Mineral compositions of some selected centaurea species from Turkey

Centaurea calolepis Boiss., Centaurea lydia Boiss. and Centaurea polyclada DC. were investigated for major minerals and trace elements by X-ray fluorescence spectrometry. Calcium and potassium were found in maximum concentrations in Centaurea species. The results revealed that the concentrations of iron, manganese and zinc were found to be high in C. calolepis. On the other hand, copper, magnesium and phosphorous were found in higher concentrations in C. polyclada. Mineral composition of Centaurea species, will be descriptive in terms of the traditional use of this species. In addition, C. calolepis, C. lydia and C. polyclada may be utilized in nutraceuticals as potential natural sources of major minerals and trace elements

Unusual case of severe aortic regurgitation in a child with bicuspid aortic valve

Aortic regurgitation (AR) is common after aortic balloon valvuloplasty in children and it has been associated with large balloon/annulus ratio, abnormal valve morphology and aortic valve prolapse. We present a rare case of severe AR after aortic balloon valvuloplasty due to aortic strands rupture, causing prolapse of the co-joined cusp.  These findings were identified by 3D echocardiography, highlighting the importance of this imaging technique even in pediatric patients

Analysis of a Cardiac-Necrosis-Biomarker Release in Patients with Acute Myocardial Infarction via Nonlinear Mixed-Effects Models

The release of the cardiac troponin T (cTnT) in patients with acute myocardial infarc tion (AMI) has been analyzed through a methodology based on nonlinear mixed-effects (NME) models. The aim of this work concerns the investigation of any possible relationship between clin ical covariates and the dynamics of the release of cTnT to derive more detailed and useful clinical information for the correct treatment of these patients. An ad-hoc mechanistic model describing the biomarker release process after AMI has been devised, assessed, and exploited to evaluate the im pact of the available clinical covariates on the cTnT release dynamic. The following approach was tested on a preliminary dataset composed of a small number of potential clinical covariates: em ploying an unsupervised approach, and despite the limited sample size, dyslipidemia, a known risk factor for cardiovascular disease, was found to be a statistically significant covariate. By increasing the number of covariates considered in the model, and patient cohort, we envisage that this approach may provide an effective means to automatically classify AMI patients and to investigate the role of interactions between clinical covariates and cTnT relea

610 Fontan associated kidney and liver disease: can we predict organ involvement with echocardiographic assessment of systolic function and atrioventricular valve insufficiency?

Abstract Aims Fontan operation represents the surgical palliative option for congenital heart disease with single ventricle physiology. With the improvement of surgical and percutaneous technique, we are facing a growing population of patients with an unique pathophysiology and potential complications. Methods and results Patients that underwent Fontan palliation in our centre between 1993 and 2016 were included in this prospective study. We excluded patients with major congenital renal anomalies, those that underwent cardiac transplantation, and redo-Fontan patients. All the subjects underwent clinical evaluation, laboratory exams with complete renal and hepatic function, transient hepatic elastography, and complete cardiac evaluation. We used Schwartz equation for estimating glomerular filtration rate in patients younger than 18 years, and CDK-EPI equation for adult patients. We enrolled 35 patients, 46% female (N = 16), and 54% male (N = 19). Medium age was 17 years old, median age 15 years old (range: 10–31 years old). Medium time from Fontan completion was 160 months (range: 57–340 months). Regarding to cardiac anatomy, 10 patients had functional single left ventricle (FSLV, 28.5%) and 21 a functional single right ventricle (FSRV, 60%); 4 patients had undetermined single ventricle (11.5%). Total cavo-pulmonary connection (TCPC) with intracardiac lateral tunnel was performed in 7 patients (20%, N = 7), whereas 28 patients had TCPC with external conduit (80%). Data from echocardiographic evaluation showed a medium EF established with Simpson's method of 60% in patients with FSLV; patients with a FSRV or undetermined single ventricle had a medium FAC of 41.1%, with 15.1% having a reduced FAC < 35%. No FSLV patients had an EF < 50%. When using creatinine-based formula, data about renal function in our population showed a stage 2 chronic kidney disease (eGFR: 60–89 ml/min 1.73 mq) in 11% of total population (N = 4), that became 26% when using cystatin C-based equation (N = 9), with one patient showing a moderate reduced loss of kidney function (eGFR: 40–59 ml/min 1.73 mq). Urinalysis showed 29% (N = 10) of patients having microalbuminuria (microalbumin/creatinine ratio between 30 and 300 mg/g). Statistical analysis demonstrated a negative correlation between systolic function (TAPSE for FSRV) and cystatin C blood levels (Pearson's R −0.428, P = 0.053), and between systolic function (FAC and Simpson) and microalbuminuria (Pearson's R −0.414 with P = 0.049 and Pearson's R −0.754 with P = 0.019, respectively). Transient elastography reported 10 patients (29.4%) with abnormal hepatic stiffness for Fontan patients. That condition appeared to be more frequent in patients with higher grade of AV valve insufficiency (P < 0.05). Conclusions Our population showed an higher prevalence of FSRV Fontan patients, with an expected lower systolic function compared with FSLV. 2D evaluation of systolic function showed a linear inverse correlation with renal function, suggesting that Fontan patients need a closer renal monitoring. Hepatic stiffness, which is a warning sign of potential hepatic cirrhosis need to be monitored in all Fontan patients, especially those with a worse AV valve insufficiency

Segmental and global longitudinal strain differences between Kawasaki disease and multi-system inflammatory syndrome in children

Multi-system inflammatory syndrome in children and Kawasaki disease have overlapping clinical features but comparative echocardiographic studies are lacking

Echocardiographic Normal Reference Ranges for Non-invasive Myocardial Work Parameters in Pediatric Age: Results From an International Multi-Center Study

This international multi-center study aimed to demonstrate the feasibility and reliability of non-invasive myocardial work (MW) parameters in the pediatric population, and to provide normal reference ranges for this useful echocardiographic tool in this specific subset of patients

Non-compaction cardiomyopathy and cardiovascular outcomes: A further plus point in favour of left ventricular twist

Left ventricle non-compaction cardiomyopathy (LVNC) is still controversial on its pathogenesis and diagnosis. Some consider it an embryological abnormality with arrest of the physiological compaction of the endocardium and the myocardium, others an acquired lesion, as if it was a frustrated attempt at hypertroph

Non-compaction cardiomyopathy and cardiovascular outcomes: A further plus point in favour of left ventricular twist

Left ventricle non-compaction cardiomyopathy (LVNC) is still controversial on its pathogenesis and diagnosis. Some consider it an embryological abnormality with arrest of the physiological compaction of the endocardium and the myocardium, others an acquired lesion, as if it was a frustrated attempt at hypertroph

Long-term outcomes of coronary artery bypass grafting versus stent-PCI for unprotected left main disease: a meta-analysis

Abstract Background Coronary artery bypass graft (CABG) surgery has traditionally represented the standard of care for left main coronary artery (LMCA) disease. However, percutaneous coronary intervention with stent implantation (PCI) has more recently emerged as a valuable alternative. The long-time awaited results of the largest randomized trials on the long-term impact of PCI versus CABG in LMCA disease, the newly published NOBLE and EXCEL studies, revealed contrasting results. Thus, aim of the present meta-analysis was to review the most robust evidence from randomized comparisons of CABG versus PCI for revascularization of LMCA. Methods Randomized studies comparing long-term clinical outcomes of CABG or Stent-PCI for the treatment of LMCA disease were searched for in PubMed, the Chochrane Library and Scopus electronic databases. A total of 5 randomized studies were selected, including 4499 patients. Results No significant difference between CABG and PCI was found in the primary analysis on the composite endpoint of death, stroke and myocardial infarction (OR = 1·06 95% CI 0·80–1·40; p = 0·70). Similarly, no differences were observed between CABG and PCI for all-cause death (OR = 1·03 95% CI 0·81–1·32; p = 0·81). Although not statistically significant, a lower rate of stroke was registered in the PCI arm (OR = 0·86; p = 0·67), while a lower rate of myocardial infarction was found in the CABG arm (OR = 1·43; p = 0·17). On the contrary, a significantly higher rate of repeat revascularization was registered in the PCI arm (OR = 1·76 95% CI 1·45–2·13; p < 0·001). Conclusions The present meta-analysis, the most comprehensive and updated to date, including 5 randomized studies and 4499 patients, demonstrates no difference between Stent-PCI and CABG for the treatment of LMCA disease in the composite endpoint of death, stroke and myocardial infarction. Hence, a large part of patients with unprotected left main coronary artery disease can be managed equally well by means of both these revascularization strategies