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James A Goodman¹, James D Quirk², Xia Ge², Yao Zhang¹, and Rachel Roth-Flach^1
1Pfizer, Inc, Cambridge, MA, United States, ²Washington University in St. Louis, St. Louis, MO, United States

Keywords: Cardiomyopathy, Cardiovascular, energetics

Cardiac energetics in patients with heart failure with preserved ejection fraction (HFpEF) may serve as a useful biomarker of disease status and therapeutic intervention.  To evaluate the potential suitability of this endpoint as a biomarker in preclinical research, we assessed cardiac energetics in the ZSF1 obese rat model of HFpEF and ZSF1 lean control.  This preclinical HFpEF model exhibited similar cardiac energetic deficits as do humans with HFpEF, indicating that that the PCr/γATP ratio may be a useful translational biomarker of disease status and intervention.

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Devin Raine Everaldo Cortes^1,2,3, Margaret C. Stapleton^2,3, Kristina E. Schwab^4,5, Noah W. Coulson^2,3, Elizabeth Mazzella^2,3,6, Dalton R West^2,3, Thomas Becker-Szurszewski^3,7, Sean Hartwick^3,4, Anthony G. Christodoulou⁸, and Yijen L Wu^1,2,3,7
1Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, United States, ²Department of Developmental Biology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States, ³Rangos Research Center Small Animal Imaging Core, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States, ⁴Rangos Research Center Animal Imaging Core, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, United States, ⁵Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States, ⁶Department of Chemistry, Dietrich School of Arts and Sciences, University of Pittsburgh, Pittsburgh, PA, United States, ⁷Department of Pediatrics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States, ⁸Biomedical Imaging Research Institue, Cedars-Sinai Medical Center, Los Angeles, CA, United States

Keywords: Heart, Toxicity, 4D fMRI, Doxorubicin, cardiomyopathy

Cardiomyopathy caused by anti-cancer anthracyclines, such as Doxorubicin (Dox), is one major cause for long-term morbidity and mortality among cancer survivors. Patients can develop cardiomyopathy leading to heart failure decades after successful cancer treatment with Dox. There is an urgent need for early detection of sub-clinical pathogenesis of Dox-induced cardiotoxicity for early intervention before irreversible cardiac tissue damage occurs.   Cellular mechanistic investigations showed that mitochondrial dysfunctions are central to the Dox-induced cardiotoxicity.  We have developed a time-and-motion-resolved 4D Oxy-wavelet MRI capable of detecting early Dox-induced mitochondrial dysfunction in the heart before irreversible myocardial damage occurred.

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Michinobu Nagao¹, Masami Yoneyama², Yasuhiro Goto¹, Isao Shiina¹, Kazuo Kodaira¹, Mana Kato¹, Yasutomo Katsumata², Yurie Shirai¹, Atsushi Yamamoto¹, Akiko Sakai¹, Risako Nakao¹, and Shuji Sakai^1
1Tokyo Women's Medical University, Tokyo, Japan, ²Philips Japan, Tokyo, Japan

Keywords: Cardiomyopathy, Inflammation

We have successfully developed cardiac cine imaging to project T2 values using T2prep-based T2 mapping with dynamic multiple trigger-delay framework. We have demonstrated that diastolic T2 values on cine T2 mapping are temporarily prolonged in patients with non-ischemic cardiomyopathy and impaired left ventricular function. Cine T2 mapping is a new noninvasive in vivo imaging technique for myocardial edema that provides an effective means of elucidating the pathogenesis of cardiomyopathy.

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Li Qing¹, Zhou Zhen¹, Gao Yifeng¹, Ke Jiang², and Lei Xu^1
1Beijing Anzhen Hospital, Beijing, China, ²Philips Healthcare, Beijing, China, Beijing, China

Keywords: Cardiomyopathy, Cardiomyopathy, cardiac power; hypertrophic cardiomyopathy; ejection fraction

Cardiac power (CP) output in patients with heart failure has been studied, while its importance in hypertrophic cardiomyopathy (HCM) patients is yet unclear.

 99 HCM patients and 65 gender- and age-matched controls with cardiac MR were included in the study. HCM patients showed significantly higher CP (p=0.031) but lowered NCP (p<0.001) than the controls. The correlation analysis of NCP and functional parameters revealed that NCP was inversely correlated with LV mass (R=-0.395, p<0.001) in HCM patients.

NCP decreased significantly in HCM patients and may continue to deteriorate with increasing LV mass.

Shujuan Yang¹ and Shihua Zhao^1
1Fuwai Hospital, Beijing, China

Keywords: Cardiomyopathy, Surgery

Eighty-eight patients with hypertrophic obstructive cardiomyopathy(HOCM) who received CMR before and after myectomy were retrospectively studied.  Thier Pre- and postmyectomy left atrial (LA) parameters derived from CMR-feature tracking were compared. Patients with HOCM after septal myectomy showed LA reverse remodeling with a reduction in LA size and restoration in LA reservoir and booster function but unchanged LA conduit function. Among volumetric and functional changes, booster function had the greatest improvement postoperatively. Besides, preoperative LAVmin index and ΔLVOT might be potential factors associated with the degree of improvement in εa.

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Xiaorui Xiang¹, Xiuyu Chen¹, and Shihua Zhao^1
1Fuwai Hospital and National Center for Cardiovascular Diseases, Beijing, China

Keywords: Cardiomyopathy, Cardiomyopathy

Despite late gadolinium enhancement (LGE) have already proved a strong association with adverse outcomes in non-ischemic dilated cardiomyopathy (NIDCM) patients, for those who with negative LGE, mortality remains a clinical issue. This study therefore aimed to investigate the prognostic impact of cardiac magnetic resonance (CMR) feature tracking derived strain in NIDCM patients without myocardial scar. 

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Ningning Song¹, Weibin Dai¹, Tingting Liu¹, Yueyou Peng¹, Qianyu Hu¹, Kunkun Liu¹, Tianfeng Shi¹, Donglian Du¹, Xiaoqiong Li¹, Yueluan Jiang², and Yanfeng Meng^1
1Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China, ²Siemens Healthineers Ltd., Beijing, China

Keywords: Heart, Cardiomyopathy

This study evaluated the left ventricle (LV) and right ventricle (RV) layer-specific (endocardium=Endo, epicardium=Epi, myocardium=Myo) strain of hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD). We also evaluated the ability of left atrium (LA) to differentiate HCM and HHD. The strain and strain rate were calculated from CMR. The difference of LV between HCM and HHD was endocardium. The difference of RV was free wall epicardium. The difference of LA was LA strain at conduit phase (LAS-cd). Combining the LV global circumferential strain rate of endocardium (GCSR-Endo) and LASR-cd can better differentiate HCM and HHD.

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Oumaima Laghzali^1,2, Sandra Lehmann^1,3, Joao dos Santos Periquito¹, Andreas Pohlmann¹, Lucie Carrier^4,5, Thoralf Niendorf^1,2,6, Sonia Waiczies¹, and Min-Chi Ku^1,2
1Berlin Ultrahigh Field Facility (B.U.F.F), Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany, ²DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany, ³Technische Universität Berlin, Berlin, Germany, ⁴Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, ⁵DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany, ⁶Experimental and Clinical Research Center, Charite Medical Faculty and the Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany

Keywords: Cardiomyopathy, Tissue Characterization, Tissue remodeling

Most cases of hypertrophic cardiomyopathy (HCM) are detected at a stage when the heart has experienced significant damage. The aim of this study is to detect subtle changes in the myocardium before the appearance of overt symptoms of HCM. We show that myocardial T₂^* mapping can detect early changes throughout the full heart cycle in a HCM mouse model that represents the human genetic heart disease. This could potentially provide a biomarker for early stages of HCM that might be useful for non-invasive diagnoses. 

Jian He¹, Wenjing Yang¹, Kelvin Chow², Jing An³, and Minjie Lu^1
1Fuwai hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China, ²Siemens Healthineers, Los Angeles, CA, United States, ³Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China

Keywords: Heart, Heart

The predisposed HFpEF has relatively unique clinical and CMR features, which indicates it may be an important subtype or precursor of HFpEF. However, the specific clinical significance of these features requires further prognostic studies.

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Di Zhou¹, Kelvin Chow², Jing An³, and Minjie Lu^1
1Fuwai hospital, Beijing, China, ²Siemens Healthineers SHS AM NAM USA DI MR COLLAB, Los Angeles, CA, United States, ³Siemens Shenzhen Magnetic Resonance Ltd. SHS DI MR R&D SZN DL, Shenzhen, China

Keywords: Cardiomyopathy, Cardiomyopathy

In this study, we explored individual weight of CMR metrics for predicting short-term outcomes in DCM. ECV fraction performed excellent potential of clinical translation for prognosis in patients with DCM. LGE has better prognostic value than other CMR metrics for SCD and aborted SCD. LV strain may contribute to predict advanced heart failure, which not aid to the risk stratification of SCD. In this way, we developed a risk stratification model based on cardiac MR imaging including NYHA functional class, left ventricular ejection fraction, late gadolinium enhancement, and mean extracellular volume. It may improve clinical assessment and individual decision making.

Zhixiang Dong¹ and Shihua Zhao^1
1Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular, Beijing, China

Keywords: Cardiomyopathy, Quantitative Imaging, arrhythmogenic right ventricular cardiomyopathy

To find out the values of strain parameters in the diagnosis and prognosis of arrhythmogenic right ventricular cardiomyopathy (ARVC), 247 patients with initial diagnosis of suspected ARVC were included in this study. Results showed that right ventricular global longitudinal strain (RV GLS) had moderate to high discriminatory power to identify patients with different likelihood of ARVC. Besides, patients with reduced RV GLS had a higher estimated cumulative incidence of combined cardiovascular events. These findings indicate that cardiac magnetic resonance feature tracking could potentially be used as a preferred imaging method in the first visit and follow-up of ARVC.

Tian-yi Zhang¹, Peng Wu², Lian-Ming Wu³, and Shan Mou^1
1Nephrology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China, ²Philips Healthcare, Shanghai, China, Shanghai, China, ³Radiology, Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital, Shanghai, China

Keywords: Cardiomyopathy, Tissue Characterization

The aim of this study was to measure left ventricular (LV) trabecular complexity by fractal dimension (FD) in patients with end-stage renal disease (ESRD), and assess whether FD is an independent risk predictor for heart failure with preserved ejection fraction (HFpEF) in this population. We found that LV mean basal FD was an independent predictor for HFpEF in the multivariate analysis. Adding LV mean basal FD to the baseline model resulted in a higher C-index and significant NRI, indicating better discriminatory ability to HFpEF en ESRD patients.

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Margaret Caroline Stapleton^1,2, Elizabeth Mazzella^1,3, Noah Coulson^1,2, George Cater⁴, Kristina Schwabb^5,6, Sean Hartwick^5,6, Thomas Becker-Szurszewski^5,6, Devin Rain Everaldo Cortes^1,2,7, and Yijen L. Wu^1,2
1Department of Developmental Biology, University of Pittsburgh, Pittsburgh, PA, United States, ²Rangos Research Center Animal Imaging Core, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States, ³Department of Chemistry, University of Pittsburgh, Pittsburgh, PA, United States, ⁴St. Clair Hospital, Pittsburgh, PA, United States, ⁵Rangos Research Center Animal Imaging Core, Children's Hospital of Pittsburgh PA, Pittsburgh, PA, United States, ⁶Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States, ⁷Department of Bioengineering, University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, United States

Keywords: Cardiomyopathy, Toxicity

Anthracycline, like Doxorubicin (DOX), induced cardiotoxicity is a major cause of morbidity among childhood cancer survivors. Prior clinical studies diagnose using isolated measures of cardiac function, but by the time cardiotoxicity is detected, irreversible damage has already occurred. We hypothesize that multi-parametric cardiac MRI (CMR), and concurrent treatment with cardioprotective agents is a more sensitive biomarker for early diagnosis of DOX-induced cardiotoxicity. We identified DOX cardiotoxicity by CMR derived LV strain and Luminex biomarker analysis prior to any decrease in EF and SV. Our study suggests multi-parametric CMR with concurrent cardioprotective treatment can be a surrogate endpoint for therapeutic efficacy.

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Mehrzad Tartibi¹, Uttam Shrestha², Youngho Deo³, Grant Gullberg⁴, Christopher T. Nguyen⁵, Vahid Ravanfar³, Qizhi Fang³, and Randall J. Lee^3
1DelBeat, Berkeley, CA, United States, ²University of California San Francisco, San Francisco, CA, United States, ³University of California, San Francisco, San Francisco, CA, United States, ⁴Lawrence Berkeley National Laboratory, Berkeley, CA, United States, ⁵Cleveland Clinic, Cleveland, OH, United States

Keywords: Cardiomyopathy, Heart, Hear efficiency

Nearly 70% of heart attacks (myocardial infarctions, MI) cases lead to a condition known as heart failure (HF), where the left ventricle (LV) remodels. Previous alginate and stem cell intramyocardial injection studies reported mixed outcomes using the LV global volumetric function and local myocardium mechanical response (strains and stresses)^1,2. Such measures involve unvalidated assumptions yielding erroneous results³.  We conducted a swine HF study treated with a particular alginate intramyocardial injection; however, instead of using the mechanical response, we directly measured the metabolic energy consumed by the myocardium before and after treatment using Positron emission tomography–magnetic resonance images (PET-MRI)⁴.

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Lu Tang¹, Jens Wetzl², Xiaoyue Zhou³, Yan Ren⁴, and Jiayu Sun^1
1Department of Radiology, West China Hospital, Sichuan University, Chengdu, China, ²MR Application Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany, ³MR Collaboration, Siemens Healthineers Ltd, Shanghai, China, ⁴West China Hospital, Sichuan University, Chengdu, China

Keywords: Myocardium, Cardiovascular, cardiac magnetic resonance imaging; left ventricle; primary aldosteronism; strain; dysfunction

This study used routine cardiac function parameters and strain parameters based on cardiac magnetic resonance imaging to evaluate the effects of specific treatments on left ventricular structure and function in patients with PA. We found that patients with PA had lower LV volumes and myocardial mass, as well as improved circumferential and longitudinal myocardial motion both after adrenalectomy and drug treatment. Specific treatment in patients of PA can not only effectively relieve the clinical symptoms, but also improve left ventricular structure and subclinical dysfunction.

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Xiaolong Liu¹, Zhanguo Sun¹, Ning Zhai¹, and Xiuzheng Yue^2
1Department of Radiology, Affiliated Hospital of Jining Medical University, Jining, China, ²Philips Healthcare (Beijing), Beijing, China

Keywords: Heart, Myocardium

Heart involvement is the leading cause of death of Danon disease (DD). However, the cardiac magnetic resonance (CMR) features of DD are not well understood. Hence, we present seven DD patients with from the same family with follow-up since 2017. In our cohort, the typically CMR features of DD were left ventricle (LV) hypertrophy, late gadolinium enhancement of LV, diminished strain, and preserved or reduced LV ejection fraction. Late gadolinium enhancement most commonly involves the LV free wall and the right ventricle insertion points. Moreover, these CMR changes in male patients appeared earlier and more significant, and progressed faster.

Yan Gao¹, Mengxiao Liu², Zhiguo Ju³, and Ximing Wang^4
1Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, China, ²Siemens Healthineers, Shanghai, China, ³College of Medical Imaging, Shanghai University of Medicine & Health Science, Shanghai, China, ⁴Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

Keywords: Myocardium, Heart

The prognosis of LVNC is remarkably heterogeneous, with heart failure (HF), ventricular arrhythmias (VAs) and systemic embolisms (SEs) being the most frequent cardiovascular complications but no specific recommendations are available at present. In the present study, we aimed to investigate whether LV entropy could efficiently predict major adverse cardiac events (MACEs) in patients with LVNC incremental to established clinical and imaging risk markers.

Shujuan Yang¹ and Shihua Zhao^1
1Fuwai Hospital, Beijing, China

Keywords: Cardiomyopathy, Heart

In a retrospective cohort study, 497 consecutive HCM patients with LGE confirmed by cardiac MR were collected. The risk of cardiovascular events increases with per percentage increase in LGE extent in HCM patients with extensive LGE (>15%). While instead of LGE extent, the subendocardium-involved LGE pattern, an underrecognized phenotype in HCM, is related to the adverse outcomes in patients with non-extensive LGE (<15%), especially for heart failure-related outcomes. RVIP LGE is commonly seen in HCM, but this LGE location does not merit a prognostic value.

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Keyan Wang¹, Jie Zheng², Jing An³, and Jingliang Cheng^1
1MRI, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China, ²Mallinckrodt Institute of Radiology, St. Louis, MO, United States, ³Siemens Healthineer, Shenzhen, China

Keywords: Myocardium, Cardiomyopathy

This study evaluated a cardiac T1ρdispersion mapping technique, termed as myocardial fibrosis index (mFI), to distinguish cardiac amyloidosis (CA) from hypertrophic cardiomyopathy (HCM). Our data showed that mFI is significantly superior to native T1 and contrasts medium-derived extracellular volume in the differential diagnosis of CA and HCM.