Diagnostic performance of multi-organ ultrasound with pocket-sized device in the management of acute dyspnea

The availability of ultra-miniaturized pocket ultrasound devices (PUD) adds diagnostic power to the clinical examination. Information on accuracy of ultrasound with handheld units in immediate differential diagnosis in emergency department (ED) is poor. The aim of this study is to test the usefulness and accuracy of lung ultrasound (LUS) alone or combined with ultrasound of the heart and inferior vena cava (IVC) using a PUD for the differential diagnosis of acute dyspnea (AD)

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

Impaired right and left ventricular function in patients with fibrotic interstitial lung diseases

Background: Interstitial lung diseases (ILDs) include idiopathic (IPF) and no idiopathic pulmonary fibrosis (no-IPF). While left ventricular (LV) and right ventricular (RV) dysfunction is known in IPF, little is known about cardiac involvement in no-IPF. This issue can be explored by advanced echocardiography. Methods: Sixty-one clinically stable and therapy-naïve fibrotic ILDs patients - 33 IPF and 28 no-IPF, and 30 healthy controls were enrolled after excluding patients with coronary artery disease, overt heart failure, primary cardiomyopathies, other forms of diffuse parenchymal lung disease, history of pulmonary embolism and primary pulmonary arterial hypertension(PAH). ILDs diagnosis was made by chest radiography, spirometry and chest high-resolution computed tomography. Lung cumulative damage was evaluated by diffusion capacity of the lung for carbon monoxide (DLCOsb). All patients underwent a complete echo-Doppler exam including 2D quantitation of global longitudinal strain (GLS) of both ventricles and of RV ejection fraction (EF) by 3D echo. Results: Our findings demonstrated LV diastolic dysfunction in both IPF and no-IPF patients, whilst a subclinical reduction of LV GLS - but not of LV EF - was found only in PF patients. An alteration of and diastolic function and of RV GLS was observed in IPF in comparison with both controls and no-IPF. An association between DLCOsb and RV GLS was found in the pooled ILDs population and in IPF, it being independent on confounders including pulmonary arterial systolic pressure. Conclusion: These findings point out the diagnostic capabilities of strain imaging in distinguishing early cardiac damage of IPF from and no-IPF patients, a task which cannot be attributed to both standard and 3D echocardiography

Device's dehiscence 3 months after implant for mitral perivalvular leak

Our case is about a complication in a case of percutaneous closure of a perimitral leak in a patient with beleaflet mechanical mitral prosthesis. An Amplatzer vascular plug III was implanted. At the time of procedure the leak was successfully closed, however after three months a device's dehiscence developed. Percutaneous closure of mitral perivalvular leak is currently a feasible alternative in highly selected individuals, whose symptoms are not adequately palliated by medical therapy and who are at high surgical risk. Our case demonstrates that the presence of a wide calcification of the native annulus may represent a contraindication to this kind of treatment. Further studies on percutaneous approaches to perivalvular prosthetic regurgitation in presence of heavy calcification are needed, in order to define optimal patient selection and the late complications of this procedure. Moreover it will also be useful to design a device adapted for the anatomy of such defects in various sizes

Non-Invasive Assessment of Right Ventricle to Arterial Coupling for Prognosis Stratification of Fibrotic Interstitial Lung Diseases

Background: The coupling of the right ventricle (RV) to the pulmonary circulation is an indicator of RV performance that can be non-invasively estimated by echocardiography. There are no data about its use in patients affected by fibrotic interstitial lung diseases (f-ILD). Methods: Fifty f-ILD patients, including 27 cases with idiopathic pulmonary fibrosis (IPF) (M = 37; mean age 67 ± 7 years), were studied with standard and speckle-tracking echocardiography and compared with 30 age-matched healthy volunteers. The mean patient follow-up was 70 ± 4 months. Results: Fibrotic ILD patients had a larger right ventricle (RV) and worse diastolic function because the RV global longitudinal strain (GLS) was significantly lower and the systolic pulmonary artery pressure (sPAP) estimates were higher in comparison with those of controls. Conversely, tricuspid annular systolic excursion (TAPSE) did not differ between controls and patients. Median values of TAPSE/sPAP and RV GLS/sPAP were significantly reduced in f-ILD patients (p p = 0.01); this parameter was an independent predictor of a worse outcome. Conclusion: Low estimates of RV GLS/sPAP are predictive of worse outcomes in f-ILD patients. RV coupling seems to be a promising surrogate biomarker of RV performance to discriminate the patient phenotype with significant management and prognosis implications

Determinants of myocardial mechanics in top-level endurance athletes: three-dimensional speckle tracking evaluation

The determinants of systolic function in the performing heart are not completely understood. Aim of the study was to assess the contributors of left ventricular (LV) strain components, using 3D speckle tracking echocardiography (STE) in endurance athletes

Overview of mitral regurgitation in Europe: results from the European Registry of mitral regurgitation (EuMiClip)

Aims To determine the prevalence of mitral regurgitation (MR) in a large cohort of consecutive patients undergoing clinically indicated echocardiography and to examine the distribution of primary and secondary MR. Methods and results All patients undergoing an echocardiographic study in 19 European centres within a 3-month period were prospectively included. MR assessment was performed as recommended by the European Association of Cardiovascular Imaging (EACVI). MR was classified according to mechanism as primary or secondary and aetiologies were reported. A total of 63 463 consecutive echocardiographic studies were reviewed. Any degree of MR was described in 15 501 patients. Concomitant valve disease of at least moderate grade was present in 28.5% of patients, being tricuspid regurgitation the most prevalent. In the subgroup of moderate and severe MR (n = 3309), 55% of patients had primary MR and 30% secondary MR. Both mechanisms were described in 14% of the studies. According to Carpentier's classification, 26.7% of MR were classified as I, 19.9% of MR as II, 22.4% of MR as IIIa, and 31.1% of MR as IIIb. Conclusion To date, this is the largest echocardiography-based study to analyse the prevalence and aetiology distribution of MR in Europe. The burden of secondary MR was higher than previously described, representing 30% of patients with significant MR. In our environment, degenerative disease is the most common aetiology of primary MR (60%), whereas ischaemic is the most common aetiology of secondary MR (51%). Up to 70% of patients with severe primary MR may have a Class I indication for surgery. However, the optimal therapeutic approach for secondary MR remains uncertain