Biatrial performance in children with hypertrophic cardiomyopathy: CMR study.

OBJECTIVES: To investigate biatrial mechanics and their relation with left ventricular outflow tract (LVOT) obstruction (LVOTO), the degree of hypertrophy, indices of ventricular diastolic function and fibrosis in children with hypertrophic cardiomyopathy (HCM). METHODS: Fifty-five consecutive, prospectively recruited children with HCM (mean age 12.5 ± 4.6 years, 69.1% male), 19 (34.5%) of whom had LVOTO, underwent cardiac magnetic resonance and echocardiography with quantification of phasic components of biatrial function, biventricular diastolic function and fibrosis. Twenty healthy, sex-matched subjects served as controls. RESULTS: We found a significant increase of left atrial (LA) and right atrial (RA) volumes and reduction in the majority of indices of contractile function, strains and strain rates (p < 0.05) in children with HCM compared with controls. Nearly all of the LA dynamics markers attained a significant association with the LVOT gradient (p < 0.05), the RA volumes and contractile functions were affected by LV fibrosis and mass (p < 0.05), and the RA mechanical components were related to the degree of LVOTO (p < 0.05). The minority of biatrial dynamics markers were associated with indices of ventricular diastolic function. CONCLUSIONS: The majority of biatrial volumetric and functional indices were severely compromised in children with HCM compared with controls. The degree of LVOTO appears to trigger LA volumetric and LA and RA mechanical malfunction. On the other hand, the deterioration of RA volumetric components was linked to LV fibrosis and mass. KEY POINTS: • Biatrial function was severely compromised in children with HCM. • Left atrial malfunction was associated with the degree of LVOTO. • Fibrosis and LV mass were related to RA volumetric and contractile dysfunction. • The degree of LVOTO was linked to right atrial mechanical abnormalities.

Cine dyscontractility index: A novel marker of mechanical dyssynchrony that predicts response to cardiac resynchronization therapy.

PURPOSE: To investigate whether magnetic resonance imaging (MRI) cine-derived dyssynchrony indices provide additional information compared to conventional tagged MRI (tMRI) acquisitions in heart failure patients undergoing cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: Patients scheduled for CRT (n = 52) underwent preprocedure MRI including cine and tMRI acquisitions. Segmental strain curves were calculated for both cine and tMRI to produce a range of standard indices for direct comparison between modalities. We also proposed and evaluated a novel index of "dyscontractility," which detects the presence of focal areas with paradoxically positive circumferential strain. RESULTS: Across conventional strain indices, there was only moderate-to-poor (R = 0.3-0.6) correlation between modalities; eight cine-derived indices showed statistically significant (P < 0.05) relations to CRT outcome compared to just two tMRI-based counterparts. The novel dyscontractility index calculated on basal slice cine images (cine dyscontractility index, "CDI") was the single best predictor of clinical response to CRT (area under the curve AUC = 0.81, P < 0.001). While poorly correlated to its tMRI counterpart (R = 0.33), CDI performed significantly better in predicting response to CRT (P < 0.005), and was also numerically better than all other tMRI indices (AUC 0.53-0.76, all P for AUC comparisons <0.17). CONCLUSION: Cine-derived strain indices offer potentially new information compared to tMRI. Specifically, the novel CDI is most strongly linked to response to cardiac resynchronization therapy in a contemporary patient cohort. It utilizes readily available MRI data, is relatively straightforward to process, and compares favorably with any conventional tagging index. J. Magn. Reson. Imaging 2016;44:1483-1492.

The use of 1.5 T magnetic resonance imaging for therapeutic decisions in patients with cardiac implantable electronic devices and significant neurological, neurosurgical and neuro-oncology diagnostic indications.

UNLABELLED: Between September 2009 and May 2014 the classification of 36 patients with cardiac implantable electronic devices (CIEDs) in terms of the feasibility of MRI scanning due to strong clinical indications was carried out. Finally MRI examinations were performed in 20 patients, of whom 27 studies were conducted and a total number of 35 anatomical regions were scanned. Neurological, neurosurgical and neuro-oncology indications for MRI were reported in 19 patients (95%) in whom 26 MRI studies (96.3%) were performed, and 34 anatomical regions (97.1%) were scanned. One patient had indications for MRI in the field of cardiology. Medical information obtained from 27 MRI studies allowed decisions to be made regarding the treatment in all patients. After 8 studies (29.6%), patients were classified into 9 different neurosurgical procedures. In the case of the remaining 19 studies (70.4%), there were no indications for surgical treatment and the decisions to implement conservative treatment were made. There were no complications related to the implanted CIEDs observed: neither immediate nor in the follow-up.

[Cardiac abnormalities in patients with myotonic dystrophy--preliminary results]. / Zaburzenia kardiologiczne u pacjentów z dystrofia miotoniczna--doniesienie wstepne.

INTRODUCTION: Myotonic dystrophy (DM) is an inherited multisystem disorder associated with myotonia, progressive skeletal muscle weakness and atrophy, involvement of peripheral and central nervous system and sudden death likely due to atrioventricular block and/or ventricular arrhythmia. AIM OF THE STUDY: to assess the type and degree of cardiac and neurological involvement in patients (pts) with DM. MATERIALS AND METHODS: 10 pts (6 male), in mean age of 35 +/- 13 years, treated for DM type I (DM1)--7 pts and type II (DM2)--3 pts. All pts underwent a neurological examination including muscle strength assessment as well as cardiac diagnostics including: standard and 48-hour ambulatory electrocardiogram, echocardiographic examination, magnetic resonance imaging (MRI) of the heart and late potentials assessment. RESULTS: Muscle strength was moderately diminished (46-48 points in MRC sub score) in 3 pts with DM1 and mildly diminished (56-58 points in MRC sub score) in 2 pts with DM2. These patients showed clinical symptoms of myopathy. Cardiovascular examinations revealed: QRS duration above 110 ms in 5 pts, clinically significant supraventricular arrhythmia or atrioventricular block in 3 pts, focal myocardial fibrosis in 3 pts, asymmetric hypertrophy of inter-ventricular septum in 1 patient, presence of late potentials in 5 pts. We have not observed correlation between impaired muscle strength and cardiac abnormalities. However, most pronounced cardiac abnormalities were observed in 2 male DM1 patients with clinical symptoms of myopathy and lowest MRC score. At a mean follow up of 3.2 +/- 1.4 years none of the pts died. CONCLUSIONS: Cardiac involvement in pts with myotonic dystrophy is frequent and is characterized by phenotypic heterogeneity. Detection of cardiac abnormalities may require extensive diagnostics. The most important is the assessment of ECG. Cardiac and neurological abnormalities vary in intensity between patients without close relationship to each other.

Repaired tetralogy of Fallot: ratio of right ventricular volume to left ventricular volume as a marker of right ventricular dilatation.

PURPOSE: To compare indexed right ventricular (RV) end-diastolic volume (RVEDVi) and the ratio of RV volume to left ventricular (LV) volume (RV/LV ratio) in prediction of significant pulmonary regurgitation (PR) after tetralogy of Fallot (TOF) repair and to assess sex differences in the RV/LV ratio. MATERIALS AND METHODS: The ethics committee approved this retrospective single-center study, and patients or their parents or guardians signed written informed consent. RVEDVi, RV/LV ratio, and PR were measured with the use of magnetic resonance imaging in 155 consecutive patients with repaired TOF (mean age, 29.2 years±10.9 [standard deviation]; 98 [63.2%] male and 57 [36.8%] female patients). PR fraction of 20% or greater was considered significant. The capability of the RVEDVi and that of the RV/LV ratio for prediction of significant PR were compared by using logistic regression analysis and receiver operating characteristic curve analysis. RESULTS: RVEDVi was significantly higher in male (162.8 mL/m2±50.4) than in female (138.2 mL/m2±37.5) patients (P=.001). Conversely, the RV/LV ratio was similar in both sexes (1.82±0.56 [male] vs 1.69±0.46 [female], P=.13) both in the entire cohort and after excluding patients with significant (≥30 mm Hg) RV outflow tract gradient and/or other residual hemodynamic abnormalities (P=.63). Receiver operating characteristic analysis revealed better discrimination of significant (≥20%) from insignificant (<20%) PR with the use of the RV/LV ratio than with RVEDVi (area under the receiver operating characteristic curve, 0.937 [model 4] vs 0.849 [model 1], P=.01). In multivariate analysis, the only independent predictor of PR fraction was the RV/LV ratio. CONCLUSION: The RV/LV ratio is more accurate than the RVEDVi in differentiation of significant from insignificant PR. After TOF repair, female and male patients have similar RV/LV ratios despite significant differences in RVEDVi between the sexes.

Right ventricular outflow tract obstruction as a confounding factor in the assessment of the impact of pulmonary regurgitation on the right ventricular size and function in patients after repair of tetralogy of Fallot.

PURPOSE: To compare right ventricular (RV) size and function between patients with combined pulmonary regurgitation (PR) plus RV outflow tract (RVOT) obstruction (RVOTO) and patients with isolated PR. MATERIALS AND METHODS: Consecutive individuals with significant PR (PR fraction ≥ 20%) after tetralogy of Fallot (TOF) repair who underwent cardiovascular magnetic resonance (CMR) were included. Patients with additional hemodynamic abnormalities (residual ventricular septal defect, extracardiac shunt, and/or more than mild regurgitation at a valve other than the pulmonary valve) were excluded. Significant RVOTO was defined as peak gradient across RVOT ≥ 30 mmHg. RESULTS: Significant differences between patients with combined PR+RVOTO (n = 9) and isolated PR (n = 33) were observed in RV end-diastolic volume (138.6 ± 25.1 vs. 167.0 ± 34.6 mL/m(2) , P = 0.02, respectively), RV end-systolic volume (65.0 ± 9.6 vs. 92.7 ± 26.2 mL/m(2) , P = 0.003), and RV ejection fraction (RVEF) (52.8 ± 3.7 vs. 45.0 ± 6.4%, P = 0.001). Both PR and peak RVOT gradient were independent predictors of RV size. CONCLUSION: Patients with combined PR+RVOTO had smaller RV volumes and higher RVEF when compared with patients with isolated PR. The confounding effect of RVOTO on RV size and function needs to be considered in CMR studies evaluating patients after TOF repair.

Percutaneous pulmonary valve implantation preceded by routine prestenting with a bare metal stent.

OBJECTIVES: To evaluate the effectiveness and safety of percutaneous pulmonary valve implantation (PPVI) with routine prestenting with a bare metal stent (BMS). BACKGROUND: PPVI is a relatively new method of treating patients with repaired congenital heart disease (CHD). Results of PPVI performed with routine prestenting have never been reported. METHODS: Consecutive patients who underwent PPVI for homograft dysfunction with prestenting with BMS were studied. The schedule of follow-up assessment comprised clinical evaluation, cardiovascular magnetic resonance, transthoracic echocardiography, and chest X-ray to screen for device integrity. RESULTS: PPVI was performed with no serious complications in all patients (n=10, mean age 26.8±4.0 years, 60% males). In nine patients with significant pulmonary stenosis, peak right ventricular outflow tract (RVOT) gradient was reduced from a mean of 80.6±22.7 to 38.8±10.4 mm Hg on the day following implantation (P=0.001). At 1-month and 6-month follow-ups, mean RVOT gradient was 34.0±9.8 and 32.0±12.2 mm Hg, respectively. In patients with significant pulmonary regurgitation, mean pulmonary regurgitation fraction decreased from 19%±6% to 2%±1% (P=0.0008). Relief of RVOT obstruction and restoration of pulmonary valve competence were associated with significant decrease in right ventricular (RV) end-diastolic and end-systolic volumes (125.5±48.6 to 109.2±42.9 mL/m2 ; P=0.002 and 68.4±41.5 vs. 50.9±40.6 mL/m2; P=0.001) as well as improvement in RV ejection fraction (48.8%±13.1% to 57.6%±14.4%; P=0.003) and New York Heart Association class (P=0.003). All patients completed 6-month follow-up. No stent fractures were observed. CONCLUSIONS: PPVI with routine prestenting with BMS is a safe and effective method of treatment in patients with repaired CHD.

The Indices of Cardiovascular Magnetic Resonance Derived Atrial Dynamics May Improve the Contemporary Risk Stratification Algorithms in Children with Hypertrophic Cardiomyopathy.

INTRODUCTION: The most efficient risk stratification algorithms are expected to deliver robust and indefectible identification of high-risk children with hypertrophic cardiomyopathy (HCM). Here we compare algorithms for risk stratification in primary prevention in HCM children and investigate whether novel indices of biatrial performance improve these algorithms. METHODS AND RESULTS: The endpoints were defined as sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator discharge. We examined the prognostic utility of classic American College of Cardiology/American Heart Association (ACC/AHA) risk factors, the novel HCM Risk-Kids score and the combination of these with indices of biatrial dynamics. The study consisted of 55 HCM children (mean age 12.5 ± 4.6 years, 69.1% males); seven had endpoints (four deaths, three appropriate ICD discharges). A strong trend (DeLong p = 0.08) was observed towards better endpoint identification performance of the HCM Risk-Kids Model compared to the ACC/AHA strategy. Adding the atrial conduit function component significantly improved the prediction capabilities of the AHA/ACC Model (DeLong p = 0.01) and HCM Risk-Kids algorithm (DeLong p = 0.04). CONCLUSIONS: The new HCM Risk-Kids individualised algorithm and score was capable of identifying high-risk children with very good accuracy. The inclusion of one of the atrial dynamic indices improved both risk stratification strategies.

Prognostic role of PET/MRI hybrid imaging in patients with pulmonary arterial hypertension.

OBJECTIVE: Right ventricular (RV) function is a major determinant of survival in patients with pulmonary arterial hypertension (PAH). Metabolic alterations may precede haemodynamic and clinical deterioration. Increased RV fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) was recently associated with progressive RV dysfunction in MRI, but the prognostic value of their combination has not been established. METHODS: Twenty-six clinically stable patients with PAH (49.9±15.2 years) and 12 healthy subjects (control group, 44.7±13.5 years) had simultaneous PET/MRI scans. FDG uptake was quantified as mean standardised uptake value (SUV) for both left ventricle (LV) and RV. Mean follow-up time of this study was 14.2±7.3 months and the clinical end point was defined as death or clinical deterioration. RESULTS: Median SUVRV/SUVLV ratio was 1.02 (IQR 0.42-1.21) in PAH group and 0.16 (0.13-0.25) in controls, p<0.001. In PAH group, SUVRV/SUVLV significantly correlated with RV haemodynamic deterioration. In comparison to the stable ones, 12 patients who experienced clinical end point had significantly higher baseline SUVRV/SUVLV ratio (1.21 (IQR 0.87-1.95) vs 0.53 (0.24-1.08), p=0.01) and lower RV ejection fraction (RVEF) (37.9±5.2 vs 46.8±5.7, p=0.03). Cox regression revealed that SUVRV/SUVLV ratio was significantly associated with the time to clinical end point. Kaplan-Meier analysis showed that combination of RVEF from MRI and SUVRV/SUVLV assessment may help to predict prognosis. CONCLUSIONS: Increased RV glucose uptake in PET and decreased RVEF identify patients with PAH with worse prognosis. Combining parameters from PET and MRI may help to identify patients at higher risk who potentially benefit from therapy escalation, but this hypothesis requires prospective validation.

Cardiac magnetic resonance imaging in patients with Fabry's disease.

Fabry's disease (FD) is a rare hereditary disorder caused by the loss of alpha galactosidase A activity leading to accumulation of glycosphingolipids in various organs including hypertrophy of the heart. Most reports on cardiac involvement in FD focus on the left ventricular hypertrophy (LVH) and its relation to diastolic function. However, recent studies demonstrated large subset of patients with FD and right ventricle (RV) hypertophy. The accurate depiction of RV volumes, function and mass is possible with cardiovascular magnetic resonance (CMR). The CMR study can be also used to identify typically localised regions of intramyocardial fibrosis (infero-lateral segments of the LV), which have been shown to be a marker of inefficacious response to enzyme replacement therapy. We present series of 8 patients with genetically confirmed FD who underwent CMR study. We demonstrated a typical concentric and diffuse pattern of LVH with RV involvement in patients with the most severe LVH without significant impact on RV function and volumes. We showed that myocardial fibrosis can be observed not only in LV but also in RV. In 2 patients FD coexisted with symptomatic coronary artery disease with evidence of subendocardial myocardial fibrosis typical for ischaemic origin in one patient. The CMR confirmation of the presence of FD in one patient at an early stage of the disease, before the onset of advanced hypertrophy or failure of other organs, supports the value of this imaging technique in differential diagnosis of concentric and diffuse LVH.

Comparison between maximal left ventricular wall thickness and left ventricular mass in patients with hypertrophic cardiomyopathy.

BACKGROUND: Cardiovascular magnetic resonance enables accurate and reproducible assessment of left ventricular (LV) dimensions and function, free of geometric assumptions and limitations related to an inadequate acoustic window. In patients with hypertrophic cardiomyopathy (HCM), LV mass (LVM) and maximal LV wall thickness (MLVWT) have prognostic significance. AIM: To compare MLVWT and LVM in patients with HCM. METHODS: The study population included 33 patients with HCM (17 males, mean age 48.5 +/- 16.5 years). Subjects after alcohol septal ablation or surgical myectomy were excluded from the study. The MLVWT and LVM were measured with the use of cardiac magnetic resonance. The MLVWT was determined with the use of the dedicated software in short axis slices after manual definition of endocardial and epicardial contours. The LVM was indexed for body surface area and expressed in g/m(2). Cut-off values for normal, mildly increased and markedly increased LVM were based on previously published studies. RESULTS: Mean LVM in the whole study group was 107.4 +/- 30.9 g/m(2) (range 57.0-163.4 g/m(2)) and was higher in males than females (120.2 +/- 30.8 g/m(2) vs 93.8 +/- 25.3 g/m(2), respectively; p = 0.01). Mean MLVWT was 23.4 +/- 4.8 mm (range 16-36 mm). There was only a weak trend toward higher MLVWT in men when compared to women (24.8 +/- 5.4 mm vs 21.9 +/- 3.7 mm, respectively; p = 0.09). There was no correlation between LVM and MLVWT (r = 0.24; p = 0.17). A significant variability in LVM was observed in subjects with similar MLVWT; a greater than two-fold difference was noted in extreme cases. In three patients (9%; one female, two male) LVM was within the normal range and in another one female (3%) patient LVM was mildly increased. In the remaining patients (n = 29; 88%) markedly increased LVM was observed. CONCLUSIONS: The MLVWT does not reflect the degree of LV hypertrophy in patients with HCM. Patients with similar MLVWT may have substantial differences in LVM. A substantial group of patients with HCM is characterised by normal, or only mildly increased LVM, despite significant LV wall hypertrophy measured as MLVWT.

Neurosurgical treatment of drug-resistant epilepsy on the basis of a fusion of MRI and SPECT images - case report.

BACKGROUND: Epilepsy concerns at least 0.5% of population and in most of the cases (approx. 70%) can be treated pharmacologically, which helps to prevent seizures. In all other patients, such a treatment does not produce the desired results. Their condition may require neurosurgical management. The aim of this work was to fuse anatomical MRI images and functional SPECT images in patients with drug-resistant epilepsy, without structural changes on MRI or with changes so severe that it would be impossible to establish which ones are responsible for seizures. The authors presented a case of a child subjected to a neurosurgical procedure carried out on the basis of the fused MRI and SPECT images. CASE REPORT: A seven-year-old boy with an extensive defect of the right hemisphere (cortical dysplasia with multiple balloon-like cells) operated on three times due to a history of treatment-resistant seizures present since the age of one. A subsequent MRI examination was performed with magnetic field intensity of 1.5 T, within a routine epilepsy protocol applying volumetric thin-slice T1-weighted images. Next, in the interictal period, a SPECT examination was performed with the use of the (99m)Tc-labelled ethyl cysteinate dimer ((99m)TcECD). For fusion and postprocessing, the following software was used: PMOD (Biomedical Image Quantification PMOD Technologies) with PFUS (Flexible Image Matching and Fusion Tool) and a program for a quantitative analysis of counts in the region of interest, so called VOI Constructor (Volume of Interest Constructor). On the basis of the fusion of images, the boy was subjected to the next operation procedure. The remaining fragments of the right frontal and parietal lobe adjacent to the occipital lobe were removed. Seizure remission was obtained and it was already 31 months long when we were writing this article. CONCLUSIONS: Owing to this multi-stage procedure, it was possible to avoid a total anatomical and functional hemispherectomy. This allowed for a resection limited to regions indicated by integrated imaging. Removal of cortical areas including lesions was advantageous in this presented case, as it allowed for saving active regions of the brain.

Diagnostic performance of 18F-PSMA-1007 PET/CT in biochemically relapsed patients with prostate cancer with PSA levels ≤ 2.0 ng/ml.

BACKGROUND: The aim of the study was to prospectively evaluate diagnostic performance of 18F-PSMA-1007 PET/CT in patients with prostate cancer (PCa) after radical treatment and low but rising prostate-specific antigen (PSA) levels. METHODS: We prospectively enrolled 40 consecutive patients after radical treatment (80%-radical prostatectomy, 20%-radiation beam therapy) of PCa and low (0.008 to ≤2.0 ng/ml), rising PSA. Skull to mid-thigh PET/CT imaging was performed 95 (±12) min after injection of 295.5 (±14.1) MBq 18F-PSMA-1007. Detection rate was correlated with PSA levels, Gleason score (GS) and T stage ≥ 3. PET/CT results were verified during 10.3 (±4.7) months follow-up to calculate sensitivity, specificity, negative predictive values (NPV) and positive predictive values (PPV). RESULTS: 18F-PSMA-1007 PET/CT was positive in 24/40 patients, which yielded overall detection rate of 60%. Detection rate was 39%, 55% and 100% for PSA < 0.5, 0.5 to <1.0 and 1.0 to ≤2.0 ng/ml, respectively. PET/CT showed metastases in locoregional lymph nodes in 55% of patients, bones in 36% of patients and local recurrence in 9% of patients. Detection rate was correlated with PSA-a 0.1 ng/ml rise in PSA level increased odds for positive PET/CT by ~30%. PET/CT positivity was independent of GS and T stage. Verification of 40 lesions yielded sensitivity, specificity, PPV and NPV of 100%, 94.4%, 66.7% and 100%, respectively. CONCLUSIONS: 18F-PSMA-1007 PET/CT shows relatively high detection rate in patients with PCa after radical treatment and low, rising PSA levels. Like other PSMA-targeting radiotracers, its detection rate is dependent on PSA levels. 18F-PSMA-1007 also presents excellent sensitivity, specificity and NPV.

[Lipomatous hypertrophy of the interatrial septum]. / Tluszczakowaty przerost przegrody miedzyprzedsionkowej.

Management of cardiac tumours depends mainly on their localisation and histological type. Cardiac magnetic resonance (CMR) imaging is a robust technique in diagnosis of cardiac tumors. It enables precise localisation of a mass and its tissue characteristics. We present a case of a lipomatous hypertrophy of the interatrial septum diagnosed by CMR.

Left ventricular diastolic function assessed with cardiovascular magnetic resonance imaging and exercise capacity in patients with non-obstructive hypertrophic cardiomyopathy.

BACKGROUND: In patients with non-obstructive hypertrophic cardiomyopathy (HCM) and preserved left ventricular (LV) systolic function, diastolic dysfunction is one of the major factors contributing to limited exercise capacity. Cardiovascular magnetic resonance (CMR) imaging has become a useful tool in diagnosis, risk stratification and treatment monitoring in patients with HCM. AIM: To assess the relationship between simple CMR parameters of LV diastolic function at rest and exercise capacity measured by means of cardiopulmonary exercise testing on a treadmill in patients with non-obstructive HCM and preserved LV systolic function. METHODS: The study included 13 patients with non-obstructive HCM and preserved LV systolic function who underwent cardiopulmonary exercise testing on a treadmill and CMR within 1 month. Analysed parameters of diastolic function included: LV mass index (LVMI), peak filling rate normalised to LV stroke volume index (PFR/LVSVI) and time from the end-systole to PFR normalised to heart rhythm (TPFR). RESULTS: There was a significant correlation between PFR/LVSVI at rest and peak oxygen uptake (V02peak) (r=0.64, p=0.02). Patients with V02peak below median (<30 ml/kg/min) had a significantly lower PFR/LVSVI than patients with higher V02peak [5.12 m2/s, interquartile range (IQR) 4.16-6.82 vs. 7.93 m2/s, IQR 7.49-8.21 respectively, p=0.035]. LVMI, TPFR were not related to exercise capacity. There was also no correlation between V02peak and age (r=-0.38, p=0.19), LV ejection fraction (r=-0.36, p=0.22) or normalised LV volume indices: LVEDVI (r=0.09, p=0.76), LVESVI (r=0.34, p=0.26). CONCLUSIONS: Assessment of LV diastolic function by peak filling rate normalised to stroke volume index by means of CMR at rest in patients with non-obstructive HCM and preserved LV systolic function is a useful marker of exercise capacity.

[Non-surgical, transcatheter pulmonary valve implantation - first experience]. / Nieoperacyjne wszczepienie zastawki plucnej - pierwsze doswiadczenia.

Transcatheter valve replacement has recently been introduced into clinical practice. We present our first experience with non-surgical, transcatheter pulmonary valve implantation in four patients (age 27-31 years, three females) with repaired congenital heart disease who required reintervention to the right ventricular outflow tract due to dysfunction of valve homograft. The Medtronic Melody Transcatheter Pulmonary Valve was successfully implanted in all four patients without complications, releasing the outflow obstruction, and normal function of the biological valve.

[Typical magnetic resonance features of cardiac fibroma--a case report]. / Typowy obraz wlókniaka serca w badaniu rezonansu magnetycznego--opis przypadku.

Cardiac tumors are rare. Magnetic resonance allows non-invasive, detailed evaluation of myocardial tissue and differential diagnosis. We present a case of a young man with unexplained cardiac mass and typical magnetic resonance features of a left ventricular fibroma.

[POL-PAVTI--Polish report on transcatheter pulmonary artery valve implantation of Melody-Medtronic prosthesis in the first 14 patients in Poland]. / Ogólnopolski raport POL-PAVTI z nieoperacyjnego wszczepienia biologicznej zastawki plucnej Melody-Medtronic u pierwszych w Polsce 14 chorych.

AIM: To assess the early results of the pulmonary artery valve transcatheter implantation (PAVTI) in pts included into POL-PAVTI registry. Detailed medical and economic analyses were performed. METHODS: Pulmonary artery valve implantation was performed in 14 pts (9 men), aged 16-31 (mean 24.6 +/- 4.8) years, with pulmonary homograft dysfunction after total repair of tetralogy of Fallot (4 pts), pulmonary atresia (2 pts), pulmonary stenosis (1 pt), common arterial trunk type I (1 pt), Ross procedure (3 pts) and TGA - Rastelli operation (3 pts). Eleven pts underwent in the past 2-5 surgical or/and catheter interventions. Indication for PAVTI was based on clinical evaluation and echocardiographic studies. Assessment of morphological and functional features of the right ventricle (RV) and homograft with the use of cardiac magnetic resonance (CMR) was performed in 10 cases. Pulmonary stenosis (max. pulmonary gradient 32-119, mean 72 +/- 28 mmHg) was observed in 13 pts and/or significant pulmonary regurgitation in 10 pts. The procedure was performed in general anesthesia. The deployment of a valved stent in the pulmonary valve position was preceded by a metal stent implantation. Results were evaluated by echocardiography two days after the procedure and one month later. Four patients were evaluated 6 months after procedure. RESULTS: Time of the procedure varied 60-190 (mean 127 +/- 35) min, time of fluoroscopy ranged 12-31 (mean 21 +/- 11) min. PAVTI was successfully performed in all pts without serious complications. Patients were discharged from the hospital 48-293 (mean 120 +/- 71) h after procedure. Significant reduction of pulmonary gradient after the procedure assessed by echocardiography was observed on the second day (20-60, mean 38 +/- 12 mmHg, p < 0.0001) and one month (19-52, mean 34 +/- 9 mmHg, p < 0.0001). Mild pulmonary regurgitation was observed in 2 pts. In 5 pts evaluated 6 months after procedure haemodynamic parameters were unchanged; no late complications were observed. Average cost of the procedure including a price of the valve (82 000 PLN) was 98 000 PLN. CONCLUSIONS: Pulmonary artery valve transvascular implantation is an effective and safe method of non-surgical treatment for patients with homograft dysfunction. Cost-effectiveness is approvable.

18F-Prostate-Specific Membrane Antigen 1007 and 18F-FCH PET/CT in Local Recurrence of Prostate Cancer.

F-prostate-specific membrane antigen (PSMA) 1007 is one of the most promising radiotracers for PET imaging of relapsing prostate cancer. Minimal urinary clearance seems to be its most valuable and outstanding feature. We present images of biochemically relapsed prostate cancer where F-PSMA-1007 PET/CT (performed to verify an ambiguous finding adjacent to the urinary bladder found in F-FCH PET/CT) proved superior to radiocholine and precisely visualized site of local recurrence.

Head-to-Head Comparison of 18F-Prostate-Specific Membrane Antigen-1007 and 18F-Fluorocholine PET/CT in Biochemically Relapsed Prostate Cancer.

PURPOSE OF THE REPORT: The aim of the study was to prospectively compare performance of F-fluorocholine (FCH) and F-prostate-specific membrane antigen (PSMA)-1007 PET/CT in patients with biochemical relapse (BCR) of prostate cancer and low prostate-specific antigen levels. METHODS: We prospectively enrolled 40 BCR patients after radical treatment and prostate-specific antigen levels 2.0 ng/mL or less. F-FCH and F-PSMA-1007 PET/CT imaging was performed within a mean interval of 54 ± 21 days. Scans were done 87 ± 10 and 95 ± 12 minutes after injecting 248 ± 35 and 295 ± 14 MBq of F-FCH and F-PSMA-1007, respectively. Rates of negative, equivocal, and positive scan results were compared per patient. Per lesion, findings were grouped as equivocal or highly suggestive of malignancy and then compared for their number, localization (local relapse, lymph nodes, bones), and SUVmax values. RESULTS: Positive, equivocal, and negative results were reported in 60%, 27.5%, and 12.5% of F-PSMA-1007 and in 5%, 37.5%, and 57.5% of F-FCH scans, respectively. In 70% of scans, F-PSMA-1007 PET/CT upgraded F-FCH PET/CT results. F-PSMA-1007 scans also showed significantly more lesions (184 vs 63, P = 0.0006). Local relapse, lymph node, and bone lesions accounted, respectively, for 9%, 58%, and 33% of F-PSMA-1007 and 5%, 89%, and 6% F-FCH of PET/CT findings. Highly suspicious lesions accounted for 74% of F-PSMA-1007 and 11% of F-FCH PET/CT findings. In F-PSMA-1007 PET/CT SUVmax values of highly suggestive lesions were significantly higher than in equivocal lesions (median, 3.6 vs 2.5; P < 0.00001). CONCLUSIONS: In early BCR patients F-PSMA-1007 showed a higher detection rate than F-FCH PET/CT. The former also showed more lesions in total, more highly suggestive lesions and less equivocal lesions.