Diastolic function and its association with diabetes, hypertension and age in an outpatient population with normal stress echocardiography findings

Abstract Background Diastolic dysfunction can be caused by hypertension or diabetes mellitus, and it is also often found with increasing age. In a given patient, the cause of diastolic dysfunction is therefore not always obvious. We sought to study the interplay of these risk factors for diastolic dysfunction in an outpatient population with a low likelihood of ischemic heart disease. Methods Consecutive patients referred for stress echocardiography were included retrospectively. Exclusion criteria included pathological stress response, atrial arrhythmia, left ventricular ejection fraction &lt; 55%, and more than mild valvular disease. Standard diastolic parameters were recorded in all patients. In a subset of patients, mechanistic analysis of early filling was performed using the parameterized diastolic filling (PDF) method. Results We included 726 patients (median [interquartile range] age 56 (44–65) years, 57% male). The prevalence of diabetes and hypertension was 43 and 49%, respectively. In multiple linear regression modeling, the presence of diabetes, hypertension, sex and increasing age explained a moderate amount of the variance in e’ velocities, E/A ratio and E/e’ (R2 = 0.31–0.48, p &lt; 0.001), and a low amount of the variance in left atrial volume index (LAVI) and the PDF parameters (n = 446, R2 = 0.05–0.17, p &lt; 0.001). Sex was only related to LAVI and E/e’ for the conventional parameters (beta − 0.94, p = 0.04, and beta − 0.91, p &lt; 0.001, respectively). Conclusions Diabetes, hypertension, increasing age, and to a lesser extent sex, explain a moderate amount of the variance in conventional diastolic parameters related to myocardial tissue velocities and E/A ratio in a healthy outpatient population. The effect of these risk factors was substantially less pronounced on left atrial volume index and the PDF parameters. </jats:sec

Successful MitraClip for severe rheumatic mitral regurgitation: a case report

Abstract Background Anatomical exclusion criteria for the MitraClip procedure have included rheumatic heart disease (RHD) involving the mitral valve. This was primarily because RHD is typically associated with mitral stenosis (MS). Case summary We report the case of an 85-year-old male who had recurrent heart failure admissions from severe rheumatic mitral regurgitation (MR). This was successfully treated with the MitraClip system. Discussion Our case demonstrated the possibility of rheumatic MR being treated by the MitraClip system in appropriately selected patients. Careful examination of the mechanism of MR to determine suitability for MitraClip must be done as well as exclusion of significant MS. </jats:sec

Giant Coronary Aneurysm Presenting as Acute Ventricular Septal Rupture

Giant coronary aneurysm presented initially as acute ventricular septal rupture in a 65-year-old man. At surgery, aneurysms measuring more than 10 cm each were found in the right coronary and left anterior descending arteries. The right coronary artery was bypassed and the aneurysm was plicated. A 2-cm ventricular septal defect was patched. Postoperatively, the patient's condition deteriorated and he succumbed to septic shock. </jats:p