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J Am Coll Cardiol, 2007; 49:1900-1901, doi:10.1016/j.jacc.2007.02.031 (Published online 20 April 2007).
© 2007 by the American College of Cardiology Foundation
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CORRESPONDENCE: LETTER TO THE EDITOR

Cardiac Imaging in Patients With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure

William O. Ntim, MB, ChB, FACC* and W. Gregory Hundley, MD, FACC

* Department of Internal Medicine, Section on Cardiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045 (Email: wntim{at}wfubmc.edu).

We read with interest the recent study by Le Jemtel et al. (1) on the diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). In the proposed diagnostic algorithm, the investigators suggested radionuclide ventriculography (RNV) in patients with technically inadequate echocardiographic study.

Although RNV provides an accurate and reproducible method of assessing ventricular function (2,3) it involves the use of radiation and the need for peripheral venous access. In addition, the myocardium itself is not seen, and the spatial resolution is low.

Cardiovascular magnetic resonance (CMR) has become the gold standard for determination of left ventricular (LV) volumes and LV ejection fraction (LVEF) (4). It compares favorably to available reference methods and has high intraobserver, interobserver, and test-retest reproducibility (5,6). Moreover, CMR does not involve the use of ionizing radiation, and LV evaluation by cine white blood imaging technique can be done without a peripheral venous access. Cardiovascular magnetic resonance may also provide tissue characterization of the diseased myocardium and prognostic information (7). Furthermore, both right ventricular (RV) volume and function by CMR have been validated in a large, multiethnic study (8). This is of particular importance in COPD patients, because RV hypertrophy determined by CMR may provide the earliest sign of RV pressure overload in COPD (9).

Presently, CMR is considered by professional societies to be an appropriate test for evaluation of LV function in heart failure patients with technically limited echocardiogram images (10). Therefore, we believe CMR should be part of any algorithm for evaluation of COPD patients with concurrent CHF.


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  1. Le Jemtel TH, Padeletti M, Jelic S. Diagnostic and therapeutic challenges in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure J Am Coll Cardiol 2007;49:171-180.[Abstract/Free Full Text]
  2. Strauss WH, Zaret BL, Hurley PJ, et al. A scintigraphic method for measuring left ventricular ejection fraction in man without cardiac catheterization Am J Cardiol 1971;28:575-580.[CrossRef][ISI][Medline]
  3. Starling MR, Dell’Italia LJ, Walsh RA, et al. Accurate estimates of absolute ventricular volumes from equilibrium radionuclide angiographic count data using a simple geometric attenuation correction J Am Coll Cardiol 1984;3:789-798.[Abstract]
  4. Pennell DJ. Cardiovascular magnetic resonance: twenty-first century solutions in cardiology Clin Med 2003;3:273-278.[ISI][Medline]
  5. Cranney GB, Lotan CS, Dean L, Baxley W, Bouchard A, Pohost GM. Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imagingValidation by calibrated ventricular angiography. Circulation 1990;82:154-163.[Abstract/Free Full Text]
  6. Chuang ML, Hibberd MG, Salton CJ, et al. Importance of imaging method over imaging modality in noninvasive determination of left ventricular volumes and ejection fraction: assessment by two- and three-dimensional echocardiography and magnetic resonance imaging J Am Coll Cardiol 2000;35:477-484.[Abstract/Free Full Text]
  7. Assomull RG, Prasad SK, Smith G, et al. Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy J Am Coll Cardiol 2006;48:1977-1985.[Abstract/Free Full Text]
  8. Tandri H, Daya SK, Nasir K, et al. Normal reference values for the adult right ventricle by magnetic resonance imaging Am J Cardiol 2006;98:1660-1664.[CrossRef][ISI][Medline]
  9. Vonk-Noordegraaf A, Marcus JT, Holverda S, Roseboom B, Postmus PE. Early changes of cardiac structure and function in COPD patients with mild hypoxemia Chest 2005;127:1898-1903.[CrossRef][ISI][Medline]
  10. Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology J Am Coll Cardiol 2006;48:1475-1497.[Free Full Text]

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Thierry H. Le Jemtel, Margherita Padeletti, and Sanja Jelic
J. Am. Coll. Cardiol. 2007 49: 1901. [Full Text] [PDF]




This Article
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