Disclosures Research Grant Support



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Disclosures

  • Research Grant Support:



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























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.





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!



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