The EACVI Textbook of Cardiovascular Magnetic Resonance最新文献_第2页

Chagas’ cardiomyopathy

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0028

Carlos Eduardo Rochitte, Otávio Rizzi Coelho-Filho

{"title":"Chagas’ cardiomyopathy","authors":"Carlos Eduardo Rochitte, Otávio Rizzi Coelho-Filho","doi":"10.1093/med/9780198779735.003.0028","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0028","url":null,"abstract":"Chagas’ cardiomyopathy is a major complication emerging from Trypanosoma cruzi infection, appearing in up to 30% of individuals with positive serology and being the principal cause of death from heart failure in some areas of South America. The natural history of Chagas’ cardiomyopathy classically includes two phases: an acute phase, typically with absence of symptoms to mild, non-specific symptoms, and a chronic phase which comprises two forms of disease—an indeterminate (latent, pre-clinical) form and a determinate or clinical form. Patients with the indeterminate form may be asymptomatic for decades, until unidentified triggers initiate disease progression to chronic chagasic cardiomyopathy, manifesting in a broad range of clinical presentations, including cardiac arrhythmias, thromboembolism, heart failure, and sudden death. Non-invasive imaging modalities capable of characterizing not only cardiac morphology and function, but also myocardial tissue remodelling and disease progression, may play an important role in Chagas’ disease. Myocardial late gadolinium enhancement by cardiovascular magnetic resonance (CMR) has been considered the most accurate method to detect myocardial fibrosis in ischaemic and non-ischaemic cardiomyopathy, including Chagas’ cardiomyopathy. Myocardial tissue characterization, uniquely provided by CMR, holds enormous potential within a complex and not completely understood cardiomyopathy, with poor prognosis and limited therapeutic options. This chapter aims to discuss several relevant aspects of Chagas’ cardiomyopathy, focusing on the usefulness of CMR in the diagnosis and risk stratification of affected patients.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121291949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 14

Myocardial iron overload 心肌铁超载

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0033

J. Carpenter, J. Wood, D. Pennell

{"title":"Myocardial iron overload","authors":"J. Carpenter, J. Wood, D. Pennell","doi":"10.1093/med/9780198779735.003.0033","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0033","url":null,"abstract":"The heart is the target lethal organ in thalassaemia major. Cardiovascular magnetic resonance (CMR) measures iron using the magnetic relaxation time T2*. This allows comparison with the left ventricular function and conventional iron measurements such as liver iron and serum ferritin. The single breath-hold cardiac-gated CMR acquisition takes only 15 seconds, making it cost-efficient and relevant to developing countries. Myocardial T2* of <20 ms (increased iron) correlates with reduced left ventricular ejection fraction, but poor correlation exists with ferritin and liver iron, indicating poor capability to assess future risk. Myocardial T2* of <10 ms is present in >90% of thalassaemia patients developing heart failure, and approximately 50% of patients with T2* of <6 ms will develop heart failure within 1 year without intensified treatment. The technique is validated and calibrated against human heart iron concentration. The treatment for iron overload is iron chelation, and three major trials have been performed for the heart. The first trial showed deferiprone was superior to deferoxamine in removing cardiac iron. The second trial showed a combination therapy of deferiprone with deferoxamine was more effective than deferoxamine monotherapy. The third trial showed that deferasirox was non-inferior to deferoxamine in removing cardiac iron. Each drug in suitable doses can be used to remove cardiac iron, but their use depends on clinical circumstances. Other combination regimes are also being evaluated. Use of T2*, intensification of chelation treatment, and use of deferiprone are associated with reduced mortality (a reduction in deaths by 71% has been shown in the United Kingdom). The use of T2* and iron chelators in the heart has been summarized in recent American Heart Association guidelines.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133639428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Valve disease 瓣膜疾病

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0038

J. Cavalcante, F. V. Knobelsdorff, S. Myerson

引用次数: 70

Infiltrative cardiomyopathy 渗透性的心肌病

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0032

J. Moon, M. Desai, M. Fontana

{"title":"Infiltrative cardiomyopathy","authors":"J. Moon, M. Desai, M. Fontana","doi":"10.1093/med/9780198779735.003.0032","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0032","url":null,"abstract":"Abnormal substances can deposit in the myocardium either in the extracellular space (infiltration) or in cells (storage). Infiltration may be cells (inflammatory, histiocytosis, or tumour) or amyloid fibrils [in ventricular myocardium light chain-related (AL) or transthyretin-related (TTR), wild-type or mutant]. Storage may be glycogen (glycogen storage diseases, Danon), lipid (Fabry, Gaucher), mucopolysaccharidoses, or iron. Iron, malignancy, and inflammation (myocarditis) are covered elsewhere. Amyloid and storage diseases are typically systemic multi-organ disease, with ‘red flag’ clinical features often present. They mainly cause heart muscle disease, with hypertrophy mimicking hypertrophic cardiomyopathy. All are relatively rare and often diagnosed late when therapies are less effective. Imaging structural and functional changes provide pointers to the underlying aetiology and additional features may be present (perfusion defects, valve disease, atrial thickening), but it is in myocardial tissue characterization where CMR adds real value. In amyloid, deposition appears to proceed stepwise, with initial subendocardial, and later transmural, late gadolinium enhancement (LGE). Myocardial nulling may be difficult, requiring the phase-sensitive inversion recovery (PSIR) technique. In Fabry disease, a characteristic initial basal inferolateral LGE pattern occurs, later with extensive LGE, leading to dilatation and impairment. Mapping adds value. In amyloid, both native T1 and the ECV are very high. Both are prognostic and candidates for surrogate endpoints in drug development studies. In Fabry disease, native T1 is low, reflecting lipid storage, and may occur early before hypertrophy. The LGE area usually has T2 elevation correlating with blood troponin, which suggests inflammation as part of disease development.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"132 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124502493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Pericardial tumours 心包肿瘤

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0044

C. Basso, P. Buser, S. Rizzo, M. Lombardi, G. Thiene

引用次数: 0

Pericardial disease 心包疾病

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0036

D. Kwon, H. She, H. Frank, T. Sykora

引用次数: 0

Novel CMR techniques for advanced surgical planning 先进手术计划的新型CMR技术

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/MED/9780198779735.003.0049

M. Fogel

引用次数: 1

Tetralogy of Fallot 法洛四联症

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0055

A. Powell

引用次数: 0

Acute ischaemic heart disease 急性缺血性心脏病

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/MED/9780198779735.003.0021

H. Thiele, N. Bettencourt, M. Salerno, E. Dall’Armellina

引用次数: 0

MRI contrast agents MRI造影剂

The EACVI Textbook of Cardiovascular Magnetic Resonance Pub Date : 2018-09-01 DOI: 10.1093/med/9780198779735.003.0011

Kim‐Lien Nguyen, J. Finn

{"title":"MRI contrast agents","authors":"Kim‐Lien Nguyen, J. Finn","doi":"10.1093/med/9780198779735.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780198779735.003.0011","url":null,"abstract":"Pharmacologic agents used in the context of a cardiovascular magnetic resonance imaging examination can be divided into three main groups: contrast agents, stress-testing agents (dobutamine, adenosine, regadenoson, dipyridamole), and agents used for treatment of hypersensitivity reactions. The safety of stress agents will be elaborated in the chapter on ischaemic heart disease. This chapter will focus on contrast agents and briefly touch upon medications used in the setting of hypersensitivity reactions. Contrast agents are used to further augment tissue contrast and have become an integral component of cardiovascular imaging. These agents typically exert strong T1 shortening (gadolinium or manganese chelates, positive contrast) or T2 shortening (iron oxide particles, negative contrast). In some cases, very small iron particles may produce enhancement on either T1- or T2-weighted pulse sequences. The common factor lies in the paramagnetic properties of the material when exposed to an external magnetic field. The largest group of compounds consists of gadolinium-based contrast agents (GBCAs). Since the first description of nephrogenic systemic fibrosis in patients with renal insufficiency in 2000, and subsequent alerts by the US Food and Drug Administration and the European Medicines Association, interest in the safety of GBCAs has increased, along with concerted efforts to seek alternative contrast agents. Overall however, GBCAs are well tolerated.","PeriodicalId":294042,"journal":{"name":"The EACVI Textbook of Cardiovascular Magnetic Resonance","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133418822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0