Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise.

OBJECTIVE: We aim to study left atrial (LA) strains in patients with hypertensive response to exercise (HRE) and determine their usefulness in predicting masked hypertension (HT). METHODS: Ninety-eight normotensive patients who had HRE were included and were divided into two groups after masked HT had been diagnosed by ambulatory blood pressure monitoring. Conventional echocardiographic parameters and two-dimensional speckle-tracking echocardiography-based LA strain parameters were compared. RESULTS: Patients with masked HT have higher left ventricle mass index (LVMI) (88.1±11.3 vs. 82.5±8.7 g/m, P<0.05), left atrium maximum volume index (LAVI) (34.5±5.1 vs. 30.2±5.6 ml/m, P<0.001), lower global longitudinal LA strain during ventricular systole (GLAs-res) (32.5±8.9 vs. 40.2±9.1%, P<0.001), and lower global longitudinal LA strain during late diastole (GLAs-pump) (15.8±4.1 vs. 18.1±5.8%, P<0.05). In univariate analysis, a good negative correlation was found between GLAs-res versus LAVI (r=-0.451, P<0.001), GLAs-res versus LVMI (r=-0.457, P<0.001) and a moderate negative correlation was present between GLAs-pump versus LAVI (r=-0.317, P<0.001) and GLAs-pump versus LVMI (r=-0.288, P<0.05). GLAs-res and LAVI were found to be independent predictors of masked HT. Receiver-operating characteristic analysis was carried out. Area under the curve to predict masked HT was 0.729 (95% confidence interval: 0.623-0.832, P<0.001). GLAs-res less than 33.1% predicted masked HT with 73% sensitivity and 61.5% specificity. CONCLUSION: LA strain parameters were impaired in patients with masked HT and can be used to predict the presence of masked HT in patients with HRE.

Right heart free-floating thrombus in a pregnant woman with massive pulmonary embolism: a case of 'emboli in transit'.

The mainstay of treatment for massive pulmonary embolism in nonpregnant individuals is urgent thrombolytic therapy, but experience with these drugs in pregnancy is limited. We report a case of a 36-year-old woman at 27 weeks' gestation who was admitted with a massive, life-threatening pulmonary embolism. The diagnosis was rapidly accomplished in the coronary care unit by transthoracic echocardiography that showed signs of pulmonary hypertension as well as a large, free-floating thrombus in the right heart. As she was hemodynamically unstable, we started treatment with tissue plasminogen activator resulting in complete resolution of cardiorespiratory symptoms. A live baby was delivered by Caesarean section at 37 weeks of gestation, and no complications were seen during the 1-year follow-up. The present case report emphasizes the pivotal role of repeat echocardiography in clinical decision-making and the life-saving potential of thrombolytic therapy without serious adverse effects.

Infective endocarditis complicating hypertrophic obstructive cardiomyopathy: is antibiotic prophylaxis really unnecessary?

Infective endocarditis is a relatively rare complication of hypertrophic cardiomyopathy. Infective endocarditis in hypertrophic cardiomyopathy is almost always seen in patients with outflow obstruction and is more common in those with both outflow obstruction and atrial dilatation. We present a case of culture negative mitral valve endocarditis in a previously asymptomatic woman with hypertrophic cardiomyopathy who died in the course of the disease.

An incomplete heart with incomplete lungs.

Congenital hypoplasia or agenesis of mitral valves is a very rare condition. It is sometimes seen together with other congenital anomalies. We present a demonstrative case of posterior mitral leaflet hypoplasia seen together with congenital lungs anomaly.

Worm-like thrombus in left main coronary artery after cytostatic treatment.

This paper reports a 43-year-old patient who had a large, mobile, worm-like thrombus in the left main coronary artery after receiving a chemotherapy regimen containing cisplatin, bleomycin and etoposide for a nonseminomatous testes tumor. The patient was successfully treated with thrombolytic therapy. Physicians should be aware that thrombotic events may be observed after the administration of certain chemotherapeutic agents, particularly cisplatin.

Type A intramural hematoma presenting with acute right heart failure caused by compression of the main pulmonary artery: a case report.

Pulmonary artery obstruction is a rare complication of intramural hematoma of the ascending aorta. There were few reported cases presenting with right heart failure due to compression of the pulmonary trunk by intramural hematoma of the aorta.