Improvement of cardiac parameters in patients with acromegaly treated with medical therapies

In acromegaly, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess results in a specific cardiomyopathy characterized by concentric cardiac hypertrophy primarily associated with diastolic dysfunction that can lead to impaired systolic function and eventually heart failure. This review of the literature evaluates the effect of therapeutic intervention on cardiac parameters. Clinical studies investigating the impact of treatments for acromegaly on cardiac function published between January 1980 and January 2009 were identified through electronic searches of Medline. Suppression of GH and IGF-1 following surgery or medical treatment with somatostatin analogue therapy is effective in decreasing left ventricular (LV) hypertrophy, with subsequent improvement in cardiac function. First-line treatment with somatostatin analogues resulted in improved cardiac outcome compared with first-line surgery, possibly due to somatostatin analogues acting directly through somatostatin receptors on cardiac cells. Additional cardiac improvement has been reported when somatostatin analogue treatment was combined with surgery. In patients where complete biochemical control was not achieved, an improved cardiac performance following treatment with somatostatin analogues has been reported. Treatment with pegvisomant has been demonstrated to reduce LV hypertrophy and improve diastolic and systolic performance. In contrast, reports have suggested that treatment with the dopamine agonist cabergoline increased the incidence of valvular heart disease. Although surgery and somatostatin analogues are effective in improving cardiomyopathy, a greater beneficial effect is observed with somatostatin analogue treatment. Selected patients with acromegaly should consider first-line therapy or pre-treatment with somatostatin analogues prior to surgery to achieve biochemical control and improve cardiac dysfunction.     

Favorable outcomes of patients with vasospastic angina associated with cardiac arrest

BackgroundThe long-term survival of vasospastic angina (VSA) patients is generally good, so long as they remain on calcium channel blockers (CCBs) and avoid smoking. However, the pathogenesis, appropriate treatments, and prognosis of VSA associated with cardiac arrest remain unclear. This study aimed to elucidate the clinical features and long-term outcomes of patients with VSA associated with cardiac arrest.Methods and resultsEighteen consecutive patients with VSA associated with cardiac arrest [13 patients resuscitated after out-of-hospital cardiac arrest (OHCA) and 5 resuscitated after in-hospital-cardiac arrest] were retrospectively analyzed. Sixteen of the eighteen patients were smokers. None had other cardiac diseases possibly causing cardiac arrest. Although 1 patient resuscitated after OHCA later died of cerebral hypoxia, the remaining 17 were discharged without complications. One patient died of cancer 50 months after resuscitation. The other 16 patients are still alive and none have shown ventricular arrhythmias, syncope, or cardiac arrest during a mean follow-up of 67 months. All are treated with long-acting CCBs/nitrates and successfully quit smoking. Six patients received implantable cardioverter defibrillators (ICD). However, none demonstrated any ventricular arrhythmias and appropriate ICD actuation was achieved.ConclusionAppropriate medical treatment can achieve favorable long-term outcomes even for patients with VSA associated with cardiac arrest.     

B型利钠肽结合血流动力学监测对呼吸困难的诊断价值

目的 探讨急诊室快速血B型利钠肽(BNP)检测并同时进行无创血流动力学监测对呼吸困难患者病因诊断的临床意义.方法 选择2007年5月至2008年1月354例因呼吸困难就诊患者,使用无创超声心排量监测仪进行心输出量(CO)测定,同时测定血BNP浓度,以是否为心源性呼吸困难进行分组,分别对CO以及BNP心源性呼吸困难的诊断情况进行统计.结果 确诊127例心源性呼吸困难患者,检测CO以及BNP具有负相关性(r=-0.645,P=0.000);在确诊227例非心源性呼吸困难组,CO及BNP两者阴性检出人数差异具有统计学意义(102例比11例,P=0.000),CO和BNP无相关性.结论 急诊室呼吸困难患者血浆BNP浓度判定心源性呼吸困难具有局限性,应用无创超声心排量监测仪监测CO血流动力学对鉴别呼吸困难具有临床应用价值.     

Coexistent cardiac rhabdomyoma with mitral valve anomaly in patients with tuberous sclerosis: a case report

Cardiac rhabdomyoma is frequently associated with tuberous sclerosis. However, very few cardiac malformations have been described with tuberous sclerosis. We report a rare case of coexistent cardiac tumor with mitral valve anomaly in a patient with tuberous sclerosis, who developed mitral regurgitation and required a surgical procedure with histological confirmation of cardiac rhabdomyoma.     

Clinical experience with cardiac amyloidosis

OBJECTIVE: Amyloidosis is a systemic disease potentially afflicting the heart. In this study we retrospectively studied patients presenting with major cardiac amyloidotic involvement. METHODS AND RESULTS: From 1997 until 2000, eight patients with major cardiac involvement of amyloidosis resulting in heart failure were diagnosed. All patients presented with heart failure. Diagnostic work-up, clinical, electrocardiographic, echocardiographic characteristics and treatment modalities are presented. Seven patients with acquired (both primary AL and postinflammatory AA) amyloidosis out of a total of eight patients died within one year after diagnosis, as a result of intractable cardiac failure due to both systolic and diastolic left ventricular dysfunction despite state-of-the-art medical treatment of heart failure. Only one patient with hereditary amyloidosis undergoing liver transplantation survived. CONCLUSIONS: Despite optimal medical cardiac failure treatment, acquired cardiac amyloidosis carries an ominous prognosis probably because patients are already in a very advanced stage of the disease at presentation.     

Pericardial hydatid cyst presenting with cardiac tamponade

Cases of cardiac hydatid cyst disease are uncommon, occurring in approximately 0.5% to 2% of patients with hydatid disease. Most cardiac hydatid cysts are located in the left ventricle and interventricular septum. Cardiac involvement may have serious consequences. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 10-year-old girl with cardiac tamponade secondary to a pericardial hydatid cyst is described.     

Life-Threatening Ventricular Tachyarrhythmias Associated with Holiday Heart Syndrome: Treatment with the Automatic Implantable Cardioverter Defibrillator

Holiday heart syndrome is defined as the occurrence of cardiac arrhythmia in aicohol users without overt heart disease after the ingestion of alcohol. Additionally, alcohol has been implicated as a potential etiology of sudden cardiac death in susceptible individuals. We report on a 53-year-old black woman with mild nonischemic dilated congestive cardiomyopathy and alcohol-provoked ventricular tachyarrhythmias who received an automatic implantable Cardioverter defibrillator (AICD). She subsequently had recurrent cardiac arrest during bouts of alcohol intoxication and with out-of-hospital AICD rescue. Electrophysiological study using alcohol infusion confirmed alcohol as the etiology of arrhythmogenicity. We propose that holiday heart be expanded to include people with overt heart disease. These individuals have a high risk of sudden cardiac death after alcohol ingestion, irrespective of underlying cardiac substrate; the AICD is an effective back-up modality of therapy.     

Diagnostic value of history in patients with syncope with or without heart disease

OBJECTIVES: We sought to establish what historical findings are predictive of the cause of syncope. BACKGROUND: The clinical features of the various types of syncope have not been systematically investigated. METHODS: Three hundred forty-one patients with syncope were prospectively evaluated. Each patient was interviewed using a standard questionnaire. A cause of syncope was assigned using standardized diagnostic criteria. RESULTS: A cardiac cause of syncope was established in 23% of the patients, a neurally mediated cause in 58% and a neurologic or psychiatric cause in 1%, and in the remaining 18%, the cause of syncope remained unexplained. In a preliminary analysis including age, gender and the presence of suspected or certain heart disease after the initial evaluation, only heart disease was an independent predictor of a cardiac cause of syncope (odds ratio 16, p = 0.00001), with a sensitivity of 95% and a specificity of 45%. In contrast, the absence of heart disease allowed us to exclude a cardiac cause of syncope in 97% of the patients. In patients with certain or suspected heart disease, the most specific predictors of a cardiac cause were syncope in the supine position or during effort, blurred vision and convulsive syncope. Significant and specific predictors of a neurally mediated cause were time between the first and last syncopal episode >4 years, abdominal discomfort before the loss of consciousness and nausea and diaphoresis during the recovery phase. In the patients without heart disease, palpitation was the only significant predictor of a cardiac cause. CONCLUSIONS: The presence of suspected or certain heart disease after the initial evaluation is a strong predictor of a cardiac cause of syncope. A few historical findings are useful to predict cardiac and neurally mediated syncope in patients with and without heart disease.     

Long-term improvement in cardiac magnetic resonance in β-thalassemia major patients treated with deferasirox extends to patients with abnormal baseline cardiac function

The management of iron overload in thalassemia has changed dramatically since the implementation of magnetic resonance imaging, which allows detection of preclinical iron overload and prevention of clinical complications. This study evaluated the effect of deferasirox (DFX), the newest once-daily oral chelator, on cardiac function, iron overload and cardiovascular events over a longer follow up in a “real world” setting. Longitudinal changes in cardiac magnetic resonance T2*, cardiac function parameters and cardiovascular clinical events were assessed in a cohort of 98 TM patients exposed to DFX for a mean of 6.9 years (range 1.8-11.6 years). No cardiac death or incident heart failure occurred. Cardiac T2* significantly increased (+2.6 ± 11.9 msec; P = 0.035) in the whole population, with a significantly greater increase (+11.6 ± 15.5 msec, P = 0.019) in patients with cardiac iron overload (T2* <20 ms). A significant improvement in left-ventricular ejection fraction (LVEF) (from 50.6 ± 6 to 60.2 ± 5; P = 0.001) was observed in 11 (84.6%) out of 13 patients who normalized cardiac function (LVEF >56%). Arrhythmias were the most frequent cardiac adverse event noted but none led to DFX discontinuation. Our data indicate that DFX is effective in maintaining cardiac iron level in the normal range and in improving cardiac iron overload. No heart failure or cardiac death was reported over this longer observation up to 12 years. For the first time, a DFX-induced improvement in LVEF was observed in a subgroup of patients with abnormal cardiac function at baseline, a preliminary observation which deserves further evaluation.     

Prognostic value of cardiopulmonary exercise testing in cardiac patients with atrial fibrillation

Parameters obtained from cardiopulmonary exercise testing (CPX) are recognized for their high prognostic value in predicting future cardiac events in cardiac patients. Our group compared the prognostic value of CPX parameters between patients with sinus rhythm (SR) and patients with atrial fibrillation (AF).Peak O2 uptake (VO2), the ratio of the increase in VO2 to the increase in work rate (ΔVO2/ΔWR), and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) were obtained from CPX in 72 AF patients and 478 SR patients. The prognostic values of these indices were compared between the two groups.Six cardiac deaths and 25 cardiac events were observed in the AF group and 9 cardiac deaths and 96 cardiac events were observed in the SR group, over a prospective follow-up period of 1,192 days. The percentages of cardiac deaths and cardiac events were higher in the AF group than in the SR group. In a multivariate Cox proportional hazards analysis, peak VO2 was identified as a sole significant predictor of cardiac death and cardiac events in SR patients and VE-VCO2 slope was identified as a sole significant predictor of cardiac death and cardiac events in AF patients.Our results suggest that the VE-VCO2 slope is strongly predictive of future cardiac events in patients with AF and that peak VO2 is strongly predictive of future cardiac events in SR patients.     

Cardiac arrest with subsequent permanent anoxaemic brain damage in a patient with the Brugada syndrome

The paper presents a case of a 20-year-old student with a history of cardiac arrest due to ventricular fibrillation. The episode of cardiac arrest occurred when the patient did not complain of any health problems, and there was no visible structural heart disease. Consequently, permanent anoxaemic brain damage was observed. Based on ECG examination, the Brugada syndrome was diagnosed as the cause of cardiac arrest. The ajmaline challenge test was performed in the members of the patient's family.     

Factors associated with referral to outpatient cardiac rehabilitation services

BACKGROUND: Although practice guidelines and policy statements for cardiac rehabilitation recommend that it be offered to all patients with cardiovascular disease, the participation rates in most Western countries are low. PURPOSE: This study aimed to determine the factors associated with referral to outpatient cardiac rehabilitation in the Hunter region of New South Wales, Australia. METHODS: The study sample comprised 1933 patients discharged from public hospitals in the Hunter region between March 1, 1998 and February 28, 1999 who were eligible for cardiac rehabilitation, and for inclusion on the Hunter Area Heart and Stroke Register (the Register). Data were obtained from the Register database (gender, age, clinical information) and via a self-completed questionnaire eliciting referral, sociodemographic, and cardiovascular disease risk factor information. Multiple logistic regression analysis was conducted to determine the factors independently associated with referral. RESULTS:: Of the respondents (1202/1933), 41% (493/1202; 95% confidence interval, 38-44%) reported that they had been referred to outpatient cardiac rehabilitation. The factors independently associated with referral were age younger than 65 years, previous participation in an outpatient cardiac rehabilitation program, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery. CONCLUSIONS: Younger age, previous participation in outpatient cardiac rehabilitation, admission to a hospital that provides outpatient cardiac rehabilitation, a discharge diagnosis of acute myocardial infarction, and coronary artery bypass surgery were associated with referral to cardiac rehabilitation. Research testing strategies designed to increase cardiac rehabilitation referral rates are needed and could include testing the potential role of modern quality management methods.     

Measurement of cardiac output with the Quantascope, a novel Doppler device: comparison with thermodilution

The Quantascope is a novel non-imaging echo-Doppler device designedto measure cardiac output. We have compared this device withthermodilution. Twenty-five patients with suspected coronary artery diseaseundergoing diagnostic coronary arteriography simultaneouslyhad cardiac output measured with the Quantascope and with thermodilution. Doppler systematically underestimated cardiac output, when comparedwith thermodilution, by a mean (SD) of 0–9 (1.5)l . min^–1(P < 0.01). The cardiac output derived by the Doppler techniquedid not correlate with that derived by thermodilution (r = 0.36,P = NS). Compared with the currently accepted reference technique ofthermodilution, we found measurement of cardiac output by theQuantascope to be inaccurate: this contradicts previous reports.     

慢性心力衰竭合并肾功能不全住院患者270例临床分析

目的探讨慢性心力衰竭住院患者肾功能不全发生率及与心功能的关系。方法收集慢性心力衰竭患者资料,应用改良的简化肾脏病饮食研究方程评估患者的肾功能,计算慢性心力衰竭住院患者肾功能不全发生率,采用有序分组数据的线性检验来检验患者肾功能与心功能的关系。结果慢性心力衰竭患者肾功能不全发生率为31．5％,NYHA心功能分级与。肾小球滤过率水平之间存在相关关系且为线性相关。结论慢性心力衰竭患者肾功能不全发生率较高;慢性心力衰竭患者NYHA心功能分级愈高,患者肾功能愈差。     

Cardiac PPARalpha expression in patients with dilated cardiomyopathy

BACKGROUND: The peroxisome proliferator-activated receptor alpha (PPARalpha) is a central regulator of myocardial fatty acid (FA) metabolism implicated in the pathogenesis of heart failure. AIMS: To characterize PPARalpha regulation in human dilated cardiomyopathy (DCM), we studied the expression of cardiac PPARalpha, cardiac carnitine palmitoyl-transferase I (CPT-1), a major PPARalpha target gene, and of the cardiac glucose transporter GLUT-4 in patients with DCM. METHODS: Left ventricular biopsies were taken from patients with DCM (n=16) and control subjects (n=15), and mRNA expression was quantitated using real-time PCR (SYBR((R))Green) and protein expression was measured by Western immunoblotting. RESULTS: Left ventricular PPARalpha mRNA levels were significantly increased in the DCM group compared to the control group (136+/-25.4% vs. control, p<0.01). Consistently, DCM patients had a significantly higher cardiac CPT-1 mRNA expression (147+/-51% vs. control, p<0.05) compared to the control group. Cardiac GLUT-4 expression was similar in both groups. CONCLUSION: Elevated cardiac PPARalpha levels followed by an induction of cardiac CPT-1 expression may result in increased fatty acid metabolism for cardiac energy production in DCM, suggesting a specific cardiac metabolic program in human DCM compared to other types of cardiomyopathy.     

Clinical and genetic variables associated with acute arousal and nonarousal-related cardiac events among subjects with long QT syndrome

In patients with the long QT syndrome (LQTS), the occurrence of cardiac events (syncope or cardiac arrest) is frequently associated with acute arousal caused by exercise, swimming, emotion, or noise. However, cardiac events may also occur during sleep or with ordinary daily activities. The purpose of this study was to determine whether there are differential clinical, electrocardiographic, and genetic features among LQTS patients who experienced cardiac events with and without acute arousal. We identified 1,325 patients with cardiac events from the International LQTS Registry. Based on the precipitating conditions of the first event, 427 patients were classified as arousal, 345 as nonarousal, and the remaining 553 were unknown (not classifiable). Gene linkage was known in 78 of the 772 patients with classifiable first events. The age at first cardiac event was significantly younger in the arousal than the nonarousal group (11.7 vs. 15.5 years, respectively; p<0.001). The arousal-type patients had a higher rate of subsequent cardiac events during follow-up after the index event than the nonarousal-type patients (p = 0.02). Arousal-related cardiac events occurred in 85% of LQT1, 67% of LQT2, and 33% of LQT3 patients (p = 0.008). This study provides evidence that the genotype is an important determinant of the LQTS phenotype in terms of arousal and nonarousal-related cardiac events.     

Aortic valve fibroelastoma presenting with myocardial infarction

Fibroelastoma is a rare, benign cardiac tumor. It is the second most common primary cardiac tumor and the most common primary cardiac valvular tumor. Nonvalvular endocardial location is rare and may be difficult to differentiate from thrombus and myxoma. Fibroelastoma consists of a small, highly papillary, pedunculated, and avascular tumor which is covered by a single layer of endothelium. It contains fine elastic fibrils arranged in whorls in a hyaline stroma. Fibroelastoma is mostly found incidentally at the time of echocardiography, cardiac catheterization, surgery, or autopsy. Symptomatic patients present with various clinical presentations, mainly cardiovascular in nature. © 2011 Wiley‐Liss, Inc.     

Cardiac tamponade in a neonate with cardiac tumour

A case of a neonate with a life-threatening cardiac tamponade due to cardiac tumour is presented. Pericardiocentesis was performed and 300 ml of purulent fluid was evacuated. Pericardial drainage was undertaken. Six months later cardiac tamponade recurred and was again successfully treated with pericardial drainage. A subsequent 10-month follow-up was uneventful. Diagnosis and treatment of cardiac tumours associated with pericardial effusion are discussed.     

Respiratory hypoxia as a heart failure complication in patients with acquired heart defects operated on with artificial circulation and its treatment by artificial pulmonary ventilation with positive expiratory pressure

The pulmonary gas exchange was studied in 148 patients with prosthesis of the cardiac valves during progressing cardiac insufficiency. It was established that with the increase of cardiac insufficiency respiratory disorders also increase, mainly at the expense of the increase of the intrapulmonary arterio-venous shunting of the blood. The use of artificial lung ventilation with positive expiratory pressure in the post-operative period decreases intrapulmonary shunting, thus increasing the partial pressure and oxygen saturation of the arterial blood, and does not exert depressing action on the cardiac activity.