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AbstractObjectiveWe sought to evaluate the risk and image quality from cardiovascular CT in patients across all stages of single-ventricle palliation, and to define accuracy by comparing findings with intervention and surgery.MethodsConsecutive CT scans performed in patients with single-ventricle heart disease were retrospectively reviewed at a single institution. Diagnosis, sedation needs, estimated radiation dose, and adverse events were recorded. Anatomical findings, image quality (1–4, 1=optimal), and discrepancy compared with interventional findings were determined. Results are described as medians with their 25th and 75th percentiles.ResultsFrom January, 2010 to August, 2015, 132 CT scans were performed in single-ventricle patients of whom 20 were neonates, 52 were post-Norwood, 15 were post-Glenn, and 45 were post-Fontan. No sedation was used in 76 patients, 47 were under minimal or moderate sedation, and nine were under general anaesthesia. The median image quality score was 1.2. The procedural dose–length product was 24 mGy-cm, and unadjusted and adjusted radiation doses were 0.34 (0.2, 1.8) and 0.82 (0.55, 1.88) mSv, respectively. There was one adverse event. No major and two minor discrepancies were noted at the time of 79 surgical and 10 catheter-based interventions.ConclusionsCardiovascular CT can be performed with a low radiation exposure in patients with single-ventricle heart disease. Its accuracy compared with that of interventional findings is excellent. CT is an effective advanced imaging modality when a non-invasive pathway is desired, particularly if cardiac MRI poses a high risk or is contraindicated.

Patients with presumed ST-elevation myocardial infarction (STEMI) have no clear culprit artery in approximately 10–15 of cases. We examined the value of cardiac magnetic resonance (CMR) for diagnosis in patients with “no culprit” STEMI. Data from a comprehensive prospective registry of STEMI patients were reviewed from March 2003 to December 2009. “No culprit” patients were followed for diagnosis and clinical outcome. CMR was performed at the discretion of the attending cardiologist. Of 2728 consecutive presumed STEMI patients, 412 (15) had no clear culprit artery. Of these, 202 (49) had abnormal cardiac biomarkers with a definitive diagnosis in 157 (78). Diagnoses in this group included myocardial infarction without a culprit lesion (24), myopericarditis (22), and stress cardiomyopathy (21). In 210 (51) patients with normal biomarkers, only 84 (40) received a definitive diagnosis. Diagnoses in this group included myopericarditis (27), noncardiac causes (21), and cardiomyopathy (14). CMR was performed in 123 (30) “no culprit” patients. Patients who had CMR were more likely to have a definitive diagnosis than those who did not (95123 77 vs. 144289 50; P= 0.01). In particular, “no culprit” patients with abnormal biomarkers were more likely to have a definitive diagnosis with CMR. CMR led to a diagnosis different from the presumptive clinical diagnosis in 53 of all cases. CMR is a valuable diagnostic tool to improve diagnostic accuracy in patients with “no culprit” STEMI.

In hypertrophic cardiomyopathy (HCM), cardiovascular MR can detect morphological abnormalities of the left ventricle (LV) not visualized with echocardiography. Although myocardial crypts (ie, narrow, blood-filled invaginations within the LV wall) have been recognized in HCM, all clinical implications of these structural abnormalities within the broad clinical HCM spectrum are not completely resolved. Therefore, we sought to characterize the prevalence and diagnostic significance of myocardial crypts in HCM patients.

In hypertrophic cardiomyopathy (HCM), the arrhythmic potential associated with a variety of left ventricular myocardial signal intensities evident on contrast-enhanced cardiovascular magnetic resonance with late gadolinium enhancement (LGE) is unresolved.

Myocardial angiogenesis occurs in response to hypoxia in ischemic tissues. This Review discusses imaging techniques that can be used to assess the effectiveness of exogenous angiogenic agents in promoting the growth of collateral vessels in ischemic myocardium.

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Supplemental Digital Content is available in the text.

Supplemental Digital Content is available in the text.