High sensitive troponin T (hsTnT) is a highly specific marker of myocardial injury and one of the keystones in the diagnosis of acute coronary syndrome. Although hsTnT is thought to be released by myocardial cell damage, recent studies reported elevated levels after exercise testing and endurance sports. The exact mechanism of this phenomenon is discussed controversially. CMR stress testing is widely used for detection of myocardial ischemia. The kinetic of troponin release after CMR stress testing has not been studied previously.

Background: After trans-catheter aortic valve implantation (TAVI), the need for postinterventional pacemaker (PM) implantation can occur in as many as 10–50% of cases, but it is not yet clear, how this need can be predicted. The aim of this study was to assess the possible predictive factors of post TAVI PM implantation based on Computed Tomography (CT) measured aortic valve calcification and its distribution. Methods: We prospectively analyzed 81 consecutive symptomatic patients with severe AS scheduled for TAVI using the CoreValve prosthesis (Medtronic, Minneapolis, USA). In all patients, a native and contrast-enhanced multislice cardiac CT was performed preinterventionally, estimating calcification load of the native valve cusps and of the adjacent outflow tract (so called ‘‘device landing zone’’, DLZ) by the Agatston Score (AgS). Objective, computer-evaluated, preprocedural ECG-analysis was performed with regards to pre-existing conduction abnormalities. Transthoracic echocardiography was performed pre and post TAVI. Results: TAVI was successful in all cases. PM implantation was deemed necessary in altogether 32 patients, out of 67 without a PM pre-TAVI (32/67, 47%). Various parameters were tested as predictors of post TAVI PM in a multivariate logistic regression analysis model. Female sex (P 5 0,005) and depressed EF (P 5 0,023) showed a significant correlation. PM implantation correlated also to the DLZ calcification, as assessed by CT (P 5 0,004). This model leads to an AUC (area under the ROC—receiver operator characteristics—curve) of 0.83. Conclusion: Calcium amount in the CoreValve DLZ in combination with clinical data could predict the need for post TAVI PM implantation. VC 2010 Wiley-Liss, Inc.

Objectives The aim of this study was to assess the influence of amount and distribution of calcifications of the aortic valve and the left ventricular outflow tract on the acute procedural outcome of patients undergoing transcatheter aortic valve implantation (TAVI).Background Transcatheter aortic valve implantation is a new percutaneous technique especially for elderly, high-risk patients with significant aortic valve stenosis (AS). After TAVI, post-interventional paravalvular aortic regurgitations (PAR) can occur, which is believed to be related partially to valve calcifications.Methods We prospectively analyzed 100 symptomatic patients with severe AS scheduled for TAVI with the CoreValve ReValving (Medtronic, Minneapolis, Minnesota) prosthesis. In all patients, a native and contrast-enhanced multislice cardiac computed tomography was performed pre-interventionally. Calcification load of the valve and the adjacent outflow tract was estimated by the Agatston Score (AgS), and the amount and distribution of calcification was semi-quantitatively assessed and graded on a 1 to 4 scale (device "landing zone" calcification score [DLZ-CS]). Aortography was performed to evaluate the PAR pre-interventionally, after initial device release (PAR0) and after termination of the procedure (PAR1). Transthoracic echocardiography was performed 2 weeks after implantation (PAR2).Results The AgS and DLZ-CS showed a significant correlation with the grade of PAR0 (AgS: r = 0.329, p = 0.001; DLZ-CS: r = 0.356, p < 0.001), PAR1 (AgS: r = 0.254, p = 0.011; DLZ-CS: r = 0.240, p = 0.016), and PAR2 (AgS: r = 0.341, p = 0.001; DLZ-CS: r = 0.300, p = 0.002). Both scores (AgS and DLZ-CS) showed a significant positive correlation (r = 0.858, p < 0.001).Conclusions Calcification in the CoreValve device "landing zone" shows a significant positive correlation to PAR after TAVI. Furthermore, the need for "second maneuvers" (i.e., post-dilation after initial device release) can be predicted by these calcification scores (AgS and DLZ-CS). (J Am Coll Cardiol Intv 2010;3:233-43) (C) 2010 by the American College of Cardiology Foundation

Background: After trans-catheter aortic valve implantation (TAVI), the need for postinterventional pacemaker (PM) implantation can occur in as many as 10-50% of cases, but it is not yet clear, how this need can be predicted. The aim of this study was to assess the possible predictive factors of post TAVI PM implantation based on Computed Tomography (CT) measured aortic valve calcification and its distribution. Methods: We prospectively analyzed 81 consecutive symptomatic patients with severe AS scheduled for TAVI using the Core Valve prosthesis (Medtronic, Minneapolis, USA). In all patients, a native and contrast-enhanced multislice cardiac CT was performed preinterventionally, estimating calcification load of the native valve cusps and of the adjacent outflow tract (so called "device landing zone", DLZ) by the Agatston Score (AgS). Objective, computer-evaluated, preprocedural ECG-analysis was performed with regards to pre-existing conduction abnormalities. Transthoracic echocardiography was performed pre and post TAVI. Results: TAVI was successful in all cases. PM implantation was deemed necessary in altogether 32 patients, out of 67 without a PM pre-TAVI (32/67, 47%). Various parameters were tested as predictors of post TAVI PM in a multivariate logistic regression analysis model. Female sex (P = 0,005) and depressed EF (P = 0,023) showed a significant correlation. PM implantation correlated also to the DLZ calcification, as assessed by CT (P = 0,004). This model leads to an AUC (area under the ROC-receiver operator characteristics-Curve) of 0.83. Conclusion: Calcium amount in the Core Valve DLZ in combination with clinical data could predict the need for post TAVI PM implantation. (C) 2010 Wiley-Luss, Inc

Objectives This study sought to assess post-procedural and mid-term outcome of patients, in which a second "in-series" CoreValve prosthesis (Medtronic, Minneapolis, Minnesota) was implanted during the same procedure.Background Because of the increasing number of patients implanted with CoreValves, the need for management of special complications has emerged. A misplaced prosthesis can be corrected by various maneuvers. An option is to pull the valve out of the aortic annulus into the ascending aorta or beyond and position a second one (in series).Methods Out of 277 patients who underwent CoreValve implantation with the 18-F device in our institution, we had to implant a second prosthesis (due to severe aortic regurgitation or dislocation of the first one) in 9 (3.2%). Immediate post-procedural as well as mid-term follow-up data (5 to 20 months, mean 10.6 +/- 6 months, total 95 patient-months) were collected for analysis.Results All implantations of the second device were successful, resulting in elimination of the gradient (mean gradient 43.1 +/- 4.0 mm Hg before to 7.0 +/- 1.1 mm Hg after implantation). There was no final aortic regurgitation grade >= 2+. The extra-anatomically placed first prosthesis (ascending aorta, n = 8; abdominal aorta, n = 1) did not cause any clinical sequelae or gradients. During midterm follow-up, none of the 18 prostheses showed any sign of malfunction. Specifically, there were no signs of valve migration or of worsening paravalvular regurgitation. No case of valve thrombosis was documented.Conclusions A second CoreValve can be safely and effectively implanted in an in-series manner, without periprocedural complications. No problems arose on mid-term follow-up, ranging up to 20 months. (J Am Coll Cardiol Intv 2010;3:244-50) (C) 2010 by the American College of Cardiology Foundation

We establish a new symmetrization procedure for the isoperimetric problem in symmetric spaces of noncompact type. This symmetrization generalizes the well known Steiner symmetrization in euclidean space. In contrast to the classical construction the symmetrized domain is obtained by solving a nonlinear elliptic equation of mean curvature type. We conclude the paper discussing possible applications to the isoperimetric problem in symmetric spaces of noncompact type.