Free-running 5D whole-heart coronary MR angiography (MRA) is gaining in popularity because it reduces scanning complexity by removing the need for specific slice orientations, respiratory gating, or cardiac triggering. At 3T, a gradient echo (GRE) sequence is preferred in combination with contrast injection. However, neither the injection scheme of the gadolinium (Gd) contrast medium, the choice of the RF excitation angle, nor the dedicated image reconstruction parameters have been established for 3T GRE free-running 5D whole-heart coronary MRA. In this study, a Gd injection scheme, RF excitation angles of lipid-insensitive binominal off-resonance RF excitation (LIBRE) pulse for valid fat suppression and continuous data acquisition, and compressed-sensing reconstruction regularization parameters were optimized for contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence at 3T. Using this optimized protocol, contrast-enhanced free-running 5D whole-heart coronary MRA using a GRE sequence is feasible with good image quality at 3T.
Background We aimed to investigate the presence and severity of coronary microvascular dysfunction (CMD) in inflammatory bowel disease (IBD) including Crohn disease and ulcerative colitis and to elucidate the influence of surgical resection of the diseased intestines on CMD by assessing coronary flow velocity reserve (CFVR) using transthoracic Doppler echocardiography. Methods and Results Thirty‐seven patients with IBD (aged 44±15 years; 22 patients with Crohn disease and 15 patients with ulcerative colitis) and 30 controls (aged 46±12 years) were enrolled. For CFVR measurement, coronary flow velocity was recorded at rest and during hyperemia by ADP infusion using transthoracic Doppler echocardiography, and CFVR <2.5 defined CMD. CFVR measurement was repeated before and within 1 year after surgery. CFVR was similarly and significantly lower in patients with Crohn disease and those with ulcerative colitis than controls (Crohn disease: 2.92±1.03 [ P <0.05 versus controls], ulcerative colitis: 2.99±0.65 [ P <0.05 versus controls], and controls: 3.84±0.75). Multiple linear regression analysis showed that the presence of IBD and baseline hs‐CRP (high‐sensitivity C‐reactive protein) were independently associated with low CFVR among all study participants (β=−0.403 [ P =0.001] and −0.237 [ P =0.037], respectively). Hyperemic coronary flow velocity significantly improved after surgery only in patients with IBD who had CMD. CFVR significantly improved in patients with IBD who had both CMD and non‐CMD, and the extent of CFVR improvements were greater in patients with CMD than non‐CMD. Multiple linear regression analysis showed that the reduction of hs‐CRP was independently associated with improvement of hyperemic coronary flow velocity and CFVR among all patients with IBD (β=−0.481 [ P =0.003] and β=−0.334 [ P =0.043], respectively). Conclusions IBD is associated with CMD, which improved after surgical resection of diseased intestines.
Purpose: We identified the best predictors of clinical response to simple add-on tolvaptan (TLV) therapy in patients with heart failure (HF). Methods: We retrospectively enrolled 60 HF patients with excess fluid retention despite receiving adequate medical therapy including oral diuretics. All patients received simple add-on TLV (median of 7.5mg/day). They underwent right heart catheterization at baseline and after 7-day treatment. Results: Although the majority of patients were successfully treated with simple add-on TLV therapy (Group 1), but 22% (Group 2) were defined as being unsuccessfully treated because 1) HF symptom score worsened or 2) HF symptom score >6, and mean pulmonary capillary wedge pressure (PCWP) >18 mmHg and mean right atrial pressure (RAP) >10 mmHg after TLV therapy. Although the degrees of body weight reduction and increment of urine volume were similar between the two groups, HF symptom score and mean PCWP and RAP improved, and plasma BNP level decreased only in the group 1 after TLV therapy. The group 2 had lower urine sodium/creatinine ratio (UNa/UCr) and higher plasma BNP level than responders at baseline, and they were identified as the independent predictors of unsuccessful TLV therapy by multivariate logistic regression analysis. Receiver operating characteristic curve analysis showed that UNa/UCr was the strongest predictor of unsuccessful TLV therapy with cut-off point of 46.5 mEq/gCr (AUC 0.847, 95% CI; 0.718-0.976, sensitivity 77%, specificity 81%, P<0.001). Furthermore, combination with UNa/UCr 778 pg/ml best predicted unsuccessful TLV therapy with sensitivity of 54%, specificity of 100%, positive predictive value of 100%, negative predictive value of 89%, and accuracy of 90%. Conclusion: Simple add-on tolvaptan therapy ameliorated HF symptoms and provided hemodynamic improvement in majority of patients with HF, and the measurements of UNa/UCr and BNP level can help clinicians tailor HF treatment.
Phase-contrast cine cardiovascular magnetic resonance (CMR) quantifies global coronary flow reserve (CFR) by measuring blood flow in the coronary sinus (CS), allowing assessment of the entire coronary circulation. However, the complementary prognostic value of stress perfusion CMR and global CFR in long-term follow-up has yet to be investigated. This study aimed to investigate the complementary prognostic value of stress myocardial perfusion imaging and global CFR derived from CMR in patients with suspected or known coronary artery disease (CAD) during long-term follow-up.
Abstract Background Inflammatory bowel disease (IBD) is a complex multisystem disease characterized by chronic inflammation, which can lead to coronary microvascular dysfunction (CMD). Purpose We aimed to investigate the presence and the severity of CMD in Crohn's disease (CD) and ulcerative colitis (UC) by assessing coronary flow reserve (CFR) using transthoracic Doppler echocardiography, and to elucidate the influence of enterectomy on CMD. Methods Thirty-seven IBD patients (22 CD patients: 39±12 years, 15 UC patients: 52±17 years), and 30 age- and gender-matched control subjects (46±12 years) who have comparable risk factors for coronary artery disease were enrolled. Smokers were excepted from the present study. For CFR measurement, coronary flow velocity was recorded at rest and during hyperemia in the left anterior descending coronary artery induced by intravenous infusion of adenosine triphosphate (0.14 mg/kg/min), and a CFR ≤2.5 calculated as the ratio of hyperemic to basal peak and mean diastolic velocity defined CMD. CFR measurement was repeated before and within 1 year after enterectomy. Serum or plasma cytokines were also measured before and after enterectomy. Results The median disease duration of CD and UC patients were 12 and 6 years. Although none of control subjects had CMD, 38% in IBD patients (CD: 41%, UC: 33%) had CMD. CFR was similarly and significantly lower in CD and UC patients than Control subjects (CD: 2.92±1.03*, UC: 2.99±0.65*, and Control: 3.84±0.75, *p<0.05 vs. Control). Serum levels of TNF-α, IL-6 and hs-CRP were significantly higher in CD and UC patients than Control subjects. Multiple linear regression analysis showed that the presence of IBD and mean diastolic flow velocity at baseline were independently associated with reduced CFR among all study participants (β=−0.324 and −0.614, p=0.001, respectively). CFR in IBD patients with both CMD and non-CMD significantly improved after enterectomy, and the extent of CFR improvement was greater in patients with CMD than those with non-CMD (Figure). Serum levels of IL-6 and hs-CRP significantly reduced among all IBD patients. Conclusion IBD was associated with CMD, which improved after enterectomy.
Left ventricular (LV) diastolic dysfunction is the main cause of heart failure with preserved ejection fraction (HFpEF), and is characterized by LV stiffness and relaxation. Abnormal LV global longitudinal strain (GLS) is frequently observed l in HFpEF, and was shown to be useful in identifying HFpEF patients at high risk for a cardiovascular event. Cardiovascular magnetic resonance (CMR) feature tracking (CMR-FT) enables the reproducible and non-invasive assessment of global strain from cine CMR images. However, the association between GLS and invasively measured parameters of diastolic function has not been investigated. We sought to determine the prevalence and severity of GLS impairment in patients with HFpEF by using CMR-FT, and to evaluate the correlation between GLS measured by CMR-FT and that measured by invasive diastolic functional indices. Eighteen patients with HFpEF and 18 age- and sex-matched healthy control subjects were studied. All subjects underwent cine, pre- and post-contrast T1 mapping and late gadolinium-enhancement CMR. In the HFpEF patients, invasive pressure–volume loops were obtained to evaluate LV diastolic properties. GLS was quantified from cine CMR, and extracellular volume fraction (ECV) was quantified from pre- and post-contrast T1 mapping as a known imaging biomarker for predicting LV stiffness. GLS was significantly impaired in patients with HFpEF (− 14.8 ± 3.3 vs.–19.5 ± 2.8%, p < 0.001). Thirty nine percent (7/18) of HFpEF patients showed impaired GLS with a cut-off of − 13.9%. Statistically significant difference was found in ECV between HFpEF patients and controls (32.2 ± 3.8% vs. 29.9 ± 2.6%, p = 0.044). In HFpEF patients, the time constant of active LV relaxation (Tau) was strongly correlated with GLS (r = 0.817, p < 0.001), global circumferential strain (GCS) (r = 0.539, p = 0.021) and global radial strain (GRS) (r = − 0.552, p = 0.017). Multiple linear regression analysis revealed GLS as the only independent predictor of altered Tau (beta = 0.817, p < 0.001) among age, LV end-diastolic volume index, LV end-systolic volume index, LV mass index, GCS, GRS and GLS. CMR-FT is a noninvasive approach that enables identification of the subgroup of HFpEF patients with impaired GLS. CMR LV GLS independently predicts abnormal invasive LV relaxation index Tau measurements in HFpEF patients. These findings suggest that feature-tracking CMR analysis in conjunction with ECV, may enable evaluation of diastolic dysfunction in patients with HFpEF.
Journal Article Corrected proof Unilateral renal artery spasm complicating hypertensive emergency in a patient with secondary aldosteronism Get access Hiroki Mori, Hiroki Mori Department of Internal Medicine, Owase General Hospital, Owase, Mie, Japan Search for other works by this author on: Oxford Academic PubMed Google Scholar Ryuji Okamoto, Ryuji Okamoto Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, JapanRegional Medical Support Center, Mie University Hospital, Tsu, Mie, JapanDepartment of Clinical Training and Career Support Center, Mie University Hospital, Tsu, Mie, Japan Corresponding author. E-mail: ryuji@clin.medic.mie-u.ac.jp https://orcid.org/0000-0002-8067-398X Search for other works by this author on: Oxford Academic PubMed Google Scholar Shintaro Sakaguchi, Shintaro Sakaguchi Department of Internal Medicine, Owase General Hospital, Owase, Mie, Japan Search for other works by this author on: Oxford Academic PubMed Google Scholar Takafumi Koji, Takafumi Koji Department of Internal Medicine, Owase General Hospital, Owase, Mie, Japan Search for other works by this author on: Oxford Academic PubMed Google Scholar Kaoru Dohi Kaoru Dohi Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507, Japan https://orcid.org/0000-0002-5078-6326 Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal - Cardiovascular Imaging, jeae010, https://doi.org/10.1093/ehjci/jeae010 Published: 11 January 2024 Article history Published: 11 January 2024 Corrected and typeset: 18 January 2024
