Anish N Bhuva1, Peter Kellman2, Adam Graham3, Manish Ramlall4, Redha Boubertakh4, Patricia Feuchter4, Angela Hawkins3, Martin Lowe3, Pier D Lambiase5, Neha Sekhri4, Richard J Schilling3, James C Moon1, Charlotte H Manisty6. 1. Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institutes for Cardiovascular Science, University College London, London, UK. 2. National Institutes of Health, Bethesda, USA. 3. Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK. 4. Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK. 5. Institutes for Cardiovascular Science, University College London, London, UK; Department of Cardiac Electrophysiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK. 6. Department of Cardiovascular Imaging, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institutes for Cardiovascular Science, University College London, London, UK. Electronic address: c.manisty@ucl.ac.uk.
Abstract
BACKGROUND: Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. METHODS: 136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. RESULTS: CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. CONCLUSION: The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.
BACKGROUND: Myocardial scar assessment using late gadolinium enhancement Cardiovascular Magnetic Resonance (LGE CMR) is commonly indicated for patients with cardiac implantable electronic devices (CIEDs), however metal artifact can degrade images. We evaluated the clinical impact of LGE CMR incorporating a device-dependent metal artifact reduction strategy in patients with CIEDs. METHODS: 136 CMR studies were performed in 133 consecutive patients (age 56 ± 19 years, 69% male) with CIEDs (22% implantable loop recorders [ILRs], 40% permanent pacemakers [PPMs], 38% implantable cardioverter defibrillators [ICDs]; 42% non-MRI conditional) over 2 years, without complication. LGE imaging was tailored to the CIED, using a wideband sequence for left-sided PPMs and ICDs and conventional sequences for ILRs and right-sided PPMs, scoring segmental artifact. Diagnostic utility and impact on clinical management were scored by consensus of experts. RESULTS: CMR provided unexpected diagnoses in 22 (16%) and changed management in 113 (83%) patients. Myocardial scar was present in 92 (68%), with other abnormalities detected in another 13%. Using conventional LGE, 43 (32%) studies were non-diagnostic (79% of defibrillators) compared to 0% using wideband LGE imaging. Wideband LGE results changed clinical management in an additional 39 (75%) defibrillator patients and 10 (19%) pacemaker patients when compared to imaging with conventional LGE sequences. CONCLUSION: The clinical yield from CMR using optimized LGE sequences in patients with CIEDs is high with no demonstrated clinical risk. A device-dependent LGE imaging strategy using wideband LGE is needed to achieve clinical utility especially in ICD recipients.
Authors: Ananna Zaman; Samantha Zhao; Jordana Kron; Antonio Abbate; Anna Tomdio; W Gregory Hundley; Jennifer H Jordan Journal: Curr Cardiol Rep Date: 2022-08-19 Impact factor: 3.955
Authors: Christopher E D Saunderson; Maria F Paton; Amrit Chowdhary; Louise A E Brown; John Gierula; Anshuman Sengupta; Christopher Kelly; Pei G Chew; Arka Das; Thomas P Craven; Rob J van der Geest; David M Higgins; Liang Zhong; Klaus K Witte; John P Greenwood; Sven Plein; Pankaj Garg; Peter P Swoboda Journal: Magn Reson Imaging Date: 2020-09-02 Impact factor: 2.546
Authors: Anish N Bhuva; Thomas A Treibel; Andreas Seraphim; Paul Scully; Kristopher D Knott; João B Augusto; Camilla Torlasco; Katia Menacho; Clement Lau; Kush Patel; James C Moon; Peter Kellman; Charlotte H Manisty Journal: Front Cardiovasc Med Date: 2021-01-29
Authors: Christopher E D Saunderson; Maria F Paton; Louise A E Brown; John Gierula; Pei G Chew; Arka Das; Anshuman Sengupta; Thomas P Craven; Amrit Chowdhary; Aaron Koshy; Hazel White; Eylem Levelt; Erica Dall'Armellina; Pankaj Garg; Klaus K Witte; John P Greenwood; Sven Plein; Peter P Swoboda Journal: Circ Cardiovasc Imaging Date: 2021-05-18 Impact factor: 7.792
Authors: Anish N Bhuva; Russell Moralee; Tamara Brunker; Karen Lascelles; Lizette Cash; Kush P Patel; Martin Lowe; Neha Sekhri; Francisco Alpendurada; Dudley J Pennell; Richard Schilling; Pier D Lambiase; Anthony Chow; James C Moon; Harold Litt; A John Baksi; Charlotte H Manisty Journal: Eur Heart J Date: 2022-07-07 Impact factor: 35.855