MRI in the assessment of ischaemic heart disease

Rodrigues, Jonathan; Baritussio, Anna; Bucciarelli-Ducci, Chiara

doi:10.1136/heartjnl-2014-306963

Cited by 24 publications

(17 citation statements)

References 113 publications

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“…A comprehensive CMR protocol was carried out including cine, T2-weighted (myocardial oedema), early and late gadolinium enhancement imaging. (23) In particular, cine images were performed using a steady-state free-precession sequence acquired in three long axis planes and a stack of short axis images covering the left ventricle (LV) and T2-weighted (T2-STIR) sequence images were acquired in the same short-axis and long-axis planes as the cine images with standard parameters, as previously described. (24,25) Intravenous gadolinium-chelate contrast agent (gadobutrol) was administered at a dose of 0.1 mmol kg-1 of body weight.…”

Section: Cmr Protocolmentioning

confidence: 99%

Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries

Dastidar

Baritussio

Gárate

et al. 2019

JACC: Cardiovascular Imaging

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174

105

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Word count: 4478words (including figures legends and references)Running title: Prognostic role of CMR and conventional risk factors in MINOCA Abstract: Objective: Assess the prognostic impact of Cardiovascular Magnetic Resonance (CMR) and conventional risk factors in patients with Myocardial infarction with non-obstructed coronaries (MINOCA). Background: MINOCA represents a diagnostic dilemma and the prognostic markers have not been clarified. Methods: 388 consecutive MINOCA patients undergoing CMR assessment were identified retrospectively from registry database and prospectively followed up for a primary clinical endpoint of all-cause mortality. 1.5T CMR was performed using a comprehensive protocol (cines, T2-weighted, and late gadolinium enhancement sequences). Patients were grouped into 4 categories based on their CMR findings: myocardial infarction (MI) (embolic/spontaneous recanalization), myocarditis, cardiomyopathy and normal CMR. Results: CMR(performed at a median of 37days from presentation) was able to identify the cause for the troponin rise in 74% of the patients (25% myocarditis, 25% MI and 25% cardiomyopathy), whilst a normal CMR was identified in 26%. Over a median follow-up of 1262days(3.5years), 5.7% patients died. Cardiomyopathy group had the worst prognosis (mortality 15%, log rank 19.9 p<0.001), MI had 4% mortality, and 2% in both myocarditis and normal CMR. In a multivariable cox regression model (including clinical and CMR parameters), CMR diagnosis of cardiomyopathy and ST-segment elevation on presentation ECG remained the only 2 significant predictors of mortality. Using presentation with ECG ST-elevation and CMR diagnosis of cardiomyopathy as risk markers, the mortality risk rates were 2%, 11% and 21% for presence of 0, 1 and 2 factor respectively(p<0.0001). Conclusion: In a large cohort of MINOCA, CMR(median 37days from presentation) identified a final diagnosis in 74% of patients. Cardiomyopathy had the highest mortality, followed by MI. The strongest predictors of mortality were a CMR diagnosis of cardiomyopathy and ST-elevation on presentation ECG.

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Section: Cmr Protocolmentioning

confidence: 99%

Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries

Dastidar

Baritussio

Gárate

et al. 2019

JACC: Cardiovascular Imaging

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174

105

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“…Probabilities for the normal coronaries model Table 5 shows the probabilities used in the model and their respective sources. From initial MEDLINE searching, a 2016 review paper by Dastidar et al 55 identified the first paper to use CMR for diagnosis in patients with normal coronaries, 20 and this was confirmed by later reviews. All citations of the Assomull et al 20 paper were reviewed, and relevant (English) results read.…”

Section: Data For the Normal Coronaries Modelmentioning

confidence: 94%

A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study

Harris

Brierley

Pufulete

et al. 2019

Health Serv Deliv Res

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Background Cardiovascular magnetic resonance (CMR) is increasingly used in patients who activate the primary percutaneous coronary intervention (PPCI) pathway to assess heart function. It is uncertain whether having CMR influences patient management or the risk of major adverse cardiovascular events in these patients. Objective To determine whether or not it is feasible to set up a national registry, linking routinely collected data from hospital information systems (HISs), to investigate the role of CMR in patients who activate the PPCI pathway. Design A feasibility prospective cohort study. Setting Four 24/7 PPCI hospitals in England and Wales (two with and two without a dedicated CMR facility). Participants Patients who activated the PPCI pathway and underwent an emergency coronary angiogram. Interventions CMR either performed or not performed within 10 weeks of the index event. Main outcome measures A. Feasibility parameters – (1) patient consent implemented at all hospitals, (2) data extracted from more than one HIS and successfully linked for > 90% of consented patients at all four hospitals, (3) HIS data successfully linked with Hospital Episode Statistics (HES) and Patient Episode Database Wales (PEDW) for > 90% of consented patients at all four hospitals and (4) CMR requested and carried out for ≥ 10% of patients activating the PPCI pathway in CMR hospitals. B. Key drivers of cost-effectiveness for CMR (identified from simple cost-effectiveness models) in patients with (1) multivessel disease and (2) unobstructed coronary arteries. C. A change in clinical management arising from having CMR (defined using formal consensus and identified using HES follow-up data in the 12 months after the index event). Results A. (1) Consent was implemented (for all hospitals, consent rates were 59–74%) and 1670 participants were recruited. (2) Data submission was variable – clinical data available for ≥ 82% of patients across all hospitals, biochemistry and echocardiography (ECHO) data available for ≥ 98%, 34% and 87% of patients in three hospitals and medications data available for 97% of patients in one hospital. (3) HIS data were linked with hospital episode data for 99% of all consented patients. (4) At the two CMR hospitals, 14% and 20% of patients received CMR. B. In both (1) multivessel disease and (2) unobstructed coronary arteries, the difference in quality-adjusted life-years (QALYs) between CMR and no CMR [‘current’ comparator, stress ECHO and standard ECHO, respectively] was very small [0.0012, 95% confidence interval (CI) –0.0076 to 0.0093 and 0.0005, 95% CI –0.0050 to 0.0077, respectively]. The diagnostic accuracy of the ischaemia tests was the key driver of cost-effectiveness in sensitivity analyses for both patient subgroups. C. There was consensus that CMR leads to clinically important changes in management in five patient subgroups. Some changes in management were successfully identified in hospital episode data (e.g. new diagnoses/procedures, frequency of outpatient episodes related to cardiac events), others were not (e.g. changes in medications, new diagnostic tests). Conclusions A national registry is not currently feasible. Patients were consented successfully but conventional consent could not be implemented nationally. Linking HIS and hospital episode data was feasible but HIS data were not uniformly available. It is feasible to identify some, but not all, changes in management in the five patient subgroups using hospital episode data. The delay in obtaining hospital episode data influenced the relevance of some of our study objectives. Future work To test the feasibility of conducting the study using national data sets (e.g. HES, British Cardiovascular Intervention Society audit database, Diagnostic Imaging Dataset, Clinical Practice Research Datalink). Funding The National Institute for Health Research (NIHR) Health Services and Delivery Research programme. This study was designed and delivered in collaboration with the Clinical Trials and Evaluation Unit, a UK Clinical Research Collaboration-registered clinical trials unit that, as part of the Bristol Trials Centre, is in receipt of NIHR clinical trials unit support funding.

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“…The basic pulse sequences used in CMRI are gradient-echo (GE) sequences that can form a cine loop and allow the assessment of wall motion and function; T1-weighted spin-echo sequences that are useful for anatomical imaging; T2-weighted spin-echo sequences that offer information about tissue edema. Late gadolinium-enhanced (LGE) images taken 15 min after the administration of the contrast agent allow the detection of myocardial fibrotic tissue (scarring), which appears as a bright area on a background of black myocardium ( 8 , 34 ); non-invasive vessel angiography is also possible using a bolus injection of gadolinium.…”

Section: Methods Of Evaluating Valve Abnormalities Pericardial Diseamentioning

confidence: 99%

Cardiovascular Imaging Techniques in Systemic Rheumatic Diseases

et al. 2018

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The risk of cardiovascular (CV) events and mortality is significantly higher in patients with systemic rheumatic diseases than in the general population. Although CV involvement in such patients is highly heterogeneous and may affect various structures of the heart, it can now be diagnosed earlier and promptly treated. Various types of assessments are employed for the evaluation of CV risk such as transthoracic or transesophageal echocardiography, magnetic resonance imaging (MRI), and computed tomography (CT) to investigate valve abnormalities, pericardial disease, and ventricular wall motion defects. The diameter of coronary arteries can be assessed using invasive quantitative coronarography or intravascular ultrasound, and coronary flow reserve can be assessed using non-invasive transesophageal or transthoracic ultrasonography (US), MRI, CT, or positron emission tomography (PET) after endothelium-dependent vasodilation. Finally, peripheral circulation can be measured invasively using strain-gauge plethysmography in an arm after the arterial infusion of an endothelium-dependent vasodilator or non-invasively by means of US or MRI measurements of flow-mediated vasodilation of the brachial artery. All of the above are reliable methods of investigating CV involvement, but more recently, introduced use of speckle tracking echocardiography and 3-dimensional US are diagnostically more accurate.

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MRI in the assessment of ischaemic heart disease

Cited by 24 publications

References 113 publications

Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries

Prognostic Role of CMR and Conventional Risk Factors in Myocardial Infarction With Nonobstructed Coronary Arteries

A national registry to assess the value of cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention pathway activation: a feasibility cohort study

Cardiovascular Imaging Techniques in Systemic Rheumatic Diseases

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