Acquired cardiac hypertrophy with outflow tract obstruction in a patient with severe Takayasu arteritis

Takayasu arteritis with coronary artery involvement is rare and its association with secondary cardiac hypertrophy with severe outflow tract obstruction is not common. We describe a case of Takayasu arteritis, diagnosed 10 years ago, whose coronary artery involvement and obstructive cardiac hypertrophy are ascertained after our investigations

Artykuł oryginalnyZwiązek pomiędzy otyłością a drożnością tętniczych pomostów wieńcowych w obserwacji odległej

Background: Arterial conduits having long-term patency rates have been increasingly used for bypass of coronary arteries although some risk factors for their occlusion such as recipient vessel size, older age, and hyperlipidaemia have been described. Obesity, on the other hand, has been well established as a coronary risk factor. However, the effects of obesity on patency of arterial conduits, especially the internal mammary artery, have not been studied previously. Aim: To assess the long-term effects of obesity on left internal mammary artery (LIMA) patency. Methods: Angiograms of all patients with a LIMA conduit only were analysed. Two groups were formed according to the LIMA patency: group 1 &#8211; patients with occluded LIMA (n = 59), and group 2 &#8211; patients with patent LIMA (n = 68). Baseline demographic, haemodynamic, and laboratory characteristics of patients in both groups were compared. Obesity was defined as body mass index ł 30 kg/m2. Results: The mean BMI value in group 1 was significantly higher than in group 2 (30.4 &plusmn; 3.1 vs. 28.7 &plusmn; 4.7, p = 0.025). The two groups differed in time from surgery, drug use, and HDL cholesterol level. In addition, patients in both groups were categorised by BMI, and obese and non-obese groups were formed. Higher BMI was significantly associated with LIMA occlusion such that 71% of patients in group 1 had increased BMI, compared with 25% of patients in group 2 (p < 0.001). Multivariate analysis showed that multiple adjusted OR of the risk of LIMA occlusion was 7.41 (95% CI 3.38-16.28) for patients with increased BMI. Conclusions: : Obesity (ł 30 kg/m2) has a significant and independent negative effect on the patency of the LIMA graft.Wstęp: Z uwagi na wysoki odsetek zachowanej po wielu latach drożności pomosty tętnicze są preferowanym sposobem wykonywania operacji rewaskularyzacyjnych (CABG). Istnieją pewne czynniki zwiększające ryzyko zamknięcia, do których należą przekrój naczynia chorego, wiek oraz hiperlipidemia. Z kolei otyłość jest dobrze udokumentowanym czynnikiem ryzyka choroby wieńcowej. Dotychczas związek pomiędzy otyłością a drożnością pomostów tętniczych, szczególnie z wykorzystaniem tętnicy piersiowej wewnętrznej (LIMA), nie był badany. Cel: Ocena związku pomiędzy otyłością a drożnością pomostów tętniczych w obserwacji długoterminowej. Metody: Poddano analizie angiogramy wszystkich chorych z LIMA. Biorąc pod uwagę drożność LIMA, utworzono dwie grupy chorych: grupa 1 &#8211; chorzy z zamkniętym pomostem (n = 59), oraz grupa 2 &#8211; chorzy z drożną LIMA (n = 68). Porównano dane demograficzne, hemodynamiczne i laboratoryjne obu grup. Otyłość zdefiniowano jako indeks masy ciała (BMI) ł 30 kg/m2. Wyniki: Średnia wartość BMI w grupie 1 była istotnie wyższa niż w grupie 2 (30,4 &plusmn; 3,1 vs 28,7 &plusmn; 4,7, p = 0,025). Obie grupy różniły się również pod względem czasu, który upłynął od zabiegu chirurgicznego, stosowanych leków i stężenia HDL-cholesterolu. Dodatkowo chorych podzielono na otyłych i nieotyłych. Otyłość wiązała się ze zwiększonym ryzykiem zamknięcia LIMA: stwierdzono ją u 71% chorych z grupy 1 wobec 25% z grupy 2 (p < 0,001). Analiza wieloczynnikowa wykazała, że ryzyko zamknięcia LIMA było 7,41 razy wyższe u chorych otyłych (95% CI 3,38&#8211;16,28). Wnioski: Otyłość jest istotnym i niezależnym czynnikiem ryzyka zamknięcia pomostu tętniczego w obserwacji odległej

Metabolic syndrome increases the risk of significant coronary artery involvement in patients with peripheral artery disease

Background Peripheral artery disease is a common condition, mainly associated with clinical cardiovascular risk factors. Patients with peripheral artery disease suffer from coronary artery disease-related complications. On the other hand, metabolic syndrome, as a constellation of specific risk factors, represents a risk factor for cardiovascular mortality. Metabolic syndrome might increase the risk of significant coronary artery disease in patients with peripheral artery disease. We aimed to examine the association of metabolic syndrome with the angiographically shown coronary artery involvement in patients with peripheral artery disease

Fine vs. coarse atrial fibrillation: Which one is more risky?

Background: Atrial fibrillation (AF) is a frequent arrhythmia, associated with morbidity and mortality. It is identified by two types on surface electrocardiogram as fine and coarse AF. We aimed to search the association of subtypes of AF with clinical parameters. Methods: Eight hundred and eleven consecutive patients, who had AF attack which lasted longer than 24 h or more, were evaluated along with clinical and laboratory data. Results: Coarse AF was noticed in 51.7% (n = 419), and fine AF in 48.3% (n = 392). Sex was associated with subtype of AF such that coarse AF was present in 46.5% of male patients, but in 56.1% of female patients (p = 0.009). Coarse AF was present in 85.3% of patients with mitral stenosis, whereas it was present in 35.3% of patients with normal heart valve (p < 0.001).). Patients having fine AF were significantly older than those having coarse AF (64 +/- 12, 57 +/- 13 years, p < 0.001). 19.6% of those with coarse AF had history of cerebrovascular event (CVE), whereas 13.5% of those with fine AF had history of CVE (p = 0.021). After controlling for age in the multivariable logistic regression analysis, presence of coarse AF (B = 1.585, p = 0.031) was found to be independently associated with the history of CVE. Conclusion: AF is identified by two morphological forms on the surface electrocardiogram. These two forms were found to be associated with different clinical parameters, acting on vascular endpoints differently. Copyright (c) 2007 S. Karger AG, Basel