Lateral annular systolic excursion ratio: A novel measurement of right ventricular systolic function by two-dimensional echocardiography.

Introduction: Accurate assessment of right ventricular (RV) systolic function has prognostic and therapeutic implications in many disease states. Echocardiography remains the most frequently deployed imaging modality for this purpose, but estimation of RV systolic function remains challenging. The purpose of this study was to evaluate the diagnostic performance of a novel measurement of RV systolic function called lateral annular systolic excursion ratio (LASER), which is the fractional shortening of the lateral tricuspid annulus to apex distance, compared to right ventricular ejection fraction (RVEF) derived by cardiac magnetic resonance imaging (CMR). Methods: A retrospective cohort of 78 consecutive patients who underwent clinically indicated CMR and transthoracic echocardiography within 30 days were identified from a database. Parameters of RV function measured included: tricuspid annular plane systolic excursion (TAPSE) by M-mode, tissue Doppler S', fractional area change (FAC) and LASER. These measurements were compared to RVEF derived by CMR using Pearson's correlation coefficients and receiver operating characteristic curves. Results: LASER was measurable in 75 (96%) of patients within the cohort. Right ventricular systolic dysfunction, by CMR measurement, was present in 37% (n = 29) of the population. LASER has moderate positive correlation with RVEF (r = 0.54) which was similar to FAC (r = 0.56), S' (r = 0.49) and TAPSE (r = 0.37). Receiver operating characteristic curves demonstrated that LASER (AUC = 0.865) outperformed fractional area change (AUC = 0.767), tissue Doppler S' (AUC = 0.744) and TAPSE (AUC = 0.645). A cohort derived dichotomous cutoff of 0.2 for LASER was shown to provide optimal diagnostic characteristics (sensitivity of 75%, specificity of 87% and accuracy of 83%) for identifying abnormal RV function. LASER had the highest sensitivity, accuracy, positive and negative predictive values among the parameters studied in the cohort. Conclusions: Within the study cohort, LASER was shown to have moderate positive correlation with RVEF derived by CMR and more favorable diagnostic performance for detecting RV systolic dysfunction compared to conventional echocardiographic parameters while being simple to obtain and less dependent on image quality than FAC and emerging techniques.

Costs associated with transradial access and same-day discharge after percutaneous coronary intervention: a systematic review and meta-analysis.

Transradial access for PCI (TRI) along with same day discharge (SDD) is associated with varying estimates of cost savings depending on the population studied, the clinical scenario and application to low-risk vs high-risk patients. A summary estimate of the true cost savings of TRI and SDD are unknown. We searched the PubMed, EMBASE®, CINAHL® and Google Scholar® databases for published studies on hospitalization costs of TRI and SDD. Primary outcome of interest in all included studies was the cost saving with TRI (or SDD), inflation-corrected US$ 2018 values using the medical consumer price index. For meta-analytic synthesis, we used Hedges' summary estimate (g) in a random-effects framework of the DerSimonian and Laird model, with inverse variance weights. Heterogeneity was quantified using the I2 statistic. The cost savings of TRI from four US studies of 349,757 patients reported a consistent and significant cost saving associated with TRI after accounting for currency inflation, of US$ 992 (95% CI US$ 850-1,134). The cost savings of SDD from six US studies of 1,281,228 patients, after inflation-correcting to the year 2018, were US$ 3,567.58 (95% CI US$ 2,303-4,832). In conclusion, this meta-analysis demonstrates that TRI and SDD are associated with mean cost reductions of by approximately US$ 1,000/patient and US$ 3,600/patient, respectively, albeit with wide heterogeneity in the cost estimates. When combined with the safety of TRI and SDD, this meta-analysis underscores the value of combining TRI and SDD pathways and calls for a wide-ranging practice change in the direction of TRI and SDD.

Evaluation of echocardiographic derived parameters for right ventricular size and function using cardiac magnetic resonance imaging.

BACKGROUND: Cardiac Magnetic Resonance Imaging (cMRI) is the gold standard for right ventricular (RV) assessment due to its high spatial resolution. The American Society of Echocardiography (ASE) recommends eight structural and six functional quantitative parameters for evaluation of the RV. This study sought to simplify echocardiographic RV assessment by examining the relative diagnostic value of the echo recommended parameters by applying them to cMRI imaging of the RV. METHODS: We applied ASE recommended measures of RV size and function to 56 cMRI's and compared them to RV volumetric analysis obtained from cMRI. Pearsons' correlation coefficient was used to compare ASE prescribed parameters to corresponding cMRI calculated RV end diastolic volume (RVEDV) and RV ejection fraction (RVEF). The diagnostic performance of each parameter in predicting abnormal RV size or function was analyzed using receiver operator characteristic curves. Youden-J index was used to determine optimal sensitivity/specificity cut-points. Stepwise regression modeling was performed to identify measurements independently associated with RV size or RVEF. RESULTS: RV end diastolic area (RVEDA) correlated best with RVEDV (r = .76, p < 0.001) and RV fractional area change (RVFAC) correlated best with RVEF (r = .7, p < 0.001). The best ASE parameter for identifying RV dilatation was RVEDA (Youden-J index = .84), the optimal cutoff was 32.3 cm2 which yielded sensitivity/specificity of 84% and 100%, respectively. The best parameter for diagnosing RV dysfunction was RVFAC (Youden-J index = .52), with an optimal cutoff of 42% leading to sensitivity/specificity of 64% and 88%, respectively. CONCLUSION: The area based echocardiographic parameters for RV size and function, RVEDA and RV fractional area change outperform linear measurements in predicting RV dilation and RV systolic dysfunction. These parameters should be examined in further echocardiographic based studies as the primary parameters to guide quantitative RV assessment.

Unrecognized perforation into the anterior interventricular vein complicating PCI for anterior STEMI: An unexpected detour.

Large iatrogenic coronary artery perforations require rapid management; however, operators must be able to recognize guidewire perforation into cardiac veins in order to avoid causing further complications with standard salvage strategies.

Percutaneous management strategies for STEMI with coexisting aneurysmal coronary- to-pulmonary artery fistula: a case report.

BACKGROUND: Coexistence of coronary artery fistulas and atherosclerotic coronary artery disease (CAD) is rare. CASE SUMMARY: We present a unique case of a patient initially presenting with an anterior ST-elevation myocardial infarction, subsequently found to have two-vessel CAD and an aneurysmal left coronary-to-right pulmonary artery fistula. DISCUSSION: After discussion with the patient and a multidisciplinary discussion with the heart team, consisting of cardiovascular surgery, interventional cardiology, and vascular surgery, a percutaneous approach was chosen. He underwent successful multivessel percutaneous coronary intervention followed by fistula embolization.

Management of a patient presenting with anterior STEMI with concomitant COVID-19 infection early in the course of the U.S. pandemic.

The coronavirus disease-2019 (COVID-19) is a viral illness with heterogenous clinical manifestations, ranging from mild symptoms to severe acute respiratory distress syndrome and shock caused by the severe acute respiratory syndrome coronavirus-2. The global healthcare community is rapidly learning more about the effects of COVID-19 on the cardiovascular system, as well as the strategies for management of infected patients with cardiovascular disease. There is minimal literature available surrounding the relationship between COVID-19 infection and acute coronary syndrome. We describe the case of a woman who presented with an acute anterior ST-elevation myocardial infarction managed by primary percutaneous coronary intervention, who subsequently developed severe COVID-19 infection and ultimately succumbed to multisystem organ failure.