Thromboaspiration of Heavy Thrombotic Load Salvages Myocardium and Prevents the No-Reflow Phenomenon in Acute Myocardial Infarction

The combination of thromboaspiration of heavy thrombotic load, coronary stenting and use of a IIB/IIIA antiplatlet agent led to full mechanical recanalization and complete restoration of TIMI 3 blood flow to the right coronary artery and obviation of the no-reflow phenomenonin in a patient with acute inferior ST-elevation myocardial infarction

Health Hazards From Trans Fatty Acids: Ban of Artificial Trans Fats Long Overdue

  Although we are all abundantly aware of the health risk of saturated fat, not much attention and proper warning is given to the even more hazardous effects of unsaturated trans fatty acids. Trans fatty acids (TFA) are created by the partial hydrogenation of vegetable oils, a process converting them into semisolid fats for use in margarines, commercial cooking, and manufacturing processes, as they offer certain commercial advantages. However, major concern has been raised for TFA as they are associated with an elevated risk of ischemic heart disease (IHD). Trans fat behaves similar to saturated fat by raising LDL levels, but furthermore, it has the additional effect of decreasing HDL levels. Health authorities should advise the public to minimize the intake of trans fats, to recognize and avoid foods containing trans fats, and impose rules and regulations restricting TFA in the industry and the restaurants and thus prevent thousands of IHD events each year worldwide

Indications for Renal Artery Stenting

Renal artery disease (RAD) is a relatively common condition in the elderly, especially in the setting of concomitant vascular disease in other anatomical sites and is most often of atheromatous origin. Rarely is it encountered in young women as a result of fibromuscular dysplasia. RAD with significant renal artery stenosis is considered responsible for refractory or accelerated hypertension, progressive loss of renal function and deterioration of patients’ cardiovascular status, with episodes of angina or pulmonary edema disproportional to the extent of coronary artery disease and left ventricle functional capacity, dominating the clinical presentation. This article summarizes the pathophysiological implications and diagnostic methods and attempts a review of the current literature on indications and efficacy of the available therapeutic options for renal artery stenosis, focusing on interventional treatment

Optimizing Cardiac Resynchronization Therapy Device Programming

Cardiac resynchronization therapy (CRT) improves symptoms and cardiac function, reduces hospitalizations and increases survival in selected patients with heart failure. It is mandatory to maximize mechanical and electrical synchronicity. Atrio-ventricular and ventriculo-ventricular intervals optimization have a substantial impact on the hemodynamic response to pacing. The number of patients with an implanted CRT system is increasing and many issues have not yet been answered about who and how will benefit the most

Telemedicine in Congenital Heart Disease

BACKGROUND: The primary rationale for the development of telemedicine has been to serve populations that have limited access to traditional, high quality medical services. These include those living in rural areas or other underserved areas, like islands, or even urban areas when a rare medical subspecialty, such as pediatric cardiology is not available. OBJECTIVE: The aim of the present study was to present our results with use of telemedicine during the European project TELEREMEDY over a period of 26 months when adult cardiologists and pediatricians of our hospital communicated with pediatric cardiologists at the tertiary Children’s Hospital “Agia Sofia” in Athens and at the Royal Brompton Hospital in London, as well as with physicians at the “Venizelio” Hospital in Crete. METHODS AND RESULTS: Over 26 months, 31 teleconference sessions were organized. During this period, 155 children with suspected congenital heart disease (CHD) underwent echocardiographic examination, which confirmed CHD in 83 (54%), acquired heart disease in 13 (8%) and normal anatomy in 59 (38%). Ventricular septal defect was diagnosed in 26/83 (31%), complex CHD in 20 (24%), atrial septal defect in 12 (14%) and patent ductus arteriosus in 8 (10%) children. Our hospital with the adult electrophysiology team was the expertise center for diagnosis and treatment of 30 children with arrhythmia. During 23 sessions with the tertiary Children’s Hospital “Agia Sofia” in Athens, an immediate transfer to the pediatric intensive care unit of the tertiary center was decided for 27 cases (17%). During 3 sessions with one participating hospital we provided consultation for 10 cases with arrhythmias. During 6 sessions with the Royal Brompton Hospital in London, rare cases of CHD, both adult and pediatric, were discussed. Two multilane conferences were organized among all participants and the systems capabilities in each hospital were discussed. CONCLUSION: Telemedicine systems, like the one used herein in the context of the TELEREMEDY program, facilitate a timely diagnosis and management of children with CHD in hospitals lacking pediatric cardiology service. In the present series, use of this program obviated unnecessary and costly transfers in 83% of cases. Thus, immediate access to specialists can guide patient management and may potentially alter the morbidity and mortality in this patient population

The Contribution of Cardiac Magnetic Resonance Imaging to the Diagnosis of Cardiac Diseases

Background: Cardiac magnetic resonance imaging (MRI) has been established in clinical practice as a valid imaging modality for the diagnosis of various cardiovascular disorders. Objectives: To underline the importance of cardiac MRI as an alternative non - invasive imaging method for the diagnosis and follow-up of cardiac patients based on findings from our own recent experience. Patients and Methods: The study included all cardiac patients referred for cardiac MRI over a period of one year. Cardiac MRI studies were performed with the use of a 1.5-Tesla scanner using a body phased-array coil, breath and ECG-triggering. Almost all cardiac sequences were gated to the patient’s cardiac cycle. Cine imaging for the evaluation of cardiac volumes and heart motion was performed using a cine breath-hold true short-axis and true four-chamber sequence with whole left ventricular coverage. Black blood imaging for the assessment of morphology was acquired on a true short-axis and true four-chamber view. Depending on the pathology under investigation, special sequences were added to the imaging protocol, such as late-enhancement imaging after gadolinium administration. Results: The study cohort comprised 114 patients who were referred for cardiac MRI with the following indications and clinical diagnoses: myocarditis (n=29), arrhythmogenic right ventricular cardiomyopathy (ARVC; n=27), valvular heart disease (n=23), history of myocardial infarction (n=13; seeking myocardial viability), hypertrophic (n=12), or dilated (n=2), or tako-tsubo (n=1), or non-compaction (n=2) cardiomyopathy, pericardial effusion (n=2) and various intracardiac masses (n=3). Cardiac MRI confirmed the clinical diagnosis and gave further specific information in 52% of myocarditis cases, in 37% of suspected ARVC cases, in 38% of coronary artery disease patients regarding myocardial viability, while it confirmed all other clinical diagnoses (100% match). Conclusions: Cardiac MRI represents a clinically useful imaging method for the diagnosis of various cardiac disorders since it has the capability of providing highly accurate and reproducible measurements of cardiac hemodynamics in addition to the detailed demonstration of cardiac anatomical structures

Reducing Barriers for Implementation of Immediate CPR with Chest Compressions Alone

  It is well known that out-of-hospital sudden cardiac death is a leading public health problem. In the absence of early defibrillation, survival rates of patients with out-of-hospital cardiac arrest are dismal and have remained essentially unchanged. The guidelines advocate the same approach for 2 entirely different pathophysiological conditions: respiratory arrest in which severe arterial hypoxia and hypotension eventually lead to secondary cardiac arrest, and primary cardiac arrest in which the arterial blood is fully saturated with oxygen at the time of the arrest. Cardiopulmonary resuscitation (CPR) is traditionally defined as chest compressions plus ventilations. The need for chest compressions is unquestionable, while the need for mouth-to-mouth ventilations for cardiac arrest has been questioned. Recent observational studies underline the paramount role of chest compressions in an alternative way of CPR, compression only CPR. Public education and training in compression only CPR is much simpler. Compression only CPR may significantly increase bystander-initiated resuscitation efforts and thereby give patients a better chance of survival, given the reluctance of lay people to provide mouth to mouth rescue breaths. In view of the above, the principal question is, what barriers are delaying the guidelines from recommending compression only CPR? Perhaps the major problem is the difficulty to change the paradigm. For decades, the "ABCs" (airway, breathing, and circulation) have been advocated for bystander basic life support, making it extremely difficult to transform the so ingrained in the popular understanding "ABC" to "AC"

Electrophysiology Catheter-Facilitated coronary sinus cannulation and implantation of cardiac resynchronization therapy systems

Background: Cardiac resynchronization therapy (CRT) device implantation is hampered by difficult placement of the left ventricular (LV) lead. We have routinely used a steerable electrophysiology catheter to guide coronary sinus (CS) cannulation and facilitate LV lead positioning. The aim of this prospective study is to present our results with this approach in 138 consecutive patients receiving a CRT device over 10 years. Methods: The study included 120 men and 18 women, aged 64.8±11.4 years, with coronary disease (n=63), cardiomyopathy (n=72), or other disease (n=3), and mean ejection fraction of 24.5±4.5%. Devices were implanted for refractory heart failure and dyssynchrony, all but 2 in the presence of left bundle branch block. Implanted devices included biventricular pacemakers (CRT-P) (n=33) and cardioverter defibrillators (CRT-D) (n=105). Results: Using the electrophysiology catheter, the CS could be engaged in 134 (97.1%) patients. In 4 patients failing CS cannulation, a dual-chamber device was implanted in 2, and bifocal right ventricular pacing was effected in 2. Bifocal (n=2) or conventional (n=1) systems were implanted in another 3 patients, in whom the LV lead got dislodged (n=2) or removed because of local dissection (n=1). Thus, finally, a CRT system was successfully established in 131 (94.9%) patients. There were 3 patients with CS dissection, of whom 1 was complicated by cardiac tamponade managed with pericardiocentesis. There were no perioperative deaths. During follow-up (31.0±21.2 months), clinical improvement was reported by 108 (82.4%) patients. Conclusion: Routine use of an electrophysiology catheter greatly facilitated CS cannulation and successful LV lead placement in ∼95% of patients undergoing CRT system implantation. Keywords: heart failure, cardiac resynchronization therapy, implantable cardioverter defibrillator, coronary sinus, left ventricular lea

The Role of Adiponectin and Brain Natriuretic Peptide in Predicting Cardiovascular Events

Adiponectin and brain natriuretic peptide (BNP) are hormones produced by adipocytes and myocardial cells respectively, and have emerged as important diagnostic and prognostic tools in cardiovascular disease. Levels of adiponectin are down-regulated in obese and diabetic individuals and this hormone exhibits favorable effects on atherogenesis, endothelial function and vascular remodeling. On the other hand, BNP and the fragment N – terminal proBNP (NT – proBNP) are natriuretic peptides released from the heart in response to pressure and volume overload and have become diagnostic tools and predictors in several cardiac abnormalities, beyond heart failure. This brief review will discuss the prognostic significance of these two hormones and epidemiological and clinical data from studies will be presented