Introduction: While primary malignant tumors of the heart are rare, angiosarcomas are the most common cardiac malignant tumors. Case Presentation: We describe a 23-year-old woman who presented with a right atrial mass, which was discovered to be a cardiac angiosarcoma. We demonstrate the use of several noninvasive imaging modalities along with pathology confirmation for the definitive and comprehensive diagnosis of a cardiac angiosarcoma, a rare entity by itself. Conclusions: With the increasing availability of noninvasive imaging techniques, the diagnosis of angiosarcomas can be made at earlier stages. If angiosarcomas are left untreated, their prognosis is very poor. Therapeutic options include surgical excision, chemotherapy, radiation therapy, and heart transplantation or a combination of these.

Introduction: Dilated cardiomyopathy (DCM) is the leading cause of heart failure and arrhythmia. Case Presentation: A 47-year-old male, diagnosed with dilated cardiomyopathy, died due to heart failure. During the screening of his family members, his 17-year-old daughter and 9-year-old son also had dilated cardiomyopathy. Another daughter had died suddenly at the age of 12 years. Conclusions: We herein describe 3 patients with dilated cardiomyopathy developing in the father, daughter, and son of the same family and justify the importance of the screening test as an important tool for identifying families affected by familial dilated cardiomyopathy.

Introduction: The Eustachian valve (EV) remnant, when present in adults, is usually rudimentary. However, in echocardiographic examinations, it may appear as a mobile long structure in the right atrium, and it rarely protrudes into the right ventricle. When it is quite large, the EV remnant could be misdiagnosed as a right atrial tumor, thrombus, or vegetation. Case Presentation: An 83-year-old patient was referred to the surgical ward for the excision of a gastric adenocarcinoma. In the course of preoperative assessment, transthoracic echocardiography showed a right atrial mobile filamentous mass that was protruding into the right ventricle. Differential diagnosis included a tumor or thrombus. After a precise evaluation through multiple views, the mass was demonstrated to be a giant EV, 7.3 cm in length. Conclusions: The giant EV remnant can persist in adults and is often diagnosed incidentally via echocardiography. Transthoracic echocardiography is a reliable noninvasive method for the diagnosis of the EV remnant and could help avoid its misdiagnosis as a tumor or thrombus. Nevertheless, sometimes transesophageal echocardiography is necessary to confirm the diagnosis or to demonstrate the existence of an additive clot on it.

Background: Coronary computed tomographic angiography (CCTA) image quality is dependent on heart rate (HR). Beta blockers are commonly administered before CCTA to lower HR and minimize variability. However, contrast media may also impact upon HR and image quality. Since iso-osmolar contrast media induce less vasodilation, this may decrease a patient's sensation of heat, minimizing patient discomfort and improving HR control and variability. Objectives: The aim of the study was to compare the impact of contrast media selection in CCTA upon HR and image quality. Patients and Methods: A total of 173 patients undergoing CCTA between February and April 2011 were allocated to different contrast media (Iodixanol, Iohexol, and Iopamidol) in 2-week blocks. The groups were analyzed for differences in baseline characteristics, imaging parameters, image quality, HR, and HR variability. Patients were also surveyed for perception of heat. Results: Baseline HR was similar across the patients assigned to Iohexol, Iopamidol, and Iodixanol (65.3 ± 9.7, 66.9 ± 10.9, and 65.3 ± 13.3, respectively; P = NS). Compared to Iohexol and Iopamidol, Iodixanol use was associated with lower HR at the time of image acquisition and immediately after CCTA (53.2 ± 8.0 bpm, 56.3 ± 7.8 bpm, and 56.8 ± 6.5 bpm; P = 0.069 and P = 0.032). A greater proportion of patients achieved HR ≤ 55 beats per minute (bpm) with Iodixanol (63%) than with Iohexol (42%; P = 0.025) and Iopamidol (39%; P = 0.011). As was expected, Iodixanol (2.34 ± 2.02) was associated with a lower perception of heat than Iohexol (6.13 ± 1.89; P < 0.001) and Iopamidol (5.22 ± 2.10; P < 0.001). Image quality was similar in all three groups. Conclusions: Compared to Iohexol and Iopamidol, Iodixanol use was associated with a lower patient perception of heat and lower HR while maintaining similar contrast-to-noise and signal-to-noise ratios.

Background: The left ventricular ejection fraction (LVEF) measurement is a common tool for evaluating the LV systolic function. The application of the global longitudinal systolic strain (GLS) parameter in the assessment of the myocardial function has also received special attention recently. Objectives: This study was aimed at comparing the LVEF and LV volumes obtained by the two methods of catheterization and two-dimensional (2D) echocardiography (available in our institution) and assessing the correlation between the LVEF and the GLS. Patients and Methods: In this cross-sectional study, 45 patients were recruited from coronary angiography candidates. The patients underwent echocardiography immediately before catheterization. The LVEF and LV volumes were measured via echocardiography using the apical four- and two chamber-views. The GLS was calculated through the automated functional imaging algorithm. Left ventriculography was performed by calculating the LVEF in the right and left oblique views. Results: The LVEF values obtained by the two methods of ventriculography and echocardiography were not significantly different. The highest correlation regarding the echocardiographic LVEF was obtained in the angiographic right anterior oblique view (P < 0.001, r = 0.95). There was a good agreement as regards the biplane LVEF between 2D echocardiography and ventriculography (-0.5 ± 13.27; CI of 95%). The GLS showed a signi.cant correlation with the estimated EF in both methods, the highest being with the Biplane Simpson method (r = -0.84; P < 0.001). Linear regression was used to obtain the formula for estimating the 2D LVEF from the GLS [LVEF = 2.53 (GLS) + 10.48]. The GLS values ≤ -11.7 and ≥ -21.7% were consistent with normal and severe global LV systolic dysfunction, respectively. The inter- and intra-observer agreement was more evident in the GLS measurement rather than in the LVEF. Conclusions: Despite the widespread use of 2D LVEF and its good agreement with ventriculography, strain analysis seems to be more reliable as a quantitative tool for ventricular assessment.

Background: Differentiating ischemic from nonischemic cardiomyopathy is important both prognostically and therapeutically, although it may be difficult clinically. Objectives: We aimed to determine the diagnostic power of Cardiogoniometry (CGM) in the differentiation of the ischemic from the nonischemic etiology of left bundle branch block (LBBB). Patients and Methods: We studied 37 patients with LBBB on the electrocardiogram (ECG) and left ventricular ejection fraction (LVEF) <30%. All of them underwent coronary angiography, and 33 patients were included. Eighteen patients were categorized as the ischemic cardiomyopathy group, and 15 patients with normal coronary angiography were assigned to the nonischemic cardiomyopathy group. Then, CGM parameters were studied and compared between the two groups. Results: Both ischemic and nonischemic cardiomyopathy groups were similar in age, LVEF, weight, height, and body mass index. Interestingly, there were no significant differences in the average value of the 40 CGM parameters that were analyzed in this study between the two study groups. Conclusions: When LBBB is the underlying rhythm, CGM cannot differentiate ischemic from nonischemic patients with good accuracy. Large studies, however, are needed to confirm our results.

Background: Cardiac involvement in Systemic Sclerosis (SSc) is a major risk factor for death. The aim of this study was to evaluate strain-based measures of the right ventricular (RV) systolic function in SSc patients without pulmonary hypertension. Objectives: The aim of this study was to assess strain-based measures of the RV systolic function in patients with SSc without pulmonary hypertension. Materials and Methods: Thirty-eight consecutive SSc patients (mean age = 48.1 ± 13 years) with normal pulmonary artery pressure and left ventricular ejection fraction and 27 healthy subjects (mean age = 53.2 ± 10 years) were investigated. The RV systolic strain and strain rate were assessed using standard echocardiography with tissue Doppler imaging (TDI) and compared with the results of the healthy subjects. Results: In the SSc patients, the RV strain (- 19 ± 10 vs. - 25 ± 4 %; P = 0.004) and the systolic strain rate (- 1.3 ± 0.5 vs. - 1.5 ± 0.3, s-1; P = 0.03) were significantly lower than those in the control group. Conclusions: This study indicated that the RV systolic strain and strain rate can be used to detect early RV systolic dysfunction in SSc patients without pulmonary hypertension. These parameters may be useful for the provision of a more adequate management of SSc patients.