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Morales MA, Yoon S, Fahmy A, Ghanbari F, Nakamori S, Rodriguez J, Yue J, Street JA, Herzka DA, Manning WJ, Nezafat R. Highly accelerated free-breathing real-time myocardial tagging for exercise cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2023; 25:56. [PMID: 37784153 PMCID: PMC10544487 DOI: 10.1186/s12968-023-00961-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/11/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Exercise cardiovascular magnetic resonance (Ex-CMR) myocardial tagging would enable quantification of myocardial deformation after exercise. However, current electrocardiogram (ECG)-segmented sequences are limited for Ex-CMR. METHODS We developed a highly accelerated balanced steady-state free-precession real-time tagging technique for 3 T. A 12-fold acceleration was achieved using incoherent sixfold random Cartesian sampling, twofold truncated outer phase encoding, and a deep learning resolution enhancement model. The technique was tested in two prospective studies. In a rest study of 27 patients referred for clinical CMR and 19 healthy subjects, a set of ECG-segmented for comparison and two sets of real-time tagging images for repeatability assessment were collected in 2-chamber and short-axis views with spatiotemporal resolution 2.0 × 2.0 mm2 and 29 ms. In an Ex-CMR study of 26 patients with known or suspected cardiac disease and 23 healthy subjects, real-time images were collected before and after exercise. Deformation was quantified using measures of short-axis global circumferential strain (GCS). Two experienced CMR readers evaluated the image quality of all real-time data pooled from both studies using a 4-point Likert scale for tagline quality (1-excellent; 2-good; 3-moderate; 4-poor) and artifact level (1-none; 2-minimal; 3-moderate; 4-significant). Statistical evaluation included Pearson correlation coefficient (r), intraclass correlation coefficient (ICC), and coefficient of variation (CoV). RESULTS In the rest study, deformation was successfully quantified in 90% of cases. There was a good correlation (r = 0.71) between ECG-segmented and real-time measures of GCS, and repeatability was good to excellent (ICC = 0.86 [0.71, 0.94]) with a CoV of 4.7%. In the Ex-CMR study, deformation was successfully quantified in 96% of subjects pre-exercise and 84% of subjects post-exercise. Short-axis and 2-chamber tagline quality were 1.6 ± 0.7 and 1.9 ± 0.8 at rest and 1.9 ± 0.7 and 2.5 ± 0.8 after exercise, respectively. Short-axis and 2-chamber artifact level was 1.2 ± 0.5 and 1.4 ± 0.7 at rest and 1.3 ± 0.6 and 1.5 ± 0.8 post-exercise, respectively. CONCLUSION We developed a highly accelerated real-time tagging technique and demonstrated its potential for Ex-CMR quantification of myocardial deformation. Further studies are needed to assess the clinical utility of our technique.
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Affiliation(s)
- Manuel A Morales
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Siyeop Yoon
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Ahmed Fahmy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Fahime Ghanbari
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Shiro Nakamori
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Yue
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jordan A Street
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | | | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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Biederman RWW. Does chance really favor (only) the prepared mind? The role of MRI tissue-tagging in solving a most vexing problem for the interventionalist. Int J Cardiovasc Imaging 2021; 37:3069-3072. [PMID: 34392442 DOI: 10.1007/s10554-021-02364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Robert W W Biederman
- Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital, Temple University School of Medicine, Allegheny Health Network, Carnegie Mellon University, 320 E. North Avenue, Pittsburgh, PA, 15212, USA.
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Yamagishi M, Tamaki N, Akasaka T, Ikeda T, Ueshima K, Uemura S, Otsuji Y, Kihara Y, Kimura K, Kimura T, Kusama Y, Kumita S, Sakuma H, Jinzaki M, Daida H, Takeishi Y, Tada H, Chikamori T, Tsujita K, Teraoka K, Nakajima K, Nakata T, Nakatani S, Nogami A, Node K, Nohara A, Hirayama A, Funabashi N, Miura M, Mochizuki T, Yokoi H, Yoshioka K, Watanabe M, Asanuma T, Ishikawa Y, Ohara T, Kaikita K, Kasai T, Kato E, Kamiyama H, Kawashiri M, Kiso K, Kitagawa K, Kido T, Kinoshita T, Kiriyama T, Kume T, Kurata A, Kurisu S, Kosuge M, Kodani E, Sato A, Shiono Y, Shiomi H, Taki J, Takeuchi M, Tanaka A, Tanaka N, Tanaka R, Nakahashi T, Nakahara T, Nomura A, Hashimoto A, Hayashi K, Higashi M, Hiro T, Fukamachi D, Matsuo H, Matsumoto N, Miyauchi K, Miyagawa M, Yamada Y, Yoshinaga K, Wada H, Watanabe T, Ozaki Y, Kohsaka S, Shimizu W, Yasuda S, Yoshino H. JCS 2018 Guideline on Diagnosis of Chronic Coronary Heart Diseases. Circ J 2021; 85:402-572. [PMID: 33597320 DOI: 10.1253/circj.cj-19-1131] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine Graduate School
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Graduate School
| | - Kenji Ueshima
- Center for Accessing Early Promising Treatment, Kyoto University Hospital
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | | | | | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui
| | | | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | | | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa Universtiy
| | | | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Atsushi Nohara
- Division of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | | | | | - Masaru Miura
- Department of Cardiology, Tokyo Metropolitan Children's Medical Center
| | | | | | | | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Toshihiko Asanuma
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School
| | - Yuichi Ishikawa
- Department of Pediatric Cardiology, Fukuoka Children's Hospital
| | - Takahiro Ohara
- Division of Community Medicine, Tohoku Medical and Pharmaceutical University
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Kinen Hospital
| | - Eri Kato
- Department of Cardiovascular Medicine, Department of Clinical Laboratory, Kyoto University Hospital
| | | | - Masaaki Kawashiri
- Department of Cardiovascular and Internal Medicine, Kanazawa University
| | - Keisuke Kiso
- Department of Diagnostic Radiology, Tohoku University Hospital
| | - Kakuya Kitagawa
- Department of Advanced Diagnostic Imaging, Mie University Graduate School
| | - Teruhito Kido
- Department of Radiology, Ehime University Graduate School
| | | | | | | | - Akira Kurata
- Department of Radiology, Ehime University Graduate School
| | - Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Eitaro Kodani
- Department of Internal Medicine and Cardiology, Nippon Medical School Tama Nagayama Hospital
| | - Akira Sato
- Department of Cardiology, University of Tsukuba
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School
| | - Junichi Taki
- Department of Nuclear Medicine, Kanazawa University
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Japan
| | | | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Ryoichi Tanaka
- Department of Reconstructive Oral and Maxillofacial Surgery, Iwate Medical University
| | | | | | - Akihiro Nomura
- Innovative Clinical Research Center, Kanazawa University Hospital
| | - Akiyoshi Hashimoto
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Hospital
| | - Masahiro Higashi
- Department of Radiology, National Hospital Organization Osaka National Hospital
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center
| | - Naoya Matsumoto
- Division of Cardiology, Department of Medicine, Nihon University
| | | | | | | | - Keiichiro Yoshinaga
- Department of Diagnostic and Therapeutic Nuclear Medicine, Molecular Imaging at the National Institute of Radiological Sciences
| | - Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University
| | - Yukio Ozaki
- Department of Cardiology, Fujita Medical University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Regional Myocardial Strain and Function: From Novel Techniques to Clinical Applications. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-1-4939-8841-9_5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Schrauben EM, Cowan BR, Greiser A, Young AA. Left ventricular function and regional strain with subtly-tagged steady-state free precession feature tracking. J Magn Reson Imaging 2017; 47:787-797. [PMID: 28722247 DOI: 10.1002/jmri.25819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/06/2017] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To provide regional strain and ventricular volume from a single acquisition, using subtly tagged steady-state free precession (SubTag SSFP) feature tracking. MATERIALS AND METHODS The effects on regional strain of tag strength in gradient recalled echo (GRE) tagging, flip angle in untagged balanced SSFP, and both in SubTag SSFP were examined in the mid left ventricle of 15 healthy volunteers at 3T. Optimal parameters were determined from varying both tag strength and SSFP flip angle using full tag saturation GRE as the reference standard. SubTag SSFP was acquired in 15 additional healthy volunteers for whole-heart volume and strain assessment using the optimized parameters. Values measured by two image analysts were compared to clinical reference standards from untagged SSFP (volumes) and GRE tagging (strains). RESULTS Regional strain accuracy was maintained with decreasing total tagging flip angle (β); less than 3% differences for β ≥ 26°. For untagged SSFP flip angle (α), whole-wall strain differences became statistically significant when α < 40°. A SubTag SSFP acquisition with α = 40° and β = 46° showed the best combination of tagging strength, blood-myocardial contrast, and tag persistence at end-systole for regional strain estimation. SubTag SSFP also showed excellent agreement with untagged SSFP for volumetrics (percent difference: end-diastolic volume = 0.6%, end-systolic volume = 0.4%, stroke volume = 1.2%, ejection fraction = 0.6%, mass = 1.1%). CONCLUSION Feature tracking for regional myocardial strain assessment is dependent on image features, mainly the tag strength, persistence, and image contrast. SubTag SSFP balances these criteria to provide accurate regional strain and volumetric assessment in a single acquisition. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2018;47:787-797.
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Affiliation(s)
- Eric M Schrauben
- Translational Medicine, the Hospital for Sick Children, Toronto, Canada
| | - Brett R Cowan
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
| | | | - Alistair A Young
- Department of Anatomy with Radiology, University of Auckland, Auckland, New Zealand
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Abstract
Transmyocardial laser revascularization is a technique for the treatment of patients with chronic angina pectoris that is refractory to medical therapy and who are not eligible for surgical intervention. Percutaneous myocardial revascularization is a less-invasive catheter-based procedure that has been adapted from transmyocardial laser revascularization. Six prospective randomized clinical trials have been performed with transmyocardial laser revascularization and 5 have been performed using percutaneous myocardial revascularization. All of the transmyocardial laser revascularization and 4 of the percutaneous myocardial revascularization studies showed a significant improvement in angina class; however, results for improved survival, increased exercise tolerance, improved ejection fraction, and improved myocardial perfusion were less definitive. Transmyocardial laser revascularization has significant potential for morbidity and mortality. This article summarizes the results of the randomized trials, explains the current theories for the mechanism of transmyocardial laser revascularization, and discusses its current role in treatment for patients, considering the evidence that currently exists.
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Affiliation(s)
- Jordan Tasse
- Department of Cardiology, Chicago Medical School, 3001 Green Bay Road, Chicago, IL 60064, USA
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7
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Mazumder R, Choi S, Clymer BD, White RD, Kolipaka A. Diffusion Tensor Imaging of Healthy and Infarcted Porcine Hearts: Study on the Impact of Formalin Fixation. J Med Imaging Radiat Sci 2016; 47:74-85. [PMID: 26989451 PMCID: PMC4790101 DOI: 10.1016/j.jmir.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Due to complexities of in-vivo cardiac diffusion tensor imaging (DTI), ex-vivo formalin-fixed specimens are used to investigate cardiac remodeling in diseases, and reported results have shown conflicting trends. This study investigates the impact of formalin-fixation on diffusion properties and optimizes tracking parameters based on controls to understand remodeling in myocardial-infarction (MI). METHODS DTI was performed on 4 healthy (controls) and 4 MI induced formalin-fixed (PoMI) ex-vivo porcine hearts. Controls were scanned pre-fixation (PrCtrl) and re-scanned (PoCtrl) after formalin-fixation. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were estimated in all hearts. Tracking parameters (FA, tract termination angle (TTA), fiber-length) were optimized in controls and then used to investigate structural remodeling in PoMI hearts. RESULTS Fixation increased ADC and decreased FA. PoMI showed increased ADC but decreased FA in infarcted zone compared to remote zone. TTA showed sharp increase in slope from 5°-10°, which flattened after 25° in all groups. Mean fiber-length for different tracking length range showed that PoCtrl had shorter fibers compared to PrCtrl. Fibers around infarction were shorter in length and disarrayed compared to PoCtrl group. CONCLUSION Formalin-fixation affects diffusion properties and hence DTI parametric trends observed in pathology may be influenced by the fixation process which can cause contradictory findings.
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Affiliation(s)
- Ria Mazumder
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Seongjin Choi
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Bradley D. Clymer
- Department of Electrical and Computer Engineering, 205
Dreese Laboratories, 2015 Neil Avenue, The Ohio State University, Columbus, Ohio
43210, USA
| | - Richard D. White
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
| | - Arunark Kolipaka
- Department of Radiology, Room 460, 395 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
- Department of Internal Medicine-Division of Cardiovascular
Medicine, 244 Davis Heart & Lung Research Institute, 473 W. 12th Avenue, The
Ohio State University, Columbus, Ohio 43210, USA
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8
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Ballo P, Nistri S, Bocelli A, Mele D, Dini FL, Galderisi M, Zuppiroli A, Mondillo S. A new method to estimate left ventricular circumferential midwall systolic function by standard echocardiography: Concordance between models and validation by speckle tracking. Int J Cardiol 2016; 203:947-58. [DOI: 10.1016/j.ijcard.2015.11.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 12/27/2022]
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9
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Jiang K, Yu X. Quantification of regional myocardial wall motion by cardiovascular magnetic resonance. Quant Imaging Med Surg 2014; 4:345-57. [PMID: 25392821 DOI: 10.3978/j.issn.2223-4292.2014.09.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/12/2014] [Indexed: 12/12/2022]
Abstract
Cardiovascular magnetic resonance (CMR) is a versatile tool that also allows comprehensive and accurate measurement of both global and regional myocardial contraction. Quantification of regional wall motion parameters, such as strain, strain rate, twist and torsion, has been shown to be more sensitive to early-stage functional alterations. Since the invention of CMR tagging by magnetization saturation in 1988, several CMR techniques have been developed to enable the measurement of regional myocardial wall motion, including myocardial tissue tagging, phase contrast mapping, displacement encoding with stimulated echoes (DENSE), and strain encoded (SENC) imaging. These techniques have been developed with their own advantages and limitations. In this review, two widely used and closely related CMR techniques, i.e., tissue tagging and DENSE, will be discussed from the perspective of pulse sequence development and image-processing techniques. The clinical and preclinical applications of tissue tagging and DENSE in assessing wall motion mechanics in both normal and diseased hearts, including coronary artery diseases, hypertrophic cardiomyopathy, aortic stenosis, and Duchenne muscular dystrophies, will be discussed.
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Affiliation(s)
- Kai Jiang
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xin Yu
- 1 Departments of Biomedical Engineering, 2 Case Center for Imaging Research, 3 Radiology, and 4 Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio, USA
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Lim SP, Mc Ardle BA, Beanlands RS, Hessian RC. Myocardial Viability: It is Still Alive. Semin Nucl Med 2014; 44:358-74. [DOI: 10.1053/j.semnuclmed.2014.07.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Goel PK, Bhatia T, Kapoor A, Gambhir S, Pradhan PK, Barai S, Tewari S, Garg N, Kumar S, Jain S, Madhusudan P, Murthy S. Left ventricular remodeling after late revascularization correlates with baseline viability. Tex Heart Inst J 2014; 41:381-8. [PMID: 25120390 DOI: 10.14503/thij-13-3585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The ideal management of stable patients who present late after acute ST-elevation myocardial infarction (STEMI) is still a matter of conjecture. We hypothesized that the extent of improvement in left ventricular function after successful revascularization in this subset was related to the magnitude of viability in the infarct-related artery territory. However, few studies correlate the improvement of left ventricular function with the magnitude of residual viability in patients who undergo percutaneous coronary intervention in this setting. In 68 patients who presented later than 24 hours after a confirmed first STEMI, we performed resting, nitroglycerin-enhanced, technetium-99m sestamibi single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) before percutaneous coronary intervention, and again 6 months afterwards. Patients whose baseline viable myocardium in the infarct-related artery territory was more than 50%, 20% to 50%, and less than 20% were divided into Groups 1, 2, and 3 (mildly, moderately, and severely reduced viability, respectively). At follow-up, there was significant improvement in end-diastolic volume, end-systolic volume, and left ventricular ejection fraction in Groups 1 and 2, but not in Group 3. We conclude that even late revascularization of the infarct-related artery yields significant improvement in left ventricular remodeling. In patients with more than 20% viable myocardium in the infarct-related artery territory, the extent of improvement in left ventricular function depends upon the amount of viable myocardium present. The SPECT-MPI can be used as a guide for choosing patients for revascularization.
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Affiliation(s)
- Pravin K Goel
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Tanuj Bhatia
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Aditya Kapoor
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sanjay Gambhir
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Prasanta K Pradhan
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sukanta Barai
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Satyendra Tewari
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Naveen Garg
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Sudeep Kumar
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Suruchi Jain
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Ponnusamy Madhusudan
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Siddegowda Murthy
- Departments of Cardiology (Drs. Bhatia, Garg, Goel, Kapoor, Kumar, and Tewari) and Nuclear Medicine (Drs. Barai, Gambhir, Jain, Madhusudan, Murthy, and Pradhan), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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12
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Oubel E, De Craene M, Hero AO, Pourmorteza A, Huguet M, Avegliano G, Bijnens BH, Frangi AF. Cardiac motion estimation by joint alignment of tagged MRI sequences. Med Image Anal 2012; 16:339-50. [PMID: 22000567 PMCID: PMC4401871 DOI: 10.1016/j.media.2011.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 09/07/2011] [Accepted: 09/13/2011] [Indexed: 11/30/2022]
Abstract
Image registration has been proposed as an automatic method for recovering cardiac displacement fields from tagged Magnetic Resonance Imaging (tMRI) sequences. Initially performed as a set of pairwise registrations, these techniques have evolved to the use of 3D+t deformation models, requiring metrics of joint image alignment (JA). However, only linear combinations of cost functions defined with respect to the first frame have been used. In this paper, we have applied k-Nearest Neighbors Graphs (kNNG) estimators of the α-entropy (H(α)) to measure the joint similarity between frames, and to combine the information provided by different cardiac views in an unified metric. Experiments performed on six subjects showed a significantly higher accuracy (p<0.05) with respect to a standard pairwise alignment (PA) approach in terms of mean positional error and variance with respect to manually placed landmarks. The developed method was used to study strains in patients with myocardial infarction, showing a consistency between strain, infarction location, and coronary occlusion. This paper also presents an interesting clinical application of graph-based metric estimators, showing their value for solving practical problems found in medical imaging.
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Affiliation(s)
- E Oubel
- Center for Computational Imaging & Simulation Technologies in Biomedicine (CISTIB), Information and Communication Technologies Department, Universitat Pompeu Fabra, Barcelona, Spain
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Grover S, Srinivasan G, Selvanayagam JB. Evaluation of myocardial viability with cardiac magnetic resonance imaging. Prog Cardiovasc Dis 2011; 54:204-14. [PMID: 22014488 DOI: 10.1016/j.pcad.2011.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Assessment of myocardial viability is of clinical and scientific significance. Traditionally, the detection of myocardial viability (either stunning or hibernation) has been used in aiding diagnosis before revascularization, especially in high-risk patients. There is a considerable body of observational evidence showing substantial improvement after revascularization in patients with significant left ventricular dysfunction and myocardial viability. Recent randomized evidence has questioned the benefit of viability testing but must be interpreted with caution. Dobutamine stress echocardiography, nuclear imaging, and cardiovascular magnetic resonance are the mainstays of viability testing and provide information on contractile function, cellular metabolism, and myocardial fibrosis, respectively. Larger, multicenter trials with outcome data are needed to define the nature of viability testing and, particularly, cardiovascular magnetic resonance in moderate-to-severe ischemic cardiomyopathy.
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Affiliation(s)
- Suchi Grover
- Department of Cardiovascular Medicine, Flinders Medical Centre, Australia
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Ibrahim ESH. Myocardial tagging by cardiovascular magnetic resonance: evolution of techniques--pulse sequences, analysis algorithms, and applications. J Cardiovasc Magn Reson 2011; 13:36. [PMID: 21798021 PMCID: PMC3166900 DOI: 10.1186/1532-429x-13-36] [Citation(s) in RCA: 203] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 07/28/2011] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular magnetic resonance (CMR) tagging has been established as an essential technique for measuring regional myocardial function. It allows quantification of local intramyocardial motion measures, e.g. strain and strain rate. The invention of CMR tagging came in the late eighties, where the technique allowed for the first time for visualizing transmural myocardial movement without having to implant physical markers. This new idea opened the door for a series of developments and improvements that continue up to the present time. Different tagging techniques are currently available that are more extensive, improved, and sophisticated than they were twenty years ago. Each of these techniques has different versions for improved resolution, signal-to-noise ratio (SNR), scan time, anatomical coverage, three-dimensional capability, and image quality. The tagging techniques covered in this article can be broadly divided into two main categories: 1) Basic techniques, which include magnetization saturation, spatial modulation of magnetization (SPAMM), delay alternating with nutations for tailored excitation (DANTE), and complementary SPAMM (CSPAMM); and 2) Advanced techniques, which include harmonic phase (HARP), displacement encoding with stimulated echoes (DENSE), and strain encoding (SENC). Although most of these techniques were developed by separate groups and evolved from different backgrounds, they are in fact closely related to each other, and they can be interpreted from more than one perspective. Some of these techniques even followed parallel paths of developments, as illustrated in the article. As each technique has its own advantages, some efforts have been made to combine different techniques together for improved image quality or composite information acquisition. In this review, different developments in pulse sequences and related image processing techniques are described along with the necessities that led to their invention, which makes this article easy to read and the covered techniques easy to follow. Major studies that applied CMR tagging for studying myocardial mechanics are also summarized. Finally, the current article includes a plethora of ideas and techniques with over 300 references that motivate the reader to think about the future of CMR tagging.
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Charoenpanichkit C, Hundley WG. The 20 year evolution of dobutamine stress cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:59. [PMID: 20977757 PMCID: PMC2984575 DOI: 10.1186/1532-429x-12-59] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Accepted: 10/26/2010] [Indexed: 01/03/2023] Open
Abstract
Over the past 20 years, investigators world-wide have developed and utilized dobutamine magnetic resonance stress testing procedures for the purpose of identifying ischemia, viability, and cardiac prognosis. This article traces these developments and reviews the data utilized to substantiate this relatively new noninvasive imaging procedure.
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Affiliation(s)
- Charaslak Charoenpanichkit
- Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - W Gregory Hundley
- Department of Internal Medicine Section on Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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West AM, Kramer CM. Cardiovascular magnetic resonance imaging of myocardial infarction, viability, and cardiomyopathies. Curr Probl Cardiol 2010; 35:176-220. [PMID: 20197150 DOI: 10.1016/j.cpcardiol.2009.12.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cardiovascular magnetic resonance provides the opportunity for a truly comprehensive evaluation of patients with a history of myocardial infarction, with regard to characterizing the extent of disease, effect on left ventricular function, and degree of viable myocardium. The use of contrast-enhanced cardiac magnetic resonance (CMR) imaging for first-pass perfusion and late gadolinium enhancement is a powerful technique for delineating areas of myocardial ischemia and infarction. Using a combination of T2-weighted and contrast-enhanced CMR images, information about the acuity of an infarct can be obtained. There is extensive published data using contrast-enhanced CMR to predict myocardial functional recovery with revascularization in patients with ischemic cardiomyopathies. In addition, CMR imaging in patients with cardiomyopathies can distinguish between ischemic and nonischemic etiologies, with the ability to further characterize the underlying pathology of nonischemic cardiomyopathies.
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Affiliation(s)
- Amy M West
- University of Virginia Health System, Departments of Medicine and Radiology, Charlottesville, VA 22908, USA
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Bodí V, Husser O, Sanchis J, Núñez J, López-Lereu MP, Monmeneu JV, Mainar L, Chaustre F, Riegger GAJ, Bosch MJ, Chorro FJ, Llácer A. Contractile reserve and extent of transmural necrosis in the setting of myocardial stunning: comparison at cardiac MR imaging. Radiology 2010; 255:755-63. [PMID: 20392984 DOI: 10.1148/radiol.10091191] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To perform a comparison of cardiac magnetic resonance (MR) imaging-derived ejection fraction (EF) during low-dose dobutamine infusion (EF(D)) with the extent of segments with transmural necrosis in more than 50% of their wall thickness (ETN) for the prediction of major adverse cardiac events (MACEs) and late systolic recovery soon after a first ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS Institutional ethics committee approval and written informed consent were obtained. One hundred nineteen consecutive patients with a first STEMI, a depressed left ventricular EF, and an open infarct-related artery underwent MR imaging at 1 week after infarction. EF(D) and ETN (by using a 17-segment model) were determined, and the prediction of MACEs and systolic recovery at follow-up was assessed by using area under the receiver operating characteristic curve (AUC) and multivariable regression analysis. RESULTS During follow-up (median, 613 days; range, 312-1243 days), 18 MACEs (five cardiac deaths, six myocardial infarctions, seven readmissions for heart failure) occurred. MACEs were associated with a lower EF(D) (43% +/- 12 [standard deviation] vs 49% +/- 10, P = .02) and a larger ETN (seven segments +/- three vs four segments +/- three, P < .001). Patients with systolic recovery (increase in EF of >5% at follow-up compared with baseline EF, n = 44) displayed a higher EF(D) (51% +/- 10 vs 47% +/- 9, P = .04) and a smaller ETN (three segments +/- two vs five segments +/- three, P = .002) at 1 week. ETN and EF(D) both related to MACEs (AUC: 0.78 vs 0.67, respectively, P = .1) and systolic recovery (AUC: 0.68 vs 0.62, respectively, P = .3). According to multivariable analysis, ETN was the only MR variable associated with time to MACEs (hazard ratio, 1.38; 95% confidence interval: 1.19, 1.60; P < .001) and systolic recovery (odds ratio, 0.76; 95% confidence interval: 0.64, 0.92; P = .004) independent of baseline characteristics. CONCLUSION ETN is as useful as EF(D) for the prediction of MACEs and systolic recovery soon after STEMI.
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Affiliation(s)
- Vicente Bodí
- Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Blasco Ibáñez 17, 46010 Valencia, Spain.
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Mastouri R, Sawada SG, Mahenthiran J. Current noninvasive imaging techniques for detection of coronary artery disease. Expert Rev Cardiovasc Ther 2010; 8:77-91. [PMID: 20030023 DOI: 10.1586/erc.09.164] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The development and widespread use of noninvasive imaging techniques have contributed to the improvement in evaluation of patients with known or suspected coronary artery disease. Stress echocardiography and single-photon computed tomography are well-established noninvasive techniques with a proven track record for the diagnosis of coronary atherosclerosis. These modalities are generally widely available and provide a relatively high sensitivity and specificity along with an incremental value over clinical risk factors for detection of coronary artery disease. PET has a high diagnostic performance but continues to have limited clinical use because of the high expense of the dedicated equipment and difficulties in obtaining adequate radionuclides. Cardiac MRI and multislice computed tomography constitute the most recent addition to the cardiac imaging armamentarium. Cardiac MRI offers a comprehensive cardiac evaluation, which includes wall-motion analysis, myocardial tissue morphology, rest and stress first-pass myocardial perfusion, as well as ventricular systolic function. Cardiac computed tomography allows coronary calcium scanning along with noninvasive anatomic assessment of the coronary tree. It can be combined with functional imaging to provide a complete evaluation of the presence and physiological significance of the atherosclerotic coronary disease. No single imaging modality has been proven to be superior overall. Available tests all have advantages and drawbacks, and none can be considered suitable for all patients. The choice of the imaging method should be tailored to each person based on the clinical judgment of the a priori risk of cardiac event, clinical history and local expertise.
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Affiliation(s)
- Ronald Mastouri
- Indiana University, Indianapolis, 1801 North Senate Boulevard, IN 46202, USA
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Shehata ML, Cheng S, Osman NF, Bluemke DA, Lima JAC. Myocardial tissue tagging with cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2009; 11:55. [PMID: 20025732 PMCID: PMC2809051 DOI: 10.1186/1532-429x-11-55] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 12/21/2009] [Indexed: 12/23/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) is currently the gold standard for assessing both global and regional myocardial function. New tools for quantifying regional function have been recently developed to characterize early myocardial dysfunction in order to improve the identification and management of individuals at risk for heart failure. Of particular interest is CMR myocardial tagging, a non-invasive technique for assessing regional function that provides a detailed and comprehensive examination of intra-myocardial motion and deformation. Given the current advances in gradient technology, image reconstruction techniques, and data analysis algorithms, CMR myocardial tagging has become the reference modality for evaluating multidimensional strain evolution in the human heart. This review presents an in depth discussion on the current clinical applications of CMR myocardial tagging and the increasingly important role of this technique for assessing subclinical myocardial dysfunction in the setting of a wide variety of myocardial disease processes.
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Affiliation(s)
- Monda L Shehata
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan Cheng
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nael F Osman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, National Institutes of Health, Bethesda, MD, USA
| | - João AC Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Bettencourt N, Chiribiri A, Schuster A, Nagel E. Assessment of myocardial ischemia and viability using cardiac magnetic resonance. Curr Heart Fail Rep 2009; 6:142-53. [PMID: 19723455 DOI: 10.1007/s11897-009-0021-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the past decade, cardiac magnetic resonance (CMR) has evolved dramatically. Its clinical applications are now a major tool in the diagnosis and prognostic assessment of patients with ischemic heart disease. CMR can be used for detection and quantification of ischemia and for viability assessment using different techniques that are now well validated. Scar can be easily detected using contrast enhancement (late gadolinium enhancement). Ischemia detection is usually achieved with stress CMR techniques, whereas prediction for the recovery of function (detection of dysfunctional but viable myocardial segments) can be deduced from scar and stress imaging. Although determination of which approach is better may depend on the population group, the major advantage of CMR is the ability to integrate different information about anatomy, wall motion, myocardial perfusion, and tissue characterization in a single comprehensive examination.
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Affiliation(s)
- Nuno Bettencourt
- Division of Imaging Sciences, King's College London, London, United Kingdom
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21
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Prognostic Value of Myocardial Infarct Size and Contractile Reserve Using Magnetic Resonance Imaging. J Am Coll Cardiol 2009; 54:1770-7. [DOI: 10.1016/j.jacc.2009.07.027] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/13/2009] [Accepted: 07/23/2009] [Indexed: 10/20/2022]
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Korosoglou G, Futterer S, Humpert PM, Riedle N, Lossnitzer D, Hoerig B, Steen H, Giannitsis E, Osman NF, Katus HA. Strain-encoded cardiac MR during high-dose dobutamine stress testing: comparison to cine imaging and to myocardial tagging. J Magn Reson Imaging 2009; 29:1053-61. [PMID: 19388131 DOI: 10.1002/jmri.21759] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate regional strain response during high-dose dobutamine stress cardiac magnetic resonance imaging (DS-CMR) using myocardial tagging and Strain-Encoded MR (SENC). MATERIALS AND METHODS Stress induced ischemia was assessed by wall motion analysis, by tagged CMR and by SENC in 65 patients with suspected or known CAD who underwent DS-CMR in a clinical 1.5 Tesla scanner. Coronary angiography deemed as the standard reference for the presence or absence of CAD (> or =50% diameter stenosis) in all patients. RESULTS SENC and conventional tagging detected abnormal strain response in six and five additional patients, respectively, who were missed by cine images and proved to have CAD by angiography (P < 0.05 for SENC versus cine, P = 0.06 for tagging versus cine and p = NS for SENC versus tagging). On a per-vessel level, wall motion analysis on cine images showed high specificity (95%) but moderate sensitivity (70%) for the detection of CAD. Tagging and SENC yielded significantly higher sensitivity of 81% and 89%, respectively (P < 0.05 for tagging and P < 0.01 for SENC versus wall motion analysis, and p = NS for SENC versus tagging), while specificity was equally high (96% and 94%, respectively, P = NS for all). CONCLUSION Both the direct color-coded visualization of strain on CMR images and the generation of additional visual markers within the myocardium with tagged CMR represent useful adjuncts for DS-CMR, which may provide incremental value for the detection of CAD in humans. J. Magn. Reson.
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Lockie T, Nagel E, Redwood S, Plein S. Use of cardiovascular magnetic resonance imaging in acute coronary syndromes. Circulation 2009; 119:1671-81. [PMID: 19332480 DOI: 10.1161/circulationaha.108.816512] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tim Lockie
- Division of Imaging Sciences, The Rayne Institute, KCL, St. Thomas' Campus, London, UK
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Neizel M, Lossnitzer D, Korosoglou G, Schäufele T, Lewien A, Steen H, Katus HA, Osman NF, Giannitsis E. Strain-encoded (SENC) magnetic resonance imaging to evaluate regional heterogeneity of myocardial strain in healthy volunteers: Comparison with conventional tagging. J Magn Reson Imaging 2009; 29:99-105. [PMID: 19097105 DOI: 10.1002/jmri.21612] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To evaluate the ability of strain-encoded (SENC) magnetic resonance imaging (MRI) for regional systolic and diastolic strain analysis of the myocardium in healthy volunteers. MATERIALS AND METHODS Circumferential and longitudinal peak systolic strain values of 75 healthy volunteers (35 women and 40 men, mean age 44 +/- 12 years) were measured using SENC at 1.5T. MR tagging was used as the reference standard for measuring regional function. Diastolic function was assessed in the 10 youngest (24 +/- 8 years) and 10 oldest (62 +/- 5 years) subjects. RESULTS Peak strain values assessed with SENC were comparable to those obtained by MR tagging, showing narrow limits of agreement (limits of agreement -5.6% to 8.1%). Regional heterogeneity was observed between different segments of the left ventricle (LV) by both techniques (P < 0.001). Longitudinal strain obtained by SENC was also heterogenous (P < 0.001). Interestingly, no age- or gender-specific differences in peak systolic strain were observed, whereas the peak rate of relaxation of circumferential strain rate was decreased in the older group. CONCLUSION SENC is a reliable tool for accurate and objective quantification of regional myocardial systolic as well as diastolic function. In agreement with tagged MRI, SENC detected slightly heterogeneous myocardial strain within LV segments.
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Affiliation(s)
- Mirja Neizel
- Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
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Diagnostic and prognostic value of cardiac magnetic resonance imaging in assessing myocardial viability. Top Magn Reson Imaging 2008; 19:15-24. [PMID: 18690157 DOI: 10.1097/rmr.0b013e31817d550c] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Assessment of viability is pivotal to the prognosis of patients with chronic coronary artery disease (CAD) and left ventricular dysfunction. Patients with viable myocardium have a better prognosis with revascularization; however, patients with nonviable myocardium have worse outcomes with higher perioperative morbidity and mortality subsequent to revascularization. Cardiac magnetic resonance (CMR) imaging not only is the current reference standard technique in measuring cardiac chamber size and function and myocardial mass and volume but also provides spatially registered 2- or 3-dimensional data sets in myocardial perfusion and myocardial contrast enhancement in the same imaging session. Late gadolinium enhancement by CMR is the best current technique in discriminating myocardial scar versus viable myocardium. An extensive body of preclinical evidence has validated the detection and characterization of the morphology of infarcted tissue. In clinical studies, infarct characteristics by CMR has demonstrated a strong clinical utility in the prediction of left ventricular functional recovery and patient prognosis. In this paper, we aim to review the current CMR techniques in characterizing the spectrum of myocardial changes because of CAD, in the prediction of myocardial viability, and the current evidence of CMR's role in patient prognosis. In addition, we will also review the current literature comparing the clinical utility of CMR with other established imaging modalities in the assessment of CAD.
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Strzelczyk J, Attili A. Cardiac Magnetic Resonance Evaluation of Myocardial Viability and Ischemia. Semin Roentgenol 2008; 43:193-203. [DOI: 10.1053/j.ro.2008.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rahimtoola SH, Dilsizian V, Kramer CM, Marwick TH, Vanoverschelde JLJ. Chronic ischemic left ventricular dysfunction: from pathophysiology to imaging and its integration into clinical practice. JACC Cardiovasc Imaging 2008; 1:536-55. [PMID: 19356479 PMCID: PMC2664223 DOI: 10.1016/j.jcmg.2008.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022]
Abstract
Chronic ischemic left ventricular dysfunction is present in a number of clinical syndromes in which myocardial revascularization results in an improvement of left ventricular function, patients' functional class, and their survival. Early diagnosis of and treatment of viability is essential. Coronary arteriography is of limited value in diagnosis of viability. Noninvasive testing is essential for diagnosis, which can be matched to the pathophysiologic changes that occur in hibernating myocardium. However, no single test has a perfect, or near perfect, sensitivity and specificity, and thus, a combination of tests are usually needed. Algorithms are developed to integrate these tests in clinical decision making.
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Affiliation(s)
- Shahbudin H Rahimtoola
- Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, University of Southern California, Los Angeles, California 90033, USA.
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Fallahi B, Beiki D, Gholamrezanezhad A, Mahmoudian B, Ansari Gilani K, Eftekhari M, Fard-Esfahani A, Mohseni Z, Saghari M. Single Tc99m Sestamibi injection, double acquisition gated SPECT after stress and during low-dose dobutamine infusion: a new suggested protocol for evaluation of myocardial perfusion. Int J Cardiovasc Imaging 2008; 24:825-35. [PMID: 18563624 DOI: 10.1007/s10554-008-9328-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Accepted: 06/04/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND The ability of low dose dobutamine (LDD) has been established in exploiting the reserved contractility of ischemic myocardium. This study was designed to assess the value of a new protocol, with an additional stress imaging during LDD infusion instead of the rest images, for evaluation of coronary artery disease (CAD) and perfusion reversibility. METHODS A total of 51 patients (42 men, 9 women; 57.2 +/- 11.3 years) were included in the study and underwent three sequential steps of imaging; the first step-stress gated SPECT with Tc-99m sestamibi, immediately followed by the second step-gated SPECT during constant infusion of 7.5 microg/kg/min dobutamine and finally the third step-rest phase scan following trinitroglycerine administration in the next day. The findings were interpreted using the images in three sets of display; first vs. second step-single injection-double acquisition gated SPECT before and during LDD (SIDAGS-LDD), first vs. third step-standard stress/rest protocol, and only first step-gated stress-only SPECT. In all cases, the Visual perfusion index of each protocols were calculated by summating the premeditated 5-point scale (5: normal, 4: completely reversible, 3: partially reversible, 2: nontransmural fixed and 1: transmural fixed defects) of 17 standard myocardial segments. The accuracy as well as the correlation and agreement of protocols for detecting perfusion abnormality and corresponding reversibility were statistically analyzed. RESULTS Calculated sensitivity, specificity, positive predictive value, negative predictive value and accuracy regarding the presence of CAD in both SIDAGS-LDD and standard protocols were 90.9% (40/44), 71.4% (5/7), 95.2% (40/42), 55.6% (5/9) and 88.2% (45/51), respectively. The extent and localization of perfusion abnormality with the new protocol were correlated well with standard method. The estimation of reversibility, however, was considerably improved by SIDAGS-LDD, especially in those with history of previous myocardial infarction (MI). CONCLUSION Our proposed protocol demonstrates good correlation and agreement with standard method and even is superior in some cases especially for estimation of viability after MI. Regarding no need for the rest phase radiotracer injection and imaging, this protocol can be more convenient (except the need for close monitoring of the patient during LDD infusion), less time-consuming, less expensive and moreover with less radiation burden to the patients and personnel.
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Affiliation(s)
- Babak Fallahi
- Research Institute for Nuclear Medicine, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
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29
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Korosoglou G, Youssef AA, Bilchick KC, Ibrahim ES, Lardo AC, Lai S, Osman NF. Real-time fast strain-encoded magnetic resonance imaging to evaluate regional myocardial function at 3.0 Tesla: Comparison to conventional tagging. J Magn Reson Imaging 2008; 27:1012-8. [DOI: 10.1002/jmri.21315] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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30
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Tecelão SRR, Zwanenburg JJM, Kuijer JPA, de Cock CC, Germans T, van Rossum AC, Marcus JT. Quantitative comparison of 2D and 3D circumferential strain using MRI tagging in normal and LBBB hearts. Magn Reson Med 2007; 57:485-93. [PMID: 17326172 DOI: 10.1002/mrm.21142] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The response to cardiac resynchronization therapy (CRT), which is applied to patients with heart failure (HF) and left bundle-branch block (LBBB), can be predicted from the mechanical dyssynchrony measured on circumferential strain. Circumferential strain can be assessed by either 2D or 3D strain analysis. In this study was evaluated the difference between 2D and 3D circumferential strain using MR tagging with high temporal resolution (14 ms). Six healthy volunteers and five patients with LBBB were evaluated. We compared the 2D and 3D circumferential strains by computing the mechanical dyssynchrony and the cross correlation (r) between 2D and 3D strain curves, and by quantifying the differences in peak circumferential shortening, time to onset, and time to peak of shortening. The obtained maximum r(2) values were 0.97 +/- 0.03 and 0.87 +/- 0.16 for the healthy and LBBB populations, respectively, and thus showed a good similarity between 2D and 3D strain curves. No significant difference was observed between 2D and 3D in time to onset, time to peak, or peak circumferential shortening. Thus, to measure dyssynchrony, 2D strain analysis will suffice. Since 2D analysis is easier to implement than 3D analysis, this finding brings the application of MRI tagging and strain analysis closer to the clinical routine.
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Affiliation(s)
- Sandra R R Tecelão
- Institute of Biophysics and Biomedical Engineering, University of Lisbon, Lisbon, Portugal.
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31
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Barmeyer AA, Stork A, Bansmann M, Muellerleile K, Bavastro M, Heuer M, Adam G, Meinertz T, Lund GK. Myocardial Contractile Response to Increasing Doses of Dobutamine in Patients with Reperfused Acute Myocardial Infarction by Cardiac Magnetic Resonance Imaging. Cardiology 2007; 110:153-9. [DOI: 10.1159/000111924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Accepted: 03/03/2007] [Indexed: 01/28/2023]
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Walsh TF, Hundley WG. Assessment of Ventricular Function with Cardiovascular Magnetic Resonance. Magn Reson Imaging Clin N Am 2007; 15:487-504, v. [DOI: 10.1016/j.mric.2007.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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33
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Abstract
The high spatial and temporal resolution of cardiovascular magnetic resonance (CMR) images makes it well-suited for use in the assessment of right ventricular and left ventricular function in patients who have cardiovascular disorders. This article reviews CMR methods used to assess regional and global ventricular function.
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Affiliation(s)
- Thomas F Walsh
- Department of Internal Medicine, Wake Forest University School of Medicine, Bowman Gray Campus, Medical Center Boulevard, Winston-Salem, NC 27157-1045, USA
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Duffy KJ, Ferrari VA. Prognosis following acute myocardial infarction: insights from cardiovascular magnetic resonance. Curr Cardiol Rep 2007; 9:57-62. [PMID: 17362686 DOI: 10.1007/s11886-007-0011-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Acute myocardial infarction and its sequelae are the leading cause of death in the United States. Diagnostic imaging of myocardial infarction in both acute and chronic settings provides valuable prognostic information for clinical decision making. Cardiovascular MRI is unique in its ability to offer several different methods for predicting prognosis with regard to viability and future cardiovascular events. These MRI methods, which include dobutamine MRI, perfusion imaging, and delayed contrast-enhanced MRI, can assess contractile function and reserve, microvascular obstruction, and scar characterization, respectively. Future work will further characterize how cardiovascular MRI can assess prognosis as these emerging technologies become incorporated in routine clinical practice.
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Affiliation(s)
- Kevin J Duffy
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Cardiology, 9 Gates Building, Philadelphia, PA 19104, USA
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35
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Barmeyer AA, Stork A, Bansmann M, Muellerleile K, Heuer M, Bavastro M, Adam G, Meinertz T, Lund GK. Prediction of myocardial recovery by dobutamine magnetic resonance imaging and delayed enhancement early after reperfused acute myocardial infarction. Eur Radiol 2007; 18:110-8. [PMID: 17701182 DOI: 10.1007/s00330-007-0728-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2007] [Revised: 06/18/2007] [Accepted: 07/06/2007] [Indexed: 12/29/2022]
Abstract
The purpose was to study dobutamine magnetic resonance cine imaging (DOB-MRI) and delayed myocardial contrast enhancement (DE) early after reperfused acute myocardial infarction (AMI) for the predicion of segmental myocardial recovery and to find the optimal dose of dobutamine. Fifty patients (56+/-12 years, 42 males) with reperfused AMI underwent DOB-MRI and DE studies 3.5 (1-19) days after reperfusion. In DOB-MRI systolic wall thickening (SWT) was measured in 18 segments at rest and during dobutamine at 5, 10 and 20 microg*kg(-1)*min(-1). Dysfunctional segments were identified and the extent of DE was measured for each segment. Segmental recovery was examined after 8 (5-15) months. Two hundred-forty-eight segments were dysfunctional with presence of DE in 193. DOB-MRI showed the best prediction of recovery at 10 microg*kg(-1)*min(-1) of dobutamine with sensitivity of 67%, specificity of 63% and accuracy of 66% using a cut-off value for SWT of 2.0 mm. DE revealed a sensitivity of 68%, specificity of 65% and accuracy of 67% using a cut-off value of 46%. Combined analysis of DOB-MRI and DE did not improve diagnostic performance. Early prediction of segmental myocardial recovery after AMI is possible with DOB-MRI and DE. No improvement is achieved by dobutamine >10 microg*kg(-1)*min(-1) or a combination of DOB-MRI and DE.
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Affiliation(s)
- Achim A Barmeyer
- Clinic of Cardiology/Angiology, University Heart-Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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36
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Knuuti J, Lauerma K. Imaging of the failing heart. Scand J Surg 2007; 96:96-101. [PMID: 17679349 DOI: 10.1177/145749690709600202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- J Knuuti
- Turku PET Centre, University of Turku, University Hospital, Finland.
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37
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Abstract
Measurements of left ventricular function with cardiovascular magnetic resonance (CMR) at rest and during intravenous dobutamine are useful for identifying myocardial ischemia, viability, and the risk of subsequent cardiovascular events. Without ionizing radiation, intravascular iodinated contrast administration, or acoustic window limitations, CMR has emerged as a useful adjunct to transthoracic echocardiography for assessing patients with or suspected of having coronary artery disease.
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38
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Mazzadi AN, André-Fouët X, Costes N, Croisille P, Revel D, Janier MF. Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning. Am J Physiol Heart Circ Physiol 2006; 291:H2570-82. [PMID: 16861690 DOI: 10.1152/ajpheart.01249.2005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patients with severe chronic coronary artery disease (CAD) exhibit a highly altered myocardial pattern of perfusion, metabolism, and mechanical performance. In this context, the diagnosis of stunning remains elusive not only because of methodological and logistic considerations, but also because of the pathophysiological characteristics of the myocardium of these patients. In addition, a number of alternative pathophysiological mechanisms may act by mimicking the functional manifestations usually attributed to stunning. The present review describes three mechanisms that could theoretically lead to reversible mechanical dysfunction in these patients: myocardial wall stress, the tethering effect, and myocardial expression and release of auto- and paracrine agents. Attention is focused on the role of these mechanisms in scintigraphically “normal” regions (i.e., regions usually showing normal perfusion, glucose metabolism, and cellular integrity as assessed by nuclear imaging techniques), in which stunning is usually considered, but these mechanisms could also operate throughout the viable myocardium. We hypothesize that reversion of these three mechanisms could partially explain the unexpected functional benefit after reperfusion recently highlighted by high-spatial-resolution imaging techniques.
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Affiliation(s)
- Alejandro N Mazzadi
- Centre de Recherche et d'Applications en Traitement de l'Mage et du Signal, Institut National de la Santé de la Recherche Médicale Unité 630, Université Claude Bernard 1, Lyon, France.
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39
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Götte MJW, Germans T, Rüssel IK, Zwanenburg JJM, Marcus JT, van Rossum AC, van Veldhuisen DJ. Myocardial strain and torsion quantified by cardiovascular magnetic resonance tissue tagging: studies in normal and impaired left ventricular function. J Am Coll Cardiol 2006; 48:2002-11. [PMID: 17112990 DOI: 10.1016/j.jacc.2006.07.048] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 07/06/2006] [Accepted: 07/12/2006] [Indexed: 02/06/2023]
Abstract
Accurate quantification and timing of regional myocardial function allows early identification of dysfunction, and therefore becomes increasingly important for clinical risk assessment, patient management, and evaluation of therapeutic efficacy. For this purpose, the application of tissue Doppler echocardiography has rapidly increased. However, echocardiography has some major inherent limitations. Cardiovascular magnetic resonance imaging with tissue tagging provides highly reproducible data on myocardial function, not only in longitudinal and radial directions, but also in the circumferential direction. Because of the development of faster imaging protocols, improved temporal resolution, less time-consuming postprocessing procedures, and the potential of quantifying myocardial deformation in 3 dimensions at any point in the heart, this technique may serve as an alternative for tissue Doppler echocardiography and is now ready for more widespread clinical use. This review discusses the clinical use of cardiovascular magnetic resonance tissue tagging for quantitative assessment of regional myocardial function, thereby underlining the specific features and emerging role of this technique.
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Affiliation(s)
- Marco J W Götte
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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40
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Figueras J, Cortadellas J, Missorici M, Castell J, Soler JS. Predischarge low-dose dobutamine test and prediction of left ventricular function at 1 year in patients with a first anterior myocardial infarction. Clin Cardiol 2006; 29:451-6. [PMID: 17063949 PMCID: PMC6654198 DOI: 10.1002/clc.4960291007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It is unclear whether spontaneous improvement in contractility following acute myocardial infarction (AMI) is related to severity of predischarge systolic dysfunction and can be predicted by isotopic ventriculography with a low-dose dobutamine test (DBT). HYPOTHESIS Spontaneous improvement in contractility would be similar in patients with more preserved and those with depressed ventricular function, and a DBT test could predict it. METHODS Left ventricular ejection fraction (LVEF), regional contractility score (RCS), and left ventricular end-diastolic volume index (EDVI) at predischarge, during DBT, and at 1 year were analyzed in 43 patients with a first anterior ST-elevation AMI. RESULTS Changes produced by DBT in patients with LVEF < 40%, RCS > or = 3, or EDVI > or = 70 ml/m2 were smaller than in those observed at 1 year (LVEF: 30 +/- 5-35 +/- 7%, p < 0.001, vs. 39 +/- 10%, p = 0.005; RCS: 4.9 +/- 1.4-4.6 +/- 2.0, NS, vs. 3.4 +/- 2.0, p < 0.02; EDVI: 92 +/- 14-86 +/- 22, NS, vs. 78 +/- 23 ml/m2, p < 0.03). In contrast, in patients with EF > or = 40%, RCS < 3 or EDVI < 70 ml/m2, changes with DBT tended to be greater than those observed at 1 year (LVEF: 52 +/- 8-57 +/- 11%, p < 0.004 vs. 55 +/- 11%, p < 0.04); RCS: 1.1 +/- 0.9-0.8 +/- 0.8, NS, vs. 1.1 +/- 1.1, NS; and EDVI: 51 +/- 9-47 +/- 11, p < 0.005, vs. 54 +/- 13 ml/m2, NS). CONCLUSIONS Among patients with a first anterior AMI, spontaneous improvement in contractility at 1 year was greatest in those with a more depressed ventricular function or a dilated ventricle, but its magnitude was underestimated by a predischarge DBT test.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain.
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41
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Pingitore A, Rovai D, Positano V, Di Bella G, Strata E, De Marchi D, Passera M, Aquaro GD, Lombardi M. Do mechanical markers of myocardial ischaemia predict the transmural extent of myocardial infarction in man? J Cardiovasc Med (Hagerstown) 2006; 7:400-5. [PMID: 16721201 DOI: 10.2459/01.jcm.0000228689.32828.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The present study aimed to explore the relationship between the transmural extent of myocardial necrosis and mechanical markers of myocardial ischaemia in man. METHODS A group of 40 patients with previous Q-wave myocardial infarction and a left ventricular ejection fraction (LVEF) of 27 +/- 11% was studied by cine and contrast-enhanced magnetic resonance imaging. RESULTS Necrotic areas of delayed contrast enhancement were present in every patient and involved 20 +/- 8% of left ventricular myocardium. In involved segments, the transmural extent of contrast enhancement varied from 5% to 100%, being on average 38 +/- 25% of the wall thickness. End-diastolic left ventricular wall thickness and systolic wall thickening were lower in contrast-enhanced segments than in the other segments (P < 0.001). Furthermore, although left ventricular wall thickness and systolic wall thickening decreased as the transmural extent of contrast enhancement increased, the correlations were weak (r = -0.382 and -0.45, respectively). Finally, a delayed contrast enhancement was present in 89% of akinetic and in 94% of dyskinetic segments; however, contrast enhancement was also present in 18% of the segments with normal wall motion and in 56% of hypokinetic segments. CONCLUSIONS Although mechanical markers of myocardial ischaemia substantially reflect the transmural extent of myocardial infarction, none of them can be considered as a substitute for the direct observation of necrotic tissue and its transmural extent, as provided by contrast-enhanced magnetic resonance imaging.
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Bove CM, DiMaria JM, Voros S, Conaway MR, Kramer CM. Dobutamine Response and Myocardial Infarct Transmurality: Functional Improvement after Coronary Artery Bypass Grafting—Initial Experience. Radiology 2006; 240:835-41. [PMID: 16926330 DOI: 10.1148/radiol.2403051150] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Investigational Review Board approved the protocol, and all patients provided signed informed consent. The protocol was compliant with HIPAA. The purpose of the study was to prospectively test the hypothesis that addition of low-dose dobutamine and quantification of inotropic reserve in segments with 1%-50% infarct transmurality (IT) would improve the predictive value for functional recovery after revascularization in chronic infarction. Fifteen patients with multivessel coronary artery disease and left ventricular systolic dysfunction were enrolled prior to coronary artery bypass grafting (CABG). Late gadolinium-enhanced cardiac magnetic resonance (MR) imaging was used to assess IT. The percentage of wall thickening was measured with cine cardiac MR imaging at rest and during infusion of 10 (microg . kg(-1))/min dobutamine. Repeat cardiac MR imaging was performed 20 weeks +/- 4 (standard error) later. Functional parameters according to segment were compared before and after CABG by using F tests with repeated-measures models. In segments with 1%-50% IT, similar functional recovery was noted in those with 1%-25% or 26%-50% IT. However, in the same segments, those that improved with dobutamine to normal range demonstrated greater improvement in the percentage of wall thickening (22% +/- 4) after revascularization than those that did not (9% +/- 4) (P < .04). In 1%-50% IT, a normal dobutamine response helps differentiate segments with greater functional recovery after CABG.
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Affiliation(s)
- Christina M Bove
- Departments of Medicine, Cardiovascular Division, Health Evaluation Sciences, and Radiology, University of Virginia Health System, University of Virginia, Lee St, Box 800170, Charlottesville, VA 22908, USA
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43
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Abstract
In the presence of coronary artery disease, global left ventricular (LV) systolic function is a critical prognostic indicator. Because of enhanced therapy for myocardial infarction, more patients survive but are left with residual myocardial damage that predisposes them to developing CHF in the future. Although treatments for CHF are evolving, preventing and minimizing further deteriorations in LV function are paramount in this population. Distinguishing severe LV dysfunction caused by thinned, infarcted myocardium with fibrosis and scarring from that due to viable but dysfunctional myocardium from chronic hypoperfusion has significant implications for clinical management. In patients in whom noninvasive testing identifies viability, undergoing revascularization improves outcomes. Noninvasive imaging techniques used to assess viable myocardium are based on demonstrating the presence of one or more of the following features: (1) contractile reserve; (2) sufficient perfusion for the delivery of substrates and removal of metabolic byproducts; (3) intact myocyte membranes to maintain ionic/electrochemical gradients; and (4) preserved metabolism with generation of high-energy phosphates. While nuclear and dobutamine echocardiography have been widely used for viability assessment, cardiac magnetic resonance imaging (CMR) is increasingly becoming an accepted clinical tool, particularly in light of its high spatial resolution, intrinsic ability to image 3-dimensionally, and greater soft tissue differentiation. Moreover, the versatility of the technique potentially allows for the simultaneous assessment of regional wall motion, perfusion, and metabolism. An overview of the CMR techniques is presented.
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Affiliation(s)
- Andre Schmidt
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
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44
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Mandapaka S, Hundley WG. Dobutamine cardiovascular magnetic resonance: A review. J Magn Reson Imaging 2006; 24:499-512. [PMID: 16892202 DOI: 10.1002/jmri.20678] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Dobutamine cardiovascular magnetic resonance (DCMR) is useful for identifying myocardial ischemia and viability in patients with known or suspected coronary artery disease (CAD). This article reviews the performance and utility of DCMR, its association with dobutamine stress echocardiography (DSE), and areas of active investigative research.
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Affiliation(s)
- Sangeeta Mandapaka
- Cardiology Section, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA
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45
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Axel L, Montillo A, Kim D. Tagged magnetic resonance imaging of the heart: a survey. Med Image Anal 2005; 9:376-93. [PMID: 15878302 DOI: 10.1016/j.media.2005.01.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Revised: 12/28/2004] [Accepted: 01/31/2005] [Indexed: 12/01/2022]
Abstract
Magnetic resonance imaging (MRI) of the heart with magnetization tagging provides a potentially useful new way to assess cardiac mechanical function, through revealing the local motion of otherwise indistinguishable portions of the heart wall. While still an evolving area, tagged cardiac MRI is already able to provide novel quantitative information on cardiac function. Exploiting this potential requires developing tailored methods for both imaging and image analysis. In this paper, we review some of the progress that has been made in developing such methods for tagged cardiac MRI, as well as some of the ways these methods have been applied to the study of cardiac function.
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Affiliation(s)
- Leon Axel
- Department of Radiology, New York University School of Medicine, New York, NY 10016, USA.
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46
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Figueras J, Cortadellas J, Rodés J, Domingo E, Castell J, Soler JS. Early negative T waves and viable myocardium in patients with a first ST-elevation acute coronary syndrome. J Electrocardiol 2005; 38:171-8. [PMID: 16003695 DOI: 10.1016/j.jelectrocard.2005.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Deep negative T waves (NTW) are a frequent finding following acute ST-segment elevation coronary syndromes but its possible relation with the status of regional contractility remains unclear. We studied 52 patients with a first ST-elevation acute coronary syndrome with or without NTW in anterior leads (> or =3 mm in > or=3 leads) and assessed the ejection fraction and regional myocardial contractility by contrast left ventriculography at baseline and during a low-dose dobutamine test (10 microg/kg per minute). Ejection fraction and regional contractility tended to be more preserved in patients with NTW, but dobutamine increased regional contractility in the jeopardized area in most patients with or without NTW and the improvement was similar in those either with or without enzyme elevation. In conclusion, deep NTW after ST-elevation acute coronary syndromes tends to be associated with a more preserved myocardium but it is neither a sensitive nor a specific marker of viable myocardium.
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Affiliation(s)
- Jaume Figueras
- Unitat Coronària-Secció d'Hemodinàmica, Servei de Cardiologia, Hospital General Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain.
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47
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Bellenger NG, Yousef Z, Rajappan K, Marber MS, Pennell DJ. Infarct zone viability influences ventricular remodelling after late recanalisation of an occluded infarct related artery. Heart 2005; 91:478-83. [PMID: 15772205 PMCID: PMC1768832 DOI: 10.1136/hrt.2004.034918] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate the influence of infarct zone viability on remodelling after late recanalisation of an occluded infarct related artery. METHODS A subgroup of 26 volunteers from TOAT (the open artery trial) underwent dobutamine stress cardiovascular magnetic resonance at baseline to assess the amount of viable myocardium present with follow up to assess remodelling at one year. TOAT studied patients with left ventricular dysfunction after anterior myocardial infarction (MI) associated with isolated proximal occlusion of the left anterior descending coronary artery with randomisation to percutaneous coronary intervention (PCI) with stent at 3.6 weeks after MI (PCI group) or to medical treatment alone (medical group). RESULTS In the PCI group there was a significant relation between the number of viable segments within the infarct zone and improvement in end systolic volume index (-7.7 ml/m2, p = 0.02) and increased ejection fraction (4.1%, p = 0.03). The relation between viability and improvements in end diastolic volume index (-8.8 ml/m2, p = 0.08) and mass index (-6.3 g/m2, p = 0.01) did not reach significance (p = 0.27 and p = 0.8, respectively). In the medical group, there was no significant relation between the number of viable segments in the infarct zone and the subsequent changes in end diastolic (p = 0.84) and end systolic volume indices (p = 0.34), ejection fraction (p = 0.1), and mass index (p = 0.24). CONCLUSION The extent of viable myocardium in the infarct zone is related to improvements in left ventricular remodelling in patients who undergo late recanalisation of an occluded infarct related artery.
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Affiliation(s)
- N G Bellenger
- Cardiovascular MR Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.
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48
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Ray T, Biederman RW, Doyle M, Mankad S. Magnetic resonance imaging in the assessment of coronary artery disease. Curr Atheroscler Rep 2005; 7:108-14. [PMID: 15727725 DOI: 10.1007/s11883-005-0032-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Magnetic resonance imaging (MRI) is gaining importance in cardiology as the noninvasive test of choice for patients with a multitude of cardiovascular problems. Recently, cardiovascular MRI has emerged as an important noninvasive diagnostic modality in the assessment of coronary artery disease. Because of its superior spatial resolution, integration of qualitative and quantitative methodology, and excellent reproducibility, MRI has advantages over conventional noninvasive modalities currently used in the evaluation of coronary artery disease. This article reviews the rapidly expanding recent literature that has now established cardiovascular MRI as an ideal choice in the evaluation of myocardial ischemia (including dobutamine cine MRI and vasodilator perfusion MRI techniques). We further discuss the role of delayed contrast-enhanced MRI and low-dose dobutamine cine MRI for evaluation of myocardial viability. Comparisons with more established techniques, such as dobutamine stress echocardiography, single-photon emission computed tomography perfusion imaging, and positron emission tomography, are reviewed.
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Affiliation(s)
- Tarang Ray
- Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA, 15212, USA
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49
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Abstract
Patients with ischemic heart disease may have left ventricular (LV) dysfunction due to reversible or irreversible causes. The ability to distinguish viable myocardium with dysfunction due to a reversible etiology (hibernation, stunning) from nonviable scar is critical for determining proper management of the patient. Cardiovascular magnetic resonance (CMR) is a technique that has been established to be useful for the detection of myocardial viability and advancements in the field promise to further increase its utility. In this review we describe the features of CMR that make it suited for this purpose and outline promising developments that may soon make CMR the reference standard for viability assessment.
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Affiliation(s)
- Steven G Lloyd
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, 35294, USA.
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50
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Paetsch I, Föll D, Kaluza A, Luechinger R, Stuber M, Bornstedt A, Wahl A, Fleck E, Nagel E. Magnetic resonance stress tagging in ischemic heart disease. Am J Physiol Heart Circ Physiol 2005; 288:H2708-14. [PMID: 15665054 DOI: 10.1152/ajpheart.01017.2003] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
High-dose dobutamine magnetic resonance stress testing has been shown to be superior to dobutamine stress echocardiography for diagnosis of coronary artery disease (CAD). We determined the feasibility of quantitative myocardial tagging during low- and high-dose dobutamine stress and tested the ability of global systolic and diastolic quantitative parameters to identify patients with significant CAD. Twenty-five patients suspected of having significant CAD were examined with a standard high-dose dobutamine/atropine stress magnetic resonance protocol (1.5-T scanner, Philips). All patients underwent invasive coronary angiography as the standard of reference for the presence (n = 13) or absence (n = 12) of significant CAD. During low-dose dobutamine stress, systolic (circumferential shortening, systolic rotation, and systolic rotation velocity) and diastolic (velocity of circumferential lengthening and diastolic rotation velocity) parameters changed significantly in patients without CAD (all P < 0.05 vs. rest) but not in patients with CAD. Identification of patients without and with CAD during low-dose stress was possible using the diastolic parameter of "time to peak untwist." At high-dose stress, none of the global systolic or diastolic parameters showed the potential to identify the presence of significant CAD. With myocardial tagging, a quantitative analysis of systolic and diastolic function was feasible during low- and high-dose dobutamine stress. In our study, the diastolic parameter of time to peak untwist as assessed during low-dose dobutamine stress was the most promising global parameter for identification of patients with significant CAD. Thus quantitative myocardial tagging may become a tool that reduces the need for high-dose dobutamine stress.
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Affiliation(s)
- Ingo Paetsch
- German Heart Institute Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
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