Longwood Area Non-invasive Cardiac
Imaging Seminar:
Overview
LV/RV Anatomy and Function
Warren J. Manning, MD
Beth Israel Deaconess Medical Center, Boston, MA
WJM 01/10
Disclosures
• Research Grant Support:
– Philips Medical Systems
– NIH, NHLBI
– Lantheus Medical Inc.
WJM 01/10
Seminar Conception - 2004
• Training in echocardiography (TTE, Stress, TEE)
was relatively mature.
• Exposure to other imaging modalities [CMR,
CCT] was less developed
• Clinical exposure to CMR and Nuclear Cardiology
by cardiology and radiology residents/fellows is
high at the BIDMC
– formal training/lectures in CMR, CCT, is more limited
• Fulfill new COCATS training recommendations
for Level I training in CMR, CCT
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Outline – Year 7
• 1 hour weekly “seminar” style series
• Monday, noon-1pm
• West Campus, Baker 4 - CV library
• ~45-50 min presentation by Longwood attending staff
• 5-10 minute questions
• Internal [CMR] Web posting of presentations
• Didactic
• CME credit for attending staff
• Clinical cases - 1 hour case based conference (2nd/4th
Friday at 12:30pm) initiated 2007
WJM 01/10
Outline
• Modalities:
• January - June
• Cardiovascular Magnetic Resonance (CMR)
• July – August
• CMR Physics [Monday noon-1pm; EAST Campus]
• September – October
• Nuclear Cardiology (Tom Hauser)
• November-December
• Cardiac Computed Tomography (CCT) (Tom Hauser)
WJM 01/10
Outline
• Primarily for cardiology fellows and radiology
residents/fellows
• also open to interested medical students, medicine
residents, sonographers, nuclear med trainees, CMR/MR
technologists, CT technologists, nurses, attendings, etc.).
WJM 01/10
Outline
• Boston area staff/teaching resources, inclusive of fellows
within and outside Longwood Medical Area:
• Longwood: BIDMC, BWH, Children’s Hospital
• Boston: Boston Medical Center, Tufts Medical Center
• Outside 128 (new for 2009/10)
• Lahey Clinic, UMass-Memorial
• Participation via web: cardiacmr.webex.com
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3 “Pillars” of Cardiology
1. Interventional/Invasive Cardiology
2. Electrophysiology
3. Non-invasive Cardiac Imaging
Beller JACC 2006; Thomas JACC 2009
[WJM: Enter from Cardiology or Radiology]
Echo (TTE, TEE, Stress, ICE, 3D)
Nuclear Cardiology/PET (PET-CT)
Cardiovascular Magnetic Resonance
Cardiac Computed Tomography
WJM 01/10
BIDMC Non-invasive Cardiovascular Imaging - Training
Cardiology
TEE
TTE*
Anesthesia
* Feroze Mahmood, MD
* Achi Grinberg, MD
TTE
Cath
Nuclear
PET
CMR**
CCT***
Radiology
**Neil Rofsky, MD
***Mel Clouse, MD
***V. Raptopoulos, MD
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CMR Teaching Staff
BIDMC:
Evan Appelbaum, MD
Eli Gelfand, MD
Robert Greenman, PhD
Yuchi Han, MD
Thomas H. Hauser, MD
Kraig V. Kissinger, RT
Robert Lenkinski, MD
Warren J. Manning, MD
Reza Nezafat, PhD
Ivan Pedrosa, MD
Dana C. Peters, PhD
Neil M. Rofsky, MD
Martin Smith, MD
Susan B. Yeon, MD
Boston Medical Center
Frederick Ruberg, MD
Children’s Hospital
Tal Geva, MD
Andrew Powell, MD
Anne Marie Valente, MD
BWH
Raymond Kwong, MD
Tufts NEMC
Martin S. Maron, MD
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TOPICS [Web site]
LV function/mass
RV function
Myocardial infarction
CMR stress
CMR viability
Cardiomyopathies
Pericardium
Congenital heart disease
Valvular heart disease
MRA – aorta, renal,
peripheral, carotid
MR venography
Coronary MRI
Non-cardiac thoracic pathology
Pulmonary vein MRA
Interventional
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Schedule
1. E-mail notification every Friday
• Let me know if you are not on list (or on list…)
2. Every Monday through the end of June, noon-1pm
• Except
• Holidays (MLK/Washington’s BDay, Patriot’s Day)
• Cardiology Fellowship interviews
(2/22, 3/22, 3/29, 4/26, 5/3)
• Research retreat (2/1)
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Additional Resources
• S Drive
– BIDMC cases (topic; MRN, images, report)
– CMR Physics
• R. Nezafat, DC Peters [BIDMC – slides]
• Robert Judd (Duke - video)
• CMR Fellows
–
–
–
–
–
–
Francesca Delling, MD
Airley Fish, MD
Susie Hong, MD
Ali Mahajerin, MD
Nisha Parikh, MD
Ali Rahimi, MD
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Multimodality Imaging in Cardiology
• Critical that training cross technology
boundries
• Efficiencies of multimodality imaging
program
Thomas JACC 2009
WJM 01/10
Level 1 – Basic training required of all trainees to be
competent consultant cardiologists. This level makes
trainees conversant with all imaging modalities
along with their clinical utility. It provides superficial
exposure to performance and interpretation….
Didactic Activities:
Duration 1 month
Perform 0 cases/Exposed to interpretation of 25 cases
Lectures and self-study in CMR
• Clinical CMR reading [East] during Echo months [2nd yr]
5 cases/wk x 16 wks = 80 cases
• Monday noon CMR seminar
• Tuesday am clinical conference
• Friday 12:30pm case based imaging conference
JACC 2002
•No “hands on” experience necessary
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Level 2 – Additional training that enables the cardiologist
to interpret cardiovascular imaging studies
independently
Didactic Activities:
3-6 months under Level 2 or Level 3 (preferred)
Supervised interpretation of 150+ cases
(Up to 50 may come from a training set)
Primary interpretation of 50+ cases
Lectures and Self Study – more advanced
JACC 2002
WJM 01/10
Level 3 – Advanced training that enables a cardiologist to
perform, interpret, and train others to perform and
interpret specific imaging studies at the highest
skill level. This is the expertise expected for
directors of imaging laboratories.
Didactic Activities:
6 (clinical) or 12 (academic) mo training under Level 3
Supervised interpretation of 300+ cases
(Up to 100 may come from a training set)
Primary interpretation of 100+ cases
Lectures and Self Study – more advanced
Summer Physics series, Monday, noon-1pm
Mon-Friday 11am-noon clinical readout
JACC 2005
3-4 mo clinical CMR fellow
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Focused research, publications
Multimodality Training – JACC 2009
Modality
Level
Echo
Nuclear
CMR
CCT
Thomas JACC 2009
1
2
3
1
2
3
1
2
3
1
2
3
Mo
Single
3
6
12
2
4-6
12
1
3-6
6-12
2
6
Multimodality
Total/Unshared
3/2
6/4
12/6
2/1
4/3
10/5
1/0
3/2
10/5
1/0
2/1
6/3
Multimodal Cases
(Perf Interpret)
75 150
150 300
300 750
35 100
35 300
35 600
0
25
50 150
100 300
0
50
50 150
100 300
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Maintenance of Skills
SCMR 2006
(JCMR 2006)
ACCF/AHA
(JACC 2005)
Level II
CME
Cases
20 hours/2yr
100/2yr
30 hours/3yr
50/yr
Level III
CME
Cases
40 hours/2yr
200/2yr
60 hours/3yr
100/yr
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Physician Credentialing in CMR
• RADIOLOGIST
• ACR Diagnostic Modality Accreditation Program
• Stereotactic Breast Biopsy Accreditation
• Breast ultrasound Accreditation
• Ultrasound Accreditation
• Magnetic Resonance Imaging Accreditation
• not CMR specific
• Nuclear Medicine and PET Accreditation
• Computed Tomography Accreditation
• Radiography/Fluoroscopy Accreditation
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Physician Credentialing in CMR
• Board certified radiologist
• Supervised and interpreted >75 CMR cases in past 36 mo
• Completed >40 hours of CME (or equivalent
supervised experience)
• >75 examinations every 3 years to maintain skills
• No specific CMR CME requirement
Radiology 2005;235:723
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M
A
N
N
SI
EN
CG
OP
NE
DN
EN
DE
I
LL
T
I
O
N
CMR Texts (NOT required)
*
Warren J. Manning *
Dudley J. Pennell
Second
Edition
www.acc.org
www.scmr.org
*WJM editor (if interested – see me)
WJM 01/10
J Cardiovasc Magn Resonance – www.jcmr-online.com
1. Original
Articles
2. How to
3. Reviews
4. Case
Reports
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If you want to learn more.....*
Society for Cardiovascular
Magnetic Resonance*
www.scmr.org
13th Annual Scientific Sessions
January 21-January 24, 2010
Phoenix, AZ
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CMR – “New Kid” on the block
Non-invasive Imaging – 2008 (estimate)
Millions
100
80
60
40
20
0
CT
MRI
Echo
Nuclear
CCT
CMR
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Cardiac imaging is frequently performed!
25
20
# of Clinical
15
Studies (millions)
10
5
0
Echo
Nuclear
CCT
CMR
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Non-invasive Imaging – Equipment Cost
2.5
2
Equipment
Cost ($mil)
1.5
1
0.5
0
Echo Nuclear 64 CT Dual/256 1.5T 3T CMR PET
CCT
CMR
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Advantages of Cardiovascular MR (CMR)
1.
2.
3.
4.
5.
6.
Excellent soft tissue contrast
Non-invasive, no ionizing radiation
High (<1mm) in-plane spatial resolution
Multiplane, true tomographic imaging
Dynamic/cine imaging (2D echo)
Exogenous contrast usually not needed
[CMR agents are less toxic than iodinated preparations]
7. Blood flow/volume – quantitative
8. Minimal post-processing
9. Potential for tissue characterization [fat, iron]
10. Thoracic skeleton and pulmonary parenchyma
do not interfere with imaging
11. “Comprehensive” CMR examination
WJM 01/10
Advantages of Cardiovascular MR (CMR)
1. Much cardiac hardware is safe…
a.
b.
c.
d.
e.
Mechanical and bioprosthetic valves
Post-sternotomy sternal wires
CABG clips/markers
Coronary stents
? ”Modern” PCM/ICDs [Circ 2004, 2006]
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Local artifacts from
sternal wires and coronary
artery bypass graft markers.
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Is it safe for patients with prosthetic
heart valves to have an MRI?
YES!
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Prosthetic Valves
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ACS Multi-link RX Duet (3)
ACS RX Multi-link (3)
AVE (2,4)
Intracoronary
Stents
Micro Stent (3)
BeStent (2,3)
Crown (4)
Giantourco-Roubin (1,2)
Giantourco-Roubin II (3)
No local heating
Minimal force/No device migration
Smaller artifacts with TSE (vs. GRE)
imaging
1.
2.
3.
4.
5.
6.
Scott & Pettigrew AJC 1994
Strohm JCMR 1999
Hug Radiology 2000
Kramer JCMR 2000
Powell SCMR 2001
Gerber JACC 2003
InFlow (2,3)
InFlow Gold (3)
JoStent (2)
MAC-Stent (3)
Multilink (2,4)
Palmaz-Schatz (1,2,3)
R-Stent (3)
Seaquence (3)
Strecker (1)
Tenax-Stent (2)
Wallstent (2,3)
Wiktor (1)
Wiktor GX (3)WJM 01/10
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CMR Coronary Stent Safety
Study
Pt Type
N
112
CMR
(days)
21+17
F/U
(days)
30
Gerber [JACC ‘03]
CAD
Schroeder [JCMR ‘00]
+CMR -CMR
Events Events
5%
AMI
47
166
21+5
35%
38%
Kramer [JCMR ‘00]
AMI
30
3+1
220+60
8%
29%
Syed [ACC ‘04]
AMI
133
2+2
133+60
6%
22%
WJM 01/10
Disadvantages of CMR
1. Most physicians did not enjoy or don’t remember much physics…
2.
3.
4.
5.
6.
Set-up is complex, many options (compared with other technologies)
CMR image interpretation is not always “intuitive”
ECG gating is “absolute” requirement yet soimetimes difficult
Claustrophobia, ?Exclusion [PCM, ICD]
Real and perceived $$
• Perceived cost is high [echo < Nuclear << CMR]
• Reimbursement is relatively low [echo < CMR << Nuclear]
• Investment is high [echo << Nuclear << CMR]
7. Other technologies are established (echo, nuclear, CT)
What is true value CMR?
New information that impacts/changes patient care
WJM 01/10
Non-invasive Imaging – Reimbursement/study
3000
2000
$$
1000
0
ECG
ETT
Echo
CCT
CMR
Nuclear
PET
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Disadvantages of CMR
Powerful magnet that is “always on”
Intracranial clips
TENS
Cochlear implants
….
stethescope
pens
ID badge clips
…
CMR is not portable
WJM 01/10
Disadvantages of CMR
Nephrogenic Systemic Fibrosis - NSF
• Systemic fibrosis (skin, lungs, muscles, heart)
• subacute swelling of distal extremities
followed by severe skin induration pain, loss of skin flexibility
• onset of symptoms 2 days to 18 mo from exposure
• 2006 [Grobner Nephrol Dial Transplant 2006]
• >200 cases reported – all with exposure to Gd-based contrast
• ?Preference for specific Gd-agent [>80% Omniscan]
• Underlying renal dysfunction (many on dialysis)
• CrCl >60 ml/min/1.73m2 = “no” risk
• FDA advisory December 2006
• BIDMC: Creatinine clearance estimate prior to Gd-DTPA exposure
Choyke questionnaire
WJM 01/10
Pacemakers/AICD
• Heating (leads)
• Threshold changes in a minority of patients
• Isolated leads without PCM generator may be more concerning
• PCM program changes
• Devices manufactured after 2000 may be “safer”
• FDA: potential risks and data do not justify routine MRI in patients
With pacemakers/ICD
• ?IRB protocol at BIDMC
• Monitoring of patients
• No PCM dependent patients
Levine et al. Safety of MRI in patients with
Cardiovascular Devices. Circulation 2007;116:2878-91.
WJM 01/10
www.
Or link from…
www.scmr.org
Or link from…
Intranet.bidmc.harvard.edu
Cardiac MR
REFERENCES
WJM 01/10
Importance of LV Anatomy/Function
• LV mass is independent risk factor for adverse cardiovascular
events
– hypertrophy (HTN, aortic stenosis/regurgitation)
• Global LV volumes are important in monitoring of patients
with valvular disease (AR, MR)
• Global LVEF provides prognostic information
– many therapeutic strategies are based on LVEF thresholds (ACE
inhibitors p-MI)
• LV regional function (CAD)
• Cardiologists are “intensely quantitative”
WJM 01/10
Echocardiography
Parasternal Long Axis
WJM 01/10
ECG
Ant Sept
Echo LV
Measures
Septum [nl<11]
Inferolateral [nl<11]
EDD
ES
Inferolateral
End-diasolic Dimension [nl<56mm]
End-systolic Dimension
WJM 01/10
M-Mode Echo Estimates
LVVol: Teichholz Formula: EDV=7D3/(2.4+D)
LVEF:
Fractional shortening = (EDD - ESD)/(EDD) [nl>0.30]
Vol (sphere) 4pR3/3
FS = 0.33  ED radius = 3; ES radius =2
LVEF = (Rd3 - Rs3) / Rd3
= 33 - 23 / 33
= 27 – 8 / 27 = 0.70
2D visual / “eye ball method”
(15-20% of cases - cannot see all the segments)
WJM 01/10
M-Mode Echo Estimates
LV MASS
Penn-Cube Method:
LVM = [(S+IL+EDD) 3 - EDD3 ])*1.05*0.8 - 13.6
LV MASS (ASE Method):
LVM = [(S+IL+EDD) 3 - EDD3 ])*1.05*0.8 + 0.6
WJM 01/10
2D Echo Estimates
Apical 4 Chamber view
a
b
d
Truncated Elipsoid
Biplane Simpson’s Rule
LV mass = 1.05p (b+t)2 [2/3(a+t) + d - (d3/d(a+t)2 -b2 [2/3a +d - d3/3a2 ]
WJM 01/10
Advantages of Cardiovascular MR (CMR)
1.
2.
3.
4.
5.
6.
7.
Excellent soft tissue contrast
Non-invasive, no ionizing radiation
High (<1mm) in-plane spatial resolution
Multiplane, true tomographic imaging
“Volumetric imaging” – no geometric assumptions
Dynamic/cine imaging with high temporal resolution(2D echo)
Exogenous contrast usually not needed
[MR agents are less toxic than iodinated preparations]
8. Blood flow/volume - quantitative
9. Potential for tissue characterization
10. Thoracic skeleton and pulmonary parenchyma
do not interfere with imaging
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Coronal or Transverse Scout – Single
Shot
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SSFP ECG gated Cine Acquisitions
Ungated
12 frames/R-R interval
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2Ch & 4Ch Breath-hold Cine MR
LA
LV
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Short Axis Cines from Base to Apex
Ape
x
Base
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LV EDV/ESV - Practical Points
1
Slice #
10
1
10
20
Phases
30
• End-diastolic phase is 1st phase in SA dataset
• End systolic phase is phase of minimum area
• End-systolic phase is defined on a mid-ventricular level.
– Phase of minimum area is then used as “end-systolic phase” for all
slices in dataset
WJM 01/10
3D Assessment of LV/RV Volumes
ED
SEDA*Thsl = EDV
SESA* Thsl = ESV
SV = EDV – ESV
EF = SV/EDV
ES
Isolated Aortic/Mitral Regurgitation
LVEDV 236 ml
LVESV 134 ml
SVLV
102 ml
RVEDV 186 ml
RVESV 102 ml
SVRV
84 ml
Regurgitant Volume 18 ml
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Why CMR for LV Mass/Volumes?
• Summation of discs
– Volumetric  No geometric assumptions
• Enhanced Accuracy (Chuang JACC 2000;35:477)
• Superior Reproducibility
– Changes more reliable for serial evaluation in patients with LVH,
valvular disease
– Reduces sample size for research studies
• High temporal (30ms) and spatial (1.4mm) resolution
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Volumetric vs. Biplane Methods
Limits of agreement
between volumetric
MRI,
biplane MRI,
volumetric Echo
and biplane echo
Chuang JACC 2000;35:477
WJM 01/10
Inter and Intraobserver LVEF Reproducibility
Volumetric
CMR
Biplane
CMR
Volumetric/3D
Echo
Biplane
Echo
Interobserver
Variability (%)
Mean +/- SD (%)
SEE
r2
3.6
0.5+1.5
1.6
0.99
13.4
-1.4+5.9
4.3
0.94
8.3
-0.1+3.8
3.7
0.96
17.8
-1.3+8.8
9.2
0.82
Intraobserver
Variability (%)
Mean +/- SD (%)
SEE
r2
5.1
-1.1+2.1
2.1
0.99
13.0
-2.0+5.6
5.4
0.91
6.9
-0.4+3.1
3.3
0.97
13.4
-0.9+6.8
6.7
0.90
Chuang JACC 2000;35:477
WJM 01/10
Interstudy SD: 2D Echo vs CMR
40
36
35
30
SD
25
24
Echo
CMR Nl
CMR CM
20
16
15
10
10
10
9.3
8.2
5.6
5
6.6
6.5
2.9
2.4
0
LVEDV (ml)
LVESV (ml)
Otterstad EurHeartJ 1997;18:507
LVEF (%)
LVM (g)
Bellenger JCMR 2000:2:271
WJM 01/10
Sample Size Calculations: 10% Change*
Sample Size
509
261
<0.05
LVM 2D echo (Teicholz)
LVM 2D echo (biplane)
LVM CMR
2443
898
35
<0.01
<0.001
LVEF 2D echo
LVEF CMR
698
91
<0.001
LV-EDD 2D Echo
LV-EDD CMR
*Strohm JMRI 2001;13:367; Grothues AJC 2002;90:29
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Comparative Sample Sizes
2D Echo vs CMR [Power 80%, P<0.05]
Change
Echo
CMR
LVEDV
8.3 mL
250
46 (18%)
LVESV
5.5 mL
250
34 (14%)
LVEF
2.3%
250
50 (20%)
LVM
12.7 g
250
8 (3%)
Bellenger JCMR 2000:2:271.
WJM 01/10
What is Normal CMR LV Anatomy?
Salton and Yeon AHA 2006
• 606 adults subjects in FHS Offspring Cohort
• all free of clinical CV disease
• No history of HTN or antihypertensive meds
• No SBP >140mmHg or DBP >90mmHg
• SSFP cine MR
• 30-40ms temporal resolution
• contiguous 10mm slices
• Short axis stack (Simpson’s Rule)
WJM 01/10
Normal CMR LV Anatomy
Variable
LV EDV (ml)
LV EDV/HT (ml/m)
LV EDVI (ml/m2)
LV ESV (ml)
LV ESVI (ml/m2)
LVM (g)
LVMI (g/m2)
LVEF (%)
Men
Mean + SD
144 + 26
81 + 14
71 + 12
51 + 14
25 + 7
Women
Mean + SD
106 + 19*
71 + 12*
61 + 9*
25 + 7*
20 + 5*
123 + 22
61 + 10
81 + 14*
47 + 7*
0.65 + 0.05
0.67 + 0.05*
Salton AHA 2006
*p<0.001 vs. men
WJM 01/10
Comparison of CMR* vs. LV gram
Variable
LVEDVI (ml/m2)
LVESVI (ml/m2)
LVEF (%)
Men-CMR
Mean (95%)
71 + 12
25 + 7
0.65 + 0.05
Women-CMR
Mean (95%)
61 + 9*
20 + 5*
0.67 + 0.05*
LV Gram
Range
50-90
15-30
50-80
* Salton AHA 2006
WJM 01/10
Normal Aging - MEN (n=239)*
Q1
SBP (mmHg)
114.5
DBP (mmHg)
74.7
LVEDDI (mm/m2) 26.6
LVEDVI (ml/m2)
76.6
LVESVI (ml/m2)
27.4
LVMI (g/m2)
62.1
LVEF (%)
0.64
Q2
116.4
74
25.8
69.3
24.4
61.6
0.65
Q3
Q4 Trend
118.4 119.6 0.003
74.4 70.9 0.005
25.8 25.5 0.049
69.4 67.3 <0.001
24.0 23.6 0.002
59.4 58.9 0.034
0.66 0.65 0.216
* Yeon AHA 2006
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Normal Aging - WOMEN (n=367)*
Q1
SBP (mmHg)
109.7
DBP (mmHg)
71.4
LVEDDI (mm/m2) 27.9
LVEDVI (ml/m2)
64.4
LVESVI (ml/m2)
21.8
LVMI (g/m2)
47.3
LVEF (%)
0.66
Q2
114.2
72.2
27.6
61.8
20.6
46.4
0.67
Q3
Q4 Trend
114.4 117.3 <0.001
70.4 68.1 0.001
27.4 27.9 0.80
59.8 57.7 <0.001
19.6 18.3 <0.001
45.6 46.9 0.51
0.67 0.69 0.001
* Yeon AHA 2006
WJM 01/10
LV Mass/Volume and CHD (MESA)
(216 events in 5098 participants)
Unadjusted
HR(95% CI)
P
LVM (10%)
1.1 (1.0-1.2)
0.05
LV volume (10%) 0.9 (0.8-0.9)
0.002
LVM/vol (g/ml)
5.5 (3.3-9.1) <0.001
LVM/vol
1st quartile
1.0 (ref)
2nd quartile
2.0 (1.0-4.0)
0.05
3rd quartile
2.0 (1.0-4.1)
0.05
4th quartile
5.3 (2.9-10.0) <0.001
*age, sex, race, smoking, lipids, BP, DM
Adjusted*
HR (95% CI)
P
1.0 (0.9-1.1)
NS
0.9 (0.8-1.0)
0.09
2.1 (1.1-4.1)
0.02
1.0 (ref)
1.5 (0.7-3.0)
1.3 (0.6-2.6)
2.3 (1.2-4.4)
NS
NS
0.01
* Bluemke JACC 2008
WJM 01/10
Regional Assessment
17 Segment Model of LV
(Echo, CMR, Nuclear, Invasive Cardiology)
AS
A
IS
AS
AL
I
IL
Base
A
IS
A
AL
I
IL
Mid
S
L
I
Apex
Apical
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RV Anatomy
• True RV short axis is not parallel with the
short-axis SA of LV
• ?Define normal population
WJM 01/10
RV End-Diastolic Volume*
Men
(n=340)
Women
(n=512)
P Value
RV EDV (ml)
155.2 + 32.2
110.2 + 22.9
<0.0001
RV EDV / ht (ml/m)
88.1 + 17.3
67.9 + 13.3
<0.0001
RV EDV / ht2.7 (ml/m)
33.7 + 6.6
29.8 + 5.7
<0.0001
RV EDV / BSA
(ml/m²)
76.3 + 14.6
63.2 + 11.8
<0.0001
5.7 + 1.3
4.3 + 1.0
<0.0001
RV EDV / BMI (ml)
* G Arora AHA 2009
WJM 01/10
RV End Systolic Volume*
Men
(n=340)
Women (n=512)
P Value
RV ESV (ml)
84.0 + 22.5
52.61 + 14.4
<0.0001
RV ESV / ht (ml/m)
47.8 + 12.3
32.4 + 8.6
<0.0001
RV ESV / ht2.7
(ml/m)
18.3 + 4.7
14.2 + 3.7
<0.0001
RV ESV / BSA
(ml/m²)
41.5 + 10.5
30.2 + 7.9
<0.0001
3.1 + 0.9
2.1 + 0.6
<0.0001
RV ESV / BMI (ml)
* G Arora AHA 2009
WJM 01/10
RV Ejection Fraction*
RVEF (%)
Men
(n=340)
Women
(n=512)
45.8 + 9.7
52.2 + 9.2
P Value
<0.0001
* G Arora AHA 2009
WJM 01/10
Normal RV Mass*
Men
(n=340)
Women
(n=512)
P Value
RVM (g)
28.3 + 6.3
21.6 + 4.3
<0.0001
RVM / ht (g/m)
16.1 + 3.4
13.3 + 2.5
<0.0001
RVM / ht2.7 (g/m)
6.2 + 1.3
5.9 + 1.1
0.0027
RVM / BSA (g/m²)
13.9 + 3.0
12.4 + 2.4
<0.0001
RVM / BMI (g)
1.1 + 0.3
0.9 + 0.2
<0.0001
* G Arora AHA 2009
WJM 01/10
Next Week:
Dr. Thomas Hauser
Viability
WJM 01/10
If you want to learn more.....*
Society for Cardiovascular
Magnetic Resonance*
www.scmr.org
13th Annual Scientific Sessions
January 21-January 24, 2010
Phoenix, AZ
WJM 01/10
Thank you!
WJM 01/10