BACKGROUND Omega-3 fatty acids from fish oil have been associated with beneficial cardiovascular effects but their role in modifying cardiac structures and tissue characteristics in patients who have suffered an acute myocardial infarction (MI) while receiving current guideline-based therapy remains unknown. METHODS In a multicenter, double-blind, placebo-controlled trial, participants presenting with an acute MI were randomized 1:1 to 6-months of high-dose omega-3 fatty acids (n=178) or placebo (n=180). Cardiac magnetic resonance imaging was used to assess cardiac structure and tissue characteristics at baseline and following study therapy. The primary study endpoint was change in left ventricular systolic volume index (LVESVI). Secondary endpoints included change in non-infarct myocardial fibrosis, LVEF, and infarct size. RESULTS By intention-to-treat analysis, patients randomized to omega-3 fatty acids experienced a significant reduction of LVESVI (−5.8%, P=0.017), and non-infarct myocardial fibrosis (−5.6%, P=0.026) compared with placebo. Per-protocol analysis revealed that those subjects who achieved the highest quartile increase in RBC omega-3 index experienced a 13% reduction in LVESVI as compared with the lowest quartile. In addition, patients in the omega-3 fatty acid arm underwent significant reductions in serum biomarkers of systemic and vascular inflammation and myocardial fibrosis. There were no adverse events associated with high-dose omega-3 fatty acid therapy. CONCLUSIONS Treatment of acute MI patients with high-dose omega-3 fatty acids was associated with reduction of adverse LV remodeling, non-infarct myocardial fibrosis, and serum biomarkers of systemic inflammation beyond current guideline-based standard of care. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00729430.

We aimed to determine whether the myocardial extracellular volume (ECV), measured using T1 measurements obtained during cardiac magnetic resonance (CMR) imaging were increased in patients treated with anthracyclines. We performed CMR imaging, an echocardiogram, and measured the ECV in 42 patients with treated with anthracyclines. Data from the CMR study were compared to healthy volunteers. The anthracycline-treated cohort consisted of 21 males and 21 females with a mean age of 55±17 years, presenting a median of 84 months after chemotherapy with a cumulative anthracycline exposure of 282±65 mg/m2, and a mean left ventricular ejection fraction of 52±12%. The ECV was elevated in anthracycline-treated patients in comparison to age and gender-matched controls (0.36±0.03 vs. 0.28±0.02, p < 0.001). There was a positive association between the ECV and left atrial volume (LAV) (ECV vs. indexed LAV, r=0.65, p < 0.001) and negative association between the ECV and diastolic function (E′ lateral, r=−.64, p < 0.001). In conclusion, the myocardial extracellular volume is elevated in patients with prior anthracycline treatment and is associated with diastolic function and increased atrial volumes.

AimsCoronary computed tomography angiography (CTA) has emerged as a non-invasive diagnostic method for patients with suspected coronary artery disease, but its usefulness in patients with complex coronary artery disease remains to be investigated. The present study sought to determine the agreement between separate heart teams on treatment decision-making based on either coronary CTA or conventional angiography. Methods and resultsSeparate heart teams composed of an interventional cardiologist, a cardiac surgeon, and a radiologist were randomized to assess the coronary artery disease with either coronary CTA or conventional angiography in patients with de novo left main or three-vessel coronary artery disease. Each heart team, blinded for the other imaging modality, quantified the anatomical complexity using the SYNTAX score and integrated clinical information using the SYNTAX Score II to provide a treatment recommendations based on mortality prediction at 4 years: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), or equipoise between CABG and PCI. The primary endpoint was the agreement between heart teams on the revascularization strategy. The secondary endpoint was the impact of fractional flow reserve derived from coronary CTA (FFRCT) on treatment decision and procedural planning. Overall, 223 patients were included. A treatment recommendation of CABG was made in 28% of the cases with coronary CTA and in 26% with conventional angiography. The agreement concerning treatment decision between coronary CTA and conventional angiography was high (Cohen’s kappa 0.82, 95% confidence interval 0.74–0.91). The heart teams agreed on the coronary segments to be revascularized in 80% of the cases. FFRCT was available for 869/1108 lesions (196/223 patients). Fractional flow reserve derived from coronary CTA changed the treatment decision in 7% of the patients.ConclusionIn patients with left main or three-vessel coronary artery disease, a heart team treatment decision-making based on coronary CTA showed high agreement with the decision derived from conventional coronary angiography suggesting the potential feasibility of a treatment decision-making and planning based solely on this non-invasive imaging modality and clinical information.Trial registration numberNCT02813473.

BackgroundData are sparse regarding the effects of prolonged prone positioning (PP) during VV-ECMO. Previous studies, using short sessions (<12 h), failed to find any effects on respiratory system compliance. In the present analysis, the effects of prolonged PP sessions (24 h) were retrospectively studied with regard to safety data, oxygenation and respiratory system compliance.MethodsRetrospective review of 17 consecutive patients who required both VV-ECMO and prone positioning. PP under VV-ECMO was considered when the patient presented at least one unsuccessful ECMO weaning attempt after day 7 or refractory hypoxemia combined or not with persistent high plateau pressure. PP sessions had a duration of 24 h with fixed ECMO and respiratory settings. PP was not performed in patients under vasopressor treatment and in cases of recent open chest cardiac surgery.ResultsDespite optimized protective mechanical ventilation and other adjuvant treatment (i.e. PP, inhaled nitric oxide, recruitment maneuvers), 44 patients received VV-ECMO during the study period for refractory acute respiratory distress syndrome. Global survival rate was 66 %. Among the latter, 17 patients underwent PP during VV-ECMO for a total of 27 sessions. After 24 h in prone position, PaO2/FiO2 ratio significantly increased from 111 (84–128) to 173 (120–203) mmHg (p < 0.0001) while respiratory system compliance increased from 18 (12–36) to 32 (15–36) ml/cmH2O (p < 0.0001). Twenty-four hours after the return to supine position, tidal volume was increased from 3.0 (2.2–4.0) to 3.7 (2.8–5.0) ml/kg (p < 0.005). PaO2/FiO2 ratio increased by over 20 % in 14/14 sessions for late sessions (≥7 days) and in 7/13 sessions for early sessions (<7 days) (p = 0.01). Quantitative CT scan revealed a high percentage of non-aerated or poorly-aerated lung parenchyma [52 % (41–62)] in all patients. No correlation was found between CT scan data and respiratory parameter changes. Hemodynamics did not vary and side effects were rare (one membrane thrombosis and one drop in ECMO blood flow).ConclusionWhen used in combination with VV-ECMO, 24 h of prone positioning improves both oxygenation and respiratory system compliance. Moreover, our study confirms the absence of serious adverse events.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-015-0078-4) contains supplementary material, which is available to authorized users.

Objectives We aimed to test the characteristics of the myocardial extracellular volume (ECV) fraction derived from pre and post-contrast T1 measurements among healthy volunteers. Background Cardiac magnetic resonance (CMR) T1 measurements of myocardium and blood before and after contrast allow quantification of the ECV, a tissue parameter that has been shown to change in proportion to the connective tissue fraction. Methods Healthy volunteers underwent a standard CMR with administration of gadolinium. T1 measurements were performed with a Look-Locker sequence followed by gradient-echo acquisition. We tested the segmental, inter-slice, inter-, intra-, and test-retest characteristics of the ECV, as well as the association of the ECV with other variables. Juvenile and aged mice underwent a similar protocol and cardiac sections were harvested for measurement of fibrosis. Results In healthy volunteers (n=32, 56% female; ages 21 to 72), the ECV averaged 0.28 ± 0.03 (range 0.23 to 0.33). The intra-class coefficients for the intra-observer, inter-observer, and test-retest absolute agreements of the ECV were 0.94 (95% confidence interval, 0.84 to 0.98), 0.93 (95% confidence interval, 0.80 to 0.98), and 0.95 (95% confidence interval, 0.52 to 0.99), respectively. In volunteers, the ECV was associated with age (r=0.74, p< 0.001), maximal LA volume index (r=0.67, p< 0.001), and indexed LV mass. There were no differences in the ECV between segments in a slice or between slices. In mice (n=12) the myocardial ECV ranged from 0.20 to 0.32 and increased with age (0.22 ± 0.02 vs. 0.30 ± 0.02, juvenile vs. aged mice, p< 0.001). In mice, the ECV correlated with the extent of myocardial fibrosis (r=0.94, p< 0.001). Conclusion In healthy volunteers, the myocardial ECV ranges from 0.23 to 0.33, has acceptable test characteristics, and is associated with age, LA volume, and LV mass. In mice, the ECV also increases with age and strongly correlates with the extent of myocardial fibrosis.

Background: Mitral valve prolapse (MVP) is a frequent disease that can be complicated by mitral regurgitation (MR), heart failure, arterial embolism, rhythm disorders and death. Left ventricular (LV) replacement myocardial fibrosis, a marker of maladaptive remodeling, has been described in patients with MVP, but the implications of this finding remain scarcely explored. We aimed at assessing the prevalence, pathophysiological and prognostic significance of LV replacement myocardial fibrosis through late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR) in patients with MVP. Methods: Four hundred patients (53±15 years, 55% male) with MVP (trace to severe MR by echocardiography) from 2 centers, who underwent a comprehensive echocardiography and LGE CMR, were included. Correlates of replacement myocardial fibrosis (LGE+), influence of MR degree, and ventricular arrhythmia were assessed. The primary outcome was a composite of cardiovascular events (cardiac death, heart failure, new-onset atrial fibrillation, arterial embolism, and life-threatening ventricular arrhythmia). Results: Replacement myocardial fibrosis (LGE+) was observed in 110 patients (28%; 91 myocardial wall including 71 basal inferolateral wall, 29 papillary muscle). LGE+ prevalence was 13% in trace-mild MR, 28% in moderate and 37% in severe MR, and was associated with specific features of mitral valve apparatus, more dilated LV and more frequent ventricular arrhythmias (45 vs 26%, P<0.0001). In trace-mild MR, despite the absence of significant volume overload, abnormal LV dilatation was observed in 16% of patients and ventricular arrhythmia in 25%. Correlates of LGE+ in multivariable analysis were LV mass (OR 1.01, 95% CI [1.002-1.017], P=0.009) and moderate-severe MR (OR: 2.28, 95% CI [1.21-4.31], P=0.011). LGE+ was associated with worse 4-year cardiovascular event-free survival (49.6±11.7 in LGE+ vs 73.3±6.5% in LGE-, P<0.0001). In a stepwise multivariable Cox model, MR volume and LGE+ (HR: 2.6 [1.4-4.9], P=0.002) were associated with poor outcome. Conclusions: LV replacement myocardial fibrosis is frequent in patients with MVP, is associated with mitral valve apparatus alteration, more dilated LV, MR grade, ventricular arrhythmia, and is independently associated with cardiovascular events. These findings suggest a MVP-related myocardial disease. Finally, CMR provides additional information to echocardiography in MVP.

Abstract-Carotid-femoral pulse wave velocity (PWV) is considered the gold-standard measurement of arterial stiffness.Obesity, however, can render inaccurate the measurement of PWV by external noninvasive devices. Phase-contrast MRI allows the determination of aortic PWV in multiple aortic locations with intra-arterial distance measurements, as well as the assessment of aortic mechanical properties. Key Words: arterial stiffness Ⅲ pulse wave velocity Ⅲ obesity Ⅲ MRI Ⅲ aortic distensibility A rterial stiffness assessed by pulse wave velocity (PWV) measurement is now well accepted as an independent predictor of cardiovascular mortality and morbidity. 1 Rapid and reproducible external noninvasive methods are the gold standard for measuring PWV by recording the pressure waves at respective carotid and femoral sites. 2 Several recent studies have indicated an effect of obesity on arterial stiffness, especially when associated with metabolic disorders. [3][4][5] Therefore, measurements of PWV in overweight and obese subjects may be of major interest in assessing cardiovascular risk. However, obesity is a well known factor of technical operator bias when assessing PWV. 2,6 This concerns both difficulties in obtaining pressure curves of good quality and technical difficulties in measuring distance. In this context, PWV assessment is questionable in overweight and obese subjects [2][3][4]6,7 ; therefore, a comparison between external PWV-recording transcutaneous devices and internal noninvasive methods, eg, phase-contrast MRI, could prove valuable, while also providing morphological information. 8 -10 In fact, the acquisition of cross-sectional MRI aortic vascular structural indices, provided by combined high spatial and temporal resolutions, should not be affected by either body composition or imaging plane.The current study was designed to assess the relationship between PWV values obtained with 2 well-validated transcutaneous devices (Complior II and PulsePen) and MRI acquisition of PWV along with aortic cross-sectional mechanical properties estimated by aortic distensibility and compliance, aortic elastic modulus, and stiffness index in a population presenting isolated abdominal obesity considered to reflect a high disease risk and defined by a waist circumference Ͼ102 cm for men and Ͼ88 cm for women in overweight and obese patients (body mass index from 27 to 35 kg m Ϫ2 ). Methods Subject SelectionEighteen male and 14 female subjects presenting with isolated abdominal obesity were prospectively recruited by local press

This article describes a general framework for multiple coil MRI reconstruction in the presence of elastic physiological motion. On the assumption that motion is known or can be predicted, it is shown that the reconstruction problem is equivalent to solving an integral equation-known in the literature as a Fredholm equation of the first kind-with a generalized kernel comprising Fourier and coil sensitivity encoding, modified by physiological motion information. Numerical solutions are found using an iterative linear system solver. The different steps in the numerical resolution are discussed, in particular it is shown how over-determination can be used to improve the conditioning of the generalized encoding operator. Practical implementation requires prior knowledge of displacement fields, so a model of patient motion is described which allows elastic displacements to be predicted from various input signals (e.g., respiratory belts, ECG, navigator echoes), after a free-breathing calibration scan. Practical implementation was demonstrated with a moving phantom setup and in two free-breathing healthy subjects, with images from the thoracic-abdominal region. Results show that the method effectively suppresses the motion blurring/ghosting artifacts, and that scan repetitions can be used as a source of over-determination to improve the reconstruction.