Search

This study sought to determine whether stress cardiac magnetic resonance (CMR) provides clinically relevant risk reclassification in patients with known coronary artery disease (CAD) in a multicenter setting in the United States.Despite improvements in medical therapy and coronary revascularization, patients with previous CAD account for a disproportionately large portion of CV events and pose a challenge for noninvasive stress testing.From the Stress Perfusion Imaging in the United States (SPINS) registry, we identified consecutive patients with documented CAD who were referred to stress CMR for evaluation of myocardial ischemia. The primary outcome was nonfatal myocardial infarction (MI) or cardiovascular (CV) death. Major adverse CV events (MACE) included MI/CV death, hospitalization for heart failure or unstable angina, and late unplanned coronary artery bypass graft. The prognostic association and net reclassification improvement by ischemia for MI/CV death were determined.Out of 755 patients (age 64 ± 11 years, 64% male), we observed 97 MI/CV deaths and 210 MACE over a median follow-up of 5.3 years. Presence of ischemia demonstrated a significant association with MI/CV death (HR: 2.30; 95% CI: 1.54-3.44; P 0.001) and MACE (HR: 2.24 ([95% CI: 1.69-2.95; P0.001). In a multivariate model adjusted for CV risk factors, ischemia maintained strong association with MI/CV death (HR: 1.84; 95% CI: 1.17-2.88; P = 0.008) and MACE (HR: 1.77; 95% CI: 1.31-2.40; P 0.001) and reclassified 95% of patients at intermediate pretest risk (62% to low risk, 33% to high risk) with corresponding changes in the observed event rates of 1.4% and 5.3% per year for low and high post-test risk, respectively.In a multicenter cohort of patients with known CAD, CMR-assessed ischemia was strongly associated with MI/CV death and reclassified patient risk beyond CV risk factors, especially in those considered to be at intermediate risk. Absence of ischemia was associated with a2% annual rate of MI/CV death. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891).

Stress cardiac magnetic resonance (CMR) provides accurate assessment of both myocardial infarction (MI) and ischemia.This study aimed to evaluate the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during assessment of coronary artery disease (CAD) by stress CMR, beyond cardiac function and ischemia.In the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, 2,349 consecutive patients (63 ± 11 years of age, 53% were male) with suspected CAD were assessed by stress CMR and followed over a median of 5.4 years. UMI was defined as the presence of late gadolinium enhancement consistent with MI in the absence of medical history of MI. This study investigated the association of UMI with all-cause mortality and nonfatal MI (death and/or MI), and major adverse cardiac events (MACE).UMI was detected in 347 patients (14.8%) and clinically recognized myocardial infarction (RMI) in 358 patients (15.2%). Compared with patients with RMI, patients with UMI had a similar burden of cardiovascular risk factors, but significantly lower left ventricular ejection fraction (p 0.001) and lower rates of guideline-directed medical therapies, including aspirin (p 0.001), statin (p 0.001), and beta-blockers (p = 0.002). During follow-up, 328 deaths and/or MIs and 528 MACE occurred. In univariate analysis, UMI and RMI were strongly associated with death and/or MI (UMI: hazard ratio [HR]: 2.15; 95% confidence interval [CI]: 1.63 to 2.83; p 0.001; RMI: HR: 2.45; 95% CI: 1.89 to 3.18) and MACE. Compared with patients with RMI, patients with UMI presented an increased risk for heart failure hospitalization (UMI vs. RMI: HR: 2.60; 95% CI: 1.48 to 4.58; p 0.001). In a multivariate model including ischemia and left ventricular ejection fraction, UMI and RMI maintained robust prognostic association with death and/or MI (UMI: HR: 1.82; 95% CI: 1.37 to 2.42; p 0.001; RMI: HR: 1.54; 95% CI: 1.14 to 2.09) and MACE.In a multicenter cohort of patients with suspected CAD, presence of UMI or RMI portended an equally significant risk for death and/or MI, independently of the presence of ischemia. Compared with RMI patients, those with UMI were less likely to receive guideline-directed medical therapies and presented an increased risk for heart failure hospitalization that warrants further study. (Stress CMR Perfusion Imaging in the United States [SPINS]; NCT03192891).

Objectives The aim of this study was to compare, using results from the multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study, the incremental cost-effectiveness of a stress cardiovascular magnetic resonance (CMR)–first strategy against 4 other clinical strategies for patients with stable symptoms suspicious for myocardial ischemia: 1) immediate x-ray coronary angiography (XCA) with selective fractional flow reserve for all patients; 2) single-photon emission computed tomography; 3) coronary computed tomographic angiography with selective computed tomographic fractional flow reserve; and 4) no imaging. Background Stress CMR perfusion imaging has established excellent diagnostic utility and prognostic value in coronary artery disease (CAD), but its cost-effectiveness in current clinical practice has not been well studied in the United States. Methods A decision analytic model was developed to project health care costs and lifetime quality-adjusted life years (QALYs) for symptomatic patients at presentation with a 32.4% prevalence of obstructive CAD. Rates of clinical events, costs, and quality-of-life values were estimated from SPINS and other published research. The analysis was conducted from a U.S. health care system perspective, with health and cost outcomes discounted annually at 3%. Results Using hard cardiovascular events (cardiovascular death or acute myocardial infarction) as the endpoint, total costs per person were lowest for the no-imaging strategy ($16,936) and highest for the immediate XCA strategy ($20,929). Lifetime QALYs were lowest for the no-imaging strategy (12.72050) and highest for the immediate XCA strategy (12.76535). The incremental cost-effectiveness ratio for the CMR-based strategy compared with the no-imaging strategy was $52,000/QALY, whereas the incremental cost-effectiveness ratio for the immediate XCA strategy was $12 million/QALY compared with CMR. Results were sensitive to variations in model inputs for prevalence of disease, hazard rate ratio for treatment of CAD, and annual discount rate. Conclusions Prior to invasive XCA, stress CMR can be a cost-effective gatekeeping tool in patients at risk for obstructive CAD in the United States. (Stress CMR Perfusion Imaging in the United States [SPINS] Study; NCT03192891

Introduction: The deleterious effects of chronic or poorly controlled diabetes mellitus (DM) on the cardiovascular system are well documented, but the prevalence of chest pain associated with inflammatory heart disease (IHD) has not been determined. This study was designed to assess and compare the prevalence of chest pain associated with IHD in diabetic (DM) and non-diabetic (ND) populations. Hypothesis: Diabetic patients may have decreased prevalence of chest pain due to IHD. Methods: A pooled cohort cardiac MRI (CMR) database was queried for all patients who had complete records pertaining to diabetes mellitus, inflammation on CMR, and concurrent chest pain. IHD was defined as myocarditis and/or pericarditis on CMR using using the Modified Lake Louise Criteria published in 2018 using not only T2 STIR and delayed gadolinium imaging, but also T1 and T2 relaxation mapping. Two of these 4 pulse sequences had to be abnormal for a IHD diagnosis. Patients were divided into disease (DM) and control (ND) groups, which were then stratified by IHD-associated chest pain. A two-tailed, two proportion Z-test with a significance value cutoff of p ≤ 0.05 was used for statistical analysis of populations. Results: A total of 951 DM patients and 3134 ND patients were identified. The DM group had 157 patients with CMR-confirmed IHD, of which 94 reported chest pain at 59.87% prevalence. The ND group had 699 patients with IHD, with 495 reporting chest pain at 70.81% prevalence. There was a statistically significant differences between groups related to prevalence of chest pain in cases of confirmed IHD (p Conclusions: The ND group demonstrated a 10.94% higher prevalence of chest pain among CMR-confirmed cases of IHD, and a 5.91% higher population prevalence of chest pain associated with IHD. This data suggests that diabetes confers a greater risk of asymptomatic IHD that may go undetected. The lower prevalence of chest pain in DM patients may possibly be explained by diabetic neuropathy induced attenuation of cardiac nociceptive pain response.

Introduction: On June 2, 2021, 6 case reports of myocarditis after the Pfizer COVID-19 vaccine surfaced. Each case had a cardiac MRI (CMR) study using T2 weighted and delayed gadolinium imaging. CMR was performed for post-vaccine symptoms. Although valuable, these data do not shed light on the prevalence of this post-vaccine occurrence. This study was designed to assess the prevalence of inflammatory heart disease(IHD) in a group of patients who had a CMR after receiving a COVID-19 vaccine. Hypothesis: Evidence of myocarditis may occur on cardiac MRI after all types of COVID-19 vaccine. Methods: From January 1 to June 8, 2021 303 patients underwent a CMR at Sharon Regional Medical Center. The date of vaccination, type of vaccine and COVID testing results and date for each of these patients were ascertained. All patients who were vaccinated prior to the CMR exam constituted the study population. IHD by CMR was defined as abnormality of 2 or more pulse sequences of the Modified Lake Louise Criteria(MLLC) of 2018: T2 STIR, Delayed enhancement after gadolinium, and prolongation of myocardial or pericardial T1 or T2 relaxation times. The number of patients with CMR evidence of IHD was tabulated for Pfizer, Moderna and Johnson&Johnson(J&J) vaccines. Results: Of 303 patients with a CMR during the study period, 77 were vaccinated prior to CMR. The mean time between vaccination and CMR was 41 days. 42 patients had a Pfizer vaccine, 30 had Moderna and 5 received J&J. 10 Pfizer receipants had IHD findings on CMR(24%), as did 7 of Moderna(23%) and 2 of J&J(40%). 13 patients had a positive COVID test prior to vaccination and IHD was present on CMR in 9 patients(69%) in this subgroup, while only 8 of 63(13%) without a positive COVID-19 test before vaccination showed evidence of IHD. Conclusions: Although retrospective, these data provide valuable information about the occurrence of IHD after COVID-19 vaccination using CMR imaging. A similar percentage of patients vaccinated with any of the 3 vaccines appear to subsequently show evidence of IHD on CMR, more so if previously COVID positive. However, evidence of IHD on post-vaccine CMR does not definitively establish causality. CMR exams before and after COVID-19 vaccination using MLLC will be required to prove a cause-effect relationship.

Introduction: Abnormalities of left ventricular (LV) strain have been shown to occur prior to impairment of global left ventricular function, measured by global LV ejection fraction (EF). Although first described in patients receiving cardiotoxic chemotherapy, impairment of LV strain prior to a decrease in EF has also been shown in many other disease states which affect LV function. This study was designed to assess impairment of LV strain in post COVID-19 patients with normal EF using cardiac MRI MyoStrain Fast-SENC (strain encoded) pulse sequences. Methods: An institutional cardiac imaging database was queried for all patients with documented COVID-19 test positivity and a normal LVEF >= 55% who underwent measurement of global longitudinal strain (GLS), global circumferential strain (GCS), and regional longitudinal and circumferential strain using cardiac MRI Fast-SENC pulse sequences. Global and regional strain measurements were compared to a cohort of healthy volunteers who also underwent CMR Fast-SENC imaging. Abnormal myocardial strain was defined as a value >-17%. Results: Of 50 COVID-19 patients in the cardiac imaging database who underwent CMR Fast-SENC imaging, 40 had a normal LVEF, constituting the study cohort. Mean GLS and GCS for the study cohort were -16.40% and -15.45% and for healthy volunteers were -19.71% and -20.93% respectively; both comparisons were statistically significant with an unpaired t-test (p Conclusions: These data suggest that impairment of LV strain (longitudinal and circumferential) occurs in COVID-19 patients who have a normal LVEF. Whether a decrease in GLS and/or GCS precede a decrease in LVEF, is beyond the scope of this study. However, the ability to evaluate progression of LV strain abnormalities with CMR may help identify changes in LV function before the onset of a reduction in LVEF and development of heart failure. The ability to identify and quantify abnormal left ventricular GLS and GCS with cardiac MRI also opens the door to assess any benefit of therapy, including anti-inflammatory agents, anti-viral drugs and steroids.

Introduction: Obesity is a known risk factor for the development of aneurysm of the ascending aorta (AscAoA). 2-D echo is the most commonly used cardiac imaging modality. 2-D Echo has a limited 90-degree field of view, and the ascending aorta may not be well visualized. Obesity causes further compromise of the field of view, as the 2-D transducer cannot be positioned in the rib space. Cardiac MRI (CMR) does not have this limitation. This study was designed to assess the detection of aneurysm of the ascending aorta in obese patients comparing 2-D echo and CMR. Hypothesis: Because of full field of view capability, CMR may be superior to 2-D Echo for the detection of aneurysm of ascending aorta in obese patients. Methods: An institutional cardiac imaging database was queried for all obese patients with a BMI greater than/equal to 30. The study cohort was composed of obese patients who had a 2-D and CMR within a 6-month period. The number of patients with AscAoA, defined as ascending aorta diameter >3.5 cm measured perpendicular to flow, was computed for both 2-D and CMR modalities. Detection rates for AscAoA were statistically compared using McNemar test. Results: Of the 6930 patients in the cardiac imaging database, 4373 were obese, of which 275 had both 2-D and CMR within a 6-month period, constituting the study cohort. Only 32 of 275 patients had a 2-D Echo report with an entered value for the diameter of the ascending aorta (10.6%), an indicator of the technical difficulty encountered when measuring the ascending aorta with 2-D Echo. Conversely, 274 patients had a CMR report with an entered diameter value for the ascending aorta (99.64%). The formal CMR report identified 167 AscAoA among the 275 patients in the study cohort, for a detection rate of 58.9%. 2-D Echo only identified 12 patients with an AscAoA in the same patient cohort, for a detection rate of 4.36%. The detection rate of aneurysm of the ascending aorta was significantly different between the 2 modalities (p-value Conclusions: Despite 2-D and CMR offering similar diagnostic information regarding left ventricular function and valve function in obese patients, CMR reports a numeric value for the ascending aorta diameter 8 times more often than 2-D, and CMR detects AscAoA 13 times more often than 2-D in obese patients.

Background: Stress cardiac magnetic resonance imaging (CMR) has demonstrated excellent diagnostic and prognostic value in single-center studies. Objectives: This study sought to investigate the prognostic value of stress CMR and downstream costs from subsequent cardiac testing in a retrospective multicenter study in the United States. Methods: In this retrospective study, consecutive patients from 13 centers across 11 states who presented with a chest pain syndrome and were referred for stress CMR were followed for a target period of 4 years. The authors associated CMR findings with a primary outcome of cardiovascular death or nonfatal myocardial infarction using competing risk-adjusted regression models and downstream costs of ischemia testing using published Medicare national payment rates. Results: In this study, 2,349 patients (63 ± 11 years of age, 47% female) were followed for a median of 5.4 years. Patients with no ischemia or late gadolinium enhancement (LGE) by CMR, observed in 1,583 patients (67%), experienced low annualized rates of primary outcome (4-fold higher annual primary outcome rate and a >10-fold higher rate of coronary revascularization during the first year after CMR. Patients with ischemia and LGE both negative had low average annual cost spent on ischemia testing across all years of follow-up, and this pattern was similar across the 4 practice environments of the participating centers. Conclusions: In a multicenter U.S. cohort with stable chest pain syndromes, stress CMR performed at experienced centers offers effective cardiac prognostication. Patients without CMR ischemia or LGE experienced a low incidence of cardiac events, little need for coronary revascularization, and low spending on subsequent ischemia testing. (Stress CMR Perfusion Imaging in the United States [SPINS]: A Society for Cardiovascular Resonance Registry Study; NCT03192891).

Introduction: Current guidelines of the American Heart Association (AHA) recommend annual serial imaging for patients with aneurysm of the ascending aorta (AscAoA). However, recent data (Park K-H et al. Eur J CT Surg 2017;51:959-64) have suggested that this imaging frequency may not be necessary. This study was designed to compare the progression in growth rates of AscAoA using cardiac MRI (CMR) in 2 large cohorts of patients reassessed every 1 year and every 2 years. Methods: An institutional cardiac imaging database was queried for all patients with AscAoA, defined as a maximum ascending aorta diameter > 3.5 cm measured perpendicular to flow using CMR. The study cohort was divided into two groups; patients who had a follow up CMR every 1 (Group A), and those who had a CMR every 2 years (Group B). AscAoA growth rates were computed for each group and statistically compared using a two-sample t-test. For analysis of cost to the healthcare system, Medicare reimbursement rates for 2019 were utilized. Published mean radiation dose for cardiac CT (CCT) was utilized to assess radiation exposure. Results: Of 6,210 patients in the cardiac imaging database, 1,849 had a diagnosis of AscAoA, of which 941 had serial CMR studies. Of these 941 patients, 342 had a follow up CMR every 1 year, while 206 had a follow up CMR every 2-years. The mean progression of AscAoA was 0.0247 ± 0.475 cm for Group A and 0.0598 ± 0.209 cm for Group B. The growth rate of AscAoA was not significantly different between groups (p=0.236). The Medicare reimbursement for CMR was $23,056 per 100 patients (CPT 75557) without radiation exposure. If CCT had been used for these patients, Medicare reimbursement would have been $20,174 per 100 patients (CPT 75572) with exposure to 10.5 mSv of radiation per study. Conclusions: There was no significant difference in progression of AscAoA diameter between Groups A and B. These data suggest that serial imaging of AscAoA every 2 years may be appropriate, with reduced cost to the healthcare system and cumulative radiation exposure. Although CMR is slightly more costly than CCT, it eliminates cumulative breast radiation exposure, a feature of particular importance for female patients.

Background Abnormalities of right ventricular (RV) strain have been shown to occur prior to impairment of global right ventricular function, measured by global RV ejection fraction (RVEF) in patients with increased RV afterload, such as pulmonary hypertension. Obesity is a form of increased afterload involving both the right and left cardiac circulations, raising suspicion that impaired RV strain may be an early indicator of myocardial dysfunction. Purpose This study was designed to assess impairment of RV strain in obese patients with normal right ventricular ejection fraction (RVEF) using cardiac MRI Fast SENC (strain encoded) pulse sequences. Methods An institutional cardiac imaging database was queried for all patients with body mass index (BMI) greater than 35 kg/m2 who underwent measurement of RV global longitudinal strain (GLS), RV global circumferential strain (GCS) and 37 segmental strain measurements using cardiac MRI Fast-SENC pulse sequences. Global RVEF was computed for all patients using a standard cardiac MRI method using non-automated hand drawn RV endocardial borders. Global and regional strain measurements were compared to a cohort of healthy volunteers who also underwent CMR Fast-SENC imaging. Abnormal myocardial strain was defined as a value greater than −17%. Results Of the 356 patients in the database, 48 had a BMI greater than 35 kg/m2. Mean RV GLS and GCS for the study cohort were −16.6 and −15.8 respectively. For healthy volunteers RV GLS and GCS were −20.8 and −19.0 respectively. Comparison of mean RV GLS and GCS of both groups were statistically significant ANOVA p Conclusions These findings suggest that morbidly many obese patients have occult RV dysfunction despite a normal RVEF. This occult RV dysfunction not only affects RV global GLS and GCS, but also the percentage of normal segmental strain values. Detection of occult RV dysfunction is of clinical significance in that it may provide an opportunity for treatment before development of symptomatic right heart failure. Figure 1 Funding Acknowledgement Type of funding source: None

The pandemic of coronavirus disease 2019 (COVID-19) secondary to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has bestowed an unprecedented challenge upon us, resulting in an international public health emergency. COVID-19 has already resulted in > 1,600,000 deaths worldwide and the fear of a global economic collapse. SARS-CoV-2 is notorious for causing acute respiratory distress syndrome, however emerging literature suggests various dreaded cardiac manifestations associated with high mortality. The mechanism of myocardial damage in COVID-19 is unclear but thought to be multifactorial and mainly driven by the host’s immune response (cytokine storm), hypoxemia and direct myocardial injury by the virus. Cardiac manifestations from COVID-19 include but are not limited to, acute myocardial injury, cardiac arrhythmias, congestive heart failure and acute coronary syndrome. Cardiac imaging is paramount to appropriately diagnose and manage the cardiac manifestations of COVID-19. Herein, we present cardiac imaging findings of COVID-19 patients with biomarker and imaging confirmed myocarditis to provide insight regarding the variable manifestations of COVID-19 myocarditis via Cardiac MRI (CMR) coupled with CMR-edema education along with recommendations on how to incorporate advanced CMR into the clinicians’ COVID-19 armamentarium. Electronic supplementary material The online version of this article (10.1007/s10554-020-02139-2) contains supplementary material, which is available to authorized users.

Aims Non-invasive assessment and risk stratification of coronary artery disease in patients with large body habitus is challenging. We aim to examine whether body mass index (BMI) modifies the prognostic value and diagnostic utility of stress cardiac magnetic resonance imaging (CMR) in a multicentre registry. Methods and results The SPINS Registry enrolled consecutive intermediate-risk patients who presented with a clinical indication for stress CMR in the USA between 2008 and 2013. Baseline demographic data including BMI, CMR indices, and ratings of study quality were collected. Primary outcome was defined by a composite of cardiovascular death and non-fatal myocardial infarction. Of the 2345 patients with available BMI included in the SPINS cohort, 1177 (50%) met criteria for obesity (BMI ≥ 30) with 531 (23%) at or above Class 2 obesity (BMI ≥ 35). In all BMI categories, >95% of studies were of diagnostic quality for cine, perfusion, and late gadolinium enhancement (LGE) sequences. At a median follow-up of 5.4 years, those without ischaemia and LGE experienced a low annual rate of hard events ( Conclusion In this large multicentre registry, elevated BMI did not negatively impact the diagnostic quality and the effectiveness of risk stratification of patients referred for stress CMR.

IMPORTANCE: The role of stress cardiac magnetic resonance (CMR) imaging in clinical decision-making by reclassification of risk across American College of Cardiology/American Heart Association guideline–recommended categories has not been established. OBJECTIVE: To examine the utility of stress CMR imaging for risk reclassification in patients without a history of coronary artery disease (CAD) who presented with suspected myocardial ischemia. DESIGN, SETTING, AND PARTICIPANTS: A retrospective, multicenter cohort study with median follow-up of 5.4 years (interquartile range, 4.6-6.9) was conducted at 13 centers across 11 US states. Participants included 1698 consecutive patients aged 35 to 85 years with 2 or more coronary risk factors but no history of CAD who presented with suspected myocardial ischemia to undergo stress CMR imaging. The study was conducted from February 18, 2019, to March 1, 2020. MAIN OUTCOMES AND MEASURES: Cardiovascular (CV) death and nonfatal myocardial infarction (MI). Major adverse CV events (MACE) including CV death, nonfatal MI, hospitalization for heart failure or unstable angina, and late, unplanned coronary artery bypass graft surgery. RESULTS: Of the 1698 patients, 873 were men (51.4%); mean (SD) age was 62 (11) years, accounting for 67 CV death/nonfatal MIs and 190 MACE. Clinical models of pretest risk were constructed and patients were categorized using guideline-based categories of low (3% year) risk. Stress CMR imaging provided risk reclassification across all baseline models. For CV death/nonfatal MI, adding stress CMR-assessed left ventricular ejection fraction, presence of ischemia, and late gadolinium enhancement to a model incorporating the validated CAD Consortium score, hypertension, smoking, and diabetes provided significant net reclassification improvement of 0.266 (95% CI, 0.091-0.441) and C statistic improvement of 0.086 (95% CI, 0.022-0.149). Stress CMR imaging reclassified 60.3% of patients in the intermediate pretest risk category (52.4% reclassified as low risk and 7.9% as high risk) with corresponding changes in the observed event rates of 0.6% per year for low posttest risk and 4.9% per year for high posttest risk. For MACE, stress CMR imaging further provided significant net reclassification improvement (0.361; 95% CI, 0.255-0.468) and C statistic improvement (0.092; 95% CI, 0.054-0.131), and reclassified 59.9% of patients in the intermediate pretest risk group (48.7% reclassified as low risk and 11.2% as high risk). CONCLUSIONS AND RELEVANCE: In this multicenter cohort of patients with no history of CAD presenting with suspected myocardial ischemia, stress CMR imaging reclassified patient risk across guideline-based risk categories, beyond clinical risk factors. The findings of this study support the value of stress CMR imaging for clinical decision-making, especially in patients at intermediate risk for CV death and nonfatal MI.

Hypertension (HTN) is a known risk for development of aortic root dilation. Echocardiography (2-D) is a Class II indication for HTN when there is suspected structural disease or CHF. Limitations of 2-D include a 90 degree arc of imaging, narrow intercostal space and difficult alignment along the

Abnormalities of left ventricular (LV) strain have been shown to occur prior to impairment of global left ventricular function, measured by global LV ejection fraction (EF). Although first described in patients receiving cardiotoxic chemotherapy, impairment of LV strain prior to a decrease in EF has

The Cardiovascular Health Study demonstrated that aortic root dilation (ARD) was associated with an increased risk of stroke and cardiovascular disease mortality in men and women. ARD is often asymptomatic and incidentally discovered on 2-D echo, since 2-D echo is the recommended ACC/AHA imaging

Patients with impaired LVEF are at high risk for cardiovascular events. It is unclear whether stress testing can adequately risk stratify these individuals. In the multicenter Stress CMR Perfusion Imaging in the US registry, we conducted a subgroup analysis of patients with abnormal LVEF to assess

Impairment of LV strain occurs prior to a decrease in global LV ejection fraction (EF) in hypertension and aortic stenosis. Since obesity is a form of increased afterload, it is hypothesized that altered LV strain may be detected prior to a decrease in EF in obesity. This study assessed LV global

Although stress-echo (SE), nuclear myocardial stress perfusion imaging (MPI) and coronary arteriography are used to detect atherosclerosis, they are not well suited for diagnosing inflammatory heart disease. Cardiac MRI (CMR) is uniquely capable of detecting myocardial and pericardial edema, a

Longitudinal left ventricle (LV) fiber dysfunction may play a role in LV non-compaction cardiomyopathy (LVNC), due to the extensive involvement of the subendocardial myocardium. Mitral Annular Plane Systolic Excursion (MAPSE), using 2-D echo or MRI imaging, is an easily performed and replicable

Hypertension (HTN) is a known risk for development of aneurysm of the ascending aorta (AscAoA) which is among the top 10 cardiovascular (CV) disorders resulting in claim payment in malpractice actions. However, AscAoA has the highest claim payment ($417 K) of any CV diagnosis. Echocardiography (2-D

Background: Of patients with acute chest pain(CP), only 10% have acute coronary syndrome. About 20% of these CP patients have an obvious non-cardiac etiology, while the remaining 70% undergo diagnostic testing to exclude coronary atherosclerosis(CAD). Myocardial perfusion imaging(MPI) is commonly used to assess these patients. A normal MPI effectively excludes CAD and the patient is labeled as having “non-cardiac” CP. Late gadolinium enhancement(LGE) by Cardiac MRI(CMR) offers detection of pericardial disease. This study was undertaken to assess the role of CMR in CP patients with a normal MPI. Methods: An institutional cardiac imaging database was queried for all patients with new onset CP. The study was composed of those CP patients who did not have ACS or an obvious non-cardiac etiology. The cohort was divided into 2 groups. Group A patients underwent MPI as their initial test and were negative for ischemia, but had continued CP. Group B had CMR as their initial test and were negative for ischemia. The detection of pericarditis in these 2 patient groups was assessed using LGE of the pericardium. Results: 3,525 patients who presented with chest pain and no evidence of ACS underwent nuclear MPI. 347(9.8%) of these 3,525 patients had a normal nuclear MPI, but subsequently underwent a CMR for persistent chest pain and constituted Group A. 63 of 347(18.1%) Group A patients with a normal MPI had evidence of pericarditis on LGE. Group B had 505 patients with chest pain who underwent a CMR stress study, noting 461(82.4%) were normal, while 89(17.6%) had evidence of CAD. Of the 461 patients with a normal CMR stress, 80(19.2%) had evidence of pericarditis on LGE. Conclusions: About 10% of patients with CP and normal MPI may continue to complain of discomfort. These patients are usually labeled as “non-cardiac”, and often undergo gastrointestinal and musculoskeletal evaluation. Evaluation of this group of patients with CMR shows that 18-19% have pericarditis by LGE and are incorrectly labeled as “non-cardiac”. Newer treatments for pericarditis with colchicine/non-steroid anti-inflammatory drugs have high success rates, while undiagnosed/untreated pericarditis is likely a precursor to constrictive disease, making the need for a correct initial diagnosis imperative.

Ventricular tachyarrhythmias are known sequelae among adults with repaired tetralogy of Fallot. The incidence of sustained ventricular tachycardia and sudden cardiac death in patients 35 years after corrective surgery is estimated at 11.9% and 8.3%, respectively.1 Studies have shown that right ventricular enlargement resulting from chronic pulmonic regurgitation is the most common hemodynamic substrate.2 QRS prolongation (>180 milliseconds) is one of the most sensitive ECG predictors and in turn correlates with right ventricular (RV) dilation.3 The exact mechanism is not as well studied as that of left ventricular arrhythmias, but it is purported that volume overload leads to RV myocardial stretching and RV fibrosis and hence serves as an arrhythmogenic focus. The anatomic location of the RV pathology leading to ventricular tachyarrhythmias after tetralogy of Fallot surgical repair is not well defined. The basal portions of the RV …

Through advancements in computer processing speed and storage capacity, new cardiac imaging modalities have become clinically feasible and useful. Cardiac computed tomographic angiography, a new diagnostic imaging modality, is capable of assessing coronary artery disease and left ventricular function on a par with invasive coronary arteriography in selected patients who meet appropriate use criteria. This imaging modality is of clinical value in the assessment of patients with chest pain who have an intermediate risk of coronary atherosclerosis. The purpose of the present report is to educate primary care physicians about the basic principles of advanced cardiac imaging techniques and to convey a useful strategy for their appropriate use in the current environment of medical economics.

Methods We retrospectively reviewed charts of 361 patients who underwent CMR exams (GE 1.5 T, Milwaukee, WI) over a six-month period at two centers. Center 1 was an academic-community hospital in Western Pennsylvania, also offering specialty services for pulmonary hypertension and cardiac transplantation. Center 2 was a private community hospital in Western Pennsylvania. Studies were reviewed for compliance with the Appropriateness Criteria for CMR published by the American College of Cardiology (ACC) in 2006. All components of CMR exam such as structure and function, phase velocity mapping (PVM), MR angiography (MRA), delayed hyperenhancement (DHE) and stress perfusion (SP) were recorded. Patient outcomes were assessed to see if CMR resulted in any independent new information, or it merely confirmed another modality. "Significant contribution", as assessed by a cardiac MRI expert at each center was defined as either: 1) new treatment 2) change in current treatment 3) important information that was missed by other imaging modalities. Disparities in assessment were settled by consensus between the two experts.

This study was designed to assess the effects of bariatric weight loss surgery on structural, functional, and inflammatory markers of coronary atherosclerosis. Obesity is a worldwide epidemic and an independent risk factor for coronary atherosclerosis. It remains unclear whether surgically induced weight loss reduces cardiovascular risk. This prospective study enrolled 50 consecutive subjects with morbid obesity who underwent Roux-en-Y gastric bypass surgery (GBS) after failed attempts at medical weight loss. Subjects were recruited through a comprehensive weight loss center affiliated with an academic tertiary care hospital. All subjects had body mass indexesor =40 kg/m(2) or body mass indexes of 35 to 40 kg/m(2) withor =2 co-morbid obesity-related conditions. Markers of coronary atherosclerosis, including brachial artery flow-mediated dilation, carotid intima-media thickness, and high-sensitivity C-reactive protein, were measured before GBS and 6, 12, and 24 months after GBS. There were statistically significant improvements in all measured markers of coronary atherosclerosis after GBS. The mean body mass index decreased from 47 to 29.5 kg/m(2) at 24 months (p0.001), the mean carotid intima-media thickness regressed from 0.84 to 0.50 mm at 24 months (p0.001), mean flow-mediated dilation improved from 6.0% to 14.9% at 24 months (p0.05), and mean high-sensitivity C-reactive protein decreased from 1.23 to 0.65 mg/dl at 6 months (p0.001) and to 0.35 mg/dl at 24 months (p0.001). In conclusion, GBS results in significant improvements in inflammatory, structural, and functional markers of coronary atherosclerosis.