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Background: Intramyocardial fat deposition occurs as an age-related process and in multiple pathologic processes. Objective: We evaluated the presence of left ventricular (LV) and right ventricular (RV) intramyocardial fat with 64-slice multidetector computed tomography (MDCT). Methods: One hundred persons with no history of coronary artery disease (47 women, 53 men; mean age [± SD], 53 ± 12.2 years) and 25 patients with CT findings of myocardial infarction (17 men, 8 women; mean age, 71.3 ± 9.6 years) were studied for intramyocardial fat in defined segments of the ventricles (17 LV and 10 RV segments) at 3 levels. Fat deposition was defined as density range of −30 to −190 Hounsfield units on images both before and after contrast. Results: In healthy persons, LV intramyocardial fat was primarily located in the basal segments (5% anteroseptal, 5% inferior), and RV intramyocardial fat was primarily located in the anterolateral (24% of base, 23% of mid) and inferolateral (27% base, 27% mid) segments. Older age was associated with an increased odds of RV (sex-adjusted odds ratio [OR] per decade increment, 1.61; 95% confidence interval [CI], 1.11–2.33; P = 0.012) but not LV (OR, 0.97; 95% CI, 0.67–1.40; P = 0.85) intramyocardial fat. Compared with women, men had a lower risk of LV (95% CI, 0.1–0.64; P = 0.004) but not RV (95% CI, 0.35–1.87; P = 0.62) intramyocardial fat. Patients with old myocardial infarction (>3 years) had increased percentage of fat in infarcted left ventricles at all 3 levels (P ≤ 0.004). Conclusions: Intramyocardial fat can be detected by MDCT and is common in healthy and infarcted myocardium. [Copyright &y& Elsevier]

Abstract: The normal tricuspid valve anatomy and function have several dissimilarities to the corresponding mitral valve in the left heart, in part, based on lower pressures in the right heart chambers. The functional abnormalities resulting from tricuspid valve disease are classified as primary and secondary. Primary valve disease is any associated intrinsic valve pathology. The list of responsible conditions includes congenital, rheumatic, infective endocarditis, carcinoid heart disease, toxic effects of chemicals, tumors, blunt trauma, and myxomatous degeneration. The secondary tricuspid valve disease does not involve intrinsic anatomic abnormalities of the valve apparatus, aside from tricuspid annular dilation secondary to right ventricular dilation and dysfunction. The most common cause of tricuspid valve disease is secondary to left heart disease, either myocardial, valvular, or mixed. Although bedside diagnosis of advanced tricuspid valve disease is feasible, echocardiography provides valuable clues to the presence and severity of tricuspid valve stenosis and/or regurgitation with considerable accuracy. The tricuspid regurgitation signal using Doppler techniques is utilized for estimation of right ventricular systolic pressure, which, in the absence of right ventricular outflow obstruction, corresponds to pulmonary arterial systolic pressure. This is clinically useful since nearly 80 to 90% of patients exhibit some degree of tricuspid regurgitation. The treatment of tricuspid valve disease is guided by underlying etiology and pathology. Tricuspid valve repair is increasingly advocated for patients with advanced tricuspid regurgitation, especially when combined with surgery on the left heart pathology. Primary tricuspid valve disease is often treated by surgical approach specific to the underlying pathology. [Copyright &y& Elsevier]

Abstract: Background: Cardiac magnetic resonance imaging (CMR) can accurately determine infarct size. Prior studies using indirect methods to assess infarct size have shown that patients with larger myocardial infarctions have a worse prognosis than those with smaller myocardial infarctions. Objectives: This study assessed the prognostic significance of infarct size determined by CMR. Methods: Cine and contrast CMR were performed in 100 patients with coronary artery disease (CAD) undergoing routine cardiac evaluation. Infarct size was determined by planimetry. We used Cox proportional hazards regression analyses (stepwise forward selection approach) to evaluate the risk of all-cause death associated with traditional cardiovascular risk factors, symptoms of heart failure, medication use, left ventricular ejection fraction, left ventricular mass, angiographic severity of CAD and extent of infarct size determined by CMR. Results: Ninety-one patients had evidence of myocardial infarction by CMR. Mean follow-up was 4.8±1.6 years after CMR, during which time 30 patients died. The significant multivariable predictors of all-cause mortality were extent of myocardial infarction by CMR, extent of left ventricular systolic dysfunction, symptoms of heart failure, and diabetes mellitus (P<.05). The presence of infarct greater than or equal to 24% of left ventricular mass and left ventricular ejection fraction less than or equal to 30% were the most optimal cut-off points for the prediction of death with bivariate adjusted hazard ratios of 2.11 (95% confidence interval 1.02–4.38) and 4.06 (95% confidence interval 1.73–9.54), respectively. Conclusions: The extent of myocardial infarction determined by CMR is an independent predictor of death in patients with CAD. [ABSTRACT FROM AUTHOR]