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Objectives To assess the relationship between extracellular volume (ECV), native T1, and systolic strain in hypertensive patients with left ventricular hypertrophy (HTN LVH), hypertensive patients without LVH (HTN Non-LVH) and normotensive controls. Background Diffuse myocardial fibrosis in HTN LVH patients, as reflected by increased ECV and native T1, may be an underlying mechanism contributing to increased cardiovascular risk when compared to HTN Non-LVH subjects and controls. Furthermore increased diffuse fibrosis in HTN LVH subjects may be associated with reduced peak systolic and early diastolic strain rate when compared to the other two groups. Methods T1 mapping was performed in 20 HTN LVH (55±11 years), 23 HTN Non-LVH (61±12) and 22 control (54±7) subjects on a Siemens 1.5T Avanto using a previously validated MOLLI pulse sequence. T1 was measured pre-contrast and 10, 15 and 20 minutes following injection of 0.15 mmol/kg Gd-DTPA, and the mean ECV and native T1 were determined for each subject. Measurement of circumferential strain parameters were performed using cine displacement encoding with stimulated echoes (DENSE). Results HTN LVH subjects had higher native T1 when compared to controls (p < 0.05). HTN LVH subjects had higher ECV when compared to HTN Non-LVH subjects and controls (p < 0.05). Peak systolic circumferential strain and early diastolic strain rate were reduced in HTN LVH subjects when compared to HTN Non-LVH subjects and controls (p < 0.05). Increased levels of ECV and Native T1 were associated with reduced peak systolic and early diastolic circumferential strain rate across all subjects. Conclusions HTN LVH patients had higher ECV, longer native T1 and associated reduction in peak systolic circumferential strain and early diastolic strain rate when compared to HTN Non-LVH and control subjects. Measurement of ECV and native T1 provide a non-invasive assessment of diffuse fibrosis in hypertensive heart disease.

The QW/NQW distinction is useful, but it is determined by the total size rather than transmural extent of underlying MI.

Background: The benefit of emergent coronary angiography after resuscitation from out-of-hospital cardiac arrest (OHCA) is uncertain for patients without ST-segment elevation (STE). The aim of this randomized trial was to evaluate the efficacy and safety of early coronary angiography and to determine the prevalence of acute coronary occlusion in resuscitated OHCA patients without STE. Methods: Adult (>18 years) comatose survivors without STE after resuscitation from OHCA were prospectively randomized in a 1:1 fashion under exception to informed consent regulations to early coronary angiography versus no early coronary angiography in this multi-center study. Early angiography was defined as ≤ 120 minutes from arrival at the percutaneous coronary intervention capable facility. The primary endpoint was a composite of efficacy and safety measures, including efficacy parameters of survival to discharge, favorable neurological status at discharge (Cerebral Performance Category ≤ 2), echocardiographic measures of left ventricular ejection fraction >50% and a normal regional wall motion score of 16 within 24 hours of admission. Adverse events included re-arrest, pulmonary edema on chest x-ray, acute renal dysfunction, bleeding requiring transfusion or intervention, hypotension (systolic arterial pressure ≤90 mmHg), and pneumonia. Secondary endpoints included the incidence of culprit vessels with acute occlusion. Results: The study was prematurely terminated before enrolling the target number of patients. A total of 99 patients were enrolled from 2015-2018, including 75 with initially shockable rhythms. Forty-nine patients were randomized to early coronary angiography. The primary endpoint of efficacy and safety was not different between the two groups (55.1% vs 46.0%; p=0.64). Early coronary angiography was not associated with any significant increase in survival (55.1% vs 48.0%; p=0.55 or adverse events (26.5% vs 26.0%; p=1.00). Early coronary angiography revealed a culprit vessel in 47%, with a total of 14% of patients undergoing early coronary angiography having an acutely occluded culprit coronary artery. Conclusions: This underpowered study, when considered together with previous clinical trials, does not support early coronary angiography for comatose survivors of cardiac arrest without ST elevation. Whether early detection of occluded potential culprit arteries leads to interventions that improve outcomes requires additional study. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02387398

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The extent of residual myocardial viability predicted by MCE is a powerful independent predictor of hard cardiac events in patients after AMI.

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