International journal of cardiology
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The aim of this study was to investigate preoperative clinical and echocardiographic characteristics and N-terminal pro-B type natriuretic peptide (NT-proBNP) levels as prognostic factors for regression of the left ventricular (LV) mass after valvular surgery in patients with chronic severe mitral regurgitation (MR). ⋯ A lower preoperative NT-proBNP level predicted the regression of LV mass after valvular surgery in patients with chronic severe MR. This measure could be used as a biomarker for predicting the postoperative course in such patients.
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Letter Comparative Study
Prospective assessment of multiple cardiac papillary fibroelastomas: an echocardiographic and surgical study.
Multiple cardiac papillary fibroelastomas (PFEs) are thought to account for less than 10% of patients with PFE. We aimed at evaluating the frequency and location of multiple PFEs and the reliability of transthoracic (TTE) and transoesophageal (TEE) echocardiography in diagnosing multiple PFEs. Twenty-six consecutive patients (52±14 years, 65% males) with pathologically confirmed PFE had 21 PFEs diagnosed by TTE, 33 by TEE, and 62 at surgery. ⋯ Aortic valve was involved in 75% of patients with multiple PFEs and left ventricle in 38% of patients. The sensitivity of TTE in diagnosing any PFEs was 51.3% and 76.9% for TEE. Our study emphasizes the high frequency of multiple PFEs, the need of TEE for all presumed PFE and the need for careful assessment of left-sided endocardial surfaces, especially of the aortic valve, during PFE excision.
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Letter Comparative Study
Accuracy of Doppler-derived pulmonary artery hypertension to predict heart failure with normal ejection fraction.
Recent advances have highlighted the clinical relevance of pulmonary artery hypertension in terms of diagnosis and prognosis in heart failure with normal ejection fraction. We addressed the usefulness of Doppler-derived pulmonary artery systolic pressure to predict heart failure with normal ejection fraction in stable patients with exertional dyspnea. 25 patients referred for clinically indicated catheterism with evidence of heart failure according to the European diagnostic flowchart on "how to diagnose heart failure with normal ejection fraction" and 12 controls referred for clinically indicated catheterism without this condition according to the diagnostic flowchart on "how to exclude heart failure with normal ejection fraction" were included. ⋯ Positive and negative predictive values were 93 and 50% for the cut-off value of 40 mmHg. Doppler-derived pulmonary artery hypertension is a landmark of heart failure with normal ejection fraction in patients without severely increased pulmonary vascular resistance and deserves further attention in upcoming international recommendations.
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Letter Case Reports
Tako-tsubo cardiomyopathy mimicking acute aortic dissection: a case report.
Tako-Tsubo cardiomyopathy is characterized by a transient and reversible left ventricular dysfunction possibly due to a catecholamine-mediated myocardial stunning. This form of cardiomyopathy is rarely associated with cardiogenic shock. Here we report on a patient with Tako-Tsubo cardiomyopathy induced low output failure in which blood flow disturbances in the thoracic aorta mimicked an acute type A aortic dissection.
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Letter Case Reports
Revelation of an obstructive hypertrophic cardiomyopathy in an elderly patient.
Hypertrophic cardiomyopathy (HCM) is classified as a primary cardiomyopathy. HCM is a clinically heterogeneous but relatively common autosomal dominant genetic heart disease that probably is the most frequently occurring cardiomyopathy. HCM is characterized morphologically and defined by a hypertrophied, nondilated left ventriculum (LV) in the absence of another systemic or cardiac disease that is capable of producing the magnitude of wall thickening evident (e.g., systemic hypertension, aortic valve stenosis). ⋯ Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract, in asymmetric septal hypertrophy, establishes which is the best treatment strategy. In the treatment of HOCM, drug therapy with negatively inotropic drugs, percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion, surgical myectomy and DDD pacemaker therapy are considered the therapeutical options. We present a case of an obstructive hypertrophic cardiomyopathy in an 84-year-old Italian woman with a left ventricular outflow tract (LVOT) peak gradient with the Valsalva maneuver of 188 mm Hg and with a history of first episode of syncope.