Jennifer Jue

Association of Feature-Tracking Cardiac Magnetic Resonance Imaging Left Ventricular Global Longitudinal Strain with All-Cause Mortality in Patients with Reduced Left Ventricular Ejection Fraction

Direct assessment of myocardial fiber deformation with echocardiographic global longitudinal strain (GLS) has shown promise in providing prognostic information that is incremental to ejection fraction (EF) in patients with left ventricular dysfunction.1 Cardiac magnetic resonance (CMR) imaging has now evolved into a major tool for evaluation of patients with left ventricular dysfunction, providing precise measurements of EF and viability assessment with late gadolinium enhancement (LGE). Recent development of CMR feature-tracking techniques now allow assessment of GLS from standard cine CMR images without the need for specialized pulse sequences or additional scanning time.2 We therefore hypothesized that CMR feature-tracking derived GLS may provide incremental prognostic information in these patients. Consecutive patients (n=470) undergoing CMR with both cine and LGE imaging for evaluation of ischemic or nonischemic dilated cardiomyopathy with EF <50% were included in this retrospective study. Comprehensive phenotyping, including clinical history, imaging, and cardiac catheterization, classified 330 individuals with ischemic and 140 with nonischemic cardiomyopathy. Institutional review board approval was obtained. Steady-state free-precession cine images were acquired in multiple short-axis and 3 long-axis views. LGE imaging was performed 10 to 15 minutes after Gadolinium contrast (0.15 mmol/kg) administration using a 2D-segmented gradient echo inversion recovery sequence in …

Compartment Syndrome of the Hand: A Rare Sequela of Transradial Cardiac Catheterization

A 64-year-old man who underwent percutaneous coronary intervention via right radial artery access reported right-hand pain and swelling 2 hours after the procedure. He had developed compartment syndrome of the hand, specifically with muscular compromise of the thenar compartment but with no involvement of the forearm. He underwent emergency right-hand compartment release and carpal tunnel release, followed by an uneventful postoperative course. In addition to our patients case, we discuss compartment syndrome of the hand and related issues.

Left ventricular long-axis function assessed with cardiac cine mr imaging is an independent predictor of all-cause mortality in patients with reduced ejection fraction: A multicenter study

Purpose To evaluate the prognostic value of a simple index of left ventricular (LV) long-axis function-lateral mitral annular plane systolic excursion (MAPSE)-in a large multicenter population of patients with reduced ejection fraction (EF) who were undergoing cardiac magnetic resonance (MR) imaging. Materials and Methods This retrospective study included 1040 consecutive patients (mean age, 59.5 years ± 15.8) at four U.S. medical centers who were undergoing cardiac MR imaging for assessment of LV dysfunction with EF less than 50%. Lateral MAPSE was measured in the four-chamber cine view. The primary end point was all-cause death. Cox proportional hazards regression modeling was used to examine the independent association between lateral MAPSE and death. The incremental prognostic value of lateral MAPSE was assessed in nested models. Results During a median follow-up of 4.4 years, 132 patients died. With Kaplan-Meier analysis, the risk of death increased significantly with decreasing tertiles of lateral MAPSE (log-rank P = .0001). Patients with relatively preserved lateral MAPSE (>9 mm) had very few deaths, regardless of whether their EF was above or below 35%. Patients with late gadolinium enhancement (LGE) and low lateral MAPSE had significantly reduced survival compared to those with LGE and high lateral MAPSE (log-rank P < .0001). Lateral MAPSE was independently associated with risk of death after adjustment for clinical and imaging risk factors, which were univariate predictors (age, body mass index, diabetes, LV end-diastolic volume index, LGE, EF) (hazard ratio = 2.051 per mm decrease; 95% confidence interval [CI]: 1.520, 2.768; P < .001). Inclusion of lateral MAPSE in this model resulted in significant improvement in model fit (likelihood ratio test P < .0001) and C statistic (increasing from 0.675 to 0.844; P < .0001). Continuous net reclassification improvement was 1.036 (95% CI: 0.878, 1.194). Conclusion Lateral MAPSE measured during routine cine cardiac MR imaging is a significant independent predictor of mortality in patients with LV dysfunction, incremental to common clinical and cardiac MR risk factors-including EF and LGE.