Innovations in Imaging: F-Fluorodeoxyglucose PET/CT for Assessment of Cardiovascular Infection and Inflammation.

Purpose Of Review: F-Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT), referred to as F-FDG PET/CT, plays a significant role in the diagnosis and management of patients with systemic infectious and inflammatory conditions. This review provides an overview of F-FDG PET/CT in systemic infectious and inflammatory conditions, including infective endocarditis (IE), cardiac implantable electrical device (CIED)/left ventricular assist device (LVAD) infection, sarcoidosis, and large-vessel vasculitis (LVV).

Recent Findings: This review highlights the past and present literature in the increasing role of F-FDG PET/CT in cardiovascular inflammation and infection, including diagnostic and prognostic findings.

Left atrial shape as a marker of atrial myopathy in embolic stroke of undetermined source.

Aims: Embolic stroke of undetermined source (ESUS) results in significant morbidity. A left atrial (LA) myopathy is implicated in a proportion of these patients. We hypothesized that LA shape varies by cause of stroke [CE (cardioembolic) vs.

Left atrial mechanics evaluated by two-dimensional strain analysis: alterations in essential hypertension.

Background: Hypertension is a cardiovascular risk factor that predisposes to cardiac structural alterations namely increased left ventricular (LV) wall thickness, reduced LV compliance and diastolic dysfunction, with consequent left atrial (LA) dilation and functional impairment. In this article, we evaluated differences in left atrial structure and function using two-dimensional speckle tracking echocardiography in patients with hypertension compared with controls.

Methods: This was a retrospective cross-sectional study of 208 hypertensive patients and 157 controls who underwent a comprehensive transthoracic echocardiogram.

Longitudinal strain with speckle-tracking echocardiography predicts electroanatomic substrate for ventricular tachycardia in nonischemic cardiomyopathy patients.

Background: Longitudinal strain (LS) derived from speckle-tracking echocardiography (STE) corresponds to regions of scar in ischemic cardiomyopathy.

Objective: We investigated if regional LS abnormalities correlate with scar location and scar burden, identified using high-density electroanatomic mapping (EAM) in nonischemic cardiomyopathy (NICM).

Methods: Fifty NICM patients with ventricular tachycardia (VT) underwent echocardiography; multilayer (endocardial, midmyocardial, and epicardial) regional LS and global LS (GLS) were evaluated prior to EAM for detection of low-voltage scar.

Electrocardiographic Characteristics and Their Correlation with Echocardiographic Alterations in Fabry Disease.

Fabry disease (FD) is an X-linked disorder with α-galactosidase A deficiency. Males (>30 years) and females (>40 years) often present with cardiac manifestations, predominantly left ventricular hypertrophy (LVH). The aim of this study was to evaluate electrocardiographic (ECG) characteristics within FD patients to identify gender related differences, and to additionally explore the association of ECG parameters with structural and functional alterations on transthoracic echocardiography (TTE).

Low Incidence of Ischemic Stroke Associated With Thrombus Aspiration in STEMI Patients Undergoing Primary PCI.

Background: Thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) was recommended to minimize distal embolization and to reduce thrombus burden prior to PPCI. Subsequent randomized trials showed no mortality benefit from TA and suggested an increased risk of stroke up to 180 days following TA, although it was not obvious that the procedure alone caused the strokes.

Methods And Results: This study retrospectively analyzed the periprocedural stroke rate in a series of STEMI patients treated with TA and PPCI at a single, large, tertiary hospital, where a rigorous uniform protocol of aspiration was used in all patients.

Segmental Cardiac Radiation Dose Determines Magnitude of Regional Cardiac Dysfunction.

Background Subclinical left ventricular dysfunction detected by 2-dimensional global longitudinal strain post breast radiotherapy has been described in patients with breast cancer. We hypothesized that left ventricular dysfunction postradiotherapy may be site specific, based on differential segmental radiotherapy dose received. Methods and Results Transthoracic echocardiograms were performed at baseline, 6 weeks, and 12 months postradiotherapy on 61 chemotherapy-naïve women with left-sided breast cancer undergoing tangential breast radiotherapy.

Changes in left atrial phasic strain and mechanical dispersion: Effects of age and gender.

Purpose: Left atrial (LA) function by two-dimensional (2D) strain is an emerging tool with increasing clinical utility. Age and gender are key modulators of strain parameters; however, the specific time course for LA structural and functional changes is not clearly defined.

Methods: A total of 147 healthy individuals (20-69 years) underwent transthoracic echocardiography; subjects were evaluated by age (decade) and gender.

Strain by speckle tracking echocardiography correlates with electroanatomic scar location and burden in ischaemic cardiomyopathy.

Aims: Ventricular tachycardia (VT) in ischaemic cardiomyopathy (ICM) originates from scar, identified as low-voltage areas with invasive high-density electroanatomic mapping (EAM). Abnormal myocardial deformation on speckle tracking strain echocardiography can non-invasively identify scar. We examined if regional and global longitudinal strain (GLS) can localize and quantify low-voltage scar identified with high-density EAM.

Inter-vendor comparison of left atrial strain using layer specific strain analysis.

Left atrial strain (LAS) on transthoracic echocardiogram (TTE) is increasingly recognised to have clinical utility in cardiovascular disease. Differences in LAS measurements between vendors remains a barrier for clinical use. We sought to compare LAS between two commonly used software platforms; the layer-specific endocardial and mid-myocardial measurements of LAS on General Electric (GE) Echopac were compared to TomTec strain.

Differing mechanisms of atrial fibrillation in athletes and non-athletes: alterations in atrial structure and function.

Aims: Atrial fibrillation (AF) is more common in athletes and may be associated with adverse left atrial (LA) remodelling. We compared LA structure and function in athletes and non-athletes with and without AF.

Methods And Results: Individuals (144) were recruited from four groups (each n = 36): (i) endurance athletes with paroxysmal AF, (ii) endurance athletes without AF, (iii) non-athletes with paroxysmal AF, and (iv) non-athletic healthy controls.

Right ventricular speckle tracking strain echocardiography in patients with acute pulmonary embolism.

Right atrial (RA) and right ventricular (RV) parameters assessed by traditional echocardiography lack sensitivity to identify pulmonary embolism (PE). We sought to determine if alterations in RV free wall longitudinal strain (FWS) would be present in PE patients and improve evaluation. This retrospective study comprised of 84 consecutive PE patients from 2 centres, with adequate transthoracic echocardiography (TTE) images for RV FWS analysis.

Focal Ventricular Tachycardias in Structural Heart Disease: Prevalence, Characteristics, and Clinical Outcomes After Catheter Ablation.

Objectives: This study sought to summarize the procedural characteristics and outcomes of patients with structural heart disease (SHD) who have focal ventricular tachycardia (VT).

Background: Scar-mediated re-entry is the predominant mechanism of VT in SHD. Some SHD patients may have a focal VT mechanism that remains poorly described.

Echocardiographic Predictors of Long-Term Mortality in Patients Presenting With Acute Pulmonary Embolism.

Pulmonary embolism (PE) is associated with a high mortality; whether echocardiographic evaluation at presentation predicts long-term adverse outcomes is of importance. We sought to determine if a composite of routinely obtained echocardiographic parameters could determine long-term adverse events in PE patients. Right ventricular (RV) size and function and right atrial (RA) size were retrospectively evaluated in 233 consecutive PE patients with an inpatient echocardiogram, and compared with 70 healthy controls; mortality at 3 years was confirmed.

Echocardiographic Strain in Clinical Practice.

The accurate evaluation of left ventricular (LV) function has been central to monitoring of therapy, institution of specific therapeutic interventions and as a prognostic marker for risk stratification in a variety of cardiovascular conditions. However, LV ejection fraction, the most commonly used measure of LV systolic function, is a 'coarse' measure of global LV function, with several limitations. Strain analysis, a measure of myocardial deformation, has come to the forefront more recently as a more sensitive measure of myocardial function than LV ejection fraction.

Persistent reduction in global longitudinal strain in the longer term after radiation therapy in patients with breast cancer.

Background: More than 80% of breast cancer patients receive radiotherapy (RT). However, RT can lead to cardiotoxicity, which usually develops insidiously over years, making diagnosis difficult. It is also unknown whether early identification of at-risk patients might improve long-term outcome.

Coronary artery vasospasm in a patient with Churg-Strauss syndrome.

Patients with Churg-Strauss syndrome often suffer from unusual cardiac manifestations and sudden cardiac death. This differs from patients with other autoimmune disorders, who typically present with premature ischaemic heart disease. We report the case of a 56-year-old man with recurrent coronary vasospasm, including an inferoposterior ST-elevation myocardial infarction, complicated by bradycardic arrest.

Clinical evaluation of a new technique to monitor return electrode skin temperature during radiofrequency ablation.

Purpose: Return electrode burns occur occasionally in cardiac radiofrequency ablation and more frequently in tumor radiofrequency ablation. A return electrode incorporating a thermochromic liquid crystal (TLC) layer, which changes color with temperature, has been shown in sheep studies to accurately indicate underlying skin temperature. We aimed to validate the accuracy of TLC-coated return electrodes in indicating skin temperature in the clinical setting of cardiac radiofrequency ablation.