Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis
Abstract Background Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. Methods Six hundred se...
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Language: | English |
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BMC
2019-02-01
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Series: | Journal of Cardiovascular Magnetic Resonance |
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Online Access: | http://link.springer.com/article/10.1186/s12968-019-0520-0 |
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doaj-7af8d3badbb148dd97f6da80f403cbc2 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Christoph Gräni Christian Eichhorn Loïc Bière Kyoichi Kaneko Venkatesh L. Murthy Vikram Agarwal Ayaz Aghayev Michael Steigner Ron Blankstein Michael Jerosch-Herold Raymond Y. Kwong |
spellingShingle |
Christoph Gräni Christian Eichhorn Loïc Bière Kyoichi Kaneko Venkatesh L. Murthy Vikram Agarwal Ayaz Aghayev Michael Steigner Ron Blankstein Michael Jerosch-Herold Raymond Y. Kwong Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis Journal of Cardiovascular Magnetic Resonance Myocarditis Outcome MACE CMR Cardiovascular magnetic resonance imaging Quantification method |
author_facet |
Christoph Gräni Christian Eichhorn Loïc Bière Kyoichi Kaneko Venkatesh L. Murthy Vikram Agarwal Ayaz Aghayev Michael Steigner Ron Blankstein Michael Jerosch-Herold Raymond Y. Kwong |
author_sort |
Christoph Gräni |
title |
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
title_short |
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
title_full |
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
title_fullStr |
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
title_full_unstemmed |
Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
title_sort |
comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis |
publisher |
BMC |
series |
Journal of Cardiovascular Magnetic Resonance |
issn |
1532-429X |
publishDate |
2019-02-01 |
description |
Abstract Background Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. Methods Six hundred seventy consecutive patients (48 ± 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods. Results Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02–1.08, p = 0.001; HR 1.02, 95%CI:1.00–1.04; p = 0.001; HR 1.02, 95%CI: 1.00–1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04–1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values. Conclusions FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients. Trial registration number NCT03470571. Registered 13th March 2018. Retrospectively registered. |
topic |
Myocarditis Outcome MACE CMR Cardiovascular magnetic resonance imaging Quantification method |
url |
http://link.springer.com/article/10.1186/s12968-019-0520-0 |
work_keys_str_mv |
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doaj-7af8d3badbb148dd97f6da80f403cbc22020-11-25T00:35:04ZengBMCJournal of Cardiovascular Magnetic Resonance1532-429X2019-02-0121111110.1186/s12968-019-0520-0Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditisChristoph Gräni0Christian Eichhorn1Loïc Bière2Kyoichi Kaneko3Venkatesh L. Murthy4Vikram Agarwal5Ayaz Aghayev6Michael Steigner7Ron Blankstein8Michael Jerosch-Herold9Raymond Y. Kwong10Noninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolCardiovascular Imaging, Department of Radiology, Frankel Cardiovascular Center, University of MichiganNoninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical SchoolNoninvasive Cardiovascular Imaging, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical SchoolAbstract Background Although the presence of late gadolinium enhancement (LGE) using cardiovascular magnetic resonance imaging (CMR) is a significant discriminator of events in patients with suspected myocarditis, no data are available on the optimal LGE quantification method. Methods Six hundred seventy consecutive patients (48 ± 16 years, 59% male) with suspected myocarditis were enrolled between 2002 and 2015. We performed LGE quantitation using seven different signal intensity thresholding methods based either on 2, 3, 4, 5, 6, 7 standard deviations (SD) above remote myocardium or full width at half maximum (FWHM). In addition, a LGE visual presence score (LGE-VPS) (LGE present/absent in each segment) was assessed. For each of these methods, the strength of association of LGE results with major adverse cardiac events (MACE) was determined. Inter-and intra-rater variability using intraclass-correlation coefficient (ICC) was performed for all methods. Results Ninety-eight (15%) patients experienced a MACE at a medium follow-up of 4.7 years. LGE quantification by FWHM, 2- and 3-SD demonstrated univariable association with MACE (hazard ratio [HR] 1.05, 95% confidence interval [CI]:1.02–1.08, p = 0.001; HR 1.02, 95%CI:1.00–1.04; p = 0.001; HR 1.02, 95%CI: 1.00–1.05, p = 0.035, respectively), whereas 4-SD through 7-SD methods did not reach significant association. LGE-VPS also demonstrated association with MACE (HR 1.09, 95%CI: 1.04–1.15, p < 0.001). In the multivariable model, FWHM, 2-SD methods, and LGE-VPS each demonstrated significant association with MACE adjusted to age, sex, BMI and LVEF (adjusted HR of 1.04, 1.02, and 1.07; p = 0.009, p = 0.035; and p = 0.005, respectively). In these, FWHM and LGE-VPS had the highest degrees of inter and intra-rater reproducibility based on their high ICC values. Conclusions FWHM is the optimal semi-automated quantification method in risk-stratifying patients with suspected myocarditis, demonstrating the strongest association with MACE and the highest technical consistency. Visual LGE scoring is a reliable alternative method and is associated with a comparable association with MACE and reproducibility in these patients. Trial registration number NCT03470571. Registered 13th March 2018. Retrospectively registered.http://link.springer.com/article/10.1186/s12968-019-0520-0MyocarditisOutcomeMACECMRCardiovascular magnetic resonance imagingQuantification method |