Cardiology

Increased serum uric acid (UA) has been shown to directly promote oxidative stress. Recent studies point toward a role for oxidative stress in the pathogenesis of ascending aortic aneurysms (AscAAs). This study was designed to examine the relationship between serum UA concentrations, total antioxidant reductive capacity, and AscAAs. The serum UA concentrations, total antioxidant reductive capacity were compared in 60 patients with ascending aortic dilatation (ectasia group (3.8-4.3 cm), 34 patients; aneurysmal group (≥4.4 cm), 26 patients) vs. 30 control subjects. The patients were evaluated by a complete transthoracic echocardiographic examination including measurement of the aortic dimensions. The serum UA concentration and total antioxidant reductive capacity were significantly higher in patients with AscAAs. In multiple linear regression analysis, hypertension and serum UA concentration were significantly associated with aortic dilatation (β = 0.3, P = 0.03; β = 0.15, P < 0.0...

Background To validate the k-adaptive-t autocalibrating reconstruction for Cartesian sampling (kat-ARC), an exclusive sparse reconstruction technique for four-dimensional (4D) flow cardiac magnetic resonance (CMR) using conservation of mass principle applied to transvalvular flow. Methods This observational retrospective study (2020/21-075) was approved by the local ethics committee at the University of East Anglia. Consent was waived. Thirty-five patients who had a clinical CMR scan were included. CMR protocol included cine and 4D flow using Kat-ARC acceleration factor 6. No respiratory navigation was applied. For validation, the agreement between mitral net flow (MNF) and the aortic net flow (ANF) was investigated. Additionally, we checked the agreement between peak aortic valve velocity derived by 4D flow and that derived by continuous-wave Doppler echocardiography in 20 patients. Results The median age of our patient population was 63 years (interquartile range [IQR] 54–73), and...

Background: Complex congenital cardiac anomalies involving ventricular hypoplasia require either staged palliative reconstruction, converting the circulatory system to a single ventricle based pump, or allogeneic transplantation. Tissue engineering offers the potential for complete reconstruction of these defects, but is limited by the inability to model myocardial tissue engineering in a small animal. Our goal was to develop a small animal model for ventricular tissue engineering using rat heterotopic heart transplantation. Methods: Donor hearts were explanted after cardioplegic arrest and the left ventricular volume was augmented by the implantation of a biodegradable engineered construct. The heart was then transplanted heterotopically into syngeneic recipients creating either a volume loaded, functioning left ventricle, or a non-functioning left ventricle. Some of the engineered constructs were seeded with multipotent bone marrow-derived mesenchymal progenitor cells before implantation. Animals were evaluated by echocardiography, morphology, histology, and immunohistochemistry after 1 month. A scaffolding constructed from polytetrafluoroethylene, polylactide mesh, and type I and IV collagen hydrogel resulted in minimal intracardiac inflammation without aneurysmal dilatation. Successful transplantation and differentiation of mesenchymal progenitor cells was accomplished using this scaffolding. No ventricular arrhythmias resulted from this surgical manipulation and echocardiography revealed both end systolic and diastolic volume augmentation with ventricular expansion. We have developed an in vivo model of ventricular tissue engineering using heterotopic heart transplantation. Future work will focus on construction of ventricular tissue around pre-fabricated vascular networks in order increase cellular engraftment for ventricular reconstruction.

Background: Intravascular ultrasound (IVUS) has been used to characterize the natural history of atheroma and associated patterns of arterial remodelling. It is unknown whether remodelling and calcification is similar between coronary and peripheral arteries. Methods: Volumetric IVUS imaging was performed within superficial femoral artery or an epicardial coronary artery of 124 patients undergoing percutaneous intervention in the peripheral (n=31) or coronary (n=93) circulations, matched for age, gender and diabetic status. Clinical characteristics, vascular dimensions and calcification were compared. Results: Mean age was 70 years, 65% male and 61% diabetic. Hypertension (97 v 84%, p=0.07) and current smokers (23 v 10%, p=0.12) were more prevalent in the peripheral group. Peripheral atherosclerosis was more severe with greater percent atheroma volume (50.4±11.4 v 41.3±8.0%, p<0.001). Lumen volume (558±240 v 284±111 mm 3 , p<0.001) and external elastic membrane (EEM, 1093±306 v 488±184 mm 3 , p<0.001) volume were greater in the peripheral group. More peripheral images contain calcium (50.5±20.6 v 36.0±24.4%, p=0.004). A stronger correlation between atheroma volume and both lumen (r=0.65 v r=0.22, p=0.01 between groups) and EEM (r=0.89 v r=0.64, p=0.002 between groups) volumes were observed in the coronary group. Different patterns of remodelling and calcification within the artery wall are observed in the setting of plaque accumulation in peripheral and coronary territories. This suggests that local factors may influence the natural history of atherosclerosis within different vascular beds.

There are limited data on the effects of anthracyclines on right ventricular (RV) structure, function, and tissue characteristics. The goal of this study was to investigate the effects of anthracyclines on the RV using cardiac magnetic resonance (CMR). This was a post-hoc analysis of a prospective study of 27 breast cancer (BC) patients (51.8 ± 8.9 years) using CMR prior, and up to 3-times after anthracyclines (240 mg/m2) to measure RV volumes and mass, RV extracellular volume (ECV) and cardiomyocyte mass (CM). Before anthracyclines, LVEF (69.4 ± 3.6%) and RVEF (55.6 ± 9%) were normal. The median follow-up after anthracyclines was 399 days (IQR 310–517). The RVEF reached its nadir (46.3 ± 6.8%) after 9-months (P &lt; 0.001). RV mass-index and RV CM decreased to 13 ± 2.8 g/m2 and 8.13 ± 2 g/m2, respectively, at 16-months after anthracyclines. The RV ECV expanded from 0.26 ± 0.07 by 0.14 (53%) to 0.40 ± 0.1 (P &lt; 0.001). The RV ECV expansion correlated with a decrease in RV mass-ind...

Cardiac dysfunction and cardiomyopathy cause > 50% of all deaths in chronic kidney failure (CKD) patients. Left ventricular hypertrophy (LVH) and myocardial insulin resistance are characteristics of CKD and lead to molecular, cellular and physiological adaptations in the heart. The aim of this study was to examine the profile of myocardial GLUT 4 expression in experimental uraemia. Uraemia was induced in male Sprague-Dawley rats (n = 5) via a two stage sub-total nephrectomy. Six weeks later, cardiomyocytes were isolated and incubated ±1 μM insulin. GLUT 4 distribution was investigated by confocal microscopy using a monoclonal antibody (Ab) to GLUT4 and an Alexa Fluor 568 conjugated Ab. Uraemic animals were characterised by hypertension, LVH and hyperinsulinaemia.

BackgroundIn contrast with the setting of acute myocardial infarction, there are limited data regarding the impact of diabetes mellitus on clinical outcomes in contemporary cohorts of patients with chronic coronary syndromes. We aimed to investigate the prevalence and prognostic impact of diabetes according to geographical regions and ethnicity.Methods and resultsCLARIFY is an observational registry of patients with chronic coronary syndromes, enrolled across 45 countries in Europe, Asia, America, Middle East, Australia, and Africa in 2009–2010, and followed up yearly for 5 years. Chronic coronary syndromes were defined by ≥1 of the following criteria: prior myocardial infarction, evidence of coronary stenosis &gt;50%, proven symptomatic myocardial ischaemia, or prior revascularization procedure.Among 32 694 patients, 9502 (29%) had diabetes, with a regional prevalence ranging from below 20% in Northern Europe to ∼60% in the Gulf countries. In a multivariable-adjusted Cox proportion...

All enrolled patients had CTCA performed on a Toshiba Aquilion One 320-slice CT scanner which was further analysed using Vitrea software. Demographic and clinical informations including relevant investigations were recorded and statistical analysis was performed. Results: Majority (58.3%, n=326) of the patients in this study are male with the mean age (±SD) of 55.35 (12.1) years old. Of these 560 patients, 97 (17.3%) was found to have myocardial bridging by CTCA. Majority (n=95) of the bridges was found in LAD, three was found in right coronary artery, and one in ramus intermedius artery. Of the 97 patients with myocardial bridging by CTCA, 26 underwent angiogram and 6 was confirmed to have bridging by angiogram procedure. There was no statistically significant association between patients' demography with the presence of myocardial bridging by CTCA. The prevalence of myocardial bridging found by CTCA in this study was 17.3% with no significant association between patients' demography and the presence of myocardial bridging.

Introduction: Human embryonic stem cell-derived cardiomyocytes (hESC-CMs) can regenerate myocardium as they can engraft, electrically couple and remuscularize. Optimally, hESC-CMs would be banked as a source of immediate off-the-shelf therapy. However, hESC-CMs have intrinsic immunoreactivity, which would require immunosuppressive regimens to prevent rejection. A significant cause of graft rejection is the recognition of the major histocompatibility complex class I (MHC-I). Cells devoid of cell surface MHC-I through deletion of beta-2 microglobulin (B2M, sine qua non required molecule for MHC-I surface expression) may be able to avoid an immune response. Objectives: To test the differentiation potential and immunogenicity of B2M -/-hESC's. Also, to test an hESC-based cardiac regenerative therapy by utilizing CMs derived from MHC-I deficient murine neonatal cardiomyocytes (NCM). Methods: Undifferentiated B2M +/+ and B2M -/-hESCs were differentiated into cardiomyocytes and tested for cell mediated immunogenicity and expression of cardiac troponin (cTn) and MHC-I. B2M +/+ and B2M -/-pregnant females were given BrdU to label NCM. B2M +/+ and B2M -/- NCMs were injected into the left ventricles of adult mice. Immunofluorescence and histology were used to detect necrosis and BrdU. Results: B2M +/+ and B2M -/-hESCs were differentiated into CM's using small moleculebased protocols resulting in 80-90% positivity for cTn-I, cTn-T, a-myosin heavy chain and NKX2.5 cardiac transcription factor. MHC-I expression was low in CMs at baseline; however, in B2M +/+ CM's there was a robust increase in MHC-I expression in response to interferon-g and tumor necrosis factor-a, which was not seen in B2M -/-CM's. Consistently, B2M -/-CMs did not trigger CD8 + or CD56 + NK-cell response in vitro. There was no evidence of rejection in hearts transplanted with B2M -/-NCM seen up to 5 weeks post injection. In contrast, hearts transplanted with B2M +/+ NCM's showed signs of myocardial death at 3-7 days. BrdU positive cells were seen in areas of necrosis. Conclusion: hESCs-derived CM derived from B2M -/-showed no expression of MCH-I and had a markedly attenuated immune response in vitro. This reduced immunity was also seen with B2M -/-NCMs which evaded rejection in vivo. This study suggests that B2M -/-hESCs may be a good strategy for the development of universal cell therapies for cardiac regeneration.

Background: Recent studies have reported a significant increase in eye lens opacities among staff in the cardiac catheterization laboratory but indicated further studies are needed to confirm the findings. Objective: To evaluate the prevalence of opacities in eyes of cardiologists, radiographers and nurses working in interventional cardiology. Methods: The eyes of 52 staff in interventional cardiology facilities and 34 age- and sex-matched unexposed controls were screened in a cardiology conference held in Kuala Lumpur by dilated slit-lamp examination, and posterior lens changes were graded. Individual cumulative lens X-ray exposures were calculated from responses to a questionnaire in terms of workload and working practice. Results: The prevalence of posterior lens opacities among interventional cardiologists was 53%, while in nurses and radiographers it was 45%. Corresponding relative risks were 2.6 (95% CI: 1.2–5.4) and 2.2 (95% CI: 0.98–4.9), for interventional cardiologists and...

Objective To investigate the association of corrected QT (QTc) interval duration and short-term outcomes in patients with acute heart failure (AHF). Methods We analyzed AHF patients enrolled in 11 Spanish emergency departments (ED) for whom an ECG with QTc measurement was available. Patients with pace-maker rhythm were excluded. Primary outcome was 30-day all-cause mortality and secondary outcomes were need of hospitalization, in-hospital mortality and prolonged hospitalization (> 7 days). Association between QTc and outcomes was explored by restricted cubic spline (RCS) curves. Results were expressed as odds ratios (OR) and 95%CI adjusted by patients baseline and decompensation characteristics, using a QTc = 450 ms as reference. The members of the ICA-SEMES research investigators are mentioned in the Acknowledgements section.

Although acute myocardial infarction (AMI) is a life-threatening disease, rapid diagnosis may reduce mortality risk. Despite being highly specific for AMI, cardiac troponin I (cTnI) does not distinguish between the etiologically diverse of myocardial injury that may be due to MI or non-MI causes. Bone morphogenetic proteins (BMPs), which are important modulators for cardiac morphogenesis, are members of the transforming growth factor-beta superfamily. This work intended to evaluate the utility of 2 members of BMPs (BMP2 and BMP4) as diagnostic biomarkers for AMI. This study included 110 AMI patients and 30 healthy volunteers. AMI patients were subdivided into 39 patients without hypercholesterolemia or diabetes mellitus (AMI without HC or DM), 33 patients with hypercholesterolemia (AMI with HC), and 38 patients with diabetes mellitus (AMI with DM). BMP2 and BMP4 levels were assessed in all subjects. The results showed that serum levels of both BMPs showed significant elevation in all AMI patients compared to healthy controls. In contrast, serum BMP2 level only was significantly elevated in AMI patients with DM compared to those without HC or DM and therefore was able to discriminate between the two subgroups, unlike cTnI and BMP4. Notably, the diagnostic efficacy of the two BMPs was improved when combined. In conclusion, the two BMPs are good diagnostic biomarkers for AMI. Nevertheless, BMP2 had a higher diagnostic performance than BMP4 in discriminating AMI with DM from AMI without HC or DM with AUC 0.919 (p=0.001) and the highest PPV (100%), meanwhile, BMP4's AUC is 0.891 (p=0.001) and a PPV (85.7%).

Diabetes is a common endocrine disorder with an ever increasing prevalence globally, placing significant burdens on our healthcare systems. It is associated with significant cardiovascular morbidities. One of the mechanisms by which it causes death is increasing the risk of cardiac arrhythmias. The aim of this article is to review the cardiac (ion channel abnormalities, electrophysiological and structural remodelling) and extracardiac factors (neural pathway remodelling) responsible for cardiac arrhythmogenesis in diabetes. It is concluded by an outline of molecular targets for future antiarrhythmic therapy for the diabetic population.

Iron‐induced cardiac dysfunction is a leading cause of death in transfusion‐dependent anemia. MRI relaxation rates R2(1/T2) and R(1/T) accurately predict liver iron concentration, but their ability to predict cardiac iron has been challenged by some investigators. Studies in animal models support similar R2 and R behavior with heart and liver iron, but human studies are lacking. To determine the relationship between MRI relaxivities and cardiac iron, regional variations in R2 and R were compared with iron distribution in one freshly deceased, unfixed, iron‐loaded heart. R2 and R were proportionally related to regional iron concentrations and highly concordant with one another within the interventricular septum. A comparison of postmortem and in vitro measurements supports the notion that cardiac R should be assessed in the septum rather than the whole heart. These data, along with measurements from controls, provide bounds on MRI‐iron calibration curves in human heart and further su...

Despite the appeal of ultra-short-term heart rate variability (HRV) methods of analysis applied in the clinical and research settings, the number of studies that have investigated HRV by analyzing R-R interval (RRi) recordings shorter than 5 min is still limited. Moreover, ultra-short-term HRV analysis has not been extensively validated during exercise and, currently, no indications exist for its applicability during resistance exercise. The aim of the present study was to compare ultra-short-term HRV analysis with standard short-term HRV analysis during low-intensity, dynamic, lower limb resistance exercise in healthy elderly subjects. Heart rate (HR) and RRi signals were collected from 9 healthy elderly men during discontinuous incremental resistance exercise consisting of 4-min intervals at low intensities (10, 20, 30, and 35% of 1-repetition maximum). The original RRi signals were segmented into 1-, 2-, and 3-min sections. HRV was analyzed in the time domain (root mean square of the of differences between adjacent RRi, divided by the number of RRi, minus one [RMSSD]), RRi mean value and standard deviation [SDNN] (percentage of differences between adjacent NN intervals that are greater than 50 ms [pNN50]), and by non-linear analysis (short-term RRi standard deviation [SD1] and long-term RRi standard deviation [SD2]). No significant difference was found at any exercise intensity between the results of ultra-short-term HRV analysis and the results of standard short-term HRV analysis. Furthermore, we observed excellent (0.70 to 0.89) to near-perfect (0.90 to 1.00) concordance between linear and nonlinear parameters calculated over 1-and 2-min signal sections and parameters calculated over 3-min signal sections. Ultrashort-term HRV analysis appears to be a reliable surrogate of standard short-term HRV analysis during resistance exercise in healthy elderly subjects.

Heart failure, a leading cause of hospitalizations and deaths, is a major clinical problem. In recent years, the increasing incidence of heart failure with preserved ejection fraction (HFpEF) has been observed. Despite extensive research, there is no efficient treatment for HFpEF available. However, a growing body of evidence suggests stem cell transplantation, due to its immunomodulatory effect, may decrease fibrosis and improve microcirculation and therefore, could be the first etiology-based therapy of the disease. In this review, we explain the complex pathogenesis of HFpEF, delineate the beneficial effects of stem cells in cardiovascular therapy, and summarize the current knowledge concerning cell therapy in diastolic dysfunction. Furthermore, we identify outstanding knowledge gaps that may indicate directions for future clinical studies.

Myocarditis is an inflammatory heart disease induced by infectious and non-infectious causes frequently triggering immune-mediated pathologic mechanisms leading to myocardial damage and dysfunction. In approximately half of the patients, acute myocarditis resolves spontaneously while in the remaining cases, it may evolve into serious complications including inflammatory cardiomyopathy, arrhythmias, death, or heart transplantation. Due to the large variability in clinical presentation, unpredictable course of the disease, and lack of established causative treatment, myocarditis represents a challenging diagnosis in modern cardiology. Moreover, an increase in the incidence of myocarditis and inflammatory cardiomyopathy has been observed in recent years. However, there is a growing potential of available non-invasive diagnostic methods (biomarkers, serum anti-heart autoantibodies (AHA), microRNAs, speckle tracking echocardiography, cardiac magnetic resonance T1 and T2 tissue mapping, p...

Coronary artery anomalies result from disturbances which may occur to the fetus in the third week of development. These disturbances may lead to anatomical variations which may affect the origin, trajectory, and termination of these arteries, or alterations in their intrinsic anatomy. PRESENTATION OF CASE: We report an unusual case in which both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently. DISCUSSION: An investigation for myocardial bridge should be performed in all congenital coronary artery anomalies. CONCLUSION: Invasive testing could be considered in patients with myocardial and equivocal noninvasive functional testing, in order to obtain better risk stratification and treatment.

Coronary artery anomalies result from disturbances which may occur to the fetus in the third week of development. These disturbances may lead to anatomical variations which may affect the origin, trajectory, and termination of these arteries, or alterations in their intrinsic anatomy. PRESENTATION OF CASE: We report an unusual case in which both anomalous origin of the right coronary artery and myocardial bridge on left anterior descending artery were detected concurrently. DISCUSSION: An investigation for myocardial bridge should be performed in all congenital coronary artery anomalies. CONCLUSION: Invasive testing could be considered in patients with myocardial and equivocal noninvasive functional testing, in order to obtain better risk stratification and treatment.

Nazofarinks kasinomunda radyoterapi(RT),radyoterapi/kemoterapi(KT) alan veya almayan hastalarda iskemik inme görülme insidansı normal populasyona göre daha yüksektir. RT ve KT'ye bağlı karotis stenozu ve serebrovasküler hastalıklar ağır dizabiliteye ve ölüme neden olabilirler. RT'nin geç komplikasyonu olarak, karotis arterde gecikmiş diffüz ateroskleroz ve oklüzyon yıllar içinde gelişebilir, mekanizmanın multifaktöryel olduğu düşünülmektedir. Bu makalede, nazofarinks karsinomaya bağlı direkt tümör invazyonu ve RT sonucu intrakranial internal karotis arter (IKA) stenozu sonrası gelişen iskemik inme olgusu bildirilmektedir. 43 yaşında erkek hasta kliniğimize sol kolda güçsüzlük şikayeti ile başvurdu. Sağ IKA alanında parçalı difüzyon kısıtlılığı görülmesi üzerine, hastaya iskemik inme tanısıyla antiagregan tedavi başlandı. Özgeçmişinde 2 yıl önce ileri evre nazofarinks karsinoma tanısı aldığı ve ilk tanı konulduğunda RT aldığı ve sonrasında KT ile devam edildiği öğrenildi. Kranial magnetik rezonans görüntüleme(MRG)'de sağ IKA çevresinde tümöral invazyon ve bası nedeniyle stenoz gözlendi.1 yıl önce kavernöz sinus invazyonu sonrası sağ gözde 3.4.6.kranial sinir parezisi mevcut olan hastanın sol üst ekstremitede saptanan 3/5 parezi taburculuğunda +4/5 kas gücüne geriledi. Bu bildiride, nazofarinks karsinomaya bağlı gelişen inmenin, RT etkisi yanısıra direkt intrakranial IKA tümör invazyonu sonucu da oluşabileceği vurgulanmak istenmiştir. Anahtar Sözcükler: Nazofarinks kanseri, iskemik inme, karotis invazyonu, geç dönem RT etkisi.

Acute ischemic stroke has an effect on electrocardiography (ECG) results and cardiac enzyme levels, but its mechanism has not been clearly established. Our aim was to research ECG and cardiac enzyme changes in acute ischemic stroke and to investigate the association between these changes and stroke localizations and prognosis. The study included 241 patients with acute ischemic stroke. Patients without cardiac arrhythmia, history of previous stroke, use of drugs affecting the pattern and duration of ECG rhythm and without acute or chronic myocardial infarction history and electrolyte imbalance were included. The vascular risk factors for stroke, creatine kinase-MB (CK-MB), and troponin I (TnI) levels, and ECG results were examined. Results: One hundred twenty-three patients had right hemisphere infarcts and 118 patients had left hemisphere infarcts with the same mean ages. HT was more prevalent in right hemisphere infarcts (p=0.013). The most common ECG abnormalities were QTc prolongation (31%) and ST depression (24%). CK-MB and TnI levels were significantly higher in patients with right hemispheric and cerebellar infarcts. QRS durations were longer in cerebellar infarcts (p=0.05). The most common ECG abnormality was QTc prolongation in patients with acute ischemic stroke within 24 hours. CK-MB and TnI levels were higher in patients with right hemisphere and cerebellar infarcts.

Nazofarinks kasinomunda radyoterapi(RT),radyoterapi/kemoterapi(KT) alan veya almayan hastalarda iskemik inme görülme insidansı normal populasyona göre daha yüksektir. RT ve KT'ye bağlı karotis stenozu ve serebrovasküler hastalıklar ağır dizabiliteye ve ölüme neden olabilirler. RT'nin geç komplikasyonu olarak, karotis arterde gecikmiş diffüz ateroskleroz ve oklüzyon yıllar içinde gelişebilir, mekanizmanın multifaktöryel olduğu düşünülmektedir. Bu makalede, nazofarinks karsinomaya bağlı direkt tümör invazyonu ve RT sonucu intrakranial internal karotis arter (IKA) stenozu sonrası gelişen iskemik inme olgusu bildirilmektedir. 43 yaşında erkek hasta kliniğimize sol kolda güçsüzlük şikayeti ile başvurdu. Sağ IKA alanında parçalı difüzyon kısıtlılığı görülmesi üzerine, hastaya iskemik inme tanısıyla antiagregan tedavi başlandı. Özgeçmişinde 2 yıl önce ileri evre nazofarinks karsinoma tanısı aldığı ve ilk tanı konulduğunda RT aldığı ve sonrasında KT ile devam edildiği öğrenildi. Kranial magnetik rezonans görüntüleme(MRG)'de sağ IKA çevresinde tümöral invazyon ve bası nedeniyle stenoz gözlendi.1 yıl önce kavernöz sinus invazyonu sonrası sağ gözde 3.4.6.kranial sinir parezisi mevcut olan hastanın sol üst ekstremitede saptanan 3/5 parezi taburculuğunda +4/5 kas gücüne geriledi. Bu bildiride, nazofarinks karsinomaya bağlı gelişen inmenin, RT etkisi yanısıra direkt intrakranial IKA tümör invazyonu sonucu da oluşabileceği vurgulanmak istenmiştir. Anahtar Sözcükler: Nazofarinks kanseri, iskemik inme, karotis invazyonu, geç dönem RT etkisi.

Introduction: Regional anesthesia is the most used in obstetric caesarean section. In particular, the use of intrathecal anesthesia has its advantages. Although the failure rate is low, the onset of this event generates difficulties that deserve attention. Objective: To describe the anesthetic management in an obstetric patient with failure of regional intrathecal anesthesia. Clinical case: Female patient, aged 20 years, who was administered intrathecal anesthesia by the specialist. There were no errors in the lumbar puncture, this was done with a trocar 25 of Whitacre tip. No sensory, motor or sympathetic block was observed, so general endotracheal anesthesia was performed, which went on smoothly. In the immediate postoperative period, joint hypermobility was observed, leading to suspicion of the diagnosis. This was positive in conjunction with the Neurology service, Ehlers-Danlos syndrome type 3 was determined. Conclusions: The failure rate is very low for subarachnoid anesthesia....

Acute coronary syndrome (ACS) is a group of conditions which often present with similar signs and symptoms while having different outcomes and complications. Therefore it is essential to differentiate between them as soon as possible and provide appropriate management. Acute coronary syndromes are classified into two categories: STE-ACS (ST segment Elevation Acute Coronary Syndrome) and NSTE-ACS (Non ST segment Elevation Acute Coronary Syndrome). STE-ACS stands for ST Elevation Acute Coronary Syndrome all of which demonstrate significant ST elevations on ECG due to complete blockage of artery by thrombus, while NSTE-ACS is due to partial occlusion of artery which exhibit ST segment depression and/or T wave inversions. Patients with NSTE-ACS who do not develop infarction are diagnosed with unstable angina, which itself is a precursor of myocardial infarction. Acute coronary syndromes are considered multifactorial and risk factors most commonly associated with development of acute cor...

Individuals diagnosed with systemic arterial hypertension (SAH) are considered risk groups for COVID-19 severity. This study assessed differences in cardiac autonomic function (CAF) and functional capacity (CF) in SAH individuals without COVID-19 infection compared to SAH individuals post-COVID-19. Participants comprised 40 SAH individuals aged 31 to 80 years old, grouped as SAH with COVID-19 (G1; n=21) and SAH without COVID-19 (G2; n=19). CAF was assessed via heart rate variability (HRV), measuring R-R intervals during a 10-minute supine period. Four HRV indices were analyzed through symbolic analysis: 0V%, 1V%, 2LV%, and 2UV%. FC assessment was performed by a 6-minute walk test (6MWT). G1 and G2 showed no difference between significant age, anthropometric, clinical and medication. G2 exhibited superior 6MWT performance, covering more distance (522±78 vs. 465±59 meters, p&lt;0.05). Specifically, G2 demonstrated a moderate, positive correlation between 6MWT and the 2LV% index (r=0.5...

Cardiovascular diseases represent, to date, the major cause of mortality worldwide. Diagnosis of the most frequent of such disease, Acute Myocardial Infarction (AMI), requires the evaluation of time-series measurement of specific cardiac biomarkers concentration. The aim of this work is to provide the clinicians with a quantitative tool to analyze such time-series, with the final goal of enhancing the diagnostic and prognostic procedures. The proposed approach is based on a novel dynamical model, which synthetically describes the basic mechanisms underlying cardiac troponin (cTnT) release into the plasma after the onset of AMI. Leveraging tools of system identification and a dataset of AMI patients treated at our University Hospital, the model has been assessed as an effective tool to quantify the characteristic release curves observed under different conditions. Furthermore, it has been shown how the devised approach is also suitable in those cases where only partial measurements are available to the clinician, to recover important clinical information. Finally, an Optimal Experimental Design (OED) analysis has been performed in order to gain insights on how to optimize the experimental data collection phase, with potentially relevant implications on both the quality and cost of the diagnosis procedure.

To investigate the efficacy of the transplantation of autologous bone marrow-derived mesenchymal stem cells (BMSCs) under arthroscopy with microfracture (MFX) compared with microfracture alone. Methods: Eleven patients with a symptomatic articular cartilage defect of the knee were included in the study. They were randomized to receive BMSCs with MFX (cell-T group, n¼7) or MFX alone (control group, n¼4). Clinical results were evaluated using International Knee Documentation committee (IKDC) knee evaluation questionnaires and the Knee Injury and Osteoarthritis Outcome Score (KOOS) before and 48 weeks after surgery. Quantitative and qualitative assessments of repair tissue were carried out at 48 weeks by T2 mapping of magnetic resonance images (MRIs) and the magnetic resonance observation of cartilage repair tissue (MOCART) scoring system with follow-up MRI. Results: No significant differences between preoperative and postoperative IKDC and KOOS were observed in the cell-T or control group. However, forty-eight weeks after surgery, the cell-T group showed a trend for a greater KOOS QOL score compared with the control group (79.4 vs. 39.1, respectively; P¼0.07). The T2 value did not differ significantly between the two groups, but the mean MOCART score was significantly higher in the cell-T group than in the control group (P¼0.02).

To develop a suite of quality indicators (QIs) for the management of patients with ventricular arrhythmias (VA) and the prevention of sudden cardiac death (SCD). The Working Group comprised experts in heart rhythm management including Task Force members of the 2022 European Society of Cardiology (ESC) Clinical Practice Guidelines for the management of patients with VA and the prevention of SCD, members of the European Heart Rhythm Association, international experts, and a patient representative. We followed the ESC methodology for QI development, which involves (i) the identification of the key domains of care for the management of patients with VA and the prevention of SCD by constructing a conceptual framework of care, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. We identified eight domains of car...

The factors which contribute to an exaggerated blood pressure response (EBPR) during the exercise treadmill test (ETT) are not wholly understood. The association between the insertion/deletion polymorphisms of the angiotensin-converting enzyme (ACE) and M235T of the angiotensinogen with EBPR during ETT still remains unstudied. To identify and compare the risk factors for hypertension between normotensive subjects with EBPR and those who exhibit a normal curve of blood pressure (BP) during ETT. In a series of EBPR cases from a historical cohort of normotensive individuals, a univariate analysis was performed to estimate the association of the studied factors with BP behavior during ETT. Additionally, logistic multivariate regression was conducted to analyze the joint effects of the variables. P-values above 0.05 were considered statistically significant. From a total of 10 027 analyzed examinations, only 219 met the criteria employed to define EBPR, which resulted in a prevalence of ...

Background Infective endocarditis (IE) following cardiac valve surgery is associated with high morbidity and mortality. Data on the impact of iatrogenic healthcare exposures on this risk are sparse. This study aimed to investigate risk factors including healthcare exposures for post open-heart cardiac valve surgery endocarditis (PVE). In this population-linkage cohort study, 23,720 patients who had their first cardiac valve surgery between 2001 and 2017 were identified from an Australian state-wide hospital-admission database and followed-up to 31 December 2018. Risk factors for PVE were identified from multivariable Cox regression analysis and verified using a case-crossover design sensitivity analysis. In 23,720 study participants (median age 73, 63% male), the cumulative incidence of PVE 15 years after cardiac valve surgery was 7.8% (95% CI 7.3-8.3%). Thirty-seven percent of PVE was healthcare-associated, which included red cell transfusions (16% of healthcare exposures) and coronary angiograms (7%). The risk of PVE was elevated for 90 days after red cell transfusion (HR = 3.4, 95% CI 2.1-5.4), coronary angiogram (HR = 4.0, 95% CI 2.3-7.0), and healthcare exposures in general (HR = 4.0, 95% CI 3.3-4.8) (all p < 0.001). Sensitivity analysis confirmed red cell transfusion (odds ratio [OR] = 3.9, 95% CI 1.8-8.1) and coronary angiogram (OR = 2.6, 95% CI 1.5-4.6) (both p < 0.001) were associated with PVE. Six-month mortality after PVE was 24% and was higher for healthcare-associated PVE than for non-healthcare-associated PVE (HR = 1.3, 95% CI 1.1-1.5, p = 0.002). The risk of PVE is significantly higher for 90 days after healthcare exposures and associated with high mortality.

Pulmonary embolism (PE) is associated with a high mortality; whether echocardiographic evaluation at presentation predicts long-term adverse outcomes is of importance. We sought to determine if a composite of routinely obtained echocardiographic parameters could determine long-term adverse events in PE patients. Right ventricular (RV) size and function and right atrial (RA) size were retrospectively evaluated in 233 consecutive PE patients with an inpatient echocardiogram, and compared with 70 healthy controls; mortality at 3 years was confirmed. PE patients had increased RV size (RV parasternal longaxis diameter (RVPLAX) and RV end-diastolic volume (p<0.001 for both)) and RA area (p<0.001). RV function was reduced in PE patients (RV fractional area change and RV ejection fraction (p<0.001 for both)). Peak tricuspid regurgitation (TR) velocity was higher in the PE group. At follow-up (3.0±2.1years), 61 patients died; multivariable analysis demonstrated RVPLAX diameter >37mm (hazard ratio (HR) 2.3, 95%CI 1.3-4.2; p=0.005), RA area >20cm 2 (HR 2.0, 95%CI 1.1-3.5; p=0.016), and TR velocity >2.9ms -1 (HR 1.9, 95% CI 1.1-3.4; p=0.021), were independent echocardiographic predictors of mortality. Patients with all 3 "risk markers" had ~17-fold increased mortality compared to those with no "risk markers" (HR 16.9, 95%CI 6.1-47.2; p<0.001). In conclusion, a composite of routinely collected echocardiographic parameters, namely an enlarged RA and RV (RVPLAX diameter), and TR velocity, were independent predictors of mortality in PE patients, with an exponential increase in mortality when all 3 parameters were significantly altered. Prospective validation is required to confirm these preliminary observations. RUNNING HEAD: Echocardiographic determinants of long-term mortality in PE patients

68.2% vs 15.9% (p<0.001), and heart failure 18.6% vs 14.2% (p¼0.06) was close to significance. In multivariate analysis were prognosis factors: age (HR¼1.020, 95CI¼1.007-1.035), creatinine clearance (each 5 points) (HR¼0.868, 95CI¼0.798-0.945), LVEF (each 5%) (HR¼0.940, 95CI¼0.890-0.992), and perfusion time (each 10 min) (HR¼1.135, 95CI¼1.111-1.160). Conclusion: They were prognosis factors for in-hospital death in multivariate analysis: age, creatinine clearance, LVEF, and perfusion time.

Results: Mean LVMI was 47.6 ± 13.6 g/m 2.7 . 68 patients had ischaemia documented on DSE. In a Cox Proportional Hazards Model, the strongest predictor of all-cause mortality was peak systolic SR (HR 4.46, 95% CI 2.45-8.11, p < 0.01), exceeding both LVH (HR 1.82, 95% CI 0.88-3.77, and. Peak systolic SR remained the strongest predictor of allcause mortality after dividing the population into those with ischaemia (n = 68, HR 8.96, 95% CI 2.78-28.91, p < 0.01), without ischaemia (n = 163, HR 3.1, 95% CI 1.49-6.46, p = 0.03), with LVH (n = 87, HR 2.84, 95% CI 1.36-5.96, p = 0.06), and without LVH (n = 144, HR 9.65, 95% CI 3.39-27.44, p < 0.01). Kaplan-Meier curves showed a significant difference after grouping the data on the basis of the presence and/or absence of LVH and/or ischaemia (p < 0.01). Conclusion: Peak systolic strain rate during dobutamine stress echocardiography is a predictor of all-cause mortality independent of left ventricular hypertrophy and myocardial ischaemia.

Purpose We hypothesize that both increased myocardial steatosis and interstitial fibrosis contributes to subclinical myocardial dysfunction in patients with increased body mass index and diabetes mellitus. Background Increased body weight and diabetes mellitus are both individually associated with a higher incidence of heart failure with preserved ejection fraction. However, it is unclear how increased myocardial steatosis and interstitial fibrosis interact to influence myocardial composition and function. Methods A total of 100 subjects (27 healthy lean volunteers, 21 healthy but overweight volunteers, and 52 asymptomatic overweight patients with diabetes) were prospectively recruited to measure left ventricular (LV) myocardial steatosis (LV-myoFat) and interstitial fibrosis (by extracellular volume [ECV]) using magnetic resonance imaging, and then used to determine their combined impact on LV global longitudinal strain (GLS) analysis by 2-dimensional (2D) speckle tracking echocardiography on the same day. Results On multivariable analysis, both increased body mass index and diabetes were independently associated with increased LV-myoFat. In turn, increased LV-myoFat was independently associated with increased LV ECV. Both increased LV-myoFat and LV ECV were independently associated with impaired 2D LV GLS. Conclusion Patients with increased body weight and patients with diabetes display excessive myocardial steatosis, which is related to a greater burden of myocardial interstitial fibrosis. LV myocardial contractile function was determined by both the extent of myocardial steatosis and interstitial fibrosis, and was independent of increasing age. Further study is warranted to determine how weight loss and improved diabetes management can improve myocardial composition and function.

Inverted left atrial appendage is an unusual complication associated with congenital cardiac surgery. Inversion of the left atrial appendage may occur during the surgical procedure or afterwards. The left atrial appendage may invert iatrogenically or as a result of the negative pressure during placement or removal of the left atrial vent or during deairing manoeuvres. This event can be life-threatening because of the mass effect of the atrial appendage within the left atrial cavity.

ontinuous-flow ventricular assist devices (CVADs) are more compact, less costly, and potentially more durable than pulsatile ventricular assist devices (PVADs). However, studies in animal models suggest that long-term continuous-flow support can result in hemodynamic dysfunction. This includes the disruption of the renin-angiotensin system 1 and the response to norepinephrine administration in comparison with PVADs. The purpose of this study was to determine whether CVAD insertion and duration of CVAD support was associated with greater hemodynamic compromise after return to pulsatility after device explantation and heart transplantation.

Although cumulative evidence indicates that risk factors for arteriosclerosis have an impact on age-related changes in brain pathology, the influence of aging without major risk factors on changes in brain structures has not yet been fully elucidated. We used magnetic resonance imaging (MRI) to study how aging affects structural changes in the brain (eg, white matter lesions, hippocampal atrophy [HA], microbleeds) in normal subjects without major risk factors for cerebrovascular diseases. We studied 1108 subjects who underwent voluntary brain screening and had no cerebrovascular risk factors, such as hypertension, diabetes mellitus, or hyperlipidemia. We examined the conventional and T2-weighted MRI to define white matter hyperintensities, HA, and cerebral microbleeds in addition to all physical parameters, blood biochemical data, and neuropsychiatric symptoms. We found that the prevalence of white matter lesions and HA increased significantly with age (P , .001). Logistic analysis showed that periventricular hyperintensity was significantly related to age (P , .0001) and depressive state (P , .01). A linear relation was found between white matter lesions and HA (P ,.05). Cerebral microbleeds also increased with age, and their presence was associated with HA (P ,.001). White matter lesions, HA, and cortical microbleeds were associated with one another in healthy elderly subjects, and these changes were affected by the aging process independent of any cerebrovascular risk factors. Cerebral amyloid angiopathy may underlie these age-related brain changes.

Abstracts: The vascular endothelium produces a large number of vasodilator and vasoconstrictor compounds which regulate vascular tone. Nitric Oxide (NO) is recognised to be the most important and best characterised mediator; its intrinsic vasodilator function is commonly used as a surrogate index of endothelial function. Various studies have demonstrated that exercise training improves endothelium-dependent vasodilator function. Yoga is a group of physical, mental, and spiritual practices or disciplines which originated in ancient India. The poses and stretches are thought to have physical and mental health benefits. Optimum exercise training schedules in the form of Yogasanas & pranayam may result in possible sequential changes in the endovascular milieu. Yoga exercise mediated improvement in endothelial function may provides plausible cardio protective benefits of exercise training. We evaluated the impact of exercise in the form of yoga v/s sedentary life on serum Nitric Oxide (N...

Unilateral absence of pulmonary artery is a rare congenital anomaly that presents with or without other cardiac anomalies. Often asymptomatic, it can lead in adulthood to exertional dyspnea, hemoptysis, or recurrent respiratory infections. We present a patient with unilateral right-sided cardiogenic pulmonary edema in whom the congenital unilateral absence of the left pulmonary artery and pulmonary vein shielded the left lung from developing pulmonary edema. A 65-year-old woman, with severe COPD, was admitted with acute hypoxemic and hypercapnic respiratory failure secondary to cardiogenic pulmonary edema following acute inferior wall myocardial infarction. The chest radiograph and chest CT scan revealed right-sided pulmonary edema with a small left lung devoid of the pulmonary artery and pulmonary vein and free of pulmonary edema. The patient responded well to the treatment. DISCUSSION: Congenital unilateral absence of the pulmonary artery (UAPA) is approximately 0.39% of all congenital heart diseases caused by the failure of the sixth aortic arch to connect with the pulmonary trunk during embryologic development and was first described by Fraentzel in 1868. The right pulmonary trunk is involved in two-thirds of the cases and is usually associated with patent ductus and anomalous pulmonary blood supply. Left-sided UAPA is linked to the tetralogy of Fallot. Congenital absence or agenesis of the pulmonary vein is not a finding that has been previously described in the literature. A rare congenital anomaly in our patient in the form of UAPA and the absence of pulmonary vein shielded the lung from developing cardiogenic pulmonary edema.