Structural assessment of myocardial infarction scars and left ventricular function with cardiac magnetic resonance imaging in patients at high risk of sudden cardiac death.

OBJECTIVES: Results of qualitative and quantitative analyses of scars and LV (left ventricle) function acquired by means of cardiac magnetic resonance (CMR) were correlated with a subsequent occurrence of malignant ventricular arrhythmias in patients at high risk of sudden cardiac death (SCD). METHODS: We have prospectively followed 47 patients (mean age 60 ± 11 years) who were hospitalized for an implantable cardioverter-defibrillator (ICD) implantation to prevent SCD. All post-MI patients had severe residual LV dysfunction (LVEF 33±14%). Patients were examined with CMR. Based on CMR analysis, we evaluated the basic functional parameters of LV as well as mass, volume, transmurality and heterogeneity of the post-MI scar. RESULTS: The patients with malignant arrhythmias were characterized by smaller LV end-diastolic diameters (LVED 192 ± 79 vs 254 ± 47 mm, p = 0.003) and end-systolic diameters (LVES 131 ± 80 vs 181 ± 45 mm, p = 0.01). As for the other observed functional and morphological CMR parameters, no significant differences between the two groups were detected. CONCLUSION: These results indicate that post-MI patients with severe residual left ventricular dysfunction and dilatation are in the long term characterized by a lower incidence of malignant arrhythmias compared to the patients with less dilated LV with a comparably severe LV dysfunction (Tab. 2, Fig. 3, Ref. 26). Text in PDF www.elis.sk.

The first experience with the high-resolution multi-slice CT-angiography in pediatric cardiology in Slovakia.

OBJECTIVES: The high-resolution multi-slice computed tomography angiography (HRMS-CTA) is a new imaging method characterized by a precise isotropic imaging of any cardiovascular system structure. The purpose of this study was to review the first experience with the high-resolution multi-slice HRMS-CTA in pediatric patients with congenital heart defects as well as with acquired cardiac diseases in the Slovak Republic. METHODS: We retrospectively reviewed benefits of HRMS-CTA and its influence on the subsequent choice of the most appropriate management in 20 patients with pulmonary atresia with ventricular septal defect and multiple aortopulmonary collaterals (PA, VSD, MAPCAs) and in 15 patients with different diagnoses with expected benefit from HRMS-CTA in terms of an exact delineation of extra-cardiac vascular structures. RESULTS: The delineation of the examined extra-cardiac structures was very detailed and clear in all 35 patients. All findings definitely contributed to the choice of the most appropriate management not only in PA, VSD, MAPCAs patients (20), but also in 15 patients with different diagnoses. CONCLUSIONS: HRMS-CTA is a new complementary imaging method with the potential to replace invasive catheterization procedures in large number of patients who need extra-cardiac vascular structure imaging (Fig. 1, Ref. 18). Full Text (Free, PDF) www.bmj.sk.