Vitamin E Supplementation Reduces Plasma Vascular Cell Adhesion Molecule-1 and von Willebrand Factor Levels and Increases Nitric Oxide Concentrations in Hypercholesterolemic Patients

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Leiomyosarcoma of the inferior vena cava in a patient with Budd-Chiari syndrome.

A 65-year-old man with no history of cardiovascular disease was admitted because of abdominal pain, nausea and lower limb edema. At clinical examination he presented hepatomegaly, ascites and laboratory evidence of liver failure. The echocardiogram (Figure 1A) showed preserved biventricular function, but a large irregular mass was visible in the right atrium (arrow; Supplementary data, Movie 1 and 2). Computed tomography (Figure 1B) showed patchy contrast uptake and positron emission tomography (Figure 1C) showed pathological uptake of 18-fluoro-deoxyglucose in the mass (arrow), extending along the inferior vena cava (arrowheads), suggesting a neoplastic nature. At cardiovascular magnetic resonance (Figure 1D and E; Supplementary data, Movie 3 and 4) the mass involved the right atrium (arrow) and extended into the inferior vena cava (arrowheads); moreover, it presented irregular contours and signal characteristics typical of a neoplastic mass

Myocardial structural, perfusion and metabolic correlates of left bundle branch block mechanical derangement in patient with dilated cardiomyopathy

Background-Left bundle branch block (LBBB) influences upon regional left ventricular (LV) structure, perfusion and metabolism were not thoroughly investigated in dilated cardiomyopathy (DCM) patients. Methods and Results-Eleven DCM patients with LBBB (69?11 years, LV ejection fraction[EF]: 35?8%) and 7 DMC patients without LBBB (58?9 years, LV EF: 37?10%) were studied by cardiac magnetic resonance (CMR) and positron emission tomography (PET). Left ventricle was divided in 3 regions: septum, adjacent (anterior-inferior) and lateral. Regional midwall circumferential strain, maximum shortening (&#1013;peak) and strain rate were obtained from tagged CMR. Systolic stretch index (SSI) was calculated as positive strain rate (stretching) divided by total strain rate. Myocardial metabolic rate of glucose (MMRG), resting and hyperemic myocardial blood flow (MBF) were quantitated using 2-[18F]fluoro-2-deoxyglucose and [13N]ammonia PET, respectively. Conversely from non LBBB patients, LBBB patients showed highly inhomogeneous systolic deformation pattern which changed gradually moving from discoordinate [(SSI: 0.485 (0.284)] and poorly contracting (&#1013;peak: -1.14?0.96%) septum to coordinate [SSI: 0.002 (0.168)] and strongly contracting (&#1013;peak: -13.63?2.58%) lateral region (both P<0.0001). This pattern was closely matched to MMRG distribution disclosing lowest, intermediate and highest values respectively in the septum, adjacent and lateral regions (P<0.0001). Septal-to-lateral thickness ratio was lower in LBBB than non LBBB patients (P=0.03). In both groups, LV distribution of resting and hyperemic MBF and MBF reserve did not differ significantly. Conclusions-In DCM patients, the extensive LV contraction abnormalities induced by LBBB caused regional myocardial metabolic and structural remodeling without consistent changes in blood flows.-

Intrapericardial paraganglioma: The role of integrated advanced multi-modality cardiac imaging for the assessment and management of rare primary cardiac tumors

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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

Relationship between location and size of myocardial infarction and their reciprocal influences on post-infarction left ventricular remodeling

AimsTo assess the intricate relationship between myocardial infarction (MI) location and size and their reciprocal influences on post-infarction left ventricular (LV) remodelling.Methods and resultsA cohort of 260 reperfused ST-segment elevation MI patients was prospectively studied with cardiovascular magnetic resonance at 1 week (baseline) and 4 months (follow-up). Area at risk (AAR) and MI size were quantified by T2-weighted and late-gadolinium enhancement imaging, respectively. Adverse LV remodelling was defined as an increase in LV end-systolic volume ≥15 at follow-up. One hundred and twenty-seven (49) patients had anterior MI and 133 (51) patients had non-anterior MI. Although the degree of myocardial salvage was similar between groups (P=0.74), anterior MI patients had larger AAR and MI size than non-anterior MI patients yielding worse regional and global LV function at baseline and follow-up. At univariable analysis, anterior MI was associated with increased risk of adverse LV remodelling (P=0.017) and lower LV ejection fraction (EF) at follow-up (P=0.001), but not when accounted for baseline MI size. Accordingly, at multivariable analysis, baseline MI size but not its location was an independent predictor of adverse LV remodelling (odds ratio 1.061, P < 0.001) and EF at follow-up (β-coefficient=-0.255, P < 0.001).ConclusionAnterior MI patients experience more pronounced post-infarction LV remodelling and dysfunction than non-anterior MI patients due to a greater magnitude of irreversible ischaemic LV damage without any independent contribution of MI location. © 2011 The Author

insights from an echo and cardiovascular magnetic resonance study of patients referred for surgical aortic valve replacement

AIMS: This study aims to assess the prevalence of relative apical sparing pattern (RASP) in patients with severe symptomatic aortic stenosis (AS), referred for surgical aortic valve replacement (AVR), to evaluate its significance, possible relation to amyloid deposition, and persistence after surgery. METHODS AND RESULTS: Prospective study of 150 consecutive patients [age 73 (interquartile range: 68-77), 51% women], with severe symptomatic AS referred to surgical AVR. All patients underwent cardiac magnetic resonance (CMR) before surgery. RASP was defined by [average apical longitudinal strain (LS)/(average basal LS + average mid LS)] > 1 by echocardiography. AVR was performed in 119 (79.3%) patients. Both Congo red and sodium sulphate-Alcian blue (SAB) stain were used to exclude amyloid on septal myocardial biopsy. LV remodelling and tissue characterization parameters were compared in patients with and without RASP. Deformation pattern was re-assessed at 3-6 months after AVR.RASP was present in 23 patients (15.3%). There was no suspicion of amyloid at pre-operative CMR [native T1 value 1053 ms (1025-1076 ms); extracellular volume (ECV) 28% (25-30%)]. None of the patients had amyloid deposition at histopathology. Patients with RASP had significantly higher pre-operative LV mass and increased septal wall thickness. They also had higher N-terminal pro b-type natriuretic peptide (NT-proBNP) levels [1564 (766-3318) vs. 548 (221-1440) pg/mL, P = 0.010], lower LV ejection fraction (53.7 ± 10.5 vs. 60.5 ± 10.2%, P = 0.005), and higher absolute late gadolinium enhancement (LGE) mass [9.7 (5.4-14.1) vs. 4.8 (1.9-8.6) g, P = 0.016] at CMR. Follow-up evaluation after AVR revealed RASP disappearance in all except two of the patients. CONCLUSION: RASP is not specific of cardiac amyloidosis. It may also be found in severe symptomatic AS without amyloidosis, reflecting advanced LV disease, being mostly reversible after surgery.publishersversionepub_ahead_of_prin

High prevalence of new clinically significant findings in patients with embolic stroke of unknown source evaluated by cardiac magnetic resonance imaging

Background: Embolic stroke of unknown source (ESUS) accounts for one in six ischaemic strokes. Current guidelines do not recommend routine cardiac magnetic resonance (CMR) imaging in ESUS and, beyond the identification of cardio-embolic sources, there are no data assessing new clinical findings from CMR in ESUS. This study aimed to assess the prevalence of new cardiac and non-cardiac findings and to determine their impact on clinical care in patients with ESUS.Methods and Results: In this prospective, multicentre, observational study, CMR was performed within 3-months of ESUS. All scans were reported according to standard clinical practice. A new clinical finding was defined as one not previously identified through prior clinical evaluation. A clinically significant finding was defined as one resulting in further investigation, follow-up or treatment. A change in patient care was defined as initiation of medical, interventional, surgical or palliative care. From 102 patients recruited, 96 underwent CMR. One or more new clinical findings were observed in 59 patients (61%). New findings were clinically significant in 48 (81%) of these patients. Of 40 patients with a new clinically significant cardiac finding, 21 (53%) experienced a change in care (medical therapy, n=15; interventional/surgical procedure, n=6). In 12 patients with a new clinically significant extra-cardiac finding, 6 (50%) experienced a change in care (medical therapy, n=4; palliative care, n=2). Conclusions: CMR imaging identifies new clinically significant cardiac and non-cardiac findings in half of patients with recent ESUS. Advanced cardiovascular screening should be considered in patients with ESUS.<br/

Valvular heart disease: what does cardiovascular MRI add?

Although ischemic heart disease remains the leading cause of cardiac-related morbidity and mortality in the industrialized countries, a growing number of mainly elderly patients will experience a problem of valvular heart disease (VHD), often requiring surgical intervention at some stage. Doppler-echocardiography is the most popular imaging modality used in the evaluation of this disease entity. It encompasses, however, some non-negligible constraints which may hamper the quality and thus the interpretation of the exam. Cardiac catheterization has been considered for a long time the reference technique in this field, however, this technique is invasive and considered far from optimal. Cardiovascular magnetic resonance imaging (MRI) is already considered an established diagnostic method for studying ventricular dimensions, function and mass. With improvement of MRI soft- and hardware, the assessment of cardiac valve function has also turned out to be fast, accurate and reproducible. This review focuses on the usefulness of MRI in the diagnosis and management of VHD, pointing out its added value in comparison with more conventional diagnostic means