Cardiac Tumors

Cardiac tumors represent a relatively rare, yet challenging diagnosis. Secondary tumors are far more frequent than primary tumors of the heart. The majority of primary cardiac tumors is benign in origin, with primary malignant tumors accounting for 25% of cases. Metastatic tumors usually arise from lung, breast, renal cancer, melanomas, and lymphomas. Clinical manifestations of cardiac tumors depend on the size and location of the mass and the infiltration of adjacent tissues rather than the type of the tumor itself. Echocardiography is the main diagnostic tool for the detection of a cardiac mass. Other imaging modalities (C-MRI, C-CT, 3D Echo) may offer further diagnostic information and the establishment of the diagnosis is made with histological examination. Management depends on the type of the tumor and the symptomatology of the patient

Spontaneous Dissection of Right Coronary Artery Manifested with Acute Myocardial Infarction

Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention

The Left Atrium: From the Research Laboratory to the Clinic

Studies of left atrial (LA) function, until the latter part of the 20th century, were mostly limited to experimental animal models and to studies related to clinical research in the cardiac catheterization laboratory. For this reason, LA function has received considerably less attention than left ventricular (LV) functions, even though evidence suggests that LA myopathy and failure may exist as an isolated entity, precede and/or coexist with LV myopathy. The introduction of echocardiography and Doppler echocardiography in clinical practice has contributed significantly to our understanding of LA function and its interrelationships with the LV, aorta, pulmonary artery and other parts of the cardiovascular system. In addition, LA with the secretion of atrial natriuretic peptides is playing an important role in cardiovascular and neurohumoral homeostasis. Today, it is well known that LA structural and functional abnormalities that are present in many diseases and disorders constitute a powerful prognostic indicator. As technology (echocardiography, magnetic resonance imaging, computed tomography and others) continues to evolve, it is expected that, in the near future, LA structure and function will be routinely used as LV function is used today. (C) 2014 S. Karger AG, Base

Multimarker approach in cardiovascular risk prediction

Various biomarkers express different pathways and pathophysiologic mechanisms of cardiovascular disease, such as inflammation, oxidative stress, myocardial injury, activation of the neurohormonal pathways, myocardial stress and renal function. Current thinking supports the notion that the combination of these biomarkers could increase their diagnostic and prognostic value. The multimarker approach offers benefits since it increases the diagnostic and prognostic information and may help in the design of a strategy for prevention or management of cardiovascular diseases. The purpose of the current review is to describe the characteristics of promising biomarkers which have shown an important additive value in the assessment of cardiovascular risk. Also, an extended reference is made regarding studies that address the prognostic value of multimarker models in the settings of primary prevention of cardiovascular disease and secondary prevention for patients with acute coronary syndromes, chronic coronary artery disease and heart failure

Dobutamine-induced changes of left atrial two-dimensional deformation predict clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensated chronic heart failure

Background: We investigated whether dobutamine-induced changes of the left atrial ( LA) two-dimensional speckle tracking parameters are related to clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensate chronic heart failure (ADCHF). Methods: Forty-six patients with ADCHF and LV ejection fraction <35%, were studied using dobutamine stress echocardiography before a 24-hour infusion of levosimendan. In a multivariable model, we included: dobutamine-induced LV contractile reserve, change (%) of LA volume, LV longitudinal strain rate and LA speckle tracking parameters to assess the improvement of NYHA class, 6-min walk distance and brain natriuretic peptide (BNP). Results: The change (%) of LA-contractile strain and LV longitudinal stain rate were independent determinants of improvement of NYHA class, and BNP and increase in the 6-min walk test distance (b=-0.59, b=-0.65, b=0.41, and b=-0.44, b=-0.40, b=0.60, respectively, p<0.05). The addition of LA-contractile strain change in the multivariable analysis including LV longitudinal stain rate change increased the value of the model from r(2)=0.46 to 0.58 for NYHA improvement and from r(2)=0.44 to 0.70, for the BNP reduction and from r(2)=0.49 to 0.60, for increase in the 6-min walk test distance (p<0.05). The change (%) of LA-reservoir strain was univariate determinant for increase in the 6-min walk test distance (b=-0.37, p=0.02) and increased the value of the multivariate model from r(2)= 0.46 to 0.58, p=0.02. Conclusion: In patients with ADCHF, left atrial two-dimensional speckle tracking parameters in addition to LV longitudinal strain rate may detect those patients who are prone to improve after levosimendan treatment. (c) 2010 Elsevier Ireland Ltd. All rights reserved

Ventricular long-axis contraction as an earlier predictor of outcome in asymptomatic aortic regurgitation

The long-term prognostic significance of left ventricular (LV) long-axis contraction was investigated prospectively in 65 consecutive patients aged 58 +/- 15 years with asymptomatic aortic regurgitation, normal LV ejection fraction at rest, and no coronary artery or aortic root disease. A complete transthoracic echocardiographic study was performed at baseline and 12 months later. In 24 of 65 patients with peak systolic wave velocity at the lateral mitral annulus (LatS) <9 cm/s, LV diameter (p <0.01), volume (p <= 0.01), mass (p <0.001), and end-systolic wall stress (p <0.001) significantly increased after 12 months, whereas LV shortening and ejection fraction (p = 0.001) and tissue Doppler right ventricular peak systolic wave velocity (p <0.05) decreased significantly. In patients with peak systolic wave velocity at the lateral mitral annulus 2:9 cm/s, none of these parameters was significantly affected during follow-up. Aortic valve replacement was performed in 6 of 24 patients (25%) with peak systolic wave velocity at the lateral mitral annulus <9 cm/s and none with peak systolic wave velocity at the lateral mitral annulus 2:9 cm/s. In patients with peak systolic wave velocity at the lateral mitral annulus <9 cm/s, a cut-off value of 6.25 cm/s predicted aortic valve replacement within the next year with 97% sensitivity and 83% specificity. In conclusion, ventricular long-axis contraction seems to be a reliable indicator for outcome prediction in patients with asymptomatic aortic regurgitation. (c) 2007 Elsevier Inc. All rights reserved

Dilated Cardiomyopathy as the Predominant Feature of Cushing's Syndrome

Cushing’s syndrome, resulting from exposure to excessive amounts of circulating glucocorticoids, is accompanied with a high mortality risk mostly due to the cardiovascular complications. Cardiac involvement is mainly associated with left ventricular hypertrophy. We report the case of a patient who presented with dilated cardiomyopathy as the predominant feature Of Cushing’s syndrome, which was fully reversed after proper Surgical treatment