FETAL ECHOCARDIOGRAPHY AS A ROUTINE ANTENATAL SCREENING TOOL FOR DETECTION OF FETAL CONGENITAL CARDIAC STRUCTURAL ANOMALIES.

Background: Fetal echocardiography plays a pivotal role in detecting congenital cardiac structural anomalies. Though foetal echocardiography is mostly reserved for high risk pregnant women, its role as a routine prenatal screening tool needs to be dened. To evaluate the role of fetal echocardiography as a routine Objectives: antenatal screening tool for detection of congenital cardiac structural anomalies.To compare the prevalence of congenital cardiac structural anomalies by fetal echocardiography in antenatal women with low risk and high risk factors for cardiac structural anomalies. The study was carried out in the department of radiodiagnosis, SNMC, Agra. Materials and methods: 500 fetal hearts between 18-26 weeks gestation were evaluated through fetal echocardiography.They were categorised into two groups -low risk (Group I) and high risk (Group II) and scanned through four chamber , LVOT , RVOT and three vessel view. Result: The prevalence of fetal congenital cardiac structural anomalies in this study is 14/1000.Fetal echocardiography had a sensitivity of 85% & specicity of 99%. PPV is 85% and NPV is 99%. The incidence of congenital cardiac structural anomalies in high risk and low risk group was 12 % & 14.8 % per 1,000 respectively. based on these ndings it is highly Conclusion: suggestive that every pregnant woman should be subjected to a detailed fetal echocardiography. Fetal echocardiography should be included as a part of routine antenatal screening irrespective of risk factors for congenital cardiac structural anomalies.

Myocardial strain analysis by 4D-speckle tracking echocardiography for prediction of coronary artery disease severity in patients with stable angina pectoris

Objective: We sought to evaluate the myocardial strain by four-dimensional speckle-tracking echocardiography (4D-STE) in patients with stable angina pectoris (SAP) to determine the severity of coronary artery disease (CAD) based on the Gensini score. Methods: The present study comprised of 150 patients with SAP. Patients with history of SAP, normal left ventricular ejection fraction, and without regional wall motion abnormalities (RWMA) were scheduled for elective coronary angiography. Based on Gensini score, there were two groups: non-critical stenosis group [Gensini score (0e19), n ¼ 117] and critical stenosis group [Gensini score 20, n ¼ 33]. Correlation between Gensini score and 4D-STE strain parameters were investigated. Results: Out of 150 patients, critical stenosis group had significantly depressed values of all 4D-STE strain parameters than non-critical stenosis group (p < 0.001), except global radial strain (GRS) parameter. Significant positive correlation was found between Gensini score and 4D global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS) with Spearman's correlation coefficient (r) as 0.626, 0.548, and 0.631, respectively (p < 0.001), whereas significant negative correlation was found between Gensini score and GRS (r ¼ 0.433, p < 0.001). A 4D GLS value of 17 had 84.9% sensitivity and 97.4% specificity, GAS 31 (90.9% sensitivity, 78.6% specificity), GCS 17 (69.7% sensitivity, 92.3% specificity), and GRS <47 (sensitivity 72.7%, specificity 76.1%) to detect critical CAD described by Gensini score 20. Conclusion: The 4D-STE can aid in the assessment of severe CAD stenosis with good sensitivity and specificity in the patients with SAP without RWMA on traditional echocardiography.

Transcatheter Mitral Valve Implantation: Implications of Interventional Technique and 3D Echocardiography for Complex Valve?in?Valve Paravalvular Leak

Transcatheter mitral valve replacement (TMVR) has emerged as a feasible alternative to surgical reoperation in failed bioprostheses and rings. Residual mitral regurgitation following TMVR can present as a valve?in?valve paravalvular leak (PVL) and is associated with increased morbidity and mortality. Current therapies for valve?in?valve PVL are limited. We present a case of a symptomatic patient with severe valve?in?valve PVL after TMVR for a previous surgical bioprosthesis leak, who then underwent a second TMVR as a valve?in?valve?in?valve implantation with a 29 mm Edwards? SAPIEN 3 valve via transseptal approach using three?dimensional (3D) echocardiography. This unique case highlights the complexity of this clinical entity and recognizes 3D transesophageal echocardiography as a valuable tool to guide valve?in?valve PVL closures.echocardiography

Normalizing Arterial Blood Pressure in Patients with Aortic Stenosis Does Not Prevent Grading Discrepancies Between Pre?Cardiopulmonary Bypass Transesophageal Echocardiography and Transthoracic Echocardiography

Background: Aortic stenosis (AS) grading discrepancies exist between pre?cardiopulmonary (pre?CPB) transesophageal echocardiography (TEE) and preoperative transthoracic echocardiography (TTE). Prior studies have not systematically controlled blood pressure. Aims: We hypothesized that normalizing arterial blood pressure during pre?CPB TEE for patients undergoing valve replacement for AS would result in equivalent grading measurements when compared to TTE. Setting: Single University Hospital Design: Prospective, Interventional Methods: Thirty?five adult patients underwent procedures for valvular AS between February 2017 and December 2020 at Medical University of South Carolina. Study participants had a TTE within 90 days of their procedure that documented blood pressure, peak velocity (Vp ), mean gradient (PGm), aortic valve area (AVA), and dimensionless index (DI). During pre?CPB TEE, if a patient抯 mean arterial pressure (MAP) fell more than 20% below their baseline blood pressure obtained during TTE, measurements were recorded as 搊ut of range.� Phenylephrine was administered to restore MAP to the baseline range and repeat TEE measurements were recorded as 搃n?range.� Statistical Analysis: Differences between imaging modalities and grading parameters were examined using a series of linear mixed models. P values were Bonferroni?adjusted to account for multiple comparisons. Main Results: Significant discrepancies between TEE and TTE were observed for Vp , PGm, and DI despite blood pressure normalization across all subjects and for out?of?range measures and corrected measures. There were no statistically significant differences between TEE and TTE for AVA. Conclusions: Blood pressure normalization during pre?CPB TEE is not sufficient to avoid AS grading discrepancies with preoperative TTE.

Comparision of Cardiac Output Measured by Transthoracic Echocardiography with Continuous Cardiac Output Measured by Pressure Recording Analytical Method

Background: Low cardiac output is a common complication following cardiac surgery and it is associated with higher mortality in the pediatric population. A gold standard method for cardiac output (CO) monitoring in the pediatric population is lacking. The present study was conducted to validate cardiac output and cardiac index measured by transthoracic echocardiography and Pressure recording analytical method, a continuous pulse contour method, MostCare Up in postoperative pediatric cardiac surgical patients. Materials and Methods: This was a prospective observational clinical study conducted at a tertiary care hospital. A total of 23 pediatric patients weighed between 2 and 20 kg who had undergone elective cardiac surgery were included in the study. Results: Spearman抯 correlation coefficient of CO between transthoracic echocardiography (TTE) and Pressure Recording Analytical Method (PRAM) showed of positive correlation (r = 0.69, 95% Confidence interval 0.59?0.77, P < 0.0001) Linear regression equations for CO between TTE and PRAM were y = 0.55 + 0.88x (R2 = 0.46, P < 0.0001). (y = PRAM, x = TTE), respectively. Bland? Altman plot for CO between TTE and PRAM showed a bias of ?0.397 with limits of the agreement being ?2.01 to 1.22. Polar plot analysis showed an angular bias of 6.55� with radial limits of the agreement being ?21.46 to 34.58 for CO and angular bias of 6.22� with radial limits of the agreement being ?22.4 to 34.84 for CI. Conclusion: PRAM has shown good trending ability for cardiac output. However, values measured by PRAM are not interchangeable with the values measured by transthoracic echocardiography.

Looking for a definition of aortic dilatation in overweight and obese individuals: body surface area-indexed values versus height-indexed diameters / En búsqueda de la definición de dilatación aórtica en individuos con sobrepeso y obesidad: rol de la indexación por altura. Análisis del Registro MATEAR

Abstract Introduction: Patient's body size is a significant determinant of aortic dimensions. Overweight and obesity underestimate aortic dilatation when indexing diameters by body surface area (BSA). We compared the indexation of aortic dimensions by height and BSA in subjects with and without overweight to determine the upper normal limit (UNL). Methods: The MATEAR study was a prospective, observational, and multicenter study (53 echocardiography laboratories in Argentina). We included 879 healthy adult individuals (mean age: 39.7 ± 11.4 years, 399 men) without hypertension, bicuspid aortic valve, aortic aneurysm, or genetic aortopathies. Echocardiograms were acquired and proximal aorta measured at the sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AA) levels (EACVI/ASE guidelines). We compared absolute and indexed aortic diameters by height and BSA between groups (men with body mass index [BMI] < 25 and BMI ≥ 25, women with BMI < 25 and BMI ≥ 25). Results: Indexing of aortic diameters by BSA showed significantly lower values in overweight and obese subjects compared to normal weight in their respective gender (for women: SV 1.75 cm/m2 in BMI < 25 vs. 1.52 cm/m2 in BMI between 25 and 29.9 vs. 1.41 cm/m2 in BMI ≥ 30; at the STJ: 1.53 cm/m2 vs. 1.37 cm/m2 vs. 1.25 cm/m2; and at the AA: 1.63 cm/m2 vs. 1.50 cm/m2 vs. 1.37 cm/m2; all p < 0.0001 and for men, all p < 0.0001). These differences disappeared when indexing by height in both gender groups (all p = NS). Conclusion: While indexing aortic diameters by BSA in obese and overweight subjects underestimate aortic dilation, the use of aortic height index (AHI) yields a similar UNL for individuals with normal weight, overweight, and obesity. Therefore, AHI could be used regardless of their weight.

Resumen Introducción: El tamaño corporal es un determinante significativo de las dimensiones aórticas. El sobrepeso lleva a subestimar la dilatación aórtica. La altura (A) permanece estable durante la adultez, por lo que sería útil para indexar diámetros aórticos en pacientes obesos, aunque desconocemos los valores normales. Comparamos la indexación de diámetros aórticos por (IA) y superficie corporal (SC) en sujetos con y sin sobrepeso para determinar el límite superior normal (LSN, P97.5). Método: Se realizó un registro nacional, prospectivo, en 53 centros de Argentina. Se realizaron ecocardiogramas a 528 sujetos con índice de masa corporal (IMC) > 25 y 351 sujetos con IMC ≤ 25 seleccionados al azar. La población se subdividió en cuatro grupos según sexo e IMC y se compararon diámetros aórticos absolutos e indexados. Resultados: Se incluyeron 879 individuos (39.7 ± 11.4 años, 399 hombres). La indexación de los diámetros aórticos por SC mostró valores significativamente más bajos en sujetos con sobrepeso y obesidad en comparación con los de peso normal en cada sexo. Estas diferencias desaparecieron al indexar por altura en ambos géneros (todos p = NS). El LSN de los diámetros IA fue de 2.20 cm/m para senos, 1.99 cm/m para unión sino-tubular (UST) y 2.09 cm/m para aorta ascendente. Conclusiones: La indexación de los diámetros aórticos por SC en individuos con sobrepeso y obesidad subestima la dilatación aórtica. El IA permite establecer un LSN sin tener en cuenta el aumento espurio de la SC determinado por la grasa corporal. Podría ser utilizado en ambos sexos y de manera independiente del peso.

Métodos diagnósticos cardiovasculares en pacientes con diabetes mellitus. Revisión / Cardiovascular diagnostic methods in patients with diabetes mellitus. A review

Resumen Las enfermedades cardiovasculares constituyen la causa más común de mortalidad en el mundo. Actualmente, la diabetes mellitus tipo 2 (DM2) representa uno de los principales factores de riesgo de eventos adversos cardiovasculares mayores. Los pacientes que las padecen tienen un riesgo cuatro veces mayor de desarrollar insuficiencia cardíaca y una mortalidad de 10 a 12 veces mayor. La ecocardiografía en todas sus modalidades es la mejor herramienta clínica para el diagnóstico de la insuficiencia cardíaca, ya que proporciona imágenes estáticas y dinámicas del corazón que permiten identificar cambios estructurales y funcionales, como alteraciones en las presiones, cambios de flujo, fracción de expulsión del ventrículo izquierdo y remodelación anatómica de las superficies miocárdicas.

Abstract Cardiovascular diseases are the most common cause of mortality in the world. Currently, type 2 diabetes mellitus (T2DM) is one of the main risk factors for major adverse cardiovascular events. T2DM patients have a four-fold higher risk of developing heart failure and 10 to 12 times higher mortality. Echocardiography in all its modalities is the best clinical tool for heart failure diagnosis, since it provides static and dynamic images of the heart that allow to identify structural and functional changes, such as pressure variations, flow changes, left ventricular ejection fraction and myocardial surfaces anatomical remodeling.

Factors Associated With Hypertension and Cardiovascular Parameters in Children With Infrequently Relapsing Nephrotic Syndrome

Objective: To assess the prevalence of hypertension in children with infrequently relapsing nephrotic syndrome (IRNS) and its association with dyslipidemia, and end organ damage including left ventricular hypertrophy (LVH), at relapse and after steroid induced remission. Methods: Prospective observational study conducted in 83 children aged 1-12 years with IRNS, presenting in relapse. Blood pressure, fundus examination, blood and urine investigations were done at relapse and then at 4 weeks of therapy. Echocardiography at 4 weeks was performed for assessment of LVH and relative wall thickness (RWT) for concentric geo-metry (CG). Results: 27 patients (32.5%) developed hypertension, out of which 21 patients (25.3%) had stage I hypertension. Hypertension in first episode (63.0%, P<0.01) and in previous relapses (87.5%, P<0.001) was significantly associated with hypertension in the current episode. 12 patients had a positive family history of hypertension, of which 8 (66.7%) were classified under the hypertensive group (P=0.016). Concentric geometry (CG) was found in 28% of hypertensive and 5.5% of non-hypertensive children (P=0.011). On regres-sion analysis, a lower Up:Uc at the time of relapse was found to have a protective role for development of hypertension. Conclusion: One third children with IRNS had hypertension at relapse and a high proportion of hypertensive patients had CG pattern on echocardiography.

The Relationship between Basal Serum Lipoprotein(a) Levels and the Pulmonary Artery to Ascending Aorta Ratio in COVID-19 Survivors

Abstract Background: Coronavirus disease (COVID-19) can cause permanent damage to vascular structures by directly or indirectly affecting the cardiopulmonary system. Lipoprotein(a) [Lp(a)] is an important identified risk factor for vascular endothelial cell dysfunction. Objective: The aim of this study was to reveal the relationship between Lp(a) levels measured at the time of COVID-19 diagnosis and the pulmonary artery (PA) to the ascending aorta (Ao) ratio (PA:Ao ratio) in survivors evaluated by transthoracic echocardiography (TTE). Methods: The study sample consisted of 100 patients who recovered from COVID-19 in the past 3 to 6 months. The relationship between the change in the PA:Ao ratio (ΔPA:Ao) and the Lp(a) levels measured at the time of diagnosis was evaluated. Diameter measurements at baseline and follow-up were evaluated with TTE. Results: A significant increase was found in PA, Ao, and epicardial adipose tissue (EAT) thickness in TTE (p< 0.001 for all). There was a weak correlation between D-dimer and high-sensitivity cardiac troponin measured at the time of diagnosis and ΔPA:Ao and ΔEAT in survivors. However, a positive and strong correlation was observed between Lp(a) levels and ΔPa:Ao (r = 0.628, p< 0.001) and ΔEAT (r = 0.633, p< 0.001). Conclusion: There may be dysfunction in vascular structures due to COVID-19. For the first time in the literature, a strong correlation was shown between the Lp(a) levels measured at the time of diagnosis and ΔPA:Ao and ΔEAT values in patients with COVID-19.

Evaluación prenatal del síndrome de heterotaxia por ecografía fetal / Prenatal assessment of heterotaxy syndrome by fetal ultrasound

Resumen El síndrome de heterotaxia es una entidad de baja prevalencia, que tiene su origen durante el desarrollo embrionario, que afecta a diversos órganos y sistemas. Es por ello que su diagnóstico representa un reto durante la gestación. El pronóstico dependerá principalmente de las malformaciones cardiacas asociadas. Se presenta el caso de un paciente con diagnóstico de síndrome de heterotaxia durante el primer trimestre. Se detallan los patrones ecográficos obtenidos durante el tamizaje del primer trimestre que auxiliaron a integrar el diagnóstico de esta entidad, así como las anomalías cardiacas asociadas. El manejo debe contemplar a un equipo multidisciplinario, el cual brinde un manejo oportuno, que será principalmente quirúrgico, enfocado en las malformaciones cardiacas.

Abstract Heterotaxy syndrome is a low prevalence entity, which originates during embryonic development, affecting diverse organs and systems. That is why its diagnosis represents a challenge during pregnancy. The prognosis depends mainly on the associated cardiac malformations. The case of a patient with a diagnosis of heterotaxy syndrome during the first trimester is presented. The ultrasound patterns obtained during the first trimester screening that helped to integrate the diagnosis of this entity are detailed, as well as the associated cardiac anomalies. Management must contemplate a multidisciplinary team, which provides timely management, which will be mainly surgical, focused on cardiac malformations.

Echocardiographic and Etiopathogenic Features of Hypertrophic Cardiomyopathy: Casablanca University Hospital Experience

Hypertrophic cardiomyopathy (HCM) is the most common non-ischemic cardiomyopathy with a prevalence of 1:500 in the general population, based on the recognition of the phenotype. HCM is defined by the presence of increased left ventricular (LV) wall thickness that is not solely explained by abnormal loading conditions and the phenotype also includes disorganized myocyte arrangement, fibrosis, small-vessel disease, and abnormalities of the mitral valve apparatus. In particular to this pathology, we have conducted a one-year prospective study to determine clinical, echocardiographic features and etiopathogenic aspects of hypertrophic cardiomyopathy in the Casablanca university hospital. The results concluded that 50% of the causes was due to amyloidosis 35%, sarcomeric HCM and 15% Fabry disease in which 2 cases were related with pregnancy. Transthoracic echocardiography and cardia MRI plays an important role in HCM diagnosis and prognosis.

Echocardiographic Aspect of Infectious Aortic Endocarditis: Experience of the Cardiology Department, Mohammed VI University Hospital of Marrakech, Morocco

Introduction: Infective Endocarditis (IE) is a serious disease whose prognosis depends on early management. Aortic localization is characterized by its progression to myocardial failure and the high number of complications motivating early recourse to surgery. The diagnosis of AR is based on microbiological and imaging studies. Echocardiography is the recommended imaging modality to make the diagnosis, assess the impact and guide surgery. Materials and Methods: This is a retrospective study, including all subjects over 20 years of age who presented with infective endocarditis of the aortic valve, hospitalized between January 2019 and December 2022, in the Department of Cardiology and Vascular Diseases at the ERRAZI-CHU Mohammed VI Hospital in Marrakech. Clinical, paraclinical and therapeutic data were collected for each case using an exploitation form. Results: During the study period, 26 patients had presented with aortic positional AR, with a sex ratio that was equal to 1.8. The mean age of the patients was 43±12.5 years. A known history of valvular disease was found in 57% of the cases. Among the native valvular diseases, rheumatic origin was found in 85%. The most common valvular lesions were represented by vegetations (88%), which were mobile in 56%, measuring between 10 and 20 mm in half of the cases, their most predominant localization was on the ventricular side with a tilt.IE on severe IAo was found in 90% of cases. The most common associated valvulopathies were MI (53%), RAo (38%) and MR (34%), whose severity was variable. The association of aortic disease with mitral disease was the most frequent association. Echocardiographic complications were presented by fistulas, perforations and peri-aortic abscesses (2 cases each) which were correlated with severe AI. Regarding the impact of the aortic AR on the LV, we noted a marked dilatation in 42% of cases with a preserved ejection fraction in 74%. A quarter of our patients had undergone transesophageal echocardiography in addition to transthoracic echocardiography, with an average time between admission and completion of 3 days. The indication of its realization was posed in front of the doubt of the visualization of an image of vegetations or suspicion of complications not visualized with the TTE. Valvular lesions found on TEE were essentially vegetations in 45% of cases, prolapses in 22% of cases, as well as abscesses, para-prosthetic leaks and prosthesis deinsertion found in 11% of cases. Conclusion: Aortic AR remains a frequent pathology in our context. Aortic insufficiency is the most predisposing valvulopathy and the most common sonographic appearance is vegetations. The results of our study have shown that complications of AE occur preferentially in patients with severe aortic insufficiency.

Diagnostic Use of Serum Ferritin as a Predictor of Hospital Outcome at Admission in Patients with Infective Endocarditis

Background: Infective endocarditis (IE) is characterised by a concentration of infection inside the heart; it is caused by a bacterial or fungal infection of the endocardial surface of the heart; and it is linked with substantial morbidity and death.The aim of this research was to assess serum ferritin as an admission predictor of in-hospital prognosis in subjects with IE. Methods: This case control researchincluded60subjects diagnosed with IEon the basis of the modified duke's criteria.Subjects were allocated equally into two groups: group I: IE subjects who were further subdivided into two groups based on presence or absence of major adverse cardiovascular events (subgroup A: 19 patients who showed IE complications or major adverse cardiac events during hospitalization and subgroup B: 11 patients who showed a smooth course during hospitalization without major adverse cardiac events or IE complications) and IE subjects as well as age and sex matched 30 healthy subjects. Results: serum ferritin level were significantly increased in group I than group II (P value<0.05). Serum ferritin level was significantly increased in subgroup A than subgroup B (P value<0.001). serum ferritin can significantly predict bad outcome (P value<0.001) with AUC of 0.964 (95% CI: 0.881 – 0.995). At cut off >1200, serum ferritin can significantly predict bad outcome with 94.44% sensitivity, 92.86% specificity, 85% PPV and 97.5% NPV. Conclusions: Serum ferritin was significantly increased in IE subjects who experiencedproblems on admission as compared to IE subjects who didn’t.

Giant Left Atrial Appendage Aneurysm or Pericardial Effusion: A Misleading Appearance on Echocardiography and a High Risk of Rupture

Left atrial appendage (LAA) aneurysm or giant LAA is an uncommon condition. It could be discovered incidentally during echocardiography examination or in symptomatic patients presenting with tachycardia or embolic events. The giant LAA is a serious condition with a high embolic risk that can cause respiratory distress and even cardiac arrest in children. A conservative surgical approach based on resection of the LAA is recommended and is mostly safe. We report the case of a four-year-old girl presenting with a symptomatic giant LAA removed successfully. The echo-cardiographer must be aware of its appearance mimicking a pericardial effusion and focus on its possible association with other congenital lesions. There are several therapeutic strategies, all with proven efficacy and safety.

Cardiac Outcome of Children With SARS-CoV-2 Related Multisystem Inflammatory Syndrome

Objective: To study the cardiac outcomes of patients with multisystem inflammatory syndrome in children (MIS-C) after 6-month of diagnosis. Methods: This review of hospital records was conducted on MIS-C patients (aged <21 years) who completed a six-month follow-up. The baseline demographic, clinical, laboratory, and treatment characteristics during the acute phase, and echocardiographic findings during follow-up were collected. Results: 116 patients (61.2% male, median age 7 years) with MIS-C were included in the study. At the time of admission, cardiac abnormalities were present in 70.7% of MIS-C patients, and the most common cardiac abnormalities were valve failure (50.9%), followed by ventricular dysfunction (39.7%), and pericardial effusion (23.3%). Six month after diagnosis, cardiac abnormalities were found in 10.3% of patients, and patients had lower rates of ventricular dysfunction (P<0.001), valve failure (P<0.001), pericardial effusion (P<0.001), and coronary involvement (P<0.001) as compared to the baseline. Intravenous immunoglobulin (IVIG) and steroid treatment significantly reduced the odds of occurrence of ventricular dysfunction (P=0.002), valve failure (P=0.004), and low ejection fraction (P=0.002) in comparison to IVIG treatment alone. Conclusion: While most MIS-C patients had abnormal echocardiographic findings at admission, only 10.3% of patients had cardiac abnormalities during follow up.

Predictores clínicos y ecocardiográficos del síndrome de bajo gasto cardiaco en la cirugía valvular cardiaca

Objetivo: Determinar los posibles elementos predictores clínicos y ecocardiográficos asociados a la aparición del síndrome de bajo gasto cardiaco. Materiales y métodos: Se realizó un estudio analítico de casos y controles en pacientes con síndrome de bajo gasto cardiaco posoperatorio atendidos en el Centro de Cardiología y Cirugía Cardiovascular del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba, desde enero 2019 a diciembre 2021. Ambos grupos de estudio formaron parte de la misma población de pacientes operados de cirugía cardiovascular, diferenciados por presentar o no síndrome de bajo gasto cardiaco postoperatorio al ingreso. La variable dependiente fue la presencia de bajo gasto cardiaco; las variables independientes, factores clínicos, hemodinámicos y ecocardiográficos. Resultados: En la serie predominaron los pacientes menores de 65 años tanto en el grupo de casos como de controles (51,2 % y 73,5 %, respectivamente). La fibrilación auricular, la función sistólica del ventrículo derecho y la hemorragia periprocedimiento (p = 0,008) presentaron alta significación estadística p 50 % (102 [91,10 %; p = 0,047]), así como amplio dominio de pacientes (76 [45,24 %; p ≤ 0,05; OR: 2,14]) con cirugías de emergencia. Se realizó una regresión logística, y se determinó que las variables clínicas y ecocardiográficas tales como la edad superior a 65 años, la función de ventrículo derecho deprimida, la circulación extracorpórea ≥90 minutos y la presión sistólica de arteria pulmonar elevada tuvieron una asociación estadísticamente significativa. El AUC mostró que variables como la edad, el tiempo de circulación extracorpórea y la hemorragia perioperatoria tuvieron capacidad predictiva. Conclusiones: Se observó que algunos elementos clínicos y ecocardiográficos, como la edad, la presencia de fibrilación auricular, la función sistólica del ventrículo derecho deprimida y la cirugía de emergencia, se asociaron como predictores de síndrome de bajo gasto cardíaco.

Objective: To determine the possible clinical and echocardiographic predictors associated with the onset of low cardiac output syndrome. Materials and methods: An analytical case-control study was conducted in patients with postoperative low cardiac output syndrome treated at Centro de Cardiología y Cirugía Cardiovascular of Hospital Provincial Docente Saturnino Lora in Santiago de Cuba from January 2019 to December 2021. Both study groups were part of the same population of patients who underwent a cardiovascular surgery but differed in the fact that, at admission, some suffered from postoperative low cardiac output syndrome and others did not. The dependent variable was the presence of low cardiac output and the independent variables were clinical, hemodynamic and echocardiographic factors. Results: In the series, patients under 65 years of age prevailed in both case and control groups (51.2 % and 73.5 %, respectively). Atrial fibrillation, right ventricular systolic function and perioperative bleeding (p = 0.008) were statistically significant (p 50 % and a large number of patients (76 [45.24 %; p ≤ 0.05; OR: 2.14]) had undergone emergency surgeries. A logistic regression analysis determined that the clinical and echocardiographic variables, such as age over 65 years, depressed right ventricular function, extracorporeal circulation ≥ 90 minutes and elevated pulmonary artery systolic pressure, had a statistically significant association. The area under the curve (AUC) showed that variables including age, extracorporeal circulation time and perioperative bleeding had predictive capability. Conclusions: It was observed that some clinical and echocardiographic elements, such as age, atrial fibrillation, depressed right ventricular systolic function and emergency surgery, were associated as predictors of low cardiac output syndrome.

Caracterización clinicoepidemiológica, ecocardiográfica y terapéutica de pacientes con infarto agudo de miocardio / Clinical, epidemiological, echocardiographic and therapeutic characterization of patients with acute myocardial infarction i: en

Introducción: Aunque la incidencia general de infarto agudo de miocardio ha disminuido en muchos países desarrollados en las últimas décadas, aún genera números elevados de morbilidad y mortalidad en los de bajos ingresos; mostrando cifras mayores en tiempos de la pandemia por coronavirus. Objetivo: Caracterizar a pacientes con diagnóstico de infarto agudo de miocardio según variables clinicoepidemiológicas, ecocardiográficas y terapéuticas. Métodos: Se realizó una investigación descriptiva y retrospectiva, desde enero de 2018 hasta noviembre de 2022, de 263 pacientes con diagnóstico de infarto agudo de miocardio, atendidos en el Centro de Cardiología y Cirugía Cardiovascular de Santiago de Cuba. Entre las variables analizadas figuraron la edad, el sexo, la topografía del infarto, las complicaciones, las alteraciones ecocardiográficas y el tratamiento trombolítico. Resultados: En la serie predominaron el sexo masculino y el grupo etario menor o igual de 65 años. Se observó una mayor frecuencia del infarto en la topografía inferior (177, para 67,3 %); de estos afectados, 52,1 % tuvo complicaciones. Asimismo, la complicación de mayor frecuencia fue la fibrilación auricular paroxística, seguida del infarto de ventrículo derecho; mientras que la fracción de eyección menor de 45 %, el volumen de la aurícula izquierda y la motilidad parietal presentaron significación estadística. Conclusiones: Las características clinicoepidemiológicas, ecocardiográficas y terapéuticas de los pacientes con infarto agudo de miocardio en la provincia de Santiago de Cuba no difieren del contexto epidemiológico mundial.

Introduction: Although the general incidence of acute myocardial infarction has diminished in many developed countries in the last decades, it still generates high numbers of morbidity and mortality in those with low income; showing higher figures in times of coronavirus. Objective: To characterize patients with diagnosis of acute myocardial infarction according to clinical, epidemiological, echocardiographic and therapeutic variables. Methods: A descriptive and retrospective investigation was carried out from January, 2018 to November, 2022, of 835 patients with diagnosis of acute myocardial infarction, assisted in the Cardiology and Cardiovascular Surgery Center of Santiago de Cuba. Among the analyzed variables there were age, sex, topography of infarction, complications, echocardiographic disorders and thrombolytic treatment. Results: In the series there was a prevalence of the male sex and the 65 or less age group. A higher frequency of infarction in the lower topography (177, for 67.3 %) was observed; of these patients, 52.9 % had complications. Also, the complication of more frequency was the paroxysmal atrial fibrillation, followed by the infarction of the right ventricle; while the ejection fraction smaller than 45 %, the volume of the left auricle and the parietal motility presented statistical significance. Conclusions: Clinical, epidemiological, echocardiographic and therapeutic characteristics of patients with acute myocardial infarction in Santiago de Cuba province do not differ from the world epidemiological context.

Subcostal right ventricular free wall strain in patients with pulmonary hypertension / Strain subcostal de la pared libre del ventriculo derecho en pacientes con hipertensión pulmonar

Abstract Right ventricular longitudinal strain (RVLS) is frequently used as a measure of right ventricular systolic function. Abnormal RV strain is associated with poor prognosis in patients with pulmonary hyper tension (PH); however, the measure is not always easy to obtain in patients with poor apical acoustic windows. Objective: This study aims to analyze the RVLS and determine if there is a difference when measured from the apical and subcostal views. Methods: In this cross-sectional study, we analyzed 22 adult outpatients (≥ 18 years old), 81% female, mean age 49.9 ± 17.3 years, with a diagnosis of PH using right heart catheterization, followed from January 2016 to January 2020. Results: RVLS measured in the RV free wall from the apical views was -15% (-19% to -10%) and subcostal views -14.5% (-18% to -11%) were highly correlated (Person's r = 0.969, p < 0.0001). Segment by segment analysis did not show significant differences either: basal four-chamber vs. sub costal view was -16.5% (-21% to -11%) vs. -15.5% (-20% to -11%), p = 0.99, mid four-chamber view vs. subcotal view was -16.5% (-21% to -12%) vs. -16.5% (-20% to -11%), p = 0.87, apical four-chamber view vs. subcostal view was -12% (-18% to -8%) vs. -13.5% (-19% to -10%), p = 0.93. Conclusion: Subcostal RVLS free wall is a feasible and accurate alternative to conventional RVLS free wall from the apical view in patients with pulmonary hypertension and could be useful in patients with poor acoustic apical four-chamber windows.

Resumen El strain longitudinal del ventrículo derecho (SLVD) permite medir la función sistólica del ventrículo derecho (VD). La disminución del strain (deformación) del VD se asocia con mal pronóstico en pacientes con hipertensión pulmonar (HP), pero no siempre es fácil de obtener en pacientes con mala ventana acústica apical. Objetivo: Este estudio tiene como objetivo analizar el SLVD y determinar si las vistas apical y subcostal son comparables. Métodos: En este estudio transversal, se incluyeron 22 pacientes adultos ambulatorios (≥18 años), 81% mujeres, edad promedio 49.9 ± 17.3 años, con diagnóstico de HP mediante cateterismo cardíaco derecho, seguidos desde enero de 2016 hasta enero de 2020. Se midió la deformación de la pared libre del ventrículo derecho desde las vistas de cuatro cámaras apical y cuatro cámaras subcostal. Resultados: El SLVD medido en la pared libre del VD desde la vista apical fue -15% (-19% a -10%) vs. -14.5% (-18% a -11%) cuando se midió desde la vista subcostal (p = 0,99). El análisis segmento por s egmento tampoco mostró diferencias significativas: el segmento basal apical vs. subcostal fue -16.5% (-21% a -11%) vs. -15.5% (-20% a -11%), p = 0.99, el segmento medio apical vs. la vista subcotal fue -16.5% (-21% a -12%) vs. a -16.5% (-20% a -11%), p = 0.87, el segmento apical vs. la vista subcostal fue -12% (-18% a -8%) frente a -13.5% (-19% a -10%), p = 0.93. Conclusión: En pacientes con HP, el SLVD obtenido en la pared libre subcostal es una alternativa útil en los casos con ventana acústica apical subóptima.

Sufficient versus deficient rims during percutaneous closure of ostium secundum type atrial septal defect: A systematic review and meta-analysis

Background: The aim of this meta-analysis was to compare the efficacy and adverse events of percutaneous occlusion among patients with sufficient and deficient rims. Methods: A systematic review of all articles published in the Pubmed, MEDLINE and Google Scholar databases was performed. Odds ratio (OR) and 95% CI were used as a measure of effect of the combination of studies. I2 with 95% CI was estimated to assess study heterogeneity. For the meta-analysis, a random effects model was used. Results: The systematic search identified ten studies which included 4355 patients; 2661 of those had sufficient rim and the remaining 1694 patients showed some rim deficiency. Implant failure rate was 4.13% CI 95% 3.53e4.72%. Compared to frequency of failures in the group with a deficient rim (5.43% CI 95% 4.35e6.50%), implant failure in patients with a sufficient rim was significantly lower (3.30% CI 95% 2.62e3.97%), OR 2.27 CI 1.34e3.83 (p 0.002). The combined adverse events were 5.19% CI 95% 4.22e6.35% vs 2.7% CI 95% 2.08e3.31% in the deficient vs sufficient rim groups respectively (OR 2.21 CI 0.93e5.29; p 0.07). Implant failures and adverse events were more frequent in patients with posterior inferior rim deficiency. Conclusion: Patients presenting a posteroinferior rim deficiency are associated to both, an increased incidence of closure failure and a combined adverse events occurrence. More studies on posterior rim deficiency are necessary to ensure the feasibility and safety of the percutaneous approach.

Mecanismos de adaptação do coração em atletas de elite do sexo feminino: comparação com indivíduos sadios e tempo de treinamento / Heart adaptation mechanisms in elite female athletes: comparison with healthy individuals and time of training

Fundamento: O exercício intenso e continuado em atletas provoca fenótipos de remodelamento adaptativo, cujos parâmetros podem ser avaliados pela ecocardiografia convencional, e de deformação miocárdica. Assim, foi comparado o remodelamento miocárdico em atletas do sexo feminino (grupo atletas) com mulheres sedentárias da mesma faixa etária (grupo-controle) e entre atletas com maior e menor tempo de treinamento. Métodos: Foram selecionadas 57 futebolistas femininas (grupo atletas) e 25 mulheres sadias sedentárias (grupocontrole). As atletas foram divididas em dois grupos: grupo principal, com 32 atletas, e grupo sub-17, com 25 atletas. Foram determinadas, através de ecocardiografia, as dimensões, a função sistólica e diastólica das câmaras cardíacas e a deformação miocárdica (strain longitudinal, circunferencial, radial e mecânica rotacional), utilizando a estatística Z com significância de p < 0,05. Resultados: A idade dos grupos atletas, controle, principal e sub-17 foi de 22,1±6,3; 21,2±5,0; 26,5±5,1; e 16,5±0,6, respectivamente. O peso, o índice de massa corporal e a frequência cardíaca foram menores no grupo atletas. A espessura das paredes, o índice de massa do ventrículo esquerdo (VE), o volume do átrio esquerdo (AE), a fração de ejeção e as dimensões do ventrículo direito (VD) foram maiores no grupo atletas, mas dentro de valores normais. A deformação miocárdica mostrou diminuição do strain radial, da rotação basal, da rotação apical e do twist, sugerindo mecanismo de reserva contrátil. Esses parâmetros foram menores no grupo principal, que também apresentava maior espessura das paredes, maior volume do AE e maior tamanho do VD, sugerindo que o aumento da reserva contrátil se relaciona com maior tempo de treinamento. Conclusões: As atletas do sexo feminino com treinamento intenso de longa duração apresentam remodelamento adaptativo das câmaras cardíacas e aumento da reserva contrátil observada em repouso, com esses parâmetros mais acentuados nas atletas com maior tempo de treinamento.(AU)

Background: Intense continuous exercise provokes adaptive remodeling phenotypes in athletes, the parameters of which can be evaluated through conventional echocardiography and myocardial deformation. We compared myocardial remodeling in female athletes (athlete group) with sedentary women of the same age range (control group) and between older and younger athletes. Methods: A total of 57 female soccer players and 25 healthy sedentary women were selected. The athlete group was subdivided into a main group and those under 17 years of age (< 17 group). The dimensions and systolic and diastolic function of the cardiac chambers and myocardial deformation (longitudinal and circumferential, as well as radial strain and rotational mechanics) was determined through echocardiography, using the Z statistic with a significance level of p< 0.05. Results: The mean age of the athlete, control, main, and < 17 groups was 22.1 (SD, 6.3); 21.2 (SD, 5.0); 26.5 (SD, 5.1); 16.5 (SD, 0.6) years, respectively. Weight, body mass index and heart rate were lower in the athlete group. Wall thickness, left ventricular mass index, left atrial (LA) volume, ejection fraction, and right ventricular dimensions were higher in athlete group, but remained within normal ranges. Regarding myocardial deformation, there was decreased radial strain, basal rotation, apical rotation, and twisting in the athlete group, suggesting a contractile reserve mechanism. These parameters were lesser in the main athlete group, who also had greater wall thickness, greater volume in the left atrium (LA) and larger size in the right ventricle (RV), suggesting that increased contractile reserve is related to longer time spent in the sport. Conclusions: In female athletes who had undergone intense long-term training, we observed adaptive remodeling of the cardiac chambers and increased contractile reserve (at rest), and these changes were more pronounced in those with longer involvement in the sport.(AU)