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Bolen MA, Popovic ZB, Rajiah P, Gabriel RS, Zurick AO, Lieber ML, Flamm SD. Cardiac MR Assessment of Aortic Regurgitation: Holodiastolic Flow Reversal in the Descending Aorta Helps Stratify Severity. Radiology 2011; 260:98-104. [DOI: 10.1148/radiol.11102064] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Devendra GP, Hart SA, Kim YY, Setser RM, Flamm SD, Krasuski RA. Modified INOvent for delivery of inhaled nitric oxide during cardiac MRI. Magn Reson Imaging 2011; 29:1145-9. [PMID: 21705165 DOI: 10.1016/j.mri.2011.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The aim of this study was to assess the feasibility of delivering NO through a modified system to allow clearance of the magnetic field and thus compatibility with cardiac magnetic resonance (CMR). Nitric oxide (NO) is an inhalational, selective pulmonary vasodilator with a wide range of applications in a variety of disease states, including diseases that affect the right ventricle. Accurate assessment of dynamic changes in right ventricular function necessitates CMR; however, delivery of NO is only possible using equipment that is not magnetic resonance imaging (MRI) compatible (INOvent delivery system, Ohmeda, Inc., Madison, WI, USA). METHODS The INOvent delivery system was modified by using 35 ft. of standard oxygen tubing to allow NO delivery through an electrical conduit and into the MRI suite. The concentrations of oxygen (O(2)), nitrogen dioxide (a harmful byproduct, NO(2)) and NO were measured in triplicate using the built-in electrochemical analyzer on the INOvent. After confirmation of safety, the system was used to administer drug to a patient x, and dynamic MRI measurements were performed. RESULTS When the standard INOvent was set to administer 40 ppm of NO, the mean/standard deviation of gas delivered was as follows: NO: 42/0 ppm; NO(2): 0.3/0.1 ppm; and O(2): 93/0 ppm. In comparison, the gas delivery of the modified INOvent was follows: NO: 41/0 ppm; NO(2): 0.5/0 ppm; and O(2): 93.7/0.6 ppm. During administration to an index patient with severe pulmonic insufficiency (PI), a measurable reduction in PI was observed by CMR. CONCLUSIONS Nitric oxide can be administered through 35 ft. of standard oxygen tubing without significantly affecting dose delivery. This technique has potential application in patients with right-sided structural heart disease for determination of dynamic physiological changes.
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Renapurkar RD, Setser RM, O'Donnell TP, Egger J, Lieber ML, Desai MY, Stillman AE, Schoenhagen P, Flamm SD. Aortic volume as an indicator of disease progression in patients with untreated infrarenal abdominal aneurysm. Eur J Radiol 2011; 81:e87-93. [PMID: 21316893 DOI: 10.1016/j.ejrad.2011.01.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 01/07/2011] [Accepted: 01/17/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The maximal diameter of an abdominal aortic aneurysm (AAA) and the change in diameter over time reflect rupture risk and are used for surgical planning. However, evidence has emerged that aneurysm volume may be a better indicator of AAA remodeling. The purpose of this study was to assess the relationship between the volume and maximal diameter of the abdominal aorta in patients with untreated infrarenal AAA. MATERIALS AND METHODS This was a retrospective study of 100 patients with infrarenal AAA who were followed for more than 6 months. We examined 2 sets of computed tomography images for each patient, acquired ≥ 6 months apart. The maximal diameter and volume of the infrarenal abdominal aorta were determined by semiautomated segmentation software. RESULTS At baseline, mean maximal infrarenal diameter was 5.1 ± 1.0 cm and mean aortic volume was 139 ± 72 mL. There was good correlation between the maximal diameter and aortic volume at baseline (r(2) = 0.55; P<0.001). The mean change in maximal diameter between studies was 0.2 ± 0.3 cm and the mean volume change was 19 ± 19 mL. However, the correlation between diameter change and volume change was modest (r(2) = 0.34; P=0.001). Most patients (n = 64) had no measurable change in maximal diameter between studies (≤ 2 mm), but the change in volume was found to vary widely (-2 to 69 mL). CONCLUSION In patients with untreated infrarenal AAA, a change in aortic volume can occur in the absence of a significant change in maximal diameter. Additional work is needed to examine the relationship between change in AAA volume and outcomes in this patient group.
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Kurra V, Lieber ML, Sola S, Kalahasti V, Hammer D, Gimple S, Flamm SD, Bolen MA, Halliburton SS, Mihaljevic T, Desai MY, Schoenhagen P. Extent of thoracic aortic atheroma burden and long-term mortality after cardiothoracic surgery: a computed tomography study. JACC Cardiovasc Imaging 2011; 3:1020-9. [PMID: 20947047 DOI: 10.1016/j.jcmg.2010.08.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 08/03/2010] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery. BACKGROUND In patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown. METHODS We reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up. RESULTS A total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03). CONCLUSIONS Extent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs.
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Flamm SD, Cheong BY. Image Fusion: Is It Merely the Blending of Pretty Pictures? JACC Cardiovasc Imaging 2010; 3:931-3. [DOI: 10.1016/j.jcmg.2010.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 05/27/2010] [Indexed: 10/19/2022]
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Austin BA, Popovic ZB, Kwon DH, Thamilarasan M, Boonyasirinant T, Flamm SD, Lever HM, Desai MY. Aortic stiffness independently predicts exercise capacity in hypertrophic cardiomyopathy: a multimodality imaging study. Heart 2010; 96:1303-10. [PMID: 20659950 DOI: 10.1136/hrt.2009.191478] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55:2614-62. [PMID: 20513610 PMCID: PMC3042771 DOI: 10.1016/j.jacc.2009.11.011] [Citation(s) in RCA: 440] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG, Ho VB, Jerosch-Herold M, Kramer CM, Manning WJ, Patel M, Pohost GM, Stillman AE, White RD, Woodard PK. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation 2010; 121:2462-508. [PMID: 20479157 PMCID: PMC3034132 DOI: 10.1161/cir.0b013e3181d44a8f] [Citation(s) in RCA: 226] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Muthupillai R, Douglas E, Huber S, Lambert B, Pereyra M, Wilson GJ, Flamm SD. Direct comparison of sensitivity encoding (SENSE) accelerated and conventional 3D contrast enhanced magnetic resonance angiography (CE-MRA) of renal arteries: effect of increasing spatial resolution. J Magn Reson Imaging 2010; 31:149-59. [PMID: 20027583 DOI: 10.1002/jmri.22002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To assess the effect of attaining higher spatial resolution in contrast-enhanced magnetic resonance angiography (MRA) of renal arteries using parallel imaging, sensitivity encoding (SENSE), by comparing the SENSE contrast-enhanced (CE) MRA against a conventional CE-MRA protocol with identical scan times, injection protocol, and other acquisition parameters. MATERIALS AND METHODS Numerical simulations and a direct comparison of SENSE-accelerated versus conventional acquisitions were performed. A total of 41 patients (18 male) were imaged using both protocols for a direct comparison. Both protocols used fluoroscopic triggering, centric encoding, breath-holding, equivalent injection protocol, and lasted approximately 30 seconds. RESULTS Simulated point-spread functions were narrower for the SENSE protocol compared to the conventional protocol. In the patient study, although the SENSE protocol produced images with lower signal-to-noise ratio (SNR), image quality was better for all segments of the renal arteries. In addition, ringing of kidney parenchyma and renal artery blurring were significantly reduced in the SENSE protocol. Finally, reader confidence improved with the SENSE protocol. CONCLUSION Despite a reduction in SNR, the higher-resolution SENSE CE-MRA provided improved image quality, reduced artifacts, and increased reader confidence compared to the conventional protocol.
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Kwon D, Popovic ZB, Menon V, Halley CM, Brennan DM, Starling RC, Flamm SD, Schoenhagen P, Lytle BW, Griffin BP, Desai MY, Desai MY. DEGREE OF MITRAL REGURGITATION AND LEFT VENTRICULAR SCARRING ARE MUCH BETTER PREDICTORS OF LONG-TERM OUTCOMES COMPARED TO VOLUMES AND SPHERICITY: A MULTI-MODALITY IMAGING STUDY IN PATIENTS WITH SEVERE ISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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To A, Gabriel RS, Popovic ZB, Renapurkar R, Bolen M, Flamm SD, Griffin BP, Desai MY. IMPACT OF DISEASE ETIOLOGY ON AORTIC STIFFNESS DETERMINED BY CARDIOVASCULAR MAGNETIC RESONANCE: A COHORT STUDY OF PATIENTS WITH AORTIC PATHOLOGY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)60777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Boonyasirinant T, Rajiah P, Setser RM, Lieber ML, Lever HM, Desai MY, Flamm SD. Reply. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2009.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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113
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Setser RM, Kotys M, Bolen MA, Muthupillai R, Flamm SD. High resolution imaging of the right ventricle using ZOOM MRI. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-m8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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114
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Kwon DH, Halley CM, Popovic ZB, Carrigan TP, Zysek V, Setser R, Schoenhagen P, Flamm SD, Starling RC, Desai MY. Gender differences in survival in patients with severe left ventricular dysfunction despite similar extent of myocardial scar measured on cardiac magnetic resonance. Eur J Heart Fail 2010; 11:937-44. [PMID: 19789396 DOI: 10.1093/eurjhf/hfp118] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS We sought to determine the association between myocardial scarring, gender, and survival in patients with significant coronary artery disease (CAD) and severe systolic left ventricular (LV) dysfunction using delayed hyper-enhancement cardiac magnetic resonance imaging (DHE-CMR). METHODS AND RESULTS We studied 339 patients (24% women, mean age 65 +/- 11 years) referred for assessment of myocardial viability by DHE-CMR. Scar was defined as myocardium with an intensity >2 SD above viable myocardium. Left ventricular scar (defined as a percentage of total LV myocardium), LV volumes, risk factors, cardiac transplantation (CTx), and all-cause mortality were recorded. There were 84 deaths and five CTx over 3.7 +/- 1.6 years (median 4 years, interquartile range 2.6-4.9 years). Left ventricular ejection fraction (LVEF) in men was only slightly different from women (23% +/- 9 vs. 25% +/- 10, P = 0.05), whereas mean scar % was similar in both groups (32 +/- 21 vs. 29 +/- 20, P = 0.3). On univariable survival analysis, age [hazard ratio, HR, 1.03 (1.01-1.05), P = 0.002], female gender [HR 2.02 (1.31-3.12), P = 0.001], and scar % [HR 1.01 (1.003-1.02), P = 0.009] predicted outcomes; and also on multivariable analysis (chi(2) 32, P < 0.0001). Women with scar % greater than the median had more events, compared with men with or without a high scar burden (log-rank P < 0.001). CONCLUSION In patients with CAD and severely reduced LVEF, women have worse outcomes than men, irrespective of myocardial scar burden.
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Kwon D, Popovic ZB, Menon V, Halley CM, Brennan D, Starling RC, Flamm SD, Schoenhagen P, Lytle BW, Griffin BP, Desai MY. Degree of mitral regurgitation and left ventricular scarring are more powerful predictors of long-term outcomes than volumes and sphericity: a multi-modality imaging study in patients with severe ischemic cardiomyopathy. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-o37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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116
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Rajiah P, Setser R, Flamm SD. Correlation among aortic stiffness, LV scar volume and diastolic dysfunction in hypertrophic cardiomyopathy: a cardiac MRI study. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-m4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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117
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Austin BA, Popovic ZB, Kwon DH, Thamilarasan M, Boonyasirinant T, Flamm SD, Lever HM, Desai MY. Exercise capacity predictors in hypertrophic obstructive cardiomyopathy patients assessed by multi-modality imaging. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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118
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Austin BA, Tang WW, Rodriguez ER, Tan C, Flamm SD, Taylor DO, Starling RC, Desai MY. Delayed Hyper-Enhancement Magnetic Resonance Imaging Provides Incremental Diagnostic and Prognostic Utility in Suspected Cardiac Amyloidosis. JACC Cardiovasc Imaging 2009; 2:1369-77. [DOI: 10.1016/j.jcmg.2009.08.008] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 07/29/2009] [Accepted: 08/10/2009] [Indexed: 12/21/2022]
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Cheong BYC, Muthupillai R, Wilson JM, Sung A, Huber S, Amin S, Elayda MA, Lee VV, Flamm SD. Prognostic significance of delayed-enhancement magnetic resonance imaging: survival of 857 patients with and without left ventricular dysfunction. Circulation 2009; 120:2069-76. [PMID: 19901193 DOI: 10.1161/circulationaha.109.852517] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular ejection fraction is a powerful independent predictor of survival in cardiac patients, especially those with coronary artery disease. Delayed-enhancement magnetic resonance imaging (DE-MRI) can accurately identify irreversible myocardial injury with high spatial and contrast resolution. To date, relatively limited data are available on the prognostic value of DE-MRI, so we sought to determine whether DE-MRI findings independently predict survival. METHODS AND RESULTS The medical records of 857 consecutive patients who had complete cine and DE-MRI evaluation at a tertiary care center were reviewed regardless of whether the patients had coronary artery disease. The presence and extent of myocardial scar were evaluated qualitatively by a single experienced observer. The primary, composite end point was all-cause mortality or cardiac transplantation. Survival data were obtained from the Social Security Death Index. The median follow-up was 4.4 years; 252 patients (29%) reached one of the end points. Independent predictors of mortality or transplantation included congestive heart failure, ejection fraction, and age (P<0.0001 for each), as well as scar index (hazard ratio, 1.26; 95% confidence interval, 1.02 to 1.55; P=0.033). Similarly, in subsets of patients with or without coronary artery disease, scar index also independently predicted mortality or transplantation (hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.68; P=0.018; and hazard ratio, 5.65; 95% confidence interval, 1.74 to 18.3; P=0.004, respectively). Cox regression analysis showed worse outcome in patients with any DE in addition to depressed left ventricular ejection fraction (<50%). CONCLUSIONS The degree of DE detected by DE-MRI appears to strongly predict all-cause mortality or cardiac transplantation after adjustment for traditional, well-known prognosticators.
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Abstract
Cardiovascular MRI can assess multiple markers of myocardial viability in a single examination. Its accuracy is at least equivalent to, if not superior to, that of other currently available noninvasive imaging techniques, including positron emission tomography. The greater spatial resolution afforded by cardiovascular MRI, especially with the delayed-enhancement MRI (DE-MRI) technique, combined with the breadth and depth of correlative pathologic data, makes cardiovascular MRI a particularly powerful tool for detecting viable and irreversibly damaged myocardium. A wealth of clinical data exist, including data from multicenter efforts, to establish DE-MRI as a new gold standard in myocardial viability assessment. As the high accuracy and broad scope of DE-MRI are recognized, the technique will gain wider clinical use for analysis of dysfunctional myocardium and be integrated into the diagnostic and therapeutic algorithm.
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121
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Boonyasirinant T, Setser RM, Desai MY, Flamm SD. Impact of Myocardial Fibrosis on Systolic Strain and Diastolic Performance Quantified by Myocardial Tagging and Velocity Encoded MRI in Patients with Hypertrophic Cardiomyopathy. J Card Fail 2009. [DOI: 10.1016/j.cardfail.2009.06.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kalahasti V, Roselli EE, Flamm SD, Krasuski RA. Aneurysmal ascending to descending aorta bypass graft compressing the pulmonary artery. Interact Cardiovasc Thorac Surg 2009; 9:730-2. [PMID: 19633026 DOI: 10.1510/icvts.2009.205179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We describe the first case of aneurysmal degeneration of ascending to descending aortic bypass graft with compression of main pulmonary artery in a young patient who had prior history of interrupted aortic arch. We also outline the value of multimodality imaging in the surgical management of this condition.
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Desai MY, Flamm SD. End of the road for delayed hyperenhancement cardiac magnetic resonance? JACC Cardiovasc Imaging 2009; 2:421-3. [PMID: 19580723 DOI: 10.1016/j.jcmg.2009.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Accepted: 02/05/2009] [Indexed: 10/20/2022]
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Kwon DH, Halley CM, Carrigan TP, Zysek V, Popovic ZB, Setser R, Schoenhagen P, Starling RC, Flamm SD, Desai MY. Extent of left ventricular scar predicts outcomes in ischemic cardiomyopathy patients with significantly reduced systolic function: a delayed hyperenhancement cardiac magnetic resonance study. JACC Cardiovasc Imaging 2009; 2:34-44. [PMID: 19356530 DOI: 10.1016/j.jcmg.2008.09.010] [Citation(s) in RCA: 221] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2008] [Revised: 08/29/2008] [Accepted: 09/09/2008] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective of the study was to determine whether the extent of left ventricular scar, measured with delayed hyperenhancement cardiac magnetic resonance (DHE-CMR), predicts survival in patients with ischemic cardiomyopathy (ICM) and severely reduced left ventricular ejection fraction (LVEF). BACKGROUND Patients with ICM and reduced LVEF have poor survival. Such patients have a high myocardial scar burden. CMR is highly accurate in delineation of myocardial scar. METHODS We studied 349 patients (76% men) with severe ICM (>or=70% disease in >or=1 epicardial coronary, and mean LVEF of 24%) that underwent DHE-CMR (Siemens 1.5-T scanner, Erlangen, Germany), between 2003 and 2006. Scar (quantified as percentage of myocardium) was defined on DHE-MR images as an intensity >2 standard deviations above the viable myocardium. Transmurality score was semiquantitatively recorded in a 17-segment model as: 0 = no scar, 1 = 1% to 25% scar, 2 = 26% to 50%, 3 = 51% to 75%, and 4 = >75%. The LVEF, demographic data, risk factors, need for cardiac transplantation (CTx), and all-cause mortality were recorded. RESULTS The mean age and follow-up were 65 +/- 11 years and 2.6 +/- 1.2 years (median 2.4 years [1.1, 3.5]), respectively. There were 56 events (51 deaths and 5 CTx). Mean scar percentage and transmurality score were higher in patients with events versus those without (39 +/- 22 vs. 30 +/- 20, p = 0.003, and 9.7 +/- 5 vs. 7.8 +/- 5, p = 0.004). On Cox proportional hazard survival analysis, quantified scar was greater than the median (30% of total myocardium), and female gender predicted events (relative risk 1.75 [95% Confidence Interval: 1.02 to 3.03] and relative risk 1.83 [95% Confidence Interval: 1.06 to 3.16], respectively, both p = 0.03). CONCLUSIONS In patients with ICM and severely reduced LVEF, a greater extent of myocardial scar, delineated by DHE-CMR is associated with increased mortality or the need for cardiac transplantation, potentially aiding further risk-stratification.
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Cheong BYC, Muthupillai R, Nemeth M, Lambert B, Dees D, Huber S, Castriotta R, Flamm SD. The utility of delayed-enhancement magnetic resonance imaging for identifying nonischemic myocardial fibrosis in asymptomatic patients with biopsy-proven systemic sarcoidosis. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2009; 26:39-46. [PMID: 19960787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The pathophysiology of sarcoidosis includes infiltrative inflammatory injury, as well as interstitial fibrosis formation. Delayed-enhancement (DE) magnetic resonance imaging (MRI) techniques have been shown to identify fibrotic tissue as areas of hyperenhancement. To test the hypothesis that DE-MRI can be used to identify myocardial fibrosis resulting from cardiac sarcoidosis, we assessed this method in asymptomatic patients with biopsy-proven systemic sarcoidosis. METHODS Thirty-one patients with biopsy-confirmed systemic sarcoidosis and no known history of heart disease or sarcoid cardiac involvement underwent DE-MRI after gadolinium-chelate administration. The location and extent of DE were quantified by 2 radiologists experienced at evaluating cardiovascular MRI images. RESULTS According to DE-MRI, 8 (26%) of the 31 patients had nonischemic fibrosis, as evidenced by abnormal DE patterns. Unlike characteristic ischemic injuries, most of the fibrosis was mid-myocardial, extending to the adjacent endocardium, epicardium, or both. The most frequent site of fibrosis was the basal inferoseptum, followed by the basal inferolateral wall. CONCLUSIONS In asymptomatic patients with systemic sarcoidosis, DE-MRI may provide a novel, noninvasive method for the early identification of myocardial fibrosis.
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