Evaluation of left atrial appendage function and thrombi in patients with atrial fibrillation: from transthoracic to real time 3D transesophageal echocardiography.

The detection of embolic sources in patients with atrial fibrillation (AF) is important to guide anticoagulant therapy. Two-dimensional transesophageal echocardiography (TEE) is the gold standard to study left atrial appendage (LAA) anatomy and morphology, despite some false-positive diagnosis. We hypothesized that real time 3D TEE (RT3DTEE) is superior to 2DTEE in detecting and/or excluding LAA thrombi. We studied 93 patients with non-valvular AF (60 males, age = 67.1 ± 14.2 years) referred for electric cardioversion with transthoracic, 2DTEE and RT3DTEE. Before cardioversion, TTE allowed a confident measurement of emptying velocity of LAA (LAAeV) only in 59/93 patients (63%). On the contrary a good quality TEE LAAeV was obtained in all patients with 49/93 (53%) dysfunctional LAA (LAAeV < 40 cm/s). A subgroup of 5 patients (7.2% of the 69 effective cardioversion) presented a persistent dysfunction after cardioversion (with LAAeV values of <40 cm/s on the TEE post-CV). TEE allowed to observe a bilobed shape in 45 patients (48.4%) and three lobes in 22 patients (23.7%). In addition, besides to several additional findings, 2DTEE managed to detect thrombi with certainty in 8/93 patients (8.6%). In other 5 cases with diagnostic doubts for thrombi with 2DTEE (5/93 patients: 5.4%), the addition of the RT3DTEE mode allowed to discriminate with certainty the presence of just pectinate muscles in 4 patients RT3DTEE in patients with AF at risk of embolism is feasible, accurate and showed an additional diagnostic capability in the differential diagnosis of selected cases with suspected LAA thrombi.

An Uncommon Pericardial Cyst in the Central Mediastinum: Incremental Diagnosis with Contrast-Enhanced Three-Dimensional Transesophageal Echocardiography.

We report a case of a 76-year-old man, with the occasional finding of a mediastinal cyst because of subtle chronic dysphagia associated to sore throat, belching, and dysphonia. The paraesophageal cyst in the central mediastinum was studied with computed tomography (CT) scan and transesophageal three-dimensional (3D) echocardiography with contrast echo. In order to clarify doubts about localization (intra- versus extrapericardial) of the mediastinal cystic lesion the 3D transesophageal echocardiography (TEE) confirmed the presence of a large round cystic mass located contiguous to the esophagus, the left atrium and the aortic root/pulmonary trunk (located at the front of the lesion), as well as located intrapericardial. The cystic mass showed no blood flow at color Doppler mode and at ultrasound contrast echo with SonoVue agent. Due to the paucity of symptoms and to the definite imaging information of this intrapericardial cyst of nonvascular nature, due to pericardial cyst in an extremely unusual location, surgery was not performed. At follow-up of 1 month echocardiogram and 3 month CT scan the cyst appeared unchanged in dimensions.

Correlation between diastolic impairment and lipid metabolism in mild-to-moderate hypertensive postmenopausal women.

BACKGROUND: Many cardiovascular risk factors are found in hypertensive patients. The aim of this study was to evaluate the correlation between cardiac abnormalities (ie, diastolic and left ventricular hypertrophy) with other cardiovascular risk factors in postmenopausal women with hypertension. METHODS: A total of 200 consecutive postmenopausal women (mean age 47.5+/-4 years) with mild-to-moderate hypertension that had never been treated were studied. Mean systolic pressure was 163+/-15 mm Hg and mean diastolic pressure 97+/-75 mm Hg. All subjects underwent M-mode two-dimensional echocardiography and cardiac Doppler. The following measurements were made: peak velocity of early left ventricular filling (E); peak velocity of late ventricular filling (A), and the ratio between early and late flow velocity peaks (E/A). The E/A ratio was then normalized for heart rate (E/Ac). Left ventricular mass index normalized for body surface was also measured. In each patient, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and plasma triglycerides were measured. We evaluated the correlation of E/Ac and left ventricular mass index (LVMI) with the following variables: total cholesterol, HDL, LDL, triglyceridemia, smoking status, systolic and diastolic blood pressure, and body mass index. RESULTS: A significant negative correlation with total cholesterol (r = -0.15, P < .05) and LDL (r = -0.20; P = .005), as well as a significant positive correlation with HDL (r = 0.20, P < .01) were found. No other variable was significantly correlated with E/A. There was no correlation between LVMI and any variable analyzed. CONCLUSION: In postmenopausal women with mild-to-moderate hypertension, high total cholesterol levels and low HDL levels are associated with impaired diastolic function.