Primary cardiac lymphoma causing coronary vasospasm.

left ventricular contraction pattern during right ventricular pacing: assessment using real-time three-dimensional echocardiography. ventricular ejection fraction and left ventricular dyssynchrony by 3D echo correlate with functional impairment in patients with dilated cardiomyopathy.chrony index determined by three-dimensional speckle area tracking can predict response to cardiac resynchronization therapy. Novel area strain based on three-dimensional wall motion analysis for assessment of global left ventricular performance after repair of tetralogy of fallot. Usefulness of real-time three-dimensional echocardiography to quantify global left ventricular function and mechanical dyssyn-chrony after heart transplantation. Three-dimensional echocardiographic characterization of left ventricular remod-eling in Olympic athletes. Prediction of response to cardiac resynchronization therapy combining two different three-dimensional analyses of left ventricular dyssynchrony. et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. Scar burden by myocardial perfusion imaging predicts echo-cardiographic response to cardiac resynchronization therapy in ischemic cardio-myopathy. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Three-dimensional speckle tracking echocardiography for automatic assessment of global and regional left ventricular function based on area strain. A 63-year-old woman with no significant medical history or risk factors presented with an acute coronary syndrome. It was her first episode of angina pectoris (AP). ECG showed ST-segment elevations in II, III, and aVF, and cardiac biomarkers were negative. Coronary angiography revealed a severe stenosis in the right coronary artery (RCA) (Panel A), which disappeared after intracoronary nitroglycerin infusion. Subsequent coronary vasomotility testing with the intracoronary infusion of acetyl-choline induced diffuse coronary vasospasm, reproducing the patient's initial AP. Despite anti-anginal medication, AP reoccurred almost daily. In order to rule out an ongoing inflamma-tory myocardial process, cardiac magnetic resonance imaging was performed, which revealed a pericardial mass (56 × 39 mm 2) encasing the RCA (Panel B) (Supplementary data online, Movie S1). A biopsy was taken after a mini-thoracotomy, and the histology was consistent with primary cardiac large B-cell lymphoma (Panel C). Upon the completion of radio chemotherapy, a significant decrease in mass size was found (Supplementary data online, Movie S2) and the patient's AP disappeared completely. Hence, coronary vasospasm was suspected to be associated with the lymphoma. A possible explanation would be the release of vasoactive agents by tumorous B-cells, inducing coronary vasospasm. Indeed, the majority of lymphoma cells showed immunoreactivity for the vasoactive agent neuropetide-Y (Panel D). In summary, myocardial ischaemic symptoms in our patient were caused by coronary vasospasms. Most likely, they were induced by …