The utility of cardiac magnetic resonance imaging in Kounis syndrome

Okur, Aylin; Kantarcı, Mecit; Karaca, Leyla; Oğul, Hayri; Aköz, Ayhan; Kizrak, Yesim; Aslan, Şahin; Pirimoğlu, Berhan; Aksakal, Enbiya; Emet, Mücahit

doi:10.5114/pwki.2015.54017

Cited by 21 publications

(18 citation statements)

References 21 publications

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“…There is no need to perform invasive FFR to confirm or exclude the severity of lesions which were qualified based on CMR perfusion. Moreover, CMR offers an overall assessment of the myocardial tissue including myocardial vitality [14]. Our research enhances the results of previous reports confirming the adequacy and consistency of both methods [15].…”

Section: Discussionsupporting

confidence: 84%

Do we need invasive confirmation of cardiac magnetic resonance results?

Siastała¹,

Kądziela²,

Małek³

et al. 2017

pwki

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IntroductionCoronary artery revascularization is indicated in patients with documented significant obstruction of coronary blood flow associated with a large area of myocardial ischemia and/or untreatable symptoms. There are a few invasive or noninvasive methods that can provide information about the functional results of coronary artery narrowing. The application of more than one method of ischemia detection in one patient to reevaluate the indications for revascularization is used in case of atypical or no symptoms and/or borderline stenosis.AimTo evaluate whether the results of cardiac magnetic resonance need to be reconfirmed by the invasive functional method.Material and methodsThe hospital database revealed 25 consecutive patients with 29 stenoses who underwent cardiac magnetic resonance (CMR) and fractional flow reserve (FFR) between the end of 2010 and the end of 2014. The maximal time interval between CMR and FFR was 6 months. None of the patients experienced any clinical events or underwent procedures on coronary arteries between the studies.ResultsAccording to the analysis, the agreement of CMR perfusion with the FFR method was at the level of 89.7%. Assuming that FFR is the gold standard in assessing the severity of stenoses, the sensitivity of CMR perfusion was 90.9%. The percentage of non-severe lesions which were correctly identified in CMR was 88.9%.ConclusionsThe study shows that CMR perfusion is a highly sensitive method to detect hemodynamically significant CAD and exclude nonsevere lesions. With FFR as the reference standard, the diagnostic accuracy of MR perfusion to detect ischemic CAD is high.

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Section: Discussionsupporting

confidence: 84%

Do we need invasive confirmation of cardiac magnetic resonance results?

Siastała¹,

Kądziela²,

Małek³

et al. 2017

pwki

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“…Dynamic cardiac magnetic resonance imaging (MRI) is also a reliable tool for assessing cardiac involvement in Kounis syndrome. Delayed contrast-enhanced images show normal washout in the subendocardial lesion area in patients with Kounis syndrome type I variant [105].…”

Section: Diagnosismentioning

confidence: 99%

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Kounis¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

311

421

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Kounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature's own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.

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“…Keita Goto et al [11] reported that thallium-201 (Tl) single-photon emission CT (SPECT) and 125I-15-(p-iodophenyl)-3-(R,S)-methylpentadecanoic acid (BMIPP) SPECT were conducted in a post-Kounis syndrome patient, and they revealed a local perfusion defect with decreased BMIPP uptake. Aylin Okur et al [12] included 26 patients with known or suspected Kounis syndrome and conducted contrast-enhanced magnetic resonance imaging. The results revealed an early-phase subendocardial contrast defect and local edema in lesion areas in T2-weighted images.…”

Section: Discussionmentioning

confidence: 99%

Contrast Media Induced Kounis Syndrome: A Case Report

et al. 2019

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Kounis syndrome is a rare anaphylactic reaction leading to coronary spasm, acute plaque rupture, or intrastent stenosis. Many types of medicine or environmental factors can potentially trigger Kounis syndrome by mast cell allergic reactions. In severe Kounis syndrome, reduced blood pressure or cardiac arrest may be accompanying symptoms. The treatment strategy for Kounis syndrome is usually difficult due to both cardiac dysfunction and allergic reactions. The delay to intervention to break the vicious circle may cause catastrophic complications. Therefore, early diagnosis is critical for physicians to outline detailed etiology for prevention and treat the cardiac and allergic symptoms in a timely manner. Here, we describe a case presenting rare severe Kounis syndrome with cardiac arrest which occurred after the administration of a contrast media.

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The utility of cardiac magnetic resonance imaging in Kounis syndrome

Cited by 21 publications

References 21 publications

Do we need invasive confirmation of cardiac magnetic resonance results?

Do we need invasive confirmation of cardiac magnetic resonance results?

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Contrast Media Induced Kounis Syndrome: A Case Report

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