Publications by authors named "Murilo Foppa"

48 Publications

Rapid prognostic stratification using Point of Care ultrasound in critically ill COVID patients: The role of epicardial fat thickness, myocardial injury and age.

J Crit Care 2021 Oct 8;67:33-38. Epub 2021 Oct 8.

Postgraduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Cardiology Division - Hospital de Clínicas de Porto Alegre, Brazil.

Purpose: The burden of critical COVID-19 patients in intensive care units (ICU) demands new tools to stratify patient risk. We aimed to investigate the role of cardiac and lung ultrasound, together with clinical variables, to propose a simple score to help predict short-term mortality in these patients.

Material And Methods: We collected clinical and laboratorial data, and a point-of-care cardiac and lung ultrasound was performed in the first 36 h of admission in the ICU.

Results: Out of 78 patients (61 ± 12y-o, 55% male), 33 (42%) died during the hospitalization. Deceased patients were generally older, had worse values for SOFA score, baseline troponin levels, left ventricular ejection fraction (LVEF), LV diastolic function, and increased epicardial fat thickness (EFT), despite a similar prevalence of severe lung ultrasound scores. Based on the multivariable model, we created the POCOVID score, including age (>60 years), myocardial injury (LVEF<50% and/or usTnI>99til), and increased EFT (>0.8 cm). The presence of two out of these three criteria identified patients with almost twice the risk of death.

Conclusions: A higher POCOVID score at ICU admission can be helpful to stratify critical COVID-19 patients with increased in-hospital mortality and to optimize medical resources allocation in more strict-resource settings.
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http://dx.doi.org/10.1016/j.jcrc.2021.09.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500966PMC
October 2021

Myocardial iron content by T2 Star cardiac magnetic resonance and serum markers of iron metabolism in patients with heart failure.

J Cardiovasc Med (Hagerstown) 2021 Sep 27. Epub 2021 Sep 27.

Post-Graduate Program in Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS) Hospital de Cli[Combining Acute Accent]nicas de Porto Alegre (HCPA), Porto Alegre, Brazil.

Aims: Iron deficiency (ID) is present in half of patients with heart failure. Cardiac magnetic resonance (CMR) is a valuable tool for evaluating patients with heart failure. The T2 Star (T2*) sequence technique was developed within CMR to evaluate iron overload, but its role for assessing myocardial iron content remains poorly understood. The present study aimed to assess correlations between T2* and blood tests for iron metabolism in patients with heart failure and left ventricular ejection fraction (LVEF) ≤ 50%.

Methods And Results: A total of 47 patients were analyzed. Mean age was 50.1±14.3 years and most were male (59.6%) and white (74.5%). Mean T2* value and LVEF in CMR were 36.5±6.6 ms and 30.7±12% respectively. The main etiology of heart failure was nonischemic (76.6%). Iron deficiency was diagnosed in 40.4% and anemia was diagnosed in 17%. No significant correlations were found between T2* and transferrin saturation (r= -0.063, P=0.678), ferritin (r= -0.164, P=0.272), or serum iron (r= 0.099, P=0.512). Age was negatively correlated (r= -0.330; P= 0.024) as heart rate at rest (r= -0.427; P= 0.003) was also negatively correlated. Hemoglobin and LVEF were not correlated with T2*. No difference in T2* was found in relation to heart failure etiology, presence or absence of anemia, or ejection fraction categories.

Conclusion: The T2* sequence in CMR had no correlation with transferrin saturation, ferritin, or serum iron in patients with heart failure and LVEF ≤ 50%. These findings constitute additional evidence that blood tests for iron metabolism do not reflect intramyocardial iron content.
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http://dx.doi.org/10.2459/JCM.0000000000001263DOI Listing
September 2021

Increased Mobility of the Atrial Septum in Aortic Root Dilation: An Observational Study on Transesophageal Echocardiography.

Front Physiol 2021 24;12:701399. Epub 2021 Aug 24.

Graduate Studies Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

There is a growing interest in the relationship between atrial septal anatomy and cardioembolic stroke. Anecdotal reports suggest that the enlargement of the aortic root could interfere with atrial septal mobility (ASM). We sought to investigate the association between ASM and aortic root dilation. From all consecutive clinically requested transesophageal echocardiogram (TEE) studies performed during the study period in a single institution, we were able to review and evaluate the ASM and anteroposterior length, aortic root diameter, and the prevalence of atrial septal aneurysm (ASA) and of patent foramen ovale (PFO) in 336 studies. Additional variables, such as left ventricular ejection fraction, left atrial diameter, diastolic dysfunction, age, sex, weight, height, previous stroke, atrial fibrillation, and TEE indication, were extracted from patient medical records and echocardiographic clinical reports. In 336 patients, we found a mean ASM of 3.4 mm, ranging from 0 to 21 mm; 15% had ASA and 14% had PFO. There was a 1.0 mm increase in ASM for every 10-mm increase in aortic root diameter adjusted for age, sex, weight, height, ejection fraction, and left atrial size ( = 0.1; = 0.04). Aortic diameter was not associated with a smaller septal length ( = 0.03; = 0.7). An increased motion of the atrial septum can occur in association with aortic dilation. These findings deserve attention for the relevance of aortic root anatomy in future studies involving atrial septal characteristics and embolic stroke risk.
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http://dx.doi.org/10.3389/fphys.2021.701399DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8421672PMC
August 2021

Predictors of coronary artery calcium incidence and progression: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Atherosclerosis 2020 09 29;309:8-15. Epub 2020 Jul 29.

Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil. Electronic address:

Background And Aims: There are limited data on serial coronary artery calcium (CAC) assessments outside North American and European populations. We sought to investigate risk factors for CAC incidence and progression in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Methods: We included individuals with no prior cardiovascular disease and two CAC measurements in ELSA-Brasil. Incident CAC was defined as a baseline CAC of 0 followed by CAC >0 on the second study. CAC progression was defined according to multiple published criteria. We performed logistic and linear regression to identify risk factors for CAC incidence and progression. We also examined risk factor effect modification by baseline CAC (0 vs. >0).

Results: A total of 2707 individuals were included (57% women, age 48.6 ± 7.7 years). Participants self-identified as white (55%), brown (24%), black (16%), Asian (4%) and Indigenous (1%). The mean period between CAC assessments was 5.1 ± 0.9 years. CAC incidence occurred in 282 (13.3%) of 2127 individuals with baseline CAC of 0. CAC progression occurred in 319 (55%) of 580 participants with baseline CAC >0. Risk factors for CAC incidence included older age, male sex, white race, hypertension, diabetes, higher BMI, smoking, lower HDL-C, higher LDL-C and triglycerides, and metabolic syndrome. Older age and elevated LDL-C were associated with CAC incidence, but not progression. Risk factors consistently associated with CAC progression were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome. On interaction testing, these four risk factors were more strongly associated with CAC progression as compared to CAC incidence.

Conclusions: CAC incidence was associated with multiple traditional risk factors, whereas the only risk factors associated with progression of CAC were hypertension, diabetes, hypertriglyceridemia, and metabolic syndrome.
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http://dx.doi.org/10.1016/j.atherosclerosis.2020.07.003DOI Listing
September 2020

Association between electrocardiographic and echocardiographic atrial abnormalities and prognosis in cryptogenic stroke.

J Stroke Cerebrovasc Dis 2020 Sep 25;29(9):105066. Epub 2020 Jun 25.

Cardiology Division, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, Porto Alegre, RS, Brazil; Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address:

Background And Purpose: The role of atrial fibrillation in cryptogenic stroke (CS) is well known. However, the usefulness of left atrial (LA) electrical and morphological abnormalities to identify more disabling strokes in sinus rhythm patients is less studied. We evaluated the association between electrocardiographic P-wave abnormalities and echocardiographic LA measures with neurological disability in patients with cryptogenic stroke.

Methods: In a retrospective cohort, we included all consecutive hospitalized patients with cryptogenic stroke. Patients were classified according to modified Rankin scale at hospital discharge and at 3 months. LA abnormalities were identified by electrocardiographic (ECG) P-wave, axis and LA enlargement criteria, and by bidimensional echocardiograph through left atrial diameter and volume index.

Results: Among the 143 patients with CS (63.4 ± 14.2 years, 53% women), 70 patients were classified as non-disabling stroke (Rankin score < 2) and 73 patients as disabling stroke (Rankin score ≥ 2) at hospital discharge. On echocardiogram, more patients with disabling stroke presented with enlarged LA volume index (48% vs. 25%; p = 0.01). This difference remained significant after adjustment for age, gender, CHADS-VASc and NIHSS scores (p = 0.02) and even when the LA volume index was analyzed as a continuous variable (p = 0.055). Also, enlarged LA volume index was more prevalent (52% vs. 25%; p = 0.03) among those with disabling stroke at 3 months after hospital discharge. Among ECG criteria, only the LA enlargement assessed by downward deflection was more prevalent in disabling stroke.

Conclusion: Our study demonstrated an association between left atrial enlargement, assessed by downward deflection from ECG and volume index from echocardiogram, and more disabling cryptogenic strokes. This information could help to identify patients with poorer prognosis, or a subgroup where atrial cardiopathy may play a role in cardioembolic pathway.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105066DOI Listing
September 2020

Stage I hypertension is associated with impaired systolic function by strain imaging compared with prehypertension: A report from the prever study.

J Clin Hypertens (Greenwich) 2019 11 25;21(11):1705-1710. Epub 2019 Sep 25.

Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

High blood pressure (BP) is associated with higher rates of cardiovascular events, even in stage I hypertension (HTN) and prehypertension (preHTN). Lower left ventricular (LV) systolic function, assessed by global longitudinal strain (GLS), has been demonstrated in individuals with HTN compared to individuals with normal BP, but a comparison of individuals with preHTN and stage I HTN was not described to date. The PREVER study includes two randomized double-blind controlled trials, performed in volunteers with preHTN (PREVER-prevention trial) or stage I HTN (PREVER-treatment trial), aged 30-70 years. A subsample of patients of both trials had GLS measured from 2D echocardiograms performed at baseline and after 18 months of follow-up. We compared baseline data from both studies and, among stage I HTN patients, clinical and echocardiographic correlates of GLS were determined. Participants with preHTN (n = 91;53% female; 55 ± 9 yo) and stage I HTN (n = 105; 44% female; 55 ± 8 yo) had similar clinical parameters beyond the expected differences in BP levels. Participants with stage I HTN had lower GLS (-17.5 ± 2.5% vs -18.2 ± 2.4%, P = .03) compared with those with preHTN. In stage I HTN, lower GLS was associated with lower e' and lower LV ejection fraction. In conclusion, patients in Stage I HTN may already express changes in GLS compared with individuals with preHTN, suggesting that even mildly difference in BP can be impact in subclinical systolic function.
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http://dx.doi.org/10.1111/jch.13695DOI Listing
November 2019

Let's Look Right during Diastolic Dysfunction Evaluation?

Arq Bras Cardiol 2019 03;112(3):258-259

Hospital de Clinicas de Porto Alegre, Porto Alegre, RS - Brazil.

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http://dx.doi.org/10.5935/abc.20190053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6424042PMC
March 2019

Diuretics are Similar to Losartan on Echocardiographic Target-Organ Damage in Stage I Hypertension. PREVER-Treatment Study.

Arq Bras Cardiol 2019 01;112(1):87-90

Serviço de Cardiologia - Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brazil.

Blood pressure (BP)-lowering therapy improves left ventricular (LV) parameters of hypertensive target-organ damage in stage II hypertension, but whether there is a drug-class difference in echocardiographic parameters in stage I hypertension patients is less often studied. In the PREVER treatment study, where individuals with stage I hypertension were randomized for treatment with diuretics (chlorthalidone/amiloride) or losartan, 110 participants accepted to participate in a sub-study, where two-dimensional echocardiograms were performed at baseline and after 18 months of antihypertensive treatment. As in the general study, systolic BP reduction was similar with diuretics or with losartan. Echocardiographic parameters showed small but significant changes in both treatment groups, with a favorable LV remodeling with antihypertensive treatment for 18 months when target blood pressure was achieved either with chlorthalidone/amiloride or with losartan as the initial treatment strategy. In conclusion, even in stage I hypertension, blood pressure reduction is associated with improvement in echocardiographic parameters, either with diuretics or losartan as first-drug regimens.
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http://dx.doi.org/10.5935/abc.20180249DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317616PMC
January 2019

Central Obesity is the Key Component in the Association of Metabolic Syndrome With Left Ventricular Global Longitudinal Strain Impairment.

Rev Esp Cardiol (Engl Ed) 2018 Jul 14;71(7):524-530. Epub 2017 Nov 14.

Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. Electronic address:

Introduction And Objectives: Subclinical systolic dysfunction is one of the proposed mechanisms for increased cardiovascular risk associated with metabolic syndrome (MS). This study investigated the association between MS and impaired left ventricular global longitudinal strain (GLS) and the role of each MS criteria in this association.

Methods: We analyzed a random sample of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) after excluding participants with prevalent heart disease.

Results: Among the 1055 participants fulfilling the inclusion criteria (53% women; 52±9 years), 444 (42%) had MS. Those with MS had worse GLS (-18.0%±2.5%) than those without (-19.0%±2.4%; P<.0001). In multiple linear regression models, MS was associated with worse GLS after adjustment for various risk factors (GLS difference=0.86%; P <.0001), even after inclusion of body mass index. Adjusted PR for impaired GLS as assessed by 3 cutoffs (1, 1.5, and 2 standard deviations) were higher among participants with than without MS: GLS -16.1% (PR, 1.76; 95%CI, 1.30-2.39); GLS -14.8% (PR, 2.35; 95%CI, 1.45-3.81); and GLS -13.5% (PR, 2.07; 95%CI, 0.97-4.41). After inclusion of body mass index in the models, these associations were attenuated, suggesting that they may, at least in part, be mediated by obesity. In quantile regression analyses, elevated waist circumference was the only MS component found to be independently associated with GLS across the whole range of values.

Conclusions: Metabolic syndrome is independently associated with impaired GLS. Among the MS criteria, central obesity best depicted the link between metabolic derangement and cardiac function.
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http://dx.doi.org/10.1016/j.rec.2017.10.008DOI Listing
July 2018

Echocardiographic Left Ventricular Reverse Remodeling After 18 Months of Antihypertensive Treatment in Stage I Hypertension. Results From the Prever-Treatment Study.

Am J Hypertens 2018 02;31(3):321-328

Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Antihypertensive treatment improves echocardiographic parameters of hypertensive target organ damage in stage II hypertension, but less is known about the effects in stage I hypertension.

Methods: In a cohort study nested in the randomized double-blind trial PREVER-treatment, 2-dimensional echocardiograms were performed in 110 individuals, aged 54.8 ± 7.9 years-old, with stage I hypertension at baseline and after 18 months of treatment with chlorthalidone/amiloride or losartan.

Results: At baseline, 66 (60%) participants had concentric remodeling. After antihypertensive treatment, systolic (SBP) and diastolic blood pressure (BP) were reduced from 141/90 to 130/83 mm Hg (P = 0.009). There was a significant reduction in left ventricular (LV) mass (LVM) index (82.7 ± 17.1 to 79.2 ± 17.5 g/m2; P = 0.005) and relative wall thickness (0.45 ± 0.06 to 0.42 ± 0.05; P < 0.001), increasing the proportion of participants with normal LV geometry (31% to 49%, P = 0.006). Left atrial (LA) volume index reduced (26.8 ± 7.3 to 24.9 ± 6.5 ml/m2; P = 0.001), and mitral E-wave deceleration time increased (230 ± 46 to 247 ± 67 ms; P = 0.005), but there was no change in other parameters of diastolic function. LVM reduction was significantly higher in the 2 higher tertiles of SBP reduction compared to the lower tertile.

Conclusions: Treatment of patients with stage I hypertension for 18 months promotes favorable effects in the LA and LV remodeling. This improvement in cardiac end-organ damage might be associated with reduction of long term clinical consequences of hypertensive cardiomyopathy, particularly heart failure with preserved ejection fraction.
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http://dx.doi.org/10.1093/ajh/hpx171DOI Listing
February 2018

Electrocardiographic Findings in Brazilian Adults without Heart Disease: ELSA-Brasil.

Arq Bras Cardiol 2017 Nov 2;109(5):416-424. Epub 2017 Oct 2.

Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG - Brazil.

Background: The electrocardiogram (ECG) is widely used in population-based studies. However, there are few studies on electrocardiographic findings in Latin America and in Brazil. The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) comprised 15,105 participants (35-74 years) from six Brazilian capitals.

Objectives: To describe electrocardiographic findings in Brazilian adults without heart disease, stratified by sex, age and race/skin color.

Methods: Cross-sectional study with baseline data of 11,094 adults (44.5% men) without heart disease from ELSA-Brasil. The ECGs were recorded with the Burdick Atria 6100 machine and stored at the Pyramis System. ECG analysis was automatically performed using the Glasgow University software. A descriptive analysis of heart rate (HR), P, QRS and T waves' duration, PR and QT intervals, and P, R and T axes was performed. After stratification by sex, race/color and age, the groups were compared by the Wilcoxon and Kruskal-Wallis test at a significance level of 5%. Linear regression models were used to evaluate the behavior of electrocardiographic parameters over age. Major electrocardiographic abnormalities defined by the Minnesota code were manually revised.

Results: Medians values of the electrocardiographic parameters were different between men and women: HR 63 vs. 66 bpm, PR 164 vs.158 ms, QT corrected 410 vs. 421 ms, QRS duration 92 vs. 86 ms, P-wave duration 112 vs. 108 ms, P-wave axis 54 vs. 57 degrees, R-wave axis 35 vs. 39 degrees, T-wave axis 39 vs. 45 degrees (p < 0.001 for all). The 2nd and the 98th percentiles of each variable were also obtained, and graphs were constructed to illustrate the behavior of the electrocardiographic findings over age of participants stratified by sex and race/skin color.

Conclusions: The values for the electrocardiographic measurements herein described can be used as reference for Brazilian adults free of heart disease, stratified by sex. Our results suggest that self-reported race/skin color have no significant influence on electrocardiographic parameters.
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http://dx.doi.org/10.5935/abc.20170146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5729777PMC
November 2017

Measuring Left Ventricular Size in Non-Electrocardiographic-gated Chest Computed Tomography: What Radiologists Should Know.

J Thorac Imaging 2018 Mar;33(2):81-87

Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.

Non-electrocardiographic (ECG)-gated computed tomography (CT) of the chest is one of the most commonly performed imaging studies. Although the heart is included in every CT study, cardiac findings are commonly underreported in radiology reports. Left ventricular size is one of the most important prognostic markers in multiple cardiac diseases and can be measured on almost all non-ECG-gated multidetector chest CT studies. This review will discuss the available evidence on different measurements of left ventricular size obtained on non-ECG-gated CT of the chest. Measurement thresholds, technical issues, and potential problems are emphasized, with practical recommendations.
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http://dx.doi.org/10.1097/RTI.0000000000000275DOI Listing
March 2018

Thyrotrophin levels and coronary artery calcification: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Clin Endocrinol (Oxf) 2017 Nov 6;87(5):597-604. Epub 2017 Jul 6.

Centro de Pesquisa Clínica, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil.

Objective: There is little information about the association between thyrotrophin (TSH) levels and coronary artery calcification (CAC). Our aim was to analyse the association between TSH quintiles and subclinical atherosclerosis measured by CAC, using baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Design: Cross-sectional study.

Patients: We excluded individuals using medications that affect thyroid function and who self-reported cardiovascular disease. We included euthyroid subjects and individuals with subclinical hypothyroidism (SCHypo) and subclinical hyperthyroidism (SCHyper). Logistic regression models evaluated CAC >100 Agatston units as the dependent variable, and increasing quintiles of TSH as the independent variable, adjusted for demographic and cardiovascular risk factors.

Results: Our sample included 3836 subjects, mean age 49 years (interquartile range 44-56); 1999 (52.1%) were female, 3551 (92.6%) were euthyroid, 239 (6.2%) had SCHypo and 46 (1.2%) had SCHyper. The frequency of women, White people and never smokers as well as body mass index and insulin resistance increased according to quintiles. The 1st quintile for TSH (0-0.99 mIU/L) was associated with CAC >100, using the 3rd quintile (1.39-1.85 mIU/L) as reference (adjusted OR=1.57, 95% CI: 1.05-2.35, P=.027), but no association was shown for the 5th quintile (2.68-35.5 mIU/L) compared to the 3rd. Restricting the analysis to euthyroid subjects did not change the results. For women, but not for men, we observed a U-shaped curve with 1st and 5th TSH quintiles associated with CAC>100.

Conclusion: Low and low-normal (1st quintile) TSH levels were associated with CAC>100 Agatston units in a sample with subclinical thyroid disorders and euthyroid subjects.
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http://dx.doi.org/10.1111/cen.13393DOI Listing
November 2017

Major Electrocardiographic Abnormalities According to the Minnesota Coding System Among Brazilian Adults (from the ELSA-Brasil Cohort Study).

Am J Cardiol 2017 06 29;119(12):2081-2087. Epub 2017 Mar 29.

Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Brazil; Service of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, UFMG, Belo Horizonte, Brazil. Electronic address:

The electrocardiogram is a simple and useful clinical tool; nevertheless, few studies have evaluated the prevalence of electrocardiographic abnormalities in the Latin American population. This study aims to evaluate the major electrocardiographic abnormalities according to the Minnesota coding system in Brazilian adults, stratified by gender, age, race, and cardiovascular risk factors. Data from 14,424 adults (45.8% men, age 35 to 74 years) were obtained at baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), according to standardized protocol. The electrocardiogram were obtained with the Burdick Atria 6100 machine, stored on Pyramis System, automatically coded according to the Minnesota coding system by the Glasgow University software and then manually revised. Major abnormalities were more prevalent in men than women (11.3% and 7.9%, p <0.001). These differences were consistent through the different age groups, race, and number of cardiovascular risk factors. Electrocardiographic major abnormalities were more prevalent in black participants for both men (black: 15.1%, mixed: 10.4%, white: 11.1%, p = 0.001) and women (black: 10%, mixed: 7.6%, white: 7.2%, p = 0.004). In conclusion, in this large sample of Brazilian adults, the prevalence of major electrocardiographic abnormalities was higher among men, the elderly, black, and among people with more cardiovascular risk factors.
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http://dx.doi.org/10.1016/j.amjcard.2017.03.043DOI Listing
June 2017

Diffuse myocardial fibrosis in patients with mitral valve prolapse and ventricular arrhythmia.

Heart 2017 02 11;103(3):204-209. Epub 2016 Aug 11.

Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Objective: We aimed to investigate the association of diffuse myocardial fibrosis by cardiac magnetic resonance (CMR) T with complex ventricular arrhythmia (ComVA) in mitral valve prolapse (MVP).

Methods: A retrospective analysis was performed on 41 consecutive patients with MVP referred for CMR between 2006 and 2011, and 31 healthy controls. Arrhythmia analysis was available in 23 patients with MVP with Holter/event monitors. Left ventricular (LV) septal T times were derived from Look-Locker sequences after administration of 0.2 mmol/kg gadopentetate dimeglumine. Late gadolinium enhancement (LGE) CMR images were available for all subjects.

Results: Patients with MVP had significantly shorter postcontrast T times when compared with controls (334±52 vs 363±58 ms; p=0.03) despite similar LV ejection fraction (LVEF) (63±7 vs 60±6%, p=0.10). In a multivariable analysis, LV end-diastolic volume, LVEF and mitral regurgitation fraction were all correlates of T times, with LVEF and LV end-diastolic volume being the strongest (p=0.005, p=0.008 and p=0.045, respectively; model adjusted R=0.30). Patients with MVP with ComVA had significantly shorter postcontrast T times when compared with patients with MVP without ComVA (324 (296, 348) vs 354 (327, 376) ms; p=0.03) and only 5/14 (36%) had evidence of papillary muscle LGE.

Conclusions: MVP may be associated with diffuse LV myocardial fibrosis as suggested by reduced postcontrast T times. Diffuse interstitial derangement is linked to subclinical systolic dysfunction, and may contribute to ComVA in MVP-related mitral regurgitation, even in the absence of focal fibrosis.
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http://dx.doi.org/10.1136/heartjnl-2016-309303DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5237392PMC
February 2017

Age, Gender, and Race-Based Coronary Artery Calcium Score Percentiles in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Clin Cardiol 2016 Jun 15;39(6):352-9. Epub 2016 Apr 15.

Center for Clinical and Epidemiologic Research, University of São Paulo, São Paulo, Brazil.

Background: Coronary artery calcium (CAC) has been demonstrated to independently predict the risk of cardiovascular events and all-cause mortality, especially among White populations. Although the population distribution of CAC has been determined for several White populations, the distribution in ethnically admixed groups has not been well established.

Hypothesis: The CAC distribution, stratified for age, gender and race, is similar to the previously described distribution in the MESA study.

Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a prospective cohort study designed to investigate subclinical cardiovascular disease in 6 different centers of Brazil. Similar to previous studies, individuals with self-reported coronary or cerebrovascular disease and those treated for diabetes mellitus were excluded from analysis.

Results: Percentiles of CAC distribution were estimated with nonparametric techniques. The analysis included 3616 individuals (54% female; mean age, 50 years). As expected, CAC prevalence and burden were steadily higher with increasing age, as well as increased in men and in White individuals. Our results revealed that for a given CAC score, the ELSA-derived CAC percentile would be lower in men compared with the Multi-Ethnic Study of Atherosclerosis (MESA) and would be higher in women compared with MESA.

Conclusions: In our sample of the Brazilian population, we observed significant differences in CAC by sex, age, and race. Adjusted for age and sex, low-risk individuals from the Brazilian population present with significantly lower CAC prevalence and burden compared with other low-risk individuals from other worldwide populations. Using US-derived percentiles in Brazilian individuals may lead to overestimating relative CAC burden in men and underestimating relative CAC burden in women.
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http://dx.doi.org/10.1002/clc.22539DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6490802PMC
June 2016

Right Ventricular Volumes and Systolic Function by Cardiac Magnetic Resonance and the Impact of Sex, Age, and Obesity in a Longitudinally Followed Cohort Free of Pulmonary and Cardiovascular Disease: The Framingham Heart Study.

Circ Cardiovasc Imaging 2016 Mar;9(3):e003810

From the Department of Medicine, Cardiovascular Division (M.F., A.A., C.J.S., W.J.M., M.L.C.) and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (M.F.); Department of Medicine, Boston University School of Medicine, MA (G.A., D.L.); The National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, MA (P.G., S.J.B., D.L., C.J.O., M.L.C.); College of Nursing and Health Sciences, University of Massachusetts, Boston (P.G.); UpToDate, Wolters Kluwer Health, Waltham, MA (S.B.Y.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (C.J.O.); Harvard Medical School, Boston, MA (C.J.O., W.J.M.).

Background: Cardiac magnetic resonance is uniquely well suited for noninvasive imaging of the right ventricle. We sought to define normal cardiac magnetic resonance reference values and to identify the main determinants of right ventricular (RV) volumes and systolic function using a modern imaging sequence in a community-dwelling, longitudinally followed cohort free of clinical cardiovascular and pulmonary disease.

Methods And Results: The Framingham Heart Study Offspring cohort has been followed since 1971. We scanned 1794 Offspring cohort members using steady-state free precession cardiac magnetic resonance and identified a reference group of 1336 adults (64±9 years, 576 men) free of prevalent cardiovascular and pulmonary disease. RV trabeculations and papillary muscles were considered cavity volume. Men had greater RV volumes and cardiac output before and after indexation to body size (all P<0.001). Women had higher RV ejection fraction than men (68±6% versus 64±7%; P<0.0001). RV volumes and cardiac output decreased with advancing age. There was an increase in raw and height-indexed RV measurements with increasing body mass index, but this trend was weakly inverted after indexation of RV volumes to body surface area. Sex, age, height, body mass index, and heart rate account for most of the variability in RV volumes and function in this community-dwelling population.

Conclusions: We report sex-specific normative values for RV measurements among principally middle-aged and older adults. RV ejection fraction is greater in women. RV volumes increase with body size, are greater in men, and are smaller in older people. Body surface area seems to be appropriate for indexation of cardiac magnetic resonance-derived RV volumes.
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http://dx.doi.org/10.1161/CIRCIMAGING.115.003810DOI Listing
March 2016

Left ventricular native T1 time and the risk of atrial fibrillation recurrence after pulmonary vein isolation in patients with paroxysmal atrial fibrillation.

Int J Cardiol 2016 Jan 11;203:848-54. Epub 2015 Nov 11.

Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. Electronic address:

Background: Native T1 mapping has emerged as a noninvasive non-contrast magnetic resonance imaging (MRI) method to assess for diffuse myocardial fibrosis. However, LV native T1 time in AF patients and its clinical relevance are unclear.

Methods: Fifty paroxysmal AF patients referred for PVI (60 ± 8 years, 37 male) and 11 healthy control subjects (57 ± 8 years, 10 male) were studied. All patients were in sinus rhythm during the MRI scan. Native T1 mapping images were acquired using a Modified Look-Locker imaging (MOLLI) sequence in 3 short-axis planes (basal, mid and apical slices) using an electrocardiogram triggered single-shot acquisition with a balanced steady-state free precession readout. Late gadolinium enhanced (LGE) MRI was acquired to evaluate for LV myocardial scar.

Results: LV ejection fraction was similar between groups (AF: 61 ± 6%; controls: 60 ± 6%, p=0.75). No LV myocardial scar was observed in any patient on LGE. Myocardial native T1 time was greater in AF patients (1099 ± 52 vs 1042 ± 20 msec, p<0.001). During a median follow-up period of 326 days, 18 of 50 (36%) patients experienced recurrence of AF. Multivariate Cox proportional hazard analysis identified elevated native T1 time as an independent predictor of recurrence of AF (HR: 6.53, 95% CI: 1.25-34.3, p=0.026).

Conclusions: There are differences in the native LV myocardial T1 time between AF patients with preserved LV function referred for PVI and normal controls. Native T1 time is an independent predictor of recurrence of AF after PVI in patients with paroxysmal AF.
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http://dx.doi.org/10.1016/j.ijcard.2015.11.073DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734756PMC
January 2016

Epicardial fat thickness: distribution and association with diabetes mellitus, hypertension and the metabolic syndrome in the ELSA-Brasil study.

Int J Cardiovasc Imaging 2016 Apr 19;32(4):563-72. Epub 2015 Nov 19.

Postgraduate Studies Program in Epidemiology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

Epicardial fat thickness (EFT) has emerged as a marker of cardiometabolic risk, but its clinical use warrants proper knowledge of its distribution and associations in populations. We aimed to describe the distribution of EFT, its demographic correlates and independent associations with diabetes, hypertension and metabolic syndrome (MS) in free-living Brazilian adults. From the baseline echocardiography of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)-a cohort study of civil servants aged 35-74 years-EFT was measured from a randomly selected sample of 998 participants as the mean of two paraesternal windows obtained at end systole (EFTsyst) and end diastole (EFTdiast). From the 421 individuals free of diabetes, hypertension and MS, we defined EFT reference values and the EFTsyst 75th percentile cut-off. Median EFTsyst was 1.5 (IQR 0-2.6) mm; a large proportion (84 %) had EFTdiast = 0. EFT was higher in women and lower in blacks, and increased with age and BMI. Although EFT was higher in those with diabetes, hypertension, and MS, EFT associations were reduced when adjusted for age, sex and ethnicity, and were non-significant after adjusting for obesity measures. In conclusion, the amount of EFT in this large multiethnic population is smaller than reported in other populations. EFT reference values varied across demographic and clinical variables, EFT associations with cardiometabolic variables being largely explained by age, sex, ethnicity and central obesity. Although EFT can help identify individuals at increased cardiometabolic risk, it will likely have a limited additional role compared to current risk stratification strategies.
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http://dx.doi.org/10.1007/s10554-015-0810-zDOI Listing
April 2016

Splenic Switch-Off for Stress Cardiovascular MR Imaging and Dipyridamole.

Radiology 2015 Nov;277(2):613-4

Cardiology, † de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

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http://dx.doi.org/10.1148/radiol.2015151067DOI Listing
November 2015

Doppler echocardiography in the evaluation of a heart murmur.

JAMA 2015 Mar;313(10):1050-1

Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts3Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.

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http://dx.doi.org/10.1001/jama.2015.1278DOI Listing
March 2015

Whole heart coronary imaging with flexible acquisition window and trigger delay.

PLoS One 2015 26;10(2):e0112020. Epub 2015 Feb 26.

Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, United States of America.

Coronary magnetic resonance imaging (MRI) requires a correctly timed trigger delay derived from a scout cine scan to synchronize k-space acquisition with the quiescent period of the cardiac cycle. However, heart rate changes between breath-held cine and free-breathing coronary imaging may result in inaccurate timing errors. Additionally, the determined trigger delay may not reflect the period of minimal motion for both left and right coronary arteries or different segments. In this work, we present a whole-heart coronary imaging approach that allows flexible selection of the trigger delay timings by performing k-space sampling over an enlarged acquisition window. Our approach addresses coronary motion in an interactive manner by allowing the operator to determine the temporal window with minimal cardiac motion for each artery region. An electrocardiogram-gated, k-space segmented 3D radial stack-of-stars sequence that employs a custom rotation angle is developed. An interactive reconstruction and visualization platform is then employed to determine the subset of the enlarged acquisition window for minimal coronary motion. Coronary MRI was acquired on eight healthy subjects (5 male, mean age = 37 ± 18 years), where an enlarged acquisition window of 166-220 ms was set 50 ms prior to the scout-derived trigger delay. Coronary visualization and sharpness scores were compared between the standard 120 ms window set at the trigger delay, and those reconstructed using a manually adjusted window. The proposed method using manual adjustment was able to recover delineation of five mid and distal right coronary artery regions that were otherwise not visible from the standard window, and the sharpness scores improved in all coronary regions using the proposed method. This paper demonstrates the feasibility of a whole-heart coronary imaging approach that allows interactive selection of any subset of the enlarged acquisition window for a tailored reconstruction for each branch region.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0112020PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342264PMC
November 2015

Reproducibility of left ventricular mass by echocardiogram in the ELSA-Brasil.

Arq Bras Cardiol 2015 Feb 28;104(2):104-11. Epub 2014 Nov 28.

Programa de Pós-Graduação em Epidemiologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Background: Echocardiography, though non-invasive and having relatively low-cost, presents issues of variability which can limit its use in epidemiological studies.

Objective: To evaluate left ventricular mass reproducibility when assessed at acquisition (online) compared to when assessed at a reading center after electronic transmission (offline) and also when assessed by different readers at the reading center.

Methods: Echocardiographers from the 6 ELSA-Brasil study investigation centers measured the left ventricular mass online during the acquisition from 124 studies before transmitting to the reading center, where studies were read according to the study protocol. Half of these studies were blindly read by a second reader in the reading center.

Results: From the 124 echocardiograms, 5 (4%) were considered not measurable. Among the remaining 119, 72 (61%) were women, mean age was 50.2 ± 7.0 years and 2 had structural myocardial abnormalities. Images were considered to be optimal/ good by the reading center for 110 (92.4%) cases. No significant difference existed between online and offline measurements (1,29 g, CI 95% -3.60-6.19), and the intraclass correlation coefficient between them was 0.79 (CI 95% 0.71-0.85). For images read by two readers, the intraclass correlation coefficient was 0.86 (CI 95% 0.78-0.91).

Conclusion: There were no significant drifts between online and offline left ventricular mass measurements, and reproducibility was similar to that described in previous studies. Central quantitative assessment of echocardiographic studies in reading centers, as performed in the ELSA-Brasil study, is feasible and useful in clinical and epidemiological studies performed in our setting.
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http://dx.doi.org/10.5935/abc.20140183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375653PMC
February 2015

Accelerated free breathing ECG triggered contrast enhanced pulmonary vein magnetic resonance angiography using compressed sensing.

J Cardiovasc Magn Reson 2014 Nov 22;16:91. Epub 2014 Nov 22.

Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston 02215, MA, USA.

Background: To investigate the feasibility of accelerated electrocardiogram (ECG)-triggered contrast enhanced pulmonary vein magnetic resonance angiography (CE-PV MRA) with isotropic spatial resolution using compressed sensing (CS).

Methods: Nineteen patients (59±13 y, 11 M) referred for MR were scanned using the proposed accelerated free breathing ECG-triggered 3D CE-PV MRA sequence (FOV=340×340×110 mm3, spatial resolution=1.5×1.5×1.5 mm3, acquisition window=140 ms at mid diastole and CS acceleration factor=5) and a conventional first-pass breath-hold non ECG-triggered 3D CE-PV MRA sequence. CS data were reconstructed offline using low-dimensional-structure self-learning and thresholding reconstruction (LOST) CS reconstruction. Quantitative analysis of PV sharpness and subjective qualitative analysis of overall image quality were performed using a 4-point scale (1: poor; 4: excellent).

Results: Quantitative PV sharpness was increased using the proposed approach (0.73±0.09 vs. 0.51±0.07 for the conventional CE-PV MRA protocol, p<0.001). There were no significant differences in the subjective image quality scores between the techniques (3.32±0.94 vs. 3.53±0.77 using the proposed technique).

Conclusions: CS-accelerated free-breathing ECG-triggered CE-PV MRA allows evaluation of PV anatomy with improved sharpness compared to conventional non-ECG gated first-pass CE-PV MRA. This technique may be a valuable alternative for patients in which the first pass CE-PV MRA fails due to inaccurate first pass timing or inability of the patient to perform a 20-25 seconds breath-hold.
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http://dx.doi.org/10.1186/s12968-014-0091-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240816PMC
November 2014

Carotid intima-media thickness value distributions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).

Atherosclerosis 2014 Nov 9;237(1):227-35. Epub 2014 Sep 9.

Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo, São Paulo, Brazil.

Objective: Carotid intima-media thickness (IMT) is a noninvasive measurement of early atherosclerosis. Most IMT studies have involved populations with low rates of racial blending. The aim of the present article is to describe IMT value distributions and analyze the influence of sex and race on IMT values in a large Brazilian sample, a setting with a high rate of racial admixture.

Methods: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a multicenter cohort of 15,105 adult (aged 35-74 years) civil servants in six Brazilian cities. Baseline assessment included IMT measurements in both common carotid arteries. Race was self-reported. We studied the association between sex and race with IMT values using multiple linear regression models. We conducted analyses in all and low-risk individuals, defined as those without classical cardiovascular risk factors.

Results: We analyzed complete IMT data from 10,405 ELSA-Brasil participants. We present nomograms by age for all and low-risk individuals, stratified by sex and race. We found that men had significantly higher maximal IMT values compared with women (β = 0.058; P < 0.001). This association remained for low-risk individuals (β = 0.027; P = 0.001). In addition, Brown and White individuals had lower maximal IMT values compared with Black individuals for all (β = -0.034 and β = -0.054, respectively; P < 0.001) and low-risk individuals (β = -0.027; P = 0.013 and β = -0.035; P < 0.001, respectively).

Conclusion: We found significantly higher IMT values in men. We found significantly higher IMT values in Black individuals than White and Brown individuals. These results persisted when analyses were restricted to low-risk individuals.
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http://dx.doi.org/10.1016/j.atherosclerosis.2014.09.004DOI Listing
November 2014

Accelerated cardiac MR stress perfusion with radial sampling after physical exercise with an MR-compatible supine bicycle ergometer.

Magn Reson Med 2015 Aug 8;74(2):384-95. Epub 2014 Aug 8.

Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.

Purpose: To evaluate the feasibility of accelerated cardiac MR (CMR) perfusion with radial sampling using nonlinear image reconstruction after exercise on an MR-compatible supine bike ergometer.

Methods: Eight healthy subjects were scanned on two separate days using radial and Cartesian CMR perfusion sequences in rest and exercise stress perfusion. Four different methods (standard gridding, conjugate gradient SENSE [CG-SENSE], nonlinear inversion with joint estimation of coil-sensitivity profiles [NLINV] and compressed sensing with a total variation constraint [TV]) were compared for the reconstruction of radial data. Cartesian data were reconstructed using SENSE. All images were assessed by two blinded readers in terms of image quality and diagnostic value.

Results: CG-SENSE and NLINV were scored more favorably than TV (in both rest and stress perfusion cases, P < 0.05) and gridding (for rest perfusion cases, P < 0.05). TV images showed patchy artifacts, which negatively influenced image quality especially in the stress perfusion images acquired with a low number of radial spokes. Although CG-SENSE and NLINV received better scores than Cartesian sampling in both rest and exercise stress perfusion cases, these differences were not statistically significant (P > 0.05).

Conclusion: We have demonstrated the feasibility of accelerated CMR perfusion using radial sampling after physical exercise using a supine bicycle ergometer in healthy subjects. For reconstruction of undersampled radial perfusion, CG-SENSE and NLINV resulted in better image quality than standard gridding or TV reconstruction. Further technical improvements and clinical assessment are needed before using this approach in patients with suspected coronary artery disease.
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http://dx.doi.org/10.1002/mrm.25405DOI Listing
August 2015

Tumorlike cardiac fungal mycetoma caused by Scedosporium apiospermum presenting as symptomatic ventricular tachycardia.

Circulation 2014 May;129(19):e488-9

From Cardiology, Radiology, and Infectious Divisions, Hospital de Clinicas de Porto Alegre, Internal Medicine Department, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

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http://dx.doi.org/10.1161/CIRCULATIONAHA.114.009162DOI Listing
May 2014

Adaptive registration of varying contrast-weighted images for improved tissue characterization (ARCTIC): application to T1 mapping.

Magn Reson Med 2015 Apr 5;73(4):1469-82. Epub 2014 May 5.

Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.

Purpose: To propose and evaluate a novel nonrigid image registration approach for improved myocardial T1 mapping.

Methods: Myocardial motion is estimated as global affine motion refined by a novel local nonrigid motion estimation algorithm. A variational framework is proposed, which simultaneously estimates motion field and intensity variations, and uses an additional regularization term to constrain the deformation field using automatic feature tracking. The method was evaluated in 29 patients by measuring the DICE similarity coefficient and the myocardial boundary error in short axis and four chamber data. Each image series was visually assessed as "no motion" or "with motion." Overall T1 map quality and motion artifacts were assessed in the 85 T1 maps acquired in short axis view using a 4-point scale (1-nondiagnostic/severe motion artifact, 4-excellent/no motion artifact).

Results: Increased DICE similarity coefficient (0.78 ± 0.14 to 0.87 ± 0.03, P < 0.001), reduced myocardial boundary error (1.29 ± 0.72 mm to 0.84 ± 0.20 mm, P < 0.001), improved overall T1 map quality (2.86 ± 1.04 to 3.49 ± 0.77, P < 0.001), and reduced T1 map motion artifacts (2.51 ± 0.84 to 3.61 ± 0.64, P < 0.001) were obtained after motion correction of "with motion" data (∼56% of data).

Conclusions: The proposed nonrigid registration approach reduces the respiratory-induced motion that occurs during breath-hold T1 mapping, and significantly improves T1 map quality.
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http://dx.doi.org/10.1002/mrm.25270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221574PMC
April 2015

Regarding effects of bariatric surgery on left ventricular mass index and geometry.

Am J Hypertens 2014 Jul 2;27(7):991-2. Epub 2014 May 2.

Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.

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http://dx.doi.org/10.1093/ajh/hpu054DOI Listing
July 2014

Accuracy, precision, and reproducibility of four T1 mapping sequences: a head-to-head comparison of MOLLI, ShMOLLI, SASHA, and SAPPHIRE.

Radiology 2014 Sep 4;272(3):683-9. Epub 2014 Apr 4.

From the Departments of Medicine (Cardiovascular Division) (S.R., S.W., M.F., K.K., L.H.N., W.J.M., R.N.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center and Harvard Medical School, 300 Brookline Ave, Boston, MA 02215; Department of Biomedical Engineering, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (K.C., R.B.T.); and National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (P.K.).

Purpose: To compare accuracy, precision, and reproducibility of four commonly used myocardial T1 mapping sequences: modified Look-Locker inversion recovery (MOLLI), shortened MOLLI (ShMOLLI), saturation recovery single-shot acquisition (SASHA), and saturation pulse prepared heart rate independent inversion recovery (SAPPHIRE).

Materials And Methods: This HIPAA-compliant study was approved by the institutional review board. All subjects provided written informed consent. Accuracy, precision, and reproducibility of the four T1 mapping sequences were first compared in phantom experiments. In vivo analysis was performed in seven healthy subjects (mean age ± standard deviation, 38 years ± 19; four men, three women) who were imaged twice on two separate days. In vivo reproducibility of native T1 mapping and extracellular volume (ECV) were measured. Differences between the sequences were assessed by using Kruskal-Wallis and Wilcoxon rank sum tests (phantom data) and mixed-effect models (in vivo data).

Results: T1 mapping accuracy in phantoms was lower with ShMOLLI (62 msec) and MOLLI (44 msec) than with SASHA (13 msec; P < .05) and SAPPHIRE (12 msec; P < .05). MOLLI had similar precision to ShMOLLI (4.0 msec vs 5.6 msec; P = .07) but higher precision than SAPPHIRE (6.8 msec; P = .002) and SASHA (8.7 msec; P < .001). All sequences had similar reproducibility in phantoms (P = .1). The four sequences had similar in vivo reproducibility for native T1 mapping (∼25-50 msec; P > .05) and ECV quantification (∼0.01-0.02; P > .05).

Conclusion: SASHA and SAPPHIRE yield higher accuracy, lower precision, and similar reproducibility compared with MOLLI and ShMOLLI for T1 measurement. Different sequences yield different ECV values; however, all sequences have similar reproducibility for ECV quantification.
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http://dx.doi.org/10.1148/radiol.14140296DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263641PMC
September 2014
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