Interferon production in BCG-sensitized rabbits challenged with PPD

Intravenous administration of PPD into BCG-primed rabbits results in the release of IFN into the circulation. Peak interferon titres occur in plasma 1 h after PPD injection, rapidly decline during the following 3 h and depend on the dose of tuberculin administered. Bilateral nephrectomy of BCG-primed rabbits challenged with PPD affects remarkably the disappearance of IFN from the circulation. Characterization of the BCG-PPD-induced IFN shows that it is heat-labile, is almost completely inactivated after dialysis at pH 2 and displays a remarkable cross-species activity, particularly on human cell lines

Layer-specific strain in dipyridamole stress echo: A new tool for the diagnosis of microvascular angina

Background: Dipyridamole stress echocardiography (DSE) represents a fundamental test in patients with suspected coronary artery disease (CAD). The diagnosis of microvascular disease is still challenging. We aimed to determine the diagnostic value of left ventricular (LV) layer-specific longitudinal (LS) and circumferential strain (CS) by Speckle Tracking in detecting CAD during DSE and to study if they can help in discriminate between a negative echo and a suspected microvascular angina. Methods and results: We enrolled 66 patients with known or suspected CAD. All underwent standard DSE. We identified 3 groups according to the result of DSE (36 negative DSE, 19 positive DSE, 11 indicatives for microvascular disease). Wall motion score index, global LV LS and CS (global longitudinal strain [GLS] and global circumferential strain [GCS]), and layer-specific LV LS and CS were measured at rest and peak stress. The Delta between rest and peak stress values was calculated. GLS increased after injection in negative DSE and microvascular disease while reducing in positive DSE. Endocardial GCS and transmural GCS values were stable in microvascular disease while increasing significantly in negative DSE, helping in the diagnosis. The specific analysis of endocardial LS showed the most powerful difference between healthy and macrovascular CAD patients, both for LS and CS. Conclusions: Global circumferential strain can be a new valuable added tool in the echocardiographic diagnosis of microvascular disease. Endocardial GLS is the best indicator of an altered wall deformation in the presence of macrovascular ischemia

Circulating esRAGE is Associated with a Pro-Inflammatory/Pro-Atherothrombotic Profile in Familial Combined Hyperlipidemia Patients with Non-alcoholic Fatty Liver Disease

Circulating esRAGE is Associated with a Pro-Inflammatory/Pro-Atherothrombotic Profile in FCHL patients with NAFLD in patients with traits of metabolic syndrom

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

Effects of levosimendan without loading dose on systolic and diastolic function in patients with end-stage heart failure.

Abstract BACKGROUND: Levosimendan (L) is used in clinical practice for the treatment of severe heart failure (HF); it has inotropic and vasodilatory effects, without increasing myocardial oxygen consumption. In acute HF, levosimendan improves hemodynamic parameters; previous studies have demonstrated that it has favorable effects on left ventricular (LV) diastolic function. The aim of our study was to evaluate the effect of on LV long-axis function that represents the earlier marker of diastolic dysfunction. METHODS: We enrolled 41 patients (age 62 ± 12 years) admitted to our Department for acute HF, NYHA class IV and severe LV dysfunction. Twenty-six patients were treated with L (0.1 μg/kg/min ev for 24 h without loading dose) and 15 patients were treated with standard therapy (C). We evaluated clinical, blood exams and echocardiographic parameters at baseline and one week after L or C treatment. RESULTS: Baseline demographic, clinical and biochemical data were similar in both groups. After one week, the L group had shown a significant improvement in NYHA class and a reduction of pro-B-type natriuretic peptide (pro-BNP). In echocardiographic study, we observed an improvement in LV longitudinal function (p 〈 0.05) and LV ejection fraction (p 〈 0.05) with a reduction of E/E' (p 〈 0.05) in the L group. We divided the L group into ischemic and non- -ischemic patients and we demonstrated a significant increase in systolic function in the former. No differences were found between subgroups in diastolic function. CONCLUSIONS: L therapy, without loading dose, improves NYHA class and ventricular function in patients with acute HF; we believe that these prolonged hemodynamic effects are due to active metabolities of

Massive mitral regurgitation secondary to acute ischemic papillary muscle rupture: the role of echocardiography.

Papillary muscle rupture is an infrequent but often fatal mechanical complication of acute myocardial infarction (AMI). We report the case of an AMI complicated by the development of an abrupt cardiogenic shock due to the rupture of the head of the postero-medial papillary muscle with echocardiographic demonstration of severe mitral regurgitation due to flail posterior mitral valve leaflet. After initial stabilization with medical therapy and diagnostic coronary angiography, the patient was referred for urgent cardiac surgery and successfully underwent mitral valve replacement with implantation of a bioprosthesis. This case confirms the importance of transthoracic echocardiography in diagnosing mechanical acute complications during an AMI and in the decision making of patients with sudden onset of hemodynamic compromise. Transthoracic echocardiography should be immediately carried out in all patients in whom a mechanical complication during an AMI is suspecte

An unusual cause of syncope in hypertrophic cardiomyopathy

Abstract Syncope and pre-syncope represent common symptoms in patients with hypertrophic cardiomyopathy. The clinical scenario of recurrent and frequent syncopal episodes is one of the most challenging in the management of patients with hypertrophic cardiomyopathy. Syncope in hypertrophic cardiomyopathy patients usually recognizes two underlying mechanisms: arrhythmias or primary hemodynamic mechanism. The concomitant presence of myocardial ischemia is one of the potential triggers in the context of syncope due to hemodynamic mechanism. Myocardial ischemia is not generally related to epicardial coronary artery atherosclerotic disease but rather to the presence of partially obliterated intramural coronary arteries or narrowed vessels. We report the rare case of a patient with hypertrophic cardiomyopathy presenting with recurrent syncopal episodes due to myocardial ischemia secondary to severe stenosis of the left anterior descending coronary artery

Influence of aetiology on long-term effects of resynchronization on cardiac structure and function in patients treated with β-blockers.

Abstract OBJECTIVES: Cardiac resynchronization therapy (CRT) elicits more beneficial effects on left-ventricular (LV) structure and function, and long-term clinical outcomes in nonischemic heart failure patients. Rates of β-blocker use in recent heart failure trials are higher than in CRT trials and this may influence the response to CRT. This study examined the long-term effects of CRT on LV structure and function in New York Heart Association class III-IV β-blocker-treated patients. METHODS: One hundred and four (41 ischemic and 63 nonischemic) CRT patients, who were receiving β-blockers before and throughout 12 months following device implantation, were retrospectively selected. Variations in echocardiographic parameters recorded before, and 6 and 12 months after CRT were analyzed. RESULTS: Selected patients were all stable on β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (97%) and diuretics (97%) before implantation. CRT was associated with significant improvements in LV morphological and systo-diastolic functional parameters at 6 months, with further improvements between 6 and 12 months seen in nonischemic patients only. Accordingly, rates of echocardiographic response to CRT were similar at 6 months but significantly higher in nonischemic patients after 1 year. The degree of reduction in LV diameters and volumes, and of increase in ejection fraction, was significantly larger in nonischemic patients at both 6 and 12 months. In addition, a significant reduction in LV mass and severity of mitral regurgitation was more evident in nonischemic patients both 6 and 12 months following CRT. CONCLUSIONS: Ischemic aetiology of heart failure is associated with less favorable long-term effects of CRT on LV structure and function despite the systematic use of β-blockers

Cardiogenic shock complicating myocardial infarction in a doped athlete

Abstract Abuse of doping agents may pose a higher risk for heart disease including acute myocardial infarction. We report the case of a 50-year-old body-builder Caucasian man with a long-standing abuse of nandrolone and erythropoietin that developed a ventricular septal defect following acute myocardial infarction. This mechanical complication led to cardiogenic shock ultimately treated with the implantation of a circulatory support by means of extracorporeal membrane oxygenation. The patient subsequently underwent orthotopic heart transplantation. The association of intense isometric exercise, abuse of erythropoietin and nandrolone is likely to have predisposed to coronary thrombus formation and acute myocardial infarction, as the patient presented no traditional cardiovascular risk factors