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Publisher: Oxford University Press   (Total: 397 journals)

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Showing 1 - 200 of 397 Journals sorted alphabetically
ACS Symposium Series     Full-text available via subscription   (SJR: 0.189, CiteScore: 0)
Acta Biochimica et Biophysica Sinica     Hybrid Journal   (Followers: 5, SJR: 0.79, CiteScore: 2)
Adaptation     Hybrid Journal   (Followers: 9, SJR: 0.143, CiteScore: 0)
Advances in Nutrition     Hybrid Journal   (Followers: 53, SJR: 2.196, CiteScore: 5)
Aesthetic Surgery J.     Hybrid Journal   (Followers: 6, SJR: 1.434, CiteScore: 1)
African Affairs     Hybrid Journal   (Followers: 66, SJR: 1.869, CiteScore: 2)
Age and Ageing     Hybrid Journal   (Followers: 91, SJR: 1.989, CiteScore: 4)
Alcohol and Alcoholism     Hybrid Journal   (Followers: 19, SJR: 1.376, CiteScore: 3)
American Entomologist     Full-text available via subscription   (Followers: 8)
American Historical Review     Hybrid Journal   (Followers: 161, SJR: 0.467, CiteScore: 1)
American J. of Agricultural Economics     Hybrid Journal   (Followers: 45, SJR: 2.113, CiteScore: 3)
American J. of Clinical Nutrition     Hybrid Journal   (Followers: 168, SJR: 3.438, CiteScore: 6)
American J. of Epidemiology     Hybrid Journal   (Followers: 190, SJR: 2.713, CiteScore: 3)
American J. of Hypertension     Hybrid Journal   (Followers: 25, SJR: 1.322, CiteScore: 3)
American J. of Jurisprudence     Hybrid Journal   (Followers: 19, SJR: 0.281, CiteScore: 1)
American J. of Legal History     Full-text available via subscription   (Followers: 8, SJR: 0.116, CiteScore: 0)
American Law and Economics Review     Hybrid Journal   (Followers: 27, SJR: 1.053, CiteScore: 1)
American Literary History     Hybrid Journal   (Followers: 16, SJR: 0.391, CiteScore: 0)
Analysis     Hybrid Journal   (Followers: 22, SJR: 1.038, CiteScore: 1)
Animal Frontiers     Hybrid Journal   (Followers: 1)
Annals of Behavioral Medicine     Hybrid Journal   (Followers: 16, SJR: 1.423, CiteScore: 3)
Annals of Botany     Hybrid Journal   (Followers: 37, SJR: 1.721, CiteScore: 4)
Annals of Oncology     Hybrid Journal   (Followers: 56, SJR: 5.599, CiteScore: 9)
Annals of the Entomological Society of America     Full-text available via subscription   (Followers: 10, SJR: 0.722, CiteScore: 1)
Annals of Work Exposures and Health     Hybrid Journal   (Followers: 34, SJR: 0.728, CiteScore: 2)
Antibody Therapeutics     Open Access  
AoB Plants     Open Access   (Followers: 4, SJR: 1.28, CiteScore: 3)
Applied Economic Perspectives and Policy     Hybrid Journal   (Followers: 18, SJR: 0.858, CiteScore: 2)
Applied Linguistics     Hybrid Journal   (Followers: 58, SJR: 2.987, CiteScore: 3)
Applied Mathematics Research eXpress     Hybrid Journal   (Followers: 1, SJR: 1.241, CiteScore: 1)
Arbitration Intl.     Full-text available via subscription   (Followers: 20)
Arbitration Law Reports and Review     Hybrid Journal   (Followers: 14)
Archives of Clinical Neuropsychology     Hybrid Journal   (Followers: 30, SJR: 0.731, CiteScore: 2)
Aristotelian Society Supplementary Volume     Hybrid Journal   (Followers: 3)
Arthropod Management Tests     Hybrid Journal   (Followers: 2)
Astronomy & Geophysics     Hybrid Journal   (Followers: 44, SJR: 0.146, CiteScore: 0)
Behavioral Ecology     Hybrid Journal   (Followers: 52, SJR: 1.871, CiteScore: 3)
Bioinformatics     Hybrid Journal   (Followers: 327, SJR: 6.14, CiteScore: 8)
Biology Methods and Protocols     Hybrid Journal  
Biology of Reproduction     Full-text available via subscription   (Followers: 9, SJR: 1.446, CiteScore: 3)
Biometrika     Hybrid Journal   (Followers: 20, SJR: 3.485, CiteScore: 2)
BioScience     Hybrid Journal   (Followers: 29, SJR: 2.754, CiteScore: 4)
Bioscience Horizons : The National Undergraduate Research J.     Open Access   (Followers: 1, SJR: 0.146, CiteScore: 0)
Biostatistics     Hybrid Journal   (Followers: 17, SJR: 1.553, CiteScore: 2)
BJA : British J. of Anaesthesia     Hybrid Journal   (Followers: 179, SJR: 2.115, CiteScore: 3)
BJA Education     Hybrid Journal   (Followers: 65)
Brain     Hybrid Journal   (Followers: 68, SJR: 5.858, CiteScore: 7)
Briefings in Bioinformatics     Hybrid Journal   (Followers: 51, SJR: 2.505, CiteScore: 5)
Briefings in Functional Genomics     Hybrid Journal   (Followers: 3, SJR: 2.15, CiteScore: 3)
British J. for the Philosophy of Science     Hybrid Journal   (Followers: 36, SJR: 2.161, CiteScore: 2)
British J. of Aesthetics     Hybrid Journal   (Followers: 25, SJR: 0.508, CiteScore: 1)
British J. of Criminology     Hybrid Journal   (Followers: 600, SJR: 1.828, CiteScore: 3)
British J. of Social Work     Hybrid Journal   (Followers: 85, SJR: 1.019, CiteScore: 2)
British Medical Bulletin     Hybrid Journal   (Followers: 6, SJR: 1.355, CiteScore: 3)
British Yearbook of Intl. Law     Hybrid Journal   (Followers: 33)
Bulletin of the London Mathematical Society     Hybrid Journal   (Followers: 4, SJR: 1.376, CiteScore: 1)
Cambridge J. of Economics     Hybrid Journal   (Followers: 65, SJR: 0.764, CiteScore: 2)
Cambridge J. of Regions, Economy and Society     Hybrid Journal   (Followers: 11, SJR: 2.438, CiteScore: 4)
Cambridge Quarterly     Hybrid Journal   (Followers: 10, SJR: 0.104, CiteScore: 0)
Capital Markets Law J.     Hybrid Journal   (Followers: 2, SJR: 0.222, CiteScore: 0)
Carcinogenesis     Hybrid Journal   (Followers: 2, SJR: 2.135, CiteScore: 5)
Cardiovascular Research     Hybrid Journal   (Followers: 14, SJR: 3.002, CiteScore: 5)
Cerebral Cortex     Hybrid Journal   (Followers: 46, SJR: 3.892, CiteScore: 6)
CESifo Economic Studies     Hybrid Journal   (Followers: 18, SJR: 0.483, CiteScore: 1)
Chemical Senses     Hybrid Journal   (Followers: 1, SJR: 1.42, CiteScore: 3)
Children and Schools     Hybrid Journal   (Followers: 6, SJR: 0.246, CiteScore: 0)
Chinese J. of Comparative Law     Hybrid Journal   (Followers: 5, SJR: 0.412, CiteScore: 0)
Chinese J. of Intl. Law     Hybrid Journal   (Followers: 22, SJR: 0.329, CiteScore: 0)
Chinese J. of Intl. Politics     Hybrid Journal   (Followers: 10, SJR: 1.392, CiteScore: 2)
Christian Bioethics: Non-Ecumenical Studies in Medical Morality     Hybrid Journal   (Followers: 10, SJR: 0.183, CiteScore: 0)
Classical Receptions J.     Hybrid Journal   (Followers: 27, SJR: 0.123, CiteScore: 0)
Clean Energy     Open Access   (Followers: 1)
Clinical Infectious Diseases     Hybrid Journal   (Followers: 70, SJR: 5.051, CiteScore: 5)
Communication Theory     Hybrid Journal   (Followers: 24, SJR: 2.424, CiteScore: 3)
Communication, Culture & Critique     Hybrid Journal   (Followers: 27, SJR: 0.222, CiteScore: 1)
Community Development J.     Hybrid Journal   (Followers: 27, SJR: 0.268, CiteScore: 1)
Computer J.     Hybrid Journal   (Followers: 9, SJR: 0.319, CiteScore: 1)
Conservation Physiology     Open Access   (Followers: 3, SJR: 1.818, CiteScore: 3)
Contemporary Women's Writing     Hybrid Journal   (Followers: 9, SJR: 0.121, CiteScore: 0)
Contributions to Political Economy     Hybrid Journal   (Followers: 5, SJR: 0.906, CiteScore: 1)
Critical Values     Full-text available via subscription  
Current Developments in Nutrition     Open Access   (Followers: 2)
Current Legal Problems     Hybrid Journal   (Followers: 29)
Current Zoology     Full-text available via subscription   (Followers: 3, SJR: 1.164, CiteScore: 2)
Database : The J. of Biological Databases and Curation     Open Access   (Followers: 8, SJR: 1.791, CiteScore: 3)
Digital Scholarship in the Humanities     Hybrid Journal   (Followers: 14, SJR: 0.259, CiteScore: 1)
Diplomatic History     Hybrid Journal   (Followers: 20, SJR: 0.45, CiteScore: 1)
DNA Research     Open Access   (Followers: 5, SJR: 2.866, CiteScore: 6)
Dynamics and Statistics of the Climate System     Open Access   (Followers: 4)
Early Music     Hybrid Journal   (Followers: 16, SJR: 0.139, CiteScore: 0)
Economic Policy     Hybrid Journal   (Followers: 42, SJR: 3.584, CiteScore: 3)
ELT J.     Hybrid Journal   (Followers: 24, SJR: 0.942, CiteScore: 1)
English Historical Review     Hybrid Journal   (Followers: 54, SJR: 0.612, CiteScore: 1)
English: J. of the English Association     Hybrid Journal   (Followers: 15, SJR: 0.1, CiteScore: 0)
Environmental Entomology     Full-text available via subscription   (Followers: 11, SJR: 0.818, CiteScore: 2)
Environmental Epigenetics     Open Access   (Followers: 3)
Environmental History     Hybrid Journal   (Followers: 27, SJR: 0.408, CiteScore: 1)
EP-Europace     Hybrid Journal   (Followers: 3, SJR: 2.748, CiteScore: 4)
Epidemiologic Reviews     Hybrid Journal   (Followers: 9, SJR: 4.505, CiteScore: 8)
ESHRE Monographs     Hybrid Journal  
Essays in Criticism     Hybrid Journal   (Followers: 19, SJR: 0.113, CiteScore: 0)
European Heart J.     Hybrid Journal   (Followers: 63, SJR: 9.315, CiteScore: 9)
European Heart J. - Cardiovascular Imaging     Hybrid Journal   (Followers: 9, SJR: 3.625, CiteScore: 3)
European Heart J. - Cardiovascular Pharmacotherapy     Full-text available via subscription   (Followers: 2)
European Heart J. - Quality of Care and Clinical Outcomes     Hybrid Journal  
European Heart J. : Case Reports     Open Access  
European Heart J. Supplements     Hybrid Journal   (Followers: 8, SJR: 0.223, CiteScore: 0)
European J. of Cardio-Thoracic Surgery     Hybrid Journal   (Followers: 9, SJR: 1.681, CiteScore: 2)
European J. of Intl. Law     Hybrid Journal   (Followers: 195, SJR: 0.694, CiteScore: 1)
European J. of Orthodontics     Hybrid Journal   (Followers: 4, SJR: 1.279, CiteScore: 2)
European J. of Public Health     Hybrid Journal   (Followers: 20, SJR: 1.36, CiteScore: 2)
European Review of Agricultural Economics     Hybrid Journal   (Followers: 10, SJR: 1.172, CiteScore: 2)
European Review of Economic History     Hybrid Journal   (Followers: 30, SJR: 0.702, CiteScore: 1)
European Sociological Review     Hybrid Journal   (Followers: 42, SJR: 2.728, CiteScore: 3)
Evolution, Medicine, and Public Health     Open Access   (Followers: 12)
Family Practice     Hybrid Journal   (Followers: 16, SJR: 1.018, CiteScore: 2)
Fems Microbiology Ecology     Hybrid Journal   (Followers: 15, SJR: 1.492, CiteScore: 4)
Fems Microbiology Letters     Hybrid Journal   (Followers: 28, SJR: 0.79, CiteScore: 2)
Fems Microbiology Reviews     Hybrid Journal   (Followers: 32, SJR: 7.063, CiteScore: 13)
Fems Yeast Research     Hybrid Journal   (Followers: 13, SJR: 1.308, CiteScore: 3)
Food Quality and Safety     Open Access   (Followers: 1)
Foreign Policy Analysis     Hybrid Journal   (Followers: 25, SJR: 1.425, CiteScore: 1)
Forest Science     Hybrid Journal   (Followers: 7, SJR: 0.89, CiteScore: 2)
Forestry: An Intl. J. of Forest Research     Hybrid Journal   (Followers: 16, SJR: 1.133, CiteScore: 3)
Forum for Modern Language Studies     Hybrid Journal   (Followers: 6, SJR: 0.104, CiteScore: 0)
French History     Hybrid Journal   (Followers: 33, SJR: 0.118, CiteScore: 0)
French Studies     Hybrid Journal   (Followers: 21, SJR: 0.148, CiteScore: 0)
French Studies Bulletin     Hybrid Journal   (Followers: 10, SJR: 0.152, CiteScore: 0)
Gastroenterology Report     Open Access   (Followers: 2)
Genome Biology and Evolution     Open Access   (Followers: 14, SJR: 2.578, CiteScore: 4)
Geophysical J. Intl.     Hybrid Journal   (Followers: 36, SJR: 1.506, CiteScore: 3)
German History     Hybrid Journal   (Followers: 23, SJR: 0.161, CiteScore: 0)
GigaScience     Open Access   (Followers: 5, SJR: 5.022, CiteScore: 7)
Global Summitry     Hybrid Journal   (Followers: 1)
Glycobiology     Hybrid Journal   (Followers: 13, SJR: 1.493, CiteScore: 3)
Health and Social Work     Hybrid Journal   (Followers: 57, SJR: 0.388, CiteScore: 1)
Health Education Research     Hybrid Journal   (Followers: 16, SJR: 0.854, CiteScore: 2)
Health Policy and Planning     Hybrid Journal   (Followers: 24, SJR: 1.512, CiteScore: 2)
Health Promotion Intl.     Hybrid Journal   (Followers: 22, SJR: 0.812, CiteScore: 2)
History Workshop J.     Hybrid Journal   (Followers: 31, SJR: 1.278, CiteScore: 1)
Holocaust and Genocide Studies     Hybrid Journal   (Followers: 28, SJR: 0.105, CiteScore: 0)
Human Communication Research     Hybrid Journal   (Followers: 15, SJR: 2.146, CiteScore: 3)
Human Molecular Genetics     Hybrid Journal   (Followers: 9, SJR: 3.555, CiteScore: 5)
Human Reproduction     Hybrid Journal   (Followers: 72, SJR: 2.643, CiteScore: 5)
Human Reproduction Open     Open Access   (Followers: 1)
Human Reproduction Update     Hybrid Journal   (Followers: 20, SJR: 5.317, CiteScore: 10)
Human Rights Law Review     Hybrid Journal   (Followers: 62, SJR: 0.756, CiteScore: 1)
ICES J. of Marine Science: J. du Conseil     Hybrid Journal   (Followers: 56, SJR: 1.591, CiteScore: 3)
ICSID Review : Foreign Investment Law J.     Hybrid Journal   (Followers: 10)
ILAR J.     Hybrid Journal   (Followers: 2, SJR: 1.732, CiteScore: 4)
IMA J. of Applied Mathematics     Hybrid Journal   (SJR: 0.679, CiteScore: 1)
IMA J. of Management Mathematics     Hybrid Journal   (SJR: 0.538, CiteScore: 1)
IMA J. of Mathematical Control and Information     Hybrid Journal   (Followers: 2, SJR: 0.496, CiteScore: 1)
IMA J. of Numerical Analysis - advance access     Hybrid Journal   (SJR: 1.987, CiteScore: 2)
Industrial and Corporate Change     Hybrid Journal   (Followers: 10, SJR: 1.792, CiteScore: 2)
Industrial Law J.     Hybrid Journal   (Followers: 39, SJR: 0.249, CiteScore: 1)
Inflammatory Bowel Diseases     Hybrid Journal   (Followers: 48, SJR: 2.511, CiteScore: 4)
Information and Inference     Free  
Integrative and Comparative Biology     Hybrid Journal   (Followers: 8, SJR: 1.319, CiteScore: 2)
Interacting with Computers     Hybrid Journal   (Followers: 11, SJR: 0.292, CiteScore: 1)
Interactive CardioVascular and Thoracic Surgery     Hybrid Journal   (Followers: 7, SJR: 0.762, CiteScore: 1)
Intl. Affairs     Hybrid Journal   (Followers: 65, SJR: 1.505, CiteScore: 3)
Intl. Data Privacy Law     Hybrid Journal   (Followers: 25)
Intl. Health     Hybrid Journal   (Followers: 6, SJR: 0.851, CiteScore: 2)
Intl. Immunology     Hybrid Journal   (Followers: 3, SJR: 2.167, CiteScore: 4)
Intl. J. for Quality in Health Care     Hybrid Journal   (Followers: 36, SJR: 1.348, CiteScore: 2)
Intl. J. of Constitutional Law     Hybrid Journal   (Followers: 64, SJR: 0.601, CiteScore: 1)
Intl. J. of Epidemiology     Hybrid Journal   (Followers: 240, SJR: 3.969, CiteScore: 5)
Intl. J. of Law and Information Technology     Hybrid Journal   (Followers: 5, SJR: 0.202, CiteScore: 1)
Intl. J. of Law, Policy and the Family     Hybrid Journal   (Followers: 28, SJR: 0.223, CiteScore: 1)
Intl. J. of Lexicography     Hybrid Journal   (Followers: 10, SJR: 0.285, CiteScore: 1)
Intl. J. of Low-Carbon Technologies     Open Access   (Followers: 1, SJR: 0.403, CiteScore: 1)
Intl. J. of Neuropsychopharmacology     Open Access   (Followers: 3, SJR: 1.808, CiteScore: 4)
Intl. J. of Public Opinion Research     Hybrid Journal   (Followers: 11, SJR: 1.545, CiteScore: 1)
Intl. J. of Refugee Law     Hybrid Journal   (Followers: 38, SJR: 0.389, CiteScore: 1)
Intl. J. of Transitional Justice     Hybrid Journal   (Followers: 11, SJR: 0.724, CiteScore: 2)
Intl. Mathematics Research Notices     Hybrid Journal   (Followers: 1, SJR: 2.168, CiteScore: 1)
Intl. Political Sociology     Hybrid Journal   (Followers: 40, SJR: 1.465, CiteScore: 3)
Intl. Relations of the Asia-Pacific     Hybrid Journal   (Followers: 23, SJR: 0.401, CiteScore: 1)
Intl. Studies Perspectives     Hybrid Journal   (Followers: 9, SJR: 0.983, CiteScore: 1)
Intl. Studies Quarterly     Hybrid Journal   (Followers: 48, SJR: 2.581, CiteScore: 2)
Intl. Studies Review     Hybrid Journal   (Followers: 25, SJR: 1.201, CiteScore: 1)
ISLE: Interdisciplinary Studies in Literature and Environment     Hybrid Journal   (Followers: 2, SJR: 0.15, CiteScore: 0)
ITNOW     Hybrid Journal   (Followers: 1, SJR: 0.103, CiteScore: 0)
J. of African Economies     Hybrid Journal   (Followers: 16, SJR: 0.533, CiteScore: 1)
J. of American History     Hybrid Journal   (Followers: 46, SJR: 0.297, CiteScore: 1)
J. of Analytical Toxicology     Hybrid Journal   (Followers: 14, SJR: 1.065, CiteScore: 2)
J. of Antimicrobial Chemotherapy     Hybrid Journal   (Followers: 15, SJR: 2.419, CiteScore: 4)
J. of Antitrust Enforcement     Hybrid Journal   (Followers: 1)
J. of Applied Poultry Research     Hybrid Journal   (Followers: 5, SJR: 0.585, CiteScore: 1)
J. of Biochemistry     Hybrid Journal   (Followers: 40, SJR: 1.226, CiteScore: 2)
J. of Burn Care & Research     Hybrid Journal   (Followers: 10, SJR: 0.768, CiteScore: 2)
J. of Chromatographic Science     Hybrid Journal   (Followers: 18, SJR: 0.36, CiteScore: 1)
J. of Church and State     Hybrid Journal   (Followers: 12, SJR: 0.139, CiteScore: 0)
J. of Communication     Hybrid Journal   (Followers: 55, SJR: 4.411, CiteScore: 5)
J. of Competition Law and Economics     Hybrid Journal   (Followers: 37, SJR: 0.33, CiteScore: 0)
J. of Complex Networks     Hybrid Journal   (Followers: 2, SJR: 1.05, CiteScore: 4)
J. of Computer-Mediated Communication     Open Access   (Followers: 29, SJR: 2.961, CiteScore: 6)
J. of Conflict and Security Law     Hybrid Journal   (Followers: 13, SJR: 0.402, CiteScore: 0)
J. of Consumer Research     Full-text available via subscription   (Followers: 47, SJR: 5.856, CiteScore: 5)

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Journal Cover
European Heart Journal - Cardiovascular Imaging
Journal Prestige (SJR): 3.625
Citation Impact (citeScore): 3
Number of Followers: 9  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2047-2404 - ISSN (Online) 2047-2412
Published by Oxford University Press Homepage  [397 journals]
  • The evolving role of cardiac magnetic resonance in primary mitral
           regurgitation: ready for prime time'
    • Authors: Liu B; Edwards N, Pennell D, et al.
      Pages: 123 - 130
      Abstract: A fifth of patients with primary degenerative mitral regurgitation continue to present with de novo ventricular dysfunction following surgery and higher rates of heart failure, morbidity, and mortality. This raises questions as to why the left ventricle (LV) might fail to recover and has led to support for better LV characterization; cardiac magnetic resonance (CMR) may play a role in this regard, pending further research and outcome data. CMR has widely acknowledged advantages, particularly in repeatability of measurements of volume and ejection fraction, yet recent guidelines relegate its use to cases where there is discordant information or poor-quality imaging from echocardiography because of the lack of data regarding the CMR-based ejection fraction threshold for surgery and CMR-based outcome data. This article reviews the current evidence regarding the role of CMR in an integrated surveillance and surgical timing programme.
      PubDate: Thu, 25 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey147
      Issue No: Vol. 20, No. 2 (2018)
  • Imaging primary mitral regurgitation: the whole is better than the sum of
           its parts
    • Authors: Lancellotti P; Vannan M.
      Pages: 131 - 132
      Abstract: This editorial refers to ‘The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time'’ by B. Liu et al., pp. 123–130.
      PubDate: Fri, 09 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey167
      Issue No: Vol. 20, No. 2 (2018)
  • Redefining successful primary PCI
    • Authors: McCartney P; Berry C.
      Pages: 133 - 135
      Abstract: This editorial refers to ‘Intramyocardial hemorrhage and prognosis after ST-elevation myocardial infarction’ by S.J. Reinstadler et al., pp. 138–146.
      PubDate: Wed, 21 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey159
      Issue No: Vol. 20, No. 2 (2018)
  • Real-time magnetic resonance imaging-guided cardiac electrophysiology: the
           long road to clinical routine
    • Authors: Nordbeck P; Bauer W.
      Pages: 136 - 137
      Abstract: This editorial refers to ‘Clinical workflow and applicability of electrophysiological cardiovascular magnetic resonance-guided radiofrequency ablation of isthmus-dependent atrial flutter’, by I. Paetsch et al., pp. 147–156.
      PubDate: Fri, 30 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey183
      Issue No: Vol. 20, No. 2 (2018)
  • Intramyocardial haemorrhage and prognosis after ST-elevation myocardial
    • Authors: Reinstadler S; Stiermaier T, Reindl M, et al.
      Pages: 138 - 146
      Abstract: AimsTo evaluate the prognostic value of intramyocardial haemorrhage (IMH) depicted by T2* imaging for risk stratification in ST-elevation myocardial infarction (STEMI) patients in comparison with established cardiac magnetic resonance (CMR) prognosis markers.Methods and resultsThis multicentre study enrolled 264 patients reperfused within 12 h after symptom onset. CMR was performed within the first week after STEMI to assess left ventricular function and infarct characteristics including IMH. The primary endpoint was a composite of death, reinfarction, and new congestive heart failure (major adverse cardiac events, MACE) at 12 months. MACE occurred in 19 patients (7.2%) showing a higher prevalence of IMH when compared with patients without MACE (47% vs. 21%, P = 0.008). The presence of IMH (n = 60, 23%) was independently associated with MACE after adjusting for clinical risk factors [hazard ratio 2.7, 95% confidence intervals (CIs) 1.1–6.6; P = 0.032] or other CMR prognosis markers (hazard ratio 3.1, 95% CI 1.2–7.7; P = 0.013). The addition of IMH to a model of prognostic CMR parameters (ejection fraction, infarct size, and microvascular obstruction) led to net reclassification improvement of 0.42 (95% CI 0.11–0.73, P = 0.009).ConclusionIMH assessed by T2* imaging may provide prognostic information that is incremental to other CMR markers of infarct severity and classical clinical risk factors. IMH could therefore be relevant as an important prognostic measure as well as therapeutic target when caring for patients after STEMI.
      PubDate: Fri, 24 Aug 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey101
      Issue No: Vol. 20, No. 2 (2018)
  • Clinical workflow and applicability of electrophysiological cardiovascular
           magnetic resonance-guided radiofrequency ablation of isthmus-dependent
           atrial flutter
    • Authors: Paetsch I; Sommer P, Jahnke C, et al.
      Pages: 147 - 156
      Abstract: AimsTo determine safety and efficacy of electrophysiological cardiovascular magnetic resonance (EP-CMR)-guided radiofrequency (RF) ablation in patients with typical right atrial flutter in a routine clinical setting.Methods and resultsThirty patients with typical right atrial flutter underwent clinically indicated EP-CMR-guided cavotricuspid isthmus ablation. EP-CMR protocols included pre- and post-ablation CMR imaging (whole heart, T2-weighted, and early-/late-gadolinium enhancement) together with electroanatomic mapping of the right atrium. Coronary sinus cannulation time and total ablation procedure duration were used as performance measures to determine the learning experience of the EP-CMR interventionalist and for comparison with conventional, fluoroscopy-guided atrial flutter ablation. Procedural safety and success rates were evaluated at 1 week and 3 months follow-up. Safety and success rates of EP-CMR were similar to conventional flutter ablations (primary success rate, 93% vs. 100%; recurrence rate, 0% vs. 3%, respectively). EP-CMR procedure duration indicated a learning experience (first vs. last six patients, 54.2 ± 23.1 vs. 29.7 ± 20.0 min) and the minimum number of procedures needed to achieve a level of competency was n = 12. An isthmus angle <110° and the presence of pouch-like isthmus anatomy were indicative of significantly prolonged EP-CMR procedure duration. CMR-defined ablation lesion size was not associated with total RF-ablation time or RF-induced maximum temperature.ConclusionIn a routine clinical setting, EP-CMR demonstrated its safety and high efficacy for the treatment of typical right atrial flutter with performance and outcome measures similar to conventional, fluoroscopy-guided flutter ablation. Hence, EP-CMR represents a valid alternative to conventional right atrial flutter ablation.
      PubDate: Wed, 10 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey143
      Issue No: Vol. 20, No. 2 (2018)
  • Progression of myocardial fibrosis in hypertrophic cardiomyopathy:
           mechanisms and clinical implications
    • Authors: Raman B; Ariga R, Spartera M, et al.
      Pages: 157 - 167
      Abstract: AimsMyocardial fibrosis as detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a powerful prognostic marker in hypertrophic cardiomyopathy (HCM) and may be progressive. The precise mechanisms underlying fibrosis progression are unclear. We sought to assess the extent of LGE progression in HCM and explore potential causal mechanisms and clinical implications.Methods and resultsSeventy-two HCM patients had two CMR (CMR1-CMR2) at an interval of 5.7 ± 2.8 years with annual clinical follow-up for 6.3 ± 3.6 years from CMR1. A combined endpoint of heart failure progression, cardiac hospitalization, and new onset ventricular tachycardia was assessed. Cine and LGE imaging were performed to assess left ventricular (LV) mass, function, and fibrosis on serial CMR. Stress perfusion imaging and cardiac energetics were undertaken in 38 patients on baseline CMR (CMR1). LGE mass increased from median 4.98 g [interquartile range (IQR) 0.97–13.48 g] to 6.30 g (IQR 1.38–17.51 g) from CMR1 to CMR2. Substantial LGE progression (ΔLGE ≥ 4.75 g) occurred in 26% of patients. LGE increment was significantly higher in those with impaired myocardial perfusion reserve (<MPRI 1.40) and energetics (phosphocreatine/adenosine triphosphate <1.44) on baseline CMR (P ≤ 0.01 for both). Substantial LGE progression was associated with LV thinning, increased cavity size and reduced systolic function, and conferred a five-fold increased risk of subsequent clinical events (hazard ratio 5.04, 95% confidence interval 1.85–13.79; P = 0.002).ConclusionMyocardial fibrosis is progressive in some HCM patients. Impaired energetics and perfusion abnormalities are possible mechanistic drivers of the fibrotic process. Fibrosis progression is associated with adverse cardiac remodelling and predicts an increased risk of subsequent clinical events in HCM.
      PubDate: Wed, 24 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey135
      Issue No: Vol. 20, No. 2 (2018)
  • Association of myocardial fibrosis and cardiovascular events: the
           multi-ethnic study of atherosclerosis
    • Authors: Ambale-Venkatesh B; Liu C, Liu Y, et al.
      Pages: 168 - 176
      Abstract: AimsWe used contrast-enhanced cardiac magnetic resonance (CMR) to evaluate differences in myocardial fibrosis measured at the year-10 examination between participants with and without cardiovascular (CV) events accrued in a large population based study over the preceding 10-year follow-up period in this retrospective study.Methods and resultsThe MESA study enrolled 6814 participants free of CV disease at baseline (2000–2002). We included MESA participants who underwent contrast-enhanced CMR at the MESA year-10 exam (N = 1840). We defined a composite CV endpoint of coronary heart disease, heart failure, atrial fibrillation, stroke, and peripheral artery disease. Using CMR, we characterized myocardial fibrosis with late-gadolinium enhancement for scar and T1 mapping indices of diffuse fibrosis. Demographic and CV-risk adjusted logistic (presence of scar) and linear regression (pre-contrast T1, T1 at 12 and 25 min post-contrast, and extracellular volume fraction or ECV) models were used to assess the relationship between fibrosis and events. The mean values of T1 indices were—pre-contrast T1: 977 ± 45 ms; T1 at 12’: 456 ± 40 ms; T1 at 25’: 519 ± 41 ms; ECV: 27.1 ± 3.2%. One-hundred and forty-six (7.9%) participants had myocardial scar. The presence of scar was strongly associated with prior CV events (adjusted coeff: 1.36, P < 0.001). Lower post-contrast T1 times and higher ECV, indicative of greater diffuse fibrosis were strongly associated with CV events (T1 at 12’: coeff = −10.0 ms, P = 0.004; T1 at 25’: coeff =−9.2 ms, P = 0.008; ECV: coeff = 1.31%, P < 0.001).ConclusionIndividuals who suffered prior CV events have greater likelihood of diffuse myocardial fibrosis when compared with event-free individuals living in the same community.
      PubDate: Tue, 16 Oct 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey140
      Issue No: Vol. 20, No. 2 (2018)
  • Predictors of post-operative cardiovascular events, focused on atrial
           fibrillation, after valve surgery for primary mitral regurgitation
    • Authors: Pimor A; Galli E, Vitel E, et al.
      Pages: 177 - 184
      Abstract: AimsPrimary mitral regurgitation (PMR) can be considered as a heterogeneous clinical disease. The optimal timing of valve surgery for severe PMR remains unknown. To determine whether unbiased clustering analysis using dense phenotypic data (phenomapping) could identify phenotypically distinct PMR categories of patients.Methods and resultsOne hundred and twenty-two patients who underwent surgery were analysed, excluding patients with pre-operative permanent atrial fibrillation (AF), were prospectively included before surgery. They were given an extensive echocardiographic evaluation before surgery, and clinical data were collected. These phenotypic variables were grouped in clusters using hierarchical clustering analysis. Then, different groups were created using a dedicated phenomapping algorithm. Post-operative outcomes were compared between the groups. The primary endpoint was post-operative cardiovascular events (PCE), defined as a composite of: deaths, AF, stroke, and rehospitalization. The secondary endpoint was post-operative AF. Data from three phenogroups with different characteristics and prognoses were identified. Phenogroup-1 (67 patients) was the reference group. Phenogroup-2 (33 patients) included intermediate-risk male and smoker patients with heart remodelling. Phenogroup-3 (22 patients) included older female patients with comorbidities (chronic renal failure, paroxysmal AF) and diastolic dysfunction. They had a higher risk of developing both PCE [(hazard ratio) HR = 3.57(1.72–7.44), P < 0.001] and post-operative AF [HR = 4.75(2.03–11.10), P < 0.001]. Pre-operative paroxysmal AF was identified as an independent risk factor for PCE.ConclusionClassification of PMR can be improved using statistical learning algorithms to define therapeutically homogeneous patient subclasses. High-risk patients can be identified, and these patients should be carefully monitored and may even be treated earlier.
      PubDate: Wed, 28 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey049
      Issue No: Vol. 20, No. 2 (2018)
  • Quantification of aortic stiffness and wall stress in healthy volunteers
           and abdominal aortic aneurysm patients using time-resolved 3D ultrasound:
           a comparison study
    • Authors: van Disseldorp E; Petterson N, van de Vosse F, et al.
      Pages: 185 - 191
      Abstract: AimsUsing non-invasive 3D ultrasound, peak wall stress (PWS) and aortic stiffness can be evaluated, which may provide additional criteria in abdominal aortic aneurysm (AAA) risk assessment. In this study, these measures were determined in both young and age-matched individuals, and AAA patients while its relation to age, maximum diameter, and growth was assessed statistically.Methods and resultsTime-resolved 3D-US data were acquired for 30 volunteers and 65 AAA patients. The aortic geometry was segmented, and tracked over the cardiac cycle using 3D speckle tracking to characterize the wall motion. Wall stress analysis was performed using finite element analysis. Model parameters were optimized until the model output matched the measured 3D displacements. A significant increase in aortic stiffness was measured between the age-matched volunteers [median 0.58, interquartile range (IQR) 0.48–0.71 kPa⋅m] and the small AAA patients (median 1.84, IQR 1.38–2.46 kPa⋅m; P < 0.001). In addition, an increase in aortic stiffness was evaluated between the small (30–39 mm) and large (≥50 mm) AAAs (median 2.72, IQR 1.99–3.14 kPa⋅m; P = 0.01). The 99th percentile wall stress showed a positive correlation with diameter (ρ = 0.73, P < 0.001), and significant differences between age-matched volunteers and AAA patients.ConclusionThe AAA pathology causes an early and significant increase in aortic stiffness of the abdominal aorta, even after correcting for the expected effect of ageing and differences in arterial pressure. Moreover, some AAAs revealed relatively high PWS, although the maximum diameter was below the threshold for surgical repair. Using the current method, these measures become available during follow-up, which could improve AAA rupture risk assessment.
      PubDate: Thu, 29 Mar 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey051
      Issue No: Vol. 20, No. 2 (2018)
  • Number of pregnancies and subsequent phenotype in a cross-sectional cohort
           of women with arrhythmogenic cardiomyopathy
    • Authors: Castrini A; Lie Ø, Leren I, et al.
      Pages: 192 - 198
      Abstract: AimsWe aimed to assess the relation between number of pregnancies and cardiac structure, function, and arrhythmic events in women with arrhythmogenic cardiomyopathy (AC).Methods and resultsWe included female AC patients in a cross-sectional study. Number of pregnancies and pregnancy related symptoms were recorded. Ventricular arrhythmias were defined as aborted cardiac arrest, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator therapy. Right and left ventricular dimensions and function, including strain analyses, were assessed by echocardiography and magnetic resonance imaging. We created a new AC severity score to grade the severity of AC disease. We included 77 women (age 47 ± 16, 43 probands and 34 AC mutation positive female relatives), 19 ± 14 years after last pregnancy. Median number of pregnancies was 2 (0–4); 19 had no previous pregnancies, 16 had 1 pregnancy, 30 had 2, and 12 had ≥3 pregnancies. Presence of a definite AC diagnosis (P = 0.36), severity of AC disease (P = 0.53), and arrhythmic events (P = 0.25) did not differ between groups of pregnancies. Number of pregnancies was related to increased right ventricular outflow tract diameter in single variable analyses [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.08–2.87; P = 0.02], but not when adjusted for body surface area and age (OR 1.56, 95% CI 0.91–2.66; P = 0.11). The number of pregnancies was not associated with any other measures of cardiac structure and function.ConclusionHigher number of pregnancies did not seem to relate to a worse phenotype in women with AC.
      PubDate: Fri, 06 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey061
      Issue No: Vol. 20, No. 2 (2018)
  • Right atrial and ventricular echocardiographic strain analysis predicts
           requirement for right ventricular support after left ventricular assist
           device implantation
    • Authors: Charisopoulou D; Banner N, Demetrescu C, et al.
      Pages: 199 - 208
      Abstract: AimsThe need for right ventricular assist device (RVAD) support after left ventricular assist device (LVAD) therapy is associated with increased morbidity and mortality. We used 2D echocardiographic strain analysis to assess right atrial (RA) and right ventricular (RV) mechanics and predict the need for RV mechanical support after LVAD implantation.Methods and resultsSeventy advanced chronic heart failure (ACHF) patients [59 male, age 47 ± 12 years, 79% dilated cardiomyopathy, left ventricular ejection fraction 23 ± 10%] received continuous-flow LVAD as a bridge to transplantation over an 18 month period. A retrospective analysis of RV and RA strain and right heart dyssynchrony was performed comparing those requiring RVAD (20%, n = 14) with those who did not (non-RVAD 80%, n = 56). One-year survival was significantly lower in the RVAD group (50% vs. 79%; P < 0.03). Independent predictors of RVAD support were: low peak RA longitudinal strain (RALS) [odds ratio (OR) 2.5, 95% confidence interval (95% CI) 1.37–2.0; P = 0.03], low RV free-wall longitudinal strain (RVFWLS) (OR 1.3, 95% CI 1.03–2.3; P = 0.04), and degree of intra-RV dyssynchrony (DRVFW-IVS, OR 1.3, 95% CI 1.02–1.3; P = 0.04).ConclusionIn LVAD recipients needing RVAD support, there was lower RALS and RVFWLS in addition to greater RV free-wall mechanical delay. We conclude that RA and RV strain and dyssynchrony analysis have the potential to add incremental value to the pre-VAD-implantation assessment made using conventional echo measurements.
      PubDate: Fri, 13 Apr 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey065
      Issue No: Vol. 20, No. 2 (2018)
  • Proximal pulmonary vascular stiffness as a prognostic factor in children
           with pulmonary arterial hypertension
    • Authors: Friesen R; Schäfer M, Ivy D, et al.
      Pages: 209 - 217
      Abstract: AimsMain pulmonary artery (MPA) stiffness and abnormal flow haemodynamics in pulmonary arterial hypertension (PAH) are strongly associated with elevated right ventricular (RV) afterload and associated with disease severity and poor clinical outcomes in adults with PAH. However, the long-term effects of MPA stiffness on RV function in children with PAH remain poorly understood. This study is the first comprehensive evaluation of MPA stiffness in children with PAH, delineating the mechanistic relationship between flow haemodynamics and MPA stiffness as well as the prognostic ability of these measures regarding clinical outcomes.Methods and resultsFifty-six children diagnosed with PAH underwent baseline cardiac magnetic resonance (CMR) acquisition and were compared with 23 control subjects. MPA stiffness and wall shear stress (WSS) were evaluated using phase contrast CMR and were evaluated for prognostic potential along with standard RV volumetric and functional indices. Pulse wave velocity (PWV) was significantly increased (2.8 m/s vs. 1.4 m/s, P < 0.0001) and relative area change (RAC) was decreased (25% vs. 37%, P < 0.0001) in the PAH group, correlating with metrics of RV performance. Decreased WSS was associated with a decrease in RAC over time (r = 0.679, P < 0.001). For each unit increase in PWV, there was approximately a 3.2-fold increase in having a moderate clinical event.ConclusionMPA stiffness assessed by non-invasive CMR was increased in children with PAH and correlated with RV performance, suggesting that MPA stiffness is a major contribution to RV dysfunction. PWV is predictive of moderate clinical outcomes, and may be a useful prognostic marker of disease activity in children with PAH.
      PubDate: Wed, 16 May 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey069
      Issue No: Vol. 20, No. 2 (2018)
  • High efficiency gamma camera enables ultra-low fixed dose stress/rest
           myocardial perfusion imaging
    • Authors: Nkoulou R; Fuchs T, Pazhenkottil A, et al.
      Pages: 218 - 224
      Abstract: AimsWe validated a 1-day myocardial perfusion imaging (MPI) protocol using an ultra low-dose(ULD) equal for stress and rest on a cadmium zinc telluride (CZT).Methods and resultsFifty-six patients underwent a 1-day MPI protocol using a standard (SD) 99mTc-tetrofosmin dose at stress (320 MBq) and rest (960 MBq) with 5 min acquisition time each (SD). Within 2 weeks MPI was repeated using ULD 99mTc-tetrofosmin equal for stress and rest (160 MBq) with 15 min acquisition time each (ULD). All scans were performed on a CZT camera (DNM 570c, GE Healthcare). Background subtraction was applied on the rest MPI of the ULD using P-mod software. Presence and extent of perfusion defect were analysed. Pearson’s correlation was used to compare ejection fraction (EF), end diastolic volume (EDV), and end systolic volume (ESV) between both protocols. SD revealed ischaemia in 23, scar in 3, and an equivocal finding in 1 patient, while normal findings were documented in 29 patients. ULD resulted in the following findings: ischaemia 23, scar 3, and 30 normal scans. Congruence of SD and ULD was 22/23 for ischaemia, 3/3 for scar, and 29/29 in normal patients; one patient with ischaemia in SD was classified as scar in ULD. Overall agreement of ULD with SD was 98%. The mean extent of defect was comparable between SD and ULD for the stress (10% vs. 11%, respectively, P = NS) and rest studies (5% vs. 7%, respectively, P = NS). An excellent correlation between SD and ULD was found for EF (r = 0.93), EDV (r = 0.95), and ESV (r = 0.97).ConclusionCZT cameras may enable reliable MPI scanning in patients with known or suspected coronary artery disease using protocols with about a factor 4-decrease in radiation dose exposure compared with traditional protocols.
      PubDate: Sat, 02 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey077
      Issue No: Vol. 20, No. 2 (2018)
  • Predictors of residual tricuspid regurgitation after percutaneous closure
           of atrial septal defect
    • Authors: Nassif M; van der Kley F, Abdelghani M, et al.
      Pages: 225 - 232
      Abstract: AimsFunctional tricuspid regurgitation (TR) associated with atrial septal defects (ASDs) is frequently present due to right-sided volume-overload. Tricuspid valve (TV) repair is often considered in candidates for surgical ASD closure, and percutaneous TV repair is currently under clinical investigation. In this study, we develop a prediction model to identify patients with residual moderate/severe TR after percutaneous ASD closure.Methods and resultsIn this observational study, 172 adult patients (26% male, age 49 ± 17 years) with successful percutaneous ASD closure had pre- and post-procedural echocardiography. Right heart dimensions/function were measured. TR was assessed semi-quantitatively. A prediction model for 6-month post-procedural moderate/severe TR was derived from uni-and multi-variable logistic regression. Clinical follow-up (FU) was updated and adverse events were defined as cardiovascular death or hospitalization for heart failure. Pre-procedural TR was present in 130 (76%) patients (moderate/severe: n = 64) of which 72 (55%) had ≥1 grade reduction post-closure. Independent predictors of post-procedural moderate/severe TR (n = 36) were age ≥60 years [odds ratio (OR) 2.57; P = 0.095], right atrial end-diastolic area ≥10cm2/m2 (OR 3.36; P = 0.032), right ventricular systolic pressure ≥44 mmHg (OR 6.44; P = 0.001), and tricuspid annular plane systolic excursion ≤2.3 cm (OR 3.29; P = 0.037), producing a model with optimism-corrected C-index = 0.82 (P < 0.001). Sensitivity analysis excluding baseline none/mild TR yielded similar results. Patients with moderate/severe TR at 6-month FU had higher adverse event rates [hazard ratio = 6.2 (95% confidence interval 1.5–26); log-rank P = 0.004] across a median of 45 (30–76) months clinical FU.ConclusionThis study shows that parallel to reduction of volume-overload and reverse remodelling after percutaneous ASD closure, TR improved substantially despite significant TR at baseline. Our proposed risk model helps identify ASD patients in whom TR regression is unlikely after successful percutaneous closure.
      PubDate: Wed, 13 Jun 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey080
      Issue No: Vol. 20, No. 2 (2018)
  • The answer lies in the third dimension
    • Authors: Addetia K; Landeras L, Yamat M, et al.
      Pages: 232 - 232
      Abstract: A 52-year-old man is sent for a transoesophageal study (TOE) to evaluate his mitral valve. He has a history of end stage renal disease, coronary disease, left ventricular dysfunction, and extensive vascular disease including a Type B aortic dissection, endovascular repair of an abdominal aortic aneurysm, and peripheral vascular disease. Towards the end of the TOE, as the probe was being pulled out, a deep, penetrating ulcer (PU) was noted in the descending thoracic aorta at the level of the main pulmonary artery (Panels 1A and B, arrow). A four-beat narrow-angle 3D acquisition of this region revealed an ulcer with extensive calcification (Panel 2 A, arrows). Transillumination (TruView) of the PU accentuated the calcified areas (Panel 2B) and depth of the ulcer crater (asterisk). Computed tomography (CT) demonstrated the PU with calcified aortic walls (Panels 3A and B, arrows). Note that Panels 3A and B on CT correspond with Panels 1 A and B on TOE, respectively. The area of calcification on the surface of the reconstructed aorta on CT (Panel 4A) denotes the PU. When the wall of the aorta was cropped into (Panel 4B) or the rendered aorta was entered from the caudal end to visualize the inside of the aorta (Panel 5), the PU was noted to look identical to the image captured on 3D. Note the singular piece of calcium (yellow arrow, Panels 2A, B, 4B, and 5) which is seen on both the 3D and CT images. This is an unusual case of a PU with excellent correlation of PU appearance between CT and 3D conveying the added insight provided by 3D echocardiography in this case.
      PubDate: Tue, 27 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey179
      Issue No: Vol. 20, No. 2 (2018)
  • Myocardial perfusion during atrial fibrillation in patients with
           non-ischaemic systolic heart failure: a cross-sectional study using
           Rubidium-82 positron emission tomography/computed tomography
    • Authors: Byrne C; Hasbak P, Kjær A, et al.
      Pages: 233 - 240
      Abstract: AimsPatients with non-ischaemic systolic heart failure often have reduced myocardial blood flow without significant coronary atherosclerosis. Likewise, patients with atrial fibrillation (AF) have reduced myocardial perfusion during AF compared with sinus rhythm. The aim of this study was to explore whether there is an additive negative effect of AF during scan on the myocardial perfusion in patients with non-ischaemic systolic heart failure.Methods and resultsWe included 27 young healthy controls and 114 patients with non-ischaemic systolic heart failure to a Rubidium-82 positron emission tomography/computed tomography perfusion scan (23 with AF during scan). To obtain the myocardial flow reserve (MFR = stress flow/rest flow), patients were scanned at rest and during adenosine-induced stress. Among patients, those with AF were older [years: 73; interquartile range (IQR) 65–78 vs. 67; IQR 60–74; P = 0.03] and more were men (87% vs. 62%; P = 0.02). Distribution of sex in controls did not differ from either patient group. Patients with AF had significantly lower MFR than patients without [MFR: 1.87; 95% confidence interval (CI) 1.58–2.22 vs. 2.50; 95% CI 2.06–2.86; percent difference: −21.5%; P = 0.01]. MFR remained significantly lower in the group with AF (estimate −24.2%; 95% CI −39.6% to −4.8%; P = 0.02) in an adjusted multivariable regression analysis. Further, patients had lower MFR compared with controls: 3.46; 95% CI 3.03–3.94; P < 0.0001. Additionally, coronary vascular resistance was highest in patients with AF and lowest in controls.ConclusionPatients with systolic heart failure had lower flow reserve than healthy controls and even lower MFR if they had AF during scan.
      PubDate: Mon, 09 Jul 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey089
      Issue No: Vol. 20, No. 2 (2018)
  • Functional imaging in echocardiography can sometimes replace direct
           structure visualization
    • Authors: Strachinaru M; Huurman R, Schinkel A.
      Pages: 241 - 241
      Abstract: A 64-year-old female patient presented with hypertrophic cardiomyopathy, complaining of exertional dyspnoea. The electrocardiogram demonstrated a sinus rhythm with repolarization abnormalities (Panel D). Transthoracic echocardiography (parasternal short-axis images) demonstrated severe hypertrophy of the mid-to-apical left ventricle (LV), with systolic cavity obliteration (Supplementary data online, Movie S1Supplementary data online, Movie S1). The quality of the apical images was poor (Panel A, Supplementary data online, Movie S2Supplementary data online, Movie S2), and the true LV apex could not be visualized. There was no systolic anterior motion of the mitral valve and no outflow tract obstruction. The apical continuous wave Doppler tracings demonstrated a short mid-systolic gradient peak (Panel E, 1), corresponding to an apical-to-mid-ventricular flow acceleration visible on colour Doppler (Panel B, 1; Supplementary data online, Movie S3Supplementary data online, Movie S3). There was also an early diastolic apex-to-base flow (Panel E, 2; Supplementary data online, Movie S3Supplementary data online, Movie S3), starting before the mitral inflow and also noticeable on colour Doppler (Panel C, 2). The mid-systolic gradient could be explained by the mid-cavity obliteration, and the early diastolic flow directed to the base suggested a LV apical ‘reservoir’ effect [an apical cavity closed in mid-systole, emptying early in diastole before the mitral inflow for two reasons: the ventricular repolarization sequence beginning at the apex and the higher pressure gradient between the apex and the mid-LV as compared to left atrium (LA)-LV gradient]. Cardiac magnetic resonance confirmed the mid-LV hypertrophy, with an LV apical aneurysm (Panels F–H: T2-balanced gradients sequences; Supplementary data online, Movies S4Supplementary data online, Movies S4 and S5S5), corresponding to the ‘reservoir’ suggested by Doppler imaging. This report underlines the importance of functional imaging in echocardiography, beyond the direct visualization of structures. Unusual findings should not be dismissed without a thorough search of a solid explanation.
      PubDate: Tue, 27 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey180
      Issue No: Vol. 20, No. 2 (2018)
  • Chronic rupture of the left ventricular wall with a giant pseudoaneurysm
    • Authors: Riesenhuber M; Schneider M, Maier A, et al.
      Pages: 242 - 242
      Abstract: A 71-year-old woman presented to the clinic with progressive chest pain and dyspnoea. Clinical history of the patient revealed an acute myocardial infarction followed by urgent coronary artery bypass grafting 2 years prior. One year thereafter, computed tomography (CT) detected a chronic left ventricular pseudoaneurysm with a size of 3 × 2 cm. Surgical treatment was refused by the patient at that time.
      PubDate: Tue, 27 Nov 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey186
      Issue No: Vol. 20, No. 2 (2018)
  • Combined checkpoint inhibitor-associated myocarditis and pulmonary
           vasculitis mimicking acute pulmonary embolism
    • Authors: Baldetti L; Melillo F, Beneduce A, et al.
      Pages: 243 - 243
      Abstract: A 68-year-old man underwent six cycles of the checkpoint inhibitor (CI) nivolumab for a squamous cell lung carcinoma. Two months earlier, he recovered from CI-associated myocarditis and pulmonary vasculitis with complete morpho-functional remission after systemic corticosteroid (CS) therapy. After CS de-escalation, he presented with hypotension, peripheral oedema, dyspnoea, electrocardiographic right ventricular (RV) strain pattern (S1Q3T3), and elevated troponin-T levels (459 ng/L, n.v. <14 ng/L). Echocardiography showed severe RV enlargement and dysfunction with severe pulmonary hypertension (PH) (Panel A). CT scanning ruled out pulmonary embolism (PE) (Panel B). Magnetic resonance (MR) T2-weighted imaging showed oedema of the RV free wall and outflow-tract, of the pulmonary artery (PA), and of the left ventricle (Panels C and D) with no evidence of late gadolinium enhancement. Positron emission tomography with 18F-FDG scanning demonstrated intense tracer’s uptake in the oedematous areas at MR (Panels E and F). These data are consistent with myocarditis and PA vasculitis relapse.
      PubDate: Tue, 11 Dec 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey191
      Issue No: Vol. 20, No. 2 (2018)
  • Thrashing petaloid flap in ascending aorta: aortic calcified amorphous
    • Authors: Ishida N; Shimabukuro K, Mitta S, et al.
      Pages: 244 - 244
      Abstract: A 66-year-old man who had been on haemodialysis to treat non-diabetic chronic renal failure for 7 years was transported on an emergency hospital due to transient unconsciousness without neurological deficits. Transthoracic echocardiography revealed a structural abnormality of the ascending aorta and the patient was referred to our facility for further evaluation. Magnetic resonance imaging and angiography revealed no evidence of either cerebral ischaemia or a circulatory disorder. Transoesophageal echocardiography showed a flap-like structure in the ascending aorta that synchronously thrashed with the cardiac cycle (Panels A and C, systolic phase; Panels B and D, diastolic phase; Supplementary data online, Videos S1Supplementary data online, Videos S1 and S2S2). Enhanced computed tomography could not detect this structure (Panel E). The structure was surgically resected under deep hypothermic circulatory arrest with a cardiopulmonary bypass to avoid cross-clamping of the ascending aorta due to severe diffuse calcification. Intraoperatively, we found a fragile structure that originated from the calcified site of the ascending aortic wall slightly distal from the non/left commissure of the aortic annulus, and it was easily torn (Panel F; green arrow, aortic flap; AO, aorta). The structure was removed from the root and the petal-shaped specimen was <1 mm thick and 45 mm long with a maximal width of 15 mm (Panel G; yellow arrow, removal site). Histological staining confirmed calcinosis accompanied by foreign body giant cells that was covered with endothelial cells, without collagen fibres, elastic fibres, or malignancy (Panel H). The non-neoplastic structure was finally diagnosed as the aortic calcified amorphous tumour.
      PubDate: Tue, 11 Dec 2018 00:00:00 GMT
      DOI: 10.1093/ehjci/jey194
      Issue No: Vol. 20, No. 2 (2018)
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