Rui Martins

Circumferential ascending aortic strain and aortic stenosis.

BACKGROUND Two-dimensional speckle tracking (2D-ST) echocardiography for the measurement of circumferential ascending thoracic aortic strain (CAAS) in the context of aortic stenosis (AS) is not elucidated. Purpose This study assesses the thoracic ascending aortic deformation using 2D-ST echocardiography in AS patients. Population and methods Forty-five consecutive patients with an aortic valvular area (AVA) ≤0.85 cm(2)/m(2) were included. Regarding aortic deformation, the global peak CAAS was the parameter used, and an average of six segments of arterial wall deformation was calculated. The corrected CAAS was calculated as the global CAAS/pulse pressure (PP). Aortic stiffness (β2) index was assessed according to ln(Ps/Pd)/CAAS. The sample was stratified according to the stroke volume index (SVI) as: Group A (low flow, SVI ≤35 mL/m(2); n = 19) and Group B (normal flow, SVI >35 mL/m(2); n = 26). RESULTS The mean age was 76.8 ± 10.3 years, 53.3% were male, the mean indexed AVA was 0.43 ± 0.15 cm(2)/m(2), and the mean CAAS was 6.3 ± 3.0%. The CAAS was predicted by SVI (β = 0.31, P < 0.01) and by valvulo-arterial impedance (Zva). The corrected CAAS was correlated with the M-mode guided aortic stiffness index (β1) (r = -0.39, P < 0.01), and was predicted by SVI, Zva, and systemic arterial compliance (β = 0.15, P < 0.01). The β2 index was significantly higher for the low-flow patients (16.1 ± 4.8 vs. 9.8 ± 5.3, P < 0.01), and was predicted by SVI (β -0.58, P < 0.01) and PP (β = 0.17, P < 0.01). Global CAAS was more accurate to predict low flow than Zva, systolic function and systemic vascular resistance. CONCLUSION In patients with moderate-to-severe aortic stenosis, SVI and LV afterload-related variables were the most important determinants of 2S-ST global CAAS.

Aortic Valve Disease and Vascular Mechanics: Two‐Dimensional Speckle Tracking Echocardiographic Analysis

Degenerative aortic valve disease (AVD) is a complex disorder that goes beyond valve itself, also undermining aortic wall. We aimed to assess the ascending aortic mechanics with two‐dimensional speckle tracking echocardiography (2DSTE) in patients with aortic regurgitation (AR) and hypothesized a relationship with degree of AR. Aortic mechanics were then compared with those of similarly studied healthy controls and patients with aortic stenosis (AS); finally, we aimed to assess the prognostic significance of vascular mechanics in AVD.

Unusual form of tricuspid stenosis

We report the case of a 72-year-old man who, in 1982, in Switzerland, underwent surgical ablation for WolfParkinson-White syndrome. The procedure was complicated by complete atrioventricular block. Permanent pacemaker was implanted. In 1992, in Portugal, the patient was hospitalized due to an infection and necrosis of the pacemaker pocket and its leads. While in hospital, the generator was removed and there was an unsuccessful attempt to extract the leads of the permanent pacemaker, which remained inside the right ventricle. Patient follow-up was lost after hospital discharge.

CHADS2 e CHA2DS2VASc como preditores de fonte cardioembólica em prevenção secundária cerebrovascular

INTRODUCTION AND OBJECTIVES Cardioembolism is one of the most common causes of ischemic stroke, with an estimated prevalence of 20-30%, and correct diagnosis is essential given the therapeutic implications. Although stroke risk scores (CHADS2 and more recently CHA2DS2-VASc) have been validated in heterogeneous populations of patients with atrial fibrillation, their accuracy has not been ascertained for secondary stroke prevention. We set out to assess the sensitivity and specificity of the CHADS2 and CHA2DS2-VASc stroke risk scores as predictors of cardioembolic sources, documented by transesophageal echocardiography (TEE) in a population with ischemic stroke. METHODS The CHADS2 and CHA2DS2-VASc scores were applied to all patients admitted to the stroke unit/neurology ward of a Portuguese tertiary hospital with atrial fibrillation (diagnosed previously or during or after admission) who underwent TEE between January and August 2011. The presence of a cardioembolic source was defined as the observation by TEE of spontaneous echo contrast in the left atrium and atrial appendage or thrombi in the left cardiac chambers. RESULTS We studied 94 patients, 66.0% male, mean age 64.4 years (standard deviation 14.2). A cardioembolic source was detected in 20 patients. ROC curve analysis identified as predictors of cardioembolic source CHADS2 score ≥4 (sensitivity of 75.0%, specificity of 66.0%, p=0.014) and CHA2DS2-VASc score ≥5 (sensitivity of 83.3%, specificity of 58.0%, p=0.009). CONCLUSIONS Both scores showed acceptable sensitivity as predictors of embolic risk in the context of secondary prevention of cardioembolic stroke. The CHA2DS2-VASc score has higher sensitivity than CHADS2 but lower specificity.

Conical Deformity of the Left Ventricle: A Case Report

Most published information on the diagnosis of constrictive pericarditis assumes that the left ventricle has normal or nearly normal systolic function. Noninvasive assessment of pericardial constriction remains crucial to the diagnosis, especially in high-risk subgroups of patients, such as patients after cardiac surgery.We present a 63-year-old Caucasian man who was admitted to the hospital for chronic decompensated heart failure. He had a past history of 3 open-heart surgeries for rheumatic heart valve disease. He was diagnosed with mixed pericardial and myocardial disease. The patient had a left ventricular ejection fraction of 38%, a functional mechanical aortic prosthesis, and a mechanical mitral prosthesis with elevated gradients. Severe pulmonary hypertension was present. The major findings that strongly suggested pericardial constriction were the presence of a conical deformity of the left ventricle, preserved indices of myocardial relaxation, and pericardial thickening. A reversed pattern of the velocities of diastolic relaxation was seen (lateral higher than septal), highlighting the possibility of mixed disease.This clinical case illustrates how noninvasive methods can be used to conclusively diagnose pericardial constriction in the presence of left ventricular systolic dysfunction.