Patrón de flujo en "4D Flow" y su vínculo con la aortopatía bicúspide / 4D Flow pattern and its role in bicuspid aortic valve aortopathy

ABSTRACT: Bicuspid aortic valve (BAV) disease is generally associated with thoracic aortic dilatation (TAD). Related factors include; genetical, morphological (valvular phenotype) and most recently, hemodynamic profiles associated with flow pattern and wall shear stress. Cardiac magnetic resonance 4D Flow (4DF) can give an integral evaluation of these later flow variables. Remarkable, different spectrums of flow and vortex direction exist in BAV that are related to the site of TAD (proximal or distal). Therefore, we present a 57 years old patient with BAV (Sievers 0) with anteroposterior leaflets distribution in which 4DF depicted an anteriorly and righthand oriented jet that correlated with the zone of grater AD; also, vortex rotation was counterclockwise, corresponding to the most frequent vortex type in BAV. In conclusion, 4DF is a powerful and ground-breaking tool that enhances our knowledge of BAV related aortopathy.

Comparison of acquisition time and dose for late gadolinium enhancement imaging at 3.0 T in patients with chronic myocardial infarction using Gd-BOPTA.

OBJECTIVES: To compare contrast doses and acquisition times for late gadolinium enhancement (LGE) imaging at 3.0 T using gadobenate dimeglumine (Gd-BOPTA) in patients with chronic myocardial infarction. METHODS: Thirty-four patients with chronic myocardial infarction were randomised to 0.10, 0.15 and 0.20 mmol/kg of Gd-BOPTA. T1-weighted inversion recovery gradient echo sequences were performed at 5, 10, 15 and 20 min post-administration of contrast in a 3.0-T scanner. Scar-to-myocardium contrast-to-noise ratio (CNR), scar-to-blood CNR, scar size and image quality were assessed. RESULTS: Imaging at 5 min was associated with a lower scar-to-blood CNR in comparison to 10, 15 and 20 min at 0.10 mmol/kg, and in comparison to 15 and 20 min at 0.20 mmol/kg. At 0.10-mmol/kg, imaging at 5 min yielded smaller infarct sizes in comparison to 15 and 20 min. Finally, at 0.20-mmol/kg, imaging at 5 min was associated with poorer image quality in comparison to later times. CONCLUSIONS: In LGE imaging at 3.0 T, low doses of Gd-BOPTA perform equally well as higher doses. Early acquisition (5 min) is associated with lower infarct sizes and image quality. Studies with sufficient diagnostic quality can be obtained after 10 min using 0.10 mmol/kg Gd-BOPTA. KEY POINTS: Good performance of low Gd-BOPTA doses for LGE imaging at 3.0 T. Imaging at 5 min yields lower contrast, infarct sizes and image quality. Diagnostic quality can be obtained after 10 min using 0.10-mmol/kg Gd-BOPTA.

Septal flash predicts cardiac resynchronization therapy response in patients with permanent atrial fibrillation.

AIMS: Patients with heart failure (HF) as well as atrial fibrillation (AF) have suboptimal response to cardiac resynchronization therapy (CRT). Identification of mechanical abnormalities, amenable to correction with CRT, might improve the selection of candidates and CRT efficiency. We evaluated whether abnormal septal motion, assessed by the presence of septal flash (SF) is related to CRT response in patients with AF. METHODS AND RESULTS: Ninety-four CRT patients with AF were included. Echocardiography was performed in all subjects at baseline and at 12-month follow-up. Abnormal septal motion was defined by the presence of SF (early septal inward/outward motion within the isovolumic contraction period/QRS duration). Response to CRT was defined as a reduction (>15%) of the end-systolic volume of the left ventricle (LV). Univariate and multivariate analyses were performed to identify the predictors of CRT response. The mean age was 69 ± 8 years, 79% were males, and 59% of patients responded to CRT. Cardiovascular death was 14.4% and all-cause mortality was 16.5% during follow-up. Patients with SF at baseline that was acutely corrected by CRT were significantly more likely to respond than patients without SF. Baseline SF was an independent predictor of CRT response (OR 5.24; 95% CI 1.95-14.11). CONCLUSION: Abnormal septal motion, assessed by the presence of SF, is a mechanism amenable to CRT correction. Its correction is associated with a higher likelihood of CRT response in HF patients with long-standing AF. This could improve the selection of candidates to CRT in a subgroup with particularly poor response and long-term prognosis.