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2013| October-December | Volume 23 | Issue 4
February 20, 2014
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The ventricular-arterial coupling: From basic pathophysiology to clinical application in the echocardiography laboratory
Francesco Antonini-Canterin, Stefano Poli, Olga Vriz, Daniela Pavan, Vitantonio Di Bello, Gian Luigi Nicolosi
October-December 2013, 23(4):91-95
The interplay between cardiac function and arterial system, which in turn affects ventricular performance, is defined commonly ventricular-arterial coupling and is an expression of global cardiovascular efficiency. This relation can be expressed in mathematical terms as the ratio between arterial elastance (EA) and end-systolic elastance (EES) of the left ventricle (LV). The noninvasive calculation requires complicated formulae, which can be, however, easily implemented in computerized algorithms, allowing the adoption of this index in the clinical evaluation of patients. This review summarizes the up-to-date literature on the topic, with particular focus on the main clinical studies, which range over different clinical scenarios, namely hypertension, heart failure, coronary artery disease, and valvular heart disease.
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Giant proximal aorta aneurysm: A successfully managed time bomb
Alberto Milan, Eleonora Avenatti, Diego Naso, Franco Veglio
October-December 2013, 23(4):102-105
Management of aortic aneurismatic disease is often care of specialists, from vascular to cardiac surgeons. However, initial diagnosis and management are not unfrequently responsibility of an emergency staff as the disease presentation may be dramatically acute. Thoracic aortic aneurysms (TAA) in particular have a silent clinical history until they become evident with dissection or rupture with a high global mortality rate. The importance of a rapid diagnosis and of correct management in such a subsetting is clear, but recent guidelines where published with the declared rationale of emphasizing the importance of an early detection of the disease. The goal is to reduce morbidity and mortality and improvement of quality of life of such patients. We present a case of successfully managed asymptomatic giant proximal aortic aneurysm in a healthy young man. On a routine transthoracic echocardiogram, severe dilatation of the proximal aorta was detected, with severe aortic regurgitation in a normal tricuspid valve determining left ventricle (LV) dilatation and impaired contractility. Computed tomography scan was scheduled, confirming the findings and open heart surgery performed within 1 week. Clinical and echocardiographical follow-up was started; after 2 months imaging studies showed good surgical results with well-functioning, non-regurgitant prosthetic aortic valve and initial recovery of left ventricular dilatation; at the last control, 14 months later, LV mass and dimensions where markedly improved, with no more signs of hypertrophy nor dilatation. TAA needs a rapid diagnosis and appropriate management. Clinicians should be aware of proper diagnostic tools and of applicable therapeutic strategies in order to grant the better assistance to the patient. In this setting, the role of echocardiography remains pivotal.
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An uncommon pericardial cyst in the central mediastinum: Incremental diagnosis with contrast-enhanced three-dimensional transesophageal echocardiography
Ennio Michelotto, Nicola Tarantino, Vittoria Ostuni, Pasquale Pedote, Paolo Colonna, Riccardo Guglielmi
October-December 2013, 23(4):106-110
We report a case of a 76-year-old man, with the occasional finding of a mediastinal cyst because of subtle chronic dysphagia associated to sore throat, belching, and dysphonia. The paraesophageal cyst in the central mediastinum was studied with computed tomography (CT) scan and transesophageal three-dimensional (3D) echocardiography with contrast echo. In order to clarify doubts about localization (intra- versus extrapericardial) of the mediastinal cystic lesion the 3D transesophageal echocardiography (TEE) confirmed the presence of a large round cystic mass located contiguous to the esophagus, the left atrium and the aortic root/pulmonary trunk (located at the front of the lesion), as well as located intrapericardial. The cystic mass showed no blood flow at color Doppler mode and at ultrasound contrast echo with SonoVue agent. Due to the paucity of symptoms and to the definite imaging information of this intrapericardial cyst of nonvascular nature, due to pericardial cyst in an extremely unusual location, surgery was not performed. At follow-up of 1 month echocardiogram and 3 month CT scan the cyst appeared unchanged in dimensions.
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Asymptomatic left ventricular dysfunction and metabolic syndrome: Results from an Italian multicenter study
Salvatore La Carrubba, Maria Chiara Todaro, Concetta Zito, Francesco Antonini-Canterin, Ines Paola Monte, Pio Caso, Paolo Colonna, Cesare de Gregorio, Antonio Pezzano, Frank Benedetto, Giovanni Di Salvo, Scipione Carerj, Vitantonio Di Bello
October-December 2013, 23(4):96-101
Metabolic syndrome (MS) is a cluster of interrelated common clinical disorders, including obesity, insulin resistance, glucose intolerance, hypertension and dyslipidemia, associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. Although MS is associated with increased cardiovascular risk (CVR), its relationship with heart failure (HF) and left ventricular (LV) dysfunction is not fully understood.
We sought to determine whether MS is associated to LV systolic and diastolic dysfunction in a sample of patients with MS and no symptoms for HF.
Subjects and Methods:
We enrolled 6422 consecutive asymptomatic patients admitted to echo-lab for a routine echocardiogram. We calculated LV systolic and diastolic function, by Simpson biplane method and validated Doppler parameters, respectively. MS was diagnosed if three or more CVR factors were found.
LV systolic function was evaluated in 6175 patients (96.2%). In the group of patients without MS (
= 5630), the prevalence of systolic dysfunction was 10.8% (
= 607) while in the group of patients with MS (
= 545) it was 12.5% (
= 87), (RR1.57; CI 95% 1.2-2.0;
< 0.001). Diastolic function was evaluated in 3936 patients (61.3%). In the group of patients without MS (
= 3566) the prevalence of diastolic dysfunction was 33.3% (
= 1187), while in patients with MS (
= 370) it was 45.7% (
= 169), (RR1.68; CI95% 1.3-2.0;
< 0.001). After adjustment for age and gender, MS proved to be an independent predictor of LV systolic and diastolic dysfunction.
Our data show that asymptomatic LV systolic and diastolic dysfunction, is correlated with MS and demonstrate that echocardiography is a useful tool to detect patients at high risk for HF. Echocardiography in asymptomatic patients with MS may lead to a therapy initiation at early stages to prevent future cardiovascular events and HF.
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Online since 08 August, 2013