scholarly journals Cardiac magnetic resonance strain and mechanical dispersion assessment in patients with chronic total coronary artery occlusion

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Grafton-Clarke ◽  
S Bhandari ◽  
A Abdelaty ◽  
M Mashicharan ◽  
G Gulsin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Magnetic Resonance ◽  
Wall Motion ◽  
Systolic Function ◽  
Left Ventricular ◽  
Stress Perfusion ◽  
Visual Evaluation ◽  
Chronic Total Occlusions ◽  
Mechanical Dispersion ◽  
Scar Assessment

Abstract Background Chronic total occlusions (CTO) are a frequent angiographic finding. Viability of CTO-subtended myocardium is dependent on the presence of an adequate collateral circulation. At rest, collateral supply may be sufficient to avert ischaemia and maintain normal systolic function. However, it remains unclear whether CTO-subtended myocardium may be considered truly normal, or whether subtle functional abnormalities may be present at rest. Purpose To determine whether, in the absence of infarction and hibernation, CTO-subtended myocardium remains functionally normal or whether abnormalities of strain and/or mechanical dispersion may be present at rest. Methods In a retrospective, single centre, observational study, we studied patients with ≥1 angiographically-diagnosed CTO referred for clinical stress perfusion cardiovascular magnetic resonance (CMR), and compared healthy volunteers (HVs) with a normal stress CMR scan. CMR imaging comprised functional and scar assessment with qualitative [visual] evaluation of infarction and segmental wall motion. Patients with infarction and/or wall motion score index (WMSI) ≥1 were excluded from further analysis. In remaining CTO subjects and HVs, segmental peak systolic longitudinal strain and circumferential strain were analysed (in 3 long-axis planes and 3 short-axis planes, respectively) and mechanical dispersion for both orientations was computed. Image analysis was performed using Medis (QStrain) software blinded to all clinical information. Results From a total of 389 patients with ≥1 angiographically-diagnosed CTO, 68 had normal WMSI and no infarction (63.0±11.7 years, 79.4% male, LVEF 62.6±4.5%). Fifty HVs (61.1±7.0 years, 74.0% males, LVEF 61.1±5.3%) were also studied. The majority of CTO patients had concomitant coronary artery disease in at least one non-CTO vessel (n=37, 54.4%). GLS was lower in CTO patients than HVs (−21.8%±1.5% versus −24.0±1.1%; p<0.0001; Figure 1). By contrast, GCS was greater in CTO patients (−32.7±2.5% versus −28.8±2.1%; p<0.0001). Mechanical dispersion was increased in CTO patients (Figure 2), both longitudinally (90.3±14.6 ms in CTO patients versus 68.6±11.1 ms in HVs; p<0.0001) and circumferentially (66.7±9.1 ms versus 55.3±6.6 ms, respectively; p=0.02). Conclusion Subclinical changes in left ventricular dynamics are present at rest in CTO patients with fully viable myocardium and no evidence of resting regional wall abnormality. Further study is warranted to evaluate the potential association between mechanical dispersion and arrhythmic events in CTO. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): NIHR Clinician Scientist Award (CS-2018-18-ST2-007 to J.R.A.) and Research Professorship award (RP-2017-08-ST2-007 to G.P.M.). Figure 1. Strain analysis. CTO vs HV Figure 2. Mechanical dispersion. CTO vs HV

scholarly journals Impairment in Quantitative Microvascular Function in Non-Ischemic Cardiomyopathy as Demonstrated Using Cardiovascular Magnetic Resonance

2021 ◽  
Author(s):  
Jeremy A. Slivnick ◽  
Karolina M. Zareba ◽  
Vien T. Truong ◽  
Ellen Liu ◽  
Alexis Barnes ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ischemic Cardiomyopathy ◽  
Systolic Function ◽  
Univariate Analysis ◽  
Myocardial Perfusion Reserve ◽  
Microvascular Function ◽  
Stress Perfusion ◽  
Visual Evaluation ◽  
Stress Cmr

Abstract Purpose Microvascular dysfunction (MVD)—defined as impaired augmentation of the microcirculation in response to stress—is present in various cardiovascular diseases and portends worse outcomes. We aimed to evaluate the relationship between MVD and non-ischemic cardiomyopathy (NICM) utilizing stress cardiovascular magnetic resonance (CMR) as compared to a cohort of control patients. Methods We retrospectively studied 41 consecutive patients with NICM (mean age 51 ± 14, 59% male) and 58 controls with preserved systolic function (mean age 51 ± 13, 31% male) who underwent adenosine stress CMR exams between 2011–2016. Microvascular function was assessed visually and with myocardial perfusion reserve index (MPRI), quantified using first pass perfusion imaging by comparing perfusion slopes of myocardium and blood pool at rest/stress. MVD was defined visually as presence of subendocardial stress perfusion defect and quantitatively by MPRI < 1.51. MPRI was compared between NICM and controls using univariate analysis and multivariable linear regression. Results Impaired MPRI was noted in 37 patients (23 in NICM and 14 in control cohorts). In patients with NICM, 23 (56%) had MVD by quantitative assessment, while 11 (27%) by visual evaluation. No differences in comorbidities were noted between cohorts. Compared with controls, NICM patients had lower rest perfusion slope (3.9 vs 4.9, p = 0.05), stress perfusion slope (8.8 vs 11.7, p < 0.001), and MPRI (1.41 vs 1.74, p = 0.02). MPRI remained associated with NICM after controlling for age, gender, hypertension, diabetes, and late gadolinium enhancement (log MPR, β coefficient = -0.17, p = 0.009). Conclusions MVD assessed with stress CMR is highly prevalent in NICM as compared to control patients with preserved systolic function. Quantitative MPRI assessment identities more NICM patients with MVD as compared to visual evaluation. NICM remains independently associated with an impaired MPRI after controlling for covariates. Further studies are needed to determine whether targeted therapies to treat MVD are beneficial in NICM.

P3558Cardiac magnetic resonance characteristics of the transplanted heart: first results of the prospective Heart-TIming CMR substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Vago ◽  
Z Dohy ◽  
C Czimbalmos ◽  
L Szabo ◽  
V Horvath ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Right Ventricular ◽  
Invasive Coronary Angiography ◽  
Significant Coronary Artery Disease ◽  
Strain Analysis ◽  
Temporal Changes ◽  
Left Ventricular ◽  
Stress Perfusion ◽  
Mechanical Dispersion ◽  
Tissue Characteristics

Abstract Background In case of heart transplantation (HTX) the heart is affected by several factors e.g. ischaemia/reperfusion, denervation, immunosuppression. During the adaptation, the heart may show marked temporal changes in terms of myocardial mechanics, function and tissue characteristics. To better understand temporal characteristics after orthotopic bicaval HTX we started the prospective Heart-TIming (Transplantation Imaging) trial in January 2018 including standard 12-lead ECG, 24-hour Holter monitor, endomyocardial biopsy, transthoracic echocardiography, invasive coronary angiography with intravascular ultrasound and optical coherence tomography and cardiac magnetic resonance (CMR). Aim In our CMR substudy we aimed to evaluate the physiological structural and functional left and right ventricular characteristics and their temporal changes after HTX using CMR. Methods As part of the study HTX patients underwent CMR at 1, 3 and 6 months after HTX (n=31; 52±10.5y, 25 male). Cine images, T2-weighted, late gadolinium enhancement (LGE) and adenosine stress perfusion (at 1 month) images were acquired. In order to describe physiological characteristics of the transplanted heart we excluded pts with significant coronary artery disease, ischaemic scar, ≥Grade II allograft rejection from this present study (n=6). We assessed the left (LV) and right ventricular (RV) ejection fractions, volumes, masses (M) and LV strain. We assessed the global strain values: longitudinal, circumferential (GCS) strain and the standard deviation (SD) of the peak longitudinal strain (LS) and the left ventricular mechanical dispersion. We compared baseline volumetric and strain parameters to age matched healthy controls (n=20; 47±11.4y, 15 male), and the temporal changes between one, three and 6 months. Results Comparing the HTX patients' CMR parameters at one month with normal controls, HTX patients had lower LV and RV end-diastolic volumes (LVEDVi: 76.6±15.9 vs 90.6±11.6ml/m2; RVEDVi 74.5±17.5 vs 90.3±12.1ml/m2, p<0.05),stroke volumes (p<0.05) and higher LVMi (67.6±14.4 vs 57.2±11g/m2, p<0.05). CMR based strain analysis of the HTX pts showed hyperkinetic GCS (−40,5±6.3% vs −35.2±4.8%, p<0.05), increased SD of peak LS and more pronounced mechanical dispersion (p<0.001) compared to the controls. Examining temporal changes in HTX pts we found a decrease in LVMi (69.57±16.4 vs 61.7±9.8g/m2, p<0.05) already at three months, normalization of GCS (−37.7±5.5% vs −32.6±4.9%, p<0.05) and decrease in SD of peak LS (13.5±2.3 vs 11.4±2.4, p<0.05) at 6 months. Oedema was present in all pts at one month after HTX, and disappeared after three months. LGE with aspecific pattern was present in 42%. LGE with aspecific pattern in HTX pts Conclusions Understanding the temporal changes of LV mechanics, function and tissue characteristics, furthermore the establishment of physiological values may help in the early, noninvasive identification of pathological changes in HTX pts. NCT number: NCT03499197 Acknowledgement/Funding Project no. NVKP_16-1-2016-0017 has been implemented with the support provided from the National Research, Development and Innovation Fund of Hungary

Abstract 4230: Comparison of Dobutamine-atropine Stress Echocardiography and Magnetic Resonance for Detection of Obstructive Coronary Artery Disease by Assessing Wall Motion and Myocardial Perfusion Abnormalities

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sandra N Falcao ◽  
Jeane Tsutsui ◽  
Carlos E Rochitte ◽  
Luis Silva ◽  
Pedro A Lemos ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Magnetic Resonance ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Contrast Echocardiography ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Mechanical Index

Background: The analysis of wall motion abnormalities (WMA) with dobutamine stress echocardiography or magnetic resonance is an established method for the detection of myocardial ischemia. Contrast echocardiography has been demonstrated a useful technique for evaluating myocardial perfusion (MP). We test the hypothesis that combination of MP and WMA would improve the diagnosis of coronary artery diseasen (CAD). Objective: To compare the diagnostic accuracy of dobutamine stress real-time myocardial contrast echocardiography (RTMCE) and gadolinium-enhanced magnetic resonance imaging (G-MRI) for detecting CAD by analyzing left ventricular WMA and MP. Methods: We prospectively studied 46 patients (23 males, mean age 58±8 years) referred for coronary angiography, RTMCE and MRI within a maximum interval of two weeks. Protocol used in RTMCE and G-MRI was four-stage dobutamine protocol (10 – 40 mcg/kg/min), with injection of atropine as required to reach 85% of age-adjusted target heart rate. Patients underwent first dobutamine stress RTMCE and then G-MRI using the same doses of dobutamine and atropine. RTMCE was performed using low-mechanical index imaging combined with intravenous commercially available contrast agent (Definity, Bristol-Myers Squibb). Positivity for the stress test was defined as new or worsening WMA or reversible perfusion defects in >2 contiguous segments. Quantitative coronary angiography (QCA) was performed in all patients. CAD was defined as the presence of lesion >50 % in at least one coronary artery territory. Results: All patients tolerated well dobutamine stress. In five patients G-MRI was not performed (2 because of claustrofobia, 1 because patient did not fit in MRI, 2 because of extensive ischemia by dobutamine RTMCE). A total of 41 patients underwent dobutamine RTMCE, G-MRI and QCA. The sensitivity, specificity, and accuracy to detect CAD by dobutamine RTMCE were 74%, 89% and 80% for the analysis of wall motion, 83%, 89% and 85% for the analysis of MP and 65%, 83% and 73% for dobutamine stress G-MRI. C onclusion: RTMCE seems to have better performance for detecting angiographically significant CAD than G-MRI using dobutamine stress. The analysis of MP increases sensitivity to RTMCE without changing specificity.

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

scholarly journals Myocardial deformation in patients with a single left ventricle using 2D cardiovascular magnetic resonance feature tracking: a case–control study

2021 ◽  
Author(s):  
Fabian Strodka ◽  
Jana Logoteta ◽  
Roman Schuwerk ◽  
Mona Salehi Ravesh ◽  
Dominik Daniel Gabbert ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricle ◽  
Feature Tracking ◽  
Systolic Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Significant Difference ◽  
Lv Volumes

AbstractVentricular dysfunction is a well-known complication in single ventricle patients in Fontan circulation. As studies exclusively examining patients with a single left ventricle (SLV) are sparse, we assessed left ventricular (LV) function in SLV patients by using 2D-cardiovascular magnetic resonance (CMR) feature tracking (2D-CMR-FT) and 2D-speckle tracking echocardiography (2D-STE). 54 SLV patients (11.4, 3.1–38.1 years) and 35 age-matched controls (12.3, 6.3–25.8 years) were included. LV global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and strain rate (GLSR, GCSR, GRSR) were measured using 2D-CMR-FT. LV volumes, ejection fraction (LVEF) and mass were determined from short axis images. 2D-STE was applied in patients to measure peak systolic GLS and GLSR. In a subgroup analysis, we compared double inlet left ventricle (DILV) with tricuspid atresia (TA) patients. The population consisted of 19 DILV patients, 24 TA patients and 11 patients with diverse diagnoses. 52 patients were in NYHA class I and 2 patients were in class II. Most SLV patients had a normal systolic function but median LVEF in patients was lower compared to controls (55.6% vs. 61.2%, p = 0.0001). 2D-CMR-FT demonstrated reduced GLS, GCS and GCSR values in patients compared to controls. LVEF correlated with GS values in patients (p < 0.05). There was no significant difference between GLS values from 2D-CMR-FT and 2D-STE in the patient group. LVEF, LV volumes, GS and GSR (from 2D-CMR-FT) were not significantly different between DILV and TA patients. Although most SLV patients had a preserved EF derived by CMR, our results suggest that, LV deformation and function may behave differently in SLV patients compared to healthy subjects.

Cardiovascular magnetic resonance to predict clinical outcome in chronic total coronary artery occlusion

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Khedr Abdelaty ◽  
C Budgeon ◽  
G.S Gulsin ◽  
S Hetherington ◽  
K Khunti ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Coronary Artery ◽  
Magnetic Resonance ◽  
Clinical Outcome ◽  
Composite Endpoint ◽  
Coronary Artery Occlusion ◽  
Stress Perfusion ◽  
Funding Source ◽  
Collateral Flow ◽  
Cmr Imaging

Abstract Background Chronic total coronary artery occlusions (CTOs) are present in approximately 20–30% of patients undergoing invasive angiography. Despite their prevalence, the optimum management strategy of CTOs remains uncertain. A potential limitation in published trials of CTO revascularisation is their failure to incorporate systematic assessment of ischaemia/viability in informing revascularisation decisions. Aim We sought to determine the prognostic utility of ischaemia/viability assessment by cardiovascular magnetic resonance (CMR) in a large, contemporaneous, real-world CTO population. Methods We retrospectively studied consecutive adult patients with≥1angiographically identified CTO who were referred for clinical CMR imaging during a consecutive 8-year period in our centre (2010–2018). Multi-parametric CMR comprised functional assessment, adenosine-stress perfusion and scar imaging. For perfusion assessment, images were analysed qualitatively with a concurrent examination of scar images. Myocardial segments were assigned to CTO or non-CTO territories according to standard criteria, taking into account coronary dominance. Significant ischaemia was defined as ≥10% and/or ≥2 contiguous myocardial segments with hibernation. Angiographic collateral flow to the CTO territory was graded using the Rentrop classification and the Collateral Connection (CC) Score. Significant CAD in non-CTO vessels was defined angiographically as ≥50% stenosis in any epicardial coronary artery/branch with diameter ≥2mm. The composite clinical endpoint comprised all-cause mortality, myocardial infarction and heart failure hospitalisation. Results From a total of 27,201 invasive angiograms performed during the study period, 389 patients were diagnosed with CTO and underwent CMR imaging (mean age 65.0±11.0 years, 84% male). CTO was present most frequently in the right coronary artery (59% of subjects, 229/389), with left circumflex (LCx) artery involvement in 29% (112/389) and left anterior descending (LAD) artery in 29% (111/389). Collaterals with CC grade ≥2 were identified in 186 subjects (48%), and Rentrop score ≥2 in 300 (77%). Significant ischaemia was present in 61% of patients, and infarction in 71% (median infarction 8.6% [interquartile range (IQR) 4.5–14.1]. With a median follow-up time of 3.30 years [IQR 0.04–8.64], 65 (17%) met the composite endpoint. On multivariate analysis, neither significant ischaemia nor infarction was associated with the composite endpoint. However, non-CTO territory ischaemia was independently predictive of adverse outcome (hazard ratio 1.93; 95% CI 1.16–3.21; p=0.0113). Conclusion CTO-territory ischaemia and infarction are not predictive of adverse clinical outcome, challenging the assertion that CTO revascularisation may be guided by ischaemia assessment. The finding that non-CTO territory ischaemia is associated with adverse cardiovascular events warrants further investigation. Kaplan-Meier curves_CTO Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): British Heart Foundation

scholarly journals Strain parameters for predicting the prognosis of non‐ischemic dilated cardiomyopathy using cardiovascular magnetic resonance tissue feature tracking

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Chengjie Gao ◽  
Yajie Gao ◽  
Jingyu Hang ◽  
Meng Wei ◽  
Jingbo Li ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Feature Tracking ◽  
Systolic Function ◽  
Radial Strain ◽  
Left Ventricular ◽  
Multivariate Logistic Regression Model ◽  
Non Ischemic Dilated Cardiomyopathy

Abstract Background A considerable number of non-ischemic dilated cardiomyopathy (NDCM) patients had been found to have normalized left ventricular (LV) size and systolic function with tailored medical treatments. Accordingly, we aimed to evaluate if strain parameters assessed by cardiovascular magnetic resonance (CMR) feature tracking (FT) analysis could predict the NDCM recovery. Methods 79 newly diagnosed NDCM patients who underwent baseline and follow-up CMR scans were enrolled. Recovery was defined as a current normalized LV size and systolic function evaluated by CMR. Results Among 79 patients, 21 (27%) were confirmed recovered at a median follow-up of 36 months. Recovered patients presented with faster heart rates (HR) and larger body surface area (BSA) at baseline (P < 0.05). Compared to unrecovered patients, recovered pateints had a higher LV apical radial strain divided by basal radial strain (RSapi/bas) and a lower standard deviation of time to peak radial strain in 16 segments of the LV (SD16-TTPRS). According to a multivariate logistic regression model, RSapi/bas (P = 0.035) and SD16-TTPRS (P = 0.012) resulted as significant predictors for differentiation of recovered from unrecovered patients. The sensitivity and specificity of RSapi/bas and SD16-TTPRS for predicting recovered conditions were 76%, 67%, and 91%, 59%, with the area under the curve of 0.75 and 0.76, respectively. Further, Kaplan Meier survival analysis showed that patients with RSapi/bas ≥ 0.95% and SD16-FTPRS ≤ 111 ms had the highest recovery rate (65%, P = 0.027). Conclusions RSapi/bas and CMR SD16-TTPRS may be used as non-invasive parameters for predicting LV recovery in NDCM. This finding may be beneficial for subsequent treatments and prognosis of NDCM patients. Registration number: ChiCTR-POC-17012586.

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