Showing papers on "Cardiac Imaging Techniques published in 2010"

Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease

Abstract: Major advances in the field of pediatric cardiology and cardiac surgery over the last several decades have led to a dramatic improvement in survival rates for most forms of congenital heart disease (CHD). For example, hypoplastic left heart syndrome, a previously lethal defect, now has early survival rates up to 90% at major centers.1 These improved outcomes have produced a growing population of survivors with complex CHD who are now reaching adulthood (Figure 1). During this period, improvements in surgical and medical treatments have been accompanied by developments in diagnostic modalities. Echocardiography has replaced catheterization as the primary diagnostic modality, and it is now uncommon for newborn infants to undergo catheterization for purely diagnostic purposes. Although echocardiography remains the bedrock of noninvasive cardiac imaging, the array of diagnostic modalities and techniques available continue to grow and this has spawned the specialty of “noninvasive cardiac imaging” and the need for the “cardiac imager” to be adept in all the different modalities. Figure 1. Percentage of patients under the age of 1 year (grey bars) and over the age of 18 years (black bars) undergoing echocardiography at Children’s Hospital Boston from 1983 through 2006. Note the reverse trends of these age groups reflecting the steady increase in the proportion of adult patients with congenital heart disease. Although the absolute number of infants undergoing echocardiography during this time period has increased, their proportion has steadily declined. Echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) are the primary modalities used for noninvasive cardiac imaging in patients with CHD. Nuclear scintigraphy is used in selected circumstances. The Table summarizes the strengths and weaknesses of each modality. Figure 2 shows temporal trends in utilization for the various noninvasive cardiac imaging techniques at our center. It is clear that echocardiography is the most frequently …

Current cardiac imaging techniques for detection of left ventricular mass.

Abstract: Estimation of left ventricular (LV) mass has both prognostic and therapeutic value independent of traditional risk factors. Unfortunately, LV mass evaluation has been underestimated in clinical practice. Assessment of LV mass can be performed by a number of imaging modalities. Despite inherent limitations, conventional echocardiography has fundamentally been established as most widely used diagnostic tool. 3-dimensional echocardiography (3DE) is now feasible, fast and accurate for LV mass evaluation. 3DE is also superior to conventional echocardiography in terms of LV mass assessment, especially in patients with abnormal LV geometry. Cardiovascular magnetic resonance (CMR) and cardiovascular computed tomography (CCT) are currently performed for LV mass assessment and also do not depend on cardiac geometry and display 3-dimensional data, as well. Therefore, CMR is being increasingly employed and is at the present standard of reference in the clinical setting. Although each method demonstrates advantages over another, there are also disadvantages to receive attention. Diagnostic accuracy of methods will also be increased with the introduction of more advanced systems. It is also likely that in the coming years new and more accurate diagnostic tests will become available. In particular, CMR and CCT have been intersecting hot topic between cardiology and radiology clinics. Thus, good communication and collaboration between two specialties is required for selection of an appropriate test.

Noninvasive imaging techniques of constrictive pericarditis.

Abstract: Constrictive pericarditis (CP) is the result of scarring and loss of elasticity of the pericardial sac, resulting in external impedance of cardiac filling. It can occur after virtually any pericardial disease process. Patients typically present with signs and symptoms of right heart failure and/or low cardiac output. An important pathophysiological hallmark of CP is exaggerated ventricular interdependence and impaired diastolic filling. Echocardiography is the initial imaging modality for diagnosis of CP. Unfortunately, no echocardiographic sign or combination of signs is pathognomonic for CP. CT scan and cardiac MRI are other imaging techniques that can provide incremental diagnostic information. CT scan can easily detect pericardial thickening and calcification, while cardiac MRI provides a comprehensive evaluation of the pericardium, myocardium and cardiac physiology. Occasionally, a multimodality approach needs to be considered for the conclusive diagnosis of CP.

Adipositas Cordis An Uncommon Cardiomyopathy Identified by Cardiovascular Magnetic Resonance

Abstract: A 54-year-old female was evaluated for worsening dyspnea on exertion and palpitations. As a young adult, a murmur had been detected during a routine physical examination of the patient, and a 2-dimensional echocardiogram revealed increased left ventricular (LV) wall thickness, which resulted in a presumed diagnosis of hypertrophic cardiomyopathy (HCM). Her medical history was significant for hypothyroidism and breast cancer treated with chemotherapy and radiation 4 years previously. The patient had no family history of heart disease or unexplained sudden death. She was treated with -blockers and calcium channel blockers for heart failure symptoms. Physical examination was notable for a III/VI systolic ejection murmur at the left upper sternal border and a body weight of 160 lb (body mass index 30 kg/m). A 12-lead ECG demonstrated normal sinus rhythm with right-axis deviation and marked LV hypertrophy with nonspecific ST/T-wave changes; a 24-hour ambulatory Holter ECG recorded 1733 premature ventricular contractions with 7 runs of nonsustained ventricular tachycardia. Although the LV wall thickness appeared qualitatively increased. In all echocardiographic imaging planes bright echodensities were present within the myocardium, which produced substantial acoustic shadowing that resulted in poor image quality. To further characterize cardiac morphology, the patient underwent cardiovascular magnetic resonance imaging (CMR). Cine steady-state free precession imaging demonstrated normal systolic function (ejection fraction 83%) of both the LV and right ventricle, with normal regional wall motion. However, there was increased wall thickness of both ventricles with a maximal thickness in the LV lateral wall of 33 mm (ventricular septum 25 mm) and 23 mm in the right ventricle, with a significantly increased LV mass index of 162 g/m (normal 75 g/m)1 and normal left and right atrial

25-on-25: twenty-five perspectives on twenty-five years of cardiopulmonary imaging.

Abstract: The 25th anniversary year of the Journal is an opportune time for both reflecting on the past and envisioning the future of cardiopulmonary imaging. The purpose of this special year-long feature is to provide our readers with the collective perspectives of 25 international leaders in the field regarding the following questions: 1. ‘‘What is the most influential article or advance in our specialty in the past 25 years?’’ 2. ‘‘Which potential advance or line of research of the last 25 years failed to live up to your expectations?’’ 3. ‘‘What are the greatest opportunities and challenges for our specialty in the coming 25 years?’’ 4. ‘‘What will our specialty look like 25 years from now?’’

[Update on cardiac imaging techniques: echocardiography, cardiac magnetic resonance and computed tomography].

Abstract: This article contains a review of the most important contributions made by echocardiography, magnetic resonance imaging and computed tomography to the field of cardiology in 2009. During this period, we helped establish values for myocardial deformation parameters in a number of different clinical settings that have enabled us to achieve better understanding of systolic and diastolic function in both ventricles. Real-time three-dimensional echocardiography has provided new ways to improve the selection and monitoring of potential candidates for an increasing number of noncoronary interventions, such as percutaneous aortic valve implantation and percutaneous mitral valve repair. Magnetic resonance imaging has clearly become the technique of choice for studying a range of different conditions, such as myocarditis and various forms of cardiomyopathy, and is now established as the reference standard in clinical practice for determining the sizes of infarcts and myocardial areas at risk. The diagnostic potential of computed tomography for assessing heart disease has been confirmed in large multicenter trials.

Advances in Cardiovascular Imaging Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease

Abstract: Major advances in the field of pediatric cardiology and cardiac surgery over the last several decades have led to a dramatic improvement in survival rates for most forms of congenital heart disease (CHD). For example, hypoplastic left heart syndrome, a previously lethal defect, now has early survival rates up to 90% at major centers.1 These improved outcomes have produced a growing population of survivors with complex CHD who are now reaching adulthood (Figure 1). During this period, improvements in surgical and medical treatments have been accompanied by developments in diagnostic modalities. Echocardiography has replaced catheterization as the primary diagnostic modality, and it is now uncommon for newborn infants to undergo catheterization for purely diagnostic purposes. Although echocardiography remains the bedrock of noninvasive cardiac imaging, the array of diagnostic modalities and techniques available continue to grow and this has spawned the specialty of “noninvasive cardiac imaging” and the need for the “cardiac imager” to be adept in all the different modalities. Modalities Echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) are the primary modalities used for noninvasive cardiac imaging in patients with CHD. Nuclear scintigraphy is used in selected circumstances. The Table summarizes the strengths and weaknesses of each modality. Figure 2 shows temporal trends in utilization for the various noninvasive cardiac imaging techniques at our center. It is clear that echocardiography is the most frequently used modality for initial assessment and follow-up of most patients with CHD, with CMR and CCT playing complementary but much smaller roles. Diagnostic cardiac catheterization is used sparingly but continues to be used in selected circumstances where detailed hemodynamic assessment is important. Based on trends at our center, the marked increase in use of noninvasive imaging over the past nearly 3 decades is driven predominantly by a growing population of patients with repaired or palliated heart disease and is not related to increased incidence of CHD or increased frequency of testing in individual patients. Figure 1 shows that a progressively increasing proportion of echocardiograms are now performed on adult survivors of CHD. Challenges An ideal modality used for noninvasive imaging of CHD should be able to delineate all aspects of the anatomy, including abnormalities of cardiac structure as well as those involving extracardiac vessels, evaluate physiological consequences of CHD such as measurement of blood flow and pressure gradients across stenotic valves or blood vessels, be cost-effective and portable, not cause excessive discomfort and morbidity, and not expose patients to harmful effects of ionizing radiation. No single modality satisfies all these requirements because noninvasive imaging of CHD poses several unique challenges. Patients range in size from a 200-g fetus to an adult weighing more than 120 kg. Each extreme poses technical difficulties specific to the imaging modality used. For example, in imaging a fetus or newborn infant, a technique with high spatial resolution such as echocardiography performs well, especially because ultrasound windows are usually good. However, the diagnostic yield of echocardiography is often limited in adults, especially after cardiac operations because of diminished ultrasound windows. CMR and CCT are well suited to adults because acoustic windows do not limit image quality but face significant technical challenges in imaging of a fetus or newborn.

Imaging modalities in cardiac electrophysiology.

Abstract: Cardiac imaging, both noninvasive and invasive, has become a crucial part of evaluating patients during the electrophysiology procedure experience. These anatomical data allow electrophysiologists to not only assess who is an appropriate candidate for each procedure, but also to determine the rate of success from these procedures. This article incorporates a review of the various cardiac imaging techniques available today, with a focus on atrial arrhythmias, ventricular arrhythmias and device therapy.