Guideline Challenge

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Lipoprotein(a) in familial hypercholesterolemia: Tips from family history.

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Double Trouble Percutaneous Disobstruction of 2 Pulmonary Veins Following Catheter Ablation for Atrial Fibrillation

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Myocardial fibrosis as a key determinant of left ventricular remodeling in idiopathic dilated cardiomyopathy: a contrast-enhanced cardiovascular magnetic study

In idiopathic dilated cardiomyopathy, there are scarce data on the influence of late gadolinium enhancement (LGE) assessed by cardiovascular magnetic resonance on left ventricular (LV) remodeling

ADIPONECTIN AND CARDIOVASCULAR RISK PREDICTION: STRATIFICATION OF CHEST PAIN PATIENTS BY A CLUSTER ANALYSIS

Cardiovascular disease (CVD) remains the major cause of death and there is the need to a better stratification of CVD patients. By an unbiased statistical approach we sought to identify clusters of patients to better stratify their risk. 202 patients with chest pain (63% males, age 62?12 yr) undergone to CT coronary angiography (CCTA) were prospectively included and classified using K-means cluster analysis of clinical, imaging and bio-humoral data. The most relevant classification resulted in three phenotypes distinguished according to Framingham score and HMW adiponectin plasma levels. Presence and severity of disease as assessed by CCTA were verified trough these phenotypes. By K-means cluster analysis, we identified CVD phenotypes allowing to stratify patients requiring different diagnostic and therapeutic approach

The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management

Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes

Chronotropic response to vasodilator-stress in patients submitted to myocardial perfusion imaging: impact on the accuracy in detecting coronary stenosis

Aims: A lower heart rate response (HRR) during vasodilator MPI has been shown to have a relevant adverse prognostic impact. We sought to evaluate the interaction among individual HRR to vasodilator stress and myocardial perfusion imaging (MPI) accuracy in patients with suspected ischemic heart disease (IHD). Methods and results: One hundred and sixty-five consecutive patients were submitted to vasodilator-stress MPI on a cardiac camera equipped with cadmium-zinc-thelluride detectors and coronary angiography. A coronary stenosis >70 % was considered significant. In every patient, the summed difference score (SDS) was computed from MPI images. Patients were categorized according to the tertiles of the distribution of individual HRR during dipyridamole: “Group 1” (HRR 12 bpm; highest tertile). Significant coronary artery disease (CAD) was present in 102 (62 %) patients. In the overall population, MPI showed a significant accuracy (AUC: 0.81, 95 % CI 0.74–0.86; p < 0.001) in unmasking the presence of significant coronary stenosis. Interestingly, in patients with a blunted HRR during dipyridamole (“Group 1”) MPI showed a significantly lower sensitivity (68 %) in detecting CAD than in those with a higher HRR (“Group 3”) (91 %, p = 0.007), despite a preserved specificity (76 % vs 77 %, P=NS). Similarly, the correlation among CAD extent and post-stress LV functional stunning was limited to “Group 3” patients, while it disappeared in those with blunted HRR. Conclusions: In patients with suspected IHD, MPI sensitivity is strongly influenced by the magnitude of patient heart rate increase to the pharmacologic stressor, suggesting an interaction among blunted HRR and lower accuracy in unmasking CAD