Fused Whole-Heart Coronary and Myocardial Scar Imaging Using 3-T CMR: Implications for Planning of Cardiac Resynchronization Therapy and Coronary Revascularization

Authors

James A. White, Robarts Research Institute, The University of Western Ontario
Nowell Fine, The University of Western Ontario
Lorne J. Gula, The University of Western Ontario
Raymond Yee, The University of Western Ontario
Mohammed Al-Admawi, The University of Western Ontario
Qi Zhang, Robarts Research Institute, The University of Western Ontario
Andrew Krahn, The University of Western Ontario
Allan Skanes, The University of Western Ontario
Anna MacDonald, The University of Western Ontario
Terry Peters, Robarts Research Institute, The University of Western OntarioFollow
Maria Drangova, Robarts Research Institute, The University of Western Ontario

Document Type

Article

Publication Date

9-2010

Journal

Journal of the American College of Cardiology: Cardiovascular Imaging

Volume

3

Issue

9

First Page

921

Last Page

930

URL with Digital Object Identifier

http://dx.doi.org/10.1016/j.jcmg.2010.05.014

Abstract

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.

Notes

Dr. James White talks about this study in the news article, Cardiac imaging breakthrough developed at Robarts.
There are also two videos that show the 3-D image of the heart and scar tissue created using a new 3-T MRI imaging technique.