Scipione Carerj¹, Concetta Zito¹, Gianluca Di Bella¹, Sebastiano Coglitore¹, Emanuele Scribano2, Fabio Minutoli², Francesco Arrigo¹, Giuseppe Oreto¹

¹Institute of Cardiology, University of Messina, Italy, ²Department of Radiology, University of Messina, Italy

FIGURES

Figure 1. Evaluation of left ventricular volumes and ejection fraction (EF) by Biplane Sympson's rule. In this patient, with previous inferior and lateral myocardial infarction, the monoplane Sympson's rule (top) overestimates the ejection fraction. MP EF: monoplane ejection fractio; BP EF: biplane ejection fraction.

Figure 2. Mitral annular systolic velocity (MASV), evaluated by Pulsed-Wave Tissue Doppler Imaging (PW-TDI). MASV measures 4 cm/sec, expression of a severe left ventricular (LV) longitudinal dysfunction. It is also shown a reduction of E' wave velocity due to a diastolic dysfunction. S': peak velocity during isovolumic LV contraction; S: peak velocity during systolic LV contraction; E': peak velocity during early-diastolic LV relaxation; A': peak velocity during end-diastolic phase.

Figure 3. Top: longitudinal 2D strain in a healthy subject (left panel) and in a patient with dilated cardiomyopathy and HF (right panel). Bottom: radial 2D strain in a healthy subject (left panel) and in a patient with dilated cardiomyopathy and HF (right panel). A reduction of both radial and longitudinal strain is present in the patient with cardiomyopathy.

Figure 4. Left panel: radial (top) and longitudinal (bottom) 2D strain in a healthy subject, at the end-systolic phase. Right panel: radial (top) and longitudinal (bottom) 2D strain in a patient with HF, at the end-systolic phase. The amplitude of radial and longitudinal strain is measured by the colour of the walls (red in normal LV; pink and blue in dysfunctioning LV). A dyssynchrony between septum and infero-lateral wall is also present in the HF patient.

Figure 5. Top: midventricular short-axis view by delayed contrast enhancement (DCE)-Cardiac Magnetic Resonance (CMR), showing the ischemic pattern of DCE (scar tissue located from subendocardial to epicardial layer) in the anterior and anteroseptal wall (white arrow). Bottom: non-ischemic pattern of DCE (epicardial localization) in the basal inferolateral segment of the left ventricle.

Figure 6. Cardiac magnetic resonance images and echocardiography strain curves in myocarditis and normal systolic LV function. Strain Doppler echocardiography identifies longitudinal segmental myocardial dysfunction derived from edema in the acute phase of myocarditis. (reproduced with permission from Di Bella G et al (49): Strain Doppler echocardiography can identify longitudinal myocardial dysfunction derived from edema in acute myocarditis. Intern J of Cardiol 2007, e-pub ahead of print).

Figure 7. Grading of diastolic dysfunction from normal to severe dysfunction (grade 3-4), evaluated by Pulse Wave (PW) Doppler of mitral inflow. Normal: DT 140-240 msec; E/A 0.75-1.5. Grade 1: DT> 240 msec, E/A <0.75. Grade 2: DT 140-240 msec, E/A 0.75-1.5. Grade 3-4: DT < 140 msec, E/A > 1.5; in grade 3, the E/A ratio is reversible, when compared to grade 4, with the pre-load changes.

Figure 8. Constrictive pericarditis and CMR. A T1-weighted (top) and a Steady-State-Free-Procession (bottom) axial CMR images show diffuse pericardial thickening (white arrows).