Oana Savu

Morphological and Functional Adaptation of the Maternal Heart during Pregnancy

Background— Pregnancy provides a unique model to study the adaptation of the heart in a physiological situation of transient load changes. The aim of this study was to assess the performance of the left ventricle (LV) in normal, uncomplicated pregnancies while considering the actual LV load and shape. Methods and Results— Serial echocardiographic examinations were performed in 51 women in each pregnancy trimester and 3 to 6 months after delivery. Data from 10 nulliparous, age-matched women were used as the control. Conventional parameters of LV function (ejection fraction) as well as myocardial deformation (strain) were interpreted, taking into consideration maternal hemodynamics and LV shape. Cardiac output increased during pregnancy because of a higher stroke volume in early pregnancy and a late increase in heart rate, whereas total vascular resistance decreased. Progressive development of eccentric hypertrophy was observed, which subsequently recovered postpartum. Sphericity index decreased from the first to the third trimester (1.92±0.17 versus 1.71±0.17) and returned postpartum to values comparable to the control. Although higher LV stroke work was noted toward the third trimester (5.9±1.1 versus 5.3±1.0 Newton meter, P<0.001), ejection fraction showed no significant changes. LV strain decreased significantly in late pregnancy (−19.5±2% to −17.6±1.6%, P<0.001) and returned to baseline values after delivery (−19.5±2%). Conclusions— Pregnancy is a physiological process associated with increased cardiac performance and progressive LV remodeling. These changes are not directly reflected by parameters traditionally considered to describe systolic function, such as ejection fraction and longitudinal deformation. While ejection fraction was insensitive to the functional changes, the transient decrease in longitudinal deformation becomes only plausible when considering the changes in LV geometry.

Accuracy of handheld echocardiography for bedside diagnostic evaluation in a tertiary cardiology center: comparison with standard echocardiography.

Aims: We aimed to assess the clinical role of a basic handheld echocardiographic device (HHE) used during cardiology training in evaluating different functional and morphological elements of the heart. Methods and results: 56 consecutive patients (pts), 26 women, mean age 60.0 ± 11.9 years admitted in our Cardiology Department had an echocardiogram performed by both cardiology trainees using a HHE with B‐mode capabilities only and by cardiologists with advanced training in echocardiography using a standard echocardiography device (SE). Several parameters were analyzed: the presence of wall motion abnormalities (WMA), aortic valve abnormalities (AVAbn), mitral valve abnormalities (MVAbn), the presence of pericardial effusion (PE), as well as the presence of a dilated (LVD) or hypertrophied left ventricle (LVH). The Kappa coefficient of correlation between the two methods (k) was determined, along with the sensitivity (Sn), specificity (Sp), negative predictive value (NPV), and positive predictive value (PPV). Both HHE and SED examinations were possible in 52 of the 56 pts (92.8% feasibility). There was a moderate correlation in the assessment of WMA (k = 0.56) with a substantial agreement for MVAbn (k = 0.72), AVAbn (k = 0.76), LVH (k = 0.67) There was excellent agreement for LVD (k = 0.81). Valvular diseases were determined by HHE with good Sp (MVAbn – 97.4%, AVAbn – 100%), although the Sn and NPV were lower. Conclusions: Bedside evaluation using HHE is helpful for assessing LV chamber and walls dimensions, LV regional function, and morphological abnormalities of the valves. The device can be used by cardiology trainees with limited experience in echocardiography but only in combination with a standard examination. (Echocardiography 2011;28:136‐141)

Images in cardiovascular medicine: Primary cardiac leiomyosarcoma: when valvular disease becomes a vascular surgical emergency.

A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …

A Paravertebral Pulsatile Mass

A 46-year–old man was admitted for severe back pain over the interscapular area radiating anteriorly along the ribs. Symptoms started intermittently 2 months previously, but became severe and persistent over the past 3 days. The patient was a former sailor and a heavy smoker, with no relevant personal or family history of cardiovascular disease. At physical examination, a pulsatile left paravertebral mass could be seen and palpated close to the spine (online-only Data Supplement Movie I). A high-pitched descrescendo diastolic murmur could be heard along the left sternal border. He was normotensive and tachycardic, with no signs of pulmonary or systemic congestion. The ECG showed sinus tachycardia (115 beats per minute) and complete right bundle-branch block with secondary ST-T …

Primary Cardiac Leiomyosarcoma

A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …

Primary Cardiac Leiomyosarcoma When Valvular Disease Becomes a Vascular Surgical Emergency

A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …A 50-year-old previously healthy woman was referred to our department for suspected mitral valve endocarditis because of a 3-week history of fever, weight loss, and the echocardiographic discovery of a mitral valve mass. On admission, the patient was cachectic (body mass index of 18 kg/m2) and subfebrile (37.5°C) with dyspnea at rest, jugular vein distension, and tender liver enlargement. Her heart examination showed regular tachycardia (100 bpm), apical systolic murmur (3/6 degree), and diastolic rumble. The ECG showed sinus tachycardia (105 bpm) and signs of left atrial abnormality (wide, notched P wave measuring 140 ms; Figure 1). Chest x-ray revealed a cardiothoracic index of 0.6, with left atrial enlargement and interstitial edema (Figure 2). Figure 1. Twelve-lead ECG shows sinus rhythm, signs of left atrial abnormality (wide, notched P wave measuring 140 ms), and nonspecific ST-T changes. Figure 2. Posteroanterior chest x-ray reveals a cardiothoracic index of 0.6, signs of left atrial enlargement, and interstitial edema. Echocardiography showed an enlarged left atrium and a partially mobile mass on the mitral valve involving mainly the anterior leaflet and the anterolateral commissure (Figure 3A and 3B and Movies I and II in the online-only Data Supplement). …

140 The effects of growth hormone excess on cardiac structure and function and carotid wall in patients with controlled versus active acromegaly

Acromegaly (ACM) is associated with increased cardiovascular (CV) morbidity and mortality, both through direct CV effects of growth hormone (GH) and IGF-1, and associated factors like hypertension (HTA) and diabetes (DM). We have studied the effects of ACM features on cardiac and vascular changes. Material and methods 33 pts with ACM (mean age 44±7y, 21 women) underwent evaluation of clinical, biologic (including basal or provoked serum GH, IGF1), echocardiography and carotid arteries echocardiography. An age-and sex-matched group of normal individuals was selected. Results Three pts were newly diagnosed, 30 treated by surgery, irradiation, or somatostatin analogues. Associated CV risk factors were: DM 12/33 pts, HTA 10/33 pts, smoking 5/33 pts. Pts were divided in 2 groups: group 1 -active ACM (n=24) and group 2 -controlled ACM (n=9). There were no differences between the 2 groups regarding age, estimated ACM duration and CV risk factors prevalence. Left ventricular (LV) dimensions were increased in ACM patients compared to controls. In ACM pts, LV volumes were correlated to GH levels and ACM duration (p=0.01). In men with active ACM, LV mass index was significantly higher (161.1±13.2g/m2) then in controlled ACM (136.6±4.2g/m2, p=0.01). LV systolic dysfunction (LVEF Conclusions ACM is associated with both cardiac and arterial structural changes vs controls. LV hypertrophy and diastolic dysfunction were more prevalent in pts with active than controlled ACM, while systolic function and early atherosclerosis were influenced by ACM duration.