Background: This prospective multicenter study assessed the prevalence of myocardial injury in patients with COVID-19 using cardiac magnetic resonance imaging (CMR).Methods and Results: We ...prospectively screened 505 patients with moderate to severe COVID-19 disease from 7 hospitals in Japan. Of these patients, 31 (mean ±SD age 63.5±10.4 years, 23 74% male) suspected of myocardial injury, based on elevated serum troponin or B-type natriuretic peptide concentrations either upon admission or 3 months after discharge, underwent CMR 3 months after discharge. The primary endpoint was the presence of myocardial injury, defined by any of the following: (1) contrast enhancement in the left or right ventricle myocardium on late gadolinium enhancement CMR; (2) left or right ventricular dysfunction (defined as <50% and <45%, respectively); and (3) pericardial thickening on contrast enhancement. The mean (±SD) duration between diagnosis and CMR was 117±16 days. The primary endpoint was observed in 13 of 31 individuals (42%), with 8 (26%) satisfying the modified Lake Louise Criteria for the diagnosis of acute myocarditis.Conclusions: This study revealed a high incidence of myocardial injury identified by CMR in patients with moderate to severe COVID-19 and abnormal findings for cardiac biomarkers.
Detecting cardiac sarcoidosis; a potentially life-threatening condition is challenging and requires a multimodality imaging approach using echocardiography, PET/CT and CMR. Although 18F-FDG is the ...recommended PET tracer for evaluating cardiac sarcoidosis, it is limited by physiological cardiac FDG uptake and requires stringent patient preparation/ dietary modifications before imaging. We hereby present a case of cardiac sarcoidosis demonstrating myocardial FAPI uptake on cardiac PET, highlighting the potential role of 68Ga-FAPI PET in the evaluation of cardiac sarcoidosis.
Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the ...introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.
This review and meta-analysis reviews the prognostic value of cardiac magnetic resonance (CMR) in nonischemic dilated cardiomyopathy (DCM).
Late gadolinium-enhanced (LGE) CMR is a noninvasive method ...to determine the underlying cause of DCM and previous studies reported the prognostic value of the presence of LGE to identify patients at risk of major adverse cardiovascular events.
PubMed was searched for studies describing the prognostic implication of LGE in patients with DCM for the specified endpoints cardiovascular mortality, major ventricular arrhythmic events including appropriate implantable cardioverter-defibrillator therapy, rehospitalization for heart failure, and left ventricular reverse remodeling.
Data from 34 studies were included, with a total of 4,554 patients. Contrast enhancement was present in 44.8% of DCM patients. Patients with LGE had increased cardiovascular mortality (odds ratio OR: 3.40; 95% confidence interval CI: 2.04 to 5.67), ventricular arrhythmic events (OR: 4.52; 95% CI: 3.41 to 5.99), and rehospitalization for heart failure (OR: 2.66; 95% CI: 1.67 to 4.24) compared with those without LGE. Moreover, the absence of LGE predicted left ventricular reverse remodeling (OR: 0.15; 95% CI: 0.06 to 0.36).
The presence of LGE on CMR substantially worsens prognosis for adverse cardiovascular events in DCM patients, and the absence indicates left ventricular reverse remodeling.
Cardiac Magnetic Resonance (CMR) is widely used in diagnosing cardiac diseases for its excellent contrast of cardiovascular features. However, due to the long imaging time of CMR scanning, the ...patient's respiration, limb shaking, and heart beating will lead to a certain degree of motion artifacts in the image, seriously degrade the image quality and affect the doctor's clinical judgment. This paper proposes a superpixel conditional Generative Adversarial Network (spcGAN) based on a conditional Generative Adversarial Network (cGAN) by applying superpixel to both generator and discriminator parts. In the generator section, a generator network based on superpixel segmentation and pooling is proposed for feature extraction at the superpixel level to enhance the reconstruction of image edge texture and structural details. In the discriminator part, superpixel pooling is used to construct a superpixel discriminator. It is fused with the traditional convolutional discriminator to produce a superpixel-based dual discriminator, which makes the discriminator consider the image's local structure and details. Based on the generator and discriminator structure proposed in this paper, superpixel pooling and edge texturing loss functions are designed for optimization. Adequate ablation experiments and comparison experiments are conducted in terms of experimental results. Three types of objective metrics, Peak Signal-to-Noise Ratio (PSNR), Structural Similarity (SSIM), and Focus Measurement (Tenengrad), were selected as references. The experimental results show that the effect of removing motion artifacts from authentic CMR images on the three datasets is most significant in the dataset produced in this paper. The results obtained from the fusion between the designed generator, discriminator, and loss function are the most obvious. Compared with the existing methods, the spcGAN proposed in this paper performs better.
•Applying superpixels to CMR artifact removal networks.•Proposing Generator Networks Based on Superpixel Segmentation and Pooling.•Constructing Superpixel Discriminator and combine them with Regular Discriminator.•Designing loss functions for superpixel pooling and edge texture optimization.
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