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Abstract
Acute myocarditis is an inflammatory disease of the heart muscle that may progress to dilated cardiomyopathy and chronic heart failure. A number of factors including the sex hormone testosterone, components of innate immunity, and profibrotic cytokines have been identified in animal models as important pathogenic mechanisms that increase inflammation and susceptibility to chronic dilated cardiomyopathy. The clinical presentation of acute myocarditis is non-specific and mimics more common causes of heart failure and arrhythmias. Suspected myocarditis is currently confirmed using advanced non-invasive imaging and histopathologic examination of heart tissue. However, the diverse presentations of myocarditis and the lack of widely available, safe, and accurate non-invasive diagnostic tests remain major obstacles to early diagnosis and population based research. Recent advances in the understanding of disease pathogenesis described in this review should lead to more accurate diagnostic algorithms and non-invasive tests.
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Affiliation(s)
- Chantal Elamm
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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202
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Chen X, Nacif MS, Liu S, Sibley C, Summers RM, Bluemke DA, Yao J. A framework of whole heart extracellular volume fraction estimation for low-dose cardiac CT images. IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE : A PUBLICATION OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY 2012; 16:842-51. [PMID: 22711778 PMCID: PMC3491075 DOI: 10.1109/titb.2012.2204405] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cardiac CT (CCT) is widely available and has been validated for the detection of focal myocardial scar using a delayed enhancement technique in this paper. CCT, however, has not been previously evaluated for quantification of diffuse myocardial fibrosis. In our investigation, we sought to evaluate the potential of low-dose CCT for the measurement of myocardial whole heart extracellular volume (ECV) fraction. ECV is altered under conditions of increased myocardial fibrosis. A framework consisting of three main steps was proposed for CCT whole heart ECV estimation. First, a shape-constrained graph cut (GC) method was proposed for myocardium and blood pool segmentation on postcontrast image. Second, the symmetric demons deformable registration method was applied to register precontrast to postcontrast images. So the correspondences between the voxels from precontrast to postcontrast images were established. Finally, the whole heart ECV value was computed. The proposed method was tested on 20 clinical low-dose CCT datasets with precontrast and postcontrast images. The preliminary results demonstrated the feasibility and efficiency of the proposed method.
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Affiliation(s)
- Xinjian Chen
- School of Electrical and Information Engineering, Soochow University, Jiangsu 215006, China.
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203
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Nassenstein K, Orzada S, Haering L, Czylwik A, Jensen C, Schlosser T, Bruder O, Ladd ME, Maderwald S. Cardiac magnetic resonance: is phonocardiogram gating reliable in velocity-encoded phase contrast imaging? Eur Radiol 2012; 22:2679-87. [PMID: 22777618 DOI: 10.1007/s00330-012-2547-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 05/01/2012] [Accepted: 05/15/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the diagnostic accuracy of phonocardiogram (PCG) gated velocity-encoded phase contrast magnetic resonance imaging (MRI). METHODS Flow quantification above the aortic valve was performed in 68 patients by acquiring a retrospectively PCG- and a retrospectively ECG-gated velocity-encoded GE-sequence at 1.5 T. Peak velocity (PV), average velocity (AV), forward volume (FV), reverse volume (RV), net forward volume (NFV), as well as the regurgitant fraction (RF) were assessed for both datasets, as well as for the PCG-gated datasets after compensation for the PCG trigger delay. RESULTS PCG-gated image acquisition was feasible in 64 patients, ECG-gated in all patients. PCG-gated flow quantification overestimated PV (Δ 3.8 ± 14.1 cm/s; P = 0.037) and underestimated FV (Δ -4.9 ± 15.7 ml; P = 0.015) and NFV (Δ -4.5 ± 16.5 ml; P = 0.033) compared with ECG-gated imaging. After compensation for the PCG trigger delay, differences were only observed for PV (Δ 3.8 ± 14.1 cm/s; P = 0.037). Wide limits of agreement between PCG- and ECG-gated flow quantification were observed for all variables (PV: -23.9 to 31.4 cm/s; AV: -4.5 to 3.9 cm/s; FV: -35.6 to 25.9 ml; RV: -8.0 to 7.2 ml; NFV: -36.8 to 27.8 ml; RF: -10.4 to 10.2 %). CONCLUSIONS The present study demonstrates that PCG gating in its current form is not reliable enough for flow quantification based on velocity-encoded phase contrast gradient echo (GE) sequences. KEY POINTS Phonocardiogram gating is an alternative to ECG-gating in cardiac MRI. Phonocardiogram gating shows only limited reliability for velocity-encoded cardiac MRI. Further refinements of the post-processing algorithm are necessary.
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Affiliation(s)
- Kai Nassenstein
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
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204
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Dwivedi G, Wells RG, Chow BJW. Cardiovascular magnetic resonance for diagnosis of coronary artery disease: quo vadis? Expert Rev Med Devices 2012; 9:219-24. [PMID: 22702251 DOI: 10.1586/erd.12.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular magnetic resonance imaging (CMR) has emerged as a potential modality for the diagnosis and risk stratification of patients with documented or suspected coronary artery disease. As such, it may be used as an alternative to other accepted noninvasive modalities. In the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) study, Greenwood et al. enrolled 752 patients with suspected angina pectoris and at least one cardiovascular risk factor, and evaluated the diagnostic accuracy of multiparametric CMR and single photon emission computed tomography (SPECT), and compared them with invasive coronary angiography as the reference standard. The authors reported significantly higher sensitivity and negative predictive values for CMR (86.5 and 90.5%, respectively) compared with SPECT (66.5 and 79.1%, respectively) and recommended that CMR be used more frequently than at present for the investigation of coronary artery disease. This robustly designed landmark trial certainly adds to the already impressive diagnostic data available with CMR in such patients, but being a new technique, it lacks the large outcome data available with SPECT. In summary, the results of this study confirm the promise for CMR, but further work and larger multicenter studies are required before its adoption into routine clinical practice.
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Affiliation(s)
- Girish Dwivedi
- Department of Medicine-Cardiology, Heart Institute, University of Ottawa, Ottawa, ON, Canada
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205
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Diagnosis of viral myocarditis by cardiac magnetic resonance and viral genome detection in peripheral blood. Int J Cardiovasc Imaging 2012; 29:121-9. [DOI: 10.1007/s10554-012-0052-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 04/04/2012] [Indexed: 01/10/2023]
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206
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Barone-Rochette G, Augier C, Rodière M, Jankowski A, Thony F, Ferretti G, Saunier C, Lantuejoul S, Chavanon O, Fagret D, Vanzetto G, Baguet JP. Diagnosis of cardiac tumors: Contribution of non-invasive cardiac imaging in routine practice. Int J Cardiol 2012; 157:298-300. [DOI: 10.1016/j.ijcard.2012.03.114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 03/11/2012] [Indexed: 10/28/2022]
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207
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Boggetto-Graham L, Chavanon O, Hacini R, Thony F, Rodière M, Lantuejoul S, Salameire D, Baguet JP. An uncommon cause of renovascular hypertension. Can J Cardiol 2012; 28:397.e1-3. [PMID: 22503378 DOI: 10.1016/j.cjca.2012.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/12/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022] Open
Abstract
Renovascular hypertension is usually due to an atherosclerotic artery stenosis or a fibromuscular dysplasia. We describe an uncommon cause of renal ischemia. A 66-year-old woman was admitted for severe hypertension. During her stay, she presented an acute myocardial infarction with normal coronary angiography. After a flank pain, a contrast-enhanced abdominal computed tomography scan was performed which revealed a stenosis of the left main renal artery. However, renal angiography displayed a thrombosis. Transesophageal echocardiography showed a mobile mass attached to the mitral valve. A diagnosis of renal artery thrombosis and acute myocardial infarction both resulting from a cardiac tumour embolism was established.
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208
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Delattre BMA, Van De Ville D, Braunersreuther V, Pellieux C, Hyacinthe JN, Lerch R, Mach F, Vallée JP. High Time-Resolved Cardiac Functional Imaging Using Temporal Regularization for Small Animal on a Clinical 3T Scanner. IEEE Trans Biomed Eng 2012; 59:929-35. [DOI: 10.1109/tbme.2011.2174363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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209
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Update on Dobutamine Stress Magnetic Resonance. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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210
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O'Donnell DH, Abbara S, Chaithiraphan V, Yared K, Killeen RP, Martos R, Keane D, Cury RC, Dodd JD. Cardiac MR imaging of nonischemic cardiomyopathies: imaging protocols and spectra of appearances. Radiology 2012; 262:403-22. [PMID: 22282181 DOI: 10.1148/radiol.11100284] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Recent technologic advances in cardiac magnetic resonance (MR) imaging have resulted in images with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MR is a valuable imaging technique for detection and assessment of the morphology and functional characteristics of the nonischemic cardiomyopathy. It has gained acceptance as a standalone imaging modality that can provide further information beyond the capabilities of traditional modalities such as echocardiography and angiography. Black-blood fast spin-echo MR images allow morphologic assessment of the heart with high spatial resolution, while T2-weighted MR images can depict acute myocardial edema. Contrast material-enhanced images can depict and be used to quantify myocardial edema, infiltration, and fibrosis. This review presents recommended cardiac MR protocols for and the spectrum of imaging appearances of the nonischemic cardiomyopathies.
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Affiliation(s)
- David H O'Donnell
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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211
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Batinic T, Utz W, Breskovic T, Jordan J, Schulz-Menger J, Jankovic S, Dujic Z, Tank J. Cardiac magnetic resonance imaging during pulmonary hyperinflation in apnea divers. Med Sci Sports Exerc 2012; 43:2095-101. [PMID: 21552160 DOI: 10.1249/mss.0b013e31821ff294] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Apnea divers hyperinflate the lung by taking a deep breath followed by glossopharyngeal insufflation. The maneuver can lead to symptomatic arterial hypotension. We tested the hypotheses that glossopharyngeal insufflation interferes with cardiac function further reducing cardiac output (CO) using cardiac magnetic resonance imaging (MRI) to fully sample both cardiac chambers. METHODS Eleven dive athletes (10 men, 1 woman; age = 26 ± 5 yr, body mass index = 23.5 ± 1.7 kg·m(-2)) underwent cardiac MRI during breath holding at functional residual capacity (baseline), at total lung capacity (apnea), and with submaximal glossopharyngeal insufflation. Lung volumes were estimated from anatomic images. Short-axis cine MR images were acquired to study biventricular function. Dynamic changes were followed by long-axis cine MRI. RESULTS Left and right ventricular end-diastolic volumes (LVEDV, RVEDV) decreased during apnea with and without glossopharyngeal insufflation (baseline: LVEDV = 198 ± 19 mL, RVEDV = 225 ± 30 mL; apnea: LVEDV = 125 ± 38 mL, RVEDV = 148 ± 37 mL, P < 0.001; glossopharyngeal insufflation: LVEDV = 108 ± 26 mL, RVEDV = 136 ± 29 mL, P < 0.001 vs baseline). CO decreased during apnea (left = -29 ± 4 %, right = -29 ± 4 %) decreasing further with glossopharyngeal insufflation (left = -38% ± 4%, right = -39% ± 4%, P < 0.05). HR increased 16 ± 4 bpm with apnea and 17 ± 5 bpm with glossopharyngeal insufflation (P < 0.01). Ejection fraction moderately decreased (apnea: left = -5% ± 2%, right = -7% ± 2%, glossopharyngeal insufflation: left = -6% ± 2%, right = -10% ± 2%, P < 0.01). With continued apnea with and without glossopharyngeal insufflation, LVEDV and CO increased over time by a similar but small amount (P < 0.01). CONCLUSIONS The major finding of our study was that submaximal glossopharyngeal insufflation decreased CO further albeit by a small amount compared to maximal inspiratory apnea. The response was not associated with severe biventricular dysfunction.
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Affiliation(s)
- Tonci Batinic
- Department of Radiology, University Hospital Split, Croatia
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212
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Nacif MS, Arai AE, Lima JAC, Bluemke DA. Gadolinium-enhanced cardiovascular magnetic resonance: administered dose in relationship to United States Food and Drug Administration (FDA) guidelines. J Cardiovasc Magn Reson 2012; 14:18. [PMID: 22376193 PMCID: PMC3305456 DOI: 10.1186/1532-429x-14-18] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 02/29/2012] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Myocardial late gadolinium enhancement was originally validated using higher than label-recommended doses of gadolinium chelate. The objective of this study was to evaluate available evidence for various gadolinium dosing regimens used for CMR. The relationship of gadolinium dose warnings (due to nephrogenic systemic fibrosis) announced in 2008 to gadolinium dosing regimens was also examined. METHODS We conducted a meta-analysis of peer reviewed publications from January, 2004 to December, 2010. Major subject search headings (MeSh) terms from the National Library of Medicine's PubMed were: contrast media, gadolinium, heart, magnetic resonance imaging; searches were limited to human studies with abstracts published in English. Case reports, review articles, editorials, MRA related papers and all reports that did not indicate gadolinium type or weight-based dose were excluded. For all included references, full text was available to determine the total administered gadolinium dose on a per kg basis. Average and median dose values were weighted by the number of subjects in each study. RESULTS 399 publications were identified in PubMed; 233 studies matched the inclusion criteria, encompassing 19,934 patients with mean age 54.2 ± 11.4 (range 9.3 to 76 years). 34 trials were related to perfusion testing and 199 to myocardial late gadolinium enhancement. In 2004, the weighted-median and weighted-mean contrast dose were 0.15 and 0.16 ± 0.06 mmol/kg, respectively. Median contrast doses for 2005-2010 were: 0.2 mmol/kg for all years, respectively. Mean contrast doses for the years 2005-2010 were: 0.19 ± 0.03, 0.18 ± 0.04, 0.18 ± 0.10, 0.18 ± 0.03, 0.18 ± 0.04 and 0.18 ± 0.04 mmol/kg, respectively (p for trend, NS). Gadopentetate dimeglumine was the most frequent gadolinium type [114 (48.9%) studies]. No change in mean gadolinium dose was present before, versus after the Food and Drug Administration (FDA) black box warning (p > 0.05). Three multi-center dose ranging trials have been published for cardiac MRI applications. CONCLUSION CMR studies in the peer-reviewed published literature routinely use higher gadolinium doses than regulatory agencies indicated in the package leaflet. Clinical trials should be supported to determine the appropriate doses of gadolinium for CMR studies.
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Affiliation(s)
- Marcelo S Nacif
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Radiology Department, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart, Lung, and Blood Institute - National Institutes - Bethesda, MD, USA
| | - Joao AC Lima
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Radiology and Imaging Sciences - National Institutes of Health Clinical Center, Bethesda, MD, USA
- Molecular Biomedical Imaging Laboratory, National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, USA
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213
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Abstract
Myocarditis is an underdiagnosed cause of acute heart failure, sudden death, and chronic dilated cardiomyopathy. In developed countries, viral infections commonly cause myocarditis; however, in the developing world, rheumatic carditis, Trypanosoma cruzi, and bacterial infections such as diphtheria still contribute to the global burden of the disease. The short-term prognosis of acute myocarditis is usually good, but varies widely by cause. Those patients who initially recover might develop recurrent dilated cardiomyopathy and heart failure, sometimes years later. Because myocarditis presents with non-specific symptoms including chest pain, dyspnoea, and palpitations, it often mimics more common disorders such as coronary artery disease. In some patients, cardiac MRI and endomyocardial biopsy can help identify myocarditis, predict risk of cardiovascular events, and guide treatment. Finding effective therapies has been challenging because the pathogenesis of chronic dilated cardiomyopathy after viral myocarditis is complex and determined by host and viral genetics as well as environmental factors. Findings from recent clinical trials suggest that some patients with chronic inflammatory cardiomyopathy have a progressive clinical course despite standard medical care and might improve with a short course of immunosuppression.
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Affiliation(s)
- Sandeep Sagar
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA
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214
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Slavich M, Florian A, Bogaert J. The emerging role of magnetic resonance imaging and multidetector computed tomography in the diagnosis of dilated cardiomyopathy. Insights Imaging 2012; 2:453-469. [PMID: 22347967 PMCID: PMC3259418 DOI: 10.1007/s13244-011-0101-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 02/25/2011] [Accepted: 05/02/2011] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance imaging and multidetector computed tomography are new imaging methods that have much to offer clinicians caring for patients with dilated cardiomyopathy. In this article we briefly describe the clinical, pathophysiological and histological aspects of dilated cardiomyopathy. Then we discuss in detail the use of both imaging methods for measurement of chamber size, global and regional function, for myocardial tissue characterisation, including myocardial viability assessment, and determination of arrhythmogenic substrate, and their emerging role in cardiac resynchronisation therapy.
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Affiliation(s)
- Massimo Slavich
- Department of Radiology and Medical Imaging Research Center, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
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215
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Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC, Bijsterveld P, Ridgway JP, Radjenovic A, Dickinson CJ, Ball SG, Plein S. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012; 379:453-60. [PMID: 22196944 PMCID: PMC3273722 DOI: 10.1016/s0140-6736(11)61335-4] [Citation(s) in RCA: 766] [Impact Index Per Article: 63.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND In patients with suspected coronary heart disease, single-photon emission computed tomography (SPECT) is the most widely used test for the assessment of myocardial ischaemia, but its diagnostic accuracy is reported to be variable and it exposes patients to ionising radiation. The aim of this study was to establish the diagnostic accuracy of a multiparametric cardiovascular magnetic resonance (CMR) protocol with x-ray coronary angiography as the reference standard, and to compare CMR with SPECT, in patients with suspected coronary heart disease. METHODS In this prospective trial patients with suspected angina pectoris and at least one cardiovascular risk factor were scheduled for CMR, SPECT, and invasive x-ray coronary angiography. CMR consisted of rest and adenosine stress perfusion, cine imaging, late gadolinium enhancement, and MR coronary angiography. Gated adenosine stress and rest SPECT used (99m)Tc tetrofosmin. The primary outcome was diagnostic accuracy of CMR. This trial is registered at controlled-trials.com, number ISRCTN77246133. FINDINGS In the 752 recruited patients, 39% had significant CHD as identified by x-ray angiography. For multiparametric CMR the sensitivity was 86·5% (95% CI 81·8-90·1), specificity 83·4% (79·5-86·7), positive predictive value 77·2%, (72·1-81·6) and negative predictive value 90·5% (87·1-93·0). The sensitivity of SPECT was 66·5% (95% CI 60·4-72·1), specificity 82·6% (78·5-86·1), positive predictive value 71·4% (65·3-76·9), and negative predictive value 79·1% (74·8-82·8). The sensitivity and negative predictive value of CMR and SPECT differed significantly (p<0·0001 for both) but specificity and positive predictive value did not (p=0·916 and p=0·061, respectively). INTERPRETATION CE-MARC is the largest, prospective, real world evaluation of CMR and has established CMR's high diagnostic accuracy in coronary heart disease and CMR's superiority over SPECT. It should be adopted more widely than at present for the investigation of coronary heart disease. FUNDING British Heart Foundation.
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Affiliation(s)
- John P Greenwood
- Multidisciplinary Cardiovascular Research Centre and Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK.
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216
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217
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Cardiac masses, part 1: imaging strategies and technical considerations. AJR Am J Roentgenol 2011; 197:W837-41. [PMID: 22021530 DOI: 10.2214/ajr.10.7260] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this article is to discuss optimal imaging strategies for the evaluation of cardiac masses. The advantages and disadvantages of echocardiography, cardiac MRI, gated cardiac CT, and nuclear imaging will be discussed and specific techniques presented. CONCLUSION Multimodality imaging plays a pivotal role in the diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis.
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218
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Jin H, Zeng MS, Yun H, Ge MY, Ma JY, Yang S. Noninvasive test of nitrate-induced coronary vasomotion by 1.5-T whole-heart 3D magnetic resonance angiography using a T2-prepared SSFP sequence. Int J Cardiovasc Imaging 2011; 28:1707-16. [PMID: 22187200 DOI: 10.1007/s10554-011-9999-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/07/2011] [Indexed: 12/31/2022]
Abstract
This study was aimed to investigate the use of 1.5-T whole-heart 3D coronary MRA employing a T2-prepared SSFP sequence for assessing epicardial coronary artery vasodilation following exogenous nitrates. Navigator-gated whole-heart 3D coronary MRA was performed before and after sublingual nitroglycerin (NTG) in 22 volunteers and a T2-prepared SSFP sequence was used for imaging of coronary arteries without MR contrast agent. Coronary cross-sectional area was measured on pre- and post-NTG images of equivalent coronary segments in the major coronary arteries and whole-heart coronary vasodilation was analyzed quantitatively. Measurements were obtained by two independent investigators. Coronary vasodilation could be observed directly on multiplanar reformatted and three-dimensional volume-rendered MR images. On quantitative analysis, NTG administration results in the whole-heart coronary vasodilation by an average of 37.3 ± 12.7%. There was moderate yet significant correlation between the NTG-induced vasodilation and age (r = -0.52, P = 0.02). The mean absolute cross-sectional area of the coronary arteries was significantly higher after sublingual NTG in all the major coronary arteries. The coronary area measurements had an interobserver variability of 8 ± 3% and an intraobserver variability of 4 ± 2%. Non-contrast-enhanced 1.5-T SSFP whole-heart coronary MRA can noninvasively measure endothelium-independent coronary vasodilation over the entire heart with high feasibility and is a promising noninvasive method to explore whole-heart coronary smooth muscle cell function following exogenous nitrates in clinical practice.
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Affiliation(s)
- Hang Jin
- Department of Radiology, Zhongshan Hospital, Fudan University and Shanghai Medical Imaging Institute, 180#, Feng Lin Road, Shanghai 200032, China.
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219
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Florian A, Jurcut R, Ginghina C, Bogaert J. Cardiac magnetic resonance imaging in ischemic heart disease: a clinical review. J Med Life 2011; 4:330-45. [PMID: 22514564 PMCID: PMC3227138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 10/18/2011] [Indexed: 11/06/2022] Open
Abstract
Cardiac magnetic resonance imaging (MRI) has emerged as a prime player in the clinical and preclinical detection of ischemic heart disease (IHD) as well in the prognosis assessment by offering a comprehensive approach for all spectrums of coronary artery disease (CAD) patients. The aim of this review is to provide the reader a state-of-the art on how the newest cardiac MRI techniques can be used to study IHD patients. In patients with suspected/stable CAD, functional and perfusion imaging both at rest and during vasodilatatory stress (adenosine, dypiridamole)/dobutamine stress can accurately depict ischemic myocardium secondary to significant coronary artery stenosis. In patients with acute MI, MRI is a robust tool for differentiating and sizing the jeopardized and the infarcted myocardium by using a combination of functional, edema, perfusion and Gd contrast imaging. Moreover, important prognostic factors like myocardial salvage, the presence of microvascular obstruction (MVO), post reperfusion myocardial hemorrhage, RV involvement and infarct related complications can be assessed in the same examination. In patients with chronic ischemic cardiomyopathy, the role of the MRI extends from diagnosis by means of Gadolinium contrast scar imaging to therapy and prognosis by functional assessment and viability testing with rest and dobutamine stress imaging. In all the circumstances mentioned, MRI derived information has been proven valuable in every day clinical decision making and prognosis assessment. Thus, MRI is becoming more and more an accepted alternative to other imaging modalities both in the acute and chronic setting.
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Affiliation(s)
- A. Florian
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - R. Jurcut
- Cardiology Department, “CC Iliescu” Institute for Emergency in Cardiovascular Diseases, Bucharest, Romania
,“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C. Ginghina
- Cardiology Department, “CC Iliescu” Institute for Emergency in Cardiovascular Diseases, Bucharest, Romania
,“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - J. Bogaert
- Radiology Department, UZ Leuven, Leuven, Belgium
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 894] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Cardiovascular Magnetic Resonance Imaging for the Biomedical Engineer. Cardiovasc Eng Technol 2011. [DOI: 10.1007/s13239-011-0066-2] [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: 11/26/2022]
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222
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Jahnke C, Kozerke S, Schnackenburg B, Marx N, Paetsch I. Three-dimensional contrast-enhanced and non-contrast-enhanced cardiac magnetic resonance imaging for the assessment of myocardial ischemic reactions: the practice of looking deeply into the myocardium. J Nucl Cardiol 2011; 18:937-51. [PMID: 21567282 DOI: 10.1007/s12350-011-9391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Cosima Jahnke
- Department of Cardiology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
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223
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Ntsinjana HN, Hughes ML, Taylor AM. The role of cardiovascular magnetic resonance in pediatric congenital heart disease. J Cardiovasc Magn Reson 2011; 13:51. [PMID: 21936913 PMCID: PMC3210092 DOI: 10.1186/1532-429x-13-51] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 09/21/2011] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has expanded its role in the diagnosis and management of congenital heart disease (CHD) and acquired heart disease in pediatric patients. Ongoing technological advancements in both data acquisition and data presentation have enabled CMR to be integrated into clinical practice with increasing understanding of the advantages and limitations of the technique by pediatric cardiologists and congenital heart surgeons. Importantly, the combination of exquisite 3D anatomy with physiological data enables CMR to provide a unique perspective for the management of many patients with CHD. Imaging small children with CHD is challenging, and in this article we will review the technical adjustments, imaging protocols and application of CMR in the pediatric population.
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Affiliation(s)
- Hopewell N Ntsinjana
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Marina L Hughes
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular MR, UCL Institute of Cardiovascular Sciences, Great Ormond Street Hospital for Children, London, UK
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224
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Bonnemains L, Mandry D, Marie PY, Micard E, Chen B, Vuissoz PA. Assessment of right ventricle volumes and function by cardiac MRI: quantification of the regional and global interobserver variability. Magn Reson Med 2011; 67:1740-6. [PMID: 22135141 DOI: 10.1002/mrm.23143] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 06/11/2011] [Accepted: 07/18/2011] [Indexed: 01/13/2023]
Abstract
Reproducibility of the manual assessment of right ventricle volumes by short-axis cine-MRI remains low and is often attributed to the difficulty in separating the right atrium from the ventricle. This study was designed to evaluate the regional interobserver variability of the right ventricle volume assessment to identify segmentation zones with the highest interobserver variability. Short-axis views of 90 right ventricles (30 hypertrophic, 30 dilated, and 30 normal) were acquired with 2D steady-state free precession sequences at 1.5 T and were manually segmented by two observers. The two segmentations were compared and the variations were quantified with a variation score based on the Hausdorff distance between the two segmentations and the interobserver 95% limits of concordance of the global volumes. The right ventricles were semiautomatically split into four subregions: apex, mid-ventricle, tricuspid zone, and infundibulum. These four subregions represented 11%, 34%, 36%, and 19% of the volume but, respectively, yielded variation scores of 8%, 16%, 42%, and 34%. The infundibulum yielded the highest interobserver regional variability although its variation score remained comparable to the tricuspid zone due to its lower volume. These results emphasize the importance of standardizing the segmentation of the infundibulum and the tricuspid zone to improve reproducibility.
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225
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Childs H, Ma L, Ma M, Clarke J, Cocker M, Green J, Strohm O, Friedrich MG. Comparison of long and short axis quantification of left ventricular volume parameters by cardiovascular magnetic resonance, with ex-vivo validation. J Cardiovasc Magn Reson 2011; 13:40. [PMID: 21834992 PMCID: PMC3169477 DOI: 10.1186/1532-429x-13-40] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 08/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of the study was to compare the accuracy and evaluation time of quantifying left ventricular (LV), left atrial (LA) volume and LV mass using short axis (SAX) and long axis (LAX) methods when using cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS We studied 12 explanted canine hearts and 46 patients referred for CMR (29 male, age 47 ± 18 years) in a clinical 1.5 T CMR system, using standard cine sequences. In standard short axis stacks of various slice thickness values in dogs and 8 mm slice thickness (gap 2 mm) in patients, we measured LV volumes using reference slices in a perpendicular, long axis orientation using certified software. Volumes and mass were also measured in six radial long axis (LAX) views.LV parameters were also assessed for intra- and inter-observer variability. In 24 patients, we also analyzed reproducibility and evaluation time of two very experienced (> 10 years of CMR reading) readers for SAX and LAX. RESULTS In the explanted dog hearts, there was excellent agreement between ex vivo data and LV mass and volume data as measured by all methods for both, LAX (r² = 0.98) and SAX (r² = 0.88 to 0.98). LA volumes, however, were underestimated by 13% using the LAX views. In patients, there was a good correlation between all three assessed methods (r² ≥ 0.95 for all). In experienced clinical readers, left-ventricular volumes and ejection fraction as measured in LAX views showed a better inter-observer reproducibility and a 27% shorter evaluation time. CONCLUSION When compared to an ex vivo standard, both, short axis and long axis techniques are highly accurate for the quantification of left ventricular volumes and mass. In clinical settings, however, the long axis approach may be more reproducible and more time-efficient. Therefore, the rotational long axis approach is a viable alternative for the clinical assessment of cardiac volumes, function and mass.
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Affiliation(s)
- Helene Childs
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
| | - Lucia Ma
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
| | - Michael Ma
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
| | - James Clarke
- Dept. of Nuclear Medicine and Radiology, Dalhousie University, Halifax, NC, Canada
| | - Myra Cocker
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
| | - Jordin Green
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
- Siemens Healthcare, Henkestr. 12791054 Erlangen, Germany
| | - Oliver Strohm
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
| | - Matthias G Friedrich
- Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, AB, Canada
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226
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Chotenimitkhun R, Hundley WG. Pharmacological stress cardiovascular magnetic resonance. Postgrad Med 2011; 123:162-70. [PMID: 21566427 DOI: 10.3810/pgm.2011.05.2295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Over the past decade, cardiovascular magnetic resonance (CMR) has evolved into a cardiac stress testing modality that can be used to diagnose myocardial ischemia using intravenous dobutamine or vasodilator perfusion agents such as adenosine or dipyridamole. Because CMR produces high-resolution tomographic images of the human heart in multiple imaging planes, it has become a highly attractive noninvasive testing modality for those suspected of having myocardial ischemia. The purpose of this article is to review the clinical, diagnostic, and prognostic utility of stress CMR testing for patients with (or suspected of having) coronary artery disease.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1045, USA
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227
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García-Ortega P, Rodríguez-Leor O. Letter to the editor: Diagnostic procedures and case related information in ICM-induced hypersensitivity. Br J Radiol 2011. [DOI: 10.1259/bjr/49569558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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228
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Hunold P, Bischoff P, Barkhausen J, Vogt FM. Acute chest pain: the role of MR imaging and MR angiography. Eur J Radiol 2011; 81:3680-90. [PMID: 21543179 DOI: 10.1016/j.ejrad.2011.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/07/2011] [Indexed: 10/18/2022]
Abstract
MR imaging (MRI) and MR angiography (MRA) have gained a high level of diagnostic accuracy in cardiovascular disease. MRI in cardiac disease has been established as the non-invasive standard of reference in many pathologies. However, in acute chest pain the situation is somewhat special since many of the patients presenting in the emergency department suffer from potentially life-threatening disease including acute coronary syndrome, pulmonary embolism, and acute aortic syndrome. Those patients need a fast and definitive evaluation under continuous monitoring of vital parameters. Due to those requirements MRI seems to be less suitable compared to X-ray coronary angiography and multislice computed tomography angiography (CTA). However, MRI allows for a comprehensive assessment of all clinically stable patients providing unique information on the cardiovascular system including ischemia, inflammation and function. Furthermore, MRI and MRA are considered the method of choice in patients with contraindications to CTA and for regular follow-up in known aortic disease. This review addresses specific features of MRI and MRA for different cardiovascular conditions presenting with acute chest pain.
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Affiliation(s)
- Peter Hunold
- Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
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229
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Chotenimitkhun R, Hundley WG. Identification of left ventricular myocardial ischemia and cardiac prognosis with cardiovascular magnetic resonance: updates from 2008 to 2010. Curr Cardiol Rep 2010; 13:77-85. [PMID: 21125353 DOI: 10.1007/s11886-010-0154-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Noninvasive imaging modalities are often used to manage patients with cardiovascular disease. Cardiovascular magnetic resonance (CMR) is increasingly used for diagnosing and evaluating myocardial ischemia and viability; moreover, stress CMR study results can be used to determine cardiac prognosis. In this article, we review recently published material regarding the performance of stress testing with CMR including a brief update regarding techniques, stress agents, diagnostic accuracy, prognosis, economic implications, and ongoing trials and future developments.
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Affiliation(s)
- Runyawan Chotenimitkhun
- Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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230
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Affiliation(s)
- Marcelo Souto Nacif
- Universidade Federal Fluminense, Brasil; National Institutes of Health, EUA; Johns Hopkins School of Medicine, EUA
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