Extent Of Myocardial Involvement Research Articles

Cardiac Tamponade following Mitral Valve Replacement for Active Infective Endocarditis with Ring Abscess

Periannular extension and abscess formation are rare but deadly complications of infective endocarditis (IE) with high mortality. Multimodality cardiac imaging, invasive and noninvasive, is needed to accurately define the extent of the disease. Debridement, reconstruction, and valve replacement, often performed in an emergent setting, remain the treatment of choice. Here we present a case of severe IE in a 29-year-old intravenous drug user who after undergoing debridement of the abscess, annular reconstruction, and mitral valve replacement (MVR) presented with recurrence of shortness of breath and pedal edema. Transthoracic echocardiogram (TTE) showed a 6.2 × 5.5 cm cavity, posterior to and communicating with the left ventricle through a 3 cm wide fistulous opening, in proximity of the reconstructed mitral annulus. The patient underwent a redo MVR with patch closure of the fistulous opening, with good clinical outcome. This case highlights the classic TTE findings and the necessity for close follow-up in the perioperative period in patients undergoing surgery for periannular extension of infection. A cardiac magnetic resonance imaging can be considered, preoperatively, in such cases to identify the extent of myocardial involvement and surgical planning.

Response to Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension

Chong CR et al. Clin Cardiol. 2013;36:401–406 We read with great interest the article by Chong et al1 titled “Dissociation Between Severity of Takotsubo Cardiomyopathy and Presentation With Shock or Hypotension,” which has recently been published in Clinical Cardiology. The authors aimed to show the association between severity of early hypotension and the extent of myocardial involvement and dysfunction in patients with takotsubo cardiomyopathy (TTC).1 They used the Simpson biplane echocardiographic method for estimating left ventricular ejection fraction and analyzed wall motion scores according to a 17-segment model. They also quantified regional and global myocardial edema via T2-weighted cardiac magnetic resonance (CMR) imaging within 6 days of admission. In their study, the authors concluded that initial hypotension did not imply severe left ventricular inflammation or systolic dysfunction. Nonetheless, some comments may be beneficial. The right ventricle (RV) may be predominantly involved in certain cardiac conditions such as arrhythmogenic right ventricular cardiomyopathy or TTC. In many congenital or acquired cardiac diseases primarily affecting the left ventricle, right heart involvement has an important role in prognosis of disease and is associated with a more severe impairment in left ventricular systolic function. The RV is difficult to evaluate using 2-dimensional (2D) imaging modalities due to its complex shape and orientation.2 Reversible RV dysfunction is common in TTC, and its presence can be associated with most severe left ventricular dysfunction and patients' clinical condition. CMR imaging has superiority in estimating and detecting RV involvement compared with 2D echocardiography. CMR imaging in the acute phase (at the time of initial clinical presentation) may provide more appropriate information about the structure and the functions of the RV. Nevertheless, due to the time delay between presentation and performing the CMR study in some patients (within 6 days), some wall motion abnormalities might be overlooked in the early period.3 Although T2-weighted imaging is the best approach for edema-weighted CMR imaging and has the capability of detecting increased myocardial water content, it has some disadvantages. T2-weighted imaging can detect the area of regional edema in the presence of an obvious normal myocardium as a reference segment. However, measuring the T2 signal may not be convenient in apical slices of patients with apical ballooning due to the absence of normal myocardial segment.4, 5 Also, T1 mapping has superior diagnostic performance compared with the T2-weighted methods in detecting myocardial edema. T1-mapping imaging can be useful in detecting myocardial changes beyond those identified by wall motion abnormality and pathologies where edema may be diffuse and patchy. T1-weighted and T2-weighted mappings are complementary techniques to each other, and they must be used together to detect a cardiac abnormality. Emre Yalcinkaya, MD Murat Celik, MD Uygar Yuksel, MD Erkan Yildirim, MD Department of Cardiology Gulhane Military Medical Faculty Ankara, Turkey Baris Bugan, MD Department of Cardiology Malatya Army Hospital Malatya, Turkey

Cardiac Masses, Part 2: Key Imaging Features for Diagnosis and Surgical Planning

The objectives of this article are to discuss key radiologic features that differentiate primary and secondary cardiac masses. Clinical scenarios are included to highlight stepwise radiologic workup of tumors of the pericardium, epicardium, myocardium, valves, and chambers. The involvement of key cardiac anatomic structures will also be emphasized to determine resectability and guide surgical planning. Multimodality imaging plays a pivotal role in diagnosis and surgical planning of cardiac masses. Clinical features, such as patient age, location, and imaging characteristics of the mass will determine the likely differential diagnosis. In addition to radiologic evaluation of the mass itself, involvement of valvular apparatus, extent of myocardial involvement, or presence of associated coronary artery involvement is necessary to determine resectability and surgical technique.

Direct T2 quantification to detect myocardial edema in patients with myocarditis and tako-tsubo cardiomyopathy

Background/objective T2-weighted cardiovascular magnetic resonance (T2W-CMR) has shown utility in diseases such as myocarditis and tako-tsubo cardiomyopathy (TTCM) where myocardial edema may be the predominant pathological abnormality. Since these conditions may affect many myocardial regions, a more quantitative approach may help identify extent of myocardial involvement and reduce uncertainty in qualitative interpretation of T2WCMR. We sought to evaluate the diagnostic utility of quantitative T2 mapping in patients presenting with acute myocarditis or TTCM.

Age and gender effects on the extent of myocardial involvement in acute myocarditis: a cardiovascular magnetic resonance study

Objective:Based upon epidemiological studies, male gender and younger age are risk factors for developing fatal myocarditis. The impact of age and gender on myocardial injury pattern in acute myocarditis, however,...

Typical and Atypical Electrocardiograms in Myocardial Infarction Caused by Acute Coronary Occlusion and Coronary Insufficiency

When an acute coronary episode occurs, if the initial electrocardiogram does not indicate a coronary occlusion, it may be difficult at first to determine the exact nature of the attack. The electrocardiogram may remain normal for a variable period or may indicate coronary insufficiency and myocardial ischemia. In the cases going on to coronary thrombosis and massive infarction, the electrocardiogram may show various rapidly changing patterns before the appearance of RS-T elevation and Q-waves. In coronary occlusion the electrocardiogram often shows involvement of more than one surface and variations of the typical patterns are frequent. The changes may be present in only a few of the 12 routine leads or only in special chest positions. In an acute coronary episode it is essential to keep the patient at rest until the extent of myocardial involvement has been determined. Not infrequently the electrocardiogram shows temporary improvement or actual return of RS-T and T to normal between the third and 10th days following myocardial infarction.