What s New in Cardiac MRI
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1 What s New in Cardiac MRI Katie M. Hawthorne, MD Director, Cardiac MRI Main Line Health Philadelphia Cardiovascular Summit November 18, 2017
2 Cardiac MRI: Disclosure 2 Disclosures No financial disclosures Use of gadolinium for cardiovascular MRI is off-label use and not FDA approved
3 CMR: Objectives 3 Objectives Review (briefly) the indications for cardiac MRI Discuss new guidelines that include cardiac MRI Discuss new technology
4 CMR: Indications Complex congenital heart disease: including anomalous coronary origin, great vessels, cardiac chambers, and valvular disease. Quantify shunt: Qp:Qs; as well as precise cardiac chamber size Evaluate left/right ventricular systolic function (*gold standard) Myocardial viability Evaluation of specific cardiomyopathies: Hypertrophic cardiomyopathy Infiltrative: sarcoid, hemochromatosis, amyloidosis Arrhythmogenic ventricular cardiomyopathy (ARVC) Cardiotoxic therapy Evaluation of cardiac masses (suspected tumor or thrombus) Myocarditis Pericardial disease: acute/chronic pericarditis, constrictive pericarditis Ventricular tachycardia: evaluate for areas scar to aid ablation Valvular disease: quantify regurgitation volume, planimetry valve area Aortic pathology Pulmonary veins/anomalies Inadequate Echo images TDS or discrepancy between clinical scenario and echocardiogram (moderate aortic regurgitation by echo, symptoms suggesting severe) Appropriateness criteria OLD Appropriateness Criteria for CCT/CMRJACC Vol. 48, No. 7, 2006
5 Title is 24 pt Arial and can continue onto 2 lines 5
6 JASE (4):
7 7 Valvular Regurgitation JASE (4):
8 8 Valvular Regurgitation JASE (4):
9 JASE (4):
10 10 Valvular Regurgitation: Key Points CMR is an excellent modality for evaluating native valvular regurgitation. While echocardiography remains the first-line modality, CMR is indicated when: Echo images are suboptimal Discordance exists between 2D echocardiographic features and Doppler findings Discordance exists between clinical assessment and severity of regurgitation by echocardiography
11 11 Valvular Regurgitation: Key Points CMR may also provide additional information about the mechanism of regurgitation and myocardial viability, both of which may have implications for surgical intervention. CMR importantly provides quantitative evaluation of chamber size, regurgitant volume and fraction.
12 12 Myocardial Characterization Mahrhold et al: Eur Heart J 2005 (26): 1461
13 Hypertrophic Cardiomyopathy Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiovascular disorder, with an estimated prevalence of 1:500 in the general population Diagnosis of HCM requires confirmation with cardiac imaging of phenotypic expression: unexplained increase in LV wall thickness ( 15 mm in adults) associated with a nondilated LV chamber More recently, CMR has emerged as a powerful complementary tool due to its unique strengths of tomographic imaging and enhanced spatial resolution, which affords better characterization of the complex HCM phenotype. CMR provides an opportunity to provide more precise LV wall thickness measurements, find atypical hypertrophy patterns and characterization of the LVOT, papillary muscle and subvalvular anatomy. J Am Coll Cardiol. 2014;64(1):83-99
14 Hypertrophic Cardiomyopathy Kaplan-Meier unadjusted estimates of freedom from reaching combined primary end point (cardiovascular death, unplanned cardiovascular admission, sustained ventricular tachycardia or ventricular fibrillation, appropriate implantable cardioverterdefibrillator discharge) in 217 hypertrophic cardiomyopathy (HCM) patients according the presence or absence of fibrosis J Am Coll Cardiol. 2010;56(11):
15 Circulation (19): e273-e344 15
16 Hypertrophic Cardiomyopathy 16
17 Circulation (19): e273-e344 17
18 18 Nonischemic Cardiomyopathy JACC: CV Imaging (10): JACC (5):
19 19 Nonischemic Cardiomyopathy EF>35% Circulation :
20 Circulation (19): e273-e344 20
21 21
22 22
23 Circulation (19): e273-e344 23
24 24 Sarcoidosis Patients with LGE had a ninefold higher rate of major adverse events (17.2 versus 1.9 percent per year) and 11.5-fold higher rate of cardiac death (11.5 versus 1.0 percent per year) as compared to patients without LGE. Circulation. 2009;120(20):1969
25 25 Tissue Characterization: New Advances Journal of CMR :75
26 Advancing Technology 26
27 27 Questions? Thank you!
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