Journal of Cardiovascular Echography最新文献

Around 25%-40% of ischemic strokes are cryptogenic, with no identifiable cause despite thorough evaluation. The mechanisms behind cryptogenic strokes are often embolic, frequently originating from occult cardiac sources. An unroofed coronary sinus (UCS), a rare congenital anomaly, involves a partial or complete absence of the coronary sinus roof, leading to a connection between the left atrium and the coronary sinus. This defect can be asymptomatic or present with symptoms such as paradoxical embolism due to shunting. We present the case of a 70-year-old male with prolonged chest pain and a history of neurological symptoms, who was later diagnosed with a UCS (types III and IV) through cardiac computed tomography (CCT). A cardiac bubble test confirmed a right-to-left shunt, which was not detected on transthoracic echocardiography. This case underscores the importance of considering advanced imaging techniques such as CCT in the diagnosis of cryptogenic stroke, as echocardiography may miss defects due to poor visualization of posterior cardiac structures.

Peripartum cardiomyopathy (PPCM) is a specific form of cardiomyopathy that manifests toward the end of pregnancy or within 5 months postpartum, characterized by a decrease in cardiac output due to impaired myocardial function. This condition has a multifactorial origin, influenced by genetic predispositions, inflammatory processes, autoimmunity, hormonal variations, and nutritional deficiencies. Prognosis varies among patients: while some recover completely within 6 months, others may develop chronic cardiac dysfunction requiring long-term treatment. Vericiguat, a soluble guanylate cyclase stimulator, has shown promising results in the treatment of heart failure with reduced ejection fraction. This drug works by enhancing the nitric oxide signaling pathway, promoting vasodilation, and improving myocardial function. Although the use of vericiguat in PPCM is not yet fully documented, its potential benefits suggest that it may represent a valid therapeutic option when standard therapies are insufficient for symptom control. We present the case of a 32-year-old woman with PPCM, initially undiagnosed, who developed severe symptoms of dyspnea, orthopnea, and peripheral edema postpartum. These symptoms were accompanied by a significant reduction in left ventricular ejection fraction. Following a suboptimal response to standard heart failure therapy, vericiguat was incorporated into her treatment regimen. In subsequent outpatient follow-ups, the patient's symptoms progressively improved, and left ventricular systolic function markedly increased. The patient became asymptomatic and was able to resume her normal daily activities. While this case suggests that vericiguat could be an effective adjunctive treatment for PPCM, it remains unclear whether these improvements were directly attributable to vericiguat or could have occurred with continued standard therapy alone. Further studies are needed to define the role of vericiguat in this condition.

Background: Atrial fibrillation (AF) results in electrical and structural remodeling of the atria, which extent is known to be associated with a higher AF recurrence rate after catheter ablation (CA). Recently, a novel echocardiographic parameter derived from tissue Doppler imaging (TDI) [PA-TDI] has been introduced to assess the total atrial activation time, as a noninvasive surrogate of fibrosis and remodeling. The aim of the study is to investigate the role of PA-TDI interval as a predictor of AF ablation efficacy.

Methods: We retrospectively included patients with paroxysmal symptomatic drug-refractory AF referred to our institution for CA procedure, who presented sinus rhythm at admission. A complete transthoracic echocardiogram was performed before the ablation procedure, including the assessment of PA-TDI interval.

Results: From January 2015 to April 2018, 128 patients (mean age: 61.86 ± 9.08 years, 68% male, body surface area: 1.97 ± 0.21 mq, body mass index: 26.98 ± 3.86 kg/mq, and ejection fraction: 59% ±6.06%) with symptomatic drug-refractory AF who received radiofrequency CA were enrolled. During the follow-up of 15.80 ± 6.7 months, 30 patients (23%) developed AF recurrence out of the blanking period. Compared with those without recurrence (group 1), patients with recurrence (group 2) had a larger left atrium (LA) size (Group 1 vs. Group 2: mean LA area: 22.2 ± 4.6 cmq vs. 25 ± 6.6 cmq, P = 0.015; mean indexed LA volume: 35 ± 10 mL/mq vs. 40 ± 12 mL/mq, P = 0.04) and longer PA-TDI interval (Group 1 vs. Group 2: 162 ± 33 ms vs. 133 ± 26 ms, P < 0.0001). A cutoff of PA-TDI > 150 ms identified patients with recurrence after ablation with a sensibility of 82% and specificity of 83% (area under the curve 0.879).

Conclusions: The total activation time assessed by PA-TDI is an independent predictor of AF recurrence and can be used to predict the efficacy of transcatheter ablation.

In the evaluation of cardiomyopathies, cardiac computed tomography (CCT) is predominantly used for assessing congenital or acquired coronary artery diseases as a potential etiology underlying the observed myocardial abnormalities. However, its utility is expected to expand. We present a case of an asymptomatic patient with claustrophobia who sought medical attention due to frequent ventricular beats. The resting electrocardiogram revealed repolarization abnormalities characterized by flattened T-waves in the lateral leads and low QRS voltages in the peripheral leads, whereas transthoracic echocardiography was normal. CCT accurately identified hypodense areas indicative of fibrofatty infiltration within the inferolateral and anterior walls of the left ventricle. Furthermore, late iodine contrast-phase imaging revealed subepicardial late enhancement striae in the same regions. These imaging findings were pivotal in establishing a diagnosis of left-dominant arrhythmogenic cardiomyopathy. This clinical vignette underscores the potential of CCT in tissue characterization, particularly when cardiac magnetic resonance imaging is contraindicated or unavailable.

Left ventricular (LV) global longitudinal strain (GLS) has recently garnered attention as a reliable and objective method for evaluating LV systolic function. One of the key advantages of GLS is its ability to detect subtle abnormalities even when the ejection fraction (EF) appears to be preserved. However, it is important to note that GLS, much like LVEF, is significantly influenced by load conditions. In recent years, researchers and clinicians have been exploring noninvasive myocardial work (MW) quantification as an innovative tool for assessing myocardial function. This method integrates measurements of strain and LV pressure, providing a comprehensive evaluation of the heart's performance. Notably, MW offers an advantage over GLS and LVEF because it provides a load-independent assessment of myocardial performance. The implementation of commercial echocardiographic software that facilitates the noninvasive calculation of MW has significantly broadened the scope of its application. This advanced technology is now being utilized in multiple clinical settings, including ischemic heart disease, valvular diseases, cardiomyopathies, cardio-oncology, and hypertension. One of the fundamental aspects of MW is its correlation with myocardial oxygen consumption, which allows for the assessment of work efficiency. Understanding this relationship is crucial for diagnosing and managing various cardiac conditions. The aim of this review is to provide an overview of the noninvasive assessment of myocardial by echocardiography, from basic principles and methodology to current clinical applications.

Cardiac sarcoidosis is an insidious condition with a highly variable clinical presentation that often mimics other diseases. Its diagnosis is particularly challenging, requiring a high index of suspicion and a comprehensive approach. Multimodality imaging plays a critical role in differentiating it from other conditions. We present a patient with cardiac sarcoidosis who also had concomitant coronary artery disease and colon cancer. The optimal therapeutic strategy for cardiac sarcoidosis remains uncertain. However, late gadolinium enhancement, a robust predictor of arrhythmic risk is crucial in guiding treatment decisions. This case report illustrates the risk of oversimplifying complex clinical scenarios by attributing signs and symptoms to a single disease, particularly in young, otherwise apparently healthy individuals. In such cases, clinicians must include rare diseases in their differential diagnosis.

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.

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.

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.

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.