Abstract:

Aim: was to evaluate the prognostic effectiveness of the method of cardiac magnetic resonance imaging (MRI) in patients with ischemic heart disease (IHD) with dysfunctional myocardium after endovascular interventions

Materials and methods: a total of 114 patients were included in the study Inclusion criteria: myocardial infarction in previously; myocardial ischemia according to stress tests; occlusion or subtotal stenosis of one or more coronary arteries according to digital angiography (SYNTAX score <32); viable myocardium in the zone of the occluded/stenotic artery; heart failure of I-III functional class (NYHA); left ventricular ejection fraction (LVEF) less than 50%. Patients were randomized into 2 equivalent groups: in the I group, myocardial viability was determined by cardiac magnetic resonance imaging (MRI) with delayed contrast, in the II group - by stress-echocardiography with dobutamine. All patients underwent stenting of coronary arteries in the zone of the viable myocardium with drug-eluting stents. Long-term results of treatment were followed to 12 months after endovascular intervention in all patients.

Results: all patients had a significant improvement in the local contractility of the myocardium after performed endovascular myocardial revascularization. After 12 months, a significant decrease in the mass fraction of ischemic viable myocardium in the peri-infarction zone was noted among patients from group I, compared with preoperative data (32.8 ± 2.4 and 24,3±2,3%, respectively, p<0.05). Thus, in I group the volume of ischemic myocardium decreased by 26%. In all studied groups, there was a significant increase in LVEF, compared with data obtained when the patient was discharged from the hospital. Survival in the I group was 100%, whereas in the II group - 97.3% (p> 0.05). The incidence of non-fatal MI was 0.88 and 3.5% in groups I and II, respectively (p <0.05).

Conclusion: cardiac MRI with delayed contrast is more effective and sensitive for diagnosis of myocardial viability and patient prognosis after endovascular intervention, compared with stress echocardiography with dobutamine. 

References

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Abstract:

Aim: was to show possibilities of magnetic resonance imaging (MRI) in the detection and characterization of neoplasms of the heart.

Materials and methods: we retrospectively studied clinical cases of heart neoplasms, diagnosed and operated in Federal National Center of Cardiovascular Surgery (FNCCS) (Penza) since 2008 tc 2014. All patients on admission underwent echocardiography, after which, in some cases to clarify the topography of neoplasms and features of individual anatomy - MRI was performed. In postoperative follow-up period, control studies were conducted. In all cases, the diagnosis was histologically verified. All operated patients were discharged in satisfactory condition. We made a search and analysis of scientific literature on beam diagnostics of space-occupying lesions of heart.

Results: for the period of 6 years, in FNCCS were examined and surgical treatment of more than 30 thousand patients, of which neoplasms of the heart were detected in 25(0.08%) cases. Cardiac myxoma was diagnosed in 19(76%) patients, of whom in 2(8%) cases, the echocardiographic picture was mixed, that had required magnetic resonance imaging. MRI has also been used in 2(8%) patients with benign and malignant transformation of mesenchyoma, and in few cases (4%) rhabdomyomas, lipomatous hypertrophy, atrial septum, epithelioid leiomyoma of the uterus in the germinating atrium and metastatic melanoma. Also, in some cases, the use of MRI allowed to rule out malignancy and to identify mural thrombus. In 1 case, MRI gave, a detailed study of the morphology and localization of tumors to evaluate its spatial relationship with neighboring structures, study of three-dimensional and functional parameters of the heart. Dynamic mode (Cine-SSFP), planar and volumetric reconstruction (MPR) demonstrated the topography of tumors. That helped a broad understanding of the pre-operative pathology and surgical simplified decision-making. MRI allowed to analyze results of surgical correction and implement dynamic monitoring during the early and late postoperative period.

Conclusions: MRI in the diagnosis of tumors of the heart significantly complements echocardiography, providing a non-invasive multi-modal visualization, necessary for a comprehensive assessment of the topography of lesions, detection of individual anatomical features of intracardiac and extracardiac structures. MRI should be included in the diagnostic algorithm of tumors of the heart, including to assess occured hemodynamic changes.  

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