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Sohal S, Mathai SV, Lipat K, Kaur A, Visveswaran G, Cohen M, Waxman S, Tiwari N, Vucic E. Multimodality Imaging of Constrictive Pericarditis: Pathophysiology and New Concepts. Curr Cardiol Rep 2022; 24:1439-1453. [PMID: 35917048 PMCID: PMC9344806 DOI: 10.1007/s11886-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review The unique pathophysiological changes of constrictive pericarditis (CP) can now be identified with better imaging modalities, thereby helping in its early diagnosis. Through this review, we outline the pathophysiology of CP and its translation into symptomology and various imaging findings which then are used for both diagnosis and guiding treatment options for CP. Recent Findings Multimodality imaging has provided us with the capability to recognize early stages of the disease and identify patients with a potential for reversibility and can be treated with medical management. Additionally, peri-procedural planning and prediction of post-operative complications has been made possible with the use of advanced imaging techniques. Summary Advanced imaging has the potential to play a greater role in identification of patients with reversible disease process and provide peri-procedural risk stratification, thereby improving outcomes for patients with CP.
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Affiliation(s)
- Sumit Sohal
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
| | - Sheetal Vasundara Mathai
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Kevin Lipat
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Arpanjeet Kaur
- Department of Medicine, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA
| | - Gautam Visveswaran
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Marc Cohen
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Sergio Waxman
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Nidhish Tiwari
- Division of Cardiovascular Diseases, Department of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Bronx, NY, 10461, USA
| | - Esad Vucic
- Division of Cardiovascular Diseases, Department of Medicine, RWJ-BH Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
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Dorfman AL, Geva T, Samyn MM, Greil G, Krishnamurthy R, Messroghli D, Festa P, Secinaro A, Soriano B, Taylor A, Taylor MD, Botnar RM, Lai WW. SCMR expert consensus statement for cardiovascular magnetic resonance of acquired and non-structural pediatric heart disease. J Cardiovasc Magn Reson 2022; 24:44. [PMID: 35864534 PMCID: PMC9302232 DOI: 10.1186/s12968-022-00873-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/24/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is widely used for diagnostic imaging in the pediatric population. In addition to structural congenital heart disease (CHD), for which published guidelines are available, CMR is also performed for non-structural pediatric heart disease, for which guidelines are not available. This article provides guidelines for the performance and reporting of CMR in the pediatric population for non-structural ("non-congenital") heart disease, including cardiomyopathies, myocarditis, Kawasaki disease and systemic vasculitides, cardiac tumors, pericardial disease, pulmonary hypertension, heart transplant, and aortopathies. Given important differences in disease pathophysiology and clinical manifestations as well as unique technical challenges related to body size, heart rate, and sedation needs, these guidelines focus on optimization of the CMR examination in infants and children compared to adults. Disease states are discussed, including the goals of CMR examination, disease-specific protocols, and limitations and pitfalls, as well as newer techniques that remain under development.
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Affiliation(s)
- Adam L. Dorfman
- Department of Pediatrics, Division of Pediatric Cardiology, University of Michigan C.S. Mott Children’s Hospital, 1540 E. Medical Center Drive, Ann Arbor, MI 48109 USA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Margaret M. Samyn
- Department of Pediatrics, Division of Pediatric Cardiology, Medical College of Wisconsin/Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI 53226 USA
| | - Gerald Greil
- Department of Pediatrics, Division of Pediatric Cardiology, University of Texas Southwestern Medical Center, Dallas, TX 75235 USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children’s Hospital, 700 Children’s Dr. E4A, Columbus, OH 43205 USA
| | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-University Medicine Berlin, Berlin, Germany
| | - Pierluigi Festa
- Department of Cardiology, Fondazione Toscana G. Monasterio, Massa, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy
| | - Brian Soriano
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Andrew Taylor
- Department of Cardiovascular Imaging, Great Ormond Street Hospital for Sick Children, University College London, London, UK
| | - Michael D. Taylor
- Department of Pediatrics, Division of Pediatric Cardiology, Cincinnati Children’s Hospital, 3333 Burnet Ave #2129, Cincinnati, OH 45229 USA
| | - René M. Botnar
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Wyman W. Lai
- CHOC Children’s, 1201 W. La Veta Avenue, Orange, CA 92868 USA
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Tuberculosis of the Heart: A Diagnostic Challenge. Tomography 2022; 8:1649-1665. [PMID: 35894002 PMCID: PMC9326682 DOI: 10.3390/tomography8040137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Tuberculosis of the heart is relatively rare and presents a significant diagnostic difficulty for physicians. It is the leading cause of death from infectious illness. It is one of the top 10 leading causes of death worldwide, with a disproportionate impact in low- and middle-income nations. The radiologist plays a pivotal role as CMR is a non-invasive radiological method that can aid in identifying potential overlap and differential diagnosis between tuberculosis, mass lesions, pericarditis, and myocarditis. Regardless of similarities or overlap in observations, the combination of clinical and certain particular radiological features, which are also detected by comparison to earlier and follow-up CMR scans, may aid in the differential diagnosis. CMR offers a significant advantage over echocardiography for detecting, characterizing, and assessing cardiovascular abnormalities. In conjunction with clinical presentation, knowledge of LGE, feature tracking, and parametric imaging in CMR may help in the early detection of tuberculous myopericarditis and serve as a surrogate for endomyocardial biopsy resulting in a quicker diagnosis and therapy. This article aims to explain the current state of cardiac tuberculosis, the diagnostic utility of CMR in tuberculosis (TB) patients, and offer an overview of the various imaging and laboratory procedures used to detect cardiac tuberculosis.
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Comprehensive review of pericardial diseases using different imaging modalities. Int J Cardiovasc Imaging 2020; 36:947-969. [DOI: 10.1007/s10554-020-01784-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022]
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Holst K, Fyrdahl A, Caidahl K, Ugander M, Sigfridsson A. Projection-based respiratory-resolved left ventricular volume measurements in patients using free-breathing double golden-angle 3D radial acquisition. MAGMA (NEW YORK, N.Y.) 2019; 32:331-341. [PMID: 30542953 PMCID: PMC6525134 DOI: 10.1007/s10334-018-0727-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 12/28/2022]
Abstract
Objective To refine a new technique to measure respiratory-resolved left ventricular end-diastolic volume (LVEDV) in mid-inspiration and mid-expiration using a respiratory self-gating technique and demonstrate clinical feasibility in patients. Materials and methods Ten consecutive patients were imaged at 1.5 T during 10 min of free breathing using a 3D golden-angle radial trajectory. Two respiratory self-gating signals were extracted and compared: from the k-space center of all acquired spokes, and from a superior–inferior projection spoke repeated every 64 ms. Data were binned into end-diastole and two respiratory phases of 15% respiratory cycle duration in mid-inspiration and mid-expiration. LVED volume and septal–lateral diameter were measured from manual segmentation of the endocardial border. Results Respiratory-induced variation in LVED size expressed as mid-inspiration relative to mid-expiration was, for volume, 1 ± 8% with k-space-based self-gating and 8 ± 2% with projection-based self-gating (P = 0.04), and for septal–lateral diameter, 2 ± 2% with k-space-based self-gating and 10 ± 1% with projection-based self-gating (P = 0.002). Discussion Measuring respiratory variation in LVED size was possible in clinical patients with projection-based respiratory self-gating, and the measured respiratory variation was consistent with previous studies on healthy volunteers. Projection-based self-gating detected a higher variation in LVED volume and diameter during respiration, compared to k-space-based self-gating.
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Affiliation(s)
- Karen Holst
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Alexander Fyrdahl
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kenneth Caidahl
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
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Chetrit M, Xu B, Verma BR, Klein AL. Multimodality Imaging for the Assessment of Pericardial Diseases. Curr Cardiol Rep 2019; 21:41. [DOI: 10.1007/s11886-019-1115-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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7
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Alajaji W, Xu B, Sripariwuth A, Menon V, Kumar A, Schleicher M, Isma’eel H, Cremer PC, Bolen MA, Klein AL. Noninvasive Multimodality Imaging for the Diagnosis of Constrictive Pericarditis. Circ Cardiovasc Imaging 2018; 11:e007878. [DOI: 10.1161/circimaging.118.007878] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wissam Alajaji
- Department of Cardiovascular Medicine, Summa Health Heart and Vascular Institute, Akron, OH (W.A.)
| | - Bo Xu
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | | | - Vivek Menon
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Arnav Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Mary Schleicher
- Cleveland Clinic Alumni Library (M.S.), Cleveland Clinic, OH
| | | | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
| | - Michael A. Bolen
- Cardiovascular Section, Imaging Institute (A.S., M.A.B.), Cleveland Clinic, OH
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Heart and Vascular Institute (B.X., V.M., A.K., P.C.C., A.L.K.), Cleveland Clinic, OH
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Aldweib N, Farah V, Biederman RWW. Clinical Utility of Cardiac Magnetic Resonance Imaging in Pericardial Diseases. Curr Cardiol Rev 2018; 14:200-212. [PMID: 29921208 PMCID: PMC6131401 DOI: 10.2174/1573403x14666180619104515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/28/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Pericardial diseases are relatively common in clinical practice and encountered in various clinical settings with consequent significant morbidity and mortality. However, the diagnosis as well as management can be complex and challenging, as the clinical presentation is usually non-specific. Therefore, there is an increasing role for Cardiac Magnetic Resonance Imaging (CMR) as an imaging tool to facilitate the diagnosis of pericardial diseases. Conclusion: Herein we describe conventional and unique CMR approaches to provide an increased non-invasive understanding of the pericardium in health and disease including a novel method to diagnose constrictive pericarditis via radio-frequency tissue tagging by defining unique visceral-parietal adherence patterns easily learned by the cardiologist and radiologist.
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Affiliation(s)
- Nael Aldweib
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
| | - Victor Farah
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
| | - Robert W W Biederman
- Division of Cardiology, Center for Cardiac MRI. Allegheny General Hospital, East North Ave, Pittsburgh, PA, United States
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Mahmoud A, Bansal M, Sengupta PP. New Cardiac Imaging Algorithms to Diagnose Constrictive Pericarditis Versus Restrictive Cardiomyopathy. Curr Cardiol Rep 2018; 19:43. [PMID: 28405937 DOI: 10.1007/s11886-017-0851-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is the mainstay in the diagnostic evaluation of constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM), but no single echocardiographic parameter is sufficiently robust to accurately distinguish between the two conditions. The present review summarizes the recent advances in echocardiography that promise to improve its diagnostic performance for this purpose. The role of other imaging modalities such as cardiac computed tomography, magnetic resonance imaging, and invasive hemodynamic assessment in the overall diagnostic approach is also discussed briefly. RECENT FINDINGS A recent study has demonstrated improved diagnostic accuracy of echocardiography with integration of multiple conventional echocardiographic parameters in to a step-wise algorithm. Concurrently, the studies using speckle-tracking echocardiography have revealed distinct and disparate patterns of myocardial mechanical abnormalities in CP and RCM with their ability to distinguish between the two conditions. The incorporation of machine-learning algorithms into echocardiography workflow permits easy integration of the wealth of the diagnostic data available and promises to further enhance the diagnostic accuracy of echocardiography. New imaging algorithms are continuously being evolved to permit accurate distinction between CP and RCM. Further research is needed to validate the accuracy of these newer algorithms and to define their place in the overall diagnostic approach for this purpose.
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Affiliation(s)
- Ahmad Mahmoud
- Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Manish Bansal
- Heart Institute - Division of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Partho P Sengupta
- Heart and Vascular Institute, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
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10
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Holst K, Ugander M, Sigfridsson A. Respiratory variation in left ventricular cardiac function with 3
D
double golden‐angle whole‐heart cine imaging. Magn Reson Med 2017; 79:2693-2701. [DOI: 10.1002/mrm.26942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Karen Holst
- Department of Clinical PhysiologyKarolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Martin Ugander
- Department of Clinical PhysiologyKarolinska Institutet, and Karolinska University HospitalStockholmSweden
| | - Andreas Sigfridsson
- Department of Clinical PhysiologyKarolinska Institutet, and Karolinska University HospitalStockholmSweden
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Paniagua González M, Sánchez Alegre ML. Extensive pericardial calcification secondary to radiotherapy, causing mixed constrictive-restrictive pathology. BJR Case Rep 2017; 3:20170036. [PMID: 30363214 PMCID: PMC6159184 DOI: 10.1259/bjrcr.20170036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/07/2017] [Accepted: 06/14/2017] [Indexed: 12/01/2022] Open
Abstract
This report presents the case of a patient who suffered from a mediastinal neuroblastoma in his childhood (in 1977), having been treated by surgery, chemotherapy and radiotherapy. As a result, he developed multiple calcifications in the atria walls, interatrial septum, right ventricular free wall, mitral and aortic valves and pericardium, triggering a mixed constrictive and restrictive pathology.
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12
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Holst K, Ugander M, Sigfridsson A. Left ventricular volume measurements with free breathing respiratory self-gated 3-dimensional golden angle radial whole-heart cine imaging - Feasibility and reproducibility. Magn Reson Imaging 2017; 43:48-55. [PMID: 28687216 DOI: 10.1016/j.mri.2017.07.002] [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: 12/02/2016] [Revised: 06/28/2017] [Accepted: 07/02/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To develop and evaluate a free breathing respiratory self-gated isotropic resolution technique for left ventricular (LV) volume measurements. METHODS A 3D radial trajectory with double golden-angle ordering was used for free-running data acquisition during free breathing in 9 healthy volunteers. A respiratory self-gating signal was extracted from the center of k-space and used with the electrocardiogram to bin all data into 3 respiratory and 25 cardiac phases. 3D image volumes were reconstructed and the LV endocardial border was segmented. LV volume measurements and reproducibility from 3D free breathing cine were compared to conventional 2D breath-held cine. RESULTS No difference was found between 3D free breathing cine and 2D breath-held cine with regards to LV ejection fraction, stroke volume, end-systolic volume and end-diastolic volume (P<0.05 for all). The test-retest differences did not differ between 3D free breathing cine and 2D breath-held cine (P<0.05 for all). CONCLUSION 3D free breathing cine and conventional 2D breath-held cine showed similar values and test-retest repeatability for LV volumes in healthy volunteers. 3D free breathing cine enabled retrospective sorting and arbitrary angulation of isotropic data, and could correctly measure LV volumes during free breathing acquisition.
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Affiliation(s)
- Karen Holst
- Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Andreas Sigfridsson
- Department of Clinical Physiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
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13
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Imazio M, Pedrotti P, Quattrocchi G, Roghi A, Badano L, Faletti R, Bogaert J, Gaita F. Multimodality imaging of pericardial diseases. J Cardiovasc Med (Hagerstown) 2016; 17:774-82. [DOI: 10.2459/jcm.0000000000000427] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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14
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Ardhanari S, Yarlagadda B, Parikh V, Dellsperger KC, Chockalingam A, Balla S, Kumar S. Systematic review of non-invasive cardiovascular imaging in the diagnosis of constrictive pericarditis. Indian Heart J 2016; 69:57-67. [PMID: 28228308 PMCID: PMC5318986 DOI: 10.1016/j.ihj.2016.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 05/26/2016] [Accepted: 06/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Diagnosis of constrictive pericarditis (CP) can be challenging. It can be nearly impossible to distinguish CP from other causes of right heart failure. Although various imaging modalities help in the diagnosis, no test is definitive. Several reviews have addressed the role of various imaging techniques in the diagnosis of CP but a systematic review has not yet been published. Objective Our intention was to study the ability of various non-invasive imaging modalities to diagnose CP in patients with surgically confirmed disease and to apply our findings to develop a clinically useful diagnostic algorithm. Methods A PubMed (NLM) search was performed with MeSH term “constrictive pericarditis”. Original articles that investigated the ability of various cardiovascular imaging modalities to noninvasively diagnose surgically confirmed CP were included in our review. Investigations that included any cases without surgical confirmation were excluded. Results The PubMed search yielded 3001 results with MeSH term “constrictive pericarditis” (January 8, 2016). We identified (40) studies on CP that matched our inclusion criteria. We summarized our results sorted by individual non-invasive CV imaging modalities – echocardiography, cardiac computed tomography (CT), and magnetic resonance imaging (MRI). Under each imaging modality, we grouped our discussion based on different parameters useful in CP diagnosis. Conclusions In conclusion, contemporary diagnosis of CP is based on clinical features and echocardiography. Cardiac MRI is recommended in patients where echocardiography is not diagnostic. Both cardiac MRI and CT can guide surgical planning but we prefer MRI as it provides both structural and functional information.
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Affiliation(s)
- Sivakumar Ardhanari
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Bharath Yarlagadda
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Vishal Parikh
- Department of Cardiology, University of South Florida, Tampa, FL, United States
| | - Kevin C Dellsperger
- Department of Medicine, Augusta University Health, Augusta, GA, United States
| | - Anand Chockalingam
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States
| | - Senthil Kumar
- Department of Medicine, Division of Cardiology, University of Missouri School of Medicine, Columbia, MO, United States.
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15
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Jogia D, Liang M, Lin Z, Celemajer DS. A Potential Echocardiographic Classification for Constrictive Pericarditis Based on Analysis of Abnormal Septal Motion. J Cardiovasc Ultrasound 2015; 23:143-9. [PMID: 26448822 PMCID: PMC4595701 DOI: 10.4250/jcu.2015.23.3.143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 06/28/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Constrictive pericarditis is an uncommon condition that could be easily confused with congestive heart failure. In symptomatic patients, septal "wobble" on echocardiography may be an important sign of constrictive physiology. This study was planned to investigate the effects of constriction on septal motion as identified by echocardiography. METHODS In this retrospective observational study, nine consecutive patients with constriction underwent careful echocardiographic analysis of the interventricular septum (IVS) with slow motion 2-dimensional echocardiography and inspiratory manoeuvres. Six patients who had undergone cardiac magnetic resonance imaging underwent similar analysis. Findings were correlated with haemodynamic data in five patients who had undergone cardiac catheterisation studies. RESULTS In mild cases of constriction a single wobble of the IVS was seen during normal respiration. In more moderate cases a double motion of the septum (termed "double wobble") was seen where the septum bowed initially into the left ventricle (LV) cavity in diastole then relaxed to the middle only to deviate again into the LV cavity late in diastole after atrial contraction. In severe cases, the septum bowed into the LV cavity for the full duration of diastole (pan-diastolic motion). We describe how inspiration also helped to characterize the severity of constriction especially in mild to moderate cases. CONCLUSION Echocardiography appears a simple tool to help diagnose constriction and grade its severity. Larger studies are needed to confirm whether the type of wobble motions helps to grade the severity of constrictive pericarditis.
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Affiliation(s)
- Dilesh Jogia
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Michael Liang
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand. ; Department of Cardiology, Khoo Teck Puat Hospital, Singapore
| | - Zaw Lin
- Department of Cardiothoracic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - David S Celemajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Hanneman K, Thavendiranathan P, Nguyen ET, Moshonov H, Wald R, Connelly KA, Paul NS, Wintersperger BJ, Crean AM. Use of Cardiac Magnetic Resonance Imaging Based Measurements of Inferior Vena Cava Cross-Sectional Area in the Diagnosis of Pericardial Constriction. Can Assoc Radiol J 2015; 66:231-7. [DOI: 10.1016/j.carj.2014.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 01/10/2023] Open
Abstract
Purpose To evaluate the value of cardiac magnetic resonance imaging (MRI)–based measurements of inferior vena cava (IVC) cross-sectional area in the diagnosis of pericardial constriction. Methods Patients who had undergone cardiac MRI for evaluation of clinically suspected pericardial constriction were identified retrospectively. The diagnosis of pericardial constriction was established by clinical history, echocardiography, cardiac catheterization, intraoperative findings, and/or histopathology. Cross-sectional areas of the suprahepatic IVC and descending aorta were measured on a single axial steady-state free-precession (SSFP) image at the level of the esophageal hiatus in end-systole. Logistic regression and receiver-operating curve (ROC) analyses were performed. Results Thirty-six patients were included; 50% (n = 18) had pericardial constriction. Mean age was 53.9 ± 15.3 years, and 72% (n = 26) were male. IVC area, ratio of IVC to aortic area, pericardial thickness, and presence of respirophasic septal shift were all significantly different between patients with constriction and those without ( P < .001 for all). IVC to aortic area ratio had the highest odds ratio for the prediction of constriction (1070, 95% confidence interval [8.0-143051], P = .005). ROC analysis illustrated that IVC to aortic area ratio discriminated between those with and without constriction with an area under the curve of 0.96 (95% confidence interval [0.91-1.00]). Conclusions In patients referred for cardiac MRI assessment of suspected pericardial constriction, measurement of suprahepatic IVC cross-sectional area may be useful in confirming the diagnosis of constriction when used in combination with other imaging findings, including pericardial thickness and respirophasic septal shift.
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Affiliation(s)
- Kate Hanneman
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Elsie T. Nguyen
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hadas Moshonov
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Rachel Wald
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Kim A. Connelly
- Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Narinder S. Paul
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Bernd J. Wintersperger
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew M. Crean
- Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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17
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Role of tissue characterization by Cardiac Magnetic Resonance in the diagnosis of constrictive pericarditis. Int J Cardiovasc Imaging 2015; 31:1021-31. [PMID: 25827067 DOI: 10.1007/s10554-015-0648-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 03/17/2015] [Indexed: 12/22/2022]
Abstract
Cardiac Magnetic Resonance (CMR) allows evaluation of the functional and flow changes in pericardial constriction as well as detection of acute pericardial inflammation, fusion and thickening of pericardial layers and pericardial effusion. We sought to evaluate the diagnostic role of tissue characterization by CMR in constrictive pericarditis (CP). We performed a CMR exam in 70 patients (mean age 58 ± 16) with clinical suspicion of constrictive pericarditis and constrictive pattern at echocardiography and/or catheterization. A multiparametric CMR approach was used to evaluate the initial diagnostic suspicion. A clinical follow-up was performed in all patients for a median of 551 days. The diagnosis of CP was confirmed in 53 patients while 12 patients presented signs of predominant pericardial active inflammation suggesting a diagnosis of transient constrictive pericarditis and five presented effusive-constrictive pericarditis. Patients with a final diagnosis of CP had worse prognosis than those with transient constrictive or effusive constrictive pericarditis. The presence of myocardial late gadolinium enhancement was associated to adverse events. Results of the current study confirmed the value of CMR in the differential diagnosis of pericardial disease. A multiparametric CMR approach allowed to distinguish between active inflammation, chronic pericarditis with constriction and effusion without inflammation.
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18
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Bolen MA, Rajiah P, Kusunose K, Collier P, Klein A, Popović ZB, Flamm SD. Cardiac MR imaging in constrictive pericarditis: multiparametric assessment in patients with surgically proven constriction. Int J Cardiovasc Imaging 2015; 31:859-66. [DOI: 10.1007/s10554-015-0616-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/06/2015] [Indexed: 12/31/2022]
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19
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Tummala LS, Young RK, Singh T, Jani S, Srichai MB. Role of Non-invasive Imaging in the Work-Up of Cardiomyopathies. Curr Atheroscler Rep 2015; 17:486. [DOI: 10.1007/s11883-014-0486-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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McRee CW, Mergo P, Parikh P, Pollak A, Shapiro BP. Modern advances in cardiovascular imaging: cardiac computed tomography and cardiovascular MRI in pericardial disease. Future Cardiol 2014; 10:769-79. [DOI: 10.2217/fca.14.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
ABSTRACT The pericardium is characterized by a two-layer sac that surrounds the heart and provides an enclosed, lubricated space. Diseases of the pericardium may occur due to active inflammation, scar, calcification or effusion. While clinical, ECG and hemodynamic evaluation have been the established methods for the diagnosis of pericardial disease, advances in cardiac computed tomography and cardiovascular MRI provide complementary tools for diagnostic, prognostic and therapeutic assessment.
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Affiliation(s)
- Chad W McRee
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Patricia Mergo
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Pragnesh Parikh
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Amy Pollak
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Brian P Shapiro
- Department of Cardiology, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Cosyns B, Plein S, Nihoyanopoulos P, Smiseth O, Achenbach S, Andrade MJ, Pepi M, Ristic A, Imazio M, Paelinck B, Lancellotti P. European Association of Cardiovascular Imaging (EACVI) position paper: Multimodality imaging in pericardial disease. Eur Heart J Cardiovasc Imaging 2014; 16:12-31. [PMID: 25248336 DOI: 10.1093/ehjci/jeu128] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Although pericardial diseases are common in the daily clinical practice and can result in a significant morbidity and mortality, imaging of patients with suspected or known pericardial disorders remain challenging. Multimodality imaging is part of the management of pericardial diseases. Echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance are often used as complementary imaging modalities. The choice of one or multiple imaging modalities is driven by the clinical context or conditions of the patient. The scope of the present document is to highlight the respective role of each technique according to the clinical context in the diagnosis and management of pericardial diseases.
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Affiliation(s)
- Bernard Cosyns
- Department of Cardiology, Universtair Ziekenhuis Brussel, Centrum Voor Hart-en Vaatziekten and CHIREC, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Sven Plein
- The Division of Cardiovascular and Diabetes Research, Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - Petros Nihoyanopoulos
- Department of Cardiology, Imperial College, NHLI Hammersmith Hospital London, London, UK
| | - Otto Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Stephan Achenbach
- Department of Cardiology, University Hospital Erlangen, Medizinische Klinik 2, Erlangen, Germany
| | - Maria Joao Andrade
- Department of Cardiology, Hospital Santa Cruz, Instituto Cardiovascular de Lisboa, Lisboa, Portugal
| | - Mauro Pepi
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Arsen Ristic
- Department of Cardiology, Clinical Center of Serbia, Belgrad, Serbia
| | - Massimo Imazio
- Department of Cardiology, Maria Vittoria Hospital, Turin, Italy
| | - Bernard Paelinck
- Cardiac Imaging, Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liege Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liege, Belgium
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22
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Amaki M, Savino J, Ain DL, Sanz J, Pedrizzetti G, Kulkarni H, Narula J, Sengupta PP. Diagnostic concordance of echocardiography and cardiac magnetic resonance-based tissue tracking for differentiating constrictive pericarditis from restrictive cardiomyopathy. Circ Cardiovasc Imaging 2014; 7:819-27. [PMID: 25107553 DOI: 10.1161/circimaging.114.002103] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Variations in longitudinal deformation of the left ventricle have been suggested to be useful for differentiating chronic constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). We assessed left ventricular mechanics derived from cardiac magnetic resonance (CMR) cine-based and 2-dimensional echocardiography-based tissue tracking to determine intermodality consistency of diagnostic information for differentiating CP from RCM. METHODS AND RESULTS We retrospectively identified 92 patients who underwent both CMR and 2-dimensional echocardiography and who had a final diagnosis of CP (n=28), RCM (n=30), or no structural heart disease (n=34). Global longitudinal strain from long-axis views and circumferential strain from short-axis views were measured on 2-dimensional echocardiographic and CMR cine images using the same offline software. Logistic regression models with receiver operating characteristics curves, continuous net reclassification improvement, and the integrated discrimination improvement (IDI) were used for assessing the incremental predictive performance. Global longitudinal strain was higher in patients with CP than in those with RCM (P<0.001), and both techniques were found to have similar diagnostic value (area under the curve, 0.84 versus 0.88 for CMR and echocardiography, respectively). For echocardiography, the addition of global longitudinal strain to respiratory septal shift and early diastolic mitral annular velocity resulted in improved continuous net reclassification improvement (P<0.001 for both) and integrated discrimination improvement (P=0.005 and 0.024) for both models. Similarly, for CMR, the addition of global longitudinal strain to septal shift and pericardial thickness resulted in improved continuous net reclassification improvement (P<0.001 for both) and integrated discrimination improvement (P=0.003 and <0.001). CONCLUSIONS CMR and echocardiography tissue tracking-derived left ventricular mechanics provide comparable diagnostic information for differentiating CP from RCM.
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Affiliation(s)
- Makoto Amaki
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - John Savino
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - David L Ain
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - Javier Sanz
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - Gianni Pedrizzetti
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - Hemant Kulkarni
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - Jagat Narula
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.)
| | - Partho P Sengupta
- From the Zena and Michael A. Wiener Cardiovascular Institute (M.A., D.L.A., J.S., G.P., J.N., P.P.S.) and Department of Medicine (J.S.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Civil Engineering and Architecture, University of Trieste, Italy (G.P.); and Department of Medicine, University of Texas Health Science Center, San Antonio (H.K.).
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23
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2014; 14:721-40. [PMID: 23847385 DOI: 10.1093/ehjci/jet123] [Citation(s) in RCA: 210] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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24
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Cardiovascular CT in the diagnosis of pericardial constriction: Predictive value of inferior vena cava cross-sectional area. J Cardiovasc Comput Tomogr 2014; 8:149-57. [DOI: 10.1016/j.jcct.2013.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 12/16/2013] [Indexed: 11/21/2022]
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25
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Goenka AH, Flamm SD. Cardiac magnetic resonance imaging for the investigation of cardiovascular disorders. Part 1: current applications. Tex Heart Inst J 2014; 41:7-20. [PMID: 24512394 PMCID: PMC3967467 DOI: 10.14503/thij-13-3920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cardiac magnetic resonance imaging is a robust noninvasive technique for investigating cardiovascular disorders. The evolution of cardiac magnetic resonance and its widening span of diagnostic and prognostic applications have generated excitement as well as uncertainty regarding its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatility and usefulness of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of cardiovascular disorders.
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Affiliation(s)
- Ajit H Goenka
- Cardiovascular Imaging Laboratory, Imaging Institute; and Cardiovascular Medicine, Heart and Vascular Institute; Cleveland Clinic, Cleveland, Ohio 44195
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26
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Klein AL, Abbara S, Agler DA, Appleton CP, Asher CR, Hoit B, Hung J, Garcia MJ, Kronzon I, Oh JK, Rodriguez ER, Schaff HV, Schoenhagen P, Tan CD, White RD. American Society of Echocardiography clinical recommendations for multimodality cardiovascular imaging of patients with pericardial disease: endorsed by the Society for Cardiovascular Magnetic Resonance and Society of Cardiovascular Computed Tomography. J Am Soc Echocardiogr 2013; 26:965-1012.e15. [PMID: 23998693 DOI: 10.1016/j.echo.2013.06.023] [Citation(s) in RCA: 403] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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27
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Lancellotti P, Nkomo VT, Badano LP, Bergler-Klein J, Bergler J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26:1013-32. [PMID: 23998694 DOI: 10.1016/j.echo.2013.07.005] [Citation(s) in RCA: 161] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardiac toxicity is one of the most concerning side effects of anti-cancer therapy. The gain in life expectancy obtained with anti-cancer therapy can be compromised by increased morbidity and mortality associated with its cardiac complications. While radiosensitivity of the heart was initially recognized only in the early 1970s, the heart is regarded in the current era as one of the most critical dose-limiting organs in radiotherapy. Several clinical studies have identified adverse clinical consequences of radiation-induced heart disease (RIHD) on the outcome of long-term cancer survivors. A comprehensive review of potential cardiac complications related to radiotherapy is warranted. An evidence-based review of several imaging approaches used to detect, evaluate, and monitor RIHD is discussed. Recommendations for the early identification and monitoring of cardiovascular complications of radiotherapy by cardiac imaging are also proposed.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, Heart Valve Clinic, University of Liège Hospital, CHU du Sart-Tilman, Liège 4000, Belgium.
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28
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Walker CM, Saldaña DA, Gladish GW, Dicks DL, Kicska G, Mitsumori LM, Reddy GP. Cardiac Complications of Oncologic Therapy. Radiographics 2013; 33:1801-15. [DOI: 10.1148/rg.336125005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
UNLABELLED The pericardium represents an important focus of morbidity and mortality in patients with cardiovascular disease. Fortunately, in recent years knowledge regarding this enigmatic part of the heart and the diagnosis of related diseases has substantially advanced. To a large extent, this can be attributed to the availability of several noninvasive cardiac imaging modalities. Transthoracic echocardiography, which combines structural and physiologic assessment, is the first-line technique for examination of patients suspected of having or known to have pericardial disease; however, cardiac computed tomography (CT) and magnetic resonance (MR) imaging are becoming increasingly popular for the study of this part of the heart. Modern multidetector CT scanners merge acquisition speed and high spatial and contrast resolution, with volumetric scanning to provide excellent anatomic detail of the pericardium. Multidetector CT is by far the modality of choice for depiction of pericardial calcifications. MR imaging is probably the best imaging modality for the acquisition of a comprehensive view of the pericardial abnormalities. MR imaging combines cardiac and pericardial anatomic assessment with tissue characterization and appraisal of the effects of pericardial abnormalities on cardiac performance. This review aims to elucidate the role of the pericardium and its interaction with the remainder of the heart in normal and pathologic conditions. It focuses on the rapidly evolving insights regarding pericardial disease provided by modern imaging modalities, not infrequently necessitating reconsideration of evidence that has thus far been taken for granted. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13121059/-/DC1.
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Affiliation(s)
- Jan Bogaert
- Department of Radiology, Medical Imaging Research Center, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium.
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30
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Mirelis JG, Garcia-Alvarez A, Fernandez-Friera L, Sawit S, Hinojar R, Fuster V, García MJ, Sanz J. Respiratory ventricular area changes measured with real-time cardiac magnetic resonance: A new, accurate, and reproducible approach for the diagnosis of pericardial constriction. Int J Cardiol 2013; 166:267-71. [DOI: 10.1016/j.ijcard.2012.09.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 09/16/2012] [Indexed: 11/17/2022]
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31
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Di Cesare E, Cademartiri F, Carbone I, Carriero A, Centonze M, De Cobelli F, De Rosa R, Di Renzi P, Esposito A, Faletti R, Fattori R, Francone M, Giovagnoni A, La Grutta L, Ligabue G, Lovato L, Marano R, Midiri M, Romagnoli A, Russo V, Sardanelli F, Natale L, Bogaert J, De Roos A. [Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging]. Radiol Med 2012. [PMID: 23184241 DOI: 10.1007/s11547-012-0899-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cardiac magnetic resonance (CMR) is considered an useful method in the evaluation of many cardiac disorders. Based on our experience and available literature, we wrote a document as a guiding tool in the clinical use of CMR. Synthetically we describe different cardiac disorders and express for each one a classification, I to IV, depending on the significance of diagnostic information expected.
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Affiliation(s)
- E Di Cesare
- Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, Università di L'Aquila, L'Aquila, Italy.
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Peebles CR, Shambrook JS, Harden SP. Pericardial disease--anatomy and function. Br J Radiol 2012; 84 Spec No 3:S324-37. [PMID: 22723538 DOI: 10.1259/bjr/16168253] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Imaging of patients with suspected or known pericardial disease remains challenging. Echocardiography is the first-line investigation for pericardial disease but it has specific limitations in terms of its abilities to visualise the pericardium fully and to identify extracardiac pathology. Cardiac cross-sectional imaging by both MRI and CT has developed significantly and now has an important role in the investigation of pericardial disease. This article examines the appearances of both healthy and diseased pericardium using CT and MRI. The typical imaging findings across a wide range of conditions are illustrated and the roles of CT and MRI are reviewed. The relative merits and weaknesses of each modality are explored and the specific functional techniques that are available are introduced.
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Affiliation(s)
- C R Peebles
- Department of Cardiothoracic Radiology, Southampton General Hospital, Southampton University Hospitals NHS Trust, Tremona Road, Southampton, UK.
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33
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Anavekar NS, Wong BF, Foley TA, Bishu K, Kolipaka A, Koo CW, Khandaker MH, Oh JK, Young PM. Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis. Int J Cardiovasc Imaging 2012; 29:363-9. [DOI: 10.1007/s10554-012-0101-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 07/12/2012] [Indexed: 11/28/2022]
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Thavendiranathan P, Verhaert D, Walls MC, Bender JA, Rajagopalan S, Chung YC, Simonetti OP, Raman SV. Simultaneous right and left heart real-time, free-breathing CMR flow quantification identifies constrictive physiology. JACC Cardiovasc Imaging 2012; 5:15-24. [PMID: 22239888 DOI: 10.1016/j.jcmg.2011.07.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/07/2011] [Accepted: 07/13/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the ability of a novel cardiac magnetic resonance (CMR) real-time phase contrast (RT-PC) flow measurement technique to reveal the discordant respirophasic changes in mitral and tricuspid valve in flow indicative of the abnormal hemodynamics seen in constrictive pericarditis (CP). BACKGROUND Definitive diagnosis of CP requires identification of constrictive hemodynamics with or without pericardial thickening. CMR to date has primarily provided morphological assessment of the pericardium. METHODS Sixteen patients (age 57 ± 13 years) undergoing CMR to assess known or suspected CP and 10 controls underwent RT-PC that acquired simultaneous mitral valve and tricuspid valve inflow velocities over 10 s of unrestricted breathing. The diagnosis of CP was confirmed via clinical history, diagnostic imaging, cardiac catheterization, intraoperative findings, and histopathology. RESULTS Ten patients had CP, all with increased pericardial thickness (6.2 ± 1.0 mm). RT-PC imaging demonstrated discordant respirophasic changes in atrioventricular valve inflow velocities in all CP patients, with mean ± SD mitral valve and tricuspid valve inflow velocity variation of 46 ± 20% and 60 ± 15%, respectively, compared with 16 ± 8% and 24 ± 11% in patients without CP (p < 0.004 vs. patients with CP for both) and 17 ± 5% and 31 ± 13% in controls (p < 0.001 vs. patients with CP for both). There was no difference in atrioventricular valve inflow velocity variation between patients without CP compared with controls (p > 0.3 for both). Respiratory variation exceeding 25% across the mitral valve yielded a sensitivity of 100%, a specificity of 100%, and an area under the receiver-operating characteristic curve of 1.0 to detect CP physiology. Using a cutoff of 45%, variation of transtricuspid valve velocity had a sensitivity of 90%, a specificity of 88%, and an area under the receiver-operating characteristic curve of 0.98. CONCLUSIONS Accentuated and discordant respirophasic changes in mitral valve and tricuspid valve inflow velocities characteristic of CP can be identified noninvasively with RT-PC CMR. When incorporated into existing CMR protocols for imaging pericardial morphology, RT-PC CMR provides important hemodynamic evidence with which to make a definite diagnosis of CP.
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Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Gupta A, Singh Gulati G, Seth S, Sharma S. Cardiac MRI in restrictive cardiomyopathy. Clin Radiol 2012; 67:95-105. [DOI: 10.1016/j.crad.2011.05.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 05/17/2011] [Accepted: 05/22/2011] [Indexed: 12/19/2022]
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Oh JK, Chang SA, Choe YH, Young PM. CMR Imaging for Diastolic Hemodynamic Assessment. JACC Cardiovasc Imaging 2012; 5:25-7. [DOI: 10.1016/j.jcmg.2011.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 10/14/2022]
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Abstract
Over the last 10 years, the development of newer pulse sequences and applications in new clinical areas has enabled cardiovascular magnetic resonance to emerge as a powerful tool for the physicians to both diagnose and guide treatments of various cardiac pathologies. The greatest strengths of cardiovascular magnetic resonance include the assessment of ischemia and viability, evaluation of nonischemic cardiomyopathies, including myocarditis, pericardial disease, congenital heart disease, and tissue characterization of cardiac masses.
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MR imaging findings in 76 consecutive surgically proven cases of pericardial disease with CT and pathologic correlation. Int J Cardiovasc Imaging 2011; 28:1099-109. [PMID: 21735292 DOI: 10.1007/s10554-011-9916-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 06/17/2011] [Indexed: 10/18/2022]
Abstract
To describe findings of patients with surgically confirmed pericardial disease on state of the art MR sequences. Retrospective review was performed for patients who underwent pericardiectomy and preoperative MR over a 5 year period ending in 2009. Patients' records were reviewed to confirm the diagnosis of chronic recurrent pericarditis, constrictive pericarditis, or pericardial tumor. MR imaging findings of pericardial thickness, IVC diameter, presence or absence of pericardial or pleural effusion, pericardial edema, pericardial enhancement, and septal "bounce" were recorded. Patients with constriction had a larger IVC diameter (3.1 ± 0.4 cm) than patients with recurrent pain and no constriction (2.0 ± 0.4 cm). Mean pericardial thickness for the 16 patients with chronic recurrent pericarditis but no evidence of constriction was 4.8 ± 2.9 mm. Mean pericardial thickness for patients with constriction was 9.2 ± 7.0 cm with calcification, and 4.6 ± 2.1 cm without calcification. 94% of patients with chronic recurrent pericarditis had gadolinium enhancement of the pericardium, while 76% of patients with constriction had pericardial enhancement. Septal "bounce" was present in 19% of chronic recurrent pericarditis cases and 86% of constriction cases. 5 patients had a pericardial neoplasm, 1 of which was not identified preoperatively. State of the art MR techniques can identify significant and distinct findings in patients with chronic recurrent pericarditis, constrictive pericarditis, and pericardial tumors.
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Cardiovascular MRI for Assessment of Infectious and Inflammatory Conditions of the Heart. AJR Am J Roentgenol 2011; 197:103-12. [PMID: 21701017 DOI: 10.2214/ajr.10.5666] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Muzzarelli S, Ordovas K, Higgins CB. Cardiovascular MRI for the assessment of heart failure: focus on clinical management and prognosis. J Magn Reson Imaging 2011; 33:275-86. [PMID: 21274968 DOI: 10.1002/jmri.22433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Cardiovascular MR (CMR) has an emerging role in the noninvasive diagnostic assessment of heart failure (HF). Different imaging sequences allow for a detailed assessment of cardiac morphology, function, myocardial perfusion, tissue characterization, and blood flow measurement. This article reviews the key applications of CMR in HF, with special focus on how CMR may influence the diagnostic and therapeutic approach of HF patients.
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Affiliation(s)
- Stefano Muzzarelli
- Department of Radiology, University of California, San Francisco, California 94143-0628, USA.
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Méndez C, Soler R, Rodriguez E, López M, Alvarez L, Fernández N, Montserrat L. Magnetic resonance imaging of abnormal ventricular septal motion in heart diseases: a pictorial review. Insights Imaging 2011; 2:483-492. [PMID: 22347969 PMCID: PMC3259355 DOI: 10.1007/s13244-011-0093-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2010] [Revised: 01/04/2011] [Accepted: 04/04/2011] [Indexed: 11/24/2022] Open
Abstract
The purpose of this article is to illustrate the usefulness of MR imaging in the clinical evaluation of congenital and acquired cardiac diseases characterised by ventricular septal wall motion abnormality. Recognition of the features of abnormal ventricular septal motion in MR images is important to evaluate the haemodynamic status in patients with congenital and acquired heart diseases in routine clinical practice.
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Cheng H, Zhao S, Jiang S, Lu M, Yan C, Ling J, Zhang Y, Liu Q, Ma N, Yin G, Jerecic R, He Z. The relative atrial volume ratio and late gadolinium enhancement provide additive information to differentiate constrictive pericarditis from restrictive cardiomyopathy. J Cardiovasc Magn Reson 2011; 13:15. [PMID: 21349202 PMCID: PMC3058035 DOI: 10.1186/1532-429x-13-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 02/25/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The differentiation of constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) is often difficult. This study sought to determine the clinical utility of cardiovascular magnetic resonance imaging (CMR) for differentiating both these disorders. METHODS Twenty-three patients with surgically documented CP, 22 patients with RCM and 25 normal subjects were included in the study. CMR yielded information about cardiac morphology, function and tissue characteristics. The left (LA) and right atrial (RA) volume was calculated using the area-length method. The relative atrial volume ratio (RAR) was defined as the LA volume divided by RA volume. Receiver operating characteristic curve analysis was used to test the ability of different variables in differentiating CP from RCM. RESULTS The maximal pericardial thickness in CP patients was significantly larger than in normal subjects and RCM patients. The RA volume index in RCM patients (90.5 ± 35.3 mL/m2) was significantly larger than in CP patients (71.4 ± 15.7 mL/m2, p = 0.006) and normal subjects (38.1 ± 9.0 mL/m2, p < 0.001). The LA volume index in RCM (96.0 ± 37.0 mL/m2) and CP patients (105.6 ± 25.1 mL/m2) was significantly larger than in normal subjects (39.5 ± 9.5 mL/m2, p < 0.001 for all). The RAR in CP patients (1.50 ± 0.29) was significantly larger than in RCM patients (1.12 ± 0.33, p < 0.001) and normal subjects (1.06 ± 0.20, p < 0.001). There were no differences between RCM patients and normal subjects in the RAR (p = 0.452). At a cut-off value of 1.32 for the RAR, the sensitivity was 82.6%, and the specificity was 86.4% in the detection of CP. Septal bounce was identified in 95.7% CP patients, in none of RCM patients and normal subjects. Late gadolinium enhancement (LGE) was present in 31.8% RCM patients and absence in all CP patients and normal subjects. CONCLUSIONS CMR with LGE and RAR can facilitate differentiation of CP from RCM.
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Affiliation(s)
- Huaibing Cheng
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shihua Zhao
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Shiliang Jiang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Minjie Lu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Chaowu Yan
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Jian Ling
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Yan Zhang
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Qiong Liu
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Ning Ma
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Gang Yin
- Department of Radiology, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
| | - Renate Jerecic
- MR Research and Development, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Zuoxiang He
- Department of Nuclear medicine, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, PR China
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Mastouri R, Sawada SG, Mahenthiran J. Noninvasive imaging techniques of constrictive pericarditis. Expert Rev Cardiovasc Ther 2010; 8:1335-47. [PMID: 20828356 DOI: 10.1586/erc.10.77] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Constrictive pericarditis (CP) is the result of scarring and loss of elasticity of the pericardial sac, resulting in external impedance of cardiac filling. It can occur after virtually any pericardial disease process. Patients typically present with signs and symptoms of right heart failure and/or low cardiac output. An important pathophysiological hallmark of CP is exaggerated ventricular interdependence and impaired diastolic filling. Echocardiography is the initial imaging modality for diagnosis of CP. Unfortunately, no echocardiographic sign or combination of signs is pathognomonic for CP. CT scan and cardiac MRI are other imaging techniques that can provide incremental diagnostic information. CT scan can easily detect pericardial thickening and calcification, while cardiac MRI provides a comprehensive evaluation of the pericardium, myocardium and cardiac physiology. Occasionally, a multimodality approach needs to be considered for the conclusive diagnosis of CP.
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Affiliation(s)
- Ronald Mastouri
- Department of Medicine of Indiana University Medical Center and the Krannert Institute of Cardiology, Indianapolis, IN, USA
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Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging 2010; 3:650-60. [PMID: 20541720 DOI: 10.1016/j.jcmg.2010.04.009] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 04/26/2010] [Accepted: 04/29/2010] [Indexed: 11/20/2022]
Abstract
Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium. Recent advances in multimodality noninvasive cardiac imaging have solidified its role in the management of patients with suspected pericardial disease. The physiologic and structural information obtained from transthoracic echocardiography and the anatomic detail provided by cardiac computed tomography and magnetic resonance have led to growing interest in the complementary use of these techniques. Optimal management of the patient with suspected pericardial disease requires familiarity with the key imaging modalities and the ability to choose the appropriate imaging tests for each patient. This report reviews the imaging modalities most useful in the assessment of patients with pericardial disease, with an emphasis on the complementary value of multimodality cardiac imaging.
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Croisille P. [Restrictive cardiomyopathy versus constrictive pericarditis in patients with diastolic dysfunction: MR imaging features]. JOURNAL DE RADIOLOGIE 2010; 91:630-638. [PMID: 20657369 DOI: 10.1016/s0221-0363(10)70079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Restrictive cardiomyopathies are characterized by diastolic dysfunction while systolic function is usually preserved. MRI is helpful by its ability to characterize tissues, especially the demonstration of interstitial or nodular fibrosis based on the underlying etiology. In the presence of constrictive pericarditis from pericardial inflammation, fibrosis or calcifications, diastolic expansion is impaired resulting in poor diastolic ventricular filling, resulting in a characteristic type of diastolic impairment, adiastole. MRI can demonstrate the underlying anatomical lesion: pericardial thickening, though the presence of a pericardium or normal thickness does not entirely exclude the possibility of constriction. As such, the presence of additional imaging features such as abnormal right ventricular shape, vena cava dilatation, and paradoxical movement of the intraventricular septum, during operator-guided deep respiration.
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Affiliation(s)
- P Croisille
- Hôpital Cardiologique L. Pradel, Service de Radiologie, 28 avenue Doyen Lepine, Lyon 69677, France.
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Föll D, Geibel-Zehender A, Bode C. Pericarditis constrictiva: Ätiologie, Diagnostik und Therapie. Herz 2010; 35:80-5. [DOI: 10.1007/s00059-010-3322-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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49
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New observations from MR velocity-encoded flow measurements concerning diastolic function in constrictive pericarditis. Eur Radiol 2010; 20:1831-40. [DOI: 10.1007/s00330-010-1741-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 12/14/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
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Abstract
MRI has acquired over the years a role in the evaluation of cardiovascular pathology especially with regards to its ability to assess right and left ventricular function and delayed postcontrast "viability" sequences. Current class I clinical indications include: viability for patients with ischemic cardiomyopathy and acute coronary syndrome, etiology and prognostic evaluation of non-ischemic cardiomyopathies including myocarditis and arrhytmogenic right ventricular cardiomyopathy, chronic pericarditis and cardiac masses, non-urgent aortic aneurysm and dissection, congenital cardiopathies: vascular malformations and follow-up after curative or palliative surgery. MRI provides a complete non operator dependent evaluation, and is particularly useful for follow-up since it may be repeated due to its absence of ionizing radiation
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