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Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed.

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Disclosure of potential conflicts of interest (COI) is used by biomedical journals to guarantee credibility and transparency of the scientific process. COI disclosure, however, is not systematically nor consistently dealt with by journals. Recent joint editorial efforts paved the way towards the implementation of uniform vehicles for COI disclosure. This paper provides a comprehensive editorial perspective on classical COI-related issues. New insights into current COI policies and practices among European Society of Cardiology national cardiovascular journals, as derived from a cross-sectional survey using a standardised questionnaire, are discussed.

Tissue Doppler imaging allows assessment of left ventricular dyssynchrony and resynchronization after biventricular pacing.

Aim. Description of embolization as a treatment for bleeding bronchopulmonary collaterals in congenital heart disease. Methods. After palliative corrective surgery of Tetralogy of Fallot with pulmonary atresia, haemoptysis due to ruptured bronchopulmonary collaterals is a well known complication. We describe a 31 year old patient with haemoptysis after incomplete correction because of Tetralogy of Fallot with pulmonary atresia. Because supportive treatment failed, the bleeding site was localized angiographically. Collaterals emerged from the right mammary artery, several intercostal arteries and the right costobrachial truncus. Embolization of these vessels with non absorbable particles stopped the bleeding. A follow-up of more than one year was uneventful. Conclusion. Embolization of bronchial collaterals has to be considered in patients with haemoptysis due to complex congenital disorders.

Background. The cardiovascular applications of magnetic resonance (MR) techniques in coronary artery disease have increased considerably in recent years. Technical advantages of MR imaging are the excellent spatial resolution, the characterization of myocardial tissue, and the potential for three-dimensional imaging. These characteristics allow the accurate assessment of left ventricular mass and volume, the differentiation of infarcted from normal tissue, and the determination of systolic wall thickening and regional wall motion abnormalities. Methods. In addition to the conventionally used spin-echo and cine-echo techniques, newer techniques such as myocardial tagging, ultrafast MR imaging and MR coronary angiography have been developed. These newer techniques allow a more accurate assessment of ventricular function (tagging), myocardial perfusion (ultrafast imaging), and evaluation of stenosis severity (MR coronary angiography). Particularly early detection and flow assessment of stenosed coronary arteries and bypasses by MR angiography would constitute a major breakthrough in cardiovascular MR imaging. Apart from the MR imaging techniques, cardiac metabolism may be well assessed using MR spectroscopy. This provides unique information on the metabolic behaviour of the myocardium under conditions stress-induced ischemia. However, the definite niche of cardiac MR spectroscopy has still to be settled. Conclusion. Currently, MR techniques allow the evaluation of anatomy and function (accepted use), perfusion and viability (development phase), and coronary angiography (experimental phase). A particular strength of MR imaging is that one single MR test may encompass cardiac anatomy, perfusion, function, metabolism and coronary angiography. The replacement of multiple diagnostic tests with one MR test may have major effects on cardiovascular healthcare economics and would outweigh the cost inherent to the MR angiography procedure.

Objectives. We addressed the question whether in patients with cardiac chest pain referred for stress myocardial perfusion scintigraphy, Tc-99m MIBI SPECT stress imaging should always be followed by a rest imaging procedure. Background. Using Tc-99m MIBI imaging a stress-rest sequence is usually performed implying that the resting study always follows the stress study irrespective of the results of the stress study. As a normal stress study would eliminate a subsequent resting study, it appears desirable to potentially define certain subsets of patients in whom a normal stress study can be expected in order to determine a more selective referral approach to the nuclear medicine department. The consequences of such a more streamlined approach would less impose on the logistics of the department of nuclear medicine, with decrease of investigation time, radiation dose, and costs in a time of retrenchment in the medical sector. Methods. A consecutive series of 460 patients (mean age 58.2 years) was studied who were stratified to 269 patients without prior myocardial infarction, and to 191 patients with documented evidence of a previously sustained mycoardial infarction. All patients underwent Tc-99m MIBI SPECT imaging according to a two-day stress-rest protocol. Results. Patients with and without a previous myocardial infarction showed suboptimal overall predictive accuracies for the exercise electrocardiograms (58% and 60%, respectively). In the total group of 460 patients, 94 (20%) patients showed a normal stress-rest Tc-99m MIBI SPECT; this occurred in 86/269 (32%) patients without a previous myocardial infarction and in only 8/191 (4%) patients with a previous myocardial infarction. Conclusions. Patients with a stress defect at Tc-99m MIBI SPECT imaging should always undergo a resting SPECT study irrespective of the clinical and stress electrocardiographic findings. As patients without a previous myocardial infarction had a normal stress SPECT study in almost one-third (32%) of patients compared to only 4% in patients with a previous myocardial infarction, it may be useful to employ different referral and imaging strategies i.e. a stress-only versus a stress-rest procedure. To schedule referring patients differently according to the presence or absence of a previously sustained myocardial infarction may be cost-saving, less demanding for the nuclear medicine personnel, and patient-convenient. In addition, a stress-only imaging procedure reduces radiation exposure to the individual patient.

ESC Committee for Practice Guidelines (CPG): Jose Luis Zamorano (Chairperson) (Spain), Stephan Achenbach (Germany), Helmut Baumgartner (Germany), Jeroen J. Bax (Netherlands), He ' ctor Bueno (Spain), Veronica Dean (France), Christi Deaton (UK), Cetin Erol (Turkey), Robert Fagard (Belgium), Roberto Ferrari (Italy), David Hasdai (Israel), ArnoW. Hoes (Netherlands), Paulus Kirchhof (Germany/UK), JuhaniKnuuti (Finland), PhilippeKolh (Belgium), Patrizio Lancellotti (Belgium), Ales Linhart (CzechRepublic), Petros Nihoyannopoulos (UK), Massimo F. Piepoli (Italy), Piotr Ponikowski (Poland), Per Anton Sirnes (Norway), Juan Luis Tamargo (Spain), Michal Tendera (Poland), AdamTorbicki (Poland), WilliamWijns (Belgium), StephanWindecker (Switzerland). Document Reviewers: Juhani Knuuti (CPG Review Coordinator) (Finland), Marco Valgimigli (Review Coordinator) (Italy), Hector Bueno (Spain), Marc J. Claeys (Belgium), Norbert Donner-Banzhoff (Germany), Cetin Erol (Turkey), Herbert Frank (Austria), Christian Funck-Brentano (France), Oliver Gaemperli (Switzerland), JoseR. Gonzalez-Juanatey (Spain), Michalis Hamilos (Greece), David Hasdai (Israel), Steen Husted (Denmark), Stefan K. James (Sweden), Kari Kervinen (Finland), Philippe Kolh (Belgium), Ste

Scintigraphic techniques can be used first, to guide appropriate referral for interventional procedures, and second to predict the effect of revascularization on regional perfusion and function prior to the intervention, thereby being able to assess efficacy of revascularization and to assess whether ischemia is the origin of recurrence of symptoms. Of increasing importance is the ability of nuclear techniques to identify those myocardial regions with abnormal function which might benefit from revascularization by showing improvement in regional wall motion. Positron emission tomography is considered to be the gold standard to assess regional myocardial perfusion and metabolism. The introduction of the reinjection technique makes 201Tl-scintigraphy the method of choice to detect jeopardized myocardium and to guide appropriate referral for revascularization procedures in those institutes where PET is not available. Even when the costly PET-instrumentation is available, cost-benefit analysis is indicated to assess the additional value of PET compared with 201Tl reinjection imaging.

Objective: To examine retrospectively the changes in ECG parameters over time and their correlation with other quantitative right ventricular (RV) function parameters in patients with chronic RV pressure overload caused by congenital heart disease. Methods: 48 patients with chronic RV pressure overload caused by the following congenital heart diseases were studied: nine with congenitally corrected transposition of the great arteries (TGA), 12 with surgically corrected TGA, and 27 with a subpulmonary pressure overloaded RV. QRS duration and dispersion were measured manually from standard ECG recorded twice within five years. RV end diastolic volume (EDV) and RV mass were determined by magnetic resonance imaging. Brain natriuretic peptide (BNP) plasma concentrations were measured. Results: QRS duration and QRS dispersion increased in all patient groups during the follow up period. QRS duration increased significantly in the congenitally corrected TGA (p = 0.04) and the subpulmonary pressure overloaded RV groups (p = 0.01). QRS dispersion increased significantly in patients with surgically corrected TGA (p = 0.03) and in the subpulmonary pressure overloaded RV group (p = 0.02). A significant correlation was found between QRS duration and RVEDV (r = 0.71, p

Heterogeneity of left ventricular myocardial perfusion is an important clinical characteristic. Different aspects of this heterogeneity were analyzed. Methods: The coefficient of variation (v), characterizing heterogeneity, was modeled as a function of the number of segments (n), characterizing spatial resolution of the measurement, using two independent pairs of mutually dependent parameters: the first pair describes v as a power function of n, and the second pair adds a correction for n small. n was Varied by joining equal numbers of neighboring segments. Local similarity of the perfusion was characterized by the correlation between the perfusions of neighboring segments, Genesis of the perfusion distribution was modeled by repeated asymmetric subdivision of the perfusion into a volume among two equal subvolumes. These analyses were applied to study the differences between 16 syndrome X patients and 16 age- and sex-matched healthy volunteers using N-13-ammonia parametric PET perfusion data with a spatial resolution of 480 segments. Results: The heterogeneity of patients is higher for the whole range of spatial resolutions considered (2 less than or equal to n less than or equal to 480; for n = 480, v = 0.22 +/- 0.03 and 0.18 +/- 0.02; p 0.1), For both groups of subjects there is a significant positive local correlation for distances up to 30 segments. This correlation is a formal description of the patchy nature of the perfusion distribution. Conclusion: When comparing values of v, these should be based on the same value of n. The model makes it possible to calculate v for all values of n 480. Mean perfusion together with the two pairs of parameters are necessary and sufficient to describe all aspects of the perfusion distribution. For n small, heterogeneity estimation is less reliable. Patients have a higher heterogeneity because their perfusion distribution is more asymmetrical from the third to the seventh generation of subdivision (8 less than or equal to n less than or equal to 128). Therefore, a spatial resolution of n greater than or equal to 128 is recommended for parametric imaging of perfusion with PET. Patients have only a very slightly more patchy distribution than volunteers. The differences in perfusion between areas with low perfusion and areas with high perfusion is larger in patients.

PURPOSE The goal of this study was to evaluate a newly developed semiautomated contour detection algorithm for the quantitative analysis of cardiovascular MRI. METHOD Left ventricular function parameters derived from automatically detected endocardial and epicardial contours were compared with results derived from manually traced contours in short-axis multislice GRE MRI studies of 10 normal volunteers and 10 infarct patients. RESULTS Compared with manual image analysis, the semiautomated method resulted in the following systematic and random differences (auto-manual; mean +/- SD): end-diastolic volume: -5.5 +/- 9.7 ml; end-systolic volume: -3.6 +/- 6.5 ml; ejection fraction: 1.7 +/- 4.1%; left ventricular mass: 7.3 +/- 20.6 g. Total analysis time for a complete study was reduced from 3-4 h for the manual analysis to < 20 min using semiautomated contour detection. CONCLUSION Global left ventricular function parameters can be obtained with a high degree of accuracy and precision using the present semiautomated contour detection algorithm.

The objective of this study was to assess the feasibility and accuracy of magnetic resonance (MR) velocity mapping to calculate pulmonary-to-systemic flow ratio (Qp : Qs) in patients with a suspected or diagnosed atrial-level shunt. During a one-year period, all patients referred to our department for further evaluation of an atrial-level shunt underwent the same imaging protocol. Multiphase-multisection gradient-echo MR image sets of the heart were acquired to measure left and right ventricular stroke volumes for validation. Ascending aorta and main pulmonary artery volume flow were measured with MR velocity mapping. Qp : Qs ratios were calculated from both stroke volume data and flow data. Twelve patients, including 6 children, were studied. Six patients had an established diagnosis of atrial septal defect, and the other 6 patients were suspected to have an atrial-level shunt. Measurements of left and right ventricular stroke corresponded closely with those of aortic (r=0.98) and pulmonary flow (r=0.99) respectively, and Qp : Qs flow ratios agreed with stroke volume ratios (r=0.92). In 5 patients with a suspected shunt, the diagnosis could be rejected. Shunts were demonstrated in the other 7 patients. MR velocity mapping offers an accurate method to measure aortic and pulmonary artery volume flow that can be useful in the evaluation of atrial-level shunts, in order to establish a definite diagnosis and/or to quantify the Qp : Qs ratio.

In the last decades increasing information has become available on changes in cardiac receptors during pathophysiological circumstances. With the advent of positron emission tomography (PET) imaging it is now theoretically possible to measure receptor density noninvasively in vivo. In the field of sympathetic innervation and postsynaptic cardiac s-adrenoceptors in the heart, the first data using the PET technique have been published. Beta-adrenoceptors have been quantified by in vitro binding assays and changes in s-adrenoceptor density have been associated with congestive heart failure,1, 2 myocardial ischemia,3, 4 cardiomyopathy,5, 6 valvular diseases,7 hypertension,8 diabetes,9, 10 hyperthyroidism11 and chronic drug administration.12, 13 Cardiac s1adrenoceptors exert positive inotropic, lusitropic, and chronotropic effects, whereas cardiac s2-adrenoceptors mainly have positive chronotropic and vasodilatory effects. Alteration in number of these receptors will affect cardiac function, especially since the human heart has a small receptor reserve for s-agonists.2

Changes in receptor populations may be early markers of disease, or indicators of the therapeutic success. A large research effort is therefore directed towards tomographic imaging of receptors and quantitative interpretation of these images in terms of receptor densities. Before human studies are possible, putative receptor-binding radiotracers should be thoroughly tested. The testing of a radioligand for imaging purposes includes two distinct areas of research: 1. It should be demonstrated that the compound binds preferentially to the chosen receptor in intact animals or humans; 2. An experimental protocol should be designed that allows changes in receptor density (e.g. due to disease) to be determined with sufficient accuracy and sensitivity. This chapter discusses the use of labeled beta-adrenoceptor ligands for cardiac imaging, as an example of receptor imaging in general.