http://www.sage-hindawi.comThe latest articles from SAGE-Hindawi Access to Research© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2010/697269.htmlHypertrophic cardiomyopathy (HCM) is an inherited cardiac disease with an autosomal dominant mode of transmission. Comprehensive genetic screening of several genes frequently found mutated in HCM is recommended for first-degree relatives of HCM patients. Genetic testing provides the means to identify those at risk of developing HCM and to institute measures to prevent sudden cardiac death (SCD). Here, we present an adoptee whose natural mother and maternal relatives were known be afflicted with HCM and SCD. The proband was followed closely from age 6 to 17 years, revealing a natural history of the progression of clinical findings associated with HCM. Genetic testing of the proband and her natural mother, who is affected by HCM, revealed that they were heterozygous for both the R719Q and T1513S variants in the cardiac beta-myosin heavy chain (MYH7) gene. The proband's ominous family history indicates that the combination of the R719Q and T1513S variants in cis may be a “malignant” variant that imparts a poor prognosis in terms of the disease progression and SCD risk.Bronwyn Harris, Jean P. Pfotenhauer, Cheri A. Silverstein, Larry W. Markham, Kim Schafer, Vernat J. Exil, and Charles C. Hong© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/802373.htmlObjective. The transverse-axial tubule system (TATS) of cardiomyocytes allows a spatially coordinated conversion of electrical excitation into an intracellular Ca2+ signal and consequently contraction. Previous reports have indicated alterations of structure and/or volume of the TATS in cardiac hypertrophy and failure, suggesting a contribution to the impairment of excitation contraction coupling. To test whether structural alterations are present in human heart failure, the TATS was visualized in myocytes from failing and non-failing human hearts. Methods and Results. In freshly isolated myocytes, the plasmalemmal membranes were labeled with Di-8-ANEPPS and imaged using two-photon excitation at 780 nm. Optical sections were taken every 300 nm through the cells. After deconvolution, the TATS was determined within the 3D data sets, revealing no significant difference in normalized surface area or volume. To rule out possible inhomogeneity in the arrangement of the TATS, Euclidian distance maps were plotted for every section, allowing to measure the closest distance between any cytosolic and any membrane point. There was a trend towards greater spacing in cells from failing hearts, without statistical significance. Conclusion. Only small changes, but no significant changes in the geometrical dimensions of the TATS were observed in cardiomyocytes from failing compared to non-failing human myocardium.Andreas Ohler, Jutta Weisser-Thomas, Valentino Piacentino 3rd, Steven R. Houser, Gordon F. Tomaselli, and Brian O'Rourke© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2010/794026.htmlSpontaneous coronary dissections (SCAD) can be asymptomatic or can manifest itself as any of the clinical spectrum of the ischemic heart disease. In this report, we present a 65 year old man presented with myocardial infarction in whom coronary angiography a nonocclusive SCAD was noticed in addition to a very late stent thrombosis and make a brief overview of the treatment for SCAD.Ismail Dogu Kilic, Halil Tanriverdi, Harun Evrengul, and Sukru Gur© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/769694.htmlInfectious thoracic aortitis is a rare entity in the antibiotic era and usually appears in patients with prior aortic disease and/or associated infective endocarditis. Infected nonaneurysmal aorta will likely progress to mycotic aneurysm if left untreated. In most of the reports, infectious thoracic aortitis presents with a mycotic aneurysm. We report the case of a patient with a nonaneurysmal infectious thoracic aortitis, probably secondary to purulent meningitis, early diagnosed by transesophageal echocardiogram.Ricardo Lopes, Jorge Almeida, Paula Dias, Paulo Pinho, and Maria Júlia Maciel© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/927385.htmlThis study was investigated the role that endothelial function and systemic vascular resistance (SVR) play in determining cardiac function reserve during exercise by a new ambulatory radionuclide monitoring system (VEST) in patients with heart disease. The study population consisted of 32 patients. The patients had cardiopulmonary stress testing using the treadmill Ramp protocol and the VEST. The anaerobic threshold (AT) was autodetermined using the V-slope method. The SVR was calculated by determining the mean blood pressure/cardiac output. Flow-mediated vasodilation (FMD) was measured in the brachial artery to evaluate endotheilial function. FMD and the percent change f'rom rest to AT in SVR correlated with those from rest to AT in ejection fraction and peak ejection ratio by VEST, respectively. Our findings suggest that FMD in the brachial artery and the SVR determined by VEST in patients with heart disease can possibly reflect cardiac function reserve during aerobic exercise.Bonpei Takase, Takashi Akima, Akimi Uehata, Masayuki Ishihara, and Akira Kurita© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/658965.htmlBackground. We studied the effect of fast induction of cardiac arrest with denosine on myocardial bax and bcl-2 expression. Methods and Results. 40 elective CABG patients were allocated into two groups. The adenosine group (n=20) received 250 μg/kg adenosine into the aortic root followed by blood potassium cardioplegia. The control group received potassium cardioplegia in blood. Bcl-2 and bax were measured. Bax was reduced in the postoperative biopsies (1.38 versus 0.47, P=.002) in the control group. Bcl-2 showed a reducing tendency (0.14 versus 0.085, P=.07). After the adenosine treatment, the expression of both bax (0.52 versus 0.59, P=.4) and bcl-2 (0.104 versus 0.107, P=.4) remained unaltered after the operation. Conclusion. Open heart surgery is associated with rapid reduction in the expression of apoptosis regulating genes bax and bcl-2. Fast Adenosine induction abolished changes in their expression.Ahmed Shalaby, Timo Rinne, Otso Järvinen, Juha Latva-Hirvelä, Kristiina Nuutila, Antti Saraste, Jari Laurikka, Helena Porkkala, Pekka Saukko, and Matti Tarkka© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/194528.htmlPurpose. Depression and antidepressant use may independently increase the risk of acute myocardial infarction and mortality in adults. However, no studies have looked at the effect of depression on a broader thrombotic event outcome, assessed antidepressant use, or evaluated elderly adults. Methods. A cohort of 7,051 community-dwelling elderly beneficiaries who experienced a thrombotic cardiovascular event (TCE) were pooled from the 1997 to 2002 Medicare Current Beneficiary Survey and followed for 12 months. Baseline characteristics, antidepressant utilization, and death were ascertained from the survey, while indexed TCE, recurrent TCE, and depression (within 6 months of indexed TCE) were taken from ICD-9 codes on Medicare claims. Time to death and first recurrent TCE were assessed using descriptive and multivariate statistics. Results. Of the elders with a depression claim, 71.6% had a recurrent TCE and 4.7% died within 12 months of their indexed TCE, compared to 67.6% and 3.9% of those elders without a depression claim. Of the antidepressant users, 72.6% experienced a recurrent TCE and 3.9% died, compared to 73.7% and 4.6% in the subset of selective serotonin reuptake inhibitor (SSRI) users. Depression was associated with a shorter time to death (P=.008) in the unadjusted analysis. However, all adjusted comparisons revealed no effect by depression, antidepressant use, or SSRI use. Conclusions. Depression was not associated with time to death or recurrent TCEs in this study. Antidepressant use, including measures of any antidepressant use and SSRI use, was not associated with shorter time to death or recurrent TCE.Christopher M. Blanchette, Linda Simoni-Wastila, Fadia T. Shaya, Denise Orwig, Jason Noel, and Bruce Stuart© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/281389.htmlWe report about an infant affected by dilated cardiomyopathy (CMP) in whom metabolic investigations evidenced medium-chain-acyl-CoA dehydrogenase deficiency (MCADD), that is one of three types of inherited disorders of mitochondrial fatty-acid β-oxidation. Long-chain and very long-chain 3-hydroxyacyl-coenzyme A dehydrogenase deficits are recognized as responsible of hypertrophic or, less frequently, dilated cardiomyopathy (CMP) in childhood. Otherwise, to our knowledge, no case of MCADD associated to dilated CMP has been reported in literature.Marcello Marcì and Patrizia Ajovalasit© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/593659.htmlBackground. Mitral valve replacement can be very difficult to obtain in infants because the valve annulus diameter can be smaller than the available prosthesis. Case Report. We describe the case of a 2-month-old female weighing 3.5 kg affected by mitral valve dysplasia leading to severe valve stenosis. Despite full medication, the clinical conditions were critical and surgery was undertaken. The mitral valve was unsuitable for repair and the orifice of mitral anulus was 12 mm, too small for a mechanical prosthesis. Therefore, a Ross-Kabbani operation was undertaken, replacing the mitral valve with the pulmonary autograft and reconstructing the right ventricular outflow tract with an etherograft. Results. The postoperative course was uneventful and the clinical conditions are good at 4-month follow-up. Conclusion. The Ross-Kabbani operation can be an interesting alternative to mitral valve replacement in infants when valve repair is not achievable and there is little space for an intra-annular mechanical prosthesis implant.Carlo Pace Napoleone, Guido Oppido, Emanuela Angeli, Alessandro Giardini, and Gaetano Gargiulo© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/152164.htmlPersistent left superior vena cava is a rare congenital venous anomaly. It results from failure of closure of the left anterior cardinal vein during cardiac development. It is usually asymptomatic but can be associated with other congenital cardiac defects including atrial septal defects, ventricular septal defects, endocardial cushion defects, tetralogy of Fallot and rhythm disturbances. PLSVC should be considered in the presence of a dilated coronary sinus on transthoracic echocardiography. The diagnosis can be made when injection of contrast in left antecubital vein results in enhancement of the dilated coronary sinus before right atrium. MRI, CT-scan and catheterisation can be used to confirm the diagnosis.Tayfun Sahin, Teoman Kilic, Umut Celikyurt, Ulas Bildirici, and Dilek Ural© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/817987.htmlAtherosclerotic renal artery disease is a common cause of hypertension and chronic kidney disease that may progress into end stage renal failure if not diagnosed and treated early. Renal artery stenosis (RAS) has been shown to be an independent risk factor for mortality in patients with coronary artery disease. We sought to determine whether race is an independent risk factor for developing RAS. A retrospective study was conducted including 324 patients with resistant hypertension who underwent renal angiography with or without coronary angiography. In univariate analysis, Caucasian race was associated with significant risk of RAS (OR = 2.3, P = .01). However, this association was no longer significant after correcting for additional clinical variables in a multivariate model (OR = 1.5, P = .07). There was a strong association between smoking and RAS (OR 2.0, P = .02). We conclude that traditional risk factors, especially smoking, rather than race, are the most important predictors of RAS development.Ayad Jazrawi, Saba Darda, Peter Burke, Marcos Daccarett, Josef Stehlik, Shukri David, and Marcel Zughaib© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/976190.htmlWe present the case of a 54-year-old woman in which a diffuse congenital supravalvular aortic stenosis (SVAS) was associated with a severe aortic valve incompetence and heavy calcification of the aortic annulus. Repair consisted in resection of the ascending aorta, patch augmentation of the hypoplastic aortic root and annulus, placement of a 20 mm Dacron tubular graft (Vascutek, Renfrewshire, UK) and aortic valve replacement with a mechanical prosthesis (Sorin, Turin, Italy). Follow-up echocardiography demonstrated normal prosthetic valve function and a postoperative three-dimensional computed tomographic scan showed a normal shape of the reconstructed ascending aorta.Giovanni Ferlan, Claudio De Pasquale, Concetta Losito, Annalisa Fiorella, Nicola Marraudino, and Francesco Tunzi© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/213954.htmlA 65-year-old man suffering from ascending aorta aneurysm and atherosclerotic three vessel disease without left main involvement underwent aortic root replacement with coronary ostia reimplantation according to the modified Bentall technique and multiple coronary artery bypass grafts. Gelatin-resorcin-formaldehyde glue was used to reinforce the aortic coronary buttons and to facilitate hemostasis. Five months after surgery, the patient experienced rapidly worsening effort angina. Coronary angiography showed severe left main narrowing. The considerable amount of time that elapsed between surgery and the onset of symptoms implies that the problem was not related to an imperfect suture technique, but was most likely caused by an inflammatory and proliferative response to the glue that had been used. We performed elective percutaneous coronary intervention and stenting of the protected coronary vessel without technical difficulties and with a satisfactory final result. The patient is currently symptom-free after 1 year's follow-up.Manrico Balbi, Flavio Scarano, and Gian Paolo Bezante© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/748272.htmlAneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 × 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention.Ashwani Kumar, Dixon Santana, and Leigh Ann Jenkins© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/187543.htmlPostural orthostatic tachycardia syndrome (POTS) commonly affects women of childbearing age. We report on a 37-year-old woman who developed symptoms of recurrent syncope in the postpartum period. Her head up tilt test and clinical presentation was consistent with POTS.Khalil Kanjwal, Beverly Karabin, Yousuf Kanjwal, and Blair P. Grubb© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/703793.htmlPulsus alternans is a rare hemodynamic condition characterized by beat-to-beat variability in systolic pressure. It is attributed to variations in stroke volume with alternate cardiac cycles and is typically seen in patients with advanced myopathic conditions. Left ventricular pulsus alternans is rare, and right ventricular pulsus alternans is even less common. There are only a few reports of biventricular pulsus alternans. We report the case of a 62-year-old female with a recent anterior wall myocardial infarction who had biventricular pulsus alternans at the time of cardiac catheterization.Param Vidwan and George A. Stouffer© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/598940.htmlThis is a case report in which a 60-year-old man who suffered from ventricular tachycardia with dilated cardiomyopathy was prescribed amiodarone. After taking amiodarone, liver enzymes were increased and computed tomographic (CT) scanning of the abdomen showed a significant increase in the density of the liver without contrast medium. He was suspected as hemochromatosis and liver biopsy was performed. An abnormal high density of liver tissue may be observed in an unenhanced CT in patients treated with amiodarone and we suggest that periodic monitoring of liver function and/or liver biopsy is warranted before an irreversible stage is reached.Sunao Kojima, Shinobu Kojima, Hirofumi Ueno, Motohiro Takeya, and Hisao Ogawa© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/943453.htmlObjectives. The transvascular closure of patent foramen ovale (PFO) with self-expanding devices carries the risk of left atrial thrombus formation related to material protruding into the left atrium. Thus, we developed a novel device with flat left atrial disc geometry. We evaluated feasibility, handling, and biocompatibility in a porcine animal model. Methods. Implantation of an Occlutech Figulla PFO device was performed in 10 mini pigs using fluoroscopy and intra-cardiac ultrasound after transseptal puncture of the interatrial septum. Angiographic follow-up was performed after six and twelve weeks. Results. Implantation was successful in 100%. There were no further implant related complications. One procedure related death occurred, as one animal died of ventricular tachycardia due to mispunture of the interatrial septum. Angiographic studies showed no residual shunt during follow-up. Histopathological evaluation could demonstrate partial neoendothelialization after 6 weeks with completion after 12 weeks. The devices were incorporated into connective tissue containing fibro muscular cells. An only mild inflammatory reaction was detected locally related to the polyester fibers. Conclusion. In terms of feasibility and handling, the new device does not seem to be inferior to other presently used implantation systems. Good biocompatibility was demonstrated with rapid and complete neoendothelialization.F. Krizanic, M. Sigler, and H. R. Figulla© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/437237.htmlHigh-output cardiac failure secondary to hepatic involvement is a rare complication of hereditary hemorrhagic telangiectasia (HHT). Here we report a 43-year-old woman who presented at 29 weeks gestation of her second pregnancy with complications of right-sided heart failure and preterm labor. After delivery via cesarean section, the patient was found to have intrahepatic arteriovenous malformations through non-invasive imaging. Subsequently, a family history of vascular malformations and epistaxis was elucidated and a diagnosis of HHT was made. This case is presented, along with a review of the literature and discussion of hepatic involvement in HHT with particular focus on the pregnant patient.Tareq Goussous, Alex Haynes, Katherine Najarian, Marcos Daccarett, and Shukri David© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/981292.htmlAneurysms of saphenous vein grafts are rare but can result in complications such as myocardial infarction or death. Percutaneous treatment has included a variety of approaches, including covered stents. Long aneurysms in saphenous vein grafts pose an additional challenge due to the lack of coronary covered stents with sufficient length. We present successful treatment of a long saphenous vein graft aneurysm with use of peripheral covered stents over two coronary guidewires, a 55-centimeter 8-French sheath and no guide catheter.Carmelo J. Panetta, Williaim Schneider, and Max A. Boller© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/687609.htmlAims. To determine the efficacy of a new distal protection method in SFA CTO interventions. Methods and Results. From June 2003 to February 2009, ninety-two consecutive, chronic total occlusions of superficial femoral arteries were treated with catheter-based intervention using a bidirectional approach. Nine of these cases were managed with our original, distal protection method, based on symptoms, angiographic images, wire resistance, and intravascular ultrasound images. The average age was 73 years; eight patients were male. The mean occlusion length was 17.1 cm. A distal protection balloon was inserted from the retrograde sheath in the popliteal artery and placed distal to the occluded lesion after successful wire crossing. Lesion dilatation with a balloon was performed antegradely and debris was removed by 6Fr. guiding catheter. Debris was retrieved from all lesions, consisting mainly of thrombus. Where we decided not to use the distal protection method, there was no distal thromboembolism. Conclusion. In SFA-CTO intervention, the risk of distal embolization is 10%, which can be anticipated and eliminated by the distal protection method.Tomoko Kobayashi, Atsushi Funatsu, Emiko Ejima, Hiromi Muranishi, Makoto Utsunomiya, Kensaku Shibata, Masahiro Mizobuchi, Yoshihisa Enjoji, and Shigeru Nakamura© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/295376.htmlBackground. It is known that after coronary artery bypass graft surgery (CABG) heart rate variability (HRV) becomes significantly decreased with a gradual recovery in a few months after surgery. However, literature data about the impact of the off-pump CABG on postoperative HRV are not complete. Therefore, the aim of this study was to analyze postoperative value of HRV in CABG patients operated on with off-pump versus on-pump coronary surgery. Methods. This study included 206 consecutive patients who underwent CABG. Sixty six patients (32%) were operated on off-pump while 140 patients (68%) were operated on using the machine for extracorporal circulation. HRV was analyzed from 24-hours Holter electrocardiogram recordings. Results. No significant differences in postoperative values of HRV variables were found between off-pump versus on-pump CABG patients (Mean RR interval 885 ± 106 versus 879 ± 125 ms, standard deviation of all normal R-R intervals 107 ± 30 versus 105 ± 34 ms, NS, total power 2298 ± 2472 versus 2156 ± 1913 ms2, NS). Conclusions. The results of the study showed that there are no differences in HRV few months after surgery between patients operated on with off-pump versus on-pump CABG.Nenad Lakusic, Valentina Slivnjak, Franjo Baborski, and Dusko Cerovec© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/376735.htmlWe evaluated a relationship between nitric oxide plasma correlation and insulin resistance in white coat hypertensive patients. Patients were screened for white coat hypertension using an ambulatory blood pressure monitoring. The homeostasis model assessment insulin resistance index (HOMA-IR) was used to assess insulin resistance, and plasma nitrate concentrations were determined by chemiluminescence. The HOMA-IR was significantly higher in hypertensive (3.84 ± 0.62) when compared to white coat (2.11 ± 0.36) and normotensive (1.40 ± 0.21). We found no correlation between HOMA-IR and plasma nitrate levels in all three groups. We suggest that the more important issue for these patients is to focus on the metabolic abnormalities where lifestyle interventions such as weight control and exercise have proven effective.Leila Maria Marchi-Alves and Evelin Capellari Carnio© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/179350.htmlIvabradine, an If inhibitor, acts primarily on the sinoatrial node and is used to reduce the heart rate with minimal effect on myocardial contractility, blood pressure, and intracardiac conduction. Heart rate reduction is an important aspect of care in patients with chronic stable angina and heart failure. Many patients with coronary artery disease have coexisting asthma or chronic obstructive airway disease, and most of them are unable to tolerate beta blockers. Ivabradine may thus be a useful medicine in therapeutic heart rate management especially in patients who are intolerant of beta-blockers.Michael Liang, Aniket Puri, and Gerard Devlin© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/351621.htmlTakotsubo cardiomyopathy is usually described following acute emotional stress. We report here the case of a 48-year-old woman admitted for acute coronary syndrome after an intensive squash match. Diagnosis of Takotsubo cardiomyopathy due to acute physical stress was suspected in presence of normal coronary arteries and transitory left ventricular dysfunction with typical apical ballooning. Cardiac magnetic resonance imaging confirmed regional wall-motion abnormalities and was helpful in excluding myocardial infarction diagnosis. During squash the body is subject to sudden and vigorous demands inducing a prolonged and severe workload on the myocardium.Mathieu Berry, Jerome Roncalli, Olivier Lairez, Meyer Elbaz, Didier Carrié, and Michel Galinier© 2010, SAGE-Hindawi Access to Research. All rights reserved.http://www.sage-hindawi.com/journals/crp/2009/308486.htmlBackground. In stress echocardiography, contrast agents are used selectively to improve endocardial border definition. Early identification of candidates may facilitate use of these agents in small and medium volume laboratories where resources are limited. Methods. We studied 15232 patients who underwent stress echocardiography. Contrast agent was used if 2 or more ventricular segments were not adequately visualized without contrast. Logistic regression models were used to evaluate the association between individual characteristics and contrast use. An 11-point score was derived from the significant characteristics. Results. Variables associated with microbubble use were age, sex, smoking, presence of multiple risk factors, bodymass index (BMI), referral for dobutamine stress echocardiography, history of coronary artery disease, and abnormal baseline electrocardiogram. All variables except BMI were given a score of 1 if present and 0 if absent; BMI was given a score of 0 to 4 according to its value. An increased score was directly proportional to increased likelihood of contrast use. The score cutoff value to optimize sensitivity and specificity was 5. Conclusions. A pretest score can be computed from information available before imaging. It may facilitate contrast agent use through early identification of patients who are likely to benefit from improved endocardial border definition.Mathieu Bernier, Sahar S. Abdelmoneim, Stuart Moir, Robert B. McCully, Patricia A. Pellikka, and Sharon L. Mulvagh© 2010, SAGE-Hindawi Access to Research. All rights reserved.