Cardiac hydatidosis.

We report a case of an adult who developed superior vena cava syndrome because of cardiac hydatidosis. A 37-year-old man from Morocco developed progressive dyspnoea and cough. Cardiac hydatidosis was diagnosed because of both the typical radiological findings and the positive serology for echinococcosis. The patient was treated by surgery and albendazole without complications.

Accuracy of Doppler-derived pulmonary artery hypertension to predict heart failure with normal ejection fraction.

Recent advances have highlighted the clinical relevance of pulmonary artery hypertension in terms of diagnosis and prognosis in heart failure with normal ejection fraction. We addressed the usefulness of Doppler-derived pulmonary artery systolic pressure to predict heart failure with normal ejection fraction in stable patients with exertional dyspnea. 25 patients referred for clinically indicated catheterism with evidence of heart failure according to the European diagnostic flowchart on "how to diagnose heart failure with normal ejection fraction" and 12 controls referred for clinically indicated catheterism without this condition according to the diagnostic flowchart on "how to exclude heart failure with normal ejection fraction" were included. None of the patients presented with Doppler-derived pulmonary vascular resistance >2.5 WU. By logistic regression analysis, pulmonary artery systolic pressure predicted heart failure with normal ejection fraction (p=0.006), with an optimal cut-off value of 35 mmHg (area under the ROC curve of 0.80 [0.64-0.92], p<0.001; sensitivity 76%, specificity 75%). Positive and negative predictive values were 93 and 50% for the cut-off value of 40 mmHg. Doppler-derived pulmonary artery hypertension is a landmark of heart failure with normal ejection fraction in patients without severely increased pulmonary vascular resistance and deserves further attention in upcoming international recommendations.

Predictors of B-type natriuretic peptide and left atrial volume index in patients with preserved left ventricular systolic function: an echocardiographic-catheterization study.

BACKGROUND: B-type natriuretic peptide (BNP) and left atrial volume index (LAVi) are used as surrogate measures for global myocardial function and are recommended for the diagnosis of heart failure with normal ejection fraction. Little is known, however, about predictors in patients with preserved systolic function. AIMS: To identify factors that influence the relation of BNP and left atrial size to invasively determined left ventricular end-diastolic pressure in stable patients with preserved left ventricular systolic function. METHODS: Fifty-nine consecutive patients were included prospectively. Clinical, biological, Doppler echocardiographic and invasive variables were collected simultaneously. RESULTS: BNP was predicted independently by left ventricular ejection fraction, diastolic function and age (p<0.05). LAVi was predicted independently by left ventricular mass index and invasive left ventricular end-diastolic pressure (p<0.01). BNP predicted increased left ventricular end-diastolic pressure greater than 16 mmHg (p=0.004); the optimal cut-off value was 33 pg/mL (area under the receiver-operating characteristic curve [AUC] 0.74 [0.6-0.84], p<0.001, sensitivity 72%, specificity 70%). LAVi predicted increased left ventricular end-diastolic pressure (p<0.001); the optimal cut-off value for LAVi was 26 mL/m(2) (AUC 0.87 [0.75-0.94], p<0.001; sensitivity 85%, specificity 80%). Unlike BNP (p=0.1), LAVi performed well in patients with abnormal relaxation at mitral filling (p<0.01). CONCLUSION: BNP is influenced by age in stable patients with preserved systolic function and should be interpreted cautiously. LAVi is a powerful surrogate for invasively determined left ventricular end-diastolic pressure regardless of age and mitral filling.

Usefulness of left atrial volume for the diagnosis of diastolic heart failure: an echocardiographic-catheterization study.

The present study attempted to determine the accuracy of left atrial volume (LAVi) by transthoracic echocardiography in the diagnosis of diastolic heart failure (DHF) in patients presenting with chronic, isolated dyspnea. We included 28 consecutive patients with a left ventricular ejection fraction >50% without prior history of heart failure. DHF was authenticated in 20 patients by invasive left ventricular end-diastolic pressure >16 mmHg. By logistic regression analysis, LAVi was predictive of DHF (p=0.015). LAVi>38 ml/m(2) was a useful predictor of DHF (area under the ROC curve of 0.84 [0.65-0.95], p<0.001, sensitivity 60%, specificity 100%). The standard cut-off value of 34 ml/m(2) was 70% sensitive and 88% specific.

Usefulness of basal B-type natriuretic peptide levels for the diagnosis of diastolic heart failure in young patients: an echocardiographic-catheterization study.

The aim of the present study was to address the diagnostic relevance of B-type natriuretic peptide (BNP) for the diagnosis of diastolic heart failure (DHF) in young patients presenting with chronic, isolated dyspnea. We prospectively included 26 consecutive patients with a left ventricular ejection fraction >50% referred for catheterism. DHF was authenticated in 15 patients with an invasive left ventricular end-diastolic pressure >16 mmHg. By logistic regression analysis, BNP was predictive of DHF (p=0.03). A cut-off value of 31 pg/ml was 67% sensitive and 73% specific for the diagnosis (area under the ROC curve of 0.76 [0.55-0.9], p=0.007).