Measurement of plasma BNP levels at rest may be useful in predicting silent myocardial ischemia in HCM.

solated congenital absence of the pericardium is a rare malformation and can vary from partial to complete absence, occurring more often on the left than the right side. 1 The features of complete absence of the left pericardium on chest X-ray and echocardiography, which are mainly related to the displacement of the whole heart, have been described by many investigators. [2][3][4][5][6][7][8] In partial absence of the pericardium, the characteristic features are quite different from those of complete absence of the pericardium because partial absence is occasionally complicated with herniation of a cardiac structure. [9][10][11] We present a case of partial absence of the left pericardium that was diagnosed by delineating the pericardium with magnetic resonance imaging (MRI), although the chest X-ray and echocardiographic features indicated a complete absence. Case ReportA 44-year-old man was referred for the evaluation of atypical chest pain. The pain eased spontaneously after several minutes, but was triggered in the left lateral position and he felt no distress. His apical impulse was prominent and displaced leftward to the anterior axillary line in the fifth intercostal space and a grade I/VI systolic murmur was present in the pulmonary valve area. Electrocardiography revealed right-axis deviation (QRS axis: 106°) and Circulation Journal Vol.68, April 2004incomplete right-bundle branch block. The chest X-ray in the standing posteroanterior view demonstrated leftward displacement of the heart without tracheal deviation. The chest X-rays in the right and the left lateral positions showed unusual cardiac mobility in the leftward direction (Fig 1). In transthoracic echocardiography, the apical window was displaced laterally in the usual left lateral position. Each echocardiogram recorded at expiration is shown (Fig 2). The 2-dimensional echocardiogram in the Magnetic Resonance Imaging Differentiated Partial From Complete Absence of the Left Pericardium in a Case of Leftward Displacement of the HeartTetsuhiro Yamano, MD; Takahisa Sawada, MD; Kenzo Sakamoto, MD; Takeshi Nakamura, MD; Akihiro Azuma, MD; Masao Nakagawa, MDA 44-year-old man was referred to hospital for the evaluation of atypical chest pain. His chest X-ray showed leftward displacement of the heart. During echocardiography, the apical window displaced laterally in the usual left lateral position and characteristic motions of the interventricular septum and left ventricular posterior wall were recognized with postural alterations. We presumed a complete absence of the left pericardium. Magnetic resonance imaging (MRI), however, demonstrated a partial left-sided pericardium. The diagnosis was corrected to partial absence of the left pericardium and we have carefully followed up this case without surgical prophylactic intervention. It is very important to differentiate partial from complete absence of the pericardium, because only in patients with partial absence of the pericardium is there a risk of fatal myocardial strangulation. The features of the c...

We have developed new software which can evaluate left ventricular (LV) diastolic functional parameters from a quantitative gated SPET (QGS) program. To examine its accuracy, we compared these findings with the LV diastolic functional indices obtained from gated radionuclide ventriculography (RNV). Twenty-four patients were selected for this study. Gated SPET with technetium-99m tetrofosmin was performed and the QGS program was used with a temporal resolution of 32 frames per R-R interval. The LV volume of each frame was calculated and four harmonics of Fourier series were retained for the analysis of the LV volume curve. From this fitted curve and its first derivative curve, we derived LV systolic functional indices, e.g. ejection fraction (EF), peak ejection rate (PER) and time to PER (TPER), as well as LV diastolic functional variables, e.g. 1/3 filling fraction (1/3 FF), peak filling rate (PFR) and time to PFR (TPFR). Within 5+/-2 days, gated RNV was performed and diastolic functional parameters were determined by the same method. No significant difference was observed between the variables calculated by gated SPET and by gated RNV. There was a good correlation between EF, PER, TPER, 1/3 FF, PFR and TPFR determined by these two methods (EF: r=0.95, P<0.0001; PER: r=0.87, P<0.0001; TPER: r=0.84, P<0.0001; 1/3 FF: r=0.87, P<0.0001; PFR: r=0.92, P<0.0001; TPFR: r=0.89, P<0.0001). Bland-Altman plots did not reveal any significant degree of directional measurement bias in any of the comparisons of gated SPET data and RNV data. It is concluded that, in addition to the conventional LV systolic functional indices, our program accurately provides LV diastolic functional parameters from gated SPET. Also, this program will be useful for detecting LV diastolic dysfunction in various cardiac diseases before LV systolic dysfunction becomes evident.

Gated single-photon emission tomography (SPET) is not yet an established procedure for the evaluation of left ventricular (LV) diastolic function. This study examined diastolic function derived from gated SPET in comparison with an established diagnostic tool, Doppler echocardiography. We examined 37 consecutive patients with normal sinus rhythm who underwent gated technetium-99m tetrofosmin SPET. A gated SPET program was used with a temporal resolution of 32 frames per R-R interval. We obtained the Doppler transmitral flow velocity waveform immediately before gated SPET image acquisition. Patients who showed a ratio of peak early transmitral flow velocity to atrial flow velocity (E/A) of >1 or whose R-R intervals differed by >5% between Doppler echocardiography and gated SPET were excluded from this investigation. We compared diastolic indices and presumed corresponding intervals in diastole using the two methods. The peak filling rate (PFR) derived from gated SPET correlated with the Doppler peak velocity of the early transmitral flow (E) wave ( r=0.65) and deceleration of the E wave ( r=0.71). The time to PFR and percent atrial contribution to LV filling from gated SPET correlated excellently with the Doppler LV isovolumic relaxation time ( r=0.93) and the E/A ratio ( r=-0.85), respectively. There was a significant linear correlation in all the intervals from the R wave to the presumed corresponding diastolic points. The point of PFR in gated SPET and the peak of the E wave in Doppler echocardiography generally coincided. The onset of filling in gated SPET tended to be closer to the second heart sound than the start of the E wave in Doppler echocardiography. We conclude that gated SPET permits the assessment of not only myocardial perfusion and LV systolic function but also diastolic function, although there may be some errors in detection of the precise beginning of LV filling.

Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.