Circulating S-Glutathionylated cMyBP-C as a Biomarker for Cardiac Diastolic Dysfunction.

Background cMyBP-C (Cardiac myosin binding protein-C) regulates cardiac contraction and relaxation. Previously, we demonstrated that elevated myocardial S-glutathionylation of cMyBP-C correlates with diastolic dysfunction (DD) in animal models. In this study, we tested whether circulating S-glutathionylated cMyBP-C would be a biomarker for DD. Methods and Results Humans, African Green monkeys, and mice had DD determined by echocardiography. Blood samples were acquired and analyzed for S-glutathionylated cMyBP-C by immunoprecipitation. Circulating S-glutathionylated cMyBP-C in human participants with DD (n=24) was elevated (1.46±0.13-fold, P=0.014) when compared with the non-DD controls (n=13). Similarly, circulating S-glutathionylated cMyBP-C was upregulated by 2.13±0.47-fold (P=0.047) in DD monkeys (n=6), and by 1.49 (1.22-2.06)-fold (P=0.031) in DD mice (n=5) compared with the respective non-DD controls. Circulating S-glutathionylated cMyBP-C was positively correlated with DD in humans. Conclusions Circulating S-glutathionylated cMyBP-C was elevated in humans, monkeys, and mice with DD. S-glutathionylated cMyBP-C may represent a novel biomarker for the presence of DD.

Relation of abnormal cardiac stress testing with outcomes in patients undergoing renal transplantation.

Cardiovascular risk stratification is often performed in patients considered for renal transplantation. In a single center, we sought to examine the association between abnormal stress testing with imaging and post-renal transplant major adverse cardiovascular events (MACE) using multivariable logistic regression. From January 2006 to May 2016 232 patients underwent renal transplantation and 59 (25%) had an abnormal stress test result. Compared to patients with a normal stress test, patients with an abnormal stress test had a higher prevalence of dyslipidemia, diabetes mellitus, obesity, coronary artery disease (CAD), and heart failure. Among those with an abnormal result, 45 (76%) had mild, 10 (17%) moderate, and 4 (7%) severe ischemia. In our cohort, 9 patients (3.9%) had MACE at 30-days post-transplant, 5 of whom had an abnormal stress test. The long-term MACE rate, at a median of 5 years, was 32%. After adjustment, diabetes (OR 2.37, 95% CI 1.12-5.00, p = 0.02), CAD (OR: 3.05, 95% CI 1.30-7.14, p = 0.01) and atrial fibrillation (OR: 5.86, 95% CI 1.86-18.44, p = 0.002) were independently associated with long-term MACE, but an abnormal stress test was not (OR: 0.83, 95% CI 0.37-1.92, p = 0.68). In conclusion, cardiac stress testing was not an independent predictor of long-term MACE among patients undergoing renal transplant.

Non-Bacterial Thrombotic Endocarditis as a Cause of Cryptogenic Stroke in Malignancy.

Non-bacterial thrombotic endocarditis (NBTE) is characterized by the deposition of fibrin and platelet thrombi on previously undamaged heart valves in the absence of bloodstream infection. It is associated with chronic disease states and can present with systemic embolic disease. Here we report a case of NBTE presenting as recurrent strokes in a patient with bladder cancer. Importantly, transthoracic echocardiography has limitations to detecting valvular lesions in NBTE, and providers should consider obtaining transesophageal echocardiography in the setting of high clinical suspicion.

Gemella Endocarditis Presenting as an ST-Segment-Elevation Myocardial Infarction.

Acute myocardial infarction from septic embolization is a rare initial presentation of endocarditis. We report the case of a 67-year-old man who presented with acute chest pain, in whom emergency cardiac catheterization revealed findings that suggested coronary embolism. The patient was found to have Gemella endocarditis, with its initial presentation an embolic acute ST-segment-elevation myocardial infarction. We suggest that endocarditis be considered among the potential causes of acute myocardial infarction.

A case of intracranial hemorrhage causing stress-induced cardiomyopathy.

The classic finding of Takotsubo's cardiomyopathy is left ventricular systolic dysfunction with echocardiographic evidence of apical ballooning in the absence of significant coronary disease. Intracranial hemorrhage is a known cause for stress-induced cardiomyopathy with a similar echocardiographic presentation. This diagnostic finding suggests a similar pathophysiologic mechanism between neurogenic cardiac damage and the wide array of medical and psychosocial disorders that are known to cause stress-induced cardiomyopathy (Takotsubo's syndrome). The neurogenic-cardiac variant of stress-induced cardiomyopathy is associated with good cardiovascular prog- nosis; the hallmark feature of the disorder is complete echocardiographic resolution of systolic dysfunction within a short period of time. While malignant presentations are rare, the disorder can present as severe heart failure or ventricular tachyarrhythmias. We report a case of a near life-threatening episode of polymorphic ventricular tachycardia due to a subarachnoid hemorrhage (SAH)-induced stress-cardiomyopathy.

Valve-sparing aortic root replacement after cocaine-induced acute ascending aortic dissection.

Cocaine-induced ascending aortic dissection is being recognized with increasing frequency. We present two cases of patients treated using valve-sparing aortic root replacement after cocaine-induced aortic root dissection. Valve-sparing aortic root replacement represents an alternative surgical technique that may be particularly well-suited toward this younger, noncompliant patient population.

Should aortas in patients with bicuspid aortic valve really be resected at an earlier stage than tricuspid? CON.

Bicuspid aortic valve (BAV)-associated aortopathy is a complex phenomenon, and the current lack of univocal interpretation of its causes and treatment can be ascribed to the multiform nature of its clinical presentation. Although there is strong bias in the literature favoring more aggressive treatment of ascending aortic dilatation in patients with BAV, evidence supporting this opinion is lacking. This review discusses some of the relevant issues relating to causation to facilitate a better analysis of the current recommendations used to guide surgical management, and concludes that treatment should be tailored by individual valvular pathology, clinical phenotype, and relevant comorbidities, using well-documented evidence-based clinical size criteria.

Assessment of myocardial recovery in a patient with acute myocarditis supported with a left ventricular assist device: a case report.

Acute myocarditis may present with profound hemodynamic compromise; however, spontaneous resolution of the inflammatory process may occur in up to half of such patients. In patients with fulminant myocarditis, mechanical circulatory support may serve as a bridge to myocardial recovery. In this report we describe a 35-year-old man with acute myocarditis who required left ventricular assist device support as a bridge to recovery, and suggest a method for determining the suitability and timing of device explantation. A combination of echocardiography, right heart catheterization, exercise testing and serial endomyocardial biopsies was used to determine the resolution of myocarditis, recovery of myocardial function and timing for device explantation. Successful device explantation was performed after 37 days of device support. Further study is required to assess the role of ventricular assist devices in combination with immunosuppressive therapy in the management of fulminant myocarditis.