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The article describes the case of a 70-year-old woman with aortic intramural hematoma and complications. The patient experienced symptoms such as hypertension and chest pain. She underwent computed tomography (CT) and transesophageal echocardiography to assess her condition. Some abnormalities observed during her M-mode electrocardiograms.

Background: Heart rate (HR) has been identified as a risk factor for adverse longterm outcomes in patients with and without heart disease. However, the relationship between discharge HR and outcomes in patients receiving guideline based therapy for HF remains unknown. Hypothesis: Heart rate at hospital discharge in patients with HF is an independent predictor of mortality and readmission rates at 1 year. Methods: Using the American Heart Association Get With The Guidelines Heart Failure national quality assurance registry linked with Medicare data, long term outcomes for patients =65 years of age hospitalized from 2005-2011 were obtained. Univariable and multivariable analyses were performed to examine the relationship between 1-year outcomes (death or all cause readmission) and discharge HR. Heart rate was analyzed as a categorical (tertiles) or continuous variable. Crude and adjusted odds ratios and 95% confidence intervals for the association between discharge HR and the risk of death or hospitalization by 1-year were obtained from logistic regression modeling. Results: The analysis sample was comprised of 45,672 patients with a valid link to Medicare data and 1 year outcome status. The mean age was 80 ±8 years; % male was 45.7; and the mean ejection fraction was 43.5 ±16. Median discharge HRs for the first, second and third tertiles significantly differed (61, 72 and 87 bpm, respectively, p <0.0001). In univariable and multivariable analyses adjusted for clinical and hospital level variables there was a statistically significant relationship between 1 year outcomes and discharge HR (Table). Conclusion: In hospitalized patients with HF, HR at the time of discharge is an independent predictor of mortality. Despite optimal adherence to current guideline based therapy, the odds for all-cause mortality increased by 13% for every 10 beat increases in HR. The use of HR both as a prognostic variable, as well as potentially modifiable risk factor, may be of value in risk-stratification algorithms at discharge. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiography (TEE) has not been compared to transthoracic echocardiography (TTE) for assessment of left ventricular diastolic function (LVDF). Left ventricular diastolic dysfunction is common in systemic lupus erythematosus (SLE), a disease model of premature myocardial disease., Methods: 66 patients with SLE (mean age 36±12 years, 91% women) and 26 age-and-sex matched healthy volunteers (mean age 34±11 years, 85% women) underwent TEE immediately followed by TTE. From basal four-chamber views, mitral inflow E and A velocities, E/A ratio, E deceleration time, isovolumic relaxation time, septal and lateral mitral E' and A' velocities, septal E'/A' ratio, mitral E to septal and lateral E' ratios, and pulmonary veins systolic to diastolic peak velocities ratio were measured. Measurements were averaged over 3 cardiac cycles and performed by 2 independent observers., Results: LVDF parameters were worse in patients than in controls by TEE and TTE (all p≤0.03). Most LVDF parameters were similar within each group by TEE and TTE (all p≥0.17). By both techniques, mitral E and A, mitral and septal E/A ratios, septal and lateral E', septal and lateral E/E' ratios, and average E/E' ratio were highly correlated (r=0.64-0.96, all p≤0.003); E deceleration time, isovolumic relaxation time, and septal A' velocities were moderately correlated (r=0.43-0.54, all p≤0.03); and pulmonary veins systolic to diastolic ratio showed the lowest correlation (r=0.27, p=0.04)., Conclusion: By TEE and TTE, LVDF parameters were worse in SLE patients than in controls; and in both groups, LVDF parameters assessed by TEE and TTE were similar and significantly correlated., Competing Interests: Conflicts of Interest None.