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To determine if health-related quality of life (HRQoL) improvement after cardiac resynchronization therapy (CRT) correlates with improved left-ventricular ejection fraction (EF).CRT was reported to improve EF and HRQoL in clinical trials of heart failure with reduced EF (HFrEF). It is unknown if improvements in HRQoL reflect EF response to CRT.We included HFrEF patients who underwent CRT and had both pre- and post-CRT HRQoL assessment. EF response was categorized as absent (0% change or decrease), modest (0%-19% increase), or significant (20% increase). We examined the associations between EF response and generic (PROMIS) and HF-specific (KCCQ-12) HRQoL.The group included 115 patients with mean age of 65 years and baseline EF of 31%; 39% were female (n = 45). Nineteen percent (n = 22) had significant, 57% (n = 66) modest, and 23% (n = 27) absent EF responses. AF burden across significant (8.9%), modest (4.8%), and absent EF responders (1.4%) was similar ( P = 0.20). Significant improvements in KCCQ-12 (43.4-57.5, P = 0.003), current health visual analog scale (49.1-55.9, P = 0.042), PROMIS fatigue (58.9-55.1, P = 0.026), and PROMIS satisfaction (42.7-46.4, P = 0.020) resulted following CRT across all groups. There was no association between significant EF improvement and HRQoL by KCCQ-12 (nonresponse, 44.4%; modest response, 33.3%; and significant response, 22.2%) at 1 year ( P = 0.52 across all groups).CRT was associated with a modest to significant EF response in a majority of patients. However, EF response did not significantly correlate with generic or HF-specific HRQoL measures. Further investigations are warranted into determinants of improved HRQoL following CRT.

Background Metastatic cardiac calcifications are often seen in patients with renal failure and dialysis associated with vascular calcification and calcifications in other organs. There is little to no evidence of metastatic cardiac calcification in patients with a history of rickets. Case summary A 40-year-old patient with a history of rickets treated in infancy and no personal history of cardiovascular or renal disease came for a periodical examination. Transthoracic echocardiogram showed an important calcification in the mitral annulus and the mitro-aortic junction. Computed tomography (CT) showed marked calcification affecting the heart fibrous skeleton. Coronary arteries were not affected. Discussion Distribution of heart calcification seen both with echocardiography and CT is important to report so they can be identified as dystrophic or metastatic. These two have different aetiologies so the description may help identify the possible cause.

The aim of this study was to investigate the prevalence, characteristics, and possible clinical impact of the thin fluttering bands detected by carotid ultrasound. This is a prospective, observational study carried out in a single center between 2016 and 2018. A thin fluttering band was defined as a hyperechoic fluttering band detected by ultrasound in the carotid lumen in absence of findings compatible with pattern of dissection. Intraobserver and interobserver variability were carried out. A total of 3440 patients (p) were evaluated by carotid ultrasound, and thin fluttering bands were detected in 118 p (prevalence of 3.43%). The mean age was 58.9 ± 8.5 years and 48 p (40.7%) were male. In total, 97.5% of patients had no symptoms or neurological history. A total of 134 thin fluttering bands were identified (1.13 TFB/p; 104 p with 1 thin fluttering band, 12 p with 2 thin fluttering bands, and 2 p with 3 thin fluttering bands), and 83% of them were visualized from both longitudinal and transversal ultrasound views. Seventy-seven (57.5%) thin fluttering bands were localized on the right side, with the carotid bifurcation as the most common location (127 thin fluttering bands, 94.8%). The mean length of the bands was 5.6 ± 2.6 mm, with no significant differences in size according to the location, intima media thickness, or presence of carotid plaques. No significant interobserver and intraobserver variability was found. In conclusion, we have presented patients with thin fluttering bands, observing a significant prevalence in our population and ruling out a visual artifact. Their relationship with the genesis of atheroma plaques or its possible neurologic impact remains unclear.

Introduction: Accurate assessment of the risk of adverse outcomes can assist in the management of patients with heart failure (HF). Hypothesis: Health-related quality of life (HRQoL) can improve prediction of HF outcomes beyond that of the more traditional clinical disease characteristics. Methods: We included consecutive patients with HF with reduced ejection fraction (HFrEF) who were seen in the HF clinic and completed patient reported outcome assessment (PROs) as part of routine care. Elastic net and gradient boosting regression analysis were used to build predictive models for HF hospitalization, heart transplant, left ventricular assist device implantation or death (composite outcome), including a range of clinical variables and PRO results as covariates. Results: There were 1,165 patients with HFrEF (mean age 60.5±16.2, 65% male) with median follow-up time of 490 days. Addition of PROs to more traditional risk factors improved model performance, as analyzed by C-statistics. The gradient boosting regression was chosen as the final model based on superior prediction performance - c-statistic 0.733 and favorable stratification of patient risk - Figure 1A . The Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ) and PROMIS dimensions of Satisfaction with social roles and activities and Physical function were covariates with high variable importance measure in the model. The predictive value of PROs was also confirmed by determining freedom from the composite endpoint in the 20th, 50th and 80th percentiles of PRO strata, while assigning the remaining clinical variables a median value ( Figure 1B ). In this analysis, PROs discriminated outcomes independent of other clinical characteristics. Conclusions: HRQoL appears to significantly modify outcome in HFrEF. Routine assessment of PROs could help to more accurately assess risk of adverse outcomes and personalize informed treatment decisions.

Background Patient-reported outcomes (PROs) quantify, from patients' perspectives, their symptoms, function, and quality of life. Our aim was to determine the feasibility of integrating PRO capture into routine clinical practice at a large heart failure (HF) clinic. Methods We examined the practicality of PRO completion at the time of clinic visit, the time required to complete the selected instruments, the completion rate, and the feasibility of immediate PRO scoring and integration of the results into the electronic health record (EHR). We deployed a computer program to capture PROs (Kansas City Cardiomyopathy Questionnaire, Patient-Reported Outcomes Measurement Information System) on a portable computer platform at the time of a clinic visit. An automated algorithm identified patients scheduled for appointments at the HF clinic at registration, provided a portable tablet computer with which to complete the appropriate PRO instruments and then scored and immediately integrated the results in the patient's EHR. Results In a 12-month period, 862 unique patients completed 1,320 PRO assessments. The mean age of this cohort was 60.1 ± 16.3 years and 66% were male. The average time for PRO assessment was 6.7 minutes and the completion rate among eligible patients was 58%, with 91% of started assessments completed in full. Conclusions These preliminary data support the feasibility of serial PRO assessment with real-time integration into the EHR in a large outpatient population of patients with HF. We identified critical steps that should enhance adoption of this approach by clinicians and render PRO results meaningful and actionable in routine clinical care.

Objectives Our goal was to identify conventional, deformational, and rotational echocardiographic parameters that could differentiate heart failure patients with preserved ejection fraction secondary to amyloidosis (HFpEF-amyloid) vs. heart failure patients with preserved ejection fraction without amyloidosis (HFpEF). Introduction HFpEF represents a heterogeneous clinical syndrome. Studies have shown that a substantial number of HFpEF patients have cardiac amyloidosis. Early identification of cardiac amyloidosis with a routine imaging modality such as echocardiography could improve disease management and outcomes. Methods and Results Medical records of patients with HFpEF-amyloid and HFpEF were reviewed. The presence of amyloidosis in the HFpEF-amyloid group was confirmed by cardiac biopsy, while cardiac magnetic resonance imaging ruled out its presence in the HFpEF group. The study included 34 patients with HFpEF-amyloid and 33 patients with HFpEF. Conventional echocardiographic parameters were compared between all subjects among the groups, while deformational and rotational parameters were compared between 10 subjects in each group, as these had adequate imaging quality to measure the parameters. Both groups had similar left ventricular ejection fraction. Subjects in the HFpEF-amyloid group had more grade III diastolic dysfunction, a shorter deceleration time, and lower tissue Doppler e’ wave velocities. Patients with HFpEF-amyloid had significantly more impaired left ventricular longitudinal and basal strains and higher relative apical sparing ratios. Conventional echocardiographic parameters with the highest diagnostic accuracy for HFpEF-amyloid were an interventricular septum thickness ≥1.3 cm, a Doppler average e’ ≤6.5 cm/sec, a septal e’ 0.8. For deformational parameters, a relative apical sparing strain ratio of ≥1.5 and a basal longitudinal strain ≥-12% showed the highest accuracy to diagnose HFpEF-amyloid with AUC of 0.98 and 0.96, respectively (Table). Conclusion In patients with HFpEF, specific conventional and deformational echocardiographic parameters could reveal patterns for earlier identification of cardiac amyloidosis.

Resumen es: La hipertrofia ventricular izquierda es un predictor de riesgo de eventos cardiovasculares. Los objetivos del presente trabajo fueron establecer los valo...

Resumen es: El aneurisma de la orejuela de la auricula izquierda, ya sea congenito o adquirido, es una anomalia extremadamente rara. Es causado por la displasia cong...

Introduction and objectives. Myxomas are the most common type of primary cardiac tumors. The aim of this study was to analyze the clinical forms of presentation of cardiac myxoma, the postoperative evolution, and the possibility of recurrence and tumoral embolism. Patients and method. From July 1992 to March 1999, 31 patients with myxoma were studied. Cell cycles (ploidy pattern of the tumoral DNA) were studied in 12 patients to evaluate the risk of recurrence and tumoral embolism. Results. The most frequent clinical manifestations were constitutional symptoms (74%), dyspnea (45%), and embolism (41%). Smaller-diameter myxomas correlated independently with tumoral embolism (45%). The inhospital mortality was 3.2%, no deaths were observed during follow-up (mean: 4.8 years). No patients had clinical or echocardiographic signs of tumoral recurrence. Patients with tumoral embolism (n = 8) were compared with patients without embolism (n = 4). Patients who suffered embolism had higher S phase > 7 and/or DNA index > 1.2 (4/4 patients [100%], p= 0.061) than patients without embolism (2/8 patients [25%]). Cytometry of the only recurrent tumor (second operation) revealed a diploid tumor with a significantly more frequent S phase (10%) than in sporadic myxomas (4.27 ± 2.32%, p = 0.039). Conclusions. Constitutional symptoms, dyspnea, and tumor embolism were the most frequent clinical manifestations. Clinical and anatomopathologic characteristics and the cell cycle were not significantly related to tumoral embolism, but there was a tendency toward a higher proportion of cells in S phase and a higher DNA index in tumors associated with embolism. The S phase was significantly more frequent in the only case of recurrent myxoma and could be a potential marker of recurrence.