This case highlights a rare but life-threatening complication of TEE—hypopharyngeal perforation. Blind probing when encountering resistance is a critical avoidable risk factor. Early recognition of symptoms and prompt diagnosis enable successful conservative management in select patients.
Background: COVID-19 has been associated with significant cardiovascular complications, yet the long-term cardiovascular consequences and prognostic biomarkers in moderate versus severe disease remain incompletely characterized. This study aimed to evaluate longitudinal cardiovascular changes, identify mortality predictors, and assess the discriminative performance of fractional exhaled nitric oxide (FeNO) and endothelin-1 (ET-1) in hospitalized COVID-19 survivors.
Methods: This prospective cohort study enrolled 480 hospitalized COVID-19 patients (240 moderate, 240 severe by WHO criteria) who survived to discharge between June 2020 and December 2023. Baseline and 1-year echocardiography, inflammatory biomarkers including FeNO and ET-1, and clinical outcomes were assessed. Multivariable Cox regression identified mortality predictors, and ROC analysis evaluated biomarker discriminative performance.
Results: Severe COVID-19 patients demonstrated significant baseline right ventricular dysfunction with reduced TAPSE (16.63 ± 2.43 vs. 20.36 ± 3.68 mm, p < 0.001) and impaired RVPA coupling (0.60 ± 0.14 vs. 0.88 ± 0.45, p < 0.001). Progressive cardiovascular deterioration occurred over 1 year, with pulmonary artery pressure increasing 17.8% in severe versus 7.1% in moderate disease. Two-year mortality was 16.9% overall. Independent mortality predictors included hypertension (HR 3.02), hyperlipidemia (HR 2.51), diabetes (HR 2.23), and left atrial volume index (HR 1.08 per mL/m2). FeNO and ET-1 predicted mortality specifically in severe disease (HR 1.028 and 1.035, respectively) and demonstrated excellent discriminative ability (AUC 0.892 and 0.865) for identifying severe COVID-19.
Conclusions: Moderate and severe COVID-19 survivors exhibit progressive cardiovascular deterioration, particularly affecting right ventricular function. FeNO and ET-1 serve as severity-specific prognostic biomarkers and demonstrate excellent discriminative performance, supporting their integration into risk stratification protocols for COVID-19 survivors.
This research aims to assess the impact of coronary microvascular dysfunction (CMD) on the systolic function of the left ventricle (LV) in patients with ischemia and no obstructive coronary artery disease (INOCA) by employing three-dimensional speckle tracking echocardiography (3D-STE).
A group of 66 individuals with INOCA participated in the research. They all went through regadenoson stress echocardiography and measurement of coronary flow velocity reserve (CFVR). Patients were divided into a CMD group with CFVR values less than 2.0 and a control group with CFVR values of 2.0 or higher.
Compared with controls, the CMD group showed reductions in stress global longitudinal strain (GLS), stress global area strain (GAS), the change in GLS from rest to stress (ΔGLS), and the change in GAS from rest to stress (ΔGAS) (all p < 0.001). All four strain parameters exhibited significant correlations with CFVR. Univariate analysis revealed that stress GLS, stress GAS, ΔGLS, and ΔGAS possessed good predictive value for CMD, among which ΔGAS had higher predictive value, having areas under the curve (AUC) of 0.923.
Strain parameters derived from 3D-STE under pharmacologic stress demonstrate excellent benefits in assessing LV systolic function in CMD patients. These parameters, especially ΔGAS, may serve as novel predictive indicators for the clinical assessment of CMD.
Behçet's disease (BD) can lead to a wide spectrum of cardiovascular manifestations. Strain echocardiography has emerged as a prominent modality in clinical practice owing to its significant prognostic value and ability to detect subclinical cardiac involvement in various cardiovascular diseases. This study was designed to evaluate left ventricular (LV), left atrium (LA), and right ventricular (RV) function in BD patients using strain echocardiography.
A total of 61 participants were included in the study, comprising 27 patients with BD and 34 healthy controls. After medical histories and cardiac symptoms were obtained from all participants, basic echocardiographic parameters were recorded, and LV, LA, and RV functions were assessed using strain echocardiography.
No significant differences were observed between the two groups in terms of cardiac chamber dimensions and diastolic parameters. No significant difference was observed in global longitudinal strain values between the BD and control groups (p = 0.078). Similarly, no significant differences were found in right ventricular strain values. Regarding LA strain (LAS) parameters, LASr was found to be significantly lower in the BD group compared with the control group (p = 0.035). In the subgroup analysis comparing BD patients with and without uveitis, there were no statistically significant differences in LASr (p = 0.813), LAScd (p = 0.963), or LASct (p = 0.911).
In conclusion, our study did not show any deterioration in LV or RV function in BD, but it did show deterioration in LA mechanical function.
Pulmonary hypertension (PH) in congenital diaphragmatic hernia (CDH) is nearly universal yet incredibly complex. A patent ductus arteriosus (PDA) is increasingly utilized to both monitor echocardiographically and manage CDH-PH. However, as pulmonary pressures are driven by both vascular resistance and blood flow, there is a risk that as the former improves, PH may in fact worsen from pathologic left-to-right (LtR) PDA shunting. Herein, we describe two cases of neonatal CDH whose PH was complicated by pathologic LtR PDA shunting and pulmonary overcirculation and improved following resolution of the transductal shunt, highlighting the underrecognized risk of pathologic PDA shunts in CDH.
Left atrial strain reservoir (LASr) has emerged as a useful parameter in assessing diastolic dysfunction and heart failure with preserved ejection fraction. LASr is typically assessed using speckle-tracking echocardiography (STE), which was developed to measure strain in the left ventricle. Despite its strength demonstrated in several clinical studies, the application of STE to the left atrium presents well-known limitations: thin walls, anatomical discontinuities, far-field location, and inter-vendor variability. The present study aims to evaluate the efficacy of an alternative method for assessing LASr, based on the percentage shortening of the atrial wall contour, by directly comparing it with STE-derived LASr values.
We retrospectively analyzed 246 patients in sinus rhythm with severe organic mitral regurgitation. The 2D contour strain method quantifies changes in the length of the two-dimensional (2D) endocardial atrial wall contour between end-systolic and end-diastolic frames. The peak strain value is calculated as: (maximum perimeter length−minimum perimeter length)/maximum perimeter length × 100.
2D contour strain measurements were feasible in all patients. A strong correlation was observed between STE-derived and 2D contour-derived LASr values, with an R-value of 0.93. On average, 2D contour strain measurements underestimated LA peak strain by approximately 1% compared to STE. The consistency of 2D contour LA strain measurements, as assessed by inter- and intra-observer reproducibility, was excellent.
These findings suggest that 2D contour LA strain is a feasible and reliable alternative to STE for assessing LASr. This approach is particularly valuable in echocardiography labs where STE software for LA is unavailable.
We show an exceptional case of a right aortic arch (RAA) in a patient with DiGeorge syndrome, breaking the rule that the first epiaortic vessel courses to the contralateral side of the aortic arch. This is a RAA with an aberrant left subclavian artery (ALSA) and an isolated left carotid artery (ILCA) arising from the left pulmonary artery (LPA) via a left anterior ductus arteriosus (LADA), along with bilateral ductus arteriosus. This unique case highlights educational pitfalls in using a simple rule to define arch sidedness. Although challenging, echocardiographic diagnosis of such vascular anomalies is feasible in expert hands. The color-flow and Doppler pattern of the epiaortic vessels provide important information about their arrangement and connection to the aortic arch. Bilateral ductus arteriosus is often a marker of complex vascular anomalies, which are frequently associated with genetic syndromes.
This retrospective study of a Black cohort sought to create predictive models to calculate the probability of a coronary artery calcium score (CACS) about one decade after obtaining cardiovascular risk measures.
Participants (n = 656) in GENOA had CV risk variables measured (1995–2000) and a CACS about one decade later (2009–2011). Using multivariate regression, computer models were written to calculate the probability of a future CACS of zero, ≥ 10, and ≥ 100. ROC values were 0.78, 0.77, and 0.76, respectively. Machine learning models did not perform any better than multivariate regression.
Age, height, smoking duration, sex, and hypertension were significant for all three models in predicting a future CACS. Height was inversely related to future CACS, but weight and BMI were not contributory to the models. Lipid-lowering medications and exercise were associated with an increased CACS, the so-called CACS “paradox.”
Predictive models of a future CACS such as these may help in identifying important risk factors for a future CACS. By identifying these risk factors and implementing early modification of CV risk factors, the development of CV disease may be slowed.
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