The importance of cardiac magnetic resonance imaging in the diagnosis of myocarditis--a case report.

The authors describe the case of a 16-year-old male, who went to the emergency department with a clinical setting characterized by chest pain, electrocardiographic pattern of inferoposterior acute myocardial infarction and elevated markers of myocardial necrosis. Cardiac catheterization revealed no significant coronary lesions and the transthoracic echocardiogram showed no segmental abnormalities. Myocarditis was suspected, and this diagnosis was confirmed by magnetic resonance imaging. This case demonstrates the difficulty of establishing a definitive diagnosis of myocarditis and the increasing importance of cardiac magnetic resonance imaging in this area.

Five cases of transient left ventricular apical ballooning--the experience of a Portuguese center.

Transient left ventricular apical dyskinesia (apical ballooning syndrome, ABS) is characterized by transient alterations in regional wall motion, involving the mid and apical segments of the left ventricle, as well as electrocardiographic alterations, mimicking ST-elevation acute myocardial infarction, in the absence of obstructive disease of the epicardial coronary arteries. In this article, we present a series of five cases of ABS and a theoretical review of the syndrome.

Early flow propagation velocity for assessment of diastolic function in myocardial infarction treated with acute reperfusion.

INTRODUCTION: Acute myocardial infarction (MI) causes left ventricular (LV) diastolic dysfunction, which influences prognosis and clinical evolution. Early flow propagation velocity (FPV), evaluated by color M-mode Doppler, has been demonstrated to be a diastolic function parameter with excellent correlation with relaxation constant tau, and is relatively independent of pre- and afterload. OBJECTIVE: The aim of this study was to evaluate left ventricular relaxation in MI patients treated with acute reperfusion therapy. METHODS: Patients with ST-elevation MI treated with reperfusion therapy were evaluated by echocardiagraphy in the first 48 hours and after one week. The parameters studied were: early peak filling velocity (E), late peak filling velocity (A), E/A ratio, E-wave deceleration time (EDT), isovolumic relaxation time (IVRT) and FPV. The values obtained at the first and second evaluation were compared; we evaluated the relation between pain-to-reperfusion time (PRT; < or =3 hours vs. >3 hours) and the presence of single-vessel or multivessel disease with the parameters previously mentioned. RESULTS: 40 patients were studied and 19 included, 15 (80%) male, mean age 57+/-14 The most prevalent risk factors were: hypertension (11 patients - 58%), smoking (14 - 74%), diabetes (6 - 30%), and dyslipidemia (12 - 63%). MI location was anterior in six patients (31%) and inferior in 13 (69%). Five patients (26%) underwent fibrinolysis and 14 (74%) direct percutaneous coronary intervention. Mean pain-to-reperfusion time was 3.7+/-2.8 hours. Four patients (21%) had single-vessel disease and 14 (74%) had multivessel disease. Near significance was found for the difference in the E/A ratio between the two evaluations and a significant difference in the FPV. A significant correlation was also found between PRT and E/A ratio at the two evaluations (p=0.003, p=0.05), and between PRT and IVRT after one week (p=0.011). E/A ratio, IVRT and FPV were normal at the two evaluations in patients who had undergone earlier reperfusion therapy. No significance was found between the number of diseased vessels and the parameters of diastolic function assessed. DISCUSSION AND CONCLUSIONS: In the early phase of M1 treated with acute reperfusion, a delayed relaxation pattern was observed, which evolved to a normal pattern by the second evaluation, as statistically confirmed by FPV. Earlier reperfusion therapy preserves diastolic function. FPV is a sensitive and independent parameter for assessment of diastolic function in MI patients treated with acute reperfusion therapy.

Evaluation of systolic and systo-diastolic function: the Tei index in acute myocardial infarction treated with acute reperfusion therapy--early and late evaluation.

INTRODUCTION: Evaluation of systolic and diastolic function by non-invasive methods in the acute phase of myocardial infarction (MI) is of great importance for risk stratification and prognosis. Ejection fraction (EF), as determined by echocardiography using the Simpson method, is the main parameter for assessing left ventricular (LV) function. The Tei index (TI), a Doppler-derived index that reflects systolic and diastolic function in MI, has an excellent correlation with prognosis. OBJECTIVE: The purpose of this study was to evaluate systolic and systo-diastolic function in the acute and late phase of ST-elevation MI treated with acute reperfusion therapy. METHODS: Patients with ST-elevation MI who underwent acute reperfusion therapy were evaluated by echocardiography in the first 48 hours and after one week. The parameters studied were: EF, wall motion score index (WMSI), and TI. The values obtained at the first and second evaluation were compared and correlated with pain to reperfusion time (PRT) (<3 vs. > or =3 hours), presence of single or multivessel disease, ejection fraction, total CK (<1500 or > or =1500 UI/l), and MI location (anterior vs. other). RESULTS: 40 patients were studied and 19 were included, of whom 15 (80%) were male, mean age 57 +/- 14 years. Risk factors included hypertension (11 patients, 58%), smoking (14, 74%), diabetes (6, 30%), and dyslipidemia (12, 63%). MI location was anterior in 6 patients (32%) and inferior in 13 (68%). Five patients (26%) underwent fibrinolysis and 14 (74%) direct percutaneous coronary intervention. Mean pain to reperfusion time was 3.7 +/- 2.8 hours. Four patients (21%) had single vessel disease and 14 (74%) multivessel disease. Significant differences were found: (a) in mean EF and WMSI between the two evaluations (p < 0.0001 and p = 0.002 respectively); (b) between PRT and EF (p = 0.001) and WMSI (p = 0.020) at 48 hours; (c) between PRT and EF (p = 0.01) and TI (p = 0.033), and MI location and EF (p = 0.005) after one week. DISCUSSION AND CONCLUSIONS: Early systolic function and LV remodeling one week after MI were accurately evaluated by EF and WMSI. Early reperfusion therapy positively influences early and late systolic and systo-diastolic function.

Suspected dysfunction of a Starr-Edwards aortic prosthesis implanted 33 years ago: the role of exercise stress echocardiography. Case report.

The authors present a case report of suspected dysfunction of a Starr-Edwards mechanical aortic prosthesis implanted in 1972. Its characteristic longevity, but also its disadvantageous hemodynamic profile, are discussed. Treadmill exercise echocardiography, whose role has yet to be clarified in the study of valve prosthesis, was used in the evaluation of the patient.

Myocardial infarction in a patient with congenital coronary anomaly.

The authors describe the clinical case of a 38-year-old patient, with a history of smoking and hypercholesterolemia, who was admitted for non-Q wave acute myocardial infarction, and in whom coronary angiography revealed severe coronary disease and a congenital coronary anomaly. Unlike many congenital coronary anomalies that are manifested in ischemic disease, the nature of this patient's anomaly may have contributed to its benign clinical evolution, and influenced the therapeutic approach.

Valve orifice area in aortic stenosis evaluated by planimetry, Gorlin and continuity equations: a prospective study.

UNLABELLED: In evaluation of the severity of aortic valve stenosis, multiple parameters can be determined. All of them, except valve orifice area, are influenced by other factors such as cardiac output, heart rate or aortic insufficiency. OBJECTIVES: This is a prospective study which proposes, in the determination of the valve orifice area in aortic stenosis, to evaluate the accuracy of and correlation between three methods--planimetry by multiplane transesophageal echocardiography, the continuity equation by transthoracic echocardiography, and invasive measurement using the Gorlin formula. METHODS: Forty-five patients with known calcified valvular aortic stenosis 27 men, mean age 70 +/- 10 years, (range 27-82), were studied. In all patients the area was determined by planimetry and by the continuity equation. In 25 (56%) patients invasive measurements were obtained using the Gorlin formula. RESULTS: Evaluation of the valve orifice area by planimetry was easily performed and did not prolong the duration of the exam, except in five patients (11%). The area determined by the continuity equation had a mean value of 0.74 +/- 0.25 cm2, by planimetry 0.74 +/- 0.24 cm2 and by the Gorlin formula 0.65 +/- 0.17 cm2. Correlations between areas obtained by the three methods used were: continuity equation and planimetry 0.82; continuity equation and Gorlin formula 0.51; and planimetry and Gorlin formula 0.80. Concordance analysis (Bland and Altman's method) gave mean (Mn) values for the differences in the areas determined by the Gorlin formula and the continuity equation of 0.01 +/- 0.15 cm2 (Mn - 2SD = -0.29, Mn + 2SD = 0.30). The estimated value by the Gorlin formula and planimetry was 0.02 +/- 0.10 (Mn - 2SD = -0.19, Mn + 2SD = 0.23). CONCLUSIONS: 1) Planimetry of the valve orifice area by transesophageal echocardiography is feasible and does not prolong the duration of the exam in the majority of patients. 2) The strong correlation and the results of concordance analysis, in the determination of valve orifice area, between traditional invasive methods and planimetry, support the use of this noninvasive method in clinical practice.