136 research outputs found
Pulmonary valve endocarditis: always look on the (B)right side!
No full textRight-sided infective endocarditis (IE) constitutes a distinct subset within the spectrum of endocarditis, accounting for a smaller fraction of cases than left-sided IE. Despite its relatively lower incidence, right-sided IE poses unique challenges in both diagnosis and treatment. Unlike left-sided IE, which primarily affects the mitral and aortic valves, right-sided IE predominantly affects the tricuspid valve (TV) and rarely the pulmonary valve (PV) and is often associated with intravenous drug use (IVDU) and intracardiac devices as prevalent predisposing factors. Diagnostic imaging, particularly echocardiography, plays a central role in the timely detection and characterization of right-sided IE. However, anatomical factors may complicate imaging and necessitate the use of adjunctive modalities for accurate diagnosis and also to search for the source of systemic embolism. In this context, we present an interesting clinical case of PV IE, highlighting the diagnostic challenges, therapeutic considerations, and clinical outcomes associated with this condition
Thr164Ile polymorphism of beta2-adrenergic receptor negatively modulates cardiac contractility: implications for prognosis in patients with idiopathic dilated cardiomyopathy
No full textBeta2-adrenergic receptor Thr164Ile (threonine (Thr) is replaced by an isoleucine (Ile) at codon 164) polymorphism was postulated to contribute to lower exercise tolerance and poor prognosis in patients with congestive heart failure. However, heart failure is associated with several abnormalities of beta receptor signalling, and underlying mechanisms are not clear
Imaging of Myocardial Fibrosis and Its Functional Correlates in Aortic Stenosis: A Review and Clinical Potential
No full textPatients with severe aortic stenosis (AS) show progressive fibrotic changes in the myocardium, which may impair cardiac function and patient outcomes even after successful aortic valve replacement. Detection of patients who need an early operation remains a diagnostic challenge as myocardial functional changes may be subtle. In recent years, speckle tracking echocardiography (STE) and cardiac magnetic resonance mapping have been shown to provide complementary information for the assessment of left ventricular mechanics and identification of subtle damage by focal or diffuse myocardial fibrosis, respectively. Little is known, however, about how focal and diffuse myocardial fibrosis occurring in severe AS are related to measurable functional changes by echocardiography and to which extent both parameters have prognostic and diagnostic value. The aims of this review are to discuss the occurrence of focal and diffuse myocardial fibrosis in patients with severe AS and to explore their relation with myocardial function, determined by STE, as well as the prognostic and diagnostic potential of both parameters
Diagnostic and Prognostic Role of Cardiac Magnetic Resonance in MINOCA: Systematic Review and Meta-Analysis
No full textBackground: Myocardial infarction with nonobstructive coronary arteries (MINOCA) is common in current clinical practice. Cardiac magnetic resonance (CMR) plays an important role in its management and is increasingly recommended by all the current guidelines. However, the prognostic value of CMR in patients with MINOCA is still undetermined. Objectives: The purpose of this study was to determine the diagnostic and prognostic value of CMR in the management of patients with MINOCA. Methods: A systematic review was performed to identify studies reporting the results of CMR findings in patients with MINOCA. Random effects models were used to determine the prevalence of different disease entities: myocarditis, myocardial infarction (MI), or takotsubo syndrome. Pooled odds ratios (ORs) and 95% CIs were calculated to evaluate the prognostic value of CMR diagnosis in the subgroup of studies that reported clinical outcomes. Results: A total of 26 studies comprising 3,624 patients were included. The mean age was 54.2 ± 5.3 years, and 56% were men. MINOCA was confirmed in only 22% (95% CI: 0.17-0.26) of the cases and 68% of patients with initial MINOCA were reclassified after the CMR assessment. The pooled prevalence of myocarditis was 31% (95% CI: 0.25-0.39), and takotsubo syndrome 10% (95% CI: 0.06-0.12). In a subgroup analysis of 5 studies (770 patients) that reported clinical outcomes, CMR diagnosis of confirmed MI was associated with an increased risk of major adverse cardiovascular events (pooled OR: 2.40; 95% CI: 1.60-3.59). Conclusions: In patients with MINOCA, CMR has been demonstrated to add an important diagnostic and prognostic value, proving to be crucial for the diagnosis of this condition. Sixty-eight percent of patients with initial MINOCA were reclassified after the CMR evaluation. CMR-confirmed diagnosis of MINOCA was associated with an increased risk of major adverse cardiovascular events at follow-up
Resolving Apparent Inconsistencies Between Area, Flow, and Gradient Measurements in Patients With Aortic Valve Stenosis and Preserved Left Ventricular Ejection Fraction
No full textInconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echocardiographic assessment of aortic stenosis (AS). This study was conducted to investigate the importance of these inconsistencies and the impact of 3 methods to resolve these inconsistencies. The study population consisted of 327 patients (age: 76.3 ± 8.6 years, 49.5% males) with severe AS (SAS) (AVA ≤ 1 cm2) and preserved left ventricular ejection fraction (≥50%). Inconsistent findings between AVA, flow, and mean gradient (MG) were observed in 78 (23.9%) patients with low flow and a high MG, 52 (15.9%) patients with normal flow and a low MG, and 37 (11.3%) patients with a low flow and a low MG. Using stroke volume index by catheterization for AVA recalculation showed the greatest effect to resolve inconsistencies in the low flow and a high MG group (85%). Decreasing the AVA cut-off values for SAS to ≤0.8 cm2resulted in a shift from SAS to moderate AS in 36 patients (69%) in the normal flow and a low MG. Indexing AVA to body surface area had only a minor impact on reclassification. In conclusion, in patients with SAS and preserved left ventricular ejection fraction, the majority of area-flow-gradient inconsistencies at echocardiography can be resolved by correcting errors in stroke volume index measurements by alternative techniques and by redefining the cut-off value for SAS to ≤0.8 cm2
Aortic valve replacement improves survival in severe aortic stenosis with gradient-area mismatch
No full textTo investigate whether and in which patients with catheter-derived low pressure gradient (PG, <40 mmHg) severe (aortic valve area ≤ 1 cm2) aortic stenosis and preserved left ventricular ejection fraction, early aortic valve replacement (AVR) might improve survival
Transcatheter Interatrial Shunt Device Provides Sustained Clinical Benefit at One Year in Patients With Preserved or Mildly Reduced Ejection Fraction: The REDUCE LAP Heart Failure Trial
No full textTranscatheter Interatrial Shunt Device Provides Sustained Clinical Benefit at One Year in Patients With Preserved or Mildly Reduced Ejection Fraction: The REDUCE LAP Heart Failure Trial
No full textCoronary Flow Velocity Reserve and Survival⁎⁎Editorials published in JACC: Cardiovascular Imaging reflect the views of the authors and do not necessarily represent the views of JACC: Cardiovascular Imaging or the American College of Cardiology.
No full text
- …
