Heart Views最新文献

Background: Electrocardiography (ECG) in patients with mitral stenosis (MS) reveals characteristic findings, including altered P-wave morphology, reflecting left atrial (LA) hemodynamic changes. This research focused on the relationship between ECG parameters and LA hemodynamics in patients with severe MS.

Methods: A cross-sectional retrospective study was conducted on 42 patients undergoing Percutaneous Transluminal Mitral Commissurotomy at Shafa Hospital, Kerman, Iran. ECG parameters, echocardiographic measurements, and angiographic findings were analyzed to assess associations between P-wave morphology and LA hemodynamic variables.

Results: Significant correlations were found between LA volume and P-wave duration, amplitude, area, and terminal force in lead V1 (P < 0.05). However, no significant correlations were observed between LA pressure or strain and ECG parameters.

Discussion: The present study highlights a significant correlation between P-wave morphology in the ECG and LA volume. Notably, the relationship between P duration and LA volume was more pronounced compared to other electrocardiographic parameters. Additionally, LA strain and strain rate analysis revealed an inverse relationship with LA volume, underscoring the potential of these metrics in assessing atrial function.

Conclusion: ECG parameters, particularly P-wave morphology, exhibit significant associations with LA volume in severe MS patients. These findings suggest the potential utility of ECG as a cost-effective tool for assessing LA volume and identifying patients who may be at risk for atrial fibrillation in MS.

Introduction: Left ventricular hypertrophy (LVH) increases the risk of chronic heart failure. Even with preserved ejection fraction (EF), mortality remains significant. Impaired systolic contraction and abnormal diastolic filling may contribute to heart failure progression.

Objective: To evaluate changes in left ventricular (LV) function based on LVH type and severity.

Methods: Retrospective analysis of 518 echocardiography-confirmed LVH patients, categorized by wall thickness, LV mass index, and relative wall thickness into mild, moderate, severe, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. Comparisons were made with 707 healthy subjects from a prior study. Echocardiographic and exercise tolerance data were analyzed.

Results: LV function markers of LV systolic and diastolic dysfunction - including EF, global longitudinal strain (GLS), treadmill test metabolic equivalents, mitral annular systolic velocity (MV s'), tricuspid systolic velocity (TV s'), and tricuspid annular plane systolic excursion (TAPSE) - declined progressively with increasing LVH severity. Conversely, indices of elevated filling pressure (E/e') and pulmonary pressure (right ventricular systolic pressure [RVSP]) increased with increasing LVH severity.

Conclusion: Parameters of LV function such as left ventricular EF, GLS, effort tolerance, MVs', and E/e' get progressively deranged as LV hypertrophy deteriorates. Simultaneous derangement of RV function is observed in TAPSE and TVs'. Pulmonary artery pressure by RVSP increases with increasing severity of LVH. Eccentric LVH resembles severe LVH, while concentric remodeling resembles mild LVH. GLS detects early LV dysfunction and predicts effort tolerance, even in mild LVH.

We report the case of a woman in her late 30 s with longstanding cyanosis diagnosed with a rare supracardiac total anomalous pulmonary venous connection (TAPVC) draining directly into the superior vena cava (SVC). Her survival into adulthood was facilitated by a large, nonrestrictive atrial septal defect, and unobstructed pulmonary venous return, allowing functional compensation despite chronic hypoxemia. Echocardiography, cardiac catheterization, and computed tomography confirmed the anatomy and surgical feasibility. This case highlights this rare anatomic variant of TAPVC with direct drainage into the SVC and underscores the importance of considering operable congenital heart disease in adults presenting with unexplained cyanosis or murmurs, even in the absence of early life symptoms.

McConnell's sign, characterized by hypokinesia of the mid-free wall of the right ventricle (RV) with preserved apical contractility, is a well-recognized echocardiographic marker in acute pulmonary embolism (PE). However, its reverse variant-apical akinesia with preserved basal function-is rare and less understood. We report the case of an 85-year-old woman presenting with acute PE, who exhibited a rare form of RV dysfunction known as Reverse McConnell's sign. Multimodality imaging-including computed tomography (CT), transthoracic echocardiography, and cardiac magnetic resonance (CMR)-revealed apical RV akinesia and a concurrent intracavitary thrombus at the RV apex. Based on imaging, laboratory biomarkers, and clinical findings, an intermediate-high risk PE was diagnosed. The patient was managed with anticoagulation, and follow-up imaging demonstrated complete recovery of RV function and resolution of the thrombus. This case highlights the diagnostic and risk-stratification utility of a multimodality imaging approach in evaluating patients with acute PE. Uncommon RV contraction patterns might be present in PE, and potential complications such as intraventricular thrombosis should be assessed and followed-up. In conclusion, reverse McConnell's sign, though uncommon, should be recognized as a potential manifestation of acute PE. Multimodal imaging plays a crucial role in its identification, differential diagnosis, and follow-up.

Background: Resolution of ST elevation (STE) is the hallmark of successful thrombolysis for ST-elevation myocardial infarction (STEMI). However, the effect of persistent STE on in-hospital outcomes following primary percutaneous coronary intervention (PPCI) is not well established.

Methods: In this single-center retrospective cohort analysis, all patients admitted between January 1, 2016, and September 30, 2018, with a diagnosis of STEMI who underwent PPCI were included. Complete resolution was defined as a >70% decrease in the STE sum on the first electrocardiogram following PPCI. Partial resolution denoted a 30%-70% decrease, and persistent STE denoted a <30% decrease or any increase in the STE sum. The study population was divided into two groups: (1) resolved STE incorporating complete and partial resolution and (2) persistent STE incorporating persistent and increased STE. Using multivariate logistic regression, we compared the rates of in-hospital mortality, cardiogenic shock, intensive care unit admission, clinical heart failure, and readmission for a cardiac reason and heart failure between the study groups.

Results: We included 1250 patients in the analysis. Most patients were male (96%) with a mean age of 52 ± 10 years. More than three-quarters were Asian. Compared with patients with resolved STE, patients with persistent STE had a higher risk of clinical heart failure (24% vs. 12%, adjusted odds ratio [aOR]: 1.7 [95% confidence interval (CI): 1.2-2.5], P = 0.003), cardiogenic shock (12.1% vs. 5.3%, aOR: 2.7 [95% CI: 1.73-4.24], P < 0.001), in-hospital mortality (5.1% vs. 2.1%, aOR: 4.8 [95% CI: 2.35-9.88], P < 0.001), and readmission for heart failure (6.9% vs. 1.6%, aOR: 3.9 [95% CI: 1.95-7.82], P < 0.001).

Conclusion: Persistent STE following PPCI is a quick clinical indicator of in-hospital adverse outcomes and readmission. Future studies may explore interventions, such as early intensive medical therapy, that can improve outcomes in this population.

Constrictive pericarditis (CP) is characterized by stiff scarred pericardium as a result of repeated inflammatory insults. Patients with CP usually present with diastolic heart failure symptoms, including ascites, hepatomegaly, pedal edema, and potentially hepatic cirrhosis. This leads to delayed diagnosis. This review aims to fill the knowledge gaps in clinical presentation, pathophysiology, and diagnostic workup of CP. Furthermore, we highlight the key medical and surgical management aspects of CP.

Essential thrombocythemia (ET) and polycythemia vera (PV) are rare chronic myeloproliferative neoplasms that have hemostatic complications (i.e., thrombosis and hemorrhage), leading to morbidity and mortality. Treatment in ET or PV is directed toward preventing thrombotic consequences. However, the increased risk of bleeding may complicate antithrombotic therapy in these patients. Thrombosis may occur in both arterial and venous vascular beds. Arterial thrombosis, such as acute coronary syndrome (ACS), is more frequent than venous thrombosis. Both ET and PV can initially present as an ACS, the management of which is highly challenging in the absence of clinical guidelines that are dedicated to such patients. The management of ACS in patients with ET or PV has not been well described in literature. Herein, this review discusses the pathogenesis, characteristics, and management of ACS in patients with ET or PV.

Infective endocarditis (IE) can lead to infectious intracranial aneurysms (IIAs) in a small percentage of cases. These aneurysms may rupture, resulting in intracerebral bleeding that is typically evident on neuroimaging. However, diagnosis becomes challenging when blood cultures and echocardiography are unremarkable, and neuroimaging is misinterpreted as a neoplasm due to overlapping features. We report a rare case of a ruptured IIA initially misdiagnosed as a brain tumor. A 43-year-old man presented with seizures, right-sided hemiparesis, and a 3-month history of fever, malaise, and 15-kg weight loss. Head computed tomography (CT) revealed a left frontal lesion with solid and hemorrhagic components, vasogenic edema, and intraventricular hemorrhage. Brain magnetic resonance imaging showed an enhancing mass-like lesion. Negative pan-cultures, normal echocardiography, and temporary improvement with oral prednisone led to a presumed diagnosis of brain tumor, and the patient was discharged for outpatient follow-up. Three months later, he was readmitted with persistent fever. This time, Streptococcus mutans bacteremia and mitral valve vegetations confirmed IE. Brain CT angiography revealed multiple IIAs. He received intravenous antibiotics. His hospital course was complicated by decompensated heart failure and a myocardial infarction due to obstructive coronary artery disease, requiring mitral valve replacement and coronary artery bypass grafting. He was discharged hemodynamically stable. This case highlights that IIAs can closely mimic brain tumors on imaging. Clinicians should maintain a high index of suspicion for IE in patients with neurological symptoms and systemic signs of infection, even when initial diagnostic studies are inconclusive.