Sarinya Puwanant

Ventricular Geometry, Strain, and Rotational Mechanics in Pulmonary Hypertension

Background— We tested the hypothesis that right ventricular (RV) pressure overload affects RV function and further influences left ventricular (LV) geometry, which adversely affects LV twist mechanics and segmental function. Methods and Results— Echocardiographic images were prospectively acquired in 44 patients (age, 46±12 years; 82% women) with evidence of pulmonary hypertension (estimated pulmonary artery systolic pressure, 71±23 mm Hg) and in 44 age- and gender-matched healthy subjects. Patients with intrinsic LV diseases were excluded. RV lateral wall longitudinal strain (LS) and interventricular septal (IVS) LS were reduced in the pulmonary hypertension group compared with control subjects (−15.9±7.6% versus −25.5±6.1%, P<0.001; and −17.3±4.4% versus −20.2±3.9%, P=0.002, respectively), whereas LV lateral wall LS was preserved. RV lateral wall LS and IVS LS, but not LV lateral wall LS, correlated with pulmonary artery systolic pressure (r=0.56, P<0.01; r=0.32, P<0.01) and LV eccentricity index (r=0.57, P<0.01; r=0.57, P<0.01). IVS and LV lateral wall circumferential strain (CS) were both reduced in the pulmonary hypertension group. Although IVS CS and LV lateral wall CS correlated with pulmonary artery systolic pressure and LV eccentricity index, after adjustment of CS for LV eccentricity index, differences between groups persisted for IVS CS (P<0.01) but not LV lateral wall CS (P=0.09). LV torsion was decreased in patients with pulmonary hypertension compared with control subjects (9.6±4.9° versus 14.7±4.9°, P<0.001). LV torsion inversely correlated with pulmonary artery systolic pressure (r=−0.39, P<0.01) and LV eccentricity index (r=−0.3, P<0.01). LV untwisting rates were similar in both groups (P=0.7). Conclusions— Chronic RV pressure overload directly affects RV longitudinal systolic deformation. RV pressure overload further influences IVS and LV geometry, which impairs LV torsion and segmental LS and CS, more for the IVS than for the free wall of the LV.

Role of CHADS2 score in evaluation of thromboembolic risk and mortality in patients with atrial fibrillation undergoing direct current cardioversion (from the ACUTE Trial Substudy).

The CHADS(2) (congestive heart failure, hypertension, age >75 years, diabetes mellitus, stroke or transient ischemic attack [2 points]) scoring scheme has been found to be a good predictor of stroke risk in patients with nonvalvular atrial fibrillation (AF). However, the value of the CHADS(2) scoring system in the risk stratification of patients with AF who undergo direct-current cardioversion has not yet been specifically investigated. In this study, a subgroup of 541 patients from the Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) study who had AF for >48 hours and planned to undergo transesophageal echocardiography before direct-current cardioversion were enrolled. Each patient had a CHADS(2) score calculated. Of the patients with CHADS(2) scores of 0, 14 (10%) were found to have left atrial appendage thrombi on transesophageal echocardiography. After 6 months of follow up, patients with CHADS(2) scores of 3 to 6 showed a significantly higher mortality rate in comparison with patients with lower CHADS(2) scores (4.3% vs 0.5%, p = 0.004), despite their similar prevalence of left atrial appendage thrombus and stroke (thrombus: 13.4% vs 11.6%, p = 0.60; stroke: 0% vs 0.3%, p = 0.70). In conclusion, the CHADS(2) scoring system may be useful for predicting short-term mortality risk in patients with AF receiving elective direct-current cardioversion. However, in the preprocedural risk assessment of these patients, the CHADS(2) scoring system is not reliable in predicting risk for left atrial appendage thrombus formation, especially in patients with low CHADS(2) scores.

Right Ventricular Myxoma

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 14-year-old girl presented with a 2-month history of dyspnea on exertion. A physical examination revealed a giant A-wave on jugular venous pulse. Echocardiography revealed a huge mobile heterogenous mass (A to D, asterisks) ,

Undetected Large Aortopulmonary Window in an Adult: A Confluence of Great Vessels

ology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; yCardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; and the zDivision of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Manuscript received May 1, 2013; accepted May 7, 2013. Journal of the American College of Cardiology Vol. 62, No. 19, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/

Intracardiac and intravenous leiomyomatosis.

36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.05.097

Pneumohydropericardium with cardiac tamponade after pericardiocentesis

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 43-year-old woman with a history of syncope was referred for open heart surgery for right atrial (RA) myxoma removal. On examination, she had a grade 2/6 systolic ejection murmur. Intraoperative

Rare angiographic and echocardiographic findings of an aortic arch interruption in a patient with differential cyanosis

A 69-year-old woman developed dyspnoea 1 day after percutaneous pericardiocentesis for idiopathic pericardial effusion. On the exam, she had a pulsus paradoxus of 12 mm Hg and an elevated jugular venous pulse. The chest radiograph showed air separating the pericardium from the heart,

A rare cause of pulsus paradoxus: acute tension hydrothorax

A 23-year-old lady with a 3-year history of undiagnosed murmur and progressive dyspnoea was referred to our institution for a percutaneous patent ductus arteriosus (PDA) closure. Physical examination revealed differential cyanosis with an oxygen saturation in the upper and lower extremity of 95 and 86%, respectively. A loud P2 with a grade 3/6 systolic murmur …

Images in CardiologyScimitar Sign in a Patient With an Atrial Septal Defect: A Comprehensive Noninvasive Assessment With Transthoracic Echocardiography and Computed Tomography

A 63-year-old man with advanced lung cancer, suffered from increasing dyspnoea for 1 week. Physical findings included tachypnoea, decreased breath sound in the entire left chest. Chest film revealed complete ‘white out’ of left hemithorax with rightward shift of mediastinum (figure 1A) while previous study last 2 months showed no effusion. Initial blood pressure was 90/50 mm Hg and exhibiting pulsus paradoxus of 25 mm Hg (figure 1B, from continuous, non-invasive haemodynamic monitoring). Transthoracic echocardiography revealed large left pleural effusion with …

Scimitar Sign in a Patient With an Atrial Septal Defect: A Comprehensive Noninvasive Assessment With Transthoracic Echocardiography and Computed Tomography

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 30-year-old woman was referred for a percutaneous atrial septal defect (ASD) closure. She was acyanotic. She had a systolic ejection murmur and a wide-fixed split S2. The chest radiograph showed cardiomegaly; pulmonary