BackgroundIn this study, we investigate the correlation between reduced global longitudinal peak systolic strain (GLPSS) and the SYNTAX score (SS) in patients undergoing coronary angiography.MethodsWe examined 71 patients undergoing both echocardiogram and coronary angiography within 15 days. All patients had normal global and/or regional wall motion on resting echocardiogram. We calculated GLPSS using two-dimensional speckle-tracking echocardiography. SS was calculated for each group of patients based on the presence and/or the severity of coronary artery disease (CAD): no CAD on angiogram (n=10, control group), low SS (n=36, SS<22) and high SS (n=25, SS≥22). We hypothesised that GLPSS at rest is inversely correlated with the angiographically derived SS.ResultsAge, sex and most of the risk factors were equally distributed among the groups. There was a significant inverse correlation between GLPSS and SS values (r2=0.3869, P<0.001). This correlation was weaker in the low-SS group (r2=0.1332, P<0.05), whereas it was lost in the high-SS group (r2=0.0002, P=NS). Receiver operating characteristic curve analysis identified that the optimal cut-off for the detection of high-SS patients was 13.95% (sensitivity=71%, specificity=90%, P<0.001).ConclusionsThe results of our study suggest that GLPSS might be promising for the detection of patients with high SYNTAX score on coronary angiogram. There is an inverse correlation between resting GLPSS and SS as assessed by coronary angiography. In patients with the highest SS, however, the correlation with GLPSS was less significant.

Aims The aim of this investigation was to evaluate echocardiographic parameters of cardiac function and in particular right ventricular (RV) function as a predictor of mortality in patients with coronavirus disease‐2019 (COVID‐19) pneumonia. Methods and Results This prospective observational study included 35 patients admitted to a UK district general hospital with COVID‐19 and evidence of cardiac involvement, that is, raised Troponin I levels or clinical evidence of heart failure during the first wave of the COVID‐19 pandemic (March–May 2020). All patients underwent echocardiography including speckle tracking for right ventricular longitudinal strain (RVLS) providing image quality was sufficient (30 out of 35 patients). Upon comparison of patients who survived COVID‐19 with non‐survivors, survivors had significantly smaller RVs (basal RV diameter 38.2 vs 43.5 mm P = .0295) with significantly better RV function (Tricuspid annular plane systolic excursion (TAPSE): 17.5 vs 15.3 mm P = .049; average RVLS: 24.3% vs 15.6%; P = .0018). Tricuspid regurgitation (TR) maximal velocity was higher in survivors (2.75 m/s vs 2.11 m/s; P = .0045) indicating that pressure overload was not the predominant driver of this effect and there was no significant difference in left ventricular (LV) ejection fraction. Kaplan–Meier and log‐rank analysis of patients split into groups according to average RVLS above or below 20% revealed significantly increased 30‐day mortality in patients with average RVLS under 20% (HR: 3.189; 95% CI: 1.297–12.91; P = .0195). Conclusion This study confirms that RVLS is a potent and independent predictor of outcome in COVID‐19 patients with evidence of cardiac involvement.

SummaryPrimary hypothyroidism is a common endocrine condition, most commonly caused by autoimmune thyroiditis (Hashimoto’s disease) while Graves’ disease is the most common cause of hyperthyroidism. Hypothyroidism is usually a permanent condition in most patients requiring lifelong levothyroxine treatment. Transformation from Hashimoto’s disease to Graves’ disease is considered rare but recently been increasingly recognised. We describe a case of a 61-year-old lady who was diagnosed with hypothyroidism approximately three decades ago and treated with levothyroxine replacement therapy. Approximately 27 years after the initial diagnosis of hypothyroidism, she started to become biochemically and clinically hyperthyroid. This was initially managed with gradual reduction in the dose of levothyroxine, followed by complete cessation of the medication, but she remained hyperthyroid, ultimately requiring anti-thyroid treatment with Carbimazole. This case highlights that there should be a high index of suspicion for a possible conversion of hypothyroidism to hyperthyroidism, even many years after the initial diagnosis of hypothyroidism. To our knowledge, this case illustrates the longest reported time interval between the diagnosis of hypothyroidism until the conversion to hyperthyroidism.Learning points:Occurrence of Graves’ disease after primary hypothyroidism is uncommon but possible.In this case, there was a time-lapse of almost 28 years and therefore this entity may not be as rare as previously thought.Diagnosis requires careful clinical and biochemical assessment. Otherwise, the case can be easily confused for over-replacement of levothyroxine.We suggest measuring both anti-thyroid peroxidase (TPO) antibodies and TSH receptor antibodies (TRAB) in suspected cases.The underlying aetiology for the conversion is not exactly known but probably involves autoimmune switch by an external stimulus in genetically susceptible individuals.

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AND SummaryThe effect of previous induced or spontaneous abortions on prematurity (defined as a gestational age of less than 37 weeks) and birthweight was studied in 4847 babies born consecutively at Alexandra Maternity Hospital, Athens, Greece. It was found that the incidence of prematurity is more than two-fold in women with one or more induced or spontaneous abortions when compared to those without abortions. Our results also showed that the inverse relationship between the mean birthweight and the number of induced or spontaneous abortions is misleading, because of the high correlation between birthweight and gestational age. It is therefore concluded that intrauterine growth of the fetus is probably not affected by previous abortions.

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Pulmonary valve endocarditis is a rare type of infective endocarditis (IE). Streptococcus pneumoniae is a pathogen that is uncommonly associated with IE. A 50 year-old male was referred to us after an incidental echocardiographic finding of a pulmonary valve vegetation. The patient had a recent admission for drainage of a scrotal abscess from which S. pneumoniae was isolated, complicated by hospital acquired pneumonia and pulmonary embolism. Analysis using polymerase chain reaction of the surgically resected mass revealed signs of 16S ribosomal DNA consistent with S. pneumoniae infection. This was an extremely rare case of pneumococcal pulmonary valve IE presenting entirely asymptomatically in the absence of any known risk factors.Learning points:Streptococcus pneumoniae endocarditis can present with very few symptoms or even entirely asymptomatically, as in this case.Pulmonary valve endocarditis can affect healthy patients, even in the absence of any known predisposing risk factors or pre-existing heart conditions.An echocardiogram may be considered following severe infection with sepsis by pneumococci, to screen for vegetations that could evolve silently over the following weeks.

We present the case of a 43-year-old lady who presented with headaches, visual impairment, and seizures, progressing rapidly over the course of a few weeks. Extensive workup excluded an inflammatory or infectious cause. Imaging studies revealed diffuse thickening of the leptomeninges and serial CSF analysis showed raised opening pressures and increased protein levels. A diagnostic biopsy of the lower thoracic dura confirmed the diagnosis of primary diffuse leptomeningeal gliomatosis (PDGL). She was managed supportively for her symptoms and unfortunately she passed away a few weeks later.