Short-axis Plane Research Articles

Place de l’écho-Doppler cervico-encéphalique dans l’ischémie cérébrale

Carotid stenosis is a common cause of ischemic stroke. The management of patients with a carotid lesion is mainly based on the degree of stenosis. Ultrasonography is a reliable and accurate method of quantification of the stenosis. The sonographic quantification is based on both velocity and morphological criteria. B mode, color or power Doppler as well as spectral Doppler are used for this purpose. The actual velocity criteria for a 70% stenosis (NASCET definition) are as follows: maximal systolic velocity above 230 cm.s-1, telediastolic velocity above 100 cm.s-1, carotid ratio above 4. The morphological quantification of the stenosis relies on Doppler imaging and B-mode coupling. With ultrasound, the residual area can be measured using a short axis plane, and the diameter reduction using a longitudinal plane. The different parameters provide complementary information that must be in agreement with one another. There is a growing interest in plaque characterization. Undoubtedly plaque structure and surface appearance also play a role in the individual risk of stroke. Thus, B-mode plaque analysis must be an integral part of the ultrasonographic examination. Transcranial Doppler is a complementary investigation that can be used to evaluate the hemodynamic consequences of the stenosis and to look for intracranial lesions. Optimal sonographic examination currently allows comprehensive evaluation of a carotid lesion.

Usefulness of Three-Dimensionally Guided Assessment of Mitral Stenosis Using Matrix-Array Ultrasound

Two-dimensional (2-D) planimetry is limited by the technical demands, time, and observer variability required to locate the minimal orifice area, limiting the confident clinical reporting of mitral valve area (MVA). In 27 consecutive patients, MVA was determined independently by 2 observers using the conventional 2-D method and a new 3-D-guided method. Using a matrix-array probe, the valve was visualized in a long-axis view and a cursor steered to intersect the leaflet tips and provide a perpendicular short-axis plane viewed side-by-side. Two-dimensional and 3-D-guided methods allowed planimetry in 24 patients. Consistent with better orifice localization, 3-D guidance eliminated the overestimation of internal orifice diameters in the planimetered short-axis view relative to the limiting diameter defined by the long-axis view (for 3-D guidance, 0.73 +/- 0.20 vs 0.73 +/- 0.21 cm, p = 0.98, vs 0.90 +/- 0.27 cm in the 2-D short-axis view, p <0.01). Accordingly, mean values for the smallest orifice area by 3-D guidance were less than by 2-D imaging (1.4 +/- 0.5 vs 1.5 +/- 0.5 cm(2), p <0.01), changing the clinical severity classification in 11 of 24 patients (46%). The 2-D method also overestimated MVA relative to 3-D guidance compared with Doppler pressure halftime and (n = 6) Gorlin areas. Phantom studies verified no differences in resolution for the 2 acquisition modes. Three-dimensional guidance reduced intraobserver variability from 9.8% to 3.8% (SEE 0.14 to 0.06 cm(2), p <0.01) and interobserver variability from 10.6% to 6.1% (SEE 0.15 to 0.09 cm(2), p <0.02). In conclusion, matrix-array technology provides a feasible and highly reproducible direct 3-D-guided method for measuring the limiting mitral orifice area.

Estimation of Right Ventricular Mass by Two-dimensional Echocardiography

This report describes two original echocardiographic approaches to measure right ventricular (RV) mass (RVM). In the bullet formula (5/24 pi D1 D2 L), where D1 and D2 are short axes and L the log axis, the RVM is obtained by subtracting the cavity volume from the RV total volume and subsequently multiplying the difference by myocardium density. The second method uses 3 endocardium segments measured at: (1) short axis plane of the aortic valve and left atrium (b1); (2) short axis plane at the midpoint between the tricuspid valve annulus and the apex (b2); and (3) 4-chamber view (h). Those segment lengths are applying in the formula A = [(b1 + b2)/2] x h. The result is multiplied by the wall thickness and by myocardium density. Both formulas were primarily tested in 30 mongrel dogs and have shown good correlation with the true mass ( r = 0.869 with the segments formula and r = 0.819 with the bullet formula). The same method was used in 20 human patients before heart transplant with similar results ( r = 0.810 with the segments formula and r = 0.836 with the bullet formula). The RVM can be satisfactorily estimated by 2-dimensional echocardiography. The linear regression between the calculated mass (using the smoothest and thinner myocardium thickness) and the actual mass may provide the correction factor for the RVM calculation. Two echocardiographic methods were used to measure right ventricular mass. One of them used a bullet formula variant (5/24 pi D1 D2 L). The second method used 3 endocardium segments measured in 3 2-dimensional echocardiographic planes (short axis of aortic valve and left ventricle, and 4-chamber view), and applied in the formula A = [(b1 + b2)/2] x h. Both formulas have shown good correlation with the true mass in 30 mongrel dogs ( r = 0.869 with the segments formula and r = 0.819 with the bullet formula) and in 20 human patients before heart transplant ( r = 0.810 and r = 0.836, respectively).

Operator Induced Variability in Cardiovascular MR: Left Ventricular Measurements and Their Reproducibility

To assess the intra- and inter-operator variability of the manual planning of cardiovascular magnetic resonance imaging and to evaluate the influence of these factors on the functional parameters of the left ventricle (LV). The study population consisted of 10 healthy volunteers. For each subject the manual planning of the short-axis cine acquisitions was carried out twice by one operator and once by a second operator. Left ventricular volume, mass, and function were manually evaluated twice by one experienced observer, resulting in an approximation of the intra-observer variability factor. The intra- and inter-operator variation factors were estimated as the difference between the total and intra-observer variation components. LV end-diastolic volume varied by 3.3% and 4.16%, and LV end-systolic volume by 5.84% and 6.23% for intra- and inter-operator studies, respectively. The variability for LV mass at end-diastole was equal to 4.23% in both studies. For the ejection fraction the variability was 3.56% and 2.97% for intra- and inter-operator studies, respectively. Comparison of reproducibility between intra- and inter-operator studies resulted in insignificant statistical differences. Bland-Altman limits of agreements revealed no systematic bias in differences between measurements with respect to their means. Reliability of the planning expressed as the angular deviation of the short-axis imaging planes amounts to 2.67 -/+ 1.5 degrees and 4.99 +/- 2.17 degrees for the intra-operator and inter-operator studies, respectively. For EDV, ESV, and EF approximately 75-80% of the total variation can be explained by the within or between operator variation, while the same percentage is 60% for LVM. Our study confirms the excellent inter- and intra-operator reproducibility of the cardiovascular magnetic resonance measurements of the left ventricular volumes and mass in a group of healthy volunteers.

Right Ventricular Function after Pulmonary Valve Replacement in Patients with Tetralogy of Fallot

To assess the time course of right ventricular (RV) function improvement after pulmonary valve replacement (PVR) in patients 25.2 years +/- 7.0 after repair of tetralogy of Fallot. The medical ethics committee approved this study, and informed consent was obtained. Cardiac magnetic resonance (MR) imaging was performed before, 7 months after, and 19 months after PVR in 25 consecutive patients with tetralogy of Fallot with a 1.5-T MR imager. RV function was assessed with gradient-echo sequences in the short-axis plane. Pulmonary flow was assessed with a velocity-encoded phase-contrast sequence. Paired t test was used to evaluate follow-up data. Independent samples t test was used to assess differences based on the presence of recurrent pulmonary regurgitation (PR). Mean indexed RV end-diastolic volume decreased from 166.9 mL/m(2) +/- 41.3 before PVR to 113.5 mL/m(2)+/- 35.7 (P < .001) at 7-month follow-up and 111.7 mL/m(2)+/- 41.1 (P = .46) at 19-month follow-up. The RV ejection fraction was corrected for PR and improved from 25.0% +/- 7.7 before surgery to 44.1% +/- 11.9 (P < .001) and 45.2% +/- 11.1 (P = .39), at 7- and 19-month follow-up, respectively. Recurrent PR after PVR was found in 11 patients; 14 patients did not have recurrent PR. Total reduction of indexed RV end-diastolic volume at 19 months follow-up was more prominent in patients who did not have recurrent PR than in patients who did have recurrent PR (P < .05). Furthermore, improvement of RV ejection fraction corrected for regurgitation was more marked in patients who did not have recurrent PR than in patients who did have recurrent PR (P < .05). In patients with tetralogy of Fallot, RV function improves rapidly after PVR and is sustained at 19-month follow-up in most patients; however, recurrence of PR after PVR appears to reduce recovery of RV systolic function.

Elasticity imaging of atheroma with transcutaneous ultrasound both in longitudinal-axis and short-axis planes

This paper describes a noninvasive method for evaluating regional viscoelasticity of the arterial wall in which a novel method is applied to measure minute changes in wall thickness caused by the change in internal pressure. (1) By comparing the pathological findings with the elasticity distribution, statistical parameters for lipid and a mixture of smooth muscle and collagen fibers can be determined. By applying the method to the common carotid arteries, thin collagen fiber was clarified and soft inclusion of lipid in plaque was detected. (2) A new beam steering method was proposed to apply the above method to the plane, which is perpendicular to the axis of the artery. (3) For improvement of classification of tissue, a method was proposed to measure viscosity by generating the change in internal pressure using the external actuation from the skin surface, namely remote actuation. These methods offer the potential for detection of plaque vulnerability in a clinical setting.

Realignment of myocardial first-pass MR perfusion images using an automatic detection of the heart-lung interface.

Magnetic resonance first-pass imaging of a bolus of contrast agent is well adapted to distinguish normal and hypoperfused areas of the myocardium. In most cases, the signal intensity-time curves in user defined regions of interest (ROI) are studied. As image acquisition is ECG-gated, the images are acquired at the same moment in the cardiac cycle, and the basic shape of the heart is similar from one view to the next. However, superficial respiratory motion can displace the heart in the short-axis plane. The aim of this study is to correct for the respiratory motion of the heart by performing an automatic realignment of the myocardial ROI based on a method tracking the movement of the lung-myocardium interface. Visual and quantitative analyses performed on 120 curves show a very good concordance between two automatic methods and the manual one.

Cross-Sectional Elasticity Imaging of Carotid Arterial Wall in Short-Axis Plane by Transcutaneous Ultrasound

We have developed the phased tracking method [H. Kanai, M. Sato, Y. Koiwa and N. Chubachi: IEEE Trans. UFFC 43 (1996) 791.] for measuring the minute change in thickness during one heartbeat and the elasticity of the arterial wall with transcutaneous ultrasound. When this method is applied to a plane perpendicular to the axis of the artery (short-axis plane) using a linear-type probe, only an ultrasonic beam which passes through the center of the artery coincides with the direction of the change in thickness. At other beam positions, the wall motion cannot be accurately tracked because the direction of wall expansion slips off the beam. To obtain the cross-sectional image of elasticity in the short-axis plane using transcutaneous ultrasound, in this paper, the directions of ultrasonic beams are designed so that each beam always passes through the center of the artery; thus, they always coincide with the direction of the wall expansion. In basic experiments, the accuracy in elasticity measurement was evaluated using a silicone rubber tube. In in vivo experiments, the minute change in wall thickness was measured along each ultrasonic beam, and the cross-sectional image of elasticity was obtained in the short-axis plane with transcutaneous ultrasound.

Combined Long? and Short?Axis Myocardial Perfusion Cardiovascular Magnetic Resonance

To date, myocardial perfusion cardiovascular magnetic resonance (CMR) has been reported in single and multiple short-axis slices. Three short-axis planes can assess 16 segments of the standard 17-segment myocardial model, but this approach fails to assess the ventricular apex that requires at least one long-axis plane. We therefore evaluated the feasibility and benefit of combined long- and short-axis perfusion CMR to enable complete 17 segments coverage for comprehensive myocardial perfusion assessment. Using a hybrid echo planar imaging (EPI) sequence, we performed rest and adenosine stress first-pass perfusion CMR studies with 3 short-axis (basal, mid, apical) planes, and additional long-axis planes in the same cardiac cycle in a broad range of cardiology patients. Perfusion CMR was performed in 53 consecutive patients using the combined short-long-axis imaging protocol. Twenty-nine of those studied had known or suspected coronary artery disease (CAD), 18 hypertrophic cardiomyopathy, and 6 suspected microvascular perfusion abnormalities. In 39 patients (70%), it was possible to acquire 5 slices at rest and stress including both the horizontal and vertical long axes. In 15 patients (27%), only one long-axis could be acquired, and in 2 patients (5%) only 3 slices (short axis) could be obtained. However, in none of the patients with known or suspected CAD was apical ischemia demonstrated by the long-axis views, despite apical ischemia having been demonstrated with recent SPECT studies in 8 of these patients. Rest-stress myocardial perfusion CMR is able to achieve complete segmental coverage of the myocardium using the combined short-long axis approach using an EPI sequence in 97% of a long series of consecutive cardiology patients, while maintaining excellent spatial resolution. However, the long-axis views were not found to be able to demonstrate inducible perfusion defects in the apex.

Myocardial Viability: Comparison of Free-Breathing Navigator-echo-gated Three-Dimensional Inversion-Recovery Gradient-Echo MR and Standard Multiple Breath-Hold Two-Dimensional Inversion-Recovery Gradient-Echo MR

Purpose: To compare a free-breathing, navigator-echo-gated, three-dimensional, inversion-recovery, gradientecho, MR pulse sequence (3D-MRI) with standard, multiple breath-hold, two-dimensional, inversion-recovery, gradient-echo MR (2D-MRI) for the evaluation of delayed hyperenhancement of nonviable myocardium in patients with chronic ischemic heart disease. Materials and Methods: Ten patients with chronic ischemic heart disease were enrolled in this study. MRI was performed on a 1.5-T system. 3D-MRI was obtained in the short axis plane at 10 minutes after the administration of Gd-DTPA (0.2 mmol/kg, 4 cc/sec). Prospective gating of the acquisition based on the navigator echo was applied. 2D-MRI was performed immediately after finishing 3D-MRI. The area of total and hyperenhanced myocardium measured on both image sets was compared with paired Student t-test and Bland-Altman method. By using a 60-segment model, the transmural extent and segmental width of the hyperenhanced area were recorded by 3-scale grading method. The agreement between the two sequences was evaluated with kappa statistics. We also evaluated the agreement of hyperenhancement among the three portions (apical, middle and basal portion) of the left ventricle with kappa statistics. Results: The two sequences showed good agreement for the measured area of total and hyperenhanced myocardium on paired t-test (p=0.11 and p=0.34, respectively). No systematic bias was shown on Bland-Altman analysis. Good agreement was found for the segmental width (ĸ=0.674) and transmural extent (ĸ=0.615) of hyperenhancement on the segmented analysis. However, the agreement of the transmural extent of hyperenhancement in the apical segments was relatively poor compared with that in the middle or basal portions. Conclusion: This study showed good agreement between 3D-MRI and 2D-MRI in evaluation of non-viable myocardium. Therefore, 3D-MRI may be useful in the assessment of myocardial viability in patients with dyspnea and children because it allows free-breathing during the examination.

Right ventricular wall motion abnormalities found in healthy subjects by cardiovascular magnetic resonance imaging and characterized with a new segmental model.

To evaluate right ventricular wall motion abnormalities in healthy subjects using a new segmental model for the right ventricle. 29 healthy subjects (9 female, 20 male, mean age 48.9+/-15 years) underwent cardiovascular magnetic resonance imaging (CMR; 1.5-Tesla Sonata, Siemens, Erlangen, Germany) for the evaluation of cardiac function and right ventricular wall motion. A steady-state free precession gradient-echo sequence (TrueFISP) was used. Right ventricular wall motion was analyzed, and the site of areas of disordered motion was classified according to the new segmental model. Such areas were seen in 27 (93.1%) of the 29 subjects. Dyskinesia was found in 22 subjects (75.9%), hypokinesia in 11 (37.9%), and bulging in 8 (27.6%). The number of wall motion abnormalities diagnosed was significantly higher in the transverse plane (86.2%) than in the short-axis plane (13.8%) and the horizontal longitudinal plane (41.4%; p = 0.000). Right ventricular wall motion abnormalities are one of the criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy. However, our findings indicate that they may also be seen around the insertion of the moderator band in healthy subjects, so that the significance of their presence at this site in patients undergoing diagnostic investigations for this disease should be interpreted with caution.

Left Ventricular Asynchrony Caused by an Intramuscular Lipoma

Routine chest x-ray of a 67-year-old woman revealed a mass contiguous with the cardiac silhouette. Echocardiogram located the mass in the anterior wall of the left ventricle. Magnetic resonance (MR) and computed tomography (CT) imaging showed a solitary mass with a clear margin resembling a balloon arising from myocardium of the left ventricle (Figure 1; Figure 2A and 2B). The mass extended from the left ventricular myocardium to the epicardial space. On CT, the nonenhanced mass showed low density with a mean CT value of -120 Hounsfield units (HU), which was compatible …

Aortic valve homograft regurgitation: Perivalvular or not?

Aortic valve homograft regurgitation: Perivalvular or not?

Analysis of global systolic and diastolic left ventricular performance using volume-time curves by real-time three-dimensional echocardiography

Background: Left ventricular (LV) volume-time curves (VTC) have been described to provide quantitative data on the dynamics of global LV performance beyond ejection fraction. However, generation of VTCs by conventional 2-dimensional imaging techniques is inherently limited because of inaccurate geometric volume assumptions. We, therefore, studied whether the new concept of volumetric scanning as realized by real-time 3-dimensional echocardiography (RT-3DE) can be used to provide accurate VTCs. Methods: In 30 healthy participants, VTCs were generated from 18 to 24 absolute LV volumes per second by transthoracic RT-3DE and compared with magnetic resonance imaging (MRI) used for reference. LVs were traced manually in 9 to 11 parallel, short-axis planes and volumes calculated by disk method. From VTCs, we determined peak ejection rate (PER), peak early filling rate (PFR), time to PER and PFR, and end-diastolic and end-systolic volumes. For initial clinical application, 2 patient groups of coronary (n = 15) and hypertensive heart disease (n = 16) were studied. Results: In healthy participants, VTCs agreed with MRI (mean errors: PER, −39 ± 67 mL/s; PFR, −18 ± 84 mL/s; time to PER, 8 ± 21 milliseconds; time to PFR 4 ± 18 milliseconds [not significant vs 0]) whereas VTCs in coronary and hypertensive groups revealed significantly impaired diastolic function. Scanning time for VTCs was only 1 to 2 minutes by RT-3DE and 8 ± 2 minutes by MRI (P <.001) and time for offline analysis was 22 ± 5 minutes versus 24 ± 4 minutes by MRI (not significant). Conclusions: Generation of VTCs by RT-3DE is feasible and shows excellent agreement with MRI used for reference. Thus, VTCs by RT-3DE is a promising new approach providing access to quantitative information on global LV performance such as LV filling rates that is currently unavailable for the cardiologist. (J Am Soc Echocardiogr 2003;16:29-37.)

Computational Modeling of Left Ventricle Dynamics and Flow Based on Ultrasonographic Data

A computational model combined ultrasonographic data and computational fluid dynamics (CFD) was developed and applied to an anatomically realistic model of the human left ventricle. The proposed methodology employs but not limited to ultrasonographic scans of a human left ventricle to obtain a set of time-varying images of morphology and dynamics of the left ventricle, which are utilized in generating a dynamic geometrical model for blood flow simulation. A so-called Two-Chamber-View modeling method has been proposed to obtain digitized anatomical images on two mutually orthogonal planes that cut through the left ventricle chamber along the long axis from base to apex, and from which two endocardial borderlines in the two planes are extracted for each time frame. Endocardial contours in the short-axis plane is approximated as an ellipse with two radii determined from the extracted endocardial borderlines in the two long-axis planes and stacked up from base to apex to generate a fully three-dimensional geometric model. Physiological conditions of inflow/outflow at orifices notionally representing the mitral and aortic vales are obtained also based on the ultrasonographic images by deriving flow rates at the orifices directly through calculating time-variation-rate of the left ventricle volume. Computational modeling of left ventricle hemodynamics is accomplished by using an in-house NS solver with specific modification for blood flow in heart chamber. The reconstructed CFD model well captures the three-dimensional dynamics of endocardial wall in terms of contraction and expansion phases in the left ventricle; and the dominant fluid dynamics involving vortices and swirls are simulated reasonably. Our computed results indicate that realistic modeling of both geometry and physiological conditions of left ventricle is of great importance in correctly predicting the behavior of the dominant vortex flow and their influence on the heart function.

3-D MRI assessment of regional left ventricular systolic wall stress in patients with reperfused MI.

The goal of this study was to assess the regional variations of end-systolic wall stress in patients with reperfused Q wave acute myocardial infarction (AMI), with the use of a three-dimensional (3-D) approach. Fifteen normal volunteers and fifty patients with reperfused AMI underwent cardiac MRI that used a short-axis fast-gradient-echo sequence. The end-systolic wall stress was calculated with the use of the Grossman formula with the radius and the wall thickness defined with a 3-D approach using the tridimensional curvature. The mean wall stress was significantly increased at each level of the short-axis plane only in patients with anterior AMI. When calculated at a regional level in patients with anterior AMI, wall stress significantly increased in anterior sector as well as normal sector. In patients with inferior AMI, wall stress significantly increased only in inferior and lateral sectors. In conclusion, the quantification of regional wall stress by cardiac MRI is better with the 3D approach than other methods for precise evaluation in patients with AMI. Despite early reperfusion, the wall stress remained high in patients with anterior AMI.

Myocardial blood flow measurements in rats with simple pulsing contrast echocardiography

Relationship between contrast intensity and ultrasound (US) pulsing interval has been utilized to quantify myocardial blood flow (MBF) during myocardial contrast echocardiography (MCE). We tested if an MCE method employing a simple pulsing sequence during intravenous contrast infusion has the ability to quantify MBF in rats. We performed MCE in 17 rats using a 5- to 12-MHz broadband transducer during microbubble infusion via the femoral vein. Acoustic density (AD) from the anterior wall of the left ventricle imaged in the short axis plane was plotted against the frame number after shortening the pulsing interval (PI) from 1:20 to 1:1 end-systolic ECG gating. The relation between AD and frame number was fitted to a decay function. The rate of the AD decay was decreased during dipyridamole infusion, but was increased by causing coronary stenosis. The AD during long PI imaging remained unchanged during the interventions. Estimated MBF by MCE after correction by heart rate exhibited a close correlation (r = 0.83) with the present “gold standard” of colored microsphere-derived MBF. Thus, the decay rate of the contrast intensity obtained with the high-frequency transducer after abrupt shortening of PI during intravenous microbubble infusion may provide for noninvasive measurement of MBF in rats. (E-mail: komori@kms.ac.jp)

Real-time 3-dimensional echocardiography imaging for right ventricular endomyocardial biopsy: A comparison with fluoroscopy

Real-time 3-dimensional (RT3D) echocardiography has the potential to precisely identify the position of an object in 3-dimensional space. Therefore, we hypothesized that RT3D echocardiography could rapidly facilitate accurate placement of a bioptome within the right ventricle and may offer advantages over a fluoroscopically guided approach. During 63 routine right ventricular biopsy procedures (total of 315 biopsy attempts) in 33 cardiac allograft recipients, the bioptome was initially guided against the intraventricular septum with the use of biplane fluoroscopy. Bioptome position was then evaluated by RT3D echocardiography by using the Volumetrics Model 1 with the transducer placed at the apex. Multiple long-axis and short-axis planes were simultaneously visualized and customized to identify the tip of the bioptome. Bioptome placement was prospectively classified as septal, free wall/septal junction, or free wall. Of the 36 patients studied, 33 (91%) had adequate RT3D images. Of 315 bioptome placements visualized by RT3D echocardiography after fluoroscopic placement, bioptome position against the septum was confirmed in 113 (36%), against the septal/free wall (anterior or posterior) junction in 140 (44%), against the free wall in 60 (19%), and in the coronary sinus in 2 (1%). RT3D echocardiography is readily feasible for use in the majority of transplant patients undergoing right ventricular endomyocardial biopsy. Visualization of the bioptome in multiple simultaneous planes allows accurate localization of the biopsy site. The potential for improved localization of the bioptome tip in the right ventricle may have important clinical implications for augmenting the efficacy of this procedure. (J Am Soc Echocardiogr 2001;14:927-33.)

Imaging longitudinal cardiac strain on short-axis images using strain-encoded MRI.

This article presents a new method for measuring longitudinal strain in a short-axis section of the heart using harmonic phase magnetic resonance imaging (HARP-MRI). The heart is tagged using 1-1 SPAMM at end-diastole with tag surfaces parallel to a short-axis imaging plane. Two or more images are acquired such that the images have different phase encodings in a direction orthogonal to the image plane. A dense map of the longitudinal strain can be computed from these images using a simple, fast computation. Simulations are conducted to study the effect of noise and the choice of out-of-plane phase encoding values. Longitudinal strains acquired from a normal human male are shown.

Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging—A pilot study

Background Anthracyclines are potent chemotherapeutics burdened by their cardiotoxicity. So far no marker to detect early cardiac damage exists. We tested the ability of magnetic resonance imaging (MRI) to show early changes in myocardial signal and cardiac function after anthracycline therapy. Methods Twenty-two patients with normal cardiac function were investigated by MRI before and 3 and 28 days after anthracycline chemotherapy. Contrast enhanced fast spin echo images were obtained to characterize myocardial enhancement. Left ventricular ejection fraction was measured by MRI in contiguous short-axis planes. Results All patients remained clinically stable. Ejection fraction decreased from 67.8% ± 1.4% to 58.9% ± 1.9% after 28 days (P < .05). The relative myocardial contrast enhancement increased from 3.8 ± 0.4 to 6.9 ± 1.1 (P < .01). An increase of the enhancement of >5 on day 3 compared with baseline predicted a significant loss of ejection fraction at 28 days (67.5% ± 2.8% to 51.4% ± 5.6%, mean difference 16.1% ± 6.6%; P < .05), whereas an increase of +5 was not associated with a significant loss of ejection fraction (67.6% ± 1.7% to 62.5% ± 1.4%, mean difference 4.1% ± 2.6%; P not significant). Conclusions MRI detects early changes in myocardial contrast and slightly deteriorating cardiac function in patients receiving anthracyclines. Larger patient cohorts and longer follow-up are needed to evaluate MRI as a predictor for anthracycline cardiotoxicity. (Am Heart J 2001;141:1007-13.)