Magnetic Resonance Imaging Correlates of Left Bundle Branch Disease in Patients With Nonischemic Cardiomyopathy.

The pathologic correlates of intraventricular conduction delays in patients with nonischemic cardiomyopathy (NIC) have been scarcely investigated. We assessed left ventricular (LV) structural, functional, and tissue abnormalities associated with intraventricular conduction left bundle disease (LBD), including left anterior hemiblock or complete left bundle branch block, in a cohort of patients with NIC submitted to cardiovascular magnetic resonance. Twelve-lead electrocardiogram and cardiovascular magnetic resonance were performed in 196 consecutive patients with NIC. The presence and extent of myocardial fibrosis was evaluated with late gadolinium enhancement (LGE) technique. Compared with normal intraventricular conduction patients, those with LBD were older (66 vs 59 years, p = 0.001), had greater LV volumes (p = 0.035 for end-diastolic and p = 0.009 for end-systolic volume) and mass (p = 0.034), and showed lower LV ejection fraction (33% vs 40%, p = 0.008). LGE was observed more commonly in LBD than in normal intraventricular conduction patients and was more often located in the ventricular septum (p < 0.001). On multivariate analysis, septal LGE was independently associated with a higher likelihood of LBD (odds ratio 6.1, 95% confidence interval 2.9 to 12.7, p < 0.001), even after correction for LV volumes, mass, and ejection fraction. In conclusion, in NIC, the presence of LBD is associated with worse LV remodeling and dysfunction than normal intraventricular conduction. Septal fibrosis yielded a 6-fold greater likelihood of LBD, independently of the degree of LV dilatation and systolic dysfunction

Relation of pain-to-balloon time and myocardial infarct size in patients transferred for primary percutaneous coronary intervention.

The paradigm of a shorter pain-to-balloon time decreasing extent of infarct size may be not completely true in transferred patients. This study evaluated the influence of pain-to-balloon time on infarct size as assessed by delayed enhancement magnetic resonance imaging in patients transferred from a peripheral hospital to a tertiary center for primary coronary angioplasty (percutaneous coronary intervention [PCI]). Sixty patients (40 men, 64 +/- 3 years of age) with first acute myocardial infarction were treated within < 168, 168 to 222, 223 to 300, and > 300 minutes. A presentation score system including clinical, laboratory, and echocardiographic data was used to classify severity of presentation at admission. Magnetic resonance imaging was performed 6 +/- 3 days after PCI. Group 1 had a higher presentation score than did group 2 (p < 0.02) and group 3 (p < 0.02). Group I had a significantly longer delayed enhancement than did group 2 (p < 0.002) and group 3 (p < 0.03). In conclusion we found that patients with worse presentation are transferred sooner for primary PCI. This approach in these patients does not decrease infarct size likely because of unavoidable delay to reperfusion. This finding suggests a different therapeutic strategy in these patients. (C) 2007 Elsevier Inc. All rights reserved

Prognostic Impact of Late Gadolinium Enhancement by Cardiovascular Magnetic Resonance in Myocarditis: A Systematic Review and Meta-Analysis

Background: Patients with acute myocarditis (AM) are at increased risk of adverse cardiac events after the index episode. Late gadolinium enhancement (LGE) detected by cardiovascular magnetic resonance in patients with AM plays an important diagnostic role, but its prognostic significance remains unresolved. This systematic review and meta-analysis sought to assess the prognostic implications of cardiovascular magnetic resonance-derived LGE in patients with AM. Methods: Data search was conducted from inception through February 28, 2020, using the following Medical Subject Heading terms: Myocarditis, CMR, Magnetic Resonance Imaging, Magnetic Resonance. From 2422 articles retrieved, we selected 11 studies reporting baseline cardiovascular magnetic resonance assessment and long-term clinical follow-up in patients with AM. Hazard ratios and CIs for a combined clinical end point were recorded for LGE presence, extent (>2 segments or >10% of left ventricular [LV] mass or >17g) and location (anteroseptal versus non-anteroseptal). A combined end point comprised all-cause mortality, cardiac mortality, and major adverse cardiovascular events. Hartung and Knapp correction improved robustness of the results. Prespecified sensitivity analyses explored potential sources of heterogeneity. The meta-analysis was conducted according to the Meta-analysis of Observational Studies in Epidemiology guidelines. Results: LGE presence (pooled hazard ratios, 3.28 [95% CIs, 1.69-6.39], P<0.001 [95% CIs, 1.33-8.11] after Hartung and Knapp correction) and anteroseptal LGE (pooled-hazard ratios, 2.58 [95% CIs, 1.87-3.55], P<0.001 [95% CIs, 1.64-4.06] after Hartung and Knapp correction) were associated with an increased risk of the combined end point. Extensive LGE was associated with worse outcomes (pooled-hazard ratios, 1.96 [95% CIs, 1.08-3.56], P=0.027), but this association was not confirmed after Hartung and Knapp correction (95% CIs, 0.843-4.57). Conclusions: LGE presence and anteroseptal location at baseline cardiovascular magnetic resonance are important independent prognostic markers that herald an increased risk of adverse cardiac outcomes in patients with AM. Registration: https://www.crd.york.ac.uk/PROSPERO/ Unique identifier: CRD42019146619. © 2021 Lippincott Williams and Wilkins. All rights reserved

Myocardial salvage by CMR correlates with LV remodeling and early ST-segment resolution in acute myocardial infarctioN

ObjectivesThe purpose of this study was to assess the association of myocardial salvage by cardiac magnetic resonance (CMR) with left ventricular (LV) remodeling and early ST-segment resolution in patients with acute myocardial infarction (MI).BackgroundExperimental studies revealed that MI size is strongly influenced by the extent of the area at risk (AAR), limiting its accuracy as a marker of reperfusion treatment efficacy in acute MI studies. Hence, an index correcting MI size for AAR extent is warranted. T2-weighted CMR and delayed-enhancement CMR, respectively, enable the determination of AAR and MI size, and the myocardial salvage index (MSI) is calculated by correcting MI size for AAR extent. Nevertheless, the clinical value of CMR-derived MSI has not been evaluated yet.MethodsIn a prospective cohort of 137 consecutive patients with acutely reperfused ST-segment elevation MI, CMR was performed at 1 week and 4 months. T2-weighted CMR was used to quantify AAR, whereas MI size was detected by delayed-enhancement imaging. MSI was defined as AAR extent minus MI size divided by AAR extent. Adverse LV remodeling was defined as an increase in LV end-systolic volume of ≥15%. The degree of ST-segment resolution 1 h after reperfusion was also calculated.ResultsAAR extent was consistently larger than MI size (32 ± 15% of LV vs. 18 ± 13% of LV, p < 0.0001), yielding an MSI of 0.46 ± 0.24. MI size was closely related to AAR extent (r = 0.81, p < 0.0001). After correction for the main baseline characteristics by multivariate analyses, MSI was a major and independent determinant of adverse LV remodeling (odds ratio: 0.64; 95% confidence interval: 0.49 to 0.84, p = 0.001) and was independently associated with early ST-segment resolution (B coefficient = 0.61, p < 0.0001).ConclusionsIn patients with reperfused ST-segment elevation MI, CMR-derived MSI is independently associated with adverse LV remodeling and early ST-segment resolution, opening new perspectives on its use in studies testing novel reperfusion strategies

Meta-Analysis of the Prognostic Role of Late Gadolinium Enhancement and Global Systolic Impairment in Left Ventricular Noncompaction.

The objective of this meta-analysis was to assess the predictive value of late gadolinium enhancement (LGE) and global systolic impairment for future major adverse cardiovascular events in left ventricular noncompaction (LVNC). The prognosis of patients with LVNC, with and without left ventricular dysfunction and LGE, is still unclear. A systematic review of published research and a meta-analysis reporting a combined endpoint of hard (cardiac death, sudden cardiac death, appropriate defibrillator firing, resuscitated cardiac arrest, cardiac transplantation, assist device implantation) and minor (heart failure hospitalization and thromboembolic events) events was performed. Four studies with 574 patients with LVNC and 677 with no LVNC and an average follow-up duration of 5.2 years were analyzed. In patients with LVNC, LGE was associated with the combined endpoint (pooled odds ratio: 4.9; 95% confidence interval: 1.63 to 14.6; p = 0.005) and cardiac death (pooled odds ratio: 9.8; 95% confidence interval: 2.44 to 39.5; p &lt; 0.001). Preserved left ventricular systolic function was found in 183 patients with LVNC: 25 with positive LGE and 158 with negative LGE. In LVNC with preserved ejection fraction, positive LGE was associated with hard cardiac events (odds ratio: 6.1; 95% confidence interval: 2.1 to 17.5; p &lt; 0.001). No hard cardiac events were recorded in patients with LVNC, preserved ejection fraction, and negative LGE. Patients with LVNC but without LGE have a better prognosis than those with LGE. When LGE is negative and global systolic function is preserved, no hard cardiac events are to be expected. Currently available criteria allow diagnosis of LVNC, but to further define the presence and prognostic significance of the disease, LGE and/or global systolic impairment must be considered for better risk stratification

Reference values of cardiac volumes, dimensions, and new functional parameters by MR: A multicenter, multivendor study.

To define reference values of cardiac volumes, dimensions, and new morpho-functional parameters normalized for age, gender, and body surface area by cine-bSSFP (balanced steady-state free-precession) magnetic resonance (MR). We enrolled 308 healthy subjects subdivided by gender and by six age classes: class I, &gt;15-20 years; class II, &gt;20-30 years; class III, &gt;30-40 years; class IV, &gt;40-50 years; class V, &gt;50-60 years; and class VI &gt;60 years. Dimensional, volumetric and morpho-functional parameters of the left (LV) and right (RV) ventricles were measured using cine-bSSFP MRI at 1.5T. The LV and RV end-diastolic volume indexes (EDVi) were inversely related to age (P &lt; 0.0001 r = -0.34 and P &lt; 0.0001 r = -0.37, respectively). In addition, the LV mass index decreased with age (P = 0.0004, r = -0.21). The LV longitudinal shortening was not significantly different among groups: ≥15% in all populations (95% confidence interval [CI]: 16-31). The sphericity index measured in end-diastole was higher in females than in males (P &lt; 0.03): the upper limit was 40% for males and 42% for females. The normality cutoff of LV global function index was ≥33% in males and ≥35% in females. The end-diastolic volume (EDV) of RV and LV was balanced (RV/LV ratio 0.85-1.15) without differences in the population. The LV EDV/mass was 1.0-1.8 in males and 1.0-2.1 in females. This study provides potential age- and gender-specific reference. 2 J. Magn. Reson. Imaging 2017;45:1055-1067