Objective: Liver cirrhosis is associated with several cardiovascular abnormalities including a hyperdynamic splanchnic and systemic circulation related to arterial vasodilatation, finally leading to sodium retention, central hypovolemia, and increased intravascular volume. The objective of this study was to evaluate the relationship between NT-proBNP and echocardiographic parameters and liver disease stage in patients with cirrhosis. Method: This prospective study included 82 consecutive patients diagnosed with liver cirrhosis and 120 healthy, age- and sex-matched subjects. Standard transthoracic echocardiography was performed in all patients. Plasma NT-proBNP levels were determined. Liver disease severity in patients with cirrhosis was established by Child-Pugh class, MELD score and presence/absence of ascites. Results: Plasma levels of NT-proBNP were significantly higher in cirrhotic patients than the corresponding levels in the healthy subjects. NT-proBNP levels were also significantly elevated in Child-Pugh class C patients compared to those in class B and A. Left atrium (LA) size, diastolic function, left ventricular (LV) wall thickness, and LV ejection fraction were significantly altered in cirrhotic patients compared to controls. Advanced cirrhosis and high levels of NT-proBNP were significantly associated with increased LA volume and signs of cardiac diastolic dysfunction. We also observed significant differences between quartile groups of MELD score for the following: NT-proBNP, Troponin I, LA volume, left ventricle wall thickness, lateral wall and septum systolic tissue Doppler velocities and global longitudinal strain. Conclusion: NT-proBNP is increased in patients with cirrhosis and is correlated with the severity of liver disease as established by Child-Pugh class, MELD score, and the presence of ascites.

Aims A byproduct of left atrial (LA) strain analysis is the automated measurement of LA maximal volume (LAVmax), which may decrease the time of echocardiography reporting, and increase the reproducibility of the LAVmax measurement. However, the automated measurement of LAVmax by two-dimensional speckle-tracking analysis (2DSTE) has never been validated. Accordingly, we sought to (i) assess the feasibility of automated LAVmax measurement by 2DSTE; (ii) compare the automated LAVmax by 2DSTE with conventional two-dimensional (2DE) biplane and three-dimensional echocardiography (3DE) measurements; and (iii) evaluate the accuracy and reproducibility of the three echocardiography techniques. Methods and results LAVmax (34–197 mL) were obtained from 198/210 (feasibility 94%) consecutive patients (median age 67 years, 126 men) by 2DSTE, 2DE, and 3DE. 2DE and 2DSTE measurements resulted in similar LAVmax values [bias = 1.5 mL, limits of agreement (LOA) ± 7.5 mL], and slightly underestimated 3DE LAVmax (biases = −5 mL, LOA ± 17 mL and −6 mL, LOA ± 16 mL, respectively). LAVmax by 2DSTE and 2DE were strongly correlated to those obtained by cardiac magnetic resonance (CMR) (r = 0.946 and r = 0.935, respectively; P < 0.001). However, LAVmax obtained by 2DSTE (bias = −9.5 mL, LOA ± 16 mL) and 2DE (bias = −8 mL, LOA ± 17 mL) were significantly smaller than those measured by CMR. Conversely, 3DE LAVmax were similar to CMR (bias = −2 mL, LOA ± 10 mL). Excellent intra- and inter-observer intraclass correlations were found for 3DE (0.995 and 0.995), 2DE (0.990 and 0.988), and 2DSTE (0.990 and 0.989). Conclusion Automated LAVmax measurement by 2DSTE is highly feasible, highly reproducible, and provided similar values to conventional 2DE calculations in consecutive patients with a wide range of LAVmax.

Keywords: 12-lead electrocardiogram, cardiomyopathy and heart failure, myocardial infarction. AbstractPrognostic markers derived from standard ECG have always been seductive.Increased dispersion of durations of the P wave, of the QRS complex, or of the QT interval has been associated with the risk of atrial fibrillation, ventricular arrhythmias, sudden cardiac death, as well as with a general negative prognosis in various settings.However, these markers have intrinsic and methodological issues that question their utility. This paper presents data supporting the utility of QRS dispersion in clinical practice. Our investigation shows that QRS dispersion is a simple electrocardiographic marker with potential value in the assessment of patients in a variety of clinical settings: ischemic heart disease, heart failure, and cardiomyopathies.More studies are needed to validate QRS clinical utility for predicting the risk for ventricular arrhythmias and sudden cardiac death, and for the evaluation of the response to cardiac resynchronization therapy.Acne conglobata is a rare, severe form of acne vulgaris characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts, located on the face, trunk, neck, arms and buttocks.Ionuț Donoiu et al. 133

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation. The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and evaluation of rheumatic diseases and permits optimal management in daily practice.

The aim of our study was to assess the sympathetic nervous system’s involvement in the evolution of gastric carcinoma in patients by analyzing the mediators of this system (epinephrine and norepinephrine), as well as by analyzing the histological expression of the norepinephrine transporter (NET). We conducted an observational study including 91 patients diagnosed with gastric carcinoma and an additional 200 patients without cancer between November 2017 and October 2018. We set the primary endpoint as mortality from any cause in the first two years after enrolment in the study. The patients were monitored by a 24-h Holter electrocardiogram (ECG) to assess sympathetic or parasympathetic predominance. Blood was also collected from the patients to measure plasma free metanephrine (Meta) and normetanephrine (N-Meta), and tumor histological samples were collected for the analysis of NET expression. All of this was performed prior to the application of any antineoplastic therapy. Each patient was monitored for two years. We found higher heart rates in patients with gastric carcinoma than those without cancer. Regarding Meta and N-Meta, elevated levels were recorded in the patients with gastric carcinoma, correlating with the degree of tumor differentiation and other negative prognostic factors such as tumor invasion, lymph node metastasis, and distant metastases. Elevated Meta and N-Meta was also associated with a poor survival rate. All these data suggest that the predominance of the sympathetic nervous system’s activity predicts increased gastric carcinoma severity.