Left ventricular (LV) twist serves as a compensatory mechanism in systolic dysfunction and its degree of reduction may reflect a more advanced stage of disease. Aim: The aim was to investigate twist alterations depending on the degree of functional mitral regurgitation (MR) by speckle-tracking echocardiography. Methods: Sixty-three patients with symptomatic dilated cardiomyopathy (DCM) were included. Patients were divided according to MR vena contracta width (VCW): group 1 with VCW <7 mm (mild/moderate MR) and group 2 with VCW ≥7 mm (severe MR). Results: There were no differences in LV geometry and function between groups. Group 2 showed lower endocardial basal rotation (BR) (–2.04° ± 1.83° vs. –3.23° ± 1.83°, p = 0.012); epicardial BR (–1.54° ± 1.18° vs. –2.31° ± 1.22°, p = 0.015); endocardial torsion (0.41°/cm ± 0.36°/cm vs. 0.63°/cm ± 0.44°/cm, p = 0.033) and mid-level circumferential strain (CSmid) (–6.12% ± 2.64% vs. –7.75% ± 2.90%, p = 0.028), when compared with group 1. Multivariable linear regression analysis identified endocardial BR, torsion and CSmid, as the best predictors of larger VCW. In the ROC curve analysis, endocardial BR and CSmid values greater than or equal to –3.63° and –9.35%, respectively, can differentiate patients with severe MR. Conclusions: In DCM patients, torsional profile was more altered in severe MR. Endocardial BR, endocardial torsion, and CSmid, can be used as indicators of advanced structural wall architecture damage.
Chest pain and dyspnoea are among the most common complaints seen in the emergency room and each symptom calls for a broad differential diagnosis. Large hiatal hernias are infrequent, but they can lead to atypical symptoms mimicking different cardiovascular, pulmonary and neoplastic diseases. We present two cases of older patients with an apparent left atrial mass on transthoracic echocardiography, which was subsequently identified as hiatal hernia by other imaging modalities. A multidisciplinary team with multimodality imaging is necessary for diagnostic work-up of chest pain and dyspnoea of non-cardiac origin and especially for a suspected mass compressing the heart, causing chest discomfort.
Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Medical University - Sofia Background Often accompanying comorbidity in patients with acute heart failure and overweight is sleep disorders. Searching and treatment of sleep apnea will be helpful in these patients. CPAP therapy may improve the prognosis. Purpose To determine the frequency and the phenotypic characteristics and of sleep apnea in patients with overweight and exacerbated heart failure. To add continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea (OSA) and monitor changes in systolic and diastolic function. To assess the survival rate in CPAP therapy group and the control group. Methods 100 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. After the selection, 61 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) > 5, Epworth Sleepiness Scale (ESS) > 6, NTproBNP>900 pg/ml, and Body mass index(BMI) >25. All patients receiving optimal medical treatment. The follow-up period was 2 years. The primary endpoint was death for any reason. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio. Results From 61 with sleep disorders 82% (n=50) has OSA and 18% (n=11) has central sleep apnea (CSA). Detected significant changes in LVEF between the OSA group and CSA group (EF% 49.6±8.5vs41.8±11.4;p=0.013). Also statistical significant changes there was about E/e’m ratio and BMI (BMI-38.5±7.1vs31.9±4.5;p=0.005 and E/e’m-17.1±3.7vs20.9±2.5;p=0.002)(Tab. 1). We found a strong reverse correlation between the LVEF and the number of central sleep apnea events (r=-0,52;p<0,001). There was a strong correlation between BMI and ESS (r=0,649;p<0,001). In the OSA group, CPAP therapy was started in 13 patients, the rest of the group (n=37) continue on optimal medication therapy. At the end of the follow-up period in statistical analysis were included 11 patients from the CPAP group and 20 patients from the control group. There was improvement about LVEF, ESS and BMI in CPAP group at end of follow-up (EF%-start: 46,82±9,61vs end of study:49,45±8,23;p=0,019, ESS–start 13±2,6vs end of study 5,9 ±1,5;p<0,001, BMI–start: 39,9±5,6vs end of study: 35,9±4,4;p=0,001). There were no significant changes in E/e'm ratio (E/e'm:start 16,3±3,2vs end of study:15±5,1;p=0,327). In the control group, there were no significant changes. Kaplan-Meier analysis confirmed that the CPAP group has a better survival rate than the control group in the follow-up period (Log-Rank p=0.049). Conclusions Obstructive sleep apnea was more common in obese heart failure patients. The left ventricular systolic function is lower in patients with central sleep apnea. Additional CPAP treatment can improved ejection fraction in patients with heart failure and obstructive sleep apnea. There is a positive effect on BMI. Base on ESS, subjective daytime sleepiness was improved. CPAP therapy can improve the survival rate.
A 23-year-old man was admitted to a cardiology department with a several-month history of increasing shortness of breath, ascites, and leg oedema. The patient had a history of a hepatic hydatid cyst and had undergone a surgical intervention four years earlier. He had poor compliance and eventually stopped the prescribed therapy with albendazole. Admission electrocardiogram demonstrated a sinus rhythm with a right bundle branch block ( Fig. 1A). There were no clinically significant laboratory findings except an elevated level of D-dimer (2050 ng/mL; reference range, < 500 ng/mL) and low albumin levels (27 g/L; reference range, 30-50 g/L). The high-sensitivity cardiac troponin I was normal (13.9 pg/mL; reference range, 29-39 pg/mL). Transthoracic echocardiography showed an extremely dilated right ventricle without any detectable cystic formations in the cardiac chambers. Severe pulmonary hypertension and plethora of the inferior vena cava were observed. Global systolic function of the left ventricle was preserved. Notably, a major pericardial effusion without a collapse of the high-pressure right chambers, although with a mild collapse of the left atrium, was detected ( Fig. 1B, C). There were no significant changes in the mitral and tricuspid inflow patterns. A full-body computed tomography (CT) scan demonstrated multiple disseminated cystic formations in the lungs, liver and peritoneal cavity (Fig. 1D, E). We performed a CT pulmonary angiography which revealed bilateral embolisation of the main branches of the pulmonary arteries (PAs). The capsulated hypodense formations in the PA had the same density as the liver and pulmonary cysts, which strongly suggested echinococcosis as the reason for PA occlusion (Fig. 1F). Because of the dissemination process, conservative treatment with albendazole was restarted. The standard therapy for right-sided heart failure was applied. The patient refused any invasive procedure and was discharged with clinical improvement. Four months after discharge the patient died at home. Autopsy was not performed. Cardiac involvement of echinococcosis includes approximately 2% of cases and most commonly involves the left-sided chambers. Engagement of the PA is extremely rare. The pathogenesis could be related to an intraoperative or spontaneous rupture of the cyst near the hepatic vein and the distribution of its contents into the inferior vena cava and subsequently to the PA [1]. The growth of the cysts gradually leads to progressive pulmonary hypertension. In some cases, endarterectomy can be performed with satisfactory outcomes [2]. Our case demonstrates severe disseminated echinococcosis with multiorgan involvement and complications, which has poor prognosis and limited therapeutic options. Adequate and timely treatment of echinococcosis is needed to prevent irreversible lesions. References
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.