Cardiologists and surgeons may soon have a new cardiac imaging tool to improve the clinical outcomes of patients requiring pacemakers, coronary artery bypass surgery, or angioplasty. The findings were published online in the Journal of the American College of Cardiology: Cardiovascular Imaging.
A study by Dr. James White of the University of Western Ontario and colleagues invented a new imaging technique that provides a single, 3D high-resolution cardiac image that clearly shows both the vasculature and scar tissue in the myocardium. The study used 3-Tesla MRI, conducted at the Roberts Institute in the West.
A heart attack or inflammation can cause permanent damage or scarring of the heart muscle. "We already know that MRI can image myocardial (heart) scar tissue, but this new technology has reached new levels of imaging scar tissue," Dr. White explained. â€œThis is the first time we have seen both myocardial scars and heart vessels, and can build a three-dimensional model of the human heart that helps us quickly understand the relationship between cardiovascular and related permanent injuries. This will help guide surgeons and cardiology. Experts better target the target vessels that respond to treatment, rather than the blood vessels in irreversible muscle lesions."
This technique resulted in the first three-dimensional coronary image with continuous contrast perfusion of contrast media, in which the blood pool image was bright and clear. When the contrast agent is injected into the blood, it is imaged with 3-T MRI to provide images of high-resolution, three-dimensional coronary vessels. Although the contrast agent in the blood and normal tissues has been completely discharged, its signal is still maintained due to the slow rate of discharge of the contrast agent from the scar tissue. After 20 minutes of repeated imaging, the scar tissue was highlighted and was three-dimensionally imaged. Since both the scar tissue and the coronary vessel use the same method using the same MRI pulse sequence, they are perfectly suited to fuse one of them to the other. It is now possible to create a three-dimensional model of the heart that simultaneously displays blood vessels and scar tissue.
The imaging technique was performed in 55 patients undergoing bypass surgery or cardiac pacemaker installation therapy called cardiac resynchronization therapy (CRT). The results show that the imaging technique is clinically feasible. This new imaging technique may be of invaluable value for patients planning a blood vessel-based cardiac intervention. Dr. White described the value of bypass surgery or angioplasty depending on whether or not the occlusion vessel is to be opened. If scar tissue is visible in that area, there is no expected benefit. The scarred myocardium that reaches the CRT pacemaker lead will prevent this treatment benefit.
The research fund is provided by the Ontario Heart and Stroke Foundation and the Canadian Innovation Foundation.
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