Congenital left main coronary artery aneurysm

Left main coronary artery aneurysm (LMCAA) is an uncommon coronary abnormality seen in 0.1% of patients during routine diagnostic coronary angiographies. The most common etiology is atherosclerosis in acquired cases. However, it can also be a congenital malformation. We present the case of a 26 year-old female with a large LMCAA. She was diagnosed with tetralogy of Fallot initially. (Cardiol J 2011; 18, 4: 430–433

A failed case of percutaneous septal closure of fenestrated atrial septal defect

A patient presenting with a history of palpitation and exertional dyspnea was initially diagnosed with two separate secundum-type atrial septal defects by transesophageal echocardiography. Subsequent transesophageal echocardiography, after failure of closure with two separate closure devices, showed another defect and an ongoing left to right shunt. During surgery, more defects were observed. The defects were successfully repaired using pericardial patch without incident. (Cardiol J 2011; 18, 1: 92-93

Red cell distribution width and its relationship with global longitudinal strain in patients with heart failure with reduced ejection fraction: a study using two-dimensional speckle tracking echocardiography

   Background: Red cell distribution width (RDW) is a measurement of size variability of the red blood cells and has been shown to be a powerful predictor of prognosis in heart failure (HF). Recently, global longitudinal strain (GLS) emerged as a more accurate marker of left ventricular (LV) systolic function. Aim: We aimed to assess the relationship between RDW and standard echocardiographic parameters and LV global strain measured by two-dimensional (2D) speckle tracking echocardiography in patients with HF with reduced EF (HFrEF). Methods: Fifty-nine HF patients with an EF < 50%, and 40 age-matched controls with normal EF were included in the study. Standard and 2D strain imaging examinations were performed. Blood tests including RDW were scheduled on the same day as the echocardiographic study. Results: Left atrial volume index, LV end-systolic and end-diastolic dimensions, and E/A and E/e’ ratios were higher and LVEF together with LV GLS were significantly lower in the HFrEF group. RDW showed positive correlations with log B-type natri­uretic peptide (r = 0.45, p = 0.0001), left atrial volume index (r = 0.38, p = 0.001), LV end-diastolic dimensions (r = 0.37, p = 0.001), and E/e’ (r = 0.33, p = 0.005) and negative correlations with haemoglobin (r = –0.54, p = 0.0001), LVEF (r = –0.27, p = 0.004) and finally LV GLS (r = –0.41, p = 0.001). HFrEF patients were divided into two groups based on the median RDW value. Patients with higher than median RDW had significantly lower GLS despite similar EF. Conclusions: Elevated RDW is associated with poorer LV deformation assessed by speckle tracking echocardiography in HF patients with similar EF. Therefore, the degree of anisocytosis could be used as an additional marker to identify these high-risk patients as well as improve treatment strategy

The association of functional mitral regurgitation and anemia in patients with non-ischemic dilated cardiomyopathy

Background: We investigated the association between anemia and functional mitral regurgitation (MR) in non-ischemic dilated cardiomyopathy (DCM) patients with sinus rhythm and normal renal function. Methods: Sixty non-ischemic DCM patients with sinus rhythm and left ventricular ejection fraction < 40% were recruited. Functional MR was quantified with the proximal isovelocity surface area method. MR was graded according to the mitral regurgitant volume (Reg Vol) or effective regurgitant orifice (ERO) area. The clinical, biochemical and echocardiographic correlates of functional MR severity were investigated in patients with DCM. Results: Hemoglobin degrees were significantly different between various MR levels (mild MR 13.9 &#177; 1.7 mg/dL, moderate MR 12.3 &#177; 1.5 mg/dL, moderate to severe MR 10.8 &#177; 0.9 mg/dL). Receiver operating characteristic (ROC) analysis was performed to assess the utility of hemoglobin levels to predict moderate or severe functional MR. A hemoglobin level less than 12.5 mg/dL predicted moderate or high MR with 80% sensitivity and 58% specificity (AUC: 0.789, 95% CI: 0.676&#8211;0.901, p < 0.0001). Logistic regression analysis was performed to determine the independent predictors of moderate or severe levels of MR. The left atrium diameter (OR: 19.3, 95% CI: 1.4-27.1, p = 0.028) and presence of anemia (OR: 11.9, 95% CI: 1.22-42.5, p = 0.0045) were independent predictors of moderate or severe functional MR. Conclusions: The presence of anemia and enlarged left atrium are independent predictors of moderate or severe functional MR in non-ischemic DCM patients with normal renal function. Hemoglobin levels less than 12.5 mg/dL should alert the physician for the presence of moderate or severe MR in patients with DCM. (Cardiol J 2010; 17, 3: 274-280

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Cardiac involvement in melanoma: A case report and review of the literature

Heart is rarely involved in metastatic cancer. A 44-year-old woman diagnosed with melanoma, with extensive metastases to whole body including interatrial septum demonstrated by PET/CT and echocardiography, was presented and discussed in light of the literature

One of the most urgent vascular circumstances: Acute limb ischemia

Acute limb ischemia is a sudden decrease in limb perfusion that threatens limb viability and requires urgent evaluation and management. Most of the causes of acute limb ischemia are thrombosis of a limb artery or bypass graft, embolism from the heart or a disease artery, dissection, and trauma. Assessment determines whether the limb is viable or irreversibly damaged. Prompt diagnosis and revascularization by means of catheter-based thrombolysis or thrombectomy and by surgery reduce the risk of limb loss and mortality. Amputation is performed in patients with irreversible damage. Despite urgent revascularization, amputation rate is 10%–15% in patients during hospitalization, mostly above the knee, and mortality within 1 year is 10%–15% due to the coexisting conditions

Cardiac involvement in melanoma: a case report and review of the literature.

Heart is rarely involved in metastatic cancer. A 44-year-old woman diagnosed with melanoma, with extensive metastases to whole body including interatrial septum demonstrated by PET/CT and echocardiography, was presented and discussed in light of the literature