Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy.

Regular blood transfusions are required for the long term survival of patients with thalassaemia major (TM) but this can cause tissue iron overload. Myocardial iron overload can lead to heart failure and subsequent death. Iron chelation therapy can reduce tissue iron levels but efficacy needs to be closely monitored. Ferritin levels and hepatic iron loading do not correlate well with cardiac iron levels thus the need for a reliable, non-invasive means of follow-up. Cardiovascular magnetic resonance (CMR) using a bright blood gradient echo sequence has been validated for the quantification of tissue iron levels. Signal intensity decreases with increasing echo time and the rate of decay is proportional to iron loading. This bright blood sequence has been widely used for clinical follow-up and efficacy of pharmacological intervention. A T2* <20 ms is considered indicative of cardiac iron overload. Contrast between blood pool and myocardium for this technique is however relatively low, and blood signal artifacts which propagate onto the myocardium can further reduce accuracy. A double inversion pulse black blood sequence has recently been developed to address these issues. It is of interest therefore to assess reproducibility in a larger group of patients and to compare differences according to iron overload levels.

/pdf/the-reproducibility-of-cardiac-t2-measurement-in-59tnzo3fnr.pdf

The reproducibility of cardiac T2* measurement in thalassaemia major patients using bright and black blood sequences

Introduction Without regular blood transfusions most patients with Thalassaemia major (TM) die during infancy. This however leads to tissue iron overload, in the heart potentially causing heart failure and subsequent death unless chelation therapy is instigated. The introduction of cardiovascular magnetic resonance (CMR) has been associated with a reduction in death rates from iron overload cardiomyopathy. Imaging allows identification of patients at risk of heart failure and regular follow-up aids the optimization of therapeutic regimes.

https://link.springer.com/content/pdf/10.1186/1532-429X-12-S1-P291.pdf

The optimisation of cardiac iron overload assessment by systolic imaging

Introduction The measurement of T2* has been established as a rapid, reproducible non-invasive method for assessing iron loading in the heart and liver. For the heart, two CMR sequences are used routinely. The first is a 'bright-blood' multi-echo, single breath-hold acquisition in early systole. The second 'dark-blood' sequence is acquired in late diastole with a double inversion-recovery pre-pulse to null the blood pool giving enhanced blood/myocardial delineation. The long breath-hold times (up to 20 seconds) can be difficult for some patients, resulting in impaired image quaility.

/pdf/the-use-of-parallel-imaging-techniques-for-the-measurement-4dtxlqnw1n.pdf

The use of parallel imaging techniques for the measurement of T2* decay

Background Cardiovascular magnetic resonance (CMR) is the gold standard for LV volumetric assessment. Detailed tracing of the endocardial border, including papillary muscles and trabeculations, can be time consuming. In many centres it is clinical practice to simplify this and trace the general outline of the endocardial border instead. Such analysis means that all non-wall adherent trabeculations are included in the LV cavity rather than within the myocardium. We aimed to assess the impact of manual and semiautomated simplified endocardial contouring on the accuracy and reproducibility of LV volumetric assessment.

https://link.springer.com/content/pdf/10.1186%2F1532-429X-12-S1-P250.pdf

The impact of simplified endocardial contouring on left ventricular volumetric assessment

Background: Cardiomyopathy (CM) frequently leads to heart failure which is associated with a high degree of mortality, morbidity and financial burden on healthcare providers. Confidence in the recognition of risk factors or in early diagnosis allows timely intervention, before heart failure develops. The right ventricle (RV) has historically been overlooked when assessing cardiac function and response to therapy but its importance is increasingly recognised. Cardiovascular magnetic resonance (CMR) is established as the gold standard for assessing the functional consequences of cardiovascular disease, being non-invasive and with high accuracy and reproducibility. It can also provide in-vivo tissue information which may be diagnostic before functional changes are apparent. With this backdrop I tested the hypothesis that CMR can provide early disease markers in patients at risk of heart failure in 3 unrelated conditions associated with heart failure including: Emery-Dreifuss muscular dystrophy (EDMD), anthracycline induced cardiomyopathy and cardiac iron overload in transfusion dependent patients. Methods and Results: Patients with 3 different clinical substrates for the development of CM were studied. In group 1, patients with EDMD were studied by CMR and echo. There was a significant reduction in inferior wall contractility using CMR tagging (0.062±0.02 versus -0.094±0.03 in the control group, p=0.048) and in echo derived early diastolic myocardial posterior wall velocity gradients (4±1.2 vs. 7.1±2.7 s-1, p=0.02). Bi-ventricular ejection fraction (EF) was normal and no late gadolinium enhancement (LGE) was detected. These findings demonstrated the relative insensitivity of EF in the detection of early disease and the need for careful follow up in these patients. In group 2, anthracycline mediated cardiotoxicity (AMC) was studied. The risk of heart failure rises with cumulative dose but not all individuals are susceptible. In a cohort of patients with early breast cancer an increase in early gadolinium relative enhancement (EGRE) from baseline to day 3 correlated with a reduction in LVEF after a year

Cardiovascular magnetic resonance in cardiomyopathies

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Cardiovascular magnetic resonance in cardiomyopathies