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Cardiac MR Detects Cardiomyopathy More Accurate Than Echocardiography.

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cardiac imaging newsA new study presented at the 2010 American Heart Association (AHA) Scientific Sessions in Chicago, discusses a special type of cardiomyopathy called Left ventricular non-compaction (LVNC). This type of cardiomyopathy still has many obscure areas and it is usually associated with heart failure (HF), stroke and ventricular arrhythmias. The researchers also reported that advanced imaging technologies revealed that developing these cardiac risks appear to progress over time in patients with LVNC.

Pathogenesis of LVNC.

LVNC is an inherited heart muscle condition in which the muscular wall of the left ventricle appears to be spongy and non-compacted, consisting of a meshwork of numerous muscle bands (trabeculations). However, its cause, development, clinical course and treatment will be the aim of ongoing research. Therefore, the study authors said that the cardiology community's understanding of the natural history of LVNC continues to evolve. "Our ability to detect and recognize this condition has grown considerably over the past decade, as our imaging technologies have advanced. Fifteen years ago, the main tool to examine cardiac muscle was echocardiography, which was not as sensitive as it is today. Now, with the advent of cardiac MR [magnetic resonance], we are able to see far more detail of the heart.", said study investigator William T. Katsiyiannis, MD, director of the Genetic Arrhythmia Center and a clinical cardiac electrophysiologist at the Minneapolis Heart Institute® at Abbott Northwestern Hospital in Minneapolis. While the current prevalence of LVNC is unknown, Katsiyiannis expects that the condition may be far more common than has been previously reported, due to poor diagnostic measures. Previous data have indicated complications for patients with LVNC include stroke from blood clots that form in the non-compacted tissue, the development of heart failure or left ventricular dysfunction and the development of potentially dangerous ventricular arrhythmias.

Echocardiography can not rule out LVNC.  

To assess the incidence of these traditional risk factors with LVNC, the researchers examined patients by echocardiography or cardiac MR, and diagnosed 125 patients with LVNC. Echocardiography diagnosed only 38.2 % of cases. Katsiyiannis said: "The incidence rates are unclear because echo has been the gold standard. Echo missed the majority of patients with LVNC. Therefore, LVNC cannot be ruled out based on a normal echo." The study's patient population had a higher than expected incidence of congestive heart failure (38.5 %), left ventricular dysfunction with ejection fraction of less than 45 % by cardiac MR (31.9 %) and ventricular tachycardia (24.8 %). In addition, the researchers at Minneapolis Heart Institute® reported that 3.1 % of patients experienced stroke and 3.1 % experienced sudden death. Katsiyiannis finally concluded that LVNC requires "much more research before clinical decisions are based on its diagnosis."

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