Echocardiographic Findings In Patients Research Articles

Is pulmonary hypertension protective against cardiac tamponade? A systematic review.

The presence of pulmonary hypertension (PH) may affect whether cardiac tamponade physiology develops from a pericardial effusion. Specifically, the increased intracardiac pressure and right ventricular hypertrophy associated with PH would seemingly increase the intrapericardial pressure threshold at which the right-sided chambers collapse. In this systematic review, we examined the impact of PH on the incidence, in-hospital and long-term mortality, and echocardiographic findings of patients with cardiac tamponade. Using the PRISMA guideline, a systematic search was conducted in PubMed, Academic Search Premier, Web of Science, Google Scholar, and the Cochrane Database for studies investigating PH and cardiac tamponade. The Newcastle-Ottawa Scale was used to analyze the quality of returned studies. Primary outcomes included the incidence of cardiac tamponade, as well as in-hospital and long-term mortality rates. Secondary outcomes were the presence or absence of echocardiographic findings of cardiac tamponade in patients with PH. Forty-three studies (9 cohort studies and 34 case reports) with 1054 patients were included. The incidence of cardiac tamponade was significantly higher in patients with PH compared to those without PH, 2.0% (95% CI 1.2-3.2%) vs. 0.05% (95% CI 0.05-0.05%), p < 0.0001, OR 40.76 (95% CI 24.8-66.9). The incidence of tamponade in patients with a known pericardial effusion was similar in those with and without PH, 20.3% (95% CI 12.0-32.3%) and 20.9% (95% CI 18.0-24.1%), p = 0.9267, OR 0.97 (95% CI 0.50-1.87). In patients with tamponade, those with PH demonstrated a significantly higher in-hospital mortality than those without PH, 38.8% (95% CI 26.4-52.8%) vs. 14.4% (95% CI 14.2-14.6%), p < 0.0001, OR 3.77 (95% CI 2.12-6.70). Long-term mortality in patients with tamponade was significantly lower in those with PH than in those without PH, 45.5% (95% CI 33.0-58.5%) vs. 59.1% (95% CI 54.7-63.4%), p = 0.0258, OR 0.576 (95% CI 0.33-1.01). However, after stratifying by non-malignant etiologies, the long-term mortality benefit for those with PH disappeared. In the studies that described specific echocardiographic findings of cardiac tamponade, only 10.5% of patients with PH and tamponade showed right atrial and right ventricular collapse. When evaluating patients with pericardial effusions, physicians must recognize the effects of underlying PH on the incidence, in-hospital and long-term mortality rates, and potentially atypical echocardiographic presentation of cardiac tamponade.

Subclinical atrial fibrillation in embolic stroke of undetermined source: Management and stroke recurrence

Subclinical atrial fibrillation (SAF) represents the most prevalent underlying etiology detected after an embolic stroke of undetermined source (ESUS). Investigating SAF is strongly recommended during the diagnostic work-up. The efficacy of oral anticoagulant (OAC) therapy in reducing the risk of stroke recurrence post-SAF detection remains a conundrum. Thus, our study aimed to analyze the management of secondary antithrombotic prophylaxis and the rate of 12-month stroke recurrence in real-life ESUS patients. We retrospectively analyzed clinical, radiographic, and echocardiographic findings of patients with ESUS who underwent non-implantable 2-week electrocardiogram (ECG) monitoring after discharge. Episodes of SAF of any duration were considered diagnostic. Antithrombotic treatment at hospital discharge and after ECG monitoring, as well as 12-month recurrence, were registered. We compared the rate of stroke recurrence between patients with and without detection of SAF. One hundred and fifty-nine patients (75 females) with a median age of 73.5 (interquartile range [IQR] = 66.75 &amp;ndash; 79) years represented the study population. At hospital discharge, 96.9% of patients received antiplatelet therapy as secondary antithrombotic prophylaxis. SAF was detected in 82 patients (51.5%), and OAC was prescribed in 98.6% of them. The median time from stroke onset to OAC prescription was 143 (IQR = 94 &amp;ndash; 178) days. Overall, 12-month stroke recurrence occurred in eight patients (5%). The stroke recurrence rate was lower in patients prescribed OAC compared with those not prescribed it, although the difference was not significant (3.7% vs. 6.25%; P = 0.7202). In our study, OACs prescribed post-SAF detection in patients with ESUS reduced, but not significantly, the risk of stroke recurrence. Future research and prospective multicenter studies are warranted.

Longitudinal Cardiac Evaluation of Children with Multisystem Inflammatory Syndrome (MIS-C) Following COVID-19 by Conventional and Speckle-Tracking Echocardiography

Multisystem inflammatory syndrome in children (MIS-C), is a rare but severe, hyperinflammatory complication of COVID-19, in which cardiovascular abnormalities are frequently detected. In this prospective study, we describe the echocardiographic findings in patients with MIS-C, with the use of conventional Echocardiography and Speckle-Tracking Echocardiography (STE) with Left Ventricular (LV) Global Longitudinal Strain (GLS) analysis, in the acute and follow-up phase. In total, 25 MIS-C patients [64% females, mean (± SD) age: 8.3 (± 3.72) years] were included. In the acute phase, median (IQR) Troponin and NT-proBNP and mean heart rate, were 8.07 (14.52) pg/mL, 2875.00 (7713.00) pg/mL, and 102.87 (± 22.96) bpm, respectively. Median (IQR) LV Ejection Fraction (LVEF) was 66 (8)% and LVEF impairment was detected in 2/25 (8%) patients. On follow-up (mean time interval:9.50 ± 4.59 months), heart rate was significantly lower, with a mean value of 90.00 (± 14.56) bpm (p-value = 0.017). Median (IQR) LVEF was 66.00 (6.70)% (p-value = 0.345) and all 25 participants had normal LVEF. In 14/25 patients, additional LV-GLS analysis was performed. During the acute phase, mean LV-GLS was − 18.02 (± 4.40)%. LV-GLS was abnormal in 6/14 patients (42.9%) and among them, only one patient had reduced LVEF. On follow-up (median (IQR) time interval:6.93 (3.66) months), mean LV-GLS was -20.31 (± 1.91)% (p-value = 0.07) and in 1/14 patient (7.1%), the LV-GLS impairment persisted. In conclusion, in the acute and follow-up phase, we detected abnormal LV-GLS values in some patients, in the presence of normal LVEF, indicating that STE-GLS is a valuable tool for identifying subclinical myocardial injury in MIS-C.

Assessment of echocardiographic findings in patients of hypertension

Background: Long-term hypertension is a substantial risk factor for coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease. Not only is echocardiography the most adaptable imaging technique for the cardiovascular system but it is also the most comprehensive and dependable hemodynamic tool. Aim and Objective: The purpose of this study was to analyze echocardiographic results in hypertensive patients. Material and Methods: It was a cross-sectional study of hypertension patients admitted to the medicine wards of the civil hospital connected to the P.D.U. Government Medical College in Rajkot, Gujarat, India. After considering inclusion and exclusion criteria, hypertensive patients were chosen at random for enrollment in the study. A total of 50 patients with hypertension were investigated. A skilled cardiologist performed the echocardiographic examinations. To simplify the observations made in the study, patients were separated into four groups based on their wall motion score. Results: The number of patients with systolic blood pressure of 169–179 mmHg was 32% (16 patients), while the number of patients with 140 mmHg was 18% (9 patients). Systolic blood pressure of 140–159 mmHg has 28% (14 patients) and more than 180 mmHg has 22% (11 patients). The most prevalent diastolic hypertension group had 22 patients (44%), and it was also the most common group among both sexes. Males had 12 patients with 90–90 mmHg and females had 10 individuals with 90–99 mmHg. Out of 50 hypertension patients, 21 (42%) had aberrant regional wall motion, while the remaining patients had no abnormal regional wall motion. In terms of diastolic function, 42 of 50 patients (84%) had diastolic dysfunction. Conclusion: Echocardiography is a valuable tool for assessing the consequences of hypertension in patients. It is also a widely and most regularly utilized imaging modality in cardiology practice due to its non-invasiveness and ease of access.

Study of echocardiography findings in patients with type II diabetes mellitus

Study of echocardiography findings in patients with type II diabetes mellitus

Echocardiography Findings in Amniotic Fluid Embolism: A Systematic Review of the Literature

(Can J Anesth/J Can Anesth. 2023;70:151–160) Amniotic fluid embolism (AFE) is a rare obstetric complication with a mortality rate ranging 20% to 60%. The pathophysiology of AFE is not well-defined. This study aimed to define the echocardiography findings in patients who suffer from AFE.

The impact of coronary revascularization on coronary flow capacity assessed by serial transthoracic echocardiographic findings in patients with chronic coronary syndrome

Abstract Background Coronary flow capacity (CFC) integrates quantitative hyperaemic myocardial blood flow and coronary flow reserve (CFR) to comprehensively assess physiological severity of coronary artery disease. This study evaluated the effects of revascularization (PCI) on CFC assessed by serial transthoracic doppler echocardiography (TDE) examinations before and after elective PCI. Methods A total of 177 patients with chronic coronary syndrome underwent stress TDE examinations of left anterior descending arteries (LAD) before and after PCI to assess changes in CFC. Resting and hyperemic diastolic peak velocity (hDPV) was used to calculate CFR. Using previously reported thresholds for ischemia and normal perfusion, vessels were stratified in four CFC categories: severely reduced, moderately reduced, minimally reduced CFC, and normal flow. The association between CFC increase and pre-procedural TDE parameters was studied. Results After PCI, fractional flow reserve (FFR) values improved in all cases (0.70, (0.62 - 0.74), P &amp;lt; 0.001), although 74 cases (41.8%) showed CFC decrease. Pre-PCI lower FFR, lower resting Pd/Pa, lower CFR, and lower hDPV were significant predictors for CFC increase after PCI. Lower baseline CFC, particularly in ischemic CFC defined as a composite of moderately, and severely reduced CFC was a predictor of CFC increase (P &amp;lt; 0.01). On multivariable analysis, pre-PCI lower hDPV, and pre-PCI ischemic CFC were independent factors predicting CFC-improvement, while pre-PCI wire-based physiological data including FFR were not significantly associated with CFC improvement. Conclusions About a half of successful LAD PCI resulted in an increase in CFC. Preprocedural TDE-derived parameters including hDPV and CFC may help identification of lesions that benefit from revascularization with respect to an increase in coronary flow capacity. Further studies are needed to elucidate the effect of CFC improvement on prognosis.Effect of preprocedural CFC after PCI

Clinical and echocardiographic findings in patients with COVID-19 across different severity levels.

Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.

Clinical and genetic predictors of cardiac dysfunction assessed by echocardiography in patients with hereditary hemochromatosis.

Hereditary hemochromatosis (HH) may cause iron deposition in cardiac tissue. We aimed to describe the echocardiographic findings in patients with HH and identify risk factors for cardiac dysfunction. In this retrospective study, we included patients with HH who underwent transthoracic echocardiography at our tertiary care center between August 2000 and July 2022. We defined three primary outcomes for cardiac dysfunction: 1) left ventricular ejection fraction (LVEF) < 55%, 2) ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e') > 15, and 3) global longitudinal strain (GLS) < 18. Multivariable logistic regression was utilized to identify predictors of cardiac dysfunction. 582 patients (median age 57 years, 61.2% male) were included. The frequency of LVEF < 55%, E/e' > 15 and GLS < 18 was 9.0% (52/580), 9.6% (51/534) and 20.2% (25/124), respectively. In multivariable analysis, non-White race, age, and hypertension were associated with E/e' > 15. No specific HFE genetic mutation was associated with LVEF < 55%. A history of myocardial infarction was strongly associated with both LVEF < 55% and E/e' > 15. In patients with LVEF ≥ 55%, the C282Y/H63D genetic mutation was associated with reduced likelihood of E/e' > 15, p = 0.024. Patients with C282Y/H63D had a higher frequency of myocardial infarction. Smoking and alcohol use were significantly associated with GLS < 18 in unadjusted analysis. We found the traditional risk factors of male sex, and history of myocardial infarction or heart failure, were associated with a reduced LVEF, irrespective of the underlying HFE genetic mutation. Patients with a C282Y/H63D genetic mutation had a higher frequency of myocardial infarction, yet this mutation was associated with reduced odds of diastolic dysfunction compared to other genetic mutations in patients with a normal LVEF.

Associations between ECG Changes and Echocardiographic Findings in Patients with Acute Non-ST Elevation Myocardial Infarction

Background: STEMI shows specific ECG changes due to sudden coronary blockage, but NSTEMI has varied ECG characteristics, including ST depressions and T wave inversions. Echocardiography, especially tissue Doppler imaging and speckle tracking, is crucial for diagnosing and predicting outcomes in acute coronary syndrome. The study aims to correlate ECG changes with echocardiographic findings in NSTEMI, offering potential diagnostic insights. Objective: The study aims to connect ECG alterations with echocardiographic findings in NSTEMI patients. Methods and Materials: This cross-sectional study took place from January to June 2023 at a Mymensingh Medical College Hospital, Mymensingh, Bangladesh. The research included 109 NSTEMI patients, both with and without cardiac history. Inclusion criteria were age above 30 and ischemic type of chest pain. Results: Out of 109 admitted patients, 67.4% were male and 6.4% were female. The average age was 54.34 ± 2.31 years, and prevalent conditions included 7.3% with diabetes, 11% with dyslipidemia, and 0.9% with edema, while 73% had a family history of ischemia. Conclusion: There were inconsistencies between the ECG and Echo in identifying the site of the infraction in the MI patients. Pulmonary hypertension, infection, ischemic stroke, and inferonasal regional wall motion abnormalities. Maximum no association was found in ECG changes and echocardiographic findings with acute non-ST elevation myocardial infarction.

The Impact of Ejection Fraction on Major Adverse Limb Events after Lower Extremity Revascularization

Peripheral arterial disease (PAD) is commonly associated with coronary artery disease, and echocardiography is frequently performed before lower extremity revascularization (LER). However, the incidence of various echocardiographic findings in patients with PAD and their impact on the outcomes of LER has not been well studied. Reduced ejection fraction (EF)≤40% is associated with increased major adverse limb events (MALE) after LER. The electronic medical records of patients undergoing LER in a single center were reviewed. Patients were divided based on the presence or absence of reduced EF. Patient, transthoracic echocardiogram, procedural characteristics, and outcomes were compared between the 2 groups. A total of 1,114 patients (N=131, 11.8% with reduced EF) underwent LER between 2013 and 2019. Patients with reduced EF were more likely to be male and have a history of coronary artery disease and heart failure. Furthermore, they were more likely to have diastolic dysfunction with moderate to severe mitral and tricuspid valve regurgitation. Patients with reduced EF were more likely to undergo LER for chronic limb-threatening ischemia, and to be treated with endovascular procedures. Perioperatively, patients with reduced EF were more likely to develop myocardial infarction. Lastly, the 2 groups had no difference in overall MALE or major amputation. However, on Kaplan-Meier curves, MALE-free survival was significantly lower for patients with reduced EF. Regression analysis demonstrated that indication and not EF was associated with MALE and MALE-free survival. Reduced EF is associated with decreased MALE-free survival for patients with PAD undergoing LER.

COMPARATIVE ANALYSIS OF THE FINDINGS OF CT ANGIOGRAPHY AND ECHOCARDIOGRAPHY IN AORTIC ARCH ANOMALIES

The retrospective study was conducted in the Department of Cardiology Nishtar Medical Hospital Multan from January 2021 to January 2022 to compare CT angiography and echocardiography findings in patients with aortic arch abnormalities. The study was conducted on a total of 200 patients. Patient data was recorded, including demographic details and CT angiographic and echocardiographic findings. Results showed that Anomalies of coarctation of the aorta (COA) were most commonly reported. The most common anomalies associated with aortic arch anomaly included patent ductus arteriosus (PDA), patent ductus arteriosus (PDA), and ventricular septal defect (VSD). Of 200 patients, 66 (33%) had normal CT results, while 64 (32%) had normal transthoracic ECG results. For aortic arch anomalies, the specificity and sensitivity of TEC were 100% and 58%, and the agreement between CT angiography and TEC was .72 (Kappa coefficient). For COA, the specificity and sensitivity of TEC were 100% and 90%, and agreement in both modalities was 0.93. Transthoracic echocardiography was unable to detect congenital anomalies in a few cases. CT angiography provides better imaging quality and anatomical coverage and can be used to improve diagnostic accuracy.

Diagnostic Accuracy of Transesophageal Echocardiographic Commissural-Biplane Approach in Identifying Mitral Valve Anatomy

Transesophageal echocardiography (TEE) conventional multiplane approach (MPA) and the newly proposed commissural-biplane approach (CBA) are the recommended algorithms for identifying the affected mitral valve (MV) segments in the setting of mitral regurgitation. To date, there are no reports to address the diagnostic performance of CBA. In this study we aim to analyze the diagnostic accuracy of CBA and MPA in comparison with three-dimensional echocardiographic findings in patients with severe mitral regurgitation. We prospectively enrolled 102 patients with severe mitral regurgitation. All patients underwent systematic TEE assessment of MV before surgical intervention to define the affected MV segments/scallops. The standard MPA includes 4-chamber, 2-chamber, long-axis, and commissural views; CBA was performed by obtaining the bicommissural view and simultaneous biplane imaging of the medial, middle, and lateral MV aspects. The findings of both TEE approaches were compared with three-dimensional TEE data to assess the diagnostic accuracy of MPA and CBA. The mean patient age was (65±11) years, and 37 (36.3%) were female. We found that CBA had an overall diagnostic accuracy between 88% and 97% in identifying the abnormal MV scallops; in contrast, MPA accuracy ranged between 82% and 95%. The CBA and MPA were the least accurate in identifying the P3 scallop-88% and 82% respectively; however, both were the most accurate in assessing the A2 segment-95% and 97%, respectively. The sensitivity of identifying commissural abnormalities was 80% with CBA and 30% with MPA. Three-dimensional TEE was found to have a strong agreement with CBA (averaged kappa of 0.81, P<.0001) and a modest agreement with MPA (averaged kappa of 0.61, P<.0001) in identifying abnormal anterior or posterior segments. On the other hand, three-dimensional TEE had a weak agreement with CBA (kappa of 0.43, P<.0001) and no agreement with MPA (kappa of 0.14, P=.153) in the assessment of commissural involvements. The CBA is more accurate than the MPA in the assessment of MV commissural involvement. Given the accuracy differences of the 2 approaches for specific leaflet/scallops, a comprehensive evaluation using both approaches is recommended for all MV scallop assessments.

Prognostic echocardiographic findings in patients supported with venoarterial extracorporeal membrane oxygenation for cardiogenic shock.

Echocardiography is critical in the management of patients supported with veno-arterial extracorporeal membrane oxygenation (V-A ECMO). This study aimed to identify the incidence of critical echocardiographic findings and determine their prognostic significance. All available echocardiograms, hemodynamic variables and outcomes of patients with CS supported with V-A in the period of 2011-2018 at the Toronto General Hospital were retrospectively reviewed. Critical echocardiographic findings were defined as minimal to no left ventricular (LV) ejection, the presence of intra-cardiac clot, significant pericardial effusion and malpositioning of ECMO cannulae. 130 patients were included in this study with in-hospital mortality of 58.5%. Critical findings were most often seen in the first echocardiogram (42/121; 35%). The incidence of critical findings in the first echocardiogram was minimal to no LV ejection in 28 patients (23%), intracardiac thromboses in 8 patients (6.6%), tamponade in 5 patients (4%) and malpositioned cannulae in 1 patient (0.8%). Presence of a critical finding in the first study was associated with an odds ratio for in-hospital mortality of 2.32 (95% CI 1.01-5.06, P = 0.011). The initial echocardiogram was most likely to demonstrate a critical finding of which the most common was minimal to no LV ejection. Critical echocardiographic findings carried prognostic significance for in-hospital mortality.

(538) Echocardiographic Findings in Patients with Methamphetamine Cardiomyopathy

(538) Echocardiographic Findings in Patients with Methamphetamine Cardiomyopathy

Association of Left Ventricular Systolic Function with Diagonal Branch Flow in Patients with First Anterior ST-Elevation Myocardial Infarction Treated with Primary Angioplasty

Background: There are few studies about the impact of diagonal branch blood flow on echocardiographic findings in patients with first acute anterior myocardial infarction undergoing primary angioplasty. Objectives: We aimed to compare left ventricular systolic function measures in patients with first acute anterior ST-segment elevation myocardial infarction (STEMI) treated with primary angioplasty based on diagonal branch blood flow after the procedure. Methods: This study was a single-center study that enrolled patients with their first acute anterior STEMI treated with primary angioplasty in our center between October 2020 and March 2021. Patients were divided into two groups: The patients with final thrombolysis in myocardial infarction (TIMI) flow III in diagonal (sufficient diagonal flow) and patients with final TIMI flow less than III in diagonal (insufficient diagonal flow) after the procedure. The left ventricular Wall-Motion Score Index (WMSI) and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: A total of 107 patients with first anterior STEMI treated with primary PCI were enrolled in the present study, of which 13 patients (12.1%) had insufficient diagonal flow after primary coronary angioplasty. The LVEF was lower in patients with insufficient diagonal flow (32.92 ± 7.29% vs. 39 ± 8.68%, P = 0.018). Also, this group had higher LV WMSI (1.68 ± 0.28 vs. 1.49 ± 0.26, P = 0.029). Conclusions: The present study showed that in patients with first acute anterior STEMI undergoing primary angioplasty, insufficient diagonal branch flow after the procedure was associated with worse left ventricular systolic function and higher LV WMSI.

Abnormal right ventricular echocardiographic findings in recovered patients associated with severe acute respiratory syndrome in COVID-19.

Right ventricular (RV) echocardiographic changes such as dilation or systolic dysfunction, and pulmonary arterial hypertension were observed in patients with COVID-19. The aim of our study was to determine the frequency of RV echocardiographic changes in patients who have recovered from COVID-19 and to verify the association between severe acute respiratory syndrome (SARS) and echocardiographic findings. Patients who had recovered from COVID-19 undergoing outpatient follow-up underwent transthoracic echocardiography, and based on the findings, were divided into two groups: normal and abnormal. It was then verified whether there is an association between SARS and RV echocardiographic abnormalities in recovered patients. The study included 61 patients, with a mean age of 54.2±12.0 years, 57.4% had presented with SARS. The mean period of time between COVID-19 and the echocardiographic examination was 11.9±7.0 months. Patients presented normal left ventricular systolic function. The frequency of RV echocardiographic changes in patients who had recovered from COVID-19 was 44.3%. RV systolic dysfunction was identified in 31.1%, followed by ventricular dilation in 14.7% and pulmonary hypertension in 9.8%. An association was observed between SARS and RV echocardiographic changes in recovered patients during outpatient follow-up (OR: 4.96; 95% CI: 1.37-17.9; p=0.015). An association was also demonstrated between SARS and RV dilation (p=0.007) and between SARS and systolic dysfunction (p=0.028). SARS is a risk factor for abnormal RV echocardiographic findings in patients recovered from COVID-19.

Echocardiography findings in amniotic fluid embolism: a systematic review of the literature.

Amniotic fluid embolism (AFE) is a leading cause of obstetrical cardiac arrest and maternal morbidity. The pathogenesis of hemodynamic collapse is thought to be from right ventricular (RV) failure; however, there is a paucity of data documenting echocardiography findings in this population. We undertook a systematic review of the literature to evaluate the echocardiography findings in patients with AFE. We retrieved all case reports and case series reporting AFE in Embase and MEDLINE from inception to 20 November 2021. Studies reporting AFE diagnosed by fulfilling at least one of three different proposed AFE criteria and echocardiography findings during hospitalization were included. Patient and echocardiographic data were retrieved, and univariate logistic regression analysis was performed for outcomes of interest. Bias was assessed using the Joanna Briggs Institute clinical appraisal tool for case series. Eighty publications reporting on 84 patients were included in the final review. Fifty-five out of 82 patients with data (67%) showed RV dysfunction, including 11/82 (13%) with biventricular dysfunction; 14/82 (17%) had normal systolic function. No data on RV or left ventricular function were reported for two patients. The presence of RV dysfunction on echocardiography was associated with cardiac arrest (odds ratio [OR], 3.66; 95% confidence interval [CI], 1.39 to 9.67; P = 0.009), and a composite risk of cardiac arrest, maternal death or use of extracorporeal membrane oxygenation (OR, 3.86; 95% CI, 1.43 to 10.4; P = 0.007). A low risk of bias was observed in 15/84 (18%) cases. Right ventricular dysfunction on echocardiography is a common finding in AFE and is associated with a high risk of cardiac arrest. The finding of RV dysfunction on echocardiography may help diagnose AFE and help triage the highest risk patients with AFE. PROSPERO (CRD42021271323); registered 1 September 2021.

Electrocardiographic and Echocardiographic Findings of Patients With Non-hemorrhagic Stroke

Background: Stroke is a significant cause of morbidity and mortality worldwide. The association between non-hemorrhagic stroke and some electrocardiographic and echocardiographic findings shows its potential cardiac source. This study aimed to evaluate electrocardiographic and echocardiographic findings of patients with non-hemorrhagic stroke. Methods: This cross-sectional study included 134 patients with non-hemorrhagic stroke admitted to the neurology ward of Shahid Mohammadi hospital, Bandar Abbas, Iran, from 2018 to 2019. Patients’ characteristics including age, gender, family history of stroke, diabetes, hypertension, dyslipidemia, inadequate physical activity, and smoking were recorded. All patients underwent electrocardiography (ECG) and echocardiography. Results: The patients’ mean age was 68.57±12.08 years. Additionally, 84 patients (62.7%) were male. The most common risk factor was dyslipidemia (72.4%) followed by hypertension (64.9%), diabetes (45.5%), smoking (44.8%), and family history of stroke (17.2%). Inadequate physical activity was found in 69.4% of the patients. The most common ECG finding was old myocardial infarction (MI) accounting for 24.6% of the patients, followed by atrial fibrillation (AF) (14.9%) and new MI (3.7%). The most common echocardiographic finding was significant mitral regurgitation (MR) (23.1%), followed by left ventricular systolic dysfunction (21.6%), significant tricuspid regurgitation (TR) (11.2%), mitral stenosis (MS) (4.5%), aortic stenosis (AS) (4.5%), and mitral annulus calcification (MAC) (2.2%). Conclusion: The most common echocardiographic and ECG findings of patients with non-hemorrhagic stroke in this study were MR and old MI and the most common risk factor was dyslipidemia.

Echocardiographic findings in patients with tetralogy of fallot prior to total corrective surgery admitted at a tertiary care hospital.

Objective: To find out echocardiographic findings in patients with tetralogy of Fallot (TOF) prior to total corrective surgery admitted at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatric Cardiology, National Institute of Cardiovascular Disease, Karachi. Period: January 2021 to December 2021. Material &amp; Methods: A total of 197 echocardiography confirmed TOF cases of both genders and age up to any years were included. Physical examination, chest radiography and electrocardiogram were done in each patient prior to transthoracic echocardiography (TTE) using Toshiba Aplio i600 using 5 Hz and 6 Hz transducers. Standard protocols were followed in all TTE procedures. Results: In a total of 197 patients with TOF, there were 121 (61.4%) male. Mean age was 8.36±10.12 years. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in 30 (15.2%) cases. Thickened and domed pulmonic valve was the most common pulmonary valvular anomaly noted in 89 (45.2%). Associated “atrial septal defect (ASD)” was observed in 47 (23.9%) cases while “patent ductus arteriosus (PDA)” was seen in 83 (42.1%) patients. History of past “Blalock and Taussig (BT) Shunt” performed was found in 20 (10.2%) cases, out of which, 15 were functioning. Conclusion: Echocardiography is an inexpensive and safe approach to cardiac evaluation among patients of tetralogy of fallot. Hypoplastic pulmonary arteries was the most frequent pulmonary artery abnormality observed in tetralogy of Fallot patients. PDA was the most frequent associated abnormality followed by associated ASD.