Atrial fibrilation and CMR

Looks like LGE in atrial fibrillation is not defined protocol standard. Given the limited data on the subject we might not more papers from other groups to really establish the method.

Interesting paper:

For those who are interested CMR and in iron overload, Dr. Seldrum and cols recently published that multiple transfused patients with normal ejection fraction and without heart failure have subclinical alterations of systolic and diastolic LV function in direct relation to the severity of cardiac iron overload. Among all parameters, left ventricular twist is affected earliest, and has the highest correlation to log (T2*), suggesting that this parameter might be used to follow systolic left ventricular function in patients with iron overload. http://jcmr-online.com/content/pdf/1532-429x-13-23.pdf (open access).

Suggested paper of the week

Cardiac magnetic resonance imaging for the diagnosis of patients presenting with chest pain, raised troponin, and unobstructed coronary arteries (Int J Cardiovasc Imaging. 2011 May 3).

Dr Gerbaud and cols aimed to evaluate the incremental diagnostic and prognostic value of cardiac magnetic resonance (CMR) in 130 patients with chest pain, raised troponin and unobstructed coronary arteries, and to compare subsequent event rates between diagnostic groups. In their study, when a single diagnosis was suspected by the referring physician, CMR validated this diagnosis in 32 patients (76.2%). CMR provided a formal diagnosis in 61 patients (69.3%) in which the clinical diagnosis was uncertain between at least two possibilities. CMR corrected a wrong diagnosis in 10 patients (7.7%). CMR-suggested diagnosis led to a modification of therapy in 42 patients (32.3%). Median follow-up was 34 months in 124 patients. Sixteen patients (12.9%) experienced major adverse cardiovascular events (MACE), but MACE rate was not different between patients with a conclusive CMR and normal CMR. They concluded that in patients with acute troponin-positive chest pain and unobstructed coronary arteries, early CMR has important diagnostic and therapeutic implications. However its association with occurrence of MACE during mid term follow-up was not obvious.

SCMR/NHLBI-NIH CMR State of the Art Course

SCMR/NHLBI-NIH CMR State of the Art Course

June 12-13, 2011

Natcher Conference Center
on the NIH Campus
Bethesda, MD

www.scmr.org

Dear colleagues,

The application deadline for a travel grant to attend the SCMR/NHLBI State of the Art CMR Course has been extended until Wednesday, May 11. The lottery drawing for the grants will take place on Friday, May 13!

This two-day introductory, state of the art course on cardiovascular MRI (CMR) is appropriate for those at introductory or intermediate level knowledge of the field. Please forward this information to all colleagues who might be interested in attending.

This course is designed for clinical practitioners, cardiology fellows, radiology residents, technologists/allied health professionals, and will include lectures, case reviews, and interactive workshops by leading faculty in the field.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Society for Cardiovascular Magnetic Resonance and the University of Minnesota. The University of Minnesota is accredited by the ACCME to provide continuing medical education for physicians.

This activity has been approved for AMA PRA Category 1 credit™. Determination of exact number of credits is pending.

Visit the SCMR website for additional information.

We hope to see you at the course!

David Bluemke, MD, PhD
Gregory Hundley, MD
Christopher Kramer, MD

Suggested paper of the week

Dynamic Changes of Edema and Late Gadolinium Enhancement after Acute Myocardial Infarction and Their Relationship to Functional Recovery and Salvage Index (Circ Cardiovasc Imaging. 2011 Mar 29. [Epub ahead of print])

Dr Erica Dall'Armellina and cols investigated changes in edema and late gadolinium enhancement (LGE) with serial imaging early after acute MI, relating these to global and segmental myocardial function at 6 months. They concluded that myocardial edema is maximal and constant over the first week post MI, providing a stable window for the retrospective evaluation of area at risk. By contrast, myocardial areas with high signal intensity in LGE images recede over time with corresponding recovery of function, indicating that acutely detected LGE does not necessarily equate with irreversible injury and may severely underestimate salvaged myocardium.

Suggested paper of the week:

Regional Left Ventricular Myocardial Dysfunction as a Predictor of Incident Cardiovascular Events MESA (Multi-Ethnic Study of Atherosclerosis) J Am Coll Cardiol. 2011 Apr 26;57(17):1735-44

Dr. Yan and his cols from the Johns Hopkins Hospital (USA) examined the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals in an asymptomatic multiethnic American cohort and concluded that RMD is an independent predictor beyond traditional risk factors and global LV assessment for incident heart failure and atherosclerotic cardiovascular events.