BACKGROUND: Delayed-enhancement magnetic resonance imaging (DE-MRI) is now a standard for the detection of myocardial scar and viability. Standard analysis needs expensive software. OBJECTIVE: To determine the accuracy of visual assessment in the detection and quantification of myocardial scar by DE-MRI technique. MATERIAL AND METHOD: The authors enrolled 32 patients with coronary artery disease (CAD) as documented by coronary angiography (CAG) and left ventricular dysfunction. All patients underwent cardiac magnetic resonance imaging for the assessment of global and regional myocardial function and DE-MRI. The presence and amount of scar in each myocardial segment was assessed by standard method. Visual assessment was performed by two methods: 1) visual drawing of the boundary of the hyperenhancement region and calculation of percentages of scar in an individual segment; 2) visual estimation of grading of hyperenhancement area from 0 (no scar) to 4 (> 75% scar). The agreement for scar detection and correlation of scar quantification for individual segments were evaluated. RESULTS: Thirty-one of 32 patients in the present study had myocardial scar. One thousand four hundred and thirty two myocardial segments were analyzed. Visual detection of myocardial scar has an excellent level of agreement with standard method of scar (Kappa = 0.963 and 0.952, p<0.001 for visual method I and II). Visual method I and II has an accuracy of 98.2% and 97.6% respectively in the detection of myocardial scar compared to standard method. Percentages of myocardial scar in each myocardial segment by visual method I correlate very well with standard method (Intraclass Correlation Coefficient = 0.885). Visual grading of amount of myocardial scar also has an excellent correlation with standard method (Spearman rank correlation coefficient = 0.934). CONCLUSION: Visual assessment of myocardial scar is accurate for the detection and quantification of scar.
Arterial stiffening is an independent predictor for cardiovascular events. Studies using a variety of different techniques have shown that visceral fat accumulation may be related to aortic stiffening. However, there are limited data available about the study using magnetic resonance imaging (MRI). The aim of the present study is to assess the correlation of visceral fat to the degree of aortic stiffness as determined by MRI.The present study examined 95 subjects (age 69.14 +/- 9. 76 years, female 50.5%, waist circumference 93 +/- 11 cm) who underwent cardiac MRI examination. Using MRI, aortic stiffness was measured as aortic pulse wave velocity (PWV) by distance divided by time delay between mid-ascending and mid-descending aorta. Body fat measures were evaluated as abdominal visceral fat volume (visceral fat), pericardial fat volume (visceral fat) and abdominal subcutaneous fat volume (subcutaneous fat). Pearson correlation analysis was performed to determine the correlation between aortic stiffness and each measure of the body fat.Mean PWV 11.41 +/- 5.30 m/s, pericardial fat 17.37 +/- 4.60 ml, abdominal visceral fat 470.85 +/- 181.12 ml and abdominal subcutaneous fat 617.57 +/- 214.70 ml. No correlation was found between PWV and each measure of body fat as follows; (1) pericardial fat volume to PWV (r = -0.025, p-value = 0.808), (2) abdominal visceral fat volume to PWV (r = 0.068, p-value = 0.520), (3) abdominal subcutaneous fat volume to PWV (r = -0.001, p-value = 0.992), (4) total abdominal fat volume to PWV (r = 0.038, p-value = 0.719), (5) total visceral fat volume to PWV (r = 0.066, p-value = 0.528). There was also no correlation found between PWV and visceral fat grouped in tertiles.There was no significant correlation between visceral fat volumes and aortic stiffness.
Abstract Background Aortic stiffness is an independent predictor of cardiovascular (CV) events and mortality. However, no data exists for the prognosis of combined aortic stiffness and myocardial ischemia. Using cardiac magnetic resonance (CMR) imaging, we assessed the association of aortic stiffness by pulse wave velocity (PWV), myocardial ischemia, and CV events in patients with known or suspected coronary artery disease (CAD). Methods Velocity-encoded CMR was performed in 520 patients who had undergone adenosine stress CMR. The PWV was determined between the mid-ascending and mid-descending thoracic aorta. Patients were divided into 4 groups by PWV (higher or lower PWV) and myocardial ischemia (positive or negative ischemia). Combined CV events including mortality, acute coronary syndrome, heart failure, coronary revascularization, and stroke were analyzed among the 4 groups. Results The median follow-up period was 46.5 months, and the median PWV was 10.54 m/sec. Myocardial ischemia was positive in 199 patients (38.3%). The group with a higher PWV and positive ischemia had the most CV events (hazard ratio 8.94, p < 0.001). The group with a higher PWV and negative ischemia also was significantly associated with CV events (HR 2.19, p = 0.02). Groups with a lower PWV-positive ischemia and a higher PWV-negative ischemia showed no difference in terms of CV events (HR 0.60, p = 0.08). Patients with myocardial ischemia who had higher PWV demonstrated significantly higher event rates than those who had lower PWV (HR 2.41, p < 0.001). Multivariate analysis demonstrated that myocardial ischemia and PWV were independent predictors for combined CV events (HR 2.71, p < 0.001 and HR 2.42, p < 0.001, respectively). Conclusions Stress perfusion CMR provided prognostic utility in patients with known or suspected CAD. Adding aortic stiffness to stress perfusion CMR could improve risk assessment and prediction for future CV events.
Diagnosis of coronary artery disease in patients with heart failure with systolic dysfunction usually requires coronary angiography. Cardiac magnetic resonance (CMR) is an accurate tool for the assessment of myocardial scar which may be the major cause of left ventricular systolic dysfunction.This study was to determine the prevalence and the difference in pattern of late gadolinium enhancement (LGE) between patients with ischemic (ICM) and non-ischemic cardiomyopathy (NICM).We enrolled 98 patients with heart failure and left ventricular systolic dysfunction with left ventricular ejection fraction less than 50%. Allpatients underwent CMR. CMR protocol included functional study and assessment of LGE. Left ventricular volume and ejection fraction was measured. The presence and extent of LGE including its pattern were assessed.There were 58 patients with ICM and 40 patients with NICM. Patients with NICM had a lower left ventricular ejection fraction than those with ICM with a similar left ventricular wall thickness. LGE was detected in 53 patients with ICM (91.5%) and 10 patients with NICM (25%). LGE pattern was transmural or subendocardial pattern in patients with ICM and midwall scar in those with NICM.The presence and pattern ofLGE can differentiate systolic heart failure from ICM and NICM.
In hypertensive patients, increased left ventricular (LV) mass and impaired aortic stiffness are independent predictors for cardiovascular events. There were some prior studies which established the correlation between left ventricular hypertrophy and aortic stiffness; nevertheless, there are limited data in hypertensive patients. Furthermore, few studies applied cardiac MRI which is a promising technique for LV mass assessment. The authors sought to assess the correlation of LV mass and impaired aortic stiffness, as measured by cardiac MRI.A total of 113 hypertensive patients (mean age 68.9 +/- 10.3 years, female 51.3%) who underwent cardiac MRI study were enrolled. Left ventricular mass was obtained by summation of multiple slice technique and then calculated into the left ventricular mass index. Aortic stiffness was measured as aortic pulse wave velocity (PWV) by distance divided by time delay between mid-ascending and mid-descending aorta. Pearson correlation analysis was applied to determine the correlation of aortic stiffness and left ventricular mass index.Mean left ventricular mass index was 53.39 +/- 18.32 g/m2, mean PWV was 11.72 +/- 5.11 m/s. No correlation was found between PWV and LV mass index (r = 0.085, p-value = 0.37). However aortic stiffness had significant correlation with age (r = 0.469, p-value < 0.001).There was no significant correlation between LV mass index and aortic stiffness in hypertensive patients. This may be explained by the relatively less severe left ventricular hypertrophy in our patients.
Acute pulmonary embolism (PE) is associated with a variety of non-specific clinical manifestations. Using diagnostic algorithms that are based on internationally recognized guidelines, pulmonary computed tomography angiography (CTA) serves as the gold standard diagnostic imaging tool in PE. However; inappropriate use of pulmonary CTA may lead to unnecessary radiation exposure, contrast exposure, and cost. Based on our review of the literature, there is no existing data regarding prevalence and appropriate use of pulmonary CTA in suspected acute PE in Thailand.To assess the prevalence of positive pulmonary CTA and evaluate appropriateness of use of pulmonary CTA, according to clinical prediction rules and recent guidelines.Three hundred consecutive patients admitted to the general medical ward at a large university-based tertiary referral center who were sent for pulmonary CTA due to suspected acute PE were included. Prevalence of positive pulmonary CTA for PE and other abnormalities were analyzed. Baseline clinical characteristics (including thromboembolic risk factors) and basic investigations (including chest X-ray, ECG, pulse oximetry, and D-dimer) were compared between patients with and without acute PE.Acute PE was diagnosed by pulmonary CTA in 110 (36.7%) patients. According to Wells score and revised Geneva score, patients were categorized into low, moderate, and high probability, as follows: 63, 178, and 59 patients, respectively, and 44, 246, and 10 patients, respectively. Patients with high probability according to Wells score and revised Geneva score had higher rate of positive pulmonary CTA results, as compared to low and moderate probability (59.3%, 7.9%, and 39.3%, respectively, and 60%, 19.5%, and 38.2%, respectively). Predictors of positive CTA were sign of deep vein thrombosis (DVT) (OR: 2.6, 95% CI: 1.497-4.514; p<0.001), S1Q3T3 (OR: 4.211, 95% CI: 2.242-7.908; p<0.001), and enlarged right pulmonary artery (OR: 2.439, 95% CI: 1.475-4.035; p<0.001). Using multivariate analysis, all three parameters remained independent factors. In the Wells score low probability group, 31 of 63 patients were not tested for D-dimer prior to pulmonary CTA, with only one patient in that group being diagnosed with acute PE.This was the first study to investigate prevalence of positive pulmonary CTA for acute PE in a large university-based tertiary referral hospital in Thailand Prevalence of positive test for PE by pulmonary CTA in patients with suspected acute PE was approximately 33%. Sign of DVT S1Q3T3 pattern, and enlarged right pulmonary artery were significant clinical predictors of positive pulmonary CTA. Positive pulmonary CTA result was much less likely in patients with low probability, especially in the absence of thromboembolic risk factors and positive D-dimer This study emphasized the importance and value of accurate and effective triage in reducing both patient care costs and patient radiation exposure.
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