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Cardiovascular Magnetic Resonance Assessment of Right Ventricular Anatomy and Function

Accurate noninvasive assessment of right ventricular (RV) mass and systolic function is important in several pathologies, such as grown-up congenital heart disease, pulmonary hypertension, interstitial lung disease, valvular heart disease, and arrhythmogenic RV cardiomyopathy. Right ventricular function is also a prognostic factor in coronary artery disease and heart failure, even after cardiac resynchronization therapy. This chapter aims to summarize the features of the normal right ventricle,…

Cardiac and Paracardiac Masses

Cardiovascular magnetic resonance (CMR) provides a noninvasive and three-dimensional (3D) assessment of masses involving the cardiac chambers, the pericardium, and extracardiac structures. CMR has become an established method to yield complementary diagnostic information and to guide cardiac surgeons in the design of an appropriate therapeutic strategy. The goals of CMR for assessing cardiac and paracardiac masses are to confirm or to exclude a mass initially suspected…

Cardiovascular Magnetic Resonance Imaging in the Evaluation of Cardiac Transplantation

Cardiac transplant recipients require lifelong surveillance for common and life-threatening posttransplant complications such as acute cardiac allograft rejection (ACAR) and coronary allograft vasculopathy (CAV). Imaging plays an important role in such screening initiatives because most posttransplant complications have long subclinical phases and produce nonspecific symptoms as a result of denervation of the transplanted heart. Heart transplant recipients are also at risk for posttransplant lymphoproliferative disease which…

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a common genetic cardiomyopathy, is present in potentially as many as 1 : 200 individuals in the general population, and is caused by over 1400 mutations in at least 11 genes encoding proteins of the cardiac sarcomere. This genetic diversity is largely responsible for the heterogeneous phenotypic expression associated with this disease, including the range in the pattern of left ventricular (LV) hypertrophy (…

Myocarditis

Myocarditis (from Greek/Latin “inflammation of the heart muscle”) is commonly used for viral myocarditis, although there are numerous other heart conditions leading to myocardial inflammation, including acute ischemic injury, infiltrative diseases, allergies, and toxic or mechanical injuries. Thus inflammatory tissue pathology is not specific to a viral etiology and any such tissue pathology visualized by cardiovascular magnetic resonance (CMR) by itself is not specific as well.…

Arrhythmogenic Right Ventricular Cardiomyopathy

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable heart muscle disease characterized by fibrofatty replacement of, predominantly, the right ventricular (RV) myocardium, which predisposes patients to potentially life-threatening arrhythmias and ventricular dysfunction. Affected patients typically present between the second and fourth decade of life with arrhythmias coming from the RV. ARVC is an unusual condition, with an estimated prevalence of 1 in 1000 to 1 in…

Cardiac Iron Loading and Myocardial T2*

Conditions Associated With Cardiac Iron Loading There are several conditions that can potentially lead to cardiac iron loading with cardiac complications. Cardiac iron loading can occur via two distinct mechanisms: first, primary disruption of iron regulation (genetic hemochromatosis syndromes) where excess gastrointestinal absorption is slow and symptoms often present in middle age; and, second, via transfusional iron overload where the iron accumulation rate is much faster…

T1 and T2 Mapping and Extracellular Volume in Cardiomyopathy

Cardiovascular magnetic resonance (CMR) exploits the inherent difference between tissues in their configuration of atoms by generating differing signals—the fundamental tissue properties T1, T2, and T2*. Whereas differences in these parameters had to be previously visualized by weighted sequences, they can now be measured in a single breath-hold with T1, T2, or T2* displayed as pixel maps where each color-coded pixel carries the absolute value. Furthermore,…

Role of Cardiovascular Magnetic Resonance in Dilated Cardiomyopathy

Dilated cardiomyopathy (DCM) is defined as a disease of the myocardium characterized by left ventricular dilatation and systolic impairment that cannot be exclusively explained by abnormal loading conditions (such as hypertension or valvular heart disease) or coronary artery disease. The true prevalence is debated because of a lack of large contemporary population studies. The original Olmsted County study, performed between 1975 and 1984, estimated the prevalence…

Valvular Heart Disease

As an imaging modality, cardiovascular magnetic resonance (CMR) offers unrivaled versatility and freedom of anatomic access. In relation to heart valve disease, its relative strengths include the following: Depiction by cine imaging of valve movements and jet flow in planes, or stacks of planes, of any orientation. Measurement of right as well as left ventricular volumes and mass by multislice cine imaging. Measurement of volume flow…

Assessment of the Biophysical Mechanical Properties of the Arterial Wall

Arteries are elastic tubes whose diameter varies with the pulsating pressure. In addition, they propagate the pulse created by ejection of blood by the heart, at a velocity that is determined largely by the elastic properties of the arterial wall. The vascular wall can be deformed by pressure and shear stress forces exerted by the blood as well as the tethering imposed by the surrounding tissues.…

Atherosclerotic Plaque Imaging: Coronaries

Coronary artery disease (CAD) is a leading cause of global mortality. It results from atherosclerosis, which is a systemic and progressive disease involving the intimal layer of large- and medium-sized arteries. Atherothrombosis, defined as atherosclerotic plaque disruption (predominantly plaque rupture) with superimposed thrombosis, can lead to arterial occlusion and subsequent life-threatening conditions such as acute myocardial infarction (MI) or ischemic stroke. The concept of a “vulnerable…

Atherosclerotic Plaque Imaging: Aorta and Carotid

Although death rates in industrialized countries have been consistently falling since the 1980s, atherosclerosis is now raging throughout the developing world. As a consequence the complications of atherosclerosis have become the leading cause of mortality and morbidity worldwide. Fundamentally, atherosclerosis is an inflammatory disease, which affects medium and large arteries from the first decade of life until death. It has a predilection for certain arterial beds,…

Coronary Artery Bypass Graft Imaging and Assessment of Flow

Since the report published in 1968 by Favaloro about the use of saphenous veins to restore coronary artery blood flow in 171 patients, a large number of coronary artery bypass grafting (CABG) procedures have been performed worldwide. In the United States alone, 219,000 patients underwent a total of 397,000 CABG procedures in 2010. The left internal mammary artery (IMA) is frequently used as an arterial conduit…

Coronary Artery and Sinus Velocity and Flow

A coronary stenosis may be observed during cardiovascular magnetic resonance (CMR) as an area of signal loss caused by turbulent flow, and although both the degree and the extent of signal loss are indicative of the severity of the stenosis, accurate quantification is not possible. However, both phasic coronary artery blood flow and flow velocity may be affected by the presence of stenosis, and the ratio…

Coronary Artery Imaging: Clinical Results

Chapter 23 reviewed the technical issues and solutions for coronary artery cardiovascular magnetic resonance (CMR) imaging. This chapter reviews the clinical data comparing coronary artery CMR with invasive x-ray coronary angiography for identification of anomalous coronary artery disease (CAD), characterization of coronary artery aneurysms, detection of native vessel disease, and assessment of coronary artery bypass graft integrity. It also describes studies comparing CMR with coronary artery…

Magnetic Resonance Imaging of Coronary Arteries: Technique

Despite significant efforts in prevention and treatment, coronary artery disease (CAD) remains the leading cause of death in the United States, accounting for one in every seven deaths. Each year nearly 700,000 Americans are estimated to have a new myocardial infarction (MI), and nearly 325,000 to have a recurrent infarction. Furthermore, an additional estimated 165,000 will have their first silent MI. The current clinical “gold standard”…

Cardiovascular Magnetic Resonance Tagging for Assessment of Left Ventricular Diastolic Function

Left ventricular (LV) diastolic function has been recognized as an important factor in the pathophysiology of many common cardiovascular diseases. Dilated and hypertrophic cardiomyopathy (HCM), coronary artery disease (CAD), and systemic hypertension are all associated with abnormal LV filling dynamics. Diastolic dysfunction has also been increasingly appreciated as a major cause of heart failure (HF), especially in the elderly. Although invasive hemodynamic measures/assessment of diastole are…

Myocardial Viability

The detection of residual myocardial viability in a patient with regional or global severe left ventricular (LV) dysfunction is of clinical importance to plan the therapeutic strategy because revascularization of dysfunctional but viable myocardium may improve LV function. Several imaging techniques have been shown to be successful in detecting myocardial viability; these include LV angiography using appropriate interventions, perfusion scintigraphy, positron emission tomography (PET), and echocardiography.…

Acute Myocardial Infarction: Ventricular Remodeling

Approximately 550,000 Americans will suffer an acute myocardial infarction (AMI) each year. Despite major advances in AMI therapies, mortality and incident heart failure (HF) remain significant problems. Five-year mortality is estimated at 36% in men and 47% in women. The five-year incidence of HF ranges from 16% in men to 22% in women. These adverse outcomes have been unequivocally linked to the development of significant left…