Yield of Echocardiography in the Evaluation of Cerebral Ischemic Events: A Single Center Cohort Study.

BACKGROUND: Echocardiography (ECO) is frequently used as a screening test in patients with acute ischemic brain disease. We aimed to evaluate the additional information and therapeutic impact resulting from ECO in these patients. METHODS: We conducted a prospective study performing ECO on consecutive patients with ischemic stroke or transient ischemic attacks, admitted to our centre between February 2013 and May 2017. RESULTS: A total of 696 patients were included (female, 57.3%; mean age, 70 ± 15.3 years). Seven hundred thirty two echocardiographic examinations were performed (696 transthoracic and 36 transesophageal). Echocardiography yielded findings judged of clinical importance in 142 patients (20.4%, 95% CI 17.5-23.5). The most frequent of these were left atrial volume enlargement or a normal evaluation. Echocardiography findings resulted in changes in the management of 76 patients (10.7% 95% CI 8.8-13.4); initiation of anticoagulation therapy, administration of IV antibiotic therapy, cardiac surgeries, or other pharmacological therapies occurring in 42 cases (6%). The presence of coronary heart disease (OR: 2.64 95% CI 1.34-5.25), atrial fibrillation (OR: 0.24; 95% CI, 0.2-0.69), and admission NIHSS (OR: 1.04; 95% CI, 1.01-1.09), were the variables associated with changes in management. CONCLUSIONS: In unselected patients with acute ischemic stroke ECO had a low yield of additional information, and it changed management in a small percentage of patients.

Correlación entre la ecocardiografìa transesofágica tridimensional y tomografìa cardíaca en la determinación del anillo aórtico previo al reemplazo de válvula aórtica con catéteres (TAVR) / Correlation between 3-D trans-esophageal echocardiography and cardiac computed tomography in the evaluation of the aortic annulus prior to transcatheter aortic valveimplantation (TAVR)

Introducción: Para el reemplazo de válvula aórtica con catéteres (TAVR) es fundamental la adecuada medición del anillo aórtico para elegir el tamaño adecuado de la prótesis y evitar complicaciones graves como la ruptura del anillo aórtico y la insuficiencia paravalvular (IAP). La tomografía computada cardíaca (TC) es el estándar de oro en la medición del anillo aórtico, pero la ecocardiografía transesofágica 3D (ETE3D) parece ser una alternativa atractiva. Objetivo: Evaluar la correlación entre las mediciones del anillo aórtico obtenidas por ETE3D y las encontradas en la TC. Los resultados obtenidos se evaluaron en términos de la prótesis elegida y la presencia de insuficiencia aórtica post TAVR. Métodos: Se realizaron de manera retrospectiva y ciega, las mediciones del anillo aórtico por TC y ETE3D en 18 pacientes consecutivos, edad promedio 82 ± 7,06 años, sometidos a TAVR usando prótesis Sapien XT (Edwards Lifescience). Se comparó el diámetro máximo, diámetro mínimo, diámetro medio, área y perímetro del anillo. Resultados: La ETE3D subvaloró el tamaño del anillo aórtico, pero demostró tener una buena correlación con los diferentes parámetros de la TC, con mejor comportamiento para el perímetro del anillo. ETE3D y TC coincidieron en la elección de la prótesis en 17 pacientes y no hubo IAP de relevancia. Conclusión: La ETE3D tiene buena correlación comparada contra la TC en la valoración del anillo aórtico. La ETE3D parece una atractiva alternativa a la TC para medición del anillo especialmente en casos complejos o cuando la disponibilidad y acceso a la TC puede estar limitada.

In TAVR, the precise measuring of the aortic annulus is essential to determine the size of the prosthesis and to avoid complications like rupture of the annulus of aortic insufficiency. Computed tomography (CT) is the gold standard to achieve these goals. 3-D trans-esophageal echocardiography (3-D TEE) to be a useful alternative method. Aim: to evaluate the correlation of aortic annulus measurements obtained with 3-dTE and CT in the determination of annulus measurements before TAVR. Prosthesis size and presence of aortic insufficiency were related to these measurements. Methods: In a retrospective blinded protocol the measurements of the aortic annulus obtained with CT or 3D-TEE were correlated in 18 consecutive patients (mean age 82 ± 7.1) submitted to TAVR with a Sapien XT (Edwards Lifescience) prosthesis. Maximal, minimal and mean diameters as well as area and annular circumference were evaluated. Results: Compared to CT, 3D-TEE under estimated de size of the aortic annulus but correlated well with other measurements of CT, especially with the annular circumference. Measurements from both methods agreed in the determination of the prosthesis size in 17 of 18 patients. No significant per prosthetic aortic insufficiency was observed in any case. Conclusion: 3DTEE correlates well with CT in evaluating the different parameters of the aortic annulus and is a good alternative to CT in complex cases and when CT is not readily available.

Successful transfemoral aortic valve replacement in a bicuspid aortic stenotic valve: requirements for a safe implant.

Although transcatheter aortic valve replacement (TAVR) has been accepted as an attractive alternative for high-risk patients with severe symptomatic aortic stenosis (AS), patients with congenital bicuspid AS has been typically disqualified for this indication due to an implied risk of device dislocation, distortion, or device malfunctioning. Nonetheless, bicuspid AS is not uncommon and frequently missed by transthoracic echocardiography. We reported an interesting case of a high-risk patient with severe symptomatic bicuspid AS who underwent successful TAVR and discussed the anatomic requirements for a safe implant in patients with bicuspid AS considered candidates for TAVR.

Current status of cardiac rehabilitation in Latin America and the Caribbean.

BACKGROUND: The prevalence of coronary artery disease (CAD) in Latin America is increasing and contributes importantly to the global burden of cardiovascular diseases. Advanced resources for the diagnosis and treatment of CAD are available in most of the region. However, preventive approaches such as cardiovascular rehabilitation programs (CVRP) may not be widely implemented. METHODS: We carried out a telephone-based survey to hospitals sampled in a random and population-weighted fashion from a list of 202 centers with cardiac catheterization laboratories in Mexico, Central and South America, and the Caribbean. We collected information of availability of cardiac procedures and imaging techniques and also extensive data about the presence, characteristics, and quality measures of CVRP. RESULTS: A total of 98 centers were contacted, and a complete survey was provided by 59 centers (60%) from 13 countries. Cardiovascular rehabilitation programs were available in only 56% of centers. There were no differences between centers with and without CVRP regarding type of hospital, availability of cardiac surgery, and annual volume of patients with myocardial infarction. Among centers with CVRP, 70% offered all phases of CVRP. The lack of CVRP was attributed to lack of qualified personnel in 41% of centers, financial constraints in 33%, and lack of physical space in 13%. All centers without CVRP performed cardiac surgery and percutaneous interventions. CONCLUSIONS: Despite the presence of state-of-the-art technology for the diagnosis and treatment of CAD, availability of CVRP, a less expensive yet effective tool for the treatment of CAD, appears to be limited in Latin America and the Caribbean.