The value of multimodality imaging for detection, characterisation and management of a wall adhering structure in the right atrium

The case presents a wall adherent structure in the right atrium in a young patient with peripheral tcell lymphoma followed by successful prolonged lysis therapy resulting in the resolution of the thrombus is presented. This case highlights the utility of multimodality imaging in an accurate assessment of the right atrium thrombus and the effectiveness of prolonged lysis therapy.peer-reviewe

High sensitivity troponin T and I reflect mitral annular plane systolic excursion being assessed by cardiac magnetic resonance imaging

Purpose: This study aims to evaluate the association between high sensitivity troponins (hsTn) and mitral annular plane systolic excursion (MAPSE) in patients undergoing cardiac magnetic resonance imaging (cMRI). Methods: Patients undergoing cMRI were prospectively enrolled. Patients with right ventricular dysfunction(< 50%) were excluded. Blood samples for measurements of hsTn and amino-terminal pro-brain natriuretic peptide (NT-proBNP) were collected at the time of cMRI. Results: 84 patients were included. Median left ventricular ejection fraction was 59% (IQR 51–64%). HsTn were correlated inversely with MAPSE within multivariable linear regression models (hsTnI: Beta − 0.19; T − 1.96; p = 0.05; hsTnT: Beta − 0.26; T − 3.26; p = 0.002). HsTn increased significantly according to decreasing stages of impaired MAPSE (p < 0.003). HsTn discriminated patients with impaired MAPSE < 11 mm (hsTnT: AUC = 0.67; p = 0.008; hsTnI: AUC = 0.64; p = 0.03) and < 8 mm (hsTnT: AUC = 0.79; p = 0.0001; hsTnI: AUC = 0.75; p = 0.001) and were still significantly associated in multivariable logistic regression models with impaired MAPSE < 11 mm (hsTnT: OR = 4.71; p = 0.002; hsTnI: OR = 4.22; p = 0.009). Conclusions: This study demonstrates that hsTn are able to reflect MAPSE being assessed by cMRI

Pericoronary radiomics texture features associated with hypercholesterolemia on a photon-counting-CT

IntroductionPericoronary adipose tissue (PCAT) stands in complex bidirectional interaction with the surrounding arteries and is known to be connected to many cardiovascular diseases involving vascular inflammation. PCAT texture may be influenced by other cardiovascular risk factors such as hypercholesterolemia. The recently established photon-counting CT could improve texture analysis and help detect those changes by offering higher spatial resolution and signal-to-noise ratio.MethodsIn this retrospective, single-center, IRB-approved study, PCAT of the left and right coronary artery was manually segmented and radiomic features were extracted using pyradiomics. The study population consisted of a test collective and a validation collective. The collectives were each divided into two groups defined by the presence or absence of hypercholesterolemia, taken from self-reported conditions and confirmed by medical records. Mean and standard deviation were calculated with Pearson correlation coefficient for correlation of features and visualized as boxplots and heatmaps using R statistics. Random forest feature selection was performed to identify differentiating features between the two groups. 66 patients were enrolled in this study (34 female, mean age 58 years).ResultsTwo radiomics features allowing differentiation between PCAT texture of the groups were identified (p-values between 0.013 and 0.24) and validated. Patients with hypercholesterolemia presented with a greater concentration of high-density values as indicated through analysis of specific texture features as “gldm_HighGrayLevelEmphasis” (23.95 vs. 22.99) and “glrlm_HighGrayLevelRunEmphasis” (24.21 vs. 23.31).DiscussionTexture analysis of PCAT allowed differentiation between patients with and without hypercholesterolemia offering a potential imaging biomarker for this specific cardiovascular risk factor

CMR findings in patients with hypertrophic cardiomyopathy and atrial fibrillation

<p>Abstract</p> <p>Objectives</p> <p>We sought to evaluate the relation between atrial fibrillation (AF) and the extent of myocardial scarring together with left ventricular (LV) and atrial parameters assessed by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM).</p> <p>Background</p> <p>AF is the most common arrhythmia in HCM. Myocardial scarring is also identified frequently in HCM. However, the impact of myocardial scarring assessed by LGE CMR on the presence of AF has not been evaluated yet.</p> <p>Methods</p> <p>87 HCM patients underwent LGE CMR, echocardiography and regular ECG recordings. LV function, volumes, myocardial thickness, left atrial (LA) volume and the extent of LGE, were assessed using CMR and correlated to AF. Additionally, the presence of diastolic dysfunction and mitral regurgitation were obtained by echocardiography and also correlated to AF.</p> <p>Results</p> <p>Episodes of AF were documented in 37 patients (42%). Indexed LV volumes and mass were comparable between HCM patients with and without AF. However, indexed LA volume was significantly higher in HCM patients with AF than in HCM patients without AF (68 ± 24 ml·m^-2versus 46 ± 18 ml·m^-2, p = 0.0002, respectively). The mean extent of LGE was higher in HCM patients with AF than those without AF (12.4 ± 14.5% versus 6.0 ± 8.6%, p = 0.02). When adjusting for age, gender and LV mass, LGE and indexed LA volume significantly correlated to AF (r = 0.34, p = 0.02 and r = 0.42, p < 0.001 respectively). By echocardiographic examination, LV diastolic dysfunction was evident in 35 (40%) patients. Mitral regurgitation greater than II was observed in 12 patients (14%). Multivariate analysis demonstrated that LA volume and presence of diastolic dysfunction were the only independent determinant of AF in HCM patients (p = 0.006, p = 0.01 respectively). Receiver operating characteristic curve analysis indicated good predictive performance of LA volume and LGE (AUC = 0.74 and 0.64 respectively) with respect to AF.</p> <p>Conclusion</p> <p>HCM patients with AF display significantly more LGE than HCM patients without AF. However, the extent of LGE is inferior to the LA size for predicting AF prevalence. LA dilation is the strongest determinant of AF in HCM patients, and is related to the extent of LGE in the LV, irrespective of LV mass.</p

Myocardial T1-mapping at 3T using saturation-recovery: reference values, precision and comparison with MOLLI

Background: Myocardial T1-mapping recently emerged as a promising quantitative method for non-invasive tissue characterization in numerous cardiomyopathies. Commonly performed with an inversion-recovery (IR) magnetization preparation at 1.5T, the application at 3T has gained due to increased quantification precision. Alternatively, saturation-recovery (SR) T1-mapping has recently been introduced at 1.5T for improved accuracy. Thus, the purpose of this study is to investigate the robustness and precision of SR T1-mapping at 3T and to establish accurate reference values for native T1-times and extracellular volume fraction (ECV) of healthy myocardium. Methods: Balanced Steady-State Free-Precession (bSSFP) Saturation-Pulse Prepared Heart-rate independent Inversion-REcovery (SAPPHIRE) and Saturation-recovery Single-SHot Acquisition (SASHA) T1-mapping were compared with the Modified Look-Locker inversion recovery (MOLLI) sequence at 3T. Accuracy and precision were studied in phantom. Native and post-contrast T1-times and regional ECV were determined in 20 healthy subjects (10 men, 27 ± 5 years). Subjective image quality, susceptibility artifact rating, in-vivo precision and reproducibility were analyzed. Results: SR T1-mapping showed  0.19; intra: p > 0.09) or consistency (inter: p > 0.07; intra: p > 0.17) between the three methods. Conclusions: Saturation-recovery T1-mapping at 3T yields higher accuracy, comparable inter-subject, inter- and intra-observer variability and less than 30 % precision-loss compared to MOLLI

Epicardial adipose tissue in patients with heart failure

<p>Abstract</p> <p>Purpose</p> <p>The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls.</p> <p>Background</p> <p>EAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM) in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts.</p> <p>Methods</p> <p>CMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM), or dilated cardiomyopathy (DCM) and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI) ratios were calculated.</p> <p>Results</p> <p>Patients with CHF had less indexed EAT mass than controls (22 ± 5 g/m²versus 34 ± 4 g/m², p < 0.0001). In the subgroup analysis there were no significant differences in indexed EAT mass between patients with ICM and DCM (21 ± 4 g/m²versus 23 ± 6 g/m², p = 0.14). Linear regression analysis showed that with increasing LV end-diastolic diameter (LV-EDD) (r = 0.42, p = 0.0004) and LV end-diastolic mass (LV-EDM) (r = 0.59, p < 0.0001), there was a significantly increased amount of EAT in patients with CHF. However, the ratio of EAT mass/LV-EDM was significantly reduced in patients with CHF compared to healthy controls (0.54 ± 0.1 versus 0.21 ± 0.1, p < 0.0001). In CHF patients higher indexed EAT/LVRI-ratios in CHF patients correlated best with a reduced LV-EF (r = 0.49, p < 0.0001).</p> <p>Conclusion</p> <p>Patients with CHF revealed significantly reduced amounts of EAT. An increase in LVM is significantly related to an increase in EAT in both patients with CHF and controls. However, different from previous reports the EAT/LVEDM-ratio in patients with CHF was significantly reduced compared to healthy controls. Furthermore, the LV function correlated best with the indexed EAT/LVRI ratio in CHF patients. Metabolic abnormalities and/or anatomic alterations due to disturbed cardiac function and geometry seem to play a key role and are a possible explanation for these findings.</p

Radiomics in Cardiac Computed Tomography

In recent years, there has been an increasing recognition of coronary computed tomographic angiography (CCTA) and gated non-contrast cardiac CT in the workup of coronary artery disease in patients with low and intermediate pretest probability, through the readjustment guidelines by medical societies. However, in routine clinical practice, these CT data sets are usually evaluated dominantly regarding relevant coronary artery stenosis and calcification. The implementation of radiomics analysis, which provides visually elusive quantitative information from digital images, has the potential to open a new era for cardiac CT that goes far beyond mere stenosis or calcification grade estimation. This review offers an overview of the results obtained from radiomics analyses in cardiac CT, including the evaluation of coronary plaques, pericoronary adipose tissue, and the myocardium itself. It also highlights the advantages and disadvantages of use in routine clinical practice

Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography.

AIMS: This study sought to characterize global and regional right ventricular (RV) myocardial function in patients with Takotsubo cardiomyopathy (TC) using 2D strain imaging. METHODS: We compared various parameters of RV and left ventricular (LV) systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement. RESULTS: At initial presentation, RV peak systolic longitudinal strain (RVPSS) and RV fractional area change (RVFAC) were significantly lower in group 1 (-13.2±8.6% vs. -21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001) and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE) did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050). Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF) and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and -5.5±4.8% vs. -10.2±6.2%, p = 0.040) at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >-19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups. CONCLUSION: In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way