Fuad Samadov

Evaluation of left atrial volume and function in systemic sclerosis patients using speckle tracking and real-time three-dimensional echocardiography

Objective: The aim of the present study was to evaluate left atrial (LA) volume and functions using real-time three-dimensional echocardiography (RT3DE) and speckle tracking in systemic sclerosis (SSc) patients. Methods: The study was designed as a cross-sectional observational study. We studied 41 consecutive SSc patients (38 females, mean age: 49.5±11.6 years) and 38 healthy controls (35 females, mean age: 48.5±10.8 years). Patients with evidence or history of cardiovascular disease and patients with risk factors as hypertension, diabetes and chronic renal failure were excluded from the study. All study subjects underwent standard echocardiography; LA speckle tracking and RT3DE was performed to assess LA volume and phasic functions. Differences between numeric variables were tested using the independent sample Student’s t-test or Mann-Whitney U test, where appropriate. Results: There were no significant differences between SSC patients and controls regarding left ventricular (LV) systolic functions and two-dimensional (2-D) atrial diameters. Presence of LV diastolic dysfunction (LVDD) was evaluated and graded according to recommendations of the American Society of Echocardiography. Accordingly, LVDD was observed to be significantly more frequent in SSc patients; 16 SSc patients (39%) and 5 controls (12.8%) were observed to have LVDD (p=0.007). With regard to results obtained from RT3DE, LA maximum, minimum, and before atrial contraction volumes were significantly higher (40.5±14.6 vs. 32.6±8.9, 15.5±8.4 vs. 9.9±3.5 and 28.7±11.7 vs. 21.4±7.0 mL respectively, p<0.05 for all), whereas LA active emptying fraction, LA total emptying fraction, LA expansion index, and passive emptying fraction values were significantly (47.1±12.0 vs. 52.9±10.1%, 62.8±10.5 vs. 69.5±6.7%, 187.5±76.0 vs. 246.6±96.0, 29.6±9.3 vs. 34.4±11.0% respectively, p<0.05 for all) in SSc patients than in controls. In addition, regarding results obtained from speckle tracking echocardiography, atrial peak-systolic longitudinal strain (e), early negative strain rate (SR), late negative SR, and peak positive SR values were observed to be significantly lower in SSc patients. Conclusion: LA volumes were significantly increased, and LA reservoir, conduit, and contractile functions were significantly impaired in SSc patients compared with controls. LA volume and functional analyses with RT3DE and speckle tracking may facilitate the recognition of subtle LA dysfunction in SSc patients.

Two cases of acute myocarditis with multiple intracardiac thrombi: The role of hypercoagulable states

In acute myocarditis, thrombus formation is an important prognostic factor. Early diagnosis and treatment of intracardiac thrombus is critical, especially when there are multiple thrombi. When a patient presents with multiple cardiac thrombi not only cardiac disorders, but other diseases such as malignancies, rheumatologic disorders and thrombophilia must be considered in the differential diagnosis. Although the presence of hypercoagulable states does not generally affect the treatment choice, it may have an impact on continuation and duration of the anticoagulant therapy. In this paper, we present two cases of acute myocarditis with multiple intracardiac thrombi. Additionally, these cases had hypercoagulable states which might have contributed to the thrombus formation.

Acute proximal left anterior descending artery occlusion with de Winter sign

Prompt recognition of electrocardiographic signs of acute coronary occlusion is essential for timely restoration of flow. ST-segment elevation or new onset left bundle-branch block are the most common electrocardiographic changes seen in acute phase of coronary occlusion. However, some patients may present with atypical electrocardiographic signs, and early diagnosis of these patients may constitute a clinical challenge. Here, we report a 41-year-old man presenting with an atypical electrocardiographic manifestation despite angiographically confirmed acute thrombotic occlusion of proximal left anterior descending artery.

Acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio.

ST elevation acute myocardial infarction in patients with a mechanical prosthetic valve is rare and usually due to inadequate anticoagulation. We present a case of acute inferior myocardial infarction in a patient with a prosthetic aortic valve and high international normalized ratio, which has not been reported previously.

Acute myocardial infarction following psoralen plus ultraviolet light therapy

Psoralen plus ultraviolet light therapy (PUVA) combines the administration of psoralen with an exposure to ultraviolet A radiation. Psoralen plus ultraviolet light therapy is used for the treatment of a variety of skin diseases including morphea and generally considered as a safe treatment modality. We present here a rare case of 65-year-old woman presented with acute myocardial infarction following PUVA session, which has not been reported previously.

Successful Treatment of a Giant Left Atrial Mass Stemming from Pulmonary Vein after Chemotherapy-radiotherapy Combination in a Patient with Lung Adenocarcinoma.

A 66-year-old male presented with fatigue, weakness, haemoptysis and severe dyspnoea for two weeks. On physical examination, heart rate was 80 beats/min, blood pressure was 110/80 mmHg and bilateral crepitant rales up to the mid zone of the lungs. Surface ECG showed sinus rhythm. Transthoracic echocardiography revealed moderate depression of left ventricular function (ejection fraction: 40%) and left atrial mass. To confirm the diagnosis, we also performed a transoesophageal echocardiography and demonstrated a lobulated mass with a diameter of 30x25 mm in the left atrium and compression of the mass to superior vena cava (Figure 1A, 1B). Cardiac magnetic resonance imaging (CMRI) confirmed the findings in the transoesophageal echocardiography (Figure 1C). Thoracic computed tomography demonstrated a mass with a diameter of 52x36 mm in the