Tissue Characterization
Edyta Blaszczyk, MD
Dr
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Edyta Blaszczyk, MD
Dr
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Jan Gröschel, MD
MD
Charité – Universitätsmedizin Berlin, ECRC, MDC, DZHK, Germany
Darian Viezzer, MSc
M. Sc.
Charité – Universitätsmedizin Berlin, ECRC, MDC, DZHK
Berlin, Berlin, Germany
Hadil Saad, MD
MD
Charité – Universitätsmedizin Berlin, Helios Klinikum Berlin Buch, Germany
Ralf Felix Trauzeddel, MD
Dr.
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Matthias Endres
Professor
Charité – Universitätsmedizin Berlin, Germany
Ulf Landmesser
Professor
Charité – Universitätsmedizin Berlin, Germany
Burkert Pieske, MD
Head of Departement
Charité – Universitätsmedizin Berlin, Berlin, Germany
Joachim Spranger
Professor
Charité – Universitätsmedizin Berlin, Germany
Joachim E. Weber, MD, PhD
Dr.
Berlin Institute of Health at Charité, Berlin, Germany
Jan Scheitz
Professor
Charité – Universitätsmedizin Berlin, Germany
Jeanette Schulz-Menger, MD
Professor
Charité – Universitätsmedizin Berlin, ECRC, MDC, Helios Klinikum Berlin Buch, DZHK, Berlin, Germany
Berlin, Berlin, Germany
It is suspected that different acute cardiovascular events like acute coronary syndrome (ACS), acute heart failure (AHF) or acute stroke (AS) may heavily impact the function of other organs that do not seem to be involved in the first place. The group of chronic vascular high-risk condition – diabetes mellitus (DM) was taken as reference group.
We aimed to identify if myocardial alteration as identified by CMR occurs also in case of non-cardiac initial events.1,2,3
Methods:
In this prospective study, patients after AS, ACS/AHF were enrolled at Charité and compared to DM. 90 days after the acute event an extensive phenotyping including CMR was performed at three Charité-sites (CBB, CBF, CCM)* using a standardized protocol at 3T Siemens scanners. Left ventricular function (LV) assessment by SSFP cine-imaging and focal myocardial tissue differentiation using late gadolinium enhancement (LGE) after 0.15 mmol/kg gadobutrol was performed. Parametric T2- and T1-mapping to quantify diffuse fibrosis and myocardial oedema was included. Images were analyzed blinded in a core lab using CVI42.
Results:
Between 2017-2021, 374 patients received CMR (256, 68% male, median age 68 +/- 14), AS: 187(49%); ACS/AHF 95(27%) and DM: 92(24%). Coronary heart disease was previously diagnosed in 72(21%), only 34(9%) patients had a history of myocardial infarction (distribution Figure 1).
LV-function was preserved in the whole cohort, while LV size was larger in the primary cardiac group ACS/AHF. Interestingly, focal fibrosis was detected in AS in 35% and in DM in a similar frequency (35%). In both conditions, patients with LGE had no previously known cardiac diseases. Unrecognized myocardial infarction was detected in AS in 26% and in DM in 25%. In the ACS/AHF group 99% of LGE positive patients myocardial infarctions were shown (see Figure 1). Patients with AS and ACS/AHF had higher T1, but lower T2 values than DM group (see Table 1). Ninety days after the acute event troponin level was similar in all three groups, while in AS and ACS/AHF NT-pro-BNP was significantly higher than in DM.
Conclusion:
It could be shown, that myocardial infarctions and diffuse fibrosis are a common finding in cardiovascular high-risk patients, independent of the clinical appearance of the acute event. Patients after acute stroke and diabetes mellitus have U
unrecognized myocardial infarction in a quarter of the patients. Furthermore, patients with diabetes had signs of a chronic inflammation. CMR has an added
value for identification of myocardial injury despite to the initial event.
*Campus Berlin Buch (CBB); Campus Benjamin Franklin (CBF), Campus Charité Mitte (CCM).