Cardiac magnetic resonance imaging (CMR) is regarded as the gold standard for evaluation of left and right ventricular volumes and ejection fraction. Assessment of valve regurgitation can be performed by flow measurement in the great arteries for the aortic and pulmonary valve. Subtraction of ventricle stroke volume and flow measurement in the affiliated great artery results in regurgitation volume of the corresponding atrioventricular valve. Aim of this study was to evaluate the reproducibility of valve regurgitations considering intra- and interobserver variability in patients with mild to moderate valve regurgitation.

Background: Detection of myocardial fibrosis and left ventricular dysfunction in Duchenne muscular dystrophy (DMD) is the corner stone for further therapeutic studies. Little is known about the ability of cardiac magnetic resonance imaging (CMR) to evaluate progression of myocardial fibrosis. Aim of our study was to provide CMR data in a previously genotyped DMD family and to evaluate whether progression of myocardial fibrosis could be visualized.Methods and results: DMD genotypes were available in 14 family members. CMR was performed in 4/5 carrier females, in 2/2 affected males and in one healthy family member with normal genotype. Functional images and late gadolinium enhanced (LGE) images in contiguous short-axis orientation were acquired at baseline and follow-up of 1231 days CMR examination could be repeated in three carrier females, in one affected male and in the healthy subject previously scanned. Mean decrease of left ventricular ejection fraction during the follow-up period was 10.5 +/- 11.0%, mean progression of LGE volume 11.7 +/- 9.5%.Conclusions: Myocardial fibrosis seems to occur prior to global left ventricular dysfunction in DMD diseased males and carrier females. CMR could be used to evaluate progression of myocardial fibrosis and left ventricular function and may thus serve as an important diagnostic tool in the evaluation of therapeutical options in DMD. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND:Diagnosis of inducible myocardial ischemia is important for deciding further diagnosis and therapy in coronary artery disease (CAD). Blood oxygen level-dependent (BOLD) cardiac magnetic resonance imaging (CMR) is a potential method to evaluate myocardial perfusion reserve alternatively to first-pass perfusion using contrast agents.METHODS AND RESULTS:We imaged 46 patients with suspected CAD on a 1.5 T whole-body CMR scanner using a T2-prepared steady-state free-precession (SSFP) BOLD-sensitive sequence and a SSFP-based first-pass sequence. All patients were scanned during rest and after 3 min of adenosine infusion (140 µg/kg/min). For myocardial first-pass visualization 0.1 mmol/kg Gadolinium-based contrast agent was used. In 90 myocardial segments a first-pass perfusion deficit could be seen. Relative BOLD signal increase was significantly lower in patients with perfusion deficits compared to patients without perfusion deficits (p < 0.0001). Patients with non-transmural and with transmural first-pass perfusion deficit also differed significantly for BOLD signal increase (p < 0.0001). ROC analysis showed an area under the curve of 0.83 for the T2-prepared SSFP sequence regarding detection of inducible perfusion deficit.CONCLUSIONS:T2-prepared BOLD imaging allows for visualization of myocardial perfusion reserve in a clinical setting without additional use of contrast agents.

Background Cardiac magnetic resonance imaging (CMR) including adenosine perfusion and late gadolinium enhancement (LGE) at 1.5 Tesla (T) has been established for noninvasive detection of relevant coronary artery disease (CAD). However, little is known about the potential advantages of 3.0-T to detect CAD. The aim of our prospective study was to compare a compiled clinical routine CMR protocol performed at both 1.5-T and 3.0-T in patients with suspected CAD undergoing coronary x-ray angiography. Methods Fifty-two patients (62.3 ± 10.2 years) with suspected CAD referred for coronary x-ray angiography were included into the study. All patients were scanned at both 1.5-T and 3.0-T including functional imaging, adenosine stress and rest perfusion, and LGE imaging. CMR images were analyzed by two blinded readers in consensus. A significant CAD was diagnosed by quantitative coronary analysis. Two thresholds of >50% and >70% stenosis in coronary arteries with a diameter of >2mm were chosen. Results Diagnostic accuracy of the combined analysis of perfusion and LGE imaging yielded better values at 1.5-T and 3.0-T than the analysis of perfusion images alone. Sensitivity and specificity at 3.0-T was superior to 1.5-T in detection of coronary stenoses >50% (0.87 vs. 0.77 and 0.91 vs. 0.76) and >70% (0.96 vs. 0.89 and 0.92 vs. 0.80). Area under receiver-operator characteristic (ROC) curve was higher for detection of coronary stenoses in the left anterior descending and left circumflex artery at 3.0-T in comparison to 1.5-T, but not in the right coronary artery. Conclusions This study showed that CMR at 3.0-T in a routine clinical setting is superior to 1.5-T in detection of significant CAD. 3.0-T might become the preferred CMR field strength for evaluation of CAD in clinical practice.

OBJECTIVE:To investigate the feasibility of MRI for non-invasive assessment of the coronary sinus (CS) and the number and course of its major tributaries in heart failure patients.METHODS:Fourteen non-ischaemic heart failure patients scheduled for cardiac resynchronisation therapy (CRT) underwent additional whole-heart coronary venography. MRI was performed 1 day before device implantation. The visibility, location and dimensions of the CS and its major tributaries were assessed and the number of potential implantation sites identified. The MRI results were validated by X-ray venography conventionally acquired during the device implantation procedure.RESULTS:The right atrium (RA), CS and mid-cardiac vein (MCV) could be visualised in all patients. 36% of the identified candidate branches were located posterolaterally, 48% laterally and 16% anterolaterally. The average diameter of the CS was quantified as 9.8 mm, the posterior interventricular vein (PIV) 4.6 mm, posterolateral segments 3.3 mm, lateral 2.9 mm and anterolateral 2.9 mm. Concordance with X-ray in terms of number and location of candidate branches was given in most cases.CONCLUSION:Contrast-enhanced MRI venography appears feasible for non-invasive pre-interventional assessment of the course of the CS and its major tributaries.

Introduction Cardiac resynchronization therapy (CRT) is still limited by the often sub-optimal response of patients in about 30% of the cases. The lack of response can partly be explained by non-optimal left ventricular (LV) lead locations, which are limited by the accessibility through the coronary veins. Knowledge of the course of the coronary veins prior to the intervention may improve patient selection for CRT. It is the intent of this study to investigate the feasibility of whole-heart coronary vein imaging in heartfailure patients scheduled for CRT for pre-interventional identification of lateral vein candidates for LV lead implantation.

AIMSCurrent studies found an incidence of 12-31% ventricular tachyarrhythmias and sudden cardiac death during cardiac pacing months or even years after pacemaker insertion. MADIT(12) and MUSTT(13) demonstrated that patients with poor LV function after Myocardial infarction (MI) showing non-sustained ventricular tachycardia (nsVT) and inducibility during electrophysiologic testing benefit from an ICD. The present study was dedicated to assess the global incidence of non-sustained ventricular arrhythmias in a general population of pacemaker patients. Special regard was on patients with a potential ICD indication, e.g. those matching the MADIT/MUSTT criteria.METHODS AND RESULTSTwo hundred and thirty-one patients (72 +/- 11 years; 134 men) with an indication for dual chamber pacing entered the study. In all patients pacemaker systems capable of automatic storing of intracardiac electrocardiograms were implanted (Pulsar, Discovery, Guidant). Follow-up time was 15 months after inclusion. In 54 (25.7%) of 210 patients with at least one follow-up, episodes of nsVT were documented by stored electrocardiograms (up to >30 beats, >200 b.p.m.). Multiple-up to nine-episodes of ventricular tachycardia were retrieved in 31 of these patients. Three out of 14 patients with an LVEF <40% after MI presented nsVT during the follow-up. One of these patients received an ICD.CONCLUSIONA significant number of pacemaker patients present with ventricular tachycardia. Intracardiac electrocardiograms and alert functions from pacemakers may enhance physicians' awareness of the patient's intrinsic arrhythmic profile and help uncover underlying mechanisms of arrhythmias by storing the initiation of the arrhythmia.