Dietary Composition, Angiographic Coronary Disease, and Cardiovascular Outcomes in the WISE Study (Women's Ischemia Syndrome Evaluation).

BACKGROUND: Studies relating diet to angiographic coronary artery disease (CAD) and subsequent major adverse cardiac events (MACE) in women are limited. Information on diet was collected in the Women's Ischemia Syndrome Evaluation (WISE), a prospective cohort study of symptomatic women referred for coronary angiography to evaluate suspected ischemic heart disease. METHODS: A consecutive subgroup (n = 201 of 936) of enrolled women completed the modified Block food frequency questionnaire (FFQ). Data on outcomes were collected and adjudicated after 8-year follow-up. A set of logistic regression models were fitted for non-obstructive versus obstructive coronary stenosis (<50% versus ≥50%). Cox proportional hazard regression models were fitted for outcomes, with each dietary composition variable adjusted for the degree of coronary stenosis. RESULTS: At baseline, the subgroup cohort was 58 ± 12 years old with a body mass index (BMI) of 30 ± 7 kg/m2. An increased proportion of calories consumed from protein was associated with higher levels of baseline obstructive coronary stenosis. Those individuals who ate a higher amount of protein, carotene, and servings of vegetables and meat, however, were each associated with lower subsequent adverse outcomes, respectively. CONCLUSIONS: Among women undergoing coronary angiography for suspected CAD, a higher percentage of protein intake was associated with higher baseline stenosis severity; however, the amount of protein intake, vegetable, meat, and carotene intake, was conversely associated with subsequent lower adverse cardiovascular outcome risk.

Soft tissue displacement for detection of left ventricle apical dyskinesis with transthoracic echocardiography.

We tested the hypothesis that the use of outward displacement of the soft tissue between the apex and the chest wall as seen in TTE, is a sign of apical displacement and would allow for more accurate diagnosis of apical dyskinesis. This is a retrospective study of 123 patients who underwent TTE and cardiac magnetic resonance imaging (MRI) within a time frame of 6 months between 2008 and 2019. 110 subjects were deemed to have good quality studies and included in the final analysis. An observer blinded to the study objectives evaluated the echocardiograms and recorded the presence or absence of apical dyskinesis. Two independent observers evaluated the echocardiograms based on the presence or absence of outward displacement of the overlying tissue at the LV apex. Cardiac MRI was used to validate the presence of apical dyskinesis. The proportion of studies which were identified as having apical dyskinesis with conventional criteria defined as outward movement of the left ventricular apex during systole were compared to those deemed to have dyskinesis based on tissue displacement. By cardiac MRI, 90 patients had apical dyskinesis. Using conventional criteria on TTE interpretation, 21 were diagnosed with apical dyskinesis (23.3%). However, when soft tissue displacement was used as the diagnostic marker of dyskinesis, 78 patients (86.7%) were diagnosed with dyskinesis, p < 0.01. Detection of displacement of soft tissue overlying the LV apex facilitates better recognition of LV apical dyskinesis.

Hemoptysis After Heart Transplantation Caused by Pulmonary Amyloidosis.

Pulmonary involvement is a common sequela of systemic amyloidosis, occurring in up to 50% of cases. The patterns of involvement include focal nodular, diffuse interstitial, and tracheobronchial. This can lead to a variety of symptoms, including cough and shortness of breath. Although hemoptysis is not uncommon, massive hemoptysis is rare. (Level of Difficulty: Advanced.).

Recurrent Myocarditis Treated with Intravenous Immune Globulin and Steroids.

BACKGROUND Myocarditis is an inflammatory process that can present as acute or chronic with either focal or diffuse involvement of the myocardium. Its incidence is approximately 1.5 million cases per year worldwide. In the United States, viral infection is the most common cause of myocarditis. Most of the reported cases are singular and self-limiting in nature. We present the case of severe recurrent myocarditis in a young adult who was transferred to the Intensive Care Unit. CASE REPORT An 18-year-old man presented with chest pressure and troponin I 33 ng/mL. He had presented to another hospital with similar symptoms 3 months prior and was diagnosed with myocarditis that had resolved with colchicine. As part of his workup during this admission, coronary angiogram was normal and biopsy obtained without evidence of an inflammatory process; however, cardiac magnetic resonance imaging (MRI) was consistent with myocarditis and Coxsackie B titers indicated prior infection, leading to a diagnosis of clinically suspected recurrent viral myocarditis. He was treated with intravenous immunoglobulin (IV Ig) and a steroid taper, with rapid improvement in symptoms over the ensuing weeks without evidence of further recurrence or sequelae. CONCLUSIONS We present a case of recurrent Coxsackie B myocarditis based on presentation and imaging. Myocarditis is an important diagnosis to consider when a young, healthy individual presents with chest pain mimicking acute coronary syndrome, especially during the COVID pandemic. If there is evidence of myocarditis on MRI or endomyocardial biopsy, immunosuppressive therapy should be considered in patients with recurrent and severe presentations.

Cocaine exposure impairs multilineage hematopoiesis of human hematopoietic progenitor cells mediated by the sigma-1 receptor [corrected].

Prenatal exposure to cocaine is a significant source of fetal and neonatal developmental defects. While cocaine associated neurological and cardiac pathologies are well-documented, it is apparent that cocaine use has far more diverse physiological effects. It is known that in some cell types, the sigma-1 receptor mediates many of cocaine's cellular effects. Here we present a novel and concise investigation into the mechanism that underlies cocaine associated hematopoietic pathology. Indeed, this is the first examination of the effects of cocaine on hematopoiesis. We show that cocaine impairs multilineage hematopoiesis from human progenitors from multiple donors and tissue types. We go on to present the first demonstration of the expression of the sigma-1 receptor in human CD34 + human hematopoietic stem/progenitor cells. Furthermore, we demonstrate that these cocaine-induced hematopoietic defects can be reversed through sigma-1 receptor blockade.