Background Obesity increases and surgical weight reduction decreases the risk of atrial fibrillation (AF) and heart failure (HF). We hypothesized that surgically induced weight loss may favorably affect left atrial (LA) mechanical function measured by longitudinal strain, which has recently emerged as an independent imaging biomarker of increased AF and HF risk. Methods We retrospectively evaluated echocardiograms performed before and 12.2 ± 2.2 months after bariatric surgery in 65 patients with severe obesity (mean age 39 [36; 47] years, 72% of females) with no known cardiac disease or arrhythmia. The LA mechanical function was measured by the longitudinal strain using the semi-automatic speckle tracking method. Results After surgery, body mass index decreased from 43.72 ± 4.34 to 30.04 ± 4.33 kg/m2. We observed a significant improvement in all components of the LA strain. LA reservoir strain (LASR) and LA conduit strain (LASCD) significantly increased (35.7% vs 38.95%, p = 0.0005 and − 19.6% vs − 24.4%, p < 0.0001) and LA contraction strain (LASCT) significantly decreased (− 16% vs − 14%, p = 0.0075). There was a significant correlation between an increase in LASR and LASCD and the improvement in parameters of left ventricular diastolic and longitudinal systolic function (increase in E’ and MAPSE). Another significant correlation was identified between the decrease in LASCT and an improvement in LA function (decrease in A’). Conclusions The left atrial mechanical function improves after bariatric surgery. It is partially explained by the beneficial effect of weight reduction on the left ventricular diastolic and longitudinal systolic function. This effect may contribute to decreased risk of AF and HF after bariatric surgery. Graphical abstract

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Multiple intracranial aneurysms and fibromuscular dysplasia of renal arteries in a woman with a variant of myosin heavy chain 11 gene

No abstract

A previously healthy 37-year-old man was admitted to a nephrology clinic due to the left-sided abdominal pain, petechiae and recurring hematuria. Laboratory tests revealed high levels of C-reactive protein and Antineutrophil Cytoplasmic Antibodies (cANCA). On this basis, vasculitis was suspected and prednisone in high doses was administered. After 30 days of immunosuppressive treatment, due to persistence of symptoms, the patient was referred for an ambulatory echocardiographic study, and because of the abnormal result, he was admitted to our department. On admission, the patient was clinically in good condition. However, the physical examination revealed a systolic-diastolic heart murmur. Transthoracic echocardiography demonstrated a vegetation attached to the non-coronary aortic leaflet and severe aortic insufficiency. Additionally, an abnormal, perforated, bulging of the anterior mitral leaflet was present, with severe mitral insufficiency (Figure 1). Three blood cultures were positive for Streptoccocus sanguinis. Therefore, the patient was diagnosed with IE according to the modified Duke criteria. Subsequently, the treatment was adjusted to include intravenous antibiotic therapy with vancomycin and ceftriaxone. Afterwards, the patient was qualified for the replacement of the aortic and mitral valves with mechanical valve prostheses. The procedure was uneventful and the patient was discharged home in good condition. The medical history of this patients is an outstanding example of how complex and misleading the IE diagnosis can be. A selected laboratory test, like cANCA is indeed an important diagnostic marker for vasculitis [1,2]. However, several infectious diseases have been reported to stimulate positive cANCA tests and therefore to mimic vasculitis. One of them is infective endocarditis, which is known to initiate the immune complex disease in about 25% of patients [3,4]. One could speculate that an immunosuppressive treatment, in our patient might have led to a blunted antibacterial response, and potentially to the expansion of the endocardial infection with the bivalvular involvement, while reducing clinical symptoms. Our patient can be a reminder of the clinical rule, that before the definitive diagnosis and treatment of suspected vasculitis, an active infection, especially IE must be excluded [5].