Relationship between overweight and obesity and cardiac dimensions and function in a paediatric population.

Obesity in adults is associated with left ventricular hypertrophy, dilatation, and myocardial fibrosis, as well as heart failure and coronary heart disease. These associations have been studied to a lesser extent in the paediatric population. This study aims to investigate the relationship between obesity and cardiac structure and function in the paediatric population. In a southern Spanish village, we selected all inhabitants aged 6-17 years stratifying by age, gender, and educational centres. We performed a complete transthoracic echocardiogram evaluating all the cardiac morphological and functional parameters commonly measured in an echocardiographic study. There were 212 children and adolescents included. Of them, 48.1% were males. The mean age was 10.9 ± 3.0 years. A total of 106 (50%) were normal weight, 57 (26.9%) overweight, and 49 (23.1%) obese. Sex and age were similar in all three groups. Overweight and obesity were associated with larger left ventricular end-diastolic and end-systolic volumes (p < 0.0005), greater left ventricular mass (p < 0.0005), and smaller ejection fraction (p < 0.0005). They were also associated with larger atrial, aortic, and right ventricular size. Lateral and mean E/e' ratios were higher (p = 0.007 and p = 0.01 respectively). Body mass index was independently associated with all cavity size variables as well as left ventricular ejection fraction. CONCLUSION: Childhood obesity is independently associated with larger heart chambers, greater left ventricle mass, and smaller left ventricle ejection fraction. WHAT IS KNOWN: • Childhood obesity is related to the development of cardiovascular risk factors and is considered an epidemic of the twenty-first century; its prevalence is rising. WHAT IS NEW: • Childhood overweight and obesity lead to changes in cardiac structure and function which, although not considered clinically pathological, are significant and a result of obesity, and which behave as unfavourable incipient alterations at an early age.

Impact on daily clinical practice of the latest evidence on percutaneous closure of patent foramen ovale after cryptogenic stroke: a single-center experience.

INTRODUCTION AND OBJECTIVES: At the end of 2017, three clinical trials demonstrated that, in selected patients, percutaneous closure of patent foramen ovale (PFO) after cryptogenic stroke (CS) reduces the risk of recurrence. Our aim was to determine the impact of these findings on routine clinical practice in a tertiary hospital. METHODS: Patients with CS and percutaneous closure of PFO during 2001-2020 were included. The clinical characteristics of the patient and the anatomical characteristics of the foramen were analyzed. Based on both, the closure indications were classified into three groups according to the latest European recommendations and were analyzed in two periods, before and after the publication date of the clinical trials. RESULTS: A total of 293 patients were included. The mean age was 49 ± 11 years, and 15% were older than 60 years. The median RoPE score was 6 [p25-75, 5-7] and 75% had complex anatomy (CA). After the publication of the studies, the frequency of CA and the mean age of the patients were significantly higher (89% vs. 69% p < 0.0005 and 51 ± 11 vs. 48 ± 11 years, p = 0.02, respectively), and the RoPE score, significantly lower (5 [5-7] versus 6 [5-7], p = 0.02). Inadequate closure indications were significantly reduced (8% vs. 18%, p = 0.02). CONCLUSION: After the publication of clinical trials that have shown benefit of PFO closure after CS, the number of inappropriate indications for closure has decreased significantly in our institution, with a higher percentage of CA, despite a clinical profile suggestive of lower causal probability of PFO.

CHA2DS2-VASc score as predictor of stroke and all-cause death in stable ischaemic heart disease patients without atrial fibrillation.

BACKGROUND: Cerebrovascular and coronary artery disease share risk factors. The aim was to study CHA2DS2-VASc score as predictor of stroke incidence and death in a sample of patients with sinus rhythm and stable ischemic heart disease (sIHD) during long-term follow-up. METHODS: 1184 patients with sIHD and without atrial fibrillation were included in this single-centre prospective cohort study between February 2000 and January 2004. Stroke and death prediction abilities of CHA2DS2-VASc score in this population were investigated. RESULTS: The median age was 66 (interquartile range (IQR), 60-73 years). The mean follow-up was 11.2 ± 10 years (maximum 17 years). Along this period, 137 patients (11.6% of the sample) suffered a stroke. The mean value of CHA2DS2-VASc score was 3.04 ± 1.36, with CHA2DS2-VASc score ≤ 4 in 85.5% of the sample. Higher CHA2DS2-VASc score at baseline was associated with higher risk of suffering stroke (Hazard Ratio = 1.36, 95% CI 1.20-1.54, p < 0,001) and all-cause death during follow-up (Hazard Ratio = 1.49, 95% CI 1.40-1.58, p < 0,001). CONCLUSIONS: Higher CHA2DS2-VASc score values were associated with higher risk of stroke and all-cause mortality during long-term follow-up in this real-world sample of patients with sIHD in sinus rhythm.

Usefulness of transesophageal echocardiography during implantation of the CoreValve percutaneous aortic prosthesis: influence of the learning curve.

BACKGROUND AND OBJECTIVES: The purpose of this study was to evaluate the usefulness of transesophageal echocardiography during the implantation of the CoreValve percutaneous aortic prosthesis and the influence of the learning curve in its indications. METHODS: From April 2008 to January 2010, 53 patients were treated for symptomatic severe aortic stenosis with a CoreValve percutaneous aortic prosthesis. Transesophageal echocardiography was performed during the procedure for two reasons: if a discrepancy between the measures of the aortic annulus arose before the implantation and to provide visualization if a complication occurred during the procedure. Patients were divided in to two groups based on the learning curve (group I:the first 25 patients, group II: all of the subsequent patients). RESULTS: Thirty-six transesophageal echocardiographies were performed on 28 patients (53%).In 15 cases the indication was to assist us in determining the proper sized prosthesis, and in the other 21 cases it was performed due to a complication during the procedure. The numbers of intraprocedure transesophageal echocardiographies were similar in both learning-curve groups, (64% in group I vs. 71% in group II, P = 0.56) but the proportion of the studies indicated by serious complications was significantly lower in the second period of the learning curve (67% in group I vs. 17% in group II, P < 0.05). CONCLUSIONS: In our experience, transesophageal echocardiography was very useful in more than one-half of the patients during the implantation of the CoreValve percutaneous aortic prosthesis. After overcoming the learning curve, its indication due to serious procedure-related complications decreased significantly.

Feasibility of bidimensional speckle-tracking echocardiography for strain analysis in consecutive patients in daily clinical practice.

PURPOSE: We aimed to analyze the feasibility of two-dimensional speckle-tracking echocardiography (2DSTE) in evaluating myocardial strain in consecutive, nonselected patients in daily clinical practice. METHODS: Strain analysis using 2DSTE was attempted in 59 consecutive patients: 24 patients with severe aortic stenosis, 28 patients with dilated cardiomyopathy, and 7 healthy controls. The analysis was done by four expert echocardiographers and one cardiology resident. RESULTS: It was possible to obtain reliable data for radial strain in 175 of 354 segments (49%), circumferential strain in 192 of 354 segments (54%), and longitudinal strain in 319 of 354 segments (90%). Experienced echocardiographers felt assessment of radial and circumferential strain was appropriate in more segments than did the cardiology resident (57% and 58% vs. 23% and 40%, respectively, P < 0.01). CONCLUSION: Longitudinal strain analysis with 2DSTE is feasible in most segments, but the radial and circumferential strain evaluation was only feasible in approximately half of the patients.