Search

Aims: No data is available about the significance of cardiovascular magnetic resonance (CMR) derived vascular distensibility (VD) and vessel wall ratio (VWR) for risk stratification in patients with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to investigate the effects of T2DM on VD and VWR using CMR in both central and peripheral territories. Methods: Thirty-one T2DM-patients and nine controls underwent CMR. Angulation of the aorta, the common carotid, and the coronary arteries was performed to obtain cross-sectional vessel areas. Results: In T2DM the Carotid-VWR and the Aortic-VWR correlated significantly. Mean values of Carotid-VWR and Aortic-VWR were significantly higher in T2DM than in controls. Coronary-VD was significantly lower in T2DM than in controls. No significant difference in Carotid-VD or Aortic-VD in T2DM vs. controls, respectively, could be observed. In a subgroup of thirteen T2DM patients with coronary artery disease (CAD), Coronary-VD was significantly lower and Aortic-VWR was significantly higher compared to T2DM patients without CAD. Conclusion: CMR allows a simultaneous evaluation of the structure and function of three important vascular territories to detect vascular remodeling in T2DM.

AimsThe main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is associated with many cardiovascular (CV) risk factors, especially since HFpEF is linked to a high risk for both mortality and recurrent heart failure (HF) hospitalizations. Therefore, there is a need for new tools to identify patients with a high risk profile early. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score is a promising tool to identify cardiac changes early.Methods and resultsHeart failure patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis the asymptomatic control group (n = 19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n = 12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnormalities (n = 7) as well as patients with HFpEF (n = 19). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG). Assessing the MyoHealth score at rest revealed preserved regional strain in 85 ± 9% of LV segments in controls, 73 ± 11% in at Risk subjects and 73 ± 8% in HFpEF patients. During stress the MyoHealth score was 84 ± 7% in controls, 83 ± 7 in at risk subjects and 74 ± 11 in HFpEF patients.ConclusionIn summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future.Clinical trial registration[https://drks.de/search/de/trial/DRKS00015615], identifier [DRKS00015615].

Aims Our study aimed to investigate the cardiac involvement with sensitive tissue characterization in non‐hospitalized children with coronavirus disease 2019 (COVID‐19) infection using cardiovascular magnetic resonance (CMR) imaging. Methods and results We prospectively enrolled children who recovered from mildly symptomatic COVID‐19 infection between November 2020 and January 2021. Patients underwent CMR at 1.5 T (Achieva, Philips Healthcare, Best, the Netherlands) including cine images, native T1 and T2 mapping. Healthy children and paediatric patients with biopsy‐proven myocarditis served as control groups. We performed CMR in 18 children with a median (25th–75th percentile) age of 12 (10–15) years, 38 (24–47) days after positive PCR test, and compared them with 7 healthy controls [15 (10–19) years] and 9 patients with myocarditis [10 (4–16) years]. The COVID‐19 patients reported no cardiac symptoms. None of the COVID‐19 patients showed CMR findings consistent with a myocarditis. Three patients (17%) from the COVID‐19 cohort presented with minimal pericardial effusion. CMR parameters of COVID‐19 patients, including volumetric and strain values as well as T1 and T2 times, were not significantly different from healthy controls, but from myocarditis patients. These had significantly reduced left ventricular (LV) ejection fraction (P = 0.035), LV global longitudinal strain, and left atrial strain values as well as elevated native T1 values compared with COVID‐19 patients (P

Einleitung: Der Goldstandard zur Vitalitätsbeurteilung von Herzmuskelgewebe nach ischämischer Schädigung ist die Delayed-Enhancement-MRT. Hierfür zugelassene Kontrastmittel sind Magnevist® und Omniscan®. Aufgrund des NSF- Risikos ist die Verwendung dieser Kontrastmittel in niereninsuffizienten Patienten kontraindiziert. Daten zur Delayed-Enhancement-MRT mit den Niereninsuffizienz-kompatiblen Kontrastmitteln Gadovist® und Dotarem® existieren bisher nach unserem besten Wissen nicht. Die ISI-2009LGE-Studie vergleicht in zwei getrennten Armen Gadovist® mit Magnevist® und Gadovist® mit Dotarem® in relaxivitätsadaptierter Dosis für die Darstellung von Myokardinfarkt-Narben mittels Delayed-Enhancement-MRT. Methoden: Alle Untersuchungen wurden an einem Siemens Magnetom Avanto MRT mit einer Feldstärke von 1,5 Tesla durchgeführt. Im ersten Arm erhielten 21 Probanden in randomisierter Reihenfolge Gadovist® und Magnevist®, im zweiten Arm 19 Probanden Gadovist® und Dotarem®. Zwischen beiden Untersuchungen lagen zwei bis 30 Tage. Als Messgrößen wurden das relative Infarktvolumen, die SNRs und die T1-Zeiten von gesundem Myokard, infarziertem Myokard und Ventrikellumen, sowie die CNRs von infarziertem Myokard zu gesundem Myokard und Ventrikellumen erfasst. Die Infarktgrößen- und SNR-Messungen wurden von zwei unabhängigen Befundern aus IR-TurboFLASH-Bildgebungen 15 Minuten nach Kontrastmittelgabe bestimmt. Die T1-Zeiten wurden über einen Zeitraum von 35 Minuten mittels TI- Scouts bestimmt. Ergebnisse: Im ersten Arm lag das mittlere relative Infarktvolumen bei den Messungen mit Gadovist® bei 16,1 % [9,8; 22,5] und für Magnevist® ebenfalls bei 16,1 % [9,7; 22,5], die mittlere Differenz von 0,1 % [-1,1; 1,2] war statistisch nicht signifikant (p-Wert 0,934). Die SNRs von infarziertem Myokard lagen für Gadovist® bei 46,5 [34,6; 58,4] und für Magnevist® bei 47,4 [35,5; 58,3], die mittlere Differenz von -1,0 [-14,5; 12,6] war statistisch nicht signifikant (p-Wert 0,883). Die SNR des Lumens war nach Gabe von Gadovist® etwas niedriger als nach Gabe von Magnevist® (40,2 [28,9; 51,6] vs. 46,6 [35,3; 58,0]), der Unterschied von -6,4 [-21,7; 8,9] jedoch statistisch nicht signifikant (p-Wert 0,387). Die CNRs von infarziertem zu gesundem Myokard unterschieden sich statistisch nicht signifikant (40,0 [30,3; 49,7] vs. 40,6 [30,9; 50,3], mittlere Differenz -0,6 [-11,1; 9,6], p-Wert 0,904). Die CNRs von infarziertem Myokard zu Ventrikellumen waren bei Messung mit Gadovist® signifikant höher (6,2 vs. 0,8, mittlere Differenz 5,4 [1,3; 9,6], p-Wert 0,013). Die T1-Relaxationszeiten im Lumen waren unter Gadovist® ab 6-9 Minuten nach Kontrastmittelgabe signifikant höher im Vergleich zu Magnevist®. Der Unterschied zwischen Infarkt und Lumen war 9-12 und 12-15 Minunten nach Kontrastmittelgabe signifikant größer für Gadovist® im Vergleich zu Magnevist® (-20 +- 35 vs. 0 +- 35, p=0,026 und -25 +- 45 vs. -10 +- 50, p=0,028). Auch im zweiten Arm waren die mittleren relativen Infarktvolumina mit 15,9 % [10,5; 21,3] für Gadovist® und ebenfalls 15,9 % [10,5; 21,3] für Dotarem® bei einer mittleren Differenz von 0,0 % [-1,3; 1,4] statistisch nicht signifikant verschieden (p-Wert 0,975). Die SNRs von infarziertem Myokard unterschieden sich nicht signifikant (48,4 [3,0; 61,9] vs. 50,1 [36,7; 63,5], mittlere Differenz -1,7 [-8,7; 5,3], p-Wert 0,620), ebenso wie die CNRs von infarziertem zu gesundem Myokard (44,1 [31,2; 57,0] vs. 45,2 [32,4; 58,1], mittlere Differenz -1,2 [-7,6; 5,3], p-Wert 0,718). Die SNRs von Ventrikellumen sowie die CNR von infarziertem Myokard zu Ventrikellumen unterschieden sich statistisch signifikant (SNR Lumen: 35,7 [26,3; 45,1] vs. 43,3 [34,0; 53,7], mittlere Differenz -7,7 [-14,5; -0,8], p-Wert 0,025. CNR Infarkt zu Lumen: 12,7 [2,6; 22,8] vs. 6,8 [-3,4; 16,9], mittlere Differenz 6,0 [1,5; 10,5], p-Wert 0,009). Die T1-Relaxationszeiten nach Gabe von Gadovist® und Dotarem® unterschieden sich zu keiner Zeit statistisch oder klinisch signifikant. Beurteilung: IR-GRE Delayed- Enhancement-Bildgebung mit 0,15 mmol/kg Gadovist® in Patienten mit chronischem Myokardinfarkt führt 15 Minuten nach Kontrastmittelgabe bei etwas besserem Bildkontrast zwischen Infarkt und Lumen zu vergleichbaren Infarktgrößen- Messwerten gegenüber 0,2 mmol/kg Magnevist® und 0,22 mmol/kg Dotarem®. Der Verlauf der T1-Zeiten über 35 Minuten lässt vermuten, dass 0,15 mmol/kg Gadovist® auch zu anderen Aufnahmezeitpunkten und in anderen T1-gewichteten Sequenzen in der Infarktdarstellung 0,2 mmol/kg Magnevist® und 0,22 mmol/kg Dotarem® nicht unterlegen ist. Gegenüber Magnevist® besteht der Vorteil der früheren Abgrenzbarkeit des Infarktes gegenüber dem Lumen., Introduction: In the mid 1980´s, gadolinium based intravenous contrast agents were introduced into clinical cardiac MRI. They were found to stick to damaged tissue for a prolonged time, while being quickly washed out of healthy tissue. This effect is known as “delayed enhancement” and opened up new possibilities for the assessment of tissue viability through MRI. In the heart, areas of delayed enhancement closely correlated to histopathological areas of infarct- and myocarditis-related scarring. Over the last decade, delayed enhancement MRI evolved as one of the most sensitive and specific diagnostic tests in the differential diagnosis of acute and chronic myocardial infarction and myocarditis. The most widely used gadolinium based contrast agents for delayed enhancement MRI so far are the linear gadolinium chelates gadopentetate (Magnevist®, Bayer Schering Pharma) and gadodiamide (Omniscan®, GE Healthcare). Recently though, linear gadolinium chelates have been linked to the development of a disabling and possibly lethal disease called nephrogenic systemic fibrosis in patients with end-stage renal failure, leading to their contraindication in this patient group. The macrocyclic gadolinium chelates gadobutrol (Gadovist®, Bayer Schering Pharma) and gadoterate (Dotarem®, Guerbet) offer a more favorable risk profile but are not yet approved for Delayed-Enhancement-MRI due to lack of clinical data. This study seeks to provide a thorough comparison of Gadovist® with Magnevist® and Gadovist® for the assessment of cardiac viability in chronic myocardial infarction via Delayed-Enhancement-MRI. Methods: 40 patients were recruited from the clinical routine of the Charité Universitätsmedizin Berlin and divided into two groups for an intraindividual comparison of 0,15 mmol/kg Gadovist® and 0,2 mmol/kg Magnevist® in the first group and 0,15 mmol/kg Gadovist® and 0,22 mmol/kg Dotarem® in the second group. Contrast agent doses were adjusted for differences in T1-relaxivities in human plasma. All exams were performed on a Siemens Magnetom Avanto MRI with a field strength of 1.5 Tesla. Infarct size, SNR and CNR were measured in a IR-TurboFLASH-Sequence 15 minutes after contrast agent application by two independent, blinded readers and statistically evaluated via mixed linear models. T1-values were calculated via nonlinear regression from TI-scouts taken on irregluar time points over 35 minutes following the application. Results: Infarct size measurements did not differ significantly between contrast agents (first group: 16.1 % [9.8; 22.5] vs. 16.1 % [9.7; 22.5], mean difference 0.1 % [-1.1; 1.2], p-value 0.934. Second group: 15.9 % [10.5; 21,3] vs. 15,9 % [10.5; 21.3], mean difference 0,0 % [-1.3; 1.4], p-value 0.975). SNRs of infarcted myocardium did not differ significantly either in both groups (first group: 46.5 [34.6; 58.4] vs. 47.4 [35.5; 58.3], mean difference -1.0 [-14.5; 12.6], p-value 0.883. Second group: 48.4 [3.0; 61.9] vs. 50.1 [36.7; 63.5], mean difference -1.7 [-8.7; 5.3], p-value 0.620), as did CNRs of infarcted to remote myocardium (first group: 40.0 [30.3; 49.7] vs. 40.6 [30.9; 50.3], mean difference -0.6 [-11.1; 9.6], p-value 0.904. Second group: 44.1 [31.2; 57.0] vs. 45.2 [32.4; 58.1], mean difference -1.2 [-7.6; 5.3], p-value 0.718). SNRs of ventricular blood showed a trend towards lower values for Gadovist® in the first group and significantly lower values in the second group (first group: 40.2 [28.9; 51.6] vs. 46.6 [35.3; 58.0], mean difference -6.4 [-21.7; 8.9], p-value 0.387. Second group: 35.7 [26.3; 45.1] vs. 43.3 [34.0; 53.7], mean difference -7.7 [-14.5; -0.8], p-value 0.025). The CNRs of infarcted myocardium to ventricular blood were significantly higher for Gadovist® in both groups (first group: 6.2 vs. 0.8, mean difference 5.4 [1.3; 9.6], p-value 0.013. Second group: 12.7 [2.6; 22.8] vs. 6.8 [-3.4; 16.9], mean difference 6.0 [1.5; 10.5], p-value 0.009). T1 relaxation times of infarcted myocardium and remote myocardium showed similar time courses for all contrast agents over 35 minutes following application. Gadovist® led to significantly higher T1 relaxation times of ventricular blood from 6-9 minutes after application onwards and a significantly higher difference between the T1 relaxation times of ventricular blood and infarcted myocardium 9-12 and 12-15 minutes after application, compared to Magnevist®. Gadovist® and Dotarem® did not differ significantly in respect to T1 relaxation times of ventricular blood. Conclusion: 0,15 mmol/kg Gadovist® is comparable to and might yield a better CNR of infarct to blood 15 minutes after application than 0,2 mmol/kg Magnevist® and 0,22 mmol/kg Dotarem® in the assessment of cardiac viability via Delayed-Enhancement-MRI in patients with chronic myocardial infarction. Later image acquisition offers better infarct to blood T1-contrast.