scholarly journals Combined single-session cardiovascular magnetic resonance: stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation patients with chest pain syndromes prior to catheter ablation

EP Europace ◽  
2019 ◽  
Vol 21 (12) ◽  
pp. 1809-1816
Author(s):  
Sabrina Oebel ◽  
Ingo Paetsch ◽  
Clara Stegmann ◽  
Simon Kircher ◽  
Philipp Sommer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Magnetic Resonance ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Pulmonary Vein ◽  
Three Dimensional ◽  
Stress Perfusion ◽  
Single Session ◽  
Pain Syndromes ◽  
Adenosine Stress Perfusion

Abstract Aims  To determine the clinical utility of a combined single-session cardiovascular magnetic resonance (CMR) imaging protocol integrating adenosine stress perfusion and three-dimensional pulmonary vein angiography for stratification of atrial fibrillation (AF) patients referred for pulmonary vein isolation (PVI) and complaining about chest pain syndromes. Methods and results  The preprocedural CMR examination (adenosine stress perfusion, late gadolinium enhancement, and three-dimensional pulmonary vein angiography) was performed in 357 consecutive AF patients with chest pain syndromes referred for PVI. Stress perfusion results were used for stratification: ischaemia positive patients underwent invasive coronary angiography, ischaemia negative patients underwent PVI, and follow-up/outcome data were collected (combined primary endpoint of cardiac death/non-fatal myocardial infarction). The integrated CMR protocol had a high success rate (356/357, 99.7%), a short total examination duration (<30 min in all patients), and delivered high-quality three-dimensional pulmonary vein angiography in all patients undergoing PVI (324/324, 100%). Variants of pulmonary vein anatomy were identified in 33% of all patients (117/357). Stress positivity (28/356, 8%) had a high positive predictive value for identification of obstructive coronary artery disease (86%), while stress negativity carried a low short-term event rate following PVI (cumulative 1-year event-free survival rate, 99.6%). Conclusion  Combined single-session CMR as a routine diagnostic workup for AF patients with chest pain syndromes prior to PVI proved to represent a time-efficient and effective stratification tool.

scholarly journals Left Atrial Flow Stasis in Patients Undergoing Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation Using 4D-Flow Magnetic Resonance Imaging

2021 ◽  
Vol 11 (12) ◽  
pp. 5432
Author(s):  
Hana Sheitt ◽  
Hansuk Kim ◽  
Stephen Wilton ◽  
James A White ◽  
Julio Garcia
Keyword(s):  
Magnetic Resonance Imaging ◽  
Atrial Fibrillation ◽  
Magnetic Resonance ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Thrombus Formation ◽  
Three Dimensional ◽  
Resonance Imaging ◽  
4D Flow ◽  
Flow Stasis

Atrial fibrillation (AF) is associated with systemic thrombo-embolism and stroke events, which do not appear significantly reduced following successful pulmonary vein (PV) ablation. Prior studies supported that thrombus formation is associated with left atrial (LA) flow alterations, particularly flow stasis. Recently, time-resolved three-dimensional phase-contrast (4D-flow) showed the ability to quantify LA stasis. This study aims to demonstrate that LA stasis, derived from 4D-flow, is a useful biomarker of LA recovery in patients with AF. Our hypothesis is that LA recovery will be associated with a reduction in LA stasis. We recruited 148 subjects with paroxysmal AF (40 following 3–4 months PV ablation and 108 pre-PV ablation) and 24 controls (CTL). All subjects underwent a cardiac magnetic resonance imaging (MRI) exam, inclusive of 4D-flow. LA was isolated within the 4D-flow dataset to constrain stasis maps. Control mean LA stasis was lower than in the pre-ablation cohort (30 ± 12% vs. 47 ± 18%, p < 0.001). In addition, mean LA stasis was reduced in the post-ablation cohort compared with pre-ablation (36 ± 15% vs. 47 ± 18%, p = 0.002). This study demonstrated that 4D flow-derived LA stasis mapping is clinically relevant and revealed stasis changes in the LA body pre- and post-pulmonary vein ablation.

scholarly journals Cardiovascular magnetic resonance stress perfusion imaging in patients with atrial fibrillation

2013 ◽  
Vol 15 (S1) ◽  
Author(s):  
Thomas Hucko ◽  
Christoph Klein ◽  
Bernhard Schnackenburg ◽  
Christopher Schneeweis ◽  
Sebastian Kelle ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Perfusion Imaging ◽  
Stress Perfusion ◽  
Stress Perfusion Imaging

scholarly journals (Epicardial and microvascular) angina or atypical chest pain: differential diagnoses with cardiovascular magnetic resonance

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E116-E120 ◽  
Author(s):  
Andrea Baggiano ◽  
Marco Guglielmo ◽  
Giuseppe Muscogiuri ◽  
Andrea Igoren Guaricci ◽  
Alberico Del Torto ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Chest Pain ◽  
Magnetic Resonance ◽  
Imaging Modality ◽  
Coronary Vessels ◽  
Stress Perfusion ◽  
Myocardial Oxygen Demand ◽  
Inadequate Response ◽  
Atypical Chest Pain ◽  
Microvascular Angina

Abstract Angina pectoris is a chest discomfort caused by myocardial ischaemia, and it is classified as ‘typical’ or ‘atypical’ if specific features are present. Unfortunately, there is a heterogeneous list of cardiac diseases characterized by this symptom as onset sign. Mostly, angina is due to significant epicardial coronary artery stenosis, which causes inadequate oxygen supply increase after raised myocardial oxygen demand. In the absence of significant epicardial stenoses, another potential cause of angina is microvascular dysfunction, related to inadequate response of resistance coronary vessels to vasodilator stimuli. The unique capability of cardiovascular magnetic resonance (CMR) in providing extremely detailed morphological and functional information, along with precise stress perfusion defects and wall motion abnormalities depiction, translates it into the test with one of the best diagnostic performance and prognostic stratification among non-invasive cardiac imaging modality. Moreover, CMR is also extremely accurate in detecting non-ischaemic cardiac causes of chest pain (such as myocardial and pericardial inflammation, or stress-related cardiomyopathy), and is very useful in helping physicians to correctly approach patients affected by chest pain.

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