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

Plasma YKL-40 Elevation on Admission and Follow-Up Is Associated with Diastolic Dysfunction and Mortality in Patients with Acute Myocardial Infarction

Objective. The aim of the study was to determine an association between the plasma YKL-40 level and echocardiographic left ventricle systolic and diastolic function parameters in patients with acute myocardial infarction. Subjects and Methods. The study included 46 patients with acute myocardial infarction. Serum brain natriuretic protein (BNP) and YKL-40 levels were analyzed on admission and after one month. Left ventricle systolic and diastolic functions and Tei index were computed by transthoracic echocardiography. Results. Plasma YKL-40 was significantly higher in patients with acute myocardial infarction (AMI) (101.7 μg/L versus 34 μg/L, resp., p<0.001) and remained higher than in healthy subjects after one month. The levels of YKL-40 on admission were correlated with log BNP on admission (r=0.41,p=0.004), Tei index (r=0.44,p=0.002), left atrium volume index (r=0.32,p=0.02), and mitral septal annular E/e′ (r=0.44,p=0.003). Death was more frequently observed in patients with plasma YKL-40 above the median value than in those with plasma YKL-40 below the median value (p=0.001; OR = 13.6 (2.5–72.3)). Conclusion. YKL-40 elevations in patients with AMI remain at least one month and are associated with serum BNP elevations, diastolic dysfunction, and long-term increased overall mortality. It has prognostic importance in patients with AMI

Evaluation of Left Ventricular Function by Conventional Echocardiography and Tissue Doppler Imaging in Patients with Acute and Chronic Mitral Regurgitation

Left ventricular function is affected differently in acute and chronic mitral regurgitation (MR). Twenty-six patients (12 men and 14 women, average age: 55±20 years) with acute severe MR caused by flail leaflet and 30 patients with chronic severe MR of organic origin (14 men and 16 women, average age: 56±14 years) were included in the study. All of the patients were evaluated in detail by conventional echocardiography and tissue Doppler imaging (TDI). Among conventional echocardiographic parameters, left ventricle ejection fraction (%) was found higher in acute MR (71±5/59±12, p=0.001) whereas left ventricle end-systolic volume, left ventricle end-diastolic volume, left ventricle end-systolic diameter, left ventricle end-diastolic diameter, left atrium dimension, and left atrial area were significantly higher in chronic MR. Among TDI parameters, peak systolic wave velocities (11.4±3.6/8.8±2.5cm/s, p=0.018), peak early diastolic velocities (10.8±4.5/9.3±3.8cm, p=0.03), and contraction time (248±56/219±47ms, p=0.04) were found higher in acute MR, whereas precontraction time (119±29/164±48ms, p=0.005) and precontraction time to contraction time ratio (0.52±0.23/0.78±0.28, p=0.008) were significantly higher in chronic MR. As evaluated by conventional echocardiography, the systolic function of chronic MR was also normal, although it was lower than that of acute MR. We also found that left ventricular systolic and diastolic functions by TDI were also relatively preserved in patients with acute MR when compared with those with chronic MR

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

Uric Acid as a Marker of Oxidative Stress in Dilatation of the Ascending Aorta

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