Subclinical left ventricular systolic dysfunction in patients with metabolic syndrome: A case–control study using two-dimensional speckle tracking echocardiography

BACKGROUND: The dramatic increase in the prevalence of metabolic syndrome is associated with more increased cardiovascular morbidity and mortality in this group. Some recent studies suggested that metabolic syndrome is associated with increased risk of subclinical left ventricular (LV) systolic dysfunction. In the present cross-sectional case&ndash;control study, the utility of two-dimensional speckle tracking echocardiography (STE) was examined to detect early LV systolic dysfunction in this population. METHODS: A total of 75 clinically asymptomatic subjects with LV ejection fraction (LVEF) &ge; 55%, 39 without metabolic syndrome and 36 with metabolic syndrome, matched for gender and age, were enrolled in this case&ndash;control study. Metabolic syndrome was diagnosed using the National Cholesterol Education Program/Adult Treatment Panel III criteria. LV systolic function was assessed by STE-derived global and segmental longitudinal strain (&epsilon;LL). RESULTS: Global &epsilon;LL was significantly lower in patients with metabolic syndrome compared with normal population (&minus;18.41 &plusmn; 2.20% vs. &minus;21.2 &plusmn; 2.1%, P &lt; 0.001). Segmental &epsilon;LL was significantly lower in patients with metabolic syndrome in comparison to control group except for basal anteroseptal (&minus;19.95 &plusmn; 2.90% vs. &minus;21.15 &plusmn; 3.30%, P = 0.106), basal anterolateral (&minus;17.5 &plusmn; 5.0% vs. &minus;18.3 &plusmn; 4.1%, P = 0.437), and basal inferolateral segments (&minus;18.1 &plusmn; 6.3% vs. &minus;18.9 &plusmn; 4.1%, P = 0.526). CONCLUSION: STE-derived longitudinal LV strain (&epsilon;LL), a marker of subclinical cardiovascular disease, is impaired in asymptomatic individuals with metabolic syndrome and normal LVEF. &nbsp;&nbsp;</div

The association of plasma high-sensitivity C-reactive protein level with rheumatic heart disease: The possible role of inflammation

Background: Currently, it is not clear whether recurrent traumatic events lead to progression of rheumatic heart disease (RHD) after the incident of acute rheumatic fever or a persistent inflammatory state at the site of the valves. The aim of this study was to assess the possible association between plasma high sensitive C Reactive Protein (hs-CRP) level as an indicator of inflammation and RHD. Materials & methods: Ninety patients with RHD and 90 healthy controls who had undergone complete echocardiographic examination were enrolled in this cross-sectional study. A score was given to each patient according to the severity of valvular involvement. Plasma hs-CRP level was checked for each patient by ELISA method twice with two-week interval, and the mean hs-CRP was calculated. Results: The mean plasma hs-CRP level in the case group was significantly higher compared to its level in the control group (2.59 ± 4.82 and 0.55 ± 0.43 in the case and control groups respectively, p < 0.001). There was also a strong association between the level of plasma hs-CRP and the severity of rheumatic valvular involvement (p < 0.001). Conclusion: The mean plasma hs-CRP level seems to have a significant association with RHD and its severity. Further studies are needed to determine the cause and effect relationship. Keywords: Rheumatic heart disease (RHD), hsCRP, Inflammatio

Evaluation of vascular graft infection following Bentall surgery using 18F‐FDG PET/CT scan: A pediatric case report

Key Clinical Message After a Bentall surgery, there is a small chance of developing a serious complication called vascular graft infection. 18F‐FDG PET/CT, a new and accurate diagnostic tool, can help detect it early, especially if the symptoms are unusual. Abstract A 14‐year‐old boy who had undergone Bentall surgery 1 year prior presented with symptoms of fever, chills, loss of appetite, and weight loss over the course of a month. The initial Bentall surgery was performed due to an aneurysm of the thoracic aorta, along with severe aortic valve insufficiency and moderate aortic valve stenosis. The patient was referred to the PET/CT department for evaluation of possible endarteritis or infection of Dacron graft, which had been reported in trans‐esophageal echocardiography as suspicious findings. Despite normal blood tests, blood cultures, and other imaging modalities, the 18F‐FDG PET/CT confirmed the diagnosis of vascular graft infection. This diagnostic tool allowed for timely and appropriate treatment and prevention of possible complications

Global Longitudinal Strain May Be the One that Appropriately Identifies Candidates of ICD Implantation

Hypertrophic cardiomyopathy (HCM) significantly contributes to an elevated risk of sudden cardiac death. Primary prevention is implemented by using an implantable cardioverter defibrillator (ICD). However, all of the HCM patients do not really need ICD therapy. Providing a superior index for ICD indication compared with the current indices like ejection fraction is essential to differentiate high-risk patients efficiently. The present study assessed the potential of global longitudinal strain (GLS) for the differentiation of HCM patients based on their need for ICD shocks. Patients with HCM were considered in four defined centers between March and June 2021. Those with previous ICD implantation or current candidates for ICD therapy were included in the study. Participants were subjected to speckle-tracking echocardiography, and GLS as well as some other echocardiographic parameters were recorded. Afterwards, data from implanted ICDs were extracted. Patients who received ICD shocks (appropriate) due to ventricular tachycardia (VT)/ventricular fibrillation (VF) were categorized in group A. The remaining patients were constituted group B who received inappropriate shocks, i.e., other than VT/VF. Overall, 34 patients were found eligible to participate with a mean age of 62 ± 16.1 years including 64.7% of males. Among a variety of echocardiographic parameters, GLS was the sole one that was significantly higher in group A compared with that in group B. Our findings revealed that only GLS could predict fatal arrhythmias. To substantiate, the odds of VT were raised by 43% with a single increase in GLS unit. GLS showed the highest accuracy for ICD indication among HCM patients and, therefore, could be a solid and early criterion to predict the incidence of life-threatening arrhythmias. In this regard, identifying appropriate HCM patients with respect to their need for ICD therapy is feasible