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  Citation statistics : Table of Contents
   2018| January-March  | Volume 28 | Issue 1  
    Online since March 6, 2018

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Multimodality Imaging and Clinical Significance of Congenital Ventricular Outpouchings: Recesses, Diverticula, Aneurysms, Clefts, and Crypts
Alberto Cresti, Pierpaolo Cannarile, Elena Aldi, Marco Solari, Bruno Sposato, Luca Franci, Ugo Limbruno
January-March 2018, 28(1):9-17
DOI:10.4103/jcecho.jcecho_72_17  PMID:29629254
The high spatial resolution of cardiac computed tomography (CT) and cardiac magnetic resonance (CMR) permit the diagnosis of congenital ventricular outpouchings (CVOs), including congenital ventricular diverticula (CVD), congenital ventricular aneurysms (CVA), clefts, and crypts. A unique classification has not been established, and these terms are used interchangeably with confounding terminology. Moreover, their significance is not univocal. A research was performed using PubMed on six subjects: (1) congenital left ventricular outpouchings; (2) congenital ventricular diverticulum; (3) congenital ventricular aneurysm; (4) ventricular clefts; (5) ventricular crypts; and (6) ventricular crevices. Usually, CVOs are small with a preserved contraction and in asymptomatic patients, the clinical relevance may be minimal, although electrocardiographic anomalies are often present. CVA and diverticula may carry an embolic risk and cases of arrhythmia and rupture are described. In the presence of clefts, or crypts a cardiomyopathy should be excluded. A simple classification can be proposed: CVD extend beyond the myocardial wall and fibrous type may be termed CVA, acquired forms should be kept distinct. Clefts, or crypts, are small recesses extending for more than 50% of the ventricular wall but not beyond its margin. The presence of fibrosis may be evaluated by CMR. A multicenter prospective registry would be helpful to investigate potential clinical implications and to exclude dubious forms of hypertrophic cardiomyopathy or ventricular noncompaction. In conclusion, CVOs have been described with different terminologies and classifications. Their significance needs to be interpreted in the clinical setting and with the help of a multimodality imaging, particularly of CMR.
  4 4,515 341
Echocardiographic Assessment of Ventricular Septal Rupture and Left Ventricular Aneurysm after Inferior and Posterior Myocardial Infarction
Giuliana Pace, Gianfranco Filippone, Egle Corrado, Fabio Triolo, Vincenzo Argano, Salvatore Novo
January-March 2018, 28(1):61-64
DOI:10.4103/jcecho.jcecho_29_17  PMID:29629264
We present a case of posterior ventricular septal rupture associated to left ventricular aneurysm manged, during peri-operative period, by transthoracic and transesophageal echocardiography. Three-dimensional transesophageal echocardiography findings add adjunctive and more accurate information regarding morphological details of the ventricular septal rupture rather than two-dimensional echocardiography, allowing, meanwhile, the detection of the outcome of the surgical repair.
  2 1,579 132
European Society of Cardiology-Proposed Diagnostic Echocardiographic Algorithm in Elective Patients with Clinical Suspicion of Infective Endocarditis: Diagnostic Yield and Prognostic Implications in Clinical Practice
Andrea Barbieri, Francesca Mantovani, Roberta Lugli, Francesca Bursi, Matteo Fabbri, Ylenia Bartolacelli, Marcella Manicardi, Guglielmo Stefanelli, Cristina Mussini, Giuseppe Boriani
January-March 2018, 28(1):26-31
DOI:10.4103/jcecho.jcecho_49_17  PMID:29629256
Background: Echocardiography plays a central role in diagnosing infective endocarditis (IE). Accordingly, the European Society of Cardiology (ESC) has proposed a diagnostic echocardiographic algorithm. However, new studies are still needed to evaluate the degree of implementation of these guidelines in clinical practice and their consequences on incidence and prognosis of IE. Aim: This study aims to investigate the diagnostic yield of the ESC proposed echocardiographic algorithm in patients with suspected IE. We also examined the association among IE diagnosis and clinical outcomes. Methods: Retrospective analysis of a series of patients undergoing the ESC algorithm for clinical suspicion of IE at our institution. Results: Between 2009 and 2013, 323 cases were managed by a multidisciplinary team for clinical suspicion of IE. Following ESC algorithm, 26 (8%) patients were diagnosed with IE and 297 (92%) had IE excluded. In 92% of patients with a good-quality negative transthoracic echocardiography (TTE) and low level of clinical suspicion, the first TTE was considered sufficient to rule out IE. During a mean follow-up of 2.3 ± 1.4 years, patients who had a final diagnosis of IE showed similar mortality (P = 0.2) and rates of combined endpoint (all-cause death, stroke/transient ischemic attack, advanced atrioventricular block, and heart failure) compared to patients without echocardiographic diagnosis of IE (P = 0.5). Only 1% of the patients who had IE excluded experienced IE in the following 3 months, none of them in the subgroup of patients, in which a first negative TTE was considered sufficient to rule out IE. Conclusions: In spite of the current ESC recommendation TTE is used as part of a routine fever screen. Consequently, only a minority of patients had a final echocardiographic diagnosis of IE. Although in patients with low clinical suspicion a first negative TTE is sufficient to rule out IE, the incidence of clinical events is similar regardless the final diagnosis of IE.
  2 1,867 196
12-year Temporal Trend in Referral Pattern and Test Results of Stress Echocardiography in a Tertiary Care Referral Center with Moderate Volume Activities and Cath-lab Facility
Andrea Barbieri, Francesca Mantovani, Francesca Bursi, Ylenia Bartolacelli, Marcella Manicardi, Maria Giulia Lauria, Giuseppe Boriani
January-March 2018, 28(1):32-38
DOI:10.4103/jcecho.jcecho_48_17  PMID:29629257
Background: Data on stress echocardiography (SE) time-related changes in referral patterns and diagnostic yield for detection of inducible ischemia could enhance Echo Lab quality benchmarks and performance measures. Aim: This study aims to evaluate temporal trends in SE test results among ambulatory patients with suspected or known coronary artery disease (CAD) in a tertiary care referral center with moderate (>100/year) volume SE activities and Cath-Lab facility. Methods: From January 2004 to December 2015, 1954 patients (mean age 62 ± 12 years, 42% women, 27% with known CAD) underwent SE (1673 exercise SE, 86%, 246 pharmacological SE, 12%, 35 pacing SE, 2%). Time was grouped into three 4 year periods, where clinical data and test results were evaluated. Results: Our series comprised low-to-intermediate pretest probability of CAD throughout the observation period (overall pretest probability of CAD 19% ± 15%). A progressive decline over time in the rate of pharmacological SE instead of a dramatic increment of exercise SE (79%–96%, P < 0.0001) was noted. The use of beta-blockers increased (from 43% to 66%, P < 0.0001), while the use of nitrates decreased (from 11% to 4%, P < 0.0001) over time. We noted a very uncommon occurrence of abnormal test results with a further decrease in the last period (from 11% to 3%, P < 0.0001). Conclusions: We observed, over a 12-year period, a progressive decrease in the frequency of inducible myocardial ischemia among patients with known or suspected CADe referred to our Echo Lab for SE with Cath-Lab facility, and this trend was parallel to changes in SE referral practice. These findings are particularly relevant if we consider the practical implications on diagnostic SE accuracy and risk assessment.
  2 1,500 88
Detection of Left Ventricular Remodeling in Acute ST Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention by Two Dimensional and Three Dimensional Echocardiography
Rakesh Kumar Ola, Chandra Bhan Meena, S Ramakrishnan, Ashish Agarwal, Smriti Bhargava
January-March 2018, 28(1):39-44
DOI:10.4103/jcecho.jcecho_32_17  PMID:29629258
Background: Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) harbingers poor prognosis. Three-dimensional echocardiography (3DE) is more accurate than 2 D echo for the assessment of left ventricle (LV) shape. We assessed LV geometry with 3D ECHO 6 months after STEMI in patients who had primary angioplasty. Materials and Methods: In this prospective study, morphological and functional analysis of LV with 3D ECHO (volumes, LVEF, 3D sphericity index [SI]) was assessed up to 7 days and 6 months in 42 STEMI patients. The LVR was considered for increase >15% of the end diastolic volume of the LV (LVEDV) 6 months after the STEMI, compared to the LVEDV up to 7 days of it. Results: Sixteen (38%) patients had LVR. 3D Echocardiographic measurements up to 7 days after the acute myocardial infarction (AMI) 1-LVEDV in ventricular remodeling group was 99.8 ± 19.1 ml and in no ventricular remodeling group was 87 ± 18.2 mL (P = 0.037); 2-LVEF was 0.48 ± 0.01 and 51 ± 0.02 (P <.001); 3D-SI was 0.41 ± 0.05 and 31 ± 0.05 (P < 0.001) II-after 6 months: 1-LVEDV in remodeling group was 114.2 ± 19.5 mL and no remodeling group was 94.2 ± 18.6 (P = 0.002); 2-LVEF was 0.58 ± 0.01 and 59 ± .01 (P = 0.003); 3D-sphericity was 0.35 ± 0.05 and 28 ± .05 (P < 0.001). Conclusion: LVR was observed in 38% of the patients 6 months after AMI. The 3D SI has been associated with occurrence of LVR and can differentiate patients with and without subsequent development of LVR accurately and early on its basis.
  1 1,876 132
Hypoplasia or Absence of Posterior Leaflet: A Rare Congenital Anomaly of The Mitral Valve in Adulthood – Case Series
Vito Maurizio Parato, Stefano Lucio Masia
January-March 2018, 28(1):45-47
DOI:10.4103/jcecho.jcecho_73_17  PMID:29629259
We present a case series of two adult patients with almost complete absence of the posterior mitral valve leaflet and who are asymptomatic or mildly symptomatic, with two different degrees of mitral regurgitation.
  - 1,462 110
Acute Right Ventricular Failure Postintubation in a Mitral Stenosis Patient
Sridhar Reddy Musuku, Saroj Pani, John Cagino
January-March 2018, 28(1):48-50
DOI:10.4103/jcecho.jcecho_27_17  PMID:29629260
Mitral stenosis (MS) is prevalent in 0.02-0.2% of the population in developed countries. The pathophysiology of MS results in elevated left atrial pressures and over-time results in pulmonary hypertension (HTN) which ultimately affects the right ventricle. In addition, MS restricts the diastolic filling of the left ventricle. Therefore, during induction patients with MS are limited by their ability to increase cardiac output by increasing stroke volume. Anesthesia goals in severe MS are to avoid sudden changes in heart rate, as well as systemic and pulmonary artery pressures. We report a patient who sustained severe hypotension upon induction and intubation which was resistant to conventional medications. Intraoperative transesophageal echocardiography displayed unique right atrial and right ventricular dilatation. In addition, the leftward inter-ventricular, inter-atrial septal shift and septal bounce were noted as the characteristic findings. Intravenous epinephrine bolus was administered to achieve normo-tension and normal chamber dimensions and interventricular septal position.
  - 1,415 94
An Unusual Left Atrial Mass in a Woman with Active Breast Cancer and Recent Cardiothoracic Surgery
Giuseppe Ciliberti, Luciano Carotti, Nicola Russo, Margherita Ilaria Gioia, Giovanni Caroli, Federico Guerra, Marco Di Eusanio, Alessandro Capucci
January-March 2018, 28(1):51-53
DOI:10.4103/jcecho.jcecho_61_17  PMID:29629261
Atrial masses are rare and more often localized in the right atrium. They are usually detected incidentally, and the leading causes are tumors, thrombi, or infective vegetations. However, normal structures and artifacts (“pseudomasses”) should also be considered in differential diagnosis, especially after cardiac and/or aortic surgery. We present a case of an unusual left atrial image observed on transthoracic echocardiography in an 83-year-old woman after an intervention of open-chest ascending aorta replacement and myocardial revascularization.
  - 1,326 69
Thrombolysis Followed by Apixaban for Massive Pulmonary Embolism and Free-floating Thrombus in Right Ventricle in a Patient with Breast Cancer
Sergio Fasullo, Nicola Morabito, Sergio Cannizzaro, Gioacchino Cosenza, Vito Pinto, Filippo Ganci, Sebastiano Scalzo, Stefania Davi, Giorgio Maringhini
January-March 2018, 28(1):54-58
DOI:10.4103/jcecho.jcecho_35_17  PMID:29629262
Free-floating thrombus in the right ventricle, associated with a massive acute pulmonary embolism (PE), is a rare phenomenon. PE is an important clinical entity with considerable mortality despite advances in diagnosis and treatment. The prognosis of PE depends on right ventricular dysfunction, myocardial injury markers, and early treatment. In this report, we present the case of a 71-year-old woman with a history of breast cancer admitted to intensive care unit for PE complicated by syncope. Although our case may seem complex because it is not represented in the guidelines, the result was satisfactory and showed how treatment with new anticoagulants (in this case apixaban) after massive thrombolysis of PE could be considered and included in the new guidelines.
  - 1,564 89
A Biatrial Myxoma with Triple Ripples
Ramachandra Barik
January-March 2018, 28(1):59-60
DOI:10.4103/jcecho.jcecho_47_17  PMID:29629263
Cardiac myxoma is a benign tumor, but it is known for its space-occupying effect at the site of origin and frequent systemic embolization. This case report highlights a biatrial myxoma of interatrial septum who presented with significant tricuspid valve regurgitation, atrial fibrillation, and cardioembolic stroke of the left parietal lobe, i.e., a biatrial myxoma with triple ripples.
  - 1,595 61
Ruptured Sinus of Valsalva: An Unusual Cause of Heart Failure
Laxman Dubey
January-March 2018, 28(1):65-66
DOI:10.4103/jcecho.jcecho_41_17  PMID:29629265
A 35-year-old male patient presented with heart failure. On examination, there was a continuous murmur over the left sternum. Transthoracic echocardiography revealed a ruptured aneurysm arising from the noncoronary sinus of Valsalva and draining into the right atrium.
  - 1,956 119
Giant Left Ventricular Pseudoaneurysm as a Late Complication of Myocardial Infarction
Inês Silveira, Patrícia Rodrigues, Catarina Gomes, Severo Torres
January-March 2018, 28(1):67-68
DOI:10.4103/jcecho.jcecho_39_17  PMID:29629266
We present a case of a 63-year-old patient referred to a cardiology consultation due to progressive symptoms of heart failure. He had a history of an inferior ST elevation acute myocardial infarction 6 years ago. Echocardiogram revealed a giant left ventricular aneurysm/pseudoaneurysm involving the inferior and inferolateral left ventricular walls, with a massive mural thrombus. Additional characterization was done by cardiac magnetic resonance, essential in establishing the diagnosis of pseudoaneurysm and to guide subsequent management. In this case, we discuss the differential diagnosis between aneurysm and pseudoaneurysm and highlight the role of non-invasive multimodality imaging.
  - 1,242 85
Williams Syndrome and Right Ventricular Noncompaction: A Rare Association
Prashanth Panduranga, Mamatha Punjee Rajarao
January-March 2018, 28(1):69-71
DOI:10.4103/jcecho.jcecho_55_17  PMID:29629267
Ventricular noncompaction and Williams syndrome are genetic disorders with typical clinical and echocardiographic cardiovascular manifestations. Here, we describe a young patient with rare association of clinical phenotype suggestive of Williams syndrome and right ventricular noncompaction.
  - 1,339 74
Takotsubo Syndrome in Patient with Severe Mitral and Aortic Regurgitation
Francesco Sbrana, Vladyslav Chubuchny, Elisa Poggianti, Emilio Maria Pasanisi
January-March 2018, 28(1):72-73
DOI:10.4103/jcecho.jcecho_30_17  PMID:29629268
  - 1,008 66
Right Ventricular Outflow Tract Systolic Excursion and Fractional Shortening for the Assessment of Right Ventricular Function
Beuy Joob, Viroj Wiwanitkit
January-March 2018, 28(1):74-74
DOI:10.4103/jcecho.jcecho_38_17  PMID:29629269
  - 959 57
Left Atrial Function and Coronary Slow Flow: Is There Diastolic Dysfunction or Not?
Luca Longobardo
January-March 2018, 28(1):75-76
DOI:10.4103/jcecho.jcecho_3_18  PMID:29629270
  - 1,057 59
Obesity, Cardiac Remodeling, and Metabolic Profile: Validation of a New Simple Index beyond Body Mass Index
Francesco Antonini-Canterin, Concetta Di Nora, Stefano Poli, Lina Sparacino, Iulian Cosei, Andreea Ravasel, Andreea Catarina Popescu, Bogdan Alexandru Popescu
January-March 2018, 28(1):18-25
DOI:10.4103/jcecho.jcecho_63_17  PMID:29629255
Aim: The body mass index (BMI), the most used anthropometric index of obesity, has an important limitation, not taking into consideration the distribution of body fat. We developed a new simple index: the waist-corrected BMI (wBMI), calculated as waist circumference (WC) × BMI. The study aim was to assess the role of wBMI, compared to BMI, WC, and Waist-to-Height Ratio (WHtR) in predicting abnormal cardiac geometry, insulin resistance, increased arterial stiffness, and dyslipidemia. Methods: This was a cross-sectional study that included 805 patients referred to our Department of Preventive Cardiology for risk factors evaluation and treatment. Eleven echographic and laboratory parameters were determined, and receiver operating characteristic (ROC) curves were derived. Areas under ROC curves (AUC) were used to assess the accuracy of the four indexes to identify unfavorable characteristics. Results: There were 29% overweight, 59% obese, and 77% hypertensive patients. Of 11 echographic and laboratory parameters, wBMI, BMI, WHtR, and WC had the largest AUC for identifying 3, 1, 6, and 1 parameters, respectively, but with overlapping 95% confidence intervals. wBMI had the largest AUC for increased arterial stiffness and insulin resistance; also, it was superior to BMI for increased left atrial volume, relative wall thickness, and triglyceride level. Conclusions: In a large population with a high prevalence of obesity and hypertension, all four indexes were associated with unfavorable characteristics. wBMI has the theoretical advantage of taking into account simultaneously the global fat mass and distribution and might be useful for a better cardiovascular risk assessment.
  - 1,804 116
Cardiovascular Multimodality Imaging: It is Time to Get on Board! A “Società Italiana di Ecocardiografia e CardioVascular Imaging” Statement
Francesco Antonini-Canterin, Giorgio Faganello, Antonio Mantero, Rodolfo Citro, Paolo Colonna, Mauro Giorgi, Vincenzo Manuppelli, Ines Monte, Licia Petrella, Alfredo Posteraro, Vitantonio Di Bello, Scipione Carerj, Frank Benedetto
January-March 2018, 28(1):1-8
DOI:10.4103/jcecho.jcecho_66_17  PMID:29629253
  - 1,945 146