Objectives To compare contrast-enhanced anatomic imaging to contrast-enhanced tissue characterization (DE-CMR) for left ventricular (LV) thrombus detection. Background Contrast echocardiography (echo) detects LV thrombus based on anatomic appearance whereas delayed-enhancement cardiac magnetic resonance (DE-CMR) imaging detects thrombus based on tissue characteristics. DE-CMR has been validated as an accurate technique for thrombus but its utility compared to contrast echo is unknown. Methods Multimodality imaging was performed in 121 patients at high-risk for thrombus due to myocardial infarction or heart failure. Imaging included three anatomic imaging techniques for thrombus detection (contrast echo, non-contrast echo, cine-CMR) and a reference of DE-CMR tissue characterization. LV structural parameters were quantified to identify markers for thrombus and predictors of additive utility of contrast-enhanced thrombus imaging. Results 24 patients had thrombus by DE-CMR. Patients with thrombus had larger infarcts (by DE-CMR), more aneurysms and lower LVEF (by CMR and echo) than those without thrombus. Contrast echo nearly doubled sensitivity (61% vs. 33%, p<0.05) and yielded improved accuracy (92% vs. 82%, p<0.01) vs. non-contrast echo. Patients who derived incremental diagnostic utility from DE-CMR had lower LVEF vs. those in whom non-contrast echo alone accurately assessed thrombus (35±9% vs. 42±14%, p<0.01), with a similar trend for patients that derived incremental benefit from contrast echo (p=0.08). Contrast echo and cine-CMR closely agreed on the diagnosis of thrombus (kappa=0.79, p<0.001). Thrombus prevalence was lower by contrast echo than DE-CMR (p<0.05). Thrombus detected by DE-CMR but not by contrast echo was more likely to be mural in shape or, when apical, small in volume (p<0.05). Conclusions Echo contrast in high-risk patients markedly improves detection of LV thrombus, but does not detect a substantial number of thrombi identified by DE-CMR tissue characterization. Thrombi detected by DE-CMR but not by contrast echo are typically mural in shape or small in volume.

Established cardiac magnetic resonance methods yield differences in left ventricular quantification due to variable exclusion of papillary muscles and trabeculae from myocardium. The relative impact of papillary muscles and trabeculae exclusion on calculated mass and ejection fraction is increased among patients with hypertrophy-associated left ventricular remodeling.

ObjectivesTo examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR).BackgroundCine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD.Methods115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD.ResultsLV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (≤ 1% inter-reader differences) and required minimal processing time (175 ± 34 images/exam, 2:09 ± 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD.ConclusionsAutomated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.

Solid organ transplantation has increased in frequency in the United States, having evolved from an area of experimentation into accepted therapy for end‐organ failure. As organ transplantation has become more common, the average age of transplant recipients has increased, thus increasing the potential for multiple comorbidities including coronary artery disease (CAD). CAD has been shown to be a major cause of morbidity and mortality in kidney, lung and liver transplant recipients. Identification of CAD in solid organ transplant candidates allows for stratification of short‐ and long‐term risk, ensuring proper use of valuable allograft resources while guiding further patient management. Assessment of asymptomatic transplant candidates for CAD is difficult. Many patients undergo stress echocardiography or nuclear imaging, which have demonstrated inconsistent rates of sensitivity and specificity for the detection of CAD in these patient populations. Cardiac computed tomography is a potential tool for detecting CAD in these populations, but has questionable utility at this time. Coronary angiography has an important role in detecting CAD in high‐risk transplant candidates, affecting their long‐term management and risk.

SPECT interpretation can vary according to image display as a result of differences in perfusion defect severity. Adjustment of abnormality criteria for gray images to reflect minor increases in defect severity provides equivalent diagnostic performance of gray and color displays for CAD assessment.