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Background: Left atrial (LA) sizing in patients with atrial fibrillation (AF) is crucial for follow-up and outcome. Recently, the automated quantification of LA using the novel three-beat averaging real-time three dimensional echocardiography (3BA-RT3DE) is introduced. The aim of this study was to assess the feasibility and accuracy of 3BA-RT3DE in patients with atrial fibrillation (AF). Methods: Thirty-one patients with AF (62.8 ± 11.7 years, 67.7 % male) were prospectively recruited to have two dimensional echocardiography (2DE) and 3BA-RT3DE (SC 2000, ACUSON, USA). The maximal left atrial (LA) volume was measured by the conventional prolate-ellipse (PE) and area-length (AL) method using three-beat averaging 2D transthoracic echocardiography and automated software analysis (eSie volume analysis, Siemens Medical Solution, Mountain view, USA); measurements were compared with those obtained by computed tomography (CT). Results: Maximal LA volume by 3BA-RT3DE was feasible for all patients. LA volume was 68.4 ± 28.2 by PE-2DE, 89.2 ± 33.1 by AL-2DE, 100.6 ± 31.8 by 3BA-RT3DE, and 131.2 ± 42.2 mL by CT. LA volume from PE-2DE (R² = 0.48, p < 0.001, ICC = 0.64, p < 0.001), AL-2DE (R² = 0.47, p < 0.001, ICC = 0.67, p < 0.001), and 3BA-RT3DE (R² = 0.50, p = 0.001, ICC = 0.65, p < 0.001) showed significant correlations with CT. However, 3BA-RT3DE demonstrated a small degree of underestimation (30.5 mL) of LA volume compared to 2DE-based measurements. Good-quality images from 3BA-RT3DE (n = 16) showed a significantly tighter correlation with images from CT scanning (R² = 0.60, p = 0.0004, ICC = 0.76, p < 0.001) compared to those of fair quality. Conclusion: Automated quantification of LA volume using 3BA-RT3DE is feasible and accurate in patients with AF. An image of good quality is essential for maximizing the value of this method in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Left atrial (LA) sizing in patients with atrial fibrillation (AF) is crucial for follow-up and outcome. Recently, the automated quantification of LA using the novel three-beat averaging real-time three dimensional echocardiography (3BA-RT3DE) is introduced. The aim of this study was to assess the feasibility and accuracy of 3BA-RT3DE in patients with atrial fibrillation (AF). Methods: Thirty-one patients with AF (62.8 ± 11.7 years, 67.7 % male) were prospectively recruited to have two dimensional echocardiography (2DE) and 3BA-RT3DE (SC 2000, ACUSON, USA). The maximal left atrial (LA) volume was measured by the conventional prolate-ellipse (PE) and area-length (AL) method using three-beat averaging 2D transthoracic echocardiography and automated software analysis (eSie volume analysis, Siemens Medical Solution, Mountain view, USA); measurements were compared with those obtained by computed tomography (CT). Results: Maximal LA volume by 3BA-RT3DE was feasible for all patients. LA volume was 68.4 ± 28.2 by PE-2DE, 89.2 ± 33.1 by AL-2DE, 100.6 ± 31.8 by 3BA-RT3DE, and 131.2 ± 42.2 mL by CT. LA volume from PE-2DE (R2 = 0.48, p < 0.001, ICC = 0.64, p < 0.001), AL-2DE (R2 = 0.47, p < 0.001, ICC = 0.67, p < 0.001), and 3BA-RT3DE (R2 = 0.50, p = 0.001, ICC = 0.65, p < 0.001) showed significant correlations with CT. However, 3BA-RT3DE demonstrated a small degree of underestimation (30.5 mL) of LA volume compared to 2DE-based measurements. Good-quality images from 3BA-RT3DE (n = 16) showed a significantly tighter correlation with images from CT scanning (R2 = 0.60, p = 0.0004, ICC = 0.76, p < 0.001) compared to those of fair quality. Conclusion: Automated quantification of LA volume using 3BA-RT3DE is feasible and accurate in patients with AF. An image of good quality is essential for maximizing the value of this method in clinical practice. [ABSTRACT FROM AUTHOR]

In evaluating the cardiac function, it is important to have a comprehensive assessment of structural factors, such as the myocardial or valvular function and intracardiac flow dynamics that pass the heart. Vortex flow that form during left ventricular filling have specific geometry and anatomical location that are critical determinants of directed blood flow during ejection. The formation of abnormal vortices relates to the abnormal cardiac function. Therefore, vortex flow may offer a novel index of cardiac dysfunction. Intracardiac flow visualization using ultrasound technique has definite advantages with a higher temporal resolution and avail-ability in real time clinical setting. Vector flow mapping based on color-Doppler and contrast echocardiography using particle image velocimetry is currently being used for visualizing the intracardiac flow. The purpose of this review is to provide readers with an update on the current method for analyzing intracardiac flow using echocardiography and its clinical applications. [ABSTRACT FROM AUTHOR]

The heart is frequently the site of metastasis of various malignant tumors. Lung cancer is one of the most common primary tumors of cardiac metastasis and usually involves the pericardium or epicardium by direct invasion and/or lymphatic spread. However, metastasis of lung cancer involving the left ventricular endocardium is extremely rare. We report a patient with adenocarcinoma of lung, metastasized to the left ventricular myocardium and endocardium, diagnosed by echocardiography and 18-fludeoxyglucose positron emission tomography-computed tomography. [ABSTRACT FROM AUTHOR]

Background Fundamental echocardiography has some drawbacks in patients with difficult-to-image echocardiograms. The aim of this study is to evaluate impact of contrast echocardiography (CE) on ventricular function assessment and clinical diagnosis in routine clinical echocardiography. Methods Two hundred sixty patients were prospectively enrolled over 3 years in 12 medical centers in Korea. General image quality, the number of distinguishable segments, ability to assess regional wall motion, left ventricular (LV) apex and right ventricle (RV) visualization, LV ejection fraction, changes in diagnostic or treatment plan were documented after echocardiography with and without ultrasound contrast agent. Results Poor or uninterpretable general image was 31% before contrast use, and decreased to 2% (p<0.05) after contrast use. The average number of visualized LV segments was 9.53 before contrast use, and increased to 14.46 (p<0.001) after contrast use. The percentage of poor or not seen LV regional wall motion was decreased from 28.4% to 3.5% (p<0.001). The percentage of poor or not seen LV apex and RV was decreased from 49.4% to 2.4% (p<0.001), from 30.5% to 10.5% (p<0.001), respectively. Changes in diagnostic procedure and treatment plan after CE were 30% and 29.6%, respectively. Conclusion Compared to fundamental echocardiography, CE impacted LV function assessment and clinical decision making in Korean patients who undergo routine echocardiography. [ABSTRACT FROM AUTHOR]

BACKGROUND: We aimed to investigate left ventricular (LV) global longitudinal strain (GLS) in end-stage renal disease patients and its change after kidney transplantation (KT). METHODS: We retrospectively reviewed patients who underwent KT between 2007 and 2018 at two tertiary centers. We analyzed 488 patients (median age, 53 years; 58% male) who had obtained echocardiography both before and within 3 years after KT. Conventional echocardiography and LV GLS assessed by two-dimensional speckle-tracking echocardiography were comprehensively analyzed. Patients were classified into three groups according to the absolute value of pre-KT LV GLS (|LV GLS|). We compared longitudinal changes of cardiac structure and function according to pre-KT |LV GLS|. RESULTS: Correlation between pre-KT LV EF and |LV GLS| were statistically significant, but the constant was not high (r = 0.292, p < 0.001). |LV GLS| was widely distributed at corresponding LV EF, especially when the LV EF was > 50%. Patients with severely impaired pre-KT |LV GLS| had significantly larger LV dimension, LV mass index, left atrial volume index, and E/e' and lower LV EF, compared to mildly and moderately reduced pre-KT |LV GLS|. After KT, the LV EF, LV mass index, and |LV GLS| were significantly improved in three groups. Patients with severely impaired pre-KT |LV GLS| showed the most prominent improvement of LV EF and |LV GLS| after KT, compared to other groups. CONCLUSIONS: Improvements in LV structure and function after KT were observed in patients throughout the full spectrum of pre-KT |LV GLS|. [ABSTRACT FROM AUTHOR]

BACKGROUND: To explore the prognostic performance of coronary computed tomography angiography (CCTA) and exercise electrocardiography (XECG) in asymptomatic subjects. METHODS: We retrospectively enrolled 812 (59 ± 9 years, 60.8% male) asymptomatic subjects who underwent CCTA and XECG concurrently from 2003 through 2009- Subjects were followed-up for major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, unstable angina, and revascularization after 90 days from index CCTA. RESULTS: The prevalence of occult coronary artery disease (CAD) detected by CCTA was 17.5% and 120 subjects (14.8%) had positive XECG. During a mean follow-up of 37 ± 16 months, nine subjects experienced MACE. In multivariable Cox-regression analysis, only the presence of CAD by CCTA independently predicted future MACE (p = 0.002). Moreover, CAD by CCTA improved the predictive value when added to a clinical risk factor model using the likelihood ratio test (p < 0.001). Notably, the prognostic value of CCTA persisted in the moderate-to-high-risk group as classified by the Duke treadmill score (p = 0.040), but not in the low-risk group (p = 0.991). CONCLUSION: CCTA provides incremental prognostic benefit over and above XECG in an asymptomatic population, especially for those in a moderate-to-high-risk group as classified by the Duke treadmill score. Risk stratification using XECG may prove valuable for identifying asymptomatic subjects who can benefit from CCTA. [ABSTRACT FROM AUTHOR]

Background: The timing and indications for surgical intervention in asymptomatic patients with severe aortic stenosis remain controversial.Methods: In a multicenter trial, we randomly assigned 145 asymptomatic patients with very severe aortic stenosis (defined as an aortic-valve area of ≤0.75 cm2 with either an aortic jet velocity of ≥4.5 m per second or a mean transaortic gradient of ≥50 mm Hg) to early surgery or to conservative care according to the recommendations of current guidelines. The primary end point was a composite of death during or within 30 days after surgery (often called operative mortality) or death from cardiovascular causes during the entire follow-up period. The major secondary end point was death from any cause during follow-up.Results: In the early-surgery group, 69 of 73 patients (95%) underwent surgery within 2 months after randomization, and there was no operative mortality. In an intention-to-treat analysis, a primary end-point event occurred in 1 patient in the early-surgery group (1%) and in 11 of 72 patients in the conservative-care group (15%) (hazard ratio, 0.09; 95% confidence interval [CI], 0.01 to 0.67; P = 0.003). Death from any cause occurred in 5 patients in the early-surgery group (7%) and in 15 patients in the conservative-care group (21%) (hazard ratio, 0.33; 95% CI, 0.12 to 0.90). In the conservative-care group, the cumulative incidence of sudden death was 4% at 4 years and 14% at 8 years.Conclusions: Among asymptomatic patients with very severe aortic stenosis, the incidence of the composite of operative mortality or death from cardiovascular causes during the follow-up period was significantly lower among those who underwent early aortic-valve replacement surgery than among those who received conservative care. (Funded by the Korean Institute of Medicine; RECOVERY ClinicalTrials.gov number, NCT01161732.). [ABSTRACT FROM AUTHOR]

The article presents a case study of a 78-year-old woman with a prior stroke presented a hypermobile echogenic mass on the mitral valve without regurgitation.

This is the first randomized clinical trial to provide data demonstrating the beneficial effect of dapagliflozin on LV diastolic dysfunction in patients with type 2 DM. Abnormal left ventricular longitudinal functional reserve in patients with diabetes mellitus: implication for detecting subclinical myocardial dysfunction using exercise tissue Doppler echocardiography. [Extracted from the article]

BACKGROUND: Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk. METHODS: Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements. RESULTS: Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (Cl) 1.249-2.622] and OR: 1.767 (95% Cl: 1.177-2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone. CONCLUSION: The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk. [ABSTRACT FROM AUTHOR]

Abiotrophia defectiva , a nutritionally variant streptococci can cause bacteremia, brain abscess, septic arthritis and in rare cases, infective endocarditis, which accounts for 5-6% of all cases. A. defectiva is characteristically difficult to diagnose and the mortality, morbidity and complication rates are high. Here, we discuss a case of infective endocarditis caused by A. defectiva. A 62-year-old female had previously undergone prosthetic valve replacement 6 years prior to admission. She developed infective endocarditis after tooth extraction. Her endocarditis was successfully treated with antimicrobial therapy and mitral valve replacement surgery. This is the first case of infective endocarditis caused by A. defectiva reported in Korea. This case shows that A. defectiva could be considered as a causative organism of infective endocarditis in Korea. [ABSTRACT FROM AUTHOR]

BACKGROUND: Atrial fibrillation (AF) is a well-established risk factor for stroke. Interestingly, ischemic stroke increases risk of incident AF in patients without prior diagnosed AF. For better risk stratification for post-stroke AF, we studied left atrial (LA) size and mechanical function using two-dimensional (2D) speckle tracking imaging in patients with acute ischemic stroke. METHODS: A total of 227 patients (132 males, age 67 12) with acute ischemic stroke without a history of AF underwent 2D transthoracic echocardiography and speckle tracking imaging for the assessment of LA volume index and global LA longitudinal strain (LALS). From clinical variables, the C H A 2DS2-VASc score and National Institute of Health Stroke Scale (NIHSS) were calculated in each patient. Post-stroke AF was defined as newly diagnosed AF during the course after ischemic stroke. RESULTS: Post-stroke AF occurred in 25 patients (11%). Patients with post-stroke AF were older and showed a higher tendency of C H A 2DS2-VASC score, significantly higher log N IHS S, larger LA volume index and lower global LALS than those without. In multivariate analysis, global LALS was an independent predictor for post-stroke AF (hazard ratio 0.9, 95% confidence interval 0.83--0.97,/< 0.01) after controlling for confounding factors. Furthermore, global LALS provided incremental predictive value for post-stroke AF over the C H A 2DS2-VASc score, N IH S S, and LA volume index. The global LALS < 14.5% better distinguished post-stroke AF (area under the curve 0.837, sensitivity 60%, specificity 95%, < 0.01) than C H A 2DS2-VASC score. CONCLUSION: Global LALS as a marker of LA mechanical function has incremental predictive value for post-stroke AF in patients with acute ischemic stroke. [ABSTRACT FROM AUTHOR]

BACKGROUND: After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. METHODS: We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles 0 and 0.05). CONCLUSION: Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure. [ABSTRACT FROM AUTHOR]

Background Transient apical wall thickening (TAWT), mimicking apical hypertrophic cardiomyopathy during recovery from stress cardiomyopathy (SCM), has recently been reported. However, the clinical significance of this phenomenon has not yet been assessed. We aimed to explore the prevalence, profiles, and impact on the clinical course of TAWT in patients with SCM. Methods We retrospectively analyzed the SCM registry from January 2009 to December 2013. Of 429 patients with SCM, 124 patients who had typical features of transient apical ballooning were included. We identified patients who showed evidence of TAWT, which became normalized on serial echocardiograms. Clinical characteristics, incidence of cardiac complications (arrhythmia, pulmonary edema, cardiogenic shock, or left ventricular thrombus), and in-hospital mortality were compared between patients with and without TAWT. Results Among 124 patients, 17 (14%) patients showed TAWT. During the follow-up period, TAWT was observed 14.6 ± 10.3 days after the initial SCM diagnosis. Patients with TAWT showed a higher prevalence of septic shock as a triggering factor of SCM than those without TAWT (41.2% vs. 19.6%, p = 0.048). Furthermore, cardiac complications were more prevalent in patients with TAWT compared to patients without (64.7% vs. 33.6%, p = 0.03). Finally, in-hospital mortality was significantly higher in patients with TAWT group during the clinical course of SCM (p = 0.009). Conclusion TAWT in patients with SCM is not uncommon. Patients with SCM and systemic inflammation with hemodynamic instability might be susceptible to TAWT, which is often associated with cardiac complications. These patients showed worse prognosis compared to those without TAWT during recovery from SCM. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is associated with increased risks of diabetes and atherosclerotic cardiovascular disease. Whether central obesity (CeO) is a prerequisite for the diagnosis of MetS in the International Diabetes Federation (IDF) definition is a substantial issue because it may influence the clinical value of MetS for predicting subclinical atherosclerosis. Methods: We investigated the relation between MetS, as defined by the National Cholesterol Education Program-Adult Treatment Panel (NCEP–ATP) III criteria, and arterial stiffness according to CeO status in 2,560 healthy Korean subjects who participated in a community-based cohort study. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Results: The prevalence of MetS was 37%; 84% of MetS subjects had CeO. The prevalence of diabetes was significantly higher in MetS subjects than in non-MetS subjects (30 vs. 8%, p <0.001). The number of MetS components was significantly correlated with baPWV (r = 0.311, p <0.001). In a subgroup analysis of MetS subjects, the prevalence of diabetes was not significantly different in MetS subjects with and without CeO. MetS subjects without CeO had significantly higher baPWV than those with CeO (1654 ± 315 vs. 1578 ± 270 cm/s, p = 0.002). Multiple regression models revealed that waist circumference was independently associated with decreased baPWV in MetS subjects. Conclusions: Despite the significant correlation between the number of MetS components and arterial stiffness, there appeared to be an inverse association between CeO and arterial stiffness in MetS subjects. In contrast to the IDF definition, our findings suggest that CeO is not crucial for the diagnosis of MetS in otherwise healthy Koreans having multiple metabolic risk factors with respect to subclinical atherosclerosis reflected in arterial stiffness. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) is associated with increased risks of diabetes and atherosclerotic cardiovascular disease. Whether central obesity (CeO) is a prerequisite for the diagnosis of MetS in the International Diabetes Federation (IDF) definition is a substantial issue because it may influence the clinical value of MetS for predicting subclinical atherosclerosis. Methods: We investigated the relation between MetS, as defined by the National Cholesterol Education Program- Adult Treatment Panel (NCEP-ATP) III criteria, and arterial stiffness according to CeO status in 2,560 healthy Korean subjects who participated in a community-based cohort study. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Results: The prevalence of MetS was 37%; 84% of MetS subjects had CeO. The prevalence of diabetes was significantly higher in MetS subjects than in non-MetS subjects (30 vs. 8%, p <0.001). The number of MetS components was significantly correlated with baPWV (r = 0.311, p <0.001). In a subgroup analysis of MetS subjects, the prevalence of diabetes was not significantly different in MetS subjects with and without CeO. MetS subjects without CeO had significantly higher baPWV than those with CeO (1654 ± 315 vs. 1578 ± 270 cm/s, p = 0.002). Multiple regression models revealed that waist circumference was independently associated with decreased baPWV in MetS subjects. Conclusions: Despite the significant correlation between the number of MetS components and arterial stiffness, there appeared to be an inverse association between CeO and arterial stiffness in MetS subjects. In contrast to the IDF definition, our findings suggest that CeO is not crucial for the diagnosis of MetS in otherwise healthy Koreans having multiple metabolic risk factors with respect to subclinical atherosclerosis reflected in arterial stiffness. [ABSTRACT FROM AUTHOR]

Background Metabolic syndrome (MetS) is associated with increased risks of diabetes and atherosclerotic cardiovascular disease. Whether central obesity (CeO) is a prerequisite for the diagnosis of MetS in the International Diabetes Federation (IDF) definition is a substantial issue because it may influence the clinical value of MetS for predicting subclinical atherosclerosis. Methods We investigated the relation between MetS, as defined by the National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III criteria, and arterial stiffness according to CeO status in 2,560 healthy Korean subjects who participated in a community-based cohort study. Arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Results The prevalence of MetS was 37%; 84% of MetS subjects had CeO. The prevalence of diabetes was significantly higher in MetS subjects than in non-MetS subjects (30 vs. 8%, p <0.001). The number of MetS components was significantly correlated with baPWV (r = 0.311, p <0.001). In a subgroup analysis of MetS subjects, the prevalence of diabetes was not significantly different in MetS subjects with and without CeO. MetS subjects without CeO had significantly higher baPWV than those with CeO (1654 ± 315 vs. 1578 ± 270 cm/s, p = 0.002). Multiple regression models revealed that waist circumference was independently associated with decreased baPWV in MetS subjects. Conclusions Despite the significant correlation between the number of MetS components and arterial stiffness, there appeared to be an inverse association between CeO and arterial stiffness in MetS subjects. In contrast to the IDF definition, our findings suggest that CeO is not crucial for the diagnosis of MetS in otherwise healthy Koreans having multiple metabolic risk factors with respect to subclinical atherosclerosis reflected in arterial stiffness. [ABSTRACT FROM AUTHOR]

Background Coronary artery disease (CAD) is a major cardiovascular complication in diabetic patients. Despite the significant association between obesity and diabetes, the majority of the diabetic subjects are not obese in an Asian population. This study evaluated the association between obesity and coronary artery disease (CAD) according to the diabetes status in a Korean population. Methods The association between obesity and CAD using the parameters of any plaque, obstructive plaque, and coronary artery calcium score (CACS) >100 according to the presence of diabetes was evaluated in 7,234 Korean adults who underwent multi-detector computed tomography for general health evaluations. Obesity was defined as a body mass index (BMI) ⩾25 kg/m2. Results The prevalence of obesity was significantly higher in diabetic subjects than in non-diabetic subjects, but the majority of the diabetic subjects were non-obese (48% vs. 37%, p <0.001). The incidence of any plaque (58% vs. 29%), obstructive plaque (20% vs. 6%), and CACS >100 (20% vs. 6%) were significantly higher in diabetic patients than in non-diabetic subjects (p <0.001, respectively). Incidence of any plaque (33% vs. 26%, p <0.001), obstructive plaque (7% vs. 6%, p = 0.014), and CACS >100 (8% vs. 6%, p = 0.002) was significantly higher in non-diabetic subjects with obesity than in those without obesity, but the incidence of all coronary parameters was not different in diabetic subjects according to the obesity status. After adjusting for confounding risk factors including age, gender, hypertension, dyslipidemia, current smoking, and mild renal dysfunction, obesity was independently associated with increased risks of any plaque (OR 1.14) and CACS >100 (OR 1.31) only in non-diabetic subjects (p <0.05, respectively). Multiple logistic regression models revealed that diabetes was independently associated with all coronary parameters. Conclusion Despite a significantly higher prevalence of obesity in diabetic subjects than in non-diabetic subjects, obesity is associated with the presence of any plaque and severe coronary calcification only in subjects without established diabetes among Korean population. [ABSTRACT FROM AUTHOR]

BACKGROUND: Abnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aim of this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients who underwent OHS using transthoracic echocardiography (TTE). METHODS: In total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valve surgery were consecutively enrolled in a prospective manner. TTE was performed preoperatively, at 3-6-month posto-peratively, and at the 1-year follow-up visit. Routine TTE images and strain analysis were performed using velocity vector imaging. RESULTS: ASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presented concomitant expiratory diastolic flow reversal of the hepatic vein, 11 (7%) had inferior vena cava plethora, and 11 (7%) had both. Only 2 patients (1%) showed clinically discernible constriction. ASM persisted 3-6 months after surgery in 38 patients (25%), but only in 23 (15%) after 1 year. There was no difference in preoperative and postoperative peak systolic strain of all segments of the left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (Vu) of the mid anterior-septum and anterior wall of the LV significantly decreased in patients with ASM. CONCLUSION: Although ASM was common (74%) immediately after OHS, it disappeared over time without causing clinically detectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreased systolic Vitad of the interventricular septum after pericardium incision. [ABSTRACT FROM AUTHOR]

There are limited data on the effect of iloprost therapy in patients with Eisenmenger syndrome (ES). The aim of our study was to evaluate the effect of inhaled iloprost therapy on exercise capacity, quality of life (QoL), cardiac function, and hemodynamics in patients with ES. Eighteen consecutive patients with ES and exertional dyspnea according to the World Health Organization functional class III or IV were prospectively recruited. Exercise capacity was assessed by a 6-minute walk test, and QoL was measured on a 12-Item Short- Form Health Survey. Echocardiographic measurements included peak systolic and mean pulmonary arterial pressures, pulmonary vascular resistance, and myocardial performance index of the right ventricle (RV). All patients underwent comprehensive evaluation at baseline and after 24 weeks of treatment. Of the 18 patients with ES, 13 were included for analysis. After 24 weeks of iloprost therapy, 6-minute walk test distance significantly increased (289.1 ± 76.9 to 369.5 ± 93.4 m, p = 0.032) in addition to concomitant improvements in the 12-Item Short-Form Health Survey physical and mental component summaries (20.6 ± 19.3 to 52.6 ± 28.0, p <0.05; 33.9 ± 19.7 to 54.9 ± 21.3, p <0.05, respectively). RV myocardial performance index improved significantly after treatment (0.80 ± 0.31 to 0.59 ± 0.12, p = 0.042). Pulmonary arterial pressure and pulmonary vascular resistance did not improve with iloprost therapy. This study showed that 24 weeks of inhaled iloprost therapy in patients with ES led to significant improvements in exercise capacity, QoL, and RV function. These results likely explain the symptomatic relief reported by patients with ES receiving iloprost therapy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hemorrhagic transformation (HT) of stroke is a disastrous complication in patients with infective endocarditis (IE). In patients with mechanical heart valves complicated by IE, physicians struggle with the appropriateness of anticoagulation administration given the risk of thromboembolism and HT of stroke. In this study, we aimed to define predictive parameters of HT of stroke in patients with prosthetic valve endocarditis (PVE). METHODS: This study was a multicenter, retrospective design. We recruited from 7 institutions a total of 111 patients diagnosed with PVE during May, 2011 to April, 2012. RESULTS: Complication of stroke was seen in 26/111 patients (23%), and HT of stroke was seen in 11/111 patients (10%). Most patients with HT (9/11, 82%) had supratherapeutic prothrombin times. However, there were no significant differences in clinical and laboratory values between PVE patients without stroke and those patients who had a stroke and with or without concurrent HT. Furthermore, echocardiographic parameters also did not show significant between-group differences. CONCLUSION: Even though this was a multicenter study, a limited number of patients was identified and may explain the negative results seen here. However, a large number of PVE patients with stroke also developed HT. Therefore, further studies to define predictive parameters of HT should be implemented in a larger population. [ABSTRACT FROM AUTHOR]

Leaflet escape of prosthetic valve is rare but potentially life threatening. It is essential to make timely diagnosis in order to avoid mortality. Transesophageal echocardiography and cinefluoroscopy is usually diagnostic and the location of the missing leaflet can be identified by computed tomography (CT). Emergent surgical correction is mandatory. We report a case of fractured escape of Edward-Duromedics mitral valve 27 years after the surgery. The patient presented with symptoms of acute decompensated heart failure and cardiogenic shock. She was instantly intubated and mechanically ventilated. After prompt evaluation including transthoracic echocardiography and CT, the escape of the leaflet was confirmed. The patient underwent emergent surgery for replacement of the damaged prosthetic valves immediately. Eleven days after the surgery, the dislodged leaflet in iliac artery was removed safely and the patient recovered well. [ABSTRACT FROM AUTHOR]

BACKGROUND: Accurate assessment of mitral regurgitation (MR) severity is crucial for clinical decision-making and optimizing patient outcomes. Recent advances in real-time three dimensional (3D) echocardiography provide the option of real-time full volume color Doppler echocardiography (FVCD) measurements. This makes it practical to quantify MR by subtracting aortic stroke volume from the volume of mitral inflow in an automated manner. METHODS: Thirty-two patients with more than a moderate degree of MR assessed by transthoracic echocardiography (TTE) were consecutively enrolled during this study. MR volume was measured by 1) two dimensional (2D) Doppler TTE, using the proximal isovelocity surface area (PISA) and the volumetric quantification methods (VM). Then, 2) real time 3D-FVCD was subsequently obtained, and dedicated software was used to quantify the MR volume. MR volume was also measured using 3) phase contrast cardiac magnetic resonance imaging (PC-CMR). In each patient, all these measurements were obtained within the same day. Automated MR quantification was feasible in 30 of 32 patients. RESULTS: The mean regurgitant volume quantified by 2D-PISA, 2D-VM, 3D-FVCD, and PC-CMR was 72.1 ± 27.7, 79-9 ± 36.9, 69-9 ± 31.5, and 64.2 ± 30.7 mL, respectively (p = 0.304). There was an excellent correlation between the MR volume measured by PC-CMR and 3D-FVCD (r = 0.85, 95% CI 0.70-0.93, p < 0.001). Compared with PC-CMR, Bland-Altman analysis for 3D-FVCD showed a good agreement (2 standard deviations: 34.3 mL) than did 2D-PISA or 2D-VM (60.0 and 62.8 mL, respectively). CONCLUSION: Automated quantification of MR with 3D-FVCD is feasible and accurate. It is a promising tool for the real-time 3D echocardiographic assessment of patients with MR. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 37-year-old man who developed bacterial endocarditis and abscess formation after his transcatheter procedure with Amplatzer septal occluder (ASO) four years ago. He had a history of a large secundum atrial septal defect and underwent a surgery to remove the infected ASO with no complications. It also mentions the development of occluding devices as a less invasive alternative to open heart surgery.

Double atrial septum is very rare atrial septal malformation which has double layered atrial septum with persistent interatrial space between the two atria. Clinically, most cases of this anomaly are asymptomatic unless manifest as thromboembolic complications, such as stroke, or transient ischemic attack, that thrombus may be originated from this interatrial space. We report a case of a 69-year-old man who was diagnosed with isolated double atrial septum by transthoracic echocardiography. [ABSTRACT FROM AUTHOR]

Kommerell's diverticulum is a rare congenital disorder characterized by typical right sided aortic arch and aberrant left subclavian artery which are usually detected by accident in asymptomatic patients. However, some of patients complain of severe symptoms caused by compression of the adjacent organs or complicated aortic dissection by the diverticulum. Early detection of the disease can lead to elective surgical correction. In this article, we report a Kommerell's diverticulum case initially detected by transesophageal echocardiography. [ABSTRACT FROM AUTHOR]