Assessment of cardiac remodeling in asymptomatic mitral regurgitation for surgery timing: a comparative study of echocardiography and magnetic resonance imaging

<p>Abstract</p> <p>Background</p> <p>Early surgery is recommended for asymptomatic severe mitral regurgitation (MR), because of increased postoperative left ventricular (LV) dysfunction in patients with late surgery. On the other hand, recent reports emphasized a "watchful waiting" process for the determination of the proper time of mitral valve surgery. In our study, we compared magnetic resonance imaging (MRI) and transthoracic echocardiography to evaluate the LV and left atrial (LA) remodeling; for better definitions of patients that may benefit from early valve surgery.</p> <p>Methods</p> <p>Twenty-one patients with moderate to severe asymptomatic MR were evaluated by echocardiography and MRI. LA and LV ejection fractions (EFs) were calculated by echocardiography and MRI. Pulmonary veins (PVs) were measured from vein orifices in diastole and systole from the tangential of an imaginary circle that completed LA wall. Right upper PV indices were calculated with the formula; (Right upper PV diastolic diameter- Right upper PV systolic diameter)/Right upper PV diastolic diameter.</p> <p>Results</p> <p>In 9 patients there were mismatches between echocardiography and MRI measurements of LV EF. LV EFs were calculated ≥60% by echocardiography, meanwhile < 60% by MRI in these 9 patients. Severity of MR evaluated by effective regurgitant orifice area (EROA) didn't differ with preserved and depressed EFs by MRI (p > 0.05). However, both right upper PV indices (0.16 ± 0.06 vs. 0.24 ± 0.08, p: 0.024) and LA EFs (0.19 ± 0.09 vs. 0.33 ± 0.14, p: 0.025) were significantly decreased in patients with depressed EFs when compared to patients with normal EFs.</p> <p>Conclusions</p> <p>MRI might be preferred when small changes in functional parameters like LV EF, LA EF, and PV index are of clinical importance to disease management like asymptomatic MR patients that we follow up for appropriate surgery timing.</p

A rare cause of dyspnea: Left atrial angiosarcoma

WOS: 000482646600012PubMed ID: 3137565

Stress Cardiomyopathy (Tako-Tsubo) Associated with Sustained Polymorphic Ventricular Tachycardia

WOS: 000317020600005PubMed ID: 22650252We present a case of 38-year-old woman with stress cardiomyopathy presenting to the emergency department with a 1-week history of recurrent syncope due to sustained polymorphic ventricular tachycardia. (PACE 2013; 36:e111-e114

Antrasiklinlere Bağlı Elektro-Mekanik Değişiklikler: Kardiyotoksisiteyi Erken Dönemde Öngörmede Strain Ekokardiyografinin Repolarizasyon Belirteçleri ile Birlikte Kullanımı

Objective: The aim of the study was to describe the acute cardiotoxic effects of anthracycline chemotherapy in echocardiographic strain and electrocardiographic repolarization parameters in patients with breast cancer. Methods: A total of 35 consecutive patients (all females, mean age: 48.9 +/- 11.8 years) who received chemotherapy due to breast cancer were prospectively included. Pre-treatment (T0) and third month (T2) 2-dimensional strain echocardiography and electrocardiography were performed. Additionally, within 3 hours of the first dose of chemotherapy (T1), additional electrocardiographic images were obtained. All mechanical and electrical parameters from different time intervals (T0, T1, and T2) were compared with each other. Results: In the acute period after treatment, electrocardiographic repolarization parameters were prolonged and this prolongation continued to the third month (QT corrected with Bazett formula [440.10 +/- 27.63 (T0), 468.00 +/- 38.98 (T1), 467.86 +/- 35.09 (T2)], QT dispersion [49.85 +/- 19.52 (T0), 69.54 +/- 16.06 (T1), 57.63 +/- 14.42 (T2)], and T-wave peak-to-end interval [94.00 +/- 45.46 (T0), 131.20 +/- 17.79 (T1), 120.00 +/- 18.32 (T2)]; P <.001). There was no significant change in global longitudinal strain values before and after treatment (global longitudinal strain avg: -21 +/- 7.1%; P =.8). However, there were significant reductions in strain parameters including circumferential and radial strain, and torsion (-17.2 +/- 3.5 to -13 +/- 2.84; P <.001, 45.1 +/- 8.3 to 35.6 +/- 10; P <.001, and 12.1 +/- 3.5 to 7.7 +/- 2.1; P <.001, respectively). Conclusion: Both the electrical and mechanical functions of the heart can be impaired acutely extending to 3 months after anthracycline chemotherapy. Therefore, cardiotoxicity should be evaluated early both electrically and mechanically after chemotherapy