Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodeling

AimsTo assess the intricate relationship between myocardial infarction (MI) location and size and their reciprocal influences on post-infarction left ventricular (LV) remodelling.Methods and resultsA cohort of 260 reperfused ST-segment elevation MI patients was prospectively studied with cardiovascular magnetic resonance at 1 week (baseline) and 4 months (follow-up). Area at risk (AAR) and MI size were quantified by T2-weighted and late-gadolinium enhancement imaging, respectively. Adverse LV remodelling was defined as an increase in LV end-systolic volume ≥15 at follow-up. One hundred and twenty-seven (49) patients had anterior MI and 133 (51) patients had non-anterior MI. Although the degree of myocardial salvage was similar between groups (P=0.74), anterior MI patients had larger AAR and MI size than non-anterior MI patients yielding worse regional and global LV function at baseline and follow-up. At univariable analysis, anterior MI was associated with increased risk of adverse LV remodelling (P=0.017) and lower LV ejection fraction (EF) at follow-up (P=0.001), but not when accounted for baseline MI size. Accordingly, at multivariable analysis, baseline MI size but not its location was an independent predictor of adverse LV remodelling (odds ratio 1.061, P < 0.001) and EF at follow-up (β-coefficient=-0.255, P < 0.001).ConclusionAnterior MI patients experience more pronounced post-infarction LV remodelling and dysfunction than non-anterior MI patients due to a greater magnitude of irreversible ischaemic LV damage without any independent contribution of MI location. © 2011 The Author

What is new in pediatric cardiac imaging?

Cardiac imaging has had significant influence on the science and practice of pediatric cardiology. Especially the development and improvements made in noninasive imaging techniques, like echocardiography and cardiac magnetic resonance imaging (MRI), have been extremely important. Technical advancements in the field of medical imaging are quickly being made. This review will focus on some of the important evolutions in pediatric cardiac imaging. Techniques such as intracardiac echocardiography, 3D echocardiography, and tissue Doppler imaging are relatively new echocardiographic techniques, which further optimize the anatomical and functional aspects of congenital heart disease. Also, the current standing of cardiac MRI and cardiac computerized tomography will be discussed. Finally, the recent European efforts to organize training and accreditation in pediatric echocardiography are highlighted

Automatic 3-D breath-hold related motion correction of dynamic multislice MRI

Magnetic resonance (MR) cine images are often used to clinically assess left ventricular cardiac function. In a typical study, multiple 2-D long axis (LA) and short axis (SA) cine images are acquired, each in a different breath-hold. Differences in lung volume during breath-hold and overall patient motion distort spatial alignment of the images thus complicating spatial integration of all image data in three dimensions. We present a fully automatic postprocessing approach to correct these slice misalignments. The approach is based on the constrained optimization of the intensity similarity of intersecting image lines after the automatic definition of a region of interest. It uses all views and all time frames simultaneously. Our method models both in-plane and out-of-plane translations and full 3-D rotations, can be applied retrospectively and does not require a cardiac wall segmentation. The method was validated on both healthy volunteer and patient data with simulated misalignments, as well as on clinical multibreath-hold patient data. For the simulated data, subpixel accuracy could be obtained using translational correction. The possibilities and limitations of rotational correction were investigated and discussed. For the clinical multibreath-hold patient data sets, the median discrepancy between manual SA and LA contours was reduced from 2.83 to 1.33 mm using the proposed correction method. We have also shown the usefulness of the correction method for functional analysis on clinical image data. The same clinical multibreath-hold data sets were resegmented after positional correction, taking newly available complementary information of intersecting slices into account, further reducing the median discrepancy to 0.43 mm. This is due to the integration of the 2-D slice information into 3-D space.Elen A., Hermans J., Ganame J., Loeckx D., Bogaert J., Maes F., Suetens P., ''Automatic 3-D breath-hold related motion correction of dynamic multislice MRI'', IEEE transactions on medical imaging, vol. 29, no. 3, pp. 868-878, March 2010.status: publishe

Impact of myocardial haemorrhage on left ventricular function and remodelling in patients with reperfused acute myocardial infarction

Myocardial haemorrhage is a common complication following reperfusion of ST-segment-elevation acute myocardial infarction (MI). Although its presence is clearly related to infarct size, at present it is unknown whether post-reperfusion haemorrhage affects left ventricular (LV) remodelling. Magnetic resonance imaging (MRI) can be used to identify MI, myocardial haemorrhage, and microvascular obstruction (MVO), as well as measure LV volumes, function, and mass.status: publishe

The Fontan circulation: who controls cardiac output?

In a Fontan circuit the mechanisms involved in control of cardiac output at rest and during exercise differ significantly from normal. The classical model presumes an unlimited preload which is not available in the Fontan circuit. This review critically analyses the role of contractility, heart rate, and afterload and highlights the importance of pulmonary vascular resistance (PVR) in determining adequate preload and, therefore, cardiac output in these patients. A conceptual model of the determinants of cardiac output in Fontan patients is presented.status: publishe

Non-invasive characterization of the area-at-risk using magnetic resonance imaging in chronic ischaemia

we investigated the performance of quantitative stress perfusion magnetic resonance imaging (MRI) as a basis for identifying and characterizing the area-at-risk subtending a chronic coronary artery (CA) stenosis.status: publishe