Evaluation of left atrial myocardial deformation in patients with acute MR after STEMI using CMR feature tracking
Tomas LapinskasLaura UrbonaitėPaulius BučiusAugustinas Povilas FedaravičiusAgnieta StabinskaitėMarta EjsmontAntanas JankauskasRemigijus Žaliūnas
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Angiology
Feature tracking
Cardiac magnetic resonance
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Cardiac magnetic resonance
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Background Cardiovascular Magnetic Resonance myocardial feature tracking (CMR-FT) is a quantitative technique tracking tissue voxel motion on standard steady-state free precession (SSFP) cine images to assess ventricular myocardial deformation. The importance of left atrial (LA) deformation assessment is increasingly recognized and can be assessed with echocardiographic speckle tracking. However atrial deformation quantification has never previously been demonstrated with CMR. We sought to determine the feasibility and reproducibility of CMR-FT for quantitative LA strain and strain rate (SR) analysis.
Feature tracking
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Cardiac magnetic resonance
Speckle tracking echocardiography
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To assess the utility of cardiovascular magnetic resonance (CMR) in acute cardiac rejection using T2 mapping.
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BackgroundCardiac allograft vasculopathy (CAV) continues to limit the long-term survival of heart transplant recipients.CAV affects both the epicardial arteries and the microvessels, however it does so independently, and epicardial and microvascular disease are both independently predictive of prognosis.Despite being associated with considerable limitations, coronary angiography has a class I recommendation for CAV surveillance and annual or biannual surveillance angiography is performed routinely in most centers.The aim of this study was to evaluate the diagnostic performance of multiparametric CMR in CAV, and to compare the performance of CMR to that of invasive coronary angiography, using contemporary invasive epicardial artery and microvascular assessment techniques as reference standards.
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ventricle and 25 patients (96%) in the left ventricle. LGE was more frequent in the inferior and inferolateral walls (17 and 16 patients, 65 and 62%) while the septum was seldom affected (7 patients, 27%). Usually, LGE was subepicardial (12 patients, 46%), but transmural (5 patients, 19%) and intramyocardial (3 patients, 12%) LGE were also observed. Left ventricle systolic dysfunction (LVEF 98ml/m2) in 3 patients, (11%) Conclusions 1. LV involvement is a frequent finding in AC 2. The most frequent abnormality is LGE in the left ventricle and the least, left ventricular dilatation 3. LGE was more frequently subepicardial and located in the inferior and inferolateral walls.
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Magnetic resonance angiography
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Introduction: Prophylactic implantation of a cardioverter/ defibrillator (ICD) has been shown to reduce mortality in patients with chronic myocardial infarction (CMI) and an increased risk for life threatening ventricular arrhythmia (VA).The use of ICDs in this large patient population is still limited by high costs and possible adverse events including inappropriate discharges and progression of heart failure.VA is related to infarct size and seems to be related to infarct morphology.Contrast enhanced cardiovascular magnetic resonance imaging (ceCMR) can detect and quantify myocardial fibrosis in the setting of CMI and might therefore be a valuable tool for a more accurate risk stratification in this setting.Hypothesis: ceCMR can identify the subgroup developing VA in patients with prophylactic ICD implantation following MADIT criteria.Methods: We prospectively enrolled 52 patients (49 males, age 69 ± 10 years) with CMI and clinical indication for ICD therapy following MADIT criteria.Prior to implantation (36 ± 78 days) patients were investigated on a 1.5 T clinical scanner (Siemens Avanto © , Germany) to assess left ventricular function (LVEF), LV end-diastolic volume (LVEDV) and LV mass (sequence parameters: GRE SSFP, matrix 256 × 192, short axis stack; full LV coverage, no gap; slice thickness 6 mm).For quantitative assessment of infarct morphology late gadolinium enhancement (LGE) was performed including measurement of total and relative infarct mass (related to LV mass) and the degree of transmurality (DT) as defined by the percentage of transmurality in each scar.(sequence parameters: inversion recovery gradient echo; matrix 256 × 148, imaging 10 min after 0.2 μg/kg gadolinium DTPA; slice orientation equal to SSFP).MRI images were analysed using dedicated software (MASS © , Medis, Netherlands).LGE was defined as myocardial areas with signal intensity above the average plus 5 SD of the remote myocardium.After implantation, patients were followed up including ICD readout after 3 and than every 6 months for a mean of 945 ± 344 days.ICD data were evaluated by an experienced electrophysiologist.Primary endpoint was the occurrence of an appropriate discharge (DC), antitachycard pacing (ATP) or death from cardiac cause.Results: The endpoint occurred in 10 patients (3 DC, 6 ATP, 1 death).These patients had a higher relative infarct mass (28 ± 7% vs. 22 ± 11%, p = 0.03) as well as high degree of transmurality (64 ± 22% vs. 44 ± 25%, p = 0.05).Their LVEF (29 ± 8% vs. 30 ± 4%, p = 0.75), LV mass (148 ± 29 g vs. 154 ± 42 g, p = 0.60), LVEDV (270 ± 133 ml vs. 275 ± 83 ml, p = 0.90) or total infarct mass (43 ± 19 g vs. 37 ± 21 g, p = 0.43) were however not significant from the group with no events.In a cox proportional hazards regression model including LVEF, LVEDV, LV mass, DT and age, only degree of transmurality and relative infarct mass emerged as independent predictors of the primary end point (p = 0.009). Conclusion:In CMI-patients fulfilling MADIT criteria ceCMR could show that the extent and transmurality of myocardial scarring are independent predictors for life threatening ventricular arrhythmia or death.This additional information could lead to more precise risk stratification and might reduce adverse events and cost of ICD therapy in this patient population.Larger trials are needed to confirm this finding.
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Myocardial fibrosis
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If papillary muscle were vs. were not traced, upper limit was 79 vs. 66 for LVMI and 35 vs. 19 for
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Methods All participants were prospectively recruited and underwent CMR in a 1.5 T scanner. LVEF 400 pg/ml. Patients with myocardial infarction were excluded. Myocardial circumferential strain (CST) and strain rate (CSR) was analyzed in mid LV of the short axis plane and the longitudinal strain (LST) and strain rate (LSR) in 4-chamber view of the SSFP cine images using feature tracking (CIM software, Auckland, New Zealand). LV end diastolic pressure (LVEDP) was estimated using normalized left atrial transition time from time-intensity curves of the first pass perfusion images.
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