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Almahata Sitta (AhS), an anomalous polymict ureilite, is the first meteorite observed to originate from a spectrally classified asteroid (2008 TC(3)). However, correlating properties of the meteorite with those of the asteroid is not straightforward because the AhS stones are diverse types. Of those studied prior to this work, 70–80% are ureilites (achondrites) and 20–30% are various types of chondrites. Asteroid 2008 TC(3) was a heterogeneous breccia that disintegrated in the atmosphere, with its clasts landing on Earth as individual stones and most of its mass lost. We describe AhS 91A and AhS 671, which are the first AhS stones to show contacts between ureilitic and chondritic materials and provide direct information about the structure and composition of asteroid 2008 TC(3). AhS 91A and AhS 671 are friable breccias, consisting of a C1 lithology that encloses rounded to angular clasts (

Monazite-(Ce) and xenotime-(Y) from tertiary pegmatites of the central Alps (Italy and Switzerland) were studied by EMPA and SCXRD analytical methods. The REE-phosphate minerals analyzed are from LCT and NYF pegmatite dikes of the Central Alps, which includes three main areas: Vigezzo (LCT and NYF from the Vigezzo valley), Bodengo (NYF from the Leggia valley and LCT from the Cama valley), and Codera (LCT from Codera and Chiavenna valleys and Alpe Rossaccio). SEM-BSE images of monazite-(Ce) show primary growth zoning, sector zoning, and patchy zoning. SEM-BSE images of xenotime-(Y) show faint patchy-type zoning and spongiform texture. Both REE-phosphates evidence secondary mineral replacements that include thorianite, thorite, and uraninite. EMPA compositions show that the monazite-(Ce) is characterized by variable amounts of huttonite (ThSiO 4 ) and cheralite [Ca(Th,U)(PO 4 )] molecules. SCXRD analyses shows that the unit-cell volume of monazite-(Ce) correlates with its chemical composition; the b cell parameter shows an evident relationship with the huttonite molecule. The unit-cell volume of xenotime-(Y) is well correlated to its chemical composition. Xenotime-(Y) related to the NYF family shows a significant increase in yttrium and a lower U + HREE content. The Tertiary pegmatite field of the central Alps is related to the Masino-Bregaglia intrusion, the San Fedelino granite, and younger magmatic pulses generated by the migration of the metamorphic thermal Lepontine Dome towards the west. The presence of poikiloblastic thorite, thorianite, and uraninite in monazite and xenotime can be induced to form from alkali-bearing fluids via coupled dissolution–reprecipitation, under moderate to high-grade and post-peak Alpine metamorphic conditions.

An ultra-miniaturised (mass 1.5 kg; volume ~22 × 6 × 12 cm3) instrument which combines X-ray diffraction and fluorescence has been developed for the mineralogical and chemical characterization of Martian soils/rocks and was included in the ExoMars-Pasteur payload. The simultaneous in situ acquisition of elemental and mineralogical information would significantly improve any robotic missions and may unravel doubtful points regarding the mantle composition, crustal evolution and resource potential. The instrument employs a fixed reflection geometry to fulfil the diffraction principle which can be applied to unprepared sample as well. The instrument basically consists of a radioisotope as source of X-rays and a CCD-based detection system. This is the first successful diffraction experiment using a radioisotope since the early tests in the 60s. For terrestrial application the radioisotope can be easily replaced with a cathodic tube. The reduced dimension as well as the possibility to perform non-destructive analysis makes it suitable for terrestrial applications, particularly in the archaeometry field. We are envisaging an X-ray tomographer to map the mineralogical and elemental composition of an artefact (i.e., painting, pottery) directly on the object without sample preparation. Nowadays, X-ray radiography or computer tomography are becoming standard techniques widely used and accepted by art historians, archaeologists, curators and conservators as these methods enable information about the manufacturing process and the condition of an object without touching the artefact or even taking original sample material.

Recently it has been shown that the relatively low closure temperature (Tc) of 500 (100)°C calculated for augite from Miller Range nakhlite (MIL 03346,13) using the available geothermometers would correspond to a slow cooling rate inconsistent with the petrologic evidence for an origin from a fast-cooled lava flow. Moreover, previous annealing experiments combined with HR-SC-XRD on an augite crystal from MIL 03346 clearly showed that at 600 °C, the Fe2+-Mg degree of order remained unchanged, thus suggesting that the actual Tc is close to this temperature. In order to clarify this discrepancy, we undertook an ex situ annealing experimental study at 700, 800, and 900 °C, until the equilibrium in the intracrystalline Fe2+-Mg exchange is reached, using an augite crystal from Miller Range nakhlite (MIL 03346,13) with a composition of about En36Fs24Wo40. These data allowed us to calculate the following new geothermometer calibration for Martian nakhlites: where The application of this new equation to other Martian nakhlites (NWA 988 and Nakhla) suggests that for augite with composition close to that of MIL 03346, the Tc is up to 170 °C higher with respect to the one calculated using the previous available geothermometer equation, thus suggesting a significantly faster cooling in agreement with petrologic evidence.

The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for CR.

The largest field of Alpine Oligocene pegmatite dikes is in the Central Alps within the Southern Steep Belt (SSB) of the Alpine nappes; it extends for about 100 km in an E–W direction and 15 km in a N–S direction north of the Periadriatic Fault, from the Bergell pluton (to the east) to the Ossola valley (to the west). The pegmatite field geographically overlaps (1) the highest temperature domain of the Lepontine Barrovian metamorphic dome and (2) the zone of Alpine migmatization. We have studied pegmatites in two areas: (1) the Codera area on the western border of the Bergell pluton and (2) the Bodengo area between the Mera and the Mesolcina valleys. Most pegmatites show a simple mineral assemblage consisting of K-feldspar, quartz, and muscovite ± biotite, and only a minor percentage of the dikes (< 5%) contains Sn-Nb-Ta-Y-REE-U oxide, Y-REE phosphate, Mn-Fe-phosphate, Ti-Zr-silicate, Be-Y-REE-U-silicate and oxide minerals (beryl, chrysoberyl, bertrandite, bavenite, and milarite), garnet (almandine-spessartine), tourmaline (schorl to rare elbaite), bismuthinite, magnetite, and rarely dumortierite and helvite. The mineral assemblages, geological context, and chemical compositions allow the distinction between LCT (lithium, cesium, tantalum) and mixed LCT-NYF (niobium, yttrium, fluorine) pegmatites (with only one exception of an NYF dike in the Bodengo area). The LCT pegmatites of the Central Alps did not reach a high degree of geochemical evolution. The most fractionated pegmatites are found in the Codera area and contain Mn-rich elbaite, triplite, pink-beryl, and Cs-Rb-rich feldspar. In the Bodengo area pegmatites locally contain miarolitic cavities and the most evolved pegmatites correspond to the beryl-columbite-phosphate type. From a structural point of view two main types of pegmatites can be distinguished: (1) pegmatites that were involved in ductile deformation and (2) pegmatites that postdated the main ductile deformation of the SSB. Many pegmatites of the Codera valley belong to the first structural type: they were emplaced at relatively high ambient temperature (ca. 500 °C) and locally show a pervasive recrystallization of quartz and a mylonitic structure. The Codera dikes trend about 70° and are steeply dipping. In the Bodengo area the main set of pegmatites (trending approximately N–S to NNE–SSW) crosscuts the ductile deformation structures of the SSB, but the area also includes an earlier generation of boudinaged and folded pegmatite dikes. The undeformed pegmatites from this area may contain miarolitic pockets. There is no systematic difference in the mineral assemblage between the two structural types of pegmatites. However, the chemistry of pegmatite minerals, especially of garnet, in addition to field data suggests that the dikes of the Codera and Bodengo areas represent two distinct generations of pegmatites. Structural data and the few existing radiometric ages suggest that pegmatites were emplaced over a time span between 29 and 25 Ma (and possibly as young as 20 Ma), with the youngest dikes postdating the ductile deformations of the Alpine nappes. The present work presents a first comprehensive field description and geochemical – mineralogical characterization of the Alpine pegmatite field of the Central Alps.

We report the case of a patient who underwent Cabrol composite graft procedure for ascending aorta aneurysm and aortic regurgitation. Sixteen years later he developed progressive dyspnea and a left-to-right shunt caused by distal detachment of the valve conduit with persistence of the perigraft space-right atrial fistula visualized with echocardiography. Our case shows that late manifestations of surgical complications of the Cabrol procedure may occur and transesophageal echocardiography may allow a comprehensive assessment in these patients. However, because surgical management of ascending aorta aneurysms has changed in the last decades a detailed knowledge of the surgical technique used is mandatory for adequate interpretation of transesophageal echocardiographic results.

The present-day configuration of the lithosphere in the eastern Alps and more broadly in the northern Adriatic zone, records a multistage geologic evolution that was active since Precambrian times. Major evolutionary events (e.g., ocean opening, collision, subduction, etc.) were marked by the emplacement of large quantities of magmatic products. In this paper we present an overview of the field, petrographic, and geochemical characteristics of the main plutonic and volcanic bodies outcropping in the northern Adriatic zone and spanning from Permian to Cainozoic. Geochemical and petrologic study of these igneous occurrences greatly helped unraveling the geologic history of this area.

Heart failure is the leading cause of hospitalization among the elderly. This study compares clinical characteristics, management, and prognosis of octogenarians (OLD) with younger (YOUNG) patients in the Italian Survey on Acute Heart Failure (AHF).A nationwide, prospective, observational study on AHF was done. Two hundred six Italian departments with intensive cardiac care units enrolled 2,807 patients in 3 months.Octogenarians (mean age 84 +/- 4 years) represented 28% of enrollees. Females were 50% in the OLD group versus 36% in the YOUNG group (P.0001). Risk factors such as obesity, diabetes, and smoking were more frequent in the YOUNG group. Comorbidities such as anemia and renal dysfunction were more common in the OLD group (64% vs 53%, P.0001, and 56% vs 43%, P.0001). More octogenarians were admitted with cardiogenic shock and pulmonary edema, whereas younger patients presented more frequently in New York Heart Association class III to IV (P = .002). Left ventricular ejection fraction was measured in 90% of octogenarians versus 93% of the younger ones and was preserved in 41% of the OLD group versus 31% of the YOUNG group (P.0001). Coronary angiography was performed in 20% of the YOUNG group and 10% of the OLD group. In-hospital mortality was twice as high in the OLD group (11.8% vs 5.6%, P.001). In multivariable analysis, the strongest predictors of this event were use of inotropic agents, advanced age (or =80 years), and elevated troponin at admission.Octogenarians represent more than one fourth of the admissions for AHF and have a more severe clinical presentation. Their management is less aggressive, and treatments recommended by guidelines are underused. In-hospital mortality is high in the OLD group independently of left ventricular ejection fraction.

Melt inclusions in ureilites occur only in the small augite- and orthopyroxene-bearing subgroups. Previously [Goodrich C.A., Fioretti A.M., Tribaudino M. and Molin G. (2001) Primary trapped melt inclusions in olivine in the olivine-augite-orthopyroxene ureilite Hughes 009. Geochim. Cosmochim. Acta65, 621-652] we described melt inclusions in olivine in the olivine-augite-orthopyroxene ureilite Hughes 009 (Hughes). FRO 90054/93008 (FRO) is a near-twin of Hughes, and has abundant melt inclusions in all three primary silicates. We use these inclusions to reconstruct the major, minor and rare earth element composition of the Hughes/FRO parent magma and evaluate models for the petrogenesis of augite-bearing ureilites. Hughes and FRO consist of 23-47 vol % olivine (Fo 87.3 and 87.6, respectively), 7-52 vol % augite (mg 89.2, Wo 37.0 and mg 88.8, Wo 38.0, respectively), and 12-56 vol % orthopyroxene (mg 88.3, Wo 4.9 and mg 88.0, Wo 4.8, respectively). They have coarse-grained (?3 mm), highly-equilibrated textures, with poikilitic relationships indicating the crystallization sequence olivine -> augite -> orthopyroxene. FRO is more shocked than Hughes, experienced greater secondary reduction, and is more weathered. The two meteorites are probably derived from the same lithologic unit. Melt inclusions in olivine consist of glass ± daughter cpx ± metal-sulfide-phosphide spherules ± chromite, and have completely reequilibrated Fe/Mg with their hosts. We follow the method of Goodrich et al. (2001) for reconstructing the composition of the primary trapped liquid they represent (olPTL), but correct an error in our treatment of the effects of reequilibration. Inclusions in augite consist of glass, which shows only partial reequilibration of Fe/Mg. The composition of the primary trapped liquid they represent (augPTL) is reconstructed by reverse fractional crystallization of wall augite from the most ferroan glass. Inclusions in orthopyroxene consist of glass + 30-50 vol % daughter cpx. The cpx shows complete, but the glass only partial, reequilibration of Fe/Mg. A range of possible compositions for the primary trapped liquid they represent (opxPTL) is calculated by modal recombination of glass and cpx, followed by addition of wall orthopyroxene and adjustment of Fe/Mg for equilibrium with the primary orthopyroxene. Only a small subset of these compositions is plausible on the basis of being orthopyroxene-saturated. Results indicate that olPTL, assumed to represent the parent magma of these rocks, was saturated only with olivine and in equilibrium with Fo ~ 83. AugPTL and opxPTL are very similar in composition; both are close to augite + orthopyroxene co-saturation and in equilibrium with Fo 87/8. We suggest that olPTL was reduced to Fo 87/8 due to smelting during ascent, and show that this produces a composition very similar to that of augPTL and opxPTL. REE data for each of the three primary silicates and the least evolved melt inclusions in olivine are used to calculate REE abundances in the Hughes/FRO parent magma. All four methods yield very similar results, indicating a REE pattern that is strongly LREE-depleted (Sm/La = 3.3-3.7), with a small negative Eu anomaly (Eu/Eu* = 0.82) and slight HREE-depletion (Gd/Lu = 1.4-1.6). The Hughes/FRO parent magma provides a robust constraint on models for the petrogenesis of augite-bearing ureilites. Its major, minor and rare earth element composition suggests derivation through mixing and/or assimilation processes, rather than as a primary melt on the ureilite parent body.

Aims The aim of this study was to assess the cost-effectiveness of using certified sonographers and miniaturized echocardiography systems to perform echocardiograms at bedside in comparison to moving inpatients from the admission department to the echocardiography laboratory (echo-lab). Methods and results From 26 September 2005 to 27 October 2005, 112 patients admitted in six hospital wards connected through a 100 Mbit LAN to the echo-lab were scanned within the admission ward by sonographers using a miniaturized echo system. Logistical data were collected and results were compared with those obtained from 194 consecutive patients coming from the same wards and studied in the echo-lab with high-end machines between 8 March 2005 and 15 April 2005. Performing echocardiograms in the admission department avoided long waiting time of the inpatients in the echo-lab before and after the study, increased the percentage of patients studied within 3 and 5 days from request (88 vs. 77% and 100 vs. 95%, respectively; P = 0.03), increased both sonographer (by 33.9%; P < 0.001) and echo-lab productivity (by 41%; P < 0.001), and reduced costs of echocardiograms by 29%. Conclusion Implementation of digital echocardiography, certified sonographers, and a miniaturized echo system allowed improvement of the cost-effectiveness of the service provided by the echo-lab for inpatients, and avoided patients' discomfort derived from prolonged waiting time before and after the exam.

Aims: To assess accuracy and reproducibility of real time simultaneous triplane echocardiography (RT3PE) for the assessment of left ventricular (LV) volumes and ejection fraction (EF) using cardiac magnetic resonance (CMR) as a reference method. Methods and Results: A total of 24 patients with various degrees of LV dysfunction (EF from 36 to 57%) in sinus rhythm with good image quality were enrolled in the study. Digital loops of apical views were recorded with standard two-dimensional imaging and with RT3PE. Echocardiography and CMR were performed within 1 hour. RT3PE measurements of LV end-diastolic volume, end-systolic volume, and EF resulted closely correlated to CMR (r = 0.95, 0.97, and 0.95, respectively) with small biases (− 4m l,−6 ml, and 1%, respectively) and narrow limits of agreement (SD = 15 ml, 12 ml, and 6%, respectively). Two-dimensional echocardiography (2DE) showed a weaker correlation with CMR (r = 0.85, 0.91, and 0.83, respectively; P < 0.06) with similar biases (− 4m l,−10 ml, 5%, respectively), but wider limits of agreement (SD = 28 ml, 21 ml, 10%, respectively, P < 0.007). RT3PE showed lower interobserver variability for the assessment of EF (SD = 2% vs. 5%, P = 0.03) and lower measurement time of LV EF (175 ± 54 sec vs. 241 ± 49 sec, respectively; P < 0.0001), as compared to 2DE. Conclusion: RT3PE allows simple and fast image acquisition and volume calculation. In addition, it allows more accurate and reproducible EF measurements than conventional 2DE. (ECHOCARDIOGRAPHY, Volume 26, January 2009) three-dimensional echocardiography, two-dimensional echocardiography, cardiac magnetic resonance, left ventricular function

Aims Several studies have demonstrated the life-saving role of implantable cardioverter-defibrillator (ICD) therapy. In order to evaluate the effects of major trials in clinical practice, we report the clinical data of patients enrolled in the Italian ICD Registry for the years 2005-07. Methods and results The Registry collects prospectively national ICD implantation activity on the basis of EURID Card. The number of ICDs per million of inhabitants was 180.6 in the year 2005, 192.5 in the year 2006, and 220.6 in the year 2007 (P = 0.02). The median age was 69 years for all 3 years considered. Implantable cardioverter-defibrillator implantation for primary prevention concerned 4692 patients in 2005 (44.2%), 5938 patients in 2006 (52.2%), 7324 patients in 2007 (55.7%) and for secondary prevention 5921 patients in 2005 (55.8%), 5447 patients in 2006 (47.8%), and 5828 patients in 2007 (44.3%). Single-chamber ICDs were implanted in 30.9, 31.0, and 28.5% of patients, dual chamber ICDs in 31.9, 31.5, and 31.7%, and biventricular ICDs in 37.2, 37.5, and 39.8%, respectively. Conclusion The ICD implantation rate in Italy increased significantly in the period 2005-07. The registry showed a significant increase in prophylactic and biventricular ICD use, reflecting a favourable adherence to trials and guidelines in the clinical practice.

Background Transient left ventricular apical ballooning syndrome, primarily described in Japanese patients, has been recently recognized outside Japan also. Aim of this study is to elucidate incidence and clinical features of left ventricular apical ballooning syndrome in a tertiary-care hospital in northeastern Italy. Methods and results From January 2002 to August 2006, 29 patients admitted for suspected acute coronary syndrome (25 women, mean age 64 ± 12 years) fulfilled the Mayo Clinic Criteria of left ventricular apical ballooning syndrome. Twenty patients (69%) had an episode of emotional or physiologic stress preceding left ventricular apical ballooning syndrome. Fourteen patients (48%) had at least one risk factor for coronary artery disease. Chest pain was present at admission in 24 patients (83%). Twenty-five patients (86%) had ST–T segment abnormalities at ECG on admission. Four patients were treated with fibrinolytic therapy and one with glycoprotein IIb/IIIa inhibitors. At coronary angiography, 23 patients (79%) had no coronary lesions, 2 (7%) had small vessel occlusion and 4 (14%) had nonsignificant coronary stenosis. ECG changes and echocardiographic wall motion abnormalities completely regressed in all patients within 10 weeks. Neither death nor major complications occurred during in-hospital stay and after discharge. Two patients (7%) experienced a recurrence during follow-up. Conclusion Left ventricular apical ballooning syndrome is a novel syndrome with a nonnegligible incidence, a clinical presentation mimicking acute myocardial infarction and a favorable outcome. The present data confirm a higher prevalence in women and the frequent association with emotional stress. The differential diagnosis with acute myocardial infarction at presentation is still puzzling, and only ECG findings in conjunction with echocardiography and coronary angiography are so far diagnostics.

Left atrial size has shown prognostic importance in a variety of cardiac conditions. Diameters, area, and volume derived from M-mode and two-dimensional (2D) echocardiography are commonly used to estimate left atrial size. However, M-mode and 2D measures of left atrial size rely on various geometrical assumptions and their accuracy remains to be determined. To address this issue, we compared M-mode and 2D parameters routinely used to estimate left atrial size with three-dimensional (3D) echo measured left atrial volume (LAV) as a reference standard.We studied 104 patients (55% males, 62 +/- 15 years, range 10-87 years), presenting for a routine echocardiographic evaluation.The mean 3D LAV for the study population was 90 +/- 68 ml (range 24-458 ml). We found highly significant (P0.0001) correlations between 3D LAV and left atrial anterior-posterior (r = 0.78, 95% CI = 0.69-0.85), superior-inferior (r = 0.74, 95% CI = 0.63-0.81) and medial-lateral (r = 0.91, 95% CI = 0.86-0.93) diameters. A highly significant correlation was also found between 3D LAV and left atrial area (r = 0.94, 95% CI = 0.91-0.96). However, using M-mode anterior-posterior diameter or left atrial area would have misclassified 57% and 70% of our study patients, respectively, regarding the degree of left atrial dilatation. Closer correlations and narrower confidence intervals were found between 3D LAV and single-plane (r = 0.98; 95% CI = 0.94-0.97) and biplane (r = 0.97; 95% CI = 0.96-0.98) 2D LAVs.Left atrial diameters and area measurements were poor predictors of 3D LAV, especially in the enlarged left atria. Therefore, these parameters can be misleading in assessing the severity of left atrial dilatation. Two-dimensional LAVs are accurate in estimating 3D LAV. The small additional accuracy obtained by using the biplane instead of the single-plane area-length method, and the fact that the biplane method is more technically demanding and time consuming, may allow the use of the area-length for routine clinical use.

The study of the intracrystalline Fe-Mg exchange between M 1 and M 2 crystallographic sites in clinopyroxene on samples a variety of geological settings has provided a framework to understand the thermal history of pyroxene-bearing rocks. The Fe-Mg exchange reaction has successfully been exploited as a geothermometric tool in the study of orthopyroxene and pigeonite-bearing rocks, but relatively few data are available for clinopyroxene. A strong correlation between total iron content and the slope of the Fe 2+ -Mg equilibrium distribution coefficient ( k D ) as a function of temperature has been found for orthopyroxene and pigeonite, and we investigate this relationship in augite. We carried out new equilibrium annealing experiments at 800, 900, and 1000 °C followed by single-crystal X-ray diffraction and structural refinement to obtain a new geothermometric calibration for augite from a 120 m thick lava flow from Ontario, Canada [Theo’s Flow, En 49 Fs 9 Wo 42 hereafter also referred as Fs 9 where Fs = 100·ΣFe/(ΣFe+Mg+Ca) with ΣFe = Fe 2+ +Fe 3+ +Mn]. This new calibration enabled us to evaluate the compositional effects (mainly Fe content) by comparison with the data previously obtained on augite from MIL 03346 martian sample (En 36 Fs 24 Wo 40 hereafter referred to as Fs 24 ). The extremely good agreement observed between the data obtained on Theo’s Flow and Miller Range (MIL 03346) augite demonstrate that for the range of compositions between Fs 9 and Fs 24 , total iron content has a negligible or null influence on equilibrium behavior. Furthermore, linear regression of data from Theo’s Flow and MIL 03346 gave a single calibration equation: ln k D = − 4040 ( ± 180 ) / T ( K ) + 1 . 12 ( ± 0 . 17 ) ( R 2 = 0 . 988 ) . This new calibration describes the equilibrium behavior of augite and can be reliably used to determine the closure temperature ( T c ) of augite with composition ranging between Fs 9 and Fs 24 .

The core of the Tauern tectonic window (Eastern Alps) consists of pre-Alpine granitoids (∼295 Ma) variably deformed during Alpine (∼30Ma) amphibolite-facies metamorphism. Episyenites occur as local alteration haloes (as wide as a few meters) surrounding steeply dipping, strike-slip faults, with offsets

Infective endocarditis (IE) in chronic haemodialysis (HD) is significantly more common and causes greater morbidity and mortality than in the general population, being second only to cardiovascular disease as the leading cause of death in this group of patients. Because of the peculiarity of this group of patients, it has been recently proposed to add a fifth category (health-care associated and HD-associated IE) in the actually four categories classification of IE (namely, native valve IE, prosthetic valve IE, IE in e.v. drug users, and nosocomial IE). Given that rates of acceptance into HD are increasing (including a higher proportion of older patients in whom valvular calcification is virtually ubiquitous), and along with improved survival in HD patients, the incidence of IE in this subset of patients will probably increase with significant diagnostic and therapeutic implications. In particular cardiac, diagnostic, echocardiographic, and surgical expertises are required to correctly identify patients at higher risk and who may benefit from surgical treatment. The aim of this review is to clarify the peculiar features of chronic HD patients with regard to pathogenesis, diagnosis, current therapeutic options, and determinants of prognosis of IE.

The complex anatomy of cardiac structures requires three-dimensional spatial orientation of images for a better understanding of structure and function, thereby improving image interpretation. Real-time three-dimensional echocardiography is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume. The simultaneous display of multiple tomographic images allows three-dimensional perspective and the anatomically correct examination of any structure within the volumetric image. As a consequence, it is less operator-dependent and hence more reproducible. Dedicated software systems and technologies are based on high-performance computers designed for graphic handling of three-dimensional images by providing possibilities beyond those obtainable with echocardiography. This methodology allows simultaneous display of multiple superimposed planes in an interactive manner as well as a quantitative assessment of cardiac volumes and ventricular mass in a three-dimensional format without a pre-established assumption of cardiac chamber geometry. In addition, myocardial contraction and/or perfusion abnormalities are clearly identified. Finally, real-time three-dimensional colour Doppler flow mapping enables complete visualisation of the regurgitant jet and new ways of assessing regurgitant lesion severity. Thus, this technique expands the abilities of non-invasive cardiology and may open new doors for the evaluation of cardiac diseases. In this article, current and future clinical applications of real-time three-dimensional echocardiography are reviewed.

Right after the first signs and symptoms of acute myocardial infarctions the prognosis is determined by the interventions which are carried out at that time. Preservation of as much myocardial tissue is the key element. Early deobstruction and reperfusion of the myocardium at jeopardy can lead to limitation of the ultimate infarct size, improved ventricular function and a halving of the 1-year mortality. Early supportive therapy with beta-blockade and calcium antagonists may enhance this effect. Data in 533 patients randomized to either a reperfusion strategy or to conventional therapy, combined with those from the recent literature on thrombolysis and early beta-blockade, provide the basis for this point of view. Once infarction is unavoidable and in the process of completion, probably 3-4 h after onset of symptoms, only supportive therapy is recommended, which will hardly change the outcome except for interventions during clinical care such as defibrillation. In 351 other survivors of myocardial infarction the value of clinical variables, a symptom-limited bicycle stress test at discharge, radionuclide ventriculography and 24-hour ambulatory electrocardiogram was compared in predicting 1-year survival. A history of previous myocardial infarction and heart failure during the current episode proved to be the strongest clinical predictors of death. Similarly, a low ejection fraction (less than 40%) and an insufficient blood pressure rise during stress testing (less than 30 mm Hg) identified a high risk group. Stress-test-induced angina and ST depression as well as ventricular arrhythmias from 24-hour electrocardiography were less good as predictors. In these patients treatment should be individualized and may require arteriography. Patients eligible for and completing a normal bicycle stress test after myocardial infarction proved to be a low risk group, which may constitute 65% of the total, seen in tertiary referral centers and even more in community hospitals. They neither require therapy nor further investigation. A subgroup with an intermediate risk can be identified when clinical variables, stress testing and/or resting radionuclide ventriculography are abnormal. This group requires 'tailored' therapy. Therefore, after infarction recovery, we recommend a pre-discharge stress test routinely to complement the clinical evaluation, since it also provides information on physical capacity, the indication of arrhythmias and the presence of myocardial ischemia. Thus, optimal management of acute myocardial infarction requires a stratified approach, which does not require expensive testing procedures.

Transesophageal echocardiography (TEE) is the most common imaging modality for the detection of acute aortic syndromes. However anomalous anatomic structures may be occasionally misunderstood as pathologic due of lack of familiarity with anatomical variations; false-positive diagnosis can result, potentially leading to unnecessary surgical intervention. It is crucial for echocardiographers to be aware of possible pitfalls which may create false positive findings, since the complementary use of other imaging modalities, such as multislice spiral computed tomography (MSCT), could improve the diagnostic accuracy of TEE. We report a case in which an image resembling an acute aortic dissection (AAD) on transthoracic (TTE) and transesophageal echocardiography was found in a patient with acute chest pain; MSCT detected an anomalous origin of the right coronary artery as cause of false aortic dissection image at echocardiography.

OBJECTIVE: Heart failure (HF) is a major health problem resulting in a high financial burden for the healthcare system. Many previous HF management programmes reduced adverse clinical outcomes and costs, but they usually involved several professional figures as well as huge investments, requiring resources and budgets not often available in our healthcare system. We evaluated the effects of our HF management programme, which included patient education and regular outpatient contact with the HF team, on re-hospitalisation and death, optimising the few resources already available at our hospital. METHODS: Two hundred consecutive patients admitted to the internal medicine department with a diagnosis of HF were randomised to the intervention group (nurse-led education programme, facilitated telephone communication and follow-up visits with an internist at 15 days, 1 and 6 months) or to the usual care group (follow-up by their primary care physician). The primary endpoints were all-cause readmissions and all-cause deaths during the 6-month post-discharge period. RESULTS: There were 81 all-cause hospital readmissions in the intervention group and 82 in the control group (P = NS). Fourteen patients (14%) in the intervention group and eight patients (8%) in the control group died during the study period (P = NS). Unplanned outpatient visits were less frequent in the intervention group than in the control group (39 [28%] versus 99 [72%], P < 0.001). CONCLUSIONS: The present low-cost HF management programme reduced unplanned outpatient visits but proved ineffective in reducing subsequent readmissions and in improving clinical status. More intense follow-up monitoring and more resources are needed to achieve better results.

The use of stented bioprostheses in elderly patients with degenerative aortic stenosis, despite being desirable, raises concerns about the harmful effects of residual obstruction to left ventricular outflow. To overcome this limitation new stented and stentless bioprostheses have been designed for supra-annular implant. However, the actual hemodynamic advantage of supra-annular implant over the intra-annular one remains incompletely understood. This review focuses on the geometry of biological valve prostheses designed for supra-annular implant and its implications for the echocardiographic assessment of valve hemodynamics. Available data about the hemodynamic performance of these valves implanted in the supra-annular position in comparison with the usual intra-annular implant are also reviewed. Other issues related to biological heart valve performance, such as biomaterials, tissue mechanics, durability, and clinical outcome are not addressed in this review.

Objective: To compare in a prospective, randomised, multicentre trial the relative merits of pre-discharge exercise ECG and early pharmacological stress echocardiography concerning risk stratification and costs of treating patients with uncomplicated acute myocardial infarction. Design: 262 patients from six participating centres with a recent uncomplicated myocardial infarction were randomly assigned to early (day 3–5) pharmacological stress echocardiography (n = 132) or conventional pre-discharge (day 7–9) maximum symptom limited exercise ECG (n = 130). Results: No complication occurred during either stress echocardiography or exercise ECG. At one year follow up there were 26 events (1 death, 5 non-fatal reinfarctions, 20 patients with unstable angina requiring hospitalisation) in patients randomly assigned to early stress echocardiography and 18 events (2 reinfarctions, 16 unstable angina requiring hospitalisation) in the group randomly assigned to exercise ECG (not significant). The negative predictive value was 92% for stress echocardiography and 88% for exercise ECG (not significant). Total costs of the two strategies were similar (not significant). Conclusion: Early pharmacological stress echocardiography and conventional pre-discharge symptom limited exercise ECG have similar clinical outcome and costs after uncomplicated infarction. Early pharmacological stress echocardiography should be considered a valid alternative even for patients with interpretable baseline ECG who can exercise.

The majority of the ∼143 ureilite meteorites are monomict (unbrecciated) ultramafic rocks, which represent the mantle (olivine+low-Ca pyroxene residues and less abundant cumulates) of a partially melted (∼25–30%), carbon-rich asteroid ⩾125 km in radius. Accumulated petrologic and geochemical studies of these meteorites have led to a picture of a ureilite parent body (UPB) that was stratified in mg#, pyroxene abundance and pyroxene type, due to the pressure dependence of carbon redox control, and which preserved a pre-magmatic heterogeneity in Δ17O. The absence, however, of ureilitic crustal rocks (i.e. basalts) in the meteorite record, leads to significant gaps in our knowledge of the geologic history of the UPB. Ureilitic breccias provide considerable information that cannot be obtained from the monomict samples, and help to fill in those gaps. Fourteen ureilites are polymict breccias (at least three of which contain solar wind gases) that formed in a regolith. They contain a variety of clast types representing indigenous ureilitic lithologies not known among the monomict samples, as well as several types of non-indigenous impactor materials. In addition, one ureilite (FRO 93008) is a dimict breccia, consisting of two ultramafic lithologies that could not have formed in close proximity on the UPB. Several feldspathic lithologies representing melts complementary to the monomict ureilite residues or cumulates have been recognized in polymict ureilites. From these lithologies we infer that melt extraction on the UPB was a rapid, fractional process in which trace element and oxygen isotopic equilibrium was not achieved. The majority of melts that reached the surface erupted explosively (due to high contents of CO/CO2) and were lost into space. Thus, it is likely that the UPB never had an extensive basaltic crust. Melts generated at the shallowest depths and late fractionates, in which carbon had largely been consumed by reduction, were the most likely to have been preserved. Our sample of the UPB is limited to depths equivalent to ∼100 bars pressure or less, but minor augite-bearing feldspathic lithologies and related cumulates may represent melts derived from deeper. In addition, we infer that the UPB was catastrophically disrupted, while still hot, by an impacting projectile. Meter-sized ejecta from this impact reaccreted into one or more daughter bodies, on which the brecciated ureilites formed. Ureilite meteorites are derived from these offspring, rather than from the UPB. The remnant of the original UPB may consist largely of olivine plus augite, and thus not resemble the majority of ureilites.

BACKGROUND Patients with acute coronary syndromes (ACS) complicated by heart failure (HF) are at increased risk of death. Treatment with angiotensin-converting enzyme inhibitors (ACEI), beta-blockers, and early invasive risk stratification are recommended for these patients. AIM The purpose of the current study was to assess adherence to treatment guidelines of patients with ACS complicated by HF in Europe and the Mediterranean region. METHODS AND RESULTS Of the 10,484 patients who participated in Euro-Heart ACS survey, 9587 had known HF status and were without cardiogenic shock; 7058 (74%) did not have symptomatic HF and 2529 (26%) presented with or developed symptomatic HF during hospitalization. HF patients were older and had more cardiovascular risk factors. ACEI were more commonly used in HF patients (75% vs 56%, P < .01), whereas beta-blockers were less frequently used (75% vs 82%, P < .01). Coronary angiography and in hospital revascularization rates were lower among HF patients (42% vs 57% for coronary angiography, P < .01, and 32% vs 42% for revascularization, P < .01). Similar trends were noticed among patients with left ventricular dysfunction (symptomatic and asymptomatic).Adjusted in-hospital mortality risk was higher among patients with ACS complicated by symptomatic HF regardless of electrocardiographic type of ACS: (ST-elevation ACS, OR 2.5, 95% CI 1.6-3.9; non-ST-elevation ACS, OR 8.9,95% CI 4.5-17.7; undetermined-ECG ACS, OR 9.3, 95% CI 2.5-34). CONCLUSIONS Patients with ACS complicated by HF were at increased risk of dying. A relatively high percentage of HF patients were treated with ACEI and beta-blockers in accordance with current recommendations. Rates of coronary angiography and revascularization were significantly lower in ACS patients with HF versus those without HF, which potentially contributed to their worse mortality [corrected]

There is now clear scientific evidence linking regular aerobic physical activity to a significant cardiovascular risk reduction, and a sedentary lifestyle is currently considered one of the five major risk factors for cardiovascular disease. In the European Union, available data seem to indicate that less than 50% of the citizens are involved in regular aerobic leisure-time and/or occupational physical activity, and that the observed increasing prevalence of obesity is associated with a sedentary lifestyle. It seems reasonable therefore to provide institutions, health services, and individuals with information able to implement effective strategies for the adoption of a physically active lifestyle and for helping people to effectively incorporate physical activity into their daily life both in the primary and the secondary prevention settings. This paper summarizes the available scientific evidence dealing with the relationship between physical activity and cardiovascular health in primary and secondary prevention, and focuses on the preventive effects of aerobic physical activity, whose health benefits have been extensively documented.

Item does not contain fulltext OBJECTIVES: The aim of this study was to evaluate percutaneous coronary intervention (PCI) in the Assessment of the Safety and Efficacy of New Thrombolytic Regimens (ASSENT-3) trial. BACKGROUND: In the ASSENT-3 trial, co-therapy with abciximab (ABC) or enoxaparin (ENOX) reduced ischemic complications after ST-elevation acute myocardial infarction treated with tenecteplase when compared with unfractionated heparin (UFH). The effect of these new co-therapies on the results of PCI is unknown. METHODS: Clinical outcomes in patients who received co-therapy with ABC, ENOX, or UFH and subsequently underwent an elective (n = 1,064) or urgent (n = 716) PCI in the ASSENT-3 trial were compared. RESULTS: No significant differences in clinical end points were observed in patients who underwent an elective PCI. A non-significant trend toward fewer in-hospital myocardial re-infarctions was seen with ABC and ENOX when compared with UFH (0.5% vs. 0.6% vs. 1.5%, respectively). The incidence of bleeding complications was similar in the three treatment arms. Significantly fewer ABC- and ENOX-treated patients needed urgent PCI compared with UFH (9.1% vs. 11.9% vs. 14.3%; p < 0.0001), but outcomes in these patients were in general less favorable (30-day mortality: 8.2% vs. 5.4% vs. 4.5%; 1-year mortality: 11.0% vs. 8.5% vs. 5.6%; in-hospital re-infarction: 3.9% vs. 2.5% vs. 2.7%; major bleeding complications: 8.8% vs. 7.0% vs. 3.4%). In pairwise comparisons with UFH, the higher one-year mortality and major bleeding rates after ABC were statistically significant (p = 0.045 and p = 0.012, respectively). CONCLUSIONS: Clinical outcomes after elective PCI were similar with the three antithrombotic co-therapies studied in ASSENT-3. Although fewer patients needed urgent PCI with ABC and ENOX, clinical outcomes were less favorable in this selected population, especially with ABC.

Temporal changes in myocardial perfusion after recanalization and their relation with functional recovery in patients with acute myocardial infarction (AMI) using intravenous myocardial contrast echocardiography (MCE) have not yet been clarified. To address this issue, 19 patients with first, uncomplicated anterior wall AMI were studied using intravenous MCE within 24 hours of recanalization and before discharge. MCE was performed using harmonic power Doppler. Each asynergic left ventricular (LV) myocardial segment was scored for myocardial perfusion (1 = complete, 0.7 = patchy but50%, 0.3 = patchy50%, and 0 = absent) and a regional perfusion index was calculated within the dysfunctioning myocardium. During the day-1 study (11 +/- 2 hours from recanalization), the regional perfusion index was 0.4 +/- 0.3 and the LV wall motion score index was 1.9 +/- 0.2. During the study before discharge (7 +/- 4 days from admission), all but 2 patients showed an improvement of either perfusion index (0.6 +/- 0.3, p0.0001) or wall motion score index (1.7 +/- 0.4, p0.0001). Changes in perfusion score from 24-hours to before discharge showed a significant correlation with LV segment contractile recovery at 2-month of follow-up (R(2) = 0.42, 95% confidence interval 0.33 to 0.50, p0.0001). Thus, our data show that after recanalized AMI, there is a significant amount of microvascular obstruction that recovers in the days after, and the extent of this perfusion improvement appears to be related with early myocardial contractile recovery. Our data provide clinical evidence for a transient microvascular dysfunction after successfully recanalized AMI.

Background: The aim of this study was to assess the utility of intraoperative transesophageal echocardiography (TEE) in the evaluation of patients undergoing aortic valve replacement with the CryoLife-O'Brien® (CLOB) Stentless Porcine Aortic Bioprosthesis. Methods: Between May 1994 and March 1995, 26 patients (15 men, mean age 68.4±10.78 years) had a CLOB valve in the aortic position. Transprosthetic gradients and valve regurgitation were detected by intraoperative TEE. Prosthetic regurgitation and transvalvular gradients were evaluated at six-month intervals using transthoracic echo-Doppler (TTE). Results: The majority of implants resulted in low gradients (83.7%), with only four patients exhibiting a moderate gradient (15.3%). Color flow Doppler imaging showed central aortic regurgitation in only four of 25 patients (trivial, n = 4; mild, n = 1). There was one paravalvular leak (trivial. n= 1). At follow-up examination (mean 37±12 months), 24 of 25 patients exhibited low mean gradients (7.25±2.81 mmHg). At follow-up one patient who had low velocities in the LVOT at perioperative evaluation exibited a moderate gradient (45 mmHg) with an effective orifice area of 0.8–0.9 cm2. Conclusions: Intraoperative TEE was effective in assessing prosthetic stentless valve function.

Effects of inbreeding of animal and dam on estimates of genetic parameters and predictions of breeding values for five productive and reproductive traits of Piedmontese cattle were studied. Traits were (a) age at first insemination, (b) age at first calving, (c) 120-day weight, (d) yearling weight of males, and (e) yearling weight of females. Data for animals born from 1970 to 1995 were used. Inbreeding coefficients were computed using pedigree records back to 1900. A sire model was used for estimating genetic parameters and predicting breeding values. Two models were used for each trait. Model 1 included fixed effects of herd–year (for traits a, b, d, and e) or herd–year and sex–age of dam (trait c) and covariates for inbreeding coefficient of animal for traits a and b and inbreeding of animal and dam for traits c, d and e. Random effects were associated with sires and dams for traits c, d, and e. Model 2 did not include covariates for inbreeding. Inbreeding increased age at first insemination and calving and decreased 120-day and yearling weights of males and females. Inbreeding was not needed in the model for estimation of variance components or for prediction of breeding values for this population.

Patient-centered treatment outcomes such as health-related quality of life are recommended in clinical care and research studies. Health-related quality of life questionnaires need to be validated in the language of the target population. The reliability and validity of the Italian version of the MacNew Questionnaire was determined in patients with angina, myocardial infarction, or ischemic heart failure. Sociodemographic and clinical data were collected on 298 patients [angina, n = 88; MI, n = 106; heart failure, n = 104; mean age, 64.8 (±10.6) years] at three centers in Italy. MacNew mean scores were higher (p

We describe the first known occurrence of primary melt inclusions in a ureilite. The ureilite is Hughes 009, one of a small number of ureilites whose primary mineralogy is olivine-augite-orthopyroxene, rather than olivine-pigeonite. Hughes 009 has a coarse-grained, equilibrated texture typical of ureilites, and homogeneous primary mineral compositions: olivine — mg 87.3; augite — mg 89.2, Wo 37.0, Al2O3 = 1.6 wt.%; orthopyroxene — mg 88.3, Wo 4.9. It shows only limited secondary reduction effects and no petrographically recognizable carbon phases, which indicates that its original carbon content was lower than in most ureilites. The melt inclusions occur in olivine crystals. They are concentrated in the central regions of their hosts, showing elongate (mostly 20–60 μm in maximum dimension), negative olivine crystal shapes and parallel alignment. These and other features indicate that they were trapped during initial growth of their hosts from a liquid, and are likely to be representative samples of that liquid. They consist of glass and single, subhedral crystals of high-Ca pyroxene, with minor Cr-rich spinel and metal-phosphide-sulfide spherules. They are surrounded by halos of olivine with rounded outlines defined by tiny bits of metal and thin arcs of glass. Pyroxenes within each inclusion show zonation patterns indicating that they nucleated at the olivine/ liquid interface with compositions close to that of the primary augite, and then grew inward with dramatically increasing Al2O3 (to 10.8 wt.%), Wo (to ≈50), TiO2 and Cr2O3 contents. Glasses within each inclusion are relatively homogeneous. Glasses from all inclusions show well-defined trends of CaO, TiO2, Cr2O3, Na2O and SiO2 vs. Al2O3, (16–23 wt.%) that can be modelled as resulting principally from crystallization of various amounts of the pyroxene. The halos, which represent olivine that grew from the trapped melts, are zoned in Cr and Ca with concentrations decreasing inward, reflecting cocrystallization of pyroxene; they have homogeneous Fe/Mg identical to that of the primary olivine, indicating reequilibration with the host. We develop a petrologic model for the postentrapment history (crystallization, reaction and reequilibration) of the inclusions, based on which we reconstruct the composition of the primary trapped liquid (PTL). The PTL was saturated only with olivine. This result implies that Hughes 009 is a cumulate (consistent with the high Mn/Mg ratio of its olivine and a low abundance of graphite) and that the composition of the PTL is close to that of its parent magma. The low-pressure equilibrium crystallization sequence predicted by MAGPOX calculations for the PTL (olivine → augite → plagioclase → pigeonite) is not, however, consistent with the primary mineralogy of Hughes 009. If the conditions of these calculations are, indeed, appropriate, then complex processes such as magma mixing must have been involved in the petrogenesis of this ureilite. This conclusion is consistent with other evidence that the olivine-augite-orthopyroxene ureilites record a more complex magmatic evolution than is evident in the olivine-pigeonite ureilites. TEM investigations of microtextural features in all phases and XRD determination of Fe2+-Mg site distribution in orthopyroxene have elucidated the cooling and shock history of this ureilite. Hughes 009 experienced an extremely high cooling rate (7 ± 5°C/h at the closure T of 630°C) late in its evolution, and two distinguishable shock events—the first at peak pressures of 5 to 10 GPa, resulting in mechanical polysynthetic twinning in augite and orthopyroxene and mild undulatory extinction in olivine; and the second at lower pressures, resulting only in brecciation and redistribution of metal. Its late history is similar to that of most ureilites, and probably reflects impact excavation.

In patients with limited exercise capacity and (relative) contraindications to direct vasodilators such as dipyridamole or adenosine, dobutamine stress nuclear myocardial perfusion imaging (DSMPI) represents an alternative, exercise-independent stress modality for the detection of coronary artery disease (CAD). Nondiagnostic test results (absence of reversible perfusion defects with submaximal stress) do occur in approximately 10% of patients. Serious side effects during DSMPI are rare, with no death, myocardial infarction or ventricular fibrillation reported in three DSMPI safety reports for a total of 2,574 patients. On the basis of a total number of 1,014 patients reported in 20 studies, the sensitivity, specificity and accuracy of the test for the detection of CAD were 88%, 74% and 84%, respectively. Mean sensitivities for one-, two- and three-vessel disease were 84%, 95% and 100%, respectively. The sensitivity for detection of left circumflex CAD (50%) was lower, compared with that for left anterior descending CAD (68%) and right CAD (88%). The sensitivity of predicting multivessel disease by multiregion perfusion abnormalities varied widely, from 44% to 89%, although specificity was excellent in all studies (89% to 94%). In direct diagnostic comparisons, DSMPI was more sensitive, but less specific, than dobutamine stress echocardiography and comparable with direct vasodilator myocardial perfusion imaging. In the largest prognostic study, patients with a normal DSMPI study had an annual hard event rate less than 1%. An ischemic scan pattern provided independent prognostic value, with a direct relationship between the extent and severity of the perfusion defects and prognosis. In conclusion, DSMPI seems a safe and useful nonexercise-dependent stress modality to detect CAD and assess prognosis.

Background Patients with left bundle branch block exhibit abnormal septal motion which may limit the interpretation of stress echocardiograms. This study sought to assess the diagnostic value of dobutamine–atropine stress echocardiography in left bundle branch block patients. Methods and Results Sixty-four left bundle branch block patients (mean age 59 years, 24 men) with suspected coronary artery disease underwent dobutamine–atropine stress echocardiography and coronary arteriography. Myocardial ischaemia was defined as new or worsening wall thickening abnormalities. Coronary artery disease was quantitatively defined as a diameter stenosis 50% in a major epicardial artery. Rest septal motion was normal (apart from the early systolic septal notch) in 34 patients (53%) and abnormal in 30 patients (47%). Rest septal thickening was normal in 32 patients (50%) and abnormal in 32 patients (50%). All seven patients with a QRS duration 160 ms and an abnormal QRS axis had abnormal rest septal motion and thickening. Inter-observer agreement for ischaemia was 88%. In all but one patient disagreement was in the septum. For the anterior and posterior circulation, respectively, sensitivity was 60% (9/ 15) and 67% (8/12), specificity was 94% (46/49) and 98% (51/52), and accuracy was 86% (55/64) and 92% (59/64). Sensitivity for the anterior circulation tended to be better in patients with normal rest septal thickening (83% vs 44%). Conclusions Dobutamine–atropine stress echocardiography has excellent diagnostic specificity in left bundle branch block patients with suspected coronary artery disease. In patients with abnormal rest septal thickening, however, dobutamine–atropine stress echocardiography may lack good sensitivity for detection of coronary artery disease in the anterior circulation. Left bundle branch block patients who potentially most benefit from dobutamine–atropine stress echocardiography may initially be selected by their resting electrocardiogram.

The aim of our study was to compare the prognostic value of stress echocardiography and exercise electrocardiography after uncomplicated non-Q-wave acute myocardial infarction in a series of 89 female patients. Our data show that stress echocardiography has independent predictive value in a female patient population recovering from uncomplicated acute myocardial infarction.