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

The effect of myocardial fibrosis on left ventricular torsion and twist in patients with non-ischemic dilated cardiomyopathy

Background: Left ventricular (LV) rotation, twist, and torsion are important aspects of thecardiac performance. Myocardial fibrosis can be identified as the late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR). In this study, we investigated the associationbetween myocardial fibrosis and LV rotational parameters in patients with nonischemic dilated cardiomyopathy (NDC).Methods: Twenty-two NDC patients were enrolled. LV dimensions, volumes and ejection fraction (EF) were measured, conventional tissue Doppler imaging data was acquired. Speckletracking imaging was performed to measure LV deformation, LV rotational parameters. Bloodsamples were obtained for NT-proBNP. Late gadolinium enhanced cardiac magnetic resonance (LGE-CMR) was used to assess cardiac fibrosis index.Results: Myocardial deformation was similar between LGE+ and LGE– groups. LGE+patients have significantly higher basal and lower apical systolic rotation, lower twist andtorsion when compared to LGE– patients. However, untwisting rate was similar between thegroups. Torsion was significantly correlated with LVEF and MR-index. Patients with reversedapical systolic rotation had significantly greater NT-proBNP values, basal systolic rotation andsignificantly lower apical systolic rotation, torsion, and MR-index.Conclusions: Cardiac fibrosis index is closely related with myocardial torsion and LV systolicfunction and may be used for the evaluation of cardiac condition. Reversed apical systolicrotation indicated more extensive cardiac fibrosis as it may reflect severe LV dyssynchrony andpoor LV performance

Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans

An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients

Impairment of the left ventricular systolic and diastolic function in patients with non-alcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is considered the liver component of the metabolic syndrome. We investigated the diastolic and systolic functional parameters of patients with NAFLD and the impact of metabolic syndrome on these parameters. Methods: Thirty-five non-diabetic, normotensive NAFLD patients, and 30 controls, were included in this study. Each patient underwent transthoracic conventional and tissue Doppler echocardiography (TDI) for the assessment of left ventricular (LV) diastolic and systolic function. Study patients were also evaluated with 24-hour ambulatory blood pressure monitoring. Results: NAFLD patients had higher blood pressures, increased body mass indices, and more insulin resistance than controls. TDI early diastolic velocity (E&#8217; on TDI) values were lower in NAFLD patients than the controls (11.1 &#177; 2.1 vs 15.3 &#177; 2.7; p < 0.001). TDI systolic velocity (S&#8217; on TDI) values were lower in NAFLD patients than the controls (9.34 &#177; 1.79 vs 10.6 &#177; 1.52; p = 0.004). E&#8217; on TDI and S&#8217; on TDI values were moderately correlated with night-systolic blood pressure, night-diastolic blood pressure, and night-mean blood pressure in NAFLD patients. Conclusions: Patients with NAFLD have impaired LV systolic and diastolic function even in the absence of morbid obesity, hypertension, or diabetes. (Cardiol J 2010; 17, 5: 457-463

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

The App-Runx1 Region Is Critical for Birth Defects and Electrocardiographic Dysfunctions Observed in a Down Syndrome Mouse Model

Down syndrome (DS) leads to complex phenotypes and is the main genetic cause of birth defects and heart diseases. The Ts65Dn DS mouse model is trisomic for the distal part of mouse chromosome 16 and displays similar features with post-natal lethality and cardiovascular defects. In order to better understand these defects, we defined electrocardiogram (ECG) with a precordial set-up, and we found conduction defects and modifications in wave shape, amplitudes, and durations in Ts65Dn mice. By using a genetic approach consisting of crossing Ts65Dn mice with Ms5Yah mice monosomic for the App-Runx1 genetic interval, we showed that the Ts65Dn viability and ECG were improved by this reduction of gene copy number. Whole-genome expression studies confirmed gene dosage effect in Ts65Dn, Ms5Yah, and Ts65Dn/Ms5Yah hearts and showed an overall perturbation of pathways connected to post-natal lethality (Coq7, Dyrk1a, F5, Gabpa, Hmgn1, Pde10a, Morc3, Slc5a3, and Vwf) and heart function (Tfb1m, Adam19, Slc8a1/Ncx1, and Rcan1). In addition cardiac connexins (Cx40, Cx43) and sodium channel sub-units (Scn5a, Scn1b, Scn10a) were found down-regulated in Ts65Dn atria with additional down-regulation of Cx40 in Ts65Dn ventricles and were likely contributing to conduction defects. All these data pinpoint new cardiac phenotypes in the Ts65Dn, mimicking aspects of human DS features and pathways altered in the mouse model. In addition they highlight the role of the App-Runx1 interval, including Sod1 and Tiam1, in the induction of post-natal lethality and of the cardiac conduction defects in Ts65Dn. These results might lead to new therapeutic strategies to improve the care of DS people