Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis.

BACKGROUND: The present study aimed to detect subtle left ventricular (LV) dysfunction in patients with severe rheumatic mitral stenosis (MS) by measuring global and segmental longitudinal strain with a two-dimensional speckle tracking echocardiography (2D-STE) method. METHODS: In this case-control study, 65 patients with severe rheumatic MS and preserved ejection fraction (EF ≥ 50% measured by conventional echocardiographic methods) were compared with 31 otherwise healthy control subjects. All patients underwent LV strain measurement by the 2D-STE method in addition to conventional echocardiography using a VIVID S60 echocardiography device. RESULTS: Absolute strain values in myocardial segments 1-8, 10, and 12 (all basal, mid anterior, mid anteroseptal, mid inferior, and mid anterolateral segments) were significantly lower in patients with severe MS compared with the control group (P < 0.05 for all). The absolute global longitudinal strain (GLS) value was higher in the control group (-19.56 vs. -18.25; P = 0.006). After adjustment for age, gender, and systolic blood pressure, the difference in GLS between the two groups was as follows: mean difference=-1.16; 95% CI: -2.58-0.25; P = 0.110. CONCLUSION: In patients with severe rheumatic MS and preserved EF, the absolute GLS tended to be lower than healthy controls. Furthermore, the segmental strain values of LV were significantly lower in most of the basal and some mid-myocardial segments. Further studies are warranted to investigate the underlying pathophysiology and clinical implications of this subclinical dysfunction in certain segments of patients with severe rheumatic MS.

Coronary artery mycotic aneurysm in a patient suffering from subacute endocarditis: a case report and literature review.

Although mycotic aneurysm is a known and important disease in the cerebrovascular system, especially the brain, there are scarce reports about coronary artery mycotic aneurysms (CAMA). CAMA can occur not only in the context of endocarditis but also as a rare adverse event of coronary artery stenting, which has been used more extensively in recent years. Accordingly, it is essential to pay greater attention to its associated presentations and clinical course. Considering the scant evidence available, reporting the disease course of each patient with CAMA can help increase the physician's knowledge about this condition, which is why we are reporting this case. A 42-year-old man with diabetes was referred to our center with embolic left cerebellar infarction 3 months earlier, as well as a 2-month history of feverishness before his referral. His blood culture was positive for Viridans Streptococci, and he had paraclinical signs of inflammation and two- and three-dimensional transthoracic and transesophageal echocardiography (2D & 3D TTE and TEE) signs of aortic and mitral valves' infective endocarditis with the destruction of the aortic valve, severe aortic and mitral regurgitation, severe pulmonary hypertension, and moderate biventricular systolic dysfunction. Regarding the obviously dilated left main coronary artery on TEE images, contrast-enhanced chest multidetector computed tomography was performed for better assessment of coronary arteries with suspicion of CAMA, which confirmed aneurysmal dilatation of the proximal left main coronary artery. The presence of bacteria was confirmed on staining the valvular tissue, resected during the surgical replacement of aortic and mitral valves. As the cardiac surgeon considered CAMA resection and coronary bypass grafting high risk for the patient, he received parenteral antibiotic therapy, for 6 weeks. At 1-year follow-up, he was doing well with no signs/symptoms of endocarditis and well-functioning mechanical prosthetic valves. This case shows the significance of considering CAMA in the setting of endocarditis, resistant to medical and/or surgical therapy or in patients with coronary aneurysm, simultaneous with active endocarditis. Therefore, more attention should be paid to this extravalvular complication of endocarditis, and its possibility should be considered and investigated in any patient presented with valvular endocarditis, especially involving the aortic valve.

Prognostic role of moderate functional tricuspid regurgitation in length of hospitalization in patients undergoing isolated coronary artery bypass grafting.

Functional tricuspid regurgitation (FTR) is defined as abnormal systolic tricuspid leakage with normal valve structures, and its prognostic role and management in patients with left-heart valve disease is well known. Due to paucity of data on FTR in patients with ischemic heart disease, the aim of our prospective study was to compare the prognostic effect of FTR between patients with moderate FTR and those with less-than-moderate FTR undergoing isolated coronary artery bypass graft (CABG) surgery. This prospective cohort study included all the patients who were candidate for isolated CABG and were referred for preoperative transthoracic echocardiography between April 2018 and November 2018. Patients were categorized into two groups: less-than-moderate FTR and moderate FTR. The endpoints of the study were the prognostic effect of FTR on short-term mortality and morbidities as a composite endpoint, as well as length of hospitalization, length of intensive care unit (ICU) stay, and ventilation time. Of a total of 410 patients, 363 patients (mean age = 62.4 years, 63.7% men) entered our final analysis. Logistic regression analysis demonstrated that composite endpoints of short-term mortality and morbidities was not significantly different between the two groups, but moderate FTR had a statistically significant effect on length of hospitalization (P = 0.002) and the ventilation time (P = 0.048). This effect, however, did not persist after adjustments for probable known confounders. Our study indicated no significant prognostic effect for preoperative FTR versus less-than-moderate FTR on short-term mortality and morbidities, as well as length of hospitalization, length of ICU stay, and the ventilation time.

Assessment of left and right ventricular rotational interdependence: A speckle tracking echocardiographic study.

OBJECTIVE: We sought to investigate the possible interdependence of the left (LV) and right ventricular (RV) rotational mechanics. BACKGROUND: Although myocardial fiber architecture and the effect of various pathologic conditions on LV torsional mechanics have already been investigated through multiple studies using different methods, there is still a significant debate about the actual presence and functional significance of RV rotational mechanics. METHODS: We perform a cross-sectional prospective study of 118 subjects, including 19 normal subjects (NS, 35±7 years), 34 patients with severe aortic stenosis (AS, 44±16 years), 26 patients with nonobstructive hypertrophic cardiomyopathies (HCM, 46±18), and 39 patients with nonischemic dilated cardiomyopathies (DCM, 39±13 years). LV and RV rotational parameters were measured using velocity vector imaging. Total LV and RV apical segment rotations as well as the rotation of the free wall of RV apex were measured separately. Interdependence of the LV and RV rotational mechanics was assessed using the Spearman rho test. RESULTS: Both LV (7.3°±4.1° in NS, 11°±4.6° in AS, 7.7°±5.2° in HCM, and 1.9°±2° in DCM, P=<.0001) and RV apexes (4.7°±2° in NS, 6.1°±4° in AS, 3.2°±3.7° in HCM, and 2.4°±3.6° in DCM, P=<.0001) rotated counterclockwise in all the four study groups. Interventricular apical rotation interdependence was stronger in the AS (Spearman rho [ρ]: .716; P=.000) and in the HCM (ρ: .395; P=.04) subgroups than in the NS (ρ: .26; P=.27) and DCM (ρ: .215; P=.18). In DCM patients, RV apex rotation appeared to be independent of LV rotation. RV free wall apical rotation was larger than its corresponding value for the total apical segments in all studied groups. This difference was significant only in the AS (P=.007). CONCLUSION: Our findings demonstrated a close correlation between RV and LV apical rotation parameters in different cardiac conditions as well as in normal subjects. However, in DCM patients, we also showed some independent rotation of the RV from the LV apex.