Emergent Diagnosis of a Flail Mitral Leaflet With Bedside Echocardiography

Hsu, Patrick; Shepherd, Caroline; Shokraneh, Keyon; Cabrera, Gabriel; Kalivoda, Eric J.

doi:10.7759/cureus.9374

Cited by 3 publications

(4 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Echocardiography stands as the primary non-invasive diagnostic tool for AMI patients, playing an essential role in evaluating mechanical complications, hemodynamics, and overall cardiac function [ 36 – 39 ]. Moreover, myocardial contrast echocardiography (MCE) employs contrast agents to illuminate infarcted areas, further facilitating the detection of ventricular aneurysms.…”

Section: Discussionmentioning

confidence: 99%

Exploratory analysis of predictors of ventricular aneurysm in a cohort of 291 patients with acute myocardial infarction

Huang,

Xu,

Qiang

et al. 2024

BMC Cardiovasc Disord

View full text Add to dashboard Cite

Objective In this study, we explored the determinants of ventricular aneurysm development following acute myocardial infarction (AMI), thereby prompting timely interventions to enhance patient prognosis. Methods In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People’s Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves. Results In our analysis of 291 AMI patients, spanning an age range of 32–91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit. Conclusion Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Exploratory analysis of predictors of ventricular aneurysm in a cohort of 291 patients with acute myocardial infarction

Huang,

Xu,

Qiang

et al. 2024

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…Acute severe mitral valve regurgitation is an etiology of shock that can be difficult to diagnose clinically but is identifiable on POCTE in the ED. Sonographic features include a regurgitant jet from the left ventricle to the left atrium with color doppler, hyperdynamic left ventricle, papillary muscle head visualized in the left atrium, dilated inferior vena cava with minimal respiratory variation, pleural effusions, and pulmonary edema [ 3 , 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…POCTE in the ED is typically directed at identifying pericardial effusion or tamponade, identifying cardiac activity, global assessing contractility, and characterizing central venous volume status [ 15 ]. Identification of valvular insufficiency and/or vegetation is not typically included but is feasible by an experienced sonographer [ 3 , 4 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Papillary muscle rupture with acute valvular regurgitation is an uncommon cause of cardiogenic shock that carries a high mortality rate [ 2 ]. Emergency physicians (EPs) can identify evidence of papillary muscle rupture on point-of-care transthoracic echocardiography (POCTE) in patients with cardiogenic shock [ 3 , 4 ]. Early diagnosis of this emergent condition is useful to direct subsequent care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Unexpected Causes and Complications of ST-Segment Myocardial Infarction That Highlight the Importance and Limitations of Point-of-Care Ultrasound in the Emergency Department

Johnson¹,

Romine²,

Flannigan³

et al. 2023

Cureus

View full text Add to dashboard Cite

Point-of-care transthoracic echocardiography is a valuable tool for Emergency Physicians evaluating a patient in shock. We describe a case report of ST-segment myocardial infarction complicated by cardiogenic shock and acute severe mitral valve regurgitation that was immediately identified by the Emergency Physician. However, subsequent testing revealed an unexpected unifying diagnosis. The diagnostic sequence in this case highlights the benefits and limitations of point-of-care ultrasound in the Emergency Department and reinforces its role to address discrete clinically relevant questions.

show abstract

Focused Cardiac Ultrasound for the Evaluation of Heart Valve Disease in Resource-Limited Settings

Klassen

Nunes

Johri

et al. 2021

Curr Treat Options Cardio Med

View full text Add to dashboard Cite

Emergent Diagnosis of a Flail Mitral Leaflet With Bedside Echocardiography

Cited by 3 publications

References 18 publications

Exploratory analysis of predictors of ventricular aneurysm in a cohort of 291 patients with acute myocardial infarction

Exploratory analysis of predictors of ventricular aneurysm in a cohort of 291 patients with acute myocardial infarction

Unexpected Causes and Complications of ST-Segment Myocardial Infarction That Highlight the Importance and Limitations of Point-of-Care Ultrasound in the Emergency Department

Focused Cardiac Ultrasound for the Evaluation of Heart Valve Disease in Resource-Limited Settings

Contact Info

Product

Resources

About