Left Ventricular Non-Compaction Cardiomyopathy: Case Report and Review of Literature

Non-compaction cardiomyopathy (NCC) is characterized by trabeculations in either one or both ventricles. Clinical presentation is highly variable: dyspnea, palpitation, thromboembolic events, arrhythmia, or sudden cardiac death. There are currently no universally-accepted criteria for classifying and diagnosing left ventricular non-compaction (LVNC) cardiomyopathy. Transthoracic echocardiography (TTE) is the diagnostic exam of choice. The diagnosis is often missed or delayed because of a lack of knowledge about this uncommon disease. Progression of LVNC is highly variable and prognosis is very difficult to predict. We report a case of a 50-year-old female patient with a history of total thyroidectomy under hormonal supplementation who consults for dyspnea and paroxysmal palpitations revealing an isolated LVNC. This case emphasizes the importance of imaging techniques, which are, TTE and cardiac magnetic resonance imaging (MRI) in early diagnosis, management, and follow-up.

Current status and prospect of preoperative assessment of heart disease risk in liver transplant recipients / 器官移植

With the changes of the disease spectrum of liver transplantation and organ allocation system, more and more patients complicated with cardiovascular complications have entered the waiting list for liver transplantation. However, surgical stress, severe infection and adverse reactions of immunosuppressive drugs will significantly increase the risk of postoperative cardiac complications and affect the short-and long-term survival of the recipients. Therefore, comprehensive evaluation of cardiac structure and function of the recipients before liver transplantation is of significance for improving clinical prognosis of the recipients. In this article, the main causes for the increased risk of heart disease during the perioperative period of liver transplantation, the time and methods of heart disease risk assessment for liver transplant recipients were reviewed, and existing assessment approaches for common heart diseases before liver transplantation were illustrated, aiming to provide reference for further reducing the incidence of heart complications after liver transplantation, improving the survival rates of grafts and recipients and enhancing clinical prognosis.

Papel de la ecocardiografía speckle-tracking (rastreo de marcas) y la resonancia magnética cardíaca-feature tracking en la circulación de Fontan. Diferencias entre los ventrículos derecho e izquierdo / Speckle-tracking echocardiography and MCR-feature tracking in Fontan circulation. Differences between right and left ventricles

Resumen Introducción: En los pacientes con DCPT, la disfunción ventricular es inevitable, y más temprana en VU derechos. La deformación miocárdica por STE y RMC-FT parece promisoria. Objetivo: Analizar la función ventricular mediante STE y RMC-FT en pacientes con DCPT, en comparación con RMC convencional según la morfología del VU y la posible implicación en su diagnóstico temprano. Método: Se recogieron medidas del strain longitudinal y circunferencial por STE y RMC-FT, volúmenes ventriculares y FE por RMC en 64 pacientes con DCPT. Resultados: La morfología ventricular no se relacionó con disfunción por RMC. Los VU derechos tuvieron valores por STE y RMC-FT disminuidos respecto de los VU izquierdos, con FE similares. Existe correlación entre STE y RMC-FT, no equivalentes, con buena factibilidad y reproducibilidad. Conclusiones: La RMC-FT y el STE son técnicas útiles en el diagnóstico temprano y la vigilancia de la función ventricular en VU derechos con FE preservada.

Abstract Introduction: In patients with TCPC, the development of ventricular dysfunction is inevitable and is more precocious in SRVs. Myocardial deformation by STE and CMR-FT is promising. Objective: To analize ventricular function in patients with TCPC using STE and CMR-FT compared with conventional cMRI, depending on SV morphology, to determine their role in early diagnosis of ventricular dysfunction. Method: Sixty-four patients with TCPC were included. Longitudinal and circumferential strain by STE and CMR-FT and ventricular volume and EF were obtained. Results: Dysfunction analyzed by cMRI showed no association with ventricular morphology. SRVs had lower values in STE and CMR-FT compared with SLVs, with similar EF. While not equivalent, correlation was observed between the STE and the CMR-FT values, demonstrating good feasibility and reproducibility. Conclusion: The strain data in CMR-FT and STE could be useful for diagnosis and monitoring of ventricular function and as markers of early SRV dysfunction with preserved EF.

Correlation of serum ST2 levels with severity of diastolic dysfunction on echocardiography and findings on cardiac MRI in patients with heart failure with preserved ejection fraction

Objective: The aim of the present study was to find a correlation of serum Suppression of tumorigenicity 2 (ST2) levels with severity of diastolic dysfunction on echocardiography and cardiac magnetic resonance imaging (CMRI) in heart failure with preserved ejection fraction (HFpEF) patients. Methods: Fifty patients aged _x0001_18 years fulfilling diagnostic criteria for HFpEF were included. ST2 levels, 2D echocardiography and CMRI were performed. Left ventricular ejection fraction, E/A, Septal E/E’, left atrial volume index (LAVI), tricuspid regurgitation (TR), assessment of diastolic dysfunction, T1 mapping in milliseconds and late gadolinium enhancement (LGE) in percentage were noted. The primary outcome measure was to study correlation of ST2 levels with severity of diastolic dysfunction, whereas the secondary outcome measures were to study correlation of ST2 levels with native T1 mapping and LGE on CMRI. Results: ST2 levels showed statistically significant and positive correlation with E/E’ (r ¼ 0.837), peak TR velocity (r ¼ 0.373), LAVI (r ¼ 0.74), E/A (r ¼ 0.420), and T1 values in milliseconds (r ¼ 0.619). There was no statistically significant correlation between ST2 level and LGE in % (r ¼ 0.145). The median ST2 levels in patients with E/E’ > 14 and E/E’ 14 were 110.8 and 36.1 respectively (p-value < 0.05). The mean ST2 levels were significantly higher in patients who had diastolic dysfunction grade III (126.4) and New York Heart Association class IV (133.3). Conclusions: Evaluation of ST2 adds important information to support the diagnosis of left ventricular diastolic dysfunction in patients with HFpEF

Valor Prognóstico da Imagem de Ressonância Magnética Cardíaca de Perfusão em Estresse com Adenosina em Idosos com Doença Arterial Coronariana Conhecida ou Suspeita / Prognostic Value of Adenosine Stress Perfusion Cardiac Magnetic Resonance Imaging in Older Adults with Known or Suspected Coronary Artery Disease

Resumo Fundamento: Há dados limitados sobre o valor prognóstico da ressonância magnética cardíaca (RMC) em estresse em pacientes idosos. Objetivo: Determinar o valor prognóstico da RMC em estresse com adenosina em idosos com doença arterial coronariana (DAC) conhecida ou suspeita. Métodos: Entre 2010 e 2015, pacientes consecutivos com 65 anos ou mais encaminhados para RMC em estresse com adenosina foram acompanhados para a ocorrência de eventos cardíacos graves (morte cardíaca e infarto do miocárdio não-fatal) e eventos cardiovasculares adversos maiores (ECAM) que também incluíram hospitalização por insuficiência cardíaca e acidente vascular cerebral isquêmico. As análises univariadas e multivariadas foram realizadas para determinar o valor prognóstico da isquemia miocárdica, com valor de p <0,05 considerado estatisticamente significante. Resultados: Após um período médio de seguimento de 50,4 meses em 324 pacientes (48% do sexo masculino, 73±7 anos), ocorreram 21 eventos cardíacos graves e 52 ECAM. Pacientes com isquemia miocárdica (n=99) apresentaram taxas significantemente maiores de eventos cardíacos graves (HR 5,25 [IC 95% 2,11-13,04], p<0,001) e ECAM (HR 3,01 [IC 95% 1,75-5,20], p<0,001) do que aqueles sem isquemia. A análise multivariada determinou a isquemia como preditor independente de eventos cardíacos graves (HR 3,14 [IC 95% 1,22-8,07], p=0,02) e ECAM (HR 1,91 [IC 95% 1,02-3,59], p=0,04). A isquemia forneceu um valor prognóstico incremental sobre fatores clínicos e fração de ejeção do ventrículo esquerdo para predizer eventos cardíacos graves e ECAM (p<0,01 para ambos). Nenhum evento adverso grave ocorreu durante ou imediatamente após os exames de RMC. Conclusão: A RMC em estresse com adenosina é segura e demonstra valor prognóstico em idosos com DAC conhecida ou suspeita.

Abstract Background: There is limited data on the prognostic value of stress cardiac magnetic resonance (CMR) in older adults. Objective: To determine the prognostic value of adenosine stress CMR in older individuals with known or suspected coronary artery disease (CAD). Methods: Between 2010 and 2015, consecutive patients aged 65 years or older referred for adenosine stress CMR were followed for the occurrence of severe cardiac events (cardiac death and nonfatal myocardial infarction) and major adverse cardiovascular events (MACE) that also included hospitalization for heart failure and ischemic stroke. Univariate and multivariate analyses were performed to determine the prognostic value of myocardial ischemia, with p-value <0.05 considered statistically significant. Results: After a mean follow-up period of 50.4 months in 324 patients (48% male, 73±7 years), 21 severe cardiac events and 52 MACE occurred. Patients with myocardial ischemia (n=99) had significantly higher rates of severe cardiac events (HR 5.25 [95% CI 2.11-13.04], p<0.001) and MACE (HR 3.01 [95% CI 1.75-5.20], p<0.001) than those without ischemia. Multivariable analysis determined ischemia as an independent predictor of severe cardiac events (HR 3.14 [95% CI 1.22-8.07], p=0.02) and MACE (HR 1.91 [95%CI 1.02-3.59], p=0.04). Ischemia provided an incremental prognostic value over clinical factors and left ventricular ejection fraction for predicting severe cardiac events and MACE (p<0.01 for both). No severe adverse events occurred during or immediately after CMR examinations. Conclusion: Adenosine stress CMR is safe and has prognostic value in older adults with known or suspected CAD.

Diagnostic value of echocardiogram and cardiac magnetic resonance imaging for hypertrophic cardiomyopathy / 中国辐射卫生

Objective To compare echocardiogram and cardiac magnetic resonance imaging (MRI) for diagnosis of hypertrophic cardiomyopathy. Methods A total of 137 patients suspected of hypertrophic cardiomyopathy were recruited. All patients received three-dimensional echocardiogram followed by cardiac MRI, and the detection rate of hypertrophic cardiomyopathy was compared. Results A total of 96 eligible patients with hypertrophic cardiomyopathy were finally enrolledin this study, including 70 males (72.9%) and 26 females (27.1%), with a mean age of 48.2 ± 10.2 years. There was a significant difference in the detection rate of hypertrophic cardiomyopathy by echocardiogram (93.8%) and by cardiac MRI (100%) (χ2 = 4.30, P = 0.03). Among the 96 subjects, there was no significant difference in the mean value of maximum left ventricular wall thickness measured by echocardiogram and cardiac MRI (22.1 ± 8.9 vs 22.8 ± 9.2 mm; t = 1.23, P = 0.32). There was a significant difference in the mean thickness of the basal anterolateral free wall in the left ventricle (18.2 ± 7.8 vs 13.9 ± 7.1 mm; t = 9.40, P = 0.0007). Conclusion Cardiac MRI scanning is superior to echocardiogram for diagnosis of hypertrophic cardiomyopathy, which may be used as an effective supplement to conventional echocardiogram.

Computer-aided intelligent diagnosis and education system for cardiac magnetic resonance imaging / 中华医学教育探索杂志

Cardiac magnetic resonance imaging (CMRI) can comprehensively observe the anatomical structure, motion function and tissue characteristics of the heart through multi-parameter and multi-plane sequence imaging, which has become the gold standard for the diagnosis of cardiomyopathy. However, there is a serious shortage of high-level imaging doctors who can diagnose CMRI due to the numerous sequences and difficult fusion of CMRI. To realize the personalized teaching and interactive education, we have designed a platform that could use artificial intelligence to pre-process medical images for clinical diagnosis, and localize the week points of knowledge, thus improving the teaching effect of cardiac imaging diagnosis.

Research progress on the presurgical evaluation of giant left ventricle associated with valvular disease / 中国胸心血管外科临床杂志

@#Due to the abnormal structure and function of the cardiac valves, cardiac valve disease gradually appears the expansion of left ventricular inner diameter and volume. When the left ventricular end-diastolic dimension and volume expand severely, it becomes a giant left ventricle. Surgical valve replacement is still one of the main treatment methods for this disease. The degree of postoperative ventricular recovery is closely related to perioperative mortality and long-term prognosis. However, the existing clinical preoperative assessment methods still cannot accurately predict the degree of postoperative left ventricular recovery and long-term prognosis of such patients, so it is difficult to determine the optimal operation timing and surgical methods for patients. Therefore, we reviewed the existing literature and discussed different evaluation methods of the giant left ventricle associated with valvular disease before surgery, so as to optimize the perioperative treatment of such patients, clarify the timing of surgery and improve the prognosis.

Resonancia magnética cardíaca en la miocardiopatía chagásica crónica. Una herramienta para optimizar el diagnóstico, la estratificación de riesgo y el pronóstico / Cardiac magnetic resonance imaging in chronic chagasic cardiomyopathy. A tool to optimize diagnosis, risk stratification and prognosis

Resumen La enfermedad de Chagas es un problema de salud pública en Latinoamérica, donde afecta a aproximadamente a 6 millones de personas. En Costa Rica se ha descrito la enfermedad desde 1941, con varios reportes de casos confirmados agudos y crónicos. La miocardiopatía chagásica afecta al 30% de los individuos con infección crónica y es la manifestación más grave de la enfermedad, con una morbimortalidad mayor que otras miocardiopatías. La resonancia magnética cardíaca, debido a su capacidad de caracterización tisular permite identificar con alta correlación histopatológica la presencia de fibrosis, edema e inflamación en la miocardiopatía chagásica. Esto ha permitido una mejor comprensión de la compleja fisiopatología de la enfermedad y además permite el diagnóstico diferencial con otras patologías simuladoras como lo es la cardiopatía isquémica. En la MCh la presencia de fibrosis miocárdica predice de manera independiente eventos adversos mayores tales como taquicardia ventricular sostenida y muerte cardiovascular. Debido a lo anterior la resonancia magnética cardíaca es una robusta herramienta capaz de mejorar el diagnóstico, la estratificación de riesgo y el pronóstico de estos pacientes, con miras a mejores y oportunas intervenciones terapéuticas.

Abstract Chagas disease is a public health problem in Latin America, where it affects approximately 6 million people. In Costa Rica the disease has been described since 1941, with several reports of acute and chronic confirmed cases. Chagas cardiomyopathy affects 30% of individuals with chronic infection and is the most serious manifestation of the disease, with a higher morbidity and mortality than other cardiomyopathies. Cardiac magnetic resonance, due to its capacity for tissue characterization, identifies the presence of fibrosis, aedema and inflammation in Chagas cardiomyopathy with high histopathological correlation. This has allowed a better understanding of the complex pathophysiology of the disease and also allows differential diagnosis with other pathologies that can simulate, such as ischemic heart disease. In Chagas cardiomyopathy, the presence of myocardial fibrosis independently predicts major adverse events such as sustained ventricular tachycardia and cardiovascular death. Due to the above, cardiac magnetic resonance is a robust tool capable of improving the diagnosis, risk stratification and prognosis of these patients, with a view to better and timely therapeutic interventions.

Correlation between three-dimensional speckle tracking echocardiography combined with cardiac magnetic resonance imaging-late gadolinium enchancemet on left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective@#To evaluate the left ventricular global systolic function and myocardial fibrosis in adult hypertrophic cardiomyopathy (HCM) patients by three-dimensional speckle tracking echocardiography(3D-STE) combined with cardiac magnetic resonance imaging-late gadolinium enchancemet (CMRI-LGE) sequence, and to explore the association between left ventricular global systolic function and myocardial fibrosis.@*Methods@#Thirty patients with HCM(HCM group) and 33 healthy controls(control group) were enrolled in the study. All patients underwent conventional two-dimensional echocardiography (2DE), tissue Doppler imaging (TDI), and 3D-STE. The following parameters were acquired and compared between the groups: interventricular septal end-diastolic thickness (IVSD), left ventricular posterior wall end-diastolic thickness (LVPWD), left ventricular mass(LVM), left ventricular mass index (LVMI), left atrial volume (LAV), and left ventricular end-systolic volume(LVESV), left ventricular end-diastolic volume (LVEDV), left ventricular outflow tract pressure gradient (LVOT-PG), left ventricular outflow tract velocity time integral (LVOT-VTI), isovolumic relaxation time (IVRT), global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS). And 28 patients who met the CMRI indications underwent CMRI-LGE to obtain the LVM, and the correlation and consistency of LVM results obtained from CMRI and 3D-STE were performed.According to LGE results, HCM patients were divided into LGE(+ ) group and LGE (-) group, the differences of GLS, GRS and GCS between the two groups were analyzed.@*Results@#①Compared with the control group, IVSD, LVPWD, LVMI, LAV, LVOT-PG, LVOT-VTI and IVRT were significantly increased in the HCM group (all P<0.05); ②There was no significant difference in GS between the two groups(P>0.05), while GLS and GRS decreased and GCS increased significantly in HCM group (P<0.05); ③The correlation between 3D-STE and CMRI in measuring measured LVM in HCM patients was good, and the results showed good concordance(r=0.807, P<0.01). ④GLS in LGE(+ ) group was lower than in LGE(-) group(P=0.004), but there was no significant difference in GCS and GRS between the two groups(P=0.597, 0.534).@*Conclusions@#①3D-STE can detect the early damage of left ventricular global systolic function in patients with HCM; ②3D-STE combined with CMRI-LGE technology can provide an important imaging reference for the evaluation of the relationship between left ventricular global systolic function and myocardial fibrosis in patients with HCM.

Advancement of imaging technology for coronary microcirculation dysfunction assessment / 生物医学工程学杂志

Coronary microcirculation dysfunction (CMVD) is an important risk factor for the prognosis of re-perfused ischemic heart. Recent studies showed that the evaluation of CMVD has significant impact on both the early diagnosis of heart diseases relevant to blood supply and prognosis after myocardial reperfusion. In this review, the definition of CMVD from the perspective of pathophysiology was clarified, the principles and features of the state-of-the-art imaging technologies for CMVD assessment were reviewed from the perspective of engineering and the further research direction was promoted.

Resonancia magnética nuclear en cardiología infantil / Magnetic resonance imaging in pediatric cardiology

Los innegables progresos en la supervivencia de los pacientes con cardiopatía congénita en los últimos años fue acompañado de los avances en todas las áreas concurrentes a la cirugía cardiovascular, incluyendo la recuperación y los métodos diagnósticos que permiten una mejor comprensión de la patología cardíaca congénita o adquirida. La velocidad con que se desarrollan estas herramientas en el arsenal médico, exige una mejor comprensión a la hora de definir la estrategia diagnóstica para cada paciente en particular. Tradicionalmente, las imágenes diagnósticas de las cardiopatías congénitas eran dominio de la ecocardiografía y el cateterismo. En los últimos 10 años, la Resonancia y la Tomografía Computada fueron ganando terreno. La principal ventaja de la Resonancia es que no utiliza Rayos X para obtener las imágenes, diferencia de la angiografía por cateterismo y la tomografía axial computada. La resonancia magnética cardíaca se ha convertido en una herramienta importante para evaluar la enfermedad cardíaca congénita y también la adquirida en niños y adultos. La variedad y complejidad de la patología y sus posibilidades quirúrgicas hace indispensable la presencia del cardiólogo infantil durante la adquisición de las imágenes y su post procesamiento. En esta sección se presentarán algunas de las herramientas o secuencias que utiliza la Resonancia Magnética Cardíaca y su utilización práctica en el diagnóstico de las cardiopatías más frecuentes (AU)

The undeniable progress in survival of patients with congenital heart defects in recent years has been accompanied by advances in all areas related to cardiovascular surgery, including recovery and diagnostic methods that allow for a better understanding of congenital or acquired heart disease. The speed with which these tools are developed in the medical arsenal requires a better understanding when defining the diagnostic strategy for each individual patient. Traditionally, diagnostic images of choice for congenital heart disease were echocardiography and catheterization. Over the last 10 years, MRI. and CT scan have become more important. The main advantage of MRI is that it does not use X-rays to obtain the images, unlike catheterization and computed tomography angiogram. Cardiac MRI has become an important tool for assessing congenital and acquired heart disease in children and adults. The variety and complexity of the disease and its surgical possibilities warrant the presence of the child cardiologist during imaging acquisition and processing. This section will present some of the MRI tools and sequences and their practical use in the diagnosis of the most common heart diseases (AU)

Imaging features of cardiac lipoma / 中国胸心血管外科临床杂志

@#Cardiac lipoma is rare and benign entities of heart, and often discovered after autopsy incidentally because most patients remain completely asymptomatic. The symptoms of cardiac lipoma depend on their location and size within the heart, such as dyspnea, chest pain, arrhythmia, and even sudden death. Surgical interventions usually have good results. Up till now, there has been no any relevant large-scale randomized controlled trial, and even no precise guideline for treatment. Surgical procedures often depend on patients' clinical manifestations and changes of hemodynamics in cardiac vessels in order to relief the symptoms as well as abort the progress of the disease. Therefore, early diagnosis and close follow-up are necessary for timely treatment. This article aims to summarize the imageological examinations for cardiac lipoma, including echocardiography, computed tomography, magnetic resonance imaging along with their characteristics and advantages, in order to get better clinical strategies.

Assessment of the hemodynamics of pulmonary artery and right ventricular function in chronic obstructive pulmonary disease with pulmonary hypertension using cardiac magnetic resonance imaging / 中华危重病急救医学

To investigate the role of cardiac magnetic resonance imaging (CMRI) in evaluating pulmonary hemodynamics and right ventricular function in patients with chronic obstructive pulmonary disease (COPD) and pulmonary hypertension (PAH); and the relationship between CMRI parameters and pulmonary function parameters, blood gas analysis parameters and 6-minute walk test (6MWT) parameters in patients with COPD complicated with PAH. Methods Thirty-seven patients were diagnosed with COPD in the department of respiratory and critical care discipline of Ningxia Medical University General Hospital from October 2013 to October 2016, who underwent transthoracic echocardiography (TTE) to measure pulmonary arterial systolic pressure (PASP), and were divided into COPD group and COPD+PAH group according to whether there was PAH [PASP > 40 mmHg (1 mmHg = 0.133 kPa) was defined as PAH]. All patients completed pulmonary function tests [1 second forced expiratory volume to forced vital capacity ratio (FEV1/FVC), FEV1 predicted value (FEV1pred)], blood gas analysis [arterial blood oxygen partial pressure (PaO2), arterial blood carbon dioxide partial pressure (PaCO2)], CMRI examination [relative dilatation of the main pulmonary artery (mPAD), mean pulmonary artery pressure (mPAP), left ventricular ejection fraction (LVEF), right ventricular ejection fraction (RVEF), right ventricular end-diastolic myocardial mass (RVMED), right ventricular end-systolic myocardial mass (RVMES)], and 6MWD [6-minute walk distance (6MWD)] within 1 week. The obtained clinical parameters had been compared between the groups, and correlation was analyzed. Results Among the 37 patients with COPD, 16 patients were complicated with PAH. There were no significant differences in FEV1/FVC, FEV1pred, PaO2, PaCO2 and other baseline indicators between the two groups. In the COPD group, TTE obtained PASP of 2 patients were normal (PSAP < 40 mmHg), while CMRI measured mPAP were higher than the normal limit (> 25 mmHg). Compared with the COPD group, mPAD, RVEF and 6MWD were significantly decreased in the COPD+PAH group [mPAD: (25.64±5.01)% vs. (44.00±22.52)%, RVEF: 0.525±0.054 vs. 0.592±0.071, 6MWD (m): 319.3±116.5 vs. 408.2±38.0, all P < 0.01], mPAP, RVMED and RVMES were significantly increased [mPAP (mmHg): 28.89±3.16 vs. 20.18±2.43, RVMED (g): 57.19±15.46 vs. 40.71±15.44, RVMES (g): 45.99±11.16 vs. 33.71±13.39, all P < 0.01], and there was no significant differences in LVEF (0.663±0.082 vs. 0.699±0.075, P > 0.05). Correlation analysis showed that mPAD was positively correlated with FEV1/FVC and FEV1pred (r1 = 0.538, P1 = 0.021; r2 = 0.448, P2 = 0.049);RVMED was negatively correlated with PaO2 (r = -0.581, P = 0.015), and positively correlated with PaCO2 (r = 0.592, P = 0.014); 6MWD was positively correlated with RVEF (r = 0.485, P = 0.041), and had no correlation with LVEF (r = 0.271, P = 0.104). Conclusions Compared with COPD patients, changes in pulmonary hemodynamics and right ventricular function in COPD patients with PAH are related to the severity of airflow limitation. CMRI can early monitor pulmonary hemodynamics and right heart function changes in patients with COPD. Once PAH appears, pulmonary hemodynamics, right heart function and exercise tolerance have changed.

Supplementary Diagnostic Landmarks of Left Ventricular Non-Compaction on Magnetic Resonance Imaging

PURPOSE: Diagnostic criteria for left ventricular non-compaction (LVNC) are still a matter of dispute. The aim of our present study was to test the diagnostic value of two novel diagnostic cardiac magnetic resonance (CMR) parameters: proof of non-compact (NC) myocardium blood flow using T2 sequences and changes in geometry of the left ventricle. MATERIALS AND METHODS: The study included cases with LVNC and controls, from a data base formed in a period of 3.5 years (n=1890 exams), in which CMR protocol included T2 sequences. Measurement of perpendicular maximal and minimal end diastolic dimensions in the region with NC myocardium from short axis plane was recorded, and calculated as a ratio (MaxMinEDDR), while flow through trabecula was proven by intracavital T2-weighted hyperintensity (ICT2HI). LVNC diagnosis met the following three criteria: thickening of compact (C) layer, NC:C>2.3:1 and NC>20%LV. RESULTS: The study included 200 patients; 71 with LVNC (35.5%; i.e., 3.76% of CMRs) and 129 (64.5%) controls. MaxMinEDDR in patients with LVNC was significantly different from that in controls (1.17±0.08 vs. 1.06±0.04, respectively; p 1.10 had sensitivity of 91.6% [95% confidence intervals (CI) 82.5–96.8], specificity of 85.3% (95% CI 78.0–90.0), and area under curve (AUC) 0.919 (95% CI 0.872–0.953; p < 0.001) for LVNC. Existence of ICT2HI had sensitivity of 100.0% (95% CI 94.9–100.0), specificity of 91.5% (95% CI 85.3–95.7), and AUC 0.957 (95% CI 0.919–0.981; p < 0.001) for LVNC. CONCLUSION: Two additional diagnostic parameters for LVNC were identified in this study. ICT2HI and geometric eccentricity of the ventricle both had relatively high sensitivity and specificity for diagnosing LVNC.

Association Between the Circumferential Pulmonary Veins Scar and Atrial Fibrillation Recurrence in Patients Undergoing Catheter Ablation of Atrial Fibrillation / 中国循环杂志

Objectives: This study aims to analyze the relationship between late gadolinium enhancement cardiac magnetic resonance imaging (LGE-cMRI) detected scar formation of circumferential pulmonary vein and recurrence rate after catheter ablation in patients with atrial fibrillation, and to compare the efficacy of the single-step cryoballoon ablation with the point-by-point radiofrequency current ablation. Methods: A total of 56 patients with nonvalvular atrial fibrillation who underwent catheter ablation from July 2014 to December 2016 in Fujian Provincial Hospital were enrolled in this study. Among them, 27 patients underwent radiofrequency ablation (RFA), and 29 cases underwent cryoballoon ablation (CBA). Scar formation of circumferential pulmonary vein was detected by LGE-cMRI in all patients at 3 months after ablation. All patients were monitored by telephone or outpatient follow-up (patients complaint, ECG or 24-hour Holter, etc.) at 6 months post ablation. Recurrent atrial tachyarrhythmias were defined as ≥ 30 seconds AF, atrial flutter, or atrial tachycardia. Results: AF recurrence was defined in 13 (23.21%) patients. The ratio of scar formation in circumferential pulmonary vein was significantly lower in recurrence patients than that in the non-recurrent patients ([63.23±5.86]% vs [79.95±7.47]%, P<0.001). The ratio of scar formation in each pulmonary vein of 56 patients was as follows: (76.80±11.60)% in the left superior pulmonary vein, (78.90±10.64)% in the left inferior pulmonary vein, (83.35±9.44)% in the right superior pulmonary vein (P<0.05 vs the left superior pulmonary vein), which was significantly lower in the right inferior pulmonary vein (66.13±13.44)% than above veins (all P<0.05). The ratio of scar formation of all four pulmonary vein was significantly lower in recurrence patients than in the non-recurrent patients, especially in left superior pulmonary vein ([61.19±4.89]% vs [81.52±8.43]%) and the right lower pulmonary vein ([52.47±7.62] % vs [70.26±12.03]%), both P<0.001.Univariate analysis showed that the recurrence rate , the total ratio of scar formation in circumferential pulmonary vein and the ratio of scar formation in recurrence patients were similar between the CBA group and the RFA group. Conclusions: Lower circumferential pulmonary vein scar is associated with higher recurrence rate post catheter ablation in atrial fibrillation patients. The scar formation ratio is low in the right inferior pulmonary vein and the left superior pulmonary vein. The circumferential pulmonary veins scar after cryoablation and radiofrequency catheter ablation is equivalent, indicating the pulmonary vein isolation efficacy of the two procedual methods is comparable.

Difference in myocardial strain between obstructive hypertrophy cardiomyopathy and nonobstructive hypertrophy cardiomyopathy / 上海交通大学学报（医学版）

Objective · To investigate the difference in myocardial strain of left ventricle between obstructive hypertrophy cardiomyopathy (HCM) and nonobstructive HCM. Methods · Cardiac magnetic resonance imaging (MRI) exam was performed on 48 sequential enrolled patients with HCM (18 with obstructive HCM, and 30 with nonobstructive HCM), whose left ventricular ejection fractions (LVEF) were over 50%. Twenty-five healthy volunteers were examined as normal controls. Global longitudinal strain (GLS), global radial strain (GRS), global circumferentialstrain (GCS), LVEF, left ventricular end diastolic volume (LVEDV), left ventricularmass (LVM), left ventricular end diastolic volume index (LVEDVI), and left ventricular mass index (LVMI) were collected and compared. Radial strain, circumferential strain and peak radial displacement were also measured in medial segment of left ventricle according to American Heart Association (AHA) 17-segment model. Results · ① LVEF of the patients with obstructive HCM was bigger than those of nonobstructive HCM patients and control group (P<0.05). LVM and LVMI of the HCM groups were bigger than those of control group (P<0.01). ② Left ventricle GLS, GRS, and GCS significantly decreased in the patients with nonobstructive HCM compared to those with obstructive HCM (P<0.05). The three parameters of two HCM groups were significantly lower than those of healthy volunteers (P<0.05). ③ Compared with obstructive HCM patients,the segmental parameters of left ventricule, the medial segment circumferential strain and radial strain of nonobstructive HCM patients significantly decreased (P<0.05), and the two parameters of both HCM groups were lower than those in healthy volunteers. Compared with obstructive HCM patients and healthy volunteers, peak radial displacement of left ventricule medial segment in nonobstructive HCM witnessed a significant decrease, while no significant difference was observed between obstructive HCM patients and healthy volunteers. Conclusion · In the LVEF preserved HCM patients, the myocardial strain of left ventricle in nonobstructive HCM patients decrease significantly than that in obstructive HCM patients, which may result in the different clinical outcomes intwo types of HCM patients. It is suggested that the myocardial strain is more sensitive than ejection fraction in the evaluation of myocardial performance of HCM patients.

Use of Cardiac Computed Tomography for Ventricular Volumetry in Late Postoperative Patients with Tetralogy of Fallot

BACKGROUND: Cardiac computed tomography (CT) has emerged as an alternative to magnetic resonance imaging (MRI) for ventricular volumetry. However, the clinical use of cardiac CT requires external validation. METHODS: Both cardiac CT and MRI were performed prior to pulmonary valve implantation (PVI) in 11 patients (median age, 19 years) who had undergone total correction of tetralogy of Fallot during infancy. The simplified contouring method (MRI) and semiautomatic 3-dimensional region-growing method (CT) were used to measure ventricular volumes. RESULTS: All volumetric indices measured by CT and MRI generally correlated well with each other, except for the left ventricular end-systolic volume index (LV-ESVI), which showed the following correlations with the other indices: the right ventricular end-diastolic volume index (RV-EDVI) (r=0.88, p<0.001), the right ventricular end-systolic volume index (RV-ESVI) (r=0.84, p=0.001), the left ventricular end-diastolic volume index (LV-EDVI) (r=0.90, p=0.001), and the LV-ESVI (r=0.55, p=0.079). While the EDVIs measured by CT were significantly larger than those measured by MRI (median RV-EDVI: 197 mL/m² vs. 175 mL/m², p=0.008; median LV-EDVI: 94 mL/m² vs. 92 mL/m², p=0.026), no significant differences were found for the RV-ESVI or LV-ESVI. CONCLUSION: The EDVIs measured by cardiac CT were greater than those measured by MRI, whereas the ESVIs measured by CT and MRI were comparable. The volumetric characteristics of these 2 diagnostic modalities should be taken into account when indications for late PVI after tetralogy of Fallot repair are assessed.

RE: Relation of Late Gadolinium Enhancement to Increased Ventricular Wall Stress in Dilated Cardiomyopathy

No abstract available.

The Use of Cardiac Magnetic Resonance in Patients with Suspected Coronary Artery Disease: A Clinical Practice Perspective

Cardiac magnetic resonance imaging (CMR) is a useful diagnostic imaging modality in patients with known or suspected coronary artery disease (CAD). It provides unique information not available from other modalities, however, it is complex. CMR is not a single technique. Instead, it consists of multiple distinct techniques and a lack of understanding of which techniques to perform and how to interpret the findings in combination limits its efficacy and widespread use. Conversely, its multiparametric nature can provide a comprehensive assessment with the potential for higher accuracy than is achievable by other modalities. Moreover, its ability to directly assess myopathic processes often contributes insights that change patient management. In this article we provide a brief technical overview and focus on specific clinical scenarios in patients with known or suspected CAD. We highlight the multiparametric nature of CMR and discuss cases which illustrate the unique information that CMR can contribute.