ONISCHEMIC DILATED CARDIomyopathy is a common heart muscle disease with a prevalence of at least 1 in 2500 adults. 1 It is characterized by left ventricular cavity enlargement and impaired contractility in the absence of significant coronary artery disease. 1 The condition is associated with significant morbidity and mortality due to progressive heart failure (HF) and sudden cardiac death (SCD). 2 Despite For editorial comment see p 929.

Background-Cardiovascular magnetic resonance is the gold-standard technique for the assessment of ventricular function.Although left ventricular volumes and ejection fraction are strong predictors of outcome in dilated cardiomyopathy (DCM), there are limited data regarding the prognostic significance of right ventricular (RV) systolic dysfunction (RVSD). We investigated whether cardiovascular magnetic resonance assessment of RV function has prognostic value in DCM. Methods and Results-We prospectively studied 250 consecutive DCM patients with the use of cardiovascular magnetic resonance. RVSD, defined by RV ejection fraction ≤45%, was present in 86 (34%) patients. During a median follow-up period of 6.8 years, there were 52 deaths, and 7 patients underwent cardiac transplantation. Received March 10, 2013; accepted July 30, 2013. From the Royal Brompton Hospital, London, United Kingdom (A.G., T.F.I., A.J., F.A., K.G., N.A.I., S.R., J.K., T.D.H.B., K.M., E.L., M.R., R.W., T.C.P., R.S., J.-P.C., S.A.C., M.R.C., R.G.A., D.J.P., S.K.P.); Ealing Hospital, London, United Kingdom (R.G.A.); National Heart & Lung Institute, Imperial College, London, United Kingdom (T.F.I., K.G., R.S., J.-.P.C., S.A.C., M.R.C., D.J.P., S.K.P.); and National Heart Centre Singapore, Singapore (S.A.C.).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.

AimsEchocardiographic studies have shown that left atrial volume (LAV) predicts adverse outcome in small heart failure (HF) cohorts of mixed aetiology. However, the prognostic value of LAV in non-ischaemic dilated cardiomyopathy (DCM) is unknown. Cardiovascular magnetic resonance (CMR) allows accurate and reproducible measurement of LAV. We sought to determine the long-term prognostic significance of LAV assessed by CMR in DCM. Methods and resultsWe measured LAV indexed to body surface area (LAVi) in 483 consecutive DCM patients referred for CMR. Patients were prospectively followed up for a primary endpoint of all-cause mortality or cardiac transplantation. During a median follow-up of 5.3 years, 75 patients died and 9 underwent cardiac transplantation. After adjustment for established risk factors, LAVi was an independent predictor of the primary endpoint [hazard ratio (HR) per 10 mL/m 2 1.08; 95% confidence interval (CI) 1.01-1.15; P ¼ 0.022]. LAVi was also independently associated with the secondary composite endpoints of cardiovascular mortality or cardiac transplantation (HR per 10 mL/m 2 1.11; 95% CI 1.04-1.19; P ¼ 0.003), and HF death, HF hospitalization, or cardiac transplantation (HR per 10 mL/m 2 1.11; 95% CI 1.04-1.18; P ¼ 0.001). The optimal LAVi cut-off value for predicting the primary endpoint was 72 mL/m 2 . Patients with LAVi .72 mL/m 2 had a three-fold elevated risk of death or transplantation (HR 3.00; 95% CI 1.92-4.70; P , 0.001). LAVi provided incremental prognostic value for the prediction of transplant-free survival (net reclassification improvement 0.17; 95% CI 0.05-0.29; P ¼ 0.002). ConclusionsLAVi is a powerful independent predictor of transplant-free survival and HF outcomes in DCM. Assessment of LAV improves risk stratification in DCM and should be incorporated into routine CMR examination.--