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    How to Assess Functional Significance of Myocardial Bridges in Athletes. A Personalized Medicine Approach

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    Myocardial bridging is a congenital coronary anomaly involving a segment of coronary artery coursing through myocardial wall, in a different depth and length, potentially affected by systolic compression. In athletes, such coronary anomaly is most often an incidental finding, due to increased use of high sensitivity noninvasive diagnostic tests. However, since myocardial bridge might potentially precipitate ischemia and even be responsible for sudden cardiac death, athletes need to be cleared for competition by an appropriate diagnostic test. Which is the ideal diagnostic test in such peculiar condition, in which the pathophysiological mechanism of ischemia is unknown and potentially different in different subjects, remains to be investigated. We focused on different diagnostic tests proposed and classified according to the most likely pathophysiological mechanism of ischemia in myocardial bridge. Accordingly, we analysed and discussed on ideal test in athletes with such condition

    Le pericarditi

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    Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention

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    Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention. Galiuto L, Barchetta S, Paladini S, Lanza G, Rebuzzi AG, Marzilli M, Crea F. Source Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. [email protected] Abstract BACKGROUND: In the thrombolytic era, persistence of ST-segment elevation was considered a marker of left ventricular (LV) aneurysm. ST-segment elevation may still be found persistently raised after successful primary percutaneous coronary intervention (PCI). Echocardiographic correlates of this finding, however, are still poorly known. METHODS AND RESULTS: 82 consecutive patients with first ST-segment elevation myocardial infarction and successful PCI were divided into patients with persistent ST-segment elevation at discharge (sum of ST >4 mm) (n = 33) and those without persistent ST-segment elevation (n = 49). Conventional and myocardial contrast echocardiography were performed at discharge and at 6 months. At discharge, LV aneurysm was more common in patients with persistent ST elevation (27% vs 8%, p<0.005). Similarly, the wall motion score index was higher (2.5 vs 2.0, p<0.005) and microvascular damage larger (2.3 vs 1.8, p<0.005) in patients with persistent ST-segment elevation. At 6 months' follow-up, LV volumes were similar in the two groups. CONCLUSIONS: After primary PCI, persistent ST-segment elevation is associated with LV aneurysm formation in 30% of cases, it is not associated with significantly larger LV dilatation but with larger microvascular damage and dysfunctioning risk area

    quantifying myocardial perfusion using contrast echocardiography

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    There is a complex relation between what can be seen using perfusion imaging techniques, and what can be measure
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