Dynamic T-Wave Inversion: Unraveling an Athlete's Heart Mystery.

A 17-year-old athlete was initially diagnosed with presumed hypertrophic cardiomyopathy, marked by deep inferolateral T-wave inversions and mild anteroseptal hypertrophy on electrocardiogram and imaging studies. Remarkably, 6 years later, following detraining, all diagnostic signs completely resolved. This case underscores the significance of vigilant athlete follow-up.

Comparison of Simultaneous Transthoracic Versus Transesophageal Echocardiography for Assessment of Aortic Stenosis.

Transthoracic echocardiography (TTE) is the gold standard for aortic stenosis (AS) assessment. Transesophageal echocardiography (TEE) provides better resolution, but its effect on AS assessment is unclear. To answer this question, we studied 56 patients with ≥moderate AS.

Natural History and Disease Progression of Early Cardiac Amyloidosis Evaluated by Echocardiography.

Since the diagnosis of cardiac amyloidosis (CA) is often delayed, echocardiographic findings are frequently indicative of advanced cardiomyopathy. We aimed to describe early echocardiographic features in patients subsequently diagnosed with CA. Preamyloid diagnosis echocardiographic studies were screened for structural and functional parameters and stratified according to the pathogenetic subtype (immunoglobulin light-chain [AL] or amyloid transthyretin [ATTR]).

Effect of Intramural Course of Coronary Arteries Assessed by Computed Tomography Angiography in Patients With Hypertrophic Cardiomyopathy.

This study evaluated the prevalence, anatomical pattern, and prognostic implications of an intramural course of the coronary arteries in patients with hypertrophic cardiomyopathy (HC). The study population consisted of 92 patients with HC and 100 patients without HC. The presence of an intramural course of the coronary arteries was evaluated by coronary computed tomography angiography (CTA), and its length and depth were measured.

Echocardiographic Assessment of Aortic Stenosis under Sedation Underestimates Stenosis Severity.

Background: Sedation can impact aortic stenosis (AS) classification, which depends on left ventricular ejection fraction (<≥ [less than or greater than and/or equal to] 50%), aortic valve area (AVA<≥ 1 cm), mean pressure gradient (<≥ 40 mm Hg), peak velocity <≥ 400 cm/sec, and stroke volume index (SVI <≥35 mL/m). We compared AS classification by transthoracic echo (TTE) during wakefulness versus sedation.

Methods: Immediately following a baseline TTE performed during wakefulness, another TTE was done during sedation delivered for a concomitant transesophageal study in 69 consecutive patients with AS (mean age 78 ± 7 years, 32 males).

Prevalence and morphology of myocardial crypts in normal and hypertrophied myocardium by computed tomography.

Myocardial crypts can be recognized in patients with hypertrophic cardiomyopathy (HCM) using magnetic resonance imaging, but similar studies using computed tomography (CT) are sparse. The aim of the present study was to evaluate the prevalence and morphology of myocardial crypts in patients with HCM, arterial hypertension, and aortic valve stenosis using contrast-enhanced CT. We also investigated the added value of a finding of myocardial crypts on CT scan to the diagnosis of HCM.

Calculated Risk for Sudden Cardiac Death in Patients with Apical Versus Nonobstructive Nonapical Hypertrophic Cardiomyopathy.

There are limited and conflicting data regarding the prognosis of patients with apical hypertrophic cardiomyopathy (HC) and their risk for sudden cardiac death (SCD). We used data from a single tertiary center for comparing the clinical course and the calculated risk for SCD in patients with nonobstructive apical HC (apical HC) versus patients with nonobstructive, nonapical HC (NONA HC). The 5-year SCD risk was calculated based on the HC risk-SCD tool.

Incremental Value of Transesophageal Echocardiography Integrated with Transthoracic Echocardiography in the Assessment of Aortic Stenosis Severity.

Background: Transthoracic echocardiography (TTE) is the standard method for evaluating the severity of aortic stenosis (AS), while transesophageal echocardiography (TEE) is useful for morphologic characterization. The study aim was to assess the impact of complementary TEE to TTE in refining hemodynamic assessment of AS severity.

Methods: A retrospective analysis was conducted of sequential TTE and TEE studies performed in 100 patients with moderate or severe AS confirmed on prior TTE.

Prevalence of Late Functional Tricuspid Regurgitation in Degenerative Mitral Regurgitation Surgery.

Background: Although significant late tricuspid regurgitation (TR) may develop after surgery for degenerative mitral regurgitation (MR), the use of routine tricuspid annuloplasty is debatable. The study aim was to determine the prevalence and predictors of significant late TR after surgery for degenerative MR.

Methods: A total of 112 patients who had undergone surgery for degenerative MR without concomitant tricuspid valve repair (average follow up 7.

Clinical and Echocardiographic Features of Mitral Annular Calcium in Patients Aged ≤50 Years.

Data regarding characteristics of young patients with mitral annular calcification (MAC) and its associations with other cardiovascular risk factors are scarce. Hence, we sought to characterize patients aged <50 years with MAC and to examine whether in these patients, MAC is also associated with cardiovascular risk factors. Consecutive patients who underwent an echocardiographic study were prospectively entered into a database.

Association Between Mitral Annular Calcium and Flail Mitral Leaflet in Degenerative Mitral Valve Disease.

The aim of this study was to assess the association between mitral annular calcium (MAC) and flail mitral leaflets in a cohort of patients with degenerative mitral valve disease. A retrospective study was conducted of consecutive patients with degenerative mitral valve disease who underwent echocardiography at Rabin Medical Center from 2003 to 2012. Special focus was attended to the presence and grade of MAC and characterization of valve pathology (myxomatous vs nonmyxomatous, prolapse vs flail).

Transoesophageal echocardiography of aortic atherosclerosis: the additive value of three-dimensional over two-dimensional imaging.

Aims: Complex aortic atherosclerotic plaques (AAPs) carry a significant risk of embolism. Currently, two-dimensional (2D) transoesophageal echocardiography (TOE) is the principal diagnostic tool of AAPs. However, we hypothesized that the data obtained from three-dimensional (3D) imaging may improve AAPs' spatial assessment.

Mid-term echocardiographic progression of patients with moderate aortic regurgitation: implications for aortic valve surgery.

Background And Aim Of The Study: Replacement of the aortic valve for moderate aortic regurgitation (AR) as an adjunct to another cardiac surgery, primarily for coronary artery bypass grafting (CABG) or mitral valve replacement or repair, remains the subject of much debate. The study aim was to monitor the progression rate of moderate AR by means of echocardiography, and to reveal the need for future surgical intervention.

Methods: A total of 262 consecutive patients (162 males, 100 females; mean age 65 +/- 15 years; range: 21-93 years) with moderate AR and no more than mild aortic stenosis, were followed for a mean of 42 +/- 31 months.

Does gender affect the rates of abnormal exercise stress echocardiography in patients with asymptomatic severe aortic stenosis?

Background And Aim Of The Study: Patient gender can affect not only the clinical manifestations of coronary artery disease (CAD) but also the clinician's interpretation of the symptoms and results of exercise stress tests for management decisions. This may be true also for aortic stenosis (AS), given its many shared features with CAD and similar symptom-based management. The study aim was to evaluate the effect of gender on the assessment of severe asymptomatic AS by exercise stress echocardiography (ESE).

The value of intraoperative transesophageal echocardiography in patients undergoing aortic valve replacement.

Background And Aim Of The Study: While the role of intraoperative transesophageal echocardiography (IOTEE) in valve repair surgery is well documented, its value in patients undergoing valve replacement is debatable. The study aim was to assess the impact of IOTEE on the management of a large cohort of patients referred for aortic valve replacement (AVR).

Methods: The departmental echocardiography database for patients undergoing AVR with IOTEE between April 1999 and September 2006 at the authors' institution was reviewed.

The association of left atrial volume with exercise capacity in patients with chronic severe mitral regurgitation.

Background: Left atrial volume and exercise capacity are strong predictors of cardiovascular risk. Decreased exercise capacity is expected when LAV is increased due to its association with abnormal left ventricular filling pressure. However, LAV enlargement is expected in chronic mitral regurgitation as well.

Right ventricular pacing increases tricuspid regurgitation grade regardless of the mechanical interference to the valve by the electrode.

Aims: The effect of right ventricular (RV) pacing on tricuspid regurgitation (TR) is debatable and is presumed to be related to an interference with valve closure by the electrode. The aim of the study was to determine the impact of pacing per se on TR grade.

Methods And Results: The study group included 23 clinically stable patients (13 males; mean age 78 +/- 12 years) with a permanent pacemaker at the RV apex (83% DDD mode) and normal left ventricular function.

Does exercise echocardiography have an added value over exercise testing alone in asymptomatic patients with severe aortic stenosis?

Background And Aim Of The Study: The study aim was to assess the clinical utility and added value of exercise stress echocardiography (ESE) over exercise testing alone in asymptomatic patients with severe aortic stenosis (AS).

Methods: The results of treadmill ESE in 101 consecutive patients (59 males, 42 females; mean age 69 +/- 10 years; range: 35-85 years) with asymptomatic severe AS (aortic valve area (AVA) <1 cm2 and/or mean transvalvular pressure gradient > or =50 mmHg) and normal left ventricular function, were analyzed. The test was considered abnormal if stopped prematurely because of limiting symptoms, a fall or small rise in systolic blood pressure, or complex ventricular arrhythmia.

Determinants of implantable defibrillator discharges in high-risk patients with hypertrophic cardiomyopathy.

Objectives: To identify the determinants of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) discharges in patients with hypertrophic cardiomyopathy (HCM).

Design: Retrospective cohort study.

Setting: ICD clinic at an academic hospital.

Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity.

Background: Patients with hypertrophic cardiomyopathy and left atrial (LA) enlargement have increased morbidity and mortality. We analyzed the clinical and echocardiographic factors related to LA enlargement, particularly the degree of left ventricular (LV) hypertrophy and diastolic function.

Methods: A total of 104 patients with hypertrophic cardiomyopathy (age 53 +/- 15 years, 64% men) were divided into two groups based on the indexed LA volume (LAVI) (mL/m2) measured by echocardiography: group A (or smaller LAVI group, n = 43) was defined as LAVI < or = 34 mL/m2; and group B (or larger LAVI group, n = 61) as LAVI > 34 mL/m2.

Usefulness of myocardial contrast echocardiographic quantification of risk area for predicting postprocedural complications in patients undergoing septal ethanol ablation for obstructive hypertrophic cardiomyopathy.

Septal ethanol ablation (SEA) is an alternative to surgical myectomy in patients who have drug-refractory obstructive hypertrophic cardiomyopathy. However, permanent atrioventricular conduction block is seen more frequently with SEA. To determine whether septal infarction risk area (SIRA) predicts outcome in patients who have obstructive hypertrophic cardiomyopathy and are undergoing SEA, we evaluated 51 patients (mean age 60 +/- 16, 53% women) who had a successful SEA at Toronto General Hospital (November 1998 to June 2003).