ABSTRACT
Atrial fibrillation (AF) is a devastating disease with a large global prevalence. The left atrial appendage (LAA) is a major source of thrombi in patients with AF. Echocardiography plays an important role in identifying LAA thrombi and has become an invaluable imaging tool in planning for LAA occlusion (LAAO) in patients intolerant to anticoagulation. This review article will discuss the role of echocardiography in selecting patients for LAAO, intraprocedural monitoring, and identifying procedure-related complications.
Subject(s)
Atrial Appendage , Atrial Fibrillation , Thrombosis , Humans , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Echocardiography, Transesophageal , Echocardiography , Atrial Fibrillation/complications , Atrial Fibrillation/surgery , Thrombosis/etiology , Treatment OutcomeABSTRACT
Heart failure is a leading global pandemic and a cause of economic burden. Although, treatments exist to help symptomatic alleviation, patient compliance and monitoring is the basis of ensuring efficacy. With devices that allow for remote wireless PA pressure monitoring such as CardioMEMS, the inconsistency in patient reporting and factors such as symptoms and hospitalizations can be reduced. A systematic review and meta-analysis utilizing the MEDLINE, Cochrane, and Scopus database was performed to identify randomized and non-randomized clinical trials evaluating baseline characteristics and hospitalizations. Five trials for the systematic review and 2 trials for the meta-analysis meeting the inclusion and exclusion criteria were included. Baseline characteristics included an average age of 64.6 years, male predominance, mean BMI of 29.6, predominance of HFrEF, hypertension the most prevalent comorbidity, and a mean PA pressure of 27.2 mm Hg. The follow-up periods ranged from 90 days to 12 months. There was a total of 64 adverse events, mostly non-serious. Patients who underwent remote PA monitoring were less likely to be hospitalized compared with patients who did not (Odds Ratio: 0.52; 95% Confidence Interval 0.39, 0.69). Remote PA pressure monitoring allows for reduced hospitalizations. With the recent and now resurging SARS-CoV-2 pandemic, devices such as CardioMEMS can allow for heart failure patients to be managed from home to not only reduce hospitalizations but for symptom prevention and management.
Subject(s)
COVID-19 , Heart Failure , Female , Hospitalization , Humans , Male , Middle Aged , Pulmonary Artery , SARS-CoV-2 , Stroke VolumeABSTRACT
Amyloidosis is an infiltrative disease with severe impact on the cardiac anatomy resulting in structural changes1. Mitral valve insult from the infiltrative process, although rare, has been known to cause severe mitral regurgitation4. Due to underlying comorbidities these patients may not be surgical candidates.17,18,19,20 The role of percutaneous mitral valve repair in cardiac amyloidosis has been described in a few prior cases.4,15 We review the epidemiology, diagnosis, and treatment of cardiac amyloidosis. We also highlight prior cases described in the literature of cardiac amyloidosis and severe mitral regurgitation, while discussing the role of percutaneous mitral valve repair in these patients.
Subject(s)
Amyloidosis , Cardiac Surgical Procedures , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Amyloidosis/complications , Amyloidosis/diagnosis , Amyloidosis/surgery , Cardiac Surgical Procedures/methods , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/surgery , Treatment OutcomeSubject(s)
Angioplasty, Balloon/methods , Aortic Coarctation/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Stents , Vascular Patency/physiology , Adult , Aortic Coarctation/surgery , Cardiac Surgical Procedures/adverse effects , Cardiac Surgical Procedures/methods , Echocardiography/methods , Echocardiography, Doppler, Color/methods , Female , Follow-Up Studies , Humans , Monitoring, Physiologic/methods , Reoperation/methods , Risk Assessment , Time Factors , Treatment OutcomeABSTRACT
Rupture of an aortic aneurysm into the pulmonary artery is a rare and often a fatal event. This complication results in the development of an acute left to right shunt, volume overload, and rapid right heart deterioration. We describe a case of thoracic aortic aneurysm in whom the diagnosis of a communication with the pulmonary artery was made on the basis of transthoracic echocardiography.
Subject(s)
Aneurysm, Ruptured/complications , Aortic Aneurysm, Thoracic/complications , Arterio-Arterial Fistula/etiology , Pulmonary Artery , Aged , Aortic Aneurysm, Thoracic/diagnostic imaging , Arterio-Arterial Fistula/diagnostic imaging , Echocardiography, Doppler, Color , Fatal Outcome , Female , Humans , Pulmonary Valve InsufficiencyABSTRACT
Transcutaneous low-frequency ultrasound (US) preserves myocardial and skeletal muscle viability by increasing tissue perfusion through an undefined nitric oxide (NO)-dependent mechanism. We have examined whether US increases tissue expression and activity of the three nitric oxide synthase (NOS) isoforms: endothelial (eNOS), neuronal (nNOS) and inducible (iNOS). The two femoral arteries of four New Zealand rabbits were ligated for a total of 120 min. After 60 min of ligation, transcutaneous low-frequency US (27 kHz, 0.13 W/cm2) was applied for 60 min to one thigh, while the contra-lateral artery served as a control (total ischemia time=120 min). Calcium-dependent (cNOS) and -independent (ciNOS) NOS activity, and concentration of total eNOS, ser-1177 phosphorylated eNOS (P-eNOS), nNOS and iNOS were then determined in the gracilis muscle. Compared with the control, US application significantly increased cNOS activity [3.34+/-0.28 versus 3.87+/-0.10x1000 counts per minute (cpm), respectively, p=0.031] and ciNOS activity (1.99+/-0.09 versus 3.26+/-0.68 cpm, respectively, p<0.001). Western immunoblotting revealed a significant increase in protein content of both iNOS (184.5+/-1.08%; p<0.0001) and P-eNOS (381.5+/-2.47%; p<0.001), with only a small increase in total eNOS and nNOS expression. In conclusion, application of transcutaneous low-frequency US to ischemic muscular tissue significantly increases both cNOS and ciNOS activity by increasing eNOS phosphorylation and iNOS expression, respectively.
Subject(s)
Ischemia/therapy , Nitric Oxide Synthase/metabolism , Ultrasonic Therapy/methods , Acute Disease , Animals , Femoral Artery/physiopathology , Hindlimb , Nitric Oxide Synthase Type I/metabolism , Nitric Oxide Synthase Type II/metabolism , Nitric Oxide Synthase Type III/metabolism , Phosphorylation , RabbitsABSTRACT
Pacing atrial stress echocardiography (PASE) has been studied over the past 3 decades for the evaluation of myocardial ischemia. Published studies suggest that PASE may be used as an alternative to exercise or pharmacologic stress imaging. The recent introduction of improved pacing electrodes, together with use of accelerated and shortened pacing protocols and improvements in transthoracic echocardiographic imaging techniques, makes PASE an appealing stress imaging method. A critical analysis of the diagnostic accuracy of PASE shows equivalence with other imaging stress modalities. PASE has been found to be highly feasible and accurate technique that may expedite the diagnosis and risk stratification of patients with coronary artery disease. This review addresses the history, hemodynamics, protocols, accuracy, clinical utility, and cost-effectiveness of PASE as well as elucidating its place among other stress modalities.
