Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update
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Abstract:
This document is an update to the 2013 publication of the Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Protocols. Concurrent with this publication, 3 additional task forces will publish documents that should be referred to in conjunction with the present document. The first is a document on the Clinical Indications for CMR, an update of the 2004 document. The second task force will be updating the document on Reporting published by that SCMR Task Force in 2010. The 3rd task force will be updating the 2013 document on Post-Processing. All protocols relative to congenital heart disease are covered in a separate document. The section on general principles and techniques has been expanded as more of the techniques common to CMR have been standardized. A section on imaging in patients with devices has been added as this is increasingly seen in day-to-day clinical practice. The authors hope that this document continues to standardize and simplify the patient-based approach to clinical CMR. It will be updated at regular intervals as the field of CMR advances.Keywords:
Angiology
Cardiac magnetic resonance
Background Diffuse myocardial fibrosis can be assessed by cardiac magnetic resonance (CMR) using the myocardial longitudinal relaxation time constant (T1). Mitral valve prolapse (MVP) is a common valvulopathy with known arrhythmic complications and in-vitro evidence of overexpression of pro-fibrotic TGF-beta. Papillary muscle fibrosis has been described in MVP, but the potential association of MVP with diffuse myocardial fibrosis is unknown. This association is important as it may increase our future understanding of ventricular arrhythmias in MVP.
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Cardiac magnetic resonance
Mitral valve prolapse
Myocardial fibrosis
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Cardiac magnetic resonance
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To assess the utility of cardiovascular magnetic resonance (CMR) in acute cardiac rejection using T2 mapping.
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Cardiac magnetic resonance
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Recent evidence underlined the importance of right (RV) involvement in suspected myocarditis. We aim to analyze the possible incremental prognostic value from RV global longitudinal strain (GLS) by CMR.
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Cardiac magnetic resonance
Feature tracking
Strain (injury)
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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.
Angiology
Cardiac magnetic resonance
Cardiac allograft vasculopathy
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Cardiac magnetic resonance
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Angiology
Cardiac magnetic resonance
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.
Angiology
Cardiac magnetic resonance
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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Cardiac magnetic resonance
Reference values
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Angiology
Cardiac magnetic resonance
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Cardiac Imaging
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