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Role of Cardiac MRI Imaging of Focal and Diffuse Inflammation and Fibrosis in Cardiomyopathy Patients Who Have Pacemakers/ICD Devices

  • Myocardial Disease (A Abbate and M Merlo, Section Editors)
  • Published:
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Abstract

Purpose of Review

This focused report aims to discuss and summarize the use of conventional and emerging methods using cardiovascular magnetic resonance (CMR) imaging in cardiomyopathy patients with implanted cardiac devices to identify diffuse and focal inflammation and fibrosis.

Recent Findings

Many cardiomyopathy patients with diffuse and focal myocardial fibrosis have a unique need for cardiac imaging that is complicated by cardiovascular implantable electronic devices (CIEDs). CMR imaging can accurately image myocardial fibrosis and inflammation using T1 mapping and late gadolinium enhancement (LGE) imaging. CMR imaging in CIED patients, however, has been limited due to severe imaging artifacts associated with the devices. The emergence of wideband imaging variants of LGE and T1 mapping techniques can successfully reduce or eliminate CIED artifacts for the evaluation of myocardial substrate in cardiomyopathy patients.

Summary

Wideband imaging variants of LGE and T1 mapping techniques provide new tools for imaging focal and diffuse fibrosis and imaging in cardiomyopathy patients with implanted cardiac devices. These emerging techniques have the potential for great impact in clinical care of such patients as well as clinical research where imaging endpoints are desired.

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Abbreviations

CIED:

Cardiovascular implantable electronic device

CMR:

Cardiovascular magnetic resonance

CVF:

Collagen volume fraction

FLASH:

Fast, low-angle shot

ICD:

Implantable cardioverter defibrillator

LGE:

Late gadolinium enhancement

MOCO:

Motion corrected

MOLLI:

Modified Look-Locker inversion recovery

MRI:

Magnetic resonance imaging

MT:

Magnetization transfer

PM:

Pacemaker

PSIR:

Phase sensitive inversion recovery

SAPPHIRE:

Saturation-pulse prepared heart-rate independent inversion recovery

SAR:

Specific absorption rate

SASHA:

Saturation recovery single-shot acquisition

shMOLLI:

Shortened modified Look-Locker inversion recovery

SR:

Saturation recovery

SSFP:

Steady-state free precession

TI:

Inversion time

WB LGE:

Wideband late gadolinium enhancement

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Funding

This work is supported by an American Heart Association Collaborative Sciences Award 19CSL0134580004, and funding from the VCU Pauley Heart Center and the VCU Wright Center for Clinical & Translation Research (CCTR) Clinical and Translational Science Award (CTSA) UL1TR002649.

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  1. Ananna Zaman and Samantha Zhao share first authorship with equal contributions.

Authors and Affiliations

  1. Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA

    Ananna Zaman, Samantha Zhao & Jennifer H. Jordan

  2. Department of Internal Medicine, Pauley Heart Center, Virginia Commonwealth University, West Hospital, 8th Floor, 1200 E. Broad Street, Richmond, VA, 23298, USA

    Jordana Kron, Antonio Abbate, Anna Tomdio, W. Gregory Hundley & Jennifer H. Jordan

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Zaman, A., Zhao, S., Kron, J. et al. Role of Cardiac MRI Imaging of Focal and Diffuse Inflammation and Fibrosis in Cardiomyopathy Patients Who Have Pacemakers/ICD Devices. Curr Cardiol Rep 24, 1529–1536 (2022). https://doi.org/10.1007/s11886-022-01770-w

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