Echocardiographic Features Of Patients Research Articles

Agreement of left atrial pressure with clinical risk scores and echocardiographic features in patients with atrial fibrillation referred for catheter ablation

Abstract Background Heart failure with preserved ejection fraction (HFpEF) frequently coexists with atrial fibrillation (AF). The diagnosis of HFpEF in AF is difficult because some diagnostic criteria for HFpEF may be associated with AF instead of HFpEF per se. Left atrial pressure (LAP) ≥15 mmHg has been used to confirm the diagnosis of HFpEF. Purpose We aimed to 1) determine LAP measurements in patients with AF undergoing catheter ablation; 2) assess the agreement between LAP measurement HFpEF risk scores and 3) determine the association between LAP measurement and clinical and echocardiographic features. Methods Consecutive patients with paroxysmal or persistent AF scheduled for catheter ablation were included. Participants were considered to have HFpEF if the mean LAP was ≥15 mm Hg. The LAP was measured only in sedated patients with spontaneous breathing. Participants had high probability of HFpEF if scored >5points in H2FPEF and/or ≥5 points in HFA-PEFF score. Results Of 107 participants, 29 (27%) had HFpEF according to mean LAP and 32 (30%) had high probability of HFpEF according to HFpEF scores. The highest agreement of HFpEF risk scores relative to elevated LAP was observed for H2FPEF score; among patients with mean LAP ≥15 mm Hg, 38% [n=11/29] of them had also high risk of HFpEF based on H2FPEF score, whereas only 10% [n=3/29] had high risk of HFpEF based on HFA-PEFF score. In multivariable analysis, the independent predictors of HFpEF were left ventricular ejection fraction (LVEF; OR 0.77, 95%CI 0,.64-0.91), intraventricular septum diameter (IVSd; OR 1.75, 95%CI 1.11-2.74), global longitudinal strain (GLS; OR 1.24, 9%CI 1.05-1.48). Conclusions More than one-fourth of patients scheduled for catheter ablation had HFpEF according to elevated LAP. The highest agreement to elevated LAP was observed for the H2FPEF score. Predictors of HFpEF diagnosis were lower LVEF, higher IVSd and GLS.

From Klinefelter Syndrome to High Grade Aneuploidies: Expanding the Gene-dosage Effect of Supernumerary X Chromosomes.

High-grade aneuploidies of X and Y sex chromosomes (HGAs) are exceedingly rare and complex conditions. We aimed to investigate the effect of supernumerary X chromosomes (extra-Xs) on the clinical, hormonal, metabolic, and echocardiographic features of patients with HGAs. In a cross-sectional study, we compared 23 subjects with HGAs and 46 age-matched subjects with 47,XXY Klinefelter syndrome (KS), according to the number of extra-Xs: two (47,XXY and 48,XXYY), three (48,XXXY and 49,XXXYY), or four supernumerary Xs (49,XXXXY). A second cohort consisting of 46 pubertal stage-matched KS subjects was employed for validation. Clinical, hormonal, metabolic and ultrasonographic parameters were collected and analyzed. The increase in the number of extra-Xs was associated with a progressive adverse effect on height, pubertal development, testicular volume and function, adrenal steroidogenesis, and thyroid function. A progressive linear increase in ACTH and a decrease in cortisol/ACTH ratios were found. Weight and body mass index, Sertoli cell function, lipid profile, and glucose tolerance post-oral glucose tolerance test were all worse in the HGA cohort compared to KS. Cardiac evaluation revealed a linear association with reduced left and right end-diastolic diameters and reduced ejection fraction. The increase in the number of extra-Xs is associated with a "dose-dependent" progressive impairment in steroid producing glands, thyroid function, cardiac structure, and performance.

Abnormal Global Longitudinal Strain Correlates with Amyloidogenic Light Chain-Induced Cardiac Dysfunction via Direct Myocardial Toxicity in Patients without Significant Amyloid Fibril Deposition

Introduction: Patients with advanced cardiac AL have high early mortality despite receiving effective plasma cell-directed therapies. Cardiac dysfunction is caused by direct myocardial toxicity from amyloidogenic light chains (LCs) and architectural distortion from amyloid fibril deposition. Diagnosis before significant fibril-induced cardiac dysfunction is critical for improving outcomes. While measuring cardiac biomarkers is standard for risk stratification of patients with newly diagnosed AL, serum concentrations can be impacted by fluid shifts and renal impairment, suggesting a need for complementary biomarkers. Our transcriptomic analysis highlighted dysregulation of myocardial contractility in cardiac cells exposed to amyloidogenic LCs, leading us to hypothesize that there could be clinically measurable differences in cardiac contractility (Ghosh et al., 2023). Global longitudinal strain (GLS) is a sensitive echocardiographic measure of myocardial contractility and may predict survival independent of serum cardiac biomarkers. Since LC-induced cardiac dysfunction via direct myocardial toxic effects is reversible with plasma cell-directed therapy and may represent an early cardiac insult in patients with cardiac AL, we identified and evaluated patients with LC-induced cardiac dysfunction and no clinical or echocardiographic evidence of significant cardiac amyloid fibril deposition to determine clinical features potentially associated with early cardiac AL. Methods: We analyzed the demographic, clinical, and echocardiographic features of patients with non-cardiac biopsy-proven AL amyloidosis and LC-induced cardiac dysfunction seen at the Boston University Amyloidosis Center between January 1, 2011 and March 31, 2023. Direct LC-induced cardiac dysfunction was defined as: (1) elevated cardiac biomarkers (BNP >176 pg/mL or NT-proBNP >899 pg/mL or troponin I >0.033 ng/mL, per institutional reference ranges); (2) normal echocardiographic interventricular septal thickness (<11 mm in males and <10 mm in females); (3) estimated glomerular filtration rate >60 mL/min/1.73m 2; (4) absence of late gadolinium enhancement on cardiac magnetic resonance imaging (if performed); and (5) negative endomyocardial biopsy (if performed). Echocardiographic variables, including left ventricular ejection fraction (LVEF) and GLS, were collected from the electronic health record or post-processed manually using TomTec 2D CPA. All statistical analyses were performed using GraphPad Prism version 8©. Overall survival (OS) was evaluated using the Kaplan-Meier estimator and log rank tests. Results: Twenty-nine patients met our criteria for direct LC-induced cardiac dysfunction. Median age at diagnosis was 65 years (range: 46-83), and 55% of patients (n=16) were male ( Table 1). LC isotype was lambda in 69% (n=20) and kappa in 31% (n=9) of patients. The difference in free light chains (dFLC) was >50 mg/L in 62% (n=18) of patients at diagnosis.Additionally, 76% (n=22) of patients met criteria for Boston University stage II cardiac disease with mildly elevated cardiac biomarkers (median BNP 237 pg/mL, median troponin I 0.053 ng/mL). Among 16 patients for whom a GLS measurement was available, 81% (13/16) had an abnormal GLS (normal < -18%). Median and mean GLS were -15.5% (-7 to -21.7) and -15.3% ± 4.5, respectively ( Figure 1). Median OS was 5.2 years for the entire cohort. Conclusion: We found that a subset of patients with AL amyloidosis demonstrate cardiac dysfunction without substantial clinical or echocardiographic evidence of amyloid deposition; this we postulate to be the result of direct myocardial toxic effects by amyloidogenic LCs. Early cardiac biomarker stage and abnormal GLS were commonly associated with LC-induced cardiac dysfunctionin these patients.

Predictors of coronary tortuosity in patients with chronic coronary syndrome.

Aim Coronary artery tortuosity is a common coronary angiographic finding. This tortuosity can cause myocardial ischemia even in the absence of significant coronary artery stenosis. Our aim was to compare the demographic, clinical and echocardiographic features of patients with chronic coronary syndrome (CCS) and with and without coronary artery tortuosity.Material and methods 361 patients who underwent elective coronary angiography (CAG) due to CCS were included in the study. These patients divided into two groups, those with coronary tortuosity (Group 1) and those without (Group 2). Univariable and multivariable logistic regression analysis was performed to identify predictors associated with coronary artery tortuosity.Results The mean age of the 361 CCS patients (44 % female; 56 % male) was 56.7±11.5 years. In the univariable regression analysis, age, female sex, hypertension (HT), PR interval, QTc interval, ST / T segment changes, left ventricle diastolic dysfunction (LVDD), left ventricle hypertrophia (LVH) were identified as predictors of coronary tortuosity. In the multivariable regression analysis, age (OR: 1.059; 95 %CI: 1.032-1.087, p<0.001) and hypertension (OR: 0.484; 95 %CI: 0.278-0.843, p=0.01) were identified as independent predictors of coronary tortuosity.Conclusion Coronary artery tortuosity is an angiographic finding that develops as a result of adaptive mechanisms in the heart and can cause myocardial ischemia. Predictors of coronary artery tortuosity in patients with CCS were long PR and QTc intervals, ST / T segment changes, LVH, LVDD, advanced age, and female gender. Evaluation of these demographic, electrocardiographic, and echocardiographic data may help clinicans to anticipate coronary artery tortuosity in patients with CCS and to be precautious for PCI.

The Relationship between Hyperuricemia and Echocardiographic Parameters in Patients with Chronic Atrial Fibrillation.

Purpose Uric acid serves as a marker for cardiovascular risk and is often linked to inflammation and oxidative stress. There is evidence suggesting an association between uric acid and atrial fibrillation (AF), including its severity and occurrence of crises, as well as its involvement in cardiovascular mechanisms. The objective of this study was to assess the correlation between hyperuricemia and echocardiographic features in patients with chronic AF lasting for more than 5 years. Methods This case-control study involved 107 patients diagnosed with chronic non-valvular AF. Uric acid levels were measured in all patients, and they were divided into two groups: the first group consisted of 66 patients with hyperuricemia (>7.2 mg/dL), while the second group included 41 patients with normal uric acid levels. Echocardiography (TTE) was performed to evaluate each patient. Various clinical and echocardiographic parameters, such as left ventricle telediastolic (LVTDD) and telesystolic (LVTSD) diameters, left atrial diameter (LAD), aortic diameter (AoD), ejection fraction (EF), and pulmonary artery pressure (PAP), were analyzed. Results Binary logistic regression analysis revealed a statistically significant relationship between uric acid levels (>7.2 mg/dL) and LAD. For each unit increase in LAD, the probability of having hyperuricemia increased by 9% [odds ratio (OD): 0.91, 95% confidence interval (CI): 0.84-0.99]. A significant relationship was found between uric acid levels (>8 mg/dL) and LVESD (p = 0.045) as well as PAP (p = 0.006). For every unit increase in LVESD, the likelihood of having uric acid levels greater than 8 mg/dL increased by 22% [OD: 0.82, 95% CI: 0.67-0.99, b = -0.2]. Likewise, for each unit increase in PAP, the probability of having uric acid levels greater than 8 mg/dL was 9.4% [OD: 0.91, 95% CI: 0.86-0.97, b = -0.09]. Conclusions This study demonstrates that hyperuricemia has a significant relationship with the development of atrial remodeling, with an important association observed between hyperuricemia and an increase in left atrial diameter. Hyperuricemia is also correlated with an enlargement of the left ventricle end-systolic diameter and pulmonary artery pressure, showing a possible influence that hyperuricemia might have also left ventricle morphology and right ventricle function.

Echocardiographic features in patients with prolactinoma long-term treated with dopamine agonists

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Clinical and Echocardiographic Features of Patients With Infective Endocarditis and Bicuspid Aortic Valve According to Echocardiographic Definition of Valve Morphology

The influence of different bicuspid aortic valve (BAV) morphology in the clinical course of infective endocarditis (IE) has not yet been investigated. This study aimed to describe the clinical and echocardiographic features of IE in patients with BAV (BAVIE) according to valve morphology. Patients with definite BAVIE prospectively enrolled in 4 high-volume referral centers from 2000 to 2019 were evaluated and divided into 2 groups according to the echocardiographic definition of fused BAV morphology: right-left coronary (RL type) and right noncoronary or left noncoronary (non-RL type) cusp fusion. All patients were followed up for 1year. One hundred thirty-eight patients with BAVIE were included (77.7% male; median age, 52 [36.83-61.00]years): 112 patients with RL type (81%) and 26 patients with non-RL type BAV (19%), with no significant differences in age, sex, and comorbidities between groups. Although 43% of the cohort had known BAV, the referral was late after symptom onset, particularly for the RL phenotype; time from symptom onset to hospitalization >30days (31.3% vs 11.5%; P=.032) and New York Heart Association class≥II (64.3% vs 42.3%; P=.039) were more frequent in patients with RL type BAV than in patients with non-RL type BAV. Conversely, patients with non-RL type BAV had a higher incidence of hemorrhagic stroke (19.2% vs 5.4%; P=.034) and high-grade atrioventricular block (11.5% vs 0.9%; P=.021). Streptococcus viridans was more frequently isolated in patients with non-RL type BAV than in patients with RL type BAV (44% vs 24.1%; P=.045). No difference in short- and intermediate-term mortality was observed between groups. Clinical profile and echocardiographic features in BAVIE patients may differ according to valve morphology, and patients with BAVIE appear to be referred late, even when BAV disease is previously known.

Clinical and echocardiographic characteristics in patients with heart failure and type 2 diabetes.

Objective: The coexistence of type 2 diabetes (T2D) and heart failure (HF) has obvious consequences during cardiovascular diagnosis. This study evaluated the relationship between T2D and clinical and echocardiographic features of patients with HF. Methods & results: 121 patients with HF were clinically evaluated by echocardiography in this case-control study. They were divided into two groups based on the presence of T2D. Patients with diabetes were subdivided and compared via an HbA1c control. Significant differences between T2D and non-T2D groups were detected by comparing the left atrial diameter, E/E' and left ventricular end-diastolic diameter. When comparing patients with diabetes, differences in acute heart failure episodes, left ventricular ejection fraction, left atrial diameter and E/E' were evaluated. Conclusion: T2D was associated with important cardiac alterations and more severe HF. Poor control of diabetes resulted in worse cardiovascular outcomes.

Infective Endocarditis: Clinical Characteristics and Echocardiographic Findings.

PurposeInfective endocarditis (IE) remains a disease with high morbidity and mortality. The aim of this study was to determine the clinical characteristics and echocardiographic features of patients with IE.MethodsWe analyzed patients with either definitive or probable diagnosis of IE who were hospitalized in a teaching hospital in Mashhad, Iran between June 2011 and January 2020. Patients who survived were followed up by echocardiography for at least 6-month after hospital discharge.ResultsA total of 82 cases with IE were included of which 62 (75.6%) received definitive diagnosis. The mean age was 39.7 ± 18.7 years and 52 (63.4%) were male. The most common preexisting structural cardiac abnormality that predispose patients to IE were congenital heart diseases (28 %) of which bicuspid aortic valve was more common (n = 12, 14.6%), followed by ventricular septal defect (n = 9, 11%) and Tetralogy of Fallot (TOF) (n = 2, 2.4%). Three (3.6 %) cases had rheumatic heart disease and 12 (14.6 %) were injecting drug users. The most common causative pathogen was Staphylococcus aureus, detected in 7 (19.4%) cases. Follow-up echocardiography revealed right or left ventricular failure in 10 (12.1%) cases. Cardiac complications occurred in 41 (50%) cases and systemic complications in 63 (76.8%). All-cause mortality was 41.5% (n = 34) and 6 (18.1%) patients died due to cardiovascular complications.ConclusionsThe short- and long-term prognosis in IE was poor and the predictors for in-hospital and 1-year mortality were defined as heart failure and septic shock. Congenital heart disease and intravenous illicit drug using (IVDU) were the most common predisposing condition which may necessitate a revision in the IE prophylaxis recommendations.

563 Different right ventricle maladaptation in patients with HFrEF and HFpEF: diagnostic and prognostic implications

Abstract Aims The prognostic impact of right ventricular (RV) dysfunction and of pulmonary hypertension (PH) in patients affected by heart failure (HF) is well known. More recently it has been demonstrated that the coupling between the afterload and the function of the right ventricle in terms of TAPSE/PAPS ratio, may provide additional prognostic information. In contrast, sparse and conflicting data have been published regarding the relevance of different echocardiographic features in patients with reduced or preserved ejection fraction. Additionally, RV function and ventricular-arterial coupling is poorly studied in acute setting. We planned a prospective monocentric study aimed at elucidating the role of PH and of RV structure and function, assessed by means of an echocardiographic examination in the early phase of hospital admission of patients with ADHF. We also compared different echo parameters in order to assess the prognostic role in patient affected by HF and reduced ejection fraction (HFrEF) vs. those with preserved ejection fraction (HFpEF). Methods and results we included 381 patients included in the study, 209 had HFrEF and 172 had HFpEF. All the examinations were performed by cardiologists according to the instructions provided by the American Society of Echocardiography. In all patients LV volumes and diastolic function analysis were performed. A detailed examination of RV dimension and function were achieved by the measurement of right ventricular diameter at basal level, Pulmonary systolic pressure (PAPS), Tricuspid anular peak systolic excursion (TAPSE) and s wave by TDI analysis at RV free wall basal level. Finally longitudinal function was measured at lateral RV wall by post processing strain analysis. Overall, the median TAPSE was 19 (16–21) mm, the median of RVEDD was 40 (36–45) mm, the median PASP was 45 (35–50) mmHg and the median s’ wave was 11 (7–14). Patients with HFrEF demonstrated a larger RVEDD compared to HFpEF (44 ± 6 vs. 38 ± 5 P < 0.05) and more reduced TAPSE (16 ± 4 vs. 20 ± 3 P < 0.05). Whereas PAPS values were similar in both groups (47 ± 10 vs. 45 ± 10 NS). Conversely, s’ wave was much more reduced in HFpEF (9 ± 3 vs. 12 ± 4 P < 0.05) RV longitudinal strain was reduced in both group but HFpEF population demonstrated more impaired values (−18 ± 5 vs. −22 ± 8; P < 0.01). TAPSE/PAPS was significantly reduced in HFrEF (0.38 ± 8 vs. 0.43 ± 5 P < 0.01). Conversely s’/PAPS was more pronounced in HFpEF group (0.25 ± 4 vs. 0.29 ± 7 P < 0.05). At univariate analysis several parameters were related to outcome: TAPSE ≤ 14 mm, [HR: 1.70 (1.14–2.52); P = 0.009], PASP≥ 40 mmHg [HR: 1.51 (1.05–2.17); P = 0.02], RVEDD > 38 mm [HR: 1.88 (1.36–2.61); P < 0.001], s wave < 9 [HR: 1.88 (1.3–2.4), P < 0.001], inferior vena cava diameter > 21 mm [HR: 1.90 (1.31–2.75); P = 0.001]. Therefore TAPSE/PAPS was associated with adverse event in HFrEF but not in HFpEF (HR: 1.75 and HR: 1.02). Whereas, s/PAPS was associated with more increased risk in HFpEF (HR: 1.8 and HR: 1.3). Conclusions Right ventricular dysfunction and maladaptation are associated with poor outcome in either HFrEF and HFpEF. However tissue excursion and longitudinal strain are much more impaired in HFpEF, whereas RV dilatation and reduced longitudinal function are closely related to HFrEF. Different prognostic values and evaluation may be comprised during the evaluation of HFrEF and HFpEF.

The relationship between electrocardiographic findings and left ventricular apical thrombus.

Persistent ST segment elevation, fragmented QRS (fQRS), and prominent R wave in lead aVR (Goldberger sign) are the parameters associated with ventricular aneurysm. The goal of this report was to examine the association with electrocardiographic findings (persistent ST elevation, QRS duration, LBBB, and Fragmented QRS [fQRS]) and LV apical thrombus in subjects following anterior MI. The study was a prospective and cross-sectional analysis that comprised of 220 consecutive subjects diagnosed after anterior MI. The echocardiographic features of patients were evaluated at least 6 weeks after anterior MI. A 12-point ECG was collected on all subjects admitted to the hospital. LBBB, persistent ST elevation, QRS duration and fQRS were evaluated in these patients. The LV ejection fraction (LVEF) was lower in the thrombus group compared to the non-thrombus group (27.2 ± 7.1/33.2 ± 10.0, p=0.008). In patients with LV apical thrombus (LVAT); LBBB, persistent ST elevation, QRS duration and fQRS were higher compared to those without LVAT (p<0.05). We demonstrated that the electrocardiographic findings (persistent ST elevation, QRS duration, LBBB, and fQRS) were closely associated with LVAT, and these findings were used as indicators of LV thrombi in anterior MI patients.

Echocardiographic Features of Patients with Coronary Heart Disease and Angina Pectoris under Deep Learning Algorithms

Based on the VGG19-fully convolutional network (FCN) (VGG19-FCN) and U-Net model in the deep learning algorithms, the left ventricle in the ultrasonic cardiogram was segmented automatically. In addition, this study evaluated the value of ultrasonic cardiogram features after segmentation by the optimized algorithm in diagnosing patients with coronary heart disease (CHD) and angina pectorisody; patients with arrhythmia; and pa. In this study, 30 patients with confirmed CHD and 30 normal people without CHD from the same hospital in a certain area were selected as the research objects. Firstly, the VGG19-FCN and U-Net model algorithms were selected to automatically segment the left ventricular part of the apical four-chamber static image, which was realized through the weights of the fine-tune basic model algorithm. Subsequently, the experimental subjects were divided into a normal group and a CHD group, and the data were obtained through the ultrasonic cardiogram feature analysis of automatic segmentation by the algorithm. The differences in the ejection fraction (EF), left ventricular fractional shortening (FS), and E/A values (in early and late of the diastolic phase) of the left ventricle for patients in the two groups were compared. In addition, the ultrasonic cardiogram left ventricular segmentation results of normal people and patients with CHD were compared. A comprehensive analysis suggested that the U-Net model was more suitable for the practical application of automatic ultrasonic cardiogram segmentation. According to the analyzed data results, the global systolic function parameters (EF, FS, and E/A values) of the left ventricle for patients showed statistically obvious differences ( P &lt; 0.05 ). In summary, deep learning algorithms can effectively improve the efficiency of ultrasonic cardiogram left ventricular segmentation, show a great role in the diagnosis of CHD patients, and provide a reliable theoretical basis and foundation research on the subsequent CHD imaging diagnosis. The comprehensive analysis showed that the U-Net model was more suitable for the practical application of echocardiographic automatic segmentation, and this study can effectively improve the efficiency of echocardiographic left ventricular segmentation, which played an important role in the diagnosis of coronary heart disease, providing a reliable theoretical basis and foundation for subsequent CHD imaging research.

Characterization of Degenerative Mitral Valve Disease: Differences between Fibroelastic Deficiency and Barlow's Disease.

Degenerative mitral valve disease causing mitral valve prolapse is the most common cause of primary mitral regurgitation, with two distinct phenotypes generally recognized with some major differences, i.e., fibroelastic deficiency (FED) and Barlow’s disease. The aim of this review was to describe the main histological, clinical and echocardiographic features of patients with FED and Barlow’s disease, highlighting the differences in diagnosis, risk stratification and patient management, but also the still significant gaps in understanding the exact pathophysiology of these two phenotypes.

Natural history and disease progression of early cardiac amyloidosis evaluated by echocardiography

Abstract Funding Acknowledgements Type of funding sources: None. Background Since the diagnosis of cardiac amyloidosis (CA) is often delayed, echocardiographic findings are frequently indicative of already advanced cardiomyopathy. Aims to describe early echocardiographic features in patients subsequently diagnosed with CA and to delineate disease progression. Methods Pre-amyloid diagnosis echocardiographic studies were screened for structural and functional parameters and stratified according to the pathogenetic amyloid subtype (immunoglobulin light-chain (AL) or amyloid transthyretin (ATTR)). Abnormalities were defined based on published guidelines. Results Our cohort included 75 CA patients of whom 42 (56%) were diagnosed with AL and 33 (44%) with ATTR. Forty-two patients had an earlier echocardiography exam available for review. Patients presented with increased wall thickness (1.3 (IQR 1.0, 1.5)cm) ≥3 years before the diagnosis of CA and relative wall thickness (RWT) was increased (0.47 (IQR 0.41, 0.50)) ≥7 years pre-diagnosis. Between 1 to 3 years before CA diagnosis restrictive left ventricular (LV) filling pattern was present in 19% of patients and LV ejection fraction (LVEF)≤50% was present in 21% of patients. Right ventricular dysfunction was detected concomitantly with disease diagnosis. The echocardiographic phenotype of ATTR versus AL-CA showed increased RWT (0.74 (IQR 0.62, 0.92) vs. 0.62 (IQR 0.54, 0.76), p = 0.004) and LV mass index (144 (IQR 129, 191) vs. 115 (IQR 105, 146)g/m2,p = 0.020) and reduced LVEF (50 (IQR 44, 58) vs. (60 (IQR 53, 60)%, p = 0.009) throughout the time course of CA progression, albeit survival time was similar. Conclusions Increased wall thickness and diastolic dysfunction in CA develop over a time course of several years and can be diagnosed in their earlier stages by standard echocardiography Abstract Figure. Schematic proposed timeline of CA

A study of etiology, clinical characteristics, electrocardiographic and echocardiographic findings in patients with cardiac tamponade in a tertiary care hospital in Western Odisha

Background: Cardiac tamponade is a life-threatening condition characterized by elevated intracardiac pressure, limitation of diastolic filling, and reduction of cardiac output and mostly requires urgent therapeutic intervention. Pericardial disease in on the rise attributed to improved survival of malignancy, growing no of cardiac interventions, chronic kidney diseases with dialysis, advent of modern chemo-radiotherapy. Still, there are paucity of data on etiology, clinical characteristics, electrocardiogram (ECG) and echocardiographic features in patients with cardiac tamponade from Odisha. Aim of this study was to emphasize the etiology, clinical characteristics, electrocardiographic and echocardiographic features in patients with cardiac tamponade.Methods: A prospective observational study of 1-year duration was undertaken for patients with cardiac tamponade admitted at VIMSAR, a cardiology unit. Data on etiology, clinical characteristics, Echocardiography, ECG findings were documented. Echo guided pericardiocentesis followed culture, cytological and biochemical analysis done.Results: Most common symptom was dyspnoea (88%), clinical signs were tachypnoea (96%), raised jugular venous pulse (64%), tachycardia (84%), pulsus paradoxus (60%). Classical beck’s triad was seen in 42% cases. X-ray showed cardiomegaly (94%) &amp; pleural effusion (64%). Common ECG findings were sinus tachycardia (84%), low voltage QRS (68%) and electrical alternans (44%). Echocardiography showed 80% and 68% of patients had right atrium collapse and right ventricle collapse respectively. Both inferior vena cava plethora and transmitral flow variation were seen in 88% of cases. 96% had normal left ventricle function. 80% had large effusion. Pericardiocentesis yield was mostly in between 500-1000ml (mean 908 ml) with 72% with haemorrhagic aspirate. All malignancy cases and 76% tubercular cases had haemorrhagic effusion. Most common etiology was tubercular (50%), followed by malignancy (28%). 6% remained idiopathic. chronic kidney disease, systemic lupus erythematosus, post MI intervention, hypothyroid were some of the other causes.Conclusions: Initial assessment with investigation and careful follow-up can yield a causal diagnosis in most cases. Early diagnosis and intervention by pericardiocentesis can be lifesaving.

Echocardiographic features of patients with COVID-19 infection: a cross-sectional study.

COVID-19 patients with cardiac involvement have a high mortality rate. The aim of this study was to investigate the echocardiographic features in COVID-19 patients between severe and non-severe groups. For this single-center study, data from patients who were treated for COVID-19 between March 25, 2020 and April 15, 2020 were collected. Two-dimensional echocardiography (2DE) images were obtained for all patients. Patients were divided into two groups based on the severity of their COVID-19 infections. 2DE parameters indicating right ventricular (RV) and left ventricular (LV) functions were compared between the two groups. A total of 90 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 63.3 ± 15.7 years, and 54% were male. The mean age of non-severe group (n = 46) was 49.7 ± 21.4 years, and 47% were male. In the severe group, RV and LV diameters were larger (RV, 36.6 ± 5.9 mm vs. 33.1 ± 4.8 mm, p = 0.003; LV 47.3 ± 5.8 mm vs. 44.9 ± 3.8 mm, p = 0.023), the LE ejection fraction (LVEF) and the RV fractional area change (RV-FAC) were lower (LVEF, 54.0 ± 9.8% vs. 61.9 ± 4.8%, p < 0.001; RV-FAC, 41.4 ± 4.1% vs. 45.5 ± 4.5%, p < 0.001), and pericardial effusions were more frequent (23% vs. 0%) compared to patients in the non-severe group. A multiple linear regression analysis determined that LVEF, right atrial diameter, high-sensitivity troponin I, d-dimer, and systolic pulmonary artery pressure, were independent predictors of RV dilatation. The results demonstrate that both right and left ventricular functions decreased due to COVID-19 infection in the severe group. 2DE is a valuable bedside tool and may yield valuable information about the clinical status of patients and their prognoses.

Natural History and Disease Progression of Early Cardiac Amyloidosis Evaluated by Echocardiography

Since the diagnosis of cardiac amyloidosis (CA) is often delayed, echocardiographic findings are frequently indicative of advanced cardiomyopathy. We aimed to describe early echocardiographic features in patients subsequently diagnosed with CA. Preamyloid diagnosis echocardiographic studies were screened for structural and functional parameters and stratified according to the pathogenetic subtype (immunoglobulin light-chain [AL] or amyloid transthyretin [ATTR]). Abnormalities were defined based on published guidelines. Our cohort included 75 CA patients of whom 42 (56%) were diagnosed with AL and 33 (44%) with ATTR. Forty-two patients had an earlier echocardiography exam available for review. Patients presented with increased wall thickness (1.3 [interquartile range {IQR} 1.0, 1.5] cm) ≥3 years before the diagnosis of CA and relative wall thickness was increased (0.47 [IQR 0.41, 0.50]) ≥7 years prediagnosis. One to 3 years before CA diagnosis restrictive left ventricular (LV) filling pattern was present in 19% of patients and LV ejection fraction ≤50% was present in 21% of patients. Right ventricular dysfunction was detected concomitantly with disease diagnosis. The echocardiographic phenotype of ATTR versus AL-CA showed increased relative wall thickness (0.74 [IQR 0.62, 0.92] versus 0.62 [IQR 0.54, 0.76], p = 0.004) and LV mass index (144 [IQR 129, 191] versus 115 [IQR 105, 146] g/m2, p = 0.020) and reduced LV ejection fraction (50 [IQR 44, 58] versus (60 [IQR 53, 60]%, p = 0.009) throughout the time course of CA progression, albeit survival time was similar. In conclusion, increased wall thickness and diastolic dysfunction in CA develop over a time course of several years and can be diagnosed in their earlier stages by standard echocardiography.

Myocardial injury in systemic lupus erythematosus according to cardiac magnetic resonance tissue characterization: clinical and echocardiographic features.

To determine the prevalence of myocardial injury (MInj) in systemic lupus erythematosus (SLE) according to cardiac magnetic resonance (CMR) criteria. To compare clinical and echocardiographic features of patients with and without MInj and identify predictors of myocardial tissue characteristics according to CMR. SLE inpatients underwent CMR screening for MInj based on the Lake Louise Criteria (LLC). Tissue characteristics included inflammation (increased T2-weighted signal or early gadolinium enhancement ratio (EGEr)) and necrosis or fibrosis (late gadolinium enhancement (LGE)). Echocardiographic parameters included left (left ventricular ejection fraction (LVEF)) and right ventricular function (tricuspid annular plane systolic excursion (TAPSE)), global longitudinal strain (GLS), wall motion score (WMSi) and left ventricular internal diameter index (LVIDi). Variables were compared with regards to the presence/absence of CMR criteria. Logistic regression identified variables predictive of CMR tissue characteristics. A hundred and six SLE patients were screened of whom 49 patients were included. Fifty-seven patients were excluded due to intolerance of or contraindication to CMR (27/57 due to renal impairment). Twenty-three patients had CMR evidence of MInj, of which 60.9% was subclinical. Inflammation occurred in 16/23 and necrosis/fibrosis in 12/23 patients. Patients with any evidence of MInj were more frequently anti-dsDNA positive (p = 0.026) and patients fulfilling LLC for myocarditis had higher SLE disease activity (p = 0.022). The LVIDi (p = 0.005), LVEF (p = 0.005) and TAPSE (p = 0.011) were more abnormal in patients with an increased EGEr, whereas WMSi (p = 0.002) and GLS (0.020) were more impaired in patients with LGE. On multivariable logistic regression analyses, TAPSE predicted inflammation (OR: 0.045, p = 0.006, CI: 0.005-0.415) and GLS predicted necrosis/fibrosis (OR: 1.329, p = 0.031, CI: 1.026-1.722). A model including lymphocyte count, TAPSE and LVIDi predicted an increased EGEr on CMR (receiver operating characteristic-curve analyses: area under the curve: 0.901, p < 0.001, sensitivity: 88.9%, specificity: 76.3%). CMR evidence of MInj frequently occurs in SLE and is often subclinical. The utility of CMR in SLE is limited by a high exclusion rate, mainly due to renal involvement. Models including echocardiographic parameters (TAPSE, LVIDi and GLS) are predictive of CMR myocardial injury. Echocardiography can be used as a cost-effective screening tool with a high negative predictive value, in particular when CMR is contraindicated or unavailable.

Echocardiographic Changes in Newly Diagnosed Type 2 Diabetes Mellitus Patients with and without Hypertension.

BackgroundWhether type 2 diabetes mellitus (T2DM) is independently associated with structural heart abnormalities is controversial because of confounders associated with T2DM. This study aimed to investigate echocardiographic features in patients with newly diagnosed T2DM, exploring changes in cardiac structure and function.Material/MethodsThis was a retrospective study of new T2DM cases treated at the Second People’s Hospital Affiliated to Nanjing Medical University (Changzhou) in 2014–2016. In all, 128 T2DM cases were included (62 hypertensive and 66 non-hypertensive individuals). Controls were selected among individuals who underwent examination at the same department/period. Interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), posterior left ventricular wall thickness (PWTD), left ventricle mass (LVM), end-diastolic thickness of left ventricular posterior wall (Dd), aortic root diameter, left atrial diameter (LAd), left atrial diameter fraction-shortening values, and left ventricular ejection fraction (LVEF) were determined routinely.ResultsIVST, LVEDD, PWTD, Dd, LAd, and left atrial diameter fraction-shortening values were larger in patients with T2DM (all P<0.05 vs. controls). LVM was higher in T2DM patients (median, 57.12 vs. 54.77 g, P=0.001). There were no differences in aortic root diameter and EF (both P>0.05). Multivariable analysis showed that IVST (OR=1.33, 95% CI: 1.01–1.76, P=0.04), LAd (OR=1.16, 95% CI: 1.07–1.25, P<0.001), TGs (OR=1.34, 95% CI: 1.09–1.63, P=0.005), and HDL (OR=1.46, 95% CI: 1.02–2.08, P=0.04) were independently associated with hypertension in patients with T2DM.ConclusionsPatients with newly diagnosed T2DM already display structural heart abnormalities. LAd and IVST are independently associated with hypertension in these patients, probably contributing to increased cardiovascular risk.

Short, medium and long-term results of a series of percutaneous mitral dilatation

Rheumatic mitral stenosis (MS) is a common valvulopathy in Tunisia. When tight, percutaneous mitral dilatation (PMD)is the treatment of choice in young subjects with favorable valvular anatomy. Describe clinical and echocardiographic features of patients with tight MS before and after short, medium and long-term of PMD. This is a retrospective, monocentrique, and a descriptive study of patients in our cardiology department between 2012 and 2018 who were hospitalized for PMD with MS. Ninety patients were identified. Age of discovery of MS:35 years(10 to 66),female predominance(68.88%)of which 8 were pregnant. TTE pre-dilatation showed: a mean mitral area (MA) at 1 cm 2 , the Average Transmitral Gradient (ATG) was 11.3 mmHg. Bi-commissural fusion in76.7%; Mitral insufficiency(MI) was minimal: 55.6%.75 patients had PAH with an average SPAP at 43.2 mmHg. The right cavities (RC) were dilated in 20%. After PMD success in 93.3%. Incidents were worsening of MI in 7 cases, newly created MI in 14 cases, pericardial effusion in 2 patients. TTE immediately after PMD showed: MA at 1.79 cm 2 (1.2 to 2.4 cm 2 ): an improvement of more than 50% in the initial MA. ATG became 5.46 mmHg, an average decrease of 4.8 mmHg. MI was not created or worsened in 76.6%. Both commissures were completely open in 65.5%. After 6 months of PMD: 60.7% of patients became asymptomatic, 31.1% remained dyspnea. Two patients had ischemic stroke. TTE at 6 months showed MA at 1.7cm 2 , SPAP decreased in all patients, PAH (which was present before PMD) disappeared in 38.9%.RC are no longer dilated in 14 patients. In the long term 33,3% remained asymptomatic, 54.8% developed dyspnea, 36.7% developed AF. The duration of surveillance was 5.5 years on average. Mitral restenosis was observed on 5 years after PMD in 55.7%. The attitude was to make a new PMD in 24.5%and a mitral valve replacement (MVR) for the other patients. PMD has a place in the treatment of MS but it should not be at the expense of MVR which has well its indications.