La Risonanza Magnetica Nella Prima Diagnosi Di Scompenso ... · Rijnierse et al. AJC 2015. Delgado...
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La Risonanza Magnetica Nella Prima Diagnosi Di Scompenso Cardiaco Gaetano Nucifora MD, PhD, FESC Division of Cardiology University Hospital “Santa Maria della Misericordia”, Udine, Italy Il Laboratorio di Cardiac Imaging Nello Scompenso Cardiaco Innovazione e Coworking Trieste – 30-31/10/2015
Transcript of La Risonanza Magnetica Nella Prima Diagnosi Di Scompenso ... · Rijnierse et al. AJC 2015. Delgado...
La Risonanza Magnetica Nella Prima Diagnosi Di Scompenso Cardiaco
Gaetano Nucifora MD, PhD, FESC
Division of Cardiology
University Hospital “Santa Maria della Misericordia”, Udine, Italy
Il Laboratorio di Cardiac Imaging Nello Scompenso CardiacoInnovazione e CoworkingTrieste – 30-31/10/2015
Il sottoscritto GAETANO NUCIFORA
DICHIARA
che negli ultimi 2 anni NON ha avuto rapporti anche di finanziamentocon soggetti portatori di interessi commerciali in campo sanitario
Fun
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ecrosis
Mycro
vascular
dam
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Magnetic Resonance and Heart Failure
Identification of Underlying Etiology
Risk stratification
Therapeutic implications3
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Magnetic Resonance and Heart Failure
Identification of Underlying Etiology
Risk stratification
Therapeutic implications3
1
2
1. Delayed wash-in and wash-out kinetics of nonviable tissue;
2. Acute and chronic disarrangement of interstitium;
3. Different volumes of distribution of Gd in viable and nonviable tissue;
4. Inversion Recovery technique with prepulse delay (250 to 350 msec) to null myocardial signal intensity .
Non viablemyocardium
Viablemyocardium
Identification of Underlying EtiologyLate Gadolinium Enhancement Imaging
LGE PATTERN
Mahrholdt et al. EHJ 2005
Identification of Underlying Etiology
Non-IschemicCardiomyopathy Ischemic
Cardiomyopathy
Heart Failure With Reduced Ejection Fraction
Felker et al. JACC 2002
1921 pts with symptomatic HFLVEF<40%
Ischemic etiology: independent predictor of mortality after correction for age, gender, diabetes, NYHA class and LVEF<40%
3-vessel CADEF < median (27%)ESVI > median (79 ml/m2)
Panza et al. JACC 2015
Identification of Underlying Etiology
Ischemic CM
Non-Ischemic CM
59%28%
13%
No LGE Mid-wall LGE Subendocardial LGESubendocardial/Transmural LGE
100%
No CAD by Cath CAD by Cath
McCrohon et al. Circulation 2003
Identification of Underlying Etiology
Non-IschemicCardiomyopathy Ischemic
Cardiomyopathy
Heart Failure With Reduced Ejection Fraction
90 patients with heart failure and LV systolic dysfunction
Regional or global myocardial SI increase in T2-W images
Increased global myocardial early gadolinium enhancement ratio between myocardium and skeletal muscle in gadolinium enhanced T1-W images
≥1 focal lesion with non-ischemic regional distribution in IR gadolinium-enhanced T1-W images (LGE)
Heart Failure With Reduced Ejection Fraction
Identification of Underlying Etiology
Myocarditis
Identification of Underlying EtiologyHeart Failure With Reduced Ejection Fraction
Myocarditis
Friedrich et al. JACC 2009
Identification of Underlying EtiologyHeart Failure With Reduced Ejection Fraction
Myocarditis
Francone et al. JACC Imaging 2014
Suspected Acute Myocarditis
Suspected Chronic Myocarditis
Lurz et al. JACC Imaging 2012
Identification of Underlying EtiologyHeart Failure With Reduced Ejection Fraction
Bohnen et al. Circ Imaging 2015
T2 of ≥60 ms: 94%sensitivity, 60%specificity, 77%accuracy, 90%negative and 71%positive predictivevalue for activemyocarditis
Radunski et al. JACC Imaging 2014
Identification of Underlying EtiologyHeart Failure With Preserved Ejection Fraction
HTN
Rudolph et al. JACC 2009Nucifora et al. Am J Physiol Heart Circ 2014
Nucifora et al. Int J Cardiovasc Imaging 2015
HC
MA
mylo
id
Identification of Underlying EtiologyHeart Failure With Preserved Ejection Fraction
Longhi et al. JACC Imaging 2015
Magnetic Resonance and Heart Failure
Identification of Underlying Etiology
Risk stratification
Therapeutic implications3
1
2
Gerber et al. JACC 2012
Kwon et al. Circulation 2012
Risk Stratification/Prognosis AssessmentIschemic Cardiomyopathy
Pegg et al. JCMR 2010
Gulati et al. JAMA 2013
Risk Stratification/Prognosis AssessmentNon-ischemic Cardiomyopathy
472 patients with dilated cardiomyopathyFollow-up: median 5.3 years
Midwall fibrosis: 142 patients (30%)73 deaths
162 patients with non-ischemic cardiomyopathyFollow-up: mean 29 months
LGE: 81 patients (50%)51 events (CV death/ICD shocks)
Neilan et al. JACC Imaging 2013
Risk Stratification/Prognosis Assessment
1293 patients with HCMFollow-up: median 3.3 years
LGE: 548 patients (42%)37 (3%) events (SCD/ICD therapy)
Chan et al. Circulation 2014
Austin et al. JACC Imaging 2009
Banypersad et al. EHJ 2015
Risk Stratification/Prognosis Assessment
Magnetic Resonance and Heart Failure
Identification of Underlying Etiology
Risk stratification
Therapeutic implications3
1
2
Klem et al. JACC 2012
Therapeutic Implications
137 patients with ischemic/non-ischemic CMP (53/47%)Follow-up: 24 months
39 events (death/ICD intervention)Scar >5% independent predictor of events
Adding scar >5% to EF reclassified 32% of patients in low/high risk
Rijnierse et al. AJC 2015
Delgado et al. Circulation 2011
Therapeutic Implications
Leyva et al. JCMR 2011
Ajmone Marsan et al. Eur Heart J 2009
Therapeutic Implications
Abbasi et al. JCMR 2013
CONCLUSIONSComprehensive information of morphology, function, tissuecharacterization
Differentiation between ischemic and non-ischemic heart failure and of differentetiologies of non-ischemic heart failure
Risk stratification of HF patients with incremental value over classical clinicalparameter, regardless of etiology
Improvement of clinical decision making, and selection of CRT and ICD candidates
Thank you for your kind attention!
