Cardiac Magnetic Resonance In Patients Research Articles

Multiparametric cardiac magnetic resonance in patients with thalassemia intermedia: new insights from the E-MIOT network.

In a relatively large cohort of thalassemia intermedia (TI) patients, we systematically investigated myocardial iron overload (MIO), function, and replacement fibrosis using cardiac magnetic resonance (CMR), we assessed the clinical determinants of global heart T2* values, and we explored the association between multiparametric CMR findings and cardiac complications. We considered 254 beta-TI patients (43.14 ± 13.69years, 138 females) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia project. MIO was quantified by T2* technique and biventricular function and atrial areas by cine images. Macroscopic myocardial fibrosis was detected by late gadolinium enhancement technique. Compared to never/sporadically transfused patients, regularly transfused (RT)-TI patients exhibited significantly lower global heart T2* values, biventricular end-diastolic volume indexes, left ventricular mass index, and cardiac index. In RT-TI patients, age and serum ferritin levels were the strongest predictors of global heart T2* values. Independently from the transfusional state, cardiac T2* values were not associated with biventricular function. Of the 103 (40.6%) patients in whom the contrast medium was administrated, 27 (26.2%) had replacement myocardial fibrosis. Age, sex distribution, cardiac iron, and biventricular function parameters were comparable between patients without and without replacement myocardial fibrosis. Twenty-five (9.8%) patients had a history of cardiac complications (heart failure and arrhythmias). Increased age and replacement myocardial fibrosis emerged as significant risk markers for cardiac complications. In TI, regular transfusions are associated with less pronounced cardiac remodeling but increase the risk of MIO. Replacement myocardial fibrosis is a frequent finding associated with cardiac complications.

Kiosk 1R-TB-01 - Prognostic Value and Safety of Dobutamine Stress Cardiac Magnetic Resonance in Patients with Prior Coronary Artery Bypass Grafting

Kiosk 1R-TB-01 - Prognostic Value and Safety of Dobutamine Stress Cardiac Magnetic Resonance in Patients with Prior Coronary Artery Bypass Grafting

Optimal timing of follow-up cardiac magnetic resonance in patients with uncomplicated acute myocarditis

BackgroundCardiac magnetic resonance (CMR) is central in the diagnosis and prognostic stratification of acute myocarditis (AM) but the timing of repeated CMR scans to assess edema resolution and late gadolinium enhancement (LGE) stabilization remain unclear.We assessed edema and LGE evolution over 12 months to identify the optimal timing of repeat CMR evaluation in AM. Methods and resultsThirty-three consecutive patients with AM underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). CMR included assessment of edema and LGE, left ventricular ejection fraction (LVEF) and left ventricular mass index (LVMi). After CMR-3 patients were followed-up every three-months by clinical evaluation, Holter-monitoring, and echocardiography.All patients had edema and LGE at CMR-1. At CMR-2 edema-positive segments (0.42 ± 0.34 vs. 3.18 ± 2.33, p < 0.005), LGE (4.98 ± 4.56 vs. 9.60 ± 8.58 g, and 4.22 ± 3.97% vs 7.50 ± 5.61%) and LVMi (69.82 ± 11.83 vs 76.06 ± 13.13 g/m2) (all p < 0.0001) significantly reduced, while LVEF (63.12 ± 5.47% vs.61.15 ± 6.87% p < 0.05) significantly improved, compared to CMR-1. At CMR-2 edema persisted in 7 patients (21%) but resolved at CMR-3 with no further changes of LVMi, LVEF and LGE. During follow-up (85 ± 15 months), 5 (15%) patients showed persistent ventricular arrhythmias. Univariate predictors of arrhythmic persistence were LGE extension at CMR-2 and CMR-3 (both p < 0.05), but not at CMR-1 (p = 0.07). ConclusionsMost patients with uncomplicated AM show edema resolution with LGE stabilization after 3 months. Further CMR evaluations should be limited to patients with persisting edema at this time. LGE extent measured after edema resolution is associated with persistent ventricular arrhythmias.

Coronary physiology thresholds associated with microvascular obstruction in myocardial infarction

ObjectivesTo ascertain whether invasive assessment of coronary physiology soon after recanalisation of the culprit artery by primary percutaneous coronary intervention is associated with the development of microvascular obstruction by cardiac...

Cardiac Magnetic Resonance in Patients with Suspected Tachycardia-Induced Cardiomyopathy: The Impact of Late Gadolinium Enhancement and Epicardial Fat Tissue.

Tachycardia-induced cardiomyopathy (TIC) is a reversible subtype of dilated cardiomyopathy (DCM) resulting from sustained supraventricular or ventricular tachycardia and diagnosed by the normalization of left ventricular ejection fraction (LVEF) after stable sinus rhythm restoration. The aim of this study was to determine the contribution of cardiac magnetic resonance (CMR) to the differential diagnosis of TIC and DCM with persistent atrial arrythmias in patients hospitalized for the first time with heart failure (HF) with reduced LVEF of nonischemic origin. A total of 29 patients (age: 58.2 ± 16.9 years; males: 65.5%; average EF: 37.0 ± 9.5%) with persistent atrial tachyarrhythmia and first decompensation of HF without known coronary artery diseases were included in this study. The patients successfully underwent cardioversion and were observed for 30 days. The study population was divided into groups of responders (TIC patients; N = 16), which implies achieving FF > 50% or its increase > 10% in 30 days of TIC, and non-responders (N = 13). The increase in left ventricle (LV) volumes measured using CMR was significantly higher in the non-responder group when compared with the responders (114.8 mL ± 25.1 vs. 68.1 mL ± 10.5, respectively, p < 0.05). Non-responders also demonstrated decreased interventricular septum thickness (9.1 ± 0.8 vs.11.5 ± 1.3, respectively, p < 0.05). Late gadolinium enhancement (LGE) was observed in 12 patients (41.4%). The prevalence of LGE was increased in the non-responder group (25.0% vs. 65.1%, respectively, p = 0.046). Notably, a septal mid-wall LGE pattern was found exclusively in the non-responders. Epicardial adipose tissue thickness was decreased in the non-responder group versus the TIC patients. Conclusion: Patients with TIC were found to have smaller atrial and ventricular dimensions in comparison to patients with DCM. In addition, LGE was more common in DCM patients.

Impaired cardiac pump function assessment with normalized cardiac power using cardiac magnetic resonance in patients with hypertrophic cardiomyopathy.

Cardiac power (CP; CP = 0.222 × cardiac output × mean blood pressure) output in patients with heart failure has been studied previously, but its importance in patients with hypertrophic cardiomyopathy (HCM) remains unclear. The present study aimed to explore the role of normalized CP (normalized CP = CP/ventricle mass) in assessing cardiac function in patients with HCM with normal ejection fraction using cardiac magnetic resonance (CMR). This cross-sectional study enrolled 99 patients with HCM who underwent CMR from December 2020 to January 2022 at Beijing Anzhen Hospital, and these patients were classified into heart failure or non-heart failure subgroups. Meanwhile, a control group comprising 65 gender- and age-matched healthy volunteers was also enrolled. The baseline clinical characteristics and cardiac functional parameters were compared between the patients with HCM and the controls, and multivariable linear regression analysis was performed to analyze the relationship between normalized CP and the relevant factors. Significantly higher CP (1.19 vs. 1.01 W; P=0.03) but lower normalized CP (0.73 vs. 1.12 W/100 g; P<0.001) were found in patients with HCM as compared with the controls. Multivariable analysis showed that HCM correlated well with normalized CP [β=-0.235; 95% confidence interval (CI): -0.341 to -0.129; P<0.001]. In the HCM group, there were 34 cases with heart failure and 65 with non-heart failure, and the patients with HCM with heart failure showed similar CP (1.14 vs. 1.24 W; P=0.06) but significantly lower normalized CP (0.54 vs. 0.78 W/100 g; P<0.001). The correlation analysis of normalized CP and functional parameters revealed that normalized CP was inversely correlated with left ventricle mass/body surface area (R=-0.509; 95% CI: -0.646 to -0.341; P<0.001) in patients with HCM. Normalized CP decreased significantly and was negatively correlated with ventricle mass, indicating impaired cardiac pump function in patients with HCM. Normalized CP might play a critical role in detecting and evaluating impaired cardiac pump function in patients with HCM with preserved ejection fraction.

Aortic Root Dilatation Measured by Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot

Background: Aortic root dilatation (AoD) frequently occurs following repaired tetralogy of Fallot (rTOF). The objective of this study was to assess aortic dimensions, investigate the prevalence of AoD, and identify predictors of AoD in rTOF patients. Methods: A cross-sectional retrospective study was conducted in repaired TOF patients from 2009 to 2020. Aortic root diameters were measured by cardiac magnetic resonance (CMR). Severe AoD of the aortic sinus (AoS) was defined as a Z-score (z) of &gt;4, reflecting a mean percentile ≥99.99%. Results: Two hundred forty-eight patients, with a median age of 28.2 years (10.2–65.3 years), were included in the study. The median age at the time of repair was 6.6 years (0.8–40.5 years) and the median interval between the repair and CMR study was 18.9 years (2.0–54.8 years). The prevalence of severe AoD was found to be 35.2% when defined by an AoS z greater than 4 and 27.6% when defined by a AoS diameter ≥40 mm, respectively. A total of 101 patients (40.7%) had aortic regurgitation (AR), with 7 patients (2.8%) having moderate AR. Multivariate analysis revealed that severe AoD was only associated with the left ventricular end diastolic volume index (LVEDVi) and a longer duration after repair. The age at the time of repair for TOF was found not to be correlated with the development of AoD. Conclusions: After repair of TOF, severe AoD was found to be prevalent, but no fatal complications were observed in our study. Mild AR was also commonly observed. Larger LVEDVi and a longer duration after repair were identified as factors associated with the development of severe AoD. Therefore, routine monitoring of AoD is recommended.

Practical Guide to Interpreting Cardiac Magnetic Resonance in Patients with Cardiac Masses.

It is common for a cardiac mass to be discovered accidentally during an echocardiographic examination. Following the relief of a cardiac mass, being able to evaluate and characterize it using non-invasive imaging methods is critical. Echocardiography, computed tomography (CT), cardiac magnetic resonance imaging (CMR), and positron emission tomography (PET) are the main imaging modalities used to evaluate cardiac masses. Although multimodal imaging often allows for a better assessment, CMR is the best technique for the non-invasive characterization of tissues, as the different MR sequences help in the diagnosis of cardiac masses. This article provides detailed descriptions of each CMR sequence employed in the evaluation of cardiac masses, underlining the potential information it can provide. The description in the individual sequences provides useful guidance to the radiologist in performing the examination.

The prognostic value of multiparametric cardiac magnetic resonance in patients with systemic light chain amyloidosis.

Late gadolinium enhancement (LGE) is a classic imaging modality derived from cardiac magnetic resonance (CMR), which is commonly used to describe cardiac tissue characterization. T1 mapping with extracellular volume (ECV) and native T1 are novel quantitative parameters. The prognostic value of multiparametric CMR in patients with light chain (AL) amyloidosis remains to be thoroughly investigated. A total of 89 subjects with AL amyloidosis were enrolled from April 2016 to January 2021, and all of them underwent CMR on a 3.0 T scanner. The clinical outcome and therapeutic effect were observed. Cox regression was used to investigate the effect of multiple CMR parameters on outcomes in this population. LGE extent, native T1 and ECV correlated well with cardiac biomarkers. During a median follow-up of 40 months, 21 patients died. ECV (hazard ratio [HR]: 2.087 for per 10% increase, 95% confidence interval [CI]: 1.379-3.157, P < 0.001) and native T1 (HR: 2.443 for per 100 ms increase, 95% CI: 1.381-4.321, P=0.002) were independently predictive of mortality. A novel prognostic staging system based on median native T1 (1344 ms) and ECV (40%) was similar to Mayo 2004 Stage, and the 5-year estimated overall survival rates in Stage I, II, and III were 95%, 80%, and 53%, respectively. In patients with ECV > 40%, receiving autologous stem cell transplantation had higher cardiac and renal response rates than conventional chemotherapy. Both native T1 and ECV independently predict mortality in patients with AL amyloidosis. Receiving autologous stem cell transplantation is effective and significantly improves the clinical outcomes in patients with ECV > 40%.

Prognostic value of ventricle epicardial fat volume by cardiovascular magnetic resonance in chronic heart failure

The purpose of this study is to explore the prognostic values of ventricle epicardial fat volume (EFV) calculated by cardiac magnetic resonance in patients with chronic heart failure (CHF). A total of 516 patients with CHF (left ventricular ejection fraction ≤ 50%) were recruited, and 136 (26.4%) of whom experienced major adverse cardiovascular events (MACE) within median follow-up of 24months. The target marker-EFV was found to be associated with MACE in both univariate and multivariable analysis adjusted for various clinical variables (p<0.01), regardless as a continuous variable and categorized by X-tile program. EFV also showed promising predictive ability, with an area under the curve of 0.612, 0.618, and 0.687 for the prediction of 1-year, 2-year, and 3-year MACE, respectively. In conclusion, EFV could be a useful prognostic marker for CHF patients, helping to identify individuals at greater risk of MACE.

Exploring the EVolution in PrognOstic CapabiLity of MUltisequence Cardiac MagneTIc ResOnance in PatieNts Affected by Takotsubo Cardiomyopathy Based on Machine Learning Analysis: Design and Rationale of the EVOLUTION Study.

Takotsubo cardiomyopathy (TTC) is a transient but severe acute myocardial dysfunction with a wide range of outcomes from favorable to life-threatening. The current risk stratification scores of TTC patients do not include cardiac magnetic resonance (CMR) parameters. To date, it is still unknown whether and how clinical, trans-thoracic echocardiography (TTE), and CMR data can be integrated to improve risk stratification. EVOLUTION (Exploring the eVolution in prognOstic capabiLity of mUlti-sequence cardiac magneTIc resOnance in patieNts affected by Takotsubo cardiomyopathy) is a multicenter, international registry of TTC patients who will undergo a clinical, TTE, and CMR evaluation. Clinical data including demographics, risk factors, comorbidities, laboratory values, ECG, and results from TTE and CMR analysis will be collected, and each patient will be followed-up for in-hospital and long-term outcomes. Clinical outcome measures during hospitalization will include cardiovascular death, pulmonary edema, arrhythmias, stroke, or transient ischemic attack.Clinical long-term outcome measures will include cardiovascular death, pulmonary edema, heart failure, arrhythmias, sudden cardiac death, and major adverse cardiac and cerebrovascular events defined as a composite endpoint of death from any cause, myocardial infarction, recurrence of TTC, transient ischemic attack, and stroke. We will develop a comprehensive clinical and imaging score that predicts TTC outcomes and test the value of machine learning models, incorporating clinical and imaging parameters to predict prognosis. The main goal of the study is to develop a comprehensive clinical and imaging score, that includes TTE and CMR data, in a large cohort of TTC patients for risk stratification and outcome prediction as a basis for possible changes in patient management.

The prognostic value of morphological and functional parameters of cardiac magnetic resonance in patients with systemic light chain amyloidosis

Objective: To investigate the features of morphological and functional parameters of cardiac magnetic resonance (CMR) in patients with systemic light chain (AL) amyloidosis, and the prognostic values of these related parameters. Methods: The data of 97 patients (including 56 males and 41 females, aged 36 to 71 years) with AL amyloidosis from April 2016 to August 2019 in the General Hospital of Eastern Theater Command were retrospectively analyzed. All patients underwent CMR examination. Those patients were divided into survival (n=76) and death groups (n=21) according to the clinical outcomes, and the differences in clinical baseline and CMR parameters between the two groups were analyzed and compared. A smooth curve fitting was used to analyze the association between morphological and functional parameters and extracellular volume (ECV), and Cox regression models were conducted to explore the association between related parameters and mortality. Results: The left ventricular global function index (LVGFI), myocardial contraction fraction (MCF) and stroke volume index (SVI) decreased with increasing ECV [β (95%CI) was -0.566 (-0.685--0.446), -1.201 (-1.424--0.977), -0.149 (-0.293--0.004), respectively;all P<0.05]. Left ventricular mass index (LVMI), and diastolic left ventricular global peak wall thickness (LVGPWT) increased with increasing ECV [β(95%CI) was 1.440 (1.142-1.739), 0.190 (0.147-0.233), respectively;both P<0.001]. While left ventricular ejection fraction (LVEF) began to decrease only at higher amyloid burden (β=-0.460, 95%CI:-0.639--0.280, P<0.001). The median follow-up time was 39 months (range 2-64 months), and 21 patients died during the follow-up period. The estimated survival rates according to Kaplan-Meier curves at 1, 3, and 5 years were 92.8%, 78.7%, and 77.1%, respectively. MCF<39% (HR=10.266, 95%CI: 4.093-25.747) and LVGFI<26% (HR=9.267, 95%CI: 3.705-23.178) were independent risk factors for death in patients with AL amyloidosis after adjusting for other CMR parameters (P<0.001). Conclusion: Multiple morphologic and functional parameters of CMR vary with the increase of ECV. MCF<39% and LVGFI<26% were independent risk factors for death.

SARC Gene Mutation Is Associated With Myocardial Fibrosis Measured by Histopathology and Cardiac Magnetic Resonance in Patients With Hypertrophic Cardiomyopathy.

Background Sarcomere gene mutation and myocardial fibrosis are both associated with poorer clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to determine the relationship between sarcomere gene mutation and myocardial fibrosis measured by both histopathology and cardiac magnetic resonance (CMR). Methods and Results Two hundred twenty-seven patients with HCM who underwent surgical treatment, genetic testing, and CMR were enrolled. We retrospectively analyzed basic characteristics, sarcomere gene mutation, and myocardial fibrosis measured by CMR and histopathology. In our study, the mean age was 43 years, and 152 patients (67.0%) were men. A total of 107 patients (47.1%) carried a positive sarcomere gene mutation. The myocardial fibrosis ratio was significantly higher in the late gadolinium enhancement (LGE)+ group (LGE+ 14.3±7.5% versus LGE- 9.0±4.3%; P=0.001). Patients with HCM with SARC+ showed a high probability of fibrosis both in histopathology (myocardial fibrosis ratio 15.3±8.0% versus 12.4±6.5%; P=0.003) and CMR examination (LGE+ 98.1% versus 84.2%; P<0.001; LGE quantification 8.3% versus 5.8%; P<0.001). Linear regression analysis showed that sarcomere gene mutation (B=2.661; P=0.005) and left atrial diameter (B=0.240; P=0.001) were related factors for histopathological myocardial fibrosis. Also, the myocardial fibrosis ratio was significantly higher in the MYH7 (myosin heavy chain) group (MYH7 18.1±9.6% versus MYBPC3 [myosin binding protein C] 13.1±5.2%; P=0.019). Conclusions Patients with HCM with positive sarcomere gene mutation had a higher myocardial fibrosis extent than patients without mutation, and a significant difference in myocardial fibrosis was also observed between the MYBPC3 and MYH7 groups. In addition, a high consistency was found between CMR-LGE and histopathological myocardial fibrosis in patients with HCM.

Cardiac Magnetic Resonance in Hypertensive Heart Disease: Time for a New Chapter

Hypertension is one of the most important cardiovascular risk factors, associated with significant morbidity and mortality. Chronic high blood pressure leads to various structural and functional changes in the myocardium. Different sophisticated imaging methods are developed to properly estimate the severity of the disease and to prevent possible complications. Cardiac magnetic resonance can provide a comprehensive assessment of patients with hypertensive heart disease, including accurate and reproducible measurement of left and right ventricle volumes and function, tissue characterization, and scar quantification. It is important in the proper evaluation of different left ventricle hypertrophy patterns to estimate the presence and severity of myocardial fibrosis, as well as to give more information about the benefits of different therapeutic modalities. Hypertensive heart disease often manifests as a subclinical condition, giving exceptional value to cardiac magnetic resonance as an imaging modality capable to detect subtle changes. In this article, we are giving a comprehensive review of all the possibilities of cardiac magnetic resonance in patients with hypertensive heart disease.

The Role of Cardiac Magnetic Resonance in patients with Amyloidosis and Aortic Stenosis

Cardiac magnetic resonance imaging (CMR) plays an important role in the diagnosis and prognosis of various heart diseases. The incidence of cardiac amyloidosis and aortic stenosis has been increasing in recent years, especially with the aging population, and their possible coexistence has created frequent diagnostic challenges in clinical practice. CMR assumes an important value in this context due to its unique capacity for multiparametric assessment evaluations that include anatomical, functional, and histopathological aspects. The present review aimed to increase our knowledge of the diagnosis and prognosis of amyloidosis in the presence of aortic stenosis and highlighted the importance of CMR in this scenario.

The Role of Cardiac Magnetic Resonance in patients with Amyloidosis and Aortic Stenosis

Cardiac magnetic resonance imaging (CMR) plays an important role in the diagnosis and prognosis of various heart diseases. The incidence of cardiac amyloidosis and aortic stenosis has been increasing in recent years, especially with the aging population, and their possible coexistence has created frequent diagnostic challenges in clinical practice. CMR assumes an important value in this context due to its unique capacity for multiparametric assessment evaluations that include anatomical, functional, and histopathological aspects. The present review aimed to increase our knowledge of the diagnosis and prognosis of amyloidosis in the presence of aortic stenosis and highlighted the importance of CMR in this scenario.

Ten questions on cardiac magnetic resonance in patients with heart failure: from etiological diagnosis to prognostic stratification

Cardiac magnetic resonance (CMR) imaging has progressively become part of the imaging methods recommended in patients with heart failure. CMR represents the gold standard for assessing volumes, function, biventricular kinetics and providing tissue characterization through scans with and without contrast medium. In patients with heart failure with reduced ejection fraction (HFrEF) and ischemic dilated cardiomyopathy, CMR allows to search for viability, accurately estimate volumes and ejection fraction. It can assess scar extent for predicting response to cardiac resynchronization therapy and for establishing an indication for implanting a defibrillator in borderline cases. In patients with HFrEF and non-ischemic dilated cardiomyopathy, CMR helps to identify specific etiological subgroups and to estimate the arrhythmic risk beyond ejection fraction. In patients with heart failure with preserved ejection fraction, CMR offers the possibility of diagnosing specific phenotypes, including sarcomeric hypertrophic cardiomyopathy, amyloidosis or Fabry disease, and adds prognostic information. Both clinical and scientific interest in this imaging method is constantly expanding; the clinicians dealing with heart failure cannot fail to know the technique, the indications and all the potential that CMR can offer.

Abstract 11885: Optimal Timing and Prognostic Value of Follow-Up Cardiac Magnetic Resonance in Patients With Acute Myocarditis

Background: cardiac magnetic resonance (CMR) is central for diagnosis, follow up and prognostic stratification of acute myocarditis. Late gadolinium enhancement (LGE) extent and persistence at follow-up represents a negative prognostic marker. However, time course of oedema resolution and LGE stabilization and optimal timing to repeat CMR are unclear. Hypothesis: we assessed time course of oedema and LGE evolution to identify optimal timing to repeat CMR in acute myocarditis. Methods: 36 acute myocarditis patients (35M, 28,8±10,3 years) underwent CMR at clinical presentation (CMR-1), after 3 months (CMR-2) and after 12-months (CMR-3). We assessed oedema and LGE and measured left ventricular ejection fraction (LVEF) and indexed mass (iLVM). After CMR-3 all patients were followed up yearly with clinical evaluation, Holter ECG and echocardiography. Results: all patients had oedema and LGE at CMR-1. At CMR-2 significant reduction of oedema (T2 positive segments 0,4±0,9 vs 4,1±3,2 p&lt;0.0001) and LGE (4,3±3,9 vs 7,5±5,6 p&lt;0.0001) was observed compared to CMR-1, with improvement of LVEF (62,7±5,6 vs 58,5±12,2% p&lt;0.05) and reduction of iLVM (71,2±13,7 vs 78,1±15,2 g/m2 p&lt;0.0001). At CMR-3 no further LGE reduction nor LVEF and iLVM improvement were observed. At 60±23-months follow-up, no major cardiovascular events nor myocarditis recurrences occurred. At Holter ECG 8/36 patients (28%) had non-sustained ventricular tachycardias. Ventricular arrhythmias were associated with lower LVEF at CMR-1 (46.25±19.55 vs 62.00±6.02 p=0.001) and higher LGE at CMR-2 (10.19±8.01 vs 3.60±3.14 p=0.007) but not with LGE at CMR-1 (10.05±7.14 vs 6.80±4.65 p=0.13). Conclusions: most patients with acute myocarditis present oedema resolution and LGE stabilization after 3 months. LVEF at baseline and LGE extension at second CMR correlates with ventricular arrhythmias persistence. Our findings redefine follow up and imaging-based prognostic stratification of acute myocarditis.

Clinical impact of cardiac magnetic resonance in patients with suspected coronary artery disease associated with chronic kidney disease (AQUAMARINE-CKD study): study protocol for a randomized controlled trial

BackgroundAlthough screening for coronary artery disease (CAD) using computed tomography coronary angiography in patients with stable chest pain has been reported to be beneficial, patients with chronic kidney disease (CKD) might have limited benefit due to complications of contrast agent nephropathy and decreased diagnostic accuracy as a result of coronary artery calcifications. Cardiac magnetic resonance (CMR) has emerged as a novel imaging modality for detecting coronary stenosis and high-risk coronary plaques without contrast media that is not affected by coronary artery calcification. However, the clinical use of this technology has not been robustly evaluated.MethodsAQUAMARINE-CKD is an open parallel-group prospective multicenter randomized controlled trial of 524 patients with CKD at high risk for CAD estimated based on risk factor categories for a Japanese urban population (Suita score) recruited from 6 institutions. Participants will be randomized 1:1 to receive a CMR examination that includes non-contrast T1-weighted imaging and coronary magnetic angiography (CMR group) or standard examinations that include stress myocardial scintigraphy (control group). Randomization will be conducted using a web-based system. The primary outcome is a composite of cardiovascular events at 1 year after study examinations: all-cause death, death from CAD, nonfatal myocardial infarction, nonfatal ischemic stroke, and ischemia-driven unplanned coronary intervention (percutaneous coronary intervention or coronary bypass surgery).DiscussionIf the combination of T1-weighted imaging and coronary magnetic angiography contributes to the risk assessment of CAD in patients with CKD, this study will have major clinical implications for the management of patients with CKD at high risk for CAD.Trial registrationJapan Registry of Clinical Trials (jRCT) 1,052,210,075. Registered on September 10, 2021.

Diagnostic and prognostic role of cardiac magnetic resonance in patients with MINOCA

Abstract Background Myocardial infarction with non-obstructed coronary arteries (MINOCA) is common in current clinical practice and cardiac magnetic resonance (CMR) plays an important role in the present management of this group of patients. However, there are still a lot of controversies concerning the etiology behind the syndrome of MINOCA. Furthermore, the prognostic value of CMR in patients with MINOCA is still undetermined. Purpose We aimed to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA. Methods A systematic review was performed to identify studies reporting the results of CMR findings in MINOCA patients (non-obstructive CAD or normal coronary arteries). Random effects models were used to determine the prevalence of different disease entities – myocarditis, myocardial infarction, Takotsubo cardiomyopathy or normal CMR findings. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. Major adverse clinical events (MACE) were defined based on the specific study definitions and included cardiovascular death, non-fatal myocardial infarction, and cardiovascular hospitalization. Results 31 studies comprising 4119 patients were included. Mean age was 54.1±3.3, 59% were males. The pooled prevalence of myocarditis was 32% (95% CI 0.25 to 0.39), myocardial infarction (MI) - 21% (95% CI 0.17 to 0.24), Takotsubo cardiomyopathy −12% (95% CI 0.09 to 0.16). Normal findings were found in 23% (95% CI 0.14 to 0.35), figure 1. In a subgroup analysis of seven studies (900 patients) that reported clinical outcomes the prognostic value of the CMR was assessed. CMR diagnosis of myocarditis was not significantly associated with increased risk of MACE (pooled OR, 1.50; 95% CI, 0.46 to 4.87; p=0.459). However, both diagnosis of MI and Takotsubo were significantly associated with increased risk of combined clinical outcomes (pooled OR, 1.75; 95% CI, 1.12 to 3.59; p&amp;lt;0.05 and pooled OR, 2.19; 95% CI, 1.34 to 5.27; p&amp;lt;0.001). Conclusion In patients with MINOCA CMR brings important diagnostic and prognostic role. The pooled prevalence of myocarditis was 32%, of MI – 21% and of Takotsubo – 12%. The CMR diagnosis of MI and Takotsubo was associated with increased risk of MACE. Funding Acknowledgement Type of funding sources: None.