MitraClip after heart transplantation: A case report

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Arrhythmic risk stratification by cardiac magnetic resonance tissue characterization: disclosing the arrhythmic substrate within the heart muscle

Sudden cardiac death (SCD) is a pivotal health problem worldwide. The identification of subjects at increased risk of SCD is crucial for the accurate selection of candidates for implantable cardioverter defibrillator (ICD) therapy. Current strategies for arrhythmic stratification largely rely on left ventricular (LV) ejection fraction (EF), mostly measured by echocardiography, and New York Heart Association functional status for heart failure with reduced EF. For specific diseases, such as hypertrophic and arrhythmogenic cardiomyopathy, some risk scores have been proposed; however, these scores take into account some parameters that are a partial reflection of the global arrhythmic risk and show a suboptimal accuracy. Thanks to a more comprehensive evaluation, cardiac magnetic resonance (CMR) provides insights into the heart muscle (the so-called tissue characterization) identifying cardiac fibrosis as an arrhythmic substrate. Combining sequences before and after administration of contrast media and mapping techniques, CMR is able to characterize the myocardial tissue composition, shedding light on both intracellular and extracellular alterations. Over time, late gadolinium enhancement (LGE) emerged as solid prognostic marker, strongly associated with major arrhythmic events regardless of LVEF, adding incremental value over current strategy in ischemic heart disease and non-ischemic cardiomyopathies. The evidence on a potential prognostic role of mapping imaging is promising. However, mapping techniques require further investigation and standardization. Disclosing the arrhythmic substrate within the myocardium, CMR should be considered as part of a multiparametric approach to personalized arrhythmic stratificatio

Right Ventricular Strain and Dyssynchrony Assessment in Arrhythmogenic Right Ventricular Cardiomyopathy: Cardiac Magnetic Resonance Feature-Tracking Study

BACKGROUND: Analysis of right ventricular (RV) regional dysfunction by cardiac magnetic resonance (CMR) imaging in arrhythmogenic RV cardiomyopathy (ARVC) may be inadequate because of the complex contraction pattern of the RV. Aim of this study was to determine the use of RV strain and dyssynchrony assessment in ARVC using feature-tracking CMR analysis. METHODS AND RESULTS: Thirty-two consecutive patients with ARVC referred to CMR imaging were included. Thirty-two patients with idiopathic RV outflow tract arrhythmias and 32 control subjects, matched for age and sex to the ARVC group, were included for comparison purpose. CMR imaging was performed to assess biventricular function; feature-tracking analysis was applied to the cine CMR images to assess regional and global longitudinal, circumferential, and radial RV strains and RV dyssynchrony (defined as the SD of the time-to-peak strain of the RV segments). RV global longitudinal strain (-17\ub15% versus -26\ub16% versus -29\ub16%; P-23.2%, SD of the time-to-peak RV longitudinal strain >113.1 ms, and SD of the time-to-peak RV circumferential strain >177.1 ms allowed correct identification of 88%, 75%, and 63% of ARVC patients with no or only minor CMR criteria for ARVC diagnosis. CONCLUSIONS: Strain analysis by feature-tracking CMR helps to objectively quantify global and regional RV dysfunction and RV dyssynchrony in patients with ARVC and provides incremental value over conventional cine CMR imaging

Facciamo il punto: miocardio non compatto

Il miocardio non compatto \ue8 una rara patologia del muscolo cardiaco caratterizzata da una marcata ipertrabecolatura parietale dovuta all\u2019arresto del processo di maturazione miocardica durante lo sviluppo fetale. Non sono stati ancora definiti dei criteri \u201cgold standard\u201d per la diagnosi; \ue8 inoltre necessaria la differenziazione da quadri parafisiologici e da altre cardiomiopatie. Rafforzano il sospetto clinico la familiarit\ue0 per la malattia, la coesistente presenza di malattia neuromuscolare, fenomeni tromboembolici, anomalie elettrocardiografiche, aritmie ventricolari, dilatazione e disfunzione ventricolare sinistra, fibrosi alla risonanza magnetica, mutazioni patogene. Molti aspetti rimangono tuttora controversi e dovranno essere chiariti con studi multicentrici, registri e studi osservazionali

OUTCOMES OF ELDERLY PATIENTS WITH ST-ELEVATION OR NON-ST-ELEVATION ACUTE CORONARY SYNDROME UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

Acute coronary syndromes have been classified according to the finding of ST-segment elevation on the presenting ECG, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far

How Coronary Perforation Looks at Optical Coherence Tomography Imaging

Coarctation of the aorta is an unusual finding in an adult person during their sixth decade of life. We present a 52-year-old male who presented with left ventricular failure with low ejection fraction and atrial fibrillation who was incidentally detected to have critical coarctation of the aorta, which was successfully managed with balloon angioplasty. The patient had a favorable result at 6 months of clinical follow-up

Hypertrophic restrictive cardiomyopathy with apical thinning: A peculiar case of genotype-phenotype correlation

No abstract

Clinical impact of myocardial fibrosis in severe aortic stenosis

8The pressure overload due to the progressive narrowing of the valve area determines the development of the left ventricular hypertrophy which characterizes aortic stenosis (AS). The onset of myocardial fibrosis marks the inexorable decline of an initially compensatory response towards heart failure. However, myocardial fibrosis does not yet represent a key element in the prognostic and therapeutic framework of AS. In this context, cardiac magnetic resonance imaging plays a major role by highlighting both the focal irreversible fibrotic replacement, using the late gadolinium enhancement (LGE) technique, and the earlier diffuse reversible interstitial fibrosis, using the T1 mapping techniques. For this reason, the presence of myocardial fibrosis would be useful to identify a subgroup of patients at greater risk of events among the subjects with severe AS. Actually, more and more evidences seem to identify the presence of LGE as a powerful prognostic factor to be used to optimize the timing of prosthetic valve replacement. Randomized clinical trials, such as the EVoLVeD trial currently underway, will be needed to better define the importance of myocardial fibrosis assessment in the management of patients with AS.openopenCastrichini, Matteo; Vitrella, Giancarlo; De Luca, Antonio; Altinier, Alessandro; Korcova, Renata; Pagura, Linda; Radesich, Cinzia; Sinagra, GianfrancoCastrichini, Matteo; Vitrella, Giancarlo; De Luca, Antonio; Altinier, Alessandro; Korcova, Renata; Pagura, Linda; Radesich, Cinzia; Sinagra, Gianfranc

Left ventricular reverse remodeling prediction in non-ischemic cardiomyopathy: present and perspectives

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