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Schenk CD, Gebker R, Berger A, Pieske B, Stehning C, Kelle S. Review of safety reports of cardiac MR-imaging in patients with recently implanted coronary artery stents at various field strengths. Expert Rev Med Devices 2020; 18:83-90. [PMID: 33295208 DOI: 10.1080/17434440.2021.1860017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Aim of this study was to review current literature and data regarding the effects of MRI-examination post stent implantation on re-occlusion rates.Methods: We focused on representative studies in the database MEDLINE. Inclusion criteria were: clinical studies with the main focus on the safety of coronary artery stents after MRI-examination in the time interval of 8 weeks post stent implantation. During a follow up period the incidence of cardiac events was recorded. In addition, the time interval between stent implantation and MRI-examination should be defined.Results: Our search resulted in a total of relevant 17 studies. There were in-vivo as well as in-vitro studies and in addition three further publications f.e. guidelines. Concerning the patients, we differentiated between MRI performed shortly after acute cardiac event and in stable CAD. MRI-examinations were performed at different field strengths and reported different stent types. Considered were the incidences of cardiac events.Conclusion: Independent of MRI field strength (1.5 Tesla or 3.0 Tesla) or used stent type (BMS or DES), there was no increased rate for cardiac events in patients, who underwent MRI < 8 weeks after stent placement. MRI < 8 weeks after stent placement seems to be safe.
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Affiliation(s)
- Christian David Schenk
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Rolf Gebker
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Alexander Berger
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | | | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
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Affiliation(s)
- Spencer T Sincleair
- Department of Radiology, Scott and White Hospital, Texas A and M University Health Science Center, Temple, USA
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Cardiac magnetic resonance imaging safety following percutaneous coronary intervention. Int J Cardiovasc Imaging 2013; 29:1485-90. [DOI: 10.1007/s10554-013-0231-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/20/2013] [Indexed: 10/26/2022]
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Santoro D, Winter L, Müller A, Vogt J, Renz W, Özerdem C, Grässl A, Tkachenko V, Schulz-Menger J, Niendorf T. Detailing radio frequency heating induced by coronary stents: a 7.0 Tesla magnetic resonance study. PLoS One 2012. [PMID: 23185498 PMCID: PMC3503867 DOI: 10.1371/journal.pone.0049963] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF) simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR) limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study.
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Affiliation(s)
- Davide Santoro
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Lukas Winter
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Alexander Müller
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Department of Physics, Humboldt University, Berlin, Germany
| | - Julia Vogt
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Department of Physics, Humboldt University, Berlin, Germany
| | - Wolfgang Renz
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Siemens Healthcare, Erlangen, Germany
| | - Celal Özerdem
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Andreas Grässl
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Valeriy Tkachenko
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Jeanette Schulz-Menger
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück Center for Molecular Medicine, Berlin, Germany
- * E-mail:
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Qayyum AA, Vejlstrup NG, Ahtarovski KA, Kofoed KF, Kastrup J. Coronary artery stent mimicking intracardiac thrombus on cardiac magnetic resonance imaging due to signal loss: case report. Magn Reson Imaging 2012; 30:889-92. [PMID: 22495236 DOI: 10.1016/j.mri.2012.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/15/2012] [Indexed: 11/20/2022]
Abstract
Since the introduction of percutaneous coronary intervention for coronary artery disease, thousands of patients have been treated with the implantation of coronary stents. Moreover, several of the patients with coronary stent undergo cardiac magnetic resonance (CMR) imaging every year. This case report is of a 77-year-old man who was previously treated with the implantation of a coronary stent in the left circumflex artery. He underwent CMR imaging, which revealed a process 14×21 mm in the left atrium. Cardiac contrast computed tomography did not demonstrate any cardiac pathology. While the signal loss on MRI associated with implanted metallic devices is known, we report a case where an implanted coronary stent in the left circumflex artery led to an intracardiac signal loss mimicking intracardiac thrombus/tumor.
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Affiliation(s)
- Abbas Ali Qayyum
- Department of Cardiology and Cardiac Catheterization Laboratory 2014, The Heart Centre, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences, Copenhagen University, Blegdamsvej 9, Copenhagen, Denmark.
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Makaryus AN, Wolff SD. Cardiac Magnetic Resonance Imaging. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Coronary heart disease remains the leading cause of morbidity and mortality in older adults, despite improved survival and declining mortality. Prevalence in and impact of heart disease on elderly people, increasing risk factors, and the underlying physiologic changes of aging are briefly reviewed. High prevalence of clinical and subclinical heart disease provides a basis for considering opportunities for prevention and follow-up. This article focuses on recently developed noninvasive techniques, such as cardiac multislice CT and cardiac MR imaging.
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Levine GN, Gomes AS, Arai AE, Bluemke DA, Flamm SD, Kanal E, Manning WJ, Martin ET, Smith JM, Wilke N, Shellock FS. Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance. Circulation 2007; 116:2878-91. [PMID: 18025533 DOI: 10.1161/circulationaha.107.187256] [Citation(s) in RCA: 311] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Advances in magnetic resonance (MR) imaging over the past 2 decades have led to MR becoming an increasingly attractive imaging modality. With the growing number of patients treated with permanent implanted or temporary cardiovascular devices, it is becoming ever more important to clarify safety issues in regard to the performance of MR examinations in patients with these devices. Extensive, although not complete, ex vivo, animal, and clinical data are available from which to generate recommendations regarding the safe performance of MR examination in patients with cardiovascular devices, as well as to ascertain caveats and contraindications regarding MR examination for such patients. Safe MR imaging involves a careful initial patient screening, accurate determination of the permanent implanted or temporary cardiovascular device and its properties, a thoughtful analysis of the risks and benefits of performing the examination at that time, and, when indicated, appropriate physician management and supervision. This scientific statement is intended to summarize and clarify issues regarding the safety of MR imaging in patients with cardiovascular devices.
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12
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Nijveldt R, Hirsch A, Hofman MBM, Beek AM, Spijkerboer AM, Piek JJ, van Rossum AC. 3.0 T cardiovascular magnetic resonance in patients treated with coronary stenting for myocardial infarction: evaluation of short term safety and image quality. Int J Cardiovasc Imaging 2007; 24:283-91. [PMID: 17805987 PMCID: PMC2233708 DOI: 10.1007/s10554-007-9264-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 08/17/2007] [Indexed: 01/09/2023]
Abstract
Purpose To evaluate safety and image quality of cardiovascular magnetic resonance (CMR) at 3.0 T in patients with coronary stents after myocardial infarction (MI), in comparison to the clinical standard at 1.5 T. Methods Twenty-five patients (21 men; 55 ± 9 years) with first MI treated with primary stenting, underwent 18 scans at 3.0 T and 18 scans at 1.5 T. Twenty-four scans were performed 4 ± 2 days and 12 scans 125 ± 23 days after MI. Cine (steady-state free precession) and late gadolinium-enhanced (LGE, segmented inversion-recovery gradient echo) images were acquired. Patient safety and image artifacts were evaluated, and in 16 patients stent position was assessed during repeat catheterization. Additionally, image quality was scored from 1 (poor quality) to 4 (excellent quality). Results There were no clinical events within 30 days of CMR at 3.0 T or 1.5 T, and no stent migration occurred. At 3.0 T, image quality of cine studies was clinically useful in all, but not sufficient for quantitative analysis in 44% of the scans, due to stent (6/18 scans), flow (7/18 scans) and/or dark band artifacts (8/18 scans). Image quality of LGE images at 3.0 T was not sufficient for quantitative analysis in 53%, and not clinically useful in 12%. At 1.5 T, all cine and LGE images were quantitatively analyzable. Conclusion 3.0 T is safe in the acute and chronic phase after MI treated with primary stenting. Although cine imaging at 3.0 T is suitable for clinical use, quantitative analysis and LGE imaging is less reliable than at 1.5 T. Further optimization of pulse sequences at 3.0 T is essential.
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Affiliation(s)
- Robin Nijveldt
- Department of Cardiology, VU University Medical Center, Room 5F003 De Boelelaan 1117, Amsterdam 1081 HV, The Netherlands.
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13
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Leary MC, Caplan LR. Technology insight: brain MRI and cardiac surgery--detection of postoperative brain ischemia. ACTA ACUST UNITED AC 2007; 4:379-88. [PMID: 17589428 DOI: 10.1038/ncpcardio0915] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2006] [Accepted: 04/05/2007] [Indexed: 11/08/2022]
Abstract
Annually, an estimated 1 million patients undergo heart surgery worldwide. Unfortunately, stroke continues to be a frequent complication of cardiac surgery, with the specific cerebrovascular risk depending upon the particular surgical procedure performed. Neuroimaging has an integral role in the initial evaluation and management of patients who present with acute stroke symptoms following cardiac surgery. The aim of this paper is to review the role brain MRI has in detecting postoperative brain ischemia in these patients. Multimodal MRI--using diffusion-weighted MRI (DWI), perfusion-weighted MRI, and gradient-recalled echo imaging--has an excellent capacity to identify and delineate the size and location of acute ischemic strokes as well as intracerebral hemorrhages. This differentiation is critical in making appropriate treatment decisions in the acute setting, such as determining patient eligibility for thrombolytic or hemodynamic therapies. At present, DWI offers prognostic value in patients with strokes following cardiac surgery. Additionally, DWI could be a valuable tool for evaluating stroke preventive measures as well as therapeutic interventions in patients undergoing CABG surgery.
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Affiliation(s)
- Megan C Leary
- Harvard Clinical Research Institute, Boston, MA, USA
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14
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Tejedor-Viñuela P, San Román-Calvar JA, Durán-Hernández JM, Gómez-Salvador I, Sierra-Román J, Fernández-Avilés F. Seguridad de la realización precoz de un estudio de resonancia magnética cardiaca en pacientes con infarto agudo de miocardio y revascularización con stent. Rev Esp Cardiol 2006. [DOI: 10.1157/13096602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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O'Regan DP, Schmitz SA. Establishing a clinical cardiac MRI service. Clin Radiol 2006; 61:211-24. [PMID: 16488203 DOI: 10.1016/j.crad.2005.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2005] [Revised: 10/27/2005] [Accepted: 10/29/2005] [Indexed: 10/25/2022]
Abstract
After several years of research development cardiovascular MRI has evolved into a widely accepted clinical tool. It offers important diagnostic and prognostic information for a variety of clinical indications, which include ischaemic heart disease, cardiomyopathies, valvular dysfunction and congenital heart disorders. It is a safe non-invasive technique that employs a variety of imaging sequences optimized for temporal or spatial resolution, tissue-specific contrast, flow quantification or angiography. Cardiac MRI offers specific advantages over conventional imaging techniques for a significant number of patients. The demand for cardiac MRI studies from cardiothoracic surgeons, cardiologists and other referrers is likely to continue to rise with pressure for more widespread local service provision. Setting up a cardiac MRI service requires careful consideration regarding funding issues and how it will be integrated with existing service provision. The purchase of cardiac phased array coils, monitoring equipment and software upgrades must also be considered, as well as the training needs of those involved. The choice of appropriate imaging protocols will be guided by operator experience, clinical indication and equipment capability, and is likely to evolve as the service develops. Post-processing and offline analysis form a significant part of the time taken to report studies and an efficient method of providing quantitative reports is an important requirement. Collaboration between radiologists and cardiologists is needed to develop a successful service and multi-disciplinary meetings are key component of this. This review will explore these issues from our perspective of a new clinical cardiac MRI service operating over its first year in a teaching hospital imaging department.
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Affiliation(s)
- D P O'Regan
- Imaging Sciences Department, MRC Clinical Sciences Centre, Hammersmith Hospital Campus, Imperial College, London, UK.
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Syed MA, Carlson K, Murphy M, Ingkanisorn WP, Rhoads KL, Arai AE. Long-term safety of cardiac magnetic resonance imaging performed in the first few days after bare-metal stent implantation. J Magn Reson Imaging 2006; 24:1056-61. [PMID: 17036357 DOI: 10.1002/jmri.20740] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To investigate the long-term safety of cardiac magnetic resonance imaging (CMR) performed one to seven days after coronary artery stent (bare metal) implantation. MATERIALS AND METHODS We analyzed 119 consecutive patients with acute myocardial infarction (MI) who underwent emergency coronary stent implantation with a bare-metal stent. CMR using a 1.5T scanner was performed on 51 patients (42.9%) at a mean of 2.7+/-3.1 days after stent implantation (CMR+ group), and the remaining 68 patients (57.1%) served as controls (CMR- group). The patients were followed up to six months for major adverse cardiac events. RESULTS The average stent size was 3.3+/-0.5x18.4+/-6.7 mm, and 86% of the stents were made of 316L stainless steel. There were no significant differences between the CMR+ and CMR- groups in terms of infarct features, angiographic findings, or stent characteristics. Over a mean follow-up of 4.4+/-2.1 months, 12 patients (10.1%) had 16 events (13.4%). Two patients had adverse events after early MRI scan (4.3%), a rate that is lower than the event rate in the patients who did not undergo MRI (16%, P=0.04), and one of the two events was clearly not MRI related. CONCLUSION CMR on a 1.5T scanner can be safely performed within one to seven days after coronary bare-metal stent implantation and is not associated with an increased risk of adverse clinical cardiac outcomes. In the light of accumulating data, the guidelines by stent manufacturers should be revised.
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Affiliation(s)
- Mushabbar A Syed
- Laboratory of Cardiac Energetics, National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland 20892, USA
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Prasad SK, Kotwinski P, Assomul R. The role of cardiovascular magnetic resonance in the evaluation of patients with heart failure. Expert Rev Cardiovasc Ther 2004; 2:53-9. [PMID: 15038413 DOI: 10.1586/14779072.2.1.53] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic heart failure is a common disorder placing significant burdens on patients and health-care services. Noninvasive imaging plays a central role in accurate diagnosis, determination of etiology and prognosis, and in monitoring therapy. Advances in technology mean cardiovascular magnetic resonance (CMR) imaging has established itself as both a valuable clinical and research tool in this arena. Not only is CMR the new gold standard for accurate and reproducible assessment of ventricular volumes and mass, but by using gadolinium contrast, underlying pathology can often be determined. In ischemic cardiomyopathy a 'one stop' assessment can be made of function, perfusion and mass. Continuing advances such as myocardial tagging and the increasing availability of CMR mean that it will become an increasingly important and useful tool for clinicians looking after patients with cardiomyopathy and heart failure.
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Affiliation(s)
- S K Prasad
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, UK.
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Gerber TC, Fasseas P, Lennon RJ, Valeti VU, Wood CP, Breen JF, Berger PB. Clinical safety of magnetic resonanceimaging early after coronary artery stent placement. J Am Coll Cardiol 2003; 42:1295-8. [PMID: 14522498 DOI: 10.1016/s0735-1097(03)00993-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Our aim was to examine the rate of adverse cardiac events in patients undergoing magnetic resonance imaging (MRI) <8 weeks after coronary stent placement. BACKGROUND The risk of coronary stent thrombosis from dislodgement due to MRI early after stent placement is not well defined. Manufacturers recommend postponing MRI studies until eight weeks after coronary stent placement. METHODS We analyzed the Mayo Clinic Rochester Percutaneous Coronary Intervention Database and examined records of 111 patients who underwent MRI <8 weeks after coronary stent placement treated with aspirin and a thienopyridine. Occurrence of death, myocardial infarction (MI), and repeat revascularization within 30 days of MRI were recorded. RESULTS Magnetic resonance imaging (1.5 tesla) was performed within a median of 18 days (range, 0 to 54 days) after coronary stent placement. Four noncardiac deaths occurred, and three patients had repeat revascularization procedures. Stent thrombosis did not occur (95% confidence interval, 0% to 3.3%). CONCLUSIONS Magnetic resonance imaging <8 weeks after coronary stent placement appears to be safe, and the risk of cardiac death or MI due to stent thrombosis is low. Postponing MRI does not appear to be necessary.
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Affiliation(s)
- Thomas C Gerber
- Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Ricciardi MJ, Wu E, Davidson CJ, Choi KM, Klocke FJ, Bonow RO, Judd RM, Kim RJ. Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation 2001; 103:2780-3. [PMID: 11401931 DOI: 10.1161/hc2301.092121] [Citation(s) in RCA: 336] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Mild elevations in creatine kinase-MB (CK-MB) are common after successful percutaneous coronary interventions and are associated with future adverse cardiac events. The mechanism for CK-MB release remains unclear. A new contrast-enhanced MRI technique allows direct visualization of myonecrosis. METHODS AND RESULTS Fourteen patients without prior infarction underwent cine and contrast-enhanced MRI after successful coronary stenting; 9 patients had procedure-related CK-MB elevation, and 5 did not (negative controls). The mean age of all patients was 61 years, 36% had diabetes, 43% had multivessel coronary artery disease, and all had a normal ejection fraction. Twelve patients (86%) received an intravenous glycoprotein IIb/IIIa inhibitor; none underwent atherectomy, and all had final TIMI 3 flow. Of the 9 patients with CK-MB elevation, 5 had a minor side branch occlusion during stenting, 2 had transient ECG changes, and none developed Q-waves. The median CK-MB was 21 ng/mL (range, 12 to 93 ng/mL), which is 2.3x the upper limit of normal. Contrast-enhanced MRI demonstrated discrete regions of hyperenhancement within the target vessel perfusion territory in all 9 patients. Only one developed a new wall motion abnormality. The median estimated mass of myonecrosis was 2.0 g (range, 0.7 to 12.2 g), or 1.5% of left ventricular mass (range, 0.4% to 6.0%). Hyperenhancement persisted in 5 of the 6 who underwent a repeat MRI at 3 to 12 months. No control patient had hyperenhancement. CONCLUSIONS Contrast-enhanced MRI provides an anatomical correlate to biochemical evidence of procedure-related myocardial injury, despite the lack of ECG changes or wall motion abnormalities. Mild elevation of CK-MB after percutaneous coronary intervention is the result of discrete microinfarction.
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Affiliation(s)
- M J Ricciardi
- Feinberg Cardiovascular Institute and the Department of Medicine, Northwestern University, Chicago, IL, USA
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Rajappan K, Bellenger NG, Anderson L, Pennell DJ. The role of cardiovascular magnetic resonance in heart failure. Eur J Heart Fail 2000; 2:241-52. [PMID: 10938483 DOI: 10.1016/s1388-9842(00)00096-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cardiovascular Magnetic Resonance (CMR) is an accepted gold standard for non-invasive, accurate, and reproducible assessment of cardiac mass and function. The interest in its use for viability, myocardial perfusion and coronary artery imaging is also widespread and growing rapidly as the hardware and expertise becomes available in more centres, and the scans themselves become more cost effective. In patients with heart failure, accurate and reproducible serial assessment of remodelling is of prognostic importance and the lack of exposure to ionizing radiation is helpful. The concept of an integrated approach to heart failure and its complications using CMR is fast becoming a reality, and this will be tested widely in the coming few years, with the new generation of dedicated CMR scanners.
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Affiliation(s)
- K Rajappan
- Cardiovascular MR Unit, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK.
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