PURPOSE:A high rate of coronary microcirculation dysfunction has been recently demonstrated in coronary artery aneurysm or ectasia (CAAE) in invasive assessment. We sought to analyse the diagnostic value of single-photon emission computed tomography (SPECT/CT) in patients with CAAE and to link it with their angiographic characteristics. METHODS:We analyzed 79 patients with CAAE without coronary artery disease who underwent coronary angiography assessed with quantitative coronary angiography (QCA). In all patients SPECT/CT with technetium agents was performed to assess the presence of reversible myocardial perfusion defect. RESULTS:The presence of reversible defect was found in 27 (34.2%) of the included patients. Patients with reversible defect were characterized by more frequent diabetes (55.6 vs 25%, P = 0.007). They were more often treated with insulin (14.8 vs 1.9%, P = 0.026) and non-insulin hypoglycemic drugs (40.7 vs 19.2%, P = 0.043). In patients with reversible defect there was a higher number of multiple CAAE (14.8 vs 5.8%, P = 0.044) without other significant differences in CAAE diameters. The percentage of reversible perfusion defect was inversely associated with distal reference diameter of CAAE (R = -0.342, P = 0.031). In the multivariable analysis, only diabetes was independently associated with presence of reversible perfusion defect (odds ratio [OR] 3.525, 95% confidence interval [CI] 1.240-10.019, P = 0.018). CONCLUSIONS:As has been shown for the first time in a high percentage of CAAE patients without coronary artery disease, a reversible perfusion defect in SPECT/CT is observed, which may explain their high symptomaticity. Diabetes, but not CAAE diameters, is the independent predictor of reversible perfusion defect.

BACKGROUND:Current guidelines suggest that statins may be beneficial in patients with myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA). However, the available data are ambiguous. OBJECTIVES:We sought to investigate the effect of statin therapy on long-term mortality among MINOCA patients. MATERIAL AND METHODS:Between 2012 and 2019, coronary angiography was performed in 1,011 patients hospitalized with a diagnosis of MI. Patients with lesions narrowing coronary arteries by less than 50% were classified as MINOCA. Baseline clinical characteristics, laboratory and echocardiographic parameters, statin type prescribed at discharge, as well as long-term all-cause mortality were collected in the MINOCA group. RESULTS:MINOCA was diagnosed in 77 (7.6%) patients, while statins were prescribed in 57 (74%) of them at discharge. Subjects treated with statins had a higher prevalence of hypertension (94.7 vs 70%, p = 0.008) and dyslipidemia (77.2 vs 45%, p = 0.008), had a higher body mass index (BMI; p = 0.028), and were less likely to suffer from active cancer (17.5 vs 55.0%, p = 0.001). In multivariable logistic regression, active cancer independently reduced (odds ratio (OR) = 0.143, 95% confidence interval (95% CI): 0.027-0.748), whereas higher baseline low-density lipoorotein cholesterol (LDL-C) (OR = 3.216, 95% CI: 1.192-8.686) independently increased the likelihood of statin prescription at discharge. In the median follow-up of 69.2 [interquartile range (IQR): 37.8-79.9] months, all-cause mortality was significantly higher in MINOCA patients not treated with statins (p = 0.025). CONCLUSIONS:Roughly 75% of MINOCA patients were treated with statins at discharge. This decision was independently influenced by clinical characteristics and lipid profile. Statin prescription was associated with lower long-term all-cause mortality.

Background/Objectives: Hyponatremia is associated with increased mortality in the general hospital population. We sought to investigate whether hyponatremia affects the long-term survival of patients following a myocardial infarction (MI) in both ST-segment elevation (STEMI) and non-ST elevation (NSTEMI) presentations. Methods: In this study, 862 MI patients who were hospitalized between 2012 and 2017 were retrospectively followed-up within the median time period of 41.9 [28.2–73.5] months. All participants were assigned to a hyponatremic or normonatremic group with hyponatremia defined as a sodium level of less than 135 mEq/L on admission. Results: In the acute phase of an MI, hyponatremia was diagnosed in 31 (3.6%) patients. The patients with hyponatremia were less often male (38.7 vs. 70.4%, p < 0.001), and less frequently had Killip class I (63.3 vs. 80%) but more often had Killip class IV on admission (16.7 vs. 4.2%, p = 0.024) and more often had a history of impaired renal function (32.3 vs. 15.5%, p = 0.013) than those with normonatremia. Hyponatremic patients had higher troponin T levels on admission by 75.1% (p = 0.003), a higher isoenzyme MB of creatine kinase level by 34.4% (p = 0.006), and lower hemoglobin (by 8.5%, p = 0.001) levels as compared to the normonatremia group. Long-term mortality was significantly higher in the patients with hyponatremia versus normonatremia (18 [58.1%] vs. 243 [29.2%], log-rank p < 0.001). This was driven by differences in the NSTEMI population (65 vs. 30.5%, p < 0.001). By a Cox proportional hazard regression analysis, hyponatremia was associated with a higher long-term mortality (hazard ratio [HR] of 2.222, a 95% confidence interval [CI] of 1.309–3.773, and p = 0.003). Conclusions: Hyponatremia rarely identified in acute phase of MI was associated with higher long-term mortality, particularly in the NSTEMI population.

HomeCirculationAhead of PrintA Prospective Randomized Trial of Direct Oral Anticoagulant Therapy with A Fully Magnetically Levitated LVAD: The DOT-HM3 Study Free AccessLetterPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBA Prospective Randomized Trial of Direct Oral Anticoagulant Therapy with A Fully Magnetically Levitated LVAD: The DOT-HM3 Study Ivan Netuka, Zuzana Tucanova, Peter Ivak, Stanislav Gregor, Dushan Michael Kolesar, Tomas Marek, Vojtech Melenovsky, Jana Binova, Zora Dorazilova, Marketa Hegarova, Martina Podolec, Hynek Riha, Jean M. Connors and Mandeep R. Mehra Ivan NetukaIvan Netuka Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Zuzana TucanovaZuzana Tucanova Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Peter IvakPeter Ivak https://orcid.org/0000-0002-1803-604X Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Stanislav GregorStanislav Gregor Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Dushan Michael KolesarDushan Michael Kolesar Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Tomas MarekTomas Marek Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Vojtech MelenovskyVojtech Melenovsky https://orcid.org/0000-0001-8921-7078 Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Jana BinovaJana Binova Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Zora DorazilovaZora Dorazilova Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Marketa HegarovaMarketa Hegarova Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Martina PodolecMartina Podolec Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Hynek RihaHynek Riha https://orcid.org/0000-0002-9861-7361 Institute for Clinical and Experimental Medicine, Prague, Czech Republic , Jean M. ConnorsJean M. Connors https://orcid.org/0000-0001-6445-582X Brigham and Women's Hospital and Harvard Medical School, Boston, MA and Mandeep R. MehraMandeep R. Mehra * Corresponding Author; email: E-mail Address: [email protected] https://orcid.org/0000-0001-8683-7044 Brigham and Women's Hospital and Harvard Medical School, Boston, MA Originally published9 Apr 2024https://doi.org/10.1161/CIRCULATIONAHA.124.069726Circulation. 2024;0Footnotes* Corresponding Author; email: mmehra@bwh.harvard.edu eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails Advertisement Article InformationMetrics © 2024 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.124.069726PMID: 38594972 Manuscript receivedMarch 20, 2024Manuscript acceptedApril 1, 2024Originally publishedApril 9, 2024 PDF download Advertisement

The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

Patients with takotsubo syndrome (TTS) may present coronary slow flow (CSF) in angiography performed in the acute myocardial infarction (MI). However, the detailed clinical relevance and its long-term impact remain poorly understood. Among 7771 MI patients hospitalized between 2012 and 2019, TTS was identified in 82 (1.1%) subjects. The epicardial blood flow was assessed with thrombolysis in myocardial infarction (TIMI) scale and corrected TIMI frame count (TFC), whereas myocardial perfusion with TIMI myocardial perfusion grade (TMPG). CSF was defined as TIMI-2 or corrected TFC > 27 frames in at least one epicardial vessel. CSF was identified in 33 (40.2%) TTS patients. In the CSF-TTS versus normal-flow-TTS group, lower values of left ventricular ejection fraction on admission (33.5 (25–40) vs. 40 (35–45)%, p = 0.019), more frequent midventricular TTS (27.3 vs. 8.2%, p = 0.020) and the coexistence of both physical and emotional triggers (9.1 vs. 0%, p = 0.032) were noted. Within a median observation of 55 months, higher all-cause mortality was found in CSF-TTS compared with normal-flow TTS (30.3 vs. 10.2%, p = 0.024). CSF was identified as an independent predictor of long-term mortality (hazard ratio 10.09, 95% confidence interval 2.12–48.00, p = 0.004). CSF identified in two-fifths of TTS patients was associated with unfavorable long-term outcomes.

Department of Coronary Artery Disease and Heart Failure, Intitute of Cadiology, Jagiellonian University Medical College, Kraków, Poland John Paul II Hospital, Kraków, Poland Department of Cardiovascular Surgery and Transplantation, Intitute of Cadiology, Jagiellonian University Medical College, Kraków, Poland Student Research Group at Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Kraków, Poland

The goal of the study was to assess the relationship between cardioprotective medications, i.e., beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), calcium channel blockers (CCBs), angiotensin II receptor blockers (ARBs), statins, acetylsalicylic acid (ASA), and periodontitis (PD). Background: Xerostomia increases the risk of PD and is a side effect of some pharmacotherapies. Information about the effect of cardioprotective treatment of periodontal status is scarce. Methods: We studied 562 dentate residents of Krakow at the age of 50 to 70 years. Information about treatment was collected using a standardized questionnaire. The pocket depth and clinical attachment level (CAL) were used to ascertain PD. Multivariate logistic regression was applied to assess the relation between cardioprotective medications and PD. Results: PD was found in 74% of participants. The range of cardioprotective drug use among participants was 7% (ARBs) to 32% (beta-blockers). After adjusting for age, sex, number of teeth, smoking, and education, ASA’s use was related to a lower prevalence of PD in all dentate participants (odds ratio (OR) = 0.63, 95% confidence interval (CI): 0.40–0.99). The use of ARBs and statins was found to be associated with a higher prevalence of PD in persons having ≥6 teeth (odds ratio (OR) = 3.57, 95% CI: 1.06–11.99 and OR = 1.81, 95% CI: 1.03–3.16, respectively). Further adjustment for CVD risk factors, history of coronary heart disease, and other chronic diseases did not attenuate the results. There was no significant relation between PD and the use of other cardioprotective drugs.

INTRODUCTION:Long lesions contribute to a significant number of percutaneous coronary interventions. AIM:To assess the efficacy and safety of a novel long-tapered drug-eluting stent (DES) at a 12-month follow-up (FU) in patients with long coronary atherosclerotic lesions. MATERIAL AND METHODS:A prospective clinical cohort study was conducted in 32 patients who underwent percutaneous coronary intervention using a BioMime Morph tapered stent (Meril Life Sciences, India). The patients were followed for 3, 6, and 12 months. The safety endpoints were death, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), and MACE and/or major bleeding. RESULTS:Mean lesion length was 48 mm (range: 35-70 mm) measured via quantitative coronary analysis (QCA). In most cases, the target lesion was located in the LAD (68.75%). A GuideLiner catheter (Vascular Solutions Inc., MN, USA) was used in 12.5% of procedures; buddy-wire technique in 9.4% of cases. Bifurcation lesions were treated in 40.6% of cases. Additional stent implantation was needed in 56% of the procedures (25% of cases due to proximal or distal dissection, or due to insufficient stent length in 31% of cases). On 12-month FU we observed 1 TLR (3.1%), 1 TVR (3.1%), and 1 non-cardiovascular death. CONCLUSIONS:The long sirolimus-eluting stent with tapered structure was characterized by good deliverability in long coronary lesions, although in some cases "buddy wire" or extension microcatheter use was necessary. Follow-up at 3, 6, and 12 months showed no significant major adverse cardiovascular events related to the device.

BACKGROUND The Systemic COronary Risk Estimation (SCORE) system is recommended for the assessment of cardiovascular disease (CVD) death risk in individuals free of CVD. AIM We sought to determine the association between carotid-femoral pulse wave velocity (CFPWV) and SCORE. METHODS The study involved 1008 Krakow residents, and a random subsample of 3424 men and 3205 women who participated in Wave 2 of the Polish part of the Health, Alcohol, and Psychosocial factors in Eastern Europe (HAPIEE) study. At baseline we performed a medical interview, physical examination, evaluation of present comorbidities, medications using standardised methods. A follow-up of 4.9 years included measurement of CFPWV using an automatic, computerised Complior® system. RESULTS Final analysis included 720 patients (378 women), aged 58.5 ± 6.5 years at baseline. In 488 individuals without his- tory of CVD and/or diabetes, SCORE was calculated. Median CFPWV was higher (p = 0.002) in men (12.5 m/s; interquartile range [IQR] 10.3-15.7) than in women (11.7 m/s; IQR 10.1-13.7). High CFPWV (> 10 m/s) was observed in 270 men (78.9%) and in 285 women (75.4%). We observed a strong association between high CVD risk (SCORE ≥ 5%) and high CFPWV (odds ratio 2.29; 95% confidence interval 1.17-4.46). The CFPWV cut-off value to differentiate between patients with low and high CVD risk was 11.7 m/s (with 58.6% sensitivity and 71.3% specificity, AUC = 0.68). CONCLUSIONS Our study is the first to describe the distribution of CFPWV in the adult Polish population. SCORE ≥ 5% pre- dicted high CFPWV in 4.9 years of follow-up, which was independent of other risk factors. CFPWV > 11.7 m/s was most valid in relation to high CVD risk.

IntroductionPeyton's four‐step approach is well‐known and commonly used in medical education. It is a practical and useful method which is simple to apply. The study presents the implementation of the modified four‐step approach method to teach how to perform the emergency echocardiographic assessment according to FATE (Focus‐Assessed Transthoracic Echo) protocol. The aim of the study was to determine the feasibility and utility of this method FATE protocol teaching.DesignWe collected students' feedback relating to perception of this way of teaching. Based on a semistructured interview conducted with the students, as well as an evaluation of the electronic survey, it has been demonstrated that the four‐step method is useful for teaching emergency echocardiographic assessment.SettingOne Polish medical school.ParticipantsThe classes were run in small groups as part of an elective ultrasound course for the fourth‐ and fifth‐year students of the Faculty of Medicine of the Medical College. Twenty‐two students were trained.ResultsBased on the opinions of the participants of the elective course and the teacher conducting the classes, which involved the use of the modified Peyton's four‐step method in teaching echocardiography in emergency cases according to the FATE protocol, it has been determined that the four‐step method is effective in imaging training. All participants claim that this method is clear and understandable. Advantages of the methodological approach: a slow‐motion demonstration by the instructor, accompanied by the commentary on the activities undertaken and practical exercises performed by the participants, learning through repetition, requirement of constant concentration.ConclusionsPeyton's approach allows to use of the class time in maximal extend by consolidating new information and facilitating memorization through adequate instructor guidance and observation of the training of the peer students and repetition of the skills acquired.

Peripartum cardiomyopathy (PPCM) is defined as an idiopathic cardiomyopathy, presenting with heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) at the end of pregnancy or in the early months after delivery. Importantly, there should be no other identifiable cause of HF. The pathophysiology of PPCM is not fully understood and is probably multifactional. The data on the PPCM prognosis are sparse. Though initial reports suggested that mortality in PPCM vary geographically. We present a case of a a nulliparous 25-year-old Caucasian woman, who gradually developed dyspnea on exertion and fatigue 2 months after successful vaginal twin deliv- ery. She did not have any typical risk factors for cardiovascular diseases, her family history was unremarkable, and the whole pregnancy period was uneventful. After initiation of anti-HF therapy her clinical status gradually improved and she was discharged home with only mild symptoms and improved LV systolic function. JRCD 2015; 2 (3): 85–88

INTRODUCTIONEarly access to Emergency Medical Services determines survival in out-of-hospital cardiac arrest. However, a significant proportion of adults do not know the emergency phone number (EN) and no intervention has been proposed to improve it. Therefore, we aimed to assess prospectively the effectiveness of single advice from a physician on knowledge of the EN in adult population.MATERIALS AND METHODSThe study was conducted among participants of "Health, Alcohol and Psychosocial Factors in Eastern Europe" study. A total of 942 persons (aged 48-82 years) randomly selected from an urban population registry were interviewed and then instructed about the correct EN (the intervention group). After 12 months knowledge of the EN was assessed in the intervention group (n=716) and in matched control group (n=435).RESULTSThe correct EN was given by 498 (69.6%) participants at baseline and in 550 (76.8%) participants 12 months afterwards (p<0.001). At follow-up the knowledge of EN was higher by in intervention group than in controls (76.8% vs 70.6%, p=0.02). Factors associated with better educational effect were male sex (OR 1.49; 95% CI 1.04-2.1) and secondary or higher level of education (OR 1.44; 95% CI 1.08-1.91).CONCLUSIONSWe concluded that a single instruction about the EN from a physician increases its long-term knowledge and should be offered during medical visits.

Correlation of the thickness of the left ventricular posterior wall (LVPWd) with various parameters, including age, gender, weight and height, was investigated in this study using regression models. Multicenter derived database comprised over 4,000 healthy individuals. The developed models were further utilized in the in vitro–in vivo (IVIV) translation of the drug cardiac safety data with use of the mathematical model of human cardiomyocytes operating at the virtual healthy population level. LVPWd was assumed to be equivalent to the length of one-dimensional string of virtual cardiomyocyte cells which was presented, as other physiological factors, to be a parameter influencing the simulated pseudo-ECG (pseudoelectrocardiogram), QTcF and ∆QTcF, both native and modified by exemplar drug (disopyramide) after I Kr current disruption. Simulation results support positive correlation between the LVPWd and QTcF/∆QTc. Developed models allow more detailed description of the virtual population and thus inter-individual variability influence on the drug cardiac safety.