11 research outputs found
Eplerenone Survival Benefits in Heart Failure Patients Post-Myocardial Infarction
Get PDFReduced left ventricular ejection fraction (≤40%) and/or signs of clinical heart failure after acute myocardial infarction (AMI) are associated with a relatively high incidence of mortality and hospitalization for heart failure. The potential of eplerenone to impact on mortality and morbidity of post-infarction heart failure patients was the subject of the EPHESUS trial (Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study). That trial concluded that eplerenone reduced total mortality by 31%, cardiovascular mortality by 32% and sudden cardiac death by 37% within 30 days of randomization after AMI. Risk reduction in mortality with eplerenone seemed to occur as early as 10 days after randomization and continued through the end of the study. In conclusion, eplerenone improves survival in heart failure patients post-AMI
Mid-ventricular obstructive hypertrophic cardiomyopathy
Get PDFMid-ventricular obstructive hypertrophic cardiomyopathy was diagnosed in a 72-year-old woman, referred to our hospital because of an episode of syncope. It was characterized by an abnormal ECG (ST segment elevation in leads V3 through V6 ) and the presence of pressure gradient between apical and basal sites in the left ventricle, asymmetric left ventricular hypertrophy and an apical aneurysm on echocardiography
Left Atrial Function Post Radiofrequency and Cryoballoon Ablation Assessed by Volume-Pressure Loops
No full textBackground: Left atrial (LA) function is linked to atrial fibrillation (AF) pathogenesis. AF catheter ablation decreases disease burden with potentially favorable effects on cardiac function. Atrial volume-pressure loops can optimally assess the LA function. Objective: To investigate changes in LA function by volume-pressure loops after paroxysmal AF ablation and explored potential differences between the radiofrequency and cryoballoon ablation. Methods: We analyzed 44 patients undergoing paroxysmal AF ablation from 2 centers, 22 treated with radiofrequency and 22 with cryoablation. Pre- and post-procedure, all patients underwent a real-time three-dimensional transthoracic ECG to evaluate LA volume, while simultaneously recording LA pressure following transseptal puncture. Volume-pressure loops pre- and post-procedure were created by paired data. Areas of A-loop (LA booster pump function) and V-loop (LA reservoir function), and the stiffness constant determining the slope of the exponential curve during LA filling were calculated. Results: Average LA pressure, A-wave amplitude, and V-wave amplitude were increased post-procedurally (p < 0.001). Overall, A-loop area decreased (p = 0.001) and V-loop area tended to increase (p = 0.07). The change in both A-loop and V-loop areas was similar between radiofrequency- and cryoballoon-treated patients (p = 0.18 and p = 0.52, respectively). However, compared with cryoballoon-treated patients, radiofrequency-treated patients had higher increase in the stiffness constant (b = 0.059; 95% CI: 0.022–0.096; p = 0.006). Conclusion: AF catheter ablation by the radiofrequency or cryoballoon is associated with the decrease of the booster pump function and increase of the reservoir function. Moreover, there is a post-procedural increase of LA pressure which is associated with an acute increase in LA stiffness in radiofrequency ablation, but not in cryoablation. Copyright © 2022 Karanasos, Tyrovolas, Tsiachris, Efremidis, Kordalis, Karmpalioti, Prappa, Karagiannis, Aggeli, Gatzoulis, Tousoulis, Tsioufis and Toutouzas
Bilateral sudden sensorineural hearing loss as a first symptom of infective endocarditis: two case reports
No full textAbstractBackground:Septic emboli are an unusual cause of sudden sensorineural hearing loss, for which few reports exist in the literature.Case report:This paper presents two cases of sudden sensorineural hearing loss, initially considered as idiopathic, but which were caused by septic emboli. Hearing loss in these cases was bilateral, sequential and total. The first patient had mild fever one week prior to their presentation with sudden sensorineural hearing loss; the other patient had no additional symptoms at presentation. These patients were later diagnosed with infective endocarditis, at two and seven months following the sudden sensorineural hearing loss respectively, showing that septic emboli had been the cause of sudden sensorineural hearing loss.Conclusion:Septic emboli should be considered as a possible cause of sudden sensorineural hearing loss in cases of total hearing loss. This form of hearing loss should prompt the otolaryngologist to further investigate for infective endocarditis.</jats:sec
Uncommon Cardiomyopathies
Get PDFAnderson-Fabry Disease (AFD) is an X-linked recessive lysosomal disorder, leading to multisystemic disease because of abnormal glycosphyngolipids widespread accumulation, the result of α-galactosidaseA deficient activity. Cardiac involvement is common; includes left ventricular hypertrophy and gradually impairing cardiac function. Although the disease is unveiled in childhood and culminates in cardiac, cerebrovascular and end-stage renal disease, diagnosis is often delayed or missed. Recently established enzyme replacement therapy (ERT) may improve most of the disease’s manifestations. Early diagnosis is thus crucial for AFD patient management. Isolated non-compaction of the ventricular myocardium (IVNC) is a rare congenital form of cardiomyopathy. It is characterized by the postnatal persistence of the embryonic pattern of myoarchitecture, consistent of prominent trabeculations and deep intertrabecular recesses, and assumed to occur as a consequence of intrauterine arrest of myocardial compaction. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and magnetic resonance imaging. Management issues revolve around the management of heart failure, arrhythmias and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Significant overlapping with many other forms of cardiomyopathies suggest that non-compaction may be a morphologic trait rather than a distinct cardiomyopathy
Right ventricular outflow tract endocardial unipolar substrate mapping: implications in risk stratification of Brugada syndrome
Get PDFBrugada syndrome (BrS) is a complex arrhythmogenic disease displaying electrical and micro-structural abnormalities mainly located at the epicardium of the right ventricular outflow tract (RVOT). It is well-known that fibrosis, fatty infiltration, inflammation and reduced gap junction expression have been demonstrated at the epicardial anterior aspect of the RVOT providing the arrhythmogenic substrate for ventricular arrhythmic events in BrS. A number of models have been proposed for the risk stratification of patients with BrS. Endocardial unipolar electroanatomical mapping is an emerging tool that has been reintroduced to identify and quantify epicardial electrical abnormalities. Interestingly, current findings correlate the presence of large-sized endocardial unipolar electroanatomical abnormalities with either ventricular fibrillation inducibility during programmed ventricular stimulation or symptom status. This review aims to present existing data about the role of endocardial unipolar electroanatomical mapping for the identification of RVOT epicardial abnormalities as well as its potential clinical implications in risk stratification of BrS. [Abstract copyright: © 2022 The Author(s). Published by IMR Press.
Epsilon-like waves and ventricular conduction abnormalities in subjects with type 1 ECG pattern of Brugada syndrome
No full textBACKGROUND: Previous studies have demonstrated an overlap between the arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and Brugada syndrome (BS). Conduction delay in the right ventricle has been demonstrated in both entities. OBJECTIVE: This study investigated specific ARVC/D electrocardiographic (ECG) markers in subjects with spontaneous or drug-induced type 1 ECG pattern of BS. METHODS: The study population consisted of 47 apparently healthy individuals (38 men, mean age 44.1 +/- 13.3 years) with spontaneous (n = 17) or drug-induced (n = 30) type 1 ECG phenotype of BS. The clinical records of these individuals were retrospectively analyzed. RESULTS: Fifteen subjects (31.9%) were symptomatic, with a history of syncope. A family history of BS or sudden cardiac death was reported in 10 (21.3%) and 8 (17.0%) cases, respectively. Epsilon-like waves in leads V1-V3 were observed in 6 subjects (12.7%). Epsilon-like waves were seen in spontaneous type 1 ECGs in 2 cases and after sodium channel blocking test in 4 cases. In baseline ECGs, localized prolongation (>110 ms) of the QRS complex in leads V1-V3, QRS duration ratio in (V1+V2+V3)/(V4+V5+V6) >/= 1.2, and prolonged S wave upstroke (>55 ms) in leads V1-V3 were seen in 48.8%, 29.8%, and 40.4% of subjects, respectively. Epsilon-like waves and delayed S wave upstroke were more commonly observed in subjects with family history of BS (P = .014 and P = .038, respectively). CONCLUSION: Specific ECG markers that reflect ventricular conduction delay in ARVC/D are commonly observed in subjects with spontaneous or drug-induced type 1 ECG pattern of BS as well. These depolarization abnormalities may be related to subtle underlying structural abnormalities.Heart Rhyth
Left atrial voltage mapping using a new impedance-based algorithm in patients with paroxysmal atrial fibrillation
No full textAims: Atrial fibrosis is associated with the pathogenesis and progression of atrial fibrillation (AF). We sought to evaluate the extent of left atrial (LA) scarring in patients with paroxysmal AF (PAF) undergoing catheter ablation using a new impedance-based algorithm. Methods: We prospectively enrolled 73 consecutive patients (43 males, 58 years) with PAF who underwent pulmonary vein antral isolation. We first performed high-density bipolar voltage mapping during sinus rhythm using Tissue Proximity Indicator (TPI), one of the features of the ConfiDense mapping module integrated in the electroanatomic mapping system. A dense LA shell was created initially without TPI (mean points 2,411) and subsequently activating TPI (mean points 1,167). Each point was classified according to the peak-to-peak bipolar voltage electrogram based on two criteria (criterion A: healthy &gt;0.8 mV, border zone: 0.4–0.8 mV, scarred: &lt;0.4 mV; criterion B: healthy: &gt;0.5 mV, border zone: 0.25–0.5 mV, scarred: &lt;0.25 mV). Results: LA voltage analysis represented significantly smaller scarred areas when mapping was performed with TPI-ON compared with TPI-OFF in both voltage criteria (average LA voltage area: 3.02 ± 5.28 cm2 vs 9.15 ± 13.11 cm2 vs in criterion A and 1.19 ± 2.54 cm2 vs 5.61 ± 9.56 cm2 in criterion B). A statistically significant voltage difference was observed in all segments of the left atrium between the two mapping protocols, particularly on the inferior wall. Conclusion: A more specific delineation of LA fibrosis may be produced using the TPI feature of the ConfiDense mapping module, through elimination of false-positive annotated mapping points due to low contact. © 2018 Wiley Periodicals, Inc
Cardiovascular disease in women: Executive summary of the expert panel statement of women in cardiology of the hellenic cardiological society
No full textThe perception that women represent a low-risk population for cardiovascular (CV) disease (CVD) needs to be reconsidered. Starting from risk factors, women are more likely to be susceptible to unhealthy behaviors and risk factors that have different impact on CV morbidity and mortality as compared to men. Despite the large body of evidence as regards the effect of lifestyle factors on the CVD onset, the gender-specific effect of traditional and non-traditional risk factors on the prognosis of patients with already established CVD has not been well investigated and understood. Furthermore, CVD in women is often misdiagnosed, underestimated, and undertreated. Women also experience hormonal changes from adolescence till elder life that affect CV physiology. Unfortunately, in most of the clinical trials women are underrepresented, leading to the limited knowledge of CV and systemic impact effects of several treatment modalities on women's health. Thus, in this consensus, a group of female cardiologists from the Hellenic Society of Cardiology presents the special features of CVD in women: the different needs in primary and secondary prevention, as well as therapeutic strategies that may be implemented in daily clinical practice to eliminate underestimation and undertreatment of CVD in the female population. © 2020 Hellenic Society of Cardiolog
