22. Cleland JG, Butcher C. When is it appropriate to withdraw cardiac resynchronization therapy? Guesses and evidence. JACC Heart Fail 2015;3:337 –339. 23. Wikstrom BG, Lundqvist CB, Andren B, Lonnerholm S, Blomstrom P, Freemantle N, Remp T, Cleland JG. The effects of aetiology on outcome in patients treated with cardiac resynchronisation therapy in the CARE-HF trial. Eur Heart J 2009;30:782 –788. 24. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, Marco TD, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM, for the comparison of medical therapy padihfCi. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New Engl J Med 2004; 350:2140 –2150. 25. Gervais R, Leclercq C, Shankar A, Jacobs S, Eiskjær H, Johannessen A, Freemantle N, Cleland JGF, Tavazzi L, Daubert C, on behalf of the CARE-HF
Investigators. Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the CARE-HF trial. Eur J Heart Fail 2009;11:699–705. 26. Gold MR, The´bault C, Linde C, Abraham WT, Gerritse B, Ghio S, St John Sutton M, Daubert JC. Effect of QRS duration and morphology on cardiac resynchronization therapy outcomes in mild heart failure: results from the resynchronization reverses remodeling in systolic left ventricular dysfunction (REVERSE) study. Circulation 2012;126:822 –829. 27. Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A, Daubert JP, Estes NAM, Foster E, Greenberg H, Kautzner J, Klempfner R, Kuniss M, Merkely B, Pfeffer MA, Quesada A, Viskin S, McNitt S, Polonsky B, Ghanem A, Solomon SD, Wilber D, Zareba W, Moss AJ. Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med 2014;370:1694 –1701.
doi:10.1093/eurheartj/ehv098 Online publish-ahead-of-print 20 April 2015
Innominate artery pleomorphic sarcoma imaged with cardiovascular magnetic resonance and Positron Emission Tomography-Computed Tomography Anne E. Davis1,2*, Henry Boardman1, Sally Trent2, Mario Petrou2, and Saul G. Myerson1,2 1 University of Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, John Radcliffe Hospital, Oxford, UK; and 2Oxford University Hospitals NHS Trust, Oxford, UK
* Corresponding author. Tel: +44 7725322800, Email: [email protected]
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A 75-year-old man presented with a right brachial arterial embolus. Following embolectomy, histology of the embolus revealed sarcomatoid carcinoma and a subsequent Positron Emission Tomography-Computed Tomography scan showed increased tracer uptake in the innominate artery (Panel A). Cardiovascular magnetic resonance (CMR) demonstrated a moderate sized elongated mass in the proximal innominate artery measuring 29 × 9 m. A T2-weighted BLADE sequence (Siemens proprietary term) was used, acquired over 2 min with freebreathing diaphragmatic navigator gating (Panel B, oblique coronal plane). This demonstrated the mass more clearly, in addition to high T2-weighted signal (unusual for thrombus), though with some heterogeneity. Postgadolinium imaging revealed little uptake of contrast on early or late imaging. Shortly following his CMR scan, he developed symptoms consistent with a stroke and a CT scan confirmed a right cerebellar infarct. A staging CT did not demonstrate any metastatic spread and he underwent excision of the origin and proximal section of the innominate artery, which contained a pedunculated, gelatinous, and fibrinous mass. The superior aspect of the aortic arch and innominate artery were reconstructed with a Dacron patch and conduit. Histology of the resected tumour confirmed high grade pleomorphic sarcoma. He subsequently underwent Intensity-Modulated Radiotherapy to the affected region (Panel C—Intensity-Modulated Radiotherapy planning image). The patient made a good recovery and returned for a CMR scan 3 months later. T2 BLADE imaging revealed no residual mass and a patent innominate artery (Panel D) at both time points.