Reduced systemic vascular resistance is the underlying hemodynamic mechanism in nitrate-stimulated vasovagal syncope during head-up tilt-table test

AbstractBackgroundNitroglycerin (NTG) challenge during head-up tilt-table testing (HUTT) is often utilized to determine the etiology of unexplained vascular syncope. However, conflicting results concerning nitrate-induced hemodynamic changes during HUTT have been reported. The purpose of this study was to assess the determinants of presyncopal symptoms during NTG-stimulated HUTT.MethodsWe evaluated 40 patients with suspected vasovagal syncope. Beat-to-beat changes in blood pressure, heart rate (HR), cardiac index (CI), and systemic vascular resistance (SVR) during HUTT were measured with thoracic impedance cardiography and a plethysmographic finger arterial pressure monitoring device.ResultsNone of the 40 patients complained of presyncopal symptoms during passive HUTT. However, after the administration of NTG 28 patients showed presyncopal symptoms (NTG+ group) and the remaining 12 patients did not (NTG– group). HR, CI, and the stroke index did not significantly differ between the two groups, whereas mean arterial pressure and SVR were significantly lower in the NTG+ group.ConclusionsPresyncopal symptoms during NTG-stimulated HUTT are SVR mediated, not cardiac output mediated. This study challenges the conventional idea of a decrease in cardiac output mediated by NTG as the overriding cause of presyncopal symptoms during HUTT

Primary Cardiac Lymphoma Presenting With Atrioventricular Block

Primary cardiac lymphomas (PCL) are extremely rare. Clinical manifestations may be variable and are attributed to location. Here, we report on a case of PCL presenting with atrioventricular (AV) block. A 55 year-old male had experienced chest discomfort with unexplained dyspnea and night sweating. His initial electrocardiogram (ECG) revealed a first degree AV block. Along with worsening chest discomfort and dyspnea, his ECG changed to show second degree AV block (Mobitz type I). Computed tomography (CT) scan showed a cardiac mass (about 7 cm) and biopsy was performed. Pathologic finding confirmed diffuse large B-cell lymphoma. The patient was treated with multi-drug combination chemotherapy (R-CHOP: Rituximab, cyclophoshamide, anthracycline, vincristine, and prednisone). After treatment, ECG changed to show normal sinus rhythm with complete remission on follow-up CT scan

Primary Cardiac Angiosarcoma Presenting With Cardiac Tamponade

Primary cardiac angiosarcoma is a very rare disease with a poor prognosis. We report a case of a patient with a primary cardiac angiosarcoma who presented with cardiac tamponade; the angiosarcoma was successfully resected surgically

Hemorheological and Glycemic Parameters and HDL Cholesterol for the Prediction of Cardiovascular Events

Abstract Background: Hemorheological and glycemic parameters and high density lipoprotein (HDL) cholesterol are used as biomarkers of atherosclerosis and thrombosis. Objective: To investigate the association and clinical relevance of erythrocyte sedimentation rate (ESR), fibrinogen, fasting glucose, glycated hemoglobin (HbA1c), and HDL cholesterol in the prediction of major adverse cardiovascular events (MACE) and coronary heart disease (CHD) in an outpatient population. Methods: 708 stable patients who visited the outpatient department were enrolled and followed for a mean period of 28.5 months. Patients were divided into two groups, patients without MACE and patients with MACE, which included cardiac death, acute myocardial infarction, newly diagnosed CHD, and cerebral vascular accident. We compared hemorheological and glycemic parameters and lipid profiles between the groups. Results: Patients with MACE had significantly higher ESR, fibrinogen, fasting glucose, and HbA1c, while lower HDL cholesterol compared with patients without MACE. High ESR and fibrinogen and low HDL cholesterol significantly increased the risk of MACE in multivariate regression analysis. In patients with MACE, high fibrinogen and HbA1c levels increased the risk of multivessel CHD. Furthermore, ESR and fibrinogen were significantly positively correlated with HbA1c and negatively correlated with HDL cholesterol, however not correlated with fasting glucose. Conclusion: Hemorheological abnormalities, poor glycemic control, and low HDL cholesterol are correlated with each other and could serve as simple and useful surrogate markers and predictors for MACE and CHD in outpatients

Długość stentu jest czynnikiem przyczyniającym się do suboptymalnego rozprężenia stentów uwalniających lek

Background: Failure to achieve optimal stent expansion poses a risk of treatment failure in percutaneous coronary intervention (PCI). Although intravascular ultrasound provides useful information for suboptimal stent expansion, a substantial portion of PCIs are currently being performed under angiographic guidance only. Aim: In order to evaluate the adequacy of stent expansion of four widely used drug-eluting stents in angiography-guided PCI, we performed a retrospective analysis of lesions undergoing PCI using quantitative coronary angiography. Methods: A total of 112 de novo lesions were analysed. Minimal lumen diameter (MLD) was measured at peak pressure during stent deployment (MLD1), after stent deployment (MLD2), and after postdilatation (MLD3). Stent underexpansion, stent elastic recoil, and stent deficit were calculated. Optimal stent deployment was defined as final MLD ≥ 90% of predicted diameter. Results: For deploying a stent balloon, higher than nominal pressure was used in 83% of cases (93/112). However, optimal deployment was observed in only 32% (36/112). Adjuvant post-dilatation was performed in 59% (45/76) of lesions with suboptimal expansion, which increased the optimal deployment rate by 60% (27/45). Final optimal stent deployment rate was achieved in 56% (63/112). We found that the MLD1 (p = 0.04), MLD3 (p = 0.02), final MLD (p = 0.04), and optimal stent deployment rate (p = 0.036) were significantly reduced in longer stent deployment lesions (≥ 20 mm) compared to shorter lesions (< 20 mm). Conclusions: Stent length may be a contributing factor of suboptimal stent expansion in angiography-guided PCI.Wstęp: Nieuzyskanie optymalnego rozprężenia stentu powoduje ryzyko niepowodzenia przezskórnej interwencji wieńcowej (PCI). Mimo że ultrasonografia wewnątrznaczyniowa pozwala uzyskać przydatne informacje dotyczące suboptymalnego rozprężenia stentu, obecnie znaczną część zabiegów PCI wykonuje się wyłącznie pod kontrolą angiografii. Cel: Przeprowadzono retrospektywną analizę zmian poddanych PCI z użyciem koronarografii ilościowej w celu oceny rozprężenia 4 stentów uwalniających lek powszechnie stosowanych w PCI pod kontrolą angiografii. Metody: Przeanalizowano łącznie 112 nowych zmian. Minimalną średnicę światła naczynia (MLD) zmierzono w momencie osiągnięcia największego ciśnienia w trakcie rozprężania stentu (MLD1), po rozprężeniu stentu (MLD2) i po postdylacji (MLD3). Dokonano obliczeń dotyczących niedostatecznego rozprężenia stentu, elastycznego odkształcenia stentu i niedoboru końcowej średnicy stentu. Optymalne rozprężenie stentu definiowano jako końcową MLD ≥ 90% prognozowanej średnicy. Wyniki: W balonach do rozprężania stentów w 83% (93/112) przypadków stosowano ciśnienie wyższe od nominalnego. Jednak optymalne rozprężenie stentu obserwowano tylko w 32% (36/112) przypadków. Dodatkową postdylację przeprowadzono w 59% (45/76) zmian z suboptymalnym rozprężeniem stentu, co spowodowało zwiększenie częstości optymalnego rozprężenia stentu do 60% (27/45). Ostatecznie osiągnięto częstość optymalnego rozprężenia stentu wynoszącą 56% (63/112). Zaobserwowano, że MLD1 (p = 0,04), MLD3 (p = 0,02), końcowa MLD (p = 0,04) i częstość optymalnego rozprężenia stentu (p = 0,036) były istotnie mniejsze w przypadku implantacji stentów w dłuższych zmianach (≥ 20 mm) niż w krótszych zmianach (< 20 mm). Wnioski: Długość stentu może być czynnikiem przyczyniającym się do suboptymalnego rozprężenia stentu w PCI przeprowadzanej pod kontrolą angiografii