AIM: This prospective study was designed to evaluate the changes in left ventricular (LV) systolic function after coronary artery bypass grafting (CABG) in patients with both normal and abnormal pre-operative systolic function. METHODS: During the period from October 2017 to October 2018, forty-seven consecutive patients undergoing CABG were enrolled in this prospective study. Transthoracic echocardiography was performed within 1 week before CABG as well as 4 to 6 months after surgery. All measurements were made by a single experienced investigator. RESULTS: While the mean LV ejection fraction (LVEF) showed neither improvement nor significant reduction in the whole group of patients following CABG (from 54.21 ± 15.36 to 53.66 ± 11.56%, p = 0.677), significant improvement in LVEF was detected in the subgroup of patients with pre-operative LV dysfunction (from 40.05 ± 8.65 to 45.85 ± 9.04%, p = 0.008). On the other hand, there was a significant decline in LEFT in the subgroup of patients with normal pre-operative LEFT (from 64.70 ± 9.72 to 59.44 ± 9.75%, p = 0.008). As for the other parameters of systolic function, significant decrease in LV end-diastolic volume index (LVEDVI) (p = 0.001), LV end-systolic volume index (LVESVI) (p = 0.0001), wall motion score index (WMSI) (p = 0.013) and LVmass index in male patients (p = 0.011) was shown only in patients with decreased LVEF after CABG. Patients with improved postoperative LVEF (53.2% of all patients) had significantly lower baseline LVEF (p = 0.0001), higher LVESVI (0.009) and higher WMSI (p = 0.006) vs patients with worsened postoperative LVEF (38.3% of all patients). Postoperative improvement of LVEF was correlated with stabile angina, lack of preoperative myocardial infarction and smoking, higher baseline WMSI, higher LV internal diameters and indexed volumes in diastole and systole and lower baseline LVEF. In stepwise linear regression analysis the value of baseline LVEF appeared as independent predictor of improved LVEF after CABG (B = 0,836%; 95% CI 0.655-1.017; p = 0.0001). CONCLUSION: Our study showed that LVEF, internal baseline diameters and indexed volumes of LV in diastole and systole are important determinants of postoperative change in LVEF. In patients with preoperative depressed myocardial function, there is an improvement in systolic function, whereas in patients with preserved preoperative myocardial function, the decline in postoperative LVEF was detected.

No abstract

BACKGROUND:Coronary artery disease (CAD) is the leading cause of mortality and morbidity in patients with diabetes (DM).AIM:The aim of our study was to analyse the ability of pharmacological SE to risk stratify patients with DM using qualitative and quantitative assessment of LV function.METHODS:We prospectively assessed 105 consecutive patients (58.7 ± 9.5 y, 39 male) with known or suspected CAD who underwent dipyridamole or dobutamine SE.RESULTS:Change of systolic LV function at maximal SE was less pronounced in patients with DM, while parameters of the diastolic function and its change with stress were almost insignificant. WMSI in comparison to GLS% didn’t make a difference in SE outcome regarding DM presence. WMSI was almost unchanged at maximal stress in diabetic patients. Conversely, GLS% showed significant worsening at maximal stress in diabetic patients. However, only WMSI at maximal stress along with DM presence appeared as independent predictors of the presence of new and worsening CAD during SE. Longitudinal strain assessed using speckle tracking during pharmacological stress echocardiography was superior to conventional echocardiography expressed by wall motion analysis in making a difference regarding DM presence.CONCLUSION:We confirmed the usefulness of stress echocardiography using qualitative and/or quantitative parameters in the detection of CAD in patients with DM.

Obesity-related atrial cardiomyopathy is a clinical entity characterized by a variety of functional and structural abnormalities in the atria's myocardium. This study aimed to investigate the morphological and functional alterations of the left atrium (LA) in overweight and obese subjects.The study included 56 subjects aged 47+9.6 years, categorized into 4 groups according to their body mass index (BMI): group 1 -overweight (BMI 25-29.9 kg/m 2 ); group 2 -class I obesity (BMI 30-34.9 kg/m2); group 3 -class II obesity (BMI 35-39.9 kg/m 2 ) and group 4 -class III obesity (BMI >40 kg/m 2 ). All subjects underwent two-dimensional (2D) conventional echocardiography and speckle tracking myocardial deformation assessment. Left atrial enlargement (LAE) was registered in all four groups, with an average value of LA diameter 40.0±4.9 mm and LA volume (LAV) indexed to height (LAVh) 35.0 +7.8 ml. Global longitudinal strain (GLS%) and circumferential strain (GCS%) of LA were lower than reference normal values in all groups. LAV indexed to body surface area (LAVI) correlated with hip circumference (r=0.264; p=0.049), whereas LAVh correlated with waist and hip circumference (r=0.378; p=0.004). Linear regression analysis showed that hip circumference was a predictive factor for increasing LAVI (B=0.114; p=0.049; 95%CI 0.000-0.227) and LAVh (B=0.266; p =0.0001; 95%CI 0.129-0.403).LAVh is a clinically useful echocardiographic parameter to assess LA size in obese population. A sensitive method for detecting subclinical functional alterations of LA is assessment of its speckle tracking longitudinal strain.

BACKGROUND: Prosthetic mechanical valve endocarditis (PVE) can be manifested as early PVE (acquired perioperatively) and late PVE (resulting from infections unrelated to the valve operation). Causes of both are similar but are late PVE are more prone to less virulent microbes. PVE resulting with paravalvular abscess is confirmed through echocardiography (transthoracic or transesophageal), it results with a high mortality rate especially if it is not early recognized. CASE PRESENTATION: We are presenting a patient with heart failure symptoms caused by PVE after Pfizer-BioNTech coronavirus disease-2019 (COVID-19) m-RNA vaccination. CONCLUSION: The exact mechanism of myocarditis in young men who received the second dose of mRNA COVID-19 vaccine is not yet known. However, this is a rare complication and most people generally recover quickly requiring only supportive treatment. In contrast, the risk of developing myocarditis from the viral infection is much higher.