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 optimal timing for magnetic resonance imaging in long-term follow-up of patients after a complete correction of the Tetralogy of Fallot.

OBJECTIVES: Long-term pulmonary regurgitation (PR) leads to right ventricular (RV) dilatation and dysfunction. In patients after a complete correction of the tetralogy of Fallot (TOF) it represents the most frequent and high risk late complication. Magnetic resonance imaging (MRI) is an objective possibility for RV measurements; on the other hand MRI is complicated and not always accessible method. BACKGROUND: We analyzed echocardiography (ECHO) and MRI parameters regarding RV dilatation and function and the correlation between these two methods with the aim to define optimal ECHO parameters indicating a necessity for further investigations. PATIENTS AND METHODS: In 50 patients with TOF > 10 years, after a complete surgical correction, ECHO and MRI were performed. RESULTS: ECHO finding of end-diastolic diameter (EDD) of RV > 30mm was detected in 13 patients (26%) and in 30 patients (60%) RV EDD above 4 standard deviations (SD) their normal values was present. MRI finding of end-diastolic volume (EDV) > 160 ml/m2 was present in 14 patients (28%) and end-systolic volume (ESV) > 85 ml/m2 in 17 patients (34%). Significant correlations between ECHO and MRI RV diastolic measurements were found (p=0.0001, r=0.34, resp. p=0.001, r=0.39). PR was significantly affecting diastolic RV dilatation (p=0.0001), on the other hand. RV dysfunction resulted in systolic RV dilatation (p=0.007). PR did not correlate with RV function (p=0.56). CONCLUSIONS: MRI is a golden standard for exact RV measurements and for the indication of pulmonary valve replacement, but ECHO still can be used during long-term follow-up, defining the point for further and more exact RV measurements (Tab. 2, Fig. 11, Ref. 17). Full Text in free PDF www.bmj.sk.

The use of nuclear magnetic resonance in cardiology--a comparison of Slovak Republic and the world.

Since beginning, NMR examination is fully established in experimental work and common clinical praxis. Its extensive use in cardiology is determined by non-invasive character and relatively short examination time. After solving predominately economical problems, NMR examination will rapidly develop even in Slovak Republic (Tab. 2, Fig. 2, Ref. 29).