Association of Major Adverse Cardiovascular Events in Patients With Stroke and Cardiac Wall Motion Abnormalities

Background The association of cardiac wall motion abnormalities (CWMAs) in patients with stroke who have major adverse cardiovascular events (MACE) remains unclear. The purpose of this study was to estimate the 50‐month risk of MACE, including stroke recurrence, acute coronary events, and vascular death in patients with stroke who have CWMAs. Methods and Results We performed a retrospective analysis of prospectively collected acute stroke data (acute stroke and transient ischemic attack) over 50 months by electronic medical records. Data included demographic and clinical information, vascular imaging, and echocardiography data including CWMAs and MACE. Of a total of 2653 patients with acute stroke/transient ischemic attack, CWMA was observed in 355 (13.4%). In patients with CWMAs, the embolic stroke of undetermined source (50.7%) was the most frequent index stroke subtype and stroke recurrences ( P =0.001). In multivariate Cox regression after adjustment for demographics, traditional risk, and confounding factors, CWMA was independently associated with a higher risk of MACE (adjusted hazard ratio [HR], 1.74; 95% CI, 1.37–2.21 [ P =0.001]). Similarly, CWMA independently conferred an increased risk for ischemic stroke recurrence (adjusted HR, 1.50; 95% CI, 1.01–2.17 [ P =0.04]), risk of acute coronary events (aHR, 2.50; 95% CI, 1.83–3.40 [ P =0.001]) and vascular death (adjusted HR, 1.57; 95% CI, 1.04–2.40 [ P =0.03]), in comparison to the patients with stroke without CWMA. Conclusions In a multiethnic cohort of ischemic stroke with CWMA, CWMA was associated with 1.7‐fold higher risks of MACE independent of established risk factors. Embolic stroke of undetermined source was the most common stroke association with CWMA. Patients with stroke should be screened for CWMA to identify those at higher risk of MACE.

Takotsubo Cardiomyopathy Induced by Epinephrine Infiltration for Liposuction: Broken Heart Syndrome

Broken heart syndrome, more commonly known as Takotsubo cardiomyopathy (TCM), is an acute cardiac condition. It is characterized by regional cardiac wall motion abnormalities triggered by physical or emotional stress or administration of catecholamines such as epinephrine. The initial clinical presentation is similar to an acute coronary syndrome and must be ruled out. Visualization of the characteristic wall motion will trigger the diagnosis of TCM. In this case report, we present a 50-year-old woman with additional liposuction and fat grafting after autologous breast reconstruction. Shortly after infiltration with a solution containing epinephrine to achieve vasoconstriction, hypotension and bradycardia was noticed. This escalated into full asystole for which cardiac resuscitation was required. ST-elevations and a decrease in systolic function were clear indicators for urgent coronarography and ventriculography. These confirmed the diagnosis of TCM. Infiltration with epinephrine-containing products to achieve local vasoconstriction is used routinely. Medical professionals should be aware that this can trigger a TCM with an estimated mortality rate of 5%. No evidence of a specific preventive measure currently exists. We know that women with a neurologic or psychiatric comorbidity and high levels of stress are more at risk. Reducing stress and anxiolytic medication prior to surgery could be useful. We also know that the cardiac wall motion abnormality is mainly related to β-adrenoreceptors. The use of a selective α-adrenoreceptor agonist could be considered. Further research in the pathophysiology and incidence of TCM could improve identification of patients at risk and lead to more effective prevention and treatment. Level of Evidence: 5

Cardiac Motions Classification on Sequential PSAX Echocardiogram

<p>Cardiac wall motions classification on 2-dimensional (2D) echocardiographic images is an important issue for quantitative diagnosiing of heart disease. Unfortunately, the bad quality of echocardiogram cause computationally classification on cardiac wall motions is still become a big homework for many researchers to provide the best result. Echocardiogram is produced by soundwaves which absolutely make its images have speckle noise in different intensity. Therefore, this research improves a set of methodology to classify cardiac wall motion semi-automatically. Raw echocardiogram will be enhanced and segmented to take the boundary of endocardium of left ventricular in PSAX cardiac images. New improvement of Semi-automatically methodology is approach on detecting the contour of endocardium and will be inputed as good features in Lucas-Kanade Optical Flow in all sequential echocargraphic images. On classifying cardiac wall motions, this research proposes two important features including length of displacement and flow direction. New proprosed flow determination algorithm and Euclidean distance is used to calculate those features. All the features will be trained by Neural Network (NN) and validated by Leave One Out (LOO) to get accurate result. NN method, which is validated by LOO, has the best result of 81.82% correctness than the other compared methods.</p>