Left ventricular thrombus mimicking primary cardiac tumor in a patient with primary antiphospholipid syndrome and recurrent systemic embolism

Primary antiphospholipid syndrome (APS) is a well-defined entity characterized by spontaneous and recurrent abortion, thrombocytopenia and recurrent vascular thromboses (arterial and venous). Left ventricular thrombus mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. In this report we describe a 39 year-old man admitted to hospital presenting with left hemiparesis and a peripheral embolism. He had no history of thrombotic events. Transthoracic echocardiography showed a large, polypoid and mobile mass (4.0 × 1.2 cm) attached to the apex of the left ventricle, highly suggestive of primary cardiac tumor. The patient subsequently underwent open heart surgery. The histological examination showed an older thrombus and a fresh thrombus. Post-operative laboratory tests showed lupus anticoagulant activity, confirming the primary APS diagnosis. The patient initiated treatment with oral anticoagulation (INR levels between 2 and 3) and was discharged 29 days after surgery. At ten month follow-up, he was symptom-free with long-term anticoagulation therapy. No evidence of intracardiac mass recurrence on two-dimensional echocardiography was seen. Intracardiac thrombus has been rarely reported as a complication of primary APS. Left ventricular mass mimicking primary cardiac tumor with recurrent systemic embolism has not been previously reported. Pre-operative investigations could not distinguish such a thrombus from a cardiac tumor and the diagnosis was made post-operatively

Early detection of left ventricular diastolic dysfunction in Chagas' disease

BACKGROUND: Chagas' disease may cause left ventricular diastolic dysfunction and its early detection in asymptomatic patients would allow to stratify the risk and to optimize medical treatment. The aim of this study is to investigate if transmitral Doppler flow can detect early abnormalities of the diastolic left ventricular function in patients during the indeterminate phase of Chagas' disease, in which the electrocardiogram (ECG), chest x-ray and 2-D echocardiogram (2D-echo) are normal. METHODS: a group of 54 patients with Chagas' disease was studied and compared to a control group of 27 subjects of similar age. All were assessed with an ECG, chest X-ray, 2-D echo, and transmitral Doppler flow. RESULTS: both groups had similar values in the 2D-echo. In patients with Chagas' disease, the transmitral Doppler showed a higher peak A velocity (control group: 0.44 m/sec, Chagas group: 0.55 m/sec, p = 0.001), a lower E/A ratio (control group: 1.45, Chagas group: 1.22, p < 0.05), and a lengthening of the deceleration time of early diastolic filling (control: 138.7 ± 26.8 msec, Chagas group: 167.9 ± 34.6 msec, p = 001), thus revealing an early disorder of the diastolic left ventricular function in patients with Chagas' disease. CONCLUSION: in patients with Chagas' disease who are in the indeterminate phase, transmitral Doppler flow allowed to identify early abnormalities of the left ventricular diastolic function, which provide useful clinical information for prognostic stratification and treatment

Two-Dimensional Speckle Tracking Echocardiography for Early Detection of Myocardial Damage in Young Patients with Fabry Disease

Fabry disease (FD) is characterized by left ventricular hypertrophy (LVH). Conventional echocardiography is not sensitive enough to perform the preclinical diagnosis To assess whether longitudinal myocardial strain of the left ventricle (LV), using speckle tracking, is useful to detect early myocardial involvement in FD. Forty‐four patients with FD who were diagnosed with genetic testing were prospectively included and were compared to a sex‐matched control group. They were divided into three groups: 22 with LVH (Group I), 22 without LVH (Group II), and 22 healthy volunteers (Group III). LV longitudinal strain was measured from the apical views. An ANOVA test was used for multiple comparisons for variables with a normal distribution, and a Kruskal–Wallis test was used for variables with non‐Gaussian distribution. Longitudinal LV strain was different in the three groups: it was ≥−15% in at least one segment in all Group I patients, in 50% of patients of Group II and in no patient of Group III. Seventy percent of the segments with abnormal strain in Group II were located in the basal regions (32/46). These findings show that the presence of at least one strain value ≥−15% demonstrates subclinical myocardial dysfunction in patients with preclinical FD. Longitudinal myocardial LV strain measured with speckle tracking is a useful tool to detect early myocardial involvement in young patients with FD. This information allows the detection and treatment of myocardial dysfunction at an early stage, which is of high clinical importance.Fil: Saccheri, María C.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Cianciulli, Tomás F.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Lax, Jorge A.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Gagliargi, Juan A.. Ministerio de Defensa. Ejército Argentino. Hospital Militar Central Cirujano Mayor "Dr. Cosme Argerich"; ArgentinaFil: Caceres, Guillermo L.. Centro para la Enfermedad de Fabry; ArgentinaFil: Quarin, Alejandra E.. Centro para la Enfermedad de Fabry; ArgentinaFil: Kisinovsky, Issac. Centro para la Enfermedad de Fabry; ArgentinaFil: Rozenfeld, Paula Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Ciencias Biológicas. Laboratorio de Investigaciones del Sistema Inmune; ArgentinaFil: Reisin, Ricardo C.. Hospital Británico de Buenos Aires; Argentin

Utilidad del Doppler pulsado tisular en la detección precoz de anormalidades diastólicas en familiares de primer grado de pacientes con miocardiopatía hipertrófica familiar

Introducción y objetivos. El Doppler pulsado tisular (DPT) permite analizar la función miocárdica regional independientemente de la precarga. Se realizó DPT a los familiares de primer grado de pacientes con miocardiopatía hipertrófica familiar (MHF) para detectar anormalidades precoces. Pacientes y método. Se estudió a 47 familiares de primer grado de pacientes con MHF (grupo GI) y se los comparó con un grupo control de 47 sujetos normales (grupo GII). Se realizó ecocardiografía 2D y Doppler pulsado de los flujos mitral y tricuspídeo. Mediante DPT en la pared lateral del ventrículo izquierdo, el ventrículo derecho y el septo interventricular se midieron las velocidades pico S', E' y A' y los períodos de relajación y contracción isovolumétricos. Se consideró función diastólica regional normal a una relación E'/A' > 1 y disfunción diastólica a una relación E'A'< 1. Resultados. No hubo alteraciones de la relajación ventricular en el GII (E'A' derecho, 1,78 ± 0,58; septo, 2,03 ± 0,53; izquierdo, 2,55 ± 0,80), mientras que en el GI la relación E'/A' permitió diferenciar 2 subgrupos: GIa de 37 familiares de primer grado que presentaron patrón de relajación normal (E'/A' derecho, 1,8 ± 0,44; septo, 2,07 ± 0,41; izquierdo, 2,35 ± 0,6, sin diferencias significativas con el grupo control) y GIb de 10 familiares de primer grado con relajación prolongada en el ventrículo derecho (E'/A', 0,70 ± 0,28; p < 0,001), con menor tendencia significativa en el septo (1,57 ± 0,49; p < 0,01) y el lateral izquierdo (1,85 ± 0,53; p < 0,01). Conclusiones. En familiares de primer grado de pacientes con MHF, el DPT permitió diferenciar anormalidades de la relajación ventricular en 10 de los 47 casos (21,3%), más manifiestas en el ventrículo derecho, que podrían ser un marcador preclínico de la enfermedad