Unusual coexistence of atrial myxoma and mitral stenosis.
Ontology highlight
ABSTRACT:
SUBMITTER: Izci S
PROVIDER: S-EPMC5324950 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction: Mitral stenosis is associated with an atrial cardiomyopathic process, leading to abnormal atrial electrophysiology, manifesting as prolonged P-wave duration (PWD), larger P-wave area, increased P-wave dispersion (PWDmax-PWDmin), and/or higher P-wave terminal force on lead V1 (PTFV1) on the electrocardiogram. Methods: This was a single-center retrospective study of Chinese patients, diagnosed with mitral stenosis in sinus rhythm at baseline, between November 2009 and October 2016. Automated ECG measurements from raw data were determined. The primary outcome was incident atrial fibrillation (AF). Results: A total 59 mitral stenosis patients were included (age 59 [54-65] years, 13 (22%) males). New onset AF was observed in 27 patients. Age (odds ratio [OR]: 1.08 [1.01-1.16], P = 0.017), systolic blood pressure (OR: 1.03 [1.00-1.07]; P = 0.046), mean P-wave area in V3 (odds ratio: 3.97 [1.32-11.96], P = 0.014) were significant predictors of incident AF. On multivariate analysis, age (OR: 1.08 [1.00-1.16], P = 0.037) and P-wave area in V3 (OR: 3.64 [1.10-12.00], P = 0.034) remained significant predictors of AF. Receiver-operating characteristic (ROC) analysis showed that the optimum cut-off for P-wave area in V3 was 1.45 Ashman units (area under the curve: 0.65) for classification of new onset AF. A decision tree learning model with individual and non-linear interaction variables with age achieved the best performance for outcome prediction (accuracy = 0.84, precision = 0.84, recall = 0.83, F-measure = 0.84). Conclusion: Atrial electrophysiological alterations in mitral stenosis can detected on the electrocardiogram. Age, systolic blood pressure, and P-wave area in V3 predicted new onset AF. A decision tree learning model significantly improved outcome prediction.
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Project description:Acquired fistulous communication with the left atrial (LA) chamber has been described in the presence of LA mural thrombus in patients with rheumatic mitral stenosis (MS). Hereby, we present the case of a 74-year-old man with rheumatic MS and a huge LA thrombus found in echocardiography. Coronary angiography revealed an extensive fistula formation feeding mainly from the atrial branches of left circumflex and right coronary arteries and draining into the LA chamber. Moreover, left anterior descending (LAD) and right coronary arteries had slow flow with regional wall motion abnormality in the LAD territory and left ventricular ejection fraction of 35% in echocardiography. <Learning objective: This is a unique case of neovascular formation in terms of number and extent of the fistulous connections. It appears that angiographic evidence of neovascularity and fistula formation in patients with rheumatic mitral stenosis is a highly specific sign for the presence of left atrial thrombus.>.
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