JournalTOCs

European Heart Journal - Cardiovascular Imaging
Journal Prestige (SJR): 3.625

Citation Impact (citeScore): 3
Number of Followers: 10

Hybrid journal (It can contain Open Access articles)
ISSN (Print) 2047-2404 - ISSN (Online) 2047-2412
Published by Oxford University Press

[409 journals]

European Association of Cardiovascular Imaging expert consensus paper: a
comprehensive review of cardiovascular magnetic resonance normal values of
cardiac chamber size and aortic root in adults and recommendations for
grading severity
- Authors: Petersen S; Khanji M, Plein S, et al.
  Pages: 1321 - 1331
  Abstract: AbstractThis consensus paper provides a framework for grading of severity of cardiovascular magnetic resonance (CMR) imaging-based assessment of chamber size, function, and aortic measurements. This does not currently exist for CMR measures. Differences exist in the normal reference values between echocardiography and CMR along with differences in methods used to derive these. We feel that this document will significantly complement the current literature and provide a practical guide for clinicians in daily reporting and interpretation of CMR scans. This manuscript aims to complement a recent comprehensive review of CMR normal value publications to recommend cut-off values required for severity grading. Standardization of severity grading for clinically useful CMR parameters is encouraged to lead to clearer and easier communication with referring clinicians and may contribute to better patient care. To this end, the European Association of Cardiovascular Imaging (EACVI) has formed this expert panel that has critically reviewed the literature and has come to a consensus on approaches to severity grading for commonly quantified CMR parameters.
  PubDate: Mon, 23 Sep 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez232
  Issue No: Vol. 20, No. 12 (2019)
Corrigendum to: European Association of Cardiovascular Imaging expert
consensus paper: a comprehensive review of cardiovascular magnetic
resonance normal values of cardiac chamber size and aortic root in adults
and recommendations for grading severity
- Pages: 1331 - 1331
  Abstract: [Eur Heart J Cardiovasc Imaging 2019;20:1321–1331]
  PubDate: Thu, 21 Nov 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez289
  Issue No: Vol. 20, No. 12 (2019)
EACVI survey on multimodality training in ESC countries
- Authors: Cameli M; Marsan N, D’Andrea A, et al.
  Pages: 1332 - 1336
  Abstract: AbstractOne of the missions of the European Association of Cardiovascular Imaging (EACVI) is ‘to promote excellence in clinical diagnosis, research, technical development, and education in cardiovascular imaging’. The future of imaging involves multimodality so each imager should have the incentive and the possibility to improve its knowledge in other cardiovascular techniques. This article presents the results of a 20 questions survey carried out in cardiovascular imaging (CVI) centres across Europe. The aim of the survey was to assess the situation of experience and training of CVI in Europe, the availability and organization of modalities in each centre and to ask for vision about potential improvements in CVI at national and European level.
  PubDate: Tue, 17 Sep 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez200
  Issue No: Vol. 20, No. 12 (2019)
The year 2018 in the European Heart Journal—Cardiovascular Imaging:
Part II
- Authors: Cosyns B; Haugaa K, Gerber B, et al.
  Pages: 1337 - 1344
  Abstract: AbstractEuropean Heart Journal - Cardiovascular Imaging was launched in 2012 as a multimodality cardiovascular imaging journal. It has gained an impressive impact factor during its first 5 years and is now established as one of the top cardiovascular journals and has become the most important cardiovascular imaging journal in Europe. The most important studies from 2018 will be highlighted in two reports. Part I of the review has focused on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on cardiomyopathies, congenital heart diseases, valvular heart diseases, and heart failure.
  PubDate: Tue, 17 Sep 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez218
  Issue No: Vol. 20, No. 12 (2019)
Strain-oriented strategy for guiding cardioprotection initiation of breast
cancer patients experiencing cardiac dysfunction
- Authors: Santoro C; Esposito R, Lembo M, et al.
  Pages: 1345 - 1352
  Abstract: AbstractAimsThis study assessed the impact of the strain-guided therapeutic approach on cancer therapy-related cardiac dysfunction (CTRCD) and rate of cancer therapy (CT) interruption in breast cancer.Methods and resultsWe enrolled 116 consecutive female patients with HER2-positive breast cancer undergoing a standard protocol by EC (epirubicine + cyclophosphamide) followed by paclitaxel + trastuzumab (TRZ). Coronary artery, valvular and congenital heart disease, heart failure, primary cardiomyopathies, permanent or persistent atrial fibrillation, and inadequate echo-imaging were exclusion criteria. Patients underwent an echo-Doppler exam with determination of ejection fraction (EF) and global longitudinal strain (GLS) at baseline and every 3 months during CT. All patients developing subclinical (GLS drop >15%) or overt CTRCD (EF reduction <50%) initiated cardiac treatment (ramipril+ carvedilol). In the 99.1% (115/116) of patients successfully completing CT, GLS and EF were significantly reduced and E/e′ ratio increased at therapy completion. Combined subclinical and overt CTRCD was diagnosed in 27 patients (23.3%), 8 at the end of EC and 19 during TRZ courses. Of these, 4 (3.4%) developed subsequent overt CTRCD and interrupted CT. By cardiac treatment, complete EF recovery was observed in two of these patients and partial recovery in one. These patients with EF recovery re-started and successfully completed CT. The remaining patient, not showing EF increase, permanently stopped CT. The other 23 patients with subclinical CTRCD continued and completed CT.ConclusionThese findings highlight the usefulness of ‘strain oriented’ approach in reducing the rate of overt CTRCD and CT interruption by a timely cardioprotective treatment initiation.
  PubDate: Sun, 21 Jul 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez194
  Issue No: Vol. 20, No. 12 (2019)
Aorta-right atrium tunnel: an unexpected diagnosis
- Authors: Fontes A; Dias-Ferreira N, Ladeiras-Lopes R, et al.
  Pages: 1352 - 1352
  Abstract: An asymptomatic 52-year-old woman was referred for the evaluation of a 4/6 continuous murmur in the right parasternal border. Patient had no relevant family history of congenital heart disease. The electrocardiogram showed sinus rhythm and the echocardiogram revealed a round, vascular communication from the left aortic sinus (LAS) to the right atrium (RA), with continuous turbulent flow on Doppler evaluation. Additionally, a cardiac computed tomography angiography was performed for better delineation of coronary and extra-cardiac anatomy. 3D volume rendered reconstructions showed a large and tortuous ‘tunnel-like’ structure arising from the LAS, coursing posteriorly to the aortic root and terminating in the roof of the RA, just inferior and medial to the superior vena cava junction (Panel A). The left anterior descending (LAD) and the circumflex (LCX) arteries arose independently from the proximal portion of the tunnel. Cardiac magnetic resonance imaging with phase-contrast cine (PC-MRI) showed non-dilated right ventricle (RV), right ventricular outflow tract (RVOT) or main pulmonary artery (MPA) and there were no signs of pressure or volume overload (Panels B–E and Supplementary dataSupplementary data online, Video S1). The Qp:Qs ratio assessed by PC-MRI was 1.8 (Panels F–I). The shunt volume assessed by in-plane PC-MRI was 37 mL, and this result was comparable to the difference between the pulmonary (PA) and aortic (Ao) flow (Qp–Qs = 40 mL). Once the patient was asymptomatic and there were no signs of right overload, we decided to manage the patient conservatively with close follow-up.
  PubDate: Mon, 10 Jun 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez154
  Issue No: Vol. 20, No. 12 (2019)
Strain as hallmark to prevent interruption of breast cancer therapy
- Authors: Bergler-Klein J.
  Pages: 1353 - 1354
  Abstract: This editorial refers to ‘Strain-oriented strategy for guiding cardioprotection initiation of breast cancer patients experiencing cardiac dysfunction’ by C. Santoro et al., pp. 1345--1352.
  PubDate: Wed, 09 Oct 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez237
  Issue No: Vol. 20, No. 12 (2019)
PM2.5 concentration in the ambient air is a risk factor for the
development of high-risk coronary plaques
- Authors: Yang S; Lee S, Park J, et al.
  Pages: 1355 - 1364
  Abstract: AbstractAimsWe aimed to investigate whether long-term exposure to particulate matter with an aerodynamic diameter <2.5 μm (PM2.5) in the ambient air is related to the development or growth of coronary plaques.Methods and resultsThis study involved 364 residents of Seoul, Korea, who underwent serial coronary computed tomographic angiography (CCTA) at an interval of ≥2 years. Each participant’s average concentration of residential PM2.5 between the two CCTAs was calculated. Primary endpoint was the development of high-risk plaque (HRP), defined as a plaque with low attenuation, spotty calcium, and positive remodelling. Secondary endpoints were the volume increase of total plaque and its component volume. Among those without HRP at baseline (n = 341), 20 patients developed HRP at follow-up CCTA, the residential PM2.5 concentration of which was significantly higher than those without HRP at follow-up (25.8 ± 2.0 vs. 25.0 ± 1.7 μg/m3 for patients with newly developed HRP vs. patients without HRP at follow-up; P = 0.047). An increase in PM2.5 concentration was associated with increased incidence of HRP at follow-up [adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.22–2.15, P < 0.001]. In a secondary analysis, the PM2.5 concentration was associated with an increased risk of the formation of either fibrofatty or necrotic core component in newly developed plaques (aHR 1.41, 95% CI 1.23–1.61, P < 0.001), and with a higher risk of total plaque volume progression in the pre-existing plaques (aHR 1.14, 95% CI 1.05–1.23, P = 0.002).ConclusionExposure to higher concentration of PM2.5 in the ambient air is significantly associated with the development of high-risk coronary plaques.
  PubDate: Wed, 14 Aug 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez209
  Issue No: Vol. 20, No. 12 (2019)
The air pollution constituent particulate matter (PM2.5) destabilizes
coronary artery plaques
- Authors: Münzel T; Daiber A.
  Pages: 1365 - 1367
  Abstract: This editorial refers to ‘PM2.5 concentration in the ambient air is a risk factor for the development of high-risk coronary plaques’, by S. Yang et al., pp. 1355--1364.
  PubDate: Sat, 19 Oct 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez261
  Issue No: Vol. 20, No. 12 (2019)
Ineffective inferior vena cava filter insertion: a pitfall in a patient
with duplicated inferior vena cava
- Authors: Nakao Y; Higashi H, Nishimura K, et al.
  Pages: 1367 - 1367
  Abstract: An 18-year-old man with no significant past medical history presented to our hospital complaining of syncope during stair-climbing. Contrast-enhanced computed tomography (CT) showed a large amount of pulmonary emboli (Panel A, arrows). In addition, we made a diagnosis of residual deep vein thrombosis (DVT) in the left common iliac vein (Panel B, arrow). As the patient had experienced a syncopal event and the large DVT remained, we decided to insert an inferior vena cava (IVC) filter into the IVC via the right internal jugular vein to prevent fatal pulmonary thromboembolism. Anticoagulant therapy with rivaroxaban (30 mg/day) was also initiated. Detailed analysis of the coagulation system revealed his protein S activity was reduced to 34%. Thus, protein S deficiency was diagnosed as the cause of the pulmonary thromboembolism and DVT.
  PubDate: Mon, 03 Jun 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez131
  Issue No: Vol. 20, No. 12 (2019)
Pulmonary blood volume index as a quantitative biomarker of haemodynamic
congestion in hypertrophic cardiomyopathy
- Authors: Ricci F; Aung N, Thomson R, et al.
  Pages: 1368 - 1376
  Abstract: AbstractAims The non-invasive assessment of left ventricular (LV) diastolic function and filling pressure in hypertrophic cardiomyopathy (HCM) is still an open issue. Pulmonary blood volume index (PBVI) by cardiovascular magnetic resonance (CMR) has been proposed as a quantitative biomarker of haemodynamic congestion. We aimed to assess the diagnostic accuracy of PBVI for left atrial pressure (LAP) estimation in patients with HCM.Methods and results We retrospectively identified 69 consecutive HCM outpatients (age 58 ± 11 years; 83% men) who underwent both transthoracic echocardiography (TTE) and CMR. Guideline-based detection of LV diastolic dysfunction was assessed by TTE, blinded to CMR results. PBVI was calculated as the product of right ventricular stroke volume index and the number of cardiac cycles for a bolus of gadolinium to pass through the pulmonary circulation as assessed by first-pass perfusion imaging. Compared to patients with normal LAP, patients with increased LAP showed significantly larger PBVI (463 ± 127 vs. 310 ± 86 mL/m2, P < 0.001). PBVI increased progressively with worsening New York Heart Association functional class and echocardiographic stages of diastolic dysfunction (P < 0.001 for both). At the best cut-off point of 413 mL/m2, PBVI yielded good diagnostic accuracy for the diagnosis of LV diastolic dysfunction with increased LAP [C-statistic = 0.83; 95% confidence interval (CI): 0.73–0.94]. At multivariable logistic regression analysis, PBVI was an independent predictor of increased LAP (odds ratio per 10% increase: 1.97, 95% CI: 1.06–3.68; P = 0.03).Conclusion PBVI is a promising CMR application for assessment of diastolic function and LAP in patients with HCM and may serve as a quantitative marker for detection, grading, and monitoring of haemodynamic congestion.
  PubDate: Thu, 29 Aug 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez213
  Issue No: Vol. 20, No. 12 (2019)
Old wine in a new bottle: non-invasive quantitative evaluation of
pulmonary congestion with pulmonary blood volume index by cardiac magnetic
resonance
- Authors: Houard L; Cosyns B, Droogmans S.
  Pages: 1377 - 1378
  Abstract: This editorial refers to ‘Pulmonary blood volume index as a quantitative biomarker of haemodynamic congestion in hypertrophic cardiomyopathy’, by F. Ricci et al., pp. 1368--1376.
  PubDate: Mon, 23 Sep 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez239
  Issue No: Vol. 20, No. 12 (2019)
Relationship between epicardial adipose tissue and coronary vascular
function in patients with suspected coronary artery disease and normal
myocardial perfusion imaging
- Authors: Nappi C; Ponsiglione A, Acampa W, et al.
  Pages: 1379 - 1387
  Abstract: AbstractAimsWe evaluated the relationship between epicardial adipose tissue (EAT) and coronary vascular function assessed by rubidium-82 (82Rb) positron emission tomography/computed tomography (PET/CT) in patients with suspected coronary artery disease (CAD).Methods and resultsThe study population included 270 patients with suspected CAD and normal myocardial perfusion at stress–rest 82Rb PET/CT. Coronary artery calcium (CAC) score and EAT volume were measured. Absolute myocardial blood flow (MBF) was computed in mL/min/ from the dynamic rest and stress imaging. Myocardial perfusion reserve (MPR) was defined as the ratio of hyperaemic to baseline MBF and it was considered reduced when <2. MPR was normal in 177 (65%) patients and reduced in 93 (35%). Patients with impaired MPR were older (P < 0.001) and had higher CAC score values (P = 0.033), EAT thickness (P = 0.009), and EAT volume (P < 0.001). At univariable logistic regression analysis, age, heart rate reserve (HRR), CAC score, EAT thickness, and EAT volume resulted significant predictors of reduced MPR, but only age (P = 0.002), HRR (P = 0.021), and EAT volume (P = 0.043) were independently associated with reduced MPR, at multivariable analysis. In patients with CAC score 0 (n = 114), a significant relation between EAT volume and MPR (P = 0.014) was observed, while the relationship was not significant (P = 0.21) in patients with CAC score >0 (n = 156).ConclusionIn patients with suspected CAD and normal myocardial perfusion, EAT volume predicts hyperaemic MBF and reduced MPR, confirming that visceral pericardium fat may influence coronary vascular function. Thus, EAT evaluation has a potential role in the early identification of coronary vascular dysfunction.
  PubDate: Sat, 13 Jul 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez182
  Issue No: Vol. 20, No. 12 (2019)
Prognostic implications of global, left ventricular myocardial work
efficiency before cardiac resynchronization therapy
- Authors: van der Bijl P; Vo N, Kostyukevich M, et al.
  Pages: 1388 - 1394
  Abstract: AbstractAimsCardiac resynchronization therapy (CRT) restores mechanical efficiency to the failing left ventricular (LV) by resynchronization of contraction. Global, LV myocardial work efficiency (GLVMWE) can be quantified non-invasively with echocardiography. The prognostic implication of GLVMWE remains unexplored, and we therefore related GLVMWE before CRT to long-term prognosis.Methods and resultsData were analysed from an ongoing registry of patients with Class I indications for CRT. GLVMWE was defined as the ratio of constructive work in all LV segments, divided by the sum of constructive and wasted work in all LV segments, as a percentage. It was derived from speckle tracking strain echocardiography and non-invasive blood pressure measurements, taken pre-CRT. Patients were dichotomized according to baseline, median GLVMWE [75%; interquartile range (IQR) 66–81%]. A total of 153 patients (66 ± 10 years, 72% male, 48% ischaemic heart disease) were analysed. After a median follow-up of 57 months (IQR 28–76 months), 31% of patients died. CRT recipients with less efficient baseline energetics (GLVMWE <75%) demonstrated lower event rates than patients with more efficient baseline energetics (GLVMWE ≥75%) (log-rank test, P = 0.029). On multivariable analysis, global LV wasted work ratio <75% pre-CRT was independently associated with a decreased risk of all-cause mortality (hazard ratio 0.48, 95% confidence interval 0.25–0.92; P = 0.027), suggesting that the potential for improvement in LV efficiency is important for CRT benefit.ConclusionGLVMWE can be derived non-invasively from speckle tracking strain echocardiography and non-invasive blood pressure recordings. A lower GLVMWE before CRT is independently associated with improved long-term outcome.
  PubDate: Sat, 25 May 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez095
  Issue No: Vol. 20, No. 12 (2019)
Imaging in patients with severe mitral annular calcification: insights
from a multicentre experience using transatrial balloon-expandable valve
replacement
- Authors: Praz F; Khalique O, Lee R, et al.
  Pages: 1395 - 1406
  Abstract: AbstractAimsTo investigate valve sizing and the haemodynamic relevance of the predicted left ventricular outflow tract (LVOT) in patients with mitral annular calcification (MAC) undergoing transatrial transcatheter valve implantation (THV).Methods and resultsIn total, 21 patients undergoing transatrial THV, multiplanar reconstruction (MPR), maximum intensity projection (MIP), and cubic spline interpolation (CSI) were compared for MA sizing during diastole. In addition, predicted neo-LVOT areas were measured in 18 patients and correlated with the post-procedural haemodynamic dimensions. The procedure was successful in all patients (100%). Concomitant aortic valve replacement was performed in eight patients (43%) (AVR group). Sizing using MPR and MIP yielded comparable results in terms of area, perimeter, and diameter, whereas the dimensions obtained with CSI were systematically smaller. The simulated mean systolic neo-LVOT area was 133.4 ± 64.2 mm2 with an anticipated relative LVOT area reduction (neo-LVOT area/LVOT area × 100) of 59.3 ± 14.7%. The systolic relative LVOT area reduction, but not the absolute neo-LVOT area, was found to predict the peak (r = 0.69; P = 0.002) and mean (r = 0.65; P = 0.004) post-operative aortic gradient in the overall population as well as separately in the AVR (peak: r = 0.91; P = 0.002/mean: r = 0.85; P = 0.002) and no-AVR (peak: r = 0.89; P = 0.003/mean: r = 0.72; P = 0.008) groups.ConclusionIn patients with severe MAC undergoing transatrial transcatheter valve implantation, MPR, and MIP yielded comparable annular dimensions, while values obtained with CSI tended to be systematically smaller. Mitral annular area and the average annular diameter appear to be reliable parameters for valve selection. Simulated relative LVOT reduction was found to predict the post-procedural aortic gradients.
  PubDate: Tue, 09 Apr 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez050
  Issue No: Vol. 20, No. 12 (2019)
Increased rotational flow in the proximal aortic arch is associated with
its dilation in bicuspid aortic valve disease
- Authors: Dux-Santoy L; Guala A, Teixidó-Turà G, et al.
  Pages: 1407 - 1417
  Abstract: AbstractAimsAortic dilation in bicuspid aortic valve (BAV) might extend to the proximal arch. Arch flow dynamics and their relationship with this segment dilation are still unexplored. Using 4D-flow cardiovascular magnetic resonance, we analysed flow dynamics in the arch for each BAV morphotype and their association with this segment dilation.Methods and resultsOne hundred and eleven BAV patients (aortic diameters ≤55 mm, non-severe valvular disease), 21 age-matched tricuspid aortic valve (TAV) patients with dilated arch and 24 healthy volunteers (HV) underwent 4D-flow. BAV were classified per fusion morphotype: 75% right-left (RL-BAV), and per arch dilation: 57% dilated, mainly affecting the right-noncoronary (RN) BAV (86% dilated vs. 47% in RL-BAV). Peak velocity, jet angle, normalized displacement, in-plane rotational flow (IRF), wall shear stress, and systolic flow reversal ratio (SFRR) were calculated along the thoracic aorta. ANCOVA and multivariate linear regression analyses were used to identify correlates of arch dilation. BAV had higher rotational flow and eccentricity than TAV in the proximal arch. Dilated compared with non-dilated BAV had higher IRF being more pronounced in the RN-morphotype. RN-BAV, IRF, and SFRR were independently associated with arch dilation. Aortic stenosis and male sex were independently associated with arch dilation in RL-BAV. Flow parameters associated with dilation converged to the values found in HV in the distal arch.ConclusionIncreased rotational flow could explain dilation of the proximal arch in RN-BAV and in RL-BAV patients of male sex and with valvular stenosis. These patients may benefit from a closer follow-up with cardiac magnetic resonance or computed tomography.
  PubDate: Thu, 28 Mar 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez046
  Issue No: Vol. 20, No. 12 (2019)
Comparison of intra-procedural vs. post-stenting prolonged bivalirudin
infusion for residual thrombus burden in patients with ST-segment
elevation myocardial infarction undergoing: the MATRIX (Minimizing Adverse
Haemorrhagic Events by TRansradial Access Site and angioX) OCT study
- Authors: Garcia-Garcia H; Picchi A, Sardella G, et al.
  Pages: 1418 - 1428
  Abstract: AbstractAimsTo compare prolonged bivalirudin infusion vs. an intra-procedural only bivalirudin infusion administration in subjects with ST-segment elevation myocardial infarction (STEMI) regarding residual stent strut thrombosis.Methods and resultsMultivessel STEMI patients undergoing primary percutaneous coronary intervention (PPCI) and scheduled for a staged percutaneous coronary intervention (PCI) before hospital discharge were selected among those allocated to either prolonged bivalirudin or intra-procedural only bivalirudin infusion in the MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and angioX) Treatment-Duration study. Optical coherence tomography (OCT) of the infarct-related artery was performed at the end of PPCI and 4–5 days thereafter during staged intervention. The predefined endpoint was the percentage difference in the number of stent cross-sections with a thrombotic area >5% at the end of PPCI and at the time of staged PCI (ΔThCS). Between September 2013 and November 2015, 137 were randomized to either intra-procedural only bivalirudin infusion (N = 64) or prolonged bivalirudin (N = 73) at 16 European sites. Mean stent area, minimum lumen area, percentage of malapposed struts, and mean percent thrombotic area were comparable after index or staged PCI. The difference in the proportion of frames with percent thrombotic area >5% (ΔTh > 5%) were −7.7 (−22.1 to 5.1) in the intra-procedural bivalirudin infusion group and −8.8 (−23.1 to 2.6) in the prolonged infusion group (P = 0.994). Time from index to follow-up OCT imaging and the infarct vessel artery did not affect this OCT-based endpoint.ConclusionA strategy of prolonged bivalirudin infusion after PPCI did not reduce residual stent strut thrombosis when compared with intra-procedural only bivalirudin infusion administration (funded by The Medicines Company and Terumo; MATRIX ClinicalTrials.gov number, NCT01433627).
  PubDate: Thu, 28 Mar 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez040
  Issue No: Vol. 20, No. 12 (2019)
Primary malignant peripheral nerve sheath tumour of the pericardium
- Authors: Lee J; Lee S, Kim W.
  Pages: 1429 - 1429
  Abstract: A 73-year-old woman presented with dyspnoea for 6 months. Echocardiogram (Panel A) and chest computed tomography (CT, Panel B) revealed a large mass (asterisks) encasing the anterolateral side of left ventricle (LV) with partial loss of epicardial fat echodensity (white arrows) and pericardial effusion. Cardiac CT (Panel C) and conventional angiography (CAG) (Panel D) demonstrated a heterogeneously enhanced mass measuring 6.0 × 4.7 × 4.0 cm and total occlusion of the middle left anterior descending artery (LAD, arrowheads) with heavy calcification. Cardiac magnetic resonance imaging (Panel E) revealed a mass with unenhanced central necrosis and perfusion defect in the LAD territory (black arrow). 18F-fluorodeoxyglucose positron emission tomography CT (Panel F) showed a hypermetabolic pericardial mass invading adjacent myocardium and small lung nodules. CT-guided biopsy (Panels G–I) revealed the diagnosis of primary malignant peripheral nerve sheath tumour (MPNST) of the pericardium with positivity for S100 (Panel H) and vimentin (Panel I). She had refused surgical intervention and received palliative chemotherapy but experienced aggravating dyspnoea after 7 months. Echocardiogram, CT, and CAG (Panels J–L) showed increased tumour size up to 9.7 cm, further myocardial invasion, depressed LV ejection fraction of 25%, embedded LAD in the tumour and progression of the occlusion to the proximal LAD.
  PubDate: Sat, 18 May 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez093
  Issue No: Vol. 20, No. 12 (2019)
Pulmonary arteriovenous malformations and embolic myocardial infarction
identified with cardiovascular magnetic resonance
- Authors: Nazir M; Ismail T, Plein S, et al.
  Pages: 1430 - 1431
  Abstract: A 42-year-old female developed central chest pain radiating to the left shoulder. Twelve lead electrocardiogram demonstrated no ischaemia and the serum troponin was raised at 28 (normal <13 ng/L), which peaked to 140 and fell to 67. Dual antiplatelet therapy with aspirin and clopidogrel was commenced for a presumed acute coronary syndrome. Transthoracic echocardiography demonstrated preserved biventricular function and mild mitral regurgitation (Supplementary data online, Movies S1 and S2Supplementary data online, Movies S1 and S2). Invasive coronary angiography demonstrated unobstructed coronary arteries and no coronary atheroma (Supplementary data online, Movies S3, S4 and S5Supplementary data online, Movies S3, S4 and S5). A cardiovascular magnetic resonance (CMR) scan was arranged to investigate aetiology of the clinical presentation.
  PubDate: Wed, 26 Jun 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez169
  Issue No: Vol. 20, No. 12 (2019)
Late presentation of right atrial diverticulum: surgical intervention
might not be imperative
- Authors: Stefil M; Stefil S.
  Pages: 1432 - 1432
  Abstract: An asymptomatic 61-year-old man was admitted due to new-onset atrial fibrillation incidentally detected upon mandatory occupational health assessment. A transthoracic echocardiogram (TTE) revealed an enlarged right atrium with volume 230 mL (Simpson’s uniplane method) and area 49 cm2; in subcostal view, the right atrium was shown to contain a membrane-like structure, longitudinally arranged, appearing to separate the right atrium into two compartments (Panel A). Tricuspid valve was structurally normal with no apical displacement (Supplementary dataSupplementary data online, Video S1); estimated systolic pulmonary pressure was normal (32 mmHg). Left ventricular ejection fraction was 58%, TAPSE 1.5 cm. Bubble study performed during transoesophageal echocardiography (TOE) showed the right atrium filled with contrast on either side of the membrane, suggestive of fenestrations (Panel B; Supplementary dataSupplementary data online, Video S2). TOE demonstrated patent foramen ovale and excluded the presence of thrombi in both atrial appendages. Cardiac magnetic resonance imaging (MRI) confirmed the diagnosis of right atrial diverticulum (Panels C–E; Supplementary dataSupplementary data online, Videos S3–S5). There was no compression of the right coronary artery as confirmed by computed tomography coronary angiography (Panel F; Supplementary dataSupplementary data online, Video S6). Sinus rhythm was recovered on direct current cardioversion, but this was not maintained. Repeat TTE at 6 months showed no change in right atrial size. The literature suggests that the usual course of action is surgical excision to prevent rupture, but this patient’s history of physically demanding occupations (previous air force parachutist, currently a miner) raises doubt over the necessity of operative treatment in this instance. The patient remains asymptomatic, on anticoagulant treatment and receives echocardiographic follow-up.
  PubDate: Sat, 29 Jun 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez174
  Issue No: Vol. 20, No. 12 (2019)
A challenging mitral valve anatomy for percutaneous repair with MitraClip:
cleft posterior leaflet
- Authors: Melillo E; Ancona F, Buzzatti N, et al.
  Pages: 1433 - 1434
  Abstract: A 66-year-old man with a history of ischaemic cardiomyopathy and heart failure was referred to our institute for worsening shortness of breath (New York Heart Association III) and orthopnoea. Transoesophageal echocardiography (TOE) showed severe functional mitral regurgitation (MR; 3D EROA 80 mm2) with a centromedial origin of the regurgitant jet, a cleft posterior leaflet between scallop P2–P3 and a spotty fibrocalcific lesion on the distal body of the anterior leaflet (scallop A2) (Panels A–D, Supplementary dataSupplementary data online, Video S1). After Heart Team discussion a MitraClip (Abbott Vascular, Santa Clara, CA, USA) procedure was planned. A first clip (XTR) was placed in central position with a slight clockwise rotation, just to the left of the cleft on the posterior leaflet, avoiding the fibrocalcific spot on the anterior leaflet (Panel E), with a successful grasping and moderate residual MR from the cleft (Panel F). Considering the reduced and distorted shape of the posteromedial orifice deriving from the non-parallel placement of the first clip, a second smaller clip (NTR) was implanted just medially to the cleft, with counterclockwise rotation (Panel G, Supplementary dataSupplementary data online, Video S2), resulting in a successful first-attempt grasping with trivial residual MR (Panels H and I, Supplementary dataSupplementary data online, Video S3).
  PubDate: Tue, 25 Jun 2019 00:00:00 GMT
  DOI: 10.1093/ehjci/jez175
  Issue No: Vol. 20, No. 12 (2019)