AW: [HSF] Correction of MR in Myopathic Ventricles

Wed Mar 7 20:32:40 EST 2007

There are many papers to that effect. I just gave you a real reason (not just a paper) why the calulation of volumes and thus EF would be better ignoring any loading issues. TEE usually requires sedation which will alter any loading compared to where the patient lives.  Gadolium uptake as seen in MRAs is rapid and cleared quickly by the myocardium. Stress (perfusion) MR shows subendocardial changes that make it arguable the best provocative test for ischemia available. The resoultion on delayed (hyper) enchancement for scar or necrosis (early MI) is both better visually by far (ie matches the pathological tissue) and more predictive clinically of recovery, late dilation , or not than any other study. The detail is anatomical in appearance. I may rant, but I seldom wax.

Try: European Heart Journal (2005) 24, 549-557 Sequelae of acute myocardial infarction regarding cardiac structure and function and their prognostic signficance as assessed by MRI, by Venzenz Hombach et al. 

It was in my brief case, so convenient to find. But there are many others. CMR for LV scarring and other things (but as we know scarring gives us insight to millions of patients dying of CHF and tens if not hundreds of thousands that can be helped) is very well worked out over the last decades, but stayed mostly in a few large academic centers. Even the US has only 50 or so sites of high CMR activity. So unlike surgery where there is lots of clinical practice and very little data, CMR has lots of (some spectacular I might add) data and little clinical penetrance. This will change quickly over the next couple of years I believe. I hope very quickly I will no longer by recognized as a surgeon "expert" (since I am almost the only surgeon who talks about it) as all the usual experts notice the advantages to their careers.

tea

----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, March 7, 2007 9:07:16 PM
Subject: Re: AW: [HSF] Correction of MR in Myopathic Ventricles

While waxing eloquently on CMR is there really any data that shows that 
it is really more accurate than say PET/ SPECT ? Or is it just the 
latest toy ? EF may be accurately measured but is viable myocardium 
accurately measured ?
Prasanna
Tea Acuff wrote:
> Roberto's point is that CMR is the most reliable and repeatable way to measure EF, or what is actually measured, the ESV and EDS by multiple short axis volume reconstructions. In an asynchronous heart the  LV "wobbles" so measuring the whole LV in one planar frame is actually impossible. One part is contracting while another is expanding. Echo's as we know from intraop TEE are also extremely variable. Severe TR may completely disappear as some have mentioned. 
> It is like our EBM. Even if it is a honest measurement (or a real p value), if it is crap it likely means crap. It just becomes Class I evidence crap. (Well maybe this wasn't exactly what Roberto meant!)
> tea
>
>
> ----- Original Message ----
> From: Dr. Roberto Battellini <battr at medizin.uni-leipzig.de>
> To: OpenHeart-L at lists.hsforum.com
> Sent: Wednesday, March 7, 2007 2:46:32 PM
> Subject: AW: [HSF] Correction of MR in Myopathic Ventricles
>
>
> It´s unbelievable! Do you have MRI´s?
> Roberto
>
> -----Ursprüngliche Nachricht-----
> Von: openheart-l-bounces at lists.hsforum.com
> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von hgrmd at aol.com
> Gesendet: Mittwoch, 7. März 2007 17:16
> An: OpenHeart-L at lists.hsforum.com
> Betreff: [HSF] Correction of MR in Myopathic Ventricles
>
> Dear Members,
>   I just saw a morbidly obese 58 yo lady in my office for followup.  In
> September '05, she presented with multiple hospitalizations for CHF.  She
> had normal coronaries, severe MR, and an EF of 8% by planimetry on TEE!  I
> did mitral and tricuspid repairs.  A few days later, she had a biventricular
> pacer inserted.  
>   Since then, she has been readmitted only once for a TIA.  She is
> completely asymptomatic.  Transthoracic echo from last month revealed trace
> MR, no TR, and an EF of 50-55%.  My belief is that most surgeons wouldn't
> have touched her with a ten foot pole.  Comments?
>
> Hal
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