5 research outputs found
Multidetector cardiac tomography: A useful tool before cardiac resynchronization therapy
Background: Left ventricular lead placement in a suitable coronary vein is a key determiÂnant of responsiveness to cardiac resynchronization therapy (CRT). Multidetector cardiac tomography (MDCT) is a non-invasive alternative to depict cardiac venous anatomy although coronary sinus (CS) retrograde venography (RV) is the gold standard. The aim of this study was to evaluate the accuracy of MDCT to determine the presence of CS tributaries before CRT.
Methods: A retrospective analysis of 41 consecutive patients eligible to CRT was performed. MDCT was assessed in all patients before CRT and RV was achieved in 39 patients. Both methods evaluated the presence of the inferior interventricular vein (IIV), posterior vein (PV) and lateral main vein (LMV). CS ostium diameter and distance between the CS ostium and right atrium (RA) lateral wall were also measured.
Results: The IIV was identified in 100% of MDCT and in 43.6% of RV. In comparison to RV, the MDCT’s sensitivity to identify PV and LMV was 100% for both, kappa coefficient of 0.792 (CI 95% 0.46–0.93) and 0.69 (CI 95% 0.46–0.91), respectively. There was no significant difference between ischemic and non-ischemic patients regarding the presence of PV or LMV. Median CS antero-posterior diameter was 10.3 mm (IQR 7.5–13) and supero-inferior was 14.1 mm (IQR 11.5–17) (p < 0.01). A positive correlation (p < 0.001) between echocardiographic RA area and the distance from CS ostium to the RA lateral wall in the MDCT was observed.
Conclusions: MDCT is as accurate as RV to depict CS and its tributaries (IIV, PV, LMV), and it could be useful as a non-invasive technique before CRT
Myocardial injury following transcatheter aortic valve implantation : insights from delayed-enhancement cardiovascular magnetic resonance
Aims: The aim of this study was to evaluate the presence, localisation and extent of myocardial injury as
determined by late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging
in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods and results: A total of 37 patients, who underwent successful TAVI with a balloon-expandable
valve (transapical [TA], n=11; non-TA, n=26), were included. Cardiac biomarker (CK-MB and cTnT) lev-
els were determined at baseline and following TAVI. CMR was performed within a week before and within
30 days following TAVI. Some increase in cardiac biomarkers was detected in 97% of the patients as deter-
mined by a rise in cTnT, and in 49% of the patients as determined by a rise in CK-MB. Following TAVI, no
new myocardial necrosis defects were observed with the non-TA approach. Nonetheless, all patients who
underwent TAVI through the TA approach had new focal myocardial necrosis in the apex, with a median myo-cardial extent and necrotic mass of 5% [2.0-7.0] and 3.5 g [2.3-4.5], respectively.
Conclusions: Although some increase in cardiac biomarkers of myocardial injury was systematically
detected following TAVI, new myocardial necrosis as evaluated by CMR was observed only in patients
undergoing the procedure through the TA approach, involving ~5% of the myocardium in the apex
Characteristics of trabeculated myocardium burden in young and apparently healthy adults
Increased myocardial trabeculations define noncompaction cardiomyopathy (NCC).
Imaging advancements have led to increasingly common identification of prominent trabeculations
with unknown implications. We quantified and determined the impact of trabeculations’
burden on cardiac function and stretch in a population of healthy young
adults. One hundred adults aged 18 to 35 years (28 – 4 years, 55% women) without known
cardiovascular disease were prospectively studied by cardiovascular magnetic resonance.
Left ventricular (LV) volumes, segmental function, and ejection fraction (EF) and left atrial
volumes were determined. Thickness and area of trabeculated (T) and dense (D) myocardium
were measured for each standardized LV segment. N-terminal pro-brain natriuretic
peptide (Nt-pro-BNP) was measured. Eighteen percent of the subjects had ‡1 positive
traditional criteria for NCC, and 11% meet new proposed NCC cardiovascular magnetic
resonance criteria. Trabeculated over dense myocardium ratio (T/D) ratios were uniformly
greater at end-diastole versus end-systole (0.90 – 0.25 vs 0.42 – 0.13, p <0.0001), in women
versus men (0.85 – 0.24 vs 0.72 – 0.19, p [ 0.006), at anterior versus nonanterior segments
(1.41 – 0.59 vs 0.88 – 0.35, p <0.0001), and at apical versus nonapical segments (1.31 – 0.56
vs 0.87 – 0.38, p <0.0001). The largest T/D ratios were associated with lower LVEF (57.0 –
5.3 vs 62 – 5.5, p [ 0.0001) and greater Nt-pro-BNP (203 – 98 vs 155 – 103, p [ 0.04).
Multivariable regression identified greater end-systolic T/D ratios as the strongest independent
predictor of lower LVEF, beyond age and gender, left atrial or LV volumes, and
Nt-pro-BNP (b [ L9.9, 95% CI L15 to 4.9, p <0.001). In conclusion, healthy adults
possess variable amounts of trabeculations that regularly meet criteria for NCC. Greater
trabeculations are associated with decreased LV function. Apparently healthy young adults
with increased trabecular burden possess evidence of mildly impaired cardiac
function
Cardiac magnetic resonance versus transthoracic echocardiography for the assessment and quantification of aortic regurgitation in patients undergoing transcatheter aortic valve implantation
Background: The transthoracic echocardiographic (TTE)
evaluation of the severity of residual aortic regurgitation
(AR) following transcatheter aortic valve implantation
(TAVI) has been controversial and lacks validation.
Objectives: This study sought to compare TTE and
cardiac magnetic resonance (CMR) for assessment of AR
in patients undergoing TAVI with a balloon-expandable
valve.
Methods: TTE and CMR exams were performed
pre-TAVI in 50 patients and were repeated postprocedure
in 42 patients. All imaging data were analysed in
centralised core laboratories.
Results: The severity of native AR as determined by
multiparametric TTE approach correlated well with the
regurgitant volume and regurgitant fraction determined
by CMR prior to TAVI (Rs=0.79 and 0.80, respectively;
p<0.001 for both). However, after TAVI, the correlation
between the prosthetic AR severity assessed by TTE and
regurgitant volume and fraction measured by CMR was
only modest (Rs=0.59 and 0.59, respectively; p<0.001
for both), with an underestimation of AR severity by TTE
in 61.9% of patients (1 grade in 59.5%). The TTE jet
diameter in parasternal view and the multiparametric
approach (Rs=0.62 and 0.59, respectively; both with
p<0.001) showed the best correlation with CMR
regurgitant fraction post-TAVI. The circumferential extent
of prosthetic paravalvular regurgitation showed a poor
correlation with CMR regurgitant volume and fraction
(Rs=0.32, p=0.084; Rs=0.36, p=0.054, respectively).
Conclusions: The severity of AR following TAVI with a
balloon-expandable valve was underestimated by
echocardiography as compared with CMR. The jet
diameter, but not the circumferential extent of the leaks,
and the multiparametric echocardiography integrative
approach best correlated with CMR findings. These
results provide important insight into the evaluation of
AR severity post-TAVI