Cardiovascular magnetic resonance of the right ventricle

Introduction: Whilst most of the attention has been devoted to the left ventricle in cardiovascular disease, the right ventricle has been somewhat neglected. In the last decades, there has been a renewal of interest in the right ventricle, in part driven by advances in cardiovascular imaging. Methods: Cardiovascular magnetic resonance is arguably the best imaging modality for the study of the right ventricle. In this research thesis, cardiovascular magnetic resonance was used as the primary research tool to assess the right ventricle in different conditions and settings. Results: This thesis encompasses five studies that have been published as peer - reviewed articles. The results of these studies were the following: 1)Right ventricular dilatation and dysfunction was found in a group of patients with Marfan syndrome, further supporting the existence of a Marfan - related cardiomyopathy; 2) In thalassaemia major, right ventricular volumes and ejection fraction differed from healthy controls, and new reference ranges based on patients without iron overload were derived; 3) Myocardial iron loading in thalassaemia major was associated with progressive right ventricular dysfunction; 4) Right ventricular dysfunction due to myocardial siderosis was reversible with effective iron chelation therapy, and; 5) In advanced heart failure, right ventricular function was a predictor of response and outcomes in patients undergoing cardiac resynchronization therapy. Conclusion: The right ventricle is an essential component of the circulatory system, and should be more widely evaluated in patients with cardiopulmonary disease

A model based on clinical parameters to identify myocardial late gadolinium enhancement by magnetic resonance in patients with aortic stenosis: An observational study

Objective With increasing age, the prevalence of aortic stenosis grows exponentially, increasing left heart pressures and potentially leading to myocardial hypertrophy, myocardial fibrosis and adverse outcomes. To identify patients who are at greatest risk, an outpatient model for risk stratification would be of value to better direct patient imaging, frequency of monitoring and expeditious management of aortic stenosis with possible earlier surgical intervention. In this study, a relatively simple model is proposed to identify myocardial fibrosis in patients with a diagnosis of moderate or severe aortic stenosis. Design Patients with moderate to severe aortic stenosis were enrolled into the study; patient characteristics, blood work, medications as well as transthoracic echocardiography and cardiovascular magnetic resonance were used to determine potential identifiers of myocardial fibrosis. Setting The Royal Brompton Hospital, London, UK Participants One hundred and thirteen patients in derivation cohort and 26 patients in validation cohort. Main outcome measures Identification of myocardial fibrosis. Results Three blood biomarkers (serum platelets, serum urea, N-terminal pro-B-type natriuretic peptide) and left ventricular ejection fraction were shown to be capable of identifying myocardial fibrosis. The model was validated in a separate cohort of 26 patients. Conclusions Although further external validation of the model is necessary prior to its use in clinical practice, the proposed clinical model may direct patient care with respect to earlier magnetic resonance imagining, frequency of monitoring and may help in risk stratification for surgical intervention for myocardial fibrosis in patients with aortic stenosis

Interaction between cadmium and mercury accumulation by Daphnia magna Straus (Crustacea, Branchiopoda)

The objective of this study was to evaluate the effects and interactions of various factors on the simultaneous accumulation of cadmium and mercury contaminants. Two chemical forms of mercury (HgCl2 and CH3HgCl) were used in conjunction with inorganic cadmium (as CdCl2). The effects of direct and trophic modes of accumulation were investigated. Daphnids (Daphnia magna) were exposed for 5 days to cadmium (CdCl2) and mercury (HgCl2 or CH3HgCl) in different combinations and concentrations. Exposure was provided either directly via water, or indirectly by providing contaminated algae (Chlorella vulgaris) as a food source. As it is often the case for aquatic organisms, methylmercury was found to be the form of mercury most efficiently accumulated by D. magna. The way of exposure to mercury was also a determinant, with the results depending on the chemical form used. Therefore, even though the preferential way of inorganic mercury accumulation was through the water, the preferential way for D. magna contaminated with methylmercury was through contaminated algae. However, accumulation of Cadmium was not significantly affected by the exposure way. Both cadmium and mercury were able to inhibit each other accumulation. Even though HgCl2 was normally the mercury form that most efficiently inhibited cadmium accumulation, inhibition of CH3HgCl was more efficient in the presence of cadmium.El objetivo de este estudio fue evaluar los efectos e interacciones de varios factores sobre la acumulación simultánea de cadmio y mercurio. Se utilizaron dos formas químicas de mercurio (HgCl2 y CH3HgCl) junto con cadmio inorgánico (como CdCl2), y se investigaron los efectos de la vía de contaminación (directa y trófica). Se expusieron ejemplares de daphnias (Daphnia magna) durante 5 días a diferentes concentraciones de cadmio (CdCl2) y mercurio (HgCl2 y CH3HgCl) en varias combinaciones. La contaminación se efectuó directamente a través del agua, o indirectamente a través de algas previamente contaminadas (Chlorella vulgaris). Como suele observarse en organismos acuáticos, el metilmercurio fue la forma de mercurio más eficientemente acumulada por D. magna. La vía de contaminación por mercurio fue también determinante con resultados dependientes de la forma química usada. Por lo tanto, aunque el modo preferente de acumulación de mercurio inorgánico fue a través del agua, en D. magna contaminada con metilmercurio el modo preferente fue a través de algas contaminadas. Sin embargo, la acumulación de cadmio no se vio significativamente afectada por la vía de contaminación. Tanto el cadmio como el mercurio fueron capaces de inhibir el proceso de acumulación del otro metal. Aunque el HgCl2 fue normalmente la forma de mercurio que más eficientemente inhibía la acumulación de cadmio, la inhibición de CH3HgCl fue más eficientemente en presencia de cadmio

Heart failure and sudden cardiac death in heritable thoracic aortic disease caused by pathogenic variants in the SMAD3 gene

Background: Predominant cardiovascular manifestations in the spectrum of Heritable Thoracic Aortic Disease include by default aortic root aneurysms- and dissections, which may be associated with aortic valve disease. Mitral- and tricuspid valve prolapse are other commonly recognized features. Myocardial disease, characterized by heart failure and/or malignant arrhythmias has been reported in humans and in animal models harboring pathogenic variants in the Fibrillin1 gene. Methods: Description of clinical history of three cases from one family in Ghent (Belgium) and one family in St. Louis (US). Results: We report on three cases from two families presenting end-stage heart failure (in two) and lethal arrhythmias associated with moderate left ventricular dilatation (in one). All three cases harbor a pathogenic variant in the SMAD3 gene, known to cause aneurysm osteoarthritis syndrome, Loeys-Dietz syndrome type 3 or isolated Heritable Thoracic Aortic Disease. Conclusions: These unusual presentations warrant awareness for myocardial disease in patients harboring pathogenic variants in genes causing Heritable Thoracic Aortic Disease and indicate the need for prospective studies in larger cohorts

Tuberculous Constrictive Pericarditis

Introduction: Constrictive pericarditis is characterized by constriction of the heart secondary to pericardial inflammation. Cardiovascular magnetic resonance (CMR) imaging is useful imaging modality for addressing the challenges of confirming this diagnosis. It can be used to exclude other causes of right heart failure, such as pulmonary hypertension or myocardial infarction, determine whether the pericardium is causing constriction and differentiate it from restrictive cardiomyopathy, which also causes impaired cardiac filling. Case Presentation: A 77-year-old man from a country with high incidence of tuberculosis presented with severe dyspnea. Echocardiography revealed a small left ventricle with normal systolic and mildly impaired diastolic function. Left heart catheterization revealed non-obstructive coronary disease, not felt contributory to the dyspnea. Anatomy imaging with cardiovascular magnetic resonance imaging (CMR) showed global, severely thickened pericardium. Short tau inversion recovery (STIR) sequences for detection of oedema/ inflammation showed increased signal intensity and free breathing sequences confirmed septal flattening on inspiration. Late gadolinium imaging confirmed enhancement in the pericardium, with all findings suggestive of pericardial inflammation and constriction. Conclusions: CMR with STIR sequences, free breathing sequences and late gadolinium imaging can prove extremely useful for diagnosing constrictive pericarditis

Detection of Eight Cannabinoids and One Tracer in Wastewater and River Water by SPE-UPLC–ESI-MS/MS

The consumption of illicit drugs represents a global social and economic problem. Using suitable analytical methods, monitoring, and detection of different illegal drugs residues and their metabolites in wastewater samples can help combat this problem. Our article defines a method to develop, validate, and practically applicate a rapid and robust analytical process for the evaluation of six naturally occurring cannabinoids (CBG, CBD, CBDV, CBN, THC, THCV), two cannabinoids in acidic form (CBDA, THCA-A), and the major cannabis-related human metabolite (THC-COOH). After SPE offline enrichment, we used a UPLC–ESI-MS/MS system, which permitted the determination of several by-products. Studied matrices were samples of different origins: (i) effluent water from a wastewater treatment plant in the Porto urban area; (ii) environmental water from Febros River, the last left-bank tributary of the Douro River. The multi-residue approach was substantiated and successfully employed to analyze the water samples collected in the above locations. The rapid and precise quantification of nine different cannabinoids in different water samples occurred within nine minutes at the ng L−1 level. The appearance of dozens of ng L−1 of some cannabis secondary metabolites, such as CBD, CBDA, CBN, THCA-A, indicates this plant species’ widespread usage among the general population in the considered area

External Aortic Root Support to Prevent Aortic Dilatation in Patients With Marfan Syndrome

Background: Personalized external aortic root support (PEARS) was introduced in 2004 for prevention of aortic root dilatation in Marfan patients. The individual's aortic root is replicated by 3-dimensional printing. A polymer mesh sleeve is manufactured, which is implanted with the aim to support and stabilize the aortic wall. / Objectives: The aim of this study was to assess effectiveness of PEARS for prevention of aortic root dilatation in Marfan patients. / Methods: A total of 24 consecutive Marfan patients operated 2004 to 2012 were prospectively monitored with magnetic resonance imaging. Following a pre-defined protocol, baseline and follow-up aorta measurements were made in a blinded random sequence. / Results: The mean age of the patients was 33 ± 13.3 years (range: 16 to 58 years), and the mean aortic root diameter was 45 ± 2.8 mm (range: 41 to 52 mm). Follow-up was 6.3 ± 2.6 years. There was no increase in the aortic root and ascending aorta diameters, but there was a tendency toward reduction: annulus diameter 28.9 ± 2.3 mm to 28.5 ± 2.4 mm (change −0.39 mm, 95% confidence interval [CI]: −1.05 to 0.27 mm), sinus of Valsalva diameter 44.9 ± 2.9 mm to 44.5 ± 3.0 mm (change −0.37 mm, 95% CI: −1.23 to 0.51 mm), and ascending aorta diameter 32.4 ± 3.6 mm to 32.3 ± 3.7 mm (change −0.10 mm, 95% CI: −0.92 to 0.74 mm). In the same period, the descending aorta diameter increased from 22.9 ± 2.4 mm to 24.2 ± 3.0 mm (change 1.32 mm, 95% CI: 0.70 to 1.94 mm; p < 0.001) with a tendency toward increase in aortic arch diameter 24.1 ± 2.0 mm to 24.5 ± 2.8 mm (change 0.41 mm, 95% CI: −0.56 to 1.37 mm). / Conclusions: PEARS is effective in stabilizing the aortic root and preventing its dilatation. It is a viable alternative for prevention of aortic root dissection in Marfan patients

Review of Journal of Cardiovascular Magnetic Resonance 2015

There were 116 articles published in the Journal of Cardiovascular Magnetic Resonance (JCMR) in 2015, which is a 14 % increase on the 102 articles published in 2014. The quality of the submissions continues to increase. The 2015 JCMR Impact Factor (which is published in June 2016) rose to 5.75 from 4.72 for 2014 (as published in June 2015), which is the highest impact factor ever recorded for JCMR. The 2015 impact factor means that the JCMR papers that were published in 2013 and 2014 were cited on average 5.75 times in 2015. The impact factor undergoes natural variation according to citation rates of papers in the 2 years following publication, and is significantly influenced by highly cited papers such as official reports. However, the progress of the journal's impact over the last 5 years has been impressive. Our acceptance rate is <25 % and has been falling because the number of articles being submitted has been increasing. In accordance with Open-Access publishing, the JCMR articles go on-line as they are accepted with no collating of the articles into sections or special thematic issues. For this reason, the Editors have felt that it is useful once per calendar year to summarize the papers for the readership into broad areas of interest or theme, so that areas of interest can be reviewed in a single article in relation to each other and other recent JCMR articles. The papers are presented in broad themes and set in context with related literature and previously published JCMR papers to guide continuity of thought in the journal. We hope that you find the open-access system increases wider reading and citation of your papers, and that you will continue to send your quality papers to JCMR for publication