Myocardial viability as integral part of the diagnostic and therapeutic approach to ischemic heart failure

Cardiolog

Diagnostic and prognostic roles of echocardiography and cardiac magnetic resonance

Cardiolog

Analysis of tricuspid regurgitation improvement following cardiac resynchronization therapy — Authors' reply

This is a response to the Letter to the Editor, EUPC-D-22-01151 ‘Analysis of Tricuspid Regurgitation Improvement Following Cardiac Resynchronization Therapy’ by Syed Yousaf Ahmad et al. [https://doi.org/10.1093/europace/euad007], about the article ‘Tricuspid regurgitation after cardiac resynchronization therapy: evolution and prognostic significance’ by Stassen et al. https://doi.org/10.1093/europace/euac034.</p

Cardiac Autonomic Nervous System in Heart Failure: Imaging Technique and Clinical Implications

The autonomic nervous system interacts in the pathophysiology of heart failure. Dysfunction of the sympathetic nervous system has been identified as an important prognostic marker in patients with chronic heart failure. At present, cardiac sympathetic nerve imaging with 123-iodine metaiodobenzylguanidine [123-I MIBG] has been employed most frequently for the assessment of cardiac sympathetic innervation and activation pattern. The majority of studies have shown that cardiac sympathetic dysfunction as assessed with 123-I MIBG imaging is a powerful predictor for heart failure mortality and morbidity. Additionally, 123-I MIBG imaging can be used for prediction of potentially lethal ventricular tachyarrhythmias in heart failure patients. At present however, the lack of standardization of 123-I MIBG imaging procedures represents an evident issue. Standardized criteria on the use of 123-I MIBG imaging will further strengthen the clinical use of 123-I MIBG imaging in heart failure patients

Multimodality imaging:Bird's eye view from the European Society of Cardiology Congress 2019 Paris, August 31st-September 4th, 2019

At the European Society of Cardiology (ESC) congress of this year 2019, held in Paris from August 31st to September 4th, 4509 abstracts were presented. Of those, 414 (9%) belonged to an imaging category. Experts in echocardiography (VD), nuclear imaging (AS), cardiac computed tomography (CT) (MD) and cardiovascular magnetic resonance (CMR) (CBD), have selected the abstracts in their areas of expertise that were of most interest to them and are summarized in this bird's eye view from this ESC meeting. These abstracts were integrated by one of the Editors of the Journal (JB).Cardiolog

Stress Echocardiography for Risk Stratification of Diabetic Patients With Known or Suspected Coronary Artery Disease

OBJECTIVE—Coronary artery disease (CAD) is a leading cause of mortality and morbidity in diabetic patients; therefore, their risk stratification is a relevant issue. Because exercise tolerance is frequently impaired in these patients, pharmacological stress echocardiography (SE) has been suggested as a valuable alternative. Our aim was to evaluate the prognostic value of this technique in diabetic patients with known or suspected CAD. RESEARCH DESIGN AND METHODS—A total of 259 consecutive diabetic patients underwent pharmacological SE (dobutamine in 108 patients and dipyridamole in 151 patients) and follow-up for 24 ± 22 months. A comparison between the prognostic value of SE and exercise electrocardiography (ECG) was made in a subgroup of 120 subjects. RESULTS—A total of 13 cardiac deaths and 13 nonfatal infarctions occurred during follow-up, and 58 patients were revascularized. Univariate predictors of outcome were known CAD, positive SE, rest and peak wall motion score index (WMSI), and peak/rest WMSI variation. Peak WMSI was the only significant and independent prognostic indicator (odds ratio 11; 95% CI 4–29, P &lt; 0.0001) on multivariate Cox's analysis. After adjustment for the most predictive clinical and exercise ECG variables, SE provided 43% additional prognostic information (gain in X2 = 7, P &lt; 0.01). Moreover, positive SE was associated with a significantly lower event-free survival. CONCLUSIONS—SE effectively predicts cardiac events in diabetic patients with known or suspected CAD and adds additional prognostic information as compared with exercise ECG