Cardiovascular magnetic resonance imaging

Recent advancements in magnetic resonance imaging hardware and software permit the assessment of cardiovascular structure and function at rest and during exercise or pharmacology-induced cardiac stress. With these developments, knowledge of cardiovascular imaging protocols in the magnetic resonance imaging environment is critical for nursing personnel. The purpose of this article is to review information pertinent to working in a magnetic resonance imaging environment and to describe the requirements of nursing personnel performing cardiovascular magnetic resonance imaging examinations.     

Cardiac Magnetic Resonance Imaging for the Investigation of Cardiovascular Disorders. Part 2: Emerging Applications

Cardiac magnetic resonance imaging has emerged as a robust noninvasive technique for the investigation of cardiovascular disorders. The coming-of-age of cardiac magnetic resonance—and especially its widening span of applications—has generated both excitement and uncertainty in regard to its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1, previously published) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatile uses of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of patients with cardiovascular disorders.     

Diagnostik kardialer Manifestationen bei HIV-positiven Patienten mittels nichtinvasiver Bildgebung

HIV infection is frequently associated with cardiovascular involvement. Particularly new treatment concepts, including the highly active antiretroviral therapy, are suspected to increase the rate of cardiac and cardiovascular complications in this patient population. Hence, noninvasive techniques such as transthoracic echocardiography and magnetic resonance imaging will become more important in the routine screening as well as in specific diagnostics of cardiovascular involvement of HIV infection. The present article describes the options of these noninvasive techniques for the detection of HIV-associated cardiac manifestations.     

Cardiac Magnetic Resonance Imaging for the Investigation of Cardiovascular Disorders. Part 1: Current Applications

Cardiac magnetic resonance imaging is a robust noninvasive technique for investigating cardiovascular disorders. The evolution of cardiac magnetic resonance and its widening span of diagnostic and prognostic applications have generated excitement as well as uncertainty regarding its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this evidence-based review is to discuss some of these issues by highlighting the current (Part 1) and emerging (Part 2) applications of cardiac magnetic resonance. Familiarity with the versatility and usefulness of cardiac magnetic resonance will facilitate its wider clinical acceptance for improving the management of cardiovascular disorders.Key words: Cardiomyo­pathies/diagnosis, fibrosis, gadolinium DTPA/diagnostic use, hypertrophy, left ventricular/diagnosis, magnetic resonance angiography, magnetic resonance imaging/standards, myocarditis/diagnosis, pericarditis, constrictive/diagnosis, sarcoidosis, stroke volume, ventricular dysfunction, left/diagnosisCardiac magnetic resonance imaging (CMR) has emerged as a robust noninvasive technique for the investigation of cardiovascular disorders. Several technical advances have facilitated the growth of CMR by enabling high-quality diagnostic imaging despite the challenges inherent to cardiac imaging: cardiorespiratory motion and flowing blood. Considerable research evidence and years of clinical experience have shown the diagnostic and prognostic usefulness of CMR in a wide spectrum of cardiovascular disorders. The coming-of-age of CMR and its widening span of applications have generated excitement, as well as uncertainty, regarding its potential clinical use and its role vis-à-vis conventional imaging techniques. The purpose of this article is to highlight the current (Part 1) and emerging (Part 2) applications of CMR, in order to assist the referring physician in the decision-making process.     

Metastatic carcinoid tumor obstructing left ventricular outflow

Cardiac tumors are rare and usually indicate metastatic disease. Characterizing a tumor and reaching an exact diagnosis can be difficult. Diagnosis has been aided greatly by advances in imaging, such as cardiovascular magnetic resonance with the use of gadolinium-pentetic acid. Carcinoid tumors are neuroendocrine neoplasms that are found most often in the intestinal tract, although they can also develop in the lung, stomach, or heart. Herein, we report the case of a 72-year-old woman with a history of intestinal carcinoid disease and presenting symptoms of dizziness, fatigue, and chest pain. We used cardiovascular magnetic resonance with gadolinium enhancement to identify a large mass obstructing left ventricular outflow. The histopathologic results of an endomyocardial biopsy confirmed that the mass was a left-sided metastatic carcinoid cardiac tumor. To our knowledge, we are reporting the 1st combined use of clinical evaluation, cardiovascular magnetic resonance, and histopathologic studies to reach such a diagnosis.     

Cardiac changes in systemic amyloidosis: visualisation by magnetic resonance imaging

Cardiac involvement is a significant cause of morbidity and mortality in patients with amyloidosis. A 73-year old Caucasian woman was admitted to a hospital with increasing dyspnoea. Examination revealed a large left-sided pleural effusion, gross peripheral oedema and a pan-systolic murmur. The electrocardiogram showed low voltage QRS complexes with lateral T wave inversion. Recent angiography had demonstrated normal coronaries. Echocardiography revealed left ventricular hypertrophy and an ejection fraction of 43%. There was a restrictive filling pattern with elevated left-sided filling pressures, left atrial enlargement and mild mitral regurgitation. The right heart was normal with normal filling pressures. The patient was referred for cardiovascular magnetic resonance imaging for investigation of restrictive cardiomyopathy. This case provides a striking demonstration of the characteristic features of cardiac amyloidosis by cardiovascular magnetic resonance imaging - impaired biventricular systolic function, thickened atrioventricular valves, bi-atrial enlargement, increased atrial septal thickness and left ventricular mass, pleural and pericardial effusions, and the most impressive finding of widespread subendocardial hyperenhancement of both ventricles, as well as the inter-atrial and inter-ventricular septa, representing infiltration with amyloid protein. Cardiac involvement with systemic amyloidosis was suspected and confirmed on biopsy. Cardiovascular magnetic resonance imaging should be considered early in the diagnostic work-up of suspected cardiac amyloidosis.     

Introduction: From fetal echocardiography to fetal cardiology: A journey of over half a century

In this Special Issue of the Journal, 8 review articles that represent the new developments and applications of fetal echocardiography and fetal cardiology for diagnosis, prognosis, and treatment of fetal cardiovascular disease are included. The goal was to provide an updated review of the evidence for the current and emerging use of fetal echocardiography and cardiac magnetic resonance, improved diagnosis of challenging congenital heart disease, new tools for evaluation of fetal systolic and diastolic function, better prognosis and risk stratification of newborns with congenital heart diseases, and new and promising therapies for fetuses with cardiovascular disease.     

Identification of Left Ventricular Myocardial Ischemia and Cardiac Prognosis with Cardiovascular Magnetic Resonance: Updates from 2008 to 2010

Noninvasive imaging modalities are often used to manage patients with cardiovascular disease. Cardiovascular magnetic resonance (CMR) is increasingly used for diagnosing and evaluating myocardial ischemia and viability; moreover, stress CMR study results can be used to determine cardiac prognosis. In this article, we review recently published material regarding the performance of stress testing with CMR including a brief update regarding techniques, stress agents, diagnostic accuracy, prognosis, economic implications, and ongoing trials and future developments.     

Magnetic resonance coronary angiography

Coronary artery disease is the leading cause of death in the United States. Catheter-based x-ray angiography is the current standard for diagnosis of coronary artery disease. Coronary angiography using cardiovascular magnetic resonance is a rapidly evolving technique that can noninvasively image the coronary arteries. The authors will discuss the basic concepts and techniques of coronary angiography with cardiovascular magnetic resonance and motion suppression. Most of the relevant clinical studies that validate the use of coronary angiography with cardiovascular magnetic resonance will be presented, and potential future developments will be described. Coronary angiography with cardiovascular magnetic resonance could become the gold standard for imaging of the coronary arteries.     

Cardiovascular imaging for the assessment of obesity-related cardiovascular disease

Obesity has reached epidemic proportions throughout the world and is associated with numerous cardiac comorbidities, such as hypertension, type 2 diabetes mellitus, and hyperlipidemia. Through its direct effects on cardiac structure and function and its impact on conventional risk factors, obesity is strongly associated with cardiovascular diseases such as heart failure and coronary heart disease (CHD). Cardiovascular imaging is applied in daily clinical practice for the diagnostic assessment of patients with suspected CHD. Imaging allows the clinician to non-invasively assess and risk-stratify patients to allow for the proper management of CHD. Imaging modalities such as radionuclide cardiac stress imaging, echocardiography and, increasingly, cardiac computed tomography and cardiac magnetic resonance play an important role in the diagnosis of CHD in patients with obesity. Due to the increasingly prevalent nature of obesity and its strong association with cardiovascular disease, CHD remains the leading cause of mortality for adult patients with obesity.     

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

Echocardiography is the most common imaging modality for the assessment of cardiovascular tumors, followed by more advanced imaging modalities, such as cardiac computed tomography or cardiac magnetic resonance imaging. Non‐neoplastic lesions that may simulate a true neoplasm on imaging are termed “cardiac pseudotumors.” As echocardiography is the initial imaging modality where pseudotumors are identified, it is imperative to have a fundamental understanding of pseudotumors evaluation using echocardiography. There is paucity of the literature describing the different kinds of pseudotumors. This review is an attempt to describe common cardiac pseudotumors and to classify them based on their origin. The tumors arising from cardiac structures, such as epicardium, endocardium, or myocardium, were termed as “intrinsic” while the pseudotumors with no cardiac origin were termed as “extrinsic.” The more common pseudotumors are described in detail with pertinent echocardiographic features and examples.     

Update in cardiac imaging techniques. Echocardiography and magnetic resonance imaging

This article is a review of the main developments in cardiac imaging techniques reported in publications during 2005. Recent advances in digital technology have led to steadily increasing reliance on imaging techniques in the management of cardiovascular disease. We discuss advances in two techniques that fall under the remit of the echocardiography working group: echocardiography and magnetic resonance imaging.     

Coronary artery abnormalities in CREST syndrome revealed by cardiovascular magnetic resonance imaging

CREST syndrome represents a subset of systemic sclerosis (SSc). Five patients with CREST syndrome and 5 with SSc without cardiac symptoms and with normal routine cardiac examination were investigated by cardiovascular magnetic resonance. All CREST patients had ectatic coronary arteries, and in 1 of them, an inferior, transmural myocardial infarction was identified. Furthermore, patchy fibrosis was identified in all the patients with SSc, although their coronary arteries were normal. Cardiovascular magnetic resonance can be a useful, noninvasive diagnostic tool in the evaluation of asymptomatic CREST and SSc patients.     

Cardiovascular magnetic resonance in the quantitative assessment of left ventricular mass, volumes and contractile function

Cardiovascular magnetic resonance is a well validated, highly accurate and reproducible technique for the assessment of ventricular volumes, function and mass. State of the art cardiovascular magnetic resonance practice is capable of a ventricular assessment that includes not only systolic but also diastolic function. Thus, it provides an insight into the complex changes in ventricular morphology, physiology and function in cardiovascular disease. This has produced great interest not only in its clinical utilization but also as an important research tool. As refinement of the technique continues to incorporate hardware and software developments, the technique becomes quicker, more accurate and easier to analyse. Here, we review recent developments and current practice.     

Cardiovascular magnetic resonance: applications in daily practice

Over the last 10 years, the development of newer pulse sequences and applications in new clinical areas has enabled cardiovascular magnetic resonance to emerge as a powerful tool for the physicians to both diagnose and guide treatments of various cardiac pathologies. The greatest strengths of cardiovascular magnetic resonance include the assessment of ischemia and viability, evaluation of nonischemic cardiomyopathies, including myocarditis, pericardial disease, congenital heart disease, and tissue characterization of cardiac masses.     

Role of Cardiac MRI in Diabetes

Diabetes and insulin resistance have a variety of detrimental effects on cardiovascular health and outcomes. Cardiac magnetic resonance offers a non-invasive means to obtain many layers of information at a tissue level, including fibrosis, edema, intramyocardial motion, triglyceride content, and myocardial energetics. The role of cardiovascular magnetic resonance is particularly important in the evaluation of recognized and unrecognized coronary artery disease. In this review, we address the current state-of-the-art in cardiac magnetic resonance imaging – for both clinical and investigational use – as it applies to diabetic cardiovascular disease.     

Long term evolution of magnetic resonance imaging characteristics in a case of atypical left lateral wall hypertrophic cardiomyopathy

We are reporting a long-time magnetic resonance imaging (MRI) follow-up in a rare case of cardiac left lateral wall hypertrophy. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder and a significant cause of sudden cardiac death. Cardiac magnetic resonance (CMR) imaging can be a valuable tool for assessment of detailed information on size, localization, and tissue characteristics of hypertrophied myocardium. However, there is still little knowledge of long-term evolution of HCM as visualized by magnetic resonance imaging. Recently, our group reported a case of left lateral wall HCM as a rare variant of the more common forms, such as septal HCM, or apical HCM. As we now retrieved an old cardiac MRI acquired in this patient more than 20 years ago, we are able to provide the thrilling experience of an ultra-long MRI follow-up presentation in this rare case of left lateral wall hypertrophy. Furthermore, this case outlines the tremendous improvements in imaging quality within the last two decades of CMR imaging.     

Clinical applications of feature-tracking cardiac magnetic resonance imaging

Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diagnosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evaluation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.     

Magnetic resonance and other imaging techniques in valvular and cardiac disease

A number of new magnetic resonance imaging techniques are offering excellent views of the cardiovascular system. These techniques can provide accurate information about chamber sizes, ventricular mass, and wall motion. Blood flow patterns can be analyzed to provide semiquantitative estimates of valvular regurgitation. Accurate measurements of the area and velocity of great vessel flow may provide the first truly quantitative magnetic resonance imaging estimates of shunt flow and regurgitant volumes. Future developments and improvements may lead to coronary artery imaging in clinical patients. In addition to these promising developments in magnetic resonance imaging, several other interesting imaging papers are discussed in this review of magnetic resonance and other imaging techniques.