PMC7495932_01
DS A female, 55 years. Left panel. Apical four-chamber echocardiographic view shows a moderately dilated left ventricle. In particular, at admission, normal parietal thickness, widely hypo-acinetic walls, and severely reduced overall pump function (ejection fraction 22%) were detected. In addition, the right ventricle was found to be slightly dilated and severely dysfunctional, with a slight circumferential pericardial effusion (maximum echo-free pericardial separation in diastole: 10 mm, see the red arrow). Based on clinical history, symptoms, and echocardiographic picture, the patient was diagnosed with acutely decompensated heart failure from anthracycline cardiomyopathy. This echocardiogram was made before starting therapy with sacubitril/valsartan. Right panel. The echocardiographic check after 2 weeks of therapy with sacubitril/valsartan shows a reduction in volumes of the left ventricle (indexed telediastolic volume: 90 mL/m2), and an improvement in regional kinetics and overall systolic function (ejection fraction: 44%) (apical four-chamber view focused on the left ventricle in telesystole).
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Transthoracic echocardiography unveiled very low left ventricular ejection fraction (LVEF) of 22%, with a slightly reduced right ventricular function (tricuspid annulus plan systolic excursion (TAPSE) = 17 mm (normal values > 20 mm)), high systolic pulmonary arterial pressure of 50 mmHg, and mild pericardial effusion with anterior echo-free space of 10 mm (Figure 1). Furthermore, a repeat echocardiogram (Figure 1) showed an LVEF of 44%.
PMC7495932_02
DE N female, 65 years. Top panel: The echocardiogram performed at the admission (top) shows severe left ventricular dilation (indexed diastolic volume 108 mL/m2), with widespread hypokinesia of the walls and severe systolic dysfunction (ejection fraction 26%). Based on clinical history, symptoms, and echocardiographic picture, the diagnosis of anthracycline cardiomyopathy was made. Bottom panel: The echocardiographic control after 2 months of therapy with sacubitril/valsartan shows an improvement in regional kinetics and global systolic function (ejection fraction 45%) (apical four-chamber view focused on the left ventricle in end-diastole). The arrow marks emphasize the improved wall kinetics after therapy with sacubitril/valsartan.
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An echocardiogram (Figure 2) showed an LVEF of 45%, normal RV with slightly reduced RV systolic function, mild bi-atrial enlargement, and systolic pulmonary arterial pressure made normal by therapy of 25 mmHg.