1367
Myocardial oxygenation and coronary stenosis severity
12. Højsgaard S, Halekoh U, Yan J. The R Package geepack for Generalized Estimating Equations. J Stat Soft 2005;15:1 –11. 13. Hastie TJ. Generalized additive models. In: Chambers JM, Hastie TJ (eds). Statistical Models in S. Pacific Grove, CA: Wadsworth & Brooks/Cole; 1992. 14. Friedrich MG, Karamitsos TD. Oxygenation-sensitive cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013;15:43. 15. 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. 16. Karamitsos TD, Leccisotti L, Arnold JR, Recio-Mayoral A, Bhamra-Ariza P, Howells RK et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging 2010;3: 32 –40. 17. Arnold JR, Karamitsos TD, Bhamra-Ariza P, Francis JM, Searle N, Robson MD et al. Myocardial oxygenation in coronary artery disease: insights from blood oxygen level-dependent magnetic resonance imaging at 3 Tesla. J Am Coll Cardiol 2012;59: 1954– 64. 18. Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T et al. Intravascular ultrasound relationship study. J Am Coll Cardiol 2013;61:917 – 23. 19. Walcher T, Manzke R, Hombach V, Rottbauer W, Wohrle J, Bernhardt P. Myocardial perfusion reserve assessed by T2-prepared steady-state free precession blood
20.
21.
22.
23.
oxygen level–dependent magnetic resonance imaging in comparison to fractional flow reserve. Circ Cardiovasc Imag 2012;5:280 –286. Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound 2008;6:30. Cosmai EM, Heller GV. The clinical importance of electrocardiographic changes during pharmacologic stress testing with radionuclide myocardial perfusion imaging. J Nucl Cardiol 2005;12:466 –72. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D et al. European Association of Echocardiography. Stress echocardiography expert consensus statement—executive summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J 2009;30: 278 –89. Granato JE, Watson DD, Belardinelli L, Cannon JM, Beller GA. Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis. J Am Coll Cardiol
1990;16:1760 – 70. 24. Dharmakumar R, Arumana JM, Tang R, Harris K, Zhang Z, Li D. Assessment of regional myocardial oxygenation changes in the presence of coronary artery stenosis with balanced SSFP imaging at 3.0 T: theory and experimental evaluation in canines. J Magn Reson Imag 2008;27:1037 – 45.
IMAGE FOCUS
doi:10.1093/ehjci/jeu131 Online publish-ahead-of-print 4 July 2014
.............................................................................................................................................................................
Multimodality imaging assessment of a rare intracardiac mass: caseous calcification of the mitral valve annulus Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132, USA
* Corresponding author. Tel: +1 801 213 2356; Fax: +1 801 581 7735. E-mail: [email protected]
A 75-year-old man with a poorly defined intracardiac mass on transthoracic echocardiogram was referred for further evaluation by cardiac magnetic resonance (CMR) imaging. CMR cine (Panel A) and dark blood (Panel B) images demonstrated a large, hypointense mass involving a mitral valve (MV) annulus. Perfusion images revealed no enhancement of the mass compared with normal myocardium (Panel C and see Supplementary data online, Video S1), consistent with an avascular mass. Late gadolinium enhancement demonstrated peripheral enhancement surrounding the mass (Panel D), consistent with a fibrous cap. Cine and velocityencoded gradient-echo images showed no significant transmitral gradient with moderate regurgitation (see Supplementary data online, Videos S2 and S3). CMR findings indicated diagnosis of caseous calcification of the MV annulus. Further imaging with non-contrast computed tomography shows nicely the bulky extent of the annular calcification (Panels E –H and see Supplementary data online, Video S2). Caseous calcification of the MV annulus is considered a rare variant of mitral annular calcification with the prevalence of 0.06 –0.07%. In the absence of related symptoms or significant MV dysfunction, surgical intervention is not indicated and the patient can be followed clinically as in our case. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium. P.S. was involved with data and image acquisition and performed the initial review of the literature and manuscript drafting. L.C. was involved in video acquisition and manuscript drafting. C.J.M. and B.W. were involved in manuscript revising and editing. All authors read and approved the final manuscript. Corresponding author had full access to all the data and final responsibility for the decision to submit for publication. 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 14, 2015
Promporn Suksaranjit*, Lowell Chang, Brent Wilson, and Christopher J. McGann
Myocardial oxygenation and coronary stenosis severity
12. Højsgaard S, Halekoh U, Yan J. The R Package geepack for Generalized Estimating Equations. J Stat Soft 2005;15:1 –11. 13. Hastie TJ. Generalized additive models. In: Chambers JM, Hastie TJ (eds). Statistical Models in S. Pacific Grove, CA: Wadsworth & Brooks/Cole; 1992. 14. Friedrich MG, Karamitsos TD. Oxygenation-sensitive cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2013;15:43. 15. 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. 16. Karamitsos TD, Leccisotti L, Arnold JR, Recio-Mayoral A, Bhamra-Ariza P, Howells RK et al. Relationship between regional myocardial oxygenation and perfusion in patients with coronary artery disease: insights from cardiovascular magnetic resonance and positron emission tomography. Circ Cardiovasc Imaging 2010;3: 32 –40. 17. Arnold JR, Karamitsos TD, Bhamra-Ariza P, Francis JM, Searle N, Robson MD et al. Myocardial oxygenation in coronary artery disease: insights from blood oxygen level-dependent magnetic resonance imaging at 3 Tesla. J Am Coll Cardiol 2012;59: 1954– 64. 18. Waksman R, Legutko J, Singh J, Orlando Q, Marso S, Schloss T et al. Intravascular ultrasound relationship study. J Am Coll Cardiol 2013;61:917 – 23. 19. Walcher T, Manzke R, Hombach V, Rottbauer W, Wohrle J, Bernhardt P. Myocardial perfusion reserve assessed by T2-prepared steady-state free precession blood
20.
21.
22.
23.
oxygen level–dependent magnetic resonance imaging in comparison to fractional flow reserve. Circ Cardiovasc Imag 2012;5:280 –286. Picano E, Molinaro S, Pasanisi E. The diagnostic accuracy of pharmacological stress echocardiography for the assessment of coronary artery disease: a meta-analysis. Cardiovasc Ultrasound 2008;6:30. Cosmai EM, Heller GV. The clinical importance of electrocardiographic changes during pharmacologic stress testing with radionuclide myocardial perfusion imaging. J Nucl Cardiol 2005;12:466 –72. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D et al. European Association of Echocardiography. Stress echocardiography expert consensus statement—executive summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur Heart J 2009;30: 278 –89. Granato JE, Watson DD, Belardinelli L, Cannon JM, Beller GA. Effects of dipyridamole and aminophylline on hemodynamics, regional myocardial blood flow and thallium-201 washout in the setting of a critical coronary stenosis. J Am Coll Cardiol
1990;16:1760 – 70. 24. Dharmakumar R, Arumana JM, Tang R, Harris K, Zhang Z, Li D. Assessment of regional myocardial oxygenation changes in the presence of coronary artery stenosis with balanced SSFP imaging at 3.0 T: theory and experimental evaluation in canines. J Magn Reson Imag 2008;27:1037 – 45.
IMAGE FOCUS
doi:10.1093/ehjci/jeu131 Online publish-ahead-of-print 4 July 2014
.............................................................................................................................................................................
Multimodality imaging assessment of a rare intracardiac mass: caseous calcification of the mitral valve annulus Division of Cardiovascular Medicine, Department of Medicine, University of Utah School of Medicine, 30 N 1900 E, Room 4A100, Salt Lake City, UT 84132, USA
* Corresponding author. Tel: +1 801 213 2356; Fax: +1 801 581 7735. E-mail: [email protected]
A 75-year-old man with a poorly defined intracardiac mass on transthoracic echocardiogram was referred for further evaluation by cardiac magnetic resonance (CMR) imaging. CMR cine (Panel A) and dark blood (Panel B) images demonstrated a large, hypointense mass involving a mitral valve (MV) annulus. Perfusion images revealed no enhancement of the mass compared with normal myocardium (Panel C and see Supplementary data online, Video S1), consistent with an avascular mass. Late gadolinium enhancement demonstrated peripheral enhancement surrounding the mass (Panel D), consistent with a fibrous cap. Cine and velocityencoded gradient-echo images showed no significant transmitral gradient with moderate regurgitation (see Supplementary data online, Videos S2 and S3). CMR findings indicated diagnosis of caseous calcification of the MV annulus. Further imaging with non-contrast computed tomography shows nicely the bulky extent of the annular calcification (Panels E –H and see Supplementary data online, Video S2). Caseous calcification of the MV annulus is considered a rare variant of mitral annular calcification with the prevalence of 0.06 –0.07%. In the absence of related symptoms or significant MV dysfunction, surgical intervention is not indicated and the patient can be followed clinically as in our case. LV, left ventricle; RV, right ventricle; LA, left atrium; RA, right atrium. P.S. was involved with data and image acquisition and performed the initial review of the literature and manuscript drafting. L.C. was involved in video acquisition and manuscript drafting. C.J.M. and B.W. were involved in manuscript revising and editing. All authors read and approved the final manuscript. Corresponding author had full access to all the data and final responsibility for the decision to submit for publication. 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 14, 2015
Promporn Suksaranjit*, Lowell Chang, Brent Wilson, and Christopher J. McGann
