Publications by authors named "Shihua Zhao"

132 Publications

Prognostic significance of myocardial fibrosis and CMR characteristics in bicuspid aortic valve with moderate and severe aortic insufficiency.

Eur Radiol 2021 Apr 16. Epub 2021 Apr 16.

MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road No 167, Xicheng District, 100037, Beijing, China.

Objectives: This study attempted to evaluate the characteristics and prognostic value of myocardial fibrosis (MF) in aortic insufficiency (AI) patients with bicuspid aortic valve (BAV) or tricuspid aortic valve (TAV) by cardiac magnetic resonance (CMR).

Methods: A total of 314 adults with CMR-diagnosed AI were retrospectively retrieved. Of them, 166 patients with moderate or severe AI were included and divided into two groups: BAV group (N = 46) and a TAV group (N = 120). The presence and characteristics of MF were assessed with CMR. The patients were followed for adverse clinical events. The prognostic capability of the parameters was assessed using Cox regression model.

Results: LV fibrosis was more common in the BAV group than in the TAV group (65.2% vs. 45.0%; p = 0.020). There was a strong association between BAV and MF even after adjusting for clinical and imaging variables (odds ratio: 3.57; p = 0.031). Kaplan-Meier analysis showed a higher rate of clinical adverse events in AI+BAV patients with MF during a median follow-up of 4.7 years. Multivariate Cox regression analysis showed that late gadolinium enhancement (LGE) was an independent predictor of clinical adverse outcome.

Conclusion: MF is more common in AI with BAV than with TAV and is a predictor of clinical adverse events.

Key Points: • The presence and extent of late gadolinium enhancement of left ventricular were more common and severer in the bicuspid aortic valve group than in the tricuspid aortic valve group in aortic insufficiency patients. • Bicuspid aortic valve was an independent factor for myocardial fibrosis in aortic insufficiency patients. • Late gadolinium enhancement could be used as an independent predictor of adverse clinical events in this population.
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http://dx.doi.org/10.1007/s00330-021-07823-yDOI Listing
April 2021

Left ventricular involvement assessed by LGE-CMR in predicting the risk of adverse outcomes of Arrhythmogenic cardiomyopathy with ICDs.

Int J Cardiol 2021 Apr 8. Epub 2021 Apr 8.

Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.

Background Arrhythmogenic cardiomyopathy (ACM) is characterized by a high incidence of ventricular tachyarrhythmia and sudden death. Implantable cardioverter-defibrillator (ICD) implantation is the cornerstone of management. Objective This study aims to reveal the prognostic value of the contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) amount in predicting varying lethal outcomes among ACM patients with ICDs. Methods The 88 patients with definite ACM who were all referred for contrast-enhanced CMR received an ICD and were followed up for a median of 4.0 years. Results Fifty-four patients had no left ventricular (LV) involvement and sixteen had an LV LGE amount > 15%. During the follow-up time, appropriate ICD therapy was seen in 57, electrical storm (ES) in 19, and cardiac death in 9 patients. Compared with those without LV involvement, patients with LV LGE amount > 15% had a higher risk of cardiac death (log-rank P = 0.021). LV LGE amount was associated with an increased risk of ICD therapy [adjusted hazard ratio (HR) 1.035, 95% confidence interval (CI) 1.008-1.062, P = 0.010], and cardiac death (adjusted HR 1.082, 95% 1.006-1.164, P = 0.034), independently of LV ejection fraction. LV LGE mass of >15% demonstrated an over 2-fold increase in ICD therapy (adjusted HR 2.180, 95%CI 1.058-4.488, P = 0.035) and an over 7-fold increase in cardiac death (unadjusted HR 7.198, 95%CI 1.399-37.043, P = 0.018) than those without LV involvement, respectively. Conclusions The LV LGE-CMR in ACM shows a dose-dependent association with ICD therapy and cardiac death. And LV LGE amount of >15% is a strong predictor.
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http://dx.doi.org/10.1016/j.ijcard.2021.04.015DOI Listing
April 2021

MRI Characteristics, Prevalence, and Outcomes of Hypertrophic Cardiomyopathy with Restrictive Phenotype.

Radiol Cardiothorac Imaging 2020 Aug 13;2(4):e190158. Epub 2020 Aug 13.

Department of Magnetic Resonance Imaging (S.L., B.W., G.Y., S.Z., M.L.), Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., G.Y.); Department of Cardiology (L.S.), Department of Echocardiography (Y.J.), and Heart-Lung Testing Center (J.H.), State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China; and Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China (B.W.).

Purpose: To investigate the MRI characteristics, prevalence, and outcomes of hypertrophic cardiomyopathy (HCM) with restrictive phenotype.

Materials And Methods: A total of 2592 consecutive patients with HCM were evaluated to identify individuals who fulfilled the diagnostic criteria of restrictive phenotype. Thirty-four patients with HCM (mean age, 41 years ± 16 [standard deviation]; range, 21-62 years, 16 men) with restrictive phenotype were retrospectively identified. Thirty-four patients with HCM with the same age and sex distributions were randomly selected as a control group. Kaplan-Meier survival curves were compared using log-rank statistics for survival analysis.

Results: The anteroposterior diameters of the left and right atria were 55 mm ± 5 and 61 mm ± 9, respectively, which were larger than those of the control group ( < .001). The maximum wall thickness in the restrictive group was lower than that in the control group (16 mm ± 2 vs 19 mm ± 3, < .001). No significant difference was found in late gadolinium enhancement fraction between the restricted phenotype and the control group (15% ± 8 vs 13% ± 7, = .376). The 5-year event-free survival from any cause of death and cardiac transplantation was 81% in the restrictive group, compared with 94% in the control group (log-rank = .018).

Conclusion: Restrictive phenotype is a rare subtype of HCM and is associated with severe clinical symptoms and poor prognosis. The MRI features of this phenotype include mild to moderate left ventricular hypertrophy, markedly enlarged atria, moderate myocardial fibrosis, and pericardial effusion.© RSNA, 2020.
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http://dx.doi.org/10.1148/ryct.2020190158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977807PMC
August 2020

Surgical septal myectomy outcome for obstructive hypertrophic cardiomyopathy after alcohol septal ablation.

J Thorac Dis 2021 Feb;13(2):1055-1065

Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Although surgical treatment of residual obstruction after alcohol septal ablation (ASA) is often challenging in patients with obstructive hypertrophic cardiomyopathy (OHCM) there are very few relevant clinical reports. Thus, outcomes of surgical septal myectomy (SSM) in this subgroup of patients remain to be determined. Therefore, this study aimed to determine the surgical and follow-up outcomes in patients with OHCM exhibiting residual obstruction after ASA.

Methods: We collected case data for 62 patients with OHCM and residual obstruction after ASA who underwent SSM at Fuwai Hospital between January 2002 and June 2019. Propensity score matching with patients having had a myectomy as the only invasive procedure-was conducted in a 1:2 ratio. Echocardiography parameters, surgery results, and follow-up outcomes were compared between the groups.

Results: The prior ASA group had a higher incidence of complete atrioventricular block (AVB) and subsequently postoperative permanent pacemaker (PPM) implantation than the primary myectomy group (9.7% 1.6%, P=0.01). Two patients died within 30 days after surgery in the prior ASA group, and one patient died in the primary myectomy group, with an operative mortality rate of 3.2% and 0.8%, respectively (P=0.2). The 5-year event-free survival rate was 86.0% in the prior ASA group (median follow-up period: 3.2 years; mean: 3.9±2.6 years; maximum, 10.6 years) and 88.5% in the primary myectomy group (median follow-up period: 2.4 years; mean 2.8±1.7 years; maximum, 9.1 years) (P=0.2). During follow-up, four of 62 (6.5%) patients in the prior ASA group and one of 124 (0.8%) patients in the primary myectomy group progressed to advanced heart failure (P=0.025).

Conclusions: Patients with OHCM following ASA are at an increased risk of developing AVB after SSM. Their surgical outcomes, and long-term survival rate were satisfactory and, osimilar to those for patients having had a myectomy as the only invasive procedure. In addition, they had an increased risk of advanced heart failure after SSM in the present study.
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http://dx.doi.org/10.21037/jtd-20-2779DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947546PMC
February 2021

Late gadolinium enhancement characteristics in giant cell myocarditis.

ESC Heart Fail 2021 Mar 2. Epub 2021 Mar 2.

MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.

Aims: This study aims to demonstrate the characteristics of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance (CMR) imaging in patients with giant cell myocarditis (GCM).

Methods And Results: Six patients histologically diagnosed with GCM were retrospectively recruited in this study. All of them underwent CMR during hospitalization. The distribution and extent of LGE were assessed on both ventricles, and the AHA-17 segment model was used for left ventricular (LV) analysis. Nine case reports with CMR in GCM were reviewed and summarized to investigate the features of LGE further. LGE was detected on both ventricular walls in all subjects. For a detailed analysis of LGE in the LV, the extent ranged from 21.6% to 56%. Among 70 segments (68.6%) involved by LGE, the subendocardial LGE was the most common pattern (46/102, including 24 segments located in the right-sided septum), followed by the subepicardial pattern (23/102). The right-sided septum, the subepicardial anterior wall, and the subendocardial right ventricular (RV) wall were observed in all subjects. To summarize the results of the present study with these case reports, the three most common patterns of LGE are the right-sided septum (73%), the subepicardial anterior wall (60%), and the subendocardial RV wall (53%).

Conclusions: Extensive LGE seems to be common in GCM, affecting both LV and RV walls. Apart from subepicardial LGE, subendocardial LGE, which was used to be implicated in ischaemic disease, was frequently presented in GCM. The right-sided subendocardial septum, the subepicardial anterior wall, and the subendocardial RV wall might be the vulnerable areas of LGE in GCM.
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http://dx.doi.org/10.1002/ehf2.13276DOI Listing
March 2021

Change in the Single Amino Acid Site 83 in Rabies Virus Glycoprotein Enhances the BBB Permeability and Reduces Viral Pathogenicity.

Front Cell Dev Biol 2020 9;8:632957. Epub 2021 Feb 9.

The State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, School of Life Sciences, Inner Mongolia University, Hohhot, China.

Lab-attenuated rabies virus (RABV) is a highly cellular adaptation and less pathogenic than wild-type RABV. However, the molecular mechanisms that regulate the cellular adaptation and pathogenicity remain obscure. In this work, we isolated a wild-type RABV (CNIM1701) from a rabid bovine in northern China. The original CNIM1701 was lethal in adult mice and restricted replication in cell cultures. After 20 serial passages in the brains of suckling mice, the virus was renamed CNIM1701-P20, which was safe in adult mice and replicated well in cell cultures. In addition, sequence comparison analysis of the original CNIM1701 and CNIM1701-P20 identified 2 amino acid substitutions on G protein (Lys83 → Arg83 and Pro367 → Ser 367) related to pathogenesis and cellular adaptation. Using site-directed mutagenesis to exchange Lys83 with Arg83 and Pro367 with Ser 367 in the G protein of the RABV SAD strain, the pathogenicity of rSAD-K83R was significantly decreased. Our data indicate that the decreased pathogenicity of rSAD-K83R is due to increasing the expression of RABV-G, which also induced a higher level of apoptosis in infected cells. Furthermore, the K83 mutation induced high expression of MMP-2 and MMP-9 on DCs and promoted blood-brain barrier (BBB) permeability. These results demonstrate that the pathogenesis of RABV is partially dependent on G expression and BBB permeability, which may help in the design and development of highly safe, live-RABV vaccines.
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http://dx.doi.org/10.3389/fcell.2020.632957DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900495PMC
February 2021

The Clinical Prognosis of Presence and Location of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Imaging in Patients with Hypertrophic Cardiomyopathy: a Single-Center Cohort Study.

J Cardiovasc Transl Res 2021 Feb 24. Epub 2021 Feb 24.

Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People's Republic of China.

Increasing data have indicated that late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR) images is associated with the clinical prognosis of hypertrophic cardiomyopathy (HCM). Recently, pioneer studies indicated that the location of LGE in CMR images also had potential predictive value for HCM prognosis. The aim of the present study was to investigate the prognostic value of the location of LGE for HCM. This present cohort study included 557 HCM patients who underwent LGE-CMR imaging, and the LGE location was classified as LGE in interventricular septum only (IVS-LGE) and LGE outside the IVS with or without IVS involvement (other than IVS-LGE). All-cause mortality, cardiovascular mortality/cardiac transplantation, and sudden cardiac death (SCD) were evaluated. During a mean follow-up time of 83.0±37.8 months, there was a significantly higher all-cause mortality, cardiovascular mortality/cardiac transplantation, and SCD in patients with other than IVS-LGE than in those with IVS-LGE. Multivariate Cox regression suggested that other than IVS-LGE were one of independent prognostic predictors. Risk reclassification for prognosis showed that there were no differences between the prediction values of the presence of LGE and the location of LGE. The presence and location of LGE in CMR images are equally independent prognostic predictors of HCM, and other than IVS-LGE location is associated with an adverse clinical prognosis. Prognosis Trial Registration: ChiCTR-ONRC-11001902.
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http://dx.doi.org/10.1007/s12265-021-10107-xDOI Listing
February 2021

The Prognostic Value of Myocardial Injury in COVID-19 Patients and Associated Characteristics.

Res Sq 2021 Feb 19. Epub 2021 Feb 19.

Since December 2019, Coronavirus disease 2019 (COVID-19) has emerged as an international pandemic. COVID-19 patients with myocardial injury might need special attention. However, understanding on this aspect remains unclear. This study aimed to illustrate clinical characteristics and the prognostic value of myocardial injury to COVID-19 patients. This retrospective, single-center study finally included 304 hospitalized COVID-19 cases confirmed by real-time RT-PCR from January 11 to March 25, 2020. Myocardial injury was determined by serum high-sensitivity troponin I (Hs-TnI). The primary endpoint was COVID-19 associated mortality. Of 304 COVID-19 patients (median age, 65 years; 52.6% males), 88 patients (27.3%) died (61 patients with myocardial injury, 27 patients without myocardial injury on admission). COVID-19 patients with myocardial injury had more comorbidities (hypertension, chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease); lower lymphocyte counts, higher C-reactive protein (CRP, median, 84.9 vs 28.5 mg/L, p<0.001), procalcitonin levels (median, 0.29 vs 0.06 ng/ml, p<0.001), inflammatory and immune response markers; more frequent need for noninvasive ventilation, invasive mechanical ventilation; and was associated with higher mortality incidence (hazard ratio, HR=7.02, 95% confidence interval, CI, 4.45-11.08, p<0.001) than those without myocardial injury. Myocardial injury (HR=4.55, 95% CI, 2.49-8.31, p<0.001), senior age, CRP levels, and novel coronavirus pneumonia (NCP) types on admission were independent predictors to mortality in COVID-19 patients. COVID patients with myocardial injury on admission is associated with more severe clinical presentation and biomarkers. Myocardial injury and higher HsTNI are both strongest independent predictors to COVID related mortality after adjusting confounding factors. In addition, senior age, CRP levels and NCP types are also associated with mortality. Not applicable.
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http://dx.doi.org/10.21203/rs.3.rs-251810/v1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899459PMC
February 2021

Multicenter Consistency Assessment of Valvular Flow Quantification With Automated Valve Tracking in 4D Flow CMR.

JACC Cardiovasc Imaging 2021 Feb 2. Epub 2021 Feb 2.

Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

Objectives: This study determined: 1) the interobserver agreement; 2) valvular flow variation; and 3) which variables independently predicted the variation of valvular flow quantification from 4-dimensional (4D) flow cardiac magnetic resonance (CMR) with automated retrospective valve tracking at multiple sites.

Background: Automated retrospective valve tracking in 4D flow CMR allows consistent assessment of valvular flow through all intracardiac valves. However, due to the variance of CMR scanners and protocols, it remains uncertain if the published consistency holds for other clinical centers.

Methods: Seven sites each retrospectively or prospectively selected 20 subjects who underwent whole heart 4D flow CMR (64 patients and 76 healthy volunteers; aged 32 years [range 24 to 48 years], 47% men, from 2014 to 2020), which was acquired with locally used CMR scanners (scanners from 3 vendors; 2 1.5-T and 5 3-T scanners) and protocols. Automated retrospective valve tracking was locally performed at each site to quantify the valvular flow and repeated by 1 central site. Interobserver agreement was evaluated with intraclass correlation coefficients (ICCs). Net forward volume (NFV) consistency among the valves was evaluated by calculating the intervalvular variation. Multiple regression analysis was performed to assess the predicting effect of local CMR scanners and protocols on the intervalvular inconsistency.

Results: The interobserver analysis demonstrated strong-to-excellent agreement for NFV (ICC: 0.85 to 0.96) and moderate-to-excellent agreement for regurgitation fraction (ICC: 0.53 to 0.97) for all sites and valves. In addition, all observers established a low intervalvular variation (≤10.5%) in their analysis. The availability of 2 cine images per valve for valve tracking compared with 1 cine image predicted a decreasing variation in NFV among the 4 valves (beta = -1.3; p = 0.01).

Conclusions: Independently of locally used CMR scanners and protocols, valvular flow quantification can be performed consistently with automated retrospective valve tracking in 4D flow CMR.
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http://dx.doi.org/10.1016/j.jcmg.2020.12.014DOI Listing
February 2021

Short- and Long-Term Outcome after Emergent Cardiac Surgery during Transcatheter Aortic Valve Implantation.

Ann Thorac Cardiovasc Surg 2021 Apr 15;27(2):112-118. Epub 2021 Jan 15.

Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Objective: Our study aimed to evaluate short- and long-term outcomes of patients who required emergent conversion from transcatheter aortic valve implantation (TAVI) to open surgery. Besides, the reasons and procedural settings of emergent cardiac surgery (ECS) were also reported.

Methods: We retrospectively reviewed the patients who underwent TAVI in our institution between 2012 and 2019 and collected the clinical data of cases who converted from TAVI to bail-out surgery. Telephone and outpatient follow-ups were performed.

Results: Of 516 TAVI patients, 20 required ECS, and the bail-out surgery occurred less frequently with the increase in TAVI volume. The most common reason for conversion was left ventricular perforation (7/20, 35.0%). Thirty-day mortality was 35.0% in ECS patients. Kaplan-Meier survival curves showed that the cumulative survival rate was 65.0% at 1 year, 50.1% at 5 years in all ECS patients, and 77.1% at 5 years in patients who survived over 30 days after conversion.

Conclusion: Although the bail-out operation was performed immediately after TAVI abortion, ECS still associated with high 30-day mortality. The long-term survival benefit was seen in patients surviving from bail-out surgery. An experienced TAVI team is of crucial importance in avoiding ECS-related life-threatening complications and providing effective salvage surgery.
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http://dx.doi.org/10.5761/atcs.oa.20-00123DOI Listing
April 2021

Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry.

Front Cardiovasc Med 2020 23;7:613684. Epub 2020 Dec 23.

Department of Coronary Heart Disease, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI. This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction < 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined. In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI ( = 0.27, = 0.01), age ( = 0.34, < 0.01), and estimated glomerular filtration rate ( = -0.30, < 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25-75th percentiles 1.5-3.3 μM vs. median 1.9 μM, 25-75th percentiles 1.5-2.7 μM; = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all > 0.05). TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization. www.ClinicalTrials.gov, identifier: NCT03593928.
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http://dx.doi.org/10.3389/fcvm.2020.613684DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786017PMC
December 2020

The Etiological Heterogeneity of Bicuspid Aortopathy between Ascending and Root Morphotype.

Heart Surg Forum 2020 Dec 22;23(6):E913-E919. Epub 2020 Dec 22.

School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, China.

Background: Valve-related hemodynamics and intrinsically regulated matrix proteases are 2 determined pathogenetic factors associated with medial elastin degeneration in bicuspid aortopathy. This study analyzed the association between elastic fiber deterioration and the 2 pathogenetic factors in ascending and root morphotypes, aiming to elucidate the etiological heterogeneity between the 2 morphotypes.

Methods: Four-dimensional flow cardiac magnetic resonance was used to measure the regional wall shear stress (WSS) on the ascending aorta, and matrix metalloproteinase (MMP) expression was assessed by immunoblotting. After histopathology analysis of aortic tissue, we assessed whether elevated regional WSS and increased MMP expression corresponded with medial elastin thinning.

Results: Increased regional WSS corresponded with medial elastin thinning in both morphotypes. Increased expression of different MMP isoforms corresponded with medial elastin degeneration in bicuspid aortopathy. The significantly increased expression of MMP-2 corresponded with a decrease of elastic fiber thickness in the ascending morphotype (P = .046), whereas elastic fiber thinning was associated with high levels of MMP-3 expression (P = .012) in the root morphotype. No association was observed between regional WSS and MMP expression.

Conclusion: There is no difference in the effect of valve-related hemodynamics between ascending and root morphotype, and MMPs are not involved in the process of elastic fiber degeneration induced by increased WSS. The increased expression of different MMP isoforms was observed in the context of elastic fiber degeneration between the 2 morphotypes, implying that heterogeneity between them is revealed in the different intrinsic pathway of medial elastin degradation.
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http://dx.doi.org/10.1532/hsf.3333DOI Listing
December 2020

Reference values of thoracic aorta and pulmonary artery diameters by age and gender in healthy Chinese adults assessed by cardiac magnetic resonance imaging: data from national center for cardiovascular diseases of China.

Int J Cardiovasc Imaging 2021 Apr 4;37(4):1423-1431. Epub 2021 Jan 4.

Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.

The aim of the study was to define normal ranges for thoracic aorta and pulmonary artery diameters relative to gender, age, body surface area (BSA) and body mass index (BMI) in healthy Chinese adults by cardiac magnetic resonance (CMR). We studied 200 healthy participants (100 men, 100 women; age range from 20-70) by using a 3.0-T CMR system. The diameters of the ascending aorta (AA), main pulmonary artery (PA), proximal descending aorta (DA) and Valsalva sinus (VAS) were measured manually by two experienced doctors on half-Fourier single-shot spin echo (HASTE) and balanced steady-state free precession (bSSFP) cine images. The mean value and age specific and gender adjusted normal limits were calculated. The linear regression analysis were performed between diameters and gender, age, BMI and BSA. The mean and 95% confidence interval(CI) of AA, PA, DA and VAS were 28.95 ± 4.61 mm(95% CI 19.92-37.99 mm), 22.41 ± 2.59 mm(95% CI 17.31-27.47 mm), 20.61 ± 2.96 mm(95% CI 14.81-26.42 mm), 31.15 ± 3.65 mm(95% CI 24.00-38.29 mm), respectively. The gender differences of all the parameters above were statistically significant (all p < 0.01). Both thoracic aorta and pulmonary artery dilates with the increase of age, while AA has the highest dilation rate. The mean PA/AA was 0.79 and showed no gender difference, but there was statistical difference among all age groups (p < 0.01). AA and DA had stronger association with age and BSA than BMI. Age- and gender-specific reference diameters of thoracic aorta and pulmonary artery were provided in healthy Chinese adults. Age and BSA have stronger effects on the ranges of diameters than BMI.
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http://dx.doi.org/10.1007/s10554-020-02116-9DOI Listing
April 2021

Early Left Ventricular Diastolic Dysfunction and Abnormal Left Ventricular-left Atrial Coupling in Asymptomatic Patients With Hypertension: A Cardiovascular Magnetic Resonance Feature Tracking Study.

J Thorac Imaging 2020 Dec 24;Publish Ahead of Print. Epub 2020 Dec 24.

Department of Magnetic Resonance Imaging, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Purpose: Hypertension (HTN) patients suffer from increased risk of left ventricular (LV) diastolic dysfunction and LV hypertrophy (LVH). Evaluation of early LV diastolic function requires accurate noninvasive diagnostic tools. The aim of this study was to evaluate whether cardiovascular magnetic resonance feature-tracking (CMR-FT) could detect early LV dysfunction and evaluate LV-left atrium (LA) correlation in HTN patients.

Materials And Methods: In all, 89 HTN patients and 38 age-matched and sex-matched controls were retrospectively enrolled and underwent CMR examination. HTN patients were divided into LVH (n=38) and non-LVH (n=51) groups. All LV deformation parameters were analyzed in radial, circumferential, and longitudinal directions, including peak strain, peak systolic strain rate and peak diastolic strain rate (PDSR), LA strain and strain rate (SR), including LA reservoir function (εs, SRs), conduit function (εe, SRe), and booster pump function (εa, SRa).

Results: Compared with controls, the LV PDSR in radial, circumferential, and longitudinal directions and the LA reservoir and conduit function were significantly impaired in HTN patients regardless of LVH (all P<0.05). LV longitudinal and radial PDSR were correlated with LA reservoir and conduit function (all P<0.01). Among all LV and LA impaired deformation parameters, the longitudinal PDSR (in LV) and εe (in LA) were the most sensitive parameter for the discrimination between non-LVH and healthy volunteers, with an area under the curve of 0.70 (specificity 79%, sensitivity 55%) and 0.76 (specificity 95%, sensitivity 49%), respectively. The area under the curve reached 0.81 (specificity 82%, sensitivity 75%) combined with the longitudinal PDSR and εe.

Conclusion: CMR-FT could detect early LV diastolic dysfunction in HTN patients, which might be associated with LA reservoir and conduit dysfunction.
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http://dx.doi.org/10.1097/RTI.0000000000000573DOI Listing
December 2020

N-terminal pro-brain natriuretic peptide and sudden cardiac death in hypertrophic cardiomyopathy.

Heart 2020 Dec 24. Epub 2020 Dec 24.

State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

Objective: Elevated levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with heart failure-related death in hypertrophic cardiomyopathy (HCM), but the relationship between NT-proBNP level and sudden cardiac death (SCD) in HCM remains undefined.

Methods: The study prospectively enrolled 977 unrelated patients with HCM with available NT-proBNP results who were prospectively enrolled and followed for 3.0±2.1 years. The Harrell's C-statistic under the receiver operating characteristic curve was calculated to evaluate discrimination performance. A combination model was constructed by adding NT-proBNP tertiles to the HCM Risk-SCD model. The correlation between log NT-proBNP level and cardiac fibrosis as measured by late gadolinium enhancement (LGE) or Masson's staining was analysed.

Results: During follow-up, 29 patients had SCD. Increased log NT-proBNP levels were associated with an increased risk of SCD events (adjusted HR 22.27, 95% CI 10.93 to 65.63, p<0.001). The C-statistic of NT-proBNP in predicting SCD events was 0.80 (p<0.001). The combined model significantly improved the predictive efficiency of the HCM Risk-SCD model from 0.72 to 0.81 (p<0.05), with a relative integrated discrimination improvement of 0.002 (p<0.001) and net reclassification improvement of 0.67 (p<0.001). Furthermore, log NT-proBNP levels were significantly correlated with cardiac fibrosis as detected either by LGE (r=0.257, p<0.001) or by Masson's trichrome staining in the myocardium (r=0.198, p<0.05).

Conclusion: NT-proBNP is an independent predictor of SCD in patients with HCM and may help with risk stratification of this disease.
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http://dx.doi.org/10.1136/heartjnl-2020-317701DOI Listing
December 2020

Collagen Cross-Linking Is Associated With Cardiac Remodeling in Hypertrophic Obstructive Cardiomyopathy.

J Am Heart Assoc 2021 Jan 25;10(1):e017752. Epub 2020 Dec 25.

Department of Cardiovascular Disease State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China.

Background Collagen cross-linking is covalent bonds among collagen fibers from catalysis of lysyl oxidase (LOX) and advanced glycation end products (AGEs). We aimed to evaluate the formation of enzymatic and nonenzymatic collagen cross-linking and its clinical significance in patients with hypertrophic obstructive cardiomyopathy. Methods and Results Forty-four patients with hypertrophic obstructive cardiomyopathy who underwent surgical myectomy were consecutively enrolled. Cardiovascular magnetic resonance parameters of left atrial/left ventricular function were measured, including peak filling rate (PFR) and early peak emptying rate (PER-E). Total collagen was the sum of soluble and insoluble collagen, which were assessed by collagen assay. The myocardial LOX and AGEs expression were measured by molecular and biochemical methods. Compared with patients without atrial fibrillation, insoluble collagen (=0.018), insoluble collagen fraction (=0.017), and AGEs (=0.039) were higher in patients with atrial fibrillation, whereas LOX expression was similar (=0.494). The insoluble collagen fraction was correlated with PFR index (PFR normalized by left ventricular filling volume) (r=-0.44, =0.005), left atrial diameters (r=0.36, =0.021) and PER-E index (PER-E normalized by left ventricular filling volume) (r=-0.49, =0.001).Myocardial LOX was positively correlated with total collagen (r=0.37, =0.025) and insoluble collagen fraction (r=0.53,  < 0.001), but inversely correlated with PFR index (r=-0.43, =0.006) and PER-E index (r=-0.35, =0.027). In multiple regression analysis, myocardial LOX was independently associated with PFR, while insoluble collagen fraction showed independent correlation with PER-E after adjustment for clinical confounders. Conclusions Collagen cross-linking plays an important role on heart remodeling in hypertrophic obstructive cardiomyopathy. Myocardial LOX expression is independently correlated with left ventricular stiffness, while accumulation of AGEs cross-links might be associated with the occurrence of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy.
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http://dx.doi.org/10.1161/JAHA.120.017752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955480PMC
January 2021

Prognostic value of myocardial scar by magnetic resonance imaging in patients undergoing coronary artery bypass graft.

Int J Cardiol 2021 Mar 6;326:49-54. Epub 2020 Dec 6.

Department of Cardiovascular Surgery, Cardiovascular Institute and Fu Wai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.. Electronic address:

Background: Previous studies demonstrated that scar tissue assessed by late gadolinium enhancement cardiovascular magnetic resonance imaging (LGE-CMR) is associated with recovery of cardiac function after coronary artery bypass graft (CABG) in patients with a history of myocardial infarction (MI). However, information on the association between myocardial scar at baseline and long-term survival after CABG in these patients is lacking.

Methods: From April 2010 to May 2013, consecutive patients with multivessel coronary artery disease (CAD, > 70% stenosis in ≥2 vessels) and MI (> 3 months) who underwent LGE-CMR within 1 month prior to isolated CABG were enrolled. Left ventricular functional parameters and scar tissue were assessed by LGE-CMR before surgery. A standard 17-segment model was used for scar quantification. Predictors for cardiovascular events (CVEs) were analyzed.

Results: Of 148 patients who met the study inclusion/exclusion criteria, 140 cases had follow-up data and were included in final analysis. Of the latter, 27 (19.3%) patients suffered CVEs perioperatively or during mean 89.6 ± 12.0 months follow-up. In Cox proportional hazard regression model, the most significant predictor for CVEs after CABG was the number of scar segments on LGE-CMR (Hazard ratio 2.078, 95% Confidence Interval 1.133-3.814, P= 0.018). In Receiver-Operator-Characteristic (ROC) analysis, number of scar segments ≥6 predicted CVEs (sensitivity, 74.1%; specificity, 95.6%; area under the curve [AUC] = 0.934, P < 0.001).

Conclusions: Scar tissue identified by LGE-CMR appears to be an independent predictor of CVEs after CABG in patients with a history of MI, which might allow preoperative risk stratification.
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http://dx.doi.org/10.1016/j.ijcard.2020.10.052DOI Listing
March 2021

Deep learning algorithm to improve hypertrophic cardiomyopathy mutation prediction using cardiac cine images.

Eur Radiol 2020 Nov 25. Epub 2020 Nov 25.

CAS Key Lab of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.

Objectives: The high variability of hypertrophic cardiomyopathy (HCM) genetic phenotypes has prompted the establishment of risk-stratification systems that predict the risk of a positive genetic mutation based on clinical and echocardiographic profiles. This study aims to improve mutation-risk prediction by extracting cardiovascular magnetic resonance (CMR) morphological features using a deep learning algorithm.

Methods: We recruited 198 HCM patients (48% men, aged 47 ± 13 years) and divided them into training (147 cases) and test (51 cases) sets based on different genetic testing institutions and CMR scan dates (2012, 2013, respectively). All patients underwent CMR examinations, HCM genetic testing, and an assessment of established genotype scores (Mayo Clinic score I, Mayo Clinic score II, and Toronto score). A deep learning (DL) model was developed to classify the HCM genotypes, based on a nonenhanced four-chamber view of cine images.

Results: The areas under the curve (AUCs) for the test set were Mayo Clinic score I (AUC: 0.64, sensitivity: 64.29%, specificity: 47.83%), Mayo Clinic score II (AUC: 0.70, sensitivity: 64.29%, specificity: 65.22%), Toronto score (AUC: 0.74, sensitivity: 75.00%, specificity: 56.52%), and DL model (AUC: 0.80, sensitivity: 85.71%, specificity: 69.57%). The combination of the DL and the Toronto score resulted in a significantly higher predictive performance (AUC = 0.84, sensitivity: 83.33%, specificity: 78.26%), compared with Mayo I (p = 006), Mayo II (p = 022), and Toronto score (p = 0.029).

Conclusions: The combination of the DL model, based on nonenhanced cine CMR images and the Toronto score yielded significantly higher diagnostic performance in detecting HCM mutations.

Key Points: • Deep learning method could enable the extraction of image features from cine images. • Deep learning method based on cine images performed better than established scores in identifying HCM patients with positive genotypes. • The combination of the deep learning method based on cine images and the Toronto score could further improve the performance of the identification of HCM patients with positive genotypes.
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http://dx.doi.org/10.1007/s00330-020-07454-9DOI Listing
November 2020

Comparison of Procedural and 1-Year Clinical Results of Transcatheter Aortic Valve Implantation Using Prostheses with Different Design of Support Frame.

Int Heart J 2020 Nov 13;61(6):1196-1203. Epub 2020 Nov 13.

Department of Structural Heart Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.

Our study aimed to investigate whether the frame design of transcatheter heart valve (THV) affects the procedural and clinical results of transcatheter aortic valve implantation (TAVI).We retrospectively reviewed 163 patients with aortic stenosis who underwent TAVI using different types of THV (Edwards SAPIEN, n = 31; Venus-A, n = 63; and J-Valve, n = 69). The procedural outcomes and follow-up results for 1-year were compared among groups.The patients who underwent TAVI using J-Valve had a higher mean transaortic pressure gradient than those using SAPIEN or Venus-A after TAVI (1-year follow-up; P = 0.017, P < 0.001, respectively), whereas no difference was observed between the patients with SAPIEN and Venus-A prosthesis (P = 0.150). The incidence of permanent pacemaker implantation was highest in patients with Venus-A (19.0%), followed by SAPIEN (9.7%), and lowest in J-Valve (4.3%) (P = 0.025). No difference was observed in the 30-day mortality rate among the groups (P = 1.000). Moreover, Kaplan-Meier survival analysis revealed that there was no significant difference in the 1-year cumulative patient survival rate among three patient cohorts (log-rank, P = 0.850).The frame design of THVs could affect the valve-related hemodynamics and the incidence of permanent pacemaker implantation in TAVI, whereas it did not influence the survival rate of TAVI patients during 1-year follow-up period. All three THVs provided a convincing short-term outcome for TAVI patients.
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http://dx.doi.org/10.1536/ihj.20-398DOI Listing
November 2020

Differentiating Nonischemic Dilated Cardiomyopathy With Incidental Infarction From Ischemic Cardiomyopathy by Geometric Indices Derived From Cardiovascular Magnetic Resonance.

J Thorac Imaging 2020 Sep 21. Epub 2020 Sep 21.

Department of MRI, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.

Purpose: The purpose of this study was to differentiate nonischemic dilated cardiomyopathy with incidental myocardial infarction (NICM with incidental MI) from ischemic cardiomyopathy (ICM) by integrating left ventricular (LV) geometric indices and ischemic late gadolinium enhancement (LGE), obtained from cardiac magnetic resonance (CMR) imaging.

Materials And Methods: All subjects were studied on a 1.5 Tesla magnetic resonance imaging scanner. All patients had an LV ejection fraction (LVEF) <50% with LV dilation. LV end-diastolic volume (LVEDV), LVEDV index (LVEDVi), LVEF, the number and distribution of ischemic LGE segments, and ratios of volumetric and functional indices to ischemic LGE segments were determined. Logistic regression was used to detect the independent predictor of ICM. Receiver operating characteristic analysis differentiated NICM with incidental MI from ICM.

Results: Of a total of 63 patients enrolled, 45 patients had ICM, and 18 patients had NICM with incidental MI. Both groups had similar LVEF. Compared with ICM, NICM with incidental MI had more LV dilation, whereas ICM had more ischemic LGE segments. A higher number of ischamic LGE segments remained an independent predictor of ICM (odds ratio: 18.2, 95% confidence interval: 1.64-201.34, P=0.018). The optimal cut-off value for detecting NICM with incidental MI is the ratio of LVEDVi to the number of ischemic LGE segments over 25 mL/m/segment (sensitivity 100%, specificity 91%, P<0.0001).

Conclusion: Patients with NICM with incidental MI can be reliably distinguished from ICM using the ratio of LVEDVi divided by the number of ischemic LGE segments. This technique may improve diagnosis and help aid management of patients with cardiomyopathy and coexistent coronary artery disease.
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http://dx.doi.org/10.1097/RTI.0000000000000560DOI Listing
September 2020

Detection of Myocardial Fibrosis and Left Ventricular Dysfunction with Cardiac MRI in a Hypertensive Swine Model.

Radiol Cardiothorac Imaging 2020 Aug 27;2(4):e190214. Epub 2020 Aug 27.

Departments of Magnetic Resonance Imaging (B.Z., C.C., J.H., S.Z., M.L.), Animal Experimental Center (X.W., G.Y.), and Pathology (X.D., H.W.), Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beilishi Road 167, Xicheng District, Beijing 100037, China; National Heart, Lung and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, Md (A.S., A.A., M.L.); and Key Laboratory of Cardiovascular Imaging (Cultivation), Chinese Academy of Medical Sciences, Beijing, China (M.L., C.C.).

Purpose: To quantitatively evaluate the dynamic changes of extracellular volume (ECV) and native T1 in hypertensive swine over time using histologic findings as standard of reference.

Materials And Methods: Eighteen hypertensive (hypertension group) and six healthy (control group) swine aged 6-12 months were studied. Both groups underwent cardiac MRI, including pre- and postcontrast T1 mapping and late gadolinium enhancement (LGE) imaging at three time points: baseline, 1 month, and 3 months after hypertensive model induction. The left ventricular function, strain, and strain rate were also calculated using the cine images. Animals were killed after the last MRI examination. Histopathologic examination of the heart was performed later. Analysis of the relationship between strain, ECV, and native T1 was carried out by Pearson correlation and linear regression models.

Results: The mean systolic and diastolic pressure increased from 111 mg Hg and 68 mm Hg to 160 mm Hg and 97 mm Hg, respectively, over 3 months during developing hypertension ( = .03, .02, respectively). There was no LGE detected at any of three imaging times. The ECV and native T1 value of myocardium in the hypertension group increased over 3 months (ECV, increased from 21.5% ± 4.4 to 27.3% ± 5.4; native T1, increased from a mean of 1056 msec ± 32 [standard deviation] to 1218 msec ± 66; all < .001). The collagen volume fraction (CVF) was calculated and correlated with ECV ( = 0.63, = .01) and native T1 ( = 0.80, < .001). In addition, ECV was associated with longitudinal diastolic strain rate ( =-.34, = .04). Native T1 was associated with radial strain ( = -0.62, < .001) as well as circumferential strain ( = 0.57, < .001).

Conclusion: Native T1 and ECV correlated significantly with the CVF, indicating that early myocardial interstitial fibrosis exists in hypertensive heart disease. As hypertension progresses, the values of ECV fraction and T1 native increase. © RSNA, 2020.
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http://dx.doi.org/10.1148/ryct.2020190214DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457934PMC
August 2020

Heart Failure With Preserved Ejection Fraction in Hypertension Patients: A Myocardial MR Strain Study.

J Magn Reson Imaging 2021 02 7;53(2):527-539. Epub 2020 Sep 7.

Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Background: Despite current recommendations for heart failure with preserved ejection fraction (HFpEF), few studies have demonstrated the ability of MRI to identify subtle functional differences between HFpEF with essential hypertension (HFpEF-HTN) patients and hypertension patients (HTN).

Purpose: This study aimed to detect and evaluate HFpEF in patients with HTN using feature-tracking (FT) and to ascertain optimal strain cutoffs for the diagnosis of HFpEF-HTN.

Study Type: Retrospective study.

Population: Three groups (84 with HFpEF-HTN; 72 with HTN; and 70 healthy controls).

Field Strength: 1.5T, steady-state free precession (SSFP), and half-Fourier single-shot turbo spin-echo (HASTE) sequences.

Assessment: All patients underwent laboratory testing and imaging protocols (echocardiography and MRI). FT-derived left ventricular (LV) strain and strain rate (SR) were measured and compared among the three groups with adjustment for confounding factors.

Statistical Tests: Kolmogorov-Smirnov's test, independent-sample t-tests, one-way analysis of variance (ANOVA), Pearson's correlation coefficient, area under the receiver-operator characteristic (ROC) curve (AUC), and logistic regression.

Results: Compared to 72 HTN patients and 70 healthy controls, HFpEF-HTN patients (84 patients) demonstrated significantly impaired LV strains (except for global peak systolic radial strain, GRS, P < 0.05 for all). Only LV global peak systolic longitudinal strain (GLS) was significantly impaired in HTN patients vs. controls (P < 0.05). The global peak systolic circumferential SR (sGCSR) showed the highest diagnostic value for the differentiation of HFpEF-HTN patients from HTN patients (AUC, 0.731; cutoff value, -1.11/s; sensitivity, 56.0%; specificity, 84.7%). Only global peak early diastolic longitudinal SR (eGLSR) remained independently associated with a diagnosis of HFpEF-HTN in multilogistic analysis. The major strain parameters significantly correlated with LV ejection fraction, end-systolic volume index, and N-terminal pro-brain natriuretic peptide (P < 0.05 for all) and also demonstrated differences between NYHA functional class.

Data Conclusion: HFpEF-HTN patients suffer from both systolic and diastolic cardiac dysfunction. FT-derived strain parameters have potential value for the diagnosis and risk stratification of HFpEF-HTN patients. Level of Evidence 3. Technical Efficacy Stage 2.
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http://dx.doi.org/10.1002/jmri.27313DOI Listing
February 2021

3.0 T magnetic resonance imaging scanning on different body regions in patients with pacemakers.

J Interv Card Electrophysiol 2020 Aug 17. Epub 2020 Aug 17.

Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, A 167 Bei Li Shi Road, Xicheng District, Beijing, 100037, China.

Purpose: Magnetic resonance imaging (MRI) at 3.0 T is becoming more common, but there is a lack of sufficient evidence on the safety of a 3.0 T scan in patients with pacemakers. This study aimed to investigate the safety and practical concerns of 3.0 T scans for patients with MR-conditional pacemakers.

Methods: Twenty consecutive patients were enrolled. A standardized protocol was developed by cardiologists, pacemaker engineers, and radiologists. Pacemaker interrogation was performed immediately before and after the scan. Scan-related adverse events were documented, and imaging quality was graded as level 1 to 4 by radiologists.

Results: Twenty-three MRI scans of different body regions (brain = 13, lumbar spine = 4, cervical spine = 2, and heart = 4) were performed, and the average time of a scan was 25 ± 11 min. No significant changes in sensing amplitude (atrial 3.1 ± 1.1 mV vs. 2.9 ± 1.2 mV, P = 0.71; ventricular 9.3 ± 3.5 mV vs. 10.2 ± 3.4 mV, P = 0.46), lead impedances (atrial 647 ± 146 Ω vs. 627 ± 151 Ω, P = 0.7; ventricular: 780 ± 247 Ω vs.711 ± 226 Ω, P = 0.36), or pacing threshold (atrial 0.6 ± 0.2 V/0.4 ms vs. 0.6 ± 0.2 V/0.4 ms, P = 0.71; ventricular 0.7 ± 0.3 V/0.4 ms vs. 0.7 ± 0.2 V/0.4 ms, P = 0.85) were observed pre- and postscan. No adverse events were detected. Image quality review showed grade 1 quality in 16 patients and grade 2 quality in 4 patients with artifacts of pulse generators and leads in cardiac MRI scan and no impact on diagnostic value.

Conclusion: Our initial data indicated that 3.0 T scanning might be feasible under a standardized protocol with good diagnostic imaging quality irrespective of body region in patients with MR-conditional pacemakers.
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http://dx.doi.org/10.1007/s10840-020-00854-3DOI Listing
August 2020

Changes in left atrial function, left ventricle remodeling, and fibrosis after septal myectomy for obstructive hypertrophic cardiomyopathy.

J Thorac Cardiovasc Surg 2020 Jul 8. Epub 2020 Jul 8.

Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Background: This study aimed to investigate the impact of septal myectomy on left atrial function, left ventricle remodeling, and fibrosis in patients with obstructive hypertrophic cardiomyopathy.

Method: From May 2012 to September 2016, preoperative cardiac magnetic resonance imaging of 507 adult patients who underwent septal myectomy at Fuwai Hospital was retrospectively collected. Until October 2019, 57 patients were followed up with postoperative cardiac magnetic resonance imaging at 11.9 months (interquartile range, 6.4-25.3). Preoperative and postoperative left atrium and left ventricle changes, as well as late gadolinium enhancement as a surrogate of myocardial fibrosis, were analyzed.

Results: Patients with hypertrophic cardiomyopathy requiring myectomy showed increased left atrium volume, stroke volume, left ventricular ejection fraction, and left ventricle mass, as well as decreased left ventricle end-systolic volume. Echocardiography demonstrated that myectomy decreased the left ventricle outflow tract gradient, left atrium diameter, left ventricular ejection fraction, and posterior wall thickness. Postoperative cardiac magnetic resonance imaging showed that the minimal left atrium volume (P < .001), stroke volume (P = .009), left ventricle ejection fraction (P < .001), and left ventricle mass (166.9 [interquartile range, 135.8] vs 149.3 [interquartile range, 100.5] g, P < .001) decreased, whereas the left ventricle end-systolic volume (P = .001) and left atrium ejection fraction (37.9% ± 14.6% vs 47.8% ± 14%, P < .001) increased. However, left ventricle myocardial fibrosis, as detected by late gadolinium enhancement, still progressed after myectomy in patients with obstructive hypertrophic cardiomyopathy (15.2% ± 9.6% vs 18.6% [interquartile range, 21.6], P = .009).

Conclusions: Septal myectomy alleviated left ventricle hypertrophy and reversed left atrium and left ventricle remodeling in patients with obstructive hypertrophic cardiomyopathy. Late gadolinium enhancement in the left ventricle increased despite myectomy in patients with obstructive hypertrophic cardiomyopathy.
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http://dx.doi.org/10.1016/j.jtcvs.2020.06.017DOI Listing
July 2020

Letter to the editor: is it time for imaging to level with pathology?

Authors:
Shihua Zhao

Int J Cardiovasc Imaging 2020 Nov 16;36(11):2249-2250. Epub 2020 Jul 16.

MR Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037, Beijing, P.R. China.

CMR provides pathology-like insights of myocardial abnormality, such as hyperemia, edema, necrosis and fibrosis, which is in-vivo, non-invasive and real-time. Hence, it is most likely to become one alternative tool for mimicking pathology, so-called pathologicalized imaging due to its extraordinary tissue characteristics. This article aims to call for a wider clinical application of CMR with more attention on its tissue characterization value.
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http://dx.doi.org/10.1007/s10554-020-01936-zDOI Listing
November 2020

Long-term Prognostic Value of Cardiac MRI Left Atrial Strain in ST-Segment Elevation Myocardial Infarction.

Radiology 2020 08 16;296(2):299-309. Epub 2020 Jun 16.

From the National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore (S.L., R.S.T., X.Z., A.S.K., D.J.H., L.Z.); Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Road, Pudong New District, Shanghai 200127, China (H.G., J.H., L.K., J.P.); The First Affiliated Hospital, Xinjiang Medical University, Wulumuqi, China (Y.Y.); Department of Radiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China (F.Y.); Nanfang Hospital, Southern Medical University, Guangzhou, China (J.X.); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, China (P.S.); Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China (S.Z.); Duke-NUS Medical School, Singapore (R.S.T., A.S.K., J.C.A., D.J.H., L.Z.); Yong Loo Lin School of Medicine, National University Singapore, Singapore (D.J.H.); The Hatter Cardiovascular Institute, University College London, London, England (D.J.H.); Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taiwan (D.J.H.); and Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (G.S.M.).

Background Left atrial (LA) dysfunction is associated with morbidity and mortality. To the knowledge of the authors, the relationship of LA strain to long-term prognosis in participants with ST-segment elevation myocardial infarction (STEMI) is unknown. Purpose To evaluate LA strain as a long-term outcome predictor in STEMI in a prospective, multicenter cardiac MRI cohort. Materials and Methods Participants with STEMI who underwent primary percutaneous coronary intervention and cardiac MRI from 10 sites (EARLY-MYO-CMR registry, clinical trial number NCT03768453) were included. The parent study took place between August 2013 and December 2018. LA longitudinal strain and strain rate parameters were derived from cine cardiac MRI by using an in-house semiautomated method. Major adverse cardiac events (MACEs) were defined as cardiovascular death, myocardial reinfarction, hospitalization for heart failure, and stroke. The association between LA performance and MACE was evaluated by using time-dependent receiver operating characteristic analysis, Kaplan-Meier analysis, and multivariable Cox regression analysis. Results A total of 321 participants (median age, 59 years; age range, 27-75 years; 90% men) were included in this study. During median follow-up of 3.7 years, MACE occurred in 76 participants (23.7%). Participants with impaired reservoir (≤22%) and conduit strain (≤10%) had a higher risk of MACE than those with reservoir strain greater than 22% and conduit strain greater than 10% ( < .001). Reservoir strain (hazard ratio, 0.84; 95% confidence interval: 0.77, 0.91; < .001) and conduit strain (hazard ratio, 0.81; 95% confidence interval: 0.73, 0.89; < .001) were independent predictors for MACE after adjustment for known risk factors. Finally, LA reservoir and conduit strains provided incremental prognostic value over traditional outcome predictors (Uno statistic comparing models, 0.75 vs 0.68; = .04). Conclusion Assessment of left atrial strain, as a measure of left atrial function, provided incremental prognostic information to established predictors in ST-segment elevation myocardial infarction. © RSNA, 2020 See also the editorial by Kawel-Boehm and Bremerich in this issue.
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http://dx.doi.org/10.1148/radiol.2020200176DOI Listing
August 2020

CMR publications from China of the last more than 30 years.

Int J Cardiovasc Imaging 2020 Sep 11;36(9):1737-1747. Epub 2020 May 11.

Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.

Cardiovascular magnetic resonance (CMR) is a non-invasive imaging technology, gradually playing an irreplaceable role in the diagnosis and treatment of cardiovascular diseases. This review demonstrates the progress and research highlights of Chinese CMR publications of the last more than 30 years. At initial stage (1988 to 1997), CMR was introduced to evaluate cardiac anatomy, blood flow and ventricular function roughly in China. In the development stage (1998-2007), CMR began to play an important role in the diagnosis of cardiovascular and pericardial disease with the emergence of new techniques, such as myocardial perfusion imaging and magnetic resonance angiography. Since 2008, the development of CMR in China has reached a prosperous period. Cardiovascular disease can be both qualitatively and quantitatively assessment by CMR "one-stop" multi-parameter imaging, including the morphology, function, myocardial perfusion, tissue characteristics, metabolism and even the microstructure of myocardial fibers, which provides comprehensive assessment of the severity, risk stratification and prognosis of cardiovascular disease. Although CMR in China developed very rapidly in recent years, China still needs to put more efforts in CMR research and make greater contributions to the development of CMR in the world.
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http://dx.doi.org/10.1007/s10554-020-01873-xDOI Listing
September 2020

Hypermethylation of the RSK4 promoter associated with BRAF V600E promotes papillary thyroid carcinoma.

Int J Oncol 2020 May 25;56(5):1284-1293. Epub 2020 Feb 25.

Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, P.R. China.

Ribosomal S6 kinase 4 (RSK4) is a putative tumor suppressor gene which is inactivated by epigenetic events in a number human malignancies; however, its role in papillary thyroid carcinoma (PTC) remains largely unknown. The aim of this study was to explore the methylation status of the RSK4 promoter in PTC, and to determine its potential role in thyroid carcinogenesis. Reverse transcription‑quantitative PCR (RT‑qPCR) and western blot analyses were performed to examine the RSK4 mRNA and protein levels, respectively. Methylation‑specific PCR (MSP) and bisulfite genomic sequencing (BGS) were used to analyze methylation status of the RSK4 gene. Sanger sequencing was further carried out to detect the BRAF V600E mutation. Cell proliferation assay was finally performed to evaluate the role of hypermethylation in the growth of PTC cells. The association between RSK4 methylation and the clinicopathological characteristics of patients with PTC was assessed. The methylation frequency of the RSK4 promoter in PTC tissues was higher than that in paired paracancerous tissues. Coincidentally, the RSK4 mRNA levels were also downregulated in PTC tissues when compared with the paracancerous counterparts. The hypermethylation of RSK4 was associated with tumor size and lymph node metastasis. Furthermore, the BRAF V600E mutation may influence RSK4 expression and methylation. Moreover, RSK4 hypermethylation was observed in thyroid cancer cell lines, which was consistent with a lack of RSK4 expression. Upon the 5‑Aza‑deoxycytidine treatment of thyroid cancer cells, RSK4 expression was significantly upregulated, while cell proliferation was inhibited. On the whole, the findings of the present study demonstrate that the hypermethylation of the RSK4 promoter may be one of the mechanisms responsible for the poor RSK4 expression in PTC. Thus, these data suggest that RSK4 may serve as a molecular target for the early diagnosis and treatment of PTC.
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http://dx.doi.org/10.3892/ijo.2020.4999DOI Listing
May 2020

The role of imaging in 2019 novel coronavirus pneumonia (COVID-19).

Eur Radiol 2020 Sep 15;30(9):4874-4882. Epub 2020 Apr 15.

Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Beilishi Road, Xicheng District, Beijing, 100037, China.

Almost the entire world, not only China, is currently experiencing the outbreak of a novel coronavirus that causes respiratory disease, severe pneumonia, and even death. The outbreak began in Wuhan, China, in December of 2019 and is currently still ongoing. This novel coronavirus is highly contagious and has resulted in a continuously increasing number of infections and deaths that have already surpassed the SARS-CoV outbreak that occurred in China between 2002 and 2003. It is now officially a pandemic, announced by WHO on the 11th of March. Currently, the 2019 novel coronavirus (SARS-CoV-2) can be identified by virus isolation or viral nucleic acid detection; however, false negatives associated with the nucleic acid detection provide a clinical challenge and thus make the imaging examination crucial. Imaging exams have been a main clinical diagnostic criteria for the 2019 novel coronavirus disease (COVID-19) in China. Imaging features of multiple patchy areas of ground glass opacity and consolidation predominately in the periphery of the lungs are characteristic manifestations on chest CT and extremely helpful in the early detection and diagnosis of this disease, which aids prompt diagnosis and the eventual control of this emerging global health emergency. Key Points • In December 2019, China, an outbreak of pneumonia caused by a novel, highly contagious coronavirus raised grave concerns and posed a huge threat to global public health. • Among the infected patients, characteristic findings on CT imaging include multiple, patchy, ground-glass opacity, crazy-paving pattern, and consolidation shadows, mainly distributed in the peripheral and subpleural areas of both lungs, which are very helpful for the frontline clinicians. • Imaging examination has become the indispensable means not only in the early detection and diagnosis but also in monitoring the clinical course, evaluating the disease severity, and may be presented as an important warning signal preceding the negative RT-PCR test results.
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http://dx.doi.org/10.1007/s00330-020-06827-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156903PMC
September 2020

A Novel Risk Stratification Score for Sudden Cardiac Death Prediction in Middle-Aged, Nonischemic Dilated Cardiomyopathy Patients: The ESTIMATED Score.

Can J Cardiol 2020 Jul 15;36(7):1121-1129. Epub 2019 Nov 15.

Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address:

Background: We aimed to develop a risk score (LGE Based Prediction of SCD Risk in Nonischemic Dilated Cardiomyopathy [ESTIMATED]) based on late gadolinium enhancement (LGE) cardiac magnetic resonance to predict sudden cardiac death (SCD) in patients with nonischemic dilated cardiomyopathy (NIDCM) and left ventricular ejection fraction ≤ 35%.

Methods: We recruited 395 consecutive middle-aged patients with NIDCM and performed 3-year follow-up for SCD events. The score was developed and verified in 295 primary prevention patients, and the predictive value was confirmed by comparing the SCD events between the high-risk patients stratified by the score and 100 secondary prevention patients.

Results: The ESTIMATED score (constructed by the LGE extent > 14%, syncope, atrial flutter/fibrillation, nonsustained ventricular tachycardia, advanced atrioventricular block, and age ≤ 20 or > 50 years) showed good calibrations for SCD prediction in the derivation (C-statistic: 0.80, 95% confidence interval: 0.74-0.86) and validation set (C-statistic: 0.80, 95% confidence interval: 0.71-0.87). By the score, 20.3% of primary prevention patients were categorized as high risk (≥ 3 points), 28.1% as intermediate risk (2 points), and 51.6% as low risk (0-1 points) for 3-year SCD events (45.9% vs 20.1% vs 5.1%, P < 0.0001). The 3-year SCD events were also well in agreement with the score stratification in patients without implantable cardioverter-defibrillator. High-risk primary prevention patients selected by the score in the derivation and validation sets had 3-year SCD events comparable with that in secondary prevention patients (47.6% vs 40.6% vs 38.7%, P = 0.81).

Conclusions: Our study derived and validated an LGE-based (ESTIMATED) risk score providing refined SCD prediction. The score may help to identify candidates for primary prevention implantable cardioverter-defibrillator in patients with NIDCM.
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http://dx.doi.org/10.1016/j.cjca.2019.11.009DOI Listing
July 2020