Abstract 14789: A Rare Case of Primary Cardiac Leiomyosarcoma Involving the Left Ventricle

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hafiz D Khalid ◽  
Danielle S Grunloh ◽  
Ahsan M Bhatti ◽  
Benjamin J Rhee ◽  
Sarwar Orakzai
Keyword(s):  
Left Ventricle ◽  
Low Voltage ◽  
Vital Signs ◽  
Large Mass ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Prior History ◽  
Arm Pain ◽  
Large Pericardial Effusion ◽  
Well Differentiated

Case Report: A 73 year old female was admitted to our hospital with complaints of acute shortness of breath on exertion and chest tightness accompanied with non-exertional left arm pain. Her prior history was significant for hypertension. Vital signs were significant for tachycardia. EKG revealed sinus tachycardia and low voltage QRS complexes. Cardiac Biomarkers were negative. CXR on admission showed massive cardiomegaly. (A) Echocardiography, Off Axis, Apical long axis view showing a large mass attached to the LV apex surrounded by large pericardial effusion. Pericardiocentesis was performed and 1200ml of bloody fluid was removed. (B) Cardiac MRI was performed which revealed a mass arising from the inferolateral wall of Left Ventricle measuring 6.5x4.9x6.2 cm Left thoracotomy, wedge biopsy of left ventricular mass was performed. (C, D)Pathological analysis confirmed well differentiated Leiomyosarcoma (grade 1 of 3) FNCLCC grading system. Tumor was strongly positive for vimentin, smooth muscle myosin and desmin.

543 Automated detection of mitral annular plane systolic excursion in transoesophageal echocardiography based on deep learning

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Nordal ◽  
E A R Berg ◽  
G Kiss
Keyword(s):  
Deep Learning ◽  
Left Ventricle ◽  
Vital Signs ◽  
Transoesophageal Echocardiography ◽  
Vertical Movement ◽  
Left Ventricular ◽  
Cardiac Monitoring ◽  
Major Surgery ◽  
Intraobserver Variability ◽  
Manual Input

Abstract Introduction Major surgery and interventions may impact cardiac function. Perioperative monitoring is currently based on vital signs and clinical observations. However, this does not offer a complete monitoring of left ventricular function throughout the intervention. We hypothesize that functional monitoring of the heart can be performed automatically based on transoesphageal echocardiography (TOE) images. One parameter that has been shown to correlate well with ejection fraction is mitral annular plane systolic excursion (MAPSE). To aid functional monitoring of the left ventricle perioperatively, we propose a technique for detecting MAPSE in TOE images of the left ventricle. Purpose The purpose of this study is to automatically track the movement of the mitral annular plane in TOE sequences of the left ventricle and detect MAPSE via a deep learning approach. Method Recordings from 131 consecutive complete TOE exams from the Echocardiography Unit were anonymized and used for training. Recordings from 23 consecutive TOE exams, also anonymized, were used as test set. All recordings were manually annotated with the location of the landmarks indicated in both 4-chamber (4C) and 2-chamber (2C) views. All recordings were made using state-of-the-art clinical scanners. The captures include 3 to 5 heart cycles of standard 4C and 2C views. An approach based on a fully convolutional neural network was implemented and trained in a supervised manner to predict the location of two landmarks on the mitral annular plane in B-mode TOE images from 4C and 2C views. The model was also trained to account for noise by recognizing when detecting the landmarks is not feasible due to poor image quality. We have implemented all necessary post processing calculations to automatically estimate MAPSE based only on raw TOE B-mode sequences. Results Preliminary results on the test data show that the landmark detector is able to track the vertical movement of landmarks on the mitral annular plane with a mean error of 0.88 mm and a standard deviation of 0.27 mm (Fig. 1: Upper left and lower left: tracked mitral attachment points on a sample case presented upper right. Lower right: all measured Y-axis excursion values versus the reference). The classifier for detecting ultrasound frames where landmark detection is not feasible has a sensitivity of 0.82 and a specificity of 0.91. Conclusion The landmark detector is showing promising results in tracking of the mitral annular plane excursion. This can provide a fast calculation of MAPSE and eliminate intraobserver variability. This may be included in a more extensive cardiac monitoring for any type of surgery without the need of manual input from echocardiographers. Further research is ongoing and a comparison with clinical MAPSE values is underway. Abstract 543 Figure 1

scholarly journals Cardiac amyloidosis mimicking acute coronary syndrome: a case report and literature review

2020 ◽  
Author(s):  
Huan T Nguyen ◽  
Chuyen T H Nguyen
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Amyloidosis ◽  
Low Voltage ◽  
Troponin T ◽  
Elevated Serum ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Abdominal Skin ◽  
Coronary Syndrome

Abstract Background Cardiac amyloidosis, a progressive cardiac disease, results from the accumulation of undegraded proteinaceous substrates in the extracellular matrix of the heart. It may present as acute coronary syndrome (ACS); therefore, a clear distinction remains challenging in clinical practice. We describe a case of cardiac amyloidosis mimicking ACS. Case summary A 72-year-old man experienced chest discomfort for 2 days. He gradually developed dyspnoea during the preceding month. Electrocardiogram (ECG) showed sinus rhythm with right bundle branch block and low voltage. Echocardiography revealed concentric left ventricular thickening, biatrial dilation, and preserved ejection fraction with predominantly left ventricular basal hypokinesis. Serial testing of the cardiac biomarkers showed persistently increased high-sensitive cardiac troponin T levels and normal serum creatine kinase myocardial band levels. He was diagnosed with ACS with haemodynamic stability. However, coronary angiography demonstrated non-obstructive coronary arteries. Furthermore, significant macroglossia and periorbital purpura were noticed. Laboratory investigations revealed elevated serum immunoglobulin free light chain (FLC) kappa and lambda levels with an increased FLC ratio. Histological analysis of the biopsied abdominal skin confirmed amyloidosis. Discussion Cardiac amyloidosis often presents as restrictive cardiomyopathy. The usual symptoms include dyspnoea and peripheral oedema. Chest pain may manifest rarely, leading to misdiagnosis as coronary artery disease. Some findings suggestive of cardiac amyloidosis include clinical signs such as amyloid deposits, dyspnoea, low ECG voltage, and basal-predominant hypokinesis with relative apical sparing in echocardiography. Serum FLC test and abdominal skin biopsy can confirm the diagnosis of amyloidosis when a myocardial biopsy is not feasible.

scholarly journals Congestive heart failure in a young cat with excessive moderator bands (false tendons) in the left ventricle

2021 ◽  
Vol 51 (10) ◽  
Author(s):  
Fernanda Genro Cony ◽  
Matheus Viezzer Bianchi ◽  
Fernando Froner Argenta ◽  
Carolina Rodrigues Oliveira ◽  
Carine Stefanello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Left Ventricle ◽  
Interventricular Septum ◽  
Single Layer ◽  
Left Ventricular ◽  
Pulmonary Atelectasis ◽  
History Of ◽  
Adult Cats ◽  
Well Differentiated

ABSTRACT: Left ventricular false tendons are fibrous or fibromuscular bands that transverse the ventricular cavity and have no attachment to the mitral valve in many species. In cats it is considered a congenital defect that is rarely related to clinical disease and death in adult cats. A 45 days-old mixed breed cat had a history of inappetence since birth. At the physical exam the patient was lethargic and presented restrictive dyspnoea. At necropsy, there were marked ascites, hydrothorax, hepatomegaly with enhanced lobular pattern (nutmeg liver), and the lungs were markedly diminished (compressive pulmonary atelectasis). The heart was enlarged due to marked dilation of the cardiac chambers. Moreover, multiple slightly whitish and irregular cord-like structures were connecting the posterior papillary muscle to the interventricular septum (excessive moderator bands /left ventricular false tendons) at the left ventricle. Microscopically, these structures were characterized by a marked proliferation of fibrous connective tissue intermixed with Purkinje cells and well-differentiated cardiomyocytes lined by a single layer of endocardium. This study described a case of excessive moderator bands (left ventricular false tendons) in a young cat associated with congestive heart failure and death.

scholarly journals P1296 Effects of contact-to-balloon time on variations of the left ventricle global and regional function during hospitalization of STEMI patients: an echocardiographic study

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Cammalleri ◽  
M Stelitano ◽  
S Muscoli ◽  
G Marsili ◽  
W Manzon ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Ejection Fraction ◽  
Wall Motion ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Regional Function ◽  
Early Reperfusion ◽  
Ventricular Ejection Fraction ◽  
Wall Motion Abnormalities

Abstract Background Ischemic time duration is one of the most important determinants of infarct size in patients with ST-segment elevation myocardial infarction (STEMI). An early reperfusion with percutaneous coronary intervention (PCI) therapy reduces the adverse events and mortality. It also influences the wall motion abnormalities and left ventricular ejection fraction (LVEF), which can be easily detected by a standard transthoracic echocardiogram (TTE). Purpose Aim of our study was to assess the immediate effects of an early percutaneous revascularization in STEMI patients on variations of the left ventricle (LV) global and regional function. Methods The study population consists of 141 consecutive patients with STEMI undergoing PCI from January to June 2018. The population was divided into two groups basing on first medical contact-to-balloon time (C2B), respectively ≤90 minutes and >90 minutes. Cardiac biomarkers were obtained uniformly. A standard TTE was performed in all patients, at moment of in-hospital admission and at the time of discharge, recording the LV wall motion abnormalities and LVEF, using the wall motion score index (WMSI) and modified Simpson’s rule, respectively. Finally, we performed a sub-analysis in the group of patients who showed an improvement of the LVEF ≥10% at discharge. Results In both groups at baseline, patients suffered from a moderately reduced LVEF (41 ± 8.3% in ≤90 min group vs 40.97 ± 8.91% in >90 min group, p = ns). A WMSI >1 was recorded uniformly: 1.78 ± 0.39 in patients with C2B ≤90 min and 1.81 ± 0.40 in patients with C2B >90 min, without significant differences between the two groups. At the time of discharge, a significant improvement of LVEF (from 41 ± 8% to 44 ± 9%, p = 0.013) and WMSI (from 1.78 ± 0.39 to 1.64 ± 0.38, p = 0.036) exclusively emerged in the ≤90 min group. Furthermore, we identified 37 patients who experienced, at the time of discharge, an improvement of the LVEF ≥10% compared to baseline values. In these patients the C2B time resulted significantly shorter, when compared with patients with LVEF improvement <10%: 42 min (IQR 18.5-77.5) vs. 104 (IQR 48-176), p < 0.0001. Additionally, these patients had lower significant levels of cardiac biomarkers. A significant improvement in WMSI was also observed in the ≥10% group (1,69 ± 0,41 vs 1,49 ± 0,41, p= 0.039). Conclusion Our study shows the immediate effects of an early revascularization. In particular, the duration of C2B time influences the recovery of ventricular function, in terms of ejection fraction and parietal kinetics. A standard TTE is a low cost and easily available examination, which may provide immediate results without impacting significantly on health costs.

scholarly journals Cardiac involvement in hospitalized patients with COVID-19 and its incremental value in outcomes prediction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Payam Pournazari ◽  
Alison L. Spangler ◽  
Fawzi Ameer ◽  
Kobina K. Hagan ◽  
Mauricio E. Tano ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Vital Signs ◽  
Left Ventricular ◽  
Hospitalized Patients ◽  
Cardiac Abnormalities ◽  
Incremental Value ◽  
Large Pericardial Effusion ◽  
And Function

AbstractRecent reports linked acute COVID-19 infection in hospitalized patients to cardiac abnormalities. Studies have not evaluated presence of abnormal cardiac structure and function before scanning in setting of COVD-19 infection. We sought to examine cardiac abnormalities in consecutive group of patients with acute COVID-19 infection according to the presence or absence of cardiac disease based on review of health records and cardiovascular imaging studies. We looked at independent contribution of imaging findings to clinical outcomes. After excluding patients with previous left ventricular (LV) systolic dysfunction (global and/or segmental), 724 patients were included. Machine learning identified predictors of in-hospital mortality and in-hospital mortality + ECMO. In patients without previous cardiovascular disease, LV EF < 50% occurred in 3.4%, abnormal LV global longitudinal strain (< 16%) in 24%, and diastolic dysfunction in 20%. Right ventricular systolic dysfunction (RV free wall strain < 20%) was noted in 18%. Moderate and large pericardial effusion were uncommon with an incidence of 0.4% for each category. Forty patients received ECMO support, and 79 died (10.9%). A stepwise increase in AUC was observed with addition of vital signs and laboratory measurements to baseline clinical characteristics, and a further significant increase (AUC 0.91) was observed when echocardiographic measurements were added. The performance of an optimized prediction model was similar to the model including baseline characteristics + vital signs and laboratory results + echocardiographic measurements.

scholarly journals Hormonal Response to Incremental and Continuous Exercise in Cyclists with Left Ventricle Hypertrophy

2020 ◽  
Vol 71 (1) ◽  
pp. 155-166
Author(s):  
Rafał Mikołajczyk ◽  
Marcin Sikora ◽  
Grzegorz Mikrut ◽  
Tomasz Zając ◽  
Aleksandra Żebrowska
Keyword(s):  
Left Ventricle ◽  
Left Ventricular ◽  
Incremental Exercise ◽  
Cardiac Biomarkers ◽  
Control Group ◽  
Post Exercise ◽  
Continuous Exercise ◽  
Left Ventricle Hypertrophy ◽  
Type Of Exercise ◽  
Ventricle Hypertrophy

AbstractThe aim of this study was to assess the effects of incremental and continuous exercise on the concentration of insulin-like growth factor-1 (IGF-1), growth hormone (GH), testosterone (T), and cortisol (C), as well as to investigate whether increased cardiac dimensions in cyclists were related to changes in these hormones and cardiac biomarkers. The study included 30 elite cyclists divided into two groups, i.e., athletes with left ventricle hypertrophy (a LVH group), and a control group (CG) without LVH. The study protocol included performance of a standard incremental exercise (IncEx) test to measure athletes’ maximum power (Pmax), maximum oxygen uptake (VO2max), and lactate threshold (LAT). The IncEx test results were then used to determine the intensity of the continuous exercise (ConEx) test which was performed after the 1-week washout period. Cyclists with LVH and without LVH did not differ in resting hormone concentrations and cardiac biomarkers levels. There was a significant effect of exercise on serum IGF-1 levels (p < 0.05) in the LVH group and a combined effect of the type of exercise and LVH on IGF-1 (p < 0.05). Cyclists with LVH demonstrated higher post exercise T levels recorded in response to exercise compared to the CG (p < 0.01). Significantly higher serum T levels were observed in response to ConEx compared to IncEx in the LVH group and the CG (p < 0.05 and p < 0.05, respectively). In the LVH group, a significant positive correlation between the post-exercise T/C ratio and left ventricular mass index was observed (r = 0.98, p < 0.01). There were no effects of heart hypertrophy on cardiac standard biomarkers. Incremental and continuous exercise caused a marked increase in steroid hormone concentrations and moderate strengthening of insulin growth factors effects. Regular incremental exercise seems to induce beneficial cardiac adaptations via significant increases in the concentration of anabolic factors compared to the same training mode yet with constant exercise intensity.

Clinical and Experimental Analysis of 201Thallium Uptake of the Heart

1978 ◽  
Vol 17 (04) ◽  
pp. 142-148
Author(s):  
U. Büll ◽  
S. Bürger ◽  
B. E. Strauer
Keyword(s):  
Oxygen Consumption ◽  
Left Ventricle ◽  
Muscle Mass ◽  
Myocardial Oxygen Consumption ◽  
Animal Experiments ◽  
Left Ventricular ◽  
Left Ventricular Wall ◽  
Ventricular Wall ◽  
Flow Measurements ◽  
Myocardial Flow

Studies were carried out in order to determine the factors influencing myocardial 201T1 uptake. A total of 158 patients was examined with regard to both 201T1 uptake and the assessment of left ventricular and coronary function (e. g. quantitative ventriculography, coronary arteriography, coronary blood flow measurements). Moreover, 42 animal experiments (closed chest cat) were performed. The results demonstrate that:1) 201T1 uptake in the normal and hypertrophied human heart is linearly correlated with the muscle mass of the left ventricle (LVMM);2) 201T1 uptake is enhanced in the inner (subendocardial) layer and is decreased in the outer (subepicardial) layer of the left ventricular wall. The 201T1 uptake of the right ventricle is 40% lower in comparison to the left ventricle;3) the basic correlation between 201T1 uptake and LVMM is influenced by alterations of both myocardial flow and myocardial oxygen consumption; and4) inotropic interventions (isoproterenol, calcium, norepinephrine) as well as coronary dilatation (dipyridamole) may considerably augment 201T1 uptake in accordance with changes in myocardial oxygen consumption and/or myocardial flow.It is concluded that myocardial 201T1 uptake is determined by multiple factors. The major determinants have been shown to include (i) muscle mass, (ii) myocardial flow and (iii) myocardial oxygen consumption. The clinical data obtained from patient groups with normal ventricular function, with coronary artery disease, with left ventricular wall motion abnormalities and with different degree of left ventricular hypertrophy are correlated with quantitated myocardial 201T1 uptake.

The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

2020 ◽  
Vol 75 (5) ◽  
pp. 514-522
Author(s):  
Alexey S. Ryazanov ◽  
Konstantin I. Kapitonov ◽  
Mariya V. Makarovskaya ◽  
Alexey A. Kudryavtsev
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Effective Area ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Angiotensin Receptor ◽  
Optimal Drug ◽  
Patients With Heart Failure ◽  
Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

New Hybrid Method for Left Ventricular Ejection Fraction Assessment from Radionuclide Ventriculography Images

2020 ◽  
Vol 16 ◽  
Author(s):  
Halima Dziri ◽  
Mohamed Ali Cherni ◽  
Dorra Ben Sellem
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Positive Predictive Value ◽  
Roc Curve ◽  
Radionuclide Ventriculography ◽  
Left Ventricular ◽  
The Other ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Background: In this paper, we propose a new efficient method of radionuclide ventriculography image segmentation to estimate the left ventricular ejection fraction. This parameter is an important prognostic factor for diagnosing abnormal cardiac function. Methods: The proposed method combines the Chan-Vese and the mathematical morphology algorithms. It was applied to diastolic and systolic images obtained from the Nuclear Medicine Department of Salah AZAIEZ Institute.In order to validate our proposed method, we compare the obtained results to those of two methods of the literature. The first one is based on mathematical morphology, while the second one uses the basic Chan-Vese algorithm. To evaluate the quality of segmentation, we compute accuracy, positive predictive value and area under the ROC curve. We also compare the left ventricle ejection fraction estimated by our method to that of the reference given by the software of the gamma-camera and validated by the expert, using Pearson’s correlation coefficient, ANOVA test and linear regression. Results and conclusion: Static results show that the proposed method is very efficient in the detection of the left ventricle. The accuracy was 98.60%, higher than that of the other two methods (95.52% and 98.50%). Likewise, the positive predictive value was the highest (86.40% vs. 83.63% 71.82%). The area under the ROC curve was also the most important (0.998% vs. 0.926% 0.919%). On the other hand, Pearson's correlation coefficient was the highest (99% vs. 98% 37%). The correlation was significantly positive (p<0.001).

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