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Introduction Anomalous origin of coronary arteries has been observed in about 0.35-2.10% of the population. Patients with anomalous right coronary artery (ARCA) may present with significant symptoms, arrhythmias or ACS, and at times sudden death. Traditionally, surgical correction has been the recommended treatment. However, these may be technically challenging, and bypass grafting for such anomalies has the potential for graft failure because of competitive flow. We sought to determine the intermediate and long-term outcomes of drug-eluting stent placement for patients with symptomatic ARCA. We also looked at angiographic findings suggestive of interarterial course as confirmed by subsequent computed tomography (CT) findings. Methods Between January 2005 and December 2012, we enrolled 11 patients for elective percutaneous coronary intervention (PCI) of ARCA in a single center, prospective, nonrandomized fashion. Patients were followed up in clinic at 1 week, 3 months, 6 months, and 1 year, and then annually or more frequently if needed. All patients underwent a cardiac CT, as well as functional stress testing when needed to assess for recurrence of disease. Results All 11 of our patients, who presented with significant symptomatic stenosis with an ARCA, were successfully treated with PCI. Mean follow-up duration was 8.5 years. The only two deaths during follow-up were related to noncardiac causes (sepsis), with a mortality rate of 18.2%. Two patients had a positive functional study and on subsequent coronary angiography, one of them had significant in-stent restenosis (target lesion revascularization of 9.1%) and one distal to the stent (target vessel revascularization 9.1%). We found the observation of a "slit-like lesion" on angiography to have a sensitivity of 100% and specificity of 86% for the diagnosis of interarterial course of the anomalous vessel seen on subsequent CT. Conclusions Our study results suggest that PCI of ARCA is an effective and low-risk alternative to surgical correction, with good procedural success and long-term outcomes. It can provide symptomatic relief in such patients and may reduce the risk of sudden death in younger patients, without the inherent risks associated with surgical repair.

Left ventricular noncompaction is frequently seen in non-ischemic cardiomyopathy (NICM). The number of non-compacted segments determines the diagnosis of left ventricular noncompaction cardiomyopathy (LVNC). This study evaluates the impact of increasing number of noncompacted segments on structural

Background Cardiac magnetic resonance imaging (CMR) can accurately delineate myocardial scar for substrate guided ventricular tachycardia (VT) ablation. Susceptibility artifact from cardiac rhythm management device (CRMD) generator and leads can significantly affect image quality limiting the evaluation of myocardial scar and foci of VT. We conducted a retrospective study to correlate scars from CMR to the voltage mapping obtained at electrophysiology study (EPS).

Background The presence of microvascular obstruction (MO) on delayed enhanced cardiac magnetic resonance (DECMR) imaging is associated with adverse remodeling and poor prognosis after STEMI. Identifying which patients that may develop MO prior to undergoing acute mechanical reperfusion maybe important in managing patients for more direct interventions. We sought to evaluate clinical predictors of MO as depicted by DECMR. Methods We included 255 patients with their first STEMI reperfused with primary percutaneous intervention. A standard DE-CMR was performed acutely at a mean of 3.9±2.0 days after admission. Clinical risk factors, time to reperfusion as well as angiographic variables were prospectively collected. The angiographic area at risk and the infarct size as a % of the left ventricle (LV) were computed. The number of segments with MO, defined as an area of hypoenhancement surrounded by delayed enhancement on DE-CMR, were summed to calculate MO extent.

Methods We analyzed 181 patients from the DEfibrillators To REduce Risk by MagnetIc ResoNance Imaging Evaluation Trial. All patients underwent cine and contrastenhanced (CE) CMR. Cine and CE studies were scored on a 17-segment model by the consensus of two readers. Cine images were scored for wall motion (WM): 0 = normal, 1 = mild hypokinesis, 2 = moderate to severe hypokinesis, 3 = akinesis, 4 = dyskinesis. CE images were scored for hyperenhanced (HE) infarct transmurality: 0 = none, 1 = 1-25% HE, 2 = 26-50% HE, 3 = 51-75% HE, 4 = 76-100% HE. Manually planimetered, quantitative analysis was also performed to obtain LV ejection fraction (EF) and infarct size using QMass MR 7.2 (Medis, Leiden, the Netherlands). DV-Myo segments were defined as having WM score ≥ 2 and HE score ≤ 1. DVMyo involving 2-4 of 17 segments (12-24% of LV) was considered prognostically significant only. DV-Myo involving ≥ 5 of 17 segments (≥ 29% of LV) was considered functionally significant. Results Baseline characteristics included male sex (84%) and mean age 61.5 ± 11.2 (31-88). Patients were on standard medical therapy, including beta-blockers (93%), ACE inhibitor/ARB (82%), anti-platelet (100%) and lipid lowering agents (94%). The population had a mean EF of 38.9 ± 11.6% (range 11.4 69.1%) and infarct size 17.3 ± 10.3% of LV (range 0 59.5%). A total of 3077 segments were evaluated, of which 442 (14%) segments met criteria for DV-Myo. Prognostically significant DV-Myo was present in 49/181 patients (27.1%). These patients had a mean of 2.7 ± 0.7 affected segments and a mean EF of 34.4 ± 7.7%. Functionally significant DV-Myo was present in an additional 33/181 patients (18.2%). These patients had a mean of 8.1 ± 3.0 affected segments and a mean EF of 26.2 ± 8.5%.

Background A growing body of data has demonstrated a direct relationship between epicardial fat volume(EFV) and cardiovascular diseases. In fact, EFV has been shown to be an independent predictor of coronary atherosclerosis and atrial fibrillation. Currently, there is no standard protocol for assessing EFV using cardiac magnetic resonance imaging (CMR). Quantification of peri-ventricular EFV utilizing end diastolic short-axis cine sequences has been described; however, this technique is often challenging due to inadequate visualization of the pericardium. Oftentimes, the pericardium is better visualized during the systolic phase. Thus, we sought to determine the correlation and reproducibility of conventional EFV quantification using end diastolic with end systolic short-axis slices.

Background Manual planimetry for quantitative analysis of ejection fraction (EF) and infarct size (IS) on cardiac magnetic resonance (CMR) imaging are too time-consuming, and therefore, impractical in daily clinical practice. We sought to derive and examine the predictive accuracy of a semi-quantitative scoring technique to screen patients with an EF ≤35% or an IS ≥18.5%, known independent predictors of increased cardiac events and mortality.