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   2018| July-September  | Volume 28 | Issue 3  
    Online since September 26, 2018

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How to write a research protocol: Tips and tricks
Matteo Cameli, Giuseppina Novo, Maurizio Tusa, Giulia Elena Mandoli, Giovanni Corrado, Frank Benedetto, Francesco Antonini-Canterin, Rodolfo Citro
July-September 2018, 28(3):151-153
DOI:10.4103/jcecho.jcecho_41_18  PMID:30306017
  4,713 387 -
Reference values of longitudinal systolic right and left ventricular function measured by M-mode echocardiography in healthy preterm and term neonates
Yazdan Ghandi, Danial Habibi, Elham Farahani
July-September 2018, 28(3):177-181
DOI:10.4103/jcecho.jcecho_31_18  PMID:30306022
Background: The mitral annular plane systolic excursion (MAPSE) and tricuspid annular plane systolic excursion (TAPSE) are parameters for evaluating systolic function, which is directly affected by ventricular morphology and geometry. Materials and Methods: A cross-sectional study in term and preterm neonates calculated TAPSE and MAPSE at the lateral and septal (LAT/SEP) mitral. The study groups were divided into three classes based on birth age: two preterm groups, 30–33 weeks and 34–37 weeks, and one term group, 38–40 weeks. Results: This study included 21 term neonates and 31 preterm neonates. The mean LAT MAPSE was 0.63 ± 0.11 cm for gestational age (GA) of 30–33 weeks, 0.76 ± 0.03 cm among GA of 34–36 weeks, and 0.84 ± 0.08 cm for GA of 37–40 weeks; the mean SEP MAPSE was 0.39 ± 0.14 cm, 0.51 ± 0.06 cm, and 0.65 ± 0.09 cm, respectively; and the mean TAPSE was 0.47 ± 0.13 cm, 0.62 ± 0.07 cm and 0.88 ± 0.15 cm, respectively. The mean LAT MAPSE was 0.63 ± 0.09 cm for neonates weighing 1500–2500 g and 0.82 ± 0.06 cm for those weighing 2500–3600 g; the mean SEP MAPSE was 0.39 ± 0.11 cm and 0.61 ± 0.09 cm, respectively. The LAT MAPSE showed a positive correlation with body surface area (BSA) and body weight (BW) (P = 0.0001). In addition, the SEP MAPSE indicated a positive correlation with BSA and BW (P = 0.0001). The TAPSE had a positive correlation with BSA (P = 0.0001) and BW (r = 0.876, P = 0.0001). Conclusions: The TAPSE and MAPSE values were calculated to establish the reference values for assessing global ventricular systolic function in neonate's health.
  2,349 113 1
Stress echocardiography: Need to optimize its appropriate use in suspected angina and a review of available additional tools for its clinical application in 2018: First do no harm! second do it at the highest possible accuracy
Nicola Gaibazzi
July-September 2018, 28(3):154-159
DOI:10.4103/jcecho.jcecho_16_18  PMID:30306018
There is a need to reassess the most appropriate indications for stress echocardiography in the current era, in patients with suspect or known coronary artery disease (CAD), and also the most helpful additional parameters that can be easily calculated in clinical practice to increase the known suboptimal sensitivity for obstructive CAD of this test. The current review tries to clarify what is and what should be the proper role for functional testing in general, but specifically regarding modern stress echocardiography in the current practice, for suspected CAD and/or atypical chest pain. Few candidate additional parameters beyond wall motion assessment are here suggested to improve diagnostic accuracy of stress echocardiography, and pertinent literature is briefly reviewed, together with a more personal view of the author regarding the characteristics of each parameter, as far as ease of acquisition, cost, and true diagnostic or prognostic clinical usefulness are concerned. The reviewed additional parameters, which can be acquired during stress echocardiography, are Doppler coronary flow reserve in the left anterior descending artery, cardiac calcium score, global longitudinal strain, ventricular elastance, and contrast myocardial perfusion. Each of them finds a potential place in the current practice or may find a place in the future practice of stress echocardiography.
  2,145 198 -
Early recovery of left ventricular systolic function after transcatheter aortic valve implantation
Wanda Deste, Simona Gulino, Paolo Zappulla, Federica Iacono, Rita Sicuso, Antonino Indelicato, P Ines Monte, Giulia Rapisarda, Danilo Trovato, Arianna Cirasa, Carmelo Sgroi, Marco Barbanti, Corrado Tamburino
July-September 2018, 28(3):166-170
DOI:10.4103/jcecho.jcecho_13_18  PMID:30306020
Background: A lot of studies have shown a positive effect of transcatheter aortic valve implantation (TAVI) on left ventricular ejection fraction (LVEF). Objectives: We aimed to investigate the effect of TAVI on left ventricular function and correlate this phenomenon with hypertrophy degree in an early follow-up. Materials and Methods: Between August 2015 and July 2016, 250 consecutive patients with symptomatic severe aortic stenosis (AS) underwent TAVI in our institution. Given the aim of this analysis, only patients with an LVEF <50%, no more than moderate mitral valve regurgitation, successful valve implantation, and 1-month follow-up available were included in the study (n = 46). Patients were enrolled in a prospective database, with clinical and echocardiographic evaluations at 1 month after TAVI. Results: All patients had severe symptomatic AS (mean transaortic pressure gradients: 44.1 ± 13.8 mmHg and mean aortic valve area: 0.66 ± 0.19 cm2). Mean baseline LVEF was 39.3 ± 8.8%. Significant hemodynamic improvement was observed after TAVI. Mean transvalvular aortic gradient decreased significantly from 44.1 ± 13.8 mmHg to 8.9 ± 4.2 mmHg (P < 0.005). A statistically significant improvement in LVEF compared to baseline was observed in the 1st month of follow-up (39.3 ± 8.8% vs. 44.1 ± 10.1%, P < 0.019). Overall, 52.2% of patients showed an increase in LVEF, 32.6% had no change, while only 2.2% had a decrease in LVEF. Interestingly, we found a significant reverse correlation between LVEF improvement and ventricular hypertrophy measured as diastolic interventricular septum thickness (Pearson index r = −0.42). Patients showing greater improvement in LVEF were those with less than moderate hypertrophy. Conclusions: Patients with depressed systolic function show a consistent and early LVEF recovery after TAVI. An impaired LVEF recovery is most likely among patients with more than moderate hypertrophy, probably responsible of left ventricular fibrosis that irremediably compromises systolic function.
  2,100 104 2
The association of epicardial adipose tissue and the metabolic syndrome in community participants in South Africa
Rosaley D Prakaschandra, Datshana P Naidoo
July-September 2018, 28(3):160-165
DOI:10.4103/jcecho.jcecho_71_17  PMID:30306019
Background: We sought to determine the association of echocardiographically derived epicardial adipose tissue (EAT) thickness, which is a component of visceral adipose tissue, with the metabolic syndrome (MetS) in a cohort of randomly selected community participants. Methods: South African-Asian Indians aged 15–64 years were recruited over a 2-year period after informed consent was obtained. All participants who had complete measurements done for biochemistry and echocardiography (using established criteria), were dichotomized into the MetS or non-MetS groups defined according to the harmonized criteria. Results: Of the 953 (232 men and 721 women) participants recruited, 47.1% (448) were classified with the MetS. These participants had larger waist circumference and body mass index (P < 0.001), with larger LA volumes and diameter, thicker ventricular walls, higher left ventricular mass, relative wall thickness, and EAT (P < 0.001). There was a corresponding increase in EAT thickness with increasing number of MetS risk factors at the transition from 0 MetS factors to 1 (95% confidence interval [CI] −0.8; −0.2) and from 2 to 3 MetS factors (95% CI −0.9; −0.4). The AUC of the receiver operator curve was highest for triglycerides (0.845), followed by fasting plasma glucose (0.795) and then EAT (0.789). An EAT value of <3.6 mm predicted the presence of the MetS with a 78% sensitivity and 70% specificity. Using backward stepwise logistic regression, the most significant independent determinants of the MetS after adjusting for age, gender, and type 2 diabetes mellitus, was fasting plasma glucose (odds ratio [OR] = 1.2), triglycerides (OR = 7.1), and EAT (OR = 2.3). Conclusion: Although EAT is associated with the MetS, and can identify individuals at increased cardiometabolic risk, it has a limited additional role compared to current risk markers.
  1,822 86 1
Impaired cardiac functions and aortic elastic properties in patients with severe Vitamin D deficiency
Yalcin Hacioglu, Turgut Karabag, Mehmet Emin Piskinpasa, Fettah Sametoglu, Yasin Yuksel
July-September 2018, 28(3):171-176
DOI:10.4103/jcecho.jcecho_82_17  PMID:30306021
Background: The study explored the effect of severe Vitamin D deficiency on cardiac functions and aortic elastic properties determined by echocardiography. Patients and Methods: It included 56 patients with Vitamin D deficiency (Group 1; 16 men, 40 women; mean age 43.1 ± 11.4 years) and 42 healthy individuals with normal Vitamin D levels (Group 2; 11 men, 31 women; mean age 40.0 ± 7.5 years). Calcium, parathormone, alkaline phosphatase, and Vitamin D levels were measured from blood samples, and all participants underwent echocardiographic examination. Results: Left ventricular diastolic functions were determined by both conventional and tissue Doppler methods and were found to be impaired in Group 1 compared to Group 2. Aortic distensibility was significantly reduced in Group 1 compared to Group 2, whereas aortic stiffness index was significantly increased. Left atrial active emptying volume and fraction (LAAEV and LAAEF) were significantly higher in Group 1 than in Group 2. There were significant negative correlations between Vitamin D level and LAAEV, LAAEF, and septal E/E′ ratio and significant positive correlations between Vitamin D level and septal, lateral, anterior, and right ventricular annular E′ velocities. Conclusion: In severe Vitamin D deficiency, echocardiographically assessed diastolic functions appeared particularly impaired, and ventricular myocardial velocities and aortic elastic parameters were also adversely affected. In addition, LA mechanical functions were impaired, probably secondary to disturbed diastolic functions.
  1,704 104 -
A rare case of dense spontaneous echo contrast within inferior vena cava
Biswajit Majumder, Pritam Kumar Chatterjee, Sharmistha Chatterjee, KN Sudeep
July-September 2018, 28(3):204-206
DOI:10.4103/jcecho.jcecho_1_18  PMID:30306030
A 33-year-old gentleman was examined because of fatigue and progressive right heart failure. A striking finding in his echocardiogram was intense and slow-moving dense echo contrast in the inferior vena cava (IVC). Cardiac catheterization revealed constrictive pericarditis, and pericardiectomy was performed. Postoperatively spontaneous echo contrast in IVC have resolved. This case helps explain the origin of spontaneous IVC contrast.
  1,694 88 -
Spontaneous rupture of sinus of valsalva aneurysm presenting as perivalvular hematoma
Arindam Sharma, Neeraja Yedlapati, Tamunoinemi Bob-Manuel, Timothy Woods, Daniel Donovan, Uzoma N Ibebuogu
July-September 2018, 28(3):201-203
DOI:10.4103/jcecho.jcecho_6_18  PMID:30306029
Acute rupture of sinus of Valsalva often presents as an acute emergency with significant hemodynamic compromise whereas contained rupture of sinus of Valsalva with a perivalvular hematoma formation is rarely seen. We describe the case of a 63-year-old male who presented with acute shortness of breath and was found to have rupture of sinus of Valsalva aneurysm (SVA) with a perivalvular hematoma and severe aortic regurgitation. We also review the presentation, diagnosis, and management of SVAs.
  1,476 80 -
Aortic valve thrombosis after valve-sparing aortic root replacement and insertion of an extracorporeal left ventricular assist device, masked by mediastinal packing
Yoshiaki Uda, Leonid Minkovich, Maral Ouzounian, Massimiliano Meineri
July-September 2018, 28(3):194-197
DOI:10.4103/jcecho.jcecho_26_18  PMID:30306027
Aortic valve (AV) or aortic root thrombus related to a left ventricular assist device (LVAD) is a relatively uncommon but potentially life-threatening complication. In the present report, we describe a complex case where echocardiographic diagnosis of AV thrombosis was obscured by the presence of mediastinal packing in a patient who underwent valve-sparing aortic root replacement and insertion of the CentriMag™ LVAD for postcardiotomy cardiogenic shock. A large AV thrombus may develop rapidly in patients with LVADs. This case highlights the importance of a careful and thorough transesophageal echocardiography examination in detecting this complication and in altering surgical management.
  1,437 76 -
Traumatic ventricular septal defect resulting from a motor vehicle collision
Robert Tonks, David Perkel, Aimee Wehber, Bret Rogers
July-September 2018, 28(3):191-193
DOI:10.4103/jcecho.jcecho_23_18  PMID:30306026
This case report describes a rare case of ventricular septal defect due to non-penetrating trauma in a 43 year old male involved in a motor vehicle collision. The diagnosis was made by echocardiogram and the patient was taken immediately to the operating room for emergent surgical repair of the ventricular septal defect and survived.
  1,433 70 -
Multimodality imaging of left ventricular clefts in an asymptomatic teenager
Chiara Bencini, Giovanni Corrado, Claudia Borghi, Stefano Carugo
July-September 2018, 28(3):182-184
DOI:10.4103/jcecho.jcecho_10_18  PMID:30306023
Left ventricular clefts (LVCs) are defined as deep, tight blood-filled invaginations within the ventricular myocardium localized predominantly in the basal posterior septum and LV-free wall. Usually, they are asymptomatic and incidentally discovered during diagnostic imaging procedures. LVC has been reported both in healthy volunteers and in patients affected with hypertrophic cardiomyopathy. Clinicians should be able to recognize LVC and to distinguish this entity from other myocardial wall defects with different pathological profile and clinical significance. We describe a case of multimodality imaging of multiple septal myocardial clefts in an asymptomatic teenager.
  1,388 84 -
Right cardiac chambers' involvement as the first manifestation of recurrent complex karyotype acute myeloid leukemia
Claudia Zanetti, Riccardo M Inciardi, Fabio Benedetti, Andrea Rossi
July-September 2018, 28(3):185-188
DOI:10.4103/jcecho.jcecho_14_18  PMID:30306024
We describe a case of a 21-year-old male, with a history of acute myeloid leukemia (AML) treated with allogeneic hematopoietic cell transplantation, referred to our department for atypical chest pain and dyspnea. Echocardiography revealed an extensive mass involving right cardiac chambers and tricuspid valve annulus, with increased thickness and impairment of right ventricle. Cardiac magnetic resonance confirmed the presence of cardiac mass involving pulmonary artery trunk, pericardial sleeves, and lung parenchyma. These findings were attributed to a manifestation of recurrent AML involving the right heart.
  1,365 73 -
Incidental discovery of an atypical cardiac tumor
Genevieve E Staudt, Amy G Fiedler, George Tolis, David M Dudzinski, Scott C Streckenbach
July-September 2018, 28(3):198-200
DOI:10.4103/jcecho.jcecho_7_18  PMID:30306028
Primary cardiac tumors are rare, present in roughly 0.05% of the population. Cardiac papillary fibroelastoma (CPF) is the second most common, accounting for 10% of primary cardiac tumors.[1] Most cases of CPFs are discovered incidentally on autopsy; however, they may present clinically with systemic embolization or heart failure symptoms. The recommended treatment for symptomatic CPF patients is surgical resection.[1] Treatment in asymptomatic patients remains somewhat controversial with incidentally discovered tumors presenting a clinical dilemma. We present a case of an atypically located CPF that was discovered incidentally on intraoperative transesophageal echocardiography (TEE) during a routine coronary artery bypass graft operation. This case highlights several important points for cardiac anesthesiologists. The first is the importance of performing a comprehensive intraoperative TEE. Next, this case reinforces the broad utility of TEE for evaluation of intracardiac tumors. Finally, this case demonstrates the importance of precise localization of intracardiac tumors.
  1,284 58 -
Pericardial agenesis as a rather unusual cause of palpitations: We only see what we know
Chrysanthos Grigoratos, Giancarlo Todiere, Giovanni Donato Aquaro, Andrea Barison
July-September 2018, 28(3):189-190
DOI:10.4103/jcecho.jcecho_15_18  PMID:30306025
Cardiac palpitations secondary to ventricular ectopic beats are a frequent clinical indication for a cardiac magnetic resonance (CMR) scan. CMR has already demonstrated its additive diagnostic value in patients with frequent arrhythmias even when echocardiogram appears normal. Hereby, we describe a case of a middle-aged male patient referred to our laboratory because of frequent ventricular ectopic beats and an inconclusive echocardiogram due to an extremely poor acoustic window. A diagnosis of pericardial agenesis (PA) was made explaining patient symptoms and arrhythmias previously detected. Furthermore, at the case report description, PA prevalence, associated cardiac pathologies, and novel CMR diagnostic criteria are being described.
  1,244 79 -