Relationship between late gadolinium enhancement extent in cardiac magnetic resonance imaging and severity of coronary artery disease in old myocardial infarction

Purpose: to assess the relationship between the severity of coronary arteries involvement and the extent and pattern of myocardial scars in Cardiac Magnetic Resonance of patients with history of remote myocardial infarction

Materials and Methods: the Cardiac Magnetic Resonance images of sixty patients with history of remote ST segment or non-ST segment elevation myocardial infarction were reviewed. The patients were candidates for selective coronary angiography and referred for Cardiac Magnetic Resonance imaging in order to evaluate the myocardial viability

Results: the age of patients with history of old myocardial infarction [n = 60], among whom 78.3% were male, averaged 61.2 [SD = 11.5]. There was no association between the severity of coronary artery stenosis in each territory and the presence of myocardial scar detected by late Gadolinium enhancement of Cardiac Magnetic Resonance [for all three vessel territories P = .05]. However, there was a significant association between the coronary artery runoff and the presence of late Gadolinium enhancement in Cardiac Magnetic Resonance [P value for left anterior descending coronary artery [LAD], left circumflex [LCX] and right coronary artery [RCA] was = .002, = .001 and = .001, respectively]. A significant relationship was found between the pattern of scar in terms of being transmural or non-transmural and the severity of coronary artery stenosis [P = .001], while the pattern of scar was not associated with the coronary artery runoff [P = .2]

Conclusion: the results of this study support the hypothesis contending that the time window for revascularization will increase in the presence of antegrade coronary flow in the jeopardized myocardium, which causes a limitation in the infarct progression and subsequent lesser extent of myocardial scar

Echocardiographic assessment of adults with repaired tetralogy of fallot: a cardiovascular magnetic resonance comparison study

Surgical management of the tetralogy of Fallot [TOP] results in anatomic and functional abnormalities in the majority of patients. Right ventricular [RV] dilation from pulmonary regurgitation [PR], residual atrial and/or ventricular septal defect, tricuspid regurgitation, right ventricular outflow tract [RVOT] aneurysm, and pulmonary artery peripheral stenosis are some of the abnormalities frequently encountered in patients with repaired TOP. Cardiovascular magnetic resonance [CMR] can provide assessments of anatomical connections, biventricular function, flow measurement, and more, without ionizing radiation. Echocardiography is the most frequently used modality for the initial assessment and follow-up of most patients with CHD. We sought to evaluate adult patients with repaired TOP by transthoracic echocardiography and compare them with CMR. 156 patients [52 women, mean age= 23 +/- 5.5 years] late after TOP repair with severe PR were evaluated. Ventricular size and function and TOP -associated anomalies such as patent ductus arteriosus [PDA], peripheral pulmonary stenosis [PPS], and persistent left superior vena cava [LSVC] were evaluated by transthoracic echocardiography and CMR separately. Mean of LV ejection fraction by CMR was 52 +/- 9% and by echocardiography was 47 +/- 5.1%. We found a significant correlation between LVEF assessed by CMR and 2D visual assessment in multiple views. Mean of RVEF by CMR was 37 +/- 8% and RV end diastolic volume index was 161 +/- 57.3 mm[3]. Linear correlation between CMR-RVEF and RVEF measured by echocardiography was weak. There was almost perfect agreement between CMR and echocardiography for the diagnosis of LSVC [99.2%]. Agreement was 88.3% in the diagnosis of PDA, 66.4% in the diagnosis of PPS, and 93% in the diagnosis of the right aortic arch was. Adults late after repaired TOF have significantly reduced biventricular systolic function. Despite abnormal LV geometry, visual assessment of LV systolic function by an expert echocardiologist has an acceptable agreement compared to the quantitative measurement of LV systolic function by CMR. However, the correlation between CMR-RVEF and RVEF measured by echocardiography is weak. We found incremental diagnostic value of CMR in PPS and PDA. Atrial septal defect and ventricular septal defect are found more frequently by echocardiography

Cardiac MRI in a patient with coincident left ventricular non-compaction and hypertrophic cardiomyopathy

Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy that affects both children and adults. Since the clinical manifestations are not sufficient to establish diagnosis, echocardiography is the diagnostic tool that makes it possible to document ventricular non-compaction and establish prognostic factors. We report a 47-year-old woman with a history of dilated cardiomyopathy with unknown etiology. Echocardiography showed mild left ventricular enlargement with severe systolic dysfunction [EF = 20-25%]. According to cardiac magnetic resonance imaging findings non-compaction left ventricle with hypertrophic cardiomyopathy was considered, and right ventricular septal biopsy was recommended. Right ventricular endomyocardial biopsy showed moderate hypertrophy of cardiac myocytes with foci of myocytolysis and moderate interstitial fibrosis. No evidence of infiltrative deposition was seen