RESUMO
BACKGROUND: Assessment of right ventricular (RV) function remains challenging because of its complex geometry. Application of speckle-tracking echocardiography (STE) to the tricuspid annulus provides rapid and automated assessment of the midpoint of the tricuspid annular plane displacement (TAD). The aim of this study was to investigate the value of tissue-tracking TAD for the assessment of RV systolic dysfunction. METHODS: We retrospectively studied 61 patients in whom RV ejection fraction (EF) measured by 3-dimensional echocardiography was performed. STE-derived displacement of the midpoint between the septal and lateral tricuspid annulus and its percentage of RV length at end-diastole (MTAD) were automatically assessed. We performed comparative analyses between the RVEF ≥45% group and the RVEF <45% group in each parameter for the assessment of RV systolic function. RESULTS: MTAD was successfully assessed in 56 (91.2%). According to receiver operating characteristics analysis, RVEF <45% was best detected by MTAD <14.7% with area under curve (AUC) 0.97, sensitivity 93%, specificity 95%, followed by RV free wall longitudinal strain (AUC 0.86), RV fractional area change (AUC 0.84), tricuspid annular plane systolic excursion (AUC 0.79), and systolic peak velocity of tricuspid annulus (AUC 0.70), although there was no significant difference between MTAD and RV free wall strain (P = 0.14). CONCLUSION: The present study showed that MTAD was simple index and useful for the assessment of RV systolic dysfunction.
Assuntos
Ecocardiografia Tridimensional/métodos , Disfunção Ventricular Direita/diagnóstico por imagem , Idoso , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
Aims: There are limited data about the optimal anti-thrombotic therapy for preventing embolism while minimizing bleeding events in patients with first acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). Methods and results: Among 2301 consecutive patients with AMI hospitalized between 2001 and 2014, we studied 1850 patients with first AMI who discharged alive to investigate clinical characteristics, incidence of systemic embolism (SE), and association between anticoagulation and embolic or bleeding events. Left ventricular thrombus was diagnosed by echocardiography, left ventriculography, or cardiac magnetic resonance imaging in 92 (5.0%) patients (62 ± 12 years). During a median follow-up period of 5.4 years (interquartile range 2.1-9.1 years), SE occurred in 15 of 92 patients with LVT (16.3%) and 51 of 1758 patients without LVT (2.9%), respectively. Kaplan-Meier analysis showed a significantly higher incidence of SE in the LVT group (log-rank test, P < 0.001). Multivariate analysis showed that LVT was an independent predictor of SE. Among the LVT patients treated with vitamin K antagonists (n = 84), we compared the patients with therapeutic range (TTR) ≥50% (n = 34) and those with TTR <50% (n = 50). Only one embolic event developed in the TTR ≥50% group and nine embolic events developed in the TTR <50% group (2.9% vs. 19%, P = 0.036). There was no difference in major bleeding events (TTR ≥50%; 9% vs. TTR <50%; 8%, P = 0.89). Conclusion: Appropriate anticoagulation therapy may decrease the incidence of embolic events without increasing the incidence of bleeding events in patients with first AMI complicated by LV thrombus.
Assuntos
Anticoagulantes , Trombose Coronária , Ventrículos do Coração/fisiopatologia , Infarto do Miocárdio , Inibidores da Agregação Plaquetária , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Trombose Coronária/tratamento farmacológico , Trombose Coronária/epidemiologia , Trombose Coronária/etiologia , Feminino , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Inibidores da Agregação Plaquetária/efeitos adversos , Inibidores da Agregação Plaquetária/uso terapêutico , Estudos RetrospectivosRESUMO
BACKGROUND: Previous reports have shown that postoperative symptoms despite successful surgical aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with aortic stenosis (AS). Left atrial minimum volume (LAVmin) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be useful as a surrogate marker of postoperative symptoms in patients with AS undergoing AVR. METHODS AND RESULTS: We studied 75 patients with AS who underwent AVR and were followed up to 600 days after AVR. We examined the postoperative symptomatic status which occurred between 60 days to 600 days after AVR. The study patients were divided into 2 groups: 19 patients (25%) with postoperative symptoms (symptomatic group) and 56 without symptoms (asymptomatic group). There were no significant differences in preoperative left ventricular volumes and ejection fraction and AS severity by echocardiography between the two groups. There were significant differences in preoperative echocardiographic LAVmin index (LAVImin) between symptomatic group and asymptomatic group (45±15 vs. 28±11ml/m2). Using receiver operating characteristic curve analysis, LAVImin≥30ml/m2 detected postoperative symptoms with the large area under the curve (0.84) (sensitivity 94% and specificity 68%). In the multivariate analysis, preoperative LAVImin was the independent predictor of the postoperative symptomatic status after AVR (odds ratio: 1.11; 95% CI: 1.04-1.18). CONCLUSIONS: The preoperative echocardiographic LAVImin measurement is useful as a surrogate marker of symptomatic status after AVR in patients with AS.
Assuntos
Doença de Alzheimer/fisiopatologia , Estenose da Valva Aórtica/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/etiologia , Volume Sistólico/fisiologia , Idoso , Doença de Alzheimer/complicações , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/psicologia , Estenose da Valva Aórtica/cirurgia , Biomarcadores/análise , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/psicologia , Período Pré-Operatório , Curva ROC , Função Ventricular Esquerda/fisiologiaAssuntos
Doença da Artéria Coronariana/terapia , Reestenose Coronária/diagnóstico por imagem , Trombose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Espectroscopia de Luz Próxima ao Infravermelho , Stents , Tomografia de Coerência Óptica , Idoso , Angioplastia com Balão/instrumentação , Doença da Artéria Coronariana/diagnóstico por imagem , Reestenose Coronária/etiologia , Reestenose Coronária/terapia , Trombose Coronária/etiologia , Trombose Coronária/terapia , Humanos , Masculino , Imagem Multimodal , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do TratamentoAssuntos
Artérias , Angiografia Coronária , Cateterismo , Doença Crônica , Humanos , Resultado do TratamentoRESUMO
A 47-year-old woman was hospitalized for syncope. An electrocardiogram showed complete right bundle branch block and T-wave inversion in leads III, aVF, and V2-4. Cardiac catheterization was performed since the echocardiogram demonstrated the existence of a left ventricular apical aneurysm and apical thrombus. Coronary angiography revealed normal coronary arteries. An endomyocardial biopsied specimen from the right ventricular apical wall demonstrated typical noncaseating granulomas with giant cells. There was no evidence suggesting the involvement of other systemic organs. The patient was diagnosed as having cardiac sarcoidosis. Cardiac sarcoidosis should be considered within a spectrum of diseases that cause left ventricular apical aneurysm.