yannis Dimitroglou, Constantina Aggeli, Alexandra Alexopoulou, Sophie Mavrogeni and Dimitris Tousoulis

J. Clin. Med. 2019, 8(12), 2132; https://doi.org/10.3390/jcm8122132 - 3 Dec 2019

Cited by 17 | Viewed by 7634

Abstract

Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications. Full article

(This article belongs to the Special Issue The Role of Cardiac Imaging in the Evaluation of Cardiac Involvement in Systemic and Neuromuscular Diseases)

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