BackgroundResults of percutaneous balloon mitral valvuloplasty (BMV) are basically dependent on suitable patient selection. Currently used two-dimensional (2D) echocardiography (2DE) scores have many limitations. Three-dimensional (3D) echocardiography (3DE)-based scores were developed for better patient selection and outcome prediction. We aimed to compare between 3D-Anwar and 2D-Wilkins scores in mitral assessment for BMV, and investigate the additive value of 3DE in prediction of immediate post-procedural outcome. Fifty patients with rheumatic mitral stenosis and candidates for BMV were included. Patients were subjected to 2D- and real-time 3D-transthoracic echocardiography (TTE) before and immediately after BMV for assessing MV area (MVA), 2D-Wilkins and 3D-Anwar score, commissural splitting, and mitral regurgitation (MR). Transesophageal echocardiography (TEE) was also undertaken immediately before and intra-procedural. Percutaneous BMV was performed by either multi-track or Inoue balloon technique.ResultsThe 2DE underestimated post-procedural MVA than 3DE (p = 0.008). Patients with post-procedural suboptimal MVA or significant MR had higher 3D-Anwar score compared to 2D-Wilkins score (p = 0.008 and p = 0.03 respectively). The 3D-Anwar score showed a negative correlation with post-procedural MVA (r = − 0.48, p = 0.001). Receiver operating characteristic (ROC) curve analysis for both scores revealed superior prediction of suboptimal results by 3D-Anwar score (p < 0.0001). The 3DE showed better post-procedural posterior-commissural splitting than 2DE (p = 0.004). Results of both multi-track and Inoue balloon were comparable except for favorable posterior-commissural splitting by multi-track balloon (p = 0.04).ConclusionThe 3DE gave valuable additive data before BMV that may predict immediate post-procedural outcome and suboptimal results.Electronic supplementary materialThe online version of this article (10.1186/s43044-019-0019-x) contains supplementary material, which is available to authorized users.
Left atrial cardiopathy as an early predictor for atrial fibrillation in patients with cryptogenic stroke.
Background: COVID-19 could lead to severe acute respiratory syndrome leading to myocardial injury. It is associated with high morbidity and mortality. COVID-19 progression severity can be predicted by cardiac signs. Biomarkers can be used for early detection of cardiac injury and damage and prediction of severe prognosis ultimately. Echocardiography is used for therapeutic management and diagnostic procedures for COVID-19 patients. Detection of subtle cardiac damage early allows for providing efficient treatment. Objective: The aim of the current study was to predict early cardiac involvement in COVID-19 depending on different laboratory and echocardiographic parameters. Patients and methods: This prospective analytical observational study included a total of 100 patients diagnosed as positive COVID-19, depending on polymerase chain reaction "PCR" of nasopharyngeal swabs. Patients underwent full echocardiographic assessment, electrocardiogram (ECG) and laboratory investigations just upon admission. Further grouping of patients according to clinical deterioration was done to detect the prognostic value of investigations. Results: Group I of clinically deteriorated patients had more lymphopenia (mean ±SD: 954.2± 6.5x10 9 /l), higher neutrophils-lymphocytic ratio (mean ±SD: 3.9± 0.2), less TAPSE (tricuspid annular plane systolic excursion) (mean ±SD: 14.85 ± 3.29mm) and more basal RV (right ventricle) diameter (mean ±SD: 39.93 ± 3.08 mm) in comparison with clinically stable patients. Deterioration of TAPSE (p value = 0.017) & basal RV diameter (p value = 0.044) were found to have significant relation with grading of respiratory failure using PO2/FiO2 ratio which had significant positive correlation with RV diameter (p value= <0.001 and r= 0.357). Conclusions: TAPSE & basal RV diameter can early predict cardiac involvement in COVID 19 disease and have the prognostic ability to predict the degree of respiratory failure in deteriorated patients.
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