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Nov 27, 2010

LGE in papillary muscle in myocardial infarction


An astonishing 40% of patients investigated in this Japanese study after an STEMI had signs of LGE in the papillary muscles. The clinical significance however was not so important since this finding was not associated with mitral regurgitation or ventricular remodeling.

Read the abstract here.

Nov 21, 2010

Valve disease : CMR as the reference method

On the other hand (see previous post), a recent manuscript in Circ Cardiovasc Imaging on mitral regurgitation has compared 2D and 3D TE echo with the reference method - yes, CMR...

If only we could convince ourselves!

Circ Cardiovasc Imaging. 2010 Nov 1;3(6):694-700. Epub 2010 Sep 1.
Quantitative Assessment of Mitral Regurgitation: Comparison Between Three-Dimensional Transesophageal Echocardiography and Magnetic Resonance Imaging.


Shanks M, Siebelink HM, Delgado V, van de Veire NR, Ng AC, Sieders A, Schuijf JD, Lamb HJ, Ajmone Marsan N, Westenberg JJ, Kroft LJ, de Roos A, Bax JJ.

Department of Cardiology and the Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology Rijnland Ziekenhuis, Leiderdorp, The Netherlands.
Abstract

Background- Quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method. Methods and Results- Two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation. Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm(2). In addition, 2D TEE underestimated the Rvol by 21.6% when compared with 3D TEE and by 21.3% when compared with MRI. In contrast, 3D TEE underestimated the Rvol by only 1.2% when compared with MRI. Finally, one third of the patients in grade 1 and ≥50% of the patients in grade 2 and 3, as assessed with 2D TEE, would have been upgraded to a more severe grade, based on the 3D TEE and MRI measurements. Conclusions- Quantification of mitral EROA and Rvol with 3D TEE is feasible and accurate as compared with MRI and results in less underestimation of the Rvol as compared with 2D TEE.

Underuse of CMR for valve assessment


Despite the high prevalence of valve disease in Latin America, CMR is still underused according to our responders.

Nov 8, 2010

Quantifying LGE in HCM


What should be the threshold for LGE quantification in HCM? According to Harrigan > 6SD is the most reproducible and closest to visual assessment than other numbers.

Semiautomation in these cases should really help to establish a number in which to follow patients longitudinally.

Read more at: http://radiology.rsna.org/content/early/2010/10/28/radiol.10090526.long

Nov 2, 2010

Move over 3.0T...


Just as we were warming up, 7.0T comes to town.

An interesting manuscript on the use of this new high field imaging in coronary arteries.

Link here.