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Prognostic implication of late gadolinium enhancement on cardiac MRI in light chain (AL) amyloidosis on long term follow up
Raymond Q Migrino, Richard Christenson, Aniko Szabo, Megan Bright, Seth Truran, Parameswaran Hari
BMC Medical Physics , 2009, DOI: 10.1186/1756-6649-9-5
Abstract: Twenty nine consecutive patients (14 females; 62 ± 11 years) with biopsy-proven AL undergoing cardiac MRI with gadolinium as part of AL workup were included. Survival was prospectively followed 29 months (median) following MRI and compared between those with and without LGE by Kaplan-Meier and log-rank analyses.LGE was positive in 23 subjects (79%) and negative in 6 (21%). Left ventricular ejection fraction was 66 ± 17% in LGE-positive and 69 ± 12% in LGE-negative patients (p = 0.8). Overall 1-year mortality was 36%. On follow-up, 14/23 LGE-positive and none of LGE-negative patients died (log rank p = 0.0061). Presenting New York Heart Association heart failure class was also associated with poor survival (p = 0.0059). Survival between two LGE groups stratified by heart failure class still showed a significant difference by a stratified log-rank test (p = 0.04).Late gadolinium enhancement is common and is associated with poor long-term survival in light chain amyloidosis, even after adjustment for heart failure class presentation. The prognostic significance of late gadolinium enhancement in this disease may be useful in patient risk-stratification.Light chain or primary amyloidosis (AL) is a plasma cell dyscrasia with production and abnormal deposition of insoluble fibrillar proteins derived from immunoglobulin light chains [1,2]. It is a rare disease but can be fatal. Amyloid protein deposition in various organs such as the heart, kidneys, gut and nervous system cause multi-organ dysfunction. Cardiac involvement was reported in 50% of cases [3] and is associated with the worst prognosis; median survival is about 4 months in the setting of advanced heart failure [4,5]. Amyloid deposition in the heart is confirmed by invasive endomyocardial biopsy. Noninvasive imaging demonstrate that some AL patients have diffuse subendocardial late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) [6]. Late gadolinium enhancement was found to be highly corre
Gadolinium enhanced MRI in patients with left ventricular apical ballooning syndrome implicates myocarditis as an etiology  [PDF]
Andrew O. Maree, Christian Witzke, Godtfred Holmvang, Gregory D. Lewis, Hani Jneid, Lindsay B. Reardon, Nadeem Afridi, Marc J. Semigran, G. William Dec, Harry C. Lowe, Igor F. Palacios
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.31A018
Abstract: Aims: Left ventricular apical ballooning syndrome (LVABS) is a clinical condition of unknown etiology, characterized by acute onset of atypical apical wall motion and absence of coronary artery disease. Gadolinium-enhanced cardiac magnetic resonance imaging (Gd-MRI) may be used to identify patients with myocarditis. Using cardiac MRI, we evaluated whether acute myocarditis may be an etiology that underlies LVABS. Methods and Results: Consecutive patients who presented with LVABS during a three-year period were included. Demographic data was recorded and echocardiography, coronary angiography, and hemodynamic assessment performed. Gd-MRI was performed in all patients. The study was deemed consistent with myocarditis when global myocardial to skeletal muscle enhancement ratio was ≥3.5. Regional Gd-MRI analysis was also performed. Patients (n = 11) were female (100%) and of mean age 72 years (72 ± 11). Preceding febrile illness occurred in 4 (36.3%) and leukocytosis in 6 (54.4%) patients. Initial mean left ventricular ejection fraction (41% ± 12%) improved (70.2% ± 8%) upon follow-up (39 ± 43 days). Global MRI analysis was positive in 5/11 (45.5%) (mean relative enhancement ratio 4.8 ± 1.4). Regional MRI analysis was positive in 4/6 further patients (overall: 9/11 (82%)). Conclusions: Gadolinium enhanced MRI imaging in LVABS implicates myocarditis as a possible etiology. Regional MRI analysis adds sensitivity to global cardiac MRI evaluation.
Subclinical Hypothyroidism Effects on Cardiac Function  [PDF]
M. Niafar,M. Toufan,S. Ghafoori,N. Aghamohammadzadeh
Pakistan Journal of Biological Sciences , 2009,
Abstract: To evaluate heart function in subclinical hypothyroid women in comparison with healthy subjects, a prospective study was performed on newly detected subclinical hypothyroid women presenting to endocrinology clinic of Tabriz Sina Hospital from October 2007 to February 2008. Thirty five women with Subclinical Hypothyroidism (SH) in case group were matched with 35 healthy euthyroid women in control group. All patients in both groups were studied by two dimensional echocardiography and Tissue Doppler Imaging (TDI) in Tabriz Shahid Madani Hospital. The FT4 and TSH levels were measured. Comparison of TDI results in Right Ventricle (RV) showed the significantly lower mean Tv excursion in case group with no significant difference in other parameters. In Left Ventricle (LV), the mean Am, Av and Ev/Em were significantly higher and E/A was lower in the case group, but there was no significant difference in other parameters. No RV diastolic dysfunction was documented in both groups. There was no case with LV systolic dysfunction in both groups. There were 21 (60%) patients with LV diastolic dysfunction in the case group comparing with 11 (31.4%) cases in the control group (p = 0.016, OR = 0.306). Frequency of LV diastolic dysfunction was significantly higher in the case group in patients aged ≥40 years (94.1% vs. 53.3%; p = 0.013). There was no case of pericardial effusion in the studied population. According to our results, SH may cause LV diastolic dysfunction. Likewise, minor RV systolic dysfunction might be seen in these patients
Primary Cardiac Involvement in Scleroderma and Role of Cardiac MRI  [PDF]
Kashif Hussain, Robert C. Stansbury
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.520168
Abstract: Systemic sclerosis (scleroderma) is a connective tissue disease characterized by vascular dysfunction and fibrosis that can affect multiple organ systems. We present case of primary cardiac involvement and the diagnostic role of cardiac MRI. Cardiovascular magnetic resonance imaging (MRI) is an accurate, quantitative method for the non-invasive assessment of myocardial perfusion. The presence of clinically apparent myocardial involvement in scleroderma portends a very poor prognosis. One study of US veterans found that clinical cardiac disease in scleroderma was associated with a 70% mortality rate at five years. Management of heart failure and conduction system abnormalities in scleroderma is similar to other cardiac disease. It includes afterload reduction, beta-blockade, defibrillator placement, etc. Patients with reduced cardiac function and normal coronary arteries may benefit from increased immune suppresion.
In vivo MRI Characterization of Progressive Cardiac Dysfunction in the mdx Mouse Model of Muscular Dystrophy  [PDF]
Daniel J. Stuckey, Carolyn A. Carr, Patrizia Camelliti, Damian J. Tyler, Kay E. Davies, Kieran Clarke
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0028569
Abstract: Aims The mdx mouse has proven to be useful in understanding the cardiomyopathy that frequently occurs in muscular dystrophy patients. Here we employed a comprehensive array of clinically relevant in vivo MRI techniques to identify early markers of cardiac dysfunction and follow disease progression in the hearts of mdx mice. Methods and Results Serial measurements of cardiac morphology and function were made in the same group of mdx mice and controls (housed in a non-SPF facility) using MRI at 1, 3, 6, 9 and 12 months after birth. Left ventricular (LV) and right ventricular (RV) systolic and diastolic function, response to dobutamine stress and myocardial fibrosis were assessed. RV dysfunction preceded LV dysfunction, with RV end systolic volumes increased and RV ejection fractions reduced at 3 months of age. LV ejection fractions were reduced at 12 months, compared with controls. An abnormal response to dobutamine stress was identified in the RV of mdx mice as early as 1 month. Late-gadolinium-enhanced MRI identified increased levels of myocardial fibrosis in 6, 9 and 12-month-old mdx mice, the extent of fibrosis correlating with the degree of cardiac remodeling and hypertrophy. Conclusions MRI could identify cardiac abnormalities in the RV of mdx mice as young as 1 month, and detected myocardial fibrosis at 6 months. We believe these to be the earliest MRI measurements of cardiac function reported for any mice, and the first use of late-gadolinium-enhancement in a mouse model of congenital cardiomyopathy. These techniques offer a sensitive and clinically relevant in vivo method for assessment of cardiomyopathy caused by muscular dystrophy and other diseases.
Biocompatible Polyhydroxyethylaspartamide-based Micelles with Gadolinium for MRI Contrast Agents  [cached]
Jeong Sang Young,Kim Hyo Jeong,Kwak Byung-Kook,Lee Ha-Young
Nanoscale Research Letters , 2010,
Abstract: Biocompatible poly-[N-(2-hydroxyethyl)-d,l-aspartamide]-methoxypoly(ethyleneglycol)-hexadecylamine (PHEA-mPEG-C16) conjugated with 1,4,7,10-tetraazacyclododecan-1,4,7,10-tetraacetic acid-gadolinium (DOTA-Gd) via ethylenediamine (ED) was synthesized as a magnetic resonance imaging (MRI) contrast agent. Amphiphilic PHEA-mPEG-C16-ED-DOTA-Gd forms micelle in aqueous solution. All the synthesized materials were characterized by proton nuclear magnetic resonance (1H NMR). Micelle size and shape were examined by dynamic light scattering (DLS) and atomic force microscopy (AFM). Micelles with PHEA-mPEG-C16-ED-DOTA-Gd showed higher relaxivities than the commercially available gadolinium contrast agent. Moreover, the signal intensity of a rabbit liver was effectively increased after intravenous injection of PHEA-mPEG-C16-ED-DOTA-Gd.
Cardiac Masses on MRI
Babak Bob Raissi
Iranian Journal of Radiology , 2011,
Abstract: The superiority of MR in assessing cardiac masses"nand review of relevant and practical techniques."nEvaluation of pseudotumors, lipomatous hypertrophy"nof the interatrial septum (LHIS), cardiac neoplasms,"nmyxomas, fibromas and other interesting cardiac"ntumors, including benign and malignant tumors."nWe will review tissue characterization, anatomic"nlocalization, in order to make cardiac MR non operator"ndependent.
Characterization of Respiratory and Cardiac Motion from Electro-Anatomical Mapping Data for Improved Fusion of MRI to Left Ventricular Electrograms  [PDF]
Sébastien Roujol, Elad Anter, Mark E. Josephson, Reza Nezafat
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078852
Abstract: Accurate fusion of late gadolinium enhancement magnetic resonance imaging (MRI) and electro-anatomical voltage mapping (EAM) is required to evaluate the potential of MRI to identify the substrate of ventricular tachycardia. However, both datasets are not acquired at the same cardiac phase and EAM data is corrupted with respiratory motion limiting the accuracy of current rigid fusion techniques. Knowledge of cardiac and respiratory motion during EAM is thus required to enhance the fusion process. In this study, we propose a novel approach to characterize both cardiac and respiratory motion from EAM data using the temporal evolution of the 3D catheter location recorded from clinical EAM systems. Cardiac and respiratory motion components are extracted from the recorded catheter location using multi-band filters. Filters are calibrated for each EAM point using estimates of heart rate and respiratory rate. The method was first evaluated in numerical simulations using 3D models of cardiac and respiratory motions of the heart generated from real time MRI data acquired in 5 healthy subjects. An accuracy of 0.6–0.7 mm was found for both cardiac and respiratory motion estimates in numerical simulations. Cardiac and respiratory motions were then characterized in 27 patients who underwent LV mapping for treatment of ventricular tachycardia. Mean maximum amplitude of cardiac and respiratory motion was 10.2±2.7 mm (min = 5.5, max = 16.9) and 8.8±2.3 mm (min = 4.3, max = 14.8), respectively. 3D Cardiac and respiratory motions could be estimated from the recorded catheter location and the method does not rely on additional imaging modality such as X-ray fluoroscopy and can be used in conventional electrophysiology laboratory setting.
Cardiac Imaging Using Clinical 1.5?T MRI Scanners in a Murine Ischemia/Reperfusion Model
Jakob G. J. Voelkl,Bernhard J. Haubner,Christian Kremser,Agnes Mayr,Gert Klug,Alexander Loizides,Silvana Müller,Otmar Pachinger,Michael Schocke,Bernhard Metzler
Journal of Biomedicine and Biotechnology , 2011, DOI: 10.1155/2011/185683
Abstract: To perform cardiac imaging in mice without having to invest in expensive dedicated equipment, we adapted a clinical 1.5 Tesla (T) magnetic resonance imaging (MRI) scanner for use in a murine ischemia/reperfusion model. Phase-sensitive inversion recovery (PSIR) sequence facilitated the determination of infarct sizes in vivo by late gadolinium enhancement. Results were compared to histological infarct areas in mice after ischemia/reperfusion procedure with a good correlation (=0.807, <.001). In addition, fractional area change (FAC) was assessed with single slice cine MRI and was matched to infarct size (=?0.837) and fractional shortening (FS) measured with echocardiography (=0.860); both <.001. Here, we demonstrate the use of clinical 1.5 MRI scanners as a feasible method for basic phenotyping in mice. These widely available scanners are capable of investigating in vivo infarct dimensions as well as assessment of cardiac functional parameters in mice with reasonable throughput.
MRI findings of cardiac metastasis of primary lung cancer
Yonca ANIK,Murat AKKOYUNLU,Ali DEM?RC?
Turkish Journal of Oncology , 2009,
Abstract: Cardiac metastasis is a rarely seen entity. Transthoracic echocardiography results may not always be sufficient for the diagnosis. Cardiac magnetic resonance imaging (MRI) plays an important role in the differential diagnosis, in defining the borders and invasion of the mass lesion and in demonstrating the effects of the mass on cardiac functions. Cardiac MRI findings of a right ventricle metastasis in a 64-year-old male with primary lung cancer are presented in this paper.
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