Direttore Dpt Cardiovascolare ed UOC Cardiologia Bergamo

Transcript

1 Ruolo attuale del multimodal immaging nel decision making in cardiologia Direttore Dpt Cardiovascolare ed UOC Cardiologia Bergamo

2 JACC CV 2008

3 JACC CV 2013

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5 MULTIMODALITY IMAGING (MMI)

6 SERIAL MULTIMODALITY IMAGING Examinations

7 INTEGRATED (hybrid) MULTIMODAL ITY IMAGING

8 MULTIMODAL IMAGING (MMI)

9 MULTIMODAL ITY IMAGING (MMI)

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13 From: Multimodality Imaging Atlas of Coronary Atherosclerosis J Am Coll Cardiol Img. 2010;3(8): doi: /j.jcmg

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16 J Am Coll Cardiol. 2014;63(4): doi: /j.jacc Figure Legend: Hierarchy of Potential Test Ordering Based on Clinical Presentation For those patients who may be classified into more than 1 of the clinical indication tables and/or algorithms, this flowchart places clinical conditions into a hierarchy to aid in assessing appropriateness. Patients sent for testing for purposes of pre-operative cardiac assessment who are rated Rarely Appropriate for testing based on surgery alone may be considered for testing for other reasons (e.g., symptomatic). CABG = coronary artery bypass graft; CAD = coronary artery disease; CV = cardiovascular; PCI = percutaneous coronary intervention. Date of download: 4/11/2015 Copyright The American College of Cardiology. All rights reserved.

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34 From: Multimodality Imaging in Transcatheter Aortic Valve Implantation and Post-Procedural Aortic Regurgitation: Comparison Among Cardiovascular Magnetic Resonance, Cardiac Computed Tomography, and Echocardiography J Am Coll Cardiol. 2011;58(21): doi: /j.jacc Figure Legend: CMR Imaging of the Aortic Root and Ascending Aorta Cardiovascular magnetic resonance (CMR) images demonstrating measurement of the sinotubular junction (*) and aortic annulus ( ) in oblique-sagittal (A) and oblique-coronal (B) planes. Three cusp commissure measurements (arrows) of the aortic sinuses were made from a short-axis cine image of the aortic root (C). The internal ascending aorta dimensions (arrows) were measured from a transaxial half-fourier acquisition single-shot turbo spin-echo image at the level of the right pulmonary artery (D). Date of download: 4/4/2015 Copyright The American College of Cardiology. All rights reserved.

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38 Emerging Role of Multimodality Imaging to Evaluate Patients at Risk for Sudden Cardiac Death by Matteo Bertini, Martin J. Schalij, Jeroen J. Bax, and Victoria Delgado Circ Cardiovasc Imaging Volume 5(4): July 17, 2012 Copyright American Heart Association, Inc. All rights reserved.

39 Integration of 3-dimensional electroanatomical voltage mapping and contrast-enhanced MRI for characterization of the arrhythmogenic substrate. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

40 Assessment of myocardial tissue heterogeneity in ischemic heart failure patients at risk for SCD. Multimodality imaging for evaluation of a 63-year old man with prior anterior myocardial infarction and LVEF 33% who was referred for ICD implantation for primary prevention. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

41 Novel MRI techniques for tissue characterization. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

42 Arrhythmogenic right ventricular dysplasia/cardiomyopathy. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

43 Neuronal cardiac imaging with 11C-HED PET. A, Myocardial 11C-HED uptake in a healthy subject, showing homogeneous distribution of the radiotracer in the left ventricle. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

44 123I-MIBG planar and SPECT imaging to assess cardiac sympathetic innervation. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

45 Assessment of arrhythmogenic substrate in hypertrophic cardiomyopathy. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

46 Assessment of mechanical left ventricular dispersion in patients with long-qt syndrome. Matteo Bertini et al. Circ Cardiovasc Imaging. 2012;5: Copyright American Heart Association, Inc. All rights reserved.

47 BC, maschio, 34 anni, fumatore Asintomatico, durante accertamenti per attività sportiva non agonistica, riscontro di extrasistolia ventricolare polimorfa organizzata anche in triplette. Ergometria: soppressione delle aritmie, negativa per ischemia inducibile. Ecocardio TT: acinesia inferiore con funzione sistolica globalmente conservata. RM cuore: focale acinesia della parete inferiore con atteggiamento discinetico, in tale sede dubbia area di delayed enhancement (esito ischemico?). Coronarografia: circolo epicardico esente da lesioni ateromasiche, fistola artero-venosa a carico del ramo interventricolare posteriore. Dimesso in terapia con sotalolo 40 mg bid Holter ECG: 7500 battiti ectopici; 2696 coppie; 337 run fino a 6 battiti. Ecocardiogramma: aneurisma della parete inferiore con lieve riduzione della funzione sitolica globale.

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54 PET

55 SPECT + MRI PET + MRI

56 Febbraio 2015 Ricovero per rivalutazione. Esami ematici nella norma. Eseguita coronarografia con evidenza di fistola artero-venosa a carico del IVP. Effettuata angioplastica con impianto di stent ricoperto (espanso a 2.08 mm nominali) con ottimo risultato angiografico immediato.

57 PET + Coronarografia

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