RESUMEN
We report a very rare case of a 43-year-old patient with fatal left ventricular subepicardial aneurysm rupture complicating embolic myocardial infarction due to mitral valve infective endocarditis.
Asunto(s)
Aneurisma Roto/diagnóstico , Endocarditis Bacteriana/diagnóstico , Aneurisma Cardíaco/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Infarto del Miocardio/diagnóstico , Tromboembolia/diagnóstico , Adulto , Aneurisma Roto/complicaciones , Aneurisma Roto/cirugía , Angiografía Coronaria/métodos , Progresión de la Enfermedad , Ecocardiografía Transesofágica/métodos , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/cirugía , Resultado Fatal , Aneurisma Cardíaco/complicaciones , Aneurisma Cardíaco/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Ventrículos Cardíacos , Dependencia de Heroína/complicaciones , Humanos , Imagenología Tridimensional , Masculino , Válvula Mitral , Imagen Multimodal/métodos , Infarto del Miocardio/complicaciones , Infarto del Miocardio/cirugía , Enfermedades Raras , Tromboembolia/complicaciones , Tromboembolia/cirugía , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: The clinical work-up of patients presenting with chest pain is a diagnostic challenge. We investigated the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict coronary artery disease (CAD) in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) but apparent normal global and regional systolic function. METHODS: 150 consecutive suspected NSTE-ACS patients were initially screened for inclusion ; 58 patients with normal LVEF (≥55%) and WMSI (=1) were prospectively enrolled. Speckle-tracking echocardiography was performed on admission and all the patients underwent coronary angiography. CAD was defined as the presence of stenosis of >50%. RESULTS: CAD was present in 33 patients (57%). LVEF was 60.7±4.6% in group 1 (CAD) and 61.1±5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (-16.7±3.4%) as compared to group 2 (-22.4±2.9%, p<0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC=0.92 [0.84-1.00], p=0.0001). TLS was able to discriminate between coronary stenosis in the LAD, LCX or RCA. CONCLUSIONS: Longitudinal 2D strain has a good diagnostic value and can efficiently localize the culprit lesion in patients presenting with NSTE-ACS but apparent normal global and regional systolic function.
Asunto(s)
Síndrome Coronario Agudo , Dolor en el Pecho/diagnóstico , Enfermedad de la Arteria Coronaria , Vasos Coronarios , Ecocardiografía/métodos , Síndrome Coronario Agudo/diagnóstico , Síndrome Coronario Agudo/etiología , Síndrome Coronario Agudo/fisiopatología , Anciano , Dolor en el Pecho/etiología , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/patología , Precisión de la Medición Dimensional , Electrocardiografía/métodos , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Volumen Sistólico , Función VentricularRESUMEN
BACKGROUND: Aortic valve stenosis (AVS) can be complicated by bleeding associated with acquired type 2A von Willebrand syndrome. The association of AVS and gastrointestinal bleeding from angiodysplasia is defined as Heyde syndrome. We sought to evaluate the effect of transcutaneous aortic valve implantation (TAVI) on hemostasis disorders and to assess its effectiveness to treat Heyde syndrome. METHODS: We prospectively enrolled 49 consecutive patients with severe AVS addressed for TAVI at our institution. Biological hemostasis parameters involving von Willebrand factor (vWF) were assessed at baseline and 1 week after the procedure. RESULTS: At baseline, a significant link between vWF abnormalities and the severity of AVS was evidenced: mean aortic transvalvular gradient was negatively correlated with the levels of vWF antigen (vWF:Ag) (r = -0.29; P < 0.05), vWF ristocetin cofactor activity (r = -0.402; P = 0.006), and vWF collagen-binding activity (vWF:CB; r = -0.441; P = 0.005). One week after the procedure, a significant increase of vWF:Ag, vWF ristocetin cofactor activity, and vWF:CB was evidenced in the whole cohort (respectively, 3.32 vs. 2.29 IU/mL, P < 0.001; 2.98 vs. 1.86 IU/mL, P < 0.001; and 3.16 vs. 2.16 IU/mL, P < 0.001). Patients with pre-TAVI vWF abnormalities consistent with a type 2A vWF syndrome (ratio vWF:CB/vWF:Ag < 0.7) preferentially improved their vWF function with respect to patients with a normal ratio (relative increase of vWF:CB of 63.8% vs. 3.5%). CONCLUSIONS: Hemostasis parameters involving vWF are improved after TAVI, especially in patients with pre-existing abnormalities consistent with acquired type 2A von Willebrand syndrome.