Disclosures Research Grant Support

Disclosures

• Research Grant Support:

• Philips Medical Systems
• NIH, NHLBI
• Lantheus Medical Inc.

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

Outline

3 “Pillars” of Cardiology

CMR Teaching Staff

TOPICS [Web site]

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

Multimodality Imaging in Cardiology

• Critical that training cross technology boundries

• Efficiencies of multimodality imaging program

CMR – “New Kid” on the block Non-invasive Imaging – 2008 (estimate)

Cardiac imaging is frequently performed!

Pacemakers/AICD

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”

Echocardiography

M-Mode Echo Estimates

M-Mode Echo Estimates

Coronal or Transverse Scout – Single Shot

SSFP ECG gated Cine Acquisitions

2Ch & 4Ch Breath-hold Cine MR

Short Axis Cines from Base to Apex

LV EDV/ESV - Practical Points

• 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

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

Interstudy SD: 2D Echo vs CMR

Sample Size Calculations: 10% Change*

Comparative Sample Sizes 2D Echo vs CMR [Power 80%, P<0.05]

Normal CMR LV Anatomy

LV Mass/Volume and CHD (MESA) (216 events in 5098 participants)

Regional Assessment 17 Segment Model of LV (Echo, CMR, Nuclear, Invasive Cardiology)

RV Anatomy

• True RV short axis is not parallel with the short-axis SA of LV

• ?Define normal population

Next Week: Dr. Thomas Hauser Viability

Thank you!