Although there are considerable individual variations, in general myopic eyes are elongated relative to emmetropic eyes, more in length than in height and even less in width. Approximately a quarter of the myopic participants fitted each of the global expansion or axial elongation model exclusively. The small proportions are due primarily to the large variability in the dimensions of emmetropic eyes.

T ransthoracic echocardiography (TTE) is the standard clinical tool for initial assessment and longitudinal evaluation of patients with valvular heart disease.1 Current clinical guidelines for the management of adults with chronic valve regurgitation include clear recommendations for measuring regurgitant severity.1,2 Quantification is recommended as a tool to identify patients at risk of adverse long-term physiological consequences, including irreversible left ventricular (LV) contractile dysfunction, and to prevent adverse clinical outcomes, including heart failure, sudden death, and cardiovascular mortality. Clinical Perspective on p 57TTE allows measurement of regurgitant volume (RVol), fraction, and orifice area and has been well validated in both experimental and clinical studies. 2 In addition, regurgitant orifice area (ROA) has been shown to be predictive of clinical outcome for both aortic regurgitation (AR) and mitral regurgitation (MR). 3 However, echocardiographic quantification of valve regurgitation can be challenging because of poor acoustic windows, dynamic or eccentric jets, and geometric assumptions. 2,4,5 Cardiovascular magnetic resonance (CMR) is an alternative modality for assessing patients with chronic valve regurgitation based on measurement of LV volumes and phase-contrast velocity mapping.6-8 CMR has several potential advantages compared with TTE, including improved endocardial definition, fewer geometric assumptions, and less angle dependence for flow measurements. However there are few data on direct systematic comparisons, including reproducibility, between TTE and CMR for quantitation of AR and MR. Thus, we hypothesized that CMR has less interobserver variability when quantifying chronic AR and MR and thus may be preferable for longitudinal follow-up in individual patients.Background-Both transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) imaging allow quantification of chronic aortic regurgitation (AR) and mitral regurgitation (MR). We hypothesized that CMR measurement of regurgitant volume (RVol) is more reproducible than TTE.Methods and Results-TTE and CMR performed on the same day in 57 prospectively enrolled adults (31 with AR, 26 with MR) were measured by 2 independent physicians. TTE RVol AR was calculated as Doppler left ventricular outflow minus inflow stroke volume. RVol MR was calculated by both the proximal isovelocity surface area method and Doppler volume flow at 2 sites. CMR RVol AR was calculated by phase-contrast velocity mapping at the aortic sinuses and RVol MR as total left ventricular minus forward stroke volume. Intraobserver and interobserver variabilities were similar. For AR, the Bland-Altman mean interobserver difference in RVol was −0.7 mL (95% confidence interval [CI], −5 to 4) for CMR and −9 mL (95% CI, −53 to −36) for TTE. The Pearson correlation was higher (P=0.001) between CMR (0.99) than TTE readers (0.89). For MR, the Bland-Altman mean difference in RVol between observers was −4 mL (95% CI, −21 to 13) for CMR compared with 0....

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Cardiac amyloidosis is a common cause of infiltrative heart disease. The combination of subtle widespread heterogeneous myocardial enhancement on delayed postcontrast inversion recovery T1-weighted images, which may initially be dismissed as a technical error, with ancillary features of restrictive cardiac disease is highly suggestive of cardiac amyloidosis.

This new method improves visualisation of the tricuspid valve and makes analysis easier and less prone to operator error than the current standard technique for MRI assessment of RV volumes.

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BackgroundThe application of transcatheter aortic valve implantation (TAVI) to intermediate‐risk patients is a controversial issue. Of concern, neurological injury in this group remains poorly defined. Among high‐risk and inoperable patients, subclinical injury is reported on average in 75% undergoing the procedure. Although this attendant risk may be acceptable in higher‐risk patients, it may not be so in those of lower risk.Methods and ResultsForty patients undergoing TAVI with the Edwards SAPIEN‐XT ™ prosthesis were prospectively studied. Patients were of intermediate surgical risk, with a mean±standard deviation Society of Thoracic Surgeons score of 5.1±2.5% and a EuroSCORE II of 4.8±2.4%; participant age was 82±7 years. Clinically apparent injury was assessed by serial National Institutes of Health Stroke Scale assessments, Montreal Cognitive Assessments (MoCA), and with the Confusion Assessment Method. These identified 1 (2.5%) minor stroke, 1 (2.5%) episode of postoperative delirium, and 2 patients (5%) with significant postoperative cognitive dysfunction. Subclinical neurological injury was assessed using brain magnetic resonance imaging, including diffusion‐weighted imaging (DWI) sequences preprocedure and at 3±1 days postprocedure. This identified 68 new DWI lesions present in 60% of participants, with a median±interquartile range of 1±3 lesions/patient and volumes of infarction of 24±19 μL/lesion and 89±218 μL/patient. DWI lesions were associated with a statistically significant reduction in early cognition (mean ΔMoCA −3.5±1.7) without effect on cognition, quality of life, or functional capacity at 6 months.ConclusionsObjectively measured subclinical neurological injuries remain a concern in intermediate‐risk patients undergoing TAVI and are likely to manifest with early neurocognitive changes.Clinical Trial Registration URL: http://www.anzctr.org.au. Australian & New Zealand Clinical Trials Registry: ACTRN12613000083796.