Documents published in 2017 : Scipedia

The effect of cardioprotective diet rich with natural antioxidants on chronic inflammation and oxidized LDL during cardiac rehabilitation in patients after acute myocardial infarction
. Polona Mlakar, . Barbara Salobir, . Nusret Čobo, . Janja Strašek, . Marija Prezelj, . Ana Debevc, . Borut Jug, . Marjeta Terčelj, . Mišo Šabovič

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 40-48

Abstract
Chronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention after acute myocardial infarction (AMI). The aim of our study was to determine the effect of diet, rich with natural antioxidants, added to physical activity (as a part of cardiac rehabilitation (CR) program) on inflammatory markers and ox-LDL, a marker of oxidative stress, closely involved in the process of chronic inflammation. 41 male patients after AMI undergoing CR were divided into a diet group (supervised cardioprotective diet throughout the CR), and control group (CR without diet). We measured hsCRP, leucocytes, neutrophils, IL-6, oxLDL, exercise capacity and classic risk factors before and after CR program. Patients from the diet group presented with a significant decline in classic risk factors (BMI, waist circumference, waist to hip ratio, systolic blood pressure, heart rate, blood glucose, total cholesterol, LDL, TAG) and inflammatory markers (hsCRP, leucocytes, neutrophils) compared to control group. Furthermore, when studying nonsmokers, we observed significant decline of oxLDL in the diet group. The addition of cardioprotective diet, rich with natural antioxidants, to physical activity as a part of a CR program, positively modifies not just classic risk factors and exercise capacity, but also diminishes chronic inflammation markers. These effects, and oxLDL decline were most prominent in nonsmoking patients.
Abstract
Chronic inflammation, the fundamental pathogenetic process of atherosclerosis, can be modified by pharmacological and non-pharmacological measures as a part of secondary prevention [...]
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Autoantibodies against basement membrane collagen type IV are associated with myocardial infarction
. Olga McLeod, . Pontus Dunér, . Ann Samnegård, . Per Tornvall, . Jan Nilsson, . Anders Hamsten, . Eva Bengtsson

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 42-47

Abstract
Collagen type IV is the major constituent of basement membranes underlying endothelial cells and is important for endothelial cell attachment and function. Autoantibodies against native collagen type IV have been found in various autoimmune diseases. Oxidation of LDL in the vascular wall results in the formation of reactive aldehydes, which could modify surrounding matrix proteins. Like oxidized LDL, these modified matrix proteins are likely to induce immune responses. We examined whether autoantibodies against native or aldehyde-modified collagen type IV are associated with myocardial infarction. IgM and IgG against native and aldehyde-modified collagen type IV were measured by ELISA in serum from 387 survivors of a first myocardial infarction and 387 age- and sex-matched controls. Post-infarction patients had significantly increased levels of IgM against native collagen type IV, and IgG against native collagen type IV was present at detectable level in 17% of patients as opposed to 7% of controls (p < 0.001). Controlling for major cardiovascular risk factors demonstrated that the presence of IgG against native collagen type IV was associated with myocardial infarction (OR 2.9 (1.6–5.4), p = 0.001). Similarly, subjects in the highest quartile of IgM against native collagen type IV had increased risk of having suffered myocardial infarction (OR 3.11 (1.8–5.4), p < 0.001) after adjusting for cardiovascular risk factors. In contrast, IgG against aldehyde-modified collagen type IV was decreased in myocardial infarction patients, but this association was not independent of established cardiovascular risk factors. Autoantibodies against collagen type IV are associated with myocardial infarction independently of traditional cardiovascular risk factors.
Abstract
Collagen type IV is the major constituent of basement membranes underlying endothelial cells and is important for endothelial cell attachment and function. Autoantibodies [...]
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Comparison of two dimensional quantitative coronary angiography (2D-QCA) with optical coherence tomography (OCT) in the assessment of coronary artery lesion dimensions
. J. Mazhar, E. Shaw, . U.K. Allahwala, . G.A. Figtree, . R. Bhindi

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 14-17

Abstract
There is limited data on how well 2D-QCA and OCT agree with each other for measurement of coronary artery lumen dimensions. We aimed to assess the agreement between the two modalities. Patients undergoing OCT for assessment of coronary artery lesions were reviewed. Minimum luminal diameter (MLD), proximal reference diameter and distal reference diameter were measured for each lesion prior to stenting. OCT was performed in 64 patients and 40 lesions were suitable for analysis. There was a good correlation for proximal and distal reference diameters (r = 0.86, p < 0.0001 and r = 0.92, p < 0.0001 respectively). There was good agreement on Bland–Altman analysis, the proximal and distal reference diameters measured by QCA were on average 0.09 mm (95% CI, − 0.52 to 0.53 mm) and 0.1 mm (95% CI, − 0.59 to 0.6 mm) smaller than OCT respectively. There was a satisfactory correlation (r = 0.63, p = < 0.0001) between QCA and OCT for MLD. However, the MLD by QCA was 0.49 mm (95% CI, − 1.57 to 0.59 mm) smaller than OCT, suggesting a poor agreement for MLD. There is a good correlation and agreement between QCA and OCT for measurement of proximal and distal reference diameters. However, the MLD was underestimated by QCA.
Abstract
There is limited data on how well 2D-QCA and OCT agree with each other for measurement of coronary artery lumen dimensions. We aimed to assess the agreement between the two [...]
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Left atrial hematoma complicating right coronary artery chronic total occlusion recanalization
. Alfonso Mayorga-Bajo, R. Estévez-Loureiro, A. Prado, . David Alonso, . Felipe Fernández-Vázquez

IJC Heart & Vasculature (2014). Vol. 5 pp. 65-67
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Low rate of access site complications after transradial coronary catheterization: A prospective ultrasound study
. Violeta Mattea, . Carsten Salomon, . Niels Menck, . Philipp Lauten, F. Malur, . Anja Schade, . Frank Steinborn, . Lisa Costello-Boerrigter, . Axel Neumeister, . Harald Lapp

IJC Heart & Vasculature (2017). Vol. 14 pp. 46-52

Abstract
Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era. A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, p = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified. Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
Abstract
Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the [...]
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Soluble CD54 induces human endothelial cells ex vivo expansion useful for cardiovascular regeneration and tissue engineering application
. N.M. Malara, . V. Trunzo, . G. Musolino, . S. Aprigliano, G. Rotta, . L. Macrina, . T. Limongi, . S. Gratteri, E. Di Fabrizio, . A. Renzulli, M. Fini, . V. Mollace

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 48-53

Abstract
Consistent expansion of primary human endothelial cells in vitro is critical in the development of engineered tissue. A variety of complex culture media and techniques developed from different basal media have been reported with alternate success. Incongruous results are further confounded by donor-to-donor variability and cellular source of derivation. Our results demonstrate how to overcome these limitations using soluble CD54 (sCD54) as additive to conventional culture medium. Isolated primary fragment of different vessel types was expanded in Hams F12 DMEM, enriched with growth factors, Fetal Calf Serum and conditioned medium of Human Umbilical Vein Endothelial Cells (HUVEC) collected at different passages. Cytokine content of culture media was analyzed in order to identify the soluble factors correlating with better proliferation profile. sCD54 was found to induce the in vitro expansion of human endothelial cells (HECs) independently from the vessels source and even in the absence of HUVEC-conditioned medium. The HECs cultivated in the presence of sCD54 (50 ng/ml), resulted positive for the expression of CD146 and negative for CD45, and lower fibroblast contamination. Cells were capable to proliferate with an S phase of 25%, to produce vascular endothelial growth factor, VEGF, (10 ng/ml) and to give origin to vessel-like tubule in vitro. Our results demonstrate that sCD54 is an essential factor for the in-vitro expansion of HECs without donor and vessel-source variability. Resulting primary cultures can be useful, for tissue engineering in regenerative medicine (e.g. artificial micro tissue generation, coating artificial heart valve etc.) and bio-nanotechnology applications.
Abstract
Consistent expansion of primary human endothelial cells in vitro is critical in the development of engineered tissue. A variety of complex culture media and techniques developed [...]
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Incidence of thromboembolism following detection by trans-oesophageal echocardiography of left atrial thrombus
. Ciara Mahon, . David Keane, . John Erwin

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 95-97

Abstract
Left atrial appendage (LAA) thrombus is an accepted risk factor for ischemic stroke. Following a literature review we were unable to identify a study that determined the incidence of ischemic stroke in patients with a confirmed LAA thrombus. The purpose of this study was to establish the incidence of ischemic stroke in patients with a LAA thrombus confirmed on trans-oesophageal echocardiography (TOE). A ten year retrospective single centre study was conducted for the period March 2005 to February 2014 in St. Vincents University Hospital, Ireland. All TOE studies performed during this period were reviewed. A chart review was carried out on any patient who had a LAA thrombus, left atrial (LA) thrombus or pre-thrombus state identified. Charts were reviewed for documented neurological deficits consistent with ischemic stroke or transient ischemic attack within six months following TOE study. Overall 1903 TOE studies were reviewed. A total of 67 TOE studies detected a LAA thrombus, LA thrombus or pre-thrombus state. In the days prior to TOE, an ischemic stroke had occurred in two of the patients. Following detection of thrombus or pre-thrombus state on TOE and optimization of oral anti-coagulation (OAC), no patient had an ischemic stroke over the subsequent six months. This is the only study to date that has looked at the incidence of ischemic stroke following a confirmed LAA thrombus, LA thrombus or pre-thrombus state. This single centre study found low stroke rates over a six month follow-up period in patients with a confirmed LAA thrombus, LA thrombus or pre-thrombus state and optimization of OAC. Larger studies would be required to confirm these findings.
Abstract
Left atrial appendage (LAA) thrombus is an accepted risk factor for ischemic stroke. Following a literature review we were unable to identify a study that determined the incidence [...]
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Left ventricular ejection fraction is determined by both global myocardial strain and wall thickness
D. H. MacIver, . Ismail Adeniran, . Henggui Zhang

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 113-118

Abstract
The purpose of this study was to determine the mathematical relationship between left ventricular ejection fraction and global myocardial strain. A reduction in myocardial strain would be expected to cause a fall in ejection fraction. However, there is abundant evidence that abnormalities of myocardial strain can occur with a normal ejection fraction. Explanations such as a compensatory increase in radial or circumferential strain are not supported by clinical studies. We set out to determine the biomechanical relationship between ejection fraction, wall thickness and global myocardial strain. The study used an established abstract model of left ventricular contraction to examine the effect of global myocardial strain and wall thickness on ejection fraction. Equations for the relationship between ejection fraction, wall thickness and myocardial strain were obtained using curve fitting methods. The mathematical relationship between ejection fraction, ventricular wall thickness and myocardial strain was derived as follows: φ = e(0.14Ln(ε) + 0.06)ω + (0.9Ln(ε) + 1.2), where φ is ejection fraction (%), ω is wall thickness (cm) and ε is myocardial strain (−%). The findings of this study explain the coexistence of reduced global myocardial strain and normal ejection fraction seen in clinical observational studies. Our understanding of the pathophysiological processes in heart failure and associated conditions is substantially enhanced. These results provide a much better insight into the biophysical inter-relationship between myocardial strain and ejection fraction. This improved understanding provides an essential foundation for the design and interpretation of future clinical mechanistic and prognostic studies.
Abstract
The purpose of this study was to determine the mathematical relationship between left ventricular ejection fraction and global myocardial strain. A reduction in myocardial [...]
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Text-messaging program improves outcomes in outpatient cardiovascular rehabilitation
. Patricia Lounsbury, A. S. Elokda, . Darin Gylten, . Ross Arena, . William Clarke, E. E.I. Gordon

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 170-175

Abstract
Outpatient cardiac rehabilitation (OP-CR) is a highly beneficial program but vastly under utilized. The efficacy of a text-messaging program was analyzed to determine if implementation could improve number of OP-CR sessions completed. All patients enrolled in OP-CR from July 2011 through December 2012 were invited to join a text-messaging program on their first visit. The program required that the patient possesses a cell phone with texting capabilities. Participants received three to five text-messages per week offering heart-healthy tips and requests for body weight, minutes of exercise, blood pressure, and medication adherence. Patients enrolled (n = 52) in the texting program (Tx) were compared with those who were not (n = 185) (NTx) in several clinical indices and were compared using matched pairs (same subjects), comparison of means and frequencies, chi-square statistics, t-tests, and the Wilcoxon Rank Sum test. Significantly more patients in the Tx group completed the OP-CR program (61.5% versus 50%, p = 0.01). For those completing OP-CR, subjects in the Tx group completed significantly more sessions (31.4) than the NTx group (25.3) (p = 0.01). Additionally, significantly more in the Tx group were younger than those in the Ntx group. Patients enrolled in OP-CR who participated in a text-messaging program were younger, attended significantly more sessions and were significantly more likely to complete the program.
Abstract
Outpatient cardiac rehabilitation (OP-CR) is a highly beneficial program but vastly under utilized. The efficacy of a text-messaging program was analyzed to determine if implementation [...]
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Cardiovascular diseases in China: Current status and future perspectives
H. Li, J. Ge

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 25-31

Abstract
Despite revolutionary advancement in medicine over the past century, cardiovascular disease (CVD) remains the leading cause of death and disability in the world. Likewise, the morbidity and mortality of CVD in China are increasing persistently, although the government has taken an active part in the prevention and control of CVD. Here we present an overview regarding the current CVD status in China with respect to various disease phenotypes, as well as the anticipated future trend in accordance with the dynamics and distribution of pathogenesis in Chinese actual situations.
Abstract
Despite revolutionary advancement in medicine over the past century, cardiovascular disease (CVD) remains the leading cause of death and disability in the world. Likewise, [...]
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Swallowing-induced tachyarrhythmia: Case report and review of literature
S. Li, . Clifford Browning, J. Popkin

IJC Heart & Vasculature (2014). Vol. 5 pp. 72-73
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The prognostic value of left ventricular global peak systolic longitudinal strain in chronic peritoneal dialysis patients
. Yen-Wen Liu, . Chin-Chung Tseng, . Chi-Ting Su, . Yu-Tzu Chang, . Ju-Yi Chen, . Li-Yin Chen, . Liang-Miin Tsai, . Jyh-Hong Chen, . Ming-Cheng Wang, . Wei-Chuan Tsai

IJC Heart & Vasculature (2014). Vol. 5 pp. 1-8

Abstract
Although left ventricular (LV) global systolic longitudinal strain (GLS) reliably and accurately assesses LV systolic function and is also a powerful prognostic predictor, the importance and prognostic value of GLS in end-stage renal disease patients receiving maintenance peritoneal dialysis (PD) remain unclear. This study sought to determine the prognostic value of GLS in chronic PD patients. This prospective study collected clinical and echocardiographic data from 106 stable PD patients (50.0 ± 13.9 years, 45% male) in a dialysis unit of a university hospital. These patients were enrolled from April 2010 to June 2010 and followed until August 2013 (follow-up duration 30.3 ± 14.3 months). The primary outcomes were the presence of major adverse events (MAEs), defined as all-cause mortality, and major adverse cardiovascular cerebral events (MACCEs), i.e. cardiovascular death, cardiac hospitalization, and stroke. Twenty-nine patients (27%) reported a primary outcome. Patients with MAEs had worse LV systolic function (MAEs vs. no MAEs, − 14.8 ± 2.8 vs. − 17.1 ± 2.5%, p = 0.003). Using multivariate Cox regression analyses, being male, having a history of heart failure, diabetes mellitus, an increased pulse pressure (≥ 60 mm Hg), and GLS ≥ − 15% were independent predictors of MAEs. The independent risk factors of MACCEs were a history of diabetes mellitus, an increased pulse pressure, and GLS ≥ − 15%. After comparison of the overall log likelihood χ2 of the predictive power, GLS was found to add prognostic information to a model based on traditional risk factors. GLS ≥ − 15% provided additional prognostic information that allowed for the early identification of high-risk PD patients.
Abstract
Although left ventricular (LV) global systolic longitudinal strain (GLS) reliably and accurately assesses LV systolic function and is also a powerful prognostic predictor, [...]
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Efficiency of different annuloplasty in treating functional tricuspid regurgitation and risk factors for recurrence
. Yiyun Lin, . Zhinong Wang, J. He, . Zhiyun Xu, . Jian Xiao, . Yufeng Zhang, H. Peng

IJC Heart & Vasculature (2014). Vol. 5 pp. 15-19

Abstract
Functional tricuspid regurgitation (FTR) is frequent in patients with mitral valve disease. Untreated tricuspid regurgitation (TR) may cause poor clinical outcomes. The surgical factors involved in annuloplasty for FTR remain controversial. Our objective was to compare effectiveness of different tricuspid annuloplasty (TVP), and reveal the risk factors of recurrence. We analyzed the clinical details of 399 consecutive patients who underwent mitral surgery with concomitant TVP, from 2006 to 2011, in two Chinese single-centers. Three methods were used for TVP: De Vega surgery was completed in 242 patients, annuloplasty using a flexible band was completed in 98 patients, and surgery with a rigid ring was performed in 59 patients. The operative mortality rate was 2.3%. After surgery, the TR grade of all patients decreased significantly. At three years postoperatively, 13.7% of patients were diagnosed with recurrent FTR. At the three year time point, severe TR in the De Vega group was 18%, which was higher than those in the flexible (8.4%) and rigid planner ring groups (5.2%). During follow-up, the recurrent rates in the rigid group were significantly lower than in the flexible group. Multivariate analysis revealed that pre-operative atrial fibrillation, severe TR, large left atrial, ejection fraction (EF) < 40%, De Vega annuloplasty, and postoperative permanent pacemaker installation were independent risk factors for severe recurrent TR. Rigid ring annuloplasty efficaciously improved post-operative tricuspid valve function in patients with FTR. Atrial fibrillation, a large left atrium, low EF and postoperative permanent pacemaker installation were independent risk factors for severe recurrent TR.
Abstract
Functional tricuspid regurgitation (FTR) is frequent in patients with mitral valve disease. Untreated tricuspid regurgitation (TR) may cause poor clinical outcomes. The surgical [...]
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Dipyridamole-induced adverse effects in myocardial perfusion scans: Dynamic evaluation
S. Lee, . Wei-Chun Huang, . Nan-Jing Peng, C. Hu

IJC Heart & Vasculature (2017). Vol. 14 pp. 14-19

Abstract
Dipyridamole-induced stress myocardial perfusion scans (MPS) has been widely used for management of coronary artery disease. The adverse effects of dipyridamole and other stress agents have been evaluated. The aim of this research is to confirm the dynamic data on dipyridamole side effects during MPS. We collected data of 183 patients who underwent dipyridamole-induced stress MPS by retrospectively reviewing their clinical records, which included the severity of dipyridamole side effects in 3 min, 10 min, and 20 min after infusion. The incidence and severity at all three points, including the effect of age and gender, were obtained. Adverse effects occurred in 96 patients (69.6%). The most frequent symptoms were dizziness (42.8%), chest tightness (24.6%), abdominal pain (18.1%), and headache (15.2%). Most symptoms were Grade 1 to 2, according to the grading system for common terminology criteria. The median duration of symptom persistence was 36 min, not significantly different among age and gender. This study demonstrates that the adverse effects of dipyridamole were generally minimal and its duration was acceptable for clinical usage.
Abstract
Dipyridamole-induced stress myocardial perfusion scans (MPS) has been widely used for management of coronary artery disease. The adverse effects of dipyridamole and other [...]
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Diagnostic accuracy of 64 slice multidetector coronary computed tomographic angiography in left ventricular systolic dysfunction
D. Lee, D. Li, . Borut Jug, . Jenny Papazian, . Matthew Budoff

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 42-46

Abstract
Detecting coronary artery disease (CAD) is pivotal in etiologic assessment and management of left ventricular (LV) systolic dysfunction. Only a limited number of studies have specifically addressed the accuracy of coronary computed tomographic angiography (CCTA) in detection/exclusion of CAD in patients with LV systolic dysfunction. We included patients who were referred for CCTA and invasive coronary angiography within 6 months of each other because of chest pain, either as part of clinical work-up in two Los Angeles medical centers from September 2006 to May 2010 or as part of the multicenter ACCURACY trial. Sensitivity, specificity, positive and negative predictive value, and likelihood ratios of 64 slice multidetector CCTA against coronary angiography were calculated. Five hundred and thirty-seven patients were included: 228 (42.5%) were women, mean age was 62 ± 12 years, 82 (15.3%) had LV systolic dysfunction (defined by LVEF < 50%). On a patient-based model, the sensitivity of CCTA to detect 50% and 70% coronary lesions was excellent across all LVEF-derived cohorts, ranging from 92% to 100%. The negative predictive value was similarly excellent, ranging from 88% to 100%. CCTA was fairly specific for CAD, with specificity ranging from 83% to 93%, and positive predictive value from 81% to 92%. There was no significant between-group difference for any of the accuracy measures for detecting coronary stenosis at 50% or 70% cutoff. Sixty-four slice multidetector CCTA is a very sensitive and fairly specific noninvasive diagnostic procedure for detecting coronary stenosis in patients with chest pain regardless of LV systolic function at presentation.
Abstract
Detecting coronary artery disease (CAD) is pivotal in etiologic assessment and management of left ventricular (LV) systolic dysfunction. Only a limited number of studies have [...]
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A study of spectrum of rheumatic heart disease in a tertiary care hospital in Central Nepal
. S. Laudari, . G. Subramanyam

IJC Heart & Vasculature (2017). Vol. 15 pp. 26-30

Abstract
Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal imparting huge familial, social and manpower burden. This is a hospital based descriptive cross-sectional study during June 2014 to April 2016 over a period of 22 months at College of Medical Sciences-Bharatpur including 235 patients with clinical and/or echocardiographic evidence of definite rheumatic heart disease. The age of the patients ranged from 7 to 76 years with mean age 39.82 ± 4.2 years with female preponderance (F:M = 2.1:1) (p < 0.01). Majority of the rheumatic heart disease patients belonged to 30–44 years (28.78%) followed by 15–29 years (25.75%) and 45–59 years (25.00%). Majority belonged to the low socioeconomic status (60.60%) (p < 0.05). The predominantly involved isolated valve was mitral in 110 patients (46.80%) followed by isolated aortic valve in 22 patients (9.36%) and 79 (33.62%) had dual valvular involvement. The common rheumatic valvular lesions were pure mitral stenosis in 32 (13.61%), isolated mitral regurgitation in 58 (24.68%), combined mitral stenosis/regurgitation in 36 (15.32%), combined mitral/aortic regurgitation in 23 (9.78%) and combined aortic stenosis/regurgitation in 18 (7.66%) patients with few overlappings. The common complications encountered were heart failure in 90 (38.30%) and arrhythmias in 124 (51.00%) patients.130 patients (55.32%) received injectable benzathine penicillin whereas 45 patients (19.15%) preferred oral penicillin V. Surgical intervention was done in 54 (22.97%) patients. 12 (5.10%) expired in the CCU during the course of treatment. RHD is a leading cause of heart failure among young populations with requirement of prolonged duration of medical treatment and many of them requiring surgery.
Abstract
Rheumatic heart disease is one of the most common cause for heart failure and associated mortalities/morbidities in the young population in developing countries like Nepal [...]
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Accurate monitoring of intravascular fluid volume: A novel application of intrathoracic impedance measures for the guidance of volume reduction therapy
B. A. Lara, . Fujian Qu, E. Kevin Heist, B. B. Pavri, A. Bakel, J. M. Herre, P. F. Binkley

IJC Heart & Vasculature (2015).

Abstract
A significant proportion of patients admitted for acute decompensated heart failure (ADHF) that undergo volume reduction therapy are discharged with unchanged or increased bodyweight suggesting that the endpoints for these therapies are not optimally defined. We aimed to identify vectors that can help monitor changes in intravascular fluid volume, that in turn may more accurately guide volume reduction therapy. Data from six different impedance vectors and corresponding changes in intravascular volume derived from changes in hematocrit were obtained from 132 clinical congestion events in 56 unique patients enrolled in a multisite trial of early detection of clinical congestion events (DEFEAT PE). Mixed effects regression models were used to determine the relation between changes in impedance derived from six different vectors and changes in intravascular plasma volume. Changes in impedance were negatively associated with changes in plasma volume. Two vectors, the right atrial ring to left ventricular ring and the left ventricular ring to the right ventricular ring, were most closely associated with changes in intravascular plasma volume. Impedance vectors derived from a multivector monitoring system reflect changes in intravascular plasma volume. Two of these vectors most closely track changes in plasma volume and may be used to more accurately guide and optimize volume reduction therapy.
Abstract
A significant proportion of patients admitted for acute decompensated heart failure (ADHF) that undergo volume reduction therapy are discharged with unchanged or increased [...]
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Successful conservative treatment of myocardial infarction in a teenager with MTHFR mutation
. Subhrajit Lahiri, B. Gulman, J. Gutierrez, . Athena Pefkarou

IJC Heart & Vasculature (2017). Vol. 15 pp. 24-25
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Performance of the “CCS Algorithm” in real world patients
S. A. LaHaye, J. B. Olesen, S. P. Lacombe

IJC Heart & Vasculature (2015).

Abstract
With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society Atrial Fibrillation Guidelines Committee has introduced a new triage and management algorithm, the so-called “CCS Algorithm”. The CCS Algorithm is based upon expert opinion of the best available evidence, however, the CCS Algorithm has not yet been validated. Accordingly, the purpose of this study is to evaluate the performance of the CCS Algorithm in a cohort of real world patients. We compared the CCS Algorithm with the European Society of Cardiology (ESC) Algorithm in 172 hospital inpatients who are at risk of stroke due to non-valvular atrial fibrillation in whom anticoagulant therapy was being considered. The CCS Algorithm and the ESC Algorithm were concordant in 170/172 patients (99% of the time). There were two patients (1%) with vascular disease, but no other thromboembolic risk factors, which were classified as requiring oral anticoagulant therapy using the ESC Algorithm, but for whom ASA was recommended by the CCS Algorithm. The CCS Algorithm appears to be unnecessarily complicated in so far as it does not appear to provide any additional discriminatory value above and beyond the use of the ESC Algorithm, and its use could result in under treatment of patients, specifically female patients with vascular disease, whose real risk of stroke has been understated by the Guidelines.
Abstract
With the publication of the 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation, the Canadian Cardiovascular Society [...]
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Left atrial appendage function assessment and thrombus identification
. Jacek Kurzawski, A. Janion-Sadowska, M. Sadowski

IJC Heart & Vasculature (2017). Vol. 14 pp. 33-40

Abstract
The diagnosis of thrombus in the left atrium in patients with persistent atrial fibrillation (AF) and may be inconsistent because of variability in thrombus morphology. In some cases it is challenging and requires unusual approach. New Doppler-derived methods might be helpful to identify such thrombi. We evaluated quantitative differences in mechanical function of the left atrial appendage (LAA) basal segments using tissue Doppler imaging (TDI)and speckle tracking echocardiography (STE) in patients with non-valvular AF with and without LAA thrombus and compared them with SR patients. A total of 80 patients with normal left ventricular ejection fraction underwent transesophageal echocardiography (40 patients with SR and 40 patients with AF on oral anticoagulants including patients with LAA thrombus). We analyzed the basal segments of LAA including left lateral ridge (LLR) and baso-medial appendage segment (BMAS). Quantitative analysis was used to calculate peak velocity, average velocity, strain, strain rate and deformation. In patients with AF the lower LLR strain rate was the sole new STE significant parameter differentiating patients with and without LAA thrombi: − 0.9(− 1.2, − 0.1)s− 1 vs. − 1.6(− 1.9, − 1.3)s− 1, (p = 0.004). Additionally, patients in SR demonstrated significantly better peak velocity, average velocity, strain, strain rate and deformation than those with AF (p < 0.001). LLR appeared to be an appropriate site for measuring Doppler derived parameters. It is possible that the strain rate in LLR area may be a novel parameter correlating with the presence of thrombus in patients with AF.
Abstract
The diagnosis of thrombus in the left atrium in patients with persistent atrial fibrillation (AF) and may be inconsistent because of variability in thrombus morphology. In [...]
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Changes in the reference lumen size of target lesions before and after coronary stent implantation: Evaluation with frequency domain optical coherence tomography
. Muneo Kurokawa, . Shiro Uemura, . Makoto Watanabe, . Yoko Dote, . Yu Sugawara, . Yutaka Goryo, . Tomoya Ueda, . Satoshi Okayama, . Michinori Kayashima, . Yoshihiko Saito

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 122-127

Abstract
In optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI), stent size is usually determined according to the pre-PCI lumen size of either the distal or proximal reference site. However, the effect of the OCT imaging catheter crossing the target lesion on the reference lumen measurements has not been studied. We evaluated changes in the reference lumen size before and after PCI using frequency domain OCT. For 100 consecutive patients with PCI, mean lumen diameter (LD) and lumen area (LA) were measured at the proximal and distal reference sites before and after coronary stent implantation with OCT. Mean LD and LA of the distal reference site were significantly increased after PCI with stent implantation (2.57 ± 0.6 to 2.62 ± 0.64 mm, p < 0.01 and 5.20 ± 2.66 to 5.41 ± 2.54 mm2, p < 0.01, respectively). By contrast, these indices at the proximal reference site were significantly decreased. ROC curve analysis selected MLA of 1.50 mm2 as the best cutoff value for changes in mean LD. Distal mean LD was markedly increased after PCI in lesions with MLA < 1.50 mm (2.28 ± 0.48 to 2.40 ± 0.17 mm, P < 0.001), but did not change in lesions with MLA > 1.50 mm2. Tissue characteristics were not correlated with changes in reference lumen size. When we select the stent size during OCT-guided PCI, we need to pay attention to the decrease in the luminal measurement of the reference sites, especially in lesions with tight stenosis.
Abstract
In optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI), stent size is usually determined according to the pre-PCI lumen size of either the distal [...]
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Poor R-wave progression and myocardial infarct size after anterior myocardial infarction in the coronary intervention era
. Satoshi Kurisu, . Toshitaka Iwasaki, . Noriaki Watanabe, . Hiroki Ikenaga, . Takashi Shimonaga, . Tadanao Higaki, . Ken Ishibashi, . Yoshihiro Dohi, . Yukihiro Fukuda, . Yasuki Kihara

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 106-109

Abstract
Regeneration of R-wave or disappearance of Q-wave sometimes occurs after myocardial infarction (MI) especially in the coronary intervention era. We assessed the impact of poor R-wave progression (PRWP) or residual R-wave in precordial leads on myocardial infarct size in patients with prior anterior MI treated with coronary intervention. Fifty-three patients with prior anterior MI and 20 age- and sex-matched patients without underwent electrocardiogram (ECG), myocardial perfusion single photon emission tomography (SPECT) and echocardiography. Poor R-wave progression (PRWP) was defined as RV3 ≤ 3 mm. R-wave was significantly lower in all precordial leads in patients with prior anterior MI than those without. Among 53 patients with prior anterior MI, 33 patients had PRWP, and the remaining 20 patients did not. Patients with PRWP had larger sum of defect score (17.5 ± 8.6 vs 7.6 ± 10.3, p < 0.001) and lower left ventricular ejection fraction (LVEF) (46.1 ± 9.8% vs 55.2 ± 12.9%, p < 0.01) than those without. The sum of R-wave in lead V1 to V6 inversely correlated with the sum of defect score (r = − 0.56, p < 0.001), and positively correlated with LVEF (r = 0.45, p < 0.001). Our data suggested that residual R-wave during the follow-up period reflected myocardial infarct size and left ventricular systolic function well in patients with prior anterior MI treated with coronary intervention.
Abstract
Regeneration of R-wave or disappearance of Q-wave sometimes occurs after myocardial infarction (MI) especially in the coronary intervention era. We assessed the impact of [...]
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Thallium-201 gated single-photon emission tomography for assessing left ventricular volumes and function in patients with aortic valve stenosis: Comparison with echocardiography as the reference standard
. Satoshi Kurisu, . Toshitaka Iwasaki, . Hiroki Ikenaga, . Noriaki Watanabe, . Tadanao Higaki, . Takashi Shimonaga, . Ken Ishibashi, . Naoya Mitsuba, . Yoshihiro Dohi, . Yasuki Kihara

IJC Heart & Vasculature (2014). Vol. 5 pp. 74-78

Abstract
Aortic valve stenosis (AS) is characterized by chronic left ventricular pressure overload, leading to left ventricular hypertrophy (LVH). We assessed correlations in left ventricular volumes and function between echocardiography and quantitative gated SPECT (QGS) in patients with AS. The study population consisted of 28 patients with AS defined as a peak velocity of > 3.0 m/s and 28 age- and sex-matched control subjects. Patients with AS had a peak pressure gradient of 73.4 ± 24.5 mm Hg and a larger LVM index compared to control subjects (115.5 ± 29.2 g/m2 vs 78.3 ± 12.1 g/m2, p < 0.01). There were good correlations in end-diastolic volume and end-systolic volume between echocardiography and QGS in patients with AS as well as control subjects. Bland–Altman plot for end-systolic volume showed a significant negative slope of − 0.51 in patients with AS. There was a good correlation in ejection fraction between the 2 methods in patients with AS as well as control subjects. However, Bland–Altman plots showed significant negative slopes of − 0.40 in patients with AS and − 0.74 in control subjects. Our data suggested that QGS was a useful method for assessing left ventricular volumes and function even in patients with AS. Cardiologists should recognize its specific characteristics.
Abstract
Aortic valve stenosis (AS) is characterized by chronic left ventricular pressure overload, leading to left ventricular hypertrophy (LVH). We assessed correlations in left [...]
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Differences between Takotsubo cardiomyopathy and reverse Takotsubo cardiomyopathy associated with subarachnoid hemorrhage
. Tadashi Kumai, . Joji Inamasu, . Eiichi Watanabe, . Keiko Sugimoto, . Yuichi Hirose

IJC Heart & Vasculature (2016). Vol. 11 pp. 99-103

Abstract
Both Takotsubo cardiomyopathy (TTC) and reverse TTC (r-TTC) are characterized by reversible regional wall motion abnormalities of the heart unrelated to coronary artery pathology. It remains unclear whether and/or how r-TTC differs from TTC. Subarachnoid hemorrhage (SAH) is occasionally causative of TTC/r-TTC, and this study was conducted to detect possible differences between TTC and r-TTC associated with SAH. A single-center retrospective study was conducted on 328 consecutive SAH patients. They routinely underwent transthoracic echocardiography (TTE), ECG, and measurements of plasma catecholamines and other cardiac biomarkers within 24 h of admission. Demographic, echocardiographic, electrocardiographic and neurochemical profiles were compared between patients with TTC and r-TTC. The diagnosis of TTC/r-TTC was based on the revised Mayo Clinic Criteria. Data of 21 SAH-induced TTC and 10 SAH-induced r-TTC patients admitted between January 2009 and December 2014 were analyzed. The patients with r-TTC were significantly younger than those with TTC (51.8 ± 10.9 vs. 63.5 ± 14.4 years, p = 0.04). The former exhibited significantly higher plasma epinephrine levels than the latter (809 ± 710 vs. 380 ± 391 pg/mL, p = 0.04). Plasma norepinephrine levels did not differ significantly (2421 ± 1374 vs. 1724 ± 1591 pg/mL, p = 0.25). No significant differences were observed in other demographic/physiologic variables, echocardiographic parameters, frequency of ECG abnormalities, and 90-day mortality. Moreover, none of the patients who underwent a follow-up TTE exhibited morphologic change from one type to the other. The pathomechanisms in TTC and r-TTC may not be identical: however, distinguishing the two conditions may not have great importance from the standpoint of clinical management and prognostication.
Abstract
Both Takotsubo cardiomyopathy (TTC) and reverse TTC (r-TTC) are characterized by reversible regional wall motion abnormalities of the heart unrelated to coronary artery pathology. [...]
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Trans-catheter closure of a large aneurysm in coarctation of abdominal aorta
. Madhumita Kuila, R. Sharma

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 81-84
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Overweight predicts poorer exercise capacity in congenital heart disease patients
. Karen Kuehl, . Alicia Tucker, . Munziba Khan, . Paula Goldberg, E. Anne Greene, . Megan Smith

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 28-31

Abstract
Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight on the cardiovascular system in ACHD is the goal of this study. Limitation of exercise capacity due to overweight or obesity might be reversible with weight loss and improve quality of life for ACHD adults. Exercise tests performed using a Bruce protocol and measurement of maximum oxygen consumption were retrospectively reviewed on 418 CHD patients. OW and OB were defined as the 85–95 or > 95 percentile respectively for age and gender or by adult criteria. Severity of CHD was assigned based on criteria published in standard guidelines. 63 patients had mild, 198 moderate, and 157 severe heart disease. Each ACHD group was 32 to 34% OW or OB. Measured exercise time (ET) of CHD patients with moderate or severe heart disease was less than that of controls in each weight categories. However, OB or OW people have shorter ET than their normal weight peers with CHD. Multiple regression using ET as the dependent variable finds that female sex, relative BMI, and VE/VCO2 at peak exercise are all associated with lesser ET with high significance. Peak heart rate is associated with greater ET, with borderline significance. Severity of heart disease is not independently associated with ET. OW and OB are strongly associated with reduced ET in persons with congenital heart disease. Losing weight may improve exercise capacity in ACHD.
Abstract
Overweight (OW) and obesity (OB) are endemic in the United States and affect adolescents and adults with congenital heart disease (ACHD). Defining the burden of excess weight [...]
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Predictors of tamponade and constriction in patients with pericardial disease undergoing interventional and surgical treatment
T. Kudaiberdiev, . Seitkhan Joshibayev, . Gulzada Imanalieva, A. Beishenaliev, A. Ashinaliev, T. Baisekeev, . Sergei Chinaliev

IJC Heart & Vasculature (2016).

Abstract
The aim of our study was to define predictors of cardiac compression development including clinical, electrocardiographic, echocardiographic, chest-X-ray and perioperative parameters and their diagnostic value. Overall 243 patients with pericardial disease, among them 123 with compression (tamponade, constriction) and 120 without signs of compression were included in the study. Clinical, laboratory, electrocardiographic, chest-X-Ray, echocardiographic and perioperative data were included in the logistic regression analysis to define predictors of tamponade/constriction development. Logistic regression analysis demonstrated large effusion (> 20 mm) (OR 5.393, 95%CI 1.202–24.199, p = 0.028), cardiac chamber collapse (OR 31.426, 95%CI 1.609–613-914, p = 0.023) and NYHA class > 3 (OR 8.671, 95%CI 1.730–43.451, p = 0.009) were multivariable predictors of compression development. The model including these three variables allowed predicting compression in 91.7% of cases. ROC analyses demonstrated that all three variables had significant diagnostic value with sensitivity of 75.6% and specificity of 74.2% for large effusion, low sensitivity and high specificity for cardiac chamber collapse (35% and 92%) and NYHA class (32.5% and 94.2%). The independent predictors of compression development are presence of large effusion > 20 mm, cardiac chamber collapse and high NYHA class. The model including all three parameters allows correctly predicting compression in 91.4% of cases. The diagnostic accuracy of each parameter is characterized by high sensitivity and specificity of large effusion, high specificity of cardiac chamber collapse and NYHA class.
Abstract
The aim of our study was to define predictors of cardiac compression development including clinical, electrocardiographic, echocardiographic, chest-X-ray and perioperative [...]
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Left ventricular deformation and torsion assessed by speckle-tracking echocardiography in patients with mutated transthyretin-associated cardiac amyloidosis and the effect of diflunisal on myocardial function
. Jun Koyama, . Masatoshi Minamisawa, . Yoshiki Sekijima, . Shu-ichi Ikeda, . Ayako Kozuka, . Soichirou Ebisawa, . Takashi Miura, . Hirohiko Motoki, . Ayako Okada, . Atsushi Izawa, . Uichi Ikeda

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 1-10

Abstract
Mutated transthyretin-associated (ATTRm) amyloidosis with heart failure is associated with decreased longitudinal left ventricular (LV) myocardial contraction, as measured by strain Doppler echocardiography. We sought to clarify whether speckle-tracking echocardiography (STE) would provide useful information in patients with ATTRm cardiac amyloidosis. One hundred twenty-three consecutive patients with ATTRm amyloidosis were divided into 3 groups. Group 1 had no evidence of cardiac involvement (n = 47), group 2 had heart involvement but no congestive heart failure (CHF) and/or serum brain natriuretic peptide (BNP) levels < 100 pg/mL (n = 35), and group 3 had heart involvement and CHF and/or serum BNP levels ≥ 100 pg/mL (n = 41). All patients underwent standard 2-dimensional (2D), Doppler echo, and STE. By standard 2D and Doppler echo, differences in parameters were only apparent between group 3 and groups 1 and 2. Global circumferential strains by STE at each LV level and LV torsion were different between group 1 and groups 2 and 3, but not between group 2 and group 3. In contrast, global longitudinal LV strain showed significant intergroup differences (− 17.3 ± 2.3%, − 13.3 ± 2.3%, − 9.9 ± 3.3% for groups 1 to 3, respectively, P < 0.0001). Radial strain also showed significant intergroup differences for each basal LV segment. Among 41 patients who could have been followed up after 1 year, 34 patients with diflunisal treatment had shown improvement in apical rotation and torsion without deterioration in multidirectional strains. ATTRm cardiac amyloidosis is characterized by progressive impairment in longitudinal and basal LV radial function when global circumferential shortening and torsion remain unchanged.
Abstract
Mutated transthyretin-associated (ATTRm) amyloidosis with heart failure is associated with decreased longitudinal left ventricular (LV) myocardial contraction, as measured [...]
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Lactated Ringers solution for preventing myocardial reperfusion injury
T. Koyama

IJC Heart & Vasculature (2017). Vol. 15 pp. 1-8

Abstract
Reperfusion of ischemic myocardium is crucial for salvaging myocardial cells from ischemic cell death. However, reperfusion itself induces various deleterious effects on the ischemic myocardium. These effects, known collectively as reperfusion injury, comprise stunned myocardium, reperfusion-induced arrhythmia, microvascular reperfusion injury, and lethal reperfusion injury. No approach has proven successful in preventing any of these injuries in the clinical setting. My colleagues and I recently proposed a new postconditioning protocol, postconditioning with lactate-enriched blood (PCLeB), for the prevention of reperfusion injury. This new approach consists of intermittent reperfusion and timely coronary injections of lactated Ringers solution, aiming to achieve controlled reperfusion with cellular oxygenation and minimal lactate washout from the cells. This approach appeared to be effective in preventing all types of reperfusion injury in patients with ST-segment elevation myocardial infarction (STEMI), and we have already reported excellent in-hospital outcomes of patients with STEMI treated using PCLeB. In this review article, I discuss a possible mechanism of reperfusion injury, which we believe to be valid and which we targeted using this new approach, and I report how the approach worked in preventing each type of reperfusion injury.
Abstract
Reperfusion of ischemic myocardium is crucial for salvaging myocardial cells from ischemic cell death. However, reperfusion itself induces various deleterious effects on the [...]
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The role of TNF-α, Fas/Fas ligand system and NT-proBNP in the early detection of asymptomatic left ventricular dysfunction in cancer patients treated with anthracyclines
A. Kouloubinis, . Sofia Sofroniadou, V. Panoulas, K. Makaritsis, . Ioanna Revela, . George Karavolias, . Vasileios Voudris, . Stamatios Adamopoulos

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 85-90

Abstract
Anthracycline-induced cardiotoxicity typically presents as congestive heart failure (CHF). As immuno-inflammatory activation and apoptosis are important mechanisms in the process of heart failure, the use of biomarkers that could detect cardiovascular toxicity before the clinical presentation is of great importance. We studied whether sTNF-a, sTNF-RI, sTNF-RII, Fas/FasLigand system and NT-proBNP associate with early cardiac dysfunction in patients receiving cardiotoxic drugs. Two groups of breast cancer patients—group A with metastatic disease under chemotherapy with epirubicin and group B with no residual disease under a less cardiotoxic regimen—as well as healthy women were included in this prosprective study. NT-proBNP, sTNF-a, sTNF-RI, sTNF-RII, sFas, sFas-Ligand and left ventricular ejection fraction (LVEF) were determined in all patients before and after the completion of chemotherapy. In Group A, an increase in sFas levels (p < 0.001), a decrease in the sFasL levels (p = 0.010), an NT-proBNP increase (p < 0.001) and a significant reduction of LVEF (p < 0.001) was recorded post-chemotherapy. The decrease in LVEF correlated significantly with the increase in sFas, the decrease in sFasL and the rise in NT-proBNP levels. In Group B, TNF-RI levels were higher (p = 0.024) and mean sFas-L levels lower (p = 0.021) post chemotherapy with no LVEF drop. Two of group A (7.6%) patients developed symptomatic CHF 12 and 14 months respectively after the end of chemotherapy. SFas, sFas-L and NT-proBNP correlate with reductions in LVEF and could be used as sensitive biochemical indices for the detection of asymptomatic left ventricular dysfunction in cancer patients under cardiotoxic chemotherapy.
Abstract
Anthracycline-induced cardiotoxicity typically presents as congestive heart failure (CHF). As immuno-inflammatory activation and apoptosis are important mechanisms in the [...]
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Echocardiographic diastolic function assessment is of modest utility in patients with persistent and longstanding persistent atrial fibrillation
. Mária Kohári, D. R. Okada, . Larraitz Gaztanaga, . Erica Zado, F. Marchlinski, D. J. Callans, Y. Han

IJC Heart & Vasculature (2015).

Abstract
Detection of concurrent diastolic dysfunction (DD) may be beneficial in patients with persistent and longstanding persistent atrial fibrillation (AF). The role of transthoracic echocardiography (TTE) in assessing DD in patients with AF has not been well characterized. We sought to determine the utility of TTE in detecting elevated left atrial pressure (LAP) in patients with persistent and longstanding persistent non-valvular AF using directly measured LAP as the reference standard. We retrospectively studied 157 patients with persistent AF and preserved left ventricular ejection fraction who underwent pulmonary vein isolation (PVI). LAP was determined in conjunction with trans-septal puncture at the time of catheter ablation. TTE was performed 1 day after PVI and included two dimensional, pulse wave spectral Doppler and tissue Doppler assessments. The clinical parameter that strongly correlated with elevated LAP is longstanding persistent AF. Four strongest TTE parameters identified to moderately correlate with LAP include 1. left atrial minimum volume (LAVmin), 2. peak velocity of early mitral diastolic inflow velocity (E), 3. pulmonary vein systolic flow velocity (PVS), and 4. ratio of early diastolic transmitral inflow velocity to mitral annular velocity at the lateral site (E/E′ lateral). Accurate assessment of diastolic dysfunction in patients with persistent and longstanding persistent AF is difficult using TTE. A combination of LAVmin, PVS, and E might be helpful to determine elevated LAP.
Abstract
Detection of concurrent diastolic dysfunction (DD) may be beneficial in patients with persistent and longstanding persistent atrial fibrillation (AF). The role of transthoracic [...]
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High perfusion pressure as a predictor of reperfusion pulmonary injury after balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension
. Hiroto Kinutani, . Toshiro Shinke, . Kazuhiko Nakayama, . Yu Taniguchi, . Hiromasa Otake, T. Takaya, T. Osue, . Akihide Konishi, . Noriaki Emoto, . Ken-ichi Hirata

IJC Heart & Vasculature (2016). Vol. 11 pp. 1-6

Abstract
Clinical efficacy of balloon pulmonary angioplasty (BPA) to the patients with non-operable chronic thromboembolic pulmonary hypertension (CTEPH) for improving pulmonary hemodynamics and exercise tolerance has been reported in these several years. However, reperfusion pulmonary injury (RPI) remains to be a major complication of BPA to overcome. This study elucidated the local predictor of RPI. Twenty-eight consecutive patients with non-operable CTEPH underwent BPA for lesions in the segmental or sub-segmental vessels. Pre- and post-BPA pulmonary arterial pressures at proximal (Pp) and distal (Pd) to the stenosis were measured by a 0.014-in. pressure wire. Positive or negative RPI was evaluated by chest computed tomography in each re-perfused segment separately 4 h after BPA. Pressure measurements pre- and post-BPA were obtained from 110 lesions, where Pd and pressure ratio (Pd/Pp) increased after BPA in all lesions. Among them, RPI was observed in 49 lesions (44.5%). In the RPI-positive lesions, post-BPA Pd and post-BPA Pd/Pp were higher compared with the RPI-negative lesions. Multivariate logistic analysis revealed that the post-BPA Pd was independently associated with RPI incidence. Receiver operating characteristic curve analysis demonstrated the best cut-off value of 19.5 mm Hg for post-BPA Pd to predict RPI. High reperfusion pressure after BPA could be a predictor of RPI. Monitoring local pressure during BPA procedure may have a potential to reduce the incidence of RPI.
Abstract
Clinical efficacy of balloon pulmonary angioplasty (BPA) to the patients with non-operable chronic thromboembolic pulmonary hypertension (CTEPH) for improving pulmonary hemodynamics [...]
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The role of optical coherence tomography in decision making during the acute phase of spontaneous coronary artery dissection
Y. Kim, . Pierre Deharo, . David Adlam, . Andreas Baumbach, T. W Johnson

IJC Heart & Vasculature (2017). Vol. 14 pp. 6-7
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Influence of cardiogenic shock with or without the use of intra-aortic balloon pump on mortality in patients with ST-segment elevation myocardial infarction
J. Jensen, . Per Thayssen, . Lisbeth Antonsen, . Mikkel Hougaard, . Anders Junker, K. Erik Pedersen, L. Jensen

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 19-24

Abstract
Cardiogenic shock is a serious complication of a ST-segment elevation myocardial infarction (STEMI). We compared short- and long-term mortality among (1) STEMI patients with and without cardiogenic shock and (2) STEMI patients with cardiogenic shock with and without the use of an intra-aortic balloon pump (IABP). From January 1, 2002 to December 31, 2010, all patients presenting with STEMI and treated with primary percutaneous coronary intervention (PCI) were identified. The hazard ratio (HR) for death was estimated using a Cox regression model, controlling for potential confounding. The study cohort consisted of 4293 STEMI patients: 286 (6.7%) with and 4007 (93.3%) without cardiogenic shock. Compared with patients without cardiogenic shock, patients with cardiogenic shock were older, and more likely to have diabetes mellitus, multi-vessel disease, anterior myocardial infarction (MI) or bundle-branch block MI and a reduced creatinine clearance. Among patients with cardiogenic shock vs. without shock, 30-day cumulative mortality was 57.3% vs. 4.5% (p < 0.001), one-year cumulative mortality was 60.7% vs. 8.2% (p < 0.001) and five-year mortality was 65.0% vs. 18.9% (p < 0.001). STEMI with cardiogenic shock was associated with higher 30-day mortality (adjusted HR = 12.89 [95% CI: 9.72–16.66]), 1-year mortality (adjusted HR = 8.83 [95% CI: 7.06–11.05]) and five-year mortality (adjusted HR = 6.39 [95% CI: 5.22–7.80]). IABP was used in 71 (25%) patients with cardiogenic shock and was associated with improved 30-day outcome (adjusted HR = 0.48 [95% CI: 0.28–0.83]). Patients with STEMI and cardiogenic shock had substantial short- and long-term mortality that may be improved with IABP implantation. More studies on use of IABP in such patients are warranted.
Abstract
Cardiogenic shock is a serious complication of a ST-segment elevation myocardial infarction (STEMI). We compared short- and long-term mortality among (1) STEMI patients with [...]
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Use of observation followed by outpatient stress testing in chest pain patients with prior coronary artery disease history: An evaluation of prognostic utility
. Yasser Khalil, M. H. Schwartz, P. S. Pandey, M. Latif, M. E. Matsumura

IJC Heart & Vasculature (2015).

Abstract
To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial perfusion imaging (MPI). Retrospective analysis of patients with CP managed with observation followed by outpatient stress MPI, comparing cardiovascular (CV) event rates stratified by CAD history. 375 patients were included: 111 with and 264 without a CAD history. All patients underwent outpatient stress MPI within 72 h of observation. MPI identified patients at risk for CV events. However, while patients with negative MPI and without a CAD history had very low rates of short- and long-term CAD events (0.8%, 0.8%, and 1.3% at 30 days, 1 year, and 3 years, respectively), event rates of those with a negative test but a CAD history were significantly higher (2.6%, 5.3%, and 6.6% at 30 days, 1 year and 3 years, respectively, p = 0.044 and p = 0.034 compared to CAD− patients at 1 year and 3 years, respectively). In a multivariable logistic regression model, a positive MPI proved to be an independent predictor of long-term CV events in patients with CP and prior CAD. Observation followed by stress MPI can effectively risk stratify CP patients with prior CAD for CV risk. These patients are at increased risk of CV events even after a low-risk stress MPI study. Patients presenting with CP and managed with a strategy of observation followed by a negative stress MPI warrant close short- and long-term monitoring for recurrent events.
Abstract
To determine the outcomes of patients with chest pain (CP) and prior history of coronary artery disease (CAD) managed with observation followed by outpatient stress myocardial [...]
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No atrial fibrillation, no histologic findings but even no obstructive sleep apnea?
. Stefanie Keymel, D. In Shin, . Stephan Steiner

IJC Heart & Vasculature (2015).
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Interatrial septal aneurysm with mitral valve prolapse in a patient with Marfan syndrome—a caveat of note
J. Ker

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 65-66
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Rare congenital anomaly of the inferior vena cava
J. Ker

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 63-64
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Novel plasma and imaging biomarkers in heart failure with preserved ejection fraction
. Prathap Kanagala, I. B. Squire, L. Ng, G. P. McCann

IJC Heart & Vasculature (2015).

Abstract
Existing diagnostic guidelines for heart failure with preserved ejection fraction (HFPEF) primarily comprise natriuretic peptides and echocardiographic assessment, highlighting the role of diastolic dysfunction. However, recent discoveries of novel plasma markers implicated in pathophysiology of heart failure and technological advances in imaging provide additional biomarkers which are potentially applicable to HFPEF. The evidence base for plasma extra-cellular matrix (ECM) peptides, galectin-3, ST2, GDF-15 and pentraxin-3 is reviewed. Furthermore, the capabilities of novel imaging techniques to assess existing parameters (e.g. left ventricular ejection fraction, systolic & diastolic function, chamber size) and additional derangements of the ECM, myocardial mechanics and ischaemia evaluation are addressed.
Abstract
Existing diagnostic guidelines for heart failure with preserved ejection fraction (HFPEF) primarily comprise natriuretic peptides and echocardiographic assessment, highlighting [...]
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Immediate, intermediate and long term clinical outcomes of percutaneous transvenous mitral commissurotomy
S. Sriram, B. Venkata, T. Sadagopan, M. Ramamurthy

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 66-70

Abstract
Percutaneous transvenous mitral commissurotomy (PTMC) is one of the nonsurgical commissurotomy in patients with hemodynamically significant mitral stenosis. The aim of the present study is to assess the immediate, intermediate and long term outcomes of PTMC in relation to initial mitral valve score and to assess its impact on mitral valve area (MVA), clinical and hemodynamic parameters. It is a retrospective study on a total of 303 patients who underwent successful PTMC between 1994 and 2001, were called back and their preprocedural, immediate post and follow-up (4, 7 and 10 year.) data were analyzed. Echo was performed in patients before and after PTMC. The patients were divided into two groups, group-I with Wilkins score of ≤ 8 and group-II with Wilkins score between 8 and 12. PTMC patients who have completed 4, 7 and 10 years of follow up revealed the mitral valve area, mean transmitral gradient and pulmonary artery pressures to be significantly different in both group-I and group-II. At all follow-up periods group-II showed higher restenosis than group-I, but its distribution between the groups was not statistically significant (χ2 = 0.029, p = 0.986). Furthermore, losses of the MVA during different periods of follow-up revealed a gradual increase in attrition. MV score, Mitral valve area, mitral gradient and pulmonary artery pressures appeared to influence the outcome of PTMC. A clear-cut prospective assessment of individual components of the mitral valve apparatus using 3-D echocardiographic images may provide a more precise prediction of the PTMC outcome based on its morphological abnormalities.
Abstract
Percutaneous transvenous mitral commissurotomy (PTMC) is one of the nonsurgical commissurotomy in patients with hemodynamically significant mitral stenosis. The aim of the [...]
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Predictors of subjective health status 10 years post-PCI
J. Berge, . Karolijn Dulfer, E. Utens, E. M.J. Hartman, . Joost Daemen, R. Geuns, R. van Domburg

IJC Heart & Vasculature (2016). Vol. 11 pp. 19-23

Abstract
Subjective health status is an increasingly important parameter to assess the effect of percutaneous coronary intervention (PCI) in clinical practice. Aim of this study was to determine medical and psychosocial predictors of poor subjective health status over a 10 years' post-PCI period. We included a series of consecutive PCI patients (n = 573) as part of the RESEARCH registry, a Dutch single-center retrospective cohort study. These patients completed the 36-item Short-Form Health Survey (SF-36) at baseline and 10 years post-PCI. We found 6 predictors of poor subjective health status 10 years post-PCI: SF-36 at baseline, age, previous PCI, obesity, acute myocardial infarction as indication for PCI, and diabetes mellitus (arranged from most to least numbers of sub domains). SF-36 scores at baseline, age, and previous PCI were significant predictors of subjective health status 10 years post-PCI. Specifically, the SF-36 score at baseline was an important predictor. Thus assessment of subjective health status at baseline is useful as an indicator to predict long-term subjective health status. Subjective health status becomes better by optimal medical treatment, cardiac rehabilitation and psychosocial support. This is the first study determining predictors of subjective health status 10 years post-PCI.
Abstract
Subjective health status is an increasingly important parameter to assess the effect of percutaneous coronary intervention (PCI) in clinical practice. Aim of this study was [...]
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Expression of Let-7 family microRNAs in skin correlates negatively with severity of pulmonary hypertension in patients with systemic scleroderma
. Yasuhiro Izumiya, . Masatoshi Jinnn, . Yuichi Kimura, . Zhongzhi Wang, . Yoshiro Onoue, . Shinsuke Hanatani, . Satoshi Araki, . Hironobu Ihn, . Hisao Ogawa

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 98-102

Abstract
Pulmonary hypertension (PH) is a serious complication in patients with systemic scleroderma (SSc), therefore it is important to identify the factors that could predict the presence and progression of PH. Skin biopsy is performed in patients with SSc to examine the type and severity of the disease. MicroRNAs (miRNAs) are potential biomarkers for various cardiovascular diseases including PH. We determined the skin miRNA expression profile in 15 SSc patients with (n = 6) and without PH (n = 9). A mixture of equal amounts of miRNAs from PH and non-PH patients were prepared and used for miRNA PCR array analysis. The analysis identified 591 upregulated miRNAs and 57 downregulated miRNAs in the PH group. Of these, only miRNAs with a Ct value of less than 35 were subjected to further analysis. When a 1.5-fold difference was considered meaningful, 32 miRNAs were upregulated and 14 miRNAs were downregulated in the PH group. Interestingly, 5 out of 14 downregulated miRNAs belonged to the let-7 family. The results were validated by quantitative real-time PCR with specific primer for each miRNA, which showed significant downregulation of five let-7 family members (let-7a, -7d, -7e, -7f, -7g) in 6 PH compared with 9 non-PH skin samples. The expression levels of let-7d and 7b correlated negatively with pulmonary arterial pressure measured by echocardiography. The results suggest that skin miRNA is a potentially useful marker for the presence and severity of PH in patients with SSc.
Abstract
Pulmonary hypertension (PH) is a serious complication in patients with systemic scleroderma (SSc), therefore it is important to identify the factors that could predict the [...]
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Changes in the risk factors for coronary spasm
M. Ishii, . Koichi Kaikita, . Koji Sato, . Kenshi Yamanaga, . Takashi Miyazaki, . Tomonori Akasaka, . Noriaki Tabata, . Yuichiro Arima, . Daisuke Sueta, . Kenji Sakamoto, . Eiichiro Yamamoto, . Kenichi Tsujita, . Megumi Yamamuro, . Sunao Kojima, . Hirofumi Soejima, . Seiji Hokimoto, . Kunihiko Matsui, . Hisao Ogawa

IJC Heart & Vasculature (2016). Vol. 12 pp. 85-87
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The independent association between altered renal arterial resistance and loop diuretic dose in chronic heart failure outpatients
M. Iacoviello, . Annalisa Doronzo, . Valeria Paradies, . Valeria Antoncecchi, . Francesco Monitillo, . Gaetano Citarelli, . Marta Leone, . Agata Puzzovivo, . Loreto Gesualdo, M. Ciccone

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 119-123

Abstract
In chronic heart failure (CHF) patients there is a wide variability in the minimal effective diuretic dose. The aim of this study is to evaluate whether renal resistance index (RRI) is associated to baseline diuretic dose and the changes at one year. 250 outpatients in a stable condition and in conventional therapy were enrolled. Baseline RRI was calculated by renal arterial Doppler. The total daily dose of loop diuretics was assessed at baseline and after one year. High diuretic dose (HDD) was defined as a daily furosemide equivalent dose > 100 mg. RRI was independently associated with baseline HDD at univariate (OR 1.39, 95% CI: 1.233–1.58, p < 0.001) and multivariate analysis (OR 1.27, 95% CI: 1.09–1.49, p: 0.002) after correction for other univariate predictors (age, NYHA class, left ventricular ejection fraction, tricuspid annulus peak of systolic excursion, NT-proBNP, glomerular filtration rate by EPI formula and central venous pressure). Moreover, baseline RRI was independently associated to one year stable increase in loop diuretic dose at univariate and multivariate regression analyses. RRI is independently associated with high dose loop diuretics and their increase during a mid-term follow-up thus suggesting its usefulness in detecting an altered diuretic response in CHF outpatients.
Abstract
In chronic heart failure (CHF) patients there is a wide variability in the minimal effective diuretic dose. The aim of this study is to evaluate whether renal resistance index [...]
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Myocardial deformation pattern in left ventricular non-compaction: Comparison with dilated cardiomyopathy
. Olivier Huttin, . Clément Venner, . Zied Frikha, . Damien Voilliot, . Pierre-Yves Marie, . Etienne Aliot, . Nicolas Sadoul, . Yves Juillière, B. Brembilla-Perrot, C. Selton-Suty

IJC Heart & Vasculature (2014). Vol. 5 pp. 9-14

Abstract
Left ventricular (LV) systolic dysfunction is the most frequent initial presentation of patient with LV noncompaction (NC). Our objectives were to evaluate myocardial contraction properties in patients with LVNC and the relationship of non-compacted segments with the degree of global and regional systolic deformation. We included 50 LVNC with an echocardiography and speckle imaging calculation of peak longitudinal strain (PLS). Each of the 16 LV myocardial segments was defined as NC (ratio NC/compacted layer > 2), borderline (NC/C 0–2) and compacted (NC/C = 0). Basal, median and apical strain values were calculated as the average of segmental strain values. For comparison a group of 50 patients with dilated cardiomyopathy (DCM) underwent the same measurements. There was no statistical difference between the 2 groups for any conventional LV systolic parameters. A characteristic deformation pattern was observed in LVNC with higher strain values in the LV apical segments (− 12.8 ± 5.9 vs − 10.7 ± 5.7) and an apical–basal ratio (1.52 ± 0.73 vs 1.12 ± 0.42, p < 0.001). There was no correlation between LV function and the degree of NC. Among 726 segments, compacta thickness was thinner in NC vs C segments (6.4 ± 1.4 vs 7.7 ± 1.8 mm, p < 0.05). There was no difference in WMS but regional strain values were significantly higher in NC compared to C segments (− 13.1 ± 6.1 vs − 10.2 ± 6.3, p < 0.05). Compared to DCM, LVNC presented with relatively preserved apical deformation as compared to basal segments. Lower regional deformation values in compacted segments confirm the concept that LVNC is a phenotypic marker of an underlying diffuse cardiomyopathy involving both C and NC myocardium.
Abstract
Left ventricular (LV) systolic dysfunction is the most frequent initial presentation of patient with LV noncompaction (NC). Our objectives were to evaluate myocardial contraction [...]
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Cumulative effects of common genetic variants on risk of sudden cardiac death
. Adriana Huertas-Vazquez, C. Nelson, J. S. Sinsheimer, . Kyndaron Reinier, . Audrey Uy-Evanado, . Carmen Teodorescu, J. Ayala, A. S. Hall, . Karen Gunson, . Jonathan Jui, N. J. Samani, S. S. Chugh

IJC Heart & Vasculature (2015).

Abstract
Genome-wide association studies and candidate-gene based approaches have identified multiple common variants associated with increased risk of sudden cardiac death (SCD). However, the independent contribution of these individual loci to disease risk is modest. To investigate the cumulative effects of genetic variants previously associated with SCD risk. A total of 966 SCD cases from the Oregon-Sudden Unexpected Death Study and 1926 coronary artery disease controls from the Wellcome Trust Case–Control Consortium were investigated. We generated genetic risk scores (GRSs) for each trait composed of variants previously associated with SCD or with abnormalities in specific electrocardiographic traits such as QRS duration, QTc interval and heart rate. GRSs were calculated using a weighted approach based on the number of risk alleles weighted by the beta coefficients derived from the original studies. We also compared the highest and lowest quintiles for the GRS composed of SCD SNPs. Increased cumulative risk was observed for a GRS composed of 14 SCD-SNPs (OR = 1.17 [1.05–1.29], P = 0.002). The risk for SCD was 1.5 fold greater in the highest risk quintile when compared to the lowest risk quintile (OR = 1.46 [1.11–1.92]). We did not observe significant associations with SCD for SNPs that determine electrocardiographic traits. A modest but significant effect on SCD risk was identified for a GRS composed of 14 previously associated SCD SNPs. While next generation sequencing methodology will continue to identify additional novel variants, these findings represent proof of concept for the additive effects of gene variants on SCD risk.
Abstract
Genome-wide association studies and candidate-gene based approaches have identified multiple common variants associated with increased risk of sudden cardiac death (SCD). [...]
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A cardioprotective insight of the cystathionine γ-lyase/hydrogen sulfide pathway
. Steve Huang, H. Li, J. Ge

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 51-57

Abstract
Traditionally, hydrogen sulfide (H2S) was simply considered as a toxic and foul smelling gas, but recently H2S been brought into the spot light of cardiovascular research and development. Since the 1990s, H2S has been mounting evidence of physiological properties such as immune modification, vascular relaxation, attenuation of oxidative stress, inflammatory mitigation, and angiogenesis. H2S has since been recognized as the third physiological gaseous signaling molecule, along with CO and NO [65, 66]. H2S is produced endogenously through several key enzymes, including cystathionine β-lyase (CBE), cystathionine γ-lyase (CSE), and 3-mercaptopyruvate sulfurtransferase (MST)/cysteine aminotransferase (CAT). These specific enzymes are expressed accordingly in various organ systems and CSE is the predominant H2S-producing enzyme in the cardiovascular system. The cystathionine γ-lyase (CSE)/H2S pathway has demonstrated various cardioprotective effects, including anti-atherosclerosis, anti-hypertension, pro-angiogenesis, and attenuation of myocardial ischemia–reperfusion injury. CSE exhibits its anti-atherosclerotic effect through 3 mechanisms, namely reduction of chemotactic factor inter cellular adhesion molecule-1 (ICAM-1) and CX3CR1, inhibition of macrophage lipid uptake, and induction of smooth muscle cell apoptosis via MAPK pathway. The CSE/H2S pathways anti-hypertensive properties are demonstrated via aortic vasodilation through several mechanisms, including the direct stimulation of KATP channels of vascular smooth muscle cells (VSMCs), induction of MAPK pathway, and reduction of homocysteine buildup. Also, CSE/H2S pathway plays an important role in angiogenesis, particularly in increased endothelial cell growth and migration, and in increased vascular network length. In myocardial ischemia–reperfusion injuries, CSE/H2S pathway has shown a clear cardioprotective effect by preserving mitochondria function, increasing antioxidant production, and decreasing infarction injury size. However, CSE/H2S pathways role in inflammation mitigation is still clouded, due to both pro and anti-inflammatory results presented in the literature, depending on the concentration and form of H2S used in specific experiment models.
Abstract
Traditionally, hydrogen sulfide (H2S) was simply considered as a toxic and foul smelling gas, but recently H2S been brought into the spot light of cardiovascular research [...]
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MTRR rs326119 polymorphism is associated with plasma concentrations of homocysteine and cobalamin, but not with congenital heart disease or coronary atherosclerosis in Brazilian patients
. Melanie Horita, C. Bueno, A. R Horimoto, P. A Lemos, A. Morandini-Filho, J. E Krieger, P. L Santos, A. C Pereira

IJC Heart & Vasculature (2017). Vol. 14 pp. 1-5

Abstract
Differences in the distribution of the MTRR rs326119 polymorphism (c.56 + 781 A > C) between patients with congenital heart disease (CHD) and controls have been described in Chinese individuals. The association is thought to be due to deregulation of homocysteine-cobalamin pathways. This has not been replicated in other populations. The primary objective of this study was to assess the influence of the MTRR rs326119 polymorphism on biochemical parameters of vitamin B12 metabolism, coronary lesions, and congenital heart disease in Brazilian subjects. We selected 722 patients with CHD, 1432 patients who underwent coronary angiography, and 156 blood donors. Genotyping for the MTRR polymorphism was evaluated by high-resolution melting analysis, and biochemical tests of vitamin B12 metabolism were measured. Subjects carrying the AC or CC genotypes had higher homocysteine concentrations (9.7 ± 0.4 μmol/L and 10.1 ± 0.6 μmol/L) and lower cobalamin concentrations (260.5 ± 13.3 pmol/L and 275.6 ± 19.9 pmol/L) compared with the subjects carrying the AA genotype (8.7 ± 0.5 μmol/L and 304.8 ± 14.7 pmol/L), respectively. A multiple linear regression model also identified a significant association between the number of C variant alleles with the concentrations of homocysteine and cobalamin. Nonetheless, the allelic and genotypic distributions for MTRR rs326119 were not associated with CHD or coronary atherosclerosis in the studied samples. Our findings indicate that the MTRR rs326119 variant might be a genetic marker associated with homocysteine and cobalamin concentrations, but not a strong risk factor for CHD or coronary atherosclerosis in the Brazilian population.
Abstract
Differences in the distribution of the MTRR rs326119 polymorphism (c.56 + 781 A > C) between patients with congenital heart disease (CHD) and controls have been described [...]
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Sex-specific temporal trends in the incidence and prevalence of hospitalized patients with preserved versus reduced left ventricular ejection fraction heart failure: A Japanese community-wide study
. Miho Honma, . Fumitaka Tanaka, . Kenyu Sato, . Toshiyuki Onoda, . Toshiaki Sakai, . Osamu Nishiyama, . Tatsuya Matsumoto, . Masayuki Onodera, . Kiyomi Sakata, . Motoyuki Nakamura

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 15-21

Abstract
Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular ejection fraction (EF) remain unclear, especially in Asian general populations. We conducted a community based HF registration study over a 10 year period in an aging cohort of the Japanese general population. A total of 2598 cases of hospitalized HF were registered during the survey period. Of these 1413 cases (55%) were initial admissions for HF (incident case). The study period was divided into five 2-year terms (T1, 2003–2004, T2, 2005–2006, T3, 2007–2008, T4, 2009–2010, T5, 2011–2012), and data were compared among the terms. Age adjusted incidence of HF (per 105 person-year) remained stable in men, but decreased significantly by 25% in women (from 104 at T1 to 79 at T5, p for trend < 0.05). Among incident cases who underwent echocardiography (≈ 90%), the proportion of HF with preserved EF increased in men (from 32% at T1 to 43% at T5, p for trend < 0.05), and was relatively high and remained stable throughout the study period in women (from 52% at T1 to 58% at T5, p for trend, NS). Although the incidence of HF has declined especially in women between 2003 and 2012 in the study population, the proportion of HF with preserved EF has increased over time. These trends suggest a future prevalence of HF with preserved EF rather than HF with reduced EF in aging Asian populations.
Abstract
Sex specific temporal trends in the incidence and prevalence of hospitalization for heart failure (HF), particularly in conjunction with reduced and preserved left ventricular [...]
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Risk stratification using the CHA2DS2-VASc score in patients with coronary heart disease undergoing percutaneous coronary intervention; sub-analysis of SHINANO registry
. Hirofumi Hioki, . Takashi Miura, . Yusuke Miyashita, . Hirohiko Motoki, . Kentaro Shimada, . Masanori Kobayashi, . Hiroyuki Nakajima, . Hikaru Kimura, . Eiichiro Mawatari, . Hiroshi Akanuma, . Toshio Sato, . Souichirou Ebisawa, . Uichi Ikeda

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 76-81

Abstract
CHADS2 or CHA2DS2-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS2 score is reported to have prognostic value in acute coronary syndrome without AF. However, clinical validation of CHA2DS2-VASc score for prognostic stratification in coronary heart disease (CHD) without AF remains uncertain. In this study, we evaluate whether CHA2DS2-VASc score could predict clinical outcome in CHD without known AF. SHINANO registry was a prospective, observational, multicenter cohort study, enrolling 1923 consecutive patients with CHD from August 2012 to July 2013. Two hundred nine patients were excluded because of known AF. We calculated CHA2DS2-VASc score in the remaining 1714 patients (mean age 70 ± 11 years, 23% female) without known AF. To assess the clinical validation of CHA2DS2-VASc score, we divided patients into 3 groups according to the tertiles (score 0–2, 3–4, and ≥ 5). The primary endpoint was MACE including death, nonfatal myocardial infarction, and ischemic stroke at 1 year. One-year follow-up was completed in 1632 patients (95.2%). Cumulative incidence of MACE was 139 cases. In Kaplan–Meier analysis, incidence of MACE was significantly higher in patients with CHA2DS2-VASc score ≥ 5 compared to 3–4 and 0–2 (14.6% vs. 6.8% vs. 5.3%, p < 0.001). In multivariate Cox-regression analysis, CHA2DS2-VASc score was an independent predictor for MACE (hazard ratio 1.26, 95% confidence interval 1.15–1.39p < 0.001). This study demonstrated that CHA2DS2-VASc score could provide prognostic information in CHD without known AF.
Abstract
CHADS2 or CHA2DS2-VASc score is used for prediction of stroke in patients with atrial fibrillation (AF). Recently, CHADS2 score is reported to have prognostic value in acute [...]
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Coronary calcification compromises myocardial perfusion irrespective of luminal stenosis
M. Y. Henein, . Tarek Bengrid, . Rachel Nicoll, . Ying Zhao, . Bengt Johansson, . Axel Schmermund

IJC Heart & Vasculature (2017). Vol. 14 pp. 41-45

Abstract
The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion assessed by cardiac magnetic resonance imaging (CMR) in a group of symptomatic patients. Retrospective analysis of 120 patients (age 65.1 ± 8.9 years, 88 males) who presented with atypical chest pain to Bethanien Hospital, Frankfurt, Germany, between 2007 and 2010 and who underwent CAC scoring using MDCT, CMR, and conventional coronary angiography. Patients were divided into those with high-grade (HG) stenosis (n = 67, age 65.1 ± 9.4 years) and those with no-HG stenosis (n = 53, age 65.1 ± 8.6 years). There were more males with HG stenosis (82.1% vs. 62.3%, p = 0.015), in whom the percentage and number of abnormal perfusion segments were higher at rest (37.3% vs. 17%, p = 0.014) but not different with stress (p = 0.83) from those with no-HG stenosis. Thirty-four patients had myocardial perfusion abnormalities at rest and 26 patients developed perfusion defects with stress. Stress-induced myocardial perfusion defects were 22.4% sensitive and 79.2% specific for detecting HG stenosis. The CAC score was lower in patients with no-HG stenosis compared to those with HG stenosis (p < 0.0001). On the ROC curve, a CAC score of 293 had a sensitivity of 71.6% and specificity of 83% in predicting HG stenosis [(AUC 0.80 (p < 0.0001)]. A CAC score of 293 or the presence of at least 1 segment myocardial perfusion abnormality was 74.6% sensitive and 71.7% specific in detecting HG stenosis, the respective values for the 2 abnormalities combined being 19.4% and 90.6%. The severity of CAC correlated with the extent of myocardial perfusion in the patient group as a whole with stress (r = 0.22, p = 0.015), particularly in those with no-HG stenosis (r = 0.31, p = 0.022). A CAC score of 293 was 31.6% sensitive and 87.3% specific in detecting myocardial perfusion abnormalities. In a group of patients with exertional angina, coronary calcification is more accurate in detecting high-grade luminal stenosis than myocardial perfusion defects. In addition, in patients with no stenosis, the incremental relationship between coronary calcium score and the extent of myocardial perfusion suggests coronary wall hardening as an additional mechanism for stress-induced angina other than luminal narrowing. These preliminary findings might have a clinical impact on management strategies of these patients other than conventional therapy.
Abstract
The aim of this study was to evaluate the relationship between coronary artery calcification (CAC) assessed by multi-detector computed tomography (MDCT) and myocardial perfusion [...]
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A case of massive aortic mural thrombus in the absence of atherosclerotic or aneurysmal disease
K. Haji, . Vanessa Heron, R. Davis, . Dee Nandurkar, . Anthony Kelman, . Alistair Miller

IJC Heart & Vasculature (2016). Vol. 12 pp. 82-84
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Substantial radiation reduction in pediatric and adult congenital heart disease interventions with a novel X-ray imaging technology
N. Haas, C. Happel, . Maria Mauti, . Cherif Sahyoun, L. Z. Tebart, . Deniz Kececioglu, K. Thorsten Laser

IJC Heart & Vasculature (2015).

Abstract
Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent years. This study aims at quantifying the patient radiation dose reduction after the introduction of an X-ray imaging technology using advanced real time image noise reduction algorithms and optimized acquisition chain for fluoroscopy and exposure in a pediatric and adult population with congenital heart disease. Patient and radiation dose data was retrospectively collected (July 2012–February 2013) for 338 consecutive patients treated with a system using state of the art image processing and reference acquisition chain (referred as “reference system”). The same data was collected (March–October 2013) for 329 consecutive patients treated with the new imaging technology (Philips AlluraClarity, referred as “new system”). Patients were divided into three weight groups: A) below 10 kg, B) 10–40 kg, and C) over 40 kg. Radiation dose was quantified using dose area product (DAP), while procedure complexity using fluoroscopy time, procedure duration and volume of contrast medium. The new system provides significant patient dose reduction compared to the reference system. Median DAP values were reduced in group A) from 140.6 cGy·cm2 to 60.7 cGy·cm2, in group B) from 700.0 cGy·cm2 to 202.2 cGy·cm2 and in group C) from 4490.4 cGy·cm2 to 1979.8 cGy·cm2 with reduction of 57%, 71% and 56% respectively (p < 0.0001 for all groups). Despite no other changes in procedural approach, the novel X-ray imaging technology provided substantial radiation dose reduction of 56% or higher.
Abstract
Pediatric catheterization exposes patients to varying radiation doses. Concerns over the effects of X-ray radiation dose on the patient population have increased in recent [...]
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Hyperdynamic left ventricle on radionuclide myocardial perfusion imaging (RNMPI): A marker of diastolic dysfunction in patients presenting with dyspnea on exertion
R. Gorantla, . Saeed Ahmed, . Dinesh Voruganti, D. Menzies

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 43-47

Abstract
We hypothesized that among patients presenting with dyspnea on exertion (DOE), those who were found to have hyperdynamic left ventricle (i.e. LVEF ≥ 70%) on stress radionuclide myocardial perfusion imaging (RNMPI), are more likely to have features of diastolic dysfunction on transthoracic echocardiography. Medical records of 1892 consecutive patients who presented between February 2011 and September 2012 with the chief complaint of DOE and were referred to stress RNMPI were reviewed. Among these, patients who had no evidence of reversible ischemia and had hyperdynamic left ventricle on perfusion imaging, were selected and their recent echocardiograms were reviewed for evidence of diastolic dysfunction. Logistic regression analysis was used to develop an equation to predict diastolic dysfunction with the ejection fraction as the predictor. A two-way analysis of variance model was used to detect differential patterns of ejection fraction across diastolic dysfunction and gender. A hyperdynamic left ventricle identified on stress RNMPI was found to be a significant predictor of diastolic dysfunction on echocardiography in logistic regression analysis (odds ratio = 1.24, 95% CI = 1.13–1.35, p < 0.0001). A hyperdynamic left ventricle on stress RNMPI has a specificity of 96.77% (CI 83.24–99.46%) and a positive predictor value of 97.83% (CI 88.43–99.64%) in identifying diastolic dysfunction. In patients presenting with DOE who have no evidence of reversible ischemia on radionuclide stress testing but have hyperdynamic left ventricle, a search should be made for alternate cardiac etiology for this complaint such as diastolic dysfunction and heart failure with preserved ejection fraction.
Abstract
We hypothesized that among patients presenting with dyspnea on exertion (DOE), those who were found to have hyperdynamic left ventricle (i.e. LVEF ≥ 70%) on stress radionuclide [...]
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Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation
. Cosmo Godino, . Anna Salerno, . Michela Cera, . Eustachio Agricola, . Gabriele Fragasso, . Isabella Rosa, . Michele Oppizzi, . Alberto Monello, . Andrea Scotti, . Valeria Magni, . Matteo Montorfano, . Alberto Cappelletti, . Alberto Margonato, . Antonio Colombo

IJC Heart & Vasculature (2016). Vol. 11 pp. 90-98

Abstract
Right ventricular dysfunction (RVdysf) is a predictor of poor outcome in patients with heart failure and valvular disease. The aim of this study was to evaluate the evolution and the impact of RVdysf in patients with moderate–severe functional mitral regurgitation (FMR) successfully treated with MitraClip. From October 2008 to July 2014, 60 consecutive high surgical risk FMR patients were evaluated and stratified into two groups: RVdysf group (TAPSE < 16 mm and/or S′TDI < 10 cm/s, 21 patients) and No-RVdysf group (38 patients). The overall mean age of patients was 73 ± 8 (83% male). Ischemic FMR etiology was present in 67%. Mean LVEF was 30 ± 10%. Overall mean time follow-up was 565 ± 310 days. The only significant difference between the two groups was a greater prevalence of stroke, ICD and use of aldosterone antagonist in RVdysf group. Acute procedural success was achieved in 90% of patients. At 6-month echo-matched analysis significant RV function improvement was observed in patients with baseline RVdysf (TAPSE 15 ± 3.0 vs. 19 ± 4.5, p = 0.007, S′TDI 7 ± 1.2 vs. 11 ± 2.8, p < 0.0001, baseline vs. 6-month, respectively). The mean improvement in the 6-min walking test was significant in both groups (120 and 143 m, RVdysf and No-RVdysf groups, respectively). At Kaplan–Meier analysis, the presence of RVdysf did not affect the outcome in terms of freedom from composite efficacy endpoint. This study shows that successful MitraClip implantation in patients with FMR and concomitant right ventricular dysfunction yields significant improvement of RV function at mid-term follow-up. Further data on larger population will be required to confirm our observations.
Abstract
Right ventricular dysfunction (RVdysf) is a predictor of poor outcome in patients with heart failure and valvular disease. The aim of this study was to evaluate the evolution [...]
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Septal rebound stretch as predictor of echocardiographic response to cardiac resynchronization therapy
. Abdul Ghani, P. Delnoy, . Ahmet Adiyaman, J. Paul Ottervanger, A. Misier, J. J. Smit, . Arif Elvan

IJC Heart & Vasculature (2015).

Abstract
Septal rebound stretch (SRSsept) reflects an inefficient deformation of the septum during systole and is a potential new echocardiographic tool to predict response to Cardiac Resynchronization Therapy (CRT). However, there are only limited data on the potential predictive value of SRSsept on echocardiographic response. We evaluated the predictive value of SRSsept on echocardiographic response to CRT in a large population. A total of 138 consecutive patients with functional class II–IV heart failure who underwent CRT were studied. Echocardiography was performed at baseline and after a mean follow-up period of 22 ± 8 months. Echocardiographic response to CRT was defined as a reduction in LV end-systolic volume ≥ 15%. Receiver operating characteristic curve analysis was performed to define the optimal cut-off value for SRSsept. Multivariable analyses were performed to adjust for potential confounders. Mean age was 68 ± 8 years (30% female). Mean baseline LV ejection fraction was 26 ± 7%, 51% had ischemic etiology. LBBB or LBBB like morphology was present in 95% of patients. Mean SRSsept was 4.4 ± 3.2%, 56% of patients had SRSsept ≥ 4%. Ninety six patients (70%) were echocardiographic responders. Baseline SRSsept was significantly higher in responders compared to non-responders (5.1 ± 3.2 vs 3.0 ± 2.7, P < 0.001). The optimal cut-off value for SRSsept to predict response to CRT was 4.0%. After both univariate (OR 3.74, 95% CI 1.72–8.10) and multivariate analyses (OR 3.71, 95% CI 1.49–9.2), baseline SRSsept > 4% independently predicted the response to CRT. Baseline septal rebound stretch is independently associated with echocardiographic response to CRT.
Abstract
Septal rebound stretch (SRSsept) reflects an inefficient deformation of the septum during systole and is a potential new echocardiographic tool to predict response to Cardiac [...]
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Is HATCH score a reliable predictor of atrial fibrillation after cavotricuspid isthmus ablation for typical atrial flutter?
. Javier García-Seara, F. Sampedro, J. Sande, X. López, M. Mañero, L. Melchor, B. Alvarez, D. Alvarez, J. Juanatey

IJC Heart & Vasculature (2016). Vol. 12 pp. 88-94

Abstract
We determined the effectiveness of the HATCH score in patients with typical atrial flutter (AFl) undergoing cavotricuspid isthmus (CTI) ablation to predict long-term atrial fibrillation (AF). We conducted an observational retrospective single-center cohort study including all patients admitted to our hospital for a CTI ablation between 1998 and 2010. The patients were divided into four categories: 1) new-onset AF (no prior AF and AF during follow-up (FU)), 2) old AF (prior AF and no AF during FU), 3) prior and post AF (AF prior and post CTI ablation), and 4) no AF. Four hundred and eight patients were included. In patients without prior AF, the hazard ratio (HR) for new-onset AF during FU was 0.98 (CI 95%: 0.65–1.50, p = 0.95) and 1.00 (CI 95%: 0.57–1.77, p = 0.98) for HATCH ≥ 2 and HATCH ≥ 3, respectively. In patients with prior AF, the HR for AF was 1.41 (CI 95%: 0.87–2.28, p = 0.17) and 1.79 (CI 95%: 0.96–3.35, p = 0.06), for HATCH ≥ 2 and HATCH ≥ 3, respectively. Left atrial enlargement was positively correlated with the occurrence of AF during FU, especially in the subgroup without prior AF, which had a HR of 2.44 (CI 95%: 1.35–4.40, p = 0.003), a HR of 2.88 (CI 95%: 1.36–6.10, p = 0.006) and a HR of 3.68 (CI 95%: 1.71–7.94, p = 0.001), for slight, moderate and severely dilated left atrial dimension, respectively, compared with a normal value. HATCH score did not predict AF in patients with typical AFl who underwent CTI ablation. Basal left atrium dimension could help predict new-onset AF.
Abstract
We determined the effectiveness of the HATCH score in patients with typical atrial flutter (AFl) undergoing cavotricuspid isthmus (CTI) ablation to predict long-term atrial [...]
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A new circular mapping-guided approach for endoscopic laser balloon pulmonary vein isolation
. Pim Gal, J. J. Smit, . Ahmet Adiyaman, A. Misier, P. Delnoy, . Arif Elvan

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 68-72

Abstract
Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is performed with the endoscopically assisted laser balloon ablation system (EAS). We hypothesized that placement of a circular mapping catheter (CMC) in the pulmonary vein (PV) distal to the laser balloon during ablation is feasible and safe. Out of 58 included patients, 37 underwent mapping-guided EAS PVI, with the CMC inside the PV during laser ablation, and 21 patients underwent standard EAS PVI, with the CMC outside the PV during laser ablation. Mean age was 56 years and 81% had paroxysmal AF. In the mapping-guided ablation group, 91% of PVs were isolated with the CMC in the PV during EAS ablation, isolation was completed in 9% of PVs after the CMC was removed from the PV. After passing a learning curve in 18 patients, a significant drop in unsuccessfully isolated PVs was observed in the mapping guided EAS PVI group (15% to 4%, P = 0.020). No major complications were seen in the mapping-guided EAS PVI group. However, in the standard EAS PVI group, laser ablation was complicated by a temporary phrenic nerve palsy in 1 patient. After a median follow-up of 16.7 months, there was no statistical difference in AF free survival among treatment groups (mapping-guided: 56% vs. 52%, P = 0.875). Mapping guided EAS PVI with a distal CMC in the PV during laser ablation is feasible and seems safe as the standard EAS PVI approach.
Abstract
Pulmonary vein isolation (PVI) for atrial fibrillation (AF) is performed with the endoscopically assisted laser balloon ablation system (EAS). We hypothesized that placement [...]
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Pulmonary vein orientation assessment: Is it necessary in patients undergoing contact force sensing guided radiofrequency catheter ablation of atrial fibrillation
P. Gal, J. F.W. Ooms, J. Paul Ottervanger, J. J. Smit, . Ahmet Adiyaman, A. Misier, P. Delnoy, P. L. Jager, . Arif Elvan

IJC Heart & Vasculature (2015).

Abstract
We hypothesized that pulmonary vein (PV) orientation influences tissue contact of the contact force (CF) sensing radiofrequency ablation catheter (CFC) and therefore atrial fibrillation (AF) free survival after pulmonary vein isolation (PVI). The aim of this study was to determine the association between PV orientation, CF and AF free survival in patients undergoing CFC PVI. Sixty consecutive patients undergoing CFC PVI were included. ECG-triggered cardiac CT scans were obtained in all patients before PVI, and the PV orientation was measured at the insertion in the LA for all PVs in both the transverse and frontal plane. PVs were assigned to 1 of 4 orientation groups: ventral–caudal, dorsal–caudal, ventral–cranial and dorsal–cranial. Mean age was 59 years, 88% had paroxysmal AF. AF free survival off anti-arrhythmic drugs after a median follow-up of 12 months was 58% after a single PVI procedure. No association was found between PV orientation and CF. Furthermore, no association was found between PV orientation and AF free survival. In univariate analysis, the number of lesions with a mean CF of 10 g was associated with AF free survival. However, in multivariate analysis, only the AF duration was significantly associated with AF free survival. This study shows that in patients undergoing PVI with the CFC ablation system, PV orientation does not affect CF and is not associated with AF free survival. PV orientation assessment does not appear to be necessary in patients undergoing CFC PVI.
Abstract
We hypothesized that pulmonary vein (PV) orientation influences tissue contact of the contact force (CF) sensing radiofrequency ablation catheter (CFC) and therefore atrial [...]
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Effectiveness of renal sympathetic denervation in renal function and blood pressure in CKD and non-CKD patients with controlled vs. uncontrolled hypertension
M. Kiuchi, S. Chen

IJC Heart & Vasculature (2016). Vol. 13 pp. 3-5
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Late gadolinium enhancement does occur in Tako-tsubo cardiomyopathy — A quantitative cardiac magnetic resonance and speckle tracking strain study
. Niranjan Gaikwad, T. Butler, R. Maxwell, E. Shaw, W. E. Strugnell, J. Chan, G. A. Figtree, R. E. Slaughter, C. Hamilton-Craig

IJC Heart & Vasculature (2016).

Abstract
Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial infarction or myocarditis. 44 consecutive patients with confirmed Mayo Clinic criteria for TTC underwent CMR imaging at 1.5 Tesla during the acute phase. 10 patients who had CMRI to exclude scar related ventricular tachycardia, and had negative studies, were used as negative controls. LGE was quantitated at two signal intensity thresholds (CircleCVi software) at > 2 and > 5 standard-deviations (SD) above reference myocardium, and compared to biomarkers. Mean door-to-CMR time was 57 hours. 18 patients (41%) had LGE > 2 SD localized to the area of abnormal wall motion, representing 28.9 ± 11.2% LV mass. In 16 of these 18 patients (89%) LGE signal intensity was > 5 SD above normal myocardium, representing 12.1 ± 10% LV mass. LGE signal intensity was significantly greater in TTC than in matched controls (p < 0.05) but lower than in STEMI patients (p < 0.05). Mean troponin was significantly higher in LGE positive patients (2.5 ± 1.8 vs 4.4 ± 6.9, p = 0.001). Mean ejection fraction (EF) by CMR was 45% ± 8.7 in LGE-negative, and 40% ± 7.1 in LGE-positive patients (p = 0.37). Recovery of segmental function was confirmed at follow-up, mean EF was 59% in both groups. LGE was present in 41% of cases of TTC, 89% of which had intense enhancement > 5 SD above normal myocardium. Presence of LGE was associated with worse myocardial injury in the acute setting, with no difference in recovery of function.
Abstract
Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been recommended to distinguish Tako-tsubo cardiomyopathy (TTC) from either acute myocardial [...]
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The experimental model of transition from compensated cardiac hypertrophy to failure created by transverse aortic constriction in mice
. Takaaki Furihata, . Shintaro Kinugawa, . Shingo Takada, . Arata Fukushima, . Masashige Takahashi, . Tsuneaki Homma, . Yoshihiro Masaki, . Masaya Tsuda, . Junichi Matsumoto, . Wataru Mizushima, . Shouji Matsushima, . Takashi Yokota, . Hiroyuki Tsutsui

IJC Heart & Vasculature (2016). Vol. 11 pp. 24-28

Abstract
Transverse aortic constriction (TAC) operation is used as an experimental model of left ventricular (LV) hypertrophy and LV failure in mice. The severity of LV remodeling or failure may depend on the degree of TAC, but is variable among operated animals. Therefore, we tried to identify the optimal diameter of TAC to create this model with ease and high reproducibility. To produce TAC in C57BL/6J mice (7–9 weeks, body weight 19–26 g, n = 109), a 7–0 nylon suture ligature was tightly tied around the transverse aorta against needles with 3 different diameters (mm), 0.40, 0.385 and 0.375. LV wall thickness, end-diastolic dimension, fractional shortening were measured by echocardiography. At 4 weeks after TAC, no mouse with the 0.400 mm gauge progressed in LV failure. The 0.385 mm pin gauge mouse kept a more survival rate compared with the 0.375 mm (59% vs 48%), representing same efficient in LV failure. With the 0.385 mm pin gauge, hearts of mice remained LV hypertrophy at 1 week after TAC, followed by LV failure at 4 weeks. TAC with the diameter of 0.385 mm can effectively induce the transition from LV hypertrophy to failure in mice with relatively preserved survival.
Abstract
Transverse aortic constriction (TAC) operation is used as an experimental model of left ventricular (LV) hypertrophy and LV failure in mice. The severity of LV remodeling [...]
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Relationship between electrocardiographic findings and Cardiac Magnetic Resonance phenotypes in patients with Hypertrophic Cardiomyopathy
. Matteo Fronza, . Claudia Raineri, . Adele Valentini, E. Maria Bassi, . Laura Scelsi, M. Laura Buscemi, . Annalisa Turco, . Grazia Castelli, . Stefano Ghio, L. Visconti

IJC Heart & Vasculature (2016). Vol. 11 pp. 7-11

Abstract
Q waves and negative T waves are common electrocardiographic (ECG) abnormalities in patients with Hypertrophic Cardiomyopathy (HCM). Several studies correlated ECG findings with presence and extent of fibrosis and hypertrophy, however, their significance remains incompletely clarified. Our study aimed to explain the mechanism behind Q and negative T waves by comparing their positions on a 12-lead ECG with phenotypes observed at Late Gadolinium Enhancement (LGE) Cardiac Magnetic Resonance (CMR). 12-lead ECG and LGE-CMR were performed in 88 consecutive patients with HCM (42 SD 16 years, 65 males). Using Delta Thickness ratio (DT ratio), and “global” and “parietal” LGE at CMR, the extent and distribution of myocardial hypertrophy and fibrosis were studied in correlation with ECG abnormalities. Q waves in different leads were not associated with “parietal” LGE score. Lateral Q waves correlated with an increased DT ratio Inferior Septum/Lateral wall (p = 0.01). A similar correlation between inferior Q waves and an increased DT Ratio Anterior wall/Inferior wall was of borderline statistical significance (p = 0.06). As expected, ECG signs of LV hypertrophy related to a raised Left Ventricular Mass Index (LVMI) (p < 0.0001) and mean wall thickness (p = 0.01). Depolarization disturbances, including negative T waves in lateral (p = 0.044) and anterior (p = 0.031) leads correlated with “parietal” LGE scores while QT dispersion (p = 0.0001) was associated with “global” LGE score. In HCM patients, Q waves are generated by asymmetric hypertrophy rather than by myocardial fibrosis, while negative T waves result from local LGE distribution at CMR.
Abstract
Q waves and negative T waves are common electrocardiographic (ECG) abnormalities in patients with Hypertrophic Cardiomyopathy (HCM). Several studies correlated ECG findings [...]
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I-1-deficiency negatively impacts survival in a cardiomyopathy mouse model
F. W. Friedrich, . Hannieh Sotoud, . Birgit Geertz, . Silvio Weber, . Frederik Flenner, . Silke Reischmann, . Thomas Eschenhagen, . Lucie Carrier, . Ali El-Armouche

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 87-94

Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy, diastolic dysfunction and increased interstitial fibrosis. Current treatment is based on beta-adrenoceptor (AR) and calcium channel blockers. Since mice deficient of protein phosphatase-1 inhibitor-1 (I-1), an amplifier in beta-AR signalling, were protected from pathological adrenergic stimulation in vivo, we hypothesized that I-1 ablation could result in an improved outcome in a HCM mouse model. We crossed mice deficient of I-1 with homozygous myosin-binding protein C knock-out (Mybpc3 KO) mice exhibiting cardiac dilatation and reduced survival. Unexpectedly, survival time was shorter in double I-1/Mybpc3 KO than in single Mybpc3 KO mice. Longitudinal echocardiographic assessment revealed lower fractional area change, and higher diastolic left ventricular inner dimensions and end-diastolic volumes in Mybpc3 KO than in WT mice. In comparison to Mybpc3 KO, double I-1/Mybpc3 KO presented higher left ventricular end-diastolic volumes, inner dimensions and ventricular surface areas with increasing differences over time. Phosphorylation levels of PKA-downstream targets and mRNA levels of hypertrophic markers did not differ between I-1/Mybpc3 KO and single Mybpc3 KO mice, except a trend towards higher beta-myosin heavy chain levels in double I-1/Mybpc3 KO. The data indicate that interference with beta-AR signalling has no long-term benefit in this severe MYBPC3-related cardiomyopathy mouse model.
Abstract
Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy, diastolic dysfunction and increased interstitial fibrosis. Current treatment is based on [...]
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Etiology-specific assessment of predictors of long-term survival in chronic systolic heart failure
. Jennifer Franke, . Christian Zugck, . Matthias Hochadel, . Anna Hack, . Lutz Frankenstein, J. Zhao, . Philipp Ehlermann, . Manfred Nelles, . Uwe Zeymer, . Ralph Winkler, . Ralf Zahn, H. A. Katus, . Jochen Senges

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 61-68

Abstract
We sought to identify prognostic factors of long-term mortality, specific for the underlying etiology of chronic systolic heart failure (CHF). Between 1995 and 2009 baseline characteristics, treatment and follow-up data from 2318 CHF-patients due to ischemic (ICM, 1100 patients) or dilated cardiomyopathy (DCM, 1218 patients) were prospectively compared. To calculate hazard ratios with 95%-confidence intervals cox regression was used. We respectively established etiology-specific multivariable models of independent prognostic factors. During the follow-up period of up to 14.8 years (mean = 53.1 ± 43.5 months, 10, 264 patient-years) 991 deaths (42.8%) occurred. In the ICM-cohort, 5-year-survival was 53.4% (95% CI: 49.9–56.7%), whereas in DCM-patients it was higher (68.1% (95% CI: 65.1–71.0%)). Age, ejection fraction, or hyponatremia were independent predictors for mortality in both cohorts, whereas diabetes, COPD, atrial fibrillation and a heart rate of ≥ 80/min carried independent predictive power only in ICM-patients. This study demonstrates the disparity of prognostic value of clinically derived risk factors between the two main causes of CHF. The effects of covariables in DCM-patients were lower, suggesting a less modifiable disease through risk factors considering mortality risk. An etiology-specific prognostic model may improve accuracy of survival estimations in CHF.
Abstract
We sought to identify prognostic factors of long-term mortality, specific for the underlying etiology of chronic systolic heart failure (CHF). Between 1995 and 2009 baseline [...]
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Percutaneous interventions in Fontan circulation
. Eduardo Franco, E. Domingo, V. Val, L. Silva, M. Marín, A. Ruiz, . Fernando Villagrá, F. Aguado

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 138-146

Abstract
Different percutaneous interventional procedures are needed to reach and maintain adequate anatomical and physiological conditions for the Fontan circulation. We aim to describe the experience gained at a childrens hospital in such interventions, and to analyze the clinical outcomes. Retrospective study of all patients with Fontan circulation completed between 1995 and 2013. We analyzed the clinical characteristics and the different types of percutaneous interventions performed, considering three different periods of time: before Glenn surgery, between Glenn and Fontan surgeries, and after Fontan was completed. Survival and time to indication of percutaneous interventions in each period were analyzed, as well as the clinical situation at last follow-up. Of the 91 patients analyzed, 46 (50.5%) required percutaneous interventions. The most frequent procedures were pulmonary artery angioplasty and angioplasty of the Fontan conduit. Estimated survival at 10, 20 and 30 years of age was 96.2%, 94.7% and 89.4%, respectively. There were no significant differences in survival of patients undergoing percutaneous interventions or not. Overall survival and time to indication of percutaneous interventions were significantly lower in the group of patients with right morphology systemic ventricle. Patients with fenestrated Fontan required interventions more frequently. At the end of follow-up, 66 patients (72.5%) were asymptomatic, without significant differences between patients who underwent or did not undergo percutaneous interventions. Interventional catheterization procedures are often necessary to reach and maintain the fragile Fontan circulation, mainly in patients with right morphology systemic ventricles and fenestrated Fontan conduits.
Abstract
Different percutaneous interventional procedures are needed to reach and maintain adequate anatomical and physiological conditions for the Fontan circulation. We aim to describe [...]
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Third CoreValve™ insertion for treatment of a severe paravalvular leak after a failed valve-in-valve procedure
R. Estévez-Loureiro, . Carlos Cuellas, . Javier Gualis, A. Prado, . Mario Castaño, . Carlos Soria, . David Alonso, . Carmen Garrote, M. Rodríguez, F. Fernández-Vázquez

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 58-60

Abstract
An 83-year-old high-risk gentleman diagnosed with severe symptomatic aortic stenosis was scheduled for TAVR. A 31 mm CoreValve was implanted but severe paravalvular leak was noted. A valve-in-valve procedure was performed. However, the valve frame was partially dislodged into de ascending aorta. We report our strategy to solve this severe leak after a failed valve-in-valve procedure.
Abstract
An 83-year-old high-risk gentleman diagnosed with severe symptomatic aortic stenosis was scheduled for TAVR. A 31 mm CoreValve was implanted but severe paravalvular leak was [...]
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Early use of beta blockers in patients with cocaine associated chest pain
C. Schmidt, . Luciano Pastori, . Gerald Pekler, . Ferdinand Visco, . Savi Mushiyev

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 167-169

Abstract
The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an “unopposed alpha adrenergic effect (UAE)”. Identify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain. We performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared. No statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes. This study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP. BB appeared safe when given early on admission to patients with CICP.
Abstract
The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key [...]
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The histology of human right atrial tissue in patients with high-risk Obstructive Sleep Apnea and underlying cardiovascular disease: A pilot study
E. van Oosten, A. H. Boag, . Kris Cunningham, . John Veinot, . Andrew Hamilton, . Dimitri Petsikas, . Darrin Payne, W. M. Hopman, D. P. Redfearn, . WonJu Song, . Shawn Lamothe, . Shetuan Zhang, . Adrián Baranchuk

IJC Heart & Vasculature (2015).

Abstract
Obstructive Sleep Apnea (OSA) results in intermittent hypoxia leading to atrial remodeling, which, among other things, facilitates development of atrial fibrillation. While much data exists on the macrostructural changes in cardiac physiology induced by OSA, there is a lack of studies looking for histologic changes in human atrial tissue induced by OSA which might lead to the observed macrostructural changes. A case control study was performed. Patients undergoing coronary artery bypass grafting (CABG) were evaluated for OSA and categorized as high-risk or low-risk. The right atrial tissue samples were obtained during CABG and both microscopic histological analysis and Sirius Red staining were performed. 18 patients undergoing CABG were included, 10 high-risk OSA and 8 low-risk OSA in evenly matched populations. No statistically significant difference between the two groups was observed in amount of myocytolysis (p = 0.181), nuclear hypertrophy (p = 0.671), myocardial inflammation (p = n/a), amyloid deposition (p = n/a), or presence of thrombi (p = n/a), as measured through routine H&E staining. As well, no statistically significant difference in interstitial and epicardial collagen was observed, as measured by Sirius Red staining (for total tissue: p = 0.619: for myocardium: p = 0.776). In this pilot study there were no observable histological differences in human right atrial tissue from individuals at high- and low-risk for OSA. Further investigation would be required for more definitive results.
Abstract
Obstructive Sleep Apnea (OSA) results in intermittent hypoxia leading to atrial remodeling, which, among other things, facilitates development of atrial fibrillation. While [...]
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Repeat remote ischaemic pre-conditioning for improved cardiovascular function in humans: A systematic review
J. Epps, G. Dieberg, . N.A. Smart

IJC Heart & Vasculature (2016). Vol. 11 pp. 55-58

Abstract
Single exposure to remote ischaemic pre-conditioning (RIPC) has been shown to be effective in reducing major adverse events during cardiac surgery. We evaluated the efficacy of repeated exposure RIPC to elicit improvements in cardiovascular function. A systematic search was conducted up until May 1st, 2015, using the following databases: EMBASE, PubMed (Medline), Web of Science and the Cochrane Central Registry of Controlled Trials (CENTRAL). Data was extracted and synthesized from published studies of repeat RIPC. Data from seven studies showed evidence of improvements in vascular function and anti-hypertensive effects of systolic, diastolic and mean arterial blood pressure following repeat RIPC. Currently existing work justifies a systematic review but not data pooling of individual study data. Repeat RIPC has also produced evidence of improvements in endothelial dependent vasodilation, but not non-endothelial dependent vasodilation, cutaneous vascular conductance or cardiorespiratory fitness. Repeated RIPC exposure has produced evidence of improvements in endothelial dependent vasodilation, ulcer healing and blood pressure but no benefit in non-endothelial dependent vasodilation, cutaneous vascular conductance or cardiorespiratory fitness. The optimal delivery of RIPC remains unclear, but at least 3 or preferably 4, 5 min exposures appears to be most beneficial, at least for reducing blood pressure. Aside from those undertaking cardiac surgery, other study populations with endothelial dysfunction may benefit from repeat exposure to RIPC.
Abstract
Single exposure to remote ischaemic pre-conditioning (RIPC) has been shown to be effective in reducing major adverse events during cardiac surgery. We evaluated the efficacy [...]
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Resistance to renal denervation therapy — Identification of underlying mechanisms by analysis of differential DNA methylation
. Frederic Emschermann, C. S. Zuern, . Johannes Patzelt, K. Rizas, . Günter Jäger, . Christian Eick, S. G. Meuth, . Meinrad Gawaz, . Axel Bauer, H. F. Langer

IJC Heart & Vasculature (2016).

Abstract
Factors causing resistance to renal denervation (RDN) for treatment of arterial hypertension are not known. In the current study, we sought to determine mechanisms involved in responsiveness to renal denervation therapy in patients with difficult-to-control and resistant hypertension. We evaluated the differential CpG methylation of genes in blood samples isolated from patients of a recently described cohort of responders or non-responders to renal denervation using microarray technique and measured protein levels of identified downstream effectors in blood samples of these patients by ELISA. Our analysis revealed up to 6103 methylation sites differing significantly between non-responders and responders to renal denervation therapy. Software based analysis showed several of these loci to be relevant for arterial hypertension and sympathetic nervous activity. Particularly, genes involved in glutamate synthesis, degradation and glutamate signaling pathways were differently methylated between both groups. For instance, genes for glutamate dehydrogenase 1 and 2 central to glutamate metabolism, genes for ionotropic (AMPA, NMDA) and metabotropic glutamate receptors as well as glutamate transporters revealed significant differences in methylation correlating with responsiveness to RDN. To underline their potential relevance for responsiveness to RDN, we measured plasma protein levels of norepinephrine, a downstream effector of the glutamate receptor pathway, which were significantly lower in non-responders to RDN. The present study describes novel molecular targets potentially contributing to reduction of blood pressure after RDN in some patients. Identifying patients with a high responsiveness to RDN could contribute to an individualized therapy in drug resistant hypertension.
Abstract
Factors causing resistance to renal denervation (RDN) for treatment of arterial hypertension are not known. In the current study, we sought to determine mechanisms involved [...]
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Non-invasive imaging in detecting myocardial viability: Myocardial function versus perfusion
I. A. Elfigih, M. Y. Henein

IJC Heart & Vasculature (2014). Vol. 5 pp. 51-56

Abstract
Coronary artery disease (CAD) is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV) dysfunction an important complication. The distinction between viable and non-viable myocardium in patients with LV dysfunction is a clinically important issue among possible candidates for myocardial revascularization. Several available non-invasive techniques are used to detect and assess ischemia and myocardial viability. These techniques include echocardiography, radionuclide images, cardiac magnetic resonance imaging and recently myocardial computed tomography perfusion imaging. This review aims to distinguish between the available non-invasive imaging techniques in detecting signs of functional and perfusion viability and identify those which have the most clinical relevance in detecting myocardial viability in patients with CAD and chronic ischemic LV dysfunction. The most current available studies showed that both myocardial perfusion and function based on non-invasive imaging have high sensitivity with however wide range of specificity for detecting myocardial viability. Both perfusion and function imaging modalities provide complementary information about myocardial viability and no optimum single imaging technique exists that can provide very accurate diagnostic and prognostic viability assessment. The weight of the body of evidence suggested that non-invasive imaging can help in guiding therapeutic decision making in patients with LV dysfunction.
Abstract
Coronary artery disease (CAD) is the most prevalent and single most common cause of morbidity and mortality [1] with the resulting left ventricular (LV) dysfunction an important [...]
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Impact of combination therapy with statin and ezetimibe on secondary prevention for post-acute myocardial infarction patients in the statin era
S. Ebisawa, . Atsushi Izawa, . Yasushi Ueki, . Hirofumi Hioki, . Masatoshi Minamisawa, . Naoto Hashizume, . Naoyuki Abe, . Yuichiro Kashima, . Takashi Miura, . Takahiro Takeuchi, . Hirohiko Motoki, . Ayako Okada, . Yusuke Miyashita, . Jun Koyama, . Uichi Ikeda

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 154-160

Abstract
Little is known concerning the effect of ezetimibe for secondary prevention in post-myocardial infarction (MI) patients. In this study, we investigated the secondary prevention effect of ezetimibe for post-MI patients. This study is a retrospective analysis of Assessing Lipophilic vs. hydrophilic Statin therapy for Acute MI (ALPS-AMI study). The patients were divided into two groups: those administered a statin to control low density lipoprotein-cholesterol (LDL-C), the ezetimibe(−) group, and those administered ezetimibe in addition to a statin to control LDL-C, the ezetimibe(+) group. The endpoints were Major Adverse Cardiac and Cerebrovascular Event (MACCE), including all-cause death, recurrence of MI, stroke, and heart failure requiring hospitalization, and MACCE with revascularization. The ezetimibe(+) and ezetimibe(−) groups contained 113 and 337 patients, respectively. Incidences of MACCE and MACCE with revascularization were lower in the ezetimibe(+) group than in the ezetimibe(−) group (2.6% vs. 11.5%, p = 0.002, 23.0% vs. 36.7%, p = 0.014, respectively). Moreover, logistic regression analysis revealed ezetimibe(+) was a significant negative predictor of MACCE (OR 0.208, 95% CI 0.048 to 0.903, p = 0.047) and MACCE with revascularization (OR 0.463, 95% CI 0.258 to 0.831, p = 0.008). The preventive effect of ezetimibe against MACCE was observed in both moderate- and high-intensity lipid lowering treatment groups (0% vs. 17%, p = 0.077, 3.1% vs. 9.4%, p = 0.033). In lipid-lowering therapy post-MI, ezetimibe and statin combination therapy improved MACCE with or without revascularization compared with statin monotherapy. These findings suggest that post-MI secondary prevention should be more intensive.
Abstract
Little is known concerning the effect of ezetimibe for secondary prevention in post-myocardial infarction (MI) patients. In this study, we investigated the secondary prevention [...]
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Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization
. Federica DeVecchi, . Emanuela Facchini, . Anna Degiovanni, . Chiara Sartori, . Chiara Cavallino, . Matteo Santagostino, V. Di Ruocco, . Andrea Magnani, . Eraldo Occhetta, P. Marino

IJC Heart & Vasculature (2016). Vol. 11 pp. 66-73

Abstract
It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This studys purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation. In 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline. There was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization. Acute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.
Abstract
It has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists [...]
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Effect of respiration on cardiac filling at rest and during exercise in Fontan patients: A clinical and computational modeling study
A. Bruaene, . Guido Claessen, A. La Gerche, . Ethan Kung, . Alison Marsden, P. De Meester, . Sarah Devroe, . Jan Bogaert, . Piet Claus, . Hein Heidbuchel, . Werner Budts, . Marc Gewillig

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 100-108

Abstract
Due to the absence of a sub-pulmonary ventricle, the Fontan circulation is sensitive to respiration-induced changes in intrathoracic pressure. However, the importance of a ‘respiratory pump’ in creating forward flow remains controversial. We aimed at evaluating the effect of respiration on ventricular filling during exercise using clinical data and computational modeling predictions. Ten Fontan patients (6 male, 20 ± 4 years) underwent ungated cardiac magnetic resonance (CMR) imaging at rest and during supine bicycle exercise to evaluate systemic ventricular volumes (end-diastolic volume index (EDVi), end-systolic volume index (ESVi) and stroke volume index (SVi)) during normal respiration and a Valsalva maneuver. Respiratory-dependent SV was calculated. Clinical results were compared to predictions made by a closed-loop lumped-parameter (LPN) computational model of Fontan circulation. Inspiration resulted in increased EDVi (98 ± 16 to 103 ± 15 mL, P = 0.001), SVi (55 ± 9 to 59 ± 9 mL, P = 0.001) and cardiac index (3.9 ± 0.7 to 4.2 ± 0.8 L/min, P = 0.002), whereas ESVi (P = 0.096) remained unchanged. The effect of inspiration on EDVi (mean effect + 6 ± 1 mL, P < 0.0001) and SVi (+ 4 ± 1 mL, P < 0.0001) was maintained during exercise. Respiratory-dependent SVi tended to increase during exercise (3 ± 2% to 5 ± 3%, P = 0.084). Valsalva resulted in decreased EDVi (P = 0.001), ESVi (P = 0.003) and SVi (P = 0.005). Computational modeling indicated higher EDV and SV at end-inspiration and expiration, showing a phased time delay between peak caval vein flow and peak SV. In Fontan patients, inspiration resulted in increased ventricular filling at rest and during exercise. Results were confirmed using a computational model indicating a phased time delay between peak SV and peak caval vein flow.
Abstract
Due to the absence of a sub-pulmonary ventricle, the Fontan circulation is sensitive to respiration-induced changes in intrathoracic pressure. However, the importance of a [...]
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Risk stratification in non-ST elevation acute coronary syndromes: Risk scores, biomarkers and clinical judgment
. David Corcoran, . Patrick Grant, . Colin Berry

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 131-137

Abstract
Undifferentiated chest pain is one of the most common reasons for emergency department attendance and admission to hospitals. Non-ST elevation acute coronary syndrome (NSTE-ACS) is an important cause of chest pain, and accurate diagnosis and risk stratification in the emergency department must be a clinical priority. In the future, the incidence of NSTE-ACS will rise further as higher sensitivity troponin assays are implemented in clinical practice. In this article, we review contemporary approaches for the diagnosis and risk stratification of NSTE-ACS during emergency care. We consider the limitations of current practices and potential improvements. Clinical guidelines recommend an early invasive strategy in higher risk NSTE-ACS. The Global Registry of Acute Coronary Events (GRACE) risk score is a validated risk stratification tool which has incremental prognostic value for risk stratification compared with clinical assessment or troponin testing alone. In emergency medicine, there has been a limited adoption of the GRACE score in some countries (e.g. United Kingdom), in part related to a delay in obtaining timely blood biochemistry results. Age makes an exponential contribution to the GRACE score, and on an individual patient basis, the risk of younger patients with a flow-limiting culprit coronary artery lesion may be underestimated. The future incorporation of novel cardiac biomarkers into this diagnostic pathway may allow for earlier treatment stratification. The cost-effectiveness of the new diagnostic pathways based on high-sensitivity troponin and copeptin must also be established. Finally, diagnostic tests and risk scores may optimize patient care but they cannot replace patient-focused good clinical judgment.
Abstract
Undifferentiated chest pain is one of the most common reasons for emergency department attendance and admission to hospitals. Non-ST elevation acute coronary syndrome (NSTE-ACS) [...]
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Medium term follow-up after percutaneous pulmonary valve replacement with the Melody® valve
B. Cools, . Werner Budts, . Ruth Heying, . Derize Boshoff, . Benedicte Eyskens, . Stefan Frerich, . Els Troost, . Marc Gewillig

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 92-97

Abstract
Data on long term function of the Melody valve are scarce. Patients and methods: single institution, results of percutaneous pulmonary valve implantation (PPVI) from 2006 to 2014. The function of the valved conduit was analyzed by Doppler echocardiography. Annual Chest X-ray after implant and permanent screening for events (e.g. Endocarditis). 112 Melody valves were implanted in 111 patients, mean age 19.3 years (4.5–81.6). No pre-stenting of the RVOT was performed (n = 4) at first. In the next 107 patients pre-stenting was always performed. In 82 patients 1 pre-stent, 18 patients 2, in 6 patients 3 stents and 1 patient 4 stents were used. The Melody stent was dilated up to 24 mm (n = 4), 22 mm (n = 72), 20 mm (n = 28) and 18 mm (n = 6). When stenotic, the Doppler gradient reduced from 67.0 mm Hg (SD 13.9) to 18.9 mm Hg (SD 10.4) (p < 0.001), pulmonary regurgitation (PR) was reduced from median 3.5/4 (range 0–4/4) to none or trivial (p < 0.001). There was no significant change in RVOT peak velocity at 5 years (p = 0.122) nor PR (p = 0.835). Type 1 stent fractures were observed in 1/4 non-pre-stented patients and in 5/107 pre-stented (p < 0.05). Endocarditis occurred in 8/112 valves, freedom of endocarditis was 85% at 5 years. In 2 patients early surgical replacement was necessary. Six were sterilized with antibiotic treatment, 2 patients required re-stenting and re-PPVI due to residual gradient. Adequate pre-stenting of the RVOT before PPVI nearly abolishes or delays stent fracture. Cusp function is well preserved in mid-term follow-up, endocarditis is a threat.
Abstract
Data on long term function of the Melody valve are scarce. Patients and methods: single institution, results of percutaneous pulmonary valve implantation (PPVI) from 2006 [...]
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Cardiovascular changes in patients with non-severe Plasmodium vivax malaria
A. Alencar-Filho, J. Ferreira, J. Luis Salinas, . Camila Fabbri, W. Monteiro, A. Siqueira, . Katashi Okoshi, M. Lacerda, M. Okoshi

IJC Heart & Vasculature (2016). Vol. 11 pp. 12-16

Abstract
Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, and serum markers of cardiovascular injury in patients with the non-severe form of vivax malaria in Manaus, Amazonas State, Brazil. We prospectively evaluated 26 patients with vivax malaria in an outpatient referral hospital and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation (day zero, D0) and seven days (D7) after malaria diagnosis. At D0 echocardiography showed higher left ventricular (LV) systolic diameter (28.8 ± 2.82 vs 30.9 ± 4.03 mm, p = 0.037) and LV diastolic volume (82.4 ± 12.3 vs 93.8 ± 25.9 ml, p = 0.05), and lower LV ejection fraction (Teicholz method: 73.2 ± 6.59 vs 68.4 ± 4.87%, p = 0.004) in patients compared to controls. Right ventricle (RV) fractional area change (54.7 ± 5.11 vs 50.5 ± 6.71%, p = 0.014) was lower, and RV myocardial performance index (0.21 ± 0.07 vs 0.33 ± 0.19, p = 0.007), and pulmonary vascular resistance (1.13 ± 0.25 vs 1.32 ± 0.26 Woods unit, p = 0.012) were higher in patients than controls. Patients presented higher serum levels of unconjugated bilirubin (0.24 ± 0.15 vs 1.30 ± 0.89 mg/dL, p < 0.001), soluble vascular cell adhesion molecule–1 (sVCAM-1, 453 ± 143 vs 1983 ± 880 ng/mL, p < 0.001), N-terminal prohormone brain natriuretic peptide (0.59 ± 0.86 vs 1.08 ± 0.81 pg/mL, p = 0.045), and troponin T (861 ± 338 vs 1037 ± 264 pg/mL, p = 0.045), and lower levels of plasma nitrite (13.42 ± 8.15 vs 8.98 ± 3.97 μM, p = 0.016) than controls. Most alterations had reversed by D7. Patients with non-severe Plasmodium vivax malaria present subclinical reversible cardiovascular changes.
Abstract
Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, [...]
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Compensatory enlargement of Ossabaw miniature swine coronary arteries in diffuse atherosclerosis
J. S. Choy, T. Luo, . Yunlong Huo, . Thomas Wischgoll, . Kyle Schultz, S. D. Teague, . Michael Sturek, G. S. Kassab

IJC Heart & Vasculature (2015).

Abstract
Studies in human and non-human primates have confirmed the compensatory enlargement or positive remodeling (Glagov phenomenon) of coronary vessels in the presence of focal stenosis. To our knowledge, this is the first study to document arterial enlargement in a metabolic syndrome animal model with diffuse coronary artery disease (DCAD) in the absence of severe focal stenosis. Two different groups of Ossabaw miniature pigs were fed a high fat atherogenic diet for 4 months (Group I) and 12 months (Group II), respectively. Group I (6 pigs) underwent contrast enhanced computed tomographic angiography (CCTA) and intravascular ultrasound (IVUS) at baseline and after 4 months of high fat diet, whereas Group II (7 pigs) underwent only IVUS at 12 months of high fat diet. IVUS measurements of the left anterior descending (LAD), left circumflex (LCX) and right coronary (RCA) arteries in Group I showed an average increase in their lumen cross-sectional areas (CSA) of 25.8%, 11.4%, and 43.4%, respectively, as compared to baseline. The lumen CSA values of LAD in Group II were found to be between the baseline and 4 month values in Group I. IVUS and CCTA measurements showed a similar trend and positive correlation. Fractional flow reserve (FFR) was 0.91 ± 0.07 at baseline and 0.93 ± 0.05 at 4 months with only 2.2%, 1.6% and 1% stenosis in the LAD, LCX and RCA, respectively. The relation between percent stenosis and lumen CSA shows a classical Glagov phenomenon in this animal model of DCAD.
Abstract
Studies in human and non-human primates have confirmed the compensatory enlargement or positive remodeling (Glagov phenomenon) of coronary vessels in the presence of focal [...]
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Gender differences in the prevalence of coronary artery tortuosity and its association with coronary artery disease
. Joseph Chiha, . Paul Mitchell, . Bamini Gopinath, . George Burlutsky, . Pramesh Kovoor, . Aravinda Thiagalingam

IJC Heart & Vasculature (2017). Vol. 14 pp. 23-27

Abstract
Little is known about the significance of severe coronary tortuosity (SCT) despite it being a relatively common finding on coronary angiography. We examined whether the presence of tortuosity was influenced by gender or cardiac risk factors. We examined 870 patients (Men = 589, Women = 281) who presented to Westmead Hospital, Sydney, Australia for invasive coronary angiography for the assessment of chest pain due to suspected CAD. Female gender and age were significantly associated with SCT (p < 0.001 for age) with 45.2% of women having SCT as opposed to 19.7% of men (p < 0.001). Men with SCT had lower Extent scores only compared than those without tortuosity (22.4 vs. 32.4, p = 0.003). However, women with SCT had less severe coronary artery disease than those with no SCT as measured by both the Extent score (12.4 vs. 19.1, p = 0.03) and Gensini score (10.4 vs. 15.5, p = 0.02). There is a significant relationship between coronary artery tortuosity and gender. Women with severe tortuosity are more likely to have normal coronary arteries or less severe disease than men despite presenting with chest pain.
Abstract
Little is known about the significance of severe coronary tortuosity (SCT) despite it being a relatively common finding on coronary angiography. We examined whether the presence [...]
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Gender differences in the severity and extent of coronary artery disease
. Joseph Chiha, . Paul Mitchell, . Bamini Gopinath, A. J.H. Plant, . Pramesh Kovoor, . Aravinda Thiagalingam

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 161-166

Abstract
To investigate whether women presenting with suspected angina would show less severe coronary artery disease in than men as determined by the extent score. We examined 994 participants of the Australian Heart Eye Study presenting for coronary angiography in the investigation of chest pain from June 2009 to February 2012. People were excluded if there was a history of coronary artery bypass surgery, previous stenting procedure or incomplete angiogram scoring. An extent and vessel score was calculated using invasive coronary angiography. Normal coronary arteries were defined as having no luminal irregularity (Extent score = 0). Obstructive coronary artery disease was defined as a luminal narrowing of greater than 50%. Women compared to men without infarction had a lower burden of CAD with up to 50% having normal coronary arteries in the 30–44 year group and 40% in the 45–59 year group. Compared to men, women with chest pain had lower mean extent scores (19.6 vs 36.8, P < 0.0001) and lower vessel scores (0.7 v 1.3, P < 0.0001). Although the mean extent score was lower in women than men with myocardial infarction, this was not statistically significant (34.8 vs 41.6 respectively, P = 0.18). There is a marked difference in coronary artery disease severity and burden between females and males presenting for the investigation of suspected angina. Women are more likely to have normal coronary arteries or less severe disease than age-matched men, particularly if they do not present with myocardial infarction.
Abstract
To investigate whether women presenting with suspected angina would show less severe coronary artery disease in than men as determined by the extent score. We examined 994 [...]
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Risk factors responsible for atrial fibrillation development between symptomatic patients with concealed or manifest atrioventricular accessory pathways
M. Chen, . Xiangfei Feng, J. Sun, . Qunshan Wang, . Pengpai Zhang, J. Wang, . Yi-Gang Li

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 69-75

Abstract
Patients with manifest atrioventricular accessory pathways (mAPs) have a greater tendency to develop atrial fibrillation (AF) compared with patients with concealed atrioventricular accessory pathways (cAPs). However, the risk factors of developing AF in patients with various atrioventricular accessory pathways (APs) are not clear. This retrospective study included 460 symptomatic patients with either cAPs (n = 246) or mAPs (n = 214) who underwent electrophysiological study and successful radiofrequency catheter ablation of APs. Clinical and electrophysiological characteristics were compared between cAPs and mAPs and between AF and non-AF groups with cAPs or mAPs. Independent risk factors of AF were analyzed using multivariate logistic regression. AF was more frequent in mAPs group than in cAPs group (23.4% vs 9.8%, p < 0.01). Clinical features were similar between cAPs and mAPs. Anterograde conduction properties served as the major electrophysiological feature of mAPs. Multivariate analysis indicated that mAPs, hypertension, post-ablation P wave dispersion (Pd), N-terminal proB-type natriuretic peptide (NT-proBNP) and creatinine were independent risk factors of AF in the complete cohort. Hypertension, post-ablation Pd and high-sensitivity C-reactive protein (hsCRP) were independent risk factors of AF in cAPs group. Post-ablation Pd, NT-proBNP, creatinine and shorter effective refractory period of anterograde accessory pathways (AAP ERP) were independent risk factors of AF in mAPs group. Results from this study demonstrate that the risk factors of AF are not homogenous between concealed and manifest APs, which might suggest heterogeneous pathogenesis of AF in these two types of APs.
Abstract
Patients with manifest atrioventricular accessory pathways (mAPs) have a greater tendency to develop atrial fibrillation (AF) compared with patients with concealed atrioventricular [...]
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The association among age, early mitral leaflet closure, cardiac structure, diastolic indices and NT-proBNP in an asymptomatic Taiwanese population
C. Chen, . Yung-Tzi Chen, . Kuang-Te Wang, . Shou-Chuan Shih, . Chuan-Chuan Liu, . Jen-Yuan Kuo, C. Hou, . Yih-Jer Wu, . Chung-Lieh Hung, . Hung-I Yeh

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 114-121

Abstract
Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evaluation cohort (2004–2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EF slope (mm/s) and serum NT-proBNP level were obtained. The association between EF slope and the other clinical or echo-based parameters was investigated. Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: − 0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multivariate models (all p < 0.05). Reduced EF slope was correlated with greater cardiac concentricity, abnormal E′ and E/E′ (AUROC: 0.74 and 0.77, respectively, both p < 0.05) and elevated NT-proBNP (Coef: 5.98 pg/mL, per − 10 mm/s EF slope, 95% CI: 7.82 to 4.17, p < 0.001). EF-slope also clearly discriminated individuals with abnormal estimated LV filling (E/E′ categorized by < 8, ≥ 8 & < 15, ≥ 15, ANOVA p < 0.001). EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor E′ and elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups.
Abstract
Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The association among aging, mitral leaflet closure (EF slope), cardiac structures, [...]
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Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters
. Huang-Chung Chen, . Wei-Chieh Lee, . Shu-Kai Hsueh, . Cheng-I Cheng, . Chien-Jen Chen, . Cheng-Hsu Yang, . Chih-Yuan Fang, . Chi-Ling Hang, . Hon-Kan Yip, . Chiung-Jen Wu, . Hsiu-Yu Fang

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 35-41

Abstract
Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for TRA CTO PCI, with a low incidence of procedure-related complications and long-term radial artery occlusion.
Abstract
Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions [...]
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Ischemic postconditioning of the isolated human myocardium: Role of the applied protocol
. Kelly Casós, . María-Llanos Pérez, . Arnau Blasco-Lucas, . Gemma Ferrer-Curriu, J. Gracia-Baena, . Carlos Sureda, . Eduard Permanyer, . Alberto Igual, . Manuel Galiñanes

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 55-61

Abstract
Ischemic postconditioning (IPostC), has been proposed as a useful approach to reduce infarct size in all species, but its clinical utility remains unclear. To investigate the role played by the protocol used on the efficacy of IPostC in protecting the diseased human myocardium. Myocardial atrial samples from patients were subjected to a 90 min ischemia/120 min reoxygenation followed by different IPostC protocols to investigate the role of the time of ischemia (30, 60, 90 and 120 s) and the number of cycles (1, 2, 3 and 4) with 60 and 120 s of total ischemic time. Muscles were also subjected to ischemic preconditioning (IPreC). The release of lactate dehydrogenase (LDH) and the measurement of tetrazolium bromide (MTT) were determined. IPostC increased the LDH and decreased the MTT values from those of control, independently of the duration of the conditioning ischemia. LDH and MTT values also worsened by augmenting the number of IPostC cycles whereas they were significantly improved by IPreC. However, analysis of individual results indicated that in approximately 1/3 of the cases IPostC exhibited some degree of protection especially in the presence of increased ischemic injury. The present findings show that IPostC of the human myocardium may be influenced by the protocol used and also by the degree of the preceding ischemic injury. IPostC was beneficial in approximately 1/3 of the cases, however in the remaining cases it increased ischemic damage and, therefore, these results raise a word of caution on its broad clinical use.
Abstract
Ischemic postconditioning (IPostC), has been proposed as a useful approach to reduce infarct size in all species, but its clinical utility remains unclear. To investigate [...]
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Acute and spontaneous coronary thrombosis in non-culprit artery during percutaneous coronary intervention in myocardial infarction with ST-segment elevation: A “shocking” case
. Dario Buccheri, . Patrizia Carità, . Michele Carella, . Davide Piraino, P. Rosa Chirco, . Giuseppe Andolina

IJC Heart & Vasculature (2015).
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Clinical evaluation of R860Q semi-conservative amino acid substitution in CACNA1C gene in association with long QT syndrome
. Usama Boles, . Chris Simpson, E. E. Gul, . Cortney Kiss, . Andres Enriquez, . Zongchao Jia, . Adrián Baranchuk, J. S. Walia

IJC Heart & Vasculature (2017). Vol. 15 pp. 21-23
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A review of the safety aspects of radio frequency ablation
. Abhishek Bhaskaran, . William Chik, . Stuart Thomas, . Pramesh Kovoor, . Aravinda Thiagalingam

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 147-153

Abstract
In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, a review of its safety aspects is timely. Serious complications do occur during supraventricular tachycardia (SVT) ablations and knowledge of their incidence is important when deciding whether to proceed with ablation. Evidence is emerging for the probable role of prophylactic ischemic scar ablation to prevent VT. This might increase the number of procedures performed. Here we look at the various complications of RF ablation and also the methods to minimize them. Electronic database was searched for relevant articles from 1990 to 2015. With better awareness and technological advancements in RF ablation the incidence of complications has improved considerably. In AF ablation it has decreased from 6% to less than 4% comprising of vascular complications, cardiac tamponade, stroke, phrenic nerve injury, pulmonary vein stenosis, atrio-esophageal fistula (AEF) and death. Safety of SVT ablation has also improved with less than 1% incidence of AV node injury in AVNRT ablation. In VT ablation the incidence of major complications was 5–11%, up to 3.4%, up to 1.8% and 4.1–8.8% in patients with structural heart disease, without structural heart disease, prophylactic ablations and epicardial ablations respectively. Vascular and pericardial complications dominated endocardial and epicardial VT ablations respectively. Up to 3% mortality and similar rates of tamponade were reported in endocardial VT ablation. Recent reports about the high incidence of asymptomatic cerebral embolism during AF ablation are concerning, warranting more research into its etiology and prevention.
Abstract
In light of recent reports showing high incidence of silent cerebral infarcts and organized atrial arrhythmias following radiofrequency (RF) atrial fibrillation (AF) ablation, [...]
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Alpha2A-adrenergic receptor and eNOS genetic polymorphisms are associated with exercise muscle vasodilatation in apparently healthy individuals
R. Nunes, L. Barroso, A. Pereira, M. Rondon, C. Negrão, J. Krieger, A. Mansur

IJC Heart & Vasculature (2016). Vol. 13 pp. 14-18

Abstract
Muscle vasodilatation during exercise has been associated with cardiovascular health and may be influenced by genetic variability. The purpose of this study was to evaluate functional genetic polymorphisms of physiologic pathways related to the regulation of the cardiovascular function (alpha-adrenergic receptors, endothelial nitric oxide synthase and bradykinin B2 receptor) and exercise muscle vasodilatation in apparently healthy men and women. We enrolled 689 individuals without established cardiovascular disease that had attended a check-up program. The vasodilatation was studied with venous occlusion plethysmography and determined by the increase of vascular conductance during handgrip exercise. Genotypes for ADRA1A Arg347Cys (rs1048101), ADRA2A 1780 C > T (rs553668), ADRA2B Del 301–303 (rs28365031), eNOS 786 T > C (rs2070744), eNOS Glu298Asp (rs1799983) and BDKRB2 (rs5810761) polymorphisms were assessed by polymerase chain reaction followed by high resolution melting analysis. The eNOS rs2070744 polymorphism was significantly associated with forearm vascular conductance during exercise in women. Women with CC genotype showed higher vasodilatation than carriers of TC and TT genotypes (p = 0.043). The ADRA2A rs553668 polymorphism was significantly associated with forearm vascular conductance during exercise in men. Men with TT genotype had higher vasodilatation than carriers of CT and CC genotypes (p = 0.025). eNOS rs207074 polymorphism in women and ADRA2A rs553668 polymorphism in men were associated with the increase of forearm vascular conductance during handgrip exercise. These findings suggest that eNOS and ADRA2A genetic polymorphisms may be potential markers of exercise muscle vasodilatation.
Abstract
Muscle vasodilatation during exercise has been associated with cardiovascular health and may be influenced by genetic variability. The purpose of this study was to evaluate [...]
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Novel linkage of LMNA Single Nucleotide Polymorphism with Dilated Cardiomyopathy in an Indian case study
A. Banerjee, P. K. Ghoshal, . Kaushik Sengupta

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 99-105

Abstract
Dilated Cardiomyopathy (DCM) is one of the most commonly encountered heart diseases reported globally. It is characterized by enlarged ventricles with impaired systolic and diastolic functions. Mutations in LMNA gene are one of the causative factors to precipitate the disease. However, association of SNPs of LMNA with DCM in particular has not been well documented. Here we present a limited and restricted case study of patients from south eastern part of India afflicted with idiopathic DCM and conduction defects. By using next generation sequencing we have sequenced the exons of LMNA gene from genomic DNA isolated from patients. We have identified the linkage of 8 different LMNA SNPs with idiopathic DCM viz. rs121117552, rs538089, rs505058, rs4641, rs646840, rs534807, rs80356803 and rs7339. These SNPs are scattered throughout the gene with prevalence for the region encoding the central rod domain of lamin A/C. Most of these SNPs in LMNA were previously reported to be involved in various disorders other than DCM. We conclude that, variation in LMNA is one of the major underlying genetic causes for the pathogenesis of DCM, as observed in few Indian populations.
Abstract
Dilated Cardiomyopathy (DCM) is one of the most commonly encountered heart diseases reported globally. It is characterized by enlarged ventricles with impaired systolic and [...]
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Postinfarction posterior ventricular septal rupture mimicking a biventricular free wall rupture with extracardiac left-to-right shunt
. Kattih Badder, . Jens Vogel-Claussen, . Udo Bavendiek, . Akin Muharrem, . Christian Kühn, . Johann Bauersachs, . Michael Brehm

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 32-36
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The renin–angiotensin–aldosterone-system and right heart failure in congenital heart disease
. Stine Andersen, A. Andersen, J. Nielsen-Kudsk

IJC Heart & Vasculature (2016). Vol. 11 pp. 59-65

Abstract
Adults with congenital heart disease represent a rapidly growing patient group. Dysfunction of the right ventricle is often present, and right heart failure constitutes the main cause of death. Heart failure therapies used in acquired left heart failure are often initiated in adults with right heart failure due to congenital heart disease, but the right ventricle differs substantially from the left ventricle, and the clinical evidence for this treatment strategy is lacking. In this review, we identified existing clinical studies evaluating the effects of ACE inhibitors, angiotensin II receptor blockers and aldosterone antagonists in adults with congenital heart disease by a systematic literature search. From 13 identified studies no clear evidence of beneficial effects was found, but the design of the studies limits the validity of the results. The studies in general include low numbers of patients, have short follow-up periods and evaluate surrogate endpoints instead of hard clinical endpoints. Specific evaluation of symptomatic patients with a systemic right ventricle indicates that these patients may benefit from RAAS inhibitory treatments, but this requires further investigation. To conclude, existing studies do not support the use of RAAS inhibitory treatments in right heart failure due to congenital heart disease but contain important limitations. Hence, there is a need for new well-designed trials including higher numbers of patients and validated endpoints to optimize and guide future treatment of this patient group.
Abstract
Adults with congenital heart disease represent a rapidly growing patient group. Dysfunction of the right ventricle is often present, and right heart failure constitutes the [...]
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Fragmented QRS and ejection fraction in heart failure patients admitted to the hospital
. Fadi Alattar, . Nashat Imran, . Fayez Shamoon

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 11-14

Abstract
Fragmented QRS (FQRS) in 12 lead ECG was recently correlated with various outcomes in ischemic and non-ischemic heart disease. We studied the relationship between FQRS and ejection fraction (EF) in heart failure patients with QRS < 120 ms. Medical records and echocardiograms of 339 patients admitted with CHF were reviewed. ECGs were read twice by a reader blinded to all data. 70 patients with wide QRS were excluded, 63 patients had FQRS and 206 patients did not have FQRS. FQRS group were more likely to be black (OR = 2.17, p = 0.0093), and diabetic (OR = 1.79, p = 0.0451). ROC curve analysis revealed a significant relationship between EF and FQRS (p = 0.002). At EF of 48%, OR for FQRS was 4.36 (95% CI: 2.1–9.05, p < .0001). Adjustment for race and diabetes did not change the OR, or confidence intervals (Adjusted OR for race: 4.08 (95% CI: 1.06–15.67, p = 0.04), for diabetes: 4.13 (95% CI: 1.46–11.69, p = 0.008)). There was a significant difference in EF between patients with FQRS involving ≥ 2 ECG areas and non-FQRS group (p < 0.05), but not between patients with ≥ 2 vs. one area, or 1 area vs. non-FQRS. In heart failure patients with QRS < 120 ms, FQRS was observed more frequently in persons of black race and in diabetics and was associated with lower EF. This was mainly seen in patients with FQRS involving ≥ 2 ECG areas.
Abstract
Fragmented QRS (FQRS) in 12 lead ECG was recently correlated with various outcomes in ischemic and non-ischemic heart disease. We studied the relationship between FQRS and [...]
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Corrigendum to “Regional variations in baseline characteristics of cardiac rhythm device recipients: The PANORAMA observational cohort study” [Int. J. Cardiol. Heart Vessels (2014) 90–96]
F. Al Kandari, . Andrejs Erglis, . Raed Sweidan, . Ingrid Dannheimer, . Milan Sepsi, . Juan Bénézet, . Michal Padour, . Ajay Naik, . Jaime Escudero, . Teena West, . Reece Holbrook, . Faizel Lorgat

IJC Heart & Vasculature (2014).
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CYP2C19 variants and epoxyeicosatrienoic acids in patients with microvascular angina
. Tomonori Akasaka, . Daisuke Sueta, . Yuichiro Arima, . Noriaki Tabata, . Seiji Takashio, . Yasuhiro Izumiya, . Eiichiro Yamamoto, . Kenichi Tsujita, . Sunao Kojima, . Koichi Kaikita, . Ayami Kajiwara, . Kazunori Morita, . Kentaro Oniki, . Junji Saruwatari, . Kazuko Nakagawa, . Seiji Hokimoto

IJC Heart & Vasculature (2017). Vol. 15 pp. 15-20

Abstract
Categorization as a cytochrome P450 (CYP) 2C19 poor metabolizer (PM) is reported to be an independent risk factor for cardiovascular disease. Epoxyeicosatrienoic acids (EETs) are metabolites of arachidonic acid by CYP2C19 epoxygenases and anti-inflammatory properties, especially in microvascular tissues. We examined the impact of CYP2C19 polymorphisms and EETs on the patients with microvascular angina (MVA) caused by coronary microvascular dysfunction. We examined CYP2C19 genotypes in patients with MVA (n = 81). MVA was defined as absence of coronary artery stenosis and epicardial spasms, and the presence of inversion of lactic acid levels between intracoronary and coronary sinuses in acetylcholine-provocation test or the adenosine-triphosphate-induced coronary flow reserve ratio was below 2.5. CYP2C19 PM have two loss-of-functon alleles (*2, *3). We measured serum dihydroxyeicosatrienoic acid (DHET) as representative EET metabolite. In MVA, the patients with CYP2C19 PM were 34.6% and high sense C-reactive protein (hs-CRP) levels in CYP2C19 PM were significantly higher than that of non-PM group (0.165 ± 0.116 vs. 0.097 ± 0.113 mg/dL, P = 0.026). Moreover, DHET levels in CYP2C19 PM were significantly lower than that of non-PM (10.4 ± 4.58 vs. 15.6 ± 11.1 ng/mL, P = 0.003 (11, 12-DHET), 12.1 ± 3.79 vs. 17.3 ± 6.49 ng/mL, P = 0.019 (14, 15-DHET)). The decline of EET owing to CYP2C19 variants may affects coronary microvascular dysfunction via chronic inflammation.
Abstract
Categorization as a cytochrome P450 (CYP) 2C19 poor metabolizer (PM) is reported to be an independent risk factor for cardiovascular disease. Epoxyeicosatrienoic acids (EETs) [...]
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Comparison of circadian, weekly, and seasonal variations of electrical storms and single events of ventricular fibrillation in patients with Brugada syndrome
. Yoshiyasu Aizawa, . Seiji Takatsuki, . Yoshiaki Kaneko, . Takashi Noda, . Yoshinori Katsumata, . Takahiko Nishiyama, . Takehiro Kimura, . Nobuhiro Nishiyama, . Kotaro Fukumoto, . Shinichi Niwano, . Takashi Kurita, . Takeshi Mitsuhashi, . Shiro Kamakura, . Akihiko Shimizu, . Minoru Horie, . Yoshifusa Aizawa, . Keiichi Fukuda

IJC Heart & Vasculature (2016). Vol. 11 pp. 104-110

Abstract
In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients showed weekly and seasonal patterns. The patients with ESs had peak episodes of VF on Saturday and in the winter and spring, while episodes of VF in patients with single VF events occurred most often on Monday with smaller seasonal variation. Except for age, there was no difference in the clinical or ECG characteristics between the patients with ESs and those with single VF episodes.
Abstract
In patients with Brugada syndrome (BS), VF occurred predominantly during the nocturnal period. Some patients also developed ESs. In addition to the circadian rhythm, patients [...]
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Pulmonary hypertension: prevalence and risk factors
S. Ait Faqih, . Béfa Noto-Kadou-Kaza, L. Abouamrane, . Naoufal Mtiou, S. El Khayat, . Mohamed Zamd, . Ghislaine Medkouri, M. Benghanem, . Benyounes Ramdani

IJC Heart & Vasculature (2016). Vol. 11 pp. 87-89

Abstract
Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving hemodialysis. It is a major problem due to its high prevalence and morbidity and mortality. Its pathophysiological mechanism is just known and the strategies for its supported not yet defined. To determine the prevalence of PAH in our hemodialysis patients and its risk factors. Single center descriptive and analytical cross-sectional study, including 111 hemodialysis patients who had benefit from a trans-thoracic cardiac Doppler ultrasound during 2014. A value greater than or equal to 35 mm Hg is considered PAH and classified as follows: mild PAH (35 50 mm Hg), moderate PAH (50 70 mm Hg), and severe pulmonary hypertension (> 70 mm Hg). Patients with a high probability of secondary PAH, especially those with the following history: chronic obstructive pulmonary disease, pulmonary embolism, were not included. The mean age was 44.3 ± 14.2 years. Among the 111 patients, 18 had pulmonary arterial pressure above 35 mm Hg corresponding to 16.22% of PAH prevalence. The average pressure was 45 mm Hg. Of these 18 patients, 11.8% had mild PAH, 3.4% moderate PAH and 0.8% severe PAH. The average hemodialysis duration was significantly associated with PAH (p = 0.003), as well as valvular calcification (p = 0.000), mitral regurgitation (p = 0.001) and tricuspid regurgitation (p = 0.002). Primary pulmonary hypertension is a major problem among our hemodialysis because of its high prevalence and its risk factors.
Abstract
Pulmonary arterial hypertension (PAH), defined as a systolic pulmonary artery pressure above 35 mm Hg, is another vascular disease entity recently described in patients receiving [...]
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Left atrial geometry and pump function in ischemic cardiomyopathy
M. Abdelzaher, W. Atteia

IJC Heart & Vasculature (2014). Vol. 5 pp. 45-50

Abstract
Many of the factors that are known to alter left atrial (LA) contractility are present in patients with ischemic cardiomyopathy (ICM). Nevertheless, preservation of LA contractile function in this group of patients was reported in previous studies. The aim of this study was to assess the changes in LA size, geometry and contractile function in ICM. 60 subjects (age: 49 ± 12 years, 53% males) in sinus rhythm undergoing coronary angiography (CA), were enrolled in this study, 15 subjects as a control group, 30 patients with reduced ejection fraction (EF) and significant coronary artery disease, as the ICM group, and 15 with reduced EF and normal CA, as the dilated cardiomyopathy (DCM) group. LA dimensions, volume, active emptying fraction (ACTEF) and eccentricity index (LAEi) as well as late diastolic velocities of the mitral annulus (a′) and LA free wall (A3) were measured. Compared with the control group, ICM patients had larger LA volume and reduced ACTEF, a′ and A3, with no significant difference between patients with ICM and DCM in any of these parameters. LA eccentricity was, non-significantly, higher in both cardiomyopathy groups than in the control group. Patients with ICM have increased LA volume and reduced LA contractile function in comparison with normal controls. LA enlargement, LA contractile dysfunction and LA geometric changes in ICM are similar to that occurring in DCM. LA size, contractile function and eccentricity may not be reliable in differentiating ischemic from idiopathic dilated cardiomyopathy.
Abstract
Many of the factors that are known to alter left atrial (LA) contractility are present in patients with ischemic cardiomyopathy (ICM). Nevertheless, preservation of LA contractile [...]
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Identification of nonlinear kinematic hardening parameters for sheet metal from biaxial loading tests
B. Söhngen

Presentations to the XIV International Conference on Computational Plasticity (COMPLAS 2017).

Abstract
In this work an anisotropic material model at finite strains with nonlinear mixed (isotropic and kinematic) hardening is used for the identification of the hardening parameters of sheet steel. The algorithmic system is thereby reduced to a single equation return mapping. For the identification, a cruciform specimen is loaded biaxially in an alternating shear test to provoke the kinematic hardening behavior and prevent the sheet from buckling. The material parameters are found through an optimization strategy by comparing the deformation field from the experiment to that from a finite element (FE) simulation. The resulting cost function is minimized by means of a gradient-based method.
Abstract
In this work an anisotropic material model at finite strains with nonlinear mixed (isotropic and kinematic) hardening is used for the identification of the hardening parameters [...]
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Time domain simulation of coupled sloshing-seakeeping problems by coupling PFEM-2 and SeaFEM
J. Colom Cobb, B. Servan Camas, P. Becker, J. García-Espinosa, S. Idelsohn

Presentations to the VII International Conference on Computational Methods in Marine Engineering (Marine 2017).

Abstract
The aim of this work is to be able to cope with complex sloshing-seakeeping problems in an effective manner. For this purpose, two different solvers will be integrated into one coupled tool to take advantage of their characteristics. The Particle Finite Element Method is a versatile framework for the analysis of fluid-structure interaction problems. The latest development within the framework of the PFEM is the X-IVAS (eXplicit Integration along the Velocity and Acceleration Streamlines) scheme. It is a semi-implicit scheme built over a Semi-Lagrangian (SL) formulation. This new scheme was named PFEM-2 and will be used in this work to solve the fluid dynamics (sloshing) inside the tanks. The PFEM-2 will be coupled in the time domain with SeaFEM, a solver developed for seakeeping problems. SeaFEM solves the second-order diffraction-radiation equations by using the Finite Element Method (FEM) and will be used in this work to simulate the interaction between waves and a floating body. The coupling of the two tools will be accomplished by using an effective coupling algorithm and a communication technique that allows simulations to be computed without affecting the global compute time and the accuracy of the solvers. This new tool has been validated against experimental benchmarks carried out in a model basin at model scale.
Abstract
The aim of this work is to be able to cope with complex sloshing-seakeeping problems in an effective manner. For this purpose, two different solvers will be integrated into [...]
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