Inflamed Colon and Pericardium: A Rare Combination of Colitis and Recurrent Pericarditis.

A 29-year-old woman with severe ulcerative colitis presented with complicated recurrent pericarditis. Cardiac magnetic resonance imaging showed improvement in pericardial inflammation with a prolonged course of anti-inflammatory therapy, but she developed several relapses on biologics. Rilonacept (newer interleukin-1 antagonist), disease-modifying antirheumatic drugs, and pericardiectomy may be considered in such patients. (Level of Difficulty: Intermediate.).

Ecocardiografía speckle tracking (rastreo de marcas) tridimensional en la amiloidosis cardiaca de cadenas ligeras: estudio de los parámetros de mecánica miocárdica ventricular izquierda y derecha / Three-dimensional speckle tracking echocardiography in light chain cardiac amyloidosis: examination of left and right ventricular myocardial mechanics parameters

Introducción y objetivos. El estudio de la mecánica miocárdica tiene un papel potencial en la detección de afectación cardiaca en pacientes con amiloidosis. El objetivo de este estudio fue caracterizar la mecánica miocárdica ventricular izquierda y derecha mediante ecocardiografía de rastreo de marcas (speckle tracking) tridimensional y examinar su relación con el péptido natriurético cerebral. Métodos. Se estudió a pacientes con amiloidosis de cadenas ligeras y se obtuvieron los valores de deformación (strain) longitudinal y circunferencial del ventrículo izquierdo (n = 40) y de strain longitudinal y desplazamiento radial del ventrículo derecho (n = 26) mediante ecocardiografía speckle tracking tridimensional. Se determinaron las concentraciones de péptido natriurético cerebral. Resultados. Todos los parámetros de la mecánica miocárdica mostraron diferencias al comparar los distintos grupos de terciles de péptido natriurético cerebral. Los valores de strain longitudinal de los ventrículos izquierdo y derecho mostraron alta correlación (r = 0,95; p < 0,001). Se observó una reducción del strain longitudinal (–9 ± 4 frente a –16 ± 2; p < 0,001) y el strain circunferencial del ventrículo izquierdo (–24 ± 6 frente a –29 ± 4; p = 0,01) en los pacientes con afectación cardiaca, y el deterioro más notable fue en los segmentos basales. Se observó una disminución del strain longitudinal (–9 ± 3 frente a –17 ± 3; p < 0,001) y el desplazamiento radial del ventrículo derecho (2,7 ± 0,8 frente a 3,8 ± 0,3; p = 0,002) en los pacientes con afectación cardiaca. En el análisis multivariable, el strain longitudinal del ventrículo izquierdo se asoció a la presencia de afectación cardiaca (odds ratio = 1,6; intervalo de confianza del 95%, 1,04-2,37; p = 0,03) con independencia de que el péptido natriurético cerebral y la troponina I mostraran criterios de amiloidosis cardiaca. Conclusiones. La mecánica miocárdica ventricular izquierda y derecha obtenida mediante ecocardiografía speckle tracking tridimensional se altera de manera creciente a medida que aumenta el péptido natriurético cerebral en la amiloidosis de cadenas ligeras. Parece que existe una asociación intensa entre el strain longitudinal del ventrículo izquierdo y la afectación cardiaca, más allá de los biomarcadores como el péptido natriurético cerebral y la troponina I (AU)

Introduction and objectives. The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. Methods. In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n = 40), and right ventricular longitudinal strain and radial displacement (n = 26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. Results. All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r = 0.95, P < .001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (–9 ± 4 vs –16 ± 2; P < .001, and –24 ± 6 vs –29 ± 4; P = .01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (–9 ± 3 vs –17 ± 3; P < .001, and 2.7 ± 0.8 vs 3.8 ± 0.3; P = .002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P = .03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. Conclusions. Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I (AU)

Three-dimensional Speckle Tracking Echocardiography in Light Chain Cardiac Amyloidosis: Examination of Left and Right Ventricular Myocardial Mechanics Parameters.

INTRODUCTION AND OBJECTIVES: The study of myocardial mechanics has a potential role in the detection of cardiac involvement in patients with amyloidosis. This study aimed to characterize 3-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics in light chain amyloidosis and examine their relationship with brain natriuretic peptide. METHODS: In patients with light chain amyloidosis, left ventricular longitudinal and circumferential strain (n=40), and right ventricular longitudinal strain and radial displacement (n=26) were obtained by 3-dimensional-speckle tracking echocardiography. Brain natriuretic peptide levels were determined. RESULTS: All myocardial mechanics measurements showed differences when compared by brain natriuretic peptide level tertiles. Left and right ventricular longitudinal strain were highly correlated (r=0.95, P<.001). Left ventricular longitudinal and circumferential strain were reduced in patients with cardiac involvement (-9±4 vs -16±2; P<.001, and -24±6 vs -29±4; P=.01, respectively), with the most prominent impairment at the basal segments. Right ventricular longitudinal strain and radial displacement were diminished in patients with cardiac involvement (-9±3 vs -17±3; P<.001, and 2.7±0.8 vs 3.8±0.3; P=.002). On multivariate analysis, left ventricular longitudinal strain was associated with the presence of cardiac involvement (odds ratio = 1.6; 95% confidence interval, 1.04 to 2.37; P=.03) independent of the presence of brain natriuretic peptide and troponin I criteria for cardiac amyloidosis. CONCLUSIONS: Three-dimensional-speckle tracking echocardiography-derived left and right ventricular myocardial mechanics are increasingly altered as brain natriuretic peptide increases in light chain amyloidosis. There appears to be a strong association between left ventricular longitudinal strain and cardiac involvement, beyond biomarkers such as brain natriuretic peptide and troponin I.

Intracardiac thrombosis in polycythemia vera.

A man in his late 60s presented with symptoms for a few months of itching and head ache after shower. Physical examination was unremarkable except for ruddy complexion and splenomegaly. Complete blood count showed haemoglobin of 18.1 g/dL and haematocrit of 56.6%. To rule out secondary causes of erythrocytosis, such as congenital heart disease with a right to left shunt, a transthoracic echocardiogram was performed, which showed normal left ventricular function with an apical area of dyskinesis and a large left ventricular apical thrombus measuring 3.0 cm×2.0 cm. Further laboratory investigations showed low erythropoietin level and Jak V617F mutation consistent with the diagnosis of polycythemia vera. He was treated with aspirin, enoxaparin, phlebotomy and hydroxyurea with no reported complications during the stay.

The syndrome of degenerative calcific aortic stenosis: prevalence of multiple pathophysiologic disorders in association with valvular stenosis and their implications.

BACKGROUND: We hypothesized that degenerative calcific aortic stenosis (DCAS) is a syndrome influenced by factors beyond aortic valve stenosis (AS). The aim of this study was to assess how frequently DCAS is complicated by increased vascular load, systolic and/or diastolic left ventricular (LV) dysfunction, and comorbid disorders. METHODS: In 215 consecutive patients > 60 years of age with severe and moderate AS, we analyzed systemic arterial compliance, global hemodynamic load, LV ejection fraction (EF), the presence of diastolic dysfunction, and other valvular or systemic disorders. RESULTS: A total of 164 patients had severe AS and 51 had moderate AS. In patients with severe AS, the prevalence of increased vascular load was 42%; LV systolic and diastolic dysfunction was present in 27% and 42%; other valve diseases in 23%; and comorbid disorders in 82%. In the moderate AS group, abnormal vascular load was found in 52%; LV systolic and diastolic dysfunction was prevalent in 26% and 31%; other valve diseases in 17%; and comorbid disorders in 78% patients. More than half the patients in both groups had symptoms. In both severe and moderate AS groups, the prevalence of increased vascular load and systolic dysfunction was higher in the symptomatic group. CONCLUSION: Considerable number of patients with DCAS have abnormal vascular load, abnormal LV function, and significant coexisting disorders. These could influence the total pathophysiologic burden on the heart and symptom expression. Thus, DCAS should not be considered just as valvular stenosis, but a syndrome of DCAS because of the diagnostic, prognostic, and therapeutic implications of various factors associated with it.