A Case Report of a Mediastinal Fistula with Liver Abscesses as a Complication of Aortic Valve Replacement Surgery

We report a case of mediastinal fistula with liver abscesses detected by thoracic and abdominal computed tomography as a complication of aortic valve replacement surgery

Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension

Introduction: In patients with systemic sclerosis (SSc), associated pulmonary arterial hypertension (SSc-APAH) is the leading cause of death. The objective of this prospective screening study was to analyse sensitivity and specificity of stress Doppler echocardiography (SDE) in detecting pulmonary hypertension (PH). Methods: Pulmonary artery pressures and further parameters of PH were assessed by echocardiography and right heart catheterisation (RHC) at rest and during exercise in patients with SSc. Investigators of RHC were blinded to the results of non-invasive measurements. Results: Of 76 patients with SSc (64 were female and mean age was 58±14 years), 22 (29 %) had manifest PH confirmed by RHC: four had concomitant left heart diseases, three had lung diseases, and 15 had SSc-APAH. Echocardiography at rest missed PH diagnosis in five of 22 patients with PH when a cutoff value for systolic pulmonary arterial pressure (PASP) was more than 40 mm Hg at rest. The sensitivity of echocardiography at rest was 72.7 % (95 % confidence interval (CI) 0.52–0.88), and specificity was 88.2 % (95 % CI 0.78–0.95). When a cutoff value for PASP was more than 45 mm Hg during low-dose exercise, SDE missed PH diagnosis in one of the 22 patients with PH and improved sensitivity to 95.2 % (95 % CI 0.81–1.0) but reduced specificity to 84.9 % (95 % CI 0.74–0.93). Reduction of specificity was partly due to concomitant left heart disease. Conclusions: The results of this prospective cross-sectional study using RHC as gold standard in all patients showed that SDE markedly improved sensitivity in detecting manifest PH to 95.2 % compared with 72.7 % using echocardiography at rest only. Thus, for PH screening in patients with SSc, echocardiography should be performed at rest and during exercise. Trial registration: ClinicalTrials.gov NCT01387035 . Registered 29 June 2011

Indexing left ventricular wall thickness to body surface area improves prognostic value

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149205/1/echo14317_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149205/2/echo14317.pd

4D-Flow Cardiovascular Magnetic Resonance Sequence for Aortic Assessment: Multi-Vendor and Multi-Magnetic Field Reproducibility in Healthy Volunteers

Objectives: Four-dimensional (4D) flow cardiac magnetic resonance (CMR) represents an emerging technique for non-invasive evaluation of the aortic flow. The aim of this study was to investigate a 4D-flow CMR sequence for the assessment of thoracic aorta comparing different vendors and different magnetic fields of MR scanner in fifteen healthy volunteers. Methods: CMR was performed on three different MRI scanners: one at 1.5 T and two at 3 T. Flow parameters and planar wall shear stress (WSS) were extracted from six transversal planes along the full thoracic aorta by three operators. Inter-vendor comparability as well as scan-rescan, intra- and interobserver reproducibility were examined. Results: A high heterogeneity was found in the comparisons for each operator and for each scanner in the six transversal planes analysis (Friedman rank-sum test; p-value <= 0.05). Among all, the most reproducible measures were extracted for the sinotubular junction plane and for the flow parameters. Conclusions: Our results suggest that standardized procedures have to be defined to make more comparable and reproducible 4D-flow parameters and mainly, clinical impactfulness. Further studies on sequences development are needed to validate 4D-flow MRI assessment across vendors and magnetic fields also compared to a missing gold standard

Prognostic Value of Coronary Calcium Score in Asymptomatic Individuals: A Systematic Review

Despite updated guidelines and technological developments that allow for an accurate diagnosis, many asymptomatic individuals have a high risk of developing CAD or cardiac events. The CAC score can estimate a correct risk level for these subjects, which is clinically significant for adequate management of risk factors and obtaining personalized preventive therapy. This systematic review aims to assess the prognostic value of CAC score in asymptomatic individuals. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the prognostic value of CAC score in asymptomatic individuals. The quality of the included studies was assessed by the QUIPS tool. A total of 45 articles were selected. Many of these (25 studies) evaluated the prognostic value of CAC score in asymptomatic subjects. In comparison, others (20 studies) evaluated the association of CAC score with other clinical parameters and imaging modalities or the comparison with computed tomography coronary angiography (CTCA). Our findings showed that the CAC score provides valuable prognostic information for predicting CAD risk in asymptomatic individuals

Type A Acute Aortic Dissection in Nonagenarian: Rare but Possible

Acute type A aortic dissection (TA-AAD) is a highly lethal clinical entity that can occur within a wide age range, associated with multiple aetiologies and various clinical presentations. In the very elderly type A aortic dissection frequently presents with non-specific symptoms and signs and is associated with high mortality and morbidity. Thus the clinician must have a high index of clinical suspicion in order to prompt the most appropriate diagnostic-therapeutic strategy.We report a nonagenarian women with TA-AAD, treated successfully with medical therapy

Clinical features and prognostic value of stent-graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes

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Circulating miR-10b-5p, miR-193a-3p, and miR-1-3p Are Deregulated in Patients with Heart Failure and Correlate with Hormonal Deficiencies

Heart failure (HF) is among the most important causes of worldwide morbidity, hospitalisation, and mortality. A reduction in anabolic hormonal axes seems to potentially play an important role in chronic HF progression and prognosis. Several lines of evidence support the critical roles of miRNAs in the endocrine system, and differentially expressed miRNA patterns were found to be able to detect HF. To date, the ability of miRNAs to detect HF patients affected by hormonal deficiencies has yet to be addressed. The aim of this study was to explore the association between circulating miRNA profiles and multiple hormonal deficiencies in HF patients to provide new insights into HF pathophysiology. The study cohort included 129 subjects (94 HF patients and 35 controls). Circulating miRNAs assayed in plasma samples were miR-1-3p, miR-10b-5p, miR-24-3p, miR-193a-5p, miR-454-3p, miR-503-5p, miR-551b-3p, and miR-598-3p. NT-proBNP, IGF-1, fT3, DHEA-S, testosterone, HF subtypes, and NYHA class were also evaluated. A multiple hormonal deficiency syndrome (MHDS) was defined as the presence of ≥two hormone deficiencies. We found that miR-10b-5p, miR-193a-5p, and miR-1-3p could distinguish chronic HF patients from controls. The identified miRNAs were downregulated in HF patients, particularly those with NYHA I-II classifications and pathological values of NT-proBNP. In addition, these three circulating miRNAs correlated with each other, and their deregulation seems to be influenced by hormone deficiencies, especially in patients with reduced ejection fraction. Among the three miRNAs, miR-10b-5p was the best able to diagnose chronic HF-MHDS patients (AUC = 0.8). These results support the clinical utility of miR-10b-5p, miR-193a-5p, and miR-1-3p in detecting HF patients, especially those with hormone deficiencies