Documents published in 2017 : Scipedia

Relative diagnostic, prognostic and economic value of stress echocardiography versus exercise electrocardiography as initial investigation for the detection of coronary artery disease in patients with new onset suspected angina
K. Zacharias, . Shahram Ahmadvazir, . Asrar Ahmed, B. N. Shah, . Dionisio Acosta, . Roxy Senior

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 124-130

Abstract
We hypothesised that stress echocardiography (SE), may be superior to exercise ECG (ExECG), for predicting CAD and outcome, and cost-beneficial, when performed as initial investigation in newly suspected angina. All patients seen in 2011, with suspected angina, no history of CAD, pre-test likelihood of CAD of > 10% and who underwent SE or ExECG as first line were identified retrospectively. Cost to diagnosis was calculated by adding the cost of all tests, up to and including coronary angiography (CA), on an intention-to-treat basis. Follow-up data on cardiac death and myocardial infarction (MI) were collected, 26 months after the presentation of the last study patient. A total of 456 patients underwent ExECG (224 (49%) negative, 93 (20%) positive, 139 (31%) inconclusive) and 241 underwent SE (200 (83%) negative, 35 (15%) positive, 6 (2%) inconclusive) as first line. In patients subsequently undergoing CA, CAD was present in 46% (37/80) of patients with positive ExECG vs. 72% (23/32) patients with positive SE (p = 0.01). Mean cost to diagnosis was £456 for the ExECG vs. £360 for the SE group (p = 0.002). Over a mean follow-up period of 31 ± 5 months, cardiac events were 2% each in negative SE vs. negative ExECG (p = 0.9). SE is superior to ExECG for prediction of CAD and is cost-beneficial when used as initial test in patients with no history of CAD presenting with suspected angina.
Abstract
We hypothesised that stress echocardiography (SE), may be superior to exercise ECG (ExECG), for predicting CAD and outcome, and cost-beneficial, when performed as initial [...]
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A feasible method for non-invasive measurement of pulmonary vascular resistance in pulmonary arterial hypertension: Combined use of transthoracic Doppler-echocardiography and cardiac magnetic resonance. Non-invasive estimation of pulmonary vascular resistance
. Chaowu Yan, . Zhongying Xu, . Jinglin Jin, . Jianhua Lv, . Qiong Liu, . Zhenhui Zhu, . Kunjing Pang, . Yisheng Shi, W. Fang, . Yang Wang

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 22-27

Abstract
Transthoracic Doppler-echocardiography (TTE) can estimate mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) reliably, and cardiac magnetic resonance (CMR) is the best modality for non-invasive measurement of cardiac output (CO). We speculated that the combined use of TTE and CMR could provide a feasible method for non-invasive measurement of pulmonary vascular resistance (PVR) in pulmonary arterial hypertension (PAH). Right heart catheterization (RHC) was undertaken in 77 patients (17M/60F) with PAH, and simultaneous TTE was carried out to evaluate MPAP, PCWP and CO. Within 2 days, CO was measured again with CMR in similar physiological status. Then, PVR was calculated with the integrated non-invasive method: TTE-derived (MPAP–PCWP)/CMR-derived CO and the isolated TTE method: TTE-derived (MPAP–PCWP)/TTE-derived CO, respectively. The PVR calculated with integrated non-invasive method correlated well with RHC-calculated PVR (r = 0.931, 95% confidence interval 0.893 to 0.956). Between the integrated non-invasive PVR and RHC-calculated PVR, the Bland–Altman analysis showed the satisfactory limits of agreement (mean value: − 0.89 ± 2.59). In comparison, the limits of agreement were less satisfactory between TTE-calculated PVR and RHC-calculated PVR (mean value: − 1.80 ± 3.33). Furthermore, there were excellent intra- and inter-observer correlations for the measurements of TTE and CMR (P < 0.001 for all). The combined use of TTE and CMR provides a clinically reliable method to determine PVR non-invasively. In comparison with RHC, the integrated method shows good accuracy and repeatability, which suggests the potential for the evaluation and serial follow-up in patients with PAH. In PAH, the non-invasive measurement of PVR is very important in clinical practice. Up to now, however, the widely accepted non-invasive method is still unavailable. Since TTE can estimate (MPAP–PCWP) reliably and CMR is the best image modality for the measurement of CO, the combined use of two modalities has the potential to determine PVR non-invasively. In this research, the integrated non-invasive method showed good diagnostic accuracy and repeatability compared with RHC. Therefore, it might be a feasible method for non-invasive measurement of PVR in patients with PAH.
Abstract
Transthoracic Doppler-echocardiography (TTE) can estimate mean pulmonary arterial pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) reliably, and cardiac magnetic [...]
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Olmesartan reverses not only vascular endothelial dysfunction but cardiac diastolic dysfunction in hypertensive patients with heart failure with preserved ejection fraction — ORION study
. Eiichiro Yamamoto, . Keisuke Ohba, . Yoshihiro Hirata, . Takanori Tokitsu, . Koichiro Fujisue, . Koichi Sugamura, . Koichi Kaikita, . Seiji Hokimoto, . Seigo Sugiyama, . Hisao Ogawa

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 128-130
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Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease?
. Fatih Yalçin, . Caner Topaloglu, . Nagehan Kuçukler, . Mehmet Ofgeli, T. P. Abraham

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 141-145

Abstract
Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regional myocardial performance index (MPI) in a hypertensive patient population. We evaluated 119 hypertensive patients who were divided into gr. I: 57 patients without left ventricular hypertrophy (LVH), (53.1 ± 10 years), and gr. II: 62 patients with LVH (55.1 ± 9 years) using conventional and tissue doppler imaging. They were compared with gr. III, a sex-age-matched normal control group (37 subjects, 53.0 ± 10 years). We detected basal septal and basal lateral contraction time (CT), isovolumetric CT and relaxation time (IVRT) and MPI. EF was 68 ± 5 % in gr. I, 69 ± 5 % in gr. II, 69 ± 4 % in gr. III. LV mass index was 122 ± 11 g/m2 in gr. I, 148 ± 13 g/m2 in gr. II and 118 ± 13 g/m2 in gr. III. Concentric LVH was detected in gr. II (relative wall thickness = 0.49 ± 0.8). LV septal and lateral MPI were abnormal in both hypertensive groups (p < 0.0001). Septal MPI was correlated moderately with septal wall thickness (r = 0.447, p < 0.001). LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness.
Abstract
Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regional myocardial performance [...]
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Letter to Editor
A. J. Weingarten, J. E. Loyd, T. P. Doyle

IJC Heart & Vasculature (2016).
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Long-term dual antiplatelet treatment and bleeding complications in diabetic patients treated with drug eluting stent implantation
. Vassilis Voudris, P. Karyofyllis, C. Doulaptsis, . Ioannis Moukas, . Sofia Thomopoulou, D. V. Cokkinos

IJC Heart & Vasculature (2014). Vol. 5 pp. 57-62

Abstract
Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment persist due to increased risk of bleeding. In this study are assessed the incidence, correlates, and clinical significance of bleeding complications in diabetic patients after long-term DAPLT post DES implantation. We studied 610 consecutive diabetic patients after DES implantation. The primary end point was the occurrence of any bleeding according to the BARC and TIMI definitions. The incidence of overall bleeding was higher in patients on DAPLT (21.1% vs. 4.4%, p < 0.001), minor/minimal according to the TIMI definition, and type 1 or 2 according to the BARC definition, were more frequently observed in patients on DAPLT (20.3% vs. 3.0%, p < 0.001, 15.6% vs. 2.0%, p < 0.001 and 4.4% vs. 0.5%, p = 0.034, respectively), whereas there was no effect on type 3 (3.5% vs. 2.0%, p = ns). DAPLT was an independent predictor for overall (HR 5.35, 95% CI: 2.69–10.67, p < 0.001), minor (HR 7.45, 95% CI: 3.25–17.12, p < 0.001, for TIMI classification) and type 1 or 2 bleeding (HR 8.17, 95% CI 3.29–20.25, p < 0.001), furthermore smoking was also predictor for overall bleeding (HR 1.65, 95% CI: 1.05–2.61, p = 0.030). Cardiovascular adverse events were not more frequent in patients with bleeding as compared with those without bleeding. Long-term DAPLT in diabetic patients after DES implantation is associated with higher risk of overall and minor but not major bleeding, smoking may have a significant role in the occurrence of bleeding complications.
Abstract
Dual antiplatelet treatment (DAPLT) for at least 12 months is recommended after drug eluting stent (DES) implantation, but concerns regarding the extended use of this treatment [...]
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Carotid intima-media thickness and carotid plaque represent different adaptive responses to traditional cardiovascular risk factors
L. Baroncini, L. Sylvestre, R. Filho

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 48-51

Abstract
To assess the effects of each traditional cardiovascular risk factor (hypertension, diabetes mellitus, dyslipidemia, and smoking), including the presence of coronary artery disease (CAD), on carotid intima-media thickness (CIMT) and to assess the degree of carotid plaque occurrence. A total of 553 outpatients (216 men and 337 women, mean age 67.06 ± 12.44 years) who underwent a carotid artery ultrasound were screened for carotid plaque and CIMT measurements. The CIMT medians were higher in males (P < .001) and in patients with hypertension (P < .001). A linear increase occurred in mean CIMT of 0.0059 mm for each year of increase in age. The presence of plaque indicated a tendency to correlate with CIMT (P = .067). The presence of hypertension associated with diabetes (P = .0061, estimated difference 0.0494 mm) or dyslipidemia (P = .0016, estimated difference 0.0472 mm) or CAD (P = .0043, estimated difference 0.0527 mm) increased the mean CIMT measurements. The probability of plaque occurrence in carotid arteries is influenced by the age (P < .001) and is higher in patients with dyslipidemia (P = .008) and CAD (P < .001). Hypertension is the strongest cardiovascular risk factor that increases CIMT, followed by age and male sex. Age and dyslipidemia increase the probability of carotid plaque. Increased CIMT and plaque could be present in the same patient caused by different risk factors and with independent effects on the artery wall and different clinical prognoses.
Abstract
To assess the effects of each traditional cardiovascular risk factor (hypertension, diabetes mellitus, dyslipidemia, and smoking), including the presence of coronary artery [...]
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Controlled heart rate and blood pressure reduce the life threatening aortic events and increase survival in patients with type B aortic dissection: A single center experience
K. Kumar, Q. Zhao, X. Bai, A. Li, . Pandit Anjali, H. Yu, W. Zhu, T. Zou, . Yingtong Ma, X. Ma

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 73-74
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Assessment of various parameters using simple non-invasive tests in patients with cardiovascular diseases with or without cardiac rehabilitation
. Takashi Ueda, . Shin-ichiro Miura, . Kanta Fujimi, . Toshihisa Ishida, . Takuro Matsuda, . Masaomi Fujita, . Yoshiyuki Ura, . Kouji Kaino, . Maya Sakamoto, . Tomoe Horita, . Tadaaki Arimura, . Yuhei Shiga, . Takashi Kuwano, . Ken Kitajima, . Keijiro Saku

IJC Heart & Vasculature (2016). Vol. 12 pp. 63-67

Abstract
Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians in the examination room to assess the usefulness of CR. We enrolled 46 consecutive CVD patients in a CR program (CR group) and prospectively followed them for 3 months. We compared them to 18 age-, gender- and body mass index-matched CVD patients without CR (non-CR group). Various parameters were measured at baseline and after 3 months using 3 simple non-invasive tests: severity of atherosclerosis [arterial velocity pulse index and arterial pressure volume index (API)] were determined using PASESA®, an autonomic nerve total activity amount index and a coefficient of variation of the R–R interval (CVRR) were determined using eHEART®, and peripheral resistance index, pressure rate product, stroke volume and cardiac index were determined using nico®]. There were no significant differences in patient characteristics including percentages (%) of ischemic heart disease and heart failure between the non-CR and CR groups. Systolic blood pressure (SBP), diastolic BP, heart rate and API at baseline significantly decreased and CVRR at baseline significantly increased after 3 months in the CR group, but not in the non-CR group. In addition, ΔAPI (Δ = the value after 3 months minus the value at baseline) was positively associated with ΔSBP in the CR group. In conclusion, CR significantly decreased BP and improved atherosclerosis and sympathetic nerve activity. These findings suggest that simple non-invasive tests may be useful for assessing the effects of CR.
Abstract
Cardiac rehabilitation (CR) improves cardiac function and exercise capacity in patients with cardiovascular disease (CVD). Simpler techniques are needed for use by physicians [...]
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Conduction abnormalities and ventricular arrhythmogenesis: The roles of sodium channels and gap junctions
G. Tse, J. Ming Yeo

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 75-82

Abstract
Ventricular arrhythmias arise from disruptions in the normal orderly sequence of electrical activation and recovery of the heart. They can be categorized into disorders affecting predominantly cellular depolarization or repolarization, or those involving action potential (AP) conduction. This article briefly discusses the factors causing conduction abnormalities in the form of unidirectional conduction block and reduced conduction velocity (CV). It then examines the roles that sodium channels and gap junctions play in AP conduction. Finally, it synthesizes experimental results to illustrate molecular mechanisms of how abnormalities in these proteins contribute to such conduction abnormalities and hence ventricular arrhythmogenesis, in acquired pathologies such as acute ischaemia and heart failure, as well as inherited arrhythmic syndromes.
Abstract
Ventricular arrhythmias arise from disruptions in the normal orderly sequence of electrical activation and recovery of the heart. They can be categorized into disorders affecting [...]
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Electrophysiological mechanisms of long and short QT syndromes
G. Tse, Y. Chan, . Wendy Keung, B. P Yan

IJC Heart & Vasculature (2017). Vol. 14 pp. 8-13

Abstract
The QT interval on the human electrocardiogram is normally in the order of 450 ms, and reflects the summated durations of action potential (AP) depolarization and repolarization of ventricular myocytes. Both prolongation and shortening in the QT interval have been associated with ventricular tachy-arrhythmias, which predispose affected individuals to sudden cardiac death. In this article, the molecular determinants of the AP duration and the causes of long and short QT syndromes (LQTS and SQTS) are explored. This is followed by a review of the recent advances on their arrhythmogenic mechanisms involving reentry and/or triggered activity based on experiments conducted in mouse models. Established and novel clinical risk markers based on the QT interval for the prediction of arrhythmic risk and cardiovascular mortality are presented here. It is concluded by a discussion on strategies for the future rational design of anti-arrhythmic agents.
Abstract
The QT interval on the human electrocardiogram is normally in the order of 450 ms, and reflects the summated durations of action potential (AP) depolarization and repolarization [...]
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Mitral regurgitation — Unmet need for improved management strategies
. Jean-Noel Trochu, . Ryan Dillon, . Finn Gustafsson, S. A. Mitchell, . Veselin Mitrovic, . Ottavio Alfieri

IJC Heart & Vasculature (2014). Vol. 5 pp. 26-41

Abstract
The management of mitral regurgitation (MR) is challenging — patients may be asymptomatic, oligosymptomatic, older with comorbidities, or clinically symptomatic and not appropriate for surgery. The current review assesses morbidity, mortality, and risk factors associated with functional and organic MR, with a focus on severe MR. A structured literature review was conducted in MEDLINE, Embase, the Cochrane Library, and via hand-searching of conference proceedings. Prospective randomised controlled trials and observational studies including adult patients with MR reporting on treatment response rates, survival, time-to-treatment failure, quality of life, and adverse events were eligible for inclusion. In total, 32 publications met the inclusion criteria (9 in functional, 18 in organic, and 5 in functional/organic). Despite study heterogeneity, an increased risk of mortality and morbidity was observed which increased with MR severity. Risk factors associated with mortality and morbidity included advancing age, presence of atrial fibrillation, increasing effective regurgitant orifice, ejection fraction, left ventricle end systolic diameter, diabetes, and increasing New York Heart Association class. The current review represents one of the most comprehensive conducted in the medical/conservative management of MR. An increased risk of mortality and morbidity, which appeared to rise with greater severity, was associated with MR (versus no MR). An unmet need exists in the management of patients with severe symptomatic MR and a high surgical risk as they have a poor prognosis and limited treatment options. Further research into alternative medical strategies and patient management is needed to improve prognoses and reduce mortality and morbidity.
Abstract
The management of mitral regurgitation (MR) is challenging — patients may be asymptomatic, oligosymptomatic, older with comorbidities, or clinically symptomatic and not [...]
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Chronic total occlusions — Current techniques and future directions
. George Touma, . David Ramsay, . James Weaver

IJC Heart & Vasculature (2015).

Abstract
Chronic total occlusions (CTOs) of coronary arteries represent a common and significant challenge to interventional cardiology. Medical therapy is often regarded as an adequate long term strategy in the management of these lesions with surgical intervention for refractory symptoms. Extensive collateralisation is used as a marker of distal coronary perfusion, further reinforcing non-invasive strategies. This together with relatively low percutaneous success rates outside of specialised centres has meant that rates of percutaneous intervention have remained low. Increasing evidence suggests that CTOs are not a benign entity. Further, symptom control and quality of life improve significantly with successful percutaneous revascularisation. Both factors have reignited interest in percutaneous modalities. The Japanese have been pioneers in the field of CTO intervention although their success rates have been difficult to replicate. New techniques and equipment developed in North America offer an alternative to the Japanese approach. These techniques focus on time, radiation and contrast minimisation. This review will assess the histopathology of CTO and shifting paradigms in CTO treatment strategies.
Abstract
Chronic total occlusions (CTOs) of coronary arteries represent a common and significant challenge to interventional cardiology. Medical therapy is often regarded as an adequate [...]
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QRS complex fragmentation and survival following left ventricular assist device implantation
I. Thomas, D. P. Cork, A. K. Bhatia, H. M. Nayak, M. C. Burke, J. D. Moss

IJC Heart & Vasculature (2015).

Abstract
In patients with heart disease, the presence of a fragmented QRS complex (fQRS) on the surface electrocardiogram (ECG) is associated with an increased risk of mortality. We sought to evaluate the prevalence and location of fQRS before and after left ventricular assist device (LVAD) implantation and any associated risk of mortality. Twelve-lead surface ECGs before (pre-LVAD, n = 98) and after (early [< 7 days], n = 96, and late [≥ 30 days], n = 85, post-LVAD) LVAD implantation were evaluated for fQRS. Mortality data were gathered via review of medical records. The prevalence of fQRS increased significantly following LVAD implantation on early post-LVAD ECGs (31% to 47%, p < 0.01). Patients with fQRS in the anterior territory (precordial leads V1 to V5) on late post-LVAD ECGs had decreased survival or survival to cardiac transplantation over a 30 month follow-up period compared with patients who did not exhibit anterior fQRS (30% and 59%, respectively, p < 0.01). The prevalence of fragmented QRS on 12-lead ECG increases significantly in the anterior territory following LVAD implantation and is associated with decreased survival.
Abstract
In patients with heart disease, the presence of a fragmented QRS complex (fQRS) on the surface electrocardiogram (ECG) is associated with an increased risk of mortality. We [...]
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Regression of cardiac amyloidosis following stem cell transplantation: a comparison between echocardiography and cardiac magnetic resonance imaging in long-term survivors
B. Fitzgerald, . John Bashford, . Katrina Newbigin, G. Scalia

IJC Heart & Vasculature (2017). Vol. 14 pp. 53-57

Abstract
AL amyloidosis and multiple myeloma result in extracellular deposition of insoluble fibrillary protein in tissue and organs. Untreated median survival is very poor, and even worse with cardiac involvement. Chemotherapy and peripheral blood stem cell transplantation (PBSCT) have been shown to dramatically improve survival, with hematologic remission documented. Regression of cardiac changes has previously been shown, as assessed by echocardiography (TTE) and cardiac magnetic resonance imaging (CMR). This study is a comparison of TTE and CMR in long-term survivors of cardiac amyloidosis with regression. Four long-term survivors with cardiac amyloidosis and regression of cardiac features on TTE were identified. Mean age was 60 years and average survival was 139 months from the time of diagnosis of cardiac involvement. Statistically significant regression of the cardiac features of cardiac amyloidosis were demonstrated on TTE. In these survivors, post-PBSCT structural assessments were similar between TTE and CMR. Classical strain imaging features of cardiac amyloidosis were only present in 50%. All patients had diffuse, patchy gadolinium enhancement on CMR after PBSCT. Treatment of cardiac amyloidosis with chemotherapy and PBSCT may result in regression of abnormalities on TTE with marked improvement in survival. Post treatment, TTE and CMR structural assessments appear similar. Gadolinium imaging suggests that microscopic residual infiltration persists despite macroscopic regression. Significant cardiac improvements with prolonged survival are seen nonetheless. Multimodality imaging has a vital role in the management of cardiac amyloidosis.
Abstract
AL amyloidosis and multiple myeloma result in extracellular deposition of insoluble fibrillary protein in tissue and organs. Untreated median survival is very poor, and even [...]
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Assessment of speckle tracking strain predictive value for myocardial fibrosis in subjects with Chagas disease
C. Macedo, T. Larocca, M. Noya-Rabelo, L. Correia, M. Moreira, A. Caldas, J. Torreão, B. Souza, R. Santos, M. Soares

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 75-80

Abstract
One of the most challenging issues of chronic Chagas disease is to provide earlier detection of heart involvement. Two-dimensional speckle tracking (2-D ST) echocardiography, a new imaging modality with useful applications in several cardiac diseases, has been validated for subjects with myocardial infarction against cardiac magnetic resonance (CMR). Here we hypothesize that the longitudinal global strain (LGS) has an incremental value to ejection fraction for predicting myocardial fibrosis in subjects with Chagas disease. This observational study comprised 58 subjects with Chagas disease, confirmed by two positive serologic tests. All subjects underwent conventional Doppler echocardiogram plus speckle tracking strain, and cardiac magnetic resonance. The ROC curve analysis revealed that both LGS (area under the curve: 0.78, p = 0.001) and ejection fraction (area under the curve: 0.82, p < 0.001) were significant predictors of myocardial fibrosis. Regarding the percentage of fibrosis, a high correlation was observed with both ejection fraction assessed by echocardiography (r = 0.70, p < 0.001) and LGS (r = 0.64, p < 0.001). However, when adjusted through multiple linear regression, the LGS lost statistical significance as a predictor of myocardial fibrosis (p = 0.111). LGS has no incremental value to conventional ejection fraction measurement in the prediction of myocardial fibrosis in subjects with Chagas disease.
Abstract
One of the most challenging issues of chronic Chagas disease is to provide earlier detection of heart involvement. Two-dimensional speckle tracking (2-D ST) echocardiography, [...]
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Successful revascularization improves long-term clinical outcome in patients with chronic coronary total occlusion
. Tomohiko Teramoto, . Etsuo Tsuchikane, . Masanori Yamamoto, . Hitoshi Matsuo, . Yoshiaki Kawase, . Yoriyasu Suzuki, . Seiji Kanou, . Tetsurou Shimura, . Hirotomo Sato, . Maoto Habara, . Kenya Nasu, . Masashi Kimura, . Yoshihisa Kinoshita, . Mitsuyasu Terashima, . Tetsuo Matsubara, . Takahiko Suzuki

IJC Heart & Vasculature (2017). Vol. 14 pp. 28-32

Abstract
Following the development of breakthrough techniques for percutaneous coronary intervention (PCI) in the treatment of chronic total occlusions (CTO), the initial success rate of PCI in CTO lesions (CTO-PCI) has improved, however, there are few reports regarding the effects of successful CTO revascularization on long-term mortality in Japan. The aim of this study was to compare the long-term clinical outcomes of patients with successful versus failed CTO recanalization and to identify related factors. From all PCI procedures performed in our hospital between 2006 and 2013, CTO-PCIs were extracted and classified into two groups: PCI success (n = 656 patients) and PCI failure (n = 82 patients). Patients with successful procedures only on a second attempt, CTO-PCI in small branches, or CTOs in more than one vessel were excluded. Survival was determined from a telephone interview or the consultation history in the outpatient clinic. Initial angiographic success was achieved in 88.9% of the patients. A Kaplan–Meier plot with log-rank analysis showed that cumulative all-cause death was significantly lower in the success group than in the failure group (p = 0.0003, average follow-up duration in success group vs. failure group was 1531.3 ± 33.5 vs. 1565.3 ± 97.5 days, p = 0.7). Moreover, the rate of evident cardiac death was significantly lower in the success group than in the failure group (3.5% [23/656] vs. 15.9% [13/82], p < 0.0001). This study suggests that successful revascularization in patients with CTO improves their long-term clinical outcomes.
Abstract
Following the development of breakthrough techniques for percutaneous coronary intervention (PCI) in the treatment of chronic total occlusions (CTO), the initial success rate [...]
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Pulmonary vein thromboses might cause and promote cardiovascular disease via genetic modulation by occluding microvessels in elderly patients
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 151-152
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Implementation of 64-MDCT assesses that short-term warfarin therapy can dissolve a completely occluding small thrombus: A new clue to treat atrial fibrillation
. Hidekazu Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 146-148
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Lower pulmonary veins are likely to have a pulmonary vein thrombus
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1)
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Pulmonary vein thrombosis is associated with chest pain in patients without coronary artery stenosis
. Hidekazu Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1)
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A long and narrow pulmonary vein thrombus attached to the wall of a pulmonary vein
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 49-50

Abstract
Pulmonary vein thrombosis (PVT) is often not diagnosed because PVT has subtle symptoms and PVT is believed to be rare. The mechanism for the formation of PVT is unclear. In this case, I describe a small thrombus in a small branch of a pulmonary vein draining into a larger vein, the right lower pulmonary vein (RLPV). The patient was a 70-year-old male with angina pectoris, and he presented with chest pain. He had no symptoms of cerebral infarction. He previously had been treated with percutaneous coronary intervention and had four stents in the coronary arteries. A 64-slice multidetector computed tomography (64-MDCT) scan was performed to evaluation for in-stent restenosis. A thrombus in the RLPV was shown in axial and sagittal images as a defect in contrast enhancement, representing a small thrombus in a small branch of a pulmonary vein draining into the RLPV. The 64-MDCT scan depicted them well. The effects of PVT are unknown, and more studies are needed.
Abstract
Pulmonary vein thrombosis (PVT) is often not diagnosed because PVT has subtle symptoms and PVT is believed to be rare. The mechanism for the formation of PVT is unclear. In [...]
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Nearly all left atrial thrombi may be extended from pulmonary vein thrombi
. Hidekazu Takeuchi

IJC Heart & Vasculature (2015). Vol. 7(1)
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A pulmonary vein thrombus in a patient with autonomic nervous dysfunction
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 37-40
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Optimum duration of dual antiplatelet treatment could be decided using 64-MDCT: A new hint to treating patients with stents
. Hidekazu Takeuchi

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 35-36
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The appearance of a small thrombus in the pulmonary vein indicates the existence of a smaller pulmonary vein
. Hidekazu Takeuchi

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 6-8
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Pulmonary vein thrombi in a patient with paroxysmal atrial fibrillation
H. Takeuchi

IJC Heart & Vasculature (2014). Vol. 5 pp. 63-64
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A jumping left atrial thrombus connected to a pulmonary vein thrombus using transthoracic echocardiography and 64-slice multi-detector computed tomography
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 32-34

Abstract
Few studies have reported the differences between transthoracic echocardiography (TTE) and 64-slice multidetector CT (64-MDCT) in identifying left atrium (LA) thrombi. I report the case of a 70 year old man with coronary artery disease and angina who was diagnosed with a thrombus in the left lower pulmonary vein extending to the LA using a non-invasive 64-MDCT scan and TTE. TTE was unable to clearly identify a thrombus in the pulmonary veins, whereas a 64-MDCT scan identified a thrombus in the pulmonary vein but was unable to detect a moving thrombus attached to the mitral valves. The 64-MDCT images of LA thrombi are smaller than those of TTE and the video created using TTE demonstrated a moving thrombus connected to the mitral valve, which was underdiagnosed by a 64-MDCT scan. This case illustrates the complementary role for both TTE and 64-MDCT in the noninvasive diagnosis of left atrial-pulmonary vein thrombi.
Abstract
Few studies have reported the differences between transthoracic echocardiography (TTE) and 64-slice multidetector CT (64-MDCT) in identifying left atrium (LA) thrombi. I report [...]
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A network of pulmonary vein thrombi is a risk factor for ischemic stroke, especially after cardiac surgery: A case report and mini review
H. Takeuchi

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 1-3

Abstract
Stroke remains a devastating complication following cardiac surgery. Pulmonary vein thrombi (PVT) are believed to be rare, but I have reported 37 cases of PVT in elderly patients with chest pain since 2012, indicating that PVT are not unusual. The present case showed that PVT can make a network among four pulmonary veins and left atrium. Currently, PVT are not recognized as a risk factor for ischemic stroke, especially following cardiac surgery. A 76-year-old male was examined by 64-slice multidetector CT (64-MDCT) to assess chest pain. The 64-MDCT scan revealed thrombi in the left upper and lower pulmonary veins, the right upper and lower pulmonary veins and the left atrium (LA) as the defects of contrast enhancements. The LA thrombi seemed to be connected to PVT forming a network of thrombi. To avoid stroke following cardiac surgery, it is important to cope with PVT. How to treat PVT during cardiac surgery should be developed.
Abstract
Stroke remains a devastating complication following cardiac surgery. Pulmonary vein thrombi (PVT) are believed to be rare, but I have reported 37 cases of PVT in elderly patients [...]
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Relationship between chronotropic incompetence and β-blockers based on changes in chronotropic response during cardiopulmonary exercise testing
. Nami Takano, . Haruhito Takano, . Taira Fukuda, . Hironobu Kikuchi, . Gaku Oguri, . Kazuya Fukumura, . Kuniaki Iwasawa, . Toshiaki Nakajima

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 12-18

Abstract
Chronotropic incompetence (CI), an attenuated heart rate (HR) response to exercise, is common in patients with cardiovascular disease. The aim of this study was to assess changes in the chronotropic response (CR) during cardiopulmonary exercise testing (CPET) in patients undergoing cardiac rehabilitation and investigate the effects of β-blockers. Patients undergoing cardiac rehabilitation performed CPET. Failure to achieve 80% of the age-predicted maximal HR (APMHR) defined CI. Values of the metabolic chronotropic relationship (MCR) were calculated from the ratio of the HR reserve to metabolic reserve at 4 stages, warm-up (MCR-Wu), anaerobic threshold (MCR-AT), respiratory compensation (MCR-Rc), and peak point (MCR-Pk), using the Wilkoff model. In patients who showed an increase in MCR at ≥ 3 of the 4 exercise stages, CR was considered to have improved. Patients with high BNP levels (≥ 80 pg/ml) had a lower MCR at all stages compared with those with low BNP levels (< 80 pg/ml). Of the 80 patients, 47 showed an increase in both peak VO2 and AT, and of these 31 (66.0%) were taking β-blockers. Improvement in CR was observed in 30 of 47 patients with CI, and 70% of these were taking β-blockers. In patients not taking β-blockers, MCR-AT was lower than MCR-Rc, whereas in those taking β-blockers MCR-AT was higher than MCR-Rc. An attenuated HR response may occur during the early stages of exercise. The HR response according to the presence or absence of β-blockers is clearly identifiable by comparing MCR-AT and MCR-Rc using the Wilkoff model.
Abstract
Chronotropic incompetence (CI), an attenuated heart rate (HR) response to exercise, is common in patients with cardiovascular disease. The aim of this study was to assess [...]
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Intracoronary administration of nicorandil during primary percutaneous coronary intervention: Impact on restoration of regional myocardial perfusion in reperfused myocardium during the subacute phase of myocardial infarction
. Wataru Takabatake, . Takahisa Noma, . Yasuyoshi Iwado, . Shohei Ishikawa, . Atsushi Tobiume, . Yusuke Hasui, . Keiji Matsunaga, . Kaoru Mantani, . Kumi Konishi, . Ryo Kawakami, . Naoko Ishihara, . Yasuhiro Ishihara, . Makoto Ishizawa, . Kaori Ishikawa, . Kazushi Murakami, . Koji Ohmori, . Yoshihiro Nishiyama, . Masakazu Kohno

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 81-86

Abstract
The impact of nicorandil as adjunctive therapy for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) is controversial. We performed 15O-labeled water positron emission tomography (PET) to quantify regional myocardial perfusion in patients with STEMI who received nicorandil or no adjunctive therapy during PCI. PCI was performed within 8 h after STEMI onset in 33 patients. 14 patients received intracoronary nicorandil 2 mg immediately after recanalization of the culprit lesion (Nico group). After 3–4 weeks, PET was performed in which myocardial blood flow (MBF) was measured at baseline and during adenosine triphosphate (ATP)-induced hyperemia. Myocardial vascular resistance (MVR) was calculated for all segments. Data were obtained from the reperfused (Rep) and normal segments (Cont) in each patient. In patients not given nicorandil (No-Nico group), the MBF was significantly lower in Rep than that in Cont at baseline and during hyperemia (Cont vs. Rep: 0.82 ± 0.14 vs. 0.68 ± 0.11, P = 0.001, ATP-Cont vs. ATP-Rep: 2.00 ± 0.72 vs. 1.52 ± 0.61, P = 0.017), which was restored in the Nico group (Cont vs. Rep: 0.79 ± 0.17 vs. 0.78 ± 0.20, ATP-Cont vs. ATP-Rep: 2.02 ± 0.84 vs. 1.84 ± 0.62). MVR was elevated in Rep at baseline and during hyperemia in the No-Nico group. MVR elevation in Rep was prevented in the Nico group. 15O-labeled water PET was feasible for segmental analysis of MBF during the subacute phase of STEMI. It revealed that intracoronary administration of nicorandil to STEMI patients who underwent PCI prevented MVR elevation and thus restored MBF in the reperfused segments to a level similar to that in the normal segments.
Abstract
The impact of nicorandil as adjunctive therapy for percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) is controversial. We [...]
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Sub-aortic obstruction of left ventricular outflow tract secondary to benfluorex-induced endocardial fibrosis
. Catherine Szymanski, . Sylvestre Maréchaux, . Patrick Bruneval, . Michel Andréjak, V. Montpréville, . Emre Belli, C. Tribouilloy

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 67-69

Abstract
Patients exposed to benfluorex have an increased risk of restrictive organic valvular heart disease. Aortic and mitral regurgitations caused by fibrotic valve disease are the most common features observed in exposure to fenfluramine derivatives in general and benfluorex in particular. We report here, for the first time to our knowledge, a well-documented case in which obstructive sub-aortic endocardium fibrosis within the left ventricular outflow tract is related with exposure to a drug that modifies the metabolism of serotonin. It now remains to be established whether extensive fibrosis of the myocardium in addition to well-documented valvular fibrosis may develop in patients exposed to amphetamine-derived drugs affecting the serotonin system.
Abstract
Patients exposed to benfluorex have an increased risk of restrictive organic valvular heart disease. Aortic and mitral regurgitations caused by fibrotic valve disease are [...]
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Myocardial ischemic preconditioning in a porcine model leads to rapid changes in cardiac extracellular vesicle messenger RNA content
. Kristina Svennerholm, . Pouria Rodsand, . Urban Hellman, . Marie Lundholm, . Anders Waldenström, . Björn Biber, . Gunnar Ronquist, . Michael Haney

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 62-67

Abstract
Extracellular vesicles (EVs) are thought to exert protective effects after ischemic and remote ischemic preconditioning. It is not well understood which EV content factors are most relevant for protective effects. We hypothesize that ischemic preconditioning leads to qualitative changes in EV mRNA content and quantitative changes in EV size and number. Using an in vivo porcine ischemic preconditioning model, EVs were collected from coronary venous blood, and isolated by differential ultracentrifugations. The presence and purity of EV were verified by electron microscopy and Western blot, and EV number was assessed by nanoparticle tracking analysis. The mRNA EV was identified by microarray. Gene ontology analysis showed enrichment of EV mRNA coding for proteins associated with regulation of transcription, translation, extracellular matrix, morphogenic development and feeding behavior. There were 11, 678 different mRNA transcripts detected in EV, where a total of 1103 was significantly increased or decreased after preconditioning, of which 638 mRNA sequences were up-regulated and/or emerged due to preconditioning. Several of them have known association with ischemic preconditioning. There was no significant difference in EV quantity or size before and after preconditioning. These findings demonstrate in an in vivo model that myocardial ischemic preconditioning influences the composition of mRNA in EV, including gene transcripts for proteins associated with the protective effect of ischemic preconditioning. The finding that preconditioned parental cells release EV containing mRNA that is qualitatively different from those released by non-preconditioned cells shows the importance of the external milieu on parental cell EV production.
Abstract
Extracellular vesicles (EVs) are thought to exert protective effects after ischemic and remote ischemic preconditioning. It is not well understood which EV content factors [...]
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An inspection of therapeutic hypothermia preceding coronary reperfusion in patients with a cardiogenic shock complicating anterior ST-segment elevation myocardial infarction
. Makoto Suzuki, . Atsushi Seki, . Itaru Takamisawa, . Tetsuya Tobaru, . Morimasa Takayama, . Tetsuya Sumiyoshi, . Hitonobu Tomoike

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 108-113

Abstract
We retrospectively investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural therapeutic hypothermia may have clinical advantages in patients with a profound cardiogenic shock complicating anterior ST-segment elevation myocardial infarction (STEMI). Of 483 consecutive patients treated with PCI for a first anterior STEMI including 31 patients with aborted sudden cardiac arrest between 2009 and 2013, a total of 37 consecutive patients with an anterior STEMI complicated with profound cardiogenic shock defined as the presence of hyperlactic acidemia (serum levels of lactate > 4 mmol/L) with mechanical circulatory support were identified. An impaired myocardial tissue-level reperfusion (angiographic myocardial blush grade 0 or 1) and in-hospital mortality were evaluated in accordance with the presence or absence of pre-PCI procedural therapeutic hypothermia. Thirteen patients were treated with pre-PCI procedural therapeutic hypothermia and 24 were not inducted with therapeutic hypothermia. Five patients with and 18 without pre-PCI procedural therapeutic hypothermia impaired myocardial tissue-level reperfusion (38% vs. 75%, p = 0.037). A total of 26 patients with in-hospital death (overall in-hospital mortality 70%) were composed of 6 with and 20 without therapeutic hypothermia (in-hospital mortality 46% vs. 83%, p = 0.028). A multivariate analysis demonstrated a significant association of pre-PCI procedural therapeutic hypothermia (p = 0.021) with in-hospital survival benefit. Adverse events associated with therapeutic hypothermia were not found in 12 patients who completed this treatment. The present study may imply a crucial possibility of clinical benefits of pre-PCI procedural therapeutic hypothermia in patients with a cardiogenic shock complicating anterior STEMI.
Abstract
We retrospectively investigated our hypothesis that pre-percutaneous coronary intervention (PCI) procedural therapeutic hypothermia may have clinical advantages in patients [...]
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Circulating level of microRNA-126 may be a potential biomarker for recovery from smoking-related vascular damage in middle-aged habitual smokers
. Tomonori Sugiura, . Yasuaki Dohi, . Sumiyo Yamashita, . Soichiro Iwaki, . Shiori Ito, . Akimasa Sanagawa, . Nobuyuki Ohte, . Satoshi Fujii

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 83-87

Abstract
Cigarette smoking promotes vascular endothelial damage and accelerates progression of atherosclerosis. The purpose of this study was to examine whether the circulating level of vascular endothelium-enriched microRNA-126 (miR-126), which is highlighted as a regulator of gene expression, would serve as a novel biomarker for recovery from smoking-related vascular damage. Middle-aged male smokers (n = 30) were enrolled and instructed to stop smoking. Their clinical profiles and laboratory findings including expression of miR-126 were investigated before and after 8 weeks of smoking cessation. Serum levels of cotinine, metabolites of nicotine, were measured to confirm smoking cessation. Endothelial function for peripheral small vessels was assessed and expressed as reactive hyperemia peripheral arterial tonometry (RH-PAT) index. The expression of miR-126 in plasma was analyzed by quantitative real-time PCR. At baseline, serum cotinine levels were inversely correlated with RH-PAT index (r = − 0.48, P < 0.01) and positively correlated with levels of metabolic parameters such as non-HDL cholesterol (r = 0.53, P < 0.01) and HOMA-IR (r = 0.52, P < 0.01). The RH-PAT index was not significantly changed after 8 weeks in all subjects, because only 13 subjects could attain smoking cessation. However, changes in the RH-PAT index showed a significant correlation with those in systolic blood pressure (r = − 0.54, P < 0.01). In smokers who completely attained smoking cessation (n = 13), RH-PAT index and plasma levels of miR-126 were significantly increased (P < 0.05, respectively). Endothelial damage was improved and plasma levels of circulating miR-126 were increased after 8 weeks of smoking cessation. These findings suggested a potential use of miR-126 as a biomarker for recovery from smoking-induced vascular damage.
Abstract
Cigarette smoking promotes vascular endothelial damage and accelerates progression of atherosclerosis. The purpose of this study was to examine whether the circulating level [...]
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More haste, less speed: Cardiac perforation by a thoracentesis catheter
. Daisuke Sueta, . Seiji Hokimoto, . Ken Okamoto, . Hisayo Yasuda, . Hiroki Usuku, . Hirokazu Tazume, . Eiichiro Yamamoto, . Kenji Sakamoto, . Yasuhiro Izumiya, . Kenichi Tsujita, . Koichi Kaikita, . Hisashi Sakaguchi, . Toshihiro Fukui, . Hisao Ogawa

IJC Heart & Vasculature (2016). Vol. 11 pp. 17-18
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Association of estimated central blood pressure measured non-invasively with pulse wave velocity in patients with coronary artery disease
. Daisuke Sueta, . Eiichiro Yamamoto, . Tomoko Tanaka, . Yoshihiro Hirata, . Kenji Sakamoto, . Kenichi Tsujita, . Sunao Kojima, . Koichi Nishiyama, . Koichi Kaikita, . Seiji Hokimoto, . Hideaki Jinnouchi, . Hisao Ogawa

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 52-54
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Usefulness of excimer laser atherectomy for balloon uncrossable lesion in chronic total occlusion
. Daisuke Sueta, . Seiji Hokimoto, . Takashi Miyazaki, . Kenji Sakamoto, . Kenichi Tsujita, . Eiichiro Yamamoto, . Noriaki Tabata, . Sunao Kojima, . Koichi Kaikita, . Hisao Ogawa

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 70-72
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QRS complex maximum deflection index in aortic cusp premature ventricular complexes
K. Siontis, . Malini Madhavan, . Suraj Kapa, S. J. Asirvatham, P. A. Noseworthy

IJC Heart & Vasculature (2015).
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Prognostic value of positron emission tomography myocardial perfusion imaging beyond traditional cardiovascular risk factors: Systematic review and meta-analysis
K. Siontis, P. Chareonthaitawee

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 54-59

Abstract
Despite substantive growth in utilization of positron emission tomography (PET) myocardial perfusion imaging (MPI), evidence on its prognostic value is limited. We aimed to comprehensively evaluate the prognostic literature of PET perfusion measures according to the most recent American Heart Association recommendations for assessment of novel cardiovascular biomarkers. We searched the literature for studies reporting associations of PET MPI measures and outcomes in patients with known or suspected coronary artery disease. We documented hazard ratios (HR) and 95% confidence intervals (CI) of association effects and quantitatively synthesized them with random-effects meta-analyses. Discrimination, calibration and risk reclassification after addition of PET MPI measures to standard prognostic models were documented. We identified 20 eligible studies with median n = 551 patients. In meta-analyses, the extents of ischemic and scarred myocardium were significantly associated with cardiac death. Meta-analyses of multivariate estimates for abnormal summed stress score ≥ 4 and myocardial perfusion reserve < 2 revealed significant associations with major adverse cardiovascular events [HR (95% CI) 2.30 (1.53–3.44) and 2.11 (1.33–3.36), respectively]. Changes in model discrimination, calibration or risk reclassification were reported in 5 studies (8 prognostic evaluations). There were marginal improvements in discrimination based on C index and no improvements in model calibration. Net reclassification index ranged from 9.8% to 14.2% and risk classification was significantly improved in 4/5 prognostic evaluations. PET MPI measures were strongly associated with adverse patient outcomes. Risk classification was more consistently improved than discrimination and calibration after addition of PET MPI measures, but reporting of such metrics was overall limited.
Abstract
Despite substantive growth in utilization of positron emission tomography (PET) myocardial perfusion imaging (MPI), evidence on its prognostic value is limited. We aimed to [...]
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Usefulness of routine aortic valve calcium score measurement for risk stratification of aortic stenosis and coronary artery disease in patients scheduled cardiac multislice computed tomography
. Kazuki Shimizu, . Masanori Yamamoto, . Yutaka Koyama, . Atsuko Kodama, . Hirotomo Sato, . Seiji Kano, . Tomohiko Teramoto, . Masashi Kimura, . Koshi Sawada, . Yoshihiro Goto, . Shinji Ogawa, . Hiroshi Baba, . Etsuo Tsuchikane, . Yasuhide Okawa, . Takahiko Suzuki

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 95-99

Abstract
This study sought to investigate the clinical utility of aortic valve calcium score (AVCS) determined by using cardiac multislice computed tomography (MSCT). Data of 1315 consecutive patients who underwent both conventional echocardiography and MSCT were reviewed. Degree of aortic stenosis (AS) was assessed according to mean pressure gradient (mPG) measured by echocardiography. Extent of coronary artery disease (CAD) derived by MSCT also was evaluated in 1173 patients who did not undergo prior coronary treatment. Both AVCS and coronary calcium score (CCS) were defined by Agatston units (AU) according to MSCT findings. A total of 613 of 1315 patients were defined as AVCS positive (mean, 100 AU [range, 31.0–380.0 AU]). AVCS showed significant correlations with mPG (Spearmans ρ = 0.81, p < 0.001), and CCS (ρ = 0.53, p < 0.001). Differential adequate cut-off values of AVCS were proved for predicting severe AS with mPG ≥ 40 mmHg (1596.5 AU, AUC, 0.88, sensitivity, 89.7%, specificity, 77.0%), and for predicting moderate AS with mPG ≥ 20 mmHg (886.5 AU, area under the curve [AUC], 0.91, sensitivity, 92.4%, specificity, 78.3%). Mean AVCS was higher with increased extent of CAD (none, 0 AU [range, 0–30 AU], single vessel, 8.5 AU [range, 0–104 AU], multivessel, 142 AU [range, 10–525 AU], p < 0.001). The optimal cut-off value of AVCS for predicting multivessel disease was 49 AU (AUC, 0.77, sensitivity, 68.8%, specificity, 78.0%). AVCS might be a surrogate marker not only for AS grading but also for CAD progression. Therefore, routine AVCS assessment could be useful for risk stratification.
Abstract
This study sought to investigate the clinical utility of aortic valve calcium score (AVCS) determined by using cardiac multislice computed tomography (MSCT). Data of 1315 [...]
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Transcatheter aortic valve implantation in patients with pre-existing chronic kidney disease
M. Rahman, . Rajan Sharma, S. Brecker

IJC Heart & Vasculature (2015). Vol. 8(1) pp. 9-18

Abstract
We investigated the effect of chronic kidney disease (CKD) on morbidity and mortality following transcatheter aortic valve implantation (TAVI) including patients on haemodialysis, often excluded from randomised trials. We performed a retrospective post hoc analysis of all patients undergoing TAVI at our centre between 2008 and 2012. 118 consecutive patients underwent TAVI, 63 were considered as having (CKD) and 55 not having (No-CKD) significant pre-existing CKD, (defined as estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2). Chronic haemodialysis patients (n = 4) were excluded from acute kidney injury (AKI) analysis. Following TAVI, in CKD and No-CKD patients respectively, AKI occurred in 23.7% and 14.5% (p = 0.455) and renal replacement therapy (RRT) was necessary in 8.5% and 3.6% (relative risk (RR) [95% CI] = 2.33 [0.47–11.5], p = 0.440), 30-day mortality rates were 6.3% and 1.8% (p = 0.370), and 1-year mortality rates were 17.5% and 18.2% (p = 0.919). Patients who developed AKI had a significantly increased risk of 30-day (12.5% vs. 1.1%, p = 0.029) mortality. We found the presence of diabetes (odds ratio (OR) [95% CI] = 4.58 [1.58–13.3], p = 0.005) and elevated baseline serum creatinine (OR [95% CI] = 1.02 [1.00–1.03], p = 0.026) to independently predict AKI to statistical significance by multivariate analysis. TAVI is a safe, acceptable treatment for patients with pre-existing CKD, however caution must be exercised, particularly in patients with pre-existing diabetes mellitus and elevated pre-operative serum creatinine levels as this confers a greater risk of AKI development, which is associated with increased short-term post-operative mortality.
Abstract
We investigated the effect of chronic kidney disease (CKD) on morbidity and mortality following transcatheter aortic valve implantation (TAVI) including patients on haemodialysis, [...]
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Fractional flow reserve in acute coronary syndromes: A review
N. R. Shah, R. Al-Lamee, . Justin Davies

IJC Heart & Vasculature (2014). Vol. 5 pp. 20-25

Abstract
Fractional flow reserve (FFR) assessment provides anatomical and physiological information that is often used to tailor treatment strategies in coronary artery disease. Whilst robust data validates FFR use in stable ischaemic heart disease, its use in acute coronary syndromes (ACS) is less well investigated. We critically review the current data surrounding FFR use across the spectrum of ACS including culprit and non-culprit artery analysis. With adenosine being conventionally used to induce maximal hyperaemia during FFR assessment, co-existent clinical conditions may preclude its use during acute myocardial infarction. Therefore, we include a current review of instantaneous wave free ratio as a novel vasodilator independent method of assessing lesion severity as an alternative strategy to guide revascularisation in ACS.
Abstract
Fractional flow reserve (FFR) assessment provides anatomical and physiological information that is often used to tailor treatment strategies in coronary artery disease. Whilst [...]
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Screening for asymptomatic coronary heart disease in the young ‘at risk’ population: Who and how?
. Nadim Shah, K. Soon, C. Wong, . Anne-Maree Kelly

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 60-65

Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented [...]
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Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization
. Aravind Sekhar, B. S. Sutton, . Prafull Raheja, A. Mohsen, . Emily Anggelis, C. N. Anggelis, M. C. Keith, . Buddhadeb Dawn, . Samantha Straton, M. P. Flaherty

IJC Heart & Vasculature (2016).

Abstract
This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. It is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). Inclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min, 95% confidence interval [CI] 25.2–30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD, the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively, P < 0.001) and incremental cost savings by strategy also favored closure over MC ($84, 807). ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization, translating into improved patient satisfaction and substantial cost savings.
Abstract
This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® [...]
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Coronary plaque morphology on multi-modality imagining and periprocedural myocardial infarction after percutaneous coronary intervention
. Akira Sato, . Kazutaka Aonuma

IJC Heart & Vasculature (2016). Vol. 11 pp. 43-48

Abstract
Percutaneous coronary intervention (PCI) may be complicated by periprocedural myocardial infarction (PMI) as manifested by elevated cardiac biomarkers such as creatine kinase (CK)-MB or troponin T. The occurrence of PMI has been shown to be associated with worse short- and long-term clinical outcome. However, recent studies suggest that PMI defined by biomarker levels alone is a marker of atherosclerosis burden and procedural complexity but in most cases does not have independent prognostic significance. Diagnostic multi-modality imaging such as intravascular ultrasound, optical coherence tomography, coronary angioscopy, near-infrared spectroscopy, multidetector computed tomography, and magnetic resonance imaging can be used to closely investigate the atherosclerotic lesion in order to detect morphological markers of unstable and vulnerable plaques in the patients undergoing PCI. With the improvement of technical aspects of multimodality coronary imaging, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes. There were numerous published data regarding the relationship between pre-PCI lesion subsets on multi-modality imaging and post-PCI biomarker levels. In this review, we discuss the relationship between coronary plaque morphology estimated by invasive or noninvasive coronary imaging and the occurrence of PMI. Furthermore, this review underlies that the value of the multimodality coronary imaging approach will become the gold standard for invasive or noninvasive prediction of PMI in clinical practice.
Abstract
Percutaneous coronary intervention (PCI) may be complicated by periprocedural myocardial infarction (PMI) as manifested by elevated cardiac biomarkers such as creatine kinase [...]
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The ascending aortic aneurysm: When to intervene?
E. Saliba, Y. Sia, A. Dore, I. El Hamamsy

IJC Heart & Vasculature (2015). Vol. 6(1) pp. 91-100

Abstract
Thoracic ascending aorta aneurysms (TAA) are an important cause of mortality in adults but are a relatively less studied subject compared to abdominal aortic aneurysms (AAA). The purpose of this review is to explain the main aspects (etiology, pathophysiology, diagnosis) of this disease and to summarize the most recent developments in its management. Literature was obtained through online health related search engines (PubMed, MEDLINE) by including the following keywords: ascending aorta aneurysm, thoracic aneurysms, Marfan syndrome, bicuspid aortic valve, familial thoracic syndrome, aortic dissection, aorta imaging and aortic aneurysm guidelines. We included articles dating from 1980 to 2014. Literature revealed how lethal this disease can be and how simple steps such as follow-up and prophylactic surgery can significantly reduce morbidity and mortality. This review also allowed us to realize the many developments that have been made in recent years in the understanding of pathologic mechanisms of this disease. TAA is a silent disease that needs to be recognized early in its course and followed closely in order to recommend appropriate preventive and prophylactic therapy in a timely manner.
Abstract
Thoracic ascending aorta aneurysms (TAA) are an important cause of mortality in adults but are a relatively less studied subject compared to abdominal aortic aneurysms (AAA). [...]
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Safety and feasibility of transcatheter renal sympathetic denervation using different types of catheter and various radiofrequency settings
B. Andrea, . Jacob Atié, . Steffen Desh, . Phillip Lurz, . Gerhard Hindricks

IJC Heart & Vasculature (2016). Vol. 11 pp. 35-42

Abstract
To evaluate in vivo the feasibility and safety of renal sympathetic denervation (RSD) with different catheters and various radiofrequency protocols. Twenty-two pigs were included. First 2 pigs were enrolled in a feasibility protocol using one catheter and power from 5 W to 20 W. The next 10 pigs underwent RSD with three different catheters and four different RF-power settings of 5 W, 8 W, 10 W and 12 W in one minute per lesion (Protocol 1). The following 10 (Pigs 13 to 22) underwent RSD with five types of catheters (including the Symplicity® catheter), powers of 8 W and 10 W and two minutes RF-application (Protocol 2). Angiographic data were obtained at baseline, during and after RSD. At last, renal arteries were excised and analyzed macroscopically. The first pig developed severe renal stenoses with lesions of 15 to 20 W correlated with macroscopic alterations. The second feasibility pig did not develop renal stenosis with 5 and 8 W. In Protocol 1 from 60 RF-lesions, we observed 7 stenoses (≥ 30%). Three were severe (one of 80% with 10 W and two of 80% with 12 W). In Protocol 2 from 57 lesions we observed only 1 stenosis of 50% with 8 W with Symplicity® catheter. Severe stenosis was not observed. In this study, renal sympathetic denervation showed safety using five types of catheters when applying RF-energy less than 10 W, within main stems of arteries larger than 3.0 mm diameter and a distance between lesions of at least 1 time catheter tip length.
Abstract
To evaluate in vivo the feasibility and safety of renal sympathetic denervation (RSD) with different catheters and various radiofrequency protocols. Twenty-two pigs were included. [...]
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Using MRI to predict future adverse cardiac remodelling in a male mouse model of myocardial infarction
R. E. Redgrave, . Simon Tual-Chalot, B. J. Davison, . Elizabeth Greally, . Mauro Santibanez-Koref, J. E. Schneider, A. M. Blamire, H. M. Arthur

IJC Heart & Vasculature (2016).

Abstract
Mice are frequently used in research to examine outcomes of myocardial infarction (MI) and to investigate therapeutic interventions at an early pre-clinical stage. The MI model is generated by surgically occluding a major coronary artery, but natural variation in murine coronary anatomy can generate variable outcomes that will inevitably affect the accuracy of such investigations. The aim of this study was to use MRI to derive the most sensitive early variable that could be used to predict subsequent adverse cardiac remodelling in a male mouse model of MI. Using a longitudinal study design, heart structure and function were evaluated using cardiac MRI at one week following surgical MI to generate the early measurements and again at four weeks, when the scar had matured. The primary variables measured at week one were left ventricular volumes at end systole (LV-ESV) and at end diastole (LV-EDV), infarct size, LV-cardiac mass, and ejection fraction (EF). Univariate and multiple regression analyses showed that LV-ESV at one week following MI could be used to accurately predict various parameters of adverse LV remodelling at four weeks post-MI. However, the highest correlation was between LV-ESV at one week following MI and LV-EDV at four weeks (r = 0.99, p < 0.0001), making LV-ESV at one week a valuable predictor variable of future adverse ventricular remodelling after MI. Using MRI to determine LV-ESV at an early stage following MI enables a more robust analysis of potential therapeutic interventions to ameliorate adverse cardiac remodelling.
Abstract
Mice are frequently used in research to examine outcomes of myocardial infarction (MI) and to investigate therapeutic interventions at an early pre-clinical stage. The MI [...]
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A predictive model to identify patients with suspected acute coronary syndromes at high risk of cardiac arrest or in-hospital mortality: An IMMEDIATE Trial sub-study
. Madhab Ray, . Robin Ruthazer, J. R. Beshansky, D. M. Kent, J. T. Mukherjee, . Hadeel Alkofide, H. P. Selker

IJC Heart & Vasculature (2015).

Abstract
The IMMEDIATE Trial of emergency medical service use of intravenous glucose–insulin–potassium (GIK) very early in acute coronary syndromes (ACS) showed benefit for the composite outcome of cardiac arrest or in-hospital mortality. This analysis of IMMEDIATE Trial data sought to develop a predictive model to help clinicians identify patients at highest risk for this outcome and most likely to benefit from GIK. Multivariable logistic regression was used to develop a predictive model for the composite endpoint cardiac arrest or in-hospital mortality using the 460 participants in the placebo arm of the IMMEDIATE Trial. The final model had four variables: advanced age, low systolic blood pressure, ST elevation in the presenting electrocardiogram, and duration of time since ischemic symptom onset. Predictive performance was good, with a C statistic of 0.75, as was its calibration. Stratifying patients into three risk categories based on the models predictions, there was an absolute risk reduction of 8.6% with GIK in the high-risk tertile, corresponding to 12 patients needed to treat to prevent one bad outcome. The corresponding values for the low-risk tertile were 0.8% and 125, respectively. The multivariable predictive model developed identified patients with very early ACS at high risk of cardiac arrest or death. Using this model could assist treating those with greatest potential benefit from GIK.
Abstract
The IMMEDIATE Trial of emergency medical service use of intravenous glucose–insulin–potassium (GIK) very early in acute coronary syndromes (ACS) showed benefit for the [...]
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Cardiac calcified amorphous tumor: A systematic review of the literature
Q. de Hemptinne, D. de Cannière, . Jean-Luc Vandenbossche, . Philippe Unger

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 1-5

Abstract
Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. To determine clinical features, current management and outcomes of this rare disease. A systematic review of all articles reporting cases of CAT in order to perform a pooled analysis of its clinical features, management and outcomes. An electronic search of all English articles using PUBMED was performed. Further studies were identified by cross-referencing from relevant papers. We restricted inclusion to articles reporting cases of CAT in the English language literature published up to July 2014. One author performed data extraction using predefined data fields. A total of 27 articles, reporting 42 cases of CAT were found and included in this review. In this review, the most frequent presenting symptoms were dyspnea and embolic events. Mitral valve and annulus were the most frequent location of CAT. Surgery was most of the time required to confirm diagnosis, and was relatively safe. Overall outcome after surgical resection was good.
Abstract
Calcified amorphous tumor (CAT) of the heart is a rare non-neoplastic intracavitary cardiac mass. Several case reports have been published but large series are lacking. To [...]
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Anatomical and hemodynamic evaluations of the heart and pulmonary arterial pressure in healthy children residing at high altitude in China
. Hai-Ying Qi, . Ru-Yan Ma, . Li-Xia Jiang, . Shu-Ping Li, S. Mai, . Hong Chen, M. Ge, . Mei-Ying Wang, . Hai-Ning Liu, . Yue-Hong Cai, S. Xu, J. Li

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 158-164

Abstract
Altitude-hypoxia induces pulmonary arterial hypertension and altered cardiac morphology and function, which is little known in healthy children at high altitude. We compared the cardiopulmonary measurements between the healthy children at 16 m and those at 3700 m in China and between the Hans and the Tibetans at 3700 m. Echocardiography was assessed in 477 children (15 day–14 years) including 220 at 16 m and 257 at 3700 m. The dimensions and wall thickness of the left- and right-sided heart, systolic and diastolic functions including cardiac output index (CI) were measured using standard methods. Mean pulmonary arterial pressure (mPAP) was estimated by the Doppler waveforms in the main pulmonary artery. Compared to the 16 m-group, 3700 m-group had higher mPAP, increasing dilatation of the right heart, and slower decrease in right ventricular hypertrophy in 14 years (p < 0.05). The left heart morphology was not different (p > 0.20). Systolic and diastolic functions of both ventricles were significantly reduced, but CI was higher (p < 0.0001). There was no difference in any measurement between the Hans and the Tibetans (p > 0.05). Children living at high altitude in China have significantly higher mPAP, dilated right heart and slower regression of right ventricular hypertrophy in the first 14 years of life. Systolic and diastolic functions of both ventricles were reduced with a paradoxically higher CI. There was no significant difference in these features between the Hans and the Tibetans. These values provide references for the care of healthy children and the sick ones with cardiopulmonary diseases at high altitude.
Abstract
Altitude-hypoxia induces pulmonary arterial hypertension and altered cardiac morphology and function, which is little known in healthy children at high altitude. We compared [...]
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Catheter-based intervention for pulmonary vein stenosis due to fibrosing mediastinitis: The Mayo Clinic experience
S. P. Ponamgi, C. DeSimone, C. J. Lenz, . Megan Coylewright, S. J. Asirvatham, D. R. Holmes, D. L. Packer

IJC Heart & Vasculature (2015).

Abstract
Fibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of the pulmonary veins (PV). Catheter-based intervention is currently the only viable option for therapy. However, the current literature on how best to manage these difficult cases, especially in regards to sequential interventions and their potential complications is very limited. We searched through a database of all patients who have undergone PV interventions at the Earl H. Wood Cardiac Catheterization Laboratory in Mayo Clinic, Rochester. From this collection, we selected patients that underwent PV intervention to relieve stenosis secondary to FM. Eight patients were identified, with a mean age of 41 years (24–59 years). Five were men, and three were women. Three patients underwent balloon angioplasty alone, and five patients had stents placed. The majority of patients had acute hemodynamic and symptomatic improvement. More than one intervention was required in five patients, four patients had at least one episode of restenosis, and four patients died within four weeks of their first PV intervention. We describe the largest reported case series of catheter-based intervention for PV stenosis in FM. Although catheter-based therapy improved hemodynamics, short-term vascular patency, and patient symptoms, the rate of life-threatening complications, restenosis, and mortality associated with these interventions was found to be high. Despite these associated risks, catheter-based intervention is the only palliative option available to improve quality of life in severely symptomatic patients with PV stenosis and FM. Patients with PV stenosis and FM (especially those with bilateral disease) have an overall poor prognosis in spite of undergoing these interventions due to the progressive and recalcitrant nature of the disease. This underscores the need for further innovative approaches to manage this disease.
Abstract
Fibrosing mediastinitis (FM) is a rare but fatal disease characterized by an excessive fibrotic reaction in the mediastinum, which can lead to life-threatening stenosis of [...]
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Intima-media thickness of the descending aorta in patients with bicuspid aortic valve
. Johan Petrini, . Mohamed Yousry, . Per Eriksson, H. M. Björk, . Anette Rickenlund, . Anders Franco-Cereceda, . Kenneth Caidahl, M. J. Eriksson

IJC Heart & Vasculature (2016). Vol. 11 pp. 74-79

Abstract
A bicuspid aortic valve (BAV) is associated with accelerated aortic valve disease (AVD) and abnormalities in aortic elasticity. We investigated the intima-media thickness of the descending aorta (AoIMT) in patients with AVD with or without an ascending aortic aneurysm (AscAA), in relation to BAV versus tricuspid aortic valve (TAV) phenotype, type of valve disease, cardiovascular risk factors, and single-nucleotide polymorphisms (SNPs) with a known association with carotid IMT. 368 patients (210 with BAV, 158 with TAV, ), mean age 64 ± 13 years) were examined using transesophageal echocardiography (TEE) before valvular and/or aortic surgery. No patient had a coronary disease (CAD). The AoIMT was measured on short-axis TEE images of the descending aorta using a semi-automated edge-detection technique. AoIMT was univariately (P < 0.05) related to age, blood pressure, smoking, creatinine, highly sensitive C-reactive protein, HDL, valve hemodynamics and BAV. In the TAV subgroup it was also associated with the rs200991 SNP. Using multivariate regression analysis, age was the main determinant for AoIMT (P < 0.001), followed by male gender (P = 0.02), BAV was no longer a significant predictor of AoIMT. AoIMT was still related to the rs200991 SNP in TAV (P = 0.034), and to creatinine in BAV (P = 0.019), when other variables were accounted for. Intima-media thickness of the descending aorta is not affected by aortic valve morphology (BAV/TAV), age is the main determinant of AoIMT. Genetic markers (SNPs) known to influence IMT in the carotid artery seem to correlate to IMT in the descending aorta only in patients with TAV.
Abstract
A bicuspid aortic valve (BAV) is associated with accelerated aortic valve disease (AVD) and abnormalities in aortic elasticity. We investigated the intima-media thickness [...]
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Coronary calcification with no flow limiting lesions: A potential cause for ischaemic dysfunction in syndrome X patients
. Elisabetta Palmerini, . Henrik Antti, . Dmitry Shungin, . Stefan Soderberg, . Sergio Mondillo, M. Y. Henein

IJC Heart & Vasculature (2015). Vol. 9(7) pp. 109-114

Abstract
Exertional angina in patients with no coronary flow limiting lesions remains a clinical puzzle. We aimed to assess the extent of coronary artery calcification (CAC) and its relationship to ventricular wall motion function using stress echocardiography in a group of patients limited by exertional angina, but no obstructive lesions. We compared CT coronary calcium score (CACS) and dobutamine stress echocardiography in 55 patients (age 64.7 ± 7.7 years), divided into Group 1 (CACS ≤ 100) and Group 2 (CACS > 100). No patient had LV ejection fraction-EF < 55%, pulmonary hypertension, arrhythmia, renal failure or parathyroid disease. Multiple linear regression analysis was used to test the association between gender-standardized continuous echocardiographic parameters and patient groups adjusted for age, body surface area, osteoporosis and CV risk factors and CACS. At rest, LV long axis ‘subendocardial’ function was reduced (amplitude: β − 1.11 SD, p < 0.05, R2 0.6 and systolic velocity: β − 1.08 SD, p < 0.05, R2 0.44), left atrial (LA) indexed volume was raised (β 1.06 SD, p < 0.05, R2 0.37) and its systolic velocity decreased (β − 1.05 SD, p < 0.05, R2 0.35) in Group 2. With stress, wall motion score index increased (p < 0.05) and long axis disturbances worsened only in the same group. Multivariate analysis demonstrated clear relationship between ischaemic LV disturbances, reduced long axis amplitude, global longitudinal systolic strain and early diastolic strain rate. Resting and stress RV lengthening velocity also correlated with CAC score. In symptomatic patients with no obstructive coronary lesions and with more than mild CAC, long axis disturbances and wall motion score index rise occur with stress, at the time of symptom development and correlate with severity of arterial calcification. These findings suggest CAC as a potential mechanism for coronary wall stiffness and consequently exertional ischaemic changes as a result of limited flow reserve.
Abstract
Exertional angina in patients with no coronary flow limiting lesions remains a clinical puzzle. We aimed to assess the extent of coronary artery calcification (CAC) and its [...]
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Left ventricular diastolic gradient in hypertrophic cardiomyopathy
. Filomena Pacelli, . Antonio Rapacciuolo, . Alessandra Giamundo, . Grazia Canciello, . Anna Franzone, . Massimo Imbriaco, . Bruno Trimarco, . Maria-Angela Losi

IJC Heart & Vasculature (2017). Vol. 14 pp. 20-22
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QRS duration predicts 30 day mortality following ST elevation myocardial infarction
C. Nwakile, . Bhaskar Purushottam, . Jeong Yun, . Vikas Bhalla, D. Lynn Morris, V. Figueredo

IJC Heart & Vasculature (2014). Vol. 5 pp. 42-44
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Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan
. Romina Navarri, . Stefano Lunghetti, . Matteo Cameli, . Sergio Mondillo, . Roberto Favilli, . Francesca Scarpini, . Luca Puccetti

IJC Heart & Vasculature (2015). Vol. 7(1) pp. 153-157

Abstract
Levosimendan improves clinical and hemodynamic parameters exerting an anti-inflammatory and antiapoptotic effect in decompensated heart failure. The aim of this study was to evaluate the effects of levosimendan on LV torsion, plasma levels of NT-proBNP and on the balance between pro-inflammatory (TNF-α, IL-6) and anti-inflammatory cytokines (IL-10). We enrolled 24 patients (age 62 ± 7 years) with acute HF, NYHA class IV and severe LV dysfunction. All patients underwent transthoracic echocardiography using two-dimensional speckle tracking analysis to detect LV twist angle (LVTA), at baseline and 1 week after treatment with levosimendan infusion. Biochemical parameters (pro-BNP, IL-6, IL-10, TNF-α) were determined by enzyme-linked immunosorbent (ELISA). After one week, we observed an improvement in LV function especially in LVTA (4.15 ± 2.54 vs 2.9 ± 2.1 p < 0.01), in LV ejection fraction (27.3 ± 8.04 vs 21.6 ± 6.8 p = 0.03) and also a significant reduction in BNP levels (1844 ± 560 vs 4713 ± 1050, p = 0.03). The multiple linear regression analysis showed a significant relation between a reduction of TNF α/IL-10 ratio (Δ > 20%) and BNP (Δ > 40%), LVEF (Δ > 10%) and LVTA (Δ > 20%) (O.R. 1.77, 95% C.I. 1.11–2.83, O.R. 1.49, 95% C.I. 1.08–2.67, O.R. 1.66, 95% C.I. 1.10–2.74, respectively, confirmed p, all < 0.01 by Hosmer–Lemeshov confirmation and the formal test for interaction). Levosimendan exerts a hemodynamic effect by improving EF and LV torsion in patients with acute HF in association with a positive effect on the balance between pro and anti-inflammatory cytokines.
Abstract
Levosimendan improves clinical and hemodynamic parameters exerting an anti-inflammatory and antiapoptotic effect in decompensated heart failure. The aim of this study was [...]
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Thrombolytics in VAD management — A single-center experience
N. Nair, . A.A. Schmitt, E. Rau, S. Anders, . D. Sandler, . T.B. Icenogle

IJC Heart & Vasculature (2016). Vol. 11 pp. 49-54

Abstract
With continued increase in the use of mechanical circulatory support, the incidence of device thrombus remains a challenge. This study is a retrospective analysis of data at a single center to assess the safety and efficacy of thrombolytic use in durable mechanical assist devices. Data was analyzed retrospectively from 154 patients who underwent left ventricular assist device (LVAD) implantation from 1/1/2005 to 6/30/2014. The HMII device was implanted in 131 patients while 23 received the HVAD. LVAD thrombus was diagnosed when lactate dehydrogenase levels exceeded 1000 units/l accompanied by clinical signs of hemolysis and heart failure, echocardiographic data and surges in pump power. TPA (tissue plasminogen activator) protocol consisted of a 5 mg intravenous bolus followed by 3 mg/h infusion in normal saline for 10 h. If symptoms persisted another cycle of TPA at 1 mg/h was continued up to 48 h. The TPA group had a 70% success rate. Success was defined as complete resolution of hemolysis and clinical symptoms with no requirement for LVAD exchange at 30 days. 95% survival was noted at 30 days and 90% were free of a hemorrhagic stroke in the TPA group. The rates of hemorrhagic strokes in the TPA group and the control group were not different (OR = 0.92). The TPA protocol described here was successful consistently. Though this study is limited by its size and retrospective nature it leads the way for larger studies to generate more robust comparisons between different types of mechanical assist devices as well as the tailored use of thrombolytics in this patient population.
Abstract
With continued increase in the use of mechanical circulatory support, the incidence of device thrombus remains a challenge. This study is a retrospective analysis of data [...]
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The effects of fibrinolytic before referring STEMI patients: A systematic review and meta-analysis
. Pajaree Mongkhon, P. Dilokthornsakul, . Kanokkorn Tepwang, . Kannika Tapanya, C. Sopitprasan, . Pitchapat Chaliawsin, . Surasak Saokaew

IJC Heart & Vasculature (2017). Vol. 15 pp. 9-14

Abstract
Accessibility of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) in primary care settings is limited. Referring patients to PCI-capable hospitals might increase cardiac events. Hence, fibrinolytic injection before referring patients to PCI-capable settings decreases cardiac events, however, the effect of fibrinolytic injection before the referral has not been systematically evaluated. This study aimed to systematically review the effect of fibrinolytic injection before referring patients with STEMI to PCI-capable settings. A systematic search with Embase, Cochrane CENTRAL, Google scholar, and PubMed was conducted. Studies conducted in patients with STEMI presented to non PCI-capable settings and compared fibrinolytic injection with no injection before referring patients to PCI-capable settings were included. The primary outcome was the composite outcomes of major adverse cardiac events (MACEs) at 30 days. Meta-analyses were performed using random-effect model. Of 912 articles, three RCTs and three non-RCTs were included. Based on RCTs, fibrinolytic injection before the referral has failed to decrease MACEs compared to non-fibrinolytic injection [relative risk (RR) 1.18, 95% confidence interval (CI), 0.89–1.57, p = 0.237]. Fibrinolytic injection has also failed to decrease mortality, re-infarction, and ischemic stroke. On the other hand, fibrinolytic injection was associated with a higher risk of major bleeding. In non PCI-capable settings, fibrinolytic injection before referring patients with STEMI to PCI-capable settings has no clinical benefit but could increase risk of major bleeding. Clinicians might more carefully consider whether fibrinolytic injection should be used in patients with STEMI before the referral.
Abstract
Accessibility of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) in primary care settings is limited. [...]
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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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