Diclofenac for reversal of right ventricular dysfunction in acute normotensive pulmonary embolism: A pilot study

Background The inflammatory response associated with acute pulmonary embolism (PE) contributes to the development of right ventricular (RV) dysfunction. Nonsteroidal anti-inflammatory drugs (NSAIDs) may facilitate the reversal of PE-associated RV dysfunction. Methods We randomly assigned normotensive patients who had acute PE associated with echocardiographic RV dysfunction and normal systemic blood pressure to receive intravenous (IV) diclofenac (two doses of 75 mg in the first 24 h after diagnosis) or IV placebo. All patients received standard anticoagulation with subcutaneous low-molecular-weight heparin (LMWH) and an oral vitamin K antagonist. RV dysfunction was defined by the presence of, at least, two of the following criteria: i) RV diastolic diameter > 30 mm in the parasternal window; ii) RV diameter > left ventricle diameter in the apical or subcostal space; iii) RV free wall hypokinesis; and iv) estimated pulmonary artery systolic pressure > 30 mm Hg. Persistence of RV dysfunction at 48 h and 7 days after randomization were the primary and secondary efficacy outcomes, respectively. The primary safety outcome was major bleeding within 7 days after randomization. Results Of the 34 patients randomly assigned to diclofenac or placebo, the intention-to-treat analysis showed persistent RV dysfunction at 48 h in 59% (95% confidence interval [CI], 33–82%) of the diclofenac group and in 76% (95% CI, 50–93%) of the placebo group (difference in risk [diclofenac minus standard anticoagulation], − 17 percentage points; 95% CI, − 47 to 17). Similar proportions (35%) of patients in the diclofenac and placebo groups had persistent RV dysfunction at 7 days. Major bleeding occurred in none of patients in the diclofenac group and in 5.9% (95% CI, 0.2–29%) of patient in the placebo group. Conclusions Due to slow recruitment, our study is inconclusive as to a potential benefit of diclofenac over placebo to reverse RV dysfunction in normotensive patients with acute PE

Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement

Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become a widespread technique for patients with severe AS considered inoperable or high risk for traditional open-surgery. This procedure could have a positive impact in LV mechanics. The aim of this study was to evaluate the immediate effect of TAVR on LV function recovery, as assessed by myocardial deformation parameters. Methods: One-hundred twelve consecutive patients (81.4 ± 6.4 years, 50% female) from 10 centres in Europe with severe AS who successfully underwent TAVR with either a self-expanding CoreValve (Medtronic, Minneapolis, MN) or a mechanically expanded Lotus valve (Boston Scientific, Natick, MA) were enrolled in a prospective multi-center study. A complete echocardiographic examination was performed at baseline and immediately before discharge, including the assessment of LV strain using standard two-dimensional images. Results: Echocardiographic examination with global longitudinal strain (GLS) quantification could be obtained in 92 patients, because of echocardiographic and logistic reasons. Between examinations, a modest statistically significant improvement in GLS could be seen (GLS% –15.00 ± 4.80 at baseline;–16.15 ± 4.97 at discharge, p = 0.028). In a stratified analysis, only women showed a significant improvement in GLS and a trend towards greater improvement in GLS according to severity of systolic dysfunction as measured by LV ejection fraction could be noted. Conclusions: Immediate improvement in GLS was appreciated after TAVR procedure. Whether this finding continues to be noted in a more prolonged follow-up and its clinical implications need to be assessed in further studies

Four chamber right ventricular longitudinal strain versus right free wall longitudinal strain. Prognostic value in patients with left heart disease

Background: There is no consensus on which right ventricle (RV) strain parameter should be used in the clinical practice: four chamber RV longitudinal strain (4CH RV-LS) or free wall longitudinal strain (FWLS). The aim of this study was to analyze which RV strain parameter better predicts prognosis in patients with left heart disease. Methods: One hundred and three outpatients with several degrees of functional tricuspid regurgitation severity secondary to left heart disease were prospectively included. 4CH RV-LS and FWLS were assessed using speckle tracking. Left ventricular (LV) systolic function was determined using LV ejection fraction and RV systolic function using tricuspid annular plane systolic excursion (TAPSE). Patients were followed up for 23.1 ± 12.4 months for an endpoint of cardiac hospitalization due to heart failure. Results: The cutoff value related to RV dysfunction (TAPSE < 17 mm) was lower, in absolute value, for 4CH RV-LS (4CH RV-LS = –17.3%; FWLS = –19.5%). There were 33 adverse events during the follow-up. Patients with 4CH RV-LS > –17.3% (log rank [LR] = 22.033; p < 0.001); FWLS > –19.5% (LR = 12.2; p < 0.001), TAPSE < 17 mm (LR = 17.4; p < 0.001) and LV systolic dysfunction (LR = 13.3; p < 0.001) had lower event-free survival (Kaplan Meier). In Cox multivariate analysis, 4CH RV-LS > –17.3% (hazard ratio [HR] = 3.593; p < 0.002), TAPSE < 17 (HR = 2.093; p < 0.055) and LV systolic dysfunction (HR = 2.087; p < 0,054) had prognostic value, whereas FWLS did not reach significance. Conclusions: Although both 4CH RV-LS and FWLS have prognostic value, 4CH RV-LS is a better predictor of episodes of heart failure in patients with left heart disease, providing additional information to that obtained by TAPSE.

Mecánica ventricular mediante resonancia magnética cardiaca como determinante pronóstico en pacientes con insuficiencia aórtica y pacientes con miocardiopatía hipertrófica

Introducción y objetivo. La función ventricular izquierda, evaluada mediante la fracción de eyección (FEVI) es el determinante pronóstico más importante en las distintas cardiopatías. La deformación miocárdica detecta precozmente el daño miocárdico antes de que se deteriore la FEVI y parece tener implicaciones en el diagnostico y pronostico de los pacientes. El objetivo principal del trabajo fue evaluar la utilidad pronóstica de los parámetros de deformación miocárdica mediante resonancia magnética cardiaca (RMC) en pacientes con insuficiencia aortica (IAO) significativa y pacientes con miocardiopatía hipertrófica (MH), en ambos casos con FEVI normal. Métodos y resultados. Se incluyeron 55 pacientes con IAO significativa y 74 pacientes con diagnóstico de MH. Los resultados se compararon con un grupo control (54 y 75 respectivamente). En ambos grupos, los parámetros de strain fueron predictores independientes de eventos con un punto de corte para el strain longitudinal global de -16% y 13,4%, strain circunferencial global -17% y -13,4% y strain radial global de 33% y 18% respectivamente. La prevalencia de un strain alterado en pacientes con IAO grado IV frente a grado II fue del 53% vs 25% para el strain longitudinal, 47% vs 31% para el strain circunferencial y 47% vs 18% para el strain radial global. En los pacientes con MH, la fibrosis y la masa ventricular fueron determinantes de un strain atenuado con los siguientes puntos de corte: 8% y 82 g/m2 para el strain longitudinal, 8,5% y 84 g/m2 para el strain circunferencial y 7,5 % para el RTG y del 93 g/m2 para el radial. Conclusiones. Las alteraciones en los parámetros de deformación miocárdica mediante RMC-FT están alterados en pacientes con IAO y MH con FEVI normal y se asocian de manera independiente a una mayor tasa de eventos en el seguimiento y a mayor gravedad de la enfermeda

Primary intrapericardialthymoma stage iv. From a rare case presentation to the relevance of an optimal surgical treatment

El timoma es el tumor de mediastino anterior más frecuente. En relación con su emplazamiento, los timomas se ubican principalmente en el mediastino anterior (90%), localización habitual de la glándula tímica. Además de esta presentación ortotópica, los timomas ectópicos pueden encontrarse de forma primaria en otros emplazamientos anatómicos, como mediastino medio y posterior, cuello, base del cráneo, parénquima pulmonar, cavidad pleural, etc. Muy raramente, los timomas aparecen de forma primaria en pericardio. Debido a lo inusual de su presentación, diagnóstico y tratamiento, reportamos un caso de timoma primario intrapericárdico estadio iv y su evolución tras tratamiento combinado, en relación con la bibliografía existente hasta el momento. En este sentido, los pacientes sometidos a tratamiento quirúrgico con resección completa o subtotal del tumor presentan los mejores niveles de supervivencia. Por lo tanto, el tratamiento quirúrgico debe plantearse en la mayor parte de los pacientes, incluso si su objetivo principal es exclusivamente citorreductor. Este hecho permite aumentar de forma clara la calidad de vida de los pacientes, haciendo posible la utilización de medidas de tratamiento complementario de una manera más efectiva. Destacamos que la resonancia magnética cardiaca y las actuales técnicas videotoracoscópicas resultan de especial utilidad para la planificación minuciosa del procedimiento quirúrgico.Thymoma is the most common tumor of the anterior mediastinum. They are mainly located in the anterior mediastinum (90%), because it is the usual location of the thymic gland. Besides this orthotopic presentation, primary ectopic thymoma can be found in other anatomical sites, including middle and posterior mediastinum, neck, skull base, lung parenchyma, pleural cavity, etc. Very rarely, thymomas appear primary in pericardium. Due to its unusual presentation, diagnosis and treatment, we report a case of primary intrapericardialthymoma, stage iv, and its evolution after combined treatment, in relation to the literature. Thus, patients undergoing surgical treatment with complete or subtotal tumor resection have the best survival rates. Therefore, surgical treatment must be considered in most patients, even if the main goal is only reduce the tumoral mass. This fact allows to increase the quality of life of patients, making possible the use of coadjuvant treatment. We note that Cardiac Magnetic Resonance and current video-thoracoscopic techniques are particularly useful for the detailed planning of the surgical procedure.0.119 SJR (2015) Q4, 283/337 Cardiology and cardiovascular medicine, 327/374 SurgeryUE

Dataset for the study of the effect of anticoagulation in the incidence of stroke and other outcomes in patients with left ventricular thrombus

The optimal duration of anticoagulation in patients with left ventricular thrombus (LVT) is unknown. The data package herein presented contains the information used to assess the effect of duration of anticoagulation in the incidence of stroke in patients with left ventricular thrombus (LVT) in a tertiary hospital. In order to collect the required data, all transthoracic echocardiography studies at our institution from January 1st 2014 to December 31st 2021 with LVT were retrieved using dedicated software (Phillips Intellispace Cardiovascular; Koninklijke Phillips N.V., 2004-2020). Second, a dataset was designed ad hoc for this study in which the recruited data for the predefined objectives were obtained from electronic medical records. These data included clinical and demographic information including treatment choices (vitamin K antagonists [VKA] versus direct oral anticoagulants [DOAC]), duration of treatment, reason for interruption of treatment, occurrence of stroke, acute myocardial infarction, bleeding events, thrombus resolution, recurrence, and death. Retrieved data were stored in an excel sheet for analysis using the statistical package STATA (StataCorp v. 15.0, College station, TX). This methodology allows the reuse of these data for further analysis, in the context of the present study and also for future recruitment of additional patients from other institutions to increase statistical power