Actinic Papillary Fibroelastoma of the Left Ventricle

We present the case of a 69-year-old woman with a history of endometrial carcinoma in 1996, who underwent a total hysterectomy and bilateral adnexectomy. The patient also received chemotherapy (doxorubicin and cisplatinum) and local radiotherapy (50 Gy) because of a single lung metastasis, with total remission during later follow-up. During follow-up, 10 years later following radiotherapy, a transthoracic echocardiogram (TTE) revealed an image consistent with a primary cardiac tumor (papillary fibroelastoma) or metastatic cardiac tumor on the posteromedial papillary muscle. Cardiac magnetic resonance imaging (MRI) revealed a solid mass on the posteromedial papillary muscle with late enhancement, consistent with a primary cardiac tumor. During surgery, the tumor located in the posteromedial papillary muscle was resected. A pathological examination revealed the presence of a tumor mass with a core of dense connective tissue surrounded by a layer of hyperplastic endocardial cells characteristic of a papillary fibroelastoma. After 8 years of follow-up, the patient remains asymptomatic

Left ventricular diverticulum, a rare echocardiographic finding: Two adult patients and review of the literature

Congenital diverticulum of the left ventricle is a very rare cardiac abnormality characterized by a local embryological development failure of the ventricular muscle. It may present as an isolated disorder or may be associated with other cardiac abnormalities. Clinically, it has been reported that it can lead to chest pain, arrhythmias, cardiac rupture, and sudden death, although frequently the course is asymptomatic. This article presents two illustrative cases of left ventricular diverticulum. The diagnosis was made by two-dimensional echocardiography and was confirmed by cardiac catheterization. There were no other thoracoabdominal or cardiac abnormalities. The patient was asymptomatic and surgical resection was not indicated. Given the few cases reported in the medical literature, the information available is scarce; hence, physicians should be trained to make the appropriate diagnosis

Subaortic and mid-ventricular obstructive hypertrophic cardiomyopathy with an apical Aneurysm: a case report

BACKGROUND: Most patients with hypertrophic cardiomyopathy (HCM) have asymmetric septal hypertrophy and among them, 25% present dynamic subaortic obstruction. Apical HCM is unusual and mid-ventricular HCM is the most infrequent presentation, but both variants may be associated to an apical aneurysm. An even more rare presentation is the coexistece mid-ventricular and apical HCM. This case is a combination of obstructive HCM with mid-ventricular HCM and an apical aneurysm, which to date, has not been reported in the literature. CASE PRESENTATION: The patient is a 49 year-old lady who presents a combination of septal asymmetric hypertrophic cardiomyopathy (HCM) and midventricular HCM, a subaortic gradient of 65 mm Hg and a midventricular gradient of 20 mm Hg, plus an apical aneurysm. Her clinical presentation was an acute myocardial infarction in June 2005. One month after hospital discharge, the electrocardiogram (ECG) showed a right bundle branch block (RBBB) with no Q waves or ST segment elevation. Coronary angiography revealed normal coronary arteries, left ventricular hypertrophy and an apical aneurysm. CONCLUSION: This case is a rare example of an asymptomatic patient with subaortic and mid-ventricular hypertrophic cardiomyopathy, who presents a myocardial infarction and normal coronary arteries, and during the course of her disease develops an apical aneurysm

Genetic Deletion of Galectin-3 Exacerbates Age-Related Myocardial Hypertrophy and Fibrosis in Mice

Background/Aims: Aging is accompanied by progressive and adverse cardiac remodeling characterized by myocardial hypertrophy, fibrosis, and dysfunction. We previously reported that galectin-3 (Gal-3) is a critical regulator of inflammation and fibrosis associated with hypertensive heart disease and myocardial infarction. Nevertheless, the role and mechanism of Gal-3 in age-related cardiac remodeling have not been previously investigated. We hypothesized that Gal-3 plays a critical role in cardiac aging and that its deficiency exacerbates the underlying mechanisms of myocardial hypertrophy and fibrosis. Methods: Male C57BL/6 (control) (n=24) and Gal-3 knockout (KO) (n=29) mice were studied at 24 months of age to evaluate the role of Gal-3 in cardiac aging. We assessed 1) survival rate; 2) systolic blood pressure (SBP) by plethysmography; 3) myocardial hypertrophy, apoptosis, and fibrosis by quantification of histological and immunohistochemical analysis; 4) cardiac expression of angiotensin (Ang) II, Ang (1–7) by Radioimmunoassay; 5) transforming growth factor-β (TGF-β), sirtuin (SIRT) 1, SIRT 7 and metalloproteinase 9 (MMP-9) by RT-qPCR and 6) ventricular remodeling and function by echocardiography. Results: We found that aged Gal-3 KO mice had a lower survival rate and exhibited exacerbated myocardial hypertrophy and fibrosis without changes in SBP. Similarly, myocardial apoptosis and MMP-9 mRNA expression was significantly increased in the hearts of Gal-3 KO mice compared to controls. Additionally, cardiac Ang II and TGF-β expression were higher in aged Gal-3 KO mice while SIRT1 and SIRT7 expression were reduced. Conclusion: Our findings strongly suggest that Gal-3 is involved in age-related cardiac remodeling by regulating critical mechanisms associated with the development of pathological hypertrophy. The gene deletion of Gal-3 reduced the lifespan and markedly increased age-dependent mechanisms of myocardial hypertrophy, apoptosis, and fibrosis, including Ang-II, TGF-β, and MMP-9. At the same time, there was diminished cardiac-specific expression of SIRT1 and SIRT7, which are extensively implicated in delaying age-dependent cardiomyopathies.Fil: Fontana Estevez, Florencia Sofía. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Betazza, Celeste. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Miksztowicz, Verónica Julieta. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Seropian, Ignacio Miguel. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Silva, Mauro Gastón. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: Penas, Federico Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Touceda, Vanessa Michelle. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Selser, Carolina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Villaverde, Alejo. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Goren, Nora Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas en Retrovirus y Sida. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas en Retrovirus y Sida; ArgentinaFil: Cianciulli, Tomás Francisco. Gobierno de la Ciudad Autónoma de Buenos Aires. Hospital General de Agudos Doctor Cosme Argerich; ArgentinaFil: Medina, Vanina Araceli. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Morales, Celina. Universidad de Buenos Aires. Facultad de Medicina. Departamento de Patología; ArgentinaFil: Gironacci, Mariela Mercedes. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Química y Físico-Química Biológicas "Prof. Alejandro C. Paladini". Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Química y Físico-Química Biológicas; ArgentinaFil: González, Germán Esteban. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentin

Two-dimensional speckle tracking echocardiography for the assessment of atrial function

Echocardiography is the most common diagnostic method for assessing atrial function but the technique has some limitations. Traditionally, assessment of left atrial function has been performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived strain. However, this method has several limitations, such as suboptimal reproducibility, angle-dependence, signal artifacts and the fact that it only measures regional strain and does not obtain information about the curved portion of the atrial roof. To overcome these limitations in the quantification of atrial function, the use of speckle tracking echocardiography (STE) strain has been proposed. This technique is not derived from Doppler but rather from 2D echocardiography; it is angle-independent and allows one to measure global as well as regional atrial strain. In this editorial, we describe the physical and pathophysiological concepts of STE and underline the clinical usefulness of this new technique

Repercusión de la elevación de troponina T con valores normales de creatincinasa sobre la función ventricular en los síndromes coronarios agudos

Background The role of elevated troponins to predict changes on ventricular function in patients with high creatine kinase (CK) levels has been well established; yet, little is known about the clinical significance of high troponin levels with normal CK levels. Objective To analyze the relation between Troponin T (TnT) levels and global and regional left ventricular function in patients with acute coronary syndromes (ACS) with normal CK and CK-MB levels. Material and Methods We included patients admitted to the coronary care unit due to ACS within 48 hours from symptoms onset with elevated TnT levels measured by quantitative determination and normal CK and CK-MB levels. Biomarkers were measured at baseline, 24 and 48 hours. Left ventricular function was analyzed by two-dimensional echocardiography at admission and before discharge, and compared with the highest levels of the biomarkers. Ejection fraction, regional wall motion and global systolic longitudinal strain based on speckle-tracking technique were evaluated. Results Thirty patients with ACS were included. The highest median value of TnT was 0.13 ìg/L (interquartile range, 0.07-0.25) measured 24 hours after admission. Left ventricular ejection fraction was 62.9%±10% at admission and 62.8%±10.3% before discharge. Wall motion index was 1.04±0.1 and 1.03±0.1, respectively. Systolic strain at admission was 14.93±3 and improved before discharge 16.51±3.33 (p = 0.0003). Conclusions High TnT values in ACS with normal CK levels do not modify global or regional left ventricular function assessed by conventional echocardiography. The evaluation of systolic strain using a more sensitive technique detects transient abnormalities. These findings might question the definition of acute myocardial infarction based on high troponin levels, considering that the classical definition is based on elevated CK values which are associated with changes in ventricular function.Introduccion La repercusion de la elevacion de troponinas sobre la funcion ventricular izquierda en pacientes que no presentan aumento de creatincinasa (CK) por sobre el valor normal se conoce poco, a diferencia de lo que ocurre con los que presentan elevacion de CK. Objetivos Analizar la relacion entre los valores de troponina T (TnT) y la funcion ventricular izquierda global y regional en pacientes con sindromes coronarios agudos (SCA) sin elevacion de CK total ni de CK-MB. Material y metodos Se estudiaron pacientes ingresados a Unidad Coronaria con SCA que durante las primeras 48 horas de evolucion presentaron elevacion de TnT medida cuantitativamente con valores normales de CK y CK-MB. Se dosaron los biomarcadores en forma basal, a las 24 y a las 48 horas. Los valores mas elevados se utilizaron para compararlos con la funcion ventricular izquierda medida con ecocardiografia bidimensional transtoracica efectuada al ingreso y antes del alta hospitalaria. Se evaluaron la fraccion de eyeccion, la motilidad parietal regional y la deformacion sistolica longitudinal global del ventriculo izquierdo, esta ultima mediante la tecnica de speckle tracking. Resultados Se incluyeron 30 pacientes con SCA. La TnT mas elevada (mediana, rango intercuartil) fue de 0,13 mg/L (0,07-0,25) correspondiente a las 24 horas del ingreso. La fraccion de eyeccion ventricular izquierda en el primer ecocardiograma fue del 62,9% �} 10% y en el segundo, del 62,8% �} 10,3%. El indice de motilidad parietal fue de 1,04 �} 0,1 y de 1,03 �} 0,1. La deformacion sistolica tuvo un valor de .14,93 �} 3 al ingreso, que mejoro antes del alta con un valor de .16,51 �} 3,33 (p = 0,0003). Conclusiones La elevacion de TnT en los SCA sin elevacion concomitante de CK no altera la funcion ventricular global ni regional medida con metodologias convencionales. Utilizando un metodo mas sensible que mide la deformacion sistolica ventricular se detectan alteraciones transitorias. Esto podria cuestionar la definicion de infarto agudo de miocardio basada en la elevacion de troponinas, teniendo en cuenta que la definicion clasica basada en la CK suele repercutir, en mayor o en menor grado, sobre la funcion ventricular

Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease

Fil: Cianciulli, Tomás Francisco. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Saccheri, María Cristina. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Papantoniou, Alonso. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Méndez, Ricardo José. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Gagliardi, Juan Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Prado, Nilda Graciela. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Riarte, Adelina. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Morita, Luis Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Clérici, Javier Eduardo. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Fil: Lax, Jorge Alberto. Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires "Dr. Cosme Argerich"; Argentina.Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls

Speckle tracking echocardiography in the indeterminate form of Chagas disease

Fil: Cianciulli, Tomás Francisco. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Albarracín, Gerardo Ariel. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Napoli Llobera, Mariano. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Prado, Nilda Graciela. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Saccheri, María Cristina. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Hernández Vásquez, Yolanda María. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología; Argentina.Fil: Méndez, Ricardo José. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Beck, Martín Alejandro. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Baez, Karina Giselle. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Fil: Balletti, Lorena Romina. Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich". Division of Cardiology. Echocardiography Laboratory; Argentina.Background: Chagas disease is one of the most common diseases in Latin-America, and cardiac involvement is a significant cause of death. Assessment of myocardial strain may detect early myocardial damage. Objectives: To determine differences in longitudinal strain using speckle tracking to assess regional and global left ventricular function in patients with the indeterminate form of Chagas disease, in comparison with a control group. Methods: This is a retrospective matched case-control study, conducted in a single center. We evaluated 45 adult patients with Chagas disease, diagnosed with 2 serological methods, without evidence of cardiac involvement, who were compared with 45 healthy control subjects, who were sex- and age-matched. All patients underwent Doppler echocardiography and longitudinal strain with speckle tracking. Results: Median age was 59 years, and 60% were female. Echocardiographic parameters were similar in patients with Chagas and control subjects. In patients with Chagas, global strain differed significantly from that of control subjects (-17 vs -20.3, P < .001). Segmental strain showed 7 abnormal segments in patients with Chagas (P < .05). Conclusions: In patients with the indeterminate form of Chagas disease, global and segmental longitudinal peak systolic strain is reduced compared with healthy subjects, thus suggesting that it could be a sensitive technique to detect early myocardial damage. These findings could provide useful information regarding the pathophysiology of cardiac involvement and understand whether they might have prognostic usefulness or help develop strategies to modify the course and prognosis of patients with Chagas disease. A longitudinal prospective study would be necessary to validate our findings