Search

BACKGROUND Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. METHODS Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. RESULTS During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P

Purpose High-risk patients can be identified by preprocedural computed tomography (CT) before lead extraction. However, CT evaluation may be difficult especially for lead tip identification due to artifacts in the leads. Selective right ventriculography (RVG) may enable preprocedural evaluation of lead perforation. We investigated the efficacy of RVG for identifying right ventricular (RV) lead perforation compared with CT in patients who underwent lead extraction. Methods Ninety-five consecutive patients who were examined by thin-section non-ECG-gated multidetector CT and RVG before lead extraction were investigated retrospectively. Newly recognized pericardial effusion after lead extraction was used as a reference standard for lead perforation. We analyzed the prevalence of RV lead perforation diagnosed by each method. The difference in the detection rates of lead perforation by RVG and CT was evaluated. Results Of the 115 RV leads in the 95 patients, lead perforation was diagnosed for 35 leads using CT, but the leads for 29 (83%) of those 35 leads diagnosed as lead perforation by CT were shown to be within the right ventricle by RVG. Three patients with 5 leads could not be evaluated by CT due to motion artifacts. The diagnostic accuracies of RVG and CT were significantly different (p < 0.001). There was no complication of pericardial effusion caused by RV lead extraction. Conclusion RVG for identification of RV lead perforation leads to fewer false-positives compared to non-ECG-gated CT. However, even in cases in which lead perforation is diagnosed, most leads may be safely extracted by transvenous lead extraction.

Heart failure (HF) is today a major public health problem affecting over 60 million people worldwide. HF continues to be underdiagnosed due to its low accuracy in clinical evaluation; therefore, the use of cardiovascular imaging methods for its correct diagnosis is fundamental. A wide variety of methods can be used to evaluate the HF patient. In the initial evaluation, we used the clinical history, physical examination, electrocardiogram, biomarkers level, chest X-ray, and tissue Doppler echocardiography. In addition, more complex exams may be used to monitor patients such as radionuclide ventriculography, myocardial perfusion imaging with gated SPECT, cardiac computed tomography, and cardiac magnetic resonance imaging. Invasive tests such as right and left cardiac catheterization, myocardial biopsy, and coronariography are useful in the search for the etiology of HF. Diagnostic methods for HF help determine HF phenotype, etiology, and pathophysiology, guide treatment, establish prognosis, and improve outcomes that increase the risk of hospitalization and death due to cardiac arrhythmias.

In the last decades, there have been great advances made in cancer diagnosis and treatment, giving a reduction in mortality, an increase in survival, and a better quality of life in cancer patients. In addition, the progress made in cancer treatments has resulted in increased exposure to the cardiotoxic effects of radio and chemotherapies. Screening for the occurrence of cardiotoxicity (CTX) is highly recommended before, during, and after the end of treatment. A number of methods and diagnostic indexes have been recommended for detecting CTX and planning therapeutic strategies. Measuring left ventricular ejection fraction (LVEF) through a conventional echocardiogram is the most used strategy, although it is a poorly refined parameter, often detectable only in the later stages. Thus, it is necessary to perform a more sensitive and reliable imaging test to detect earlier CTX (Felker et al., N Engl J Med 342:1077–84, 2000; Barros-Gomes et al., Cardio-Oncology 2:5, 2016). Cardiac nuclear medicine imaging techniques have proved extremely useful for both identifying subclinical disease in the context of CTX and assessing late CTX by LVEF measurement. In this chapter, we will discuss on nuclear imaging techniques and molecular radiotracers using for detection of CTX in cancer patients.

Aim. To assess the potential of stress tomographic radionuclide ventriculography (T-RVG) in long-term prognosis of left ventricular (LV) re-remodeling after surgery of ischemic cardiomyopathy.Material and methods. Thirty patients with ischemic cardiomyopathy, before surgical treatment, underwent resting T-RVG and with increasing doses of dopamine (5/10/15 pg/kg/min (5 min/dose). All patients underwent two-dimensional echocardiography before surgery, in the short- (7-14 days) and long-term postoperative period. In the long-term postoperative period (476±36 days), the patients were divided into two groups: group 1 (n=19) — patients with ongoing LV remodeling (increase in the LV end-systolic volume (ESV) or decrease 10%.Results. The results revealed significant differences between the groups in the dynamics (Δ) of the LV ejection fraction (EF) (%) (2 (2;8); 11 (5;12), p=0,02), peak ejection rate (%) (32 (14;51); 63 (34;79), p=0,009), LV dyssynchrony (PSDo (3 (0;7); -2 (-9;3), p=0,004); Entropy (%) (2 (-1;6); 0 (-4;2), p=0,01)). Univariate regression showed that ΔLVEF (odds ratio (OR), 0,88; confidence interval (CI), 0,8; 0,97; p=0.008), ΔLVPSD (OR, 1,13; CI, 1,03; 1,25; p=0,005), and coronary stenosis >75% (OR, 4,25; CI, 1,57; 11,48; p=0,001) had a predictive value. According to the ROC-analysis, the sensitivity, specificity, and AUC were 87%, 64% and 0,727 for ΔLVPSD (threshold >-1); 84%, 46% and 0,691 for coronary stenosis >75% >75% (threshold >2); 65%, 82% and 0,674 for ΔLVEF (threshold ≤4), respectively. The logistic model, which included these parameters and the presence of diabetes, showed a significantly greater AUC (0,907, pConclusion. Preoperative values of ΔLVEF and ΔLVPSD obtained with stress T-RVG have prognostic significance in relation to LV long-term re-remodeling.

Aims To investigate predictors of the occurrence of subacute ventricular arrhythmias (VAs), defined as any VAs presenting after 48 h from admission in patients with Takotsubo Syndrome (TTS), and to evaluate the related in-hospital mortality. Methods This is a retrospective single-center study enrolling patients admitted between 2012 and 2017 with TTS according to International Takotsubo diagnostic criteria. Data collection included ECG on admission and at 48 h, telemetry monitoring and transthoracic echocardiogram. Results We enrolled 93 patients; during in-hospital stay (mean 14 ± 16 days) subacute VAs occurred in 25% of patients (VAs group). Life-threatening VAs occurred in 6% of patients (3 sustained ventricular tachycardia, 1 torsade de pointes, 1 ventricular fibrillation) and not life-threatening VAs in 19% (6 non-sustained ventricular tachycardia and 12 premature ventricular contractions > 2000 in 24 h). Mortality was higher in the VAs than in the non-VAs group (P = 0.03), without differences in terms of life-threatening and not life-threatening subacute VAs (P = 0.65) and VAs on admission (P = 0.25). Logistic regression identified the following independent predictors of subacute VAs occurrence: VAs on admission {odds ratio [OR] 22.5 (3.9-131.8), P = 0.001]}, New York Heart Association (NYHA) class III-IV on admission [OR 6.7 (1.3- 34.0), P = 0.021] and QTc at 48 h [OR 1.01 (1.00-1.03), P = 0.046]. Conclusion TTS patients with VAs and NYHA class III-IV on admission and higher QTc at 48 h are at increased risk of subacute VAs occurrence, associated with higher in-hospital mortality. Awareness of this potential complication is critical for proper patients management.

The evaluation of ventricular contractility is an important factor helping doctors in choosing the appropriate therapy for abnormal heart functioning occurring at the level of contractilities such as hypokinesia, diskinesia, and akinesia. Applying covariance analysis to track the ventricular contractility is the purpose of this study. We examined the proposed method on radionuclide ventriculography images corresponding to 44 patients with abnormal contractility and 6 with normal contractility. The Experimental results of this study show that the proposed method has a good reproducibility in the assessment of the ventricular function (accuracy=0.94, sensitivity=0.94,specificity= 1 and AUC =0.97).

Cardiovascular diseases are the most common cause of death in patients over 60 years old. Pivotal imaging modalities in cardiac diagnostic workup are echocardiography, magnetic resonance, multi‑row detector computed tomography, coronary angiography, and radioisotope tests. In this study, we summarize the techniques of nuclear medicine (positron emission tomography, single‑photon emission computed tomography, radionuclide ventriculography) that could be implemented in the cardiovascular diagnostic algorithms. Despite being acknowledged in a few cardiology guidelines, these imaging methods are still underestimated by practitioners. Nevertheless, noninvasive diagnostic tools are of increasing potential and should be implemented whenever possible. We discuss the usefulness of particular techniques in the management of patients with obstructive and nonobstructive coronary artery disease, including assessment of myocardial perfusion, contractility, viability, and detection of unstable atherosclerotic plaques. Radioisotope imaging can also be valuable in the diagnostic workup of infective endocarditis, as well as cardiac sarcoidosis and amyloidosis. Apart from theoretical principles of nuclear cardiology, we also provide 3 case reports illustrating a practical implementation of these imaging modalities.

Knowledge of preoperative right heart function of adult patients with cystic fibrosis (CF) awaiting lung transplant (LUTX) is limited. The echocardiography of adult patients with CF enlisted for LUTX was retrospectively analyzed and compared with standards and invasive analyses (right heart catheterization, multigated radionuclide ventriculography). We included 49 patients (reported as mean ± standard deviation; 29 ± 9 years of age; forced expiratory volume in first second of expiration, 31% ± 11% predicted; lung allocation score, 36 ± 5; invasive mean pulmonary artery pressure, 17 ± 5 mm Hg; multigated radionuclide ventriculography right ventricle [RV] ejection fraction, 50% ± 9%). Patients had increased RV end-diastolic area, RV wall thickness, and increased pulmonary artery acceleration time with subnormal tricuspid annular plane systolic excursion, tissue Doppler positive peak systolic velocity, and fraction area change. Subnormal tricuspid annular plane systolic excursion (23 mm), tissue Doppler positive peak systolic velocity (14 cm/s), and fraction area change (49%) had high sensitivity and negative predictive value in predicting impaired RV. EJECTION FRACTION: A good correlation between echocardiographic estimated and invasively measured systolic pulmonary artery pressure was observed (R

Diabetic cardiomyopathy (DCM) is a type of cardiac dysfunction that affects approximately 12% of diabetic patients, ultimately leading to heart failure or even death. However, there is currently no efficient or specific biomarker for DCM diagnosis.A total of 266 subjects with type II diabetes (T2DM) were enrolled in this study and were divided into the T2DM with cardiac dysfunction (DCM) group and T2DM without cardiac dysfunction (non-DCM) group. The diagnostic efficacy of miR-21 was determined and compared with that of serum hemoglobin A1c% (HbA1c%). Db/db mice and H9c2 cells stimulated with high glucose (HG)/high fatty acid (PA) were used as in vivo and in vitro models of DCM, respectively.Through echocardiography and gated-myocardial perfusion imaging (gated-MPI), 49 patients were selected to be enrolled in the DCM group, with 49 matched controls in the non-DCM group. The circulating miR-21 levels were significantly decreased in the DCM group compared to the non-DCM group (P 0.001). The diagnostic efficiency of miR-21 (area under the curve AUC = 0.899) was higher than that of other parameters, including HbA1c%. Moreover, when miR-21 was combined with the duration of diabetes, HbA1c%, and lipid profiles, the AUC was the highest (AUC = 0.939) and had the highest diagnostic efficiency. Furthermore, overexpression of miR-21 improved the impaired mitochondrial biogenesis and decreased the cardiomyocyte apoptosis induced by HG/PA, while inhibition of miR-21 exerted the opposite effects.Our findings identify circulating miR-21 as a novel biomarker in the diagnosis of DCM and provide an underlying mechanism for miRNA-based therapy for the treatment of DCM.The study was approved by the Ethics Committee of the Third Affiliated Hospital of Soochow University and has been registered in the Chinese Clinical Trial Registry (ChiCTR1900027080).

Background Accurate diagnostic tools to identify patients at risk of cancer therapy-related cardiac dysfunction (CTRCD) are critical. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function. Methods In this retrospective study, approximate entropy (ApEn), synchrony, entropy, and standard deviation from the phase histogram (phase SD) were investigated as potential early markers of LV dysfunction to predict CTRCD. These phase parameters were calculated from the baseline RNVG phase image for 177 breast cancer patients before commencing cardiotoxic therapy. Results Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. Conclusions The results suggest that RNVG phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF.

Transposition of the great arteries (TGA) is a common congenital cardiac malformation, in which many patients survive into adulthood. From the 1960s through much of the 1980s, the majority of those with D-TGA were repaired with an atrial switch procedure, in which the right ventricle (RV) remains the systemic ventricle. Congenitally corrected TGA patients often remain with a systemic RV. In these patients, heart failure risks result from residual sequelae of childhood repair, which often include tricuspid regurgitation, RV failure, and atrial and ventricular arrhythmias. Imaging techniques, including echocardiography, cardiac magnetic resonance imaging, multi-detector computed tomography, and radionuclide ventriculography focus on evaluation of anatomy and function as both diagnostic and prognostic tools. Biomarkers are used for risk stratification. Structural and surgical interventions are targeted for palliation and prevention of further decompensation in conjunction with pharmacologic, ablative, and device-based therapies for acute and chronic management of heart failure.

BACKGROUND Takotsubo cardiomyopathy is a myocardial infarction-like clinical entity commonly occurring after a stressful incident, leading to reversible systolic dysfunction. It involves several subtypes, most often associated with a good prognosis; however, a late diagnosis can contribute to a poor cardiovascular outcome. CASE REPORT We report an unusual case of mid-ventricular takotsubo cardiomyopathy in a 76-year-old woman who presented with recent-onset shortness of breath and compressive chest pain, typically characterized by a hawk's beak shape on left ventriculogram, highlighting the importance of this helpful descriptive but little-known fluoroscopic sign. The final diagnosis was made using transthoracic echocardiography, contrast-enhanced pulmonary angiography, coronary angiography, and left ventriculography. She was successfully treated by beta-blockers and angiotensin-converting enzyme inhibitor, with a good clinical outcome evaluated at 3-month follow-up after hospital discharge. CONCLUSIONS Ventriculography is an important tool for use in making the differential diagnosis in patients presenting with acute coronary syndrome without obstructive coronary artery disease. The hawk's beak shape is an early fluoroscopic diagnostic marker characterizing the mid-ventricular subtype of takotsubo.

Objectives. We aimed to explore the radiologic characteristics and interventional strategies for perimembranous ventricular septal defect (pmVSD) with aneurysm. Methods. 257 patients who underwent transcatheter closure of pmVSD with aneurysm were included in our study. We retrospectively reviewed the left ventricular opening of the aneurysm (a), diameter of the midsegment of the aneurysm (b), and diameter of the right ventricular opening of the aneurysm (c). If there were multiple defects within the aneurysm, the largest defect was denoted as c1 and so forth. We developed a novel VSD classification method in which pmVSD with aneurysm was classified into three types (A, B, and C). When a >b ≥ c, it was classified as type A, when b > a ≥ c, it was type B, and when c > a ≥ b, it was type C; c/c1 described the relationship among defects. Results. All of the 257 cases of pmVSD with aneurysm were defined using left ventriculography: type A, 60, type B, 58, and type C, 139. Transcatheter closure was attempted in 244 patients and succeeded in 227 cases (success rate was 93.0%; 227/244). Forty symmetric VSD occluders and 13 asymmetric VSD occluders were used for type A aneurysm occlusion; 31 symmetric VSD occluders, 19 asymmetric VSD occluders, and one Amplatzer duct occluder II (ADOII) were used for type B; 59 VSD symmetric occluders, 59 asymmetric VSD occluders, three eccentric VSD occluders, and two ADOII were used for type C. Within 24 hours after procedure, 2.2% patients had postprocedural residual shunt, and 2.2% experienced malignant arrhythmia (including type II second-degree AVB, cAVB, and CLBBB). Two hundred and twelve patients completed follow-up (93%, 212/227). No new severe complications were reported during follow-up, except in one patient who underwent surgery (removal of the device, VSD repair, and tricuspid valvuloplasty) due to severe postprocedural tricuspid regurgitation. Conclusions. It is safe and effective to apply this method for the classification of pmVSD with aneurysm and its interventional strategy.

Important changes in cardiac structure and function have been reported in patients with hypothyroidism, whose severity depends on the degree and duration of thyroid hormone deficiency. The most important cardiac abnormality in patients with overt and subclinical hypothyroidism is the impairment of the left ventricular diastolic function, which is characterized by an altered myocardial relaxation and ventricular filling. Left ventricular systolic and diastolic dysfunctions at rest and during effort have been documented by sensitive techniques such as Doppler echocardiography, cardiac magnetic resonance imaging, and radionuclide ventriculography. Cardiovascular hemodynamic is progressively worsened in long-term untreated hypothyroidism, leading to heart failure in patients with overt and severe subclinical hypothyroidism. Data from prospective cohorts show that the risk of HF events is significantly increased among patients with TSH greater than 10.0 mU/L.

Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0–38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10 3 cells/μL emerged as independent predictors for thrombus formation or embolism. Conclusions: Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01947621.

Left ventricular ejection fraction (LVEF) is a valuable measure to assess left ventricular systolic function. Lipid lowering therapy by statins has been shown to have an impact on LVEF already after a 6 months treatment. Higher doses of statins have been claimed to be more effective as compared to a conventional one and even a difference between lipophilic and hydrophilic compounds has been reported. The effect of regular lipoprotein-apheresis (LP-apheresis) on LVEF was previously poorly examined. Patients involved in a regular LP-apheresis program are supposed to undergo a number of follow-up investigations among them myocardial scintigraphy and LVEF, measured by radionuclide ventriculography.We examined 18 patients before initiation and after one year of ongoing LP-apheresis. 13 patients (11 males, 2 females, mean age 58.3 ± 5.3 years, groups A) were since more than a year on stable, unchanged statin treatment (atorvastatin 40 mg, simvastatin 40 mg, rosuvastatin 20 mg±ezetimibe), the other 5 patients (3 males, 2 females, mean age 57.1 ± 4.6 years, group B) were intolerant to statins being on micronized fenofibrate±resorption inhibitors (cholestyramine). All patients had a Lp(a) 30 mg/dl. As part of the usual follow-up monitoring, LVEF was determined by means of radionuclide ventriculography after application of 550 MBqThe follow-up LVEF was checked at a mean of 48.7 weeks in group A and 51.2 weeks in group B. Except in 1 patient (LVEF 46.8% before vs. 45.2% after LP-apheresis initiation) in group A we noted a significant increase in LVEF in 12 patients of group A (92%) and in all patients of group B. Mean LVEF increased significantly in both groups (A: 42.7±8.1 → 46.5±7.5% (p 0.001) and B: 41.9±8.4 → 46.5±6.3 %; p 0.001). The relative rise was nearly identical (group A 9.6%, in group B 9.7%).Our findings indicate that regular long-term LP-apheresis treatment apparently increases LVEF, independently on current statin treatment. This implies a role of lowering of atherogenic lipoproteins as underlying mechanism. A prospective study should clarify the relative extent of LVEF improvement induced by LP-apheresis.

Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Aims To investigate the accuracy of tomographic equilibrium radionuclide ventriculography (t-ERV) for the quantification of tricuspid regurgitation (TR). Methods and results Sixty-one patients (44 men; mean age 59±12 years) who underwent both t-ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. A sub-group of 22 patients underwent both t-ERV and CMR. Patients with mitral/aortic regurgitation by TTE were excluded of the study. TR regurgitant volume (RVol) was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from t-ERV. RVol tended to be higher using the ERV volumetric method as compared to PISA method (43±35 and 35±33 ml, respectively; P Linear regression (left) and Bland-Altma Conclusion TR assessment using the t-ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

Our objectives were to evaluate the temporal changes in CMR-based strain imaging, and examine their relationship with left ventricular ejection fraction (LVEF), in patients treated with trastuzumab.In this prospective longitudinal observational study, 41 women with HER2+ breast cancer treated with chemotherapy underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab (treatment duration 12 months). LVEF and LV strain (global longitudinal[GLS] and circumferential[GCS]) measurements were independently measured by 2 blinded readers.Of the 41 patients, 56% received anthracycline-based chemotherapy. Compared to baseline (60.4%, 95%CI 59.2-61.7%), there was a small but significant reduction in LVEF at 6 months (58.4%, 95%CI 56.7-60.0%, p = 0.034) and 12 months (57.9%, 95%CI 56.4-59.7%, p = 0.012), but not at 18 months (60.2%, 95%CI 58.2-62.2%, p = 0.93). Similarly, compared to baseline, GLS and GCS decreased significantly at 6 months (p = 0.024 and 0.001, respectively) and 12 months (p = 0.002 and 0.001, respectively) with an increase in LV end-diastolic volume, but not at 18 months. There were significant correlations between the temporal (6 month-baseline) changes in LVEF, and all global strain measurements (Pearson's r = -0.60 and r = -0.75 for GLS and GCS, respectively, all p 0.001).There was a significant reduction in LV strain during trastuzumab treatment, which correlated with a concurrent subtle decline in LVEF and was associated with an increase in LV end-diastolic volume. LV strain assessment by CMR may be a promising method to monitor for subclinical myocardial dysfunction in breast cancer patients receiving chemotherapy. Future studies are needed to determine its prognostic and therapeutic implications.

OBJECTIVES: We aimed to assess association between abnormal LVEF, in the absence of coronary artery disease (CAD), and 25-year incidence of major outcomes of diabetes (MOD) in a cardiology substudy of the Pittsburgh Epidemiology of Diabetes Complications cohort of childhood-onset type 1 diabetes. METHODS: 115 normotensive type 1 diabetes individuals without known CAD, underwent a baseline exercise radionuclide ventriculography. Abnormal LVEF was defined as a resting ejection fraction 5% (men) or a fall in ejection fraction with exercise (women). Cox proportional hazards models were used to predict the composite endpoint of MOD (first instance of major CAD, stroke, end-stage renal disease, blindness, amputation or diabetes-related death). RESULTS: Mean baseline age was 28 and diabetes duration 19 years. In a mean follow-up of 19 years, 50 MOD events were identified. Allowing for established risk factors at baseline, abnormal LVEF (n=22) independently predicted MOD incidence (HR=2.12, 95% CI: 1.12–4.00, p=0.022) but not major CAD (HR=1.33, 95% CI: 0.53–3.33, p =0.539). CONCLUSIONS: An abnormal LVEF may identify diabetic cardiomyopathy and predict long term risk of MOD (but not CAD alone) in type 1 diabetes individuals, consistent with it reflecting microvascular disease.

Left ventricular pseudo-aneurysm is a rare complication that usually occurs after myocardial infarction or cardiac surgery. Sometimes it is related to cardiac rupture. We report on surgical management for a left ventricular pseudo-aneurysm that developed four years after surgery for ventricular septal defect in a patient with acute myocardial infarction.

Endocardial mapping of the left ventricle (LV) using the NOGA® XP Cardiac Navigation System can identify chronically ischemic and viable myocardium in patients with coronary artery disease by generating electromechanical maps. These maps are very useful when targeting myocardial tissue for injection of stem cells. We present the case of a woman who developed a perforation at the site of an LV aneurysm during NOGA mapping prior to the transendocardial injection of stem cells, as part of a multicenter clinical trial. The presence of an LV aneurysm is currently not a contraindication (or caution) to the use the NOGA mapping catheter. As the field of stem cell therapy evolves and the use of this technique increases, operators must be aware that the presence of an LV aneurysm may increase the risk of perforation during a NOGA mapping procedure.

A 71-year-old woman without a cardiovascular history was transferred to our hospital with persistent hypotension days following an inferior ST-segment elevation myocardial infarction (STEMI). Urgent coronary angiography for refractory shock showed a proximal occlusion of the right coronary artery (

Learning objectives Nuclear Cardiology is the most frequently used functional imaging test in the UK and throughout the world. It was the first test used to localise and quantify myocardial ischaemia. The wealth of evidence related to diagnosis and long-term prognosis in varying subgroups is unparalleled.1 Radionuclide ventriculography (RNV) provides a geometrically independent assessment of ventricular function which remains the gold standard. Nuclear techniques can be used in patients with renal dysfunction, obesity, dysrhythmias and claustrophobia. Up until a few years ago, gamma camera hardware relied on the inexpensive technology of the 1960s, which has only recently undergone a revolution in response to improvements to complementary modalities. Radiation doses continue to fall. Exciting developments in positron emission tomography (PET) and hybrid imaging are promising a bright future with a potential resurgence in popularity for this ‘workhorse’. The mainstay of Nuclear Cardiology, myocardial perfusion scintigraphy (MPS), is performed using single photon emission computed tomography (SPECT) via a gamma camera. Worldwide, there is significant interest and investment in the role of PET in the assessment of myocardial disease. Gamma cameras have used the scintillation properties of sodium iodide (NaI) since the 1960s. Solid-state detectors using cadmium zinc telluride (CZT) are available on modern systems which allow for a significant improvement in sensitivity, additional radiation dose reductions or reduced scanning time.2 On a new CZT system, a scan time of 4–6 min is achievable with a much lower injected dose than that used for a NaI gamma camera. Iterative reconstruction with resolution recovery software is available for …

Author(s): Lee, Tetz C; Qian, Min; Mu, Lan; Di Tullio, Marco R; Graham, Susan; Mann, Douglas L; Nakanishi, Koki; Teerlink, John R; Lip, Gregory YH; Freudenberger, Ronald S; Sacco, Ralph L; Mohr, Jay P; Labovitz, Arthur J; Ponikowski, Piotr; Lok, Dirk J; Estol, Conrado; Anker, Stefan D; Pullicino, Patrick M; Buchsbaum, Richard; Levin, Bruce; Thompson, John LP; Homma, Shunichi; Ye, Siqin; WARCEF Investigators | Abstract: AimsThere is debate on whether the beneficial effect of implantable cardioverter-defibrillators (ICDs) is attenuated in patients with non-ischaemic cardiomyopathy (NICM). We assess whether any ICD benefit differs between patients with NICM and those with ischaemic cardiomyopathy (ICM), using data from the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial.Methods and resultsWe performed a post hoc analysis using WARCEF (N = 2293; ICM, n = 991 vs. NICM, n = 1302), where participants received optimal medical treatment. We developed stratified propensity scores for having an ICD at baseline using 41 demographic and clinical variables and created 1:2 propensity-matched cohorts separately for ICM patients with ICD (N = 223 with ICD; N = 446 matched) and NICM patients (N = 195 with ICD; N = 390 matched). We constructed a Cox proportional hazards model to assess the effect of ICD status on mortality for patients with ICM and those with NICM and tested the interaction between ICD status and aetiology of heart failure. During mean follow-up of 3.5 ± 1.8 years, 527 patients died. The presence of ICD was associated with a lower risk of all-cause death among those with ICM (hazard ratio: 0.640; 95% confidence interval: 0.448 to 0.915; P = 0.015) but not among those with NICM (hazard ratio: 0.984; 95% confidence interval: 0.641 to 1.509; P = 0.941). There was weak evidence of interaction between ICD status and the aetiology of heart failure (P = 0.131).ConclusionsThe presence of ICD is associated with a survival benefit in patients with ICM but not in those with NICM.

This paper reports a case of multiple congenital ventricular diverticula, a rare anomaly that is associated with heart failure.

ObjectivesAnaemia is a risk of worsening heart failure. However, anaemia sometimes remains undetected because the superficial cardiac function does not precisely reflect the adverse impact of anaemia. Plasma B-type natriuretic peptide (BNP) could be helpful in these cases. However, the direct anaemic effects on BNP remain unknown. Herein, we compared the direct effect of anaemia on BNP and left ventricular ejection fraction (LVEF) using an advanced statistical procedure.DesignA retrospective study.SettingSecondary care (cardiology), single-centre study.ParticipantsThe study consisted of 3756 inpatients, including 684 without ischaemic heart disease (IHD) and 3072 with IHD.Primary and secondary outcome measuresRelationship between plasma BNP levels and LVEF values.ResultsA path model was constructed to simultaneously examine the adverse impact of anaemia on LVEF and plasma BNP, allowing for renal function. The path model revealed that LVEF increased in response to low haemoglobin (Hb), and the phenomenon was prominent in non-IHD (standardised regression coefficients (St.β): −0.264, pConclusionThe current study demonstrated that anaemia was a substantial risk for worsening cardiac overload as estimated by plasma BNP. The anaemic response of LVEF likely changed depending on underlying cardiac disorders (IHD or not). However, the response of BNP was robustly observed.

Early Detection and Monitoring of Cancer Chemotherapy-Related Left Ventricular Dysfunction by Imaging Methods

The isotopic ventriculography is one of the most important imaging techniques used for heart pathologies diagnosis and monitoring. It is a qualitative and quantitative exploration offering to clinician the possibility to track the cardiac function. This study proposes a method of segmentation to delimit the left ventricle based on adaptive diffusion flow algorithm. To validate our results, an experimental study is carried out on 50 radionuclide ventriculography sequence of 50 patients (each sequence spans one heart cycle) visually analyzed by an expert. Then, statistical study is carried out in order to evaluate the results by comparing our method to a morphological based segmentation. Results show that the proposed method is better in detecting left ventricular boundaries with a 99.7\% of AUC value and a correlation factor r=0.97 compared to 91.9\% and a correlation factor r=0.37 for the morphological based segmentation.

Background Pulmonary hypertension and associated right ventricular (RV) dysfunction are important determinants of morbidity and mortality, which are optimally characterized by invasive hemodynamic measurements. Objectives This study sought to determine whether metabolite profiling could identify plasma signatures of right ventricular-pulmonary vascular (RV-PV) dysfunction. Methods We measured plasma concentrations of 105 metabolites using targeted mass spectrometry in 71 individuals (discovery cohort) who underwent comprehensive physiological assessment with right-sided heart catheterization and radionuclide ventriculography at rest and during exercise. Our findings were validated in a second cohort undergoing invasive hemodynamic evaluations (n = 71), as well as in an independent cohort with or without known pulmonary arterial (PA) hypertension (n = 30). Results In the discovery cohort, 21 metabolites were associated with 2 or more hemodynamic indicators of RV-PV function (i.e., resting right atrial pressure, mean PA pressure, pulmonary vascular resistance [PVR], and PVR and PA pressure-flow response [ΔPQ] during exercise). We identified novel associations of RV-PV dysfunction with circulating indoleamine 2,3-dioxygenase (IDO)–dependent tryptophan metabolites (TMs), tricarboxylic acid intermediates, and purine metabolites and confirmed previously described associations with arginine–nitric oxide metabolic pathway constituents. IDO-TM levels were inversely related to RV ejection fraction and were particularly well correlated with exercise PVR and ΔPQ. Multisite sampling demonstrated transpulmonary release of IDO-TMs. IDO-TMs also identified RV-PV dysfunction in a validation cohort with known risk factors for pulmonary hypertension and in patients with established PA hypertension. Conclusions Metabolic profiling identified reproducible signatures of RV-PV dysfunction, highlighting both new biomarkers and pathways for further functional characterization.

Aim. To estimate an effect of metabolic corrector mildronate on cardiac hemodynamics and endothelium function in patients with ischemic heart disease (IHD) and heart failure (HF)Material and methods. 60 patients with IHD and HF of I-III functional class according to NYHA were included into the study. 30 patients of the main group received mildronate at a daily dose of 1000 mg during 3 months additionally to standard therapy. Patients of the control group took standard therapy only. Cardiac function was estimated by 4D Gated Equilibrium Radionuclide Ventriculography. The endothelium function was measured as endothelium dependent vasodilation.Results. During 3 months mildronate therapy resulted in increase of left ventricular (LV) ejection fraction, peak filling and peak ejecting rate of LV.Conclusion. Metabolic corrector mildronate has positive effect on cardiac function in patients with IHD and CHF.

Obstruction of the left ventricular outflow can be caused by several lesions. These are classified by location as subvalvular, valvular, or supravalvular. Subvalvular aortic stenosis, which may have a dynamic component, may be due to a fibrous membrane, muscular obstruction, or a combination of the

ICDS are recommended for patients with HF with EF ≤35% for primary prevention of SCD. EF measured by gated radionuclide ventriculography (MUGA) has traditionally been characterized by a lower “normal” threshold value than EF measured by 2-dimensional echocardiography (ECHO). The objective of

Left ventricular assist devices (LVADs) require serial assessment of right and left ventricular (RV & LV) volumes and function. Because the RV is not assisted, its function is a critical determinant of the hemodynamic and contributes significantly to postoperative morbidity and mortality. We evaluated the feasibility and the accuracy of tomographic-equilibrium radionuclide ventriculography (t-ERV) for the assessment of patients with LVADs. Twenty-four patients with LVAD underwent t-ERV. Because of the limited acoustic window, transthoracic echocardiography (TTE) was only feasible in 19 patients. Functional evaluation including six-minute walk test (6MWT) and peak oxygen consumption (POC) was performed in 18 patients. Nine patients underwent a cardiac multidetector computed tomography (MDCT). Eight patients underwent a second evaluation by ERV 4.3 ± 1.4 months later. Reliability between t-ERV and MDCT for LV end-diastolic volume, LV end-systolic volume, LV ejection fraction, RV end-diastolic volume, RV end-systolic volume, and RV ejection fraction (RVEF) was 0.900 (P = .001), 0.911 (P = .001), 0.765 (P = .021), 0.728 (P = .042), 0.875 (P = .004), and 0.781 (P = .023), respectively. There was no correlation between t-ERV and RV systolic parameters assessed by TTE. RVEF was correlated with POC (R = 0.521; P = .027). A cut-off value of 40% for RVEF measured by t-ERV could discriminate patients with poor functional status (P = .048 for NYHA stage; P = .016 for 6MWT and P = .007 for POC). t-ERV is a simple, reproducible, and an accurate technique for the assessment of RV function in patients with LVADs and warrants consideration in the evaluation and monitoring of symptomatic patients.

BACKGROUND Structural and morphological changes accompanying liver cirrhosis lead to portal hypertension (PHT), which is the first step of most of the complications in patients with liver cirrhosis. Therefore, the development of noninvasive techniques to detect PHT is crucial for prognosis and treatment. AIM The aim of our study was to assess the diagnostic performance of a new spleno-hepatic index (SHI) measured from equilibrium radionuclide ventriculography (ERV) images in detecting patients with cirrhotic PHT. METHODS AND RESULTS A total of 38 patients with PHT were compared with 30 controls without liver disease. The SHI was measured on the sum of the tomographic images from the ERV and calculated according to the following formula: SHI=(mean splenic count×longest hepatic length)/mean hepatic count. Mean SHI was 54±14 and 36±8 (P

Background Quantitative assessment of valve regurgitation using volumetric method by comparing right and left ventricular stroke volumes is still under investigations. Aims To investigate the accuracy of equilibrium radionuclide ventriculography (ERV) for the quantification of tricuspid regurgitation (TR) severity. Methods Thirty-three patients (25 men; mean age 63 ± 10 years) who underwent both ERV and transthoracic echocardiography (TTE) studies within 2 weeks for right ventricular systolic function assessment were eligible for inclusion. Patients with significant mitral regurgitation by TTE were excluded of the study. TR was calculated using the proximal isovelocity surface area (PISA) method from TTE and the volumetric method (right ventricular stroke volume minus left ventricular stroke volume) from ERV. Results TR tended to be higher using the ERV volumetric method as compared to PISA method (48 ± 36 vs. 43 ± 31 mL, respectively; P = 0.06). There was a significant correlation between TR as assess by ERV and by TTE (R = 0.8, P Conclusion TR assessment using the ERV correlates well with PISA from TTE in patients referred for right ventricular systolic function assessment.

Background Integrated bedside and sophisticated cardiac imaging techniques help characterize the discrepancy between myocardial injury and mechanic dysfunction in acute myocardial infarction. Case presentation A 57 year-old woman presented with sudden onset chest pain and ventricular fibrillation after hearing of her brother’s death. The electrocardiography indicated “anterior wall ST segment elevation myocardial infarction”. Coronary angiography ruled out obstructive lesion in the major coronary arteries, but revealed fibromuscular dysplasia of the distal left anterior descending artery. The ventriculography showed remarkable ventricular dilation, which affected much broader myocardium than the culprit vessel supplied. In a subsequent cardiac magnetic resonance study, delayed contrast (gadolinium) image revealed a focal left ventricular (LV) apical infarction. Her LV systolic function normalized within 1 week, except for a residual apical hypokinesis. She developed recurrent chest pain and LV dilation when she was laid off 9 months later. After supportive therapy, her symptoms improved and LV dysfunction normalized again. Conclusions “Tako-tsubo” syndrome can occur recurrently in the heart with pre-existing localized myocardial infarction. Its molecular mechanism and clinical significance warrants further investigation.

ObjectiveThe prevalence of heart failure (HF) among adult patients with congenital heart disease (ACHD) is rising. Right ventricle (RV) exercise reserve and its relationship to outcomes have not been characterised. We aim to evaluate the prognostic impact of impaired RV reserve in an ACHD population referred for cardiopulmonary exercise testing (CPET).MethodsThis retrospective study evaluates patients with ACHD who underwent CPET (n=147) with first-pass radionuclide ventriculography at a single tertiary care centre. RV reserve was categorised as normal, mild to moderately or severely impaired. The primary composite clinical outcome included clinical right HF, arrhythmia, transplantation or death.ResultsPatients were median age 41±13 years, 50% were female and median follow-up was 1.1 (IQR: 0.7–2.0) years. Exercise RV reserve was impaired in 103 patients (70%), of whom 32% were asymptomatic. Resting RV systolic function poorly predicted RV reserve, with 52% of patients with severe impairment having a qualitatively normal echocardiographic assessment. The severely impaired reserve group had lower peak oxygen consumption (VO2)(17.2 vs 22.5 mL/kg/min, p2, age, sex, RV pathology, QRS duration, New York Heart Association class, resting RV ejection fraction and RV dilation by echocardiography or MRI (HR 3.7, 95% CI 1.1 to 13.0, p=0.039).ConclusionImpaired RV reserve, occurred in asymptomatic patients, was not well predicted by resting systolic function assessment, and strongly predicted adverse cardiovascular outcomes.

Concept of deterioration of myocardial contractile function under long-term intake of antiarrhythmic drugs may be regarded as one of the myths of modern cardiology. Multiple references to negative influence of majority of antiarrhythmic drugs on myocardial inotropic function are speculative. Studies on estimation of influence of arrhythmia treatment strategy on myocardial contractile function are almost absent.Aim. To estimate dynamics of myocardial contractile function in patients with ischemic heart disease (IHD) and persistent atrial fibrillation (AF) compared among those treated with amiodarone 200 mg daily and with bisoprolol 5 mg daily.Material and methods. A total of 47 IHD patients with persistent AF were enrolled into the study. Sinus rhythm (SR) was restored during the first 24 hours of hospitalization in all the pa- tients. After SR restoration the patients were randomly allocated to two groups receiving either amiodarone 200 mg daily during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate myocardial inotropic function all patients underwent steady-state radionuclide ventriculography (RVG) and echocardiography during the first 24 hours after SR restoration and 6 months later.Results. We revealed changes in left ventricle (LV) diastolic function, reduction of left atrium (LA) contribution to LV diastole and enlargement of LA anterior-posterior dimension during the first 24 hours after SR restoration in the patients of both groups.6-month SR maintenance in the first group of patients promoted significant decrease in isovolumic relaxation time (IVRT) from 103.4±1.01 ms to 96.4±1.1ms (р=0.02) and reduction of LA anterior-posterior dimension up to 36.1±3.8 mm (р=0.03). Target VR achievement in the second group of patients promoted restoration of LV diastolic function (decrease in IVRT from104.3±1.2 ms to 97.3±1.2 ms; р=0.03) but did not influence LA size (44.1±3.1 mm and 43.5±3.0 mm, respectively). Atrial inotropic function was only changed in the patients of group 1, the patients of group 2 did not reveal significant change in LA contribution to LV diastole.Conclusion. 6-month SR maintenance at amiodarone intake in IHD patients with persistent AF resulted in LA contraction, restoration of its contractility and improvement of LV diastolic parameters. Target VR for 6 months of bisoprolol intake led to LV diastolic function improvement, but did not influence LA dimension and contractile function.

Aim. To study the change of local myocardial contractility in patients with ischemic heart disease (IHD) and paroxysmal atrial fibrillation (AF) during treatment with amiodarone 200 mg daily compared with bisoprolol therapy 5 mg daily.Material and methods. A total of 47 IHD patients with persistent AF were enrolled in the study. Sinus rhythm (SR) was restored during the first 24 hours after admission in all the patients. After SR restoration patients were randomly allocated into two groups receiving either amiodarone 200 mg/day during 6 months for SR maintenance (group 1) or bisoprolol 5 mg daily for ventricular rate (VR) control (group 2). To estimate a local myocardial systolic function all the patients were undergone steady-state radionuclide ventriculography in the first 24 hours after SR restoration and 6 months later.Results. Sinus rhythm saving at amiodarone therapy within 6 months led to an improvement of the local myocardial contractility of the left ventricle with a significant increase in normokinesis zones from 79 (58.1%) to 92 (67.6%), hypokinesis and akinesia zones reduction from 46 (33.8%) to 41 (30.2%) and from 11 (8.1%) to 3 (2.2%) (pConclusion. 6-month SR maintenance with amiodarone intake in IHD patients with persistent AF resulted in significant reduction of akinesia zones and increase in the number of normokinesia segments.

Cardiologists and oncologists are challenged to optimize safety and effectiveness of chemotherapy. The quest for therapeutic cancer cure is hampered by the risk of cardiotoxicity including potentially fatal clinical heart failure. Management of chemotherapy administration concordant with strategic baseline EF guideline recommendations for cumulative doxorubicin dose-related timing of accurate and precise radionuclide LVEF measurements, and recommendations for termination of therapy have been demonstrated in high-risk patients to change the natural history of heart failure associated with anthracycline cardiotoxicity.– Personalizing cardiooncologic care with specific chemotherapy regimens requires use of techniques and monitoring guidelines which have been proven effective by study of long term outcomes in high-risk patients who have abnormal baseline LVEF or those whose residual cancer risk requires consideration of ongoing chemotherapy. However, evidence of safe and effective management for timing and termination of chemotherapy by serial EF determinations without use of strategic baseline EF guidelines, use of other techniques such as echocardiographic EF and strain imaging, LV and RV volume indices, MIBG, biomarkers, and other novel markers remains undefined by prospective trials in high-risk patients receiving anthracycline and other types of chemotherapy. A potentially important set of novel risk markers of chemotherapy-induced heart failure includes measures of diastolic LV dysfunction which can precede systolic dysfunction in anthracycline and perhaps other chemotherapies and provide a more sensitive and specific predictor of long-term chemotherapy-induced heart failure. The importance of diastolic dysfunction and its progression to diastolic heart failure, now called ‘‘HFpEF’’ or ‘‘heart failure with preserved ejection fraction’’ in clinical cardiology, have been recognized for decades. Early studies identified a role for the negative inotropic and chronotropic therapies including the calcium channel blocker verapamil and beta blockers in the management of diastolic heart failure in hypertension or hypertrophic cardiomyopathy.– Radionuclide ventriculography identified a reduction in the diastolic peak filling rate and prolongation of the time to peak filling associated with HFpEF, and improvements in these dynamic filling characteristics and clinical heart failure with calcium and beta blockade therapy have been demonstrated.– Diastolic dysfunction was identified by Lee et al. with serial radionuclide angiography as an early marker of doxorubicin cardiotoxicity prior to reduction of LVEF in patients receiving doxorubicin. This observation was soon followed by reports of early diastolic dysfunction using Doppler echocardiography of LV filling dynamics during doxorubicin treatment. These observations suggested nearly three decades ago the potential to enhance the diagnostic and prognostic assessment of heart failure risk associated with progressive myocytolysis defined by serial endomyocardial biopsy during anthracycline Reprint requests: Ronald G. Schwartz, MD MS, Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester; ronald_schwartz@urmc.rochester.edu J Nucl Cardiol 2016;23:833–6. 1071-3581/$34.00 Copyright 2015 American Society of Nuclear Cardiology.

10.2217/FON.15.108 © 2015 Future Medicine Ltd During the past four decades, marked advances have been made in the treatment of childhood cancers, such that long-term survival is an expected outcome for many children diagnosed with cancer today [1]. However, improvements in outcome have come at a cost. It is estimated that nearly a third of all childhood cancer survivors will develop a severe or life-threatening health condition years after completion of cancerdirected therapy [2]; these include second cancers, endocrinopathies, neurosensory impairment and cardiovascular disease [2]. Outcomes following onset of cardiovascular disease are especially poor; 5-year overall survival is less than 50% [3], emphasizing the need to develop early screening and prevention strategies in survivors at highest risk of developing cardiovascular disease. Research on survivorship issues has revealed a clear association between certain therapeutic exposures such as anthracycline chemotherapy and/or mediastinal radiation and risk of cardiovascular complications such as heart failure [4]. In these survivors, there is often a long latency between initial exposure to cardiotoxic therapies and onset of clinically overt heart disease [4]. This period is characterized by the development of asymptomatic systolic and/or diastolic cardiomyopathy that can be detected using a variety of imaging modalities [4,5]. Radionuclide angiography (multigated acquisition scan and radionuclide ventriculography) was historically considered the gold standard for assessment of cardiac function [4,5]. However, exposure to ionizing radiation, along with a limited ability to detect structural abnormalities and early cardiac dysfunction, has limited its use in childhood cancer survivors [4,5]. 2D echocardiography offers a readily available assessment of both structure and function without exposure to radiation, and has therefore been widely used to follow childhood cancer survivors. [4,5] Frequently measured echocardiographic parameters of cardiac function include ejection fraction, shortening fraction, velocity of fiber shortening corrected for heart rate, stress–velocity index, left ventricular end-systolic wall stress and more subtle measures of diastolic function [4–6]. More recently, cardiac MRI has emerged as a sensitive and reproducible alternative to echocardiography in nononcology populations and cancer survivors [7,8]. However, despite its diagnostic advantages, higher cost and limited availability impede its use for routine screening. Consequently, current guidelines continue to recommend 2D echocardiography as the screening modality of choice for childhood cancer survivors [6]. COMMENTARY Special Focus Issue: Cardio-oncology

Left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) are important tools in clinical decision-making. We hypothesized that two-dimensional echocardiography (2DE), three-dimensional echocardiography (3DE), radionucleotide ventriculography (RNV), cardiac computed tomography (CT), gated single-photon emission CT (SPECT), and invasive cardiac cine ventriculography (ICV) provide variable accuracy for LVEF and RVEF when using cardiac magnetic resonance imaging (MRI) as a gold standard.We systematically searched published databases for studies comparing LVEF and RVEF measured by CT, 3DE, 2DE, RNV, ICV, and SPECT compared with MRI. We utilized meta-analytic methods to determine the pooled bias (mean weighted difference), limits of agreement (LOA), and correlation coefficient for each modality. For LVEF, 174 studies (7047 patients) were included. For RVEF, 46 studies (1720 patients) were included. Pooled LOA for LVEF were different between modalities: CT and 3DE had smaller LOA than 2DE, SPECT, ICV, and RNV. 2DE showed the largest LOA and a weaker correlation for LVEF (-13.3 to 12.1%, r = 0.660). For RVEF, CT and 3DE have the best data to support their use with a bias5% and tight LOA and correlation coefficients with (r)0.75.For LVEF, CT and 3DE had the lowest bias and the best agreement with MRI. Compared with MRI, CT and 3DE comparably estimate RVEF and have the most evidence to support their use.

Accessory Pathway Target in Ebstein's Anomaly Introduction Knowledge about local electrogram and atrial/ventricular electrogram amplitude ratio (A/V ratio) at the true atrioventricular ring for successful ablation of accessory pathways (APs) in patients with Ebstein's anomaly is limited. Methods Twenty-two adults with Ebstein's anomaly and APs were managed by 24 sessions of radiofrequency catheter ablation (RFCA). A right atrial/ventricular angiogram with or without 3-dimensional electroanatomic mapping was performed to delineate the true atrioventricular ring and atrialized right ventricle (ARV). Electrograms of successful targets were analyzed. For each right-sided AP target, 2 AP targets matched by location and conduction property from normal hearts were selected as controls, and their A/V ratios were compared. Results In 32 right-sided APs of all 22 patients, local ventricular activation at successful site presented as normal electrogram in 14, fractionated ventricular electrogram (FVE) in 16, and double ventricular potentials in 2. The bipolar voltage of ARV was markedly lower than in normal hearts. The A/V ratio at the successful target was significantly higher in APs with FVE than in control (1.64 ± 1.34 vs. 0.47 ± 0.19, P < 0.01), and was similar in APs with normal ventricular electrogram and in the control (0.38 ± 0.15 vs. 0.46 ± 0.15, P = 0.1726). The A/V ratio at the successful target with double ventricular potentials (after surgical correction) was 0.30 ± 0.20. All APs were successfully ablated without complications. Conclusions In patients with Ebstein's anomaly, FVE was found in 50% of the successful targets of APs. High A/V ratio at successful sites with FVE and normal A/V ratio at targets with normal ventricular electrogram can facilitate target recognition and ablation.

Aims Duchenne muscular dystrophy (DMD), an inherited X-linked muscular disease, is associated with dilated cardiomyopathy that is responsible for death in 40% of patients. Our objective was to determine whether inotropic reserve is predictive of LV trend over time. Methods and results A total of 69 DMD patients (age 12.2 ± 2.3 years) were investigated. At baseline, LVEF and the presence of inotropic reserve (defined as an increase in LVEF >10% during dobutamine infusion) were investigated using radionuclide ventriculography. During follow-up (FU), LVEF was remeasured after a mean 29 ± 19 months delay. In the whole population, mean LVEF was 58 ± 8% at baseline and declined to 54 ± 11% during FU (P = 0.004). At baseline, 21 patients (30.4%) had LVEF 45% or 55% at baseline. Conclusion Inotropic reserve assessment allows the distinction of DMD patients who will vs. those who will not show a deterioration in LVEF, thus offering a sensitive approach for delineating the presence and progression of cardiovascular disease in these patients.