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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Cardiac magnetic resonance imaging (CMR) is useful for evaluating diseases of the myocardium. Injection of gadolinium allows assessment of MI, fibrosis and infiltrative diseases (Figure 7.8d). CMR can also assess for acute inflammation and myocarditis, myocardial iron levels in haemachromatosis and myocardial ischaemia with adenosine stress perfusion protocol. CMR also provides detailed anatomy of the great vessels, the pericardium and the thoracic aorta and assessment of abnormal cardiac masses.
The Role of Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Gulhane Avanti, Lakhani Zeeshan, Raj Vimal
This is a major contributor to the pathophysiology of HF in HCM, identified as a restrictive LV filling pattern with a ratio of mitral peak velocity of early filling (E) to mitral peak velocity of late filling (A) ≥ 2, and an E-wave deceleration time ≤ 150 ms on echocardiography [34]. Mitral inflow velocities and pulmonary vein flow can be derived from phase contrast CMR to assess diastolic dysfunction on CMR. Further, elevated LV filling pressure, transmitted in retrograde into the pulmonary circulation, leads to an increase in central transit time, pulmonary blood volume, and increased pulmonary capillary hydrostatic pressure, which can be measured on CMR to identify diastolic dysfunction in patients with HCM [35]. The pulmonary blood volume index (PBVI) measured by first-pass perfusion CMR imaging has been shown to differentiate between stages of diastolic dysfunction in patients with HF and a reduced LV ejection fraction, and has thus been proposed as a quantitative biomarker of hemodynamic congestion in HCM [36]. On CMR, the pulmonary transmit time is defined by the time interval between the peaks of the two signal intensity/time curves for the right ventricle (RV) and LV respectively. Pulmonary blood volume index can be obtained as the product between the RV stroke volume index and the pulmonary transit time, normalized by the R-R interval. The best cut-off point of 413 mL/m2 is a reported diagnostic of LV diastolic dysfunction, with increased left atrial pressure, with a good diagnostic accuracy [37].
Pathophysiology of acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
JPS Sawhney, Prashant Wankhade, Simran Sawhney
Cardiac magnetic resonance (CMR) imaging is one very helpful imaging technique due to its unique non-invasive tissue characterisation, ability to identify wall motion abnormalities, presence of oedema, and myocardial scar/fibrosis presence and pattern. CMR within two weeks after onset of symptoms should be considered for identifying the aetiological cause of MINOCA [20].
Characterisation of patients with and without cardiac magnetic resonance imaging abnormalities presenting with myocardial infarction with non-obstructive coronary arteries (MINOCA)
Published in Acta Cardiologica, 2021
Bhupendar Tayal, Phillip Freeman, Filip Ericsson, Kristian Hay Kragholm, Niels Holmark Andersen, Andreas Hagendorff, Jens Aaroe, Peter Sogaard, Tomas Zaremba
Patients with MINOCA are described to be younger age and more often female [17] which is also what we observed in the present MINOCA cohort. Among the baseline parameters at presentation, TNT was significantly higher in patients with ischaemic changes on CMR. This study indicates that TNT can be used as a marker to select patients in whom CMR should be performed particularly in those centres where CMR is not performed routinely in all MINOCA patients. A minor elevation in TNT may imply non-significant myocardial injury and hence no ischaemic changes on CMR are observed. ECG changes are rather unspecific in this group of patients. While ischaemic changes on CMR are observed among non-STEMI patients without ECG changes, many of the patients with ECG changes (STEMI and non-STEMI) did not have any ischaemic changes on the CMR. Therefore, performing CMR cannot be limited to patients with MINOCA having STEMI or acute ischaemic changes. However, when patients had ischaemic changes on both ECG and CMR, they are found to be correlated. Echocardiography seems to have a limited ability to identify patients with ischaemic changes on CMR which further underscores the importance of performing CMR in these patients. GLS by 2D STE is described to be moderately correlated to myocardial fibrosis in the literature [20,21], but in the current study no significant difference in GLS is observed between those with and without ischaemic changes on CMR. This could be because of a small study cohort and most of the patients have subendocardial fibrosis with a small scar burden.
COVID-19 myocarditis and prospective heart failure burden
Published in Expert Review of Cardiovascular Therapy, 2021
Anastasia Shchendrygina, Eike Nagel, Valentina O. Puntmann, Silvia Valbuena-Lopez
On one hand, early recognition and systematic assessment of residual cardiac injury of those who recovered from COVID-19 are desirable, in order to identify subclinical damage and be able to initiate disease-modifying therapies that can prevent or delay the progression to HF. However, routine diagnostic tests performed in the routine cardiologic diagnostic work-up, i.e. ECG or echocardiogram, are only able to detect advanced stages of the disease, basically when LV dysfunction is already present. CMR is an accurate and sensitive imaging technique that allows for in-depth tissue characterization and the identification of the variety of underlying pathophysiological processes in the myocardium (inflammation, edema, fibrosis, ischemia). The availability of new, highly reliable, and reproducible techniques that not only detect, but also measure and quantify these processes, offers us the possibility of a shift of paradigm, from treating the late consequences of established HF, to going ahead of the disease, starting therapy at an early stage and preventing the consequences of advanced HF. Additionally, CMR allows for monitoring of disease activity and response to treatment, guiding pharmacologic therapy.
Effect of long-term remote ischemic conditioning on inflammation and cardiac remodeling
Published in Scandinavian Cardiovascular Journal, 2019
Kasper Pryds, Michael Rahbek Schmidt, Mette Bjerre, Steffen Thiel, Jens Refsgaard, Hans Erik Bøtker, René Drage Østgård, Roni Ranghøj Nielsen
We recruited patients with compensated CIHF from the outpatient heart failure clinic at Department of Cardiology, Aarhus University Hospital, Denmark and Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark. At the time of study enrollment, all patients were clinically stable and in optimal heart failure treatment. Criteria for inclusion were: (I) age ≥18 years, (II) left ventricular ejection fraction (LVEF) ≤45%, and (III) New York Heart Association functional class I-III. Criteria for exclusion were: (I) permanent atrial fibrillation, (II) diabetes mellitus, (III) peripheral neuropathy, (IV) current dialysis treatment, (V) contraindication to cardiac magnetic resonance (CMR) imaging examination (e.g. metal implants including implantable cardiac device and pacemaker), (VI) hospitalization for cardiovascular disease within 30 days, and (VII) strenuous exercise within three days prior to each study visit.