Use of Optical Coherence Tomography in MI with Non-obstructive Coronary Arteries

MI with non-obstructive coronary arteries (MINOCA) comprises an important minority of cases of acute MI. Many different causes have been implicated in the pathogenetic mechanism of MINOCA. Optical coherence tomography (OCT) is an indispensable tool for recognising the underlying pathogenetic mechanism when epicardial pathology is suspected. OCT can reliably identify coronary lesions not apparent on conventional coronary angiography and discriminate the various phenotypes. Plaque rupture and plaque erosion are the most frequently found atherosclerotic causes of MINOCA. Furthermore, OCT can contribute to the identification of ischaemic non-atherosclerotic causes of MINOCA, such as spontaneous coronary artery dissection, coronary spasm and lone thrombus. Recognition of the exact cause will enable therapeutic management to be tailored accordingly. The combination of OCT with cardiac magnetic resonance can set a definite diagnosis in the vast majority of MINOCA patients

Sinus node disease in subjects with type 1 ECG pattern of Brugada syndrome

AbstractBackgroundThe spectrum of phenotypes related to mutations of the SCN5A gene include Brugada syndrome (BS), long QT syndrome, progressive cardiac conduction defect, and sinus node disease (SND). The present study investigated the incidence of SND in subjects with type 1 electrocardiogram (ECG) pattern of BS.Methods and resultsThe study population consisted of 68 individuals (55 males, mean age 44.8±12.8 years) with spontaneous (n=27) or drug-induced (n=41) type 1 ECG pattern of BS. Twenty-eight subjects were symptomatic with a history of syncope (41.2%). SND was observed in 6 symptomatic subjects (8.8%), and was mainly attributed to sino-atrial block with sinus pauses. Two patients were initially diagnosed with SND, and received a pacemaker. Patients with SND displayed an increased P-wave duration in leads II and V2, PR interval in leads II and V2, QRS duration in leads II and V2, and increased QTc interval in lead V2 (p<0.05). AH and HV intervals as well as corrected sinus node recovery time (cSNRT) were significantly prolonged in subjects with SND (p<0.05). During a mean follow-up period of 5.0±3.6 years, five subjects with a history of syncope suffered appropriate implantable cardioverter defibrillator (ICD) discharges due to ventricular arrhythmias (7.4%). None of those diagnosed with SND suffered syncope or ICD therapies.ConclusionSND is not an uncommon finding in subjects with type 1 ECG pattern of BS. The occurrence of SND in relatively young patients may deserve meticulous investigation including sodium channel blocking test

The Role of Inflammation in Diabetes: Current Concepts and Future Perspectives

Diabetes is a complex metabolic disorder affecting the glucose status of the human body. Chronic hyperglycaemia related to diabetes is associated with end organ failure. The clinical relationship between diabetes and atherosclerotic cardiovascular disease is well established. This makes therapeutic approaches that simultaneously target diabetes and atherosclerotic disease an attractive area for research. The majority of people with diabetes fall into two broad pathogenetic categories, type 1 or type 2 diabetes. The role of obesity, adipose tissue, gut microbiota and pancreatic beta cell function in diabetes are under intensive scrutiny with several clinical trials to have been completed while more are in development. The emerging role of inflammation in both type 1 and type 2 diabetes (T1D and T1D) pathophysiology and associated metabolic disorders, has generated increasing interest in targeting inflammation to improve prevention and control of the disease. After an extensive review of the possible mechanisms that drive the metabolic pattern in T1D and T2D and the inflammatory pathways that are involved, it becomes ever clearer that future research should focus on a model of combined suppression for various inflammatory response pathways

2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death the Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC) Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC)

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Μελέτη της επίδρασης των σκιαγραφικών υλικών στην ενεργοποίηση του συμπληρώματος κατά τη διενέργεια στεφανιογραφίας σε ασθενείς με σταθερή στηθάγχη

Background: The effects of radiographic contrast media on markers of complement activation and apoptosis in patients with chronic coronary artery disease are unknown. The purpose of this study was to assess the comparative effects of ionic high-osmolar and non-ionic iso-osmolar radiographic contrast media on plasma markers of complement activation and apoptosis in patients with chronic coronary artery disease undergoing coronary angiography. Methods and Population: Forty-four patients undergoing coronary angiography for chronic coronary artery disease were randomly assigned to receive the ionic high-osmolar radiographic contrast agent diatrizoate (Group A) or the non-ionic iso-osmolar contrast agent iodixanol (Group B) during angiography. Complement component 5 (C5a) and apoptotic markers sFas and sFasL were measured just prior to angiography and one hour after completion of angiography. Results: Forty-four patients (22 in each group, 25 men, age 59±8,6) were included. Comparison of mean pre- and post-angiography plasma marker levels showed significantly greater increases in plasma levels in group A than in group B of C5a (29.30 + 5.45 ng/ml for group A and 0.47 + 0.70 ng/ml for group B (p<0.00001), sFas (2.36 + 1.63 ng/ml for group A and 0.23 + 0.90 ng/ml for group B (p<0.00001) and sFasL (14.00 + 5.41 pg/ml for Group A and 0.01 + 1.00 pg/ml for group B (p<0.00001). Conclusion: The results suggest that in patients with chronic coronary artery disease the use of ionic high-osmolar radiographic contrast media during coronary angiography is associated with a more marked effect on the inflammatory and apoptotic milieu than that associated with the use of non-ionic iso-osmolar radiographic contrast media.Θεωρητικό υπόβαθρο και σκοπός της μελέτης: Η επίδραση των ακτινολογικών σκιαγραφικών μέσων στους δείκτες ενεργοποίησης του συμπληρώματος και απόπτωσης σε ασθενείς με χρόνια στεφανιαία νόσο δεν έχει επαρκώς διερευνηθεί. Σκοπός της παρούσας μελέτης ήταν να εκτιμήσει συγκριτικά τις επιδράσεις των ιονικών υψηλής ωσμωτικότητας και των μη ιονικών ισο-ωσμωτικών σκιαγραφικών μέσων σε δείκτες ενεργοποίησης του συμπληρώματος στο πλάσμα, καθώς και σε δείκτες αποπτωτικής δραστηριότητας, σε ασθενείς με σταθερή χρόνια στεφανιαία νόσο που υποβάλλονται σε στεφανιογραφία. Μέθοδοι και πληθυσμός: Σαράντα τέσσερις ασθενείς υποβαλλόμενοι σε στεφανιογραφία λόγω σταθερής στηθάγχης, τυχαιοποιήθηκαν για ναλάβουν κατά τη στεφανιογραφία είτε τον ιονικό υψηλής ωσμωτικότητας παράγοντα diatrizoate (Ομάδα A) είτε το μη ιονικό ισο-ωσμωτικό σκιαγραφικό παράγοντα iodixanol (Ομάδα B). Το ενεργοποιημένο συστατικό του συμπληρώματος 5 (C5a) και οι αποπτωτικοί δείκτες sFas και sFasL μετρήθηκαν αμέσως πριν και μία ώρα μετά την ολοκλήρωση της στεφανιαίας αρτηριογραφίας σε δείγματα περιφερικού αίματος. Αποτελέσματα: Περιελήφθησαν συνολικά 44 ασθενείς (22 σε κάθε ομάδα, 25 άνδρες, ηλικία 59±8,6). Η σύγκριση των επίπεδων πλάσματος των ανωτέρω δεικτών πριν και μετά τη στεφανιογραφία έδειξε σημαντικά μεγαλύτερες αυξήσεις στην Ομάδα A σε σύγκιρση με την Ομάδα B, σε ό,τι αφορά το C5a (αύξηση 29,30 + 5,45 ng/ml στην Ομάδα A και 0,47 + 0,70 ng/ml στην Ομάδα B (p<0,00001), το sFas (αύξηση 2,36 + 1,63 ng/ml στην Ομάδα A and 0,23 + 0,90 ng/ml στην Ομάδα B (p<0,00001) και στο sFasL (14,00 + 5,41 pg/ml στην Ομάδα A and 0,01 + 1,00 pg/ml στην Ομάδα B (p<0,00001). Συμπέρασμα: Τα αποτελέσματα δείχνουν ότι σε ασθενείς με σταθερή χρόνια στεφανιαία νόσο οι οποίοι υποβάλλονται σε στεφανιαία αρτηριογραφία, η χρήση ιονικών υψηλής ωσμωτικότητας σκιαγραφικών μέσων σχετίζεται με εντονότερη ενεργοποίηση των παραγόντων ενεργοποίησης του συμπληρώματος και της απόπτωσης, σε σύγκριση με τα μη ιονικά ισο-ωσμωτικά μέσα