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We sought to determine whether the thickness of the non-contrast-enhanced myocardial rim (RIM) predicts recovery of territorial myocardial function after revascularization in chronic ischemic cardiomyopathy (ICM).Non-contrast-enhanced dysfunctional myocardium at late gadolinium-enhanced CMR depicts the presence of viable myocardium.In 29 patients (65 +/- 8 years) with ICM (EF 33 +/- 10), ceCMR and cine images were acquired 5 +/- 10 days before revascularization. Cine images were repeated after 6 months. Regional wall thickness, wall thickening and RIM were determined in each of 12 segments per short-axis slice (4-8/patient), which were assigned to the respective supplying coronary artery (LAD, LCX and RCA). A threshold for normal wall-thickening was derived from a control group (n = 14; 52 +/- 17 years). Functional improvement at follow-up was defined as wall thickening2 mm.Of the 1,896 analyzed segments, 655 segments showed severe dysfunction. At follow-up, 307 segments demonstrated functional improvement. The RIM differed between segments with and without improvement (6.6 +/- 2.4 mm vs. 2.8 +/- 2.0 mm; p0.0001). The area under the receiver operator characteristic (ROC) for predicting overall functional recovery was 0.91 (95%, CI 0.88-0.93, p0.001). A RIM of 4.0 mm predicted functional recovery after revascularization of the supplying coronary artery with a sensitivity and a specificity of 88 and 82% for the LAD, 96 and 86% for the RCA and 88 and 83% for the LCX, respectively.RIM may be a useful marker for predicting territorial functional recovery after revascularization in patients with chronic ICM.

Recently, a new generation of transesophageal echocardiography (TEE) probes with a novel matrix array technique was introduced, allowing three-dimensional (3D) presentation of cardiac structures in real-time. This article aims to describe our first experiences with this new technique in the guidance of percutaneous cardiac interventions in the catheter laboratory. We used a matrix array 3D TEE probe connected to a 3D-capable echocardiographic system. The 3D TEE system provides exact imaging of the pathomorphology of cardiac structures as well as intracardiac catheters and devices in real-time. We applied this innovative technique to monitor percutaneous cardiac interventions in the catheter laboratory, such as atrial septal defect (ASD) or patent foramen ovale (PFO) closures, revalving procedures such as percutaneous transvenous mitral valve annuloplasty (PTMA), aortic valve replacements, and electrophysiological procedures. Our findings demonstrate that real-time 3D TEE provides a novel imaging technique to guide interventions in the catheter laboratory, providing fast and complete information about the underlying pathomorphology, improving spatial orientation, and additionally monitoring online the procedure without loss of image quality. These benefits may accelerate the learning curve and improve confidence of the interventional cardiologist in order to increase safety, accuracy, and efficacy of interventional cardiac procedures.

Stress cardiomyopathy is a novel clinical syndrome affecting predominantly elderly female patients. It is characterized by severe reversible left ventricular dysfunction demonstrating a peculiar pattern of extensive apical wall motion abnormality known as "apical ballooning". The syndrome is typically precipitated by acute severe emotional, psychological or physical stress. It mimics acute coronary syndrome exhibiting typical clinical and electrocardiographic features of acute myocardial infarction. At angiography, however, significant coronary artery disease is invariably excluded. In the acute phase, the syndrome may be complicated by cardiogenic shock or ventricular fibrillation. Clinical data indicate that the disease is associated with an extensive increase of endogenous cathecholamine levels which may exhibit a direct toxic effect on the myocytes causing non-ischemic myocardial "stunning". This mechanism may have important implications for the management of patients in the acute phase of the disease. The prognosis of stress cardiomyopathy, however, seems favorable with recovery of global and regional myocardial function within a few weeks in the vast majority of patients. Yet, long-term outcome data in larger patient populations are lacking. We report the case of a female patient presenting with stress cardiomyopathy and review the current knowledge of the disease.