Overcoming the difficulties to adequately detect myocardial ischaemia in women

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Magnetic resonance perfusion or fractional flow reserve in coronary disease. Reply

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Myocardial tagging for the analysis left ventricular function

8. Conclusions: Based on our measurements following observations were made: (1) The left ventricle performs a systolic wringing motion which occurs mainly during isovolumic contraction. (2) Diastolic untwisting is found predominantly during isovolumic relaxation and occurs opposite to systolic rotation. (3) After myocardial infarction regional shortening is reduced in infarcted and remote regions. Predominantly diastolic untwisting is delayed and prolonged. (4) In patients with aortic stenosis apical rotation is enhanced, whereas diastolic untwisting is significantly inhibited, which explains the diastolic dysfunction in these patients. Myocardial tagging makes an accurate regional wall motion analysis and the assessment of cardiac rotation possible and, thus, allow new insight into the mechanical function of the hear

Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking.

BACKGROUND: Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a recently described method of post processing routine cine acquisitions which aims to provide quantitative measurements of circumferentially and radially directed ventricular wall strain. Inter-study reproducibility is important for serial assessments however has not been defined for CMR-FT. METHODS: 16 healthy volunteers were imaged 3 times within a single day. The first examination was performed at 0900 after fasting and was immediately followed by the second. The third, non-fasting scan, was performed at 1400.CMR-FT measures of segmental and global strain parameters were calculated. Left ventricular (LV) circumferential and radial strain were determined in the short axis orientation (Ecc(SAX) and Err(SAX) respectively). LV and right ventricular longitudinal strain and LV radial strain were determined from the 4-chamber orientation (Ell(LV), Ell(RV), and Err(LAX) respectively). LV volumes and function were also analysed.Inter-study reproducibility and study sample sizes required to demonstrate 5% changes in absolute strain were determined by comparison of the first and second exams. The third exam was used to determine whether diurnal variation affected reproducibility. RESULTS: CMR-FT strain analysis inter-study reproducibility was variable. Global strain assessment was more reproducible than segmental analysis. Overall Ecc(SAX) was the most reproducible measure of strain: coefficient of variation (CV) 38% and 20.3% and intraclass correlation coefficient (ICC) 0.68 (0.55-0.78) and 0.7 (0.32-0.89) for segmental and global analysis respectively. The least reproducible segmental measure was Ell(RV): CV 60% and ICC 0.56 (0.41-0.69) whilst the least reproducible global measure was Err(LAX): CV 33.3% and ICC 0.44 (0-0.77). Variable reproducibility was also reflected in the calculated sample sizes, which ranged from 11 (global Ecc(SAX)) to 156 subjects (segmental Ell(RV)). The reproducibility of LV volumes and function was excellent. There was no diurnal variation in global strain or LV volumetric measurements. CONCLUSIONS: Inter-study reproducibility of CMR-FT varied between different parameters, as summarized above and was better for global rather than segmental analysis. It was not measurably affected by diurnal variation. CMR-FT may have potential for quantitative wall motion analysis with applications in patient management and clinical trials. However, inter-study reproducibility was relatively poor for segmental and long axis analyses of strain, which have yet to be validated, and may benefit from further development

Assessment of prosthetic aortic valve performance by magnetic resonance velocity imaging

Objectives: Magnetic resonance (MRI) velocity mapping was used to evaluate non-invasively the flow profiles of the ascending aorta in normal volunteers and in patients with an aortic (mechanical) valve prosthesis. Background: In patients with artificial aortic valves the flow profile in the ascending aorta is severely altered. These changes have been associated with an increased risk of thrombus formation and mechanical hemolysis. Methods: Velocity profiles were determined 30 mm distal to the aortic valve in six healthy volunteers and seven patients with aortic valve replacement (replacement within the last 2 years) using ECG triggered phase contrast MRI. Peak flow, mean flow and mean reverse flow were measured in intervals of 25 ms during the entire heart cycle. Systolic reverse flow, end-systolic closing and diastolic leakage volume were calculated for all subjects. Results: Peak flow velocity during mid-systole was significantly higher in patients with valvular prosthesis than in normals (mean±SD, 1.9±0.4 m/s vs. 1.2±0.03 m/s,P<0.001) with a double peak and a zone of reversed flow close to the inner (left lateral) wall of the ascending aorta of the patients. Closing volume was significantly larger in patients than in controls (−3.3±1.2 ml/beat vs. −0.9±0.5 ml/beat;P<0.001). There was reverse flow during systole in valvular patients amounting to 15.7±6.7% of total cardiac output compared to 2.3±1.2% in controls (P<0.001). Diastolic mean flow was negative in patients after valve replacement but not in controls (−11.0±15.2 ml/beat vs. 6.8±3.2 ml/beat;P<0.01). Conclusions: The following three major quantitative observations have been made in the present study: (1) Mechanical valve prostheses have an increased peak flow velocity with a systolic reverse flow at the inner (left lateral) wall of the ascending aorta. (2) A double peak flow velocity pattern can be observed in patients with bileaflet (mechanical) prosthesis. (3) The blood volume required for leaflet closure and the diastolic leakage blood volume are significantly higher for the examined bileaflet valve than for native heart valve