Andrew E Arai's research while affiliated with National Heart, Lung, and Blood Institute and other places

Publications (449)

Article
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Introduction Heart failure (HF) in hypertrophic cardiomyopathy (HCM) is associated with high morbidity and mortality. Predictors of HF, in particular the role of myocardial fibrosis and microvascular ischemia remain unclear. We assessed the predictive value of cardiovascular magnetic resonance (CMR) for development of HF in HCM in an observational...
Article
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Background: Coronavirus disease 2019 (COVID-19) has outbroken in China and subsequently spread worldwide since the end of 2019. Chest computed tomography (CT) plays an important role in the diagnosis of lung diseases, but its value in the diagnosis of cardiac injury remains unknown. Methods: We enrolled 241 consecutive hospitalized patients (aged 6...
Article
What is the most likely diagnosis in a patient in their 30s with no remarkable medical history who reported dyspnea on exertion? Heart rhythm monitoring showed episodes of nonsustained ventricular tachycardia, and echocardiography revealed reduced left ventricular (LV) systolic function. Cardiovascular magnetic resonance imaging demonstrated thinni...
Article
Objectives The aim of this study is to examine the prognostic value of T1 mapping and the extracellular volume (ECV) fraction in patients with dilated cardiomyopathy (DCM). Background Patients with DCM with functional left ventricular remodeling have poorer prognoses. Noninvasive assessment of myocardial fibrosis using T1 mapping and the ECV fract...
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Hemorrhagic smallpox, caused by variola virus (VARV), was a rare but nearly 100% lethal human disease manifestation. Hemorrhagic smallpox is frequently characterized by secondary bacterial infection, coagulopathy, and myocardial and subendocardial hemorrhages. Previous experiments have demonstrated that intravenous (IV) cowpox virus (CPXV) exposure...
Article
Objectives This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States. Background Despite improvements in medical therapy and coronary revascularization, patients with previous CA...
Article
Background Obesity is a well-established risk factor for heart failure (HF). However, implications of pericardial fat on incident HF is unclear. Objectives This study sought to examine the association between pericardial fat volume (PFV) and newly diagnosed HF. Methods This study ascertained PFV using cardiac computed tomography in 6,785 particip...
Article
Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is ex...
Article
Background Few data exist on long-term outcome in patients undergoing combined coronary CT angiography (CTA) and myocardial CT perfusion imaging (CTP) as well as invasive coronary angiography (ICA) and single photon emission tomography (SPECT). Methods At 16 centers, 381 patients were followed for major adverse cardiac events (MACE) for the CORE32...
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First pass gadolinium-enhanced cardiovascular magnetic resonance (CMR) perfusion imaging allows fully quantitative pixel-wise myocardial blood flow (MBF) assessment, with proven diagnostic value for coronary artery disease. Segmental analysis requires manual segmentation of the myocardium. This work presents a fully automatic method of segmenting t...
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In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a confirmed diagnosis of Proteus syndrome at our institution from 10/2001 to 10/2019, 38 individuals (men, n = 23; average age = 24 years) underwent cardiothoracic imaging (routine c...
Preprint
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Background: Since December 2019, Coronavirus disease 2019 (COVID-19) has emerged as an international pandemic. COVID-19 patients with myocardial injury might need special attention. However, understanding on this aspect remains unclear. This study aimed to illustrate clinical characteristics and the prognostic value of myocardial injury to COVID-19...
Article
Objectives Cardiac magnetic resonance (CMR) first-pass perfusion is an established noninvasive diagnostic imaging modality for detecting myocardial ischemia. A CMR perfusion sequence provides a time series of 2D images for dynamic contrast enhancement of the heart. Accurate myocardial segmentation of the perfusion images is essential for quantitati...
Article
Aims Non-invasive assessment and risk stratification of coronary artery disease in patients with large body habitus is challenging. We aim to examine whether body mass index (BMI) modifies the prognostic value and diagnostic utility of stress cardiac magnetic resonance imaging (CMR) in a multicentre registry. Methods and results The SPINS Registry...
Article
Background Changes in myocardial microstructure that underlie post-myocardial infarction (MI) left ventricular (LV) remodelling may contribute to progressive deterioration in cardiac function and increased risk of adverse clinical events. Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) derived parameters provide in vivo measures of heli...
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The emergence of the SARS-CoV-2 virus has been associated with perplexing clinical sequelae and phenomena that often have no clear link to the underlying infection. There is a wide spectrum of symptoms associated with infection, from minimal respiratory complaints to severe multi-organ failure, often resulting in death. Individuals with malignancie...
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BACKGROUND Gadolinium-based contrast agents were not approved in the United States for detecting coronary artery disease (CAD) prior to the current studies. OBJECTIVES The purpose of this study was to determine the sensitivity and specificity of gadobutrol for detection of CAD by assessing myocardial perfusion and late gadolinium enhancement (LGE)...
Article
Background: Despite current recommendations for heart failure with preserved ejection fraction (HFpEF), few studies have demonstrated the ability of MRI to identify subtle functional differences between HFpEF with essential hypertension (HFpEF-HTN) patients and hypertension patients (HTN). Purpose: This study aimed to detect and evaluate HFpEF i...
Conference Paper
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Background: Aging is associated with structural and functional deteriorations of the heart. Mitochondrial dysfunction (MD) promotes oxidative stress, and is a common feature of aging, metabolic disorders and cardiomyopathy. The 18 kDa mitochondrial translocator protein (TSPO) is expressed in the outer mitochondrial membrane. Several TSPO-targeted P...
Article
Objectives The aim of this study was to investigate the prognostic value of stress cardiac magnetic resonance imaging (CMR) in patients with reduced left ventricular (LV) systolic function. Background Patients with ischemic cardiomyopathy are at risk from both myocardial ischemia and heart failure. Invasive testing is often used as the first-line...
Article
Background Stress cardiac magnetic resonance (CMR) provides accurate assessment of both myocardial infarction (MI) and ischemia. Objectives This study aimed to evaluate the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during assessment of coronary artery disease (CAD) by stress CMR, beyond cardiac function and...
Article
Purpose: To quantitatively evaluate the dynamic changes of extracellular volume (ECV) and native T1 in hypertensive swine over time using histologic findings as standard of reference. Materials and methods: Eighteen hypertensive (hypertension group) and six healthy (control group) swine aged 6-12 months were studied. Both groups underwent cardia...
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Left ventricular pseudoaneurysm is a potentially life-threatening complication of acute myocardial infarction. Timely diagnosis is crucial to improve the patient’s prognosis. We describe a multimodality diagnostic approach with emphasis on cardiac magnetic resonance imaging for a left ventricular pseudoaneurysm found surreptitiously in 72-year-old...
Article
Importance The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline–recommended categories has not been established. Objective To examine the utility of stress CMR imaging for risk reclassification in patients witho...
Article
Patients with bi-allelic loss-of-function mutations in the gene ANO5 most commonly present with muscular dystrophy. In some studies patients with ANO5-related dystrophy (ANO5-RD) had evidence of mild cardiac abnormalities; however, cardiac magnetic resonance imaging (MRI) has not been used for myocardial characterization. Ten patients with genetica...
Article
Objectives The aim of this study was to compare, using results from the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, the incremental cost-effectiveness of a stress cardiovascular magnetic resonance (CMR)–first strategy against 4 other clinical strategies for patients with stable symptoms suspicious for myocardial isc...
Article
Purpose: To develop an accelerated wideband cardiac perfusion pulse sequence and test whether it can produce diagnostically acceptable image quality and whether it can be used to reliably quantify myocardial blood flow (MBF) in patients with a cardiac implantable electronic device (CIED). Materials and methods: A fivefold-accelerated wideband pe...
Article
Purpose: To investigate the incidence, mechanism, and risk factors of aortic regurgitation (AR) in patients with hypertrophic cardiomyopathy (HCM) by using echocardiography and cardiac magnetic resonance (CMR). Methods: 105 HCM patients, 52 hypertension (HTN) patients and 50 healthy controls (HC) were retrospectively recruited. HCM patients were...
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Aims: Endothelin-1 (ET-1) is a potent vasoconstrictor peptide linked to vascular diseases through a common intronic gene enhancer [(rs9349379-G allele), chromosome 6 (PHACTR1/EDN1)]. We performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction (CMD) in patients wit...
Article
Arrhythmogenic ventricular cardiomyopathy (AVC) is a heritable heart muscle disorder characterized by fibrofatty infiltration of the myocardium. Intramyocardial fat deposition is considered arrhythmogenic and predisposes patients to life-threatening arrhythmias and sudden cardiac death. The classic subtype of AVC is characterized by fibrofatty repl...
Article
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Background: Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. Objectives: This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. Methods:...
Article
Objective: To better characterize adult myotubularin 1 (MTM1)-related myopathy carriers and recommend a phenotypic classification. Methods: This cohort study was performed at the NIH Clinical Center. Participants were required to carry a confirmed MTM1 mutation and were recruited via the Congenital Muscle Disease International Registry (n = 8),...
Article
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Background: Bone marrow stromal/stem cells (BMSCs) remain a promising potential therapy for ischemic cardiomyopathy. The primary objective of this study was to evaluate the safety and feasibility of direct intramyocardial injection of autologous BMSCs in patients undergoing transmyocardial revascularization (TMR) or coronary artery bypass graft su...
Article
Objectives: This study sought to quantify myocardial blood flow (MBF) and myocardial perfusion reserve (MPR) in dilated cardiomyopathy (DCM) and examine the relationship between myocardial perfusion and adverse left ventricular (LV) remodeling. Background: Although regarded as a nonischemic condition, DCM has been associated with microvascular d...
Article
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Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate contrast bolus timing, coronary veins can be depicted with excellent detail on CT. Knowledge of variant coronary venous anatomy can sometimes play a role in pre-procedural planning. An...
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After a reperfused myocardial infarction (MI), dynamic tissue changes occur (edema, inflammation, microvascular obstruction, hemorrhage, cardiomyocyte necrosis, and ultimately replacement by fibrosis). The extension and magnitude of these changes contribute to long-term prognosis after MI. Cardiac magnetic resonance (CMR) is the gold-standard techn...
Article
Importance It is uncertain whether unrecognized myocardial infarction (MI) is a risk factor for cerebral infarction. Objective To determine whether unrecognized MI detected by cardiac magnetic resonance imaging (MRI) is associated with cerebral infarction. Design, Setting, and Participants This is a cross-sectional study of ICELAND MI, a cohort s...
Article
In Reply We thank McCaw et al for the statistical insights on our analysis of the prognosis of unrecognized myocardial infarction (UMI).¹ In our study, the UMI curve approaches recognized MI (RMI) toward the end of the follow-up period for major adverse cardiac events (Figure, B¹) and clearly crosses RMI for all-cause mortality (Figure, A¹). Thus,...
Chapter
Cardiovascular magnetic resonance (CMR) is a well established imaging modality for assessing patients with coronary artery disease. CMR images can provide high quality information about myocardial anatomy, function, perfusion, and viability. These are all critical elements in the diagnosis and management of coronary artery disease. Perfusion and vi...
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Introduction Angina with no obstructive coronary artery disease (ANOCA) is a common syndrome with unmet clinical needs. Microvascular and vasospastic angina are relevant but may not be diagnosed without measuring coronary vascular function. The relationship between cardiovascular magnetic resonance (CMR)-derived myocardial blood flow (MBF) and refe...
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Background: Dark rim artifacts in first-pass cardiovascular magnetic resonance (CMR) perfusion images can mimic perfusion defects and affect diagnostic accuracy for coronary artery disease (CAD). We evaluated whether quantitative myocardial blood flow (MBF) can differentiate dark rim artifacts from true perfusion defects in CMR perfusion. Methods...
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Background Immune checkpoint inhibitors have revolutionized treatment and improved survival in many cancers. However, since immune-related adverse events (irAEs) are potentially fatal, early recognition and prompt treatment are warranted. One of the rarest but most dramatic irAE is myocarditis, which has significant morbidity and mortality if not r...
Article
Aims: Non-ischaemic cardiomyopathies (NICM) can cause heart failure and death. Cardiac magnetic resonance (CMR) detects myocardial scar/fibrosis associated with myocardial infarction (MI) and NICM with late gadolinium enhancement (LGE). The aim of this study was to determine the prevalence and prognosis of ischaemic and non-ischaemic myocardial fi...
Article
Importance Cardiac magnetic resonance (CMR) imaging can identify unrecognized myocardial infarction (UMI) in the general population. Unrecognized myocardial infarction by CMR portends poor prognosis in the short term but, to our knowledge, long-term outcomes are not known. Objective To determine the long-term outcomes of UMI by CMR compared with c...
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T1 mapping and extracellular volume (ECV) fraction are useful new magnetic resonance imaging (MRI) techniques to evaluate myocardial fibrosis; however, their prognostic value has not been well described. In this study, a systematic review and meta-analysis evaluating the prognostic value of these techniques is performed in patients with ischemic an...
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Late gadolinium enhancement (LGE) imaging is the currently the gold standard for in-vivo detection of myocardial infarction. However, gadolinium contrast administration is contraindicated in patients with renal insufficiency. We aim to evaluate the diagnostic sensitivity and specificity of this contrast-free MRI technique, native T1 mapping, in det...
Article
Although mortality after ST-segment elevation myocardial infarction (MI) is on the decline, the number of patients developing heart failure as a result of MI is on the rise. Apart from timely reperfusion by primary percutaneous coronary intervention, there is currently no established therapy for reducing MI size. Thus, new cardioprotective therapie...
Article
Aim: To evaluate the image quality and diagnostic agreement with a head-to-head comparison of late gadolinium enhancement (LGE) images acquired by the motion-corrected (MOCO) balanced steady-state free precession (bSSFP) phase sensitivity inversion recovery (PSIR) and conventional segmented fast low angle shot (FLASH) PSIR methods15,16in a patient...
Article
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Objectives: The authors developed a fully automated framework to quantify myocardial blood flow (MBF) from contrast-enhanced cardiac magnetic resonance (CMR) perfusion imaging and evaluated its diagnostic performance in patients. Background: Fully quantitative CMR perfusion pixel maps were previously validated with microsphere MBF measurements a...