Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx. Study Design: A Case-Control Study. Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina. Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited. All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period. Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels. Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.

Echocardiographic Wall Motion Abnormalities in Hypertensive Patients with Electrocardiographic Left Ventricular Hypertrophy

Background: During the cardiac cycle with the effect on cardiac function, Echocardiographic wall motion abnormalities are kinetic alterations in the cardiac wall motion. It can be characterized as per their grades and their distribution pattern like segmental or global. It can be attributed to a coronary territory or follow a non-coronary distribution. Aim of the study: The aim of the study was to evaluate the patterns of echocardiographic wall motion abnormalities among hypertensive patients with electrocardiographic left ventricular hypertrophy.Material & Methods:This was prospective observational study which was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital & Research Institute, Dhaka, Bangladesh from January 2020 to January 2021. In total 76 hypertensive patients with electrocardiographic left ventricular hypertrophy were included as the study subjects for this study. This study was approved by the ethical committee of the mentioned hospital. A predesigned questioner was used in data collection. All data were collected, processed and analyzed by using MS Office and SPSS version 23 programs as per necessity.Results:In this study, in analyzing the status of wall motion abnormalities (WMA) among the participants we observed that, 22% of the patients were with segmental wall motion abnormalities, 18% were with global dysfunction and 59% were fully free from any type of WMA. Among patients with global dysfunctions, 71% were with mild and 12% were with moderate-to-severe dysfunction whereas this ratio was 47:24 in segmental abnormality patients. On the other hand, in analyzing the severity and location of patients with segmental WMA we observed that 47%, 24%, 53%, 41%, 18%, 24%, 29%, 47%, 35%, 53% and 41% were with mild dysfunction, moderate-to-severe dysfunction, inferior wall dysfunction, antero-septal dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction respectively.Conclusion:In this study, majority of the participants were found free from any type of wall motion abnormality. ‘Mild dysfunction’, inferior wall dysfunction, anterior wall dysfunction, lateral wall dysfunction, posterior septal dysfunction, LV base dysfunction, LV mid-cavity dysfunction and LV apical dysfunction are found as some more frequent dysfunctions among patients with WMA.

Fístula arteriovenosa para hemodiálisis en receptores de trasplante renal. Su repercusión clínica, humoral y cardiovascular / Arteriovenous fistula for hemodialysis in renal transplant recipients. Clinical, humoral and cardiovascular repercussions

Introducción: La fístula arteriovenosa para hemodiálisis repercute negativamente sobre la hemodinamia, la morfología y las funciones cardíacas. Objetivo: Determinar la repercusión del cierre del acceso vascular sobre variables clínicas, humorales, morfológicas y funcionales del corazón derecho en receptores de trasplante renal. Material y Métodos: Estudio cuasi-experimental longitudinal que incluyó 92 pacientes divididos en dos grupos, experimental (n=46): con cierre del acceso vascular, y de comparación (n=46): sin cierre del angioacceso. Se determinaron variables clínicas, de laboratorio, y ecocardiográficas en dos tiempos: inicial y seis meses posteriores. Resultados: La media de edad en ambos grupos fue de 46,87 ±12,04 y 45,50 ±12,47 años respectivamente. Prevaleció el sexo masculino; 26 (56,52 %) y el color de piel blanca; 34 (73,91 %). Las palpitaciones fueron la manifestación clínica más frecuente con mejoría a la segunda observación en el grupo experimental, al igual que las presiones sistólica y diastólica, así como la creatinina sérica; de 108,24 ±24,53 a 100,00 ±22,35 μMol/L (p=0,004). Las variables mensuradas por ecocardiografía mejoraron en el grupo intervenido respecto al de comparación. Las diferencias final-inicial para las presiones sistólica y media de la arteria pulmonar mostraron relaciones muy significativas (p <0,001) para las fístulas localizadas en la muñeca y en el pliegue del codo izquierdos. Conclusiones: Las variables estudiadas mostraron cambios ostensibles en el grupo experimental respecto al de comparación posterior al cierre de la fístula arteriovenosa sin constatar asociación entre su localización y la severidad de la afectación cardíaca.

Introduction: Arteriovenous fistula for hemodialysis has a negative impact on hemodynamics, morphology, and cardiac functions. Objective: To determine the repercussion of vascular access closure on clinical, humoral, morphological and functional variables of the right heart in renal transplant recipients. Material and Methods: Quasi-experimental longitudinal study that included 92 patients divided into two groups: experimental (n=46): with vascular access closure, and comparison (n=46): those who did not have the angioaccess closed. Clinical, laboratory and echocardiographic variables were determined at two points in time: initial and six months later. Results: The mean age in both groups was 46.87 ±12.04 and 45.50 ±12.47 years, respectively. Male sex: 26 (56.52 %), as well as white skin color: 34 (73.91 %), prevailed in the study. Palpitations were the most frequent clinical manifestation with improvement at the second observation in the experimental group, as were systolic and diastolic pressures, as well as serum creatinine: from 108.24 ±24.53 to 100.00 ±22.35 μMol/L (p=0,004). The variables measured by echocardiography improved in the intervention group with respect to the comparison group. The final - initial differences for systolic and mean pulmonary artery pressures showed highly significant relationships (p<0.001) for fistulas located at the left wrist and elbow crease. Conclusions: The variables studied showed ostensible changes in the experimental group with respect to the comparison after closure of the arteriovenous fistula without finding an association between their location and the severity of cardiac involvement.

Clinical and Echocardiographic Predictor of Atrial Fibrillation in Patient with Rheumatic Mitral Valve Disease

Background: Rheumatic fever principally influences kids in developing states, particularly where deficiency is common. Atrial fibrosis is a mutual characteristic of clinical atrial fibrillation (AF) and is accompanying with AF in a diversity of experiment sittings, Aim and Objectives: The current work aimed to assess whether there are any clinical or echo-cardiographic parameters that expect the existence of AF among cases with rheumatic mitral valve disorder (RMVD), Subjects and Methods: The current study was a comparative cross-sectional was conducted on 100 RMVD cases at cardio-vascular medicine department Tanta university hospitals within 6-mths starting from September 2019. Cases have been allocated into 2 groups: Group-I: 50 cases with sinus rhythm. Group-II: 50 cases with AF, Results: A significant change was found among study groups regarding Fibrosis characteristics, There is a highly significant difference between the three different types regarding mitral valve area (MVA), LA-diameter, LA volume, LA-diameter/BSA and LA volume index, Age, area of mitral valve, LA-diameter and LA volume were found to be significant predictors for AF, Conclusion: Echo-cardiography factors could recognize cases at higher danger of advancing AF among RMVD cases who may benefit from preventive measures.

Echocardiographic epicardial fat thickness and immature granulocyte are novel inflammatory predictors of acute ischemic stroke: a prospective study

ABSTRACT BACKGROUND: Acute ischemic stroke (AIS) is the most common type of stroke. Inflammation is the primary factor in the pathogenesis of atherosclerosis. Use of immature granulocytes (IGs) has been recommended as a new indicator of systemic inflammation. However, data on the association between echocardiographic epicardial fat tissue thickness (EFT) and IGs in patients with AIS are limited. OBJECTIVE: To evaluate the association between the presences of IGs, epicardial fat tissue and AIS. DESIGN AND SETTING: Prospective study in a tertiary-care university hospital in Antalya, Turkey. METHODS: Our study included 53 AIS patients and 41 healthy controls with age and gender compatibility. Blood samples and transthoracic echocardiography of all participants were compared. RESULTS: IG levels were significantly higher in patients with AIS than in controls (0.62 ± 0.36 versus 0.28 ± 0.02, P < 0.001). The mean EFT was 3.74 ± 0.61 mm in the control group and 6.33 ± 1.47 mm in the AIS patient group. EFT was significantly greater in AIS patients than in controls (P < 0.001). For the optimum cut-off value for IG (0.95), the area under the curve (AUC) was determined to be 0.840; sensitivity was determined to be 81.1% and specificity, 92.5%. For the optimum cut-off value for EFT (4.95 mm), the AUC was determined to be 0.953; sensitivity was determined to be 90.6% and specificity, 90%. CONCLUSIONS: IG and echocardiographic EFT are clinical markers that can be used to predict AIS risk.

Segurança do Agente de Contraste SF6 (SonoVueⓇ) no Ecocardiograma sob Estresse Farmacológico / Safety of SF6(SonoVue®) Contrast Agent on Pharmacological Stress Echocardiogram

Resumo Fundamento Em 2007, a Food and Drug Administration (FDA) determinou revisões sobre segurança dos agentes de contraste ecocardiográfico (ACE) disponíveis no mercado após relatos de mortes. Ao longo desses anos, diversos estudos comprovaram a segurança dos ACE, porém com poucos estudos relacionados ao SonoVue®. Objetivos Avaliar a segurança do SonoVue® durante o ecocardiograma sob estresse farmacológico (EEF) por meio da análise da incidência de reações alérgicas e da comparação entre os grupos quanto ao surgimento de arritmia, efeitos colaterais menores e eventos adversos. Métodos Estudo observacional, prospectivo, no qual 2.346 pacientes foram submetidos ao EEF e divididos em dois grupos: grupo 1 com ACE (n=1.099) e grupo 2 sem ACE (n=1.247). Os pacientes foram avaliados durante o EEF - 24 horas e 30 dias. Foi definido p significativo quando <0,05. Resultados O grupo 1 apresentou efeitos colaterais mais leves, como cefaleia (5/0,5% vs. 19/1,5%, p=0,012) e hipertensão reativa (3/0,3% vs . 19/1,5%, p=0,002), menos arritmias como extrassístoles ventriculares (180/16,4% vs . 247/19,8%, p=0,032) e taquicardia paroxística supraventricular (2/0,2% vs . 15/1,2%, p=0,003), assim como nenhum evento adverso como infarto agudo do miocárdio (IAM) e óbito. No grupo 2, um paciente apresentou IAM <24h (1/01%) e dois óbitos <30 dias (2/0,1%). Urticária relacionada ao SonoVue® foi observada em 3 (0,3%) pacientes sem reação anafilática. Conclusão SonoVue® demonstrou segurança durante o EEF, não sendo observados morte, IAM ou reação anafilática. Observou-se menor incidência de efeitos colaterais mais leves e arritmias no grupo que utilizou o ACE, assim como baixa incidência de reações alérgicas leves.

Abstract Background In 2007, the United States Food and Drug Administration mandated safety reviews of commercially available echocardiographic contrast agents (ECA), following reports of death. During the past years, different studies have proven the safety of ECA, but there have been few studies on SonoVue®. Objectives To evaluate the safety of SonoVue® during pharmacological stress echocardiography (PSE), by analyzing the incidence of allergic reactions and comparing groups regarding the appearance of arrhythmia, minor side effects and adverse events. Methods In this observational, prospective study, 2346 patients underwent PSE, and they were divided into the following 2 groups: group 1 with ECA (n = 1099) and group 2 without ECA (n = 1247). Patients were evaluated during PSE, at 24 hours, and at 30 days. Statistical significance was defined as p < 0.05. Results Group 1 had fewer minor side effects, such as headache (5/0.5% versus 19/1.5%, p = 0.012) and less reactive hypertension (3/0.3% versus 19/1.5%, p = 0.002); fewer arrhythmias, such as ventricular extrasystoles (180/16.4% versus 247/19.8%, p = 0.032) and paroxysmal supraventricular tachycardia (2/0.2% versus 15/1.2%, p = 0.003); and no adverse events, such as acute myocardial infarction (AMI) or death. In group 2, 1 patient had AMI in < 24 hours (1/01%), and there were 2 deaths in < 30 days (2/0.1%). SonoVue®-related urticaria was seen in 3 (0.3%) patients, without anaphylactic reaction. Conclusion SonoVue® demonstrated safety during PSE. No cases of death, AMI, or anaphylactic reaction were observed. There was a lower incidence of minor side effects and arrhythmias in the group that received ECA, as well as a low incidence of mild allergic reactions.

Síndrome cardiorrenal: aspectos clínicos y ecocardiográficos / Cardiorenal syndrome: Clinical and echocardiographic aspects

Resumen El síndrome cardiorrenal (SCR) es un trastorno en el que intervienen el corazón y los riñones, interactuando y produciendo una disfunción entre ellos en forma aguda o crónica. Existen diferentes fenotipos clínicos bien identificados como «desórdenes del corazón y riñón en los que la disfunción aguda o crónica en un órgano induce la disfunción aguda o crónica del otro¼. La alta incidencia de morbimortalidad cardiovascular presente en los pacientes con enfermedad renal crónica terminal (ERCT), en especial la insuficiencia cardiaca (IC), origina inicialmente una lesión miocárdica que conlleva remodelamiento ventricular, lo cual induce a la activación de mecanismos compensadores, entre los cuales el riñón es pieza fundamental, ya que regula la homeostasis hidroelectrolítica y así el volumen circulante, siendo esto en la etapa dialítica más evidente. Los cambios funcionales y anatómicos cardiovasculares que se producen en estos pacientes son muy prevalentes e incluyen las interacciones hemodinámicas del corazón y los riñones en la insuficiencia cardiaca, y el impacto de la enfermedad aterosclerótica en ambos sistemas de órganos. También describimos estrategias diagnósticas y terapéuticas aplicables al síndrome cardiorrenal, que determinan la importancia de la ecocardiografía como modelo de diagnóstico útil. Finalmente, se analizan las posibilidades de tratamiento y la remisión de las alteraciones funcionales cardiacas con el trasplante renal en los pacientes con ERCT.

Abstract Cardiorenal syndrome (CRS) is a disorder in which the heart and kidneys are involved, interacting and producing a dysfunction between them in an acute or chronic way. There are different clinical phenotypes well identified as "heart and kidney disorders in which acute or chronic dysfunction in one organ induces acute or chronic dysfunction in the other". The high incidence of cardiovascular morbimortality in patients with chronic terminal kidney disease (CKD), especially heart failure (HF), initially causes a myocardial lesion that leads to ventricular remodeling, which induces the activation of compensatory mechanisms, among which the kidney is a fundamental part since it regulates the hydroelectrolytic homeostasis and thus the circulating volume, being this in the dialytic stage more evident. The functional and anatomical changes at cardiovascular level that occur in these patients are very prevalent, and include hemodynamic interactions of the heart and kidneys in heart failure and the impact of atherosclerotic disease in both organ systems. We also describe diagnostic and therapeutic strategies applicable to cardiorenal syndrome, which determine the importance of echocardiography as a useful diagnostic model. Finally, we analyze the possibilities of treatment and remission of cardiac functional alterations with renal transplantation in patients with T-CKD.

Evaluation of left atrial function in asymptomatic dogs with chronic myxomatous mitral valve disease: two-dimensional feature-tracking echocardiography and Simpsons monoplanar methods / Avaliação da função atrial esquerda em cães assintomáticos com degeneração mixomatosa crônica de valva mitral: métodos ecocardiográficos bidimensional feature tracking e monoplanar de Simpson

The present study evaluated the volume and function of the left atrium by two-dimensional echocardiographic feature-tracking imaging (2D-FTI) and Simpson's monoplanar modeling in dogs with asymptomatic degenerative mitral valve disease (DMVD). The study consisted of 80 dogs that were divided into the following three groups: Group 1, 21 dogs (A); Group 2, 30 dogs (B1) and Group 3, 29 dogs (B2). The variable strain (contraction phase) was significantly lower in Group 3 than in Group 1 (12.92±4.54 x 16.69±5.74, p=0.014), and significant differences in the contraction strain index (CSI) were observed between all of the groups that were evaluated (1 = 46.82±8.10, 2 = 39.88±8.03, 3 = 35.25±5.64, p<0.0001). The atrial diastolic volume index (AdVi) that was measured by 2D-FTI was significantly higher in Group 3 than in Group 1 (1.31±0.95 x 0.96±0.31, p=0.038), and the atrial cardiac index (ACI) was also higher in Group 3 than in Group 1 (102.38±80.18 x 78.19±33.38, p=0.030). Atrial function was assessed by Simpson's monoplanar method, which demonstrated an increase in the left atrial systolic volume, while the contractile function decreased with an increasing disease severity (Group 1 0.21±0.06; Group 2 0.25±0.06; Group 3 0.32±0.08, p<0.0001). The intraobserver and interobserver assessments showed low to moderate variability; most of the values for the coefficient of variation for the variables that were analysed with each method were below 25%. Thus, DMVD was determined to cause an alteration in atrial function, especially in the contraction phase, and even in asymptomatic animals, and the methods of 2D-FTI echocardiography and Simpson's monoplanar evaluation are sensitive and early methods for the detection of left atrial dysfunction.(AU)

O presente estudo avaliou o volume e a função atrial esquerda obtidos por meio da ecocardiografia bidimensional feature tracking (2D-FTI) e pelo método monoplanar de Simpson em cães saudáveis e cães com DMVD assintomáticos. Foram avaliados 80 cães distribuídos em três grupos: Grupo 1, 21 cães (classe A); Grupo 2, 30 cães (classe B1) e Grupo 3, 29 cães (classe B2). A variável strain (fase de contração) foi significativamente menor no Grupo 3 que no Grupo 1 (12,92±4,54 x 16,69±5,74, p=0,014) e para a variável índice de strain de contração (CSI), houve diferença estatística entre todos os grupos avaliados (1 = 46,82±8,10; 2 = 39,88±8,03; 3 = 35,25±5,64, p<0,0001). O índice de volume diastólico atrial (iVdA) mensurado por meio do 2D-FTI foi significativamente maior no Grupo 3 que no Grupo 1 (1,31±0,95 x 0,96±0,31, p=0,038), assim como para o índice cardíaco atrial (iCA) também foi maior no Grupo 3 (102,38±80,18 x 78,19±33,38, p=0,030). A função atrial avaliada pelo método monoplanar de Simpson demonstrou um aumento do volume atrial esquerdo e do volume sistólico do átrio esquerdo, enquanto que a função contrátil diminuiu com o aumento da gravidade da doença (Grupo 1 0,21±0,06; Grupo 2 0,25±0,06; Grupo 3 0,32±0,08; p<0,0001). A avaliação intraobservador e interobservador, demonstrou variabilidade baixa a moderada, uma vez que a maioria dos valores de coeficiente de variação se concentraram abaixo de 25% para as variáveis analisadas em ambos os métodos. Dessa forma, conclui-se que a DMVD causa alteração na função atrial, principalmente na fase de contração, mesmo em animais assintomáticos e que a ecocardiografia 2D-FTI e o método monoplanar de Simpson são métodos sensíveis e precoces na detecção da disfunção atrial esquerda.(AU)

Relationship between C-reactive protein level and incidence of left atrial spontaneous echocardiographic contrast in patients with nonvalvular atrial fibrillation / 中华心血管病杂志

Objective: To investigate the relationship between high sensitivity C-reactive protein (hs-CRP) level and incidence of left atrial spontaneous echocardiographic contrast (LASEC) in the patients with nonvalvular atrial fibrillation (AF). Methods: Four hundred and ninety consecutive patients with nonvalvular atrial fibrillation who underwent radiofrequency ablation for the first time from January 1, 2018 to June 30, 2018 in the Department of Cardiology, Beijing Anzhen Hospital were enrolled. According to the results of transesophageal echocardiography before radiofrequency ablation, patients were divided into the group without LASEC (n=338) and the group with LASEC (n=152). hs-CRP was determined by latex enhanced immunoturbidimetry. The relationship between hs-CRP and LASEC in patients with nonvalvular atrial fibrillation was investigated by univariate and multivariate logistic analysis. Results: LASEC was detected in 152 (31%) of 490 patients. Significant differences in age, type of atrial fibrillation, previous embolic events, fibrinogen, D-dimer, the left atrial anteroposterior diameter and CHA(2)DS(2)-VASc scores were found between patients with and without LASEC (all P<0.05). Compared with the group without LASEC, the serum hs-CRP level was significantly higher in the group with LASEC (3.16 (1.30, 5.23) mg/L vs. 0.67 (0.37, 1.48) mg/L, P<0.001). Multivariate logistic regression analysis showed that hs-CRP (OR=1.136, 95%CI 1.060 - 1.217, P<0.001) and D-dimer (OR=1.040, 95%CI 1.011 - 1.070, P=0.007) were independent determinants for LASEC in this patient cohort. Conclusions: hs-CRP is an independent determinant for LASEC in patients with nonvalvular atrial fibrillation. Inflammation may thus be involved in the formation of prethrombotic state in patients with nonvalvular atrial fibrillation.

Hipertensão pulmonar persistente neonatal: análise do diagnóstico e tratamento / Pulmonary hypertension of the newborn: analysis of diagnoses and treatment

Objetivos: Descrever fatores de risco, perfil do recém-nascido, alterações ecocardiográficas, tratamento e desfecho da Hipertensão Pulmonar Persistente Neonatal em uma unidade de cuidados terciários na cidade de Joinville/SC, Brasil. Métodos: Estudo descritivo observacional transversal envolvendo a avaliação dos prontuários dos neonatos com sinais clínicos de hipertensão pulmonar, comprovação ecocardiográfica e internação em Unidade de Terapia Intensiva no período de um ano. Foram coletados dados fetais, maternos, ecocardiográficos, tratamentos e desfechos. Resultados: Foram estudados 29 recém-nascidos. A mediana da idade gestacional foi de 37,4 semanas, 65,5% dos partos foram realizados por via alta e 48,3% das mães realizaram acompanhamento pré-natal de alto risco. O peso de nascimento variou de 585 a 4270g, 58,6% dos pacientes eram do sexo feminino, 48,3% dos recém-nascidos apresentaram Índice de Apgar <7 no 1º minuto. Ao estudo ecocardiográfico, 62,1% dos pacientes apresentaram shunt cardíaco direito-esquerdo e a pressão pulmonar média calculada foi de 40,5 mmHg (26,3-66,0). As drogas mais utilizadas foram Milrinona, Óxido Nítrico Inalatório e Alprostadil. A amostra contou com 6 óbitos. Não houve valor de p significativo nas variáveis devido a limitação na quantidade da amostra estudada. Conclusão: O perfil do RN encontrado foi de neonatos do gênero feminino, a termo, com nascimento por via alta. Os sinais clínicos de hipertensão pulmonar foram observados na maioria dos pacientes sendo demonstrado grau leve pelas alterações ecocardiográficas. Não houve diferença significativa na comparação das medicações utilizadas e o tempo de suporte ventilatório comparado a severidade da doença. A taxa de mortalidade foi semelhante a outros estudos.

Objectives: To describe risk factors, newborn profile, echocardiographic changes, treatment and outcome of Persistent Pulmonary Hypertension of Newborn diagnosed in a hospital in the South of Brazil. Methods: This was a cross-sectional descriptive study. The research was performed with medical records of newborns presenting clinical signs of pulmonary hyperterion, echocardiographic changes and neonatal ICU for one year. Our variables included neonatal data, maternal data, echocardiographic data, treatments and outcomes. Results: We studied 29 newborns. The median gestational age was 37.4 weeks, 65.5% of deliveries were cesarean and 48.3% of mothers underwent high-risk prenatal care. Birth weight ranged from 585 to 4270 g, 58.6% were female patients, 48.3% of newborns had Apgar score <7 in the first minute. Among the echocardiographic changes, we found 62.1% of patients with right-to-left cardiac shunt and mean pulmonary pressure calculated was 40.5 mmHg (26.3-66.0). The main prescribed drugs were Milrinone, Inhaled Nitric Oxide and Alprostadil (Prostaglandin E1 agonist). The total sample had 6 deaths. Due the limitation of the amount of the sample studied, an insignificant p-value was obtained in all variables. Conclusion: The profile of the newborn was female genre, with term pregnancy, by cesarian. Clinical signs of pulmonary hypertension were observed in most of patients, and mild levels were demonstrated by echocardiographic changes. There was no significant difference in the comparison between the medications used and the duration of ventilatory support associated with the severity of the disease. The mortality rate was similar to other studies.

Cardiovascular abnormalities in severe scrub typhus

Background: Himachal Pradesh is an endemic area for scrub typhus. If not treated early, it can lead to life threatening complications, affecting various systems of the body. Hence, this study was done with an objective to study the cardiovascular abnormalities in patients of severe scrub typhus.Methods: Authors conducted a hospital-based study in Departments of Medicine and Cardiology, of a tertiary care hospital in Sub-himalayan region in patients of severe scrub typhus from June 2016 to May 2017.Results: Thirty-two (55%) patients were aged <60 years with female preponderance (72%).   Electrocardiographic changes included sinus tachycardia in 56 (97%), axis deviation in 5(9%), ST-T changes in 3(5%) and atrial fibrillation in 1(2%). Echocardiographic changes included tricuspid regurgitation in 14(24%), pericardial effusion in 4(7%), myocarditis in 1(2%) and Regional wall motion abnormality in 1(2%). Left ventricular ejection fraction >45% in 47 (81%) and <45% in 11(19%).  Fifty-one patients had hypotension at presentation and 49 (90%) of them improved. Interestingly, 10 of 11 patients with reduced EF (<45%) survived whereas 6 of total 7 patients, who died, had preserved EF (>45 %).Conclusions: Severe scrub typhus manifested with ST/T changes, myocarditis, pericardial effusion, arrhythmias, shock and patients with reduced EF on Echocardiography had better outcome.

Rheumatic heart disease in the modern era: recent developments and current challenges

Abstract Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology and increased understanding of disease mechanisms, RHD continues to be a serious public health problem throughout the world, especially in low- and middle-income countries. Echocardiographic screening has played a key role in improving the accuracy of diagnosing RHD and has highlighted the disease burden. Most affected patients present with severe valve disease and limited access to life-saving cardiac surgery or percutaneous valve intervention, contributing to increased mortality and other complications. Although understanding of disease pathogenesis has advanced in recent years, key questions remain to be addressed. Preventing or providing early treatment for streptococcal infections is the most important step in reducing the burden of this disease.

Factores pronósticos en hipertensión pulmonar Nuestra experiencia

Introducción. La hipertensión pulmonar (HP) es una enfermedad multifactorial de elevada morbimortalidad. Si bien su evolución clínica ha mejorado en los últimos años gracias al avance en su diagnóstico y tratamiento, disponemos de escasa información, en nuestra región, acerca de los factores clínicos y pronósticos vinculados con dicha entidad. Objetivos. Determinar la prevalencia y las características de los factores pronósticos adversos en nuestra población con diagnóstico reciente de HP. Materiales y métodos. Se incluyeron pacientes con diagnóstico reciente de HP (menos de 7 días desde el diagnóstico) confirmado por cateterismo cardíaco derecho (CCD) con presión de arteria pulmonar media (PAPm) ≥ 25 mm Hg, entre Marzo de 2012 y Diciembre de 2016, por diferentes servicios especializados en insuficiencia cardíaca (IC) e HP. Se obtuvieron los siguientes datos personales y variables clínicas: síntomas y clase funcional (CF); grupo de HP (G); parámetros hemodinámicos directos: PAPm, presión de oclusión arterial pulmonar (POAP), presión en aurícula derecha (PAD) e índice cardíaco (Ic); datos funcionales: distancia en caminata de 6 minutos (DC6M); variables ecocardiográficas: función sistólica del ventrículo derecho (FSVD), desplazamiento sistólico del plano del anillo tricuspídeo (siglas en inglés, TAPSE), presión sistólica en arteria pulmonar (PSAP) y derrame pericárdico (DP). Los factores de mal pronóstico analizados fueron: historia de IC, síncope, CF avanzada (III/IV), DC6M < 350 metros, presencia de DP, TAPSE ≤ 15 mm, PAD ≥ 12 mm Hg e Ic ≤ 2,2 L/min/m². Resultados. Se incluyeron 107 pacientes, el 74% fue de sexo femenino, con una edad media de 58,8 (± 19) años, el 33% ≥ 70 años. El tiempo medio al diagnóstico fue de 24 meses desde la presencia del primer signo o síntoma referido. La distribución por grupde HP fue: GI (64%), GII (15%), GIII (9%), GIV (6%) y GV (6%). Dentro del GI se destacó la esclerodermia como etiología preponderante (29%). La CF de presentación fue: CF II del 41%, CF III del 35%, CF IV del 20%, CF I del 4%. Las variables clínicas destacadas fueron: historia de IC (72%), síncope (23%) y angina (19%). La DC6M tuvo una media de 320 (±148) m, siendo≤ 350 m en el 47% de los casos. Los parámetros hemodinámicos por CCD fueron: PAPm de 48,3 (±16) mm Hg; PAD 9,7 (±5,2) mm Hg y ≥14 mm Hg en un 27% con un Ic de 2,78 L/min/m² (≤ 2,2-23%). La evaluación ecocardiográfica constató deterioro de la FSVD en el 79% de los casos (42%: leve, 18%: moderado y 19%: severo) con un TAPSE medio de 17,8 (±4) mm y ≤ 15 mm en un 37%; en el 25% se observó DP. Conclusiones. En nuestra población con diagnóstico reciente de HP, se presenta un elevado porcentaje de pacientes añosos y de factores de mal pronóstico. Estos hallazgos remarcan la necesidad de un diagnóstico precoz y terapéuticas de inicio temprano.

Introduction. Pulmonary hypertension (PH) is a multifactorial disease with high morbidity and mortality. Although its clinical evolution has improved in recent years due to the advance in its diagnosis and treatment, we have little information about clinical and prognostic factors associated with this entity. Purpose. To determine the prevalence and characteristics of adverse prognostic factors in our population with a recent diagnosis of PH. Material and methods. Patients with a recent diagnosis of PH (less than 7 days after diagnosis) confirmed by right heart catheterization (RHC) with mPAP ≥ 25 mm Hg, between March 2012 and December 2016, by different specialized services in heart failure (HF) and PH were included. The following personal data and clinical variables were obtained: symptoms and functional class (FC); HP group (G); hemodynamic parameters: mPAP, pulmonary arterial occlusion pressure (PAOP), right atrial pressure (RAP) and cardiac index (CI); functional data: 6-minute walk distance (6MWD); echocardiographic variables: right ventricle systolic function (RVSF), tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (SPAP) and pericardial effusion (PE). Poor prognosis factors analyzed were: history of HF, syncope, advanced FC (III/IV), 6MWD <350 meters, presence of PE, TAPSE ≤ 15 mm, RA ≥12 mm Hg and CI ≤ 2.2 L/min/m². Results. One hundred seven patients were included, 74% female, with a mean age of 58.8 (± 19) years, 33%≥ 70 years. The mean time to diagnosis was 24 months from the presence of the first sign or symptom recorded. Distribution by HP G was: GI (64%), GII (15%), GIII (9%), GIV (6%) and GV (6%). Considering GI, sclerodermia was the predominant etiology (29%). FC of presentation was: FC II 41%, FC III 35%, FC IV 20%, FC I 4%. Among the clinical variables, history of HF was present in 72% of patients, syncope in 23% and angina in 19%. Mean 6MWD was 320 (± 148) m, ≤ 350 m in 47% of the patients. The direct hemodynamic parameters by RHC were: mPAP 48.3 (± 16) mm Hg; RAP 9.7 (± 5.2) mm Hg and ≥14 mm Hg in 27%, CI 2.78 L/min/m² (≤ 2.2-23%). Echocardiographic analysis showed Impaired RVSF in 79% of cases (42% mild, 18% moderate and 19% severe) with a mean TAPSE of 17.8 (± 4) mm and ≤ 15 mm in 37%; PE was present in 25% of patients. Conclusions. In our population with recent diagnosis of PH, there is a high percentage of elderly patients and poor prognosis factors. This findings remark the need for early diagnosis and therapeutic strategies.

Introdução. A hipertensão pulmonar (HP) é uma doença multifatorial, com alta morbimortalidade. Embora sua evolução clínica tenha melhorado nos últimos anos devido ao avanço em seu diagnóstico e tratamento, temos pouca informação, em nossa região, sobre os fatores clínicos e prognósticos associados a essa entidade. Objetivos. Determinar a prevalência e as características de fatores prognósticos adversos em nossa população com diagnóstico recente de HP. Materiais e métodos. Foram incluídos pacientes com diagnóstico recente de HP (menos de 7 dias após o diagnóstico), confirmados por cateterismo cardíaco direito (CCD) com a pressão da artéria pulmonar média (PAPm) ≥ 25 mm Hg entre Março de 2012 e Dezembro de 2016, por diferentes serviços especializados em insuficiência cardíaca (IC) e HP. Foram obtidos os seguintes dados pessoais e variáveis clínicas: sintomas e classe funcional (CF); Grupo HP (G); parâmetros hemodinâmicos diretos: PAPm, pressão de oclusão arterial pulmonar (POAP), pressão atrial direita (PAD) e índice cardíaco (Ic); dados funcionais: distância de caminhada de 6 minutos (DC6M); variáveis ecocardiográficas: função sistólica do ventrículo direito (FSVD), excursão sistólica do plano anular da tricúspide (TAPSE), pressão sistólica da artéria pulmonar (PSAP) e derrame pericárdico (DP). Os fatores analisados de prognóstico pobre foram: história de IC, síncope, CF avançado (III/IV), DP6M<350 metros, a presença de DP, TAPSE ≤ 15 mm, PAD ≥12 mm Hg e Ic ≤ 2,2 L/min/m². Resultados. Foram incluídos 107 pacientes, sendo o 74% do sexo feminino, com média de idade de 58,8 (± 19) anos, o 33% ≥ 70 anos. O tempo médio para o diagnóstico foi de 24 meses a partir da presença do primeiro sinal ou sintoma referido. A distribuição por grupo de HP foi: GI (64%), GII (15%), GIII (9%), GIV (6%) e GV (6%). No GI, a esclerodermia foi destacada como a etiologia predominante (29%). A apresentação CF: CF II 41%, CF III 35%, CF IV-20%, CF I 4%. As variáveis clínicas destacadas: história de IC em 72%, síncope 23% e angina 19%. A DC6M teve uma média de 320 (± 148) m, sendo ≤ 350 m em 47% dos casos. Os parâmetros hemodinâmicos pelo CCD foram: PAPm 48,3 (± 16) mm Hg; PAD 9,7 (± 5,2) mm Hg e ≥14 mm Hg em 27% com Ic 2,78 L/min/m² (≤ 2,2-23%). A análise ecocardiográfica mostrou FSVD diminuída em 79% (42% leve, 18% moderada e 19% grave) com um TAPSE média de 17,8 (± 4) mm e ≤ 15 mm em o 37%; em o 25% foi observado DP. Conclusões. Em nossa população com diagnóstico recente de HP, há um alto percentual de pacientes idosos e fatores de mau prognóstico. Esses achados destacam a necessidade de diagnóstico precoce e início terapêutico precoce.

Study of Cardiac Manifestations in Patients with HIV Infection and Their Correlation with CD4 Count in Indian Population.

Background: HIV continues to be a major global public health issue. In 2014 an estimated 36.9 million people were living with HIV, a global prevalence of 0.8 %. The clinical spectrum of HIV infection encompasses a spectrum ranging from an acute syndrome associated with primary infection to a prolonged symptomatic state to an advanced cardiac disease in HIV affected patients is becoming more prevalent as therapy and longevity improve Infection HIV is one of the causes of acquired heart disease in these patients. With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Methods: During the period of 1 year from July 2015 to September 2016, total 100 cases of HIV/AIDS were included. The occurrence of cardiac involvement in HIV/AIDS cases was determined based on cardiac enzymes, ECG findings & 2D Echocardiography findings. An attempt was made to correlate various cardiac findings with CD4 T cell count. Results: Male to female ratio was 3:1. Common clinical symptoms were fever (68%), cough (44%) & extertional breathlessness (33%) Echocardiographic abnormalities were seen in 54.3% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (46.3%) followed by pericardial effusion (16.66%), pulmonary artery hypertension (11.11%), dilated cardiomyopathy (9.25%), diastolic dysfunction (9.25%), regional wall motion abnormality (1.85%) and valvular regurgitation (5.55%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.05). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusion: Echocardiographic abnormalities are more prevalent in HIV/AIDS patients and their prevalence increases as the CD4 count falls andoccur more in advanced stage of the disease. So we should aim at starting ART early in HIV infected patients so as to improve the quality of life of people living with HIV/AIDS.

Effect of clopidogrel on serum inflammatory factors and echocardiography in patients with acute myocardial infarction complicated with heart failure / 中国生化药物杂志

Objective To study the effect of clopidogrel on serum inflammatory factors and echocardiography in patients with acute myocardial infarction complicated with heart failure.Methods60 cases of patients admitted in our hospital from July 2014 to August 2016 were selected as the research object in this study.They were randomly divided into the control group and the experimental group, each group had a total of 30 cases.Patients in the control group were treated with diuretics, nitroglycerin and aspirin, while the experimental group received clopidogrel on the basis of the control group.After treatment in June, comparative analysis of the experimental group and the control group of patients with treatment effect and related clinical indicators.ResultsAfter treatment, 6months after the corresponding, compared with before treatment, the experimental group and the control group of patients with C-reactive protein and vascular cell adhesion molecule 1, 6min mediated leukocyte walking experiment, Su-6 and the heart rate of treatment were improved, with statistical difference (P<0.05), left ventricular end diastolic there was no significant difference between the change in diameter.In the control group, C-reactive protein, vascular cell adhesion molecule 1, 6min walking test, interleukin-6 and heart rate were significantly better than those in the control group, with statistical difference (P<0.05).ConclusionThe application of clopidogrel in acute myocardial infarction complicated with heart failure in the can to a great extent on the inflammatory response in patients, improve the patient's left ventricular ejection fraction and heart rate, with the further promotion and application in clinical significance.

Evaluación ecocardiográfica longitudinal en pacientes con leucemia linfoide aguda que recibieron antraciclinas durante la edad pediátrica / Longitudinal ecocardiographic assesment in patients with acute lymphoid leukemia that received anthracyclines during childhood

Introducción: La cardiotoxicidad tardía causada por el tratamiento del cáncer puede ser un problema frecuente en los sobrevivientes por lo que se decidió realizar un estudio ecocardiográfico longitudinal de la función cardiovascular con el objetivo de detectar las alteraciones causadas por la administración de antraciclinas en pacientes que tuvieron una leucemia linfoide aguda en la edad pediátrica. Métodos: se incluyeron todos los pacientes atendidos por esta leucemia en el Servicio de Pediatría del Instituto de Hematología e Inmunología ,desde abril de 2002 hasta febrero de 2015, que además debían tener al menos 2 evaluaciones ecocardiográficas posteriores a la conclusión del tratamiento. A todos se les realizó examen físico, se tomaron datos generales de las historias clínicas, se les calculó la dosis acumulativa de antraciclinas y el tiempo transcurrido hasta la realización de la evaluación. De los ecocardiogramas realizados se tomaron las medidas de aurícula izquierda, ventrículo derecho, fracción de eyección y fracción de acortamiento. Resultados : predominaron los signos de cardiotoxicidad tardía subclínica con una media de 9 años después de suspendido el tratamiento y estuvieron afectados ambos sexos por igual. En el primer ecocardiograma realizado, tres años después de la suspensión, la mayor frecuencia de alteraciones estuvieron en las medidas de aurícula izquierda y ventrículo derecho. Los estudios se repitieron cada tres años y en el tercer estudio fue más frecuente la afectación de las fracciones de eyección y de acortamiento. Se encontró que había relación estadísticamente significativa entre el uso de mayores dosis de antraciclinas y las alteraciones ecocardiográficas. Conclusiones: las afectaciones de la función cardiovascular fueron ligeras y aumentaron durante el seguimiento(AU)

Introduction Cancer therapy could cause frequent cardiac toxicity, so we decided to perform an echocardiographic longitudinal study of the late effects caused by anthracyclines administration in patients that were treated for acute lymphoid leukemia during childhood. Methods All the patients admitted in the Pediatric Service of Institute of Hematology and Immunology, with acute lymphoid leukemia since april 2002 until february 2015 and that have at least two echocardiographic studies after finishing therapy. A complete physical exammination was performed to all of them and the cumulative dose of anthracyclines received was calculated and also time until evaluation. From the echocardiograms were taken the measurements of left auricle, right ventricle, ejection fraction and shortening fraction. Results: the main findings were signs of late subclinical cardiotoxicity with a mean of 9 years after therapy completion and there were no sex predominance. In the first echocardiogram performed three years after stopping therapy there were more alterations in the measures of left auricle and right ventricle. The studies were repeated every three years and in the third one there were more alterations in ejection fraction and shortening fraction and there also were a statiscally significative relation between cumulative anthracyclines doses and echocardiographic findings. Conclusions: There were found subclinical cardiac dysfunction that increases as time goes by(AU)

Echocardiographic findings: Experience in 1,468 cases / Hallazgos ecocardiográficos: experiencia en 1,468 casos

Abstract: Background: Echocardiogram is an important diagnostic tool to evaluate cardiac disease and very usefull in diagnosis and management. It is important to know the spectrum of cardiac abnormalities detected by transthoracic echocardiography, the frequency of findings that may vary depending on the prevalence of the disease and type of studied population. Objective: To know the spectrum of findings identified in resting transthoracic echocardiography in 1,468 patients. Material and methods: A 3 years retrospective review of resting transthoracic echocardiograms in 1,468 patients. Results: The age range of the 1,468 patients was from 1 day to 94 years with mean (SD) age 51 ± 7.2 years; females 52.9% (n = 776) and males 47.1% (n = 692). One hundred thirty three patients (9.05%) had normal echocardiograms; 1,335 patients had an average of 1.8 findings/patient; 2,464 findings were classified in ten different categories: heart valves abnormalities was the most frequent alteration detected in 36.47% (n = 487); diastolic dysfunction 30.71% (n = 410); and cardiac chambers dilation 27.79% (n = 371). Conclusions: Clinical history and physical examination can not be substituted by an imaging test, but with the clinical data obtained, in conjunction with an echocardiographic study, gives us clues to the diagnosis and pathophysiology of heart disease essential for the properly evaluation and management.

Resumen: Antecedentes: La ecocardiografía es una herramienta indispensable para evaluar y manejar a las enfermedades cardiacas. Es importante conocer el espectro de anormalidades cardiacas detectadas por ecocardiografía transtorácica en reposo y la frecuencia de esos hallazgos, los cuales varían de acuerdo a cada enfermedad cardiaca. Objetivo: Reportar el espectro de hallazgos ecocardiográficos en 1,468 pacientes. Material y métodos: Los estudios ecocardiográficos transtorácicos en reposo realizados durante un período de 3 años. Resultados: Un total de 1,468 pacientes con edades comprendidas entre el primer día de vida y 94 años con edad promedio y desviación estándar de 51 ± 7.2 años; correspondiendo 52.9% (n = 776) al género femenino y 47.1% al masculino (n = 692). De los estudios, 9.05% (n = 133) fueron normales; 1,335 pacientes presentaron un promedio de1.8 hallazgos/paciente; se detectaron 2,464 hallazgos catalogándose en 10 capítulos. Los tres hallazgos más frecuentes fueron: valvulares 36.47% (n = 487); disfunción diastólica 30.71% (n = 410); y dilatación de cámaras cardiacas 27.79% (n = 371). Conclusiones: Una imagen no puede sustituir a la historia clínica y a la exploración física, siendo la ecocardiografía una prolongación de esta última, permitiendo valorar la estructura y fisiología cardiaca así como sus alteraciones, por lo que actualmente es esencial su realización en la valoración cardiaca.

Can Right Heart Parameters of Runners Participating in High Altitude Race be Influenced by Training Altitude or Have Any Impact on Their Performances?.

Objectives: This work was aimed at investigating, by means of ultrasonography, the influence of training altitudes on haemodynamic parameters of the right heart and the impact of these parameters on the performances of runners participating in endurance races. Experimental Design: This was a cross-sectional study. Place and Duration of the Study: The study was carried out in Cameroon. Echocardiographic parameters were recorded at the Regional Hospital annex of Buea (Cameroon) on the 12th and 13th February while race times were recorded at Molyko Stadium of Buea, on the 15th February 2014. Methodology: Out of 241 runners who finished the senior Mount Cameroon Race of Hope, 68 who were at least at their second participation, had voluntarily participated in the study. Right heart parameters such as the Mid Right Ventricle Diameter (MRVD), the right ventricle Base-To-Apex Length (BAL), the Right Wall Motion (RWM), the Free Wall Thickness (FWT), the tricuspid annular plan systolic excursion (TAPSE) were collected through 2D transthoracic ultrasonography. Mann-Withney or Kruskal-Wallis tests and Spearman’s correlation were used for statistical analysis. The significance level was set at p-value<0.05. Results: Performances improved with the increasing number of participation in the race. From all the above echocardiographic parameters only the values of TAPSE were significantly different (p=0.035), with respect to genders (1.8±0.3 vs. 1.6±0.3 cm/m2, for males and females respectively). The Spearman’s correlation analysis did not show any relationship between training altitude and MRVD (r=-0.19; p=0.19), TAPSE (r=0.14; p=0.35) or FWT (r=-0.04; p=0.77). However, there was a correlation, although weak, between training altitude and BAL (r=-0.33; p=0.02). BAL decreased as training altitude was getting higher. None of these haemodynamic parameters seemed to impact the performances of runners. Conclusion: The training altitudes can impact right ventricle BAL, but not TAPSE and the latter is affected by gender. However, these parameters seem not to impact the performances of high altitude endurance runners.

Factores trombogénicos en aurícula izquierda en pacientes con fibrilación auricular / Thrombogenic factors in left atrium in patients with atrial fibrilation

INTRODUCCIÓN: trabajos de Agmon y Fatkin, demostraron que la dilatación de la aurícula izquierda (AI), contraste espontáneo (CE) en AI y velocidades de ingreso y salida de la orejuela izquierda (OI) menores a 20 cm/s son factores de riesgo trombogénico en pacientes con fibrilación auricular (fa). OBJETIVO: identificar los factores trombogénicos en la AI en pacientes con fa en nuestro medio. MATERIAL Y MÉTODOS: se revisaron los estudios de ETE de pacientes con fa, que asistieron al servicio de Cardiología del Hospital Obrero Nº 1 de la Caja Nacional de Salud en La Paz; se dividieron en 2 grupos: 1) pacientes sin trombo en AI y 2) pacientes con trombo en AI, comparándolos con la presencia de dilatación de AI, CE en AI y velocidades de flujo de ingreso y salida en la OI con Doppler pulsado, obteniendo el Odds Ratio (OR) y su intervalo de confianza al 95% (IC) para estas variables. RESULTADOS: se encontraron 131 casos. Relacionando la presencia de trombos en AI, con dilatación de esta cavidad, se obtuvo un OR de 4,84. Con la presencia de CE el OR fue 12,54. En relación a la velocidad de flujo de ingreso a la OI se evidenció que cuando es ≤10 cm/s se tiene un OR de 4,87 y de 11-20 cm/s el OR fue 3,77, siendo el valor de ésta velocidad inversamente proporcional a la presencia de trombo en AI, lo mismo ocurre en la velocidad de salida de OI, ya que con velocidades ≤ 10 cm/s el OR fue 12,3 y con velocidades 11-20 cm/s el OR fue 9,7. CONCLUSIÓN: la dilatación de AI, CE y velocidades de flujo de ingreso y salida en OI ≤ 20 cm/s constituyen un factor de riesgo para la presencia de trombos en AI en pacientes con fa.

INTRODUCTION: previous Works of Agmon and Fatkin, demonstrated that the presence of left atrium (LA) dilatation, spontaneous echocardiographic contrast (SEC) in LA, input and output flow in left atrial appendage (LAA), measured with pulse wave Doppler, less than 20 cm/s are thrombogenic risk factors in patients with atrial fibrillation (af). AIM: to identify the factors associate with thrombi in left atrium in patients with atrial fibrillation in our country. MATERIAL AND METHODS: we reviewed studies of patients with atrial fibrillation, subject to transesophageal echocardiography (TOE), realized in the Cardiology Service in Hospital Obrero­ C.N.S. of La Paz; they were divided in 2 groups: 1) patients with LA thrombi and 2) patients withouth LA thrombi, comparing them with the presence of LA dilatation, SEC and input and output flow into the LAA with pulsed Doppler wave, we obtained the OR, and its respective confidence interval at 95% (CI) for all these variables. RESULTS: we found 131 studies. Making the relationship with the presence of LA thrombi with dilated LA, we got a 4.84 OR. With SEC in LA an OR of 4.87. Input flow velocities in LAA ≤ 10 cm/s was 4.87, velocities between 11 to 20 cm/s the OR was 3.77, being this value inversely proportional with the existence of LA thrombi. The same occurs with output flow velocities, so with ≤10 cm/s we got an OR of 12.3 and with velocities between 11 and 20 cm/s the OR was 9.7. CONCLUSION: LA dilatation, SEC, input and output flow in LAA ≤ 20 cm/s, are risk factors to the formation of thrombi in LA in patients with af.

Association of Left Atrial Spontaneous Echocardiographic Contrast with Inflammatory Markers in Mitral Stenosis Patients.

Background: Spontaneous echocardiographic contrast (SEC) is a risk factor for left atrial thrombus formation and an important indicator of potential systemic embolism originated from heart. An established relation exists between the inflammatory status and the prothrombotic state. The present study was conducted to evaluate the association between left atrial spontaneous echocardiographic contrast with inflammatory markers in mitral stenosis patients. Methods: This observational analytical study was undertaken in the department of Cardiology, National Institute of Cardiovascular diseases (NICVD), Dhaka. A total of 70 patients with mitral stenosis were categorized into two groups: group I with left atrial SEC and group II without left atrial SEC. All patients underwent transthoracic as well as transoesophageal echocardiography. Complete blood count with ESR was done and neutrophil lymphocyte ratio was calculated. The high sensitive C-reactive protein (hs-CRP) was assayed. Results: The hs-CRP levels were significantly greater in the SEC-positive group (5.6±2.1vs 1.5±0.7, p=0.001). The mean ESR level was significantly greater in the SEC-positive group (32.6±15.5 mmvs15.8±4.7 mm).The neutrophil levels ((76.1±1.9 vs 63.7±3.3) were significantly greater in the SEC-positive group, and the lymphocyte levels (33.3±3.0 vs 21.5±1.3) were significantly greater in the SEC-negative group (p=0.001 for each). The neutrophil/lymphocyte (N/L) ratio was also significantly greater in the SEC-positive group (3.4±0.4 vs2.1±0.6, p=0.001).On multivariate analysis hs-CRP, neutrophil/lymphocyte ratio, raised ESR, mitral valve area and left atrial diameter were independent risk factors for SEC in patients with mitral stenosis. Conclusion: From this study it may be concluded that left atrial SEC is associated with raised inflammatory markers in majority of patients with mitral stenosis. So, SEC may be considered as a reflection of ongoing inflammatory process in patients with mitral stenosis.