Strain Analysis in Patients with Frequent Premature Ventricular Complexes and Preserved Left Ventricular Function Undergoing Ablation.

Background: Frequent premature ventricular complexes (PVCs) can cause PVC-induced cardiomyopathy. The value of PVC ablation in patients with preserved left ventricular function in the low-normal range (ejection fraction: 50-55%) is not established. Strain analysis has been used to estimate changes in left ventricular function beyond assessment of the ejection fraction (EF).

Spontaneous Coronary Artery Dissection: An Underdiagnosed Clinical Entity-A Primer for Cardiac Imagers.

Spontaneous coronary artery dissection (SCAD) is a nonatherosclerotic cause of myocardial infarction in young and middle-aged women that has gained increasing awareness in recent years. Its diagnosis presents a challenge. Invasive coronary angiography is the primary imaging modality for diagnosing SCAD; however, it carries risk in these patients, who have an increased predisposition to complications.

The Clinical Impact of Imaging Surveillance and Clinic Visit Frequency after Acute Aortic Dissection.

Background:  Guidelines recommend frequent follow-up after acute aortic dissection (AAD), but optimal rates of follow-up are not clear.

Methods:  We examined rates of imaging and clinic visits in 267 individuals surviving AAD during recommended intervals (≤1, > 1-3, > 3-6, > 6-12 months, then annually), frequency of adverse imaging findings, and the relationship between follow-up and mortality.

Results:  Type A and B AAD were noted in 46 and 54% of patients, respectively.

Effect of Race on Echocardiographic Measures of Cardiac Structure and Function.

The relations between race and cardiac structure and function are incompletely understood. We hypothesized that race-specific differences in echocardiography measurements exist. We compared the relation between echocardiography measurements and race among 12,429 nonobese adults without known cardiovascular disease who underwent echocardiography.

Differences in Echocardiographic Measures of Aortic Dimensions by Race.

It is not clear whether there are differences in aortic dimensions by race. Our hypothesis was that race-specific differences in aortic size exist. We compared the relation between race and aortic dimensions among 15,295 adults without known risk factors for cardiovascular disease or aortic dilatation, who underwent clinically indicated transthoracic echocardiography.

Indexing left ventricular wall thickness to body surface area improves prognostic value.

Background: Guidelines provide normal ranges of left ventricular (LV) wall thicknesses (WT) without indexing. We hypothesized that indexing WT to body surface area (BSA) improves prognostic value.

Methods: We examined the relationship between WT and BSA in 9737 patients undergoing echocardiography without risk factors for LV hypertrophy other than obesity.

Extracorporeal Membrane Oxygenation in a 29-Year-Old Man with Respiratory Failure and AIDS.

The use of extracorporeal membrane oxygenation (ECMO) in patients who have acute respiratory distress syndrome has been generally beneficial. However, because of various concerns, ECMO has rarely been used in patients who have human immunodeficiency virus infection with or without acquired immune deficiency syndrome. We report our successful use of venovenous ECMO in a 29-year-old man who presented with severe respiratory distress secondary to Pneumocystis jirovecii pneumonia associated with undiagnosed infection with the human immunodeficiency virus and acquired immune deficiency syndrome.

Presenting Systolic Blood Pressure and Outcomes in Patients With Acute Aortic Dissection.

Background: Presenting systolic blood pressure (SBP) is a powerful predictor of mortality in many cardiovascular settings, including acute coronary syndromes, cardiogenic shock, and acute heart failure.

Objectives: This study evaluated the association of presenting SBP with in-hospital outcomes, specifically all-cause mortality, in acute aortic dissection (AAD).

Methods: The study included 6,238 consecutive patients (4,167 with type A and 2,071 with type B AAD) enrolled in the International Registry of Acute Aortic Dissection.

Acute aortic syndromes: diagnosis and management, an update.

Acute aortic syndromes (AAS) encompass a constellation of life-threatening medical conditions including classic acute aortic dissection (AAD), intramural haematoma, and penetrating atherosclerotic aortic ulcer. Given the non-specific symptoms and physical signs, a high clinical index of suspicion is necessary to detect the disease before irreversible lethal complications occur. In order to reduce the diagnostic time delay, a comprehensive flowchart for decision-making based on pre-test sensitivity of AAS has been designed by the European Society of Cardiology guidelines on aortic diseases and should be thus applied in the emergency scenario.

Anomalous Coronary Arteries That Need Intervention: Review of Pre- and Postoperative Imaging Appearances.

Coronary artery anomalies constitute a diverse group of abnormalities, ranging from anatomic variants to those having hemodynamic consequences. This review focuses on major anomalies that have clinical implications requiring treatment, including anomalous origin of the coronary artery from the opposite sinus with interarterial course specifically with an intramural course, coronary artery origin from the pulmonary artery, and coronary artery fistula. Comprehensive imaging evaluation is necessary to precisely delineate the anatomy as well as pathophysiologic aspects of the anomaly before determining treatment options for a specific patient.

Utilization of "Stand-By" Extracorporeal Membrane Oxygenation in a High-Risk Parturient With Methamphetamine-Associated Cardiomyopathy Undergoing Dilation and Evacuation: A Case Report.

Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of "stand-by" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery.

SYNTAX Score Derived From Coronary CT Angiography for Prediction of Complex Percutaneous Coronary Interventions.

Rationale And Objectives: SYNTAX score is a useful metric determined at the time of invasive coronary angiography (ICA) to assess the complexity of coronary artery disease, and improves prediction of complications at the time of percutaneous complex intervention (PCI). We aimed to determine whether SYNTAX score can be reliably determined from coronary computed tomography angiography (CCTA) and whether a CCTA-derived SYNTAX score can predict complex PCI.

Materials And Methods: SYNTAX scores were calculated on per-patient, per-vessel, and per-segment basis in 154 consecutive patients who underwent CCTA and ICA.

Iterative Reconstruction Results in Larger Computed Tomography Measurements of Iliofemoral Artery Diameter in Patients Referred for Transcatheter Aortic Valve Replacement.

Objectives: We hypothesized that improved iterative reconstruction increases image quality and reduces artifacts for iliofemoral artery computed tomography imaging in patients referred for transcatheter aortic valve replacement (TAVR).

Methods: We examined 56 consecutive patients undergoing computed tomography for possible TAVR and compared image quality and iliofemoral artery size between adaptive statistical iterative reconstructions (ASIRs) and improved model-based iterative reconstructions (MBIRs).

Results: Model-based iterative reconstruction (vs ASIR) was associated with improved (P < 0.

Increased pericardial fat accumulation is associated with increased intramyocardial lipid content and duration of highly active antiretroviral therapy exposure in patients infected with human immunodeficiency virus: a 3T cardiovascular magnetic resonance feasibility study.

Background: The aim of the current study was to examine whether the use of highly active antiretroviral therapy (HAART) in patients with HIV is associated with changes in pericardial fat and myocardial lipid content measured by cardiovascular magnetic resonance (CMR).

Methods: In this prospective case-control study, we compared 27 HIV seropositive (+) male subjects receiving HAART to 22 control male subjects without HIV matched for age, ethnicity and body mass index. All participants underwent CMR imaging for determination of pericardial fat [as volume at the level of the origin of the left main coronary artery (LM) and at the right ventricular free wall] and magnetic resonance spectroscopy (MRS) for evaluation of intramyocardial lipid content (% of fat to water in a single voxel at the interventricular septum).

Effect of circadian variability in frequency of premature ventricular complexes on left ventricular function.

Background: Frequent idiopathic premature ventricular complexes (PVCs) can result in a reversible form of cardiomyopathy.

Objective: The purpose of this study was to assess the impact of variability in PVC frequency throughout the day on PVC-induced cardiomyopathy.

Methods: The subjects of this study were 107 consecutive patients (58 men [54%]; mean age 49.

Mortality Predictors in Patients Referred for but Not Undergoing Transcatheter Aortic Valve Replacement.

Although transcatheter aortic valve replacement (TAVR) has expanded the proportion of patients with aortic stenosis (AS) who are candidates for valve replacement, some patients remain untreated, and their outcomes are not clear. We evaluated 172 consecutive patients with severe symptomatic AS referred for TAVR who declined (n = 55) or were not candidates for (n = 117) intervention. We examined clinical and echocardiographic variables associated with mortality.

Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement.

Introduction: Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN).

Objective: To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN.

Approach: We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33).

A clinical model to identify patients with high-risk coronary artery disease.

Objectives: This study sought to develop a clinical model that identifies patients with and without high-risk coronary artery disease (CAD).

Background: Although current clinical models help to estimate a patient's pre-test probability of obstructive CAD, they do not accurately identify those patients with and without high-risk coronary anatomy.

Methods: Retrospective analysis of a prospectively collected multinational coronary computed tomographic angiography (CTA) cohort was conducted.