Three-dimensional transesophageal echocardiographic evaluation of aortic plaque after cerebrovascular event.

INTRODUCTION AND OBJECTIVES: Transesophageal echocardiography (TEE) is crucial in order to assess aortic anatomy after stroke. Although routinely used to assess cardiovascular anatomy and function, three-dimensional echocardiography (3D TEE) is less used for aortic evaluation. We thus sought to assess prospectively whether additional information on aortic plaque morphology could be obtained with 3D TEE after an ischemic stroke. METHODS: Patients within one week of a stroke (confirmed by brain computed tomography/magnetic resonance) underwent TEE and 3D findings were compared with two-dimensional (2D) (aorta plaque number, dimensions, area and the presence of debris and ulcerations). Patients were followed for two years for death or a new stroke. RESULTS: We assessed 78 patients, 43 (55%) male, aged 62±14 years old, 92% in sinus rhythm. Aortic atheroma was found mainly in the descending aorta (50%); plaque thickness was similar for 2D TEE (0.29±0.03 cm) and 3D TEE (0.29±0.04 cm), whereas plaque area was slightly increased for 3D measurements (0.24±0.02 cm2 versus 0.37±0.03 cm2 respectively, p<0.05), with a strong correlation found both for aortic plaque thickness (r=0.91) and area (r=0.80) measurements. While aortic debris were equally seen with both techniques, 3D TEE defines the presence of ulcerations (six ulcerations unseen with 2D TEE better, p=0.03). There were 11 events (six deaths and five new strokes) during follow-up, unrelated to plaque characteristics. CONCLUSION: To evaluate aortic plaque morphology, 3D TEE is superior to 2D TEE due to improved detection of ulcerated aortic plaque; this might provide additional information in patients after ischemic stroke.

Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM").

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM). Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM. Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included. Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution. Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Remodelado inverso de aurícula izquierda en pacientes con estenosis de válvula mitral tras valvuloplastia percutánea: estudio ecocardiográfico bidimensional y tridimensional / Left atrium reverse remodeling in patients with mitral valve stenosis after percutaneous valvuloplasty: A 2- and 3-dimensional echocardiographic study

Introducción y objetivos. La aurícula izquierda tiene importancia clínica en pacientes con estenosis de la válvula mitral. El objetivo de este estudio es analizar los efectos de la valvuloplastia percutánea con balón en los volúmenes auriculares izquierdos y la fracción de vaciado auricular izquierdo en pacientes con estenosis de válvula mitral sintomática, mediante el empleo de ecocardiografía transtorácica bidimensional y tridimensional en tiempo real. Métodos. Se llevó a cabo un estudio prospectivo de 28 pacientes consecutivos, 24 de ellos mujeres (85,6%), de 22-72 (media, 39 ± 11,5) años de edad, con estenosis de válvula mitral sintomática a los que se practicó una valvuloplastia percutánea con balón entre marzo de 2009 y mayo de 2011. Se realizaron exploraciones de ecocardiografía transtorácica bidimensional y tridimensional y transesofágica (fibrilación auricular) y una medición invasiva del área de válvula mitral. Se efectuó un análisis ecocardiográfico antes de la valvuloplastia percutánea con balón y a las 72 h y los 12 meses de realizada. Se analizaron los siguientes parámetros: a) área de válvula mitral (planimetría bidimensional, semitiempo de presión, ecocardiografía tridimensional, medición invasiva de parámetros hemodinámicos); b) volúmenes indexados máximo y mínimo de la aurícula izquierda, y c) fracción de vaciado auricular izquierdo. Resultados. Los parámetros tridimensionales de los pacientes con estenosis de válvula mitral antes y 72 h y 12 meses después de la valvuloplastia con balón percutánea fueron los siguientes: a) área de válvula mitral, 0,9 ± 0,1 cm2, 1,8 ± 0,2 cm2 (p < 0,001) y 1,7 ± 0,2 cm2 (p < 0,001); b) volúmenes máximos de la aurícula izquierda, 49,9 ± 12; 42 ± 11,4 (p < 0,001) y 40,3 ± 10,2 ml/m2 (p < 0,001), y c) fracción de vaciado auricular izquierdo, 30,1 ± 9,4%; 40,6 ± 7,4% (p < 0,001) y 44,1 ± 8% (p < 0,001) respectivamente. Conclusiones. En los pacientes con estenosis de válvula mitral sintomática tratados con valvuloplastia percutánea con balón, el análisis mediante ecocardiografía bidimensional y tridimensional mostró una mejora del remodelado inverso de la aurícula izquierda y de la fracción de vaciado auricular izquierdo a las 72 h y a los 12 meses de la intervención(AU)

Introduction and objectives. The left atrium is clinically relevant in patients with mitral valve stenosis. The objective of this study was to analyze the effects of percutaneous balloon valvuloplasty on left atrium volumes and the left atrium emptying fraction in symptomatic mitral valve stenosis patients using 2-dimensional and real-time 3-dimensional transthoracic echocardiography. Methods. We carried out a prospective study of 28 consecutive symptomatic mitral valve stenosis patients, aged 22-72 (39 [11.5]) years, 24/28 (85.6%) women, who underwent to percutaneous balloon valvuloplasty between March 2009 and May 2011. Patients underwent 2- and 3-dimensional transthoracic and transesophageal echocardiography (atrial fibrillation) and invasive mitral valve area measurement. Echocardiographic analysis was performed before, 72h after and 12 months after percutaneous balloon valvuloplasty. The following parameters were analyzed: a) mitral valve area (2-dimensional planimetry, pressure half-time, 3-dimensional echocardiography, invasive hemodynamic measurement); b) indexed left atrium maximum and indexed minimum volumes, and c) left atrium emptying fraction. Results. The 3-dimensional parameters of the mitral valve stenosis patients before and 72h and 12 months after percutaneous balloon valvuloplasty were as follows: a) mitral valve area: 0.9 (0.1) cm2; 1.8 (0.2) cm2 (P<.001); 1.7 (0.2) cm2 (P<.001); b) left atrium maximum volumes: 49.9 (12) mL/m2; 42 (11.4) mL/m2 (P<.001); 40.3 (10.2) mL/m2 (P<.001), and c) left atrium emptying fraction: 30.1 (9.4%); 40.6 (7.4%) (P<.001); 44.1 (8%) (P<.001), respectively. Conclusions. In symptomatic mitral valve stenosis patients who underwent percutaneous balloon valvuloplasty analysis by 2- and 3-dimensional echocardiography, improvements in left atrium reverse remodeling and left atrium emptying fraction were observed 72h and 12 months after the procedure(AU)