Objective Prognosis in pulmonary hypertension is largely determined by right ventricular (RV) function. However, uncertainty remains about what metrics of RV function might be most clinically relevant. The purpose of this study was to assess the clinical relevance of metrics of RV functional adaptation to increased afterload. Methods Patients referred for pulmonary hypertension (PH) underwent right heart catheterization and RV volumetric assessment within 48 hours. A RV maximum pressure (Pmax) was calculated from the RV pressure curve. The adequacy of RV systolic functional adaptation to increased afterload was estimated either by a stroke volume (SV)/end-systolic volume (ESV) ratio, a Pmax/ mean pulmonary artery pressure (mPAP) ratio, or by ejection fraction (RVEF). Diastolic function of the RV was estimated by a diastolic elastance coefficient β. Survival analysis was via Cox proportional hazard ratio and Kaplan-Meier with the primary outcome of time to death or lung transplant. Results Patients (n=50; age 58±13) covered a range of mPAP (13–79 mmHg) with an average RVEF of 39±17% and ESV of 143±89 ml. Average estimates of the ratio of end-systolic ventricular to arterial elastance were 0.79±0.67 (SV/ESV) and 2.3±0.65 (Pmax/mPAP-1). Transplantation-free survival was predicted by right atrial pressure, mPAP, pulmonary vascular resistance, β, SV, ESV, SV/ESV, and RVEF but after controlling for right atrial pressure, mPAP, and SV, SV/ESV was the only independent predictor. Conclusions The adequacy of RV functional adaptation to afterload predicts survival in patients referred for pulmonary hypertension. Whether this can simply be evaluated using RV volumetric imaging will require additional confirmation.

Branched polyethylene glycol (four arms, MW = 15 000) having a cinnamylidene acetyl moiety as a pendant group was synthesized by an esterification reaction between polyethylene glycol and cinnamylidene acetyl chloride. The photosensitive polymer was irradiated with a 450 W medium pressure Hg lamp (λ > 300 nm) from 5 min to 3 h to produce polyethylene glycol hydrogels. These gels were swollen in water and showed characteristic properties of a hydrogel. The degree of swelling was controlled by the content of cinnamylidene acetyl moiety in the polymer and the time of ultraviolet irradiation. A reduced degree of substitution resulted in increased swellability of the synthesized hydrogel. The photoscission of the gel, which was monitored by its UV spectrum, was performed by irradiating the hydrogel with a 150 W Xenon lamp at 254 nm using a bandpass filter. The biocompatibility of the synthesized gel was also determined. The antithrombogenic behavior (99.6% reduction in platelet deposition) of the synthesized b-PEG-CA hydrogel was demonstrated by measuring platelet adhesion onto coverslips which had been coated with PMMA with a second coating film of b-PEG-CA hydrogel.

Background Routine clinical use of novel free-breathing, motion-corrected, averaged late gadolinium enhancement (moco-LGE) cardiovascular magnetic resonance may have advantages over conventional breath held LGE (bh-LGE) especially in vulnerable patients. Methods and Results In 390 consecutive patients, we collected bh-LGE and moco-LGE with identical image matrix parameters. In 41 patients, bh-LGE was abandoned due to image quality issues, including 10 with myocardial infarction (MI). When both were acquired, MI detection was similar (McNemar test, p=0.4) with high agreement (kappa statistic 0.95). With artifact-free bh-LGE images, pixelwise MI measures correlated highly (R2=0.96) without bias. Moco-LGE was faster, and image quality and diagnostic confidence were higher on blinded review (p<0.001 for all). Over a median of 1.2 years, 20 heart failure hospitalizations and 18 deaths occurred. For bh-LGE, but not moco-LGE, inferior image quality and bh-LGE non acquisition were linked to patient vulnerability confirmed by adverse outcomes (logrank p<0.001). Moco-LGE significantly stratified risk on the full cohort (logrank p<0.001), but bh-LGE did not (logrank p=0.056) since a significant number of vulnerable patients did not receive bh-LGE (due to arrhythmia or inability to breath hold). Conclusions MI detection and quantification are similar between moco-LGE and bh-LGE when bh-LGE can be acquired well, but bh-LGE quality deteriorates with patient vulnerability. Acquisition time, image quality, diagnostic confidence and the number of successfully scanned patients are superior with moco-LGE which extends LGE-based risk stratification to include patients with vulnerability confirmed by outcomes. Moco-LGE may be suitable for routine clinical use.

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Atrial fibrillation (AF) is a common cardiac rhythm disturbance and its incidence is increasing. Radiofrequency catheter ablation (RFCA) is a highly successful therapy for treating AF, and its use is becoming more widespread; however, with its increasing use and evolving technique, known complications are better understood and new complications are emerging. Computed tomography (CT) of the pulmonary veins, or more correctly, the posterior left atrium (LA), has an established role in precisely defining the complex anatomy of the LA and pulmonary veins preablation and has an expanding role in identifying the myriad of possible complications postablation. The purposes of this article are: to review AF and RFCA; to discuss CT evaluation of the LA and pulmonary veins preablation; and to review the complications of RFCA focusing on the role of CT postablation.