Incidence of cerebral ischemic events in patients with atrial septal aneurysm

Atrial septal aneurysm (ASA) is a localized saccular deformity, generally at the level of fossa ovalis, which protrudes to the right or left atrium, or both. A possible relationship between ASA and cerebral ischemic events have been suggested in retrospective and case-control studies. The purpose of this study was to determine the embolic potential of ASA by following-up patients with this abnormality. Of the 2319 consecutive patients undergoing transesophageal echocardiogaphy (TEE) for various indications, we identified 65 (2.8%) patients with ASA. Forty-four of these who were in sinus rhythm and were contactable were followed-up prospectively for 2.3 years. Their mean age was 43.8 years. During the follow-up of 101.6 patient-years, one patient had a transient ischemic attack (TIA), whereas none of the patients suffered a stroke or other systemic thromboembolism. The patient who had the TIA had primary pulmonary hypertension, enlargement of the right heart chambers and a bidirectional and very mobile ASA, and an intact interatrial septum. She had no history of a previous cerebrovascular accident. As a result, the yearly incidence of a cerebral ischemic event was about 1% in our hospital based cohort. We conclude that ASA found on TEE may be associated with TIA and embolic stroke, but the risk seems to be low

Noncompaction cardiomyopathy and dextroversion of the heart

The prevalence of patients with noncompaction is reported to be 0.014% on echocardiographic examination. The estimated incidence of dextroversion (dextrocardia with isolated reversal of the heart with normally positioned visceral organs) is 1:2,800, while the real incidence of dextroversion and left ventricular noncompaction is still not known; to our knowledge only two cases have been reported in the literature. Noncompaction can generally be diagnosed using echocardiography; however, in the case reported here cardiac magnetic resonance imaging was important for the definitive diagnosis of dextroversion and noncompaction, because no adequate echocardiographic images could be obtained

Procalcitonin and C-reactive protein in infective endocarditis: Correlation with etiology and prognosis

Background. The aim of this study was to investigate the diagnostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in infective endocarditis (IE) and to correlate them with the etiology of the disease and the prognosis of the patients. Methods: Fifty patients who were diagnosed as having IE based on Duke criteria (major and/or minor) were included in the study at the Istanbul University Cardiology Institute and Florence Nightingale Hospital. Forty patients with bacteremia (non-IE) and 50 healthy blood donors were also included in the study as the control group. During the 45 days of medical follow-up, in those patients who had a response to medical therapy based on the results of left ventricular function tests, transesophageal echocardiography (TEE) and culture, among other factors, PCT and CRP levels were measured in 5-cm(3) blood samples obtained without anticoagulant when they were first admitted (day 0), as well as 24 h and 15, 30 and 45 days after admission. In the patients who had valve replacement, 5-cm(3) blood samples without anticoagulant were similarly obtained on the day of admission, after 24 h and/or on the 15th day, and 1 day before and on the 2nd and 5th days after the operation. Results: In this study, a significant difference (p 0.05). The sensitivity of PCT in comparison to CRP was found to be lower (84 vs. 100%); however, its specificity was determined to be higher (88 vs. 72%). The median values of serum PCT in the nonoperated and operated cases at the time of admission, after 24 h and on the 15th day were 3.71, 5.35 and 0.44, and 2.45, 4.28 and 4.22 ng/ml, respectively, and those of CRP were 9.30, 10.95 and 10.65, and 9.5, 10.9 and 10.2 mg/dl, respectively. The median values of serum PCT were found to be higher in cases with IE and non-IE related to gram-negative bacteria than those related to gram-positive bacteria (p 0.05). Conclusions: As a result, this study suggests that in the diagnosis of IE, it would be beneficial to use PCT, besides TEE, culture and other clinical criteria, for its high specificity and positive predictive value in comparison to CRP. This study also suggests that in determining the response to medical treatment in the follow-up period, PCT could be a more valuable parameter than CRP, as PCT has a high prognostic value and is a good indicator for valve replacement in addition to the major criteria. Furthermore, serum PCT levels may help the physician to decide on the antimicrobial therapy combination before obtaining the culture results, or in situations in which the agent could not be isolated yet. Copyright (C) 2003 S. Karger AG, Basel