EuroCMR (European Cardiovascular Magnetic Resonance) RegistryResults of the German Pilot Phase
Oliver Bruder, MD*,*,
Steffen Schneider, PhD ,
Detlef Nothnagel, MD ,
Thorsten Dill, MD ,
Vinzenz Hombach, MD||,
Jeanette Schulz-Menger, MD¶,
Eike Nagel, MD#,
Massimo Lombardi, MD**,
Albert C. van Rossum, MD,
Anja Wagner, MD,
Juerg Schwitter, MD,
Jochen Senges, MD,
Georg V. Sabin, MD*,
Udo Sechtem, MD|||| and
Heiko Mahrholdt, MD||||
* Department of Cardiology and Angiology, Elisabeth Hospital, Essen, Germany
Institut für Herzinfarktforschung, Ludwigshafen, Germany
Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
|| Department of Internal Medicine II, Cardiology, University of Ulm, Ulm, Germany
¶ Franz-Volhard-Klinik, Klinik für Kardiologie, HELIOS Klinikum Berlin-Buch Charité Universitätsmedizin Berlin, Berlin, Germany
# King's College London BHF Centre of Excellence, Division of Imaging Sciences, NIHR Biomedical Research Centre at Guy's and St. Thomas' NHS Trust Foundation, The Rayne Institute, St. Thomas' Hospital, London, United Kingdom
** Clinical Physiology Institute/G. Monasterio Foundation, Pisa, Italy
Department of Cardiology, VU Medical Centre, Amsterdam, the Netherlands
Hahnemann University Hospital, Drexel University College of Medicine, Philadelphia, Pennsylvania
Cardiac MR Centre, University Hospital Lausanne, Lausanne, Switzerland
|||| Department of Cardiology, Robert Bosch Medical Centre, Stuttgart, Germany
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Figure 1 Registry Goals
Illustration of the role and importance of imaging registry data in the continuous circle of optimizing patient management and prognosis, as well as short-term goals and future plans for the EuroCMR (European Cardiovascular Magnetic Resonance) registry. CAD = coronary artery disease; CHF = congestive heart failure; HCM = hypertrophic cardiomyopathy; SCD = sudden cardiac death.
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Figure 2 Cardiomyopathies
Steady-state free precession (left 2 columns [systole and diastole]), and contrast cardiovascular magnetic resonance images (right column, late gadolinium enhancement [LGE]) of a 51-year-old male patient presenting for workup of myocardial disease after aborted sudden cardiac death. Short- and long-axis images clearly show eccentric septal hypertrophy as a typical feature of hypertrophic cardiomyopathy (systolic steady-state free precession). Myocardial scarring, which is suspected to be an important arrhythmogenic substrate, can be visualized and quantified noninvasively by contrast cardiovascular magnetic resonance (white arrows, right column, LGE).
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Figure 3 Risk Stratification in Suspected CAD
Steady-state free precession cine (diastole and systole), fast gradient echo perfusion (stress and rest), as well as contrast-enhanced cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) images of a 65-year-old woman presenting for workup of atypical chest pain and diabetes mellitus as her only cardiovascular risk factor. She was referred to adenosine stress CMR after a normal stress electrocardiogram up to 125 W and normal echocardiography at rest. Adenosine perfusion CMR revealed stress-induced ischemia in several coronary artery territories (top and middle) without myocardial scarring or wall motion abnormalities. Based on the CMR results, invasive angiography was performed demonstrating triple-vessel coronary artery disease (bottom). The patient underwent subsequent surgical revascularization. Note the stress perfusion defects in the perfusion areas of the left anterior descending (LAD), and the right coronary artery (RCA) (top, white arrows), matching significant stenosis of the corresponding coronary vessels (bottom, white arrows). CAD = coronary artery disease; LCX = left circumflex artery.
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Figure 4 Myocardial Viability
Steady state free precession cine (diastole and systole), as well as contrast-enhanced CMR images of a 69-year-old man with known triple-vessel disease (see coronary angiography in the right row), and severely impaired left ventricular function presenting for workup of myocardial viability before planned surgical revascularization. Note that only a small nontransmural anterior wall myocardial infarction is present (LGE, white arrows), whereas the remaining myocardium is dysfunctional but viable. Thus, after surgical revascularization, the left ventricular function significantly improved (bottom panels, 6 months after surgery). CABG = coronary artery bypass grafting; LCA = left circumflex artery; other abbreviations as in Figure 3.
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Figure 5 Completely New Diagnosis by CMR
Steady state free precession cine (diastole, systole, and aortic valve area [AVA]), as well as contrast-enhanced CMR (LGE) images of a 78-year-old man presenting for workup of heart failure, and discrepant previous findings regarding possible aortic stenosis. Whereas steady-state free precession CMR sufficiently assessed the AVA to be 1.3 cm2, contrast CMR (LGE) revealed diffuse subendocardial enhancement in the large parts of the left ventricle (white arrows), which is typical for cardiac amyloidosis. After CMR, this diagnosis was confirmed by endomyocardial biopsy (bottom row). Abbreviations as in Figure 3.
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