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Introduction Cardiac computed tomography angiography (CCTA) derived fractional flow reserve (FFRCT) has been shown to add incremental diagnostic value by providing functional severity of coronary lesion in patients with coronary artery disease (CAD). Purpose We aimed to assess the prognostic value of FFRCT in patients with suspected CAD. Methods Consecutive patients who had clinically indicated CCTA and FFRCT determination at a tertiary care cardiology practice were included. FFRCT was determined off-site using computational flow dynamics. Patients were followed for major adverse cardiovascular events (MACE, inclusive of all-cause death, non-fatal myocardial infarction, and late percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) 90-days after imaging test.) Results A total of 667 patients with at least Coronary Artery Disease Reporting & Data System (CAD-RADS) 2 were included. Mean age was 68±10 years, 37% were women, 73% had hypertension, 12% had diabetes and 61% had dyslipidemia. More than half (57%) of the patients had moderate (CAD-RADS 3) stenosis. FFRCT Conclusion Our results suggest that in a real-world cohort of patients with suspected CAD, FFRCT can identify patients at higher risk of incident cardiovascular outcomes. Funding Acknowledgement Type of funding sources: None.

Learning Point for Clinicians Hydralazine-induced lupus syndrome is uncommon, but timely diagnosis is needed in life-threatening illnesses. Severe organ involvement is exceedingly rare; however, pericardial tamponade has been reported. Patients on chronic hydralazine should be monitored for signs and symptoms of systemic lupus erythematosis periodically. If they develop HILS, immediate discontinuation of hydralazine is warranted to prevent serious complications. Hydralazine-induced lupus syndrome (HILS) was first reported in 1953.1 The syndrome occurs in 5–10% of patients taking hydralazine, presenting with arthralgia, myalgia, fever and serositis. Severe cardiac involvement is rare, and only three cases of tamponade were reported.1–3 We describe an unusual case of impending cardiac tamponade in a patient taking hydralazine and coumadin. A 68-year-old female presented with exertional dyspnea and pleuritic chest pain of 1 week duration. The pain …

A 40-year-old woman presented with a 1 month history of shortness of breath and easy fatigability. Two-dimensional echocardiography and real-time three-dimensional echocardiography (RT3DE) showed a large right atrial mass protruding into the right ventricle and an atrial septal defect (ASD). Successful excision of the mass, which proved to be a myxoma, and closure of the ASD completely relieved her symptoms. To our knowledge, this is the first report of RT3DE in a patient with right atrial myxoma associated with an ASD.

Introduction: There are no known pathognomonic ECG findings in constrictive pericarditis (CP). Increased pericardial thickness in CP is associated with low QRS voltage secondary to thickening and calcification. We sought to study the correlation between pericardial thickness identified by cardiac magnetic resonance (CMR) and ECG changes pre and post pericardiectomy. Methods and results: 80 consecutive patients with proven constriction underwent pericardiectomy at a Cleveland Clinic between 2009 and 2011. Baseline characteristics, CMR, and pathological specimens were reviewed retrospectively (Table one). Paired t-test and McNemar test were used to analyze pre and post ECG changes for continuous and categorical variables, respectively. There were significantly less patients with Afib, LBBB, RBBB or 1st degree AVB post-pericardiectomy (table1). Also, significant increase in limb and precordial R-wave voltage postop (ΔR 8.2±3.7 and 9±4.3, respectively, p