Double Connection of Left-Sided Partial Anomalous Pulmonary Vein Return in a Young Man.

Double connection of partial anomalous pulmonary venous return is a very rare congenital anomaly where at least one pulmonary vein, but not all, drains into the left atrium and systemic venous circulation with subsequent left to right shunt.

Sudden Cardiac Arrest as first Manifestation of Malignant Mitral Valve Prolapse in a Young Patient: A Case Report and Review of the Literature.

Mitral valve prolapse (MVP) is a primary valvular disease of the mitral valve with a prevalence of 2.4% of the general population. Valve abnormalities range from simple fibroelastic deficiency of the leaflets to diffuse myxomatous degenerative changes. MVP is a usually a benign condition. However, the scattered reports of sudden cardiac death in patients with MVP in the absence of severe mitral insufficiency or coronary artery disease suggest the existence of a malignant phenotype of MVP. We report a case of a young female who survived life-threatening arrhythmias and cardiac arrest and was found to have characteristic features of the malignant phenotype of MVP and had an implantable cardioverter defibrillator as a secondary prevention. LEARNING POINTS: Malignant MVP may be associated with life-threatening arrhythmias and sudden cardiac death.MVP is not always a benign condition, and physicians should be aware of the diagnostic criteria for malignant MVP.Echocardiography and cardiac magnetic resonance are crucial diagnostic methods to detect signs suggestive of malignant MVP.

Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor?

Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = - 0.73) and MVA (r = - 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = - 0.62), LAV (r = - 0.65), LAVI (r = - 0.56), E (r = - 0.46), A (r = - 0.3), and PAP (r = - 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.

Novel echocardiographic parameters in pulmonary hypertension assessment and the relationship between echocardiography and 6-minute walking test.

Pulmonary artery stiffness (PAS) has been shown to be related to pulmonary artery pressure in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. This cross-sectional study was performed on patients with PAH who were confirmed by right heart catheterization and referred to Imam Reza PAH clinic for routine follow-up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow, and velocity time integral, as well as PAS, were measured. All patients performed a 6-minute walk test. Fifty patients with a mean age of 41.90 ±â€…14.73 years old participated in this study. The majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and pulmonary artery systolic pressure (r = 0.302, P = .041), second pulmonary valve pulse Doppler velocity (V2) (r = -0.461, P = .003), time from onset of pulmonary flow ejection to V2/first pulmonary valve pulse Doppler velocity (r = -0.311, P = .037) and Z3 ratio (r = -0.346, P = .023). There was no significant correlation between PAS and 6-minute walk test, pulmonary vascular resistance, and tricuspid annular plane systolic excursion (P > .05). There was a significant correlation between V2 and pulmonary vascular resistance (r = 0.359, P = .049). PAS and first pulmonary valve pulse Doppler velocity are simple, noninvasive, available tools for the evaluation of pulmonary vascular beds and diagnosis of presymptomatic clinical status in patients with PAH.

Coronary Cameral Fistula Manifested as Angina Pectoris in a 40-Year Old Female.

Coronary cameral fistula (CCF) is defined as an abnormal connection between the coronary artery and any cardiac chamber. It usually appears due to abnormal embryogenesis and represents less than 1% of the population. Most CCF cases are asymptomatic, however large CCFs may cause symptoms and complications. We present a case of a young female with symptomatic CCF suspected on echocardiography and confirmed by computed tomography coronary angiography. She was successfully treated surgically with total improvement of symptoms. LEARNING POINTS: Coronary cameral fistula (CCF) is an abnormal communication between the coronary arteries and cardiac chambers. Most fistulas are asymptomatic, however, large CCFs can cause symptoms.CCF can cause angina pectoris due to the coronary steal phenomenon, and may require surgical intervention.Coronary computed tomography angiography is a highly sensitive method for detecting coronary artery fistulas noninvasively.

Recurrent High-Risk Pulmonary Thromboembolism Treated with Repeated Thrombolytic Therapy Could be Helpful for Certain Patients: A Case Report and Review of the Literature.

Acute pulmonary thromboembolism (PTE) is considered the third most frequent acute cardiovascular syndrome behind myocardial infarction and stroke, with annual incidence rates ranging from 39 to 115 per 100,000 people and ranking high among the causes of cardiovascular mortality. High-risk PTE is characterised by haemodynamic instability and encompasses clinical manifestations such as cardiac arrest, obstructive shock and persistent hypotension. The European Society of Cardiology (ESC) recommends a reperfusion strategy with systemic thrombolytic therapy for high-risk PTE under class I, level B if there are no contraindications. Overall, unsuccessful thrombolytic therapy and recurrent PTE have been reported in 8% of patients with high-risk PTE. The guidelines recommend surgical pulmonary embolectomy if thrombolysis is contraindicated or has failed. The position of repeated thrombolytic therapy as a treatment option in patients with recurrent high-risk PTE, especially in situations with a lack of surgical expertise or resources, was not mentioned in the guidelines. We report the case of a patient who suffered a recurrent high-risk PTE and was treated with repeated thrombolytic therapy that was effective and resulted in excellent outcomes. LEARNING POINTS: Acute pulmonary thromboembolism (PTE) is a serious medical condition and widespread disease with well-recognised morbidity and mortality.Systemic thrombolytic therapy should be the first choice in patients with high-risk PTE without contraindication.Repeated thrombolytic therapy in recurrent high-risk PTE might be effective in patients with low risk of bleeding as an alternative to surgical embolectomy or catheter-directed therapy.

Spontaneous Recovery of Isolated Advanced Heart Block in Patient with Celiac Disease by Starting a Strict Gluten Free Diet: A Case Report and Review of the Literature.

Cardiac conduction disorder may have a wide range of aetiology and can manifest with symptomatic bradycardia and syncope. Celiac disease is a malabsorptive long-term autoimmune disorder where the small intestine is the primarily affected organ due to gluten intolerance in genetically predisposed individuals. The associations between celiac disease and cardiac pathology are uncommon. We report a case of a 50-year-old woman with a known case of celiac disease who presented with a symptomatic cardiac conduction abnormality that improved with a gluten-free diet. LEARNING POINTS: Celiac disease is a malabsorptive long-term autoimmune disorder where the small intestine is the primarily affected organ due to gluten intolerance and affects 1% of the general population.Cardiovascular pathology, including dilated cardiomyopathy, myocarditis, arrhythmias, and premature atherosclerosis, was found to be more prevalent in patients with celiac disease than in others without celiac disease.The association of celiac disease with isolated advanced atrioventricular conduction abnormality is rare and a gluten-free diet may help improve the conduction abnormality.

Angina Pectoris as a Manifestation of ALCAPA Syndrome in a 20-Year-Old Female: A Case Report and Review of Literature.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is considered a rare congenital heart disease where the take-off of the left coronary artery abnormally originates from the pulmonary artery instead of left aortic sinus. It is associated with a high mortality rate in the first year of life and sudden death in adults if left untreated. We report an adult form of ALCAPA syndrome in a 20-year-old female who presented with anginal pain for the previous few months. Unfortunately, the patient was hesitant to have surgery at the time. LEARNING POINTS: The abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare and potentially fatal coronary congenital disease, accounting for 0.5% of all congenital heart diseases; it is associated with poor outcomes if left untreated.ALCAPA is classified into infantile and adult forms. The prevalence of adult individuals with ALCAPA syndrome has significantly increased as a result of recent developments in non-invasive cardiac imaging.The prevalence of sudden mortality in childhood and the early stages of adulthood makes surgery the preferred treatment, and coronary reimplantation surgery is considered the surgical procedure of choice.

Evaluation of blood pressure response during dobutamine stress echocardiography in patients without cardiovascular diseases.

Dobutamine stress echocardiography (DSE) is a diagnostic tool for determining coronary artery disease. Considering hypotension and hypertension as important complications of DSE, we aimed to evaluate the blood pressure (BP) responses during DSE. Patients without known cardiovascular diseases who underwent DSE were included. We excluded patients who had hypertension, diabetes mellitus, a known history of cardiovascular diseases, and those taking vasoactive medications. Systolic (SBP) and diastolic (DBP) blood pressure were recorded at baseline and peak stress. We included 688 patients with an age of 57.9 ± 12.01 years. During DSE, SBP (+19.72 ± 26.51 mm Hg, p < 0.001), DBP (+5.52 ± 17.35 mm Hg, p < 0.001), and HR (+54.05 ± 22.45 bpm, p < 0.001) significantly increased from baseline to peak stress. The normal cut-off value was measured between 101-210 mm Hg for SBP and 50-121 mm Hg for DBP. According to this normal cutoff, 11 (1.3%) and 30 (4.4%) patients had hypotensive and hypertensive SBP and 15 (2.2%) and 21 (3.1%) patients had hypotensive and hypertensive DBP, respectively. The hypotensive response was correlated with baseline SBP (r = 0.6, p = 0.001) and atropine (r = -2.18, p = 0.043), and the hypertensive response was correlated with baseline SBP (r = 0.048, p < 0.001). Baseline BP and atropine consumption were the independent variables associated with the outside-the-normal range of blood pressure responses.

Comparison of echocardiographic pulmonary flow Doppler markers in patients with massive or submassive acute pulmonary embolism and control group: A cross-sectional study.

Background and Aims: Computed tomography angiography (CTA) is the gold standard for the diagnosis of massive (MPE) and submassive pulmonary embolism (SMPE). Ultrasound has not been accepted as a diagnostic tool. We aim to evaluate the pattern of pulmonary Doppler echocardiography in patients with pulmonary embolism (PE). Methods: From 2020 to 2022, 30 patients with acute MPE or SMPE confirmed by CTA and normal pulmonary pressures were selected. A control group was created with 30 individuals without PE. All patients had an echocardiography Doppler study of the pulmonary flow with a focus on early systolic notching (ESN), McConnell's (MC) sign, Right ventricular outflow tract velocity time integral (RVOT VTI), segmental thickness variability (STV), right ventricular end-diastolic diameter (RVEDD), tricuspid regurgitation (TR) gradient, pulmonary artery pressure (PAP), and acceleration (AT) or ejection time (ET). Results: ESN was identified in 96.6% of PE patients and 0% of the control group (p < 0.001). In comparison with the control group, STV (p < 0.001), RVOT VTI (p < 0.001), ET (p = 0.04), and AT (p < 0.001) values were lower in patients with PE while RVEDD, TR gradient, PAP, ESN, MC sign, and d-shape were higher (p < 0.001). Identification of the ESN pattern and AT/ET < 0.4 showed excellent predictive ability for MPE and SMPE with a sensitivity of 97.0% and 100%, specificity of 99.0% and 97%, and an area under the ROC curve of 0.967 (95% CI 0.914-1.00) and 0.933 (95% CI 0.844-1.00), respectively. Conclusion: Doppler echocardiography with particular attention to ESN, may be a suitable noninvasive method for the diagnosis of MPE and SMPE. Further studies with more sample sizes are needed to confirm its diagnostic benefit.

Cardiac Hydatid Disease with Palpitations as the Only Presenting Complaint: The Egg in the Nest.

Hydatid disease, also known as cystic echinococcosis, is a parasitic infection caused by the larval stage of Echinococcus granulosus. It usually invades organs such as the liver and the lungs but can affect any organ. Isolated cardiac involvement is a rare manifestation. We present a case of isolated left ventricle hydatid cyst with negative serological tests, which was treated with surgical removal and confirmed by histopathological examination. LEARNING POINTS: Isolated cardiac hydatid disease is rare and accounts for only 0.5-2% of cases among infected patients.Cardiac hydatidosis may present with a wide variety of clinical manifestations ranging from no symptoms to sudden death; palpitations may be the only complaint.Surgical excision is the treatment of choice for cardiac hydatid disease to avoid high-risk complications.

Successful Thrombolytic Therapy Using Ultraslow Low-Dose Infusion During Pregnancy for Mitral Mechanical Valve Thrombosis: A Case Series and Review of the Literature.

According to the modified World Health Organization (WHO) classification, pregnant women with mechanical valves face a very high risk of complications (Risk Category III). Mechanical valve thrombosis is a serious complication that significantly increases during pregnancy due to multiple mechanisms. Thrombolytic therapy has recently been used as a first-line treatment for mechanical valve thrombosis during pregnancy. However, the consensus regarding the optimal treatment strategy, type, dose and route of administration was unclear. We present three cases of mechanical mitral valve thrombosis during pregnancy treated successfully with repeated doses of ultraslow infusion of low-dose tissue-type plasminogen activator (t-PA) alteplase. We also present a review of the literature on this subject. LEARNING POINTS: Pregnancy in women with mechanical heart valves significantly increases the risk of maternal mortality or severe morbidity.Non-compliance with anticoagulant therapy and/or less frequent monitoring of therapeutic levels during pregnancy can result in serious complications such as valve thrombosis and thromboembolism.Thrombolytic therapy with low-dose tissue-type plasminogen activator can be an attractive alternative to surgical valve replacement and medical treatment in appropriately selected pregnant women with thrombosis of a mechanical valve.

A PREGNANT WOMAN WITH AN EXTRA CARDIAC CAVITY: AN ACQUIRED IATROGENIC COMPLICATION - A CASE REPORT AND LITERATURE REVIEW.

According to the modified World Health Organization (WHO) classification, mechanical valves pose a high maternal risk and complications for pregnant women with heart disease. Left atrial appendage aneurysm (LAAA) is a rare condition that can manifest clinically in several ways or remain silent for a long time and can be either congenital or acquired. We present the case of a pregnant woman who had a LAAA discovered several years after her last mitral valve replacement. LEARNING POINTS: Left atrial appendage aneurysm is a rare entity and, in most cases, is congenital due to poor myocardial contractility of dysplastic pectinate muscles.Clinical manifestations range from an asymptomatic course with an incidental finding on echocardiography up to serious sequelae such as cardioembolic manifestations.The treatment approach includes a conservative strategy using anticoagulation and a surgical strategy with aneurysmectomy.

Antioxidant activity in off and on-pump coronary artery bypass grafting and valve replacement surgery.

OBJECTIVES: Cardiac surgeries initiate oxidative stress, increasing organ dysfunction development and mortality. The present study investigated the superoxide dismutase (SOD) activity, as an antioxidant enzyme, in patients undergoing coronary artery bypass (CABG) and heart valve replacement surgeries. METHODS: A prospective study was performed on patients with proven coronary artery disease (CAD) or valvular heart disease (VHD) candidates for on- or off-pump CABG and valve replacement surgery. Serum SOD activity was measured preoperatively, at 24 h postoperatively, and at the time of discharge. In addition, echocardiography was performed before surgery and at discharge. RESULTS: A total of 48, 51, and 47 patients were enrolled in the on-pump, off-pump CABG, and valve replacement groups, respectively. Baseline serum SOD activity showed no significant association with BMI, age, and blood pressure in either CAD or VHD patients. The SOD values decreased at the 24 h postoperative time and then increased at the time of discharge in all groups, except for a slight decrease in the on-pump group. The changes in serum SOD values were not significantly different for the three surgical groups. CONCLUSIONS: The serum SOD activities fell significantly after CABG and valve replacement surgery. Further investigation is emphasized for the role of SOD in oxidative stress after cardiac surgery.

Changes in serum zinc and copper concentrations in patients with cardiovascular disease following cardiac surgery.

The trace elements copper (Cu) and zinc (Zn) are essential for maintaining oxidative balance, and cardiac surgery is known to provoke an increase in oxidative stress. We investigated the variations in serum Zn and Cu concentrations before and after surgery in patients undergoing on- and off-pump CABG and heart valve replacement. We performed a prospective study on patients undergoing on- or off-pump CABG, or heart valve replacement surgery (48, 51, and 47 patients, respectively). Venous blood samples were obtained, and serum Cu and Zn concentrations were measured preoperatively, 24 h postoperatively, and the time of discharge. In addition, echocardiography was carried out on all patients before surgery and again on the day of discharge. We found the temporal changes in Cu, Zn, and Zn/Cu ratio were significantly different in all three groups of surgery (p < 0.05). In each group, Cu and Zn values and Zn/Cu ratio decreased at the 24-h postoperative time and rose at the discharge time. There were no significant differences between surgery groups in the changes induced in Zn or Cu values (p > 0.05). In conclusion, the concentrations of Cu and Zn were markedly reduced after on- and off-pump CABG and valve replacement surgery. This may suggest that supplementary Zn and Cu administration could be beneficial during open-heart surgeries. However, more long-term studies with more patients are needed to confirm this hypothesis.

The effects of low-dose anthracycline-based chemotherapy on the levels of serum NT-proBNP level and left ventricular systolic and diastolic dysfunctions: A prospective observational study.

Background and Aims: The present study aimed to evaluate the relationship between serum N-terminal (NT)-pro-brain natriuretic peptide (BNP) levels and incidence of left ventricular (LV) systolic and diastolic dysfunction in patients who underwent low-dose anthracycline chemotherapy. Methods: This observational, prospective study was conducted on all patients with proven breast cancer, Hodgkin lymphoma, or non-Hodgkin lymphoma and no history of previous cardiac or any chronic diseases who were candidates for low-dose anthracycline chemotherapy from March 2017 to February 2018. We evaluated the serum NT-proBNP level and performed trans-thoracic echocardiography at baseline, 6, and 9 months after the chemotherapy. Results: Among 57 patients who successfully finished the study, 13 (22.8%) patients were men and 44 (77.19%) patients were women, and the total mean age was 52 ± 14.86 years. Our results revealed that the LV systolic and diastolic function and NT-proBNP mean levels were in the normal range at all three measured times. Additionally, no significant differences were observed between the levels of NT-proBNP, LV systolic, and diastolic function at baseline, 6, and 9 months after chemotherapy with low-dose anthracycline (p = 0.6, 0.1, and 0.4, respectively). Conclusion: Following low-dose anthracycline chemotherapy, none of our patients encountered LV systolic and diastolic dysfunctions and changes in serum NT-proBNP level. However, further studies with a larger population, longer follow-up duration, and higher dosage of anthracyclines are required to determine the effects of low-dose anthracycline on NT-proBNP level and LV systolic and diastolic functions.

A comparative study on the results of beating and arrested heart isolated tricuspid valve surgery: A cross-sectional study.

Background and Aims: The isolated tricuspid valve surgery is performed using beating or arrested heart surgery. The present study aimed to evaluate and compare the results of patients who underwent isolated tricuspid valve surgery using the beating and arrested heart techniques. Methods: In this retrospective observational study, all patients undergoing isolated tricuspid valve surgery between 2011 and 2018 were included. The patient's demographic information, echocardiographic, surgery, and hospitalization results were collected, and the EuroSCORE was calculated from the patient's medical records. Results: Fifty-three patients were included in the study of which 21 (39.63%) and 32 (60.37%) underwent a beating heart and arrested heart surgeries, respectively. There were no significant differences between the two studied groups in the echocardiographic results before and after the surgery, total hospitalization days (p = 0.56), and the mortality in the first 30 days after the surgery (p = 0.152). However, the duration of surgery (p < 0.001), EuroSCORE (p = 0.005), and patients who underwent lateral thoracotomy (p = 0.007) were notably lower in the arrested heart than in the beating heart group. In contrast, the duration of cardiopulmonary bypass and hospitalization in an intensive care unit after the surgery was remarkably lower in the beating heart than in the arrested heart group (p < 0.001 for both cases). Conclusion: Although there were some significant differences between the two kinds of surgery techniques, it seems superficial that made a particular decision to consider each method's superiority. Therefore, further studies with larger populations and meta-analyses are required to recommend the preferred method for the surgeons certainly.

Infective Endocarditis: Clinical Characteristics and Echocardiographic Findings.

Purpose: Infective endocarditis (IE) remains a disease with high morbidity and mortality. The aim of this study was to determine the clinical characteristics and echocardiographic features of patients with IE. Methods: We analyzed patients with either definitive or probable diagnosis of IE who were hospitalized in a teaching hospital in Mashhad, Iran between June 2011 and January 2020. Patients who survived were followed up by echocardiography for at least 6-month after hospital discharge. Results: A total of 82 cases with IE were included of which 62 (75.6%) received definitive diagnosis. The mean age was 39.7 ± 18.7 years and 52 (63.4%) were male. The most common preexisting structural cardiac abnormality that predispose patients to IE were congenital heart diseases (28 %) of which bicuspid aortic valve was more common (n = 12, 14.6%), followed by ventricular septal defect (n = 9, 11%) and Tetralogy of Fallot (TOF) (n = 2, 2.4%). Three (3.6 %) cases had rheumatic heart disease and 12 (14.6 %) were injecting drug users. The most common causative pathogen was Staphylococcus aureus, detected in 7 (19.4%) cases. Follow-up echocardiography revealed right or left ventricular failure in 10 (12.1%) cases. Cardiac complications occurred in 41 (50%) cases and systemic complications in 63 (76.8%). All-cause mortality was 41.5% (n = 34) and 6 (18.1%) patients died due to cardiovascular complications. Conclusions: The short- and long-term prognosis in IE was poor and the predictors for in-hospital and 1-year mortality were defined as heart failure and septic shock. Congenital heart disease and intravenous illicit drug using (IVDU) were the most common predisposing condition which may necessitate a revision in the IE prophylaxis recommendations.

Assessment of functional and structural echocardiography parameters in patients with frequent premature ventricular contractions without structural heart disease.

BACKGROUND: Premature ventricular contractions (PVCs) are early depolarizations of the myocardium which originate from the ventricle. PVCs have previously been considered a benign condition. The clinical significance of PVCs in patients without structural heart disease is controversial. METHODS: In this cross-sectional study, patients with a palpitation complaint who underwent electrocardiography (ECG) Holter recording for 48 hours were analyzed. Patients with frequent PVCs (more than ten times in 1 hour) were identified and enrolled in the study. 26 patients were in the PVC group, and 26 patients were in the control group without PVC. The identified patients underwent an echocardiographic examination with strain modality. RESULTS: There were 15 women (57.7%) in the PVC group and 17 women (65.4%) in the control group (P = 0.57). Two patients in the PVC group and three patients in the control group were hypertensive (P > 0.99). There was only one patient with diabetes in PVC and control group (P > 0.99). There were two smokers in the PVC group, whereas there was no smoker in the control group (P = 0.49). In comparison between two groups, patients with frequent PVCs had significantly larger left ventricular end-diastolic volume index (LVEDVI) (P = 0.048) along with lower left ventricular ejection fraction (LVEF) (P = 0.011), lower (more positive) left ventricular global longitudinal strain (LVGLS) (P = 0.001), and lower peak systolic mitral annular velocity (S') (P = 0.045). The left atrial volume index (LAVI) was significantly larger in the PVC group (P = 0.001). In speckle tracking echocardiography (STE) parameters, global peak atrial longitudinal strain (PALS) (P = 0.001) and peak atrial contraction strain (PACS) (P = 0.001) were significantly lower and time to peak longitudinal strain (TPLS) (P = 0.002) was significantly higher in the PVC group. CONCLUSION: In this study, left atrial (LA) and left ventricular (LV) function and geometry were adversely affected by frequent PVCs. Early diagnosis of these effects is possible with echocardiography along with strain analysis. It can guide the timely treatment of PVC to avoid the harmful effects of frequent PVCs on the heart.

Echocardiographic parameters in patients with and without hypotension during dialysis.

Introduction: Hypotension during dialysis is a common complication of hemodialysis and is associated with increased patient mortality and morbidity. Intradialytic hypotension is a decrease in systolic BP ≥20 mm Hg or a reduction in mean arterial pressure by 10 mm Hg along with clinical events and the need for correction. This study compares cardiac function, using transthoracic echocardiography with strain modality in patients with intradialytic hypotension with those without hypotension during dialysis. Methods: We studied 60 patients with chronic renal failure undergoing regular hemodialysis from April 2018 to February 2019. We compared thirty patients in the intradialytic hypotension group, with the remaining 30 patients in the control group. We did transthoracic echocardiography a day after hemodialysis using conventional, tissue doppler, and strain imaging. Results: Early diastolic mitral annulus velocity (e') was lower in the intradialytic hypotension group in comparison with the control group which their difference was statistically significant (5.540 ± 1.51 versus 6.920 ± 1.98, P value:0.007) Left Ventricular Ejection Fraction (LVEF) was also significantly lower in the intradialytic hypotension group (51.07 ± 8.714 versus 59.43 ± 4.133, P value < 0.001). Global Longitudinal Strain (GLS) was significantly lower in the intradialytic hypotension group (-14.17 ± 2.79 versus -18.99 ± 2.25, P value < 0.001). The receiver operator characteristics (ROC) curve point-coordinates that GLS of -16.85 and lower (more positive) has 83% sensitivity and 87% specificity for intradialytic hypotension. Conclusion: The echocardiographic assessment could be used as a tool for the prediction of hypotension during dialysis.