Global longitudinal strain (GLS) continued to be the area of major interest, and a substantial body of evidence shows its superiority over traditional measures like ejection fraction (EF). There ...might be opportunity in form of aggressive management of traditional risk factors in patients treated for childhood cancers (8) or beta-blocker use in adult chemotherapy-related toxicity (9). ...exploiting the synergy between cardiac magnetic resonance (CMR) and echo for evaluating the interstitium is starting to reveal insights into discriminating various forms of HFpEF (23)—GLS and extracellular volume can separate HFpEF from hypertensive heart disease, with the latter being more effective. A large prospective study looking at patients presenting with an acute ischemic stroke found that LV remodeling influenced the relationship between blood pressure and outcome—those with altered LV geometry had a reverse J-shaped relationship, but those without abnormal geometry did not (27).Valvular Heart Disease The natural history of valve disease progression is important if we are to intervene at the right time, and some populations might progress differently and might need a preponed interventional strategy.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Cardiac computed tomography angiography (CTA) is now a frontline investigation, and the last couple of years have seen a plethora of high-quality original research papers. The JACC family of journals ...has been fortunate to host some of the best papers in this field. We summarize our favorite original research papers across the various JACC Journals.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
...17), the mechanics of right ventricular dysfunction in nonischemic cardiomyopathy was clarified as due to both LV dysfunction and increased afterload; right ventricular ejection fraction predicted ...cardiac mortality independent of established risk factors and LV ejection fraction. Predicting contractile recovery after myocardial infarction (MI) was of major interest. Since acute injury is a mix of damaged and dead myocardium, infarct ECV (a continuous measure of myocardial injury) might be better than scar alone. ...a novel fully automated system for quantifying MBF in near real-time from routine CMR perfusion images discriminated regional perfusion variations with high diagnostic accuracy in coronary artery disease (CAD) (25). A large study found that coronary flow reserve (CFR) from coronary sinus flow predicted risk of major adverse cardiovascular events (MACE) even after adjustment for ischemia extent, LGE, and ejection fraction (26). Since a negative stress CMR has good prognosis, there might be a subset within these patients (negative for ischemia or scar but positive for reduced CFR) that needs closer follow up and aggressive risk factor management.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Cardiovascular magnetic resonance provides insights into myocardial structure and function noninvasively, with high diagnostic accuracy and without ionizing radiation. Myocardial tissue ...characterization in particular gives cardiovascular magnetic resonance a prime role among all the noninvasive cardiovascular investigations. Late gadolinium enhancement imaging is an established method for visualizing replacement scar, providing diagnostic and prognostic information in a variety of cardiac conditions. Late gadolinium enhancement, however, relies on the regional segregation of tissue characteristics to generate the imaging contrast. Thus, myocardial pathology that is diffuse in nature and affecting the myocardium in a rather uniform and global distribution is not well visualized with late gadolinium enhancement. Examples include diffuse myocardial inflammation, fibrosis, hypertrophy, and infiltration. T1 mapping is a novel technique allowing to diagnose these diffuse conditions by measurement of T1 values, which directly correspond to variation in intrinsic myocardial tissue properties. In addition to providing clinically meaningful indices, T1-mapping measurements also allow for an estimation of extracellular space by calculation of extracellular volume fraction. Multiple lines of evidence suggest a central role for T1 mapping in detection of diffuse myocardial disease in early disease stages and complements late gadolinium enhancement in visualization of the regional changes in common advanced myocardial disease. As a quantifiable measure, it may allow grading of disease activity, monitoring progress, and guiding treatment, potentially as a fast contrast-free clinical application. We present an overview of clinically relevant technical aspects of acquisition and processing, and the current state of art and evidence, supporting its clinical use.
Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside ...examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.
PDF
