Publications by authors named "Ying-Kun Guo"

101 Publications

Association of left ventricular systolic dysfunction with coronary artery dilation in Kawasaki disease patients: Assessment with cardiovascular magnetic resonance.

Eur J Radiol 2021 Nov 16;145:110039. Epub 2021 Nov 16.

Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China. Electronic address:

Purpose: To quantify global and regional left ventricular (LV) strain parameters in patients with Kawasaki disease (KD) using cardiovascular magnetic resonance (CMR) tissue tracking and assess the association of coronary artery dilation (CA dilation) with LV systolic dysfunction.

Methods: Thirty-one KD patients with CA dilation, 22 patients without CA dilation and 27 age- and sex-matched normal controls underwent 3.0 T CMR examination. Z score of >2 was defined as CA dilation. Global LV strain parameters and regional LV strain parameters in 16 American Heart Association segmentation, including radial, circumferential and longitudinal peak strain (PS) and LV function were measured and compared among groups.

Results: No significant difference in LV ejection fraction has been observed among controls, KD patients with CA dilation and without CA dilation (all p > 0.05). However, global longitudinal PS (GLPS) was lower in groups with CA dilation than those without CA dilation (-12.6 ± 4.1% vs -14.9 ± 2.6%, p < 0.05). For regional strain parameters, the segments with CA dilation (n = 301) were lower than those in both normal controls (n = 416) and segments without CA dilation (n = 547) in regional radial, circumferential and longitudinal PS (all p < 0.05). The severity of CA dilation was positively correlated to GLPS and regional longitudinal PS (r = 0.388 and r = 0.222; both p < 0.05) in KD patients. After adjusting for clinical characteristics, the multivariate analysis demonstrated that Z score was independently associated with GLPS in KD patients (β = 0.469, p = 0.000, model R = 0.355).

Conclusions: CMR tissue tracking could sensitively identify subclinical LV dysfunction in KD patients with CA dilation. LV systolic dysfunction occurs particularly in the myocardium dominated by the dilated coronary artery. CA dilation is an independent predictor of LV systolic dysfunction.
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http://dx.doi.org/10.1016/j.ejrad.2021.110039DOI Listing
November 2021

Association Between Heart Failure With Preserved Left Ventricular Ejection Fraction and Impaired Left Atrial Phasic Function in Hypertrophic Cardiomyopathy: Evaluation by Cardiac MRI Feature Tracking.

J Magn Reson Imaging 2021 Nov 19. Epub 2021 Nov 19.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Background: The majority of heart failure (HF) in hypertrophic cardiomyopathy (HCM) manifests as a phenotype with preserved left ventricular (LV) ejection fraction; however, the exact contribution of left atrial (LA) phasic function to HF with preserved ejection fraction (HFpEF) in HCM remains unresolved.

Purpose: To define the association between LA function and HFpEF in HCM patients using cardiac magnetic resonance imaging (MRI) feature tracking.

Study Type: Retrospective.

Population: One hundred and fifty-four HCM patients (HFpEF vs. non-HF: 55 [34 females] vs. 99 [43 females]).

Field Strength/sequence: 3.0 T/balanced steady-state free precession.

Assessment: LA reservoir function (reservoir strain [ε ], total ejection fraction [EF]), conduit function (conduit strain [ε ], passive EF), booster-pump function (booster strain [ε ] and active EF), LA volume index, and LV global longitudinal strain (LV GLS) were evaluated in HCM patients.

Statistical Tests: Chi-square test, Student's t-test, Mann-Whitney U test, multivariate linear regression, logistic regression, and net reclassification analysis were used. Two-sided P < 0.05 was considered statistically significant.

Results: No significant difference was found in LV GLS between the non-HF and HFpEF group (-10.67 ± 3.14% vs. -10.14 ± 4.01%, P = 0.397), whereas the HFpEF group had more severely impaired LA phasic strain (ε : 27.40 [22.60, 35.80] vs. 18.15 [11.98, 25.90]; ε : 13.80 [9.20, 18.90] vs. 7.95 [4.30, 14.35]; ε : 13.50 [9.90, 17.10] vs. 7.90 [5.40, 14.15]). LA total EF (37.91 [29.54, 47.94] vs. 47.49 [39.18, 55.01]), passive EF (14.70 [7.41, 21.49] vs. 18.07 [9.32, 24.78]), and active EF (27.19 [17.79, 36.60] vs. 36.64 [26.63, 42.71]) were all significantly decreased in HFpEF patients compared with non-HF patients. LA reservoir (β = 0.90 [0.85, 0.96]), conduit (β = 0.93 [0.87, 0.99]), and booster (β = 0.86 [0.78, 0.95]) strain were independently associated with HFpEF in HCM patients. The model including reservoir strain (Net Reclassification Index [NRI]: 0.260) or booster strain (NRI: 0.325) improved the reclassification of HFpEF based on LV GLS and minimum left atrial volume index (LAVI ).

Data Conclusion: LA phasic function was severely impaired in HCM patients with HFpEF, whereas LV function was not further impaired compared with non-HF patients.

Level Of Evidence: 4 TECHNICAL EFFICACY: Stage 3.
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http://dx.doi.org/10.1002/jmri.28000DOI Listing
November 2021

A CT-based radiomics nomogram for predicting early recurrence in patients with high-grade serous ovarian cancer.

Eur J Radiol 2021 Nov 5;145:110018. Epub 2021 Nov 5.

Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China. Electronic address:

Purpose: To develop and validate a radiomics nomogram for predicting early recurrence in high-grade serous ovarian cancer (HGSOC) patients.

Materials And Methods: From May 2008 to December 2019, 256 eligible HGSOC patients were enrolled and divided into training (n = 179) and test cohorts (n = 77) in a 7:3 ratio. A radiomics signature (Radscore) was selected by using recursive feature elimination based on a support vector machine (SVM-RFE) and building a radiomics model for recurrence prediction. Independent clinical risk factors were generated by univariable and multivariable Cox regression analyses. A combined model was developed based on the Radscore and independent clinical risk factors and presented as a radiomics nomogram. Its performance was assessed by AUC, Kaplan-Meier survival analysis and decision curve analysis.

Results: Seven radiomics features were selected. The radiomics model yielded AUCs of 0.715 (95% CI: 0.640, 0.790) and 0.717 (95% CI: 0.600, 0.834) in the training and test cohorts, respectively. The clinical model (FIGO stage and residual disease) yielded AUCs of 0.632 and 0.691 in the training and test cohorts, respectively. The combined model demonstrated AUCs of 0.749 (95% CI: 0.678, 0.821) and 0.769 (95% CI: 0.662, 0.877) in the training and test cohorts, respectively. In the combined model, PFS was significantly shorter in the high-risk group than in the low-risk group (P < 0.0001).

Conclusions: The radiomics nomogram performed well for early individualized recurrence prediction in patients with HGSOC and can also be used to differentiate high-risk patients from low-risk patients.
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http://dx.doi.org/10.1016/j.ejrad.2021.110018DOI Listing
November 2021

Impact of myocardial scars on left ventricular deformation in type 2 diabetes mellitus after myocardial infarction by contrast-enhanced cardiac magnetic resonance.

Cardiovasc Diabetol 2021 10 25;20(1):215. Epub 2021 Oct 25.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Background: Type 2 diabetes mellitus (T2DM) is a major risk factor for coronary artery disease and myocardial infarction (MI). The interaction of diabetic cardiomyopathy and MI scars on myocardial deformation in T2DM patients is unclear. Therefore, we aimed to evaluate myocardial deformation using cardiac magnetic resonance (CMR) in T2DM patients with previous MI and investigated the influence of myocardial scar on left ventricular (LV) deformation.

Methods: Overall, 202 T2DM patients, including 46 with MI (T2DM(MI+)) and 156 without MI (T2DM(MI-)), and 59 normal controls who underwent CMR scans were included. Myocardial scars were assessed by late gadolinium enhancement. LV function and deformation, including LV global function index, LV global peak strain (PS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR), were compared among these groups. Correlation and multivariate linear regression analyses were used to investigate the relationship between myocardial scars and LV deformation.

Results: Decreases were observed in LV function and LV global PS, PSSR, and PDSR in the T2DM(MI+) group compared with those of the other groups. Reduced LV deformation (p < 0.017) was observed in the T2DM(MI+) group with anterior wall infarction. The increased total LV infarct extent and infarct mass of LV were related to decreased LV global PS (radial, circumferential, and longitudinal directions; p < 0.01) and LV global PSSR (radial and circumferential directions, p < 0.02). Multivariate analysis demonstrated that NYHA functional class and total LV infarct extent were independently associated with LV global radial PS (β =  - 0.400 and β =  - 0.446, respectively, all p < 0.01; model R = 0.37) and circumferential PS (β = 0.339 and β = 0.530, respectively, all p < 0.01; model R = 0.41), LV anterior wall infarction was independently associated with LV global longitudinal PS (β = 0.398, p = 0.006).

Conclusions: The myocardial scarring size in T2DM patients after MI is negatively correlated with LV global PS and PSSR, particularly in the circumferential direction. Additionally, different MI regions have different effects on the reduction of LV deformation, and relevant clinical evaluations should be strengthened.
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http://dx.doi.org/10.1186/s12933-021-01407-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8547068PMC
October 2021

Global, segmental and layer specific analysis of myocardial involvement in Duchenne muscular dystrophy by cardiovascular magnetic resonance native T1 mapping.

J Cardiovasc Magn Reson 2021 10 14;23(1):110. Epub 2021 Oct 14.

Department of Radiology, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China.

Background: Progressive cardiomyopathy accounts for almost all mortality among Duchenne muscular dystrophy (DMD) patients.‍ Thus, our aim was to comprehensively characterize myocardial involvement by investigating the heterogeneity of native T1 mapping in DMD patients using global and regional (including segmental and layer-specific) analysis across a large cohort.

Methods: We prospectively enrolled 99 DMD patients (8.8 ± 2.5 years) and 25 matched male healthy controls (9.5 ± 2.5 years). All subjects underwent cardiovascular magnetic resonance (CMR) with cine, T1 mapping and late gadolinium enhancement (LGE) sequences. Native T1 values based on the global and regional myocardium were measured, and LGE was defined.

Results: LGE was present in 49 (49%) DMD patients. Global native T1 values were significantly longer in LGE-positive (LGE +) patients than in healthy controls, both in basal slices (1304 ± 55 vs. 1246 ± 27 ms, p < 0.001) and in mid-level slices (1305 ± 57 vs. 1245 ± 37 ms, p < 0.001). No significant difference in global native T1 was found between healthy controls and LGE-negative (LGE-) patients. In segmental analysis, LGE + patients had significantly increased native T1 in all analyzed segments compared to the healthy control group. Meanwhile, the comparison between LGE- patients and healthy controls showed significantly elevated values only in the basal anterolateral segment (1273 ± 62 vs. 1234 ± 40 ms, p = 0.034). Interestingly, the epicardial layer had a significantly higher native T1 in LGE- patients than in healthy controls (p < 0.05), whereas no such pattern was noticed in the global myocardium. Epicardial layer native T1 resulted in the highest diagnostic performance for distinguishing between healthy controls and DMD patients in receiver operating curve analyses (area under the curve [AUC] 0.84 for basal level and 0.85 for middle level) when compared to global native T1 and endocardial layer native T1.

Conclusions: Myocardial regional native T1, particularly epicardial native T1, seems to have potential as a novel robust marker of very early cardiac involvement in DMD patients.

Trial Registration: Chinese Clinical Trial Registry ( http://www.chictr.org.cn/index.aspx ) ChiCTR1800018340, 09/12/2018, Retrospectively registered.
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http://dx.doi.org/10.1186/s12968-021-00802-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515679PMC
October 2021

Accuracy of flow-void diameters on MR images in diagnosing uterine arteriovenous malformations in patients with pregnancy-related diseases.

Sci Rep 2021 Oct 6;11(1):19806. Epub 2021 Oct 6.

Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, Sichuan, China.

To evaluate the "flow void" diameter in patients with pregnancy-related diseases with and without uterine AVMs and assess the diagnostic performance of unenhanced MRI for uterine AVMs. From May 2014 to April 2019, 79 patients with pregnancy-related diseases were included, including 36 with and 43 without uterine AVMs confirmed by DSA. On MRI, the diameter of the most prominent "flow void" (hereinafter referred to as fv-D) was measured and compared between patients with and without uterine AVMs. The diagnostic performance of fv-D was estimated with receiver operating characteristic curves. The "flow void" sign was observed in patients with and without uterine AVMs (P > 0.05). The fv-D was significantly larger in patients with uterine AVMs in the myometrium and parametrium than in patients without uterine AVMs (P < 0.0001). The fv-D achieved a reliable diagnostic performance in the myometrium (sensitivity 80.6%, specificity 60.5%, negative predictive value 78.8%, positive predictive value 63%, AUC 0.727, cut-off: > 1.33 mm) and parametrium (sensitivity 97.2%, specificity 67.4%, negative predictive value 96.7%, positive predictive value 71.4%, AUC 0.881, cut-off > 2.6 mm). On MRI, fv-D could diagnose uterine AVMs. The fv-D had a much higher diagnostic efficiency in the parametrium than in the myometrium. The parametrium fv-D greatly improved the diagnostic sensitivity and provides a more accurate, noninvasive method of investigating possible uterine AVMs.
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http://dx.doi.org/10.1038/s41598-021-99209-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8494937PMC
October 2021

Impact of BMI on Left Atrial Strain and Abnormal Atrioventricular Interaction in Patients With Type 2 Diabetes Mellitus: A Cardiac Magnetic Resonance Feature Tracking Study.

J Magn Reson Imaging 2021 Sep 22. Epub 2021 Sep 22.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China.

Background: Type 2 diabetes mellitus (T2DM) and obesity often coexist and together contribute to left atrial (LA) functional abnormalities. However, little is known about the impact of body mass index (BMI) on LA strains measured using cardiac magnetic resonance feature tracking (MR-FT).

Purpose: To investigate the additive effect of BMI on LA functional remodeling using MR-FT as well as to explore abnormal atrioventricular interaction in T2DM patients.

Study Type: Retrospective.

Population: One hundred and fifty-nine T2DM patients (53, 34, and 72 normal-weight, overweight, and obese individuals) and 105 non-diabetic controls (46, 32, and 27 normal-weight, overweight, and obese individuals).

Field Strength/sequence: 3.0 T/balanced steady-state free precession.

Assessment: LA reservoir strain (ε ), conduit strain (ε ), and active strain (ε ) and their corresponding strain rates (SRs, SRe, SRa) were measured together with left ventricular (LV) radial, circumferential, and longitudinal peak strain, peak systolic strain rate, and peak diastolic strain rate.

Statistical Tests: Student's t-test or Mann-Whitney U test, one-way ANOVA, univariate and multivariate linear regression. A P value <0.05 was considered statistically significant.

Results: Compared to controls in the same BMI category, T2DM patients had significantly decreased reservoir and conduit function, while pump function was not significantly different (ε and SRa: P = 0.757 and 0.583 for normal-weight, P = 0.171 and 0.426 for overweight, P = 0.067 and 0.330 for obese). LA strains were significantly correlated with BMI (r = -0.346 for ε , -0.345 for ε ) in T2DM patients. Multivariable linear regression analysis indicated that BMI was independently associated with LA ε and ε , LV global longitudinal strain was independently associated with LA ε and ε , and LV circumferential peak diastolic strain rate was independently associated with LA ε .

Data Conclusion: These findings suggest that the coexistence of increased body weight and T2DM patients can exacerbate the impairment of LA strains and indicate abnormal atrioventricular interactions.

Level Of Evidence: 3 TECHNICAL EFFICACY: Stage 3.
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http://dx.doi.org/10.1002/jmri.27931DOI Listing
September 2021

The Development and Validation of a CT-Based Radiomics Nomogram to Preoperatively Predict Lymph Node Metastasis in High-Grade Serous Ovarian Cancer.

Front Oncol 2021 31;11:711648. Epub 2021 Aug 31.

Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.

Purpose: To develop and validate a radiomics model for predicting preoperative lymph node (LN) metastasis in high-grade serous ovarian cancer (HGSOC).

Materials And Methods: From May 2008 to January 2018, a total of 256 eligible HGSOC patients who underwent tumor resection and LN dissection were divided into a training cohort (n=179) and a test cohort (n=77) in a 7:3 ratio. A Radiomics Model was developed based on a training cohort of 179 patients. A radiomics signature (defined as the Radscore) was selected by using the random forest method. Logistics regression was used as the classifier for modeling. An Integrated Model that incorporated the Radscore and CT_reported LN status (CT_LN_report) was developed and presented as a radiomics nomogram. Its performance was determined by the area under the curve (AUC), calibration, and decision curve. The radiomics nomogram was internally tested in an independent test cohort (n=77) and a CT-LN-report negative subgroup (n=179) using the formula derived from the training cohort.

Results: The AUC value of the CT_LN_report was 0.688 (95% CI: 0.626, 0.759) in the training cohort and 0.717 (95% CI: 0.630, 0.804) in the test cohort. The Radiomics Model yielded an AUC of 0.767 (95% CI: 0.696, 0.837) in the training cohort and 0.753 (95% CI: 0.640, 0.866) in the test. The radiomics nomogram demonstrated favorable calibration and discrimination in the training cohort (AUC=0.821), test cohort (AUC=0.843), and CT-LN-report negative subgroup (AUC=0.82), outperforming the Radiomics Model and CT_LN_report alone.

Conclusions: The radiomics nomogram derived from portal phase CT images performed well in predicting LN metastasis in HGSOC and could be recommended as a new, convenient, and non-invasive method to aid in clinical decision-making.
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http://dx.doi.org/10.3389/fonc.2021.711648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8438232PMC
August 2021

Effect of diabetes mellitus on the development of left ventricular contractile dysfunction in women with heart failure and preserved ejection fraction.

Cardiovasc Diabetol 2021 09 14;20(1):185. Epub 2021 Sep 14.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Background: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome with sex-specific pathophysiology. Estrogen deficiency is believed to be responsible for the development of HFpEF in women. However, estrogen deficiency does not seem to be completely responsible for the differences in HFpEF prevalence between sexes. While diabetes mellitus (DM) frequently coexists with HFpEF in women and is associated with worse outcomes, the changes in myocardial contractility among women with HFpEF and the DM phenotype is yet unknown. Therefore, we aimed to investigate sex-related differences in left ventricular (LV) contractility dysfunction in HFpEF comorbid with DM.

Methods: A total of 224 patients who underwent cardiac cine MRI were included in this study. Sex-specific differences in LV structure and function in the context of DM were determined. LV systolic strains (global longitudinal strain [GLS], circumferential strain [GCS] and radial strain [GRS]) were measured using cine MRI. The determinants of impaired myocardial strain for women and men were assessed.

Results: The prevalence of DM did not differ between sexes (p > 0.05). Despite a similar LV ejection fraction, women with DM demonstrated a greater LV mass index than women without DM (p = 0.023). The prevalence of LV geometry patterns by sex did not differ in the non-DM subgroup, but there was a trend toward a more abnormal LV geometry in women with DM (p = 0.072). The magnitudes of systolic strains were similar between sexes in the non-DM group (p > 0.05). Nevertheless, in the DM subgroup, there was significant impairment in women in systolic strains compared with men (p < 0.05). In the multivariable analysis, DM was associated with impaired systolic strains in women (GLS [β = 0.26; p = 0.007], GCS [β = 0.31; p < 0.001], and GRS [β = -0.24; p = 0.016]), whereas obesity and coronary artery disease were associated with impaired systolic strains in men (p < 0.05).

Conclusions: Women with DM demonstrated greater LV contractile dysfunction, which indicates that women with HFpEF comorbid with DM have a high-risk phenotype of cardiac failure that may require more aggressive and personalized medical treatment.
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http://dx.doi.org/10.1186/s12933-021-01379-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8442278PMC
September 2021

Evaluation of the effects of glycated hemoglobin on cardiac function in patients with short-duration type 2 diabetes mellitus: A cardiovascular magnetic resonance study.

Diabetes Res Clin Pract 2021 Aug 14;178:108952. Epub 2021 Jul 14.

Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 GuoXue Street, Chengdu 610041, Sichuan, People's Republic of China. Electronic address:

Aims: To investigate the association between glycated hemoglobin (HbA1c) and myocardial dysfunction and to determine whether its association is independent of myocardial perfusion.

Methods: Sixty-four patients with type 2 diabetes mellitus (T2DM) were recruited. They were divided into groups according to their HbA1c level: the controlled T2DM group (HbA1c < 7%) and uncontrolled T2DM groups (HbA1c ≥ 7%). Meanwhile, 30 age-matched healthy volunteers were included. All patients with T2DM and healthy controls underwent cardiovascular magnetic resonance imaging to evaluate the myocardial mechanics and perfusion parameters.

Results: The circumferential and longitudinal peak strain (PS) (p = 0.009 and 0.002 respectively) and global radial, circumferential, and longitudinal peak strain diastolic strain rates (PDSRs) (p = 0.002, 0.001, and 0.001 respectively) were lower in the uncontrolled T2DM group than in the controls without diabetes. In multivariable linear regression analysis, HbA1c was independently related to all directions of the PS and PDSR. The myocardial perfusion parameters were not independently associated with the PS or PDSR.

Conclusions: Cardiac function is impaired in Chinese T2DM patients with poor glucose control (HbA1c ≥ 7%), with preserved left ventricular (LV) ejection fraction, and disease duration <10 years. Poor blood glucose control is an independent predictor of LV myocardial dysfunction for patients with short-term T2DM.
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http://dx.doi.org/10.1016/j.diabres.2021.108952DOI Listing
August 2021

Inflammation in Remote Myocardium and Left Ventricular Remodeling After Acute Myocardial Infarction: A Pilot Study Using T2 Mapping.

J Magn Reson Imaging 2021 Jul 9. Epub 2021 Jul 9.

Department of Radiology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Sichuan, China.

Background: The pathophysiological changes in the remote myocardium after acute myocardial infarction (MI) remains less understood.

Purpose: To assess the inflammation in the remote myocardium post-MI and its association with left ventricular (LV) remodeling using T2 mapping.

Study Type: Prospective.

Animal Model And Subjects: Twelve pigs at 3-day post-MI, 6 pigs at 3-month post-MI, 6 healthy pigs; 54 patients at 3-day and 3-month post-MI, 31 healthy volunteers; FIELD STRENGTH/SEQUENCE: A 3 T MRI/ steady-state free-precession sequence for T2 mapping (animals: 0, 30, and 55 msec; human: 0, 25, and 55 msec), phase-sensitive inversion recovery gradient echo for late gadolinium enhancement (LGE), balanced steady free-precession sequence for cine.

Assessment: Infarcted myocardium was defined on LGE, remote T2 was measured on T2 maps. LV remodeling was evaluated as LV end-diastolic volume change index between two scans using cine. CD68 staining was conducted to detect monocyte/macrophage.

Statistical Tests: Student-t test and one-way ANOVA were used to compare remote T2 with normal controls. The association of remote T2 with LV remodeling was assessed using linear regression. P values of <0.05 were used to denote statistical significance.

Results: Compared with healthy pigs, remote T2 significantly increased from 3 days to 3 months post-MI (31.43 ± 0.67 vs. 33.53 ± 1.15 vs. 36.43 ± 1.07 msec). CD68 staining demonstrated the inflammation in remote myocardium post-MI but not in healthy pigs. Significant remote myocardial alterations in T2 were also observed in human group (40.51 ± 1.79 vs. 41.94 ± 1.14 vs. 42.52 ± 1.71 msec). In patients, the 3-month remote T2 (β = 0.432) and remote T2 variation between two scans (β = 0.554) were both independently associated with LV remodeling.

Conclusion: T2 mapping could characterize the abnormalities in the remote myocardium post-MI, which was potentially caused by the inflammatory response. Moreover, variations in remote T2 were associated with LV remodeling.

Evidence Level: 1 TECHNICAL EFFICACY: Stage 3.
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http://dx.doi.org/10.1002/jmri.27827DOI Listing
July 2021

Utility of single-shot compressed sensing cardiac magnetic resonance cine imaging for assessment of biventricular function in free-breathing and arrhythmic pediatric patients.

Int J Cardiol 2021 09 26;338:258-264. Epub 2021 Jun 26.

Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, Sichuan 610041, China. Electronic address:

Background: This study aimed to explore the feasibility and accuracy of single-shot compressed-sensing (CS) cardiac magnetic resonance cine technology for the assessment of biventricular function and morphology in free-breathing (FB) pediatrics, especially those with arrhythmia.

Methods: Seventy consecutive pediatric participants (6.27 ± 3.8 years, range:0.5-14 years) were enrolled between August 2019 and July 2020. Single-shot CS and conventional balanced steady-state free-precession (bSSFP) cine were obtained. The total scanning time, image quality and biventricular function parameters were compared for both sequences.

Results: Single-shot CS cine had shorter acquisition time compared with the conventional bSSFP cine (all P < 0.001). The single-shot CS cine also had fewer artifacts than conventional bSSFP cine (breath-hold (BH): 4.6 ± 0.6 vs. 4.3 ± 0.6; FB without ongoing arrhythmia: 4.5 ± 0.6 vs. 3.6 ± 0.9; FB with ongoing arrhythmia: 4.7 ± 0.5 vs. 2.6 ± 1.1; all P < 0.05). No statistical difference of left ventricular parameters and right ventricular end-systolic volume/ejection fraction were found between the single-shot CS and conventional bSSFP cine in both BH and FB without ongoing arrhythmia group. There was an excellent correlation (R = 0.60-0.98, all P < 0.001) and good intra-(range: R = 0.57-0.99, P < 0.001)/inter-observer agreements (range: R = 0.76-1, P < 0.001) for single-shot CS cine images in terms of biventricular function parameters.

Conclusions: The single-shot CS cine can significantly reduce the image acquisition time, offering reliable quantification of biventricular function in free breathing condition for arrhythmic patients.
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http://dx.doi.org/10.1016/j.ijcard.2021.06.043DOI Listing
September 2021

Characteristics of coronary artery disease in patients with subclinical hypothyroidism: evaluation using coronary artery computed tomography angiography.

BMC Cardiovasc Disord 2021 06 15;21(1):303. Epub 2021 Jun 15.

Department of Radiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Background: Subclinical hypothyroidism (SCH) has recently been acknowledged as an independent risk factor for coronary artery disease (CAD). However, the characteristics of CAD in patients with SCH are not fully understood. This study aims to evaluate the features of CAD in patients with SCH using coronary computed tomographic angiography (CCTA).

Materials And Methods: From 1 April, 2018 to 30 June, 2020, 234 consecutive SCH patients with coronary plaques identified on CCTA were included retrospectively. They were further subdivided into different degree of SCH groups (mild SCH vs. moderate SCH vs. severe SCH: 143 vs 62 vs 28) and different gender groups (men with SCH vs. women with SCH:116 vs 118). The distributions and types of plaques, luminal narrowing, segment involvement scores (SIS) and segment stenosis scores (SSS) were evaluated and compared among the different groups.

Results: Patients with severe SCH had fewer calcified plaques (0.7 ± 0.9 vs. 2.0 ± 1.9, p < 0.001) and more non-calcified plaques (0.9 ± 1.0 vs. 0.3 ± 0.5, p < 0.001) than those with mild SCH. As the SCH condition worsened, the proportion of non-calcified plaques significantly increased. Whereas there were no significant discrepancies in SIS and SSS among patients with different grades of SCH (all p > 0.05). Men with SCH had higher SIS (3.9 ± 2.3 vs. 3.0 ± 2.3, p = 0.004) and SSS (7.8 ± 5.4 vs. 5.4 ± 3.0, p = 0.002) than women. Multivariate logistic and linear regression analysis demonstrated that grades of SCH (Moderate SCH, odds ratio [OR] 2.11; 95% CI 1.03-4.34, p = 0.042; severe SCH, OR: 10.00; 95% CI 3.82-26.20, p < 0.001, taken mild SCH as a reference) was independently associated with the presence of non-calcified plaques, whereas sex (B: 1.67; 95% CI 0.27-3.10, p = 0.009) was independently associated with SSS.

Conclusions: Severe SCH is associated with non-calcified plaques, and men with SCH have higher total plaque burden than women. We suggest that it is important to evaluate for coronary plaque in SCH patients, especially those with severe SCH and men with SCH.
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http://dx.doi.org/10.1186/s12872-021-02116-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207731PMC
June 2021

Increased oxygenation is associated with myocardial inflammation and adverse regional remodeling after acute ST-segment elevation myocardial infarction.

Eur Radiol 2021 Dec 18;31(12):8956-8966. Epub 2021 May 18.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.

Objectives: To explore the relationships between oxygenation signal intensity (SI) with myocardial inflammation and regional left ventricular (LV) remodeling in reperfused acute ST-segment elevation myocardial infarction (STEMI) using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR).

Methods: Thirty-three STEMI patients and 22 age- and sex-matched healthy volunteers underwent CMR. The protocol included cine function, OS imaging, precontrast T1 mapping, T2 mapping, and late gadolinium enhancement (LGE) imaging. A total of 880 LV segments were included for analysis based on the American Heart Association 16-segment model. For validation, 15 pigs (10 myocardial infarction (MI) model animals and 5 controls) received CMR and were sacrificed for immunohistochemical analysis.

Results: In the patient study, the acute oxygenation SI showed a stepwise rise among remote, salvaged, and infarcted segments compared with healthy myocardium. At convalescence, all oxygenation SI values besides those in infarcted segments with microvascular obstruction decreased to similar levels. Acute oxygenation SI was associated with early myocardial injury (T1: r = 0.38; T2: r = 0.41; all p < 0.05). Segments with higher acute oxygenation SI values exhibited thinner diastolic walls and decreased wall thickening during follow-up. Multivariable regression modeling indicated that acute oxygenation SI (β = 2.66; p < 0.05) independently predicted convalescent segment adverse remodeling (LV wall thinning). In the animal study, alterations in oxygenation SI were correlated with histological inflammatory infiltrates (r = 0.59; p < 0.001).

Conclusions: Myocardial oxygenation by OS-CMR could be used as a quantitative imaging biomarker to assess myocardial inflammation and predict convalescent segment adverse remodeling after STEMI.

Key Points: • Oxygenation signal intensity (SI) may be an imaging biomarker of inflammatory infiltration that could be used to assess the response to anti-inflammatory therapies in the future. • Oxygenation SI early after myocardial infarction (MI) was associated with left ventricular segment injury at acute phase and could predict regional functional recovery and adverse remodeling late after acute MI. • Oxygenation SI demonstrated a stepwise increase among remote, salvaged, and infarcted segments. Infarcted zones with microvascular obstruction demonstrated a higher oxygenation SI than those without. However, the former showed less pronounced changes over time.
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http://dx.doi.org/10.1007/s00330-021-08032-3DOI Listing
December 2021

Impact of type 2 diabetes mellitus on left ventricular diastolic function in patients with essential hypertension: evaluation by volume-time curve of cardiac magnetic resonance.

Cardiovasc Diabetol 2021 03 25;20(1):73. Epub 2021 Mar 25.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Background: Essential hypertension and type 2 diabetes mellitus (T2DM) are two common chronic diseases that often coexist, and both of these diseases can cause heart damage. However, the additive effects of essential hypertension complicated with T2DM on left ventricle (LV) diastolic function have not been fully illustrated. This study aims to investigate whether T2DM affects the diastolic function of the LV in patients with essential hypertension using the volume-time curve from cardiac magnetic resonance (CMR).

Methods: A total of 124 essential hypertension patients, including 48 with T2DM [HTN(T2DM +) group] and 76 without T2DM [HTN(T2DM-) group], and 52 normal controls who underwent CMR scans were included in this study. LV volume-time curve parameters, including the peak ejection rate (PER), time to peak ejection rate (PET), peak filling rate (PFR), time to peak filling rate from end-systole (PFT), PER normalized to end-diastolic volume (PER/EDV), and PFR normalized to EDV (PFR/EDV), were measured and compared among the three groups. Multivariate linear regression analyses were performed to determine the effects of T2DM on LV diastolic dysfunction in patients with hypertension. Pearson correlation was used to analyse the correlation between the volume-time curve and myocardial strain parameters.

Results: PFR and PFR/EDV decreased from the control group, through HTN(T2DM -), to HTN(T2DM +) group. PFT in the HTN(T2DM-) group and HTN(T2DM +) group was significantly longer than that in the control group. The LV remodelling index in the HTN(T2DM -) and HTN(T2DM +) groups was higher than that in the normal control group, but there was no significant difference between the HTN(T2DM -) and HTN(T2DM +) groups. Multiple regression analyses controlling for covariates of systolic blood pressure, age, sex, and heart rate demonstrated that T2DM was independently associated with PFR/EDV (β = 0.252, p < 0.05). The volume-time curve method has good repeatability, and there is a significant correlation between volume-time curve parameters (PER/EDV and PFR/EDV) and myocardial peak strain rate, especially circumferential peak strain rate, which exhibited the highest correlation (r = - 0.756 ~ 0.795).

Conclusions: T2DM exacerbates LV diastolic dysfunction in patients with essential hypertension. The LV filling model changes reflected by the CMR volume-time curve could provide more information for early clinical intervention.
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http://dx.doi.org/10.1186/s12933-021-01262-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993470PMC
March 2021

Distinguishing cardiac myxomas from cardiac thrombi by a radiomics signature based on cardiovascular contrast-enhanced computed tomography images.

BMC Cardiovasc Disord 2021 03 25;21(1):152. Epub 2021 Mar 25.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.

Background: Cardiac myxomas (CMs) and thrombi are associated with high morbidity and mortality. These two conditions need totally different treatments. However, they are difficult to distinguish using naked eye. In clinical, misdiagnoses occur now and then. This study aimed to compare the characteristics of CMs and cardiac thrombi and investigate the value of a radiomics signature in distinguishing CMs from cardiac thrombi, based on cardiovascular contrast-enhanced computed tomography (CECT) images.

Methods: A total of 109 patients who had CMs (n = 59) and cardiac thrombi (n = 50) were enrolled in this retrospective study from 2009 to 2019. First, the lesion characteristics of cardiovascular CECT images were documented and compared by two radiologists. Then all patients were randomly allotted to either a primary group or a validation group according to a 7:3 ratio. Univariate analysis and the least absolute shrinkage and selection operator were used to select robust features. The best radiomics signature was constructed and validated using multivariate logistic regression. An independent clinical model was created for comparison.

Results: The best radiomics signature was developed using eight selected radiomics. The classification accuracies of the radiomics signature were 90.8% and 90.9%, and the area under the receiver operating characteristic curves were 0.969 and 0.926 in the training and testing cohorts, respectively. Cardiovascular CECT images showed that the two diseases had significant differences in location, surface, Hydrothorax, pericardial effusion and heart enlargement. The naked eye findings were used to create the clinical model. All metrics of the radiomics signature were higher than those of clinical model.

Conclusions: Compared with clinical model, the radiomics signature based on cardiovascular CECT performed better in differentiating CMs and thrombi, suggesting that it could help improving the diagnostic efficiency.
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http://dx.doi.org/10.1186/s12872-021-01961-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993472PMC
March 2021

The mitral regurgitation effects of cardiac structure and function in left ventricular noncompaction.

Sci Rep 2021 02 25;11(1):4616. Epub 2021 Feb 25.

Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# Section 3 South Renmin Road, Chengdu, 610041, China.

This study evaluated the effects of mitral regurgitation (MR) on cardiac structure and function in left ventricular noncompaction (LVNC) patients. The clinical and cardiovascular magnetic resonance (CMR) data for 182 patients with noncompaction or hypertrabeculation from three institutes were retrospectively included. We analyzed the difference in left ventricular geometry, cardiac function between LVNC patients with and without MR. The results showed that patients with MR had a worse New York Heart Association (NYHA) class and a higher incidence of arrhythmia (P < 0.05). MR occurred in 48.2% of LVNC patients. Compared to LVNC patients without MR, the two-dimensional sphericity index, maximum/minimum end-diastolic ratio and longitudinal shortening in LVNC patients with MR were lower (P < 0.05), and the peak longitudinal strain (PLS) of the global and segmental myocardium were obviously reduced (P < 0.05). No significant difference was found in strain in LVNC patients with different degree of MR; end diastolic volume, end systolic volume, and global PLS were statistically associated with MR and NYHA class (P < 0.05), but the non-compacted to compacted myocardium ratio had no significant correlation with them. In conclusion, the presence of MR is common in LVNC patients. LVNC patients with MR feature more severe morphological and functional changes. Hypertrabeculation is not an important factor affecting structure and function at the heart failure stage.
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http://dx.doi.org/10.1038/s41598-021-84233-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907249PMC
February 2021

Characterization of infarcted myocardium by T1-mapping and its association with left ventricular remodeling.

Eur J Radiol 2021 Apr 12;137:109590. Epub 2021 Feb 12.

Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, China; Department of Radiology, West China Hospital, Sichuan University, China. Electronic address:

Purpose: Acutely infarcted native T1 (native T1) and extracellular volume (ECV) could quantify myocardial injury after acute myocardial infarction (AMI). Therefore, we sought to further explore their association with left ventricular (LV) remodeling during follow-up.

Methods: 56 ST-segment-elevation MI patients were prospectively recruited and completed acute and 3-month cardiac magnetic resonance scans. T1 mapping, late gadolinium enhancement and cine imaging were performed to measure native T1, ECV, infarct size and LV global function, respectively. LV remodeling was evaluated as the change in LV end-diastolic volume index (△EDV) at follow-up scan compared with baseline.

Results: In acute scan, 37 patients (66.07 %) had microvascular obstruction (MVO). The native T1 did not significantly differ between patients with or without MVO (1482.0 ± 80.6 ms vs. 1469.0 ± 71.6 ms, P =  0.541). However, ECV in patients without MVO was lower than that in patients with MVO (49.60 ± 8.57 % vs. 58.53 ± 8.62 %, P = 0.001). The native T1 only correlated with △EDV in patients without MVO (r = 0.495, P = 0.031); while ECV was associated with △EDV in all patients (r = 0.665, P =  0.002; r = 0.506, P =  0.001; r = 0.570, P <  0.001). Furthermore, ECV was independently associated with LV remodeling in multivariable linear regression analysis (β = 0.490, P =  0.002).

Conclusion: As a promising parameter for early risk stratification after AMI, ECV is associated with LV remodeling during follow-up; while native T1 may be feasible when MVO is absent.
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http://dx.doi.org/10.1016/j.ejrad.2021.109590DOI Listing
April 2021

The Effect of Posture on Maximum Grip Strength Measurements.

J Clin Densitom 2021 Oct-Dec;24(4):638-644. Epub 2021 Jan 19.

Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China. Electronic address:

Introduction/background: The purpose of this study was to compare the grip strength values obtained under 4 postures, and to identify the position providing the maximum grip strength value. We also explored the effects of different body positions on grip strength measurements and the significance of the selection of measurement position for guiding the screening and diagnosis of sarcopenia.

Methodology: A total of 764 people (409 males and 355 females) participated in this study. Grip strength was measured in 4 positions: (1) standing with the elbow fully extended; (2) standing with arms raised; (3) sitting with the elbow flexed 90°; and (4) sitting with the elbow extended. Multiple linear regression model was used to compare the grip strength measurements obtained from these 4 positions by each hand when considering the influence of age, gender, body mass index, and other factors.

Results: Both male and female grip strength values in the standing position with the elbow fully extended were significantly greater than those in other positions. In addition, the grip strength measured by standing posture was generally greater than measured by sitting posture. In contrast, grip strength values in the 2 sitting positions did not differ significantly. The grip strength of men was generally greater than that of women.

Conclusions: The findings reveal that grip strength measured while standing with the elbow fully extended is greater than that measured while sitting, which is the posture currently recommended in clinical practice. Clinicians and researchers should choose the appropriate and optimal postures to measure grip strength.
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http://dx.doi.org/10.1016/j.jocd.2021.01.005DOI Listing
November 2021

Noninvasive oxygenation assessment after acute myocardial infarction with breathing maneuvers-induced oxygenation-sensitive magnetic resonance imaging.

J Magn Reson Imaging 2021 07 12;54(1):284-289. Epub 2021 Jan 12.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.

The safety profiles when performing stress oxygenation-sensitive magnetic resonance imaging (OS-MRI) have raised concerns in clinical practice. Adenosine infusion can cause side effects such as chest pain, dyspnea, arrhythmia, and even cardiac death. The aim of this study was to investigate the feasibility of breathing maneuvers-induced OS-MRI in acute myocardial infarction (MI). This was a prospective study, which included 14 healthy rabbits and nine MI rabbit models. This study used 3 T MRI/modified Look-Locker inversion recovery sequence for native T mapping, balanced steady-state free precession sequence for OS imaging, and phase-sensitive inversion recovery sequence for late gadolinium enhancement. The changes in myocardial oxygenation (ΔSI) were assessed under two breathing maneuvers protocols in healthy rabbits: a series of extended breath-holding (BH), and a combined maneuver of hyperventilation followed by the extended BH (HVBH). Subsequently, OS-MRI with HVBH in acute MI rabbits was performed, and the ΔSI was compared with that of adenosine stress protocol. Student's t-test, Wilcoxon rank test, and Friedman test were used to compare ΔSI in different subgroups. Pearson and Spearman correlation was used to obtain the association of ΔSI between breathing maneuvers and adenosine stress. Bland-Altman analysis was used to assess the bias of ΔSI between HVBH and adenosine stress. In healthy rabbits, BH maneuvers from 30 to 50 s induced significant increase in SI compared with the baseline (all p < 0.05). By contrast, hyperventilation for 60 s followed by 10 s-BH (HVBH 10 s) exhibited a comparable ΔSI to that of stress test (p = 0.07). In acute MI rabbits, HVBH 10 s-induced ΔSIs among infarcted, salvaged, and the remote myocardial area were no less effectiveness than adenosine stress when performing OS-MRI (r = 0.84; p < 0.05). Combined breathing maneuvers with OS-MRI have the potential to be used as a nonpharmacological alternative for assessing myocardial oxygenation in patients with acute MI. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 2.
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http://dx.doi.org/10.1002/jmri.27509DOI Listing
July 2021

Features of family clusters of COVID-19 patients: A retrospective study.

Travel Med Infect Dis 2021 Jan-Feb;39:101950. Epub 2020 Dec 8.

Department of Radiology, West China Hospital, Sichuan University, Chengdu, China. Electronic address:

Background: To investigate and compare the clinical and imaging features among family members infected with COVID-19.

Methods: We retrospectively collected a total of 34 COVID-19 cases (15 male, 19 female, aged 48 ± 16 years, ranging from 10 to 81 years) from 13 families from January 17, 2020 through February 15, 2020. Patients were divided into two groups: Group 1 - part of the family members (first-generation) who had exposure history and others (second-generation) infected through them, and Group 2 - patients from the same family having identical exposure history. We collected clinical symptoms, laboratory findings, and high-resolution computed tomography (HRCT) features for each patient. Comparison tests were performed between the first- and second-generation patients in Group 1.

Results: In total there were 21 patients in Group 1 and 20 patients in Group 2. For Group 1, first-generation patients had significantly higher white blood cell count (6.5 × 10/L (interquartile range (IQR): 4.9-9.2 × 10/L) vs 4.5 × 10/L (IQR: 3.7-5.3 × 10/L); P = 0.0265), higher neutrophil count (4.9 × 10/L (IQR: 3.6-7.3 × 10/L) vs 2.9 × 10/L (IQR: 2.1-3.3 × 10/L); P = 0.0111), and higher severity scores on HRCT (3.9 ± 2.4 vs 2.0 ± 1.3, P = 0.0362) than the second-generation patients. Associated underlying diseases (odds ratio, 8.0, 95% confidence interval: 3.4-18.7, P = 0.0013) were significantly correlated with radiologic severity scores in second-generation patients.

Conclusion: Analysis of the family cluster cases suggests that COVID-19 had no age or sex predominance. Secondarily infected patients in a family tended to develop milder illness, but this was not true for those with existing comorbidities.
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http://dx.doi.org/10.1016/j.tmaid.2020.101950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7722491PMC
March 2021

Myocardial perfusion assessment in the infarct core and penumbra zones in an in-vivo porcine model of the acute, sub-acute, and chronic infarction.

Eur Radiol 2021 May 6;31(5):2798-2808. Epub 2020 Nov 6.

Department of Radiology, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.

Objectives: To assess the longitudinal changes of microvascular function in different myocardial regions after myocardial infarction (MI) using myocardial blood flow derived by dynamic CT perfusion (CTP-MBF), and compare CTP-MBF with the results of cardiac magnetic resonance (CMR) and histopathology.

Methods: The CTP scanning was performed in a MI porcine model 1 day (n = 15), 7 days (n = 10), and 3 months (n = 5) following induction surgery. CTP-MBF was measured in the infarcted myocardium, penumbra, and remote myocardium, respectively. CMR perfusion and histopathology were performed for validation.

Results: From baseline to follow-up scans, CTP-MBF presented a stepwise increase in the infarcted myocardium (68.51 ± 11.04 vs. 86.73 ± 13.32 vs. 109.53 ± 26.64 ml/100 ml/min, p = 0.001) and the penumbra (104.92 ± 29.29 vs. 120.32 ± 24.74 vs. 183.01 ± 57.98 ml/100 ml/min, p = 0.008), but not in the remote myocardium (150.05 ± 35.70 vs. 166.66 ± 38.17 vs. 195.36 ± 49.64 ml/100 ml/min, p = 0.120). The CTP-MBF correlated with max slope (r = 0.584, p < 0.001), max signal intensity (r = 0.357, p < 0.001), and time to max (r = - 0.378, p < 0.001) by CMR perfusion. Moreover, CTP-MBF defined the infarcted myocardium on triphenyl tetrazolium chloride staining (AUC: 0.810, p < 0.001) and correlated with microvascular density on CD31 staining (r = 0.561, p = 0.002).

Conclusion: CTP-MBF could quantify the longitudinal changes of microvascular function in different regions of the post-MI myocardium, which demonstrates good agreement with contemporary CMR and histopathological findings.

Key Points: • The CT perfusion-based myocardial blood flow (CTP-MBF) could quantify the microvascular impairment in different myocardial regions after myocardial infarction (MI) and track its recovery over time. • The assessment of CTP-MBF is in good agreement with contemporary cardiac MRI and histopathological findings, which potentially facilitates a rapid approach for pathophysiological insights following MI.
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http://dx.doi.org/10.1007/s00330-020-07220-xDOI Listing
May 2021

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study.

Int J Cardiol Heart Vasc 2020 Dec 8;31:100649. Epub 2020 Oct 8.

Cardiothoracic Surgery Department, Guang'an People's Hospital, Sichuan Province, China.

Background: Anomalous left coronary artery from the opposite sinus (left-ACAOS) is a rare congenital heart disease. While "interarterial course" is considered as the malignant anatomic feature for these patients, a number of patients with left-ACAOS, who don't follow the above anatomic pattern, were reported with ischemic symptoms.

Purpose: This study aims to evaluate the anatomic characteristics of left-ACAOS and their clinical relevance.

Methods: The coronary computed tomography angiography (CCTA) data from 44 patients with 46 left-ACAOS vessels were retrospectively included. Patients were divided into 2 groups: those with ischemic symptoms (n = 19) and those without ischemic symptoms (n = 25). Baseline clinical characteristics were recorded and the follow-up was done by telephone. CCTA images were reviewed for anomalous coronary artery, take-off angle and level, ostia morphology and grading, proximal narrowing, anomalous course and atherosclerotic plaques.

Results: The prevalence of left-ACAOS was approximately 0.09% among 48, 719 consecutive patients referred for coronary CTA in our institution. Right sinus of Valsalva (RSV) was the most common origin (36/46, 78.26%). Left-ACAOS arising from right coronary artery (RCA) had narrower proximal segment (P = 0.014) and more prone to atherosclerosis (P = 0.040) than left-ACAOS arising from right sinus of Valsalva (RSV). Proximal narrowing severity (P < 0.001) and degree of maximal coronary stenosis (P = 0.034) of the anomalous left artery was higher in patients with ischemic symptoms than those without. Of note, no MACE was recorded during a mean follow-up of 43.4 ± 26.2 months.

Conclusion: Left-ACAOS arising from RCA seems to be more prone to atherosclerosis than other subtypes. Proximal narrowing was more severe in patients with ischemia symptoms, which may contribute to risk stratification and clinical management.
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http://dx.doi.org/10.1016/j.ijcha.2020.100649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558218PMC
December 2020

Additive effect of hypertension on left ventricular structure and function in patients with asymptomatic type 2 diabetes mellitus.

J Hypertens 2021 03;39(3):538-547

Department of Radiology, West China Hospital, Sichuan University.

Objective: We aimed to comprehensively determine the effects of hypertension on left ventricular (LV) structure, microcirculation, tissue characteristics, and deformation in type 2 diabetes mellitus (T2DM) using multiparametric cardiac magnetic resonance (CMR) imaging.

Methods: We prospectively enrolled 138 asymptomatic patients with T2DM (80 normotensive and 58 hypertensive individuals) and 42 normal glucose-tolerant and normotensive controls and performed multiparametric CMR examination to assess cardiac geometry, microvascular perfusion, extracellular volume (ECV), and strain. Univariable and multivariable linear analysis was performed to analyze the effect of hypertension on LV deformation in patients with T2DM.

Results: Compared with controls, patients with T2DM exhibited decreased strain, decreased microvascular perfusion, increased LV remodeling index, and increased ECV. Hypertension lead to greater deterioration of LV strain (peak strain-radial, P = 0.002; peak strain-longitudinal, P = 0.006) and LV remodeling index (P = 0.005) in patients with T2DM after adjustment for covariates; however, it did not affect microvascular perfusion (perfusion index, P = 0.469) and ECV (P = 0.375). In multivariable analysis, hypertension and diabetes were independent predictors of reduced LV strain, whereas hypertension is associated with greater impairment of diastolic function (P = 0.009) but not systolic function (P = 0.125) in the context of diabetes, independent of clinical factors and myocardial disorder.

Conclusion: Hypertension in the context of diabetes is significantly associated with LV diastolic function and concentric remodeling; however, it has little effect on systolic function, myocardial microcirculation, or fibrosis independent of covariates, which provide clinical evidence for understanding the pathogenesis of comorbidities and explaining the development of distinct heart failure phenotypes.
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http://dx.doi.org/10.1097/HJH.0000000000002643DOI Listing
March 2021

Multimodal cardiac magnetic resonance imaging of ALCAPA syndrome.

Eur Heart J 2021 02;42(7):798

Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University.

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http://dx.doi.org/10.1093/eurheartj/ehaa816DOI Listing
February 2021

The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study.

Cardiovasc Diabetol 2020 09 30;19(1):161. Epub 2020 Sep 30.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.

Background: Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals.

Materials And Methods: Seventy hypertensive patients without T2DM [HTN(T2DM-)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni's post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension.

Results: Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM-), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM-) and control groups. Compared with controls, HTN(T2DM-) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM-) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R= 0.383; GCPS: p < 0.001, model R= 0.472; and GLPS: p = 0.002, model R= 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R= 0.293; TTM: p < 0.001, model R= 0.299; and MaxSI: p < 0.001, model R= 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R= 0.390) and GCPS (p = 0.002 and 0.001, model R= 0.424), and T2DM but not perfusion indices was independently associated with GLPS (p = 0.002, model R= 0.424).

Conclusion: In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.
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http://dx.doi.org/10.1186/s12933-020-01138-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528579PMC
September 2020

Retraction Note: Prognostic value of heart failure in hemodialysis-dependent end-stage renal disease patients with myocardial fibrosis quantification by extracellular volume on cardiac magnetic resonance imaging.

BMC Cardiovasc Disord 2020 09 15;20(1):407. Epub 2020 Sep 15.

Department of Radiology, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12872-020-01688-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491183PMC
September 2020

Effect of prediabetes on the long-term all-cause mortality of patients undergoing percutaneous coronary intervention: A protocol for systematic review and meta analysis.

Medicine (Baltimore) 2020 Aug;99(33):e21623

Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan.

Background: Prediabetes is an abnormal metabolic state that develops prior to the onset of diabetes with proven to common comorbid states of coronary artery disease. However, whether prediabetes worsens prognosis after percutaneous coronary intervention remains controversial. The aim of this study is to summarize previous cohort studies and to specify the impact of prediabetes on the long-term outcomes after percutaneous coronary intervention.

Methods: This meta-analysis will be performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines for conducting and reporting meta-analysis data. Pubmed, Embase and Google scholar will be systematically searched, and supplemented with manual searches of the included reference lists to identify cohort studies. Pooled effects on the discontinuous variables will be expressed by adjusted hazard ratios with 95% confidence intervals. All analyses will be performed with Stata 15.0 (StataCorp LP, College Station, TX).

Results: The results of this study will be published in a peer-reviewed journal.

Conclusion: This systematic review will provide new information and help enhance clinical decision-making on management of these patients.

Registration Number: INPLASY202060079.
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http://dx.doi.org/10.1097/MD.0000000000021623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437842PMC
August 2020

Assessment of left ventricular deformation in patients with type 2 diabetes mellitus by cardiac magnetic resonance tissue tracking.

Sci Rep 2020 08 4;10(1):13126. Epub 2020 Aug 4.

Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, China.

To quantify the global and regional left ventricular (LV) myocardial strain in type 2 diabetes mellitus (T2DM) patients using cardiac magnetic resonance (CMR) tissue-tracking techniques and to determine the ability of myocardial strain parameters to assessment the LV deformation. Our study included 98 adult T2DM patients (preserved LV ejection fraction [LVEF], 72; reduced LVEF, 26) and 35 healthy controls. Conventional LV function, volume-time curve parameters and LV remodeling index were measured using CMR. Global and regional LV myocardial strain parameters were measured using CMR tissue tracking and compared between the different sub-groups. Receiver operating characteristic analysis was used to assess the diagnostic accuracy. Regression analyses were conducted to determine the relationship between strain parameters and the LV remodeling index. The results show that global radial peak strain (PS) and circumferential PS were not significantly different between the preserved-LVEF group and control group (P > 0.05). However, longitudinal PS was significantly lower in the preserved-LVEF group than in the control group (P = 0.005). Multivariate linear and logistic regression analyses showed that global longitudinal PS was independently associated (β = 0.385, P < 0.001) with the LV remodeling index. In conclusion, early quantitative evaluation of cardiac deformation can be successfully performed using CMR tissue tracking in T2DM patients. In addition, global longitudinal PS can complement LVEF in the assessment of cardiac function.
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http://dx.doi.org/10.1038/s41598-020-69977-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7403307PMC
August 2020

The combined effects of cardiac geometry, microcirculation, and tissue characteristics on cardiac systolic and diastolic function in subclinical diabetes mellitus-related cardiomyopathy.

Int J Cardiol 2020 Dec 15;320:112-118. Epub 2020 Jul 15.

Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041, China. Electronic address:

Background: Diabetes mellitus-related cardiomyopathy has recently been described as a distinct progression of left ventricular (LV) systolic and diastolic dysfunction. Pathological changes in the myocardium may explain the development of two different phenotypes. We evaluated the effects of LV geometry, myocardial microcirculation, and tissue characteristics on cardiac deformation in patients with subclinical type 2 diabetes mellitus (T2DM) utilizing multiparametric cardiac magnetic resonance (CMR) imaging.

Methods: A total of 135 T2DM patients and 55 matched controls were prospectively enrolled and performed multiparametric CMR examination. CMR-derived parameters including cardiac geometry, function, microvascular perfusion, T1 mapping, T2 mapping, and strain were analyzed and compared between T2DM patients and controls.

Results: The univariable and multivariable analysis of systolic and diastolic function revealed that longer duration of diabetes was associated with decreased longitudinal peak systolic strain rate (PSSR-L) (β = 0.195, p = .013), and higher remodeling index and higher extracellular volume (ECV) tended to correlate with decreased longitudinal peak diastolic strain rate (PDSR-L) (remodeling index, β = -0.339, p = .000; ECV, β = -0.172, p = .026), whereas microvascular perfusion index and T2 value affected both PSSR-L (perfusion index, β = -0.328, p = .000; T2 value, β = 0.306, p = .000) and PDSR-L (perfusion index, β = 0.209, p = .004; T2 value, β = -0.275, p = .000) simultaneously.

Conclusions: The LV concentric remodeling and myocardial fibrosis correlated with diastolic function, and perfusion function and myocardial edema were associated with both LV systolic and diastolic function.
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http://dx.doi.org/10.1016/j.ijcard.2020.07.013DOI Listing
December 2020
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