Elevated Plasma N-terminal Pro-B-type Natriuretic Peptide Level In Isolated Ventriclar Noncompaction And Assessment With Combination Of Multiple Cardiac MRI Techniques

PARTⅠ:Assessment of isolated ventricular noncompaction:Comparison of cardiac MR imaging with echocardiography manifestation and with a pathological studyObjective Compare with 2D echocardiography and to describe morphologic feature with cardiac MRI in the evaluation of patients with noncompaction of left ventricular myocardiumMaterials and Methods Twenty-seven IVNC patients diagnosed by echocardiography underwent MRI, scanning of black-blood sequence, white-blood sequence and Cine MRI, included four chamber view, two chamber view and short axis view of left ventricle.Results Noncompacted myocardium was characterized by prominent and excessive myocardial trabeculations and deep intratrabecular recesses.All segments could be analysed by Cardiac MRI whereas only 131(82.3%) could be showed by echocardiography. CMRI identified a higher rate of NC/C maximum ratio compared with echocardiography. No significant difference was observed of two-layered structures except in the anterolateral and inferolateral segments. One case eventually underwent heart transplantation because of severe congestive heart failure. Gross findings demonstrated prominent muscular trabeculations, with deep intratrabecular recesses into lesion heart. Noncompaction of ventricular myocardium showed a thin, compacted epicardial and an extremely thickened endocardium, which coincided well with MRI findings.Conclusion Cardiac MRI appears superior to standard echocardiography in assessing the extent of noncompaction and provides supplemental morphological information beyond that obtained with conventional echocardiography.PART II:Delayed contrast enhancement of MRI in ventricular noncompaction:Emphasis on segmental fibrosisObjective The purpose of this study is to describe the delayed contrast-enhancement pattern feature of the noncompaction of the left ventricle in cardiac magnetic resonance imagingMaterials and Methods Twenty-seven IVNC patients diagnosed by echocardiography underwent delayed contrast enhancement MRI, scanning of Phase-sensitive Inversion Recovery (PSIR) sequence, included four chamber view, two chamber view and short axis view of left ventricle.Results Noncompaction was seen in 16 cases. CMRI demonstrated 94(20.4%) segments contrast enhancement mostly in the apical and midventricular lateral segment. Delayed contrast enhancement was seen not only involved noncompaction segments (73.4%) but also normal segments of the heart (26.5%). Myocardial fibrosis was demonstrated predominates subendocardial patterns (92.5%) and transmural patterns (7.4%).More segments (20.4%) occurred in IVNC patients with increased fibrosis mass (5.72±4.36g) compared to normal control. Histological findings demonstrated interstitial fibrosis in all delayed contrast enhanced segments with endomyocardial thickening and subendocardial fibroelastosis.Conclusion Fibrosis is a common finding in ventricular noncompaction. Delayed contrast enhancement CMRI is a valuable imaging method in patients with ventricular concompaction by showing fibrosis.PART III:Quantification of left ventricular function in left ventricular noncompaction with cardiac MRIObjective The aim of the study was to evaluate the clinic value of MRI for quantitative assessment of systolic and diastolic left ventricular function in IVNC patients.Materials and Methods Twenty-seven IVNC patients diagnosed by echocardiography underwent MRI. All patients were divided by their heart function.There were 5 patients in NYHA classⅠorⅡ,22 patients in NYHA classⅢorⅣ,15 in normal group. ECG gated trueFISP and Phase-sensitive Inversion Recovery imaging were performed, including four chamber view, two chamber view and short axis view of left ventricle. Left ventricular end diastole volume (LVEDV), Left ventricular end systole volume (LVESV), Left ventricular myocardial mass (LV MASS), Left ventricular ejection fraction (LVEF),cardiac output(CO), stroke volume(SV),peak filling rate(PFR),peak ejection rate(PER), time of PFR(TPFR) and time of PER(TPER) were estimated.Results Significant differences among clinical severity groups (A, B, C) divided by NYHA class were noted in left ventricular function quantitative by MRI. The means of LVESV,LVEDV, LVEF,PER,PFR in group A, B and C had significant difference(P< 0.05),no significant differences occurred on means of LVMM,SV,CO,TPFR,TPER(P> 0.05).The extent of left ventricular noncompaction, NC/C maximum ratioand the degree of trabecular delayed hyper enhancement correlated significantly with ejection fraction (LVEF),(r=0.376,0.45,0.501, P<0.05).Conclusion Cardiac MRI allows for reliable assessment of systolic and diastolic left ventricular function. Evaluating the extent and severity of left ventricular noncompaction and delayed hyperenhancement may improve the ability of predict LVEF of IVNC.PARTⅣ:Elevated plasma N-terminal pro-B-type natriuretic peptide level in isolated ventriclar noncompaction:Correlation with left ventricular function and delayed contrast enhancement of cardiac MRIObjective To determine the correlation between the plasma NT-proBNP and left ventricular function, delayed contrast-enhancement extent of cardiac MRI and to evaluate the diagnosis values of NT-proBNP in IVNC patient with heart failure.Materials and Methods Twenty-one IVNC patients diagnosed by echocardiography underwent MRI,ECG gated trueFISP and Phase-sensitive Inversion Recovery imaging were performed, including four chamber view, two chamber view and short axis view of left ventricle. Plasma NT-proBNP concentrations were measured with immunoradiometric assay and MRI were detected in all patients to measure left ventricular function and extent of delayed contrast-enhancement.Results Plasma NT-proBNP was increased in patients with IVNC compared to control subjects. NT-proBNP were correlated with LVEDV, LVESV and LVEF in IVNC patients(r=0.69,0.749,0.48, P<0.01). Conclusion The plasma NT-proBNP levels showed significant correlation with LVEDV, LVESV and LVEF. It suggests that NT-proBNP might be used to evaluate the heart failure and to predict prognosis.