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Article ; Online: Future cardiovascular healthcare via magnetic resonance imaging-driven robotics.

Lloyd, Peter / Dall'Armellina, Erica / Schneider, Jurgen E / Valdastri, Pietro

2024

Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	603098-1
ISSN	1522-9645 ; 0195-668X
ISSN (online)	1522-9645
ISSN	0195-668X
DOI	10.1093/eurheartj/ehae095
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Article ; Online: From Recognized to Novel Quantitative CMR Biomarkers of LV Recovery: A Paradigm Shift in Acute Myocardial Infarction Imaging.

Dall'Armellina, Erica

JACC. Cardiovascular imaging

2016 Volume 10, Issue 9, Page(s) 1000–1002

MeSH term(s)	Biomarkers ; Humans ; Myocardial Infarction ; Myocardium
Chemical Substances	Biomarkers
Language	English
Publishing date	2016-10-19
Publishing country	United States
Document type	Editorial ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2016.07.007
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Article ; Online: Utilization and impact of cardiovascular magnetic resonance on patient management in heart failure: insights from the SCMR Registry.

Roifman, Idan / Hammer, Michael / Sparkes, John / Dall'Armellina, Erica / Kwong, Raymond Y / Wright, Graham

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

2022 Volume 24, Issue 1, Page(s) 65

Abstract: Background: Cardiovascular magnetic resonance (CMR) is an important diagnostic test used in the evaluation of patients with heart failure (HF). However, the demographics and clinical characteristics of those undergoing CMR for evaluation of HF are ... ...

Abstract	Background: Cardiovascular magnetic resonance (CMR) is an important diagnostic test used in the evaluation of patients with heart failure (HF). However, the demographics and clinical characteristics of those undergoing CMR for evaluation of HF are unknown. Further, the impact of CMR on subsequent HF patient care is unclear. The goal of this study was to describe the characteristics of patients undergoing CMR for HF and to determine the extent to which CMR leads to changes in downstream patient management by comparing pre-CMR indications and post-CMR diagnoses. Methods: We utilized the Society for Cardiovascular Magnetic Resonance (SCMR) Registry as our data source and abstracted data for patients undergoing CMR scanning for HF indications from 2013 to 2019. Descriptive statistics (percentages, proportions) were performed on key CMR and clinical variables of the patient population. The Fisher's exact test was used when comparing categorical variables. The Wilcoxon rank sum test was used to compare continuous variables. Results: 3,837 patients were included in our study. 94% of the CMRs were performed in the United States with China, South Korea and India also contributing cases. Median age of HF patients was 59.3 years (IQR, 47.1, 68.3 years) with 67% of the scans occurring on women. Almost 2/3 of the patients were scanned on 3T CMR scanners. Overall, 49% of patients who underwent CMR scanning for HF had a change between the pre-test indication and post CMR diagnosis. 53% of patients undergoing scanning on 3T had a change between the pre-test indication and post CMR diagnosis when compared to 44% of patients who were scanned on 1.5T (p < 0.01). Conclusion: Our results suggest a potential impact of CMR scanning on downstream diagnosis of patients referred for CMR for HF, with a larger potential impact on those scanned on 3T CMR scanners.
MeSH term(s)	Humans ; Female ; Predictive Value of Tests ; Magnetic Resonance Spectroscopy ; Heart Failure/diagnostic imaging ; Heart Failure/therapy ; Magnetic Resonance Imaging/methods ; Registries
Language	English
Publishing date	2022-11-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1458034-2
ISSN	1532-429X ; 1097-6647
ISSN (online)	1532-429X
ISSN	1097-6647
DOI	10.1186/s12968-022-00890-0
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Article ; Online: In vivo diffusion MRI of the human heart using a 300 mT/m gradient system.

Afzali, Maryam / Mueller, Lars / Coveney, Sam / Fasano, Fabrizio / Evans, Christopher John / Engel, Maria / Szczepankiewicz, Filip / Teh, Irvin / Dall'Armellina, Erica / Jones, Derek K / Schneider, Jürgen E

Magnetic resonance in medicine

2024

Abstract: Purpose: This work reports for the first time on the implementation and application of cardiac diffusion-weighted MRI on a Connectom MR scanner with a maximum gradient strength of 300 mT/m. It evaluates the benefits of the increased gradient performance ...

Abstract	Purpose: This work reports for the first time on the implementation and application of cardiac diffusion-weighted MRI on a Connectom MR scanner with a maximum gradient strength of 300 mT/m. It evaluates the benefits of the increased gradient performance for the investigation of the myocardial microstructure. Methods: Cardiac diffusion-weighted imaging (DWI) experiments were performed on 10 healthy volunteers using a spin-echo sequence with up to second- and third-order motion compensation ( Results: The MD values with Conclusion: This work demonstrates cardiac DWI in vivo with higher b-value and higher order of motion compensated diffusion gradient waveforms than is commonly used. Increasing the motion compensation order from
Language	English
Publishing date	2024-04-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	605774-3
ISSN	1522-2594 ; 0740-3194
ISSN (online)	1522-2594
ISSN	0740-3194
DOI	10.1002/mrm.30118
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Article ; Online: An unusual case of apical myocarditis: a case report.

Das, Arka / Kidambi, Ananth / Plein, Sven / Dall'Armellina, Erica

European heart journal. Case reports

2020 Volume 4, Issue 6, Page(s) 1–5

Abstract: Background: Myocardial infarction with non-obstructed coronary arteries (MINOCA) syndrome accounts for ∼6-8% of acute coronary syndrome presentations. Historically, MINOCA has been thought of as a benign condition, however, recent evidence suggests that ...

Abstract	Background: Myocardial infarction with non-obstructed coronary arteries (MINOCA) syndrome accounts for ∼6-8% of acute coronary syndrome presentations. Historically, MINOCA has been thought of as a benign condition, however, recent evidence suggests that some aetiologies of MINOCA such as cardiomyopathies are associated with significantly higher mortality than other causes such as myocarditis. Therefore, identifying the underlying cause of MINOCA is important in determining patient management and prognosis. Case summary: We describe the case of a 58-year-old lady with an acute admission with MINOCA syndrome. Cardiac magnetic resonance (CMR) examination on Day 9 demonstrated hypertrophy of the apical segments of the left ventricle (LV), with diffuse mid-wall hyper-enhancement on late gadolinium enhancement (LGE) images. T2-weighted imaging was suggestive of active inflammation in the hypertrophied segments. A repeat CMR scan was performed 3 months later showed normalization of LV wall thickness, LGE and T2 values in the apical segments. Discussion: This case report highlights the benefits of CMR with oedema-weighted imaging in the acute stages of MINOCA syndrome, as well as the importance of serial imaging in this patient cohort. While baseline imaging raised the possibility of apical hypertrophic cardiomyopathy, resolution of apical hypertrophy on follow-up CMR showed that the patient had acute myocarditis, specifically involving the apical segments.
Language	English
Publishing date	2020-11-07
Publishing country	England
Document type	Journal Article
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytaa347
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Article ; Online: Role of CMR in Prognostic Stratification in Myocardial Infarction.

Das, Arka / Plein, Sven / Dall'Armellina, Erica

Revista espanola de cardiologia (English ed.)

2018 Volume 72, Issue 2, Page(s) 115–119

MeSH term(s)	Heart Ventricles/diagnostic imaging ; Heart Ventricles/physiopathology ; Humans ; Magnetic Resonance Imaging, Cine/methods ; Myocardial Infarction/diagnosis ; Myocardial Infarction/physiopathology ; Myocardium/pathology ; Predictive Value of Tests ; Prognosis ; Ventricular Function, Left/physiology ; Ventricular Remodeling
Language	Spanish
Publishing date	2018-09-14
Publishing country	Spain
Document type	Editorial
ZDB-ID	2592481-3
ISSN	1885-5857 ; 1885-5857
ISSN (online)	1885-5857
ISSN	1885-5857
DOI	10.1016/j.rec.2018.08.008
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Article ; Online: Detection of Intramyocardial Iron in Patients Following ST-Elevation Myocardial Infarction Using Cardiac Diffusion Tensor Imaging.

Das, Arka / Kelly, Christopher / Teh, Irvin / Sharrack, Noor / Stoeck, Christian T / Kozerke, Sebastian / Schneider, Jürgen E / Plein, Sven / Dall'Armellina, Erica

Journal of magnetic resonance imaging : JMRI

2022 Volume 56, Issue 4, Page(s) 1171–1181

Abstract: Background: Intramyocardial hemorrhage (IMH) following ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. In cardiac magnetic resonance (MR), T2* mapping is the reference standard for detecting IMH while cardiac diffusion ... ...

Abstract	Background: Intramyocardial hemorrhage (IMH) following ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. In cardiac magnetic resonance (MR), T2* mapping is the reference standard for detecting IMH while cardiac diffusion tensor imaging (cDTI) can characterize myocardial architecture via fractional anisotropy (FA) and mean diffusivity (MD) of water molecules. The value of cDTI in the detection of IMH is not currently known. Hypothesis: cDTI can detect IMH post-STEMI. Study type: Prospective. Subjects: A total of 50 patients (20% female) scanned at 1-week (V1) and 3-month (V2) post-STEMI. Field strength/sequence: A 3.0 T; inversion-recovery T1-weighted-imaging, multigradient-echo T2* mapping, spin-echo cDTI. Assessment: T2* maps were analyzed to detect IMH (defined as areas with T2* < 20 msec within areas of infarction). cDTI images were co-registered to produce averaged diffusion-weighted-images (DWIs), MD, and FA maps; hypointense areas were manually planimetered for IMH quantification. Statistics: On averaged DWI, the presence of hypointense signal in areas matching IMH on T2* maps constituted to true-positive detection of iron. Independent samples t-tests were used to compare regional cDTI values. Results were considered statistically significant at P ≤ 0.05. Results: At V1, 24 patients had IMH on T2. On averaged DWI, all 24 patients had hypointense signal in matching areas. IMH size derived using averaged-DWI was nonsignificantly greater than from T2 (2.0 ± 1.0 cm<sup>2</sup> vs 1.89 ± 0.96 cm<sup>2</sup> , P = 0.69). Compared to surrounding infarcted myocardium, MD was significantly reduced (1.29 ± 0.20 × 10<sup>-3</sup> mm<sup>2</sup> /sec vs 1.75 ± 0.16 × 10<sup>-3</sup> mm<sup>2</sup> /sec) and FA was significantly increased (0.40 ± 0.07 vs 0.23 ± 0.03) within areas of IMH. By V2, all 24 patients with acute IMH continued to have hypointense signals on averaged-DWI in the affected area. T2* detected IMH in 96% of these patients. Overall, averaged-DWI had 100% sensitivity and 96% specificity for the detection of IMH. Data conclusion: This study demonstrates that the parameters MD and FA are susceptible to the paramagnetic properties of iron, enabling cDTI to detect IMH. Evidence level: 1 TECHNICAL EFFICACY: Stage 2.
MeSH term(s)	Diffusion Tensor Imaging ; Female ; Hemorrhage/pathology ; Humans ; Iron ; Magnetic Resonance Imaging, Cine/methods ; Male ; Myocardium/pathology ; Prospective Studies ; ST Elevation Myocardial Infarction/diagnostic imaging ; ST Elevation Myocardial Infarction/pathology
Chemical Substances	Iron (E1UOL152H7)
Language	English
Publishing date	2022-01-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1146614-5
ISSN	1522-2586 ; 1053-1807
ISSN (online)	1522-2586
ISSN	1053-1807
DOI	10.1002/jmri.28063
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Article ; Online: Acute intra-cavity 4D flow cardiovascular magnetic resonance predicts long-term adverse remodelling following ST-elevation myocardial infarction.

Das, Arka / Kelly, Christopher / Ben-Arzi, Hadar / van der Geest, Rob J / Plein, Sven / Dall'Armellina, Erica

Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance

2022 Volume 24, Issue 1, Page(s) 64

Abstract: Background: Despite advancements in percutaneous coronary intervention, a significant proportion of ST-elevation myocardial infarction (STEMI) survivors develop long-term adverse left ventricular (LV) remodelling, which is associated with poor prognosis. ...

Abstract	Background: Despite advancements in percutaneous coronary intervention, a significant proportion of ST-elevation myocardial infarction (STEMI) survivors develop long-term adverse left ventricular (LV) remodelling, which is associated with poor prognosis. Adverse remodelling is difficult to predict, however four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) can measure various aspects of LV intra-cavity flow beyond LV ejection fraction and is well equipped for exploring the underlying mechanical processes driving remodelling. The aim for this study was to compare acute 4D flow CMR parameters between patients who develop adverse remodelling with patients who do not. Methods: Fifty prospective 'first-event' STEMI patients underwent CMR 5 days post-reperfusion, which included cine-imaging, and 4D flow for assessing in-plane kinetic energy (KE), residual volume, peak-E and peak-A wave KE (indexed for LV end-diastolic volume [LVEDV]). All subjects underwent follow-up cine CMR imaging at 12 months to identify adverse remodelling (defined as 20% increase in LVEDV from baseline). Quantitative variables were compared using unpaired student's t-test. Tests were deemed statistically significant when p < 0.05. Results: Patients who developed adverse LV remodelling by 12 months had significantly higher in-plane KE (54 ± 12 vs 42 ± 10%, p = 0.02), decreased proportion of direct flow (27 ± 9% vs 11 ± 4%, p < 0.01), increased proportion of delayed ejection flow (22 ± 9% vs 12 ± 2, p < 0.01) and increased proportion of residual volume after 2 consecutive cardiac cycles (64 ± 14 vs 34 ± 14%, p < 0.01), in their acute scan. Conclusion: Following STEMI, increased in-plane KE, reduced direct flow and increased residual volume in the acute scan were all associated with adverse LV remodelling at 12 months. Our results highlight the clinical utility of acute 4D flow in prognostic stratification in patients following myocardial infarction.
MeSH term(s)	Humans ; ST Elevation Myocardial Infarction/diagnostic imaging ; ST Elevation Myocardial Infarction/therapy ; Prospective Studies ; Predictive Value of Tests ; Magnetic Resonance Spectroscopy ; Magnetic Resonance Imaging/methods ; Ventricular Remodeling
Language	English
Publishing date	2022-11-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1458034-2
ISSN	1532-429X ; 1097-6647
ISSN (online)	1532-429X
ISSN	1097-6647
DOI	10.1186/s12968-022-00889-7
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Article ; Online: Absolute quantification of myocardial tissue composition: an additional level of complexity or an achievable clinical target?

Dall'Armellina, Erica

JACC. Cardiovascular imaging

2012 Volume 5, Issue 12, Page(s) 1240–1242

MeSH term(s)	Coronary Circulation/physiology ; Female ; Humans ; Magnetic Resonance Imaging, Cine/methods ; Male ; Myocardial Infarction/diagnosis ; Myocardium/pathology ; Phantoms, Imaging
Language	English
Publishing date	2012-12
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2012.07.015
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Article: Early prediction of left ventricular function improvement in patients with new-onset heart failure and presumed non-ischaemic aetiology.

Goh, Ze Ming / Javed, Wasim / Shabi, Mubien / Klassen, Joel R L / Saunderson, Christopher E D / Farley, Jonathan / Spurr, Melanie / Dall'Armellina, Erica / Levelt, Eylem / Greenwood, John / Halliday, Brian / Plein, Sven / Swoboda, Peter

Open heart

2023 Volume 10, Issue 2

Abstract: Objectives: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology.: Methods: We ... ...

Abstract	Objectives: To determine baseline characteristics predictive of left ventricular ejection fraction (LVEF) recovery in patients diagnosed with heart failure with reduced ejection fraction (HFrEF) and presumed non-ischaemic aetiology. Methods: We prospectively recruited patients who were diagnosed with HFrEF (LVEF ≤40%) on echocardiography and subsequently underwent cardiac MRI. Patients were excluded if they had a known history of coronary artery disease (>70% on invasive coronary angiography), myocardial infarction, coronary revascularisation or anginal symptoms. At cardiac MRI assessment, patients were categorised as either ongoing HFrEF or heart failure with improved ejection fraction (HFimpEF, LVEF >40% with ≥10% of absolute improvement). Clinical characteristics were compared between the groups. Logistic regression was performed to identify variables that were associated with LVEF recovery. Optimal cut-offs in QRISK3 score and baseline LVEF for prediction of LVEF recovery were identified through receiver operating characteristic curve analysis. Results: A total of 407 patients were diagnosed with HFrEF, and 139 (34%) attained HFimpEF at cardiac MRI assessment (median 63 days, IQR 41-119 days). Mean age of the patients was 63±12 years, and 260 (63.9%) were male. At multivariate logistic regression, both QRISK3 score (HR 0.978; 95% CI 0.963 to 0.993, p=0.004) and baseline LVEF (HR 1.044; 95% CI 1.015 to 1.073, p=0.002) were independent predictors of HFimpEF. Among patients with baseline LVEF ≤25%, only 22 (21.8%) recovered. In patients with baseline LVEF 25-40%, QRISK3 score >18% was associated with lack of recovery (HR 2.75; 95% CI 1.70 to 4.48, p<0.001). Additionally, QRISK3 score was associated with the presence of ischaemic late gadolinium enhancement (HR 1.035; 95% CI 1.018 to 1.053, p<0.001). Conclusions: The QRISK3 score helps identify patients with HFrEF with undiagnosed vascular disease. Patients with either a very low baseline LVEF or a high QRISK3 score have less chance of left ventricular recovery and should be prioritised for early cardiac MRI and close monitoring.
MeSH term(s)	Humans ; Male ; Middle Aged ; Aged ; Female ; Ventricular Function, Left ; Stroke Volume ; Heart Failure/diagnostic imaging ; Heart Failure/etiology ; Contrast Media ; Gadolinium
Chemical Substances	Contrast Media ; Gadolinium (AU0V1LM3JT)
Language	English
Publishing date	2023-08-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2747269-3
ISSN	2053-3624
ISSN	2053-3624
DOI	10.1136/openhrt-2023-002429
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