A monster into the heart: an unusual presentation of cardiac leiomyosarcoma.

BACKGROUND: Malignant primary cardiac tumors are infrequent and can lead to an unfavorable prognosis if not identified and treated promptly. Early detection and prompt treatment of malignant primary cardiac tumors are crucial for a better prognosis. This article presents a case of primary cardiac leiomyosarcoma and reviews the literature on this topic. CASE PRESENTATION: Female patient that developed recurrent pericardial effusion and hemodynamic instability caused by a cardiac tumor, later identified as leiomyosarcoma. Multidisciplinary treatment was administered to the patient. CONCLUSIONS: The initial approach to this type of pathology should include multimodality imaging to establish a prompt diagnosis leading to complete standard treatment, to minimize risks to the patient's heart function which may include resection with complete margins of the neoplasm, otherwise the prognosis may be poor.

[Correlation between left ventricular stroke work loss index and aortic valve area in patients with aortic stenosis]. / Correlación entre el índice de pérdida de trabajo-latido ventricular izquierdo y el área valvular aórtica en pacientes con estenosis aórtica.

UNLABELLED: In echocardiographic evaluation of patients with aortic stenosis (AS), prospective studies have demonstrated that left ventricular stoke work loss index (LVSWLI) provide a more clinical efficacy than calculate of aortic valve area (AVA) by continuity equation to estimate severity of stenosis. The aim of this study was assess in our population of patients with AS the correlation between LVSWLI and AVA in regard to severity. MATERIAL AND METHODS: Forty nine patients with moderate and severe AS were evaluated by transthoracic echocardiography. Grades of AS were assessed by transaortic flow velocity (Vmax) and mean aortic transvalvular gradient (deltaP). AVA and LVSWLI were calculated and Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at <0.05. RESULTS: The age of the patients was 66 +/- 13 (31-84 years). Thirty four (69%) patients had severe AS and 15 (31%) moderate AS. The Pearson's correlation coefficient between LVSWLI and AVA was 0.79 (p<0.04) and between LVSWLI and deltaP was 0.90 (p<0.03). The Spearman's correlation coefficient between LVSWLI and symptomatic status was 0.70 (rho = 0.70, p < 0.003). CONCLUSIONS: In patients with moderate and severe AS, the correlation between LVSWLI and deltaP is higher than correlation between LVSWLI and AVA. Moreover LVSWLI has a higher correlation with presence of symptoms than AVA.

[The echocardiography in cardiac remodeling after acute myocardial infarction]. / La ecocardiografía en la remodelación cardíaca después del infarto agudo de miocardio.

OBJECTIVES: The goal of this study was to assess the impact of left ventricular diastolic filling on remodeling and survival after acute myocardial infarction. METHODS: We studied 36 patients with first acute myocardial treated with thrombolytic agents. A Doppler echocardiography was performed at 24 hours, 30 and 90 days after infarction. It measured the relation between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms), as well as the flow propagation velocity using color mode M and the E'-wave by tissular Doppler at the lateral mitral ring. RESULTS: Patients were divided into three groups. Group I, restrctive filling (deceleration time < 140 ms, E/FPV > or = 2, E/A> 2 and E/E' > 15). Group II, elevated filling pressure (deceleration time > or = 140 ms, E/FVP > or = 2, E/A 1,2 and E/E' < or = 15). Group III, normal filling pressure (deceleration time > or = 140 ms, E/FVP < 2, E/A < 1 and E/E' < 15). The E/FPV showed a better correlation in the group with restrictive filling and left ventricular filling pressure was significantly greater than in the group with normal filling pressure at 90 days (2.18 +/- 0.90 vs. 1.5 +/- 0.35; r = 0.99; P = .0001). The end diastolic volume (EDV) was similar in the three groups 24 hours after infarction. EDV varied at 90 days after infarction in those patients that underwent successful coronary angioplasty. Group I, 142.48 +/- 32 vs. 112.48 +/- 32, r = 573; P < .0001). CONCLUSIONS: E/FVP, using color M-mode Doppler echocardiography, estimates left ventricular filling pressure and predicts left ventricular dilation after acute myocardial infarction.

Left atrial longitudinal strain by speckle tracking as independent predictor of recurrence after electrical cardioversion in persistent and long standing persistent non-valvular atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in humans. After successful cardioversion, there is a recurrence of 60% due to atrial remodeling, and it has been shown that the global peak atrial longitudinal strain (GPALS) is decreased in these subjects. The aim of this study was to evaluate the predictive value of GPALS for AF recurrence. A prospective cohort of patients with persistent (PnVAF) and long standing persistent non-valvular AF (LSPnVAF) which underwent electrical cardioversion was evaluated with standard echocardiographic variables and GPALS quantification. The primary endpoint was AF recurrence at 6 months. We included PnVAF (n = 50, aged 68.4 ± 10.2 years, female 46%, lasted AF 6 months) and LSPnVAF (n = 81, aged 66.5 ± 13.1 years, female 36%, lasted AF 18 months). At 6 months there were a 68% of recurrence of AF in PnVAF and 53% in LSPnVAF group. GPALS was lower in recurrence 7.8 ± 2.0% versus 21.2 ± 8.9% (p < 0.001) for PnVAF and 7.3 ± 2.7% versus 20.7 ± 7.6% (p < 0.001) in LSPnVAF. GPALS ≤ 10.75% discriminates recurrence at 6 months with a sensitivity of 85%, specificity 99%, PPV 85%, NPV 90%, LR + 8.5 and LR- 0.17. The independent predictors of recurrence in PnVAF were GPALS ≤ 10.75% HR 8.89 [(2.2-35.7), p < 0.01] meanwhile in LSPnVAF were age HR 1.039 [(1.007-1.071), p = 0.01], and GPALS ≤ 10.75% HR 28.1 [(7.2-109.1), p < 0.001]. In subjects with PnVAF and LSPnVAF with successful electrical cardioversion, GPALS ≤ 10.75% predicts arrhythmia recurrence at 6-month follow-up.

[Pulmonary thromboembolism: Recent experience of 4 years at a cardiology hospital]. / Tromboembolismo pulmonar: experiencia reciente de 4 años en un hospital de cardiología.

It comprised a series of cases over a period of 4 years, held at the Hospital of Cardiology of the Centro Médico Nacional Siglo XXI, IMSS. From 2008 to 2011, admitted to Emergency 184 patients with suspected pulmonary embolism, of which 41 were removed; of the 143 remaining cases, only 127 patients was diagnosed with PE. The other 16 patients had other diagnoses. In 86% of patients showed electrocardiographic pattern S1Q3T3 and 39% had RBBB, in 17 (13.3%) patients there was hemodynamic instability, and in 94.4% showed enlargement of the right chambers by echocardiography, 55.9% showed paradoxical septal motion, PASP was 66.2+22.8 mm Hg and in 43.3% the Mc Connell sign was positive. A total of 48 patients (37.7%) received thrombolysis, the remaining patients received conventional medical treatment with anticoagulation. Overall mortality was 14%.

Se trata de una serie de casos comprendida en un periodo de 4 años, realizada en el Hospital de Cardiología del Centro Médico Nacional Siglo XXI del IMSS. Del año 2008 al 2011, se ingresaron al servicio de Urgencias 184 pacientes con sospecha de tromboembolismo pulmonar (TEP), de los cuales se eliminaron 41; de los 143 casos restantes, solo a 127 pacientes se les diagnosticó TEP, los 16 pacientes restantes presentaron otros diagnósticos. En el 86% de los casos se demostró patrón electrocardiográfico S1Q3T3, y en 39% BRDHH. En 17 pacientes existió inestabilidad hemodinámica; en el 94.4% se demostró dilatación de cavidades derechas por ecocardiografía, en 55.9% se demostró movimiento septal paradójico, la PSAP fue de 66.2+22.8 mm Hg y en 43.3% el signo de Mc Connell fue positivo. A un total de 48 pacientes se les administró trombólisis, mientras que el resto de los pacientes recibió tratamiento médico convencional con anticoagulación. La mortalidad global fue del 14%.

Evaluación de la función ventricular y auricular derecha con ecocardiografía 3D en tromboembolia pulmonar aguda / Assessment of right ventricular and atrial function with 3D echocardiography in acute pulmonary embolism

Introducción: La tromboembolia pulmonar aguda (TEP) es un padecimiento grave. La ecocardiografía tridimensional (ECO-3D) es un método accesible, novedoso y preciso para cuantificar la función ventricular y auricular derechas. A la fecha, no existen suficientes estudios que evalúen su papel en esta entidad. Objetivo: Determinar la utilidad del ECO-3D en la evaluación de la función ventricular y auricular derecha, y el riesgo de complicaciones cardiovasculares en pacientes con TEP aguda. Material y métodos: Se analizaron 35 pacientes, admitidos al HC CMN SXXI con TEP por angioTAC, mediante equipo Phillips IE 33, se midieron parámetros bidimensionales (2D) y 3D relacionados con función ventricular y auricular derecha (TomTec y qlab 10). Se evaluaron complicaciones cardiovasculares intrahospitalarias. Resultados: El riesgo relativo de eventos cardiovasculares mayores combinados (ECMC) intrahospitalarios por ECO-3D fue: índice de esfericidad de la aurícula derecha > 1.32; RR 20.3 IC 95% 2.9-13.8; p = 0.0001, FEVD RR 7.3 IC 95% 2.5-20.9; p = 0.0001, VDFVD > 77 mL RR de 7.3 IC 95% 2.56-20.9; p = 0.0001, VSFVD RR 5.5 IC 95% 2.26-13.3; p = 0.0001. El análisis multivariado mostró tres predictores de riesgo independiente: índice de esfericidad de la aurícula derecha > 1.32, TEP masiva y presión arterial media. Conclusiones: La evaluación combinada mediante ecocardiografía 3D de función ventricular y auricular derechas permiten una evaluación cuantitativa, predicción del riesgo para la presentación de complicaciones cardiovasculares y tiempo de estancia intrahospitalarios en pacientes con TEP aguda.

Introduction: Acute pulmonary embolism (PE) is a serious condition. Tridimensional Ecocardiography (3D ECHO) is an accessible, novel and accurate method for determination of right ventricular and atrial function. To date there are insufficient studies to assess their role in this entity. Objective: Determine the usefulness of ECO-3D in evaluating right atrial and ventricular function, and the risk of cardiovascular complications in patients with acute PE. Material and methods: 35 patients were admitted to the HC CMN SXXI with PE by CT angiogram, we analized 2D and 3D parameters by Philips iE33, right atrial and ventricular function (TomTec and QLAB 10). Hospital cardiovascular complications were evaluated. Results: The relative risk of major combined cardiovascular events for 3D ECHO was: right atrial sphericity index > 1.32; RR 20.3 95% CI 2.9-13.8; p = 0.0001, RVEF RR 7.3 95% CI 2.5-20.9; p = 0.0001, RVEDV> 77 mL RR 2.56 95% CI 7.3-20.9, p = 0.0001, RR 5.5 RVESV 95% CI 2.26-13.3; p = 0.0001. Multivariate analysis showed three independent risk predictors: right atrial sphericity index > 1.32, massive PE and mean arterial pressure. Conclusions: The combined assessment by 3D echocardiography right ventricular and atrial function allow a quantitative assessment, risk prediction for cardiovascular complications and presentation of time-hospital stay in patients with acute PE.

Correlación entre el índice de pérdida de trabajo-latido ventricular izquierdo y el área valvular aórtica en pacientes con estenosis aórtica / Correlation between left ventricular stroke work loss index and aortic valve area in patients with aortic stenosis

In echocardiographic evaluation of patients with aortic stenosis (AS), prospective studies have demonstrated that left ventricular stoke work loss index (LVSWLI) provide a more clinical efficacy than calculate of aortic valve area (AVA) by continuity equation to estimate severity of stenosis. The aim of this study was assess in our population of patients with AS the correlation between LVSWLI and AVA in regard to severity. MATERIAL AND METHODS: Forty nine patients with moderate and severe AS were evaluated by transthoracic echocardiography. Grades of AS were assessed by transaortic flow velocity (Vmax) and mean aortic transvalvular gradient (deltaP). AVA and LVSWLI were calculated and Pearson's and Spearman's correlation coefficients between both methods were assessed. Significance level was set at <0.05. RESULTS: The age of the patients was 66 +/- 13 (31-84 years). Thirty four (69%) patients had severe AS and 15 (31%) moderate AS. The Pearson's correlation coefficient between LVSWLI and AVA was 0.79 (p<0.04) and between LVSWLI and deltaP was 0.90 (p<0.03). The Spearman's correlation coefficient between LVSWLI and symptomatic status was 0.70 (rho = 0.70, p < 0.003). CONCLUSIONS: In patients with moderate and severe AS, the correlation between LVSWLI and deltaP is higher than correlation between LVSWLI and AVA. Moreover LVSWLI has a higher correlation with presence of symptoms than AVA.

La ecocardiografía en la remodelación cardíaca después del infarto agudo de miocardio / The echocardiography in cardiac remodeling after acute myocardial infarction

OBJECTIVES: The goal of this study was to assess the impact of left ventricular diastolic filling on remodeling and survival after acute myocardial infarction. METHODS: We studied 36 patients with first acute myocardial treated with thrombolytic agents. A Doppler echocardiography was performed at 24 hours, 30 and 90 days after infarction. It measured the relation between E and A waves peak velocities (E/A ratio) and of the E deceleration time (EDT, ms), as well as the flow propagation velocity using color mode M and the E'-wave by tissular Doppler at the lateral mitral ring. RESULTS: Patients were divided into three groups. Group I, restrctive filling (deceleration time < 140 ms, E/FPV > or = 2, E/A> 2 and E/E' > 15). Group II, elevated filling pressure (deceleration time > or = 140 ms, E/FVP > or = 2, E/A 1,2 and E/E' < or = 15). Group III, normal filling pressure (deceleration time > or = 140 ms, E/FVP < 2, E/A < 1 and E/E' < 15). The E/FPV showed a better correlation in the group with restrictive filling and left ventricular filling pressure was significantly greater than in the group with normal filling pressure at 90 days (2.18 +/- 0.90 vs. 1.5 +/- 0.35; r = 0.99; P = .0001). The end diastolic volume (EDV) was similar in the three groups 24 hours after infarction. EDV varied at 90 days after infarction in those patients that underwent successful coronary angioplasty. Group I, 142.48 +/- 32 vs. 112.48 +/- 32, r = 573; P < .0001). CONCLUSIONS: E/FVP, using color M-mode Doppler echocardiography, estimates left ventricular filling pressure and predicts left ventricular dilation after acute myocardial infarction.