Omer Mirza

Regression of Cardiac Amyloidosis After Stem Cell Transplantation Assessed by Cardiovascular Magnetic Resonance Imaging

A previously fit 52-year-old man presented with severe progressive exertional dyspnea. He was in heart-failure with an elevated jugular-venous-pressure, edema, and increased plasma-NTpro-BNP levels of 4285 μg/mL (upper limit of normal <900 μg/mL). His ECG demonstrated sinus-rhythm with low limb and chest lead voltages (Figure 1). He had significant proteinuria with renal and bone marrow biopsies confirming light-chain amyloidosis. Cardiac magnetic resonance imaging revealed concentric left-ventricular hypertrophy with an ejection fraction of 65%, left-ventricular end-diastolic volume of 146 mL, left-ventricular end-systolic volume of 51 mL, left-ventricular mass of 245 g, and left-atrial volume of 144 …

Left ventricular global longitudinal strain predicts mortality and heart failure admissions in African American patients: Left ventricular strain in African Americans with heart failure

Several studies have demonstrated the importance of left ventricular (LV) global longitudinal strain (GLS) as a reliable prognostic indicator in patients with heart failure (HF). These studies have included few African American (AA) patients, despite the growing prevalence and severity of HF in this patient population.

Overall impact of outpatient stress cardiac magnetic resonance (CMR) imaging on clinical care is independent of appropriate use criteria

Background Stress cardiac-magnetic-resonance (CMR) imaging can provide important diagnostic and prognostic information in patients with known or suspected coronary artery disease. However, given the rising costs of imaging, there is increasing pressure to provide evidence for direct additive impact on clinical care. Appropriate use criteria (AUC) have been developed by professional organizations as a response to rising costs, with the goal of optimizing test-patient selection. Consequently, the AUC are now increasingly used by third-party-payers to assess reimbursement. However, these criteria were created by expert consensus with limited systematic validation. The aim of this study was to determine whether the AUC can predict rates of active change in clinical care resulting from stress CMR.

Apical hypertrophic cardiomyopathy: the spade of hearts

A 42-year-old policeman with no prior medical problems presented with a several-month history of intermittent palpitations without syncope. His electrocardiogram showed sinus rhythm with prominent precordial T-wave inversions. Echocardiography was suboptimal due to poor acoustic windows. Cardiac–magnetic resonance imaging demonstrated the classic spade-shaped left-ventricular cavity of apical hypertrophic cardiomyopathy (Figure 1 and supplementary video). Apical hypertrophic cardiomyopathy is a form of hypertrophic cardiomyopathy predominantly involving the left ventricular apex. 1 It is most common in Japan but also seen in western populations. Apical thrombus, left-ventricular non-compaction and endomyocardial fibrosis may create a similar echocardiographic appearance, which can be distinguished from apical hypertrophic cardiomyopathy using cardiac–magnetic resonance imaging. 2,3 Patients are typically male and present in middle age with symptoms of palpitations, chest pain or dyspnea. Although autosomal-dominant inheritance has been reported in a few families, the condition is usually sporadic. 4 The electrocardiogram typically shows pronounced precordial T-wave inversions. Sudden cardiac death from ventricular arrhythmia has been described, and prophylactic defibrillator implantation is occasionally performed. However, the prognosis is generally more benign than other types of hypertrophic cardiomyopathy. 5

Appropriate use criteria and the impact of stress cardiovascular magnetic resonance (CMR) imaging on management of patients with known or suspected coronary artery disease

Background Stress-CMR provides important diagnostic and prognostic information in patients with known or suspected coronary artery disease. However, in the current fiscal environment, use of a newer imaging modality like stress-CMR requires evidence for direct additive impact on clinical management. Appropriate use criteria (AUC) have recently been developed to provide guidance to physicians and payers regarding the appropriateness of this test in various clinical scenarios. However, these criteria were created by expert consensus and have never been systematically validated. The aims of this study were 1) to evaluate the impact of stress-CMR on clinical management; and 2) to determine the relationship of the AUC with active clinical impact.

Impact of Cardiac Magnetic Resonance (CMR) on utilization of Implantable-Cardioverter-Defibrillators (ICD) for primary prophylaxis of sudden cardiac death

Background Currently, left ventricular dysfunction derived from echocardiography is the main basis for determining eligibility of patients for implantable cardioverter-defibrillator (ICD) placement in the primary prevention of sudden cardiac death (SCD). However, recent trials suggest that approximately 14 to 18 patients with ventricular dysfunction need to have an ICD implanted to prevent 1 death. Given the substantial cost and potential for complications, improved risk stratification to identify patients who would benefit most from ICD implantation remains an important public health challenge. Cardiac magnetic resonance imaging (CMR) is the current gold standard for measurement of left ventricular ejection fraction (LVEF). We hypothesized that using LVEF derived from CMR compared with echocardiography may lead to a significant impact on ICD implantation rates which could translate into improved selection of patients and possible cost reductions.