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Barison A, Ricci F, Pavon AG, Muscogiuri G, Bisaccia G, Camastra G, De Lazzari M, Lanzillo C, Raguso M, Monti L, Vargiu S, Pedrotti P, Piacenti M, Todiere G, Pontone G, Indolfi C, Dellegrottaglie S, Lombardi M, Schwitter J, Aquaro GD. Cardiovascular Magnetic Resonance in Patients with Cardiac Electronic Devices: Evidence from a Multicenter Study. J Clin Med 2023; 12:6673. [PMID: 37892813 PMCID: PMC10607654 DOI: 10.3390/jcm12206673] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Most recent cardiac implantable electronic devices (CIEDs) can safely undergo a cardiovascular magnetic resonance (CMR) scan under certain conditions, but metal artifacts may degrade image quality. The aim of this study was to assess the overall diagnostic yield of CMR and the extent of metal artifacts in a multicenter, multivendor study on CIED patients referred for CMR. METHODS We analyzed 309 CMR scans from 292 patients (age 57 ± 16 years, 219 male) with an MR-conditional pacemaker (n = 122), defibrillator (n = 149), or loop recorder (n = 38); CMR scans were performed in 10 centers from 2012 to 2020; MR-unsafe implants were excluded. Clinical and device parameters were recorded before and after the CMR scan. A visual analysis of metal artifacts was performed for each sequence on a segmental basis, based on a 5-point artifact score. RESULTS The vast majority of CMR scans (n = 255, 83%) were completely performed, while only 32 (10%) were interrupted soon after the first sequences and 22 (7%) were only partly acquired; CMR quality was non-diagnostic in 34 (11%) scans, poor (<1/3 sequences were diagnostic) in 25 (8%), or acceptable (1/3 to 2/3 sequences were diagnostic) in 40 (13%), while most scans (n = 201, 68%) were of overall good quality. No adverse event or device malfunctioning occurred, and only nonsignificant changes in device parameters were recorded. The most affected sequences were SSFP (median score 0.32 [interquartile range 0.07-0.91]), followed by GRE (0.18 [0.02-0.59]) and LGE (0.14 [0.02-0.55]). ICDs induced more artifacts (median score in SSFP images 0.87 [0.50-1.46]) than PMs (0.11 [0.03-0.28]) or ILRs (0.11 [0.00-0.56]). Moreover, most artifacts were located in the anterior, anteroseptal, anterolateral, and apical segments of the LV and in the outflow tract of the RV. CONCLUSIONS CMR is a versatile imaging technique, with a high safety profile and overall good image quality even in patients with MR-conditional CIEDs. Several strategies are now available to optimize image quality, substantially enhancing overall diagnostic yield.
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Affiliation(s)
- Andrea Barison
- Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
- Life Science Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Anna Giulia Pavon
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
| | - Giuseppe Muscogiuri
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | | | - Manuel De Lazzari
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
| | | | - Mario Raguso
- Ospedale Policlinico Casilino, 00169 Roma, Italy
| | - Lorenzo Monti
- IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Sara Vargiu
- Cardiologia 3, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Patrizia Pedrotti
- Cardiac Magnetic Resonance Laboratory, Cardiologia 4, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | | | | | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Ciro Indolfi
- Division of Cardiology, Magna Graecia University, 88100 Catanzaro, Italy
- Center for Cardiovascular Research, Magna Graecia University, 88100 Catanzaro, Italy
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Santo Dellegrottaglie
- Advanced Cardiovascular Imaging Unit, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Juerg Schwitter
- Division of Cardiology, Cardiovascular Department, University Hospital Lausanne—CHUV, 1011 Lausanne, Switzerland
- CMR Center, University Hospital Lausanne—CHUV, 1011 Lausanne, Switzerland
- Faculty of Biology & Medicine, University of Lausanne—UniL, 1015 Lausanne, Switzerland
| | - Giovanni Donato Aquaro
- Academic Radiology Unit, Department of Surgical Medical and Molecular Pathology and Critical Area, University of Pisa, 56126 Pisa, Italy
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Xiang J, Lamy J, Lampert R, Peters DC. Balanced Steady-State Free Precession Cine MR Imaging in the Presence of Cardiac Devices: Value of Interleaved Radial Linear Combination Acquisition With Partial Dephasing. J Magn Reson Imaging 2023; 58:782-791. [PMID: 36373998 DOI: 10.1002/jmri.28528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Balanced steady-state free precession (bSSFP) is important in cardiac MRI but suffers from off-resonance artifacts. The interpretation-limiting artifacts in patients with cardiac implants remain an unsolved issue. PURPOSE To develop an interleaved radial linear combination bSSFP (lcSSFP) method with partial dephasing (PD) for improved cardiac cine imaging when implanted cardiovascular devices are present. STUDY TYPE Prospective. PHANTOM AND SUBJECTS Flow phantom adjacent to a pacemaker and 10 healthy volunteers (mean age ± standard deviation: 31.9 ± 2.9 years, 4 females) with a cardioverter-defibrillator (ICD) positioned extracorporeally at the left chest in the prepectoral region. FIELD STRENGTH/SEQUENCE A 3-T, 1) Cartesian bSSFP, 2) Cartesian gradient echo (GRE), 3) Cartesian lcSSFP, and 4) radial lcSSFP cine sequences. ASSESSMENT Flow artifacts mitigation using PD was validated with phantom experiments. Undersampled radial lcSSFP with interleaving across phase-cyclings and cardiac phases (RLC-SSFP), combined with PD, was then employed for achieving improved quality of cine images from left ventricular short-axis view. The image quality in the presence of cardiac devices was qualitatively assessed by three independent raters (1 = worst, 5 = best), regarding five criteria (banding artifacts, streak artifacts, flow artifacts, cavity visibility, and overall image quality). STATISTICAL TESTS Wilcoxon rank-sum test for the five criteria between Cartesian bSSFP cine and RLC-SSFP with PD. Fleiss kappa test for inter-reader agreement. A P value < 0.05 was considered statistically significant. RESULTS Based on simulations and phantom experiments, 60 projections per phase cycling and 1/6 PD were chosen. The in vivo experiments demonstrated significantly reduced banding artifacts (4.8 ± 0.4 vs. 2.7 ± 0.7), fewer streak artifacts (3.7 ± 0.6 vs. 2.6 ± 0.7) and flow artifacts (4.4 ± 0.4 vs. 3.7 ± 0.6), therefore improved cavity visibility (4.1 ± 0.4 vs. 2.9 ± 0.9) and overall quality (4.0 ± 0.4 vs. 2.7 ± 0.7). DATA CONCLUSION RLC-SSFP method with PD may improve cine image quality in subjects with cardiac devices. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Jie Xiang
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
| | - Jerome Lamy
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
| | - Rachel Lampert
- Department of Medicine, Cardiovascular Division, Yale University, New Haven, Connecticut, USA
| | - Dana C Peters
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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3
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Bergamaschi L, Pavon AG, Angeli F, Tuttolomondo D, Belmonte M, Armillotta M, Sansonetti A, Foà A, Paolisso P, Baggiano A, Mushtaq S, De Zan G, Carriero S, Cramer MJ, Teske AJ, Broekhuizen L, van der Bilt I, Muscogiuri G, Sironi S, Leo LA, Gaibazzi N, Lovato L, Pontone G, Pizzi C, Guglielmo M. The Role of Non-Invasive Multimodality Imaging in Chronic Coronary Syndrome: Anatomical and Functional Pathways. Diagnostics (Basel) 2023; 13:2083. [PMID: 37370978 DOI: 10.3390/diagnostics13122083] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Coronary artery disease (CAD) is one of the major causes of mortality and morbidity worldwide, with a high socioeconomic impact. Currently, various guidelines and recommendations have been published about chronic coronary syndromes (CCS). According to the recent European Society of Cardiology guidelines on chronic coronary syndrome, a multimodal imaging approach is strongly recommended in the evaluation of patients with suspected CAD. Today, in the current practice, non-invasive imaging methods can assess coronary anatomy through coronary computed tomography angiography (CCTA) and/or inducible myocardial ischemia through functional stress testing (stress echocardiography, cardiac magnetic resonance imaging, single photon emission computed tomography-SPECT, or positron emission tomography-PET). However, recent trials (ISCHEMIA and REVIVED) have cast doubt on the previous conception of the management of patients with CCS, and nowadays it is essential to understand the limitations and strengths of each imaging method and, specifically, when to choose a functional approach focused on the ischemia versus a coronary anatomy-based one. Finally, the concept of a pathophysiology-driven treatment of these patients emerged as an important goal of multimodal imaging, integrating 'anatomical' and 'functional' information. The present review aims to provide an overview of non-invasive imaging modalities for the comprehensive management of CCS patients.
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Affiliation(s)
- Luca Bergamaschi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Anna Giulia Pavon
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Domenico Tuttolomondo
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Alberto Foà
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University Federico II, 80138 Naples, Italy
| | - Andrea Baggiano
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Saima Mushtaq
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Giulia De Zan
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Serena Carriero
- Postgraduate School of Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy
| | - Maarten-Jan Cramer
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Lysette Broekhuizen
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Ivo van der Bilt
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
| | - Giuseppe Muscogiuri
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, IRCCS Istituto Auxologico Italiano, San Luca Hospital, 20149 Milan, Italy
| | - Sandro Sironi
- School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Radiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
| | - Laura Anna Leo
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete, 48, 6900 Lugano, Switzerland
| | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Viale Antonio Gramsci 14, 43126 Parma, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gianluca Pontone
- Perioperative and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy
| | - Marco Guglielmo
- Department of Cardiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Cardiology, Haga Teaching Hospital, 2545 GM The Hague, The Netherlands
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Scatteia A, Dellegrottaglie S. Cardiac magnetic resonance in ischemic cardiomyopathy: present role and future directions. Eur Heart J Suppl 2023; 25:C58-C62. [PMID: 37125306 PMCID: PMC10132558 DOI: 10.1093/eurheartjsupp/suad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Ischemic cardiomyopathy is a significant cause of mortality and morbidity, with peculiar needs for accurate diagnostic and prognostic characterization. Cardiac magnetic resonance (CMR) can help to satisfy these requirements by allowing a comprehensive evaluation of myocardial function, perfusion and tissue composition, with a demonstrated utility in guiding clinical management of patients with known or suspected ischemic cardiomyopathy. When compared with alternative non-invasive imaging modalities, such as stress echocardiography and nuclear techniques, CMR is able to provide accurate (function and perfusion) or peculiar (tissue characterization) information on cardiac pathophysiology, while avoiding exposition to ionizing radiations and overcoming limitations related to the quality of the imaging window. In particular, stress perfusion CMR showed to be accurate, safe, cost-effective, and clinically valuable as a non-invasive test for detecting severity and distribution of myocardial ischemia. In many circumstances, however, local availability of the technique, together with procedural costs, and scanning and post-processing time duration still limit the use of CMR in clinical routine. In the current review, we focused on clinical applications of CMR in ischemic cardiomyopathy. The consolidated role of the technique is described by illustrating both standard and advanced sequences that constitute the current body of a dedicated CMR examination. Ongoing developments and potential future diagnostic and prognostic applications of CMR when assessing ischemic cardiomyopathy are also discussed, with a focus on artificial intelligence-based implementations proposed for refining the efficiency of CMR analysis and reporting.
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Affiliation(s)
- Alessandra Scatteia
- Advanced Cardiovascular Imaging Unit, Ospedale Accreditato Villa dei Fiori, Corso Italia 157, 80011 Acerra, Naples, Italy
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5
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Pezel T, Lacotte J, Horvilleur J, Toupin S, Hovasse T, Unterseeh T, Sanguineti F, Said MA, Salerno F, Fiorina L, Manenti V, Zouaghi A, Faradji A, Nicol M, Ah-Sing T, Dillinger JG, Henry P, Garot P, Bousson V, Garot J. Safety, feasibility, and prognostic value of stress perfusion CMR in patients with MR-conditional pacemaker. Eur Heart J Cardiovasc Imaging 2023; 24:202-211. [PMID: 36214336 DOI: 10.1093/ehjci/jeac202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
AIMS To assess the safety, feasibility, and prognostic value of stress cardiovascular magnetic resonance (CMR) in patients with pacemaker (PM). METHODS AND RESULTS Between 2008 and 2021, we conducted a bi-centre longitudinal study with all consecutive patients with MR-conditional PM referred for vasodilator stress CMR at 1.5 T in the Institut Cardiovasculaire Paris Sud and Lariboisiere University Hospital. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction. Cox regression analyses were performed to determine the prognostic value of CMR parameters. The quality of CMR was rated by two observers blinded to clinical details. Of 304 patients who completed the CMR protocol, 273 patients (70% male, mean age 71 ± 9 years) completed the follow-up (median [interquartile range], 7.1 [5.4-7.5] years). Among those, 32 experienced a MACE (11.7%). Stress CMR was well tolerated with no significant change in lead thresholds or pacing parameters. Overall, the image quality was rated good or excellent in 84.9% of segments. Ischaemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 11.71 [95% CI: 4.60-28.2]; and HR: 5.62 [95% CI: 2.02-16.21], both P < 0.001). After adjustment for traditional risk factors, ischaemia and LGE were independent predictors of MACE (HR: 5.08 [95% CI: 2.58-14.0]; and HR: 2.28 [95% CI: 2.05-3.76]; both P < 0.001). CONCLUSION Stress CMR is safe, feasible and has a good discriminative prognostic value in consecutive patients with PM.
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Affiliation(s)
- Théo Pezel
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Lacotte
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Jérôme Horvilleur
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Solenn Toupin
- Siemens Healthcare France, 93200 Saint-Denis, France
| | - Thomas Hovasse
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Thierry Unterseeh
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Francesca Sanguineti
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Mina Ait Said
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Fiorella Salerno
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Laurent Fiorina
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Vladimir Manenti
- Institut Cardiovasculaire Paris Sud, Department of Invasive Cardiology and Electrophysiology, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Amir Zouaghi
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris, Service de Cardiologie, Department of Cardiology and Electrophysiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Alyssa Faradji
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Martin Nicol
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France.,Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Tania Ah-Sing
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Patrick Henry
- Université de Paris Cité, Department of Cardiology, Hôpital Lariboisière - APHP, Inserm UMRS 942, 75010 Paris, France
| | - Philippe Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
| | - Valérie Bousson
- Université de Paris Cité, Department of Medical Imaging, Hôpital Lariboisière - APHP, 75010 Paris, France
| | - Jérôme Garot
- Institut Cardiovasculaire Paris Sud, Department of Cardiovascular Magnetic Resonance, Hôpital Privé Jacques CARTIER, Ramsay Santé, 91300 Massy, France
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Miller L, Airapetov S, Pillai A, Kalahasty G, Ellenbogen KA, Gregory Hundley W, Trankle CR. Hemodynamic response and safety of vasodilator stress cardiovascular magnetic resonance in patients with permanent pacemakers or implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol 2022; 33:2127-2135. [PMID: 35842792 PMCID: PMC9561044 DOI: 10.1111/jce.15630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/20/2022] [Accepted: 06/13/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. METHODS AND RESULTS Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. CONCLUSION This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.
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Affiliation(s)
- Lauren Miller
- School of MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Sergei Airapetov
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ajay Pillai
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Gautham Kalahasty
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Kenneth A. Ellenbogen
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - W. Gregory Hundley
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Cory R. Trankle
- Division of Cardiology, VCU Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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7
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Chyou JY, Axel L. Considerations for Stress Perfusion Cardiac Magnetic Resonance Imaging in Patients with Cardiac Implantable Electronic Devices. J Cardiovasc Electrophysiol 2022; 33:2136-2138. [PMID: 35842797 DOI: 10.1111/jce.15629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/29/2022]
Abstract
With increasing collective experience with cardiac magnetic resonance (CMR) imaging in patients with cardiac implantable electronic devices (CIEDs), guided by published safety data and professional society scientific documents,1 there has been growing interest in extending the application of CMR imaging in patients with CIEDs This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Janice Y Chyou
- Icahn School of Medicine at Mount Sinai, Cardiovascular Institute, New York, NY, USA
| | - Leon Axel
- NYU Grossman School of Medicine, Department of Radiology, New York, NY, USA
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Stress Perfusion Cardiac Magnetic Resonance in Long-Standing Non-Infarcted Chronic Coronary Syndrome with Preserved Systolic Function. Diagnostics (Basel) 2022; 12:diagnostics12040786. [PMID: 35453834 PMCID: PMC9031407 DOI: 10.3390/diagnostics12040786] [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: 01/31/2022] [Revised: 03/22/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The impact of imaging-derived ischemia is still under debate and the role of stress perfusion cardiac magnetic resonance (spCMR) in non-high-risk patient still needs to be clarified. The aim of this study was to evaluate the impact of spCMR in a case series of stable long-standing chronic coronary syndrome (CCS) patients with ischemia and no other risk factor. (2) Methods: This is a historical prospective study including 35 patients with history of long-standing CCS who underwent coronary CT angiography (CCTA) and additional adenosine spCMR. Clinical and imaging findings were included in the analysis. Primary outcomes were HF (heart failure) and all major cardiac events (MACE) including death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, or resuscitated cardiac arrest. (3) Results: Mean follow-up was 3.7 years (IQR: from 1 to 6). Mean ejection fraction was 61 ± 8%. Twelve patients (31%) referred primary outcomes. Probability of experiencing primary outcomes based on symptoms was 62% and increased to 67% and 91% when multivessel disease and ischemia, respectively, were considered. Higher ischemic burden was predictive of disease progression (OR: 1.59, 95%CI: 1.18–2.14; p-value = 0.002). spCMR model resulted non inferior to the model comprising all variables (4) Conclusions: In vivo spCMR-modeling including perfusion and strain anomalies could represent a powerful tool in long-standing CCS, even when conventional imaging predictors are missing.
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