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Background In patients with conventional pacemakers or ICD's, MRI is infrequently performed due to safety concerns. Recent reports have allayed many of these concerns. However, the additive clinical value of scanning patients with cardiac implants has not been established. Objective Assessing the additive value of thoracic and non-thoracic MRI in patients with implantable cardiac devices. Methods and results Prospective data were analyzed in 500 patients with implanted cardiac devices that underwent MRI over a 12 year period at a single institution (Allegheny General Hospital, Pittsburgh, PA). A set of three questions were answered following scan interpretation by both the MRI technologist and interpreting MRI physician(s): 1) Did the primary diagnosis change? 2) Did MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ‘Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or guiding therapy. Scans encountered were neurological/neurosurgical 354 (70.8%), cardiac 98 (19.6%) and orthopedic 48 (9.6%) in nature. In 431 (86%) MRI added additional information to the primary diagnosis and in 277 (55.4%) MRI changed the primary diagnosis. In 304 (60.8%) cases management changed, 265 (53%) due to a change in diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered and no adverse effects of MRI scan were noted. Conclusions MRI in patients with implanted cardiac devices was of additive value to diagnosis and management thereby informing risk-benefit considerations. Condensed abstract 500 patients with implanted cardiac devices who underwent a MRI examination over a 12 year period were followed prospectively. Imaging primarily focus on three anatomical regions (neurological/neurosurgical, cardiac and orthopedic) providing added information to the primary diagnosis in 431 (86%) cases and changing the primary diagnosis in 277 (55.4%) cases. In 304 (60.8%) cases management changed with 265 (53%) being due to a change of diagnosis and in 39 (7.8%) due to providing additional information. No safety issues were encountered using a defined protocol. Conclusions: MR imaging retains its diagnostic yield in patients with implanted devices.

Introduction: While many studies have unequivocally demonstrated MRI safety in pts with thoracic devices, the clinical value is rarely considered. Yet, recent CMS-NCD supports more widespread considerations providing a unique opportunity for improved care. Hypothesis: We propose that MRI in pts with PM/ICDs are crucial to existing diagnosis and often substantially alters diagnosis and subsequent care. Methods: An evaluation of 1145 PM/ICDs pts who underwent MRI (GE 1.5T,WI) over 12 yrs (95% 1). Specific criteria were followed to objectively determine if MRI diagnosis altered pt care. Accordingly, 4 Boolean Logic Construct questions were posed within 1 week of MRI by technologist/MD: 1) Did primary diagnosis change? 2) Did MRI provide additional diagnoses? 3) Was pre-MRI (tentative) diagnosis confirmed? 4) Did pt care change? If 'Yes' was answered to any question, MRI was considered of value to pt diagnosis and/or impending therapy. Result: Avg MRI: 34±21min. In 1145 pts: 819 (72%) were neuro/neurosurgery (NS), 110 (10%) were musculoskeletal (MK) and 216 (19%) were cardiac (CV) pts. On review, NS-MRI's, 669 (87%) provided additional information. The diagnoses changed in 553 (73%) and medical therapy changed in 536 (70%). In only 73(10%) did MRI simply confirm original diagnosis. In 216 CV cases, MRI provided additional data. In 178 pts (82%), MRI changed the original diagnosis and in 138 (64%), pt care. MRI was uninterpretable in 29 (11%; ICD artifact) while in 41 (19%) pts there was no diagnostic change. In essence, 174 (81%) of the CV cases benefited by MRI. Finally, in 110 MK cases, MRI provided additional data in 103 (96%), in 95 (88%) changed pt care and in 1 pt simply confirmed the diagnosis. Importantly, with careful attention to device reprogramming and scanner sequences, no safety/device issues occured. Conclusion: In 1145 pts with devices, MRI adds substantial clinical value to diagnosis and subsequent management justifying any residual risk. We believe, this is the largest study to focus solely on diagnostic value and efficacy under the assumption that safety can be routinely accomplished; a new paradigm in the error of a generation of non-CIED devices.

Objectives The objective of this study was to assess the diagnostic usefulness of thoracic and nonthoracic magnetic resonance imaging (MRI) imaging in patients with implantable cardiac devices (permanent pacemaker or implantable cardioverter-defibrillators [ICDs]) to determine if there was a substantial benefit to patients with regard to diagnosis and/or management. Background MRI is infrequently performed on patients with conventional pacemakers or ICDs. Multiple studies have documented the safety of MRI scans in patients with implanted devices, yet the diagnostic value of this approach has not been established. Methods Evaluation data were acquired in 136 patients with implanted cardiac devices who underwent MRIs during a 10-year period at a single institution. Specific criteria were followed for all patients to objectively define if the diagnosis by MRI enhanced patient care; 4 questions were answered after scan interpretation by both MRI technologists and MRI physicians who performed the scan. 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? Results If “Yes” was answered to any of the preceding questions, the MRI scan was considered to be of value to patient diagnosis and/or therapy. In 97% (n = 132) of patients, MR added value to patient diagnosis and management. In 49% (n = 67) of patients, MRI added additional valuable information to the primary diagnosis, and in 30% (n = 41) of patients, MRI changed the principle diagnosis and subsequent management of the patient. No safety issues were encountered, and no adverse effects of undergoing the MRI scan were noted in any patient. Conclusions MRI in patients with implanted pacemakers and defibrillators added value to patient diagnosis and management, which justified the risk of the procedure.

MRI is infrequently performed on patients with conventional pacemakers and ICDs. While many studies have documented MRI safety, the clinical value has not been considered. Yet, the recent CMS-NCD supported more widespread considerations. We propose that MRI in pts with a PM/ICD is crucial to the

The objective of this study was to assess the diagnostic usefulness of thoracic and nonthoracic magnetic resonance imaging (MRI) imaging in patients with implantable cardiac devices (permanent pacemaker or implantable cardioverter-defibrillators [ICDs]) to determine if there was a substantial benefit to patients with regard to diagnosis and/or management.MRI is infrequently performed on patients with conventional pacemakers or ICDs. Multiple studies have documented the safety of MRI scans in patients with implanted devices, yet the diagnostic value of this approach has not been established.Evaluation data were acquired in 136 patients with implanted cardiac devices who underwent MRIs during a 10-year period at a single institution. Specific criteria were followed for all patients to objectively define if the diagnosis by MRI enhanced patient care; 4 questions were answered after scan interpretation by both MRI technologists and MRI physicians who performed the scan. 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If "Yes" was answered to any of the preceding questions, the MRI scan was considered to be of value to patient diagnosis and/or therapy.In 97% (n = 132) of patients, MR added value to patient diagnosis and management. In 49% (n = 67) of patients, MRI added additional valuable information to the primary diagnosis, and in 30% (n = 41) of patients, MRI changed the principle diagnosis and subsequent management of the patient. No safety issues were encountered, and no adverse effects of undergoing the MRI scan were noted in any patient.MRI in patients with implanted pacemakers and defibrillators added value to patient diagnosis and management, which justified the risk of the procedure.

MRI is infrequently performed on pts with conventional PM/ICDs. While many studies have unequivocally documented safety, the clinical value has not been considered. We propose that MRI in pts with PM/ICDs is crucial to the existing diagnosis and many times, substantially alters the diagnosis and

Background: MRI is infrequently performed on patients with conventional pacemakers/ICD’s. Multiple recent studies and registries (MagnaSafe) have documented the safety of MRI in these patients, yet the diagnostic value of this approach has not been established remaining a critical issue to advance this field in an era of progressive MRI useage. Objective: 1) to examine a protocol to assess the diagnostic utility of thoracic and non-thoracic MRI in patients with implantable devices and 2) to determine if there is substantial benefit to the pt with regard to diagnosis and/or management. Methods: Over 8 years, 134 pts with PM/AICD’s underwent MRI (GE, 1.5T Milwaukee, WI) at a single institution. Specific criteria were followed for all pts to objectively define whether final diagnosis by MRI imaging enhanced patient care. A checklist of three questions was answered following scan interpretation by both the technologist and performing MRI physician(s):1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Did patient management change? If ’Yes’ was answered to any of the above questions, it was considered that the MRI scan was of value to patient diagnosis and/or therapy. Results: All 134 pts underwent MRI/CMR without complications: avg scan time 24±9min including 42 pts with ICD’s, 5 pts with a retained lead and 87 non-MR conditional pacemakers. In 83% (n=112) MR added value to patient diagnosis and management. In 64% (n=86) MRI added additional valuable information to the primary diagnosis and in 19% (n=26) MRI was life-saving, changing the principal diagnosis and subsequent management of the pt. There were no deaths, arrhythmias or power-on-resets encountered and no adverse effects were noted in any pt. No post-procedure revisions or reimplantations of generator/lead were required. Conclusions: MR imaging in patients with implanted cardiac devices adds substantial value to patient diagnosis and management justifying the risk of the procedure. In this real-world patient population, we have shown that MR imaging retains its very high diagnostic yield. Risk-benefit ratios clearly justify the performance of MRI even in this higher risk population, that is, until such time as MR-conditional devices are universal.

Today, MRI is infrequently performed in pts with conventional PM/lCDs. While MagnaSafe, published in NEJM for non-thoracic MRI, unequivocally documented safety, the clinical value remains unconsidered. A myopic, potentially prohibitive, focus on safety continues. MRI in PM/lCDs pts is crucial to

Background Pacemaker/AICD use may no longer be prohibitive in the MRI environment. Seminal work by us and others has pointed towards increasing safety and specifically, the marked additive clinical value. Historically, on only extraordinarily high-risk patients with acute diagnoses were imaged. However, over time, we began to note an interesting trend as our understanding, science and comfort level admixed with zero-event rate almost imperceptibly causes us to ‘relax’ the mandate for acuity. We wondered, “Has imaging a patient with a pacemaker that was once considered a last resort procedure started to evolve into a routine study? What have we learned from performing these procedures?

Background Pacemaker/ AICD imaging is currently clincally performed in the MRI environment. A vigilant team consisting of Cardiologist, EP staff, and technologists with close patient monitoring and supervision has evolved this heretofore risky endeavor into a procedure with established safety if done properly. However, once safety is established, does such add valuable irrefutable information to merit that risk?

Methods A total of 48 patients were imaged on a GE CV/i Excite Version 12, 1.5 T system (GE, Milwaukee, WI). 8 patients had an AICD, 7 had an AICD/Pacemaker, 2 had a single pacemaker lead, 2 REVO pacemakers and 29 patients had a traditional dual-chamber pacemaker. A specific criteria was followed for all the patients undergoing this procedure to scrutinize if the final diagnosis provided additional information in patient care. A checklist of three questions were gathered and answered after the final interpretation of the MRI. Does the diagnosis change? Does the MRI provide additional information to the existing diagnosis? Does patient management change? If ‘yes’ was answered any of the above questions it was considered that the MRI scan was of value to patient diagnosis.

Previous investigations in normotensive animals have demonstrated a marked natriuretic and diuretic response following the acute administration of supraphysiologic doses of synthetic leptin. However, the importance of endogenous leptin in the regulation of renal sodium and water balance is not yet defined. This study examined the hemodynamic and renal excretory effects of circulating leptin blockade with a specific polyclonal antibody in groups of normotensive, chronically saline-loaded Sprague-Dawley rats. In the experimental group (n = 10), leptin antibody significantly decreased urinary sodium excretion and urinary flow by approximately 30% compared to the control rats (n = 10). Mean arterial pressure remained unchanged. Collectively, these results are interpreted to suggest that leptin is an important renal sodium-regulating factor under conditions of mild sodium and volume expansion.

Objective: Previous investigations have demonstrated that leptin promotes natriuresis with a renal tubular effect. However, the mechanisms involved in this response are unclear. The present study was designed to examine the hypothesis that the natriuretic response to leptin in normotensive Sprague-Dawley rats is regulated by nitric oxide (NO). Research Methods and Procedures: The hemodynamic and renal excretory effects of intravenous bolus administration of pharmacological doses of synthetic murine leptin were examined in groups of control Sprague-Dawley rats (n = 8), Sprague-Dawley rats treated for 4 days with the NO synthase inhibitor Nω-nitro-l-arginine methyl ester (l-NAME) (n = 8), and Sprague-Dawley rats treated for 4 days with l-NAME followed by acute treatment with sodium nitroprusside (n = 8). Results: In the control group (n = 8), an intravenous bolus of leptin, 400 μg/kg body weight, increased urinary sodium excretion 4- to 6-fold. In the Sprague-Dawley rats chronically administered l-NAME (n = 8), an intravenous bolus of 400 μg/kg of leptin did not increase sodium excretion. Acute sodium nitroprusside infusion to Sprague-Dawley rats chronically treated with l-NAME (n = 8) was associated with partial restoration of the sodium excretory response to leptin administration. Discussion: Collectively, these results are interpreted to suggest that the natriuretic and diuretic responses to leptin observed in the Sprague-Dawley rat require a functional NO system.

A 54-year-old male patient with bilateral metal-on-metal hip prosthesis and recently diagnosed cobalt toxicity presented with gradually worsening symptoms of heart failure. Serum cobalt (120 μg/l; normal

Background Pacemaker/AICD use may no longer be prohibitive in the MRI environment. Seminal work by us and others has pointed towards increasing safety and specifically, the marked additive clinical value. Historically, only extraordinarily high-risk patients with acute life-threatening diagnoses were imaged. However, over time, we began to note an interesting trend as our understanding, science and comfort level admixed with zero-event rate almost imperceptibly causes us to ‘relax’ the mandate for ‘acuity’. We wondered, “Has imaging a patient with a pacemaker that was once considered a last resort procedure started to evolve into a ‘routine’ study?

Background Sarcoidosis is a multisystem disease. Involvement of the left ventricle (LV) in Sarcoidosis detected by CMR in the form of early (EGE) and late gadolinium enhancement (LGE) is well validated. Autopsy studies have shown abnormalities in the right ventricle (RV) as well, albeit less frequently than the LV. There have also been several case reports of sarcoidosis mimicking ARVD suggesting predominant RV involvement in those cases Objective: We sought to determine if there was evidence of RV involvement in patients with Sarcoidosis that could be detected via early and late gadolinium enhancement on CMR.