Circumferential strain acquired by CMR early after acute myocardial infarction adds incremental predictive value to late gadolinium enhancement imaging to predict late myocardial remodeling and subsequent risk of sudden cardiac death

2017 ◽  
Vol 50 (3) ◽  
pp. 211-218 ◽  
Author(s):  
Anthony A. Holmes ◽  
Jorge Romero ◽  
Jeffrey M. Levsky ◽  
Linda B. Haramati ◽  
Newton Phuong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Late Gadolinium Enhancement ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Circumferential Strain ◽  
Late Gadolinium Enhancement Imaging ◽  
Myocardial Remodeling ◽  
Gadolinium Enhancement ◽  
Subsequent Risk

Early and late gadolinium enhancement

2018 ◽  
pp. 119-132
Author(s):  
Joseph Selvanayagam ◽  
Gaetano Nucifora
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Late Gadolinium Enhancement ◽  
Late Gadolinium Enhancement Imaging ◽  
Breath Hold ◽  
Cardiac Diseases ◽  
Gadolinium Enhancement ◽  
Prognostic Information ◽  
Clinical Benefits ◽  
Recovery Technique

The peculiar features of gadolinium-chelated contrast agents and the development of contrast-enhanced inversion recovery technique in the late 1990s formed the basis of early and late gadolinium enhancement imaging, revolutionizing the application of magnetic resonance imaging in patients with cardiac diseases. Several clinical studies have indeed demonstrated the clinical benefits of early and late gadolinium enhancement imaging, including the discrimination between scarred/fibrotic myocardium and normal myocardium and the identification of mural thrombi and areas of microvascular obstruction among patients with acute myocardial infarction. The technique currently plays a key role in the differential diagnosis between cardiac diseases with ischaemic and non-ischaemic aetiology and in the assessment of patients with acute myocardial infarction and its complications. Due to its invaluable ability to provide diagnostic and prognostic information, it is indeed more frequently implemented for patients’ clinical management and decision-making. This chapter discusses the technical aspects of early and late gadolinium enhancement imaging, reviews the initial studies that led to the validation of the technique, and focuses on its application according to the main clinical syndromes (i.e. acute and chronic myocardial infarction, heart failure, conduction diseases, and ventricular arrhythmias). Guidelines for correct image acquisition and interpretation will be also provided, in particular, how to deal with patients with cardiac arrhythmias or with patients unable to breath-hold properly, and how to discriminate true late gadolinium enhancement areas from artefacts is discussed.

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

scholarly journals Late Gadolinium Enhancement–Dispersion Mapping

2020 ◽  
Vol 13 (6) ◽  
Author(s):  
Giovanni Donato Aquaro ◽  
Chrysanthos Grigoratos ◽  
Antonio Bracco ◽  
Alberto Proclemer ◽  
Giancarlo Todiere ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Average Score ◽  
Cardiac Events ◽  
Gadolinium Enhancement ◽  
Net Reclassification Improvement ◽  
Kaplan Meier ◽  
Central Pixel

Background: Late gadolinium enhancement (LGE) is an important prognostic marker in hypertrophic cardiomyopathy and an extent >15% it is associated with high risk of sudden cardiac death. We proposed a novel method, the LGE-dispersion mapping, to assess heterogeneity of scar, and evaluated its prognostic role in patients with hypertrophic cardiomyopathy. Methods: One hundred eighty-three patients with hypertrophic cardiomyopathy and a low- or intermediate 5-year risk of sudden cardiac death underwent cardiac magnetic resonance imaging. A parametric map was generated from each LGE image. A score from 0 to 8 was assigned at every pixel of these maps, indicating the number of the surrounding pixels having different quality (nonenhancement, mild-enhancement, or hyperenhancement) from the central pixel. The Global Dispersion Score (GDS) was calculated as the average score of all the pixels of the images. Results: During a median follow-up time of 6 (25th–75th, 4–10) years, 22 patients had hard cardiac events (sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, resuscitated cardiac arrest, and sustained ventricular tachycardia). Kaplan-Meier analysis showed that patients with GDS>0.86 had worse prognosis than those with lower GDS ( P <0.0001). GDS>0.86 was the only independent predictor of cardiac events (hazard ratio, 9.9 [95% CI, 2.9–34.6], P =0.0003). When compared with LGE extent >15%, GDS improved the classification of risk in these patients (net reclassification improvement, 0.39 [95% CI, 0.11–0.72], P <0.019). Conclusions: LGE-dispersion mapping is a marker of scar heterogeneity and provides a better risk stratification than LGE presence and its extent in patients with hypertrophic cardiomyopathy and a low-intermediate 5-year risk of sudden cardiac death.

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