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To combat the coronavirus disease 2019 (COVID‐19) pandemic, many countries have started population vaccination programs using messenger ribonucleic acid (mRNA) vaccines. With the widespread use of such vaccines, reports are emerging worldwide, of the vaccine's association with the development of myocarditis. Younger men are more likely to develop postvaccine myocarditis, which usually presents as self‐limiting chest pain within a week after the second dose. We present a case of myocarditis following vaccination with tozinameran (BNT162b2, Pfizer‐BioNTech), which presented late, with ventricular tachycardia (VT) reduced left ventricular ejection fraction (LVEF). [ABSTRACT FROM AUTHOR]

Background: Cardiac amyloidosis is a protein misfolding disorder involving deposition of amyloid fibril proteins in the heart. The associated fibrosis of the conduction tissue results in conduction abnormalities and arrhythmias. "Classical" electrocardiogram (ECG) findings in cardiac amyloidosis include that of low voltage complexes with increased left ventricular wall thickness on echocardiography. However, this "classical" finding is neither sensitive nor specific. As cardiac amyloidosis is associated with a generally poor prognosis, the need for early recognition of this disease is important given the availability of new treatment options. In this review, we highlight 3 cases of patients with cardiac amyloidosis. Although presenting with typical clinical signs and symptoms, ECG for all 3 patients was not consistent with the classical findings described. They underwent further diagnostic tests which clinched the diagnosis of cardiac amyloidosis, allowing patients to receive targeted treatment. Through the review of the literature, we will highlight the different ECG patterns in patients with different types of cardiac amyloidosis and clinical scenarios, as well as the pitfalls of using ECG to identify the condition. Lastly, we also emphasize the current paradigms in diagnosing cardiac amyloidosis through the non‐invasive methods of echocardiography, cardiac magnetic resonance imaging, and nuclear technetium‐pyrophosphate imaging. Conclusions: Electrocardiogram is often the first investigation used in evaluating many cardiac disorders, including cardiac amyloidosis. However, classical features of cardiac amyloidosis on ECG are often not present. A keen understanding on the ECG features of cardiac amyloidosis and knowledge of the diagnostic workflow is important to diagnose this condition. [ABSTRACT FROM AUTHOR]

Aim: Growth differentiation factor 15 (GDF15) is a cytokine highly expressed in states of inflammatory stress. We aimed to study the clinical correlates and prognostic significance of plasma GDF15 in heart failure with preserved ejection fraction (HFpEF) vs. reduced ejection fraction(HFrEF), compared with N-terminal pro-brain natriuretic peptide (NT-proBNP), an indicator of haemodynamic wall stress.Methods: Plasma GDF15 and NT-proBNP were prospectively measured in 916 consecutive patients with HFrEF (EF <50%; n = 730) and HFpEF (EF ≥50%; n = 186), and measured again at 6 months in 488 patients. Patients were followed up for a composite outcome of death or first HF rehospitalization.Results: Median GDF15baseline values were similarly elevated in HFpEF [2862 (1812 represent the 25th percentile and 4176 represent the 75th percentile) ng/L] and HFrEF [2517 (1555, 4030) ng/L] (P = 0.184), whereas NT-proBNP was significantly lower in HFpEF than HFrEF (1119 ng/L vs. 2335 ng/L, P < 0.001). Independent correlates of GDF15baseline were age, systolic blood pressure, New York Heart Association (NYHA) class, diabetes, atrial fibrillation, sodium, haemoglobin, creatinine, diuretic therapy, high sensitivity troponin T (hsTnT) and NT-proBNP (all P < 0.05). During a median follow-up of 23 months, there were 379 events (307 HFrEF, 72 HFpEF). GDF15 remained a significant independent predictor for composite outcome even after adjusting for important clinical predictors including hsTnT and NT-proBNP (adjusted hazard ratio 1.76 per 1 Ln U, 95% confidence interval 1.39-2.21; P < 0.001), regardless of HF group (Pinteraction  = 0.275). GDF15baseline provided incremental prognostic value when added to clinical predictors, hsTnT and NT-proBNP (area under receiver operating characteristic curve increased from 0.720 to 0.740, P < 0.019), with a net reclassification improvement of 0.183 (P = 0.004). Patients with ≥20% GDF156months increase had higher risk for composite outcome (adjusted hazard ratio 1.68, 95% confidence interval 1.15-2.45; P = 0.007) compared with those with GDF156months within ± 20% of baseline.Conclusions: The similarly elevated levels and independent prognostic utility of GDF15 in HFrEF and HFpEF suggest that beyond haemodynamic stress (NT-proBNP), inflammatory injury (GDF15) may play an important role in both HF syndromes. [ABSTRACT FROM AUTHOR]

Background: Left ventricular mass (LVM) is an independent risk factor for cardiovascular outcome. We aimed to define normal reference values of LVM/body surface area (BSA) in a multiethnic Southeast Asian population across ages, and define demographic parameters that predict LVM/BSA. Methods: 198 subjects (44% men, mean age 40 ± 14 years, 82% Chinese, 13% Malay and 5% Indian) with no cardiovascular comorbidity and had normal echo images for age were included in the analysis. Echo LVM was calculated as: 1.04 ×[(left ventricular internal diameter at end-diastole {LVIDd}+ interventricular septal thickness at end-diastole {IVSd}+ left ventricular posterior wall thickness at end-diastole {LVPWd})3− LVIDd3× 0.8]+ 0.61, indexed by BSA (LVM/BSA)* and expressed as g/m2. Results: BSA and blood pressure (BP) were comparable between dichotomous age groups < or ≥ 50 years within the same gender. Women aged ≥ 50 years had larger IVSD, LVPWd, LVM and LVM/BSA compared to younger cohort. (p < 0.01 for all variables). The 95th percentile of LVM in men and women were 189 g and 148 g respectively; corresponding values for LVM/BSA were 106 and 96 g/m2. These values are consistently smaller than published values from the West. Age (r = 0.27, P < 0.001), gender (r =−0.30, P < 0.001), and systolic BP (r = 0.25, P = 0.003) were significant univariate predictors of LVM/BSA. Conclusion: We therefore propose a different cutoff value for the diagnosis of LV hypertrophy among Southeast Asians. [ABSTRACT FROM AUTHOR]

Background: Stroke-work loss (SWL) represents the amount of energy the left ventricle dissipates as heat because of outflow obstruction. Recent studies suggest that SWL > 25% was the most clinically efficient Doppler measure for predicting hemodynamic significance, symptomatic status, and outcome in patients with aortic stenosis (AS). However, SWL may be affected by systolic blood pressure (SBP). Objective: To determine if SWL reliably predicts hemodynamic significance of AS in patients with hypertension. Methods: We studied 42 consecutive patients with hemodynamically significant AS requiring aortic valve replacement (AVR). Data on demographics, preoperative hemodynamics, and echocardiographic parameters were obtained. SWL was measured using the formula SWL = 100 × mean PG/ (mean PG + SBP), where PG is transaortic pressure gradient. Patients were considered hypertensive if their BP > 140/90 mmHg or if they are on antihypertensive medications. Results: There were 27 males (64%) and mean age was 68 ± 11 years. Twenty-four patients (57%) were hypertensive. Mean SBP was 134 ± 24 mmHg, mean transaortic PG 47 ± 20 mmHg, effective valve orifice area (EOA) by Doppler estimation 0.74 ± 0.23 cm2, and SWL 26 ± 9%. Patients with hypertension had smaller SWL than normotensives ( table I ). SWL was >25% in 20 (49%) patients, and fewer patients with hypertension have SWL >25% (33% vs 71%, P = 0.019). Of note, patients with SWL ≤25% had significantly higher SBP (145 ± 21 mmHg vs 122 ± 22 mmHg, P = 0.02). Conclusion: SWL underestimates the hemodynamic significance of aortic stenosis in the majority of patients with hypertension. [ABSTRACT FROM AUTHOR]

Cor triatriatum dexter ( CTD) is an extremely rare congenital condition arising from the persistence of the right valve of the sinus venosus. It divides the right atrium (RA) into 2 separate chambers. We report a case of a 50-year-old man who had an incidental finding of CTD on transesophageal echocardiogram. An incomplete membrane of the RA was seen, and three-dimensional echocardiogram delineated the structure clearly as a triangular sail-like structure with multiple orifices and a fenestration. [ABSTRACT FROM AUTHOR]