Cardiovascular Magnetic Resonance In Diagnosis Research Articles

Parametric mapping by cardiovascular magnetic resonance imaging in sudden cardiac arrest survivors.

Etiology of sudden cardiac arrest (SCA) is identified in less than 30% of survivors without coronary artery disease. We sought to assess the diagnostic role of myocardial parametric mapping using cardiovascular magnetic resonance (CMR) in identifying SCA etiology. Consecutive SCA survivors undergoing CMR with myocardial parametric mapping were included in the study. The determination if CMR was decisive or contributory in identifying SCA etiology was made if the diagnosis was unclear prior to CMR, and the discharge diagnosis was consistent with the CMR result. Parametric mapping was considered essential for establishing probable SCA etiology by CMR if the SCA cause could not have been determined without its utilization. If the CMR diagnosis could have been potentially based on the combination of cine and LGE imaging, parametric mapping was considered contributory. Of the 35 patients (mean age 46.9 ± 14.1years; 57% males) included, SCA diagnosis was based on CMR in 23 (66%) patients. Of those, parametric mapping was essential for the diagnosis of myocarditis and tako-tsubo cardiomyopathy (11/48%) and contributed to the diagnosis in 10 (43%) additional cases. Inclusion of quantitative T1 and T2 parametric mapping in the SCA CMR protocol has the potential to increase diagnostic yield of CMR and further specify SCA etiology, especially myocarditis.

Cardiovascular magnetic resonance imaging in COVID-19 patients: An important tool in everyday clinical practice.

Myocarditis is a typical complication of many viral diseases1 and has also been described in other coronavirus diseases other than COVID-19.2, 3 However, it is only one possible complication of cardiac involvement in COVID-19 and requires an endomyocardial biopsy or a combination of suggestive clinical and imaging findings to reach a definitive diagnosis.4 Cardiovascular magnetic resonance (CMR) imaging is a cornerstone of the non-invasive diagnosis of myocarditis. Clinical studies have reported the diagnosis of myocarditis by CMR both in acute infections and in the post-acute phase.5 Cardiac involvement in COVID-19 was described early in the pandemic as a risk factor for poor outcomes.6 Inflammatory, thromboembolic and ischemic events are relevant complications of acute SARS-CoV-2 infection. However, even months after acute infection, many patients describe cardiopulmonary symptoms,7 and CMR indicates inflammatory processes,5 although their contribution to often complex clinical syndromes is questionable in some cases. Palmisano et al. investigated cardiac changes on CMR in 39 patients in the acute or post-acute phase of COVID-19 and found inflammatory changes in most patients.8 However, ischemic, valvular or other cardiomyopathies could also be diagnosed on the basis of CMR. The authors mention the heterogeneous patient population as a limitation of their study. On the contrary, this demonstrates the real additional impact of CMR since it has been shown that it can be used in a broad range of clinical scenarios. CMR can lead to a diagnosis independent of other accompanying factors and allows the exclusion or confirmation of possible differential diagnoses in the case of suspected virus-associated myocarditis. This is one of the most important tasks of cardiac imaging in the context of COVID-19. Especially potentially pre-existing but unknown cardiovascular diseases can be exacerbated in the context of SARS-CoV-2 infection and should therefore be excluded. Three major factors in Palmisano et al.'s study should be emphasized. First, the rate of diagnosed myocarditis (53%) appears to be very high. Although early studies on survivors of SARS-CoV-2 infection postulated high myocarditis rates, this could not be confirmed in actual autopsy studies,9 in which the use of histological criteria for the diagnosis of myocarditis showed a high degree of cardiac involvement but actual myocarditis in only 7.2% of the cases. In Palmisano et al.'s study, this can likely be explained by the good clinical pre-specification of the patients with a high clinical pre-test probability. This illustrates that CMR contributes to confirming the diagnosis, especially when it is well indicated. Second, the authors examined 17 patients with acute SARS-CoV-2 infection using CMR over a period of 5 months. Experience has shown that at several hospitals, this has not been done in fear of exposing staff to the risk of infection. This demonstrates the feasibility of CMR for infectious patients in a clinical setting. Third, with mostly normal biventricular function, non-invasive tissue characterization with an appropriate pre-test probability offers insights that goes far beyond pure functional or volumetric analyses. CMR diagnosis is not the first-line imaging method for diagnosis of myocarditis in mildly ill patients. However, in patients with a clinically justifiable diagnosis due to abnormal ECG and particularly echocardiographic findings and/or abnormal troponin levels accompanied with typical symptoms, CMR should be a diagnostic cornerstone in the acute and post-acute phase. The ongoing debate about short- and long-term cardiovascular consequences of COVID-19 needs to be put in a broader perspective than just the treatment of patients during pandemic. The great scientific effort and gained knowledge can potentially be used for other post-infectious syndromes, such as sequelae of Lyme disease, influenza and pneumococcal pneumonia. Moreover, this and similar studies showed that cardiovascular imaging in general and particularly advanced methods such as CMR and T1-derived parametric mapping should become a clinical routine that will serve not only for better understanding of cardiac involvement in COVID-19, but in overall better acceptance of CMR in everyday clinical practice in large spectrum of cardiovascular diseases. Open Access funding enabled and organized by Projekt DEAL.

Cardiovascular Magnetic Resonance Versus Histopathologic Study for Diagnosis of Benign and Malignant Cardiac Tumours: A Systematic Review and Meta-Analysis.

The gold standard for diagnosis of cardiac tumours is histopathological examination. Cardiovascular magnetic resonance (CMR) is a valuable non-invasive, radiation-free tool for identifying and characterizing cardiac tumours. Our aim is to understand CMR diagnosis of cardiac tumours by distinguishing benign vs. malignant tumours compared to the gold standard. A systematic search was performed in the PubMed, Web of Science, and Scopus databases up to December 2022, and the results were reviewed by 2 independent investigators. Studies reporting CMR diagnosis were included in a meta-analysis, and pooled measures were obtained. The risk of bias was assessed using the Quality Assessment Tools from the National Institutes of Health. A total of 2,321 results was obtained; 10 studies were eligible, including one identified by citation search. Eight studies were included in the meta-analysis, which presented a pooled sensitivity of 93% and specificity of 94%, a diagnostic odds ratio of 185, and an area under the curve of 0.98 for CMR diagnosis of benign vs. malignant tumours. Additionally, 4 studies evaluated whether CMR diagnosis of cardiac tumours matched specific histopathological subtypes, with 73.6% achieving the correct diagnosis. To the best of our knowledge, this is the first published systematic review on CMR diagnosis of cardiac tumours. Compared to histopathological results, the ability to discriminate benign from malignant tumours was good but not outstanding. However, significant heterogeneity may have had an impact on our findings.

Timing of cardiovascular magnetic resonance imaging and diagnostic yield in patients with acute myocardial infarction with nonobstructive coronary arteries

Abstract Background Accurate diagnosis of the underlying cause of myocardial infarction (MI) without obstructive coronary artery disease (MINOCA) is crucial. Cardiovascular magnetic resonance (CMR) plays an important role in the work up of patients with MINOCA. However, the timing of performance of CMR may impact on the diagnosis yield. Purpose To establish the diagnostic yield of CMR in a large cohort of patients admitted with MINOCA based on the timing of referral to CMR. Methods All patients referred to CMR from January 2009 to February 2022 with MINOCA were included. Studies were performed on a 1.5 T or 3T scanners. SSFP cines, T2-weighted black-blood fat-sat images and DE-segmented GE IR images 10–15 minutes after iv gadolinium-DTPA administration (0.15mmol/kg) were performed in 3 long-axis and 11–15 parallel short-axis views. All images were reviewed and analyzed off-line with specialized post-processing software. Results A total of 203 patients (median age 49 years, 60% men) with MINOCA diagnosis were included. Main ECG alterations were ST-segment elevation (STE) (57%) and T wave inversion (19%). Mean peak high sensitivity (HS)-TnI levels were 3706pg/mL. Median time to CMR was 7 days (5–9 days). Mean LVEF was 58% (range 18–83%) and mean LVEDVi 77 mL/m2 (range 35–210 mL/m2). Regional wall abnormalities were present in 123 patients (62%). High signal in T2w images was detected in 153 cases (75%) and late gadolinium enhancement (LGE) in 143cases (71%). Final CMR diagnosis resulted in myocarditis in 46%, MI in 20%, Takotsubo in 18%, and other cardiomyopathies in 6.4%. CMR was normal in 15 patients and not conclusive in 1. When CMR was performed within 7 days of admission (median: 5 days (4–6 days); n: 116 patients), the distribution of diagnoses was myocarditis in 53%, MI in 20%, Takotsubo in 16%, other cardiomyopathies in 6% and normal CMR in 4%. Whereas, if CMR was performed after 7 days (median: 10 days (8–12 days); n: 87 patients), the diagnoses were as flows: myocarditis in 36%, MI in 22%, Takotsubo 20%, cardiomyopathies in 7%, not conclusive in 1% and normal CMR in 13% (Table 1). Conclusions CMR led to the underlying diagnosis of MINOCA in 92% of patients. Myocarditis was the most frequent diagnosis. The final diagnosis of myocarditis was more frequent when CMR was performed within 7 days with a lesser percentage of normal CMR. Funding Acknowledgement Type of funding sources: None.

Frequency, Penetrance, and Variable Expressivity of Dilated Cardiomyopathy-Associated Putative Pathogenic Gene Variants in UK Biobank Participants.

There is a paucity of data regarding the phenotype of dilated cardiomyopathy (DCM) gene variants in the general population. We aimed to determine the frequency and penetrance of DCM-associated putative pathogenic gene variants in a general adult population, with a focus on the expression of clinical and subclinical phenotype, including structural, functional, and arrhythmic disease features. UK Biobank participants who had undergone whole exome sequencing, ECG, and cardiovascular magnetic resonance imaging were selected for study. Three variant-calling strategies (1 primary and 2 secondary) were used to identify participants with putative pathogenic variants in 44 DCM genes. The observed phenotype was graded DCM (clinical or cardiovascular magnetic resonance diagnosis); early DCM features, including arrhythmia or conduction disease, isolated ventricular dilation, and hypokinetic nondilated cardiomyopathy; or phenotype-negative. Among 18 665 individuals included in the study, 1463 (7.8%) possessed ≥1 putative pathogenic variant in 44 DCM genes by the main variant calling strategy. A clinical diagnosis of DCM was present in 0.34% and early DCM features in 5.7% of individuals with putative pathogenic variants. ECG and cardiovascular magnetic resonance analysis revealed evidence of subclinical DCM in an additional 1.6% and early DCM features in an additional 15.9% of individuals with putative pathogenic variants. Arrhythmias or conduction disease (15.2%) were the most common early DCM features, followed by hypokinetic nondilated cardiomyopathy (4%). The combined clinical/subclinical penetrance was ≤30% with all 3 variant filtering strategies. Clinical DCM was slightly more prevalent among participants with putative pathogenic variants in definitive/strong evidence genes as compared with those with variants in moderate/limited evidence genes. In the UK Biobank, ≈1 of 6 of adults with putative pathogenic variants in DCM genes exhibited early DCM features potentially associated with DCM genotype, most commonly manifesting with arrhythmias in the absence of substantial ventricular dilation or dysfunction.

Long-term clinical outcomes in patients with a working diagnosis of myocardial infarction with non-obstructed coronary arteries (MINOCA) assessed by cardiovascular magnetic resonance imaging

BackgroundMyocardial infarction with non-obstructed coronary arteries (MINOCA) is a distinct entity among patients presenting with troponin-positive acute chest pain. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. There is paucity of evidence on the long-term (> 5 years) clinical outcomes of these patients as graded by their acute CMR diagnosis. Methods and resultsA total of 229 patients with a working diagnosis of MINOCA who underwent CMR assessment during the acute admission (2010–2017) were prospectively studied. The primary endpoint was major adverse cardiac events (MACE) defined as a composite of all-cause mortality and cardiovascular readmissions, identified from hospital and primary care records. CMR performed at a median of 6 days (IQR 2, 8) from presentation provided a diagnosis in 85% of the patients (38% myocarditis, 28% acute myocardial infarction and 19% Takotsubo cardiomyopathy). Over a median follow-up of 7.1 years (IQR 3.7, 8.2), 56 (24%) patients experienced a MACE. We found a strong association between CMR diagnosis and MACE (log rank 30.47, p < 0.001). In multivariate analysis, age (hazard ratio = 1.07; 95% confidence interval = 1.05, 1.10; p < 0.001) and CMR diagnosis of acute myocardial infarction (hazard ratio = 8.87; 95% confidence interval = 2.58, 30.4; p = 0.001) were independent predictors of MACE. ConclusionsIn a large cohort of patients with a working diagnosis of MINOCA, one in four suffer a MACE during long-term clinical follow-up. CMR diagnosis of acute myocardial infarction and age were significant predictors of MACE even in the absence of significant coronary artery obstruction.

Prevalence of abnormal cardiovascular magnetic resonance findings in recovered patients from COVID-19: a systematic review and meta-analysis

BackgroundThe prevalence of abnormal cardiovascular magnetic resonance (CMR) findings in recovered coronavirus disease 2019 (COVID-19) patients is unclear. This study aimed to investigate the prevalence of abnormal CMR findings in recovered COVID-19 patients.MethodsA systematic literature search was performed to identify studies that report the prevalence of abnormal CMR findings in recovered COVID-19 patients. The number of patients with abnormal CMR findings and diagnosis of myocarditis on CMR (based on the Lake Louise criteria) and each abnormal CMR parameter were extracted. Subgroup analyses were performed according to patient characteristics (athletes vs. non-athletes and normal vs. undetermined cardiac enzyme levels). The pooled prevalence and 95% confidence interval (CI) of each CMR finding were calculated. Study heterogeneity was assessed, and meta-regression analysis was performed to investigate factors associated with heterogeneity.ResultsIn total, 890 patients from 16 studies were included in the analysis. The pooled prevalence of one or more abnormal CMR findings in recovered COVID-19 patients was 46.4% (95% CI 43.2%–49.7%). The pooled prevalence of myocarditis and late gadolinium enhancement (LGE) was 14.0% (95% CI 11.6%–16.8%) and 20.5% (95% CI 17.7%–23.6%), respectively. Further, heterogeneity was observed (I2 > 50%, p < 0.1). In the subgroup analysis, the pooled prevalence of abnormal CMR findings and myocarditis was higher in non-athletes than in athletes (62.5% vs. 17.1% and 23.9% vs. 2.5%, respectively). Similarly, the pooled prevalence of abnormal CMR findings and LGE was higher in the undetermined than in the normal cardiac enzyme level subgroup (59.4% vs. 35.9% and 45.5% vs. 8.3%, respectively). Being an athlete was a significant independent factor related to heterogeneity in multivariate meta-regression analysis (p < 0.05).ConclusionsNearly half of recovered COVID-19 patients exhibited one or more abnormal CMR findings. Athletes and patients with normal cardiac enzyme levels showed a lower prevalence of abnormal CMR findings than non-athletes and patients with undetermined cardiac enzyme levels.Trial registration The study protocol was registered in the PROSPERO database (registration number: CRD42020225234).

T2-mapping increase is the prevalent imaging biomarker of myocardial involvement in active COVID-19: a Cardiovascular Magnetic Resonance study

BackgroundEarly detection of myocardial involvement can be relevant in coronavirus disease 2019 (COVID-19) patients to timely target symptomatic treatment and decrease the occurrence of the cardiac sequelae of the infection.The aim of the present study was to assess the clinical value of cardiovascular magnetic resonance (CMR) in characterizing myocardial damage in active COVID-19 patients, through the correlation between qualitative and quantitative imaging biomarkers with clinical and laboratory evidence of myocardial injury.MethodsIn this retrospective observational cohort study, we enrolled 27 patients with diagnosis of active COVID-19 and suspected cardiac involvement, referred to our institution for CMR between March 2020 and January 2021.Clinical and laboratory characteristics, including high sensitivity troponin T (hs-cTnT), and CMR imaging data were obtained. Relationships between CMR parameters, clinical and laboratory findings were explored.Comparisons were made with age-, sex- and risk factor–matched control group of 27 individuals, including healthy controls and patients without other signs or history of myocardial disease, who underwent CMR examination between January 2020 and January 2021.ResultsThe median (IQR) time interval between COVID-19 diagnosis and CMR examination was 20 (13.5–31.5) days. Hs-cTnT values were collected within 24 h prior to CMR and resulted abnormally increased in 18 patients (66.6%). A total of 20 cases (74%) presented tissue signal abnormalities, including increased myocardial native T1 (n = 11), myocardial T2 (n = 14) and extracellular volume fraction (ECV) (n = 10), late gadolinium enhancement (LGE) (n = 12) or pericardial enhancement (n = 2). A CMR diagnosis of myocarditis was established in 9 (33.3%), pericarditis in 2 (7.4%) and myocardial infarction with non-obstructive coronary arteries in 3 (11.11%) patients. T2 mapping values showed a moderate positive linear correlation with Hs-cTnT (r = 0.58; p = 0.002). A high degree positive linear correlation between ECV and Hs-cTnT was also found (r 0.77; p < 0.001).ConclusionsCMR allows in vivo recognition and characterization of myocardial damage in a cohort of selected COVID-19 individuals by means of a multiparametric scanning protocol including conventional imaging and T1–T2 mapping sequences. Abnormal T2 mapping was the most commonly abnormality observed in our cohort and positively correlated with hs-cTnT values, reflecting the predominant edematous changes characterizing the active phase of disease.

Long-term clinical outcomes of troponin-positive chest pain and unobstructed coronary arteries assessed by cardiovascular magnetic resonance imaging

Abstract Background and introduction Troponin-positive chest pain with unobstructed coronary arteries is a distinct entity with different pathophysiological causes. We have previously reported on the incremental diagnostic capability of cardiovascular magnetic resonance (CMR) in this cohort. However, there is paucity of literature on the long-term clinical outcomes of these patients assessed with CMR. Objectives Using the unique cohort of patients previously studied, we sought to assess the long-term clinical outcomes in patients with troponin-positive chest pain and unobstructed coronary arteries, as graded by their acute CMR presentation. Methods A total of 122 consecutive patients with troponin-positive chest pain and unobstructed coronary arteries undergoing CMR assessment during the acute admission (2010–2014) were studied. The primary endpoint was major adverse cardiac event (MACE), defined as a composite of all-cause mortality and cardiovascular readmissions (heart failure, acute myocardial infarction [AMI], atrial or ventricular arrhythmia and stroke). Patients were grouped into 4 categories based on their initial CMR findings: AMI, acute myocarditis, Takotsubo cardiomyopathy and normal CMR. Results The mean age of the study cohort was 55.6±16.5 years and 56.5% were women. CMR (performed at a median of 6 days from presentation) provided a diagnosis in 87% of the patients (38% myocarditis, 28% Takotsubo cardiomyopathy and 21% AMI). Patients with a diagnosis of AMI were prescribed guideline recommended medical therapy. Over a median follow-up of 2524 days (6.9 years), 32 (26.2%) patients experienced a MACE. The all-cause mortality was 2.5%. The most common indication for cardiovascular readmissions in this cohort was heart failure (12.3%) and AMI (9%). In multivariate analysis, a CMR diagnosis of AMI (hazard ratio = 2.6; 95% confidence interval = 1.2, 5.7; p=0.019) and peak troponin (hazard ratio = 1.0003; 95% confidence interval = 1.00003, 1.0006; p=0.028) were significantly associated with MACE after adjusting for age and gender. In addition, CMR diagnosis of AMI was significantly associated with a lower event-free survival rate compared with a diagnosis of non-AMI (adjusted hazard ratio = 2.57, p=0.019) (Figure). Conclusions The long-term prognosis of patients with troponin-positive chest pain and unobstructed coronary arteries is not benign. CMR diagnosis of AMI is a significant predictor of MACE even in the absence of significant coronary artery obstruction and despite guideline recommended post AMI therapy. Figure 1 Funding Acknowledgement Type of funding source: None

Cardiovascular magnetic resonance imaging characteristics and influence factors of aortic insufficiency patients with myocardial fibrosis

Objective: To investigate the cardiovascular magnetic resonance (CMR) imaging characteristics and influence factors of aortic insufficiency (AI) patients with myocardial fibrosis. Method: This retrospective study included 59 AI patients who received CMR and transthoracic echocardiography (TTE) examinations from June 2011 to February 2015. AI patients were divided into 2 groups: bicuspid aortic valve (BAV) group (n=30) and non-BAV group (n=29). Patients were also divided into late gadolinium enhancement (LGE) group (n=27) and non-LGE group (n=32). The baseline clinical characteristics were collected through electronic medical records. Hemodynamic parameters such as grade of AI, cardiac functional parameters and LGE mass fraction (LGE%) were measured by CMR post-processing analysis. Kappa test was used to assess the consistency of AI severity between CMR and TTE, and the multivariate logistic regression analysis was performed to evaluate influence factors of myocardial fibrosis in AI patients. Results: (1) 56 (94.9%) patients were male, and the mean age was (44.2±11.0) years old. There was no significant difference in age and gender, hypertension, hyperlipidemia, alcoholic consumption between BAV and non-BAV group (all P>0.05). There were a higher proportion of smoking history (P=0.008), a lower body mass index (BMI) (P=0.020) in the LGE group than in the non-LGE group. (2) The accuracy of CMR in diagnosis of BAV was 96.7% (29/30) compared to the gold standard. In the BAV group, 20 patients (66.7%) were with fusion of left and right cusp (L-R), 5 patients (16.7%) were with fusion of right and noncoronary cusp (R-N), 5 patients (16.7%) were with fusion of left and noncoronary cusp (L-N); patients with BAV had larger left ventricular end diastolic volume index (LVEDVi), left ventricular end systolic volume index (LVESVi), higher proportion of LGE and lower left ventricular ejection fraction (LVEF) than those in non-BAV group (all P<0.05). There were 19 patients with BAV in the LGE group, the cases of L-R, R-N, L-N were 10 (52.6%), 5 (26.3%), and 4 (21.1%), respectively. In the non-LGE group, patients with BAV of L-R, R-N, L-N were 10 (90.9%), 0, and 1 (9.1%), respectively. Patients with LGE had lower body surface area (BSA), LVEF and larger LVEDVi, LVESVi, left ventricular mass index (LVMi) and higher proportion of BAV compared patients without LGE. In addition, the proportion of moderate and severe AI patients was significantly higher in BAV group than in non-BAV group (P=0.009). (3) The consistency of CMR and TTE in evaluating the severity of AI patients: the agreement between TTE and CMR regarding AI severity was satisfactory (kappa value was 0.624, 95%CI 0.402-0.831, P<0.001). (4) The linear regression analysis demonstrated a negative correlation between LVEF and LGE% in BAV and non-BAV group (P<0.001). The multivariate logistic regression analysis showed that the presence of BAV was an independent risk factor of left ventricucar fibrosis (OR=5.050, 95%CI 1.220-20.908, P=0.025) after adjustment for LVEF, hypertension, LVEDVi and LVMi. Conclusion: Multi-parametric CMR provides a satisfactory noninvasive tool for estimation of myocardial fibrosis and ventricular remodeling in patients with AI, and BAV is an independent risk factor for myocardial fibrosis in patients with AI.

Diagnosis and Prognosis in Sudden Cardiac Arrest Survivors Without Coronary Artery Disease: Utility of a Clinical Approach Using Cardiac Magnetic Resonance Imaging.

Determining the pathogenesis of sudden cardiac arrest or periarrest without significant coronary artery disease is crucial for management and prognosis. Cardiovascular magnetic resonance (CMR) can detect morphological, functional, or tissue abnormalities, and we sought to evaluate the role of CMR in determining sudden cardiac arrest pathogenesis and prognosis in survivors. We retrospectively reviewed cardiac investigations and clinical outcomes in consecutive survivors of potentially fatal arrhythmias without coronary artery disease admitted to our institutions from 2008 to 2014. After coronary angiography and echocardiography, all underwent CMR and, when indicated, electrophysiology studies. Major adverse cardiac events (MACE), comprising significant nonfatal ventricular arrhythmia or death, was the primary outcome. Of 164 included subjects (65% men; mean age 48 [18-80] years), CMR contributed to the diagnosis in 80 (49%) and was decisive in 50 cases (30%). Dilated cardiomyopathy (n=27), myocarditis or sarcoidosis (n=22), occult myocardial infarction (n=13), and hypertrophic cardiomyopathy (n=9) were most frequent. Arrhythmic causes were found in 14% while no cause was identified in 36%. MACE occurred in 31% of subjects during a median follow-up of 32 months. MACE associated with presence of a CMR diagnosis, extent of late gadolinium enhancement, and left and right ventricular ejection fractions. Right ventricular ejection fraction was an independent predictor of MACE. CMR identified a likely pathogenesis for sudden cardiac arrest in nearly half of survivors in whom coronary artery disease had been excluded. One in 3 subjects had MACE; risk doubled in those with a CMR diagnosis and some CMR parameters-late gadolinium enhancement, left ventricular ejection fraction, and especially right ventricular ejection fraction-associated with prognosis.

50 Incremental diagnostic value of cardiovascular magnetic resonance in young adult survivors of sudden cardiac arrest

BackgroundThe prevalence of underlying cardiovascular disease in those who die suddenly varies with age (Finocchiaro et al 2016). Cardiovascular magnetic resonance (CMR) imaging can provide incremental in-vivo diagnostic value in...

The usefulness of cardiovascular magnetic resonance imaging in children with myocardial diseases.

Cardiovascular magnetic resonance (CMR) imaging is a clinically proven and reliable diagnostic method for the assessment of morphology, function, and characteristics of myocardial tissue in patients with myocardial diseases. The use of gadolinium contrast agents has created new diagnostic possibilities for tissue characterisation in patients with suspected or known cardiomyopathy, myocarditis, and cardiac tumours. To evaluate the usefulness of CMR in the diagnostic process in children with myocardial diseases and to compare the results of CMR and other non-invasive cardiovascular methods, including echocardiography. The study included 112 children, with an average age of 12 ± 4.64 years, with various forms of myocardial disease: 63 children with hypertrophic cardiomyopathy (HCM), 9 with suspected myocarditis, 5 with history of myocarditis, 4 with dilated cardiomyopathy (DCM), 9 with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC), 6 with left ventricular non-compaction cardiomyopathy (LVNC), 9 with suspected restrictive cardiomyopathy (RCM) to be differentiated with constrictive pericarditis (CP), and 7 with cardiac tumours. CMR confirmed the echocardiographic diagnosis of HCM in 92% of children and ruled it out in 8%, and in three children apical hypertrophy was found. CMR revealed the presence of myocardial fibrosis in 60% of patients with HCM. In 33% of children with clinically suspected myocarditis CMR confirmed this diagnosis, while in 44% of them DCM was recognised. Of the five children with a history of myocarditis, in one patient CMR performed 13 years after myocarditis revealed features of post-inflammatory DCM. In 75% of patients with the echocardiographic diagnosis of post-inflammatory DCM the result of CMR was consistent. CMR ruled out the presence of ARVC in 89% of children. Echocardiographic and CMR diagnosis of LVNC was consistent in 67% of children. CMR confirmed the clinical diagnosis of RCM in 63% of patients, and in one patient CP was recognised. CMR confirmed the presence of cardiac tumour in 57% of children and excluded it in 43% of patients. CMR is increasingly recognised as an important tool in the investigation of myocardial disease and should be part of routine clinical work-up. CMR provides an additional diagnostic technique to assess the presence or exclusion of an active myocarditis. In children with clinical and echocardiographic suspicion of LVNC, ARVC, RCM, CP, and cardiac tumours CMR can conclusively confirm the presence of the disease.

Cardiovascular magnetic resonance in diagnosis of peripartum cardiomyopathy

Cardiovascular magnetic resonance in diagnosis of peripartum cardiomyopathy

Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis.

BackgroundThe diagnosis of myocarditis is challenging due to its varying clinical presentation. Since myocarditis can be associated with significant 5-year mortality, and postmortem data show myocarditis in almost 10% of all adults suffering sudden cardiac death, individual risk stratification for patients with suspected myocarditis is of great clinical interest. We sought to demonstrate that patients with clinically suspected myocarditis and a normal cardiovascular magnetic resonance (CMR) according to our definition have a good prognosis, independent of their clinical symptoms and other findings.MethodsProspective clinical long-term follow-up of consecutive patients undergoing CMR for work-up of clinically suspected myocarditis at our institution in 2007-2008.ResultsFollow-up was available for n = 405 patients (all-comers, 54.8% inpatients, 38% outpatient referrals from cardiologists). Median follow-up time was 1591 days. CMR diagnosis was “myocarditis” in 28.8%, “normal” in 55.6% and “other pathology” in 15.6%. Normal CMR was defined as normal left ventricular (LV) volumes and normal left ventricular ejection fraction (LV-EF) in the absence of late Gadolinium Enhancement (LGE). The overall mortality was 3.2%. There were seven cardiac deaths during follow-up, in addition one aborted SCD and two patients had appropriate internal cardioverter defibrillator (ICD) shocks – all of these occurred in patients with abnormal CMR. Kaplan-Meier analysis with log-rank test showed significant difference for major adverse cardiac events (cardiac death, sudden cardiac death (SCD), ICD discharge, aborted SCD) between patients with normal and abnormal CMR (p = 0.0003).ConclusionIn our unselected population of consecutive patients referred for CMR work-up of clinically suspected myocarditis, patients with normal CMR have a good prognosis independent of their clinical symptoms and other findings.

The value of cardiovascular magnetic resonance for diagnosis of viral myocarditis

Endocardial myocardial biopsy is the gold standard in the diagnosis of viral myocarditis.However,the limitations of sampling to the low sensitivity,and invasive inspection methods limit its clinical application.The traditional diagnostic tool electrocardiography,laboratory values and echocardiography are lack of specificity.Thus,a non-invasive diagnostic approach with high sensitivity is in need.Cardiovascular magnetic resonance(CMR) can evaluate the function of the heart parameters,such as left ventricular function and regional wall motion,and various CMR imagings including T2-weighted imaging,and early- and late-contrast enhanced T1-weighted imaging can evaluate the hyperemia,oedema and necrosis of myocardial inflammation histological character.CMR provides a scientific basis for the diagnosis of viral myocarditis in clinical. Key words: Viral myocarditis; Diagnosis; Endomyocardial biopsy; Cardiovascular magnetic resonance

Cardiovascular magnetic resonance for diagnosis of coronary artery disease: quo vadis?

Cardiovascular magnetic resonance imaging (CMR) has emerged as a potential modality for the diagnosis and risk stratification of patients with documented or suspected coronary artery disease. As such, it may be used as an alternative to other accepted noninvasive modalities. In the Clinical Evaluation of Magnetic Resonance Imaging in Coronary Heart Disease (CE-MARC) study, Greenwood et al. enrolled 752 patients with suspected angina pectoris and at least one cardiovascular risk factor, and evaluated the diagnostic accuracy of multiparametric CMR and single photon emission computed tomography (SPECT), and compared them with invasive coronary angiography as the reference standard. The authors reported significantly higher sensitivity and negative predictive values for CMR (86.5 and 90.5%, respectively) compared with SPECT (66.5 and 79.1%, respectively) and recommended that CMR be used more frequently than at present for the investigation of coronary artery disease. This robustly designed landmark trial certainly adds to the already impressive diagnostic data available with CMR in such patients, but being a new technique, it lacks the large outcome data available with SPECT. In summary, the results of this study confirm the promise for CMR, but further work and larger multicenter studies are required before its adoption into routine clinical practice.

Usefulness of Pericardial Effusion as New Diagnostic Criterion for Noninvasive Detection of Myocarditis

Cardiovascular magnetic resonance (CMR) imaging holds promise for diagnosing myocarditis in vivo. The CMR diagnosis of myocarditis is determined by the ventricular morphology/function, late gadolinium enhancement, and T(2)-weighted imaging for myocardial edema. However, in routine clinical practice, we encounter patients with suspected myocarditis in the absence of left ventricular dysfunction, myocardial edema, or late gadolinium enhancement. In the present study, we sought to determine whether the presence of pericardial effusion could serve as a new diagnostic criterion and improve the sensitivity of CMR imaging to detect myocarditis. A total of 35 consecutive patients with biopsy proven virus-associated myocarditis, onset of clinical symptoms within the past 3 months, and normal left ventricular function were enrolled in the present study. All patients underwent echocardiography, CMR imaging, and endomyocardial biopsy for workup of myocarditis. Late gadolinium enhancement was present in 16 patients (46%). Myocardial edema on T(2)-weighted imaging was present in 4 patients, but in just 1, it was the only abnormal finding. Pericardial effusion was present in 14 patients (40%). In 7 patients with myocarditis (20%), pericardial effusion was the only abnormal finding. Pericardial effusion, used as an additional diagnostic criterion, improved the sensitivity of CMR imaging for myocarditis from 46% to 66% (p = 0.023). In conclusion, pericardial effusion detected by CMR imaging might serve as a new diagnostic criterion for the noninvasive diagnosis of myocarditis in patients with recent onset of clinical symptoms and normal left ventricular function.

Type B aortic dissection in a patient with unknown left ventricular non-compaction cardiomyopathy: Cardiovascular magnetic resonance diagnosis

A 61-year-old man was referred at our hospital for a cardiac evaluation after an episode of oppressive chest pain at rest. He was discharged with a MRI diagnosis of non-compaction cardiomyopathy presented with typical angina, left ventricle dysfunction and ischemic EKG findings without atherosclerotic narrowing and also with a type B aortic dissection, documented also by computed tomography.

Comprehensive cardiovascular magnetic resonance for diagnosis of cardiac hydatid cyst

A 54-year-old woman was referred for palpitation and dyspnoea on exertion. The 12-lead ECG and physical exam were unremarkable. Transthoracic echocardiography revealed a cystic mass located at the apical and lateral region of the left ventricle. Because exact location, extent, and tissue composition of the mass were unclear, the patient underwent cardiovascular magnetic resonance (CMR) (1.5 T Siemens Symphony®, Erlangen, Germany). …