SBC -DCC

October, 2019

Rio de Janeiro – RJ - Brazil

RM Cardiovascular

Cine-RM

FSE-T1

Tagging

FSE-T1 FSE-FatSat

Perfusão Cine-RM

Cine-RM

FLUXO

Perfusão Estresse

Realce Tardio

Realce Tardio

Realce Tardio

FSE-T2-Edema

Angio-RM

Mapa T1

DE-CMR↑↑↑↑ EC volume

Ischemic

- Always involvesubendocardium

-Related to coronary

territories

NonIschemic

-Probably will Notinvolve

subendocardium

-Not restricted to coronary

territories

Mahrholdt H et al European Heart Journal (2005) 26, 1461–1474

Kim et al., Circulation 1999;100:1992-2002.

Lima et al Circulation 1995;92:1117-1125

Rochitte, CE Circulation 1998; 98:1006-1014

Mewton . JACC 2011;57:891–903

DIFFUSE FIBROSIST1 Mapping and ECV

ECV= 26.7%

Magn Reson Imaging Clin N Am. 2015 Feb;23(1):25-34

DIFFUSE FIBROSIST1 Mapping and ECV

ECV= 26.7%

Fernandes and Rochitte. Reson Imaging Clin N Am. 2015 Feb;23(1):25-34

Puntmann V et al. Circ Res. 2016;119:277-299

CAD vs. Non Ischemic CMP

Puntmann V et al. Circ Res. 2016;119:277-299

DIFFUSE FIBROSIST1 Mapping and ECV

ECV= 26.7%

Magn Reson Imaging Clin N Am. 2015 Feb;23(1):25-34

Tang CX et al. Trends in Cardiovascular Medicine 0 0 0 (2018) 1–12

Kellman et al. Journal of Cardiovascular Magnetic Resonance 2012, 14:63

Liu et al. Journal of Cardiovascular Magnetic Resonance (2017) 19:74

T1 Map

Sado DM et al. Circ Cardiovasc Imaging. 2013;6:392-398

CMR in Hypertension Indications

Assess target organ damage Detect identifiable causes

Not in the guidelines Cardiac MR

LVH LA dilatation Myocardial Fibrosis Diastolic dysfunction Higher risk for CAD

Maceira and Mohiaddin JCMR 2012, 14:28

LVH Regression

Maceira and Mohiaddin JCMR 2012, 14:28

LV Dimension, Geometry and Function

Accurate and Precise for LV mass Gold-Standard for Volumes, Mass and Function Lower Intraobserver and Interobserver variablity

2.0-7.4% and 3.3 – 7.7%

LVH differential diagnosis HCM, infiltrative disease, Fabry´s, sarcoidosis,

aortic stenosis, exercise-induced, athlete´s heart

Maceira and Mohiaddin JCMR 2012, 14:28

Khan et al. Journal of Cardiovascular Magnetic Resonance (2019) 21:4

LA Volume Mortality

Khan et al. Journal of Cardiovascular Magnetic Resonance (2019) 21:4

LVH Differential Diagnosis

Maceira and Mohiaddin JCMR 2012, 14:28

Detection of Myocardial Fibrosis

Serum markers of fibrosis carboxyterminal propeptide of

procollagen type I (PIP), a marker of collagen synthesis

Querejeta R et al. Circulation 2000;101:1729–35.Maceira and Mohiaddin JCMR 2012, 14:28

Hemochromatosis-related hypertension

Nunez OC et al. ,Rev Esp Cardiol. 2017;70(12):1135

Cardiac T2* CMR identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major and is superior to serum ferritin and liver iron.Kirk P et al. C irculation. 2009;120:1961-1968

Modell B et al. JCMR 2008, 10:42Anderson LJ et al . 2001 Eur Heart J; 22: 2171–2179

Cardiac Siderosis

MF Histopathology Histological basis of myocardial LGE in patients with systemic hypertension:

localized myocardial interstitial fibrosis in the midwall (or outer myocardium) and replacement fibrosis in the subendocardium.

Chaowu Y et al. Circulation. 2014;130:2210-2212

MF in Arterial Hypertension

45% of patients with arterial hypertension showed DE on cardiac MRI

K. Andersen et al. European Journal of Radiology 71 (2009) 75–81

Tahir E et al.J Am Coll Cardiol Img 2018;11:1260–70

dsf

Rudolph A. et al.J Am Coll Cardiol 2009;53:284–91

Heart 2011;97:1257-1261.

Cardiopatia Congênita - VD

DAC - IsquemiaMiocárdica

Lockie T et al. J Am Coll Cardiol 2011;57:70–5

(%) RMC SPECT

Sens 86.5 66.5

Espec 83.4 82.6

VPP 77.2 71.4

VPN 90.5 79.1

Greenwood JP et. al. Lancet. 2012;379:453-60

TC Cardiovascular

Aorta torácica e abdominal

Maceira and Mohiaddin JCMR 2012, 14:28

Preditor de Eventos Coronários

Escore de Risco de Framingham

Greenland et al. JAMA 2004; 291:210-5

Escore de Risco de Framingham

Mohlenkamp et al. JACC 2011; 57:1455-64

Risk Markers Accuracy

Intermediate risk:

YEBOAH, J. et al. JAMA, 2012.

AUC FRS + CAC = 0,784AUC FRS + HF = 0,675

Thomas DM et al. Curr Cardiovasc Imaging Rep. 2015;8(6):18

O Que Fazer Depois

Grundy SM, et al.2018 Cholesterol Clinical Practice Guidelineshttps://doi.org/10.1016/j.jacc.2018.11.003

J Am Coll Cardiol 2009;54:49–57

15/02/2013 25/03/2014

Plaque Burden and Prognosis

Bittencourt MS et al . Circ Cardiovasc Imaging. 2014;7:282-291

Non Obstructive Extensive CAD

Obstructive Less Extensive CAD

O Que Fazer Depois

Thomas DM et al. Curr Cardiovasc Imaging Rep. 2015;8(6):18

Newby DE et al. N Engl J Med 2018;379:924-33.

A

B

C

D F

E

Cury, Rochitte et al . Am J Cardiol 2010:106:310-315

Single Center Study

Multi-Center Trial comparing 320 x 0.5mm CT & CTP to cath & SPECT

JHUJHU

BIDBID

INCORINCOR

LUMCLUMCChariteCharite IwateIwate

TGHTGH

Mt EMt E

MieMie

BWHBWHNIHNIH KeioKeio

EinsteinEinstein

NHCNHC

RigsRigs

St LukeSt Luke

Rochitte et al. European Heart Journal (2014) 35, 1120–1130

Rochitte et al. European Heart Journal (2014) 35, 1120–1130

FFRct vs. FFR

Discovery-Flow

J Am Coll Cardiol. 2011 Nov 1;58(19):1989-97.

DeFacto

Min JK et al. JAMA. 2012;308(12):1237-1245

NXT

Norgaard B, et al. J Am Coll Cardiol. 2014 Apr 1;63(12):1145-55

DIC 2018 – PREMIO MELHOR TRABALHO, HCOR

r=0,77p=0,0007

AcuráciaTCCor 53%

AcuráciaFFRct 80%

P=0,003

Média da diferença: -0,033

Limites de concordância: -0,176 – 0,111

Conclusões HAS Lesão de Órgão Alvo

Coração e Vasos (CoAo, Renovasc, Adrenais)

RMC Fibrose miocárdica

focal – RT difusa – Mapa T1 e ECV

Infarto e isquemia

TCC Estratificação de Risco Cardiovascular

Escore de Cálcio DAC não obstrutiva Placa Vulnerável

DAC obstrutiva Avaliação anatômica – angioTC de Coronárias Avaliação funcional Perfusão, CTP e FFRct

Instituto do Coração - InCor

Dr. Clério AzevedoDr. Guilherme AzevedoDr. Leonardo SaraDr. Afonso A. ShiozakiDr. Tiago SenraDra. Marly SilvaDr. Jorge A TorreãoDr. Joalbo AndradeDr. Marcelo NacifDr. Alexandre Volney Villa

Dr Adriano CarneiroDra. Valéria Melo MoreiraDr. Tiago MagalhãesDra. Juliana BelloDr. Carlos Prazeres

Hospital do Coração - HCor

Dr. Leonardo ZancanerDra. Roberta Iki MochidukyDr. Ricardo RochaDr. Roberto NeryDr. Mateus FahelDr. Carlos Henrique RassiDr. Fabio Petrucci

Dr. Bernardo AbreuDr. Fábio V. FernandesDra. Mariana LamaciéDr. Helder GomesDr. Matheus FreitasDr. Paulo Ferraz DiasDra. Natália AthaydeDra. Mariana BaptistaDr. Jasvan Leite de OliveiraDr. Jamil Calil NetoDr. Dário Quirino FirminoDr. Flavio Magnani LauandDr. Matheus L M GodoiDr. Issac Torquato Q e SilvaDra. Natália B SaçvattiiDra. Hilka CarvalhoDr. Pedro Macedo BarbosaDra. Paula Rodrigues CostaDra Fernanda Soares Rêgo

Dr. Pedro LemosDr. Amarino OliveiraDr. David BluemkeDr. João AC LimaProf. Dr. Roberto Kalil FilhoProf. Dr. Giovanni G. Cerri

Thank you for your Attention!!!

Dra. Simone C. S. CostaDra. Thais Pinheiro LimaDra. Renata Ávila CintraDr. Marcus PicoralDr. Ismar MarquesDr . Raphael Scoppetta

Dra. Jacob Sessim FilhoDra. Ariane PachecoDra. Gabriela SouzaDr. Ari AraújoDra. Carol ReiserDr. Antonildes Assunção Jr.Dra. Débora NakamuraDra. Alejandra VilanuevaDr. Bernardo LopesDr. Rodrigo MeloDra Liliane RochaDr. Ricardo OguroDra. Solange Ayala

Dra. Thamara C. MoraisDra. Elissa IshieDr. Marcelo M.CastroDra. Ana Carolina P. CostaDra. Bruna MS. AndradeDra. Giovanna AbdallaDra. Pricilla GianottoDra. Thalita CanevariDra. Andrea BerchtDr. Ivanhoé LeiteDr. Rosse OsórioDr. José Henrique de AndradeDr. José Roberto P da FonsecaDr. Marcelo MontemorDra Naiana ZaminDra. Renata M de SouzaDr. Nevelton Heringer Filho