Adjunction of selective β1-blockade to standard septic shock management enhances intrinsic cardiac contractility and vascular responsiveness to catecholamines. These protective cardiovascular effects are likely predominantly attributed to the anti-inflammatory effect of esmolol.

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Purpose:To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis. Materials and Methods:A total of 27 consecutive patients (age ϭ 45 Ϯ 17 years; 14 male) presenting with ACS (chest pain, positive troponin-I) and no coronary stenosis, underwent cardiac MRI 9 Ϯ 7 days after pain onset and 8 Ϯ 5 months later (N ϭ 19). Steady-state free-precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion-recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi-gated-single photon emission CT (SPECT) was also systematically performed.Results: Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C-reactive protein (CRP) levels (38 Ϯ 32 vs. 14 Ϯ 24 mg/mL; P ϭ 0.04), lower Framingham cardiovascular risk (3 Ϯ 3% vs. 9 Ϯ 5%; P Ͻ 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P ϭ 0.01), higher left ventricular (LV) enddiastolic volume (77 Ϯ 16 vs. 64 Ϯ 10 mL/m 2 ; P ϭ 0.02), and higher regression of DCE areas at follow-up (-65 Ϯ 17% vs. -18 Ϯ 23%; P ϭ 0.002).Conclusion: DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis.

Concentric remodeling is frequently documented by MRI in the middle-aged men with abdominal obesity and in association with a decrease in TAC no longer counter-balanced by a decrease in TPVR, suggesting a remodeling from proximal to peripheral vasculature.