1,721,053 research outputs found
Summertime loneliness as a trigger for all variants of stress-cardiomyopathy in the elderly
No full textUnruptured Giant Aneurysm of Sinus of Valsalva
No full textAn apparently healthy young adult was referred for echocardiography because of a cardiac 2/6 diastolic murmur, heard during physical examination in the context of our competitive sports screening progra
Safety of contrast flash-replenishment stress echocardiography in 500 patients with a chest pain episode of undetermined origin within the last 5 days
No full textSafety concerns regarding the use of echo-contrast agents during baseline and SE in patients with recent chest pain have been raised. The purpose of the present study was to provide evidence regarding the safety of flash-replenishment contrast dipyridamole-atropine echocardiography (DASE) in such patients.
Five hundred consecutive individuals who presented to the Emergency Department with chest pain, normal electrocardiograms (ECG) and troponin I were selected based on a less than 5 days interval between chest pain episode and performance of contrast flash-replenishment DASE. Analysis of myocardial perfusion with SonoVue(C) infusion after dipyridamole was routinely added on top of standard wall motion assessment during DASE. Adverse events (AEs) were reported according to standardized terminology and then compared with a historical control group in which contrast was not used. No deaths, myocardial infarctions, sustained arrhythmias, or any other life-threatening events were observed. Adverse events were not significantly different between the study group and the control group. In the selected subgroup of patients (n = 149) who underwent coronary angiography, accuracy of DASE with additional perfusion assessment was higher (88%, 95% C.I. 83-93%) than without (72%, 95% C.I. 65-79%).
DASE with SonoVue(C) infusion for myocardial perfusion assessment was exceptionally safe even when routinely performed within the first 5 days following a chest pain episode of undetermined origin in subjects without ECG and troponin abnormalities
History-taking still the best diagnostic modality? the case of a threatening mass in the right ventricle
No full textResting global longitudinal strain and stress echocardiography to detect coronary artery disease burden
No full textNON
Effect of Pharmacologic Stress Test Results on Outcomes in Obese versus Nonobese Subjects Referred for Stress Perfusion Echocardiography
No full textBackground Real-time contrast stress echocardiography (RTCSE) permits the simultaneous analysis of myocardial perfusion and wall motion during stress echocardiography, which has resulted in improved coronary artery disease detection. Although several studies have confirmed a protective effect of obesity in coronary artery disease, it is unclear whether this benefit is dependent on the functional significance of the disease. The objective of this study was to compare outcomes in obese versus nonobese subjects referred for pharmacologic RTCSE. Methods A retrospective comparison of wall motion and myocardial perfusion with RTCSE was assessed in 481 obese and 961 nonobese patients matched for age and gender without known coronary artery disease referred for either dobutamine (n = 1,056) or dipyridamole (n = 386) stress echocardiography at two separate institutions. Outcomes (death or nonfatal infarction) were determined over a median follow-up period of 1,195 days. Results Abnormal myocardial perfusion and/or wall motion was seen in 207 (20%) dobutamine and 61 (16%) dipyridamole studies. Abnormal rates were similar in obese (17%) and nonobese (19%) subjects. Event-free survival was significantly worse only for nonobese subjects referred for dobutamine RTCSE, with obesity (not test result) being an independent predictor of event-free survival on multivariate analysis (P = .001). No protective effect of obesity was observed following dipyridamole RTCSE. Conclusions Obese subjects in the United States referred for demand stress testing have better outcomes when directly compared with age- and gender-matched nonobese subjects with similar degrees of inducible ischemia
Association between Resting Global Longitudinal Strain and Clinical Outcome of Patients Undergoing Stress Echocardiography
No full textBackground: Reduced global longitudinal strain (GLS) of the left ventricle is associated with adverse prognosis in healthy subjects and in different cardiovascular conditions. Resting GLS may enable risk assessment independently from stress echocardiography (SE). We assessed whether there is an association of GLS measured at rest before SE with long-term outcome, independent of clinical parameters or reversible wall motion abnormalities and Doppler coronary flow velocity reserve. Methods: Five hundred thirty patients who underwent SE for ischemia evaluation between 2010 and 2012 and who had rest images available were selected. Resting GLS was measured off-line (absolute value <15% was considered abnormal). Cox models were used to examine the association between clinical variables, ejection fraction, SE variables, and resting GLS with mortality and cardiac events (cardiac death and nonfatal myocardial infarction). The independent prognostic value of GLS over known rest and stress variables was assessed. Results: Over a median follow-up of 7.5 years, 137 patients died from any cause and 50 had a nonfatal myocardial infarction. Patients with resting GLS <15% had significantly lower event-free survival (log-rank P < .0001). Resting GLS was significantly associated with risk of all-cause death and hard cardiac events, after adjustment for clinical risk factors, reversible wall motion abnormalities, and coronary flow velocity reserve. Adding resting GLS into a model with clinical, rest, and stress imaging variables significantly increased the model C index (P = .031). Conclusions: In a large cohort of patients with suspected coronary artery disease referred for SE, resting GLS <15% was independently associated with mortality and hard cardiac events, incremental to SE data. Model discrimination including resting GLS measurement was comparable to discrimination including SE results
Hypoglicemia related to big Haemangiopericitoma: a difficult diagnostic definition
No full textWe describe the case of a 91 years old woman admitted to our department for dyspnea associated with drowsiness. At the admission to the Emergency Room the patient stay in a comatose state and blood tests performed showing severe hypoglycemia (38 mg/dl at admission in non diabetic patient). Anamnestic history: multifactorial anemia; frequent hospitalizations for heart failure; AMI treated with stenting; in 1986 Haemangiopericytoma resection in the right iliac region; in 2006 palliative surgery for recurrence with residual mass. Blood tests showed lower levels of insulin and normal C- peptide serum concentration in correspondence of low glucose concentration (in relation to continuous and adequate parenteral nutrition), IGF 1 and GH level was respectively suppressed (IGF1=47 ng/ml whit normal range 97-331 ng/ml) and normal/low (GH 0.43 uUI/mL whit normal range 0.06-14.00 uUI/mL).Therefore hypoglycemia appeared related to paraneoplastic production of IGF -2
Heart failure and acute pulmonary edema linked to sepsis: a case report and a short review of literature
No full textHeart failure is a most dangerous and insidious complication of the septic state. We describe the case of a patient admitted to our department for weakness of all four limbs and fever. During hospitalization the patient developed a septic state that has manifested itself through the development of heart failure with acute pulmonary edema
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