Local Thrombolysis for Successful Treatment of Acute Stroke in an Adolescent with Cardiac Myxoma

Intracardiac myxomas are the most common benign cardiac tumors in adults. They are a rare source of cardiogenic embolisms and sudden death, especially in young patients. This report describes the case of a male adolescent who presented with right-sided paresis and aphasia. Magnetic resonance imaging of the brain revealed an ischemic stroke without evidence of acute bleeding. Intra-arterial local thrombolysis was immediately started. An echocardiographic screening after successful thrombolysis with a remarkable recovery of symptoms detected a thrombotic-like mass in the left atrium. The mass was excised surgically, confirmed as a benign atrial myxoma, and the patient was discharged with restitution ad integrum. Thus, contrary to some critical reports, thrombolytic therapy for acute ischemic strokes due to atrial myxomas may be safe and highly effective

Accuracy of Doppler-Echocardiographic Mean Pulmonary Artery Pressure for Diagnosis of Pulmonary Hypertension

Background: The validity of Doppler echocardiographic (DE) measurement of systolic pulmonary artery pressure (sPAP) has been questioned. Recent studies suggest that mean pulmonary artery pressure (mPAP) might reflect more accurately the invasive pressures. Methodology/Principal Findings: 241 patients were prospectively studied to evaluate the diagnostic accuracy of mPAP for the diagnosis of PH. Right heart catheterization (RHC) and DE were performed in 164 patients mainly for preoperative evaluation of heart valve dysfunction. The correlation between DE and RHC was better when mPAP (r = 0.93) and not sPAP (r = 0.81) was assessed. Bland-Altman analysis revealed a smaller variation of mPAP than sPAP. The following ROC analysis identified that a mPAP$25.5 mmHg is useful for the diagnosis of PH. This value was validated in an independent cohort of patients (n = 50) with the suspicion of chronic-thromboembolic pulmonary hypertension. The calculated diagnostic accuracy was 98%, based on excellent sensitivity of 98 % and specificity of 100%. The corresponding positive and negative predictive values were 100%, respectively 88%. Conclusion: mPAP has been found to be highly accurate for the initial diagnosis of PH. A cut-off value of 25.5 mmHg might be helpful to avoid unnecessary RHC and select patients in whom RHC might be beneficial

Diagnostic accuracy of NT-proBNP ratio (BNP-R) for early diagnosis of tachycardia-mediated cardiomyopathy: a pilot study

Background When heart failure and tachycardia occur simultaneously, a useful diagnostic tool for early discrimination of patients with benign tachycardia-mediated cardiomyopathy (TMC) versus major structural heart disease (MSHD) is not available. Such a tool is required to prevent unnecessary and wearing diagnostics in patients with reversible TMC. Moreover, it could lead to early additional diagnostics and therapeutic approaches in patients with MSHD. Methods A total of 387 consecutive patients with supraventricular arrhythmia underwent assessment at a single center. Of these patients, 40 fulfilled the inclusion criteria with a resting heart rate >= 100 bpm and an impaired left ventricular ejection fraction = 2.3 was useful for TMC diagnosis indicated by an accuracy of 90%, sensitivity of 84% and specificity of 95%. Conclusion BNP-R was found to be highly accurate for the early diagnosis of TMC

Characteristics of 164 patients and indications for RHC.

<p>BMI indicates body mass index (kg/m²), RHC indicates right heart catheterization.</p

Study flowchart in accordance to the STARD criteria.

<p>In phase 0 diagnostic criteria were evaluated in 164 patients undergoing DE and RHC. In phase 1 the calculated cut-off value for mPAP was validated in a cohort of patients with the suspicion of PH.</p

Analysis of relative differences and ROC analysis of mPAP for diagnosis of PH.

<p>A, the relative positive and negative deviation between DE and RHC were larger for sPAP than mPAP. B, ROC analysis reveal an excellent diagnostic accuracy of mPAP for the diagnosis of PH with an area under the curve (AUC) of 0.95.</p

DE versus RHC correlations.

<p>DE mPAP (B) was better correlated with RHC than sPAP (A). Dotted lines mark virtual best correlation of 1 and solid lines mark the real correlation. r indicates the correlation coefficient, sPAP indicates systolic pulmonary artery pressure.</p

Randomized Control of Sympathetic Drive With Continuous Intravenous Esmolol in Patients With Acute ST-Segment Elevation Myocardial Infarction The BEtA-Blocker Therapy in Acute Myocardial Infarction (BEAT-AMI) Trial

OBJECTIVES This study sought to evaluate the role of esmolol-induced tight sympathetic control in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND Elevated sympathetic drive has a detrimental effect on patients with acute STEMI. The effect of beta-blocker-induced heart rate mediated sympathetic control on myocardial damage is unknown. METHODS The authors conducted a prospective, randomized, single-blind trial involving patients with STEMI and successful percutaneous intervention (Killip class I and II). Patients were randomly allocated to heart rate control with intravenous esmolol for 24 h or placebo. The primary outcome was the maximum change in troponin T release as a prognostic surrogate marker for myocardial damage. A total of 101 patients were enrolled in the study