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Cardiovascular Magnetic Resonance in Heart Failure

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Abstract

Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Lloyd-Jones D, Adams RJ, Brown TM, et al. Heart disease and stroke statistics–2010 update: a report from the American heart association. Circulation. 2010;121:e46–e215.

    Article  PubMed  Google Scholar 

  2. Karamitsos TD, Francis JM, Myerson S, et al. The role of cardiovascular magnetic resonance imaging in heart failure. J Am Coll Cardiol. 2009;54:1407–24.

    Article  PubMed  Google Scholar 

  3. Hudsmith LE, Neubauer S. Magnetic resonance spectroscopy in myocardial disease. JACC Cardiovasc Imaging. 2009;2:87–96.

    Article  PubMed  Google Scholar 

  4. Kribben A, Witzke O, Hillen U, et al. Nephrogenic systemic fibrosis: pathogenesis, diagnosis, and therapy. J Am Coll Cardiol. 2009;53:1621–8.

    Article  PubMed  CAS  Google Scholar 

  5. Karamitsos TD, Hudsmith LE, Selvanayagam JB, et al. Operator induced variability in left ventricular measurements with cardiovascular magnetic resonance is improved after training. J Cardiovasc Magn Reson. 2007;9:777–83.

    Article  PubMed  Google Scholar 

  6. Christiansen JP, Karamitsos TD, Myerson SG. Assessment of valvular heart disease by cardiovascular magnetic resonance imaging: a review. Heart Lung Circ. 2011;20:73–82.

    Google Scholar 

  7. Abdel-Aty H, Simonetti O, Friedrich MG. T2-weighted cardiovascular magnetic resonance imaging. J Magn Reson Imaging. 2007;26:452–9.

    Article  PubMed  Google Scholar 

  8. Piechnik SK, Ferreira VM, Dall’armellina E, et al. Shortened modified look-locker inversion recovery (shmolli) for clinical myocardial t1-mapping at 1.5 and 3 t within a 9 heartbeat breathhold. J Cardiovasc Magn Reson. 2010;12:69.

    Article  PubMed  Google Scholar 

  9. Giri S, Chung YC, Merchant A, et al. T2 quantification for improved detection of myocardial edema. J Cardiovasc Magn Reson. 2009;11:56.

    Article  PubMed  Google Scholar 

  10. Kim RJ, Fieno DS, Parrish TB, et al. Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation. 1999;100:1992–2002.

    PubMed  CAS  Google Scholar 

  11. Nagel E, Lehmkuhl HB, Bocksch W, et al. Noninvasive diagnosis of ischemia-induced wall motion abnormalities with the use of high-dose dobutamine stress MRI: comparison with dobutamine stress echocardiography. Circulation. 1999;99:763–70.

    PubMed  CAS  Google Scholar 

  12. Christiansen JP, Karamitsos TD, Myerson SG, et al. Stress perfusion imaging using cardiovascular magnetic resonance: a review. Heart Lung Circ. 2010;19:697–705.

    Google Scholar 

  13. Karamitsos TD, Ntusi NA, Francis JM, et al. Feasibility and safety of high-dose adenosine perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010;12:66.

    Article  PubMed  Google Scholar 

  14. Karamitsos TD, Arnold JR, Pegg TJ, et al. Tolerance and safety of adenosine stress perfusion cardiovascular magnetic resonance imaging in patients with severe coronary artery disease. Int J Cardiovasc Imaging. 2009;25:277–83.

    Article  PubMed  Google Scholar 

  15. Leyva F. Cardiac resynchronisation therapy guided by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010;12:64.

    Article  PubMed  Google Scholar 

  16. Ypenburg C, Schalij MJ, Bleeker GB, et al. Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients. Eur Heart J. 2007;28:33–41.

    Article  PubMed  Google Scholar 

  17. White JA, Yee R, Yuan X, et al. Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony. J Am Coll Cardiol. 2006;48:1953–60.

    Article  PubMed  Google Scholar 

  18. Wagner A, Mahrholdt H, Holly TA, et al. Contrast-enhanced MRI and routine single photon emission computed tomography (spect) perfusion imaging for detection of subendocardial myocardial infarcts: an imaging study. Lancet. 2003;361:374–9.

    Article  PubMed  Google Scholar 

  19. Kwong RY, Chan AK, Brown KA, et al. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation. 2006;113:2733–43.

    Article  PubMed  Google Scholar 

  20. Kwong RY, Sattar H, Wu H, et al. Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction. Circulation. 2008;118:1011–20.

    Article  PubMed  Google Scholar 

  21. Kim RJ, Wu E, Rafael A, et al. The use of contrast-enhanced magnetic resonance imaging to identify reversible myocardial dysfunction. N Engl J Med. 2000;343:1445–53.

    Article  PubMed  CAS  Google Scholar 

  22. Selvanayagam JB, Kardos A, Francis JM, et al. Value of delayed-enhancement cardiovascular magnetic resonance imaging in predicting myocardial viability after surgical revascularization. Circulation. 2004;110:1535–41.

    Article  PubMed  Google Scholar 

  23. Wellnhofer E, Olariu A, Klein C, et al. Magnetic resonance low-dose dobutamine test is superior to scar quantification for the prediction of functional recovery. Circulation. 2004;109:2172–4.

    Article  PubMed  Google Scholar 

  24. • Pegg TJ, Selvanayagam JB, Jennifer J, et al. Prediction of global left ventricular functional recovery in patients with heart failure undergoing surgical revascularisation, based on late gadolinium enhancement cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2010;12:56. This is an important paper that describes the ability of LGE to predict not only regional but also global recovery of function post revascularization.

    Article  PubMed  Google Scholar 

  25. Yan AT, Shayne AJ, Brown KA, et al. Characterization of the peri-infarct zone by contrast-enhanced cardiac magnetic resonance imaging is a powerful predictor of post-myocardial infarction mortality. Circulation. 2006;114:32–9.

    Article  PubMed  Google Scholar 

  26. Roes SD, Borleffs CJ, van der Geest RJ, et al. Infarct tissue heterogeneity assessed with contrast-enhanced MRI predicts spontaneous ventricular arrhythmia in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillator. Circ Cardiovasc Imaging. 2009;2:183–90.

    Article  PubMed  Google Scholar 

  27. •• Rahimi K, Banning AP, Cheng AS, et al. Prognostic value of coronary revascularisation-related myocardial injury: a cardiac magnetic resonance imaging study. Heart. 2009;95:1937–43. This paper describes the prognostic value of procedural myocardial injury in patients undergoing percutaneous coronary intervention or coronary artery bypass grafting.

    Article  PubMed  CAS  Google Scholar 

  28. Kelle S, Roes SD, Klein C, et al. Prognostic value of myocardial infarct size and contractile reserve using magnetic resonance imaging. J Am Coll Cardiol. 2009;54:1770–7.

    Article  PubMed  Google Scholar 

  29. Aletras AH, Tilak GS, Natanzon A, et al. Retrospective determination of the area at risk for reperfused acute myocardial infarction with t2-weighted cardiac magnetic resonance imaging: histopathological and displacement encoding with stimulated echoes (dense) functional validations. Circulation. 2006;113:1865–70.

    Article  PubMed  Google Scholar 

  30. Dall’Armellina E, Karamitsos TD, Neubauer S, Choudhury RP. Cmr for characterization of the myocardium in acute coronary syndromes. Nat Rev Cardiol. 2010;7:624–36.

    Article  PubMed  Google Scholar 

  31. Hamon M, Fau G, Nee G, et al. Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease. J Cardiovasc Magn Reson. 2010;12:29.

    Article  PubMed  Google Scholar 

  32. Schwitter J, Wacker CM, van Rossum AC, et al. Mr-impact: comparison of perfusion-cardiac magnetic resonance with single-photon emission computed tomography for the detection of coronary artery disease in a multicentre, multivendor, randomized trial. Eur Heart J. 2008;29:480–9.

    Article  PubMed  Google Scholar 

  33. Cheng AS, Pegg TJ, Karamitsos TD, et al. Cardiovascular magnetic resonance perfusion imaging at 3-tesla for the detection of coronary artery disease: a comparison with 1.5-tesla. J Am Coll Cardiol. 2007;49:2440–9.

    Article  PubMed  Google Scholar 

  34. Bodi V, Sanchis J, Lopez-Lereu MP, et al. Prognostic value of dipyridamole stress cardiovascular magnetic resonance imaging in patients with known or suspected coronary artery disease. J Am Coll Cardiol. 2007;50:1174–9.

    Article  PubMed  Google Scholar 

  35. Jahnke C, Nagel E, Gebker R, et al. Prognostic value of cardiac magnetic resonance stress tests: adenosine stress perfusion and dobutamine stress wall motion imaging. Circulation. 2007;115:1769–76.

    Article  PubMed  Google Scholar 

  36. Korosoglou G, Elhmidi Y, Steen H, et al. Prognostic value of high-dose dobutamine stress magnetic resonance imaging in 1, 493 consecutive patients: assessment of myocardial wall motion and perfusion. J Am Coll Cardiol. 2010;56:1225–34.

    Article  PubMed  CAS  Google Scholar 

  37. • Kato S, Kitagawa K, Ishida N, et al. Assessment of coronary artery disease using magnetic resonance coronary angiography: a national multicenter trial. J Am Coll Cardiol. 2010;56:983–91. This is a Japanese multicenter study describing the utility of state-of-the-art three-dimensional whole-heart coronary angiography.

    Article  PubMed  Google Scholar 

  38. Schuetz GM, Zacharopoulou NM, Schlattmann P, Dewey M. Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging. Ann Intern Med. 2010;152:167–77.

    PubMed  Google Scholar 

  39. Bluemke DA, Achenbach S, Budoff M, et al. Noninvasive coronary artery imaging: Magnetic resonance angiography and multidetector computed tomography angiography: a scientific statement from the American heart association committee on cardiovascular imaging and intervention of the council on cardiovascular radiology and intervention, and the councils on clinical cardiology and cardiovascular disease in the young. Circulation. 2008;118:586–606.

    Article  PubMed  Google Scholar 

  40. Spuentrup E, Ruhl KM, Botnar RM, et al. Molecular magnetic resonance imaging of myocardial perfusion with ep-3600, a collagen-specific contrast agent: initial feasibility study in a swine model. Circulation. 2009;119:1768–75.

    Article  PubMed  CAS  Google Scholar 

  41. • Karamitsos TD, Leccisotti L, Arnold JR, et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging. 2010;3:32–40. This is a validation study of the BOLD CMR technique at 3 T against positron emission tomography in normal volunteers and patients with coronary artery disease.

    Article  PubMed  Google Scholar 

  42. McAteer MA, Akhtar AM, von Zur Muhlen C, Choudhury RP. An approach to molecular imaging of atherosclerosis, thrombosis, and vascular inflammation using microparticles of iron oxide. Atherosclerosis. 2010;209:18–27.

    Article  PubMed  CAS  Google Scholar 

  43. McCrohon JA, Moon JC, Prasad SK, et al. Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108:54–9.

    Article  PubMed  CAS  Google Scholar 

  44. Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardiol. 1987;60:1340–55.

    Article  PubMed  CAS  Google Scholar 

  45. Assomull RG, Prasad SK, Lyne J, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy. J Am Coll Cardiol. 2006;48:1977–85.

    Article  PubMed  Google Scholar 

  46. Petersen SE, Jerosch-Herold M, Hudsmith LE, et al. Evidence for microvascular dysfunction in hypertrophic cardiomyopathy: new insights from multiparametric magnetic resonance imaging. Circulation. 2007;115:2418–25.

    Article  PubMed  Google Scholar 

  47. Maron MS. The current and emerging role of cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy. J Cardiovasc Transl Res. 2009;2:415–25.

    Article  PubMed  Google Scholar 

  48. Adabag AS, Maron BJ, Appelbaum E, et al. Occurrence and frequency of arrhythmias in hypertrophic cardiomyopathy in relation to delayed enhancement on cardiovascular magnetic resonance. J Am Coll Cardiol. 2008;51:1369–74.

    Article  PubMed  Google Scholar 

  49. Papavassiliu T, Germans T, Fluchter S, et al. Cmr findings in patients with hypertrophic cardiomyopathy and atrial fibrillation. J Cardiovasc Magn Reson. 2009;11:34.

    Article  PubMed  Google Scholar 

  50. •• Bruder O, Wagner A, Jensen CJ, et al. Myocardial scar visualized by cardiovascular magnetic resonance imaging predicts major adverse events in patients with hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56:875–87. This is a study that describes the independent prognostic value of LGE in patients with HCM.

    Article  PubMed  Google Scholar 

  51. •• O’Hanlon R, Grasso A, Roughton M, et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2010;56:867–74. This study demonstrates the independent prognostic value of LGE in patients with HCM.

    Article  PubMed  Google Scholar 

  52. Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation. 2010;121:1533–41.

    Article  PubMed  Google Scholar 

  53. Jain A, Tandri H, Calkins H, Bluemke DA. Role of cardiovascular magnetic resonance imaging in arrhythmogenic right ventricular dysplasia. J Cardiovasc Magn Reson. 2008;10:32.

    Article  PubMed  Google Scholar 

  54. Sen-Chowdhry S, Syrris P, Prasad SK, et al. Left-dominant arrhythmogenic cardiomyopathy: an under-recognized clinical entity. J Am Coll Cardiol. 2008;52:2175–87.

    Article  PubMed  Google Scholar 

  55. Anderson LJ, Holden S, Davis B, et al. Cardiovascular t2-star (t2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2001;22:2171–9.

    Article  PubMed  CAS  Google Scholar 

  56. •• Kirk P, Roughton M, Porter JB, et al. Cardiac t2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120:1961–8. This is a study that demonstrates the ability of cardiac T2* CMR to predict HF development in patients with thalassemia major.

    Article  PubMed  CAS  Google Scholar 

  57. Abdel-Aty H, Boye P, Zagrosek A, et al. Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. J Am Coll Cardiol. 2005;45:1815–22.

    Article  PubMed  Google Scholar 

  58. •• Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a jacc white paper. J Am Coll Cardiol. 2009;53:1475–87. This is a paper that describes the comprehensive evaluation of patients with myocarditis using CMR.

    Article  PubMed  Google Scholar 

  59. Mahrholdt H, Wagner A, Deluigi CC, et al. Presentation, patterns of myocardial damage, and clinical course of viral myocarditis. Circulation. 2006;114:1581–90.

    Article  PubMed  Google Scholar 

  60. Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004;109:1250–8.

    Article  PubMed  Google Scholar 

  61. Maceira AM, Joshi J, Prasad SK, et al. Cardiovascular magnetic resonance in cardiac amyloidosis. Circulation. 2005;111:186–93.

    Article  PubMed  Google Scholar 

  62. Syed IS, Glockner JF, Feng D, et al. Role of cardiac magnetic resonance imaging in the detection of cardiac amyloidosis. JACC Cardiovasc Imaging. 2010;3:155–64.

    Article  PubMed  Google Scholar 

  63. Austin BA, Tang WH, Rodriguez ER, et al. Delayed hyper-enhancement magnetic resonance imaging provides incremental diagnostic and prognostic utility in suspected cardiac amyloidosis. JACC Cardiovasc Imaging. 2009;2:1369–77.

    Article  PubMed  Google Scholar 

  64. Patel MR, Cawley PJ, Heitner JF, et al. Detection of myocardial damage in patients with sarcoidosis. Circulation. 2009;120:1969–77.

    Article  PubMed  Google Scholar 

  65. De Cobelli F, Esposito A, Belloni E, et al. Delayed-enhanced cardiac MRI for differentiation of fabry’s disease from symmetric hypertrophic cardiomyopathy. AJR Am J Roentgenol. 2009;192:W97–W102.

    Article  PubMed  Google Scholar 

  66. Petersen SE, Selvanayagam JB, Wiesmann F, et al. Left ventricular non-compaction: Insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol. 2005;46:101–5.

    Article  PubMed  Google Scholar 

  67. Karamitsos TD, Bull S, Spyrou N, et al. Tako-tsubo cardiomyopathy presenting with features of left ventricular non-compaction. Int J Cardiol. 2008;128:e34–6.

    Article  PubMed  Google Scholar 

  68. Ariyarajah V, Jassal DS, Kirkpatrick I, Kwong RY. The utility of cardiovascular magnetic resonance in constrictive pericardial disease. Cardiol Rev. 2009;17:77–82.

    Article  PubMed  Google Scholar 

  69. Karamitsos TD, Bull S, Francis JM, et al. Massive melanotic myocardial metastasis characterized by multiple cardiac imaging modalities. Int J Cardiol. 2011;146:e27–9.

    Article  PubMed  Google Scholar 

  70. Syed IS, Feng D, Harris SR, et al. Mr imaging of cardiac masses. Magn Reson Imaging Clin N Am. 2008;16:137–64. vii.

    Article  PubMed  Google Scholar 

  71. Kilner PJ, Geva T, Kaemmerer H, et al. Recommendations for cardiovascular magnetic resonance in adults with congenital heart disease from the respective working groups of the European society of cardiology. Eur Heart J. 2010;31:794–805.

    Article  PubMed  Google Scholar 

  72. Storkecky S, Suter TM. Insights into cardiovascular side-effects of modern anticancer therapeutics. Curr Opin Oncol. 2010;22:312–7.

    Article  Google Scholar 

  73. Estep JD, Shah DJ, Nagueh SF, et al. The role of multimodality cardiac imaging in the transplanted heart. JACC Cardiovasc Imaging. 2009;2:1126–40.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by the British Heart Foundation (PG/08/101/26126) and by the Oxford NIHR Biomedical Research Centre. S. Neubauer also acknowledges support from the BHF Centre of Research Excellence, Oxford.

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Karamitsos, T.D., Neubauer, S. Cardiovascular Magnetic Resonance in Heart Failure. Curr Cardiol Rep 13, 210–219 (2011). https://doi.org/10.1007/s11886-011-0177-2

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