A 54-year-old male with history of cocaine abuse underwent trans-thoracic echocardiography that showed hyper-echogenicity of the basal segments of the septum and infero-lateral wall of the left ventricle. The patient underwent cardiac CT that reported diffuse non-obstructive CAD. Cardiac MR showed LGE patterns consistent with non-ischemic myocardial damage associated with cocaine abuse

Arcadi, T. (Teresa)

Bolognesi, M. (Massimo)

Cademartiri, F. (Filippo)

Maffei, E. (Erica)

The International Journal of Cardiovascular Imaging

English

Erasmus University Digital Repository

IMAGES IN CARDIOLOGYCardiac magnetic resonance in cocaine-induced myocardialdamageTeresa Arcadi • Massimo Bolognesi •Erica Maffei • Filippo CademartiriReceived: 14 January 2014 / Accepted: 21 January 2014 / Published online: 31 January 2014 Springer Science+Business Media Dordrecht 2014Abstract A 54-year-old male with history of cocaineabuse underwent trans-thoracic echocardiography thatshowed hyper-echogenicity of the basal segments of theseptum and infero-lateral wall of the left ventricle. Thepatient underwent cardiac CT that reported diffuse non-obstructive CAD. Cardiac MR showed LGE patterns con-sistent with non-ischemic myocardial damage associatedwith cocaine abuse.Keywords Cocaine abuse  Myocardial fibrosis Echocardiography  Cardiac computed tomography Cardiac magnetic resonanceA 54-year-old male with family history of ischemic heartdisease, psychosis, type 2 diabetes mellitus, bicuspid aorticvalve and ascending aortic dilatation was admitted to ouroutpatient clinic. Five years earlier the patient was admit-ted to the psychiatric service for a delusional disordersubstance abuse (cocaine). For over 5 years he was treatedfor diabetes and high blood pressure medications.Trans-thoracic echocardiography showed no wall-motion abnormalities with normal global LV function; noECG/biomarker abnormalities, arrhythmias (24-h Holtermonitoring), angina, inducible ischemia (stress ECG) wereobserved.During the latest echocardiographic examination heshowed mild aortic valve steno-insufficiency and a slightincrease of ascending aorta dilatation (45 mm); the inves-tigation demonstrated left ventricular hypertrophy withintra-myocardial patches of hyper-echogenicity in the basalsegment of the septum and inferior-lateral wall (Fig. 1a,arrow; movie 1). The patient underwent cardiac CT whichshowed three-vessel non obstructive coronary artery dis-ease and confirmed the LV hypertrophy (15 mm at septalbasal segment; Fig. 1b, arrow) and the dilation of ascend-ing aorta (44 mm).Cardiac MR was performed for the assessment of LVtissue (Fig. 1c–e). No significant wall-motion or signalabnormalities were detected at pre-contrast T1/T2 weigh-ted images in the left ventricle. Mild aortic valve regurgi-tation was observed (6 %) with normal LV ejectionfraction (55 %) and end-diastolic volume (80 ml/m2).CMR showed the presence of subtle intra-myocardial areasof early (Fig. 1c, arrowheads; Movie 2) and late Gadolin-ium Enhancement at the level of mid-basal septum(Fig. 1d, e, arrowheads) and infero-lateral mid-basal wallof the left ventricle (Fig. 1d, e, arrow). Given the non-ischemic pattern of LGE location and distribution, theabsence of typical patterns associated to LV hypertrophyand the lack of hypertrophic/dilated cardiomyopathy fea-tures, the finding is consistent with chronic fibrosisElectronic supplementary material The online version of thisarticle (doi:10.1007/s10554-014-0381-4) contains supplementarymaterial, which is available to authorized users.T. ArcadiSDN Foundation, IRCCS, Naples, ItalyM. BolognesiSports Cardiology Medicine Centre, Asl 112 District of Cesena,Cesena, ItalyE. Maffei  F. Cademartiri (&)Department of Radiology, Giovanni XXIII Clinic,Monastier di Treviso, Italye-mail: filippocademartiri@gmail.comF. CademartiriDepartment of Radiology, Erasmus Medical Center, Rotterdam,The Netherlands123Int J Cardiovasc Imaging (2014) 30:769–771DOI 10.1007/s10554-014-0381-4770 Int J Cardiovasc Imaging (2014) 30:769–771123associated with cocaine abuse. Echocardiography is usefulmean to address this kind of subtle tissue abnormalities andCMR can complete the assessment with a precise patterndefinition.Conflict of interest None.Fig. 1 Cardiac CT and conventional coronary angiography findings.Multimodality imaging of left ventricle. Echocardiography shows thehyper-echogenicity of the mid-basal septum (a—arrow) while on firstpass CT there is no evidence of tissue damage (b—arrow). Cine MRimages performed early after Gadolinium administration show a mildhyper-intensity of the basal septum with intramural distribution (d—arrowheads). Delayed MR images clearly depict late Gadoliniumenhancement at the level of the basal septum (d, e—arrowheads) andat the level of the basal lateral wall (d, e—arrows) with intra-myocardial distributionbInt J Cardiovasc Imaging (2014) 30:769–771 771123

Cardiac magnetic resonance in cocaine-induced myocardial damage

Arcadi, T

Bolognesi, M

Maffei, E

Cademartiri, F.

EUR Research Repository

Teresa Arcadi

Massimo Bolognesi

Erica Maffei

Filippo Cademartiri

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https://repub.eur.nl/pub/68746/art-3A10.1007-2Fs10554-014-0381-4.pdf

Cardiac magnetic resonance in cocaine-induced myocardial damage

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