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Background: Active infection is generally considered a contraindication for heart transplantation. The rare combination of a patient with an active Coxiella burnetii infection and a congenital corrected transposition of the great arteries requiring heart transplantation impose challenging treatment decisions. We would like to demonstrate that if Q fever is restricted to the heart only, heart transplantation is also beneficial from an infectious point of view, therefore treating two severe conditions simultaneously., Case Summary: A patient with end-stage heart failure due to congenital corrected transposition of the great arteries and requiring heart transplantation developed chronic Q fever and endocarditis. Different antibiotic regimes were tried due to severe adverse reactions. Antibiotic treatment was precisely monitored by measuring Q fever polymerase chain reaction (PCRs) and phase I IgG antibody titres. A positron emission tomography scan revealed that Q fever was confined to the heart only after which it was decided to perform heart transplantation. Based on the results of PCR and antibody testing, antibiotic treatment was stopped after 1 year. After 5 years of follow-up, patient is still in an optimal condition., Discussion: In case of a patient with end-stage heart failure and chronic Q fever, a combined treatment with PCR-/antibody monitored antibiotics and heart transplantation can cure both conditions., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Aims: Left ventricular (LV) ejection fraction is an important determinant of prognosis in heart failure. We evaluated the accuracy of a novel algorithm for LV ejection fraction quantification based on indicator dilution curve (IDC) principles using ultrasound contrast as indicator, and compared the results with contrast enhanced biplane LV ejection fraction assessment. Method A diluted ultrasound contrast bolus (SonoVue) was injected intravenously in 31 patients (19 male, age 65 +/- 11) with known or suspected heart disease. A total of 68 recordings were made. The developed algorithm used the left atrium and LV IDC for LV ejection fraction measurement. Biplane enhanced LV ejection fraction measurements with pure ultrasound contrast (SonoVue) were determined in multiple four- and two-chamber recordings as reference., Results: The mean LV ejection fraction measured by biplane and IDC method was 33 +/- 17% and 35 +/- 18%, respectively. A correlation coefficient r = 0.93 was observed between the two methods. Bland-Altman analysis demonstrated a slight LV ejection fraction overestimation with IDC (mean 1.9 +/- 6.3%)., Conclusion: A new fast method for LV ejection fraction assessment based on IDC principles is described and comparison with contrast enhanced biplane LV ejection fraction quantification shows accurate results.

The long-term effects of oral nisoldipine or placebo on clinical variables, exercise test results and echo Doppler-determined systolic and diastolic functions were studied in 30 consecutive patients with reduced left ventricular function (predischarge echocardiographic wall motion score greater than or equal to 8) following myocardial infarction. Groups were comparable in clinical variables, exercise results, echo Doppler measurements and coronary anatomy. During 6 months follow-up, death, reinfarction and bypass surgery or balloon angioplasty were equally distributed. A significant increase in exercise duration and time to onset of ST-depression was found in the nisoldipine treatment group, compared to the placebo group after 3 and 6 months. Time to onset of angina was not significantly different. Echocardiographic indices of left ventricular systolic function (ejection fraction and wall motion score) were unaltered; however, the time-velocity integral of the early diastolic filling phase and the early vs late diastolic flow velocity ratio were significantly increased while the atrial time-velocity integral vs total time-velocity integral was significantly decreased in the nisoldipine treatment group after 3 and 6 months of follow-up. In conclusion, nisoldipine reduced exercise-induced ischaemia, improved exercise capacity and diastolic left ventricular function in postinfarction patients with reduced left ventricular function.

Magnetic resonance (MR) techniques have recently been introduced, allowing quantitative measurement of blood flow with high spatial and temporal resolutions. These techniques are based on the phase of the MR signal rather than on the amplitude, and are referred to as MR phase or velocity mapping. Clinical validation is still lacking. We therefore performed an in vivo validation of such a technique in 17 healthy volunteers. Velocity maps were acquired at 50 ms intervals over the cardiac cycle in the aorta, superior and inferior vena cava. Plots were made of flow velocity and volume flow vs time and used for calculation of left ventricular stroke volume (SV), cardiac output (CO) and venous return. Comparison with Doppler ultrasound (x) yielded y = -7.5 + 1.1x (r = 0.76) for SV measurements (ml), and y = 0.3 + 0.9x (r = 0.86) for CO calculations (1 min-1). Comparison between MR SV (x) and MR determination of venous return (y), obtained by summation of the flow volumes per cardiac cycle in the superior and inferior vena cava, was close to identity, y = 1.3 + 1.0x (r = 0.91). Also, preliminary applications are presented in patients with aortic diseases. The findings of this study show that magnetic resonance velocity imaging can be accurately applied in vivo as a non-invasive means of measuring flow.