Influence of Intramyocardial Adipose Tissue on the Accuracy of Endocardial Contact Mapping of the Chronic Myocardial Infarction Substrate

Samanta, Rahul; Kumar, Saurabh; Chik, W.; Qian, Pierre; Barry, Michael A.; Raisi, Sara Al; Bhaskaran, Abhishek; Farraha, Melad; Nadri, F.; Kizana, Eddy; Kovoor, Pramesh; Pouliopoulos, Jim

doi:10.1161/circep.116.004998

Cited by 15 publications

(8 citation statements)

References 36 publications

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“…No consensus has been reached about the potential endocrinological role of intramyocardial fat in heart disease nor its relation to conductive system disturbances, especially with sudden cardiac death [42, 51–53]. Recent studies have demonstrated that intramyocardial fat contributes to ventricular electrophysiological remodelling in patients with ischemic heart disease and influences endocardial scar mapping during electrophysiological exams of ventricular tachycardia [54, 55].…”

Section: Cardiac Visceral Adipose Tissuementioning

confidence: 99%

Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link?

Selthofer-Relatić¹,

Kibel²,

Delić-Brkljačić

et al. 2019

Journal of Obesity

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Obesity is a risk factor for cardiometabolic and vascular diseases like arterial hypertension, diabetes mellitus type 2, dyslipidaemia, and atherosclerosis. A special role in obesity-related syndromes is played by cardiac visceral obesity, which includes epicardial adipose tissue and intramyocardial fat, leading to cardiac steatosis; hypertensive heart disease; atherosclerosis of epicardial coronary artery disease; and ischemic cardiomyopathy, cardiac microcirculatory dysfunction, diabetic cardiomyopathy, and atrial fibrillation. Cardiac expression of these changes in any given patient is unique and multimodal, varying in clinical settings and level of expressed changes, with heart failure development depending on pathophysiological mechanisms with preserved, midrange, or reduced ejection fraction. Progressive heart failure with misbalanced metabolic and catabolic processes will change muscle, bone, and fat mass and function, with possible changes in the cardiac fat state from excessive accumulation to reduction and cardiac cachexia with a worse prognosis. The question we address is whether cardiac obesity or cardiac cachexia is to be more feared.

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Section: Cardiac Visceral Adipose Tissuementioning

confidence: 99%

Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link?

Selthofer-Relatić¹,

Kibel²,

Delić-Brkljačić

et al. 2019

Journal of Obesity

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“…Cardiac fat has been shown to carry important diagnostic information to characterize lipomatous metaplasia, 15 which has high prevalence and prognostic value in patients with myocardial infarction. 16,17 Moreover, water and fat partial volume is a known source of error in parametric mapping, 18 and previous works have explored simultaneous T 1 and fat imaging to reduce partial volume effects and quantify epicardial fat volumes. 19 Therefore, the extension of cardiac MRF to enable additional fat fraction (FF) quantification and partial volume correction is desired.…”

Section: Introductionmentioning

confidence: 99%

Water–fat Dixon cardiac magnetic resonance fingerprinting

Jaubert

Cruz

Bustin

et al. 2019

Magnetic Resonance in Med

101

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Purpose Cardiac magnetic resonance fingerprinting (cMRF) has been recently introduced to simultaneously provide T1, T2, and M0 maps. Here, we develop a 3‐point Dixon‐cMRF approach to enable simultaneous water specific T1, T2, and M0 mapping of the heart and fat fraction (FF) estimation in a single breath‐hold scan. Methods Dixon‐cMRF is achieved by combining cMRF with several innovations that were previously introduced for other applications, including a 3‐echo GRE acquisition with golden angle radial readout and a high‐dimensional low‐rank tensor constrained reconstruction to recover the highly undersampled time series images for each echo. Water–fat separation of the Dixon‐cMRF time series is performed to allow for water‐ and fat‐specific T1, T2, and M0 estimation, whereas FF estimation is extracted from the M0 maps. Dixon‐cMRF was evaluated in a standardized T1–T2 phantom, in a water–fat phantom, and in healthy subjects in comparison to current clinical standards: MOLLI, SASHA, T2‐GRASE, and 6‐point Dixon proton density FF (PDFF) mapping. Results Dixon‐cMRF water T1 and T2 maps showed good agreement with reference T1 and T2 mapping techniques (R2 > 0.99 and maximum normalized RMSE ~5%) in a standardized phantom. Good agreement was also observed between Dixon‐cMRF FF and reference PDFF (R2 > 0.99) and between Dixon‐cMRF water T1 and T2 and water selective T1 and T2 maps (R2 > 0.99) in a water–fat phantom. In vivo Dixon‐cMRF water T1 values were in good agreement with MOLLI and water T2 values were slightly underestimated when compared to T2‐GRASE. Average myocardium septal T1 values were 1129 ± 38 ms, 1026 ± 28 ms, and 1045 ± 32 ms for SASHA, MOLLI, and the proposed water Dixon‐cMRF. Average T2 values were 51.7 ± 2.2 ms and 42.8 ± 2.6 ms for T2‐GRASE and water Dixon‐cMRF, respectively. Dixon‐cMRF FF maps showed good agreement with in vivo PDFF measurements (R2 > 0.98) and average FF in the septum was measured at 1.3%. Conclusion The proposed Dixon‐cMRF allows to simultaneously quantify myocardial water T1, water T2, and FF in a single breath‐hold scan, enabling multi‐parametric T1, T2, and fat characterization. Moreover, reduced T1 and T2 quantification bias caused by water–fat partial volume was demonstrated in phantom experiments.

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“…Fat quantification is a useful biomarker to characterize infarction and fatty infiltration [55]; additionally, fatty infiltrations can introduce bias in myocardial tissue characterization [56]. Cardiac MRF has been extended to simultaneous T 1 , T 2 , and fat fraction quantification [57] at 1.5T.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Magnetic Resonance Fingerprinting: Technical Developments and Initial Clinical Validation

et al. 2019

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Purpose of Review Magnetic resonance imaging (MRI) has enabled non-invasive myocardial tissue characterization in a wide range of cardiovascular diseases by quantifying several tissue specific parameters such as T 1 , T 2 , and T2* relaxation times. Simultaneous assessment of these parameters has recently gained interest to potentially improve diagnostic accuracy and enable further understanding of the underlying disease. However, these quantitative maps are usually acquired sequentially and are not necessarily co-registered, making multi-parametric analysis challenging. Magnetic resonance fingerprinting (MRF) has been recently introduced to unify and streamline parametric mapping into a single simultaneous, multi-parametric, fully co-registered, and efficient scan. Feasibility of cardiac MRF has been demonstrated and initial clinical validation studies are ongoing. Provide an overview of the cardiac MRF framework, recent technical developments and initial undergoing clinical validation. Recent Findings Cardiac MRF has enabled the acquisition of co-registered T 1 and T 2 maps in a single, efficient scan. Initial results demonstrate feasibility of cardiac MRF in healthy subjects and small patient cohorts. Current in vivo results show a small bias and comparable precision in T 1 and T 2 with respect to conventional clinical parametric mapping approaches. This bias may be explained by several confounding factors such as magnetization transfer and field inhomogeneities, which are currently not included in the cardiac MRF model. Initial clinical validation for cardiac MRF has demonstrated good reproducibility in healthy subjects and heart transplant patients, reduced artifacts in inflammatory cardiomyopathy patients and good differentiation between hypertrophic cardiomyopathy and healthy controls. Summary Cardiac MRF has emerged as a novel technique for simultaneous, multi-parametric, and co-registered mapping of different tissue parameters. Initial efforts have focused on enabling T 1 , T 2 , and fat quantification; however this approach has the potential of enabling quantification of several other parameters (such as T 2 * , diffusion, perfusion, and flow) from a single scan. Initial results in healthy subjects and patients are promising, thus further clinical validation is now warranted.

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Influence of Intramyocardial Adipose Tissue on the Accuracy of Endocardial Contact Mapping of the Chronic Myocardial Infarction Substrate

Abstract: These novel findings enhance our understanding of the confounding influence of IMAT on endocardial scar mapping. Combined bipolar and unipolar voltage mapping using optimal thresholds may be useful for delineating IMAT dense regions of myocardium, in postinfarct cardiomyopathy.

Cited by 15 publications

References 36 publications

Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link?

Cardiac Obesity and Cardiac Cachexia: Is There a Pathophysiological Link?

Water–fat Dixon cardiac magnetic resonance fingerprinting

Cardiac Magnetic Resonance Fingerprinting: Technical Developments and Initial Clinical Validation

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