RESUMEN
PURPOSE: We aimed to explore the hypothesis that early subclinical cardiac chamber dysfunction secondary to tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma could be signaled by abnormal cardiac mechanics demonstrated by velocity vector imaging. METHODS: Echocardiographic images were acquired from the apical views in 23 metastatic renal cell carcinoma patients. All patients had baseline and at least a 3-month follow-up echocardiogram after receiving TKI therapy. Subendocardial borders of all the cardiac chambers were traced to obtain volumetric and deformation indices. RESULTS: Mean age was 67 ± 9 years with 92% men. The right ventricle peak systolic global longitudinal strain (GLÉ) and strain rate were significantly lower after TKIs (-23.49 ± 5.1 versus -19.81 ± 5.5, p = 0.002 and -1.52 ± 0.52 versus -1.24 ± 0.35 p = 0.02, respectively). LV GLÉ was not statistically different. Volumetric and deformation indices showed a minimal decrease of the right atrium reservoir and conduit functions, and no significant changes of left atrial function. CONCLUSIONS: The right heart exhibited greater strain changes than the left heart after TKI treatment. The implications of these findings and their potential significance warrant further work.
Asunto(s)
Carcinoma de Células Renales/tratamiento farmacológico , Ecocardiografía/métodos , Atrios Cardíacos/fisiopatología , Ventrículos Cardíacos/fisiopatología , Neoplasias Renales/tratamiento farmacológico , Inhibidores de Proteínas Quinasas/efectos adversos , Disfunción Ventricular/inducido químicamente , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/complicaciones , Carcinoma de Células Renales/secundario , Ecocardiografía Doppler , Femenino , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/efectos de los fármacos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/efectos de los fármacos , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Inhibidores de Proteínas Quinasas/uso terapéutico , Estudios Retrospectivos , Volumen Sistólico/efectos de los fármacos , Sístole , Disfunción Ventricular/diagnóstico , Disfunción Ventricular/fisiopatologíaAsunto(s)
Lesiones Cardíacas/etiología , Válvula Tricúspide/lesiones , Heridas no Penetrantes/etiología , Accidentes de Tránsito , Ecocardiografía Doppler en Color , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/fisiopatología , Heridas no Penetrantes/diagnóstico por imagen , Heridas no Penetrantes/fisiopatologíaRESUMEN
BACKGROUND: Trastuzumab has substantially improved overall survival and reduced the risk of disease recurrence in patients with human epidermal growth factor receptor type II (HER-II)-positive breast cancer. However, this benefit may be at the increased risk of cardiotoxicity. We aimed to explore the early subclinical left and right ventricular as well as atrial dysfunction, in trastuzumab-treated patients with HER-II-positive breast cancer, using velocity vector imaging. METHODS: Echocardiography images were acquired in 50 patients with HER-II-positive breast cancer undergoing trastuzumab therapy. All patients had baseline and 3-6 months and 12-15 months of follow-up echocardiograms after initiation of trastuzumab therapy. Subendocardial borders of all the cardiac chambers were traced from the apical views to obtain volumetric and deformation indices. RESULTS: Mean age was 60 ± 13 years. Left ventricular (LV) ejection fraction as well as conventional indices of right ventricular (RV) function did not change with trastuzumab. The RV peak systolic global longitudinal strain (GLε) significantly decreased (-24.53 ± 6.03 vs. -21.28 ± 5.11 vs. -21.84 ± 5.15, baseline vs. first and second follow-ups, P = 0.01). LV peak systolic GLε was reduced by 1.19 at early follow-up (P < 0.05). Left atrial reservoir and booster pump functions as well as right atrial reservoir function were reduced through follow-up as well. CONCLUSIONS: The RV exhibited greater change in strain after trastuzumab treatment when compared to the LV. Atria function was reduced by trastuzumab as well. The repercussion of these findings and their potential implication will warrant further study.
Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Ecocardiografía/métodos , Trastuzumab/administración & dosificación , Trastuzumab/efectos adversos , Disfunción Ventricular/inducido químicamente , Disfunción Ventricular/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Antineoplásicos/efectos adversos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/metabolismo , Femenino , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/efectos de los fármacos , Humanos , Aumento de la Imagen/métodos , Interpretación de Imagen Asistida por Computador/métodos , Persona de Mediana Edad , Receptor ErbB-2/metabolismo , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Volumen Sistólico/efectos de los fármacos , Resultado del TratamientoRESUMEN
For the non-cardiologist emergency physician and intensivist, performing an accurate estimation of left ventricular ejection fraction (LVEF) is essential for the management of critically ill patients, such as patients presenting with shock, severe respiratory distress or chest pain. Our objective was to develop a semi-quantitative method to improve visual LVEF evaluation. A group of 12 sets of transthoracic echocardiograms with LVEF in the range of 18-64% were interpreted by 17 experienced observers (PRO) and 103 untrained observers or novices (NOV), without previous training in echocardiography. They were asked to assess LVEF by two different methods: i) visual estimation (VIS) by analysing the three classical left ventricle (LV) short-axis views (basal, midventricular and apical short-axis LV section) and ii) semi-quantitative evaluation (base, mid and apex (BMA)) of the same three short-axis views. The results for each of these two methods for both groups (PRO and NOV) were compared with LVEF obtained by radionuclide angiography. The semi-quantitative method (BMA) improved estimation of LVEF by PRO for moderate LV dysfunction (LVEF 30-49%) and normal LVEF. The visual estimate was better for lower LVEF (<30%). In the NOV group, the semi-quantitative method was better than than the visual one in the normal group and in half of the subjects in the moderate LV dysfunction (LVEF 30-49%) group. The visual estimate was better for the lower LVEF (ejection fraction <30%) group. In conclusion, semi-quantitative evaluation of LVEF gives an overall better assessment than VIS for PRO and untrained observers.
RESUMEN
Double-chambered right ventricle (DCRV) is an uncommon congenital anomaly in which anomalous muscle bands divide the right ventricle into two chambers; a proximal high-pressure and distal low-pressure chamber. It may be associated with mid right ventricular obstruction. It is commonly associated with other congenital anomalies, most frequently perimembranous ventricular septal defect (PM-VSD). We herein present 5 adult patients with concomitant DCRV and PM-VSD who varied in their symptomatic presentations and the ways of management.
RESUMEN
BACKGROUND: Atrial function is an important contributor of ventricular function and has a prognostic role in various cardiovascular diseases. We tested the hypothesis that right and left atrial (RA & LA) function may not be equal despite their accommodating identical cardiac output. METHODS: Two-dimensional (2D) speckle tracking echocardiography was acquired from the apical four-chamber view in 100 normal subjects. Both RA/LA subendocardial borders were traced to obtain atrial volumes, strain (ε) and strain rate (SR). Reservoir, conduit, and booster pump functions were evaluated. Consequently, εNeg (corresponding to pump function) and εPos (corresponding to conduit function) were gauged. The SR parameters (SRLateNeg, SRPos, and SREarlyNeg), corresponding respectively to atrial systole, inception of ventricular systole, and inception of ventricular diastole, were measured. RESULTS: Mean age was 39 ± 15 years with 50 men (50%). Volumetric indices revealed that reservoir (Filling Volume = 35.1 ± 10.4 mL for LA vs. 27.47 ± 11.93 mL for RA, expansion index = 52.18 ± 16.89% for LA vs. 45.03 ± 16.49% for RA and diastolic emptying index = 52.85 ± 16.85 for LA vs. 45.62 ± 16.5 for RA, P < 0.001) and conduit (passive emptying (%) of total emptying = 34.49 ± 10.4 for LA vs. 26.82 ± 11.98 for RA and passive emptying index = 52.63 ± 16.86 for LA vs. 45.39 ± 16.5 for RA, P < 0.001) functions were significantly higher in the LA compared to the RA. Nevertheless, deformation indices demonstrated an opposite pattern (SRpos = 1.88 ± 0.74 for RA vs. 1.56 ± 0.54 for LA, P = 0.03 and εPos = 59.56 ± 30.63 for RA vs. 45.94 ± 16.67 for LA, P < 0.001). Reservoir, conduit, and booster pump functions showed no statistical significance among both genders. CONCLUSIONS: Evaluation of global and regional RA/LA function by speckle tracking echocardiography is feasible. The current report provides insights regarding dissimilarities between both atria in healthy individuals. The significance of these findings and their potential application will warrant further work.
Asunto(s)
Función del Atrio Izquierdo/fisiología , Función del Atrio Derecho/fisiología , Interpretación de Imagen Asistida por Computador , Adulto , Femenino , Atrios Cardíacos/diagnóstico por imagen , Humanos , Masculino , Valores de Referencia , UltrasonografíaAsunto(s)
Gadolinio , Aumento de la Imagen , No Compactación Aislada del Miocardio Ventricular/diagnóstico por imagen , No Compactación Aislada del Miocardio Ventricular/patología , Adulto , Medios de Contraste , Insuficiencia Cardíaca/complicaciones , Humanos , No Compactación Aislada del Miocardio Ventricular/complicaciones , Imagen por Resonancia Magnética , Masculino , Miocardio , Tiempo , Ultrasonografía , Adulto JovenRESUMEN
We report a patient with chronic Q-fever endocarditis who was treated with Bentall procedure on two occasions due to persistent endocarditis. A chronic pseudoaneurysm of the aortic root was discovered incidentally by cardiac magnetic resonance and computed tomography eight years post-operatively. Due to chronicity of the pseudoaneurysm and great risk of re-intervention, conservative management was recommended.
Asunto(s)
Endocarditis/diagnóstico por imagen , Endocarditis/etiología , Imagen por Resonancia Magnética , Fiebre Q/complicaciones , Fiebre Q/diagnóstico por imagen , Adulto , Endocarditis/terapia , Humanos , Masculino , Fiebre Q/terapia , RadiografíaAsunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Arteria Pulmonar/cirugía , Válvula Pulmonar/cirugía , Tetralogía de Fallot/cirugía , Bioprótesis , Técnicas de Imagen Sincronizada Cardíacas , Ecocardiografía Doppler , Electrocardiografía , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Tomografía Computarizada Multidetector , Valor Predictivo de las Pruebas , Diseño de Prótesis , Reoperación , Tetralogía de Fallot/diagnóstico , Adulto JovenRESUMEN
Herein we report a 21 year-old woman with a previously documented patent ductus arteriosus and Eisenmenger physiology. She presented with increasing cyanosis and exercise intolerance which could be explained by a new finding of right to left shunting through an interatrial communication. She was started on Bosentan therapy aiming to reduce the pulmonary pressure with consideration for heart-lung transplantation should any further deterioration occur.
Asunto(s)
Conducto Arterioso Permeable/complicaciones , Complejo de Eisenmenger/complicaciones , Adulto , Conducto Arterioso Permeable/patología , Conducto Arterioso Permeable/terapia , Complejo de Eisenmenger/patología , Complejo de Eisenmenger/terapia , Femenino , HumanosRESUMEN
McArdle's disease (glycogen storage disease type V) is a rare autosomal recessive metabolic myopathy due to myophosphorylase deficiency. It classically manifests by exercise intolerance, leg cramps, muscle pain and occasionally exercise induced myoglobinuria. The onset of exercise intolerance is typically in the second or third decades of life. It has a specific predilection to skeletal muscle involvement, yet cardiac muscle involvement is very rare. This report describes an unusual case of a 33 year-old man with known McArdle's disease who presented with an incidental finding of severe obstructive hypertrophic cardiomyopathy.