What cardiologists need to know about cardiovascular magnetic resonance (CMR)

Cardiovascular Magnetic Resonance (CMR) is increasingly used in the evaluation of patients with cardiac and aortic disease. The ability to characterise myocardial tissue, function and anatomy (in any plane) without any exposure to ionising radiation are the main advantages over other imaging modalities used in cardiology. In this article we discuss the principles underlying the imaging technique, safety issues, indications and strengths of CMR. It aims to provide a concise, practical overview for the general cardiologist

A young man with typical STEMI presentation: A case of myocarditis A Cardiac MRI Diagnosis

A 19 years old man, originated from Kongo, presented to a hospital with acute chest pain since several hours before admission. The pain was sharp in quality, distributed in the middle of left chest, not exercise related and not radiating. Although there were times in which the patient felt the pain was downgrading, it did not totally fade away. The patient was non-smoker with no risk factors of diabetic, hypertension and dyslipidaemia. He was oriented with temperature of 38.5 C, pulse was 110 tpm, blood pressure was 128/85 mmHg with fast and shallow respiration at the rate of 32 tpm. S1/S2 normal, no additional sound and significant murmur detected. Apart from minimal harsh respiratory sound at the basis of left lung, the examinations of JVP, lung and abdomen were unremarkable. Since 7 days before admission, the patient suffered cough, runny nose and throat pain with feverish but did not seek treatment for it. ECG showed sinus tachycardia with ST-elevation in inferior and anterolateral leads. Elevated cardiac enzymes CKMB 32 and Trop T 1,86

Left and right ventricular myocardial deformation and late gadolinium enhancement:incremental prognostic value in amyloid light-chain amyloidosis

Background: Previous cardiac magnetic resonance (CMR) studies have shown that both late gadolinium enhancement (LGE) and left ventricular (LV) strain have prognostic value in amyloid light-chain (AL) amyloidosis, but the right ventricular (RV) strain has not yet been studied. We aim to determine the incremental prognostic value of LV and RV LGE and strain in AL amyloidosis. Methods: This prospective study recruited 87 patients (age, 56.9 +/- 9.1 years; M/F, 56/31) and 20 healthy subjects (age, 52.7 +/- 8.1 years; M/F, 11/9) who underwent CMR. The LV LGE was classified into no, patchy and global groups. The RV LGE was classified into negative and positive groups. Myocardial deformation was measured using a dedicated software. Follow-up was performed for all-cause mortality using Cox proportional hazards regression and Kaplan-Meier curves. Results: During a median follow-up of 21 months, 34 deaths occurred. Presence of LV LGE [HR 2.44, 95% confidence interval (CI), 1.10-5.45, P=0.029] and global longitudinal strain (GLS) (HR 1.13 per 1% absolute decrease, 95% CI, 1.02-1.25, P=0.025) were independent LV predictors. RV LGE (HR 4.07, 95% CI, 1.09-15.24, P=0.037) and GLS (HR 1.10 per 1% absolute decrease, 95% CI, 1.00-1.21, P=0.047) were independent RV predictors. Complementary to LV LGE, LV GLS impairment or RV LGE further reduced survival (both log rank P Conclusions: This study confirms the incremental prognostic value of LV GLS and RV LGE in AL amyloidosis, which refines the conventional risk evaluation based on LV LGE. GLS based on non-contrast-enhanced CMR are promising new predictors

Changes of left ventricular mechanics after trans-catheter aortic valve implantation and surgical aortic valve replacement for severe aortic stenosis: A tissue-tracking cardiac magnetic resonance study

Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). The aim of the present study was to assess their changes early and late after trans-catheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) using cardiac magnetic resonance (CMR) tissue-tracking imaging. Methods: In 59 patients with severe AS undergoing either TAVI (n = 35) or surgical AVR (n = 24), CMR with late gadolinium enhancement (LGE) imaging was performed before and early post-procedure to evaluate LV function and mass, and presence/extent of LGE. A third CMR scan was performed in 29 patients after a mean follow-up of 15 ± 4 months. Tissue-tracking analysis was applied to cine CMR images, to assess LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains.
 Results: The TAVI and surgical AVR groups were similar with respect to baseline (p = 0.14) and early post-procedure (p = 0.16) LV ejection fraction. However, baseline LV GLS was significantly impaired in TAVI patients compared to surgical AVR patients (p = 0.025). Early post-procedure, TAVI resulted in a significant improvement of LV GLS (p = 0.003), while a significant worsening of LV GLS was observed early after surgical AVR (p = 0.012). At longer term follow-up, both TAVI and surgical AVR groups experienced a significant reduction of LV mass and a significant improvement of LV myocardial mechanics in all the three directions. Conclusions: Treatment-specific differences in the changes of LV myocardial mechanics early after afterload release by TAVI and surgical AVR are present. Later, both interventions are associated with an improvement of LV myocardial deformation, alongside a regression of LV hypertrophy