Case report
Cardiac magnetic resonance in a patient with MRI-conditional pacemaker
Ressonância magnética cardíaca numa doente com pacemaker RM-condicional
Read
7477
Timeswas read the article
1762
Total PDF
5715
Total HTML
Share statistics
array:24 [ "pii" => "S2174204913000457" "issn" => "21742049" "doi" => "10.1016/j.repce.2013.02.007" "estado" => "S300" "fechaPublicacion" => "2013-02-01" "aid" => "211" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:159-62" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4360 "formatos" => array:3 [ "EPUB" => 158 "HTML" => 3505 "PDF" => 697 ] ] "itemSiguiente" => array:19 [ "pii" => "S2174204913000469" "issn" => "21742049" "doi" => "10.1016/j.repce.2013.02.008" "estado" => "S300" "fechaPublicacion" => "2013-02-01" "aid" => "212" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:163-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2957 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 2255 "PDF" => 564 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in cardiology</span>" "titulo" => "Novel mutation in the <span class="elsevierStyleItalic">KCNH2</span> gene associated with long QT syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "163" "paginaFinal" => "164" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Nova mutação identificada no gene <span class="elsevierStyleItalic">KCNH2</span> associado à síndrome do QT longo" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3035 "Ancho" => 3000 "Tamanyo" => 1065308 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) and (B) The first two electrocardiograms, with corrected QT interval between 428 and 468 ms. (C) The novel mutation identified in exon 4 of the <span class="elsevierStyleItalic">KCNH2</span> gene.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Doroteia Silva, Gabriel Miltenberger-Miltenyi, Maria José Correia, António Nunes Diogo" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Doroteia" "apellidos" => "Silva" ] 1 => array:2 [ "nombre" => "Gabriel" "apellidos" => "Miltenberger-Miltenyi" ] 2 => array:2 [ "nombre" => "Maria José" "apellidos" => "Correia" ] 3 => array:2 [ "nombre" => "António Nunes" "apellidos" => "Diogo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000469?idApp=UINPBA00004E" "url" => "/21742049/0000003200000002/v1_201305171228/S2174204913000469/v1_201305171228/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S2174204913000275" "issn" => "21742049" "doi" => "10.1016/j.repce.2013.01.014" "estado" => "S300" "fechaPublicacion" => "2013-02-01" "aid" => "197" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2013;32:153-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6725 "formatos" => array:3 [ "EPUB" => 158 "HTML" => 5560 "PDF" => 1007 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Subvalvular aortic stenosis associated with 8p23 deletion" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "153" "paginaFinal" => "157" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Estenose aórtica subvalvular associada à deleção 8p23" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1465 "Ancho" => 1502 "Tamanyo" => 187152 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Echocardiogram.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Patrício Aguiar, Diogo Cruz, Rita Ferro Rodrigues, Francisco Araújo, José Luís Ducla Soares" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Patrício" "apellidos" => "Aguiar" ] 1 => array:2 [ "nombre" => "Diogo" "apellidos" => "Cruz" ] 2 => array:2 [ "nombre" => "Rita Ferro" "apellidos" => "Rodrigues" ] 3 => array:2 [ "nombre" => "Francisco" "apellidos" => "Araújo" ] 4 => array:2 [ "nombre" => "José Luís" "apellidos" => "Ducla Soares" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "pt" => array:9 [ "pii" => "S0870255112003010" "doi" => "10.1016/j.repc.2012.05.025" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "pt" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255112003010?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000275?idApp=UINPBA00004E" "url" => "/21742049/0000003200000002/v1_201305171228/S2174204913000275/v1_201305171228/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Cardiac magnetic resonance in a patient with MRI-conditional pacemaker" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "159" "paginaFinal" => "162" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "António Miguel Ferreira, Lígia Mendes, Luís Soares, Maria da Graça Correia, Victor Gil" "autores" => array:5 [ 0 => array:4 [ "nombre" => "António Miguel" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "miguelferreira.md@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Lígia" "apellidos" => "Mendes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Luís" "apellidos" => "Soares" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Maria" "apellidos" => "da Graça Correia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Victor" "apellidos" => "Gil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital dos Lusíadas, Lisboa, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de São Bernardo, Setúbal, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Serviço de Imagiologia, Hospital dos Lusíadas, Lisboa, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Ressonância magnética cardíaca numa doente com <span class="elsevierStyleItalic">pacemaker</span> RM-condicional" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 896 "Ancho" => 900 "Tamanyo" => 54424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">b-SSFP cine image of the aortic valve at end-systole, showing moderate aortic stenosis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The presence of implantable cardiovascular electronic devices (pacemakers, implantable cardioverter-defibrillators and cardiac resynchronization devices) is generally considered a contraindication for magnetic resonance imaging (MRI) due to safety issues.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> Potential adverse interactions between pacemakers and MRI include heating, induction of ventricular fibrillation, rapid atrial or ventricular pacing, reed switch malfunction, asynchronous pacing, inhibition of pacing output, alteration of programming with potential damage to the pacemaker circuitry, and movement of the device.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This contraindication is particularly important due to the parallel exponential growth in both the use of MRI and the number of patients with such devices,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> 50–75% of whom are expected to need an MRI during their lifetime.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The recent introduction of MRI-conditional pacemakers represents an important step in overcoming one of the major limitations of MRI.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 68-year-old woman with a history of longstanding hypertension presented to the emergency department with pre-syncope and heart rate <30 bpm. The ECG revealed complete heart block, which persisted after the washout time of heart rate-lowering drugs, thus establishing the need for pacemaker implantation. Her echocardiogram showed good left ventricular systolic function, moderate septal hypertrophy with a speckled appearance, and moderate aortic stenosis. The patient's older sister had died recently from biopsy-proven amyloid heart disease and it was noted that the echocardiograms of both patients (performed four years apart) were remarkably similar. Her sister's differential diagnosis between senile amyloidosis vs. familial amyloidosis restricted to the heart was very difficult to achieve since all other organs seemed to be spared. She did not have signs of neuropathy or nephropathy, rectal and abdominal fat biopsies were negative, as were studies for AL and AA amyloidosis. Endomyocardial biopsy was only performed after a cardiac MRI that was highly suggestive of cardiac amyloidosis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the foreseeable need for cardiac MRI in our patient, an MRI-conditional dual chamber pacemaker was implanted (Ensura DR MRI™ SureScan™ EN1DR01 with 5086 leads, Medtronic<span class="elsevierStyleSup">®</span>). Subsequently, cardiac MRI was requested to assess for amyloid heart disease as a possible concurrent cause for this patient's left ventricular hypertrophy. Prior to scanning on a 1.5 T MRI system, the device was interrogated, lead integrity checked and the pacemaker was switched to DOO mode at 60 bpm at 5 V @ 1 ms. The exam was well tolerated and completely uneventful. After scanning, all parameters were reviewed to verify that they were unaffected, and normal operation was resumed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Cardiac MRI showed predominantly septal left ventricular (LV) hypertrophy, maximal end-diastolic wall thickness of 16 mm, and an estimated LV mass of 78 g/m<span class="elsevierStyleSup">2</span> (normal values for women >35 years of age: 34–70 g/m<span class="elsevierStyleSup">2</span>).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> LV volumes and systolic function were normal, with no regional wall motion abnormalities. Metallic artefacts from the pacemaker lead and generator were visible but did not hinder image analysis and interpretation (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). Cine imaging of the aortic valve confirmed the presence of moderate aortic stenosis (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Delayed enhancement imaging (10 minutes after intravenous injection of gadopentetate dimeglumine) showed no areas of hyperenhancement (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). Overall, these findings are consistent with LV hypertrophy secondary to hypertension and aortic stenosis. Nonetheless, since the absence of delayed enhancement is insufficient to rule out cardiac amyloidosis in its early stages,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> diagnostic workup continues and a follow-up cardiac MRI is scheduled in one year.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The first MRI-conditional pacemaker was introduced in 2010 and was initially approved for use in 1.5 T MRI scanners to image all body regions except the chest. The latest systems (such as the one our patient received) have recently been approved for imaging all body regions (chest included), thus making cardiac MRI possible.</p><p id="par0030" class="elsevierStylePara elsevierViewall">MRI-conditional devices differ from standard pacemakers in several aspects. The amount of ferromagnetic material is minimized, the pacemaker leads are insulated (minimizing increases in temperature), and the gradient and radiofrequency fields do not interfere with the pacing function (so long as MRI mode is activated). Even though MRI-conditional pacemakers are specially designed for safe use in the MRI environment, it should be emphasized that scanning patients with such devices is only safe if a certain number of conditions are fulfilled. Prior to scanning, the MRI-conditional nature of both pacemaker generator and leads should be confirmed (this can be done by looking for specific markers on a chest radiograph), and the absence of other cardiac leads or electromagnetic cardiac devices must be ensured. A special programming mode (MRI mode) must be set on the MRI-conditional pacemaker before the scan, and turned off immediately afterwards. Close cooperation between cardiologist and radiologist is therefore mandatory. So far, scanning can only take place in MRI scanners with a field strength of 1.5 T, and limits in specific absorption rate and gradient slew rate should be observed.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Despite these constraints, the introduction of MRI-conditional devices overcomes an important limitation of MRI, allowing clinicians to take full advantage of this imaging method in the growing number of patients with a cardiac pacemaker. For this reason, it is very likely that MRI-compatible pacemakers will become standard of care in the near future. Meanwhile, at least those patients requiring a pacemaker who also have pre-existing comorbidities of an oncological, neurological, orthopedic or cardiovascular disease should be proposed for implantation of an MRI-conditional device.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This case illustrates the feasibility of cardiac MRI in this setting and the usefulness of the recently introduced MRI-conditional pacemaker systems. To the best of our knowledge, this was also the first cardiac MRI performed in Portugal on a patient with an MRI-conditional pacemaker. We welcome it as the first of many to come.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:2 [ "identificador" => "xres177662" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec166317" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres177663" "titulo" => "Resumo" ] 3 => array:2 [ "identificador" => "xpalclavsec166316" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:3 [ "identificador" => "sec0020" "titulo" => "Ethical disclosures" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Confidentiality of data" ] ] ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-10-17" "fechaAceptado" => "2012-10-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec166317" "palabras" => array:3 [ 0 => "Cardiac magnetic resonance imaging" 1 => "Pacemaker" 2 => "MRI-conditional pacemaker" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec166316" "palabras" => array:3 [ 0 => "Ressonância magnética cardíaca" 1 => "Pacemaker" 2 => "Pacemaker RM-condicional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">An implanted pacemaker is generally considered a contraindication for magnetic resonance imaging (MRI). The increasing number of indications for MRI and the rising prevalence of implanted cardiac pacemakers have prompted the recent development of MRI-conditional pacemaker systems.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 68-year-old woman with left ventricular hypertrophy, hypertension, aortic valve stenosis and a family history of cardiac amyloidosis, who developed complete heart block. In view of the foreseeable need for cardiac MRI, an MRI-conditional dual chamber pacemaker was implanted. The MRI scan confirmed moderate left ventricular hypertrophy and aortic valve stenosis, and showed no delayed enhancement suggestive of amyloid heart disease. This case illustrates the feasibility of cardiac MRI in this setting and the usefulness of the recently introduced MRI-conditional pacemaker systems.</p>" ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A presença de um pacemaker é habitualmente considerada uma contra-indicação para a realização de ressonância magnética (RM). O número crescente de indicações para RM e de doentes portadores de pacemaker motivaram o desenvolvimento de pacemakers RM-condicionais.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Apresentamos o caso de uma mulher de 68 anos com hipertrofia ventricular esquerda, hipertensão arterial, estenose valvular aórtica e história familiar de amiloidose cardíaca, que desenvolveu bloqueio auriculo-ventricular completo. Devido à necessidade previsível de realizar uma RM cardíaca, foi-lhe implantado um pacemaker RM-condicional. A RM cardíaca confirmou a hipertrofia ventricular esquerda moderada e estenose valvular aórtica, não tendo evidenciado realce tardio sugestivo de amiloidose cardíaca. Este caso ilustra a exequibilidade da RM cardíaca neste contexto e a utilidade dos pacemakers RM-condicionais actualmente ao nosso dispor.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 810 "Ancho" => 1800 "Tamanyo" => 155239 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Balanced steady-state free precession (b-SSFP) cine images depicting the left ventricle at end-diastole in short-axis views from base to apex. Note the increased septal wall thickness and the metallic artefact from the pacemaker generator (arrows) and lead (arrowheads).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 896 "Ancho" => 900 "Tamanyo" => 54424 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">b-SSFP cine image of the aortic valve at end-systole, showing moderate aortic stenosis.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 464 "Ancho" => 1600 "Tamanyo" => 87075 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Inversion recovery delayed enhancement images in 2-, 3- and 4-chamber views (A, B and C, respectively) demonstrating the absence of areas of hyperenhancement.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Safety of magnetic resonance imaging in patients with cardiovascular devices: an American Heart Association scientific statement from the Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology, and the Council on Cardiovascular Radiology and Intervention: endorsed by the American College of Cardiology Foundation, the North American Society for Cardiac Imaging, and the Society for Cardiovascular Magnetic Resonance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G.N. Levine" 1 => "A.S. Gomes" 2 => "A.E. Arai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.107.187256" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2007" "volumen" => "116" "paginaInicial" => "2878" "paginaFinal" => "2891" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18025533" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Roguin" 1 => "J. Schwitter" 2 => "C. Vahlhaus" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/europace/eun021" "Revista" => array:6 [ "tituloSerie" => "Europace" "fecha" => "2008" "volumen" => "10" "paginaInicial" => "336" "paginaFinal" => "346" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18308754" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Magnetic resonance imaging and cardiac pacemaker safety at 1.5-Tesla" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "E.T. Martin" 1 => "J.A. Coman" 2 => "F.G. Shellock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2003.12.016" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2004" "volumen" => "43" "paginaInicial" => "1315" "paginaFinal" => "1324" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15063447" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Current clinical issues for MRI scanning of pacemaker and defibrillator patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Kalin" 1 => "M.S. Stanton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1540-8159.2005.50024.x" "Revista" => array:6 [ "tituloSerie" => "Pacing Clin Electrophysiol" "fecha" => "2005" "volumen" => "28" "paginaInicial" => "326" "paginaFinal" => "328" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15826268" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "L.E. Hudsmith" 1 => "S.E. Petersen" 2 => "J.M. Francis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Cardiovasc Magn Reson" "fecha" => "2005" "volumen" => "7" "paginaInicial" => "775" "paginaFinal" => "782" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16353438" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and management of the cardiac amyloidoses" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.H. Falk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCULATIONAHA.104.489187" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2005" "volumen" => "112" "paginaInicial" => "2047" "paginaFinal" => "2060" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16186440" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003200000002/v1_201305171228/S2174204913000457/v1_201305171228/en/main.assets" "Apartado" => array:4 [ "identificador" => "9919" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003200000002/v1_201305171228/S2174204913000457/v1_201305171228/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204913000457?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 1 | 6 |
| 2024 October | 39 | 29 | 68 |
| 2024 September | 49 | 19 | 68 |
| 2024 August | 46 | 26 | 72 |
| 2024 July | 31 | 39 | 70 |
| 2024 June | 36 | 19 | 55 |
| 2024 May | 37 | 19 | 56 |
| 2024 April | 30 | 24 | 54 |
| 2024 March | 32 | 19 | 51 |
| 2024 February | 28 | 22 | 50 |
| 2024 January | 28 | 24 | 52 |
| 2023 December | 11 | 26 | 37 |
| 2023 November | 33 | 26 | 59 |
| 2023 October | 27 | 19 | 46 |
| 2023 September | 19 | 21 | 40 |
| 2023 August | 37 | 14 | 51 |
| 2023 July | 35 | 20 | 55 |
| 2023 June | 25 | 14 | 39 |
| 2023 May | 47 | 19 | 66 |
| 2023 April | 18 | 5 | 23 |
| 2023 March | 44 | 18 | 62 |
| 2023 February | 28 | 21 | 49 |
| 2023 January | 39 | 9 | 48 |
| 2022 December | 45 | 19 | 64 |
| 2022 November | 39 | 28 | 67 |
| 2022 October | 34 | 19 | 53 |
| 2022 September | 32 | 18 | 50 |
| 2022 August | 37 | 26 | 63 |
| 2022 July | 35 | 29 | 64 |
| 2022 June | 30 | 19 | 49 |
| 2022 May | 27 | 28 | 55 |
| 2022 April | 47 | 22 | 69 |
| 2022 March | 24 | 34 | 58 |
| 2022 February | 33 | 13 | 46 |
| 2022 January | 43 | 13 | 56 |
| 2021 December | 36 | 29 | 65 |
| 2021 November | 40 | 26 | 66 |
| 2021 October | 42 | 34 | 76 |
| 2021 September | 36 | 28 | 64 |
| 2021 August | 57 | 29 | 86 |
| 2021 July | 37 | 25 | 62 |
| 2021 June | 48 | 17 | 65 |
| 2021 May | 47 | 34 | 81 |
| 2021 April | 144 | 36 | 180 |
| 2021 March | 62 | 13 | 75 |
| 2021 February | 80 | 12 | 92 |
| 2021 January | 43 | 9 | 52 |
| 2020 December | 37 | 6 | 43 |
| 2020 November | 24 | 7 | 31 |
| 2020 October | 23 | 5 | 28 |
| 2020 September | 55 | 6 | 61 |
| 2020 August | 18 | 3 | 21 |
| 2020 July | 41 | 6 | 47 |
| 2020 June | 42 | 1 | 43 |
| 2020 May | 44 | 4 | 48 |
| 2020 April | 42 | 5 | 47 |
| 2020 March | 48 | 6 | 54 |
| 2020 February | 121 | 14 | 135 |
| 2020 January | 40 | 11 | 51 |
| 2019 December | 26 | 10 | 36 |
| 2019 November | 29 | 6 | 35 |
| 2019 October | 46 | 6 | 52 |
| 2019 September | 22 | 9 | 31 |
| 2019 August | 34 | 6 | 40 |
| 2019 July | 34 | 11 | 45 |
| 2019 June | 23 | 13 | 36 |
| 2019 May | 38 | 9 | 47 |
| 2019 April | 39 | 17 | 56 |
| 2019 March | 155 | 7 | 162 |
| 2019 February | 103 | 10 | 113 |
| 2019 January | 78 | 5 | 83 |
| 2018 December | 68 | 7 | 75 |
| 2018 November | 81 | 5 | 86 |
| 2018 October | 121 | 29 | 150 |
| 2018 September | 50 | 7 | 57 |
| 2018 August | 27 | 11 | 38 |
| 2018 July | 23 | 7 | 30 |
| 2018 June | 53 | 7 | 60 |
| 2018 May | 57 | 5 | 62 |
| 2018 April | 74 | 9 | 83 |
| 2018 March | 70 | 11 | 81 |
| 2018 February | 55 | 2 | 57 |
| 2018 January | 60 | 5 | 65 |
| 2017 December | 92 | 12 | 104 |
| 2017 November | 61 | 12 | 73 |
| 2017 October | 34 | 21 | 55 |
| 2017 September | 37 | 4 | 41 |
| 2017 August | 46 | 11 | 57 |
| 2017 July | 32 | 9 | 41 |
| 2017 June | 41 | 9 | 50 |
| 2017 May | 40 | 7 | 47 |
| 2017 April | 43 | 2 | 45 |
| 2017 March | 73 | 25 | 98 |
| 2017 February | 61 | 8 | 69 |
| 2017 January | 32 | 2 | 34 |
| 2016 December | 49 | 8 | 57 |
| 2016 November | 36 | 2 | 38 |
| 2016 October | 42 | 4 | 46 |
| 2016 September | 54 | 3 | 57 |
| 2016 August | 20 | 5 | 25 |
| 2016 July | 25 | 3 | 28 |
| 2016 June | 14 | 2 | 16 |
| 2016 May | 9 | 5 | 14 |
| 2016 April | 27 | 1 | 28 |
| 2016 March | 38 | 11 | 49 |
| 2016 February | 36 | 9 | 45 |
| 2016 January | 30 | 4 | 34 |
| 2015 December | 25 | 5 | 30 |
| 2015 November | 23 | 0 | 23 |
| 2015 October | 33 | 5 | 38 |
| 2015 September | 26 | 7 | 33 |
| 2015 August | 28 | 4 | 32 |
| 2015 July | 28 | 2 | 30 |
| 2015 June | 21 | 4 | 25 |
| 2015 May | 29 | 12 | 41 |
| 2015 April | 47 | 11 | 58 |
| 2015 March | 20 | 3 | 23 |
| 2015 February | 19 | 5 | 24 |
| 2015 January | 21 | 7 | 28 |
| 2014 December | 34 | 9 | 43 |
| 2014 November | 21 | 3 | 24 |
| 2014 October | 12 | 4 | 16 |
| 2014 September | 15 | 6 | 21 |
| 2014 August | 28 | 8 | 36 |
| 2014 July | 38 | 13 | 51 |
| 2014 June | 20 | 8 | 28 |
| 2014 May | 26 | 7 | 33 |
| 2014 April | 18 | 5 | 23 |
| 2014 March | 42 | 16 | 58 |
| 2014 February | 44 | 5 | 49 |
| 2014 January | 27 | 9 | 36 |
| 2013 December | 33 | 20 | 53 |
| 2013 November | 30 | 12 | 42 |
| 2013 October | 37 | 12 | 49 |
| 2013 September | 40 | 9 | 49 |
| 2013 August | 40 | 13 | 53 |
| 2013 July | 43 | 9 | 52 |
| 2013 June | 34 | 7 | 41 |
| 2013 May | 33 | 10 | 43 |
| 2013 April | 45 | 22 | 67 |
| 2013 March | 40 | 10 | 50 |
Show all
