Age- and Sex-Specific MR-Feature Tracking Reference Values of Right Atrial Deformation in Healthy Adults.

BACKGROUND: Although right atrial (RA) myocardial deformation has important implications for patient diagnosis, prognosis, and risk stratification, its implementation in clinical practice has been hampered by limited normal reference values, especially in Asian populations. PURPOSE: To establish age- and sex-specific reference values for RA strain, strain rate (SR), and displacement based on a large sample of healthy Chinese adults using MR-feature tracking (MR-FT). STUDY TYPE: Retrospective. POPULATION: 524 healthy Chinese adults (287 male; mean age 43.7 ± 11.9 years). FIELD STRENGTH/SEQUENCE: 1.5T/balanced steady-state free precession. ASSESSMENT: RA deformation parameters, including reservoir, conduit, and booster strain (εs, εe, and εa), peak positive, early negative, and late negative SR (SRs, SRe, and SRa), and total, passive, and active displacement (Ds, De, and Da), were assessed using MR-FT. STATISTICAL TESTS: Student's t-test, one-way ANOVA, coefficients of determination (r2 ), intraclass correlation coefficients (ICC), and Bland-Altman plots. A P value <0.05 was considered significant. RESULTS: Women demonstrated significantly greater magnitudes of RA deformation parameters than men: εs (57.4% ± 15.1% vs. 44.3% ± 12.6%), εe (37.5% ± 13.4% vs. 27.4% ± 10.9%), εa (19.9% ± 5.7% vs. 16.9% ± 5.0%), SRs (2.62 ± 0.88 sec-1 vs. 2.00 ± 0.63 sec-1 ), SRe (-2.98 ± 1.26 sec-1 vs. -2.16 ± 0.92 sec-1 ), SRa (-2.28 ± 0.75 sec-1 vs. -1.84 ± 0.62 sec-1 ), Ds (-7.80 ± 1.90 mm vs. -7.46 ± 1.70 mm), and De (-4.84 ± 1.31 mm vs. -4.49 ± 1.21 mm). For both sexes, aging was significantly associated with decreased RA reservoir and conduit function (εs, SRs, Ds, εe, SRe, and De), and with increased εa and Da. RA deformation measurements had good to excellent intraobserver and interobserver reproducibility, with ICCs ranging from to 0.790 to 0.972. DATA CONCLUSION: This study provides age- and sex-specific reference values of RA strain, SR, and displacement based on a large cohort of healthy Chinese adults using MR-FT. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Healthy Adult Left and Right Ventricular Torsion and Torsion Rates With MR-Feature Tracking.

BACKGROUND: The clinical value of myocardial torsion quantification in prognostic assessment and risk stratification of various cardiovascular diseases is gradually being recognized. However, normal values of left and right ventricular (LV and RV) torsion and torsion rates (TRs) have not been fully determined, and their correlation with age and gender has not been well studied. PURPOSE: To establish normal ranges of biventricular torsion, peak systolic and diastolic TRs using magnetic resonance feature tracking (MR-FT) technique based on a large sample of healthy adults, and further investigate their relationship with age and gender. STUDY TYPE: Retrospective. POPULATION: 566 Healthy adults (312 males, aged 43 ± 10 years; 254 females, aged 43 ± 11 years). FIELD STRENGTH/SEQUENCE: 1.5T/gradient echo. ASSESSMENT: Biventricular torsion, peak systolic, and diastolic TRs. STATISTICAL TESTS: Shapiro-Wilk test, Student's t-test, Mann-Whitney-U test, linear regression, intraclass correlation coefficient, Bland-Altman analysis. Differences were regarded as statistically significant at P < 0.05. RESULTS: Women demonstrated greater magnitudes of left ventricle (LV) torsion (1.23 ± 0.44 vs. 1.00 ± 0.42°/cm), peak systolic TR (9.69 ± 3.70 vs. 8.27 ± 3.73°/cm*sec), peak diastolic TR (-7.78 ± 2.82 vs. -6.06 ± 2.44°/cm*sec), and RV torsion (2.20 ± 1.23 vs. 1.65 ± 1.11°/cm*sec), peak systolic TR (16.07 ± 8.18 vs. 12.62 ± 7.08°/cm*sec), peak diastolic TR (-15.39 ± 6.53 vs. -11.70 ± 6.03°/cm*sec). For both genders, the magnitudes of LV and RV torsion, peak systolic, and diastolic TRs increased linearly with age. All the measurements of biventricular torsion, peak systolic and diastolic TRs achieved good to excellent intraobserver and interobserver reproducibility, with all intraclass correlation coefficients >0.70. DATA CONCLUSION: The present study systematically provided age- and sex-stratified reference values for LV and RV torsion and TRs using MR-FT technique. Women and aging are associated with greater magnitudes of biventricular torsion, peak systolic, and diastolic TRs. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY: Stage 2.

Myocardial Viability and Long-Term Outcomes in Ischemic Cardiomyopathy.

BACKGROUND: The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. Furthermore, although improvement in left ventricular function is one of the goals of revascularization, its relationship to subsequent outcomes is unclear. METHODS: Among 601 patients who had coronary artery disease that was amenable to coronary-artery bypass grafting (CABG) and who had a left ventricular ejection fraction of 35% or lower, we prospectively assessed myocardial viability using single-photon-emission computed tomography, dobutamine echocardiography, or both. Patients were randomly assigned to undergo CABG and receive medical therapy or to receive medical therapy alone. Left ventricular ejection fraction was measured at baseline and after 4 months of follow-up in 318 patients. The primary end point was death from any cause. The median duration of follow-up was 10.4 years. RESULTS: CABG plus medical therapy was associated with a lower incidence of death from any cause than medical therapy alone (182 deaths among 298 patients in the CABG group vs. 209 deaths among 303 patients in the medical-therapy group; adjusted hazard ratio, 0.73; 95% confidence interval, 0.60 to 0.90). However, no significant interaction was observed between the presence or absence of myocardial viability and the beneficial effect of CABG plus medical therapy over medical therapy alone (P = 0.34 for interaction). An increase in left ventricular ejection fraction was observed only among patients with myocardial viability, irrespective of treatment assignment. There was no association between changes in left ventricular ejection fraction and subsequent death. CONCLUSIONS: The findings of this study do not support the concept that myocardial viability is associated with a long-term benefit of CABG in patients with ischemic cardiomyopathy. The presence of viable myocardium was associated with improvement in left ventricular systolic function, irrespective of treatment, but such improvement was not related to long-term survival. (Funded by the National Institutes of Health; STICH ClinicalTrials.gov number, NCT00023595.).

Age- and sex-specific reference values of biventricular strain and strain rate derived from a large cohort of healthy Chinese adults: a cardiovascular magnetic resonance feature tracking study.

BACKGROUND: As a noninvasive tool, myocardial deformation imaging may facilitate the early detection of cardiac dysfunction. However, normal reference ranges of myocardial strain and strain rate (SR) based on large-scale East Asian populations are still lacking. This study aimed to provide reference values of left ventricular (LV) and right ventricular (RV) strain and SR based on a large cohort of healthy Chinese adults using cardiovascular magnetic resonance (CMR) feature tracking (FT). METHODS: Five hundred and sixty-six healthy Chinese adults (55.1% men) free of hypertension, diabetes, and obesity were included. On cine CMR, biventricular global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), and the peak radial, circumferential, and longitudinal systolic, and diastolic SRs (PSSRR, PSSRC, PSSRL, PDSRR, PDSRC, and PDSRL), and regional radial and circumferential strain at the basal, mid-cavity, and apical levels were measured. Associations of global and regional biventricular deformation indices with age and sex were investigated. RESULTS: Women demonstrated greater magnitudes of LV GRS (37.6 ± 6.1% vs. 32.1 ± 5.3%), GCS (- 20.7 ± 1.9% vs. - 18.8 ± 1.9%), GLS (- 17.8 ± 1.8% vs. - 15.6 ± 1.8%), RV GRS (25.1 ± 7.8% vs. 22.1 ± 6.7%), GCS (- 14.4 ± 3.6% vs. - 13.2 ± 3.2%), GLS (- 22.4 ± 5.2% vs. - 20.2 ± 4.6%), and biventricular peak systolic and diastolic SR in all three coordinate directions (all P < 0.05). For the LV, aging was associated with increasing amplitudes of GRS, GCS, and decreasing amplitudes of PDSRR, PDSRC, PDSRL (all P < 0.05). For the RV, aging was associated with an increase in the magnitudes of GRS, GCS, GLS, PSSRR, PSSRC, PSSRL, and a decrease in the magnitude of PDSRR, PDSRC (all P < 0.05). Biventricular radial and circumferential strain measurements at the basal, mid-cavity, and apical levels were all significantly related to age and sex in both sexes (all P < 0.05). CONCLUSIONS: We provide age- and sex-specific normal values of biventricular strain and SR based on a large sample of healthy Chinese adults with a broad age range. These results may be served as a reference standard for cardiac function assessment, especially for the Chinese population.

Reference Values for Left Atrial Strain and Strain Rate Based on a Large Sample of Healthy Chinese Adults: An MR-Feature Tracking Study.

BACKGROUND: While reference values of left atrial (LA) deformation parameters in Western populations have been established, reference data in healthy Asian populations are limited. PURPOSE: To establish age- and sex-specific reference values for LA strain and strain rate (SR) based on a large sample of healthy Chinese adults using magnetic resonance-feature tracking (MR-FT). STUDY TYPE: Retrospective. POPULATION: Four hundred and eight healthy Chinese adults (220 males, aged 43.5 ± 11.5 years; 188 females, aged 45.3 ± 12.8 years). FIELD STRENGTH/SEQUENCE: 1.5 T/balanced steady-state free precession. ASSESSMENT: Reservoir strain (εs ), conduit strain (εe ), booster strain (εa ), peak positive SR (SRs), peak early negative SR (SRe), and peak late negative SR (SRa) were obtained by MR-FT. STATISTICAL TESTS: We used Shapiro-Wilk test, Student's t-test, Mann-Whitney U-test, linear regression, and coefficient of determination (r2 ). RESULTS: Women demonstrated significantly greater LA strain (εs [%]: 44.0 ± 9.9 vs. 38.3 ± 8.7; εe [%]: 26.7 ± 8.0 vs. 22.3 ± 6.8; εa [%]: 17.3 ± 4.4 vs. 16.0 ± 3.8) and SR (SRs [/second]: 1.8 ± 0.5 vs. 1.6 ± 0.4; SRe [/second]: -2.5 ± 0.9 vs. -2.1 ± 0.7; SRa [/second]: -1.9 ± 0.6 vs. -1.8 ± 0.5) than men. For both sexes, aging was significantly associated with decreased εs , SRs, εe , and SRe (r2  = 0.07, r2  = 0.05, r2  = 0.19, and r2  = 0.24 for men; r2  = 0.13, r2  = 0.11, r2  = 0.31, and r2  = 0.46 for women), and significantly increased εa (r2  = 0.03 and r2  = 0.05 for men and women). There was no significant correlation between age and SRa in both sexes (P = 0.057 and P = 0.377 for men and women, respectively). DATA CONCLUSION: We provide age- and sex-specific reference values for LA strain and SR based on a large sample of healthy Chinese adults using MR-FT. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 5.

Coronary-artery bypass surgery in patients with left ventricular dysfunction.

BACKGROUND: The role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established. METHODS: Between July 2002 and May 2007, a total of 1212 patients with an ejection fraction of 35% or less and coronary artery disease amenable to CABG were randomly assigned to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). The primary outcome was the rate of death from any cause. Major secondary outcomes included the rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. RESULTS: The primary outcome occurred in 244 patients (41%) in the medical-therapy group and 218 (36%) in the CABG group (hazard ratio with CABG, 0.86; 95% confidence interval [CI], 0.72 to 1.04; P=0.12). A total of 201 patients (33%) in the medical-therapy group and 168 (28%) in the CABG group died from an adjudicated cardiovascular cause (hazard ratio with CABG, 0.81; 95% CI, 0.66 to 1.00; P=0.05). Death from any cause or hospitalization for cardiovascular causes occurred in 411 patients (68%) in the medical-therapy group and 351 (58%) in the CABG group (hazard ratio with CABG, 0.74; 95% CI, 0.64 to 0.85; P<0.001). By the end of the follow-up period (median, 56 months), 100 patients in the medical-therapy group (17%) underwent CABG, and 555 patients in the CABG group (91%) underwent CABG. CONCLUSIONS: In this randomized trial, there was no significant difference between medical therapy alone and medical therapy plus CABG with respect to the primary end point of death from any cause. Patients assigned to CABG, as compared with those assigned to medical therapy alone, had lower rates of death from cardiovascular causes and of death from any cause or hospitalization for cardiovascular causes. (Funded by the National Heart, Lung, and Blood Institute and Abbott Laboratories; STICH ClinicalTrials.gov number, NCT00023595.).

Why currently used diagnostic techniques for heart failure in rheumatoid arthritis are not enough: the challenge of cardiovascular magnetic resonance imaging.

Rheumatoid arthritis (RA) is a multiorgan inflammatory disorder affecting approximately 1% of the population that leads to progressive joint destruction and disability. Patients with RA exhibit a high risk of cardiovascular disease, which results in premature morbidity and mortality and reduced life expectancy, when compared with the general population. Among various guises of myocardial involvement, heart failure (HF) has been recently recognized as an important contributory factor to the excess cardiovascular mortality associated with RA. HF in RA typically presents with occult clinical symptomatology and is mainly associated with structural and functional left ventricular abnormalities leading to diastolic dysfunction, while systolic myocardial performance remains well preserved. As isolated diastolic dysfunction is a predictor of high mortality, the evaluation of patients in early asymptomatic stages, when treatment targeting the heart is more likely to be effective, is of great importance. Although patient history and physical examination remain the cornerstones of HF evaluation, noninvasive imaging of cardiac chambers, coronary arteries, and great vessels may be necessary. Echocardiography, nuclear techniques, and invasive coronary angiography are already established in the routine assessment of HF; however, many aspects of HF pathophysiology in RA remain obscure, due to the limitations of currently used techniques. The capability of cardiovascular magnetic resonance (CMR) to capture early tissue changes allows timely detection of pathophysiologic phenomena of HF in RA, such as myocardial inflammation and myocardial perfusion defects, due to either macrovascular (coronary artery disease) or microvascular (vasculitis) disease. Therefore, CMR may be a useful tool for early, accurate diagnosis and research in patients with RA.

Influence of baseline left ventricular function on the clinical outcome of surgical ventricular reconstruction in patients with ischaemic cardiomyopathy.

AIMS: The Surgical Treatment for Ischemic Heart Failure (STICH) trial demonstrated no overall benefit when surgical ventricular reconstruction (SVR) was added to coronary artery bypass grafting (CABG) in patients with ischaemic cardiomyopathy. The present analysis was to determine whether, based on baseline left ventricular (LV) function parameters, any subgroups could be identified that benefited from SVR. METHODS AND RESULTS: Among the 1000 patients enrolled, Core Lab measures of baseline LV function with adequate quality were obtained in 710 patients using echocardiography, in 352 using cardiovascular magnetic resonance, and in 344 using radionuclide imaging. The relationship between LV end-systolic volume index (ESVI), end-diastolic volume index, ejection fraction (EF), regional wall motion abnormalities, and outcome were first assessed only by echocardiographic measures, and then by 13 algorithms using a different hierarchy of imaging modalities and their quality. The median ESVI and EF were 78.0 (range: 22.8-283.8) mL/m2 and 28.0%, respectively. Hazard ratios comparing the randomized arms by subgroups of LVESVI and LVEF measured by echocardiography found that patients with smaller ventricles (LVESVI <60 mL/m2) and better LVEF (≥33%) may have benefitted by SVR, while those with larger ventricles (LVESVI >90 mL/m(2)) and lower LVEF (≤25%) did worse with SVR. Algorithms using all three imaging modalities found a weaker relationship between LV global function and the effects of SVR. The extent of regional wall motion abnormality did not influence the effects of SVR. CONCLUSIONS: Subgroup analyses of the STICH trial suggest that patients with less dilated LV and better LVEF may benefit from SVR, while those with larger LV and poorer LVEF may do worse. Clinical Trial Registration #: NCT00023595.

Systemic vasculitis: an underestimated cause of heart failure - assessment by cardiovascular magnetic resonance.

Cardiovascular manifestations in systemic vasculitis include initially silent cardiomyopathy due to either ischemic or inflammatory causes. The combination of vasculitis and cardiomyopathy is associated with a poor prognosis. Early treatment with immunosuppressants in conjunction with appropriate cardiac pharmacotherapy is considered important and has dramatically improved prognosis. Cardiovascular magnetic resonance, due to its nonionizing, noninvasive evaluation of the cardiovascular system, can be of great value in the diagnosis, follow-up, and treatment of patients with systemic vasculitis.

Evaluation of left ventricular systolic and diastolic function in subjects with prediabetes and diabetes using cardiovascular magnetic resonance-feature tracking.

AIMS: The aim of this study was to evaluate alterations in left ventricular (LV) systolic and diastolic function in subjects with prediabetes and diabetes using cardiovascular magnetic resonance-feature tracking (CMR- FT). METHODS: We included 35 subjects with prediabetes, 30 subjects with diabetes, and 33 healthy controls of similar age and sex distributions who underwent CMR examination. LV global radial, circumferential, and longitudinal strain (GRS, GCS, and GLS), peak systolic strain rate (PSSR), and peak diastolic strain rate (PDSR) were measured and compared among the three groups. Pearson's correlation and linear regression analyses were applied for statistical analyses. RESULTS: Subjects with prediabetes and diabetes had a significantly lower GLS than healthy controls, but there were no significant differences in ejection fraction (EF), GRS, GCS, or global radial, circumferential and longitudinal PSSR among the three groups. Global radial, circumferential, and longitudinal PDSR in patients with diabetes were all significantly lower than those in the healthy controls. Compared to subjects with prediabetes, patients with diabetes had a significantly lower global circumferential PDSR. Global longitudinal PDSR in subjects with prediabetes was significantly lower than that in healthy controls. Multivariable linear regression analyses demonstrated that elevated HbA1c levels were independently associated with decreased global circumferential and longitudinal PDSR (ß = -0.203, p = 0.023; ß = -0.207, p = 0.040, respectively). CONCLUSIONS: CMR-FT has potential value to evaluate early alterations in LV systolic and diastolic function in subjects with prediabetes and diabetes. Elevated HbA1c levels were independently associated with impaired LV diastolic function in the general population free of overt cardiovascular diseases.

Reference values of left and right atrial volumes and phasic function based on a large sample of healthy Chinese adults: A cardiovascular magnetic resonance study.

BACKGROUND: The left and right atrial (LA and RA) size and function are tightly linked to the morbidity and mortality of multiple cardiovascular diseases. We aimed to establish cardiovascular magnetic resonance (CMR) reference values for LA and RA volumes and phasic function based on a large sample of healthy Chinese adults. METHODS: 408 validated healthy Chinese adults (54% men; aged 21-70 years) were included. LA and RA maximum, minimum, and pre-atrial contraction volumes (Vmax, Vmin, and Vpac); total, passive, and booster emptying fractions (EF total, EF passive, and EF booster); and total, passive, and active emptying volumes (TEV, PEV, and AEV) were measured on cine CMR. Normal reference values were calculated and were stratified by sex and age decades. RESULTS: Men demonstrated greater LAVmax, LAVmin, LAVpac, LAPEV, RAVmax, RAVmin, RAVpac, RATEV, and RAAEV, while women had higher LAEF total, LAEF booster, RAEF total, RAEF passive, and RAEF booster (all p < 0.05). Age was positively correlated with LAVpac and RAVpac in both sexes but was positively correlated with LAVmax, LAVmin, RAVmax, and RAVmin only in women (all p < 0.05). For both sexes, aging was associated with decreased LAEF total, LAEF passive, RAEF total, and RAEF passive, but increased LAEF booster (all p < 0.05). CONCLUSION: We systematically provide age- and sex-specific CMR reference values for LA and RA volumes and phasic function based on a large sample of healthy Chinese adults with a wide age range. Both age and sex are closely associated with biatrial volumes and function.

Biventricular Morphology and Function Reference Values Derived From a Large Sample of Healthy Chinese Adults by Magnetic Resonance Imaging.

Background: Quantification of cardiac structure and function is essential for diagnostic interpretation and clinical decision making. We sought to establish cardiovascular magnetic resonance (CMR) reference values of left and right ventricular (LV and RV) morphology and function based on a large sample of healthy Chinese adults. Methods: Five hundred fifty validated healthy Chinese adults (aged 21-70 years; 323 men) free of hypertension, diabetes, and obesity were included in this study. All the subjects were stratified by gender (men and women) and age decades. On cine CMR, measurements of biventricular end-diastolic, end-systolic, and stroke volumes (EDV, ESV, and SV), ejection fraction (EF), and end-diastolic LV wall thickness (LVWT) and mass (LVM) were obtained. Results: Men had greater LVEDV (111.6 ± 19.8 vs. 94.6 ± 15.6 ml), LVESV (36.5 ± 9.8 vs. 28.2 ± 7.9 ml), LVM (121.1 ± 19.9 vs. 86.1 ± 14.5 g), global end-diastolic LVWT (8.1 ± 1.1 vs. 6.7 ± 1.0 mm), RVEDV (128.0 ± 23.6 vs. 101.7 ± 17.0 ml), and RVESV (53.5 ± 13.7 vs. 36.8 ± 8.9 ml), while women had greater LVEF (67.5 ± 5.4 vs. 70.4 ± 5.7%) and RVEF (58.5 ± 5.2 vs. 64.0 ± 5.3%) (all p < 0.001). For both men and women, age was negatively correlated with LVEDV (r = -0.31 and r = -0.32), LVESV (r = -0.37 and r = -0.47), RVEDV (r = -0.31 and r = -0.29), and RVESV (r = -0.33 and r = -0.44), while it was positively correlated with LVEF (r = 0.28 and r = 0.43) and RVEF (r = 0.28 and r = 0.41) (all p < 0.001). Aging was associated with increasing global end-diastolic LVWT and LVM/LVEDV in both sexes (all p < 0.001). Older age was associated with increasing LVM only in women (r = 0.36, p < 0.001), not in men (r = 0.05, p = 0.359). Conclusions: We systematically provide age-, sex-, and body size-specific CMR reference values for biventricular morphology and function based on a large sample of healthy Chinese adults. Biventricular structure and function are significantly associated with age and sex.

ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the American Society of Nuclear Cardiology, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society of Nuclear Medicine.

The American College of Cardiology Foundation (ACCF), along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical scenarios where cardiac radionuclide imaging (RNI) is frequently considered. This document is a revision of the original Single-Photon Emission Computed Tomography Myocardial Perfusion Imaging (SPECT MPI) Appropriateness Criteria, published 4 years earlier, written to reflect changes in test utilization and new clinical data, and to clarify RNI use where omissions or lack of clarity existed in the original criteria. This is in keeping with the commitment to revise and refine appropriate use criteria (AUC) on a frequent basis. The indications for this review were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Sixty-seven clinical scenarios were developed by a writing group and scored by a separate technical panel on a scale of 1 to 9 to designate appropriate use, inappropriate use, or uncertain use. In general, use of cardiac RNI for diagnosis and risk assessment in intermediate- and high-risk patients with coronary artery disease (CAD) was viewed favorably, while testing in low-risk patients, routine repeat testing, and general screening in certain clinical scenarios were viewed less favorably. Additionally, use for perioperative testing was found to be inappropriate except for high selected groups of patients. It is anticipated that these results will have a significant impact on physician decision making, test performance, and reimbursement policy, and will help guide future research.

Systolic 3D first-pass myocardial perfusion MRI: Comparison with diastolic imaging in healthy subjects.

Three-dimensional (3D) first-pass myocardial perfusion imaging (MPI) is a promising alternative to conventional two-dimensional multislice MPI due to its contiguous spatial coverage that is beneficial for estimating the size of perfusion defects. Data acquisition at mid-diastole is a typical choice for 3D MPI yet is sensitive to arrhythmia and variations in R-R interval that are common in cardiac patients. End systole is the second longest quiescent cardiac phase and is known to be less sensitive to the R-R variability. Therefore, 3D MPI with systolic acquisition may be advantageous in patients with severe arrhythmia once it is proven to be comparable to diastolic MPI in subjects with negligible R-R variation. In this work, we demonstrate the feasibility of 3D MPI with systolic data acquisition in five healthy subjects. We performed 3D MPI experiments in which 3D perfusion data were acquired at both end-systole and mid-diastole of every R-R interval and analyzed the similarity between resulting time intensity curves (TIC) from the two data sets. The correlation between systolic and diastolic TICs was extremely high (mean = 0.9841; standard deviation = 0.0166), and there was a significant linear correlation between the two time intensity curve upslopes and peak enhancements (P < 0.001).

Improved 3-Tesla cardiac cine imaging using wideband.

Cine balanced steady-state free precession (SSFP) is the most widely used sequence for assessing cardiac ventricular function at 1.5 T because it provides high signal-to-noise ratio efficiency and strong contrast between myocardium and blood. At 3 T, the use of SSFP is limited by susceptibility-induced off-resonance, resulting in either banding artifacts or the need to use a short-sequence pulse repetition time that limits the readout duration and hence the achievable spatial resolution. In this work, we apply wideband SSFP, a variant of SSFP that uses two alternating pulse repetition times to establish a steady state with wider band spacing in its frequency response and overcome the key limitations of SSFP. Prospectively gated cine two-dimensional imaging with wideband SSFP is evaluated in healthy volunteers and compared to conventional balanced SSFP, using quantitative metrics and qualitative interpretation by experienced clinicians. We demonstrate that by trading off temporal resolution and signal-to-noise ratio efficiency, wideband SSFP mitigates banding artifacts and enables imaging with approximately 30% higher spatial resolution compared to conventional SSFP with the same effective band spacing.

Progesterone, progestins, and the heart.

All combination hormone replacement regimens contain estrogen and a progestational agent. The Women's Health Initiative trial demonstrated that taking the combination of conjugated estrogen and medroxyprogesterone resulted in a higher risk of myocardial infarction and stroke in the study population. However, not all progestational agents are alike in their cardiovascular properties. This article reviews what is known about the most commonly prescribed agents: progesterone, medroxyprogesterone, norethindrone, and norethindrone acetate. We compare data on markers of lipid metabolism, inflammation, and clotting function, and review studies that measure their direct effects on cardiac vessels.

Progesterone, progestins, and the heart.

All combination hormone replacement regimens contain estrogen and a progestational agent. The Women's Health Initiative trial demonstrated that taking the combination of conjugated estrogen and medroxyprogesterone resulted in a higher risk of myocardial infarction and stroke in the study population. However, not all progestational agents are alike in their cardiovascular properties. This article reviews what is known about the most commonly prescribed agents: progesterone, medroxyprogesterone, norethindrone, and norethindrone acetate. We compare data on markers of lipid metabolism, inflammation, and clotting function, and review studies that measure their direct effects on cardiac vessels.

Improved coronary MR angiography using wideband steady state free precession at 3 tesla with sub-millimeter resolution.

PURPOSE: To suppress off-resonance artifacts in coronary artery imaging at 3 Tesla (T), and therefore improve spatial resolution. MATERIALS AND METHODS: Wideband steady state free precession (SSFP) sequences use an oscillating steady state to reduce banding artifacts. Coronary artery images were obtained at 3T using three-dimensional navigated gradient echo, balanced SSFP, and wideband SSFP sequences. RESULTS: The highest in-plane resolution of left coronary artery images was 0.68 mm in the frequency-encoding direction. Wideband SSFP produced an average SNR efficiency of 70% relative to conventional balanced SSFP and suppressed off-resonance artifacts. CONCLUSION: Wideband SSFP was found to be a promising approach for obtaining noncontrast, high-resolution coronary artery images at 3 Tesla with reliable image quality.

Cardiovascular imaging to risk-stratify in chronic angina.

The location, extent, and severity of obstructive coronary artery disease impact cardiovascular risk and mortality in independent and profound ways. Cardiovascular imaging modalities allow physicians to better define the anatomy and physiology of coronary obstructive disease. Conventional coronary angiography remains the most commonly used modality to define coronary anatomy. Computed tomography coronary angiography represents an important innovation, particularly by allowing coronary anatomy to be assessed in a noninvasive fashion. Stress myocardial perfusion imaging with single-photon emission computed tomography is a valuable prognostic tool. Stress testing, echocardiography, and stress myocardial radionuclide perfusion can all play important roles in risk stratification. Stress echocardiography is particularly useful in the clinic, due to the relatively low cost of equipment acquisition and the ability to image without exposure to radiation. The emerging modality of cardiac positron emission tomography offers the prospect of improved resolution, accurate quantification of blood flow, and shorter examination times.