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Early T1 Myocardial MRI Mapping: Value in Detecting Myocardial Hyperemia in Acute Myocarditis.

早期 T1 心肌 MRI 标测: 检测急性心肌炎心肌充血的价值。

  • 影响因子:5.83
  • DOI:10.1148/radiol.2020191623
  • 作者列表:"Palmisano A","Benedetti G","Faletti R","Rancoita PMV","Gatti M","Peretto G","Sala S","Boccia E","Francone M","Galea N","Basso C","Del Maschio A","De Cobelli F","Esposito A
  • 发表时间:2020-03-10
Abstract

:Background Hyperemia is a key component of acute myocarditis (AM). Early gadolinium uptake because of myocardial hyperemia may be quantified by using T1 mapping. Purpose To evaluate the value of early enhanced T1 shortening for the diagnosis of acute myocarditis. Materials and Methods Study participants suspected of having AM and healthy control (HC) participants were prospectively enrolled from September 2016 to May 2019. Participants underwent 1.5-T cardiac MRI including Lake Louise criteria, T2 mapping, native T1, and extracellular volume, with the addition of early enhanced T1 mapping (2 minutes after intravenous administration of 0.15 mmol/kg gadobutrol). Color-coded maps of the percentage of T1 shortening from precontrast to early postcontrast were generated. Optimal early T1 shortening cut-off value and its diagnostic performance in the identification of acute myocarditis were calculated. Results Forty-five study participants with AM (median age, 40 years; interquartile range [IQR], 20-46 years; 22 women) diagnosed according to multidisciplinary clinical evaluation, electrocardiography, laboratory test, echocardiography, cardiac MRI, and coronary CT and/or invasive angiography. Findings were confirmed by endomyocardial biopsy in 64% (29 of 45) of participants. MRI parameters were compared with 19 HC participants (median age, 39 years; IQR, 28-46 years; seven women). Median early T1 shortening was 75% (IQR, 72%-78%) in participants with AM versus 65% (IQR, 61%-66%) in HC participants (P < .001). Early T1 shortening showed high diagnostic performance (area under the receiver operating characteristic curve [AUC], 0.97; 95% confidence interval [CI]: 0.94, 1.00) and excellent interobserver reproducibility (intraclass correlation coefficient: 0.98; 95% CI: 0.96, 1.00). Early T1 shortening of 70% or greater identified acute myocarditis with 93% sensitivity, 100% specificity, and 95% diagnostic accuracy. Early T1 shortening had better diagnostic performance than late percentage T1 shortening (AUC, 0.97 vs 0.90, respectively; P = .03) and extracellular volume (AUC, 0.97 vs 0.88, respectively; P = .046), and similar to native T1 (AUC, 0.97 vs 0.93, respectively; P = .63) and T2 mapping (AUC, 0.97 vs 0.97, respectively; P > .99). Conclusion In this proof-of-concept study, percentage of T1 shortening at early enhanced T1 mapping showed high accuracy for the diagnosis of acute myocarditis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by De Cecco and Monti in this issue.

摘要

: 背景充血是急性心肌炎 (AM) 的关键组成部分。由于心肌充血引起的早期钆摄取可通过使用 T1 mapping 进行定量。目的探讨早期增强 T1 缩短对急性心肌炎的诊断价值。材料和方法研究从 2016年9月至 2019年5月前瞻性入组了怀疑患有 AM 的参与者和健康对照 (HC) 参与者。参与者接受了 1.5 T 心脏 MRI 检查,包括 Lake Louise 标准、 T2 mapping 、原生 T1 和细胞外体积,加入早期增强 T1 mapping (静脉给予 0.15 mmol/kg gadobutrol 后 2 分钟)。生成了从对比前到对比后早期 T1 缩短百分比的彩色编码图。计算最佳早期 T1 缩短临界值及其在急性心肌炎鉴别中的诊断性能。结果根据多学科临床评估、心电图、实验室检查、超声心动图、心脏 MRI 、冠状动脉 CT 和/或侵入性血管造影。结果通过心内膜心肌活检证实了 64% (45 例中的 29 例) 的参与者。将 MRI 参数与 19 例 HC 参与者 (中位年龄,39 岁; IQR,28-46 岁; 7 例女性) 进行比较。AM 参与者的中位早期 T1 缩短为 75% (IQR,72%-78%),而 HC 参与者为 65% (IQR,61%-66%) (P <.001)。早期 T1 缩短显示高诊断性能 (受试者工作特征曲线下面积 [AUC],0.97; 95% 置信区间 [CI]: 0.94,1.00) 和优秀的观察者间再现性 (组内相关系数: 0.98; 95% CI: 0.96,1.00)。早期 T1 缩短 70% 或以上确定急性心肌炎的敏感性为 93%,特异性为 100%,诊断准确率为 95%。早期 T1 缩短的诊断性能优于晚期百分比 T1 缩短 (AUC 分别为 0.97 vs 0.90; P = .03) 和细胞外体积 (AUC 分别为 0.97 vs 0.88); P = .046),与天然 T1 相似 (AUC 分别为 0.97 vs 0.93; P = .63)和 T2 mapping (AUC 分别为 0.97 vs 0.97; P> .99)。结论在本概念验证研究中,早期增强 T1 标测时 T1 缩短百分比对急性心肌炎的诊断具有较高的准确性。©本文提供 RSNA,2020 在线补充材料。另见 De Cecco 和 Monti 在本期的社论。

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影响因子:2.06
发表时间:2020-01-12
DOI:10.1186/s12872-019-01311-4
作者列表:["Nattawut Wongpraparut","Sarawut Siwamogsatham","Tomorn Thongsri","Pornchai Ngamjanyaporn","Arintaya Phrommintikul","Kompoj Jirajarus","Tarinee Tangcharoen","Kid Bhumimuang","Pinij Kaewsuwanna","Rungroj Krittayaphong","Rungtiwa Pongakasira","Harvey D. White"]

METHODS:Abstract Background Ischemic cardiomyopathy is a high-cost, resource-intensive public health burden that is associated with a 1-year mortality rate of about 16% in western population. Different in patient ethnicity and pattern of practice may impact the clinical outcome. We aim to determine 1-year mortality and to identify factors that significantly predicts 1-year mortality of Thai patients with ischemic cardiomyopathy. Methods This prospective multicenter registry enrolled consecutive Thai patients that were diagnosed with ischemic cardiomyopathy at 9 institutions located across Thailand. Patients with left ventricular function  75% in the left main or proximal left anterior descending artery or coronary angiography, and/or two major epicardial coronary stenoses; 2) prior myocardial infarction; 3) prior revascularization by coronary artery bypass graft or percutaneous coronary intervention; or, 4) magnetic resonance imaging pattern compatible with ischemic cardiomyopathy. Baseline clinical characteristics, coronary and echocardiographic data were recorded. The 1-year clinical outcome was pre-specified. Results Four hundred and nineteen patients were enrolled. Thirty-nine patients (9.9%) had died at 1 year, with 27 experiencing cardiovascular death, and 12 experiencing non-cardiovascular death. A comparison between patients who were alive and patients who were dead at 1 year revealed lower baseline left ventricular ejection fraction (LVEF) (26.7 ± 7.6% vs 30.2 ± 7.8%; p = 0.021), higher left ventricular end-diastolic volume (LVEDV) (185.8 ± 73.2 ml vs 155.6 ± 64.2 ml; p = 0.014), shorter mitral valve deceleration time (142.9 ± 57.5 ml vs 182.4 ± 85.7 ml; p = 0.041), and lower use of statins (94.7% vs 99.7%; p = 0.029) among deceased patients. Patients receiving guideline-recommended β-blockers had lower mortality than patients receiving non-guideline-recommended β-blockers (8.1% vs 18.2%; p = 0.05). Conclusions The results of this study revealed a 9.9% 1-year mortality rate among Thai ischemic cardiomyopathy patients. Doppler echocardiographic parameters significantly associated with 1-year mortality were LVEF, LVEDV, mitral E velocity, and mitral valve deceleration time. The use of non-guideline-recommended β-blockers rather than guideline recommended β-blockers were associated with increased with 1-year mortality. Guidelines recommended β-blockers should be preferred. Trial registration Thai Clinical Trials Registry TCTR20190722002. Registered 22 July 2019. “Retrospectively registered”.

影响因子:4.69
发表时间:2020-01-07
DOI:10.1186/s12968-019-0590-z
作者列表:["Yao-Dan Liang","Yuan-Wei Xu","Wei-Hao Li","Ke Wan","Jia-Yu Sun","Jia-Yi Lin","Qing Zhang","Xiao-Yue Zhou","Yu-Cheng Chen"]

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影响因子:4.69
发表时间:2020-01-05
DOI:10.1186/s12968-019-0589-5
作者列表:["Yingxia Yang","Gang Yin","Yong Jiang","Lei Song","Shihua Zhao","Minjie Lu"]

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