Risk stratification for sudden cardiac death in patients with heart failure : Emerging role of imaging parameters.

BACKGROUND: Heart failure with reduced ejection fraction is a common condition that has a poor prognosis. Accurate selection of patients with ischemic heart disease and idiopathic dilated cardiomyopathy, who are at risk of sudden cardiac death (SCD), remains a challenge. In these cases, current indications for implantable cardioverter-defibrillators (ICD) rely almost entirely on left ventricular ejection fraction. However, this parameter is insufficient. Recently, noninvasive imaging has provided insight into the mechanism underlying SCD using myocardial deformation on echocardiography and magnetic resonance imaging. The aim of this review article was to underline the emerging role of these novel parameters in identifying high-risk patients. METHODS: A literature search was carried out for reports published with the following terms: "sudden cardiac death," "heart failure," "noninvasive imaging," "echocardiography," "deformation," "magnetic resonance imaging," and "ventricular arrhythmia." The search was restricted to reports published in English. RESULTS: The findings of this analysis suggest that cardiac magnetic resonance imaging and strain assessment by echocardiography, particularly longitudinal strain, can be promising techniques for cardiovascular risk stratification in patients with heart failure. CONCLUSION: In future, risk stratification of arrhythmia and patient selection for ICD placement may rely on a multiparametric approach using combinations of imaging modalities in addition to left ventricular ejection fraction.

Thrombolysis for pulmonary embolism during pregnancy . About four cases.

Pregnancy is correlated with a significant increase in the risk of pulmonary embolism (PE) given the physiological changes in fibrinolysis and mechanical stress induced by the pregnant uterus. Our goal is to demonstrate through four cases of massive bilateral PE occurred during pregnancy, the possibility of thrombolysis in pregnant women. We report the observation of four pregnant patients, between 28 and 38 years old and whose term varies between nine and 36 last menstrual period, hospitalized for serious PE complicated by cardiorespiratory arrest in one case and haemodynamic instability in other cases. Pulmonary angioscan was performed in three cases and transesophageal echocardiography in a patient with cardiogenic shock. Thrombolysis based on rtPA was performed in all cases, with a favorable evolution in 3 cases. No maternal or fetal complication has been observed during pregnancy or on follow-up that ranges from two to seven years. These findings underscore the safety and efficacy of thrombolysis, which remains the only life-saving therapeutic method immediately available in these severe forms of PE during pregnancy. The risk of bleeding induced by pregnancy should not be a contraindication.

Current and new imaging techniques in risk stratification of asymptomatic severe aortic stenosis.

Aortic stenosis (AS) is one of the most common valvular diseases in clinical practice. The prevalence of calcified AS with moderate or severe stenosis exceeds 2% after 75 years. The optimal timing of intervention for asymptomatic severe AS is uncertain and controversial. Identification of high-risk patients is based on echocardiographic parameters (left ventricular dysfunction, AS severity and progression), hemodynamic response to exercise, pulmonary hypertension, and elevated brain natriuretic peptides. However, early surgical aortic valve replacement (AVR), when compared to the watchful waiting approach, was associated with survival advantage. Moreover, new insights into pathophysiology of AS and advances in imaging modalities were helpful in the management of asymptomatic AS. In this report, we detail the potential role of echocardiography to guide timing of surgery and we discussed the use of early risk features based on recent imaging modalities.

A giant calcified aneurysm of the basal inferior wall: a rare phenomenon.

Left ventricular aneurysms (LVA) are mainly a late consequence of transmural myocardial infarction. Approximately 80% of LVA are located in the anterior and/or apical walls, most commonly associated with left anterior descending artery occlusion but any region may be engaged. Basal inferior wall aneurysms are rare and constitute nearly 3% of all LVA. A calcified LVA is seldom observed in modern clinical practice. And a calcified basal inferior LVA is an even rarer coincidence. We report a case of an 82-year-old women with life threatening arrhythmia revealing a giant calcified aneurysm of the basal inferior wall, medically treated with good outcomes. The exact incidence of left ventricular aneurysms (LVA) following myocardial infarctions is hard to precise but it is clearly decreasing. Eighty percent (80%) of LVA are located in the anterior or apical walls, but any region may be engaged. Basal inferior wall aneurysms constitute 3% of all LVA. Echocardiography is the first diagnostic tool and there is still no clear guidelines on how to treat LVAs. Surgery is preferred but medical treatment may help improve the quality of life.

Idiopathic pulmonary vein thrombosis: An unexpected cause of respiratory distress and acute heart failure. A case report and review of the literature.

INTRODUCTION: Pulmonary vein thrombosis is a potentially fatal disease. The association between pulmonary vein thrombosis and chronic heart failure has not been described in the literature. CASE REPORT: Herein, we report a case involving a 73-year-old woman, with a medical history of ischemic congestive heart failure, who was hospitalised for acute decompensated heart failure with respiratory distress. A computed tomography pulmonary angiography was performed to rule out the possibility of pulmonary embolism, and it showed evidence of pulmonary vein thrombosis. No cause was determined for the pulmonary vein thrombosis; hence, it was considered idiopathic and anticoagulation therapy was initiated for the patient. However, the patient died a few days after admission to the intensive care unit. CONCLUSION: This case of pulmonary vein thrombosis is presented to promote awareness of this disease entity. We also want to emphasize the importance of maintaining a high index of clinical suspicion for this diagnosis, particularly in patients with acute decompensated heart failure who are refractory to standard therapy.