Skip to main content
SpringerLink
Log in

Towards risk stratification in systemic atherosclerosis: value of myocardial function and viability imaging as an adjunct to MR angiography

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To longitudinally assess the value of cardiac functional and viability imaging as a supplement to MR angiography in patients with atherosclerotic disease.

Methods

Cardiac MRI was performed in 195 consecutive patients with symptomatic peripheral arterial disease. Of these, 186 patients were followed for 22 ± 5 months for the presence of cardiac events (cardiac death, acute coronary syndrome and hospitalisation as a result of congestive heart failure).

Results

Myocardial viability imaging showed a high prevalence of known (n = 31) and occult myocardial infarctions (MI) (n = 26). Cardiac events occurred more often in patients with reduced ventricular function (ejection fraction (EF) less than 40%, cardiac event in 4/8 patients; EF 40–55%, cardiac event in 10/40 patients; EF greater than 55%, cardiac event in 15/138 patients) as well as in patients with occult MI (8/25 patients) and known MI (11/30 patients). In patients with normal function, the detection of a previous MI was of high relevance to prognosis.

Conclusions

Both reduced EF and the presence of MI influence patients’ prognoses. Performing cardiac MRI in this patient population may influence further patient management including intensified risk factor intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Ross R (1999) Atherosclerosis—an inflammatory disease. N Engl J Med 340:115–126

    Article  CAS  PubMed  Google Scholar 

  2. Leng GC, Lee AJ, Fowkes FG et al (1996) Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol 25:1172–1181

    Article  CAS  PubMed  Google Scholar 

  3. Kioka Y, Tanabe A, Kotani Y et al (2002) Review of coronary artery disease in patients with infrarenal abdominal aortic aneurysm. Circ J 66:1110–1112

    Article  PubMed  Google Scholar 

  4. Seeger A, Grimm F, Fenchel M et al (2008) Cardiac MRI in addition to MR angiography: a longitudinal study in vascular risk patients. Rofo 180:423–429

    CAS  PubMed  Google Scholar 

  5. White HD, Norris RM, Brown MA et al (1987) Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction. Circulation 76:44–51

    CAS  PubMed  Google Scholar 

  6. Ross DL, Davis KB, Pettinger MB et al (1987) Features of cardiac arrest episodes with and without acute myocardial infarction in the Coronary Artery Surgery Study (CASS). Am J Cardiol 60:1219–1224

    Article  CAS  PubMed  Google Scholar 

  7. Kannel WB, Cupples LA, Gagnon DR (1990) Incidence, precursors and prognosis of unrecognized myocardial infarction. Adv Cardiol 37:202–214

    CAS  PubMed  Google Scholar 

  8. Kwong RY, Chan AK, Brown KA et al (2006) Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113:2733–2743

    Article  PubMed  Google Scholar 

  9. Kannel WB, Abbott RD (1984) Incidence and prognosis of unrecognized myocardial infarction. An update on the Framingham study. N Engl J Med 311:1144–1147

    CAS  PubMed  Google Scholar 

  10. Cox CJ (1967) Return to normal of the electrocardiogram after myocardial infarction. Lancet 1:1194–1197

    CAS  PubMed  Google Scholar 

  11. Prince MR (1998) Contrast-enhanced MR angiography: theory and optimization. Magn Reson Imaging Clin N Am 6:257–267

    CAS  PubMed  Google Scholar 

  12. Fenchel M, Scheule AM, Stauder NI et al (2006) Atherosclerotic disease: whole-body cardiovascular imaging with MR system with 32 receiver channels and total-body surface coil technology—initial clinical results. Radiology 238:280–291

    Article  PubMed  Google Scholar 

  13. Miller S, Simonetti OP, Carr J et al (2002) MR Imaging of the heart with cine true fast imaging with steady-state precession: influence of spatial and temporal resolutions on left ventricular functional parameters. Radiology 223:263–269

    Article  PubMed  Google Scholar 

  14. Dulce MC, Mostbeck GH, Friese KK et al (1993) Quantification of the left ventricular volumes and function with cine MR imaging: comparison of geometric models with three-dimensional data. Radiology 188:371–376

    CAS  PubMed  Google Scholar 

  15. Thiele H, Paetsch I, Schnackenburg B et al (2002) Improved accuracy of quantitative assessment of left ventricular volume and ejection fraction by geometric models with steady-state free precession. J Cardiovasc Magn Reson 4:327–339

    Article  PubMed  Google Scholar 

  16. Mahrholdt H, Wagner A, Judd RM et al (2005) Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies. Eur Heart J 26:1461–1474

    Article  PubMed  Google Scholar 

  17. Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–542

    Article  PubMed  Google Scholar 

  18. Gordon T, Kannel WB (1972) Predisposition to atherosclerosis in the head, heart, and legs. The Framingham study. JAMA 221:661–666

    Article  CAS  PubMed  Google Scholar 

  19. Criqui MH, Langer RD, Fronek A et al (1992) Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 326:381–386

    CAS  PubMed  Google Scholar 

  20. Leng GC, Lee AJ, Fowkes FG et al (1996) Incidence, natural history and cardiovascular events in symptomatic and asymptomatic peripheral arterial disease in the general population. Int J Epidemiol 25:1172–1181

    Article  CAS  PubMed  Google Scholar 

  21. CAPRIE (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events. CAPRIE Steering Committee. Lancet 348:1329–1339

    Article  Google Scholar 

  22. Diehm C, Schuster A, Allenberg JR et al (2004) High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis 172:95–105

    Article  CAS  PubMed  Google Scholar 

  23. Dormandy JA, Rutherford RB (2000) Management of peripheral arterial disease (PAD). TASC Working Group. TransAtlantic Inter-Society Consensus (TASC). J Vasc Surg 31:S1–S296

    Article  CAS  PubMed  Google Scholar 

  24. Sheifer SE, Gersh BJ, Yanez ND et al (2000) Prevalence, predisposing factors, and prognosis of clinically unrecognized myocardial infarction in the elderly. J Am Coll Cardiol 35:119–126

    Article  CAS  PubMed  Google Scholar 

  25. Kwong RY, Sattar H, Wu H et al (2008) Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction. Circulation 118:1011–1020

    Article  PubMed  Google Scholar 

  26. Ricciardi MJ, Wu E, Davidson CJ et al (2001) Visualization of discrete microinfarction after percutaneous coronary intervention associated with mild creatine kinase-MB elevation. Circulation 103:2780–2783

    Article  CAS  PubMed  Google Scholar 

  27. Kim RJ, Fieno DS, Parrish TB et al (1999) Relationship of MRI delayed contrast enhancement to irreversible injury, infarct age, and contractile function. Circulation 100:1992–2002

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Achim Seeger, Michael Fenchel, Ulrich Kramer, Christiane Bretschneider, Florian Grimm, Bernhard Klumpp, Claus D. Claussen & Stephan Miller

  2. Department for Thorax, Cardiac and Vascular Surgery, Eberhard Karls University Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany

    Albertus Scheule

  3. Department of Internal Medicine IV, Eberhard Karls University Tuebingen, Otfried-Mueller-Str. 10, 72076, Tuebingen, Germany

    Bernd Balletshofer

Authors
  1. Achim Seeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Fenchel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ulrich Kramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christiane Bretschneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Florian Grimm
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bernhard Klumpp
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Albertus Scheule
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bernd Balletshofer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claus D. Claussen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Stephan Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Achim Seeger.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seeger, A., Fenchel, M., Kramer, U. et al. Towards risk stratification in systemic atherosclerosis: value of myocardial function and viability imaging as an adjunct to MR angiography. Eur Radiol 20, 838–845 (2010). https://doi.org/10.1007/s00330-009-1607-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-009-1607-z

Keywords

Search

Navigation