Never trust first impressions when assessing the heart of a pregnant woman

We describe the echocardiographic finding of a 35-year-old pregnant woman, referred for a clinical consultation at our institution because of congestive heart failure. She underwent echocardiography with only little information about a history of cardiac surgery during infancy. At the first sight, parasternal long axis view demonstrates normal structures, but on the apical view we diagnosed a very rare condition with typical imaging findings: Criss Cross heart

Nondipping pattern and carotid atherosclerosis : a systematic review and meta-analysis

Evidence on the association of nondipping pattern with carotid atherosclerosis is scarce. We performed a meta-analysis in order to provide comprehensive information on subclinical carotid alterations in nondipping as compared with dipping individuals. A computerized search was performed using PubMed, OVID, EMBASE and Cochrane library databases from 1 January 1990 up to 31 March 2015. Full articles providing data on carotid intima-media thickness (IMT) and plaque in nondipping and dipping individuals, as assessed by ultrasonography, were analyzed. A total of 2753 adult individuals (1003 nondipping and 1750 dipping) included in 13 studies were considered. Common carotid IMT was higher in nondipping than in dipping individuals [807 +/- 36m vs. 746 +/- 28m, standard means difference, SMD: 0.37 +/- 0.09, confidence interval (CI): 0.19-0.56, P<0.01]. From data on plaque prevalence provided by five studies, the odds ratio for carotid plaques resulted 67% higher in nondipping (95% CI: 1.26-2.21, P<0.01) than in dipping individuals. Our findings support an association between nondipping pattern and increased risk of subclinical carotid alterations. In a practical perspective, the present meta-analysis reinforces the view that an effective blood pressure control over the entire 24-h period, in particular at night, may prevent the progression of vascular damage associated with nondipping phenotype

Nocturnal Hypertension and Subclinical Cardiac and Carotid Damage : an Updated Review and Meta-Analysis of Echocardiographic Studies

Evidence on the association of nocturnal hypertension (NH) with subclinical cardiac and vascular damage is scanty. The authors performed a meta-analysis to provide comprehensive information on this clinically relevant issue. Full articles providing data on subclinical cardiac and carotid damage as assessed by ultrasonographic methods in patients with NH as compared with patients with nocturnal normotension (NN) were considered. A total of 3657 patients (NH=2083, NN=1574) of both sexes were included in seven studies. Left ventricular mass index was higher in individuals with NH than in those with NN (112\ub14.7 g/m(2) vs 98\ub14.8 g/m(2) ; standard mean difference [SMD], 0.54\ub10.16; confidence interval [CI], 0.23-0.85; P<.01). Similarly, common carotid intima-media thickness was greater in patients with NH than in those with NN (751\ub134 \u3bcm vs 653\ub114 \u3bcm; SMD, 0.44\ub10.08; CI, 0.29-0.59; P<.01). The present meta-analysis shows an association between NH pattern and increased likelihood of cardiac and carotid structural alterations

Association of metabolic syndrome with carotid thickening and plaque in the general population : A meta-analysis

We performed a meta-analysis of population studies reporting data on carotid intima-media thickness and plaque in patients with and without metabolic syndrome (MetS) to provide a new piece of information on the relationship of MetS with both phenotypes of vascular damage. The Ovid MEDLINE, PubMed, and Cochrane CENTRAL databases were searched without time restriction up to December 31, 2016. Overall, 19\uc2\ua0696 patients (22.2% with MetS) were included in eight studies. Common carotid intima-media thickness was greater in patients with MetS compared with those without it (788\uc2\ua0\uc2\ub1\uc2\ua047\uc2\ua0\uce\ubcm vs 727\uc2\ua0\uc2\ub1\uc2\ua044\uc2\ua0\uce\ubcm), with a standard means difference of 0.28\uc2\ua0\uc2\ub1\uc2\ua00.06 (P\uc2\ua0=.00003). Increased intima-media thickness in patients with MetS was paralleled by a higher prevalence of plaques. The present meta-analysis shows that MetS is associated with both ultrasonographic phenotypes of carotid damage. This finding is consistent with the view of MetS as a cluster of hemodynamic and nonhemodynamic factors promoting vascular hypertrophy and plaque

Metabolic syndrome and subclinical carotid damage : A meta-Analysis from population-based studies

Aim: Metabolic syndrome (MetS) is a phenotype of growing prevalence in the general population. Information on the association between MetS and vascular damage in this setting is only based on data provided by single reports. We performed a meta-Analysis of population-based studies aimed to assess the association of MetS with carotid atherosclerosis. Design: Studies were identified by the following search terms: 'metabolic syndrome', 'general population,' 'carotid intima-media thickness' (IMT), 'carotid atherosclerosis,' 'carotid damage,' 'ultrasonography.' The OVID-MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials databases were searched for English-language articles without time restriction up to 30 September 2016. Results: Overall, 34635 study participants (22.9% with MetS) of both sexes were included in 21 studies (sample size range 182-11502). Mean common carotid IMT was higher in MetS study participants as compared with their non-MetS counterparts (759\uc2\ub141 vs. 695\uc2\ub127\uce\ubcm), the standard means difference being 0.39\uc2\ub10.05 (confidence interval: 0.29-0.48, P<0.0001). This was also the case when pooled data were separately analysed according to sex. Differences in carotid IMT were unaffected by the presence of publication bias or single-study effect. Conclusion: Our findings support the view that MetS is a risk factor for early carotid atherosclerosis in members of the general population, regardless of sex. From a practical perspective, the ultrasound search of subclinical carotid disease may refine cardiovascular risk stratification and decision-making strategies in MetS individuals

Renal artery stenosis and left ventricular hypertrophy: An updated review and meta-analysis of echocardiographic studies

Aim: Data on left ventricular hypertrophy (LVH) in patients with renal artery stenosis (RAS) and its regression following renal revascularization are scanty. We performed a meta-analysis to provide comprehensive information on this clinically relevant issue. Methods: Full articles providing data on: LVH, as assessed by echocardiography, in RAS patients as compared with essential hypertensive counterparts; changes of left ventricular (LV) mass index after renal artery revascularization were considered. Results: A total of 905 study participants (RAS=446, essential hypertensive=459) of both sex were included in nine studies. Pooled LV mass index was higher in RAS than in essential hypertensive patients (140.4\uc2\ub111.1g/m 2 versus 121.8\uc2\ub16.2g/m 2, standard mean difference being 0.41\uc2\ub10.07 [95% confidence interval (CI) 0.27-0.51, P<0.001]. Among 360 RAS patients undergone renal revascularization from eight studies, baseline and post-intervention pooled mean LV mass index values were 129.0\uc2\ub110.2g/m 2 and 115.5\uc2\ub19.9g/m 2, respectively, the standard mean difference being-0.36\uc2\ub10.06 (95% CI from -0.47 to -0.25, P<0.001). These findings were unaffected by publication bias or single study effect. Conclusion: Our meta-analysis indicates that RAS patients have an increased likelihood of LVH compared with essential hypertensive counterparts and renal artery revascularization has a beneficial effect on LV structure, as reflected by a significant decrease in LV mass index

Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring : an updated review

Reverse or inverted dipping (ie, the phenomenon characterized by higher nighttime compared with daytime blood pressure values) is an alteration of circadian blood pressure rhythm frequently documented in hypertension, type 2 diabetes mellitus, chronic kidney disease, and sleep apnea syndrome, and generally regarded as a harmful condition. Available literature on the clinical and prognostic implications of reverse dipping is scanty. The present article will review a number of relevant issues concerning reverse dipping, in particular: (1) its possible mechanisms; (2) prevalence and clinical correlates, (3) concomitant cardiac and extracardiac subclinical organ damage; (4) association with acute and chronic cardiovascular diseases; (5) prognostic value in predicting cardiovascular events and mortality; and (6) therapeutic interventions aimed at reverting this abnormal circadian blood pressure rhythm

Coronary-specific quantification of myocardial deformation by strain echocardiography may disclose the culprit vessel in patients with non-ST-segment elevation acute coronary syndrome

Aims To compare the diagnostic accuracy of speckle tracking echocardiography technique using territorial longitudinal strain (TLS) for the detection of culprit vessel vs. vessel-specific wall motion score index (WMSI) in non-ST-segment elevation–acute coronary syndrome (NSTE-ACS) patients scheduled for invasive coronary angiography (ICA). Methods and results One hundred and eighty-three patients (mean age: 66 ± 12 years, male: 71%) diagnosed with NSTE-ACS underwent echocardiography evaluation at hospital admission and ICA within 24 h. Culprit vessels were left anterior descending (LAD), left circumflex (CX), and right coronary arteries (RCAs) in 38.5%, 39.6%, and 21.4%, respectively. An increase of affected vessels [1-, 2-, and 3-vessel coronary artery disease (CAD)] was associated with increased WMSI and TLS values. There was a statistically significant difference of both WMSI-LAD, WMSI-CX, WMSI-RCA and TLS-LAD, TLS-CX, TLS-RCA of myocardial segments with underlying severe CAD compared to no CAD (P = 0.001 and P &lt; 0.001, respectively). Moreover, a significant difference of TLS-LAD, TLS-CX, TLS-RCA, and WMSI-CX of myocardial segments with an underlying culprit vessel compared to non-culprit vessels (P &lt; 0.001, P &lt; 0.001, P = 0.022, and P &lt; 0.001, respectively) was identified. WMSI-LAD and WMSI-RCA did not show statistical significant differences. A regression model revealed that the combination of WMSI þ TLS was more accurate compared to WMSI alone in detecting the culprit vessel (LAD, P = 0.001; CX, P &lt; 0.001; and RCA, P = 0.019). Conclusion Territorial longitudinal strain allows an accurate identification of the culprit vessel in NSTE-ACS patients. In addition to WMSI, TLS may be considered as part of routine echocardiography for better clinical assessment in this subset of patients