Multi-modality imaging of cardiac amyloidosis: Contemporary update

Cardiac amyloidosis is a heterogeneous and challenging diagnostic disease with poor prognosis that is now being altered by introduction of new therapies.Echocardiography remains the first-line imaging tool, and when disease is suspected on echocardiography, cardiac magnetic resonance imaging and nuclear imaging play critical roles in the non-invasive diagnosis and evaluation of cardiac amyloidosis. Advances in multi-modality cardiac imaging allowing earlier diagnosis and initiation of novel therapies have significantly improved the outcomes in these patients. Cardiac imaging also plays important roles in the risk stratification of patients presenting with cardiac amyloidosis. In the current review, we provide a clinical and imaging focused update, and importantly outline the imaging protocols, diagnostic and prognostic utility of multimodality cardiac imaging in the assessment of cardiac amyloidosis.

Tricuspid valve endocarditis:Cardiovascular imaging evaluation and management

Right-sided infective endocarditis is an increasingly recognized disease entity,with tricuspid valve being most frequently involved.Risk factors for tricuspid valve endocarditis(TVIE)include intravenous drug use,cardiac implantable electronic devices and indwelling catheters.Staphylococcus aureus is the predominant causative organism in TVIE.The diagnosis of infective endocarditis(IE)is based on clinical manifestations,blood cultures,and the presence of valvular vegetations detected by echocardiography.Complementary imaging is helpful when there is ongoing clinical suspicion for IE following initially negative echocardiography.Multislice computed tomography allows for assessment of extra-cardiac complications in TVIE,including pulmonary septic emboli.18F-fluorodeoxyglucose positron emission tomography/computed tomography and radiolabelled white blood cell,single-photon emission computed tomography provide important clinical information concerning the presence of IE in right-sided prosthetic valves or cardiac implantable electronic devices.The aim of this review is to provide an update on TVIE,discussing the role of multimodality imaging in TVIE and the management of these patients.

Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis:A contemporary narrative review

Infective endocarditis is one of the leading life-threatening infections around the world.With the exponential growth in the field of transcatheter interventions and advances in specialized surgical techniques,the number of prosthetic valves and cardiac implantable devices has significantly increased.This has led to a steep rise in the number of cases of prosthetic valve endocarditis(PVE)comprising up to 30%of all cases.Clinical guidelines rely on the use of the modified Duke criteria;however,the diagnostic sensitivity of the modified Duke criteria is reduced in the context of PVE.This is in part attributed to prosthesis related artifact which greatly affects the ability of echocardiography to detect early infective changes related to PVE in certain cases.There has been increasing recognition of the roles of complementary imaging modalities and updates in international society recommendations.Prompt diagnosis and treatment can prevent the devastating consequences of this condition.Imaging modalities such as cardiac computed tomography and 18-fluorodeoxyglucose positron emission tomography/computed tomography are diagnostic tools that provide a complementary role to echocardiography in aiding diagnosis,pre-operative planning,and treatment decisionmaking process in these challenging cases.Understanding the strengths and limitations of these adjuvant imaging modalities is crucial for the implementation of appropriate imaging modalities in clinical practice.

Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review

There is increasing evidence on the utility of cardiac computed tomography(CCT)in infective endocarditis(IE)to investigate the valvular pathology,the extracardiac manifestations of IE and pre-operative planning.CCT can assist in the diagnosis of perivalvular complications,such as pseudoaneurysms and abscesses,and can help identify embolic events to the lungs or systemic vasculature.CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum.Finally,hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis.This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.

左室血栓的临床、影像和病理学特征:在经手术或病理确诊病例中比较对比增强MRI、经胸超声心动图和经食管超声心动图

Background: Left ventricular(LV) thrombus is a frequent and potentially dangerous complication of ischemic heart disease(IHD). We evaluated the clinical, imaging, and pathology characteristics of confirmed LV thrombus and compared the diagnostic value of contrast-enhanced magnetic resonance imaging(MRI) with transthoracic(TTE) and transesophageal echocardiography(TEE) for the diagnosis of LV thrombi. Methods: Between November 1997 and December 2003, 361 patients with IHD had surgical and/or pathological confirmation of presence or absence of LV thrombus. Clinical information and preoperative imaging study reports were retrospectively reviewed regarding detection of thrombus. Comparisons were made between clinical and imaging characteristics of patients with and without confirmed thrombus. Results: Left ventricular thrombus was present in 106(29%) of 361 patients in this study. Patients with thrombus had a higher incidence of recent embolic events(6.1%vs 0.8%, P< .005). In 160 patients with all 3 imaging modalities performed within 30 days of surgical or pathological confirmation, contrast-enhanced MRI showed the highest sensitivity and specificity(88%±9%and 99%±2%, respectively) compared with TTE(23%±12%and 96%±3.6%, respectively) and TEE(40%±14%and 96%±3.6%, respectively) for thrombus detection. Conclusions: Left ventricular thrombus occurs frequently in patients with IHD and is associated with risk of systemic embolization. Contrast-enhanced MRI provided the highest sensitivity and specificity for LV thrombus when compared to TTE and TEE, and should be considered in the care of patients at high risk of LV thrombus formation.

静脉内超声造影对无法进行胸廓超声心动图诊断的重症监护病房(ICU)患者的补救

Transthoracic echocardiography (TTE) is often technically difficult on patient s in intensive care units. Contrast echocardiography can improve left ventricula r wall visualization and the assessment of regional and global left ventricular wall motion. Our study undertook to determine what proportion of nondiagnostic T TE studies on patients in intensive care units could be salvaged (i.e., converte d to diagnostic studies) with contrast. Ninety-two patients with nondiagnostic TTEs had a repeat study after contrast. Using predefined criteria, 51%of studie s were salvaged with contrast. Female gender emerged as the only factor associat ed with less likelihood of salvaging a study.