Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging

Abstract Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiomyopathy. Early diagnosis is important to prevent mortality. They have a high risk of sudden cardiac death due to ventricular arrhythmia, which requires the implantation of a cardioverter-defibrillator. We describe the case of a cardiac arrest survivor with background electrocardiography (ECG) findings suggestive of ventricular tachycardia. The new 2020 international criteria for ARVC made it possible to easily detect such cases. We suspected right ventricular cardiomyopathy based on the patient’s history, ECG, and echocardiography findings, who later underwent cardiac magnetic resonance imaging. This was a “Definitive ARVC” case based on 2020 International criteria for ARVC. Clinicians should be aware of these criteria to detect such cases easily.

Neelesh Damor

Nitin Modi

Atul Karande

Ashish Mishra

Sunil Sharma

Arrhythmogenic Right Ventricular Cardiomyopathy Diagnosed with 2020 International Criteria

2020年国际标准诊断的致心律失常性右室心肌病

Abstract Pulmonary embolism (PE) is a relatively common cardiovascular disorder with high early mortality rates, despite advances in diagnosis and treatment. The risk of mortality is quite high in case the diagnosis is missed. High clinical suspicion is crucial in the diagnosis, more so in the young. Rarely, systemic embolism can occur in a patient with PE through a preexisting patent foramen ovale (PFO) (paradoxical embolism). Paradoxical embolism is associated with very high mortality rates. We report the case of a 31-year-old male, who was diagnosed with massive PE by echocardiography along with a thrombus-in-transit, trapped in a PFO, but without systemic embolization.

Raj Kumar

Rahul Mehrotra

Almost a Double Whammy! Acute Pulmonary Embolism and an Impending Paradoxical Embolism

几乎双重打击！急性肺栓塞与即将发生的矛盾性栓塞

Dear Editor, We most commonly use echocardiography to measure cardiac dimensions and cardiac functions. There are normal dimensions as specified by the European Association of Cardiovascular Imaging and the American Society of Echocardiography in 2015.[1] According to these guidelines, all echocardiographic measurements are to be indexed by body surface area (BSA), as it had shown to be the best predictor in the multivariate analysis. However, few small studies[2-4] have used body mass index (BMI) for analyzing its effect on cardiac dimensions, but nothing conclusive could be obtained. In fact, one study has shown that in both obese and nonobese people, BSA indexing works well.[5] However, we do not have any data that compared how good BMI and BSA could index the echocardiographic parameters. Hence, we did a small retrospective analysis, where we correlated echocardiographic dimensions of normal individual without any comorbidity with both BMI and BSA and tried to find out how they correlated with these dimensions in Indian population. This was a single hospital-based retrospective study where subjects aged 35–45 years who came for routine health checkup in 1 month (March 2023) to Neotia Getwel Multispecialty Hospital, and all investigations were normal including normal lipid profile (fasting low-density lipoprotein <100 mg/dl) and euglycemia. Informed consent was obtained from all subjects. We followed the ethical standards of human experimentation (institutional and national) and we were in accordance with the Helsinki Declaration of 1964. The study was approved by the institutional review board. Transthoracic echocardiographic studies were done using Vivid S60 machines with an M3S matrix array probe with a frequency range from 1.7 to 3.2 MHz (GE Vingmed, Horten, Norway) by a single experienced cardiologist. All echocardiographic measurements were done as per standard guidelines.[1] BMI was calculated as per the standard calculation. Mosteller formula was used to calculate BSA.[6] We analyzed the echocardiographic parameters and did Pearson’s correlation between BMI and BSA with the echocardiographic parameters. A total of 42 subjects were included in the study. 22 (52.4%) were male and 20 (47.6%) were female. The mean age was 39.83 ± 3.32 years. The mean BMI was 19.96 ± 2.80 kg/m2 and the mean BSA was 1.61 ± 0.15 m2. Table 1 presents the absolute echocardiographic chamber dimensions in the study population. We did Pearson’s correlation between BMI and BSA with the echocardiographic parameters [Table 2]. We found a strong positive correlation between both BMI and BSA with left ventricular end diastolic volume (LVEdV), left ventricular end systolic volume (LVEsV), left ventricular end diastolic diameter (LVEdD), Left Atrial Volume (LAv), Left Atrial Diameter, Right ventricular end diastolic diameter (RVEdD) and a negative correlation between both BMI, BSA with Left ventricular ejection fraction and left ventricular fractional shortening. No correlation was found between either BMI or BSA with aortic dimension. The Fisher’s Z transformation of Pearson’s correlation coefficient was higher for BMI as compared to BSA for LVEdV, LVEsV, LAv, and RVEdD.Table 1: Mean values of echocardiographic parametersTable 2: Correlation between echocardiographic parameters with body mass index and body surface areaOver the years, echocardiographic parameters have been indexed by BSA. We have shown that at least in this small population, BMI was as good as BSA in indexing echocardiographic parameters. However, the sample size was very small. Hence, we need a larger multicentric study to finally substantiate the hypothesis. Authors’ contributions Avishek Bagchi: Concept, design, definition of intellectual content, literature search, clinical studies, experimental studies, data acquisition, data analysis, statistical analysis, manuscript preparation, manuscript editing and manuscript review. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Avishek Bagchi

Comparing Body Mass Index and Body Surface Area for Indexing Echocardiographic Parameters: A Small Pilot Study

比较体重指数与体表面积用于指数超声心动图参数：一个小型试点研究

Imaging plays an important role in the diagnosis, management, and prognosis of cardiac conditions. Over the last three decades, cardiac magnetic resonance (CMR) has established itself as a promising imaging tool in the assessment of patients with various cardiac ailments. CMR is now being considered as a one-stop-shop diagnostic test because of its ability to comprehensively assess the heart. The greatest strength of CMR is its ability to characterize the myocardium noninvasively aiding in the diagnosis of patients. Despite its growing use worldwide, the adoption of the modality in India has been relatively slow. One major reason for this is the lack of expertise and resources to perform CMR. Another reason for the slow adoption of CMR in India is the limited understanding of practicing clinicians on how the modality works and what the various clinical applications of CMR are. In this review, we aimed to address these shortcomings by outlining some basics of CMR and its utility in day-to-day practice with a special focus on myocardial tissue characterization.

Suraj Gowda

Richa Jayesh Kothari

Vimal Raj

Myocardial Tissue Characterization by Cardiac Magnetic Resonance: A Primer for the Clinician

心脏磁共振心肌组织特征分析：临床医生入门指南

The potential utility of strain imaging as a tool for quantitative assessment of myocardial contractile function has already been demonstrated in many cardiac conditions. Numerous studies have explored its utility in patients with coronary artery disease (CAD) also. Almost the entire spectrum of CAD has been studied and several different strain parameters and indices derived from global or regional longitudinal, circumferential, radial and area strain as well as left ventricular rotation have been employed. These studies have mostly shown that strain imaging can have an incremental role in the diagnosis and prognosis assessment of CAD. However, a few important limitations are there. Most importantly, CAD involves the left ventricle in a segmental manner and unfortunately, segmental strain at present has significant measurement variability rendering it unsuitable for routine clinical use. Nevertheless, strain imaging has many potential uses in CAD. This review describes the current understanding about the role of strain imaging in the evaluation and management of CAD.

Manish Bansal

Ravi R. Kasliwal

Role of Strain Imaging in Ischemic Heart Disease

应变成像在缺血性心脏病中的作用

Abstract Coronary sinus (CS) is the largest coronary vein that receives blood from all the venous tributaries of the heart. Its variations in anatomy are significant from the surgical point of view, especially in patients with complex congenital heart diseases (CHDs). CS anomalies are rare, but with increasing advancements in imaging, they are often diagnosed with cardiac computed tomography (CT). These are associated with other CHDs, so the radiologists are alerted to look further for different anomalies. The data in this study were collected from the routine contrast-enhanced CT examinations of the patients referred to the Department of Radiology, Narayana Hrudayalaya Hospital, Bengaluru, from January 2019 to August 2023. It was observed that the anomalies were seldom seen as a single entity and instead were seen as a part of the spectrum of anomalies such as persistent left superior vena cava (LSVC), Raghib complex, total anomalous pulmonary venous connection, and interrupted inferior vena cava. Out of these, the most common associated anomaly was found to be persistent LSVC. These anomalies are essential to detect in the preoperative assessment because they may cause significant morbidity in some cases if left uncorrected. Therefore, we must search for other cardiac anomalies when encountering CS anomalies.

Akshata J. Chauhan

Coronary Sinus Anomalies with Case Illustrations

冠状窦异常病例图解

Abstract A 59-year-old male presented with syncope and nonsustained ventricular tachycardia and was diagnosed to have hypertrophic obstructive cardiomyopathy. He underwent dual-chamber implantable converter defibrillator (ICD) insertion. Following ICD insertion, in view of some red flags, routine cardiac magnetic resonance imaging was performed, which showed biventricular hypertrophy, diffuse subendocardial gadolinium enhancement of both the ventricles, prolonged T1 and T2, and left ventricular extracellular volume fraction of 50%. A pyrophosphate scan of the heart was strongly positive both at 1 and 3 h intervals. M-band was observed on plasma protein electrophoresis. Serum and urinary immunofixation studies suggested lambda light-chain gammopathy. Multiparametric flow cytometry of the bone marrow aspirate revealed 20% plasma cells immunophenotyped to produce only light-chain immunoglobulins. The patient is on specific chemotherapy for the past 7 months and is asymptomatic.

Madhu Shukla

Jagdish Chander Mohan

Cardiac Amyloidosis Masquerading as Hypertrophic Obstructive Cardiomyopathy: Co-existence or Coincidence?

心脏淀粉样变伪装成肥厚型梗阻性心肌病：共存还是巧合？

Jay Gohri

Sachin Sharma

Extensive Calcification Involving the Entire Length of Aorta: A Rare Presentation of Porcelain Aorta

广泛钙化累及整个主动脉：瓷化主动脉的罕见表现

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Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging

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Arrhythmogenic Right Ventricular Cardiomyopathy Diagnosed with 2020 International Criteria

Almost a Double Whammy! Acute Pulmonary Embolism and an Impending Paradoxical Embolism

Comparing Body Mass Index and Body Surface Area for Indexing Echocardiographic Parameters: A Small Pilot Study

Myocardial Tissue Characterization by Cardiac Magnetic Resonance: A Primer for the Clinician

Role of Strain Imaging in Ischemic Heart Disease

Arrhythmogenic Right Ventricular Cardiomyopathy Diagnosed with 2020 International Criteria

Almost a Double Whammy! Acute Pulmonary Embolism and an Impending Paradoxical Embolism

Coronary Sinus Anomalies with Case Illustrations

Cardiac Amyloidosis Masquerading as Hypertrophic Obstructive Cardiomyopathy: Co-existence or Coincidence?

Extensive Calcification Involving the Entire Length of Aorta: A Rare Presentation of Porcelain Aorta