Objective: To explore the characteristics of intra-cardiac blood cysts to provide a reference for accurate diagnosis and prognosis. Methods: In this study, 8 cases of cardiac blood cysts were analyzed retrospectively from January 2006 to March 2020, and the clinical symptoms, echocardiography, operation and prognosis were analyzed. Results: All clinical symptoms were not typical and cysts were isolated. The cysts were attached to the anterior leaflet of the mitral valve (n=4), posterior papillary muscle and chordae of mitral valve (n=1), septal leaflet of the tricuspid valve (n=2), or the tricuspid valve orifice and tricuspid anterior annulus (n=1). Echocardiography revealed the cysts were small and balloon‑like. They had high tension wall, the wall was thin and smooth. Calcification could be seen on the cyst wall. The inside was none echogenicity area and the cyst moved and swung with the valve or chordae. Of the 8 patients, 1 had no hemodynamic effects and did not need surgery. The other 7 cases were confirmed by surgery and pathology for the cardiac blood cysts. 3 subjects underwent simple cystectomy alone. 1 with infectious endocarditis and mitral valve vegetation, and the other one caused the left ventricular outflow tract obstruction. 2 subjects had a history of mitral valve abnormality with mechanical mitral valve replacement. Conclusions: Cardiac blood cysts are rare and benign heart condition in adults. They can be diagnosed by echocardiography to guide intervention.
Background This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-Fluorodeoxyglucose–Positron Emission Tomography (FDG-PET) are limited by cost and availability. Methods We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD) between the sarcoidosis group and controls. A random effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results Nine studies with 967 patients were included in our analysis. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, p< 0.001, also was significantly lower in patients who suffered Major Cardiac Events(MCE), -3.89, 95% CI -6.14, -1.64, p< 0.001 . GCS was significantly lower in the extra-cardiac sarcoidosis group as compared to controls, SMD: -3.33, 95% CI -4.71, -1.95, p< 0.001 Conclusion LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.
Background: Echocardiography derived myocardial performance may be impaired.Objectives: To evaluate cardiac involvement including cardiac biomarkers, echocardiographic findings in patients with COVID-19 and to explore the effect of cardiac impairment on short-term outcome.Methods: This study cohort was conducted from February 9, 2020, to March 28, 2020, in a single center at Wuhan Leishenshan Hospital. 213 patients whose echocardiography were included. Demographic data, laboratory results, echocardiographic findings were analyzed. Results:Among 213 patients confirmed with COVID-19,150 non-critical patients and 35 critical patients were discharged. 28 critical patients needed invasive mechanical ventilation, 16 of whom died during the hospitalization, and another 12 patients were transferred for continued treatment with tracheotomy. The incidence of cardiovascular complications including acute myocardial injury, arrhythmia and acute myocardial infarction was higher in critical group . A total of 108 patients had abnormities on echocardiography. 26(12.2%) patients have presented the signs of pulmonary hypertension and the presence of pulmonary hypertension in critical group was higher than that in non-critical group The cardiac biomarkers at admission in critical patients were significantly higher compared with non-critical patients.Multivariate analysis showed high-sensitivity cardiac troponin I elevation and echocardiographic signs of pulmonary hypertension ere independent risk factors of adverse outcome.CONCLUSIONS: The elevation of cardiac markers and echocardiographic signs of pulmonary hypertension are risk factors of adverse outcome in patients with COVID-19. It’s meaningful to combine echocardiography with cardiac markers to evaluate the prognosis of patients with COVID-19.
Background: Patients with cardiovascular disease are more susceptible to coronavirus disease 2019 (COVID-19) and have worse outcomes when infected. This study reports the largest and most comprehensive echocardiographic evaluation of patients with severe COVID-19 at a quaternary care hospital in the second most affected state in the US, New Jersey. Methods: Clinical, biochemical and echocardiographic features of consecutive patients with severe COVID-19 undergoing echocardiography were studied. Clinical outcome data including length of stay, requirement of mechanical ventilation and in-hospital mortality were collected. Results: 987 patients with confirmed COVID-19 infection were treated at our institution of which 146 consecutive patients (15%) underwent echocardiographic evaluation. Median age was 63 years ;37% were females, 21% had known CAD and 20% had CKD. 57% of patients required mechanical ventilation and 50% required vasopressors . 31% of patients died during the index hospitalization. There was a high prevalence of echocardiographic abnormalities including right ventricular dilation (33%) or dysfunction (21%), left ventricular dysfunction (20%), and pericardial effusion (13%). Multiple biomarkers including troponin T, pro BNP, dimer and CRP were strongly associated with echocardiographic abnormalities and in-hospital mortality. On Cox regression analysis, age (HR 1.04/year) and CAD (HR 2.4) were independent predictors of mortality. Conclusions: Severe COVID-19 infection is accompanied by a significant burden of echocardiographic abnormalities that are strongly correlated with higher degrees of inflammation and biomarker elevation. Additional investigation is warranted in assessing the role of a biomarker-guided approach for early cardiac surveillance using echocardiography in further risk stratifying patients and tailoring adjunctive therapy.
Background The accurate measurement of left ventricular (LV) ejection fraction (EF) is highly dependent on professional experience and adequate visualization. The tissue motion of mitral annular displacement (TMAD) can be easily and quickly assessed using speckle tracking echocardiography (STE) for evaluating the LV systolic function, even in patients with poor acoustic windows. Therefore, this study aimed to validate whether LVEF can be estimated using the STE-derived TMAD when LVEF is not available. Methods Four-hundred fifty-six outpatients were consecutively enrolled in this study. An optimized regression model for LVEF-TMAD was developed in the derivation set (n=287), and its reliability was verified in the validation set (n=123) and regional wall motion abnormalities (RWMA) set (n=46). Results In the derivation set, the power models had the highest F-value, and the power equations were chosen to estimate LVEF according to TMAD in the validation set. Near-zero bias and a narrow range of differences were observed between the observed and estimated LVEF. The highest intra-class correlation coefficient was observed between the observed LVEF and estimated LVEF according to the normalized TMAD at the midpoint of mitral annular (nTMADmid). Moreover, there were no significant differences between the observed and estimated LVEF in the RWMA set. Conclusion The LVEF can be estimated with the STE-derived TMAD using a power equation, even for patients with RWMA, and the nTMADmid may be the optimal parameter. The proposed method may provide a clinically acceptable alternative for evaluating LV systolic function when the direct measurement of LVEF is not available.
Cardiac injury presents a great challenge to the emergency doctors because these injuries require urgent intervention to prevent death. Sometimes serious cardiac injury may manifest only subtle or occult symptoms or signs. Cardiac foreign bodies induced cardiac penetrating injury infrequently and may lead to unpredictable complications, especially for those with sharp nature. However, we know little about the migrating paths or the foreign bodies location changes of such cases. As there is a rarely reported case of cardiac penetrating injury caused by a self-inflicted needle that migrated from the neck to the heart, we herein present a review of such injury on dynamic monitoring using perioperative echocardiography showed the needle shuttled through the ventricular wall along with increasing pericardial effusion.
Paravalvular leak (PVL) after mitral valve replacement is the most common type of nonstructural prosthetic valve dysfunction. While most patients with only mild-moderate PVL are asymptomatic, those with severe PVL can present with heart failure and hemolysis, leading to significant morbidity and mortality. Surgical correction has remained the gold standard therapy for symptomatic PVL; however, for high surgical risk patients, percutaneous approaches have emerged as an alternative management. With the emergence of transcatheter mitral valve-in-valve techniques for failed bioprosthesis and rings, valve-in-valve PVL is being encountered more frequently and is identified as a challenging entity. We present a case of a symptomatic patient with a moderate – severe valve-in-valve PVL after two mitral valve replacements who then underwent a transcatheter mitral valve-in-valve-in-valve implantation with a 29mm Edwards® SAPIEN3 valve via transseptal approach. This unique case highlights the complexity of this clinical entity and recognizes three-dimensional transesophageal echocardiography as a tool to guide valve-in-valve PVL closures.
Constrictive pericarditis (CP) characterized by the presence of a thick, fibrotic and/or calcified non-compliant pericardium limits diastolic filling and forces one side of the heart to fill at the expense of the other side. CP results in right heart failure and even reconstruction of the heart, especially for CP caused by tuberculosis (TB). As the leading cause of CP, TB is affecting the management of CP from many aspects, which contributes to high morbidity and mortality. The purpose of this manuscript is to: (1)Review the etiology, epidemiology, pathophysiology, diagnosis, treatment of tuberculosis constrictive pericarditis (TBCP); (2)Review animal models for CP or pericarditis through different methods; (3)Remind us that more research should be done for TBCP.
Vascular rings(VRs) are defined as congenital abnormalities of the aortic arch and its branches. The most common vascular rings include right aortic arch (RAA) and double aortic arches(DAA). Vascular rings can form a ring that may compress the esophagus and trachea ,which likely result feeding difficulties and respiratory distress. We have reported three cases about diagnosis of vascular rings using High-definition flow(HD-flow) render mode and spatiotemporal image correlation(STIC). In addition ,we have evaluated the postnatal imaging features of vascular rings.
Background: Cardiovascular impairment is an important complication of end-stage renal disease (ESRD) undergoing hemodialysis (HD) therapy. Left atrial (LA) deformation is closely related to left ventricular (LV) filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in ESRD patients using four-dimensional(4D) auto left atrial quantification(4D-LAQ). Methods: Thirty-seven ESRD patients (aged 51.68±15.98 years; 43% male) on HD and 34 healthy individuals (aged 42.03±11.50 years; 38% male) were enrolled in the study. All participants underwent conventional echocardiographic examinations and 4D-LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the LV long axis and apical 4-chamber views, which were taken offline using software (GE EchoPac 203). Results: In patients with ESRD, LA dimension and volume were higher than the healthy group, while the LASr (22.54±6.14 vs 33.74±5.07; p<0.05), LAScd (-12.54±5.83 vs -20.03±5.21;p<0.05), LASct (-10.00±4.93 vs -13.56±5.17;p<0.05 ), LASr-c (28.00±6.61 vs 35.29±7.24;p<0.05), and LAScd-c (-13.27±5.58 vs -18.47±8.65; p<0.05) were significantly lower. Furthermore, a good positive correlation was observed between the LAEF, LASr, and LAScd-c values and LV filling pressure, which reflect diastolic dysfunction. Conclusion: We demonstrated that the LA strain in dialysis patients was impaired before the occurrence of LA dilation. LA strain is more sensitive than traditional echocardiographic parameters, and LASr and LAScd-c may be useful to detect early myocardial involvement.
Background: The change of left ventricular function deteriorated with age because of gradual increases of blood pressure may result in increased energy loss (EL) in left ventricle (LV). The present study investigated EL in LV among hypertensive elderly patients and examined factors contributing to EL. Methods: A single-center retrospective study was performed on elderly hypertensive outpatients (65 years) who underwent echocardiography (N=105). EL in the LV was measured using an vector flow mapping system, and factors affecting peak EL during the early diastolic phase (ED-EL), late diastolic phase (LD-EL), and systolic phase (Sys-EL) were evaluated. Result: Mean age was 79.9±6.4 years (male 43%). Mean ED-EL, LD-EL, and Sys-EL were 42.1±46.7, 75.6±60.2, and 40.4±40.2 mJ/N/s. In a stepwise regression analysis, the E wave peak velocity of transmitral flow (unstandardized B=0.002, 95%CI 0.001 to 0.002, standardized β=0.547, p<0.001) and stroke volume in the LV outflow tract (LVOT) (B=0.001, 95%CI 0.000 to 0.001, β=0.190, p=0.034) were identified as factors affecting ED-EL. The factors affecting LD-EL were the E/A ratio (B=-0.122, 95%CI -0.180 to -0.064, β=-0.451, p<0.001) and peak velocity in LVOT (unstandardized B=0.001, 95%CI 0.0001 to 0.001, β=0.339, p=0.003). The factors influencing Sys-EL were peak velocity in LVOT (B=0.001, 95%CI 0.001 to 0.001, β=0.619, p<0.001) and the E/A ratio (B=-0.050, 95%CI -0.087 to -0.013, β=-0.241, p=0.008). Conclusion: Peak EL in the LV was higher during diastolic phase than systolic phase among elderly hypertensive patients. Peak EL during each phase was affected by systolic blood flow in LVOT and LV transmitral flow.
Bioprosthetic valve thrombosis (BPVT) is more common than previously thought and likely underreported. BPVT can be accurately diagnosed with cardiac imaging and treated successfully with anticoagulation, thus preventing re-operation. We hereby report a case of recurrent BPVT in the mitral position successfully treated with anticoagulation along with review of literature.
Sequential atrioventricular activation plays a critical role in the physiology of Fontan circulation. Although bradycardia is usually well tolerated, retroconducted junctional rhythm may acutely increase atrial pressure impairing cardiac output. Echocardiographic evaluation can reveal clues of this hemodynamic condition. The clinical impact of arrhythmic disturbance on the follow up of patients who had undergone total cavo-pulmonary connection is well recognized but the role of transient periods of retroconducted junctional rhythm on the immediate post-operative course is less defined. We describe two cases of acute Fontan circulatory failure due to postoperative retroconducted escaping junctional rhythm despite an adequate heart rate and circadian variation. The patients rapidly improved after atrial pacing, allowing discharge with a minimal dose of diuretic.
Purpose:The aim of our study was to examine whether left atrial dispersion and left atrial strain as measured by speckle tracking echocardiography and clinic paramaters are predictors for the development of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy. Methods: A total of 137 patients (70% male, mean age 49.6 ± 14.2 years) with HCM were included in the study. Patients’ clinical, electrocardiographic, 2D classic and speckle tracking echocardiographic (STE) data were collected. AF was searched by 12-lead electrocardiograms or 24-hour Holter recordings during follow-up period. Atrial dispersion was defined as the standard deviation of time to peak strain in 12 left atrial segments Results: During a follow-up period of 5 years 37 patients (16.9%) developed AF. At follow-up, the patients with occurrence of AF were older than in patients without AF. Atrial dispersion was observed to be higher in the AF developing group (61.4 ± 23.2 vs 43.1±15.8, p=<0.001). The multivariate in Cox regression analysis (including atrial dispersion, PALS, age, LA) atrial dispersion (msn) (HR 1.017, 95% CI: 1.001-1.03, p= 0.035) and age were found to be independent predictors of AF occurrence. In the ROC analysis atrial dispersion > 44.7 msn predicted occurrence of AF with 82.4% sensitivity and 64 % specificity. Conclusion: In patients with hypertrophic cardiomyopathy, atrial dispersion and age are predictive of the development of atrial fibrillation. Atrial dispersion measured by the speckle tracking-based method may provide further information in evaluating left atrial functions in patients with hypertrophic cardiomyopathy or other disease states
Aim : In this study , according to the diagnosed left ventricular diastolic dysfunction (LVDD) grades, we aimed to determine the correlation of the 2D speckle tracking echocardiography (2DSTE) derived left atrial functional parameters and echocardiographic right ventricular (RV) systolic functions and pulmonary vascular resistance (PVR) estimates in reduced ejection fraction heart failure patients (HFrEF). Methods : Dilated cardiomyopathy patients with an EF lower than 40% included. Echocardiographic examinations including PVR calculations and the 2DSTE performed ; LASr: left atrial reservoir strain , LAScd: left atrial conduit strain, LASct: left atrial contraction strain were calculated. LVDD grading was performed according to guidelines. Results: The mean EF was 28.8 ± 6.0 %. The estimated PVR was strongly correlated with LASr, LAScd and LASct (p<0,0001 for each parameter) . All of the LA strain parameters were in decreasing trend along with the increased LVDD grades. The LASct were lower in Grade III when compared with the Grade II LVDD (p<0.01) . Conclusion: The decrease of LA contraction function in Grade 3 diastolic dysfunction is evident and it may be associated with the extent of LA remodelling in these patients. PVR estimates well correlates with the LA strain parameters. Future studies may evaluate the value of estimated PVR for grading of LVDD.
Epicardial fat is the true visceral fat located around the heart, particularly around sub epicardial coronary arteries . Epicardial and intra-abdominal fat derive from brown adipose tissue within embryogenesis . Because of the close anatomical relationship to the heart, and the absence of fascial boundaries, epicardial adipose tissue (EAT) may locally interact and modulate the coronary arteries and myocardium through paracrine or vasocrine secretion of anti-inflammatory and proatherogenic cytokines . Therefore, it is meaningful to explore its connection with CAD.
Introduction In the current literature, several studies show that pulmonary artery stiffness (PAS) is associated with right ventricular (RV) dysfunction, pulmonary arterial hypertension (PAH), and disease severity in patients with structural heart disease, human immunodeficiency virus (HIV), and chronic lung disease. Hence, in this study, we aimed to use PAS to show the early changes in the pulmonary vascular bed in patients with cirrhosis. Material and Methods In this prospective, cross-sectional study, 39 subjects who were being followed up with cirrhosis and 41 age- and sex-matched healthy participants were enrolled. For each case, the PAS value was calculated by dividing mean peak velocity of the pulmonary flow by the pulmonary flow acceleration time (PfAT). Results The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic patients and 19.09 ± 4.16 (Hz/msn) in healthy subjects (p < 0.001). We found a positive statistical significance between PAS and systolic pulmonary arterial pressure (sPAP) (r = 0.378; p = 0.001). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate logistic regression analysis (OR: 1.209; 95% CI: 1.059–1.381; p = 0.005). Conclusion Based on the study results, we consider that PAS may help in the early detection of changes in the pulmonary vascular bed, even if the RV function parameters or sPAP are within the normal range.
Objective: We aimed to evaluate myocardial performance in fetuses with increased nuchal translucency. Method: Cases with increased NT without any associated structural anomalies were enrolled in this study. The study group consisted of 53 pregnancies complicated with thickened NT > 3.5 mm. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled in the study as the control group. The TEI index was evaluated before performing CVS in the group with an increase in NT. Karyotype analysis was performed via CVS in all patients with increased NT. In both groups, detailed fetal sonographic examinations, including fetal echocardiograms, were performed between 18 and 24 weeks of gestation. Results: The differences between normal and increased NT groups in terms of isovolumetric relaxation time (IRT), ejection time (ET), and myocardial performance index (MPI) variables were found to be statistically significant (p values of 0.023, 0.004, and < 0.001, respectively). For IRT and MPI variables, the median values of the group with an increase in NT were found to be significantly higher than that of the normal NT group, whereas the median value of the ET variable of the group with increased NT was significantly lower than that of the normal NT group Conclusion: The MPI significantly increased in the group with increased NT, but no difference was observed between those with and without Down syndrome. This suggests that increased NT is caused by cardiac dysfunction, whether or not Down syndrome is present.