The relation of echo-derived lateral MAPSE to left heart functions and biochemical markers in patients with preserved ejection fraction: Short-term prognostic implications.

OBJECTIVE: Mitral annular plane systolic excursion (MAPSE) is a simple way to evaluate-left ventricle (LV) function. Our aim was to explain the relationship of MAPSE with LV function and biochemical markers in patients with preserved ejection fraction (EF), and to determine whether it has an effect on prognosis in echocardiography (echo) practice. METHODS: Consecutive patients referred to the echo laboratory between November 2020 and March 2021 were included in the study. In addition to conventional parameters, MAPSE of the lateral mitral annulus was measured in all patients. Patients were divided into three groups according to lateral MAPSE: low (<12 mm), relatively preserved (12-15 mm), and high (≥15 mm). RESULTS: A total of 512 patients with preserved EF were included in the study. MAPSE was low in 44 patients (9%), relatively preserved in 231 patients (45%), and high in 237 patients (46%). The mean age was higher in the low group compared to the other two groups (p < 0.001) and the body mass index was increased in the low group compared to the high group (p = 0.010). Atrial fibrillation and hypertension were more common in patients with low MAPSE. The rate of diastolic dysfunction (DD) and all-cause hospitalization were higher in the low and relatively preserved groups than in the high group (p < 0.001, p = 0.002; respectively). The pro-BNP level and mortality rate were higher in the low group compared to the relatively preserved and high groups (p = 0.007, p = 0.005; respectively). MAPSE was identified as independent predictor of hospitalization (OR: 0.284, 95% CI: 0.093-0.862, p = 0.026) via multivariate analysis and independent predictor of in-hospital mortality (HR: 0.002, 95% CI: 0-0.207, p = 0.008). CONCLUSIONS: Analysis of LV longitudinal function by echo-derived lateral MAPSE when LV ejection fraction is normal provides important information about DD and related heart failure and may predict prognosis in echo practice.

Wide QRS Complex and Lateral ST-T Segment Abnormality Are Associated With Worse Clinical Outcomes in COVID-19 Patients.

BACKGROUND: The information on electrocardiographic features of patients with coronavirus disease 2019 (COVID-19) is limited. Our aim was to determine if baseline electrocardiographic features of hospitalized COVID-19 patients are associated with markers of myocardial injury and clinical outcomes. METHODS: In this retrospective, single center cohort study, we included 223 hospitalized patients with laboratory-confirmed COVID-19. Clinical, electrocardiographic and laboratory data were collected and analyzed. Primary composite endpoint of mortality, need for invasive mechanical ventilation, or admission to the intensive care unit was assessed. RESULTS: Forty patients (17.9%) reached the primary composite endpoint. Patients with the primary composite endpoint were more likely to have wide QRS complex (>120 ms) and lateral ST-T segment abnormality. The multivariable Cox regression showed increasing odds of the primary composite endpoint associated with acute respiratory distress syndrome (odds ratio 7.76, 95% CI 2.67-22.59; p < 0.001), acute cardiac injury (odds ratio 3.14, 95% CI 1.26-7.99; p = 0.016), high flow oxygen therapy (odds ratio 2.43, 95% CI 1.05-5.62; p = 0.037) and QRS duration longer than >120 ms (odds ratio 3.62, 95% CI 1.39-9.380; p = 0.008) Patients with a wide QRS complex (>120 ms) had significantly higher median level of troponin T and pro-BNP than those without it. Patients with abnormality of lateral ST-T segment had significantly higher median level of troponin T and pro-BNP than patients without. CONCLUSIONS: The presence of QRS duration longer than 120 ms and lateral ST-T segment abnormality were associated with worse clinical outcomes and higher levels of myocardial injury biomarkers.

Obstructive mechanical mitral valve thrombosis and gastric adenocarcinoma: A therapeutic dilemma.

Fibrinolysis is an option for the management of mechanical prosthetic valve thrombosis when surgery has prohibitive risks. Current guidelines suggest recombinant tissue plasminogen activator (not to exceed 100 mg) with unfractionated heparin. A low-dose (25 mg) alteplase regimen as treatment in patients with a high risk of bleeding warrants further research. This report describes the case of a 65-year-old woman with a history of mechanical prosthetic mitral valve replacement who was diagnosed with signet ring cell adenocarcinoma of the stomach and obstructive mechanical prosthetic thrombosis on echocardiogram. Details of challenging aspects of this case and the use of modified fibrinolytic therapy are provided.

Ni and Cu incorporated mesoporous nanocomposite catalytic materials.

Nickel and copper incorporated MCM-41-like mesoporous nanocomposite materials prepared by the direct hydrothermal synthesis and the impregnation procedures showed highly attractive pore structure and surface area results for catalytic applications. The XRD patterns showed that characteristic MCM-41 structure was preserved for the materials synthesized following an impregnation procedure before the calcination step. The surface area of the Cu impregnated material with a quite high Cu/Si atomic ratio (0.19) was 631 m2/g. Very narrow pore size distributions with an average pore diameter of about 2.7 nm were obtained as a result of plugging of some of the smaller pores by Cu nanoballs. For lower metal to Si ratios (for instance for Ni/Si = 0.06) much higher surface area values (1130 m2/g) were obtained. In the case of nanocomposite materials synthesized by the direct hydrothermal route, MCM-41 structure was not destroyed for samples containing metal to Si atomic ratios as high as 0.12. In the case of materials containing Cu/Si and Ni/Si ratios over 0.2 wider pore size distributions and some decrease of surface area were observed.