Advances in cardiovascular magnetic resonance in ischaemic heart disease and non-ischaemic cardiomyopathies

Motwani, Manish; Kidambi, Ananth; Greenwood, John P; Plein, Sven

doi:10.1136/heartjnl-2013-304680

Cited by 19 publications

(9 citation statements)

References 31 publications

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“…Myocardial infarction is frequently unrecognized at the time of its occurrence, accounting for 20–40% of all prior MI in high risk populations diagnosed on ECG criteria [ 2 , 3 ]. Cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging offers a more sensitive means of diagnosis than ECG and is considered the reference standard non-invasive imaging technique for the detection of prior MI [ 4 , 5 ]. Studies using this approach have suggested that unrecognized MI is more common than recognized prior MI in certain populations, with a prevalence of 18% in an elderly, community-based cohort [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction

Fent

Garg

Foley

et al. 2017

Int J Cardiovasc Imaging

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Prior myocardial infarction (MI) is associated with increased mortality and is prevalent in certain high risk patient groups. Electrocardiogram may be used in diagnosis, however, sensitivity is limited, thus non-invasive imaging techniques may improve diagnosis. We investigated whether global longitudinal strain (GLS) and longitudinal strain parameters are reduced in patients with prior MI but preserved left ventricular ejection fraction (LVEF). The study included 40 clinical patients with prior MI occurring >3 months previously (defined as subendocardial hyperenhancement on late Gadolinium enhancement imaging) with LVEF ≥ 55% and 40 controls matched for age and LVEF. GLS, global longitudinal strain rate (GLSR) and early diastolic longitudinal strain rate (GLSRe) were measured from cine imaging feature tracking analysis. Presence of wall motion abnormality (WMA) and minimum systolic wall thickening (SWT) were calculated from cine imaging. GLS was −17.3 ± 3.7% in prior MI versus −19.3 ± 1.9% in controls (p = 0.012). GLSR was −88.0 ± 33.7%/s in prior MI versus −103.3 ± 26.5%/s in controls (p = 0.005). GLSRe was 76.4 ± 28.4%/s in prior MI versus 95.5 ± 26.0%/s in controls (p = 0.001). GLS accurately identified prior MI [AUC 0.662 (95% CI 0.54–0.785) p = 0.012] whereas WMA [AUC 0.500 (95% CI 0.386–0.614) p = 1.0] and minimum SWT [AUC 0.609 (95% CI 0.483–0.735) p = 0.093] did not. GLS, GLSR and GLSRe are reduced in prior MI with preserved LVEF. Normal LVEF and lack of WMA cannot exclude prior MI. Prior MI should be considered when reduced GLS, GLSR or GLSRe are detected by non-invasive imaging.

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Section: Introductionmentioning

confidence: 99%

The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction

Fent

Garg

Foley

et al. 2017

Int J Cardiovasc Imaging

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“…Of the modalities available for investigating LVNC, cardiovascular magnetic resonance imaging (CMR) offers a comprehensive assessment of myocardial anatomy, function, perfusion and tissue characteristics [ 16 , 17 ]. Its high spatial resolution allows for better differentiation between non-compacted and compacted layers of myocardium, compared to two-dimensional (2D) echocardiography and computed tomography (CT) imaging.…”

Section: Introductionmentioning

confidence: 99%

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Cai

Bryant

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundLeft ventricular (LV) non-compaction (LVNC) is defined by extreme LV trabeculation, but is measured variably. Here we examined the relationship between quantitative measurement in LV trabeculation and myocardial deformation in health and disease and determined the clinical utility of semi-automated assessment of LV trabeculations.MethodsCardiovascular magnetic resonance (CMR) was performed in 180 healthy Singaporean Chinese (age 20–69 years; males, n = 91), using balanced steady state free precession cine imaging at 3T. The degree of LV trabeculation was assessed by fractal dimension (FD) as a robust measure of trabeculation complexity using a semi-automated technique. FD measures were determined in healthy men and women to derive normal reference ranges. Myocardial deformation was evaluated using feature tracking. We tested the utility of this algorithm and the normal ranges in 10 individuals with confirmed LVNC (non-compacted/compacted; NC/C ratio > 2.3 and ≥1 risk factor for LVNC) and 13 individuals with suspected disease (NC/C ratio > 2.3).ResultsFractal analysis is a reproducible means of assessing LV trabeculation extent (intra-class correlation coefficient: intra-observer, 0.924, 95% CI [0.761–0.973]; inter-observer, 0.925, 95% CI [0.821–0.970]). The overall extent of LV trabeculation (global FD: 1.205 ± 0.031) was independently associated with increased indexed LV end-diastolic volume and mass (sβ = 0.35; p < 0.001 and sβ = 0.13; p < 0.01, respectively) after adjusting for age, sex and body mass index. Increased LV trabeculation was independently associated with reduced global circumferential strain (sβ = 0.17, p = 0.013) and global diastolic circumferential and radial strain rates (sβ = 0.25, p < 0.001 and sβ = −0.15, p = 0.049, respectively). Abnormally high FD was observed in all patients with a confirmed diagnosis of LVNC. Five out of 13 individuals with suspected LVNC had normal FD, despite NC/C > 2.3.ConclusionThis study defines the normal range of LV trabeculation in healthy Chinese that can be used to make or refute a diagnosis of LVNC using the fractal analysis tool, which we make freely available. We also show that increased myocardial trabeculation is associated with higher LV volumes, mass and reduced myocardial strain.Electronic supplementary materialThe online version of this article (10.1186/s12968-017-0413-z) contains supplementary material, which is available to authorized users.

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“…Unfortunately, echocardiography suffers from limited ability in tissue characterization. Conversely, CMR represents the non-invasive gold standard technique for myocardial tissue characterization, due to its high accuracy in detecting edema and fibrosis, with the latter further differentiated in ischemic and non-ischemic patterns [45] . Non-contrast T2-weighted spin-echo, T1, T2 and LGE sequences with cine loops allow for detection of focal subepicardial or middle-wall edema (suggesting myocarditis), intense edema usually involving the apex (classic TTS), or subendocardial to transmural edema affecting myocardial segments according to coronary distribution (myocardial infarction).…”

Section: Radiologic Imaging In Inflammatory Myocardial Damagementioning

confidence: 99%

Role of multimodality imaging in evaluation of cardiovascular involvement in COVID-19

Citro

Pontone

Bellino

et al. 2021

Trends in Cardiovascular Medicine

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The management of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be difficult due to the need for dedicated in-hospital pathways, protective measures for healthcare professionals and isolated beds of intensive care, particularly in areas overwhelmed by wide viral spread. Although pneumonia is the most common clinical manifestation in coronavirus disease 2019 (COVID-19), a variety of cardiovascular complications have been reported. An integrated diagnostic algorithm in SARS-CoV-2-infected patients with suspected cardiac involvement (laboratory findings of myocardial injury and electrocardiographic changes) may help to avoid unnecessary examinations and minimize the risk of operator infection. Due to its mobility and bedside feasibility, echocardiography is the first-line imaging technique in this clinical setting. It quickly provides information on ventricular functions, pulmonary hypertension, valve disease and pericardial effusion. In case of ST-segment elevation (STE), urgent coronary angiography should be performed. Cardiac ultrasound helps distinguish between ischemic and non-ischemic myocardial disease and may detect pericardial disease. Transmural ischemic electrocardiographic changes, with or without early elevated troponin levels or echocardiographic wall motion abnormalities, will determine the need for early invasive coronary angiography. Computed tomography (CT) through its multiple applications (chest CT; CT pulmonary angiography and coronary CT angiography; late iodine enhancement CT) and cardiac magnetic resonance might be helpful in reinforcing or redirecting diagnostic hypothesis emerged by other clinical, electrocardiographic and echocardiographic findings. The current pandemic makes it challenging to perform serial invasive and non-invasive diagnostic testing in COVID-19 patients and high serum troponin level. Nevertheless, thoughtful and systematic use of an appropriate multimodality imaging strategy is clinically relevant to detect cardiac injury and distinguish myocardial infarction from, myocarditis, takotsubo syndrome and pulmonary embolism.

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Advances in cardiovascular magnetic resonance in ischaemic heart disease and non-ischaemic cardiomyopathies

Cited by 19 publications

References 31 publications

The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction

The utility of global longitudinal strain in the identification of prior myocardial infarction in patients with preserved left ventricular ejection fraction

Fractal analysis of left ventricular trabeculations is associated with impaired myocardial deformation in healthy Chinese

Role of multimodality imaging in evaluation of cardiovascular involvement in COVID-19

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