The pericardium covers the heart and expands to the pulmonary trunk, the upper caval vein, and the ascending aorta. The pericardial sac consists of an inner visceral and outer parietal layer, which constitute for the pericardial cavity. The parietal pericardium localizes...

In patients with STEMI (ST elevation myocardial infarction), primary and rescue percutaneous coronary intervention (PCI) reduce mortality and the risk of re-infarction and stroke compared with thrombolysis alone. For these reasons, primary and rescue PCI are recommended...

Recent years have evidenced a renewed interest in the blood flow inside the cardiac chambers, especially inside the Left Ventricle (LV) where the fluid dynamics is believed to represent a fundamental factor of its function and its regulatory ability. LV fluid dynamics has...

For more than 30 years, several devices have been used to close patent ductus arteriosus (PDA) in children. Coils are generally used for small PDAs and occluding devices for larger PDAs . Recently, the new Amplatzer duct occluder II (ADO II), made of a fabric‐free fine nitinol wire net in to two...

In this seven-minute video interview conducted at the American College of Cardiology’s (ACC's) 61st Annual Scientific Session & Expo in Chicago, GetInsideHealth talked to Dr Alain Cribier after his presentation at Thought Leader Theater of the Heart of Innovations.

Reperfusion therapy has significantly reduced mortality in patients with acute myocardial infarction (AMI). It has been shown that the extent and degree of irreversible myocardial tissue injury after AMI are strong predictors of long-term patient outcomes. Myocardial perfusion...

Endovenous laser ablation (ELA) is a well-accepted alternative to surgery for the treatment of superficial venous insufficiency . The procedure is normally performed by using local tumescent anesthesia (TA). TA not only eliminates pain during ELA, but also protects the surrounding...

Congenital heart disease is a major cause of infant and childhood mortality,   and is the leading organ‐specific birth defect in the United States. More than half of infants affected with congenital heart disease are born to mothers without any previously known risk factors, emphasizing...

Behçet’s disease (BD) is a systemic vasculitis of unknown etiology mainly characterized by mucocutaneous lesions and also by ocular, articular, neurological and vascular involvement. BD affects almost all types and sizes of blood vessels, and approximately 20 to 30% of these patients will...

Although congenital coronary artery anomalies are relatively uncommon, they are the second most common underlying cause associated with sudden cardiac arrest (SCA) and sudden cardiac death (SCD) among athletes, accounting for 15-25% of cases . These anomalies can be relatively difficult to...

Abstract

Introduction Over the past several decades, liposomes have been used in a variety of applications, from delivery vehicles to cell membrane models. In terms of pharmaceutical use, they can offer control over the release of active agents encapsulated into their lipid bilayer or aqueous core, while providing protection from degradation in the body.

A specialist reviews differences between men and women in the presentation, assessment, and treatment of cardiovascular disease.

Why are current guidelines on the management of cardiovascular disease (CVD) "not yet fit for women"? Why should postmenopausal women be routinely assessed for CVD? Dr Janneke Wittekoek answers these and other questions in this video interview conducted exclusively for GetInsideHealth in March 2011.

Why are current guidelines on the management of cardiovascular disease (CVD) "not yet fit for women"? Why should postmenopausal women be routinely assessed for CVD? Dr Janneke Wittekoek answers these and other questions in this video interview conducted exclusively for GetInsideHealth in March 2011.

DEEP VENOUS THROMBOSIS and pulmonary embolism are two interrelated conditions that involve either propagation or embolization of venous thrombi. The spectrum of pulmonary emboli ranges from the clinically unsuspected, to massive embolisms causing death, which is why noninvasive diagnostic methods for...

How big a problem is it, what are the risk factors, and can the screening of athletes be effective in preventing deaths?

In this 5-minute video interview conducted at the 2011 meeting of the American College of Cardiology, Dr. John Carroll reports that the introduction of new devices for structural heart disease has been accompanied by parallel developments in imaging. However, there is no single type of imaging best in all settings. Rather, physicians will have to understand how to match the best imaging modality with the procedure performed.

Previous research has suggested that up to 50% of patients with paroxysmal AF receiving pharmacologic therapy will progress to persistent AF. Risk factors for progression include age, hypertension, a prior transient ischemic event, chronic obstructive pulmonary disease, and heart failure (as indicated by the HATCH score).

In a new study, specialists from the University of Michigan, in Ann Arbor, investigated the effect of RFA on the progression of paroxysmal AF in 504 patients (mean age 58 years). Just over one-third of the patients (38%) had a repeat RFA procedure.

Specialists from University RWTH Aachen, in Germany, compared five different techniques in 49 consecutive patients with severe aortic stenosis who were due to undergo TAVI: angiography, 2D transthoracic echocardiography (TTE), 2D transesophageal echocardiography (TEE), 3D TEE, and dual-source CT (DSCT).

The researchers found that the sagittal diameters measured by all five techniques were smaller than the coronal diameters that could be determined by angiography, 3D TEE and DSCT.

Researchers from specialist cardiology centres in New York evaluated the utility of FT-MRI measures of LV global and regional strain in patients with prior MI.

In this 4-minute video interview conducted at the 2011 meeting of the American College of Cardiology, Prof. David Erlinge from Lund University in Sweden reports on the progress so far in developing hypothermia as a tool to limit the damage to heart muscle from an acute myocardial infarction (MI). Hypothermia is already being used to prevent muscle damage during heart transplant and reduce brain damage in post cardiac arrest, and the potential for benefit in acute MI, based on experimental studies, is substantial.

Researchers from Stony Brook University Medical Center, New York, evaluated the first 1,089 CCTAs performed at a large emergency department dealing with 90,000 visits per year. A control group comprised 4,556 other patients with acute chest pain who attended the emergency department in the same time period but who did not undergo CCTA.

All patients in the study had a negative initial ECG and troponin I level, and were considered to be low-risk chest pain patients. Patients known to have coronary artery disease were excluded from having CCTA. A 50% luminal diameter stenosis in any major vessel on CCTA was used as the threshold distinguishing obstructive from non-obstructive cases.

FDG-PET has been validated as a measure of carotid inflammation, but relatively little is understood about whether FDG uptake can also be used to evaluate inflammatory activity in atherosclerotic segments of the aorta. Although atherosclerotic inflammation is known to occur predominantly within lipid-rich plaques in the lesser curvature of the ascending aorta, providing an opportunity for FDG PET studies to quantify disease activity in these areas, it was unclear whether potential obstacles, such as peri-aorta fat, might limit accuracy or reproducibility.

The researchers, from centers in Boston and New York, performed both MRI and FDG-PET in 15 subjects with atherosclerosis (the mean age of the subjects was 65 years). FDG update was measured within the aortic wall at 30-degree intervals on axial images. Lipid-rich plaques were defined as wall regions that were hyper-intense on both T1 and TOF [time of flight] MRI, and peri-aortic fat was also identified on MRI.

Researchers from NHS Tayside in Dundee, UK, studied use of a digital dosimeter worn on top of the lead apron, providing live information on exposure during fluoroscopy. They compared fluoroscopy usage in the 6 months before the introduction and implementation of the dosimeter, and in the 6 months afterwards.

A total of 208 pacemaker implantation procedures were performed in the study period. The mean X-ray screening time was reduced significantly with use of the dosimeter, from 3.7 min to 3.0 min. Similarly, the dose area product (DAP) for each procedure was reduced from a mean of 247 microGray/cm2 to 185 microGray/cm².

The group of researchers from the University of Munich in Germany, led by Dr. Martin Hadamitzky, assessed the value of CCTA data in addition to clinical risk predictors and CASC in the prediction of severe cardiac events.

A group of researchers from the University of Ottawa Heart Institute, Ottawa, Canada, have compared the accuracy of 2 different algorithms to predict mortality risk in octogenarian patients undergoing aortic valve replacement (AVR) or AVR plus coronary artery bypass grafting (CABG). 

A total of 394 patients (mean age 83 years, 53% male) undergoing AVR or AVR/CABG were included in the study. Expected hospital mortality was predicted using 2 risk-prediction algorithms: the STS predictive risk of mortality algorithm, and the LES algorithm. Patients were classified as low-, medium-, or high-risk, according to the criteria of the different algorithms, and were followed up for a mean of 4.7 years. Observed/expected (O/E) mortality ratios were calculated.

Previous research has demonstrated an association between obstructive sleep apnea and AF, but no studies have investigated whether treating sleep apnea, with CPAP therapy, can reduce the risk of AF. To rectify this, specialists from the sleep center at the Toranomon Hospital in Tokyo, Japan, studied the effect of CPAP therapy on P-wave duration - a prolonged P-wave duration being a marker of left atrial abnormality and understood to be a strong predictor of AF.

Specialists from centers in Adelaide, Australia, evaluated 362 consecutive patients referred to a tertiary cardiology center for stress perfusion CMR. Almost one-third of the patients had a history of previous myocardial infarction or percutaneous coronary intervention (PCI). Perfusion imaging was performed at stress (with adenosine 140 mcg/kg/min) and at rest on a 1.5T machine, and late enhancement was assessed with dual pass gadolinium at a total dose.

In this audio interview conducted exclusively for GetInsideHealth in March 2011, Professor Pierre Jaïs provides expert insights into recent developments in catheter ablation for atrial fibrillation (AF).

An important challenge in cardiac CT is to minimize the radiation dose while maintaining and optimizing image quality. How this can be achieved is discussed in a new GetInsideHealth audio interview conducted with Dr Gilbert Raff, medical director of the Ministrelli Center for Advanced Cardiovascular Imaging at the William Beaumont Hospital in Royal Oak, Michigan, USA.

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Over the past years, cardiovascular magnetic resonance (CMR) has proven its efficacy in large clinical trials, and consequently, the assessment of function, viability, and ischaemia by CMR is now an integrated part of the diagnostic armamentarium in cardiology. By combining these CMR applications, coronary artery disease (CAD) can be detected in its early stages and this allows for interventions with the goal to reduce complications of CAD such as infarcts and subsequently chronic heart failure (CHF). As the CMR examinations are robust and reproducible and do not expose patients to radiation, they are ideally suited for repetitive studies without harm to the patients. Since CAD is a chronic disease, the option to monitor CAD regularly by CMR over many decades is highly valuable. Cardiovascular magnetic resonance also progressed recently in the setting of acute coronary syndromes. In this situation, CMR allows for important differential diagnoses. Cardiovascular magnetic resonance also delineates precisely the different tissue components in acute myocardial infarction such as necrosis, microvascular obstruction (MVO), haemorrhage, and oedema, i.e. area at risk. With these features, CMR might also become the preferred tool to investigate novel treatment strategies in clinical research. Finally, in CHF patients, the versatility of CMR to assess function, flow, perfusion, and viability and to characterize tissue is helpful to narrow the differential diagnosis and to monitor treatment.

Cardiovascular disease remains the leading cause of mortality, morbidity and disability in the developed world, predominantly affecting the adult population. In the early 1990s coronary heart disease (CHD) was established as affecting one in two men and one in three women by the age of forty. Despite the dramatic progress in the field of cardiovascular medicine in terms of diagnosis and treatment of heart disease, modest improvements have only been achieved when the reduction of cardiovascular mortality and morbidity indices are assessed. To better understand coronary atherosclerosis, new imaging modalities have been introduced. These novel imaging modalities have been used in two ways: (1) for the characterization of plaque types; (2) for the assessment of the progression and regression of tissue types. These two aspects will be discussed in this review.

Introduction

In the year 2010, the International Journal of Cardiovascular Imaging received very interesting contributions dealing with a wide variety of imaging modalities. Papers came from all corners of the world and dealt with both experimental and clinical observations. Since we deal today with image-guided diagnoses, therapies and interventions, there is a growing interest in the increasing capabilities of the existing imaging modalities. Developments in imaging are therefore not only interesting to imaging experts themselves, but in particular to medical specialists such as cardiologists, radiologists, nuclear medicine specialists, and internal medicine specialists. Improvements in imaging capabilities may directly lead to improved health care. Within the whole spectrum from primary prevention to intervention, myocardial imaging becomes an indispensible tool. Both patients with suspected and known cardiovascular disease may benefit from the tremendous achievements in cardiac and vascular imaging.

Imaging has a central role in the evaluation of patients with heart failure (HF). Cardiovascular magnetic resonance (CMR) is rapidly evolving as a versatile imaging modality that often provides additional information to echocardiography in patients with suspected or known HF. CMR is the only imaging modality that has the ability to assess, without exposure to ionizing radiation, cardiac function, structure (tissue characterization), perfusion, and viability. Moreover, magnetic resonance spectroscopy techniques can assess the pathophysiologic role of deranged cardiac energetics in HF. In this review we discuss the role of CMR in the evaluation of patients with HF giving particular emphasis to recent developments and the additional information that can be obtained with this imaging modality, over and above standard echocardiography.

Recent advances in fatty acid (FA) imaging using positron emission tomography (PET) include the development of a method to assess endogenous triglyceride metabolism and the design of new fluorine-18 labeled tracers. Studies of patients with diabetes have shown that the heart is resistant to insulin-mediated glucose uptake and that metabolism of nonesterified FA is upregulated.

Motivated by the promise to transform preclinical research and clinical care, cardiovascular molecular imaging has made advances toward targeting coronary atherosclerosis and heart failure. Here, we discuss recent progress in the field, highlight how molecular imaging may facilitate preventive patient care, and review specific challenges associated with coronary and heart failure imaging. Practical considerations stress the potential of fluorescence imaging for basic research and discuss hybrid protocols such as FMT-CT and PET-MRI.

Procedure time, fluoroscopy time, dose area product (DAP), and contrast media volume were used as indicators of quality of performance. We analyzed data from 4,200 coronary angiographies. Performance curves of seven trainees were compared with recommended reference levels and to those of seven interventional cardiologists.

An imaging specialist discusses cardiac CT, including new clinical guidance and future applications of the technique. In this exclusive audio interview for GetInsideHealth, conducted in January 2011, Dr Morten Bøttcher of Aarhus University Hospital, Denmark, discusses the use of cardiac CT in daily clinical practice. The interview includes discussion of the updated “Appropriate Use Criteria” for cardiac CT published in October 2010 by a consortium of professional societies. Originally published in 2006, the updated guidance increases the number of appropriate uses, taking into account the expanding evidence base.

Abstract

Rapid technetium-99 m methoxyisobutylisonitrile (99 mTc-MIBI) washout has been shown to occur in impaired myocardia. This study is based on the hypothesis that scintigraphy can be applied to calculate the myocardial 99 mTc-MIBI washout rate (WR) to diagnose and evaluate heart failure severity and other left ventricular functional parameters specifically in idiopathic dilated cardiomyopathy (IDCM) patients.

Abstract

Purpose To prospectively determine the most reproducible approach for left-atrial size assessment using cardiovascular magnetic resonance (CMR) imaging in patients with atrial fibrillation and its value for prediction of pulmonary vein isolation (PVI) treatment success.

Abstract

Background:  The transradial approach for coronary procedures is associated with a low complication rate, but specific training is considered mandatory.

Abstract

Introduction Lipomatous hypertrophy of the interatrial cardiac septum is a benign disorder. In rare cases, the disorder can cause obstruction of atrial inflow, causing symptoms of heart failure, or cardiac arrhythmias resulting from the involvement of the atrial wall and atrioventricular conduction pathways.

Abstract

Introduction Early repolarization (ERep) abnormalities on electrocardiogram (ECG) are common immediately following cardiac arrest. We characterized and correlated electrocardiographic repolarization abnormalities immediately after cardiac arrest with acute coronary angiography.

Is the demand for catheter ablation for atrial fibrillation (AF) likely soon to exceed supply? In the past few months, several papers have been published that point to significant benefits from use of the technique and an increasing demand. At the same time there are suggestions from surveying physicians that this increasing demand for catheter ablation for AF is not being matched by an increase in the provision of electrophysiology services.

What has the recently published research shown? In one study published last year in the journal Heart, specialists investigated the long-term efficacy of catheter ablation for AF in a total of 285 patients who underwent 530 procedures (an average of 1.9 per patient – 1.7 for paroxysmal AF and 2.0 for persistent AF). The patients were followed up for an average of 2.7 years (range 0.2 to 7.4 years) after the last procedure.

Chronic cerebrospinal venous insufficiency (CCSVI) is a putative new theory that has been suggested by some to have a direct causative relation with the symptomatology associated with multiple sclerosis (MS) [1].

Background and Purpose We compared the effectiveness of using computed tomographic angiography and venography (CTAV) with digital subtraction angiography (DSA) in young or nonhypertensive patients with acute spontaneous intracerebral hemorrhage.

Background and objectives Type-2 diabetic patients constitute a high-risk population for atherosclerosis. Primary prevention, although recommended, is not well funded. Our aim was to evaluate the degree of subclinical atherosclerosis, in asymptomatic diabetic patients, using coronary multi-slice computed tomography (MSCT) angiography.

Background The Intracardiac Echocardiography Guided Cardioversion Helps Interventional Procedures study evaluated the concordance of intracardiac echocardiography (ICE) with transesophageal echocardiography (TEE) in patients with atrial fibrillation (AF).

Carotid thickening and plaque detected by B-mode imaging ultrasound are useful to improve the ischemic risk evaluation in asymptomatic subjects over and beyond the traditional cardiovascular risk factors. Some plaque’s echographic parameters help describing the vascular risk. We hypothesized that the stenosis degree, plaque surface irregularity, echolucency and texture, compounded in a Total Plaque Risk Score (TPRS), are predictors of the ischemic events in the San Daniele study, a general population-based study of 1,348 subjects followed for 12 years in average. In the 171 subjects with at least one plaque at baseline, high TPRS was the most powerful independent predictor of cerebrovascular events, which occurred in 115 subjects. Addition of plaque characteristics significantly increased the area under the ROC curve (0.90 vs. 0.88, p = 0.04) versus the Framingham risk score alone. The TPRS is a potential new tool to improve the stroke risk prediction.

Background Unstable carotid plaques that consist of large lipid pool and intraplaque hemorrhage are more likely to cause cerebral infarction. We previously developed an integrated backscatter (IBS) ultrasound color-coded mapping method to evaluate the tissue characteristics of plaques. The purpose of this study was to determine whether 3-dimensional IBS color-coded mapping and signal intensity ratio (SIR) from magnetic resonance imaging (MRI) could distinguish the early symptomatic plaques from late symptomatic plaques.

Background Advances in contrast-enhanced multidetector CT enable detailed characterization of the left ventricular myocardium. Myocardial scar and border zone (BZ), as the target of ventricular tachycardia ablations, displays abnormal anatomic, dynamic, and perfusion characteristics during first-pass CT. This study assessed how contrast-enhanced CT can predict voltage-defined scar and BZ and integrate its scar reconstructions into clinical mapping systems to guide ventricular tachycardia ablations.

Background and objectives Type-2 diabetic patients constitute a high-risk population for atherosclerosis. Primary prevention, although recommended, is not well funded. Our aim was to evaluate the degree of subclinical atherosclerosis, in asymptomatic diabetic patients, using coronary multi-slice computed tomography (MSCT) angiography.

In this audio interview conducted exclusively for GetInsideHealth on 20 December 2010, Dr Alan Groves discusses the cardiovascular causes of neurological disorders observed in preterm neonates, and how imaging techniques such as echocardiography and MRI are helping to advance our understanding.

Dr Groves discusses:
The role of circulatory factors in the pathophysiology of brain injury resulting in poor long-term outcomes in preterm infants.
The indicators/variables that specialists are monitoring in order to assess circulatory adequacy in neonatal units.
The insights being provided by cardiac MRI in preterm neonates.

Background   Echocardiography provides both morphological and functional information offering a potential advantage over nuclear medicine gated blood pool scans which only estimate ejection fraction. This additional information may be relevant to management of patients receiving potentially cardiotoxic cancer treatment.

The imaging study was conducted in 27 consecutive patients who were undergoing  TAVI due to severe aortic valve stenosis. Imaging studies were conducted with ECG-gated MDCT before and after Dyna-CT.

Dr. Capunay started his presentation by pointing out that, “previous studies in patients with suspected CAD and normal functional studies showed that CTCA can recognize a wide range of anatomic observations.”

Dr. Capunay and colleagues used CTCA to evaluate the presence and severity of coronary stenosis in 36 patients with normal cardiac functional studies (CFS). All patients were referred for exclusion of CAD. 

To investigate whether CT can provide similar information to MR regarding pericardial thickness and delayed enhancement, specialists at the Mayo Clinic in Rochester, Minnesota, searched hospital records for MR examinations of the heart or chest with an indication including “pericardium”, “pericardial”, “pericarditis”, or “constrictive” over a period of 5 years. Results were cross-referenced to identify patients who had undergone pericardiectomy and also had a preoperative CT scan of the chest for any indication.

The study was done by John Nance, MD, and colleagues at the Medical University of South Carolina, Charleston, South Carolina, who used cCTA to evaluate patients with acute chest pain and then correlated the findings with clinical outcomes.

Dr. Nance’s team enrolled 286 consecutive patients (33% male, mean age 55±11 years) who presented with acute chest pain and underwent contrast-enhanced cCTA for the assessment of atherosclerotic lesions.

“Left ventricular diastolic dysfunction has prognostic implications for various cardiac diseases, such as ischemic heart disease, heart failure, cardiomyopathy, and atrial fibrillation,” said Zhaoying Wen, MD, Beijing Anzhen Hospital, Beijing, China, who presented the study. “But it is invasive to measure left ventricular diastolic function using a catheter,” he added. “However, left atrial size and function has been proposed to reflect left ventricular diastolic function sensitively, and this can be assessed using MDCT,” Dr. Wen explained.

In their study, Dr. Wen and colleagues enrolled 73 patients who had been referred to CT coronary angiography. All patients were examined by MDCT and real-time 3D echocardiography (RT-3DE) on the same day.

The study was performed by specialists at Hull Royal Infirmary, in Hull, UK, to explore the factors influencing the experience of patients undergoing interventional radiological procedures.  

The researchers sent out questionnaires to 315 patients undergoing interventional vascular procedures prior to treatment, immediately following treatment, as well as 4 weeks and 3 months after the procedure.

The questionnaires were aimed at surveying the patients’ understanding of the procedure, their level of anxiety, and the amount of pain they were experiencing. The latter was assessed using a visual analog scoring system (VAS). The short form 36 (SF 36) health survey questionnaire was used to evaluate quality of life changes associated with the procedure.

The study, conducted by specialists at the Medical University of South Carolina, Charleston, South Carolina, evaluated the feasibility of adenosine-stress myocardial perfusion imaging, using 128-slice dual-source CT, for the qualitative and quantitative assessment of myocardial blood flow (MBF) compared to stress perfusion and viability MRI.

The researchers enrolled 20 patients (14 male, 6 female; mean age 60±11 years) who underwent a standardized cardiac CT protocol consisting of prospectively ECG-triggered coronary CT angiography, dynamic adenosine-stress myocardial perfusion imaging using a “shuttle” mode, and delayed enhancement acquisitions.

“Until now, trans-thoracic echocardiography has been the most widely used method for the diagnosis of AMIS,” Dr. Joe noted. However, the diagnostic accuracy of TTE is not very high, and it has limited value for detailed morphological assessment,” he added.