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We report a case of tako-tsubo cardiomyopathy, complicated by left ventricular apical thrombus. [ABSTRACT FROM AUTHOR]

In a prospective study, atrial morphology was evaluated by both transoesophageal and precordial echocardiography in 86 unoperated children with congenital heart disease (age range = 0.2 to 14.8 years, mean = 3.8 years) to determine what advantages, if any, might be inherent in the transoesophageal approach. The information derived from both ultrasound approaches was correlated and compared to information obtained during subsequent cardiac catheterization (78patients) and, or, surgical inspection (53 patients). A trial appendage morphology and hence atrial sit us was determined by transoesophageal echocardiography in every case (82 solitus, two right atrial isomerism, two left atrial isomerism). In addition, the transoesophageal approach indicated left juxtaposition in four patients, compared to only one by precordial examination. Probe patency of the foramen ovale was correctly predicted in 21 patients by transoesophageal imaging, but in only 10 by precordial imaging. In two children significant secundum defects, undetected by the precordial route, were identified. Multiple atrial septal defects were correctly defined infour patients by transoesophagealstudy but in only one by precordial study. Sinus venosus defects were documented in four by the transoesophageal approach, but in only one by the precordial. Primum defects were equally well documented (nine patients) by either technique, but the associated valve leaflet morphology was better documented by transoesophageal study in 5/9. A subtotal cor triatriatum was diagnosed in one child only by transoesophageal investigation. Transoesophageal echocardiography allows a much more detailed evaluation of atrial morphology than precordial imaging even in infants. It provides direct diagnosis of atrial situs, detection ofjuxtaposed atrial appendages and improved demonstration or definitive exclusion of atrial septal defects. [ABSTRACT FROM PUBLISHER]

To determine the relative value of exercise two-dimensional echocardiography and 99m Tc methoxyisobutylisonitrile single photon emission computed tomography (MIBI SPECT) for the detection of myocardial ischaemia, 103 consecutive patients with either proven or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques during the same symptom-limited upright bicycle exercise test. Appropriate echocardiographic images were recorded both at rest and immediately post-exercise and subsequently analysed by means of digital cine loop processing. Both echocardiographic and MIBI SPECT images were visually analysed. For each technique, three different responses to exercise were defined: normal (absence of rest and exercise abnormalities), ischaemic (transient scintigraphic perfusion defects and transient wall motion abnormalities during exercise echocardiography); and fixed abnormalities (fixed scintigraphic perfusion defects; echocardiographic wall motion abnormalities at rest without worsening after exercise). To allow a valid comparison of each technique in localizing ischaemia, the left ventricle was divided into the following six major regions for both methods: anterior, posterolateral, inferior, interventricular septum (subdivided in anterior and posterior septum) and apex. Eleven of the 103 patients had to be excluded from the final analysis because of unsatisfactory examinations: seven with non-interpretable exercise echocardiograms and four with non-interpretable MIBI SPECT images. The response to exercise was concordantly classified by both techniques in 84% ofpatients (k = 0·18). Exercise echocardiography revealed the presence of ischaemia in 38 and MIBI SPECT in 45 patients (agreement = 77%). When regional analysis was performed, concordance of exercise echocardiography and MIBI SPECT was observed in 91% of the 552 regions (k = 0·81), while agreement for the presence of myocardial ischaemia was lower (72%), with a trend for a higher occurrence of transient perfusion defects in posterolateral and inferior regions and in patients with previous myocardial infarction. In the 30 patients without previous myocardial infarction who underwent coronary angiography, the sensitivities of exercise ECG, echocardiography and SPECT for the diagnosis of coronary artery disease (diameter stenosis ≥ 50%) were 56%, 70% and 77%, respectively. [ABSTRACT FROM PUBLISHER]

To determine the relative value of exercise two-dimensional echocardiography and 99m Tc methoxyisobutylisonitrile single photon emission computed tomography (MIBI SPECT) for the detection of myocardial ischaemia, 103 consecutive patients with either proven or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques during the same symptom-limited upright bicycle exercise test. Appropriate echocardiographic images were recorded both at rest and immediately post-exercise and subsequently analysed by means of digital cine loop processing. Both echocardiographic and MIBI SPECT images were visually analysed. For each technique, three different responses to exercise were defined: normal (absence of rest and exercise abnormalities), ischaemic (transient scintigraphic perfusion defects and transient wall motion abnormalities during exercise echocardiography); and fixed abnormalities (fixed scintigraphic perfusion defects; echocardiographic wall motion abnormalities at rest without worsening after exercise). To allow a valid comparison of each technique in localizing ischaemia, the left ventricle was divided into the following six major regions for both methods: anterior, posterolateral, inferior, interventricular septum (subdivided in anterior and posterior septum) and apex. Eleven of the 103 patients had to be excluded from the final analysis because of unsatisfactory examinations: seven with non-interpretable exercise echocardiograms and four with non-interpretable MIBI SPECT images. The response to exercise was concordantly classified by both techniques in 84% ofpatients (k = 0·18). Exercise echocardiography revealed the presence of ischaemia in 38 and MIBI SPECT in 45 patients (agreement = 77%). When regional analysis was performed, concordance of exercise echocardiography and MIBI SPECT was observed in 91% of the 552 regions (k = 0·81), while agreement for the presence of myocardial ischaemia was lower (72%), with a trend for a higher occurrence of transient perfusion defects in posterolateral and inferior regions and in patients with previous myocardial infarction. In the 30 patients without previous myocardial infarction who underwent coronary angiography, the sensitivities of exercise ECG, echocardiography and SPECT for the diagnosis of coronary artery disease (diameter stenosis ≥ 50%) were 56%, 70% and 77%, respectively. [ABSTRACT FROM PUBLISHER]

To determine the relative value of exercise two-dimensional echocardiography and 99m Tc methoxyisobutylisonitrile single photon emission computed tomography (MIBI SPECT) for the detection of myocardial ischaemia, 103 consecutive patients with either proven or suspected coronary artery disease, who were referred for perfusion scintigraphy, were studied by a combination of the two techniques during the same symptom-limited upright bicycle exercise test. Appropriate echocardiographic images were recorded both at rest and immediately post-exercise and subsequently analysed by means of digital cine loop processing. Both echocardiographic and MIBI SPECT images were visually analysed. For each technique, three different responses to exercise were defined: normal (absence of rest and exercise abnormalities), ischaemic (transient scintigraphic perfusion defects and transient wall motion abnormalities during exercise echocardiography); and fixed abnormalities (fixed scintigraphic perfusion defects; echocardiographic wall motion abnormalities at rest without worsening after exercise). To allow a valid comparison of each technique in localizing ischaemia, the left ventricle was divided into the following six major regions for both methods: anterior, posterolateral, inferior, interventricular septum (subdivided in anterior and posterior septum) and apex. Eleven of the 103 patients had to be excluded from the final analysis because of unsatisfactory examinations: seven with non-interpretable exercise echocardiograms and four with non-interpretable MIBI SPECT images. The response to exercise was concordantly classified by both techniques in 84% ofpatients (k = 0·18). Exercise echocardiography revealed the presence of ischaemia in 38 and MIBI SPECT in 45 patients (agreement = 77%). When regional analysis was performed, concordance of exercise echocardiography and MIBI SPECT was observed in 91% of the 552 regions (k = 0·81), while agreement for the presence of myocardial ischaemia was lower (72%), with a trend for a higher occurrence of transient perfusion defects in posterolateral and inferior regions and in patients with previous myocardial infarction. In the 30 patients without previous myocardial infarction who underwent coronary angiography, the sensitivities of exercise ECG, echocardiography and SPECT for the diagnosis of coronary artery disease (diameter stenosis ≥ 50%) were 56%, 70% and 77%, respectively. [ABSTRACT FROM PUBLISHER]

The authors describe a case of spontaneous angina during catheterization in a patient with left anterior descending and circumflex stenosis promptly relieved by diltiazem, 10 mg, given in the left ventricle. Coronary and systemic haemodynamics measured during and at the end of angina demonstrated an increase in blood flow to the ischaemic myocardium as the mechanism responsible for the diltiazem-induced angina relief. [ABSTRACT FROM PUBLISHER]

The authors describe a case of spontaneous angina during catheterization in a patient with left anterior descending and circumflex stenosis promptly relieved by diltiazem, 10 mg, given in the left ventricle. Coronary and systemic haemodynamics measured during and at the end of angina demonstrated an increase in blood flow to the ischaemic myocardium as the mechanism responsible for the diltiazem-induced angina relief. [ABSTRACT FROM PUBLISHER]

An abstract of the article "Myocardial viability predicts reverse remodelling after cardiac resynchronization therapy (CRT): a 2D strain echocardiography (2DSE) study," by R. Iengo and colleagues is presented.

An abstract of the article "Comparison among different intraventricular asynchrony indices to predict revese remodelling after cardiac resynchronization therapy (crt)," by L. Ascione and colleagues is presented.

An abstract of the article "Ultrasonographic assessment of coronary flow reserve to predict significant left anterior descending artery stenosis in patients with inferior acute myocardial infarction" by L. Ascione, S. Rumolo and M. Accadia is presented.

An abstract of the article "Impact of acute hyperhomocysteinemia on coronary flow reserve in healthy adults" by L. Ascione and colleagues is presented.