Echocardiographic and clinical markers of left ventricular ejection fraction and moderate or greater systolic dysfunction in left ventricular noncompaction cardiomyopathy.

BACKGROUND: Left ventricular noncompaction (LVNC) is associated with progressive LV systolic dysfunction and dilated cardiomyopathy. We aimed to investigate the echocardiographic and clinical characteristics associated with LV ejection fraction (LVEF) and moderate or greater systolic dysfunction in patients with LVNC. METHODS: Our institutional echocardiography database was retrospectively reviewed between 2008 and 2014, and 62 patients with LVNC were identified. Forty-three (69%) had moderate or greater LV systolic dysfunction (LVEF ≤ 40%) and were compared with 19 (31%) patients with preserved or mildly reduced LVEF (>40%). Linear regression analyses were utilized to identify markers associated with LVEF. RESULTS: The mean age was 63 ± 17 years and noncompacted-to-compacted ratio was 2.3 ± 0.5, and was larger in patients with LVEF ≤ 40% (2.4 vs 2.1; P = .02). Patients with LVEF ≤ 40% were older, had more congestive heart failure, significant QRS interval prolongation, and greater LV remodeling and worse mean global longitudinal strain (GLS). Multivariate regression analysis revealed increased age (standardized regression coefficient (ß) = -0.17; P = .04) and QRS duration (ß = -0.13; P = .08), congestive heart failure (ß = -0.18; P = .04), and worsened GLS (ß = -0.40; P = .001) were independently associated with decreased LVEF in the cohort (overall model fit R2  = 0.71; P < .0001). Increased age (ß = -0.49; P = .01) and QRS duration (ß = -0.50; P = .002), and worsened GLS (ß = -0.33; P = .04), were also associated with a lower LVEF in patients with LVEF > 40%. CONCLUSIONS: The independent markers associated with LVEF and moderate or greater LV systolic dysfunction in patients with LVNC, in particular GLS and QRS duration, may detect high-risk candidates for more aggressive clinical surveillance and medical therapy.

Usefulness of the CHA2DS2VASc score to predict postoperative stroke in patients having cardiac surgery independent of atrial fibrillation.

Despite its association with cardioembolic stroke, atrial fibrillation (AF) appears to be inconsistent as a risk factor for postoperative strokes in patients who underwent cardiac surgery. Furthermore, the relation between AF and the CHA2DS2VASc score has not been definitively established with respect to postoperative stroke. We retrospectively analyzed the records of all cardiac surgery performed at our institution between January 2008 and July 2013. Baseline characteristics, operative data, and postoperative outcomes were compared in patients who developed stroke with those who did not. Previously recognized stroke risk factors, including AF, were analyzed along with the CHADS2 and CHA2DS2VASc scores. A total of 3,492 consecutive patients were identified, of which 2,077 (60%) underwent valve surgery, 915 (26%) had coronary artery bypass grafting, 399 (11%) underwent combined coronary artery bypass grafting and valve procedures, and 101 (3%) had other cardiac operations. Postoperative ischemic strokes occurred in 44 patients (1.2%). The development of a stroke was associated with older age (74 ± 12 vs 69 ± 12, p = 0.008), preoperative antiplatelet medication use (38.6% vs 24.5%, p = 0.043), congestive heart failure (37% vs 20%, p = 0.002), and greater CHADS2 (2.48 ± 1.3 vs 1.98 ± 1.1, p = 0.015) and CHA2DS2VASc scores (4.2 ± 1.8 vs 3.4 ± 1.6, p = 0.002). Multivariable analysis demonstrated that the CHA2DS2VASc score was the only independent predictor of postoperative strokes (odds ratio 1.25; 95% confidence interval 1.05 to 1.5, p = 0.014). In conclusion, the CHA2DS2VASc score appears to predict postoperative strokes independent of the presence of AF.

Bicuspid Aortic Valve and Aortic Root Morphology in Hispanic Patients.

BACKGROUND: The study aim was to evaluate the aortic valve and aortic root morphology in Hispanic patients with a bicuspid aortic valve (BAV). BAV disease is one of the most common congenital anomaly of the heart, and is associated with abnormalities of the aorta. Interracial differences have been described between Caucasian and African-American patients with BAV, which may have clinical and therapeutic implications. The clinical and anatomical spectrum of BAV disease in Hispanic patients has not been well established. METHODS: A retrospective review was conducted of all heart operations performed at the authors' institution between April 2008 and June 2013. Patients with BAV who underwent aortic valve replacement (AVR) were identified. All echocardiograms available were reviewed in order to compare cusp morphology, valvular function, and ascending aorta dimensions between Hispanic and non-Hispanic individuals. RESULTS: A total of 291 patients (159 Hispanic, 132 non-Hispanic) with a mean age of 62 ± 13 years were identified. The baseline characteristics were similar between the two groups. In both Hispanics and non-Hispanics, the most prevalent cusp morphology was fusion of the right and left coronary cusps (82% for both groups). The most common indication for surgery was aortic stenosis. Hispanic patients had a larger aortic annulus diameter (2.58 ± 0.32 cm versus 2.39 ± 0.39 cm, p = 0.04). However, this difference was not significant after adjusting for age, gender, body surface area, and the presence of moderate-to-severe aortic insufficiency. Ascending aortopathy was present in 42.7% of the total study population. Regardless of ethnicity, the most common pattern of aortopathy involved the tubular ascending aorta with mild to moderate root enlargement (type 1). CONCLUSIONS: Compared with other ethnic groups, Hispanics with BAVs have similar aortic valve morphology and function, as well as comparable aortopathy.

Subclavian artery stenosis: a case series and review of the literature.

Subclavian artery stenosis (SAS) is a significant form of peripheral artery disease, which may be a marker of diffuse atherosclerosis and increased risk for cardiovascular events. SAS can lead to symptomatic ischemia affecting the upper extremities, the brain, and, in some cases, the heart. In general, asymptomatic subclavian artery disease is treated with medical therapy and invasive treatment is reserved for the more symptomatic patients. This article discusses the evaluation of four patients with varying presentations of subclavian artery disease.

Outcomes of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach.

BACKGROUND AND AIM OF THE STUDY: The feasibility of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach was evaluated. METHODS: A retrospective analysis was conducted on all patients who underwent minimally invasive triple valve surgery via a right anterior thoracotomy approach at the authors' institution between December 2009 and February 2013. The operative times and intensive care unit and hospital lengths of stay, postoperative complications, and mortality were analyzed. RESULTS: Six patients (three males, three females; mean age 76.7 +/- 5.4 years) were identified. Five patients had a prosthetic aortic valve, and one patient had an aortic valve repaired by commissuroplasty. In four patients the mitral valve repair was effected with an annuloplasty ring, while in two patients a transaortic edge-to-edge mitral valve repair was performed. All patients had tricuspid valve repair with a ring annuloplasty. The median aortic cross-clamp time was 136 min (IQR: 119-188 min), and the median cardiopulmonary bypass time was 185 min (IQR: 145-231 min). The median intensive care unit and hospital lengths of stay were 62 h (IQR: 50-111 h) and 12 days (IQR: 7-23 days), respectively. There were no postoperative cerebrovascular accidents, myocardial infarctions or acute kidney injuries. Two patients developed post-surgical atrial fibrillation, and two died at 30 days postoperatively. CONCLUSION: In patients requiring triple valve surgery, a minimally invasive approach performed via a right anterior thoracotomy may be a feasible option in these high-risk patients.