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Introduction and objectives The pocket sized KardiaMobile (KM) is a monitoring device for ECG recording through a smartphone-based application. This system is generally aimed as screening tool to detect alterations in cardiac rhythm but its diagnostic potential for detection of ST changes remains largely unknown. This study sought to assess the diagnostic sensitivity of the KM system for detection of ST changes in patients with ST elevated myocardial infarction (STEMI). Methods Patients admitted with diagnosis of STEMI were consecutively included. Recordings with KM were obtained in leads I, II and anterior precordial. KM recordings were obtained as well from healthy individuals. All recordings were submitted for blinded assessment. Results A total of 112 patients with STEMI and 25 healthy individuals were included. Among those showing ST changes, these consisted mostly in depression (75%). Sensitivity was modest for individual leads (57-58%). The combination of 2-leads, when including the precordial, and the combination of 3-leads markedly increased sensitivity (88-98% and 100% respectively) for both inferior and anterior STEMI. Specificity was very high (96-100%) and the Youden's J statistic was excellent for the 2-leads combinations that included the precordial lead (0.84-0.94) and for the 3-leads combination (0.96). Conclusions The Kardia Mobile system with the combination of 2-leads (I + precordial or II + precordial) or 3-leads shows a very high sensitivity for both anterior and inferior STEMI.

El diagnóstico de la miocardiopatía inflamatoria aguda (MIA) continúa siendo un reto en la actualidad. La resonancia magnética nuclear (RMN) constituye una prueba clave, gracias a su capacidad para detectar la presencia de edema miocárdico, hiperemia o fibrosis. La tomografía por emisión de positrones (PET), aunque ha sido reconocida como una herramienta útil en la sarcoidosis cardiaca, tiene todavía un papel limitado en la MIA. Comparado con la RMN, el PET podría constituir una forma más directa para la identificación de la MIA y permitir cuantificar la actividad metabólica del infiltrado inflamatorio.

Mycotic mitral valve aneurysm is an uncommon complication that rarely appears in isolated mitral valve endocarditis. The weakened aneurysmal wall may rupture, causing severe mitral regurgitation. In this situation surgery is essential. We present a case of a rare complicated mycotic posterior mitral aneurysm. After completing the antibiotic course for Streptococcus agalactiae infective endocarditis, an unexpected healing process within the aneurysm led to the virtual disappearance of the mitral regurgitation and remarkably changed the patient's clinical outcome. We emphasize the key role of three-dimensional transesophageal echocardiography, as it is becoming the reference imaging technique for infective endocarditis.

Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best therapeutic strategy for these patients remains a matter for debate.Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR.A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/mAfter matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio [HR] 1.80, 95% confidence interval [CI]: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737).SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity.

Se presenta el caso de una mujer de 77 años, hipertensa, dislipémica y con enfermedad renal crónica en estadio V. Durante una sesión de hemodiálisis experimenta dolor precordial por fibrilación auricular paroxística con respuesta ventricular rápida. En el electrocardiograma se observa un descenso generalizado del segmento ST. La analítica revela una ligera elevación de la troponina I ultrasensible, que posteriormente muestra una curva de ascenso y descenso sugestiva de síndrome coronario agudo. Ante estos hallazgos, se indica coronariografía. En la angiografía coronaria se encuentra una arteria coronaria derecha única (figura 1) que discurre por el surco auriculoventricular, generando ramas que perfunden todos los territorios miocárdicos de los ventrículos izquierdo y derecho (figura 2 y vídeo del material adicional). Figura 1. Figura 2. La prevalencia de arteria coronaria única es del 0,024-0,066%; en concreto, la arteria coronaria derecha única es una de las variantes más infrecuentes. En estos pacientes, el flujo debe atravesar un sistema con una larga secuencia de resistencias en serie. Con estos hallazgos, podría plantearse que la perfusión en los segmentos medioapicales se encontraría en una situación de isquemia «relativa» respecto al resto. Esto se acentuaría en situaciones de aumento de la demanda miocárdica, como en una taquiarritmia. Aunque se han descrito casos de...

This is the case of a 77-year-old woman with hypertension, dyslipidemia, and stage V chronic kidney disease. While on hemodialysis she experiences precordial pain due to paroxysmal atrial fibrillation with rapid ventricular response. The electrocardiogram shows widespread ST-segment depression. The blood tests confirm the presence of slightly elevated ultrasensitive troponin I levels later showing an ascending and descending curve suggestive of acute coronary syndrome. A coronary angiography is indicated after these findings. The coronary angiography shows a single right coronary artery (figure 1) running through the atrioventricular sulcus and generating branches with perfusion to all myocardial territories of the left and right ventricles (figure 2 and video of the supplementary data). Figure 1. Figure 2. The prevalence of single right coronary artery is between 0.024% and 0.066%; the single right coronary artery is, actually, one of the rarest variants. In these patients, flow runs through a system with a large sequence of serial resistances. Based on these findings, we could argue that the perfusion of medioapical segments would be in a situation of «relative» ischemia compared to the rest. This would exacerbate in situations of greater myocardial demand as in tachyarrhythmias. Although cases of...

Background Recent technological advances have led to several novel electrocardiographic monitoring devices appearing on the market. The pocket sized Kardia Mobile is a monitoring device that requires the patient to trigger the ECG recording through a smartphone-based application. This system is generally aimed to detect alterations in cardiac rhythm and its potential for detection of ST changes remains largely unknown. Purpose This study sought to assess the diagnostic sensitivity of the Kardia Mobile system for detection of ST changes in patients with ST elevated myocardial infarction (STEMI). Methods Patients admitted with diagnosis of STEMI according to current universal standard definition were consecutively included. Recordings with Kardia were obtained in leads I, II and anterior precordial (prec). All anonymized recordings were submitted for review to a single cardiologist blinded to the 12 leads ECG findings and to all clinical data. A Kardia recording was considered positive if any significant elevation or depression of ST segment was observed. Results A total of 102 consecutive patients were included (age 60.6±11.4 years, 27% females, weight 78.6±17.4 kg) admitted with diagnosis of STEMI after a median of 165 (IQR 120–367) minutes of chest pain. STEMI was anterior-lateral in 48% and inferior-posterior in 52%. Values of sensitivity for each lead and for combination of leads are shown in Table for all STEMI and separately for anterior and inferior locations. ST changes in all leads consisted mostly in depression (70–78%). Poor quality recording rates were 8% for lead I, 1% for lead II and 3% for lead prec. Conclusions The Kardia Mobile system with single lead use shows a modest sensitivity for detection of ST changes (mostly depression) in STEMI patients. However, the combination of two leads (particularly I+prec or II+prec) or three leads shows a very high sensitivity for both anterior and inferior STEMI. Funding Acknowledgement Type of funding source: None

La ecocardiografía tridimensional transesofágica ha revolucionado la forma en que se observa hoy día el tabique interauricular, permitiendo una visión anatómica (no accesible previamente) de los remanentes de la circulación fetal: fosa oval y foramen oval. Más de un 25% de la población presenta un foramen oval permeable, que ocasionalmente puede tener relevancia clínica. Además, gran parte de los procedimientos de intervencionismo estructural se llevan a cabo por vía transeptal tras la punción de la fosa oval. Por tanto, actualmente resulta necesario tener un adecuado conocimiento de la anatomía del septo interauricular, así como de sus variantes normales y patológicas.

We present the case of how a massive proximal deep vein thrombosis result of an unknown recurrence of a previously colonic malignancy treated, classically known Trousseau´s Syndrome, can mimic symptoms of severe peripheral arterial disease in a patient affected of peripheral chronic arterial disease surgically treated. Trousseau´s Syndrome is commonly associated with serious and chronic diseases and a variety of paraneoplastic thromboembolic disorders. Thrombotic episodes may precede the diagnosis of cancer and be the potential marker for an unknown and occult malignancy. We highlight the key points of the Trousseau´Syndrome and those paraneoplastic vasculopathies related that can mimic a vascular disease or complication.

The consideration of bleeding risk is of paramount importance for tailoring dual antiplatelet therapy (DAPT) duration. In this regard the recently released focused update on DAPT of the European Society of Cardiology includes the recommendation to use the PRECISE DAPT score to estimate the risk of

The use of intravascular ultrasound (IVUS) seems to improve the prognosis of patients undergoing PCI of the left main coronary artery (LM) with drug-eluting stents (DES), but there are not well-established criteria for application in the procedural optimization. In our institution, since January