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1.  The role of renin angiotensin system antagonists in the prevention of doxorubicin and trastuzumab induced cardiotoxicity 
Background
Cardio-Oncology is an evolving discipline that focuses on the management of cancer patients who develop cardiovascular complications as a result of their treatment. Although the current combination of surgical resection, radiation, and chemotherapy may lead to a cure in cancer patients, the administration of anti-cancer drugs, in particular Doxorubicin (DOX) and Trastuzumab (TRZ), is associated with an increased risk of cardiotoxicity. Little is known on the potential cardioprotective role of renin angiotensin system (RAS) antagonists in the prevention of DOX+TRZ mediated cardiotoxicity.
Objective
The aim of the study was to determine whether RAS antagonists would be useful in attenuating DOX+TRZ induced cardiotoxicity.
Methods
A total of 240 C57Bl/6 mice were randomized to prophylactic treatment with placebo, Aliskiren, Perindopril, or Valsartan for a total of 13 weeks. Within each arm, mice received treatment with either DOX, TRZ, or the combination of both drugs. Serial murine echocardiography was performed weekly to characterize the degree of cardiovascular remodeling within each group.
Results
In wild-type (WT) mice treated with DOX+TRZ, LV end diastolic internal diameter (LVID) increased from 3.1 ± 0.2 mm at baseline to 4.6 ± 0.3 mm at week 13 (p < 0.05) and the LV fractional shortening (FS) decreased from 52 ± 2% at baseline to 26 ± 2% at week 13 (p < 0.05). Prophylactic treatment with Aliskiren, Perindopril, or Valsartan attenuated the degree of LV cavity dilatation with LVID dimensions of 3.9 ± 0.2 mm, 4.1 ± 0.2 mm, and 4.2 ± 0.1 mm at week 13, respectively (p < 0.05). Similarly, prophylactic treatment with Aliskiren, Perindopril, or Valsartan was partially cardioprotective with FS of 40 ± 1%, 32 ± 1%, and 33 ± 2% at week 13, respectively (p < 0.05). As compared to WT mice receiving DOX+TRZ, prophylactic treatment with RAS inhibition was also associated with improved survival, corroborating the echocardiographic findings.
Conclusion
The cardiotoxic effects of DOX+TRZ were partially attenuated by the prophylactic administration of RAS antagonists in a chronic murine model of chemotherapy induced cardiac dysfunction.
doi:10.1186/s12947-015-0011-x
PMCID: PMC4393607  PMID: 25889218
Cardio-Oncology; Doxorubicin; Trastuzumab; RAS antagonists; Murine echocardiography
2.  The utility of pocket-sized echocardiography to assess left ventricular systolic function prior to permanent pacemaker implantation 
Background
A subset of patients receiving first-time permanent pacemakers (PPM) may also benefit from an implantable cardioverter defibrillator (ICD) based on the presence of left ventricular systolic dysfunction (LVSD). Routine screening using pocket-sized echocardiography (PSE) may be useful in identifying such patients.
Objective
To determine whether PSE can be used by an inexperienced sonographer to adequately screen for LVSD in a patient population receiving a first-time PPM.
Methods
A sonographic trainee (medical student) acquired images using PSE, which were then evaluated by an experienced echocardiologist for both image quality and presence of LVSD. The sensitivity and specificity of assessment by the inexperienced sonographer was compared to the level 3 echocardiologist.
Results
The patient population included 71 individuals (66% male, mean age 77 ± 12 years). Interpretable images where left ventricular ejection fraction (LVEF) could be adequately assessed were obtained in 93% of the patient population. As compared with the echocardiologist, the sonographic trainee had a sensitivity of 60% and a specificity of 98% in detecting LVSD.
Conclusions
For patients receiving first-time PPM, the use of PSE by a sonographic trainee combined with interpretation by an experienced imaging cardiologist can triage for the need to perform standard transthoracic echocardiography (sTTE) by determining the presence of LVSD.
doi:10.1186/s12947-015-0004-9
PMCID: PMC4369064  PMID: 25888874
Permanent pacemaker; Pocket-sized echo (PSE)
3.  Multimodality cardiac imaging of a left ventricular thrombus: a case report 
BMC Research Notes  2015;8:59.
Background
Left ventricular thrombus (LVT) formation occasionally complicates patient recovery post myocardial infarction, conveying a significant risk of systemic embolism. Accordingly, thrombus detection and subsequent anticoagulation is imperative in order to minimize patient morbidity and mortality. Transthoracic echocardiography (TTE) is the imaging modality most widely used to screen for thrombus formation despite its suboptimal sensitivity and specificity.
Case presentation
This report describes the discordant imaging findings of a LVT in a 56 year old Caucasian male with an anterior ST elevation myocardial infarction. Left ventriculography revealed a filling defect, suggestive of a potential left ventricular (LV) thrombus, which could not be confirmed by TTE. Cardiac magnetic resonance imaging (MRI) demonstrated evidence of a full thickness scar involving the mid to distal anterior wall and apical regions, with confirmation of a small LV apical thrombus.
Conclusions
This case illustrates the limitations of TTE when used as a tool to screen for thrombus formation. It highlights the importance of multimodality cardiac imaging for the detection of post myocardial infarction (MI) complications, in the context of a high clinical suspicion.
doi:10.1186/s13104-015-1024-0
PMCID: PMC4350915  PMID: 25889319
Ventriculography; Cardiac MRI; Transthoracic echocardiography; Left ventricular thrombus
4.  Right ventricular free wall dyskinesis in the setting of left ventricular non compaction: a case report 
BMC Research Notes  2014;7:787.
Background
Left ventricular non compaction is a relatively rare congenital disorder characterized by prominent trabeculations and intertrabecular recesses with the potential for thromboembolism, arrhythmias, and sudden cardiac death as adverse effects. Echocardiography has traditionally been employed as the primary mode of imaging; however, with the advent of cardiac magnetic resonance as a more precise imaging technique, the disorder known as left ventricle non compaction is becoming more broadly defined with increasing recognition of right ventricle (RV) involvement.
Case presentation
This report describes a 52-year-old Caucasian female with new onset atrial fibrillation with an unusual finding of left ventricular non compaction and right ventricular dysfunction on transthoracic echocardiogram with preserved left ventricular ejection fraction. Cardiac magnetic resonance imaging demonstrated a disproportionately affected right ventricle, with apical free wall dyskinesis.
Conclusions
This case illustrates the unique occurrence of left ventricular non compaction with preserved ejection fraction alongside RV free wall dyskinesis and RV systolic dysfunction. The significance of this is yet unknown given the paucity of existing literature. This report serves to highlight the vast heterogeneity within left ventricular non compaction as we are better able to delineate this disorder using increasingly sophisticated imaging techniques.
doi:10.1186/1756-0500-7-787
PMCID: PMC4233058  PMID: 25374312
Left ventricular non compaction; Multi-modality cardiac imaging
5.  Successful cardiac resuscitation with extracorporeal membrane oxygenation in the setting of persistent ventricular fibrillation: a case report 
BMC Research Notes  2014;7:782.
Background
Extracorporeal membrane oxygenation (ECMO) technology is a viable option for short-term support in the setting of acute cardiac ischemia. To supplement cardiopulmonary resuscitation (CPR) in select patients, ECMO is used successfully for witnessed in hospital cardiac arrest. In the setting of an acute myocardial infarction (MI), bridging to a revascularization procedure is important in improving overall survival.
Case presentation
We describe the first known case of a 56-year-old Caucasian male with an anterior ST elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention (PCI) in which the entire procedure was carried out with the patient being in persistent ventricular fibrillation (VF) resistant to defibrillation on ECMO support. Subsequent to revascularization, the patient’s cardiac rhythm converted back to sinus rhythm with a single defibrillation shock with excellent neurologic recovery.
Conclusion
Our case highlights the importance of early initiation of ECMO during PCI in achieving both improved cardiac and neurological outcomes during an acute coronary syndrome (ACS).
doi:10.1186/1756-0500-7-782
PMCID: PMC4236475  PMID: 25371096
ECMO; Resuscitation; Percutaneous coronary intervention; Arrhythmia
6.  Cardiovascular remodeling during long-term nocturnal home hemodialysis 
Background
Cardiovascular disease is the leading cause of morbidity and mortality in patients with kidney failure. Nocturnal home hemodialysis (NHD) is a form of kidney replacement therapy whereby hemodialysis is performed for at least 6-h overnight, at least 4 days per week. Little is known about the effects of NHD on cardiovascular remodeling as assessed by transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMR).
Objectives
The primary objective of the study was to determine the long-term effects of NHD on cardiovascular remodeling using different imaging modalities over a one-year follow-up.
Methods and results
A total of 11 patients were included in the study (6 males, mean age 48 ± 16 years) between 2009 and 2011 inclusive at a single tertiary care center. All patients underwent TTE and CMR at baseline and after 1 year of NHD. Left ventricular mass index decreased significantly at 1 year by both TTE (152 ± 7–129 ± 8 g/m2, p < 0.05) and CMR (162 ± 4–124 ± 4 g/m2, p < 0.05). There was also a significant decrease in both left and right atrial volume as well as in right ventricular mass index over 1 year of follow-up. Diastolic dysfunction, graded from 0 to 4, improved from a baseline grade of 3.4 to 1.2 at 1-year follow-up.
Conclusions
Long-term nocturnal hemodialysis leads to favorable cardiovascular remodeling with a reduction in cavity dimensions, regression of left ventricular hypertrophy, and an improvement in diastolic function, as assessed by both TTE and CMR.
doi:10.1007/s10157-014-0992-z
PMCID: PMC4469297  PMID: 24894700
Home hemodialysis; High dose hemodialysis; Left ventricular hypertrophy; Cardiac imaging
7.  The Utility of Cardiovascular Magnetic Resonance in Constrictive Pericardial Disease 
Cardiology in review  2009;17(2):77-82.
Cardiovascular magnetic resonance (CMR) has a high diagnostic accuracy for constrictive pericarditis (CP). CMR allows for high-resolution imaging of the pericardium and associated structures in any imaging plane compared with that provided by other imaging modalities. We briefly discuss the specific quantitative and qualitative CMR sequences that can be tailored to answer the clinical questions pertaining to CP, where the diagnostic yield has been proven when characteristic CMR features of CP are present. Such features allow for differentiation of CP from restrictive cardiomyopathy, where the clinical differentiation between the 2 can often be challenging.
doi:10.1097/CRD.0b013e318197e950
PMCID: PMC3955034  PMID: 19367149
constrictive pericarditis; restrictive cardiomyopathy; cardiovascular magnetic resonance; pericardium
8.  Cardiovascular magnetic resonance in pregnancy: Insights from the cardiac hemodynamic imaging and remodeling in pregnancy (CHIRP) study 
Background
Cardiovascular disease in pregnancy is the leading cause of maternal mortality in North America. Although transthoracic echocardiography (TTE) is the most widely used imaging modality for the assessment of cardiovascular function during pregnancy, little is known on the role of cardiovascular magnetic resonance (CMR). The objective of the Cardiac Hemodynamic Imaging and Remodeling in Pregnancy (CHIRP) study was to compare TTE and CMR in the non-invasive assessment of maternal cardiac remodeling during the peripartum period.
Methods
Between 2010–2012, healthy pregnant women aged 18 to 35 years were prospectively enrolled. All women underwent TTE and CMR during the third trimester and at least 3 months postpartum (surrogate for non-pregnant state).
Results
The study population included a total of 34 women (mean age 29 ± 3 years). During the third trimester, TTE and CMR demonstrated an increase in left ventricular end-diastolic volume from 95 ± 11 mL to 115 ± 14 mL and 98 ± 6 mL to 125 ± 5 mL, respectively (p < 0.05). By TTE and CMR, there was also an increase in left ventricular (LV) mass during pregnancy from 111 ± 10 g to 163 ± 11 g and 121 ± 5 g to 179 ± 5 g, respectively (p < 0.05). Although there was good correlation between both imaging modalities for LV mass, stroke volume, and cardiac output, the values were consistently underestimated by TTE.
Conclusion
This CMR study provides reference values for cardiac indices during normal pregnancy and the postpartum state.
doi:10.1186/1532-429X-16-1
PMCID: PMC3882291  PMID: 24387349
Pregnancy; Cardiovascular magnetic resonance; Cardiovascular remodeling; Transthoracic echocardiography
9.  Eosinophilic myocarditis: two case reports and review of the literature 
BMC Research Notes  2013;6:538.
Background
Eosinophilic myocarditis is a rare and often under-diagnosed subtype of myocarditis with only around 30 cases published in the medical literature. In this article we present two patients with eosinophilic myocarditis with the aim to demonstrate the often elusive nature of the disease and present the current scientific literature on this topic.
Case presentation
A 76 years old Caucasian gentleman and a 36 years old Aboriginal gentleman both presenting with heart failure symptoms were eventually diagnosed with eosinophilic myocarditis after extensive evaluation. Their presentation, assessment, and medical management is explored in this article.
Conclusions
Eosinophilic myocarditis remains a rare and likely under-diagnosed subtype of myocarditis. The key features of this disease include myocardial injury in the setting of non-contributory coronary artery disease. Endomyocardial biopsy remains the definitive gold standard for diagnosis of noninfectious eosinophilic myocarditis. Non-invasive cardiac imaging in the setting of peripheral eosinophilia can be strongly suggestive of eosinophilic myocarditis with potential for earlier diagnosis. Failure to diagnose eosinophilic myocarditis and the delay of therapy may lead to irreversible myocardial injury. Therapies for this disease have yet to be validated in large prospective studies.
doi:10.1186/1756-0500-6-538
PMCID: PMC3878496  PMID: 24344829
Eosinophilia; Myocarditis; Endomyocardial; Biopsy
10.  Spontaneous dissection of the coronary and vertebral arteries post-partum: case report and review of the literature 
Background
Spontaneous coronary and vertebral artery dissections are rare events occurring most commonly in otherwise healthy women during pregnancy or the post-partum period.
Case presentation
This report describes a 35-year-old female who presented with an acute inferior ST elevation myocardial infarction 7 months post-partum secondary to spontaneous dissection of the left obtuse marginal coronary artery. Despite appropriate medical therapy with dual anti-platelet therapy, the patient presented four weeks later with a spontaneous dissection of the right vertebral artery.
Conclusion
We review the presentation, diagnosis, and management of spontaneous dissections of the vasculature in the peri-partum period.
doi:10.1186/1471-2393-12-122
PMCID: PMC3495043  PMID: 23121892
Spontaneous dissection; Vasculature; Pregnancy; Imaging
11.  Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report 
BMC Research Notes  2012;5:583.
Background
Ventricular septal rupture (VSR), a mechanical complication following an acute myocardial infarction (MI), is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE) with color flow Doppler and cardiac MRI (CMR) are reliable tests for the non-invasive diagnosis of VSR.
Case presentation
A 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography.
Conclusion
We review the presentation, diagnosis and management of VSR post MI.
doi:10.1186/1756-0500-5-583
PMCID: PMC3505164  PMID: 23098382
Echocardiography; Cardiac Mri; Ventricular septal rupture
12.  Vanishing left ventricular thrombus in a woman with peripartum cardiomyopathy: a case report 
BMC Research Notes  2012;5:544.
Background
Peripartum cardiomyopathy (PPCM) is a rare cardiac disorder characterized by the development of heart failure in the last month of pregnancy or up to 5 months postpartum in women without other identifiable causes of cardiac failure. The combination of left ventricular (LV) systolic dysfunction and hypercoaguability can cause thromboembolic complications including intra-cardiac thrombi.
Case presentation
A 25-year-old Caucasian female with PPCM demonstrated multiple thrombi in the LV on transthoracic echocardiography. Following anticoagulation with parenteral heparin, a cardiac MRI four days later demonstrated near resolution of the thrombi.
Conclusion
We review the presentation, diagnosis and management of LV thrombi in the clinical setting of PPCM.
doi:10.1186/1756-0500-5-544
PMCID: PMC3551696  PMID: 23031314
Peripartum cardiomyopathy; Multimodality cardiac imaging; Thrombus
13.  Multimodality cardiac imaging of a double chambered right ventricle with intrapulmonary shunting: a case report 
BMC Research Notes  2012;5:516.
Background
Double chambered right ventricle (DCRV) is a relatively rare congenital heart disease, characterized by the abnormal division of the right ventricle into a high-pressure inlet and low-pressure outlet by anomalous muscle bundles. Extra-cardiac right-to-left shunts may present with clinical symptoms in adulthood and should be sought in patients with previous cavo-pulmonary shunt procedures.
Case presentation
We report a case of DCRV in a 29 year old Caucasian male presenting in adulthood with a right-to-left shunt secondary to venous collaterals, following cavopulmonary anastomosis for congenital pulmonary atresia and hypoplastic right ventricle.
Conclusion
Multimodality cardiac imaging using echocardiography, cardiac CT, cardiac MRI and cardiac catheterization is often required for complete characterization of complex congenital heart anomalies in adulthood.
doi:10.1186/1756-0500-5-516
PMCID: PMC3508884  PMID: 22999111
Echocardiography; Cardiac CT; Cardiac MRI; Cardiac catheterization; Double chambered right ventricle; Aortopulmonary shunt
14.  The impact of repeated marathon running on cardiovascular function in the aging population 
Background
Several studies have correlated elevations in cardiac biomarkers of injury post marathon with transient and reversible right ventricular (RV) systolic dysfunction as assessed by both transthoracic echocardiography (TTE) and cardiovascular magnetic resonance (CMR). Whether or not permanent myocardial injury occurs due to repeated marathon running in the aging population remains controversial.
Objectives
To assess the extent and severity of cardiac dysfunction after the completion of full marathon running in individuals greater than 50 years of age using cardiac biomarkers, TTE, cardiac computed tomography (CCT), and CMR.
Methods
A total of 25 healthy volunteers (21 males, 55 ± 4 years old) from the 2010 and 2011 Manitoba Full Marathons (26.2 miles) were included in the study. Cardiac biomarkers and TTE were performed one week prior to the marathon, immediately after completing the race and at one-week follow-up. CMR was performed at baseline and within 24 hours of completion of the marathon, followed by CCT within 3 months of the marathon.
Results
All participants demonstrated an elevated cTnT post marathon. Right atrial and ventricular volumes increased, while RV systolic function decreased significantly immediately post marathon, returning to baseline values one week later. Of the entire study population, only two individuals demonstrated late gadolinium enhancement of the subendocardium in the anterior wall of the left ventricle, with evidence of stenosis of the left anterior descending artery on CCT.
Conclusions
Marathon running in individuals over the age of 50 is associated with a transient, yet reversible increase in cardiac biomarkers and RV systolic dysfunction. The presence of myocardial fibrosis in older marathon athletes is infrequent, but when present, may be due to underlying occult coronary artery disease.
doi:10.1186/1532-429X-14-58
PMCID: PMC3438060  PMID: 22905796
Marathon running; Cardiac biomarkers; Echocardiography; Cardiac computed tomography; Cardiovascular magnetic resonance
15.  An unusual presentation of left ventricular free wall rupture 
The Canadian Journal of Cardiology  2010;26(8):e328-e329.
Left ventricular free wall rupture (LVFWR) is one of the most lethal complications following myocardial infarction. It accounts for approximately 12% to 21% of all in-hospital deaths following myocardial infarction. The majority of patients die shortly after LVFWR from instantaneous pericardial tamponade and hemodynamic collapse. However, up to one-third of cases are subacute in nature, allowing limited time for emergent surgical repair to prevent sudden death. A high index of suspicion and timely use of diagnostic tests are important in recognizing cases. The present report describes the case of a 69-year-old man who initially presented with acute pericardial tamponade and was subsequently diagnosed with LVFWR in the operating room as the cause of his hemopericardium. The pathology, diagnosis and management of LVFWR are reviewed.
PMCID: PMC2954544  PMID: 20931104
Echocardiography; Hemopericardium; Mechanical complications; Myocardial infarction
16.  A case of circumferential multi-vessel coronary intramural hematoma in a post-menopausal woman 
Heart International  2011;6(2):e10.
Spontaneous coronary dissections are a well described entity which are often difficult to treat. Intramural hematoma is one type of coronary dissection. Previous case reports have described the treatment for angiographically visible dissection. We describe the first report of diffuse intramural hematoma visualized only on intravascular ultrasound with no angiographically obvious evidence of dissection treated with multivessel drug eluting stenting. This case highlights the importance of a high level of suspicion and atypical presentations of coronary dissection, and the use of multimodality imaging with intravascular ultrasound and computerized tomography for both diagnosis and therapy.
doi:10.4081/hi.2011.e10
PMCID: PMC3205786  PMID: 22049309
PCI; IVUS; CT; intramural hematoma.
17.  Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series 
Introduction
Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described.
Case presentation
We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman) with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water.
Conclusion
This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive.
doi:10.1186/1752-1947-5-479
PMCID: PMC3189152  PMID: 21943086
18.  Trastuzumab-induced cardiac dysfunction: A ‘dual-hit’ 
In Canada, breast cancer is the leading cause of cancer-related death in women. Approximately 25% to 30% of breast cancers overexpress the human epidermal growth factor receptor 2. Trastuzumab (Trz), which is a monoclonal antibody against epidermal growth factor receptor 2, reduces recurrence and mortality by 50% and 33%, respectively. Other clinical studies have shown that 5% to 10% of patients who receive Trz following doxorubicin treatment develop cardiac dysfunction. This reviews discusses the various mechanisms that may account for doxorubicin and Trz-induced cardiac dysfunction.
Trastuzumab (Trz) is a monoclonal antibody against the human epidermal growth factor receptor 2 that is found to be overexpressed in 25% to 30% of breast cancer patients. In spite of the therapeutic benefits of Trz, cardiotoxic side effects are still an issue. This effect is potentiated particularly when Trz is administered following doxorubicin (DOX) treatment. Among the various mechanisms that may account for DOX and Trz-induced cardiotoxicity, the role of oxidative stress has gained significant support. The present review discusses the evidence supporting the hypothesis that oxidative stress comes from multiple sources through an increase in the production of reactive oxygen species and/or a decrease in antioxidant defense systems. The adjuvant use of Trz can potentiate cardiomyocyte damage through a ‘dual-hit’ mechanism, which includes inhibition of the neuregulin-1 survival signalling pathway and angiotensin II-induced activation of NADPH oxidase, with the ability to further increase reactive oxygen species production. Preventive therapies for DOX- and Trz-induced cardiac dysfunction have eluded investigators, but may include the prophylactic use of angiotensin-converting enzyme inhibitors, beta-blockers and use of antioxidants. Thus, a better understanding of the mechanisms leading to this characteristic drug-induced cardiomyopathy, as well as potential cardioprotective strategies is required.
PMCID: PMC3209542  PMID: 22065936
Doxorubicin; Epidermal growth factor; Heart failure; Oxidative stress; Renin-angiotensin system
20.  Evaluating the effectiveness of rosuvastatin in preventing the progression of diastolic dysfunction in aortic stenosis: A substudy of the aortic stenosis progression observation measuring effects of rosuvastatin (ASTRONOMER) study 
Background
Tissue Doppler imaging (TDI) is a noninvasive echocardiographic method for the diagnosis of diastolic dysfunction in patients with varying degrees of aortic stenosis (AS). Little is known however, on the utility of TDI in the serial assessment of diastolic abnormalities in AS.
Objective
The aim of the current proposal was to examine whether treatment with rosuvastatin was successful in improving diastolic abnormalities in patients enrolled in the Aortic Stenosis Progression Observation Measuring Effects of Rosuvastatin (ASTRONOMER) study.
Methods
Conventional Doppler indices including peak early (E) and late (A) transmitral velocities, and E/A ratio were measured from spectral Doppler. Tissue Doppler measurements including early (E') and late (A') velocities of the lateral annulus were determined, and E/E' was calculated.
Results
The study population included 168 patients (56 ± 13 years), whose AS severity was categorized based on peak velocity at baseline (Group I: 2.5-3.0 m/s; Group II: 3.1-3.5 m/s; Group III: 3.6-4.0 m/s). Baseline and follow-up hemodynamics, LV dimensions and diastolic functional parameters were evaluated in all three groups. There was increased diastolic dysfunction from baseline to follow-up in each of the placebo and rosuvastatin groups. In patients with increasing severity of AS in Groups I and II, the lateral E' was lower and the E/E' (as an estimate of increased left ventricular end-diastolic pressure) was higher at baseline (p < 0.05). However, treatment with rosuvastatin did not affect the progression of diastolic dysfunction from baseline to 3.5 year follow-up between patients in any of the three predefined groups.
Conclusion
In patients with mild to moderate asymptomatic AS, rosuvastatin did not attenuate the progression of diastolic dysfunction.
doi:10.1186/1476-7120-9-5
PMCID: PMC3041733  PMID: 21299902
21.  Multimodality imaging of anomalous pulmonary veins 
Partial anomalous pulmonary venous connection (PAPVC) is an extremely rare congenital condition where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with unexplained right ventricular enlargement on transthoracic echocardiography (TTE), cardiac MRI is able to delineate the anatomical variant. We present a case of a 65-year-old male diagnosed with left sided PAPVC using multimodality cardiac imaging.
doi:10.1186/1476-7120-9-3
PMCID: PMC3038141  PMID: 21288339
23.  Myocardial siderosis due to hemochromatosis in an individual with hypertrophic cardiomyopathy 
The Canadian Journal of Cardiology  2009;25(12):e424-e425.
A patient with hypertrophic cardiomyopathy (HCM) and transfusion-dependent sideroblastic anemia, who presented with decompensated heart failure, is described. The present case demonstrates the usefulness of cardiac magnetic resonance imaging as a noninvasive imaging modality to assess the etiology of new systolic dysfunction in the setting of HCM. Cardiac magnetic resonance imaging is able to differentiate between the dilated ‘burned-out’ phase of HCM and a concomitant dilated cardiomyopathy secondary to myocarditis or hemosiderosis.
PMCID: PMC2807840  PMID: 19960138
Cardiac MRI; Hemochromatosis; Hypertrophic cardiomyopathy
24.  An unusual case of left ventricular aneurysm in duchenne muscular dystrophy 
Duchenne muscular dystrophy (DMD) leads to structural heart disease, including dilated cardiomyopathy, in 90% of patients >18 years of age. Despite the ubiquity of cardiomyopathy associated with DMD, ventricular aneurysms in these patients have rarely been reported. We present a case of a basal inferoposterior aneurysm of the left ventricle in a 23-year-old male patient with DMD.
doi:10.1186/1476-7120-8-49
PMCID: PMC3000834  PMID: 21073752

Results 1-25 (37)