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Purpose To demonstrate the hemodynamic changes of pulmonary arterial hypertension using cardiac MRI and to determine which parameters are best representative of the pulmonary artery pressure. Patient and methods We examined 44 patients with pulmonary arterial hypertension using cine cardiac imaging and phase-contrast velocity encoding sequence to obtain data regarding ventricular morphology, function and pulmonary artery flow. The resulting parameters were correlated to echocardiography-derived mean pulmonary artery pressure. Results We found increased right ventricular end diastolic, end systolic volumes and mass with decreased stroke volume and ejection fraction. The left ventricular end diastolic volume and stroke volume decreased and the end systolic volume increased while the ventricular mass index has increased compared to normal populations. The mean pulmonary artery pressure had significant positive correlation with the ventricular mass index ( r = 0.61; p = 0.02) and right ventricular mass ( r = 0.40; p = 0.02) with significant negative correlation with right ventricular ejection fraction ( r = −0.48; p = 0009). Conclusion MR-derived ventricular mass index, right ventricular mass, and right ventricular ejection fraction had the strongest relation with the pulmonary artery pressure, and hence they could be reliable parameters on monitoring patients with pulmonary arterial hypertension. [ABSTRACT FROM AUTHOR]

We present the case of a 17-year-old asymptomatic boy with a diagnosis of arrhythmogenic cardiomyopathy. Merging of cardiac magnetic resonance imaging and three-dimensional electroanatomic mapping provided striking visualization of the association between structural and electrical alterations and guided the decision to implant an implantable cardioverter defibrillator. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Background: Cardiomyopathy is a leading cause of late morbidity and mortality in childhood cancer survivors (CCS). Evidence-based guidelines recommend risk-stratified screening for cardiomyopathy, but the management approach for abnormalities detected when screening asymptomatic young adult CCS is poorly defined., Objectives: The aims of this study were to build upon existing guidelines by describing the expert consensus-based cardiomyopathy screening practices, management approach, and clinical rationale for the management of young adult CCS with screening-detected abnormalities and to identify areas of controversy in practice., Methods: A multispecialty Delphi panel of 40 physicians with expertise in cancer survivorship completed 3 iterative rounds of semi-open-ended questionnaires regarding their approaches to the management of asymptomatic young adult CCS at risk for cardiomyopathy (screening practices, referrals, cardiac testing, laboratory studies, medications). Consensus was defined as ≥90% panelist agreement with recommendation., Results: The response rate was 100% for all 3 rounds. Panelists reached consensus on the timing and frequency of echocardiographic screening for anthracycline-associated cardiomyopathy, monitoring during pregnancy, laboratory testing for modifiable cardiac risk factors, and referral to cardiology for ejection fraction ≤50% or preserved ejection fraction with diastolic dysfunction. Controversial areas (<75% agreement) included chest radiation dose threshold to merit screening, indications for advanced cardiac imaging and cardiac serum biomarkers for follow-up of abnormal echocardiographic findings, and medical management of asymptomatic left ventricular systolic dysfunction., Conclusions: Expert practice is largely consistent with existing risk-based screening guidelines. Some recommendations for managing abnormalities detected on screening echocardiography remain controversial. The rationale offered by experts for divergent approaches may help guide clinical decisions in the absence of guidelines specific to young adult CCS., Competing Interests: This work was supported by National Institutes of Health T32 research training grant CA136432-12 to Dr Aziz-Bose and the Jack and Dorothy Byrne Foundation. Dr Nohria is a consultant for AstraZeneca, Bantam Pharmaceuticals, Boehringer Ingelheim, and Takeda Oncology; and has received research support from Amgen. Dr Yock has received in-kind software support from Mim Software for a multicenter Pediatric Radiation Registry (Pediatric Proton/Photon Consortium Registry). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Radiation therapy is an important component of cancer therapy for many malignancies. With improvements in cardiac-sparing techniques, radiation-induced cardiac dysfunction has decreased but remains a continued concern. In this review, we provide an overview of the evolution of radiotherapy techniques in thoracic cancers and associated reductions in cardiac risk. We also highlight data demonstrating that in some cases radiation doses to specific cardiac substructures correlate with cardiac toxicities and/or survival beyond mean heart dose alone. Advanced cardiac imaging, cardiovascular risk assessment, and potentially even biomarkers can help guide post-radiotherapy patient care. In addition, treatment of ventricular arrhythmias with the use of ablative radiotherapy may inform knowledge of radiation-induced cardiac dysfunction. Future efforts should explore further personalization of radiotherapy to minimize cardiac dysfunction by coupling knowledge derived from enhanced dosimetry to cardiac substructures, post-radiation regional dysfunction seen on advanced cardiac imaging, and more complete cardiac toxicity data., Competing Interests: This work was supported by the National Institutes of Health (R01HL147884) and National Center for Advancing Translational Sciences of the National Institutes of Health (UL1TR002345). Dr Bergom has received research funding from the National Institutes of Health, Susan G. Komen Foundation, and Innovation Pathways. Dr Bradley has received an Ion Beam Application travel grant (April 2018) and funding from the Bankhead Coley Foundation and Ocala Royal Dames Foundation. Dr Ng has received funding from ViewRay. Dr Robinson has received research funding from the National Institutes of Health and the American Heart Association. Dr Mitchell has received research funding from Pfizer, Longer Life Foundation, and Children’s Discovery Institute and consultancy for Pfizer. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.)

Background: The incidence of acute cardiac injury in COVID-19 patients is very often subclinical and can be detected by cardiac magnetic resonance imaging. The aim of this study was to assess if subclinical myocardial dysfunction could be identified using left ventricular global longitudinal strain (LV-GLS) in patients hospitalized with COVID-19., Methods: We performed a search of COVID-19 patients admitted to our institution from January 1st, 2020 to June 8th, 2020, which revealed 589 patients (mean age = 66 ± 18, male = 56%). All available 60 transthoracic echocardiograms (TTE) were reviewed and off-line assessment of LV-GLS was performed in 40 studies that had sufficient quality images and the views required to calculate LV-GLS. We also analyzed electrocardiograms and laboratory findings including inflammatory markers, Troponin-I, and B-type natriuretic peptide (BNP)., Results: Of 589 patients admitted with COVID-19 during our study period, 60 (10.1%) underwent TTE during hospitalization. Findings consistent with overt myocardial involvement included reduced ejection fraction (23%), wall motion abnormalities (22%), low stroke volume (82%) and increased LV wall thickness (45%). LV-GLS analysis was available for 40 patients and was abnormal in 32 patients (80%). All patients with LV dysfunction had elevated cardiac enzymes and positive inflammatory biomarkers., Conclusions: Subclinical myocardial dysfunction as measured via reduced LV-GLS is frequent, occurring in 80% of patients hospitalized with COVID-19, while prevalent LV function parameters such as reduced EF and wall motion abnormalities were less frequent findings. The mechanism of cardiac injury in COVID-19 infection is the subject of ongoing research., Competing Interests: The authors report no relationships that could be construed as a conflict of interest., (© 2021 The Authors.)

We describe a case of testicular teratoma with metastasis to the right ventricle. The mass nearly completely resolved with chemotherapy, obviating the need for upfront surgery. We review the workup of intracardiac metastatic tumors. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

Competing Interests: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed., Competing Interests: Dr. Liu has received consultant fees for Bay Labs, Pfizer, and Philips; and is supported by the National Institutes of Health/National Cancer Institute (NIH/NCI) Cancer Center Support Grant (P30 CA008748). Dr. Barac has received advisory fees for Bristol Myers Squibb and Takeda Inc. Dr. Thavendiranathan is supported by the Canadian Institutes of Health Research New Investigator Award; and has been on the Speakers Bureau of Amgen, Takeda, and Blood Institute. Dr. Scherrer-Crosbie is supported by NIH-NHLBI R01 130539., (© 2020 The Authors.)

Background: In the era of High-sensitive troponin (hs-Tn), up to 50% of patients with a mild increase of hs-Tn will finally have a normal invasive coronary angiogram. Fractional Flow Reserve (FFR) derived from coronary computed tomographic angiography (FFR-CT) has never been used as a non-invasive tool for the diagnosis of coronary artery disease in patients with high-risk acute coronary syndrome without ST segment elevation (NSTE-ACS)., Aims: The study aims to determine the role of coronary CT angiography and FFR-CT in the setting of high-risk NSTE-ACS., Methodology: We will conduct a prospective trial, enrolling 250 patients admitted with high-risk NSTE-ACS who will rapidly undergo a coronary CT angiography and then a coronary angiography with FFR measurements. Results of coronary CT, FFR-CT and coronary angiography (± FFR) will be compared., Potential Significance: In conclusion, non-invasive identification of patients with high-risk NSTE-ACS who could avoid coronary angiography would reduce procedure related risks and medical costs., Competing Interests: Dr Fournier reports an institutional consultancy for Bayer and Cathworks. Dr. De Bruyne receives grant support from Abbott, Boston Scientific, Biotronik AG, and St Jude Medical and receives consulting fees on behalf of Dr De Bruyne from St. Jude Medical, Opsens, and Boston Scientific outside of the submitted work Dr. De Bruyne is a shareholder for Siemens, GE, Bayer, Philips, HeartFlow, Edwards Life Sciences, and Ceyliad. Dr. Collet reports receiving research grants from Biosensor, Heart Flow Inc. and Abbott Vascular; and consultancy fees from Heart Flow Inc, Abbott Vascular and Philips Volcano., (© 2020 The Authors. Published by Elsevier B.V.)