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Background@#There is a strong correlation between risk factors for coronary artery disease (CAD) and aortic aneurysm (AA). We aimed to investigate the prevalence and prognostic impact of CAD and AA in patients who underwent coronary aorta computed tomography (CACT) protocol, which allowed simultaneous evaluation of coronary artery and aorta. @*Methods@#Between 2010 and 2021, 1,553 patients who underwent CACT were enrolled from a tertiary center. The presence and location of AA and the presence of CAD were identified from CT. The primary outcome was a composite of cardiovascular death, acute coronary syndrome requiring urgent revascularization, and stroke at 3 years after the index CT scan. @*Results@#Out of 1,553 enrolled patients, 179 (11.5%) had AA. The prevalence of CAD was significantly higher in patients with AA than those without (47.5% vs. 18.3%, P < 0.001). Among patients with AA, the prevalence of comorbid CAD was higher in those with abdominal AA than thoracic AA (57.3% vs. 37.8%, P = 0.014), respectively. In multivariable analysis, the presence of CAD was an independent predictor of primary outcome at 3 years (hazard ratio [HR], 2.58; 95% CI, 1.47–4.51; P = 0.001), while AA was not (HR, 1.00; 95% CI, 0.48–2.07; P = 0.993). @*Conclusion@#In this cohort of patients undergoing simultaneous evaluation of coronary artery and aorta using CACT protocol, patients with AA had an increased risk of comorbid CAD compared to those without AA. CAD was independently associated with adverse clinical outcomes at 3 years.
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Idiopathic hypereosinophilic syndrome (iHES) is a rare systemic disease that is characterized by persistent peripheral eosinophilia (absolute eosinophil count ≥1500/uL) for more than 6 months, with end-organ damage and absence of a primary cause for eosinophilia. Coronary artery aneurysm (CAA) is a rare but life-threatening complication. Here, we report a case of CAA with thrombosis in a patient with iHES in whom the disease activity was well-controlled (eosinophil count <500/uL) for several years. Despite modest control of the disease activity, giant CAA can be associated with iHES; and therefore, close surveillance and monitoring for the development of complications is warranted.
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Objective@#This study aimed to evaluate the effect of implementing the consensus statement from the Asian Society of Cardiovascular Imaging-Practical Tutorial 2020 (ASCI-PT 2020) on the reliability of cardiac MR with late gadolinium enhancement (CMR-LGE) myocardial viability scoring between observers in the context of ischemic cardiomyopathy. @*Materials and Methods@#A total of 17 cardiovascular imaging experts from five different countries evaluated CMR obtained in 26 patients (male:female, 23:3; median age [interquartile range], 55.5 years [50–61.8]) with ischemic cardiomyopathy. For LGE scoring, based on the 17 segments, the extent of LGE in each segment was graded using a five-point scoring system ranging from 0 to 4 before and after exposure according to the consensus statement. All scoring was performed via webbased review. Scores for slices, vascular territories, and total scores were obtained as the sum of the relevant segmental scores. Interobserver reliability for segment scores was assessed using Fleiss’ kappa, while the intraclass correlation coefficient (ICC) was used for slice score, vascular territory score, and total score. Inter-observer agreement was assessed using the limits of agreement from the mean (LoA). @*Results@#Interobserver reliability (Fleiss’ kappa) in each segment ranged 0.242–0.662 before the consensus and increased to 0.301–0.774 after the consensus. The interobserver reliability (ICC) for each slice, each vascular territory, and total score increased after the consensus (slice, 0.728–0.805 and 0.849–0.884; vascular territory, 0.756–0.902 and 0.852–0.941; total score, 0.847 and 0.913, before and after implementing the consensus statement, respectively. Interobserver agreement in scoring also improved with the implementation of the consensus for all slices, vascular territories, and total score. The LoA for the total score narrowed from ± 10.36 points to ± 7.12 points. @*Conclusion@#The interobserver reliability and agreement for CMR-LGE scoring for ischemic cardiomyopathy improved when following guidance from the ASCI-PT 2020 consensus statement.
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Most cardiac tumors are metastases, and primary cardiac tumors are rare; even among primary cardiac tumors, primary cardiac neuroendocrine tumors (NETs) are extremely rare. Herein, we report a case of a patient presenting a left atrial mass without past medical history. Because of the location and movement of the mass, as well as the patient's cerebral infarction episode, the mass was initially suspected to be a thrombus. However, the mass was surgically diagnosed as NET.
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Background@#Reduced exercise capacity reflects symptom severity and clinical outcomes in patients with hypertrophic cardiomyopathy (HCM). The present study aimed to identify factors that may affect exercise capacity in patients with HCM. @*Methods@#In 294 patients with HCM and preserved left ventricular (LV) ejection fraction, we compared peak oxygen consumption (peak VO2 ) evaluated by cardiopulmonary exercise testing as a representative parameter of exercise tolerance with clinical and laboratory data, including N-terminal pro-hormone of brain natriuretic peptide (NT-proBNP), diastolic parameters on echocardiography, and the grade of myocardial fibrosis on cardiac magnetic resonance imaging (CMR). @*Results@#Median peak VO2 , was 29.0 mL/kg/min (interquartile range [IQR], 25.0–34.0). Age (estimated β = −0.140, P < 0.001), female sex (β = −5.362, P < 0.001), NT-proBNP (β = −1.256, P < 0.001), and E/e′ ratio on echocardiography (β = −0.209, P = 0.019) were significantly associated with exercise capacity. Peak VO2 was not associated with the amount of myocardial fibrosis on CMR (mean of late gadolinium enhancement 12.25 ± 9.67%LV). @*Conclusion@#Decreased exercise capacity was associated with age, female sex, increased NTproBNP level, and E/e′ ratio on echocardiography. Hemodynamic changes and increased filling pressure on echocardiography should be monitored in this population for improved outcomes.
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Objective@#Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadoliniumenhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). @*Materials and Methods@#Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing mocoss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. @*Results@#The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). @*Conclusion@#Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.
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Objective@#We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. @*Materials and Methods@#We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. @*Results@#The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2 , 0.82 ± 0.34 cm2 , and 0.80 ± 0.26 cm2 , respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). @*Conclusion@#High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
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Objective@#Motion-corrected averaging with a single-shot technique was introduced for faster acquisition of late-gadoliniumenhancement (LGE) cardiovascular magnetic resonance (CMR) imaging while free-breathing. We aimed to evaluate the image quality (IQ) of free-breathing motion-corrected single-shot LGE (moco-ss-LGE) in patients with hypertrophic cardiomyopathy (HCM). @*Materials and Methods@#Between April and December 2019, 30 patients (23 men; median age, 48.5; interquartile range [IQR], 36.5–61.3) with HCM were prospectively enrolled. Breath-held single-shot LGE (bh-ss-LGE) and free-breathing mocoss-LGE images were acquired in random order on a 3T MR system. Semi-quantitative IQ scores, contrast-to-noise ratios (CNRs), and quantitative size of myocardial scar were assessed on pairs of bh-ss-LGE and moco-ss-LGE. The mean ± standard deviation of the parameters was obtained. The results were compared using the Wilcoxon signed-rank test. @*Results@#The moco-ss-LGE images had better IQ scores than the bh-ss-LGE images (4.55 ± 0.55 vs. 3.68 ± 0.45, p < 0.001). The CNR of the scar to the remote myocardium (34.46 ± 11.85 vs. 26.13 ± 10.04, p < 0.001), scar to left ventricle (LV) cavity (13.09 ± 7.95 vs. 9.84 ± 6.65, p = 0.030), and LV cavity to remote myocardium (33.12 ± 15.53 vs. 22.69 ± 11.27, p < 0.001) were consistently greater for moco-ss-LGE images than for bh-ss-LGE images. Measurements of scar size did not differ significantly between LGE pairs using the following three different quantification methods: 1) full width at half-maximum method; 23.84 ± 12.88% vs. 24.05 ± 12.81% (p = 0.820), 2) 6-standard deviation method, 15.14 ± 10.78% vs. 15.99 ± 10.99% (p = 0.186), and 3) 3-standard deviation method; 36.51 ± 17.60% vs. 37.50 ± 17.90% (p = 0.785). @*Conclusion@#Motion-corrected averaging may allow for superior IQ and CNRs with free-breathing in single-shot LGE imaging, with a herald of free-breathing moco-ss-LGE as the scar imaging technique of choice for clinical practice.
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Objective@#We aimed to compare the aortic valve area (AVA) calculated using fast high-resolution three-dimensional (3D) magnetic resonance (MR) image acquisition with that of the conventional two-dimensional (2D) cine MR technique. @*Materials and Methods@#We included 139 consecutive patients (mean age ± standard deviation [SD], 68.5 ± 9.4 years) with aortic valvular stenosis (AS) and 21 asymptomatic controls (52.3 ± 14.2 years). High-resolution T2-prepared 3D steady-state free precession (SSFP) images (2.0 mm slice thickness, 10 contiguous slices) for 3D planimetry (3DP) were acquired with a single breath hold during mid-systole. 2D SSFP cine MR images (6.0 mm slice thickness) for 2D planimetry (2DP) were also obtained at three aortic valve levels. The calculations for the effective AVA based on the MR images were compared with the transthoracic echocardiographic (TTE) measurements using the continuity equation. @*Results@#The mean AVA ± SD derived by 3DP, 2DP, and TTE in the AS group were 0.81 ± 0.26 cm2 , 0.82 ± 0.34 cm2 , and 0.80 ± 0.26 cm2 , respectively (p = 0.366). The intra-observer agreement was higher for 3DP than 2DP in one observer: intraclass correlation coefficient (ICC) of 0.95 (95% confidence interval [CI], 0.94–0.97) and 0.87 (95% CI, 0.82–0.91), respectively, for observer 1 and 0.97 (95% CI, 0.96–0.98) and 0.98 (95% CI, 0.97–0.99), respectively, for observer 2. Inter-observer agreement was similar between 3DP and 2DP, with the ICC of 0.92 (95% CI, 0.89–0.94) and 0.91 (95% CI, 0.88–0.93), respectively. 3DP-derived AVA showed a slightly higher agreement with AVA measured by TTE than the 2DP-derived AVA, with the ICC of 0.87 (95% CI, 0.82–0.91) vs. 0.85 (95% CI, 0.79–0.89). @*Conclusion@#High-resolution 3D MR image acquisition, with single-breath-hold SSFP sequences, gave AVA measurement with low observer variability that correlated highly with those obtained by TTE.
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Objective@#The clinical course of an individual patient with heart failure is unpredictable with left ventricle ejection fraction (LVEF) only. We aimed to evaluate the prognostic value of cardiac magnetic resonance (CMR)-derived myocardial fibrosis extent and to determine the cutoff value for event-free survival in patients with non-ischemic cardiomyopathy (NICM) who had severely reduced LVEF. @*Materials and Methods@#Our prospective cohort study included 78 NICM patients with significantly reduced LV systolic function (LVEF < 35%). CMR images were analyzed for the presence and extent of late gadolinium enhancement (LGE). The primary outcome was major adverse cardiac events (MACEs), defined as a composite of cardiac death, heart transplantation, implantable cardioverter-defibrillator discharge for major arrhythmia, and hospitalization for congestive heart failure within 5 years after enrollment. @*Results@#A total of 80.8% (n = 63) of enrolled patients had LGE, with the median LVEF of 25.4% (19.8–32.4%). The extent of myocardial scarring was significantly higher in patients who experienced MACE than in those without any cardiac events (22.0 [5.5–46.1] %LV vs. 6.7 [0–17.1] %LV, respectively, p = 0.008). During follow-up, 51.4% of patients with LGE ≥ 12.0 %LV experienced MACE, along with 20.9% of those with LGE ≤ 12.0 %LV (log-rank p = 0.001). According to multivariate analysis, LGE extent more than 12.0 %LV was independently associated with MACE (adjusted hazard ratio, 6.71; 95% confidence interval, 2.54–17.74; p < 0.001). @*Conclusion@#In NICM patients with significantly reduced LV systolic function, the extent of LGE is a strong predictor for longterm adverse cardiac outcomes. Event-free survival was well discriminated with an LGE cutoff value of 12.0 %LV in these patients.
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Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiac anomaly that can be difficult to detect and often remains undiagnosed. PAPVR is diagnosed using non-invasive imaging techniques such as echocardiography, CT, and MRI. Image data are reviewed on a 2-dimensional (D) monitor, which may not facilitate a good understanding of the complex 3D heart structure. In recent years, 3D printing technology, which allows the creation of physical cardiac models using source image datasets obtained from cardiac CT or MRI, has been increasingly used in the medical field. We report a case involving a 3D-printed model of PAPVR with a biatrial connection. This model demonstrated separate drainages of the right upper and middle pulmonary veins into the lower superior vena cava (SVC) and the junction between the SVC and the right atrium, respectively, with biatrial communication through the right middle pulmonary vein.
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Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiac anomaly that can be difficult to detect and often remains undiagnosed. PAPVR is diagnosed using non-invasive imaging techniques such as echocardiography, CT, and MRI. Image data are reviewed on a 2-dimensional (D) monitor, which may not facilitate a good understanding of the complex 3D heart structure. In recent years, 3D printing technology, which allows the creation of physical cardiac models using source image datasets obtained from cardiac CT or MRI, has been increasingly used in the medical field. We report a case involving a 3D-printed model of PAPVR with a biatrial connection. This model demonstrated separate drainages of the right upper and middle pulmonary veins into the lower superior vena cava (SVC) and the junction between the SVC and the right atrium, respectively, with biatrial communication through the right middle pulmonary vein.
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BACKGROUND: The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. METHODS: Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session. RESULTS: Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 ± 0.8 to 1.7 ± 0.6, P = 0.002), 6MWD (387.0 ± 86.4 to 453.4 ± 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 ± 3.6 to 15.6 ± 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 ± 13.1 to 32.1 ± 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 ± 452.3 to 406.7 ± 265.4 dyne.sec.cm−5, P = 0.01) but not in cardiac index (2.94 ± 0.79 to 2.96 ± 0.93 L/min/m2, P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury. CONCLUSION: BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA.
Subject(s)
Humans , Angioplasty , Cardiac Catheterization , Cardiac Catheters , Echocardiography , Endarterectomy , Hemodynamics , Hypertension, Pulmonary , Peas , Pulmonary Artery , Recurrence , Reperfusion Injury , Vascular Resistance , World Health OrganizationABSTRACT
PURPOSE: To evaluate quantification results of single breath-hold (SBH) magnetic resonance (MR) cine imaging compared to results of conventional multiple breath-hold (MBH) technique for left ventricular (LV) function in patients with cardiac arrhythmia. MATERIALS AND METHODS: MR images of patients with arrhythmia who underwent MBH and SBH cine imaging at the same time on a 1.5T MR scanner were retrospectively reviewed. Both SBH and MBH cine imaging were performed with balanced steady state free precession. SBH scans were acquired using temporal parallel acquisition technique (TPAT). Fifty patients (65.4 ± 12.3 years, 72% men) were included. End-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), myocardial mass, and LV regional wall motion were evaluated. RESULTS: EF, myocardial mass, and regional wall motion were not significantly different between SBH and MBH acquisition techniques (all P-values > 0.05). EDV, ESV, and SV were significant difference between the two techniques. These parameters for SBH cine imaging with TPAT tended to lower than those in MBH. EF and myocardial mass of SBH cine imaging with TPAT showed good correlation with values of MBH cine imaging in Passing-Bablok regression charts and Bland-Altman plots. However, SBH imaging required significantly shorter acquisition time than MBH cine imaging (15 ± 7 sec vs. 293 ± 104 sec, P < 0.001). CONCLUSION: SBH cine imaging with TPAT permits shorter acquisition time with assessment results of global and regional LV function comparable to those with MBH cine imaging in patients with arrhythmia.
Subject(s)
Humans , Arrhythmias, Cardiac , Retrospective Studies , Stroke Volume , Ventricular Function, LeftABSTRACT
In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.
Subject(s)
Humans , Area Under Curve , Asian People , Clinical Decision-Making , Consensus , Coronary Artery Disease , Echocardiography , Electrocardiography , Heart Diseases , Magnetic Resonance Imaging , Methods , Positron-Emission Tomography , Radionuclide Imaging , Tomography, Emission-ComputedABSTRACT
Epilepsy is a brain disorder that affects millions of people worldwide. It is characterized by recurrent and unpredictable seizures that are usually controlled with antiepileptic/anticonvulsive drugs. However, most antiepileptic drugs produce various side effects such as tolerance and sedation. Thus, there is a growing interest for alternative anticonvulsive drugs, preferably from natural or herbal sources. In this study, we evaluated the anticonvulsive effects of Rehmannia glutinosa (RG). The anticonvulsive effect of RG extract was evaluated using electroshock- and chemical-induced seizure tests in mice. To identify its probable mechanism of action, the effects of RG extract on Cl− influx was measured in vitro. We found that RG extract has anticonvulsive effects against electroshock-induced seizures, as indicated by an increased seizure threshold in mice. The RG extract also decreased the percentage of seizure responses induced by the GABAergic antagonist, pentylenetetrazole. These results suggest that the anticonvulsive effects of RG extract are mediated through a GABAergic mechanism. In support of this mechanism, our in vitro test showed that RG extract increases intracellular Cl− influx. Furthermore, RG extract did not show sedative and/or muscle relaxant effects in the open-field and rota-rod tests. Altogether, these results confirm that RG extract could be a herbal anticonvulsant and a potential alternative for clinical use.
Subject(s)
Animals , Mice , Anticonvulsants , Brain Diseases , Epilepsy , gamma-Aminobutyric Acid , In Vitro Techniques , Pentylenetetrazole , Rehmannia , Seizures , WaterABSTRACT
We report a case of perivalvular abscess in a 66-year-old man with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. No clinical features suspicious of infective endocarditis were noted, however, transthoracic echocardiography revealed non-specific echogenic focal wall thickening at mitral-aortic intervalvular fibrosa. Perivalvular abscess in the aortic valve was demonstrated as focal wall thickening between the anterior mitral leaflet and the non-coronary cusp of the aortic valve with peripheral enhancement and central low signal intensity on LGE CMR imaging. Other features suggestive of infective endocarditis, such as neither vegetation nor valvular perforation were present. The perivalvular abscess did not grow after intensive intravenous antibiotics therapy, and the patient was discharged without surgical treatment. CMR with LGE provided an early accurate diagnosis of perivalvular abscess. The diagnosis of perivalvular abscess using LGE CMR imaging was not previously reported in Korea.
Subject(s)
Aged , Humans , Abscess , Anti-Bacterial Agents , Aortic Valve , Diagnosis , Echocardiography , Endocarditis , Korea , Magnetic Resonance ImagingABSTRACT
BACKGROUND AND OBJECTIVES: The diagnosis of ischemic (ICM) and non-ischemic cardiomyopathy (NICM) is conventionally determined by the presence or absence of coronary artery disease (CAD) in the setting of a reduced left systolic function. However the presence of CAD may not always indicate that the actual left ventricular (LV) dysfunction mechanism is ischemia, as other non-ischemic etiologies can be responsible. We investigated patterns of myocardial fibrosis using delayed hyperenhancement (DHE) on cardiac magnetic resonance (CMR) in ICM and NICM. SUBJECTS AND METHODS: Patients with systolic heart failure who underwent a CMR were prospectively analyzed. The heart failure diagnosis was based on the modified Framingham criteria and LVEF <35%. LV dysfunction was classified as ICM or NICM based on coronary anatomy. RESULTS: A total of 101 subjects were analyzed; 34 were classified as ICM and 67 as NICM. The DHE pattern was concordant with the conventional diagnosis in 27 (79.4%) of the patients with ICM and 62 (92.5%) of the patients with NCIM. A discordant NICM DHE pattern was present in 8.8% of patients with ICM, and an ICM pattern was detected 6.0% of the patients with NICM. Furthermore, 11.8% of the patients with ICM and 1.5% of those with NICM demonstrated a mixed pattern. CONCLUSION: A subset of patients conventionally diagnosed with ICM or NICM based on coronary anatomy demonstrated a discordant or mixed DHE pattern. CMR-DHE imaging can be helpful to determine the etiology of heart failure in patients with persistent LV systolic dysfunction.
Subject(s)
Humans , Cardiac Imaging Techniques , Cardiomyopathies , Coronary Artery Disease , Diagnosis , Fibrosis , Heart Failure , Heart Failure, Systolic , Ischemia , Magnetic Resonance Imaging , Prospective StudiesABSTRACT
OBJECTIVE: To evaluate the feasibility of coronary artery calcium scoring based on three virtual noncontrast-enhanced (VNC) images derived from single-source spectral dual-energy CT (DECT) as compared with true noncontrast-enhanced (TNC) images. MATERIALS AND METHODS: This prospective study was conducted with the approval of our Institutional Review Board. Ninety-seven patients underwent noncontrast CT followed by contrast-enhanced chest CT using single-source spectral DECT. Iodine eliminated VNC images were reconstructed using two kinds of 2-material decomposition algorithms (material density iodine-water pair [MDW], material density iodine-calcium pair [MDC]) and a material suppressed algorithm (material suppressed iodine [MSI]). Two readers independently quantified calcium on VNC and TNC images. The Spearman correlation coefficient test and Bland-Altman method were used for statistical analyses. RESULTS: Coronary artery calcium scores from all three VNC images showed excellent correlation with those from the TNC images (Spearman's correlation coefficient [ρ] = 0.94, 0.88, and 0.89 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Measured coronary calcium volumes from VNC images also correlated well with those from TNC images (ρ = 0.92, 0.87, and 0.91 for MDW, MDC, and MSI, respectively; p < 0.001 for all pairs). Among the three VNC images, coronary calcium from MDW correlated best with that from TNC. The coronary artery calcium scores and volumes were significantly lower from the VNC images than from the TNC images (p < 0.001 for all pairs). CONCLUSION: The use of VNC images from contrast-enhanced CT using dual-energy material decomposition/suppression is feasible for coronary calcium scoring. The absolute value from VNC tends to be smaller than that from TNC.