scholarly journals P2867Late gadolinium enhancement at cardiac magnetic resonance accurately predicts arrhythmias in patients with non-ischemic cardiomyopathy

2018 ◽  
Vol 39 (suppl_1) ◽  
Author(s):  
C Raineri ◽  
C Pavesi ◽  
A Turco ◽  
S Ghio ◽  
L Scelsi ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ischemic Cardiomyopathy ◽  
Gadolinium Enhancement

P575Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
P Sanchez Somonte ◽  
F Zaraket ◽  
L Quinto ◽  
P Garre ◽  
F Alarcon ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Primary Prevention ◽  
Magnetic Resonance ◽  
Primary Endpoint ◽  
Cardiac Death ◽  
Ischemic Cardiomyopathy ◽  
Border Zone ◽  
Gadolinium Enhancement ◽  
Cardioverter Defibrillator ◽  
Funding Acknowledgements

Abstract Funding Acknowledgements No funding acknowledgements OnBehalf VT and sudden cardiac death Background   The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods All consecutive patients who underwent a LGE-MR prior to ICD implantation in primary prevention were prospectively included.  Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67 +/- 28 years, 80% men, mean ejection fraction 26%+/-9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46,33 months.  46 patients (22%) reached the primary endpoint. Greater scar mass  (36,05 grams vs 21,5 grams; HR 1.04; 95% CI (1.03-1-05), p <0.001), core mass (9,8 grams vs 5,6 grams; HR 1.06; 95% CI (1.04-1-09), p <0.001),  border zone mass (26,2 grams vs 15,9 grams; HR 1.05; 95% CI (1.04-1-09), p <0.001) and channel mass (3,0  grams vs 1,6 grams; HR 1.15 95% CI (1.06-1.25), p <0.001) were associated with appropriate therapies and SCD.  A border zone mass >5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15-19.73), p = 0.03). Conclusions  The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Abstract Figure. Scar characterization

Usefulness of late gadolinium enhancement cardiac magnetic resonance to predict appropriate therapies in implantable cardioverter defibrillator patients in primary prevention

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sanchez Somonte ◽  
L Quinto ◽  
F Zarakett ◽  
P Garre ◽  
F Alarcon ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Primary Prevention ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
Primary Endpoint ◽  
Ischemic Cardiomyopathy ◽  
Border Zone ◽  
Gadolinium Enhancement ◽  
Cardioverter Defibrillator

Abstract Background The scar and the amount of border zone measured by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) has been proposed as an independent predictor of ventricular arrhythmias in patients with ischemic and non-ischemic cardiomyopathy. However, at the present time, the guidelines are based only on the ejection fraction to recommend an implantable cardioverter defibrillator (ICD) in primary prevention, and only a minority of these patients receive appropriate therapies. So, prevention needs to be improved. Purpose To identify predictors of appropriate therapies in patients with a primary prevention ICD using cardiac magnetic resonance imaging and a dedicated software (ADAS-3D) to characterize the scar. Methods Patients who underwent a LGE-MR prior to ICD implantation in primary prevention were retrospectively included. Clinical and cardiac imaging characteristics were collected. The myocardium was segmented with ADAS-3D software in 10 layers (from endocardium to epicardium). The scar, border zone, core and conducting channels were automatically measured in grams by the software. Results Since 2008 to 2017, 206 patients were included. Mean age was 67±28 years, 80% men, mean ejection fraction 26%±9, 52% with ischemic cardiomyopathy and 48% non-ischemic. The primary endpoint was appropriate therapies and/or sudden cardiac death (SCD). Median follow-up was 46.33 months. 46 patients (22%) reached the primary endpoint. Greater scar mass (36.05 grams vs 21.5 grams; HR 1.04; 95% CI (1.03–1-05), p<0.001), core mass (9.8 grams vs 5.6 grams; HR 1.06; 95% CI (1.04–1-09), p<0.001), border zone mass (26.2 grams vs 15.9 grams; HR 1.05; 95% CI (1.04–1-09), p<0.001) and channel mass (3.0 grams vs 1.6 grams; HR 1.15 95% CI (1.06–1.25), p<0.001) were associated with appropriate therapies and SCD. A border zone mass >5.3 grams was independently associated with the primary endpoint (HR: 4.77; 95% CI (1.15–19.73), p=0.03). Conclusions The amount of border zone, core and channel mass measured by LGE-MR and ADAS software are independent predictors of appropriate therapies and SCD in patients with ICD in primary prevention. Scar characterization Funding Acknowledgement Type of funding source: None

scholarly journals POS0886 COULD BE INTERSTITIAL MYOCARDITIS A FEATURE OF THE ANTISYNTHETASE SYNDROME?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 699.1-699
Author(s):  
A. Gil-Vila ◽  
G. Burcet ◽  
A. Anton-Vicente ◽  
D. Gonzalez-Sans ◽  
A. Nuñez-Conde ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Late Gadolinium Enhancement ◽  
Magnetic Resonance ◽  
Interstitial Lung Disease ◽  
Cardiac Involvement ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Interstitial Tissue ◽  
Antisynthetase Syndrome ◽  
Gadolinium Enhancement

Background:Antisynthetase syndrome (ASS) is characterized by inflammatory myopathy, interstitial lung disease, arthritis, mechanical hands and Raynaud phenomenon, among other features. Recent studies have shown that idiopathic inflammatory myopathies (IIM) may develop cardiac involvement, either ischemic (coronary artery disease) or inflammatory (myocarditis). We wonder if characteristic lung interstitial involvement (interstitial lung disease) that appears in patients with the ASS may also affect the myocardial interstitial tissue. New magnetic resonance mapping techniques could detect subclinical myocardial involvement, mainly as edema (increase extracellular volume in interstitium and extracellular matrix), even in the absence of visible late Gadolinium enhancement (LGE).Objectives:Our aim was to describe the presence of interstitial myocarditis in a group of patients with ASS.Methods:Cross-sectional, observational study performed in a tertiary care center. We included 13 patients diagnosed with ASS (7 male, 53%, mean (SD) age at diagnosis 56,8 years (±11,8)). The patients were consecutively selected from our outpatient myositis clinic. Myositis specific and associated antibodies were performed by means of line immunoblot (EUROIMMUN©). Cardiac magnetic resonance (CMR) was performed on all patients. The study protocol includes functional cine magnetic resonance and standard late gadolinium enhancement (LGE), as well as novel parametric T1 and T2 mapping sequences (modified look locker inversion recovery sequences - MOLLI) with extracellular volume (ECV) calculation 20 minutes after the injection of a gadolinium-based contrast material.Results:CMR could not be performed in one patient due to anxiety. All patients studied (12) had a normal biventricular function, without alteration of segmental contraction. A third (4 out of 12, 33%) of the studied patients showed elevated T2 myocardial values without focal LGE, half of them (2/4) with an elevated ECV, consistent with myocardial edema. Two patients with normal T2 values showed unspecific LGE focal patterns, one in the right ventricle union points and another with mild interventricular septum enhancement (Figure 1). None of the patients studied refer any cardiac symptomatology. All the four patients with T2 mapping alterations (100%) had interstitial lung involvement, but only 4 out of 8 (50%) of the rest ASS patients without T2 mapping positivity. The autoimmune profile was as follows: 10 anti-Jo1/Ro52, 1 anti-EJ/Ro52, 2 anti-PL12.Conclusion:Myocarditis, although subclinical, appears to be a feature in ASS patients. T1 and T2 mapping sequences might be valuable to detect and monitor subclinical cardiac involvement in these patients. The possibility that the same etiopathogenic mechanism may be involved in the interstitial tissue in lung and myocardium is raised. More studies must be done in order to assert the prevalence of myocarditis in ASS.References:[1]Dieval C et al. Myocarditis in Patients With Antisynthetase Syndrome: Prevalence, Presentation, and Outcomes. Medicine (Baltimore). 2015 Jul;94(26):e798.[2]Myhr KA, Pecini R. Management of Myocarditis in Myositis: Diagnosis and Treatment. Curr Rheumatol Rep. 2020 Jul 22; 22:49.[3]Sharma K, Orbai AM, Desai D, Cingolani OH, Halushka MK, Christopher-Stine L, Mammen AL, Wu KC, Zakaria S. Brief report: antisynthetase syndrome-associated myocarditis. J Card Fail. 2014 Dec;20(12):939-45.Figure 1.Cardiac magnetic resonance images from ASS patients.Disclosure of Interests:None declared

scholarly journals Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
EC D"angelo ◽  
P Paolisso ◽  
L Bergamaschi ◽  
A Foa ◽  
I Magnani ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pericardial Effusion ◽  
Tissue Characterization ◽  
Descriptive Analysis ◽  
Gadolinium Enhancement ◽  
Malignant Lesions ◽  
T1 And T2 ◽  
Cardiac Masses

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background  Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose  To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours.  Results  The descriptive analysis of the morphologic features showed that diameter > 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p <0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002).  Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor.  Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

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