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Gatti M, Gallone G, D'Angelo T, Torlasco C, Andreis A, Castelletti S, D'Ascenzo F, Frea S, Muscogiuri G, Olivieri M, Blandino A, De Ferrari GM, Di Bella G, Micari A, Fonio P, Faletti R. Rationale and design of the CT-STEMI study (Cardiac Computed Tomography for comprehensive risk stratification of arrhythmic, atherothrombotic and heart failure events following reperfused ST-segment Elevation Myocardial Infarction). J Cardiovasc Comput Tomogr 2025:S1934-5925(25)00082-6. [PMID: 40274431 DOI: 10.1016/j.jcct.2025.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/10/2025] [Accepted: 04/17/2025] [Indexed: 04/26/2025]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) remains a major cause of morbidity and mortality, with survivors facing high risk of heart failure, recurrent ischemia, and arrhythmias. Risk stratification traditionally relies on echocardiography, while cardiac magnetic resonance (CMR) is the most effective tool for predicting adverse outcomes. However, its routine use is limited by accessibility, cost, and logistical constraints. Recently, cardiac computed tomography (CCT) has evolved from an angiographic tool to a comprehensive imaging modality capable of assessing wall motion abnormalities and myocadial tissue characteristics. OBJECTIVES The CT-STEMI study aims to (1) evaluate the diagnostic accuracy of CCT for myocardial morphofunctional assessment and tissue characterization compared to CMR, (2) determine the prognostic value of CCT-derived features for adverse outcomes, and (3) assess the role of CCT in quantifying atherosclerotic burden in STEMI patients. METHODS CT-STEMI (NCT06020209) is a prospective, multicenter observational study enrolling STEMI patients treated with primary PCI within 24 h of symptom onset. Each patient undergoes comprehensive CCT (pre-contrast imaging, full R-R interval angiography, and late iodine enhancement) and CMR within 10 days of the acute event, with imaging sequence randomized. Patients will be followed longitudinally for heart failure, arrhythmic events, and recurrent ischemic complications. SUMMARY This study aims to validate CCT as a cost-effective, comprehensive imaging modality for post-STEMI risk stratification, with the added benefit of coronary artery evaluation. If successful, CCT could serve as an efficient, one-stop diagnostic tool, enhancing patient outcomes while optimizing healthcare resources.
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Affiliation(s)
- Marco Gatti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Guglielmo Gallone
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
| | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Azienda Ospedaliera Universitaria "Gaetano Martino", 98124 Messina, Italy.
| | - Camilla Torlasco
- Istituto Auxologico Italiano IRCCS, Department of Cardiology, piazzale Brescia 20, Milan, 20149, Italy.
| | - Alessandro Andreis
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy; Advanced Cardiovascular Echocardiography Unit, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino University Hospital, Italy.
| | - Silvia Castelletti
- Istituto Auxologico Italiano IRCCS, Department of Cardiology, piazzale Brescia 20, Milan, 20149, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
| | - Simone Frea
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
| | | | - Marzia Olivieri
- Istituto Auxologico Italiano IRCCS, Department of Radiology, piazzale Brescia 20, Milan, 20149, Italy.
| | - Alfredo Blandino
- Diagnostic and Interventional Radiology Unit, Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Azienda Ospedaliera Universitaria "Gaetano Martino", 98124 Messina, Italy.
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department Cardiovascular and Thoracic, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy.
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Gaetano Martino", 98124 Messina, Italy.
| | - Antonio Micari
- Cardiology Unit, Department of Biomedical and Dental Sciences and of Morphological and Functional Images, University of Messina, Azienda Ospedaliera Universitaria Policlinico "Gaetano Martino", 98124 Messina, Italy.
| | - Paolo Fonio
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
| | - Riccardo Faletti
- Department of Surgical Sciences, Radiology Unit, University of Turin, Via Genova 3, 10126, Turin, Italy.
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Bartoli A, Gnasso C, Palmisano A, Bettinelli A, Vignale D, Esposito A. Myocardial Characterization on CT: Late Iodine Enhancement and Extracellular Volume. Echocardiography 2025; 42:e70108. [PMID: 39963992 DOI: 10.1111/echo.70108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 01/08/2025] [Accepted: 02/03/2025] [Indexed: 05/10/2025] Open
Abstract
Myocardial tissue characterization is fundamental in diagnosing, treating, and managing various cardiac diseases. In recent years, cardiac computed tomography (CCT) emerged as a valuable alternative to cardiac magnetic resonance (CMR) for myocardial tissue characterization, with the possibility to detect myocardial scar and quantify the extracellular volume fraction in a single CT study with the advantage of combined coronary arteries evaluation, shorter scanning time, and less susceptibility to device artifacts compared to CMR. However, CCT is typically affected by a lower contrast-to-noise ratio and potentially increased radiation exposure. Therefore, a deep understanding of the available technology and the strategies for acquisition optimization is of fundamental importance to improve image quality and accuracy, while minimizing radiation exposure. This review summarizes principles of myocardial characterization on CCT, acquisition protocols according to the different technologies available including the dual-energy CT and the innovative photon-counting detector CT, and setting of clinical utility.
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Affiliation(s)
- Axel Bartoli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Radiology, TIMONE Hospital, AP-HM, Marseille, France
- CRMBM - UMR CNRS 7339, Aix-Marseille University, Marseille, France
| | - Chiara Gnasso
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Bettinelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Schulz A, Otton J, Hussain T, Miah T, Schuster A. Clinical Advances in Cardiovascular Computed Tomography: From Present Applications to Promising Developments. Curr Cardiol Rep 2024; 26:1063-1076. [PMID: 39162955 PMCID: PMC11461626 DOI: 10.1007/s11886-024-02110-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 08/21/2024]
Abstract
PURPOSE OF THE REVIEW This review aims to provide a profound overview on most recent studies on the clinical significance of Cardiovascular Computed Tomography (CCT) in diagnostic and therapeutic pathways. Herby, this review helps to pave the way for a more extended but yet purposefully use in modern day cardiovascular medicine. RECENT FINDINGS In recent years, new clinical applications of CCT have emerged. Major applications include the assessment of coronary artery disease and structural heart disease, with corresponding recommendations by major guidelines of international societies. While CCT already allows for a rapid and non-invasive diagnosis, technical improvements enable further in-depth assessments using novel imaging parameters with high temporal and spatial resolution. Those developments facilitate diagnostic and therapeutic decision-making as well as improved prognostication. This review determined that recent advancements in both hardware and software components of CCT allow for highly advanced examinations with little radiation exposure. This particularly strengthens its role in preventive care and coronary artery disease. The addition of functional analyses within and beyond coronary artery disease offers solutions in wide-ranging patient populations. Many techniques still require improvement and validation, however, CCT possesses potential to become a "one-stop-shop" examination.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - James Otton
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tarique Hussain
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Tayaba Miah
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
- Departments of Paediatrics, Southwestern Medical Center, University of Texas, Dallas, TX, USA
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center, Göttingen, Germany.
- FORUM Cardiology, Rosdorf, Germany.
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4
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Emoto T, Kidoh M, Oda S, Sakabe D, Morita K, Hatemura M, Nakaura T, Nagayama Y, Inoue T, Funama Y, Takashio S, Tsujita K, Hirai T. Diagnostic performance of unenhanced electrocardiogram-gated cardiac CT for detecting myocardial edema. Medicine (Baltimore) 2024; 103:e38295. [PMID: 38758838 PMCID: PMC11098205 DOI: 10.1097/md.0000000000038295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024] Open
Abstract
To assess the diagnostic performance of unenhanced electrocardiogram (ECG)-gated cardiac computed tomography (CT) for detecting myocardial edema, using MRI T2 mapping as the reference standard. This retrospective study protocol was approved by our institutional review board, which waived the requirement for written informed consent. Between December 2017 to February 2019, consecutive patients who had undergone T2 mapping for myocardial tissue characterization were identified. We excluded patients who did not undergo unenhanced ECG-gated cardiac CT within 3 months from MRI T2 mapping or who had poor CT image quality. All patients underwent unenhanced ECG-gated cardiac CT with an axial scan using a third-generation, 320 × 0.5 mm detector-row CT unit. Two radiologists together drew regions of interest (ROIs) in the interventricular septum on the unenhanced ECG-gated cardiac CT images. Using T2 mapping as the reference standard, the diagnostic performance of unenhanced cardiac CT for detecting myocardial edema was evaluated by using the area under the receiver operating characteristic curve with sensitivity and specificity. Youden index was used to find an optimal sensitivity-specificity cutoff point. A cardiovascular radiologist independently performed the measurements, and interobserver reliability was assessed using intraclass correlation coefficients for CT value measurements. A P value of <.05 was considered statistically significant. We included 257 patients who had undergone MRI T2 mapping. Of the 257 patients, 35 patients underwent unenhanced ECG-gated cardiac CT. One patient was excluded from the study because of poor CT image quality. Finally, 34 patients (23 men; age 64.7 ± 14.6 years) comprised our study group. Using T2 mapping, we identified myocardial edema in 19 patients. Mean CT and T2 values for 34 patients were 46.3 ± 2.7 Hounsfield unit and 49.0 ± 4.9 ms, respectively. Mean CT values moderately correlated with mean T2 values (Rho = -0.41; P < .05). Mean CT values provided a sensitivity of 63.2% and a specificity of 93.3% for detecting myocardial edema, with a cutoff value of ≤45.0 Hounsfield unit (area under the receiver operating characteristic curve = 0.77; P < .01). Inter-observer reproducibility in measuring mean CT values was excellent (intraclass correlation coefficient = 0.93; [95% confidence interval: 0.86, 0.96]). Myocardial edema could be detected by CT value of myocardium in unenhanced ECG-gated cardiac CT.
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Affiliation(s)
- Takafumi Emoto
- Department of Central Radiology, Kumamoto University Hospital, Chuo-ku, Kumamoto, Japan
| | - Masafumi Kidoh
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Daisuke Sakabe
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Kosuke Morita
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Masahiro Hatemura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Takeshi Nakaura
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Yasunori Nagayama
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Taihei Inoue
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
| | - Yoshinori Funama
- Department of Medical Physics, Faculty of Life Sciences, Chuo-ku, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Chuo-ku, Kumamoto, Japan
| | - Toshinori Hirai
- Department of Diagnostic Radiology, Graduate School of Medical Sciences, Chuo-ku, Kumamoto, Japan
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5
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Talakić E, Schöllnast H, Kaufmann-Bühler AK, Hohenberg F, Mijović K, Nagy E, Fuchsjäger M, Tschauner S. The "cardiac neglect": a gentle reminder to radiologists interpreting contrast-enhanced abdominal MDCT. Front Cardiovasc Med 2023; 10:1147166. [PMID: 37180771 PMCID: PMC10167052 DOI: 10.3389/fcvm.2023.1147166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/24/2023] [Indexed: 05/16/2023] Open
Abstract
Myocardial infarction (MI) may be visible on contrast-enhanced multidetector computed tomography (MDCT) scans of the abdomen. In the previous literature, potentially missed MI in abdominal MDCTs was not perceived as an issue in radiology. This retrospective single-center study assessed the frequency of detectable myocardial hypoperfusion in contrast-enhanced abdominal MDCTs. We identified 107 patients between 2006 and 2022 who had abdominal MDCTs on the same day or the day before a catheter-proven or clinically evident diagnosis of MI. After reviewing the digital patient records and applying the exclusion criteria, we included 38 patients, with 19 showing areas of myocardial hypoperfusion. All MDCT studies were non ECG-gated. The delay between the MDCT examination and MI diagnosis was shorter in studies with myocardial hypoperfusion (7.4 ± 6.5 hours and 13.8 ± 12.5 hours) but not statistically significant p = 0.054 . Only 2 of 19 (11%) of these pathologies had been noted in the written radiology reports. The most common cardinal symptom was epigastric pain (50%), followed by polytrauma (21%). STEMI was significantly more common in cases of myocardial hypoperfusion p = 0.009 . Overall, 16 of 38 (42%) patients died because of acute MI. Based on extrapolations using local MDCT rates, we estimate several thousand radiologically missed MI cases worldwide per year.
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Affiliation(s)
- Emina Talakić
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Helmut Schöllnast
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Institute of Radiology, LKH Graz II, Graz, Austria
| | | | - Florian Hohenberg
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Ksenija Mijović
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Emergency Radiology Department, Center for Radiology and MRI, University Clinical Center of Serbia, Belgrade, Serbia
| | - Eszter Nagy
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Sebastian Tschauner
- Division of Paediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
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6
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Harris NR, Bálint L, Dy DM, Nielsen NR, Méndez HG, Aghajanian A, Caron KM. The ebb and flow of cardiac lymphatics: a tidal wave of new discoveries. Physiol Rev 2023; 103:391-432. [PMID: 35953269 PMCID: PMC9576179 DOI: 10.1152/physrev.00052.2021] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/16/2022] [Accepted: 07/18/2022] [Indexed: 12/16/2022] Open
Abstract
The heart is imbued with a vast lymphatic network that is responsible for fluid homeostasis and immune cell trafficking. Disturbances in the forces that regulate microvascular fluid movement can result in myocardial edema, which has profibrotic and proinflammatory consequences and contributes to cardiovascular dysfunction. This review explores the complex relationship between cardiac lymphatics, myocardial edema, and cardiac disease. It covers the revised paradigm of microvascular forces and fluid movement around the capillary as well as the arsenal of preclinical tools and animal models used to model myocardial edema and cardiac disease. Clinical studies of myocardial edema and their prognostic significance are examined in parallel to the recent elegant animal studies discerning the pathophysiological role and therapeutic potential of cardiac lymphatics in different cardiovascular disease models. This review highlights the outstanding questions of interest to both basic scientists and clinicians regarding the roles of cardiac lymphatics in health and disease.
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Affiliation(s)
- Natalie R Harris
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - László Bálint
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Danielle M Dy
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Natalie R Nielsen
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hernán G Méndez
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amir Aghajanian
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kathleen M Caron
- Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Myocardial Fluid Balance and Pathophysiology of Myocardial Edema in Coronary Artery Bypass Grafting. Cardiol Res Pract 2020; 2020:3979630. [PMID: 32550020 PMCID: PMC7256715 DOI: 10.1155/2020/3979630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
Myocardial edema is one of the most common complications of coronary artery bypass grafting (CABG) that is linearly related to many coronary artery diseases. Myocardial edema can cause several consequences including systolic dysfunction, diastolic dysfunction, arrhythmia, and cardiac tissue fibrosis that can increase mortality in CABG. Understanding myocardial fluid balance and tissue and systemic fluid regulation is crucial in order to ultimately link how coronary artery bypass grafting can cause myocardial edema in such a setting. The identification of susceptible patients by using imaging modalities is still challenging. Future studies about the technique of imaging modalities, examination protocols, prevention, and treatment of myocardial edema should be carried out, in order to limit myocardial edema occurrence and prevent complications.
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Karamitsos TD, Arvanitaki A, Karvounis H, Neubauer S, Ferreira VM. Myocardial Tissue Characterization and Fibrosis by Imaging. JACC Cardiovasc Imaging 2019; 13:1221-1234. [PMID: 31542534 DOI: 10.1016/j.jcmg.2019.06.030] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/23/2022]
Abstract
Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.
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Affiliation(s)
- Theodoros D Karamitsos
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
| | - Alexandra Arvanitaki
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Haralambos Karvounis
- 1st Department of Cardiology, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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9
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The evaluation of epicardial adipose tissue radiodensity according to age. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.774738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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10
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Stephens NR, Restrepo CS, Saboo SS, Baxi AJ. Overview of complications of acute and chronic myocardial infarctions: revisiting pathogenesis and cross-sectional imaging. Postgrad Med J 2019; 95:439-450. [PMID: 30975728 DOI: 10.1136/postgradmedj-2018-136279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/06/2019] [Accepted: 02/09/2019] [Indexed: 01/14/2023]
Abstract
Myocardial infarction (MI) remains one of the leading contributors to overall mortality and morbidity in the modern world, even with recent advances in medicine. Various complications can arise following an MI, particularly with delayed or inadequate treatment. Even though many of these complications are uncommon, they can have a significant impact on patient outcomes. Some of these complications can be diagnosed based on clinical, laboratory and echocardiographic evaluation. Other times, however, cardiac MR and multidetector CT are necessary in their diagnosis and proper evaluation. Accurate detection of these complications is an important aspect of optimising prompt and effective patient care, leading to better clinical outcomes. It is the goal of this article to review the role of cross-sectional imaging in patients with post-MI as well as the characteristic imaging findings and differential diagnosis of common and uncommon complications of MI.
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Affiliation(s)
- Nicholas R Stephens
- Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Carlos S Restrepo
- Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Sachin S Saboo
- Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ameya J Baxi
- Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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11
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La Grutta L, Toia P, Maffei E, Cademartiri F, Lagalla R, Midiri M. Infarct characterization using CT. Cardiovasc Diagn Ther 2017; 7:171-188. [PMID: 28540212 DOI: 10.21037/cdt.2017.03.18] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Myocardial infarction (MI) is a major cause of death and disability worldwide. The incidence is not expected to diminish, despite better prevention, diagnosis and treatment, because of the ageing population in industrialized countries and unhealthy lifestyles in developing countries. Nowadays it is highly requested an imaging tool able to evaluate MI and viability. Technology improvements determined an expansion of clinical indications from coronary plaque evaluation to functional applications (perfusion, ischemia and viability after MI) integrating additional phases and information in the mainstream examination. Cardiac computed tomography (CCT) and cardiac MR (CMR) employ different contrast media, but may characterize MI with overlapping imaging findings due to the similar kinetics and tissue distribution of gadolinium and iodinated contrast media. CCT may detect first-pass perfusion defects, dynamic perfusion after pharmacological stress, and delayed enhancement (DE) of non-viable territories.
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Affiliation(s)
| | - Patrizia Toia
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Erica Maffei
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada
| | - Filippo Cademartiri
- Department of Radiology, Montreal Heart Institute/Universitè de Montreal, Montreal, Canada.,Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roberto Lagalla
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
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Saeed M, Bajwa HZ, Do L, Hetts SW, Wilson MW. Multi-detector CT and MRI of microembolized myocardial infarct: monitoring of left ventricular function, perfusion, and myocardial viability in a swine model. Acta Radiol 2016; 57:215-24. [PMID: 25735621 DOI: 10.1177/0284185115574737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/31/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with acute myocardial infarct (MI) show additional damage after coronary interventions. PURPOSE To longitudinally quantify structural and functional changes in the left ventricle (LV) subjected to microembolized MI using multidisciplinary computed tomography (MDCT) and independent reference methods. MATERIAL AND METHODS Swine (n = 20) served as controls (group I) or were subjected to a combination of coronary occlusion, microembolization, and reperfusion and imaged at 3 days (group II) or 3 days and 5 weeks (group III). LV volumes, perfusion, and MI mass were quantified on cine, perfusion, and delayed contrast enhancement (DE) MDCT. MRI, cardiac injury biomarkers, histochemical and histopathologic stains were used as independent references. RESULTS MDCT showed a reduction in ejection fraction and increased end systolic volume (31 ± 2% and 82 ± 3 mL, respectively) of group III compared with I (48 ± 2% and 57 ± 1 mL, respectively). It also demonstrated perfusion deficits in microembolized MI and peri-infarcts. DE-MDCT delineated microvascular obstruction (MVO) zones embedded in acute microembolized MI and microinfarct specks resulting from persistent MVO by deposited microemboli in microvessels of peri-infarct zone. Bland-Altman test showed close agreements between the extents of microembolized MI measured on DE-MDCT, DE-MRI, and histochemical TTC staining, but not between these modalities and microscopy. MI resorption was evident between 3 days and 5 weeks (13.4 ± 0.5 g and 9.8 ± 0.5 g, P < 0.017) and histologic examination revealed incomplete healing. Injury biomarkers were increased after intervention. CONCLUSION MDCT can longitudinally quantify regional perfusion deficits, LV dysfunction, and resorption of microembolized MI. MDCT or MRI can be used alternatively after coronary interventions in cases of contraindications for one modality or the other.
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Affiliation(s)
- Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Hisham Z Bajwa
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Loi Do
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, California, USA
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14
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Burk LM, Wang KH, Wait JM, Kang E, Willis M, Lu J, Zhou O, Lee YZ. Delayed contrast enhancement imaging of a murine model for ischemia reperfusion with carbon nanotube micro-CT. PLoS One 2015; 10:e0115607. [PMID: 25635838 PMCID: PMC4312037 DOI: 10.1371/journal.pone.0115607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 11/30/2014] [Indexed: 11/24/2022] Open
Abstract
We aim to demonstrate the application of free-breathing prospectively gated carbon nanotube (CNT) micro-CT by evaluating a myocardial infarction model with a delayed contrast enhancement technique. Evaluation of murine cardiac models using micro-CT imaging has historically been limited by extreme imaging requirements. Newly-developed CNT-based x-ray sources offer precise temporal resolution, allowing elimination of physiological motion through prospective gating. Using free-breathing, cardiac-gated CNT micro-CT, a myocardial infarction model can be studied non-invasively and with high resolution. Myocardial infarction was induced in eight male C57BL/6 mice aged 8–12 weeks. The ischemia reperfusion model was achieved by surgically occluding the LAD artery for 30 minutes followed by 24 hours of reperfusion. Tail vein catheters were placed for contrast administration. Iohexol 300mgI/mL was administered followed by images obtained in diastole. Iodinated lipid blood pool contrast agent was then administered, followed with images at systole and diastole. Respiratory and cardiac signals were monitored externally and used to gate the scans of free-breathing subjects. Seven control animals were scanned using the same imaging protocol. After imaging, the heart was harvested, cut into 1mm slices and stained with TTC. Post-processing analysis was performed using ITK-Snap and MATLAB. All animals demonstrated obvious delayed contrast enhancement in the left ventricular wall following the Iohexol injection. The blood pool contrast agent revealed significant changes in cardiac function quantified by 3-D volume ejection fractions. All subjects demonstrated areas of myocardial infarct in the LAD distribution on both TTC staining and micro-CT imaging. The CNT micro-CT system aids straightforward, free-breathing, prospectively-gated 3-D murine cardiac imaging. Delayed contrast enhancement allows identification of infarcted myocardium after a myocardial ischemic event. We demonstrate the ability to consistently identify areas of myocardial infarct in mice and provide functional cardiac information using a delayed contrast enhancement technique.
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Affiliation(s)
- Laurel M. Burk
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- * E-mail:
| | - Ko-Han Wang
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - John Matthew Wait
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Eunice Kang
- Division of Cardiology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Monte Willis
- Division of Cardiology, McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Jianping Lu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- Curriculum in Applied Science and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Otto Zhou
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- Curriculum in Applied Science and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
| | - Yueh Z. Lee
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States of America
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Chai Q, Liu J, Hu Y. Comparison of femoral and aortic remote ischaemia preconditioning for cardioprotection against myocardial ischaemia/reperfusion injury in a rat model. Interact Cardiovasc Thorac Surg 2014; 19:1013-8. [PMID: 25205781 DOI: 10.1093/icvts/ivu303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Remote ischaemia preconditioning (RIPC) induces some protection against heart ischaemia/reperfusion (IR) injury. However, many different methods were tried in the past, and no consensus exists. The aim of this study was to compare femoral and aortic ischaemia preconditioning on cardiac markers and on heart injury after IR. METHODS Sixty male Sprague-Dawley rats were randomly allocated into four groups: the sham group, control group, femoral group (F, bilateral femoral artery ischaemia) and aorta group (A, abdominal aorta ischaemia). They were submitted to 30 min occlusion of the left coronary artery and to 180 min reperfusion (except the sham group) after different preconditioning protocols (femoral versus aortic). Cardiac markers, infarct area and cardiomyocyte apoptosis index were compared between groups using analysis of variance. RESULTS Creatine kinase-MB, lactate dehydrogenase and cardiac troponin I levels were lower in Group F compared with the control group, while there was no difference between Group A and the control group for these three parameters. There were significant differences between the control and experimental groups in myocardial infarct size (control: 48.34 ± 6.79% vs F: 29.64 ± 4.51% and A: 31.81 ± 9.62%, P <0.001). Group F had a lower cardiomyocyte apoptosis index than controls (18.32 ± 9.30 vs 31.75 ± 10.65%, P = 0.016), but there was no difference between Group A and controls (23.25 ± 4.77%, P = 0.107). CONCLUSIONS These results confirmed the cardioprotection of RIPC against myocardial IR injury. However, they did not provide sufficient supporting evidence for the enhancement of cardioprotection with an increased area of remote ischaemia preconditioning in rat, or with different ischaemia sites.
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Affiliation(s)
- Qing Chai
- Department of Critical Medicine and Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Critical Medicine and Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Hu
- Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wince WB, Suranyi P, Schoepf UJ. Contemporary cardiovascular imaging methods for the assessment of at-risk myocardium. J Am Heart Assoc 2013; 3:e000473. [PMID: 24366853 PMCID: PMC3959708 DOI: 10.1161/jaha.113.000473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- W Benjamin Wince
- Department of Medicine, Medical University of South Carolina Heart and Vascular Center, Medical University of South Carolina, Charleston, SC
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Liu CP, Lin YH, Lin MS, Huang WC, Lin SL. Evaluation of myocardial infarction patients after coronary revasculation by dual-phase multi-detector computed tomography: Now and in future. World J Cardiol 2013; 5:115-118. [PMID: 23675560 PMCID: PMC3653013 DOI: 10.4330/wjc.v5.i4.115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/19/2013] [Accepted: 03/23/2013] [Indexed: 02/06/2023] Open
Abstract
Multidetector-row computed tomography (MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years. In selected patients, MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography. Chiou et al reported a delicate infarcted myocardium at-risk score. According to their results, the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score (r = 0.841, P < 0.001). They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk. In this commentary, we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect, detecting reversible myocardial ischemia, assessing myocardial viability, estimating target lesion restenosis, and calculating of fractional flow reserve from MDCT.
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18
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Reply. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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19
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CT of coronary heart disease: Part 1, CT of myocardial infarction, ischemia, and viability. AJR Am J Roentgenol 2012; 198:531-47. [PMID: 22357992 DOI: 10.2214/ajr.11.7082] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This article reviews the CT-based approaches aimed at the assessment of myocardial infarction, ischemia, and viability described in the recent literature. CONCLUSION Rapid advances in CT technology not only have improved visualization of coronary arteries but also increasingly enable noncoronary myocardial applications, including analysis of wall motion and the state of the myocardial blood supply. These advancements hold promise for eventually accomplishing the goal of comprehensively evaluating coronary heart disease with a single noninvasive modality.
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Magnetic resonance imaging/magnetic resonance spectroscopy biomarkers evaluation of stunned myocardium in canine model. Invest Radiol 2011; 46:209-14. [PMID: 21343826 DOI: 10.1097/rli.0b013e31820218a4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate whether dynamic alterations in high-energy phosphate (HEP) occur in postischemic "stunned" myocardium (SM) in canine model and to investigate the correlation between HEP and cardiac function, using cine magnetic resonance imaging (cine-MRI) and phosphorus-31 magnetic resonance spectroscopy (31P-MRS). MATERIALS AND METHODS Dogs (n = 13) underwent cine MRI and 31P-MRS at 60 minutes, 8 days after 10 minutes full left anterior descending occlusion followed by reperfusion. The same MRI/MRS experiments were repeated on 5 reference animals (dogs without ischemic reperfusion) at the same time points to serve as internal reference myocardium (RM). After MR data acquisitions, the SM dogs (n = 3 at 60 minutes; n = 10 at 60 minutes and day 8) and RM dogs (n = 5) were euthanized and myocardial tissues were sampled for histologic study by triphenyltetrazolium chloride staining, hematoxylin and eosin staining, and electron microscopic examination. RESULTS The myocardial stunning at 60 minutes was confirmed by electron microscopy examinations from the 3 randomly chosen animals with SM. The phosphocreatine (PCr)/β- adenosine triphosphate (ATP) ratio of SM was significantly lower at 60 minutes than that at day 8 (1.07 ± 0.20 vs. 1.97 ± 0.28, P < 0.05). However, no significant difference was found between 60 minutes and day 8 in RM group (1.91 ± 0.14 at 60 minutes vs. 1.89 ± 0.16 at day 8, P > 0.05). At 60 minutes, the PCr/β-ATP ratio has significant difference between SM and RM groups; while at day 8, the ratio shows no significant difference between the 2 groups. The same results were obtained for left ventricle ejection fraction (LVEF). In SM group, LVEF has good correlation with myocardial PCr/β-ATP ratios at 60 minutes (R2 = 0.71, P < 0.05) and at day 8 (R2 = 0.73, P < 0.05), respectively. CONCLUSIONS The HEP alterations were confirmed by 31P-MRS in SM and there is a good correlation between PCr/β-ATP ratio and LVEF for SM at 60 minutes and recovered myocardium at day 8. The combined MRS/MRI method offers the potential to systematically assess the cardiac function, morphology, and metabolism of SM. These MRS/MRI biomarker datasets could be used to dynamically monitor therapeutic efficiency and predict cardiac events.
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Abstract
Over recent decades, noninvasive imaging has become well established in the diagnostic work-up of patients suffering from myocardial infarction. It provides insights into the individual patient's prognosis and guides therapeutic decisions. MRI has long been considered the standard of reference in the noninvasive imaging of myocardial infarction. Only recently have different multidetector-row spiral computed tomography (MDCT) techniques successfully been evaluated for the visualization of myocardial infarction. This article describes different concepts of cardiac MDCT imaging in acute and chronic myocardial infarction. MDCT assessment of myocardial edema, myocardial perfusion and delayed myocardial contrast enhancement are introduced, with the latter evolving as key concept of viability imaging by means of MDCT. The current status of MDCT in the diagnostic work-up of myocardial infarction is reviewed.
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Affiliation(s)
- Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, D-52074 Aachen, Germany.
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22
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The Year in Cardiac Imaging. J Am Coll Cardiol 2011; 57:1721-34. [DOI: 10.1016/j.jacc.2011.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 12/27/2010] [Accepted: 01/02/2011] [Indexed: 11/21/2022]
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Eitel I, Friedrich MG. T2-weighted cardiovascular magnetic resonance in acute cardiac disease. J Cardiovasc Magn Reson 2011; 13:13. [PMID: 21332972 PMCID: PMC3060149 DOI: 10.1186/1532-429x-13-13] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 02/18/2011] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) using T2-weighted sequences can visualize myocardial edema. When compared to previous protocols, newer pulse sequences with substantially improved image quality have increased its clinical utility. The assessment of myocardial edema provides useful incremental diagnostic and prognostic information in a variety of clinical settings associated with acute myocardial injury. In patients with acute chest pain, T2-weighted CMR is able to identify acute or recent myocardial ischemic injury and has been employed to distinguish acute coronary syndrome (ACS) from non-ACS as well as acute from chronic myocardial infarction.T2-weighted CMR can also be used to determine the area at risk in reperfused and non-reperfused infarction. When combined with contrast-enhanced imaging, the salvaged area and thus the success of early coronary revascularization can be quantified. Strong evidence for the prognostic value of myocardial salvage has enabled its use as a primary endpoint in clinical trials. The present article reviews the current evidence and clinical applications for T2-weighted CMR in acute cardiac disease and gives an outlook on future developments."The principle of all things is water"Thales of Miletus (624 BC - 546 BC).
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Affiliation(s)
- Ingo Eitel
- University of Leipzig - Heart Center, Department of Internal Medicine - Cardiology, Leipzig, Germany
- Stephenson Cardiovascular Magnetic Resonance Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
| | - Matthias G Friedrich
- Stephenson Cardiovascular Magnetic Resonance Centre at the Libin Cardiovascular Institute of Alberta, Departments of Cardiac Sciences and Radiology, University of Calgary, Calgary, Canada
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Pracon R, Kruk M, Kepka C, Pregowski J, Opolski MP, Dzielinska Z, Michalowska I, Chmielak Z, Demkow M, Ruzyllo W. Epicardial Adipose Tissue Radiodensity Is Independently Related to Coronary Atherosclerosis - A Multidetector Computed Tomography Study -. Circ J 2011; 75:391-7. [DOI: 10.1253/circj.cj-10-0441] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Radoslaw Pracon
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology
| | - Mariusz Kruk
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology
| | - Cezary Kepka
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology
| | - Jerzy Pregowski
- Department of Cardiology and Interventional Angiology, Institute of Cardiology
| | | | - Zofia Dzielinska
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology
| | | | | | - Marcin Demkow
- Department of Coronary Artery Disease and Structural Heart Diseases, Institute of Cardiology
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Nikolaou K, Alkadhi H, Bamberg F, Leschka S, Wintersperger BJ. MRI and CT in the diagnosis of coronary artery disease: indications and applications. Insights Imaging 2010; 2:9-24. [PMID: 22347932 PMCID: PMC3259311 DOI: 10.1007/s13244-010-0049-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 09/27/2010] [Accepted: 10/19/2010] [Indexed: 01/16/2023] Open
Abstract
In recent years, technical advances and improvements in cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI) have provoked increasing interest in the potential clinical role of these techniques in the non-invasive work-up of patients with suspected coronary artery disease (CAD) and correct patient selection for these emerging imaging techniques. In the primary detection or exclusion of significant CAD, e.g. in the patient with unspecific thoracic complaints, and also in patients with known CAD or advanced stages of CAD, both CT and MRI yield specific advantages. In this review, the major aspects of non-invasive MR and CT imaging in the diagnosis of CAD will be discussed. The first part describes the clinical value of contrast-enhanced non-invasive CT coronary angiography (CTCA), including the diagnostic accuracy of CTCA for the exclusion or detection of significant CAD with coronary artery stenoses that may require angioplastic intervention, as well as potentially valuable information on the coronary artery vessel wall. In the second section, the potential of CT for the imaging of myocardial viability and perfusion will be highlighted. In the third and final part, the range of applications of cardiac MRI in CAD patients will be outlined.
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The culprit lesion and its consequences: combined visualization of the coronary arteries and delayed myocardial enhancement in dual-source CT: a pilot study. Eur Radiol 2010; 20:2834-43. [DOI: 10.1007/s00330-010-1864-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2010] [Accepted: 05/04/2010] [Indexed: 01/10/2023]
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Dongaonkar RM, Stewart RH, Geissler HJ, Laine GA. Myocardial microvascular permeability, interstitial oedema, and compromised cardiac function. Cardiovasc Res 2010; 87:331-9. [PMID: 20472566 DOI: 10.1093/cvr/cvq145] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The heart, perhaps more than any other organ, is exquisitely sensitive to increases in microvascular permeability and the accumulation of myocardial interstitial oedema fluid. Whereas some organs can cope with profound increases in the interstitial fluid volume or oedema formation without a compromise in function, heart function is significantly compromised with only a few percent increase in the interstitial fluid volume. This would be of little consequence if myocardial oedema were an uncommon pathology. On the contrary, myocardial oedema forms in response to many disease states as well as clinical interventions such as cardiopulmonary bypass and cardioplegic arrest common to many cardiothoracic surgical procedures. The heart's inability to function effectively in the presence of myocardial oedema is further confounded by the perplexing fact that the resolution of myocardial oedema does not restore normal cardiac function. We will attempt to provide some insight as to how microvascular permeability and myocardial oedema formation compromise cardiac function and discuss the acute changes that might take place in the myocardium to perpetuate compromised cardiac function following oedema resolution. We will also discuss compensatory changes in the interstitial matrix of the heart in response to chronic myocardial oedema and the role they play to optimize myocardial function during chronic oedemagenic disease.
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Affiliation(s)
- Ranjeet M Dongaonkar
- Michael E. DeBakey Institute, Texas A&M University, College Station, TX 77843-4466, USA
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