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Background:
Patients with systemic sclerosis (SSc) have high cardiovascular mortality even though there is no or little increase in prevalence of epicardial coronary stenosis. First-pass perfusion on cardiovascular magnetic resonance (CMR) have detected perfusion defects indicative of microvascular disease, but the quantitative extent of hypoperfu...
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Background:
Recent studies using stress-rest perfusion cardiovascular magnetic resonance (CMR) demonstrated a close correlation between myocardial ischemia and reduced fractional flow reserve (FFR). However, its diagnostic concordance may be reduced in patients with multivessel disease. We sought to evaluate the concordance of adenosine stress-res...
Background
The relationship between mean arterial pressure (MAP) and coronary blood flow is well described. There is autoregulation within a MAP range of 60 to 140 mmHg providing near constant coronary blood flow. Outside these limits flow becomes pressure-dependent. So far, response of myocardial oxygenation to changes in pressure and flow has be...
Background:
In patients with reperfused ST-elevation myocardial infarction (STEMI) both invasive and non-invasive assessments of microvascular dysfunction, the index of microcirculatory resistance (IMR), and microvascular obstruction (MVO) by cardiovascular magnetic resonance (CMR), independently predict poor long-term outcomes.
Aims:
The aims o...
Citations
... Adenosine serves as a precursor in the biosynthesis of essential compounds like ATP and AMP and plays a crucial role in modulating various physiological processes. Its functions include promoting vasodilatation to prevent thrombosis, accelerating vasoconstriction in the hepatic vasculature to promote the breakdown of hepatic glycogen, and other relevant activities (Gyllenhammar et al., 2018). ...
To obtain nutritious, healthy, and flavor-enriched sour meat products, the effects of different frying methods (microwave, air-frying, and traditional frying) on the flavor quality of low-salt sour meat were evaluated using metabolomics and other flavor analysis techniques. The pH value of the sour meat rose dramatically, while the TBARS value dropped significantly after frying. E-nose and E-tongue results showed that air-frying could reduce acidity and improve umami. The comprehensive analysis of all samples revealed the identification of 107 volatile flavor compounds, including 10 unique aroma compounds that were specifically detected in the AF group. Additionally, the air frying process notably increased the free amino acid and nucleotide concentrations in sour meat by 53.58% and 159.29%, respectively, while causing a significant reduction in both fatty acid and lactic
acid content by 22.84% and 49.29%, respectively. All three frying methods altered the flavor of the samples, but air frying performed better in terms of flavor and texture.
... 13,14 Additionally, with the use of a pharmacological stress agent, myocardial perfusion can be measured to detect epicardial coronary artery disease as well as microvascular dysfunction. 15,16 It is, therefore, the ideal technique to investigate the incremental effect of systemic inflammation on myocardial involvement in SSc-PAH compared with patients with isolated PAH, to reach a better understanding of the mechanism leading to a worse outcome in patients with SSc-PAH. ...
... Compared with healthy controls, patients with SSc did have significantly decreased global myocardial perfusion. 16 The sensitivity to detect subtle differences in the degree of microvascular dysfunction may be limited by the semiquantitative approach used in our study, particularly when considering the relatively small sample size. Another possible explanation could be that patients with IPAH also show a degree of coronary microvascular dysfunction, as reported previously. ...
Aims
Systemic sclerosis (SSc) is characterized by vasculopathy, inflammation, and fibrosis, and carries one of the worst prognoses if patients also develop pulmonary arterial hypertension (PAH). Although PAH is a known prognosticator, patients with SSc–PAH demonstrate disproportionately high mortality, presumably due to cardiac involvement. In this cross-sectional study, the relationship between cardiac involvement revealed by cardiovascular magnetic resonance (CMR) and systemic microvascular disease severity measured with nailfold capillaromicroscopy (NCM) in patients with SSc–PAH is evaluated and compared with patients with idiopathic PAH (IPAH).
Methods and results
Patients with SSc–PAH and IPAH underwent CMR, echocardiography, and NCM with post-occlusive reactivity hyperaemia (PORH) testing on the same day. CMR imaging included T2 (oedema), native, and post-contrast T1 mapping to measure the extracellular volume fraction (ECV, fibrosis) and adenosine-stress-perfusion imaging measuring the relative myocardial upslope (microvascular coronary perfusion). Measures of peripheral microvascular function were related to CMR indices of oedema, fibrosis, and myocardial perfusion. SSc-PAH patients (n = 20) had higher T2 values and a trend towards a higher ECV, compared with IPAH patients (n = 5), and a lower nailfold capillary density (NCD) and reduced capillary recruitment after PORH. NCD correlated with ECV and T2 (r = −0.443 and −0.464, respectively, P < 0.05 for both) and with markers of diastolic dysfunction on echocardiography. PORH testing, but not NCD, correlated with the relative myocardial upslope (r = 0.421, P < 0.05).
Conclusion
SSc-PAH patients showed higher markers of cardiac fibrosis and inflammation, compared with IPAH patients. These markers correlated well with peripheral microvascular dysfunction, suggesting that SSc-driven inflammation and vasculopathy concurrently affect peripheral microcirculation and the heart. This may contribute to the disproportionate high mortality in SSc–PAH.
... Therefore, a total of 67 independent populations were included. Among the 47 studies, 22 were from Japan [19-21, 23-37, 42, 44, 45, 47], eight from the United States [7,14,22,40,41,48,51,55], five from Sweden [12,16,17,53,54], three from Germany and Sweden [11,15,46], two from Finland [38,39], and one each from Australia [18], France [43], Italy [9], Norway [13], Turkey [10], the United Kingdom [49], Switzerland [7], and the Netherlands [50]. Year of publication ranged from 1992 to 2022. ...
Background
Phase-contrast cine cardiovascular magnetic resonance (CMR) of the coronary sinus has emerged as a non-invasive method for measuring coronary sinus blood flow and coronary flow reserve (CFR). However, its clinical utility has not yet been established. Here we performed a meta-analysis to clarify the clinical value of CMR-derived CFR in various cardiovascular diseases.
Methods
An electronic database search was performed of PubMed, Web of Science Core Collection, Cochrane Advanced Search, and EMBASE. We compared the CMR-derived CFR of various cardiovascular diseases (stable coronary artery disease [CAD], hypertrophic cardiomyopathy [HCM], dilated cardiomyopathy [DCM]) and control subjects. We assessed the prognostic value of CMR-derived CFR for predicting major adverse cardiac events (MACE) in patients with stable CAD.
Results
A total of 47 eligible studies were identified. The pooled CFR from our meta-analysis was 3.48 (95% confidence interval [CI], 2.98–3.98) in control subjects, 2.50 (95% CI, 2.38–2.61) in stable CAD, 2.01 (95% CI, 1.70–2.32) in cardiomyopathies (HCM and DCM). The meta-analysis showed that CFR was significantly reduced in stable CAD (mean difference [MD] = −1.48; 95% CI, −1.78 to −1.17; p < 0.001; I ² = 0%; p for heterogeneity = 0.33), HCM (MD = −1.20; 95% CI, −1.63 to −0.77; p < 0.001; I ² = 0%; p for heterogeneity = 0.49), and DCM (MD = −1.53; 95% CI, −1.93 to −1.13; p < 0.001; I ² = 0%; p for heterogeneity = 0.45). CMR-derived CFR was an independent predictor of MACE for patients with stable CAD (hazard ratio = 0.52 per unit increase; 95% CI, 0.37–0.73; p < 0.001; I ² = 84%, p for heterogeneity < 0.001).
Conclusions
CMR-derived CFR was significantly decreased in cardiovascular diseases, and a decreased CFR was associated with a higher occurrence of MACE in patients with stable CAD. These results suggest that CMR-derived CFR has potential for the pathological evaluation of stable CAD, cardiomyopathy, and risk stratification in CAD.
... T1 mapping with extracellular volume (ECV) quantification is an established technique for detection of diffuse fibrosis, and multiple studies report increased ECV in SSc (8,9). Myocardial perfusion abnormalities and decreased myocardial perfusion reserve (MPR) have also been documented in SSc (10,11). ...
... Targeted vasodilator and/or ACEI treatment and change in CMR measures. Although the means remained within normal limits, patients with SSc receiving targeted vasodilator treatment had lower LVESV/BSA compared to those with no vasodilator treatment at visit 1 (mean [SD] 25 [4] vs. 32 [11], P = 0.021) (Figure 3, Supplementary Table 2). A non-clinically significant decrease in LVSV/BSA between visit 1 and visit 2 in patients receiving targeted vasodilator treatment or commencing new vasodilator therapy during follow-up was noted (mean [SD] 47 [6] vs. 43 [7], P = 0.013) (Supplementary Table 3). ...
Objective:
Subclinical systemic sclerosis (SSc) primary heart involvement is commonly described. Whether these findings progress over time is not clear. The study aimed to investigate cardiovascular magnetic resonance (CMR) interval change of subclinical SSc primary heart involvement.
Methods:
Patients with SSc with no cardiovascular disease underwent two CMR scans that included T1 mapping and quantitative stress perfusion. The CMR change (mean difference) and association between CMR measures and clinical phenotype were assessed. The study had a prospective design.
Results:
Thirty-one patients with SSc participated, with a median (interquartile range) follow-up of 33 (17-37) months (10 [32%] in the diffuse subset, 16 [52%] with interstitial lung disease [ILD], and 11 [29%] who were Scl-70+). Four of thirty-one patients had focal late gadolinium enhancement (LGE) at visit 1; one of four had an increase in LGE scar mass between visits. Two patients showed new focal LGE at visit 2. No change in other CMR indices was noted. The three patients with SSc with increased or new LGE at visit 2 had diffuse cutaneous SSc with ILD, and two were Scl-70+. A reduction in forced vital capacity and total lung capacity was associated with a reduction in left ventricular ejection fraction (ρ = 0.413, P = 0.021; ρ = 0.335, P = 0.07) and myocardial perfusion reserve (MPR) (ρ = 0.543, P = 0.007; ρ = 0.627, P = 0.002). An increase in the N-terminal pro-brain natriuretic peptide level was associated with a reduction in MPR (ρ = -0.448, P = 0.042). Patients on disease-modifying antirheumatic drugs (DMARDs) had an increase in native T1 (mean [SD] 1208 [65] vs. 1265 [56] milliseconds, P = 0.008). No other clinically meaningful CMR change in patients receiving DMARDs or vasodilators was noted.
Conclusion:
Serial CMR detects interval subclinical SSc primary heart involvement progression; however, this study suggests abnormalities remain largely stable with follow-up.
... In some autopsy studies, myocardial brosis was found to be very common in SSc patients, with an incidence of up to 81% [8,15]. Focal injury of the myocardium, necrosis of the myocardial contractile zone and brous scarring have all been reported but unrelated to the corresponding area supplied by the coronary artery [8,16,17]. ...
Background: Myocardial involvement (MI) is the primary cause of death in patients with systemic sclerosis (SSc). We analyzed patients with SSc and MI to identify any associations between this complication and their characteristics.
Method: We retrospectively collated data from SSc patients with MI admitted to Peking Union Medical College Hospital between January 2012 and May 2021. SSc patients without MI were randomly selected as controls after matching age and gender at a ratio of 1:3.
Results: In total, 21 SSc patients (17 females) with MI were enrolled. The mean age at SSc onset was 44.8±15.1 years. Compared with controls, myositis (42.3% vs. 15.4%, P=0.004) were more common in patients with MI; elevations of creatine kinase (CK) (30.8% vs. 6.9%, P=0.006). Of the 7 patients without cardiovascular symptoms, 5 showed elevations in cardiac troponin-I (cTnI), 6 showed elevations of N-terminal brain natriuretic peptide (NT-proBNP). Thirteen patients were followed up for median period of 15.5 months and four patients developed newly occurring left ventricular ejection fraction (LVEF)< 50%.
Conclusion: Almost 50% of SSc patients with MI were subclinical. Regular monitoring of CTnI, NT-proBNP and echocardiography is helpful for the diagnosis of MI during the early stages. Its progress is rapid and prognosis is poor.
... Gyllenhammar et al. [165] 2018 ...
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by heterogeneous changes involving numerous organs and systems. The currently available data indicate that muscle injury (both smooth and striated muscles) is widespread and leads to significant morbidity, either directly or indirectly. From the consequences of smooth muscle involvement in the tunica media of blood vessels or at the level of the digestive tract, to skeletal myopathy (which may be interpreted strictly in the context of SSc, or as an overlap with idiopathic inflammatory myopathies), muscular injury in scleroderma translates to a number of notable clinical manifestations. Heart involvement in SSc is heterogenous depending on the definition used in the various studies. The majority of SSc patients experience a silent form of cardiac disease. The present review summarizes certain important features of myocardial, as well as smooth and skeletal muscle involvement in SSc. Further research is needed to fully describe and understand the pathogenic pathways and the implications of muscle involvement in scleroderma.
... Outcome was defined as a composite of death or lung transplantation with end of follow-up 2019-09-01. CMR images and clinical data from 20 sex and age-matched healthy volunteers included in previous studies from our group were analyzed for definition of cut-off from normal values [10,11]. Controls had no reported diseases or medications and had normal ECG and blood pressure. ...
To investigate if left and right atrioventricular plane displacement (AVPD) or regional contributions to SV are prognostic for outcome in patients with pulmonary arterial hypertension (PAH). Seventy-one patients with PAH and 20 sex- and age-matched healthy controls underwent CMR. Myocardial borders and RV insertion points were defined at end diastole and end systole in cine short-axis stacks to compute biventricular volumes, lateral (SV lat% ) and septal (SV sept% ) contribution to stroke volume. Eight atrioventricular points were defined at end diastole and end systole in 2-, 3- and 4-chamber cine long-axis views for computation of AVPD and longitudinal contribution to stroke volume (SV long% ). Cut-off values for survival analysis were defined as two standard deviations above or below the mean of the controls. Outcome was defined as death or lung transplantation. Median follow-up time was 3.6 [IQR 3.7] years. Patients were 57 ± 19 years (65% women) and controls 58 ± 15 years (70% women). Biventricular AVPD, SV long% and ejection fraction (EF) were lower and SV lat% was higher, while SV sept% was lower in PAH compared with controls. In PAH, transplantation-free survival was lower below cut-off for LV-AVPD (hazard ratio [HR] = 2.1, 95%CI 1.2–3.9, p = 0.02) and RV-AVPD (HR = 9.8, 95%CI 4.6–21.1, p = 0.005). In Cox regression analysis, lower LV-AVPD and RV-AVPD inferred lower transplantation-free survival (LV: HR = 1.16, p = 0.007; RV: HR = 1.11, p = 0.01; per mm decrease). LV-SV long% , RV-SV long% , LV-SV lat% , RV-SV lat% , SV sept% and LV- and RVEF did not affect outcome. Low left and right AVPD were associated with outcome in PAH, but regional contributions to stroke volume and EF were not.
... Similar to stress echocardiography, stress CMR may be more sensitive than rest CMR in detecting subclinical disease. Asymptomatic patients with SSc show evidence of significantly decreased myocardial perfusion on adenosine stress CMR when compared to controls, even when there is no difference on rest CMR (65). An additional study found that, of those patients with stress CMR perfusion defects, none had correlating stenotic lesions on coronary CT, suggesting that microvascular disease, rather than epicardial CAD, may be the primary driver of hypoperfusion in SSc (66). ...
Systemic sclerosis (SSc) is a complex connective tissue disease with multiple clinical and subclinical cardiac manifestations. SSc can affect most structural components of the heart, including the pericardium, myocardium, valves, and conduction system through a damaging cycle of inflammation, ischemia, and fibrosis. While cardiac involvement is the second leading SSc-related cause of death, it is frequently clinically silent in early disease and often missed with routine screening. To facilitate identification of cardiac disease in this susceptible population, we present here a review of cardiac imaging modalities and potential uses in the SSc patient population. We describe well-characterized techniques including electrocardiography and 2D echocardiography with Doppler, but also discuss more advanced imaging approaches, such as speckle-tracking echocardiography, cardiovascular magnetic resonance imaging (CMR), and stress imaging, among others. We also suggest an algorithm for the appropriate application of these modalities in the workup and management of patients with SSc. Finally, we discuss future opportunities for cardiac imaging in SSc research to achieve early detection and to optimize treatment.
... Independent datasets with 43 healthy controls (25 females, 61 ± 12 years old) and 130 patients with chronic HF (28 females, 60 ± 13 years old) [12,13,14,15] were used to compare their MA and TA diameters. ...
Our recent work on mitral and tricuspid valve tracking in cardiovascular magnetic resonance (CMR) imaging to obtain accurate evaluations of longitudinal myocardial valve motion (both relaxation and contraction) has enabled an automated diastolic function assessment (e') with CMR. Its time-resolved capability allows a further evaluation of the valve dynamics by providing valve dimension measurements, which are essential to define the etiologies and mechanisms of valve regurgitation. In this paper, we extended the framework to automatically measure mitral annular (MA) and tricuspid annular (TA) dimensions in CMR long-axis cines with a residual neural network backbone. The framework is able to measure MA and TA diameters with an overall excellent accuracy (mean ICC=0.92), on par with an evaluated inter-observer variability (mean ICC=0.92), and to distinguish valvular dimensions between healthy controls and patients with chronic heart failure (p<0.001). Dimension measurements may benefit patients requiring annular sizing and planning of valvular interventions.
... Studies in different disease settings, including IIM and non-IIM (such as SLE, RA, and SSc), revealed early myocardial perfusion defects coexisting with normal coronary arteries, significantly lower global strain, and LGE-positive states evaluated by CMR [16,31,[35][36][37]. Being similar to such studies, the current research revealed that, in contrast to normal controls, both subgroups of IIM and non-IIM patients demonstrated impaired LV global deformation (involving the GLPS, PSSR-L, and PDSR-L) and lower myocardial perfusion (manifesting as reduced global upslope, MaxSI, and increased TTM), as well as presence of LGE. ...
The aim of this study was to evaluate left ventricular (LV) myocardial involvement in connective tissue disease (CTD) patients using multiparemetric imaging derived from cardiovascular magnetic resonance (CMR). CMR was performed on 146 CTD patients (comprising of 74 with idiopathic inflammatory myopathy (IIM) and 72 with non-IIM) and 72 healthy controls and included measures of LV global strains [including peak strain (PS), peak systolic (PSSR) and diastolic strain rate (PDSR)], myocardial perfusion [including upslope, max signal intensity (MaxSI), and time to maximum signal intensity (TTM)], and late gadolinium enhancement (LGE) parameters. Univariable and multivariable linear regression analyses were performed to determine the association between LV deformation and microvascular perfusion, as well as LGE. Our results indicated that CTD patients had decreased global longitudinal PS (GLPS), PSSR, PDSR, and myocardial perfusion (all p < 0.017) compared with normal controls. Non-IIM patients exhibited lower LV global strain and longer TTM than IIM patients. The presence of LGE was independently associated with global radial PS (GRPS: β = − 0.165, p = 0.011) and global circumferential PS (GCPS: β = − 0.122, p = 0.022). TTM was independently correlated with GLPS (β = − 0.156, p = 0.027). GLPS was the best indicator for differentiating CTD patients from normal controls (area under curve of 0.78). This study indicated that CTD patients showed impaired LV global myocardial deformation and microvascular perfusion, and presence of LGE. Cardiac involvement might be more severe in non-IIM patients than in IIM patients. Impaired microvascular perfusion and the presence of LGE were independently associated with LV global deformation.
