Assessment of Papillary Muscle Infarction with Dark-Blood Delayed                     Enhancement Cardiac MRI in Canines and Humans

Wendell, David C.; Jenista, Elizabeth; Kim, Han W.; Chen, Enn-Ling; Filho, Clério Francisco de Azevedo; Kaolawanich, Yodying; Enezi, Fawaz Al; Rehwald, Wolfgang G; Darty, Stephen; Parker, Michele; Kim, Raymond J.

doi:10.1148/radiol.220251

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…All pigs underwent sedation with general anesthesia and intubated for mechanical ventilatory support during the duration of the imaging studies. All images were acquired during ventilated breath holds and with cardiac gating applied using electrocardiography (ECG) [ 20 – 22 ]. For the post-transplantation CMR studies, both the native and transplanted heart were able to be gated independently.…”

Section: Methodsmentioning

confidence: 99%

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Cardiac magnetic resonance imaging characterization of acute rejection in a porcine heterotopic heart transplantation model

Mendiola Pla,

Milano,

Glass

et al. 2024

PLoS ONE

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Preclinical disease models are important for the advancement of therapeutics towards human clinical trials. One of the difficult tasks of developing a well-characterized model is having a reliable modality with which to trend the progression of disease. Acute rejection is one of the most devastating complications that can occur following organ transplantation. Specifically in cardiac transplantation, approximately 12% of patients will experience at least one episode of moderate or severe acute rejection in the first year. Currently, the gold standard for monitoring rejection in the clinical setting is to perform serial endomyocardial biopsies for direct histological assessment. However, this is difficult to reproduce in a porcine model of acute rejection in cardiac transplantation where the heart is heterotopically transplanted in an abdominal position. Cardiac magnetic resonance imaging is arising as an alternative for serial screening for acute rejection in cardiac transplantation. This is an exploratory study to create and define a standardized cardiac magnetic resonance screening protocol for characterizing changes associated with the presence of acute rejection in this preclinical model of disease. Results demonstrate that increases in T1 mapping, T2 mapping, left ventricular mass, and in late gadolinium enhancement are significantly correlated with presence of acute rejection.

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Section: Methodsmentioning

confidence: 99%

“…of the imaging studies. All images were acquired during ventilated breath holds and with cardiac gating applied using electrocardiography (ECG) [20][21][22]. For the post-transplantation CMR studies, both the native and transplanted heart were able to be gated independently.…”

Section: Plos Onementioning

confidence: 99%

Cardiac magnetic resonance imaging characterization of acute rejection in a porcine heterotopic heart transplantation model

Mendiola Pla,

Milano,

Glass

et al. 2024

PLoS ONE

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“…Flow-independent dark-blood delayed enhancement (FIDDLE) cardiac MRI, based on LGE-MRI, can suppress the bright blood pool signal and retain only the high signal of necrotic myocardium, thus improving the detection rate of myocardial infarction [51,52]. In 2022, Wendell et al [13] verified in a canine infarction model that the accuracy of the FIDDL for the detection of PapMI was fully consistent with the pathologic findings. Using FIDDLE as the gold standard, they reported that the prevalence of anterolateral and posteromedial PapMI in patients with infarction was approximately 37% and 44%, respectively.…”

Section: Qualitative Assessment Of Pm Functionmentioning

confidence: 99%

“…The incidence of ischemic posteromedial papillary muscle rupture (PMR) is approximately 2.3 times greater than that of anterolateral PM rupture. However, the findings of David Wendell’s team [ 13 ] in 2022 showed that in patients with myocardial infarction with single-segment coronary occlusion, the LAD was 1.7 times more likely to develop obstruction than the RCA, but infarction involved the posteromedial PM more frequently than the anterolateral PM. In response to this paradox, they further correlated the obstructed vessels with the infarcted PM, concluding that “it is because there are more coronary segments associated with posteromedial PM infarction than anterolateral PM”.…”

Section: Normal Anatomy Of the Pmmentioning

confidence: 99%

“…Therefore, Doppler ultrasound can be utilized to evaluate the hemodynamic characteristics of the heart, facilitating a comprehensive imaging assessment. Due to its high temporal and spatial resolution, as well as diverse functional imaging sequences, cardiac magnetic resonance imaging (CMR) has become the predominant imaging modality for studying the structure and function of the PM at present [ 5 , 13 , 25 , 40 ]. Computed tomography (CT) allows dynamic assessment of the PM by cardiac gating, but its inability to provide hemodynamic information and radiation exposure limits its use in clinical practice [ 41 , 42 ].…”

Section: Multimodal Image Evaluation Of Pmmentioning

confidence: 99%

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Left Ventricular Papillary Muscle: Anatomy, Pathophysiology, and Multimodal Evaluation

Li,

Wang,

et al. 2024

Diagnostics

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As an integral part of the mitral valve apparatus, the left ventricle papillary muscle (PM) controls mitral valve closure during systole and participates in the ejection process during left ventricular systole. Mitral regurgitation (MR) is the most immediate and predominant result when the PM is structurally or functionally abnormal. However, dysfunction of the PM is easily underestimated or overlooked in clinical interventions for MR-related diseases. Therefore, adequate recognition of PM dysfunction and PM-derived MR is critical. In this review, we systematically describe the normal anatomical variations in the PM and the pathophysiology of PM dysfunction-related diseases and summarize the commonly used parameters and the advantages and disadvantages of various noninvasive imaging modalities for the structural and functional assessment of the PM.

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Magnetization-transfer flow-independent dark-blood delayed enhancement cardiac MRI optimizes discrimination of ST-elevation myocardial infarct borders

Poskaite,

Kremser,

Pamminger

et al. 2024

Eur Radiol

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Objectives To prospectively compare image quality and infarct sizing methods between magnetization-transfer “flow-independent dark-blood delayed enhancement” (MT-FIDDLE) and standard “bright-blood”-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) sequence. Methods “Bright-blood”-LGE and MT-FIDDLE sequence were acquired in 110 patients at 4 days (n = 33), 4 months (n = 39) and 12 months (n = 38) after acute ST-elevation myocardial infarction (STEMI). Subjective image quality, including confidence in infarct segmentation and blood-pool bordering, were each rated on a 4-point Likert scale. Objective image quality was assessed by the detectability index (DI). Infarct volumes derived via full-width at half-maximum (FWHM) and different number of standard deviations (“n-SD”) methods on MT-FIDDLE images were compared with FWHM and reference 5-SD results from “bright-blood-LGE images. Results Overall subjective median image quality was excellent for both LGE sequences. Qualitative analysis revealed a significantly higher confidence in infarct segmentation and in blood-pool bordering for MT-FIDDLE as compared to “bright-blood”-LGE (all p < 0.001). Infarct volumes assessed by the FWHM technique on MT-FIDDLE and “bright-blood”-LGE showed excellent agreement overall (Concordance correlation coefficient, CCC = 0.96). The 3-SD technique for MT-FIDDLE showed the best agreement with the 5-SD method for “bright-blood”-LGE overall (CCC = 0.94), as well as in the subgroup with excellent confidence in infarct segmentation on “bright-blood”-LGE (CCC = 0.96). DI of scar versus LV blood-pool was higher for MT-FIDDLE (8.9 ± 5.5) compared to “bright-blood”-LGE sequence (2.0 ± 1.5; p < 0.001). Conclusion MT-FIDDLE significantly optimizes the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients. As compared to the established 5-SD technique on “bright-blood”-LGE, the 3-SD method on MT-FIDDLE results in consistent infarct volumes. Key Points QuestionDoes magnetization-transfer “flow-independent dark-blood delayed enhancement” (MT-FIDDLE) offer any benefits over standard “bright-blood”-late gadolinium enhancement (LGE) cardiac-magnetic-resonance (CMR) for identifying STEMI infarct borders? FindingsMT-FIDDLE image quality was higher than LGE CMR and measured infarct volume comparability to the standard 5-SD-threshold-technique. Clinical relevanceMT-FIDDLE facilitates the assessment of myocardial infarctions at the subendocardial border, improving the discrimination between myocardial infarction and adjacent blood-pool in STEMI patients.

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Assessment of Papillary Muscle Infarction with Dark-Blood Delayed Enhancement Cardiac MRI in Canines and Humans

Cited by 4 publications

References 25 publications

Cardiac magnetic resonance imaging characterization of acute rejection in a porcine heterotopic heart transplantation model

Cardiac magnetic resonance imaging characterization of acute rejection in a porcine heterotopic heart transplantation model

Left Ventricular Papillary Muscle: Anatomy, Pathophysiology, and Multimodal Evaluation

Magnetization-transfer flow-independent dark-blood delayed enhancement cardiac MRI optimizes discrimination of ST-elevation myocardial infarct borders

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