Normal Echocardiographic Findings Research Articles

Non-Obstructive Coronary Artery Disease due to COVID-19 Infection: St-Segment Elevation due to Endothelial Dysfunction

The ongoing inflammatory process in COVID infection is reported to cause acute cardiac injury either due to direct cytotoxicity or oxidative stress injury to myocytes. Hypercoagulability and endothelial dysfunction are the two main events resulting in the transient thrombotic process. Objective: To assess the coronary artery occlusion in COVID infected patients presenting with ST-elevation myocardial injury. Methods: A descriptive case series study was conducted on 52 patients presenting with ST-elevation myocardial infarction along with COVID infection. Data was collected regarding demographic profile, Troponin levels, COVID PCR, changes in ECG, Echocardiographic findings and coronary arteries were assessed angiographically. Data were analyzed using SPSS software and various percentages were calculated. Results: Of all the 52 patients studied, 46 patients (88%) tested positive for COVID -19 on RT-PCR done via nasopharyngeal swab. Other 6 patients tested negative initially but they had findings on their CXR and HRCT suggestive of interstitial pneumonia. All the patients were in age group 30-60 years with 32 patients (62%) being males and 20 being females (38%). None of the patients previously had any history of angina or myocardial infarction. Inflammatory markers were raised in about 43 patients (82.7%). ECG showed ST segment elevation in anterior leads in 35 patients (67%) and in inferior leads in 9 patients (17%) and in lateral leads in 2 patients (3.8%). Qualitative Troponin I test was positive in all the patients, whereas, about 41 patients (78%) had Quantitative Troponin I test in high probability range. About 50 patients (96%) had Ejection Fraction greater than 45% and normal segmental wall motion analysis. The coronary arteries were reported to be normal or recanalized in 40 patients (76%) and mild-moderate disease in single or two vessels are present in rest of the 12 patients. None of the patients had shown culprit artery severe disease or clot burden on angiograms. Conclusions: Acute Cardiac injury in previously asymptomatic patients may be related to the pro-thrombotic state created by COVID-19 infection resulting in endothelial dysfunction and mimicking ST-elevation myocardial injury raising Troponin levels indicated by raised D-Dimers and CRP level. The auto-recanalization of the coronary arteries and normal echocardiographic findings, are good prognostic factors for the post cardiac injury rehabilitation.

The impact of ethnicity on abnormal electrocardiographic findings in elite Brazilian football players: B-pro foot ECG pilot study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Black athletes may be more likely to have uncommon electrocardiogram findings than white athletes. The prevalence of abnormal electrocardiographic findings in elite Brazilian football players (EBFP) of different ethnicities is unknown. Purpose To compare the prevalence of these changes and their correlation with the echocardiogram and cardiac magnetic resonance (CMR) in Caucasian, Mixed-race (MR), and Afro-Brazilian (AB) EBFP. Methods A multicenter cross-sectional descriptive study was conducted with exams performed on EBFP as a pre-participation assessment from February 18, 2002, through October 20, 2022. Results 4,363 EBFP from 51 professional clubs (from all five regions of Brazil; 15 states, and 21 cities), aged 15-35 years (median: 19 years; IQR: 16-23) were evaluated. 2,027 were Caucasians, 1,324 were MRs, and 1,012 were ABs. T-wave inversion (TWI) in leads II and aVF (4.2% vs. 2.3%), V5 (4.0% vs. 1.7%), and in V5-V6 (3.0% vs. 1.4%) was more common in AB than in Caucasian players, respectively (P = 0.002 for all comparisons). In addition, AB demonstrated a significantly greater prevalence of inferolateral TWI (2.3%) than Caucasian (1.1%), and MR (1.3%) EBFP, respectively. TWI in leads V1-V3 in Caucasians or MRs >16 years was present in 0.9% (30/3,351). PR interval ≥400 ms was observed in one Caucasian and in one AB athlete. The Wolff-Parkinson-White pattern was identified in two Caucasians, and a suggestive case of a type 2 Brugada Pattern in one Caucasian. Overall, 208 (4.8%) EBFP had electrocardiographic changes considered to be abnormal (4.5% in Caucasians, 4.8% in MRs, and 5.2% in ABs). Of these, 150/208 (72.1%) underwent an echocardiogram. Isolated inferior TWI was not associated with echocardiographic abnormalities (n = 25), similar to persistent juvenile TWI patterns (in Caucasians or MRs). However, TWI in inferolateral leads was associated with 10.5% echocardiographic abnormalities (4/38). Of these, 75% (3/4) had abnormal CMR findings: one AB with hypertrophic cardiomyopathy (CMP), and two Caucasians with non-compaction CMP; one Caucasian with an abnormal echocardiogram demonstrated normal CMR, suggesting "athlete's heart". Finally, one AB had normal echocardiogram results, but the CRM showed a finding compatible with apical hypertrophic CMP. Conclusion In this large cohort of EBFP, approximately 5% of the electrocardiographic findings were considered abnormal. In those with inferolateral TWI, the use of CMR may indicate the presence of potentially malignant cardiac disease, even with normal echocardiographic findings. AB ethnicity was associated with a higher prevalence of TWI in the inferior and/or lateral leads in comparison to Caucasian or MR ethnicities.

P320 AN UNUSUAL CASE SYNCOPE DUE TO SILENT CORONARY VASOSPASM

Abstract Background Variant angina is a condition due to a transient vasospasm of the epicardial coronary arteries, which usually causes chest pain episodes and may be associated with dangerous arrhythmias. A non–negligible subset of patients can also experience silent myocardial ischemia, defined as objective documentation of myocardial ischemia in the absence of angina or equivalents. This condition is associated with increased cardiac mortality and incidence of acute cardiac events. Description of the case. A 65–years–old man was admitted to our Emergency Department for syncope. He reported palpitations before the event without chest pain. ECG showed biphasic T waves in V2–V6 (Fig 1A), troponin values were normal. Immediately after admission in our coronary care unit for monitoring, he developed dynamic ST segment elevation with signs of inferior and posterior transmural ischemia (Fig 1B) and non–sustained polymorphic ventricular tachycardias (Fig 2), being symptomatic only for palpitations. ECG abnormalities and symptoms quickly resolved after intra–venous nitrates administration. Coronary angiography was performed showing a critical non–occlusive (85%) fixed stenosis at the proximal right coronary artery (Fig 3 A). The lesion was treated by angioplasty and stenting (Fig 3 B) and the patients was discharged on dual anti–platelet therapy, statins and oral high–dose calcium–channel antagonist. Discussion This case underlines first the importance of searching for high–risk features in patients with syncope of non–obvious origin: our patient reported palpitations and ECG changes consistent with myocardial ischemia (even with normal troponin values and echocardiographic findings). A peculiarity of our case is that the patient did not complaint any chest pain despite the presence of ST elevation, a condition known as silent ischemia. The transient nature of ECG modification and ventricular arrhythmias, their dramatic response to nitrates and coronary angiography findings were suggestive of silent vasospasm. Coronary vasospasm induces transient myocardial ischemia and may cause ventricular arrhythmias which in turn can cause syncope due to transient cerebral hypoperfusion or, when sustained, even cardiac arrest and sudden death. We did not perform provocative test with acetylcholine or ergonovine due to the likely vasospastic origin of myocardial ischemia and to their potential risks, especially in the presence of non–sustained plymorphic ventricular tachycardias.

Echocardiographic characterization of cardiac chambers and vasculatures in buffaloes (Bubalus bubalis) during diastolic and systolic phases.

Ultrasonography had diagnostic importance in the evaluation of different diseases in buffaloes, including cardiovascular diseases. The current work describes the normal echocardiographic findings in healthy buffaloes, along with establishing reference values for echocardiographic dimensions for both sides of the heart, i.e., left and right ones. About 30 healthy adult buffaloes that belonged to private farms in Assiut, Egypt, were included in this study. Each animal underwent a complete clinical evaluation as well as hematological analyses, lipid profile indices, liver functions, cardio-thoracic radiography, and echocardiography to confirm no diseased conditions were detected. The study was conducted on healthy buffaloes (n = 30) in Assiut Governorate, Egypt. The obtained results reported healthy buffaloes with normal clinical findings as well as indices of blood pictures and serum biochemicals that were within the reference intervals. Radiography revealed a free reticulum and a well-defined diaphragm. The heart was seen as a typical radio-opaque organ. Ultrasonographically, using grayscale B-mode and M-mode, the heart was commonly imaged from the left fourth intercostal space. Different echocardiographic views were described, including the four chamber view, i.e., right atrium (RA), right ventricle (RV), tricuspid valve (TCV), left atrium, left ventricle, mitral valve, and interventricular septum (IVS), and the right ventricular outflow tract, i.e., RA, TCV, RV, pulmonary artery (PA), and pulmonary valve. Cross sections in each of the apex and base of the heart were described. Echocardiographic dimensions during cardiac diastole and systole, including diameters and wall thickness of each of the atria and ventricles, were demonstrated. Interventricular septal thickness wall thickness as well as diameters of the aorta and PA, were stated. The work tried to put reference values on the normal echocardiographic dimensions using 2-D B-mode gray scale ultrasonography in healthy adult buffaloes. These echocardiographic reference dimensions with normal echocardiographic imaging will be very helpful in enhancing the diagnostic efficacy of ultrasounds for recognizing abnormal findings related to cardiac disorders.

729 BIOMARKERS FOR EARLY DIAGNOSIS OF CARDIAC INVOLVEMENT IN SYSTEMIC SCLEROSIS

Abstract Introduction Systemic Sclerosis (SSc) is an autoimmune disease characterized by microvascular damage, immune system dysregulation and fibrosis of skin and internal organs. It is reported that asymptomatic involvement of the heart was found in 70% of SSc patients. The role of biomarkers in the early detection of fibrosis and vascular damage in SSc is not yet completely defined. Serum levels of sST2, Galectin 3, ANP, IL6 are a potential marker of cardiac involvement. In patients with chronic heart failure elevated levels of galectin-3 (>17.8 ng/ml) are a marker of worse prognosis. Moreover, a previous study reported a possible role of galectin-3 as an independent predictor of all-cause and cardiovascular mortality in SSc. Material and Methods We enrolled 62 SSc patients (53 females, median age 52 years) who fulfilled inclusion criteria. 35 patients had limited cutaneous SSc and 27 diffuse cutaneous SSc. 30 Healthy Controls (HC) were also enrolled [20 females; median age 50 years]. All SSc patients had normal echocardiographic and cardiac MRI findings. Results In SSc patients, the median Galectin value was 16.7 ng/ml, significantly higher than HC median (10,7 ng/Ml). sST2 and IL-6 median value was 30 ng/mL and 12,3 pg/mL respectively, which resulted significantly higher than the median value of HC patient (21,55 ng/mL and 4,5 pg/mL respectively). Therefore, there was a significant difference in biomarkers levels in the SSc group compared with controls. Conclusion These data suggest that these biomarkers can help identify a subgroup of SSc patients, with normal echocardiographic and RMN findings, who are at risk of developing heart involvement. In fact, all patients are scheduled for yearly echocardiographic re-evaluation as ESC guidelines recommend for earlier detection of pulmonary arterial hypertension (PAH), a leading cause of death in systemic sclerosis (SSc).

728 GALECTINE-3 AND SST2 IN SYSTEMIC SCLEROSIS: AN EARLY DETECTION OF PULMONARY VASCULAR INVOLVEMENT IS REALLY POSSIBLE?

Abstract Introduction Pulmonary arterial hypertension (PAH) is a rare form of pulmonary hypertension (PH) that may also be associated with connective tissue diseases (CTD). In particular, PAH may affect from 5 to 19% of patients with systemic sclerosis (SSc), leading to a significant prognostic worsening. The current challenge is an early detection of PAH in such patients, in order to provide an early referral to PH centers to supply specific therapies as soon as possible. In the latest ESC guidelines for PH, cardiopulmonary exercise testing (CPET) has been included in the diagnostic algorithm for patients with unexplained exertional dyspnoea and/or suspected PH. Patients with PAH show a typical pattern, with a low end-tidal partial pressure of carbon dioxide (PETCO2), high ventilatory equivalent for carbon dioxide (VE/VCO2), low oxygen pulse (VO2/ HR) and low peak oxygen uptake (VO2). CPET may identify patients with SSc at low risk of PAH, to avoid unnecessary right heart catheterization (RHC). However, CPET is not available in all centers. So, we designed a preliminary study to identify new biomarkers that correlate with CPET's parameters. Material and Methods We enrolled 62 SSc patients [53 females, median age 52 years] with no other comorbidities and asymptomatic for dyspnea or other symptoms. 56% and 44% of them presented limited cutaneous SSc (lcSSc) and diffuse cutaneous SSc (dcSSc), respectively. For all patients we performed serum analysis for sST2, Galectine-3, pro-ANP, BNP and IL6, diagnostic imaging with echocardiography and cardiac MRI, CPET and pulmonary functionality test (PFT). Results All patients presented normal echocardiographic and RMI imaging findings. Galectin-3, sST2, pro-ANP, BNP and IL6 presented respectively the following median value: 13.45 ng/mL [11.78; 18.70], 23.25 ng/mL [13.04; 43.35], 1897 fmol/ml [1487; 2445], 12.18 pg/mL [9.34; 15.01]. Both Galectin-3 and sST2 showed a linear correlation with VE/VCO2 slope with R 0.339 (P-value 0.018) and 0.355 (P-value 0.013) respectively. After linear regression analysis, Galectin-3 and sST2 were overall statistically significant with R2 of 0.115 and 0.126, F of 5.97 and 6.62 and P-value of 0.018 and 0.013, respectively. It was found that Galectin-3 and SST2 significantly predicted VE/VCO2 slope with β = 0.364 [0,064; 0,665] for Galectin-3 and 0.137 [0,030; 0,244] for SST2. All other CPET parameters did not show correlation with the biomarkers. Conclusion Our preliminary results suggest that Galectine-3 and sST2 may be useful biomarkers for predicting increasing VE/VCO2 slope. Future analysis may confirm the role of these new biomarkers for early detection of pulmonary vascular involvement in SSc patients to allow an early referral and treatment and, conversely, to avoid unnecessary RHC.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Abstract 13294: Role of Retrospective Cardiac Computed Tomography Angiography in the Detection of Prosthetic Valve Endocarditis

Case presentation A 47-year-old man was readmitted for evaluation of recurrent fevers, night sweats, and weight loss over a 3 month period. He had a history of bioprosthetic aortic and mitral valve replacements for rheumatic valve disease and heart failure with reduced ejection fraction due to non-ischemic cardiomyopathy. Physical examination was remarkable for a[LMD1] grade II/VI systolic murmur. Laboratory notable for neutrophilic leukocytosis elevated C-reactive protein and erythrocyte sedimentation rate. Blood cultures demonstrated Staphylococcus epidermidis . On transthoracic echocardiogram (TTE) performed in the current admission and transesophageal echocardiogram (TEE) done 2 months prior the prosthetic valves were not clearly visualized, but there was no regurgitation, stenosis or vegetation noted. Due to a high index of suspicion for prosthetic valve endocarditis (PVE), a retrospectively gated cardiac computed tomography angiography (CCTA) of the entire cardiac cycle was performed. It revealed a 13 mm mobile vegetation attached to the ventricular side of the left coronary cusp (Figure 1). Subsequently, the patient underwent a redo aortic valve replacement. Blood cultures cleared and the patient was discharged on hospital day 16 to complete 6 weeks of Cefazolin and Rifampin. Discussion: The modified Duke criteria play an important role in the diagnosis of native valve infective endocarditis (IE) (~ 80% sensitive), but it carries a lower diagnostic yield in the detection of PVE. While TEE carries high accuracy in the diagnosis of native valve endocarditis, approximately 30% of patients with PVE and/or intra-cardiac devices have inconclusive or normal echocardiographic findings. Inability to recognize IE in a timely fashion (<4 days) leads to greater embolic events. We showed how CCTA can be used to expedite the diagnosis of PVE.

Cardiac-specific deficiency of 3-hydroxy-3-methylglutaryl coenzyme A lyase in mice causes cardiomyopathy and a distinct pattern of acyl-coenzyme A-related biomarkers.

Deficiency of 3-hydroxy-3-methylglutaryl-CoA (HMG-CoA) lyase (HL) is an autosomal recessive inborn error of acyl-CoA metabolism affecting the last step of leucine degradation. Patients with HL deficiency (HLD) can develop a potentially fatal cardiomyopathy. We created mice with cardiomyocyte-specific HLD (HLHKO mice), inducing Cre recombinase-mediated deletion of exon 2 at two months of age. HLHKO mice survive, but develop left ventricular hypertrophy by 9 months. Also, within minutes after intraperitoneal injection of the leucine metabolite 2-ketoisocaproate (KIC), they show transient left ventricular hypocontractility and dilation. Leucine-related acyl-CoAs were elevated in HLHKO heart (e.g., HMG-CoA, 34.0 ± 4.4 nmol/g versus 0.211 ± 0.041 in controls, p < 0.001; 3-methylcrotonyl-CoA, 5.84 ± 0.69 nmol/g versus 0.282 ± 0.043, p < 0.001; isovaleryl-CoA, 1.86 ± 0.30 nmol/g versus 0.024 ± 0.014, p < 0.01), a similar pattern to that in liver of mice with hepatic HL deficiency. After KIC loading, HMG-CoA levels in HLHKO heart were higher than under basal conditions, as were the ratios of HMG-CoA/acetyl-CoA and of HMG-CoA/succinyl-CoA. In contrast to the high levels of multiple leucine-related acyl-CoAs, biomarkers in urine and plasma of HLHKO mice show isolated hyper-3-methylglutaconic aciduria (700.8 ± 48.4 mmol/mol creatinine versus 37.6 ± 2.4 in controls, p < 0.001), and elevated C5-hydroxyacylcarnitine in plasma (0.248 ± 0.014 μmol/L versus 0.048 ± 0.005 in controls, p < 0.001). Mice with liver-specific HLD were compared, and showed normal echocardiographic findings and normal acyl-CoA profiles in heart. This study of nonhepatic tissue-specific HLD outside of liver reveals organ-specific origins of diagnostic biomarkers for HLD in blood and urine and shows that mouse cardiac HL is essential for myocardial function in a cell-autonomous, organ-autonomous fashion.

Complete heart block ensuing from a metastatic small cell carcinoma: a case report

IntroductionNotwithstanding the diagnostic and therapeutic advancements, the incidence of cardiac metastases has increased in recent decades. Lung cancers are the most common primary malignant neoplasms with cardiac metastasis potential. The clinical presentation of cardiac metastases is either silent or vague, and largely depends on the infiltrated location and tumor burden. Although arrhythmias are not uncommon in metastatic cardiac tumors, complete heart block is relatively a rare manifestation. We present a case of complete heart block due to a metastatic small cell carcinoma in a 67-year-old male of African origin.Case presentationA 67-year-old male of African origin from rural Tanzania was referred to us for expert management. He is a retired agromechanic with over 30 years exposure to asbestos-containing brake linings. His past medical history was unremarkable, but the family-social history was evident for a heavy alcohol intake and chronic cigarette smoking. He presented with a 24-week history of progressive shortness of breath and an 8-week history of recurrent syncopal attacks coupled with a significant weight loss. He had normal echocardiographic findings, however, the electrocardiogram showed features of complete heart block. Chest X-ray showed a homogeneous opacification on the right side and computed tomography scan revealed a solid right lung mass with metastases to the liver, heart, bowels, and bone. He underwent bronchoscopy, which revealed an endobronchial mass obstructing the bronchus intermedius. Histological examination of a section of lung biopsy taken during bronchoscopy confirmed the diagnosis of a small cell carcinoma. The patient underwent dual chamber pacemaker implantation with successful sinus rhythm restoration. He made an informed refusal of chemotherapy and inevitably died 18 months post pacing.ConclusionsDespite the advancements in medical diagnostics and management, lung cancers are often diagnosed in advanced stages, with an inevitable grave prognosis. Small cell carcinoma has the potential to metastasize to the heart, resulting in complete heart block.

Fetal cardiac sectional schemas - Normal and abnormal. Part 1: Upper abdominal and thoracic sections.

A representational illustrated cardiac schema is useful for understanding and interpreting normal and abnormal fetal echocardiographic findings. Normal and abnormal fetal echocardiographic images can be better appreciated with the support of sectional schemas. An attempt is made to include normal and abnormal variations in both grayscale and color images for easy understanding with the help of the schemas. The fetal cardiac sectional schemas are drawn by the author, using Microsoft Office Word drawing canvas. It is based on the best grayscale, color Doppler, power-angio, 3-dimensional, and high definition flow ultrasound images, supported by embryological and anatomic specimens in literature. Different sections are drawn in accordance with the planes suggested by Society for Maternal-Fetal Medicine, Society of Radiologists in Ultrasound, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American College of Radiology, and American Society of Echocardiography. Every effort has been meticulously pursued to match with the best ultrasound images with minor modifications for better clarity, understanding, and reproducibility. The drawings include normal and most of the common cardiac anomalies depicting different sectional views starting from the abdomen and upward. Each drawing complies with the ultrasound images. Users with basic computer knowledge can easily modify these images using them as templates for reference, reporting, and publications. An attempt is made to represent the fetal echocardiographic images by simplified memorable sectional schemas. These schemas will facilitate a better understanding and interpretation of various normal and abnormal fetal echocardiographic images. Being electronically transmittable, these schemas can be used as templates for further modifications.

Screening Echocardiogram in High-Risk Women with Class III Obesity to Predict the Risk of Preeclampsia.

Objective Women with obesity and other comorbidities such as hypertension and diabetes are at an increased risk of preeclampsia and perinatal morbidity. This study evaluates whether screening echocardiogram can identify women with obesity at a higher risk of preeclampsia. Methods We conducted a retrospective cohort study of women with class III obesity (body mass index [BMI] ≥40 kg/m 2 ) and one or more medical comorbidities associated with an increased risk of preeclampsia (such as diabetes, hypertension, and rheumatologic disease) undergoing screening echocardiogram. Abnormal findings were defined as the presence of one or more of the following: diastolic dysfunction, ejection fraction of ≤45%, or cardiac chamber enlargement or hypertrophy. Multivariable logistic regression was used to estimate the odds ratio (OR) of gestational hypertension/mild preeclampsia, severe preeclampsia, and any preterm delivery <37 weeks associated with abnormal echocardiographic findings when controlling for potential confounders. Results Of 267 eligible women, 174 (64%) underwent screening echocardiograms. Sixty-nine women (40%) had abnormal echocardiograms. Maternal clinical characteristics were similar between women with normal echocardiographic findings and women with abnormal findings. Women with abnormal echocardiograms were more likely to have chronic hypertension (78 vs. 62%, p = 0.04) and a history of preeclampsia (27 vs. 10%, p = 0.02). After controlling for confounders, women with abnormal echocardiogram were at an increased risk of hypertensive disorders of pregnancy, OR 6.80 (95% confidence interval [CI] 3.32–13.93, p = 0.01), and in particular severe preeclampsia, OR 8.77 (95% CI 3.90–19.74, p = 0.01). Conclusion Among pregnant women with class III obesity and medical comorbidities, screening echocardiogram may help identify a subset of women at the highest risk of developing preeclampsia. Key Points Women with obesity and comorbid conditions are at a high risk of abnormal echocardiogram.Women with obesity, medical comorbid conditions, and abnormal echo are at a high risk of preeclampsia.Screening echocardiogram can help identify obese women at the highest risk of severe preeclampsia.

Follow-Up Duration of Echocardiography in Patients with Kawasaki Disease with No Initial Coronary Aneurysms

To evaluate the optimal duration of echocardiographic follow-up in patients with Kawasaki disease without an initial coronary aneurysm. In this single-center, retrospective, observational study, we reviewed the results of follow-up echocardiography in children with Kawasaki disease enrolled in the Prospective Observational Study on Stratified Treatment with Immunoglobulin Plus Steroid Efficacy for Kawasaki Disease from a children's hospital. The main enrollment criterion was the absence of coronary aneurysms, defined as a maximum z-score (Zmax) ≥2.5, in the proximal right coronary artery and the proximal left anterior descending artery within 9days from treatment initiation. The primary outcome was Zmax on follow-up echocardiography at up to 5years. Among 386 patients, 106 (27.5%) received prednisolone with intravenous immunoglobulin for first-line therapy, and 57 (14.8%) showed a poor response. Echocardiography at 1month detected 9 patients with a Zmax ≥2, including 3 (0.8%) with coronary aneurysms requiring additional antithrombotic treatment and observation. Of 7 patients (1.8%) with normal echocardiographic findings at 1month but a Zmax ≥2 later, 2 were lost to follow-up and 5 experienced spontaneous resolution, but none of the 7 patients required any change in management. The optimal duration of echocardiographic follow-up may be 1month in patients with no initial coronary aneurysms and a Zmax <2 at 1month. Coronary artery abnormalities observed after 1month are rare and mostly benign in this category of patients.

Magnetic Resonance Detects Structural Heart Disease in Patients with Frequent Ventricular Ectopy and Normal Echocardiographic Findings.

The prognosis of patients with ventricular ectopy and a normal heart, as evaluated by echocardiography, is virtually unknown. Cardiac magnetic resonance (CMR) can detect focal ventricular anomalies that could act as a possible site of origin for premature ventricular contractions (PVCs). The aim of this study was to investigate the presence of cardiac anomalies in patients with normal findings at echocardiogram. Methods: Fifty-one consecutive patients (23 women, 28 men, mean age 59 years) with very high PVC burden (>10,000 PVC/day) and normal findings at standard echocardiography and exercise test were examined with CMR. The outcome was pathologic findings, defined as impaired ejection fraction, regional wall motion abnormalities, abnormal ventricular volume, myocardial edema and fibrosis. Results: Sixteen out of 51 patients (32%) had structural ventricular abnormalities at CMR. In five patients CMR showed impairment of the left ventricular and/or right ventricular systolic function, and six patients had a dilated left and/or right ventricle. Regional wall motion abnormalities were seen in six patients and fibrosis in four. No patient had CMR signs of edema or met CMR criteria for arrhythmogenic right ventricular cardiomyopathy. Five patients had extra-ventricular findings (enlarged atria in three cases, enlarged thoracic aorta in one case and pericardial effusion in one case). Conclusions: In this study 16 out of 51 patients with a high PVC burden and normal findings at echocardiography showed signs of pathology in the ventricles with CMR. These findings indicate that CMR should be considered in evaluating patients with a high PVC burden and a normal standard investigation.

COVID-19-related echocardiographic patterns of cardiovascular dysfunction in critically ill patients: A systematic review of the current literature.

PurposeCoronavirus disease 2019 (COVID-19) infection may trigger a multi-systemic disease involving different organs. There has been growing interest regarding the harmful effects of COVID-19 on the cardiovascular system. This systematic review aims to systematically analyze papers reporting echocardiographic findings in hospitalized COVID-19 subjects.Materials and methodsWe included prospective and retrospective studies reporting echocardiography data in >10 hospitalized adult subjects with COVID-19; from 1st February 2020 to 15th January 2021.ResultsThe primary electronic search identified 1120 articles. Twenty-nine studies were finally included, enrolling 3944 subjects. Overall the studies included a median of 68.0% (45.5–100.0) of patients admitted to ICU. Ten studies (34.4%) were retrospective, and 20 (68.9%) single-centred. Overall enrolling 1367 subjects, three studies reported normal echocardiographic findings in 49 ± 18% of cases. Seven studies (24.1%) analyzed the association between echocardiographic findings and mortality, mostly related to right ventricular (RV) dysfunction.ConclusionsData regarding the use of echocardiography on hospitalized, predominantly ICU, COVID-19 patients were retrieved from studies with heterogeneous designs, variable sample sizes, and severity scores. Normal echocardiographic findings were reported in about 50% of subjects, with LVEF usually not affected. Overall, RV dysfunction seems more likely associated with increased mortality.Trial RegistrationCRD42020218439.

Point-of-care N-terminal pro B-type natriuretic peptide assay to screen apparently healthy cats for cardiac disease in general practice.

BackgroundPoint‐of‐care (POC) N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) ELISA test has been evaluated for screening cats for cardiac disease in the referral veterinary setting but less is known about its use in general practice (GP).ObjectivesTo evaluate the diagnostic utility of a POC NT‐proBNP ELISA in cats seen in GPs.AnimalsTwo hundred and seventeen apparently healthy cats from 21 GPs.MethodsThis was a prospective, cross‐sectional study. Cardiac auscultation and POC NT‐proBNP ELISA were done by veterinarians at their GPs. After enrollment at GPs, cats were sent to a cardiology referral hospital for cardiac auscultation and echocardiographic diagnosis. Results were interpreted based on whether cats had normal or abnormal echocardiographic findings.ResultsPoint‐of‐care NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 43%, specificity of 96%. In cats with a heart murmur at GPs, POC NT‐proBNP ELISA results differentiated cats in the abnormal group from those in the normal group with a sensitivity of 71% and a specificity of 92%.Conclusion and Clinical ImportanceIn apparently healthy cats in GPs, positive POC NT‐proBNP results are associated with heart disease, warranting an echocardiogram, but negative results do not reliably exclude heart disease. These results suggest POC NT‐proBNP is not an effective screening test for apparently healthy cats in GPs, although its performance is improved if it is used only in cats that have a heart murmur.

Mild fever in a patient with two mechanical prosthetic valves: Normal echocardiographic findings and poor microbial documentation: added value of 18F-FDG PET/CT imaging.

Mild fever in a patient with two mechanical prosthetic valves: Normal echocardiographic findings and poor microbial documentation: added value of 18F-FDG PET/CT imaging.

Decreased global strains of the left ventricle in asymptomatic female carriers for duchenne muscular dystrophy gene using feature-tracking: a prospective study

Abstract Background Duchenne muscular dystrophy (DMD) is an X-linked recessive disease manifested in males predominantly by skeletal muscle wasting but also dilated myocardium. Heterozygous female carriers often have normal echocardiographic findings. Nevertheless, untreated could develop in 4th and 5th decade of life to cardiomyopathy, probably due to progressive myocardial fibrosis. CMR feature tracking (FT) is an innovative technique that measures the myocardial wall deformation and could help to detect the contractile dysfunction, even in its early stages, due to its high sensitivity. Thus, it could identify asymptomatic carriers at higher risk of developing cardiomyopathy later in life. Aim This prospective study aimed to assess left ventricular systolic function (LV) in DMD carriers using CMR-FT. Methodology Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) were evaluated by CMR-FT. End-systolic (ESV), end-diastolic (EDV) LV volumes and ejection fraction (EF) LV were also measured using CMR-FT. There were 37 carriers, and 20 healthy controls enrolled in the study. The measured parameters showed a Gaussian distribution and were compared using a t-test, followed by Benjamini-Hochberg correction. Results Groups carriers and controls did not differ in basic demographic data (age: 39.5±9.1 vs. 39.1±10.7 years). In contrast, there were found statistically significant differences in EF LV (56±5 vs. 60±3%), and all strain parameters (GLS (−19.4±2.4 vs. −22.3±2.2%), GCS (26.8±3.3 vs. 29.5±2.0%) and GRS (59.8±12.9 vs. 70.9±14.8%, all p&amp;lt;0.05)). Conclusion Carriers had significantly lower values of all strains compared to controls using CMR-FT, although they had preserved EF LV. CMR-FT could be beneficial for early diagnosis of the developing heart disease in asymptomatic patients with a genetic predisposition. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The work was supported by project no. LQ1605 from the National Program of Sustainability II (MEYS CR).This publication was written at Masaryk University as part of the project “Evaluation of left ventricular function using the feature tracking technique of Duchenne muscular dystrophy genes carriers” MUNI/A/1493/2018 with the support of the Specific University Research Grant, as provided by the Ministry of Education, Youth and Sports of the Czech Republic in the year 2018.

Prevalence of different type of valvular heart disease and other cardiac pathologies of the heart in high risk patients with suspicion of heart failure. A retrospective cohort study.

Background: Valvular heart disease and other cardiac pathologies are associated with impending heart failure. An early diagnosis of these can help prevent the disabling ad disastrous effects and improve the prognosis. Aim: The prevalence of various pathologies associated with heart failure is not known. This study helps in recognizing various pathologies that can lead to heart failure, which if diagnosed early can improve the patient’s outcome. Materials and Methods: A total of 4560 patients were included in the study. All the patients were aged greater than 15 years. Patients with suspicion of heart failure on symptoms were ordered echocardiography. Transthoracic echo was done using echocardiography ultrasound machine using the British Society of Echocardiography guidelines. Echocardiography was done by registered sonologists. Echocardiograph were later read by cardiologists. Data was collected on Excel sheet. Echocardiographic results Of 9 690 patients, were admitted to the hospital during the year 2013 to year 2017 with the suspicion of heart failure based on symptoms echocardiogram was ordered. Among these 2448 patients had normal echocardiographic findings were as 4560 had valvular disease. Among the valvular disease patients 2951(64.71%) were females and 1609(35.2%) were males. Among these 2950(64.6%) had mild valvular disease 959(21.0%) had moderate valvular disease and 651(14.2) patients had severe valvular disease. Mitral stenosis occurred in 1200(26.3%) patients, mitral regurgitation in 2953(64.7%) patients, tricuspid stenosis in 40 (0.008%)patients ,tricuspid regurgitation in 1592(34.8%) patients, aortic stenosis in 81 (0.017%) patients and aortic regurgitation in 1957(42.9%) patients. Ischemic cardiomyopathy was present in 24 patients, dilated cardiomyopathy in 14 patients, rheumatic heart disease in 23 patients, ventricular septum defect in 5 patients ,Atrial septum defect in 2 patients , Apical aneurysm formation in 4 patients, Uremic cardiomyopathy on 3 patients, Grade 1 diastolic dysfunction in 2200 patients, Grade 3 diastolic dysfunction in 400 patients, Bicuspid aortic valve in 5 patients and restrictive cardiomyopathy in two patients, 1100 patients had a thin rim of pericardial effusion and were ordered Thyroid function tests. Conclusion: In the community heart failure is a common cause of death. Various pathologies of the heart are predictors of the outcome and hence early diagnosis can help in proper treatment and increased survival

An unusual cause of ventricular fibrillatory arrest.

Myocarditis is an important cause of arrhythmogenic sudden cardiac arrest in the young. A strong index of suspicion is required as not only can arrhythmias be the only clinical manifestation but also because these patients can have normal cardiac biomarkers, electrocardiographic and echocardiographic findings, and inflammatory markers. Patients with ventricular arrhythmias in the setting of viral myocarditis, especially the ones in whom cardiac MRI findings normalise upon follow-up, tend to do well in the long run and an implantable cardioverter-defibrillator should be avoided in these patients; instead, a wearable defibrillator should be temporarily used as we did in this 7-year-old.