One hundred consecutive female patients with active systemic lupus erythematosus (SLE) were studied from the cardiovascular point of view by means of non invasive methods. Seventy percent of the cases presented some type of cardiovascular anomaly. Seventy four percent of the resting electrocardiograms were abnormal as well as 72% of the M mode echocardiograms and 55% of the cardiac X ray series. The most frequent observed complications were: pericarditis and or pericardial effusion (39%), arterial hypertension (22%), ischemic heart disease (16%), myocarditis (14%), congestive heart failure (10%), pulmonary hypertension (9%), valvular heart disease (9%), pleural effusion (7%) and cerebro vascular accident (3%). We analyzed each one of these complications and found of special interest the high incidence of ischemic heart disease which is more frequent than has been hitherto reported. Ischemic heart disease was observed in two types of patients: a) Those with long term steroid therapy. In these, the mechanism seems to be an atherosclerotic disease probably induced by the chronic use of steroids. The management of these cases do not differ from other types of coronary heart disease due to atherosclerosis. b) Those with frank episodes of vasculitis in whom the basic mechanism is an inflammatory process of the coronary arteries and its treatment is fundamentally that of the vasculitis. We consider necessary to study routinely all patients with SLE through non invasive cardiological methods.

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Proper timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients is not well established and is an area of intense interest. In addition, optimizing LVAD performance after implantation remains difficult and represents a significant clinical need. Implantable hemodynamic monitoring systems may provide physicians with the physiologic information necessary to improve the timing of LVAD implantation as well as LVAD performance when compared with current methods. The CardioMEMS Heart sensor Allows for Monitoirng of Pressures to Improve Outcomes in NYHA Class III heart failure patients (CHAMPION) Trial enrolled 550 previously hospitalized patients with New York Heart Association (NYHA) class III heart failure. All patients were implanted with a pulmonary artery (PA) pressure monitoring system and randomized to a treatment and control groups. In the treatment group, physicians used the hemodynamic information to make heart failure management decisions. This information was not available to physicians for the control group. During an average of 18 month randomized follow-up, 27 patients required LVAD implantation. At the time of PA pressure sensor implantation, patients ultimately requiring advanced therapy had higher PA pressures, lower systemic pressure, and similar cardiac output measurements. Treatment and control patients in the LVAD subgroup had similar clinical profiles at the time of enrollment. There was a trend toward a shorter length of time to LVAD implantation in the treatment group when hemodynamic information was available. After LVAD implantation, most treatment group patients continued to provide physicians with physiologic information from the hemodynamic monitoring system. As expected PA pressures declined significantly post LVAD implant in all patients, but the magnitude of decline was higher in patients with PA pressure monitoring. Implantable hemodynamic monitoring appeared to improve the timing of LVAD implantation as well as optimize LVAD performance when compared with current methods. Further studies are necessary to evaluate these findings in a prospective manner.

Although parameters of right ventricular (RV) size and function are clinically important, echocardiographic assessment of this chamber is complex. Existing quantitative approaches rely on manual measurements performed on different images, and are thus time-consuming. Consequently, in clinical practice, qualitative assessment is usually used instead. We tested a new approach for automated measurements of RV size and function using speckle tracking by comparing them to the conventional manual methodology. Transthoracic images were obtained in 149 patients with a wide range of RV size and function, and were analyzed by an expert using conventional techniques to obtain RV end-diastolic and end-systolic areas, fractional area change, dimensions (basal and mid-cavity diameters and length), tricuspid annular plane systolic excursion and peak systolic velocity. Same parameters were obtained using the semi-automated software (Epsilon Imaging), which requires tracing of the RV endocardial boundary in a single frame in the RV focused view. Fifteen patients were excluded due to image quality (90% feasibility). Time required for the automated analysis was approximately 30 s per patient, compared to 4 min for conventional analysis. The parameters obtained with the semi-automated approach were in good agreement with manual measurements: r-values 0.79-0.95 for RV size and 0.70-0.74 for function indices and biases of 2-22% of the mean measured values, which were comparable to the intrinsic variability of the conventional technique. In conclusion, the semi-automated technique is feasible, fast and provides quantitative parameters of RV size and function, which are comparable to conventional measurements.

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