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Isaac Kofi Owusu,1,2 Emmanuel Acheamfour-Akowuah,1,2 Yaw Amo Wiafe3 1Department of Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 2Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana; 3Department of Medical Diagnostics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaCorrespondence: Isaac Kofi Owusu, Email ikeowusu@yahoo.comBackground: Rheumatic heart disease (RHD) is mainly among populations in low-to-middle income nations. The burden of this disease on communities and even hospital settings is little understood. This study aimed at analysing the clinical and socio-demographic features of RHD patients in our adult outpatient cardiac department over a 3-year period.Methods: The study was conducted at the Komfo Anokye Teaching Hospital’s Adult Cardiac Clinic in Kumasi, Ghana. Medical records of patients seen at the adult cardiac clinic between 2016 and 2019 with the diagnosis of rheumatic heart disease were examined. The data were captured using EPI-DATA (version 3.1). Stata 14 was used in analysing the mean (standard deviation) and median of continuous variables (inter-quartile range). The frequency and percentages were used to describe categorical data. The Chi-square test was used to establish the statistical significance of a relationship, with a p-value of less than 0.05.Results: A total of 140 RHD cases were included in the study. The average age of patients was 39.7 years. Majority of the participants (82.9%) were from rural areas. Palpitation was the commonest symptom (54.29%), followed by chest pains (36.43%), dyspnoea (25.00%), and dizziness (24.29%). Over seventy-seven percent (77.14%) of the patients had moderate-to-severe rheumatic heart disease. The commonest valvular lesion was isolated mitral regurgitation (56.43%), followed by pure aortic regurgitation (30.71%), and isolated tricuspid regurgitation (12.14%).Conclusion: RHD occurred more commonly in the third decade of life. Rural participants, who are primarily females, were the most affected. Efforts to reduce prevalence rates should be stepped up.Keywords: rheumatic heart disease, acute rheumatic fever, heart failure, mitral regurgitation, echocardiography

Polliana B Dos Santos,1 Rodrigo P Simões,1,2 Cássia da L Goulart,1 Meliza G Roscani,3 Renan S Marinho,1 Patrícia Faria Camargo,1 Renata F Arbex,1 Guilherme Casale,3 Cláudio R Oliveira,3 Renata G Mendes,1 Ross Arena,4 Audrey Borghi-Silva1 1Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil; 2Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil; 3Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil; 4Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USACorrespondence: Audrey Borghi-SilvaCardiopulmonary Physiotherapy Laboratory, Federal University of São Carlos, UFSCar, São Carlos, São Paulo, BrazilTel +551633066704Fax +551633612081Email audrey@ufscar.brAim: Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness.Methods: The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer.Results: Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e’ ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: − 0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: − 0.62; p: 0.001) in the CHF+COPD group.Conclusion: Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.Keywords: heart failure, chronic obstructive pulmonary disease, eccentric hypertrophy, ventricular dysfunction, cardiopulmonary exercise testing, echocardiography

Abstract Introduction: In this study, we aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on serum apelin levels in patients with severe symptomatic aortic valve stenosis (AS). Methods: Forty-six consecutive patients (76.9±7.4 years, n=27 women) who underwent TAVI and 45 age- and sex-matched control subjects were included in the study. Echocardiographic parameters, serum apelin, pro-brain natriuretic peptide (Pro-BNP), and troponin I levels were compared between the groups. In addition, the preprocedural and first-month follow-up echocardiographic parameters and serum apelin values of TAVI patients were compared. Results: Serum median troponin I and Pro-BNP levels were significantly higher and serum apelin levels were significantly lower in TAVI patients before TAVI procedure than in the control subjects (P

Syncope is a common reason for emergency room visits and hospital admission and, in about one patient out of six it can be a manifestation of pulmonary embolism (PE). The prognosis of this condition is largely dependent on the timing of diagnosis and treatment since early anticoagulation may modify the clinical consequences of PE and further loss of consciousness. In this article, we describe the case of a woman presenting with syncope, who showed at the admission a cardiac ultrasound highly specific cluster of signs of pulmonary embolism. This rapid non-invasive evaluation permitted to identify causal diagnosis and to speed up the clinical process.

OBJECTIVE: Current guidelines recommend an implantable cardiac defibrillator (ICD) in patients with symptomatic heart failure and reduced ejection fraction (HFrEF; left ventricular ejection fraction [LVEF] ≤35%) despite ≥3 months of optimal medical therapy. Recent observations demonstrated that sacubitril/ valsartan induces beneficial reverse cardiac remodeling in eligible HFrEF patients. Given the pivotal role of LVEF in the selection of ICD candidates, we sought to assess the impact of sacubitril/ valsartan on ICD eligibility and its predictors in HFrEF patients. PATIENTS AND METHODS: We retrospectively evaluated 48 chronic HFrEF patients receiving sacubitril/valsartan and previously implanted with an ICD in primary prevention. We assumed that ICD was no longer necessary if LVEF improved >35% (or >30% if asymptomatics) at follow-up. RESULTS: Over a median follow-up of 11 months, sacubitril/valsartan induced a significant drop in LV end-systolic volume (-16.7 ml/ m2, p=0.023) and diameter (-6.8 mm, p=0.022), resulting in a significant increase in LVEF (+3.9%, p<0.001). As a consequence, 40% of previously implanted patients resulted no more eligible for ICD at follow-up. NYHA class improved in 50% of the population. A dose-dependent effect was noted, with higher doses associated to more reverse remodeling. Among patients deemed no more eligible for ICD, lower NYHA class (odds ratio (OR) 3.73 [95% CI 1.05; 13.24], p=0.041), better LVEF (OR 1.23 [95% CI 1.01; 1.48], p=0.032) and the treatment with the intermediate or high dose of sacubitril/valsartan (OR 5.60 [1.15; 27.1], p=0.032) were the most important predictors of status change. CONCLUSIONS: In symptomatic HFrEF patients, sacubitril/valsartan induced beneficial cardiac reverse remodeling and improved NYHA class. These effects resulted in a significant reduction of patients deemed eligible for ICD in primary prevention. [ABSTRACT FROM AUTHOR]

Atrial septal defect (ASD) is one of the most common congenital heart defects. Intracardiac repair via midline sternotomy or right thoracotomy and cardiopulmonary bypass have been considered the standard treatment for the closure of atrial septal defects, but transcatheter closure with Amplatzer septal occluder has recently become an alternative option. Transcatheter device closure of secundum ASD is a more than a decade old technology. This has become an alternative to surgical therapy, and has been regarded as generally safe and effective device closure. Device embolization is a potential complication of every attempted ASD closure, and the causative factors include undersized device, floppy rim, and operator-related technical issues, such as malposition during a “push-pull” maneuver. In this paper, we report a 32-year-old HIV positive female patient who presented with gradual onsite of dyspnea, NYHA class II, and successfully underwent a device closure of large atrial septal defect.

The objective of this study was to correlate cardiovascular parameters with obesity in adult cats. Forty mixed-breed cats (20 obese and 20 controls) underwent echocardiographic measurements and thoracic radiography to establish a relationship between the obtained data and the body condition score (BCS), body mass index (BMI), and vertebral heart size (VHS). Systolic arterial pressure (SAP) was also studied in 15 obese cats. Compared to the control cats, obese cats presented higher VHS values across several measurements, but among the echocardiographic parameters, only the difference in the left ventricular free wall at diastole was statistically significant. A positive relationship was established between body weight, left ventricular internal diameter at diastole, and left ventricular free wall at diastole. Positive relationships were also observed between BMI and diameter of the aorta, BCS and the left ventricular free wall at diastole, VHS and the left atrium, and the left atrial to aortic root diameter ratio and the left ventricular internal diameter at diastole. SAP was higher in obese cats and presented a positive correlation with body weight. Obesity correlated with an increase in SAP and with some echocardiographic and radiographic cardiac measurements in adult cats. Further studies are needed to better assess the effects of obesity on the cardiovascular system of cats and to reassess the parameters related to body weight and condition.

BACKGROUND AND OBJECTIVE: Severe mitral valve regurgitation, which occurs primarily or secondary to various cardiovascular diseases, has undergone surgery and valve replacement and artificial valve insertion from several years ago. Within the last few years, severe mitral valve regurgitation has undergone repair surgery. This study was conducted to determine the results of mitral valve repair surgery. METHODS: This cross-sectional study was conducted among 210 patients who had undergone surgery with the diagnosis of severe mitral valve regurgitation. Transesophageal Echocardiography (TEE) was performed for all patients before surgery, and echocardiography was performed one week after surgery and six months later and the results were evaluated in terms of regurgitation in three mild, moderate and severe cases. FINDINGS: The mean age of patients with secondary mitral regurgitation was 43 – 85 years. In patients with secondary mitral regurgitation, 143 (83%) patients did not have mitral regurgitation, 27 (15%) patients had mild mitral regurgitation and 3 patients had moderate to severe mitral regurgitation, whereas in patients with primary mitral regurgitation, 30 (81%) patients did not have mitral regurgitation, 5 (14%) patients had mild mitral regurgitation and 2 (5%) patients had moderate to severe mitral regurgitation. CONCLUSION: The results of the study showed that mitral valve repair with primary or secondary etiology had good results and can replace artificial valve in the future.

We present the case of a 59-year-old patient with severe aortic stenosis, asymptomatic mild to moderate pericardial effusion and no major risk factors for poor prognosis. He underwent four-week course of non-steroidal anti-inflammatory drugs (ibuprofen 600 mg TID) with no improvement of the effusion. After complete diagnostic work-up and examination, we discovered that he had a prostate cancer with bone metastasis. On the bone scintigraphy, there was particular involvement of ribs and sternum. We decided to treat our patient with an association of docetaxel and hormone therapy, after six months we observed a reduction in the pericardial effusion. Even in the presence of a patient without risk factor of poor prognosis, pericardial effusion can be the first sign of occult neoplasia.

Coronary fistulas are defined as the presence of an abnormal connection between the coronary arteries and the low-pressure vascular area or the cardiac cavity. The clinical significance depends on the amount of blood flow through the fistula segment, the volumetric load on the right and left heart chambers, and whether it leads to a coronary steal phenomenon. Although fistula flow can be better visualized by angiographic methods, it can also be seen by echocardiography. In this case, the fistula flow draining to the left ventricle was demonstratively visualized.

Background: Hypertrophic Cardiomyopathy (HCM) is characterized by myocardial hypertrophy, fibrosis, and sarcomeric disarray., Objective: To evaluate the expression levels of circulating miR-21 and -29 in patients with HCM and their association with clinical characteristics and myocardial fibrosis., Methods: In this case-control study, 27 subjects with HCM, 13 subjects with hypertensive cardiomyopathy, and 10 control subjects were enrolled. Evaluation of patients' functional capacity was made by the six-minute walk test. Echocardiographic measurements of left ventricle systolic and diastolic function were conducted. Cardiac magnetic resonance late gadolinium enhancement (LGE) -through a semiquantitative evaluation- was used in the assessment of myocardial fibrosis extent in HCM patients. The expression of miR-21 and -29 in peripheral blood samples of all patients was measured via the method of quantitative reverse transcription polymerase chain reaction., Results: Circulating levels of miR-21 were higher in both hypertensive and HCM (p<0.001) compared to controls, while expression of miR-29 did not differ between the three studied groups. In patients with HCM and LGE-detected myocardial fibrosis in more than 4 out of 17 myocardial segments, delta CT miR-21 values were lower than in patients with myocardial LGE in 3 or fewer myocardial segments (2.71 ± 1.06 deltaCT vs. 3.50 ± 0.55 deltaCT, p<0.04), indicating the higher expression of circulating miR-21 in patients with more extensive myocardial fibrosis., Conclusion: MiR-21 was overexpressed in patients with HCM and hypertensive cardiomyopathy. Importantly, in patients with HCM, more extensive myocardial fibrosis was associated with higher levels of miR-21., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Ostium primum atrial septal defect (ASD) is a congenital cardiac malformation involving atrial septum contiguous with atrioventricular valve annulus, often resulting in associated atrioventricular valves malformations. It is typically repaired in the first years of life1,2. Case report: 32-year-old female asked for cardiology examination after she started to feel chest pain and dyspnea during mild activity. We found out that she is a child from an identical twin pregnancy and has been knowing for heart murmur since childhood. Except Arnold-Chiari malformation type 1, she had no other medical history. On transthoracic echocardiography (TTE) we found normal left ventricular size and function, enlarged right ventricle and significant primum ASD with possible cleft mitral valve leaflet (CMVL) as a cause of mitral regurgitation (MR) (Figure 1). Due to additional evaluation transesophageal echocardiography (TEE) was done and ASD was measured about 22-24 mm long with Qp:Qs ratio of 1,9 and a cleft of posterior mitral valve leaflet was confirmed (Figure 2 and Figure 3). Right heart catheterization showed mildly increased pressures in pulmonary circulation, increased cardiac output with sinus tachycardia and significant left-to-right shunt. She was referred to a cardiac surgeon and operated; CMVL was repaired and ASD was closed with an autologous pericardial patch. Postoperative recovery was doing well and control TTE shows mild mitral regurgitation and no signs of shunt over good positioned interatrial patch. Conclusion: The diagnoses of ostium primum atrial septal defect and cleft mitral valve can easily and successfully be made by echocardiography. The long-term results with this congenital anomalies repair are excellent. [ABSTRACT FROM AUTHOR]

Background and Objectives: Coronary slow flow phenomenon (CSF) is a microvascular disorder characterized by delayed opacification of coronary arteries in the absence of any evidence of obstructive epicardial coronary disease. In this study we aimed to compare the LV global longitudinal strain (GLS) obtained by 2D- echocardiography in diabetic and hypertensive patients with slow flow coronary arteries and diabetic and hypertensive patients with normal coronary arteries. Subjects and Methods: This is a case-control study conducted on 22 diabetic and hypertensive patients with angiographically proven normal coronary arteries and slow flow in all coronary artery (TIMI frame count>27 and TIMI-2-flow) and 25 diabetic and hypertensive patients with normal coronary without slow flow phenomenon. The patients in both groups underwent 2D echocardiography to measure LV ejection fraction, GLS and LVH. Results: In this study, 20 women and 27 men with the average age of 55.55±11.16 (range 31 to 80 years) were enrolled. There was no significant difference in GLS between CSF and control group (-13.58 ± 5.50% versus -12.28 ± 7.03%, P<0.489). There was no significant difference between both groups in terms of LVEF and LVH (P <0.05). Conclusion: The GLS in diabetic and hypertensive patients with and without CSF is not different. These data suggest that measurement of global longitudinal strain using 2D echocardiography is not helpfull in diagnose of CSF in these groups of patients. [ABSTRACT FROM AUTHOR]

Objective: to examine the relationship between structural and functional heart remodeling and sclerodermic lung disease.Material and methods. The study involved 62 women: 21 with systemic sclerosis (SSC) (mean age 49,4±2,1 years) and 41 healthy women (mean age 45±1,7 years) (р=0,127). Examination and treatment of patients with SSC was performed according to the guidelines. Instrumental diagnostics included cardiac US, chest X-ray, pulmonary high-resolution computed tomography.Results. SSC patients, as compared to control group, demonstrated significant increase of end-diastolic left ventricular size, septal thickness, left ventricular mass and mass index. End-diastolic and end-systolic left ventricular size was significantly greater in patients with diffuse pulmonary fibrosis than with basal pulmonary fibrosis.Conclusion. Our data indicate significant changes in the structural and functional parameters of the heart in SSC and their relationship with the progression of pulmonary pathology.

Objective: As a highly rare congenital defect, cor triatriatum sinister represents only 0.1% of congenital cardiac anomalies. Depending on the degree of obstruction and the accompanying symptoms, cor triatriatum can be diagnosed at any age. This case series described 5 patients with cor triatriatum sinister who underwent operation. Methods: Five patients with cor triatriatum sinister were seen at our institution between 2007 and 2013. The demographic characteristics and surgical results of these patients are outlined in this retrospective review. Results: The surgical approach consists of left or right atriotomy, excision of the obstructing membrane, and repair of the associated intracardiac anomalies. After an uneventful postoperative hospital stay, all patients were discharged 5–10 days postoperatively. There were no instances of recurrent constriction after surgical treatment of the cor triatriatum membrane. Patients were followed up for a median of 4 years and were symptom free. Conclusion: In the surgical management of this easily and fully treatable congenital cardiac anomaly, it is difficult to determine which atriotomy approach is comparatively more advantageous. However, in the management of cor triatriatum sinister, priority should be given to confirmation of the diagnosis and full resection of the membrane. Thus, the surgeon should not hesitate to perform additional incisions if deemed necessary.

Psoriasis is a systemic inflammatory disease with a great prevalence in general population. The inappropriate activation of the cellular immune system has been hypothesized to be an independent cardiovascular risk factor, given the higher incidence of cardiovascular disorders in psoriatic patients. Echocardiographic abnormalities have been demonstrated too: the aim of our study was to evaluate the presence of preclinical cardiac dysfunction in a cohort of psoriatic patients without cardiovascular risk factors. We enrolled 52 patients with the diagnosis of chronic plaque psoriasis, compared with a control group not affected by any relevant systemic diseases and inflammatory disorders. In all patients and control group, echocardiographic conventional and tissue Doppler (TDI) studies were conducted. The analysis of echocardiographic parameters revealed normal dimension, mass and systolic function of the left ventricle. Left ventricular diastolic dysfunction was found in 36.5% patients in the psoriasis group versus 0% in control group, and significant reduction of the E/A ratio was found also for the right ventricle. A significant increase of mitral regurgitation has been found in psoriatic patients (p=0.005). The early recognition of cardiovascular pre-clinic disease in psoriatic patients may guide a strict follow up and an early treatment, potentially improving cardiovascular prognosis.

BACKGROUND Right heart dysfunction (RHD) is related to adverse outcomes in acute pulmonary embolism (PE). AIM OF THE STUDY To evaluate the relation between RHD, pulmonary clots distribution and biomarkers and prognosis of patients with PE. METHODS We analysed echocardiographic data of 70 patients with diagnosis of PE confirmed by pulmonary computer tomography, hCT. We considered the enddiastolic right/left ventricles ratio > 1 as index of RHD; echocardiographic data were compared with clots distribution in pulmonary vascular tree such as hCT findings and biomarkers. For each patient we calculated the shock index (heart rate/systolic blood pressure ratio, shock defined as ratio ≥ 1). RESULTS Hospital mortality was 8.5%. Mean age of dead patients was significantly higher compared to alive (85.67 vs 71.57 years, p < 0.05). 41% of patients revealed unilateral PE, 59% had bilateral. In 10% of patients main pulmonary artery was interested by clot, 48% of patients had involved one of the main branches, 90% had involved at least one of the lobar branches, 59% one of segmental branches of pulmonary arteries. 52% of patients had RHD. Mortality in RHD patients was 14.8% vs 8% in no RHD, p < 0.05. Mean values of troponin I and D-dimer were significantly higher in RHD patients. Shock index was ≥ 1 in 37.5% of RHD and 20% in no RHD. RHD patients showed significantly higher involvement of main pulmonary artery and its branches and higher bilateral involvement. CONCLUSIONS RHD is related to proximal and bilateral pulmonary clots distribution and troponin I and D-dimer values and poorer prognosis.

Aim. Red cell distribution width (RDW) is a measure of anisocytosis. Higher values are robustly associated to adverse outcome in several conditions, including chronic heart failure (HF). The present study aimed to compared its prognostic role with that of echocardiographic parameters in this kind of patients. Methods. 232 stable and optimally treated chronic HF patients were enrolled. We excluded subjects suffering from valvular diseases or atrial fibrillation. They underwent blood sampling and echocardiographic examination. The primary endpoint of the study was cardiovascular death and/or HF hospitalization in the first year after enrolment. Results. 49 patients reached the primary endpoint. RDW best cut-off at ROC curve was 14.45%. Univariate analysis associated mitral regurgitation grade, left ventricular ejection fraction (LVEF), posterior wall thickness (PWT), LV mass index, and RDW>14.45% to the primary endpoint. Multivariate regression analysis showed that LVEF, PWT, and RDW>14.45% predict the primary endpoint. Area under ROC curve was 0.808 for LVEF, 0.762 for NYHA class, and 0.761 for RDW. Conclusion. In chronic HF patients RDW is a better predictor of adverse outcome than several echocardiographic parameters associated to outcome itself (LV mass index, mitral regurgitation grade), predicts prognosis even adjusting for those parameters, age and NYHA class, and is associated to several echocardiographic measurements. In conclusion, RDW can expand our tool bag in order to better follow-up these patients.

ABSTRACT: Infective endocarditis (IE) is an inflammatory disease which interests heart endothelium and mostly heart valves. IE is not a uniform disease, but presents in a variety of different forms that makes the diagnosis difficult. Echocardiography is a crucial diagnostic tool for the diagnosis, especially in those patients who have no typical symptoms as in the case here presented, in which the possibility of a myxoma was also considered.

Background: Rheumatic heart disease (RHD) continues to be a major public health problem in developing countries like Pakistan. There is no data regarding the prevalence of RHD in our part of country. So we conducted this study to determine the frequency of RHD in patients undergoing echocardiography in District Dera Ismail Khan. Material & Methods: This descriptive cross-sectional study was conducted between September 2011 and March 2013. A total of 1215 patients who were sent for echocardiography for evaluation of dyspnea, palpitation, Shortness of breath, murmur on auscultation and arrhythmia on ECG were included in the study. Frequency of RHD in the study population was noted. Results: A total of 1215 patients between five to 60 years of age were included in the study. All patients underwent echocardiography as per AHA /ACCA Guidelines. There were 753 (62%) males and 462 (38%) females in the study population, with (1.6 to 1) male to female ratio. Mean age of the study population was 38±11yrs. Frequency of RHD was 5.68%. There were 46(66.6%) females and 23(33.3%) males having RHD, mean age of the patients having RHD was 34.33±14 years. Mitral valve was the most common valve involved. Conclusion: Frequency of rheumatic heart disease was high in our study population. It was more common in young female patients. Mitral was the most common valve involved.

The erroneous denomination “lipomatous hypertrophy of the interaatrial septum” is a benign lesion characterized by an important epicardial fat accumulationin the interaatrial septum. We present a female patient with shortness of breath at great efforts and transthoracic and transesophageal echocardiographydiagnosis of hourglass configuration of the interaatrial septum provoking inflow obstruction of the superior vena cava.

Nonbacterial thrombotic endocarditis (NBTE), known as marantic endocarditis, is a phenomenon due to hypercoagulability with a complex pathogenesis. Originally described by Ziegler, the lesions of NBTE were considered to be fibrin thrombi deposited on normal or superficially degenerated cardiac valves [1]. Numerous reports have identified the relationship between NBTE and a variety of different inflammatory states, including chronic diseases like malignancy and autoimmune disease [2, 3]. NBTE is a serious manifestation of prothtombotic state that is characterized by the deposition of thrombi on previously undamaged heart valves in the absence of a bloodstream bacterial infection and by the increased frequency of arterial embolic events in patients with chronic debilitating diseases. Although hypercoagulability is often seen in patients with pancreatic cancer, NBTE has rarely been reported antemortem. We report a case of marantic endocarditis in patient with pancreatic cancer, in which neurological symptoms preceded the diagnosis of pancreatic cancer.

BACKGROUND Left atrial enlargement (LAE) is a marker of hypertensive heart disease associated with increased cardiovascular risk. We reviewed recent literature about the prevalence of LAE, as assessed by echocardiography, to update our information about the clinical relevance of this cardiac phenotype in human hypertension. METHODS We performed a search of MEDLINE using the key words “left atrial enlargement,” “left atrial dilatation,” “left atrial size,” “hypertension,” “echocardiography,” and “atrial fibrillation” to identify relevant papers. We considered full articles published in English from January 1, 2000 to July 1, 2012 reporting studies involving adult individuals. RESULTS We analyzed a total of 15 studies, including 10,141 untreated and treated subjects. LAE was defined according to 11 different criteria (4 studies applied two or three criteria), and its prevalence consistently varied among studies, from 16.0–83.0%, with a prevalence in the pooled population of 32%. A gender-based analysis of 9 studies (8,588 patients) showed the prevalence of LAE as being similar in women and men (OR, 1.23; 95% CI, 0.83–1.83; P = 0.30). Data provided by 10 studies (n = 9,354 patients) showed the prevalence of left-ventricular hypertrophy as being significantly higher in patients with LAE (68.2%) than in their counterparts without LAE (41.8%) (OR, 2.97; 95% CI, 2.68–3.29; P < 0.01). CONCLUSIONS Our analysis shows that LAE is present in a relevant fraction of the hypertensive population. Because LAE is an independent predictor of cardiovascular events, the accurate detection of this phenotype may improve the evaluation of risk in hypertensive patients. [ABSTRACT FROM AUTHOR]

Mechanical dyssynchrony is a common phenomenon in patients with congestive heart failure, which usually identified by noninvasive cardiac imaging tools such as echocardiography. It demonstrates electromechanical delay in some regions of the failing heart which in turn contributes to further impairment of cardiac function. The diagnostic, therapeutic and prognostic values of mechanical dyssynchrony have been reported in a number of studies. Therefore, this review describes briefly the methods of measurement, but more importantly, explains the clinical implication of its assessment in heart failure related aspects including cardiac resynchronization therapy, functional mitral regurgitation, diastolic heart failure and mortality. [ABSTRACT FROM AUTHOR]

The relation to the pressure gradient as assessed by echocardiography and the CMR-derived planimetry of the LVOT is not known, no values for the differentiation of obstruction exist. We studied 37 patients with hypertrophic cardiomyopathy and 14 healthy controls using standard sequences with 3D coverage of the left ventricular outflow tract. A cutoff value of 2.7 cm 2 identified obstruction as defined by echocardiography with 100% accuracy. CMR planimetry at rest is a promising tool to evaluate patients with hypertrophic cardiomyopathy. [ABSTRACT FROM AUTHOR]

The maintenance of circulating blood volume within an optimal range is necessary for haemodialysis patients to avoid circulating complications, including over-hydration and dehydration. Inferior vena cava diameter (IVCD) estimation is a non-invasive method to obtain a well correlation with the intravascular fluid status, and it may get a reliable ideal dry weight (DW) for chronic haemodialysis patients. We try to analysis the life quality changes and circulating complication in chronic haemodialysis patients who adjust DW with this tool in comparing with the traditional method. A total of 100 chronic haemodialysis patients, ranging from 26 to 77 years old, were involved in this study. They are randomly divided into study (n = 50) and control group (n = 50). All of them received the IVCD estimation by echocardiography every month for 3 months. The patients in the study group adjusted the DW with the IVCD estimated by echocardiographic method, however, patients in the control group with the traditional method. The quality of life (QOL) was evaluated with the short form 36 questionnaire (SF-36) in the beginning and the end of the study. The scores of physical functioning (PF), role limitation-physical (RP), general health (GH) and role limitation-emotional (RE) have much improvement in the patients of the study group than those in the control group. Besides, the occurrence of clinical events due to circulating complications during the study period showed significant reduction in the extents of hypotension, gastrointestinal upset, discontinuation of haemodialysis, muscular cramps, tinnitus, headache and chest discomforts with electrocardiographic changes; and these effects, especially, are significant in the patients with over-dehydrated status, which with the IVCD < 8 mm/m2 detected by echocardiographic method. The study demonstrated that ideal DW estimated by echocardiographic method not only improved the QOL but also reduced the circulating complications during haemodialysis for chronic haemodialysis patients. [ABSTRACT FROM AUTHOR]

Aims: Left atrial function is abnormal in a wide range of cardiac diseases. This study was designed to assess the effects of normal ageing and sex on left atrial morphology and function.Methods and Results: Echocardiography was performed in 123 subjects (age 57±19 years, range 22 to 89 years, 59 women) with no evidence of cardiovascular disease. M-mode derived left atrial size, B-mode derived left atrial maximal and minimal volumes, and the volume at onset of atrial systole (P-volume) were measured. Left atrial filling, active and passive emptying volumes and ejections fractions, and expansion index were calculated. Subjects were divided into four groups according to age. Left atrial diameter increased with age, with significantly smaller left atrial size in younger subjects. The oldest subjects had significantly higher (P<0·05) left atrial minimal, maximal and P-volume indices. Filling volume index was highest in the oldest subjects (21·9±5·6 ml/m2). Passive emptying volume index was the lowest in those of middle age (10·5±2·8 ml/m2). Active emptying volume index progressively increased with age (P<0·001). Left atrial expansion index and active emptying fraction were not different between the age groups. There was significant difference in passive emptying fraction (P<0·001) with highest values in the youngest (44·7±7·3%) and lowest values in the oldest subjects (33·6±5·4%).Conclusions: Age- and sex-related reference values of echocardiographic indices of left atrial morphology and function are reported. Ageing is associated with left atrial dilatation. Left atrial conduit function deteriorates with age while reservoir and pump function are maintained. Left atrial anteroposterior diameter is smaller in women than in men, but overall left atrial function is not influenced by sex. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved. [ABSTRACT FROM AUTHOR]

Aims: The analysis of the mitral regurgitation using the proximal isovelocity surface area method has not been extended to clinical practice because of its complexity. Our objective was to design and validate a simplified semi-quantitative method based on proximal isovelocity surface area to assess the severity of mitral regurgitation.Methods and Results: We studied 58 patients with mitral regurgitation. We found a good correlation between the angiographic grade of mitral regurgitation and the parameters derived from proximal isovelocity surface area: maximal regurgitant flow, regurgitant orifice and volume (r: 0·90 to 0·92, P<0·05). The values of maximal regurgitant flow that best predicted the grades of angiographic severity (I–IV) were estimated by regurgitant orifice curves, with cut points of 16, 56 and 160 ml.s−1κp=0·92). Considering that maximal regurgitant flow only depends on the radius of proximal isovelocity surface area and the velocity of aliasing used, we constructed a nomogram with the previously described limits. Twenty-four new patients were studied using this nomogram and angiography. An excellent degree of agreement was found (κp=0·93). The inter- and intraobserver variability showed a κp=0·89 and 0·91, respectively.Conclusion: This nomogram allows a fast semi-quantitative estimation of the grade of MR, feasible and highly correlative with the invasive methods. [ABSTRACT FROM AUTHOR]

El ventrículo único ocurre en 1 x 6 500 nacimientos, asociándose a la transposición de grandes vasos y en la estenosis pulmonar, entre otros. El cuadro clínico dependerá de la anomalía coexistente. Mediante ecocardiografía 2-D (desde aproximación apical), se muestra imagenológicamente la ausencia de tabique interventricular y cámara rudimentaria en un varón de 38 años, cianótico desde el nacimiento. Se confirma a través del angiocateterismo la existencia de un ventrículo común. The single ventricle occurs in 1 x 6 500 births. It is associated with the transposition of great vessels and also with lung stenosis, among others. The clinical picture depends on the coexistent anomaly. Echocardiography 2-D (from apical approximation) was used to show the absence of intraventricular septum and rudimentary chamber in a 38 year old man, who was cyanotic since birth. The single ventricle is confirmed by angiocatheterism.

El diagnóstico de los tumores cardíacos se hace difícil cuando sus manifestaciones principales son síntomas constitucionales inespecíficos. Se presenta el caso de una mujer de 58 años ingresada por adelgazamiento progresivo, fiebre y soplo cardíaco de muy baja intensidad (II/VI). Mediante ecocardiografía transtorácica bidimensional se detecta: masa tumoral adosada a la pared auricular izquierda (mixoma auricular); durante la diástole prolapsa hacia el interior del ventrículo izquierdo. Se comentan los elementos clínicos, inmunológicos e imagenológicos de dichos tumores. The diagnosis of cardiac tumors is found to be difficult when its main manifestations are non-specific constitutional symptoms. The case of a 58-year old woman who was admitted to hospital presenting with progressive weight loss, fever, and low intensity cardiac murmur (II-VI), is reported. By two-dimensional transthoracic echocardiography a tumor mass in the left atrial wall (atrial myxoma) was detected; during diastole prolapsing towards the interior of the left ventricle. The clinical, immunological, and imaging elements of such tumors are pointed out.

Several neurological syndromes, including syncope, convulsions, amnesia, transient ischaemic attacks and cerebral infarction, have been associate with mitral valve prolapse. It has been presumed that emboli may account for some of these. We report a case of retinal infarction in association with mitral valve prolapse. [ABSTRACT FROM AUTHOR]

To evaluate the possible relation between the age of intracardiac thrombi and the presence and degree of their activity, 29 patients with left ventricular thrombi that developed after an anterior myocardial infarction were evaluated by means of 111 In-oxine autologous platelet imaging. None of the patients was treated with anti-coagulants or platelet inhibitors during either the acute phase of infarction or the follow-up.The time of appearance and the shape of left ventricular thrombi were assessed by serial cross-sectional echocardiograms, obtained within 24 hours of onset of the chest pain, every 24 hours until the fifth day, every 48 hours until the 15th day, and then every month for a follow-up of 1 to 17 months (mean: 8 months). At the time of the scintigraphic examination, left ventricular thrombi were aged 1 month in 9 patients, and 2 to 14 months in the remaining 20 patients.111In-oxine imaging with autologous platelets was obtained in all patients at 4, 24, 48 and 72 hours, in the sagittal, 30° and 45° left anterior oblique projections. In 25 patients the degree of haematological activity of the thrombi was evaluated by dividing the values of thrombus activity/background activity, obtained at 4, 24, 48 and 72 hours, respectively, by the value observed at 4 hours (uptake index). Scintigraphic imaging showed the presence of an active thrombus in every patient. In the 9 patients with recent thrombi, the uptake index was significantly greater than in subjects with older ones (P<0.01). Hence, in patients with anterior myocardial infarction, untreated with anticoagulants or platelet inhibitors, haematologically active thrombi can be observed even more than one year after their appearance. The uptake of platelets on the surface of thrombi is greater in recent left ventricular thrombi than in older ones. [ABSTRACT FROM PUBLISHER]

The case of a child with beta-thalassaemia major who developed a massive haemorrhagic pericardial effusion is reported and in whom the clinical picture completely resolved after pericardiocentesis. Possible causes are discussed and the role of echocardiography in the follow-up of thalassaemic patients is emphasized. [ABSTRACT FROM PUBLISHER]

Left ventricular end-diastolic and end-systolic volumes and ejection fraction were calculated by means of single plane two-dimensional apex echocardiography (echo) in 34 consecutive patients undergoing left ventricular cine-angiography (angio). Adequate echocardiographic studies could be obtained in 30 patients. Of these 10 were normal, 10 had valvular heart disease and 10 coronary artery disease. We consistently used the right anterior oblique equivalent view because of its comparability with the cine-angiographic right anterior oblique projection. Stop frames from the tape-recorded two-dimensional echocardiograms were processed with the same computer programme already in use for cine-angiographic measurements. Good correlations were found between echo and angio for end-diastolic and end-systolic volume index (r=0.84 and r=0.85, respectively) and for ejection fraction (r = 0.91). Thus two-dimensional apex echocardiography using the right anterior oblique equivalent view offers a simple non-invasive means of calculating left ventricular volumes and ejection fraction [ABSTRACT FROM PUBLISHER]

Introduction: In this study, we aimed to investigate the impact of transcatheter aortic valve implantation (TAVI) on serum apelin levels in patients with severe symptomatic aortic valve stenosis (AS)., Methods: Forty-six consecutive patients (76.9±7.4 years, n=27 women) who underwent TAVI and 45 age- and sex-matched control subjects were included in the study. Echocardiographic parameters, serum apelin, pro-brain natriuretic peptide (Pro-BNP), and troponin I levels were compared between the groups. In addition, the preprocedural and first-month follow-up echocardiographic parameters and serum apelin values of TAVI patients were compared., Results: Serum median troponin I and Pro-BNP levels were significantly higher and serum apelin levels were significantly lower in TAVI patients before TAVI procedure than in the control subjects (P<0.001, for all). Median troponin I and Pro-BNP levels were significantly decreased and apelin levels were significantly increased after TAVI procedure compared to the peri-procedural levels. There was a significant and moderate negative correlation between Pro-BNP and apelin levels measured before and after TAVI procedure. A statistically significant and strong negative correlation was found between aortic valve area and Pro-BNP level before TAVI procedure, while a statistically significant but weak positive correlation was found between valve area and apelin level., Conclusion: In our study, apelin levels were significantly lower and Pro-BNP levels were higher in AS patients compared with the control group. Moreover, after TAVI procedure, a significant increase in apelin levels and a significant decrease in Pro-BNP levels were observed. There was also a negative and moderate correlation between apelin and Pro-BNP levels.

Aims: Congenital heart disease is among the most common congenital anomalies in pediatrics. The aim of this study was to evaluate the prevalence of congenital heart disease in children in Khorramabad, Iran., Methods: This is a descriptive-cross sectional study where all the children diagnosed with congenital heart disease by echocardiography were enrolled to the Shahid Madani Hospital. Patient information was collected by means of a questionnaire. Of 1600 children who underwent cardiac counseling, 9.75% presented congenital heart disease. These were most prevalent among the children of 0-28 days of the age (14.7%) and least in children aged 1 month-1 year. According to this study, atrial (20.3%) and ventricular septal defect (10.5%) were the most common heart defects, respectively. Among signs and symptoms of cardiac disease, 49.1% of children had cyanosis, 89.7% with increased CT (cardiothoracic)-ratio, and 82.7% of had heart murmur. Congenital heart disease was more prevalent in male infants (58%) and 6.6% patients had heart failure and 1.4% had other congenital conditions, such as Down syndrome., Results: According to our findings, atrial and ventricular septal defects are the most common congenital heart anomalies, respectively, in pediatric patients in Khorramabad., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Endocarditis, myocarditis and pericarditis are a heterogeneous group of phenotypic syndromes where the culprit area of inflammation is the heart. Inflammation may be determined by an infective agent, toxins, drugs or an activated immune system. Clinical manifestations can be subtle and diagnosis remains a challenge for cardiologists, requiring high level of suspicion and advanced multimodal cardiac imaging to avoid life-threatening consequences. The purpose of this review is to report the recent advances of PET/CT imaging with 18FDG in helping the management of patients affected by inflammatory heart disease. Two independent reviewers searched in PubMed articles published before or in June 2019 and final decisions on the inclusion of references were done in consensus with a third reviewer. At the end of the selection process 23/206 articles on "cardiac inflammation"; 26/235 articles on "endocarditis", "prosthetic heart valve", "pacemaker", "implantable cardiac device"; 7/103 articles on "myocarditis"; 13/330 articles on sarcoidosis" and 2/19 articles on "pericarditis" were included. Compared with the conventional methods, molecular imaging has the advantage to non-invasively and directly trace the inflammatory process, and to identify earlier the presence and the extent of intra-cardiac and extra-cardiac involvement, to enable quantification of disease activity, guide therapeutic interventions, and monitor treatment success., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Heart failure often coexists with many comorbidities, including anaemia. However, the pattern of anaemia in heart failure and its clinical and echocardiographic associations have not been adequately studied among Nigerians., Objective: To describe the pattern of anaemia, its clinical characteristics, and its echocardiographic associations among heart failure subjects in Nigeria., Methodos: One hundred and forty subjects with heart failure were recruited from the cardiology clinics of two teaching hospitals in southwest Nigeria: Ladoke Akintola University of Technology and Bowen University Teaching Hospitals, Ogbomoso. Complete blood analyses, among other tests, were done. Statistical analysis was done with Statistical Package for the Social Sciences (SPSS) 20.0. P <0.05 was taken as statistically significant., Results: Anaemia, as defined by the World Health Organisation, occurred in 106 (75.7%) of the heart failure patients. The patterns of anaemia among participants include combined anaemia of chronic diseases (ACD) with iron deficiency in 64 (45.7%) patients, and ACD alone in 40 (28.6%). Anaemia was more significantly associated with previous diagnosis of diabetes mellitus, presence of pulmonary hypertension, and heart failure with reduced ejection fraction. Mean systolic and diastolic blood pressures, ejection fraction, and fractional shortening were significantly lower among heart failure subjects with anaemia, while serum creatinine, left atrial dimension, left ventricular end diastolic dimension, and left ventricular mass index were significantly higher among heart failure subjects with anaemia compared to those without anaemia., Conclusion: Anaemia occurs very frequently among heart failure patients in southwest Nigeria. It is associated with many poor prognostic factors, including diabetes mellitus, pulmonary hypertension, and kidney failure., (© Association of Resident Doctors, UCH, Ibadan.)

Pericardial effusion (PE) remains an important cause of morbidity after cardiac surgery, and it can be life threatening when tamponade leads to hemodynamic compromise. Transthoracic echocardiography is the most important tool for diagnosis, grading, performing the pericardiocentesis procedure and follow up of post surgical pericardial effusions. The present case highlights the unique technique of posterior approach for pericardio-centesis for a post surgical effusion in the presence of a large left pleural effusion which otherwise would have required surgical drainage. [ABSTRACT FROM AUTHOR]

Psoriasis is a systemic inflammatory disease with a great prevalence in general population. The inappropriate activation of the cellular immune system has been hypothesized to be an independent cardiovascular risk factor, given the higher incidence of cardiovascular disorders in psoriatic patients. Echocardiographic abnormalities have been demonstrated too: the aim of our study was to evaluate the presence of preclinical cardiac dysfunction in a cohort of psoriatic patients without cardiovascular risk factors. We enrolled 52 patients with the diagnosis of chronic plaque psoriasis, compared with a control group not affected by any relevant systemic diseases and inflammatory disorders. In all patients and control group, echocardiographic conventional and tissue Doppler (TDI) studies were conducted. The analysis of echocardiographic parameters revealed normal dimension, mass and systolic function of the left ventricle. Left ventricular diastolic dysfunction was found in 36.5% patients in the psoriasis group versus 0% in control group, and significant reduction of the E/A ratio was found also for the right ventricle. A significant increase of mitral regurgitation has been found in psoriatic patients (p=0.005). The early recognition of cardiovascular pre-clinic disease in psoriatic patients may guide a strict follow up and an early treatment, potentially improving cardiovascular prognosis.