Although cardiac myxoma (CM) are rare and benign, they can cause life-threatening complications, such as hemodynamic disturbances or embolization. Surgical excision of the tumour is the treatment of ...choice. The aim of the study was to evaluate the epidemiological characteristics, clinical presentation, imaging findings, and outcomes of surgical treatment of patients with CM treated in the largest tertiary care centre in Slovenia.
We retrospectively analysed the medical records of all patients referred to our institution between January 2005 and December 2020 and identified 39 consecutive adult patients with pathologically confirmed CM.
The average annual incidence of CM in the study was 3 per 2 million population per year. Patients were more often female (n = 25, 64%). The mean age at diagnosis was 63.1 ± 13.6 years. Dyspnoea was the most common presenting symptom (31%). CM was an incidental finding in 11 patients (28%). Seven patients presented with thromboembolic event (18%). Transthoracic echocardiography (TTE) was performed in all patients, however additional imaging was required in 22 patients (56%). All patients in our series were successfully treated surgically without in-hospital mortality. During the follow-up period (6 months to 16 years) three patients (8%) died, and all deaths were unrelated to CM. There was no recurrence of CM during the follow-up.
Our single-centre study confirms that CM is rare cardiac tumour with diverse clinical presentation. Our data shows data that CM might be more prevalent than considered before. Surgical resection of the tumour is safe with excellent short- and long-term outcomes.
To determine the prevalence of mitral regurgitation (MR) in a large cohort of consecutive patients undergoing clinically indicated echocardiography and to examine the distribution of primary and ...secondary MR.
All patients undergoing an echocardiographic study in 19 European centres within a 3-month period were prospectively included. MR assessment was performed as recommended by the European Association of Cardiovascular Imaging (EACVI). MR was classified according to mechanism as primary or secondary and aetiologies were reported. A total of 63 463 consecutive echocardiographic studies were reviewed. Any degree of MR was described in 15 501 patients. Concomitant valve disease of at least moderate grade was present in 28.5% of patients, being tricuspid regurgitation the most prevalent. In the subgroup of moderate and severe MR (n = 3309), 55% of patients had primary MR and 30% secondary MR. Both mechanisms were described in 14% of the studies. According to Carpentier's classification, 26.7% of MR were classified as I, 19.9% of MR as II, 22.4% of MR as IIIa, and 31.1% of MR as IIIb.
To date, this is the largest echocardiography-based study to analyse the prevalence and aetiology distribution of MR in Europe. The burden of secondary MR was higher than previously described, representing 30% of patients with significant MR. In our environment, degenerative disease is the most common aetiology of primary MR (60%), whereas ischaemic is the most common aetiology of secondary MR (51%). Up to 70% of patients with severe primary MR may have a Class I indication for surgery. However, the optimal therapeutic approach for secondary MR remains uncertain.
This report compares the cumulative efficacy of cardioversion and skeletal muscle injury after either damped sine wave monophasic or truncated exponential biphasic transthoracic cardioversion of ...persistent atrial fibrillation. The trial sought to refute the null hypothesis of therapeutic equivalence between monophasic and biphasic waveforms. Results of the study reveal similar cumulative efficacy of waveforms and greater levels of skeletal muscle damage when patients are younger and male, and when monophasic waveforms are used.
The concept of disproportionate mitral regurgitation (dispropMR) has been introduced to identify patients with functional mitral regurgitation (MR) who benefit from percutaneous treatment. We aimed ...to examine echocardiographic characteristics behind this entity. We retrospectively included 172 consecutive patients with reduced left ventricular ejection fraction (LVEF), and more than mild MR referred to clinically indicated echocardiography. According to the proportionality ratio (effective regurgitant orifice area (EROA)/left ventricular end-diastolic volume (LVEDV)) patients were divided into dispropMR and proportionate MR (propMR) group. Potential factors which might affect proportionality definition were analyzed. 55 patients (32%) had dispropMR. Discrepant grading of MR severity was observed when using regurgitant volume (RegVol) by proximal isovelocity surface area (PISA) method or volumetric method, with significant discordance only in dispropMR (p < 0.001). Patients with dispropMR had more frequently left ventricular foreshortened images for LVEDV calculation than patients with propMR (p = 0.003), resulting in smaller LVEDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR. Accordingly, EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method. This was more pronounced in dispropMR (bias:10.5 ± 28.3 mm
2
) compared to propMR group (bias:6.4 ± 12.8 mm
2
). DispropMR may be found in roughly one third of clinically indicated echocardiographic studies in patients with reduced LVEF and more than mild MR. EROA overestimation due to dynamic variation of regurgitant flow and LVEDV underestimation due to LV foreshortening were more frequently found in dispropMR. Our results indicate that methodological limitations of echocardiographic MR grading could not be neglected in classifying the proportionality of MR.
Acute respiratory failure is one of the most challenging critical conditions due to a wide variety of differential diagnosis. Bedside lung ultrasound in emergency (BLUE) protocol allows accurate ...differentiation between the most common underlying causes of acute respiratory failure in up to 90% of the cases. The assessment of left atrial pressure affecting left ventricular filling is essential in critically ill patients guiding volume substitution, optimization of left ventricular function and prevention of pulmonary congestion, thus ensuing haemodynamic stability. A simple, non-invasive method of left atrial pressure evaluation is the echocardiographic assessment of interatrial septum shape and motion, which is affected by interatrial pressure gradient. Aiming to improve the accuracy of the BLUE protocol, we propose the simple, non-invasive echocardiographic assessment of interatrial septum shape and motion as an upgrade, providing additional information of the loading of left and right atrium thus distinguishing the most common causes of acute respiratory failure.
IntroductionThe underlying mechanisms of CD34+ cell therapy in patients with non-ischemic dilated cardiomyopathy (DCM) are poorly defined.HypothesisIn a substudy of a protocol investigating the ...clinical effects of transendocardial CD34+ cell transplantation in DCM we sought to evaluate the effects of this therapy on diastolic parameters.MethodsFrom May 2013 until January 2014 we enrolled 38 DCM patients with NYHA class III and LVEF <40%. All patients underwent transendocardial CD34+ cell transplantation. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of electomechanical missmatch. Patients were followed for 1 year after the procedure.ResultsAt baseline, diastolic parametes were impaired (E/Em≥15) in 18 patients (Group A), and normal (E/Em<15) in 20 patients (Group B). The two groups did not differ in age (54±9 years vs. 52±10 years; P=0.62), gender (male85% vs. 78%; P=0.57), or LVEF (31±7 % vs. 34±6 %; P=0.37). When compared to Group B patients in Group A had more segments with myocardial scar (4.9±2.7 vs. 2.7±2.9; P=0.03). and myocardial hibernation (2.2±1.6 vs. 0.9±1.1; P=0.02) on electroanatomical mapping. The number of injected CD34+ cells was 92.6±45.8 million in Group A, and 139.2±85.3 million in Group B (P=0.08). During follow-up there was an improvement in diastolic parameters in Group A (E/Emfrom 24.3±12.1 to 16.3±8.0; P=0.005), but not in Group B (E/Emfrom 10.2±3.7 to 13.2±9.1; P=0.19). Accordingly, in Group A, we found an increase in 6-minute walk distance (from 463±83 m to 546±91 m; P=0.03), and a decrease in NT-proBNP (from 2140±1743 pg/mL to 863±836 pg/mL; P=0.02).ConclusionsIn non-ischemic DCM, diastolic parametes appear to correlate with areas of myocardial scar and hibernation on electroanatomical mapping. Transendocardial CD34+ cell transplantation may improve diastolic parameters in this patient cohort.
We sought to evaluate the physiological background and the effects of CD34+ cell transplantation on diastolic parameters in nonischemic dilated cardiomyopathy patients (DCM). We enrolled 38 DCM ...patients with NYHA class III and LVEF < 40% who underwent transendocardial CD34+ cell transplantation. Peripheral blood CD34+ cells were mobilized by G‐CSF, collected via apheresis, and injected transendocardially in the areas of myocardial hibernation. Patients were followed for 1 year. At baseline, estimated filling pressures were significantly elevated (E/e′ ≥ 15) in 18 patients (Group A), and moderately elevated (E/e ′< 15) in 20 patients (Group B). The groups did not differ in age (54 ± 9 years vs. 52 ± 10 years; p = .62), gender (male: 85% vs. 78%; p = .57), or LVEF (31 ± 7% vs. 34 ± 6%; p = .37). When compared to Group B patients in Group A had more segments with myocardial scar (4.9 ± 2.7 vs. 2.7 ± 2.9; p = .03), myocardial hibernation (2.2 ± 1.6 vs. 0.9 ± 1.1; p = .02), and longer average local relaxation time on electroanatomical mapping (378 ± 41 ms vs. 333 ± 34 ms, p = .01). During follow‐up there was an improvement in diastolic parameters in Group A (E/e′: from 24.3 ± 12.1 to 16.3 ± 8.0; p = .005), but not in Group B (E/e′: from 10.2 ± 3.7 to 13.2 ± 9.1; p = .19). Accordingly, in Group A, we found an increase in 6‐minute walk distance (from 463 ± 83 m to 546 ± 91 m; p = .03), and a decrease in NT‐proBNP (from 2140 ± 1743 pg/ml to 863 ± 836 pg/ml; p = .02). In nonischemic DCM, diastolic dysfunction appears to correlate with areas of myocardial scar and hibernation. Transendocardial CD34+ cell transplantation may improve diastolic parameters in this patient cohort. Stem Cells Translational Medicine 2017;6:1515–1521
Summary
Background
MitraClip is a percutaneous mitral repair technology increasingly used for high surgical risk patients with primary or secondary mitral regurgitation. We describe initial Slovenian ...experience with MitraClip and discuss the importance of identifying the suitable candidates for this procedure.
Methods
We retrospectively analyzed the first 10 patients (mean age 75.6 ± 6.9 years, logistic Euroscore 28.4 ± 10.9%) with severe and moderate to severe mitral regurgitation (8 secondary, 1 primary and 1 mixed etiology) who underwent a MitraClip procedure between January 2015 and February 2017.
Results
Acute reduction of mitral regurgitation was achieved in all but one patient (90%). There were no periprocedural mortalities and at short to mid-term follow-up (median 12 months, interquartile range 3–15 months). In eight patients improvement of functional class was observed at discharge. No functional improvement was achieved in a patient with advanced ischemic cardiomyopathy, and in a patient with degenerative mitral disease in whom the MitraClip procedure had failed necessitating mitral valve surgery. One patient experienced late leaflet detachment and was effectively managed with a second MitraClip procedure. There were two vascular complications at the access site and one percutaneous closure of an iatrogenic atrial septal defect.
Conclusion
Our initial experiences with a small number of patients indicate that percutaneous mitral repair with MitraClip is a feasible and safe method in high-risk patients. Special attention should be paid to careful patient selection including detailed echocardiographic evaluation of mitral valve anatomy, technical performance and final result, particularly at the beginning of the learning curve in order to reduce the rate of serious complications.
Abstract only
Introduction:
We investigated the effects of transendocardial transplantation of CD34+ stem cells on left ventricular segmental wall motion in patients with ischemic cardiomyopathy ...(ICM).
Methods:
We performed transendocardial CD34+ cell transplantation in 31 ICM patients with NYHA class III heart failure and LVEF <40%. Peripheral blood CD34+ cells were mobilized by G-CSF, collected via apheresis, and injected transendocardially in the areas of hibernating myocardium as defined by electromechanical mapping (unipolar voltage ≥9 mV and linear shortening <6%). Left ventricular segmental wall motion analysis was evaluated with TomTec software using a 17-segment model of the left ventricle. Of 31 patients enrolled, 85% were male, their age was 57±6 years; their creatinine, bilirubin and NT-proBNP levels were 89±22 μmol/L, 17±9 μmol/L, and 3,322±3,411 pg/mL respectively. The average Syntax score was 27.9±10.5 and the average number of injected CD34+ cells was 90.6±7.5 million. Patients were followed for 6 months and good clinical response was defined as an increase of left ventricular ejection fraction (LVEF) ≥5%.
Results:
During follow-up, we found a significant improvement in LVEF (from 27.1±6,6% to 34.7±10.9%; P=0.001), left ventricular end-systolic diameter (from 5.3±0.7 cm to 4.9±0.9 cm; P=0.04), and left ventricular end-systolic volume (from 152±45 mL to 135±44 mL; P=0.03). Left ventricular segmental wall motion analysis showed significantly improved myocardial longitudinal strain in injected segmentes as opposed to noninjected segments (2.4±8.3 vs. -0.9±6.1; P=0.05). We also established a correlation between improvement in myocardial strain and clinical response to cell therapy: responders demonstrated a significant improvement in longitudinal strain in injected segments, but non-responders did not (6.29±8.1 vs. -3.4±5.1; P=0.007). No difference was seen between responders and nonresponders with regards to myocardial strain of noninjected segments (2.4±8.4 vs. -0.97±6.1; P=0.59).
Conclusions:
Intramyocardial CD 34+ cell transplantation appears to improve left ventricular segmental wall motion in patients with ischemic cardiomyopathy.
Myocardial deformation derived by speckle tracking imaging (STI) is a novel method in echocardiography, that provides an insight into cardiac mechanics and is becoming more widely used in daily ...clinical practice. With this method a new global parameter of left ventricular longitudinal deformation (global longitudinal strain -GLS) has been introduced, which has been shown to be more sensitive for early detection of myocardial impairment compared to conventional echocardiographic systolic function parameters. It has been proved that myocardial deformation parameters have diagnostic as well as prognostic value in several cardiac diseases. Typical findings that can be demonstrated by STI in ischemic heart disease are lower values of systolic deformation, early systolic lengthening and post-systolic shortening in ischemic myocardium. STI can be helpful in early detection of systolic dysfunction in patients with left ventricular hypertrophy and in differentiation of the causes of left ventricular hypertrophy. With STI we can detect early subclinical myocardial impairment after chemotherapy, therefore European recommendations have given priority to STI over classical echocardiographic parameters in further decision-making. In asymptomatic patients with moderate to severe valvular heart disease lower GLS values suggest subtle myocardial damage and predict higher risk of postoperative complications. In patients with myocarditis STI can identify lower values of segmental myocardial deformation, reflecting focal damage of the left ventricle. Additionally, myocardial deformation can also successfully predict response in patitents treated with cardiac resynchronization therapy. The present paper provides detailed step-by-step description of the GLS analysis, that can be used regardless of the type of ultrasound machine and software package. The use of STI is presented on particular cardiac diseases where clinical usefulness of STI has been confirmed.
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