The value of cardiac MRI in the risk stratification in patients with hypertrophic cardiomyopathy / 中华心血管病杂志

Objective: To explore the value of cardiac magnetic resonance imaging (CMR) in the risk stratification of hypertrophic cardiomyopathy (HCM). Methods: HCM patients who underwent CMR examination in Fuwai Hospital between March 2012 and May 2013 were retrospectively enrolled. Baseline clinical and CMR data were collected and patient follow-up was performed using telephone contact and medical record. The primary composite endpoint was sudden cardiac death (SCD) or and equivalent event. The secondary composite endpoint was all-cause death and heart transplant. Patients were divided into SCD and non-SCD groups. Cox regression was used to explore risk factors of adverse events. Receiver operating characteristic (ROC) curve analysis was used to assess the performance and the optimal cut-off of late gadolinium enhancement percentage (LGE%) for the prediction of endpoints. Kaplan-Meier and log-rank tests were used to compare survival differences between groups. Results: A total of 442 patients were enrolled. Mean age was (48.5±12.4) years and 143(32.4%) were female. At (7.6±2.5) years of follow-up, 30 (6.8%) patients met the primary endpoint including 23 SCD and 7 SCD equivalent events, and 36 (8.1%) patients met the secondary endpoint including 33 all-cause death and 3 heart transplant. In multivariate Cox regression, syncope(HR=4.531, 95%CI 2.033-10.099, P<0.001), LGE% (HR=1.075, 95%CI 1.032-1.120, P=0.001) and left ventricular ejection fraction (LVEF) (HR=0.956, 95%CI 0.923-0.991, P=0.013) were independent risk factors for primary endpoint; Age (HR=1.032, 95%CI 1.001-1.064, P=0.046), atrial fibrillation (HR=2.977, 95%CI 1.446-6.131, P=0.003),LGE% (HR=1.075, 95%CI 1.035-1.116, P<0.001) and LVEF (HR=0.968, 95%CI 0.937-1.000, P=0.047) were independent risk factors for secondary endpoint. ROC curve showed the optimal LGE% cut-offs were 5.1% and 5.8% for the prediction of primary and secondary endpoint, respectively. Patients were further divided into LGE%=0, 0<LGE%<5%, 5%≤LGE%<15% and LGE%≥15% groups. There were significant survival differences between these 4 groups whether for primary endpoint or secondary endpoint (all P<0.001) and the accumulated incidence of primary endpoint was 1.2% (2/161), 2.2% (2/89), 10.5% (16/152) and 25.0% (10/40), respectively. Conclusion: LGE is an independent risk factor for SCD events as well as all-cause death and heart transplant. LGE is of important value in the risk stratification in patients with HCM.

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.

Incidence of coronary artery disease and outcome of patients with left ventricular noncompaction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the incidence of coronary artery disease (CAD) and outcome of patients with left ventricular noncompaction (LVNC).</p><p><b>METHODS</b>Fifty-one patients with LVNC evaluated by echocardiography and/or cardiac magnetic resonance (CMR) from January 2006 to August 2010 were retrospectively reviewed. Coronary angiography or MDCT was performed for detecting coronary artery disease. Predictors of the cardiac events were analyzed by Cox regression analysis.</p><p><b>RESULTS</b>There were 31 LVNC patients without CAD and 20 LVNC patients with CAD including single vessel coronary disease in 9 cases, double vessel coronary disease in 3 cases, three vessel coronary disease in 5 cases and left main coronary disease in 3 cases. Coronary artery bypass graft and percutaneous coronary intervention (PCI) were performed in 4 patients. Compared to LVNC patients without CAD, mean age (P = 0.008), incidence of hypertension (65.0% vs. 19.4%, P = 0.001), diabetes mellitus (40.0% vs. 12.9%, P = 0.026) and hyperlipidemia (55.0% vs. 25.8%, P = 0.035) were significantly higher while NT-proBNP level was significantly lower (P = 0.049) in LVNC patients with CAD. Incidence of major cardiac events was similar in LVNC patients with or without CAD. LogNT-proBNP is the independent prognostic factor for adverse cardiac events in patients with LVNC (HR 3.993, 95%CI 1.140 - 13.988, P = 0.030).</p><p><b>CONCLUSIONS</b>Coronary artery disease is common in patients with LVNC and associated with traditional risk factors for CAD. Poor prognosis is associated with increased NT-proBNP but not with CAD in this patient cohort.</p>

Differentiation of true from false left ventricular aneurysm with magnetic resonance imaging in patients after myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the value of cardiac magnetic resonance imaging (MRI) for differentiation of true from false left ventricular aneurysm in patients after myocardial infraction (MI).</p><p><b>METHODS</b>Twenty-six patients [22 males/4 females, mean age (59.3 ± 9.3) years] with left ventricular aneurysm after MI were imaged with MRI, echocardiography and coronary angiography. The respective findings were compared with surgical pathology results.</p><p><b>RESULTS</b>There were 24 patients with dyspnea and 15 patients with hypertension. LVEF measured by echocardiography was 36.9% ± 9.1% in this patient cohort. Cardiac MRI showed that the left ventricular end diastolic wall thickness was thinner than 5.5 mm in 24 cases, and between 5.5 to 8 mm in 2 cases. The dimension of left ventricle was (67.8 ± 9.3) mm. Dyskinesia presented in 24 cases, and akinesia in 2 cases. Delayed enhancement was shown in all cases by MRI. Cardiac MRI detected left ventricular true aneurysm in 23 cases, false aneurysm in 3 case and left ventricular thrombi in 7 cases. The diagnosis by magnetic resonance imaging corresponded well to pathological findings. Echocardiography misdiagnosed pseudoaneurysm in 1 patient, and failed to detected left ventricular thrombi in 2 cases.</p><p><b>CONCLUSION</b>Cardiac MRI could correctly differentiate true from false left ventricular aneurysm in patients after MI.</p>

Clinical characteristics of fat replacement of left ventricular myocardium / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the clinical characteristics of left ventricular fat replacement.</p><p><b>METHODS</b>We identified 45 patients [28M/17F, mean age (51.9 ± 14.7) years] with left ventricular myocardial fat replacement (CT value ≤ -30 Hu) by cardiovascular CT.</p><p><b>RESULTS</b>Among 45 patients, 25 patients [20M/5F, mean age (61.2 ± 10.4) years]were diagnosed as coronary artery disease (CAD). There was 56%single-vessel disease, 20% double-vessel disease and 24%triple-vessel disease, true left ventricular aneurysm was detected in 3 patients and left ventricular thrombi in 1 patient, the dimension of left ventricle was (54.5 ± 9.4) mm and the LVEF was (51.8 ± 13)% in CAD group. In this group, fat replacement occurred in the region of myocardial infarction and presented as curvilinear band in subendocardial region. The left ventricular wall thickness was lower than 5 mm in 21 cases. The location of fat replacement in CAD group is as follows: apical region in 18 patients, distal septal in 15 patients, distal anterior in 11 patients, mid-septal in 7 patients, mid-anterior in 7 patients and basal in 1 patients. The age of remaining 20 patients (8M/12F) without CAD were (57.8 ± 13.3) years. In the group of non-CAD, dilated cardiomyopathy was diagnosed in 3 patients, atrial septal defect in 1 patient, rheumatic heart disease in 1 patient, there was no structural heart disease in the remaining 15 patients. The dimension of left ventricle was (51.1 ± 9.1) mm and the LVEF was (59.4 ± 13.9)%. In non-CAD group, fat replacement mainly occurred in septal region, presented as curvilinear band in 17 patients and patch in 3 patients. The location of fat replacement in this group is as follows: mid-septal region in 11 patients, distal-septal in 10 patients and apical in 9 patients. The intramural fat replacement was detected in 14 patients: subendocardial fat replacement in 10 patients and both intramural and subendocardial fat replacement in 4 patients.</p><p><b>CONCLUSIONS</b>Left ventricular fat replacement could be documented in CAD patients, non-CAD cardiomyopathy patients and in patients without structural heart disease. Left ventricular fat replacement often positioned in apical region in CAD patients as a consequence of infarct healing while mostly positioned in septal region in non-CAD patients, the definite clinical implication of left ventricular fat replacement in non-CAD patients remains to be clarified.</p>

Comparison of clinical and MRI features between dilated cardiomyopathy and left ventricular noncompaction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To characterize the clinical and cardiac MRI features of dilated cardiomyopathy (DCM) and left ventricular noncompaction (LVNC).</p><p><b>METHODS</b>Compared the clinical and MRI features between 25 patients with LVNC and 21 patients with DCM. The MRI derived diastolic left ventricular wall thickness and the number and degree of noncompaction (NC) were evaluated using the 17-segment model.</p><p><b>RESULTS</b>Chest distress, shortness of breath and abnormal ECG were presented in all DCM patients, abnormal ECG was evidenced in 22 LVNC patients and 21 out of 25 LVNC patients presented similar clinical symptoms as DCM patients while the rest 4 LVNC patients were asymptomatic. Left atrial and ventricular dimensions were significantly smaller in LVNC patients compared to DCM patients. The degree of left ventricular (LV) spherical remodeling was significantly greater in patients with DCM (sphericity index, SI = 0.81 +/- 0.06) than in patients with LVNC (SI = 0.74 +/- 0.11, P < 0.05). The LV ejection fraction (LVEF) was significantly higher in patients with LVNC (32.7% +/- 14.2%) than that in patients with DCM (15.0% +/- 5.1%). The number of NC segments in LVNC patients (9 +/- 1) was significantly higher than the number of hypertrabeculation segment in DCM patients (5 +/- 2). The left ventricular apex (the 17th segment) was unexceptionally involved in all LVNC patients, while hypertrabeculation was absent in the 17th segment of DCM patients. The NC was more common in the apical and mid segments (16th, 12th and 11th segments) than in basal and mid septal segments (2nd, 3rd, 8th and 9th segments) in both LVNC and DCM patients. The thickness of compacted myocardium of the segments associated with noncompaction appeared thin in two groups. The wall thickness of noncompaction myocardium segments was thicker in LVNC patients than in DCM patients. The end-diastolic NC/C ratio was, on average, higher in patients with LVNC (3.3 +/- 0.6) than in patients with DCM (1.9 +/- 0.3).</p><p><b>CONCLUSIONS</b>The clinical manifestation is similar while there are significant differences in the morphology and function of left atria and left ventricle between the LVNC and DCM patients. The different distribution and degree of NC were helpful to differentiate LVNC from DCM.</p>

Clinical characteristics and hypertrophic segments distribution of patients with hypertrophic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>to analyze the clinical data and hypertrophic segments distribution of patients with hypertrophic cardiomyopathy (HCM).</p><p><b>METHODS</b>clinical data including signs and symptoms, electrocardiogram and echocardiography were collected. All patients were imaged with cardiac magnetic resonance imaging (CMR).</p><p><b>RESULTS</b>from March 2004 to March 2007, 225 consecutive patients [163 males, mean age (50.4 ± 14.5) years] with CMR defined HCM were included in this study, positive familial history was obtained in 73 patients, 50 patients were associated with hypertension, 14 patients with coronary artery disease and 5 patients with diabetes mellitus, 28 patients were asymptomatic, 197 patients were symptomatic, and 11 patients with syncope. Electrocardiogram abnormalities occurred in 216 patients. Systolic murmurs were present in 126 patients. Echocardiography examination evidenced left ventricular outflow obstruction in 95 patients, mitral insufficiency in 32 patients, 32.1% segments were hypertrophied, asymmetrical hypertrophy presented in 222 patients and symmetrical hypertrophy in 3 patients. The left atrial dimension was (39.4 ± 8.3) mm, and left ventricular diastolic dimension was (47.8 ± 5.5) mm in this cohort. Apical hypertrophy occurred in 67 patients. The thickness of ventricular septum was (24.3 ± 5.3) mm in obstructive HCM and (21.6 ± 4.6) mm in non-obstructive HCM (P < 0.05). The thickness of hypertrophy apical segment was (15.6 ± 3.4) mm.</p><p><b>CONCLUSIONS</b>HCM in Chinese patients is characterized by the high prevalence among men and late onset of presentation. Combining clinical, electrocardiogram, echocardiographic and CMR results are of importance for correctly diagnosing HCM in daily practice.</p>

In vivo re-distribution of intra-coronary transplanted stem cells into beating and arrested hearts by magnetic resonance imaging in an acute myocardial infarction swine model / 中华心血管病杂志

<p><b>OBJECTIVE</b>To analyze the stem cell re-distribution after intra-coronary infusion (ICI) into arrested and beating hearts in a swine myocardial infarction (MI) model using magnetic resonance imaging (MRI).</p><p><b>METHODS</b>Bone marrow-derived mesenchymal stem cells were obtained from male swine and labeled with iron oxide during culture. One week after MI in female swine, the survivors were randomly divided into 4 groups. Cardiopulmonary bypass was set up to arrest the heart, and then SPIO labeled male stem cells (1 × 10(8)) were infused through coronary of beating heart (n = 6) and the arrested heart (n = 6). Saline was injected in either the beating or arresting heart as respective controls. Three days later, cell distribution was assessed by T2(*) change with magnetic resonance imaging and Y-chromosome (SRY) was detected with quantitative polymerase chain reaction.</p><p><b>RESULTS</b>The reduction of T2(*) values was significantly different in the hearts, spleens, livers and lung between the transplantation groups and the control groups. Only few transplanted cells were localized in the heart and T2(*) values were similar between beating and arrest heart groups [(-7.81 ± 2.03) ms vs. (-6.56 ± 1.72) ms, P > 0.05], while T2(*) value reduction was more significant in the spleen and liver in arrest heart group than in beating heart group [spleen: (-16.72 ± 2.83) ms vs. (-22.18 ± 3.98) ms, P < 0.01, liver: (-2.40 ± 0.44) ms vs. (-5.32 ± 3.40) ms, P < 0.05]. T2(*) value was similar in kidney among the four groups. qRT-PCR detected SRY gene was similar in the heart, less in the spleen and liver while more in the lung in beating heart group compared to arrested heart group. In vitro Prussian blue stained positively transplanted cells were found in the above organs in transplantation group.</p><p><b>CONCLUSIONS</b>The majority of stem cells transplanted by ICI would be entrapped by the extracardiac organs. Stem cell transplantation via ICI into the arrested heart does not favor more cells retention in the injured myocardium. Further investigation is needed to optimize the approach of stem cell delivery.</p>

Gelatin microspheres containing vascular endothelial growth factor enhances the efficacy of bone marrow mesenchymal stem cells transplantation in a swine model of myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the efficacy of transplantation of mesenchymal stem cells (MSC) with gelatin microspheres containing vascular endothelial growth factor in ischemic regions in infracted swine hearts.</p><p><b>METHODS</b>Twelve Chinese mini swines with infarction were randomized to receive autogenetic MSC injection to the peri-infarction area of left ventricular wall (MSC group, n = 6) or MSC transplantation with gelatin hydrogel microspheres incorporating vascular endothelial growth factor (VEGF-MSC group, n = 6). Three weeks later, left ventricular function was assessed by magnetic resonance imaging (MRI). The contrast of the MSC hypointense lesion was determined using the difference in signal intensity between the hypointense and normal myocardium divided by signal intensity of the normal region. Myocardial capillary density, the number of DAPI positive MSC and the apoptotic MSC were also determined.</p><p><b>RESULTS</b>The diameter of the microspheres averaged (104.0 +/- 22.6) microm. At 24 hours after transplantation, MSC were identified by MRI as large intramyocardial signal voids at injection sites which persisted up to 3 weeks. There was no significant difference in the contrast of the lesions and in the size of the lesions at 24 hours between two groups. At 3 weeks after injection, the size of the lesions and the contrast of the lesion were decreased (P < 0.05) in both groups. The capillary density of the injection site was significantly more in the MSC-VEGF microsphere group than that in MSC group [(15.2 +/- 5.4)/HPF vs. (10.2 +/- 5.0)/HPF, t = 2.43, P < 0.05], and there were more dense DAPI labeled MSC per high power fields in injection sites of MSC-VEGF microsphere group than that in MSC group [(354 +/- 83)/HPF vs. (278 +/- 97)/HPF, t = 3.14, P < 0.05]. Moreover, the apoptosis rate of MSCs of MSCs-VEGF microsphere group was less than that of MSC group [(6.4 +/- 4.1)% vs. (11.9 +/- 4.8)%, t = 2.97, P < 0.05].</p><p><b>CONCLUSIONS</b>MSC transplantation with gelatin hydrogel microspheres incorporating VEGF enhanced the efficacy of MSC in this swine model of myocardial infarction. MRI tracking of MSC is feasible and represents a preferred method for studying the engraftment of MSCs in infracted tissue.</p>

Assessment of therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction by magnetic resonance imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the therapeutic effects of stem cell transplantation in heart failure patients with old myocardial infarction (OMI) by MRI.</p><p><b>METHODS</b>Heart failure patients [NYHA 2.7 +/- 0.7, male = 18, mean age (59.5 +/- 10.1) y] with OMI were randomly divided into 2 groups (group A: CABG + stem cell transplantation, group B: CABG; n = 10 each). Left ventricular (LV) function was measured by MRI, viable myocardium was detected by (18)F-FDG myocardial metabolism imaging and late contrast-enhanced at baseline and 6 months post intervention.</p><p><b>RESULTS</b>LVEF and LVEDV at baseline for group A were (20.71 +/- 6.09)% and (172.73 +/- 32.74) ml, and for group B were (27.59 +/- 2.31)% and (155.13 +/- 28.36) ml, respectively (P > 0.05). The LVEF was equally improved in group A and B (mean 8.63% vs. 10.37%, P > 0.05) while DeltaLVEDV was significant higher in group A than that in group B [(9.91 +/- 39.50) ml vs. (-22.34 +/- 31.35) ml, P < 0.05]. Ventricular wall thickening ratio at 6 months post intervention was significantly higher in group A than that in group B [(11.40 +/- 11.53)% vs. (2.27 +/- 7.20)%, P < 0.05]. Late contrast-enhanced MRI results correlated with (18)F-FDG myocardial metabolism imaging SPECT well in assessment of myocardial viability (kappa value: 0.446, P < 0.001; sensitivity: 68.3% and specificity: 92.5%).</p><p><b>CONCLUSIONS</b>Stem cell therapy on top of CABG aggravated LV remodeling in heart failure patients with old myocardial infarction. The specificity of MRI is similar to (18)F-FDG SPECT while the sensitivity is inferior to (18)F-FDG SPECT on detecting viable myocardium.</p>

Effects of Tongxinluo-facilitated cellular cardiomyoplasty with autologous bone marrow-mesenchymal stem cells on postinfarct swine hearts / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Treatment of ischemic heart disease remains an important challenge, though there have been enormous progresses in cardiovascular therapeutics. This study was conducted to evaluate whether Tongxinluo (TXL) treatment around the transplantation of mesenchymal stem cells (MSCs) can improve survival and subsequent activities of implanted cells in swine hearts with acute myocardial infarction (AMI) and reperfusion.</p><p><b>METHODS</b>Twenty-eight Chinese mini-pigs were divided into four groups including a control group (n = 7); group 2, administration of low-dose TXL alone from the 3rd day prior to AMI to the 4th day post transplantation (n = 7); group 3, MSCs alone (n = 7) and group 4, TXL + MSCs (n = 7). AMI models were made by occlusion of the left anterior descending coronary artery for 90 minutes. Autologous bone marrow-MSCs (3 x 10(7) cells/animal) were then injected into the post-infarct myocardium immediately after AMI and reperfusion. The survival and differentiation of implanted cells in vivo were detected by immunofluorescent analysis. The data of cardiac function were obtained at baseline (1 week after transplantation) and endpoint (6 weeks after transplantation) by single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Apoptosis was detected by TUNEL assay and the oxidative stress level was investigated in the post-infarct myocardium at endpoint.</p><p><b>RESULTS</b>At endpoint, there was less fibrosis and inflammatory cell infiltration with more surviving myocardium in group 4 than in the control group. In group 4 the survival and differentiation of implanted MSCs were significantly improved more than that seen in group 3 alone (P < 0.0001); the capillary density was also significantly greater than in the control group, group 2 or 3 both in the infarcted zone (P < 0.0001) and the peri-infarct zone (P < 0.0001). MRI showed that parameters at baseline were not significantly different between the 4 groups. At endpoint, regional wall thickening and the left ventricular ejection fraction were increased while the left ventricular mass index, dyskinetic segments and infarcted size were decreased only in group 4 compared with control group (P < 0.0001). SPECT showed that the area of perfusion defect was significantly decreased at endpoint only in group 4 compared with control group (P < 0.0001). TUNEL assay indicated that TXL administration significantly decreased cell apoptosis in peri-infarct myocardium in groups 2 and 4. Furthermore, superoxide dismutase (SOD) significantly increased and malondialdehyde (MDA) decreased in groups 2 and 4 by the administration of TXL.</p><p><b>CONCLUSIONS</b>Our study demonstrates the following: (1) immediate intramyocardial injection of MSCs after AMI and reperfusion resulted in limited survival and differentiation potential of implanted cells in vivo, thus being incapable of beneficially affecting post-hearts; (2) TXL-facilitation resulted in a significant survival and differentiation potential of implanted cells in vivo via inhibition of apoptosis and oxidative stress, accompanied by significant benefits in cardiac function.</p>

Identification of viable myocardium delayed enhancement magnetic resonance imaging and 99Tcm-sestamibi or 18F-fluorodeoxyglucose single photon emission computed tomography / 中华心血管病杂志

<p><b>OBJECTIVE</b>The aim of this study was to investigate the feasibility and accuracy of delayed enhancement magnetic resonance imaging (DE-MRI) for the assessment of myocardial viability in patients with myocardial infarction in comparison with (99)Tc(m)-sestamibi (MIBI) single photon emission computed tomography (SPECT) and (18)F-fluorodeoxyglucose (FDG) SPECT. Scar was defined as regionally increased MRI signal intensity 15 minutes after injection of 0.2 mmol/kg gadolinium-diethylenetriamine pentaacetic acid or reduced perfusion and glucose metabolism defined by SPECT.</p><p><b>METHODS</b>A total of 34 patients with myocardial infarction (29 males, 58.0 +/- 9.8 years) were imaged with MRI and SPECT.</p><p><b>RESULTS</b>A total of 578 segments were analyzed. DE-MRI and SPECT identified 431 and 336 viable segments respectively and SPECT also identified 30 ischemic segments. Necrotic segments identified by DE-MRI and SPECT were 147 and 212 respectively. Sensitivity and specificity of DE-MRI in identifying segments with matched flow/metabolism defects (scar tissues) was 61.3% and 95.4%, respectively. Quantitatively assessed relative MRI infarct area correlated well with SPECT infarct size. The value of Kappa was 0.51.</p><p><b>CONCLUSION</b>DE-MRI provides a good tool for differentiating viable myocardium from scar tissues and the detection accuracy is comparable between DE-MRI and SPECT.</p>

Diagnostic value of magnetic resonance imaging for arrhythmogenic right ventricular cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the diagnostic value of magnetic resonance imaging (MRI) for arrhythmogenic right ventricular cardiomyopathy (ARVC).</p><p><b>METHODS</b>MRI was performed in 27 (male 21, mean age: 37.4 y, ranging from 15 - 67 y) clinically diagnosed ARVC patients according to the 1994 ARVC diagnosis criteria of WHO from Oct. 2004 to Jun. 2006. Heart chamber size, fat infiltration, local or global ventricular function, myocardium perfusion of contrast first pass and late enhancement were examined.</p><p><b>RESULTS</b>Fat infiltration was found in 24 (88.89%), trabecular disarray in 17 (62.96%), significant dilated right ventricle outlet (RVOT) in 18 (66.67%), dilated RV apex in 14 (51.85%), dilated RV free wall and posterior wall in 18 (66.67%) and right atrium enlargement in 11 (40.74%) patients. Local RV dysfunction was found in 18.52% (5/27), global RV dysfunction in 70.37% (19/27) of patients with mean RV ejection fraction (EF) of 35%. Left ventricle was affected in 40.74% (11/27) of patients. Perfusion defects were found in only 10.52% (2/19) of patients. Positive late enhancement of myocardium were found in 36.84% (7/19) of patients and affecting mainly the wall of RVOT and the free wall associated with lateral wall enhancement of LV. Five patients received heart transplantation and histology on transplanted hearts confirmed the MRI findings.</p><p><b>CONCLUSION</b>"One-stop-shop" MRI scanning can be used for the diagnosis of ARVC. While for some ARVC cases with dominant abnormality in LV, it is difficult for MRI to differentiate ARVC from dilated cardiomyopathy or coronary heart disease. We found fibrosis of lateral wall of LV can be a characteristic sign of ARVC.</p>

Clinical characterizations of patients with isolated left ventricular noncompaction diagnosed by magnetic resonance imaging / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the clinical and magnetic resonance imaging (MRI) characterizations in patients with isolated left ventricular noncompaction (LVNC).</p><p><b>METHODS</b>All patients were examined by MRI. The LV was divided into 9 segments for localizing non compacted segments. A new value, C/VS, was introduced to assess the degree of non compacted segments.</p><p><b>RESULTS</b>A total of 31 patients was diagnosed as LVNC (23 males; 39.9 +/- 15.7 years). Palpitations presented in 74% of patients, abnormal EKG found in 93.5% of patients, 33.3% segments were affected and most commonly in the mid-ventricular and apical segments, 84% of patients had > or = 2 affected segments. Right ventricle was affected in 2 patients. Left ventricular thrombi were detected in 3 patients. LVEF was 37.2% +/- 16.5% (14% - 70%), N/C was 3.6 +/- 1.4 (2.2 - 9.2) and C/VS was 0.43 +/- 0.11 (0.27 - 0.69).</p><p><b>CONCLUSIONS</b>Cardiac MRI allows accurate LVNC assessment.</p>

Arrhythmogenic right ventricular cardiomyopathy with left ventricular involvement:histopathology and MRI features / 中华放射学杂志

Objective The aim of the present investigation was to confirm histopathology and MR features of arrhythmogenic right ventricular cardiomyopathy(ARVC),particularly with the left ventricular involvement.Methods Nine patients(4 male,5 female;13 to 54 years old,mean age 40.44?15.99), with a pathologic diagnosis of ARVC at heart transplantation,were included,of which 7 patients were scanned for MR imaging before transplantation.Results Severe dilation of right ventricular(RV)cavity and left ventricular one(LV)were observed in 7 and 8 hearts,respectively.All hearts showed severe and transmural RV muscle loss,where RV wall was almost completely filled with either fatty tissue(3 cases)or fibrofatty tissue(6 cases).LV involvement was diagnosed histologically in all cases.Both the septum and the LV free wall were affected in 2 cases;7 cases disclosed selective free wall involvement.LV fatty or fibrofatty substitution was predominantly located in the subepicardial and mediomural wall layers in 5 hearts. a diffuse interstitial fibrosis with patchy infiltration was noted in the other 4 hearts.7 patients underwent MR scanning.MR scanning demonstrated global RV severe dilation and thinning in 5 cases,of which linear fatty infiltration was found in 3 cases.RV presented wall thickness preservation and normal cavity in the remaining 2 cases,in which left involvement existed.LV was dilated in all cases(mildly in 3,moderately in 2,severely in 2).The LV ejection fraction was(21.66?7.05)%,and subepicardial fatty infiltration was found in 2 patients,selectively involving posterolateral wall.4 patients showed the LV wall thinning diffusely in free wall,and the other 3 mainly involved septum,apex and posterolateral wall,respectively.All 5 patients with delayed enhancement showed varying degrees of hyperenhancement,mainly involving the posterolateral wall(transmural in 2 and epicardial in 2),septum(mediomural in 2)and apex in 2(focal or transmural).Additionally,transmural hyperenhancement was also found in the RV wall,involving free wall in 2,RV apex in 1 and posterior wall in 1 case,respectively.Conclusions ARVC with reference to left ventricular involvement had severe cardiomegaly and heart failure.MRI can partially reveal tissue characteristics,including fatty infiltration and fibrosis,as well as morphologic features.

Sress cardiomyopathy:clinical features and imaging findings / 中华放射学杂志

Objective One typical case with stress cardiomyopathy was reported and the current knowledge of the syndrome was reviewed to improve relevant knowledge.Methods A 71-year-old female patient presented dyspnea and chest pain due to emotional stress.ECG,echocardiography,selective coronary artery angiography,left ventriculography,~(99)Tc~m-MIBI single photon emission computed tomography (SPECT),~(18)F-FDG SPECT and MRI were performed.Results Electrocardiogram at admission showed ST segment elevation and T wave inversion in leads V1—V4.Pathological Q wave occurred 1 week later,it disappeared 1 month later however and severe T wave inversion occurred.Normal or slightly elevated cardiac enzymes in the blood were found during the course.Left ventriculogram at admission showed left ventricular apical ballooning with LVEF of 30%.The ballooning volume was about 3/4 of left ventricular volume, without any corresponding coronary artery diseases found in coronary angiogram.The abnormal apical ballooning decreased significantly in the follow-up left ventriculogram performed one month later.The LVEF rose up to 63.6%.~(99)Tc~m-MIBI and ~(18)F-FDG SPECT showed mismatch of perfusion and metabolism in the corresponding region,indicating presence of viable myocardium.MRI showed left ventricular apical ballooning without perfusion defect and late enhancement,indicating viability of corresponding myocardium. Conclusions Emotional stress can cause transient left ventricular apical ballooning called"stress cardiomyopathy".Either ~(99)Tc~m-MIBI SPECT associated with ~(18)F-FDG SPECT or delayed enhancement MRI plays an important role in identification of myocardial viability,which can efficiently guide clinical treatment.

Cardiac functional analysis with time-adaptive sensitivity encoding technique:comparison with generalized autocalibrating partially parallel acquisitions technique / 中华放射学杂志

0.05).Conclusion Compared with multi-breath hold GRAPPA technique,single breath hold TSENSE technique is a fast,accurate and reproducible method and can be an substitute for GRAPPA to evaluate ventricular function.