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Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis

BACKGROUND: The diagnostic utility of cardiovascular magnetic resonance (CMR) is limited during the early stages of myocarditis. This study examined whether ferumoxytol-enhanced CMR (FE-CMR) could detect an earlier stage of acute myocarditis compared to gadolinium-enhanced CMR. METHODS: Lewis rats w...

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Autores principales: Tada, Yuko, Tachibana, Atsushi, Heidary, Shahriar, Yang, Phillip C., McConnell, Michael V., Dash, Rajesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913003/
https://www.ncbi.nlm.nih.gov/pubmed/31842900
http://dx.doi.org/10.1186/s12968-019-0587-7
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author Tada, Yuko
Tachibana, Atsushi
Heidary, Shahriar
Yang, Phillip C.
McConnell, Michael V.
Dash, Rajesh
author_facet Tada, Yuko
Tachibana, Atsushi
Heidary, Shahriar
Yang, Phillip C.
McConnell, Michael V.
Dash, Rajesh
author_sort Tada, Yuko
collection PubMed
description BACKGROUND: The diagnostic utility of cardiovascular magnetic resonance (CMR) is limited during the early stages of myocarditis. This study examined whether ferumoxytol-enhanced CMR (FE-CMR) could detect an earlier stage of acute myocarditis compared to gadolinium-enhanced CMR. METHODS: Lewis rats were induced to develop autoimmune myocarditis. CMR (3 T, GE Signa) was performed at the early- (day 14, n = 7) and the peak-phase (day 21, n = 8) of myocardial inflammation. FE-CMR was evaluated as % myocardial dephasing signal loss on gradient echo images at 6 and 24 h (6 h- & 24 h-FE-CMR) following the administration of ferumoxytol (300μmolFe/kg). Pre- and post-contrast T2* mapping was also performed. Early (EGE) and late (LGE) gadolinium enhancement was obtained after the administration of gadolinium-DTPA (0.5 mmol/kg) on day 14 and 21. Healthy rats were used as control (n = 6). RESULTS: Left ventricular ejection fraction (LVEF) was preserved at day 14 with inflammatory cells but no fibrosis seen on histology. EGE and LGE at day 14 both showed limited myocardial enhancement (EGE: 11.7 ± 15.5%; LGE: 8.7 ± 8.7%; both p = ns vs. controls). In contrast, 6 h-FE-CMR detected extensive myocardial signal loss (33.2 ± 15.0%, p = 0.02 vs. EGE and p < 0.01 vs. LGE). At day 21, LVEF became significantly decreased (47.4 ± 16.4% vs control: 66.2 ± 6.1%, p < 0.01) with now extensive myocardial involvement detected on EGE, LGE, and 6 h-FE-CMR (41.6 ± 18.2% of LV). T2* mapping also detected myocardial uptake of ferumoxytol both at day 14 (6 h R2* = 299 ± 112 s(− 1)vs control: 125 ± 26 s(− 1), p < 0.01) and day 21 (564 ± 562 s(− 1), p < 0.01 vs control). Notably, the myocardium at peak-phase myocarditis also showed significantly higher pre-contrast T2* (27 ± 5 ms vs control: 16 ± 1 ms, p < 0.001), and the extent of myocardial necrosis had a strong positive correlation with T2* (r = 0.86, p < 0.001). CONCLUSIONS: FE-CMR acquired at 6 h enhance detection of early stages of myocarditis before development of necrosis or fibrosis, which could potentially enable appropriate therapeutic intervention.
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spelling pubmed-69130032019-12-30 Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis Tada, Yuko Tachibana, Atsushi Heidary, Shahriar Yang, Phillip C. McConnell, Michael V. Dash, Rajesh J Cardiovasc Magn Reson Research BACKGROUND: The diagnostic utility of cardiovascular magnetic resonance (CMR) is limited during the early stages of myocarditis. This study examined whether ferumoxytol-enhanced CMR (FE-CMR) could detect an earlier stage of acute myocarditis compared to gadolinium-enhanced CMR. METHODS: Lewis rats were induced to develop autoimmune myocarditis. CMR (3 T, GE Signa) was performed at the early- (day 14, n = 7) and the peak-phase (day 21, n = 8) of myocardial inflammation. FE-CMR was evaluated as % myocardial dephasing signal loss on gradient echo images at 6 and 24 h (6 h- & 24 h-FE-CMR) following the administration of ferumoxytol (300μmolFe/kg). Pre- and post-contrast T2* mapping was also performed. Early (EGE) and late (LGE) gadolinium enhancement was obtained after the administration of gadolinium-DTPA (0.5 mmol/kg) on day 14 and 21. Healthy rats were used as control (n = 6). RESULTS: Left ventricular ejection fraction (LVEF) was preserved at day 14 with inflammatory cells but no fibrosis seen on histology. EGE and LGE at day 14 both showed limited myocardial enhancement (EGE: 11.7 ± 15.5%; LGE: 8.7 ± 8.7%; both p = ns vs. controls). In contrast, 6 h-FE-CMR detected extensive myocardial signal loss (33.2 ± 15.0%, p = 0.02 vs. EGE and p < 0.01 vs. LGE). At day 21, LVEF became significantly decreased (47.4 ± 16.4% vs control: 66.2 ± 6.1%, p < 0.01) with now extensive myocardial involvement detected on EGE, LGE, and 6 h-FE-CMR (41.6 ± 18.2% of LV). T2* mapping also detected myocardial uptake of ferumoxytol both at day 14 (6 h R2* = 299 ± 112 s(− 1)vs control: 125 ± 26 s(− 1), p < 0.01) and day 21 (564 ± 562 s(− 1), p < 0.01 vs control). Notably, the myocardium at peak-phase myocarditis also showed significantly higher pre-contrast T2* (27 ± 5 ms vs control: 16 ± 1 ms, p < 0.001), and the extent of myocardial necrosis had a strong positive correlation with T2* (r = 0.86, p < 0.001). CONCLUSIONS: FE-CMR acquired at 6 h enhance detection of early stages of myocarditis before development of necrosis or fibrosis, which could potentially enable appropriate therapeutic intervention. BioMed Central 2019-12-16 /pmc/articles/PMC6913003/ /pubmed/31842900 http://dx.doi.org/10.1186/s12968-019-0587-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Tada, Yuko
Tachibana, Atsushi
Heidary, Shahriar
Yang, Phillip C.
McConnell, Michael V.
Dash, Rajesh
Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title_full Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title_fullStr Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title_full_unstemmed Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title_short Ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
title_sort ferumoxytol-enhanced cardiovascular magnetic resonance detection of early stage acute myocarditis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913003/
https://www.ncbi.nlm.nih.gov/pubmed/31842900
http://dx.doi.org/10.1186/s12968-019-0587-7
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