Lateral Wall Of Left Ventricle Research Articles

Pathophysiology of Q waves in II, III, avF in systemic lupus erythematosus. Evaluation using cardiovascular magnetic resonance imaging

To investigate the pathophysiology of Q waves in II, III, avF in systemic lupus erythematosus (SLE) by cardiovascular magnetic resonance (CMR). Inflammation evaluation by CMR using T2, early (EGE) and late gadolinium enhanced images (LGE) was performed in 20 SLE patients with mild cardiac symptoms and Q in leads II, III, avF of ECG. Their results were compared with 20 SLE patients with the same symptoms and normal ECG. In both groups, T2, EGE and left ventricular ejection fraction were normal. However, in 3/20 with Q in II, III, avF, CMR revealed lesions indicative of acute myocarditis. In the rest of them, CMR documented transmural LGE, due to past inferior myocardial infarction in 4/20 and epicardial LGE due to past myocarditis in 8/20 (4/8 in the inferior and 4/8 in the lateral wall of left ventricle). No LGE was found in 5/20 and the Q was attributed to the position of the heart. In 3/20 with normal ECG, CMR detected past myocarditis in 2/3 and myocardial infarction in 1/3. Coronary angiography assessed coronary artery disease in all SLE with evidence of myocardial infarction and normal coronaries in 9/10 patients with past myocarditis. Q in II, III, avF in SLE may indicate myocardial infarction, acute or past inflammation or be a positional finding. The lack of Q does not exclude the possibility of infarction or inflammation. CMR is the best tool to reveal the pathophysiology of Q waves in SLE and guide treatment of heart involvement in these patients.

Coronary Ectasia Is Associated with Impaired Left Ventricular Myocardial Performance in Patients without Significant Coronary Artery Stenosis

Objectives: To determine both ventricular functions and tissue Doppler echocardiography (TDE)-derived myocardial performance index (MPI) in patients with coronary artery ectasia (CAE). Subjects and Methods: Twenty-five patients with CAE (13 men; mean age 57 ± 9 years) and 25 age- and sex-matched controls without CAE (8 men; mean age 54 ± 10 years) were enrolled in the study. Left and right ventricular functions were detected using conventional echocardiography and TDE. Results: Left ventricle-lateral wall (0.61 ± 0.17; 0.50 ± 0.10, p = 0.02), interventricular septum (0.66 ± 0.17; 0.52 ± 0.10, p = 0.007) and mean MPI (0.63 ± 0.15; 0.51 ± 0.09, p = 0.004) were increased in the CAE group compared to the control group. Right ventricular MPI was similar in both the CAE and control groups (0.58 ± 0.18; 0.52 ± 0.19, p > 0.05). Conclusion: The findings show that left ventricular MPI is different in CAE patients without obstructive coronary artery disease compared to the normal control group. Also in these patients, right ventricular MPI was similar to the control group.

Abstract 17270: The Effects of Cardiac Resynchronization Therapy on Myofilament Calcium Sensitivity are Global and Mediated by Protein Phosphorylation

We have previously shown that calcium sensitivity is significantly decreased with dyssynchrony, but is improved with cardiac resynchronization therapy (CRT) using trabeculae from the right ventricle (RV). However, dyssynchrony and resynchronization cause regional changes in stress, with the RV and left ventricle (LV) experiencing differing loads. To investigate the regional effects of CRT, we used 3 canine models: dyssynchronous heart failure (HF dys , left bundle ablation, 6 wks atrial tachypacing), CRT (left bundle ablation, 3 wks atrial tachypacing, 3 wks biventricular tachypacing), and non-paced controls. Steady-state force-calcium relationships were measured in skinned myocytes isolated from the LV lateral wall. Compared to control, HF dys exhibited decreased maximal calcium-activated force (F max , Con: 35.00 ± 4.61 93 mN•mm -2 , n = 7 myocytes from 3 dogs, HF dys : 13.44 ± 1.66 mN•mm -2 , n = 7 myocytes from 3 dogs, P < 0.01), and decreased calcium sensitivity (EC 50 , Con: 1.92 ± 0.16 μM, HF dys : 2.58 ± 0.11, P < 0.01). These parameters were returned to near control values in the CRT dog (F max : 36.16 ± 2.78 mN•mm -2 , EC 50 : 2.00 ± 0.19 μM, n = 8 myocytes P < 0.05 vs HF dys , P = N.S. vs Con). To discover if these changes were mediated by altered phosphorylation state, we treated skinned RV trabeculae muscles with the phosphatase PP1 (2,500 U/ml) for 60 minutes, and measured force-calcium curves before and after treatment. None of the groups had a statistically significant change in F max after treatment ( P = N.S.). However, there was an increase in EC 50 in both Con (ΔEC 50 : 1.09 ± 0.22 μM, n = 6) and CRT (ΔEC 50 : 0.70 ± 0.23 μM, n = 5), while there was no effect on HF dys trabeculae (ΔEC 50 : -0.06 ± 0.14 μM, n = 5, P < 0.05 vs Con and CRT). This suggests that myofilament protein phosphorylation is responsible for the changes in calcium sensitivity. In summary, these results show that despite opposing regional changes in stress, the myofilament responds in a globally homogenous manner and is mediated by altered global kinase/phosphatase activity, and not by local stress response. Overall, this is encouraging data for the development of a pharmacological intervention to recreate the beneficial aspects of CRT, since regional targeting may be unnecessary.

Giant Intramural Left Ventricular Rhabdomyoma in a Newborn

A 1-day-old newborn was referred with prenatal echocardiographic diagnosis of cardiac mass. Born by caesarean section at 38+3 weeks of pregnancy, he presented with cyanosis and bradycardia at birth, requiring immediate intubation and mechanical ventilation. Chest x-ray demonstrated cardiomegaly with a cardiothoracic index of 0.7 (Figure 1). Echocardiographic examination (Figure 2 and Movie I in the online-only Data Supplement) confirmed the diagnosis of a large cardiac mass located at the posterior wall and at the apex of the left ventricle (LV). The child presented with several episodes of paroxysmal supraventricular tachycardia, which were treated with DC shock and various pharmacological agents, such as amiodarone, adenosine, flecainide, digoxin, and metoprolol, and 1 episode of ventricular fibrillation with cardiac arrest requiring resuscitation. MRI showed a single large mass (5.5×5 cm) arising from the left atrioventricular groove and extending to the LV lateral wall and apex, up to the interventricular septum, with no LV inflow or outflow obstruction, and was suggestive …

Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis

Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis. The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus. Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement.

Spatial Heterogeneity of Protein Expression Induced by Dyssynchronous Right Ventricular Pacing in the Left Ventricle of Dogs With Preserved Systolic Function

Background Right ventricular (RV) apical pacing may result in ventricular dyssynchrony, which is associated with functional and morphological changes in the left ventricle (LV). Our aim is to assess contraction and hypertrophy-related protein expression changes in the LV after RV apical pacing. Methods and Results Six dogs underwent dual chamber pacemaker (DDD) implantation and atrioventricular nodal catheter ablation. The pacing group received atria-sensed RV apical pacing for 12 weeks. LV dyssynchrony was assessed with speckle tracking technique. Subsequently, hearts were processed for Western blotting. Four sham-operated dogs were included for comparison. After 12 weeks of RV pacing, cardiac chamber size and LV ejection fraction remained unchanged. Both electrical and mechanical dyssynchrony were evident in RV-paced dogs compared with sham-operated dogs. The late-activated LV lateral wall of paced dogs displayed a 23% reduction in the amount of sarcoplasmic reticulum Ca 2+ ATPase, a 32% reduction in phospholamban levels, but a 3.6-fold increase in phospho-JNK expression, a 2.2-fold increase in phospho-p38, and 1.9-fold increase in phospho-ERK expression. There were no significant differences in the early-activated LV septum between paced and sham dogs. Conclusions Temporal dispersion of mechanical activation by RV apical pacing induced spatial dispersion of protein expression in the LV.

Safety of Remote Magnetic Navigation in Patients With Pacemakers and Implanted Cardioverter Defibrillators

Remote magnetic catheter navigation (MNS) has been shown to be feasible and safe for radiofrequency catheter ablation of various cardiac arrhythmias. However, its safety in patients with implanted pacemakers or cardioverter-defibrillators has not yet been studied. This retrospective case series study intends to assess the acute and short-term safety of remote MNS in patients with implanted pacemakers or cardioverter-defibrillators. Between January 2008 and June 2009, a total of 31 patients with implanted pacemakers (n = 5) or cardioverter-defibrillators (n = 26) underwent 32 catheter ablation procedures using the remote MNS. Baseline pacing thresholds, sensed amplitudes, pacing and, if available, shock impedances as well as battery status were measured in all devices before, immediately after, and 1-3 months after catheter ablation. After ablation, no statistically significant difference in atrial sensing (2.7 ± 1.5 mV vs 3.1 ± 1.9 mV, P = 0.18) and impedance (457 ± 104 Ω vs 449 ± 101 Ω, P = 0.37) were observed. After ablation, no statistically significant difference in right ventricular sensing (10.4 ± 3.8 mV vs 10.9 ± 4.9 mV, P = 0.43) and impedance (535 ± 118 Ω vs 534 ± 120 Ω, P = 0.913) were observed. No changes in pacing threshold could be observed in all but 2 patients with biventricular cardioverter-defibrillators who underwent ventricular tachycardia ablation in lateral wall of left ventricle near the implanted epicardial electrode. Ablation procedures using remote MNS can be performed safely in patients with implanted devices with no significant effects on device system integrity. Long endocardial ablation close to the insertion site of the implanted epicardial left ventricular leads can affect the pacing and/or sensing characteristics of these electrodes.

Screening for cardiomyopathy in muscular dystrophy with tissue doppler imaging

To study role of Tissue Doppler imaging (TDI) in identification of cardiomyopathy before development of ventricular dysfunction. Twenty-five patients with Duchenne's (DMD) and 10 with Becker's (BMD) muscular dystrophy along with 20 controls were evaluated using TDI. Pulse Tissue Doppler signals of the lateral left ventricle wall (lateral mitral annulus) revealed reduced systolic velocities in the DMD patients (mean +/- SD: 7.8 +/- 1.1 cm/sec vs. 8.6 +/- 1.1 cm/sec in controls) in patients of DMD. 60% of the non ambulatory DMD (ejection fraction 45+/-9%) patients had mild LV dysfunction and reduced systolic velocities (6.96 +/- 1.7 cm/sec, p<0.05 vs controls). The ambulatory DMD patients also had reduced systolic velocities (7.8 +/- 1.1 cm/sec) though ejection fraction was normal. Reduced tissue Doppler systolic velocities in the ambulatory DMD patients with normal conventional echocardiography would suggest that perhaps some of these patients (20% had velocities less than Mean - 2 SD of controls) have early myocardial dysfunction (picked up only as abnormal myocardial velocities). TDI picked up systolic dysfunction of the lateral wall in DMD even when overall LV function was normal conventional echocardiography. Tissue Doppler imaging is a useful technique to pick up early ventricular dysfunction and should be evaluated in larger studies and also with other techniques like magnetic resonance imaging.

Left Ventricular Extracellular Matrix Remodeling in Dogs with Right Ventricular Apical Pacing

Right ventricle (RV) apical pacing is associated with increased incidence of heart failure due to left ventricle (LV) desynchronization. We aim to investigate extracellular matrix (ECM) remodeling of the LV in dogs with atria-sensed RV apical pacing. Dogs with pacemakers underwent AV nodal ablation. After 12 weeks of atria-sensed obligatory RV pacing, LVs were separated into septum and lateral wall for analysis. Zymographic activity, including matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitors of metalloproteinase-1 (TIMP-1), TIMP-3, collagen transcript expression, and histology were examined in opposite portions of the LV to identify possible ECM remodeling changes by RV apical pacing. Compared with sham-operated dogs, increased interstitial fibrosis and fragmentation of myofibrils was found in the LV lateral wall in the pacing group. Collagen type II mRNA showed a significant 2-fold increase in the LV lateral wall in the pacing group. Although collagen type I mRNA was increased, the difference was not significant. Zymography demonstrated MMP-9 activity was enhanced in both the LV lateral wall and septum in the pacing group, but MMP-2 activity was enhanced in the LV lateral wall. Immunofluorescence stain confirmed the activation of MMP-2 and MMP-9 in the LV lateral wall in the pacing group. Protein expression of TIMP-1 and TIMP-3 showed regional differences in the pacing group and both proteins were increased in the LV lateral wall. LV dyssynchrony by RV apical pacing elicits heterogeneous ECM remodeling in the LV. These findings assist in the elucidation of the pathophysiology of LV desynchronization.

Right-to-Left Ventricular Diastolic Delay in Chronic Thromboembolic Pulmonary Hypertension Is Associated With Activation Delay and Action Potential Prolongation in Right Ventricle

Delayed left ventricle (LV)-to-right ventricle (RV) peak shortening results in cardiac output reduction in patients with chronic thromboembolic hypertension (CTEPH) and other types of pulmonary arterial hypertension. Why the synchrony between LV and RV is lost is unknown. We hypothesized that RV electrophysiological remodeling, notably, conduction slowing and action potential prolongation, contribute to this loss in synchrony. We conducted epicardial mapping during pulmonary endarterectomy in 26 patients with CTEPH and compared these findings with clinical, hemodynamic, and echocardiographic variables. We consecutively placed a multielectrode grid on the epicardium of the RV free wall and LV lateral wall. These regions corresponded to RV and LV areas where echocardiographic Doppler sample volumes were placed to measure RV-to-LV diastolic interventricular delay. RV and LV epicardial action potential duration was assessed by measuring activation-recovery interval. Onset of diastolic relaxation of RV free wall with respect to LV lateral wall (diastolic interventricular delay) was delayed by 38+/-31 ms in patients with CTEPH versus -12+/-13 ms in control subjects (P<0.001), because, in patients with CTEPH, RV completed electric activation later than LV (65+/-20 versus 44+/-7 ms, P<0.001) and epicardial action potential duration, as assessed by activation-recovery interval measurement, was longer in RV free wall than in LV lateral wall (253+/-29 versus 240+/-22 ms, P<0.001). Additive effects of electrophysiological changes in RV, notably, conduction slowing and action potential prolongation, assessed by epicardial activation-recovery interval, contribute to diastolic interventricular delay in patients with CTEPH.

Magnetic resonance in isolated noncompaction of the ventricular myocardium

Non-compaction of the ventricular myocardium (LCVM) is a rare disorder of myocardial morphogenesis usually diagnosed in paediatric age. The diagnosis was echocardiographically made on the basis of a reported spongeous/compacted ratio > 2 in one or more segments of the left ventricle during the diastolic period. We aimed to test the diagnostic accuracy of cardiovascular magnetic resonance (CMR) imaging in distinguishing pathological left ventricular non-compaction. Methods We collected a consecutive series of 8 patients, 5 males and 3 females, with a mean age of 14.9 years with non-compaction of left ventricular myocardium. All patients were admitted in our divisions of cardiology. In all cases the diagnosis was performed by echocardiography. The diagnosis was obtained when the spongeous/compacted ratio was > 2 in one or more segments of left ventricle, evaluated in systolic and diastolic period. In the end we completed the diagnosis by scanning with a Signa HD 1.5 T (GE, Milwaukee, USA) the same 8 patients affected by non compaction of ventricular myocardium. In all patients cardiac-gated T1 and T2 black-blood FSE images in short axis and in four-chamber horizontal long axis were obtained. Breath hold cine MR sequences (FIESTA) were performed, covering the whole left ventricle in short-axis plane and in four-chamber view. A segmented inversion-recovery fast gradient echo sequence (IR-FGE) was performed in the short-axis plane of the LV and in four-chamber-view after Gadolinium injection in 8 patients affected by non compaction of left ventricle. At the end of examination the spongeous/compacted ratio > 2 was calculated in all involved segments of the left ventricle in diastole. Results In all cases we demonstrated by echocardiography an involvement of the ventricular apex. In 3 cases the structural alterations involved also lateral wall of left ventricle. Magnetic resonance evaluation showed that involvement demonstrated by the echocardiogram was the same: ventricular apex involved in every patient, lateral wall in 3 and all segments in 2. However the spongeous/compacted ratio was >> 2 in all patients, with a mean value of 3,1. Conclusions Although our data refer to a small population of patients and need further confirmation, they suggest that it seems reasonable increase the cut-off for spongeous/compacted ratio from a value of 2 to 2.5 for non-compaction diagnosis when high-resolution magnetic resonance is used.

Abstract 4244: Longitudinal Cardiac Rotation Affects Systolic Myocardial Velocities and Velocity-Defined Measures Of Ventricular Dyssynchrony

Background : Left ventricle (LV) of cardiac resynchronization therapy (CRT) candidates often displays rotational motion in the horizontal plane, a phenomenon we named longitudinal rotation (LR). We assessed if magnitude and direction of LR affects myocardial velocity-based measures of LV dyssynchrony. Methods : In 100 CRT patients (age 64±13 yrs, 76 men) LR was assessed in the apical 4-chamber view by speckle-tracking while myocardial systolic velocities of basal septum and lateral LV wall were measured from 2-dimensional color tissue Doppler data. Patients were classified into quartiles based on their LR values. Intraventricular dyssynchrony was calculated as the absolute, while septo-lateral delay was calculated as the true difference between the time to peak systolic velocity of the septum and lateral wall. Results : LR in all quartiles except Quartile 4 had a clockwise (negative) direction when viewed in apical 4-chamber view. As quartiles increased, patients were more frequently ischemic, systolic septal velocity and septo-lateral delay decreased, while intraventricular dyssynchrony showed a U shaped relationship (Table ). While difference in peak amplitude of basal septal and lateral systolic velocities and LR correlated with end-systolic volume (ESV) decrease at follow-up in non-ischemic patients (r = 0.44 and r = 0.49, p &lt; 0.01 for both), neither intraventrivcular dyssynchrony nor septal-lateral delay correlated with ESV decrease in either etiology. Conclusions : LR affects amplitudes and timing of myocardial velocities. While difference in peak amplitude of basal septal and lateral systolic velocities and LR predict LV reverse remodeling, time-based velocity measures do not. ICM:/DCM: ischemic/dilated cardiomyopathy; T(sep/lat): time to peak (septal/lateral) systolic velocity; S(sep/lat): peak systolic (septal/lateral) velocity; S-L delay: septo-lateral delay; Dys: intraventricular dyssynchrony; ΔESV: end-systolic volume decrease

A Hypo-Echoic, Intramyocardial Space: Echocardiographic Characteristics of an Intramyocardial Dissecting Hematoma

A Hypo-Echoic, Intramyocardial Space: Echocardiographic Characteristics of an Intramyocardial Dissecting Hematoma

Altered ventricular stretch contributes to initiation of cardiac memory

Cardiac memory is a change in T-wave morphology induced by ventricular pacing or arrhythmias that persist after resumption of normal AV conduction. Changing the pacemaker site from atrium to ventricle alters ventricular activation and the mechanical pattern of ventricular contraction. Either or both alterations affect T-wave configuration. The purpose of this study was to study the role of altered contractile patterns on initiation of cardiac memory. Isolated rabbit hearts were immersed in Tyrode's solution (37 degrees C) and aortically perfused at a constant pressure of 70 mmHg. Three orthogonal quasi-ECG leads were recorded via six Ag-AgCl electrodes located on the walls of the bath. Hearts were paced at a constant cycle length from either the right atrial appendage or left ventricle lateral wall. The pulmonary artery was sealed, and both ventricles contracted isovolumetrically. Cardiac memory was quantified as T-wave vector displacement expressed as distance between T-wave vector peaks during atrial pacing before and after ventricular pacing. Five minutes of ventricular pacing induced significant T-wave vector displacement that returned to control in 5 to 10 minutes. No significant changes in intraventricular pressure occurred during and after ventricular pacing. Interventions that decreased ventricular load (shunting both ventricles to the bath) or contractility (excitation-contraction uncoupler blebbistatin) significantly decreased developed pressure and eliminated T-wave vector displacement. Neither intervention affected ventricular activation during ventricular pacing. Locally applied left ventricular epicardial stretch induced T-wave vector displacement similar to that induced by ventricular pacing. Altered ventricular activation during ventricular pacing initiates cardiac memory via induction of altered contractile patterns and altered stretch.

Efeitos das cardioplegias sangüínea e cristalóide no miocárdio hipertrófico de coelho: avaliação estrutural e ultra-estrutural

To experimentally compare the structural and ultrastructural changes in isolated hypertrophied rabbits' hearts submitted to cardiac arrest protected using sanguineous and crystalloid cardioplegia solutions. The study comprised two experimental groups and one control group. In Experimental Group I, cardiac arrest was achieved by the continuous infusion of tepid sanguineous cardioplegia solution. In Experimental Group II, cardiac arrest was obtained by an intermittent infusion of a cold crystalloid cardioplegia solution. In the Control Group the hearts were submitted to normothermic anoxic arrest for 45 minutes. After the procedures, eight samples of the left ventricle lateral wall were collected and fixed in 10% formaldehyde and 2.5% glutaraldehyde for structural and ultrastructural analysis. The structural and ultrastructural results demonstrated that the hearts submitted to cardiac arrest protected by continuous tepid sanguineous cardioplegia, Group I, were better preserved and with less accentuated cellular alterations compared to those submitted to cardiac arrest protected using intermittent cold crystalloid cardioplegia and the Control Group. Continuous tepid sanguineous cardioplegia was more efficient in the preservation of the structural and ultrastructural integrity of the myocardium when compared to intermittent cold crystalloid cardioplegia.

Transmural and endocardial Purkinje activation in pigs before local myocardial activation after defibrillation shocks

Earliest recorded postshock myocardial activations in pigs originate in the subepicardium of the apex and lateral free wall of the left ventricle (LV) 30-90 ms after the shock. The purpose of this study was to determine whether the Purkinje system is a candidate for the source of postshock activations by performing endocardial and transmural postshock activation mapping. In five pigs, 32 plunge needles with 12 electrodes (1-mm spacing) were inserted into the LV apex and lateral free wall. Up to 70 plunge needles with six electrodes (2-mm spacing) were spread throughout the remainder of the LV, while 9-12 plunge needles with four electrodes (2-mm spacing) were inserted into the right ventricle. A basket catheter with 32 bipolar recording sites was inserted into the LV. Defibrillation-threshold (DFT)-level shocks were delivered during 10 episodes of electrically induced ventricular fibrillation. Electrograms of postshock activation cycles were analyzed for Purkinje and myocardial activations. Purkinje activations were recorded before local myocardial activation in 9% of basket electrograms and in 15% of plunge needles during the first postshock activation cycle. Purkinje activations were identified during the first and subsequent several postshock activation cycles in at least one basket and one needle electrogram in 96% and 98% of defibrillation episodes, respectively. The Purkinje system is active during the early postshock activation cycles after DFT-level shocks. Further studies are required to determine whether activation initiates in the Purkinje system or whether it is activated by the myocardium or by Purkinje-myocardial junctional cells.

SPECT de perfusión miocárdica con 99mTc-Tetrofosmin y SPECT torácica con Galio-67 en paciente con dolor torácico y antecedente de sarcoidosis

We present the case of a 54-year-old male patient, with history of diagnosed sarcoidosis some years ago and myocardial involvement, who being asymptomatic, shows chest pain because of which he goes to the emergency room of the hospital. During the first hours of his admission the pain relieves with nonsteroidal antiinflammatory medication, an electrocardiogram demonstrates changes of early repolarisation with pericardial involvement, the enzymes don't rise and the echocardiogram reveals a slight pericardial effusion. The differential diagnosis is between a chest pain due to ischemia, and the secondary to myopericarditis in the clinical context of a sarcoidosis. Myocardial perfusion rest SPECT is required which is compatible with lateral acute myocardial infarction (AMI) with extension to inferior wall. A coronary angiography was carried out and showed two vessels disease (RCA and Cx), PTCA and stent were carried out successfully. During the admission a thoracic scintigraphy and SPECT with gallium -67 showed an uptake in lateral wall of left ventricle (LV). Nothing about active sarcoidosis was found.

Doppler Tissue, Strain, and Strain Rate Imaging in Pediatric Patients with Alström Syndrome: Are There Regional Functional Abnormalities?

We sought to determine the potential additive usefulness of Doppler tissue imaging (DTI), strain (epsilon), and epsilon rate (SR) imaging in assessing systolic function in pediatric patients with Alström syndrome. We conducted a case-control study at a pediatric hospital with 5 patients (age 5-18 years) with Alström syndrome living in Atlantic Canada and 21 age- and sex-matched healthy control subjects. Standard echocardiographic examination was followed by DTI of the interventricular septum (IVS) and left ventricle (LV) lateral wall, longitudinal epsilon, and SR at the basal, mid, and apical segments of the LV lateral, inferior, and anterior walls, and the IVS. We also imaged radial epsilon and SR of the interventricular posterior wall. For patients versus control subjects, conventional ejection fraction (0.65 vs 0.72) and fractional shortening (0.30 vs 0.35) did not distinguish between groups. DTI-derived s-waves consistently demonstrated significant differences in systolic function (LV lateral wall 0.073 vs 0.100; IVS 0.064 vs 0.080; LV anterior wall 0.066 vs 0.096; LV inferior wall 0.069 vs 0.092 [P < .05 in all positions]). Epsilon differences were observed in the movement of the mid-LV lateral (-10.4 vs -15.2, P = .035), basal LV anterior wall (-16.3 vs -22.9, P = .004), and the apical IVS (-6.3 vs -13.8, P = .015). SR at the midposition of the LV lateral wall (-0.7 vs -1.4, P = .000) also differed between the groups. Substantial diastolic function differences were also observed between patients and control subjects. Detection of systolic and diastolic function abnormalities in patients with Alström syndrome can potentially be enhanced by the use of DTI, epsilon, and SR imaging.

Left ventricular diastolic function and carotid artery wall in elderly athletes and sedentary controls

Advancing age is characterized by structural and functional change of left ventricle (LV) and large elastic arteries. Recent advances in tissue Doppler imaging (TDI) and integrated backscatter (IBS), new ultrasound tools, have allowed non-invasive assessment of structural and functional characterization of myocardium and artery wall. Our aim was to compare LV diastolic function and carotid artery remodeling in elderly athletes and sedentary controls. Twenty-five elderly athletes (males, aged 68.6 ± 4.2 years) were compared to 25 age-sex-matched sedentary controls. All the subjects underwent either conventional Doppler echocardiography with pulsed TDI to evaluate LV diastolic function, and conventional ultrasonography and integrated backscatter (IBS) analysis to evaluate the carotid wall. Corrected IBS values (C-IBS) were obtained by subtracting the IBS value of the adventitia. Body mass index and blood pressure were not different in the two groups; athletes showed lower heart rate ( P < 0.0001) and, as expected, higher LV mass than sedentary subjects ( P < 0.0001). Transmitral Doppler analysis showed in trained subjects a significantly lower peak A and a higher E/ A ratio ( P < 0.001). On regards to TDI measurements, athletes exhibited a higher E m, a lower A m, and, subsequently, an increased E m/ A m ratio of both lateral wall and septum ( P < 0.0001). The IVRT m was shorter in trained subjects ( P < 0.001). Athletes showed a lower C-IBS (–26.8 ± 2.9 vs. –23.4 ± 3.8 dB, P < 0.001) and a smaller intima-media thickness (IMT: 0.66 ± 0.14 vs. 0.80 ± 0.18 mm, P < 0.001) respect to sedentary controls. Moreover, a significant direct correlation was found between E m/ A m of LV septal and lateral wall and C-IBS values (respectively, r = 0.62 and r = 0.56, P < 0.001). Thus the aging heart manifests structural and functional changes in response to physical activity. The expected pattern of cardiac and arterial alterations normally seen in response to age is modified in the older athletes, suggesting the exercise training is an effective stimulus in shaping arterial structure and left ventricular function in older heart. It would appear that pulsed TDI and IBS analysis may play an important role in detecting training-induced LV and carotid artery structural and functional modifications.

Imagen de seudoaneurisma ventricular izquierdo por resonancia magnética cardíaca

Rev Esp Cardiol 2003;56(11):1133 1133 A 58-year-old man hospitalized with posterolateral acute myocardial infarction was referred to the cardiac magnetic resonance (CMR) unit to determine the precise morphology of the left ventricle (LV) as well as its overall and regional function. The test was indicated because of an extremely poor ultrasound window that did not allow characterization by transthoracic echocardiography. In the CMR study, cine gradient-echo T1 sequences were done along the cardiac axes. The 2-chamber view (Figure 1) findings were normal for structure and function, but the 4-chamber view and the basal shortaxis view (oblique sagittal view of the heart) showed rupture of the myocardium in the basal segment of the LV lateral wall (Figures 2 and 3). This created a pseudoaneurysm (PS) with a 2.6-cm neck (N), opening to the pericardial cavity. No thrombi were observed and ventricular function was 46% by the Simpson method. Cardiac magnetic resonance was highly accurate in IM AG E S I N CA R D I O L O G Y