Coronary tortuosity: normal variant or pathological condition?

HighlightsCoronary tortuosity is a common coronary angiography finding. The aetiology and the clinical significant are not well defined, generally considered a normal variant. We showed a case of marked tortuosity of all coronary arteries associated with myocardial ischemia. </p

Altered two-dimensional strain measures of the right ventricle in patients with Brugada syndrome and arrhythmogenic right ventricular dysplasia/cardiomyopathy

Aims: Brugada syndrome (BrS) is an inherited channelopathy that can be characterized by mild right ventricular (RV) abnormalities that are not detectable with conventional echocardiography. The aim of this study was to evaluate the presence of RV abnormalities in BrS patients when compared with controls and a group of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using two-dimensional (2D) strain analysis. Methods and results: We enrolled 25 BrS, 15 ARVD/C patients, and 25 controls. Right and left ventricular dimension and systo-diastolic function were evaluated by conventional echocardiography. Longitudinal systolic strain (sS) peak, systolic and early diastolic strain rate of lateral RV segments were evaluated by 2D speckle tracking analysis. Left ventricle global and segmental strain measures were also evaluated. A reduced basal or mid-RV lateral sS were the parameters mostly associated with both BrS and ARVD/C. In BrS patients the minimum sS observed in these segments was significantly lower than that of controls (-28.9±3.2% vs. -32.3±3.2%, P: 0.002) but significantly greater than that evaluated in ARVD/C patients (-24.6 ±6.7%, P < 0.001 both vs. BrS and controls). No differences were found between the BrS and the control group when left ventricular strain measures were analysed. Conclusion: By 2D strain technique it is possible to observe mild abnormalities in RV systolic and diastolic function of BrS patients that are less pronounced than those observed in ARVD/C patients. These results help to better define the phenotypic characteristics of BrS patients and represent the basis for future studies aimed at testing their clinical usefulness in BrS patients

Higher reliability of 18F-FDG target background ratio compared to standardized uptake value in vulnerable carotid plaque detection: a pilot study.

Objective: To evaluate the role of [18F]-fluorodeoxyglucose positron emission tomography/computer tomography [18F-FDG PET/CT] comparing target background ratio (TBR) and standardized uptake value (SUV) with the histopathological inflammatory status of the carotid plaques. Background: Vulnerable carotid plaques are the primary cause of acute cerebrovascular events. 18F-FDG PET/CT represents a morpho-functional technique able to identify the highly inflamed and most vulnerable carotid plaques. Several literature studies experimented this new method to identify vascular inflammation, but few have effectively compared PET/CT results with plaque histological data and no studies had directly compared TBR to SUV. Methods: Thirty-two consecutive patients (20 men and 12 women, mean age 74 ± 8 years) undergoing carotid endarterectomy were enrolled and studied with carotid 18F-FDG PET/CT. Maximum and mean SUV and TBR were used to quantify 18F-FDG uptake while surgical specimens were analyzed by optical microscopy to identify inflamed carotid plaques, with evaluation of macrophages infiltration by mean of immunohistochemistry. On the basis of the presence of inflammation at the histological analysis, we divided population in two groups: group A (n = 12) patients with inflamed carotid plaques and group B (n = 20) patients with non-inflamed ones, then crossed and evaluated the histological data with 18F-FDG PET/CT findings. Results: SUV max and SUV mean values resulted higher in group A (respectively, 2.14 ± 0.77 and 1.99 ± 0.68) than in group B (respectively, 1.79 ± 0.37 and 1.64 ± 0.34) without reaching a statistical significance (p = ns). TBR max and TBR mean values resulted higher in group A (respectively, 1.42 ± 0.32 and 1.34 ± 0.26) than in group B (respectively, 1.16 ± 0.19 and 1.03 ± 0.20) with a statistically significant differences between the two groups and carotid inflammation (respectively, p < 0.01 and p < 0.001). Conclusion: TBR (max and mean values) is a more reliable parameter than SUV in identifying inflamed plaques. Although limited by the small population analyzed, our results suggest the important role of 18F-FDG PET/CT, using TBR, in identification of high-risk carotid atherosclerotic plaques. © 2014 The Japanese Society of Nuclear Medicine

Neutrophil-dependent pentraxin-3 and reactive oxygen species production modulate endothelial dysfunction in haemodialysis patients.

BACKGROUND: The aim of this study was to investigate neutrophil activation and its role in long pentraxin-3 (PTX3) release and oxidative stress generation during haemodialysis (HD) and to correlate neutrophil PTX3 and oxidant expression with endothelial dysfunction. METHODS: Forty-seven uraemic patients on stable HD, 12 healthy subjects and 15 patients with congestive heart failure (New York Heart Association classes III and IV) were enrolled. Neutrophil PTX3 protein expression was evaluated by confocal microscopy. l-selectin expression, intracellular PTX3 localization and reactive oxygen species (ROS) generation in human neutrophils were measured by flow cytometry. NADPH-dependent superoxide generation was investigated by chemiluminescence. PTX3 plasma concentrations were measured by ELISA. Endothelial dysfunction was studied by flow-mediated dilation (FMD). RESULTS: The low baseline levels of FMD significantly improved after HD, but worsened by 24 h. A significant up-regulation of PTX3 protein expression, localized within secondary granules, was detected in neutrophils isolated at 30 and 240 min of HD, along with an increase in l-selectin expression. The up-regulation in intracellular PTX3 in neutrophils was associated with a significant increase in PTX3 plasma concentrations at 240 min. HD increased ROS production and NADPH oxidase activity in neutrophils. In a univariate analysis, pre-treatment with FMD was inversely correlated with PTX3 expression and ROS generation in neutrophils. In a multivariate analysis, both circulating pre-HD PTX3 and intracellular ROS generation by neutrophils were independent predictors of abnormal FMD. CONCLUSIONS: Neutrophil overexpression of PTX3 is associated with ROS overproduction and endothelial dysfunction and may represent an emerging marker of vascular damage progression in HD patients. © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved

Non-alcoholic fatty liver disease is associated with early left ventricular dysfunction in childhood acute lymphoblastic leukaemia survivors.

Background: Childhood acute lymphoblastic leukaemia (ALL) survivors have an increased risk of metabolic and cardiovascular disease. We aimed to assess the presence of non-alcoholic fatty liver disease (NAFLD) in childhood ALL and if it is associated with early cardiovascular dysfunction. Methods: In total, 53 childhood ALL survivors and 34 controls underwent auxological evaluation, biochemical assay, liver, heart and vascular ultrasound study. Results: NAFLD was more frequent in ALL patients than in controls (39.6% vs 11.7%, P &lt; 0.01). Patients with NAFLD were more obese and insulin resistant than patients without NAFLD. Flow-mediated dilatation and interventricular septum were lower in the ALL group than those in the control group (P &lt; 0.001 for both). The patients with NAFLD showed lower left ventricular ejection fraction than those without NAFLD (P = 0.011). In ALL survivors, BMI-SDS and subcutaneous fat were the strongest predictors of NAFLD, whereas preperitoneal adipose tissue and C-reactive protein were the strongest predictors of left ventricular ejection fraction. Conclusions: Childhood ALL survivors had higher prevalence of NAFLD than healthy controls, which is associated with early left ventricular impairment. In the case of fatty liver, a comprehensive heart evaluation is mandatory. We strongly recommend to prevent visceral adiposity in ALL survivors, to search for metabolic syndrome or its components and to reinforce the need of intervention on diet and lifestyle during the follow-up of these patients

Aorto-left atrial fistula, the role of transesophageal echocardiography: a case report

A 73 woman with a history of replacement of heart valves (mitro-aortic replacement with biological prosthesis about a year before) was referred for surgical evaluation for a progressive worsening of fatigue and dyspnea and for low-grade fever in the evening. She was diabetic and with rheumatoid arthritis on treatment with corticosteroids. She had a history of previous duodenal ulcer, hysterectomy and splenectomy

percutaneous approach to a tight post isthmic aortic coarctation a case report and literature review

Correction: Figure 1 and Figure 2 were omitted from the PDF. On 5th June 2017, the new PDF including the figures was uploaded and the page numbers of the article changed from 41-44 TO 41-45.A 17 years-old boy with hypertension underwent cardiology assessment for episodes of dyspnoea and palpitations. Cardiac angiography showed post-istmic severe aortic coarctation. The malformation was successful treated by implanting a covered stent in aorta. The manuscript describes in detail this case and analyzes the available literature on the topic.Journal of Advances in Internal Medicine Vol.5(2) 2016: 41-4

Increased carotid IMT in overweight and obese women affected by Hashimoto's thyroiditis: an adiposity and autoimmune linkage?

<p>Abstract</p> <p>Background</p> <p>Hashimoto's thyroiditis is the most important cause of hypothyroidism. It is a systemic disease that can even affect the cardiovascular system, by accelerating the atherosclerotic process. Aim of this study was to examine whether autoimmune thyroiditis has an effect on the intima-media thickness of the common carotid artery (IMT-CCT), independently of the thyroid function and well-known cardiovascular risk factors. Hashimoto's thyroiditis is a systemic disease. The aim is to examine whether autoimmune thyroiditis and adiposity can effect carotid IMT independently of thyroid hormones and cardiovascular risk factors.</p> <p>Methods</p> <p>A total of 104 obese women (BMI ≥ 25.0 kg/m^-2), with FT3 and FT4 serum levels in the normal range and TSH levels < 4.5 μU/ml, were investigated. None of these patients was taking any kind of drug influencing thyroid function. Measurements were made of the IMT-CCT, BMI, waist circumference, blood pressure levels, as well as fasting TSH, FT3, FT4, anti-thyroid antibodies, insulin, fasting glycemia, triglycerides, total and HDL-cholesterol serum concentrations.</p> <p>Results</p> <p>Of the 104 women, 30 (28.8%) were affected by autoimmune thyroiditis. Significantly higher values of IMT-CCT (p < 0.05), TSH (p < 0.05), and triglycerides (p < 0.05) were obtained, and significantly lower values of FT4 (p < 0.05), in patients with Hashimoto's thyroiditis as compared to those with a normal thyroid function. When examining the whole group together, at multiple regression analysis Hashimoto's thyroiditis maintained a positive association with the IMT (p < 0.001), independently of age, hypertension, BMI, and the fasting serum levels of TSH, FT3, FT4, insulin, fasting glycemia, triglycerides, total and HDL-cholesterol levels.</p> <p>Conclusions</p> <p>The present study shows that Hashimoto's thyroiditis is associated to an increased IMT only in overweight and obese, independently of the thyroid function, BMI and cardiovascular risk factors. These results suggest that Hashimoto's thyroiditis is a marker of evolution of the atherosclerosis if combined to adiposity.</p

late age at menarche increased common carotid artery intima media thickness in overweight and obese women

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