The Salvaged Area at Risk in Reperfused Acute Myocardial Infarction as Visualized by Cardiovascular Magnetic Resonance Matthias G. Friedrich, Hassan Abdel-Aty, Andrew Taylor, Jeanette Schulz-Menger, ...Daniel Messroghli, Rainer Dietz In acutely reperfused myocardial infarction, the amount of salvaged myocardium contains important prognostic and therapeutic information. Cardiovascular magnetic resonance (CMR) has reliably visualized reversible myocardial injury, but patient data have been lacking. We studied 18 healthy control subjects and 92 patients by CMR 3 ± 3 days after acutely reperfused infarction. Using T2-weighted and contrast-enhanced techniques, respectively, we could visualize both reversible and irreversible myocardial damage in all patients. We found that reversible injury was transmural in all patients and exceeded the necrotic area by an absolute 16 ± 11%. The salvaged area at risk as an important marker can be reliably assessed in patients by CMR.
Cardiovascular magnetic resonance (CMR) has become the primary tool for noninvasive assessment of myocardial inflammation in patients with suspected myocarditis. The International Consensus Group on ...CMR Diagnosis of Myocarditis was founded in 2006 to achieve consensus among CMR experts and develop recommendations on the current state-of-the-art use of CMR for myocarditis. The recommendations include indications for CMR in patients with suspected myocarditis, CMR protocol standards, terminology for reporting CMR findings, and diagnostic CMR criteria for myocarditis (i.e., “Lake Louise Criteria”).
Hypertrophic cardiomyopathy (HCM) is the most common monogenic heart disease with a frequency as high as 1 in 200. In many cases, HCM is caused by mutations in genes encoding the different components ...of the sarcomere apparatus. Hypertrophic cardiomyopathy is characterized by unexplained left ventricular hypertrophy, myofibrillar disarray, and myocardial fibrosis. The phenotypic expression is quite variable. Although most patients with HCM are asymptomatic, serious consequences are experienced in a subset of affected individuals who present initially with sudden cardiac death or progress to refractory heart failure. The Hypertrophic Cardiomyopathy Registry study is a National Heart, Lung, and Blood Institute–sponsored 2,750-patient, 44-site, international registry and natural history study designed to address limitations in extant evidence to improve prognostication in HCM (NCT01915615). In addition to the collection of standard demographic, clinical, and echocardiographic variables, patients will undergo state-of-the-art cardiac magnetic resonance for assessment of left ventricular mass and volumes as well as replacement scarring and interstitial fibrosis. In addition, genetic and biomarker analyses will be performed. The Hypertrophic Cardiomyopathy Registry has the potential to change the paradigm of risk stratification in HCM, using novel markers to identify those at higher risk.
Abstract Cardiovascular magnetic resonance (CMR) has evolved from a pioneering research tool to an established noninvasive imaging method for detecting inducible myocardial perfusion deficits. In ...this consensus document, experts of different imaging techniques summarize the existing body of evidence regarding CMR perfusion as a viable complement to other established noninvasive tools for the assessment of perfusion and discuss the advantages and pitfalls of the technique. A rapid, standardized CMR perfusion protocol is described, which is safe, clinically feasible, and cost-effective for centers with contemporary magnetic resonance equipment. CMR perfusion can be recommended as a routine diagnostic tool to identify inducible myocardial ischemia.
Cardiac Magnetic Resonance Monitors Reversible and Irreversible Myocardial Injury in Myocarditis Anja Zagrosek, Hassan Abdel-Aty, Philipp Boyé, Ralf Wassmuth, Daniel Messroghli, Wolfgang Utz, Andre ...Rudolph, Steffen Bohl, Rainer Dietz, Jeanette Schulz-Menger This study aimed to assess the value of cardiovascular magnetic resonance (CMR) to monitor myocarditis-related myocardial injury over the course of the disease. Thirty six patients hospitalized with acute myocarditis were studied acutely and 18 ± 10 months later. Acutely, T2 signal was elevated in 86%, global T1-signal post-contrast in 80%, and late gadolinium enhancement (LGE) was present in 63%. At follow-up, ejection fraction increased from 56% to 62% while both T2 and global T1 decreased. LGE persisted in all but one patient. Thus, the time course of signal properties in the myocardium as assessed by CMR can differentiate acute from healed myocarditis.
Objectives We hypothesized that infarct transmurality assessed with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) predicts arrhythmic events in patients with chronic myocardial ...infarction. Background Patients with decreased left ventricular function due to chronic myocardial infarction are at increased risk for life-threatening arrhythmias related to infarcted tissue. LGE-CMR accurately detects infarct morphology. Methods We prospectively enrolled 52 patients with chronic myocardial infarction referred for primary preventive implantable cardioverter-defibrillator (ICD) implantation following MADIT (Multicenter Automatic Defibrillator Implantation Trial) study criteria. Using LGE-CMR, left ventricular volumes, function, and infarct morphology were assessed including calculation of total and relative infarct mass, infarct border, infarct border zone, and infarct transmurality. Results Patients were followed for 1,235 ± 341 days. The primary combined endpoint including appropriate device therapy (ICD discharge or antitachycardia pacing) or death from cardiac cause occurred in 16 individuals resulting in an annual event rate of 4.7%. Six patients received an appropriate shock, 7 patients received recurrent appropriate antitachycardia pacing for sustained ventricular tachycardia, and 3 patients died of cardiac cause. There was a significant association to relative infarct mass (38 ± 8% vs. 28 ± 14%, p = 0.02), infarct transmurality (24 ± 8 g vs. 16 ± 12 g, p = 0.02), and relative infarct transmurality (RIT) (63 ± 12% vs. 48 ± 23%, p = 0.01). In separate logistic regression models, no variable emerged as significant when combined with RIT. As a single effect, RIT emerged as a predictor of the primary endpoint (p = 0.02). A RIT cutoff at 43% resulted in a sensitivity of 88%, a specificity of 50%, a positive predictive value of 44%, and a negative predictive value of 90%. Conclusions In patients with chronic myocardial infarction scheduled for primary preventive ICD implantation, infarct transmurality as defined by LGE-CMR identifies a subgroup with increased risk for life-threatening arrhythmias and cardiac death.
The authors state in their discussion that "delayed enhancement of the lateral wall of the LV within the mid-myocardium portion represents a common feature in breast-cancer patients with ...trastuzumab-induced cardiomyopathy."
Abstract Background Cardiac involvement in Churg-Strauss vasculitis worsens the prognosis. Early detection is, therefore, warranted. Cardiac magnetic resonance (CMR) can visualize various forms of ...inflammatory changes in the myocardium. We tested whether CMR could elucidate cardiac damage in patients with biopsy-proven Churg-Strauss syndrome and clinical evidence of cardiac involvement. Methods and Results Eleven patients underwent a CMR protocol including cine imaging for left ventricular function in long axes, T2-weighted imaging for edema detection, and contrast-enhanced T1-weighting for early and late gadolinium enhancement. CMR detected various form of myocardial injury in all patients. Systolic left ventricular function was impaired in 6 patients. Mean left ventricular ejection fraction was 45 ± 15%. Left ventricular size was mildly enlarged (left ventricular end-diastolic volume index 94 ± 23 mL/m2 ). Edema was present in 4 cases; 7 patients had pericardial effusion. Six patients had increased early contrast uptake. CMR detected late enhancement lesions in 9 of 11 patients, even in those with normal left ventricular size and function. Conclusions CMR has the potential to detect myocardial injury in Churg-Strauss syndrome even when left ventricular function appears normal.
Training in cardiovascular MR (CMR) is an important topic in times of growing acceptance of the method for accurate diagnosis and management of cardiovascular disease. However, off-site training is ...becoming less acceptable with increasing cost and time pressures. We introduce a novel CMR network, capable of providing, remotely, part of CMR training and continuous expert support. By providing a technical and operational blueprint, we want to share our experience in building teaching networks.
Conceptual, technical, and content-related characteristics of our teaching methods are introduced. A total of 97 participants in traditional fellowship CMR teaching and novel module-based network teaching were surveyed to assess their CMR performance.
The number of hospitals in our CMR network increased from five in 2009 to 14 in 2014. A total of 79% of network hospitals conducted >100 CMR scans annually. Among these network hospitals are four small institutions (<400 beds), and five medium-sized hospitals (400-1,000 beds). Network teaching reduced off-site training to only five weeks. The time to the first independently conducted CMR scans was one week, with network teaching, but >1 month for 32% of participants in traditional CMR teaching. The CMR network enables experts from distant locations to supervise and control CMR scans in a distant hospital, in real time.
CMR networks provide an efficient teaching platform with a minimum of off-site time for trainees. Real-time remote supervision and scan control capabilities support the decentralization of CMR expertise and enables even small and rurally located institutions to offer high-quality CMR scans.
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