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Magnetic Resonance Materials in Physics, Biology and Medicine

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Open Access 01-02-2018 | Research Article

Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging

Authors: Tomas Lapinskas, Bernhard Schnackenburg, Marc Kouwenhoven, Rolf Gebker, Alexander Berger, Remigijus Zaliunas, Burkert Pieske, Sebastian Kelle

Published in: Magnetic Resonance Materials in Physics, Biology and Medicine | Issue 1/2018

Abstract

Objective

This study aimed to investigate the advantages of recently developed cardiac imaging techniques of fat–water separation and feature tracking to characterize better individuals with chronic myocardial infarction (MI).

Materials and methods

Twenty patients who had a previous MI underwent CMR imaging. The study protocol included routine cine and late gadolinium enhancement (LGE) technique. In addition, mDixon LGE imaging was performed in every patient. Left ventricular (LV) circumferential (Ecc_LV) and radial (Err_LV) strain were calculated using dedicated software (CMR⁴², Circle, Calgary, Canada). The extent of global scar was measured in LGE and fat–water separated images to compare conventional and recent CMR imaging techniques.

Results

The infarct size derived from conventional LGE and fat–water separated images was similar. However, detection of lipomatous metaplasia was only possible with mDixon imaging. Subjects with fat deposition demonstrated a significantly smaller percentage of fibrosis than those without fat (10.68 ± 5.07% vs. 13.83 ± 6.30%; p = 0.005). There was no significant difference in Ecc_LV or Err_LV between myocardial segments containing fibrosis only and fibrosis with fat. However, Ecc_LV and Err_LV values were significantly higher in myocardial segments adjacent to fibrosis with fat deposition than in those adjacent to LGE only.

Conclusions

Advanced CMR imaging ensures more detailed tissue characterization in patients with chronic MI without a relevant increase in imaging and post-processing time. Fatty metaplasia may influence regional myocardial deformation especially in the myocardial segments adjacent to scar tissue. A simplified and shortened myocardial viability CMR protocol might be useful to better characterize and stratify patients with chronic MI.

Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, Khalife K, Goldstein P, Cattan S, Vaur L, Cambou JP, Ferrières J, Danchin N, USIK USIC 2000 Investigators, FAST MI Investigators (2012) Associations of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA 308(10):998–1006CrossRefPubMed

Baroldi G, Silver MD, De Maria R, Parodi O, Pellegrini A (1997) Lipomatous metaplasia in left ventricular scar. Can J Cardiol 13(1):65–71PubMed

Goldfarb JW, Arnold S, Roth M, Han J (2007) T1-weighted magnetic resonance imaging shows fatty deposition after myocardial infarction. Magn Reson Med 57(5):828–834CrossRefPubMed

Mordi I, Radjenovic A, Stanton T, Gardner RS, McPhaden A, Carrick D, Berry C, Tzemos N (2015) Prevalence and prognostic significance of lipomatous metaplasia in patients with prior myocardial infarction. JACC Cardiovasc Imaging 8(9):1111–1112CrossRefPubMed

Burke AP, Farb A, Tashko G, Virmani R (1998) Arrhythmogenic right ventricular cardiomyopathy and fatty replacement of the right ventricular myocardium: are they different diseases? Circulation 97(16):1571–1580CrossRefPubMed

Homsi R, Meier-Schroers M, Gieseke J, Dabir D, Luetkens JA, Kuetting DL, Naehle CP, Marx C, Schild HH, Thomas DK, Sprinkart AM (2016) 3D-Dixon MRI based volumetry of peri- and epicardial fat. Int J Cardiovasc Imaging 32(2):291–299CrossRefPubMed

Goldfarb JW (2008) Fat-water separated delayed hyperenhanced myocardial infarct imaging. Magn Reson Med 60(3):503–509CrossRefPubMed

Kellman P, Hernando D, Shah S, Zuehlsdorff Jerecic R, Mancini C, Liang ZP, Arai AE (2009) Multiecho dixon fat and water separation method for detecting fibrofatty infiltration in the myocardium. Magn Reson Med 61(1):215–221CrossRefPubMedPubMedCentral

Eggers H, Brendel B, Duijndam A, Herigault G (2011) Dual-echo dixon imaging with flexible choice of echo times. Magn Reson Med 65(1):96–107CrossRefPubMed

10.

Kempny A, Fernández-Jiménez R, Orwat S, Schuler P, Bunck AC, Maintz D, Baumgartner H, Diller GP (2012) Quantification of biventricular myocardial function using cardiac magnetic resonance feature tracking, endocardial border delineation and echocardiographic speckle tracking in patients with repaired tetralogy of Fallot and healthy controls. J Cardiovasc Magn Reson 14:32CrossRefPubMedPubMedCentral

11.

Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43CrossRefPubMedPubMedCentral

12.

Kowallick JT, Morton G, Lamata P, Jogiya R, Kutty S, Lotz J, Hasenfuß G, Nagel E, Chiribiri A, Schuster A (2016) Inter-study reproducibility of left ventricular torsion and torsion rate quantification using MR myocardial feature tracking. J Magn Reson Imaging 43(1):128–137CrossRefPubMed

13.

Lapinskas T, Bucius P, Urbonaite L, Stabinskaite A, Valuckiene Z, Jankauskaite L, Benetis R, Zaliunas R (2017) Left atrial mechanics in patients with acute STEMI and secondary mitral regurgitation: a prospective pilot CMR feature tracking study. Med (Kaunas) 53(1):11–18

14.

Suinesiaputra A, Bluemke DA, Cowan BR, Friedrich MG, Kramer CM, Kwong R, Plein S, Schulz-Menger J, Westenberg JJ, Young AA, Nagel E (2015) Quantification of LV function and mass by cardiovascular magnetic resonance: multi-center variability and consensus contours. J Cardiovasc Magn Reson 17:63CrossRefPubMedPubMedCentral

15.

Mikami Y, Kolman L, Joncas SX, Stirrat J, Scholl D, Rajchl M, Lydell CP, Weeks SG, Howarth AG, White JA (2014) Accuracy and reproducibility of semi-automated late gadolinium enhancement quantification techniques in patients with hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 16:85CrossRefPubMedPubMedCentral

16.

Kelle S, Roes SD, Klein C, Kokocinski T, de Roos A, Fleck E, Bax JJ, Nagel E (2009) Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J Am Coll Cardiol 54(19):1770–1777CrossRefPubMed

17.

Cerqueira MD, Wiessman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS, American Heart Association Writing Group on Myocardial Segmentation and Registration for Cardiac Imaging (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Int J Cardiovasc Imaging 18(1):539–542PubMed

18.

Maret E, Todt T, Brudin L, Nylander E, Swahn E, Ohlsson JL, Engvall JE (2009) Functional measurements based on feature tracking of cine magnetic resonance images identify left ventricular segments with myocardial scar. Cardiovasc Ultrasound 7:53CrossRefPubMedPubMedCentral

19.

Ramage EJ, Reid JH, Hardwick D (2003) Subendocardial fat: an unusual finding. Clin Radiol 58(10):816–817CrossRefPubMed

20.

Winer-Muram HT, Tann M, Aisen AM, Ford L, Jennings SG, Bretz R (2004) Computed tomography demonstration of lipomatous metaplasia of the left ventricle following myocardial infarction. J Comput Assist Tomogr 28(4):455–458CrossRefPubMed

21.

Schmitt M, Samani N, McCann G (2007) Images in cardiovascular medicine. Lipomatous metaplasia in ischemic cardiomyopathy: a common but unappreciated entity. Circulation 116(1):e5–e6CrossRefPubMed

22.

Su L, Siegel JE, Fishbein MC (2004) Adipose tissue in myocardial infarction. Cardiovasc Pathol 13(2):98–102CrossRefPubMed

23.

Zafar HM, Litt HI, Torigian DA (2008) CT imaging features and frequency of left ventricular myocardial fat in patients with CT findings of chronic left ventricular myocardial infarction. Clin Radiol 63(3):256–262CrossRefPubMed

24.

Goldfarb JW, Roth M, Han J (2009) Myocardial fat deposition after left ventricular myocardial infarction: assessment by using MR water-fat separation imaging. Radiology 253(1):65–73CrossRefPubMed

25.

Aquaro GD, Nucifora G, Pederzoli L, Strata E, De Marchi D, Todiere G, Andrea B, Pingitore A, Lombardi M (2012) Fat in left ventricular myocardium assessed by steady-state free precession pulse sequences. Int J Cardiovasc Imaging 28(4):813–821CrossRefPubMed

26.

Hsu LY, Ingkanisorn WP, Kellman P, Aletras AH, Arai AE (2006) Quantitative myocardial infarction on delayed enhancement MRI. Part II: clinical application of an automated feature analysis and combined thresholding infarct sizing algorithm. J Magn Reson Imaging 23(3):309–314CrossRefPubMed

27.

Wu YW, Tadamura E, Yamamuro M, Kanao S, Abe M, Kimura T, Kita T, Togashi K (2007) Identification of lipomatous metaplasia in old infarcted myocardium by cardiovascular magnetic resonance and computed tomography. Int J Cardiol 115(1):e15–e16CrossRefPubMed

28.

Dixon WT (1984) Simple proton spectroscopic imaging. Radiology 153(1):189–194CrossRefPubMed

29.

Farrelly C, Shah S, Davarpanah A, Keeling AN, Carr JC (2012) ECG-gated multiecho dixon fat-water separation in cardiac MRI: advantages over conventional fat-saturated imaging. AJR Am J Roentgenol 199(1):W74–W83CrossRefPubMed

30.

Ma J (2008) Dixon techniques for water and fat imaging. J Magn Reson Imaging 28(3):543–558CrossRefPubMed

31.

Flett AS, Sado DM, Quarta G, Mirabel M, Pellerin D, Herrey AS, Hausenloy DJ, Ariti C, Yap J, Kolvekar S, Taylor AM, Moon J (2012) Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging 13(10):819–826CrossRefPubMed

32.

Kellman P, Bandettini WP, Mancini C, Hammer-Hansen S, Hansen MS, Arai AE (2015) Characterization of myocardial T1-mapping bias caused by intramyocardial fat in inversion recovery and saturation recovery techniques. J Cardiovasc Magn Reson 17:33CrossRefPubMedPubMedCentral

33.

Hor KN, Gottliebson WM, Carson C, Wash E, Cnota J, Fleck R, Wansapura J, Klimeczek P, Al-Khalidi HR, Chung ES, Benson DW, Mazur W (2010) Comparison of magnetic resonance feature tracking for strain calculation with harmonic phase imaging analysis. JACC Cardiovasc Imaging 3(2):144–151CrossRefPubMed

34.

De Bakker JM, van Capelle FJ, Janse MJ, Wilde AA, Coronel R, Becker AE, Dingemans KP, van Hemel NM, Hauer RN (1988) Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation. Circulation 77(3):589–606CrossRefPubMed

35.

Pouliopoulos J, Chik WW, Kanthan A, Sivagangabalan G, Barry MA, Fahmy PN, Midekin C, Lu J, Kizana E, Thomas SP, Thiagalingam A, Kovoor P (2013) Intramyocardial adiposity after myocardial infarction: new implications of a substrate for ventricular tachycardia. Circulation 128(21):2296–2308CrossRefPubMed

36.

Taylor RJ, Moody WE, Umar F, Edwards NC, Taylor TJ, Stegemann B, Townend JN, Hor KN, Steeds RP, Mazur W, Leyva F (2015) Myocardial strain measurement with feature-tracking cardiovascular magnetic resonance: normal values. Eur Heart J Cardiovasc Imaging 16(8):871–881CrossRefPubMed

Title: Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging
Authors: Tomas Lapinskas
Bernhard Schnackenburg
Marc Kouwenhoven
Rolf Gebker
Alexander Berger
Remigijus Zaliunas
Burkert Pieske
Sebastian Kelle
Publication date: 01-02-2018
Publisher: Springer Berlin Heidelberg
Published in: Magnetic Resonance Materials in Physics, Biology and Medicine / Issue 1/2018
Print ISSN: 0968-5243
Electronic ISSN: 1352-8661
DOI: https://doi.org/10.1007/s10334-017-0639-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fatty metaplasia quantification and impact on regional myocardial function as assessed by advanced cardiac MR imaging

Abstract

Objective

Materials and methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objective

Materials and methods

Results

Conclusions

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