SummaryWe present a sole intracardiac mass with no other cardiac involvement in a patient with metastatic lung cancer disease. This mass can be well characterized by advanced 3D echocardiography and echocardiographic contrast. Seminars in Cardiovascular Medicine 2017; 23:9-10Keywords: mass, intracardiac, echocardiography, cancer A 70-year-old female presented with sudden low back pain. She was previously diagnosed with dyslipidaemia and type 2 diabetes mellitus. There was no history of previous cardiac illness. She did not suffer from dyspnea or chest pain. Cardiovascular examination was normal, without cardiac murmurs. Musculoskeletal magnetic resonance showed L2 metastatic epiduritis and multiple lumbosacral and iliac metastatic lesions, and thoracoabdominal computed tomography showed primitive neoplasm in the upper lobe of the left lung. Pathological study of needle aspiration sample of the lung was diagnostic for adenocarcinoma.PET-study demostered lung and bone lesions and also mass in the left ventricle. A transthoracic 2D-echocardiogram was performed (Movie I in the Data supplement), showing a mass in the left ventricle.No other intracardiac masses were found and there was not pericardial effusion. Left ventricular systolic function was normal, with ejection * Corresponding address: Daniel Grados-Saso, Hospital Clínico Universitario, Zaragoza. Avenida San Juan Bosco, 15, 50009 Zaragoza, Spain. E-mail: danielgrados_87@hotmail.com (D. Grados-Saso). fraction of 63%. Tricuspid, aortic and pulmonary valve were normal and mitral valve had trace mitral regurgitation. There was no intraventricular pressure gradient caused by the mass, by color flow Doppler and continuous wave Doppler results. Conventional transthoracic echocardiography was repeated a week later, without changes. 2D-echocardiographic study was completed with intravenous echocardiographic contrast to demonstrate perfusion of the mass, excluding the diagnosis of thrombus (Movie II in the Data supplement) and with 3D echocardiography for better visualization and establishing spatial relation-
Purpose: Right ventricle plays an important role in heart failure with preserved and mid-range ejection fraction. Right ventricular dysfunction is common and associated with increased morbidity and mortality in this population. Quantification of right ventricular functional parameters by echocardiography is challenging. Right ventricular strain represents a tool that can provide useful information in the assessment of RV function, offering information with potential prognostic implications.Methods: In a cohort of 71 prospectively included patients admitted for an episode of heart failure with mid-range and preserved ejection fraction (LVEF >40%) right ventricular function was evaluated through right ventricular free wall longitudinal strain. Left ventricular global longitudinal strain was also calculated. Relationship with variables such as hospital readmission and cardiovascular mortality was studied. Results: Worse right ventricular free wall longitudinal strain was associated to higher probability of cardiovascular mortality at six months. In a multivariate analysis RV free wall strain remained a predictor of cardiovascular mortality at 6 months. Significant linear correlation (p <0.01) was observed between longitudinal deformation indices of both ventricles. Conclusion In patients with heart failure with preserved and mid-range ejection fraction, impairment of right ventricular free wall strain is common and is related to worse clinical outcome (increased cardiovascular mortality at six months) regardless of other right ventricular functional parameters and left ventricular ejection fraction. Therefore, representing a sensitive non-invasive prognostic indicator in these patients, and could be useful in stratifying the risk of adverse events. RV and LV strain are correlated indicating biventricular involvement of deformation parameters with prognostic significance.
Introduction and Objectives: Bidimensional speckle tracking (ST-2D) enables the quantitative assessment of the left ventricle deformation. This study was aimed to assess discriminative and prognostic value of the left ventricle myocardial deformation analysis (MDA) in patients with heart failure (HF) irrespective ejection fraction. Methods: Patients were included during admission for decompensated HF. After clinical stabilization, MDA by 2D-echocardiography was performed. Patients were followed up for 180 days. Differences in MDA profiles were compared between reduced (HF with reduced EF [HFrEF]) and preserved (HF with preserved EF [HFpEF]) EF. An additional prospective follow-up cohort analysis to assess prognostic value of MDA was carried out. End point was a composite of death, non-scheduled emergency visits, and readmissions. Results: We included 101 patients, 57 (56.4%) with EF > 50%. Fourteen patients (13.9%) died during follow-up; 31 were readmitted (30.7%); and 17 (16.7%) had unscheduled emergency visits. Global systolic circumferential strain rate (SR) had the highest prognostic value. There was an association between a SR below the median (−1.56 cm/s) and unfavorable development (odds ratio [OR] 2.31, confidence interval at 95% [CI 95%] 1.34-3.96, p = 0.002). In patients with HFrEF, an NT-proB-NP above the median and SR below the median the OR for events during follow-up were 2.85 (CI 95% 1.15-9.25, p = 0.042), while in HFpEF were 1,778 (CI 95% 1.13-3.65, p = 0.022). Conclusions: In patients with HF, MDA, especially global circumferential SR, is predictive of adverse events during follow-up and combined with NT-proBNP improves risk stratification irrespective of EF phenotype. Furthermore, MDA can be useful for refining classification of patients with HF and intermediate EF range.
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