The Role of Cardiovascular Magnetic Resonance Imaging in Heart Failure

University of Oxford Centre for Clinical Magnetic Resonance Research, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom.
Journal of the American College of Cardiology (Impact Factor: 16.5). 10/2009; 54(15):1407-24. DOI: 10.1016/j.jacc.2009.04.094
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ABSTRACT Noninvasive imaging plays a central role in the diagnosis of heart failure, assessment of prognosis, and monitoring of therapy. Cardiovascular magnetic resonance (CMR) offers a comprehensive assessment of heart failure patients and is now the gold standard imaging technique to assess myocardial anatomy, regional and global function, and viability. Furthermore, it allows assessment of perfusion and acute tissue injury (edema and necrosis), whereas in nonischemic heart failure, fibrosis, infiltration, and iron overload can be detected. The information derived from CMR often reveals the underlying etiology of heart failure, and its high measurement accuracy makes it an ideal technique for monitoring disease progression and the effects of treatment. Evidence on the prognostic value of CMR-derived parameters in heart failure is rapidly emerging. This review summarizes the advantages of CMR for patients with heart failure and its important role in key areas.

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Available from: Theodoros Karamitsos, Sep 26, 2015
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    • "In addition to other vulnerable organs, myocardial dysfunction can occur from long-standing pressure loading and cyanosis, and heart failure is a common cause of eventual death [1]. As such, the etiology of ventricular dysfunction and its bearing on survival are of interest, including the process of myocardial fibrosis, which can be detected using cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE) [2]. "
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    ABSTRACT: Background A relationship between myocardial fibrosis and ventricular dysfunction has been demonstrated using late gadolinium enhancement (LGE) in the pressure-loaded right ventricle from congenital heart defects. In patients with Eisenmenger syndrome (ES), the presence of LGE has not been investigated. The aims of this study were to detect any myocardial fibrosis in ES and describe major clinical variables associated with the finding. Methods From 45 subjects screened, 30 subjects (age 43 ± 13 years, 20 female) underwent prospective cardiovascular magnetic resonance with LGE to quantify biventricular volume and function as well as maximal and submaximal exercise during a single visit. Standard cine acquisitions were obtained for ventricular volume and function. Further imaging was performed after administration of 0.1 mmol/kg gadolinium contrast. Regions of LGE were evaluated qualitatively and quantitatively by manual contouring of identified areas, with total area expressed as a percentage of mass. Patients were followed prospectively (mean follow up 7.4 ± 0.4 years) and any deaths recorded. Patients with LGE findings were compared to those without. Results LGE was present in 22/30 (73%) patients, specifically in RV myocardium (70%), RV trabeculae (60%), LV myocardium (33%) or LV papillary muscles (30%), though in small amounts (mean 1.4% of total ventricular mass, range 0.16 – 6.0%). Those with any LGE were not different in age, history of arrhythmia, desaturation, nor hemoglobin, nor ventricular size, mass, or function. Exercise capacity was low, but also not different between those with and without LGE. Similarly no significant associations were found with amount of fibrosis. There were five deaths among patients with LGE, versus two in patients without, but no difference in survival (log rank =0.03, P = 0.85). Conclusions Myocardial fibrosis by LGE is common in ES, though not extensive. The presence and quantity of LGE did not correlate with ventricular size, function, degree of cyanosis, exercise capacity, or survival in this pilot study. More data are clearly required before recommendations for routine use of LGE in these patients can be made.
    Journal of Cardiovascular Magnetic Resonance 05/2014; 16(1):32. DOI:10.1186/1532-429X-16-32 · 4.56 Impact Factor
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    • "This causes the damaged tissue to appear hyperenhanced in the image, since the paramagnetic contrast shortens the T1 relaxation time. Therefore, CE-CMR is of great interest in IHD, as well as in several nonischemic pathologies such as myocarditis or hypertrophic cardiomyopathy (HCM) [5], [6]. About IHD, it is well known that some of the affected myocardium may recover its functionality by revascularization if there is viable tissue [7]. "
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    ABSTRACT: We propose a fully three-dimensional methodology for the computation of myocardial non-viable tissue transmurality in contrast enhanced magnetic resonance images. The outcome is a continuous map defined within the myocardium where not only current state-of-the-art measures of transmurality can be calculated, but also information on the location of non-viable tissue is preserved. The computation is done by means of a partial differential equation framework we have called Multi- Stencil Streamline Fast Marching (MSSFM). Using it, the myocardial and scarred tissue thickness is simultaneously computed. Experimental results show that the proposed 3D method allows for the computation of transmurality in myocardial regions where current 2D methods are not able to as conceived, and it also provides more robust and accurate results in situations where the assumptions on which current 2D methods are based -i.e., there is a visible endocardial contour and its corresponding epicardial points lie on the same slice-, are not met.
    IEEE transactions on medical imaging 01/2014; DOI:10.1109/TMI.2013.2276765 · 3.54 Impact Factor
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    • "Magnetic resonance spectroscopy (MRS) is an ideal tool for the non-invasive study of metabolism, due to the extensive range of compounds it can detect, using nuclei such as carbon (13C) and phosphorus (31P), and it has been used many times to interrogate cardiac energy metabolism in animals and in patients [10-12]. However, applications of MR measurements of metabolism have been limited by an intrinsically low sensitivity. "
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    ABSTRACT: Alterations in cardiac metabolism are now considered a cause, rather than a result, of cardiac disease. Although magnetic resonance spectroscopy has allowed investigation of myocardial energetics, the inherently low sensitivity of the technique has limited its clinical application in the study of cardiac metabolism. The development of a novel hyperpolarization technique, based on the process of dynamic nuclear polarization, when combined with the metabolic tracers [1-13C] and [2-13C] pyruvate, has resulted in significant advances in the understanding of real time myocardial metabolism in the normal and diseased heart in vivo. This review focuses on the changes in myocardial substrate selection and downstream metabolism of hyperpolarized 13C labelled pyruvate that have been shown in diabetes, ischaemic heart disease, cardiac hypertrophy and heart failure in animal models of disease and how these could translate into clinical practice with the advent of clinical grade hyperpolarizer systems.
    Journal of Cardiovascular Magnetic Resonance 10/2013; 15(1):93. DOI:10.1186/1532-429X-15-93 · 4.56 Impact Factor
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