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Objectives: To investigate dual-phase multi-detector computed tomography (MDCT) for assessing extent and severity of jeopardised and infarcted myocardium subtended by infarct-related artery (IRA), and its indication for revascularisation after acute myocardial infarction (AMI). Designs, setting and patients: Prospective, singlecentre study included 107 patients with uncomplicated post-AMI 3-7 days, who met criteria and underwent dual-phase 64-slice MDCT. IRA, culprit lesion and extent of jeopardised/infarcted myocardium were assessed by three-dimensional (3D) volume-rendered images with myocardium maps and computed tomography angiography (CTA), compared with stress-redistribution thallium-201 single-photon emission computed tomography (SPECT) plus conventional coronary angiography (CCA). MDCT-jeopardised score (severity of jeopardised myocardium) was defined as extent of jeopardised myocardium multiplied by the weighted factor dependent on culprit lesion severity compared with SPECT-SRS (summation of segmental reversible score). The IRA indication for revascularisation was evaluated by MDCT-jeopardised score plus CTA. SPECT-SRS >2 plus CCA-culprit lesion >50% was the standard reference. Results: The presence of MDCT-delayed enhancement was found in 101 (94.4%) patients. The IRA and culprit lesion were identified in 99 (92.5%) patients by MDCTmyocardium maps plus CTA. The concordance between MDCT and SPECT for detecting infarcted myocardium was good (kappa = 0.702). The correlation between MDCTjeopardised score and SPECT-SRS was 0.741. The correlation between CTA and CCA for culprit lesion severity was 0.85. The sensitivity, specificity, negative and positive predictive values of MDCT-jeopardised score >2.5 plus CTA for indicating revascularisation were 90.2%, 80.4%, 86.0% and 85.9%, respectively. Conclusions: Dual-phase MDCT has good accuracy for identifying IRA, and assessing infarcted and jeopardised myocardium for clinical relevance. It provides an alternative for triage and therapeutic planning in post-AMI.Appropriate risk triage and therapeutic decisionmaking in patients with acute myocardial infarction (AMI) who have not undergone primary or rescue angioplasty requires information about the status of infarct-related territory regarding the area of irreversibly injured myocardium (infarcted myocardium) and the area at risk for post-infarct ischaemia (jeopardised myocardium).1 2 Currently, single-photon emission computed tomography (SPECT) is widely accepted as the reference standard in physiologically recognising jeopardised and infarcted myocardium. If revascularisation is necessary, invasive conventional coronary angiography (CCA) is added for assigning the infarct-related artery (IRA) and evaluating culprit lesion severity.Technological advances in multi-detector computed tomography (MDCT) provide computed tomography angiography (CTA) with high accuracy in detecting significant coronary artery disease in comparison with CCA 3-5 and robust quality for evaluating left ventricular (LV) function. 6 ...

Aims Little is known of the impact of systolic pulmonary regurgitation (PR) on acute decompensated heart failure (HF). We assessed the prevalence and prognostic significance of systolic PR in patients with severe HF. Methods and results According to recent 10 year echocardiographic database of E‐Da Hospital, 533 patients admitted for first systolic heart failure (HF) and left ventricular ejection fraction <35% were under investigation. Systolic PR was defined as the presence of pulmonary backward flow persistent after QRS in electrocardiogram. Isovolumic contraction/relaxation time and myocardial performance index were derived by tissue Doppler imaging. Right ventricular (RV) function was assessed by RV fractional area change. Estimated pulmonary vascular resistance (PVR) was assessed by the ratio of peak tricuspid regurgitation velocity to the RV outflow tract time–velocity integral. The factors associated with systolic PR were assessed by multivariate logistic regression. Cox proportional regression analyses were used to estimate the impact of cardiovascular events including HF rehospitalization and cardiovascular death. For estimated prevalence of 5480 control subjects, echocardiographic screens in those with normal left ventricular ejection fraction were performed. Of 533 systolic HF cases, 143 (26.8%) had systolic PR during indexed hospitalization. Among 143 cases, 86% systolic PR disappeared during late follow‐up. In control subjects, 0.3% (18/5480) had systolic PR. Systolic PR correlated to RV dysfunction, estimated PVR, E/e′, sign of low cardiac output, and pulmonary oedema. Systolic PR was associated independently with further cardiovascular events (hazard ratio 2.266, 95% confidence interval 1.682–3.089, P < 0.0001) including cardiovascular death and HF rehospitalization. Conclusions Systolic PR is not uncommon in systolic HF and is associated with high PVR and RV dysfunction. Systolic PR significantly impacts cardiovascular outcome.

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