Coronary artery calcium score, which is calculated by computed tomography (CT), is an independent predictor of adverse cardiac events in both symptomatic as well as asymptomatic patients. CT coronary angiography is growingly employed not only to evaluate the vessel stenosis, but also to characterise and quantify the extent and amount of coronary atherosclerosis. The four features of high-risk plaques on CT coronary angiography include napkin-ring sign, low CT attenuation, spotty calcification, and the remarkable positive remodelling. Spotty calcium is closely associated with unstable plaques and acute coronary syndrome. Managing patients with calcified coronaries is a dilemma for the interventional cardiologists. Intravascular imaging, either an IVUS or OCT, is recommended in order to have a meticulous analysis of the severity and characterization of the plaque morphology as coronary angiography alone underestimates calcium and does not easily allow its quantification. Performing percutaneous coronary intervention on a heavily calcified coronary lesion poses several technical challenges. IVL is an up-and-coming new treatment modality for tackling coronary artery calcification. In the foreseeable future, this calcium-modification technique is likely to become the established strategy for dealing with challenging complex, calcified lesions.
Intravenous drug abuse remains a significant health concern worldwide. Complications of intravenous drug use include transmission of infectious diseases, infective endocarditis, and localized infection. Central needle embolization of needle fragments from intravenous drug use is extremely rare and can result in life threatening complications. However, management of these patients poses a clinical dilemma for physicians when considering conservative versus surgical treatment. We present a case of a young male with a history of intravenous drug abuse who presented with fevers and shortness of breath and was found to have infective endocarditis and septic pulmonary emboli secondary to a retained needle fragment. Ultimately, a conservative management approach was decided after risk versus benefit analysis was completed.
Introduction: MicroRNAs (miRNAs) constitute a class of endogenous small non-coding RNAs. Expandig evidence evidence indicates that a set of miRNAs, expressed in a spatially and temporally controlled manner in the brain, are involved in neuronal development, differentiation and synaptic plasticity. Aim: The aim of our review was to summarize the the role of miRNAs in the development of ischemic stroke based on animal and human and preclinical treatment studies. Conclusion: Disregulated miRNAs have revealed their complex role in pathophysiological processes in both animal and human research, and have also shown their potential role in disease diagnosis, and use as drug targets in ischemic stroke. Although miRNAs represent a potentially powerful treatment paradigm, much work remains to be done in describing individual specific miRNA-mRNA interactions, understanding the regional and cell type specific distribution of miRNAs within the nervous system, and in developing organ-targeted delivery systems to optimize the therapeutic potential of miRNAs.
All major studies generated evidence that validated the association between hyperlipidemia and cardiovascular disease. Low-Density Lipoprotein (LDL) has always been the target for risk reduction and the most frequently used therapeutic option. Statins reduce the LDL and improves the cardiovascular (CV) outcomes. However, in specific clinical cases where statins cannot be used, the therapy must include non-statin drugs. There are many options available, but the not all improve the CV outcome. Ezetimibe and PCSK9 inhibitors had clear evidence of benefit to reduce atherosclerotic cardiovascular disease risk, while other therapy are showing less evidence. The current review highlights the evidence related to non-statins in the reduction of CV outcomes.
BACKGROUND: The aim of our pilot study was to investigate the endothel dysfunction, hemorheological and agonist-induced platelet aggregation changes in aspirin-treated cerebrovascular patients after parenteral vinpocetine admission (VP). METHODS: Hemorheological parameters (hematocrit, plasma fibrinogen, whole blood viscosity, red blood cell aggregation and deformability), endothel dysfunction markers (von Willebrand factor, soluble P-selectin) and agonist-induced (collagen, epineprine, arachidonic acid and adenosine-diphosphate) platelet aggregation values were evaluated at baseline, 7th and 30th day. RESULTS: Parenteral vinpocetine infusion significantly decreased von Willebrand factor levels and arachidonic acid-induced platelet aggregation values and they still remained significant after 30 days. Red blood cell deformability was significantly decreased after a month. No statistical differences among the other examined hemorheological parameters could be found. CONCLUSION: Vinpocetine, partially by its benefitial hemorheological and endothel-dysfunction improving profile may help to overcome aspirin resistance.
Infective endocarditis is a relatively rare disease, but with a significant impact. Staphylococcus aureus, Coagulase-negative staphylococci and oral streptococci are commonly causative organism. Mycobacterium tuberculosis or non-tuberculous mycobacteria are very rare etiology of infective endocarditis. Here, we report a case of tuberculosis of hematopoietic organs and tuberculous endocarditis in an immunocompetent patient. A 32-year-old man was hospitalized for a 15-day-history of persistent fever, asthenia, anorexia and diarrhea. His laboratory investigations showed elevated inflammatory markers and pancytopenia. All investigations, even sputum smear was negative for acid-fast bacilli. Thoracoabdominal computed tomography showed abdominal lymph nodes with a slight pleural and peritoneal effusion. Transthoracic echocardiography revealed a 25 mm mobile vegetation on the large mitral valve. Blood cultures were negative. The serological testing for Coxiella burnetii , Bartonella quintana , Bartonella henselae , Brucella species and Legionella species were negative, as well. Bone marrow biopsy showed tuberculosis of hematopoietic organs. The patients received antitubercular therapy for a 15-month-duration. The disease evolution was favourable. The echocardiography showed no vegetation after 70 days therapy. Tuberculous endocarditis should be bearded in mind, especially in endemic countries. An early diagnosis followed by the adequate antitubercular treatment might avoid serious complications and death.
Objectives: We present the classification of bicuspid aortic valve (BAV) and morphometric analysis of the ascending aorta in patients with BAV. Methods: From 2003 to 2018, 102 patients underwent aortic valve replacement for BAV in our institution. Surgical treatment for aorta reconstruction was performed in 39 patients. All patients were evaluated by Sievers classification of the BAV and Fazel Cluster classification of the aortic form. Results: Sievers classification of the BAV showed 8 patients for type 0, 30 cases for type 1, and 1 case for type 2. Additionally, type 0 subtype included one patient of ap-type and seven patients of lat-type. In type 1, there are 18 patients as LR fusion type, 9 patients as RN fusion type, and 3 patients as LN fusion type. The mean diameter of the ascending aorta of 39 BAV patients who underwent aortic surgery was 47.8 ± 6.1 mm. Fazel Cluster classification showed eight patients in type 1, 28 patients in type 2 and 3, and three patients in type 4. Conclusion: The frequency of Sievers classification was the same as that reported previously. All BAV types may be associated with a risk of the enlargement of ascending and arch aorta.
Objectives: There has been substantial progress in the treatment of varicose veins. This study aims to examine the early outcomes in patients treated using polidocanol endovenous microfoam (PEM) (Varithena®, BTG plc., London, United Kingdom) therapy. Methods: We retrospectively reviewed and analyzed the early clinical course of 50 patients with refractory varicose veins who underwent PEM therapy in 2018. Data relating to patient characteristics , disease etiology and post-operative outcomes were collected. Results: Etiology of varicose veins in 50 patients consisted of five primary diseases; valve impairment of saphenofemoral junction (7 patients), post-operative stasis dermatitis (10 patients), post-operative residual veins (30 patients), veins with significant tortuosity (2 patients) and recurrence due to neovascularization (1 patient). Initial PEM therapy success rate was 86.3 %. No 30-day mortality and no severe complications were noted. Conclusion: PEM therapy could help to shed light on the treatment of refractory varicose veins with various backgrounds.
Sick sinus syndrome (SSS) is an organic disorder of the sinoatrial node and its adjacent tissues, which causes problems in sinus node pacing function and sinus node conduction, thus leading to arrhythmias and multiple symptoms. The aetiology of the syndrome is complex, and the pathogenesis is unknown. Traditional therapies for SSS include drug therapy and pacemaker implantation, which have only partially succeeded clinically and cannot cure SSS. Hence, there is an urgent need to develop targeted therapies in order to treat SSS. This article aims to summarize the aetiology and pathogenesis of SSS, discuss the advantages and disadvantages of traditional treatment methods, and focus on the biological pacing strategies based on gene and cell therapy.
The emerging novel coronavirus outbreak (COVID-19) highlits several interesting notes for cardiologist. Research has confirmed Angiotensin-converting enzyme 2 (ACE2) as the key SARS-CoV-2 (the COVID-19 causative agent ) cell entry receptor 1 with ACE2 affinity 10-20 times higher than SARS-CoV 2 .
Major cardiovascular events (MACEs) are leading cause of premature death in general population, as well as in the patients with known atherosclerosis and coronary artery disease (CAD). Manifestation and progression of atherosclerosis is tightly related to systemic and local microvascular inflammation that accelerate vascular remodeling, triggers endothelial dysfunction and promote negative impact of the dyslipidemia on the vasculature. The bromodomain and extra terminal (BET) proteins were first proposed as anticancer drugs and then cardio and vascular protective effects were found. The aim of the mini review is summarize knowledge for BET protein inhibitors in prevention of poor clinical outcomes in patients with atherosclerosis and CAD. The results of pool analysis of some clinical trials, such as ASSERT, ASSURE-I, SUSTAIN, are disputed. It has been shown positive effects of apabetalone on the levels of Apo A-I and high-density lipoprotein cholesterol that was associated with significant declining of the systemic and local inflammatory reaction. There is evidence regarding that the apabetalone induced reverse of the atherosclerotic plaque volume.
Objectives: Although the “mechanical valve” has historically been the popular choice to use as a prosthetic valve to treat dialysis patients requiring aortic value replacement (AVR) for aortic stenosis, bioprosthetic valves have also started to be considered for use, due to improvements of surgical outcomes observed through its technical improvements. In this study, we demonstrated our valve treatment strategy and investigated the early outcome to patients with dialysis. Methods: 470 patients received an AVR between January 2009 and December 2012. We retrospectively reviewed and analyzed the clinical course of 32 patients with dialysis. 15 patients were male and 17 patients were female, with an average age of 72.4 ± 7.3 years (range: 57-86 years). The mean duration of hemodialysis was 8.7 years (range: 0.1-36 years). The mean Society of Thoracic Surgery score and Euro Score II was 17.0% and 8.9%, respectively. We used a bioprosthetic valve for patients aged >65 years. Results: Mean observation period was 958 days. Regarding early mortality, there were 5 operative deaths within 30 days after operation (15.6%). There were 6 operative late deaths (20.7%). 1- and 3-year survivals in the bioprosthetic valve group were 68% and 46%, respectively. On the other hand, those in the mechanical valve group were 75% and 50%, respectively. Conclusion: The use of bioprosthetic valves should be considered due to its added benefits and because there is no statistically significant difference on survival and valve-related complications between bioprosthetic and mechanical valve group.
Introduction : Cardiovascular diseases are one of the leading causes of mortality worldwide. It is known to have a reduced incidence in premenopausal women compared to the opposite sex. This appears to be related to the female hormones and their fluctuation throughout the menstrual cycle. Objectives : To evaluate and correlate behavior patterns of cerebral dynamics and arterial reactivity throughout the menstrual cycle and to identify possible differences caused by the use of oral contraceptives (OC). Methods : The sample consisted of 21 healthy, eumenorrheic and non-smoking young womens, belonging to the 18-21 age group. There were two distinct groups: 11 in the group without oral contraceptive (SCO) and 10 in the oral contraceptive group (CCO). Both groups performed an evaluation in the menstrual phase (MP), from the 1st to the 4th day, and in the ovulatory phase (OP), from the 12th to the 16th day. The third evaluation was performed in the late luteal phase (LLP) from the 26th to the 30th day, in the SCO group and in the OC pause, from the 21st to the 28th day, in the CCO group. Four noninvasive procedures were performed: blood pressure measurement, axillary temperature, carotid and right brachial artery sonography. Results : There were no statistically significant differences in carotid parameters, however, there were variations in the velocity of the systolic peak (VPS) of the common carotid artery (CCA) and internal carotid artery (ICA) and the ICA resistance index (IR), throughout the cycle. The SCO group showed a significant increase in FMD from MF to OF (p = 0.023), decreasing in LL (p = 0.012). The CCO group demonstrated a relative stabilization of FMD values. In OP, there were statistically significant differences between the two groups in relation to the FMD value (p = 0.040). Conclusions : Cyclic fluctuations of estrogen appear to influence cerebral vascular impedance and arterial reactivity but in different proportions. In conclusion, this study supports the idea of standardizing the timing of vascular testing in a premenopausal woman.
More than 90% of hip fracture patients are older than 70 years and in most studies mean age is close to 85 years. Increasing age is also associated with a higher prevalence of atrial fibrillation (AF). In present review we will try to answer 3 main questions about the effect of atrial fibrillation in patients with hip fracture: (a) Is there a relationship between AF and risk of hip fracture? (b) Which should be perioperative management of anticoagulant treatment? (c) has AF a long term prognostic value on survival after hip fracture surgery and is there a relationship between AF and the results of rehabilitative treatment? Moreover we evaluated the few reports about incidence and prognostic value of new onset postoperative atrial fibrillation.
Background: Several studies have supported the idea that smoking induces changes with direct impact on endothelial function and arterial stiffness. The main purpose of this study was to assess the acute effects of smoking on vascular function in healthy young adults. Methods: We designed a quasi-experimental study, including ninety participants aged between 18 and 25 years. Participants were divided into three groups: Active exposure group (AG) - 30 usual smokers; passive exposure group (PG) and non-exposure control group (CG), each including 30 non-smokers matched for age, gender and overall lifestyle. Heart rate (HR), brachial blood pressure (bBP), flow-mediated dilation (FMD), aortic pulse wave velocity (PWV) and carotid pulse wave analysis (PWA) were evaluated in two moments: baseline and 30 minutes after smoking exposition (AG and PG) or 30 minutes after the first evaluation (CG). Results: Significant changes from baseline were observed only in the AG, with an increase in PWV, from 5.6 ± 0.7 m/s to 6.1 ± 0.2 m/s post-smoking (p = 0.040), and a decrease in FMD of about -5.7 ± 2.3% after smoking one cigarette (p < 0.001). A significant increase in brachial and central BP was also observed in the AG. A trend for increase in brachial and central BP, and decrease in the FMD was observed in the PG and no significant changes were depicted in the CG. Conclusion: Just one cigarette produces significant detrimental acute effects on the vascular endothelium and hemodynamic profile of healthy young short-term smokers. Changes are also observed, although to a lesser extent, in passive smokers.
Current clinical guidelines of European Society of Cardiology and American Heart Association regarding the diagnosis and treatment of acute and chronic HF recommend to use natriuretic peptides (NPs) as powerful diagnostic and predictive biomarker, while other biomarkers, such as galectin-3, cardiac troponins, and soluble suppressor of tumorigenisity (ST2) are embedded onto American Heart Association statement to improve a risk stratification, as well as NPs are considered for performing biomarker-guided therapy. The aim of the Editorial is to summarize knowledge among clinical efficacy of heart failure (HF) guidance care based on serial measure of sST2. Elevated levels of sST2 are established biomarker of high risk of all-cause and cardiovascular mortality, new diagnosed HF and re-admission due to HF decompensation, Therefore, a trend to declined serum levels of sST2 was associated with improved survival and decreased re-hospitalization in patients with different phenotypes of HF. It has shown that serial measure of sST2 concentrations in HF patients can predict poor clinical outcomes and personally optimize treatment care, especially in combination with repetitive measure of NT-proBNP levels. However, the role of combined biomarker approach (sST2 + NT-proBNP) in the clinical care of the HF patient is not yet partially defined and more large clinical trials are needed.
Background: Macrophage inhibitory factor (MIF) plays a pivotal role in late adverse cardiac remodeling in acute ST-segment elevation myocardial infarction (STEMI). The aim of the study was to investigate the predictive role of the circulating MIF in adverse cardiac remodeling in STEMI patients undergoing percutaneous coronary intervention (PCI). Methods: A total of 73 patients with confirmed acute STEMI successfully treated with PCI were enrolled for participation in the study. Control group was included 20 healthy volunteers. All patients signed informed consent to participate in the study. Echo and Doppler, biomarker assay and MIF determinations were performed at baseline and at 6 month after study entry. Results: There were significant differences (P 2582.80 ng/mL (n = 37). We found that cut-off MIF level ≥2644.5 ng/ml at baseline predicted adverse cardiac remodeling (AUC = 0.736, 95% CІ = 0.515 to 0.956, Р=0.0362; sensitivity = 72.7%; specificity = 81.8%; positive predictive value = 52.7%; negative predictive value = 32.4%; positive likelihood ratio = 0.89 and negative likelihood ratio = 0.72). Conclusions: The MIF level ≥2644.5 ng/mL might be predictor for late adverse cardiac remodeling after STEMI.
The role of two new compounds - Sacubitril/valsartan and Ivabradine in treatment of systolic heart failure (HFrEF) was evaluated. Sacubitril/valsartan (also called as Entresto), together the remaining optimal medical therapy, antagonize HFrEF both strengthening the beneficial effects of natriuretic peptides (NP) and acting against angiotensin II by angiotensin receptor blocker (ARB), valsartan. PARADIGM-HF study has demonstrated that Sacubitril/valsartan is superior to angiotensin-converting-enzyme (ACE) alone in reducing the risks of death and hospitalization for HFrEF. On the contrary Ivabradine, a selective inhibitor of the “funny” channel current present in the sino-atrial node, acts against HFrEF inducing a reduction of heart rate in sinus rhythm patients. This reduction yields an improvement in stroke volume due to the increased of LV diastolic filling, improving the HFrEF symptoms. The results reported in the SHIFT Trial support the importance of heart rate reduction obtained with Ivabradine for improvement of clinical outcomes in HFrEF and confirm the important role of heart rate in the pathophysiology of this disorder. Two drugs act with two diverse and innovative mechanisms and, together the remaining optimal medical therapy, represent an effective improvement in HFrEF therapy.
