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OBJECTIVE: To determine whether, compared with fundamental imaging, second harmonic imaging can improve the accuracy of dobutamine stress echocardiography for identifying viable myocardium, using nuclear imaging as a reference. PATIENTS: 30 patients with chronic left ventricular dysfunction (mean (SD) age, 60 (8) years; 22 men). METHODS: Dobutamine stress echocardiography was carried out in all patients using both fundamental and second harmonic imaging. All patients underwent dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) with (99m)technetium-tetrofosmin/(18)F-fluorodeoxyglucose on a separate day. Myocardial viability was considered present by dobutamine stress echocardiography when segments with severe dysfunction showed a biphasic sustained improvement or an ischaemic response. Viability criteria on DISA-SPECT were normal or mildly reduced perfusion and metabolism, or perfusion/metabolism mismatch. RESULTS: Using fundamental imaging, 330 segments showed severe dysfunction at baseline; 144 (44%) were considered viable. The agreement between dobutamine stress echocardiography by fundamental imaging and DISA-SPECT was 78%, kappa = 0.56. Using second harmonic imaging, 288 segments showed severe dysfunction; 138 (48%) were viable. The agreement between dobutamine stress echocardiography and DISA-SPECT was significantly better when second harmonic imaging was used (89%, kappa = 0.77, p = 0.001 v fundamental imaging). CONCLUSIONS: Second harmonic imaging applied during dobutamine stress echocardiography increases the agreement with DISA-SPECT for detecting myocardial viability.

Objective—To study differences between repetitive monomorphic ventricular tachycardia (RMVT) of right ventricular origin, and ventricular tachycardia in arrhythmogenic right ventricular dysplasia (ARVD). Patients—Consecutive groups with RMVT (n = 15) or ARVD (n = 12), comparable for age and function. Methods—Analysis of baseline, tachycardia, and signal averaged ECGs, clinical data, and right endomyocardial biopsies. Pathological findings were related to regional depolarisation (QRS width) and repolarisation (QT interval, QT dispersion). Results—There was no difference in age, ejection fraction, QRS width in leads I, V1, and V6, and QT indices. During ventricular tachycardia, more patients with ARVD had a QS wave in V1 (p

Inflammation plays an important part in the pathophysiology of coronary artery disease (CAD).1 High sensitive C reactive protein (hsCRP) reflects activation of the inflammatory system and independently predicts risk of first coronary events at all levels of low density lipoprotein (LDL)-cholesterol and a full spectrum of Framingham risk categories.2 Recent trials indicate that statins reduce inflammation.3,4 This leads to a better clinical outcome and reduces the rate of atherosclerosis progression independently of the reduction in cholesterol levels. The reasons why patients with raised levels of C reactive protein (CRP) have a worse outcome are, however, not clear. The inflammatory biomarkers interleukin 6 (IL6), soluble tumour necrosis factor receptors (sTNFr) 1 and 2 have proinflammatory and procoagulant properties. Our first aim was to evaluate whether high levels of hsCRP in patients with stable CAD receiving standard statin treatment are associated with activation of these biomarkers. Our second aim was to evaluate whether hsCRP and cytokine levels are determined by LDL-cholesterol or by neurohumoral activation measured by levels of N-terminal pro-B type natriuretic peptide (NT-proBNP). We analysed a subgroup of an ongoing prospective study comprising 153 statin treated patients with stable CAD. They were evaluated >6 months from myocardial infarction or cardiac revascularisation, and were free from infection, inflammatory diseases, malignancy and anti-inflammatory treatment. …

A case is reported of haemodynamic collapse in a 51 year old male heterotopic heart transplant recipient caused by native heart ventricular tachycardia. An accurate diagnosis was made by selective right and left sided electrocardiography. Synchronised electrical cardioversion of the native heart (200 J) resulted in restoration of sinus rhythm with prompt relief of symptoms and amelioration of the clinical situation. Keywords: transplantation; ventricular tachycardia