RV contractile abnormalities may follow the same LV regional distribution in Takotsubo cardiomyopathy; the type of presentation rather than the presence of RV dysfunction seems to be responsible for an increased risk of complications and severity of functional impairment.

The impact of pulmonary embolism on right ventricular (RV) performance can be evaluated by echocardiography, however, the relationship between pulmonary vascular involvement and RV burden is controversial. To assess the effect of clot burden on RV performance we studied 85 patients (aged 53 ± 17 years, 39 female) with confirmed PE by multislice computed tomography (CT) and echocardiography within 24 h of diagnosis. A CT score ranging from 1 to 20 points according to the pulmonary arteries involved was used. RV function was evaluated with fractional area change (FAC), with dysfunction present when FAC < 40%. Tissue Doppler RV systolic (s') velocities and myocardial performance index (MPI) were obtained, as well as pulmonary artery pressure (PAP). Mean CT score was 9.4 ± 6.7. Only 31 out of 85 patients (37%) presented with RV dysfunction, with FAC measuring 27.8 ± 7.2% in patients with dysfunction compared to 47.8 ± 4.4 for those with preserved RV function (p < 0.05). RV dysfunction was associated to older age, higher CT scores, increased pulmonary pressures and MPI and decreased s' (p < 0.001). An inverse correlation with CT clot burden was found for FAC (r = -0.57), whereas a direct correlation was seen for PAP (r = 0.51) and MPI (0.32). No correlation was observed for tissue Doppler velocities. In patients with acute PE, the effect of clot burden on RV performance is better expressed FAC than tissue Doppler indexes; the increase in pulmonary pressure is proportional to the magnitude of obstruction.

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Magnetic Ressonance Imaging (MRI) using T2 star (T2*) tecnique appears to be a very useful method for monitoring iron overload and iron chelation therapy in thalassaemia. In Brazil, we have around 400 thalassaemic major patients all over the country. They were treated with hipertransfusion protocols and desferroxamine and/or deferiprone chelation. We developed a cooperative program with the Brazilian Thalassaemic Patients Association (ABRASTA) in order to developT2* tecnique in Brazil to submit brazilian patients to an annual iron overload monitoring process with MRI.. We performed the magnetic ressonance T2* using GE equipment (GE, Milwaukee USA), with validation to chemical estimation of iron in patients undergoing liver biopsy. Until now, 60 patients were scanned, median age=23,2 (12–54); gender: 18 male (30%) and 42 female (70%). The median ferritin levels were 2030 ng/ml (Q1=1466; Q3=3296). As other authors described before, there was a curvilinear inverse correlation between iron concentration by biopsy, liver T2*(r=0,92) and also there were a correlation with ferritin levels. We also correlated myocardial iron measured by T2* with ventricular function.. As miocardial iron increased, there was a progressive decline in ejection fraction and no significant correlation was found between miocardial T2* and the ferritin levels. Liver iron content can be predicted by ferritin levels. On the other hand, cardiac disfunction is the most important cause of mortality among thalassaemic patients. Since Miocardio iron content cannot be predicted from serum ferritin or liver iron, and ventricular function can only detect those with advance disease, intensification and combination of chelation therapy, guided by T2* MRI tecnique should reduce mortality from the reversible cardiomyopathy among thalassaemic patients.

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