446 In clinical practice, heart failure (HF), caused by a predominant abnormality in diastolic function, is a common entity and a cause of significant morbidity and mortality. According to the American Heart Association, the prevalence of HF in adults was 5.3 million in 2005, of which almost half had a normal left ventricular (LV) ejection fraction (EF) (1). Diastolic dysfunction occurs when LV relaxation and/or compliance are impaired and is considered an early marker of cardiovascular disease (2). Diastolic HF is a clinical entity, and the diagnosis requires three conditions: the presence of signs or symptoms of HF, normal or slightly abnormal LV systolic function (EF >50%), and demonstration of LV diastolic dysfunction (3). Assessment of diastolic function by cardiovascular magnetic resonance imaging (CMRI) is feasible and could provide a more comprehensive clinical understanding of LV function in addition to a systolic functional assessment. LV diastolic dysfunction occurs in several cardiac and systemic diseases such as hypertension, ischemic heart disease, hypertrophic cardiomyopathy, aortic valve stenosis, and infiltrative cardiomyopathies such as amyloidosis (4).The purpose of this study was to review the pathophysiology of diastolic dysfunction, to illustrate the different degrees of diastolic dysfunction, and to provide an overview of the role of CMRI in the assessment of diastolic dysfunction. Physiology of diastoleDiastole represents the portion of the cardiac cycle that begins with isovolumic relaxation and ends with mitral valve (MV) closure, leading to ventricular filling (5).Diastole can be divided into four phases ( Fig. 1): 1) Isovolumic relaxation: Relaxation is an energy-dependent process that starts in late systole and ends in mid-diastole. The elastic recoil of the contracted myocardium creates a "suction" mechanism causing the intra-ventricular pressure to decline, while maintaining a virtually constant volume. 2) Rapid filling: Pressure continues to decline due to LV relaxation and elastic recoil until it is below the left atrial (LA) pressure so the MV will open, and rapid filling begins. It ends when LV pressure equals LA pressure and is responsible for nearly 70% of LV filling. 3) Diastasis: It is the period between rapid filling and atrial contraction, when LA and LV pressures have reached an equilibrium. LV filling continues because of the inertia of pulmonary venous return flow, accounting for <5% of LV filling. 4) Atrial contraction: This corresponds to the LA contraction that causes LA pressure to rise above the ventricular pressure; it induces new blood flow into the LV and accounts for nearly 25% of LV filling (4). ABSTRACT Diastolic dysfunction is a common entity and the predominant cause of heart failure in 40%-50% of patients. Diagnosis of diastolic dysfunction is clinically relevant and associated with a poor prognosis. The aim of this essay was to review the pathophysiology and different grades of diastolic dysfunction and to provide an overview on the role of cardiovascula...

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Introduction: Thymic clear cell carcinoma is the most uncommon subtype of thymic carcinoma, with 20 cases reported worldwide. Case Description: We present the case of a 61-year-old female with dyspnoea and chest pain for 2 days. Computed tomography (CT) angiography showed pulmonary thromboembolism and the existence of mediastinal and bilateral hilar lymphadenopathy, the largest infracarinal with an inferior axis of 25 mm, and also, micronodules on the left pulmonary parenchyma. The patient was admitted for aetiological assessment and underwent anticoagulant therapy. After a month, she had an ischaemic stroke, the sequelae of which proved to be fatal. The autopsy showed a mass in the superior-anterior mediastinum, with dimensions of 11×8×6 cm, corresponding to a thymus signet ring cell primary carcinoma. The immunohistochemistry study revealed that this mass was positive for AE1/AE3, CK5/6 and CK7. Conclusion: The clinical, morphological and immunophenotypic diversity of this tumour makes its diagnosis a difficult multidisciplinary challenge, which requires a high level of clinical knowledge and accurate imaging and histological investigation.