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Aims: Ischemic heart disease is a leading worldwide cause of death. The Seattle Post Myocardial Infarction Model (SPIM) was developed to predict survival 6 months to 2 years after an acute myocardial infarction with evidence of left ventricular dysfunction.Methods and Results: A total of 6632 subjects from the EPHESUS trial were used to derive the predictive model, while 5477 subjects from the OPTIMAAL trial were used to validate the model. Cox proportional hazards modeling was used to develop a multivariate risk score predictive of all-cause mortality. The SPIM risk score integrated lab and vital parameters, Killip class, reperfusion or revascularization, the number of cardiac evidence-based medicines (aspirin, statin, β blocker, ACEI/ARB, aldosterone blocker), and the number of cardiac risk factors. The model was predictive of all-cause mortality after myocardial infarction, with an AUC of 0.75 at 6 months and 0.75 at 2 years in the derivation cohort and 0.77 and 0.78 for the same time points in the validation cohort. Model predicted versus Kaplan-Meier observed survival was excellent in the derivation cohort. It remained so in the validation cohort—84.9% versus 85.0% at 2 years. The 10% of subjects with the highest predicted risk had approximately 25 times higher mortality at 2 years than the 10% of subjects with the lowest predicted risk.Conclusion: The SPIM score was a powerful predictor of outcomes after myocardial infarction with left ventricular dysfunction. Its highly accurate predictions should improve patient and physician understanding of survival and may prove a useful tool in post-infarct risk stratification.

This article reviews the development and current status of catheter-based, intravascular ultrasound imaging. The first section provides an introduction to some of the general technical issues encountered in the design of the catheter imaging systems and compares the potential merits of the multiple-element versus the mechanical approach. The second section of the article reviews the data from early studies correlating the intravascular ultrasound images with histologic sections (in vitro) and angiography (in vivo). The article concludes with a discussion of potential clinical applications and future technical developments.

Right ventricular volume is difficult to measure accurately from one or two views because the complexity of right ventricular shape invalidates simplifying geometric assumptions. This article describes a new three-dimensional echocardiography reconstruction method of right ventricular volume calculation, and reports the results of testing this method in vitro using normal animal hearts and pathologic specimens from infants and children who died with aortic stenosis or hypoplastic left heart. The correlation with reference volumes was excellent for both groups (r = 0.98, n = 25 for the animai data; r = 0.97, n = 15 for the human data). Given the calculated echo-cardiographic volume (Vc), the reference volume (Vr) was best estimated by the equation Vr = 1.16 Vc for the animal data and Vr = 0.92 Vc for the human data. Three-dimensional echocardiographic measurement ot right ventricular volume is an accurate method that deserves further study and application in a clinical setting.

Introduction:Previous work has shown that there are ethnic differences in incidence of atrial fibrillation (AF).Hypothesis:We explored the ethnic variation of presentation of atrial fibrillation in the Multi-Ethnic Study on Atherosclerosis (MESA), hypothesizing that there were ethnic differences in presentation as well as incidence.Methods:We examined the incidence of new atrial fibrillation documented by hospital diagnosis or self-reported in followup interview and grouped by ethnicity. We noted if the diagnosis was reported only in a followup interview, or also in a hospital diagnosis. There were 6,807 subjects followed an average of 7.9 years. The incidence rate for each ethnic group, non-hispanic White (NHW), Chinese, Hispanic, and Black and each type of presentation was compared to the average for all groups.Results:Total AF was higher in NHW and lower in Hispanics, while hospitalized AF was also higher in NHW but lower in Chinese. AF that was only self-reported was lower in Hispanics (see table).Conclusions:There are significant, up to fourfold differences in incidence rate by presentation between ethnic groups in MESA. The causes are not clear, but possibilities that could be explored include variations in pattern (paroxysmal vs. persistent/permanent), degree of symptoms, access to medical care, risk factors, or genetic differences. This may also have implications for screening strategies for atrial fibrillation.