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Table of Contents
July-September 2020
Volume 30 | Issue 3
Page Nos. 125-185
Online since Monday, November 9, 2020
Accessed 8,210 times.
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ORIGINAL ARTICLES
Echocardiographic evaluation of right ventricular function and its role in the prognosis of chronic obstructive pulmonary disease
p. 125
Syed Aijaz Nasir, Sukhvinder Singh, Madhulata Fotedar, Sai Kiran Chaudhari, Kamal Kumar Sethi
DOI
:10.4103/jcecho.jcecho_10_20
Background:
Chronic obstructive pulmonary disease (COPD) is associated with structural and mechanical changes in the pulmonary vascular bed that increase right ventricular (RV) afterload and subsequently right heart failure.
Objectives:
The aim of the study was to elucidate RV dysfunction at rest by echocardiography in a cohort of COPD patients and to study its impact on prognosis.
Methods:
84 patients of COPD and 40 matching healthy controls were evaluated at baseline. Evaluation included clinical examination, pulmonary function tests; 6 minutes walk test and echocardiography. Patient with COPD were again evaluated after 6 months.
Results:
All echocardiographic parameters of RV function were significantly impaired in COPD patients as compared to controls. Clinical deterioration in COPD group was much more in patients with baseline abnormal RV function (89%) and patients with RV systolic pressure ≥35 mmHg (
P
= 0.018). All the six patients who died had three or more abnormal RV systolic function parameters.
Conclusions:
RV myocardial performance index and basal strain showed largest difference between controls and COPD cases. Clinical deterioration was more common in patients with abnormal RV function parameters and pulmonary hypertension.
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Detection of functionally significant coronary artery disease: Role of regional post systolic shortening
p. 131
Egle Rumbinaite, Arnas Karuzas, Dovydas Verikas, Egle Kazakauskaite, Vilius Venckus, Povilas Jakuška, Rimantas Benetis, Justina Jolanta Vaskelyte
DOI
:10.4103/jcecho.jcecho_55_19
Background:
The main goal of this manuscript was to evaluate the diagnostic value of the global and regional postsystolic shortening (PSS) parameters, assessed by two-dimensional (2D) speckle-tracking echocardiography, at rest and during dobutamine stress for the detection of functionally significant coronary artery stenoses in patients with moderate pretest probability of stable coronary artery disease (CAD).
Methods:
Dobutamine stress echocardiography (DSE) and adenosine stress myocardial perfusion imaging by cardiac magnetic resonance (CMR-MPI) were performed on 83 patients with moderate pretest probability of stable CAD and left ventricle ejection fraction ≥55%. CAD was defined as ≥50% diameter stenoses on invasive coronary artery angiography (CAA) validated as hemodynamically significant by CMR-MPI. According to invasive CAA and CMR-MPI results, patients were divided into two groups: Nonpathologic CAD (−) group: 38 (45.8%) and pathologic CAD (+) group: 45 (54.2%).
Results:
There were no significant differences in clinical characteristics, conventional 2D echocardiography between the two groups at rest and during low dobutamine dose. Regional postsystolic index (PSI) during recovery phase had the highest area under the receiver operating characteristic curve (AUC) (AUC 0.882, sensitivity 87%, specificity 92%) for the detection of functionally significant one-vessel disease. During high dobutamine dose, regional PSI had sensitivity 78% and specificity 81% (AUC 0.78) to detect significant CAD. Regional PSI remained the same tendency remains for the detection of multiple-vessel CAD. Other myocardial deformation parameters were less sensitive and specific during high dobutamine dose and recovery phase.
Conclusions:
PSS parameters showed to be sensitive and specific in detecting hemodynamically significant coronary artery stenosis in patients with stable CAD with moderate pretest probability. The study revealed that the assessment of regional PSI performed during recovery improves the diagnostic accuracy of DSE for the detection of functionally significant CAD.
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Value of speckle tracking echocardiography for early detection of left ventricular dysfunction in patients with systemic lupus erythematosus
p. 140
Shereen Ibrahim Farag, Reda Biomy Bastawisy, Mohamed Ahmed Hamouda, Wael Anwer Hassib, Hala Ahmed Wahdan
DOI
:10.4103/jcecho.jcecho_12_20
Background:
Cardiac dysfunction due to systemic lupus erythematosus (SLE) may be subclinical, but those patients are at high risk for developing clinical heart failure.
Aim:
The aim of this study is to assess the role of speckle tracking echocardiography (STE) in the early detection of systolic dysfunction in SLE patients.
Patients and Methods:
This was a case–control study. Participants were subdivided into two groups: Group 1 included 50 SLE patients and Group 2 included 50 healthy controls. Clinical evaluation, echocardiography, tissue Doppler, and STE were performed.
Results:
Global longitudinal strain (GLS) was significantly reduced in SLE group (−18.95 ± 2.02 vs. −21.4 ± 2.1,
P
< 0.001). However, there was no significant difference in left ventricular ejection fraction between both groups (
P
= 0.801). There was a significant positive correlation between the disease duration and age (
r
= 0.480,
P
< 0.001), pulmonary artery systolic pressure (PASP) (
r
= 0.628,
P
< 0.001), and GLS (%) (
r
= 0.417,
P
= 0.012). There was also a significant positive correlation between the disease activity index and GLS (%) (
r
= 0.7,
P
< 0.001) and PASP (
r
= 0.522,
P
< 0.001).
Conclusion:
SLE group had GLS % lower than the control group, and this was statistically significant, denoting early systolic dysfunction. Longer duration and high SLE activity index significantly affect GLS. GLS is an excellent noninvasive tool for early detection of subclinical left ventricular systolic dysfunction in SLE patients.
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Analysis of regional right ventricular function by tissue doppler imaging and three-dimensional echocardiography in highly trained athletes
p. 146
Maria Vincenza Polito, Rodolfo Citro, Gennaro Galasso, Andreas Hagendorff
DOI
:10.4103/jcecho.jcecho_30_20
Background:
Regional right ventricular (RV) function has not yet been characterized in highly trained athletes, and the effects of increased RV volumes on resting changes of regional RV deformation are unknown.
Purpose:
The aim of the study was to analyze global and regional RV function by a multisegmental approach using tissue Doppler imaging (TDI) and to determine whether higher RV volumes evaluated by three-dimensional echocardiography (3DE) had an impact on the RV mechanics assessed by resting regional TDI parameters.
Methods:
We enrolled prospectively 25 professional soccer players and 25 age- and sex-matched nonathletic controls. Transthoracic echocardiography including additional views of the RV was performed. The TDI sample volume was placed in the basal region of the anterior, inferior, and RV free wall to assess the following parameters: isovolumic contraction time (IVCT
RV
), isovolumic relaxation time (IVRT
RV
), ejection time (ET
RV
), and myocardial performance index (MPI
RV
). Furthermore, conventional left ventricular (LV) and RV parameters at two-dimensional (2D) and 3DE were determined.
Results:
In athletes, LV mass index/body surface area (BSA), left atrial volume index, 2D LV volumes/BSA were significantly increased in comparison with controls. Moreover, athletes had higher 2D LV and RV stroke volume (SV), lower values for A wave and E/e' ratio, higher basal RV diameter, and right atrial (RA) area (
P
< 0.0001). Moreover, athletes showed significantly increased LV and RV volumes and SV indexed for BSA (
P
< 0.0001) evaluated at 3DE. In athletes, ET
RV-free wall
, ET
RV-anterior
, IVCT
RV-inferior
, and IVCT
RV-anterior
were statistically increased (
P
< 0.0001). Conversely, IVRT
RV-anterior
was reduced in comparison with controls. A significant positive correlation between IVRT
RV-inferior
and three-dimensional (3D) RV end-diastolic volume (EDV), end-systolic volume, and SV was observed in athletes. Finally, a good positive correlation was observed between 3D RV EDV and 3D LV SV indexed for BSA.
Conclusions:
In athletes, the higher 3D RV volumes are proportionally related to an increase of IVRT
RV-inferior
and 3D LV SV. Further studies on the resting changes of regional RV deformation for screening and follow-up in these participants are needed.
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Severe aortic valve stenosis: Symptoms, biochemical markers, and global longitudinal strain
p. 154
Giuseppe Bottaro, Paolo Zappulla, Wanda Deste, Francesca Famà, Federica Agnello, Danilo Trovato, Antonio Indelicato, Marco Barbanti, Carmelo Sgroi, Ines P Monte, Corrado Tamburino
DOI
:10.4103/jcecho.jcecho_13_20
Background:
According to the actual guidelines regarding severe aortic valve stenosis (AS), symptoms are the most important trigger for aortic valve replacement (AVR). However, the objective analysis of cardiological clinic can be confused, considering the aging population this disease affects and the comorbidities.
Objectives:
Looking for an objective marker of disease, useful for scheduling the correct AVR, we researched the relation between some biochemical markers of left ventricular (LV) dysfunction and its global longitudinal strain.
Materials and Methods:
We analyzed 74 consecutive patients (82 ± 4 years) with severe AS. We identified 61 patients with symptoms (angina, dyspnea, and syncope) and 13 asymptomatic patients. The clinical and echocardiographic parameters were compared between these two groups. LV ejection fraction (LVEF), LV global longitudinal strain (LVGLS), NT-pro-B-type brain natriuretic peptide (BNP), troponin T (TNT), creatine kinase-MB (CPK-MB), and myoglobin were determined at the time of evaluation.
Results:
Compared with the asymptomatic group, patients in the symptomatic group had a lower LVGLS (
P
= 0.002) and an increased pro-BNP (
P
= 0.0002). LVGLS showed a good correlation with pro-BNP as a marker of myocardial damage, with a linear increase of pro-BNP in patients with a linear decrease of LVGLS (
r
= 0.43). Despite the normal value of LVEF > 50% in asymptomatic patients, some of them (46%) have an early dysfunction of LVGLS. No other statistically significant difference emerged from the biochemical analysis, in TNT (
P
= 0.29), CPK-MB (
P
= 0.36), and myoglobin (
P
= 0.38).
Conclusions:
Pro-BNP and LVGLS can be considered an objective marker of clinical severity of AS disease, useful for management and scheduling of AVR, especially in asymptomatic patients.
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CASE REPORTS
Isolated double-chambered right ventricle – A rare entity
p. 162
Ashok Garg, Deepak Agrawal, GL Sharma
DOI
:10.4103/jcecho.jcecho_36_20
A double-chambered right ventricle (DCRV) is a rare congenital heart disease and an uncommon cause of congestive heart failure. An anomalous muscle band divides the right ventricle into two cavities: the proximal high-pressure chamber and the distal low-pressure chamber. Most cases are diagnosed and treated during childhood. Furthermore, there is a tendency for progression, if not treated early. Echocardiography is considered useful for the diagnosis of this ailment. Most of the patients have associated congenital anomalies, such as ventricular septal defect, pulmonary stenosis, and subaortic stenosis. Isolated DCRV is a rare entity. Hence, we report a case of an isolated DCRV in an adult patient.
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A floating right atrial and ventricular thrombus in a patient with syncope
p. 165
Abdullah Al-kasasbeh, Philipp Lurz, Rasheed Ibdah, Sukaina Ismael Rawashdeh, Basheer Khassawneh
DOI
:10.4103/jcecho.jcecho_15_20
Here, we describe a rare echocardiographic finding of a floating right heart thrombus in an elderly woman who presented with an unexplained syncope. Our case demonstrates the pivotal role of echocardiography in the workup of patients admitted with syncope.
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A rare complication of implantable cardiac defibrillator placement
p. 167
João André dos Santos Ferreira, Célia Marques Domingues, Susana Isabel Monteiro Dias da Costa, Maria Fátima Franco Silva, Lino Manuel Martins Gonçalves
DOI
:10.4103/jcecho.jcecho_8_20
Implantable cardiac defibrillators (ICDs) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. The authors present a case of a 64-year-old female with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block (RBBB) pattern and later confirmed by echocardiography which showed the lead tip in contact with the midsegment of the left ventricular anterolateral wall. As the patient's hospitalization was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. An electrocardiogram showing a RBBB pattern during VVI pacing should arise the suspicion of inadvertent incorrect placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.
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Transesophageal echocardiography reveals a missed right atrial aneurysm in a patient with atrial septal defect and mitral valve prolapse
p. 171
Subramanian Chellappan, Krishnamanohar R Soman, Yogesh Sathe, Prachi Kukshal, Arya James
DOI
:10.4103/jcecho.jcecho_20_20
Right atrial (RA) aneurysms are rare entities reported in the literature. Affected patients are usually asymptomatic, but sometimes, they tend to present with arrhythmias or even heart failure if big. They may form a nidus for thrombus formation and subsequent thromboembolic complications. We report a coincidental finding of a RA aneurysm in a 22-year-old female with the atrial septal defect and mitral valve prolapse, causing moderate mitral regurgitation. The aneurysm was detected incidentally on transesophageal echo after anesthetic induction for elective surgery of the primary pathology. The mitral valve was repaired, and the atrial septal defect was closed. The aneurysm was excised in toto and RA wall repaired.
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Apical hypertrophic cardiomyopathy masked by Takotsubo syndrome
p. 174
Elisa Gherbesi, Vera Lucia Paiocchi, Laura Anna Leo, Susanne Anna Schlossbauer, Giuseppina Chiarello, Francesco Fulvio Faletra
DOI
:10.4103/jcecho.jcecho_46_20
We describe the case of a 66-year-old female presented to our emergency department (ER) with acute chest pain and diagnosed with Takotsubo syndrome that initially prevented from suspecting an apical hypertrophic cardiomyopathy at echocardiography.
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Figure 8 shadow, what is your diagnosis?
p. 177
Hassan H Allam, Abdulhalim Jamal Kinsara, Tareq Tuiama, Shadwan E Alfakih
DOI
:10.4103/jcecho.jcecho_90_20
We report this case, which described the echocardiographic and chest X-ray appearance of the amplatzer device. The echo images raised suspicion of a mass in the left atrium, but a simple X-ray showed that the mass is an amplatzer device for left atrial appendage closure.
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Aortic and mitral disease due to an unusual etiology
p. 179
Juan I Cotella, Julio Dantur, Eduardo Hasbani, Javier Hasbani, Marcela Ortiz Mayor, Aldo Prado
DOI
:10.4103/jcecho.jcecho_87_20
Relapsing polychondritis (RP) is a rare multisystem disease characterized by inflammation in cartilaginous structures and other connective tissues throughout the body, affecting the ears, nose, eyes, joints, respiratory tract, heart, and blood vessels. Cardiovascular involvement is the second most common cause of mortality after laryngotracheal involvement.
[1]
Here, we report a successful surgical case of RP in which the patient underwent aortic and mitral valve replacement and concomitant coronary artery bypass grafting.
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LETTERS TO EDITOR
Embolism somewhere, thrombus nowhere, origin is there in the left atrium: Atrial cardiomyopathy and cryptogenic stroke
p. 183
Ismail Mohamed Ibrahim
DOI
:10.4103/jcecho.jcecho_40_20
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Left atrial angiosarcoma: A rare cardiac tumor at an uncommon site
p. 185
Mahmood Dhahir Al-Mendalawi
DOI
:10.4103/jcecho.jcecho_38_20
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Online since 08 August, 2013