scholarly journals 750 Mitral annulus disjunction in consecutive patients undergoing cardiovascular magnetic resonance: arrhythmogenic substrate or anatomical variant?

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Stefano Figliozzi ◽  
Sara Bombace ◽  
Kamil Stankowski ◽  
Marzia Olivieri ◽  
Ludovica Lofino ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Clinical Significance ◽  
Ventricular Arrhythmias ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Mitral Annulus ◽  
Ventricular Ejection Fraction ◽  
Anatomical Variant ◽  
Arrhythmogenic Substrate

Abstract Aims Mitral annulus disjunction (MAD) has been associated with sudden cardiac death in selected patients with arrhythmic presentation, while its clinical significance in unselected cohorts remains unknown. Our purpose was to assess the prevalence and clinical significance of MAD in consecutive patients referred to cardiovascular-magnetic-resonance (CMR). Methods and results Our population included 103 consecutive patients undergoing CMR at our Institution, between August and September 2021. MAD was defined as a  ≥ 1 mm atrial displacement of the mitral leaflet hinge point in standard long-axis cine images during end-systole. MAD analysis was performed in 97 patients (feasibility = 94%) and resulted positive in 49 (51%). MAD—patients were more often males (75% vs. 57%; P = 0.045) and affected by ischaemic (35% vs. 12%, P = 0.01) and non-ischaemic cardiomyopathy (38% vs. 16%, P = 0.026) compared to MAD+ patients. No significant differences were found in terms of age, history of ventricular arrhythmias, bi-ventricular and bi-atrial volumes, bi-ventricular ejection fraction, native T1 and T2 mapping values, extracellular volume, and prevalence of late gadolinium enhancement (P > 0.05 for all) between MAD + vs. MAD—patients. MAD extent was higher in patients with mitral valve prolapse (MVP; n = 7), (3.5 ± 1.5 mm in MVP+ vs. 2.0 ± 1.0 mm in MVP– patients; P = 0.004). No significant differences were conversely found in MAD extent between patients with and without ventricular arrhythmias (2.5 ± 1.1 mm vs. 2.3 ± 1.1 mm; P = 0.815). Conclusions Our findings suggest a high prevalence of MAD in unselected cohorts of patients, with no clinical significance. Prospective studies are needed to further elucidate the interplay between MAD and malignant ventricular arrhythmias in unselected cohorts of patients.

scholarly journals Moderated Posters session: cardiovascular magnetic resonanceP967Simplified segmental calculation of extracellular volume with T1 mapping for evaluation of diffuse interstitial fibrosisP968Diffuse myocardial fibrosis quantification by magnetic resonance imaging in patients with aortic valve diseasesP969Occult anthracycline cardiac injury in adolescents and young adults cancer survivors with normal left ventricular ejection fractionP970Reference values for regional and global myocardial T2 mapping with cardiovascular magnetic resonance at 1.5T vs 3TP971The accuracy of a real-time MR method in the assessment of right ventricular volume and functionP972Can blunted heart rate response to adenosine vasodilator stress have prognostic implications on myocardial perfusion imaging by cardiovascular magnetic resonance?P973Association of vitamin d with left atrial fibrosis in patients with lone AF undergoing cryoablationP974Left ventricular remodelling after mitral valve reconstruction: a 1-year prospective cMRI studyP975Abnormal regional myocardial motion in patients with left ventricular pressure overload detected by MR tissue phase mapping at rest and during stressP976Potential utility of splenic switch-off to improve the diagnostic performance of vasodilator stress cardiac magnetic resonance. Preliminary study.

2015 ◽  
Vol 16 (suppl 2) ◽  
pp. S150-S152 ◽  
Author(s):  
P Bazal ◽  
O-A Nastase ◽  
MS Vieira ◽  
A M Maceira Gonzalez ◽  
J Kowal ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Cardiac Injury ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Vasodilator Stress ◽  
Left Ventricular Ejection ◽  
Tissue Phase Mapping

scholarly journals Cardiovascular magnetic resonance frontiers: Tissue characterisation with mapping

2016 ◽  
Vol 20 (2) ◽  
Author(s):  
Rebecca Schofield ◽  
Anish Bhuva ◽  
Katia Manacho ◽  
James C. Moon
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Clinical Decision Making ◽  
T2 Mapping ◽  
Full Range ◽  
Extracellular Volume ◽  
Clinical Decision ◽  
Diffuse Fibrosis ◽  
Acute Infarction ◽  
Cardiac Siderosis

The clinical use of cardiovascular magnetic resonance (CMR) imaging has expanded rapidly over the last decade. Its role in cardiac morphological and functional assessment is established, with perfusion and late gadolinium enhancement (LGE) imaging for scar increasingly used in day-to-day clinical decision making. LGE allows a virtual histological assessment of the myocardium, with the pattern of scar suggesting disease aetiology, and the extent of predicting risk. However, even combined, the full range of pathological processes occurring in the myocardium are not interrogated. Mapping is a new frontier where the intrinsic magnetic properties of heart muscle are measured to probe further. T1, T2 and T2* mapping measures the three fundamental tissue relaxation rate constants before contrast, and the extracellular volume (ECV) after contrast. These are displayed in colour, often providing an immediate appreciation of pathology. These parameters are differently sensitive to pathologies. Iron (cardiac siderosis, intramyocardial haemorrhage) makes T1, T2 and T2* fall. T2 also falls with fat infiltration (Fabry disease). T2 increases with oedema (acute infarction, takotsubo cardiomyopathy, myocarditis, rheumatological disease). Native T1 increases with fibrosis, oedema and amyloid. Some of these changes are large (e.g. iron, oedema, amyloid), others more modest (diffuse fibrosis). They can be used to detect early disease, distinguish aetiology and, in some circumstances, guide therapy. In this review, we discuss these processes, illustrating clinical application and future advances.

scholarly journals Multiparametric Early Detection and Prediction of Cardiotoxicity Using Myocardial Strain, T1 and T2 Mapping, and Biochemical Markers: A Longitudinal Cardiac Resonance Imaging Study During 2 Years of Follow-Up

2021 ◽  
Author(s):  
Sorin Giusca ◽  
Grigorios Korosoglou ◽  
Moritz Montenbruck ◽  
Blaž Geršak ◽  
Arne Kristian Schwarz ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
T2 Mapping ◽  
Left Ventricular ◽  
Normal Myocardium ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
T1 And T2

Background: Our goal was to evaluate the ability of cardiovascular magnetic resonance for detecting and predicting cardiac dysfunction in patients receiving cancer therapy. Left ventricular ejection fraction, global and regional strain utilizing fast-strain-encoded, T1 and T2 mapping, and cardiac biomarkers (troponin and BNP [brain natriuretic peptide]) were analyzed. METHODS: Sixty-one patients (47 with breast cancer, 11 with non-Hodgkin lymphoma, and 3 with Hodgkin lymphoma) underwent cardiovascular magnetic resonance scans at baseline and at regular intervals during 2 years of follow-up. The percentage of all left ventricular myocardial segments with strain ≤−17% (normal myocardium [%]) was analyzed. Clinical cardiotoxicity (CTX) and sub-CTX were defined according to standard measures. Results: Nine (15%) patients developed CTX, 26 (43%) had sub-CTX. Of the 35 patients with CTX or sub-CTX, 24 (69%) were treated with cardioprotective medications and showed recovery of cardiac function. The amount of normal myocardium (%) exhibited markedly higher accuracy for the detection of CTX and sub-CTX compared with left ventricular ejection fraction, T1, and T2 mapping as well as troponin I (Δareas under the curve=0.20, 0.24, and 0.46 for normal myocardium (%) versus left ventricular ejection fraction, troponin I, and T1 mapping, P <0.001 for all). In addition, normal myocardium (%) at baseline accurately identified patients with subsequent CTX ( P <0.001), which was not achieved by any other markers. Conclusions: Normal myocardium (%) derived by fast-strain-encoded cardiovascular magnetic resonance, is an accurate and sensitive tool that can establish cardiac safety in patients with cancer undergoing cardiotoxic chemotherapy not only for the early detection but also for the prediction of those at risk of developing CTX. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03543228.

scholarly journals The Evolving Role of Cardiovascular Magnetic Resonance Imaging in the Evaluation of Systemic Amyloidosis

2019 ◽  
Vol 12 ◽  
pp. 1178623X1984351 ◽  
Author(s):  
Sanjay M Banypersad
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiovascular Magnetic Resonance Imaging ◽  
T2 Mapping ◽  
Extracellular Volume ◽  
Systemic Amyloidosis ◽  
Response To Treatment ◽  
Resonance Imaging ◽  
The Impact

Systemic amyloidosis is a serious multiorgan disease with reduced life expectancy, irrespective of type. The impact of magnetic resonance imaging (MRI) in managing this condition has been immense. The last decade in particular has seen a surge of interest in the assessment and evaluation of the heart in patients with systemic amyloidosis by cardiovascular magnetic resonance imaging (CMR), with approximately 85% of all publications on this subject arising in the last 10 years. This has been largely driven by the creation of new sequences and their subsequent modernisation and technical development, thereby rendering previously prohibitive methods clinically more relevant and applicable. In turn, this has led to an increased awareness and recognition of the disease. This review demonstrates how MRI has become a pivotal diagnostic tool in the assessment of cardiac amyloidosis over the last 2 decades, with the ability to track disease and predict mortality. Several different pathognomonic patterns of late gadolinium enhancement (LGE) are now recognised and are able to prognosticate. T1 mapping and extracellular volume (ECV) techniques have resulted in even earlier disease detection before LGE is even visible and along with T2 mapping, provide new insights into biology. As newer therapies also evolve and become available, the need for accurate tracking of cardiac disease response to treatment carries increasing importance. All these are examined in this review, mainly focussing on light-chain (AL) and transthyretin (ATTR) amyloidosis.

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 First-phase ejection fraction by cardiovascular magnetic resonance predicts outcomes in aortic stenosis

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Haotian Gu ◽  
Rong Bing ◽  
Calvin Chin ◽  
Lingyun Fang ◽  
Audrey C. White ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Proportional Hazards ◽  
Function Analysis ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Cox Proportional Hazards

Abstract Background First-phase ejection fraction (EF1; the ejection fraction measured during active systole up to the time of maximal aortic flow) measured by transthoracic echocardiography (TTE) is a powerful predictor of outcomes in patients with aortic stenosis. We aimed to assess whether cardiovascular magnetic resonance (CMR) might provide more precise measurements of EF1 than TTE and to examine the correlation of CMR EF1 with measures of fibrosis. Methods In 141 patients with at least mild aortic stenosis, we measured CMR EF1 from a short-axis 3D stack and compared its variability with TTE EF1, and its associations with myocardial fibrosis and clinical outcome (aortic valve replacement (AVR) or death). Results Intra- and inter-observer variation of CMR EF1 (standard deviations of differences within and between observers of 2.3% and 2.5% units respectively) was approximately 50% that of TTE EF1. CMR EF1 was strongly predictive of AVR or death. On multivariable Cox proportional hazards analysis, the hazard ratio for CMR EF1 was 0.93 (95% confidence interval 0.89–0.97, p = 0.001) per % change in EF1 and, apart from aortic valve gradient, CMR EF1 was the only imaging or biochemical measure independently predictive of outcome. Indexed extracellular volume was associated with AVR or death, but not after adjusting for EF1. Conclusions EF1 is a simple robust marker of early left ventricular impairment that can be precisely measured by CMR and predicts outcome in aortic stenosis. Its measurement by CMR is more reproducible than that by TTE and may facilitate left ventricular structure–function analysis.

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