The evolving role and use of echocardiography in the evaluation of cardiac source of embolism

Celeste, Fabrizio; Muratori, Manuela; Mapelli, Massimo; Pepi, Mauro

doi:10.4103/jcecho.jcecho_1_17

Cited by 27 publications

(25 citation statements)

References 84 publications

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“…1 It is an accurate technique to identify and characterize intracardiac masses, defining their location (right-sided or left-sided), morphology (fixed with no detectable independent motion, fixed with a mobile free edge, sessile, or pedunculated), size (> or <1 cm), echogenicity (low or increased), and mobility (hypomobile or hypermobile) and the possible presence and extent of any consequent hemodynamic derangement. 7,8,24…”

Section: Discussionmentioning

confidence: 99%

Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

Sonaglioni

Nicolosi²,

Lombardo

et al. 2020

Angiology

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Pulsed wave tissue Doppler imaging (PW-TDI) easily detects motion of cardiac structures. Hence, PW-TDI could be of value for assessing potentially cardioembolic masses. We sought to evaluate the prognostic value of left ventricular (LV) thrombus mobility assessed by PW-TDI. In 83 consecutive patients with echocardiographically detected LV thrombi, PW-TDI echocardiographic study was performed. At 1-year follow-up, the composite of major adverse cardiovascular events (MACE) defined as all-cause mortality plus hospitalizations for stroke/systemic embolism was evaluated. Seventy-two patients (77.1 ± 13.1 year/old, 32 males) were studied. All thrombi were located at the LV apex. At 1-year follow-up, 17 cardioembolic events occurred. By univariable Cox analysis, variables associated with MACE were heart rate (hazard ratio: 1.02, 95% CI: 1.00-1.05; P = .03), thrombi with mobile free edge (hazard ratio: 3.25, 95% CI: 1.25-8.44; P = .01), hypoechoic thrombi (hazard ratio: 2.86, 95% CI: 1.10-7.42; P = .03), and mass peak antegrade velocity (Va) ≥10 cm/s (hazard ratio: 8.79, 95% CI: 2.00-38.5; P = .004). By multivariable analysis, thrombi with mobile free edge (hazard ratio: 3.54, 95% CI: 1.23-10.2; P = .02), and mass peak Va ≥10 cm/s (hazard ratio: 7.97, 95% CI: 1.60-39.6; P = .01) retained statistical significance. Mass peak Va ≥10 cm/s predicted the composite end point with 94% sensitivity and 85% specificity (area under the curve = 0.86). In conclusion, PW-TDI allows objective prognostication of LV thrombi embolic risk.

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Section: Discussionmentioning

confidence: 99%

Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

Sonaglioni

Nicolosi²,

Lombardo

et al. 2020

Angiology

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“…The newly diagnosed AF was defined as those who present for the first time with persistent or paroxysmal AF during regular follow-up period, regardless of whether the duration of the arrhythmia is known at the time of presentation. The cardiac thrombosis was evaluated according to the ASE’s guidelines [ 18 ]. Stroke was defined as the presence of a focal/global neurological event with symptoms and signs lasting > 24 h. All stroke subjects were survivors of CS, and determined by magnetic resonance image and/or computed tomography scanning of the brain referring to relevant guidelines [ 19 ].…”

Section: Methodsmentioning

confidence: 99%

Association of ACE2 variant rs4646188 with the risks of atrial fibrillation and cardioembolic stroke in Uygur patients with type 2 diabetes

Liu

Pei

Lai

et al. 2021

BMC Cardiovasc Disord

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Background Atrial fibrillation (AF) is the most common cardiac arrhythmia. Type 2 diabetes (T2D) is an independent risk factor for AF. The cardioembolic stroke (CS) risk is increased when both conditions coexist. Whether angiotensin-converting enzyme 2 (ACE2) genetic variants predict increased risks AF and CS in Uygur patients with T2D remain elusive. Methods A total of 547 Uygur subjects (272 controls and 275 T2D patients) were recruited to the study from south Xinjiang. Eight ACE2 variants were identified by MassARRAY system. Results ACE2 rs2074192 (CC, adjusted RR = 2.55, 95% CI 1.35–4.80, P = 0.004), rs4240157 (CC + CT, adjusted RR = 2.26, 95% CI 1.27–4.04, P = 0.006) and rs4646188 (TT, adjusted RR = 2.37, 95% CI 1.16–4.86, P = 0.018) were associated with higher AF risk. ACE2 rs4240157 (CC + CT, adjusted RR = 2.68, 95% CI 1.36–5.27, P = 0.004) and rs4646188 (TT, adjusted RR = 2.56, 95% CI 1.06–6.20, P = 0.037) were further associated with higher CS risk. The 3 ACE2 variants were related to larger left atrial end-systolic diameter (LAD) (all P < 0.05), but not all of the 3 ACE2 variants were related to increased levels of serum sodium (rs4240157 and rs4646188, all P < 0.05), HsCRP (rs4240157 and rs4646188, all P < 0.05) as well as decreased serum potassium levels (rs2074192 and rs4646188, all P < 0.05). The 3 ACE2 variants exhibited heterogeneity on circulating RAAS activation. In particular, ACE2 rs4646188 was associated with higher levels of ACE (P = 0.017 and 0.037), Ang I (P = 0.002 and 0.001), Ang II (both P < 0.001) and ALD (P = 0.005 and 0.011). Conclusion These results indicated ACE2 rs4646188 was associated with increased risk of AF and CS among diabetic patients in Uygurs, which could be a promising genetic predisposition marker for early and personalized prevention strategies for the aforementioned clinical pathologies.

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“…Secondly, cardiopulmonary bypass (CPB) is a risk factor of stroke, whose pathophysiological mechanisms refer to hemorrhagic, global ischemia, and embolic [68]. TEE plays a vital role in evaluating embolism originated from the heart [69]. On the other hand, it is instrumental to detect the pathogenesis of hypotension, guide fluid replenishment and identify mitral regurgitation and shunt flow [70].…”

Section: Tmp ¼ Cpp ¼ Map−icpmentioning

confidence: 99%

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

et al. 2020

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Background: Embolic stroke is a common complication of atrial myxoma, whereas multiple cerebral aneurysms associated with atrial myxoma is rare. The pathogenesis of the cerebral vascular disease related to an atrial myxoma is still not well known, and there are no guidelines to guide treatment and anesthesia management in such patients. Case presentation: In this report, we present a 38-year-old woman with occasional dizziness and headache diagnosed as multiple cerebral fusiform aneurysms, in whom transthoracic echocardiography revealed a mass attached to the interatrial septum in the left atrium. Myxoma resection was performed in fast track cardiac surgery pathway without neurological complications, and no intervention was carried out on the cerebral aneurysms. She was discharged home 6 days after the procedure for followed-up. Furthermore, we reviewed and analyzed the literature in the PubMed and Google Scholar databases in order to conclude the optimal treatment in such cases. Conclusions: Atrial myxoma-related cerebral aneurysms are always multiple and in a fusiform shape in most occasions. Early resection of myxoma and conservative therapy of aneurysm is an optimal treatment. TEE and PbtO 2 monitoring play an essential role in anesthesia management. Fast track cardiac anesthesia is safe and effective to early evaluate neurological function. Long term follow-up for "myxomatous aneurysms" is recommended. And outcome of most patients is excellent.

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The evolving role and use of echocardiography in the evaluation of cardiac source of embolism

Cited by 27 publications

References 84 publications

Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

Prognostic Relevance of Left Ventricular Thrombus Motility: Assessment by Pulsed Wave Tissue Doppler Imaging

Association of ACE2 variant rs4646188 with the risks of atrial fibrillation and cardioembolic stroke in Uygur patients with type 2 diabetes

Anesthesia management of atrial myxoma resection with multiple cerebral aneurysms: a case report and review of the literature

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