Role Of Cardiovascular Magnetic Resonance Research Articles

The Value of Cardiovascular Magnetic Resonance in Heart Transplant Patients.

Heart transplant patients present a unique set of anatomical and pathophysiological considerations. Patients often present non-specifically, requiring a low index for further investigation. Accurate assessment with standard imaging modalities can be difficult, and cardiovascular magnetic resonance (CMR) is becoming an increasingly useful modality in the assessment of heart transplant patients. This review describes the anatomy of the transplanted heart and typical CMR appearances and discusses the role of CMR in heart transplant disease.

The role of cardiovascular magnetic resonance in sudden death risk stratification in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is the most common cause of sudden death in young patients, but current risk stratification strategies do not identify all patients at risk. Contrast-enhanced cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) can identify areas of abnormal myocardial substrate comprising fibrosis, the structural nidus for potentially life-threatening ventricular arrhythmias. More recently, follow-up studies have demonstrated a strong relationship between extent of LGE in patients with HCM and increased risk of adverse disease-related events, including sudden death.

Role of cardiovascular magnetic resonance in acute coronary syndrome.

Acute coronary syndrome (ACS) represents a life-threatening manifestation of atherosclerosis, which usually occurs in the setting of sudden plaque erosion or rupture with intracoronary thrombosis and partial to complete cessation of the downstream myocardial perfusion.1 The diagnosis, management, and treatment of the various forms of ACS, which include persistent ST-segment elevation myocardial infarction (MI), non-ST-segment elevation MI, and unstable angina (UA), have rapidly been evolving in recent years with subsequently a significant decrease in early and late mortality.2–4 Nevertheless, large multicenter studies have shown despite early and successful reperfusion and optimized medication, the actual hospital mortality remains approximately 7%, not mentioning the evolution towards ischemic heart failure in a considerable number of surviving patients.5 The current diagnostic tools - i.e., blood biomarkers (e.g. troponin), electrocardiography, and ultrasonography - are key tools in the diagnosis of ACS and fast patient triage, but these markers provide only a partial insight in the complex, evolving processes occurring in the jeopardized myocardium.6 Moreover, patients with ACS encompasses a broad and heterogeneous population and many patients with acute chest pain turn out not to have ACS. The accurate diagnosis and differentiation of ACS from other acute cardiac diseases (e.g. aortic dissection, pulmonary embolism, myocarditis, Takotsubo cardiomyopathy) which is essential for therapeutic decision making and specific therapies (e.g. timely reperfusion) may be challenging or even impossible with the above diagnostic tools. Cardiovascular magnetic resonance (CMR) imaging offers the cardiologist a comprehensive view on ACS at the tissue level (e.g. edema, necrosis, microvascular injury, hemorrhage) and may add important information for the diagnosis and differential diagnosis of ACS. As recent studies have demonstrated CMR-derived parameters yield independent prognostic value in addition to traditional risk factors, CMR may be also important for patient risk stratification. Despite the diagnostic and prognostic utility of CMR in ACS many cardiologists are not yet familiar with this fascinating and clinical helpful imaging modality. The aim of this review is therefore to elucidate the role of CMR in this group of cardiac high-risk patients.

11 The impact of cardiac magnetic resonance viability assessment on the management of patients with ischaemic heart disease and left ventricular dysfunction: Abstract 11 Table 1

Background Identifying patients with ischaemic left ventricular dysfunction that would benefit from revascularisation is challenging. The aim of this study was to investigate the role of cardiovascular magnetic resonance (CMR) imaging in the decision making process in patients being considered for revascularisation. Methods All patients referred for CMR viability assessment at a regional centre were identified retrospectively between January 2011 and March 2013. Patient records were reviewed to determine the revascularisation strategy and patient outcomes. Results 324 consecutive patients were identified, of which 256 were being considered for revascularisation. The remainder were undergoing viability assessment for other reasons. Of the patients being considered for revascularisation, 38 (14%) had preserved left ventricular (LV) systolic function, 33 (17%) mild LV dysfunction, 77 (28%) moderate LV dysfunction and 108 (40%) severe LV dysfunction. Of the patients with severe LV dysfunction 22 subsequently underwent coronary artery bypass grafting (CABG), 30 had percutaneous coronary intervention (PCI) and the remaining 56 patients were managed medically. Patient characteristics and outcomes at the end of the follow-up period (median, 28 months) are detailed in Table 1. Death from any cause occurred in 3 (14%) patients in the CABG group, 4 (13%) in the PCI group and 14 (25%) in the medical-therapy group (p = 0.32). Hospitalisation for cardiac causes occurred in 1 patient (5%) in the CABG group, 1 (3%) in the PCI group and 28 (50%) in the medical-therapy group (p Conclusions Patients undergoing surgical revascularisation had significantly less adverse remodelling than those managed with PCI or medical therapy. Patients undergoing CABG with viability prior to revascularisation demonstrated good outcomes, similar to those undergoing PCI. The medical therapy group had a significantly higher number of non-viable segments and outcome was poor.

Imaging in HF-PEF with Cardiovascular Magnetic Resonance

Heart failure with preserved ejection fraction (HFPEF) represents up to 50 % of all patients with heart failure. Cardiac imaging modalities play a central role in the evaluation of this syndrome. Cardiovascular magnetic resonance (CMR) offers alternative and complementary applications to echocardiography for the evaluation of systolic and diastolic function. This report aims to highlight the potential role of CMR to identify specific aetiologies in HFPEF syndrome and to review the available CMR modalities for the evaluation of diastolic dysfunction.

The role of imaging in hypertensive heart disease.

Hypertensive heart disease (HHD) describes a spectrum of target organ response that includes left ventricular hypertrophy, systolic, and diastolic dysfunction. A variety of imaging techniques can be used to assess the various aspects of HHD. Echocardiography has for many years been the main imaging technique in the evaluation of HHD, but there is an increasing role for cardiovascular magnetic resonance (CMR) imaging due to its ability to provide an unrestricted field of view and noninvasive tissue characterization. This article reviews the current role of imaging for HHD with particular focus on echocardiography and CMR applications.

Safety and feasibility of dobutamine stress cardiac magnetic resonance for cardiovascular assessment prior to renal transplantation

Current guidelines recommend cardiovascular risk assessment prior to renal transplantation. There is currently no evidence for the role of cardiovascular magnetic resonance (CMR) in this population, despite an established evidence base in the non-chronic kidney disease (CKD) population. Our aim is to determine the feasibility and safety of dobutamine stress CMR (DSCMR) imaging in the risk stratification of CKD patients awaiting renal transplantation. CKD patients who were deemed at high risk for coronary artery disease (CAD) and awaiting renal transplantation underwent DSCMR. Forty-one patients whose median age was 56 years (range 28–73 years) underwent DSCMR. Nineteen were undergoing haemodialysis, 10 peritoneal dialysis and 12 pre-dialysis. The aetiology of the renal failure was diabetes mellitus in 29%, glomerulonephritis in 24%, hypertension in 22% and autosomal dominant polycystic kidney disease in 10%. Thirty-eight patients (93%) achieved the end point, either positive for ischaemia or negative, achieving at least 85% of age-predicted heart rate. Two of them did not achieve target heart rate and one was discontinued because of severe headache. Of the 38 patients who achieved the end point, 35 (92%) were negative for inducible wall motion abnormalities and four (10%) were positive. There were no serious adverse effects. DSCMR is a well tolerated and viable investigation for the cardiovascular risk stratification of high-risk CKD patients prior to renal transplantation. DSCMR already has an established evidence base in the non-CKD population with superiority over other noninvasive techniques. Larger studies with outcome data are now required to define its true utility in the CKD population.

The Role of Cardiac Magnetic Resonance Imaging in Patients with Ischemic Heart Disease

Over the last decade, cardiovascular magnetic resonance (CMR) imaging has emerged as a powerful non-invasive imaging modality with pivotal role in the evaluation and management of patients with coronary artery disease. In particular, it quantifies ventricular function, detects myocardial ischemia and scar, visualizes myocardial edema and hemorrhage. CMR provides high resolution images that are not limited by acoustic window, and without the use of radiation or iodine contrast, hence being an attractive alternative to other non-invasive modalities. In this paper we present four different cases illustrating the role of CMR in the diagnosis of patients with known or suspected coronary artery disease, how it provides prognostic information and may guide or alter the management.

Congenital muscular diverticulum of the left ventricular apex

We report the incidental finding of a muscular congenital diverticulum of the left ventricular apex in a young adult with AV node reentry tachycardia. The role of cardiovascular magnetic resonance in the differential diagnosis of this rare cardiac malformation is briefly discussed.

Role of Cardiac MRI in Diabetes

Diabetes and insulin resistance have a variety of detrimental effects on cardiovascular health and outcomes. Cardiac magnetic resonance offers a non-invasive means to obtain many layers of information at a tissue level, including fibrosis, edema, intramyocardial motion, triglyceride content, and myocardial energetics. The role of cardiovascular magnetic resonance is particularly important in the evaluation of recognized and unrecognized coronary artery disease. In this review, we address the current state-of-the-art in cardiac magnetic resonance imaging - for both clinical and investigational use - as it applies to diabetic cardiovascular disease.

Role of cardiovascular magnetic resonance in assessment of acute coronary syndrome.

Cardiovascular disease (CVD) is the leading cause of death in the western world and is becoming more important in the developing world. Recently, advances in monitoring, revascularisation and pharmacotherapy have resulted in a reduction in mortality. However, although mortality rates have declined, the burden of disease remains large resulting in high direct and indirect healthcare costs related to CVDs. In Australia, acute coronary syndrome (ACS) accounts for more than 300000 years of life lost due to premature death and a total cost exceeding eight billion dollars annually. It is also the main contributor towards the discrepancy in life expectancy between indigenous and non-indigenous Australians. The high prevalence of CVD along with its associated cost urgently requires a reliable but non-invasive and cost-effective imaging modality. The imaging modality of choice should be able to accelerate the diagnosis of ACS, aid in the risk stratification of de novo coronary artery disease and avail incremental information of prognostic value such as viability which cardiovascular magnetic resonance (CMR) allows. Despite its manifold benefits, there are limitations to its wider use in routine clinical assessment and more studies are required into assessing its cost-effectiveness. It is hoped that with greater development in the technology and imaging protocols, CMR could be made less cumbersome, its imaging protocols less lengthy, the technology more inexpensive and easily applied in routine clinical practice.

Cardiovascular Magnetic Resonance in Rare Systemic Diseases

The heart may be involved in a number of systemic syndromes. The pericardium, myocardium, heart valves, and coronary arteries may be involved either singly or in various combinations. In most cases the cardiac manifestations are not the dominant feature, but in some it is the primary determinant of symptoms and survival. Both the early identification of cardiac involvement and the etiology underneath is of paramount importance, as some causes require specific treatment and may be correctable. In this respect non-invasive imaging plays a central role especially in the context of rare cardiac disease, where specific imaging features can help to make the appropriate diagnosis on a substantial proportion of them, enabling the physician to choose the best management strategy tailored to the disease. Whereas echocardiography is the firstline investigation for detecting a cardiac involvement in systemic disease, cardiovascular magnetic resonance (CMR) provides additional incremental data allowing in addition to a detailed examination of cardiac structure and function also the tissue characterization. The aim of this review is therefore to delineate the role of CMR in detecting cardiac involvement in patients with rare systemic diseases and delineate the specific imaging features of the different etiologies.

The emerging role of cardiovascular magnetic resonance in the evaluation of Kawasaki disease

Kawasaki disease (KD) is a vasculitis affecting the coronary and systemic arteries. Myocardial inflammation is also a common finding in KD post-mortem evaluation during the acute phase of the disease. Coronary artery aneurysms (CAAs) develop in 15-25% of untreated children. Although 50-70% of CAAs resolve spontaneously 1-2 years after the onset of KD, the remaining unresolved CAAs can develop stenotic lesions at either their proximal or distal end and can develop thrombus formation leading to ischemia and/or infarction. Cardiovascular magnetic resonance (CMR) has the ability to perform non-invasive and radiation-free evaluation of the coronary artery lumen. Recently tissue characterization of the coronary vessel wall was provided by CMR. It can also image myocardial inflammation, ischemia and fibrosis. Therefore CMR offers important clinical information during the acute and chronic phase of KD. In the acute phase, it can identify myocardial inflammation, microvascular disease, myocardial infarction, deterioration of left ventricular function, changes of the coronary artery lumen and changes of the coronary artery vessel wall. During the chronic phase, CMR imaging might be of value for risk stratification and to guide treatment.

The Role of Cardiovascular Magnetic Resonance (CMR) and Computed Tomography (CCT) in Facilitating Heart Failure Management

Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) offer advantages for detecting left or right ventricular dysfunction in patients with or suspected of heart failure. CMR does not expose patients to ionizing radiation, and thus is well-suited for functional assessments and serial studies. CCT provides high spatial resolution, making it useful for the identification of coronary arteriosclerosis associated with ischemic cardiomyopathy. In this review, the clinical applications of CMR and CCT are individually discussed, with comparisons made between them to examine the strengths of each modality. The major techniques for each modality are outlined, as well as their uses for the evaluation of cardiomyopathy in heart failure patients with reduced left ventricular ejection fraction, preserved left ventricular ejection fraction, and valvular heart disease. Finally, we review the utility of CMR and CCT in determining which patients will benefit from cardiac resynchronization therapy.

Cardiac involvement in Becker muscular dystrophy: role of cardiovascular magnetic resonance

We report the case of a 40-year-old male known carrier of the Becker muscular dystrophy (BMD) who presented with fatigue in the outpatient clinic. Echocardiographic examination revealed a regional inferior left ventricular (LV) wall motion abnormality (Supplementary data online, Movie S1 ). A cardiovascular magnetic resonance imaging study (CMR) was indicated, showing …

Role of Cardiovascular Magnetic Resonance in Takotsubo Cardiomyopathy

Cardiac MRI (CMR) has become an important tool in the diagnosis of cardiomyopathies. CMR is a unique tool for further evaluating and characterizing patients with takotsubo cardiomyopathy (TTC) and studying the underlying causes and pathophysiologic mechanisms of TTC. Using CMR, regional wall motion abnormalities, right ventricular involvement, intraventricular thrombi, and reversible myocardial injury (inflammation or ischemic edema) or irreversible myocardial injury (necrosis or fibrosis) can be detected in patients presenting with TTC. CMR imaging can distinguish between acute myocardial infarction and TTC.

Cardiac fibro-fatty masses in tuberous sclerosis: role of cardiovascular magnetic resonance

A 19-year-old male with tuberous sclerosis (TS) was referred to the outpatient clinic of cardiology for the follow-up of cardiac rhabdomyomas. The diagnosis of TS was established in childhood based on the presence of large biventricular cardiac rhabdomyomas, epilepsy, and mental retardation. Magnetic resonance imaging of his brain showed tuberomas, hamartomas, and subependymal nodules. There was no involvement of other organs. The patient was asymptomatic and his examination was unremarkable. His ECG and Holter were normal. The …

Role of cardiovascular magnetic resonance in the differential diagnosis of cardiomyopathies

Cardiovascular magnetic resonance (CMR) is a unique diagnostic imaging tool for the assessment of cardiomyopathies, allowing a non-invasive detection of the most common diseases of the heart muscle. In the real world, patients with suspected cardiomyopathies who show signs and symptoms of heart failure should undergo a thorough diagnostic evaluation. Besides clinical and echocardiographic assessment, coronary angiography is the most important and common examination performed to detect or rule out coronary artery disease. This approach is relevant for the clinical decision-making, as it may obviate the need for further diagnostic evaluation of the heart structure and muscle function. CMR can reliably detect a variety of heart muscle diseases without requiring bioptic confirmation of the diagnosis. In addition, CMR provides anatomo-functional information that possesses incremental and independent prognostic value. This represents a new paradigm shift as it moves the attention from the coronary arteries to the heart muscle. CMR is useful in establishing the correct diagnosis of several clinical conditions and cardiomyopathies, thus guiding therapeutic strategies and influencing patient prognosis.

Letter by Hamilton-Craig et al Regarding Article, “Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology”

To the Editor: Assomull et al1 present encouraging data for the role of cardiovascular magnetic resonance (CMR) for noninvasive testing in patients with heart failure of unknown etiology. We agree with the many of the findings in this article, and have adopted a similar approach by using CMR for first-line evaluation of patients newly diagnosed with heart failure at our quaternary referral and transplant center. However, we would draw referring clinicians' attention to the fact that a CMR showing severe …

Response to Letter Regarding Article, “Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology”

We thank Dr Hamilton-Craig and colleagues for their insightful remarks regarding our work. We concur with their assertion that “the absence of late gadolinium enhancement does not necessarily obviate the need to image coronary arteries,” because a small proportion (0%–7.1%) of patients will have global hibernation secondary to proximal severe coronary artery disease (CAD) without infarction.1,2 In their own study, revascularization in these patients resulted in improved outcome stemming from augmented ventricular function.2 For precisely this reason, our protocol used magnetic …