1410 21. Al-Saadi N, Nagel E, Gross M, Bornstedt A, Schnackenburg B, Klein C et al. Noninvasive detection of myocardial ischemia from perfusion reserve based on cardiovascular magnetic resonance. Circulation 2000;101:1379 –83. 22. Greenwood JP, Maredia N, Younger JF, Brown JM, Nixon J, Everett CC et al. Cardiovascular magnetic resonance and single-photon emission computed tomography for diagnosis of coronary heart disease (CE-MARC): a prospective trial. Lancet 2012; 379:453–60. 23. Schwitter J, Wacker CM, Wilke N, Al-Saadi N, Sauer E, Huettle K et al. MR-IMPACT II: Magnetic Resonance Imaging for Myocardial Perfusion Assessment in Coronary artery disease Trial: perfusion-cardiac magnetic resonance vs. single-photon emission computed tomography for the detection of coronary artery disease: a comparative multicentre, multivendor trial. Eur Heart J 2013;34:775 – 81. 24. Nissen SE, Tuzcu EM, Schoenhagen P, Brown BG, Ganz P, Vogel RA et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004;291: 1071 – 80.
C. Jahnke et al.
25. Suzuki M, Saito M, Nagai T, Saeki H, Kazatani Y. Prevention of positive coronary artery remodeling with statin therapy in patients with coronary artery diseases. Angiology 2006;57:259 –65. 26. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316: 1371 –5. 27. Brandts A, Roes SD, Doornbos J, Weiss RG, de Roos A, Stuber M et al. Right coronary artery flow velocity and volume assessment with spiral K-space sampled breathhold velocity-encoded MRI at 3 tesla: accuracy and reproducibility. J Magn Reson Imaging 2010;31:1215 –23. 28. Hundley WG, Lange RA, Clarke GD, Meshack BM, Payne J, Landau C et al. Assessment of coronary arterial flow and flow reserve in humans with magnetic resonance imaging. Circulation 1996;93:1502 –8. 29. Wacker CM, Hartlep AW, Pfleger S, Schad LR, Ertl G, Bauer WR. Susceptibilitysensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol 2003;41:834 –40.
IMAGE FOCUS
doi:10.1093/ehjci/jeu150 Online publish-ahead-of-print 7 August 2014
.............................................................................................................................................................................
Chemotherapy-related cardiomyopathy in acute myeloid leukaemia assessed by cardiovascular magnetic resonance imaging Chrysanthos Grigoratos*, Konstantinos Bratis, Markus Henningsson, Islam Mahmoud, and Eike Nagel * Corresponding author. Tel: +44 (0) 7984062442. E-mail: [email protected]
A 21-year-old male patient with newly diagnosed acute myeloid leukaemia was referred for cardiomyopathy assessment using cardiac magnetic resonance (CMR). The patient had recently undertaken doxorubicin treatment and routine cardiac assessment revealed incidental findings of T-wave inversion on electrocardiogram (Panels A and B) and an echocardiographic suspicion of left ventricular (LV) thrombus. Short-axis CMR cine showed borderline normal global and regional LV systolic function (see Supplementary data online, Video S1). Shortaxis T2-weighted spin-echo images demonstrated areas of subtle signal increase (arrows) in the inferolateral (Panel C) and anterior/anterolateral (Panels D and E) walls with associated late gadolinium enhancement (arrowheads) on post-contrast T1-weighted inversion-recovery images (Panels I– K ), suggestive of an ongoing inflammatory process. A short-axis mid-LV septal pre-contrast T1 map was obtained using a modified Look– Locker inversion-recovery sequence. T1 values were increased (measured T1 value: 1057 ms and normal value: ,1000 ms), indicative of myocardial involvement. The presence of an apical LV thrombus (curved arrow) was confirmed, as noted on early enhancement short- and long-axis (Panels H and L, respectively) and late enhancement short-axis (Panel K) post-contrast images. Given the clinical context, a chemotherapy-related cardiomyopathy was diagnosed. Doxorubicin was suspended and anticoagulation was initiated. With the use of robust tools for macroscopic and interstitial myocardial tissue characterization, CMR can detect early changes in subclinical cardiotoxicity and potentially predict overt heart failure. CMR could become a useful screening tool during initial stages of chemotherapy treatment for identifying patients at higher risk of chemotherapy-related cardiomyopathy and provide efficient guidance of patient management. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on November 16, 2015
Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
C. Jahnke et al.
25. Suzuki M, Saito M, Nagai T, Saeki H, Kazatani Y. Prevention of positive coronary artery remodeling with statin therapy in patients with coronary artery diseases. Angiology 2006;57:259 –65. 26. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries. N Engl J Med 1987;316: 1371 –5. 27. Brandts A, Roes SD, Doornbos J, Weiss RG, de Roos A, Stuber M et al. Right coronary artery flow velocity and volume assessment with spiral K-space sampled breathhold velocity-encoded MRI at 3 tesla: accuracy and reproducibility. J Magn Reson Imaging 2010;31:1215 –23. 28. Hundley WG, Lange RA, Clarke GD, Meshack BM, Payne J, Landau C et al. Assessment of coronary arterial flow and flow reserve in humans with magnetic resonance imaging. Circulation 1996;93:1502 –8. 29. Wacker CM, Hartlep AW, Pfleger S, Schad LR, Ertl G, Bauer WR. Susceptibilitysensitive magnetic resonance imaging detects human myocardium supplied by a stenotic coronary artery without a contrast agent. J Am Coll Cardiol 2003;41:834 –40.
IMAGE FOCUS
doi:10.1093/ehjci/jeu150 Online publish-ahead-of-print 7 August 2014
.............................................................................................................................................................................
Chemotherapy-related cardiomyopathy in acute myeloid leukaemia assessed by cardiovascular magnetic resonance imaging Chrysanthos Grigoratos*, Konstantinos Bratis, Markus Henningsson, Islam Mahmoud, and Eike Nagel * Corresponding author. Tel: +44 (0) 7984062442. E-mail: [email protected]
A 21-year-old male patient with newly diagnosed acute myeloid leukaemia was referred for cardiomyopathy assessment using cardiac magnetic resonance (CMR). The patient had recently undertaken doxorubicin treatment and routine cardiac assessment revealed incidental findings of T-wave inversion on electrocardiogram (Panels A and B) and an echocardiographic suspicion of left ventricular (LV) thrombus. Short-axis CMR cine showed borderline normal global and regional LV systolic function (see Supplementary data online, Video S1). Shortaxis T2-weighted spin-echo images demonstrated areas of subtle signal increase (arrows) in the inferolateral (Panel C) and anterior/anterolateral (Panels D and E) walls with associated late gadolinium enhancement (arrowheads) on post-contrast T1-weighted inversion-recovery images (Panels I– K ), suggestive of an ongoing inflammatory process. A short-axis mid-LV septal pre-contrast T1 map was obtained using a modified Look– Locker inversion-recovery sequence. T1 values were increased (measured T1 value: 1057 ms and normal value: ,1000 ms), indicative of myocardial involvement. The presence of an apical LV thrombus (curved arrow) was confirmed, as noted on early enhancement short- and long-axis (Panels H and L, respectively) and late enhancement short-axis (Panel K) post-contrast images. Given the clinical context, a chemotherapy-related cardiomyopathy was diagnosed. Doxorubicin was suspended and anticoagulation was initiated. With the use of robust tools for macroscopic and interstitial myocardial tissue characterization, CMR can detect early changes in subclinical cardiotoxicity and potentially predict overt heart failure. CMR could become a useful screening tool during initial stages of chemotherapy treatment for identifying patients at higher risk of chemotherapy-related cardiomyopathy and provide efficient guidance of patient management. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected].
Downloaded from by guest on November 16, 2015
Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK
