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  Citation statistics : Table of Contents
   2017| April-June  | Volume 27 | Issue 2  
    Online since March 31, 2017

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The evolving role and use of echocardiography in the evaluation of cardiac source of embolism
Fabrizio Celeste, Manuela Muratori, Massimo Mapelli, Mauro Pepi
April-June 2017, 27(2):33-44
DOI:10.4103/jcecho.jcecho_1_17  PMID:28465991
This report will review the role of echocardiography in the diagnosis of cardiac sources of embolism. Embolism of cardiac origin accounts for around 15%–30% of ischemic strokes. The diagnosis of a cardioembolic source of stroke is frequently uncertain and relies on the identification of a potential cardiac source of embolism in the absence of significant autochthonous cerebrovascular occlusive disease. Transthoracic and/or transesophageal echocardiography serves as a cornerstone in the evaluation, diagnosis, and management of these patients. This article reviews potential cardiac sources of embolism and discusses the role of echocardiography in clinical practice. Recommendations for the use of echocardiography in the diagnosis of cardiac sources of embolism are given including major and minor conditions associated with the risk of embolism.
  6 4,498 389
Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia
Mohamad Jihad Mansour, Wael Aljaroudi, Ali Mroueh, Omar Hamoui, Walid Honeine, Nada Khoury, Jinane Abi Nassif, Elie Chammas
April-June 2017, 27(2):45-51
DOI:10.4103/jcecho.jcecho_44_16  PMID:28465992
Background: Echocardiography has been the subject of interest in diagnosing diastolic dysfunction and estimating left ventricular filling pressures (LVFPs). The present study is set to estimate the correlation between the worsening of diastolic parameters and the evidence of inducible ischemia during an exercise stress echocardiography (SE) in comparison with the results of coronary computed tomographic angiogram (CCTA). Methods: A total of 191 consecutive patients from the executive screening program who underwent exercise SE followed by CCTA were evaluated. Baseline demographics, heart rate, and blood pressure measurements were extracted for analysis. Standard two-dimensional and tissue Doppler imaging parameters were analyzed. Diastolic function was graded at rest and peak exercise. Results: Patients who had worsening of diastolic function by at least one grade had had 2–3-fold higher odds of having abnormal SE. In addition, patients with worsening of diastolic function had higher stress LVFPs (E/e' = 11.7 ± 2.7 vs. E/e' 8.0 ± 2.0; P < 0.0001), more E/e' change >25% (48% vs. 22%, P = 0.012), and were more likely to have obstructive coronary artery disease (CAD) on CCTA (23.8% vs. 9.2%; P = 0.045). A change in E/e' >25% (stress-rest) was highly associated with a positive stress test and abnormal CCTA result. Patients with no change or improvement in diastolic function with stress had a 92% negative predictive value of having normal SE and 91% of normal/nonobstructive CCTA. Conclusion: A worsening of diastolic function and a change in E/e' >25% (stress-rest) were associated with abnormal SE, positive stress test, and obstructive CAD when compared to CCTA results.
  5 3,035 166
Right ventricular outflow tract systolic excursion and fractional shortening: Can these echocardiographic parameters be used for the assessment of right ventricular function?
Lamyaa Elsayed Allam, Ahmed Mohammed Onsy, Hylan Ahmed Ghalib
April-June 2017, 27(2):52-58
DOI:10.4103/2211-4122.203557  PMID:28465993
Background: Echocardiographic right ventricular (RV) function assessment is difficult and still a gray area despite rapid advancement of imaging modalities. The aim of this study is to assess the role of echocardiographic RV outflow tract (RVOT) function in the form of RVOT fractional shortening (RVOT FS) and RVOT systolic excursion (RVOT SE) for the assessment of RV function. Methods: We studied ninety individuals divided equally into two groups. The control group included 45 normal healthy individuals and age-matched patient group included 45 patients with RV dysfunction which was defined by tricuspid annular plane systolic excursion (TAPSE) <16 mm and RV fractional area change (RV FAC) ≤35%. Echocardiography was performed to measure RVOT FS and RVOT SE and correlate them with other parameters of RV function including TAPSE, RV FAC, peak systolic velocity of the lateral tricuspid annulus (S') using pulsed tissue Doppler, and pulmonary acceleration time (PAcT). Results: RVOT FS showed positive correlation with TAPSE (r = 0.75, P = 0.02), RV FAC (r = 0.45, P = 0.003), and PAcT (r = 0.39, P = 0.00) and negative correlation with left atrial dimensions (LADs) (r = −0.359, P = 0.017) and left ventricular end-diastolic dimensions (r = −0.304, P = 0.042). RVOT FS <32% was 93% sensitive and 98% specific to identify patients with impaired RV function. However, RVOT SE showed weak correlation with echocardiographic RV parameters. RVOT SE <5 mm was 80% sensitive and 76% specific to identify patients with impaired RV function. Conclusion: RVOT FS is a simple valuable parameter that can be used for the assessment of RV function. However, RVOT SE is less accurate than RVOT FS in RV function assessment.
  4 2,559 184
Asymptomatic left ventricular dissection
Andras Nagy, Zafar Iqbal Khan, Saeed Yahya Al Sayari, Abdelaziz Sabry Aboushaeshae, Rathibala Natarajan
April-June 2017, 27(2):62-63
DOI:10.4103/jcecho.jcecho_40_16  PMID:28465995
Intramyocardial dissection is an uncommon complication of myocardial infarction, chest trauma, and percutaneous intervention. It is usually caused by a hemorrhagic dissection among the spiral myocardial fibers. Carries high mortality and there is still uncertainty regarding invasive or conservative management. We present a case of the left ventricular dissection discovered incidentally.
  1 1,880 101
Coronary involvement in marfan syndrome: The role of electrocardiographically gated computed tomography angiography
Rocco Donato, Emanuele David, Alfredo Blandino, Michele Gaeta, Domenico Spinelli, Giorgio Ascenti
April-June 2017, 27(2):64-65
DOI:10.4103/jcecho.jcecho_43_16  PMID:28465996
We report a case of coronary artery and aortic root aneurysms in a 50-year-old man with Marfan syndrome. The coexistence of these findings is uncommon and rarely reported. We underline the role of electrocardiographically gated computed tomography angiography in the diagnosis of coronary aneurysm in this category of patients.
  1 1,627 72
Left ventricular postinfarction pseudoaneurysm: diagnostic advantages of three-dimensional echocardiography
Fulvio Cacciapuoti, Paolo Tirelli, Federico Cacciapuoti
April-June 2017, 27(2):74-76
DOI:10.4103/jcecho.jcecho_49_16  PMID:28465999
We present a case of posterior left ventricular pseudoaneurysm, a rare but potentially lethal complication of inferior acute myocardial infarction. The clinical findings and the customary, noninvasive diagnostic methods used are illustrated. Particularly, the most evident display obtained by the employment of three-dimensional echocardiography in comparison to those supplied by two-dimensional ultrasonic method was illustrated.
  1 1,436 89
Over the exceptions: Psychiatric disorder, medical stress, and takotsubo cardiomyopathy
Francesca De Angelis, Ketty Savino, Viviana Oliva, Alessandra Biadetti, Stefano Coiro, Giuseppe Ambrosio
April-June 2017, 27(2):66-70
DOI:10.4103/jcecho.jcecho_4_17  PMID:28465997
Exact natural history and physiopathology of takotsubo cardiomyopathy (TC) are incompletely understood. In the last years, a lot of special cases of TC appeared in the literature. This case report is a typical case of TC, which meets all Mayo Clinic diagnosis criteria, over the exceptions; its main feature is that it has both physical (medical) and emotional (psychiatric) triggers. The protagonist is a woman affected by anxious-depressive syndrome, hospitalized for a cardiogenic syncope. After pacemaker (PMK) implantation, she first has convulsive hysteric crisis, and the following day, she has a transient left ventricular apical ballooning without coronary artery stenosis: takotsubo syndrome. This case underlines the depth and strong relationship between takotsubo syndrome and psychiatric illness, which is both clinical substrate and triggering acute event, with the significant role of PMK implantation which might have had a role both as flare of psychiatric disease and as a trigger for the syndrome itself.
  - 1,875 92
Pyopericardium with cardiac tamponade in a Nigerian child with acute osteomyelitis
Igoche David Peter, Abdullahi U Shehu, Umma A Ibrahim, Mustafa O Asani, Ibrahim Aliyu, Yunusa Sanusi, Jameel I Ahmad
April-June 2017, 27(2):71-73
DOI:10.4103/jcecho.jcecho_45_16  PMID:28465998
In pyopericardium, pus accumulates in the pericardial space as a result of infection by pyogenic organisms, most common of which are Staphylococcus aureus and Mycobacterium tuberculosis. These patients are at risk of cardiac tamponade. Apart from pericardiocentesis in the management of these patients, definitive drug treatment may pose a formidable challenge in a setting of coinfection as in patients with tuberculosis who are predisposed to secondary bacterial infections. This was the case of our patient. We here highlight the challenges faced with etiologic diagnosis in resource-limited settings.
  - 1,528 69
Low-gradient structural valve deterioration in a patient of cardiac sarcoidosis
Shintaroh Koizumi, Kaoru Matsuura, Yoshio Kobayashi, Goro Matsumiya
April-June 2017, 27(2):59-61
DOI:10.4103/jcecho.jcecho_47_16  PMID:28465994
We report a case of structural valve deterioration, which occurred 7 years after aortic valve replacement in a 78-year-old male with cardiac sarcoidosis. His echocardiography showed low transprosthetic valve gradient and depressed left ventricular function. A dobutamine stress echocardiography was performed to identify his pathophysiology, and it revealed that his depressed left ventricular function was not due to cardiac sarcoidosis but to structural valve deterioration. Reoperation for structural valve deterioration was performed, and his left ventricular function recovered.
  - 1,788 85
Double-chambered right ventricle: The importance of a long-term follow-up
Lilia Oreto
April-June 2017, 27(2):77-77
DOI:10.4103/jcecho.jcecho_14_17  PMID:28466000
  - 1,460 68
Myocardial bridge: If you wait longer you can find it!
Roberta Manganaro
April-June 2017, 27(2):78-79
DOI:10.4103/jcecho.jcecho_15_17  PMID:28466001
  - 1,283 54