Latest advances in imaging - CMR from basic LGE -DT CMR - UMICO

1. Dr.N.PRAVEEN
MD, DM
YearinCardiology 2019
–Imaging–
CardiacMagneticResonance

2. Prevalenceandprognosisofischaemic
andnon-ischaemicmyocardialfibrosis
inolderadults

3. ICELAND MI study
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Shanbhag et al.,
LGE CMR group No. of patients
MI 211
Major non ischaemic fibrosis (well established classic
patterns associated with myocarditis,infiltrative
cardiomyopathies or pathological hypertrophy)
54
Minor non ischemic fibrosis ( remaining localised
patterns not meeting major criteria)
238
No LGE (reference group) 397

6. 
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 major non-ischaemic fibrosis
MI minor non-ischaemic LGE
 associated with a poorer outcome

8. Take home message
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9. long-termoutcomes of UMI by CMR compared
with clinically recognized myocardialinfarction(RMI)
and nomyocardialinfarction(MI)

10. Acharya et al..
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11. 
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 that all-cause mortality in UMI patents was lower than
recognized MI for at least 5 years
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12. All-cause mortality (A), major adverse cardiac events (B), incident nonfatalmyocardial infarction (MI) (C), and incident heart
failure (D) in participants with unrecognized MI (UMI), recognized MI (RMI), and no MI at baseline.

13. TAKE HOME MESSAGE

14. Howdoyoudetermine
whichpatientswillbenefit
fromICDinNICMP

15. Gutman et al
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18. Take home message
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19. Isanthracyclineinducedcardiotoxicity
reversible?
CanweidentifyearlyonCMR??

20. Galan-Arriola et al
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 increased T2 relaxation
intramyocyte oedema
 Changes in T1 and the extracellular volume on T1 mapping occurred much later
and coincided with wall motion abnormalities
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23. Asterisks indicate statistically significant statistical differences
compared with week 0 for each time point: *p < 0.05, **p < 0.01,
***p < 0.001, or nonsignificant (NS).
(A)Fibrosis (%) in the infused area for each group at sacrifice.
Representative images show Sirius Red staining.
(B) (B) ECV (%) in the infused area for each group at
sacrifice. Representative images show CMR native T1-MOLLI
with a 550 to 1,750 ms masked range. Red arrows mark areas with
significantly increased signal.
(C) Water content (normalized to dry weight) in the infused area
for each group at sacrifice. Representative hematoxylin and eosin
images are shown. Black arrows mark
intracardiomyocyte vacuolization.
(D) T2-GraSE mapping (ms) in the infused area for each group at
sacrifice. Representative images show CMR T2-GraSE mapping
with a 20 to 120 ms mask range.
Red arrows mark areas with significantly increased signal.
Abbreviations as in Figures 2 and 3.

25. TAKE HOME MESSAGE
 COMPETENCY IN PATIENT CARE AND PROCEDURAL SKILLS
 TRANSLATIONAL OUTLOOK

26. Takotsubocardiomyopathy

27. 
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29. EffectofairpollutiononCVD

30. UK Biobank study
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31. DiffusionTensor
DTCMR

32. 
 Sheetlets
 fractional anisotropy (a measure
of myocyte organization) and mean diffusivity (a measure of myocyte packing).
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33. 
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34. Khalique et al
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 switched to right handed
return to left handed at the apex
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40. Ariga et al
 50 patients
 Fractional anisotropy reflects packing of the myocytes and could therefore be
reduced in myocardial disarray
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46. 
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47. Assessment of aortic valve

48. Aortic valve
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49. Clinical Perspective
 What Is New?
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 What Are the Clinical Implications?
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50. Risk assessment in Marfan’s syndrome

51. Marfan syndrome
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 the growth rate of the aortic diameter was
0.62mm/year
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52. European Heart Journal, Volume 40, Issue 25, 1 July 2019, Pages 2047–2055, https://doi.org/10.1093/eurheartj/ehz191
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53. Thank you