A Case for Utilizing Ultrasound Contrast Agents During Echocardiography

The Devastating Impact of Artificial Intelligence (AI) on the Traditional Ways of Practising Imaging and Cardiology Are ‘imagers’ an endangered species, and should trainees rethink their careers?

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<p>Provocative comments can entertain and instruct as long as they are used to stimulate a civilized discussion, and it is fun to embrace an opportunity to change one’s mind (and learn). I am therefore delighted to respond to Adrian Ionescu’s comments, although I think he has got it wrong—as I will aim to demonstrate. In the spirit of this debate, please indulge me while I too let off some steam!</p>
<p>I have always disliked the fact that one of the subspecialties within cardiology, which did not exist when I qualified in the 1970s, has come to be known as “cardiac imaging.” Cardiac diagnosis is not about pictures, although some conditions are indeed instantly recognizable. Usually, what we need to know to understand disease is how the heart is functioning, much more than what it looks like. That is true for coronary arteriography as much as for non-invasive imaging. If I am forced to adopt a subspeciality label, then I would much prefer to be considered a clinical pathophysiologist.</p>
<p>Accurate diagnosis is the sine <italic>qua non</italic> of logical evidence-based clinical practice, yet we often get it wrong. And there remain many patients with disease that we cannot diagnose precisely because we do not understand it sufficiently. Why does this patient with heart failure with reduced ejection fraction have impaired left ventricular function? Why does that patient with normal blood pressure have left ventricular hypertrophy? In this patient in sinus rhythm, which particular aspects of cardiovascular function will influence the development of dementia? Cardiologists who are expert in performing, analyzing, and interpreting detailed echocardiographic and cardiovascular investigations are needed to give us the best chance of answering such questions. They cannot be replaced by an uninterpretable computer algorithm when no-one yet knows the answer—but by staying in control, researchers can use artificial intelligence (AI) to help their thinking.</p>
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A Counterblast to Pessimists and Naysayers – Intelligent Echocardiography Remains the Foundation Stone of Evidence-Based Clinical Cardiology

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<h3>Background</h3>
<p>Two-dimensional speckle-tracking echocardiography (2D-STE) provides a quantitative tool to evaluate LV function at the regional level. The purpose of this study was to classify the types of regional longitudinal strain curves (LSC). Moreover, we propose a novel longitudinal strain curve index (LSCI) which we compared to the wall motion score index (WMSI).</p>
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<h3>Methods</h3>
<p>We enrolled 100 healthy volunteers and 50 patients with prior myocardial infarction (MI). Each LSC was classified considering the positive peak (peak P), peak maximum strain (PMS), and time to maximum peak strain (TPMS) as follows: Type 1 (Peak P&lt;6%, PMS>6%, TPMS before aortic valve closure [AVC]); Type 2 (Peak P&lt;6%, PMS≥6%, TPMS after AVC); Type 3 (Peak P≥6%, PMS≥6%, TPMS before AVC); Type 4 (Peak P≥6%, PMS≥6%, TPMS after AVC); Type 5 (Peak P&lt;6%, PMS≥6%, TPMS first third of systole); Type 6 (Peak P&lt;6%, PMS&lt;6%); and Type 7 (Peak P≥6%, PMS&lt;6%). The longitudinal curve score index (LCSI) was obtained (sum of LSC type/18 segments).</p>
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<h3>Results</h3>
<p>A total of seven types of LSC were identified. In the healthy subjects, LSC Type 1 (T1) and Type 2 (T2) were the most frequent. Type 3 (T3) and Type 4 (T4) were found in insignificant percentages while Type 5 (T5), Type 6 (T6), and Type 7 (T7) were not identified. When analyzed for the entire population, LSCI correlated strongly with WMSI (r=0.83, p&lt;0.01).</p>
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<h3>Conclusions</h3>
<p>Analysis of LSC may provide a substantial support to visual assessment of regional LV function and the LCSI represents an index that is highly reproducible, independent of the examiner’s experience.</p>
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Classification of longitudinal strain curves measured by speckle-tracking echocardiography in normal and pathological myocardial segments

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<h3>Background</h3>
<p>This review is based on the case of a 71-year-old female patient, with cardiovascular risk factors, who was referred for emergency cardiological evaluation after experiencing severe anterior chest pain that had lasted for more than 5 hours at the time of admission.</p>
<p>A diagnosis of inferior-posterior ST-segment elevation myocardial infarction was established, and emergency coronary angiography was performed. It revealed severe, diffuse dilation of the entire arterial coronary tree with slow flow and the presence of a large quantity of thrombotic material in the right coronary artery. Thromboaspiration was deemed unfit since the operator believed that there was a high risk of distal embolization with subsequent no-reflow, when passing with the catheter. As such, the patient started receiving anticoagulant therapy, and after one month she was scheduled for a control angiogram. The follow-up coronary angiography identified complete dissolution of the thrombus from the right coronary artery and a moderate stenosis in the distal segment, so no stent implantation was required.</p>
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<h3>Rationale for review</h3>
<p>After performing a complete and comprehensive differential diagnosis, presence of isolated coronary artery ectasia was established.</p>
<p>Coronary artery ectasia is a rare disease, usually found incidentally during coronary angiograms performed for other indications (chronic and acute coronary syndromes) with a vast etiology and complex pathophysiology. Because there are common morphopathologic pathways between coronary artery ectasia and atherosclerotic coronary artery disease, the clinical presentation of the former might have similar characteristics with the latter, but the management and prognosis of these patients is much less studied compared to the patients suffering from different phenotypes of coronary atherosclerosis. This review aims to summarize the etiopathogenesis, clinical presentation, diagnostic modalities, and different management pathways of coronary artery ectasia.</p>
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Isolated coronary artery ectasia presenting as inferior-posterior STEMI—a case-based state-of-the-art review of the current literature

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<h3>Introduction</h3>
<p>Left ventricular hypertrabeculation is a recently described ventricular phenotype characterized by the alternation of excessive trabeculations with deep intertrabecular recesses that communicate with the left ventricular cavity but not with the coronary circulation.</p>
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<h3>Case presentation</h3>
<p>We report the case of a young patient, recently diagnosed with ischemic stroke, in whom the cardiological assessment revealed the coexistence of left ventricular hypertrabeculation and dilated cardiomyopathy, which pathologies associated with a high risk of embolic events. The treatment administered followed the therapy for chronic heart failure, control of rhythm disorders that might occur, and the prevention of embolic accidents.</p>
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<h3>Conclusions</h3>
<p>The particularity of the case is represented by atypical onset through a complication of the disease in a cardiovascular paucisymptomatic patient. Multimodal imaging corroborated with clinical and anamnestic elements had an essential role in the diagnosis.</p>
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What can a cryptogenic stroke hide in a young patient?

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<p>A 43-year-old woman with a recent history of confirmed hepatitis B presented with yellow sclera and dyspnea. Clinically, she had tachycardia and tachypnea as well as signs of jaundice and right upper quadrant pain. She was in sinus rhythm with a normal aspect of cardiac examination. She was treated with corticosteroids and her symptoms were partially relieved, however, her mild fever remained unchanged and a transthoracic echocardiogram (TTE) and transesophageal echocardiography (TEE) were done to rule out embolic or in situ infective endocarditis. Images from the TEE and TTE showed a ping-pong-like clot in the left atrium with a normal cardiac function and a normal mitral valve function. The mitral leaflets appeared to be normal with no regurgitation, and no clot was noted in other chambers or valves, including the atrial appendages. A differential diagnosis of infective vegetations, clots, or tumors was considered. The three subsequent blood cultures were negative. A complete thrombophilia assay revealed a severe reduced protein C factor, however, the IgG anti cardiolipin and lupus anticoagulant were normal. The woman’s anti-nuclear antibody and anti-double-stranded DNA were negative, confirming the diagnosis of acquired protein C deficiency. The patient underwent an open surgical removal of the clot and postoperative treatment with steroids, warfarin, and heparin. The postoperative course was uneventful, and the patient was discharged on the 13th day of operation in good condition. This case was interesting because we did not find any mitral valve pathology such as mitral stenosis, or arrhythmia like atrial fibrillation.</p>
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Free-floating left atrial thrombi with acquired protein C deficiency in hepatitis

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<h3>Introduction</h3>
<p>Rheumatoid arthritis (RA) is a chronic inflammatory rheumatic disease with an autoimmune component that preferentially affects the small joints of the hands and feet. Extra-articular manifestations may be associated with it. These are rather long-term complications compared to the inaugural forms of the disease.</p>
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<h3>Observation</h3>
<p>We report the observation of a 62-year-old female patient with a history of high blood pressure under monotherapy by a conversion enzyme inhibitor, followed for recurrent pericarditis for three years, who was initially treated with anti-bacillary drugs without improvement. She presented two years ago an episode of pericarditis of great abundance requiring a pericardial drainage. The pericardial biopsy was non-specific. The etiological work-up revealed the presence of anti-citrullinated peptide antibodies (ACPA) and a rheumatoid factor (RF) at very high levels. The patient did not present any other systemic signs, especially articular ones. Joint imaging was normal. The evolution was marked by the persistence of a pericardial effusion of a small to medium size. RA could not be retained according to the American College of Rheumatology/ European League Against Rheumatism’s (ACR/EULAR) 2010 criteria. Glucocorticoids therapy at a dose of 0.5 mg/kg/day allowed the resolution of the pericarditis without recurrence, with a six-month follow-up period.</p>
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<h3>Conclusion</h3>
<p>This is an extra-articular manifestation that would be inaugural of RA. It is an atypical presentation in the usual history of the disease. The inclusion of extra-articular involvement in the classification criteria and in the groups at risk of developing RA would be useful in these cases.</p>
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Recurrent ACPA-positive pericarditis, would it be a pre-clinical manifestation of RA?

AHEAD OF PRINT

Volume 34 (2024): Issue 1 (March 2024)

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Volume 33 (2023): Issue 3 (September 2023)

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Volume 32 (2022): Issue 4 (December 2022)

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Volume 31 (2021): Issue 4 (December 2021)

Volume 31 (2021): Issue 3 (September 2021)

Volume 31 (2021): Issue 2 (June 2021)

Volume 31 (2021): Issue 1 (March 2021)

Romanian Journal of Cardiology

The Romanian Journal of Cardiology (RJC) is the official journal of the Romanian Society of Cardiology (Societatea Romana de Cardiologie) and is published quarterly.   The aim of the Romanian Journal of Cardiology was stated from the moment of its foundation in 1991: to provide an open forum for exchange of ideas and a strong connection between basic and clinical cardiology. The journal serves the interest of both practicing clinicians and researchers.   The Romanian Journal of Cardiology is an international, English language, peer-reviewed journal publishing original scientific articles in a wide range of basic, clinical, and experimental research areas. It covers all aspects of cardiology and its related specialties. The Journal publishes articles relevant to adult and pediatric cardiologists, cardiac surgeons, internists, and professionals from other areas of medicine interested in cardiovascular diseases.   The Romanian Journal of Cardiology publishes a diverse and high-quality selection of review articles, clinical trials, case reports, short communications, points of view, letters to the editor, editorials and Images in Cardiology. A letter of transmittal must accompany the submission of a manuscript, indicating that all the authors have contributed to the paper and that they have reviewed and agree with the content of the article.   The journal is based on independent and unbiased blind peer-reviewed principles. The Journal accepts for submission only unpublished papers that are not under review for publication elsewhere.   There is no charge for authors to submit articles to the Romanian Journal of Cardiology, which is an Open Access Journal. This allows the interested reader to search, access, download, or print the full-text articles and use them for any other lawful purpose.   All statements and opinions are solely the responsibility of the authors.  Archiving  Sciendo archives the contents of this journal in Portico - digital long-term preservation service of scholarly books, journals and collections.  Plagiarism Policy  The editorial board is participating in a growing community of Similarity Check System's users in order to ensure that the content published is original and trustworthy. Similarity Check is a medium that allows for comprehensive manuscripts screening, aimed to eliminate plagiarism and provide a high standard and quality peer-review process. 