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Role of cardiac MRI in assessment of patients with dilated cardiomyopathy. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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102
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Abstract
Cardiac computed tomography angiography (CCTA) is a noninvasive imaging technique that has been rapidly adopted into clinical practice. Over the past decade, technological advances have improved CCTA accuracy, and there is an increasing amount of data supporting its prognostic value in the assessment of coronary artery disease. Recently, "appropriate use criteria" has been used as a tool to minimize inappropriate testing and reduce patient exposure to unnecessary risk and inconclusive studies. This review will summarize the appropriate uses of CCTA in patients before and after cardiac surgery. Although the most common indication for CCTA is assessment of patency of native coronary arteries, other potential perioperative uses (eg, assessment of congenital heart disease, valvular heart disease, pericardial disease, myocardial disease, cardiac anatomy, bypass grafts, aortic disease, and cardiac masses) will be reviewed.
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Aquaro GD, Di Bella G, Castelletti S, Maestrini V, Festa P, Ait-Ali L, Masci PG, Monti L, di Giovine G, De Lazzari M, Cipriani A, Guaricci AI, Dellegrottaglie S, Pepe A, Marra MP, Pontone G. Clinical recommendations of cardiac magnetic resonance, Part I: ischemic and valvular heart disease: a position paper of the working group 'Applicazioni della Risonanza Magnetica' of the Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2017; 18:197-208. [PMID: 28072628 DOI: 10.2459/jcm.0000000000000498] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Cardiac magnetic resonance (CMR) has emerged as a reliable and accurate diagnostic tool for the evaluation of patients with cardiac disease in several clinical settings and with proven additional diagnostic and prognostic value compared with other imaging modalities. This document has been developed by the working group on the 'application of CMR' of the Italian Society of Cardiology to provide a perspective on the current state of technical advances and clinical applications of CMR and to inform cardiologists on how to implement their clinical and diagnostic pathways with the inclusion of this technique in clinical practice. The writing committee consisted of members of the working group of the Italian Society of Cardiology and two external peer reviewers with acknowledged experience in the field of CMR.
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Affiliation(s)
- Giovanni Donato Aquaro
- aU.O.C. Risonanza Magnetica per Immagini, Fondazione G. Monasterio CNR-Regione Toscana Pisa bUO Cardiologia, Università di Messina, Messina cIstituto Auxologico Italiano, Milano dDepartment of Cardiovascular, Respiratory, Geriatric, Anesthesiologic and Nephrologic Sciences, Sapienza University of Rome, Rome, Italy eCentre for Cardiac MR, Cardiology Unit, University Hospital Lausanne, Lausanne, Switzerland fU.O. Radiologia Diagnostica, Humanitas Hospital, Milan gDivision of Cardiology, Azienda Ospedaliera-Universitaria 'Maggiore della Carità', Eastern Piemont University, Novara hU.O. Clinica Cardiologica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università di Padova, Padua iUnità Operativa di Cardiologia Universitaria Dipartimento di Emergenze e Trapianti di Organi (D.E.T.O.) Azienda Ospedaliera Policlinico Consorziale di Bari, Bari jLaboratorio di RM Cardiovascolare Divisione di Cardiologia Clinica Villa dei Fiori, Acerra kU.O. Cardiologia, Centro Cardiologico Monzino, Milano, Italy
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Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity. Curr Oncol Rep 2017; 19:63. [PMID: 28791609 DOI: 10.1007/s11912-017-0622-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Contemporary cancer management has increased the overall number of cancer survivors, but cardiotoxicity remains a subject of concern, which is a major cause of noncancer mortality among survivors. Among the potential cardiovascular complications, left ventricular (LV) systolic dysfunction is a poor prognostic factor. The importance of its early detection is based on the principle that the likelihood of response to heart failure (HF) treatment is temporally related to the initiation of HF treatment. For these reasons, cardiac monitoring is commonly applied in general practice, based on serial measurements of LV ejection fraction (LVEF); transthoracic echocardiography (TTE) is generally used. However, the LVEF, as a diagnostic and predictive parameter, has significant limitations, which calls for more effective multimodality imaging strategies. This approach requires further study, but there is increasing available data in the literature, encouraging the combination of multimodality imaging parameters and techniques for early cancer therapeutic-related cardiac dysfunction (CTRCD) detection.
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Schmidt EJ, Watkins RD, Zviman MM, Guttman MA, Wang W, Halperin HA. A Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005091. [PMID: 27729363 DOI: 10.1161/circimaging.116.005091] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Subjects undergoing cardiac arrest within a magnetic resonance imaging (MRI) scanner are currently removed from the bore and then from the MRI suite, before the delivery of cardiopulmonary resuscitation and defibrillation, potentially increasing the risk of mortality. This precludes many higher-risk (acute ischemic and acute stroke) patients from undergoing MRI and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the seconds of MRI after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. METHODS AND RESULTS A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by the addition of novel radiofrequency filters between the generator and commercial disposable surface pads. The radiofrequency filters reduced emission into the MRI scanner and prevented cable/surface pad heating during imaging, while preserving all the defibrillator monitoring and delivery functions. Human volunteers were imaged using high specific absorption rate sequences to validate MRI image quality and lack of heating. Swine were electrically fibrillated (n=4) and thereafter defibrillated both outside and inside the MRI bore. MRI image quality was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface pads did not create artifacts deeper than 6 mm below the skin surface. Radiofrequency heating was within US Food and Drug Administration guidelines. Defibrillation was completely successful inside and outside the MRI bore. CONCLUSIONS A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading the image quality or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures.
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Affiliation(s)
- Ehud J Schmidt
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.).
| | - Ronald D Watkins
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Menekhem M Zviman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Michael A Guttman
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Wei Wang
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
| | - Henry A Halperin
- From the Department of Radiology, Brigham and Women's Hospital, Boston, MA (E.J.S., W.W.); Department of Radiology, Stanford University, CA (R.D.W.); and Department of Cardiology, Johns Hopkins University, Baltimore, MD (M.M.Z., M.A.G., H.A.H.)
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106
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Farhad H, Staziaki PV, Addison D, Coelho-Filho OR, Shah RV, Mitchell RN, Szilveszter B, Abbasi SA, Kwong RY, Scherrer-Crosbie M, Hoffmann U, Jerosch-Herold M, Neilan TG. Characterization of the Changes in Cardiac Structure and Function in Mice Treated With Anthracyclines Using Serial Cardiac Magnetic Resonance Imaging. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.003584. [PMID: 27923796 DOI: 10.1161/circimaging.115.003584] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 09/29/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anthracyclines are cardiotoxic; however, there are limited data characterizing the serial changes in cardiac structure and function after anthracyclines. The aim of this study was to use cardiac magnetic resonance to characterize anthracycline-induced cardiotoxicity in mice. METHODS AND RESULTS This was a longitudinal cardiac magnetic resonance and histological study of 45 wild-type male mice randomized to doxorubicin (n=30, 5 mg/kg of doxorubicin/week for 5 weeks) or placebo (n=15). A cardiac magnetic resonance was performed at baseline and at 5, 10, and 20 weeks after randomization. Measures of primary interest included left ventricular ejection fraction, myocardial edema (multiecho short-axis spin-echo acquisition), and myocardial fibrosis (Look-Locker gradient echo). In doxorubicin-treated mice versus placebo, there was an increase in myocardial edema at 5 weeks (T2 values of 32±4 versus 21±3 ms; P<0.05), followed by a reduction in left ventricular ejection fraction (54±6 versus 63±5%; P<0.05) and an increase in myocardial fibrosis (extracellular volume of 0.34±0.03 versus 0.27±0.03; P<0.05) at 10 weeks. There was a strong association between the early (5 weeks) increase in edema and the subacute (10 weeks) increase in fibrosis (r=0.90; P<0.001). Both the increase in edema and fibrosis predicted the late doxorubicin-induced mortality in mice (P<0.001). CONCLUSIONS Our data suggest that, in mice, anthracycline-induced cardiotoxicity is associated with an early increase in cardiac edema and a subsequent increase in myocardial fibrosis. The early increase in edema and subacute increase in fibrosis are strongly linked and are both predictive of late mortality.
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Affiliation(s)
- Hoshang Farhad
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pedro V Staziaki
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Daniel Addison
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Otavio R Coelho-Filho
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ravi V Shah
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Richard N Mitchell
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Balint Szilveszter
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Siddique A Abbasi
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Raymond Y Kwong
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Marielle Scherrer-Crosbie
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Udo Hoffmann
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Michael Jerosch-Herold
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Tomas G Neilan
- From the Non-Invasive Cardiovascular Imaging Program and the Cardiovascular Division, Department of Medicine (H.F., S.A.A., R.V.S., R.Y.K.), Department of Pathology (R.N.M.), and Department of Radiology (M.J.-H.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Faculty of Medical Science, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil (O.R.C.-F.); and Cardiac MR PET CT Program, Division of Radiology (P.V.S., D.A., B.S., U.H., T.G.N.) and Division of Cardiology, Department of Medicine (M.S.-C., T.G.N.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
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107
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Paiman EHM, Lamb HJ. When should we use contrast material in cardiac MRI? J Magn Reson Imaging 2017; 46:1551-1572. [PMID: 28480596 DOI: 10.1002/jmri.25754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/18/2017] [Indexed: 12/29/2022] Open
Abstract
At present, most of the cardiac magnetic resonance imaging (MRI) examinations rely on contrast-enhanced protocols, but noncontrast alternatives are emerging. Late gadolinium enhancement (LGE) imaging for the detection of myocardial scar can be considered the main cause for the embedding of cardiac MRI into the clinical routine. The novel noncontrast technique of native T1 mapping shows promise for tissue characterization in ischemic and nonischemic cardiomyopathy and may provide additional information over conventional LGE imaging. Technical issues, including measurements variability, still need to be resolved to facilitate a wide clinical application. Ischemia detection can be performed with contrast-based stress perfusion and contrast-free stress wall motion imaging. For coronary magnetic resonance angiography (MRA), protocols with and without contrast material have been developed. Research on coronary atherosclerotic plaque characterization has introduced new applications of contrast material. For MRA of the aorta, which traditionally relied on contrast administration, several noncontrast protocols have become available. This review provides an overview of when to use contrast material in cardiac and cardiac-related vascular MRI, summarizes the major imaging building blocks, and describes the diagnostic value of the available contrast-enhanced and noncontrast techniques. Contrast material in cardiac MRI should be used for LGE imaging for tissue characterization in ischemic or nonischemic cardiomyopathy and may be used for stress perfusion imaging for the detection of ischemia. In cardiac-related vascular MRI, use of contrast material should be avoided, unless high-quality angiography is required that cannot be obtained with noncontrast protocols. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1551-1572.
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Affiliation(s)
- Elisabeth H M Paiman
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hildo J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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108
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Zuin G, Parato VM, Groff P, Gulizia MM, Di Lenarda A, Cassin M, Cibinel GA, Del Pinto M, Di Tano G, Nardi F, Rossini R, Ruggieri MP, Ruggiero E, Scotto di Uccio F, Valente S. ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain. Eur Heart J Suppl 2017; 19:D212-D228. [PMID: 28751843 PMCID: PMC5520764 DOI: 10.1093/eurheartj/sux025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: (i) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; and (ii) the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.
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Affiliation(s)
- Guerrino Zuin
- Cardiology Unit, Ospedale dell’Angelo, Mestre, Via Paccagnella, 11 30174 VE, Italy
| | - Vito Maurizio Parato
- Cardiology Rehabilitation, Ospedale Madonna del Soccorso, Cardiology Unit, ASUR Marche/AV5—Madonna del Soccorso Hospital, 4-7, via Luciano Manara, 63074, San Benedetto del Tronto (Ascoli Piceno), Italy
| | - Paolo Groff
- Emergency Department, Ospedale Madonna del Soccorso, San Benedetto del Tronto (Ascoli Piceno), Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione “Garibaldi”, Catania, Italy
| | - Andrea Di Lenarda
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Matteo Cassin
- Cardiology Department, A.O. Santa Maria degli Angeli, Pordenone, Italy
| | | | | | | | - Federico Nardi
- Cardiology Department, Ospedale Castelli, Verbania, Italy
| | - Roberta Rossini
- Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Pia Ruggieri
- Emergency-Admission Department, A.O. San Giovanni-Addolorata, Rome, Italy
| | | | | | - Serafina Valente
- Intensive Integrated Cardiology Department, AOU Careggi, Florence, Italy
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109
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Dodd JD, Murphy DJ. Invited Commentary on “Radiologic-Pathologic Correlation of Primary and Secondary Cardiomyopathies”. Radiographics 2017; 37:737-739. [DOI: 10.1148/rg.2017170001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan D. Dodd
- Department of Radiology, St. Vincent’s University Hospital and University College Dublin School of Medicine Dublin, Ireland
| | - David J. Murphy
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School Boston, Massachusetts
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Spartera M, Damascelli A, Mozes F, De Cobelli F, La Canna G. Three-dimensional speckle tracking longitudinal strain is related to myocardial fibrosis determined by late-gadolinium enhancement. Int J Cardiovasc Imaging 2017; 33:1351-1360. [DOI: 10.1007/s10554-017-1115-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 03/09/2017] [Indexed: 01/09/2023]
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111
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Bulluck H, Go YY, Crimi G, Ludman AJ, Rosmini S, Abdel-Gadir A, Bhuva AN, Treibel TA, Fontana M, Pica S, Raineri C, Sirker A, Herrey AS, Manisty C, Groves A, Moon JC, Hausenloy DJ. Defining left ventricular remodeling following acute ST-segment elevation myocardial infarction using cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:26. [PMID: 28285594 PMCID: PMC5346848 DOI: 10.1186/s12968-017-0343-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/16/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The assessment of post-myocardial infarction (MI) left ventricular (LV) remodeling by cardiovascular magnetic resonance (CMR) currently uses criteria defined by echocardiography. Our aim was to provide CMR criteria for assessing LV remodeling following acute MI. METHODS Firstly, 40 reperfused ST-segment elevation myocardial infarction (STEMI) patients with paired acute (4 ± 2 days) and follow-up (5 ± 2 months) CMR scans were analyzed by 2 independent reviewers and the minimal detectable changes (MDCs) for percentage change in LV end-diastolic volume (%ΔLVEDV), LV end-systolic volume (%ΔLVESV), and LV ejection fraction (%ΔLVEF) between the acute and follow-up scans were determined. Secondly, in 146 reperfused STEMI patients, receiver operator characteristic curve analyses for predicting LVEF <50% at follow-up (as a surrogate for clinical poor clinical outcome) were undertaken to obtain cut-off values for %ΔLVEDV and %ΔLVESV. RESULTS The MDCs for %ΔLVEDV, %ΔLVESV, and %ΔLVEF were similar at 12%, 12%, 13%, respectively. The cut-off values for predicting LVEF < 50% at follow-up were 11% for %ΔLVEDV on receiver operating characteristic curve analysis (area under the curve (AUC) 0.75, 95% CI 0.6 to 0.83, sensitivity 72% specificity 70%), and 5% for %ΔLVESV (AUC 0.83, 95% CI 0.77 to 0.90, sensitivity and specificity 78%). Using cut-off MDC values (higher than the clinically important cut-off values) of 12% for both %ΔLVEDV and %ΔLVESV, 4 main patterns of LV remodeling were identified in our cohort: reverse LV remodeling (LVEF predominantly improved); no LV remodeling (LVEF predominantly unchanged); adverse LV remodeling with compensation (LVEF predominantly improved); and adverse LV remodeling (LVEF unchanged or worsened). CONCLUSIONS The MDCs for %ΔLVEDV and %ΔLVESV between the acute and follow-up CMR scans of 12% each may be used to define adverse or reverse LV remodeling post-STEMI. The MDC for %ΔLVEF of 13%, relative to baseline, provides the minimal effect size required for investigating treatments aimed at improving LVEF following acute STEMI.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - Gabriele Crimi
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Andrew J. Ludman
- Royal Devon and Exeter Hospital, NHS Foundation Trust, Exeter, UK
| | | | | | - Anish N. Bhuva
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | | | | | - Silvia Pica
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, Milan, Italy
| | - Claudia Raineri
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS), Policlinico San Matteo, Pavia, Italy
| | - Alex Sirker
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Anna S. Herrey
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Royal Free Hospital, London, UK
| | - Charlotte Manisty
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Ashley Groves
- UCL Institute of Nuclear Medicine, University College London Hospital, London, UK
| | - James C. Moon
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Derek J. Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, UK
- The National Institute of Health Research, University College London Hospitals, Biomedical Research Centre, London, UK
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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Giusca S, Mereles D, Ochs A, Buss S, André F, Seitz S, Riffel J, Fortner P, Andrulis M, Schönland S, Katus HA, Korosoglou G. Incremental value of cardiac magnetic resonance for the evaluation of cardiac tumors in adults: experience of a high volume tertiary cardiology centre. Int J Cardiovasc Imaging 2017; 33:879-888. [PMID: 28138817 DOI: 10.1007/s10554-017-1065-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/04/2017] [Indexed: 12/21/2022]
Abstract
To assess the value of cardiac magnetic resonance imaging (CMR) in evaluating cardiac tumours in a tertiary cardiology centre. Between 2004 and 2014, 125 patients (pts.) from a total of 17000 who received a CMR examination in our institution were referred with the suspicion of cardiac tumours. A dedicated protocol was used that included standard cine SSFP acquisitions as well as tissue characterization using T1 and T2 black-blood (T1 BB and T2 BB respectively) with and without fat suppression, perfusion of the structure and late gadolinium enhancement. Patients' files were retrospectively analysed and data related to clinical status, results from other examinations (echocardiography), therapeutic approach and histology results, when performed, were collected. In 65 pts., a diagnosis of cardiac tumour was reached. 45 Pts had a biopsy. The CMR examination was concordant with the histology results in 35 (76%) pts. superior to that showed by echocardiography, 26 (58%) pts., p = 0.03. Forty-two (65%) pts. had a benign tumour and 23 (35%) a malignant process. Myxoma was the most frequent benign tumour, 27 (65%) and cardiac metastases were the most frequent form of malignancies, 21 (91%), with B cell non-Hodgkin lymphoma being the most frequent one, 4 (19%). Benign tumours were mostly located in the left atrium, 27 (64%) versus 6 (26%), p = 0.007, whereas malignant tumours had a predilection for the right atrium und left ventricle [11 (48%) vs. 3 (7%), p = 0.001 and 8 (35%) vs. 3 (7%), p = 0.03]. All benign cardiac tumours were single and did not show signs of infiltration. Conversely, malignant cardiac tumours were larger (43 ± 35 vs. 24 ± 16, p = 0.007) with a significant proportion (65%) showing myocardial infiltration. Pts with malignant cardiac tumours had a higher proportion of LGE (82 vs. 60%, p = 0.05) and exhibited more frequently an isointense signal in T1 BB images (78 vs. 61%, p = 0.04). Both groups showed similar proportion of perfusion and signal intensity in the T2 BB acquisitions (p = NS). CMR is a valuable tool in evaluating cardiac tumours, proving superior to echocardiography in establishing the type of cardiac tumour.
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Affiliation(s)
- Sorin Giusca
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Andreas Ochs
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian Buss
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Sebastian Seitz
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Philipp Fortner
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | | | - Stefan Schönland
- Department of Haematology, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Cardona A, Zareba KM, Raman SV. The role of stress cardiac magnetic resonance in women. J Nucl Cardiol 2016; 23:1036-1040. [PMID: 27457529 DOI: 10.1007/s12350-016-0597-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/21/2016] [Indexed: 10/21/2022]
Abstract
Coronary artery disease (CAD) is the leading cause of death in women. Nevertheless, extensive evidence demonstrates under-diagnosis and under-treatment of women for suspected or known ischemic heart disease (IHD). Stress cardiac magnetic resonance (CMR) is becoming readily available and offers significant advantages over other stress imaging modalities. The high spatial and temporal resolution of CMR provides the unique ability to identify subendocardial ischemia, viability, and the presence of microvascular disease. Furthermore, CMR is free from ionizing radiation, and image quality is not compromised by attenuation artifacts or patient size. Over the past two decades, evidence-based data have demonstrated the high diagnostic and prognostic performance of stress CMR in the context of IHD, often superior to other stress imaging techniques. Importantly, ad hoc studies confirmed these results in women with known or suspected IHD. Stress CMR warrants consideration as the modality of choice for women requiring an imaging test for ischemia given its strong evidence base, superior test characteristics, comprehensive nature, and unique ability to characterize both epicardial and microvascular disease.
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Affiliation(s)
- Andrea Cardona
- Ohio State University, 473 W 12th Ave, Suite 200, Columbus, OH, 43210, USA
- Division of Cardiology, University of Perugia, Perugia, Italy
| | - Karolina M Zareba
- Ohio State University, 473 W 12th Ave, Suite 200, Columbus, OH, 43210, USA
| | - Subha V Raman
- Ohio State University, 473 W 12th Ave, Suite 200, Columbus, OH, 43210, USA.
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CT myocardial perfusion imaging: current status and future directions. Clin Radiol 2016; 71:739-49. [DOI: 10.1016/j.crad.2016.03.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/08/2016] [Accepted: 03/10/2016] [Indexed: 01/15/2023]
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Esteban-Fernández A, Coma-Canella I, Bastarrika G, Barba-Cosials J, Azcárate-Agüero PM. [Is stress cardiovascular magnetic resonance really useful to detect ischemia and predict events in patients with different cardiovascular risk profile?]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2016; 87:116-123. [PMID: 27484888 DOI: 10.1016/j.acmx.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/23/2016] [Accepted: 07/05/2016] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic and prognostic usefulness of stress cardiovascular magnetic resonance (stress CMR) in patients with different cardiovascular risk profile and to assess if the degree of hypoperfusion is important to guide clinical decisions. METHOD We included patients submitted to adenosine stress CMR to rule out myocardial ischemia. We evaluated its diagnostic accuracy with likelihood ratio (LR) and its prognostic value with survival curves and a Cox regression model. RESULTS 295 patients were studied. The positive LR was 3.40 and the negative one 0.47. The maximal usefulness of the test was found in patients without previous ischemic cardiomyopathy (positive LR 4.85), patients with atypical chest pain (positive LR 8.56), patients with low or intermediate cardiovascular risk (positive LR 3.87) and those with moderate or severe hypoperfusion (positive LR 8.63). Sixty cardiovascular major events were registered. The best survival prognosis was found in patients with a negative result (p=0.001) or mild hypoperfusion (p=0.038). In the multivariate analysis, a moderate or severe hypoperfusion increased cardiovascular event probability (HR=2.2; IC 95% 1.26-3.92), with no differences between a mild positive and a negative result (HR=0.93; IC 95% 0.38-2.28). CONCLUSIONS Stress CMR was specially useful in patients with low or intermediate cardiovascular risk, patients with atypical chest pain, patients without previous ischemic cardiomyopathy and those with moderate or severe hypoperfusion. Hypoperfusion degree was the main issue factor to guide clinical decisions.
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Affiliation(s)
| | - Isabel Coma-Canella
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, España
| | - Gorka Bastarrika
- Departamento de Radiología, Clínica Universidad de Navarra, Pamplona, España
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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121
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8820] [Impact Index Per Article: 1102.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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125
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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126
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Rigolli M, Anandabaskaran S, Christiansen JP, Whalley GA. Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis. Open Heart 2016; 3:e000388. [PMID: 27158524 PMCID: PMC4854151 DOI: 10.1136/openhrt-2015-000388] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/09/2016] [Accepted: 03/15/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose Cardiac MR (CMR) is the gold standard for left ventricular (LV) quantification. However, two-dimensional echocardiography (2DE) is the most common approach, and both three-dimensional echocardiography (3DE) and multidetector CT (MDCT) are increasingly available. The clinical significance and interchangeability of these modalities remains under-investigated. Therefore, we undertook a systemic review to evaluate the accuracy and absolute bias in LV quantification of all the commonly available non-invasive imaging modalities (2DE, CE-2DE, 3DE, MDCT) compared to cardiac MR (CMR). Methods Studies were included that reported LV echocardiographic (2DE, CE-2DE, 3DE) and/or MDCT measurements compared to CMR. Only modern CMR (SSFP sequences) was considered. Studies involving small sample size (<10 patients) and unusual cardiac geometry (ie, congenital heart diseases) were excluded. We evaluated LV end-diastolic volume (LVEDV), end-systolic volume (LVESV) and ejection fraction (LVEF). Results 1604 articles were initially considered: 65 studies were included (total of 4032 scans (echo, CT, MRI) performed in 2888 patients). Compared to CMR, significant biased underestimation of LV volumes with 2DE was seen (LVEDV—33.30 mL, LVESV −16.20 mL, p<0.0001). This difference was reduced but remained significant with CE-2DE (LVEDV −18.05, p<0.0001) and 3DE (LVEDV −14.41, p<0.001), while MDCT values were similar to CMR (LVEDV −1.20, p=0.43; LVESV −0.13, p=0.91). However, excellent agreement for echocardiographic LVEF evaluation (2DE LVEF 0.78–1.01%, p=0.37) was observed, especially with 3DE (LVEF 0.14%, p=0.88). Conclusions Comparing imaging modalities to CMR as reference standard, 3DE had the highest accuracy in LVEF estimation: 2DE and 3DE-derived LV volumes were significantly underestimated. Newer generation CT showed excellent accuracy for LV volumes.
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Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | | | | | - Gillian A Whalley
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Institute of Diagnostic Ultrasound, Australasian Sonographers Association, Melbourne, Victoria, Australia
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Suzuki T, Nazarian S, Jerosch-Herold M, Chugh SS. Imaging for assessment of sudden death risk: current role and future prospects. Europace 2016; 18:1491-1500. [PMID: 27098112 DOI: 10.1093/europace/euv456] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/28/2015] [Indexed: 12/18/2022] Open
Abstract
Sudden cardiac death (SCD) remains a major public health problem and there is an urgent need to maximize the impact of primary prevention using the implantable defibrillator. While implantable defibrillators are of utility for prevention of SCD, current methods of selecting candidates have significant shortcomings. Major advancements have occurred in the field of cardiac imaging, with significant potential to identify novel cardiac substrates for improved prediction. While assessment of the left ventricular ejection fraction remains the current major predictor, it is likely that several novel imaging markers will be incorporated into future risk stratification approaches. The goal of this review is to discuss the current status and future potential of cardiac imaging modalities to enhance risk stratification for SCD.
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Affiliation(s)
- Takeki Suzuki
- Division of Cardiology, Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Saman Nazarian
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sumeet S Chugh
- The Heart Institute, Advanced Health Sciences Pavilion Suite A3100, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd, Los Angeles, CA 90048, USA
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Li WWL, van Boven WJP, Annema JT, Eberl S, Klomp HM, de Mol BAJM. Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis 2016; 8:E175-84. [PMID: 27076967 DOI: 10.21037/jtd.2016.02.55] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished.
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Affiliation(s)
- Wilson W L Li
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Wim Jan P van Boven
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Jouke T Annema
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Susanne Eberl
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Houke M Klomp
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
| | - Bas A J M de Mol
- 1 Department of Cardiothoracic Surgery, 2 Department of Respiratory Medicine, 3 Department of Anesthesiology, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands ; 4 Department of Thoracic Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, 1066 CX Amsterdam, the Netherlands
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Eid M, De Cecco CN, Schoepf UJ, Mangold S, Tesche C, Varga-Szemes A, Suranyi P, Stalcup S, Ball BD, Caruso D. The Role of MRI and CT in the Diagnosis of Atherosclerosis in an Aging Population. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0141-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yune S, Choi DC, Lee BJ, Lee JY, Jeon ES, Kim SM, Choe YH. Detecting cardiac involvement with magnetic resonance in patients with active eosinophilic granulomatosis with polyangiitis. Int J Cardiovasc Imaging 2016; 32 Suppl 1:155-62. [PMID: 26831057 DOI: 10.1007/s10554-016-0843-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/19/2016] [Indexed: 01/31/2023]
Abstract
Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome). The aims of this study were to describe findings of cardiac magnetic resonance (CMR) in patients with active EGPA and to find factors associated with cardiac involvement detected by CMR that could help identify patients who would benefit from the examination. Medical records and CMR images in 16 consecutive EGPA patients (8 women and 8 men, median age of 47 years ranging from 34 to 68 years) were reviewed. Clinical features and results of laboratory tests were compared according to the presence of myocardial late gadolinium enhancement (LGE) on CMR images. The patients were followed for the development of cardiac symptoms and signs (mean follow up duration, 40.5 ± 12.8 months). Among the total of 16 patients, 8 (50 %) had myocardial LGE according to CMR, located in the subendocardial layer in 7 of them (87.5 %). The extent of LGE had a significant negative correlation with left ventricular ejection fraction (LVEF, ρ = -0.723, p = 0.043). The presence of LGE was associated with larger end-systolic left ventricle internal dimension (34 vs. 28 mm, p = 0.027) and presence of diastolic dysfunction (75 vs. 0 %, p = 0.008) on echocardiography, elevated NT-proBNP (75 vs. 12.5 %, p = 0.012), and elevated CK-MB (62.5 vs. 0 %, p = 0.010) compared to the group without LGE. Only one patient (6.3 %) had cardiac symptoms before CMR and another patient (6.3 %) developed heart failure 4 years later during remission. The other 14 patients remained free from cardiac signs and symptoms during the follow-up period. In patients with active EGPA, CMR enables detection of cardiac involvement when cardiac symptoms are not present. Echocardiographic diastolic dysfunction and elevated NT-proBNP or CK-MB may help identify active EGPA patients who can benefit from CMR to detect cardiac involvement without cardiac symptoms.
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Affiliation(s)
- Sehyo Yune
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Dong-Chull Choi
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jin-Young Lee
- Center for Health Promotion, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Eun-Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Yeon Hyeon Choe
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Fordyce CB, Douglas PS. Optimal non-invasive imaging test selection for the diagnosis of ischaemic heart disease. Heart 2016; 102:555-64. [DOI: 10.1136/heartjnl-2015-307764] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Quality control of cardiac MRI for tetralogy of Fallot: Combination of standard measurements and physiological analysis to detect invalid examinations. Arch Cardiovasc Dis 2016; 109:96-103. [PMID: 26778086 DOI: 10.1016/j.acvd.2015.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 11/17/2015] [Accepted: 11/19/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is the key examination for patients with tetralogy of Fallot, but it remains challenging. The MRI report should at least mention left (L) and right (R) ventricle end-diastole volumes (V), ejection fraction (EF) and pulmonary regurgitation (PR). These variables are linked by basic physiology rules and (V × EF)L=(V × EF)R(1-PR). AIMS To investigate this formula as a quality control of Fallot MRI. METHODS A total of 98 consecutive Fallot MRI were included retrospectively. Examinations that failed the formula (with a 10% tolerance) constituted the invalid group and were compared with a control group of the same size. MRIs of both groups were randomly submitted to a senior observer for blinded reassessment. The initial and new reports were compared. The inter-observer limits of agreement were calculated for the different variables within both groups. RESULTS Twelve examinations failed to pass the validation formula. From the 24 reanalysed examinations (12 invalid+12 controls), four failed to pass the formula (all from the invalid group). Two examinations had significant artefacts in the aorta or pulmonary trunk due to sternal wires. The quality check detected two other patients with atypical anatomy (persistent septal defects), which were not known by the MRI physician and were not detected during the examination. The inter-observer disagreements within the invalid group concerned essentially VR (P<0.02). CONCLUSION The quality control detected questionable MRI examinations, in which 83% corresponded to unreliable right ventricle volumes due to questionable manual contours or unreliable output flow due to artefacts.
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Bonnemains L, Raimondi F, Odille F. Specifics of cardiac magnetic resonance imaging in children. Arch Cardiovasc Dis 2016; 109:143-9. [PMID: 26778085 DOI: 10.1016/j.acvd.2015.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 11/28/2022]
Abstract
This review points out three specific features of cardiac magnetic resonance imaging (MRI) in children: the small size of the heart modifies the usual balance between signal-to-noise ratio and spatial resolution; the higher and more variable heart rate limits tissue characterization and temporal resolution; and motion artefacts (notably respiratory motions) must be dealt with. In the second part of this review, we present the current and future practices of cardiac magnetic resonance (CMR) in children, based on the experience of all French paediatric cardiac MRI centres.
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Affiliation(s)
- Laurent Bonnemains
- Department of Cardiac Surgery, CHU de Strasbourg, 67000 Strasbourg, France; U947, Inserm, 54000 Nancy, France; IADI, University of Lorraine, 54000 Nancy, France; University of Strasbourg, 67000 Strasbourg, France.
| | - Francesca Raimondi
- Department of Paediatric Cardiology, CHU Necker-Enfants-Malades, 75000 Paris, France
| | - Freddy Odille
- U947, Inserm, 54000 Nancy, France; IADI, University of Lorraine, 54000 Nancy, France; CIC-IT 1433, Inserm, 54000 Nancy, France
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135
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IRM cardiaque dans le dépistage des complications. ONCOLOGIE 2016. [DOI: 10.1007/s10269-015-2577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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136
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Murphy DJ, Lavelle LP, Gibney B, O'Donohoe RL, Rémy-Jardin M, Dodd JD. Diagnostic accuracy of standard axial 64-slice chest CT compared to cardiac MRI for the detection of cardiomyopathies. Br J Radiol 2015; 89:20150810. [PMID: 26670156 DOI: 10.1259/bjr.20150810] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of standard axial chest CT compared with cardiac MRI for cardiomyopathies. METHODS The standard axial 64-slice chest CTs of 49 patients with cardiomyopathies and 27 controls were blindly assessed for the presence of a cardiomyopathy by two independent readers. Qualitative and quantitative analysis included assessment of: (i) interatrial septal thickness, (ii) left atrial diameter, (iii) myocardial hypertrophy, thinning or fat, (iv) myocardial and papillary muscle calcification, (v) papillary muscle thickness, (vi) calcified coronary artery segments, (vii) left ventricular (LV) diameter, (viii) interventricular septal thickness and (ix) right ventricular diameters. Cardiac MRI was the gold standard. RESULTS There were 21 (42.9%) dilated, 16 (32.7%) hypertrophic, 8 (16.3%) ischaemic and 4 other (8.2%) (LV non-compaction × 2, amyloid, idiopathic restrictive) patients with cardiomyopathies. An LV diameter of 47 mm, interventricular septal thickness of 14 mm and coronary artery/papillary muscle calcification on axial chest CT best distinguished dilated, hypertrophic and ischaemic cardiomyopathies from controls, respectively; kappa = 0.45 (moderate interobserver agreement). The sensitivity (95% confidence interval), specificity, positive- and negative-predictive values (95% confidence interval) and diagnostic accuracy of chest CT in diagnosing cardiomyopathies were 68% (52-83), 100%, 100%, 66% (55-85) and 80%, respectively. CONCLUSION Cardiomyopathies may be detected on standard chest CT with good sensitivity and high specificity. ADVANCES IN KNOWLEDGE It is useful to assess for an underlying cardiomyopathy on standard chest CT, especially in a patient with unexplained dyspnoea.
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Affiliation(s)
- David J Murphy
- 1 Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Lisa P Lavelle
- 1 Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Brian Gibney
- 1 Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Rory L O'Donohoe
- 1 Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
| | - Martine Rémy-Jardin
- 2 Department of Thoracic Imaging, Hospital Calmette, University Lille, CHU Lille, Lille, France
| | - Jonathan D Dodd
- 1 Department of Radiology, St Vincent's University Hospital, Dublin, Ireland
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Ermis E, Demirelli S, Korkmaz AF, Sahin BD, Kantarci A. An isolated single L-II type coronary artery anomaly: A rare coronary anomaly. Intractable Rare Dis Res 2015; 4:203-6. [PMID: 26668781 PMCID: PMC4660862 DOI: 10.5582/irdr.2015.01025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The incidence of congenital artery anomalies is 0.2-1.4%, and most are benign. Single coronary artery (SCA) anomalies are very rare. The right coronary artery (RCA) originating from the left coronary system is one such SCA anomaly, and the risk of sudden cardiac death (SCD) increases if it courses between the pulmonary artery and aorta and coexists with other congenital heart diseases. Additionally, coursing of the RCA between the great vessels increases the risk of atherosclerosis. We herein present the case of a 57 year-old man who was admitted to our cardiology outpatient clinic and diagnosed with an SCA anomaly in which the RCA arose from the left main coronary artery (LMCA) and coursed between the pulmonary artery and aorta. However a critical stenosis was not detected in imaging techniques, and myocardial perfusion scintigraphic evidence of ischaemia was found in a small area. Therefore, he was managed with conservative medical therapy.
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Affiliation(s)
- Emrah Ermis
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
- Address correspondence to: Dr. Emrah Ermis, Department of Cardiology, Erzurum Education and Research Hospital, 25240, Erzurum, Turkey. E-mail:
| | - Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Ali Fuat Korkmaz
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Bingul Dilekci Sahin
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Abdulmecit Kantarci
- Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey
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138
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Risk stratification by cardiac magnetic resonance imaging after ST-elevation myocardial infarction. Curr Opin Cardiol 2015; 30:681-9. [DOI: 10.1097/hco.0000000000000227] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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139
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Balassy C, Roberts D, Miller SF. Safety and efficacy of gadoteric acid in pediatric magnetic resonance imaging: overview of clinical trials and post-marketing studies. Pediatr Radiol 2015; 45:1831-41. [PMID: 26045036 DOI: 10.1007/s00247-015-3394-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/03/2014] [Accepted: 05/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gadoteric acid is a paramagnetic gadolinium macrocyclic contrast agent approved for use in MRI of cerebral and spinal lesions and for body imaging. OBJECTIVE To investigate the safety and efficacy of gadoteric acid in children by extensively reviewing clinical and post-marketing observational studies. MATERIALS AND METHODS Data were collected from 3,810 children (ages 3 days to 17 years) investigated in seven clinical trials of central nervous system (CNS) imaging (n = 141) and six post-marketing observational studies of CNS, musculoskeletal and whole-body MR imaging (n = 3,669). Of these, 3,569 children were 2-17 years of age and 241 were younger than 2 years. Gadoteric acid was generally administered at a dose of 0.1 mmol/kg. We evaluated image quality, lesion detection and border delineation, and the safety of gadoteric acid. We also reviewed post-marketing pharmacovigilance experience. RESULTS Consistent with findings in adults, gadoteric acid was effective in children for improving image quality compared with T1-W unenhanced sequences, providing diagnostic improvement, and often influencing the therapeutic approach, resulting in treatment modifications. In studies assessing neurological tumors, gadoteric acid improved border delineation, internal morphology and contrast enhancement compared to unenhanced MR imaging. Gadoteric acid has a well-established safety profile. Among all studies, a total of 10 children experienced 20 adverse events, 7 of which were thought to be related to gadoteric acid. No serious adverse events were reported in any study. Post-marketing pharmacovigilance experience did not find any specific safety concern. CONCLUSION Gadoteric acid was associated with improved lesion detection and delineation and is an effective and well-tolerated contrast agent for use in children.
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Affiliation(s)
- Csilla Balassy
- Department of Radiology, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
| | - Donna Roberts
- Department of Radiology, Medical University of South Carolina, Charleston, SC, USA
| | - Stephen F Miller
- Department of Radiology, LeBonheur Children's Hospital, Memphis, TN, USA
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New-Onset Myocarditis in an Immunocompetent Adult with Acute Metapneumovirus Infection. Case Rep Med 2015; 2015:814269. [PMID: 26421018 PMCID: PMC4572465 DOI: 10.1155/2015/814269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/11/2015] [Accepted: 08/20/2015] [Indexed: 12/16/2022] Open
Abstract
Introduction. A number of viruses have been implicated in viral myocarditis; however, there has been no previous report of human metapneumovirus (hMPV) causing this condition. Discovered in 2001, hMPV is typically associated with upper respiratory illness, mainly affecting children. Case Presentation. We report the case of a 25-year-old man with acute systolic heart failure from viral myocarditis secondary to the hMPV. The patient was initially admitted to the general medical ward but developed increasing oxygen requirements resulting in transfer to the cardiac intensive care unit. Cardiac magnetic resonance imaging was used to help confirm the diagnosis. He was treated with intravenous diuretics, and afterload and preload agents, and he was subsequently discharged home after seven days of hospitalization. Discussion. hMPV is typically a respiratory pathogen; however, it was associated with in myocarditis in our patient. Due to the recent ability to detect this virus, we may see more cases of this, particularly during peak months of infection. Conclusion. This is the first case description of myocarditis associated with hMPV infection.
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141
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Hamilton-Craig C, Strugnell W, Gaikwad N, Ischenko M, Speranza V, Chan J, Neill J, Platts D, Scalia GM, Burstow DJ, Walters DL. Quantitation of mitral regurgitation after percutaneous MitraClip repair: comparison of Doppler echocardiography and cardiac magnetic resonance imaging. Ann Cardiothorac Surg 2015; 4:341-51. [PMID: 26309843 DOI: 10.3978/j.issn.2225-319x.2015.05.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/27/2015] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Percutaneous valve intervention for severe mitral regurgitation (MR) using the MitraClip is a novel technology. Quantitative assessment of residual MR by transthoracic echocardiography (TTE) is challenging, with multiple eccentric jets and artifact from the clips. Cardiovascular magnetic resonance (CMR) is the reference standard for left and right ventricular volumetric assessment. CMR phase-contrast flow imaging has superior reproducibility for quantitation of MR compared to echocardiography. The objective of this study was to establish the feasibility and reproducibility of CMR in quantitating residual MR after MitraClip insertion in a prospective study. METHODS Twenty-five patients underwent successful MitraClip insertion. Nine were excluded due to non-magnetic resonance imaging (MRI) compatible implants or arrhythmia, leaving 16 who underwent a comprehensive CMR examination at 1.5 T (Siemens Aera) with multiplanar steady state free precession (SSFP) cine imaging (cine CMR), and phase-contrast flow acquisitions (flow CMR) at the mitral annulus atrial to the MitraClip, and the proximal aorta. Same-day echocardiography was performed with two-dimensional (2D) visualization and Doppler. CMR and echocardiographic data were independently and blindly analyzed by expert readers. Inter-rater comparison was made by concordance correlation coefficient (CCC) with 95% confidence intervals (CIs), and Bland-Altman (BA) methods. RESULTS Mean age was 79 years, and mean LVEF was 44%±11% by CMR and 54%±16% by echocardiography. Inter-observer reproducibility of echocardiographic visual categorical grading by expert readers was poor, with a CCC of 0.475 (-0.7, 0.74). Echocardiographic Doppler regurgitant fraction reproducibility was modest (CCC 0.59, 0.15-0.84; BA mean difference -3.7%, -38% to 31%). CMR regurgitant fraction reproducibility was excellent (CCC 0.95, 0.86-0.98; BA mean difference -2.4%, -11.9 to 7.0), with a lower mean difference and narrower limits of agreement compared to echocardiography. Categorical severity grading by CMR using published ranges had good inter-observer agreement (CCC 0.86, 0.62-0.95). CONCLUSIONS CMR performs very well in the quantitation of MR after MitraClip insertion, with excellent reproducibility compared to echocardiographic methods. CMR is a useful technique for the comprehensive evaluation of residual regurgitation in patients after MitraClip. Technical limitations exist for both techniques, and quantitation remains a challenge in some patients.
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Affiliation(s)
- Christian Hamilton-Craig
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Wendy Strugnell
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Niranjan Gaikwad
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Matthew Ischenko
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Vicki Speranza
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Jonathan Chan
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Johanne Neill
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - David Platts
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Gregory M Scalia
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Darryl J Burstow
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
| | - Darren L Walters
- 1 Heart & Lung Institute, Prince Charles Hospital, Brisbane, Australia ; 2 University of Queensland, Brisbane, Australia ; 3 University of Washington, Seattle, WA, USA ; 4 School of Medicine & Menzies Health Institute, Griffith University, Queensland, Australia
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Kidambi A, Sourbron S, Maredia N, Motwani M, Brown JM, Nixon J, Everett CC, Plein S, Greenwood JP. Factors associated with false-negative cardiovascular magnetic resonance perfusion studies: A Clinical evaluation of magnetic resonance imaging in coronary artery disease (CE-MARC) substudy. J Magn Reson Imaging 2015; 43:566-73. [PMID: 26285057 PMCID: PMC4762538 DOI: 10.1002/jmri.25032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/01/2015] [Accepted: 08/04/2015] [Indexed: 12/28/2022] Open
Abstract
Purpose To examine factors associated with false‐negative cardiovascular magnetic resonance (MR) perfusion studies within the large prospective Clinical Evaluation of MR imaging in Coronary artery disease (CE‐MARC) study population. Myocardial perfusion MR has excellent diagnostic accuracy to detect coronary heart disease (CHD). However, causes of false‐negative MR perfusion studies are not well understood. Materials and Methods CE‐MARC prospectively recruited patients with suspected CHD and mandated MR, myocardial perfusion scintigraphy, and invasive angiography. This subanalysis identified all patients with significant coronary stenosis by quantitative coronary angiography (QCA) and MR perfusion (1.5T, T1‐weighted gradient echo), using the original blinded image read. We explored patient and imaging characteristics related to false‐negative or true‐positive MR perfusion results, with reference to QCA. Multivariate regression analysis assessed the likelihood of false‐negative MR perfusion according to four characteristics: poor image quality, triple‐vessel disease, inadequate hemodynamic response to adenosine, and Duke jeopardy score (angiographic myocardium‐at‐risk score). Results In all, 265 (39%) patients had significant angiographic disease (mean age 62, 79% male). Thirty‐five (5%) had false‐negative and 230 (34%) true‐positive MR perfusion. Poor MR perfusion image quality, triple‐vessel disease, and inadequate hemodynamic response were similar between false‐negative and true‐positive groups (odds ratio, OR [95% confidence interval, CI]: 4.1 (0.82–21.0), P = 0.09; 1.2 (0.20–7.1), P = 0.85, and 1.6 (0.65–3.8), P = 0.31, respectively). Mean Duke jeopardy score was significantly lower in the false‐negative group (2.6 ± 1.7 vs. 5.4 ± 3.0, OR 0.34 (0.21–0.53), P < 0.0001). Conclusion False‐negative cardiovascular MR perfusion studies are uncommon, and more common in patients with lower angiographic myocardium‐at‐risk. In CE‐MARC, poor image quality, triple‐vessel disease, and inadequate hemodynamic response were not significantly associated with false‐negative MR perfusion. J. MAGN. RESON. IMAGING 2016;43:566–573.
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Affiliation(s)
- Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Neil Maredia
- Multidisciplinary Cardiovascular Research Centre & the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Manish Motwani
- Multidisciplinary Cardiovascular Research Centre & the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Julia M Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Jane Nixon
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Colin C Everett
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & the Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
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Schnell F, Claessen G, La Gerche A, Bogaert J, Lentz PA, Claus P, Mabo P, Carré F, Heidbuchel H. Subepicardial delayed gadolinium enhancement in asymptomatic athletes: let sleeping dogs lie? Br J Sports Med 2015. [DOI: 10.1136/bjsports-2014-094546] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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144
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Ripley DP, Motwani M, Brown JM, Nixon J, Everett CC, Bijsterveld P, Maredia N, Plein S, Greenwood JP. Individual component analysis of the multi-parametric cardiovascular magnetic resonance protocol in the CE-MARC trial. J Cardiovasc Magn Reson 2015; 17:59. [PMID: 26174854 PMCID: PMC4502933 DOI: 10.1186/s12968-015-0169-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The CE-MARC study assessed the diagnostic performance investigated the use of cardiovascular magnetic resonance (CMR) in patients with suspected coronary artery disease (CAD). The study used a multi-parametric CMR protocol assessing 4 components: i) left ventricular function; ii) myocardial perfusion; iii) viability (late gadolinium enhancement (LGE)) and iv) coronary magnetic resonance angiography (MRA). In this pre-specified CE-MARC sub-study we assessed the diagnostic accuracy of the individual CMR components and their combinations. METHODS All patients from the CE-MARC population (n = 752) were included using data from the original blinded-read. The four individual core components of the CMR protocol was determined separately and then in paired and triplet combinations. Results were then compared to the full multi-parametric protocol. RESULTS CMR and X-ray angiography results were available in 676 patients. The maximum sensitivity for the detection of significant CAD by CMR was achieved when all four components were used (86.5%). Specificity of perfusion (91.8%), function (93.7%) and LGE (95.8%) on its own was significantly better than specificity of the multi-parametric protocol (83.4%) (all P < 0.0001) but with the penalty of decreased sensitivity (86.5% vs. 76.9%, 47.4% and 40.8% respectively). The full multi-parametric protocol was the optimum to rule-out significant CAD (Likelihood Ratio negative (LR-) 0.16) and the LGE component alone was the best to rue-in CAD (LR+ 9.81). Overall diagnostic accuracy was similar with the full multi-parametric protocol (85.9%) compared to paired and triplet combinations. The use of coronary MRA within the full multi-parametric protocol had no additional diagnostic benefit compared to the perfusion/function/LGE combination (overall accuracy 84.6% vs. 84.2% (P = 0.5316); LR- 0.16 vs. 0.21; LR+ 5.21 vs. 5.77). CONCLUSIONS From this pre-specified sub-analysis of the CE-MARC study, the full multi-parametric protocol had the highest sensitivity and was the optimal approach to rule-out significant CAD. The LGE component alone was the optimal rule-in strategy. Finally the inclusion of coronary MRA provided no additional benefit when compared to the combination of perfusion/function/LGE. TRIAL REGISTRATION Current Controlled Trials ISRCTN77246133.
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Affiliation(s)
- David P Ripley
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Manish Motwani
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Julia M Brown
- Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK.
| | - Jane Nixon
- Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK.
| | - Colin C Everett
- Clinical Trials Research Unit, University of Leeds, Clinical Trials Research House, 71-75 Clarendon Rd, Leeds, UK.
| | - Petra Bijsterveld
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Neil Maredia
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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145
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Sozzi FB, Iacuzio L, Civaia F, Canetta C, Berthier F, Rusek S, Rossi P, Lombardi F, Dreyfus G, Dor V. Incremental value of normal adenosine perfusion cardiac magnetic resonance: Long-term outcome. Am Heart J 2015; 169:841-6. [PMID: 26027622 DOI: 10.1016/j.ahj.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 03/01/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of the study was to determine the long-term prognostic value of normal adenosine stress cardiac magnetic resonance imaging (CMR) in patients referred for evaluation of myocardial ischemia. METHODS We reviewed 300 consecutive patients (age 65 ± 11 years, 74% male) with suspected or known coronary disease and normal wall motion who had undergone adenosine stress CMR negative for ischemia and scar. Most patients were at intermediate risk of coronary artery disease. The end points studied were all causes of mortality and major adverse cardiac events, including cardiac death, myocardial infarction, revascularization, and hospitalization for unstable angina. RESULTS During a mean follow-up of 5.5 years (mean = 5.4 ± 1.1), 16 patients died because of various causes (cardiac death in 5 patients). Three patients had a nonfatal myocardial infarction, 7 patients were hospitalized for revascularization, and 11 were medically treated for unstable angina. The annual cardiac event rate was 1.3% (0.78% in the first 3 years and 1.9% between the fourth and sixth years). The predictors of major adverse cardiac events in a multivariate analysis model were as follows: advanced age (hazard ratio [HR] 1.15, 95% confidence interval [95% CI] 1.02-1.30), diabetes (HR 17.5, 95% CI 2.2-140), and the habit of smoking (HR 5.9, 95% CI 1.0-35.5). For all causes of mortality, the only predictor was diabetes (HR 11.4, 95% CI 1.76-74.2). Patients with normal stress CMR had an excellent outcome during the 3 years after the study. The cardiac event rate was higher between the fourth and sixth years. CONCLUSION Over a 5.5-year period, a low event rate and excellent prognosis occurred in patients with normal adenosine stress CMR. Low- to intermediate-risk patients with a normal CMR are at low risk for subsequent cardiac events.
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Affiliation(s)
| | | | | | - Ciro Canetta
- Ospedale Maggiore Policlinico Cà Granda, IRCCS, Milan, IT
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146
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Abstract
Patients with type 1 diabetes (T1D) suffer excess mortality from cardiovascular disease (CVD) that has persisted despite substantial reductions in microvascular complications. Although T1D and type 2 diabetes (T2D) are etiologically distinct, it has generally been assumed that CVD in T1D is "the same disease" as that found in T2D. Here, we review the most recent epidemiological and clinical studies on heart disease in T1D, highlighting differences between CVD in T1D and T2D. In addition, we discuss experimental and clinical evidence for a post-myocardial infarction (MI) autoimmune heart syndrome in T1D, including the development of diagnostic assays which we believe can, for the first time, differentiate between heart disease in T1D and T2D. We postulate that a clinically unrecognized form of chronic myocardial inflammation ("myocarditis") triggered by MI contributes to the poor CVD outcomes in T1D. These findings provide a conceptual shift in our understanding of CVD in T1D and have important diagnostic and therapeutic implications.
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Affiliation(s)
- Myra A Lipes
- Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Rm. 373, Boston, MA, 02215, USA,
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147
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Comparison of the strain field of abdominal aortic aneurysm measured by magnetic resonance imaging and stereovision: A feasibility study for prediction of the risk of rupture of aortic abdominal aneurysm. J Biomech 2015; 48:1158-64. [DOI: 10.1016/j.jbiomech.2015.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/23/2014] [Accepted: 01/11/2015] [Indexed: 11/22/2022]
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149
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Nuclear medicine in the management of patients with heart failure: guidance from an expert panel of the International Atomic Energy Agency (IAEA). Nucl Med Commun 2015; 35:818-23. [PMID: 24781009 PMCID: PMC4076031 DOI: 10.1097/mnm.0000000000000143] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart failure is increasing worldwide at epidemic proportions, resulting in considerable disability, mortality, and increase in healthcare costs. Gated myocardial perfusion single photon emission computed tomography or PET imaging is the most prominent imaging modality capable of providing information on global and regional ventricular function, the presence of intraventricular synchronism, myocardial perfusion, and viability on the same test. In addition, 123I-mIBG scintigraphy is the only imaging technique approved by various regulatory agencies able to provide information regarding the adrenergic function of the heart. Therefore, both myocardial perfusion and adrenergic imaging are useful tools in the workup and management of heart failure patients. This guide is intended to reinforce the information on the use of nuclear cardiology techniques for the assessment of heart failure and associated myocardial disease.
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150
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Schnell F, Riding N, O’Hanlon R, Axel Lentz P, Donal E, Kervio G, Matelot D, Leurent G, Doutreleau S, Chevalier L, Guerard S, Wilson MG, Carré F. Recognition and Significance of Pathological T-Wave Inversions in Athletes. Circulation 2015; 131:165-73. [DOI: 10.1161/circulationaha.114.011038] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background—
Pathological T-wave inversion (PTWI) is rarely observed on the ECG of healthy athletes, whereas it is common in patients with certain cardiac diseases. All ECG interpretation guidelines for use within athletes state that PTWI (except in leads aVR, III and V1 and in V1–V4 when preceded by domed ST segment in asymptomatic Afro-Caribbean athletes only) cannot be considered a physiological adaptation. The aims of the present study were to prospectively determine the prevalence of cardiac pathology in athletes presenting with PTWI, and to examine the efficacy of cardiac magnetic resonance in the work-up battery of further examinations.
Methods and Results—
Athletes presenting with PTWI (n=155) were investigated with clinical examination, ECG, echocardiography, exercise testing, 24h Holter ECG, and cardiac magnetic resonance. Cardiac disease was established in 44.5% of athletes, with hypertrophic cardiomyopathy (81%) the most common pathology. Echocardiography was abnormal in 53.6% of positive cases, and cardiac magnetic resonance identified a further 24 athletes with disease. Five athletes (7.2%) considered normal on initial presentation subsequently expressed pathology during follow-up. Familial history of sudden cardiac death and ST-segment depression associated with PTWI were predictive of cardiac disease.
Conclusions—
PTWI should be considered pathological in all cases until proven otherwise, because it was associated with cardiac pathology in 45% of athletes. Despite echocardiography identifying pathology in half of these cases, cardiac magnetic resonance must be considered routine in athletes presenting with PTWI with normal echocardiography. Although exclusion from competitive sport is not warranted in the presence of normal secondary examinations, annual follow-up is essential to ascertain possible disease expression.
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Affiliation(s)
- Frédéric Schnell
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Nathan Riding
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Rory O’Hanlon
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Pierre Axel Lentz
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Erwan Donal
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Gaelle Kervio
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - David Matelot
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Guillaume Leurent
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Stéphane Doutreleau
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Laurent Chevalier
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Sylvain Guerard
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - Mathew G. Wilson
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
| | - François Carré
- From the Department of Physiology, Rennes1 University, Rennes France (F.S., F.C.); the Department of Sport Medicine, Pontchaillou Hospital, Rennes, France (F.S., F.C.); INSERM UMR 1099, Rennes France (F.S., E.D., G.K., D.M., F.C.); the Department of Sports Medicine, ASPETAR, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar (N.R., M.G.W.); the Centre for Cardiovascular Magnetic Resonance, Blackrock Clinic, Dublin, Ireland (R.O.); the Department of Radiology, Pontchaillou Hospital, Rennes
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