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Purpose. This study compared cardiac computed tomography (CT) and two-dimensional transthoracic echocardiography (ECC) for assessing left ventricular ejection fraction (LVEF) using real-world data from a large patient population. Materials and methods. We studied 450 patients (284 males; mean age 64 +/- 12 years; range 12-88) who underwent CT and ECC due to suspected coronary artery disease. For CT, we used multiphase short-axis reconstructions and evaluated them with a dedicated software tool that uses Simpson's rule to compute LV volumes. For ECC, computation was based on the biplane Simpson's method. Results in terms of EF were compared with the paired Student's t test, Pearson's correlation coefficient (r), and Bland-Altman analysis. Results. EF was 52%+/- 15% for CT and 55%+/- 13% for ECC. Statistically significant differences, albeit with correlation, were observed between the measurements (r=0.71; p50% and overestimated in those with EF 35%-50% and

Cardiac and coronary computed tomography (CT) is becoming increasingly common in clinical practice. Even if there is no well-established evidence, this diagnostic modality is so strong and effective and, in skilled hand, it can be readily used in clinical practice. After learning its potential and the technical limits, this tool could be used for risk stratification as well as for revascularization evaluation. In this review, we will describe the results of present literature, clinical applications at present considered suitable to CT technology (i.e. 64-slice and dual-source scanners) and future applications and innovations.

SARS-CoV2 infection, responsible for the COVID-19 disease, can determine cardiac as well as respiratory injury. In COVID patients, viral myocarditis can represent an important cause of myocardial damage. Clinical presentation of myocarditis is heterogeneous. Furthermore, the full diagnostic algorithm can be hindered by logistical difficulties related to the transportation of COVID-19 patients in a critical condition to the radiology department. Our aim was to study longitudinal systolic cardiac function in patients with COVID-19-related myocarditis with echocardiography and to compare these findings with cardiac magnetic resonance (CMR) results. Patients with confirmed acute myocarditis and age- and gender-matched healthy controls were enrolled. Both patients with COVID-19-related myocarditis and healthy controls underwent standard transthoracic echocardiography and speckle-tracking analysis at the moment of admission and after 6 months of follow-up. The data of 55 patients with myocarditis (mean age 46.4 ± 15.3, 70% males) and 55 healthy subjects were analyzed. The myocarditis group showed a significantly reduced global longitudinal strain (GLS) and sub-epicardial strain, compared to the control (p < 0.001). We found a positive correlation (r = 0.65, p < 0.0001) between total scar burden (TSB) on CMR and LV GLS. After 6 months of follow-up, GLS showed marked improvements in myocarditis patients on optimal medical therapy (p < 0.01). Furthermore, we showed a strong association between baseline GLS, left ventricular ejection fraction (LVEF) and TSB with LVEF at 6 months of follow-up. After a multivariable linear regression analysis, baseline GLS, LVEF and TSB were independent predictors of a functional outcome at follow-up (p < 0.0001). Cardiac function and myocardial longitudinal deformation, assessed by echocardiography, are associated with TSB at CMR and have a predictive value of functional recovery in the follow-up.

OBJECTIVE: To assess the feasibility of single-breath-hold three-dimensional cine b-SSFP (balanced steady-state free precession gradient echo) sequence (3D-cine), accelerated with k-t BLAST (broad-use linear acquisition speed-up technique), compared with multiple-breath-hold 2D cine b-SSFP (2D-cine) sequence for assessment of left ventricular (LV) function. METHODS: Imaging was performed using 1.5-T MRI (Achieva, Philips, The Netherlands) in 46 patients with different cardiac diseases. Global functional parameters, LV mass, imaging time and reporting time were evaluated and compared in each patient. RESULTS: Functional parameters and mass were significantly different in the two sequences [3D end-diastolic volume (EDV) = 129 ± 44 ml vs 2D EDV = 134 ± 49 ml; 3D end-systolic volume (ESV) = 77 ± 44 ml vs 2D ESV = 73 ± 50 ml; 3D ejection fraction (EF) = 43 ± 15% vs 2D EF = 48 ± 15%; p

Purpose. This study was undertaken to describe the correlation between the distribution of coronary artery disease (CAD) in a symptomatic population with suspected ischaemic heart disease, cardiovascular risk factors (RF) and clinical presentation. Materials and methods. We studied 163 patients (mean age 65.5 years; 101 men and 62 women) referred for multidetector computed tomography coronary angiography (MDCT-CA) to rule out CAD. The patients had no prior history of revascularisation or myocardial infarction. We analysed how the characteristics of CAD (severity and type of plaque) can change with the increase in RF and how they are related to different clinical presentations. Results. Patients were divided into three groups according to the number of RF: zero or one, two or three, and four or more. The percentage of coronary arteries with no plaque, nonsignificant disease and significant disease was 55%, 41% and 4%, respectively, in patients with zero or one RF; 27%, 51% and 22%, respectively, in patients with two or three RF; and 19%, 38% and 44%, respectively, in patients with four or more RF. Plaque in patients with nonsignificant disease was mixed in 65%, soft in 18% and calcified in 17%. The percentage of coronaries with no plaque in the three RF groups was 50%, 20% and 0% in patients with typical chest pain and 46%, 24% and 12% in those with atypical pain. The percentage of significant disease in patients with typical pain was 0%, 47% and 86% and in those with atypical pain 4%, 20% and 29%. Conclusions. MDCT plays an important role in the identification of CAD in patients with suspected ischaemic heart disease. Severity and type of disease is highly correlated with RF number and assumes different characteristics according to clinical presentation.

Pulmonary arterial hypertension (PAH) is a rare disease characterized by a dramatic, progressive rise of pulmonary vascular resistance (PVR), leading to elevated pulmonary artery pressures, right ventricular (RV) overload, and, eventually, failure. Current evaluation of PAH is based on invasive hemodynamics (RHC), exercise capacity, echocardiography, and N-terminal pro brain natriuretic peptide (NT-proBNP) levels [1]; although published survival data support a strong clinical role for cardiac magnetic resonance imaging (CMR) of the RV, this technique is still underused [2]. Much research is currently focusing on the exploration of candidate soluble biomarkers of RV dysfunction and prognosis. Soluble ST2 (sST2) is a member of the interleukin 1-receptor family, which increases in response to acute and chronic cardiomyocyte strain [3]; its circulating levels rise in chronic and acutely decompensated heart failure, and the extent of their elevation seems to be especially related to the presence and severity of RV compromise [4,5]. The circulating ligand of sST2, interleukin 33 (IL-33), probably plays a role in several inflammatory states. The aimof the present studywas to assess peripheral serumlevels of sST2 and IL-33 in a group of patients with PAH of different etiology and severity compared with healthy controls, and to explore their possible relation with clinical features and with parameters of RV remodeling and failure as measured by CMR.

The milestone definition of “Cardiac Function” has to be attributed to William Harvey, the discoverer of the circulation, who in 1628 stated: “The movement of the blood is constantly in a circle, and is brought about by the beat of the heart” [1, 2]. From a modern point of view, the main function of the heart is the delivery of oxygen to metabolizing tissues. Since oxygen delivery is dependent on (1) the oxygen-carrying capacity of blood, (2) the flow output from the heart, and (3) regional distribution of flow, then the heart is nowadays regarded as a pump with the function of supplying flow in blood vessels [2].

We present the case of a 68-year-old man with previous history of myocardial infarction and coronary artery bypass grafting. An initial chest X-ray showed a curvilinear calcification involving the left-sided profile of the mediastinal shadow. Cardiac MRI cine images demonstrated findings compatible with a calcified anterior myocardial infarction.

Background: Anderson-Fabry disease is a multisystem X linked disorder of lipid metabolism frequently associated with cardiac symptoms, including left ventricular (LV) hypertrophy gradually impairing cardiac function. Evidence showing that enzyme-replacement therapy (ERT) can be effective in reducing LV hypertrophy and improving myocardial function in the long term is limited. Objective: This study aimed to assess the long-term effects of ERT with recombinant alpha-galactosidase A (agalsidase beta, Fabrazyme) on LV function and myocardial signal intensity in 11 patients with Anderson Fabry disease. Patients: Eleven patients (eight males, three females) with varying stages of genetically confirmed Anderson Fabry disease were examined by means of physical examination and magnetic resonance imaging before ERT with agalsidase beta at 1 mg/kg every other week (study 1) and after a mean treatment duration of 45 months (study 2). Results: At 45 months of treatment, LV mass and LV wall thickness had significantly reduced: 188 (SD 60) g versus 153 (47) g, and 16 (4) mm versus 14 (4) mm, respectively. Furthermore, a significant reduction in myocardial T2 relaxation times was noted in all myocardial regions, that is, interventricular septum 80 (5) ms versus 66 (8) ms, apex 79 (10) ms versus 64 (10) ms, and lateral wall 80 (8) ms versus 65 (16) ms. Changes in LV ejection fraction were not significant. Amelioration of clinical symptoms was observed in all patients. Conclusions: Long-term therapy with agalsidase beta at 1 mg/kg every 2 weeks was effective in significantly reducing LV hypertrophy, improving overall cardiac performance and ameliorating clinical symptoms in patients with Anderson-Fabry disease.

PURPOSE: This study compared two quantitative semiautomated software packages for volumetric analysis of the left ventricle (LV) by magnetic resonance (MR) imaging using two-dimensional (2D) cine balanced steady-state free precession (b-SSFP) sequences. MATERIALS AND METHODS: We included 46 consecutive patients who underwent cardiac MR imaging for various indications. Two-dimensional cine b-SSFP sequences were used to assess the LV. Data sets were evaluated with two dedicated software packages: ViewForum, version 4.2, and Argus, version Va60C. Results were compared with Student's t test for paired samples, Pearson's r correlation coefficient and R2 coefficient of determination; ejection fraction differences were assessed with Bland-Altman analysis. The time required for analysis was also recorded. RESULTS: We observed very high levels of concordance and reproducibility. High correlation was observed for ejection fraction (p>0.05; r=0.9; R (2)=0.82). The time required for analysis was 7.6+/-2.78 min vs. 7.52+/-2.4 min (p>0.05; r=0.85; R (2)=0.73). Intraobserver and interobserver variability did not show significant differences. CONCLUSIONS: LV volume evaluation is an integral part of cardiac MR imaging. In our experience, there is no significant difference between the commonly used software packages in either quantitative output or time required for analysis.