Journal of Cardiovascular Echography最新文献

Lipomatous hypertrophy of the interatrial septum (LHIS) is a histologically benign cardiac lesion that is defined by excessive fat accumulation in the area of the interatrial septum (IAS) that does not include the fossa ovalis. Another unusual illness is lipomatosis, which is defined as a broad overgrowth of mature adipose tissue that involves a large portion of an extremity or trunk. We describe a rare case with significant LHIS accompanied by subcutaneous lipomatosis. Echocardiography revealed a mass in the right atrium in this patient. Magnetic resonance imaging revealed that this mass was composed of the adipose tissue and was an extension of a huge thickened IAS. Furthermore, this significant hypertrophy of the IAS was in direct continuation with the excessive mediastinal and epicardial fat.

The Chiari network is a common benign finding usually found incidentally in the right atrium (RA). This lesion frequently coexists with patent foramen ovale (PFO). Although the Chiari network is diagnosed easily and has no clinical importance, sometimes, the accurate diagnosis becomes hard and the lesion itself, or with PFO, can lead to clinical events. Accordingly, cardiologists should consider the Chiari network and its differential diagnosis in the evaluation of RA masses.

Background: The Severe acute respiratory syndrome coronavirus 2, is the pathogen that causes COVID-19. Cardiovascular (CV) involvement during this infection, has been related to adverse outcomes. Interestingly, some patients may remain symptomatic beyond the first 14 days of disease diagnosis. Although a particular reduction on left ventricular (LV) global longitudinal strain (GLS) in basal segments has been recently described in patients hospitalized with diagnosis of COVID-19, the correlation of these findings with the persistence of symptoms has not been determined.

Objectives: The objective of this study is to describe echocardiographic findings in patients recovered from COVID-19 and to determine its association with persistent dyspnea.

Methods: Seventy-six patients were analyzed. Forty-six were asymptomatic (group N°1) and 30 referred persistent dyspnea at the time of examination (group N°2), and a cohort of 25 healthy individuals was included as a control group. Total LV GLS, average basal LV GLS, and average mid-apical LV GLS were assessed. Basal-mid-apical index (BMAI) was calculated. A difference in BMAI bigger than 15% between both groups was stablished as cutoff point.

Results: Nonsignificative differences on standard echocardiographic measurements were found between the analyzed groups. When compared to the control group, there was nonsignificative reduction on basal LV GLS values in patients with persistent dyspnea. However, BMAI values were bigger than 15% in 70% of patients from group N°2 but in none of the patients from the control group ( = 0.0002).

Conclusions: This new index allowed to identify an abnormal relation in LV GLS values between basal and medium-apical segments among patients recovered from COVID-19 and persistent dyspnea.

Membranous ventricular septal aneurysm (VSA) is an uncommon cardiac abnormality, potentially leading to several cardiac complications such as aortic valve prolapse, arrhythmias, and aneurysm rupture. A young competitive soccer player presented for a post-COVID sports cardiology assessment, denying any previous cardiological evaluations. On transthoracic echocardiography, a membranous VSA was incidentally found with no other cardiac abnormality nor hemodynamic impairment associated. A well-oriented anamnesis guided by echocardiographic findings revealed that a ventricular septal defect was diagnosed at birth with spontaneous closure at 4 years old. From that moment, no further follow-up was performed. Before granting cardiological approval to competitive sport, transesophageal echocardiography and Holter electrocardiogram were performed to confirm the absence of interventricular shunt and any other cardiac abnormality or arrhythmias associated with VSA. This case highlights the value of an accurate and comprehensive clinical and echocardiographic evaluation when performing a cardiological sports assessment, even in a young asymptomatic athlete.

Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of cardiac valves that is most commonly seen in advanced malignancy. We describe a case report of a 63-year-old male with NBTE and multiple embolizations (encephalic, coronary, splenic, and renal). The patient was admitted to the emergency department for stroke. During hospitalization, the patient complained of left leg pain and a venous echo color Doppler of the lower limbs was performed, showing bilateral distal deep-vein thrombosis. A thoracoabdominal computed tomography scan, which was performed to rule out pulmonary embolism, revealed a primary lung cancer and subcarinal lymphadenopathy. As collateral findings, multiple ischemic lesions in the spleen and in both kidneys were identified. In addition, areas of subendocardial hypodensity compatible with ischemia were also highlighted. An electrocardiogram showed acute myocardial infarction and focused echocardiographic evaluation displayed hypokinesis of the lateral and posterior in the mid- and distal segments and aortic and mitral valve vegetations, confirmed by a transesophageal echocardiography. Empiric antimicrobial therapy was started; all blood culture sets were negative and the patient was apyretic throughout the hospitalization. These findings supported the hypothesis of NBTE with multiple embolizations during a hypercoagulable state associated with advanced lung cancer.

Isolated pulmonic valve infective endocarditis (PV-IE) is a rare form of endocarditis. The authors report a case of giant vegetations detected by transthoracic echocardiography (TTE) on PV in a young patient, 33-year-old, with drug abuse history. The patient underwent surgical intervention by pulmonary valved bioconduit implantation. After operation, a pulmonary embolism episode was treated by a direct oral anticoagulant. The final outcome was favorable. The difficulty in diagnosing PV-IE is due to the inability to properly visualize the PV by echocardiography. In this case, with such large vegetations, TTE allowed a correct diagnosis and an effective surgical planning, confirming its importance as a diagnostic tool.

Rheumatic heart disease is the most common valvular heart disease in developing countries. Recurrent syncope due to a large, free-floating left atrial thrombus is a rare presentation of rheumatic mitral stenosis. We report this uncommon finding on echocardiogram in an elderly woman presenting to the emergency department with giddiness for the past few months.

Background: Left atrial (LA) reservoir strain provides interesting information about left ventricular (LV) filling pressure. However, the advantages of atrial reservoir strain in comparison with conventional parameters in patients with myocardial infarction are not clear yet.

Methods: Fifty patients with ST-elevation myocardial infarction (STEMI) prospectively underwent echocardiographic assessment of LV systolic and diastolic function by conventional parameters and two-dimensional speckle tracking longitudinal strain of left atrium. LV filling pressure was estimated by brain natriuretic peptide (BNP) levels.

Results: Systolic and conventional diastolic parameters did not show significant differences between patients with increased and normal BNP values, whereas LA reservoir strain was reduced (33.1 ± 8% vs. 46.5 ± 9.8%; P = 0.001) in patients with higher BNP levels. LA reservoir strain had higher area under curve value (0.880) than the other parameters in identifying patients with elevated BNP and a cut-off value of 40.5% reached sensitivity and specificity values of 93% and 86% and positive and negative predictive values of 92% and 85%. LA reservoir strain reclassified 23 patients with increased BNP values, which were previously estimated to have normal (16 patients) and undeterminable LA pressure (seven patients) by using the recommended algorithm for diastolic function.

Conclusions: LA reservoir strain is a useful tool for the evaluation of diastolic function and seems to be more sensitive than conventional parameters in the detection of subtle increase of LV filling pressure in patients with STEMI. It allows physicians to reclassify patients with undeterminable diastolic function according to conventional algorithm.

The aim of the study was to evaluate the application of global longitudinal strain (GLS) and myocardial work (MW) at rest and during exercise in healthy sedentary or trained participants, to test their ability to improve echocardiographic information and to complement prescribing exercise, cardiac screening, or rehabilitation programs.

Methods: Thirty healthy males were divided into three groups of 10, sedentary (G1), resistance (G2) and power (G3) athletes, underwent a standard clinical evaluation protocol and exercise stress testing echocardiography.

Results: During stress, all showed increased left ventricular ejection fraction and mitral annulus tissue Doppler (E'). G1 showed a decrease in left atrial volume (LAVi) as opposed to an increase in G3. E/E 'a decrease in G2, unlike the increase in G3. All groups showed increase of Strain (GLS average AV, Longitudinal LS, Medio-Basal MB Apical AP), global constructive work (GCW), and Global wasted work. G1 showed increase for global work efficiency, G2 and G3 for global work index (GWI). G3 showed a greater variation of E/E', LAVi, GWI and GCW compared to G1 and G2, greater of GLS AV, LS-AP compared to G2. Only G3 showed differences for GLS AV versus LS-AP. The relative regional strain ratio showed a greater value in G3 versus G1 at the end of stress compared to rest.

Conclusions: The new echocardiographic applications to study the physiological adaptation could open new perspectives for the diagnostic and therapeutic development through the prescription of personalized exercises and screening and follow-up of the early pathological changes of the athlete's heart.

Primary tumors of the heart are extremely rare. The most common is the left atrial myxoma. This article presents a case of large asymptomatic left atrial myxoma in an 80-year-old woman. The patient was admitted to the hospital emergency department after a traffic accident. After a performed trauma scan and an echocardiographic examination, a diagnosis of asymptomatic left atrial myxoma was made. The patient was discharged from the hospital with a referral for a consultation at a cardiac surgery center, which the patient did not attend. The treatment of choice for myxomas is surgical removal. The detection of a myxoma usually is considered as an emergency however the tumor described here has the characteristics of myxoma in the complication-free phase. Given the patient's age, reluctance to undergo invasive surgery, and tumor characteristics, it seems that abandoning invasive management in favor of monitoring the patient's condition may be the preferred therapy.