Three-dimensional transesophageal echocardiographic evaluation of aortic plaque after cerebrovascular event.

INTRODUCTION AND OBJECTIVES: Transesophageal echocardiography (TEE) is crucial in order to assess aortic anatomy after stroke. Although routinely used to assess cardiovascular anatomy and function, three-dimensional echocardiography (3D TEE) is less used for aortic evaluation. We thus sought to assess prospectively whether additional information on aortic plaque morphology could be obtained with 3D TEE after an ischemic stroke. METHODS: Patients within one week of a stroke (confirmed by brain computed tomography/magnetic resonance) underwent TEE and 3D findings were compared with two-dimensional (2D) (aorta plaque number, dimensions, area and the presence of debris and ulcerations). Patients were followed for two years for death or a new stroke. RESULTS: We assessed 78 patients, 43 (55%) male, aged 62±14 years old, 92% in sinus rhythm. Aortic atheroma was found mainly in the descending aorta (50%); plaque thickness was similar for 2D TEE (0.29±0.03 cm) and 3D TEE (0.29±0.04 cm), whereas plaque area was slightly increased for 3D measurements (0.24±0.02 cm2 versus 0.37±0.03 cm2 respectively, p<0.05), with a strong correlation found both for aortic plaque thickness (r=0.91) and area (r=0.80) measurements. While aortic debris were equally seen with both techniques, 3D TEE defines the presence of ulcerations (six ulcerations unseen with 2D TEE better, p=0.03). There were 11 events (six deaths and five new strokes) during follow-up, unrelated to plaque characteristics. CONCLUSION: To evaluate aortic plaque morphology, 3D TEE is superior to 2D TEE due to improved detection of ulcerated aortic plaque; this might provide additional information in patients after ischemic stroke.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.