Epicardial adipose tissue in obesity with heart failure with preserved ejection fraction: Cardiovascular magnetic resonance biomarker study

BACKGROUND Obesity has become a serious public health issue,significantly elevating the risk of various complications.It is a well-established contributor to Heart failure with preserved ejection fraction(HFpEF).Evaluating HFpEF in obesity is crucial.Epicardial adipose tissue(EAT)has emerged as a valuable tool for validating prognostic biomarkers and guiding treatment targets.Hence,assessing EAT is of paramount importance.Cardiovascular magnetic resonance(CMR)imaging is acknowledged as the gold standard for analyzing cardiac function and mor-phology.We hope to use CMR to assess EAT as a bioimaging marker to evaluate HFpEF in obese patients.AIM To assess the diagnostic utility of CMR for evaluating heart failure with preserved ejection fraction[HFpEF;left ventricular(LV)ejection fraction≥50%]by measuring the epicardial adipose tissue(EAT)volumes and EAT mass in obese patients.METHODS Sixty-two obese patients were divided into two groups for a case-control study based on whether or not they had heart failure with HFpEF.The two groups were defined as HFpEF+and HFpEF-.LV geometry,global systolic function,EAT volumes and EAT mass of all subjects were obtained using cine magnetic resonance sequences.RESULTS Forty-five patients of HFpEF-group and seventeen patients of HFpEF+group were included.LV mass index(g/m2)of HFpEF+group was higher than HFpEF-group(P<0.05).In HFpEF+group,EAT volumes,EAT volume index,EAT mass,EAT mass index and the ratio of EAT/[left atrial(LA)left-right(LR)diameter]were higher compared to HFpEF-group(P<0.05).In multivariate analysis,Higher EAT/LA LR diameter ratio was associated with higher odds ratio of HFpEF.CONCLUSION EAT/LA LR diameter ratio is highly associated with HFpEF in obese patients.It is plausible that there may be utility in CMR for assessing obese patients for HFpEF using EAT/LA LR diameter ratio as a diagnostic biomarker.Further prospective studies,are needed to validate these proof-of-concept findings.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction

Objective To investigate the impact of microvascular obstruction(MVO)on the global and regional myocardial function by cardiac magnetic resonance feature-tracking(CMR-FT)in ST-segment-elevation myocardial infarction(STEMI)patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1-7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study.Based on the presence or absence of MVO on late gadolinium enhancement images,patients were divided into groups with MVO and without MVO.The infarct zone,adjacent zone,and remote zone were determined based on a myocardial 16-segment model.The radial strain(RS),circumferential strain(CS),and longitudinal strain(LS)of the global left ventricle(LV)and the infarct,adjacent,and remote zones were measured by CMRFT from cine images and compared between patients with and without MVO using independent-samples t-test.Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients(mean age 56.66±11.38 years)were enrolled.MVO was detected in 37.58%(59/157)of STEMI patients,and the mean size of MVO was 3.00±3.76 mL.Compared with patients without MVO(n=98),the MVO group had significantly reduced LV global RS(t=-4.30,P<0.001),global CS(t=4.99,P<0.001),and global LS(t=3.51,P=0.001).The RS and CS of the infarct zone in patients with MVO were significantly reduced(t=-3.38,P=0.001;t=2.64,P=0.01;respectively)and the infarct size was significantly larger(t=8.37,P<0.001)than that of patients without MVO.The presence of LV MVO[OR=4.10,95%CI:2.05-8.19,P<0.001]and its size[OR=1.38,95%CI:1.10-1.72,P=0.01],along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis,while only heart rate(OR=1.08,95%CI:1.03-1.13,P=0.001)and LV infarct size(OR=1.10,95%CI:1.03-1.16,P=0.003)were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO,and MVO deteriorates the global and regional LV myocardial function.

Value of cardiac magnetic resonance on the risk stratification of cardiomyopathies

Cardiomyopathies represent a diverse group of heart muscle diseases with varying etiologies,presenting a diagnostic challenge due to their heterogeneous manifestations.Regular evaluation using cardiac imaging techniques is impera-tive as symptoms can evolve over time.These imaging approaches are pivotal for accurate diagnosis,treatment planning,and optimizing prognostic outcomes.Among these,cardiovascular magnetic resonance(CMR)stands out for its ability to provide precise anatomical and functional assessments.This manuscript ex-plores the significant contributions of CMR in the diagnosis and management of patients with cardiomyopathies,with special attention to risk stratification.CMR’s high spatial resolution and tissue characterization capabilities enable early detec-tion and differentiation of various cardiomyopathy subtypes.Additionally,it offers valuable insights into myocardial fibrosis,tissue viability,and left ven-tricular function,crucial parameters for risk stratification and predicting adverse cardiac events.By integrating CMR into clinical practice,clinicians can tailor patient-specific treatment plans,implement timely interventions,and optimize long-term prognosis.The non-invasive nature of CMR reduces the need for invasive procedures,minimizing patient discomfort.This review highlights the vital role of CMR in monitoring disease progression,guiding treatment decisions,and identifying potential complications in patients with cardiomyopathies.The utilization of CMR has significantly advanced our understanding and management of these complex cardiac conditions,leading to improved patient outcomes and a more personalized approach to care.

Real-time cardiovascular magnetic resonance-guided radiofrequency ablation:A comprehensive review

Cardiac magnetic resonance(CMR)imaging could enable major advantages when guiding in real-time cardiac electrophysiology procedures offering high-resolu-tion anatomy,arrhythmia substrate,and ablation lesion visualization in the absence of ionizing radiation.Over the last decade,technologies and platforms for performing electrophysiology procedures in a CMR environment have been developed.However,performing procedures outside the conventional fluoro-scopic laboratory posed technical,practical and safety concerns.The development of magnetic resonance imaging compatible ablation systems,the recording of high-quality electrograms despite significant electromagnetic interference and reliable methods for catheter visualization and lesion assessment are the main limiting factors.The first human reports,in order to establish a procedural workflow,have rationally focused on the relatively simple typical atrial flutter ablation and have shown that CMR-guided cavotricuspid isthmus ablation represents a valid alternative to conventional ablation.Potential expansion to other more complex arrhythmias,especially ventricular tachycardia and atrial fibrillation,would be of essential impact,taking into consideration the widespread use of substrate-based strategies.Importantly,all limitations need to be solved before application of CMR-guided ablation in a broad clinical setting.

Cardiac magnetic resonance in clinical cardiology

Over the last decades, cardiac magnetic resonance(CMR) has transformed from a research tool to a widely used diagnostic method in clinical cardiology. This method can now make useful, unique contributions to the work-up of patients with ischemic and non-ischemic heart disease. Advantages of CMR, compared to other imaging methods, include very high resolution imaging with a spatial resolution up to 0.5 mm × 0.5 mm in plane, a large array of different imaging sequences to provide in vivo tissue characterization, and radiationfree imaging. The present manuscript highlights the relevance of CMR in the current clinical practice and new perspectives in cardiology.

Clinical applications of feature-tracking cardiac magnetic resonance imaging

Cardiovascular diseases represent the leading cause of mortality and morbidity in the western world. Assessment of cardiac function is pivotal for early diag-nosis of primitive myocardial disorders, identification of cardiac involvement in systemic diseases, detection of drug-related cardiac toxicity as well as risk stratification and monitor of treatment effects in patients with heart failure of various etiology. Determination of ejection fraction with different imaging modalities currently represents the gold standard for evaluation of cardiac function. However, in the last few years, cardiovascular magnetic resonance feature tracking techniques has emerged as a more accurate tool for quantitative evalu-ation of cardiovascular function with several parameters including strain, strain-rate, torsion and mechanical dispersion. This imaging modality allows precise quantification of ventricular and atrial mechanics by directly evaluating myocardial fiber deformation. The purpose of this article is to review the basic principles, current clinical applications and future perspectives of cardiovascular magnetic resonance myocardial feature tracking, highlighting its prognostic implications.

Investigation of cardiomyopathy using cardiac magnetic resonance imaging part 1:Common phenotypes

Cardiac magnetic resonance imaging(CMRI) has emerged as a useful tertiary imaging tool in the investigation of patients suspected of many different types of cardiomyopathies,CMRI sequences are now of a sufficiently robust quality to enable high spatial and temporal resolution image acquisition.This has led to CMRI becoming an effective non-invasive imaging gold standard for many cardiomyopathies.In this 2-part review,we outline the typical sequences used to image cardiomyopathy,and present the imaging spectrum of cardiomyopathy.Part 1 focuses on the current classification of cardiomyopathy,basic CMRI sequences used in evaluating cardiomyopathy and the imaging spectrum of common phenotypes.

Optimized cardiac magnetic resonance imaging inversion recovery sequence for metal artifact reduction and accurate myocardial scar assessment in patients with cardiac implantable electronic devices

Late gadolinium enhancement(LGE) cardiovascular magnetic resonance(CMR) is the gold standard for imaging myocardial viability.An important application of LGE CMR is the assessment of the location and extent of the myocardial scar in patients with ventricular tachycardia(VT), which allows for more accurate identification of the ablation targets.However, a large percentage of patients with VT have cardiac implantable electronic devices(CIEDs), which is a relative contraindication for cardiac magnetic resonance imaging due to safety and image artifact concerns.Previous studies showed that these patients can be safely scanned on 1.5 T scanners provided that an adequate imaging protocol is adopted.Nevertheless, imaging patients with a CIED result in metal artifacts due to the strong frequency off-resonance effects near the device; therefore, the spins in the surrounding myocardium are not completely inverted, and thus give rise to hyperintensity artifacts.These artifacts obscure the myocardial scar tissue and limit the ability to study the correlation between the myocardial scar structure and the electro-anatomical map during catheter ablation.In this study, we developed a modified inversion recovery technique to alleviate the CIED-induced metal artifacts and improve the diagnostic image quality of LGE images in patients with CIEDs without increasing scan time or requiring additional hardware.The developed technique was tested in phantom experiments and in vivo scans, which showed its capability for suppressing the hyperintensity artifacts without compromising myocardium nulling in the resulting LGE images.

Cardiac functional magnetic resonance imaging at 7T:Image quality optimization and ultra-high field capabilities

BACKGROUND 7T cardiac magnetic resonance imaging(MRI)introduces several advantages,as well as some limitations,compared to lower-field imaging.The capabilities of ultra-high field(UHF)MRI have not been fully exploited in cardiac functional imaging.AIM To optimize 7T cardiac MRI functional imaging without the need for conducting B1 shimming or subject-specific tuning,which improves scan efficiency.In this study,we provide results from phantom and in vivo scans using a multi-channel transceiver modular coil.METHODS We investigated the effects of adding a dielectric pad at different locations next to the imaged region of interest on improving image quality in subjects with different body habitus.We also investigated the effects of adjusting the imaging flip angle in cine and tagging sequences on improving image quality,B1 field homogeneity,signal-to-noise ratio(SNR),blood-myocardium contrast-to-noise ratio(CNR),and tagging persistence throughout the cardiac cycle.RESULTS The results showed the capability of achieving improved image quality with high spatial resolution(0.75 mm×0.75 mm×2 mm),high temporal resolution(20 ms),and increased tagging persistence(for up to 1200 ms cardiac cycle duration)at 7T cardiac MRI after adjusting scan set-up and imaging parameters.Adjusting the imaging flip angle was essential for achieving optimal SNR and myocardium-toblood CNR.Placing a dielectric pad at the anterior left position of the chest resulted in improved B1 homogeneity compared to other positions,especially in subjects with small chest size.CONCLUSION Improved regional and global cardiac functional imaging can be achieved at 7T MRI through simple scan set-up adjustment and imaging parameter optimization,which would allow for more streamlined and efficient UHF cardiac MRI.

Cardiac magnetic resonance imaging:Which information is useful for the arrhythmologist?

Cardiac magnetic resonance(CMR) is a non-invasive,nonionizing,diagnostic technique that uses magnetic fields,radio waves and field gradients to generate images with high spatial and temporal resolution.After administration of contrast media(e.g.,gadolinium chelate),it is also possible to acquire late images,which make possible the identification and quantification of myocardial areas with scar/fibrosis(late gadolinium enhancement,LGE).CMR is currently a useful instrument in clinical cardiovascular practice for the assessment of several pathological conditions,including ischemic and nonischemic cardiomyopathies and congenital heart disease.In recent years,its field of application has also extended to arrhythmology,both in diagnostic and prognostic evaluation of arrhythmic risk and in therapeutic decisionmaking.In this review,we discuss the possible useful applications of CMR for the arrhythmologist.It is possible to identify three main fields of application of CMR in this context:(1) arrhythmic and sudden cardiac death risk stratification in different heart diseases;(2) decisionmaking in cardiac resynchronization therapy device implantation,presence and extent of myocardial fibrosis for left ventricular lead placement and cardiac venous anatomy; and(3) substrate identification for guiding ablation of complex arrhythmias(atrial fibrillation and ventricular tachycardias).

The Role of Clinical Cardiac Magnetic Resonance Imaging in China:Current Status and the Future

Cardiac magnetic resonance(CMR)imaging plays an important role in the diagnosis and management of cardiovascular diseases.The state-of-the-art CMR imaging has many advantages in cardiac imaging,including excellent spatial and temporal resolution,unrestricted imaging fi eld,no exposure to ionizing radiation,excellent tissue contrast,and unique myocardial tissue characterization.Clinical CMR imaging is used during the cardiovascular diagnostic workup in the United States and some European countries.Use of CMR imaging is emerging in hospitals in China and has a promising future.This review briefl y describes the real-world clinical application of CMR imaging in China and discuss obstacles for its future development.

Depression and myocardial injury in ST-segment elevation myocardial infarction:A cardiac magnetic resonance imaging study

BACKGROUND Depression is common in patients with myocardial infarction and has been independently associated with adverse outcomes.However,the association between depression and myocardial injury on cardiac magnetic resonance(CMR)in patients with ST-segment elevation myocardial infarction(STEMI)has still not been assessed.AIM To assess the association between depression and myocardial injury on CMR in patients with STEMI.METHODS A total of 107 STEMI patients undergoing primary percutaneous coronary intervention(P-PCI)were analyzed in this prospectivecohort study.Each subject completed the Patient Health Questionnaire-9(PHQ-9)to assess the presence and severity of depressive symptoms.CMR was performed at a median of 3 d after PPCI for quantifying post-MI myocardial injury.Correlations between depression identified by the PHQ-9 and myocardial injury measured on CMR were assessed.RESULTS In this study,19 patients(17.8%)were diagnosed with major depression identified by the PHQ-9≥10.PHQ-9 was analyzed both as a continuous variable and dichotomous variable.After multivariable adjustment,the proportion of patients with large infarction size was significantly higher in the major depression group(PHQ-9≥10)(OR:4.840,95%CI:1.122–20.868,P=0.034).When the PHQ-9 was evaluated as a continuous variable,after multivariable adjustment,an increased PHQ-9 score was associated with an increased risk of large infarction size(OR:1.226,95%CI:1.073–1.401,P=0.003).CONCLUSION In patients with STEMI undergoing PCI,depression was independently associated with a large infarction size.

Role of cardiac magnetic resonance imaging in the diagnosis and management of COVID-19 related myocarditis: Clinical and imaging considerations

There is a growing evidence of cardiovascular complications in coronavirusdisease 2019 (COVID-19) patients. As evidence accumulated of COVID-19 mediatedinflammatory effects on the myocardium, substantial attention has beendirected towards cardiovascular imaging modalities that facilitate this diagnosis.Cardiac magnetic resonance imaging (CMRI) is the gold standard for thedetection of structural and functional myocardial alterations and its role inidentifying patients with COVID-19 mediated cardiac injury is growing. Despiteits utility in the diagnosis of myocardial injury in this population, CMRI’s impacton patient management is still evolving. This review provides a framework for theuse of CMRI in diagnosis and management of COVID-19 patients from theperspective of a cardiologist. We review the role of CMRI in the management ofboth the acutely and remotely COVID-19 infected patient. We discuss patientselection for this imaging modality;T1, T2, and late gadolinium enhancementimaging techniques;and previously described CMRI findings in other cardiomyopathieswith potential implications in COVID-19 recovered patients.

Cardiac Amyloidosis: The Role of Magnetic Resonance Imaging

Amyloidosis, an infiltrative disease characterized by deposition of high molecular weight insoluble protein has a low detection rate and poor prognosis with congestive heart failure being the most common cause of death. Although definitive diagnosis is based on endomyocardial biopsy, this is rarely performed due to procedural risk and sampling error. Traditional non-invasive imaging, such as transthoracic echocardiography (TTE) and electrocardiogram (ECG) lacks sensitivity detecting the disease in its early stages. This case report demonstrates the utility of cardiac Magnetic Resonance Imaging in addition to traditional imaging modalities in this often clinically challenging problem.

Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction

Objective To quantitatively evaluate the associations of infarct size,regional myocardial function examined by cardiac magnetic resonance feature tracking(CMR-FT)strain analysis with infarct location in patients with ST-segment elevation myocardial infarction(STEMI)treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion.The patients were divided into the anterior wall myocardial infarction(AWMI)and nonanterior wall myocardial infarction(NAWMI)groups.Infarct characteristics were assessed by late gadolinium enhancement.Global and regional strains and associated strain rates in the radial,circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images.The associations of infarct size,regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod.Results There were 44 patients in the AWMI group and 51 in the NAWMI group.The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group(24.47±11.89,21.06±12.08%LV;t=3.928,P=0.008).In infarct zone analysis,strains in the radial,circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group(z=-20.873,-20.918,-10.357,all P<0.001).The volume(end-systolic volume index),total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group(all P<0.001).Conclusion In STEMI patients treated by percutaneous coronary intervention,myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

Effects of Weight Loss on Pericardial Fat and Left Ventricular Mass Assessed with Cardiac Magnetic Resonance Imaging in Morbid Obesity

Background: Obesity is a risk factor for cardiovascular disease and mortality. Significant weight loss has beneficial effects on left ventricular structure, in particular on regression of left ventricular hypertrophy (LVH). We therefore evaluated the consequences of significant weight loss on left ventricular morphology, hemodynamics and pericardial fat. Methods: We performed volumetric cardiac magnetic resonance (CMR) imaging before and after significant weight loss due to laparoscopic adjustable gastric banding (LAGB). CMR was used to measure cardiac mass, volume and function, as well as to quantify pericardial fat. Results: Eleven patients (age 40.5 ± 10 yrs, body mass index 42.5 ± 3.9 kg/m2) underwent CMR imaging before and a median 15.4 months after gastric banding. The BMI declined by 9.3 ± 3.3 kg/m2 (p Discussion: Significant weight loss in obesity is accompanied by a marked regression of LVH, with no apparent change in cardiac volume or function. The local effect of a diminished amount of pericardiac fat tissue may be more important than absolute weight loss with respect to the regression of LVH in obesity.

Evolutionary GAN–Based Data Augmentation for Cardiac Magnetic Resonance Image

Generative adversarial networks(GANs)have considerable potential to alleviate challenges linked to data scarcity.Recent research has demonstrated the good performance of this method for data augmentation because GANs synthesize semantically meaningful data from standard signal distribution.The goal of this study was to solve the overfitting problem that is caused by the training process of convolution networks with a small dataset.In this context,we propose a data augmentation method based on an evolutionary generative adversarial network for cardiac magnetic resonance images to extend the training data.In our structure of the evolutionary GAN,the most optimal generator is chosen that considers the quality and diversity of generated images simultaneously from many generator mutations.Also,to expand the distribution of the whole training set,we combine the linear interpolation of eigenvectors to synthesize new training samples and synthesize related linear interpolation labels.This approach makes the discrete sample space become continuous and improves the smoothness between domains.The visual quality of the augmented cardiac magnetic resonance images is improved by our proposed method as shown by the data-augmented experiments.In addition,the effectiveness of our proposed method is verified by the classification experiments.The influence of the proportion of synthesized samples on the classification results of cardiac magnetic resonance images is also explored.

Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings

BACKGROUND Cardiac magnetic resonance(CMR)is a unique tool for non-invasive tissue characterization,especially for identifying fibrosis.AIM To present the existing data regarding the association of electrocardiographic(ECG)markers with myocardial fibrosis identified by CMR-late gadolinium enhancement(LGE).METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February 2021.In addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://www.referencecitationanalysis.com).RESULTS A total of 32 studies were included.In hypertrophic cardiomyopathy(HCM),fragmented QRS(fQRS)is related to the presence and extent of myocardial fibrosis.fQRS and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients,while fQRS has also been related to fibrosis in myocarditis.Selvester score,abnormal Q waves,and notched QRS have also been associated with LGE.Repolarization abnormalities as reflected by increased Tp-Te,negative Twaves,and higher QT dispersion are related to myocardial fibrosis in HCM patients.In patients with Duchenne muscular dystrophy,a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was observed.In atrial fibrillation patients,advanced inter-atrial block is defined as P-wave duration≥120 ms,and biphasic morphology in inferior leads is related to left atrial fibrosis.CONCLUSION Myocardial fibrosis,a reliable marker of prognosis in a broad spectrum of cardiovascular diseases,can be easily understood with an easily applicable ECG.However,more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.

Correlation between myocardial infarction activity assessed by cardiac magnetic resonance imaging and the evolution of cardiac function after PCI

Objective:To investigate the correlation of cardiac magnetic resonance imaging(MRI)in the assessment of myocardial activity in patients with myocardial infarction and the outcome of cardiac function after PCI.Methods:30 patients with myocardial infarction(MI)who had complete clinical and imaging data from July 2016 to December 2018 after PCI were analyzed retrospectively.MR and echocardiogram were performed before and 6 months after PCI,and the parameters related to left ventricular function were measured by post-processing software of MRI workstation.The left ventricular transmural degree of CMR late gadolinium enhancement was compared with the left ventricular wall motion degree of 6-month echocardiography as a standard to judge the viable myocardium.Result:There were 193 left ventricular segmental abnormalities in 30 cases,including 121 viable myocardium and 72 non viable myocardium in CMR-LGE before operation.Six months after PCI,echocardiography showed that 125 of 193 abnormal segments of left ventricle detected by CMR-LGE before PCI were viable myocardium and 68 were non viable myocaridium.The sensitivity and specificity of CMR-LGE to determinate of viable myocardium were 92.0%and 91.1%respectively.The larger the non-viable myocardial area of the left ventricular wall,the worse the recovery of wall motion ability,and there was a negative correlation between them(r=0.416,P<0.05).The first-pass perfusion time in CMR-LEG region was significantly longer than that in normal myocardial region(4.85(+)1.51)s and(3.79(+)1.73)s,respectively.The difference was statistically significant(t=5.191,P<0.05).Conclusion:MRI can evaluate the myocardial activity of myocardial infarction,reflect the range of viable myocardium,and provide imaging basis for clinical treatment and prognosis.

Cardiac involvement in hydrocarbon inhalant toxicity--role of cardiac magnetic resonance imaging:A case report

BACKGROUND We report a patient who was diagnosed with toxic myopericarditis secondary to hydrocarbon abuse using cardiac magnetic resonance imaging(CMR).CASE SUMMARY A 25-year-old male presented to emergency department with chest pain for 3 d.Patient also reported sniffing hydrocarbon containing inhalant for the last 1 year.Labs showed elevated troponin and electrocardiography was suggestive of acute pericarditis.Echocardiogram showed left ventricular(LV)ejection fraction(EF)of 40%.Given patient’s troponin elevation and reduced EF,cardiac catheterization was performed which showed normal coronaries.CMR was performed for myocardial infarction with non-obstructive coronary arteries evaluation.CMR showed borderline LV function with edema in mid and apical LV suggestive of myocarditis.CONCLUSION CMR can be used to diagnose toxic myopericarditis secondary to hydrocarbon abuse.