10 research outputs found
Hypertrophic cardiomyopathy – contribution of magnetic resonance imaging
No full textХипертрофичната кардиомиопатия (ХКМП) е една от най-често срещаните форми на кардиомиопатии. Характеризира се с първична хипертрофия на миокарда, дезорганизация на кардиомиоцитите и фиброза. Тези морфологични характеристики обуславят и приложимостта и значимостта на магнитнорезонансното изследване при оценка на тези пациенти. Магнитният резонанс на сърце допринася в диагностиката чрез идентифициране на сегменти на хипертрофия, които не се визуализират добре чрез ехокардиография, осигурява по-точни измервания на дебелината на миокарда и диференцира ХКМП от други причини за левокамерна хипертрофия. Методът дава възможност освен за качествена и за количествена оценка на фокална и дифузна фиброза, което има важна роля при оценка на прогнозата и проследяване на пациентите. Целта на настоящата статия е да се направи преглед на ролята на сърдечния магнитен резонанс в диагностиката на ХКМП, демонстрирайки различни форми и техните типични морфологични и тъканни промени, както и да се покаже ролята на метода в диференциалната диагноза на хипертрофичния миокард. Hypertrophic cardiomyopathy (HCM) is one of the most common form of cardiomyopathies. It is characterized by primary hypertrophy, disorganization, and fibrosis of the myocardium. These morphological characteristics determine the applicability and significance of magnetic resonance imaging in the evaluation of these patients. Cardiac magnetic resonance helps the diagnostic process by identifying hypertrophic segments, which are less accessible by echocardiography ensures more precise measurements of wall thickness and differentiates HCM from other causes of left ventricular hypertrophy. The method allows for not only qualitative but also quantitive evaluation of focal and diffuse fibrosis which plays an important role in evaluation of patients’ prognosis and follow up. The aim of this article is to review the role of cardiac magnetic resonance in the diagnosis of HCM, demonstrating different forms and their typical morphological features, as well as to demonstrate the role of the method in the differential diagnosis of myocardial hypertrophy
Тechnical aspects of cardiac magnetic resonance tomography
No full textCardiac magnetic resonance tomography (CMRT) is a method of high diagnostic value in the assessment of cardiac vitality through the application of various perfusion techniques, as well as in the evaluation and diagnosis of early myocardial ischemic changes. The aim of this article is to review the different technical aspects of CMRT. A major problem in CMRT studies is the deterioration of image quality due to the presence of motion artefacts. This necessitates the development of ECG-gated and respiratory triggered or breath-holding techniques and their implementation in practice. In contrast to most other applications of MRT, the planes used in CMRT are defined with respect to the orientation of the heart so that they are parallel and orthogonal to the cardiac axes. Two main groups of sequences are used in CMRT: 1) to determine morphology, function, and blood flow and 2) to provide good tissue contrast of the heart. Technological development of the method has not stopped, and techniques and pulse sequences continue to be developed to improve the diagnostic capabilities of CMRT. Through proper planning, a thorough understanding of the cardiac planes, and appropriate selection of technical parameters for the respective sequences depending on the clinical finding being addressed, a successful performance of each CMRT study is achieved
Cardiac magnetic resonance imagining for assessment of the myocardial involvement in COVID-19
No full textThe SARS-CoV-2 virus, fi rst identifi ed in December 2019 in the city of Wuhan, has become a huge public health care challenge, with nearly 90 million people infected and more than 1.9 million reported deaths worldwide. Although the main focus of the disease are the respiratory system complications, recently much attention has been drawn to the extrapulmonary manifestation of the virus, which in some cases is decisive for the course of the disease. Increasing evidence suggests that the virus can directly affect the cardiovascular system and lead to complications such as myocarditis, acute coronary syndrome, arrhythmias and venous thromboembolism. The pathogenesis of cardiac damage is currently unclear. Presumed mechanisms include direct viral invasion, cytokine-mediated damage, mismatch between needs and oxygen supply, and ischemic damage resulting from microvascular thrombosis. Cardiac magnetic resonance imaging plays an important role in assessing myocardial changes in patients with COVID-19. The method allows assessment of cardiac morphology and function, as well as characterization of tissue changes in the myocardium. The most commonly observed magnetic resonance changes in patients with COVID-19 are signs of myocarditis with varying degrees of myocardial involvement, and the identifi cation of necrosis and fi brosis is an important predictive sign for the prognosis in these patients. The purpose of this paper is to review the literature and to share our experience with assessment of myocardial damage in COVID-19 with cardiac magnetic resonance imaging
Cardiac magnetic resonance imaging in acute and chronic myocardial ischemia: current clinical application and future directions
No full textIschemic heart disease, its sequelae and complications contribute substantially to morbidity and mortality worldwide. Significant technological progress in recent years has significantly expanded the application of non-invasive imaging modalities in the systematic and complex evaluation of patients with ischemic heart disease in the preclinical and clinically developed stages of the disease. Cardiac magnetic resonance imaging includes a complex morphological and functional assessment. Regional and global myocardial kinetics and function, morphological changes in myocardial tissue in the form of edema, hemorrhage, and scarring determine various manifestations of myocardial ischemia in its acute and chronic form. Currently established clinical protocols have already demonstrated their diagnostic and prognostic value. Under the influence of unceasing clinical interest, cardiac magnetic resonance imaging is constantly developing and improving with emerging imaging technologies that provide additional information based on advanced quantification of imaging biomarkers and improved diagnostic accuracy, therefore potentially allowing reduction or avoidance of contrast and/or stressor agents
Cardiac echinococcosis, a multidisciplinary approach in the diagnosis and treatment of this rare entity: two case reports and literature review
No full textWe present two case reports of cardiac echinococcosis. Case 1 was a 33-year-old woman with hepatic and cardiac echinococcosis. The parasitic cyst was located intramyocardially in the free wall of the left ventricle leading to cranial dislocation of the left circumflex coronary artery (LCx). The patient was successfully operated. Case 2 was a 28-year-old woman with hepatic and cardiac echinococcosis. The parasitic cyst was located in the left ventricular myocardium in the area of the apex and manifested clinically as paroxysms of ventricular tachycardia. The ultrasound study showed a 3.2×2.8 cm cyst dislocating the papillary muscles and causing moderate mitral regurgitation. Bulgaria ranks first in the European Union in terms of the number of echinococcosis patients. Although cardiac involvement is uncommon, occurring in only 0.5%–2% of cases, it can cause a wide range of clinical symptoms. Multimodal imaging is a key step in the management of patients with cardiac involvement
Complete Left-Sided Pericardial Congenital Absence
No full textBackground: Congenital absence of pericardium is a rare cardiac disorder with a reported incidence of less than 1 in 10,000. Although most of the cases are of little clinical significance, some of them are associated with serious complications, including risk of herniation and strangulation or coronary artery compression. Detailed Case Description: We report a case of a 36-year-old male referred for routine cardiovascular examination. He had a medical history of a heart murmur since childhood. Electrocardiogram (ECG) revealed sinus rhythm, normal axis, poor R-wave progression in the precordial leads and repolarization abnormalities with negative T waves in leads V1–V4. On 2D transthoracic echocardiography (TTE), an unusual heart position was noted with poor image quality from the standard acoustic windows. The parasternal long axis view gave the impression of right ventricular dilatation. The findings raised the suspicion of left to right shunt and possible atrial septal defect. For further evaluation, the patient was referred for cardiac magnetic resonance which demonstrated complete left-sided absence of the pericardium. Discussion: Due to indistinct and atypical symptoms and lack of clinical awareness, pericardial congenital absence is frequently misdiagnosed. Patients may complain of atypical chest pain. Patient’s history and physical examination are often nonspecific. In cases with complete pericardial absence, ECG findings may include right axis deviation, right bundle block and sinus bradycardia. Echocardiography findings are also not characteristic, but some may raise the clinical suspicion of this diagnosis. The imaging modalities of choice are computed tomography and cardiac magnetic resonance. Treatment depends on the type of defect and clinical symptoms
Role of cardiac magnetic resonance imaging in the diagnosis of nonischemic cardiomyopathies
No full textIn recent decades, cardiac magnetic resonance imaging (CMR) has been established  as a valuable tool in the diagnosis of patients with or at risk of heart failure. With its ability to characterize tissue changes in the myocardium, CMR can provide detailed and clinically useful information about the type and severity of cardiac damage. The method is not only important for differentiation of ischemic from non-ischemic cardiomyopathy, but also contributes to the correct diagnosis of non-ischemic cardiomyopathy subtypes. It is also widely accepted as a reference standard for the quantification of myocardial mass, volumes and ejection fraction. The purpose of this article is to review the role of CMR in the diagnosis and treatment of non-ischemic cardiomyopathies
Age and sex-related differences in T1 and T2 mapping. 1.5 magnetic resonance referent values
No full textВъведение: Параметричното картиране е неинвазивен метод за количествена оценка на тъканните промени в миокарда чрез измерване на времената за релаксация T1, T2 и T2* и екстрацелуларния обем, като се изисква предварително установяване на интервал от нормални стойности. Целта е да се установят референтни стойности за нативни Т1 и Т2 времена за релаксация на миокарда при здрави индивиди на 1.5 Т магнитен резонанс и да се оценят промените в стойностите им в зависимост от сегментите на лява камера, възраст, пол, сърдечна честота и дебелина на миокарда. Материал и методи: Проведено е проспективно проучване на 1.5 Т магнитен резонанс с доброволното участие на 50 здрави индивиди в различни възрастови групи. Анализът на образите е извършен от рентгенолог с 5 години опит в областта на кардиомагнитнорезонансната томография и допълнително съгласувани с рентгенолог с над 20-годишен опит в областта. За изчисляване на обемите и функцията на двете камери е използван интегриран софтуер ARGUS на Siemens. Измерени са глобални и сегментни стойности на Т1 и Т2 в срез по къса ос на средно ниво чрез ръчно очертаване на областта на интерес. Дебелината на миокарда е измерена в същия срез септално. Резултати: Разпределението на доброволците е 25 мъже и 25 жени. Наблюдават се достоверно по-високи стойности в глобалното Т1 при жените (1027,7 ± 25,4 ms) спрямо мъжете (992,9 ± 24,4 ms), при p < 0,001. Същата зависимост се наблюдава и в отделните сегменти, с достоверна разлика между половете. Изследването на корелацията между Т1 и останалите параметри доказа негативна линейна зависимост единствено с дебелината на миокарда. Глобалното Т2 при жените (48,6 ± 2,49 ms) също е достоверно по-високо от това при мъжете (44,6 ± 2,06 ms), с наблюдавана разлика от 3,95, p < 0,001. Глобалното Т2 показа много силна отрицателна корелационна връзка с дебелината на миокарда (r = -0,769; p < 0,001). Не се доказа достоверна корелационна връзка между Т2 времената и сърдечния ритъм и възрастта на пациентите. Заключение: Доказа се статистически значима разлика в нативните стойности на Т1 и Т2 по полов признак. Препоръчва се използването на полово определени референтни стойности за разграничаване на здравия от патологично засегнатия миокард. Introduction: Parametric mapping is a non-invasive method to quantify tissue changes in the myocardium by measuring T1, T2 and T2* relaxation times and extracellular volume, requiring a pre-established range of normal values. Purpose: To establish reference values for native T1 and T2 myocardial relaxation times in healthy subjects on 1.5 T magnetic resonance imaging and to assess changes in their values according to left ventricular segments, age, sex, heart rate, and myocardial thickness. Material and Methods: A prospective 1.5 T magnetic resonance imaging study was performed with the voluntary participation of 50 healthy individuals in different age groups. Image analysis was performed by a radiologist with 5 years of experience in the field of CMRT and further coordinated with a radiologist with more than 20 years of expe-rience in the field. Siemens ARGUS integrated software was used to calculate the volumes and function of both cameras. Global and segmental T1 and T2 values were measured in the shortaxis midlevel section by manually delineating the region of interest. Myocardial thickness of the mid septum was measured for each patient. Results: The distribution of volunteers was 25 men and 25 women. Significantly higher global T1 values were observed in women (1027.7 ± 25.4 ms) compared to men (992.9 ± 24.4 ms), at p < 0.001. The same correlation was observed in individual segments, with a significant difference between genders. Examination of the correlation between T1 and other parameters demonstrated a negative linear relationship only with myocardial thickness. Global T2 in women (48.6 ± 2.49 ms) was also significantly higher than in men (44.6 ± 2.06 ms), with an observed difference of 3.95, p < 0.001. Global T2 showed a very strong negative correlation with myocardial thickness (r = -0.769; p < 0.001). There was no sig-nificant correlation between T2 times and heart rate and age of patients. Conclusion: A statistically significant difference in native T1 and T2 values by sex was demonstrated. The use of sex-specific reference values to distinguish healthy from pathologically affected myocardium is recommended
Magnetic resonance imaging of MINOCA in underlying non-ischemic dilated cardiomyopathy: a case report
No full textMyocardial infarction with non-obstructive coronary arteries (MINOCA) is a syndrome of diverse etiology and unclear pathogenesis, with an incidence of 5-15% and varying prognosis. Cardiac magnetic resonance imaging (MRI) is playing an increasing role in the diagnosis of MINOCA and in distinguishing the causes that led to it, while being at the same time an important predictor of prognosis in these patients. We present a 40-year-old man with clinical, laboratory and instrumental data for acute coronary syndrome complicated by acute heart failure. The invasive assessment ruled out obstructive coronary heart disease as well as Takotsubo cardiomyopathy. MINOCA and myocarditis were discussed in the differential diagnostic plan. To differentiate them, cardiac MRI was performed, which confi rmed the diagnosis of &bdquo;myocardial infarction with non-obstructive coronary arteries&ldquo;
Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation
No full textAnatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial fi brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signifi cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after fi rst pulmonary vein isolation
