Background: Epicardial fat is recognized as active endocrine organ and as emerging risk factor for cardio-metabolic diseases. The aim of this study was to explore the relationship between epicardial fat and carotid intima–media thickness in type 2 diabetes patients. Methods: Epicardial fat thickness was measured in 76 type 2 diabetes patients without clinical atherosclerotic cardiovascular disease and 30 age- and sex-matched controls. In addition to laboratory tests, all patients underwent transthoracic echocardiography for epicardial fat thickness and ultrasonographic examination of carotid intima–media thickness. Results: Patients with diabetes had higher epicardial fat thickness and carotid intima–media thickness than those of the controls (6.23 ± 1.27 mm vs 4.6 ± 1.03 mm, p < 0.001 and 0.77 ± 0.150 mm vs 0.58 ± 0.08 mm, p < 0.001, respectively). Epicardial fat thickness was correlated significantly with age, duration of type 2 diabetes, body mass index, waist circumference, HbA1c, carotid intima–media thickness, Homeostasis Model Assessment Index for insulin resistance and lipid profile in the type 2 diabetic patients. Stepwise regression analysis showed that carotid intima–media thickness, duration of diabetes, triglyceride and body mass index were the independent predictors of epicardial fat thickness, with carotid intima–media thickness the most important predictor ( β = 3.078, t = 4.058, p < 0.001). Receiver operating characteristic curve analysis was done and cut-off high-risk epicardial fat thickness value of 6.1 mm was determined with a sensitivity and specificity of 71.4% and 72%, respectively. Conclusion: Patients with type 2 diabetes have higher carotid intima–media thickness and epicardial fat thickness. Epicardial fat thickness was found to be a strong predictor of subclinical atherosclerosis.
Introduction Hypereosinophilic syndrome (HES) is a myeloproliferative disorder characterized by persistent eosinophilia that is associated with damage to multiple organs. Case Presentation Herein, we describe a case of left ventricular (LV) Löffler endocarditis on top of idiopathic HES leading to inflow and outflow obstruction. The posterior mitral leaflet was involved in the fibrotic process leading to severe mitral valve regurgitation. There was a mural thrombus in the left ventricle, which resulted in thrombo-embolic complications in the form of lower limb ischaemia. The patient was treated with high-dose corticosteroids and anticoagulants with significant improvement of his cardiac condition. Discussion In patients with persistent hypereosinophilia, thorough workup is recommended to identify any possible primary cause and detect associated end-organ damage. Treatment should be started as early as possible after establishing the diagnosis to reduce morbidity and prevent complications. Corticosteroids are the first-line therapy that usually cause a rapid reduction in the level of the eosinophilia and must be started promptly if cardiac involvement is present to attain rapid reduction in the eosinophil level and reverse the cardiac damage.
Pericardial sarcomas are extremely rare aggressive neoplasms. Non-specific symptoms and incidental discovery are usually the rule. Multimodality imaging is extremely important for diagnosis and tissue characterisation of all cardiac masses. Despite treatment, pericardial sarcomas are considered extremely fatal. We encountered a 27-year-old female patient who presented to our facility with progressive dyspnoea. On examination, clinical signs of cardiac tamponade were appreciated, transthoracic echocardiography revealed a tamponading pericardial effusion and a large heterogeneous pericardial mass. Pericardiocentesis revealed haemorrhagic fluid. Subsequently, CT revealed a pericardial mass compressing the right atrium. Excision biopsy showed a well-circumscribed mass, and cut sections showed friable grey–white tissue with areas of haemorrhage and necrosis. Pathological examination confirmed the diagnosis of high-grade undifferentiated sarcoma of the pericardium. The patient was started on adjuvant chemotherapy and radiotherapy. Follow-up after 1 year showed no relapse.
Background Right sided infective endocarditis (IE) accounts for 5-10% of IE cases, systemic embolization is uncommon and if present it is linked to the presence of shunt or concomitant left sided IE. Clinical presentation A 35-years old gentleman with history of heroin intravenous drug abuse (IV), presented with a history of unexplained fever for two weeks along with exertional dyspnea, productive cough, chest pain and severe left hypochondria pain. On examination he had a blood pressure of 130/80 mmHg, a heart rate of 130 bpm, a temperature of 40oC, elevated jugular venous pressure and a harsh pansystolic murmur over the lower left sternal border. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for methicillin-resistant staphylococcus aureus (MRSA), electrocardiography showed sinus tachycardia and abdomen computed tomography scan revealed multiple splenic infarctions. Methods and results 2D&3DTrans-Thoracic Echocardiography (TTE) revealed the presence of an echogenic elongated highly mobile mass measures 2.0 cm in maximum dimension attached to the atrial surface of the anterior tricuspid valve leaflet a long with severe valvular regurgitation. Patent foramen ovale (PFO) was visualized by Color Doppler and right to left shunt was confirmed by contrast study with a complete opacification of the left side. The left ventricle dimensions were normal , there was an evidence of hyokinesis of inter-ventricular septum (IVS) and inferior wall and function was reduced, estimated LVEF = 45%. Hence, coronary angiography was done and revealed normal coronaries. 3D Trans-esophageal Echocardiography(TEE) was done for better visualization of the interatrial septum (IAS), vegetation and to rule out complications. The study confirmed the presence of PFO, there was no concomitant IAS defects, the vegetation is highly mobile and facing the IAS. Accordingly, patient was diagnosed with tricuspid infective endocarditis complicated with paradoxical embolization, anti-biotics were commenced and patient underwent successful tricuspid valve replacement and PFO closure. Discussion Tricuspid valve endocarditis has been linked to IV drug abuse and staphylococcus aureus has been recognized as the most commonly implicated organism. While systemic emboli are rare in right sided IE, our patient represent this uncommon complication. He had multiple splenic infractions and TTE contrast study showed PFO with a high degree of right to left shunt. Coronary embolization was a suspect in our patient as well given the presence of regional wall motion abnormalities involving the left ventricle inferior wall and IVS. Conclusion Echocardiography is a crucial imaging modality in patient with long standing fever and history of IV drug abuse to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations and detection of infective endocarditis complication. Abstract P1299 Figure. Tricuspid valve infective endocarditis
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