ABSTRACT
Use of cardiac magnetic resonance (CMR) to aid in diagnosis, management, and prognosis of ischemic and nonischemic cardiomyopathy has advanced tremendously in the past several decades. These advances have expanded our understanding of both ischemic and nonischemic cardiomyopathies while also allowing for new avenues of diagnosis and treatment. This review summarizes key concepts of CMR technology and CMR use in the diagnosis and prognosis in ischemic, infiltrative, inflammatory, and other nonischemic cardiomyopathies and discusses the use of CMR in the patient presenting with ventricular arrhythmia with unclear diagnosis and advances in CMR in the management cardiomyopathy.
Subject(s)
Contrast Media/pharmacology , Heart Failure/diagnosis , Magnetic Resonance Imaging, Cine/methods , Magnetic Resonance Spectroscopy/methods , Humans , PrognosisSubject(s)
Anticoagulants/therapeutic use , Pulmonary Embolism/drug therapy , Adult , Aged , Anticoagulants/adverse effects , Female , Hemorrhage/chemically induced , Humans , Male , Middle Aged , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/mortality , Recurrence , Retrospective Studies , Risk Factors , Tertiary Care Centers , Time Factors , Treatment OutcomeABSTRACT
Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy, which usually presents early in life but may also manifest into adulthood. We present the case of an elderly woman with left ventricular non-compaction cardiomyopathy, which was discovered incidentally following an ST-elevation myocardial infarction.
Subject(s)
Aspirin/administration & dosage , Cardiomyopathy, Hypertrophic, Familial , ST Elevation Myocardial Infarction , Thrombosis , Ticlopidine/analogs & derivatives , Warfarin/administration & dosage , Aged , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Cardiomyopathy, Hypertrophic, Familial/complications , Cardiomyopathy, Hypertrophic, Familial/diagnosis , Clopidogrel , Coronary Angiography/methods , Drug-Eluting Stents , Echocardiography, Doppler, Color/methods , Electrocardiography/methods , Female , Hematologic Agents/administration & dosage , Humans , Incidental Findings , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Thrombosis/etiology , Ticlopidine/administration & dosage , Treatment OutcomeABSTRACT
BACKGROUND: At the onset of acute hypoxic respiratory failure, critically ill patients with acute lung injury (ALI) may be difficult to distinguish from those with cardiogenic pulmonary edema (CPE). No single clinical parameter provides satisfying prediction. We hypothesized that a combination of those will facilitate early differential diagnosis. METHODS: In a population-based retrospective development cohort, validated electronic surveillance identified critically ill adult patients with acute pulmonary edema. Recursive partitioning and logistic regression were used to develop a decision support tool based on routine clinical information to differentiate ALI from CPE. Performance of the score was validated in an independent cohort of referral patients. Blinded post hoc expert review served as gold standard. RESULTS: Of 332 patients in a development cohort, expert reviewers (κ, 0.86) classified 156 as having ALI and 176 as having CPE. The validation cohort had 161 patients (ALI = 113, CPE = 48). The score was based on risk factors for ALI and CPE, age, alcohol abuse, chemotherapy, and peripheral oxygen saturation/Fio(2) ratio. It demonstrated good discrimination (area under curve [AUC] = 0.81; 95% CI, 0.77-0.86) and calibration (Hosmer-Lemeshow [HL] P = .16). Similar performance was obtained in the validation cohort (AUC = 0.80; 95% CI, 0.72-0.88; HL P = .13). CONCLUSIONS: A simple decision support tool accurately classifies acute pulmonary edema, reserving advanced testing for a subset of patients in whom satisfying prediction cannot be made. This novel tool may facilitate early inclusion of patients with ALI and CPE into research studies as well as improve and rationalize clinical management and resource use.
