This article presents a case of a papillary fibroelastoma of the tricuspid valve discovered 18 months after tricuspid valve surgery. Through multimodal imaging, a relatively complete diagnosis and differential diagnosis of the tumor can be made.
This article presents a case of a papillary fibroelastoma of the tricuspid valve discovered 18 months after tricuspid valve surgery. Through multimodal imaging, a relatively complete diagnosis and differential diagnosis of the tumor can be made.
Metastatic intracardiac hepatoblastoma is an extremely rare entity. Metastasis pathways include lymphatic, hematogenous routes, direct, or transvenous spread. The multimodality imaging has enabled the identification of the etiology of intracardiac mass in many cases. The significant characteristics of indicating malignant cardiac tumors include irregular borders, vascular invasion, and rapid growth on echocardiography. Additionally, malignant cardiac tumors are characterized by heterogeneous enhancement, necrosis, and restricted diffusion on cardiac magnetic resonance (CMR).
Echocardiography and right heart catheterization (RHC) are useful in the evaluation of heart failure with preserved ejection fraction (HFpEF). We compared the two among decompensated HFpEF patients to determine their relative value in predicting all-cause mortality and a composite of cardiovascular (CV) death and heart failure (HF) readmission at 1 year.
One hundred seventy-eight decompensated HFpEF patients who underwent both procedures and survived to hospital discharge were retrospectively identified. Hospital records and the National Death Index were queried to determine outcomes. Echocardiographic and invasive parameters were tested for significant associations with each outcome. Additionally, three predictive models were developed: Model-1: basic demographics and comorbidities, Model-2: adding echocardiographic parameters, and Model-3: adding invasive hemodynamic parameters.
For mortality (n = 26; 15%), echocardiographic E/average e′, invasive mean pulmonary artery pressure (mPAP), and pulmonary capillary wedge pressure (PCWP) showed significant associations. Model-1 yielded a c-statistic of 0.65; 95% CI (0.54–0.76). Adding echocardiographic and hemodynamic variables produced a nonsignificant increase to 0.71; 95% CI (0.60–0.82), though mPAP remained an independent predictor (OR 1.05; 95% CI 1.01–1.09, p = 0.025). For the composite outcome (n = 31; 17%), significant associations were found for echocardiographic right atrial reservoir strain (RAsr), E/average e′, and invasive right atrial pressure, mPAP, and PCWP. Model-1 had a c-statistic of 0.70; 95% CI (0.60–0.79). Adding echocardiographic parameters significantly increased this to 0.81; 95% CI (0.73–0.88). Adding hemodynamic parameters (model-3) resulted in a nonsignificant increase to 0.83; 95% CI (0.76–0.90).
Among decompensated HFpEF patients, the addition of echocardiographic parameters significantly improved model prediction for the composite endpoint of CV death and HF hospitalization. Further addition of invasive hemodynamic variables did not.
The cover image is based on the article Prognostic Value of Right Ventricular Global Wasted Work in Precapillary Pulmonary Hypertension: A 3D Echocardiographic Study by Ashwin Venkateshvaran et al., https://doi.org/10.1111/echo.70344
Aortic dissection is a rare but life-threatening complication that can occur after endovascular aneurysm repair (EVAR). We report the case of a 72-year-old woman with a history of coronary artery bypass grafting and EVAR who presented with acute chest and lower limb pain. CT angiography revealed a Stanford type A dissection with collapse of the stent graft and iliac thrombosis. Shortly after imaging, she developed respiratory distress and cardiac arrest, with unsuccessful resuscitation. This case emphasizes the diagnostic value of multimodality imaging in recognizing fatal complications after EVAR.
Atrial arrhythmia is prevalent in patients with hypertrophic cardiomyopathy (HCM) and is prognostically deleterious. Catheter ablation (CA) has poor efficacy in HCM, making predictors of outcome valuable. Left atrial size is associated with morbidity and mortality, and E/e′ has been proposed. The current study evaluates whether these predict non-paroxysmal atrial arrhythmia, interventions for atrial arrhythmia and all-cause mortality.
233 patients from the echocardiography database were included; patients with any mitral annular calcification were excluded. Medical records were reviewed for sample characteristics. Survival analysis was performed for left atrial diameter (LAD), left atrial volume index (LAVi, by area-length method), and E/e′ with respect to endpoints, namely: non-paroxysmal atrial arrhythmia; atrial intervention (composite of CA and pace-and-ablate); and all-cause mortality. If LAD or LAVi were significant in multivariate analysis, ROC analysis and DeLong's test were performed to evaluate and compare their discriminative power.
Over a median follow-up of 8 years (median age 53, 73% male), the overall prevalence of non-paroxysmal atrial arrhythmia was 31%. In multivariate models, LAVi was predictive of non-paroxysmal atrial arrhythmia and atrial intervention; LAD was only predictive of arrhythmia. LAVi demonstrated greater discriminative power for predicting atrial intervention. E/e′ was not predictive of any outcome. No echocardiographic variable predicted death in multivariate analysis.
LAVi may have greater clinical utility compared to two-dimensional measurements like LAD. Future work should clarify which measures of left atrial size are most appropriate in clinical practice.
Left ventricular ejection fraction (LVEF) is a widely used echocardiographic prognostic marker; however, its ability to reflect forward flow is limited. Left ventricular outflow tract velocity time integral (LVOT VTI) reflects stroke distance and has prognostic value in patients with cardiac and non-cardiac pathology, yet its incremental value beyond LVEF remains incompletely defined.
To determine whether LVOT VTI confers prognostic value beyond LVEF in a large real-world cohort of hospitalized patients.
Index echocardiograms performed between January and June 2021 at a single tertiary hospital were retrospectively analyzed. Demographics, echocardiographic parameters, biomarkers, and mortality data were collected. Patients were stratified by LVOT VTI (>13 and <13 cm) and LVEF (>40% and <40%). Associations with mortality were evaluated with Cox proportional hazard models.
Altogether, 1325 patients (mean age 70 years) were included; 368 (28%) died over a median follow-up of 35.9 months (IQR 34.4–37.4). Both LVEF < 40% (HR 1.95, 95% CI 1.52–2.50; p < 0.001) and LVOT VTI < 13 cm (HR 1.91, 95% CI 1.41–2.59; p < 0.001) were associated with increased mortality. LVOT VTI < 13 cm remained predictive after adjustment for LVEF, although this was attenuated after adjustment for age. Mortality was greatest in patients with both LVEF < 40% and LVOT VTI < 13 cm (HR 2.37, 95% CI 1.63–3.46; p < 0.001).
LVOT VTI < 13 cm is independently associated with long-term mortality in hospitalized patients. Its incremental prognostic value beyond LVEF warrants prospective validation as a reproducible marker to enhance risk stratification in hospitalized patients.
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