Myocardial strain in nonischemic dilated cardiomyopathy with feature tracking. Feasibility and prognostic implications.

INTRODUCTION AND OBJECTIVES: Myocardial strain analysis could provide additional information to left ventricular ejection fraction (LVEF) in nonischemic dilated cardiomyopathy (NIDC). Our aim was to analyze the feasibility of left ventricular strain evaluation using cardiac magnetic resonance feature tracking (FT) in NIDC, and to determine its clinical and prognostic impact. METHODS: We retrospectively included consecutive patients with NIDC who underwent cardiac magnetic resonance. Left ventricular global longitudinal, circumferential and radial strain were obtained from standard cine sequences using FT analysis software. We evaluated their association with a composite endpoint (heart failure, implantable cardioverter-defibrillator in secondary prevention, or death). RESULTS: FT analysis could be performed in all of the 98 patients (mean age 68±13 years, 72% men). Intra- and interobserver concordance was good for global longitudinal and circumferential strain but was worse for radial strain. Global circumferential strain was independently associated (OR, 1.16; P=.045) with LVEF normalization during follow-up and was the only morphological parameter independently associated with the composite endpoint (OR, 1.15; P=.038). A cutoff value <-8.2% was able to predict the incidence of this event during follow-up (log-rank 4.6; P=.032). CONCLUSIONS: Left ventricular strain analysis with FT is feasible and reproducible in NIDC. Global circumferential strain was able to predict LVEF recovery and the appearance of major cardiovascular events during follow-up.

Engrosamiento miocárdico transitorio de la pared posterior en paciente con miopericarditis aguda / Transient myocardial thickening of the posterior wall in a patient with acute myopericarditis

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Cardiopatía de estrés o síndrome de Tako-Tsubo: conceptos actuales / Stress-Related Cardiomyopathy or Tako-Tsubo Syndrome: Current Concepts

El síndrome de Tako-Tsubo, también conocido como cardiopatía de estrés o apical ballooning, representa una entidad recientemente descripta que mimetiza muchas de las características de un síndrome coronario agudo, clínicas, analíticas, electrocardiográficas y ecocardiográficas. La presencia de arterias coronarias sin obstrucciones significativas y la forma típica en la ventriculografía, junto con la ulterior recuperación total del ventrículo apoyan el diagnóstico. Se observa generalmente en mujeres posmenopáusicas y es frecuente la presencia de una situación estresante, tanto física como emocional. El tratamiento, empíricamente, es similar al del infarto agudo de miocardio, con especial atención en la introducción de betabloqueantes y anticoagulación. Aunque durante el momento agudo es una patología no exenta de complicaciones, predominantemente insuficiencia cardíaca, a largo plazo tiene buen pronóstico y su recurrencia es rara. En la presente revisión se discuten estos aspectos, así como la fisiopatología de este síndrome, cuyo diagnóstico es cada vez más frecuente en nuestro medio.

Tako-Tsubo syndrome, also referred to as stress-related cardiomyopathy or apical ballooning syndrome, is a condition that has been recently described mimicking an acute coronary syndrome in its clinical, analytical, electrocardiographic and echocardiographic characteristics. The diagnosis is made on the basis of coronary arteries with absence of significant obstruction, a typical left ventricular shape and complete recovery of ventricular function. This condition occurs mostly in post-menopausal women under some form of physical or mental stress. Treatment is empirical and similar to that of acute myocardial infarction, with special attention in the administration of beta blockers and anticoagulation therapy. Although associated complications, such as heart failure, may occur in the acute phase, its clinical course is favorable and recurrence is exceptional. These features, as well as the pathophysiology of this syndrome that is becoming more frequent in our environment, are discussed in this review.

[Transient left midventricular dyskinesia: clinical features of a new variant]. / Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante.

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in takotsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions.

Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante / Transient Left midventricular dyskinesia: clinical features of a new variant

Presentamos 5 casos consecutivos de discinesia medioventricular transitoria, una variante recientemente descrita de discinesia apical transitoria. Se trata de un síndrome que presenta similitudes con la anterior en cuanto a características clínicas, pronósticas y probablemente etiopatogénicas. Los pacientes, la mayoría en relación con un episodio física o emocionalmente estresante, acudieron a urgencias con un cuadro compatible con infarto agudo de miocardio que incluía discinesia/acinesia de los segmentos medios en la ventriculografía. Las alteraciones ventriculares se resolvieron de manera temprana y completa. Las arterias coronarias no mostraron alteraciones en ningún caso. Su existencia denota que no sólo las porciones apicales, afectas en el síndrome tako-tsubo, pueden alterarse de manera reversible. La aparición de nuevas variantes abre nuevos interrogantes sobre la relación de sistema nervioso, catecolaminas y lesión miocárdica reversible

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in tako-tsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions

[Hepatosplenic and renal embolisms in infective endocarditis]. / Endocarditis infecciosa y embolias del eje hepatoesplenorrenal.

INTRODUCTION AND OBJECTIVES: Among the complications of infective endocarditis, systemic embolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms. MATERIAL AND METHOD: Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304). RESULTS: There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolated in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death. CONCLUSIONS: Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death.

Endocarditis infecciosa y embolias del eje hepatoesplenorrenal / Hepatosplenic and Renal Embolisms in Infective Endocarditis

Introducción y objetivos. Dentro de las complicaciones de la endocarditis infecciosa, la embolia sistématica constituye un evento ominoso respecto al pronóstico final. El objetivo de este estudio es analizar las características demográficas, clínicas y microbiológicas de los episodios de endocarditis que cursan con embolias en el bazo, el hígado o el riñón y compararlas con los que no las presentan. También se ha querido conocer el impacto pronóstico de estas embolias. Material y método. Estudio de cohorte clínica prospectivo, multicéntrico. Se han analizado 338 episodios consecutivos de endocarditis izquierda en 308 pacientes, clasificados en 2 grupos: grupo I, episodios con embolias hepatoesplenorrenales (n = 34); y grupo II, episodios sin estas embolias (n = 304). Resultados. Se documentaron 41 embolias en 34 episodios (10%): 34 embolias en el bazo, 5 en el riñón y 2 en el hígado. Ciertas formas de presentación clínica fueron más frecuentes en el grupo I: dolor abdominal, esplenomegalia, hematuria, manifestaciones cutáneas, embolia en otras localizaciones y shock séptico. Staphylococcus aureus y enterococos se aislaron con más frecuencia en el grupo I que en el grupo II. La detección de vegetaciones mediante eco- cardiograma transesofágico fue más frecuente en el grupo I, y tenían un tamaño mayor. La presencia de embolias hepatoesplenorrenales no se asoció de forma independiente a la necesidad de cirugía ni al riesgo de mortalidad. Conclusiones. Las embolias hepatoesplenorrenales aparecen en un 10% de los episodios de endocarditis izquierda, con una forma de presentación clínica característica. Las vegetaciones en estos episodios son de mayor tamaño que en los demás. Su presencia no incrementa la necesidad de cirugía ni el riesgo de muerte (AU)

Introduction and objectives. Among the complications of infective endocarditis, systemic enbolisms are an ominous prognostic sign. The aim of the present study was to compare the demographic, clinical, microbiologic and echocardiographic features of episodes of endocarditis accompanied and unaccompanied by embolisms in the spleen, kidney or liver. We also assessed the prognostic impact of these embolisms. Material and method. Prospective, multicenter clinical cohort study. We analyzed 338 consecutive episodes of left-sided infective endocarditis in 308 patients. Episodes were classified in two groups: group I, episodes with hepatosplenic or renal embolisms (n=34); group II, episodes without embolisms (n=304). Results. There were 41 embolisms in 34 episodes (10%). Of these, 34 were located in the spleen, 5 in the kidney and 2 in the liver. Some forms of clinical presentation predominated in group I, e.g., abdominal pain, splenomegaly, cutaneous stigmata, hematuria, embolisms in other locations, and septic shock. Staphylococcus aureus and enterococci were more commonly isolted in group I. Detection of vegetations (by transesophageal echocardiography) was more frequent in group I, and they were larger than vegetations in group II. Hepatosplenic and renal embolisms were not independently associated with the need for cardiac surgery or death. Conclusions. Hepatosplenic and renal embolisms occur in 10% of left-sided episodes of infective endocarditis. The clinical presentation of these episodes has characteristic features. Vegetations are larger than in episodes without these embolism. Hepatosplenic and renal embolisms do not increase neither the need of cardiac surgery nor the risk of death (AU)