Image in Cardiology
Basal type ‘broken heart’ in a postpartum woman: Utility of speckle tracking echocardiography
Miocardiopatia de stress do tipo basal em puérpera: utilidade da ecocardiografia de speckle tracking
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Bull's eye plot of left ventricular longitudinal strain showing (A) impaired values of basal walls in the acute phase and (B) their recovery one month later. ANT: anterior wall; ANT_SEPT: anteroseptal wall; INF: inferior wall; LAT: lateral wall; POST: posterior wall; SEPT: septal wall.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nikolaos Miaris, Nearchos Kasinos, Archontoula Michelongona, Afroditi Konstantara, Dimitrios Barmpagiannis, Antonios Destounis, Panagiotis Zachos, Evangelia Nyktari, Anastasios Theodosis-Georgilas, Dimitrios Beldekos, Evangelos Pisimisis" "autores" => array:11 [ 0 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Miaris" ] 1 => array:2 [ "nombre" => "Nearchos" "apellidos" => "Kasinos" ] 2 => array:2 [ "nombre" => "Archontoula" "apellidos" => "Michelongona" ] 3 => array:2 [ "nombre" => "Afroditi" "apellidos" => "Konstantara" ] 4 => array:2 [ "nombre" => "Dimitrios" "apellidos" => "Barmpagiannis" ] 5 => array:2 [ "nombre" => "Antonios" "apellidos" => "Destounis" ] 6 => array:2 [ "nombre" => "Panagiotis" "apellidos" => "Zachos" ] 7 => array:2 [ "nombre" => "Evangelia" "apellidos" => "Nyktari" 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class="elsevierStyleItalic">ostium</span> coronário esquerdo oculto: caso clínico e revisão da literatura" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2373 "Ancho" => 1582 "Tamanyo" => 249243 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Left: the seven (A-G) anatomic types of quadricuspid valves described by Hurwitz and Roberts. Type H was added later by Vali et al.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">5</span></a>. The most common is type B and the rarest is type D. Right: the simplified classification of Nakamura et al., based on the position of the supernumerary cusp. L: left coronary cusp; N: non-coronary cusp; R: right coronary cusp; S: supernumerary cusp. Red circles identify the case presented in this report.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Filipe R. Soares, Carlos Branco, Gonçalo F. Coutinho, David Prieto, Manuel J. Antunes" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Filipe R." "apellidos" => "Soares" ] 1 => array:2 [ "nombre" => "Carlos" "apellidos" => "Branco" ] 2 => array:2 [ "nombre" => "Gonçalo F." "apellidos" => "Coutinho" ] 3 => array:2 [ "nombre" => "David" "apellidos" => "Prieto" ] 4 => array:2 [ "nombre" => "Manuel J." 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0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 8 => array:3 [ "nombre" => "Anastasios" "apellidos" => "Theodosis-Georgilas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Dimitrios" "apellidos" => "Beldekos" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">†</span>" "identificador" => "fn0005" ] ] ] 10 => array:3 [ "nombre" => "Evangelos" "apellidos" => "Pisimisis" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Cardiology Department, “Tzaneio” General Hospital of Piraeus, Piraeus, Greece" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Bioiatriki Magnetic Resonance Unit, Athens, Greece" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Miocardiopatia de <span class="elsevierStyleItalic">stress</span> do tipo basal em puérpera: utilidade da ecocardiografia de <span class="elsevierStyleItalic">speckle tracking</span>" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1802 "Ancho" => 2175 "Tamanyo" => 556385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular magnetic resonance one month after the acute phase. (A) Gadolinium study with no late enhancement; (B) T2-weighted short tau inversion recovery imaging showing no residual macroscopic myocardial inflammation or edema; (C) T1 mapping study and (D) T2 mapping study showing low-grade septal edema.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 34-year-old female with no cardiovascular history presented chest pain within two hours of a 38-week-gestation cesarean delivery. She was hemodynamically stable. Serum troponin I (2529.6 ng/l, cutoff 15.6 ng/l) and brain natriuretic peptide (508 pg/ml, cutoff 100 pg/ml) were elevated. Her electrocardiogram showed normal sinus rhythm (heart rate 50 bpm) without ischemic changes. Transthoracic echocardiography (TTE) revealed increased left ventricular (LV) dimensions, left ventricular ejection fraction (LVEF) 47%, global longitudinal strain (GLS) -19% with marked basal impairment, moderate central mitral regurgitation (MR) with apical displacement of the leaflet coaptation point, and normal right ventricular dimensions and function (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#sec0010">Video 1</a>). Invasive coronary angiography revealed no lesions (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>), while myocarditis was precluded by the absence of infection and pericardial effusion and normal serum C-reactive protein levels.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">One month later, repeat TTE revealed LV recovery (LVEF 63%, GLS -21% with apparent improvement in basal segments, trivial MR) (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B, <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and <a class="elsevierStyleCrossRef" href="#sec0010">Video 1</a>). Meanwhile, cardiovascular magnetic resonance showed no late gadolinium enhancement and normal T2-weighted short tau inversion recovery imaging, while T1 and T2 mapping were consistent with low-grade edema at the basal septum where systolic dysfunction was noted in the acute setting (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>). Indexed LV end-diastolic and end-systolic volumes were 110 ml/m<span class="elsevierStyleSup">2</span> and 33 ml/m<span class="elsevierStyleSup">2</span>, respectively (LVEF 70%).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The physical and emotional stress associated with cesarean surgery, LV basal segment systolic impairment leading to basal ballooning and moderate functional MR (also enhanced by peripartum hemodynamic conditions) and the rapid recovery suggest basal Takotsubo cardiomyopathy.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-17" "fechaAceptado" => "2020-04-28" "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "†" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Deceased. In memoriam of his dedication to cardiology, echocardiography and knowledge sharing.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par0030" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix A" "titulo" => "Supplementary material" "identificador" => "sec0015" ] ] ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 953 "Ancho" => 2093 "Tamanyo" => 192534 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography. Bull's eye plot of left ventricular longitudinal strain showing (A) impaired values of basal walls in the acute phase and (B) their recovery one month later. ANT: anterior wall; ANT_SEPT: anteroseptal wall; INF: inferior wall; LAT: lateral wall; POST: posterior wall; SEPT: septal wall.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 852 "Ancho" => 1713 "Tamanyo" => 125313 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Invasive coronary angiography revealing no lesions. (A) Left anterior oblique view of the right coronary artery; (B) right anterior oblique view of the left coronary artery.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1802 "Ancho" => 2175 "Tamanyo" => 556385 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cardiovascular magnetic resonance one month after the acute phase. (A) Gadolinium study with no late enhancement; (B) T2-weighted short tau inversion recovery imaging showing no residual macroscopic myocardial inflammation or edema; (C) T1 mapping study and (D) T2 mapping study showing low-grade septal edema.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">GLS: global longitudinal strain; LV: left ventricular; LVEDD: left ventricular end-diastolic diameter; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic diameter; MR: mitral regurgitation; TTE: transthoracic echocardiography.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TTE findings \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Acute phase \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">One month later \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEDD (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVESD (mm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LVEF<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">47% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LV GLS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-19%Impairment of basal segments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-21% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ModerateCentral jet direction, apical displacement of leaflet coaptation point \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Trivial \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2530819.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Measured by the modified Simpson's biplane rule using apical 4-chamber and 2-chamber views.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography findings indicating impaired basal left ventricular systolic function with basal ballooning in the acute phase and resolution of findings one month later.</p>" ] ] 4 => array:7 [ "identificador" => "upi0005" "etiqueta" => "Supplementary Video 1" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:3 [ "fichero" => "mmc1.mp4" "ficheroTamanyo" => 8983870 "Video" => array:2 [ "mp4" => array:5 [ "fichero" => "mmc1.m4v" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] "flv" => array:5 [ "fichero" => "mmc1.flv" "poster" => "mmc1.jpg" "tiempo" => 0 "alto" => 0 "ancho" => 0 ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Transthoracic echocardiography. Comparison between the acute phase and one month later showing improvement in both basal left ventricular systolic function and mitral regurgitation.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000004000000001/v1_202102241115/S2174204921000088/v1_202102241115/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000004000000001/v1_202102241115/S2174204921000088/v1_202102241115/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204921000088?idApp=UINPBA00004E" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 7 | 12 |
| 2024 October | 45 | 48 | 93 |
| 2024 September | 40 | 23 | 63 |
| 2024 August | 38 | 37 | 75 |
| 2024 July | 38 | 39 | 77 |
| 2024 June | 22 | 30 | 52 |
| 2024 May | 30 | 22 | 52 |
| 2024 April | 33 | 28 | 61 |
| 2024 March | 37 | 31 | 68 |
| 2024 February | 27 | 26 | 53 |
| 2024 January | 27 | 24 | 51 |
| 2023 December | 27 | 28 | 55 |
| 2023 November | 58 | 42 | 100 |
| 2023 October | 34 | 14 | 48 |
| 2023 September | 23 | 19 | 42 |
| 2023 August | 29 | 17 | 46 |
| 2023 July | 45 | 14 | 59 |
| 2023 June | 29 | 12 | 41 |
| 2023 May | 36 | 27 | 63 |
| 2023 April | 26 | 9 | 35 |
| 2023 March | 34 | 21 | 55 |
| 2023 February | 25 | 20 | 45 |
| 2023 January | 32 | 17 | 49 |
| 2022 December | 27 | 29 | 56 |
| 2022 November | 38 | 33 | 71 |
| 2022 October | 47 | 19 | 66 |
| 2022 September | 38 | 41 | 79 |
| 2022 August | 35 | 26 | 61 |
| 2022 July | 23 | 40 | 63 |
| 2022 June | 33 | 30 | 63 |
| 2022 May | 27 | 27 | 54 |
| 2022 April | 33 | 33 | 66 |
| 2022 March | 28 | 45 | 73 |
| 2022 February | 29 | 41 | 70 |
| 2022 January | 41 | 27 | 68 |
| 2021 December | 27 | 36 | 63 |
| 2021 November | 47 | 33 | 80 |
| 2021 October | 55 | 53 | 108 |
| 2021 September | 21 | 34 | 55 |
| 2021 August | 35 | 29 | 64 |
| 2021 July | 20 | 18 | 38 |
| 2021 June | 33 | 33 | 66 |
| 2021 May | 35 | 38 | 73 |
| 2021 April | 67 | 71 | 138 |
| 2021 March | 95 | 49 | 144 |
| 2021 February | 25 | 7 | 32 |
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