Ct Assessment Of Left Ventricular Myocardial Thickness As A Marker Of Viability: A Head-to-head Comparison With Cardiac Magnetic Resonance Late Gadolinium Enhancement

2021 ◽  
Vol 15 (4) ◽  
pp. S12
Author(s):  
N. Mekkhala ◽  
M. May ◽  
M. Saake ◽  
J. Podzus ◽  
F. Ammon ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Myocardial Thickness

scholarly journals Evolving Diagnostic Criteria for Arrhythmogenic Cardiomyopathy

2021 ◽  
Vol 10 (18) ◽  
Author(s):  
Domenico Corrado ◽  
Alessandro Zorzi ◽  
Alberto Cipriani ◽  
Barbara Bauce ◽  
Riccardo Bariani ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Right Ventricular ◽  
Task Force ◽  
Left Ventricular ◽  
Arrhythmogenic Cardiomyopathy ◽  
Ventricular Cardiomyopathy ◽  
Gadolinium Enhancement ◽  
New Criteria

Abstract Criteria for diagnosis of arrhythmogenic cardiomyopathy (ACM) were first proposed in 1994 and revised in 2010 by a Task Force. Although the Task Force criteria demonstrated a good accuracy for diagnosis of the original right ventricular phenotype (arrhythmogenic right ventricular cardiomyopathy), they lacked sensitivity for identification of the expanding phenotypic spectrum of ACM, which includes left‐sided variants and did not incorporate late‐gadolinium enhancement findings by cardiac magnetic resonance. The 2020 International criteria (“Padua criteria”) have been developed by International experts with the aim to improve the diagnosis of ACM by providing new criteria for the diagnosis of left ventricular phenotypic features. The key upgrade was the incorporation of tissue characterization findings by cardiac magnetic resonance for noninvasive detection of late‐gadolinium enhancement/myocardial fibrosis that are determinants for characterization of arrhythmogenic biventricular and left ventricular cardiomyopathy. The 2020 International criteria are heavily dependent on cardiac magnetic resonance, which has become mandatory to characterize the ACM phenotype and to exclude other diagnoses. New criteria regarding left ventricular depolarization and repolarization ECG abnormalities and ventricular arrhythmias of left ventricular origin were also provided. This article reviews the evolving approach to diagnosis of ACM, going back to the 1994 and 2010 International Task Force criteria and then grapple with the modern 2020 International criteria.

P1077Late gadolinium enhancement with cardiac magnetic resonance imaging demonstrates left ventricular involvement is under-recognized in arrhythmogenic right ventricular cardiomyopathy

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Mohamed ◽  
M Kunz ◽  
S Casey ◽  
W Katsiyiannis ◽  
R Abdelhadi ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Right Ventricular ◽  
Arrhythmogenic Right Ventricular Cardiomyopathy ◽  
Left Ventricular ◽  
Fatty Tissue ◽  
Post Mortem ◽  
Ventricular Cardiomyopathy ◽  
Gadolinium Enhancement

Abstract Funding Acknowledgements The study is partially funded by Medtronic and the Minneapolis Heart Institute Foundation. Background/Introduction: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by replacement of the myocardium with fibrous and fatty tissue that may lead to an increased risk of ventricular arrhythmias and heart failure.  Although left ventricular (LV) and biventricular forms have been identified post-mortem resulting in the increased use of the term arrhythmogenic cardiomyopathy, there is only inclusion of right ventricular wall motion abnormalities in the taskforce diagnostic criteria. Purpose The aim of our study was to examine the utility of cardiac magnetic resonance (CMR) imaging in characterizing LV or biventricular involvement with late gadolinium enhancement (LGE) in a large cohort of patients with suspected ARVC. Methods Retrospective, single-institution, chart review of 76 patients diagnosed with ARVC between January 2009 and July 2019. Data collection and analysis included baseline demographics and parameters specific to diagnosis (definite, borderline, or possible) and risk stratification of ARVC based on 2019 modified taskforce criteria, as well as detailed CMR evaluation. Results Of the 76 patients with ARVC, 66 (87%) had at least one CMR with gadolinium administered. In that subset of patients, 27 (41%) had LGE. Of those with LGE, LV involvement was identified in 23 (85%) patients. The pattern of LGE was not localized to one myocardial region but demonstrated variable LV enhancement patterns including anterior, inferior, lateral, septal, basal, mid, apical, and from the sub-epicardium into the mid-myocardium. Conclusions   Left ventricular involvement reflected by LGE was identified in a high percentage of patients with suspected ARVC, and there was significant variation in the pattern of distribution in terms of region and depth of myocardial involvement.  While post-mortem examination of patients with ARVC demonstrates a high prevalence of left ventricular involvement, this study shows that CMR can consistently detect late gadolinium enhancement, and ARVC should be considered in the differential diagnosis for biventricular cardiomyopathy.  The identification of variable locations of LGE within the LV suggests there is more than one phenotype, and this imaging modality may help to clarify the implications of left ventricular involvement in disease progression.

scholarly journals P363 Cardiac magnetic resonance characteristics of patients in the grey zone of hypertrophy

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Czimbalmos ◽  
I Csecs ◽  
V Horvath ◽  
E Deetjen ◽  
C Nardocci ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Standard Deviation ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Grey Zone ◽  
Peak Strain ◽  
Gadolinium Enhancement ◽  
Systolic Volume ◽  
Time To Peak

Abstract Funding Acknowledgements National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277); Project no. NVKP_16-1-2016-0017. Supported by the ÚNKP-18-3-IV Background Differentiation between athlete’s heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy. Purpose We aimed to analyse cardiac magnetic resonance (CMR) characteristics of healthy athletes, sedentary HCM and athletic HCM patients in the grey zone of hypertrophy. Methods Male HCM patients with slightly elevated maximal end-diastolic wall thickness (EDWT 13-18 mm) and highly trained healthy athletes (n = 34, 20.4 ± 2.3 training hrs/week) were consecutively enrolled. HCM patient group was divided to sedentary (n = 35, <7 training hrs/week) and athletic HCM group (n = 13; >7 h/week, 13.2 ± 5.0 h training hrs/week).We determined conventional CMR parameters (left ventricular (LV) ejection fraction (EF),BSA-corrected end-diastolic (EDVi) and end-systolic volume (ESVi), mass (Mi)), derived parameters such as EDWT/LVEDVi, LVM/LVEDV and CMR based strain parameters such as global longitudinal (GLS), radial (GRS) and circumferential strain (GCS), standard deviation of peak LS, RS and CS (SD LS peak, SD RS peak, SD CS peak), standard deviation of time to peak LS, RS and CS (TTP LS, TTP RS, TTP CS) using feature tracking. Presence of late gadolinium enhancement (LGE) was determined on delayed contrast enhanced images. Inter-observer analysis for strain values was performed in a subgroup of 20 patients conducted by two blinded observer. Results Healthy athletes showed lower LVEF, GCS and GRS than sedentary and athletic HCM patients, respectively (57.9 ± 5.2 vs 65.3 ± 7.4, 62.7 ± 5.1; -19.7 ± 7.0 vs -24.4 ± 4.6, -22.8 ± 4.8; 61.7 ± 11.2 vs 75.4 ± 21.4, 69.3 ± 19.8). Both healthy athletes and athletes with HCM showed higher LVEDVi, LVESVi, LVSVi and LVMi than sedentary HCM patients. Although sedentary athletes showed higher SD peak strain values and more pronounced intraventricular dyssynchrony than healthy athletes (TTP LS 15.4 ± 4.9 vs 11.7 ± 4.3), none of the global strain values, SD of peak strain values or TTP strain values showed any difference between athletic HCM and healthy athletes. EDWT/LVEDVi ratio was significantly lower in healthy athletes than in sedentary and athletic HCM, respectively (0.11 ± 0.02 vs 0.19±.0.04; 0.18 ± 0.04). Inter-observer analysis showed good agreement in GLS (κ=0.77), GRS (κ=0.69) and TTP LS (κ=0.74), moderate agreement in GCS (κ=0.54), and only fair or poor agreement in SD peak strain, TTP CS and TTP RS values. None of the healthy athletes showed LGE, 62% of athletic HCM and 71% of sedentary HCM patients showed LGE in the hypertrophic segments or in the insertion points. Conclusions Based on our results CMR characteristics of sedentary and athletic HCM differs significantly, therefore establishing diagnostic parameters and cut-off values based on comparison between athletic HCM and healthy athletes would be essential. Presence of late gadolinium enhancement and derived parameters may have an important role in the differential diagnosis.

scholarly journals Mean Scar Entropy by Late Gadolinium Enhancement Cardiac Magnetic Resonance Is Associated With Ventricular Arrhythmias Events in Hypertrophic Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Yang Ye ◽  
ZhongPing Ji ◽  
Wenli Zhou ◽  
Cailing Pu ◽  
Ya Li ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Hypertrophic Cardiomyopathy ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Risk Indicators ◽  
Left Ventricular Ejection ◽  
Gadolinium Enhancement ◽  
Ventricular Ejection Fraction

Background: Ventricular arrhythmias are associated with sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Previous studies have found the late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) was independently associated with ventricular arrhythmia (VA) in HCM. The risk stratification of VA remains complex and LGE is present in the majority of HCM patients. This study was conducted to determine whether the scar heterogeneity from LGE-derived entropy is associated with the VAs in HCM patients.Materials and Methods: Sixty-eight HCM patients with scarring were retrospectively enrolled and divided into VA (31 patients) and non-VA (37 patients) groups. The left ventricular ejection fraction (LVEF) and percentage of the LGE (% LGE) were evaluated. The scar heterogeneity was quantified by the entropy within the scar and left ventricular (LV) myocardium.Results: Multivariate analyses showed that a higher scar [hazard ratio (HR) 2.682; 95% CI: 1.022–7.037; p = 0.039] was independently associated with VA, after the adjustment for the LVEF, %LGE, LV maximal wall thickness (MWT), and left atrium (LA) diameter.Conclusion: Scar entropy and %LGE are both independent risk indicators of VA. A high scar entropy may indicate an arrhythmogenic scar, an identification of which may have value for the clinical status assessment of VAs in HCM patients.

scholarly journals Myocardial Perfusion Defects in Hypertrophic Cardiomyopathy Mutation Carriers

2021 ◽  
Author(s):  
Rebecca K. Hughes ◽  
Claudia Camaioni ◽  
João B. Augusto ◽  
Kristopher Knott ◽  
Ellie Quinn ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Myocardial Perfusion ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Myocardial Perfusion Reserve ◽  
Left Ventricular ◽  
Gadolinium Enhancement ◽  
Perfusion Reserve

Background Impaired myocardial blood flow (MBF) in the absence of epicardial coronary disease is a feature of hypertrophic cardiomyopathy (HCM). Although most evident in hypertrophied or scarred segments, reduced MBF can occur in apparently normal segments. We hypothesized that impaired MBF and myocardial perfusion reserve, quantified using perfusion mapping cardiac magnetic resonance, might occur in the absence of overt left ventricular hypertrophy (LVH) and late gadolinium enhancement, in mutation carriers without LVH criteria for HCM (genotype‐positive, left ventricular hypertrophy‐negative). Methods and Results A single center, case‐control study investigated MBF and myocardial perfusion reserve (the ratio of MBF at stress:rest), along with other pre‐phenotypic features of HCM. Individuals with genotype‐positive, left ventricular hypertrophy‐negative (n=50) with likely pathogenic/pathogenic variants and no evidence of LVH, and matched controls (n=28) underwent cardiac magnetic resonance. Cardiac magnetic resonance identified LVH‐fulfilling criteria for HCM in 5 patients who were excluded. Individuals with genotype‐positive, left ventricular hypertrophy‐negative had longer indexed anterior mitral valve leaflet length (12.52±2.1 versus 11.55±1.6 mm/m 2 , P =0.03), lower left ventricular end‐systolic volume (21.0±6.9 versus 26.7±6.2 mm/m 2 , P ≤0.005) and higher left ventricular ejection fraction (71.9±5.5 versus 65.8±4.4%, P≤ 0.005). Maximum wall thickness was not significantly different (9.03±1.95 versus 8.37±1.2 mm, P =0.075), and no subject had significant late gadolinium enhancement (minor right ventricle‒insertion point late gadolinium enhancement only). Perfusion mapping demonstrated visual perfusion defects in 9 (20%) carriers versus 0 controls ( P =0.011). These were almost all septal or near right ventricle insertion points. Globally, myocardial perfusion reserve was lower in carriers (2.77±0.83 versus 3.24±0.63, P =0.009), with a subendocardial:subepicardial myocardial perfusion reserve gradient (2.55±0.75 versus 3.2±0.65, P =<0.005; 3.01±0.96 versus 3.47±0.75, P =0.026) but equivalent MBF (2.75±0.82 versus 2.65±0.69 mL/g per min, P =0.826). Conclusions Regional and global impaired myocardial perfusion can occur in HCM mutation carriers, in the absence of significant hypertrophy or scarring.

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