Klinische Anwendung und neue Entwicklungen: Welches Verfahren für welche Indika:on? Kardiales MR. 17. Zürcher Herzkurs
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1 Klinische Anwendung und neue Entwicklungen: Welches Verfahren für welche Indika:on? Kardiales MR 17. Zürcher Herzkurs Dr. med. Gabriella De Pasquale HerzGefässZentrum Zürich Klinik im Park
2 Most common current indica:ons for CMR in UK Prof. S. Plein, ESC 2017
3 Coronary heart disease Func=on Perfusion Scar
4 2014 ESC Guidelines on myocardial revascularisaton
5 CMR Goldstandard LV/ RV Volumes LV/ RV Mass Shunt Quan:fica:on Qp/Qs Congenital heart disease CMR preferred imaging method Myocardial fibrosis Late Gadolinium Enhancement T1 Mapping Best alterna:ve imaging if echo non diagnos=c Useful for ae=ology of heart failure
6 Cine imaging
7 3D Volumes
8 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure European Heart Journal (2016)
9 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure European Heart Journal (2016)...dis:nguish between ischaemic and non- ischemic myocardial damage in case of equivocal clinical and other imaging data...
10 ...assessment of structure and func:on...
11 Histological Valida:on Bright is dead
12 LGE and Differen:als Ischemic Non- Ischemic Marholdt H et al EHJ 2005;26:
13 LGE and Prognosis
14 Gimelli A et al., Eur Heart Journal 2014;35:
15 Clinical Vignege 84 years old man Pulmonary edema No chest pain No syncope Peripheral edema Normal coronaries 2015 Diabetes mellitus 2 Arterial hypertension
16 Echocardiography
17 Cine 4CH/ 3CH
18
19 Late Gadolinium Enhancement
20 Na:v T1 Mapping (T1 > 3T)
21 Post KM T1 Mapping (ECV 55%)
22 Parametric Imaging T1 Mapping and ECV (Extracellular Volume) Adapted from Ugander M SCMR 2014
23 Amyloidosis LGE and Prognosis Survival func=ons for LGE paoern in AL pa=ents Survival func=ons for LGE paoern in ATTR pa=ents Fontana M et al. Circula:on 2015;132:1570-9
24 Parametric Imaging T1 Mapping - ECV Amyloid Deposi:on: inters::al expansion Endomyocardial biopsie = reference Sampling Error... T1 Mapping quan:ta:ve assessment of diffuse inters::al process ECV ñ Fontana M., Na:ve T1 Mapping in transthyre:n amyloidosis JACC Cardiovasc Imaging 2014 Sado DM., Elliog P., Cardiovascular magne:c resonance measurement of myocardial extracellular volume in health and disease. Heart:2013
25 Mapping Sequence Salerno M, Kramer CM. JACC CV Imaging, 2013;6:806-22
26 Assessment of Extracellular Volume as a Novel Imaging Biomarker The late gadolinium enhanced technique has become an important imaging biomarker for the detec:on of focal fibrosis in both ischemic and nonischemic cardiomyopathies. However, several cardiac pathologies result in more diffuse altera:ons of the extracellular matrix, which are not easily detected using late gadolinium enhanced. CMR T1 mapping techniques may be used in conjunc:on with magne:c resonance imaging contrast agents to quan:fy the expansion of the extracellular volume (ECV) resul:ng from inflamma:on, edema, infiltra:on, or fibrosis
27 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy European Heart Journal (2014) 35,
28 Extent LGE Freedom from SCD >20% LGE Incidence of SCD event Chan et al, Circula:on 2014;130:484
29 Dilated Cardiomyopathy Midwall LGE and Prognosis Gula: A et al., JAMA 2013;309:
30 Conclusions CMR Imaging I Gold standard for evalua:ng myocardial func:on, volumes, and scarring unique in its comprehensive :ssue characteriza:on assessment of myocardial edema myocardial iron overload myocardial perfusion diffuse myocardial fibrosis
31 Conclusions CMR Imaging II Several cardiac pathologies result in more diffuse altera:ons of the extracellular matrix, which are not easily detected using LGE T1 mapping techniques may be used in conjunc:on with magne:c resonance imaging contrast agents to quan:fy the expansion of the extracellular volume (ECV) resul:ng from inflamma:on, edema, infiltra:on, or fibrosis.
32 Conclusions CMR Imaging III indispensable tool in the evalua:on of congenital heart disease heart failure cardiac masses pericardial disease coronary artery disease
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