Acute myocardial infarction: what is new?

Current recommendations on the management of acute myocardial infarction and the use of thrombolysis are reviewed.     

Does chronic mitral regurgitation influence Doppler pressure half-time-derived calculation of the mitral valve area in patients with mitral stenosis?

Background

In patients with mitral stenosis (MS), Doppler pressure half-time (PHT) may be influenced by hemodynamic variables other than the anatomic mitral valve orifice narrowing. This study was undertaken to assess whether the presence of concomitant mitral regurgitation (MR) affects mitral valve area (MVA) estimation by PHT.

Methods

Consecutive patients (n = 166) with noncalcific MS, in sinus rhythm, were studied. Group 1 (n = 106) had no or mild MR, and group 2 (n = 60) had moderate or severe MR. MVA was assessed by using the PHT method and planimetry.

Results

There was a strong correlation between planimetry and PHT MVA in both groups (group 1: r = 0.86, P < .001; group 2: r = 0.73, P < .001). However, compared with planimetry MVA, PHT underestimated MVA by ≥20% in 18 patients (17%) in group 1 and 21 patients (35%) in group 2 (P < .01). Overestimation by ≥20% occurred in 12 patients (11%) in group 1 and in 7 (12%) in group 2. Group 2 subanalysis (group 2A: moderate MR, n = 16; group 2B: severe MR, n = 44) revealed that linear regression weakened with increasing severity of MR (group 2A: r = 0.824, P < .001, group 2B: r = 0.70, P < .001). PHT underestimation of MVA occurred in 31% and 36% of patients in Groups IIA and IIB, respectively (P = NS).

Conclusions

PHT appears to be reliable for estimating MVA in most patients with MS, even in the presence of MR. However, the presence of significant MR reduces the reliability of PHT-derived MVA, with underestimation of MVA in a significant number of subjects. The severity of MR has a direct impact on PHT-derived MVA.     

Cardiac unilateral pulmonary edema: is it really a rare presentation?

Unilateral pulmonary edema is a distinctly unusual clinical entity that presents interesting and confusing diagnostic challenges. It is usually described as occurring with re-expansion of a collapsed lung after rapid thoracocentesis of pleural air or pleural fluid. Unilateral pulmonary edema as an initial presenting manifestation for heart failure is uncommon and can be confused with other more common causes of alveolar or interstitial infiltrate, which can lead to a significant delay in treatment.     

Age of onset of myocardial infarction: is promoter polymorphism of the RAGE gene implicated?

Receptor for advanced glycation endproducts (RAGE) is a cell-surface molecule member of the immunoglobulin superfamily and engages differing ligands relevant to distinct processes. A growing body of evidence has suggested that RAGE may promote vascular inflammation through several mechanisms. The objective of this study was to identify the possible relationship between the -374 T/A polymorphism of the RAGE gene, myocardial infarction (MI), and its age of onset. A total of 691 MI patients and 234 matched controls were investigated. In this study, the frequency of the A allele and AA genotype of the -374 T/A promoter polymorphism is significantly lower in patients with MI respect to the control group (p?相似文献