Background Stroke is one of the leading complications during continuous flow-left ventricular assist device (CF-LVAD) support. Risk factors have been well described, though less is known regarding treatment and outcomes. We present a large single center experience on stroke outcome and transplant eligibility by stroke subtype and severity in CF-LVAD patients. Methods 301 patients underwent CF-LVAD (266 HeartMate II (HM II) and 35 HeartWare (HVAD)) between 1/1/2008 and 4/1/2015. Stroke was defined as a focal neurological deficit with abnormal neuroimaging. Intracerebral hemorrhage (ICH) definition excluded subdural hematoma and hemorrhagic conversion of an ischemic stroke (IS). Treatment in IS included intra-arterial embolectomy (IAE) when appropriate; treatment in ICH included reversal of coagulopathy. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS). Outcomes were in-hospital mortality and transplant status. Results 40 patients suffered a stroke: 8 ICH (4 HM II, 4 HVAD) and 32 IS (26 HM II, 6 HVAD). Among 8 ICH there were 4 deaths (50%) (NIHSS 18.8±13.7 vs 1.8±1.7 in survivors, p=0.049). Among 32 IS, 12 had hemorrhagic conversion and 5 were treated with IAE. There were 9 deaths (28%) (NIHSS 16.2±10.8 vs 7.0±7.6 in survivors, p=0.011). Among the 32 IS patients, 12 underwent transplant and 1 is awaiting transplant; no ICH patients were transplanted. Conclusions In-hospital mortality after stroke is significantly affected by the initial neurological impairment. Patients with IS appear to benefit the most from in-hospital treatment and often make sufficient recovery to be able to progress to transplant.

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Background. Measures of adverse cardiac remodeling, left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic function, are predictive of cardiac events in patients with severe aortic stenosis (AS). How these parameters of cardiac function change following TAVR requires further investigation. Methods. A number of 109 consecutive patients with symptomatic severe AS who were seen in the heart valve clinic between 2014 and 2019 for TAVR were included. All patients underwent echocardiographic assessment prior to and 30 days following TAVR, with LVGLS and LA phasic function evaluation using 2D speckle-tracking echocardiography. Heart failure hospitalization, and death were assessed at 12 months. Results. The mean age of the study cohort was 81 ± 7.3 years. Following TAVR, there was a significant reduction in NYHA class III/IV symptoms [89 (82%) vs. 12 (11%), p < 0.01], and median mean aortic valve gradient [44 mmHg (16) vs. 9 mmHg (7), p < 0.01]. There was no significant change in the median LVEF [62% (13) vs. 62% (6.0), p = 0.2]; however, the LVGLS significantly increased following TAVR [15 ± 3.5% vs. 18 ± 3.3%, p < 0.01]. The median LA reservoir, conduit and contractile function significantly improved following TAVR [22.0% (14.0) vs. 18.0% (14.0) p < 0.01, 8.9% (5.4) vs. 7.8% (4.8) p < 0.01, 12% (11.0) vs. 9.6% (11.0) p < 0.01, respectively]. The incidence of death or heart failure hospitalization at 12 months was low, and occurred in eight patients (7.3%). Conclusions. TAVR results in significant short-term reverse LV and LA remodeling, as shown by improvement in LV GLS and all three components of LA phasic function, despite no change in the LVEF. The findings indicate the possible utility of strain imaging for the assessment of global LV and LA function following TAVR.

The gastrointestinal tract is commonly involved in patients with lymphoma. Involvement of the oesophagus occurs in about 1% of patients. This case report describes a patient with oesophageal obstruction due to Hodgkin’s disease of the oesophagus as the sole manifestation of a second relapse 10 years after initial diagnosis of the lymphoma.

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ObjectivesTo identify echocardiographic signatures featuring left ventricular longitudinal strain (LS) associated with genetic risk for cardiac amyloidosis (CA) due to the TTR Val142Ile (V142I) variant in African American (AA) and Hispanic/Latinx (H/L) individuals.BackgroundHereditary transthyretin amyloidosis (hATTR) can cause CA in ∼60-70% of older V142I carriers, but amyloid deposition progresses over many years. Disease-modifying therapy for CA is now available and early initiation is a priority for improving outcomes. Genomic screening programs and familial cascade genetic testing uncover pre-symptomatic V142I carriers, yet no guidelines exist for early CA detection.MethodsExome sequencing data linked to electronic health records (EHRs) of BioMe biobank participants were queried for AA or H/L TTR- and TTR+ (V142I) subjects without hATTR diagnoses and with prior echocardiograms suitable for retrospective LS analysis. Systemic “red flag” features of ATTR were extracted from EHRs of TTR+ subjects. Speckle tracking echocardiography was retrospectively applied to determine global (GLS) and segmental LS. Relative apical sparing (RAS) was calculated.Results57 TTR+ and 46 TTR-age- and ancestry-matched subjects were included. GLS declined with age in females but not males, and was abnormal (<16%) in 18 (31.6%) TTR+ and 7 (15.2%) TTR-subjects (p = 0.066). Apical sparing was observed in 13 (22.8%) TTR+ and 11 (23.9%) TTR-subjects (p = 1.0). After adjusting for relevant demographic and echocardiographic covariates, neither GLS nor RAS was associated with TTR+ V142I status. Red flag features were not associated with GLS or RAS in TTR+ subjects.ConclusionsNeither GLS nor RAS were significantly different between TTR+ and TTR-subjects. Since >50% of TTR+ subjects were ≥ 60 years old, penetrance of CA by echocardiography among unselected V142I carriers may be lower than previously estimated. These findings indicate that surveillance for CA in individuals at increased genetic risk due to V142I should not rely solely on echocardiography, even with LS.

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