scholarly journals Safety and effectiveness of intravenous procainamide in patients with frequent ventricular ectopics during cardiac magnetic resonance scanning: a way to ensure high quality imaging

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Nikolaidou ◽  
J Leal-Pelado ◽  
K Kouskouras ◽  
VP Vassilikos ◽  
H Karvounis ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Average Dose ◽  
High Quality ◽  
Ventricular Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging in patients with frequent ventricular arrhythmias provides significant diagnostic and prognostic information but is challenging due to artefacts. In patients with occasional ventricular premature contractions (VPCs), arrhythmia rejection algorithms can be used to acquire good quality cine images at the expense of longer breath-hold times. However, arrhythmia sorting in not practical in cases of frequent VPCs; other options include triggered data acquisition which compromises image quality or use of low temporal and spatial resolution ‘real-time’ imaging. Purpose The aim of our study was to examine the safety and effectiveness of the class Ia antiarrhythmic medication procainamide for suppressing ventricular ectopy and acquiring high quality CMR images. Methods 50 consecutive patients (mean age 48 ± 16 years; 52% female) with a high burden of VPCs during CMR scanning were included in the study. Procainamide was administered on the scanner table prior to CMR scanning at intermittent intravenous bolus doses of 50 mg every minute, until suppression of VPCs was achieved or a maximum dose of 10 mg/kg was reached. Blood pressure was measured every minute and there was continuous monitoring of heart rate and ECG trace. CMR studies were performed on a 1,5T Magnetom Avanto scanner using a standard cardiac protocol. Results The average dose of procainamide administered was 567 ± 197 mg (range 200-1000 mg). Procainamide successfully suppressed VPCs in 82% of patients (20 patients with complete suppression and 21 with significant reduction); 7 patients had minimal suppression of VPCs, while there was no effect of procainamide in only 2 patients. Baseline blood pressure (BP) was mildly reduced (mean change systolic BP -12 ± 9 mmHg; diastolic BP -4 ± 9 mmHg) but none of the patients developed symptomatic hypotension. Baseline heart rate (HR) was relatively unchanged (baseline 75 ± 11 beats per minute (bpm) – peak procainamide HR 74 ± 12 bpm (mean HR change -1 ± 6 bpm).  None of the patients developed pathological ECG changes. CMR scan had normal findings in 42% of the patients, 26% had non-ischemic cardiomyopathy, in 16% the most likely diagnosis was VPC-related cardiomyopathy, 14% had previous myocarditis, and 1 patient had dual pathology (dilated cardiomyopathy with previous myocardial infarction). Mean left ventricular ejection fraction was 55% ± 9%. Conclusion We propose the bolus intravenous administration of procainamide prior to CMR scanning as a safe and effective alternative approach for suppressing VPCs and acquiring high quality images in patients with frequent ventricular arrhythmias and normal or only mildly impaired left ventricular function. Further studies are needed to assess its safety and effectiveness in larger patient cohorts, including also patients with ventricular systolic impairment.

scholarly journals Bolus Intravenous Procainamide in Patients with Frequent Ventricular Ectopics during Cardiac Magnetic Resonance Scanning: A Way to Ensure High Quality Imaging

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 178 ◽  
Author(s):  
Chrysovalantou Nikolaidou ◽  
Konstantinos Kouskouras ◽  
Nikolaos Fragakis ◽  
Vassilios P. Vassilikos ◽  
Haralambos Karvounis ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Baseline Heart Rate ◽  
Average Dose ◽  
High Quality ◽  
Premature Ventricular Contractions ◽  
Ventricular Ejection Fraction

Acquiring high-quality cardiac magnetic resonance (CMR) images in patients with frequent ventricular arrhythmias remains a challenge. We examined the safety and efficacy of procainamide when administered on the scanner table prior to CMR scanning to suppress ventricular ectopy and acquire high-quality images. Fifty consecutive patients (age 53.0 [42.0–58.0]; 52% female, left ventricular ejection fraction 55 ± 9%) were scanned in a 1.5 T scanner using a standard cardiac protocol. Procainamide was administered at intermittent intravenous bolus doses of 50 mg every minute until suppression of the ectopics or a maximum dose of 10 mg/kg. The average dose of procainamide was 567 ± 197 mg. Procainamide successfully suppressed premature ventricular contractions (PVCs) in 82% of patients, resulting in high-quality images. The baseline blood pressure (BP) was mildly reduced (mean change systolic BP −12 ± 9 mmHg; diastolic BP −4 ± 9 mmHg), while the baseline heart rate (HR) remained relatively unchanged (mean HR change −1 ± 6 bpm). None of the patients developed proarrhythmic changes. Bolus intravenous administration of procainamide prior to CMR scanning is a safe and effective alternative approach for suppressing PVCs and acquiring high-quality images in patients with frequent PVCs and normal or only mildly reduced systolic function.

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 Left ventricular noncompaction—a rare cause of triad: heart failure, ventricular arrhythmias, and systemic embolic events: a case report 

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Despina Toader ◽  
Alina Paraschiv ◽  
Petrișor Tudorașcu ◽  
Diana Tudorașcu ◽  
Constantin Bataiosu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
The Right

Abstract Background Left ventricular noncompaction is a rare cardiomyopathy characterized by a thin, compacted epicardial layer and a noncompacted endocardial layer, with trabeculations and recesses that communicate with the left ventricular cavity. In the advanced stage of the disease, the classical triad of heart failure, ventricular arrhythmia, and systemic embolization is common. Segments involved are the apex and mid inferior and lateral walls. The right ventricular apex may be affected as well. Case presentation A 29-year-old Caucasian male was hospitalized with dyspnea and fatigue at minimal exertion during the last months before admission. He also described a history of edema of the legs and abdominal pain in the last weeks. Physical examination revealed dyspnea, pulmonary rales, cardiomegaly, hepatomegaly, and splenomegaly. Electrocardiography showed sinus rhythm with nonspecific repolarization changes. Twenty-four-hour Holter monitoring identified ventricular tachycardia episodes with right bundle branch block morphology. Transthoracic echocardiography at admission revealed dilated left ventricle with trabeculations located predominantly at the apex but also in the apical and mid portion of lateral and inferior wall; end-systolic ratio of noncompacted to compacted layers > 2; moderate mitral regurgitation; and reduced left ventricular ejection fraction. Between apical trabeculations, multiple thrombi were found. The right ventricle had normal morphology and function. Speckle-tracking echocardiography also revealed systolic left ventricle dysfunction and solid body rotation. Abdominal echocardiography showed hepatomegaly and splenomegaly. Abdominal computed tomography was suggestive for hepatic and renal infarctions. Laboratory tests revealed high levels of N-terminal pro-brain natriuretic peptide and liver enzymes. Cardiac magnetic resonance evaluation at 1 month after discharge confirmed the diagnosis. The patient received anticoagulants, antiarrhythmics, and heart failure treatment. After 2 months, before device implantation, he presented clinical improvement, and echocardiographic evaluation did not detect thrombi in the left ventricle. Coronary angiography was within normal range. A cardioverter defibrillator was implanted for prevention of sudden cardiac death. Conclusions Left ventricular noncompaction is rare cardiomyopathy, but it should always be considered as a possible diagnosis in a patient hospitalized with heart failure, ventricular arrhythmias, and systemic embolic events. Echocardiography and cardiac magnetic resonance are essential imaging tools for diagnosis and follow-up.

scholarly journals EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
C Rios-Navarro ◽  
J Gavara ◽  
J Nunez ◽  
C Bonanad Lozano ◽  
E Revuelta-Lopez ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Microvascular Obstruction ◽  
Systolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Systolic Volume

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was funded by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Bachground. Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in endothelium adhesion, is an understudied area in the MVO setting. Purpose. We aimed to evaluate whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods. We prospectively included 106 patients with a first STEMI treated with primary percutaneous coronary intervention, quantifying serum levels of EpCAM 24 hours post-reperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction (LVEF) was evaluated. Results. The mean age of the sample was 59 ± 13 years and 76% were male. Patients were dichotomized according to EpCAM median (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (p-value = 0.02) and greater infarct size (p-value = 0.02). At presentation, only EpCAM values were significantly associated with the presence of MVO in univariate (Odds Ratio [95% confidence interval] (OR [95% CI]): 0.58 [0.38-0.88], p-value = 0.01) and multivariate logistic regression models (OR [95% CI]: 0.54 [0.34-0.85], p-value = 0.007). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: depressed LVEF (p-value = 0.009) and higher left ventricular end-systolic volume (p-value = 0.04). Conclusions. EpCAM is associated with occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI. Future studies are needed to confirm EpCAM as biomarker, and eventually biotarget in STEMI pathophysiology.

Comprehensive evaluation of structural and functional myocardial impairments in Becker muscular dystrophy using quantitative cardiac magnetic resonance imaging

2018 ◽  
Vol 20 (8) ◽  
pp. 906-915 ◽  
Author(s):  
Benjamin Marty ◽  
Raymond Gilles ◽  
Marcel Toussaint ◽  
Anthony Béhin ◽  
Tanya Stojkovic ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Muscular Dystrophy ◽  
Comprehensive Evaluation ◽  
Becker Muscular Dystrophy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Impairments ◽  
Ventricular Ejection Fraction ◽  
Native T1

Abstract Aims Becker muscular dystrophy (BMD) is a genetic neuromuscular disease characterized by an alteration of the dystrophin protein. Myocardial involvement is frequent, eventually progressing to a dilated cardiomyopathy, and represents the most common cause of death for this pathology. We performed a comprehensive evaluation of myocardial functional and structural alterations encountered in a large cohort of BMD patients using quantitative cardiac magnetic resonance (CMR) imaging. Methods and results Eighty-eight BMD patients and 26 age-matched volunteers underwent standard cine and tag imaging to assess myocardial function and dyssynchrony, while native T1, T2, and extracellular volume fraction (ECV) were measured for tissue characterization. The left ventricular ejection fraction (LV-EF) was significantly reduced in 26% of the BMD patients. Patients exhibited higher dyssynchrony index than controls (6.94 ± 3.17 vs. 5.09 ± 1.25, P = 0.005). Diastolic dyssynchrony also exists in patients where systolic function was normal. BMD subjects, compared with controls, had significantly higher native T1, T2, and ECV (1183 ± 60 ms vs. 1164 ± 22 ms, 47.5 ± 4.5 ms vs. 45.6 ± 3.4 ms, 0.282 ± 0.050 vs. 0.231 ± 0.027, respectively, P < 0.05). Native T1, T2, and ECV correlated with LV-EF (R = −0.79, −0.70, and −0.71, respectively, P < 0.001) and N-terminal-pro brain natriuretic peptide (R = 0.51, 0.58, and 0.44, respectively, P < 0.001). Conclusion Quantitative CMR represents a powerful tool to evaluate structural and functional impairments in the myocardium of BMD subjects. Native T1, T2, and ECV provided quantitative biomarkers related to inflammation and fibrosis, and could stratify disease severity.

P1111Arrhythmogenic substrate detection in ischemic patients undergoing ventricular tachycardia ablation using multi-detector computed tomography: compared evaluation with cardiac magnetic resonance

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Jauregui ◽  
D Soto-Iglesias ◽  
G Zucchelli ◽  
C Teres ◽  
A Ordonez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ventricular Tachycardia ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Predictive Values ◽  
Arrhythmogenic Substrate ◽  
Subendocardial Mi

Abstract Background  Cardiac magnetic resonance (CMR) is capable of accurately identifying arrhythmogenic substrate (AS), leading to longer arrhythmia-free survival when used to guide ventricular tachycardia (VT) substrate ablation procedures. However, the use of CMR may be limited in certain centers or patient subsets.  Purpose  To evaluate the performance of multidetector cardiac computed tomography (MDCT) imaging in identifying heterogeneous tissue channels (HTCs) detected by CMR in ischemic patients undergoing VT substrate ablation. Methods  Thirty ischemic patients undergoing both CMR and MDCT before VT substrate ablation were included. Using a dedicated post-processing software, two blinded operators, assigned either to CMR or MDCT analysis, characterized the presence of CMR- and CT-channels, respectively. CMR-channels were classified as endocardial (layers &lt;50%), epicardial (layers ≥50%) or transmural. CMR- vs. CT-channel concordance was considered when the orientation was the same and they were located in the same AHA segment. Results  Mean age was 69 ± 10 years; 90% were male. Mean left ventricular ejection fraction (LVEF) was 35 ± 10%. All patients had CMR-channels (n = 76), whereas only 26/30 (86.7%) had CT-channels (n = 91). Global sensitivity (Se) and positive predictive values (PPV) for detecting CMR-channels were 61.8% and 51.6%, respectively. MDCT performance improved in patients with epicardial CMR-channels (Se 80.5%), and transmural scars (Se 72.2%). In 4/11 (36%) patients with subendocardial MI, MDCT was unable to identify the AS. Conclusion  MDCT fails to detect the presence of AS in 36% of patients with subendocardial MI and shows a modest sensitivity identifying the presence of HTCs, although its performance improves in patients with transmural scar. Abstract Figure. Multimodality imaging AS detection

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