Evaluation of beta-blockers on left ventricular dyssynchrony and reverse remodeling in idiopathic dilated cardiomyopathy: A randomized trial of carvedilol and metoprolol

Background: The effect of b-blockage on cardiac dyssynchrony in idiopathic dilated cardio­myopathy (IDC) is unknown. This study evaluated the impact of carvedilol and metoprolol succinate on left ventricular (LV) dyssynchrony and reverse remodeling in IDC. Methods: In this small, prospective, double-blind study, we randomly assigned 81 IDC pa­tients to receive carvedilol or metoprolol succinate. Echocardiographic measurements (dyssyn­chrony, LV volumes and ejection fraction [EF]) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were obtained at baseline and at first and sixth month of therapy. Results: A total of 74 (91%) patients completed all investigations at sixth month (38 and 36 taking carvedilol and metoprolol succinate, respectively). In the carvedilol group, reduction in LV end diastolic volume (D LVEDV at 6 months, 50 ± 15 mL to 40 ± 17 mL, p = 0.03) and increase in LVEF (D LVEF, 7 ± 2% to 5 ± 3%, p = 0.02) was higher compared to the meto­prolol group. Also improvement in inter-ventricular dyssynchrony achieved with carvedilol was higher than metoprolol (D interventricular delay at 6 months, 11 ± 8 ms to 6 ± 7 ms, p = 0.03). However, improvement in intraventricular dyssynchrony was similar in the two groups (D intraventricular delay, 9 ± 7 ms to 9 ± 6 ms, p = 0.91). Improvements in LV mechanical dyssynchrony and reverse remodeling achieved with both drugs were accompanied by reduction in NT-proBNP levels in both carvedilol and metoprolol groups (1614 ± 685 pg/mL to 654 ± ± 488 pg/mL and 1686 ± 730 pg/mL to 583 ± 396 pg/mL, respectively, p < 0.001 for both). Conclusions: Although reduction in LVEDV and increase in LVEF was higher with carvedilol, improvement in intraventricular dyssynchrony was similar in carvedilol and metoprolol groups.

Long term clinical outcomes of brachytherapy, bare-metal stenting, and drug-eluting stenting for de novo and in-stent restenosis lesions: Five year follow-up

Background: We aimed to investigate the effects of brachytherapy, drug-eluting stent (DES) and bare metal stent (BMS) applications in the treatment of coronary artery disease, on five- -year clinical outcomes and mortality. Methods: Two hundred and seventeen patients who were treated in our clinics between January 2000 and December 2003 with brachytherapy, DES, or BMS for both de novo and in- -stent restenosis lesions were included in this cohort study. Of these 217 patients, 69 received brachytherapy, 80 were given BMS and 68 were given DES. The clinical outcomes of the patients during hospitalization and over a long-term follow-up were evaluated. Cardiovascular events, revascularizations and mortality rates were compared among the three groups over a five-year follow-up. Results: The mean age was 60.1 ± 9.5 years in the brachytherapy group, 55.7 ± 9.2 years in the BMS group, and 58.9 ± 9.8 years in the DES group (p = 0.44). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients, and four (5.9%) DES patients (p = 0.01). Cardiovascular event was the cause of death for 14 (20.3%) brachytherapy patients, 16 (20%) BMS patients and four (5.9%) DES patients (p = 0.001). All-cause mortality rates were 20 (29%) brachytherapy patients, 22 (27.5%) BMS patients and four (5.9%) DES patients. All-cause and cardiovascular mortality rates were significantly lower in the DES group compared to both the BMS and the brachytherapy groups (p = 0.01 and p = 0.001, respectively). Conclusions: DES application for in-stent restenosis and de novo lesions was superior to brachytherapy and BMS application with respect to all-cause and cardiovascular mortalities. (Cardiol J 2011; 18, 6: 654–661

Multiple Giant Coronary Arterial Aneurysms Leading to Stable Angina

Coronary artery aneurysm (CAA) is defined as abnormal dilatation of a coronary artery luminal diameter to 1.5 to 2 times wider than the adjacent normal segment. Giant coronary artery aneurysms are rare, with a reported prevalence of 0.02% to 0.2% [1]. Most of the giant coronary artery aneurysms are asymptomatic, but some patients present with angina pectoris, sudden death, fistula formation, pericardial tamponade, compression of surrounding structures, or congestive heart failure. A 61-year-old man referred to our outpatient clinic with stable angina pectoris lasting approximately 3 months, rising with exercise and relaxing with resting. He had no cardiovascular risk factor except smoking a pack/ day for 10 years. ECG revealed right bundle branch block and no signs of acute ischemia. Transthoracic echocardiography showed normal LV wall motion and a normal ascending aorta in diameter. Optimal medical treatment (OMT) for stable angina pectoris including acetyl salicylic acid, metoprolol and rosuvastatin was initiated immediately. However, angina continued despite a short course of OMT. Then coronary angiography was planned to identify options for revascularization. Coronary angiography revealed giant coronary aneurysms on the proximal left anterior descending artery (20 X 18 mm) and circumflex artery (16 X 20 mm) and accompanying atherosclerotic stenosis adjacent to the aneurysms (Figure 1). Hs- CRP was measured 4.5 mg/L. Antinuclear antibody, anti-ds-DNA level, and p-ANCA and c-ANCA levels were in normal range. Because our patient had multivessel CAD and SYNTAX score was 30, heart team considered CABG was more beneficial for this patient and accordingly he was transferred to cardiovascular surgery (CVS) department for CABG.</p

Double Valve Infective Endocarditis Presenting with Acute Ischemic Stroke

Infective endocarditis (IE); is an infectious disease which generally develops due to the involvement of cardiac valves, congenital cardiovascular lesions, prosthetic valves and other prosthetic materials by specific microorganisms during transient bacteremia. Despite developments in diagnosis and treatment, high mortality rates make it an important element of our current agenda. Embolic events are common and one of the life-threatening complications of IE; which may result in difficulty in diagnosis as they can imitate other pathological conditions [1,2]. In this report, we present a patient with double valve IE whose first diagnosis was ischemic stroke due to embolic complications of IE.</p

Atrial Electromechanical Delay Is Impaired in Patients with Psoriasis

Objective: In this study, we aimed to investigate atrial electromechanical delay (EMD) in patients with psoriasis. Subjects and Methods: A total of 43 patients with psoriasis (26 mild-moderate, 17 severe) and 17 healthy control subjects were enrolled. Patients with psoriasis were divided into two groups: the mild-moderate group and the severe group according to their psoriasis area severity index (PASI) scores. Atrial EMD was measured from the lateral mitral annulus and called 'PA lateral', from the septal mitral annulus, called ` PA septal', and from the right ventricle tricuspid annulus, called 'PA tricuspid'. Atrial EMD was defined as the time interval from the onset of atrial electrical activity (P wave on surface ECG) to the beginning of mechanical atrial contraction (late diastolic A wave). All three groups were compared with each other, and correlation analysis was performed to investigate the relationship between the PASI score and interatrial EMD. Results: PA lateral was significantly higher in both the mild-moderate psoriasis group and the severe psoriasis group compared to controls (69 +/- 12 and 78 +/- 13 vs. 60 +/- 6 ms; p = 0.001). Also, PA septal (63 +/- 11 vs. 53 +/- 6 ms; p = 0.005, post hoc analysis) and PA tricuspid (49 +/- 7 vs. 41 +/- 5 ms; p = 0.009, post hoc analysis) were significantly higher in the severe psoriasis group than in the control group. Correlation analysis revealed that the PASI score was well correlated with PA lateral (r = 0.520, p < 0.001), PA septum (r = 0.460, p = 0.002), interatrial EMD (r = 0.371, p = 0.014) and intra-atrial EMD (r = 0.393, p = 0.009). Conclusion: Atrial EMD was prolonged in patients with psoriasis. The measurement of atrial EMD might be used to determine the risk of development of AF in patients with psoriasis. (C) 2014 S. Karger AG, Base