Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

Purpose: To compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA). Methods and Materials: 147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too. Results: Diabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic. Conclusions: Diabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics

Recurrent syncope on effort due to concealed constrictive pericarditis.

A 69-year-old male patient was admitted for two syncopal episodes on effort associated with dyspnoea and jugular constrain. Clinically, he was found to have mild bilateral pleural effusion, jugular vein distension, and marked peripheral oedema. Echocardiographic examination showed a leftward interventricular septum during peak inspiration owing to the increasing right ventricle pressure (Figure 1A) and a dilation (27 mm) and absent collapse of the inferior vena cava and hepatic veins (Figure 1B). Ventriculography does not reveal calcifications of the pericardium (Figure 1C). At the invasive haemodynamic evaluation, simultaneous right and left catheterization showed the square root sign of LV diastolic pressure trackings and equalization of LV and RV diastolic plateau pressure tracking. Magnetic resonance images (coronal T1-weighted FSE sequence image; Harmony, Siemens, Erlangen, Germany) showed the thickened pericardium (>5 mm) with irregular margins (white arrows) (Figure 1D). After administration of contrast media, the late acquisitions revealed diffuse and homogeneous hyperintense pericardium (white arrows) (Figure 1E and F; a, left ventricle; b, right ventricle). An endomyocardial biopsy was performed and excluded associated restrictive myocardial diseases. A diagnosis of constrictive pericarditis was put forward and the patient underwent pericardiectomy. Surgical pathology examination of the resected pericardium revealed, at gross examination, a diffuse severe fibrous thickening (Figure 2A). At histology, multiple foci of chronic inflammation (lymphocytes and plasma cells) are detected associated only with mild calcification (Figure 2B, haematoxylin\u2013eosin 740; and Figure 2C, B-lymphocytes CD20; Figure 2D, T-lymphocytes CD3; Figure 2E, macrophages CD68; Figure 2F, plasma cells CD79a; Figure 2G, cytotoxic T-lymphocytes CD8, all magnification 7160). Initially, the constrictive pericarditis was concealed because of the coexistence of equivocal clinical symptoms. Because of sleeping troubles, a diagnosis of mild constrictive pulmonary disease together with obstructive sleep apnoea syndrome was put forward. An electroencephalogram was performed suggesting focal epilepsy and valproic acid therapy was undertaken. The patient was discharged home 7 days after surgery. Nowadays, he is able to practice a light mountain-bike activity

Expression of the mu opioid receptor and effects of the opioid antagonist Naloxone on in vitro maturation of oocytes recovered from anestrous bitches

The mu-opioid receptor (MOR) is expressed in bovine, human, equine and canine oocytes, and in seasonal breeders, it is expressed with higher intensity during the anoestrous phase. Supplementation of in vitro maturation (IVM) medium with opioid agents, agonists or antagonists, was shown to affect oocyte maturation in several species such as rat, bovine and equine. This study reports the effects of supplementing IVM medium with naloxone (Nx), an opioid antagonist, on nuclear and cytoplasmic maturation rate of oocytes recovered from anoestrous bitches. Cytoplasmic maturation was examined in terms of mitochondrial (mt) distribution. In order to confirm the receptor-mediated action of Nx, in oocytes of anoestrous bitches, MOR expression was analyzed by Western blot. Cumulus-oocyte complexes, recovered from the ovaries of bitches in anoestrous, were cultured in vitro and Nx was added at the concentrations of 1 x 10(-6), 1 x 10(-8) and 1 x 10(-10) M. The rate of oocytes resuming meiosis after culture in presence of 1 x 10(-6,) M Nx (29%) was significantly higher than that of oocytes of control group (12%; p < 0.05). However, treatment with Nx did not affect mt distribution pattern. In denuded oocytes and in corresponding cumulus cells, a doublet of 65 and 50 kDa was observed. We conclude that, in oocytes of anoestrous bitches, MOR is expressed and Nx significantly improves nuclear maturation rate. Further studies should be performed to elucidate the expression of other opioid receptors, such as delta and kappa, and possible interactive effects of their antagonists on canine oocyte maturation

Current interpretation of myocardial stunning

Myocardial stunning is a temporary post-ischemic cardiac mechanical dysfunction. As such, it is a heterogeneous entity and different conditions can promote its occurrence. Transient coronary occlusion, increased production of catecholamines and endothelin, and myocardial inflammation are all possible causes of myocardial stunning. Possible underlying mechanisms include an oxyradical hypothesis, calcium overload, decreased responsiveness of myofilaments to calcium, and excitation-contraction uncoupling due to sarcoplasmic reticulum dysfunction. The aim of this review is to summarize the clinical conditions that may be responsible for stunned myocardium

Coronary artery calcium score on low-dose computed tomography for lung cancer screening

To evaluate the feasibility of coronary artery calcium score (CACS) on low-dose non-gated chest CT (ngCCT).Sixty consecutive individuals (30 males; 73 ± 7 years) scheduled for risk stratification by means of unenhanced ECG-triggered cardiac computed tomography (gCCT) underwent additional unenhanced ngCCT. All CT scans were performed on a 64-slice CT scanner (Somatom Sensation 64 Cardiac, Siemens, Germany). CACS was calculated using conventional methods/scores (Volume, Mass, Agatston) as previously described in literature. The CACS value obtained were compared. The Mayo Clinic classification was used to stratify cardiovascular risk based on Agatston CACS. Differences and correlations between the two methods were compared. A P-value 0 in the ngCCT. Of the 3 patients with 1-10 Agatston score on gCCT, 1 (33\%) showed an Agatston score of 0 in the ngCCT. Overall, 23 (38\%) patients were reclassified in a different cardiovascular risk category, mostly (18/23; 78\%) shifting to a lower risk in the ngCCT. The estimated radiation dose was significantly higher for gCCT (DLP 115.8 ± 50.7 vs 83.8 ± 16.3; Effective dose 1.6 ± 0.7 mSv vs 1.2 ± 0.2 mSv; P < 0.01).CACS assessment is feasible on ngCCT; the variability of CACS values and the associated re-stratification of patients in cardiovascular risk groups should be taken into account