775
Prognostic value of radial artery IMT
16.
17. 18.
19.
20.
symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012;34:290 –6. Khot UN, Friedman DT, Pettersson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation 2004;109:2086 – 91. Kobayashi J. Radial artery as a graft for coronary artery bypass grafting. Circ J 2009;73: 1178– 83. Ruengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton B. Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis. Circulation 1999;100 (19 Suppl):II139 –44. van der Heijden-Spek JJ, Staessen JA, Fagard RH, Hoeks AP, Boudier HA, van Bortel LM. Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000;35:637–42. Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME. Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. Arterioscler Thromb 1993;13:90– 7.
21. Dammers R, Stifft F, Tordoir JH, Hameleers JM, Hoeks AP, Kitslaar PJ. Shear stress depends on vascular territory: comparison between common carotid and brachial artery. J Appl Physiol 2003;94:485 –9. 22. Reneman RS, Hoeks AP. Wall shear stress as measured in vivo: consequences for the design of the arterial system. Med Biol Eng Comput 2008;46:499 –507. 23. Doriot PA, Dorsaz PA, Dorsaz L, De Benedetti E, Chatelain P, Delafontaine P. In-vivo measurements of wall shear stress in human coronary arteries. Coron Artery Dis 2000; 11:495–502. 24. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA 1999;282:2035 –42. 25. Samijo SK, Willigers JM, Barkhuysen R, Kitslaar PJ, Reneman RS, Brands PJ et al. Wall shear stress in the human common carotid artery as function of age and gender. Cardiovasc Res 1998;39:515 –22. 26. Dammers R, Tordoir JH, Hameleers JM, Kitslaar PJ, Hoeks AP. Brachial artery shear stress is independent of gender or age and does not modify vessel wall mechanical properties. Ultrasound Med Biol 2002;28:1015 –22. 27. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006;37:87–92.
IMAGE FOCUS
doi:10.1093/ehjci/jet283 Online publish-ahead-of-print 23 January 2014
.............................................................................................................................................................................
Multimodality imaging of mid-ventricular obstruction in left ventricular noncompaction
1 Referral Centre for Primary Cardiomyopathies, Cardio-thoracic and Vascular Department, San Raffaele University Hospital, Milan, Italy; 2Department of Radiology, San Raffaele University Hospital, Milan, Italy; and 3San Raffaele Vita-Salute University, Milan, Italy
* Corresponding author. Tel: +39 0226437608; Fax: +39 0226436218, Email: [email protected]
Noncompaction cardiomyopathy (NCM) is a myocardial disorder, which is thought to occur due to the failure of left ventricle (LV) compaction during embryogenesis, leading to distinct morphological characteristics in the ventricular chamber. The exact prevalence of NCM is still unknown. Several limitations for this assessment are the different diagnostic criteria, the heterogeneous populations, and the retrospective design of most studies. The reported prevalence of NCM in patients referred to echocardiography laboratories ranges between 0.014 and 1.26%. We report of a 42-year-old woman that underwent transthoracic echocardiography for the recent onset of a transient ischemic attack. Echo images revealed a rare case of apical left ventricular noncompaction (LVNC) (Panel A, Supplementary data online, Video S1) with mid-ventricular obstruction (white arrows). A mid-ventricular diastolic gradient of 20 mmHg was present after Valsalva maneuver at pulsed-wave Doppler analysis (Panel B). A diastolic gradient was also present during ventricular ectopic beats (Panel C) with mild increase in the systolic gradient (Panel D). Cardiac magnetic resonance (CMR) two-chamber views (Panel E: diastole; Panel F: systole) confirmed apical LVNC (Supplementary data online, Video S2). Late-gadolinium analysis (Panels G and H) showed a large area of apical myocardial fibrosis compatible with LV aneurysm. Usually, LVNC leads to systolic heart failure and sudden cardiac death. The presence of mid-ventricular obstruction with apical aneurysm is a rare condition with important prognostic and therapeutic implications in LVNC. Multimodality cardiac imaging with CMR integration could better identify patients with large extension of myocardial fibrosis, an important marker for systolic dysfunction progression and ventricular arrhythmias. Moreover, CMR could be more sensitive than echocardiography alone in detecting apical thrombi. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 17, 2015
Roberto Spoladore1*, Umberto Gianni1, Alberto Castella1, Francesco De Cobelli2,3, and Paolo G. Camici1,3
Prognostic value of radial artery IMT
16.
17. 18.
19.
20.
symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012;34:290 –6. Khot UN, Friedman DT, Pettersson G, Smedira NG, Li J, Ellis SG. Radial artery bypass grafts have an increased occurrence of angiographically severe stenosis and occlusion compared with left internal mammary arteries and saphenous vein grafts. Circulation 2004;109:2086 – 91. Kobayashi J. Radial artery as a graft for coronary artery bypass grafting. Circ J 2009;73: 1178– 83. Ruengsakulrach P, Sinclair R, Komeda M, Raman J, Gordon I, Buxton B. Comparative histopathology of radial artery versus internal thoracic artery and risk factors for development of intimal hyperplasia and atherosclerosis. Circulation 1999;100 (19 Suppl):II139 –44. van der Heijden-Spek JJ, Staessen JA, Fagard RH, Hoeks AP, Boudier HA, van Bortel LM. Effect of age on brachial artery wall properties differs from the aorta and is gender dependent: a population study. Hypertension 2000;35:637–42. Benetos A, Laurent S, Hoeks AP, Boutouyrie PH, Safar ME. Arterial alterations with aging and high blood pressure. A noninvasive study of carotid and femoral arteries. Arterioscler Thromb 1993;13:90– 7.
21. Dammers R, Stifft F, Tordoir JH, Hameleers JM, Hoeks AP, Kitslaar PJ. Shear stress depends on vascular territory: comparison between common carotid and brachial artery. J Appl Physiol 2003;94:485 –9. 22. Reneman RS, Hoeks AP. Wall shear stress as measured in vivo: consequences for the design of the arterial system. Med Biol Eng Comput 2008;46:499 –507. 23. Doriot PA, Dorsaz PA, Dorsaz L, De Benedetti E, Chatelain P, Delafontaine P. In-vivo measurements of wall shear stress in human coronary arteries. Coron Artery Dis 2000; 11:495–502. 24. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA 1999;282:2035 –42. 25. Samijo SK, Willigers JM, Barkhuysen R, Kitslaar PJ, Reneman RS, Brands PJ et al. Wall shear stress in the human common carotid artery as function of age and gender. Cardiovasc Res 1998;39:515 –22. 26. Dammers R, Tordoir JH, Hameleers JM, Kitslaar PJ, Hoeks AP. Brachial artery shear stress is independent of gender or age and does not modify vessel wall mechanical properties. Ultrasound Med Biol 2002;28:1015 –22. 27. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006;37:87–92.
IMAGE FOCUS
doi:10.1093/ehjci/jet283 Online publish-ahead-of-print 23 January 2014
.............................................................................................................................................................................
Multimodality imaging of mid-ventricular obstruction in left ventricular noncompaction
1 Referral Centre for Primary Cardiomyopathies, Cardio-thoracic and Vascular Department, San Raffaele University Hospital, Milan, Italy; 2Department of Radiology, San Raffaele University Hospital, Milan, Italy; and 3San Raffaele Vita-Salute University, Milan, Italy
* Corresponding author. Tel: +39 0226437608; Fax: +39 0226436218, Email: [email protected]
Noncompaction cardiomyopathy (NCM) is a myocardial disorder, which is thought to occur due to the failure of left ventricle (LV) compaction during embryogenesis, leading to distinct morphological characteristics in the ventricular chamber. The exact prevalence of NCM is still unknown. Several limitations for this assessment are the different diagnostic criteria, the heterogeneous populations, and the retrospective design of most studies. The reported prevalence of NCM in patients referred to echocardiography laboratories ranges between 0.014 and 1.26%. We report of a 42-year-old woman that underwent transthoracic echocardiography for the recent onset of a transient ischemic attack. Echo images revealed a rare case of apical left ventricular noncompaction (LVNC) (Panel A, Supplementary data online, Video S1) with mid-ventricular obstruction (white arrows). A mid-ventricular diastolic gradient of 20 mmHg was present after Valsalva maneuver at pulsed-wave Doppler analysis (Panel B). A diastolic gradient was also present during ventricular ectopic beats (Panel C) with mild increase in the systolic gradient (Panel D). Cardiac magnetic resonance (CMR) two-chamber views (Panel E: diastole; Panel F: systole) confirmed apical LVNC (Supplementary data online, Video S2). Late-gadolinium analysis (Panels G and H) showed a large area of apical myocardial fibrosis compatible with LV aneurysm. Usually, LVNC leads to systolic heart failure and sudden cardiac death. The presence of mid-ventricular obstruction with apical aneurysm is a rare condition with important prognostic and therapeutic implications in LVNC. Multimodality cardiac imaging with CMR integration could better identify patients with large extension of myocardial fibrosis, an important marker for systolic dysfunction progression and ventricular arrhythmias. Moreover, CMR could be more sensitive than echocardiography alone in detecting apical thrombi. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]
Downloaded from by guest on November 17, 2015
Roberto Spoladore1*, Umberto Gianni1, Alberto Castella1, Francesco De Cobelli2,3, and Paolo G. Camici1,3
