Journal of Cardiovascular Echography最新文献

Cardiac calcified amorphous tumors (CAT) are rarely encountered nonneoplastic tumors that may arise within any cardiac chamber. Involvement of the mitral valve causing pathology is even less frequently reported. We report the case of a CAT arising on the posterior mitral valve leaflet resulting in chordal rupture and severe mitral insufficiency. Multi-modality imaging was performed before definitive diagnosis through histology. We review the morphological features encountered in our case to highlight the diagnostic difficulties and raise awareness of this peculiar pathology.

Background: Compared to standard echocardiography, speckle tracking echocardiography (STE) looks more accurate for the detection of subclinical dysfunction of the myocardium. The aim of our work was to assess the value of STE in the diagnosis of subclinical ventricular dysfunction and as a prognostic index in sepsis patients.

Patients and methods: An observational prospective study involving critically ill patients aged ≥ 18 years diagnosed with sepsis or septic shock. All patients were subjected to full history-taking, clinical assessment, and scoring system, including Acute Physiology and Chronic Health (APACHE) II score and quick sequential organ failure assessment score. Investigations were done for all patients, including laboratory (complete blood count, C-reactive protein, N-terminal pro-brain natriuretic peptide [NT-proBNP], and troponin-I and serum lactate level), ECG, and echocardiographic examination (conventional and speckle tracking) for measurement of global left ventricular strain.

Results: This study involved 50 patients, nine patients with sepsis and 41 patients with septic shock. Regarding cardiac biomarkers, the mean value of troponin-I was 0.18 ± 0.05 ng/L and for NT-proBNP was 1228.2 ± 832.9 pmol/L. All patients in the study had elevated lactate levels. There was a significant correlation between global longitudinal strain (GLS) and troponin I, NT-proBNP, and lactate levels after 3 days of admission. GLS, lactate, NT-proBNP, troponin levels, and APACHE II Score were significant predictors of mortality with a sensitivity of 76.5%, 88.2%, 88.2%, 76.5%, and 88.2%, respectively.

Conclusion: GLS measured by speckle tracking echocardiography looks to be a sensitive diagnostic tool for early detection of subclinical left ventricular dysfunction in patients with sepsis in addition to be a sensitive predictor of in-hospital mortality.

Crista terminalis is a crescent-shaped fibromuscular ridge in the posterolateral wall of the right atrium (RA) which separates the smooth posterior region of RA from a more muscular anterior region. When prominent, it frequently mimics RA thrombus, vegetation, or tumors such as myxoma. Differentiation of such anatomical structural variations from other masses is vital to minimize misdiagnosis and avoid disease-related apprehension. Different diagnostic modalities may be needed which have their own imaging characteristics as well as limitations. Our case emphasizes the differentiating features of prominent crista terminalis using two-dimensional and three-dimensional transesophageal echocardiography.

Objective: Ankylosing spondylitis (AS) is a persistent inflammatory disease affecting the axial skeleton which may lead to cardiovascular involvement. We examined the relationship between the presystolic wave (PW), which is frequently encountered in the evaluation of the left ventricular (LV) outflow tract, and AS.

Methods: The study included 117 consecutive patients with 73 of them being male. Demographic and clinical characteristics of the participants were recorded and echocardiographic examination was performed.

Results: Patients were categorized into two groups: patients diagnosed with AS (n = 64) and patients without AS (n = 53). LV ejection fraction (P = 0.014), LV mass index (P < 0.001), mitral E wave velocity (P = 0.002), and PW (P = 0.014) were independently linked with AS.

Conclusion: A substantial correlation was found between PW and AS.

Background: Severe tricuspid regurgitation (TR), pulmonic regurgitation (PR), large atrial septal defect (ASD), and large pulmonary embolism (PE) will lead to decreased left ventricular preload, and therefore, might alter left ventricle (LV) filling diastolic parameters. Significant LV preload reduction might preclude LV diastolic function assessment indeterminate.

Methods: This is a controlled study where patients with severe TR, PR, ASD, PE, and without significant LV disease were included in the study group. Stroke volume (SV), E-wave velocity, A-wave velocity, E/A, septal e', lateral e', average E/e', deceleration time, and isovolumic relaxation time (IVRT) were captured from the study group and the control group. The difference of mean of the diastolic parameters in both groups was evaluated as well as the correlation between the SV and the diastolic parameters of the pooled data from both groups.

Results: E wave velocity, E/A ratio, IVRT, deceleration time, septal and lateral e', and SV were significantly lower in the study group while E/e' was significantly higher in the study group. IVRT showed a strong positive correlation with SV. Lateral and septal e' showed a moderate positive correlation to SV while the average E/e' showed inverse correlation to SV.

Conclusion: Standard diastolic parameters should be interpreted with caution in assessing diastolic function in patients with severely decreased preload. However, a significant preload reduction might preclude diastolic function assessment indeterminate.

A 54-year-old patient with a medical history of hypertension, dyslipidemia, and diabetes underwent mitral valve replacement surgery with a biologic valve. During a chest computed tomography scan for breast neoplasia staging, a reduced luminal filling in the left atrium (3.6 cm) was unexpectedly found, prompting further cardiac evaluation. The patient was referred to the emergency department experiencing shortness of breath and fatigue, which improved after furosemide administration, and remaining stable throughout hospitalization. A transesophageal echocardiogram was performed the following day and revealed a biologic mitral valve prosthesis slightly displaced toward the left ventricle with an average transprosthetic gradient of 7 mmHg. Notably, a sizable intermediate echogenic mass measuring 3.0 cm × 3.5 cm was detected and attached to the prosthesis ring in a lateral and posterior position, within the left atrium. A mild degree of periprosthetic regurgitation was also noted. Given the substantial suspicion that the observed mass was a thrombus, the patient was commenced on anticoagulation therapy while awaiting cardiac magnetic resonance imaging for better characterization of the mass. Over 4 weeks, the thrombus notably decreased in size, disappearing entirely by the 6^th week. This case highlights the significance of employing multiple imaging techniques in managing cardiac masses. The incidental discovery of the mass, its characterization, and subsequent management through anticoagulation, followed by confirmation and monitoring through echocardiogram, underscore the importance of a multimodal approach in diagnosing and treating such conditions.

There has been increasing evidence supporting the importance of left atrial (LA) functional analysis and measurement in various physiologic and pathologic cardiovascular conditions due to its high diagnostic and prognostic values. Assessment of LA strain (LAS) has emerged as an early marker of subclinical LA dysfunction. Using speckle-tracking echocardiography, LAS can be measured in all phases of LA function (reservoir, conduit, and booster pump). In valvular heart disease (VHD), surgical and nonsurgical interventions should be performed before irreversible left ventricular (LV) and/or LA myocardial dysfunction. The current guidelines recommended using LV strain as a parameter for early detection and timely intervention. Currently, many published data have shown the diagnostic and prognostic values of LAS in VHD, which is encouraging to integrate LAS during echo assessment. In this review, we aim to collect the current data about the clinical utility of LAS changes in risk stratification, predicting outcome, and guiding the time of intervention in VHD. The review summarized these data according to the type of valve pathologies.

Background and aims: Functional capacity is reduced in mitral stenosis (MS) patients. Previous studies showed a correlation between left atrial strain and functional capacity in this population. However, currently, no left ventricle (LV) echocardiographic parameters were associated with functional capacity in patients with MS. Noninvasive LV pressure-strain loop analysis is a new echocardiographic method for evaluating LV function, integrating longitudinal strain from speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work (MW) that overcomes the preload-dependent characteristics conventional parameters by integrating afterload. This study aimed to evaluate the association between MW and functional capacity measured using exercise tests in patients with severe MS and preserved LV ejection fraction (LVEF).

Methods: Adult patients with symptomatic severe rheumatic MS (mitral valve area <1.5 cm²), and preserved LVEF (>50%) and sinus rhythm who underwent echocardiography and exercise stress test in our hospital from 2019 to 2021 were included. Exclusion criteria were suboptimal image quality for myocardial deformation analysis, significant mitral regurgitation or aortic valve lesions, coronary artery disease, intracardiac shunt, and atrial fibrillation. Standard echocardiographic parameters were measured, and all MW parameters were included. Exercise treadmill testing was performed using the modified Bruce protocol.

Results: A total of 33 individuals with isolated severe rheumatic MS in sinus rhythm (age 39.8 ± 9.8 years) were included in the study. Patients with severe isolated MS showed significantly impaired LV-global longitudinal strain values compared to normal reference values. Furthermore, patients with severe MS showed significantly lower values of global work index, global constructive work, and efficiency compared to normal values and higher wasted work. Global work efficiency was significantly correlated to the duration of exercise (P = 0.025, Pearson's r = 0.389).

Conclusions: In stable patients with isolated severe mitral stenosis, MW efficiency significantly correlated with functional capacity measured objectively through exercise testing.

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification, and a multimodality approach is advised to ensure an accurate diagnosis. We report a case of a patient with CCMA, associated with severe mitral regurgitation. An 82-year-old woman was admitted due to worsening heart failure. Transthoracic echocardiography revealed a fixed, hyperechogenic mass, accompanied by restriction of the posterior mitral leaflet, and subsequent severe mitral regurgitation. Transesophageal echocardiography demonstrated a restricted motion of the posterior mitral leaflet, because of a large, echogenic mass (15 mm × 11 mm), attached to the mitral annulus, vacuolated with a central echolucent aspect, lacking acoustic shadowing. Contrast-enhanced cardiac computed tomography identified a distinct oval mass (18 mm × 11 mm × 19 mm) presenting a central hypodense content and peripheral calcification, strongly suggestive of CCMA. Considering the patient's profile, surgical valvular replacement was considered unsuitable. Therefore, a transcatheter edge-to-edge repair was performed, resulting in mild residual regurgitation.