BackgroundNo published data exist about the safety of diagnostic magnetic resonance (MR) of the heart performed in a larger series of patients implanted with MR conditional pacemakers (PM). The purpose of our study is to analyse safety and potential alterations of electrical lead parameters in patients implanted with the EnRhythm/Advisa MRI SureScan PM with 5086MRI leads (Medtronic Inc.) during and after MR of the heart at 1.5 Tesla.MethodsPatients enrolled in this single center pilot study who underwent non-clinically indicated diagnostic MR of the heart were included in this analysis. Heart MR was performed for analyses of potential changes in right and left ventricular functional parameters under right ventricular pacing at 80 and 110 bpm. Atrial/ventricular sensing, atrial/ventricular pacing capture threshold [PCT], and pacing impedances were assessed immediately before, during, and immediately after MR, as well at 3 and 15 months post MR.ResultsThirty-six patients (mean age 69 ± 13 years; high degree AV block 18 [50%]) underwent MR of the heart. No MR related adverse events occurred during MR or thereafter. Ventricular sensing differed significantly between the FU immediately after MR (10.3 ± 5.3 mV) and the baseline FU (9.8 ± 5.3 mV; p < 0.05). Despite PCT [V/0.4ms] was not significantly different between the FUs (baseline: 0.84 ± 0.27; in-between MR scans: 0.82 ± 0.27; immediately after MR: 0.84 ± 0.24; 3-month: 0.85 ± 0.23; 15-month: 0.90 ± 0.67; p = ns), 7 patients (19%) showed PCT increases by 100% (max. PCT measured: 1.0 V) at the 3-month FU compared to baseline. RV pacing impedance [Ω/5V] differed significantly at the FU in-between MR scans (516 ± 47), and at the 15-month FU (482 ± 58) compared to baseline (508 ± 75).ConclusionThe results of our study suggest MR of the heart to be safe in patients with the MR conditional EnRhythm/Advisa system, albeit although noticeable but clinically irrelevant ventricular PCT changes were observed.
Spinal leptomeningeal metastases occur at a late stage of systemic disease, and the prognosis is generally poor. In literature, outcomes after surgery are reported as devastating, with mortality and morbidity rates of up to 20 and 60%. The aim of surgery is to relieve pain, preserve or even restore neurological function, and reveal histology if uncertain. This may be achieved by debulking the tumor without placing the patient at an unacceptably high risk. Surgery should be performed in selected cases of spinal leptomeningeal metastases, in patients who are still ambulatory with controlled systemic disease, and should be followed by adjuvant therapy.
This study was designed to assess the effects of afterload reduction in asymptomatic patients with severe aortic regurgitation (AR) and maintained LV function by cine-MRI. We studied 13 patients at baseline and after 0.2 mg/kg Hydralazine (I.V.). Patients were stratified according to the volumetric LV response to acute afterload reduction: Group I comprised patients with improved LV response; Group II comprised patients with unchanged or deteriorated LV response. Baseline LV function and severity of AR were not significantly different between groups. However, regurgitant fraction decreased (50 ؎ 12 vs. 36 ؎ 9%; P < 0.03) and cardiac output increased (4.9 ؎ 1.4 vs. 7.1 ؎ 1.6l/minute; P < 0,001) in Group I and remained unchanged in Group II (54 ؎ 10 vs. 55 ؎ 10%, P ؍ n.s. and 5.5 ؎ 1.4 vs. 6.6 ؎ 0.9l/minute; P ؍ n.s.) during maximal vasodilation. Beat-to-beat analysis revealed a decrease of left ventricular endsystolic volume index in group I (48 ؎ 13 vs. 37 ؎ 9 ml/beat; P < 0.05) and no change in group II (61 ؎ 20 vs. 62 ؎ 20 ml/beat; P ؍ n.s.). In the natural history of chronic AR, the absence of improved LV performance during acute vasodilation using beat-to-beat analysis by MRI may identify patients with more advanced cardiac adaptation to chronic volume overload.
Spinal leptomeningeal metastases occur at a late stage of systemic disease, and the prognosis is generally poor. In the literature, outcomes after surgery are reported as devastating, with mortality and morbidity rates of up to 20% and 60%. The aim of surgery is to relieve pain, preserve or even restore neurological function, and reveal histology if uncertain. This may be achieved by debulking the tumor without placing the patient at an unacceptably high risk. Surgery should be performed in selected cases of spinal leptomeningeal metastases, in patients who are still ambulatory with controlled systemic disease, and should be followed by adjuvant therapy.
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