PAPER OF THE WEEK

Value of scar imaging and inotropic reserve combination for the prediction of segmental and global left ventricular functional recovery after revascularisation (Journal of Cardiovascular Magnetic Resonance 2011, 13:35)

Dr. Glaveckaite and cols compared three cardiovascular magnetic resonance (CMR) viability parameters: inotropic reserve (IR) during low-dose dobutamine (LDD) administration, late gadolinium enhancement transmurality (LGE) and thickness of the non-contrast-enhanced myocardial rim surrounding the scar (RIM) and concluded that LDD-CMR is superior to LGE-CMR as a predictor of segmental recovery. They show that the advantage is greatest in the segments with an LGE from 26% to 75%. The RIM cut-off value of 4 mm had no superiority over the LGE cut-off value of 50% in predicting the segmental recovery. Patients with [greater than or equal to]50% of viable segments from all dysfunctional and revascularised had a tendency to improve LVEF by [greater than or equal to]5% after revascularisation.

Significant proportion of people with salaries depending on CMR

LA CONQUISTA.................
SIN DUDA ALGUNA RM CARDIACA ES FASCINANTE.........A NUESTROS AMIGOS ELECTROFISIOLOGOS PREMIARNOS UNA VEZ MAS........CON EL GRAN APORTE QUE ESTAN RECIBIENDO DE LA IMAGENOLOGIA CARDIACA.

Imaging of Scar in Patients with Ventricular Arrhythmias of Right Ventricular Origin: Cardiac Magnetic Resonance Versus Electroanatomic Mapping.

Santangeli P, Hamilton-Craig C, Russo AD, Pieroni M, Casella M, Pelargonio G, Biase LD, Smaldone C, Bartoletti S, Narducci ML, Tondo C, Bellocci F, Natale A.

Abstract
Imaging of Scar in Patients with RV Origin Arrhythmias: CMR Versus EAM. Introduction: Assessment of late gadolinium enhancement (LGE) at cardiac magnetic resonance is often used to detect scar in patients with arrhythmias of right ventricular (RV) origin. Recently, electroanatomic mapping (EAM) has been shown to reliably detect scars corresponding to different cardiomyopathic substrates. We compared LGE with EAM for the detection of scar in patients with arrhythmias of RV origin.
Methods and Results: Thirty-one patients with RV arrhythmias and biopsy-proven structural heart disease (18 ARVC and 13 myocarditis), and 5 with idiopathic RV outflow tract arrhythmias underwent LGE analysis and EAM with scar validation through EAM-guided endomyocardial biopsy. EAM scars were present in 23 (64%) patients (all with structural heart disease), whereas LGE was present only in 12 (33%). In 2 cases, EAM provided a false-positive diagnosis of a small scar in the basal perivalvular area. LGE correctly diagnosed EAM scar in 48% of patients, resulting in high positive (92%) but low negative (50%) predictive values. The distribution of LGE was significantly associated with the distribution of EAM scars (P < 0.001 in the free wall, P = 0.003 in the outflow tract, and P = 0.023 in the posterior/inferior wall). Presence of LGE reflected a higher extension of EAM scars (34.4 ± 16.5% vs 7.9 ± 10.1% of the RV area, P < 0.001). At receiver operating characteristic (ROC) analysis, an extension of scar ≥20% of the RV area was the best cut-off value to detect LGE (sensitivity 83%, specificity 92%). Of note, LGE missed 10 of 11 (91%) patients with EAM scars <20% of RV area.
Conclusions: LGE is significantly less sensitive than EAM in identifying RV cardiomyopathic substrates. Absence of LGE does not rule out the presence of small scars, and EAM with biopsy should be considered to increase the diagnostic yield. (J Cardiovasc Electrophysiol, Vol. pp. 1-8).

J Cardiovasc Electrophysiol. 2011 Jul 7

PAPER OF THE WEEK

Effect of Deferiprone or Deferoxamine on Right Ventricular Function in Thalassemia Major Patients with Myocardial Iron Overload (JCMR 2011, 13:34)
Dr. G. Smith from Dr. Pennell's group, studied Thalassaemia major patients and made a retrospective analysis of a prospective randomized controlled trial, concluding that deferiprone monotherapy was superior to deferoxamine for improvement in RV EF and end-systolic volume. This improvement in the RV volumes and function may contribute to the improved cardiac outcomes seen with deferiprone.

JCMR IF increased

The new JCMR Impact Factor has increased to a solid 4.33. In the last year it has steadily risen with 2010 showing a huge gain:
2006 1.74
2007 1.87
2008 2.15
2009 2.28
2010 4.33
Interestingly, self-reporting has been relatively low at 14% with a bit upward numbers to 26% to years used in IF calculation. Even without self cites, it would still post a significant increase to 3.2 this year.
How do we compare to other CV and Rad journals? The median values for CV and Rad are 1.99 and 1.87 respectively. Here is a selected list of journals in order of IF:
Radiology 6.1
JACC Imaging 5.5
Circ Imaging 4.8
Invest radiol 4.7
Eur Radiol 3.6
MRM 3.3
Int J Cardiovas Imag 2.5

Solo

Most readers go solo when reading CMR exams. They leave a double reading for complicated cases only.

Paper of the week

Late gadolinium enhanced cardiovascular magnetic resonance of lamin A/C gene mutation related dilated cardiomyopathy (Journal of Cardiovascular Magnetic Resonance 2011, 13:30)

Dr. Miia Holmstrom and cols, concluded that cardiac conduction abnormalities, mildly dilated LV and depressed systolic dysfunction are common in dilated cardiomyopathy, (DCM) caused by a lamin A/C gene mutation. However, other cardiac diseases may produce similar symptoms. CMR is an accurate tool to determine the typical cardiac involvement in lamin A/C cardiomyopathy and may help to initiate early treatment in this malignant familiar form of DCM.

Paper of the week

Sex and Race Differences in Right Ventricular Structure and Function: The Multi-Ethnic Study of Atherosclerosis–Right Ventricle Study (Circulation. 2011;123:2542-2551.)

Right ventricular (RV) morphology is an important predictor of outcomes in heart and lung disease. Dr Kauwt and cols from the John`s Hopkins Hospital examined the demographic factors associated with RV morphology and function in a population-based multiethnic sample free of clinical cardiovascular disease and concluded that age, sex, and race are associated with significant differences in RV mass, RV volumes, and RV ejection fraction, potentially explaining distinct responses of the RV to cardiopulmonary disease.

Relation of myocardial T2* to right ventricular function in thalassaemia major (EHJ,2010:31, 1648–1654)
Dr. Francisco Alpendurada and cols, supervised by Prof. Dudley Pennell from the Royal Brompton Hospital in London, have many studies about Iron Overload. One very interesting is about RV iron deposition. We can`t miss it... They concluded that myocardial iron deposition is strongly associated with RV dysfunction, which mirrors the decrease in LV function seen with worsening cardiac iron loading. Right ventricular dysfunction may play a significant role in heart failure associated with myocardial siderosis...

Angiotomografia de coronárias CDI: Início do Blog

Angiotomografia de coronárias CDI: Início do Blog: "Olá a todos, a partir de hoje usaremos esse canal para divulgarmos informações e conhecimento sobre a tomografia de coron..."