Achim Seeger, Presenter: Nothing to Disclose

Michael Christian Fenchel MD, Abstract Co-Author: Nothing to Disclose

Ulrich Kramer MD, Abstract Co-Author: Nothing to Disclose

Jörg Döring MD, Abstract Co-Author: Nothing to Disclose

Claus Detlef Claussen MD, Abstract Co-Author: Nothing to Disclose

Stephan Miller MD, Abstract Co-Author: Nothing to Disclose

Florian Grimm, Abstract Co-Author: Nothing to Disclose

Bernhard Klumpp MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

Community based studies showed that known and unrecognised myocardial infarctions influence the individual prognosis. Aim of the study was to longitudinally assess the diagnostic value of delayed cardiac gadolinium enhancement (DE) as a supplement to a state-of-the-art MR-angiography (MRA) in the case of vascular risk patients.

182 consecutive patients (141 male, 66±9.7 years) with symptomatic peripheral arterial disease (PAD) were examined at a 1.5T whole-body system. 10 minutes after the MRA (0.18 mmol gadolinium containing contrast agent) DE imaging was performed using an IR turboFLASH 2D sequence. Image analysis was done qualitatively by two observers. A follow-up was carried out two years later (22±5 months) with regards to major cardiac events (cardiac death, myocardial ischemia, heart insufficiency).

In total, 58/182 (32%) patients had myocardial infarctions shown in DE. In 32 patients (18%), the myocardial infarction was already known whereas in 26 patients (14%) an occult progressing infarction was diagnosed. In the follow-up period 26 patients had a major cardiac event, 19 (73%) of them already showed DE in the MRI. In the group with occult progressing infarctions, cardiac events occurred in 31% (8/26, cardiac death n=1, ischemia n=5, heart insufficiency n=2), in patients with known infarction in 34% (11/32, cardiac death n=1, ischaemia n=7, heart insufficiency n=3) and in 6% of patients without myocardial scars (7/124, cardiac death n=1, ischemia n=5, heart insufficiency n=1, p<0.05).

Unrecognised myocardial infarction is a common and clinically significant event in patients suffering of PAD. The high prevalence of myocardial infarctions and the relevance to the prognosis show that cardiac MRI is a meaningful supplement to MRA in this setting. Important additional information as to the risk stratification and best targeted therapy can be obtained.  

The combination of MRA and DE imaging provides important information concerning myocardial infarctions and patients prognosis without the need of additional contrast agent.  

Seeger, A, Fenchel, M, Kramer, U, Döring, J, Claussen, C, Miller, S, Grimm, F, Klumpp, B, et al, , A Longitudinal Study of Cardiac Events in Patients with Peripheral Artery Disease: Is Cardiac MRI in Addition to MR Angiography Useful?.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6010684.html