Search

Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real‐time (CRT) sequences with the reference of segmented cine steady‐state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT 02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56–111) and 54 h (interquartile range 31–78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78–1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.

Eine Herzinsuffizienz erhöht das Risiko für einen ischämischen Schlaganfall und ist bei Schlaganfallpatienten mit einer höheren Morbidität und Mortalität im Vergleich zu Schlaganfallpatienten ohne Herzinsuffizienz verbunden. Obwohl die Hälfte aller Patienten mit chronischer Herzinsuffizienz eine erhaltene Ejektionsfraktion aufweist, ist der Kenntnisstand bezüglich der Diagnose und möglicher Behandlungsimplika-tionen einer solchen Herzinsuffizienz für Schlaganfallpatienten unzureichend. In dieser Arbeit wurde die diagnostische Aussagekraft einer kardialen Magnetreso-nanztomographie bei 3 Tesla hinsichtlich der Herzfunktion bei Patienten mit akutem ischämischem Schlaganfall im Rahmen der prospektiven, monozentrischen HEBRAS Studie der Charité – Universitätsmedizin Berlin untersucht. Weiterhin wurde die Validität prospektiv getriggerter Echtzeit Cine-Sequenzen mit retrospektiv gegateten segmentierten Cine-Sequenzen zur Beurteilung der linksventrikulären Herzfunktion verglichen. Soweit möglich, erfolgte eine Korrelation der Herzfunktion mit Sequenzen zur Detektion von Kontrastmittelspätanreicherung, dem Herzinsuffizienzmarker NT-proBNP sowie der echokardiographisch ermittelten Herzfunktion. Eine kardiale MRT konnte bei 185 der 229 Studienteilnehmer (81%) durchgeführt werden. Bei 50 Patienten wurde die Analyse von Herzfunktionsparametern durch die genannten Cine-Sequenzen verglichen. Hier fand sich kein signifikanter Unterschied bzgl. Ejektionsfraktion (p=0,96), enddiastolischer Myokardmasse (p=0,22), Time to peak filling rate (p=0,647) und dem transmitralen Flussquotienten E/A (p=0,365). Eine Beurteilung der Herzfunktion war bei 172 Patienten möglich und ergab in 43 Fällen (25%) eine systolische und in 102 Fällen (59%) eine diastolische Dysfunktion. Kontrastmittelspätanreicherung und eine Erhöhung des NT-proBNP korrelierten jeweils signifikant mit dem Vorliegen einer systolischen, nicht aber einer diastolischen Dysfunktion. Echokardiographiebefunde waren nur teilweise vorhanden und erlaubten keinen aussagekräftigen Vergleich. Die kardiale MRT bei 3 Tesla ist ein geeignetes Verfahren zur Analyse der Herzfunktion in einer selektierten Kohorte von Schlaganfallpatienten. Echtzeit Cine-Sequenzen erlauben grundsätzlich eine Beurteilung der systolischen und diastolischen Herzfunktion, erfordern jedoch aufgrund der abweichenden zeitlichen und räumlichen Auflösung eine Neubestimmung spezifischer Normwerte., Heart failure increases the risk of ischemic stroke and is associated with higher morbidity and mortality in stroke patients compared to stroke patients without heart failure. Although half of all patients with chronic heart failure present with a preserved ejection fraction, knowledge regarding the diagnosis and possible implications on treatment in patients with acute ischemic stroke is limited. This study investigated the diagnostic value of cardiovascular magnetic resonance imaging at 3 Tesla for the analysis of cardiac function in a cohort of acute ischemic stroke patients as part of the prospective, monocentric HEBRAS trial (HEart and BRain interfaces in Acute ischemic Stroke, NCT02142413) at the Charité – Universitätsmedizin Berlin. Furthermore, the validity of prospectively triggered cine real-time sequences was compared to retrospectively gated, segmented high resolution cine images for left ventricular functional assessment. As far as possible, systolic and diastolic cardiac function was correlated with late gadolinium enhancement, the cardiac marker NT-proBNP and echocardiographic analysis of cardiac function. Cardiac MRI was performed in 185 of 229 study participants (81%). The comparison of high resolution and cine real-time imaging in 50 patients revealed no significant difference in ejection fraction (p=0.96), enddiastolic myocardial mass (p=0.22), time to peak filling rate (p=0.647) and the transmitral flow gradient E/A (p=0.365). Evaluation of cardiac function was successful in 172 patients and revealed systolic dysfunction in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Late gadolinium enhancement and elevated NT-proBNP levels were significantly associated with systolic, but not diastolic dysfunction. Data from echocardiography was not available for all patients and did not allow meaningful comparison. Cardiac MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with acute ischemic stroke. Cine real-time imaging allows the assessment of systolic and diastolic function in principle, but requires determination of specific normal values with regard to the different spatial and temporal resolution.

Introduction The diagnosis of constrictive pericarditis can be challenging through conventional imaging. Novel imaging techniques have been proposed to improve it. Clinical Case A 74-year-old man with a previous diagnosis of heart failure with preserved ejection fraction and permanent atrial fibrillation (AF) was admitted because of worsening dyspnea, peripheral edema, and ascites refractory to diuretics therapy. ECG revealed low QRS voltages and AF with normal heart rate and laboratory exams detected increased values of BNP and hepatic stasis indices; blood count and CRP were normal. Echocardiography revealed mildly reduced bi-ventricular pump function (left ventricular ejection fraction = 52%, right ventricular fractional area change = 25%) and slightly increased wall thickness. Atria were moderately dilated (left and right atrium 46 and 44 ml/mq, respectively) and mitral and tricuspid annuli were dilated too. There was inferior vena cava plethora, moderate atriogenic tricuspid regurgitation and mild-to-moderate atriogenic mitral regurgitation. A paradoxical interventricular septal motion and significant respiratory changes on trans-mitral (>25%) and trans-tricuspid (>30%) pulsed Doppler were noted; however, there was no "annulus reversus" (lateral and septal e’ 13 and 11 cm/sec, respectively) at TDI analysis. In contrast, 2D-speckle-tracking global longitudinal strain showed impaired deformation ​​of the lateral segments with relative sparing of the septal segments. The latter pattern has been recently described as "strain reversus" or "hot septum sign". The findings were suspected of constrictive pericarditis, but a chest Computed Tomography excluded pericardial calcifications. Cardiac magnetic resonance (CMR) was then performed revealing a "septal shift" at cine-real time sequences analysis. The pericardium was slightly thickened (4-5 mm) with widespread late gadolinium enhancement but without signs of acute inflammation at T2-weighted imaging. Tricuspid regurgitation was confirmed to be "moderate" after phase-contrast imaging. Cardiac catheterization finally revealed normal coronary arteries and confirmed the diagnosis of constrictive pericarditis (square root sign, equalization of bi-ventricular end-diastolic pressures). The patient underwent pericardiectomy and tricuspid and mitral valve repair and was asymptomatic at 6-months follow-up. Conclusions Constrictive pericarditis represents a potentially reversible cause of heart failure but can be easily missed through conventional imaging. In the present case, advanced echocardiography and CMR were essential to come up with an accurate diagnosis, guiding the patient's clinical management with excellent outcome.

To analyze differences in systolic and diastolic left ventricular (LV) as well as left atrial (LA) function parameters obtained from identical cardiac magnetic resonance (MR) imaging techniques during inspiratory breath-holding and breathing (breath-hold to breathing differences).56 subjects without signs of heart failure (23/33 male/female, age 58 ± 14 years) underwent 3 T MR cine real-time and transmitral phase contrast imaging with the same spatial and temporal resolution during inspiratory breath-holding and free breathing. LV and LA volumetric function parameters were derived from segmentation of cine series, transmitral peak velocities and early-diastolic myocardial peak velocity from phase contrast series. Corresponding breath-hold and breathing parameters were compared by Bland-Altman analysis; repeatability of breath-hold and breathing measurements was quantified by variance component analysis. p 0.05 was regarded as statistically significant.Mean differences between results obtained during inspiratory breath-holding vs. breathing were significant for LV volumetric function (end-diastolic volume=-7 mL, p = 0.002; end-systolic volume=-7 mL, p 0.001; ejection fraction = 3 %, p 0.001; peak ejection rate = 22 mL/s, p = 0.002; early-diastolic peak filling rate=-34 mL/s, p = 0.025), LA volumetric function (maximum volume=-6 mL, p 0.001; total ejection fraction=-4%, p 0.001; active ejection fraction=-2%, p = 0.013; before contraction ejection fraction=-4%, p 0.001) and early-diastolic velocities (transmitral=-6 cm/s, p 0.001; tissue velocity=-1.8 cm/s, p 0.001). Standard deviations of breath-hold-to-breathing differences exceeded the corresponding repeatabilities of breath-hold and breathing measurements.Systolic and diastolic LV and LA function parameters acquired during inspiratory breath-holding and breathing differ, and large inter-individual breath-hold-to-breathing variations are possible. Thus, the breathing state should be taken into account, especially when comparing results in patient follow-up acquired in different respiratory states.

To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics. Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1. Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249 ± 58 ms vs. 1186 ± 33 ms, p

Purpose To validate an optimal 12-fold accelerated real-time cine MRI pulse sequence with radial k-space sampling and compressed sensing (CS) in patients at 1.5T and 3T. Methods We used two strategies to reduce image artifacts arising from gradient delays and eddy currents in radial k-space sampling with balanced steady-state free precession readout. We validated this pulse sequence against a standard breath-hold cine sequence in two patient cohorts: a myocardial infarction (n = 16) group at 1.5T and chronic kidney disease group (n = 18) at 3T. Two readers independently performed visual analysis of 68 cine sets in four categories (myocardial definition, temporal fidelity, artifact, noise) on a 5-point Likert scale (1 = nondiagnostic, 2 = poor, 3 = adequate or moderate, 4 = good, 5 = excellent). Another reader calculated left ventricular (LV) functional parameters, including ejection fraction. Results Compared with standard cine, real-time cine produced nonsignificantly different visually assessed scores, except for the following categories: 1) temporal fidelity scores were significantly lower (P = 0.013) for real-time cine at both field strengths, 2) artifacts scores were significantly higher (P = 0.013) for real-time cine at both field strengths, and 3) noise scores were significantly (P = 0.013) higher for real-time cine at 1.5T. Standard and real-time cine pulse sequences produced LV functional parameters that were in good agreement (e.g., absolute mean difference in ejection fraction

Aims Heart failure (HF) is frequent in patients with acute ischaemic stroke (AIS) and associated with higher morbidity and mortality. Assessment of cardiac function in AIS patients using cardiovascular MRI (CMR) may help to detect HF. We report the rate of systolic and diastolic dysfunction in a cohort of patients with AIS using CMR and compare cine real-time (CRT) sequences with the reference of segmented cine steady-state free precession sequences. Methods and results Patients with AIS without known atrial fibrillation were prospectively enrolled in the HEart and BRain Interfaces in Acute Ischemic Stroke (HEBRAS) study (NCT02142413) and underwent CMR at 3 Tesla within 7 days after AIS. Validity of CRT sequences was determined in 50 patients. A total of 229 patients were included in the analysis (mean age 66 years; 35% women; HF 2%). Evaluation of cardiac function was successful in 172 (75%) patients. Median time from stroke onset to CMR was 82 h (interquartile range 56-111) and 54 h (interquartile range 31-78) from cerebral MRI to CMR. Systolic dysfunction was observed in 43 (25%) and diastolic dysfunction in 102 (59%) patients. Diagnostic yield was similar using CRT or segmented cine imaging (no significant difference in left ventricular ejection fraction, myocardial mass, time to peak filling rate, and peak filling rate ratio E/A). Intraobserver and interobserver agreement was high (κ = 0.78-1.0 for all modalities). Conclusions Cardiovascular MRI at 3 Tesla is an appropriate method for the evaluation of cardiac function in a selected cohort of patients with AIS. Systolic and diastolic dysfunction is frequent in these patients. CRT imaging allows reliable assessment of systolic and diastolic function.