Metabolic Correlates of Coronary Atherosclerosis, cardiovascular Risk, Both or Neither. Results of the 2x2 Phenotypic CAPIRE Study

Background Traditional cardiovascular risk factors (RFs) and coronary artery disease (CAD) do not always run parallel. We investigated functional-metabolic correlations of CAD, RFs, or neither in the CAPIRE (Coronary Atherosclerosis in Outlier Subjects: Protective and Novel Individual Risk Factors Evaluation) 2 × 2 phenotypic observational study. Methods Two hundred and fortyone subjects were included based on RF burden, presence/absence of CAD (assessed by computed tomography angiography), age and sex. Participants displayed one of four phenotypes: CAD with ≥3 RFs, no-CAD with ≥3 RFs, CAD with ≤1 RF and no-CAD with ≤1 RF. Metabolites were identified by gas chromatography–mass spectrometry and pathways by metabolite set enrichment analysis. Results Characteristic patterns and specific pathways emerged for each phenotypic group: amino sugars for CAD/high-RF; urea cycle for no-CAD/high-RF; glutathione for CAD/low-RF; glycine and serine for no-CAD/low-RF. Presence of CAD correlated with ammonia recycling; absence of CAD with the transfer of acetyl groups into mitochondria; high-risk profile with alanine metabolism (all p < 0.05). The comparative case-control analyses showed a statistically significant difference for the two pathways of phenylalanine, tyrosine and tryptophan biosynthesis and phenylalanine metabolism in the CAD/Low-RF vs NoCAD/Low-RF comparison. Conclusions The present 2 × 2 observational study identified specific metabolic pathways for each of the four phenotypes, providing novel functional insights, particularly on CAD with low RF profiles and on the absence of CAD despite high-risk factor profiles

The strengths and frailties of women with cardiovascular disease

Shakespeare and popular belief have tended to reinforce the view that females are weak. Scientific methodology applied to the field of cardiovascular disease suggests, to the contrary, that women are strong and enduring. Compared to males, females live at least 4 years longer, develop ischemic heart disease about 10 years later, require more risk factors before manifesting heart disease5, are less subject to sudden cardiac death6, and appear to have a more favorable outcome after the onset of heart failure

Gender differences in diagnostic procedures

This review examines the contribution of the literature to the controversial issue of diagnostic procedures in women affected by coronary artery disease (CAD), on which a large number of papers have been published. It has been reported that cerebro- and cardiovascular diseases represent the first cause of death in the New as well as in the Old World, Italy included. Some studies are conditioned by bias; one of these is the Framingham study, in which angina was reported and defined only clinically and for a relatively young age range, as a benign condition in women. Angiographic studies, such as the CASS, considered a super elected group of women referred to the hemodynamic laboratory for chest pain, which in the female gender often has atypical characteristics. In our opinion, it is mandatory to take into account: 1) what chest pain really means in women; 2) the fact that there are gender differences: women have a different biological and hormonal status, lifestyle, and perception of the disease; 3) that there is a different approach of the physicians to a woman with possible or suspected CAD. We suggest, therefore, a more peculiar and individualized diagnostic approach to women suspected as having CAD. This approach should also take the pre-test probability of disease into consideration. The first investigational step we recommend is the exercise ECG test; should this be unfeasible or not interpretable, an imaging and/or pharmacological stress test is advisable. In case of positive first test results, coronary angiography should be performed. © 2003 CEPI Srl

Congenital complete absence of the pericardium: A multimodality imaging diagnostic approach

The complete congenital absence of the pericardium is a rare and benign condition, which often presents a diagnostic dilemma. We reported a case of essentially complete absence of the pericardium with an otherwise normal heart in a 16 year old that was imaged with both transthoracic echocardiography and MRI. \uc2\ua9 2010, Wiley Periodicals, Inc

Endothelial dysfunction in postmenopausal women and hypertension

‘Menopause is a cardiovascular risk factor for endothelial dysfunction … It also represents a unique opportunity to study the effect of endothelial dysfunction in healthy women and predicts the development of atherosclerosis and atherosclerosis-related diseas

Failure of mitral valve repair: Partial detachment of valvular ring by 3D transesophageal echocardiography reconstruction

(ECHOCARDIOGRAPHY, Volume 26, January 2009)

The authors' reply

We appreciate Dr West's comments on our paper1; he has given us the opportunity to clarify some points that seem unresolved