scholarly journals Role of Cardiac Magnetic Resonance Imaging in the Evaluation of Athletes with Premature Ventricular Beats

2022 ◽  
Vol 11 (2) ◽  
pp. 426
Author(s):  
Giulia Brunetti ◽  
Alberto Cipriani ◽  
Martina Perazzolo Marra ◽  
Manuel De Lazzari ◽  
Barbara Bauce ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Training Session ◽  
Left Ventricular ◽  
Special Focus ◽  
Premature Ventricular Beats ◽  
Myocardial Substrate ◽  
Diagnostic Work ◽  
Cmr Imaging

Premature ventricular beats (PVBs) in athletes are not rare. The risk of PVBs depends on the presence of an underlying pathological myocardial substrate predisposing the subject to sudden cardiac death. The standard diagnostic work-up of athletes with PVBs includes an examination of family and personal history, resting electrocardiogram (ECG), 24 h ambulatory ECG (possibly with a 12-lead configuration and including a training session), maximal exercise testing and echocardiography. Despite its fundamental role in the diagnostic assessment of athletes with PVBs, echocardiography has very limited sensitivity in detecting the presence of non-ischemic left ventricular scars, which can be revealed only through more in-depth studies, particularly with the use of contrast-enhanced cardiac magnetic resonance (CMR) imaging. The morphology, complexity and exercise inducibility of PVBs can help estimate the probability of an underlying heart disease. Based on these features, CMR imaging may be indicated even when echocardiography is normal. This review focuses on interpreting PVBs, and on the indication and role of CMR imaging in the diagnostic evaluation of athletes, with a special focus on non-ischemic left ventricular scars that are an emerging substrate of cardiac arrest during sport.

scholarly journals Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death

Circulation ◽  
2019 ◽  
Vol 140 (11) ◽  
pp. 952-964 ◽  
Author(s):  
Cristina Basso ◽  
Sabino Iliceto ◽  
Gaetano Thiene ◽  
Martina Perazzolo Marra
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Mitral Valve ◽  
Sudden Death ◽  
Mitral Valve Prolapse ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Premature Ventricular Beats ◽  
Electrophysiologic Studies

Despite a 2% to 3% prevalence of echocardiographically defined mitral valve prolapse (MVP) in the general population, the actual burden, risk stratification, and treatment of the so-called arrhythmic MVP are unknown. The clinical profile is characterized by a patient, usually female, with mostly bileaflet myxomatous disease, mid-systolic click, repolarization abnormalities in the inferior leads, and complex ventricular arrhythmias with polymorphic/right bundle branch block morphology, without significant regurgitation. Among the various pathophysiologic mechanisms of electrical instability, left ventricular fibrosis in the papillary muscles and inferobasal wall, mitral annulus disjunction, and systolic curling have been recently described by pathological and cardiac magnetic resonance studies in sudden death victims and patients with arrhythmic MVP. In addition, premature ventricular beats arising from the Purkinje tissue as ventricular fibrillation triggers have been documented by electrophysiologic studies in MVP patients with aborted sudden death. The genesis of malignant ventricular arrhythmias in MVP probably recognizes the combination of the substrate (regional myocardial hypertrophy and fibrosis, Purkinje fibers) and the trigger (mechanical stretch) eliciting premature ventricular beats because of a primary morphofunctional abnormality of the mitral valve annulus. The main clinical challenge is how to identify patients with arrhythmic MVP (which imaging technique and in which patient) and how to treat them to prevent sudden death. Thus, there is a necessity for prospective multicenter studies focusing on the prognostic role of cardiac magnetic resonance and electrophysiologic studies and on the therapeutic efficacy of targeted catheter ablation and mitral valve surgery in reducing the risk of life-threatening arrhythmias, as well as the role of implantable cardioverter defibrillators for primary prevention.

scholarly journals Incremental value of feature-tracking cardiac magnetic resonance imaging in detecting myocardial dysfunction in patients with idiopathic ventricular arrhythmias

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Nikolaidou ◽  
C Kotanidis ◽  
J Leal-Pelado ◽  
K Kouskouras ◽  
VP Vassilikos ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Ventricular Arrhythmias ◽  
Feature Tracking ◽  
Myocardial Dysfunction ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Volume Index ◽  
Control Subjects ◽  
Cmr Imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac magnetic resonance (CMR) imaging can identify the underlying substrate in patients with ventricular arrhythmias (VAs) and normal echocardiography. Myocardial strain has emerged as a superior index of systolic performance compared to ejection fraction (EF), with an incremental prognostic value in many cardiac diseases. Purpose To assess myocardial deformation using 2-D feature-tracking CMR strain imaging (CMR-FT) in patients with frequent VAs (≥500 ventricular premature contractions (VPC)/24 hours; and/or non-sustained ventricular tachycardia), and structurally normal hearts on echocardiography without evidence of coronary artery disease. Methods Sixty-eight consecutive patients (mean age 46 ± 16 years; 54% female) and 72 healthy controls matched for age and body surface area were included in the study. CMR imaging was performed on a 1.5T Magnetom Avanto (Siemens, Erlangen, Germany) scanner using a standard cardiac protocol. Results CMR showed normal findings in 30 patients (44%), while 16 (24%) had previous myocarditis, 6 (9%) had a diagnosis of non-ischaemic cardiomyopathy (NICM), 15 (22%) were diagnosed with VPC-related cardiomyopathy, and 1 patient had subendocardial infarction [excluded from strain analysis]. Mean left ventricular EF (LVEF) in patients was 62% ± 6% and right ventricular EF 64% ± 6% (vs. 65% ± 3% and 66% ± 4% in controls, respectively). Compared to control subjects, patients with VAs had impaired peak LV global radial strain (GRS) (28.88% [IQR: 25.87% to 33.97%] vs. 36.65% [IQR:33.19% to 40.2%], p < 0.001) and global circumferential strain (GCS) (-17.73% [IQR: -19.8% to -16.33%] vs. -20.66% [IQR: -21.72% to -19.6%], p < 0.001, Panel A). Peak LV GRS could differentiate patients with previous myocarditis from patients with NICM and those with VPC-related cardiomyopathy (Panel B). Peak LV GCS could differentiate patients with previous myocarditis from patients with NICM (Panel C). Peak LV GRS showed excellent diagnostic accuracy in detecting patients from control subjects (Panel D). In a multivariable regression model, subjects with a low GRS (<29.91%-determined by the Youden’s index) had 5-fold higher odds of having VAs (OR:4.99 [95%CI: 1.2-21.95]), after adjusting for LVEF, LV end-diastolic volume index, age, sex, BMI, smoking, hypertension, and dyslipidaemia. Peak LV global longitudinal strain (GLS) and RV strain indices were not statistically different between patients and controls. Conclusion Peak LV GRS and GCS are impaired in patients with frequent idiopathic VAs and can detect myocardial contractile dysfunction in patients with different underlying substrates. Our findings suggest that LV strain indices on CMR-FT constitute independent markers of myocardial dysfunction on top and independently of EF. Abstract Figure.

Ischemic and non-ischemic dilated cardiomyopathy

Open Medicine ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Giovanni Fazio ◽  
Federica Vernuccio ◽  
Emanuele Grassedonio ◽  
Giuseppe Grutta ◽  
Giuseppe Lo Re ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
High Sensitivity ◽  
Left Ventricular ◽  
Ischemic Disease ◽  
Coronary Imaging ◽  
Diagnostic Potential ◽  
Non Ischemic Dilated Cardiomyopathy ◽  
Cmr Imaging

AbstractDilated Cardiomyopathy is a high-incident disease, which diagnosis of and treatments are clinical priority. The aim of our study was to evaluate the diagnostic potential of cardiac magnetic resonance (CMR) imaging; echocardiography and the biochemical parameters that can help us differentiate between the post-ischemic and non-ischemic dilated cardiomyopathy. Materials and methods. The study enrolled 134 patients with dilated cardiomyopathy: 74 with the post-ischemic form and 60 with the non-ischemic one. All patients underwent a coronary imaging test, with echocardiogram, cardiac magnetic resonance and a blood test. Pro-inflammatory cytokines were evaluated using Luminex kit. Data was compared between the two groups. Results. Echocardiography allowed recognition of Left Ventricular Non Compaction in 2 patients. Longitudinal and circumferential strains were significantly different in the two groups (p<0.05). Using CMR imaging a post-myocarditis scar was diagnosed in 2 patients and a post-ischemic scar in 95% of patients with the chronic ischemic disease. The interleukin IL-1, IL-6 and TNF-α levels were higher in the post-ischemic group compared with the non-ischemic one. Conclusions. The use of second level techniques with a high sensitivity and specificity would help distinguish among different sub-forms of dilated cardiomyopathy.

scholarly journals Advanced cardiac magnetic resonance imaging in takotsubo cardiomyopathy

2020 ◽  
Vol 93 (1115) ◽  
pp. 20200514
Author(s):  
Vineeta Ojha ◽  
Rishabh Khurana ◽  
Kartik P Ganga ◽  
Sanjeev Kumar
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Takotsubo Cardiomyopathy ◽  
Left Ventricular ◽  
Diagnostic Modality ◽  
Coronary Syndrome ◽  
Lv Dysfunction ◽  
Reversible Condition

Takotsubo cardiomyopathy (TC) is a reversible condition in which there is transient left ventricular (LV) dysfunction characterised most commonly by basal hyperkinesis and mid-apical LV ballooning and hypokinesia. It is said to be triggered by stress and mimics, such as acute coronary syndrome (ACS) clinically. Diagnosis is usually suspected on echocardiography due to the characteristic contraction pattern in a patient with symptoms and signs of ACS but normal coronary arteries on catheter angiography. Cardiac magnetic resonance (CMR), with its latest advancements, is the diagnostic modality of choice for diagnosis, prognosis and follow-up of patients. The advances in CMR (including T1, T2, ECV mapping and threshold-based late gadolinium enhancement (LGE) measurements have revolutionised the role of CMR in tissue characterisation and prognostication in patients with TC. In this review, we highlight the current role of CMR in management of TC and enumerate the CMR findings in TC as well the current advances in the field of CMR, which could help in prognosticating these patients.

scholarly journals Midwall Fibrosis: Cardiac Magnetic Resonance Imaging in Risk Stratifying Cardiomyopathies

2015 ◽  
Vol 9 (1) ◽  
pp. 89-90
Author(s):  
D.P. Ripley ◽  
P. Garg ◽  
A. Kotecha ◽  
O.E. Gosling ◽  
N.G. Bellenger
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Potential Role ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Resonance Imaging ◽  
Management Challenge

The United Kingdom’s National Institute for Health and Care Excellence guidance on implantable cardiac defibrillator (ICD) therapy recommend ICD in those with left ventricular dysfunction and a high risk of sudden cardiac death (SCD). SCD accounts for 30% deaths in non-ischaemic dilated cardiomyopathy (DCM), however risk stratifying and predicting SCD in DCM is a major management challenge. We present two cases demonstrating the potential role of cardiac magnetic resonance imaging in risk stratifying DCM.

The role of right ventricular late gadolinium enhancement scoring by cardiac magnetic resonance imaging in cardiac sarcoidosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Koyanagawa ◽  
M Naya ◽  
O Manabe ◽  
S Furuya ◽  
S Tsuneta ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Right Ventricular ◽  
Cardiac Sarcoidosis ◽  
Inverse Correlation ◽  
Left Ventricular ◽  
Entire Cohort ◽  
Septal Lesions ◽  
Axial View ◽  
Cmr Imaging

Abstract Background The right ventricular (RV) function is a significant predictor of the prognosis and exercises tolerance in patients with left ventricular dysfunction. The previous study reported that RV late gadolinium enhancements (LGE) as assessed by cardiac magnetic resonance (CMR) imaging were present in 16% of pulmonary sarcoidosis. Although RV LGE is associated with a poor prognosis, a semi-quantitative assessment of RV LGE was not been established so far. Moreover, the frequency of RV dysfunction (RVD) in cardiac sarcoidosis (CS) and predictors of RVD are unclear. Purpose Our aim of this study is to establish RV LGE semi-quantitative scores and to clarify the rate and predictors of RVD in CS. Methods Forty-four consecutive patients with CS who underwent CMR imaging (median age, 63 [IQR 54–71] years old; 10 males) were studied. They were diagnosed as definitive based on the Heart Rhythm Society expert consensus statement. Two patients were excluded due to no long axial view. Thus, a total of 42 patients were included in this study. RV LGE was semi-quantitatively evaluated using the original score developed by ours. RV was classified into RV outflow tract (OT), basal, middle and apex. RVOT and apex are assigned 1 segment for each, and basal and middle are assigned 4 segments include anterior, septal, inferior and lateral (Figure1). In total, 10 segments were evaluated. RV LGE scores were analysed independently by the two operators. The RV ejection fraction was assessed in a long axial view without an RVOT (20 phases, 12 slices). We divided the cohort into the non-RVD group (RVEF ≥45%) and the RVD group (RVEF &lt;45%) and compared the RV scores between the two groups. Results The RVD was present in 31% of the entire cohort. The presence of RV LGE was significantly higher in the RVD group than the non-RVD group (83% vs. 43%, p=0.037). RV LGE score in the RVD group was significantly higher than that in the non-RVD group (2.83±1.95 vs. 0.83±1.21, p=0.001). The septal lesions in basal and middle levels accounted for 54% in all segments. RVEF showed a significant inverse correlation with RV LGE score (r=−0.57, p&lt;0.0001). In the ROC curve for RVD, the RV LGE score of more than 2 and equal could discriminate RVD from non-RVD with AUC of 0.813 (Sensitivity = 0.77, Specificity = 0.76, p=0.003). Conclusion RVD was observed in 31% of patients with definitive CS. The septal lesions were the most frequent in the RV LGE site, which suggests that the longitudinal abnormal motion of RV is a significant predictor of the RVD in patients with CS. RV LGE score is a valuable method to assess RVD. RV LGE score Funding Acknowledgement Type of funding source: None

scholarly journals Focal myocarditis in a young male with SARS-CoV-2 infection

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Ruchika Meel ◽  
Tyral D Ramsamy ◽  
Rajiv Narsing ◽  
Michelle Wong
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Clinical Presentation ◽  
Viral Myocarditis ◽  
Young Male ◽  
Cardiac Biomarkers ◽  
Shortness Of Breath ◽  
Chest Discomfort ◽  
Cmr Imaging

ABSTRACT A 31-year- old male with no comorbidities presented with chest discomfort and shortness of breath following SARS-CoV-2 infection. Primary viral myocarditis was confirmed with the aid of cardiac biomarkers and cardiac magnetic resonance (CMR) imaging. Herein, we detail his clinical presentation, management and highlight the role of CMR in viral myocarditis.

Sign in / Sign up

Export Citation Format

Share Document