Echocardiography is widely used to carry out non-invasive cardiac evaluation at the bedside and provides useful real-time information about hemodynamics. It can also be used to diagnose a stress-induced cardiomyopathy and its complications such as shock, heart failure and apical thrombus. Early diagnosis and management are important to prevent possible complications, and short-term follow-up by echocardiography can readily determine the improvement in these abnormalities. In this brief review, we summarize the role of echocardiography in stress-induced cardiomyopathy, with a special focus on its benefits in the era of new emerging diagnostic technology.

Hypocalcemia is a rare cause of dilated cardiomyopathy. Hypocalcemia induced cardiomyopathy is usually reversible when calcium level returns to normal range. We experienced a case of 57-year-old woman who had suffered from hypocalcemia after total thyroidectomy and its consequence of dilated cardiomyopathy. After supplementation of calcium and vitamin D, symptoms of heart failure and LV function were recovered.

Background and Aims The synergistic association of remnant cholesterol (remnant-C) and low-density lipoprotein cholesterol (LDL-C) levels with incident cardiovascular disease (CVD) in various subgroups of Koreans was investigated. Methods Using the national health insurance data, we included subjects aged between 40 and 70 without a history of CVD and at least two health screenings between 2009 and 2011. The subjects were divided into four groups by LDL-C and remnant-C levels. The primary outcome was CVD, which occurred between 2014 and 2017. Results Among 3,686,034 (45.6% women) of subjects, 144,004 cardiovascular events occurred. Individuals in both high LDL-C and high remnant-C [hazard ratio (HR) 1.266, 95% confidence interval (CI) 1.243–1.289; 7.9%], high LDL-C only (HR 1.098, 95% CI 1.083–1.113; 21.2%), and high remnant-C only groups (HR 1.102, 95% CI 1.087–1.118; 19.1%) had higher risks of CVD than the reference group (LDL-C < 3.4 mmol/L and remnant-C < 0.8 mmol/L; 51.8%). A continuous and linear increase in CVD risk was found in those with higher remnant-C levels after adjustment for several confounders, including LDL-C levels. The association of remnant-C ≥ 0.8 mmol/L with an increased CVD risk was consistent across various strata. Conclusions Combined high remnant-C and LDL-C levels confer a higher CVD risk than that individually. Elevated remnant-C values, independent of LDL-C levels, were associated with a risk of incident CVD. Remnant-C levels in addition to LDL-C levels are important considerations in risk stratification for the primary prevention of CVD.

A 51-year-old male presented with intermittent claudication of the right calf for 1 year. The right ankle-brachial index at rest and during exercise was 0.96 and 0.87, respectively. Total occlusion of the right popliteal artery (PA) was detected on a volume-rendered threedimensional computed tomography (CT) image ( Figure 1A), but popliteal aneurysmal dilatation occluded by a hypoattenuating filling defect was revealed on a contrast-enhanced CT axial image ( Figure 1B). Interestingly, an angiography revealed no significant stenosis at the lesion ( Figure 1C). The intravascular ultrasound revealed no definite atherosclerosis but extravascular hypoechoic lesion compatible with a cyst ( Figure 1D). Finally, the T2-weighted magnetic resonance imaging (MRI) ( Figure 1E) revealed that multi-lobulated cysts (arrowheads) extending from the articular surface to the PA (arrow) encompassed the PA circumferentially. These findings were consistent with cystic adventitial disease (CAD). After excision of the cystic wall ( Figure 1F, arrowheads), the medial layer of PA ( Figure 1F, arrow) was exposed. The entire cyst and underlying PA were excised and replaced with a synthetic graft. At 6-month of follow-up, he remains free of symptoms. CAD is a rare non-atherosclerotic vasculopathy where mucinous cyst forms within the adventitia of the arteries and veins.1) This can cause luminal narrowing and various symptoms depending on the vessel affected. The etiology of CAD remains unclear but articular (synovial) theory appears most well-founded.2) The MRI in our case also demonstrated that cysts connected with the knee joint. This joint connection could explain the mechanism of the symptom and the discrepancy between the CT and angiography findings. Instead of a graft, simplified treatment such as joint connection ligation could be done if we had a better understanding of the etiology of CAD. Our case highlights the importance of multi-modality images to make a differential diagnosis in a patient with intermittent claudication and define the etiology of CAD.