Search

Aims Pulmonary transit time (PTT) is the time blood takes to pass from the right ventricle to the left ventricle via pulmonary circulation. We aimed to quantify PTT in routine cardiovascular magnetic resonance imaging perfusion sequences. PTT may help in the diagnostic assessment and characterization of patients with unclear dyspnoea or heart failure (HF). Methods and results We evaluated routine stress perfusion cardiovascular magnetic resonance scans in 352 patients, including an assessment of PTT. Eighty-six of these patients also had simultaneous quantification of N-terminal pro-brain natriuretic peptide (NTproBNP). NT-proBNP is an established blood biomarker for quantifying ventricular filling pressure in patients with presumed HF. Manually assessed PTT demonstrated low inter-rater variability with a correlation between raters >0.98. PTT was obtained automatically and correctly in 266 patients using artificial intelligence. The median PTT of 182 patients with both left and right ventricular ejection fraction >50% amounted to 6.8 s (Pulmonary transit time: 5.9–7.9 s). PTT was significantly higher in patients with reduced left ventricular ejection fraction (600 ng/L) was 0.70 (P < 0.001) with a specificity of 78% and sensitivity of 61%. Conclusion PTT as an easily, even automatically obtainable and robust non-invasive biomarker of haemodynamics might help in the evaluation of patients with dyspnoea and HF.

Aims To evaluate the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging from a risk-stratification and therapeutic-management perspective in patients with suspected cardiac tumours. Methods and results Cardiovascular magnetic resonance exams of 41 consecutive patients (aged 61 ± 14 years, 21 men) referred for evaluation of a suspected cardiac mass were reviewed for tumour morphology and signal characteristics in various unenhanced and contrast-enhanced sequences. Cardiovascular magnetic resonance-derived diagnosis and treatment were compared with clinical outcome and histology in patients undergoing surgery or autopsy ( n = 20). In 18 of 41 patients, CMR excluded masses or reclassified them as normal variants; all were treated conservatively. In 23 of 41 patients, CMR diagnosed a neoplasm (14 ‘benign’, 8 ‘malignant’, and 1 ’equivocal’); 18 of these patients were operated on, 2 managed conservatively, and 3 by palliation. During follow-up of 705 (inter-quartile range 303–1472) days, 13 patients died. No tumour-related deaths occurred in conservatively managed patients. Patients with a CMR-based diagnosis and treatment of benign tumour had a similar survival as patients without detectable tumour. Compared with histology, CMR correctly classified masses as ‘benign or malignant’ in 95% of the cases. Tumour perfusion, invasiveness, localization, and pericardial fluid were valuable to distinguish between malignant and benign tumours. Soft tissue contrast and signal intensity patterns in various sequences were valuable for excluding neoplastic lesions and helped to obtain tissue characterization at the histological level in selected tumour cases, respectively. Conclusion Comprehensive CMR provides a confident risk-stratification and clinical-management tool in patients with suspected tumours. Patients where CMR excludes tumours can be managed conservatively.

Figure 1: A CT scan 2 years (A) and 14 years (B) after the initial aortic repair. It shows the enlarged prosthesis diameter of 42 mm (black dotted arrows), which has remained stable over time. Compared with the original dimension, the cross-sectional area of the prosthesis increased by 96%, and the prosthesis wall tension by 40%. Figure 2: Reconstructed three-dimensional angiography demonstrating the enlarged aortic prosthesis compared with the aortic root and the proximal aortic arch. White arrows mark the proximal and distal anastomosis site.

A 32-year-old man with a history of hypertension and no prior coronary heart disease was referred to our hospital with suspected acute coronary syndrome. He suffered from chest pain during his work. Except an upper respiratory tract infection, his personal history was unremarkable. The initial electrocardiogram (ECG) demonstrated ST-elevation in lead V2. The first Troponin T …