Improved dark blood late gadolinium enhancement (DB-LGE) imaging using an optimized joint inversion preparation and T2 magnetization preparation.

PURPOSE: To develop a dark blood-late gadolinium enhancement (DB-LGE) sequence that improves scar-blood contrast and delineation of scar region. METHODS: The DB-LGE sequence uses an inversion pulse followed by T2 magnetization preparation to suppress blood and normal myocardium. Time delays inserted after preparation pulses and T2 -magnetization-prep duration are used to adjust tissue contrast. Selection of these parameters was optimized using numerical simulations and phantom experiments. We evaluated DB-LGE in 9 swine and 42 patients (56 ± 14 years, 33 male). Improvement in scar-blood contrast and overall image quality was subjectively evaluated by two independent readers (1 = poor, 4 = excellent). The signal ratios among scar, blood, and myocardium were compared. RESULTS: Simulations and phantom studies demonstrated that simultaneous nulling of myocardium and blood can be achieved by selecting appropriate timing parameters. The scar-blood contrast score was significantly higher for DB-LGE (P < 0.001) with no significant difference in overall image quality (P > 0.05). Scar-blood signal ratios for DB-LGE versus LGE were 5.0 ± 2.8 versus 1.5 ± 0.5 (P < 0.001) for patients, and 2.2 ± 0.7 versus 1.0 ± 0.4 (P = 0.0023) for animals. Scar-myocardium signal ratios were 5.7 ± 2.9 versus 6.3 ± 2.6 (P = 0.35) for patients, and 3.7 ± 1.1 versus 4.1 ± 2.0 (P = 0.60) for swine. CONCLUSIONS: The DB-LGE sequence simultaneously reduces normal myocardium and blood signal intensity, thereby enhancing scar-blood contrast while preserving scar-myocardium contrast. Magn Reson Med 79:351-360, 2018. © 2017 International Society for Magnetic Resonance in Medicine.

Defying the Odds of Sudden Cardiac Death in Hypertrophic Cardiomyopathy.

We report an unusual case of a patient with hypertrophic obstructive cardiomyopathy, anomalous aortic origin of a coronary artery, obesity hypoventilation syndrome, and acquired long QT syndrome who was able to defy the odds of sudden cardiac death in the rarest of circumstances. (Level of Difficulty: Advanced.).

Heterogeneity of treatment effect in SPRINT by age and baseline comorbidities: The greatest impact of intensive blood pressure treatment is observed among younger patients without CKD or CVD and in older patients with CKD or CVD.

The Systolic Blood Pressure Intervention Trial (SPRINT), a large randomized controlled trial funded by the National Institutes of Health, randomized 9361 patients with hypertension over 50 years of age and at least one cardiovascular risk factor to intensive (SBP < 120 mm Hg) or standard (SBP < 140 mm Hg) blood pressure treatment. The trial found a significant reduction in primary cardiovascular and mortality outcomes in the intensive treatment group. We performed an IRB-approved post hoc analysis of the SPRINT trial data, recently made available through the NEJM SPRINT Data Analysis Challenge. Our subgroup analysis stratified subjects by age (≥75 years vs. <75 years) and presence or absence of pre-existing chronic kidney disease (CKD) or cardiovascular disease (CVD). We found that intensive blood pressure control was associated with a significantly lower rate of the primary CVD outcome and all-cause mortality in subjects age <75 years with no prior CVD or CKD and in subjects age ≥75 years with pre-existing CVD or CKD.