Role of calcified spots detected by intravascular ultrasound in patients with ST-segment elevation acute myocardial infarction.

Electron beam computed tomographic studies have demonstrated that the extent of intracoronary calcium is related to risk of coronary events. This study was performed to gain further insight into the distribution of focal calcifications and their relation to the site of plaque rupture within the culprit artery in consecutive patients (n = 60) with acute myocardial infarction (AMI) using intravascular ultrasound imaging. Calcifications in the culprit lesion and adjacent segments were classified and counted according to their arc (< 45 degrees, 45 degrees to 90 degrees, 90 degrees to 180 degrees, > 180 degrees), length (< 1.

Serial reevaluation for ARVD/C is indicated in patients presenting with left bundle branch block ventricular tachycardia and minor ECG abnormalities.

Introduction: Diagnosis of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is based on a set of criteria proposed by the International Task Force (TF) for Cardiomyopathies in 1994. To fulfill these criteria, presence of both electrocardiographic and anatomical abnormalities must be assessed with ECG and imaging techniques, respectively. This may be difficult in patients with early/mild forms of the disease as detectable structural abnormalities may still be absent.

Cardiac resynchronization therapy in patients with systolic left ventricular dysfunction and symptoms of mild heart failure secondary to ischemic or nonischemic cardiomyopathy.

Cardiac resynchronization therapy (CRT) is beneficial in selected patients with moderate to severe heart failure (New York Heart Association [NYHA] classes III to IV). Patients with mildly symptomatic heart failure (NYHA class II) are currently not eligible for CRT and the potential beneficial effects in these patients have not been well studied. Fifty consecutive patients in NYHA class II heart failure and 50 consecutive patients in NYHA classes III to IV (control group) were prospectively included.

Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease.

The purpose of the present study was to determine the diagnostic accuracy of current 64-slice multislice computed tomography (MSCT) in the detection of significant coronary artery disease, using conventional coronary angiography as the gold standard. In 61 patients scheduled for conventional coronary angiography, 64-slice MSCT was performed and evaluated for the presence of significant (>or=50% luminal narrowing) stenoses. One patient had to be excluded because of a heart rate>90 beats/min during data acquisition.

Combined utility of brain natriuretic peptide and cardiac troponin T may improve rapid triage and risk stratification in normotensive patients with pulmonary embolism.

Background: Evaluation of the combined utility of brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) for risk stratification in normotensive patients with acute pulmonary embolism. The changing patterns of BNP and cTnT levels during the initial management of pulmonary embolism and their correlation with clinical outcome were the focus of this study.

Methods: BNP and cTnT levels were measured in 28 consecutive normotensive on admission patients (age 53+/-18 years) with acute pulmonary embolism.

Mobile right heart thrombus and massive pulmonary embolism.

The current report describes a patient with pulmonary embolism, treated unsuccessfully with heparin. Transthoracic echocardiography revealed free-floating right heart thrombus. Migrating deep vein thrombus to the right heart was suspected.

Assessment of left ventricular dyssynchrony in patients with conduction delay and idiopathic dilated cardiomyopathy: head-to-head comparison between tissue doppler imaging and velocity-encoded magnetic resonance imaging.

Objectives: This study sought to compare tissue Doppler imaging (TDI) with velocity-encoded (VE) magnetic resonance imaging (MRI) for left ventricular (LV) dyssynchrony assessment.

Background: Cardiac resynchronization therapy (CRT) is proposed for patients with heart failure, depressed LV function, and a wide QRS complex. Selection is based mainly on electrocardiogram criteria, but recent data suggest that intraventricular dyssynchrony may be preferred for selection.

Ablation of focal atrial arrhythmia in patients with congenital heart defects after surgery: role of circumscribed areas with heterogeneous conduction.

Background: In patients late after surgical repair of congenital heart disease (CHD), areas with abnormal electrophysiologic properties may serve as slow conducting pathways within a macroreentrant circuit or may be the source of focal atrial tachycardia.

Objectives: The purpose of this study was to evaluate the role of abnormal areas during focal atrial tachycardia prior to ablation.

Methods: Electroanatomic activation mapping of 62 atrial tachycardias was performed in 43 consecutive patients (37 +/- 12 years) after surgical repair of CHD.

Usefulness of intramyocardial injection of autologous bone marrow-derived mononuclear cells in patients with severe angina pectoris and stress-induced myocardial ischemia.

Bone marrow cell transplantation has been proposed as a novel therapeutic option for patients with coronary artery disease. This study investigated whether autologous bone marrow-derived mononuclear cell injection into the ischemic myocardium of patients with severe angina pectoris could safely reduce anginal symptoms, improve myocardial perfusion, and increase left ventricular (LV) function. In a total of 20 patients (63 +/- 10 years old; 16 men) with angina pectoris, myocardial segments with stress-induced ischemia as assessed by gated single-photon emission computed tomography were injected with 30 to 100 million mononuclear cells.

Effect of radiofrequency catheter ablation for atrial fibrillation on left atrial cavity size.

Left atrial (LA) remodeling is associated with atrial fibrillation (AF). Radiofrequency catheter ablation offers a good treatment option for AF, with reasonable long-term results. The purpose of the present study was to assess whether LA reverse remodeling occurs after successful catheter ablation.

Effect of intramyocardial injection of autologous bone marrow-derived mononuclear cells on perfusion, function, and viability in patients with drug-refractory chronic ischemia.

Unlabelled: Intramyocardial injection of bone marrow cells has been proposed as a new therapeutic option for patients with chronic ischemic heart disease. We investigated whether autologous bone marrow-derived mononuclear cell injection into the myocardium of patients with drug-refractory ischemia reduces anginal symptoms, improves left ventricular (LV) function, increases myocardial perfusion, and alters the extent of scar tissue.

Methods: In 25 patients (mean age +/- SD, 64 +/- 10 y; 21 male) with drug-refractory angina pectoris (Canadian Cardiovascular Society [CCS] class III-IV), despite optimized medical therapy and without options for conventional revascularization, bone marrow was aspirated from the iliac crest.

Prediction of functional recovery after revascularization in patients with coronary artery disease and left ventricular dysfunction by gated FDG-PET.

Background: Traditionally, cardiac fluorodeoxyglucose (FDG) uptake is combined with regional perfusion for optimal evaluation of viability. Gated FDG-positron emission tomography (PET) may be an alternative technique for detection of viability because it permits combined assessment of glucose metabolism uptake and wall thickening (WT). In this study the value of FDG uptake and WT (analyzed from a stand-alone gated FDG-PET study) for the prediction of recovery of regional and global left ventricular (LV) function in patients with coronary artery disease undergoing revascularization is studied.

Left ventricular dyssynchrony in patients with heart failure: pathophysiology, diagnosis and treatment.

The number of patients with chronic heart failure is increasing rapidly in the Western world. Despite the introduction of new pharmacologic therapies, the prognosis of these patients remains poor. Left ventricular (LV) dyssynchrony is a frequently observed feature in patients with heart failure, and is recognized as an important predictor of poor outcome if left untreated.

Prediction of functional recovery after revascularization in patients with chronic ischaemic left ventricular dysfunction: head-to-head comparison between 99mTc-sestamibi/18F-FDG DISA SPECT and 13N-ammonia/ 18F-FDG PET.

Purpose: (18)F-FDG PET is an important modality for myocardial viability assessment in patients with left ventricular (LV) dysfunction. Dual-isotope simultaneous acquisition (DISA) SPECT may be an alternative to PET. The aim of this study was to compare the diagnostic performance of PET and DISA SPECT for the prediction of improvement in regional and global LV function as well as LV reverse remodelling after revascularization.

Hemodynamic effects of long-term cardiac resynchronization therapy: analysis by pressure-volume loops.

Background: Acute hemodynamic effects of cardiac resynchronization therapy (CRT) were reported previously, but detailed invasive studies showing hemodynamic consequences of long-term CRT are not available.

Methods And Results: We studied 22 patients scheduled for implantation of a CRT device based on conventional criteria (New York Heart Association class III or IV, left ventricular [LV] ejection fraction <35%, left bundle-branch block, and QRS duration >120 ms). During diagnostic catheterization before CRT, we acquired pressure-volume loops using conductance catheters during atrial pacing at 80, 100, 120, and 140 bpm.

Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy.

Background: Currently, one third of patients treated with cardiac resynchronization therapy (CRT) do not respond. Nonresponse to CRT may be explained by the presence of scar tissue in the posterolateral left ventricular (LV) segments, which may result in ineffective LV pacing and inadequate LV resynchronization. In the present study, the relationship between transmural posterolateral scar tissue and response to CRT was evaluated.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy: screening, diagnosis, and treatment.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a heart muscle disorder characterized pathologically by fatty or fibrofatty replacement and electrical instability of the right ventricular myocardium. Clinical manifestations include structural and functional malformations (fatty infiltration, dilatation, aneurysms) of the right ventricle, ECG abnormalities, and presentation with ventricular tachycardias with left bundle branch block pattern or sudden death. The disease often is familial with an autosomal inheritance.

Meta-analysis of comparative diagnostic performance of magnetic resonance imaging and multislice computed tomography for noninvasive coronary angiography.

Background: Magnetic resonance imaging (MRI) and multislice computed tomography (MSCT) have emerged as potential noninvasive coronary imaging techniques. The objective of the present study was to clarify the current accuracy of both modalities in the detection of significant coronary artery lesions (compared to conventional angiography as the gold standard) by means of a comprehensive meta-analysis of the presently available literature.

Methods: A total of 51 studies on the detection of significant coronary artery stenoses (> or = 50% diameter stenosis) and comparing results with conventional angiography were identified by means of a MEDLINE search.

Clinical versus echocardiographic parameters to assess response to cardiac resynchronization therapy.

Currently, a clear definition of response to cardiac resynchronization therapy (CRT) is still lacking, and clinical and echocardiographic end points are used. It is also unclear whether patients with clinical responses also improve in echocardiographic end points (and vice versa). To better understand and define response to CRT, the relation between improvement in clinical and echocardiographic parameters was evaluated in 144 patients.

Outcome after mitral valve repair for acute and healed infective endocarditis.

Objective: To evaluate the long-term clinical and echocardiographic outcomes after mitral valve surgery for acute and healed infective endocarditis.

Methods: Of 37 consecutive patients presenting with native mitral valve endocarditis, mitral valve repair (MVRep) was feasible in 34 (92%) patients. In 17 (50%) patients, surgery was indicated during antibiotic therapy (acute endocarditis), whereas 17 (50%) underwent surgery after antibiotic therapy was completed (healed endocarditis).

Does a gender difference in response to cardiac resynchronization therapy exist?

Background: Cardiac resynchronization therapy (CRT) has a beneficial effect on clinical symptoms, exercise capacity, and systolic left ventricular (LV) performance in patients with heart failure. The aim of the current study was to evaluate whether a gender difference exists in response to CRT.

Methods: Consecutive patients with end-stage heart failure (New York Heart Association, NYHA, class III-IV), LV ejection fraction (LVEF) < or =35%, QRS duration >120 ms, and left bundle branch block configuration underwent CRT.