Echocardiographic assessment of patient hemodynamics in heart failure.

Heart failure (HF) is a clinical syndrome which is due to cardiac structural and/or functional abnormalities that result in elevated intra-cardiac pressures and/or inadequate cardiac output. Hemodynamic assessment in HF allows the identification and characterization of cardiac dysfunction, systemic and/or pulmonary congestion and the eventual impairment of systemic perfusion which are fundamental to phenotype HF, risk stratify HF patients and to guide their treatment. Patient hemodynamics can be characterized invasively with right heart catheterization but also non-invasively with the use of echocardiography and other non-invasive ultrasound tools. The aim of the present review is to summarize the main echocardiographic and ultrasound parameters to characterize the hemodynamics of patients with HF and help clinicians to make the most of these non-invasive tools to guide HF patient management.

Nonbacterial Thrombotic Endocarditis with Multiple Systemic Emboli in a Patient with Primary Lung Cancer.

Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of cardiac valves that is most commonly seen in advanced malignancy. We describe a case report of a 63-year-old male with NBTE and multiple embolizations (encephalic, coronary, splenic, and renal). The patient was admitted to the emergency department for stroke. During hospitalization, the patient complained of left leg pain and a venous echo color Doppler of the lower limbs was performed, showing bilateral distal deep-vein thrombosis. A thoracoabdominal computed tomography scan, which was performed to rule out pulmonary embolism, revealed a primary lung cancer and subcarinal lymphadenopathy. As collateral findings, multiple ischemic lesions in the spleen and in both kidneys were identified. In addition, areas of subendocardial hypodensity compatible with ischemia were also highlighted. An electrocardiogram showed acute myocardial infarction and focused echocardiographic evaluation displayed hypokinesis of the lateral and posterior in the mid- and distal segments and aortic and mitral valve vegetations, confirmed by a transesophageal echocardiography. Empiric antimicrobial therapy was started; all blood culture sets were negative and the patient was apyretic throughout the hospitalization. These findings supported the hypothesis of NBTE with multiple embolizations during a hypercoagulable state associated with advanced lung cancer.

Acute Myocarditis Associated with Legionella Infection: Usefulness of Layer-specific Two-dimensional Longitudinal Speckle-tracking Analysis.

Pneumonia is the most commonly described manifestation of Legionella pneumophila infection (legionellosis), and extrapulmonary manifestations are uncommon. There are a few descriptions of acute myocarditis associated with legionellosis. We present a case of acute myocarditis in a patient admitted for legionellosis with multisystemic involvement (lung, heart, and kidney). Left ventricular (LV) dysfunction was documented by cardiac magnetic resonance (CMR) and two-dimensional speckle-tracking echocardiography; layer-specific strain analyses were performed, which allowed to differentiate subendocardial or subepicardial contractile impairment. Layer-specific strain analyses by echocardiography demonstrated impairment of subepicardial deformation in the inferolateral wall, which mirrored CMR findings, showing late gadolinium enhancement in the subepicardium of the same LV segments. After initiation of appropriate antibiotic therapy with levofloxacin, LV systolic function rapidly improved as assessed by both CMR and strain analyses, with concomitant normalization of both clinical and biochemical abnormalities. The basic mechanisms of myocardial involvement during legionellosis are unclear; we discussed our findings according to the limited available evidence.