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Iacopo Olivotto,
Barry J Maron,
Benedetta Tomberli,
Evan Appelbaum,
Carol Salton,
Tammy S Haas,
C Michael Gibson,
Stefano Nistri,
Eleonora Servettini, Raymond H Chan,
James E Udelson,
John R Lesser,
Franco Cecchi,
Warren J Manning,
Martin S Maron
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ABSTRACT: OBJECTIVE: To assess the impact of body mass index (BMI) on cardiac phenotypic and clinical course in a multicenter HCM cohort. BACKGROUND: It is unresolved whether clinical variables promoting left ventricular (LV) hypertrophy in the general population, such as obesity, may influence cardiac phenotypic and clinical course in patients with hypertrophic cardiomyopathy (HCM). Therefore, we assessed the impact of body mass index (BMI) on disease expression in a multicenter HCM cohort. METHODS: In 275 adult HCM patients (age 48±14 years; 70% male), we assessed the relation of BMI to LV mass, determined by cardiovascular magnetic resonance (CMR) and heart failure progression. RESULTS: . At multivariate analysis, BMI proved independently associated with the magnitude of hypertrophy: pre-obese and obese HCM patients (BMI 25-30 and >30 kg/m(2), respectively) showed a 65% and 310% increased likelihood of an LV mass in the highest quartile (>120 g/m(2)), compared to normal weight patients (BMI <25; hazard ratio [HR] 1.65, 95%CI 0.73-3.74; p=0.22 and 3.1, 95%CI 1.42-6.86;p=0.004, respectively). Other features associated with LV mass >120 g/m(2) were LV outflow obstruction (HR 4.9; 95%CI 2.4-9.8; p<0.001), systemic hypertension (HR 2.2; 95%CI 1.1-4.5; p=0.026) and male gender (HR 2.1; 95%CI 0.9-4.7; p=0.083). During a median follow-up of 3.7 years (inter-quartile range 2.5-5.3), obese patients showed a 3.6 HR (95%CI 1.2-10.7; p=0.02) for developing NYHA class III-IV symptoms compared to non-obese patients, independent of outflow obstruction. Noticeably, the proportion of patients in NYHA class III at the end of follow-up was 13% among obese patients, compared to 6% among those of normal weight (p=0.03). CONCLUSIONS: In HCM patients, extrinsic factors such as obesity are independently associated with increase in LV mass and may dictate progression of heart failure symptoms.
Journal of the American College of Cardiology 04/2013; · 14.16 Impact Factor
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Hussein Rayatzadeh,
Alex Tan, Raymond H Chan,
Shalin J Patel,
Thomas H Hauser,
Long Ngo,
Jaime L Shaw,
Susie N Hong,
Peter Zimetbaum,
Alfred E Buxton,
Mark E Josephson,
Warren J Manning,
Reza Nezafat
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ABSTRACT: BACKGROUND: Despite the survival benefit of implantable-cardioverter-defibrillators (ICDs), the vast majority of patients receiving an ICD for primary prevention do not receive ICD therapy. We sought to assess the role of heterogeneous scar area (HSA) identified by late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) in predicting appropriate ICD therapy for primary prevention of sudden cardiac death (SCD). METHODS: From September 2003 to March 2011, all patients who underwent primary prevention ICD implantation and had a pre-implantation LGE-CMR were identified. Scar size was determined using thresholds of 4 and 6 standard deviations (SD) above remote normal myocardium; HSA was defined using 3 different criteria; as the region between 2 SD and 4 SD (HSA2-4SD),between 2SD and 6SD (HSA2-6SD), and between 4SD and 6SD (HSA4-6SD). The end-point was appropriate ICD therapy. RESULTS: Out of 40 total patients followed for 25 +/- 24 months, 7 had appropriate ICD therapy. Scar size measured by different thresholds was similar in ICD therapy and non-ICD therapy groups (P = NS for all). However, HSA2-4SD and HSA4-6SD were significantly larger in the ICD therapy group (P = 0.001 and P = 0.03, respectively). In multivariable model HSA2-4SD was the only significant independent predictor of ICD therapy (HR = 1.08, 95%CI: 1.00-1.16, P = 0.04). Kaplan-Meier analysis showed that patients with greater HSA2-4SD had a lower survival free of appropriate ICD therapy (P = 0.026). CONCLUSIONS: In primary prevention ICD implantation, LGE-CMR HSA identifies patients with appropriate ICD therapy. If confirmed in larger series, HSA can be used for risk stratification in primary prevention of SCD.
Journal of Cardiovascular Magnetic Resonance 04/2013; 15(1):31. · 3.72 Impact Factor
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ABSTRACT: PURPOSE: To enable accelerated isotropic sub-millimeter whole-heart coronary MRI within a 6-min acquisition and to compare this with a current state-of-the-art accelerated imaging technique at acceleration rates beyond what is used clinically. METHODS: Coronary MRI still faces major challenges, including lengthy acquisition time, low signal-to-noise-ratio (SNR), and suboptimal spatial resolution. Higher spatial resolution in the sub-millimeter range is desirable, but this results in increased acquisition time and lower SNR, hindering its clinical implementation. In this study, we sought to use an advanced B(1) -weighted compressed sensing technique for highly accelerated sub-millimeter whole-heart coronary MRI, and to compare the results to parallel imaging, the current-state-of-the-art, where both techniques were used at acceleration rates beyond what is used clinically. Two whole-heart coronary MRI datasets were acquired in seven healthy adult subjects (30.3 ± 12.1 years; 3 men), using prospective 6-fold acceleration, with random undersampling for the proposed compressed sensing technique and with uniform undersampling for sensitivity encoding reconstruction. Reconstructed images were qualitatively compared in terms of image scores and perceived SNR on a four-point scale (1 = poor, 4 = excellent) by an experienced blinded reader. RESULTS: The proposed technique resulted in images with clear visualization of all coronary branches. Overall image quality and perceived SNR of the compressed sensing images were significantly higher than those of parallel imaging (P = 0.03 for both), which suffered from noise amplification artifacts due to the reduced SNR. CONCLUSION: The proposed compressed sensing-based reconstruction and acquisition technique for sub-millimeter whole-heart coronary MRI provides 6-fold acceleration, where it outperforms parallel imaging with uniform undersampling. Magn Reson Med, 2013. © 2013 Wiley Periodicals, Inc.
Magnetic Resonance in Medicine 02/2013; · 2.96 Impact Factor
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ABSTRACT: BACKGROUND: Esophageal injuryhas been documented following pulmonary vein isolation (PVI), but damage to other mediastinal structures such as the aorta is seldom reported. Hyperenhancement of the aorta is occasionally seen oncardiac magnetic resonance imaging with late gadolinium enhancement (CMR LGE)in patientsundergoing PVI. OBJECTIVE: We sought to determine the frequency of aortic wall LGE following PVI. METHODS: Patients undergoing PVI with pre- and post-CMR LGE at our institution between January 2009 and September 2011 were retrospectively identified. Studies were assessed for hyperenhancement, defined as LGE of the aorta or left atrium(LA) at 10 standard deviations greater than the mean signal intensity of the aortic blood pool. RESULTS: Forty-seven PVI and 14 MiniMaze patients were included in this analysis. A significant increase in the number of patients with aortic wall LGE was found post-PVI compared to pre-PVI (28/47 versus 14/47, p= 0.018). Ninety-six percent (26/27) of those with aortic wall enhancement post-PVI also had post-PVI LA enhancement. Eighty-six percent (24/28) of patients with aortic wall LGE post-PVI had direct contact of the LA and aorta on the pre-PVI CMR. Patients undergoing MiniMaze did not exhibit a significant increase in LA or aortic enhancement following surgery. CONCLUSIONS: Rates of aortic wall LGE were increased among patients undergoing PVI but not MiniMaze, despite a trend toward larger LA in the latter group. The clinical implications of aortic LGE remain undefined.However, these data suggest that hyperenhancementof the aorta post-PVI is common.
Heart rhythm: the official journal of the Heart Rhythm Society 01/2013; · 4.56 Impact Factor
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Mehdi H Moghari,
Sébastien Roujol, Raymond H Chan,
Susie N Hong,
Natalie Bello,
Markus Henningsson,
Long H Ngo,
Beth Goddu,
Lois Goepfert,
Kraig V Kissinger,
Warren J Manning,
Reza Nezafat
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ABSTRACT: Respiratory motion compensation using diaphragmatic navigator gating with a 5 mm gating window is conventionally used for free-breathing cardiac MRI. Because of the narrow gating window, scan efficiency is low resulting in long scan times, especially for patients with irregular breathing patterns. In this work, a new retrospective motion compensation algorithm is presented to reduce the scan time for free-breathing cardiac MRI that increasing the gating window to 15 mm without compromising image quality. The proposed algorithm iteratively corrects for respiratory-induced cardiac motion by optimizing the sharpness of the heart. To evaluate this technique, two coronary MRI datasets with 1.3 mm(3) resolution were acquired from 11 healthy subjects (seven females, 25 ± 9 years); one using a navigator with a 5 mm gating window acquired in 12.0 ± 2.0 min and one with a 15 mm gating window acquired in 7.1 ± 1.0 min. The images acquired with a 15 mm gating window were corrected using the proposed algorithm and compared to the uncorrected images acquired with the 5 and 15 mm gating windows. The image quality score, sharpness, and length of the three major coronary arteries were equivalent between the corrected images and the images acquired with a 5 mm gating window (P-value > 0.05), while the scan time was reduced by a factor of 1.7. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.
Magnetic Resonance in Medicine 11/2012; · 2.96 Impact Factor
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Journal of the American College of Cardiology 10/2012; · 14.16 Impact Factor
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ABSTRACT: PURPOSE: To investigate the use of radiofrequency (RF) gating in conjunction with a paramagnetic contrast agent to reduce the specific absorption rate (SAR) and increase the blood-myocardium contrast in balanced steady-state free precession (bSSFP) 3D cardiac cine. MATERIALS AND METHODS: RF gating was implemented by synchronizing the RF-excitation with an external respiratory sensor (bellows), which could additionally be used for respiratory gating. For reference, respiratory-gated 3D cine images were acquired without RF gating. Free-breathing 3D cine images were acquired in eight healthy subjects before and after contrast injection (Gd-BOPTA) and compared to breath-hold 2D cine. RESULTS: RF-gated 3D cine reduced the SAR by nearly 40% without introducing significant artifacts while providing left ventricle (LV) measurements similar to those obtained with 2D cine. The contrast-to-noise ratio (CNR) was significantly higher for 3D cine compared to 2D cine, both before and after contrast injection; however, no statistically significant CNR increase was observed for the postcontrast 3D cine compared to the precontrast acquisitions. CONCLUSION: Respiratory-triggered RF gating significantly reduces SAR in 3D cine acquisitions, which may enable a more widespread clinical use of 3D cine. Furthermore, CNR of 3D bSSFP cine is higher than of 2D and administration of Gd-BOPTA does not improve the CNR of 3D cine. J. Magn. Reson. Imaging 2012;. © 2012 Wiley Periodicals, Inc.
Journal of Magnetic Resonance Imaging 09/2012; · 2.70 Impact Factor
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Martin S Maron,
Ethan J Rowin,
David Lin,
Evan Appelbaum,
C Michael Gibson, Raymond H Chan,
John R Lesser,
Jana Lindberg,
Tammy S Haas,
James E Udelson,
Warren J Manning,
Barry J Maron
Circulation Cardiovascular Imaging 09/2012; 5(5):e67-37. · 5.94 Impact Factor
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ABSTRACT: To evaluate the use of low-dimensional-structure self-learning and thresholding (LOST) compressed sensing acquisition and reconstruction in the assessment of left atrial (LA) and left ventricular (LV) scar by using late gadolinium enhancement (LGE) magnetic resonance (MR) imaging with isotropic spatial resolution.
The study was approved by the local institutional review board and was compliant with HIPAA. All subjects provided written informed consent. Twenty-eight patients (eight women; mean age, 58.0 years ± 10.1) with a history of atrial fibrillation were recruited for the LA LGE study, and 14 patients (five women; mean age, 54.2 years ± 18.6) were recruited for assessment of LV myocardial infarction. With use of a pseudorandom k-space undersampling pattern, threefold accelerated three-dimensional (3D) LGE data were acquired with isotropic spatial resolution and reconstructed off-line by using LOST. For comparison, subjects were also imaged by using standard 3D LGE protocols with nonisotropic spatial resolution. Images were compared qualitatively by three cardiologists with regard to diagnostic value, presence of enhancement, and image quality. The signed rank test and Wilcoxon unpaired two-sample test were used to test the hypothesis that there would be no significant difference in image quality ratings with different resolutions.
Interpretable images were obtained in 26 of the 28 patients (93%) in the LA LGE study. LGE was seen in 17 of 30 cases (57%) with nonisotropic resolution and in 18 cases (60%) with isotropic resolution. Diagnostic quality scores of isotropic images were significantly higher than those of nonisotropic images with coronal views (median, 3 vs 2, respectively [25th and 75th percentiles: 3, 3 vs 2, 3]; P < .001) and sagittal views (median, 3 vs 2 [25th and 75th percentiles: 3, 4 vs 2, 3]; P < .001) but lower with axial views (median, 4 vs 3 [25th and 75th percentiles: 3, 4 vs 3, 3]; P < .001). For the LV LGE study, all patients had interpretable images. LGE was seen in six of 14 patients (43%), with 100% agreement between both data sets. Diagnostic quality scores of high-isotropic-resolution LV images were higher than those of nonisotropic images with short-axis views (median, 4 vs 3 [25th and 75th percentiles: 3, 4 vs 2, 3]; P = .014) and two-chamber views (median, 4 vs 3 [25th and 75th percentiles: 3, 4 vs 2, 3]; P = .001).
An accelerated LGE acquisition with LOST enables imaging with high isotropic spatial resolution for improved assessment of LV, LA, and pulmonary vein scar.
Radiology 07/2012; 264(3):691-9. · 5.73 Impact Factor
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Martin S Maron,
Ethan J Rowin,
David Lin,
Evan Appelbaum, Raymond H Chan,
C Michael Gibson,
John R Lesser,
Jana Lindberg,
Tammy S Haas,
James E Udelson,
Warren J Manning,
Barry J Maron
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ABSTRACT: In hypertrophic cardiomyopathy (HCM), cardiovascular MR can detect morphological abnormalities of the left ventricle (LV) not visualized with echocardiography. Although myocardial crypts (ie, narrow, blood-filled invaginations within the LV wall) have been recognized in HCM, all clinical implications of these structural abnormalities within the broad clinical HCM spectrum are not completely resolved. Therefore, we sought to characterize the prevalence and diagnostic significance of myocardial crypts in HCM patients.
Cine and late gadolinium enhancement cardiovascular MR and 2-dimensional echocardiography were obtained in 292 consecutive patients with HCM including 31 genotype-positive/phenotype-negative family members without LV hypertrophy (28 ± 16 years; 51% male) and 261 patients with LV hypertrophy (46 ± 18 years; 60% male). Ninety-eight subjects without cardiovascular disease were controls. Myocardial crypts (1-6/patient) were identified only by cardiovascular MR in 19 of 31 genotype-positive/phenotype-negative patients (61%) compared with only 10 of 261 (4%) patients with HCM with LV hypertrophy (P<0.001) and were absent in control subjects. Twelve-lead electrocardiograms were normal in 10 (53%) of the genotype-positive/phenotype-negative patients with crypts. Crypts were confined to the basal LV, most commonly in the ventricular septum (n=21) or posterior LV free wall (n=4), and associated with normal LV contractility and absence of late gadolinium enhancement in all but one patient.
LV myocardial crypts represent a distinctive morphological expression of HCM, occurring with different frequency in HCM patients with or without LV hypertrophy. Crypts are a novel cardiovascular MR imaging marker, which may identify individual HCM family members who should also be considered for diagnostic genetic testing. These data support an expanded role for cardiovascular MR in early evaluation of HCM families.
Circulation Cardiovascular Imaging 05/2012; 5(4):441-7. · 5.94 Impact Factor
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ABSTRACT: An example axial slice (left) and reformatted axial image (right) depicting the right coronary artery (RCA) of a subject using zero filling (acquired) and low-dimensional-structure self-learning and thresholding (LOST) reconstruction. The LOST reconstruction allows better definitions (image score 3.7 ± 0.7 vs. 1.5 ± 0.5) of the RCA in the proximal, mid, and distal regions from the article by Akçakaya et al (pp 1434-1443).
Magnetic Resonance in Medicine 05/2012; 67(5):spcone. · 2.96 Impact Factor
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ABSTRACT: We sought to evaluate the efficacy of prospective random undersampling and low-dimensional-structure self-learning and thresholding reconstruction for highly accelerated contrast-enhanced whole-heart coronary MRI. A prospective random undersampling scheme was implemented using phase ordering to minimize artifacts due to gradient switching and was compared to a randomly undersampled acquisition with no profile ordering. This profile-ordering technique was then used to acquire contrast-enhanced whole-heart coronary MRI in 10 healthy subjects with 4-fold acceleration. Reconstructed images and the acquired zero-filled images were compared for depicted vessel length, vessel sharpness, and subjective image quality on a scale of 1 (poor) to 4 (excellent). In a pilot study, contrast-enhanced whole-heart coronary MRI was also acquired in four patients with suspected coronary artery disease with 3-fold acceleration. The undersampled images were reconstructed using low-dimensional-structure self-learning and thresholding, which showed significant improvement over the zero-filled images in both objective and subjective measures, with an overall score of 3.6 ± 0.5. Reconstructed images in patients were all diagnostic. Low-dimensional-structure self-learning and thresholding reconstruction allows contrast-enhanced whole-heart coronary MRI with acceleration as high as 4-fold using clinically available five-channel phased-array coil.
Magnetic Resonance in Medicine 03/2012; 67(5):1434-43. · 2.96 Impact Factor
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ABSTRACT: A respiratory navigator with a fixed acceptance gating window is commonly used to reduce respiratory motion artifacts in cardiac MR. This approach prolongs the scan time and occasionally yields an incomplete dataset due to respiratory drifts. To address this issue, we propose an adaptive gating window approach in which the size and position of the gating window are changed adaptively during the acquisition based on the individual's breathing pattern. The adaptive gating window tracks the breathing pattern of the subject throughout the scan and adapts the size and position of the gating window such that the gating efficiency is always fixed at a constant value. To investigate the image quality and acquisition time, free breathing cardiac MRI, including both targeted coronary MRI and late gadolinium enhancement imaging, was performed in 67 subjects using the proposed navigator technique. Targeted coronary MRI was acquired from eleven healthy adult subjects using both the conventional and proposed adaptive gating window techniques. Fifty-six patients referred for cardiac MRI were also imaged using late gadolinium enhancement with the proposed adaptive gating window technique. Subjective and objective image assessments were used to evaluate the proposed method. The results demonstrate that the proposed technique allows free-breathing cardiac MRI in a relatively fixed time without compromising imaging quality due to respiratory motion artifacts. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.
Magnetic Resonance in Medicine 02/2012; · 2.96 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P156. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:O99. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P246. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P245. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:O21. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:O22. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:O8. · 3.72 Impact Factor
