Abstract Introduction Limited data exist regarding the presence and importance of diastolic parameters in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). We sought to evaluate RV diastolic parameters and echo‐based diastolic predictors of major adverse cardiovascular events (MACE). Method 48 patients with a definitive diagnosis of ARVC were included and followed for 6‐18 months. A comprehensive standard two‐dimensional (2D) transthoracic echocardiography (TTE) with precise evaluation of systolic and diastolic indices of both ventricles was done. RV isovolumetric relaxation time (IVRT), RV myocardial performance index (MPI), and right atrial (RA) volume were evaluated. Results 48 patients (mean age = 38.5 ± 14 years; 79.2% male) were enrolled. 27.3% had grade I, 68.2% had grade II, and 4.5% had grade III RV diastolic dysfunction. In 12‐month follow‐up, 12 patients (25%, with mean RV3DEF = 24.8 ± 9%) experienced MACE and required hospitalization: ventricular tachyarrhythmia in 7 patients (14.6%), RV clot in 2 subjects (4.2%), and right‐sided failure in 3 cases (6.3%). In logistic regression analysis, tissue Doppler velocity of tricuspid annulus (e' TV) ( P = .02, OR = 0.581, CI = 0.368‐0.917), peak E mitral valve ( P = .043, OR = 0.95, CI = 0.913‐0.999), tissue Doppler velocity of septal e' ( P = .052, OR = 0.733, CI = 0.536‐1.003), and MPI ( P = .009, OR = 95, CI = 3.083‐2942) were powerful predictors of MACE. Conclusion In our study, RV diastolic function parameters including e' TV and e′ MV, RA volume and area, and RV MPI were powerful predictors of MACE and may be considered during the baseline and follow‐up of the ARVC patients.
Abstract Introduction Evaluation of right ventricular (RV) function is essential in the follow up of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). Role of advance echocardiography including 3D transthoracic echocardiography (3DTTE) for evaluation of 3D RV function and RV longitudinal strain in predicting prognosis in ARVC patients, has not been well investigated. Purpose We aimed to evaluate 3DTTE parameters in predicting major advance cardiovascular events (MACE) defined as ventricular arrhythmia, cardiac hospitalization, heart transplantation, and death in ARVC patients. Methods Forty-eight definite ARVC subjects based on the 2010 Task force criteria were evaluated with standard 2D transthoracic echocardiography (2DTTE) and 3DTTE. Patients with poor image quality were excluded. RV function was evaluated by 2D and 3D TTE including: fractional area change (FAC), RV global and free wall longitudinal strain (RV2DGLS and RV2DFWLS) and 3D RV ejection fraction (RV3DEF), RV global and free wall longitudinal strain (RV3DGLS, and RV3DFWLS). The patients were followed up for a median period of 12 months (6–18 months) to record MACE. Results Forty-eight patients with mean age =38.5±14 years; 79.2% male, and mean RV3DEF =30.33%, were included. During the mean follow up 12 months, 12 patients (25%, with mean RV3DEF = 24.8±9%) experienced MACE whereas mean RV3EF in patient without any cardiovascular events during follow up was 34.21±9%. The most common causes of hospitalization were arrhythmia, right-sided heart failure, and RV clot as the following: Ventricular arrhythmia in 7 patients (14.6%, with mean RV3DEF = 29.01±8.82%), RV clot in 2 cases (4.2%, with mean RV3DEF = 20.2%), right-sided heart failure in 3 patients (6.3%, with mean RV3DEF = 16.83±3.6%) that 2 of them (2.1%, with mean RV3DEF = 14.58±0.63) underwent heart transplantation. Logistic regression analysis revealed RV3DTTE (p-value = 0.03, OR=0.90, CI: 0.82–0.99), RV3DGLS (p-value = 0.05, OR=1.27, CI: 0.99–1.61) and RV3DFWLS (p-value = 0.01, OR=1.29, CI: 1.05–1.59), predicted cardiac adverse events, but there were no significant association between RV2DGLS, RV2DEWLS and FAC with MACE. Conclusion RV3DEF, RV3DGLS, and RV3DFWLS were powerful predictors of morbidity and mortality and can be useful as a valuable method in the prediction of major cardiovascular complications in ARVC patients. Funding Acknowledgement Type of funding source: None
Background: For many patients with neurological complaints, a non-enhanced brain computed tomography (CT) scan is the first workup. In some of these patients, there is no pathological finding. Anemia is a condition that can present with neurological symptoms without any imaging findings. The correlation of dural venous sinus density with hemoglobin (Hb) level has been shown in some recent studies. Objectives: This study aimed to propose a strategy to predict the level of Hb and investigate the possibility of underlying anemia based on dural venous sinus density to facilitate treatment. Patients and Methods: The CT scans of selected patients, who were referred to Faghihi Hospital in Shiraz, Iran, from October 2018 until February 2019, were reviewed in this study; the complete blood count (CBC) was measured for cases without any findings. The data of 78 patients, including CBC parameters and the mean Hounsfield unit (HU) in the superior sagittal sinus (SSS), torcula herophili (TH), and transverse sinuses (TS), were also analyzed. Results: A relatively strong direct linear correlation was found between the Hb level and HU. The Hb level was calculated based on the following formula: Hb level = 0.2 × SSS HU + 1.2 × sex factor - 0.01 × age (where sex factor is zero for females and one for males). Besides, measurement of the cutoff point for the mean HU of SSS, based on the ROC curve to predict anemia, showed that with SSS HU ≤ 50, anemia could be predicted with 84.62% sensitivity, 75.38% specificity, and 75.64% accuracy in the general population. Conclusion: A significant positive correlation was found between the Hb level and the mean HU of dural venous sinuses. Therefore, the level of Hb is predictable based on HU, and differential diagnoses are limited.
ABSTRACT Arrhythmogenic right ventricular cardiomyopathy (ARVC) is known as a primary genetic heart disease that leading to the myocardial deposition of fibrofatty tissue in right ventricular (RV) wall. Sometimes, it occurs in the left ventricular (LV) subepicardial wall. This study introduces a child referred to our hospital with influenza-like symptoms and ventricular tachyarrhythmia, followed by cardiac failure. However, in our subsequent evaluation, there was evidence of severe LV and RV dysfunction based on the echocardiography. Moreover, cardiac magnetic resonance showed not only the major criteria of ARVC but also those of Lake Luise seen in myocarditis. Regarding the deteriorating condition during the hospital course, he was later scheduled for heart transplantation. Finally, the histopathological study of explanted heart revealed RV myocyte atrophy with the infiltration of fibrofatty tissue in myocardium diagnostic of ARVC, resolving dilemma between ARVC and myocarditis.
Abstract Background : Methadone, buprenorphine, and opium tincture are effective in the treatment of opioid dependency. Currently, in Iran, these three drugs are used in the maintenance therapy program of opioids. On the other word, there are concerns about the incidence of secondary torsade de point (TdP) arrhythmia caused by the prolonged drug-dependent QTc interval. This cross-sectional study has been designed to evaluate and compare the effects of these three maintenance therapies on the QTc interval. Methods : The study population included 110 patients (85% male with the mean age of 51.66±13.34) who participated in an opioid maintenance therapy program for at least 6 months. These patients were assigned to three groups of maintenance therapy with methadone (n = 50), buprenorphine (n = 30) and opium tincture (n = 30). For each patient, a 12-lead ECG was acquired and interpreted. The QT interval was corrected based on the QTc = QT + 1/75 (heart rate - 60) formula. Results : The mean QTc interval was 408.51 ± 25.88 msec in the maintenance therapy group with methadone, 405.58 ± 20.8 msec with buprenorphine and 406.31 ± 16.9 with opium tincture. There was no significant difference between the three groups (P = 0.83). There was only one case with QTc more than 500 msec (511.25 msec) in the maintenance therapy group with methadone. Conclusions : Methadone, buprenorphine and opium tincture are safe drugs in terms of prolonging the QTc interval and are suitable candidates for maintenance therapy of opioid.
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