Circulating adhesion molecules and arterial stiffness

Aim: VCAM-1 and ICAM-1 are two important members of the immunoglobulin gene superfamily of adhesion molecules, and their potential role as biomarkers of diagnosis, severity and prognosis of cardiovascular disease has been investigated in a number of clinical studies. The aim of the present study was to determine the relationship between circulating ICAM-1 and VCAM-1 levels and aortic stiffness in patients referred for echocardiographic examination. Methods: Aortic distensibility was determined by echocardiography using systolic and diastolic aortic diameters in 63 consecutive patients referred for echocardiography. Venous samples were collected in the morning after a 12-hour overnight fast, and serum concentrations of ICAM-1 and VCAM-1 were measured using commercial enzyme immunoassay kits. Results: Data of a total of 63 participants (mean age 55.6 ± 10.5 years, 31 male) were included in the study. Circulating levels of adhesion molecules were VCAM-1: 12.604 ± 3.904 ng/ml and ICAM-1: 45.417 ± 31.429 ng/ml. We were unable to demonstrate any correlation between indices of aortic stiffness and VCAM-1 and ICAM-1 levels. Conclusion: The role of soluble adhesion molecules in cardiovascular disease has not been fully established and clinical studies show inconsistent results. Our results indicate that levels of circulating adhesion molecules cannot be used as markers of aortic stiffness in patients

Non-atherosclerotic causes of acute coronary syndrome and management of the patients

Acute coronary syndromes (ACS) are one of the leading causes of death and morbidity in industrialized countries. Typical presentation includes acute chest pain, cardiac troponin elevation and possibly associated electrocardiogram abnormalities. In great majority of the cases, myocardial infarction (MI) is due to atherosclerosis, usually with plaque rupture and consequent vessel occlusion. However, a minority of patients may suffer an MI for a range of other rare reasons such as coronary vasospasm, coronary thrombosis in situ or embolization from a distal source, hypercoagulable states, spontaneous coronary dissection, some coronary anomalies including coronary bridges and inflammatory states

Sustained ventricular tachycardia in a patient with isolated non-compaction cardiomyopathy

Isolated non-compaction of the left ventricular myocardium (INVM) was first described in 1984 as an unclassified cardiomyopathy, not being dilated, hypertrophic or restrictive. It is assumed to occur as a result of an arrest in endomyocardial morphogenesis during normal development of the heart. The disease is characterised by heart failure due to systolic and diastolic left ventricular (LV) dysfunction, systemic emboli and ventricular arrhythmias. Echocardiography has been shown to be the method of choice in diagnosis. INVM is a rare congenital cardiomyopathy and only a few cases of this condition have been reported. It is characterised by prominent and excessive trabeculation in a ventricular wall segment, with deep inter-trabecular spaces perfused from the ventricular cavity. We report a case of INVM with ventricular tachycardia induced during electrophysiological study in a 24-year-old female patient with a family history of sudden death

Atrial tachycardia treated by coil embolization of a giant coronary artery fistula

Coronary artery fistulas are the second most frequently seen coronary anomaly following abnormalities of coronary artery origin and distribution. A coronary fistula is defined as a direct communication between a coronary artery and any cardiac chamber or vessel. Treatment options include percutaneous embolization and surgical intervention. Herein, we present a case of a giant coronary artery fistula and right atrial tachycardia that was induced during a diagnostic electrophysiologic study but was not inducible after the successful treatment of the fistula. This is the first case indicating this association. © 2013 Sociedade Portuguesa de Cardiologia

Appropriateness of the current guidelines on reperfusion treatment for patients applying to our hospital with ST-segment elevation acute myocardial infarction

PubMed ID: 23363894Objectives: This study investigated the appropriateness of treatment for patients admitted with ST-segment elevation myocardial infarction (STEMI) according to the current guidelines. We also aimed to determine in-patient and out-patient factors affecting optimal re perfusion therapy. Study design: The reperfusion therapy of 176 patients with STEMI was determined. The time period from first contact with a healthcare provider to the time of balloon inflation (door to balloon time), and from the time period of first contact with a healthcare provider to the time of initiation of a thrombolytic (door to needle time) were calculated. Similarly, the time from admission at the emergency service (ES) of our hospital after referral to the moment of balloon inflation (ES to balloon time) and the period from admission to ES at our hospital to the moment of initiation of a thrombolytic (ES to needle time) were calculated. In order to determine the amount of in-hospital delay, the time from ES admission to the call to the cardiology department and the time for the cardiologist to evaluate the patient and transfer time were recorded. Whether the referring physician was a cardiologist and the effect of work hours on the reperfusion period was also recorded. Results: The door to balloon time in the referred patient group was calculated as an average of 228 minutes, while the time for patients directly admitted to ES was calculated as an average of 98 minutes. Patients referred for the mechanical reperfusion period compared to American Heart Association (AHA) guidelines consisted of only 6% of the eligible patients, while according to the European Society of Cardiology (ESC) guidelines 13% of patients were appropriate. Patients who were directly admitted to ES, experienced rates according to AHA guidelines and 73% experienced these rates according to ESC guidelines. We also found no significant effect of working hours or referring physician's specialty (cardiologist or other) on reperfusion time. Conclusion: Compliance rates of reperfusion therapy for patients presenting with STEMI was very low. We realized, when taking into consideration the reasons for delay in terms of both health community and the policy of the country, it is obvious that we have to take strict measures. © 2012 Turkish Society of Cardiology

Assessment of left ventricular systolic and diastolic function with conventional and tissue Doppler echocardiography imaging techniques in patients administered tyrosine kinase inhibitor

PubMed ID: 23363943Objectives: The aim of this study was to use echocardiographic techniques to determine the possible cardiotoxic effects of low molecular weight tyrosine-kinase inhibitors (TKI) in patients receiving the therapy for the first time. Study design: Thirty patients (17 females; 13 males; mean age 49±16; range 22 to 76 years) who met the exclusion criteria and were diagnosed as having malignancy were enrolled. All patients underwent conventional echocardiography and tissue Doppler imaging (TDI) prior to the treatment. The conventional echocardiogram was repeated 2 months later as the patients were concurrently receiving therapy. Myocardial Performance Index was obtained by conventional echocardiography and by TDI techniques to evaluate left ventricular systolic and diastolic function. Results: Statistically significant increase occurred in mean left ventricle (LV) end-systolic volume. However, there was significant decrease in both mean LV ejection fraction and LV stroke volume values (64±3, 62±4, p=0.000 and 67±13, 61±13, p=0.000, respectively). Anterior wall Em/Am ratio measured by using the TDI technique was significantly decreased at the end of two months (0.99±0.49, 0.90±0.41, p=0.03). In addition, decreases were determined in Sm values obtained from all of four LV walls and also in mean Sm value, but this decrease was significant only for the lateral wall Sm measurement (12.8±2.9, 11.6±2.3, p=0.004). Conclusion: Tyrosine-kinase inhibitors therapy can be administered safely to patients without predisposing factors for cardiotoxicity in short treatment intervals, and low molecular TKIs may cause subtle or clinically significant cardiotoxicity following the treatment period even in patients without predisposing factors for cardiotoxicity, so clinicians should consider this possibility. © 2012 Turkish Society of Cardiology

Limitation of motion and shoulder disabilities in patients with cardiac implantable electronic devices

The aim of this study is to investigate the presence of limitations in the shoulder range of motion (ROM) or the loss of upper extremity function on the affected side in patients with cardiac implantable electronic devices (CIEDs) with respect to the implantation time. Forty-nine patients (30 men and 19 women), mean age 64.84 ±11.18 years, who had been living with a CIED for less than 3 months were included in the short-term recipient (STR) group and 127 patients (85 men and 42 women), mean age 64.91± 14.70 years, and with the device for longer than 3 months were included in the long-term recipients group. Shoulder ROMs were measured using a digital goniometer. The other arm was used as the control. The Constant-Murler Score, Shoulder Pain Disability Index, and Shoulder Disability Questionnaire were used to assess the functional status. Limitations of ROM for flexion, abduction, and internal rotation were found to be significantly lower in the arm on the side of CIED compared with the control arm. Significant differences in shoulder flexion, abduction, and external rotation in STRs were found compared with longterm recipient (P<0.05). However, the functional comparison of groups by the Constant-Murler Score was not significant. A low to moderate amount of shoulder disability measured by Shoulder Pain Disability Index and Shoulder Disability Questionnaire was found in patients with CIEDs, which was more prominent in STRs (P<0.05). Pain, association of CIED with pectoral muscles, a possible subtle ongoing capsular pathology, and avoidance behaviors of patients to minimize the risk of lead dislodgement might be related to restriction of motion and function in the shoulder joint in patients with CIEDs. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved