Background-Cardiovascular magnetic resonance is the gold-standard technique for the assessment of ventricular function.Although left ventricular volumes and ejection fraction are strong predictors of outcome in dilated cardiomyopathy (DCM), there are limited data regarding the prognostic significance of right ventricular (RV) systolic dysfunction (RVSD). We investigated whether cardiovascular magnetic resonance assessment of RV function has prognostic value in DCM. Methods and Results-We prospectively studied 250 consecutive DCM patients with the use of cardiovascular magnetic resonance. RVSD, defined by RV ejection fraction ≤45%, was present in 86 (34%) patients. During a median follow-up period of 6.8 years, there were 52 deaths, and 7 patients underwent cardiac transplantation. Received March 10, 2013; accepted July 30, 2013. From the Royal Brompton Hospital, London, United Kingdom (A.G., T.F.I., A.J., F.A., K.G., N.A.I., S.R., J.K., T.D.H.B., K.M., E.L., M.R., R.W., T.C.P., R.S., J.-P.C., S.A.C., M.R.C., R.G.A., D.J.P., S.K.P.); Ealing Hospital, London, United Kingdom (R.G.A.); National Heart & Lung Institute, Imperial College, London, United Kingdom (T.F.I., K.G., R.S., J.-.P.C., S.A.C., M.R.C., D.J.P., S.K.P.); and National Heart Centre Singapore, Singapore (S.A.C.).The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl

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The increasing worldwide prevalence of heart failure is associated with numerous and protracted hospital admissions. The multidisciplinary team approach together with telemonitoring aims at reducing the number of rehospitalizations, length of hospital stay, and mortality rates. Novel cardiac resynchronization therapy (CRT) devices have a Home Monitoring capability, offering wireless, everyday transfer of the essential status and therapy data to the attending physician. The transmitted data include potential predictors of death or hospitalization, such as the onset of atrial and ventricular arrhythmias, duration of physical activity, mean heart rates over 24 h and at rest, percentage of CRT delivered, and lead impedances. We present here interim results of the prospective, longitudinal, multicenter Home CARE Phase 0 study, conducted in 123 patients (age: 67+/-9 years, 83% male) with clinical indication for CRT. Twenty-nine patients (24%) received a CRT pacemaker, 52 (42%) a prophylactic implantable cardioverter defibrillator (ICD), and 42 (34%) had other ICD indications. All devices have an integrated Home Monitoring feature. In a mean (interim) follow-up period of 3 months (9194 observational days), 11 unplanned rehospitalizations of cardiovascular etiology and 9 deaths occurred. In 70% of the rehospitalization events, the retrospective analysis of transmitted data via Home Monitoring revealed an increase in mean heart rate at rest and in mean heart rate over 24 h within 7 days preceding hospitalization. A decrease in the percentage of CRT was observed in 43% and a reduction in the patients' daily activity in 30% of rehospitalized patients. These interim findings suggest that Home Monitoring data may predict events leading to hospitalization and encourage further research.

A 57-year-old woman had previously undergone a right hemicolectomy for Duke B adenocarcinoma of caecum. She presented with acute back pain. A magnetic resonance imaging scan of her thoracic spine showed destruction of a vertebra with a tumor deposit at T11 ( Figure 1A). She underwent a course of radiotherapy (20 Gray in 5 fractions) to this area. Good symptomatic relief was obtained. Biopsy demonstrated a sarcomatoid tumor suggestive of leiomyosarcoma. Over the next 2 months she developed dyspnea on exertion, fatigue, and leg edema. Examination revealed a Figure 1. A, Magnetic resonance image (MRI) of thoracic spine identified destruction of a T11 vertebral body with metastatic replacement and impingement of spinal cord. B, Three-dimensional (3D) transthoracic echocardiogram (TEE) demonstrating the mass originating from the superior vena cava extending to the right atrium and prolapsing through the tricuspid valve into the right ventricle (RV). LV indicates left ventricle; LA, left atrium. C, 3D TTE. The mass was seen to obstruct the right ventricular inflow, almost completely occluding the tricuspid valve annulus during diastole. D, Myocardial contrast echocardiogram (MCE). To assess the vascularity of the mass, the patient underwent MCE. Limited passage of microbubbles into mass (arrow; partial enhancement) suggests tumor of low vascularity.