The unique value of cardiovascular magnetic resonance in patients with suspected acute coronary syndrome and culprit-free coronary angiograms.

BACKGROUND: Patients with chest pain, elevated troponin, and unobstructed coronary disease present a clinical dilemma. The purpose of this study was to investigate the incremental diagnostic value of cardiovascular magnetic resonance (CMR) in a cohort of patients with suspected acute coronary syndrome (ACS) and unobstructed coronary arteries. RESULTS: Data files of patients meeting the inclusion criteria in two cardiology centres were searched and analysed. The inclusion criteria included: 1) thoracic pain suspected with ACS; 2) a significant increase in the high-sensitive Troponin T value; 3) ECG changes; 4) coronary arteries without any significant stenosis; 5) a CMR examination included in the diagnostic process; 6) an uncertain diagnosis before the CMR exam; and 7) the absence of known CMR and contrast media contraindications. Special attention was paid to the benefits of CMR in determining the final diagnosis. In total, 136 patients who underwent coronary angiography for chest pain were analysed. The most frequent underlying causes were myocarditis (38%) and perimyocarditis (18%), followed by angiographically unrecognised acute myocardial infarction (18%) and Takotsubo cardiomyopathy (15%). The final diagnosis remained unclear in 6% of the patients. The contribution of CMR in determining the final diagnosis determination was crucial in 57% of the patients. In another 35% of the patients, CMR confirmed the suspicion and, only 8% of the CMR examinations did not help at all and had no influence on diagnosis or treatment. CONCLUSION: CMR provided a powerful incremental diagnostic value in the cohort of patients with suspected ACS and unobstructed coronary arteries. CMR is highly recommended to be incorporated as an inalienable part of the diagnostic algorithms in these patients.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part II]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatie Cást II.

Hypertrophic cardiomyopathy is currently understood as a group of diseases with left ventricular hypertrophy, which are not based on adaptive mechanisms. The first part of the review details the possibility of cardiac magnetic resonance in the diagnosis of sarcomeric forms of hypertrophic cardiomyopathy, the second part will focus on the possibilities of distinguishing the sarcomeric forms from their phenocopies.Key words: cardiac magnetic resonance - hypertrophic cardiomyopathy - phenocopies.

[The role of cardiovascular magnetic resonance imaging in the diagnosis of hypertrophic cardiomyopathy. Part I]. / Význam zobrazení srdce pomocí magnetické rezonance v diagnostice hypertrofické kardiomyopatieCást I.

Hypertrophic cardiomyopathy is the most common genetic cardiomyopathy in our population. The diagnosis of this disease is based on imaging methods, mainly echocardiography. Cardiac magnetic resonance offers more accurate and detailed information about the disease than echocardiography. Development of this method has become a standard part of the diagnostic algorithm. In the first part of review, the authors analyze the potential and significance of cardiac magnetic resonance in the diagnosis of hypertrophic cardiomyopathy.Key words: cardiac magnetic resonance - fibrosis - hypertrophic cardiomyopathy.

Septal ventricular tachycardia with alternating LBBB-RBBB morphology in isolated ventricular noncompaction.

Knowledge on ventricular tachycardia (VT) in isolated ventricular noncompaction (IVNC) is limited. We report on a patient with IVNC who presented with cardiogenic shock due to an incessant drug-resistant VT that was cured by radiofrequency ablation. The VT had characteristics of a deep septal focal arrhythmia, which was distinctive by ablation-induced alternation of the rightward and leftward exits, and was difficult to ablate from either side of the ventricular septum.

Left atrium assessment: the evolving role of MRI.

The left atrium plays an integral role in cardiac performance. Data regarding the left atrial size, volume, function, and structure are clinically important in the management of patients with different diagnoses. Moreover, left atrial size and function were recognized as robust predictors of poor outcome across a broad range of cardiac diseases. These data are usually obtained using echocardiography. MRI can be used as an alternative tool or in clinical or experimental situations when more exact and detailed assessment is required. In the left atrial functional analysis, MRI is considered to be a gold standard technique that overcomes many of the limitations associated with echocardiographic assessment. In comparison with the other techniques, late gadolinium enhancement provides a unique opportunity to assess left atrial myocardial tissue in vivo. Complex cardiac magnetic resonance data may help to make a diagnosis, determine a prognosis and provide an impact on therapeutic actions.This review summarizes the potential role of cardiac magnetic resonance in left atrium assessment, with special emphasis on recent data and the potential future research directions.

The prognostic impact of myocardial late gadolinium enhancement.

Cardiovascular magnetic resonance using late gadolinium enhancement (LGE) provides a unique opportunity to assess myocardial tissue in vivo. LGE enables tissue characterization in ischemic and nonischemic cardiomyopathies and other cardiac diseases. LGE is associated with adverse clinical outcomes across a range of different cardiac conditions and may improve risk stratification for death, sudden cardiac death, or serious adverse events beyond traditional prognostic markers. Generally, matching data for the prognostic impact of LGE are frequently reached in cardiac disorders. In other diseases, only a limited number of trials are available, but it is anticipated that the prognostic impact of delayed enhancement will become evident. The development and validation of new cardiovascular magnetic resonance methods for diffuse myocardial fibrosis measurements would even improve the prognostic impact of LGE. The evaluation of diffuse myocardial fibrosis has a great potential in large-scale diseases, including their initial phases, with the possibility to identify patients at risk for subsequent development of clinical heart failure, to assess repeatedly the stage and progression of cardiac diseases, and to monitor the effect of treatment.