Author + information
- Received September 28, 2009
- Revision received April 26, 2010
- Accepted May 3, 2010
- Published online September 1, 2010.
- James A. White, MD*,†,‡,* (, )
- Nowell Fine, MD*,
- Lorne J. Gula, MD, MSc*,
- Raymond Yee, MD*,
- Mohammed Al-Admawi, MD*,
- Qi Zhang, PhD†,
- Andrew Krahn, MD*,
- Allan Skanes, MD*,
- Anna MacDonald*,
- Terry Peters, PhD†,§ and
- Maria Drangova, PhD†,§
- ↵*Reprint requests and correspondence:
Dr. James A. White, Cardiovascular MRI Clinical Research (CMCR) Program, 3T-7T MRI Unit, Robarts Research Institute, P.O. Box 5015, 100 Perth Drive, London, Ontario, N6A 5K8 Canada
Objectives The aim of this study was to demonstrate the feasibility of providing spatially matched, 3-dimensional (3D) myocardial scar and coronary imaging for the purpose of fused volumetric image display in patients undergoing cardiac resynchronization therapy (CRT) or coronary artery revascularization (CAR).
Background Clinical success in coronary vascular-based interventions is mitigated by the presence of scar in related myocardium. Pre-procedural fused volumetric imaging of both myocardial scar and coronary vasculature may benefit pre-procedural planning and patient selection in populations referred for CRT or CAR.
Methods A total of 55 studies were performed in patients referred for either CRT (n = 42) or CAR (n = 13). Coronary-enhanced and scar-enhanced imaging was performed on a 3-T cardiac magnetic resonance scanner using the same cardiac-gated, 3D, free-breathing cardiac magnetic resonance technique during and 20 minutes following slow gadolinium infusion. Matched image datasets were fused and volume-rendered to simultaneously display coronary anatomy and myocardial scar. Visual scoring of coronary artery, coronary vein, and myocardial scar image quality (score 0 to 4) was performed. The clinical impact of imaging was also scored using a physician survey.
Results Mean age was 57 ± 14 years. Combined 3D coronary and scar imaging was successful in 49 studies (89%). A quality score ≥2 was obtained for 97% of proximal- and mid-coronary artery and vein segments. The mean quality score of 3D scar imaging was 2.8 ± 1.0 and was scored as ≥2 in 86% of patients with myocardial scar. All patients with a scar quality score ≥2 achieved successful image fusion. Transmural scar was present below ≥1 planned target vessel in 9 patients (39%) planned for CRT and 8 patients (62%) planned for CAR. Physician surveys demonstrated incremental clinical impact in 67% of patients.
Conclusions Three-dimensional myocardial scar and coronary imaging with fused volumetric display is clinically feasible and may be valuable for the planning of vascular-based interventions when regional myocardial scar is pertinent to therapeutic success.
Dr. White is a clinician scientist and Dr. Drangova is a career scientist with the Heart and Stroke Foundation of Ontario. Funding for the research was provided in part by the Heart and Stroke Foundation of Ontario grant NA 6488 (to Dr. White) and the Canadian Foundation for Innovation Leaders opportunity fund 18847 (to Dr. White). Dr. White receives in-kind research contributions from Bayer Inc. in the form of CMR contrast agents. All other authors report that they have no relationships to disclose.
- Received September 28, 2009.
- Revision received April 26, 2010.
- Accepted May 3, 2010.
- American College of Cardiology Foundation