Cardiology

PURPOSE: To report a case in which observation of increased ocular pulse amplitude (OPA) estimates in both eyes lead to a diagnosis of, and was presumably due to, aortic regurgitation. DESIGN: Case report. METHODS: An incidental finding of high OPA estimates in both eyes lead to a finding of widened arterial pulse pressure and aortic regurgitation. OPA estimates were taken after aortic valve surgery when arterial pulse pressure was normal. RESULTS: OPA estimates were 9 mm Hg in both eyes when arterial pulse pressure was high and 3 mm Hg in each eye when normal. CONCLUSION: Widened arterial pulse pressure may lead to increased OPA. (Am J Ophthalmol 2004;138:503.

The effects of hemodialysis on the cerebral circulation of humans and the correlation between changes in blood flow velocity in the basal cerebral arteries and those of several physiological variables influenced by hemodialysis have been inadequately studied. Blood flow velocities were obtained from the middle cerebral artery and the basilar artery by transcranial Doppler ultrasonography in 27 patients receiving chronic maintenance hemodialysis immediately before and after the procedure. Changes in body weight, hematocrit, blood pressure, and arterial blood gases were recorded simultaneously. There was a significant reduction in mean flow velocity in the middle cerebral artery (P < .01) and the basilar artery (P < .01) after hemodialysis. We observed a significant negative correlation between the relative change in mean flow velocity and the loss of weight after hemodialysis, the amount of fluid removed, and the increase in hematocrit in the middle cerebral artery and the basi...

Objectives The aim of this study was to investigate cardiac involvement detected by ECG in patients with idiopathic inflammatory myopathies (IIMs) and to evaluate possible associations between the autoantibody profile and ECG changes in these patients. Methods In a Scandinavian cross-sectional study, patients were included from two Danish centres and one Swedish centre. Resting 12-lead ECG was investigated in 261 patients with IIM compared with 102 patients with systemic sclerosis (SSc) and 48 healthy controls (HCs). ECG changes were correlated to clinical manifestations and myositis-specific and myositis-associated autoantibodies (MSAs and MAAs, respectively). Results Patients with IIM had a longer mean corrected QT (QTc) duration and more frequently presented with prolonged QTc (≥450 ms; P = 0.038) compared with HCs. A longer QTc duration was recorded in SSc compared with IIM [433 ms (s.d. 23) vs 426 (24); P = 0.011], yet there was no significant difference in the fraction with pr...

Idiopathic inflammatory myopathies (IIM) include the main subgroups polymyositis (PM), dermatomyositis (DM), inclusion body myositis (IBM) and juvenile DM ( JDM). The mentioned subgroups are characterised by inflammation of skeletal muscles leading to muscle weakness and other organs can also be affected as well. Even though clinically significant heart involvement is uncommon, heart disease is one of the major causes of death in IIM. Recent studies show an increased prevalence of traditional cardiovascular risk factors in JDM and DM/PM, which need attention. The risk of developing atherosclerotic coronary artery disease is increased twofold to fourfold in DM/PM. New and improved diagnostic methods have in recent studies in PM/DM and JDM demonstrated a high prevalence of subclinical cardiac involvement, especially diastolic dysfunction. Interactions between proinflammatory cytokines and traditional risk factors might contribute to the pathogenesis of cardiac dysfunction. Heart involvement could also be related to myocarditis and/or myocardial fibrosis, leading to arrhythmias and congestive heart failure, demonstrated both in adult and juvenile IIM. Also, reduced heart rate variability (a known risk factor for cardiac morbidity and mortality) has been shown in long-standing JDM. Until more information is available, patients with IIM should follow the same recommendations for cardiovascular risk stratification and prevention as for the corresponding general population, but be aware that statins might worsen muscle symptoms mimicking myositis relapse. On the basis of recent studies, we recommend a low threshold for cardiac workup and follow-up in patients with IIM.

Background Childhood dilated cardiomyopathy (CDCM) is the most common cardiomyopathy in children and it is risk factor to heart failure and sudden death. Most of the different etiologic factors which have been postulated to DCM are idiopathic, and its pathogenesis remains uncertain. So it was worth investigating the potential DCM pathogenicity models to establish early noninvasive diagnosis parameters especially in CDCM patients. Beside that miRNAs in the circulatory blood are genetically considered the best option for noninvasive diagnosis; also, implementation of miRNAs as early diagnostic markers for children with DCM is urgent because those children have high risk to sudden heart death. We aimed to identify discriminator diagnostic circulatory miRNA expression levels in CDCM patients. Results The expression levels of miR-454-3p and miR-194-5p were found significant upregulated (p value = 0.001 and 0.018; CI 95%, respectively), while miR-875-3p was found significant downregulated...

generation rate coupled to substrate oxidation. (Pediatr Res 37: 634-639, 1995) Abbreviations mtDNA, mitochondrial DNA NARP , neurogenic muscle weakness, ataxia, retinitis pigmentosa nt, nucleotide LHON, Leber hereditary optic neuroretinopathy MELAS, mitochondrial encephalomyopathy, lactic acidosis and strokelike episodes CT, computerized tomography PCR, polymerase chain reaction NARP syndrome is associated with a heteroplasmic mtDNA point mutation, a T G change at nt 8993 of mtDNA (5) of the gene encoding the subunit 6 of FIFo ATP synthase. Two

Left ventricular pseudoaneurysm is a rare complication of acute myocardial infarction, associated with high mortality. However, it can present in a non-specific manner, complicating and delaying the diagnosis. The authors present the case of a 65-year-old patient, hypertensive, with no other known relevant medical history, who presented with chest pain, cough and left pleural effusion, initially attributed to a pulmonary process. However, these were in fact the result of a left ventricular pseudoaneurysm following silent acute myocardial infarction. The diagnosis was suspected on echocardiography and confirmed by cardiac magnetic resonance imaging, and the patient underwent successful surgical pseudoaneurysm repair. This case illustrates an atypical presentation of a left ventricular pseudoaneurysm, in which the manifestations resulted from pericardial and pleural extension of the inflammatory process associated with contained myocardial rupture. The case demonstrates the need for a...

Ventricular oversensing in patients with defibrillators is an infrequent but deleterious condition. We report a patient with a cardiac resynchronizationedefibrillation device that presented with hyperkalemia and syncope. Device interrogation revealed ventricular double-counting within the QRS of a slow ventricular tachycardia, resulting detection of the slow ventricular tachycardia in the ventricular fibrillation zone, and delivery of an effective therapy, below device programmed detection rate. This case of defibrillator inappropriate detection emphasizes the relevance of device electrogram interrogation in order to minimize inappropriate therapies.

Eletrofisiologia cardíaca; Ablac ¸ão por cateter; Cardioversordesfibrilhador implantável; Resumo Os autores analisam o número e tipo de procedimentos efetuados durante o ano de 2012 com base em inquéritos enviado aos centros nacionais que durante este ano praticaram eletrofisiologia diagnóstica e de intervenc ¸ão e/ou implantaram cardioversores-desfibrilhadores (CDI), e comparam estes dados com os de anos anteriores. Em 2012 foram efetuados 2561 estudos eletrofisiológicos diagnósticos, seguidos de ablac ¸ão em 2017 dos casos, o que representa uma estabilizac ¸ão comparativamente ao ano anterior. Registou-se um aumento de 12% no número de ablac ¸ões de fibrilhac ¸ão auricular, que passou a representar a indicac ¸ão mais frequente para ablac ¸ão, ultrapassando a taquicardia por reentrada nodal auriculoventricular. O número total de primeiras implantac ¸ões de CDI foi de 1048 (cerca de 100/milhão de habitantes), sendo que, destes, 375 eram CDI com ressincronizac ¸ão ventricular (CDI BIV). Estes dados traduzem um ligeiro decréscimo (3,3%) do número de primeiras implantac ¸ões, com um aumento relativo de 10% no número de CDI BIV face ao ano anterior. No entanto, verificou-se um crescimento muito significativo no número de substituic ¸ões de geradores de CDI, de que resultou um acréscimo de 3,5% no total de implantac ¸ões efetuadas em 2012. São feitas algumas considerac ¸ões acerca da evoluc ¸ão e estado atual desta atividade hospitalar e sobre alguns fatores que poderão influenciar a dinâmica verificada nesta área da cardiologia de intervenc ¸ão.

The aim of this study is to investigate the correlation between AVS with the involvement of coronary arteries and the risk factors. The relationship among aortic sclerosis, the presence and severity of CAD and cardiovascular endpoints in patients presenting with chest pain was studied by an observational cross-sectional study. Results: Patients aged >60 years with aortic valve sclerosis had higher prevalence of coronary artery disease with p value of <0.05 & AVS is considered as independent predictor of obstructive CAD. Our study predicts that AVS is strongly correlated with the extent of coronary artery obstruction and that echocardiographic evaluation of AVS in patients undergoing coronary angiography may be considered as a substitute marker for the extent of coronary atherosclerosis and thus of CAD.

Background -There is scarcity of data regarding CAD and the outcome following PCI in young south Indian population. We sought to analyze the clinical, coronary angiographic features and outcome in young adults(≤45 years of age) with CAD who underwent PCI and also to compare that between young male and female patients . Methods-Angiographic and clinical data from total 150 patients aged ≤ 45 years of which, 110 male patients who underwent PCI from January 2014 to January 2016 were compared to age-matched 40 female patients in our centre . All patients were treated according to guidelines. 1, 6 and 12 months clinical follow-up were performed in all patients. Coronary angiography was performed only if patients were symptomatic or TMT positive. Results -CAD risk factors were more prevalent in young male patients, Diabetes mellitus was found in 32. 72%, hypertension (34.54%), dyslipidemia (36.36%), smoking (38.18%), tobacco consumption (21.81%) and hyperhomocysteinemia (23.63%) as compared to female group (17.5%,20%,12.5%,0%,5%,12.5% respectively). Family history of CAD was found to be higher in female patients as compared to males (40% vs 6.36%; p =0.000). Single vessel disease was found to be common among female patients(60% vs 40.92%) and

properties of the diaphragm are equivocal. This investigation used the in vitro diaphragm muscle preparation to determine the effects of glucocorticoids on isotonic muscle contraction parameters in costal diaphragm muscle . Adult male rats (N=8) were administered prednisolone (PRED) (5 mg/kg b.w. ) or an equal volume of the vehicle solution (CTL) (N= 9) for 10 days. Diaphragm strips were suspended vertically between two plexiglass clamps and stimulated along their entire lengths by plate electrodes . Tetanic contractions were produced by a supramaximal voltage delivered in trains of 2 ms impulses (40 pps for 330 ms). Maximal isometric tetanic tension was determined and a force velocity curve was developed using at least eight points of varying loads. Fatigue was assessed by contracting the muscle against a load that was 30 % of peak tetanic force at 1 train sec-' until the muscle reached 50% of the original power output. Specific tension (Po), maximal velocity of shortening (Vmax), time to fatigue and the general shape of the force velocity curve (a/Po) were measured in both treated and untreated diaphragm strips. There was no significant difference between groups for Vmax, the fatigue index or the a /Po relationship. However, a significant difference existed for Po between FRED ( 1.60 ± 0.19 kg/cmz) and CTL (2.17 ± 0.44 kg/cmz). This decrease in specific tension of the diaphragm suggests that the decrease in ability to generate tension is not simply due to atrophy of the muscle, but may be due to changes in fiber type.

Objective: Deleterious electrical abnormalities evolve during myocardial infarction. The goal of this study was to analyse current changes during the late decompensated phase of heart disease induced by coronary ligation and to compare them in various heart regions. Methods: Young rats were submitted to left coronary ligature. After 4-6 months, cells were enzymatically dissociated and isolated from the upper part basal region of the left ventricle, as well as from the septum, apex and the right ventricle before being studied under 21 whole-cell patch-clamp. Results: Basal L-type Ca current, I elicited at 110 mV did not exhibit regional dependence neither in CaL control nor after post-myocardial infarction (PMI). I showed both a significantly reduced peak amplitude (17.162.8 pA / pF versus CaL 9.961.4 pA / pF in seven control and seven PMI hearts, n532 and 40, respectively) and a slower inactivation, such that the amount of inward charges during a 200 ms-depolarizing pulse was nearly unchanged. b-Adrenergic stimulation was less effective in increasing I CaL 1 in PMI cells but it slowed inactivation further. Significant differences in the K currents were observed. A regional distribution was seen for I only, with the largest amplitude in the right ventricle (in pA / pF: 23.162.4, 18.263.9, 14.862.4, 8.361.7 in the right ventricle, to apex, septum and left ventricle, respectively n58, 7, 8 and 9). This was also true in failing heart cells despite I being halved in each of to the four regions (in pA / pF: 12.262.5, 11.261.9, 5.161.0 and 4.861.0, respectively n512, 12, 11 and 13). I was also significantly K1 reduced by 20% in the PMI cells. Two-way analyses of variance demonstrated the absence of interaction between the topographical origin of the cells and the physiological state of the rats. The a -adrenergic agonist, methoxamine significantly reduced I and I to the same 1 to K1 extent in both sham and PMI cells, by about 35% and 20% respectively. Conclusions: Long-term left coronary occlusion induces 21 1 significant alterations in both Ca and K currents that occur with similar amplitude in both ventricles. They include a marked reduction in I amplitude as well as a slowing of I inactivation. Both factors could contribute to the disturbances in cellular electrical behaviour to CaL and the occurrence of arrhythmias in the post-myocardial infarcted heart.

The cardiac myosin phenotype, an important determinant of myocardial contractility, is modified by chronic increases in hemodynamic load. To quantify the proportion of atrial alpha-myosin heavy chain in various types of left atrial overload and to assess the possible relation between this proportion and atrial size, 34 patients were studied , 4 with Wolff-Parkinson-White syndrome, 29 with various types of mitral valvedysfunction and 1 with an atrial septal defect. Four normal autopsy hearts were also studied. The proportion of alpha-myosin heavy chain among total (alpha plus beta) myosin heavy chains was determined in each atrial sample, using an enzyme-linked immunosorbent assay. The size of the left atrium was assessed by one-and two-dimensional echocardiography. Alpha-myosin heavy chain was the main isoform present in the normal atria (85.5 ± 9% of total myosin heavy chains). Patients with pure tight mitral stenosis (n = 9), mitral stenosis plus mild regurgitation (n = 8) Hypertrophy is characteristic of hearts subjected to a chronic increase in hemodynamic work . The adaptive nature of this process at the level of the cardiac pump is well established, because the resulting increase in ventricular wall thicknes s tends to restore normal systolic or diastolic wall stress , or both (I ). In addition to this quantitative process , qualitati ve changes in several proteins involved in myocyte contractile function also occur. In this respect , the isomyosin transition From the

Left ventricular remodeling after myocardial infarction is accompanied by electrical abnormalities that might predispose to rhythm disturbances. To get insight into the ionic mechanisms involved, we studied myocytes isolated from four different regions of the rat ventricles, 4-6 months after ligation of the left coronary artery. Using the whole-cell patch-clamp technique, we never observed T-type Ca 2+ current in both diseased and control hearts. In contrast, in 41 out of 78 cells isolated from 16 post-myocardial infarcted rats, analysed in the presence of 30 m Na + ions, we found a tetrodotoxin (TTX)-resistant Na + current with quite variable amplitude in every investigated region. Albeit being resistant to 100  TTX, this Na + -dependent current was highly sensitive to lidocaine since 3  lidocaine induced about 65% tonic block. It was also inhibited by 5  nifedipine and 2 m Co 2+ , but was insensitive to 100  Ni 2+ . The TTX-resistant Na + channel availability was shifted rightward by 25-30 mV with respect to TTX-sensitive Na + current; therefore, a large "window current" might flow in the voltage range from -70 to -20 mV. In conclusion, in late post-myocardial infarction, a Na + current with specific kinetics and pharmacology may provide inward charges in a critical range of membrane voltages that are able to alter action potential time course and trigger ventricular arrhythmia. These apparent new characteristics of the Na + channel might result in part from environmental changes during heart remodeling.

We analyzed regional wall motion in 238 patients by using cineangiograms recorded in the 30" right anterior oblique projection. The sample was divided into three groups: a normal group (n = 71), a group with isolated obstruction of the left anterior descending coronary artery and previous anterior myocardial infarction (n = 85), and a group with isolated obstruction of the right coronary artery and previous inferior myocardial infarction (n = 82). Both anterior and inferior groups also had motion abnormality within the corresponding anterior or inferior wall as judged by the qualitative analysis of cineangiograms. Four quantitative methods were compared: a long axis method and a center of mass method using internal reference systems, a method derived from the Stanford model and an area-based method using external reference systems. Normal regional values were determined from the normal group to evaluate the specificity and sensitivity of the methods. The area-based method was the most sensitive in the anterior infarction group, whereas the center of mass method was the most sensitive in the inferior infarction group. We conclude that there is no evidence that any method, among those tested, is superior to others for every expected location of wall motion abnormality.

Inflammatory rheumatological conditions, also known as inflammatory rheumatic conditions (IRC), constitute a category of autoimmune and inflammatory ailments primarily affecting the musculoskeletal system, encompassing the joints, muscles, and connective tissues. The objective of this meta-analysis is to evaluate the impact of inflammatory rheumatological conditions (IRC) on post-acute coronary syndrome (ACS) outcomes. This study was performed as per the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. The PubMed, Web of Science, and Scopus databases were searched by two authors without any language constraints from January 1, 2015, to October 15, 2023. The primary outcome assessed in this meta-analysis was all-cause mortality. Other outcomes included myocardial infarction and revascularization. A total of 11 studies were included in this meta-analysis. The risk of allcause mortality was significantly higher in patients with IRC compared to non-IRC patients (RR: 1.12, 95% CI: 1.00 to 1.26, p-value: 0.04). There is a significantly higher risk of myocardial infarction and revascularization in patients with IRC as opposed to those without IRC. Furthermore, while there was a higher risk of stroke in the IRC group compared to the non-IRC group, this disparity did not reach statistical significance. Future research should focus on specific inflammatory rheumatoid conditions, a comprehensive evaluation of cardiovascular events, and targeted interventions to enhance patient outcomes in this vulnerable population.

411A 59 ~ 11 years (69% mates). History of prevmus MI was present in 4b% el the I:)ts and 13% presented with cardtogenic shock, The culpnt lesion was located in tha LAD (23%), RCA (37%), LCX (11%) or a ~apbenous vein graft (28%), Adjunhv~ pereutaneou~ mvasculanzation wag I~rtormed tn 93% of the I~t~ents; PTCA alone (46%), coronary stentmg (46%), and rotational athemctomy (1%) Pemont dmmeter stenosm was reduced from 82% to 50% after Anglolet. and to 2_4% after (f~finitM~ treatment (P = 0,0001 ), Procedural SuccesS. defined as the esto~ti0n of TIMI 3 flow and m. hO~l~l ~ froth (~41th, eff~flf]6ftf bY~ISS §urg~ry or malor d~saJ~ling ~tf¢~ke, wSS ~i~hed in g8%, Procedure compl~tmns included d~st~l ~lzallon (2%), translenl no.relfow (2%), and al~'upt Closure (:~) At 1 Oir,¢al !~ UP, 2 (2%) pl~ cf;ed; 3 (3%) patients had recurrent Mt and 2_ (~'~) requtft~l mpe-~h~;I t~lOel vessel parcutaneous re~a~lanzation At ! month fcdlOw UP 82 (92%) pabents were stive and free from recurrent MI and repeat mvasO~anzaben pmOadum, Conctuszons: The Ar~,olet m a promising adtuntrve device for establishm 9 pateno/m th~ laden Les~. !t t5 Of parlv~ula f utility if1 ~cute mvo¢ardlal mfarcl~n where the ~nce Of coronary t~rom~ enhances the pa~prOco, dum C~tm~ rate.

411A 59 ~ 11 years (69% mates). History of prevmus MI was present in 4b% el the I:)ts and 13% presented with cardtogenic shock, The culpnt lesion was located in tha LAD (23%), RCA (37%), LCX (11%) or a ~apbenous vein graft (28%), Adjunhv~ pereutaneou~ mvasculanzation wag I~rtormed tn 93% of the I~t~ents; PTCA alone (46%), coronary stentmg (46%), and rotational athemctomy (1%) Pemont dmmeter stenosm was reduced from 82% to 50% after Anglolet. and to 2_4% after (f~finitM~ treatment (P = 0,0001 ), Procedural SuccesS. defined as the esto~ti0n of TIMI 3 flow and m. hO~l~l ~ froth (~41th, eff~flf]6ftf bY~ISS §urg~ry or malor d~saJ~ling ~tf¢~ke, wSS ~i~hed in g8%, Procedure compl~tmns included d~st~l ~lzallon (2%), translenl no.relfow (2%), and al~'upt Closure (:~) At 1 Oir,¢al !~ UP, 2 (2%) pl~ cf;ed; 3 (3%) patients had recurrent Mt and 2_ (~'~) requtft~l mpe-~h~;I t~lOel vessel parcutaneous re~a~lanzation At ! month fcdlOw UP 82 (92%) pabents were stive and free from recurrent MI and repeat mvasO~anzaben pmOadum, Conctuszons: The Ar~,olet m a promising adtuntrve device for establishm 9 pateno/m th~ laden Les~. !t t5 Of parlv~ula f utility if1 ~cute mvo¢ardlal mfarcl~n where the ~nce Of coronary t~rom~ enhances the pa~prOco, dum C~tm~ rate.

ABSTRACT… Objective: To present our experience of modified del Nido Cardioplegia for chemical arrest and myocardial protection during congenital heart defect in pediatric cardiac surgeries. Study Design: Retrospective Cross Sectional. Setting: Department of Cardiac Surgery, PAQSJIMS, Gambat, Khairpur. Period: 15th March, 2021 to 10th October, 2022. Material & Methods: del Nido solution is generally constituted in plasma lyte A solution, not available in Pakistan; therefore, we constituted del Nido solution in ringer lactate solution. We had collected our data retrospectively for our study to assess the safety and efficacy of modified del Nido cardioplegic arrest during the open heart surgeries for congenital heart defects. We report clinical outcomes of our patients that include spontaneous rhythm, ionotropic score and duration of mechanical ventilation underwent open heart surgeries with. Results: During the study period we had performed 102 surgeries for correction or palliation o...

Left ventricular-arterial coupling (VAC) is a key determinant of global cardiovascular performance, calculated as the ratio between arterial elastance (EA) and left ventricular end-systolic elastance (EES). Over the years, acute myocardial infarction (STEMI) has remained an important cause of morbidity and mortality worldwide. Although, until recently, it was considered a disease occurring mostly in older patients, its prevalence in the young population is continuously rising. In this study, we aimed to investigate the role of 3D VAC and its derived indices in predicting adverse outcomes in young patients with STEMI. We prospectively enrolled 84 young patients (18-51 years) with STEMI who underwent primary PCI and 28 healthy age and sex-matched controls. A 3D echocardiography was used for non-invasive measurements of end-systolic elastance (EES), arterial elastance (EA), and VAC (EA/EES). The occurrence of major adverse cardiac events (MACE) was assessed one year after the index STEMI. Out of 84 patients, 15.4% had adverse events at 12 months follow-up. Patients were divided into two groups according to the presence or absence of MACE. There were no significant differences in arterial elastance between the two groups. EA was higher in the MACE group but without statistical significance (2.65 vs. 2.33; p = 0.09). EES was significantly lower in the MACE group (1.25 ± 0.34 vs. 1.91 ± 0.56. p < 0.0001) and VAC was higher (2.2 ± 0.62 vs. 1.24 ± 0.29, p < 0.0001). ROC analysis showed that VAC has a better predictive value for MACE (AUC 0.927) compared with EA or EEA but also compared with a classical determinant of LV function (LVEF and LVGLS). A VAC value over 1.71 predicts unfavourable outcome with 83.3% sensitivity and 97.1% specificity. In both univariate and multivariate COX regression analysis, VAC remained an independent predictor for MACE and demonstrated incremental prognostic value over LVEF and LVGLS in the proposed statistical models. In conclusion, 3D VAC is an independent predictor of adverse events in young patients with STEMI at a 12 month follow-ups and could be used for a more accurate risk stratification in the acute phase.

After bidirectional cavopulmonary connection (BDCPC) central pulmonary arteries (PAs) of single ventricle (SV) patients can be affected by stenosis or even closure. Aim of this study is to compare SV patients with and without PA-stent implantation post-BDCPC regarding risk factors for stent implantation and outcome. Single center, retrospective (2006Single center, retrospective ( -2021) ) study of 136 SV consecutive patients with and without PA-stent implantation post-BDCPC. Patient characteristics, risk factors for PA-stent implantation and PA growth were assessed comparing angiographic data pre-BDCPC and pre-TCPC. A total of 40/136 (29%) patients underwent PA-stent implantation at median (IQR) 14 (1.1-39.0) days post-BDCPC. 37/40 (92.5%) underwent LPA-stenting. Multiple regression analysis showed single LV patients to receive less likely PA-stents than single RV patients (OR 0.41; p = 0.05). Reduced LPA/BSA (mm/m2) and larger diameter of neo-ascending aorta pre-BDCPC were associated with an increased likelihood of PA-stent implantation post-BDCPC (OR 0.89, p = 0.03; OR 1.05, p = 0.001). Stent re-dilatation was performed in 36/40 (89%) after 1 (0.8-1.5) year. Pulmonary artery diameters pre-BDCPC were lower in the PA-stent group: McGoon (p < 0.001), Nakata (p < 0.001). Indexed pulmonary artery diameters increased equally in both groups but remained lower pre-TCPC in the PA-stent group: McGoon (p < 0.001), Nakata (p = 0.009), and Lower Lobe Index (p = 0.003). LPA and RPA grew symmetrically in both groups. Single RV, larger neo-ascending aorta, and small LPA pre-BDCPC are independent risk factors for PA-stent implantation post-BDCPC. Pulmonary artery diameters after PAstent implantation and stent re-dilatation showed significant growth together with the contralateral side, but the PA-system remained symmetrically smaller in the stent group.

OBJECTIVES: Bidirectional cavopulmonary anastomosis (BDCPA) is part of the staged Fontan palliation for congenital heart defects with single-ventricle morphology. The aim of this study was to describe incidence and characteristics of early postoperative arrhythmias in patients undergoing BDCPA. METHODS: Retrospective analysis of 60 patients undergoing BDCPA at the age of <12 months from 2001 to 2008 at a single centre. Arrhythmias were subclassified in sinus bradycardia, premature atrial/ventricular contraction, supraventricular tachycardia and atrioventricular block. The groups were compared according to age at operation and diagnosis. Postoperative follow-up data were included until Fontan completion. Postoperative arrhythmia was observed in 20 patients: 12 temporary and 8 persisting until hospital discharge. Sinus bradycardia is a common postoperative arrhythmia and occurred in 16 patients (9 transient, 7 persistent until hospital discharge). One patient undergoing BDCPA and a Damus-Kaye-Stansel procedure had a persisting first-degree atrioventricular block. The occurrence of a postoperative arrhythmia was independent of age and diagnostic group (hypoplastic left heart vs non-hypoplasic left heart). After hospital discharge, five of the eight arrhythmia resolved spontaneously resulting in 2 patients with sinus bradycardia and 1 patient with a first-degree AV block immediately before the Fontan completion was undertaken. Postoperative arrhythmias in patients with BDCPA occur early after surgery and are temporary. Severe and life-threatening arrhythmias are rare although the interventions are complex and the patients very young. The most common arrhythmia is sinus bradycardia.

Aims Correct timing of pulmonary valve replacement (PVR) is crucial for preventing complications of pulmonary regurgitation and right ventricular (RV) dilatation after repair of tetralogy of Fallot. We sought to assess the remodelling of the RV after early PVR in children, using cardiovascular magnetic resonance (CMR). Methods and results Twenty children with severe pulmonary regurgitation and RV dilatation and mean age 13.9+3 years underwent CMR evaluation 5.6 + 1.8 months before and 5.9 + 0.6 months after PVR. PVR was performed when the RV end-diastolic volume exceeded 150 mL/m 2 , as measured by CMR. The time interval between primary repair and PVR was 12 + 3 years. Post-operative CMR demonstrated a significant reduction of the RV end-diastolic volume from 189.8 + 33.4 to 108.7 + 25.8 mL/m 2 (P , 0.0001), of the RV end-systolic volume from 102.4 + 27.3 to 58.2 + 16.3 mL/m 2 (P , 0.0001), and of the RV mass from 48.7 + 12.3 to 35.8 + 7.7 g/m 2 (P , 0.0001). The RV ejection fraction did not change significantly. Conclusion Prompt RV remodelling, with reduction of RV volume and mass, is observed after performing PVR if the RV end-diastolic volume exceeds 150 mL/m 2 . Early PVR may prevent the detrimental complications of severe pulmonary regurgitation.

Currently OSAS is recognized as an independent predictor for obesity, and this, in turn, is characterized as the main risk factor for OSAS. This article aims to review the existing literature on the relationship between OSA and obesity, whereas endocrine and metabolic aspects of this relationship and to discuss the role of weight loss in the treatment of this syndrome. Several studies have shown that OSA is directly associated with endocrine disorders such as leptin levels and ghrelin, hormones related to hunger and satiety, and can contribute to increased insulin resistance and cortisol, increasing the risk of chronic diseases such as cardiovascular. Whereas OSAS is an independent risk factor for hypertension and cardiovascular disease, as well as being strongly associated with obesity and insulin resistance, various treatments have been currently proposed, including surgery, oral appliances, CPAP use, as well as changes in lifestyle, which focus on inclusion of exercise and decrea...

Реферат. Зміни рівня галектину-3, β-2-мікроглобуліну, альбумінурії та продуктів кінцевого глікірування у хворих з хронічною серцевою недостатністю і фібриляцією передсердь під впливом лікування. Курята О.В., Мухаммад Мухаммад, Митрохіна О.С. Поєднання хронічної серцевої недостатності і фібриляції передсердь вважається одним з найбільш прогностично несприятливих поєднань серед серцево-судинних захворювань. Зараз активно обговорюється потреба в нових маркерах як потенційних мішенях для терапевтичного впливу. На сьогоднішній день продовжується активне вивчення кардіоренального синдрому, що в свою чергу веде до активного пошуку препаратів, що зменшують нефрологічний ризик, особливо в категорії осіб, що має комбіновану серцево-судинну патологію. Метою дослідження було порівняти вплив ірбесартану й інгібіторів АПФ на рівень галектину-3, β-2-мікроглобуліну, альбумінурії і продуктів кінцевого глікірування (AGE) у хворих з хронічною серцевою недостатністю з фібриляцією передсердь і порушенням функції нирок. Представлені і проаналізовані результати впливу препаратів у пацієнтів з хронічною серцевою недостатністю з фібриляцією передсердь. Дані свідчать про необхідність більш ретельної уваги до цієї групи хворих, а саме про необхідність діагностики функціонального стану нирок, що має дуже важливе значення для розробки ефективних заходів, спрямованих на запобігання прогресування цих захворювань.

Sleep is regarded as one of the basic needs of human. Several factors can cause sleep disturbances in hospitalized inpatients, among which noise and light can be taken into account in Coronary Care Unit(CCU). Therefore, this study intended to investigate the effect of eyemasks and earplugs use on sleep quality of patients suffering from Myocardial Infarction in CCU. In this randomized clinical trial, a sample size of 90 patients admitted in CCU was selected. The samples were randomly divided into three groups on the first night of stay: patients with an eye mask and ear plug, patients with only an eye mask and patients in the control group. The intervention was performed from the first night of admission until discharge and sleep quality was assessed by Visual Analog Scale. Moreover, the study data were analyzed via SPSS software (ver,18) using ANOVA, paired t-test, independent t-test and post hoc Don. The mean score of sleep quality showed a significant difference after the intervention between the two experimental groups with the control group (p<0/05), whereas no significant difference was observed between the two experimental groups after the intervention (p>0/05). The study findings revealed that using eyemasks and earplugs as low-cost and uncomplicated devices can improve sleep quality in patients in CCU.

Atrial fibrillation ranks among the most common heart rhythm disorders. Considering the lack of any trusted method capable of foreseeing possible recurrence of atrial fibrillation after it has been terminated, nonlinear analyses of beat-tobeat heart rate variability demonstrate promising potential. This work focuses on verifying the capability of the nonlinear methods to differentiate patients with early recurrence of atrial fibrillation from those with stable normal sinus rhythm after cardioversion. Both patients groups underwent the active-standing test involving ECG measurement. Recurrence quantification analysis was used to evaluate sequences of intervals between two consecutive heart beats. The data were derived from body surface ECG signal. The results selected those parameters capable of identification of patient groups during the initial phase of the active-standing test prior to cardioversion.

Progressive conduction system disease affects patients with transthyretin cardiac amyloidosis, often requiring permanent pacing as the His-Purkinje system is affected. We present a case of left bundle branch pacing in a patient with transthyretin cardiac amyloidosis and infra-Hisian conduction disease with a favorable improvement in cardiac function and stable pacing thresholds. (Level of Difficulty: Intermediate.

About one-third of ischemic strokes may be associated with a patent foramen ovale (PFO). This article presents an unusual case of a 68-year-old woman with simultaneous paradoxical thrombo-embolization to different systemic sites. The patient presented initially with visual deficits and intracerebellar hemorrhage but was found to have concomitant saddle pulmonary embolism, sub-acute cerebral infarction with focal neurological deficits, and thromboembolism to the superior mesenteric artery (SMA) that resulted in an ischemic bowel. The unifying diagnosis was paradoxical embolism through a PFO and an atrial septal aneurysm with highrisk features. The patient underwent percutaneous closure of the PFO with an Amplatzer device.

In cirrhosis, cardiac symptoms and physical signs occur as the liver functions worsen. Cirrhosis is associated with hyperdynamic circulation and b-adrenergic system activation responsible for the cardiovascular changes. The purpose of the present study was to explore the cardiovascular response to exercise in cirrhotic patients. A total of 20 patients (16 men, four women) with cirrhosis of hepatitis B or C without any cardiac dysfunction were included in the study. Ten people (eight men, two women) were enrolled in the control group. Plasma noradrenaline and adrenaline concentrations, blood pressures in supine and standing positions, exercise echocardiography and exercise radionuclide ventriculography were carried out. In cirrhotics, the exercise capacity was lower and also there was an impaired cardiovascular response to exercise with lower than expected peak heart rate without any cardiac dysfunction, which may have important clinical implications for the ability of these patients to withstand cardiovascular stress.

In cirrhosis, cardiac symptoms and physical signs occur as the liver functions worsen. Cirrhosis is associated with hyperdynamic circulation and b-adrenergic system activation responsible for the cardiovascular changes. The purpose of the present study was to explore the cardiovascular response to exercise in cirrhotic patients. A total of 20 patients (16 men, four women) with cirrhosis of hepatitis B or C without any cardiac dysfunction were included in the study. Ten people (eight men, two women) were enrolled in the control group. Plasma noradrenaline and adrenaline concentrations, blood pressures in supine and standing positions, exercise echocardiography and exercise radionuclide ventriculography were carried out. In cirrhotics, the exercise capacity was lower and also there was an impaired cardiovascular response to exercise with lower than expected peak heart rate without any cardiac dysfunction, which may have important clinical implications for the ability of these patients to withstand cardiovascular stress.

ABSTRACT Background. The concentration of collagen degradation products in plasma may reflect the process of left ventricular remodeling in patients after acute myocardial infarction. The aim of this study was to confirm that mean fluorescence lifetime of plasma is decreased in patients with left ventricular systolic dysfunction. Patients, materials and methods. The study group consisted of patients treated with primary percutaneous coronary intervention for acute myocardial infarction admitted to the Department of Cardiology and Internal Medicine at the University Hospital in Bydgoszcz. The overall group comprised of 65 patients. From each patient 8 mL of blood was taken to obtain plasma that was used for further examination. The time-resolved spectrometer Life Spec II with the sub-nanosecond pulsed 360 nm EPLED® diode was used in order to measure fluorescence lifetime of samples. Results. Significant differences were observed in mean fluorescence lifetime of plasma between groups ...

Background Physical activity contributes to changes in cardiac morphology, which are known as "athlete's heart". Therefore, these modifications can be characterized using different imaging modalities such as echocardiography, including Doppler (flow Doppler and Doppler myocardial imaging) and speckle-tracking, along with cardiac magnetic resonance, and cardiac computed tomography. Main text Echocardiography is the most common method for assessing cardiac structure and function in athletes due to its availability, repeatability, versatility, and low cost. It allows the measurement of parameters like left ventricular wall thickness, cavity dimensions, and mass. Left ventricular myocardial strain can be measured by tissue Doppler (using the pulse wave Doppler principle) or speckle tracking echocardiography (using the two-dimensional grayscale B-mode images), which provide information on the deformation of the myocardium. Cardiac magnetic resonance provides a comprehensive evaluation of cardiac morphology and function with superior accuracy compared to echocardiography. With the addition of contrast agents, myocardial state can be characterized. Thus, it is particularly effective in differentiating an athlete's heart from pathological conditions, however, is less accessible and more expensive compared to other techniques. Coronary computed tomography is used to assess coronary artery anatomy and identify anomalies or diseases, but its use is limited due to radiation exposure and cost, making it less suitable for young athletes. A novel approach, hemodynamic forces analysis, uses feature tracking to quantify intraventricular pressure gradients responsible for blood flow. Hemodynamic forces analysis has the potential for studying blood flow within the heart and assessing cardiac function. In conclusion, each diagnostic technique has its own advantages and limitations for assessing cardiac adaptations in athletes. Examining and comparing the cardiac adaptations resulting from physical activity with the structural cardiac changes identified through different diagnostic modalities is a pivotal focus in the field of sports medicine.

Chronic obstructive pulmonary disease (COPD) is projected to become the third leading cause of death worldwide in 2030. It is a chronic disease that is mostly present in the elderly. A lot of COPD associated features (anatomical and functional) are part of normal lung aging that seems to be accelerated in this disease. LópezOtín, et al. have proposed nine cellular and molecular hallmarks of aging. These hallmarks seem to be present in COPD suggesting that accelerated aging could be a part of the pathogenesis of this disease. Therefore, new potential therapeutic targets based on these mechanisms could modify the evolution of this disease providing better quality of live and prolonged life expectancy. *Correspondence to: Margarida Pimenta Valério, Pulmonology Resident; Serviço de Pneumologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal Received: December 07, 2020; Accepted: December 11, 2020; Published: December 14, 2020 Introduction Aging is characterized by pro...

The aim of this study was to determine the correlation between the size of acute myocardial infarction (AMI) and the time of initiation of reperfusion therapy with cardiac perfusion scintigraphy. Overall, 80 patients with acute ST elevation myocardial infarction (STEMI) were examined. All patients were treated with primary percutaneous coronary intervention (pPCI). Data on patient and system delay expressed in minutes were recorded and compared with recommended timelines. Cardiac scintigraphy was performed with 99m Tc-sestamibi single-photon emission computed tomography (SPECT). The median time of cardiac scintigraphy was 20 days. The correlation between the size of infarction and the time of initiation of reperfusion therapy was evaluated. The mean age of patients was 60.5±11.5 years, and 72.5% were male. The average system delay was 348 min, and the average patient delay was 173 min. The mean total ischemic time was 800 min. There was a correlation between time delays of reperfusion therapy and infarct size. Patients with a shorter time delay to patent artery after FMC showed smaller infarct size when compared to the patients with longer delay times. Multiple linear regression analysis showed that FMC, being male, and smokers had statistical significance when predicting infarct size. There is a correlation between the size of myocardial infarction and the time of initiation of reperfusion therapy determined by perfusion myocardial scintigraphy. The study showed that there are time delays in starting the treatment of AMI with pPCI when compared to the recommended time, which requires an action plan in the near future to ensure earlier treatment for our patients.

Background Heart failure (HF) pathophysiology complicating cardiac amyloidosis (CA) is poorly explored due to the lack of relevant animal model. A recently transgenic mouse expressing an amyloidogenic variant of human apolipoprotein AII was developed that showed ubiquitous amyloid deposit but limited data on cardiac involvement. Purpose To investigate heart structure and function in transgenic mice expressing an amyloidogenic variant of human apolipoprotein AII Methods Seventy-nine mice ageing 2 to 3 months were included in this study as follow: amyloidosis group (n=44) and sham (i.e. genetic mutation without phenotypic expression, n=35). Both were serially imaged by echocardiography (Vevo3100 Fujifilm) and cardiac magnetic resonance imaging (CMR, Biospec 4.7 tesla), and invasively explored by left–sided catheterization (pressure-volume loop [PV loop], Millar Catheterization), before sacrifice and histological investigations. Results As soon as 2–3 months of age, the amyloidosis gro...

The coronary vascular resistance (CVR) after off pump coronary bypass (OPCAB) surgery has never been clarified and ways of preventing stunning are wanted. We wished to investigate the effect of ischaemic preconditioning (IPC) on the CVR and stunning in the postoperative period after OPCAB. In 20 pigs (80 kg), 7 piezo-electric crystals were placed on the left ventricle to assess global and local myocardial contractility. Coronary vascular resistance was measured as the relation between perfusion pressure and coronary artery blood flow. IPC was obtained in ten pigs with one period of 10 min of coronary occlusion, followed by 15 min of reperfusion and 20 min of ischaemia. Ten control animals were exposed to 20 min of ischaemia only. Reperfusion was allowed for 120 min. The CVR was higher in the IPC group (measured by the slopes of the curves in the reperfusion period) (IPC: -0.33 (CI: (-0.62)-(-0.03)); 0.31 (CI: (-0.03)-(0.67)), P&lt;0.005. There was no difference in the local myocardi...

Background: Transapical chordae replacement is a promising new therapy for mitral regurgitation due to leaflet prolapse. However, there is concern that tension of artificial chordae in this non-physiological position may be higher than tension in artificial chordae attached to papillary muscle tips (PMs), thereby impairing repair durability. In eight 80 kg pigs primary chordae of anterior leaflet (A2 segment) were cut while on cardiac bypass to produce severe mitral leaflet prolapse. The chordae were replaced by a 5-0 PTFE chordae with a miniature force transducer in line and attached first to the PM (FPM) and, on a second cardiac bypass, to the LV apex (FTA). After recovery from each procedure simultaneous recordings of LV and left atrial pressure and chordae tension were obtained. Tension data were normalized to identical hemodynamic conditions (LV pressure =100 mmHg). Data are mean ±SD. : Figure 1 shows representative chordae tension curves. No statistically significant difference was observed between peak (0.48±0.25 N vs 0.50±0.40 N, P=0.86) or mean (0.34±0.19 N vs 0.26±0.15 N, P=0.36) systolic FTA and FPM or between variations of FTA and FPM in systole (0.18±0.15 N vs 0.09±0.06 N; P=0.18). Tension in transapical artificial chordae was not different from tension in artificial chordae attached to the PMs. These observations suggest that durability of transapical chordae replacement is not impaired by non-physiological high load on the artificial chordae and mitral leaflets.

Background Valvular aortic stenosis is the most common cause of left ventricular hypertrophy due to gradually increasing pressure work. As the stenosis develop the left ventricular hypertrophy may lead to congestive heart failure, increased risk of perioperative complications and also increased risk of sudden death. A functional porcine model imitating the pathophysiological nature of valvular aortic stenosis is very much sought after in order to study the geometrical and pathophysiological changes of the left ventricle, timing of surgery and also pharmacological therapy in this patient group. Earlier we developed a porcine model for aortic stenosis based on supracoronary aortic banding, this model may not completely imitate the pathophysiological changes that occurs when valvular aortic stenosis is present including the coronary blood flow. It would therefore be desirable to optimize this model according to the localization of the stenosis. Methods In 20 kg pigs subcoronary (n = 8)...

Objectives: Decellularized porcine heart valves treated with deoxycholic acid (DOA) have demonstrated complete recellularization and absence of calcification when implanted into the pulmonary position in sheep. We studied recellularization and calcification in stented DOAtreated heart valves compared with conventional stented glutaraldehyde-treated valves in the aortic position in juvenile pigs 6 months after implantation. Methods: DOA heart valves (n = 12) and glutaraldehyde-treated valves (Carpentier-Edwards) (n = 15) were implanted into the aortic position in 8-month old 90 kg female pigs. Six months postoperatively, the valves were explanted and subjected to gross pathology examination, high-resolution (HR) X-ray imaging, and histological evaluation. Results: Five DOA valves and five glutaraldehyde-treated valves were explanted after 6 months. Fourteen animals died before follow-up because of non-valve related causes and three because of infective endocarditis. Gross pathologic examination showed all DOA valves to be well functioning with only minor thrombotic depositions located mostly in the commissural area. Three glutaraldehyde valves had limited thrombosis and two had severe thrombosis. HR X-ray imaging demonstrated almost complete absence of cusp calcification in the DOA valves, but severe calcification in all glutaraldehyde valves. Overgrowth of endothelial cells and ingrowth of fibroblasts in the stent-adjacent area and basal part of the cusps were seen in all DOA valves, but not in glutaraldehyde valves. Immunohistochemistry revealed larger amounts of inflammatory cells in all glutaraldehyde valves compared with DOA valves. Conclusions: DOA-treated heart valves demonstrated greater recellularization and less calcification compared with standard glutaraldehyde-treated valves 6 months after implantation in the aortic position in pigs. DOA-treated heart valves demonstrated less calcification compared with standard glutaraldehyde-treated valves by qualitative analysis. Endothelial and fibroblast recellularization of the cusps was only observed in DOA-treated valves.

Objective: High intensity transient signals (HITS) representing microembolization to the brain have been found to contribute to cognitive impairment and psychoneurological dysfunction in patients carrying a mechanical aortic valve. It is unknown, whether HITS represent gaseous or solid emboli. This animal study evaluates the impact of valve orientation on HITS for two different mechanical valves with both valves implanted in their best and worst orientation, which has been de®ned in previous studies with respect to downstream turbulence. Methods: In four pigs a rotation device carrying either a Medtronic Hall (MH) or St. Jude Medical (SJM) valve size 23 mm was implanted. The device allowed rotation of the implanted valves without reopening of the aorta. Approximately 30 min after weaning from extracorporeal circulation, a Doppler probe was placed on both common carotid arteries. In different orientations of the implanted valves (best and worst position), HITS were detected by the Doppler probe and recorded for ten min by a transcranial Doppler sonography device (Medilab Inc., Estenfeld, Germany). Results: HITS showed signi®cant change with rotation for both valve designs. With the major ori®ce of the MH oriented towards the non-coronary lea¯et (optimum position) very low HITS-counts (0.8±1.7/min) were observed. In the worst orientation HITS rose to 43±66/min. For the SJM the HITS count in the optimum position was 23.4±24/min and in the worst orientation 38±48/min. Conclusions: Valve orientation has an important impact on microembolization to the brain. In the optimum orientation (large ori®ce facing the non-coronary lea¯et) the Medtronic Hall valve showed neglectible incidence of HITS. The St. Jude Medical bilea¯et valve showed less variation but demonstrated signi®cant HITS counts at any orientation. As the MH in the worst position shows signi®cantly higher turbulent stresses than the SJM but no higher incidence of HITS, a strong correlation between turbulence and HITS was not demonstrated by this study.

Objective: To give a detailed evaluation on main pulmonary artery blood velocity patterns, in patients with ischemic heart disease and to provide recommendations for pulsed Doppler sample volume placement, in order to optimize cardiac output estimation. Methods: Using magnetic resonance phase and esophageal color Doppler velocity mapping in 12 patients with ischemic heart disease and undergoing coronary artery by-pass grafting, very similar data on pulmonary artery blood velocity patterns were provided for comparison with each other. Results: Peak blood velocities were located in the inferior half of the main pulmonary artery cross-sectional area. Early Ž . after peak systole the highest velocities shifted towards the superiorrleft major curvature with a simultaneous decrease in velocities Ž . inferiorly. The velocity decrease further evolved into retrograde flow to the inferiorrright minor curvature . This feature was significantly enhanced compared to earlier findings in healthy volunteers. The mean temporal blood velocity profiles were asymmetrically skewed, thereby giving unreliable cardiac output estimates based on single point Doppler blood velocity recordings. The error incurred may amount to more than 100% in extreme cases. According to our data, optimal assessment of cardiac output should be based on multiple sample volumes placed along the inferiorrright to superiorrleft diameter. Conclusions: MR-phase velocity mapping and multiplane transesophageal color Doppler recordings provided similar blood velocity patterns in patients with ischemic heart disease. The skewness of the mean temporal blood velocity profile is enhanced compared with healthy subjects, resulting in error in the assessment of CO by means of pulsed Doppler echocardiography. By using multiple Doppler sample volumes, the error can be minimized. q 1997 Elsevier Science B.V.

Takotsubo or stress cardiomyopathy is a non ischemic disease affecting the myocardium, which presents with typical features of myocardial ischemia. Although the presentation with acute central chest pain and shortness of breath mimics acute myocardial ischemia, there is an absence of actual disruption of cardiac blood supply via the coronaries due to acute plaque rupture or vascular spasm. The underlying pathophysiology of this clinical entity remains largely unclear, but a definite association with physical or emotional stress has been well established, hence the term “stress cardiomyopathy.” The list of potential triggers continues to grow as the disorder is increasingly detected by clinicians and cardiologists, with better clinical insight and improved availability of cardiac investigations. We report a patient with Takotsubo cardiomyopathy associated with severe hyponatremia.

Background Our goal is to investigate the use of the oxygen reserve index (ORi) to detect hypoxemia and its relation with parameters such as; peripheral oxygen saturation, perfusion index (PI), and pleth variability index (PVI) during one-lung ventilation (OLV). Methods Fifty patients undergoing general anesthesia and OLV for elective thoracic surgeries were enrolled in an observational cohort study in a tertiary care teaching hospital. All patients required OLV after a left-sided double-lumen tube insertion during intubation. The definition of hypoxemia during OLV is a peripheral oxygen saturation (SpO2) value of less than 95%, while the inspired oxygen fraction (FiO2) is higher than 50% on a pulse oximetry device. ORi, pulse oximetry, PI, and PVI values were measured continuously. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and accuracy were calculated for ORi values equal to zero in different time points during surgery to predict hypoxemi...

Contact address: Alina Hohaci, MD, Discipline of Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Carol I Avenue, no. 50, Iasi, Romania. E-mail: [email protected] 1 Discipline of Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Iasi, Romania 2 “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania 3 Department of Interventional Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Iasi, Romania 4 Discipline of Cardiothoracic Surgery, “Prof. Dr. George I. M. Georgescu”, Institute of Cardiovascular Diseases, Iaşi, România Abstract: Introduction – Takotsubo cardiomyopathy (TCM) is a cardiac condition that mimics the clinical presentation of acute coronary syndrome, but without any evidence of obstructive atherosclerotic coronary artery disease. The prognosis is usually good, with improvement of the left ventricular (LV) dysfunction within a few weeks. There are some ...

Background--We studied (1) the rates of stroke or systemic embolism and bleeding in patients with atrial fibrillation and peripheral artery disease (PAD) and ( ) the efficacy and safety of apixaban versus warfarin in patients with atrial fibrillation with and without PAD. Methods and Results--The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial randomized 18 201 patients with atrial fibrillation to apixaban or warfarin for stroke/systemic embolism prevention; 884 (4.9%) patients had PAD at baseline. Patients with PAD had higher unadjusted rates of stroke and systemic embolism (hazard ratio [HR] 1.73, 95% CI 1.22-2.45; P=0.002) and major bleeding (HR 1.34, 95% CI 1.00-1.81; P=0.05), but after adjustment, no differences existed in rates of stroke and systemic embolism (HR 1.32, 95% CI 0.93-1.88; P=0.12) and major bleeding (HR 1.03, 95% CI 0.76-1.40; P=0.83) compared with patients without PAD. The risk of stroke or systemic embolism was similar in patients assigned to apixaban and warfarin with PAD (HR 0.63, 95% CI 0.32-1.25) and without PAD (HR 0.80, 95% CI 0.66-0.96; interaction P=0.52). Patients with PAD did not have a statistically significant reduction in major or clinically relevant nonmajor bleeding with apixaban compared with warfarin (HR 1.05, 95% CI 0.69-1.58), whereas those without PAD had a statistically significant reduction (HR 0.65, 95% CI 0.58-0.73; interaction P=0.03). Conclusions--Patients with PAD in ARISTOTLE had a higher crude risk of stroke or systemic embolism compared with patients without PAD that was not present after adjustment. The benefits of apixaban versus warfarin for stroke and systemic embolism were similar in patients with and without PAD. These findings highlight the need to optimize the treatment of patients with atrial fibrillation and PAD.

on behalf of the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Steering Committee and Investigators Background--Patients with atrial fibrillation (AF) and hypertension are at high risk for stroke. Previous studies have shown elevated risk of stroke in patients with AF who have a history of hypertension (regardless of blood pressure [BP] control) and in patients with elevated BP. We assessed the association of hypertension and BP control on clinical outcomes. Methods and Results--In ARISTOTLE (n=18 201), BP was evaluated as history of hypertension requiring treatment and elevated BP (systolic ≥140 and/or diastolic ≥90 mm Hg) at study entry and any point during the trial. Hazard ratios (HRs) were derived from Cox proportional hazards models including BP as a time-dependent covariate. A total of 15 916 (87.5%) patients had a history of hypertension requiring treatment. In patients with elevated BP measurement at any point during the trial, the rate of stroke or systemic embolism was significantly higher (HR, 1.53; 95% confidence interval [CI], 1.25-1.86), as was hemorrhagic stroke (HR 1.85; 95% CI, 1.26-2.72) and ischemic stroke (HR, 1.50; 95% CI, 1.18-1.90). Rates of major bleeding were lower in patients with a history of hypertension (HR, 0.80; 95% CI, 0.66-0.98) and nonsignificantly lower in patients with elevated BP at study entry (HR, 0.89; 95% CI, 0.77-1.03). The benefit of apixaban versus warfarin on preventing stroke or systemic embolism was consistent among patients with and without a history of hypertension (P interaction=0.27), BP control at baseline (P interaction=0.43), and BP control during the trial (P interaction=0.97). Conclusions--High BP measurement at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism. These results strongly support efforts to treat elevated BP as an important strategy to optimally lower risk of stroke in patients with AF.