Effect of carvedilol on silent anthracycline-induced cardiotoxicity assessed by strain imaging: A prospective randomized controlled study with six-month follow-up

Background: The use of antracycline (ANT) in breast cancer has been associated with adverse cardiac events. Two-dimensional (2D) strain imaging (SI) can provide a more sensitive measure of altered left ventricular (LV) systolic function. We aimed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT.Methods: Patients receiving ANT were randomly assigned to the carvedilol- or placebo-receiving group. Each received an echocardiographic examination with conventional 2D echocardiography, pulsed tissue Doppler, and 2D SI prior to and 6 months post ANT treatment.Results: During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy treatments due to doxorubicin-induced cardiotoxicity. Both left ventricular ejection fraction (LVEF) and fractional shortening (FS) were within normal limits for all patients before and after ANT therapy. EF, FS and LV dimensions were measured using M-mode echocardiography and found to be similar in both groups before and after ANT therapy. The mean EF, FS, and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months. Though baseline SI parameters were similar between the groups, there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group.Conclusions: These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT.

A patient treated with tilt training and midodrine after 68 seconds asystole during head-up tilt table testing

Neurocardiogenic syncope is a relatively common cause of syncope and is diagnosed by head-up tilt testing. A 21-year-old man was examined for frequent syncope episodes which occurred after episodes of blood drawing and standing in queue. Syncope developed in tilt table testing. After about 68 seconds, sinus rhythm returned. Recent reports have shown that tilt training is a very effective therapy for recurrent neurocardiogenic syncope. In our case, the patient was treated with midodrine 2.5 mg once a day and a tilt training programme. Therapy resulted in improvement and during a follow-up of six months, no major events occurred

Znaczenie kliniczne i uwarunkowania szybkiej dostępności krążenia obocznego w pierwotnej przezskórnej interwencji wieńcowej

Background: Due to ischaemic time delays from the chest pain occurrence in acute ST elevation myocardial infarction (STEMI), prompt recruitment collaterals (PRCCs) to infarct-related artery (IRA) are the major protective structures during this period. Aim: We aimed to investigate the clinical significance and determinants of PRCCs in acute STEMI patients. Methods: A total of 1375 consecutive acute STEMI patients were prospectively enrolled in the study. The patients were divided into two groups, according to PRCCs to IRA; Rentrop ≤ 1 were defined as inadequate collateral development (ICD) group and Rentrop ≥ 2 defined as adequate collateral development (ACD) group. Results: Patients in the ICD group had higher incidence of baseline risk characteristics, including older age, hypertension, and diabetes mellitus; however, pre-infarct angina incidence was lower than in the ACD group (p < 0.05 for all). In addition, the ICD group had worse haemodynamic status on admission and 30-day mortality. Compared to the ACD group, the non-IRA chronic total occlusion (CTO), peak troponin-T, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (hs-CRP) levels were higher in the ICD group. On multivariate logistic regression analysis, non-IRA CTO (b = 3.114, 95% CI 1.382–7.017, p < 0.006) with pre-infarction angina together with higher values of peak troponin-T, NT-proBNP, and hs-CRP were associated with PRCCs in acute STEMI. Conclusions: Taking into account that the main message of the study is that if patients have higher cardiac biomarkers and adverse clinical findings (which, of note, may show the extent of myocardial infarction) and have non-IRA CTO, there is a higher chance that they will have inadequate collateralisation.Wstęp: Ze względu na opóźnienie między wystąpieniem niedokrwienia a pojawieniem się bólu w klatce piersiowej w ostrym zawale serca z uniesieniem odcinka ST (STEMI) szybko dostępne naczynia oboczne (PRCC) w obszarze unaczynienia tętnicy odpowiedzialnej za zawał (IRA) są strukturami mającymi w tym okresie najważniejsze znaczenie ochronne. Cel: Badanie przeprowadzono w celu oceny znaczenia klinicznego i czynników determinujących PRCC u chorych z ostrym STEMI. Metody: Do badania włączono prospektywnie 1375 kolejnych pacjentów z ostrym STEMI. Chorych podzielono na dwie grupy w zależności od PRCC w obszarze IRA; osoby z oceną w skali Rentropa wynoszącą ≤ 1 przydzielano do grupy z niedostatecznie rozwiniętym krążeniem obocznym (ICD), a osoby z oceaną w skali Rentropa wynoszącą ≥ 2 — do grupy z wystarczająco rozwiniętym krążeniem obocznym (ACD). Wyniki: U chorych z grupy ICD stwierdzono częstsze występowanie czynników ryzyka w ocenie wyjściowej, w tym starszy wiek, nadciśnienie tętnicze i cukrzycę, jednak przedzawałowe objawy dławicowe występowały u tych pacjentów rzadziej niż w grupie ACD (p < 0,05 dla wszystkich porównań). Ponadto grupa ICD charakteryzowała się gorszymi parametrami hemodynamicznymi przy przyjęciu do szpitala oraz wyższą śmiertelnością w okresie 30 dni. W tej grupie częściej stwierdzano obecność przewlekle niedrożnej tętnicy innej niż IRA (non-IRA CTO) oraz wyższe wartości takich parametrów, jak: maksymalne stężenie troponiny T, stężenie N-końcowego propeptydu natriuretycznego typu B (NT-proBNP) i białka C-reaktywnego o wysokiej czułości (hs-CRP) niż w grupie ACD. W wieloczynnikowej analizie regresji logistycznej wykazano, że obecność non-IRA CTO (b = 3,114; 95% CI 1,382–7,017; p < 0,006) z występowaniem przedzawałowych bólów dławicowych, a także wyższymi stężeniami troponiny T, NT-proBNP i hs-CRP wiązały się z PRCC w ostrym STEMI. Wnioski: Głównym wnioskiem z badania jest stwierdzenie, że u chorych z wysokimi stężeniami biomarkerów sercowych oraz niekorzystnymi wynikami badania klinicznego (które mogą wskazywać na wielkość zawału), a także z non-IRA CTO, występuje większe ryzyko tego, że mają niedostatecznie rozwinięte krążenie oboczne

Patients with papillary thyroid carcinoma associated with high stimulated serum calcitonin levels.

Among various substances produced by C-cells, the most important one is calcitonin (CT) that is used for detection, postoperative follow-up and evaluation of individuals at risk of developing medullary thyroid carcinoma (MTC). However, the role of serum CT measurement in the evaluation of thyroid nodules has been widely discussed, and there is still no consensus about the role of CT in the initial evaluation of all thyroid nodules. Two patients with thyroid nodules whose fine-needle aspiration results were compatible with benign cytology besides having mildly elevated basal serum calcitonin levels were reported. Calcitonin responses (peak levels were 313 and 229 pg/mL, respectively) to calcium stimulation test were compatible with the possible diagnosis of MTC. However, the final diagnosis was papillary thyroid carcinoma of the thyroid gland. There are limited numbers of case reports showing such an increased serum calcitonin responses to calcium stimulation test associated with papillary or follicular thyroid carcinoma of the thyroid. We suggest to measure serum CT level once and in case of normal levels, no further CT measurement is necessary. Physicians should keep in mind that thyroid carcinomas other than MTCs may also be associated with high serum CT levels