5964Hybrid PET/MR imaging for the prediction of left ventricular (LV) recovery after revascularisation of chronic total occluded coronaries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Vitadello ◽  
C Rischpler ◽  
N Langwieser ◽  
K Kunze ◽  
S Nekolla ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Fdg Pet ◽  
Wall Motion Abnormality ◽  
Wall Motion ◽  
Imaging Techniques ◽  
Interventional Cardiology ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Total Occlusion

Abstract Background Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents one of the major challenges in interventional cardiology. Physicians are still reluctant in referring for PCI, assuming non viability of the myocardium subtended by the CTO. Data are controversial in assessing the improvement of left ventricular (LV) wall motion after revascularisation and the prognostic value of viability testing to guide patient selection. Purpose The aim of this study was to determine, whether hybrid fluorodeoxyglucose positron emission tomography/magnetic resonance (FDG PET/MR) imaging allows a more accurate prediction of LV regional wall motion recovery after successful PCI of CTOs in comparison to PET or MR alone. Methods We enrolled 49 consecutive symptomatic patients with CTO and evidence of wall motion abnormality in the corresponding CTO-territory. All patients underwent hybrid FDG PET/MR imaging as semi-quantitative assessment of myocardial viability - glucose metabolism in PET and late gadolinium enhancement (LGE) transmurality in MR – prior of PCI of the CTO. Follow-up MRI was performed in 23 patients 3–6 months after successful revascularisation to evaluate wall motion changes. Results We assessed viability in 124 myocardial segments subtended by a CTO in 23 patients with successful PCI who underwent serial imaging. Segments with wall motion abnormality at baseline (n=80) were analysed. Most of these segments (n=54, 68%) were concordantly assessed viable by PET and MR, conversely only 2 (2%) segments were assessed non-viable by both imaging techniques. However, almost one third of the segments showed discordant patterns of viability either PET not viable/ MR viable (3 (4%) segments) or PET viable/ MR not viable (21 (26%) segments): particularly the latter revealed a significant wall motion improvement (p=0.033). The combination of PET and MR showed a fair accuracy in predicting myocardial segments with wall motion improvement after CTO revascularisation (PET/MR area under ROC curve (AUC) 0.72, SE 0.07, p=0.002), which was superior to MR-LGE (AUC=0.66, SE 0.09) and FDG-PET (AUC=0.58, SE 0.10) alone (Figure). Comparisons of ROC curves Conclusion Hybrid PET/MR imaging prior to successful CTO showed a better performance than PET or MR alone in predicting regional improvement of disturbed wall motion. The complimentary information derived from both modalities may particularly help to identify small amounts of viable epicardial myocardium within large scars which can improve contractility after CTO-revascularisation.

scholarly journals Hybrid PET/MR imaging for the prediction of left ventricular recovery after percutaneous revascularisation of coronary chronic total occlusions

2020 ◽  
Vol 47 (13) ◽  
pp. 3074-3083 ◽  
Author(s):  
Teresa Vitadello ◽  
Karl P. Kunze ◽  
Stephan G. Nekolla ◽  
Nicolas Langwieser ◽  
Christian Bradaric ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Fdg Pet ◽  
Wall Motion ◽  
Left Ventricular ◽  
Viability Assessment ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Motion Recovery ◽  
Myocardial Viability Assessment

Abstract Purpose To evaluate myocardial viability assessment with hybrid 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/magnetic resonance imaging ([18F]FDG-PET/MR) in predicting left ventricular (LV) wall motion recovery after percutaneous revascularisation of coronary chronic total occlusion (CTO). Methods and results Forty-nine patients with CTO and corresponding wall motion abnormality (WMA) underwent [18F]FDG-PET/MR imaging for viability assessment prior to percutaneous revascularisation. After 3–6 months, 23 patients underwent follow-up MR to evaluate wall motion recovery. In total, 124 segments were assigned to the CTO territories, while 80 segments displayed impaired wall motion. Of these, 68% (54) were concordantly viable in PET and MR; conversely, only 2 segments (2%) were assessed non-viable by both modalities. However, 30% showed a discordant viability pattern, either PET non-viable/MR viable (3 segments, 4%) or PET viable/MR non-viable (21 segments, 26%), and the latter revealed a significant wall motion improvement at follow-up (p = 0.033). Combined imaging by [18F]FDG-PET/MR showed a fair accuracy in predicting myocardial recovery after CTO revascularisation (PET/MR area under ROC curve (AUC) = 0.72, p = 0.002), which was superior to LGE-MR (AUC = 0.66) and [18F]FDG-PET (AUC = 0.58) alone. Conclusion Hybrid PET/MR imaging prior to CTO revascularisation predicts more accurately the recovery of dysfunctional myocardium than PET or MR alone. Its complementary information may identify regions of viable myocardium with increased potential for functional recovery.

Abstract 2838: Sequential Changes of Left Ventricular Systolic and Diastolic Synchronicity in Acute ST-Elevation Myocardial Infarction after Primary Coronary Intervention

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Seong-Mi Park ◽  
Yong-Hyun Kim ◽  
Soon-Jun Hong ◽  
Do-Sun Lim ◽  
Wan-Joo Shim
Keyword(s):  
Myocardial Infarction ◽  
Wall Motion ◽  
Chronic Phase ◽  
Regional Wall Motion ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Doppler Imaging ◽  
Regional Wall ◽  
St Elevation

The aims of this study were to assess the sequential changes of left ventricular (LV) systolic and diastolic synchronicity in patients with acute myocardial infarction (AMI) and to assess their relation with LV recovery and remodeling. Forty-patients with acute ST-elevation MI were examined within 2days, 6weeks and 6months after primary coronary intervention. Fifteen-age matched subjects were enrolled for normal control. The time from the onset of QRS complex to peak systolic velocity (Ts) and to peak early diastolic velocity (Te) were measured on color-coded tissue Doppler imaging. To assess LV synchronicity, SDs of Ts (Ts-SD) and Te (Te-SD) of all 12 segments were calculated (within 2days, at 6weeks and 6months; SD1, SD2 and SD3, respectively). LV recovery was defined as the improvement of wall motion at least more than two segments at 6 weeks. In all AMI patients, the wall motion score index was 1.72±0.27 and LV ejection fraction was 45.9±9.9%. The Ts-SD1 was higher in AMI patients than in controls (45.4±13.5 vs 29.4±13.3ms, p<0.05), but Te-SD1 was not different (18.7±6.9 vs 16.2±10.0). Twenty-two patients (group1) showed a recovery and 18 patients (group2) showed no recovery. The Ts-SD1 was smaller in group1 than in group2 (43.4±12.6 vs 47.9±11.7 ms, p<0.05). In group1, Ts-SD were much decreased as follow up (Ts-SD2, 3; 36.6±14.0 and 31.1±9.5, respectively, p<0.05). In contrast, in group2, Ts-SD was not significantly changed (Ts-SD2,3; 46.7±13.2 and 43.7±8.8, respectively) but Te-SD was increased as follow up (Te-SD1,2,3; 17.8±5.5, 20.4±4.3 and 25.0±3.8, respectively, p<0.05). The LV end-diastolic and systolic volume were increased and the deceleration time of early diastolic mitral inflow velocity was shortened in group2 (p<0.05). This clinical study shows: 1) in acute phase, the regional wall motion abnormalities of AMI had an impact on LV systolic synchronicity; 2) the AMI patients with LV recovery showed better LV systolic synchronicity; 3) the LV systolic synchronicity became better as regional wall motion was improved; and 4) in chronic phase, the LV diastolic synchronicity became worse in AMI patients with no recovery, which might be related to LV remodeling and worsening of LV diastolic function.

Flecainide toxicity with high pacemaker capture thresholds and associated takotsubo syndrome

2021 ◽  
Vol 14 (8) ◽  
pp. e243326
Author(s):  
Dario Manley-Casco ◽  
Stephanie Crass ◽  
Rana Alqusairi ◽  
Steven Girard
Keyword(s):  
Wall Motion Abnormality ◽  
Wall Motion ◽  
Apical Ballooning ◽  
Persistent Atrial Fibrillation ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall Motion Abnormality ◽  
Regional Wall ◽  
Ventricular Response ◽  
Bicarbonate Infusion

We describe a case of a woman in her 80s with persistent atrial fibrillation (AF) despite being on flecainide who was admitted for AF with rapid ventricular response. Attempts with direct-current cardioversions were unsuccessful despite increased doses of the antiarrhythmic therapy. At atrioventricular (AV) nodal ablation, very high right ventricular capture thresholds resulted in abortion of the procedure as back-up ventricular pacing could not be assured with adequate margin for safety. Shortly following the electrophysiology (EP) study, the patient developed cardiogenic shock with new apical left ventricular regional wall motion abnormality suggestive of apical ballooning and a toxic-appearing wide QRS complex electrocardiogram (EKG). The patient was successfully treated with sodium bicarbonate infusion for presumed flecainide toxicity. The regional wall motion abnormality and EKG changes resolved along with normalisation of capture thresholds after 2 days of treatment. The patient underwent an uncomplicated successful AV nodal ablation several weeks later.

scholarly journals Echocardiographic Findings and Associated Factors in HIV Infected Patients at a Tertiary Hospital in Ethiopia

2021 ◽  
Author(s):  
Esubalew Woldeyes ◽  
Hailu Abera Mulatu ◽  
Abiy Ephrem ◽  
Henok Benti ◽  
Mehari Wale Alem ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Left Ventricular Hypertrophy ◽  
Diastolic Dysfunction ◽  
Wall Motion Abnormality ◽  
Ventricular Hypertrophy ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall Motion Abnormality ◽  
Regional Wall

Abstract Background: Non-communicable diseases including cardiovascular diseases are becoming an important part of Human Immunodeficiency Virus (HIV) care. Echocardiography is a useful non-invasive tool to assess for cardiac disease and different echocardiographic abnormalities have been seen previously. Available evidence on the echocardiographic abnormalities in Ethiopia is scarce. The aim of this study was to investigate the echocardiographic abnormalities in HIV infected patients and factors associated with the findings.Methods: A cross-sectional study was conducted on 285 patients with HIV infection including collection of clinical and echocardiographic data. Logistic regression was used to examine the association between echocardiographic abnormalities and associated factors with variables with a p-value of < 0.05 in the multivariate model considered statistically significant.Results: Diastolic dysfunction was the most common abnormality seen in 30.1% of the participants followed by regional wall motion abnormality (22.2%), left ventricular hypertrophy (10.3%), enlarged left atrium (8.1%), pulmonary hypertension (3.5%) and pericardial effusion (2.1%). Almost all patients had normal left ventricle systolic function. Diastolic dysfunction was independently associated with increasing age, elevated blood pressure and left ventricular hypertrophy while regional wall motion abnormality was associated with male gender, increasing age and abnormal fasting blood glucose. Left ventricular hypertrophy was associated with increasing age and blood pressure and the later was associated with left atrial enlargement. The level of immunosuppression did not affect echocardiography findings. Conclusions: A high prevalence of echocardiographic abnormalities was found and included diastolic dysfunction, regional wall motion abnormality, left ventricular hypertrophy and left atrial enlargement. Male gender, age above 50 years, elevated blood pressure and elevated fasting blood glucose were associated with echocardiographic abnormalities. Appropriate screening and treatment of echocardiographic abnormalities is needed.

scholarly journals Global Myocardial Work in Coronary Artery Disease Patients Without Regional Wall Motion Abnormality: Correlation With Gensini Score

2021 ◽  
Author(s):  
Miao Li ◽  
Yuhao Wang ◽  
Lin Li ◽  
Wenfang Wu ◽  
Pingyang Zhang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Wall Motion Abnormality ◽  
Wall Motion ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Regional Wall Motion Abnormality ◽  
Gensini Score ◽  
Regional Wall ◽  
Artery Disease

Abstract PurposeThis study aimed to investigate global myocardial work (GMW), derived from non-invasive left ventricular (LV) pressure-strain loops (PSLs) in coronary artery disease (CAD) patients without regional wall motion abnormality (RWMA), and explored the relationship between GMW and severity of CAD using Gensini score (GS) . Methods120 patients prepared for coronary angiography (CAG) who had left ventricular ejection fraction≥55%, no resting RWMA in two-dimensional echocardiography were enrolled. Global longitudinal strain (GLS), GMW parameters (including global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW) and global myocardial work efficiency (GWE)) were quantified. The severity of coronary lesions was evaluated by GS system based on CAG findings. We divided CAG-confirmed CAD patients into three subgroups according to the tertiles of GS: low 0<GS 16, mid 16<GS 38, and high GS>38. ResultsCAD patients showed a significantly reduced GLS and GWE, but an increased GWW. GLS, GWE, GWI and GCW were significantly decreased in the high-GS group while GWW was increased. GLS, GWE, GWI and GCW was negatively correlated with the GS, GWW was positively correlated with GS. Multivariate regression analysis showed that GWE was the independent factor of predicting coronary stenosis. ROC analysis demonstrated that GWE was the most powerful predictor of high-GS and was superior to GLS. GWE under 91% had the optimal sensitivity and specificity for identifying high-GS. ConclusionThe proposed GWE, which outperformed the GLS, showed the optimal performance and could be considered as a potential predictive indicator to detect severe coronary disease in non-RWMA CAD patients.

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