Small Left Atrium: An Adjunctive Sign of Hemodynamically Compromised Massive Pulmonary Embolism

Pulmonary embolism (PE) is a common disease with a high mortality rate due to right ventricular dysfunction and underfilling of the left ventricle. We present a case of a 33-year-old man with hemodynamically compromised massive PE. His left atrium was collapsed with marked dilatation of the right atrium and ventricle on multi-detector-row CT scans. The patient was treated with an intracatheter injection of a mutant tissue-type plasminogen activator and subsequently showed clinical and radiological improvements. The small left atrial size in combination with a right ventricular pressure overload was considered to be an adjunctive sign of hemodynamically compromised massive PE

Clinical outcomes of left atrial circumferential ablation and box ablation for paroxysmal atrial fibrillation

Left atrial circumferential ablation （LACa） and box ablation （BOXa） are two common treatments for paroxysmal atrial fibrillation （PAF）. However, only a few studies have compared these two approaches. This study aimed to compare the clinical outcomes of these two therapeutic modalities. Patients with PAF who underwent catheter ablation were randomly assigned to either the LACa or BOXa groups and were followed up for 6 months. The primary outcomes were the rate of atrial fibrillation （AF） recurrence after 6 months and changes in the left atrial ejection fraction （LAEF） measured via magnetic resonance imaging from baseline to follow-up. The secondary outcomes included the frequency of supraventricular premature beats （SPBs） and short supraventricular runs （SVRs） on a 24-h electrocardiogram at follow-up. A total of 40 patients were randomly assigned to the LACa （n＝21） or BOXa group （n＝19）. No significant between-group differences were observed in the patient characteristics and LAEF at baseline or the rate of AF recurrence at 6 months （LACa, 4.8％ ［1/21］ vs. BOXa, 5.3％ ［1/19］; P＝0.94） as well as changes in the LAEF at 3 and 6 months. However, the frequency of SPB and SVR at 6 months was significantly lower in the LACa group than in the BOXa group （0.2 ［−0.2, 0.50］/24h vs. 0.8 ［0.5, 1.2］/24h, P＝0.01; 2.2 ［−4.2, 8.7］/24h vs. 11.9 ［4.8, 18.9］/24h, P＝0.04, respectively）. Although the rates of AF recurrence and changes in the LAEF were comparable between the LACa and BOXa groups, the higher incidence of SPBs and SVRs at 6 months in the BOXa group suggests that BOXa provided no advantage in the treatment of PAF patients

Inward or Outward Costophrenic Angles: A Simple Sign on Chest X-ray for the Screening of Metabolic Syndrome

Prevention of cardiovascular diseases is a top-priority issue in Japan. To this end, we have developed a new screening method for metabolic syndrome (MetS) using chest X-ray. We recruited 200 patients who visited our outpatient cardiology clinic from March 2014 to August 2014. Patients with severe lung disease, acute coronary syndrome, and end-stage renal failure were excluded. We collected data on each patient\u27s medical history, laboratory results, waist circumference (WC), body weight, and height. Additionally, we measured two parameters from the chest X-ray: (A) width at the level of right dome of diaphragm and (B) width between the costophrenic (CP) angles. We classified the CP angles as either inward (A≥B) or outward (A<B). Increased WC was defined as ≥85cm in males and ≥90cm in females. Patients with outward CP angles had a significantly larger WC compared to those with inward CP angles (92.3±8.9 vs. 80.5±7.8cm, P<0.001). In particular, the percentage of male patients with increased WC (≥ 85cm) was significantly higher in patients with outward CP angles than in those with inward CP angles (89.2% vs. 41.3%, P<0.001). Body weight and BMI were both significantly higher in patients with outward CP angles than in those with inward CP angles in both gender groups. When laboratory data and risk factors were compared, patients with outward CP angles and those with positive WC criteria consistently tended toward high morbidity from hypertension, dyslipidemia, and diabetes. The inward/outward CP identified candidates for MetS, especially in the male subjects. Chest X-ray could become a useful screening tool for the detection of increased WC and coronary risk factors

Histopathology of the Posterolateral Myocardium in a Responder to Cardiac Resynchronization Therapy

We present a 72-year-old man with idiopathic dilated cardiomyopathy, who was in New York Heart Association class III and had left ventricular (LV) dyssynchrony on tissue Doppler imaging. Cardiac resynchronization therapy (CRT) was performed for his heart failure, which improved to class I. Two years later, ventricular arrhythmias recurred, resulting in death. The LV posterior vein containing a pacing lead showed half-circumferential fibrous thickening. The LV myocardium of this region was relatively well preserved, and interstitial fibrosis due to cardiomyopathy was mild. Absence of a massive fibrotic scar on the LV posterior wall and positioning of the pacing lead in the optimal coronary vein (a posterolateral vein) might have been positive factors determining this patient's response to CRT