Midventricular Level Research Articles

Myocardial native T1 mapping at 3T cardiac magnetic resonance–closing the full-vendor reporting cycle of normal values

Cardiac magnetic resonance is currently an indispensable tool in the diagnosis of cardiac pathologies, with mapping techniques being one of the most recent advances in this area. T1 mapping is a robust tool that uses the T1 magnetic relaxation time as a quantitative marker of myocardial tissue composition. However, multiple T1 mapping sequences are used, and data comparing them, especially on different vendors, is limited. This study aims to determine the T1 relaxation values in the cardiac muscle of healthy individuals using GE's Discovery 3T scanner, allowing the use of the T1 mapping technique in patients on a sustained basis. Thirty-one healthy volunteers were submitted to T1 mapping at 3T magnetic resonance imaging (MRI) equipment, with 3 being excluded from the analysis (54% women; mean age: 39.2±13.9 years). The MOLLI 5(3)3 sequence was used, acquiring one short axis slice at midventricular level. Native T1 values were presented as means (± standard deviation), and t-student independent samples tests evaluated gender differences in T1 values. The results show an average global native T1 value of 1193±39 ms, with women's values being statistically higher than men (1211±40 vs 1173±27 ms, respectively, p<0.006). Gender remained the only determinant of native T1 times on a multiple linear regression model that included age, ejection fraction, and T2 status. This study has established one of the few native T1 values for a 3T GE Discovery scanner that are on par with those already reported by other vendors for a similar sequence, closing the circle in full-vendor reporting.

Optimal left ventricular diameter measurement in subjects with sigmoid septum: comparison with three-dimensional left ventricular volume.

The purpose of this study was to determine the most appropriate measurement of left ventricular (LV) end-diastolic diameter for subjects with the sigmoid septum (SS) by measuring the LV end-diastolic diameter at the base and mid-ventricle and by examining the relationship between these measurements and the three-dimensional (3D) echocardiographic LV end-diastolic volume. In 91 patients who underwent echocardiography for screening cardiovascular abnormalities, the aorto-septal angle (ASA) was measured as an index of the sigmoid septum. LV end-diastolic diameter was measured at the base and mid-ventricular level (DDbase and DDmid, respectively), and their average value was calculated (DDavg). By using 3D echocardiography, LV end-diastolic volume (EDV3D) was measured. Among 91 patients, 48 patients had narrow ASA (< 120 degrees) and were divided into the sigmoid septum (SS) group, and the remaining 43 patients were divided into the non-SS group. In the SS group, all DDbase, DDmid, and DDavg were significantly correlated with EDV3D (r = 0.59, 0.80, and 0.76, respectively), and the correlation coefficient between DDbase and EDV3D was significantly lower than that between DDmid and EDV3D (p < 0.01). On the other hand, in the non-SS group, all DDbase, DDmid, and DDavg were significantly correlated with EDV3D (r = 0.77, 0.85, and 0.84, respectively), and the correlation coefficient between DDbase and EDV3D was statistically comparable to that between DDmid and EDV3D (p = 0.12). ASA was significantly correlated with the difference of DDmid minus DDbase (r = - 0.71, p < 0.001). In patients with SS, DDmid and DDavg were well reflected the 3D echocardiographic LV end-diastolic volume.

Additional value of cardiac magnetic resonance feature tracking parameters for the evaluation of the arrhythmic risk in patients with mitral valve prolapse

ObjectivesThe identification of patients with mitral valve prolapse (MVP) presenting high arrhythmic risk remains challenging. Cardiovascular Magnetic Resonance (CMR) feature tracking (FT) may improve risk stratification. We analyzed the role of CMR-FT parameters in relation to the incidence of complex ventricular arrhythmias (cVA) in patients with MVP and mitral annular disjunction (MAD). Methods42 patients with MVP and MAD who underwent 1.5 T CMR were classified as MAD-cVA (n = 23, 55%) in case of cVA diagnosed on a 24-h Holter monitoring and as MAD-noVA in the absence of cVA (n = 19, 45%). MAD length, late gadolinium enhancement (LGE), basal segments myocardial extracellular volume (ECV) and CMR-FT were assessed. ResultsLGE was more frequent in the MAD-cVA group in comparison with the MAD-noVA group (78% vs 42%, p = 0.002) while no difference was observed in terms of basal ECV. Global longitudinal strain (GLS) was reduced in MAD-cVA compared to MAD-noVA (− 18.2% ± 4.6% vs − 25.1% ± 3.1%, p = 0.004) as well as global circumferential strain (GCS) at the mid-ventricular level (− 17.5% ± 4.7% vs − 21.6% ± 3.1%, p = 0.041). Univariate analysis identified as predictors of the incidence of cVA: GCS, circumferential strain (CS) in the basal and mid infero-lateral wall, GLS, regional longitudinal strain (LS) in the basal and mid-ventricular inferolateral wall. Reduced GLS [Odd ratio (OR):1.56 (confidence interval (CI) 95%: 1.45–2.47; p < 0.001)] and regional LS in the basal inferolateral wall [OR: 1.62 (CI 95%: 1.22–2.13; p < 0.001)] remained independent prognostic factors in multivariate analysis. ConclusionIn patients with MVP and MAD, CMR-FT parameters are correlated with the incidence of cVA and may be of interest in arrhythmic risk stratification.

Significant difference in cardiac ventricular dimensions when measured using two different standard methods

Cardiac ventricular dimensions measured at postmortem examination are used to assess whether there is hypertrophy of the heart chambers. However, there is no clear consensus on where these measurements should be taken. Some have proposed this should be measured at the mid-ventricular level, but others advocate it should be measured at a set distance (e.g. 20 mm) from the base of the heart. Twenty consecutive adult hearts were examined and showed the ventricular dimensions were significantly higher (mean: 5–15 mm, p < 0.01) when measured at a level 20 mm from the base of the heart compared to the mid-ventricular level. Of clinical significance is that in slightly less than half the cases, normal ventricular dimensions at mid ventricle level fell within the criteria considered pathological (> 40 mm) when measured at 20 mm from the base of the heart. In terms of actual ventricular dimensions, only the left ventricle diameter measured at 20 mm from the base of the heart correlated significantly (albeit moderately) with heart weight, suggesting it can be a predictor for cardiac hypertrophy.

Evaluation of adalimumab effects on left ventricle performance by echocardiography indexes among patients with immunosuppressant refractory ulcerative colitis.

Inflammatory bases lead to a simultaneous flourishing of cardiovascular complications with inflammatory bowel disease (IBD). As a released cytokine, tumor necrosis factor-α (TNF-α) can either disrupt or preserve cardiovascular performance. Due to this controversy, this study aimed to appraise the short-term anti-TNF (adalimumab [ADA]) relics on cardiac function by gauging the echocardiography indexes in patients with immunosuppressant refractory ulcerative colitis (UC). All cases with a definite diagnosis of UC were included based on providing written informed consent and owning the severe form of active disease (Mayo score ≥7), which did not dampen with immunosuppressant. Patients were excluded in the case of previous cardiac ailments/risk factors and prior related surgical or pharmaceutical intervention. Transthoracic echocardiography (TTE) was carried out before and 3 months after biological regimen allocation and changes in indexes [ejection fraction (EF), left ventricular end-diastolic volume (LVEDV)/left ventricular end-systolic volume (LVESV), and global longitudinal strain (GLS) in standard parasternal short axis from mid-ventricular level, two-, three-, and four-chamber apical long axes] were compared via statistical analyses. The study consisted of 13 (65%) men and 7 (35%) women, with a mean age of 36.54 ± 11.3 years. Participants mainly possessed Montreal class I (45%) and an average of 3.25 years of disease duration. The intervention significantly controlled inflammation [endoscopic Mayo score (P = 0.001), partial Mayo score (P = 0.001), and C-reactive protein (P = 0.001)]. Endoscopic and clinical remission was obtained in 7 (35%) and 9 (45%) patients, respectively; however, no significant discrepancy related to the LVEDV (P = 0.86), LVESV (P-value = 0.25), EF (P-value = 0.06), and GLS in standard parasternal short axis (P = 0.73), long axis [apical 2-chamber (P-value = 0.61), apical 3-chamber (P-value = 0.15), and apical 4-chamber (P-value = 0.19) views] was observed before and after the intervention. Furthermore, no statistically significant correlation between disease activity and cardiac function was found, neither before nor after ADA administration. The present perusal found no deterioration in left ventricular function indexes with ADA intervention among patients with IBD without cardiac ailment. Thus, prescribing the anti-TNF to alleviate the inflammation can be carried out with less concern about cardiac consequences and considering other adverse traces in the target group.

Collapsed Woman With a D-Shaped Left Ventricle on Echocardiogram

A 45-year-old woman presented to the emergency department with unwitnessed out-of-hospital cardiac arrest with asystole rhythm. After intubation, transesophageal echocardiography was performed to search for possible etiologies of cardiac arrest. It showed a D-shaped left ventricle at the midventricular level in the transgastric short-axis view (Figure A and Video, available at http://www.annemergmed.com). After the return of spontaneous circulation, transesophageal echocardiography revealed the resolution of the D-shaped left ventricle (Figure B). Dilated right ventricle because of cardiac arrest. The right ventricle to left ventricle ratio was described as an echocardiographic sign suggesting pulmonary embolism with high specificity in previous studies.1Fields J.M. Davis J. Girson L. et al.Transthoracic echocardiography for diagnosing pulmonary embolism: a systematic review and meta-analysis.J Am Soc Echocardiogr. 2017; 30: 714-723.e4Abstract Full Text Full Text PDF PubMed Scopus (72) Google Scholar In our case, right ventricle dilation with septal flattening was also observed during resuscitation, which returned to normal size after the return of spontaneous circulation. In Aagaard's porcine studies,2Aagaard R. Caap P. Hansson N.C. et al.Detection of pulmonary embolism during cardiac arrest—ultrasonographic findings should be interpreted with caution.Crit Care Med. 2017; 45: e695-e702Crossref PubMed Scopus (27) Google Scholar,3Aagaard R. Granfeldt A. Bøtker M.T. et al.The right ventricle is dilated during resuscitation from cardiac arrest caused by hypovolemia: a porcine ultrasound study.Crit Care Med. 2017; 45: e963-e970Crossref PubMed Scopus (32) Google Scholar the right ventricle size showed no correlation with the causes of arrest. The right ventricle dilation might be inherent to cardiac arrest. Our case supported Aagaard’s studies; therefore, the dilated right ventricle noted on the echocardiography during resuscitation must be interpreted cautiously. Other differential diagnoses should be considered if the dilated right ventricle resolves after the return of spontaneous circulation. In patients with cardiac arrest, thrombus visualized in the proximal pulmonary arteries or right heart might be a more specific sign to diagnose pulmonary embolism and guide further treatment, such as thrombolytic therapy.4Konstantinides S.V. Meyer G. Becattini C. et al.2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).Eur Heart J. 2020; 41: 543-603Crossref PubMed Scopus (1340) Google Scholar Gastric ulcer perforation was diagnosed following the return of spontaneous circulation by computed tomography. Gastrorrhaphy and drainage of intra-abdominal abscess were done; however, the patient died the next day because of a profound septic shock. eyJraWQiOiI4ZjUxYWNhY2IzYjhiNjNlNzFlYmIzYWFmYTU5NmZmYyIsImFsZyI6IlJTMjU2In0.eyJzdWIiOiI0ODMwZGY4ZmNmZjg3MWZkNjRiYzVkNTgyMjQ1YTNhNyIsImtpZCI6IjhmNTFhY2FjYjNiOGI2M2U3MWViYjNhYWZhNTk2ZmZjIiwiZXhwIjoxNjcwOTg5Mzc1fQ.GE5j2RbdtAaHLdnx_AuVeAXfSftnIEpj1OAn9NZU9Stpu06w5LMVtZlgBhaB1tMFs6TOjMwr5LfsP17MhOD7AgBQr4O2BAy1vl0OVBHuhL5TuNK8RFAIVShVmQL_BYFiB4Py1xh8kiU5JsL9kuInpRDAEX4P1ANaxTL9CyTD4X3O9sFEHJLh6LgERT2fq6XjhXu3qODqLCmCDR5S7EOiP8HuU5Mt_PONO5bLGStTYYHOK1vIP7OlT_nLlacBrdeUxJqIHmLdtMZCEkZLFAPedhLGI0Tok-ncrbC-qlUnk1JI2PIYwPtgdKEJrxh6SHIK4D0haEmqAqE7Fbj6EggPDw Download .mp4 (2.92 MB) Help with .mp4 files VideoThe transesophageal echocardiography showing a D-shaped left ventricle at the midventricular level in the transgastric short-axis view during resuscitation, which turned back to a normal shape after the return of spontaneous circulation was achieved.

Abstract 9482: Coronary Spasm in a Patient With Argininosuccinic Aciduria

Case presentation: A 39-year-old male patient was referred for the treatment of hypertension. The patient had been treated for argininosuccinic aciduria (ASA) since eight months of age. Therapeutic drugs including, L-arginine, sodium phenylbutyrate and antiepileptic drugs had been administered. A detailed medical history taking revealed that the patient sometimes complained of chest discomfort under psychological stress. A 12-lead electrocardiogram showed abnormal q waves in lead III and aVF. Transthoracic echocardiography showed hypokinesis of left ventricular posterior wall. Endothelial function was quantified with brachial artery flow-mediated dilatation (FMD). The patient’s FMD value was 2.4% (normal cut off value 7.0%). Coronary computed tomography angiography showed no significant coronary stenosis. Cardiac magnetic resonance revealed transmural late gadolinium enhancement in the mid-ventricular level of the left ventricular posterior wall. The patient was suspected to have prior myocardial infarction. The patient was started on amlodipine and irbesartan, however, he continued to complain of chest discomfort at rest. Cardiac catheterization was performed to make a definitive diagnosis. The acetylcholine spasm provocation test revealed diffuse left and right coronary vasospasm. Transient ST-segment elevation with chest discomfort was observed. The patient was diagnosed as having coronary spastic angina. Chest discomfort was disappeared after additional administration of isosorbide mononitrate. Discussion: ASA is a genetic disorder of the urea cycle, caused by deficiency of argininosuccinate lyase (ASL). Specific laboratory findings are hyperammonemia, argininosuccinic acidemia and low plasma arginine levels. ASL is required to utilize extracellular arginine for NOS-dependent NO synthesis in endothelial cell. Reduction of ASL enzymatic activity leads to decline in NO production even if arginine is supplemented. Efficacy of NO supplementation for treatment of long-term complications in ASA patients has been reported. The precise mechanisms of coronary spasm remain to be elucidated. Our case report might support the significance of endothelial function in the pathogenesis of coronary spasm.

The veins of the left ventricular summit in patients undergoing cardiac resynchronization therapy

Abstract Introduction While the coronary sinus and its left ventricular branches have been extensively described, the veins of the left ventricle summit (LVS) have been much less studied. The emergence of new ablation techniques for ventricular tachycardias, which make use of the LVS veins, has generated a renewed interest in the anatomy of these venous conduits. Purpose The aim of the study was to describe in detail the anatomy of the LVS veins using rotational venous angiography. Material and methods All patients (N=106, age 68±12 years, 72 men) underwent coronary venous angiography during the cardiac resynchronization implant procedures. Results The LVS veins identified were the great cardiac vein (GCV), the anterior interventricular vein (AIV) and the mitro-aortic LVS vein (MALVSV). The MALSV emerged from the GCV between 12 and 2 o'clock on the mitral ring, coursed inside the left atrioventricular groove, towards the aorto-mitral continuity (AMC), where it turned towards the ventricular septum and coursed parallel to the AIV, tapered down and ended at midventricular level. Most of the course of this vein was in the region of the LVS. The diameter of the venous conduit at the GCV-AIV junction was 4.9±1.0 mm. The MALVSV was present in 76 patients (72%; Figure 1). The MALVSV diameter was 2.4±0.6mm at the ostium (Figure 2) and 1.8±2.0 mm at the AMC. The takeoff angle was 134±27°. The total length of the vein was 34±16 mm, of which 23±14mm were inside the AV groove and 11±9mm, were along the ventricular septum. The length of the MALSV segment embedded in the left AV groove as well as the total length of MALSV correlated significantly with the left atrial diameter (r=0.44; P=0.040 and r=0.45; p=0.016 respectively) as well as with the right ventricular systolic pressure (r=0.50; p=0.028 and r=0.57; P=0.030 respectively). Conclusions This study brings new insights into the angiographic anatomy of the LVS veins. Detailed knowledge of these venous tributaries could help with the development of new strategies for ablation of LVS tachycardias. Funding Acknowledgement Type of funding sources: None.

Pericardial fat is adversely related to cardio-mechanical interaction in heart failure with preserved ejection fraction: implications for exercise intolerance

Abstract Background Exercise intolerance is the primary manifestation in heart failure with preserved ejection fraction (HFpEF); however, the pathophysiologic mechanism(s) remains incompletely understood. Excess cardiac adiposity may physically constrain the myocardium, resulting in adverse Cardio-Mechanical Interaction (i.e., greater left ventricular eccentricity); a phenomenon only expected to worsen during exercise, with increased respiratory excursion and hemodynamic load. Evidence for this hypothesis, however, remains limited to a small number of observations, from a single group, made only under resting conditions using transthoracic echocardiography. Purpose To evaluate the relationship between pericardial fat and cardio-mechanical interaction in HFpEF at rest and during exercise using high resolution cardiac magnetic resonance imaging (cMRI). Methods We performed real-time (ungated), free-breathing cinematic imaging of the left ventricular (LV) short axis in 11 individuals with HFpEF (4M/7F, BMI: 36±6, age: 69±4 years). Imaging was performed at rest and during dynamic leg exercise (30 Watts) using an MRI-compatible ergometer (Ergospect, Austria). Epicardial and paracardial fat area were measured using high resolution cine images in the horizontal long axis imaging plane, with epicardial fat defined as the adipose tissue within the pericardium and paracardial fat defined as the adipose tissue outside of the pericardium (Figure 1A); the sum of which defined pericardial fat area. The LV eccentricity index was calculated as the ratio of LV short axis diameter parallel to the septum (anteroposterior dimension, AP) to the LV short axis diameter perpendicular to the septum (septolateral dimension, SL, Figure 1A) at mid-ventricular level, during inspiration at end-diastole. Results At rest, adverse cardio-mechanical interaction (i.e., AP/SL &amp;gt;1.0) was observed in 5 of the 11 cases. In those with adverse cardio-mechanical interaction both epicardial and paracardial fat area were significantly higher, resulting in greater pericardial fat area (Figure 1B). While epicardial fat area was not related to LV eccentricity index (R2=0.19, P=0.18), we observed a strong correlation between paracardial fat area and LV eccentricity index (R2=0.93, P&amp;lt;0.01), and pericardial fat area and LV eccentricity index (R2=0.86, P&amp;lt;0.01, Figure 1C). In contrast to our hypothesis, however, supine exercise did not exacerbate cardio-mechanical interaction, with LV eccentricity index remaining elevated in 4 of the 5 original cases, improving the fifth case (1.1 to 0.9, rest to exercise). Conclusions Taken together, these data extend prior reports of adverse cardio-mechanical interaction in HFpEF, showing greater contribution from paracardial fat versus epicardial fat. Future studies are needed to examine cardio-mechanical interaction during upright exercise in HFpEF patients. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health

A Starry Myocardium at CT: Cardiac Cysticercosis.

Supplemental material is available for this article.

Native T1 and T2 reference values for maltese healthy cohort.

Cardiac Magnetic Resonance (CMR) is increasingly being used for diagnosing various cardiac conditions. Parametric mapping enables quantitative myocardial characterization by directly measuring myocardial T1 and T2 values. However, reference values of parametric mapping are not standardized across different vendors and scanners, causing drawbacks for clinical implementation of this technique across different sites. We assessed the reference ranges of native T1 and T2 values in a healthy Maltese cohort to establish a local parametric mapping service. Healthy subjects [n = 51; mean age 36.0 (range 19-59) years] with normal cardiac function on CMR were recruited. Subjects underwent uniform parametric mapping pulse sequences [MOLLI 5b(3b)3b for native T1 mapping, and gradient echo single shot FLASH readout for T2 mapping] on a 3T Siemens MAGNETOM Vida scanner. Native T1 and T2 values were measured by placing a region of interest within the interventricular septum at midventricular level. Intra- and inter-observer variability were assessed using Bland-Altman plots. Mean ± 1.96 SD was used as a reference range. Mean native T1 and T2 values were 1200.1 ± 30.7ms and 39.5 ± 1.8ms, respectively. There was no significant bias in repeated measurements by the same and different observers. For the first time in Malta, we established the native T1 and T2 parametric mapping reference values for healthy Caucasian Maltese individuals. This will assist cardiologists to establish diagnosis, disease progression, and response to treatment of various myocardial diseases locally.

T1 values and extracellular volume fraction in asymptomatic subjects: variations in left ventricular segments and correlation with cardiovascular risk factors

To evaluate variations in pre-contrast (preT1) and post-contrast (postT1) myocardial T1 values and extracellular volume fraction (ECV) according to left ventricular (LV) segments and to find correlations between them and cardiovascular risk factors. The 233 asymptomatic subjects (210 men, 23 women; aged 54.1 ± 6.0 years) underwent cardiac magnetic resonance imaging with preT1 and postT1 mapping on a 1.5-T scanner. T1 values and ECVs were evaluated according to LV segments, age, sex, and estimated glomerular filtration rate (eGFR). Based on the presence of hypertension (HTN) and diabetes mellitus (DM), subjects were subdivided into the control, HTN, DM, and HTN and DM (HTN-DM) groups. T1 values and ECV showed significant differences between septal and lateral segments at the mid-ventricular and basal levels (p ≤ 0.003). In subgroup analysis, the HTN-DM group showed a significantly higher ECV (0.260 ± 0.023) than the control (0.240 ± 0.021, p = 0.011) and HTN (0.241 ± 0.024, p = 0.041) groups. Overall postT1 and ECV of the LV had significant correlation with eGFR (r = 0.19, p = 0.038 for postT1; r = − 0.23, p = 0.011 for ECV). Septal segments show higher preT1 and ECV but lower postT1 than lateral segments at the mid-ventricular and basal levels. ECV is significantly affected by HTN, DM, and eGFR, even in asymptomatic subjects.

Cardiac Multislice Computed Tomography in the Detection of Phenotypic Polymorphism of Hypertrophic Cardiomyopathy

Background. Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease with a prevalence of 1 case per 500 people and is the most common cause of sudden cardiac death in young patients. As clinical manifestations and electrocardiographic data are nonspecific and diverse, noninvasive imaging techniques play a key role in the detection of HCM and the understanding of its pathophysiology.&#x0D; The aim. To evaluate the possibilities of ECG-synchronized cardiac multislice computed tomography (MSCT) as a highly informative diagnostic tool for assessing the morpho-functional state of the heart in patients with HCM.&#x0D; Materials and methods. This was a retrospective analysis conducted at the National Amosov Institute of Cardiovascular Surgery from January 2020 to December 2021. We examined 221 cardiac MSCT scans of patients who underwent the examination to assess the spread of myocardial hypertrophy. Particular attention was paid to the presence of crypts at different levels of the left ventricle (LV), anatomical features of the mitral valve and subvalvular apparatus. The presence of systolic pulling of the anterior mitral valve to the interventricular septum, myocardial mass, LV end-diastolic, LV end-systolic volumes and the corresponding indices of body surface area, ejection fraction were determined and calculated during the functional analysis. Additionally, the anatomy and patency of the coronary arte­ ries were assessed. The studies were performed on a 640-slice Canon Aquilion One CT scanner with retrospective ECG gating and subsequent image processing. The studies were transferred to a workstation for review and evaluation by a team of radiologists.&#x0D; Results. The mean patient age was 46 ± 23 years, 48% were male. Mean maximal LV wall thickness was 19 mm (range 16–34). In 159 patients (71.9%), there was an asymmetric form of HCM with a predominant thickening of the anterior and anteroseptal segments of the left ventricle at the basal and midventricular levels. Fifty-four (24.4%) patients had symmetric form of HCM. The midventricular form of HCM was detected in 4 patients (1.8%). Apical form of HCM was detected in 3 patients (1.3%). One patient was diagnosed with a tumor-like variant of HCM (0.5%). In 198 patients (89.6%), systolic anterior motion of the mitral valve to the interventricular septum was found. In 95 cases (42.9%), morphological abnormality, abnormality of the number or attachment of the papillary muscles were detected. Forty-eight myocardial crypts were detected in 44 patients (21.7%). In 194 patients (87.7%), patent coronary arteries without signs of stenosis were found, 68 patients (30.7%) had 74 myocardial bridges (33.4%).&#x0D; Conclusions. HCM is a genetic heart disease with enormous phenotypic diversity. Due to its high spatial resolution, cardiac MSCT is an accurate diagnostic tool, which allows to assess the morphofunctional state of the LV, mitral valve, subvalvular apparatus, as well as to analyze the anatomy and narrowing of coronary arteries in patients with HCM.

ASSOCIATIONS BETWEEN EPICARDIAL FAT AND LEFT VENTRICULAR GEOMETRY IN YOUNG NON-OBESE HYPERTENSIVES

Objective: Epicardial adipose tissue (EAT) has been considered as a marker of cardiovascular risk. Previously association between the EAT volume with the insulin resistance index, metabolic parameters and emodelling parameters of the left heart was observed in young obese people with abdominal obesity. Aim: to evaluate the relations between epicardial adipose tissue thickness (EAT) with metabolic parameters and left ventricular geometry in young non-obese individuals with hypertension comparing to normotensive subjects. Design and method: 30 young non-obese subjects with untreated essential hypertension (HTN) diagnosed by office blood pressure (BP) measurements by Korotkoff method and/or ambulatory BP monitoring (ESH, 2018) were included as study group (mean age - 23 ± 3 yrs, 100% were male, mean BMI 26 ± 6 kg/m2, office SBP/DBP 138 [130; 171] / 74 [64; 97] mm Hg). The control group consisted of 20 healthy volunteers without HTN (mean age - 33 ± 6 yrs, 100% were male, mean BMI 26 ± 4 kg/m2, office SBP/DBP 126 [124; 128] / 70 [65; 75] mm Hg). The thickness and area of the epicardial fat were measured by CT-scan images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view directly surrounding the main coronary arteries Results: EAT thickness was higher in AH group comparing to healthy volunteers (7,42 [5,22; 11,01] vs 7,17 [4,67; 9,67] mm, p &lt; 0.05) and EAT square was larger in study group comparing to control group (93,5 [60,3; 267.0] vs 88,7 [50,7; 126,6] mm2, p &lt; 0.05). Correlations between EAT square and LDL-cholesterol (r = 0.53, p &lt; 0,05), HDL-cholesterol (r = -0,51, p &lt; 0,05), interventricular septum thickness of the left ventricle (r = 0.47, p &lt; 0,05), left ventricular posterior wall thickness (r = 0.56, p &lt; 0,05), relative wall thickness (r = 0.45, p &lt; 0,05) were found in AH group. No significant correlations were found in the control group. Conclusions: The accumulation of EAT among patients with AH is larger than among people with normal blood pressure. Epicardial adipose tissue thickness as early marker of visceral obesity associated with left ventricular emodelling in young non-obese patients with essential hypertension.

Impact of apical and mid-ventricular transmural infarcts in patients with acute myocardial infarction determined by using late gadolinium enhancement combined with feature tracking magnetic resonance.

To analyze the relationship between left ventricular (LV) myocardial strain and transmurality of myocardial infarction at three circular sections (basal, mid-ventricular, apical) by a combined analysis of cardiac magnetic resonance feature tracking (CMR-FT) and late gadolinium enhancement (LGE) information in a cohort of ST-elevation acute myocardial infarction (STEMI) patients after primary percutaneous coronary intervention (PPCI). In all, 136 patients with STEMI who underwent PPCI within 12 hours of symptom onset were included. CMR-FT and LGE-MRI were performed 5±2 days after PCI for measuring regional and global myocardial strain indexes and transmural extent. Multivariate regression analysis and Kaplan-Meier survival analysis were performed. Regional radial and circumferential strain decreased with increasing transmurality of myocardial infarction irrespective of basal, mid-ventricular, or apical segments. Segmental longitudinal strain was significantly decreased in the transmural infarcted segments only at the apical and mid-ventricular levels. A significant correlation was found between the number of transmural infarcts and global strain parameters in the apical and mid-ventricular portions. Transmural infarcted segments in apical + mid-ventricular portions >2 was related to an increased risk of cardiac events in patients with STEMI following PPCI than those ≤2. GLS was found to be an independent predictor of cardiac events in these patients. The number of transmural infarcted segments in apical + mid-ventricular portions affects LV global function and prognosis. Global longitudinal strain (GLS) is a significant predictor of adverse events after PPCI for STEMI. Morphologic and functional data fused to study complex pathophysiologic processes of LV early after STEMI may help in risk stratification of patients.

Usefulness of Right Ventricular Free Wall Strain Obtained with Two-Dimensional Speckle-Tracking Echocardiography in Patients with Repaired Tetralogy of Fallot and Pulmonary Regurgitation.

Right ventricular (RV) dysfunction caused by chronic pulmonary regurgitation (PR) is a major determinant of clinical outcome in adults with repaired tetralogy of Fallot (rTOF). However, the accurate assessment of RV function by conventional echocardiography remains challenging. This study tested the feasibility and usefulness of RV free-wall (RVFW) strain obtained by two-dimensional (2D) speckle-tracking echocardiography (STE) in evaluation of RV function in adults with rTOF by comparing cardiac magnetic resonance (CMR) imaging. We enrolled 22 consecutive patients (male/female, 8/14; mean age, 25.0 years) with rTOF who underwent transthoracic echocardiography at Tohoku University Hospital from July 2016 to June 2019. We measured RVFW strain by STE and compared them with 22 hemodynamically normal subjects (NOR) (male/female, 9/13; mean age, 32.0 years). The correlation between RV strain and CMR-derived RV ejection fraction (RVEF) or PR fraction (PRF) were also evaluated. All rTOF patients had more than moderate PR but were near asymptomatic. RVFW longitudinal strain (RVFW-LS) was significantly decreased in the rTOF group compared with that in the NOR group (-19.6 vs. -24.7, P < 0.01). In the rTOF group, RVFW-LS correlated with PRF (r = 0.44, P < 0.05), whereas RVFW circumferential strain at the mid-ventricular level correlated with RVEF (r = 0.57, P < 0.01). Intra-observer variability of RVFW strain was acceptable. These results indicate that RV systolic function and PR severity in rTOF could be assessed by RVFW strain measured by 2D STE. This method is feasible and can be used as a complement to CMR imaging.

Radial strain imaging-guided lead placement for improving response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy: the Raise CRT trial.

To evaluate the benefit of speckle tracking radial strain imaging (STRSI)-guided left ventricular (LV) lead (LVL) positioning in cardiac resynchronization therapy (CRT) in patients (pts) with ischaemic cardiomyopathy with CRT indication. We conducted a prospective randomized controlled trial. Patients were enrolled in nine centres with 2:1 randomization into two groups (guided vs. control). Patients underwent STRSI to identify the optimal LV position from six LV segments at midventricular level. Implantation via STRSI was attempted for recommended segment in the guided group only. Follow-up included echocardiography (6 months) and clinical evaluation (6 and 12 months). The primary endpoint was comparison % reduction in LV end-systolic volume at 6 months with baseline. Secondary endpoints included hospitalizations for heart failure and death, and improvement in additional echocardiographic measurements and quality of life score. A total of 172 patients (115 guided vs. 57 control) were enrolled. In the guided group, 60% of the implanted LV leads were adjudicated to be successfully located at the recommended segment, whereas in the control group 44% reached the best STRSI determined segment. There was no difference between the groups in any of the primary or secondary endpoints at 6 and 12 months. Our findings suggest that echo-guided implantation of an LV lead using STRSI does not improve the clinical or echocardiographic response compared with conventional implantation.

Evaluation of myocardial strain assessed by CMR tissue-tracking to predict adverse cardiovascular events in patients with cardiac amyloidosis

Abstract Background Cardiac affectation in amyloidosis is presented among 50% patients what implies worse prognostic. Early diagnosis and prognostic stratification is mandatory after the appearance of new therapies that could modify the course of the disease. Purpose The aim of our study was to assess the prognostic value of cardiac magnetic resonance parameters, including Tissue deformation, in cardiac amyloidosis patients. Methods We recruited patients (p) prospectively followed in our cardiomyopathy unit, for a mean period of 10 years (from 2010 to 2020) who were diagnosed with CA. Baseline clinical, laboratory and echocardiographic data were obtained. Contrast-enhanced CMR was performed on a 1.5 T clinical scanner. Routine analysis was performed with a semi-automatic software for volumetric analysis. When late gadolinium enhancement was present, percentage of area of enhancement (LGE) was calculated.All strain parameters were measured off-line using dedicated software. Left ventricular circumferential strain (CS) measurements were obtained using mid-ventricular level short-axis cine views. Longitudinal strain (LS) derived from cine SSFP of 2-, 3-, and 4-chamber long axis views.Finally we evaluated the CMR parameters related with the combined event of mortality and heart failure in the follow-up. Results A total of 98 p were included, with a mean age of 67.5±16.9 years old. Mean follow-up was 42,2±32 months. 22 p (24,4%) had light-chain amyloidosis (AL), 34 p (37,8%) wild type transthyretin amyloidosis (ATTRwt) and 34 p (37,8%) familiar transthyretin amyloidosis (ATTRm). 59p (60,8%) died or present heart failure during the follow-up. Patients who died or present heart failure in the follow-uo had lower left ventricular ejection fraction (48,25±12,2% vs 56,13±11,03%, p=0,003), higher myocardial mass (156,05±54,8g vs 120,84±56,1g, p=0,007), higher LGE (8,6±6,8% vs 4,4±2%), worst GLS (−14,76±6,1% vs −18,67±6,2%) and worst GCS (−23,3±9,7% vs −30,04±9,1%). Both, GLS and GCS were independently associated with the combined event of dead or heart failure when evaluated within a multivariate analysis in a Cox regression model, but GCS was the stronger predictor of events in the follow-up over other CMR parameters like LGE an myocardial mass (p&amp;lt;0,001). Tertile distribution for GCS identified subgroups with different adverse events, particularly for the lowest-risk tertile: GCS &amp;lt;−34%, who had a combinated event in 13,6% of cases, significantly lower than patients in the mid-risk tertile (41,5%) and highest-risk tertile (53,8%) (Log-rank p=0,02) Conclusion Mortality and appearance of heart failure in cardiac amyloid patients is high. The assessment of myocardial strain parameters by CMR tissue-tracking in this population is useful to predict adverse outcomes in the follow-up. Particularly, GCS, stratify patients in subgroups with different risk of events, with added value to classical CMR parameters. Funding Acknowledgement Type of funding sources: None. Death &amp; Heart Failure by GCS

Effect of trabeculated myocardial mass on left ventricle global and regional functions in noncompaction cardiomyopathy.

BACKGROUNDLeft ventricular (LV) noncompaction cardiomyopathy is a rare cardiomyopathic subtype that has been recognized in recent years and is being diagnosed at an increased rate. There is no consensus regarding the diagnosis of the disease, and increased trabeculation rates that meet the existing diagnostic criteria may even be present in healthy asymptomatic people. This indicates that differentiating criteria for diagnosis are needed.AIMTo examine the increase in myocardial trabeculation and the change in left ventricular global and regional functions.METHODSThis retrospective study included 65 patients (28 females, 37 males) diagnosed with LV noncompaction cardiomyopathy who underwent cardiac magnetic resonance imaging between January 2011 and August 2016 and had a noncompacted/compacted myocardial thickness ratio of over 2.3 in more than one segment in the left ventricle. The distribution and ratios of trabeculations in apical, midventricular, and basal regions were examined in short-axis images obtained from cardiac magnetic resonance. In addition, by using short-axis cine images, regional ejection fraction (EF) and global EF were calculated using the Simpson method in the left ventricle at apical, basal, and midventricular levels. RESULTSWhile the number of trabeculated segments were similar at the apical (3.2 ± 1.0) and midventricular levels, a statistically significant level of involvement was not observed at the basal level (0.4 ± 0.9) (P > 0.05). The highest noncompacted/compacted (trabeculation) ratio was observed at the apical level (3.9 ± 1.4), while this ratio was higher at the anterior (59%-89.4%) and lateral (62%-84.8%) segments (P > 0.05). Global EF was positively correlated with apical, midventricular, and basal regional EF (P < 0.05). However, there was no significant correlation between regional EF and the number of trabeculated segments or trabeculation ratio in all three regions; nor was there a significant correlation between regional EF and the number of trabeculated segments or trabeculation ratio in the entire LV (P > 0.05).CONCLUSIONNo global or regional relationship was observed between LV dysfunction and trabeculation rate or the number of trabeculated segments. This limits the usefulness of change in LV functions in the differentiation between normal and pathological trabeculation.

Acute Myocardial Infarction Due to Microvascular Obstruction in a Young Woman Who Recently Recovered from COVID-19 Infection

Although cardiovascular complications are common in hospitalized COVID-19 patients, those with milder cases who recovered at home are less studied. Here, we report the case of a young woman who recently recovered from COVID-19 at home. A week after recovery, she was admitted to our institution with acute chest pain, signs of ischemia on the electrocardiogram and elevated cardiac troponins. Coronary angiography showed normal epicardial coronary arteries, but the cardiac magnetic resonance showed transmural late gadolinium enhancement (LGE) in the mid-ventricular level of the lateral wall. The findings were strongly suggestive of a minor transmural myocardial infarction. This case report highlights the role of multimodality imaging in detecting cardiac injury in COVID-19 patients as well as the fact that mild COVID-19 cases who recovered at home are also exposed to thromboembolic events during the convalescent period.