CMR Assessment of Viability: Case Based Review

Gerry McCannNIHR PD Fellow/Consultant CardiologistUniversity Hospitals Leicester/Leicester

Cardiovascular BRU

NO CONFLICT OF INTEREST TO DECLARE

Case 1• 78yo M• NSTEMI

– CK 1100 IU• ETT electrically +ve• Transferred from DGH angio ?proceed• Pain free for 5/7 since presentation• ECG normal• Echo

– Lat wall ? akinetic

CMR

Transmural Post-Lateral MI (OM)Discharged 2y prevention

Case 2

• 57 yo male• Diabetic• New angina last 2 weeks• ECG ant Q waves• Angiography

– LAD occluded– LV Mod-severe impaired

CMR: Viability LAD

Case 3

• 66 yr M diabetic

• First presentation– Late Ant STEMI– Trop I > 50,000, CK 2500 IU

• Angio ? proceed

CMR: Viability RCA and LAD

LGE

Stress Perfusion

Case 4

• 66 yo Male• Ant STEMI 2007

– Lysis– PCI to LAD/DI

• Presents with worsening angina• Angiography

AGIOGRAPHY

CMR VIABILITY:LGE

CMR: Rest and low dose Dobutamine

LV Function Post PCI

Thank you

Case 4

• 71yo male• Previous MI 1998• Permanent AF• Worsening angina

• Listed for angio graphy ? revascularisation

CMR for Viability: Cines

CMR: LGE

Rest and low dose Dobutamine