67 research outputs found
Acute effects of caffeine and cigarette smoking on ventricular long-axis function in healthy subjects
<p>Abstract</p> <p>Background</p> <p>Few data exist regarding the direct effects of caffeine and smoking on cardiac function. We sought to explore the acute effects of caffeine assumption, cigarette smoking, or both on left ventricular (LV) and right ventricular (RV) function in a population of young normal subjects.</p> <p>Methods</p> <p>Forty-five healthy subjects aged 25 ± 2 years underwent echocardiography. Fifteen of them were non-smokers and habitual coffee consumers (group 1), 15 were smokers and not habitual coffee consumers (group 2), and 15 were smokers and habitual coffee consumers (group 3). Peak systolic (S<sub>a</sub>), early diastolic E<sub>a</sub>, and late diastolic (A<sub>a</sub>) velocity of mitral annulus were measured by pulsed Tissue Doppler, and left atrioventricular plane displacement was determined by M-mode. Tricuspid annular velocities and systolic excursion (TAPSE) were also determined. Measurements were performed at baseline and after oral assumption of caffeine 100 mg in group 1, one cigarette smoking in group 2, and both in group 3.</p> <p>Results</p> <p>No changes in ventricular function were observed in group 1 after caffeine administration. In group 2, cigarette smoking yielded an acute increase in mitral A<sub>a </sub>(+12.1%, p = 0.0026), tricuspid S<sub>a </sub>(+9.8%, p = 0.012) and TAPSE (+7.9%, p = 0.017), and a decrease in the mitral E<sub>a</sub>/A<sub>a </sub>ratio (-8.5%, p = 0.0084). Sequential caffeine assumption and cigarette smoking in group 3 was associated with an acute increase in mitral A<sub>a </sub>(+13.0%, p = 0.015) and tricuspid A<sub>a </sub>(+11.6%, p < 0.0001) and a reduction in mitral E<sub>a</sub>/A<sub>a </sub>ratio (-8.5%, p = 0.0084) tricuspid E<sub>a </sub>(-6.6%, p = 0.048) and tricuspid E<sub>a</sub>/A<sub>a </sub>ratio (-9.6%, p = 0.0003). In a two-way ANOVA model controlling for hemodynamic confounding factors, changes in the overall population remained significant for mitral A<sub>a </sub>and E<sub>a</sub>/A<sub>a </sub>ratio, and for tricuspid A<sub>a </sub>and E<sub>a</sub>/A<sub>a </sub>ratio.</p> <p>Conclusion</p> <p>In young healthy subjects, one cigarette smoking is associated to an acute impairment in LV diastolic function and a hyperdynamic RV systolic response. Caffeine assumption alone does not exert any acute effect on ventricular long-axis function, but potentiates the negative effect of cigarette smoking by abolishing RV supernormal response and leading to a simultaneous impairment in both LV and RV diastolic function.</p
Evidence of scar tissue: contra-indication to cardiac resynchronization therapy?
Ventricular Dysfunction & Heart Failur
Out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation in patients with normal electrocardiograms:results from a multicentre long-term registry
AIMSâ: To define the clinical characteristics and long-term clinical outcomes of a large cohort of patients with idiopathic ventricular fibrillation (IVF) and normal 12-lead electrocardiograms (ECGs). METHODS AND RESULTS: Patients with ventricular fibrillation as the presenting rhythm, normal baseline, and follow-up ECGs with no signs of cardiac channelopathy including early repolarization or atrioventricular conduction abnormalities, and without structural heart disease were included in a registry. A total of 245 patients (median age: 38âyears; males 59%) were recruited from 25 centres. An implantable cardioverter-defibrillator (ICD) was implanted in 226 patients (92%), while 18 patients (8%) were treated with drug therapy only. Over a median follow-up of 63âmonths (interquartile range: 25-110âmonths), 12 patients died (5%); in four of them (1.6%) the lethal event was of cardiac origin. Patients treated with antiarrhythmic drugs only had a higher rate of cardiovascular death compared to patients who received an ICD (16% vs. 0.4%, Pâ=â0.001). Fifty-two patients (21%) experienced an arrhythmic recurrence. Age â€16âyears at the time of the first ventricular arrhythmia was the only predictor of arrhythmic recurrence on multivariable analysis [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.18-0.92; Pâ=â0.03]. CONCLUSIONâ: Patients with IVF and persistently normal ECGs frequently have arrhythmic recurrences, but a good prognosis when treated with an ICD. Children are a category of IVF patients at higher risk of arrhythmic recurrences
Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial
Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium â„6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D
Implications of serial measurements of natriuretic peptides in heart failure: insights from BIOSTATâCHF
No abstract available
Subocclusion of the sinus node artery during coronary angioplasty: arrhythmological considerations.
We report the case of a 58-year-old man who developed atrial fibrillation as a result of iatrogenic subocclusion of a diseased sinus node artery, originating from the left circumflex artery (LCx), occurring during LCx stenting, suggestive of an ischemic etiology of sinus node dysfunctio
How should I treat pulmonary arteriovenous malformations in a patient with Rendu-Osler disease presenting with transient ischaemic attack
Abstract
BACKGROUND: A 42-year-old man with no cardiovascular risk factors or history was admitted for evaluation of an episode of transient ischaemic attack (TIA). He had no cardiovascular risk factors and his physical examination was unremarkable. INVESTIGATION: Physical examination, electrography, transesophageal echocardiogram, coronary angiogram. DIAGNOSIS: Intrapulmonary shunting, in the presence of arteriovenous malformations, possible hereditary haemorrhagic telangectasia. TREATMENT: Transcatheter occlusion of multiple pulmonary arteriovenous malformations using an AMPLATZER vascular plu
La frequenza cardiaca: fattore di rischio o epifenomeno?
The role of heart rate (HR) as an independent predictor of cardiovascular morbidity and mortality remains controversial. Direct evidence supporting a causal association between HR and prognosis is still lacking even if such relation appears plausible and may be inferred from epidemiological studies and clinical trials with HR lowering agents. The introduction of If current blocking agents, namely ivabradine, has offered the novel and unique opportunity to directly and exclusively interfere with HR and, thus, to validate the presence of a causal relationship between HR and prognosis. The BEAUTIFUL trial has recently confirmed that HR is a powerful negative prognostic predictor in patients with coronary artery disease and left ventricular systolic dysfunction. Particularly, subjects with a resting HR >70 b/min showed an increased risk of major adverse cardiovascular events. In these patients, HR reduction with ivabradine was associated with a reduction in major cardiac ischemic events, though not mortality. Further data will become available with the SHIFT trial in which patients with heart failure and HR > or =70 b/min are included and reduction in cardiovascular mortality and heart failure hospitalizations is the primary endpoint
Unusual evolutionary electrocardiogram pattern in a white patient with apical hypertrophic cardiomyopathy.
Abstract
We report the case of a 85-year-old white woman diagnosed with apical hypertrophic cardiomyopathy, in whom we observed an unusual progression of initial T waves inversion to a nearly normal electrocardiogram (EKG) to giant negative T waves and back to a nearly normal EKG
Pleiotropic Effects of Long-Term Monotherapy with Rosuvastatin in Dogs with Moderate Heart Failure
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