The emerging clinical role of cardiovascular magnetic resonance imaging

Kumar, Andreas; Patton, David J.; Friedrich, Matthias G.

doi:10.1016/s0828-282x(10)70396-2

Cited by 20 publications

(5 citation statements)

References 149 publications

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“…CMR may detect myocardial edema and inflammation using T2 weighted imaging as well as detect myocardial scarring and fibrosis using late gadolinium enhancement (LGE) (7). Multiple recent studies have been published regarding CMR assessment of prognosis in CS, in particular examining the presence of LGE and its association with adverse outcomes (8-10).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Coleman¹,

Shaw²,

Balfour³

et al. 2017

JACC: Cardiovascular Imaging

198

103

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Objectives This study sought to perform a systematic review and meta-analysis to understand the prognostic value of myocardial scarring as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with known or suspected cardiac sarcoidosis. Background Although CMR is increasingly used for the diagnosis of cardiac sarcoidosis, the prognostic value of CMR has been less well described in this population. Methods PubMed, Cochrane CENTRAL, and meta-Register of Controlled Trials were searched for CMR studies with ≥ 1 year of prognostic data. Primary end-points were all-cause mortality and a composite outcome of arrhythmogenic events (ventricular arrhythmia, ICD shock, sudden cardiac death) plus all-cause mortality during follow-up. Summary effect estimates were generated with random-effects modeling. Results Ten studies were included, involving a total of 760 patients with a mean follow up of 3.0 ± 1.1 years. Patients had a mean age of 53 years, 41% were male, 95.3% had known extra-cardiac sarcoidosis, and 21.6% had known cardiac sarcoidosis. The average ejection fraction was 57.8 ± 9.1%. Patients with late gadolinium enhancement had higher odds for all-cause mortality (odds ratio [OR]: 3.06, p < 0.03) and higher odds of the composite outcome (OR: 10.74, p< .00001) compared to those without LGE. Patients with LGE had an increased annualized event rate of the composite outcome (11.9% v. 1.1%; p<0.0001) Conclusions In patients with known or suspected cardiac sarcoidosis, the presence of late gadolinium enhancement on cardiac MRI is associated with increased odds of both all-cause mortality and arrhythmogenic events.

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Section: Introductionmentioning

confidence: 99%

Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Coleman¹,

Shaw²,

Balfour³

et al. 2017

JACC: Cardiovascular Imaging

198

103

View full text Add to dashboard Cite

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“…CMR, on the other hand, has unique advantages in comparison to TTE, since it does not suffer from unfavorable acquisition windows and can be acquired in any direction [ 6 ]. However, CMR is typically used clinically in the subgroup of patients with moderate and severe disease as an alternative to more invasive techniques (cardiac catheterization and transesophageal echo) when TTE results are equivocal.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular magnetic resonance (CMR) has recently emerged as an important diagnostic modality for noninvasive evaluation of a variety of diseases, including AS [ 6 ]. CMR has unique advantages in comparison to TTE, since the entire heart can be visualized without limitations of acoustic windows, and imaging planes can be prescribed in any direction.…”

Section: Introductionmentioning

confidence: 99%

Quantification of aortic stenosis diagnostic parameters: comparison of fast 3 direction and 1 direction phase contrast CMR and transthoracic echocardiography

Silveira

Smyke

Rich

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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BackgroundAortic stenosis (AS) is a common valvular disorder, and disease severity is currently assessed by transthoracic echocardiography (TTE). However, TTE results can be inconsistent in some patients, thus other diagnostic modalities such as cardiovascular magnetic resonance (CMR) are demanded. While traditional unidirectional phase-contrast CMR (1Dir PC-CMR) underestimates velocity if the imaging plane is misaligned to the flow direction, multi-directional acquisitions are expected to improve velocity measurement accuracy. Nonetheless, clinical use of multidirectional techniques has been hindered by long acquisition times. Our goal was to quantify flow parameters in patients using 1Dir PC-CMR and a faster multi-directional technique (3Dir PC-CMR), and compare to TTE.MethodsTwenty-three patients were prospectively assessed with TTE and CMR. Slices above the aortic valve were acquired for both PC-CMR techniques and cine SSFP images were acquired to quantify left ventricular stroke volume. 3Dir PC-CMR implementation included a variable density sampling pattern with acceleration rate of 8 and a reconstruction method called ReVEAL, to significantly accelerate acquisition. 3Dir PC-CMR reconstruction was performed offline and ReVEAL-based image recovery was performed on the three (x, y, z) encoding pairs. 1Dir PC-CMR was acquired with GRAPPA acceleration rate of 2 and reconstructed online. CMR derived flow parameters and aortic valve area estimates were compared to TTE.ResultsReVEAL based 3Dir PC-CMR derived parameters correlated better with TTE than 1Dir PC-CMR. Correlations ranged from 0.61 to 0.81 between TTE and 1Dir PC-CMR and from 0.61 to 0.87 between TTE and 3Dir-PC-CMR. The correlation coefficients between TTE, 1Dir and 3Dir PC-CMR Vpeakwere 0.81 and 0.87, respectively. In comparison to ReVEAL, TTE slightly underestimates peak velocities, which is not surprising as TTE is only sensitive to flow that is parallel to the acoustic beam.ConclusionsBy exploiting structure unique to PC-CMR, ReVEAL enables multi-directional flow imaging in clinically feasible acquisition times. Results support the hypothesis that ReVEAL-based 3Dir PC-CMR provides better estimation of hemodynamic parameters in AS patients in comparison to 1Dir PC-CMR. While TTE can accurately measure velocity parallel to the acoustic beam, it is not sensitive to the other directions of flow. Therefore, multi-directional flow imaging, which encodes all three components of the velocity vector, can potentially outperform TTE in patients with eccentric or multiple jets.Electronic supplementary materialThe online version of this article (doi:10.1186/s12968-017-0339-5) contains supplementary material, which is available to authorized users.

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“…These tests can be performed with different noninvasive imaging techniques but MRI is the reference standard for noninvasive measurement of global and local cardiac function as it provides three dimensional imaging data with high spatial and temporal resolution [7][8][9]. Using MR images, changes in flow, ventricular volume, and cardiac output can be measured throughout the cardiac cycle [10,11]. In addition, cardiac perfusion can be assessed [12].…”

Section: Introductionmentioning

confidence: 99%

Low Cost Magnetic Resonance Imaging-Compatible Stepper Exercise Device for Use in Cardiac Stress Tests

Forouzan

Flink

Warczytowa

et al. 2014

Journal of Medical Devices

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Cardiovascular disease is the leading cause of death worldwide. Many cardiovascular diseases are better diagnosed during a cardiac stress test. Current approaches include either exercise or pharmacological stress echocardiography and pharmacological stress magnetic resonance imaging (MRI). MRI is the most accurate noninvasive method of assessing cardiac function. Currently there are very few exercise devices that allow collection of cardiovascular MRI data during exercise. We developed a low-cost exercise device that utilizes adjustable weight resistance and is compatible with magnetic resonance (MR) imaging. It is equipped with electronics that measure power output. Our device allows subjects to exercise with a leg-stepping motion while their torso is in the MR imager. The device is easy to mount on the MRI table and can be adjusted for different body sizes. Pilot tests were conducted with 5 healthy subjects (3 male and 2 female, 29.2 6 3.9 yr old) showing significant exercise-induced changes in heart rate Journal of Medical DevicesDECEMBER 2014, Vol. 8 / 045002-1 Copyright V C 2014 by ASME (þ42%), cardiac output (þ40%) and mean pulmonary artery (PA) flow (þ%49) post exercise. These data demonstrate that our MR compatible stepper exercise device successfully generated a hemodynamically stressed state while allowing for high quality imaging. The adjustable weight resistance allows exercise stress testing of subjects with variable exercise capacities. This low-cost device has the potential to be used in a variety of pathologies that require a cardiac stress test for diagnosis and assessment of disease progression.

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The emerging clinical role of cardiovascular magnetic resonance imaging

Cited by 20 publications

References 149 publications

Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Quantification of aortic stenosis diagnostic parameters: comparison of fast 3 direction and 1 direction phase contrast CMR and transthoracic echocardiography

Low Cost Magnetic Resonance Imaging-Compatible Stepper Exercise Device for Use in Cardiac Stress Tests

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