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Знаходження шляхів подолання шкільної дезадаптації є важливою і актуальною проблемою для охорони здоров’я дітей. У зв’язку с цим активно розробляються здоров’язберігаючі технології, впровадження яких дозволяє зберегти той рівень здоров’я, з яким дитина прийшла до школи. Мета. Оцінити вплив здоров’язберігаючої технології «Навчання у русі» як метод профілактики шкільної дезадаптації у дітей молодшого шкільного віку. Матеріали і методи дослідження. Проведено поглиблене клініко-інструментальне обстеження 153 дітей молодшого шкільного віку перед початком навчання в початковій школі (2013 р.), через 1 і 2 роки навчання (2014, 2015 рр.) та після закінчення початкової школи (2017 р.) в гімназії №287 м. Києва, де впроваджена авторська здоров’язберігаюча технологія “Навчання у русі” професора О.Д. Дубогай (основна група (n=65), та в ЗОШ №3 м. Боярка Київської області, де таку технологію не застосовували (група контролю (n=88). Після закінчення початкової школи задовільну адаптацію в основній групі згідно показника індексу Баєвського мали 97,2% школярів, тоді як в групі порівняння – лише 33,3%. Для визначення індивідуальних психологічних особливостей школярів та наявності шкільної дезадаптації використовували спеціально-орієнтовані методики: анкета для оцінки рівня шкільної мотивації. (Н.Г.Лусканової), тест шкільної тривожності Філіпса, проективний тест тривожності Р. Теммл, М. Доркі, В. Амена, анкетування батьків. При виконанні тесту Лусканової на початку навчання обох групах превалювали діти з середнім рівнем мотивації до навчання в школі – 83,1% в основній групі та 76,1 % в групі порівняння. По закінченні 4 року навчання після здоров’язберігаючої технології «Навчання у русі» в основній групі учнів з низькою мотивацією до навчання та проявами шкільної дезадаптації не було, а відмічено зростання частки дітей з високою мотивацією з 12,3 % до 27%. В той же час в групі порівняння виросла питома вага дітей з низькою мотивацією з 6,9% до 15%. За роки спостереження за даними проективного тесту Р.Тєммл, М. Доркі та В. Амен спостерігалось достовірне зниження дітей з високим рівнем тривожності в основній групі з 46,1% до 9,2%, а в групі порівняння кількість дітей з високим рівнем тривожності виросло до 55,7%. Через 4 роки застосування ЗЗТ в основній групі спостерігалась позитивна динамика щодо зниження кількості дітей з високим рівнем тривожності, особливо в позиціях страху невідповідності очікуванням оточення (з 40% до 4,6%), низькою фізіологічною опірністю до стресових ситуацій (з 26,1% до 4,6%), страхом ситуації перевірки знань (з 24,1% до 6,1%). У групі порівняння питома вага дітей з високим рівнем тривожності навпаки виросла, що негативно впливає як на загальний стан здоровя учнів так на шкільну успішність. Висновок. Застосування здоров’язберігаючої технології забезпечує можливість успішного вирішення проблеми профілактики шкільної дезадаптація в напрямку попередження виникнення тривожності або її зниження до оптимальних показників.

Вступ. В сучасних умовах спостерігається тенденція до збільшення показників захворюваності серед дітей, особливо після їх вступу до школи, що обумовлює необхідність впровадження здоров’язберігаючих технологій (ЗЗТ) для збереження того рівню здоров’я, з яким дитина прийшла до школи. Мета. Оцінити вплив ЗЗТ «Навчання в русі» на фізичний розвиток дітей молодшого шкільного віку та його гармонійність. Матеріали і методи дослідження. Проведене поглиблене клініко-інструментальне обстеження 153 дітей молодшого шкільного віку перед початком навчання в початковій школі (2013 р.), через 1 та 2 роки (2014, 2015 рр.) та після закінчення початкової школи (2017 р.) в гімназії №287 м. Києва, де впроваджена ЗЗТ “Навчання у русі” професора О.Д. Дубогай, та в ЗОШ №3 м. Боярка Київської області, де ЗЗТ не застосовували. Дітям оцінювали антропометричні показники згідно наказу МОЗ України № 802 від 13.09.2013 року “Критерії оцінки фізичного розвитку дітей шкільного віку” і визначали індекс маси тіла (ІМТ). Результати та їх обговорення. На протязі навчання в основній групі після закінчення початкової школи питома вага дітей з гармонійним розвитком збільшилася з 46,2% до 72,2 % (р < 0,05), тоді як в групі порівняння змін не відбулося (39,8 % та 41,7 % відповідно). При цьому, в групі порівняння за роки навчання достовірно виросла питома вага дітей з ожирінням та надлишковою масою тіла з 33,4 % до 50,0 %. В той час, як в основній групі відмічалася тенденція до зниження кількості таких дітей (з 20,0 % до 16,7 %.). Висновок. Отже, використання ЗЗТ “Навчання у русі” супроводжується оптимальним рівнем фізичного розвитку школярів та збереженням його гармонійності, що дозволяє рекомендувати вказану технологію для широкого впровадження в закладах освіти.

Background: Myocardial infarction without obstructive coronary artery disease (MINOCA) is a challenging condition which requires appropriate management and therapy. Although specific guidelines and recommendations for this condition have been introduced, there are few data about management implementation over time. The aim of this study is to compare two cohorts of patients affected by suspected MINOCA to assess the temporal trends change in the clinical characteristics and management., Methods: Two patient cohorts were retrospectively selected from a single centre (Cardiology Department of Perugia University Hospital) and compared to investigate the differences in characteristics and management before and after the release of 2018 MINOCA guidelines. The Group included patients enrolled from January 2006 to December 2014, and the Group 2 from July 1st, 2020, to July 31st, 2023., Results: Group 1 included 150 patients and Group 2 83 patients. Compared to group 1, group 2 showed higher prevalence of hypercholesterolemia (57 % vs 27 % p < 0,001), prior acute myocardial infarction (23 % vs 5 %, p <0,001), preserved left ventricular ejection fraction (90 % vs 67 %, p = 0,03), use of cardiovascular magnetic resonance (27 % vs 0 %,p < 0.001), prescription of beta-blockers (69 % vs 31 %,p < 0.001), calcium channel blockers (46 % vs 16 %, p < 0.001), statins (81 % vs 59 %, p = 0.03) and a less frequent occurrence of ST-elevation on admission ECG (9 % vs 24 %, p = 0.005), prescription of dual antiplatelet therapy (20 % vs 58 %, p < 0.001) and nitrates (12 % vs 54 %, p < 0.001)., Conclusions: In the present study, characteristics and management of patients with suspected MINOCA has significantly changed over time. However, discrepancies with guidelines recommendation still exist and implementation strategies are needed to fill this gap and improve clinical practice., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Background: Many data were published about Long-Covid prevalence, very few about the findings of new cardiac alterations (NCA) in COVID-19-recovered people. ARCA-post-COVID is an observational study designed to investigate the prevalence of NCA in patients recovered from Covid-19.Methods: from June 2020 to December 2022, we enrolled 502 patients with a positive nasopharyngeal swab for SARS-CoV2 and a subsequent negative one. We performed anamnesis, lab-test, and routine cardiological tests (ECG, Holter, TTE)., Results: The median age was 56 years (IQR 44-67); women were 52.19%; in the acute phase 24.1% of patients were treated in a medical department, 7.2% in the ICU and the others at home. At the visit, 389 patients (77.49%) complained of a broad range of symptoms. We reported patients' characteristics according to the course of the disease and the persistence of symptoms. NCA were found in 138 patients (27.49%): among them 60 cases (11.95%) of pericardial effusion. Patients with NCA were older (median 60y, IQR: 47-72, vs median 56y, IQR 42-65), had a higher prevalence of smokers (27% vs 17%; p0.014), CAD (11% vs 6%; p0.048) and stroke/TIA (3.6% vs 0.3%; p0.002) and a lower prevalence of hypercholesterolemia (18% vs 30%; p0.007). The prevalence of NCA seems constant with different subtypes of the virus., Conclusion: the prevalence of NCA in patients who recovered from COVID-19 is high and constant since the beginning of the pandemic; it is predictable based on hospitalization and long-lasting symptoms (9.64%-42.52%). Patients with one of these characteristics should undergo cardiological screening., Competing Interests: The authors report no relationships that could be construed as a conflict of interest., (© 2024 The Authors.)

Cardiac involvement in sickle beta thalassemia (Sβ-thal) patients has been poorly investigated. We aimed to evaluate cardiac function and myocardial iron overload by cardiovascular magnetic resonance (CMR) in patients with Sβ-thal. One-hundred and eleven Sβ-thal patients consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network were studied and compared with 46 sickle cell anemia (SCA) patients and with 111 gender- and age- matched healthy volunteers. Cine images were acquired to quantify biventricular function. Myocardial iron overload (MIO) was assessed by the T2* technique, while macroscopic myocardial fibrosis was evaluated by the late gadolinium enhancement (LGE) technique. In Sβ-thal and SCA patients, the morphological and functional CMR parameters were not significantly different, except for the left atrial area and left ventricular (LV) stroke volume, indexed by body surface area ( p = 0.023 and p = 0.048, respectively), which were significantly higher in SCA patients. No significant differences between the two groups were found in terms of myocardial iron overload and macroscopic myocardial fibrosis. When compared to healthy subjects, Sβ-thal patients showed significantly higher bi-atrial and biventricular parameters, except for LV ejection fraction, which was significantly lower. The CMR analysis confirmed that Sβ-thal and SCA patients are phenotypically similar. Since Sβ-thal patients showed markedly different morphological and functional indices from healthy subjects, it would be useful to identify Sβ-thal/SCA-specific bi-atrial and biventricular reference values.

Costus igneus , commonly known as the 'Insulin plant' has been traditionally used in India to lower blood sugar levels. Its method of action is through a protein peculiar to itself, which has hypoglycaemic action. It therefore may prove harmful if used in excess, or together with other hypoglycaemic agents., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hypereosinophilic syndrome (HES) is a systemic disorder with various manifestations, characterized by hypereosinophilia and caused by primary or secondary conditions. Loeffler's endocarditis (LE) represents a frequent cardiac manifestation of HES, caused by infiltration of the myocardium by eosinophilic cells, which determines endocardial damage, with subsequent inflammation, thrombosis, and fibrosis of either one or both ventricles. The diagnosis of cardiac involvement is based on a multimodality approach (i.e., two-dimensional transthoracic echocardiography [2D-TTE], speckle-tracking echocardiography [STE], and cardiac magnetic resonance [CMR]), with different findings depending on the stage of disease. STE may be useful in the initial phase when traditional imaging techniques may result negative, whereas CMR allows myocardial tissue characterization along with a better definition of the right ventricle. We present a rare case of LE with isolated right ventricular involvement in a patient with HES caused by chronic eosinophilic leukemia with constitutively activated fusion tyrosine kinase on chromosome 4q12, successfully treated with imatinib mesylate., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Cardiovascular Echography.)

Right-sided infective endocarditis (IE), which represents a small but not negligible percentage of IE cases, can be observed in patients with congenital heart diseases. We discuss the case of a young woman with unrepaired perimembranous ventricular septal defect and repeated episodes of right ventricle and tricuspid valve IE with septic embolism., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Cardiovascular Echography.)

Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that refers to a spectrum of noninfectious lesions of cardiac valves that is most commonly seen in advanced malignancy. We describe a case report of a 63-year-old male with NBTE and multiple embolizations (encephalic, coronary, splenic, and renal). The patient was admitted to the emergency department for stroke. During hospitalization, the patient complained of left leg pain and a venous echo color Doppler of the lower limbs was performed, showing bilateral distal deep-vein thrombosis. A thoracoabdominal computed tomography scan, which was performed to rule out pulmonary embolism, revealed a primary lung cancer and subcarinal lymphadenopathy. As collateral findings, multiple ischemic lesions in the spleen and in both kidneys were identified. In addition, areas of subendocardial hypodensity compatible with ischemia were also highlighted. An electrocardiogram showed acute myocardial infarction and focused echocardiographic evaluation displayed hypokinesis of the lateral and posterior in the mid- and distal segments and aortic and mitral valve vegetations, confirmed by a transesophageal echocardiography. Empiric antimicrobial therapy was started; all blood culture sets were negative and the patient was apyretic throughout the hospitalization. These findings supported the hypothesis of NBTE with multiple embolizations during a hypercoagulable state associated with advanced lung cancer., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Cardiovascular Echography.)

Pneumonia is the most commonly described manifestation of Legionella pneumophila infection (legionellosis), and extrapulmonary manifestations are uncommon. There are a few descriptions of acute myocarditis associated with legionellosis. We present a case of acute myocarditis in a patient admitted for legionellosis with multisystemic involvement (lung, heart, and kidney). Left ventricular (LV) dysfunction was documented by cardiac magnetic resonance (CMR) and two-dimensional speckle-tracking echocardiography; layer-specific strain analyses were performed, which allowed to differentiate subendocardial or subepicardial contractile impairment. Layer-specific strain analyses by echocardiography demonstrated impairment of subepicardial deformation in the inferolateral wall, which mirrored CMR findings, showing late gadolinium enhancement in the subepicardium of the same LV segments. After initiation of appropriate antibiotic therapy with levofloxacin, LV systolic function rapidly improved as assessed by both CMR and strain analyses, with concomitant normalization of both clinical and biochemical abnormalities. The basic mechanisms of myocardial involvement during legionellosis are unclear; we discussed our findings according to the limited available evidence., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Cardiovascular Echography.)

Primary cardiac lymphoma (PCL) is among the rarest heart neoplasms. Its estimated incidence is about 1%-2% among primary cardiac tumor and 0.5% of extranodal lymphoma. It usually causes heart failure, pericardial effusion, tamponade, and arrhythmias. Prognosis is poor; treatment is combined medical and surgical. We described the case of a 62-year-old male with PLC that presented with syncope and cardiac tamponade, submitted to R-CHOP therapy because of failure of surgery. Clinical state is stable 3 months after diagnosis and first chemotherapy cycle., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Cardiovascular Echography.)

Pseudoaneurysm complicated by aortopulmonary fistula (APF) after a Bentall procedure is extremely rare but potentially fatal, so timely diagnosis and treatment are critical. We present a subacute case of a post-traumatic APF which has had initial aspecific symptoms and later an acute worsening heart failure with chest pain not responding to medical treatment and requiring emergency surgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Cardiovascular Echography.)

The availability of miniaturized ultrasound machines has changed our approach to many cardiovascular diseases. Handheld ultrasound imaging can be performed at the bedside, it is easy to use, and the information provided, although limited, is of unquestionable importance for a quick diagnosis that leads to early treatment. They have unique characteristics: Low cost, wide availability, safety, accuracy, and can be used in different clinical scenarios and by operators with different backgrounds. Image acquisition and interpretation is rapid and provides, in each situation, useful information for diagnosis, prognosis, and clinical and therapeutic management. This review focuses on the use of handheld ultrasound devices, describes differences with other equipment, their limitations, and the numerous advantages derived from their use., Competing Interests: The authors declare no conflict of interest.

Background: Patent foramen ovale (PFO) is present in as many as 25% of the general population and is considered an irrelevant condition in healthy subjects. Here, we sought to determine an association between an asymptomatic PFO at baseline and postoperative short-term adverse events in patients undergoing major pulmonary resection for lung cancer. In addition, we evaluated for the rate of PFO after pulmonary resections., Methods: This prospective, observational study assessed patients by transcranial Doppler with contrast at baseline and discharge. To confirm interatrial shunting, patients with positive transcranial Doppler at baseline also underwent contrast transthoracic echocardiography. Multivariate logistic regression models were adopted to investigate for independent factors that could have been associated with complications. Backward stepwise procedure was used for model selection., Results: Median age was 67.7 ± 9.2 years (range, 36 to 86), and 67% were men. Overall, 18 patients underwent pneumonectomy, 11 bilobectomy, and 118 lobectomy; 54% underwent right-sided procedure and 46%, left-sided. One perioperative death was recorded, and 34 patients had one or more cardiopulmonary complications. At baseline, PFO was positive in 25% (37 of 147) and negative in 75% (110 of 147); of the latter, 11% were positive at discharge. Detection of PFO at baseline, on multivariate analysis, was significantly associated with a risk of postoperative complications (odds ratio 2.5; 95% confidence interval: 1.1 to 5.8). Specifically, we observed a significant association between atrial fibrillation and positive PFO at baseline (odds ratio 3.5; 95% confidence interval: 1.4 to 9.0)., Conclusions: Preoperative asymptomatic PFO was independently associated with postoperative adverse events. Moreover, 11% of patients who had negative transcranial Doppler studies at baseline had asymptomatic PFOs at discharge. Larger prospective studies are needed to further investigate for a prognostic impact of PFO in thoracic surgery., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Transitional atrioventricular (AV) septal defects are uncommon congenital heart defects, and diagnosis is usually made in childhood. We present the case of intermediate AV canal diagnosed in a man referring to cardiological examination for the first time in his life at the age of fifty for exertional dyspnea. The absence of medical examination or execution of electrocardiogram or echocardiogram in childhood or in youth and the very late appearance of symptoms lead to a late diagnosis of this congenital heart disease (CHD). This case underlines the importance of including CHD in the differential diagnosis of symptoms such as chronic dyspnea, also in adulthood., Competing Interests: There are no conflicts of interest.

Cardiovascular imaging has radically changed the management of patients with arrhythmogenic cardiomyopathies. This article focuses on the role of echocardiography and MRI in the diagnosis of these structural diseases. Cardiomyopathies with hypertrophic pattern (hypertrophic cardiomyopathy, restrictive cardiomyopathies, amyloidosis, Anderson-Fabry disease, and sarcoidosis), cardiomyopathies with dilated pattern, inflammatory cardiac diseases, and right ventricular arrhythmogenic cardiomyopathy are analyzed. Finally, anatomic predictors of arrhythmias and sudden cardiac death are discussed. Each paragraph is attended by clinical cases that are discussed on the electrocardiogram, after integrated with the anatomic, functional, and hemodynamic modifications of cardiovascular imaging., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Despite the availability of anti-hypertensive medications with proven efficacy and good tolerability, many hypertensive patients have blood pressure (BP) levels not at the goals set by international societies. Some of these patients are either non-adherent to the prescribed drugs or not optimally treated. However, a proportion has resistant hypertension (RH) defined as office BP above goal despite the use of ≥3 antihypertensive medications at maximally tolerated doses (one ideally being a diuretic). Diagnosis of RH based upon office measurements, however, needs confirmation through 24-h BP monitoring to exclude "white coat" RH since cardiovascular events and mortality rates follow mean ambulatory BPs. Standardized combination therapy based upon angiotensin converting enzyme inhibitors or angiotensin receptor blockers, amlodipine or other dihydropiridine calcium channel blockers and thiazide or thiazide-like diuretics has been advocated to treat RH with spironolactone as preferred fourth add-on drug. Interventional procedures such as renal denervation have been devised to treat RH and tested with insofar not positive results in series of patients not responding to medical treatment. It is unclear whether RH constitutes a specific phenotype of EH or should rather be considered a more serious form of uncontrolled hypertension. Whatever the case, its presence associates with an increased cardio- and cerebrovascular risk and deserves, therefore, particular care.

Sympathetic nervous system plays a pivotal role in essential hypertension and in the development of left ventricular hypertrophy. Moreover, cardiac sympathetic dys-regulation has been demonstrated as a key con-causal factor in the genesis and progression of pathologic conditions such as congestive heart failure and ischemic heart disease to which hypertension predisposes as a risk factor. However, despite its fundamental role in cardiac pathophysiology, the evaluation of cardiac sympathetic nervous system has never gained a wide clinical application, remaining mostly a research tool. In this context, nuclear imaging techniques are the only modalities to allow the direct evaluation of cardiac sympathetic nervous integrity, giving the chance to obtain objective measures of the sympathetic tone. This review, while summarizing the general profile of currently available tests for autonomic evaluation, focuses on 123 I-metaiodobenzylguanidine nuclear imaging as a preferential tool to assess cardiac sympathetic status. Specifically, the review discusses the available evidence on cardiac 123 I-metaiodobenzylguanidine scintigraphy in arterial hypertension and left ventricular hypertrophy and its diagnostic and prognostic potential in congestive heart failure and ischemic heart disease.

The prevalence of chronic heart failure (CHF) is steadily increasing. Both sexes are affected, with significant differences in etiology, epidemiology and clinical presentation, prognosis, comorbidities, and response to treatment. Women tend to develop CHF at a more advanced age, present more often with HF with preserved ejection fraction, are more symptomatic, and have a worse quality of life than men, but also a better prognosis. In women, CHF has more frequently a non-ischemic etiology, and arterial hypertension and diabetes mellitus are leading comorbidities. Furthermore, many sex-related differences have been detected in the response to treatment, for example a greater prognostic benefit from angiotensin-receptor blockers in women, a higher incidence of complications after defibrillator implantation, and a greater response to cardiac resynchronization therapy. Furthermore, women are less likely to receive defibrillator therapy or heart transplantation. The significant underrepresentation of women in clinical trials limits our capacity to evaluate the extent of sex-related differences in CHF, although their characterization seems crucial in order to achieve the ultimate goal of a tailored therapy for this condition., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

: Structural changes in left and right cardiac chambers that occur in arterial hypertension (AH) may lead to an increased risk of atrial fibrillation. Considering that AH is currently the most common cardiovascular disease in the general population, it represents a major risk factor for atrial fibrillation development. This review explores the complex relationship between atrial fibrillation and AH, starting from its pathophysiological basis. It focuses on the role of echocardiography in the management of hypertensive and atrial fibrillation patients, with emphasis on what should be evaluated about left ventricular remodeling, diastolic and systolic function, left atrial (LA) size and function and right ventricular deformation in patients with AH.

Aim: Functional analysis and measurement of left atrium are an integral part of cardiac evaluation, and they represent a key element during non-invasive analysis of diastolic function in patients with hypertension (HT) and/or heart failure with preserved ejection fraction (HFpEF). However, diastolic dysfunction remains quite elusive regarding classification, and atrial size and function are two key factors for left ventricular (LV) filling evaluation. Chronic left atrial (LA) remodelling is the final step of chronic intra-cavitary pressure overload, and it accompanies increased neurohormonal, proarrhythmic and prothrombotic activities. In this systematic review, we aim to purpose a multi-modality approach for LA geometry and function analysis, which integrates diastolic flow with LA characteristics and remodelling through application of both traditional and new diagnostic tools., Methods: The most important studies published in the literature on LA size, function and diastolic dysfunction in patients with HFpEF, HT and/or atrial fibrillation (AF) are considered and discussed., Results: In HFpEF and HT, pulsed and tissue Doppler assessments are useful tools to estimate LV filling pressure, atrio-ventricular coupling and LV relaxation but they need to be enriched with LA evaluation in terms of morphology and function. An integrated evaluation should be also applied to patients with a high arrhythmic risk, in whom eccentric LA remodelling and higher LA stiffness are associated with a greater AF risk., Conclusion: Evaluation of LA size, volume, function and structure are mandatory in the management of patients with HT, HFpEF and AF. A multi-modality approach could provide additional information, identifying subjects with more severe LA remodelling. Left atrium assessment deserves an accurate study inside the cardiac imaging approach and optimised measurement with established cut-offs need to be better recognised through multicenter studies., (© 2017 John Wiley & Sons Ltd.)

Pericardial cysts (PCs) are very rare, often congenital, mediastinal masses. Usually, they are located in the right cardiophrenic angle and only in 8% of cases in the anterior or posterior mediastinum. Computed tomography and/or magnetic resonance imaging are accurate tools for the diagnosis and characterization of mediastinal masses. However, echocardiography is, in many cases, a good screening technique. If asymptomatic, they do not require surgical excision. The authors describe a case of posterior mediastinum PC; in these cases, echocardiography cannot see the mass and three-dimensional imaging techniques are required. The clinical management of this case is discussed., Competing Interests: There are no conflicts of interest.

Exact natural history and physiopathology of takotsubo cardiomyopathy (TC) are incompletely understood. In the last years, a lot of special cases of TC appeared in the literature. This case report is a typical case of TC, which meets all Mayo Clinic diagnosis criteria, over the exceptions; its main feature is that it has both physical (medical) and emotional (psychiatric) triggers. The protagonist is a woman affected by anxious-depressive syndrome, hospitalized for a cardiogenic syncope. After pacemaker (PMK) implantation, she first has convulsive hysteric crisis, and the following day, she has a transient left ventricular apical ballooning without coronary artery stenosis: takotsubo syndrome. This case underlines the depth and strong relationship between takotsubo syndrome and psychiatric illness, which is both clinical substrate and triggering acute event, with the significant role of PMK implantation which might have had a role both as flare of psychiatric disease and as a trigger for the syndrome itself., Competing Interests: There are no conflicts of interest.

Coronary computed tomography angiography is a noninvasive heart imaging test currently undergoing rapid development and advancement. The high resolution of the three-dimensional pictures of the moving heart and great vessels is performed during a coronary computed tomography to identify coronary artery disease and classify patient risk for atherosclerotic cardiovascular disease. The technique provides useful information about the coronary tree and atherosclerotic plaques beyond simple luminal narrowing and plaque type defined by calcium content. This application will improve image-guided prevention, medical therapy, and coronary interventions. The ability to interpret coronary computed tomography images is of utmost importance as we develop personalized medical care to enable therapeutic interventions stratified on the bases of plaque characteristics. This overview provides available data and expert's recommendations in the utilization of coronary computed tomography findings. We focus on the use of coronary computed tomography to detect coronary artery disease and stratify patients at risk, illustrating the implications of this test on patient management. We describe its diagnostic power in identifying patients at higher risk to develop acute coronary syndrome and its prognostic significance. Finally, we highlight the features of the vulnerable plaques imaged by coronary computed tomography angiography., (© 2016, Wiley Periodicals, Inc.)

Background: Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right-to-left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists., Aims: This review aims to evaluate the role of PFO in cryptogenic stroke, the diagnostic accuracy of transcranial Doppler, contrast transthoracic and transesophageal echocardiography in the diagnosis of left-fright shunt and PFO; and discuss the indications to medical treatment and percutaneous closure of PFO., Methods: All studies published in the literature on PFO and cryptogenic stroke are considered and discussed., Results: We define an appropriate diagnostic and clinical management of PFO patients with cryptogenic stroke., Conclusion: After many years of interest on PFO and many concluded studies, there are still no definitive data. However, we are on good track for an appropriate management of PFO patients and cryptogenic stroke., (© 2016 John Wiley & Sons Ltd.)

Background: We prospectively assessed the incremental value of a pocket-sized echocardiography (PSE) device during cardiology consultations, in addition to physical examination, ECG reading, and chest x-ray., Methods: A total of 443 consecutive patients (53% men), referred for bedside consultations, underwent physical examination, ECG, and CXR, followed by PSE examination. The physician completed a detailed questionnaire (clinical and echocardiographic data, scanning time, abnormal results). Receiver operating characteristic (ROC) curve analysis was generated to test the predictive discrimination value of the different methods. The incremental value of PSE examination compared to clinical visit alone or combined with ECG results was expressed as a global chi-square value., Results: The PSE examination did not influence the definitive diagnosis in only 23.5% of cases, while 25.3% of the diagnoses were confirmed and verified by PSE. The clinical diagnosis was enriched by PSE in 21.9% of cases, and the diagnosis was changed in 26.2%. The area under curve (AUC) of physical examination + ECG results (sensitivity: 80%; specificity: 67%) was significantly higher than physical examination alone (sensitivity: 75%; specificity: 62%) (P < 0.0002), and the AUC of PSE results (sensitivity: 88%; specificity: 86%) was significantly higher than physical examination + ECG results (P < 0.0001). The PSE results, combined with clinical and ECG results, had a significant incremental diagnostic value during cardiology consultation when compared to the clinical visit alone or with ECG results (P < 0.0001)., Conclusions: PSE had an incremental diagnostic value during bedside cardiology consultation, increasing the number of appropriate diagnoses and reducing the routine use of echocardiography., (© 2015, Wiley Periodicals, Inc.)

The quadricuspid aortic valve (QAV) is a rare malformation; often isolated, sometimes associated with other heart diseases. Before the era of echocardiography, the diagnosis was made incidentally at autopsy or during surgery of valve replacement. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic approach is suitable for the diagnosis but, transesophageal echocardiography is a tool for the accurate definition of the valve anatomy. This review analyzes, after the presentation of a clinical case, the current knowledge on embryogenesis, classification, diagnosis and clinical course of QAV., Competing Interests: There are no conflicts of interest.

The management of medical emergency, in particular cardiac emergency, requests prompt intervention and the possibility to communicate in real time from the emergency area / ambulance to the hospital as much diagnostic information as possible about the patient. This would enable a prompt emergency diagnosis and operation and the possibility to prepare the appropriate actions in the suitable hospital department. To address this scenario, the CONCERTO European project proposed a wireless communication system based on a novel cross-layer architecture, including the integration of building blocks for medical media content fusion, delivery and access. This paper describes the proposed system architecture, outlining the developed components and mechanisms, and the evaluation of the proposed system, carried out in a hospital with the support of medical staff. The technical results and the feedback received highlight the impact of the CONCERTO approach in the healthcare domain, in particular in enabling a prompt and reliable diagnosis in challenging medical emergency scenarios.

The quality of experience and quality of service provided in the healthcare sector are critical in evaluating the reliable delivery of the healthcare services provided. Medical images and videos play a major role in modern e-health services and have become an integral part of medical data communication systems. The quality evaluation of medical images and videos is an essential process, and one of the ways of addressing it is via the use of quality metrics. In this paper, we evaluate the performance of seven state-of-the-art video quality metrics with respect to compressed medical ultrasound video sequences. We study the performance of each video quality metric in representing the diagnostic quality of the video, by evaluating the correlation of each metric with the subjective opinions of medical experts. The results indicate that the visual information fidelity, structural similarity index, and universal quality index metrics show good correlation with the subjective scores provided by medical experts. The tests also investigate the performance of the emerging video compression standard, high-efficiency video coding-HEVC, for medical ultrasound video compression. The results show that, using HEVC with the considered ultrasound video sequences, a diagnostically reliable compressed ultrasound video can be obtained for compression with values of the quantization parameter up to 35.

Rupture of the interventricular septum is a rare and life-threatening complication of acute myocardial infarction. Postmyocardial infarction, ventricular septal defect is associated with very high morbidity and mortality. The therapy of this complication is the surgical closure. The Amplatzer occluder is currently used to close percutaneously atrial septal defect, patent foramen ovale, and selected congenital ventricular septal defect. Few cases are described regarding transcatheter closure of a postinfarction ventricular septal defect. Here we report a case of a large postinfarction ventricular septal defect successfully closed with Amplatzer multifenestrated atrial septal defect occluder device because of its peculiar anatomical characteristics.