Cardiology Research and Practice The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Single Center Retrospective Analysis of Conventional and Radial TIG Catheters for Transradial Diagnostic Coronary Angiography Tue, 08 Sep 2015 09:50:32 +0000 Current guidelines favor the radial approach for coronary angiography. Therefore, specialty radial diagnostic catheters were designed to engage both coronary arteries with a single device. However, it is unclear if single catheters are superior to conventional catheters. A retrospective analysis was performed of consecutive right radial coronary angiographies to determine catheter use, fluoroscopy time, radiation dosage, and consumption of contrast. Procedures were performed with a single TIG catheter or conventional catheters (CONV). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded. 273 transradial procedures were performed successfully. 95 procedures were performed with CONV and 178 procedures with a TIG. Crossover to additional catheters was higher in TIG (15.2%) compared to CONV (5.3%, ). Fluoroscopy time was comparable between CONV and TIG, without crossover ( min versus  min; n.s.), however, greater in the case of crossover for CONV () and TIG (; ). Radiation dosage was similar in CONV and the TIG, without crossover (, cGycm2 versus ; n.s.), however, greater for CONV () and TIG (, ) with crossover. Overall, the amount of contrast was greater in TIG ( mL) versus CONV ( mL; ). CONV femoral catheters may be the primary choice for radial approach. Marc Vorpahl, Till Koehler, Jason Foerst, Spyridon Panagiotopoulos, Heinrich Schleiting, Klaus Koss, Gunda Ziegler, Hilmar Brinkmann, Melchior Seyfarth, and Klaus Tiroch Copyright © 2015 Marc Vorpahl et al. All rights reserved. Calcification Characteristics of Low-Flow Low-Gradient Severe Aortic Stenosis in Patients Undergoing Transcatheter Aortic Valve Replacement Mon, 07 Sep 2015 11:17:47 +0000 Low-flow low-gradient severe aortic stenosis (LFLGAS) is associated with worse outcomes. Aortic valve calcification patterns of LFLGAS as compared to non-LFLGAS have not yet been thoroughly assessed. 137 patients undergoing transcatheter aortic valve replacement (TAVR) with preprocedural multidetector computed tomography (MDCT) and postprocedural transthoracic echocardiography were enrolled. Calcification characteristics were assessed by MDCT both for the total aortic valve and separately for each leaflet. 34 patients had LFLGAS and 103 non-LFLGAS. Total aortic valve calcification volume (), mass (), and density () were lower in LFLGAS as compared to non-LFLGAS patients. At 30-day follow-up, mean transaortic pressure gradients and more than mild paravalvular regurgitation did not differ between groups. In conclusion, LFLGAS and non-LFLGAS express different calcification patterns which, however, did not impact on device success after TAVR. Barbara E. Stähli, Thi Dan Linh Nguyen-Kim, Cathérine Gebhard, Thomas Frauenfelder, Felix C. Tanner, Fabian Nietlispach, Francesco Maisano, Volkmar Falk, Thomas F. Lüscher, Willibald Maier, and Ronald K. Binder Copyright © 2015 Barbara E. Stähli et al. All rights reserved. Relation between Apolipoprotein E Gene Polymorphism and Severity of Coronary Artery Disease in Acute Myocardial Infarction Mon, 24 Aug 2015 08:42:21 +0000 Apolipoprotein E (ApoE) is a plasma protein and associated with cholesterol transport system. In several studies, the relationship between ApoE gene polymorphism and severity of coronary artery disease (CAD) has been shown. However, the relationship between ApoE gene polymorphism and severity of CAD in patients with acute myocardial infarction (MI) has not been well known. The aim of this study is to investigate the relation between ApoE polymorphism and severity of CAD in patients with acute MI by using the Gensini Score. In this study, 138 patients were admitted to cardiology clinic with diagnosis of acute MI, and angiographic assessment was performed using the Gensini Score. Blood samples were obtained from all patients in the first day. The patients with ApoE34 genotype had high Gensini scores. Besides, the patients with E4 allele carriers were associated with high Gensini score compared with the patients without E4 allele carriers (). The patients with E4 allele carriers were associated with higher LDL cholesterol and total cholesterol compared with the patients without E4 allele carriers ( and , resp.). There were no statistically significant differences between ApoE genotypes and severity of CAD by using the Gensini Score. But, the patients with E4 allele carriers were associated with high lipid levels. Zülküf Karahan, Murat Uğurlu, Berzal Uçaman, Ali Veysel Uluğ, İlyas Kaya, Kemal Çevik, Önder Öztürk, and Hikmet Iyem Copyright © 2015 Zülküf Karahan et al. All rights reserved. Factors Associated with the Use of Drug-Eluting Stents in Patients Presenting with Acute ST-Segment Elevation Myocardial Infarction Thu, 28 May 2015 12:56:11 +0000 Background. Drug-eluting stents (DES) have proven clinical superiority to bare-metal stents (BMS) for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Decision to implant BMS or DES is dependent on the patient’s ability to take dual antiplatelet therapy. This study investigated factors associated with DES placement in STEMI patients. Methods. Retrospective analysis was performed on 193 patients who presented with STEMI and were treated with percutaneous coronary intervention at an urban, tertiary care hospital. Independent factors associated with choice of stent type were determined using stepwise multivariate logistic regression. Odds ratio (OR) was used to evaluate factors significantly associated with DES and BMS. Results. 128 received at least one DES, while 65 received BMS. BMS use was more likely in the setting of illicit drug or alcohol abuse ([OR] 0.15, 95% CI 0.05–0.48, ), cardiogenic shock (OR 0.26, 95% CI 0.10–0.73, ), and larger stent diameter (OR 0.28, 95% CI 0.11–0.68, ). Conclusions. In this analysis, BMS implantation was associated with illicit drug or alcohol abuse and presence of cardiogenic shock. This study did not confirm previous observations that non-White race, insurance, or income predicts BMS use. Jose F. Chavez, Jacob A. Doll, Anuj Mediratta, Francesco Maffessanti, Janet Friant, Jonathan D. Paul, John E. A. Blair, Sandeep Nathan, Neeraj Jolly, and Atman P. Shah Copyright © 2015 Jose F. Chavez et al. All rights reserved. A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study Wed, 27 May 2015 09:13:02 +0000 Aim of Study. To assess the feasibility of a new proposed maneuver “RATLe-90” using real-time three-dimensional transesophageal echocardiography (RT-3DTEE) for anatomically oriented visualization of the interatrial septum (IAS) in guiding the transseptal puncture TSP. Methods. The study included 20 patients (mean age, years; 60% males) who underwent TSP for different indications. RT-3DTEE was used to guide TSP. The proposed maneuver RATLe-90 (Rotate-Anticlockwise-Tilt-Left-90) was applied in all cases to have the anatomically oriented en face view of the IAS from the right atrial (RA) aspect. Having this anatomically oriented view, we guided the TSP catheter towards the proper puncture site according to the planned procedure. Results. Using the RATLe-90 maneuver, the anatomically oriented en face view of the IAS from the RA was obtained in all patients. We were able to guide the puncture catheter to the proper puncture site on the IAS. The 3D images obtained were clearly understood by both echocardiographers and interventionists. The RATLe-90 maneuver acquisition time was seconds. The time-to-tent was seconds. Less TEE probe manipulations were needed while guiding the TSP. Conclusions. Application of RT3D-TEE during TSP using RATLe-90 maneuver is feasible with shorter fluoroscopy time and minimizing TEE probe manipulations. Hani M. Mahmoud, Mohammed A. Al-Ghamdi, Abdullah E. Ghabashi, and Ashraf M. Anwar Copyright © 2015 Hani M. Mahmoud et al. All rights reserved. Current Status of Sodium Bicarbonate in Coronary Angiography: An Updated Comprehensive Meta-Analysis and Systematic Review Mon, 20 Apr 2015 09:54:36 +0000 This systematic review with meta-analysis sought to determine comparison of efficacy and safety of hydration with sodium bicarbonate versus sodium chloride on contrast induced nephropathy and clinical outcomes. We searched major electronic databases for studies in randomized controlled trials. A value of for Q test or % indicated significant heterogeneity between the studies. Literature search of all databases retrieved 650 studies. 29 studies enrolled in meta-analysis. Pooled analysis indicated about the incidence of CIN (OR of 0.718; 95% CI: 0.60 to 0.85; ), requirement of hemodialysis (OR of 1.00; 95% CI: 0.49 to 2.01; ), mean changes of serum creatinine (WMD of 2.321; 95% CI: 1.995 to 2.648; ), length of hospital stays (WMD of −0.774; 95% CI: −1.65 to 0.10; ), major adverse cardiovascular events (OR = 1.075, 95% CI: 0.59 to 1.95; ), and mortality (OR of 0.73; 95% CI: 0.42 to 1.26; ). Overall, hydration with sodium bicarbonate could significantly reduce CIN and the length of hospital stay compared to sodium chloride. In addition NAC added as a supplement to sodium bicarbonate could increase prophylactic effects against nephropathy. Sadegh Ali-Hassan-Sayegh, Seyed Jalil Mirhosseini, Elham Rahimizadeh, Zahra Ghodratipour, Zahra Sarrafan-Chaharsoughi, Ali Mohammad Dehghan, Mohammad Reza Lotfaliani, Mohammad Rezaeisadrabadi, Elham Kayvanpour, Farbod Sedaghat-Hamedani, Mohamed Zeriouh, Alexander Weymann, Anton Sabashnikov, and Aron-Frederik Popov Copyright © 2015 Sadegh Ali-Hassan-Sayegh et al. All rights reserved. Among Ectasia Patients with Coexisting Coronary Artery Disease, TIMI Frame Count Correlates with Ectasia Size and Markis Type IV Is the Commonest Tue, 03 Feb 2015 06:47:58 +0000 Background. Coronary artery ectasia (CAE) occurs in 0.3 to 5.3% of patients undergoing coronary angiography. TIMI frame count (TFC) is an index of coronary flow that correlates with flow velocity. In ectasia patients, there is delayed coronary flow with increased TFC. Methods. We evaluated angiograms of 789 patients for presence of CAE, coronary artery disease (CAD), and Markis type of CAE. We measured ectasia size and length and their correlation with TFC in ectatic right coronary arteries (RCA) of patients with CAE and CAD. Results. 30 patients had CAE (3.8%). Of these 16.7% had isolated CAE, while 83.87% had CAE and CAD. Among CAE and CAD patients, the RCA was most involved (70.4%), and Markis type IV CAE was the commonest (64%). In isolated CAE, the RCA, LAD, and LCx were equally involved (33.3%). Patients with CAE and CAD had significantly higher TFC compared to controls, . There was a positive correlation of moderate strength, between ectasia size and TFC, r(17) = 0.598, . Ectasia length was not significantly correlated with TFC, rho (17) = 0.334, . Conclusion. Among patients undergoing angiography, CAE has a prevalence of 3.8% and Markis type IV is the commonest. Larger ectasias are associated with slower coronary flow. Hasahya Tony, Kai Meng, Bangwei Wu, and Qiutang Zeng Copyright © 2015 Hasahya Tony et al. All rights reserved. Cardiovascular Complications of HIV-Associated Immune Dysfunction Sun, 11 Jan 2015 11:41:16 +0000 Prolonged survival in HIV infection is accompanied by an increased frequency of non-HIV-related comorbidities. It is suggested that cardiovascular diseases (CVD) occur earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed which can be categorized into traditional and nontraditional risk factors. Immune dysfunction is a nontraditional risk factor that contributes significantly to cardiovascular pathology. Markers of inflammation are elevated in HIV-infected patients, and elevations in markers such as high-sensitivity C-reactive protein, D-dimer, and interleukin-6 (IL-6) have been associated with increased risk for cardiovascular disease. However, the data currently suggest the most practical advice is to start antiretroviral therapy early and to manage traditional risk factors for CVD aggressively. A better understanding of the mechanisms of CVD in this population and further efforts to modify chronic inflammation remain an important research area. Akram M. Zaaqoq, Faisal A. Khasawneh, and Roger D. Smalligan Copyright © 2015 Akram M. Zaaqoq et al. All rights reserved. Antithrombotic Therapy in Patients with Acute Coronary Syndrome in the Intermountain Heart Collaborative Study Thu, 08 Jan 2015 05:53:59 +0000 Objective. To determine factors associated with single antiplatelet (SAP) or dual antiplatelet (DAP) therapy and anticoagulants (AC) use in hospital and after discharge among patients with acute coronary syndrome (ACS). Methods. We evaluated 5,294 ACS patients in the Intermountain Heart Collaborative Study from 2004 to 2009. Multivariable logistic regressions were used to determine predictors of AC or AP use. Results. In hospital, 99% received an AC, 79% DAP, and 19% SAP; 78% had DAP + AC. Coronary stents were the strongest predictors of DAP use in hospital compared to SAP (). After discharge, 77% received DAP, 20% SAP, and 9% AC; 5% had DAP + AC. DAP compared to SAP was less likely for patients on AC (odds ratio [OR] = 0.30, ) after discharge. Placement of a stent increased the likelihood of DAP (bare metal: OR = 54.8, ; drug eluting: OR = 59.4, ). 923 had atrial fibrillation and 337 had a history of venous thromboembolism; these patients had increased use of AC (29% and 40%, resp.). Conclusion. While in-hospital use of AC was nearly universal, postdischarge AC use was rare. Concern for providing the best antithrombotic therapy, while maintaining an acceptable bleeding risk, may explain the selection decisions. Stacey Knight, Winslow Klaskala, Scott C. Woller, Benjamin D. Horne, T. Jared Bunch, Viet T. Le, Roger M. Mills, and Joseph B. Muhlestein Copyright © 2015 Stacey Knight et al. All rights reserved. Exercise Hemodynamics and Quality of Life after Aortic Valve Replacement for Aortic Stenosis in the Elderly Using the Hancock II Bioprosthesis Tue, 02 Dec 2014 08:12:32 +0000 Background and Aim. While aortic valve replacement for aortic stenosis can be performed safely in elderly patients, there is a need for hemodynamic and quality of life evaluation to determine the value of aortic valve replacement in older patients who may have age-related activity limitation. Materials and Methods. We conducted a prospective evaluation of patients who underwent aortic valve replacement for aortic stenosis with the Hancock II porcine bioprosthesis. All patients underwent transthoracic echocardiography (TTE) and completed the RAND 36-Item Health Survey (SF-36) preoperatively and six months postoperatively. Results. From 2004 to 2007, 33 patients were enrolled with an average age of 75.3 ± 5.3 years (24 men and 9 women). Preoperatively, 27/33 (82%) were New York Heart Association (NYHA) Functional Classification 3, and postoperatively 27/33 (82%) were NYHA Functional Classification 1. Patients had a mean predicted maximum (mL/kg/min) of 19.5 ± 4.3 and an actual max of 15.5 ± 3.9, which was 80% of the predicted . Patients were found to have significant improvements () in six of the nine SF-36 health parameters. Conclusions. In our sample of elderly patients with aortic stenosis, replacing the aortic valve with a Hancock II bioprosthesis resulted in improved hemodynamics and quality of life. Theodore Long, Becky M. Lopez, Christopher Berberian, Mark J. Cunningham, Vaughn A. Starnes, and Robbin G. Cohen Copyright © 2014 Theodore Long et al. All rights reserved. Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention Thu, 20 Nov 2014 11:54:02 +0000 Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery. Xiangfei Wang and Junbo Ge Copyright © 2014 Xiangfei Wang and Junbo Ge. All rights reserved. Mean Platelet Volume in Patients with Obstructive Sleep Apnea and Its Relationship with Simpler Heart Rate Derivatives Wed, 10 Sep 2014 08:10:27 +0000 Some studies show increased mean platelet volume (MPV) in obstructive sleep apnea (OSA). The aim of this study was to evaluate MPV in OSA patients without cardiovascular risk factors and the possible association of heart rate derivatives with MPV. A total of 82 patients (aged 30–70 years) were divided into 2 groups according to the presence of either OSA or non-OSA as the control group. The OSA group consisted of 52 patients and the control group consisted of 30 subjects. Neither group was significantly different in terms of MPV values as well as heart rate (HR) derivatives such as minimum HR, maximum HR, the difference between maximum HR and minimum HR, mean HR, and heart rate performance index (HRPI) [(HR max. − HR min.)/HR mean] (P > 0.05 for all variables). In multivariate analysis, platelet count and percentages of recording time spent at arterial oxygen saturation < 90% significant variables are associated with MPV (: −0.004 ± 0.002, 95% CI, −0.008 to −0.001; P = 0.034) and (: 2.93 ± 1.93, 95% CI, 0.167 to 5.69; P = 0.038). Consequently, our findings predominantly suggest that there is a casual and reciprocal interaction between MPV and autonomic activation. Aydın Akyüz, Dursun Çayan Akkoyun, Mustafa Oran, Hasan Değirmenci, and Recep Alp Copyright © 2014 Aydın Akyüz et al. All rights reserved. High-Sensitivity Troponin T: A Biomarker for Diuretic Response in Decompensated Heart Failure Patients Thu, 28 Aug 2014 00:00:00 +0000 Background. Patients presenting with acutely decompensated heart failure (ADHF) and positive circulating cardiac troponins were found to be a high-risk cohort. The advent of high-sensitive troponins resulted in a detection of positive troponins in a great proportion of heart failure patients. However, the pathophysiological significance of this phenomenon is not completely clear. Objectives. The aim of this study is to determine the early evolution and clinical significance of high-sensitivity troponin T (hsTnT) in ADHF. Methods. Retrospective, secondary analysis of a prospective study including 100 patients with ADHF. Results. Globally, high-sensitivity troponin T decreased from day 1 to day 3 . However, in the subgroup of patients who remained decompensated no significant differences in hsTnT from day 1 to day 3 were observed , whereas in successfully compensated patients a significant reduction in hsTnT levels was observed . High-sensitivity troponin T decrease was correlated with NTproBNP reduction . Patients with hsTnT increase had longer length of stay . Conclusions. Episodes of ADHF are associated with transient increases in the blood levels of hsTnT that are reduced with effective acute episode treatment. The decrease in hsTnT can translate less myocardial damage along with favourable ADHF treatment. João Pedro Ferreira, Mário Santos, Sofia Almeida, Irene Marques, Paulo Bettencourt, and Henrique Carvalho Copyright © 2014 João Pedro Ferreira et al. All rights reserved. How Aortic Stiffness in Postmenopausal Women Is Related to Common Cardiovascular Risk Factors Wed, 16 Jul 2014 12:57:31 +0000 Objective. Our study investigates major common cardiovascular risk factors relation with aortic stiffness on 269 postmenopausal women by global pulse wave velocity (PWVg), useful to relate PWVg to risk of major cardiovascular events. Patients and Methods. Women were categorized as hypertensive (H), hypercholesterolemic (C), or diabetic (D). Aortic stiffness was assessed by PWVg measured with pulsed Doppler, at the left ventricular outflow tract (LVOT) and at the right common femoral artery. Results. All population mean PWVg was 8.2 m/s. 85 (26.5%) women were H; mean PWVg was 7.9 m/s. HC women were 118 (36.7%), with mean PWVg 8.3 m/s. HD women were 30 (9.5%), with mean PWVg 7.8 m/s. HDC women were 36 (11.2%), with mean PWVg 9.3 m/s. 52 (16.1%) menstruate women without risk factor were control group (CG), with mean PWVg 6.5 m/s. Highly significant was the statistical difference in PWVg between HDC women and each other group: versus CG; versus H; versus HC, and versus HD. No difference in PWG was observed comparing the other groups. There was difference for age among all groups, except for CG, made by younger women. Conclusion. PWVg was highly increased in postmenopausal women affected by hypertension, diabetes, and hypercholesterolemia all at once. Hypertension is the major determinant for PWVg. The only addition of diabetes or hypercholesterolemia did not increase significantly PWVg. Our study supports the usefulness of the assessment of aortic stiffness as a marker of cardiovascular disease. Maria Maiello, Annapaola Zito, Marco Matteo Ciccone, and Pasquale Palmiero Copyright © 2014 Maria Maiello et al. All rights reserved. The Prevalence of Cardiovascular Disease Risk Factors among Employees in the Kingdom of Bahrain between October 2010 and March 2011: A Cross-Sectional Study from a Workplace Health Campaign Sun, 06 Jul 2014 00:00:00 +0000 Background. High prevalence of CVD risk factors has been reported in Bahrain. Objective. This study aims to estimate the CVD risk factors prevalence among government employees in Bahrain. Design. A cross-sectional study design. Setting. Different government workplaces in Bahrain. Method. Data was collected from 1139 employees between October 2010 and March 2011 through interviews, including physical measurements, patient blood testing, and expired carbon monoxide (CO) levels as particles per million (ppm) for smokers. A summary of composite CVD risk factors was identified. Results. The following overall prevalence rates were reported: overweight and obesity 78.4% and reported hypertension 36.9% (included both those who were on and not on treatments), with an estimated prevalence of 21.6% for measured systolic blood pressure (Sbp) ≥ 140 mmHg and 23.3% for diastolic blood pressure (dbp) ≥90 mmHg. The prevalence of total cholesterol levels ≥5.2 mmol/dl was 24.2% and LDL levels >3.3 mmol/dl 10.8%. Prevalence of HDL-C levels (≤1.03 mmol/dl) was 47.55% and (≥1.5 mmol/dl) in 12.31%. The low HDL level (<1.03 mmol/dl) among males was 64.1%, while it was 26.6% among females. Half the participants (50.8%) do not engage in any type of physical activity. Moreover, 24.3% were not eating daily servings of fruits and vegetables. About 16.1% of them were current smokers. The majority of the participants (95.35%) had either no or less than 3 CVD risk factors. Only 4.65% had 3–5 risk factors. Conclusions. Among the employees in Bahrain, the high CVD risk factors prevalence is evident. CVD risk factors prevention and control are a priority. Ameera Ali AL-Nooh, Abdulhussain Abdulabbas Abdulla Alajmi, and David Wood Copyright © 2014 Ameera Ali AL-Nooh et al. All rights reserved. Aerobic Exercise as an Adjunct Therapy for Improving Cognitive Function in Heart Failure Thu, 03 Jul 2014 00:00:00 +0000 Persons with heart failure (HF) are typically older and are at a much higher risk for developing cognitive impairment (CI) than persons without HF. Increasingly, CI is recognized as a significant, independent predictor of worse clinical outcomes, more frequent hospital readmissions, and higher mortality rates in persons with HF. CI can have devastating effects on ability to carry out HF effective self-care behaviors. If CI occurs, however, there are currently no evidence based guidelines on how to manage or improve cognitive function in this population. Improvement in cognition has been reported following some therapies in HF and is thought to be the consequence of enhanced cerebral perfusion and oxygenation, suggesting that CI may be amenable to intervention. Because there is substantial neuronal loss with dementia and no effective restorative therapies, interventions that slow, reverse, or prevent cognitive decline are essential. Aerobic exercise is documented to increase cerebral perfusion and oxygenation by promoting neuroplasticity and neurogenesis and, in turn, cognitive functioning. Few studies have examined exercise as a potential adjunct therapy for attenuating or alleviating cognitive decline in HF. In this review, the potential benefit of aerobic exercise on cognitive functioning in HF is presented along with future research directions. Rebecca A. Gary and Kathryn Brunn Copyright © 2014 Rebecca A. Gary and Kathryn Brunn. All rights reserved. Characterization of Pulmonary Vein Dimensions Using High-Definition 64-Slice Computed Tomography prior to Radiofrequency Catheter Ablation for Atrial Fibrillation Wed, 25 Jun 2014 06:08:01 +0000 Background. Contrast-enhanced computed tomography is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AFib) to guide the procedure. We analyzed pulmonary vein (PV) ostial diameter and volumes on a high-definition 64-slice CT (HDCT) scanner in patients with AFib prior to RFCA. Methods and Results. This retrospective study included 50 patients (mean age 60.2 ± 11.4 years, 30 males) undergoing cardiac HDCT scanning before RFCA for drug refractory AFib and 50 age-, BMI-, and sex-matched controls with normal sinus rhythm undergoing HDCT. PV ostial diameter and volume were measured and calculated using a semiautomatic calliper tool. Total ostial PV volume was significantly increased in patients with AFib as compared to controls (). Similarly, total ostial PV diameter was significantly increased in AFib compared to controls (). In AFib, the largest PV volume and diameters were measured in right superior PV ( versus controls). The difference in PV volume between patients and controls was most pronounced in right superior PVs (). Right middle PVs were found more often in patients with AFib (16/50; 32%) than in normal subjects (7/50; 14%). Conclusion. Enlargement of PV ostial area and enlargement of volume are frequent findings in patients with drug refractory AFib. These parameters may add to the risk stratification for AFib recurrence following RFCA. Catherine Gebhard, Nazmi Krasniqi, Barbara E. Stähli, Bernd Klaeser, Tobias A. Fuchs, Jelena R. Ghadri, Laurent Haegeli, Thomas F. Lüscher, Philipp A. Kaufmann, and Firat Duru Copyright © 2014 Catherine Gebhard et al. All rights reserved. Left Atrial Anatomy Relevant to Catheter Ablation Tue, 24 Jun 2014 09:04:38 +0000 The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. Damián Sánchez-Quintana, José Ramón López-Mínguez, Yolanda Macías, José Angel Cabrera, and Farhood Saremi Copyright © 2014 Damián Sánchez-Quintana et al. All rights reserved. Central Arterial Hemodynamic Effects of Dark Chocolate Ingestion in Young Healthy People: A Randomized and Controlled Trial Tue, 27 May 2014 09:00:31 +0000 Introduction. The aim of this study was to assess the vascular benefits of dark chocolate in healthy and young individuals. Methods. A randomized and controlled trial was carried out involving 60 healthy volunteers, randomized into two groups: control group (CG; ) and intervention group (IG; ). The IG ingested a daily dosage of 10 g of dark chocolate (>75% cocoa) for a month. Blood pressure (BP), flow-mediated dilation (FMD), arterial stiffness index (ASI), aortic pulse wave velocity (PWV), and pulse wave analysis (PWA) were assessed at baseline and one week after the one-month intervention period. Results. Arterial function improved after intervention in the IG, with PWV decreasing from  m/s to  m/s (), with no significant differences observed in the CG. A significant decrease in ASI ( to ; ) and AiX ( to ; ) was also depicted for the IG. Endothelial function improved in the IG, with the FMD increasing 9.31% after the 1-month intervention (), with no significant variation in the CG. Conclusion. The daily ingestion of 10 g dark chocolate (>75% cocoa) during a month significantly improves vascular function in young and healthy individuals. T. Pereira, J. Maldonado, M. Laranjeiro, R. Coutinho, E. Cardoso, I. Andrade, and J. Conde Copyright © 2014 T. Pereira et al. All rights reserved. Mortality Trends in Patients Hospitalized with the Initial Acute Myocardial Infarction in a Middle Eastern Country over 20 Years Mon, 28 Apr 2014 13:48:57 +0000 We aimed to define the temporal trend in the initial Acute Myocardial Infarction (AMI) management and outcome during the last two decades in a Middle Eastern country. A total of 10,915 patients were admitted with initial AMI with mean age of 53 ± 11.8 years. Comparing the two decades (1991–2000) to (2001–2010), the use of antiplatelet drugs increased from 84% to 95%, β-blockers increased from 38% to 56%, and angiotensin converting enzyme inhibitors (ACEI) increased from 12% to 36% ( for all). The rates of PCI increased from 2.5% to 14.6% and thrombolytic therapy decreased from 71% to 65% ( for all). While the rate of hospitalization with Initial MI increased from 34% to 66%, and the average length of hospital stay decreased from 6.4 ± 3 to 4.6 ± 3, all hospital outcomes parameters improved significantly including a 39% reduction in in-hospital Mortality. Multivariate logistic regression analysis showed that higher utilization of antiplatelet drugs, β-blockers, and ACEI were the main contributors to better hospital outcomes. Over the study period, there was a significant increase in the hospitalization rate in patients presenting with initial AMI. Evidence-based medical therapies appear to be associated with a substantial improvement in outcome and in-hospital mortality. Emad Ahmed, Jassim Al Suwaidi, Ayman El-Menyar, Hajar A. H. AlBinali, Rajvir Singh, and A. A. Gehani Copyright © 2014 Emad Ahmed et al. All rights reserved. Filters in 2D and 3D Cardiac SPECT Image Processing Tue, 01 Apr 2014 00:00:00 +0000 Nuclear cardiac imaging is a noninvasive, sensitive method providing information on cardiac structure and physiology. Single photon emission tomography (SPECT) evaluates myocardial perfusion, viability, and function and is widely used in clinical routine. The quality of the tomographic image is a key for accurate diagnosis. Image filtering, a mathematical processing, compensates for loss of detail in an image while reducing image noise, and it can improve the image resolution and limit the degradation of the image. SPECT images are then reconstructed, either by filter back projection (FBP) analytical technique or iteratively, by algebraic methods. The aim of this study is to review filters in cardiac 2D, 3D, and 4D SPECT applications and how these affect the image quality mirroring the diagnostic accuracy of SPECT images. Several filters, including the Hanning, Butterworth, and Parzen filters, were evaluated in combination with the two reconstruction methods as well as with a specified MatLab program. Results showed that for both 3D and 4D cardiac SPECT the Butterworth filter, for different critical frequencies and orders, produced the best results. Between the two reconstruction methods, the iterative one might be more appropriate for cardiac SPECT, since it improves lesion detectability due to the significant improvement of image contrast. Maria Lyra, Agapi Ploussi, Maritina Rouchota, and Stella Synefia Copyright © 2014 Maria Lyra et al. All rights reserved. A Comprehensive Review on Metabolic Syndrome Tue, 11 Mar 2014 00:00:00 +0000 Metabolic syndrome is defined by a constellation of interconnected physiological, biochemical, clinical, and metabolic factors that directly increases the risk of cardiovascular disease, type 2 diabetes mellitus, and all cause mortality. Insulin resistance, visceral adiposity, atherogenic dyslipidemia, endothelial dysfunction, genetic susceptibility, elevated blood pressure, hypercoagulable state, and chronic stress are the several factors which constitute the syndrome. Chronic inflammation is known to be associated with visceral obesity and insulin resistance which is characterized by production of abnormal adipocytokines such as tumor necrosis factor α, interleukin-1 (IL-1), IL-6, leptin, and adiponectin. The interaction between components of the clinical phenotype of the syndrome with its biological phenotype (insulin resistance, dyslipidemia, etc.) contributes to the development of a proinflammatory state and further a chronic, subclinical vascular inflammation which modulates and results in atherosclerotic processes. Lifestyle modification remains the initial intervention of choice for such population. Modern lifestyle modification therapy combines specific recommendations on diet and exercise with behavioural strategies. Pharmacological treatment should be considered for those whose risk factors are not adequately reduced with lifestyle changes. This review provides summary of literature related to the syndrome’s definition, epidemiology, underlying pathogenesis, and treatment approaches of each of the risk factors comprising metabolic syndrome. Jaspinder Kaur Copyright © 2014 Jaspinder Kaur. All rights reserved. Coronary Artery Disease and the Profile of Cardiovascular Risk Factors in South South Nigeria: A Clinical and Autopsy Study Mon, 10 Mar 2014 08:28:07 +0000 Introduction. Death from coronary artery disease (CAD) has been until recently considered rare in Nigeria. We present a report of a study of CAD with its predisposing cardiovascular (CVD) risk factors in South South Nigeria. Methods. We examined the autopsy reports of 747 coroner cases and 41 consecutive clinically diagnosed cases of ischemic heart disease seen in South South Nigeria. Results. CAD was diagnosed in 13 (1.6%) of 747 autopsies. They were predominantly males, urban residents, and of high social class with combination of CVD risk factors of hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activities, and obesity. The mean serum cholesterol of the clinical subjects was  mmol/L and  mmol/L for angina and myocardial infarction, respectively, which was higher than the mean total cholesterol for locality of 3.1 mmol/L. Conclusion. CAD and its risk factors are contributing to mortality and morbidity in South South Nigeria. These risk factors include hypertension, alcohol use, diabetes mellitus, cigarette smoking, poor physical activity, and obesity. Nigerians in this locality with CAD have raised serum lipids. Okon Ekwere Essien, Joseph Andy, Victor Ansa, Akaninyene Asuquo Otu, and Alphonsus Udoh Copyright © 2014 Okon Ekwere Essien et al. All rights reserved. A Pathological Study of the Epidemiology of Atherosclerosis in Mexico City Wed, 26 Feb 2014 08:39:37 +0000 Objective. To examine the frequency and patterns of association of cardiovascular risk factors with atherosclerosis in five different arterial territories at post-mortem in Mexico City. Methods. We obtained five arterial territories arteries (circle of Willis, coronary, carotid, renal, and aorta) of 185 men and women 0 to 90 years of age who underwent autopsy at the Medical Forensic Service of Mexico City. We determined the prevalence and extent of atherosclerotic lesions by histopathology according to the classification of the American Heart Association as early (types I–III) and advanced (types IV–VI), and according to the degree of stenosis and correlated with cardiovascular risk factors. Results. Atherosclerotic lesions were identified in at least one arterial territory in 181 subjects (97.8%), with involvement of two ore more territories in 178 subjects (92.2%). Advanced lesions were observed in 36% and 67% of subjects under 15 and between 16 and 35 years, respectively. Any degree of atherosclerosis was associated with the presence of diabetes mellitus, hypertension, overweight, obesity, and smoking, and to a greater extent with the presence of two or more risk factors (). However, emerging and advanced athersoclerosis was observed in 53% and 20% people with no risk factors. Conclusions. The study shows a high prevalence of atherosclerosis in all age groups and both sexes. There is considerable development of atherosclerotic disease in subjects without known risk factors. Joel Rodríguez-Saldaña, Marcela Rodriguez-Flores, Carlos Cantú-Brito, and Jesús Aguirre-Garcia Copyright © 2014 Joel Rodríguez-Saldaña et al. All rights reserved. Leptin Receptor Gene Gln223Arg Polymorphism Is Not Associated with Hypertension: A Preliminary Population-Based Cross-Sectional Study Thu, 13 Feb 2014 07:36:57 +0000 Hypertension is responsible for high morbidity and mortality as one of the most important cardiometabolic risk factors. The aim of the study was to investigate whether the Gln223Arg in the leptin receptor (LEPR) influences the prevalence of hypertension. A cross-sectional study was carried out in individuals aged ≥ 18 years. Polymorphism identification was performed using PCR-RFLP analysis. Participants with blood pressure ≥ 140/90 mmHg or medication use were considered hypertensive. Frequencies, means, cross-tabulations, and multivariate models were produced to study differences in hypertension prevalence by genotypes. The study includes 470 participants. The frequency of GG polymorphism variant was 10.43%, 46.81% AG, and 42.77% AA. The distribution of hypertension frequency by LEPR genotypes was the following: AA 43.8%, AG 40.4%, and GG 40.8%; there were no significant differences between groups. Comparative analysis which used multivariate Poisson regression adjusted by many potential confounders (age, sex, schooling, smoking, alcohol intake, obesity, and family history of parental obesity) did not modify this result. In this large sample of population-based study, the association of the LEPR Gln223Arg gene polymorphism with hypertension was not observed. Geórgia das Graças Pena, Andre L. S. Guimarães, Rosângela R. Veloso, Tatiana C. Reis, Crizian S. Gomes, João F. R. Neto, and Gustavo Velasquez-Melendez Copyright © 2014 Geórgia das Graças Pena et al. All rights reserved. Atrioventricular Left Ventricular Apical Pacing Improves Haemodynamic, Rotational, and Deformation Variables in Comparison to Pacing at the Lateral Wall in Intact Myocardium: Experimental Study Sun, 09 Feb 2014 12:58:46 +0000 Aim. To assess the effect on left ventricular (LV) function of atrioventricular (AV) and ventricular pacing at the LV apical or lateral wall and to compare the normal torsional and deformation pattern of the intact LV myocardium with those created by the aforementioned LV pacing modes and sites. Methods. Experiments were conducted in pigs () with normal LV function to investigate the acute hemodynamic effects of epicardial AV and ventricular LV pacing at the LV apical or lateral wall. Torsional and deformation indices of LV function were assessed using speckle tracking echocardiography. Results. AV pacing at the apex revealed a significant reduction in the radial strain of the base (), without affecting significantly the ejection fraction and the LV torsion or twist. In contrast, AV pacing at the lateral wall produced, in addition to the reduction of the radial strain of the base (), significant reduction of the circumferential and the radial strain of the apex (both ) as well as of the ejection fraction () and twist (). Conclusions. In pig hearts with intact myocardium, LV function is maintained at sinus rhythm level when AV pacing is performed at the LV apex. Savvas Toumanidis, Anna Kaladaridou, Dimitrios Bramos, Elias Skaltsiotes, John Agrios, Constantinos Pamboucas, George Kottis, Anna Antoniou, Elektra Papadopoulou, and Spyridon Moulopoulos Copyright © 2014 Savvas Toumanidis et al. All rights reserved. C-Reactive Protein: Clinical and Epidemiological Perspectives Thu, 06 Feb 2014 14:26:20 +0000 An important etiopathogenic component of cardiovascular disease is atherosclerosis, with inflammation being an essential event in the pathophysiology of all clinical pictures it comprises. In recent years, several molecules implicated in this process have been studied in order to assess cardiovascular risk in both primary and secondary prevention. C-reactive protein is a plasmatic protein of the pentraxin family and an acute phase reactant, very useful as a general inflammation marker. Currently, it is one of the most profoundly researched molecules in the cardiovascular field, yet its clinical applicability regarding cardiovascular risk remains an object of discussion, considered by some as a simple marker and by others as a true risk factor. In this sense, numerous studies propose its utilization as a predictor of cardiovascular risk through the use of high-sensitivity quantification methods for the detection of values <1 mg/L, following strict international guidelines. Increasing interest in these clinical findings has led to the creation of modified score systems including C-reactive protein concentrations, in order to enhance risk scores commonly used in clinical practice and offer improved care to patients with cardiovascular disease, which remains the first cause of mortality at the worldwide, national, and regional scenarios. Juan Salazar, María Sofía Martínez, Mervin Chávez, Alexandra Toledo, Roberto Añez, Yaquelín Torres, Vanessa Apruzzese, Carlos Silva, Joselyn Rojas, and Valmore Bermúdez Copyright © 2014 Juan Salazar et al. All rights reserved. What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study Thu, 06 Feb 2014 11:13:38 +0000 Objective. Bilateral internal thoracic artery (BITA) grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA) revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD) and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA) connections directly off the aorta (Ao) () or as a “t” graft off the LITA (t) (). The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times ( versus minutes, ) and total cardiopulmonary bypass times ( versus minutes, ) were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow ( versus , ), mean RITA conductance (flow/mean arterial pressure) ( versus , ), RITA fractional flow ( versus , ), and RITA fractional conductance ( versus , ) than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33%) in the Ao group and 2 patients in the t group (16%). One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta provides more acute fractional RITA flow than composite “t” grafting to the LITA. Longer-term angiographic and clinical followup are necessary to determine the consequences of these acute hemodynamic findings. S. Neragi-Miandoab, R. E. Michler, F. Lalezarzadeh, R. Bello, and J. J. DeRose Copyright © 2014 S. Neragi-Miandoab et al. All rights reserved. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture Thu, 06 Feb 2014 09:49:59 +0000 The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER. Anahita Dua, Jason McMaster, Pathik J. Desai, Sapan S. Desai, SreyRam Kuy, Maggy Mata, and Jamie Cooper Copyright © 2014 Anahita Dua et al. All rights reserved. Minimizing Cardiovascular Adverse Effects of Atypical Antipsychotic Drugs in Patients with Schizophrenia Tue, 04 Feb 2014 11:05:28 +0000 The use of atypical antipsychotic agents has rapidly increased in the United States and worldwide in the last decade. Nonetheless, many health care practitioners do not appreciate the significance of the cardiovascular side effects that may be associated with their use and the means to minimize them. Thus, atypical antipsychotic medications can cause cardiovascular side effects such as arrhythmias and deviations in blood pressure. In rare cases, they may also cause congestive heart failure, myocarditis, and sudden death. Patients with schizophrenia have a higher risk of cardiovascular mortality than healthy individuals, possibly because of excessive smoking, the underlying disorder itself, or a combination of both factors. Increased awareness of these potential complications can allow pharmacists and physicians to better manage and monitor high risk patients. Accurate assessments are very important to avoid medications from being given to patients inappropriately. Additionally, monitoring patients regularly via blood draws and checking blood pressure, heart rate, and electrocardiogram can help catch any clinical problems and prevent further complications. Finally, patient and family-member education, which pharmacists in particular can play key roles in, is central for the management and prevention of side effects, which is known to reflect positively on morbidity and mortality in these patients. Fadi T. Khasawneh and Gollapudi S. Shankar Copyright © 2014 Fadi T. Khasawneh and Gollapudi S. Shankar. All rights reserved.