Hospital Chronicles (E-Journal)
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Cardiology News / Recent Literature Review / First Quarter 2015
Get PDFHRS Meeting: Boston, 13-16/5/2015EuroPCR: Paris, 19-22/5/2015Europace: Milan, 21-24/6/2015ESC: London, 29/8-2/9/2015TCT 2015: San Francisco, 11-15/10/2015HCS: Thessaloniki, 29-31/10/2015AHA: Orlando, 7-11/11/2015Low-Level Transcutaneous Electrical Vagus Nerve Stimulation (LLTS) Suppresses Atrial Fibrillation Patients with paroxysmal AF were randomized to 1 h of 20 Hz LLTS (n= 20) or sham control (n= 20) by attaching a flat metal clip onto the tragus in the right ear. AF was induced by burst atrial pacing at baseline and after 1 h of LLTS or sham treatment. Blood samples from the coronary sinus and the femoral vein were collected at those time points and analyzed for inflammatory cytokines, including tumor necrosis factor alpha and C-reactive protein. Pacing-induced AF duration decreased significantly by 6.3 ± 1.9 min compared with baseline in the LLTS but not in the control group (p=0.002). AF cycle length increased significantly from baseline by 28.8 ± 6.5 ms in the LLTS but not in control group (p= 0.0002). Femoral vein but not coronary sinus tumor necrosis factor (TNF)-alpha and C-reactive protein levels decreased significantly only in the LLTS group. The authors concluded that LLTS suppresses AF and decreases inflammatory cytokines in patients with paroxysmal AF, supporting a role of neuromodulation to treat AF (Stavrakis S et al, J Am Coll Cardiol 2015;65:867-875).Among Patients with Early Repolarization Syndrome, Programmed Stimulation Does not Predict Future Arrhythmic EventsIn a multicenter study, 81 patients, aged 36+13 years, with early repolarization (ER) syndrome and aborted sudden death due to ventricular fibrillation (VF) underwent an electrophysiology study (EPS). VF was inducible in only 18 of 81 (22%) patients. During follow-up of 7.0 ± 4.9 years, 6 of 18 (33%) patients with inducible VF, and 21 of 63 (33%) noninducible patients experienced VF recurrences (p= NS). VF storm occurred in 3 inducible and 4 noninducible patients. VF inducibility was not associated with maximum J-wave amplitude or J-wave distribution (inferior, odds ratio -OR: 0.96; lateral, OR: 1.57; inferior and lateral, OR: 0.83; all p = NS), which have previously been shown to predict outcome in patients with an ER pattern. The authors concluded that EPS did not enhance risk stratification in ER syndrome (Mahida S et al, J Am Coll Cardiol 2015;65:151-159)... (excerpt
Atrial Flutter Mimicking Acute Myocardial Infarction
Get PDFA 37-year old male came to the emergency room complaining of atypical chest pain of a few hours duration. Initial ECG displayed atrial flutter with 3:1 atrioventricular (AV) conduction with mostly pronounced inferior-wall but also diffuse ST-T changes suspect of acute ST elevation myocardial infarction (STEMI) (Figure, panel A) with already established inferior Q waves. However, due to non-convincing clinical history, further investigation was undertaken, which showed a normal bedside echocardiogram, while determination of cardiac enzymes confirmed normal values which remained normal at subsequent measurements... (excerpt
Predictive Factors for Positive Coronary Angiography and the Role of Early Intervention After Out-of-Hospital Cardiac Arrest
Get PDFBackground: In recent years, there has been considerable research in the field of post-resuscitation care. Recent guidelines recommend early coronary angiography and percutaneous coronary intervention (PCI) as the best strategy in survivors of out-of-hospital cardiac arrest (OOHCA) with ST elevation myocardial infarction (STEMI). However, there are no decisive data for patients who do not exhibit clinical and ECG criteria suggestive of STEMI. We sought to review current evidence regarding the predictive factors of positive coronary angiography and the role of early PCI in an OOHCA setting.Methods & Results: Between 1995 and 2014, we identified 35 studies reporting on adult survivors of OOHCA who underwent coronary angiography and PCI. In total, there are over 16,000 patients included in reported series of resuscitated OOHCA victims who have undergone coronary angiography and PCI when indicated. PCI was successful in 92% (51% - 100%) of the attempted cases. The survival rate was 64% (22% - 88%) with a satisfactory neurological outcome at follow-up that varied from 47% to 96%. As the survival benefit seems to be time dependent, the selection of which patients are candidates for early PCI is under considerable research. Predictive factors for positive coronary angiography and outcome were ventricular fibrillation, history of coronary heart disease and diabetes mellitus, ST elevation on ECG, male gender, and intact brain stem functions. Negative predictive factors were normal ECG on admission or the presence of plain repolarization abnormalities, and loss of brain stem functions.Conclusions: Early coronary angiography and PCI is a promising management strategy in the OOHCA setting. As there is evidence that the survival benefit from PCI is time dependent, the research is still ongoing in identifying which patients would benefit most from an aggressive revascularization approach
Electrophysiological Neuroimaging using sLORETA Comparing 22 Age Matched Male and Female Schizophrenia Patients
Get PDFBACKGROUND: Standardized low resolution brain electric tomography (sLORETA) is a validated neuroimaging method for localizing the electric activity in the brain based on multichannel surface electroencephalogram (EEG) recordings, having the benefit of improved time resolution of EEG measurements, better than that of functional magnetic resonance imaging (fMRI), and with a spatial resolution similar to that of fMRI.OBJECTIVE: The purpose of this electrophysiological neuroimaging study was to provide a deeper mechanistic understanding of both olanzapine and risperidone pharmacodynamics relative to gender. In doing so, we age-matched 22 men and women and initially evaluated their resting-state EEG recordings and later used sLORETA to visualize the differences in brain activity amongst the two patient groups.METHODS: In this investigation, EEG data were analyzed from male and female schizophrenia patients treated with either olanzapine or risperidone, both atypical antipsychotics, during their in-patient stay at the Department of Psychiatry. Twenty two males and females were age-matched and EEG recordings were analyzed from 19 silver/silver chloride electrodes. Thirty-seconds of resting EEG were spectrally transformed into sLORETA. Three-dimensional statistical non-paramentric maps for the sLORETA global field power within each band were finally computed.RESULTS: The results indicated that, relative to males patients, females schizophrenia patients had increased neuronal synchronization in delta frequency, slow-wave, EEG band located in the dorsolateral prefrontal cortex, within the middle frontal gyrus (t= -2.881, p <0.03580). These findings suggest that females experience greater dopamine receptor and serotonin receptor neuronal blockade relative to age-matched males. Further, our findings provided insight to the pharmacodynamics of secondgeneration antipsychotics olanzapine and risperidone.CONCLUSION: When compared to male patients, female patients suffering from schizophrenia have dopamine and serotonin receptors that are blocked more readily than age-matched male schizophrenia patients. Clinically, this may translate into a quicker time to treatment-response in females as compared to male patients
Short Tandem Repeats Loci in Parentage Testing
Get PDFThe need for confirmation or exclusion of biological father and / or biological mother is a social phenomenon, which is imposed by socio-economic and, sometimes, by moral-psychological factors. Modern science has significantly contributed to solving this problem, as many medical methods have been applied for this purpose. Biological markers that have been conducted for distinguishing between individuals were the human ABO blood groups, the Rh, MNS, Duffy, Kidd, and Kell systems, as well as the human leukocyte antigens (HLA) system. For a long time theHLA testing represented the standard testing in forensic genetics, but, due to the linkage disequilibrium and the predominance of certain HLA alleles and as the demand for parentage investigations is rapidly increasing during the recent years, this serological era has been replaced by molecular markers through the introduction of “DNA profilingâ€, which is based on polymorphisms of short tandem repeats (STRs) loci. Nowadays, “DNA profiling†by analysis of STR loci is the method of choice for human identification and parentage investigations. This technique is the most informative, accurate, robust, rapid, cost-effective method of genotyping and has worldwide acceptance in the courts, as the probability of parentage will typically be greater than 99.99999%
Acute Hemorrhagic Leukoencephalitis: Multimodal Diagnosis and Treatment
Get PDF We report a case of a previously healthy 26 year old male, admitted to the intensive care unit due to cerebral oedema. The patient was admitted 3 days earlier to the neurological department because of sudden onset of headache and vision disturbances. The brain MRI on admission revealed an extended right parietooccipital lesion with marginal contrast enhancement and extension towards the corpus callosum. The patient quickly deteriorated, became comatose and was intubated and transferred to the intensive care unit. In order to control intracranial hypertension, decompressive craniectomy was decided which also allowed for a brain biopsy. According to clinical, radiological and laboratory data, acute disseminated encephalomyelitis was the working diagnosis. The patient was treated with high dose corticosteroids and plasmapheresis sessions and gradually improved and transferred to a rehabilitation center. Brain biopsy concluded to acute hemorrhagic leucoencephalitis or Hurst disease, a variant of acute disseminated encephalomyelitis. Â
How to Diagnose Low-Gradient Critical Aortic Stenosis
Get PDFAortic stenosis (AS) has become the most frequent type of valvular heart disease in Europe and North America, accounting for 34% of all native valve disease and 43% of all single valve disease
Hypertension: Renal Denervation: Hype After Initial Hope/Lessons to be Learned From its Fall/Other Methods Influencing the Autonomic Nervous System
Get PDFThe unexpected announcement of Symplicity HTN-3 trial by the sponsor company that renal sympathetic denervation (RDN) failed to meet its primary efficacy end-point at 6 months raised concerns regarding the extent of blood pressure (BP) lowering results of the procedure.1 But the answer to the “burning†question of whether we should stop research and clinical implementation of RDN based on the results of one trial needs a cautious approach
Hybrid Approach to Atrial Fibrillation Ablation
Get PDFSequential surgical thoracoscopic and electrophysiological (EP) ablation is gaining popularity as a novel approach for the treatment of patients with stand-alone, persistent and long standing persistent atrial fibrillation (AF)
Early Coronary Angioplasty After Thrombolysis
Get PDFOver the recent years it has been clearly demonstrated that reperfusion by primary angioplasty in patients with ST-elevation myocardial infarction (STEMI) is the treatment of choice. For hospitals without the capacity of performing primary angioplasty, reperfusion with on-site thrombolysis or transportation of the patient to another institution for primary percutaneous coronary intervention (PCI) within a tight frame rate are the alternative options. For the latter strategy, an organized network of centers is needed to rapidly transfer STEMI patients for primary PCI. Although transferring STEMI patients for primary PCI is superior reperfusion therapy in comparison to on-site thrombolysis, there are concerns, regarding time delays of transfer in daily practice, which is a major drawback of this therapeutic strategy as delays of >120min from first medical contact to primary PCI negate the advantage of primary PCI over thrombolysis. The narrow time interval (<90-120min) that is mandatory for the superiority of primary PCI, could be extended if a pharmacoinvasive strategy (fibrinolysis followed by routine “early†angioplasty of the culprit artery) was chosen. Convincing results from trials such as TRANSFER-AMI, FAST-MI, GRACIA-2, WEST-MI, CARESS-AMI, NORDISTEMI and STREAM indicated that combined use of thrombolysis and PCI in a sufficient time course (>3hours to 6-12hours), in order to neutralize the pre-hemorrhagic effects of thrombolysis and allow full action of antiplatelet and antithrombotic agents, had comparable efficacy in comparison to primary PCI regarding early and 1 year survival. This appears to be an effective alternative option for the treatment of STEMI patients, at least for those hospitals whereby immediate PCI is unavailable