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Circulation 04/2012; 125(13):e525-8. · 14.74 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P25. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P154. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P22. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Gopal Ghimire,
Jyotshana Shrestha,
Manuel Gonzalez,
Ana Barac,
Rebecca Torguson,
William Suddath,
Lowell Satler,
Augusto Pichard,
Ron Waksman, Anthon Fuisz,
Gaby Weissman
Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Mark Doyle,
Nicole Weinberg,
Gerald M Pohost,
C Noel Bairey Merz,
Leslee J Shaw,
George Sopko, Anthon Fuisz,
William J Rogers,
Edward G Walsh,
B Delia Johnson, [......],
Carl J Pepine,
Sunil Mankad,
Steven E Reis,
Diane A Vido,
Geetha Rayarao,
Vera Bittner,
Lindsey Tauxe,
Marian B Olson,
Sheryl F Kelsey,
Robert W W Biederman
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ABSTRACT: The purpose of this study was to assess the prognostic value of global magnetic resonance (MR) myocardial perfusion imaging (MPI) in women with suspected myocardial ischemia and no obstructive (stenosis <50%) coronary artery disease (CAD).
The prognostic value of global MR-MPI in women without obstructive CAD remains unknown.
Women (n = 100, mean age 57 ± 11 years, age range 31 to 76 years), with symptoms of myocardial ischemia and with no obstructive CAD, as assessed by coronary angiography, underwent MR-MPI and standard functional assessment. During follow-up (34 ± 16 months), time to first adverse event (death, myocardial infarction, or hospitalization for worsening anginal symptoms) was analyzed using global MPI and left ventricular ejection fraction (EF) data.
Adverse events occurred in 23 (23%) women. Using univariable Cox proportional hazards regression modeling, variables found to be predictive of adverse events were global MR-MPI average uptake slope (p < 0.05), the ratio of MR-MPI peak signal amplitude to uptake slope (p < 0.05), and EF (p < 0.05). Two multivariable Cox models were formed, 1 using variables that were performance site dependent: ratio of MR-MPI peak amplitude to uptake slope together with EF (chi square: 13, p < 0.005); and a model using variables that were performance site independent: MR-MPI slope and EF (chi square: 12, p < 0.005). Each of the 2 multivariable models remained predictive of adverse events after adjustment for age, disease history, and Framingham risk score. For each of the Cox models, patients were categorized as high risk if they were in the upper quartile of the model and as not high risk otherwise. Kaplan-Meier analysis of time to event was performed for high risk versus not high risk for site-dependent (log rank: 15.2, p < 0.001) and site-independent (log rank: 13.0, p < 001) models.
Among women with suspected myocardial ischemia and no obstructive CAD, MR-MPI-determined global measurements of normalized uptake slope and peak signal uptake, together with global functional assessment of EF, appear to predict prognosis.
JACC. Cardiovascular imaging 10/2010; 3(10):1030-6. · 14.29 Impact Factor
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Journal of Cardiovascular Magnetic Resonance. 01/2010;
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ABSTRACT: Acute brain embolization (ABE) in left-sided infective endocarditis has significant implications for clinical decision making. The true incidence of ABE, including subclinical brain embolization, is unknown.
We prospectively studied 56 patients with definite left-sided infective endocarditis. Patients were examined by a study neurologist, and those without contraindication had magnetic resonance imaging of the brain. Patients without clinical evidence of acute stroke but with magnetic resonance imaging evidence of ABE were considered to have subclinical brain embolization. Clinical stroke was present in 14 of 56 patients (25%). Among 40 patients undergoing magnetic resonance imaging, the incidence rates of subclinical brain embolization and any ABE were 48% and 80%, respectively. ABE was present in 18 of 19 patients (95%) with Staphylococcus aureus infection. At 3 months, mortality was similar among patients with clinical stroke and subclinical brain embolization (62% versus 53%; P=NS) and was higher among patients with any ABE than among those without ABE (56% versus 12%; P=0.046). Valvular surgery was performed in 25 patients (45%), including 16 with ABE, at a median of 4 days. No patient suffered a postoperative neurological complication. Surgery was independently associated with a lower risk of mortality at 3 months (odds ratio, 0.1; 95% confidence interval, 0.03 to 0.6; P=0.008).
Magnetic resonance imaging detected subclinical brain embolization in a substantial number of patients with left-sided infective endocarditis, suggesting that the incidence of ABE may be significantly higher than reports based on clinical and computed tomography findings have indicated. Brain magnetic resonance imaging may play a role in the complex decision about surgical intervention in infective endocarditis.
Circulation 09/2009; 120(7):585-91. · 14.74 Impact Factor
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Mark Doyle, Anthon Fuisz,
Eduardo Kortright,
Robert W. W. Biederman,
Edward G. Walsh,
Edward T. Martin,
Lindsey Tauxe,
William J. Rogers,
C. Noel Bairey Merz,
Carl Pepine,
Barry Sharaf,
and Gerald M. Pohost,
for the WISE Study Group
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ABSTRACT: Myocardial flow reserve (MFR) is not routinely assessed in myocardial perfusion imaging (MPI) studies but has been hypothesized to affect test accuracy when assessing disease severity by coronary vessel lumenography. Magnetic resonance imaging (MRI) is an emerging diagnostic technique that can both perform MPI and assess MFR. We studied women (n=184) enrolled in the Women's Ischemia Syndrome Evaluation (WISE) study with symptoms suggesting ischemic heart disease. Tests performed were coronary angiography and MPI by both MR and gated radionuclide single photon emission computed tomography (gated-SPECT). The MFR index was calculated using the MR data acquired at baseline and under vasodilation (dipyridamole) conditions. The study was structured with a pilot and an implementation phase. During the pilot phase (n=46) data were unmasked and an MFR threshold was defined to divide patients into those with an adequate (AMFRI) or inadequate (IMFRI) MFR index. During the implementation phase, the MFR index threshold was prospectively applied to patients (n=138). In the implementation phase, MPI ischemia detection accuracy compared to severe (≥70%) coronary artery diameter narrowing by angiography was higher in the AMFRI vs. the IMFRI group for MRI (86% vs. 70%, p<0.05) and gated-SPECT (89% vs. 67%, p<0.01). The IMFRI group (n=55, 30% of study population) had a higher resting rate-pressure product compared with the AMFRI group (10,599±2871 vs. 9378±2447 bpm mm Hg, p<0.01), consistent with higher resting myocardial flow. When compared with each other, MRI and gated-SPECT MPI showed no difference in accuracy among MFR groups. Myocardial perfusion patterns in the IMFRI group may have resulted in atypical perfusion patterns, which either masked or mimicked epicardial coronary artery disease.
07/2009; 5(3):475-485.
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Journal of Cardiovascular Magnetic Resonance. 01/2008;
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Journal of Cardiovascular Magnetic Resonance. 01/2008;
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Journal of Cardiovascular Magnetic Resonance. 01/2008;
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Journal of Cardiovascular Magnetic Resonance. 01/2008;
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Journal of Cardiovascular Magnetic Resonance. 01/2008;
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ABSTRACT: Half the patients who survive ST-segment elevation anterior myocardial infarction continue to have ST elevation (STE) 6 months after the event. The mechanism for this and its clinical significance are unclear. There are data to suggest that larger infarcts are more likely to have persistent changes in the ST segment. This study is designed to test this association further using a novel means of assessing the presence and magnitude of myocardial scar using cardiac magnetic resonance imaging (MRI). Delayed imaging by MRI after injection of gadolinium is commonly used to detect myocardial scar through the appearance of delayed contrast hyperenhancement. Consecutive patients referred for myocardial viability imaging were reviewed. The volume of scar as a percentage of anterior wall volume was calculated, and the 26 patients with scar involving >or=10% of the anterior wall were selected for inclusion. All had an electrocardiogram recorded within 15 days of MRI, and none had an intervening cardiac event. Observers unaware of MRI findings independently measured ST-segment changes. Nine patients had STE >1 mm and 17 did not. Mean anterior scar volume in the group without STE was 31.9 +/- 17.1% of the anterior wall volume compared with 50.3 +/- 15.9% in the group with STE >1 mm (p = 0.01). The larger the myocardial scar, the more likely STE was to be present. Only 1 of 10 patients (10%) with scar in the anterior wall <30% had such an elevation compared with 3 of 9 (33%) with scar size of 30% to 49% and 5 of 7 (78%) with scars >or=50%. In conclusion, persistent anterior STE is associated with the size of myocardial scar detected using MRI.
The American Journal of Cardiology 04/2007; 99(8):1106-8. · 3.37 Impact Factor
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ABSTRACT: The diameter and the angle of the coronary sinus (CS) ostium was analyzed in 101 patients who underwent cardiac magnetic resonance imaging and had left ventricular ejection fractions < or =0.35 (n = 40) or > or =0.65 (n = 61). The angle of the CS ostium in patients with LVEFs < or =0.35 was less acute than in patients with LVEFs > or =0.65 (73 degrees +/- 12 degrees vs 65 degrees +/- 10 degrees, p <0.01). There was no statistically significant difference in the diameter of the CS ostium in patients with LVEFs < or =0.35 compared with those with LVEFs > or =0.65 (8 +/- 3 vs 8 +/- 2 mm, p = 0.5). The diameter and the angle of the CS ostium were not different when analyzed on the basis of the duration of the QRS complex, left atrial dimension, or left ventricular end-diastolic dimension. In conclusion, on the basis of cardiac magnetic resonance imaging data, the angle of the CS is less acute in patients with LVEFs < or =0.35 than in those with LVEFs > or =0.65.
The American Journal of Cardiology 11/2006; 98(10):1400-2. · 3.37 Impact Factor
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ABSTRACT: The presence of Q waves in the electrocardiogram (ECG) has been used as a marker of prior myocardial infarction (MI). Its accuracy, however, is uncertain. The purpose of this study is to determine the accuracy of an ECG to detect prior MI compared with a novel criterion standard.
This study conducted retrospective inclusion with de novo analysis of ECG and cardiac magnetic resonance (CMR) by independent blinded readers in a single-institution setting. The population consisted of a consecutive sample of 146 patients referred for CMR for evaluation of myocardial viability and necrosis. Q/QS waves on ECG were defined as per Minnesota Code criteria. Myocardial scar was quantified and localized by CMR delayed contrast hyperenhancement and assumed as criterion standard. Sensitivity, specificity, and predictive values of ECG were calculated for different scar sizes (>1%, >15%, and >30% of the myocardium) and location (global, anterior, inferior, and lateral walls).
Sensitivity was 48.4%; specificity, 83.5; positive predictive accuracy, 72.0%; and negative predictive accuracy, 64.2%. Sensitivity improved when only large infarcts were considered (64.2%), but specificity decreased to 72.7%. Sensitivity for detecting isolated anterior or inferior wall scars was similar, but isolated lateral wall scar was rarely identified (14.3%). When all 3 walls were involved, sensitivity was still low at 57.9%.
The lack of sensitivity and the resulting low negative predictive value of Q/QS criteria seriously limit its accuracy as a marker of prior MI.
American heart journal 11/2006; 152(4):742-8. · 4.65 Impact Factor
