Incidence Of Cardiac Abnormalities Research Articles

Symptom burden, coagulopathy and heart disease after acute SARS-CoV-2 infection in primary practice

SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study aimed to investigate symptom burden and incidence of cardiac abnormalities after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 and to correlate these results with biomarkers of immunological response and coagulation. SETANTA was a prospective, single-arm observational cross-sectional study condcuted in a primary practice setting, and prospectively registered with ClinicalTrials.gov (identifier: NCT04823182). Patients with recent COVID-19 infection (≥ 6 weeks and ≤ 12 months) were prospectively enrolled. Primary outcomes of interest were markers of cardiac injury detected by cardiac magnetic resonance imaging (CMR), which included left ventricular ejection fraction, late gadolinium enhancement and pericardial abnormalities, as well as relevant biomarkers testing immunological response and coagulopathy. 100 patients (n = 129 approached) were included, amongst which 64% were female. Mean age of the total cohort was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% of participants had at least one persistent symptom, while 96% had positive serology for prior SARS-CoV-2 infection. Late gadolinium enhancement, pericardial effusion, was present in 2.2% and 8.3% respectively, while left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients and Fibrinogen and D-Dimer levels were found to be elevated in 10.2% and 11.1% of patients, respectively. In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on CMR compared with prior reports of patients assessed in a hospital setting.Trial Registration: Clinicaltrials.gov, NCT04823182 (prospectively registered on 30th March 2021).

Symptom burden, coagulopathy and heart disease, and quality of life at baseline and after 1-year follow-up following acute SARS-CoV-2 infection in a community medicine setting

Abstract Introduction Several studies assessing the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 on myocardial tissue through the medium of cardiac magnetic resonance (CMR) imaging have been published. These studies have generally been small or have focused on specific populations. The prevalence and severity of heart disease and coagulopathy in a community setting following recovery from severe COVID-19 infection are not well characterised. Purpose The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study was to investigate symptom burden and incidence of cardiac abnormalities after recovery from COVID-19 infection and correlate these results with immunological response, biomarkers of coagulation and quality of life. Methods The SETANTA study was a prospective, single-arm, cross-sectional study conducted in a community medicine setting. Patients with recent COVID-19 infection ≥ 6 weeks and ≤ 12 months before enrolment were enrolled. Primary outcomes of interest and inclusion/exclusion criteria are summarised in Figure 1. Results 100 patients were included in the study, 64% were female. Mean age was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% had at least one persistent symptom. 96% had positive serology for prior SARS-CoV-2 infection. CMR results are summarised in Figure 1. Late gadolinium enhancement and pericardial effusion was present in 2.2% and 8.3% respectively; left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients. Fibrinogen and D-Dimer levels were raised in 10.2% and 11.1% of patients, respectively. In total 99, 100 and 97 patients completed their 1, 6 and 12-month telephone follow-ups respectively. There were no significant serious adverse events reported at 6-months follow-up; one case of hospitalization for 7 nights for fever of unknown origin was reported at 12 months. All 100 patients completed their modified version of SAQ7 (Seattle Angina Questionnaire, short form) and EQ-5D-5L (EuroQol 5-dimension 5 level) questionnaires at baseline, while 75 and 72 patients, respectively, completed both their questionnaires at 6- and 12-month follow-up timepoints; responses are displayed as Figure 2 (SAQ7 as Panel A, and EQ-5D-5L as Panel B) and show improvement over time in terms of symptoms as well as quality of life though the follow-up period. Conclusions In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on cardiac MRI compared with prior reports of patients assessed in a hospital setting. Symptom burden improved over time and there were no major adverse events during follow-up to 1 year.Figure 1.Figure 2.

Study of cardiac function in adults with dengue

Background: Medical literature has reports of isolated cases of atrioventricular conduction disorders, supraventricular arrhythmias, and myocarditis in dengue fever (DF). There is a paucity of data available in the published literature on the cardiac manifestations of DF from India. The aim of the present study was to assess the cardiac manifestations of DF. Methods: The 140 patients aged ≥18 years with DF confirmed with a serology-dengue non-structural protein 1 antigen-positive were included for this prospective observational study. Three serial ECGs were taken on day one, day three and day seven or day of discharge. All the patients were evaluated using 2D echo on day one, day seven or day of discharge. The primary outcome measures were to find the incidence and type of echocardiographic abnormalities and electrocardiographic changes in dengue.Results: The incidence of cardiac abnormalities on ECG and 2D echo was 30 (21.4%), and 5 (7.0%) respectively. On ECG, 14 (10%) 9 (6.4%) 3 (2.1%) 3 (2.1%) and 1 (0.7%) patients had sinus bradycardia, sinus tachycardia, non-specific ST-T changes, right bundle branch block and atrio-ventricular block on ECG respectively. On 2D echo, 7 (5.0%), 5 (3.6%) and 1 (0.7%) patient had systolic dysfunction, ejection fraction (<45.0%) and diastolic dysfunction respectively.Conclusions: The incidence of cardiac abnormalities on ECG and 2D ECHO in dengue patients was considerable. ECG and 2 D echo should be undertaken in patients with DF.

The Relationship between Abnormal Echocardiography Findings in Fetus with Small Gestational Age

Background: Intrauterine growth restriction (IUGR), refers to a condition in which the fetus does not grow well according to its genetic potential. Development of the cardiovascular system and impairing fetal developmental planning ultimately caused long-term cardiovascular morbidity. In the present study, the incidence of cardiac abnormalities in fetuses affected by IUGR as well as factors related to the occurrence of these abnormalities were evaluated.
 
 Material and Methods: In this descriptive-analytical study, pregnant women referred to the Imam Khomeini Hospital in Ahvaz during February 2018 to January 2020 were recruited. Complete clinical information was recorded using a questionnaire. The recorded information included age, birth weight, gestational age, weight and BMI and comorbidities. Then, echocardiographic data; structural abnormalities including septal condition, valves and outflow of large arteries, and the presence of mass or oxygen in the heart and pulmonary arteries, EF and HR, were extracted from the medical records.
 
 Results: In the present study, 152 patients were studied. The mean age of patients was 28.2 ranged from 17- to 40year. Fetal echocardiography showed that nearly 60% of fetuses had heart abnormalities. The most common disease was ventricular septal defect (VSD) (n = 21,13.8%), followed by atrial septal defec(ASD) (n = 15,9.9%) and concurrent ASD and VSD was observed in of 11.2% cases (n = 17). The incidence of echocardiographic abnormalities in IUGR fetuses was significantly higher than in SGA (p = 0.0001). However, the type of IUGR did not have a significant relationship with the incidence of echocardiographic findings in terms of time of performance (Early or late). Among the Doppler ultrasound factors, uterine artery PI (p = 0.001) and umbilical artery PI (p = 0.008) were associated with fetal heart abnormalities.
 
 Conclusion: In general, the findings of this study showed that the incidence of heart disorders in IUGR fetuses is high and is related to the severity of fetal growth restriction. Cardiac abnormalities are more common in IUGR fetuses than in SGA. Our results have also shown that the umbilical artery PI and uterine artery PI can be used as predictive factors in diagnosing fetal heart abnormalities. Our findings suggest an evaluation of echocardiography in IUGR fetuses.

Ondansetron Use in Pregnancy and Birth Defects: A Systematic Review.

To examine the risk of birth defects in children born to women who used ondansetron early in pregnancy for nausea and vomiting of pregnancy or hyperemesis gravidarum. PubMed, EMBASE, Cochrane, Scopus, Web of Science, Journals@Ovid Fulltext, ClinicalTrials.gov, and Google Scholar databases. Studies were included for review if they were written in English, included a comparison population of patients not exposed to ondansetron, and reported human data, original research, exposure to ondansetron during the first trimester, and structural birth defects as an outcome. A total of 423 records were identified. After accounting for duplicate records and including only relevant articles, a total of eight records met criteria for review. Data from the various studies were conflicting: whereas the three largest studies showed no increased risk of birth defects as a whole (36 malformations, 1,233 exposed compared with 141 malformations and 4,932 unexposed; 58/1,248 exposed compared with 31,357/895,770 unexposed; and 38/1,349 exposed compared with 43,620/1,500,085 unexposed; with odds ratios [ORs] of 1.12 (95% confidence interval [CI] 0.69-1.82), 1.3 [95% CI 1.0-1.7], and 0.95 [95% CI 0.72-1.26], respectively), two of these studies demonstrated a slightly increased risk of cardiac defects specifically (OR 2.0 [95% CI 1.3-3.1] and 1.62 [95% CI 1.04-2.14]), a finding that was not replicated in other studies. The most consistent association (if any) appears to be a small increase in the incidence of cardiac abnormalities, the bulk of which are septal defects. The overall risk of birth defects associated with ondansetron exposure appears to be low. There may be a small increase in the incidence of cardiac abnormalities in ondansetron-exposed neonates. Therefore, ondansetron use for nausea and vomiting of pregnancy should be reserved for those women whose symptoms have not been adequately controlled by other methods.

Spectrum of pregnancy with heart diseases in Menoufia governorate

Objective: The aim of this study was to assess the spectrum of pregnancy with heart diseases in Menoufia governorate. Background: Heart diseases during pregnancy are the leading indirect cause of maternal death worldwide.Although the incidence of cardiac abnormalities during pregnancy has remained more or less unchanged, the relative contribution of the different causes of heart disease preceding or diagnosed during pregnancy varies with study population and study period. Patients and methods: This is a cross-sectional study of pregnant women with heart disease who underwent delivery between January 2012 and January 2013 at University Hospital and Shebin El Kom Teaching Hospital (Menoufia, Egypt). Maternal and fetal outcome and complications were evaluated for each patient. Results: The overall prevalence of pregnant women with heart disease was 9.3%. Hypertensive disorders during pregnancy were the most common cardiac disease diagnosed in our study (83%); native and prosthetic valvular heart diseases were present in 10 and 1.1%, respectively, whereas cardiomyopathy and congenital heart disease were present in 5.7 and 0.2%, respectively. The most prevalent maternal complication was bleeding (4.8%). Most women had spontaneous vaginal deliveries (57.4%), although 42.6% of women underwent cesarean sections. The most prevalent neonatal complications were premature birth (1.5%), babies requiring incubator support or on mechanical ventilation (7.8%), and fetal mortality (1.7%). Conclusion: Women of child-bearing age who are at risk for, or already have, cardiovascular disease should receive early counseling and treatment not only from their family physician but also from an interdisciplinary team comprising gynecologists, cardiologists, and, if necessary, cardiac surgeons.

Multi-parametric cardiovascular magnetic resonance imaging detects subclinical myocardial involvement in patients diagnosed with phaeochromocytoma

Background In patients with phaeochromocytoma, acute or chronic exposure to catecholamines may lead to cardiac pathology, including left ventricular (LV) hypertrophy, myocardial infarction, stress-induced cardiomyopathy and heart failure. The burden of myocardial involvement in this disease with systemic effects is unknown. In this prospective, multicentre study, we sought to describe the variety and incidence of cardiac abnormalities in patients diagnosed with phaeochromocytoma using multi-parametric cardiovascular magnetic resonance (CMR) imaging. Methods We studied 50 patients diagnosed with phaeochromocytoma. Twenty patients (n=20, age 51±14 yrs) newly-diagnosed with confirmed phaeochromocytoma prospectively underwent CMR before and after curative surgical resection of the phaeochromocytoma (median follow-up 1 year). In addition, 30 patients (n=30, age 52±14 yrs) previously diagnosed with phaeochromocytoma who had curative surgery were also recruited for cardiac characterisation. Patients with known cardiac conditions were excluded. CMR included cine imaging for global and regional LV function, dark-blood T2-weighted imaging for oedema and late gadolinium enhancement imaging to detect the presence and patterns of any scarring. Results In patients with newly-diagnosed phaeochromocytoma, the mean LV ejection fraction was 67±10% (EF range 4788%); of these patients, 20% (n=4/20) had mild global LV dysfunction (EF 47-56%). A significant proportion (65%, n=13/20) demonstrated scarring, all with a non-ischaemic pattern, but these areas were small (<10% myocardium); no patient had evidence of myocardial infarction (isolated subendocardial scarring). One patient demonstrated global myocardial oedema with normal EF. All LV dysfunction or oedema were reversible and normalised at postoperative follow-up. In patients previously-diagnosed who already had had curative surgery, the mean LVEF was essentially normal (73±7%) with only one patient (3%) who had mild global LV dysfunction (EF=56%). Compared to the newlydiagnosed patients, a significantly smaller proportion of previously-diagnosed patients (17% vs. 65%; p<0.001) demonstrated areas of scarring, which were also small in areas with a non-ischaemic pattern, except for one patient who suffered a small myocardial infarction. Conclusions Subclinical cardiac abnormalities are frequent findings on CMR in patients newly-diagnosed with phaeochromocytoma, including mild LV dysfunction, myocardial oedema and small areas of non-ischaemic scarring, with the former two demonstrating normalization after surgical resection of the phaeochromocytoma. In patients who had previously undergone curative surgical resection of their phaeochromocytomas, the incidence of cardiac

122 Cardiac Abnormalities are Common in Patients Diagnosed with Phaeochromocytoma as Detected by Cardiovascular Magnetic Resonance Imaging

IntroductionSudden and/or chronic exposure to catecholamines may predispose patients with phaeochromocytoma to cardiac pathology, including left ventricular (LV) hypertrophy, myocardial infarction, stress-induced cardiomyopathy and heart failure. This is a prospective,...

Congestive Heart Failure (CHF) During Induction In ACUTE Promyelocytic Leukemia (APL) Patients

BackgroundAPL is a highly curable malignancy with cure rates of greater than 90% in most co-operative group trials. Population-based studies show that the survival is only about 65-70% with up to 30% early deaths. The most common reasons of early deaths are bleeding, differentiation syndrome (DS) and infection. Differentiation syndrome is very peculiar to this disease and potentially fatal unless recognized early. The wide variety of clinical presentations associated with DS might lead to delay in diagnosis in some patients which may lead to poorer outcomes. European Leukemia Net recommendations suggest that congestive heart failure (CHF) is one of the presenting features of DS and most of the reports on cardiac abnormalities focus on pericardial effusion. Cardiac stunning is only briefly reported in the literature. Cardiac stunning might be a result of cytokine storm attributable to tumor lysis in addition to being part of the DS. Here we report the incidence of CHF in patients undergoing induction for APL. MethodsWe performed a retrospective chart review on patients diagnosed with APL who received induction between December 1, 2004 and July 31, 2013 at Georgia Regents University and also patients who were referred to us from surrounding treatment centers with whom we co-manage these patients. Baseline and follow up ejection fractions (EF) were recorded by echocardiogram or nuclear medicine scan. We evaluated patients who had a drop in EF during the induction period. Results41 consecutive patients with APL with normal ejection fraction at diagnosis were evaluated. 1 patient refused treatment and was excluded. 38/40 patients received idarubicin and ATRA remission induction and 2 patients received Arsenic and ATRA. There were seven deaths during induction phase of treatment In the surviving patients, 10 patients had a repeat ECHO during the first 30 days of induction phase for suspected cardiomyopathy. 5 patients (15.1% of surviving patients) demonstrated a decrease in EF and all five were in the anthracycline group. The age range of patients with drop in EF was 30-75 years. Absolute drop in EF was between 10- 35%. Only one patient had mild elevation in troponins while others had no elevation. 3 out of the 5 patients had significant DS. Of the surviving patients, 4 out of 5 patients recovered their EF completely with one patient recovering partially to 45-50% (from 20-25%). ConclusionsAnthracyclines, along with ATRA, are still the mainstay of treatment for this curable malignancy. Although the incidence of cardiac abnormalities is described with repeated courses of anthracyclines, a single dose of anthracyclines can also play a role in cardiac injury. The highly inflammatory state present during the early treatment of APL might also play a role in cardiac injury resulting in higher number of patients with decreased EFs. DS clinical presentation most commonly involves dyspnea and edema, which are also symptoms of heart failure. Prompt cardiac evaluation should be undertaken to rule out congestive heart failure as an early start to therapy will lead to improved outcomes. Disclosures:Awan:Lymphoma Research Foundation: Research Funding; Spectrum Pharmaceuticals Inc.: Speakers Bureau. Jillella:Lymphoma Leukemia society: Research Funding. Kota:Teva: Speakers Bureau; Ariad: Advisory board, Advisory board Other.

Correction of the hypertensive response in the treadmill testing by the work performance improves the prediction of hypertension by ambulatory blood pressure monitoring and incidence of cardiac abnormalities by echocardiography: Results of an eight year follow-up study

Background Studies of the association between hypertensive response (HR) in the exercise treadmill testing (ETT) and end organ damage are mostly cross-sectional and have not used ABPM. We investigated the association of different definitions of HR with incidence of hypertension by ABPM and development of cardiac structural abnormalities. Methods Normotensive individuals were submitted to ETT and had clinical, office BP, ABPM, and echocardiogram done in the baseline evaluation and after 8.1 ± 1.0 years of follow-up. The variation of these parameters and the incidence of hypertension by tertiles of BP response corrected by MET and by the absolute variation of BP were tested in multivariate models. Results 69 of the 75 (92%) participants were examined in the follow-up. The higher baseline office BP and ABPM, BMI and left atrial dimension in individuals classified at the top tertile persisted in the follow-up. Posterior wall (8.7 ± 1.4, 9.0 ± 1.2, 10.0 ± 1.2 mm, P = 0.005), septum thickness (9.4 ± 1.7, 10.1 ± 2.3, 11.0 ± 1.6 mm, P = 0.030), and isovolumetric relaxation time (0.73 ± 0.19, 0.76 ± 0.15, 0.85 ± 0.14 s, P = 0.044) became significantly higher in the follow-up visit in the top tertile. The incidence of hypertension by ABPM was higher in individuals with HR defined by the top tertile in comparison with the absolute response ≥ 210 mmHg. Conclusions The correction of the HR in the ETT by MET may improve the prediction of hypertension by ABPM and of cardiac structural abnormalities.

Cardiac complications after aneurysmal subarachnoid hemorrhage

Background Cardiac complications are frequently encountered by neurointensivists caring for patients with SAH. Our aim was to better characterize the natural history of various cardiac abnormalities in this population. We sought to determine the risk factors for cardiac abnormalities, patient outcome, and impact of treatment type on cardiac abnormalities. Methods We performed a single center retrospective review of admissions of patients with aneurysmal SAH to the neurosurgical ICU in a large university hospital. Patient demographics, pertinent history, cardiac tests, hospital LOS, intervention type, and discharge outcome were collected. Results Data from 266 patients were available for analysis. Of these patients, 50% (n = 133) demonstrated cardiac abnormalities as indicated by abnormal EKG, ECHO, or troponin I. Only age was determined to be an independent statistically significant predictor of cardiac abnormality ( P = .01). There was no difference in mortality between the cardiac abnormality and control groups ( P = .33). However, there was increased morbidity in the cardiac abnormality group as demonstrated by worse discharge disposition, in addition to increased length of hospital stay (22.6 vs 17.1 days, P < .01). The incidence of cardiac abnormalities was the same among surgical and endovascular treatment groups. Conclusions Cardiac abnormalities, including those that meet ACC criteria for MI, are common among patients with SAH. However, in contrast to cardiac events outside the context of SAH, these abnormalities do not increase mortality. They do, however, adversely affect discharge disposition and prolong hospital LOS. The type of aneurysm treatment does not affect the incidence or outcome of cardiac abnormalities.

Cardiac Abnormalities among NCAA Division II Athletes

As an athlete is routinely exposed to rigorous physical training programs to improve cardiorespiratory function, the heart undergoes sport-specific physiologic changes. While the majority of these physiologic changes have been documented among NCAA Division I, professional, and elite athletes and are considered normal variants within the sport community, there has been an increased concern for identifying cardiac abnormalities and syndromes commonly associated with sudden cardiac death (SCD). PURPOSE: To quantify cardiac abnormalities among NCAA Division II athletes. METHODS: Following written informed consent, 178 (90 male, 88 female) athletes (mean ± SEM; age = 19.9 ± 0.1 yr; ht = 109.2 ± 0.9 cm; wt = 115.7 ± 1.7 kg) completed a resting Mason-Likar 12-lead electrocardiogram. Data were analyzed by gender and ethnicity (113 Caucasian, 42 African American, 23 Hispanic). RESULTS: MANOVAs (Wilks' Lambda) indicated a significant main effect across gender (F10,167 = 19.527; P < 0.001; n-β = 1.00), and ethnicity (F22,330 = 2.123; P = 0.003; n-β = 0.99). Post hoc analyses revealed that males exhibited a higher incidence of prehyp/hypertension (30.5 vs. 12.5%, P < 0.001), murmurs (6.4 vs. 0.0%, P = 0.03), abnormal heart rate (HR; 42.6 vs. 10.2%, P < 0.001), rate dependent abnormalities (RATE; 96.8 vs. 97.7%, P < 0.001), conduction defects (BLOCK; 49.9 vs. 27.1%, P < 0.001), and ventricular hypertrophy (VHYPER; 44.7 vs. 3.4%, P < 0.001), but a significantly lower incidence of atrial hypertrophy (AHYPER; 55.7 vs. 26.6%, P < 0.001) than females, respectively. No other significant differences were observed between gender. African Americans exhibited a significantly higher incidence of prehyp/hypertension (36.4 vs. 17.4%, P = 0.01), extended QT duration (29.6 vs. 3.5%, P = 0.01), and sinus arrhythmias (29.5 vs. 15.7%, P = 0.03), but a lower occurrence of AHYPER (58.3 vs. 18.2%, P = 0.001) than Caucasians, respectively. African Americans also revealed a significantly higher incidence of VHYPER than both Caucasians (45.5 vs. 18.3%, P < 0.001) and Hispanics (45.5 vs. 17.4%, P = 0.01), respectively. No other significant differences were observed between ethnicities. CONCLUSION: There was a significant difference in the incidence of cardiac abnormalities between gender and ethnicity among NCAA Division II athletes. The majority of the cardiac abnormalities observed throughout this study, however, are considered normal variants which are commonly associated with athletic hearts and, at this time, are not indicative of more serious conditions leading to SCD.

Screening for Cardiac Disease After Mediastinal Irradiation

Patients with Hodgkin's disease often undergo irradiation of the mediastinum, a procedure that is associated with symptomatic pericardial and valvular disease and with accelerated atherosclerosis. But what is the incidence of cardiac abnormalities in asymptomatic patients, and what is the yield of screening in previously irradiated patients? These researchers evaluated 294 patients (mean age, 42) …

Incidence of cardiac abnormalities in children with human immunodeficiency virus infection: The prospective P2 C2 HIV study

Objective: To describe the 5-year cumulative incidence of cardiac dysfunction in human immunodeficiency virus (HIV)-infected children. Study design: We used a prospective cohort design, enrolling children at 10 hospitals. Group I included 205 vertically HIV-infected children enrolled at a median age of 1.9 years. Group II consisted of 600 HIV-exposed children enrolled prenatally or as neonates, of whom 93 were ultimately HIV-infected. The main outcome measures were echocardiographic indexes of left ventricular dysfunction. Results: In group I, the 5-year cumulative incidence of left ventricular fractional shortening ≤25% was 28.0%. The 5-year incidence of left ventricular end-diastolic dilatation was 21.7%, and heart failure and/or the use of cardiac medications 28.8%. The mortality rate 1 year after the diagnosis of heart failure was 52.5% [95% CI, 30.5-74.5]. Within group II, the 5-year cumulative incidence of decreased fractional shortening was 10.7% in the HIV-infected compared with 3.1% in the HIV-uninfected children (P =.01). Left ventricular dilation, heart failure, and/or the use of cardiac medications were more common in infected compared with uninfected children. Conclusions: During 5 years of follow-up, cardiac dysfunction occurred in 18% to 39% of HIV-infected children and was associated with an increased risk of death. We recommend that HIV-infected children undergo routine echocardiographic surveillance for cardiac abnormalities. (J Pediatr 2002;141:327-35)

Primary hyperparathyroidism: Incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy

purpose: This prospective study was designed to assess the effect of primary hyperparathyroidism on heart muscle, valves, and myocardial function. Echocardiography was used to evaluate changes in mechanical performance, the thickness of the left ventricular wall, myocardial calcific deposits, and valvular calcifications in patients with primary hyperparathyroidism. methods: Echocardiography was performed in 54 patients with hyperparathyroidism prior to surgery and 12 ± 2 months after successful parathyroidectomy. A matched control group was followed for comparison. results: In a blinded fashion, aortic and mitral valve calcifications were detected in 63% and 49% of patients with primary hyperparathyroidism (controls: 12% and 15%, respectively). Calcific deposits in the myocardium were found in 69% of patients with hyperparathyroidism and 17% of the control subjects. After parathyoidectomy and 12 months of normocalcemia, a significant regression of left ventricular hypertrophy (p <0.001) was observed. conclusions: The present data show a high incidence of left ventricular hypertrophy, calcific deposits in the myocardium, and/or aortic and mitral valve calcification in patients with primary hyperparathyroidism. A 1-year follow-up after parathyroidectomy (and restoration of normocalcemia) discloses regression of hypertrophy, while calcifications persist without evidence of progression.

The technique of fetal echocardiography, with its indications and results in a selected population

SummaryOne of the most important contributions of echocardiography to the diagnosis of congenital cardiac malformations is represented by its use in prenatal evaluation. In the present work we discuss the analysis of echocardiographic findings in a preliminary study of the hearts of fetuses in 273 pregnant women. The cases have been divided into three groups. The first group of 169 women was made up of those without a known factor conferring high risk on the pregnancy. The second group of 18 women was comprised of those of suspicions of either arrhythmias or congenitally malformed hearts. The final group of 86 women, consisted of those having had previous children with congenital heart disease. The incidence of pathology in those without risk was 0.5%. In those referred because of suspicion of disease, the incidence was 16.6%, while in those with previous history of children with heart disease, the incidence was 5.8%. Our findings proved the utility of the echocardiogram for the diagnosis of heart malformations prior to birth and confirmed the increased incidence of malformations in fetuses in mothers who had previously produced children with congenital heart disease. The high incidence of cardiac abnormalities in the group referred on the basis of an earlier scan is due to the filter represented by routine echocardiography performed by the obstetricians.

Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption.

One hundred and forty-five alcoholics without known causes of heart disease, who were serially admitted to the alcohol detoxification centre, were studied to see the incidence of cardiac abnormalities and dose related effects of ethanol. All patients were divided into heavy (consumed more than the equivalent amount of 125 ml of pure ethanol daily for 10 years or more) and moderate drinkers (consumed 75 to 125 ml of ethanol daily). All of them were ambulatory and free from cardiac symptoms. There was no difference among heavy and moderate drinkers in the incidence of abnormalities detected by the electrocardiograms and chest x-ray films. In the alcoholics, the most frequent finding was a prolonged QTc interval of more than 0.44 s on the electrocardiogram (62 patients, 42.8%), unrelated to serum electrolytes imbalance. Cardiomegaly on chest x-ray film was observed in 25 patients (17.2%). M-mode echocardiogram was recorded in randomly selected patients and compared with age and sex matched controls. The interventricular septum and posterior wall were thicker in alcoholics, while left ventricular volume showed no difference. Left ventricular muscle mass was significantly increased only in heavy drinkers. Left ventricular function at rest was not depressed in these patients at an average of 31 days after the last drink of ethanol. Severe heart failure was not found even among the group of heavy drinkers, of whom more than 90% had liver dysfunction. Cardiac hypertrophy seems to occur in heavy drinkers, but is clinically well compensated in the majority of alcoholics.

Cardiac Abnormalities in Chronic Alcoholism

The incidence of cardiac abnormalities was studied in 107 cases with chronic alcoholism, admitted to a psychiatric ward. More than half of them adhered to drink Japanese sake almost exclusively.Either palpitation or shortness of breath was seen in 49 cases, cardiothoracic ratio was more than 0.50 in 15 of the 78 cases examined, and abnormal ECG was obtained in 65 of the 103 cases.Among ECG abnormalities, broad and tall PII, high RV5, high T in leads V2 and V3 and QT prolongation were the most frequent. Various arrhythmias and conduction disturbances were also seen.The clinical picture suggested more than incidental association of diffuse myocardial involvement with chronic alcoholism.