Higher rate of aortic stenosis progression in patients with bicuspid versus tricuspid aortic valve – A single center experience

PurposeWe sought to investigate aortic stenosis (AS) progression rate (pr) with the comparison between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) morphology.Materials and methodsWe compared ASpr in patients with BAV and TAV examined by transthoracic echocardiography (TTE) in the years 2004–2019.ResultsData from 363 TTEs in 161 AS patients (median age 70 [61–77] years; 63% men; 25% with BAV; 20% with severe AS) performed at different time points (median time interval 10 months) was analyzed. We assessed changes of AS severity with peak velocity through aortic valve (Vmax), mean/peak pressure gradients (MG/PG), aortic valve area by planimetry and continuity equation (AVAce). We compared pr (defined as parameter change per year) between the BAV and the TAV groups. BAV patients showed faster ASpr with odds ratio 3.467 and 95% confidence intervals 1.36 to 8.86, moreover, expressed as a quicker AVAce decrease 0 (−0.4-0.0) in the BAV vs. 0 (−0.15 – 0.0) cm²/year in the TAV group, p ​= ​0.02. Furthermore, in BAV, female sex was associated with lower ASpr (p ​= ​0.01), and in the whole group a larger aortic diameter was a predictor of faster progression (p ​< ​0.001).ConclusionThe ASpr, expressed as a decrease in the AVAce, was faster in BAV. Moreover, ASpr depends on both: valve morphology being faster in BAV and Vmax increase. Furthermore, the female sex was related to slower pace of AVA reduction in BAV subgroup whereas the larger baseline aortic diameter associated to faster AS progression in the whole studied group.     

Transapical aortic valve implantation – a rescue procedure for patients with aortic stenosis and “porcelain aorta”

Surgical aortic valve replacement (AVR) still remains the treatment of choice in symptomatic significant aortic stenosis (AS). Due to technical problems, extensive calcification of the ascending aorta (“porcelain aorta”) is an additional risk factor for surgery and transapical aortic valve implantation (TAAVI) is likely to be the only rescue procedure for this group of patients. We describe the case of an 81-year-old woman with severe AS and “porcelain aorta”, in whom the only available life-saving intervention was TAAVI.     

Heart perforation in patients with permanent cardiac pacing – pilot personal observations

Introduction

Heart perforation is a rare complication of pacemaker (PM)/implantable cardioverter-defibrillator (ICD) implantation.

Material and methods

In our clinic in 2005–2010, 6 patients with heart perforation were hospitalized (3 women, 3 men), mean age 58.6 ±20.8 years (17 to 73 years). The indication to PM/ICD implantation was tachy-brady syndrome in 3 cases, second-degree atrioventricular block, advanced with losses of consciousness, vaso-vagal syndrome type II B with asystole lasting 12 s and recurrent non-sustained ventricular tachycardia in 1 patient. We analyzed patient''s medical records, X-rays, echocardiography, computed tomography (CT) and procedure protocols.

Results

The incidence of heart perforation was 0.09%. Symptoms developed 4 to 990 days (mean 186.3 ±394.3) after PM/ICD implantation. The perforation site was found in the right atrial wall in 1 cases and the right ventricular wall in 6 cases. The TTE revealed an accumulation of fluid in the pericardium over 10 mm behind the posterior wall of the left ventricle in all patients. The CT scan confirmed perforation of the heart chambers (atrium and in 6 cases ventricle). In 5 cases the whole device was removed by direct traction or percutaneous lead extraction with pericardiocentesis when necessary (pericardium drainage in 3 cases) while in 1 case cardiac surgery was needed.

Conclusions

The perforating lead may be removed by direct traction in the operating room with cardiosurgical, anesthesiological and echocardiographical backup. In case of the lead perforation outside the pericardial sac or its atypical location, cardiac surgery is a safer method. The most important diagnostic method remains computed tomography.     

Association between heart rate at rest and myocardial perfusion in patients with acute myocardial infarction undergoing cardiac rehabilitation – a pilot study

Introduction

This study was conducted to determine if there was a link among heart rate at rest (rHR), muscle volume changes, and single photon emission computed tomography (SPECT) parameters after 6-month cardiac rehabilitation in patients with acute myocardial infarction (AMI).

Material and methods

Twenty-nine consecutive AMI patients (mean age: 63.0 ±9.1 years) who received appropriate percutaneous coronary intervention on admission were enrolled. ^99mTc-Sestamibi myocardial SPECT images were obtained at the early (30 min) and delayed (4 h) phases after tracer injection at 2 weeks (0M) and 6 months (6M) after the onset of AMI. Within a few days of SPECT, all patients underwent cardiopulmonary exercise test for evaluation of cardiac rehabilitation effects. Before the initiation of exercise test, leg muscle volume was measured. All patients were stratified into the ≥ 70 beats per minute (bpm) (n = 15) or < 70 bpm (n = 14) group based on rHR at 6M.

Results

There were no significant differences in the recanalization time, peak cardiac enzyme, or initial left ventricular ejection fraction between the two groups. After the 6-month training, the muscle volume changes in the lower limbs (< 70 bpm, 0.23 ±0.22; ≥ 70 bpm, –0.07 ±0.26, p < 0.05) were significantly greater in the < 70 bpm group than the ≥ 70 bpm group. The decreased rate of rHR had a significant correlation with the improved global severity (r = 0.62, p = 0.001) and extent (r = 0.48, p = 0.017) of left ventricle evaluated by ^99mTc-Sestamibi myocardial SPECT delayed phase.

Conclusions

The result of this preliminary study demonstrated that improved myocardial perfusion was closely related to decreased rHR after cardiac rehabilitation.     

Celiac antibodies in children with type 1 diabetes – A diagnostic validation study

Introduction: Autoimmune diseases, such as celiac disease (CD) and diabetes mellitus type 1, tend to co-occur within the same patient. The prevalence of CD in diabetic children is higher than in the general population, and is estimated to be 0.6–16.4%. The diagnosis of CD is based on histopathological examination and serological testing, however, these methods are still imperfect and new diagnostic algorithms should be considered.

Aim: The aim of the study was to assess the diagnostic value of serological tests detecting antibodies against deamidated gliadin peptide, endomysium, tissue transglutaminase, neo-epitope tissue transglutaminase and to identify HLA-related genetic predisposition to CD in patients with type 1 diabetes mellitus (DM1).

Methods: Autoantibodies were measured in the sera of 392 children suffering from DM1 aged 1–19 years old (mean 11.76?±?4.14 years old). Additionally, PCR-based assessment of HLA DQ2/DQ8 genotyping was performed.

Results: A positive result of at least one serological test was obtained from 81 children (20.66%). The sensitivity and specificity were 76.47% and 91.67% for anti-DGP IgA, 70.59% and 58.33% for IgG anti-DGP, respectively. A positive predictive value was 100% for the anti-TG IgA at cutoff levels of 5 and 10 times higher than upper limit of reference values. HLA DQ2 and/or DQ8 were found in 97.6% of examined children.

Conclusions: Tests based on anti-TG IgA are more accurate for detecting CD in children with type 1 diabetes than anti-DGP IgA. A high percentage of diabetic children carry HLA alleles predisposing to CD, which indicates that genetic screening in this group of patients is not obligated.     

Severe aortic stenosis,bicuspid aortic valve and atrial septal defect in a child with Joubert Syndrome and Related Disorders (JSRD) – A case report and review of congenital heart defects reported in the human ciliopathies

We report a case of a 2 year-old boy with Joubert Syndrome and Related Disorders (JSRD), severe congenital aortic stenosis, bicuspid aortic valve and an atrial septal defect.     

Heart rate variability in diabetic patients during orthostatic load — A spectral analytic approach

Summary Spectral analysis of heart rate variability (HRV) was used to assess the autonomic nervous control of cardiac function during orthostatic load in insulin-dependent diabetic patients and healthy subjects. The diabetic patients were divided into three groups: diabetics without neuropathy (group 1), diabetics with peripheral neuropathy (group 2), and diabetics with peripheral and autonomic neuropathy (group 3). Resting mid-frequency (MF, 0.05–0.15 Hz) and respiration-related (RF, power around respiration rate) HRV were significantly lower in group 2 and 3 diabetics than in controls, indicating a reduced parasympathetic nervous system influence on the heart. Standing MF and RF spectral power data were significantly lower in all diabetic groups than in controls, suggesting marked alterations in the autonomic cardiovascular control during a mild physical load not only in symptomatic diabetics but also in patients with no signs and symptoms of neuropathy. The difference between supine and standing MF power, an estimate of-adrenergic influence on the heart, was significantly lower in all diabetic subject groups studied than in controls. This suggests a reduced sympathetic nervous system influence on the heart in diabetic patients. Our data suggest that computerized spectral analysis of HRV during orthostatic load seems to be a very sensitive method of evaluating of the autonomie nervous systems influence on the heart in patients suffering from diabetes niellitus.Abbreviations dB decibel - HRV heart rate variability - LF low-frequency component - MF mid-frequency component - RF respiration related frequency component     

Decomposition and entomological colonization of charred bodies – a pilot study

Aim

To use forensic entomological approach to estimate the post mortem interval (PMI) in burnt remains.

Methods

Two experiments were performed in a field in the outskirts of Milan, in winter and summer 2007. Four 60-kg pigs were used: two for each experiment. One pig carcass was burnt until it reached the level 2-3 of the Glassman-Crow scale and the not-burnt carcass was used as a control. In order to describe the decomposition process and to collect the data useful for minimum PMI estimation, macroscopic, histological, and entomological analyses were performed.

Results

In the winter part of the experiment, the first insect activity on the burnt carcass began in the third week (Calliphora vomitoria) and at the beginning of the fourth week an increase in the number of species was observed. In the summer part, adult flies and first instar maggots (Phormia regina) appeared a few minutes/hours after the carcass exposure. Both in winter and summer, flies belonging to the first colonization wave (Calliphoridae) appeared on burnt and control pigs at the same time, whereas other species (Diptera and Coleoptera) appeared earlier on burnt pigs.

Conclusion

In forensic practice, burnt bodies are among the most neglected fields of entomological research, since they are supposed to be an inadequate substratum for insect colonization. Entomological approach for PMI estimation proved to be useful, although further studies on larger samples are needed.Estimation of the post mortem interval (PMI) plays an important role in forensic investigation. In the early post mortem period, PMI can be estimated by temperature-based methods, but when decomposition begins, this estimation can be influenced by several variables (1,2). In addition, in cases of concealment, body dismemberment, explosion, and burning there is no standardized method based on experimental studies for deriving time since death from morphological characteristics of the corpse.Entomological approach is a well known and widely accepted method to estimate the minimum PMI (3). However, in the literature there are only a few cases referring to charred bodies (4-8). Gruenthal et al (9) found dung fly Scathophaga stercoraria, larvae of Calliphora vicina and Calliphora vomitoria, and immature beetle forms, not further identified in 24 pig carcasses charred up to Glassman Crow scale-1 (GCS-1) for the head, neck, limbs, and CGS 2 for the torso. Catts and Goff (6) observed a few days’ delay in the arrival of blowflies on a corpse burnt and charred inside an open-topped metal drum, and a week’s delay in the case of a pig burnt inside a car that was set afire (6). Introna et al (4) also highlighted that burnt flesh delayed the arrival of blowflies. Due to the relevant lack of literature, the aim of our study was to report the results of an experimental approach to burnt bodies using pigs (Sus scrofa) as models.     

Relevance of 123I-BMIPP delayed scintigraphic imaging for patients with angina pectoris – a pilot study

Introduction

The study was designed to clarify the role of ¹²³I-β-methyl-iodophenylpentadecanoic acid (¹²³I-BMIPP) in the evaluation of myocardial fatty acid metabolism in patients with stable angina pectoris (AP) before and after percutaneous coronary intervention (PCI).

Material and methods

Ten controls (mean age: 70.4 ±10.5 years) and 12 patients with AP (mean age: 67.4 ±11.6 years) and single vessel coronary artery disease participated in the radionuclide cardiac study. Scintigraphic images were acquired at 30 min and at 4 h after ¹²³I-BMIPP injection to determine early and delayed BMIPP uptake, respectively. The heart-to-mediastinum (H/M) ratio and the washout rate (WR) were calculated from the planar images. All patients underwent scintigraphy one day before PCI and again 1 month after successful PCI.

Results

No significant differences in the early or delayed H/M ratios were observed between the patients and the controls before PCI (early: 2.70 ±0.36 vs. 2.73 ±0.57; delayed: 2.26 ±0.33 vs. 2.40 ±0.43; p > 0.2 for both). The early and delayed H/M ratios remained unchanged with the comparison with before PCI (early: 2.72 ±0.27, delayed: 2.23 ±0.22; p > 0.2 for both). The global WR before PCI was significantly higher in the patients than in the control group (36.7 ±9.3%, vs. 28.1 ±8.2%, p = 0.02). However, the WR after PCI did not significantly differ between the patients and the controls (34.3 ±7.8% vs. 28.1 ±8.2%, p = 0.1).

Conclusions

These data may suggest that the WR of ¹²³I-BMIPP determined from the planar images enhances the presence of myocardial ischaemia.     

Is a designated arterial catheter indicated in transcatheter aortic valve replacement procedure?

<正>Aortic stenosis(AS) is the most common valvular disorder frequently affecting patients as they get older,and resulting in life-altering symptoms such as dyspnea, angina, pre-syncope, and syncope, which are often made worse with exertion. Often, AS is caused by age-related calcification of the valve;     

Ectopic thyroid tissue in the periaortic area,cardiac cavity and aortic valve in a Beagle dog – A case report

Microscopic examination of the heart of a clinically normal 14-month-old female Beagle dog revealed the presence of ectopic thyroid tissue at the base of the heart, around the aorta, and intracardially at the level of the left ventricle and the aortic valve. The tissue was composed of well-differentiated follicles lined by a cuboidal epithelium and containing colloid. Follicular cells and colloid exhibited strong thyroglobulin immunoreactivity, while no parafollicular cells were noted and the immunoreactions for calcitonin remained consistently negative. Although in the dog ectopic thyroid tumors represent 1–10% of all heart base neoplasms (Capen, 1978, Bracha et al., 2009), to the best of our knowledge, nonneoplastic ectopic thyroid tissue has not been reported in the heart of the dog itself or within the dog aortic valve.     

Prognostic value of tissue factor in patients with abdominal aortic and iliac arterial aneurysms – preliminary study

Introduction

The decision on the time and choice of strategy of treatment of abdominal aortic aneurysm must be especially carefully balanced. The aim of the study was to evaluate the tissue factor (TF) plasma level as a potential factor useful in anticipation of abdominal aortic aneurysm and/or iliac arterial aneurysm via comparison of plasma TF level in patients with ruptured and non-ruptured aneurysms.

Material and methods

The study included 33 patients with aneurysm (17 operated on electively because of non-ruptured aneurysm and 16 operated on emergently due to ruptured aneurysm), 33 claudicant patients with atherosclerosis of the abdominal aorta and iliac arteries with normal diameter of arteries, and 30 healthy controls. Plasma TF level was assessed by ELISA method using the IMUBIND Tissue Factor ELISA Kit (American Diagnostica Inc.).

Results

The study showed an increased TF level in patients with aneurysm (134 ±54 pg/ml) and in patients with atherosclerosis without concomitant aneurysm (91 ±30 pg/ml) in comparison with the control group (62 ±20 pg/ml), respectively p < 0.001 and p = 0.008. A significantly higher TF plasma level was observed in patients with ruptured abdominal aortic aneurysms (160 ±57 pg/ml) as compared to patients with non-ruptured aortic aneurysms (109 ±39 pg/ml) or peripheral arterial occlusive disease (91 ±30 pg/ml), respectively p < 0.001 and p < 0.001. The difference in TF level between the group with non-ruptured aortic aneurysms (109 ±39 pg/ml) and the patients with atherosclerosis without aneurysm (91 ±30 pg/ml) was not statistically significant.

Conclusions

No difference in TF level between patients with non-ruptured AAA/IAA and patients with aortic and iliac atherosclerosis without aneurysm indicates that an increased TF plasma level is not specific for any of the above-mentioned vascular pathologies.     

Reduced heart rate variability predicts poor sleep quality in a case–control study of chronic fatigue syndrome

Parasympathetic function is important in the induction and maintenance of sleep. We examined whether nocturnal vagal modulation of heart rate is related to the poor sleep quality commonly reported in chronic fatigue syndrome (CFS). Heart rate (HR, as R–R intervals) was continuously monitored during sleep in 20 patients with CFS and 20 matched control subjects. Questionnaires assessed demographic information, symptoms, functional impairment, and subjective sleep quality. CFS was associated with more sleep problems in general and poorer subjective sleep quality on the study night (all p < 0.003), and reports of repeated awakening during the night were 7 times more likely compared to healthy subjects (p = 0.017). Time and frequency-domain parameters of HR variability during sleep were significantly lower in patients with CFS (all p < 0.006). Multiple regression analyses revealed that heart rate variability (HRV) parameters were the best predictors of subjective sleep measures. This study identified significant reductions in vagal modulation of heart rate during sleep in CFS. Low HRV strongly predicted sleep quality—suggesting a pervasive state of nocturnal sympathetic hypervigilance in CFS.     

The use of whey protein concentrate in management of chronic hepatitis C virus – a pilot study

Introduction

Whey protein contains biologically active ingredients that can prevent and attenuate disease besides being nutritive. The aim of the study was to clarify the effects of oral administration of whey protein on viral load and host defence mechanisms, in particular, phagocytic function of neutrophils, selected immunomodulatory cytokines and serum inflammatory markers, in compensated chronic hepatitis C virus (HCV) patients.

Material and methods

Twenty-seven HCV patients (20 males and 7 females) recruited from the hepatology clinic of the Theodor Bilharz Research Institute (TBRI) were given whey protein concentrate (WPC) twice daily for two months. In addition, 15 age and sex matched healthy participants were included in the study, as a control group. Neutrophil phagocytic activity, serum intercellular adhesion molecule (sICAM), interleukin-2 (IL-2), nitric oxide (NO), as well as HCV-RNA levels and routine investigations were determined for patients, before and after WPC supplementation and once for the control group.

Results

There was a significant decrease in viral load and markers of active inflammation, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), while serum albumin, total leucocyte counts and absolute neutrophil counts showed significant elevation accompanied by improvement of neutrophil phagocytic activity after WPC supplementation compared to pre-treated levels. The oral WPC supplementation was well tolerated without any serious adverse events.

Conclusions

Oral supplementation of WPC has promising results as a new therapeutic strategy against HCV and its sequelae by decreasing the viral load and active inflammation as well as improving the synthetic capacity of the liver and the phagocytic function of neutrophils, in these patients.     

Twelve-year experience with the Carpentier–Edwards pericardial aortic valve at a single Japanese center

Our aim was to evaluate the long-term results of implantation of the Carpentier–Edwards pericardial (CEP) valve in the aortic position. Between January 1996 and December 2007, 244 patients who underwent aortic valve replacement using the CEP valve were enrolled in this study. A 19-mm valve was used in 39 patients, a 21-mm valve in 94 patients, a 23-mm valve in 81 patients, and a 25-mm valve in 30 patients. The early and the late results were evaluated. Furthermore, echocardiographic examination was performed at follow-up. There were 5 early deaths, with an early mortality rate of 2.0%. Follow-up was performed in 95.4% of the survivors of the operation for a mean period of 4.1 years. Actuarial survival rates at 5, 10, and 12 years were 85.3 ± 2.8, 80.0 ± 3.7 and 70.0 ± 9.8%, respectively. Thromboembolism was observed in 6 patients, endocarditis in 2 patients, reoperation in 4 patients, and structural valve deterioration in 2 patients. Actuarial freedoms from thromboembolism, endocarditis, and reoperation at 10 years were 96.9 ± 0.14, 97.7 ± 0.16, and 97.0 ± 0.16%, respectively. Echocardiographic examination revealed that the pressure gradients across the valve prosthesis for valves of each size were acceptable. Left ventricular mass index decreased significantly in all valve sizes. The long-term results of implantation of the CEP bioprosthesis in the aortic position were satisfactory. The CEP bioprosthesis maintained its hemodynamic performance even as late as 10 years after implantation.     

Cellular pharmacodynamic effects of Pycnogenol® in patients with severe osteoarthritis: a randomized controlled pilot study

Background

The standardized maritime pine bark extract (Pycnogenol®) has previously shown symptom alleviating effects in patients suffering from moderate forms of knee osteoarthritis (OA). The cellular mechanisms for this positive impact are so far unknown. The purpose of the present randomized pilot controlled study was to span the knowledge gap between the reported clinical effects of Pycnogenol® and its in vivo mechanism of action in OA patients.

Methods

Thirty three patients with severe OA scheduled for a knee arthroplasty either received 100 mg of Pycnogenol® twice daily or no treatment (control group) three weeks before surgery. Cartilage, synovial fluid and serum samples were collected during surgical intervention. Relative gene expression of cartilage homeostasis markers were analyzed in the patients’ chondrocytes. Inflammatory and cartilage metabolism mediators were investigated in serum and synovial fluid samples.

Results

The oral intake of Pycnogenol® downregulated the gene expression of various cartilage degradation markers in the patients’ chondrocytes, the decrease of MMP3, MMP13 and the pro-inflammatory cytokine IL1B were statistically significant (p ≤?0.05). Additionally, protein concentrations of ADAMTS-5 in serum were reduced significantly (p?≤?0.05) after three weeks intake of the pine bark extract.

Conclusions

This is the first report about positive cellular effects of a dietary supplement on key catabolic and inflammatory markers in patients with severe OA. The results provide a rational basis for understanding previously reported clinical effects of Pycnogenol® on symptom scores of patients suffering from OA.

Trial registration

ISRCTN10754119. Retrospectively registered 08/10/2015.