Hemorrhagic Transformation of Ischemic Stroke: Severe Complications of Prosthetic Valve Endocarditis

Ischemic stroke is a common complication of infective endocarditis (IE), occurring in 20-40% of left side IE cases. In these subsets, anticoagulation therapy may provoke hemorrhagic transformation (HT) of ischemic stroke, and complications of this magnitude deteriorate the clinical course for IE patients. However, in cases of IE complicated with a mechanical prosthetic valve, the physician can be concerned over the maintenance of anticoagulation due to the risk of thrombotic complication. According to our retrospective review, HT of ischemic stroke in prosthetic valve endocarditis occurred 13.8% (4/29) of the time in a variety of situations. Some of these even arose in patients with a subtherapeutic range of prothrombin time

Magnetic Resonance Imaging of Transient Left Ventricular Apical Ballooning Related to Emotional Stress: a Case Report

Transient left ventricular apical ballooning is characterized by transient wall motion abnormalities involving the left ventricular apex and mid-ventricle in the absence of coronary arterial occlusion. A 66-year-old woman presented to the emergency department with chest pain that mimicked acute myocardial infarction. An aortogram showed akinesis from the mid to apical left ventricle with sparing of the basal segments. Four days later, she underwent MRI, which demonstrated characteristic apical contractile dysfunction, the same as the aortogram, without evidence of myocardial infarction on the MRI. Two weeks later, her symptoms were resolved and follow-up echocardiography showed normal ventricular function

Association of Plasma Retinol-Binding Protein 4, Adiponectin, and High Molecular Weight Adiponectin with Insulin Resistance in Non-Diabetic Hypertensive Patients

∙The authors have no financial conflicts of interest. Purpose: The aim of this study was to determine whether retinol-binding protein 4 (RBP4), adiponectin and high molecular weight (HMW) adiponectin are associated with insulin resistance (IR) and metabolic parameters in non-diabetic hypertensive patients. Also, we sought to compare the predictive values of these adipocytokines for IR in non-diabetic hypertensive patients. Materials and Methods: Analyses of RBP4, adiponectin, and HMW adiponectin were performed on 308 non-diabetic hypertensives (148 males, age 58 ± 10 years, 189 non-metabolic syndrome and 119 metabolic syndrome). The homeostasis model assessment (HOMA) index for IR, lipid profiles, and anthropometric measure-ments were assessed. Results: There was no significant difference in RBP4 levels according to the presence of metabolic syndrome, although adiponectin and HMW adiponectin were significantly lower in metabolic syndrome. Correlation analysis of log RBP4 with IR and metabolic indices revealed that there was no significant correlation of RBP4 with wais

Transient Right Ventricular Dysfunction After Pericardiectomy in Patients With Constrictive Pericarditis

Pericardiectomy is the standard treatment in patients with chronic constrictive pericarditis who have persistent symptoms. However, myocardial atrophy with prolonged pericardial constriction and abrupt increase in venous return can lead to heart failure with volume overload after pericardial decompression, especially in the right ventricle (RV). We experienced a 44 year old male patient who developed transient RV failure after pericardiectomy for constrictive pericarditis. Echocardiography revealed a markedly dilated RV with decreased peak systolic velocity of the tricuspid annulus, suggesting severe RV dysfunction. After treatment with inotropics and diuretics, a follow-up echocardiography revealed an improved systolic function with decreased RV chamber size. This case demonstrates the importance of volume overload and RV dysfunction in patients with constrictive pericarditis undergoing pericardiectomy

Clinical and Echocardiographic Findings of Newly Diagnosed Acute Decompensated Heart Failure in Elderly Patients

PURPOSE: Elderly patients (pts) (EPs; ≥ 65 years old) with newly diagnosed-acute decompensated heart failure (ND-ADHF) have not yet been studied. The aim of the present study was to investigate clinical characteristics, including echocardiographic findings and prognosis, for EPs with ND-ADHF and to compare those with non-elderly pts (NEPs). MATERIALS AND METHODS: We retrospectively investigated 256 pts (144 males, 63.0 ± 14.8 years old) who were admitted to our hospital between January 2005 and March 2009 with ND-ADHF. Clinical characteristics and echocardiographic parameters were analyzed in EPs (n = 135, 58 males) and NEPs (n = 121, 86 males). RESULTS: In intergroup comparison, female gender, diabetes mellitus, previous stroke and hypertension were more common in EPs. Body mass index (22.3 ± 4.5 vs. 24.0 ± 4.4 kg/m(2)), estimated glomerular filtration rate (54.8 ± 24.3 vs. 69.2 ± 30.7 mL/min/m(2)), C-reactive protein (28.5 ± 46.9 vs. 7.6 ± 11.6 mg/dL), hemoglobin (12.3 ± 2.1 vs. 13.6 ± 2.3 g/dL) and N-terminal pro-brain natriuretic peptide level (10,538.2 ± 10,942.3 vs. 6,771.0 ± 8,964.7 pg/mL) were significantly different (p < 0.05 for all). Early mitral inflow velocity to early diastolic mitral annular velocity (E/E') was significantly higher in EPs than in NEPs (21.2 ± 9.4 vs. 18.0 ± 8.9, p < 0.05). During follow-up (44.7 ± 14.5 months), there were no significant differences in in-hospital mortality, re-hospitalization and cardiovascular mortality between EPs and NEPs (p = NS for all). CONCLUSION: EPs with ND-ADHF have different clinical characteristics and higher LV filling pressure when compared with NEPs. However, the clinical outcomes for NEPs with ND-ADHF are not necessarily more favorable than those for EPs.ope