Paper of the Week

Incremental Prognostic Significance of Combined Cardiac Magnetic Resonance

Imaging, Adenosine Stress Perfusion, Delayed Enhancement, and Left Ventricular Function Over Preimaging Information for the Prediction of Adverse Events

(Circulation. 2011;123:1509-1518.)

Dr Bingham and cols followed up 908 consecutive patients who underwent combined CMR for suspicion of coronary stenosis and/or ischemia at 2.6_1.2 years, during which 101 total cardiac events occurred (all-cause death, myocardial infarction, or late revascularization). In the studied population, cardiac magnetic resonance imaging without abnormalities had a 2.4% event rate per year (<1% cardiac death or myocardial infarction). Abnormal CMR was associated with event rates of 5.6% to 7.0% per year, varying with which and how many components were abnormal. They concluded that CMR analysis of ventricular volume, aortic flow, myocardial viability, and stress perfusion all add incremental value for prediction of adverse events over pre-CMR data and can be combined to further enhance prognostication. Normal combined CMR confers a low risk of subsequent cardiac events.

Paper of the Week

Role of Cardiovascular Magnetic Resonance as a Gatekeeper to Invasive Coronary Angiography in Patients Presenting With Heart Failure of Unknown Etiology. (Circulation. 2011;124:1351-1360.)

Dr. Assomull and cols assessed the diagnostic accuracy of a cardiovascular magnetic resonance (CMR) protocol incorporating late gadolinium enhancement (LGE) and magnetic resonance coronary angiography (CA) as a noninvasive gatekeeper to CA in determining the etiology of heart failure in patients and concluded that LGE-CMR is a safe, clinically effective, and potentially economical gatekeeper to CA in patients presenting with heart failure of uncertain etiology.

PAPER OF THE WEEK

Prevalence of scarred and dysfunctional myocardium in patients with heart failure of ischaemic origin: A cardiovascular magnetic resonance study
Journal of Cardiovascular Magnetic Resonance 2011, 13:53

Dr. Christos V Bourantas and cols assessed the prevalence of dysfunctional myocardium, including partial thickness scar in patients with heart failure and ischaemic heart disease who denied angina symptoms. They concluded that in their cohort of patients with left ventricular systolic dysfunction and ischaemic heart disease, about half of all segments had contractile dysfunction but only one third of these had >50% of the wall thickness affected by scar, suggesting that most dysfunctional segments could improve in response to an appropriate intervention.