Surviving Ventricular Standstill for 111 Seconds during Holter Monitoring

Holter electrocardiogram recording revealed symptomatic prolonged ventricular standstill lasting for about two minutes which terminated without any external cardiopulmonary resuscitation. Ann Noninvasive Electrocardiol 2012;17(1):61–62     

Right ventricular endomyocardial fibrosis – A case report

Endomyocardial fibrosis (EMF) is a progressive type of restrictive cardiomyopathy. It affects inflow portion of right and/or left ventricle and apex. It is a neglected tropical disease. Here we report a rare case of right ventricular endomyocardial fibrosis. A 70-year-old female presented to us with history suggestive of right-sided heart failure of two months duration. There was no eosinophilia. Chest X-ray showed cardiomegaly. Echocardiogram showed dilated right atrium and obliteration of the apex of the right ventricle. A diagnosis of Right ventricular Endomyocardial fibrosis was made. She was treated with diuretics and anticoagulants and she improved.     

3D-QSAR and docking studies of benzoyl urea derivatives as tubulin-binding agents for antiproliferative activity

Tubulins, an αβ heterodimers, the major component of microtubules, are important molecular target of numerous small molecule ligands for anticancer therapy. In this study, the molecular modeling studies were performed to develop predictive 3D-QSAR models using set of 32 compounds of benzoyl urea derivatives as tubulin-binding agents for antiproliferative activity. A five-point common pharmacophore hypotheses with one hydrogen bond acceptor (A), two hydrogen bond donors (D), one hydrophobic (H), and one ring (R) vector features were selected for alignment of all compounds. The 3D-QSAR models generated using training set of 21 compounds and test set of 11 compounds showed good partial least squares statistical results. The developed CPHs and 3D-QSAR models were validated further externally by predicting the activity of database of compounds from literature and comparing it with actual activity. Docking studies were also carried out for all compounds on colchicine-binding site of β-tubulin for studying of binding affinity of compounds for antiproliferative activity. The results of these molecular modeling studies are helpful to refine the pharmacophore for design of new potential compounds for antiproliferative activity.     

Dual Antiplatelet Therapy and Outcomes in Patients With Atrial Fibrillation and Acute Coronary Syndromes Managed Medically Without Revascularization: Insights From the TRILOGY ACS Trial

Associations between atrial fibrillation (AF), outcomes, and response to antiplatelet therapies in patients with acute coronary syndrome (ACS) managed medically without revascularization remain uncertain. We examined these associations for medically managed ACS patients randomized to dual antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial. DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5 mg/d for those <60 kg or age ≥75 years). Patients receiving oral anticoagulants were excluded. Cox proportional hazards regression modeling was used to characterize associations between patients with AF (AF+) vs those without (AF?) and risk of ischemic and bleeding events, and to explore effects of randomized treatment on outcomes. Among 9101 patients with baseline AF status, 710 (7.8%) had AF. AF+ patients were older and had more comorbidities. Unadjusted associations of the composite of cardiovascular death/myocardial infarction/stroke were significantly higher among AF patients at 30 months (31.1% vs 18.4%; HR: 1.61, 95% CI: 1.35‐1.92, P < 0.001), but differences did not persist after adjustment (HR: 1.16, 95% CI: 0.97‐1.39, P = 0.11). When individual components of the composite endpoint were evaluated, 30‐month risk of events in AF+ patients was significantly higher. Thirty‐month risk of all‐cause death was significantly higher in AF+ patients: 18.1% vs 11.1% (HR: 1.62, 95% CI: 1.30‐2.02, P < 0.001). There was no significant interaction with randomized treatment and AF for the primary endpoint. Among medically managed high‐risk ACS patients receiving DAPT, AF was associated with higher unadjusted risks of ischemic and bleeding outcomes that were similar by treatment group.     

Impact of Percutaneous Coronary Intervention on Outcomes in Patients With Heart Failure: JACC State-of-the-Art Review

Coronary artery disease (CAD) is highly prevalent in patients with heart failure (HF) and accounts for nearly two-thirds of cases. The use of percutaneous coronary intervention (PCI) in HF patients with CAD has markedly increased and has been suggested to be associated with improved outcomes in numerous observational studies. Randomized data comparing the impact of PCI with that of coronary artery bypass graft (CABG) or contemporary guideline-directed medical therapy alone on clinical outcomes and myocardial recovery in patients with HF are lacking. The purpose of this review is to describe the available evidence regarding the impact of PCI in acute HF (in the presence and absence of an acute coronary syndrome), chronic HF with reduced ejection fraction, and HF with preserved ejection fraction. Adequately-powered randomized clinical trials examining the outcomes with PCI in these distinct HF populations are warranted.