Prognostic incremental role of right ventricular function in acute decompensation of advanced chronic heart failure.

Aims: The purpose of this study was to evaluate the additional prognostic value of echocardiography in acute decompensation of advanced chronic heart failure (CHF), focusing on right ventricular (RV) dysfunction and its interaction with loading conditions. Few data are available on the prognostic role of echocardiography in acute HF and on the significance of pulmonary hypertension in patients with severe RV failure.

Methods And Results: A total of 265 NYHA IV patients admitted for acute decompensation of advanced CHF (EF 22 ± 7%, systolic blood pressure 107 ± 20 mmHg) were prospectively enrolled.

Fatal pulmonary embolism: when the cause is not a thrombus.

Study Design: We report a case of pulmonary embolism of polymethylmethacrylate material after percutaneous vertebroplasty.

Objective: To describe a severe vertebroplasty complication, the pulmonary embolism, which proved to be fatal in a patient with many chronic disabilities.

Summary Of Background Data: Until 2007, the literature noted that the risk of embolism of polymethylmethacrylate after a percutaneous vertebroplasty counted a small number of pulmonary cement embolism and a smaller number of fatal consequences.

Echocardiography-guided versus fluoroscopy-guided temporary pacing in the emergency setting: an observational study.

Background: The insertion of a temporary pacemaker can be a lifesaving procedure in the emergency setting.

Objectives: This is an observational monocentric study comparing echocardiography-guided temporary pacemaker via the right internal jugular vein to standard fluoroscopy-guided temporary pacemaker via the femoral vein; the procedure was tested for noninferiority.

Methods: Patients needing urgent pacing were consecutively enrolled.

Refractory acute decompensated heart failure: an observational study on a noninvasive hemodynamic monitoring system aimed at improving the therapeutic approach.

Background: Inotropic agents should only be administered in acute decompensated heart failure (ADHF) refractory to vasodilators at optimal doses because they are associated with adverse outcome. In this setting a noninvasive hemodynamic monitoring system (NHMS) could be useful for optimizing treatment.

Inclusion Criteria: advanced chronic heart failure, ejection fraction 30% or less, admission for ADHF with systolic blood pressure 115 mmHg or less and inadequate response at 48 h of therapy.

[Temporary emergency cardiac pacing under continuous echocardiographic control. Feasibility and safety of the procedure without using fluoroscopy].

Background: Cardiac pacing often turns out to be the only effective treatment of severe brady-arrhythmias. Several invasive and noninvasive temporary pacing procedures are known, whose application is sometimes difficult or time-consuming. An alternative temporary cardiac pacing procedure is described in this article, which is based on echocardiographic control.

[Bolus injection of recombinant tissue-type plasminogen activator during cardiopulmonary resuscitation in massive pulmonary embolism complicated with heart arrest. Report of 2 cases and review of the literature].

In the early phase of fulminant pulmonary embolism mortality is extremely high, with 50% of all deaths occurring within 2 hours after the onset of symptoms. We describe 2 cases of massive pulmonary embolism accompanied by cardiac arrest requiring cardiopulmonary resuscitation. The patients received 100 mg of recombinant tissue-type plasminogen activator in bolus injection and showed a definite improvement in the clinical-hemodynamic status.

Early dobutamine echocardiography for the assessment of coronary stenosis after first Q-wave myocardial infarction.

We assessed the accuracy of early dobutamine stress echocardiography to detect infarct-related coronary artery and multivessel disease in patients with first Q wave myocardial infarction after withdrawal of cardioactive drugs. Dobutamine-atropine echocardiography was performed in 91 consecutive patients (mean age 59+/-6 years) 7+/-4 days after myocardial infarction. Dobutamine was infused at incremental doses of 5, 10, 20, 30 to 40 microg/kg/min each one dose for 3 min.

Potential influence of pre-infarction angina on myocardial viability and residual ischemia.

Background: The effects of recent pre-infarction angina on myocardial viability and residual ischemia are unknown. This study evaluates them in 90 patients with a first Q-wave myocardial infarction using early dobutamine stress echocardiography.

Methods: Patients were classified according to the absence or presence of recent pre-infarction angina, defined as chest pain lasting < 30 min during a period of 7 days before the acute myocardial infarction.

[Intermittent diastolic dysfunction of a mechanical aortic prosthesis: a clinical case].

We describe the case of a 48 year-old man whose Sorin bileaflet aortic prosthesis presented persistent systolic and intermittent diastolic failure due to fibrous tissue overgrowth in the left ventricular outflow tract.

A large false aneurysm of the right ventricle within a giant epicardial lipoma.

Lipomas, which account for approximately 10% of all neoplasms of the heart, may be detected in asymptomatic patients by chance during echocardiography, CT scan, or MRI scan. Occasionally, lipomas are complicated by arrhythmias. We describe a patient who presented with severe cardiomegaly and paroxysmal supraventricular tachycardia.

Significance of T-wave changes during early dobutamine stress echocardiography in patients with Q-wave acute myocardial infarction.

The relation between T-wave changes and regional contraction during dobutamine stress echocardiography at low (5 to 10 microg/kg/min) and high (20 to 40 microg/kg/min) doses in 43 consecutive patients, early (7+/-2 days) after first recent Q-wave acute myocardial infarction has been evaluated. T-wave changes detected in > or =2 infarct-related electrocardiographic leads during dobutamine infusion were defined as follow: (1) negative T waves becoming positive, (2) positive T waves becoming upright > or =2 mm, and (3) negative T waves becoming upright > or =2 mm from baseline. Wall motion score index (WMSI) was defined as the sum of the echocardiographic scores of 16 segments divided by total segments considered at baseline, and at low and peak doses of dobutamine.