Cardiac Magnetic Resonance Imaging

Background Real world cardiology is faced with a low diagnostic yield of coronary angiography (CXA) in patients presenting with ACC/AHA class II CXA indication. Our aim was to analyze the clinical implication of a Cardiac MR (CMR) protocol including adenosine stress perfusion in this patient population. We examined whether CMR could enhance appropriate CXA indication and thus reduce the rate of pure diagnostic CXA. In addition, we compared the relative impact of CMR exam components (perfusion, function and viability assessment) in achieving this target. Methods 176 patients were referred for CXA with class II indication. 171 underwent complete additional CMR exam in a 1.5-T whole body CMR-scanner for myocardial function, ischemia and viability prior to CXA. The routine protocol for assessment of CAD consisted of functional imaging (long and short axes), adenosine stress- and rest-perfusion in short axis orientation and “late enhancement” imaging in long and short axes. Images were analyzed by two independent and blinded investigators. Interobserver differences were resolved by a third reader. Results There was a high association between CMR results and subsequent invasive findings (chi square for CMR perfusion deficit and stenosis >70% in CXA: 113.7, p70%. Four (2.3%) patients had false negative CMR findings. In 58 patients (33.9%) no relevant coronary artery stenosis could be observed, correctly predicted by CMR in 48 cases; in 10 (5.8%) patients CMR provided false positive results. Sensitivity of CMR to detect relevant CAD (>70% luminal narrowing) was 0.96, specificity 0.83, positive predictive value 0.92 and negative predictive value 0.92. Of the CMR components, perfusion deficit was the strongest independent predictor (odds ratio 132.3, p Conclusion In a great number of patients being referred to cath lab with ACC/AHA class II indication for CXA, CMR provides a high accuracy for decision making regarding appropriateness of the invasive exam. CMR prior to CXA could substantially reduce pure diagnostic coronary angiographies in patients with intermediate probability for CAD, in our patient-cohort from approximately 34% to 6%. Further studies are warranted to identify rare false negative CMR results.

The scope of the study was to evaluate a recent software for angiographic volume determination as compared to cardiovascular magnetic resonance imaging. A new right ventricular analysis software closes a diagnostic gap in quantitative angiography. Cardiovascular magnetic resonance imaging short axis multi slice summation is a validated reference standard. Right ventricular angiograms were acquired in frontal and lateral projection in 15 pediatric and 17 adult patients. Additional angiograms were acquired in RAO30 degrees /LAO60 degrees projections in 10 adult patients. The tested models comprised area length with different regressions, multi-slice with different regressions, Boak, and pyramid method. Original regressions were used to calculate angiographic right ventricular volume. Right ventricular reference volumes were determined by multi-slice summation from cardiac magnetic resonance short-axis images. Mean inter-observer difference was -1 ml (95% confidence: -35-34 ml) and mean intra-observer difference was 0 ml (95% confidence: -22-22 ml). There was no significant difference (4 ml, 95% confidence: -22-30 ml) between geometric calibration and calibration by a sphere. The area length and multi-slice models demonstrated the best agreement with the cardiac magnetic resonance reference. Performance was best for the Onnasch Lange models. The evaluated software provides acceptably accurate volume estimates for the majority of ventricles. In a few cases larger errors may occur, however. The area length and multi-slice models preferably with Onnasch Lange regressions may be recommended. Inter- and intra-observer agreement were excellent. Geometric calibration using data from DICOM header files may be used.

Aim: Women with evidence of ischemia and no obstructive coronary artery disease (INOCA) have an increased
risk of major adverse cardiac events, including heart failure with preserved ejection fraction (HFpEF). To investigate
potential links between INOCA and HFpEF, we examined pathophysiological findings present in both INOCA and
HFpEF.
Methods: We performed adenosine stress cardiac magnetic resonance imaging (CMRI) in 56 participants,
including 35 women with suspected INOCA, 13 women with HFpEF, and 8 reference control women. Myocardial
perfusion imaging was performed at rest and with vasodilator stress with intravenous adenosine. Myocardial
perfusion reserve index was quantified as the ratio of the upslope of increase in myocardial contrast at stress vs.
rest. All CMRI measures were quantified using CVI42 software (Circle Cardiovascular Imaging Inc). Statistical
analysis was performed using linear regression models, Fisher’s exact tests, ANOVA, or Kruskal-Wallis tests.
Results: Age (P = 0.007), Body surface area (0.05) were higher in the HFpEF group. Left ventricular ejection
fraction (P = 0.02) was lower among the INOCA and HFpEF groups than reference controls after age adjustment.
In addition, there was a graded reduction in myocardial perfusion reserve index in HFpEF vs. INOCA vs. reference
controls (1.5 ± 0.3, 1.8 ± 0.3, 1.9 ± 0.3, P = 0.02), which was attenuated with age-adjustment.
Conclusion: Reduced myocardial perfusion reserve appears to be a common pathophysiologic feature in INOCA
and HFpEF patients.

This review paper presents, in the first part, the different classes of contrast media that are already used or are in development for cardiac magnetic resonance imaging. A classification of the different types of contrast media is proposed based on the distribution of the compounds in the body, their type of relaxivity and their potential affinity to particular molecules. In

Although restoration of dystrophin expression via exon skipping in both cardiac and skeletal muscle has been successfully demonstrated in the mdx mouse, restoration of cardiac dystrophin expression in large animal models of Duchenne muscular dystrophy (DMD) has proven to be a challenge. In large animals, investigators have focused on using intravenous injection of antisense oligonucleotides (AO) to mediate exon skipping. In this study, we sought to optimize restoration of cardiac dystrophin expression in the golden retriever muscular dystrophy (GRMD) model using percutaneous transendocardial delivery of recombinant AAV6 (rAAV6) to deliver a modified U7 small nuclear RNA (snRNA) carrying antisense sequence to target the exon splicing enhancers of exons 6 and 8 and correct the disrupted reading frame. We demonstrate restoration of cardiac dystrophin expression at 13 months confirmed by reverse transcription-PCR (RT-PCR) and immunoblot as well as membrane localization by immunohistoche...

Background—A medical treatment that decreases the likelihood of left ventricular (LV) dysfunction or symptoms would benefit patients with moderate to severe degenerative mitral regurgitation. The aim of this pilot study was to determine the short-term effects of a -blocker on mitral regurgitant volume and LV work in these patients. Methods and Results—Twenty-five patients with moderate or severe degenerative mitral regurgitation

T2-weighted short-tau inversion recovery (T2w-STIR) imaging is the best approach for oedema-weighted cardiac magnetic resonance imaging (MRI), as it suppresses the signal from flowing blood and from fat and enhances sensitivity to tissue fluid. The purpose of this pictorial review is to illustrate the clinical use and application of this technique in various ischaemic and non-ischaemic conditions. In ischaemic heart disease, T2w-STIR represents the technique of choice for detecting oedema in patients with acute myocardial infarction (MI), allowing discrimination of acute and chronic injuries. Myocardial haemorrhage may also be depicted as a region of signal abnormality characterised by a central hypointense core with a peripheral hyperintense rim, presumably reflecting the presence of intracellular methaemoglobin within the necrotic area. In the acute setting, elevated T2 relaxation times in association with regional contractile dysfunction but no signs of delayed enhancement may al...

Dynamic cardiac magnetic resonance imaging (MR) and computed tomography (CT) provide cardiologists and cardiac surgeons with high-quality 4-D images for diagnosis and therapy, yet the effective use of these high-quality anatomical models remains a challenge. Ultrasound (US) is a flexible imaging tool, but the US images produced are often difficult to interpret unless they are placed within their proper 3-D

We compared 3-Tesla (3-T) and 1.5-Tesla (1.5-T) cardiac magnetic resonance imaging (MRI) for the assessment of myocardial viability in nearly identical experimental conditions. Thirty-five patients (mean age 63+/-11; 94.2% men) submitted to primary coronary angioplasty underwent both 3-T and 1.5-T cardiac MRI, which was considered the gold standard. Comparison was performed on the basis of the same viability imaging protocol, which included resting cine-MR [balanced fast-field echo (B-FFE) sequence] followed by contrast-enhanced MR to evaluate perfusion and delayed enhancement (DE). We then performed functional index measurements and visual estimation of kinesis, perfusion and DE referring to a 5-point scale. Image quality was assessed on the basis of signal to noise ratio (SNR) and contrast to noise ratio (CNR). We found nonsignificant differences between the two scanners (P=NS) in measuring the functional and viability parameters. Myocardial SNR was significantly higher with 3-T M...

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease affecting both intramyocardial and epicardial coronary arteries and is observed in patients during long-term survival after cardiac transplantation. We report a case of CAV complicated with silent transmural myocardial infarction and massive left ventricular thrombus formation associated with silent pericarditis and with ischemic and non-ischemic scar tissue, as detected by cardiac magnetic resonance imaging (CMRI). The authors suggest CMRI as an additional technique along with echocardiography during follow-up of heart transplant recipients. CMRI may contribute to the early identification of areas of myocardial wall abnormalities suggestive of CAV, thus guiding diagnosis and prompt percutaneous treatment. Die kardiale Allotransplantat-Vaskulopathie („cardiac allograft vasculopathy“, CAV) ist eine rasch progrediente Form der koronaren Herzkrankheit (KHK), die intramyokardiale und epikardiale Koronararterien betrifft und bei Langzeitüberlebenden nach Herztransplantation auftreten kann. Wir berichten über einen Patienten mit CAV und klinisch asymptomatischem transmuralem Myokardinfarkt. Kompliziert wurde das Krankheitsbild durch eine massive linksventrikuläre Thrombusbildung mit stummer Perikarditis sowie ischämischem und nichtischämischem Narbengewebe, wie mittels kardialer Magnetresonanztomographie (MRT) nachgewiesen werden konnte. Die Autoren empfehlen, die kardiale MRT zusätzlich zur Echokardiographie als bildgebende Technik in der Lanzeitbetreuung nach Herztransplantation einzusetzen. Sie kann dazu beitragen, myokardiale Wandbewegungsstörungen aufgrund einer CAV früh zu entdecken und damit die Diagnostik sowie die zur Behandlung erforderliche perkutane Intervention zu beschleunigen.