Taigang He

On T2* Magnetic Resonance and Cardiac Iron

Background— Measurement of myocardial iron is key to the clinical management of patients at risk of siderotic cardiomyopathy. The cardiovascular magnetic resonance relaxation parameter R2* (assessed clinically via its reciprocal, T2*) measured in the ventricular septum is used to assess cardiac iron, but iron calibration and distribution data in humans are limited. Methods and Results— Twelve human hearts were studied from transfusion-dependent patients after either death (heart failure, n=7; stroke, n=1) or transplantation for end-stage heart failure (n=4). After cardiovascular magnetic resonance R2* measurement, tissue iron concentration was measured in multiple samples of each heart with inductively coupled plasma atomic emission spectroscopy. Iron distribution throughout the heart showed no systematic variation between segments, but epicardial iron concentration was higher than in the endocardium. The mean±SD global myocardial iron causing severe heart failure in 10 patients was 5.98±2.42 mg/g dry weight (range, 3.19 to 9.50 mg/g), but in 1 outlier case of heart failure was 25.9 mg/g dry weight. Myocardial ln[R2*] was strongly linearly correlated with ln[Fe] (R2=0.910, P<0.001), leading to [Fe]=45.0×(T2*)−1.22 for the clinical calibration equation with [Fe] in milligrams per gram dry weight and T2* in milliseconds. Midventricular septal iron concentration and R2* were both highly representative of mean global myocardial iron. Conclusions— These data detail the iron distribution throughout the heart in iron overload and provide calibration in humans for cardiovascular magnetic resonance R2* against myocardial iron concentration. The iron values are of considerable interest in terms of the level of cardiac iron associated with iron-related death and indicate that the heart is more sensitive to iron loading than the liver. The results also validate the current clinical practice of monitoring cardiac iron in vivo by cardiovascular magnetic resonance of the midseptum.

Myocardial T *2 measurement in iron‐overloaded thalassemia: An ex vivo study to investigate optimal methods of quantification

Reproducible and accurate myocardial T  2* measurements are required for the quantification of iron in heart tissue in transfused thalassemia. The aim of this study was to determine the best method to measure the myocardial T  2* from multi‐gradient‐echo data acquired both with and without black‐blood preparation. Sixteen thalassemia patients from six centers were scanned twice locally, within 1 week, using an optimized bright‐blood T  2* sequence and then subsequently scanned at the standardization center in London within 4 weeks, using a T  2* sequence both with and without black‐blood preparation. Different curve‐fitting models (monoexponential, truncation, and offset) were applied to the data and the results were compared by means of reproducibility. T  2* measurements obtained using the bright‐ and black‐blood techniques. The black‐blood data were well fitted by the monoexponential model, which suggests that a more accurate measure of T  2* can be obtained by removing the main source of errors in the bright‐blood data. For bright‐blood data, the offset model appeared to underestimate T  2* values substantially and was less reproducible. The truncation model gave rise to more reproducible T  2* measurements, which were also closer to the values obtained from the black‐blood data. Magn Reson Med 60:1082–1089, 2008.

Application of independent component analysis in removing artefacts from the electrocardiogram

Routinely recorded electrocardiograms (ECGs) are often corrupted by different types of artefacts and many efforts have been made to enhance their quality by reducing the noise or artefacts. This paper addresses the problem of removing noise and artefacts from ECGs using independent component analysis (ICA). An ICA algorithm is tested on three-channel ECG recordings taken from human subjects, mostly in the coronary care unit. Results are presented that show that ICA can detect and remove a variety of noise and artefact sources in these ECGs. One difficulty with the application of ICA is the determination of the order of the independent components. A new technique based on simple statistical parameters is proposed to solve this problem in this application. The developed technique is successfully applied to the ECG data and offers potential for online processing of ECG using ICA.

International reproducibility of single breathhold T2* MR for cardiac and liver iron assessment among five thalassemia centers.

To examine the reproducibility of the single breathhold T2* technique from different scanners, after installation of standard methodology in five international centers.

Black-blood T2* technique for myocardial iron measurement in thalassemia

To compare the effectiveness and reproducibility of a new black‐blood sequence vs. a conventional bright‐blood gradient‐echo T2* sequence for myocardial iron overload measurement in thalassemia.

Development of a novel optimized breathhold technique for myocardial T2 measurement in thalassemia.

To develop a reproducible fast spin‐echo (FSE) technique for accurate myocardial T2 measurement with application to iron overload assessment in thalassemia.

Clinical recommendations for cardiovascular magnetic resonance mapping of T1, T2, T2* and extracellular volume: A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI)

Parametric mapping techniques provide a non-invasive tool for quantifying tissue alterations in myocardial disease in those eligible for cardiovascular magnetic resonance (CMR). Parametric mapping with CMR now permits the routine spatial visualization and quantification of changes in myocardial composition based on changes in T1, T2, and T2*(star) relaxation times and extracellular volume (ECV). These changes include specific disease pathways related to mainly intracellular disturbances of the cardiomyocyte (e.g., iron overload, or glycosphingolipid accumulation in Anderson-Fabry disease); extracellular disturbances in the myocardial interstitium (e.g., myocardial fibrosis or cardiac amyloidosis from accumulation of collagen or amyloid proteins, respectively); or both (myocardial edema with increased intracellular and/or extracellular water). Parametric mapping promises improvements in patient care through advances in quantitative diagnostics, inter- and intra-patient comparability, and relatedly improvements in treatment. There is a multitude of technical approaches and potential applications. This document provides a summary of the existing evidence for the clinical value of parametric mapping in the heart as of mid 2017, and gives recommendations for practical use in different clinical scenarios for scientists, clinicians, and CMR manufacturers.

In vivo comparison of myocardial T1 with T2 and T2* in thalassaemia major

To compare myocardial T1 against T2 and T2* in patients with thalassemia major (TM) for myocardial iron characterization.

Multi-center transferability of a breath-hold T2 technique for myocardial iron assessment

BackgroundCardiac iron overload is the leading cause of death in thalassemia major and is usually assessed using myocardial T2* measurements. Recently a cardiovascular magnetic resonance (CMR) breath-hold T2 sequence has been developed as a possible alternative. This cardiac T2 technique has good interstudy reproducibility, but its transferability to different centres has not yet been investigated.Methods and ResultsThe breath-hold black blood spin echo T2 sequence was installed and validated on 1.5T Siemens MR scanners at 4 different centres across the world. Using this sequence, 5–10 thalassemia patients from each centre were scanned twice locally within a week for local interstudy reproducibility (n = 34) and all were rescanned within one month at the standardization centre in London (intersite reproducibility). The local interstudy reproducibility (coefficient of variance) and mean difference were 4.4% and -0.06 ms. The intersite reproducibility and mean difference between scanners were 5.2% and -0.07 ms.ConclusionThe breath-hold myocardial T2 technique is transferable between Siemens scanners with good intersite and local interstudy reproducibility. This technique may have value in the diagnosis and management of patients with iron overload conditions such as thalassemia.

Relation of myocardial T2* to right ventricular function in thalassaemia major

AIMS Myocardial T2* cardiovascular magnetic resonance (CMR) provides a rapid and reproducible measure of cardiac iron loading and is being increasingly used worldwide for monitoring of transfusion-dependent thalassaemia patients. Although myocardial siderosis (T2* <20 ms) is associated with impaired left ventricular (LV) function, little is known of its relation with right ventricular (RV) function. The aim of this study was to investigate the relationship between cardiac T2* and RV function. METHODS AND RESULTS A retrospective analysis of 319 patients with beta-thalassaemia major presenting for their first CMR scan was performed (45.1% male, mean age 25.6 years). In patients with normal myocardial T2* (>20 ms), the RV ejection fraction (EF) was within the normal range in 98% of patients. When myocardial T2* was <20 ms, there was a progressive and significant decline in RV EF. There was a linear relationship between RV and LV EF. CONCLUSION Myocardial iron deposition is strongly associated with RV dysfunction, which mirrors the decrease in LV function seen with worsening cardiac iron loading. Right ventricular dysfunction may play a significant role in heart failure associated with myocardial siderosis.