UNASSIGNED: Infective endocarditis (IE) predominantly involves the cardiac valves. Timely diagnosis and initiation of therapy significantly reduce morbidity and mortality. Infective endocarditis presenting as a large left ventricular outflow tract (LVOT) mass is an atypical manifestation that provides significant challenges to the treating team.
UNASSIGNED: A 19-year-young male presented with exertional shortness of breath, palpitations, and presyncope for 4 months with constitutional symptoms for the last 6 months. Two-dimensional echocardiogram showed a large LVOT mass arising from the mitral aortic intervalvular fibrosa causing dynamic severe aortic valve obstruction, moderate aortic regurgitation, and severe mitral regurgitation. He was managed on lines of IE and received intravenous antibiotics. In view of worsening heart failure and cardiogenic shock, he underwent mass excision, mechanical aortic valve replacement, and mitral valve repair. Histopathology confirmed it as vegetation. He was discharged and is doing well at 2-month follow-up.
UNASSIGNED: An atypical presentation of IE as a large LVOT mass was observed in this young male. Sound clinical judgement, judicious use of ancillary imaging, and a multidisciplinary approach ensured timely diagnosis and appropriate treatment. Management included appropriate intravenous antibiotics followed by surgery.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic performance and relationships of cardiac MRI structural parameters and strain components in patients with cardiac amyloidosis (CA) and to estimate the capabilities of these variables to discriminate between CA and non-amyloid cardiac hypertrophy (NACH).
METHODS: Seventy patients with CA (56 men; mean age, 76 ± 10 [standard deviation] years) and 32 patients (19 men; mean age, 63 ± 10 [standard deviation] years) with NACH underwent cardiac MRI. Feature tracking (FT) global longitudinal strain (GLS), radial strain (GRS), circumferential strain (GCS), strain AB ratio (apical strain divided by basal strain), myocardial T1, myocardial T2 and extracellular volume (ECV) were calculated. Comparisons between patients with CA and those with NACH were made using Mann-Whitney rank sum test. The ability of each variable to discriminate between CA and NACH was estimated using area under the receiver operating characteristic curve (AUC).
RESULTS: Patients with CA had higher median GLS (-7.0% [Q1, -9.0; Q3, -5.0]), higher median GCS (-12.0% [Q1, -15.0; Q3, -9.0]), and lower median GRS (16.5% [Q1, 13.0; Q3, 23.0]) than those with NACH (-9.0% [Q1, -11.0; Q3, -8.0]; -17.0% [Q1, -20.0; Q3, -14.0]; and 25.5% [Q1, 16.0; Q3, 31.5], respectively) (P < 0.001 for all). Median myocardial T1 and ECV were significantly higher in patients with CA (1112 ms [Q1, 1074; Q3, 1146] and 47% [Q1, 41; Q3, 55], respectively) than in those with NACH (1056 ms [Q1, 1011; Q3, 1071] and 28% [Q1, 26; Q3, 30], respectively) (P < 0.001). Basal ECV showed the best performance for the diagnosis of CA (AUC = 0.975; 95% confidence interval [CI]: 0.947-1). No differences in AUC were found between AB ratio of GRS (0.843; 95% CI: 0.768-0.918) and basal myocardial T1 (0.834; 95% CI: 0.741-0.928) for the diagnosis of CA (P = 0.81). The combination of the AB ratio of FT-GRS and basal myocardial T1 had a diagnostic performance not different from that of basal ECV (P = 0.06).
CONCLUSIONS: ECV outperforms FT-strain for the diagnosis of CA with cardiac MRI. The AB ratio of FT-GRS associated with myocardial T1 provides diagnostic performance similar to that achieved by ECV.

UNASSIGNED: Cardiac magnetic resonance imaging (MRI) is the gold standard in the assessment of left ventricle (LV) mass and wall thickness. In recent years, cardiac computed tomography angiography (CCTA) has gained widespread usage as an imaging modality. Despite this, limited previous investigations have specifically addressed the potential of CCTA as an alternative modality for quantitative LV assessment. The aim of this study was to compare CCTA derived LV mass and wall thickness with cardiac MRI utilizing machine learning algorithms.
UNASSIGNED: Fifty-seven participants who underwent both CCTA and cardiac MRI were identified. LV mass and wall thickness was calculated using LV contours which were automatically placed using in-house developed machine learning models. Pearson\'s correlation coefficients were calculated along with Bland-Altman plots to assess the agreement between the LV mass and wall thickness per region on CCTA and cardiac MRI. Inter-observer correlations were tested using Pearson\'s correlation coefficient. Average LV mass and wall thickness for CCTA and cardiac MRI were 127 g, 128 g, 7, and 8 mm, respectively. Bland-Altman plots demonstrated mean differences and corresponding 95% limits of agreement of -1.26 (25.06; -27.58) and -0.57 (1.78; -2.92), for LV mass and average LV wall thickness, respectively. Mean differences and corresponding 95% limits of agreement for wall thickness per region were -0.75 (1.34; -2.83), -0.58 (2.14; -3.30), and -0.29 (3.21; -3.79) for the basal, mid, and apical regions, respectively. Inter-observer correlations were excellent.
UNASSIGNED: Quantitative assessment of LV mass and wall thickness on CCTA using machine learning algorithms seems feasible and shows good agreement with cardiac MRI.

UNASSIGNED: Hydroxychloroquine (HCQ) is a disease-modifying antirheumatic used in rheumatological diseases such as systemic lupus erythematosus. Long-term exposure to HCQ results in drug accumulation and predisposes to adverse effects.
UNASSIGNED: We present the case of a 45-year-old woman with long-term treatment with HCQ who presented to the Emergency Department with acute heart failure. Transthoracic echocardiogram, previously normal, showed severe biventricular hypertrophy and biventricular systolic dysfunction. Cardiac magnetic resonance (CMR) confirmed the previous findings and showed elevated native T1 and T2 values, elevated extracellular volume, and extensive mid-wall late gadolinium enhancement (LGE). Infiltrative cardiomyopathy was suspected, and endomyocardial biopsy performed. Light microscopy showed myocyte hypertrophy and vacuolar change and absence of lymphocytic inflammatory infiltrates. The diagnosis of HCQ-induced cardiomyopathy was established, and the drug was withdrawn. A CMR performed 1 year later showed normal systolic function of both ventricles and normalization of T2 values, reflecting resolution of myocardial oedema. However, severe hypertrophy, elevated native T1 values, and LGE persisted.
UNASSIGNED: Our case shows that although discontinuation of the drug stops the progression of the disease, established myocardial structural damage persists. Early diagnosis of this entity is therefore essential to improve prognosis.

暂无摘要。

Fabry disease (FD) is an X-linked lysosomal storage disorder which leads to the accumulation of globotriaosylceramide (Gb3) in various organs, including the heart. FD can be subdivided into classic disease resulting from negligible residual enzyme activity and a milder, atypical phenotype with later onset and less severe clinical presentation. The use of multimodality cardiac imaging including echocardiography, cardiac magnetic resonance and nuclear imaging is important for the diagnostic and prognostic evaluation in these patients. There are gaps in the literature regarding the comprehensive description of cardiac findings of FD and its evaluation by multimodality imaging. In this review, we describe the contemporary practices and roles of multimodality cardiac imaging in individuals affected with Fabry disease.

BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated reduction in heart failure outcomes in patients with type 2 diabetes mellitus, although the exact mechanism of benefit remains unclear. Alteration in left atrial (LA) function due to chronic pressure or volume overload is a hallmark of heart failure.
OBJECTIVE: To evaluate the effect of the SGLT2 inhibitor empagliflozin on LA volume and function.
METHODS: 90 patients with coronary artery disease and type 2 diabetes (T2DM) were randomized to empagliflozin (n = 44) or placebo (n = 46), and underwent cardiac magnetic resonance (CMR) imaging at baseline and after 6 months. The main outcome was change in LA volume; LA function, including active and passive components, was also measured by a blinded reader.
RESULTS: At baseline, there was no significant difference in LA volumes between the empagliflozin (indexed maximum LA volume 26.4 ± 8.4mL/m2, minimum LA volume 11.1 ± 5.7mL/m2) and placebo (indexed maximum LA volume 28.7 ± 8.2mL/m2, minimum LA volume 12.6 ± 5.0mL/m2) groups. After 6 months, changes in LA volumes did not differ with adjusted difference (empagliflozin minus placebo): 0.99 mL/m2 (95% CI: -1.7 to 3.7 mL/m2; p = 0.47) for indexed maximum LA volume, and 0.87 mL/m2 (95% CI: -0.9 to 2.6 mL/m2; p = 0.32) for indexed minimum LA volume. Changes in total LA emptying fraction were also similar, with between-group adjusted mean difference - 0.01 (95% CI: -0.05 to 0.03, p = 0.59).
CONCLUSIONS: SGLT2 inhibition with empagliflozin for 6 months did not have a significant impact on LA volume and function in patients with T2DM and coronary artery disease. (Effects of Empagliflozin on Cardiac Structure in Patients with Type 2 Diabetes [EMPA-HEART]; NCT02998970).

BACKGROUND: The usefulness of monitoring treatment effect of tafamidis using magnetic resonance imaging (MRI) extracellular volume fraction (ECV) has been reported.
OBJECTIVE: we conducted a meta-analysis to evaluate the usefulness of this method.
METHODS: Data from 246 ATTR-CMs from six studies were extracted and included in the analysis. An inverse variance meta-analysis using a random effects model was performed to evaluate the change in MRI-ECV before and after tafamidis treatment. The analysis was also performed by classifying the patients into ATTR-CM types (wild-type or hereditary).
RESULTS: ECV change before and after tafamidis treatment was 0.33% (95% CI: -1.83-2.49, I2 = 0%, p = 0.76 for heterogeneity) in the treatment group and 4.23% (95% CI: 0.44-8.02, I2 = 0%, p = 0.18 for heterogeneity) in the non-treatment group. The change in ECV before and after treatment was not significant in the treated group (p = 0.76), but there was a significant increase in the non-treated group (p = 0.03). There was no difference in the change in ECV between wild-type (95% CI: -2.65-3.40) and hereditary-type (95% CI: -9.28-4.28) (p = 0.45).
CONCLUSIONS: The results of this meta-analysis suggest that MRI-ECV measurement is a useful imaging method for noninvasively evaluating the efficacy of tafamidis treatment for ATTR-CM.

暂无摘要。

​Head and neck squamous cell carcinomas (HNSCC) are common malignancies that can metastasize to various distant sites. Cardiac metastasis (CM) from a primary HNSCC is an extremely rare finding that presents a significant challenge due to its association with a poor prognosis and limited treatment options. Due to their rare occurrence, there is no clear consensus on how to diagnose and manage such cases. In this article, we review a patient with complicated CM from buccal squamous cell carcinoma, which was incidentally detected by fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT).