Echocardiogram Findings Research Articles

Dizziness, Light-Headedness or A Clot-In-Transit: Obtaining a History and Physical Examination is Both a Science and an Art.

Venous thromboembolism (VTE) rarely presents with dizziness as the primary complaint, which can delay diagnosis. We report a rare case of dizziness as the chief complaint for a clot-in-transit and extensive bilateral pulmonary emboli. A 70-year-old woman presented to the emergency room (ER) with dizziness and a fall, without reporting loss of consciousness. Her symptoms included positional dizziness, tinnitus and visual darkness, alongside prior exertional fatigue and dull chest pressure. Despite a history of left leg oedema and inconsistent use of medications for hypertension and diabetes, initial examinations suggested vestibular neuritis and decompensated heart failure, confirmed by echocardiogram findings and response to prednisone. While hospitalised, she experienced pre-syncope after showering, initially deemed vasovagal. However, exertional hypotension led to further investigation, revealing right heart strain. Ultrasound identified a left popliteal deep vein thrombosis, and a computed tomography (CT) angiogram confirmed extensive bilateral pulmonary emboli with right heart strain. Cardiology discovered large, mobile thrombi in transit in the heart, necessitating an urgent mechanical thrombectomy. Following treatment, her pulmonary pressure improved, and she was discharged on anticoagulation medicine. One month later, an echocardiogram showed normalised heart function. This case highlights the importance of differentiating dizziness from pre-syncope, as exertional pre-syncope can indicate an obstructive physiology such as VTE. Cognitive bias can obscure diagnosis in atypical presentations. A pulmonary embolism response team could improve management of these cases, where prompt diagnosis and treatment are essential for favourable outcomes. Cognitive bias should be consistently challenged while ruling out pulmonary emboli based on the absence of typical signs.It is essential to differentiate vertigo from light-headedness or pre-syncope in patients presenting with a complaint of dizziness.Pre-syncope can be an important presenting complaint of haemodynamically significant pulmonary emboli and clots in transit.

Echocardiographic Evaluation in Cardiac Resynchronization Therapy: A Single Center Experience.

Introduction Heart failure develops as a result of dysfunction in the cardiac muscle, which impairs the heart's ability to pump blood effectively. For this reason, many studies have shown that cardiac resynchronization therapy (CRT) has significantly reduced symptoms and improved cardiac function in patients with heart failure. Echocardiography is crucial in assessing CRT response, as it helps differentiate between patients who benefit from CRT and those who do not by evaluating key parameters like left ventricular ejection fraction (LVEF), a critical parameter in determining CRT eligibility. However, few studies focus specifically on the effectiveness of echocardiography for assessing CRT response, with existing research limited by a lack of standardized protocols and inadequate predictive tools. Accordingly, this study aims to assess the role of echocardiography in evaluating the efficacy of CRT in patients with heart failure at King Faisal Cardiac Center. Methodology This was a retrospective analytical cohort study that included all adult patients diagnosed with heart failure and underwent CRT between January 2017 and December 2021 at King Faisal Cardiac Center, King Abdulaziz Medical City, Jeddah, Saudi Arabia. Data were obtained from the Cardiac Non-invasive Lab, which was selected for its essential diagnostic tools for comprehensive echocardiographic evaluation of CRT efficacy. Study subjects were over 18 years old, diagnosed with heart failure with reduced ejection fraction (LVEF <35%), underwent CRT, and had echocardiograms at baseline and at least six months post-therapy. The collected data were retrieved from electronic medical records (BestCare; ezCaretech Co., Ltd,Seoul, South Korea), including relevant demographics and echocardiographic parameters such as end-systolic volume (ESV), end-diastolic volume (EDV), and ejection fraction (EF). Statistical analysis, paired t-tests,and Shapiro-Wilk test to assess data normality were conducted to evaluate pre- and post-CRT changes, with significance set at P<0.05. Results A total of 53 heart failure patients met the inclusion and exclusion criteria. The results of the study indicate statistically significant differences in the mean EF before and after CRT increased from 29.09±6.52% to 33.3±10.69% (p-value=0.0014). The mean ESV decreased from 114.46±60.63 mL to 97.13±65.89 mL, demonstrating a clinically significant improvement (p=0.056), and the mean EDVdecreased from 157.08±64.67 mL to 138.87±78.07 mL (p = 0.0158). Furthermore, the EF increased by 14.47%, and the ESV decreased by 15.14% after CRT.These findings indicate improvement in left ventricular function following CRT. Conclusion The study demonstrates significant improvements in echocardiographic parameters based on echocardiogram findings, particularly the outcomes of EF and ESV after CRT in patients with heart failure with reduced ejection fraction.These findings highlight the potential of CRT as an effective therapy and aid in detecting responders to treatment. Nevertheless, the study is limited by a relatively small sample size, exclusion of comorbidities, and short follow-up period. Therefore, further longitudinal studies with larger cohorts and consideration of comorbidities are recommended.

Nitisinone attenuates progression of aortic stenosis in patients with alkaptonuria: an analysis of the SONIA 2 study

Abstract Background/introduction Alkaptonuria (AKU) is a rare metabolic disorder caused by a defective enzyme, resulting in deposition of unmetabolised homogentisic acid in various connective tissues throughout the body (also termed "ochronosis"). Ochronosis of the aortic valve leading to progressive aortic stenosis is a rare but serious complication. Nitisinone decreases urinary and serum homogentisic acid levels and has been shown to improve morbidity and slow disease progression in AKU but the effects of this treatment on the progression of aortic stenosis have not yet been described. This review extrapolated from the data set of the SONIA 2 study, a 4-year multi-centre, randomised controlled trial investigating the effect of nitisinone on a composite clinical measure of AKU disease activity, but looked more specifically at measures of aortic stenosis disease progression. Methods Data was obtained from echocardiograms performed on 138 patients at baseline, 12, 24, 36 and 48 months of follow-up. In measuring the degree of aortic stenosis, the peak trans-aortic velocity (Vmax) was examined. A linear mixed effects regression model was used to assess the association between treatment and Vmax and to ascertain the difference in this measure at baseline and 48 months between the treatment and control groups. The mixed effects model incorporated both fixed effects for population parameters (age, sex, baseline Vmax, follow-up time) and treatment; and random effects, to account for intra-subject correlation of longitudinal observations of Vmax, inter-subject variability of baseline measurements of Vmax, and centre. Results At baseline, 19/138 patients (13.8%) had aortic stenosis, as classified by echocardiogram findings in accordance with the European Society of Cardiology (ESC) guidance on valvular heart disease, with 9/19 having mild aortic stenosis, 6/19 having moderate aortic stenosis and 4/19 having severe aortic stenosis. 25/138 had aortic sclerosis (see figure 1). The prevalence of aortic valve disease increased with age. From the 4-year follow-up period, 613 longitudinal observations of 138 subjects across all sites were obtained. At baseline, the difference in Vmax between the control and treatment groups was 0.063 m/s [95% CI: -0.054 m/s to 0.18 m/s] and did not reach statistical significance (p=0.23). At the end of the 4-year treatment period, the difference in Vmax was 0.10 m/s [95% CI: -0.0007 m/s to 0.20 m/s] and was statistically significant (p=0.05) (see figure 2). Conclusion Nitisinone slowed progression of aortic stenosis in patients with AKU. This may be grounds for timely initiation of nitisinone in those deemed to be at high risk, as identified by echocardiography. Of note, this is the first time that any medical therapy has ever been shown to affect the natural history of aortic stenosis.

Acute coronary syndrome or cardiac involvement due to leptospirosis: A case report

Leptospirosis is a globally prevalent zoonotic infection. Cardiac involvement in leptospirosis, including myocarditis, can be easily missed due to non-specific symptoms and concurrent multiorgan dysfunction. A 46-year-old male presented to the emergency department with weakness, fever, palpitations, and widespread joint and muscle pain. His temperature was 40&amp;deg;C, and his blood pressure dropped to 50/30 mm Hg. The patient, with elevated high-sensitivity troponin levels in laboratory findings, was referred to the cardiology department. Anti-ischemic treatment was started for a preliminary diagnosis of acute coronary syndrome. The leptospirosis polymerase chain reaction (PCR) test in serum was positive, whereas the urine Leptospira PCR test was negative. The patient presented with septic shock and elevated cardiac biomarkers and was re-evaluated based on electrocardiogram and echocardiogram findings. Considering these clinical and laboratory results, acute coronary syndrome was ruled out, and myocardial involvement due to leptospirosis was considered. This case highlights the importance of recognizing cardiac involvement in leptospirosis.

Validity of Wrist-Worn Activity Tracker Heart Rate Detection in Fontan Patients During Exercise.

Physical activity and a healthy lifestyle play an essential role in optimizing long-term health in patients with Fontan physiology. Wrist-worn activity trackers may be useful in medically directed exercise programs for patients with Fontan physiology. The objective of this study was to measure the validity of Garmin and Fitbit activity tracker heart rate detection in patients with Fontan circulation when compared to electrocardiogram (ECG) during cardiopulmonary exercise testing (CPET). 47 Fontan patients undergoing CPET for clinical indications were included and wore activity trackers during CPET. Heart rate via the activity tracker was collected at baseline, maximal exercise, and recovery. Patient heart rates, peak VO2, and peak respiratory exchange ratio (RER) were collected using standard CPET protocols and equipment. Heart rate at each time point was compared between the activity trackers and CPET ECG. Median age of participants was 17.1 years, 15.1 years since Fontan completion. Mean percent of predicted peak VO2 was 56.8%, z-score -3.2 with 61.7% of participants completing a maximal CPET (RER ≥ 1.09). Baseline oxygen saturation mean was 92.9%, 90.0% at maximal exercise. Activity trackers demonstrated mean absolute percentage error < 10% at most time points, comparable with other studies. Demographics, Fontan-associated comorbidities, and echocardiogram findings did not impact the accuracy. Consumer-oriented wrist-worn activity trackers show promising accuracy for heart rate monitoring in medically directed exercise programs for adolescents and young adults with Fontan physiology. Further validation across different exercise modalities is needed.

Cardiac effects of COVID-19 infection in children.

It is known established that the cardiac effects of COVID-19 infection are associated with poor prognosis and high mortality rates in infected patients. The aim of this study was to evaluate the cardiac effects of COVID-19 infection in paediatric patients and identify the correlations between clinical and laboratory data and the degree of cardiac involvement. A retrospective data analysis was conducted on 64 paediatric patients at Gazi University Department of Pediatrics who were treated as inpatients with a diagnosis of COVID-19. Patients were classified as "COVID-19-related cardiac involvement cases" if their electrocardiogram and echocardiogram results indicated a pathology and/or if their laboratory data indicated increased cardiac enzymes. All patients were divided into subgroups based on whether they had cardiac involvement and whether they were diagnosed with multisystem inflammatory syndrome in children. In comparison to patients who did not have cardiac involvement, those with cardiac involvement had significantly higher levels of hs-Troponin T, Pro-BNP, and D-dimer. Patients with multisystem inflammatory syndrome in children had significantly longer PR intervals than those without multisystem inflammatory syndrome in children (p = 0.0001). Patients with multisystem inflammatory syndrome in children had a significantly higher rate of pathological valve insufficiencies (68.1%) than those without multisystem inflammatory syndrome in children (14.2%) (p = 0.001). In our study, the strongest predictive biomarker of cardiac involvement in paediatric patients with COVID-19 infection was determined to be hs-Troponin T. It was observed that pathologic electrocardiogram changes could reflect cardiac involvement in the absence of any other signs. Patients with multisystem inflammatory syndrome in children exhibited significantly greater rates of pathologic echocardiogram findings and myocardial dysfunction than those without multisystem inflammatory syndrome in children. In all patients, pathologic electrocardiogram and echocardiogram findings were found to be strongly associated with the severity of inflammation.

A Multicentre Prospective Cohort Study to Identify High-Risk Transient Ischemic Attack/Minor Stroke Patients Benefitting from Echocardiography

BackgroundWe aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography. MethodsThis multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings. ResultsIn 7149 eligible patients, a clinically significant finding was found in 556 (7.8%). There were a further 2421 (33.9%) with potentially significant findings. History of heart failure (adjusted odds ratio [OR], 3.9) or coronary artery disease (OR, 2.7) were the factors most strongly associated with clinically significant echocardiogram findings, whereas young age, male sex, valvular heart disease, and infarct (any age) on neuroimaging were modestly associated (OR, 1.3-1.9). The model combining these predictors into a score (range: 0-15), had a C-statistic of 0.67 (95% confidence interval [CI], 0.65-0.70). A cut point of 6 points or more classified 6.6% of cases as high likelihood, defined as > 15% for clinically significant echocardiogram findings. ConclusionsEchocardiography is a very useful test in the investigations of patients with TIA/minor stroke. We identified high-risk clinical features—combined to create a clinical decision rule—to identify which patients with TIA/minor stroke are likely to have clinically significant echocardiogram findings requiring an immediate change in management. These patients should have echocardiography prioritized, whereas others may continue to have echocardiography conducted in a less urgent fashion.

Measurement of left atrial size as a predictor of severity of illness in sickle cell disease

BackgroundSickle cell disease (SCD) is characterized by microvascular occlusion which leads to multiorgan damage, including left ventricular diastolic dysfunction. Left ventricular diastolic dysfunction has been shown to be an independent risk factor for death in SCD patients. Left atrial dilation (LAD) has been used as a surrogate marker for identification of left ventricular diastolic dysfunction. ObjectiveInvestigate the association of LAD, as determined by echocardiography, with increased disease burden in SCD as reflected by increased emergency department (ED) utilization, increased hemolysis markers, and worsening anemia. MethodsA retrospective cohort study of patients from a single university hospital were selected from a national registry. Age, sickle cell phenotype, echocardiogram findings, ED utilization, baseline hemoglobin, and lab values needed for calculation of hemolytic index were recorded for each patient. Patients were then stratified into two distinct groups based on the presence or absence of LAD to compare ED utilization, baseline hemoglobin and hemolytic index between the two groups. Results129 patients met the criteria for inclusion with 88 having normal left atrial volume and 41 with LAD. There was a higher percentage of high ED utilizers in the LAD group compared to the normal left atrial volume group [34% vs. 17%, p = 0.03]. Average hemoglobin was lower in the LAD group compared with the normal left atrial volume group [mean 8.57 g/dL vs. 9.47 g/dL, p = 0.011]. The mean hemolytic index was higher in the LAD group when compared with the normal left atrial volume group [0.44 vs. −0.21, p < 0.001]. ConclusionsLAD was associated with higher ED utilization, lower hemoglobin level, and more hemolysis in patients with SCD.

A Study of Abnormal Echocardiogram Findings in Patients With Chronic Kidney Disease With Reference to Cardiac Biomarkers.

Background Chronic kidney disease (CKD) isprevalent, especially in populations with multiple risk factors, such as undiagnosed and untreated hypertension and diabetes mellitus. Cardiovascular diseases (CVDs) leading to poor quality of life or even death have been noted as an increasing trend among CKD patients. This study aims to use cardiac biomarkers to evaluate their association with abnormal echocardiogram findings in CKD patients, which may allow for the improvement of quality of life with early treatment. Methods and materials This observational, cross-sectional study was conducted on 103 diagnosed CKD patients at the Department of Medicine, Dr. D.Y. Patil Medical College, Hospital, and Research Centre in Pimpri, Pune, from January 2023 to January 2024. Ethical approval was acquired, and written consent was obtained from participants. The study utilised cardiac biomarkers such as N-terminal pro-B type natriuretic peptide (NT-proBNP), troponin I (Trop I), and a radiological tool, transthoracic echocardiography (TTE). All patients with diagnosed stages 3, 4, and 5 CKD between the ages of 18-80 years were included, and the exclusion criteria consisted of patients who had already undergone cardiac interventional procedures or known cases of CVDs. Results In our study, out of 103 participants, the majority were aged between 51 and 60 years (35, 34%). The study had a majority of male participants (76, 73.8%). Major risk factors were considered, noting hypertension in 63 (61.2%) and diabetes mellitus in 81(78.6%). Participants were divided into stages of CKD. Cardiac biomarkers such as NT-proBNP and Trop I levels were assessed in all participants in the different stages of CKD showing elevated levels of NT-proBNP across all stages. Transthoracic echocardiogram (TTE) screening tests were also evaluated for all patients, showing diastolic dysfunction (DD) as the most common finding in stage 3 (5, 41.67%), stage 4 (25, 62.5%), and stage 5 (35, 68.83%), followed by left ventricular hypertrophy (LVH) as a common finding in stage 3 (4, 33.3%), stage 4 (20, 50%), and stage 5 (30, 58.2%) CKD. Furthermore, the association between raised cardiac biomarkers and abnormal echocardiogram findings across the stages of CKD was evaluated, resulting in a statistically significant association with p-values < 0.05. Conclusion This research sheds light on the association between cardiac biomarkers and abnormal echocardiogram findings in CKD patients and helps us determine if there is any added benefit orpredictive value in screening these individuals at different stages of the disease to allow early interventionand improvement in treatment and quality of life.

Evaluating the Rates of Mortality and Cardiac Catheterization Using High-Sensitivity Troponin and Conventional Troponin Assays.

Non-ST segment elevation myocardial infarction (NSTEMI) is an acute coronary syndrome event where myocardial ischemia is present, with an increase of cardiac troponins without an elevation of the ST segment.One of the fundamental measures used to diagnose or rule out acute coronary syndrome (ACS) is troponin levels in the blood.Troponin is a broad term used for the category of muscle contraction regulatory proteins and is commonly measured during ACS evaluation. Troponin I is only released by cardiac tissue, while some assay measurements will also pick up troponin released by skeletal muscle injury. This retrospective observational study was performed investigating troponin assays and how they relate to patient's outcomes. The troponin assays used in this Miami hospital where the database of patients was collected between 2018 and 2023 were troponin I (cTnI), the conventional troponin assay, and the newer high-sensitivity troponin I assay (hs-cTn). In this observational study patients who received an admitting diagnosis of NSTEMI corroborated by an independent cardiologist had their respective troponin assay levels included. Patients found to have ECG changes significant for non-ischemic pathologies, or echocardiogram findings suggestive of myocardial dysfunction not clinically correlated to an ACS were excluded from the study. A total of 75 patients were included in this study and the mean age was 75.97 ±14.72 years, with a presentation of chest pain, dyspnea and general weakness recorded in 59% (n = 45) of patients. The median time between troponin samples was 6.63 hours across both assays and hs-cTn showed a 4.99% increase in variation between samples while cTnI had a decrease of 2.53%. The study objective is to support whether there is a difference in rates of cardiac catheterization or mortality based on the type of troponin testing. There was no significant association found between, the type of troponin assay used during hospital admission, and the outcomes of catheterization and death (p > 0.009).

Comparison of post-operative transesophageal and transthoracic echocardiogram findings following atrioventricular septal defect repair.

Success of atrioventricular septal defect repair is defined by post-operative atrioventricular valve function and presence of residual intracardiac shunting. We evaluated differences in interpretation of atrioventricular valve function and residual defects between transesophageal and transthoracic echocardiography in a contemporary cohort of infants undergoing atrioventricular septal defect repair. Among 106 patients, we identified an increase in left and right atrioventricular valve regurgitation, right atrioventricular valve inflow gradient, and increased detection rate of residual intracardiac shunting on transthoracic compared to transesophageal echocardiograms, although residual shunts identified only on transthoracic echocardiogram were not haemodynamically significant. Findings may help inform expectation of post-operative transthoracic echocardiogram findings based on intraoperative assessment.

WHEN CLINICAL FINDINGS TAKE YOU DOWN THE WRONG PATH: PERSISTENT FEVER IN A PATIENT WITH PREVIOUS CARDIAC SURGERY

Abstract Introduction In a patient who underwent previous cardiac surgery, persistent fever may be related to endocarditis. Symptoms and cardiovascular imaging, such as echocardiogram and PET/CT, may guide clinicians and surgeons to the correct diagnosis. Discussion A 43–years–old man came to our attention because of persistent fever (lasting several months) associated with cough and asthenia. When he was 5 years old, he underwent cardiac surgery for partial atrioventricular canal defect (atrial septal defect was about 4 cm) and mitral valve cleft. 14 years ago he undertook chemotherapy due to Hodgkin‘s lymphoma. Recently a cerebral artery aneurysm, radiologically defined as mycotic but proved to be fusiform, was diagnosed and treated with neurosurgery. During a recent hospitalization, blood culture positive for Streptococcus Mitis and brachial rash were reported and antibiotic therapy was started. Suspecting endocarditis, he was referred to our department. Echocardiogram revealed anterior mitral leaflet fissure, resulting in severe mitral regurgitation. Moreover a periannular cavity of doubtful interpretation (seemingly an abscess) was described. Subsequent 18FDG–PET/CT did not detect any abnormal cardiac metabolic activity. Due to severe valve regurgitation, cardiac surgery was performed: myxomatous degenerative mitral valve leaflets, failure of mitral valve cleft closure and anomalous coronary sinus communication to the left atrium (mimicking echocardiogram findings of suspected empty abscess cavity) were observed. Thus mitral valve replacement using a biological valve prosthesis was performed. Macroscopically there was no evidence of endocarditis, confirming PET/CT scan results. During the post–surgery period, third–degree atrioventricular block episodes were noted. Therefore a bicameral pacemaker was implanted. Conclusions This case report demonstrates the importance of not stopping at the first impression, as failure of previous mitral valve repair in a patient presented with persistent fever can mimic endocarditis. Therefore, the results of diagnostic tests should be compared to patients’ medical history and their clinical presentation.

Relationship of Biochemical Parameters and Echocardiogram Findings with Appetite in Patients having Reduced Ejection Fraction Heart Failure

Objective: To determine the relationship of biochemical parameters and echocardiogram findings with appetite and nutritional status in patients with heart failure with reduced ejection fraction. Study Design: Cross-sectional study.Place and Duration of Study: This study was conducted at the Department of Medicine, Combined Military Hospital (CMH), Peshawar, Pakistan, from February 2022 to August 2022.Methods: The study was conducted on adult patients with heart failure for at least three months. Indoor patients, those with hospitalization within the last four weeks, and unwilling patients were excluded. The Council on Nutrition Appetite Questionnaire and Mini Nutritional Assessment questionnaire were administered in direct face-to-face interviews. A transthoracic echocardiogram was done to document the left ventricular ejection fraction. Different hematological and biochemical parameters were also analyzed.Results: There were 76 patients aged 55.92± 15.22 years. Mean mini nutritional assessment and Council on Nutrition appetite questionnaire scores were 17.89± 5.23 and 20.74± 8.19, respectively. Based on mini nutritional assessment scores, 36 were malnourished, 27 were at risk of malnutrition, and 13 had normal nutritional status. Using Council on Nutrition appetite questionnaire scores, 57 were at risk of malnutrition, while 19 had no risk. Left ventricular ejection fraction and hemoglobin were lower in malnourished patients. However, there were no differences in other biochemical parameters amongst patients with good or poor nutritional status.Conclusion: Patients with heart failure had poor appetite and nutritional status proportionate to the degree of left ventricular systolic dysfunction. How to cite this: Saeed B, Arshad AR, Hussain M. Relationship of Biochemical Parameters and Echocardiogram Findings with Appetite and Nutritional Status in Patients with Heart Failure with Reduced Ejection Fraction. Life and Science. 2024; 5(2): 144-150. doi: http://doi.org/10.37185/LnS.1.1.359

Prevalence and impact of viral myocarditis in patients with severe fever with thrombocytopenia syndrome.

To explore the association and impact between viral myocarditis and mortality in patients with severe fever with thrombocytopenia syndrome. A dynamic analysis was conducted between fatal group and nonfatal group regarding the daily epidemiology data, clinical symptoms, and electrocardiogram (ECG), echocardiogram, and laboratory findings. Outcomes of patients with and without viral myocarditis were compared. The association between viral myocarditis and mortality was analyzed. Among 183 severe fever with thrombocytopenia syndrome patients, 32 were in the fatal group and 151 in the nonfatal group; there were 26 (81.25%) with viral myocarditis in the fatal group, 66 (43.70%) with viral myocarditis in the nonfatal group (p < 0.001), 79.35% of patients had abnormal ECG results. The abnormal rate of ECG in the fatal group was 100%, and in the nonfatal group was 74.83%. Univariate analysis found that the number of risk factors gradually increased on Day 7 of the disease course and reached the peak on Day 10. Combined with the dynamic analysis of the disease course, alanine aminotransferase, aspartate aminotransferase, creatine kinase, creatine kinase fraction, lactate dehydrogenase, hydroxybutyrate dehydrogenase, neutrophil count, serum creatinine, Na, Ca, carbon dioxide combining power, amylase, lipase, activated partial thromboplastin time and thrombin time had statistically significant impact on prognosis. The incidence of fever with thrombocytopenia syndrome combined with viral myocarditis is high, especially in the fatal group of patients. Viral myocarditis is closely related to prognosis and is an early risk factor. The time point for changes in myocarditis is Day 7 of the course of the disease.

Changes in cardiac functions in patients treated with parathyroidectomy for secondary hyperparathyroidism

Our study aims to investigate the changes in cardiac functions, especially myocardial performance index (MPI), in patients who underwent parathyroidectomy for secondary hyperparathyroidism. Patients who underwent parathyroidectomy for secondary hyperparathyroidism between June 2010 and September 2021 were analyzed retrospectively. The patients were divided into two groups: those who underwent total parathyroidectomy (group 1) and those who underwent subtotal parathyroidectomy (group 2). The groups were compared according to the echocardiogram findings performed in the preoperative period and the postoperative sixth month. In addition, cardiac structure, and systolic and diastolic functions, especially myocardial performance index, were evaluated by echocardiography and Doppler imaging. Thirty-seven patients were examined; 16 (43.2%) underwent total parathyroidectomy, and 21 (56.8%) had subtotal parathyroidectomy performed. Group 1’s mean left ventricular end-systolic diameter (LVES) decreased from 2.53 ± 0.57 to 2.35 ± 0.37 cm after parathyroidectomy. In Group 1, the postoperative value of LVES and end-systolic volume decreased significantly compared to the preoperative period (p = 0.042, p = 0.008, respectively). EF increased from 59.25 ± 0.05 to 67.81 ± 4.04. In Group 1, EF and EV postoperatively increased significantly compared to the preoperative period (p = 0.023, p = 0.021, respectively). The mean MPI decreased from 0.45 ± 0.07 to 0.39 ± 0.04 after parathyroidectomy in group 1. In group 2, it decreased from 0.46 ± 0.06 to 0.40 ± 0.04 (p < 0.001). The present study provides an improvement in myocardial functions after parathyroidectomy. While LVES, EF, ejection volume, end-systolic volume, and MPI improved in both groups, the MPI improvement was more evident in the total parathyroidectomy group.Graphical

Perfusion Index as a Predictor of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Newborns

Aim To assess the value of perfusion index (PI) and arrive at the ideal cut-off value of delta PI (DPI) (pre and postductal difference in PI) in identifying hemodynamically significant patent ductus arteriosus (HsPDA). Methods Prospective observational study was conducted on 156 preterm newborns of &lt;37 weeks in the NICU of tertiary care center, from August 2019 to March 2020 after ethical clearance. 156 preterm babies were classified into noPDA, HsPDA and Non-HsPDA based on echocardiogram findings and compared with DPI value on Day 1 to 3 of life. Receiver operating characteristic (ROC) curve was constructed to establish cut-offs for DPI in diagnosing HsPDA. A P value &lt;.05 is considered for statistical significance. Results There was a significantly lower PI in both preductal and post ductal limbs with HsPDA compared to other groups. A DPI Cut-off of 0.75 on day 2 of life has a sensitivity of 75%, specificity of 100% and positive predictive value (PPV) of 100% and a negative predictive value of 89%. Conclusion PI is a simple non-invasive bedside index predict the presence of a HsPDA in preterm newborns and DPI of &gt;0.75 indicates for presence of HsPDA.

Immediate Postpartum Breastfeeding following Pregnancy with Cardiac Disease.

This study aimed to identify predictors of immediate postpartum breastfeeding among women with maternal cardiac disease (MCD). This study included all gravidas with MCD who delivered at a single institution from 2012 to 2018. Charts were abstracted for maternal demographics, obstetrical outcome, cardiac diagnoses, cardiac risk stratification scores, and prepregnancy echocardiogram findings. Kruskal-Wallis and Fisher's exact tests were used to compare the breastfeeding (BF) group versus the nonbreastfeeding (NBF) group. Logistic regression was used to obtain odds ratios (ORs) with 95% confidence intervals (CIs). Among 211 gravidas with MCD, 12% were not breastfeeding at the time of postpartum hospital discharge. Compared with the BF group, the NBF group had a significantly higher proportion of women with cardiomyopathy (21% NBF vs. 7% BF, OR = 3.44, 95% CI: 1.12-10.71), with modified World Health Organization (WHO) classification ≥III (33 vs. 14%, OR = 3.16, 95% CI: 1.22-8.15), and with prepregnancy ejection fraction (EF) < 50% (55 vs. 14%, OR = 7.20, 95% CI: 1.92-27.06). There were otherwise no differences between the two groups with regards to other cardiac diagnoses or cardiac risk scores. In women with MCD, cardiomyopathy, modified WHO class ≥III, and a prepregnancy EF < 50% were associated with NBF in the immediate postpartum period. These findings may guide providers in identifying a subset of women with MCD who can benefit from increased breastfeeding counseling and support. · Eighty-two percent of patients with cardiac disease are breastfeeding at the time of postpartum discharge.. · Cardiomyopathy is associated with an increased odds of not breastfeeding at postpartum discharge.. · Rationale for not breastfeeding is infrequently documented in the medical record..

Cardiopulmonary Involvement in Patients with Systemic Sclerosis: A Cross-sectional Study

Introduction: One of the most challenging aspects of systemic sclerosis is the potential involvement of the cardiopulmonary system, which can lead to significant morbidity and mortality if not detected and managed promptly. Aim: To assess the clinical characteristics and prevalence of specific cardiopulmonary involvement and to investigate its association with disease duration in patients with systemic sclerosis from South India. Materials and Methods: This cross-sectional, observational study was conducted at the Department of General Medicine, Government Medical College, Thrissur, India, between January 1, 2020, and December 31, 2020. Forty patients with systemic sclerosis were included according to the European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology classification criteria. Skin thickening was evaluated using the modified Rodnan Skin Score (mRSS). Investigations such as chest X-ray, echocardiogram, and antibody profiling were conducted to evaluate cardiopulmonary involvement. The data were analysed using Statistical Package for Social Sciences (SPSS) version 23.0, and the Chi-square test was used to compare qualitative variables between groups. Results: Sixteen patients (40%) had an mRSS score between 11 and 20, followed by 14 patients (35%) with mRSS scores between 21 and 30. The prevalence of Interstitial Lung Disease (ILD) was 50%. The echocardiogram findings showed mitral regurgitation and moderate Pulmonary Arterial Hypertension (PAH) in 30% (n=12) and 25% (n=10) of patients, respectively. High-Resolution Computed Tomography (HRCT) and pulmonary function tests were normal in 10 patients (25%). The duration of the disease was three to eight years in 14 patients and eight to 12 years in 12 patients. Both ILD and PAH were significantly associated with the duration of the disease (p&lt;0.05). Antiscleroderma-70 and anti-centromere were the most common antibodies present in patients with ILD and PAH, respectively. Conclusion: The study indicated a high prevalence of PAH and ILD in patients with systemic sclerosis. Moreover, both ILD and PAH were significantly associated with the duration of the underlying disease, with longer disease duration being associated with a higher likelihood of these conditions.

Association between anti-Helicobacter pylori immunoglobulin G status and coronary artery disease among hypertensives: Myth or fact?

Abstract Background: Chronic persistent inflammation associated with Helicobacter pylori (H. pylori) infection accelerates vascular complications which are prone to cause atherogenesis and coronary artery disease (CAD). This study was undertaken to assess the significance of the association between H. pylori immunoglobulin G (IgG) serostatus and the occurrence of CAD among hypertensives. Materials and Methods: A total of 90 hypertensive subjects without stroke and CAD symptoms were tested for serum H. pylori IgG. Their electrocardiogram and echocardiogram (ECHO) outcomes were analyzed after 3 months. Results: Among the 90 subjects, 52 (57.8%) were H. pylori IgG positive. The adjusted odds ratio for abnormal ECHO outcome and H. pylori IgG positivity was 2.494. There was a positive correlation between H. pylori IgG positivity, sedentary lifestyle, alcoholism, and elevated serum C-reactive protein and abnormal ECHO findings suggestive of CAD. Conclusions: This study found a positive correlation between H. pylori IgG seropositivity and abnormal ECHO outcomes. The prevention of CAD with antimicrobial therapy for H. pylori is simple and innovative. Lifestyle modification and hand hygiene can obviate the adverse circumstances of CAD to some extent.

Gene-Specific Discriminative Echocardiogram Findings in Hypertrophic Cardiomyopathy Determined Using Artificial Intelligence: A Pilot Study

Hypertrophic cardiomyopathy (HCM) is among the most common forms of cardiomyopathies, with a prevalence of 1:200 to 1:500 people. HCM is caused by variants in genes encoding cardiac sarcomeric proteins, of which a majority reside in MYH7, MYBPC3, and TNNT2. Up to 40% of the HCM cases do not have any known HCM variant. Genotype–phenotype associations in HCM remain incompletely understood. This study involved two visits of 46 adult patients with a confirmed diagnosis of HCM. In total, 174 genes were analyzed on the Next-Generation Sequencing platform, and transthoracic echocardiography was performed. Gene-specific discriminative echocardiogram findings were identified using the computer vision library Fast AI. This was accomplished with the generation of deep learning models for the classification of ultrasonic images based on the underlying genotype and a later analysis of the most decisive image regions. Gene-specific echocardiogram findings were identified: for variants in the MYH7 gene (vs. variant not detected), the most discriminative structures were the septum, left ventricular outflow tract (LVOT) segment, anterior wall, apex, right ventricle, and mitral apparatus; for variants in MYBPC3 gene (vs. variant not detected) these were the septum, left ventricle, and left ventricle/chamber; while for variants in the TNNT2 gene (vs. variant not detected), the most discriminative structures were the septum and right ventricle.