Document Detail


Fused whole-heart coronary and myocardial scar imaging using 3-T CMR implications for planning of cardiac resynchronization therapy and coronary revascularization.
MedLine Citation:
PMID:  20846626     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to demonstrate the feasibility of providing spatially matched, 3-dimensional (3D) myocardial scar and coronary imaging for the purpose of fused volumetric image display in patients undergoing cardiac resynchronization therapy (CRT) or coronary artery revascularization (CAR).
BACKGROUND: Clinical success in coronary vascular-based interventions is mitigated by the presence of scar in related myocardium. Pre-procedural fused volumetric imaging of both myocardial scar and coronary vasculature may benefit pre-procedural planning and patient selection in populations referred for CRT or CAR.
METHODS: A total of 55 studies were performed in patients referred for either CRT (n = 42) or CAR (n = 13). Coronary-enhanced and scar-enhanced imaging was performed on a 3-T cardiac magnetic resonance scanner using the same cardiac-gated, 3D, free-breathing cardiac magnetic resonance technique during and 20 minutes following slow gadolinium infusion. Matched image datasets were fused and volume-rendered to simultaneously display coronary anatomy and myocardial scar. Visual scoring of coronary artery, coronary vein, and myocardial scar image quality (score 0 to 4) was performed. The clinical impact of imaging was also scored using a physician survey.
RESULTS: Mean age was 57 ± 14 years. Combined 3D coronary and scar imaging was successful in 49 studies (89%). A quality score ≥ 2 was obtained for 97% of proximal- and mid-coronary artery and vein segments. The mean quality score of 3D scar imaging was 2.8 ± 1.0 and was scored as ≥ 2 in 86% of patients with myocardial scar. All patients with a scar quality score ≥ 2 achieved successful image fusion. Transmural scar was present below ≥ 1 planned target vessel in 9 patients (39%) planned for CRT and 8 patients (62%) planned for CAR. Physician surveys demonstrated incremental clinical impact in 67% of patients.
CONCLUSIONS: Three-dimensional myocardial scar and coronary imaging with fused volumetric display is clinically feasible and may be valuable for the planning of vascular-based interventions when regional myocardial scar is pertinent to therapeutic success.
Authors:
James A White; Nowell Fine; Lorne J Gula; Raymond Yee; Mohammed Al-Admawi; Qi Zhang; Andrew Krahn; Allan Skanes; Anna MacDonald; Terry Peters; Maria Drangova
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  3     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  921-30     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada. jwhite@imaging.robarts.ca
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Comment In:
JACC Cardiovasc Imaging. 2010 Sep;3(9):931-3   [PMID:  20846627 ]

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