Recent technologic advances in cardiac MRI have resulted in the rapid acquisition of images of the heart with high spatial and temporal resolution and excellent myocardial tissue characterization. Cardiac MRI provides optimal assessment of the location, functional characteristics, and soft-tissue features of cardiac tumors, allowing accurate differentiation of benign and malignant lesions.

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Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium. Recent advances in multimodality noninvasive cardiac imaging have solidified its role in the management of patients with suspected pericardial disease. The physiologic and structural information obtained from transthoracic echocardiography and the anatomic detail provided by cardiac computed tomography and magnetic resonance have led to growing interest in the complementary use of these techniques. Optimal management of the patient with suspected pericardial disease requires familiarity with the key imaging modalities and the ability to choose the appropriate imaging tests for each patient. This report reviews the imaging modalities most useful in the assessment of patients with pericardial disease, with an emphasis on the complementary value of multimodality cardiac imaging.

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Although exercise training-induced changes in left ventricular (LV) structure are well characterized, adaptive functional changes are incompletely understood. Detailed echocardiographic assessment of LV systolic function was performed on 20 competitive rowers (10 males and 10 females) before and after endurance exercise training (EET; 90 days, 10.7 Ϯ 1.1 h/wk). Structural changes included LV dilation (end-diastolic volume ϭ 128 Ϯ 25 vs. 144 Ϯ 28 ml, P Ͻ 0.001), right ventricular (RV) dilation (end-diastolic area ϭ 2,850 Ϯ 550 vs. 3,260 Ϯ 530 mm 2 , P Ͻ 0.001), and LV hypertrophy (mass ϭ 227 Ϯ 51 vs. 256 Ϯ 56 g, P Ͻ 0.001). Although LV ejection fraction was unchanged (62 Ϯ 3% vs. 60 Ϯ 3%, P ϭ not significant), all direct measures of LV systolic function were altered. Peak systolic tissue velocities increased significantly (basal lateral SЈ⌬ ϭ 0.9 Ϯ 0.6 cm/s, P ϭ 0.004; and basal septal SЈ⌬ ϭ 0.8 Ϯ 0.4 cm/s, P ϭ 0.008). Radial strain increased similarly in all segments, whereas longitudinal strain increased with a base-to-apex gradient. In contrast, circumferential strain (CS) increased in the LV free wall but decreased in regions adjacent to the RV. Reductions in septal CS correlated strongly with changes in RV structure (⌬RV end-diastolic area vs. ⌬LV septal CS; r 2 ϭ 0.898, P Ͻ 0.001) and function (⌬peak RV systolic velocity vs. ⌬LV septal CS, r 2 ϭ 0.697, P Ͻ 0.001). EET leads to significant changes in LV systolic function with regional heterogeneity that may be secondary to concomitant RV adaptation. These changes are not detected by conventional measurements such as ejection fraction.athlete's heart; left ventricle; strain; ventricular interdependence LEFT VENTRICULAR (LV) structural adaptation in response to aerobic endurance exercise training (EET) has been well characterized. Increases in LV chamber dimensions, wall thickness, and mass have been documented among individuals who participate in EET, and it is these structural attributes that underlie the concept of the "athlete's heart" (8,38,41). At the present time, the impact of EET on LV functional mechanics is less clear.Several reports demonstrate that EET results in enhanced LV diastolic function (3,23,31). In contrast, existing data suggest that LV systolic function is unchanged by EET (9,15,39). Previous studies examining the impact of EET on LV systolic function have relied on indexes such as ejection fraction or fractional area change that may lack the sensitivity to detect regional changes in myocardial function. Novel imaging techniques such as two-dimensional strain and tissueDoppler echocardiography are direct, more sensitive methods of assessing myocardial systolic function (13,14). To date, a prospective and longitudinal assessment of the impact of EET on LV systolic function using these techniques has not been conducted.We hypothesized that EET would result in enhanced resting LV contractility but that this adaptation would be underrepresented by conventional indexes of systolic function. To address this hypothesis, we performed a focused ...

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Although cardiac remodeling occurs in both ER and SR, specific aspects of cardiac structure and function differ between rowers who compete at the elite and the subelite levels of sport.

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