Minerva cardioangiologica最新文献

Background: Although mitral valve prolapse (MVP) is a benign disease, several studies have indicated its association with ventricular arrhythmias (VAs). Some histopathological studies have pointed to left ventricular fibrosis as the underlying cause of arrhythmia in MVP patients. Fragmented QRS (fQRS) on electrocardiography (ECG) has been shown to be a marker of myocardial fibrosis. This study aimed to investigate the association between fQRS and complex VAs in patients with MVP.

Methods: A total of 230 consecutive patients who were diagnosed with MVP were included in the study. The control group consisted of 302 healthy individuals matched according to age and sex. fQRS was defined as additional R' wave or notching/splitting of S wave in two contiguous ECG leads. All patients underwent 24-hour Holter monitoring and VAs were classified using Lown's scoring system. Lown class ≥3 VAs were considered as complex VAs.

Results: As compared to the healthy individuals, prevalence of fQRS (40% vs. 9.6%, P<0.001) and complex VAs (18.7% vs. 0%, P<0.001) were significantly higher in patients with MVP. Furthermore, complex VAs (35.9% vs. 7.2%, P=0.001) were significantly higher in MVP patients with fQRS. In multiple logistic regression analysis, the presence of bileaflet prolapse (OR: 2.567, 95%CI: 1.434 to 4.367; P=0.002) and presence of fQRS (OR: 3.021, 95%CI: 1.556 to 6.232; P<0.001) were independent predictors for complex VAs.

Conclusions: The presence of fQRS may be associated with complex VAs in patients with MVP. Therefore, fQRS may be used in risk stratification of complex VAs in patients with MVP.

Cardiac patients are managed medically or with an intervention. This review aimed to explore the survival benefit of each approach in the management of cardiac patients. We reviewed updated evidence of survival benefit from the most recent trials and guidelines. Patients with ST-segment-elevation myocardial infarction (STEMI) have a mortality benefit when a primary cardiac intervention is implemented. No similar benefit has been shown in chronic stable coronary artery disease. Heart failure patients show a mortality benefit using medication and similarly, mild or moderate valve disease patients do not require an intervention. In atrial fibrillation, the CABANA trial using ablation therapy, had no mortality benefit. Hypertension drug therapy showed a significant mortality benefit, a similar benefit was noted with drug therapy for the treatment of dyslipidemia, when achieving the target lipid goal. Not all interventional procedures result in a mortality benefit. Medical therapy alone increases survival in many cardiac diseases.

Background: Ventricular fibrillation is an electrophysiological disorder leading to cardiac arrest that can be caused using chemicals. The 2-aminoethoxydiphenyl borate (2-apb) is a poorly understood compound that modulates store operated calcium entry and gap junctions and can provoke ventricular fibrillation. Our study aimed to investigate the effect of 2-apb on the work of an isolated rat heart and coronary vessels under normoxic conditions, as well as under conditions of hypoxia/reoxygenation, that affect intracellular calcium.

Methods: In order to accomplish this task, we used Langendorff rat heart preparation and multi-electrode registration of bioelectric activity of the heart with flexible arrays. An analysis of changes in the volume of coronary blood flow was also performed.

Results: Arrhythmogenic effect of 2-apb on an isolated rat heart was shown: an increase in the frequency and variability of the heart rhythm, a decrease in the electrical conductivity of the myocardium, and the appearance of ventricular fibrillation. Under hypoxic conditions, the arrhythmogenic effect of 2-apb decreased and no ventricular fibrillation was observed. In addition, 2-apb had a stabilizing effect on coronary vessels and weakened the effect of reoxygenation on the electrical activity of the heart.

Conclusions: Obtained results indicate that the effect of arrhythmogenic chemicals, for example, proarrhythmic drugs that affect the myocardial [Ca²⁺]in, depended on the oxygen supply to the heart. The components of the store operated calcium entry and gap junctions can become promising therapeutic targets for controlling the physiological disorders of the heart and blood vessels caused or accompanied by reoxygenation.

Background: Synthetic cannabinoids are part of a group of drugs called new psychoactive substances. The increase in substance use among young adults is becoming a major problem in the world. In this study we aimed to investigate the effects of synthetic cannabinoid drugs such as bonsai to electrocardiographic (ECG) parameters, in patients who were admitted to emergency service with self-reported usage of bonsai.

Methods: Seventy-two patients (68 males; mean age 33.8±11.8) with self-reported use of bonsai and 27 (22 males; mean age 37.1±8.7) age and sex-matched healthy control group enrolled the study. ECG parameters and rhythm holter were measurements calculated in both groups.

Results: Groups were age and sex matched. Glucose, potassium, white blood cell count, heart rate end smoking status was significantly different in patients compared to control group. P wave max time, P wave min. time, P wave dispersion, QT max. time QT dispersion, QT corrected time and index of cardiac-electrophysiological balance measurements (iCEB) were significantly different in groups of patients. A multivariate logistic regression analysis was used to determine independent predictors of ≥30 Ventricular premature beat (VPB)/h using parameters found to be associated with ≥30 VPB/h in a univariate analysis (potassium, QTmax time, QTc, QRS time, iCEB).In a multivariate analysis, independent predictors of ≥30 VPB/h were potassium (Odds ratio [OR]: 0.107, 95% CI: 0.024-0.481;P=0.004) and iCEB (OR: 4.474, 95% CI: 1.752-11.429;P=0.002). In generalize linear model β-coefficient value of interaction terms between K*iCEB has no important effect on ventricular premature beats.

Conclusions: If the results are confirmed in further studies, iCEB seems to be a simple, easily measurable and non-invasive marker to predict cannabinoid-induced ventricular arrhythmias.

Background: Extracorporeal shockwave myocardial revascularization (ESMR) is a non-invasive treatment designed to improve symptoms in refractory angina (RA) patients. Enhanced perfusion through local vasodilation and neo-capillarization is postulated to be the mechanism of the observed clinical benefit. However, the impact of ESMR on the ischemic burden of RA patients has not been adequately assessed.

Methods: One-hundred twenty-one consecutive RA patients suitable for ESMR were treated. Twenty-nine RA patients not suitable for treatment were clinically followed-up as a control group for clinical endpoints. ESMR-treated patients underwent baseline and 6-month single photon emission computed tomography (SPECT) to evaluate the changes in ischemic burden. The operator was blinded to the pre/post-treatment status of the SPECT exam. The primary endpoint was the difference in summed stress score (SSS) and summed difference score (SDS) between follow-up and baseline SPECTs. Secondary endpoints included the changes in Canadian Cardiovascular Society (CCS) angina class and nitroglycerin use between 6-month follow-up and baseline. Clinical endpoints were further compared between ESMR-treated patients and the control group.

Results: Following ESMR, a significant reduction in the ischemic burden was observed (follow-up SSS: 14.2±10 vs. baseline SSS: 21.2±9.42, P<0.0001; follow-up SDS: 4.6±5.9 vs. baseline SDS 10.2±7.9, P<0.0001) including less patients with moderate to severe ischemia (19% vs. 46% P<0.0001). CCS class and nitroglycerin use were significantly reduced (CCS: 1.5±0.6 vs. 2.7±0.6, P<0.0001; patients needing nitroglycerin: 24% vs. 64%, P<0.0001). When compared to the control group, CCS class reduction, nitroglycerin use and hospitalizations were significantly lower for ESMR treated vs. non-treated RA patients at 6-month follow-up.

Conclusions: In this single-center cohort of RA patients undergoing ESMR treatment and serial myocardial perfusion imaging, ESMR was associated with a significant reduction in the ischemic burden. These findings provide a physiological rationale and mechanism for the observed clinical benefit.