MRI
Axial Balanced SSFP
2ch Cine SSFP
4ch Cine SSFP
3ch Cine SSFP
Short axis Cine SSFP
Short axis STIR
Short axis nT1 mapping
Short axis Perfusion
Short axis PSIR
2ch PSIR
2ch DIR
4ch DIR
3ch DIR
Short axis pT1 mapping
In the setting of an acute myocardial infarction, which finding could resemble a mural cardiac thrombus on a cardiac MRI?
Microvascular obstruction.
What defines ischaemic cardiomyopathy?
Left ventricular dysfunction in the setting of significant coronary artery disease.
Outline the treatment of ischaemic cardiomyopathy.
Optimal medical therapy aimed at inhibiting adverse remodelling is a cornerstone in the management. Coronary revascularisation might be beneficial, especially in patients with viable myocardium. Additional device therapy such as an ICD or cardiac resynchronization therapy might be indicated in specific patient groups.
List a few complications of ischaemic cardiomyopathy.
Ischaemic cardiomyopathy has a wide range of complications including congestive heart failure, mitral valve incompetence, life-threatening arrhythmias and thromboembolic events.
Heart rate: irregular 80-130 bpm
Image quality: respiratory and arrhythmia artifacts, otherwise no limitations
Functional analysis of the left ventricle (endo-volume):
EDVI: 190 mL/m²
ESVI: 150 mL/m²
SVI: 40 mL/m²
EF: 21%
cardiac output: 7.6 L/min
cardiac index: 3.4 L/min/m²
ED wall mass index (without papillary muscles): 87 g/cm²
septum thickness: 12 mm
Findings:
Dilated cardiac apex with akinetic apical segments and midventricular septal and inferior segments with concomitant extensive transmural late gadolinium enhancement (LGE) in those segments.
Due to motion artifacts T1 mapping was not helpful in this case other than for delineation of the thrombus in the source sequences.
Minimal bilateral pleural effusions.
Impression:
ischaemic cardiomyopathy with extensive transmural scar of the left ventricular apex as well as the midvenricular septal and inferior segments with giant apical aneurysm and huge left ventricular thrombus
heart failure with highly reduced ejection fraction
Exam courtesy: Sven Winzler (imaging technologist)