Primary cardiac undifferentiated sarcoma of the right atrium presenting with cardiac tamponade.

This report illustrates the serial imaging of a primary cardiac undifferentiated sarcoma of the right atrium using echocardiography, chest X-ray, and computed tomography. Transthoracic echocardiography on presentation showed an extensive mass of the right atrial free wall with an impending cardiac tamponade. Symptoms were controlled with pericardiocentesis, pericardial window, and radiotherapy but recurred 8 months later with pleural effusion and tumor spread to the great arteries. Primary cardiac sarcoma (PSC) is a rare and aggressive malignancy that is usually diagnosed late due to its nonspecific symptoms. Cytology and cardiac biopsy may be negative, and suspicion for the tumor is warranted in recurrent pericardial effusion. Analogous to parietal pleural biopsy in lung tumors with pleural effusion, parietal pericardial biopsy may be positive in PSC of the right atrium with pericardial effusion. Echocardiography is the major diagnostic tool and aids pericardiocentesis. Pericardial window may be useful for recurrent pericardial effusion but does not preclude its reaccumulation. There is no proven effective treatment for PSC, and treatments include surgical resection, cardiac transplant, chemotherapy, and radiotherapy. Despite its poor prognosis, symptomatic relief is important and attainable.

A simple risk score for prediction of mortality in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS).

AIMS: To develop an easily applicable prognostic model that can predict mortality risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS). METHODS AND RESULTS: A retrospective analysis of 630 consecutive patients undergoing PCI for NSTEACS at our institution between January 1999 and December 2000 (development phase). Multivariate logistic regression analysis to identify independent predictors of mortality. Development of a 'weighted' and an 'unweighted' risk prediction model, each including the following 8 parameters: age > 65 years, age >75 years, left ventricular systolic function (LVEF) <50%, renal impairment (serum creatinine > 200 mmol/L), multi-vessel (3 vessel) disease, peripheral vascular disease, diabetes mellitus and female gender. Validation of the predictive model on the following 500 patients that underwent PCI over a 20 month period (validation phase). Prognostic models tested for their ability to predict mortality. The derived model was applied to the validation group and the area under receiver operating characteristic curves (ROC) was used to estimate the predictive ability of the prognostic models. The area under the ROC curve on the validation phase was 0.835, signifying a good ability to predict 30 day mortality following PCI. CONCLUSION: We have derived a simple easily applicable predictive model based on readily available information that can predict mortality following PCI for NSTEACS.