Comparison of Noninvasive Cardiac Test Strategies for Newly Diagnosed Chagas Disease in a Non-Endemic Zone.

Chagas disease is an emerging infectious disease in Europe and other non-endemic areas, mainly owing to migration from endemic areas. We aimed at investigating the value of advanced echocardiography (ECHO) and cardiac magnetic resonance (CMR) in patients newly diagnosed with Chagas disease to compare findings with those of electrocardiogram (ECG) and conventional ECHO and thus detecting cardiac abnormalities. We included consecutive patients with newly diagnosed Chagas disease and registered cardiac test results (ECG, ECHO, and CMR). We divided ECHO parameters into three tiers: 1) left ventricular ejection fraction, regional wall motion abnormality, and left ventricular diastolic dimension (ECHO-1); 2) other common ECHO parameters (ECHO-2); and 3) global longitudinal strain (GLS) (ECHO-3). Cardiac magnetic resonance included global and segmental biventricular function, the presence of myocardial fibrosis, and edema. The study comprised 100 patients from South America. The mean age was 43.9 ± 0.9 years, and 66% were women. Mean time living in Spain was 9.7 ± 0.5 years. The ECG revealed ≥ 2 abnormal findings in 47% of patients. ECHO-1 was abnormal in 22% of patients, ECHO-2 in 52%, and GLS in 16%. Cardiac magnetic resonance was abnormal in 50% of cases, and in 3% of these, ECHO was normal. When ECG and conventional ECHO were taken together, abnormalities were detected in 83% of patients. This value increased to 86% and 92% for GLS and CMR, respectively. These findings suggest that ECG and conventional ECHO should be used routinely as standard cardiac tests for newly diagnosed cases of Chagas disease. The value of advanced ECHO techniques and CMR is low.

Respuesta al ECG de junio de 2018 / Response to ECG, June 2018

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ECG de junio de 2018 / ECG, June 2018

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Obstrucción coronaria durante el implante percutáneo de válvula aórtica: ¿relacionada con calcificación o con trombo? Respuesta / Coronary obstruction during transcatheter aortic valve replacement: related to calcification or thrombus? Response

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Un caso inusual de insuficiencia tricúspide / An unusual case of tricuspid regurgitation

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Tromboembolia coronaria durante implante percutáneo de prótesis aórtica / Coronary thromboembolism during transcatheter aortic valve replacement

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Utility of intracardiac echocardiography for catheter ablation of complex cardiac arrhythmias in a medium-volume training center.

AIMS AND OBJECTIVES: New electrophysiology tools like intracardiac echocardiography (ICE) might help to minimize and early detect complications during cardiac ablation procedures. The aim of the study was to assess the utility and vascular safety of ICE during catheter ablation of complex cardiac arrhythmias in a medium-volume training center. METHODS: Prospective, observational study consisted of consecutive patients who underwent catheter-based ablation of complex cardiac arrhythmias. All procedures were performed using three-dimensional electro-anatomical mapping and routine cannulation of right and left femoral veins. The ICE probe was initially positioned at the mid-level of the right atrium and properly moved to monitor different steps of the procedure and identify complications. All procedure-related vascular complications were registered. RESULTS: One hundred two patients (age 61.4 ± 13.1 years, 69 male) underwent 110 ablation procedures. Pulmonary vein isolation was the most common ablation substrate (55.4%). Ventricular tachycardia (17.2%) and left atrial flutter procedures (16.4%) were also common. The use of ICE enabled us to early initiate anticoagulation and to optimize the transseptal puncture. It also provided the capability to early detect life-threatening complications such as tamponade (3.6%), along with important information during the procedure such as exact catheter location, lesion formation, and stability during radiofrequency delivery. Such benefits were not associated with a higher number of vascular complications. CONCLUSION: The use of ICE during catheter-based ablation of complex cardiac substrates provides technical features that may decrease complications and increase accuracy while applying radiofrequency, especially in training centers where fellows start to perform complex procedures.

Pericardiotomía percutánea con balón como tratamiento inicial del derrame pericárdico grave de origen tumoral / Percutaneous balloon pericardiotomy as the initial and definitive treatment for malignant pericardial effusion

Introducción y objetivos. El derrame pericárdico tumoral presenta una elevada tasa de recurrencia tras la pericardiocentesis. Se busca confirmar la eficacia de la pericardiotomía percutánea con balón como tratamiento inicial de elección de estos derrames. Métodos. Análisis retrospectivo de las características clínicas, ecocardiográficas y evolutivas de una serie monocéntrica y consecutiva de pericardiotomías percutáneas con balón en pacientes con enfermedad oncológica avanzada. Resultados. Se han realizado 17 pericardiotomías percutáneas con balón en 16 pacientes (media de edad, 66,2 ± 15,2 años); 14 pacientes tenían confirmación anatomopatológica de enfermedad neoplásica metastásica; 3 habían requerido una pericardiocentesis previa, mientras que en los restantes la pericardiotomía percutánea con balón fue la primera intervención sobre el derrame. Todos los casos presentaban derrame circunferencial grave, y la mayoría tenían datos ecocardiográficos de compromiso hemodinámico. El éxito inicial se logró sin complicaciones agudas y con buena tolerancia en un primer intento. Durante el seguimiento (mediana, 44 [intervalo intercuartílico, 36-225] días) tampoco hubo complicaciones infecciosas. En 1 paciente se demostró la aparición de un derrame pleural significativo, que no precisó tratamiento. Fue necesario realizar una reintervención sobre el pericardio en 3 pacientes: dos ventanas pericárdicas quirúrgicas programadas y una segunda pericardiotomía percutánea con balón. Conclusiones. La pericardiotomía percutánea con balón es un técnica sencilla y segura que puede resultar eficaz en un gran número de pacientes con derrame pericárdico tumoral grave para evitar que recurra. Por sus características, resultaría de especial utilidad en este grupo de pacientes para evitar abordajes más agresivos y peor tolerados (AU)

Introduction and objectives. Malignant pericardial effusion has a high recurrence rate after pericardiocentesis. We sought to confirm the efficacy of percutaneous balloon pericardiotomy as the initial treatment of choice for these effusions. Methods. Retrospective analysis of the clinical, echocardiographic, and follow-up characteristics of a consecutive series of percutaneous balloon pericardiotomies carried out in a single center in patients with advanced cancer. Results. Seventeen percutaneous balloon pericardiotomies were performed in 16 patients with a mean age of 66.2 (15.2) years. Fourteen patients had pathologically confirmed metastatic neoplastic disease, 3 had previously required pericardiocentesis, and in the remaining patients percutaneous balloon pericardiotomy was the first treatment for the effusion. All patients had a severe circumferential effusion, and most presented evidence of hemodynamic compromise on echocardiography. In all cases, the procedure was successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications during follow-up (median, 44 [interquartile range, 36-225] days). One patient developed a large pleural effusion that did not require treatment. Three patients needed a new pericardial procedure: 2 had elective pericardial window surgeries and 1 had a second percutaneous balloon pericardiotomy. Conclusions. Percutaneous balloon pericardiotomy is a simple, safe technique that can be effective in the prevention of recurrence in many patients with severe malignant pericardial effusion. The characteristics of this procedure make it particularly useful in this group of patients to avoid more aggressive, poorly tolerated approaches (AU)

Triple therapy with darbepoetin alfa, idebenone, and riboflavin in Friedreich's ataxia: an open-label trial.

Minimal objective evidence exists regarding management of Friedreich's ataxia (FRDA). Antioxidant and recombinant human erythropoietin therapies have been considered potential treatments to slow progression of FRDA in a small number of studies. The primary objective of the current study was to test the efficacy, safety, and tolerability of triple therapy-darbepoetin alfa, idebenone, and riboflavin-in FRDA in a clinical pilot study. Patients included in this study were nine females, 16 to 45 years of age (average 28 ± 8), diagnosed with FRDA with confirmed GAA repeat expansion mutations in the FXN gene and a GAA repeat ≥400 on the shorter allele. Patients had a baseline score between 8 and 28.5 (average 20.7 ± 8.3) on the scale for the assessment and rating of ataxia and 94.3 ± 27.2 g/m(2) in left ventricular mass index (LVMI). Patients had been treated with triple therapy with 150 µg darbepoetin alfa every 2 or 3 weeks, 10-20 mg/kg/day idebenone, and 10-15 mg/kg/day riboflavin for 32 ± 19.4 months (range of 8-56 months). Triple therapy was tolerated. Although not statistically significant, improvement of ataxia was observed during the first six 4-month periods of the study. Furthermore, a small decrease in disease progression during the first 2 years of treatment was observed. Long-term statistically nonsignificant improvement of LVMI and stability of the echocardiographic parameters could be considered. Triple therapy may slow disease progression of FRDA.

Left atrial myxofibrosarcoma: Diagnostic approach through imaging techniques.

Primary cardiac sarcomas are rare. A 63-year-old woman presented with progressive symptoms of fatigue, palpitations, and dyspnea. Transthoracic echocardiography detected a mass in the left atrium, fixed and probably attached to the interatrial septum suggestive of myxoma. Transesophageal echocardiography confirmed the existence of a large lobulated mass in the left atrium measuring 45 mm × 25 mm in diameter. Subsequent cardiac magnetic resonance imaging showed a mass of heterogeneous appearance, with broad base of implantation on the posterior wall of the left atrium. The extension study with multidetector computed tomography showed superficial infiltration of the atrial wall, without involvement of the mitral valve or pulmonary veins and no extension to other extracardiac structures. The patient underwent surgery resecting a bilobed mass, smooth and yellowish, strongly attached to the posterior wall of left atrium. The pathologic study was consistent with the diagnosis of myxofibrosarcoma. .