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Role of cardiac MRI in an advanced heart care center

Cardiac magnetic resonance imaging (MRI) produces detailed high-resolution images, and depicts accurately function of the heart and its surrounding structures, using a magnetic field and radio waves. It is useful not only in heart conditions present since birth but also acquired in adulthood.

Cardiac MRI has made a position in cardiac imaging, along with traditionally used CT and ECHO, as it addresses the shortcomings of both these modalities, i.e. cardiac MRI gives an excellent soft tissue contrast image without use of ionizing radiation as compared to CT, and has minimal inter-observer and intra-observer variability as compared to echocardiography. It is the gold standard for assessing ventricular volumes, ejection fraction and myocardial mass and LV parameters when the ventricular shape is abnormal due to ischemic or dilated cardiomyopathy.

We have hence installed a cardiac 1.5T MRI scan in 2022 at SSB Heart and Multispecialty Hospital, Faridabad, for new opportunities unavailable with existing modalities.

Cardiac MRI is superior to other imaging techniques for diagnosis, characterization, and follow-up in patients of cardiac tumors and infiltrative diseases like amyloidosis, sarcoidosis, glycogen-storage diseases, and iron overload in thalassemia patients. These were earlier diagnosed with a biopsy, which is an invasive procedure and thus has serious complications, including mortality, and while ECHO could detect a mass but could not characterize the nature of the mass.

Use of cardiac MRI has decreased the time taken for diagnosis, allows better assessment of effect of treatment, and decreased rate of complications, as it is a non-invasive procedure.

It also has an important role in patients with coronary artery disease as it can detect the extent and recoverability of a prior myocardial infarction. Late gadolinium enhancement (LGE) reflects fibrosis and irreversible damage to myocardium after MI, which helps to assess recovery of function after revascularization. It can also be used to predict future arrhythmia risk in post-MI patients by evaluating the size of the peri-infarct border zone versus the core infarct.

Studies suggest an important role of LGE in troponin-positive, chest pain patients without coronary obstruction to identify the cause for troponin elevation–majorly being myocarditis, MI, or cardiomyopathies. It has much greater sensitivity and comparable specificity for detection of left ventricular thrombi in the MI patients than TTE (trans-thoracic echocardiography) and TEE (trans-esophageal echocardiography), with sensitivity being 88 percent versus 23 percent, and 40 percent with TTE and TEE, respectively, and specificity of 99 percent versus 96 percent with TTE and TEE. Thus, it plays an important role in decreasing the risk of emboli and future morbidity. It has thus been the strongest predictor of major adverse cardiovascular events (MACE).

Cardiac MRI is also an excellent approach to differentiate between restrictive cardiomyopathy and constrictive pericardial diseases. It is the diagnostic procedure of choice for detection of certain pericardial diseases, such as non-calcified constrictive pericarditis, tumor invasion of the pericardium, and congenital absence of the pericardium.

Cardiac MRI is also helpful in patients with a poor ECHO window, i.e., where bones or lung shadows might obscure the abnormalities like in patients with obesity, COPD, and asthma. Here cardiac MRI allows proper visualization and assessment of the heart, its valves, and their functions.

It is useful in the follow-up after surgery for aortic dissection or aneurysm and in the diagnosis of aortic coarctation, and it is the method of choice for evaluating aortic involvement in patients with Marfan’s syndrome. We have successfully treated a 22-year-old male with Marfan’s syndrome found to have aortic dilatation of 9 cm on cardiac MRI.

Cardiac MRI is emerging for use in coronary angiography and interventional procedures, especially for arrhythmias. Thus investing in cardiac MRI will be even more beneficial in the future.

It is indeed a dynamic technique that has now entered the main stage of cardiovascular imaging. 

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