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Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative tool to evaluate LV function at the regional level. The purpose of this study was to classify the types of regional longitudinal strain curves (LSC). Moreover, we propose a novel longitudinal strain curve index (LSCI) which we compared to the wall motion score index (WMSI). We enrolled 100 healthy volunteers and 50 patients with prior myocardial infarction (MI). Each LSC was classified considering the positive peak (peak P), peak maximum strain (PMS), and time to maximum peak strain (TPMS) as follows: Type 1 (Peak P<6%, PMS>6%, TPMS before aortic valve closure [AVC]); Type 2 (Peak P<6%, PMS≥6%, TPMS after AVC); Type 3 (Peak P≥6%, PMS≥6%, TPMS before AVC); Type 4 (Peak P≥6%, PMS≥6%, TPMS after AVC); Type 5 (Peak P<6%, PMS≥6%, TPMS first third of systole); Type 6 (Peak P<6%, PMS<6%); and Type 7 (Peak P≥6%, PMS<6%). The longitudinal curve score index (LCSI) was obtained (sum of LSC type/18 segments). A total of seven types of LSC were identified. In the healthy subjects, LSC Type 1 (T1) and Type 2 (T2) were the most frequent. Type 3 (T3) and Type 4 (T4) were found in insignificant percentages while Type 5 (T5), Type 6 (T6), and Type 7 (T7) were not identified. When analyzed for the entire population, LSCI correlated strongly with WMSI (r=0.83, p<0.01). Analysis of LSC may provide a substantial support to visual assessment of regional LV function and the LCSI represents an index that is highly reproducible, independent of the examiner's experience. [ABSTRACT FROM AUTHOR]

Adults living with HIV (human immunodeficiency virus) infection (ALHIV) have high rates of cardiovascular events. New approaches are needed to detect subclinical cardiac dysfunction. We used conventional and speckle tracking echocardiography to investigate whether ALHIV display latent cardiac dysfunction. We analyzed 85 young subjects with HIV infection and free from cardiovascular risk factors (31 ± 4 years) and 80 matched healthy volunteers. We measured left ventricular (LV) layered global longitudinal strain, circumferential strain, peak longitudinal strain in the reservoir and contraction phases of the left atrium (LASr respectively LASct). In the HIV group, LV ejection fraction and s' TDI (tissue doppler imaging) were slightly lower but still in the normal ranges. Layered longitudinal strain showed no significant difference, whereas circumferential global strain was significantly lower in the HIV group (−20.3 ± 3.9 vs. −22.3 ± 3.0, p < 0.001). LASr (34.3% ± 7.3% vs. 38.0% ± 6.9%, p < 0.001) was also lower in ALHIV and multivariate analysis showed that age (β = −0.737, p = 0.01) and infection duration (β = −0.221, p = 0.02) were independently associated with LASr. In the absence of cardiovascular risk factors, adults living with HIV display normal LV systolic function. Left atrial reservoir strain, is, however, decreased and suggests early diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Background: The slope of the relationship between segmental PreS and total systolic shortening (S) has been proposed as a non-invasive index of left ventricular contractility. The aim of this study was to correlate this novel parameter to invasive gold standard measurements of contractility and to investigate how it is influenced by afterload. Methods: In domestic pigs, afterload was increased by either balloon inflation in the aorta or by administration of phenylephrine while contractility was increased by dobutamine infusion. During all interventions, left ventricular pressure-volume measurements and trans-diaphragmatic two-dimensional echocardiographic images were acquired. The PreS-S slope was constructed from 18 segmental strain curves obtained by speckle tracking analysis and compared to the slope of the end systolic PV relationship (Emax) and the pre-load recruitable stroke work (PRSW). Results: Sixteen datasets of increased contractility and afterload were analyzed. During dobutamine infusion, the LV volumes decreased (p<0.05) while ejection fraction increased (p<0.05). Emax, PRSW and the slope of the intra-ventricular PreS-S relation increased significantly during dobutamine infusion. Afterload increase led to increase in systolic blood pressure (105±16mmHg vs. 138±25mmHg; p<0.01) and decrease of LV stroke volume and ejection fraction (p<0.01). The PreS-S slope was not influenced by loading conditions in concordance with the PRSW findings. The absolute values of the PreS-S slope did not correlate with Emax or PRSW. However, the change of the PreS-S slope in relation with different interventions demonstrated good correlation with changes in PRSW or Emax, (r = 0.66, p<0.05 and r = 0.69, p<0.05). Conclusions: The slope of the PreS-S relationship is sensitive to changes in inotropy and is less load-dependent than conventional non-invasive parameters of left ventricular function. The magnitude of the change of this slope correlates well with changes in invasive contractility measurements making it an attractive parameter to assess contractile reserve or contractile changes during longitudinal follow-up of patients. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus type 1 (DM1) is associated with a high risk for cardiovascular disease, and early detection of myocardial dysfunction is crucial for the prevention of cardiac complications. Objectives: The aim of this study was to evaluate left ventricular (LV) and right ventricular (RV) function by using both conventional echocardiography as well as multi-layered speckle tracking echocardiography (STE) in young adults with DM1. Methods: We included 50 young asymptomatic adults diagnosed with DM1 (mean interval from diagnosis 9 ± 6 years) and 80 healthy controls. STE was acquired using the GE Vivid S60 equipment. The LV longitudinal strain (LS), layer-specific strains of the endocardium, myocardium, and epicardium (global longitudinal strain [GLS]endo, GLSmyo, GLSepi) as well as RV strain were obtained using the EchoPAC BT13 workstation. Results: No significant intergroup differences in LV ejection fraction were noted. GLSendo and GLSmyo were reduced in the DM1 group (–20.6 ± 2.7 vs. –22.0 ± 2.3 and –18.0 ± 2.4 vs. –19.1 ± 1.9, respectively, p < 0.05) compared to controls. Mechanical dispersion was higher in the diabetes group (34 ± 11 vs. 29 ± 7, p < 0.05). RV strain measurements showed no significant difference between the groups. Conclusions: Young adults with DM1 and without known heart disease have subclinical myocardial dysfunction with lower LV endocardium and myocardium LS and higher mechanical dispersion demonstrated by multi-layered STE. [ABSTRACT FROM AUTHOR]

Background. Diabetes mellitus type 1 (DM1) is associated with high risk for cardiovascular disease and early detection of myocardial dysfunction is very important for the prevention of cardiac complications. Although the functionality of right ventricule is important in a lot of disease affecting long time prognosis and progression, in diabetic type 1 patients has not been studied in depth yet. Objectives. To evaluate the right ventricular function by using both conventional echocardiography as well as speckle tracking echocardiography (STE) in young adults with diabetes mellitus type 1. Methods. We included 60 young asymptomatic adults diagnosed with diabetes mellitus type 1 (mean interval from diagnosis 9±6 years) and 90 healthy controls. Conventional and STE Echocardiography was acquired using the GE Vivid S60 equipment. The longitudinal right ventricular strain 6 segments (RV GLS global) and 3 segments (RVFW GLS) of right ventricle (RV GLSbazal, RV GLSmid, RV GLSapex) as well were obtained using the EchoPAC BT13 workstation. Results. No significant intergroup differences in EF were noted. Conventional echocardiographic parameters revealed lower tricuspid annular velocities Et, At and Et/At ratio compared to controls suggesting a diastolic disfunction in diabetes group. RV speckle tracking strain measurements showed no significant difference between the groups. Conclusions. Young adults with type 1 diabetes mellitus and without known heart disease have diastolic right ventricular dysfunction. The subclinical myocardial systolic function is preserved in early stages. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated intra‐observer, test–retest, and inter‐observer reproducibility of right ventricular (RV) longitudinal strain (LS) measurements derived from two‐dimensional speckle tracking echocardiography. Background: The assessment of RV deformation has demonstrated to hold valuable prognostic and diagnostic data in clinical practice. Data about the reproducibility of the measurements, however, are missing. Methods: In 200 subjects, apical modified four‐chamber view focused on the right ventricle (RV) was obtained. In 150 subjects (75%), a second set of images was acquired for test–retest analysis. Global RV LS (RVGLS‐4C), free wall strain (RVFW‐4C), and segmental maximum peak strain (base, mid, and apex) were calculated (EchoPac vBT13, GE Vingmed Ultrasound, Horten, Norway). Additionally, the reliability and feasibility of RV free wall strain derived from single wall tracking (RVFW‐SWT) were tested. The absolute difference between repeated measurements and inter‐class correlation coefficients (ICC) for consistency was calculated. Results: RVGLS‐4C and RVFW‐4C measurement could be obtained in all subjects. RVGLS‐4C demonstrated lower intra‐observer, test–retest, and inter‐observer absolute difference compared to RVFW‐4C (1.4 ± 1.2%, 1.8 ± 1.5%, and 1.7 ± 1.9%, respectively, vs 2.4 ± 2.4, 2.2 ± 1.9, and 2.6 ± 3.0, respectively, P < 0.01). ICC ranged between 0.83 and 0.90 for RVGLS‐4C measurements and between 0.76 and 0.79 for RVFW‐4C measurements. RVFW‐SWT was feasible in 82.5% of the subjects and showed noninferior reproducibility compared to RVFW‐4C. Basal and apical segments demonstrating the highest variability. Conclusions: The measurement of RVGLS‐4C appears to be reliable in clinical practice and demonstrates better reproducibility compared to RV free wall LS measurements. Segmental LS measurements presented high variability and such parameters should be interpreted with caution. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to evaluate the prevalence and potential impact of elevated pulmonary arterial systolic pressure (PASP) on left and right cardiac morphology and function in young elite athletes. Methods: In total, 85 professional athletes (40 endurance, 20 strength, and 25 mixed training, mean age 17.8 ± 4.0) and 50 sedentary controls (mean age 18.6 ± 3.3) underwent transthoracic echocardiographic examination. Two‐dimensional measurements of the right (RV) and left ventricle (LV) were obtained. PASP was estimated from the peak tricuspid regurgitant velocity (TRV). Speckle tracking‐derived longitudinal LV and RV strain measurements (RV_LS) were calculated for function estimation. Results: Maximum TRV (2.2 ± 0.3 vs 2.0 ± 0.2 m/s, P < .01) and PASP (26 ± 5 vs 22 ± 5 mm Hg, P < .01) were higher in athletes compared to controls. PAPS above 30 mm Hg (35 ± 3 mm Hg, range 31–40 mm Hg) was identified in 11 athletes (12.9%). Athletes with elevated PASP demonstrated higher LV mass (P < .01), LV stroke volume indexed (P < .01), larger RV‐end‐systolic area (ESAi), RV‐end‐diastolic area (EDAi), right atrium ES volume and ED volume, and decreased RV fractional area change (FAC) (P < .01) when compared to matched controls and higher RV‐EDAi (13.0 ± 1.6 vs 11.1 ± 1.5, P < .01), RV‐ESAi (8.2 ± 1.5 vs 6.1 ± 0.9, P < .01), and significantly reduced RV FAC (38.1 ± 5.8 vs 44.6 ± 2.5, P < .01) when compared to matched athletes. LV global longitudinal strain and RV_LS showed no differences between the groups. Conclusions: Pulmonary arterial systolic pressure elevation in young athletes is associated with pronounced right ventricular enlargement, even when compared to matched athletes. Conventional and speckle tracking echocardiography showed preserved right ventricular function. [ABSTRACT FROM AUTHOR]

Despite effective antiviral treatment, the rate of acute cardiac events remains high in subjects with HIV. Left atrium strain (LAS) was shown to be an independent predictor of cardiovascular events in the general population. Therefore, the aim of this study was to investigate whether left atrial (LA) strain has incremental value over conventional echocardiographic parameters to identify HIV subjects with subclinical cardiac disease. We prospectively included 100 young patients (mean age 31.3±4.8; 60 males) with acquired HIV (mean interval from diagnosis 18 ± 9 years) and 80 healthy volunteers matched by age and gender. Echocardiography was performed using a Vivid iQ machine (GE Healthcare). Left ventricular (LV) and LA conventional measurements were obtained according to current recommendations. LA strain during the reservoir (LASr) phase was calculated using a dedicated tracking tool (EchoPac v 20.4). The treatment protocol included reverse-transcriptase inhibitors (RTIs) (40%), a combination of RTIs with non-nucleoside reverse transcriptase inhibitors (NNRTIs) (25%), a combination of RTIs with HIV protease inhibitors (20%), or a combination of RTIs with HIV integrase inhibitors (15%). No significant difference in LV ejection fraction between the groups was found (57±6 vs. 59±7, p=0.15). Subjects with HIV had higher LV mass (78±19 vs. 68±15, p< 0.001) and E/Eˈ ratio (6±2 vs. 5±1, p< 0.01). While LA volume showed similar values (38 ±11ml vs 41 ±12 ml, p=0.14), LASr was significantly reduced in patients with HIV compared to healthy subjects (33±8 vs. 38±7, p < 0.001). In multivariate analysis, LASr was independently associated with age (p=0.01) and years since HIV diagnosis (p=0.03). The choice of treatment protocol did not influence LA strain (p=0.16). In our study, both groups had similar LA volumes according to measurements derived from conventional echocardiography, while 2D-STE measurements proved a significantly reduced LA strain during the reservoir phase in patients with HIV compared to healthy volunteers. Our study shows evidence that LA strain is impaired in young asymptomatic subjects with HIV, prior to conventional echocardiographic measurements and the measurement could be useful in the detection of subjects at risk for developing heart failure. [ABSTRACT FROM AUTHOR]

Left ventricular non-compaction cardiomyopathy is a genetic disorder characterized by the presence of two myocardial layers with numerous prominent trabeculations and deep inter-trabecular recesses that communicate with the ventricular cavity. The diagnosis is often challenging because excessive trabeculations may also be a normal finding in performance athletes and black people. Echocardiography is the gold standard for diagnosis of this condition, but other useful diagnostic techniques may include cardiac magnetic resonance imaging, computed tomography, and contrast ventriculography. Moreover, newer echocardiographic methods such as three-dimensional imaging and speckle tracking analysis promise to improve the diagnosis of left ventricular non-compaction cardiomyopathy. The purpose of this paper is to review the pathogenesis, diagnosis, and management of this disease. [ABSTRACT FROM AUTHOR]

Since its initial description, a number of studies have described the use of microvolt T-wave alternans (MTWA) as a predictor of the primary or secondary occurrence of ventricular arrhythmic events. These studies, however, have been limited by small sample sizes and disparate patient populations. Studies of MTWA in postmyocardial infarction (MI) patients are few in number, but hold predictive value for risk of ventricular arrhythmias. We performed a study of MTWA in post-myocardial infarction patients to clarify the predictive accuracy and usefulness of MTWA compared to other invasive and non-invasive techniques. We enrolled 120 patients (74 men, 46 women, mean age 62.3 ± 15.2 years in men, and 64.2 ± 13.8 years in women) with a history of myocardial infarction but no prior sustained ventricular arrhythmias. Patients were assessed by echocardiography, Holter, signal averaged ECG, MTWA, and electrophysiology study. Mean follow-up was 14 months. The MTWA test had a good negative predictive value for arrhythmic events in post-MI patients and can be used for risk stratification. We consider that in patients with positive MTWA further invasive evaluation, respectively electrophysiology study, is necessary. [ABSTRACT FROM AUTHOR]

BACKGROUND: A plethora of echo parameters has been suggested for distinguishing cardiac amyloidosis (CA) from other causes of myocardial thickening with, however, scarce data on their head-to-head comparison. This study aimed at comparing the diagnostic accuracy of various deformation and conventional echo parameters in differentiating CA from other hypertrophic substrates, especially in the gray zone of mild hypertrophy (maximum wall thickness ≤16 mm) or normal ejection fraction (EF). METHODS AND RESULTS: We included 100 subjects, of which 40 were patients with newly diagnosed, biopsy-proven CA (65.5±10.8 years, 65% male, 62.5% amyloidosis light chain [AL] type), 40 patients with hypertrophic cardiomyopathy matched for demographics and maximum wall thickness (60.1±14.8 years, 85% male), and 20 hypertensives with prominent myocardial remodeling. Quantifiable conventional morphological and functional parameters along with multidimensional strain and strain-derived ratios indices, previously suggested to diagnose CA, were analyzed. EF global longitudinal strain ratio showed the best performance to discriminate CA (area under the curve, 0.95; 95% confidence intervals, 0.89--0.98; P<0.00005). Traditional echo indices showed overall low sensitivities and high specificities (among them myocardial contraction fraction ratio had the highest area under the curve, 0.80; 95% confidence intervals, 0.7--0.87; P<0.0001). In the challenging subgroups (maximum wall thickness ≤16 mm and EF>55%), EF global longitudinal strain ratio remained the best predicting parameter of CA diagnosis (multiple logistic regression models P<0.00005 and P=0.0002, respectively) independent of the CA type. CONCLUSIONS: Our study demonstrated that in patients with thickened hearts, EF global longitudinal strain ratio has the best accuracy in detecting CA, even among the most "challenging" patient subgroups as those with mild hypertrophy and normal EF. [ABSTRACT FROM AUTHOR]

Prinzmetal's angina is characterized by recurrent episodes of chest pain which occur during rest or sleep, associated with transient elevation of the ST segment on the electrocardiogram. The underlying mechanism is focal or diffuse coronary artery spasm that can affect one or multiple coronary artery sites simultaneously or consecutively. We report the case of a 53-year-old woman with persistent angina which presented with multivessel spasm recorded during coronary angiography without provocation test. The symptomatology of the patient was effectively relieved by combining two calcium channel blockers with a selective inhibitor of phosphodiesterase-3 and a long-lasting nitrate. [ABSTRACT FROM AUTHOR]

Background and aim: The presence of mechanical dyssynchrony on echocardiography is associated with reverse remodelling and decreased mortality after cardiac resynchronization therapy (CRT). Contrarily, myocardial scar reduces the effect of CRT. This study investigated how well a combined assessment of different markers of mechanical dyssynchrony and scarring identifies CRT responders. Methods: In a prospective multicentre study of 170 CRT recipients, septal flash (SF), apical rocking (ApRock), systolic stretch index (SSI), and lateral-to-septal (LW-S) work differences were assessed using echocardiography. Myocardial scarring was quantified using cardiac magnetic resonance imaging (CMR) or excluded based on a coronary angiogram and clinical history. The primary endpoint was a CRT response, defined as a ≥15% reduction in LV end-systolic volume 12 months after implantation. The secondary endpoint was time-to-death. Results: The combined assessment of mechanical dyssynchrony and septal scarring showed AUCs ranging between 0.81 (95%CI: 0.74–0.88) and 0.86 (95%CI: 0.79–0.91) for predicting a CRT response, without significant differences between the markers, but significantly higher than mechanical dyssynchrony alone. QRS morphology, QRS duration, and LV ejection fraction were not superior in their prediction. Predictive power was similar in the subgroups of patients with ischemic cardiomyopathy. The combined assessments significantly predicted all-cause mortality at 44 ± 13 months after CRT with a hazard ratio ranging from 0.28 (95%CI: 0.12–0.67) to 0.20 (95%CI: 0.08–0.49). Conclusions: The combined assessment of mechanical dyssynchrony and septal scarring identified CRT responders with high predictive power. Both visual and quantitative markers were highly feasible and demonstrated similar results. This work demonstrates the value of imaging LV mechanics and scarring in CRT candidates, which can already be achieved in a clinical routine. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the accuracy and reproducibility of vendor-specific regional strain values by echocardiography using in silico data. Synthetic 2-D ultrasound gray-scale images of the left ventricle (LV) were generated with knowledge of the longitudinal segmental strain values from the underlying electromechanical LV model. Four of five models mimicked transmural infarctions with systolic segmental stretching in different vascular areas. Cine loops in the three apical views were synthetically generated at four noise levels. All in silico images were repeatedly analyzed by a single investigator and some by another investigator. The absolute errors varied significantly between vendors from 3.3 ± 3.1% to 11.2 ± 5.9%. The area under the curve for the identification of segmental stretching ranged from 0.80 (confidence interval: 0.77-0.83) to 0.96 (0.95-0.98). The levels of agreement for intra-investigator variability varied between -3.0% to 2.9% and -5.2% to 4.8%, and for inter-investigator variability, between -3.6% to 3.5% and -14.5% to 8.5%. Segmental strain analysis allows the identification of areas with segmental stretching with good accuracy. However, single segmental peak-strain values are not accurate and should be interpreted with caution. Nevertheless, our results indicate the usefulness of semiquantitative strain assessment for the detection of regional dysfunction. [ABSTRACT FROM AUTHOR]

Non-alcoholic fatty liver disease affects about 30% of the population and it has a growing tendecy with the increasing incidence of obesity. Currently, a large amount of clinical evidence has shown that cardiovascular disease represents the main cause of mortality in patients suffering from non-alcoholic fatty liver disease. Objective: In this study we investigated the structural and functional changes of the left ventricle in young adults with hepatic steatosis using modern echocardiographic techniques. Methods:By using tissue Doppler imaging and also Speckle tracking echocardiography the left ventricle systolic function was assessed. Results: All patients included in the study had a normal left ventricular ejection fraction but, when the longitudinal function of the left ventricle was assessed using the tissue Doppler technique (maximum systolic velocity S) statistically significant differences were found in both the group of patients with non-alcoholic fatty liver as well as in the group of patients associated with diabetes. Using speckle tracking echocardiography, we found a statistically significant decrease of the global longitudinal strain in the endocardium, in the group of patients with non-alcoholic liver disease but also in the group of those with diabetes. The overall longitudinal strain at the myocardium was significantly reduced only in the group of patients with non-alcoholic fatty liver disease and diabetes, while the overall longitudinal strain at the epicardium showed no changes in any of the groups studied. Also, no changes were observed at the circumferential strain. Conclusion: Nonalcoholic fatty liver disease, diagnosed in asymptomatic young adults may be a risk factor for remodeling the left ventricle over time, being associated with subclinical myocardial dysfunction, regardless of the presence of other cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

There is strong evidence that, in addition to increasing the risk of cirrhosis as well as hepatocellular carcinoma, nonalcoholic liver disease represents an independent risk factor for different diseases including cardiovascular and chronic kidney disease and also type 2 diabetes. Objective: to assess whether nonalcoholic fatty liver disease is associated with diastolic dysfunction of the left ventricle, independent of other classic risk factors. Methods: we included 79 patients aged 15-45, diagnosed with non-alcoholic liver disease, and a group of 80 healthy people in the same age group. We assessed left ventricular diastolic function using Doppler pulsed wave transmitral flow and Tissue Doppler Imaging methods. Results: there were lower velocities of E and e’ wave, a decrease in E/A ratio and an increase in E/e’ ratio in the group of patients with hepatic steatosis and in those with associated diabetes compared to the control group, but not the same was observed when comparing patients with steatosis alone vs. hepatic steatosis and associated diabetes mellitus. Conclusion: nonalcoholic steatosis is linked to echocardiographic features of early diastolic dysfunction that are present in patients suffering from diabetes. [ABSTRACT FROM AUTHOR]

determined. Liver disease severity in patients with cirrhosis was established by Child-Pugh class, MELD score and presence/absence of ascites. Results: Plasma levels of NT-proBNP were significantly higher in cirrhotic patients than in the healthy subjects. NT-proBNP levels were also significantly elevated in Child-Pugh class C patients compared to those in class B and A. Left atrium size, diastolic function, left ventricular wall thickness and left ventricular ejection fraction were significantly altered in cirrhotic patients compared to controls. Advanced cirrhosis and high levels of NT-proBNP were significantly associated with increased left atrium volume and signs of cardiac diastolic dysfunction. We also observed significant differences between quartile groups of MELD score for the following: NT-proBNP, Troponin I, left atrium volume, left ventricle wall thickness, lateral wall and septum systolic tissue doppler velocities and global longitudinal strain. Conclusion: NT-proBNP is increased in patients with cirrhosis and is correlated with the severity of liver disease as established by Child-Pugh class, MELD score and presence of ascites. [ABSTRACT FROM AUTHOR]

Real-time 3D Echocardiography (RT3DE) has been proven to be an accurate tool for left ventricular (LV) volume assessment. However, identification of the LV endocardium remains a challenging task, mainly because of the low tissue/blood contrast of the images combined with typical artifacts. Several semi and fully automatic algorithms have been proposed for segmenting the endocardium in RT3DE data in order to extract relevant clinical indices, but a systematic and fair comparison between such methods has so far been impossible due to the lack of a publicly available common database. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms developed to segment the LV border in RT3DE. A database consisting of 45 multivendor cardiac ultrasound recordings acquired at different centers with corresponding reference measurements from three experts are made available. The algorithms from nine research groups were quantitatively evaluated and compared using the proposed online platform. The results showed that the best methods produce promising results with respect to the experts' measurements for the extraction of clinical indices, and that they offer good segmentation precision in terms of mean distance error in the context of the experts' variability range. The platform remains open for new submissions. [ABSTRACT FROM AUTHOR]

We present the case of a 19-year-old patient who was brought to the emergency room of the local hospital during the night for an episode of chest pain that lasted for about 2 hours during the morning, which recurred in the evening, though of lesser intensity and duration. The clinical picture, initial presentation data and paraclinical workup with echocardiography, coronary angiography and cardiac MRI balanced the diagnosis between two possibilities: myocarditis and acute coronary synrome caused by a myocardial bridge causing severe LAD stenosis. The papers discusses the current literature on both diseases and describes the diagnostic and management algorythm we followed. [ABSTRACT FROM AUTHOR]