Impact of guideline-recommended versus non-guideline-recommended ß-blocker and Doppler echocardiographic parameters on 1-year mortality in Thai ischemic cardiomyopathy patients: A prospective multicenter registry.

BACKGROUND: Ischemic cardiomyopathy is a high-cost, resource-intensive public health burden that is associated with a 1-year mortality rate of about 16% in western population. Different in patient ethnicity and pattern of practice may impact the clinical outcome. We aim to determine 1-year mortality and to identify factors that significantly predicts 1-year mortality of Thai patients with ischemic cardiomyopathy. METHODS: This prospective multicenter registry enrolled consecutive Thai patients that were diagnosed with ischemic cardiomyopathy at 9 institutions located across Thailand. Patients with left ventricular function < 40% and one of the following criteria were included: 1) presence of epicardial coronary stenoses > 75% in the left main or proximal left anterior descending artery or coronary angiography, and/or two major epicardial coronary stenoses; 2) prior myocardial infarction; 3) prior revascularization by coronary artery bypass graft or percutaneous coronary intervention; or, 4) magnetic resonance imaging pattern compatible with ischemic cardiomyopathy. Baseline clinical characteristics, coronary and echocardiographic data were recorded. The 1-year clinical outcome was pre-specified. RESULTS: Four hundred and nineteen patients were enrolled. Thirty-nine patients (9.9%) had died at 1 year, with 27 experiencing cardiovascular death, and 12 experiencing non-cardiovascular death. A comparison between patients who were alive and patients who were dead at 1 year revealed lower baseline left ventricular ejection fraction (LVEF) (26.7 ± 7.6% vs 30.2 ± 7.8%; p = 0.021), higher left ventricular end-diastolic volume (LVEDV) (185.8 ± 73.2 ml vs 155.6 ± 64.2 ml; p = 0.014), shorter mitral valve deceleration time (142.9 ± 57.5 ml vs 182.4 ± 85.7 ml; p = 0.041), and lower use of statins (94.7% vs 99.7%; p = 0.029) among deceased patients. Patients receiving guideline-recommended ß-blockers had lower mortality than patients receiving non-guideline-recommended ß-blockers (8.1% vs 18.2%; p = 0.05). CONCLUSIONS: The results of this study revealed a 9.9% 1-year mortality rate among Thai ischemic cardiomyopathy patients. Doppler echocardiographic parameters significantly associated with 1-year mortality were LVEF, LVEDV, mitral E velocity, and mitral valve deceleration time. The use of non-guideline-recommended ß-blockers rather than guideline recommended ß-blockers were associated with increased with 1-year mortality. Guidelines recommended ß-blockers should be preferred. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20190722002. Registered 22 July 2019. "Retrospectively registered".

Fragmented QRS in prediction of ischemic heart disease diagnosed by stress cardiovascular magnetic resonance imaging.

BACKGROUND: In patients with ischemic heart disease (IHD), many studies demonstrated an association between fragmented QRS complex (fQRS) on 12-lead ECG and myocardial scar, heart failure, and increased mortality. However, data in adults without history of IHD is limited. We aimed to evaluate whether there is an association between fQRS and IHD diagnosed by stress cardiac MRI. METHOD: We retrospectively reviewed demographic data, 12-lead ECG, and stress cardiac MRI data from 604 patients. Fragmented QRS was defined as the presence of additional R wave (R'), notching in the nadir of R or S wave, or the presence of more than one R' in any ECG leads. Both cardiac MRI and ECG were analyzed by two independent observers. RESULT: Final analysis included 554 patients, 39% were male, with a mean age of 67.8 ± 11.1 years. There was positive stress cardiac MRI in 219 patients (39.5%). Older age, diabetes mellitus, and hypertension were more frequent in the positive group (p < .05). fQRS was identified in 300 patients (54.2%). Baseline characteristic did not differ significantly between patients with and without fQRS. There is an association between fQRS and IHD, OR 1.605 (95% CI 1.14-2.27), p = .007. After adjustment for age, diabetes, hypertension, renal function, and left ventricular ejection fraction, the strong association between fQRS and IHD persisted, OR 1.71 (95% CI 1.18-2.47), p = .004. CONCLUSION: In patients without known history of coronary artery disease, fragmented QRS is independently associated with ischemic heart disease diagnosed by stress cardiac MRI.

Significantly elevated hepatic extracellular volume in adult patients with a Fontan circulation and its correlation with impaired functional capacity.

Fontan-associated liver disease is a major concern in patients who have undergone the procedure. Regular imaging of the liver is currently recommended for Fontan patients, but not other congenital heart diseases. The extracellular volume (ECV) of the liver obtained during CMR scanning and studies can show the high liver ECV in Fontan patients. However, the correlation between the liver ECV and the functional capacity of Fontan patients has not yet been reported. This study aimed to compare the liver ECV between Fontan patients and other congenital heart diseases with significant pulmonic regurgitation (PR) or tricuspid regurgitation (TR), and to evaluate the correlation between the liver ECV in adult Fontan patients and their functional capacity as well as clinical characteristics. Retrospective analysis of cardiovascular magnetic resonance imaging from patients with history of Fontan surgery between 2017 and 2021 were conducted. The clinical characteristics and liver ECV were evaluated and compared between patients and control group. Functional capacity was evaluated using a 6-min walk distance (6MWD). The correlation between the liver ECV and functional capacity was analyzed. 35 patients were enrolled in the study, including 13 Fontan patients, 12 Ebstein's anomaly or repaired tetralogy of Fallot (rTOF) patients with significant PR or TR, and 10 patients for the control group. The liver ECV were significantly higher in Fontan patients compared with Ebstein's anomaly/rTOF and the control group (41.% in Fontan group, 33.9% in Ebstein's anomaly/rTOF, and 31.7% in control group with p = 0.01 and 0.0008 in Fontan vs. Ebstein's anomaly/rTOF and Fontan vs. control group, respectively). In Fontan patients, there was a significant correlation between the liver ECV and the liver blood biochemistry with r = 0.879, p = 0.01 for AST/ALT ratio and r = 0.65, p = 0.005 for AST. The liver ECV was inversely correlated with the six-minute walk distance (r = -0.55, p = 0.02). The liver ECV in patients who had undergone Fontan operation showed a significantly elevated and has significantly inversed correlation with their functional capacity. These findings indicated that the liver ECV may be a potentialmarker for adverse clinical outcomes. However, due to small size population, further prospective study with larger number of patients may validate this findings.

Discordance between the European and the United States guideline criteria for atrial septal defect closure in adult patients with pulmonary hypertension and its clinical impact.

BACKGROUND: The criteria for ASD closure in patients with PAH are different between the AHA/ACC and the ESC guidelines. We aimed to study the prevalence of patients with different guideline criteria for ASD closure and its impact on the clinical outcome after closure. METHODS AND RESULTS: A retrospective cohort study recruiting patients who underwent ASD closure from 2011-2020 was conducted in a single university hospital. Patients were grouped into ASD closure recommended (class I, class IIa, and class IIb) and ASD closure not recommended groups (class III). The primary outcome was the prevalence of patients with discordant criteria and the clinical outcomes and echocardiographic parameters after ASD closure. A total of 17 of 66 ASD patients (25.8 %) were diagnosed with ASD with pulmonary hypertension. Two patients were excluded due to incomplete right heart catheterization data. 13 patients (86.7 %) were classified as ASD-closure recommended group by both guidelines. Two patients, classified as class IIb by ACC/AHA guidelines, were unsuitable for ASD closure by ESC guidelines. After ASD closure, all 15 patients reported functional class improvement and no significant difference in the echocardiography parameters. However, the number of patients with a low probability of PHT was higher in patients with ESC guideline-recommended closure. CONCLUSIONS: Most patients (86.7 %) are in concordant classification regarding ASD closure recommendations. The ESC guidelines are more restrictive than the AHA/ACC guidelines, allowing fewer patients for ASD closure. However, the clinical outcomes after ASD closure are not significantly different between these guidelines.

Mendelian randomization study of the effect of coronary artery calcification on atherosclerotic cardiovascular diseases.

Calcium calcification in the wall of arteries (CAC) leads to a higher risk of atherosclerosis related outcomes, especially myocardial infarction (MI). Nevertheless, the causal role of CAC on other related outcomes is unclear. In this study, we used Mendelian randomization (MR) to systematically investigate the causal role of CAC across a broad range of atherosclerotic cardiovascular diseases including coronary heart disease, angina, MI, ischemic heart disease, stroke, and peripheral vascular disease. Publicly available data from the UK biobank and other data sources were used. Using the two-sample Mendelian randomization (MR) approach, we applied 3 MR models including the inverse variance weighted, the weighted-median, and the weighted-mode methods. Eight SNPs associated with CAC were selected as instrumental variables. We observed causal evidence of CAC on MI consistently across all MR models (PIVW = 1.0 × 10-4, PW-Median = 1.1 × 10-4, PW-Mode = 3.8 × 10-2) and this causation is shown in an acute transmural MI of inferior wall (PIVW = 1.5 × 10-4, PW-Median = 4.8 × 10-5, PW-Mode = 3.2 × 10-2) but not consistently observed in an anterior wall. As each site of acute MI was suggested to have relatively specific mechanisms, our finding suggested that the causal role of CAC on MI is in an inferior wall possibly as a consequence of large calcification from a prolonged process, whereas non-calcified artery plaque or other underlying mechanisms may predominantly play role in an anterior infarction during an advanced atherosclerotic process.

Genomic findings of hypertrophic and dilated cardiomyopathy characterized in a Thai clinical genetics service.

Hypertrophic cardiomyopathy (HCM) and dilated cardiomyopathy (DCM) are the most common referrals in the Inherited Cardiovascular Condition (ICC) Genetics Service. Several issues must be discussed with patients and their families during the genetic consultation session, including the options for genetic testing and cardiovascular surveillance in family members. We developed an ICC registry and performed next-generation-based DNA sequencing for all patients affected by non-syndromic HCM and idiopathic DCM in our joint specialist genetics service. The target gene sequencing panel relied on the Human Phenotype Ontology with 237 genes for HCM (HP:0001639) and 142 genes for DCM (HP:0001644). All subjects were asked to contact their asymptomatic first-degree relatives for genetic counseling regarding their risks and to initiate cardiovascular surveillance and cascade genetic testing. The study was performed from January 1, 2014, to December 31, 2020, and a total of 62 subjects (31-HCM and 31-DCM) were enrolled. The molecular detection frequency was 48.39% (32.26% pathogenic/likely pathogenic, 16.13% variant of uncertain significance or VUS for HCM, and 25.81% (16.13% pathogenic/likely pathogenic, 9.68% VUS) for DCM. The most prevalent gene associated with HCM was MYBPC3. The others identified in this study included ACTN2, MYL2, MYH7, TNNI3, TPM1, and VCL. Among the DCM subjects, variants were detected in two cases with the TTN nonsense variants, while the others were missense and identified in MYH7, DRSP3, MYBPC3, and SCN5A. Following the echocardiogram surveillance and cascade genetic testing in the asymptomatic first-degree relatives, the detection rate of new cases was 8.82% and 6.25% in relatives of HCM and DCM subjects, respectively. Additionally, a new pre-symptomatic relative belonging to an HCM family was identified, although the genomic finding in the affected case was absent. Thus, ICC service is promising for the national healthcare system, aiming to prevent morbidity and mortality in asymptomatic family members.

Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging.

PURPOSE: To evaluate the feasibility and accuracy of magnetic resonance (MR) coronary angiography for the detection of coronary artery anomalies in infants and children by using surgical findings as a reference. MATERIALS AND METHODS: The data analysis was approved by the institutional review board. One hundred children with congenital heart disease underwent MR coronary angiography while under general anesthesia (mean age ± standard deviation, 3.9 years ± 3; age range, 0.2-11 years). A navigator-gated, T2-prepared, three-dimensional steady-state free precession whole-heart protocol (isotropic voxel size, 1.0-1.3 mm(3); mean imaging time, 4.6 minutes ± 1.2; mean navigator efficiency, 70%; 3-mm gating window) was used after injection of gadopentetate dimeglumine. The cardiac rest period (end systole or middiastole) and acquisition window were prospectively assessed for each patient. Coronary artery image quality (score of 0 [nondiagnostic] to 4 [excellent]), vessel sharpness, and coronary artery anomalies were assessed by two observers. Surgery was performed in 58 patients, and those findings were used to define accuracy. Variables were assessed between age groups by using either analysis of variance or Kruskal-Wallis tests. RESULTS: Diagnostic image quality (score, ≥1 for all coronary artery segments) was obtained in 46 of the 58 patients (79%) who underwent surgery. The origin and course of the coronary artery anatomy depicted with MR imaging was confirmed at surgery in all 46 patients-including the four (9%) with substantial coronary artery anomalies. Diagnostic-quality images were obtained in 84 of the 100 patients. The rate of success improved significantly when patients were older than 4 months (88% for patients >4 months vs 17% for patients ≤4 months, P < .001). CONCLUSION: Improved whole-heart MR coronary angiography enables accurate detection of abnormal origin and course of the coronary artery system even in very young patients with congenital heart disease.

Transcatheter tricuspid valve-in-valve implantation for degenerative surgical bio-prosthesis using SAPIEN 3: A case series.

We evaluated early outcomes of transcatheter valve-in-valve (ViV) implantation in patients with degenerated bio-prosthesis in tricuspid position. Total of 5 patients were included in our case series. Baseline native tricuspid valve etiology were highly varied ranging from chest wall trauma, Ebstein anomaly, rheumatic heart disease, infective endocarditis and complex congenital heart disease. These differences also made patient comorbidities highly varied. Procedure details were also varied due to different clinical and technical challenges. All cases underwent successful Tricuspid VIV implantation with satisfactory hemodynamics results. All patients experienced improved clinical symptoms at follow up.

Visualization of the cardiac venous system using cardiac magnetic resonance.

We sought to investigate the value of cardiac magnetic resonance to depict cardiac venous anatomy. For cardiac resynchronization therapy the lead for the left ventricle is usually placed by transvenous approach into a tributary of the coronary sinus (CS). Knowledge of the anatomy and variations of the cardiac venous system may facilitate the positioning of the left ventricle lead. The cardiac magnetic resonance examinations of 23 subjects (16 volunteers and 7 patients) were retrospectively analyzed. All examinations were performed using navigator-gated whole-heart steady-state free precession coronary artery imaging after administration of intravascular contrast agents (gadofosveset in volunteers; Gadomer-17 in patients). The cardiac venous system was visualized in all subjects. The most frequent anatomical variant observed (in 12 subjects [52%]) was a connection of the small cardiac vein to the CS at the crux cordis. In 10 subjects (44%) the small veins entered the right atrium independently from the CS, and the posterior interventricular vein was connected to the CS at the crux cordis. Only one subject had a disconnection between the CS and posterior interventricular vein, which entered into the right atrium independently. The mean distance of the posterior vein of the left ventricle and the left marginal vein to the ostium of the CS was 15.2+/-4.7 mm and 49.7+/-14.1 mm, respectively. In conclusion, the anatomy of the cardiac venous system and its anatomical variability can be described using cardiac magnetic resonance. Its preimplantation visualization may help to facilitate the implant procedure and to reduce fluoroscopy time.

Efficiency of the home cardiac rehabilitation program for adults with complex congenital heart disease.

OBJECTIVE: We aimed to study the efficiency and safety of once-a-week outpatient rehabilitation followed by home program with tele-monitoring in patients with complex cyanotic congenital heart disease. DESIGN: Prospective nonrandomized study. METHOD: Patients who have been diagnosed either Eisenmenger's syndrome or inoperable complex cyanotic heart disease and able to attend 12-week cardiac rehabilitation program were included. Training with treadmill walking and bicycling under supervision at cardiac rehabilitation unit once-a-week in the first 6 weeks followed by home-based exercise program (bicycle and walking) with a target at 40%-70% of maximum heart rate (HRmax) at pretraining peak exercise for another 6 weeks was performed in the intervention group. Video and telephone calls were scheduled for evaluation of compliance and complication. Data from cardiopulmonary exercise testing (CPET) on cycle ergometry including peak oxygen consumption (peakVO2 ), oxygen pulse (O2 pulse), ventilatory equivalent for carbon dioxide (VE/CO2 at anaerobic threshold), constant work-rate endurance time (CWRET) at 75% of peak VO2 , and 6-minute walk distance (6MWD) were compared between baseline and after training by paired t test. RESULT: Of the 400 patients in our adult congenital heart disease clinic, 60 patients met the inclusion criteria. Eleven patients who could follow program regularly were assigned home program. There was a statistically significant improvement of CWRET, O2 pulse, and 6MWD after finishing the program (P = .003, .039, and .001, respectively). The mean difference of 6MWD change in the home-program group was significantly higher than in the control group (69.3 ± 47.9 meters vs. 4.1 ± 43.4 meters, P = .003). No serious adverse outcomes were reported during home training. CONCLUSION: Once-a-week outpatient hospital-based exercise program followed by supervised home-based exercise program showed a significant benefit in improvement of exercise capacity in adults with complex cyanotic congenital heart disease without serious adverse outcomes.

Comparison of Image Acquisition Techniques in Four-Dimensional Flow Cardiovascular MR on 3 Tesla in Volunteers and Tetralogy of Fallot Patients.

Four-dimensional phase-contrast (PC) velocity-encoded flow magnetic resonance imaging (4D flow MRI) is a potentially valuable tool for studying cardiovascular hemodynamics for disease monitoring and/or treatment planning. In this study we compared the performance of two 4D flow MRI pulse sequences - echo-planar imaging (EPI) and segmented gradient-echo (turbo-field-echo or TFE on vendor's platform) - on a clinical 3T system in 6 human subjects including 3 patients with Tetralogy of Fallot (TOF). For aortic flow rate, the coefficients of variation (COV) between 2D and 4D EPI were 7.0% and 7.7% for controls and patients respectively. The corresponding COV between 2D and 4D TFE were 19.0% and 18.3% for controls and patients respectively. The COV between 4D TFE and 4D EPI were larger than 18.7% in kinetic energy analysis. 4D EPI demonstrated acceptable accuracy of intra-cardiac flow quantification, which was also shown in the ex-vivo phantom measurements.

Magnetic resonance imaging planning in children with complex congenital heart disease - A new approach.

OBJECTIVES: To compare a standard sequential 2D Planning Method (2D-PM) with a 3D offline Planning Method (3D-PM) based on 3D contrast-enhanced magnetic resonance angiography (CE-MRA) in children with congenital heart disease (CHD). DESIGN: In 14 children with complex CHD (mean: 2.6 years, range: 3 months to 7.6 years), axial and coronal cuts were obtained with single slice spin echo sequences to get the final double oblique longitudinal cut of the targeted anatomical structure (2D-PM, n = 31). On a separate workstation, similar maximal intensity projection (MIP) images were generated offline from a 3D CE-MRA. MIP images were localizers for repeated targeted imaging using the previous spin echo sequence (3D-PM). Finally, image coverage, spatial orientation and acquisition time were compared for 2D-PM and 3D-PM. MAIN OUTCOME MEASURES: 2D-PM and 3D-PM images were similar: both perfectly covered the selected anatomic regions and no spatial differences were found (p>0.05). The mean time for creation of the final imaging plane was 241 ± 31 s (2D-PM) compared to 71 ± 18 s (3D-PM) (p<0.05). CONCLUSIONS: 3D-PM shows similar results compared to 2D-PM, but allows faster and offline planning thereby reducing the scan time significantly. As newly developed high-resolution 3D datasets can also be used further improvement of this technology is expected.

CHA2DS2-VASc scores predict mortality after hospitalization for atrial fibrillation.

OBJECTIVE: The outcome of patients hospitalized for atrial fibrillation (AF) is relatively poor. We sought to determine the mortality rate and predictors of mortality following hospitalization for AF and to evaluate whether the CHA2DS2-VASc score was a predictor of mortality. METHODS: We examined the national database of Thailand residents who registered for government provided health insurance in 2005 and reviewed patient records from 2005 to 2010 to determine all-cause mortality. A total of 8981 patients (mean age, 65 years; 42% male) were admitted to the hospital with a diagnosis of AF. Data on demographics and comorbidities were retrieved from the database. The CHA2DS2-VASc score was calculated for each patient. RESULTS: The hospitalization rate for AF was 15.5 per 100,000 person-years. The two most common comorbidities were hypertension (N=1638, 18.2%) and diabetes (N=1349, 15.0%). The average CHA2DS2-VASc score for all patients was 1.8. By the 72-month follow-up (average 46 months), 3948 patients (44.0%) had died. The CHA2DS2-VASc score was directly related to the mortality rate (P log-rank <0.0001). Multivariate analysis showed that a CHA2DS2-VASc score ≥ 6 (hazard ratio [HR] 2.2, 95% confidence interval [CI], 1.4-3.7, P=0.002) and the presence of chronic kidney disease (HR 2.0, 95% CI 1.7-2.4, P<0.0001) were the strongest predictors of death. CONCLUSION: The outcome after hospitalization for AF is relatively poor. The CHA2DS2-VASc score is an independent prognostic marker of poor outcomes following hospitalization for AF.

Impact of heart rate variability in patients with normal sinus rhythm on image quality in coronary magnetic angiography.

PURPOSE: To evaluate the influence of heart rate variability on image quality in patients with suspected coronary artery disease during magnetic resonance coronary angiography (MRCA). MATERIALS AND METHODS: The coronary images from 70 patients who underwent target-volume MRA were retrospectively analyzed. Two independent observers evaluated image quality using a score from 0 (nonvisible) to 4 (excellent quality). Images were grouped into good (score > 2) and poor image quality (score 0-2). Five parameters (effective scan duration, navigator efficiency, mean heart rate, acquisition window, and heart rate variability) were evaluated. RESULTS: In all, 56 of the 70 patients (80%) were scored as good and 14 as poor image quality. Only the navigator efficiency, heart rate variability, and acquisition window showed statistically significant for the prediction of image quality, with navigator efficiency being the strongest predictor. Subgroup analysis showed that patients with navigator efficiency >60% had good image quality independent of the heart rate variability. In patients with navigator efficiency < or =60%, heart rate variability is the only remaining significant parameter (P = 0.03). CONCLUSION: Navigator efficiency was the most important predictor of MRCA image quality. Heart rate variability is the most important predictor of image quality in patients with a navigator efficiency < or =60%.

Assessment of left ventricular volumes and mass with fast 3D cine steady-state free precession k-t space broad-use linear acquisition speed-up technique (k-t BLAST).

PURPOSE: To compare left ventricular (LV) volume and mass assessment using two-dimensional (2D) cine steady-state free precession (SSFP) and k-t space broad-use linear acquisition speed-up technique (k-t BLAST) accelerated 3D magnetic resonance imaging (MRI). MATERIALS AND METHODS: On a commercially available 1.5T MR scanner, 2D cine SSFP, six- and eight-fold accelerated 3D k-t BLAST were performed to evaluate LV volumes and mass in 17 volunteers. After semiautomatic segmentation of the different MR data sets, the resulting volumes and mass were compared according to the mean difference, 95% confidence interval, standard deviation (SD), Pearson's correlation coefficient, Bland-Altman analysis, and the Pitman-Morgan test. RESULTS: Data acquisition was successful in all subjects. The number of required breathholds was reduced from a maximal of five for the 2D cine SSFP sequence to two for 3D k-t BLAST sequences. Comparing LV volumes, there was excellent agreement between 2D and 3D cine 8x k-t BLAST SSFP volumes (mean difference +/- 2SD end-diastolic volume [EDV] = 5 +/- 8 mL, end-systolic volume [ESV] = 1 +/-12 mL, and stroke volume [SV] = 3 +/- 8 mL), and mass (-1.8 +/- 9 g). CONCLUSION: k-t BLAST-accelerated 3D sequences allow accurate assessment of LV volumes and mass compared to 2D cine SSFP. This method may reduce costs and increase patient comfort due to shortened data acquisition time and reduced number of breathholds.

Whole-heart coronary magnetic resonance angiography with MS-325 (Gadofosveset).

BACKGROUND: Magnetic resonance coronary angiography (MRCA) is limited by a low signal-to-noise-ratio (SNR), low spatial resolution, and limited coverage of the coronary artery tree. These aspects might be significantly improved by intravascular contrast agents. The aim of the study was to evaluate the feasibility of whole-heart contrast-enhanced MRCA using the intravascular contrast agent gadofosveset, formerly known as MS-325. MATERIAL/METHODS: Free-breathing navigator-gated MRCA using a single 3D volume with transversal slice orientation before and after injection of MS-325 (0.05 mmol/kg body-weight) was performed in 17 volunteers (6 men, aged 30+/-8 years). Signal intensities from the myocardium and left ventricular blood were assessed for non-enhanced and contrast-enhanced images. Signal-to-noise ratio of blood and contrast-to-noise ratios (CNR) were calculated. Image quality (0: no visualization, 1: nondiagnostic, 2: moderate, 3: good, 4: excellent) and MR angiograms (15-segment model following AHA/ACC guidelines) were evaluated. Visible vessel length and vessel sharpness were measured and visible coronary artery segments assessed. RESULTS: MR coronary artery imaging using MS-325 was successfully performed in 16 volunteers. One volunteer was excluded from the analysis because of trigger problems. SNR did not improve significantly after administration of MS-325 (14.1 vs. 14.6, p=NS), but CNR did (8.03 vs. 12.73, p<0.001). Image quality increased with MS-325 from 2.5+/-0.4 to 2.8+/-0.3 (p<0.05). Overall vessel length and vessel sharpness improved significantly after MS-325 administration (p<0.05). CONCLUSIONS: Whole-heart coronary MRA with the intravascular contrast agent MS-325 enables significant improvement in CNR, blood-myocardial contrast, image quality, visible vessel length, and vessel sharpness over non-contrast MRCA.

Anatomical and functional evaluation of myocardial bridging on the left anterior descending artery by cardiovascular magnetic resonance imaging.

A myocardial muscle bridge spans a segment of a major epicardial coronary artery that is located in the myocardium. This anatomic configuration can be responsible for angina pectoris, arrhythmias or even death. The current reference standard for diagnosis is conventional x-ray coronary angiography showing systolic compression of an epicardial vessel and the typical angiographic "milking effect." We report the case of a patient with myocardial bridging on the left anterior descending artery, in whom a combination of noninvasive high resolution display of the coronary artery lumen, visualization of the myocardium and functional assessment of blood flow during dobutamine stimulation by cardiovascular magnetic resonance imaging was performed.

Evaluation of multiple coronary artery aneurysms in Kawasaki's disease by whole heart non-contrast enhanced MRI.

We describe a patient with history of an acute coronary syndrome. Cardiovascular magnetic resonance (CMR) was used for the assessment of coronary artery status using a high-resolution whole heart coronary artery imaging sequence, cardiac function at rest and detection of myocardial fibrosis using delayed enhancement. In the current case there were multiple giant aneurysms, one with evidence of thrombosis in combination with wall motion abnormalities and late enhancement in the myocardial segments supplied by this coronary artery.