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

Late gadolinium enhancement distribution pattern of left ventricular wall in patients with dilated cardiomyopathy: a preliminary study / 中华心血管病杂志

Objective: To investigate the distribution pattern of late gadolinium enhancement (LGE) in left ventricular free wall of patients with dilated cardiomyopathy (DCM). Methods: A total of 130 consecutive DCM patients who were hospitalized in our hospital, underwent both CMR and CTA examinations and met the inclusion and exclusion criteria including negative results of coronary angiography or coronary CTA, were retrospective included in this study. The LGE pattern, extent and distribution in left ventricular free wall were analyzed. Results: Left ventricular free wall LGE was detected in 56 out of 130 DCM patients. LGE was observed in both septal and free wall in 53 out of 56 patients with LGE (94.6%). Prevalence of NYHA classification Ⅲ/Ⅳ, intraventricular block, paroxysmal ventricular tachycardia, and secondary mitral insufficiency was significantly higher, while left ventricular ejection fraction was significantly lower, left ventricular end-diastolic/systolic volume, left ventricular end-diastolic/systolic volume index and left ventricular end-diastolic diameters values were larger in patients with LGE than without LGE (all P<0.05). In terms LGE pattern among these 56 patients, percent of involved myocardial segments in patients with subepicardial LGE (n=19) was significantly higher than patients with intermural LGE (n=30), patients with transmural LGE (n=21), and patients with subendocardial LGE (n=9)(60.8%(127/209) vs. 32.4%(107/330), 32.5%(75/231), 26.3%(26/99), respectively, all P < 0.01). Transmural LGE was most likely to involve the left ventricular inferior lateral basal (18/21) and mid (13/21) segment, followed by anterior lateral basal (15/21) and mid (11/21) segments and inferior mid segment (9/21). Subepicardial LGE was more likely to occur in the inferior lateral basal (13/19) and mid (16/19) segment, anterior lateral basal (13/19) and mid (15/19) segment, anterior lateral basal (13/19) and mid (15/19) segment, lateral apical (13/19), anterior and inferior mid segment (12/19 and 10/19), and apical segment (15/19 and 10/19). Intermural LGE mostly involved the anterior and inferior basal (19/30, 16/30) and mid (18/30 and 14/30) segment. There were 33 cases of single LGE pattern and 23 cases of multiple LGE pattern. Percent of involved myocardial segments was significantly higher in multiple LGE group than single LGE group (60.9% (154/253) vs. 49.9%(181/363), P = 0.007). Of 130 patients, 23 received heart transplantation, of which 6 patients had septal LGE alone and 17 patients had septal and free wall LGE. The rate of heart transplantation in the latter group was higher (32.1% (17/53)vs. 13.6%(6/44), P=0.034). Conclusions: There are several LGE distribution patterns in left ventricular wall among DCM patients.

Role of Myocardial Extracellular Volume Fraction Measured with Magnetic Resonance Imaging in the Prediction of Left Ventricular Functional Outcome after Revascularization of Chronic Total Occlusion of Coronary Arteries

OBJECTIVE: The purpose of this study was to prospectively investigate the value of the myocardial extracellular volume fraction (ECV) in predicting myocardial functional outcome after revascularization of coronary chronic total occlusion (CTO). MATERIALS AND METHODS: Thirty patients with CTO underwent cardiovascular magnetic resonance (CMR) before and 6 months after revascularization. Three baseline markers of functional outcome were evaluated in the dysfunctional segments assigned to the CTO vessels: ECV, transmural extent of infarction (TEI), and unenhanced rim thickness (RIM). At the global level, the ECV values of the whole myocardium with and without a hyperenhanced region (global and remote ECV) were respectively measured. RESULTS: In per-segment analysis, ECV was superior to TEI and RIM in predicting functional recovery (area under receiver operating characteristic curve [AUC]: 0.86 vs. 0.75 and 0.73, all p values < 0.010), and it emerged as the only independent predictor of regional functional outcome (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.77–0.89; p < 0.001) independent of collateral circulation. In per-patient analysis, global baseline ECV was indicative of ejection fraction (EF) at the follow-up examination (β = −0.61, p < 0.001) and changes in EF (β = −0.57, p = 0.001) in multivariate regression analysis. A patient with global baseline ECV less than 30.0% (AUC, 0.93; sensitivity 94%, specificity 80%) was more likely to demonstrate significant EF improvement (OR: 0.38; 95% CI: 0.17–0.85; p = 0.019). CONCLUSION: Extracellular volume fraction obtained by CMR may provide incremental value for the prediction of functional recovery both at the segmental and global levels in CTO patients, and may facilitate the identification of patients who can benefit from revascularization.

Late gadolinium enhancement and T1 mapping for the diagnosis of cardiac amyloidosis / 中华危重病急救医学

Objective@#To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis.@*Methods@#Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed.@*Results@#The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1 497.3±22.0 vs. 1 273.3±30.1, 1 329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1 484.8±6.5 vs. 1 497.3±22.0, P = 0.11).@*Conclusions@#One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

Late gadolinium enhancement and T1 mapping for the diagnosis of cardiac amyloidosis / 中华危重病急救医学

Objective To explore the role of late gadolinium enhancement (LGE) and T1 mapping for detection of cardiac amyloidosis. Methods Nine cases of cardiac amyloidosis who had diagnosed by renal biopsy diagnosed type light-chain (AL) amyloidosis and acute heart failure suspected involvement of the heart in Tianjin First Central Hospital from May 2018 to March 2019 were enrolled, and at the same time 14 cases of non-obstructive hypertrophic cardiomyopathy patients, 12 cases of healthy physical examination at the same period were enrolled as the control. All patients underwent Philips 3.0-T including plain scan as cine, T2WI, native T1 mapping and enhanced scan as perfusion, LGE imaging, post T1 mapping. For LGE cardiac magnetic resonance imaging (CMRI), a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minutes delay, ECG-gated images were acquired in 3 long-axis and a stack of short-axis slices identical to those of cine images using a breath-hold gradient recalled echo phase-sensitive or magnitude only inversion recovery sequence. LGE and T1 mapping CMRI observation, including cardiac function index [left ventricle end-diastolic volume (LVEDV), left ventricle end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological index [including left ventricular wall thickness, left ventricular weight (LVM)], myocardial histological characteristics and markers N-terminal pro-brain natriuretic peptide (NT-proBNP) and accompanying signs (including pericardial effusion, pleural effusion) were performed. Results The predominant LGE pattern in amyloidosis was diffuse left ventricular sub endocardial enhancement (3/9), diffuse in left ventricular wall enhancement (3/9), and transmural delayed enhancement in left ventricular (2/9) and non-typical delayed enhancement (1/9). Myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 1497.3±22.0 vs. 1273.3±30.1, 1329.3±42.6, both P < 0.05). Myocardial T1 was increased in AL amyloid before LGE. A post-contrast myocardial T1 was significantly elevated in cardiac AL amyloidosis patients compared to normal subjects and hypertrophic cardiomyopathy (ms: 476.7±44.2 vs. 516.1±41.5, 569.9±12.3, both P > 0.05). Three of 9 amyloidosis patients with review images showing T1 value and cardiac function was no significantly different with the first check (ms: 1484.8±6.5 vs. 1497.3±22.0, P = 0.11). Conclusions One-stop CMRI can improve the diagnosis of cardiac amyloidosis, LGE can display the myocardial scarring and fibrosis, and T1 mapping is sensitive to myocardial edema and diffuse fibrosis. LGE and T1 mapping can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

Single-Dose Gadoterate Meglumine for 3T Late Gadolinium Enhancement MRI for the Assessment of Chronic Myocardial Infarction: Intra-Individual Comparison with Conventional Double-Dose 1.5T MRI

OBJECTIVE: To intra-individually compare 3T magnetic resonance (MR) images obtained with one dose gadoterate meglumine to 1.5T MR using conventional double dose for assessment of chronic myocardial infarction. MATERIALS AND METHODS: Sixteen patients diagnosed with chronic myocardial infarctions were examined on single-dose 3T MR within two weeks after undergoing double-dose 1.5T MR. Representative short-axis images were acquired at three points after administration of gadoterate meglumine. Contrast-to-noise ratios between infarcted and normal myocardium (CNRinfarct-normal) and between infarct and left ventricular cavity (CNRinfarct-LVC) were calculated and compared intra-individually at each temporal scan. Additionally, two independent readers assessed relative infarct size semi-automatically and inter-observer reproducibility was evaluated using intraclass correlation coefficient. RESULTS: While higher CNRinfarct-normal was revealed at single-dose 3T at only 10 minutes scan (p = 0.047), the CNRinfarct-LVC was higher at single-dose 3T MR at each temporal scan (all, p 0.05). However, inter-observer reproducibility was higher at single-dose 3T MR (all, p < 0.05). CONCLUSION: Single-dose 3T MR is as effective as double-dose 1.5T MR for delineation of infarcted myocardium while being superior in detection of infarcted myocardium from the blood cavity, and provides better reproducibility for infarct size quantification.

Value of cardiovascular MR tissue-tracking imaging in the quantitative evaluation of myocardial strain after myocardial infarction / 中华放射学杂志

Objective@#To investigate the application value of cardiovascular magnetic resonance tissue-tracking (CMR-TT) in the quantitative assessment of global and segmental myocardial strain after myocardial infarction.@*Methods@#From June 2013 to June 2017, 45 patients with chronic myocardial infarction from the Second Affiliated Hospital of Nanchang University and eighteen normal volunteers as a control group were included in our research. All participants received CMR examination on a 3.0 T MRI scanner. Imaging protocol including FIESTA cine sequence (left ventricle short-axis planes, four chamber and two chamber long-axis planes) and late gadolinium enhancement (LGE). CMR-TT was undertaken using cvi 42 dedicated commercial software, global peak systolic circumferential, longitudinal, radial strains (GPCS, GPLS, GPRS) and segmental peak systolic circumferential, longitudinal, radial strains (PCS, PLS, PRS) in accordance with the American Heart Association's sixteen segment model were all derived. All segments were divided into five groups according to transmural extent expressed as enhanced area per segment: 0% as non-LGE segments group, 1 %-25 % as mild LGE segments group, 26%-50 % as moderate LGE segments group, 51%-75% as severe LGE segments group and >75% as complete LGE segments group. Two-independent samples t-test and Kruskal-Wallis H test were used, respectively, to compare means of 2 and 3 or more groups of continuous variables. Variables with normal distribution were presented as ±s, non-normal variables were reported as median (interquartile range).@*Results@#Patients showed significant lower GPRS, GPCS and GPLS than the control group (15.13%±8.18%, -8.25%±3.23%, -7.11%±2.41% versus 32.41%±12.99%, -14.92%±3.32%, -11.50%±2.51%). PRS, PCS and PLS statistically significantly decreased with increasing extent of myocardial enhancement (t=-6.35,7.33,6.44, P<0.001).Segmental peak systolic strains of five groups were:PRS:24.87% (10.95%,39.02%), 13.26%(5.94%,24.24)%, 9.47%(4.01%,18.40%), 5.98%(-3.74%,11.86%), -2.65%(-6.62%,8.59%), respectively; PCS: -11.84%±5.34%, -8.60%±5.48%, -7.32%±5.59%, -5.30%±5.52%, -2.74%±5.24%, respectively; PLS: -9.47%±6.82%, -7.72%±6.22%, -7.07%±6.49%, -5.55%±5.95%, -3.54%±5.44%, respectively. The differences in the groups were statistically significant (H=164.47,166.61, 59.06, P<0.001). GPRS was positively correlated with LVEF(r=0.543, P<0.001), while GPCS and GPLS were both negatively associated with LVEF (r=-0.654, P<0.001; r=-0.682, P<0.001, respectively).@*Conclusions@#CMR-TT can quantitatively assess the severity of myocardial infarction accurately and reliably.Strain parameters have a good correlation with cardiac function indexes, this may be helpful in the recognition of left ventricular remodel after MI.

Predictors of late gadolinium enhancement in hypertrophic cardiomyopathy by electrocardiogram and echocardiography / 中华超声影像学杂志

Objective To explore the predictive value of routine echocardiographic and electrocardiographic parameters in late gadolinium enhancement ( LGE ) in hypertrophic cardiomyopathy ( HCM ) . Methods The study population consisted of a consecutive series of 95 HCM patients .According to the presence of LGE on cardiac magnetic resonance (CMR) ,these patients were divided into two groups :HCM patients with LGE ( n = 71) and HCM patients without LGE ( n = 24) . The parameters of routine echocardiography and electrocardiography were compared between the two groups . ROC and Logistic analysis were made to find the predictors of LGE . Results ① As compared to those without LGE ,HCM patients with LGE had higher prevalence of chest pain ( P = 0 .027) ,β-blocker treatment ( P = 0 .024) , increased maximal left ventricular wall thickness ( MLVWT ) ( P < 0 .0001 ) ,non-sustained ventricular tachycardia ( P = 0 .034) ,prolonged the rate-corrected cardiac QT interval ( QTc) ( P = 0 .011) ,T-wave inversion ( TWI) ( P = 0 .009) ,but reduced early diastolic mitral annular velocity ( e′) ( P = 0 .001) . ②Univariate predictors of LGE on CMR were :increased MLVWT ,reduced e′ ,prolonged QTc and more TWI . Only MLVWT ( OR = 1 .23 ,95％ CI = 1 .05 - 1 .44 , P = 0 .013) and e′( OR = 1 .23 ,95％ CI = 0 .52 - 0 .96 , P =0 .028) remained independent after multivariable analysis . Furthermore ,the ROC analysis showed that these two parameters had discriminative ability to identify those with LGE . To be specific ,HCM patients with MLVWT ≥ 21 .5 mm or e′ ≤ 5 .55 cm /s were more likely to present with LGE . ③ The leads number of TWI was positively correlated with percentage of LGE in left ventricular mass ( LGE ％ ) ( r = 0 .220 , P =0 .044) ,but there was no correlation between location of TWI on ECG and territory of LGE on CMR . Conclusions In HCM patients ,MLVWT and e′ are independent predictors of LGE on CMR . Furthermore , although the leads number of TWI is correlated with LGE ％ ,no correlation has been found between location of TWI on ECG and territory of LGE on CMR .

Comparison of Apical and Asymmetric Septal Phenotype in Patients With Hypertrophic Cardiomyopathy: Clinical Features and Prognosis / 中国循环杂志

Objectives: To compare the clinical features and long-term outcomes of patients with apical hypertrophic cardiomyopathy (ApHCM) and patients with asymmetric septal hypertrophic cardiomyopathy (ASHCM). Methods: Data from 600 patients (300 with ApHCM and 300 with ASHCM) identified in a consecutive single-center cohort between 1996 and 2014 were retrospectively analyzed. The two groups were 1:1 matched by age of diagnosis, gender and the presence of outflow tract obstruction. Clinical features, cardiovascular mortalities, incidence of sudden cardiac death and cardiovascular morbidity (including unexplained syncope, atrial fibrillation, nonsustained ventricular tachycardia, progressive heart failure, embolic stroke or transient ischemic attack and myocardial infarction) were compared between the two groups. Results: Forty-two patients (14.0%) had a maximum LV wall thickness of ≥30 mm in the ASHCM group compared to only 11 patients (3.7%) in the ApHCM group (P<0.01). 156 patients in ApHCM group (52.0%)and 168 patients in ASHCM group(56.0%)underwent cardiovascular NMR examination, the incidence of late gadolinium enhancement was significantly lower in ApHCM group than in ASHCM group(26.9% vs 76.2%,P<0.01). The mean follow-up durations for ApHCM and ASHCM were (7.5 ± 4.0) years and (6.6 ± 5.4) years, respectively. The incidence of cardiovascular death (1.0% vs 5.7%), sudden cardiac death (0.33% vs 3.3%) and major adverse cardiovascular event (18.3% vs 40.3%) were significantly lower in the ApHCM group than in the ASHCM group (all P<0.01). Unexplained syncope, nonsustained ventricular tachycardia, and progressive heart failure were less common in ApHCM group than in ASHCM group (all P<0.05). Multivariate COX regression analysis showed that late gadolinium enhancement positivity (HR=4.62, 95% CI: 2.28- 68.0, P=0.02) and unexplained syncope (HR=8.56, 95% CI: 2.1-16.6, P<0.01) were independent predictors of cardiovascular mortality. Unexplained syncope was independent predictor for sudden cardiac death (HR=4.40, 95% CI: 1.5-15.2, P=0.02). Conclusions: After eliminating the interference of age at diagnosis, gender and outflow tract obstruction, patients with ApHCM represent a more benign prognosis with a lower incidence of cardiovascular mortality and morbidity than patients with ASHCM.

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.

Self-Gated Late Gadolinium Enhancement at 7T to Image Rats with Reperfused Acute Myocardial Infarction

OBJECTIVE: A failed electrocardiography (ECG)-trigger often leads to a long acquisition time (TA) and deterioration in image quality. The purpose of this study was to evaluate and optimize the technique of self-gated (SG) cardiovascular magnetic resonance (CMR) for cardiac late gadolinium enhancement (LGE) imaging of rats with myocardial infarction/reperfusion. MATERIALS AND METHODS: Cardiovascular magnetic resonance images of 10 rats were obtained using SG-LGE or ECG with respiration double-gating (ECG-RESP-gating) method at 7T to compare differences in image interference and TA between the two methods. A variety of flip angles (FA: 10°–80°) and the number of repetitions (NR: 40, 80, 150, and 300) were investigated to determine optimal scan parameters of SG-LGE technique based on image quality score and contrast-to-noise ratio (CNR). RESULTS: Self-gated late gadolinium enhancement allowed successful scan in 10 (100%) rats. However, only 4 (40%) rats were successfully scanned with the ECG-RESP-gating method. TAs with SG-LGE varied depending on NR used (TA: 41, 82, 154, and 307 seconds, corresponding to NR of 40, 80, 150, and 300, respectively). For the ECG-RESP-gating method, the average TA was 220 seconds. For SG-LGE images, CNR (42.5 ± 5.5, 43.5 ± 7.5, 54 ± 9, 59.5 ± 8.5, 56 ± 13, 54 ± 8, and 41 ± 9) and image quality score (1.85 ± 0.75, 2.20 ± 0.83, 2.85 ± 0.37, 3.85 ± 0.52, 2.8 ± 0.51, 2.45 ± 0.76, and 1.95 ± 0.60) were achieved with different FAs (10°, 15°, 20°, 25°, 30°, 35°, and 40°, respectively). Optimal FAs of 20°–30° and NR of 80 were recommended. CONCLUSION: Self-gated technique can improve image quality of LGE without irregular ECG or respiration gating. Therefore, SG-LGE can be used an alternative method of ECG-RESP-gating.

Cardiac Magnetic Resonance Predictor of Ventricular Function after Surgical Coronary Revascularization

We evaluated echocardiographic changes of left ventricular (LV) function in coronary artery bypass grafting (CABG) patients with LV dysfunction, and examined cardiac magnetic resonance (CMR) parameters associated with improved LV function. Seventy-seven CABG patients presenting with decreased LV ejection fraction (LVEF, ≤ 35%) and who underwent preoperative gadolinium-enhanced CMR were enrolled. A 16-segment model was used to analyze CMR imaging. A viable myocardial segment was defined as ≤ 50% transmural extent of late gadolinium enhancement. Serial echocardiographic examinations were performed preoperatively, pre-discharge (median 6 days), and during postoperative year 1 (median 11 months) in 70 patients. Predictors of absolute increase in LVEF (≥ 5%) and proportional changes in LVEF were analyzed. Serial echocardiography demonstrated that LVEF measured 28.6% ± 5.4% preoperatively, 31.5% ± 8.0% median 6 days, and 42.1% ± 10.5% median 11 months postoperatively. Absolute increase of LVEF was observed in 27 patients at pre-discharge and in 24 patients by median 11 months. Proportional changes in LVEF at postoperative median 6 days and 11 months were 14% ± 28% and 57% ± 45%, respectively. The median number of viable myocardial segments was 14 (range, 9–16) in the 16 segment CMR model. Multivariable models demonstrated that the median number of overall viable myocardial segments (≥ 14) in preoperative CMR was associated with absolute increase (P = 0.046) and proportional changes (P = 0.005) in LVEF. In conclusion, the number of viable myocardial segments (≥ 14) in preoperative CMR predicted LV function improvement after CABG in patients with LV dysfunction.

Detection of Perivalvular Abscess with Late Gadolinium-Enhanced MR Imaging in a Patient with Infective Endocarditis

We report a case of perivalvular abscess in a 66-year-old man with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. No clinical features suspicious of infective endocarditis were noted, however, transthoracic echocardiography revealed non-specific echogenic focal wall thickening at mitral-aortic intervalvular fibrosa. Perivalvular abscess in the aortic valve was demonstrated as focal wall thickening between the anterior mitral leaflet and the non-coronary cusp of the aortic valve with peripheral enhancement and central low signal intensity on LGE CMR imaging. Other features suggestive of infective endocarditis, such as neither vegetation nor valvular perforation were present. The perivalvular abscess did not grow after intensive intravenous antibiotics therapy, and the patient was discharged without surgical treatment. CMR with LGE provided an early accurate diagnosis of perivalvular abscess. The diagnosis of perivalvular abscess using LGE CMR imaging was not previously reported in Korea.

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

No abstract available.

Diagnosis of Right Ventricular Vegetation on Late Gadolinium-Enhanced MR Imaging in a Pediatric Patient after Repair of a Ventricular Septal Defect

We report a case of vegetation in a 4-year-old female with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. The patient had a history of primary closure for ventricular septal defect and presented with mild febrile sensation. No remarkable clinical symptoms or laboratory findings were noted; however, transthoracic echocardiography demonstrated a 14 mm highly mobile homogeneous mass in the right ventricle. On LGE CMR imaging, the mass showed marginal rim enhancement, which suggested the diagnosis of vegetation rather than thrombus. The extracellular volume fraction (≥ 42%) of the lesion was higher than that of normal myocardium. Based on the patient's clinical history of congenital heart disease and pathologic confirmation of the lesion, a diagnosis of infective endocarditis with vegetation was made.

Late Gadolinium Enhancement in Cardiac MRI in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Systolic Function Is Related to Attenuated Improvement of Left Ventricular Geometry and Filling Pressure after Aortic Valve Replacement

BACKGROUND AND OBJECTIVES: We investigated echocardiographic predictors: left ventricular (LV) geometric changes following aortic valve replacement (AVR) according to the late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with severe aortic stenosis (AS) and preserved LV systolic function. SUBJECTS AND METHODS: We analyzed 41 patients (24 males, 63.1+/-8.7 years) with preserved LV systolic function who were scheduled to undergo AVR for severe AS. All patients were examined with transthoracic echocardiography (TTE), CMR before and after AVR (in the hospital) and serial TTEs (at 6 and 12 months) were repeated. RESULTS: The group with LGE (LGE+) showed greater wall thickness (septum, 14.3+/-2.6 mm vs. 11.5+/-2.0 mm, p=0.001, posterior; 14.3+/-2.5 mm vs. 11.4+/-1.6 mm, p<0.001), lower tissue Doppler image (TDIS', 4.4+/-1.4 cm/s vs. 5.5+/-1.2 cm/s, p=0.021; TDI E', 3.2+/-0.9 cm/s vs. 4.8+/-1.4 cm/s, p=0.002), and greater E/e' (21.8+/-10.3 vs. 15.4+/-6.3, p=0.066) than those without LGE (LGE-). Multivariate analysis show that TDI e' (odds ratio=0.078, 95% confidence interval=0.007-0.888, p=0.040) was an independent determinant of LGE+. In an analysis of the 6- and 12-month follow-up compared with pre-AVR, LGE- showed decreased LV end-diastolic diameter (48.3+/-5.0 mm vs. 45.8+/-3.6 mm, p=0.027; 48.3+/-5.0 mm vs. 46.5+/-3.4 mm, p=0.019). Moreover, E/e' (at 12 months) showed further improved LV filling pressure (16.0+/-6.6 vs. 12.3+/-4.3, p=0.001) compared with pre-AVR. However, LGE+ showed no significant improvement. CONCLUSION: The absence of LGE is associated with favorable improvements in LV geometry and filling pressure. TDI E' is an independent determinant of LGE in patients with severe AS and preserved LV systolic function.