Reversible cerebral vasoconstriction syndrome: Is it more than just cerebral vasoconstriction?

Cephalalgia ◽  
2014 ◽  
Vol 35 (7) ◽  
pp. 631-634 ◽  
Author(s):  
Seby John ◽  
Rula A Hajj-Ali ◽  
David Min ◽  
Leonard H Calabrese ◽  
Russell Cerejo ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Case Series ◽  
Left Ventricular ◽  
Reversible Cerebral Vasoconstriction Syndrome ◽  
Left Ventricular Ejection ◽  
Retrospective Case ◽  
Ventricular Ejection Fraction ◽  
Cerebral Vasoconstriction ◽  
Artery Disease

Background Systemic vascular alterations have not been described in reversible cerebral vasoconstriction syndrome (RCVS). We present a case series of RCVS patients having cardiac dysfunction during ictus, with a subset showing complete resolution of cardiomyopathy. Methods Retrospective case-series: Cardiac left ventricular ejection fraction (LVEF) and wall motion abnormalities (WMA) visualized on transthoracic echocardiography (TTE), performed during RCVS ictus and follow-up was analyzed. Results Of 68 patients, 18 (26%) had a TTE performed around ictus. Three of 18 (17%) patients demonstrated WMA on initial TTE. All three patients were female without previous coronary artery disease or heart failure, and were asymptomatic from the cardiac dysfunction. WMA resolved completely on follow-up in Patients 1 and 2. Global LV dysfunction persisted for at least 90 days in Patient 3. Conclusion Although the exact pathophysiology of the cardiomyopathy is uncertain, it may be related to localized coronary vasoconstriction causing myocardial ischemia/infarction. Vasoconstriction may not be limited to the cerebral vasculature and may involve extracerebral organs. Cardiac ventricular abnormalities may be a part of the RCVS spectrum.

scholarly journals Dissolution of large intracardiac thrombus, potential role of the emerging oral fibrinolytic agent

2016 ◽  
Vol 25 (1) ◽  
pp. 62-6
Author(s):  
Rony M. Candrasatria ◽  
Manoefris Kasim
Keyword(s):  
Thrombolytic Agent ◽  
Case Series ◽  
Bleeding Risk ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Intracardiac Thrombus ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Intracardiac thrombus may persist in some cases even after anticoagulant therapy. This opens a possibility to add a potent thrombolytic agent into therapeutic regimen without increasing bleeding risk any further. Increasing evidence showed a promising efficacy and safety of oral fibrin specific lumbrokinase as a thrombolytic agent. To the best of our knowledge, report of the use of lumbrokinase on intracardiac thrombus is limited. We reported two cases of intracardiac thrombi. In first patient, after two-month therapy with lumbrokinase, the previous 8 cm2 left atrial thrombus was completely disappeared. Second patient had left ventricular thrombus due to low left ventricular ejection fraction caused by coronary artery disease. A significant dissolution in thrombus size on repeated follow-up was found. Both patients did not experience any significant adverse effect. This case series aims to present the potential use of lumbrokinase as as oral antithrombotic therapy in intracardiac thrombus.

Assessment of trastuzumab-related cardiac dysfunction in the Herceptin Adjuvant (HERA) Trial with 3.6 years median follow- up

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 540-540
Author(s):  
M. J. Procter ◽  
T. Suter ◽  
E. de Azamuja ◽  
S. Muehlbauer ◽  
U. Dafni ◽  
...  
Keyword(s):  
Treatment Period ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Term Outcome ◽  
Ventricular Ejection Fraction ◽  
Long Term Outcome ◽  
Group Randomized Trial ◽  
Neo Adjuvant Chemotherapy

540 Background: The Herceptin Adjuvant (HERA) Trial is a three-group randomized trial that compared 1 year or 2 years trastuzumab with observation. We investigated cardiac dysfunction in HERA patients randomized to observation or 1 year trastuzumab and report results at a median follow-up of 3.6 years. Methods: Only patients who after completion of (neo)adjuvant chemotherapy with or without radiotherapy had normal left ventricular ejection fraction (LVEF > 55%) were eligible. Cardiac function was monitored throughout the trial. A repeat LVEF assessment was required in case of cardiac dysfunction. Results: There were 1,698 patients randomized to observation and 1,703 randomized to 1 year trastuzumab. The incidence of discontinuation of trastuzumab due to cardiac disorders was low (5.1%). The incidence of cardiac endpoints was low (severe CHF 0.77% in the trastuzumab group). The incidence of cardiac endpoints was higher in the trastuzumab group compared to observation (severe CHF 0.77% vs 0.00%; confirmed significant LVEF drops 3.57% vs 0.64%). In the trastuzumab group, there were no occurrences of severe CHF after the end of the scheduled treatment period of 1 year. Among the patients in the trastuzumab group with confirmed significant LVEF drop, the first occurrence was within the scheduled treatment period of 1 year for 55 out of 60 patients (91.7%). In the trastuzumab group, 59 of 73 patients (80.8%) with a cardiac endpoint reached acute recovery and of these 59 patients 52 (88.1%) were consider to have a favourable long term outcome. Conclusions: The incidence of cardiac endpoints remains low even with longer term follow-up. The cumulative incidence of any type of cardiac endpoint increases during the scheduled treatment period of 1 year, but appears to remain approximately constant after the scheduled treatment period of 1 year is completed. [Table: see text]

scholarly journals Impact of cardio-oncology strategies in the management of breast cancer patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R Karmous ◽  
E Bennour ◽  
I Kammoun ◽  
A Sghaier ◽  
W Chaieb ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Mean Delay ◽  
Anti Cancer ◽  
The Mean

Abstract Background Cardio-oncology has arisen as one of the most rapidly expanding fields of cardiovascular medicine. The accumulated evidence on the possibilities of early diagnosis of cardiotoxicity provided by imaging techniques as well as on the benefits of preventive and therapeutic interventions is also increasing. Objective This study reported our echocardiography lab's initial experience of a cardio-oncology follow-up program. Methods We prospectively studied the outcomes of 107 patients diagnosed with breast cancer who attended our follow-up program between 2017 and 2020. An echocardiographic monitoring were realised according to the chemotherapy protocol. Cancer therapy-related cardiac dysfunction (CTRCD) is defined, according to the european society of cardiology (ESC) guidelines of 2016, as a drop of left ventricular ejection fraction (LVEF) by >10 percentage points from baseline to a value <50%. A new entity named subclinical systolic dysfunction, is defined by a drop of global longitudinal strain (GLS) by >15% from baseline, however, LVEF remains >50%. The diagnosis should be confirmed by a second echocardiogram after 2–3 weeks. Results We enrolled 107 patients diagnosed with breast cancer and receiving anthracycline and/or trastuzumab. 27 patients were excluded for many reasons: 17 patients were lost to follow-up, 10 patients had an inadequate echo-imaging (8 had a follow-up without measurement of GLS and 2 patients were poorly echogenic). Only eighty patients were finally retained. The average age of our patients was 49.9±10.8 years. The mean left ventricular ejection fraction (LVEF) was at 64±4.4%. The incidence of CTRCD was 6%. the mean delay of diagnosis from the onset of chemotherapy was 174 days. It was reversible in 60% of cases after the initiation of a cardioprotective treatment which allowed the anti-cancer treatment pursuit. The incidence of subclinical cardiac dysfunction was 25%. The mean delay between the initiation of anti-cancer treatment and the diagnosis was 314.5 days. A cardioprotective treatment with Bblockers and angiotensin-converting enzyme (ACE) inhibitors was prescribed and all these patients recovered a normal GLS with a mean delay of three months and pursuied their chemotherapy. Conclusion We showed that timely cardiovascular evaluation, intervention and close monitoring in the context of a structured service allowed the majority of patients (99%) to pursue their anti-cancer treatment and to avoid the evolution to CTRCD in patients diagnosed with subclinical cardiac dysfunction. FUNDunding Acknowledgement Type of funding sources: None. Treated subclinical cardiac dysfunction

Anthracycline associated cardiotoxicity in a sub-Saharan African population - tertiary care experience

2020 ◽  
Author(s):  
Joseph Odunga Abuodha ◽  
Asim Jamal Shaikh ◽  
Jasmit Shah ◽  
Mohamed Jeilan ◽  
Anders Barasa
Keyword(s):  
Cardiac Dysfunction ◽  
Standard Dose ◽  
Global Longitudinal Strain ◽  
Tertiary Care ◽  
Left Ventricular ◽  
African Population ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Sub Saharan

Abstract Background Anthracyclines are associated with irreversible cardiotoxicity, with changes in echocardiographic parameters preceding clinically manifest cardiac dysfunction. We sought to evaluate the incidence of early cardiac dysfunction post anthracyclines, and associated clinical, echocardiographic and treatment parameters in a sub-Saharan African population. Methods Cancer patients aged ≥18years at anthracycline initiation with archived baseline echocardiograms, underwent repeat echocardiographic assessment. Cases (with cardiac dysfunction) had (1) >15% relative decline from baseline in global longitudinal strain (GLS), or (2) a decline in left ventricular ejection fraction (LVEF) from baseline to <53% with either (i) symptoms (assessed by the Duke Activity Status Index at follow-up echocardiogram) and LVEF decline by >5 to ≤10%, or (ii) LVEF decline >10% regardless of symptoms. Comparisons in clinical, echocardiographic and treatment parameters were made with controls (no cardiac dysfunction). Results Among 141 patients (mean age, 47.7years ± 11.2, Africans 95%, females 85.1%, breast cancer 82%), 39 (27.7%) had cardiac dysfunciton at a mean inter-echocardiogram interval of 14.9months ± 14.3, mean cumulative anthracycline dose of 244.7mg/m 2 ± 72.2, and mean DASI score was 50.0 ± 13.3. Mean cardiotoxic doxorubicin equivalence dose was 236.7mg/m 2 ± 57.4 for cases and 217.3 ± 61.9 for controls [p = 0.033, OR = 1.00 (95% CI: 0.99 - 1.01)]. The assessed clinical, echocardiographic and treatment parameters were not associated with cardiac dysfunction. Conclusion Incidence of early cardiac dysfunction after standard dose anthracyclines in an adult Sub-Saharan population is 27.7% at a mean follow-up of 14.9 months post anthracycline. Routine pre- and post-exposure cardiac assessment should be considered.

Abstract 5936: Can Apoptosis Predict Functional Recovery in Acute Myocarditis?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Antonio Abbate ◽  
Gianfranco Sinagra ◽  
Rossana Bussani ◽  
Nicholas N Hoke ◽  
Stefano Toldo ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Cardiac Dysfunction ◽  
Acute Myocarditis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Causal Association ◽  
Double Positive ◽  
Cytokeratin 18 ◽  
Ventricular Ejection Fraction

Background. Acute myocarditis is characterized by acute cardiac dysfunction followed by a variable recovery over time. Recent data have shown the presence of apoptosis in acute myocarditis. We hypothesized that the presence and extent of apoptosis evaluated at endomyocardial biopsy (EMB) could predict functional recovery in patients with acute myocarditis, with more apoptosis predicting less recovery. Methods. Sixteen patients with acute myocarditis were studied with EMB. Baseline and follow up echocardiography was obtained in all cases. The patients were retrospectively divided in 2 groups according to the final left ventricular ejection fraction (LVEF): LVEF>40% [recovery] and LVEF≤40% [no recovery]. Co-staining for DNA fragmentation (TUNEL) and caspase-cleaved cytokeratin-18 (CytoDeath) were performed to quantify the cardiomyocyte apoptosis in EMB specimens. Four subjects dying of non-cardiac causes were selected as control hearts at time of autopsy. Results. Six patients showed functional recovery (38%) while 8 did not (62%). The apoptotic rate (AR, expressed as % of double positive cardiomyocytes on total number per field) was significantly higher in the hearts of patients with acute myocarditis (1.1%[0.7–2.2] vs 0.01%[0.01–0.01] in control hearts, p<0.001). Unexpectedly, patients with functional recovery had a significantly higher AR than patients without recovery (3.2%[1.1–8.0] vs 0.5%[0.3–1.0], p=0.001), and the AR correlated with follow-up LVEF (R=+0.54, p=0.030). Six of the 8 patients (75%) with AR above average showed functional recovery vs 0 of the 8 patients (0%) with AR below average (p=0.007). Conclusions. This study surprisingly shows that the presence of greater apoptosis at EBM in patients with acute myocarditis predicts functional recovery at 12 months. Whether this represents a true cause-effect association or it simply represents a non-causal association remains unclear and warrants further studies.

scholarly journals The outcomes of acute myocardial infarction patients comorbidity with hypertension and hyperhomocysteinemia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jumei Yan ◽  
Jiamin Zhou ◽  
Jun Huang ◽  
Hongyu Zhang ◽  
Zilin Deng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Stay ◽  
Vital Signs ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

AbstractThis study investigated the outcomes and major adverse cardiovascular events (MACEs) incurred by acute myocardial infarction (AMI) patients comorbiding with hypertension and hyperhomocysteinemia (HHcy) during hospitalization and 1-year follow-up. 648 consecutive AMI patients were divided into four categories: (1) hypertension with Hcy ≥ 15 µmol/L; (2) hypertension with Hcy < 15 µmol/L; (3) no-hypertension with Hcy ≥ 15 µmol/L; (4) no-hypertension with Hcy < 15 µmol/L. Information taken from these case files included gender, past medical history, vital signs, laboratory examination, electrocardiogram, coronary angiography, cardiac ultrasound, and medicine treatment. The primary endpoints were duration of coronary care units (CCU) stay, duration of in-hospital stay, and MACEs during follow-up. Our data show that hypertension and HHcy have a synergistic effect in AMI patients, AMI comorbiding with hypertension and HHcy patients had more severe multi-coronary artery disease and more frequent non-culprit coronary lesions complete clogging, had a higher prevalence of pro-brain natriuretic peptide, and significant decreases in the left ventricular ejection fraction. These patients had significant increases in the duration of CCU stay and in-hospital stay, had significant increase in the rate of MACEs, had significant decreases in the survival rate during follow-up.

P936Impact of left ventricular ejection fraction in patients with peripheral artery disease: from I-PAD registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Fujimori ◽  
A Nagae ◽  
T Miura ◽  
T Katoh ◽  
M Hirabayashi ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Peripheral Artery Disease ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Peripheral Artery ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Abstract Introduction In patients with peripheral artery disease (PAD) it is known that CVD is one of prognostic factors. But, it is unclear whether left ventricular ejection fraction (LVEF) affects prognosis of PAD patients. So we investigated that LVEF affects prognosis of PAD patients. Methods From July 2015 to July 2016, 371 consecutive PAD patients who performed endovascular treatment (EVT) were enrolled in I-PAD registry. We could conduct follow up survey about 337 (age 73.8±9.6, men 72.4%) patients and divided two groups according to their LVEF (group with LVEF≤40%, n=18, group without LVEF≤40%, n=319). The primary end point was major adverse limb events (MALE: TLR, TVR, major amputations) and secondary end point was all-cause death. Results The median follow-up period was 13.6±5.7 months. The 18 months MALE and all-cause death rate were significantly higher in the group with low LVEF than group without low LVEF (61.1% vs 21.6% p<0.001, 44.4% vs 11.6% p<0.001). Conclusion LVEF was significantly associated with MALE and all-cause death in patients with PAD.

scholarly journals Prognostic Significance of CMR Findings in Patients with Known Coronary Artery Disease – Experience from a South Asian Country

2020 ◽  
Vol 10 ◽  
pp. 75
Author(s):  
Syed Waqar Ahmed ◽  
Fateh Ali Tipoo Sultan ◽  
Safia Awan ◽  
Imran Ahmed
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Stratification ◽  
South Asian ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Objectives: South Asians (SA) have a higher burden of coronary artery disease (CAD) and are known to have a worse prognosis compared to other ethnicities. Therefore, it is imperative to improve the risk stratification of SA patient with CAD and to seek out newer prognostic markers beyond the conventional echocardiography.The aim of this study was to investigate whether variables obtained by cardiac magnetic resonance (CMR) improve risk stratification of South Asian patients with known CAD. Material and Methods: We retrospectively analyzed 147 patients with evidence of CAD that had a CMR at our center between January 2011 and January 2019. LV volumes and regional wall motions were acquired by cine images, while infarct size (IS) was measured by late gadolinium enhancement. At a mean follow-up of 3.36 ± 2.22 years, cardiac events (non-fatal myocardial infarction, hospitalization due to heart failure, life-threatening arrhythmia, or cardiac death) occurred in 49 patients. An IS ≥35%, left ventricular ejection fraction (LVEF) ≤31%, and a wall motion score index (WMSI) ≥1.9 were strongly associated with follow-up cardiac events (P < 0.001). Patients that had none or less than 3 of these factors, showed a lower risk of cardiac events (HR 0.22 CI [0.11–0.44] P < 0.001 and HR 0.12 CI [0.04–0.32] P < 0.001, respectively) compared to those with all three factors. Conclusion: Integration of CMR derived factors such as IS and WMSI with LVEF can improve the prognostication of the SA population with CAD. Better risk stratification of patients can lead to improved and cost-effective therapeutic strategies to ameliorate the prognosis of these patients.

scholarly journals 614 Implantable cardiac monitors predict arrhythmic events in post-infarction patients with mildly reduced left ventricular ejection fraction

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Vincenzo Riverso ◽  
Antonio Curcio ◽  
Alessia Tempestini ◽  
Emilia De Luca ◽  
Sabrina La Bella ◽  
...  
Keyword(s):  
Remote Monitoring ◽  
Cardiac Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment ◽  
Group A ◽  
Group B

Abstract Aims Complications of acute myocardial infarction (MI) can be life-threatening leading to sudden cardiac death. While guidelines recommend prompt revascularization and prolonged intensive care hospitalization, predictors of major adverse cardiovascular outcomes are yet poorly understood. The role of implantable cardioverter-defibrillators, even in cases of non-sustained arrhythmias is still debated. To date, it is unknown how to follow-up patients with mild cardiac dysfunction after MI. Implantable cardiac monitors (ICMs) can be helpful for stratifying patients in the early discharge period, and remote monitoring might speed up arrhythmia recognition and treatment. We investigated the role of remote monitoring of ICMs to detect arrhythmic events in post-MI patients without overt cardiac dysfunction. Methods and results We enrolled 13 patients (9 males; 69.8 years) after either ST-segment (N = 7) or non-ST-segment elevation (N = 6) MI with a left ventricular ejection fraction (LVEF) &gt;35%, admitted to our coronary care unit for urgent revascularization between September 2019 and September 2021. Twelve patients underwent percutaneous myocardial revascularization, whereas one was treated with medical therapy only. All patients received an ICM during hospitalization according to echo and EKG parameters. We considered LVEF ≤ 40% as sole risk factor or LVEF between 40% and 50% in addition to either PQ length prolongation, or QRS widening, or pathologic heart rate variability, or non-sustained ventricular tachycardia/paroxysmal advanced second degree atrioventricular block. Patients with multiple revascularization procedures and several hospital admissions were excluded. Implanted ICM were frequently monitored both remotely and in-office when required. During follow-up, brady- and tachy-arrhythmias were recorded in four patients (30.8%). The remote monitoring of the ICM documented new-onset atrial fibrillation, high-degree atrioventricular block, severe bradycardia, and sustained ventricular tachycardia. Three patients required hospitalization and upgrade of the implanted device with pacemakers and cardioverter/defibrillator. For arrhythmic risk stratification, patients were divided into two subgroups; group A included patients with LVEF 40% associated with heart rate &gt; 60 b.p.m., PQ length &gt;160 ms and QRS width &gt;86 ms (N = 4); group B included patients with EF 41%/50%, PQ length &lt;159 and QRS width &lt;85 ms (N = 10). First group experienced more advanced rhythm disorders than group B (P &lt; 0.05). Device implantation was significantly higher in group A (P &lt; 0.05%). Conclusions OFF-label implementation of ICMs coupled with remote device monitoring may be effective for early detection of serious adverse cardiac rhythm alterations in patients after MI and LVEF higher than 35%. Further monitoring is ongoing for assessing the occurrence of multiple arrhythmias or their increased occurrence.

scholarly journals D-Dimer is a Predictive Factor of Cancer Therapeutics-Related Cardiac Dysfunction in Patients Treated With Cardiotoxic Chemotherapy

2021 ◽  
Author(s):  
Masayoshi Oikawa ◽  
Daiki Yaegashi ◽  
Tetsuro Yokokawa ◽  
Tomofumi Misaka ◽  
Takamasa Sato ◽  
...  
Keyword(s):  
Cardiac Dysfunction ◽  
Independent Predictor ◽  
Cancer Therapeutics ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Multivariable Logistic Regression Analysis ◽  
Ventricular Ejection Fraction ◽  
Cancer Associated Thrombosis ◽  
D Dimer

Abstract Background: D-dimer is a sensitive biomarker for cancer-associated thrombosis, but little is known about its significance on cancer therapeutics-related cardiac dysfunction (CTRCD). Methods: Consecutive 169 patients planned for cardiotoxic chemotherapy were enrolled and followed up for 12 months. All patients underwent echocardiography and blood test at baseline, as well as at 3-month, 6-month, and 12-month. Results: The patients were divided into 2 groups based on the level of D-dimer (> 1.65 µg/ml or ≦ 1.65 µg/ml) at baseline before chemotherapy: High D-dimer group (n = 37) and low D-dimer group (n = 132). Left ventricular ejection fraction (EF) decreased at 3-month and 6-month after chemotherapy in high D-dimer group (baseline, 65.2% [62.8%-71.4%]; 3-month, 62.9% [59.0%-67.7%]; 6-month, 63.1% [60.0%-67.1%]; 12-month, 63.3% [58.8%-66.0%], P = 0.03), but no change was observed in low D-dimer group. The occurrence of CTRCD within the 12-month follow-up period was higher in high D-dimer group than in low D-dimer group (16.2% vs. 4.5%, P = 0.0146). Multivariable logistic regression analysis revealed that high D-dimer level at baseline was an independent predictor of the development of CTRCD (odds ratio 3.93, 95% CI [1.00-15.82], P = 0.047). Conclusion: Elevated D-dimer is a pivotal biomarker to predict CTRCD.

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