Age was independently correlated with LV concentric/functional changes regardless of LV hypertrophy, suggesting that ageing is independently involved in the progression of LV remodelling.

BPV is related to coronary plaque volume, but not to coronary plaque vulnerability. In addition to conventional coronary risk factors, BPV may be a therapeutic target for coronary atherosclerosis.

Streptococcus agalactiae (Group B streptococcus, GBS) is the major pathogen encountered in the perinatal period, although the incidence of GBS infection has recently increased among non-pregnant adults. Nevertheless, GBS infective endocarditis (IE) is uncommon and often accompanies aortic embolism. We experienced two cases of GBS IE. In Case 1, mobile vegetation of the aortic valve caused an infective cerebral aneurysm. In Case 2, the patient experienced an acute aortic embolic episode. Generally, early surgery for large mobile sites of vegetation is recommended as a class IIb therapy in the guidelines. GBS IE often exhibits a severe clinical course and specificity of vegetation. Therefore, early surgery should be considered in such cases.

BackgroundThe purposes of this study were to assess the usefulness of myocardial 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) for evaluating myocardial metabolic status in hypertrophic cardiomyopathy (HCM) and the therapeutic efficacy of alcohol septal ablation (ASA) in hypertrophic obstructive cardiomyopathy (HOCM).MethodsThirty HCM patients (64.4±10.5 years, 14 male, 12 hypertrophic non-obstructive cardiomyopathy [HNCM], 16 HOCM, and 2 dilated phase of HCM) underwent 18F-FDG-PET/CT. 18F-FDG uptake was semi-quantitatively evaluated using an uptake score in each 17 segment and the entire LV or regional standardized uptake value (SUV).Results18F-FDG uptake was observed mostly in a hypertrophied myocardium in HNCM patients, whereas 18F-FDG was extensively accumulated beyond the hypertrophied myocardium in HOCM patients. There was a positive correlation between the summed uptake score of 18F-FDG and high-sensitive troponin T level in HNCM patients (r = 0.603, p = 0.049), whereas the score was positively correlated with brain natriuretic peptide level (r = 0.614, p = 0.011) in HOCM patients. In 10 patients who received ASA, the maximum SUV of the entire LV was significantly reduced from 5.6±2.6 to 3.2±2.1 (p = 0.040) after ASA. Reduction of that maximum SUV was particularly significant in the lateral region (from 5.5±2.6 to 2.9 ±2.2, p = 0.024) but not significant in the anteroseptal region (from 4.5±2.6 to 2.9±1.6, p = 0.12).ConclusionExtensive 18F-FDG uptake beyond the hypertrophied myocardium was observed in HOCM. ASA attenuates 18F-FDG uptake in a remote lateral myocardium.

We report an 87-year-old woman with right ventricular perforation due to a permanent pacemaker lead detected 4-days after implantation. The pacemaker lead was seen to perforate through the myocardium and pericardium and to reach the left pleural cavity. We removed the wire surgically by median sternotomy. The pericardial effusion was cloudy and yellowish, suggesting infection. However, no bacteria were detected by bacterial cultures of the pericardial effusion and pacing wire. The patient developed neither mediastinitis nor sepsis after the operation, and a new pacemaker was implanted safely one month later.Keywords: permanent pacemaker, lead perforation, yellowish pericardial effusion tion, failure of the lead to pace or sense appropriately, erosions of the pulse generator, and subclavian vein thrombosis are well-recognized, delayed complications of cardiac devices implantation.2) The predictors of post-implantation pericardial effusion, which serves as a marker of perforation, include concomitant use of another transvenous device, steroid use within 7 days, and old age. 2)We report a case of the patient who presented with a lead perforation 4 days after pacemaker implantation. The pericardial effusion was cloudy and yellow, suggesting infection of the implanted pacemaker. However, bacterial cultures were negative. CaseAn 87-year-old woman was followed at an outpatient psychiatric clinic for dementia. Five months prior to the present admission, her heart rate decreased, and she was diagnosed with sick sinus syndrome. A pacemaker was implanted from the left subclavian vein. An X-ray just after the operation showed the pacemaker wire to have been correctly placed. Slight redundancy of the pacing wire could be seen inside the superior vena cava (SVC). On the 2nd postoperative day (POD), she was delirious and moved her shoulders vigorously in circles throughout the night. On the 3rd POD, she had the symptom of

Background: Elderly patients admitted to hospital with heart failure (HF) often have cognitive impairment, but the association between these conditions is unclear. Methods and Results: We enrolled 43 patients admitted to a geriatric hospital with HF. We evaluated echocardiography, Mini Mental State Examination (MMSE), and extracellular water/total body water (ECW/TBW) ratio (Inbody S10). Mean age was 85.1±8.0 years (range, 60-99 years) and 44.2% of the patients were men. Mean MMSE score was 20.5±5.4, with 66.7% of the patients showing cognitive impairment (MMSE ≤23). There was a significant negative correlation of MMSE score with age (r=−0.344, P=0.032), regular alcohol drinking (r=0.437, P=0.007), uric acid level (r=0.413, P=0.010), and ECW/TBW ratio (r=−0.437, P=0.007). On stepwise regression analysis including these covariates, MMSE score was significantly associated with the ECW/TBW ratio (β=0.443, P=0.009). When several echocardiography parameters (i.e., end-diastolic left ventricular volume, r=0.327, P=0.048; left atrial volume index, r=−0.411, P=0.012; and transmitral inflow A wave velocity, r=−0.625, P=0.001) were added to the model, MMSE score was found to be related to the A wave (P=0.001) and to atrial volume index (P=0.015), which are measures of diastolic function. Conclusions: In elderly patients with HF, cognitive function might be influenced by body water distribution and diastolic heart function.

No abstract

LETTER TO THE EDITORDear Editor, Coronavirus disease 2019 arrived in Singapore in January 2020 as imported cases, followed by local transmission predominantly involving dormitories, with later spread within the wider community. Children still represent the minority of cases in Singapore, with around 8,000 paediatric cases as of 6 November 2021 out of a total of over 200,000 cases. Only 0.034% of children younger than 12 years old needed oxygen supplementation, intensive care, or died. 1,2 A few possible reasons have been postulated: firstly, children may have more robust innate responses to viral infections; secondly, angiotensin-converting enzyme 2 receptors may be immature or less expressed in the respiratory tract of a child; and thirdly, children may have increased mucociliary clearance. 3 In 2021, with the emergence of the Delta variant, rising local transmission, and children <12 years old remaining unvaccinated, we started to experience the fuller spectrum of paediatric SARS-CoV-2 infection. We describe the first Singapore cases known to the authors of vertically transmitted COVID-19, and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, in the setting of a tertiary paediatric unit in National University Hospital in Singapore. The unit has about 109 paediatric inpatient beds and an intensive/high dependency care capacity of 18 beds.Vertically transmitted COVID-19 in a newborn. In our centre, mothers with active COVID-19 infection are offered the option of rooming separately from their newborn after delivery, especially if they are deemed highly infectious by being early in illness with a low cycle threshold (CT) value. Active COVID-19 infection is defined as duration of the illness and infectivity is generally taken to be 10 days if the woman is fully vaccinated and 14 days if she is unvaccinated. Breast milk is the preferred feeding option regardless of whether the newborn is separated from the mother or rooming with her. Investigation-wise, cord blood is sent for SARS-CoV-2 serology at birth. Initially, nasopharyngeal swabs for SARS-CoV-2 RNA polymerase chain reaction (PCR) were performed in neonates after birth, and on days 1 and 2 of life, with accompanying stool samples sent for PCR. This has since been rationalised to only on days 1 and 2 of life. If the neonate