Cardiac tumors: echo assessment

Cardiac tumors are exceedingly rare (0.001–0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses

Non-Invasive Cardiovascular Imaging for Cardiovascular Risk Assessment in Rheumatoid Arthritis

People with rheumatoid arthritis (RA) are often under-recognised as a group with elevated risk of cardiovascular (CV) disease and increased morbidity from CV events. Standard clinical risk assessment tools, which take into account traditional CV risk factors such as smoking, diabetes, hypertension, hyperlipidaemia, and family history do not accurately predict CV risk in patients with autoimmune rheumatic disorders; therefore, there is an unmet need for other methods to assess their risk. Non-invasive CV imaging is evolving as a novel clinical tool to determine subclinical atherosclerotic coronary artery disease in patients with RA. Non-invasive imaging studies, such as tests of endothelial function (i.e. reactive hyperaemia index and flow-mediated dilation) and arterial stiffness (i.e. pulse-wave velocity), have been identified as a potential means for providing accurate assessment of early CV risk in the general population and are evolving in their utility for patients with RA. These types of non-invasive imaging have the potential to eliminate the current use of invasive assessments for identification of precursors to coronary artery disease, such as coronary angiography for early endothelial cell dysfunction. By combining the expertise of subspecialists in cardio-rheumatology clinics, the expectation is to pre-emptively identify RA patients with early coronary artery disease, allowing early modification of risk factors through either medical management or lifestyle modification

Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis

Background—Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. Methods and Results—We prospectively performed multidetector computed tomography in 665 patients with AS (aortic valve area, 1.05±0.35 cm2; mean gradient, 39±19 mm Hg) to measure AVC and to assess the impact of sex on the AVC–AS severity link in men and women. AS severity was comparable between women and men (peak aortic jet velocity: 4.05±0.99 versus 3.93±0.91 m/s, P=0.11; aortic valve area index: 0.55±0.20 versus 0.56±0.18 cm2/m2; P=0.46). Conversely, AVC load was lower in women versus men (1703±1321 versus 2694±1628 arbitrary units; P0.67; P<0.0001), for any level of AS severity measured by peak aortic jet velocity or aortic valve area index, AVC load, absolute or indexed, was higher in men versus women (all P=0.01). Conclusions—In this large AS population, women incurred similar AS severity than men for lower AVC loads, even after indexing for their smaller body size. Hence, the relationship between valvular calcification process and AS severity differs in women and men, warranting further pathophysiological inquiry. For AS severity diagnostic purposes, interpretation of AVC load should be different in men and in women