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Cardiac Magnetic Resonance Imaging (cardiac + magnetic_resonance_imaging)

Distribution by Scientific Domains

Medical Sciences	96%

Distribution within Medical Sciences

Cardiovascular Disease	35%
General & Internal Medicine	23%

Selected Abstracts

Dobutamine Stress Cardiac Magnetic Resonance Imaging to Detect Myocardial Ischemia in Women

PREVENTIVE CARDIOLOGY, Issue 3 2008
Subha V. Raman MD
This study sought to evaluate dobutamine stress cardiac magnetic resonance imaging (DCMRI) in women with abnormal stress nuclear testing results. Women with findings on stress nuclear exams, including electrocardiography and/or perfusion, thought to require further evaluation with invasive coronary angiography were prospectively enrolled. Multiplane cine imaging was obtained at rest and at each stage of inotropic stress with atropine as needed to achieve target heart rate. DCMRI results were compared with stress nuclear and invasive cardiac catheterization results. Of 23 patients enrolled successfully, 22 completed DCMRI examination without complications. In all cases, DCMRI imaging demonstrated appropriate stress response with no ischemia despite abnormalities on stress nuclear testing. In the 18 patients who also underwent invasive coronary angiography, no significant obstructive disease was identified. DCMRI may be a useful alternative to stress nuclear examination in women; larger studies are warranted to determine its potential to more accurately predict obstructive coronary artery disease. [source]

Fragmented QRS Complexes on 12-Lead ECG: A Marker of Cardiac Sarcoidosis as Detected by Gadolinium Cardiac Magnetic Resonance Imaging

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2009
Mohamed Homsi M.D.
Background: Fragmented QRS complexes (fQRS) on a 12-lead ECG are a marker of myocardial scar in patients with coronary artery disease. Cardiac sarcoidosis is also associated with myocardial granuloma formation and scarring. We evaluated the significance of fQRS on a 12-lead ECG compared to Gadolinium-delayed enhancement images (GDE) in cardiac magnetic resonance imaging (CMR). Method and results: The ECGs of patients (n = 17, mean age: 52 ± 11 years, male: 53%) with established diagnosis of sarcoidosis who underwent a CMR for evaluation of cardiac involvement were studied. ECG abnormalities included bundle branch block, Q wave, and fQRS. fQRS, Q wave, and bundle branch block were present in 9 (53%), 1 (6%), and 4 (24%) patients, respectively. The sensitivity and specificity of fQRS for detecting abnormal GDE were 100% and 80%, respectively. Sensitivity and specificity of Q waves were 11% and 100%, respectively. Conclusions: fQRS on a 12-lead ECG in patients with suspected cardiac sarcoidosis are associated with cardiac involvement as detected by GDE on CMR. [source]

Effect of reduced total blood volume on left ventricular volumes and kinetics in type 2 diabetes

ACTA PHYSIOLOGICA, Issue 1 2010
S. Lalande
Abstract Aim:, Although impaired left ventricular (LV) diastolic function is commonly observed in patients with type 2 diabetes, it remains unclear whether the impairment is caused by altered LV relaxation or changes in LV preload. The purpose of this study was to examine the influence of LV function and LV loading conditions on stroke volume in men with type 2 diabetes. Methods:, Cardiac magnetic resonance imaging scans were performed in eight men with type 2 diabetes and 11 non-diabetic men matched for age, weight and physical activity level. Total blood volume was determined with the Evans blue dye dilution technique. Results:, End-diastolic volume (EDV), the ratio of peak early to late mitral inflow velocity (E/A) and stroke volume were lower in men with type 2 diabetes than in non-diabetic individuals. Peak filling rate and peak ejection rate were not different between diabetic and non-diabetic individuals; however, men with type 2 diabetes had proportionally longer systolic duration than non-diabetic individuals. Heart rate was higher and total blood volume was lower in men with type 2 diabetes. The lower total blood volume was correlated with a lower EDV in men with type 2 diabetes. Conclusions:, Men with type 2 diabetes have an altered cardiac cycle and lower end-diastolic and stroke volume. A lower total blood volume and higher heart rate in men with type 2 diabetes suggest that changes in LV preload, independent of changes in LV relaxation or contractility, influence LV diastolic filling and stroke volume in this population. [source]

Live/Real Time Three-Dimensional Transthoracic Echocardiographic Assessment of Left Ventricular Volumes, Ejection Fraction, and Mass Compared with Magnetic Resonance Imaging

ECHOCARDIOGRAPHY, Issue 2 2007
Xin Qi M.D.
Due to reliance upon geometric assumptions and foreshortening issues, the traditionally utilized transthoracic two-dimensional echocardiography (2DTTE) has shown limitations in assessing left ventricular (LV) volume, mass, and function. Cardiac magnetic resonance imaging (MRI) has shown potential in accurately defining these LV characteristics. Recently, the emergence of live/real time three-dimensional (3D) TTE has demonstrated incremental value over 2DTTE and comparable value with MRI in assessing LV parameters. Here we report 58 consecutive patients with diverse cardiac disorders and clinical characteristics, referred for clinical MRI studies, who were evaluated by cardiac MRI and 3DTTE. Our results show good correlation between the two modalities. [source]

Role of cardiac magnetic resonance imaging in ischaemic heart disease

INTERNAL MEDICINE JOURNAL, Issue 9 2009
J. Wright
Abstract Cardiac magnetic resonance imaging is a new imaging method that has much to offer clinicians caring for patients with ischaemic heart disease. This article describes briefly the basic principles and practical aspects of cardiac magnetic resonance imaging, and summarizes the pathophysiology of ischaemic heart disease. Then it discusses in detail the use of cardiac magnetic resonance imaging for detection of coronary artery disease, and for assessment of acute and stable coronary syndromes. [source]

Cardiac magnetic resonance imaging in the evaluation of cardiac sarcoidosis: an Australian single-centre experience

INTERNAL MEDICINE JOURNAL, Issue 2 2009
V. Manins
Abstract Background:, Cardiac involvement in systemic sarcoidosis is common; however, current diagnostic tools are imprecise. Recognition of cardiac sarcoidosis (CS) is important as it has a relatively poor prognosis. Gadolinium-enhanced cardiac magnetic resonance imaging (Gad-CMR) is emerging as an excellent technique in determining the presence of and extent to which cardiac muscle is affected by sarcoidosis. Methods:, A retrospective analysis was performed on all patients with biopsy-proven systemic sarcoidosis referred for Gad-CMR scanning to evaluate potential cardiac involvement. All patients also underwent an electrocardiogram, Holter monitor and echocardiography. Gallium-67 radionuclide investigation, positron emission tomography and cardiac biopsy were ordered at the discretion of the treating physician. Results:, Eleven of the 20 patients had Gad-CMR images supportive of the diagnosis of CS. Eight of these 11 patients met the Japanese Ministry of Health and Welfare (JMHW) criteria for the diagnosis of CS; three abnormal Gad-CME scans consistent with diagnosis of CS were seen in patients who did not meet JMHW criteria. No patients with normal Gad-CMR scan met JMHW criteria for CS. Conclusion:, These findings suggest that Gad-CMR is potentially superior to the JMHW criteria in the diagnosis of cardiac sarcoidosis. [source]

Improvement of biventricular function after transcatheter closure of atrial septal defect: A case report

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 5 2006
Yat-Yin Lam MRCP
Abstract We report a 17-year-old man presented with palpitation. Echocardiography demonstrated secundum atrial septal defect (ASD) with marked right sided dilatation, indicating significant left to right intracardiac shunting. Cardiac magnetic resonance imaging performed 3 months after transcatheter ASD closure demonstrated marked improvement in biventricular systolic function. © 2005 Wiley-Liss, Inc. [source]

Diagnostic performance of cardiac magnetic resonance imaging in coronary artery disease

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 2 2010
Jussi P. Pärkkä
Summary Background:, Cardiac magnetic resonance imaging (CMR) is a promising method for detecting coronary artery disease (CAD). The first reports of new diagnostic techniques indicated generally unrealistic diagnostic performance relying on retrospectively observed cut-off values of quantitative parameters. Although visual analysis of CMR is the most applicable method for clinical work, its diagnostic performance is not fully elucidated for study components such as wall motion, perfusion and late enhancement in patients with different severity of CAD. Methods:, A total of 30 subjects including 20 patients with CAD and 10 healthy volunteers were selected for the study. Of the patients, ten had stable CAD, five confirmed myocardial infarction (MI) without Q-waves in electrocardiogram (ECG) and five confirmed MI with Q-waves in ECG. All patients underwent coronary angiography and CMR for evaluating resting wall motion, rest and stress perfusion and late enhancement. Results:, Combining the data from the three CMR techniques, 12 out of 20 patients were correctly identified as having CAD, and all controls were found to be healthy. Sensitivity, specificity, accuracy, positive and negative predictive values were 60·0%, 100·0%, 73·0%, 100·0% and 55·6%, respectively. Of the CMR components, resting wall motion and late enhancement gave the most diagnostic yield. Conclusions:, We conclude that evaluation of CAD is feasible in patients with different severity of CAD using visually analysed CMR, especially when available CMR methodologies are combined together. [source]

Cardiac magnetic resonance imaging in valvular heart disease

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 4 2009
Juha W. Koskenvuo
Summary Cardiac magnetic resonance imaging (CMR) has rapidly gained acceptance as an accurate, reproducible and non-invasive imaging method for assessment of a wide range of cardiovascular diseases. However, CMR has not been used widely for diagnostic purposes in valvular heart disease (VHD). Unlike echocardiography it has no body habitus-related limitations and can thus be used to complement echocardiography. It is an especially good alternative for clinical follow-up in patients with VHD, as it allows accurate measurement of valvular dysfunction and related ventricular burden. Additionally, CMR is an ideal method for evaluating complex congenital heart disease and determining the significance of its components. It can also be used to study the physiological course of valvular dysfunction and response to therapeutic interventions. In this review, we present a basic introduction to CMR methodology, including its advantages and potential problems, and the physiology and quantification in VHD. We also discuss clinical applications of CMR in VHD. Furthermore, we describe how a CMR study statement should be structured in order to increase clinical use of this valuable methodology in cardiology. [source]

Quantification of left ventricular volumes and ejection fraction from gated 99mTc-MIBI SPECT: MRI validation of the exini heart software package

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 2 2009
Oliver H. Winz
Summary The aim of the study was to validate the accuracy of the exini heart software (exini) package in assessing left ventricular end-diastolic/systolic volumes (EDV, ESV) and ejection fraction (LVEF) from gated 99mTc-MIBI single-photon emission tomography (SPECT). Cardiac magnetic resonance imaging (cMRI) was used as reference. Furthermore, effects of perfusion defects and image quality in SPECT on correlation between gated SPECT and magnetic resonance imaging were investigated. Methods:, Seventy patients were examined using gated SPECT (rest study, eight gates per cardiac cycle). EDV, ESV and LVEF were calculated from gated SPECT using exini. Directly before or after SPECT, cMRI (20 gates cardiac per cycle) was performed. EDV, ESV and LVEF were calculated using Simpson's rule. Perfusion defects were quantified using the summed-rest-score (SRS). Total number of myocardial counts were used to rate image quality. Results:, Correlation between results of gated SPECT and cMRI was high for EDV (R = 0·89) and ESV (R = 0·94) and good for LVEF (R = 0·78). ESV (exini 54 ± 31 ml versus cMRI 57 ± 34 ml) and LVEF (exini 62·9 ± 11·7% versus cMRI 60·6 ± 13·9%) did not differ significantly whereas exini overestimated EDV significantly compared with cMRI (exini 144 ± 41 ml versus cMRI 137 ± 36 ml; P<0·005). No correlation was found between absolute differences of the results given by gated SPECT and cMRI and SRS or total myocardial counts (R < 0·18). Conclusion:, End-diastolic volume, ESV and LVEF calculated from gated SPECT using exini agree with cMRI over a wide range of values. Correlation between both the methods was good for EDV and ESV, and acceptable for LVEF. No relevant influence of image quality or SRS on the accuracy of exini results was found. [source]

Huge Left Ventricular Aneurysm in a Minimally Symptomatic 11-Year-Old Boy

CONGENITAL HEART DISEASE, Issue 1 2009
Stéphane Moniotte MD
ABSTRACT An 11-year-old boy presented with mild shortness of breath and tachycardia and was diagnosed with a huge left ventricular aneurysm ruptured in a secondary pseudoaneurysm. This report highlights the complementary use of echocardiography and cardiac magnetic resonance imaging in the preoperative assessment of this anomaly. [source]

Evaluation of Right Ventricular Fibrosis in Adult Congenital Heart Disease Using Gadolinium-enhanced Magnetic Resonance Imaging: Initial Experience in Patients with Right Ventricular Loading Conditions

CONGENITAL HEART DISEASE, Issue 5 2006
Lopa P. Hartke MD
ABSTRACT Objective., Gadolinium-enhanced cardiac magnetic resonance imaging has been used to show myocardial fibrosis, a finding that appears as late gadolinium enhancement. Its role in the evaluation of right ventricular fibrosis in congenital heart disease is unclear. The purpose of this study was to demonstrate late gadolinium enhancement of the right ventricle in adult and adolescent congenital heart disease and to investigate the relationship between this enhancement and clinical and pathophysiological data. Design., In total, 24 patients, 16 patients with congenital heart disease and right ventricular loading conditions and 8 controls, underwent gadolinium-enhanced viability imaging. Diagnoses varied and included repaired, palliated, and unrepaired lesions. The presence and extent of right ventricular late gadolinium enhancement was compared with patient clinical and hemodynamic data. Exact Wilcoxon tests, Fisher's exact tests, and Spearman's rank correlation were used to compare variables. Results., Nine of 16 patients (56%) were found to have right ventricular late gadolinium enhancement, ranging from 5% to 80% of right ventricular myocardium affected (mean 36.1%, SD 29.7). The combination of right ventricular systolic pressure ,98 mm Hg and systemic oxygen saturation ,93% strongly suggested the presence of right ventricular late gadolinium enhancement (positive predictive value 100%), but no single variable or combination of variables could reliably predict its absence (negative predictive values ,75%). Extent of right ventricular late gadolinium enhancement did not correlate with degree of either hypoxia or right ventricular hypertension. Conclusions., Gadolinium-enhanced cardiac magnetic resonance demonstrates right ventricular late gadolinium enhancement in some patients with congenital heart disease and right ventricular loading conditions. Clinical variables were associated with the presence of fibrosis but did not reliably predict severity. Myocardial preservation is likely a multifactorial process that may affect the right and left ventricles differently. [source]

ECHO ROUNDS: Percutaneous Balloon Valvuloplasty for Pulmonic Stenosis: The Role of Multimodality Imaging

ECHOCARDIOGRAPHY, Issue 2 2008
Davinder S. Jassal M.D., F.R.C.P.C.
Pulmonic valvular stenosis represents the most frequent cause of right ventricular outflow obstruction. Transthoracic echocardiography is the imaging modality of choice in the diagnosis, evaluation and longitudinal follow-up of individuals with pulmonic stenosis (PS). Although valvular PS is usually diagnosed by two-dimensional imaging, Doppler echocardiography allows for the quantification of severity of the valvular lesion. In patients with limited acoustic windows, computed tomography and cardiac magnetic resonance imaging may provide complementary anatomical characterization of the pulmonic annulus and valve prior to percutaneous balloon valvuloplasty. [source]

Correlation of echocardiography parameters with cardiac magnetic resonance imaging in transfusion-dependent thalassaemia major

EUROPEAN JOURNAL OF HAEMATOLOGY, Issue 1 2007
Athanassios Aessopos
Abstract Background and objective:,Heart iron load (cardiac Fe) can be indirectly quantified by cardiac magnetic resonance (CMR) T2*. CMR accessibility is limited, whereas echocardiography (Echo) is relatively inexpensive and readily available. The objective was to find Echo parameters that may be useful for predicting cardiac Fe. Design and methods:,We compared a number of parameters derived from Echo to cardiac Fe in 142 thalassaemia major patients who had undergone a CMR study. Results:,All patients with decreased left ventricular (LV) function had cardiac Fe. After removing those patients from the analysis, the total diameter index (Tdi) >5.57 cms/m2, left atrial diameter index >2.41 cm/m2, and the diastolic parameter E/A > 1.96 were highly specific (91.4%, 97.1% and 96.9% respectively) but had low sensitivity (31.8%, 20.45% and 21.8%) in predicting iron load. A right ventricular index >1.47 cm/m2, LV systolic index >2.26 cm/m2 or Tdi >6.26 cm/m2 discriminated between patients with no, or mild to moderate cardiac Fe from those with heavy load, with specificity of 91%, 98.5%, and 98.5%, respectively, but with low sensitivity. Interpretation and conclusions:,Echo parameters for cardiac Fe prediction have restricted value, whereas CMR is essential to assess cardiac Fe. However, patients with decreased LV systolic function should be considered a priori as having cardiac Fe, and chelation therapy should be intensified. This also applies to patients who have the above-described Echo criterion values, even if CMR is not available. Once a patient is found by CMR to have cardiac Fe, then the above Echo criterion values may be useful for ongoing monitoring. [source]

Role of cardiac magnetic resonance imaging in ischaemic heart disease

Cardiac magnetic resonance imaging in the evaluation of cardiac sarcoidosis: an Australian single-centre experience

Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography

JOURNAL OF INTERNAL MEDICINE, Issue 5 2002
C. M. Sköld
Abstract. Sköld CM, Larsen FF, Rasmussen E, Pehrsson SK, Eklund AG (Karolinska Hospital and Institutet, Stockholm, Sweden). Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography. J Intern Med 2002; 252: 465,471. Objectives. To elucidate whether cardiac magnetic resonance imaging (MRI) could be useful in disclosing structural changes in the myocardium in sarcoidosis patients and to relate echo-Doppler derived indices of left ventricular function to electrocardiogram (ECG) findings. Design. The MRI was performed in 18 consecutive patients with sarcoidosis. Left ventricular ejection fraction (LVEF), i.e. systolic function, was estimated echocardiographically by Simpson's two-dimensional method (n = 16). Diastolic function was estimated by age-corrected Doppler-derived indices: isovolumetric relaxation time (IVRT), deceleration time (DT) and early filling/atrial contraction ratio (E/A ratio). Results. Eleven patients had conduction defects or dysrhythmias (ECG+) whilst seven patients had a normal ECG (ECG,). In two patients, high signalling, contrast-enhanced, isolated regions, suggestive of deposits, were seen in the left ventricular myocardium on MRI. Both these patients had abnormal ECGs and signs of systolic and/or diastolic dysfunction on echocardiography. LVEF was subnormal in seven of 10 of the ECG+ patients and in two of six of the ECG,. Signs of diastolic dysfunction were found in 59% and 56% of the measurements in the ECG+ and ECG, patients, respectively. Conclusion. We conclude (i) that myocardial deposits on MRI in sarcoidosis patients have a high specificity for cardiac involvement but a rather low sensitivity; (ii) that a substantial proportion of sarcoidosis patients with abnormal ECGs have echocardiographic signs of systolic and/or diastolic dysfunction. [source]

Dobutamine Stress Cardiac Magnetic Resonance Imaging to Detect Myocardial Ischemia in Women

Fragmented QRS Complexes on 12-Lead ECG: A Marker of Cardiac Sarcoidosis as Detected by Gadolinium Cardiac Magnetic Resonance Imaging

Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: A controlled cardiac magnetic resonance imaging study

ARTHRITIS & RHEUMATISM, Issue 7 2010
Karim Sacré
Objective Antiphospholipid syndrome (APS) may cause coronary thrombosis. This study was undertaken to determine the prevalence of silent myocardial disease in patients with APS, using late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (CMRI). Methods Twenty-seven consecutive patients with APS and 81 control subjects without known cardiovascular disease underwent CMRI. The prevalence of occult myocardial ischemic disease, as revealed by LGE, was compared between patients with APS and controls, and factors associated with myocardial disease were identified in patients with APS. Results Myocardial ischemic disease, as characterized by LGE on CMRI, was present in 8 (29.6%) of 27 patients with APS, and imaging with LGE showed a typical pattern of myocardial infarction (MI) in 3 patients (11.1%). The myocardial scarring revealed on CMRI was not detected by electrocardiography or echocardiography. Although both patients with APS and control subjects shared a low risk of cardiovascular events, as calculated with the Framingham risk equation (mean ± SD 5.1 ± 8.2% and 6.5 ± 7.6%, respectively, for the absolute risk within the next 10 years; P = 0.932), the prevalence of myocardial ischemia was more than 7 times higher in patients with APS (P = 0.0006 versus controls). No association was found between myocardial disease in patients with APS and classic coronary risk factors. The presence of myocardial scarring tended to be more closely associated with specific features of APS, such as duration of the disease, presence of livedo, and positivity for anti,,2 -glycoprotein I antibodies. Conclusion The finding of a significant and unexpectedly high prevalence of occult myocardial scarring in patients with APS indicates the usefulness of CMRI with LGE for the identification of silent myocardial disease in such patients. [source]

Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging

ARTHRITIS & RHEUMATISM, Issue 4 2010
Jon T. Giles
Objective Heart failure is a major contributor to cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA), but little is known about myocardial structure and function in this population. This study was undertaken to assess the factors associated with progression to heart failure in patients with RA. Methods With the use of cardiac magnetic resonance imaging, measures of myocardial structure and function were assessed in men and women with RA enrolled in the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis study, a cohort study of subclinical cardiovascular disease in patients with RA, in comparison with non-RA control subjects from a cohort enrolled in the Baltimore Multi-Ethnic Study of Atherosclerosis. Results Measures of myocardial structure and function were compared between 75 patients with RA and 225 frequency-matched controls. After adjustment for confounders, the mean left ventricular mass was found to be 26 gm lower in patients with RA compared with controls (P < 0.001), an 18% difference. In addition, the mean left ventricular ejection fraction, cardiac output, and stroke volume were modestly lower in the RA group compared with controls. The mean left ventricular end systolic and end diastolic volumes did not differ between the groups. In patients with RA, higher levels of anti,cyclic citrullinated peptide (anti-CCP) antibodies and current use of biologic agents, but not other measures of disease activity or severity, were associated with significantly lower adjusted mean values for the left ventricular mass, end diastolic volume, and stroke volume, but not with ejection fraction. The combined associations of anti-CCP antibody level and biologic agent use with myocardial measures were additive, without evidence of interaction. Conclusion These findings suggest that the progression to heart failure in RA may occur through reduced myocardial mass rather than hypertrophy. Both modifiable and nonmodifiable factors may contribute to lower levels of left ventricular mass and volume. [source]

Cardiac involvement in Churg-Strauss syndrome

ARTHRITIS & RHEUMATISM, Issue 2 2010
Robert M. Dennert
Objective Churg-Strauss syndrome (CSS) is a rare form of systemic vasculitis. Previous studies showing cardiac involvement in CSS patients were limited in the number of patients and were often based solely on clinical manifestations. The aim of the present study was to determine in detail the incidence of cardiac involvement in a large population of ambulatory CSS patients. Methods Thirty-two consecutive patients with CSS in remission (mean ± SD duration of disease between diagnosis and enrollment 6.1 ± 5.8 years, mean ± SD age 61 ± 10 years) who were previously unaware of cardiac involvement were compared with 32 randomly selected age- and sex-matched control subjects, using clinical evaluation, electrocardiography (EKG), echocardiography, and cardiac magnetic resonance imaging (MRI). Results Detailed cardiac evaluation revealed a 62% prevalence of cardiac involvement in CSS patients compared with 3% in controls (P < 0.001), with clinical symptoms in 26% and 3%, respectively (P = 0.009), EKG abnormalities in 66% and 3%, respectively (P < 0.001), and echocardiographic defects in 50% and 3%, respectively (P < 0.001). Cardiac MRI detected cardiac manifestations in 62% of CSS patients. In the presence of cardiac MRI abnormalities, echocardiography could detect cardiac involvement with a sensitivity of 83% and a specificity of 80%. The absence of symptoms or EKG abnormalities did not exclude cardiac involvement, because abnormalities could still be detected in 38% of these patients at the time of echocardiography or cardiac MRI. Conclusion These results demonstrate a high incidence of cardiac involvement in CSS patients. Systematic cardiac evaluation including detailed imaging is required to properly identify CSS patients with cardiac involvement. [source]