Tip of the iceberg: extracardiac CT findings in infective endocarditis.

Infective endocarditis (IE) is a disease with high morbidity and mortality rate, but diagnosis is confounded by diverse clinical presentations, which mimic other pathologies. A history of illicit intravenous drug use, previous cardiac valve surgery, and indwelling intracardiac devices increases the risk for developing infective endocarditis. The modified Duke criteria serve as the standard diagnostic tool, though its accuracy is reduced in certain cases. Radiologists in the Emergency Room setting reading body CT may be the first to identify the secondary extra-cardiac complications and facilitate expeditious management by considering otherwise unsuspected infective endocarditis. This review highlights common extracardiac complications of IE and their corresponding CT findings in the chest, abdomen, pelvis, and brain. If IE is suspected radiologists should suggest further investigation with echocardiography.

Prognostic value of strain by feature-tracking cardiac magnetic resonance in arrhythmogenic right ventricular cardiomyopathy.

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Adequate arrhythmic risk assessment is important to prevent sudden cardiac death. We aimed to study the incremental value of strain by feature-tracking cardiac magnetic resonance imaging (FT-CMR) in predicting sustained VA in ARVC patients. METHODS AND RESULTS: CMR images of 132 ARVC patients (43% male, 40.6 ± 16.0 years) without prior VA were analysed for global and regional right and left ventricular (RV, LV) strain. Primary outcome was sustained VA during follow-up. We performed multivariable regression assessing strain, in combination with (i) RV ejection fraction (EF); (ii) LVEF; and (iii) the ARVC risk calculator. False discovery rate adjusted P-values were given to correct for multiple comparisons and c-statistics were calculated for each model. During 4.3 (2.0-7.9) years of follow-up, 19% of patients experienced sustained VA. Compared to patients without VA, those with VA had significantly reduced RV longitudinal (P ≤ 0.03) and LV circumferential (P ≤ 0.04) strain. In addition, patients with VA had significantly reduced biventricular EF (P ≤ 0.02). After correcting for RVEF, LVEF, and the ARVC risk calculator separately in multivariable analysis, both RV and LV strain lost their significance [hazard ratio 1.03-1.18, P > 0.05]. Likewise, while strain improved the c-statistic in combination with RVEF, LVEF, and the ARVC risk calculator separately, this did not reach statistical significance (P ≥ 0.18). CONCLUSION: Both RV longitudinal and LV circumferential strain are reduced in ARVC patients with sustained VA during follow-up. However, strain does not have incremental value over RVEF, LVEF, and the ARVC VA risk calculator.