Procalcitonin in acute heart failure

Acute heart failure (AHF) isa time critical disease and it is of outmost importance to identify the underlyingprecipitating factors as soon as possible as this can improve patient outcomes. Infection is such a significant factor. Procalcitonin (PCT), as a biomarker of bacterial infection, can be used in AHF patients to establish the diagnosis of concomitant bacterial infection. PCT can guide the early initiation of antibiotic therapy and provide prognostic information regarding AHF patients. This short review summarizes the current evidence on PCT use in AHF including the preliminary results of the IMPACT-BIC-18 trial.&nbsp

Right Atrial Mass: Time for Contrast Echocardiography

We present the case of a 42-year-old man with dyspnea New York Heart Association class III-IV, leg edema and ascites for the last 3 months. ECG and chest X-ray were unremarquable. The echo study revealed a large triangular mass in the right atrium attached to the interatratrial septum with a wide base. There were also severe tricuspid stenosis and regurgitation

Acute post cardiac injury syndrome occurring immediately after a demanding percutaneous coronary intervention.

Postcardiac injury syndrome (PCIS) occurs as a complication of myocardial infarction (Dressler's syndrome), of cardiac surgery (post-pericardiotomy syndrome), or post-traumatic (either iatrogenic or non-iatrogenic) and involves a pericardial or myocardial injury. There is scarce data regarding occurrence and pathogenesis of PCIS after invasive procedures. Herein, we describe a unique case of acute PCIS with typical clinical, laboratory, echocardiographic findings that occurred one hour after a demanding multi-stenting percutaneous coronary intervention. Possible pathogenetic mechanisms and treatment options are being discussed

The adverse reactions to contrast media during percutaneous coronary interventions; keep in mind the non-idiosyncratic reactions.

Background: Iodinated contrast media (ICM) have been among the most commonly used agents in the modern era of medicine and have become of paramount importance in the field of interventional cardiology. Although ICM have an overall good safety profile, severe or life-threatening reactions can occur as well. Description of case: Herein, we report the case of a 74-year-old female patient who presented with a non-ST elevation myocardial infarction and underwent a successful percutaneous coronary intervention (PCI). At completion of the procedure, the patient complained of dizziness and a metallic taste. She became severely hypotensive with simultaneous bradycardia, simulating a vasovagal reaction. The persistence, however, of the reaction despite initial appropriate measures, guided our thought to a non-idiosyncratic reaction to the contrast media. The patient was hemodynamically stabilized with administration and up-titration of vasopressors and transferred to the coronary care unit, where she developed the full-blown clinical picture of an ICM adverse reaction. She was discharged 8 days later with no further complications.        Conclusion: Non-idiosyncratic reactions to contrast media during a PCI can be misinterpreted as a complication of the procedure per se or as a vasovagal reaction. A high level of clinical suspicion is warranted to ensure prompt recognition and appropriate management

The “Elpis” Registry on Percutaneous Coronary Interventions: A Three-Year Experience

The advent of percutaneous coronary intervention (PCI) transformed the treatment of obstructive coronary artery disease (CAD) by creating a less invasive revascularization option to coronary-artery bypass grafting (CABG).1 Although, randomized controlled clinical trials (RCTs) are the gold standard in medical research, there is not always the possibility to conduct properly designed RCTs. The gap between evidence from RCTs and clinical practice can be filled by epidemiological studies and properly designed registries.2 The results of the Hellenic Heart Registry on Percutaneous Coronary Interventions (HHR-PCI), a national registry of patients with stable angina or acute coronary syndromes who underwent PCI, were only recently published.3 The purpose of the current study is to report the experience of a newly formed Catheterization laboratory at a tertiary hospital of Athens and to compare its findings to those reported by the HHR-PCI... (excerpt

Quantitative analysis of left atrial function in asymptomatic patients with b-thalassemia major using real-time three-dimensional echocardiography

<p>Abstract</p> <p>Background</p> <p>There is strong evidence that left atrial (LA) size is a prognostic marker in a variety of heart diseases. Recently, real-time three-dimensional echocardiography (RT3DE) has been reported as a useful tool for studying the phasic changes of the left atrial volumes. The aim of this study was to investigate the performance of the left atrium in beta-thalassemic patients with preserved left ventricular ejection fraction (EF) and no iron overload, using RT3DE.</p> <p>Methods</p> <p>Twenty-eight asymptomatic b-thalassemic patients (32.2 ± 4.3 years old, 17 men) who were on iron chelating therapy, as well as 20 age- and sex-matched healthy controls underwent transthoracic RT3DE. The patient group had normal echocardiographic systolic and diastolic indices, while there was no myocardial iron disposition according to MRI. Apical full volume data sets were obtained and LA volumes were measured at 3 time points of the cardiac cycle: (1) maximum volume (LAmax) at end-systole, just before mitral valve opening; (2) minimum volume (LAmin) at end-diastole, just before mitral valve closure; and (3) volume before atrial active contraction (LApreA) obtained from the last frame before mitral valve reopening or at time of the P wave on the surface electrocardiogram. From the derived values, left atrial active and passive emptying volumes, as well as the respective emptying fractions were calculated.</p> <p>Results</p> <p>Left ventricular EF (59.2 ± 2.5% patients vs. 60.1 ± 2.1% controls), E/A, E/E' were similar between the two groups. Differences in the LAmax, LAmin and LApreA between b-thalassemic patients and controls were non-significant, LAmax:(35.5 ± 13.4 vs 31.8 ± 9.8)cm³, LAmin:(16.0 ± 6.0 vs. 13.5 ±4.2)cm³, and LApreA:(25.4 ± 9.8 vs. 24.3 ± 7.2)cm³. However, left atrial active emptying fraction was reduced in the patient group as compared to the healthy population (34.3 ± 16.4% vs. 43.2 ± 11.4%, p < 0.05).</p> <p>Conclusion</p> <p>RT3DE may be a novel technique for the evaluation of LA function in asymptomatic patients with b-Thalassemia Major. Among three-dimensional volumes and indices, left atrial active emptying fraction may be an early index of LA dysfunction in the specific patient population.</p

How to develop a national heart failure clinics network: a consensus document of the Hellenic Heart Failure Association

Heart failure (HF) is rapidly growing, conferring considerable mortality, morbidity, and costs. Dedicated HF clinics improve patient outcomes, and the development of a national HF clinics network aims at addressing this need at national level. Such a network should respect the existing health care infrastructures, and according to the capacities of hosting facilities, it can be organized into three levels. Establishing the continuous communication and interaction among the components of the network is crucial, while supportive actions that can enhance its efficiency include involvement of multidisciplinary health care professionals, use of structured HF-specific documents, such as discharge notes, patient information leaflets, and patient booklets, and implementation of an HF-specific electronic health care record and database platform

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe