Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgitation (MR). Additionally, to assess interobserver and intraobserver variability of the technique.Twenty patients with STEMI underwent CMR with a 1.5Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR(-). Total LA strain (ɛs), passive LA strain (ɛe), and active LA strain (ɛa) were obtained. Additionally, total, passive and active strain rates (SRs, SRe, and SRa) were calculated. To assess interobserver agreement data analysis was performed by second independent observer.LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: ɛs (27.67±10.25 for MR(-) vs. 32.80±6.95 for MR(+); P=0.01), ɛe (15.29±7.30 for MR(-) vs. 19.22±6.04 for MR(+); P=0.01) and ɛa (12.38±4.23 for MR(-) vs. 14.44±5.19 for MR(+); P=0.03). Only SRe significantly increased in patients with MR (-0.57±0.24 for MR(-) vs. -0.70±0.20 for MR(+); P=0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement.Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible.
Abstract Streptococcus pneumoniae is an uncommon cause of infective endocarditis; it often requires prolonged antibacterial treatment and involves a high mortality rate. We report a rare case of pneumococcal endocarditis manifesting with unusual complications — meningitis and endophthalmitis. Streptococcus pneumoniae species grew from the cerebrospinal fluid. The diagnosis of native aortic valve infective endocarditis was confirmed after some delay by transesophageal echocardiography. The patient’s eye was lost because of infective complications, but his life was saved following an aggressive antibacterial therapy in combination with an immediate aortic valve replacement.
Objective: The influence of anxiety and depression on blood pressure (BP) control and on efficacy of treatment of arterial hypertension (AH) might be underestimated. The aim of this study was to determine the prevalence of anxiety and depression in patients with arterial hypertension and analyse the association with gender, age, education and co-morbid medical conditions. Design and method: A study was performed in 13 outpatient clinics in Lithuania. It randomly enrolled 764 patients diagnosed with AH. They completed a self-administered questionnaire consisting of demographic characteristics (gender, age, education, body weight, blood pressure), self-reported medical history (diabetes, myocardial infarction and current smoking status), and symptoms of depression and anxiety. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale (HADS). Results: Anxiety, depression and co-morbid disorders were observed in 22.4% (169), 7.4% (56) and 13.4% (101) of hypertensive patients, respectively. Hypertensive patients more often had anxiety symptoms. Male, who had symptoms of anxiety were younger than female – 51.8 ± 12.3 and 58.5 ± 10.0 years, respectively (p = 0.001). Anxiety and mixed anxiety and depression symptoms were more prevalent in female compared to male (74.6% (n = 127) and 78.2% (n = 79), respectively, p < 0.05). Attained educational level was related to emotional status (chi square - 35.33, p < 0.001), i.e. depression was more prevalent in patients with secondary educational level – 28 (50%). Emotional symptoms in obese vs. non-obese subjects or comparing smoking status did not differ significantly; nevertheless, HADS depression scores were higher for obese compared to non-obese patients (8.1 ± 0.2 vs7.2 ± 0.2, respectively, p = 0.002) and HADS anxiety scores were higher for non-smokers compared to current or former smokers (9.5 ± 0.2 vs. 8.7 ± 0.2, respectively; p = 0.007). Patients with long-lasting hypertension (>10 years) were more likely to be depressed (n = 38 (9.9%)), anxious (n = 93 (24.4%)) or had combined anxiety and depression (n = 66 (17.3%)) compared to other individuals (p < 0.05). Conclusions: Anxiety, depression and co-morbid conditions are prevalent in hypertensive patients and are associated with age, gender, educational level and other heart disease risk factors, such as obesity. The association of mood disorders and hypertension is complex, with one increasing the likelihood of the other.
Undifferentiated pleomorphic sarcoma is a very rare and aggressive type of primary cardiac tumors. Most cardiac sarcomas result in rapid growth and quick death. According to different sources the median survival is typically 6 to 12 months. We are presenting a case of primary cardiac sarcoma with 26 months disease free survival following cytoreductive surgery and chemotherapy. A 48-year-old woman with progressing symptoms of dyspnea and palpitations for over 2 months was referred to a cardiologist. With the help of echocardiography and cardiovascular magnetic resonance cardiac sarcoma was suspected. Open biopsy and cytoreductive surgery were performed, complete resection of the tumor was not possible. Histology revealed undifferentiated pleomorphic sarcoma. Seven cycles of chemotherapy with Doxorubicine and Ifosfamide were completed. Cardiovascular magnetic resonance revealed a complete response – only signs of fibrosis without any signs of tumor were visible. Follow ups with echocardiography, cardiovascular magnetic resonance and chest, abdomen and pelvic computed tomography is performed every 3 months. Twenty-six months from initial diagnosis the patient is still free of recurrence of tumor with no compromises of the quality of life. Standard chemotherapy together with cytoreductive surgery can have a complete response effect in undifferentiated pleomorphic sarcoma with unusual long-term survival.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3c/g%3e%3cuse xlink:href='%23d' x='45.714'/%3e%3cuse xlink:href='%23e' transform='matrix(-1 0 0 1 479.792 0)'/%3e%3cg id='f' fill='%23fff'%3e%3cpath fill='%23039' d='M232.636 202.406v.005c0 2.212.85 4.227 2.212 5.69 1.365 1.466 3.245 2.377 5.302 2.377 2.067 0 3.944-.905 5.303-2.365 1.358-1.459 2.202-3.472 2.202-5.693v-10.768l-14.992-.013-.028 10.766'/%3e%3ccircle cx='236.074' cy='195.735' r='1.486'/%3e%3ccircle cx='244.392' cy='195.742' r='1.486'/%3e%3ccircle cx='240.225' cy='199.735' r='1.486'/%3e%3ccircle cx='236.074' cy='203.916' r='1.486'/%3e%3ccircle cx='244.383' cy='203.905' r='1.486'/%3e%3c/g%3e%3cuse xlink:href='%23f' y='-26.016'/%3e%3cuse xlink:href='%23f' x='-20.799'/%3e%3cuse xlink:href='%23f' x='20.745'/%3e%3cuse xlink:href='%23f' y='25.784'/%3e%3c/svg%3e)