Spatio-temporal hybrid neural networks reduce erroneous human "judgement calls" in the diagnosis of Takotsubo syndrome.

Background: We investigate whether deep learning (DL) neural networks can reduce erroneous human "judgment calls" on bedside echocardiograms and help distinguish Takotsubo syndrome (TTS) from anterior wall ST segment elevation myocardial infarction (STEMI).

Methods: We developed a single-channel (DCNN[2D SCI]), a multi-channel (DCNN[2D MCI]), and a 3-dimensional (DCNN[2D+]) deep convolution neural network, and a recurrent neural network (RNN) based on 17,280 still-frame images and 540 videos from 2-dimensional echocardiograms in 10 years (1 January 2008 to 1 January 2018) retrospective cohort in University of Iowa (UI) and eight other medical centers. Echocardiograms from 450 UI patients were randomly divided into training and testing sets for internal training, testing, and model construction.

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries.

Background: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe.

Methods: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries.

Cardiac MRI in Pulmonary Hypertension: From Magnet to Bedside.

Pulmonary hypertension (PH) is a disease characterized by progressive rise of pulmonary artery (PA) pressure, which can lead to right ventricular (RV) failure. It is usually diagnosed late because of the nonspecificity of its symptoms. RV performance and adaptation to an increased afterload, reflecting the interaction of the PA and RV as a morphofunctional unit, constitute a critical determinant of morbidity and mortality in these patients.

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale.

Right Heart Mass in Transit with a Hemorrhagic Pericardial Effusion: A Diagnostic Dilemma.

Metastatic disease to the heart is more often a post-mortem diagnosis due to non-specific symptoms and a low index of suspicion. Our case is a unique presentation of a rare case of cardiac metastasis from oropharyngeal cancer, which eluded echocardiographic diagnosis despite the presence of a hemorrhagic pericardial effusion. The cardiac metastasis, in fact, starts as pericardial seeding, as illustrated by the positron emission tomography (PET) imaging.

Abnormal Global Longitudinal Strain Predicts Future Deterioration of Left Ventricular Function in Heart Failure Patients With a Recovered Left Ventricular Ejection Fraction.

Background: Patients with recovery of left ventricular ejection fraction (LVEF) remain at risk for future deterioration of LVEF. However, there are no tools to risk stratify these patients. We hypothesized that global longitudinal strain (GLS) could predict sustained recovery within this population.

Inverted Takotsubo cardiomyopathy and the fundamental diagnostic role of echocardiography.

Takotsubo cardiomyopathy is characterized by the development of transient focal wall-motion abnormalities that involve the apical and midventricular segments, in the absence of obstructive coronary artery disease. A variant, inverted takotsubo cardiomyopathy, was described in 2010. We report 3 cases in which each patient's transthoracic echocardiogram revealed the characteristic basal and midventricular segmental akinesis of this variant.

Right ventricular outflow tract obstruction by lymphoma: case series and review of the literature.

External compression of the right ventricular outflow tract (RVOT) by lymphoma is a rare clinical entity. We present a series of three adult patients with varying clinical presentations, in which RVOT compression by lymphoma was diagnosed using echocardiogram. Review of the literature identified a total of 13 prior cases of RVOT obstruction by lymphoma diagnosed with echocardiogram.

Transthoracic echocardiographic assessment of continuous-flow left ventricular assist devices.

An increasing number of patients are implanted with continuous-flow left ventricular assist devices (LVAD) for the treatment of severe congestive heart failure. In parallel with this growing experience has been an increase in knowledge of how these devices alter cardiac physiology and the important implications this has for cardiac function. Echocardiography offers the ability to provide serial noninvasive evaluation before and after LVAD implantation to document these changes, guide management decisions, and identify LVAD dysfunction.

Worsening of nose bleeding heralds high cardiac output state in hereditary hemorrhagic telangiectasia.

Background: Hereditary hemorrhagic telangiectasia is characterized by arteriovenous malformations or telangiectasias in multiple organs. Nose bleeding is the most common manifestation of hereditary hemorrhagic telangiectasia and can be debilitating. Cardiac involvement in the form of high-output cardiac failure is a poorly studied complication of hereditary hemorrhagic telangiectasia.

Strain rate imaging differentiates hypertensive cardiac hypertrophy from physiologic cardiac hypertrophy (athlete's heart).

Background: This study sought to determine whether strain rate imaging could distinguish between individuals with hypertensive left ventricular hypertrophy (LVH) and those with strength-training athletic LVH.

Methods: In all, 108 participants (30 hypertensive LVH, 30 strength-training LVH, 48 control) were enrolled. In addition to a baseline echocardiogram, strain, peak systolic strain rate (SR(S)), peak early diastolic strain rate (SR(E)), and peak late diastolic strain rate values were compared in the apical 4-chamber view.

Fragmented left sided QRS in absence of bundle branch block: sign of left ventricular aneurysm.

Background: A left ventricular aneurysm (LVA) occurs between 3.5% and 9.4% of all cases of acute myocardial infarction.

The bicuspid aortic valve.

The bicuspid aortic valve affects 1 to 2% of the population and may be complicated by aortic stenosis or aortic insufficiency and infective endocarditis. The bicuspid aortic valve is associated with abnormalities of the aortic wall such as coarctation of the aorta, aortic dissection, and aortic aneurysm. Most patients with a bicuspid aortic valve will develop some complication during life.

New-onset congestive heart failure secondary to a "huge" right atrial mass--a case report.

Transesophageal echocardiography is a useful adjunct to other diagnostic modalities in uncovering the etiology of congestive heart failure. The authors describe the case of a 75-year-old woman with a 4-week history of progressive congestive heart failure, in whom transesophageal echocardiography played a critical role in the diagnosis of a right atrial mass, accounting for this patient's constellation of symptoms.

[Rational use of noninvasive cardiac stress testing in the diagnosis of coronary artery disease].

A variety of noninvasive tests are available to clinicians for the evaluation of patients in whom ischemic heart disease is suspected because of chest pain, clinical antecedents, or a combination of the two. Although all tests in general help to varying degrees to refine (by inclusion or exclusion) the diagnosis in a given patient, there are undoubtedly important differences between tests regarding their scope and diagnostic accuracy in general, and with respect to certain groups of patients in particular. Because of this, and in view of the obvious economic implications, the topic merits critical review before the information obtained from these tests is used in patient management.

Cardioversion of atrial fibrillation with ibutilide: when is it most effective?

Background: Atrial fibrillation (AF) is found in 1% of persons above the age of 60 years. More than 5% of the population older than 69 years and about 14% of octogenarians are at risk for this arrhythmia. It is estimated that 1.

Asymptomatic left ventricular permanent pacemaker malposition detected on routine follow-up--a case report.

The authors present an asymptomatic left ventricular pacemaker lead malposition that was detected upon routine 2-D Echocardiography. Clinical implication diagnosis and therapeutic options on left ventricular pacemaker lead malposition are discussed.

Prolonged QRS duration (QRS >/=170 ms) and left axis deviation in the presence of left bundle branch block: A marker of poor left ventricular systolic function?

Background: Left bundle branch block (LBBB) is commonly associated with structural heart disease and left ventricular dysfunction. We propose that the QRS duration and degree of left-axis deviation (LAD) identify significant left ventricular systolic dysfunction in patients with LBBB.

Methods: In this prospective study the ejection fraction (EF) of 300 consecutive patients with LBBB was evaluated by echocardiography.

Acute reversible cardiomyopathy and thromboembolism after cisplatin and 5-fluorouracil chemotherapy--a case report.

Acute development of cardiomyopathy and occlusive thromboembolic events following cisplatin and 5-fluorouracil (5-FU) is rare but frequently lethal. The authors report the successful management of such an event in a 52-year-old man with squamous cell carcinoma of the soft palate. The possible pathophysiological mechanisms are discussed.