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The utility of a comprehensive cardiac magnetic resonance examination for the evaluation of patients with heart failure
  1. N P Nikitin,
  2. R de Silva,
  3. J G F Cleland

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We report two cases of patients referred for assessment to a heart failure clinic. The first case is a 62 year old woman with a history of previous myocardial infarction. The second case is a 65 year old woman with a history of heart failure, chest pains, smoking, and hypertension. Both patients presented with symptoms of moderate-to-severe heart failure. Echocardiography in both cases was limited by suboptimal image quality but showed significant left ventricular (LV) dilatation with severe global and regional (septal dyskinesia) systolic dysfunction.

Investigation by cardiac magnetic resonance (CMR) imaging confirmed the presence of LV dilatation (LV end diastolic volume: case 1  =  230 ml, case 2  =  276 ml) and severe systolic dysfunction (LV ejection fraction: case 1  =  27%, case 2  =  30%). Unlike echocardiography, CMR provided high quality images demonstrating thinning of dysfunctional segments (sign of previous infarct) in case 1 and preserved myocardial thickness in case 2. CMR performed 10 minutes after an injection of gadolinium based contrast agent revealed areas of delayed enhancement corresponding to areas of myocardial scar. Extensive delayed enhancement was found in case 1 suggesting transmural post-infarction scar and no enhancement in case 2 indicating viable myocardium.

These cases demonstrate that a comprehensive CMR examination can provide accurate information on LV morphology and function in cases with suboptimal echocardiographic images and give important additional information on the extent of scar and myocardial viability in patients with LV systolic dysfunction. This may help identify patients for appropriate interventions.

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All images represent mid ventricular short axis views. Upper panels show end diastolic phases obtained using ECG triggered gradient echo cine CMR. Lower panels demonstrate contrast enhanced images obtained using a segmented inversion recovery fast gradient echo sequence. Upper left panel. Case 1: LV dilatation with myocardial thinning and dyskinesia (arrow) in anterior and anteroseptal segments. Upper right panel. Case 2: LV dilatation with wall paradoxical septal motion (arrow). Note preserved myocardial thickness of intraventricular septum. Lower left panel. Case 1: A contrast enhanced scan showing extensive transmural scarring (bright areas of contrast enhancement) in anteroseptal, anterior, and lateral segments (arrows). Lower right panel. Case 2: A contrast enhanced scan with no delayed enhancement indicating absence of myocardial scar.