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Background: This study assessed if invasive coronary angiogram (CA) could be replaced by multislice (64- or 256-row) computed tomography (MSCT) to systematically rule out coronary allograft vasculopathy in heart transplant patients. Methods: Electrocardiogram-gated contrast-enhanced MSCT (64-row for the first 25 patients and 256-row for the others) was compared with CA. MSCT parameters, adapted to the patient’s weight, included 120 kV, 800 mAs, 0.625-mm slice thickness, and 0.42/0.27-second rotation time. The primary end point was the negative predictive value (NPV) of MSCT for the detection of significant (>50%) coronary stenosis. Secondary end points were the comparison of X-ray (mSv) and iodine contrast agent (ml) exposures. Results: The study prospectively included 102 patients (mean age, 53±14 years). Transplantation occurred 6±5 years before inclusion. At CA, 41.8% had stenosis≤50% and 8% had stenosis>50%. Among the 1,308 angiographic coronary segments≥1.5 mm, 1,250 (95.6%) were evaluable by MSCT. The NPV of MSCT was 96.6% by patient analysis and 99.7% by segment analysis. The positive predictive value (PPV) was 45.5%. The total volume of contrast agent was 139±43 vs 91±12 vs 56±19 ml (p<0.05) with 64-row MSCT, 256-row MSCT, and CA, respectively. The effective radiation dose was higher using retrospective gating (17.8±5.5 mSv, p<0.05), but similar with prospective gating (6.2±1.9 mSv, p = 0.571) compared with CA (6.0±3.5 mSv). Conclusion: Newer generations of MSCT (64- or 256-row) have a good NPV and may represent an alternative to invasive CA to rule out significant (>50%) coronary vasculopathy in heart transplant patients, despite a low PPV. [Copyright &y& Elsevier]

Primary cardiac tumors are uncommon. Malignant neoplasms account for 25%, including 75% of cardiac sarcomas. A 53-year-old female complained of exertional dyspnea and orthopnea. Chest computed tomography revealed a mass within the left atrium. Echocardiography confirmed a bilobed left atrial mass protruding through the mitral valve orifice. The tumor was completely resected and was histologically diagnosed as a high-grade pleomorphic sarcoma. A 13-month follow-up was achieved without any recurrence on magnetic resonance imaging. [ABSTRACT FROM AUTHOR]

Takayasu arteritis (TA) may affect myocardium and cause coronary stenosis. The aim of this study was to assess the prevalence and pattern of myocardial disease in patients with TA, using late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (CMRI). Twenty-seven consecutive patients with TA and 80 age- and gender-matched controls without known cardiovascular disease underwent CMRI. The prevalence of myocardial ischemic disease, as revealed by LGE, was compared between patients with TA and controls, and factors associated with myocardial disease were identified in patients with TA. Myocardial ischemic disease, as characterized by LGE on CMRI, was present in 7 (25.9%) of 27 patients with TA, and imaging with LGE showed a typical pattern of myocardial infarction in 6 patients (22.2%). Although both patients with TA and control subjects shared a similar risk of cardiovascular events, the prevalence of myocardial ischemia was >5× greater in patients with TA (p = 0.002 vs controls). No association was found between myocardial disease in patients with TA and cardiovascular atherosclerotic risk factors. The presence of myocardial scarring tended to be more closely associated with specific features of TA such as renovascular hypertension, older age at the onset of TA symptoms, male gender, aneurysmal dilatation, and Numano type V. In conclusion, finding of a significant and unexpectedly high prevalence of occult myocardial scarring in patients with TA indicates the usefulness of CMRI with LGE for the identification of occult myocardial disease in such patients. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Quantification of cardiac magnetic resonance (CMR) myocardial perfusion remains time consuming since it requires manual interventions to compensate for motion. Thus, the aim of this study was to evaluate a semiautomated registration method. Materials and Methods: A rigid edge-based registration algorithm was applied on 10 patients who had rest and stress CMR acquisitions on three slice levels (apical, midventricular and basal slices). Registration efficiency was assessed qualitatively by evaluating the quality of k-means maps in terms of symmetry and heart structures identification before and after registration and quantitatively by estimating noise amplitude within the myocardium. Finally, residual registration errors were manually estimated. Results: Before registration, k-means maps were satisfactory for 15 of 30 slices at rest and for only 5 of 30 slices during stress. After registration, the k-means maps quality was satisfactory for 29 of 30 slices at rest and for 30 of 30 slices during stress. Moreover, registration reduced noise amplitude from 49±26 to 29±11 at rest (P<.01) and from 52±14 to 30±10 during stress (P<.01). The residual horizontal and vertical shifts were 0.06±0.12 and 0.04±0.08 mm at rest and 0.32±0.69 and 0.28±0.53 mm at stress. Conclusion: The registration was successfully tested on rest and stress CMR perfusion data. It provides a valuable basis for quantitative evaluation of myocardial perfusion. [Copyright &y& Elsevier]