Myocarditis
Mary N. Sheppard in Practical Cardiovascular Pathology, 2022
Cardiac magnetic resonance imaging (CMR) is now established as a diagnostic test in suspected acute myocarditis, and can be used to localize sites for endomyocardial biopsy with late gadolinium enhancement in areas of the myocardium. There is often a diffuse, nodular or patchy nonsegmental distribution in myocarditis patients. Patients with ischaemic cardiomyopathy have subendocardial or regional transmural enhancement. T2-weighted images mark interstitial oedema, which is an integral part of the inflammatory response. Thus, visual assessment of T2 images relating the signal intensity of the myocardium to that of skeletal muscle allows estimation of global oedema and offers a high accuracy to identify myocarditis, with a sensitivity of 100% and specificity of 90%. Regions of myocarditis are reported to correlate closely with regions of abnormal signal and cardiac fibrosis may also be visualized as an adverse prognosis factor leading to sudden death where there has been myocarditis. CMR is most accurate to diagnose acute myocarditis in subjects with <2–3 weeks of symptoms, because scar and inflammation appear similar at later stages on tissue characterization sequences. Extracellular volume fraction mapping and T1/T2 mapping have significant improvement in diagnostic accuracy over traditional Lake Louise criteria. These, as well as augment diagnosis, can track myocarditis disease activity, therapeutic response and development of fibrosis.7
Cardiac Emergencies in Obstetrics
Sanjeewa Padumadasa, Malik Goonewardene in Obstetric Emergencies, 2021
In some cases, additional tests may need to be performed in order to arrive at a diagnosis.Cardiac magnetic resonance imaging (MRI) scan – This procedure is used to look for thrombi and exclude infection or inflammation of the heart when findings from the echocardiogram are not clear.Coronary angiogram – This technique is done to look for coronary artery disease.Endomyocardial biopsy – This is not usually required.
Future directions in cardio-oncology research
Susan F. Dent in Practical Cardio-Oncology, 2019
Cardiac magnetic resonance imaging (CMR) is the gold standard for the quantification of ventricular volumes and ejection fraction (35). In addition to the advantages of being radiation-free and not affected by limitations of poor acoustic windows, CMR can detect subtle alterations within the myocardium. It can also provide detailed assessment of other cardiac structures (e.g., heart valves and pericardium) and cardiac perfusion status. CMR appears to be an ideal “one stop for all” imaging tool, but its use is hindered by high cost and reduced availability, and it is not suitable for patients with claustrophobia or noncompatible implantable cardiac devices.
Plasma Tenascin-C: a prognostic biomarker in heart failure with preserved ejection fraction
Published in Biomarkers, 2020
Prathap Kanagala, Jayanth R. Arnold, Jamal N. Khan, Anvesha Singh, Gaurav S. Gulsin, Daniel C. S. Chan, Adrian S. H. Cheng, Jing Yang, Zhuyin Li, Pankaj Gupta, Iain B. Squire, Gerry P. McCann, Leong L. Ng
Heart failure with preserved ejection fraction (HFpEF) currently accounts for nearly half of all hospitalised HF patients (Owan et al. 2006). Compared to heart failure with reduced ejection fraction (HFrEF) however, HFpEF still remains poorly understood and lacks proven, effective therapies (Ponikowski et al. 2016). In addition, while a plethora of prognostic markers exist for diagnosis and prognosis in HFrEF, few biomarkers perform beyond base models of clinical variables for risk assessment in HFpEF (Cheng et al. 2013). Most epidemiological and clinical trial data on HFpEF are largely echocardiography derived (Lam et al. 2011). Cardiovascular magnetic resonance imaging (CMR) is the recognized gold standard for the majority of imaging parameters that comprise latest guidance on HFpEF (Ponikowski et al.2016), namely left ventricular ejection fraction (LVEF), left atrial volume and LV mass. CMR additionally provides unique tissue characterisation to enable surrogate assessments of the extra-cellular matrix (ECM), for example, late gadolinium enhancement imaging (LGE) for focal fibrosis (Karamitsos et al. 2009) and T1 mapping for extracellular volume (ECV) quantification, all parameters previously implicated in HFpEF pathophysiology (Komajda and Lam 2014). In spite of this, CMR studies in this setting are sparse.
Association of left atrial fibrosis with aortic excess pressure and white matter lesions
Published in Scandinavian Cardiovascular Journal, 2019
Mateusz Wykretowicz, Katarzyna Katulska, Marcin Zwanzig, Tomasz Krauze, Jaroslaw Piskorski, Przemyslaw Guzik, Andrzej Wykretowicz
Cardiac magnetic resonance imaging was performed on a 3-Tesla LGE-CMR scanner (Magnetom Skyra, Siemens Erlangen Germany) equipped with a 32-channel cardiac coil. 3D-LGE images were acquired from 10 to 20 min after an intravenous bolus injection of 0.2 mmol/kg gadobutrol (Gadovist, Bayer Schering, Germany) in using a 3D free-breathing navigator and an electrocardiogram-gated inversion recovery gradient-echo sequence applied in axial orientation. Typical imaging parameters were the following: TR/TE, 367.04/1.23 ms; flip angle, 22°; voxel size, 0.6 × 0.6 × 1.2 mm; inversion time, 340–360 ms depending on the results of a TI scout scan performed immediately before acquisition; parallel imaging using GRAPPA technique with R = 2; 42 reference lines; acquisition time, 5–10 minutes depending on patient’s heart and breath rate.
Tetralogy of Fallot with isolated levocardia in a young female
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Zeeshan Sattar, Hafez Muhammad Abdullah, Sohaib Roomi, Waqas Ullah, Adnan Khan, Ali Ghani, Asrar Ahmad
The underlying pathogenesis of isolated levocardia is not fully understood [11]. The condition may be diagnosed via a detailed history and physical examination, chest radiography, EKG, and cardiac imaging [2]. Cardiac imaging studies include computed tomography (CT) or cardiac magnetic resonance imaging (CMR). Cardiac CT is helpful in delineating the position of visceral organs, the cardiac apex, intracardiac anatomy and branching of the great vessel. However, cardiac CT involves significant exposure to radiation and may have harmful effects on children. CMR can be utilized instead in these patients as it does not involve exposure to ionizing radiation. Cardiac function and cardiac volumes can also be measured more accurately with CMR [12,13].
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