Previous studies investigating the role of circulating microRNAs in acute coronary syndrome (ACS) were based on small patient numbers, performed no comparison with established markers of cardiac injury and did not have appropriate controls. We determined the potential diagnostic value of circulating microRNAs as novel early biomarkers in 332 suspected ACS patients on presentation to the emergency department (ED) in a prospective single-centre study including cardiac miRNAs (miR-1, -208a and -499), miR-21 and miR-146a. Levels of all miRs studied were significantly increased in 106 patients diagnosed with ACS, even in patients with initially negative high-sensitive (hs) troponin or symptom onset <3 h. MiR-1, miR-499 and miR-21 significantly increased the diagnostic value in all suspected ACS patients when added to hs-troponin T (AUC 0.90). These three miRs were strong predictors of ACS independent of clinical co-variates including patient history and cardiovascular risk factors. Interestingly, the combination of these three miRs resulted in a significantly higher AUC of 0.94 than hs-troponin T (0.89). Circulating microRNAs hold great potential as novel early biomarkers for the management of suspected ACS patients.

ECG-gated acquisition of 3D IVUS image sets is feasible and permits the application of automated contour detection to provide reproducible measurements of the lumen and atherosclerotic plaque CSA and volume in a relatively short analysis time.

Objective-To compare vessel, lumen, and plaque volumes in atherosclerotic coronary lesions with inadequate compensatory enlargement versus lesions with adequate compensatory enlargement. Design-35 angiographically significant coronary lesions were examined by intravascular ultrasound (IVUS) during motorised transducer pullback. Segments 20 mm in length were analysed using a validated automated three dimensional analysis system. IVUS was used to classify lesions as having inadequate (group I) or adequate (group II) compensatory enlargement. Conclusions-In lesions with inadequate compensatory enlargement, both vessel and plaque volume appear to be smaller than in lesions with adequate compensatory enlargement. (Heart 1998;79:137-142) Keywords: intravascular ultrasound; ultrasonics; remodelling; coronary artery disease Intravascular ultrasound provides transmural images of coronary arteries in vivo. The coronary vascular wall, the cross sectional area of the atherosclerotic plaque, the consequences of plaque accumulation, and the mechanisms of lesion formation can be studied in humans in a manner previously not possible. Results-There 1-9Atherosclerotic arteries tend to undergo compensatory vascular enlargement to accommodate increasing plaque burden during the early stages of plaque accumulation.10-12 Because of this adaptation, lumen dimensions are preserved and an angiographic underestimation of coronary atherosclerosis often occurs. 13This concept was initially derived from anatomical and histopathological studies in vitro.10-12 It has been confirmed using intravascular and epicardial ultrasound studies in vivo.14- In the present study, we examined 35 atherosclerotic coronary lesions which were classified as having inadequate (group I) or adequate compensatory enlargement (group II). Automated three dimensional intravascular ultrasound analysis of the lumen, vessel, and plaque dimensions was performed [25][26][27][28][29] to gain insight into the volumetric characteristics 6 of these lesions. Methods PATIENT POPULATIONThe study population consisted of 35 patients with primary (not restenotic) atherosclerotic lesions examined using preintervention intravascular ultrasound. Inclusion criteria were: angiography documented non-curved lesion segments; limited plaque calcification throughout a lesion length of 20 mm; absence of a complete occlusion of the stenotic lumen during the ultrasound imaging run; and absence of major side branches. Thirty two men and three women (mean (SD) age 61 (9) years) were examined. Lesions were located in the left anterior descending coronary artery (n = 20), right coronary artery (n = 10), and left circumflex coronary artery (n = 5); 32 were proximal and three were in the mid-portion. The study was approved by the Local Council on Human Research. All patients signed a written informed consent form, approved by the local medical ethics committees.

The current report describes a rare case of a pseudotumor in the left ventricle. Transthoracic and transesophageal echocardiography demonstrated a round, echodense, mobile mass attached to the posterior mitral leaflet and annulus. At surgical exploration caseous annular calcification of the posterior mitral leaflet was diagnosed. After resection of the mass, successful mitral valvular plasty was performed. Review of the literature indicated that mitral annular calcification is associated with an increased risk of stroke. Optimal treatment may be surgery, especially when valve plasty can be performed, although randomized trials are currently lacking.

The current report describes a patient with pulmonary embolism, treated unsuccessfully with heparin. Transthoracic echocardiography revealed free-floating right heart thrombus. Migrating deep vein thrombus to the right heart was suspected. Transesophageal echocardiography confirmed origin of the thrombus in the inferior cava vein. Mortality rate of mobile right heart thrombus is over 40%, therefore urgent surgical embolectomy was performed with relief of symptoms.