April 2016 Br J Cardiol 2016;23:(1) doi: 10.5837/bjc.2016.015 Online First
Azeem S Sheikh, Asma Abdul Sattar, Claire Williams
Despite the significant improvements in both diagnostic and therapeutic procedures in recent years, infective endocarditis (IE) remains a medical challenge due to poor prognosis and high mortality. Echocardiographically, the majority of the patients demonstrate vegetations on a single valve, while demonstration of involvement of two valves occurs much less frequently; triple-valve involvement is extremely rare. Reported operative mortality after triple-valve surgery is high and ranges between 20% and 25%.
Surgical treatment is used in approximately half of patients with IE because of severe complications. Reasons to consider early surgery in the active phase, i.e. while the patient is still receiving antibiotic treatment, are to avoid progressive heart failure and irreversible structural damage caused by severe infection, and to prevent systemic embolism. Prognosis in IE is influenced by four main factors: characteristics of the patient, the presence or absence of cardiac and non-cardiac complications, the infecting organism, and echocardiographic findings. Prognosis of right-sided native valve endocarditis is relatively good, with an in-hospital mortality rate of about 10%.
We present a case of a young man with triple-valve endocarditis followed by a brief review of the literature.
April 2016 Br J Cardiol 2016;23:(1) doi: 10.5837/bjc.2016.016 Online First
Fatemeh Homaei Shandiz, Afsoon Fazlinezhad, Ahmad Tashakori Beheshti, Hesam Mostafavi Toroghi, Golkoo Hosseini, Maliheh Bakaiyan
This was a pilot study, in which 55 breast cancer patients were enrolled, to evaluate the alterations of strain and strain-rate parameters in breast cancer patients receiving doxorubicin and compare them with serial conventional echocardiography changes. A week prior to, and a week after, chemotherapy with doxorubicin, left ventricular ejection fraction (LVEF) and strain and strain-rate parameters were measured by conventional 2D echocardiography and tissue Doppler-based imaging, respectively.
Comparison of the results of pre- and post-chemotherapy evaluation demonstrated that strain and strain-rate parameters were significantly reduced. Mean difference (standard deviation) for the strain measurement of basal-septal, basal-lateral, basal-inferior, and basal-anterior values were 2.58% (2.15), 3.20% (1.94), 4.13% (3.48), and 2.86% (2.65), respectively; and for the strain-rate values were 0.18 s–1 (0.17), 0.17 s–1 (0.17), 0.24 s–1 (0.19), and 0.19 s–1 (0.14), respectively; all p values <0.001. There was no significant change in patients’ LVEF after chemotherapy (pre-intervention 61.10 (4.86), post-intervention 61.06 (4.82), p=0.857).
In conclusion, strain/strain-rate significant reduction, in the setting of normal range LVEF, suggests subclinical heart failure. Whether the strain and strain-rate imaging should replace the conventional echocardiography for early monitoring of cardiotoxicity of doxorubicin requires further investigations.
April 2016 Br J Cardiol 2016;23:(1) doi: 10.5837/bjc.2016.017 Online First
Luciano Candilio, Juliana Duku, Alexander W Y Chen
A 79-year-old lady was taken to the emergency department by her carer, who had noticed an acute deterioration of her general condition. Unfortunately, it was difficult to obtain an accurate history from the patient due to cognitive impairment, and her carer was not aware of her past medical history. However, she had been observed clenching her hands to her chest. She was not previously known to the admitting hospital.
March 2016 Br J Cardiol 2016;23:21–6 doi: 10.5837/bjc.2016.009
Mamta H Buch
Current transcatheter mitral valve techniques are at the beginning of an era of innovation before their full potential is realised. The broadening of available options for mitral regurgitation (MR) reduction is welcome and transcatheter mitral valve interventions provide complementary strategies in the drive for more safe and effective therapies for patients. In this article, the evidence and indications for MitraClip® are reviewed.
March 2016 Br J Cardiol 2016;23:33 doi: 10.5837/bjc.2016.010
Lesley Kavi, Michaela Nuttall, David A Low, Morwenna Opie, Lorna M Nicholson, Edward Caldow, Julia L Newton
Postural tachycardia syndrome (PoTS) is a recently recognised condition that usually affects younger women, who develop symptoms of orthostatic intolerance and a persistent tachycardia on standing upright. Healthcare professionals, patients and the national patient support group (PoTS UK) together created a survey, and the responses of 779 UK PoTS patients were analysed. The most common symptoms of PoTS at presentation were the triad of fatigue, lightheadedness and palpitations. Mobility, ability to work or attend education, and quality of life were significantly restricted. Cardiologists, followed by patients, were most likely to be the first to suggest the diagnosis of PoTS. Patients waited a mean of almost four years from presentation to obtain their diagnosis and, meantime, psychiatric mislabeling was common. Advice given to patients regarding lifestyle changes was variable, and those referred to specialist practitioners for help, found practitioners had limited knowledge about management of PoTS. Increased education of healthcare professionals and improved services for patients are recommended.
MEETING REPORT Online First