BackgroundMany echocardiographic parameters have been proposed to evaluate right ventricular (RV) systolic function. We comprehensively assessed a wide range of quantitative echocardiographic parameters in a single cohort compared with same-day cardiovascular magnetic resonance (CMR).Methods and results92 subjects were examined prospectively: Group 1 consisted of 46 healthy controls (21 males, 33.4 ± 11.4 years), Group 2 consisted of 46 patients (20 males, 38.5 ± 18.9 years) undergoing RV functional assessment by CMR (1.5 T). Echocardiography was performed on the same day as CMR; fractional area change (RVFAC), myocardial performance index via spectral Doppler (RVMPI), RVMPI via Doppler tissue imaging (RVMPI-DTI), peak systolic myocardial velocity by DTI (RVSm), tricuspid annular plane systolic excursion (TAPSE), speckle tracking strain, and three dimensional right ventricular ejection fraction (3DE-RV). Linear regression, Bland–Altman and receiver-operator-characteristic (ROC) analyses were performed. At ROC analysis, the most predictive echocardiographic methods were; RVFAC (AUC = 0.892), RVMPI (AUC 0.785), TAPSE (AUC 0.849) and 3DE-RV (AUC 0.909). 3DE-RV appeared the most accurate compared to CMR, although underestimated true RV volumes.ConclusionAs compared to CMR; 3DE-RV, RVFAC, TAPSE and RVMPI were the most reliable predictors of RV function. These parameters can be recommended for clinical use.

BackgroundLate gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis.Method44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at > 2 and > 5 standard-deviations (SD) above reference myocardium, and compared to biomarkers.FindingsMean door-to-CMR time was 57 hours. 18 patients (41%) had LGE > 2 SD localized to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was > 5 SD above normal myocardium, representing 12.1 ± 10% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p < 0.05) but lower than in STEMI patients (p < 0.05). Mean troponin was significantly higher in LGE positive patients (2.5 ± 1.8 vs 4.4 ± 6.9, p = 0.001). Mean ejection fraction (EF) by CMR was 45% ± 8.7 in LGE-negative, and 40% ± 7.1 in LGE-positive patients (p = 0.37). Recovery of segmental function was confirmed at follow-up, mean EF was 59% in both groups.ConclusionLGE was present in 41% of cases of TTC, 89% of which had intense enhancement > 5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.

Summary: Published data on the use of transtelephonic electrocardiographic monitoring for evaluation of episodic symptoms suggestive of cardiac arrhythmia are sparse and conflicting. We have reviewed the use of one such device 'Cardiomemo' on our unit over an 18 month period. The study showed that transtelephonic electrocardiographic monitoring is useful in documentation of infrequent or sporadic episodes directly related to symptoms when 24-hour ambulatory electrocardiograph monitoring is normal.

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Antiplatelet therapy constitutes a cornerstone in the strategies aimed at the effective management of acute coronary syndrome. Abciximab is the oldest and most commonly used intravenous antiplatelet agent in this context, in particular when an invasive strategy is adopted. It is very commonly used in more unstable and high-risk patients. Trials have proven the event-free survival benefits of using abciximab in the right context. This agent also has some adverse outcomes associated with its use that the clinicians need to be well aware of and take precautions against. The comparative cost efficacy with its use too is of significance. There is a growing evidence base on the different ways abciximab is used and the benefits and risks thereof. Since the development and introduction of novel anticoagulants and more potent oral anti-platelet agents, the place of abciximab in the treatment of acute coronary syndrome today needs to be reviewed and clearly defined. This review attempts to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of abciximab and spotlight the most recent guidelines published by the different global peak bodies to provide a practical overview to the clinician.

Presented is a case report of a 54-year-old male Jehovah's Witness diagnosed with an anomalous right coronary artery originating from the main pulmonary artery with the initial presentation with a history of episodic fatigue, chest pain, palpitation, and bodily weakness. The patient was managed with reimplantation of the anomalous coronary artery onto the ascending aorta.

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