Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography.

In patients with significant cardiac valvular disease, intervention with either valve repair or valve replacement may be inevitable. Although valve repair is frequently performed, especially for mitral and tricuspid regurgitation, valve replacement remains common, particularly in adults. Diagnostic methods are often needed to assess the function of the prosthesis.

Think Outside the Heart: An Unusual Cause of Large Hemopericardium.

Pericardial effusions secondary to tumors are commonly metastatic, originating primarily from the lung, breast, and lymphomas. Pericardial tamponade is a rare oncological emergency warranting early identification and treatment. We describe a 66-year-old male found to have a large bloody pericardial effusion causing tamponade physiology, and multimodality imaging was consistent with intrapericardial malignancy with no identifiable primary source.

Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification.

Background: Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis.

Objectives: In this study, the authors sought to determine the association of LV diastolic function by echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations.

Atypical Presentation of Right Ventricular Cardiac Hamartoma in a Young Man.

Cardiac tumors in adults are exceedingly rare and usually benign. We describe a 29-year-old man with a previous diagnosis of interventricular septal hypertrophy who presented with increasing severity of dyspnea and fatigue. Work-up revealed a 4.

Cardiovascular risk profile of Middle Eastern immigrants living in the United States-the National Health Interview Survey.

Background: Middle Eastern (ME) immigrants are one of the fastest-growing groups in the US. Although ME countries have a high burden of atherosclerotic cardiovascular disease (ASCVD), the cardiovascular health status among ME immigrants in the US has not been studied in detail. This study aims to characterize the cardiovascular health status (CVD risk factors and ASCVD burden) among ME immigrants in the US.

Added prognostic value of plaque burden to computed tomography angiography and myocardial perfusion imaging.

Background And Aims: Cardiac computed tomographic angiography (CCTA) - derived measures of coronary artery disease (CAD) burden have been shown to independently predict incident cardiovascular events. We aimed to compare the added prognostic value of plaque burden to CCTA anatomic assessment and single photon emission computed tomography (SPECT) physiologic assessment in a cohort with high prevalence of risk factors undergoing both tests.

Methods: Consecutive patients who underwent clinically indicated CCTA and SPECT myocardial imaging for suspected CAD were included.

Outcomes of patients with moderate-to-severe Ischemia excluded from the ischemia trial.

Background: The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial showed no difference in outcomes between medical therapy vs coronary revascularization in the management of patients with stable coronary artery disease. We aimed to determine the percentage of patients with at least moderate ischemia that would have been eligible for enrollment and evaluate the outcomes of those who would not.

Methods: Consecutive patients who underwent cardiac single-photon emission computed tomography (SPECT) between April 2016 and September 2019 were identified and all-cause mortality was determined.

Association Between FFR and Instantaneous Wave-Free Ratio (iFR) of Intermediate Lesions on Coronary Computed Tomography Angiography.

Background: New data suggests long term outcomes of coronary revascularization based on instantaneous wave free ratio (iFR) are equivalent to invasive fractional flow reserve (FFR). We aimed to evaluate the correlation between non-invasive FFR derived from cardiac CT (FFR) and iFR.

Methods: Data from 21 patients with 26 vessels, who underwent both FFR computation and invasive iFR measurement, were analysed.

Imaging in mitral stenosis.

Purpose Of Review: Mitral stenosis remains clinically relevant in developing countries where rheumatic heart disease is the predominant culprit. In the western world, mitral annular and valvular calcification is an increasingly recognized cause, particularly in an aging population. Echocardiography plays a primary role in imaging mitral stenosis with a growing role for cardiac computed tomography and magnetic resonance imaging.

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases.

The population of patients with adult congenital heart disease has grown and is currently estimated to include approximately 1 million people in the United States. Cardiologists and imagers frequently encounter complex patients who have undergone multiple prior operations and interventions. A myriad of imaging tests are currently available, including echocardiography, cardiovascular magnetic resonance imaging, and computed tomography, all of which collectively provide invaluable information on cardiac anatomy and hemodynamics.

CMR in the Evaluation of Diastolic Dysfunction and Phenotyping of HFpEF: Current Role and Future Perspectives.

Heart failure with preserved ejection fraction presents a challenging diagnosis given a heterogeneous patient population and limited therapeutic options. Diastolic function assessment using echocardiography has been a cornerstone in the work-up and is as important as systolic functional assessment. There has been increased awareness to the potential utility of cardiac magnetic resonance (CMR) imaging over the past decade as a promising, radiation-free, robust imaging modality providing an unrestricted field of view and high-resolution images for global and regional functional assessment.

Interobserver Variability in Applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 Guidelines for Estimation of Left Ventricular Filling Pressure.

Background: Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown.

Methods: Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications.

Sirolimus for Recurrent Giant Cell Myocarditis After Heart Transplantation: A Unique Therapeutic Strategy.

Clinical Features: Giant cell myocarditis (GCM) is a rare and a rapidly progressive disorder with fatal outcomes such that patients often require heart transplantation. We present a case of recurrent GCM in a transplanted patient with a history of Crohn disease requiring a novel therapeutic approach.

Therapeutic Challenge: After the orthotopic heart transplantation, GCM recurred on aggressive immunosuppression over the months, which included corticosteroids, basiliximab, tacrolimus, antithymocyte globulin, and rituximab.

Noninvasive Evaluation of Symptomatic Women with Suspected Coronary Artery Disease.

Cardiovascular disease (CVD) is the leading cause of death in the United States, yet several factors make it challenging to diagnose in women. Although women have more frequent chest pain than men, atypical symptoms such as nausea, dyspnea, and fatigue make it difficult to determine their risk of coronary artery disease (CAD) before testing. Current guidelines recommend exercise electrocardiography (ex-ECG) as the initial test in symptomatic women with intermediate pretest probability who can exercise and have a normal resting ECG; however, treadmill ex-ECG testing has a significantly lower positive predictive value in women.

Handheld Echocardiography: Current State and Future Perspectives.

Echocardiography is the primary imaging modality for diagnosing cardiac conditions. Over the past 2 decades, technological advancements have resulted in the emergence of miniaturized handheld ultrasound equipment that is compact and battery operated, and handheld echocardiography can be readily performed at the point of care with reasonable image quality. The simplicity of use, availability at the patient's bedside, easy transportability, and relatively low cost have encouraged physicians to use these devices for prompt medical decision making.

Critical congenital heart disease screening.

Critical congenital heart disease (CCHD) is a heart lesion for which neonates require early surgical intervention to survive. Without intervention, the rates of mortality and survival with significant disability are extremely high. Early diagnosis can potentially improve health outcomes in newborns with CCHD.

Bioprosthetic mitral valve thrombosis complicating antiphospholipid antibody syndrome, successfully treated with thrombolysis.

The incidence of bioprosthetic valve thrombosis and related embolic complications is extremely rare, obviating the need for long-term anticoagulation. As a result, experience in the diagnosis and treatment of bioprosthetic valve thrombosis is fairly limited. We report the first case of antiphospholipid antibody syndrome presenting as bioprosthetic mitral valve thrombosis, 15 months after valve replacement, and successfully treated with thrombolytic therapy.