Showing papers in "Cardiology Journal in 2012"

5-fluorouracil induced cardiotoxicity: review of the literature.

Abstract: 5-fluorouracil (5-FU) is a key chemotherapeutic agent in the treatment of many gastrointestinal tract adenocarcinomas. Despite its proven therapeutic efficacy, 5-FU also possesses several undesired cardiac toxicities, including coronary vasospasm, coronary thrombosis, cardiomyopathy, and sudden cardiac death. This review addresses the incidence, mechanisms of action, clinical presentation, risk stratification, and management of 5-FU associated cardiotoxicity; it also highlights the importance of careful pre-administration cardiac risk stratification and close monitoring during and after drug administration.

QRS fragmentation: diagnostic and prognostic significance.

Abstract: Fragmentation of QRS (fQRS) complex is an easily evaluated non-invasive electrocardiographic parameter. Fragmentation of narrow QRS is defined as presence of an additional R wave (R') or notching in the nadir of the S wave, or the presence of > 1 R' in 2 contiguous leads, corresponding to a major coronary artery territory on the resting 12-lead ECG. Fragmentation of wide complex QRS consists of various RSR patterns, with more than 2 R waves (R'') or more than 2 notches in the R wave, or more than 2 notches in the downstroke or upstroke of the S wave. Presence of fQRS has been associated with alternation of myocardial activation due to myocardial scar and myocardial fibrosis. Initial studies reported higher sensitivity of fQRS than Q wave for detecting myocardial scar and postulated that the presence of fQRS could be a good predictor of cardiac events among the patients with coronary artery disease. The presence of fQRS has been investigated among the patients with ischemic and non-ischemic cardiomyopathy suggesting that this ECG parameter may affect prognosis and risk of sudden cardiac death, risk of implantable cardioverter-defibrillator therapy and response to cardiac resynchronization therapy. In addition, there is evidence that fQRS could play an important role as screening and prognostic tool among the patients with Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular dysplasia and cardiac sarcoidosis. This paper reviews definition, diagnostic and prognostic value of fQRS in different patient populations.

New devices for very long-term ECG monitoring

Abstract: Present day 24-h Holter monitors have been shown to miss many arrhythmias that may occur infrequently or under specific circumstances. The advancement in electronic and adhesive technologies have enabled the development of first generation wearable long-term 14-day patch ECG monitors that attach directly to the skin and require no electrodes and wires to operate. This new technology is unobtrusive to the patients and offers them unprecedented mobility. It enables very long-term monitoring of critical patients while they are carrying out daily activities. The monitors are waterproof, offer good adhesion to the skin and can operate as either recorders or wireless streaming devices.

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Abstract: Background: The main purpose of this study is to determine the correlation of inter- and intraatrial conduction times between the electrophysiological and tissue Doppler echocardiographic measurements, and to evaluate the appropriateness of tissue Doppler echocardiography for this measurement. Methods: One-hundred and one patients were included in the study who underwent electrophysiological study for clinical arrhythmias. Inter- and intraatrial conduction times were measured from intracardiac electrograms. Atrial conduction times were also measured by tissue Doppler echocardiography by evaluating atrial electromechanical delay between lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus. The correlation between electrophysiological and echocardiographic atrial conduction times were analyzed. Results: We found a weak correlation between the measurements of interatrial conduction times with the electrophysiological and tissue Doppler techniques (r = 0.308; p = 0.002). The correlation for intraleft atrial conduction times was moderate (r = 0.652; p Conclusions: We concluded that tissue Doppler echocardiography can be used for the measurement of interatrial and intra-left atrial conduction times. Tissue Doppler echocardiography can be a suitable technique to evaluate atrial substrate. (Cardiol J 2012; 19, 5: 487-493)

Anomalous origin of the right coronary artery from the left anterior descending artery: review of the literature.

Abstract: Coronary artery anomalies that take place during fetal development are determined in approximately 1.3% of coronary angiograms. The right coronary artery originating from the left coronary system is an extremely rare variation of the single coronary artery anomaly in which the prognosis is usually benign provided that the anomalous vessel dose not pass between the aorta and the pulmonary artery. Anomalous right coronary artery anomaly has been rarely associated with other congenital cardiovascular anomalies such as transposition of the great vessels and tetralogy of Fallot. To date, a few attempts at classification have been made for coronary artery anomalies, but none of them seems comprehensive or practical for clinicians. The clinical significance of coronary anomalies is usually determined by underlying anatomic features of the wrong coronary origin and/or coronary atherosclerosis. Although coronary angiography is an important diagnostic method, new non-invasive methods such as coronary computed tomography angiography and cardiac magnetic resonance imaging have important roles to play in characterizing this coronary anomaly. It should be noted that the management strategy of these patients may vary based on clinical presentation, anatomical details and additional findings.

Determination of right ventricular dysfunction using the speckle tracking echocardiography method in patients with obstructive sleep apnea.

Abstract: Background: The speckle tracking echocardiography (STE) method shows the presence of right ventricular (RV) dysfunction before the advent of RV failure and pulmonary hypertension in patients with cardiopulmonary disease. We aimed to assess subclinical RV dysfunction in obstructive sleep apnea (OSA) using the STE method. Method: Twenty-one healthy individuals and 58 OSA patients were included. According to severity as determined by the apnea–hypopnea index (AHI), OSA patients were examined in three groups: mild, moderate and severe. RV free wall was used in STE examination. Results: Right ventricle strain (ST %) and systolic strain rate (STR-S 1/s) were decreasing along with the disease severity (ST — healthy: –34.05 ± –4.29; mild: –31.4 ± –5.37; moderate: –22.75 ± –4.89; severe: –20.89 ± –5.59; p Conclusions: Subclinical RV dysfunction can be established in OSA patients even in the absence of pulmonary hypertension and pathologies which could have adverse effects on RV functions. In addition to the methods of conventional, Doppler and tissue Doppler echocardiography, using the STE method can determine RV dysfunction in the subclinical phase. (Cardiol J 2012; 19, 2: 130–139)

Impedance cardiography: recent advancements.

Abstract: The aim of this paper is the presentation of recent advancements in impedance cardiography regarding methodical approach, applied equipment and clinical or research implementations. The review is limited to the papers which were published over last 17 months (dated 2011 and 2012) in well recognised scientific journals.

The use of short-term analysis of heart rate variability to assess autonomic function in obese children and its relationship with metabolic syndrome.

Abstract: Background: The cardiovascular autonomic nervous system in obese children is one of the main initiators of coronary heart disease and hypertension and may have a close relationship with insulin resistance. Heart rate variability is one non-invasive method to assess the cardiovascular autonomic system. In this method, low frequency parameters reflect sympathovagal activity, high frequency parameters reflect vagal activity and the ratio of these parameters reflects sympathovagal balance. Methods: In this study, a short-term analysis of heart rate variability was conducted in 66 obese children and 40 healthy controls. Results: While high frequency parameter values are lower in the obese group compared to the controls (16.02 ± 12.9 nu vs. 21.45 ± 13.6 nu, p = 0.046), the low frequency/high frequency ratio is found significantly higher (3.79 ± 2.34 vs. 2.25 ± 0.93, p Conclusions: We found that vagal activity was decreased in the obese group and the autonomic nervous system balance was impaired in favor of sympathetic activity in the short-term heart rate analysis. (Cardiol J 2012; 19, 5: 501-506)

How effective are continuous flow left ventricular assist devices in lowering high pulmonary artery pressures in heart transplant candidates

Abstract: Background: Pulmonary hypertension (PH) is considered a risk factor for morbidity and mortality in patients undergoing heart transplantation. Medical therapy with oral and pharmacologic agents is not always effective in reducing pulmonary artery (PA) pressures. Left ventricular assist devices (LVADs) have been used to reduce PA pressures in cases of PH unresponsive to medical therapy. Methods and results: Our study sought to evaluate the effectiveness of axial- and centrifugal- continuous flow LVADs in reversing PH in heart transplant candidates. Hemodynamics were assessed pre- and post-operatively in nine patients undergoing HeartMate II and six patients undergoing HeartWare continuous flow LVADs. Mean PA pressures were reduced from 31.9 ± 10.6 mm Hg to 22.1 ± 6.6 mm Hg (p = 0.001), and pulmonary vascular resistance was reduced from 3.08 ± 1.6 mm Hg to 1.8 ± 1.0 mm Hg (p = 0.007). This improvement was seen within seven days of LVAD implantation. Three of 15 patients were successfully transplanted, with 100% survival at an average of 199 days post-transplant. Conclusions: The results of this study suggest that both axial- and centrifugal-continuous flow LVADs are effective in immediately lowering PA pressures in heart transplant candidates with PH. (Cardiol J 2012; 19, 2: 153–158)

Improvement of ventricular function in systolic heart failure patients with oral L-citrulline supplementation

Abstract: Background: The utility of L-arginine and L-citrulline in treatment of arterial hypertension by increasing vascular oxide nitric availability has been demonstrated. Photoplethysmography, a simple and low-cost optical technique, makes it possible to assess vascular function and to detect changes in blood flow, pulse and swelling of the microvascular tissular space. The aim of the study was to evaluate the effect of L-citrulline supplementation on functional class, ejection fraction and peripheral blood flow in patients with systolic heart failure. Methods: Thirty-five stable outpatients attending the Heart Failure Clinic at the INCMNSZ underwent clinical evaluation, radioisotopic ventriculography and photoplethysmography before and at the end of 4 months. They were randomized into two groups: experimental group, with oral L-citrulline supplementation (3 g/day, n = 20) and control group, without supplementation (n = 15). Results: In the experimental group the left ventricular ejection fraction (LVEF) increased 20.3% at rest and 12.7% with stress, as well as the right ventricular ejection fraction at rest of 15.10% and 14.88% with stress. In addition, functional class improved in 35%, and the maximum amplitude time/total time (MAT/TT) index decreased 23.1%. These changes were statistically significant compared with the control group. Conclusions: Citrulline supplementation significantly improved the LVEF, the endothelial function (MAT/TT index) and functional class. Citrulline can be an important co-adjuvant in the treatment of stable and stable systolic heart failure patients. (Cardiol J 2012; 19, 6: 612-617)

Oxidative stress and severity of coronary artery disease in young smokers with acute myocardial infarction.

Abstract: Background: Cigarette smoking increases the oxidative stress mediated vascular dysfunction in young adults. We aimed to investigate the relation between the oxidative stress indices and coronary artery disease (CAD) severity in young patients presenting with acute myocardial infarction (AMI). Methods: Young patients (aged Results: Forty two young patients were admitted to the hospital with AMI (age 32.4 ± 2.6 years; 39 males, 3 females). Current and heavy smoking was commonly observed among the patients (79%). All patients underwent emergency coronary angiography. Twenty-eight healthy subjects were selected as controls. Patients had significantly higher OSI and TOS levels (median, interquartile range) [0.44 (0.26–1.75) vs 0.25 (0.22–0.30), p vs 4.1 (3.7–4.6), p vs 1.7 ± 0.1, p = 0.02 and 3.0 ± 0.8 vs 3.6 ± 0.4, p= 0.001], respectively, compared to the control group. CAD severity correlated positively with OSI (r = 0.508, p = 0.001) and TOS levels (r = 0.471, p = 0.002). Subjects with an intermediate to high SYNTAX score (≥ 22) demonstrated significantly higher OSI (median, interquartile range) [0.40 (0.34–1.75) vs 0.34 (0.26–0.68), p = 0.01] and TOS [6.9 (4.4–20.8) vs 5.8 (4.5–11.4), p = 0.01] levels compared to subjects with low SYNTAX score. Conclusions: Oxidative stress is an important contributor to CAD severity among young smokers. Elevated OSI and TOS levels reflect disease severity and vascular damage related to heavy smoking in early onset CAD.

Coronary artery fistula: review of 54 cases from single center experience.

Abstract: Background: Demographic and clinical characteristics and angiographic findings of Turkish patients with coronary artery fistula have been investigated in this study and diagnostic tests and treatment methods used in these patients have also been evaluated in detail. Methods: We have examined the cardiac catheterization laboratory database retrospectively between March 2006 and July 2010. Among 49,567 patients, we have noted 60 patients diagnosed as coronary artery fistula. After coronary angiographic images were evaluated by two invasive cardiologists, 54 patients who had clear evidence of vessel of origin and drainage were included in the study. Results: A total of 54 (0.1%) patients with coronary artery fistula were noted. Mean age was 56.7 ± 10.7 years; 42 out of 54 patients had accompanying cardiac disorders. Patients’ complaints were directly associated with the presence of the fistula. Chest pain was the admission symptom in all of the patients with isolated coronary artery fistula. Six patients had coexistent congenital anomalies. Myocardial infarction with ST segment elevation occurred in 11 of the patients. In contrast to the previous reports, the most common artery of origin of the fistula was left anterior descending artery (50.8%) and pulmonary artery was found to be the most frequent region of the fistula drainage by 53.7%. Conclusions: Our findings suggest that large fistulas originating from the proximal segments of coronary arteries may increase the likelihood of atherosclerosis and myocardial infarction even in asymptomatic patients with no evidence of ischemia in noninvasive tests and no dilatation of cardiac chambers, and should therefore be closed.

Autonomic dysreflexia: An important cardiovascular complication in spinal cord injury patients

Abstract: Autonomic dysreflexia (AD) is a life-threatening complication of spinal cord injury (SCI) at T6 or above that results in an uncontrolled sympathetic discharge in response to noxious stimuli. It is a symptom complex characterized by a lethal rise in blood pressure with dangerous consequences. Autonomic dysreflexia is often secondary to urological, gastrointestinal, or gynecological problems or manipulations. Early recognition and prompt treatment of AD is vital to prevent complications, including death. Its management starts primarily with its prevention. Easy measures can avoid this high risk event, and physicians should be aware of the simple procedures and the possible treatment cascade that could be undertaken. The purpose of this systematic review is to review the clinical data on the mechanisms and pathophysiology of this condition and the clinical evidence about the various strategies currently used to prevent and manage AD in the SCI population; and to improve awareness of AD among cardiologists, family physicians and medical personnel in the emergency department. (Cardiol J 2012; 19, 2: 215–219)

How to do: telerehabilitation in heart failure patients.

Abstract: According to the present guidelines for heart failure patients, regular exercise training has obtained the class of recommendation I, level of evidence A. Despite the benefits of cardiac rehabilitation, many heart failure patients are inactive. Common patient’s rejection of existing forms of rehabilitation and limitations resulting from the disease itself hinder the outpatient cardiac rehabilitation. That is why home telerehabilitation seems to be the optimal form of physical activity for heart failure patients. (Cardiol J 2012; 19, 3: 243–248)

“Benign” early repolarization versus malignant early abnormalities: Clinical-electrocardiographic distinction and genetic basis

Abstract: In the great majority of cases the ECG pattern of early repolarization (ERP) is a benign phenomenon observed predominantly in teenagers, young adults, male athletes and the black race. The universally accepted criterion for its diagnosis is the presence, in at least two adjoining leads, of ≥ 1 mm or 0.1 mV ST segment elevation. In benign ERP reciprocal ST segment changes are possible only in lead aVR. In contrast, reciprocal ST segment changes can be observed in several leads in idiopathic ventricular fibrillation (IVF) and acute coronary syndrome. In benign ERP the ST segment and T wave patterns have a relative temporal stability. IVF is an entity with low prevalence, possibly familiar, and characterized by the occurrence of VF events in a young person. More frequently this occurs in male subjects without structural heart disease and with otherwise with normal ECG even using high right accessory leads and/ /or after ajmaline injection. Several clinical entities cause ST segment elevation include asthenic habitus, acute pericarditis, ST segment elevation myocardial infarction, Brugada syndrome, congenital short QT syndrome, and idiopathic VF. In these circumstances clinical and ECG data are most important for differential diagnosis. In IVF the modifications could be dramatic and predominantly at night during vagotonic predominance when J waves > 2 mm in amplitude. The ST/T abnormalities are dynamic, inconstant, and reversed with isoproterenol. Convex upward J waves, with horizontal/descending ST segments or "lambda-wave" ST shape are suggestive of IVF with early repolarization abnormalities. Premature ventricular contractions with very short coupling and "R on T" phenomenon are characteristics with two pattern: When originate from right ventricular outflow tract left bundle branch block morphology and from peripheral Purkinje network, left bundle branch block pattern. The inherited-familial forms are not frequent in IVF; however mutations were identified in the genes KCNJ8, DPP6, SCN5A, SCN3B, CACNA1C, CACNB2, and CACNA2D1. The management of IVF has class I indication for ICD implantation. Ablation therapy is considered additional to ICD implantation in those patients with repetitive ventricular arrhythmia. Quinidine is a highly efficient drug that prevents recurrence. (Cardiol J 2012; 19, x: xx-xx)

Increased mean platelet volume associated with extent of slow coronary flow

Abstract: Background: Slow coronary flow (SCF) is characterized by delayed opacification of epicardial coronary vessels. SCF can cause ischemia and sudden cardiac death. We investigated the association between presence and extent of SCF, and cardiovascular risk factors and hematologic indices. Methods: In this study, 2467 patients who received coronary angiography for suspected or known ischemic heart disease were retrospectively evaluated between April 2009 and November 2010. Following the application of exclusion criteria, our study population consisted of 57 SCF patients (experimental group) and 90 patients with age- and gender-matched subjects who proved to have normal coronary angiograms (control group). Baseline hematologic indices were measured by the automated complete blood count (CBC) analysis. The groups were evaluated for cardiovascular risk factors and medications. Patients were categorized based on the angiographic findings of vessels with or without SCF. Moreover, patients with SCF were divided into subgroups relative to the extent of SCF. Results: Among the 147 patients (mean age 52.7 ± 10.0, 53.7% male), mean platelet volume (MPV) ranged from 6.5 fL to 11.7 fL (median 7.9 fL, mean 8.1 ± 0.8 fL). Diabetes (OR = 3.64, 95% CI 1.15–10.43, p = 0.03), hypercholesterolemia (OR = 4.94, 95% CI 1.99–12.21, p = 0.001), smoking (OR = 3.54, 95% CI 1.43–8.72, p = 0.006), hemoglobin (OR = 1.69, 95% CI 1.22–2.36, p = 0.002), and MPV (OR = 2.52, 95% CI 1.43–4.44, p = 0.001) were found to be the independent correlates of SCF presence. Only MPV (OR = 2.13, 95% CI 1.05–4.33, p = 0.03) was identified as an independent correlate of extent of SCF. Conclusions: Elevated baseline MPV value was found to be an independent predictor of the presence and extent of SCF.

Simvastatin and atorvastatin attenuate VCAM-1 and uPAR expression on human endothelial cells and platelet surface expression of CD40 ligand

Abstract: Background: In addition to their cholesterol lowering ability, statins have proven pleiotropic effects in the cardiovascular system. Chronic inflammation with interactions between platelets and endothelial cells leads to an upregulation of activity markers of atherosclerosis. The purpose of this study was to investigate the effects of simvastatin and atorvastatin on platelets and endothelial cells in an in vitro endothelial cell model. Methods and Results: After a 24 h incubation period with either simvastatin or atorvastatin (1 μmol/L), human umbilical vein endothelial cells were stimulated for 1 h with lipopolysaccharide (LPS), and were then incubated in direct contact with activated platelets. Platelet surface expression of CD40L and CD62P and expression of ICAM-1, VCAM-1, uPAR and MT1-MMP on endothelial cells were measured by flow cytometry. Supernatants were analyzed by ELISA for soluble MMP-1. The increased expression of VCAM-1 and uPAR on endothelial cells by stimulation with LPS and by direct contact with activated platelets was significantly reduced to a similar extent through pre-incubation with both atorvastatin and simvastatin (p Conclusions: These effects may explain the ability of statins to reduce the progression of atherosclerosis in addition to their cholesterol-lowering properties. (Cardiol J 2012; 19, 1: 20–28)

Antiarrhythmic potential of aldosterone antagonists in atrial fibrillation

Abstract: Upstream therapy is the promising issue in the treatment of atrial fibrillation (AF) especially in patients with arterial hypertension and heart failure. The possible beneficial effects of renin-angiotensin-aldosterone system blockade with ACE-inhibitors and angiotensin receptor antagonists in AF prevention have been demonstrated in experimental and clinical studies. There is growing mass of evidence, from both theoretical and experimental research studies, to suggest that upstream therapy using spironolactone or eplerenone may reduce the deleterious effect of excess aldosterone secretion and further modify the environment of AF including inhibition of atrial muscle fibrosis. It refers to patients with different forms of AF, including chronic AF. Aldosterone antagonists treatment may be a simple and valuable additional option in low-risk, hypertensive and heart failure patients in primary and secondary prevention of refractory paroxysmal and persistent AF.

QT interval prolongation and torsades de pointes in a patient undergoing treatment with vorinostat: a case report and review of the literature.

Abstract: Vorinostat is a histone deacetylase inhibitor used in the treatment of recurrent or persistent cases of cutaneous T-cell lymphoma (CTCL) A retrospective review of 116 patients from phase I and II clinical trials who had a baseline and at least one subsequent ECG revealed that four patients had Grade 2 and one patient had Grade 3 QTc interval prolongation; however, a MEDLINE search found no reported cases of torsades de pointes (TdP) in patients treated with vorinostat We describe the case of a 49 year-old male with a history of CTCL actively undergoing treatment with vorinostat During day 1 of hospitalization, he developed a pulseless polymorphic ventricular tachycardia requiring resuscitation He was found to have a QTc of 826 ms Following correction of potassium and magnesium, QTc gradually decreased and no further ventricular arrhythmia was noted Other factors implicated in this case included concurrent sertraline and doxepin therapy (both drugs have been associated with the development of TdP in overdose) The mechanism of development of TdP in this patient is postulated to be related to vorinostat use in combination with hypokalemia and concomitant treatment with medications associated with QTc prolongation This case highlights the importance of post-market surveillance

Epicardial fat necrosis: an uncommon etiology of chest pain.

Abstract: Epicardial fat necrosis (EFN) is a rare cause of severe chest pain We present a case of EFN successfully treated conservatively With the advent of computed tomography and magnetic resonance imaging, the diagnosis can be made more precisely, avoiding the need for surgical intervention We review the clinical characteristics, pathogenesis and treatment options of EFN

ARISTOTLE RE-LYs on the ROCKET. What's new in stroke prevention in patients with atrial fibrillation?

Abstract: Warfarin has long been considered the gold standard for stroke prevention in patients with atrial fibrillation (AF). Recently, three major trials comparing the efficacy and safety of new drugs: a thrombin inhibitor dabigatran and two inhibitors of factor Xa - rivaroxaban and apixaban, with that of warfarin, have been published. The aim of this paper is to present the main results of the RE-LY, ROCKET AF and ARISTOTLE trials, compare study populations and outcomes, and discuss clinical implications of their results for the long-term anticoagulation in patients with nonvalvular AF.

Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery.

Abstract: Background: Pulmonary arterial hypertension is of importance in congenital cardiac surgery as being a significant cause of morbidity and mortality. Although therapy options are limited, inhaled nitric oxide (NO) is used as a standard therapy. The present study aimed to compare inhaled NO and aerosolized iloprost in children with secondary pulmonary hypertension who underwent congenital cardiac surgery. Methods: Sixteen children included in the study were randomized into either inhaled NO or aerosolized iloprost group. For both groups, the observation period terminated at 72 h after cardiopulmonary bypass. Results: There was no significant difference between the groups in terms of mean age, weight, cross clamp time, pump time, and extubation time. No significant change was observed in the arterial tension and central venous pressure of both groups before the operation, 30 min after the pump, 45 min after the pump, and after extubation, whereas an increase was observed in the heart rate and cardiac output, and a decrease was observed in the pulmonary artery pressure. The mean values at the above-mentioned time points showed no difference between the groups. No serious adverse event and mortality was detected. Conclusions: Both inhaled NO and aerosolized iloprost were found to be effective and comparable in the management of pulmonary hypertension.

Mitral valve myxoma: clinical features, current diagnostic approaches, and surgical management.

Abstract: Background: The purpose of this article is to document the clinical features of the unusual mitral valve myxoma based on the literature of recent years. Methods: A literature retrieval of the mitral valve myxoma reported in recent years was made using the MEDLINE and EMBASE databases. The clinical information about this unusual disorder was collected and analyzed. Results: Mitral valve myxoma showed female predilection. Their major symptoms were cardiovascular or cerebrovascular, in addition to constitutional or embolic. The diagnosis was usually made based on two- and three-dimensional transthoracic and/or transesophageal echocardiography, as well as magnetic resonance imaging in the current era. Surgical resection with mitral valve defect repair was the commonest remedy for mitral valve myxoma when mitral valve function could be preserved, and the mitral valve should be replaced when necessary. Patients showed good response to surgical treatment during the follow-up of 17.0 ± 28.4 months after the operation. Conclusions: Two- and three-dimensional echocardiography and magnetic resonance imaging are the major diagnostic tools for the diagnosis of a cardiac myxoma. After diagnosis, surgery should be performed urgently, in order to prevent complications such as embolic events or obstruction of the mitral orifice. Due to the fact that myxomas can recur, regular, postoperative cardiological control is mandatory. (Cardiol J 2012; 19, 1: 105–109)

Pheochromocytoma-induced reverse tako-tsubo with rapid recovery of left ventricular function.

Abstract: Pheochromocytoma is a rare, catecholamine-secreting tumor of neuroendocrine cells. It has been documented to present atypically as myocardial ischemia, arrhythmias, or congestive heart failure. We present the case of a patient who had transient cardiomyopathy with hypokinesia of the basal portions of the left ventricle and hyperkinesia of the apex triggered by a pheochromocytoma crisis similar to that of tako-tsubo cardiomyopathy, but with an inverse left ventricular contractile pattern (‘inverted tako-tsubo’). (Cardiol J 2012; 19, 5: 527-531)

Atherosclerosis burden and coronary artery lesion complexity in acute coronary syndrome patients

Abstract: Background: Syntax score (SS) is a prognostic marker in patients with acute coronary sydromes (ACS). Carotid intima media thickness (CIMT) and cardio ankle vascular index (CAVI) are well known surrogate marker of atherosclerosis burden. But association between atherosclerosis burden and coronary artery disease (CAD) complexity in ACS patients has not been investigated yet. Methods and Results: Consecutive patients with first time diagnosis of ACS (n = 172) were enrolled. SS, a marker of CAD complexity, was assessed by dedicated computer software. CIMT was examined by B-mode ultrasound. CAVI was assessed by VaSera VS-1000 cavi instrument. SS for low, intermediate and high tertiles of CIMT value were 10.1 ± 8.2 vs 11.4 ± ± 7.9 and 15.2 ± 8.8; p = 0.02). SS for normal, borderline and abnormal CAVI values were 4 ± 3.7 vs 11.1 ± 7.2 and 14.1 ± 9.1, respectively p = 0.009). Also, there was independent association between SS and CIMT (95% coinfidence interval [CI] 2.1–19, p = 0.014) and CAVI (95% CI 15–29, p = 0.021]. Neither traditional cardiovascular risk factor nor thrombolysis in myocardial infarction (TIMI) risk score was independent determinant of SS. Conclusions: We have shown that patients with higher atherosclerosis burden have more complex coronary artery lesions. Also these patients may be identified early by using surrogate markers of atherosclerosis. Its clinical significance requires further research.

Comparison of infarct-related artery vs multivessel revascularization in ST-segment elevation myocardial infarction with multivessel disease: analysis from Korea Acute Myocardial Infarction Registry

Abstract: Background: Many ST-segment elevation myocardial infarction (STEMI) patients have multivessel disease. There is still controversy in treatment strategy in STEMI patients with multivessel disease. We compared clinical outcomes of multivessel revascularization with infarct- related artery (IRA) revascularization in STEMI patients. Methods: The 1,644 STEMI patients with multivessel disease (1,106 in IRA group, 538 in multivessel group) who were received primary percutaneous coronary intervention (PCI) were analyzed from a nationwide Korea Acute Myocardial Infarction Registry. Primary endpoint was 12-month major adverse cardiac events (MACE, defined as death, myocardial infarction, and repeated revascularization). Secondary endpoints were 1-month MACE and each component, stent thrombosis during 12 month follow-up, and each components of the 12-month MACE. Results: There were more patients with unfavorable baseline conditions in IRA group. 12-month MACE occurred in 165 (14.9%) patients in IRA group, 81 (15.1%) patients in multivessel group (p = 0.953). There were no statistical significance in the rate of 1-month MACE, each components of 1-month MACE, and stent thrombosis during 12 month follow-up. Each components of 12-month MACE were occurred similarly in both groups except for target lesion revascularization (2.4% in IRA group vs 5.9% in multivessel group, p Conclusions: There were no significant differences in clinical outcomes between both groups except for high risk of target lesion revascularization in multivessel revascularization group.

Updated evidence on intracoronary abciximab in ST-elevation myocardial infarction: A systematic review and meta-analysis of randomized clinical trials

Abstract: Background: Intracoronary (IC) abciximab administration remains a promising approach aimed to increase a drug concentration in the target area and possibly improve clinical outcomes in the setting of ST-segment elevation myocardial infarction (STEMI). The goal of this literature review and meta-analysis is to update available knowledge comparing IC and intravenous (IV) abciximab administration in STEMI patients. Methods: A total of 7 randomized clinical trials (RCTs) with a median follow-up of 3 months were included in the meta-analysis (n = 3311). All-cause mortality was selected as the primary end point while recurrent myocardial infarction (re-MI), target vessel revascularization (TVR) and major bleeding complications were the secondary end points. Results: IC abciximab did not provide any benefits in terms of all-cause mortality as compared with IV abciximab (odds ratio (OR) 0.67; 95% confidence interval (CI) 0.34n1.34). However, this neutral effect was driven by the AIDA STEMI trial. The IC route was associated with a reduced rate of re-MI when compared with IV administration (OR 0.61; 95% CI 0.40n0.92) but the difference disappeared after one of the RCTs was excluded from the analysis. Both strategies were equal regarding TVR (OR 0.66; 95% CI 0.40n1.09) and major bleeding complications (OR 1.18; 95% CI 0.76n1.83). Conclusions: Our updated meta-analysis shows that the clinical superiority of IC over IV abciximab administration in STEMI patients is no longer clear after the release of the AIDA STEMI trial results. Further research in high-risk STEMI patients is warranted to finally determine clinical advantages of IC vs IV abciximab administration. (Cardiol J 2012; 19, 3: 230n242)

Red cell distribution width is associated with acute myocardial infarction in young patients.

Abstract: Background: There are few studies about predictors of ST elevation myocardial infarction (STEMI) in young patients. High red cell distribution width (RDW) levels were associated with adverse outcomes in patients with STEMI. We aimed to investigate the relationship between RDW and STEMI in young patients. Methods: This study included 370 patients who presented to our hospital with acute myocardial infarction (Group 1: 198 young patients, Results: Compared with Group 3, Group 1 had a significantly higher value of RDW (Group 1 RDW 14.1 ± 1.1%, Group 3 RDW 13.4 ± 0.9, p1 Conclusions: High levels of RDW were associated with STEMI in young patients. We think that RDW is a widely available marker with no additional costs, in contrast to other novel markers of cardiovascular risk.

Acute and mid-term outcomes of transvenous implant of a new left ventricular quadripolar lead versus bipolar leads for cardiac resynchronization therapy: Results from a single-center prospective database

Abstract: Background: The purpose of this study was to evaluate the feasibility of the use of a quadripolar left ventricular (LV) lead for cardiac resynchronization therapy and to compare its acute and mid-term outcomes with those obtained with bipolar leads. Cardiac resynchronization exhibits a high incidence of problems involving the LV lead when conventional leads are used, and these problems may be minimized by using multipolar leads. Methods: We gathered clinical, implant, and follow-up data at 3 and 9 months from 21 consecutive patients in whom a quadripolar (Group Q) or bipolar (Group B) lead was used for a biventricular defibrillator implant. Results: The leads were successfully implanted in all of the patients. In Group B, more than one lead was used in 20% (p = 0.048) of cases. There were no clinical differences or differences in the implant parameters between the two groups except for the radiation dose, which was greater in group B (p = 0.035). The incidence of problems related to the LV lead during follow-up was higher in group B, but the difference was not significant (42.9% vs. 23.8%, p = 0.326). The use of more than one LV lead was the only variable that was significantly associated with lead-related problems during follow-up (p = 0.03; OR = 10.8; 95% CI 1.07–108.61). Conclusions: The quadripolar lead was associated with excellent implantation success rates and mid-term performance. The multi-programmability capabilities of quadripolar leads facilitated the achievement of implant goals and helped to reduce problems during the implant and follow-up. (Cardiol J 2012; 19, 5: 470-478)

Cardiac tamponade in association with anorexia nervosa: a case report and review of the literature.

Abstract: Anorexia nervosa (AN) is a complex psychiatric disorder that can have devastating cardiovascular complications. Its lesser-known association with pericardial effusion has been recently described in the literature. We present the case of a 45 year-old female who presented with a recurrent small bowel obstruction requiring lysis of adhesions and who was found to have a large pericardial effusion that progressed to cardiac tamponade necessitating surgical intervention. The patient had a body mass index of 14.8 kg/m2 (i.e. 71% of ideal body weight) and a long-standing history of food aversion, extreme exercise habits, and weight obsession consistent with AN. To the best of our knowledge, this is the first case of AN-associated cardiac tamponade in the United States, and the first requiring surgical intervention. In conclusion, with this and current data regarding AN-associated pericardial effusions, we recommend a low threshold for performing pre-operative echocardiography for those in whom AN is suspected.