Transthoracic Echocardiography Findings Research Articles

Clinical characteristics and long-term outcome of patients with bioprosthetic mitral valve- Experience from a South Asian country.

Due to rheumatic heart disease, young people are more likely to develop valvular heart disease in developing countries. In countries like Pakistan, surgeons implant more bioprosthetic mitral valves (MVs) in younger patients. However, bioprosthetic valves degenerate rapidly in younger people, leading to bioprosthetic MV dysfunction (BMVD). This study aims to evaluate the clinical characteristics and long-term outcomes of patients with bioprosthetic MV replacement (MVR) at a tertiary care hospital in a South Asian country. This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bioprosthetic MVR from the year 2006 to 2020. Clinical and surgical characteristics along with transthoracic echocardiographic findings (pre-surgery and recent most follow-up studies) were noted. Follow-up data were also collected. Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. MVR was done as an elective procedure due to the New York Heart Association (NYHA) II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 ± 2.99 years, BMVD was observed in 183 (36.5%) patients. However, re-do MV surgery was done in only 49 (9.8%) patients. Patients were divided into two groups based on normal functioning bioprosthetic MV and BMVD. Comparing the two groups, individuals with normal functioning bioprosthetic MV had a mean age of 51.6 ± 14.27 years, while those with BMVD had a mean age of 45.639 ± 14.33 years at the time of index surgery (P = 0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%), and death (n = 6, 3.28%) in the BMVD group which were statistically significant. This study is distinct because it demonstrates the outcomes of bioprosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bioprosthetic valve in younger patients, significant number of patients developed BMVD along with poor long-term clinical outcomes, even at a short follow-up period of <10 years. These findings are similar to international data and signify that mechanical MVR may be a more reasonable alternative in younger patients.

Clinical Characteristics and Outcomes Associated With Distinct Hemodynamic Patterns in End-stage Liver Disease: A Retrospective Cohort Analysis

IntroductionDespite advances in the diagnosis and therapeutics strategies for pulmonary hypertension (PH) in patients with end-stage liver disease (ESLD), the impact of hemodynamic patterns among ESLD patients identified through right heart catheterization (RHC) on clinical outcomes remains poorly understood. MethodsThis single-center retrospective cohort study identified patients diagnosed with ESLD who underwent RHC from August 2018 to June 2023. Demographic and clinical data, including comorbidities, transthoracic echocardiography, and RHC findings, were obtained. Our outcomes of interest were all-cause mortality and the chance of receiving orthotopic liver transplantation (OLT) within a year after RHC. Kaplan-Meier with log-rank test was employed to generate survival curves. ResultsWe identified 415 ESLD patients with the RHC results. The median (IQR) age was 59 years (52-66), and 62% were male. Caucasians accounted for 43%, followed by African Americans (30%). Up to 89% had a diagnosis of portal hypertension. Median MELD-Na score was 30 (19-36). The etiology of ESLD was mainly from alcohol use (55%). Patients were classified based on RHC results as pre-capillary PH (19%), post-capillary PH (28%), and non-PH (53%) groups. Overall, one-year mortality post-RHC was 22%, with no significant difference in mortality regardless of hemodynamic group. However, the pre-capillary PH group was less likely to receive OLT compared to other groups (p<0.001). ConclusionWe observed no difference in all-cause mortality among hemodynamic groups. However, pre-capillary PH group were less likely to undergo OLT compared to others. Further investigations are necessary to determine how this should be addressed in clinical practice.

Impact of Stress Echocardiography on Aortic Valve Stenosis Management.

Rest and stress echocardiography (SE) play a fundamental role in the evaluation of aortic valve stenosis (AS). According to the current guidelines for the echocardiographic evaluation of patients with aortic stenosis, four broad categories can be defined: high-gradient AS (mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s, aortic valve area (AVA) ≤ 1 cm2 or indexed AVA ≤ 0.6 cm2/m2); low-flow, low-gradient AS with reduced ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm2, left ventricle ejection fraction (LVEF) < 50%, stroke volume index (Svi) ≤ 35 mL/m2); low-flow, low-gradient AS with preserved ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm2, LVEF ≥ 50%, SVi ≤ 35 mL/m2); and normal-flow, low-gradient AS with preserved ejection fraction (mean gradient < 40 mmHg, AVA ≤ 1 cm2, indexed AVA ≤ 0.6 cm2/m2, LVEF ≥ 50%, SVi > 35 mL/m2). Aortic valve replacement (AVR) is indicated with the onset of symptoms development or LVEF reduction. However, there is often mismatch between resting transthoracic echocardiography findings and patient's symptoms. In these discordant cases, SE and CT calcium scoring are among the indicated methods to guide the management decision making. Additionally, due to the increasing evidence that in asymptomatic severe aortic stenosis an early AVR instead of conservative treatment is associated with better outcomes, SE can help identify those that would benefit from an early AVR by revealing markers of poor prognosis. Low-flow, low-gradient AS represents a challenge both in diagnosis and in therapeutic management. Low-dose dobutamine SE is the recommended method to distinguish true-severe from pseudo-severe stenosis and assess the existence of flow (contractile) reserve to appropriately guide the need for intervention in these patients.

COVID-19 sequelae on transthoracic echocardiography findings in pediatric patients with septal congenital heart disease: A retrospective comparative analysis

COVID-19 sequelae on transthoracic echocardiography findings in pediatric patients with septal congenital heart disease: A retrospective comparative analysis

Role of Vascular Function in the Prognosis of Heart Failure Patients.

Background: Blood vessels have the Windkessel effect and are involved in blood circulation. The breakdown of this mechanism is also involved in the pathogenesis of heart failure (HF); however, the relationship between vascular dysfunction and HF prognosis is not fully understood. Methods: We evaluated 214 patients hospitalized for HF at our institution who underwent a cardio-ankle vascular index (CAVI), which evaluates vascular function, between January 2012 and July 2018. To investigate factors (including CAVI) associated with major adverse cardiac events (MACE) during 1 year after patients with HF were discharged, we evaluated clinical profiles, blood tests, chest X-P, 12-lead electrocardiography, and transthoracic echocardiographic findings. MACE was defined as cardiovascular death or readmission for HF. Results: The severity of HF between the MACE and non-MACE was not significantly different. Previous HF and chronic kidney disease were significantly more common in the MACE group. CAVI and % mean atrial pressure in the MACE group were statistically higher than those in the non-MACE group. The cardiac shadow as shown by chest X-P and left ventricular size in the MACE group were significantly bigger, and HF preserved ejection fraction (EF) (EF > 50%) was significantly more common in the MACE group. In multivariate analysis, CAVI was an independent predictive factor for the occurrence of MACE (model 1; hazard ratio (HR): 1.33, 95% confidence interval (CI): 1.05-1.68, p = 0.018; model 2; HR: 1.31, 95% CI: 1.07-1.60, p = 0.009). Conclusions: Because high CAVI is associated with poor prognosis of HF, these patients require more careful treatment.

Radiological Imaging and Analysis of Laboratory Values in Case of Acute Ischemic Stroke

Background: The rate of death and disability due to acute ischemic stroke ranks second in the world. In this study it was planned to analyze the demographic characteristics and additional diseases in the etiology as well as radiological imaging and laboratory values in patients with ischemic stroke. Materials and Methods: This study was conducted retrospectively by analyzing the patients hospitalized with the diagnosis of ischemic stroke from the emergency department between 01.01.2022 and 31.12.2022. Routine laboratory values, lipids, vitamin levels, radiological imaging and tests for etiology were analyzed in the patients. Results: One hundred seventy seven patients were analyzed in the study. 53.1% of the patients were male. The mean age was 75±12.75 years. The most common comorbidities were hypertension, diabetes and hyperlipidemia. As ischemic infarction, involvement was most common in the areas fed by the middle cerebral artery. In the carotid and/or vertebral doppler ultrasonography performed in the patients, plaque was observed in the vessels at a rate of 83.1%. According to the transthoracic echocardiographic findings, 79.3% of the patients were found to have heart valve pathology. Pathologically the majority of patients had hyperglycemia, vitamin D deficiency and low HDL cholesterol levels. Thrombolytic therapy was applied in six patients and three patients benefited and one patient died due to bleeding. 13.6% of the patients were treated in the intensive care unit. Conclusion: The risk of ischemic stroke increases in advanced age. Hypertension and diabetes are among the most important risk factors. Vitamin D and vitamin B12 deficiency and folic acid deficiency pose a risk in terms of atherosclerosis. At the same time, low HDL cholesterol levels increase the risk of stroke. These factors which are considered as preventable causes in etiology should be controlled with treatment.

701 Effect of Methamphetamine Use on Transthoracic Echocardiographic Findings in Burn Patients

701 Effect of Methamphetamine Use on Transthoracic Echocardiographic Findings in Burn Patients

How to use MRI in cardiac disease with diastolic dysfunction?

Left ventricular (LV) diastolic dysfunction (DD) is an initially asymptomatic condition that can progress to heart failure, either with preserved or reduced ejection fraction. As such, DD is a growing public health problem. Impaired relaxation, the first stage of DD, is associated with altered LV filling. With progression, reducing LV compliance leads to restrictive cardiomyopathy. While cardiac magnetic resonance (CMR) imaging is the reference for LV systolic function assessment, transthoracic echocardiography (TTE) with Doppler flow measurements remains the standard for diastolic function assessment. Rather than simply replicating TTE measurements, CMR should complement and further advance TTE findings. We provide herein a step-by-step review of CMR findings in DD as well as imaging features which may help identify the underlying cause.

Abstract TP259: Slower Early Mitral Inflow Velocity and Lesion in Anterior Circulation is Associated With Right-to-Left Shunt in Embolic Stroke of Undetermined Source Right-to-Left Shunt in Embolic Stroke of Undetermined Source

Background and Purpose: Right-to-left shunt (RLS) is one of the potential embolic sources in embolic stroke of undetermined source (ESUS), but the eligibility of conducting shunt study to detect RLS in ESUS is still unknown. To reveal clinical features associated with RLS in ESUS, we aimed to compare clinical features including transthoracic echocardiography findings and imaging findings with and without RLS in ESUS. Methods: Consecutive ischemic stroke patients in a comprehensive stroke center were screened between April 2013 and April 2023. Inclusion criteria were: 1) who fulfilled the ESUS criteria based on NAVIGATE-ESUS trial, 2) who underwent transesophageal echocardiogram, and 3) admitted 7 days from the onset. We compared clinical features, including transthoracic echocardiography findings and imaging findings such as lesion characteristics (size, cortical or subcortical, and anterior or posterior), between ESUS patients with RLS (RLS-ESUS) and without RLS (non RLS-ESUS). Results: We screened 2,304 consecutive ischemic stroke patients, including 225 ESUS patients (166 [74%] male, median age 64 years old). Of all, 76 patients had RLS (59 [78%] male, median age 62 years old, Figure A). RLS-ESUS showed higher frequency of anterior circulation lesion (RLS-ESUS vs. non RLS-ESUS; 84% vs. 71%, p = 0.035), slower early mitral inflow velocity (E) (51.6 vs. 54.9 cm/s, p = 0.021). In multivariable analysis, E (OR 0.83, 95%CI0.70-0.99, p = 0.037) and anterior circulation lesion (OR 2.23, 95%CI 1.08-4.62, p = 0.036) were independently associated with RLS-ESUS (Figure B). Conclusions: In ESUS patients, slower early mitral inflow velocity and lesion in anterior circulation was associated with RLS, suggesting shunt study should be conducted to reveal RLS in such patients.

Diabetes mellitus is associated to high-risk late gadolinium enhancement and worse outcomes in patients with nonischemic dilated cardiomyopathy

BackgroundDiabetes mellitus (DM) is associated with a worse prognosis in patients with heart failure. Our aim was to analyze the clinical and imaging features of patients with DM and their association with outcomes in comparison to nondiabetic patients in a cohort of patients with nonischemic dilated cardiomyopathy (DCM).MethodsThis is a prospective cohort study of patients with DCM evaluated in a tertiary care center from 2018 to 2021. Transthoracic echocardiography and cardiac magnetic resonance findings were assessed. A high-risk late gadolinium enhancement (LGE) pattern was defined as epicardial, transmural, or septal plus free-wall. The primary outcome was a composite of heart failure hospitalizations and all-cause mortality. Multivariable analyses were performed to evaluate the impact of DM on outcomes.ResultsWe studied 192 patients, of which 51 (26.6%) had DM. The median left ventricular ejection fraction was 30%, and 106 (55.2%) had LGE. No significant differences were found in systolic function parameters between patients with and without DM. E/e values were higher (15 vs. 11.9, p = 0.025), and both LGE (68.6% vs. 50.4%; p = 0.025) and a high-risk LGE pattern (31.4% vs. 18.5%; p = 0.047) were more frequently found in patients with DM. The primary outcome occurred more frequently in diabetic patients (41.2% vs. 23.6%, p = 0.017). DM was an independent predictor of outcomes (OR 2.01; p = 0.049) and of LGE presence (OR 2.15; p = 0.048) in the multivariable analysis. Patients with both DM and LGE had the highest risk of events (HR 3.1; p = 0.003).ConclusionDM is related to a higher presence of LGE in DCM patients and is an independent predictor of outcomes. Patients with DM and LGE had a threefold risk of events. A multimodality imaging approach allows better risk stratification of these patients and may influence therapeutic options.

CT and transthoracic echocardiographic findings of cardiac rhabdomyosarcoma in an adult: a case report

CT and transthoracic echocardiographic findings of cardiac rhabdomyosarcoma in an adult: a case report

Comparison of lung ultrasonography, transthoracic echocardiography and clinical findings in assessing volume status in patients receiving renal replacement therapy

While transthoracic echocardiography and clinical findings are used to assess body volume status, lung ultrasonography (LUS), which is a non-invasive method, has also been used in assessing hypervolemia in recent years. This study aims to compare LUS, transthoracic echocardiography (TTE) and clinical findings in the assessment of body volume status in patients receiving renal replacement therapy (RRT). The study included 99 subjects who received RRT and were followed-up in our hospital. The patients were randomly selected from kidney transplant patients and those who had been receiving peritoneal dialysis (PD) or hemodialysis (HD) for at least the past three months. In addition, a control group consisting of 52 healthy subjects was also enrolled. LUS and TTE were simultaneously performed (within 24 hours). The mean left atrial (LA) diameter was 37.8±2.7 mm, 37.9±3.4 mm, 38.6±3.5 mm and 29.0±4.4 mm in patients who received PD, kidney transplantation, HD and in the control group, respectively. There was a moderate positive correlation between the total number of B-lines and LA diameter (mm) in the combined group consisting of the patient and control groups (p=0.0001, r=0.286). In this study, the number of B-lines on LUS has been found to be higher in patients receiving renal replacement therapy due to the effect of hypervolemia compared to the control group. However, there was no statistically significant difference in terms of the number of B-lines and LA diameter in echocardiography.

Factors associated with acute kidney injury in patients undergoing transcatheter aortic valve implantation: Short-term outcomes and impact of right heart failure.

Transcatheter aortic valve implantation (TAVI) was developed as an alternative to surgery for symptomatic, high-risk patients with severe aortic stenosis (AS). Acute kidney injury, a major complication of TAVI, is associated with a poor prognosis. In our study, we planned to investigate the effect of right heart failure on the development of acute kidney injury after TAVI and other factors contributing to the development of AKI. Between January 2015 and December 2020, 198 patients who underwent TAVI due to severe symptomatic aortic stenosis at Dr. Siyami Ersek Cardiovascular Surgery Hospital were screened. Local ethics committee approval was obtained (HNEAH-KAEK 2021/134-3343). Transthoracic echocardiographic findings and laboratory evaluations were recorded. Patients were evaluated according to Acute Kidney Injury Network (AKIN) criteria. The rate of AKI after TAVI was found to be 41.9%. The mean age of patients who developed AKI was higher (80.90±6.8). AKI development rates were higher in the female gender (68.7%) and patients with hypertension (44.8%). It was observed that the risk of developing AKI was higher in patients who underwent TAVI and developed AKI afterwards, especially in patients with stage-3 and stage-4 advanced CKD before TAVI (p<0.01) We did not find an independent relationship between AKI and right-heart failure in our analysis. We observed that chronic kidney disease before TAVI, advanced age, and female gender are important determinants of the development of AKI after TAVI. Although a relationship between TAVI and right heart failure has not been demonstrated, large-scale studies are needed in the future.

Comparison of the Early Results of Supra-Annular and Intra-Annular Aortic Valve Replacement in Isolated Aortic Valve Replacement.

This study aims to compare the early results of patients who underwent isolated aortic valve replacement (AVR) with supra-annular and intra-annular AVR. Between 2013 and 2019, 113 patients (77 males; mean age 57.8±16.36 years) who underwent isolated AVR were evaluated. The patients were divided into two groups those who underwent supra-annular (n=59) and intra-annular (n=54) AVR. The most commonly used valves in surgeries St Jude Medical Masters (St. Jude Medical, Minneapolis, MN, USA), (n=35, 30.9%), Sorin Mitroflow (Sorin Group Inc., Mitroflow Division, Canada), (n=32, 28.3%, and Carbomedics Top Hat (Sulzer, Carbomedics, Austin, TX), (n=31, 27.4%). The cross-clamp (XCL) and cardiopulmonary bypass (CPB) times of the patients who underwent supra-annular AVR were found to be significantly higher than the patients who underwent intra-annular AVR. However, there was no significant difference between the two groups in terms of postoperative adverse events. There was no significant difference between the two groups in the postoperative first-week transthoracic echocardiographic (TTE) findings. When comparing supra-annular and intra-annular valve positioning results in patients undergoing isolated AVR, no significant difference was found between the groups in terms of postoperative complications, gradient differences in postoperative TTE, and ejection fractions. Supra-annular valve positioning should be considered, especially in patients with small annulus, in the presence of suitable anatomical features. However, this issue needs to be investigated in future prospective studies with more patients.

Aortic regurgitation in athletes: the challenges of echocardiographic interpretation

BackgroundBicuspid aortic valve (BAV) is the most common congenital cardiac defect and prone to premature degeneration causing aortic regurgitation (AR). The assessment of AR in athletic individuals poses several challenges as the pathological left ventricle (LV) remodelling caused by AR may overlap with the physiological remodelling of intense exercise. The purpose of this study is to highlight these challenges, review the existing literature and discuss how to tackle these conundrums. As a real-world example, we compare the resting transthoracic echocardiographic (TTE) findings in a cohort of individuals with BAV and AR, sub-grouped into “highly active” or “lightly active”.MethodsAdult male subjects with an index TTE performed at a tertiary referral centre between 2019 and 2022 were included if the TTE confirmed a BAV and at least moderate AR. Further strict inclusion criteria were applied and parameters of valve disease severity was made in accordance with existing guidelines. Subjects completed a physical activity questionnaire over the telephone, and were classified into either group 1: “highly active” or group 2: “lightly active” based on their answers. Demographics and TTE parameters were compared between the two groups.Results30 male subjects (mean age 44 ± 13 years) with BAV-AR were included – 17 were highly active, and 13 lightly active. There was no significant difference in age (group 1, 45 ± 12.7 years vs. group 2, 42 ± 17 years; p = 0.49), height (p = 0.45), weight (p = 0.268) or severity of AR, when quantitative assessment was possible. Group 1 had a significantly higher stroke volume (131 ± 17mls vs. 102 ± 13 mls; p = 0.027), larger LV volumes, diastolic dimensions and significantly larger bi-atrial and right ventricular size. This LV dilatation in the context of AR and athleticism poses a diagnostic and management conundrum. Despite this, none of these 17 highly active individuals demonstrated any of the traditional criteria used to consider surgery.ConclusionThere is significant overlap between the physiological adaptations to exercise and those caused by AR. Multi-modality imaging and stress testing can aid clinicians in diagnostic and management decisions in exercising individuals when there is discordance between AR severity and symptoms.

Prevalence of pulmonary hypertension in chronic simple silicosis patients and its correlation with smoking history, occupation type, age and duration of silica exposure.

Silicosis is a preventable occupational health hazard with potential for permanent physical disability and increased socio-economic burden. Pulmonary hypertension (PH) secondary to chronic respiratory diseases signifies poorer prognosis and transthoracic echocardiography (TTE) has proven its usefulness as a screening tool for PH diagnosis. The objectives were to determine PH prevalence in chronic simple silicosis patients through TTE screening and correlate PH prevalence with smoking status, occupation type, age and duration of silica exposure (DSE). We enrolled 104 patients in the study based on occupational exposure to silica dust and radiologic confirmation of chronic simple silicosis. The study sample was divided into significant smokers (SS group) and insignificant smokers (InS group) on the basis of ≥10 pack years smoking history, and into drillers and dressers based on occupation type. TTE examination was performed to measure resting mean pulmonary artery pressure (mPAP) and the patients were classified into: no PH (mPAP≤20 mm Hg), borderline PH (mPAP>20 and <25 mmHg), and PH (mPAP≥25). PH prevalence was 25% in study subjects (26/104); 29.6% (16/54) among SS group versus 20% (10/50) among InS group (.52) ; and 34.2% (14/41) among drillers versus 19.1% (12/63) among dressers (p=.024). Mean age and mean duration of silica exposure among SS and InS groups were comparatively similar, while they had lower values among dressers against dressers with no statistical significance. Logistic regression analysis established a significant association of PH prevalence with higher age in the study sample, SS group and drillers group, while a significant association of PH prevalence with longer DSE was only seen in the study sample. PH prevalence was significantly associated (p=.007) with SS-driller group on comparing TTE findings with combined smoking and occupation type based groups. This study has shown PH prevalence in chronic simple silicosis patients at alarming levels, having associations with driller occupation, older age and longer DSE with varying results among groups and complex interplay with smoking exposure, suggesting the need for large sample-based molecular and genetic studies. Including TTE in the initial work-up of silicosis patients will promote timely intervention and reduce morbidity and mortality with a high benefit-cost ratio.

Feasibility of transcatheter device closure of secundum atrial septal defect under transthoracic echocardiography guidance.

Objective: To determine the usefulness and safety of transthoracic echocardiography (TTE) imaging for real time guidance in transcatheter device closure of atrial septal defect (ASD) secundum. Study Design: Cross-sectional study. Setting: Department of Paediatric Cardiology, CPEIC, Multan, Pakistan. Period: January 2022 to December 2023. Material &amp; Methods: Patients of both genders aged above 3 years with clinical and echocardiographic evidence of ASD secundum with significant left to right shunt were analysed. All cases had morphologically suitable margins of defect confirmed on TTE. Usefulness and safety of intra-procedure and immediate post-procedure transcatheter device closure of secundum ASD were noted. Results: In a total of 34 patients, 20 (58.8%) were female and 14 (41.2%) male. The mean age was 21.32±17.21 years. The TTE findings revealed that the mean ASD side was 17.47±4.32 mm. Aortic margins were deficient among 28 (82.4%) cases. The mean fluoroscopy and procedure time were 9.29±6.98 minutes and 49.91±39.76. Residual leak was noted in one (2.9%) cases while none of the cases were observed to have superior vena cava, inferior vena cava or pulmonary vein obstructions. Post-procedure, transient supraventricular tachycardia (SVT) arrhythmia was the most common type of complication reported among 2 (5.9%) cases. None of the cases needed any kind of emergency surgical exploration. No cases of pericardial effusion were found. No mortality was reported. Conclusion: Transcatheter device closure of secundum atrial septal defect was found to be effective and safe using TTE.

Clinical Outcomes of Acute Chest Syndrome in Patients with Sickle Cell Disease and Pulmonary Hypertension

Introduction: Sickle-cell disease (SCD) is an inherited hemoglobinopathy frequently complicated by vaso-occlusive episodes (VOE) and acute chest syndrome (ACS). Likely due to chronic hemolysis and inflammation, roughly 10% of patients with SCD develop pulmonary hypertension (PH) (Gordeuk et al., 2016). Early signs of PH in patients with SCD often present as elevated pulmonary pressures and right ventricular (RV) dysfunction, which could be exacerbated by VOE or ACS (Dessap et al., 2007). Multiple studies have shown that ACS and PH are individually established causes of increased mortality in patients with SCD, but less is known about the relationship between concurrent ACS and PH and the effects on clinical outcomes. The diagnostic criteria for PH were recently updated, and the impact of those changes on outcomes in SCD remain unknown. We sought to evaluate clinical outcomes in patients with SCD who met PH diagnostic criteria when hospitalized for ACS. Methods: We retrospectively collected clinical information from the electronic medical record (EMR) for all ACS admissions from 2017-2021 at the University of Chicago. Patients were assessed if they met PH diagnostic criteria based on available right heart catheterization (RHC) and transthoracic echocardiography (TTE) reports prior to the ACS admission date. PH was defined as having a mean pulmonary artery pressure &amp;gt;20 mmHg on RHC, tricuspid regurgitation velocity (TRV) &amp;gt;3.4 m/s, or TRV 2.9-3.4 m/s with two additional concerning TTE findings. ACS was defined as a new pulmonary opacity on imaging and at least one diagnostic symptom such as fever, chest pain, or hypoxemia. Depending on frequencies, chi-square or Fisher's exact tests were used to assess associations between PH and clinical outcomes: intensive care unit (ICU) transfer within 8 days of ACS diagnosis, 28-day readmission, and 28-day mortality. Two-sample t-test was used to assess the association between length of stay (LOS) and PH. Results: There were 231 ACS admissions from 2017-21, but 1 admission was excluded from analysis due to lack of past medical history within the EMR. In total, 10 out of 230 ACS admissions (4%) met PH diagnostic criteria prior to admission, comprised of 8 out of 127 patients (6%). There were no significant associations between PH and clinical outcomes except for LOS (14.5 days for PH vs 9.1 days for no PH, p=0.04). Conclusions: If a patient with SCD and PH was admitted for ACS, their LOS was 5 days longer than a patient without PH. An increased LOS may be due to a higher degree of complications such as elevated pain scores, prolonged oxygen requirements, or greater hemodynamic compromise. Future directions of the study will assess for causes of an increased LOS in the setting of PH. Only 6% of this cohort of patients with ACS admissions had PH, and this was likely under identified due to lack of adequate work-up (RHC or TTE). Diagnosis of PH prior to ACS admission may help with future prognostication and clinical decision-making regarding early intervention. The study highlights the increased healthcare requirements accompanying PH and a continued need to study PH, specifically in patients with SCD who may be at high risk for adverse clinical outcomes during an ACS episode.

Noninvasive Hemodynamic Characterization of Shock and Preshock Using Echocardiography in Cardiac Intensive Care Unit Patients.

Shock and preshock are defined on the basis of the presence of hypotension, hypoperfusion, or both. We sought to determine the hemodynamic underpinnings of shock and preshock noninvasively using transthoracic echocardiography (TTE). We included Mayo Clinic cardiac intensive care unit patients from 2007 to 2015 with TTE within 1 day of admission. Hypotension and hypoperfusion at the time of cardiac intensive care unit admission were used to define 4 groups. TTE findings were evaluated across these groups, and in-hospital mortality was evaluated according to TTE findings in each group. We included 5375 patients with a median age of 69.2 years (36.8% women). The median left ventricular ejection fraction was 50%. Groups based on hypotension and hypoperfusion were assigned as follows: no hypotension or hypoperfusion, 59.7%; isolated hypotension, 15.3%; isolated hypoperfusion, 16.4%; and both hypotension and hypoperfusion, 8.7%. Most TTE variables of interest varied across these groups, with worse biventricular function, lower forward flow, and higher filling pressures as the degree of hemodynamic compromise increased. In-hospital mortality occurred in 8.2%, and inpatient deaths had more TTE parameter abnormalities. In-hospital mortality increased with the degree of hemodynamic compromise, and a marked gradient in in-hospital mortality was observed when the clinical classification of shock and preshock was combined with TTE findings reflecting worse biventricular function, lower forward flow, or higher filling pressures. Substantial differences in cardiac function are observed between cardiac intensive care unit patients with preshock and shock using TTE, and the combination of the clinical and TTE hemodynamic assessment provides robust mortality risk stratification.

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