Aim: To assess the diagnostic value of left atrial deformation parameters during dobutamine stress echocardiography to predict significant coronary artery stenosis in patients with moderate pretest probability of coronary artery disease (CAD). Materials & methods: Rest and stress echocardiography were performed on 61 patients with a moderate and high probability of CAD. Based on presence of CAD patients were divided into pathological and nonpathological groups. Results: Early diastolic strain rate (LAe SR) was significantly lower among the pathological group at high dobutamine doses. LAe SR was evaluated with receiver operating characteristic curve and threshold prognostic value was set of -2.05 (sensitivity 78%, specificity 50%, area under the curve 0.638; p = 0.026). Conclusion: Measuring LAe SR has predictive value and might be a helpful parameter in assessing ischemia.
Patient presentation A 33-year-old man was referred to our hospital suffering fever with shivers, dyspnea, dry cough, and weakness. Initial work up Symptoms appeared three weeks until hospitalization. Laboratory results showed leukocytosis and high levels of inflammatory markers. Haematological diseases were excluded, a chest x-ray showed infiltration in the lower lobe of the right lung, antibiotics were prescribed. Diagnosis and management When clinical and laboratory results showed no signs of improvement, chest computed tomography (CT) scan was performed and bilateral pulmonary artery thromboembolism with right lung infarct-pneumonia was diagnosed (Figure 1, 2). Treatment was supplemented with intravenous anticoagulants. In the course of treatment patient’s status worsened, respiratory failure progressed, so CT scan was performed again and showed massive pulmonary artery thromboembolism without the effect of treatment. Transthoracic 2D echocardiography showed dilated right heart chambers, relative severe tricuspid valve regurgitation, increased systolic pulmonary artery pressure (Video 1, figure 3), pulmonary artery valve masses in the stem which caused obstruction with maximum gradient about 50 mmHg(Video 2, figure 4). For a detailed workup, magnetic resonance imaging (MRI) was done, that revealed tumorous masses from pulmonary artery valve to the pulmonary trunk and right pulmonary branch (Figure 5, 6, 7). The patient underwent pulmoangiography and biopsy was taken out of the masses that suspected sarcoma. The multidisciplinary team came to a conclusion to perform surgery considering worsening patient’s status. The patient underwent pulmonary artery prosthesis implantation and right pneumonectomy (Figure 8). Masses from pulmonary artery valve were examined by pathologists, surgical specimen results showed high grade poorly differentiated pulmonary artery intimal sarcoma (Figure 9, 10). Follow up Early postoperative period was complicated with cardiogenic shock and respiratory failure. Despite extracorporeal membrane oxygenation (ECMO) and high doses of vasopressors patient did not survive the 2nd postoperative day. Conclusions Pulmonary artery sarcoma (PAS) frequently can be misdiagnosed as thromboembolism. Multimodality imaging should be considered pulmonary artery filling defects persist despite proper anticoagulation therapy for early diagnosis and better survival. Abstract P1450 Figure 3.
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