Cardiovascular Magnetic Resonance Imaging in Familial Dilated Cardiomyopathy.

Dilated cardiomyopathy (DCM) is a common cause of non-ischaemic heart failure, conferring high morbidity and mortality, including sudden cardiac death due to systolic dysfunction or arrhythmic sudden death. Within the DCM cohort exists a group of patients with familial disease. In this article we review the pathophysiology and cardiac imaging findings of familial DCM, with specific attention to known disease subtypes. The role of advanced cardiac imaging cardiovascular magnetic resonance is still accumulating, and there remains much to be elucidated. We discuss its potential clinical roles as currently known, with respect to diagnostic utility and risk stratification. Advances in such risk stratification may help target pharmacological and device therapies to those at highest risk.

Anabolic Steroid-induced Reversible Cardiomyopathy in a Young Non-athletic Female.

Anabolic androgenic steroid (AAS) abuse is widespread nowadays, not only in athletes but in non-athletic populations; and rapidly becoming a public health challenge. Cardiomyopathy (both dilated and hypertrophic) is a known complication of anabolic steroid use. A 47-year woman presented with acute pulmonary edema, in the background of exertional dyspnea for the last few weeks. Echocardiogram revealed severe left ventricular systolic dysfunction in the presence of hypertrophy, global hypokinesia, and septal dyssynchrony. She was treated with guideline-directed treatment for heart failure. Investigation into the causes revealed that she had been using anabolic of steroids for social reasons. She was counselled and managed to abstain from the use steroids. Cardiac MRI, five months later, showed mild left ventricular systolic impairment and no hypertrophy. There was no perfusion defect, scar or infiltration. At nine months follow-up, she improved symptomatically with better exercise tolerance. Key Words: Anabolic steroids, Cardiac MRI, Cardiomyopathy.

Olive oil and clove oil-based nanoemulsion for topical delivery of terbinafine hydrochloride: in vitro and ex vivo evaluation.

In this article, formulation studies for terbinafine hydrochloride nanoemulsions, prepared by high-energy ultrasonication technique, are described. Pseudo-ternary phase diagram was constructed in order to find out the optimal ratios of oil and surfactant/co-solvent mixture for nanoemulsion production. Clove and olive oils were selected as oil phase. Based on the droplet size evaluation, maximum nanoemulsion region were determined for formulation development. Further characterization included polydispersity index (PDI), zeta potential, Fourier transform infrared (FT-IR) spectroscopy, morphology, pH, viscosity, refractive index, ex vivo skin permeation, skin irritation, and histopathological examination. Droplet sizes of optimized formulations were in colloidal range. PDI values below 0.35 indicated considerably homogeneous nanoemulsions. Zeta potential values were from 13.2 to 18.1 mV indicating good stability, which was also confirmed by dispersion stability studies. Ex vivo permeation studies revealed almost total skin permeation of terbinafine hydrochloride from the nanoemulsions (96-98%) in 6 hours whereas commercial product reached only 57% permeation at the same time. Maximum drug amounts were seen in epidermis and dermis layers. Skin irritation and histopathological examination demonstrated dermatologically safe formulations. In conclusion, olive oil and clove oil-based nanoemulsion systems have potential to serve as promising carriers for topical terbinafine hydrochloride delivery.

Persistent Mullerian Duct Syndrome.

Persistent Mullerian Duct Syndrome is extremely rare. Our patient, a 32 years old male, with history of orchidectomy presented with mass abdomen. He was initially diagnosed with seminoma and subsequently treated with chemotherapy. Biopsy of the mass showed germ cell tumour and MRI abdomen revealed female rudimentary organs confirmed on per operative and later on histopathology. Karyotype was 46 XY.

Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race.

BACKGROUND: Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. METHODS: This was a multicentre, retrospective, observational study including 164 adults (aged 61 ± 13 years; 78% male; 36% BAME) hospitalized with COVID-19 undergoing echocardiography between March 16 and May 9, 2020 at 3 days (interquartile range 2-5) from admission. The primary outcome was all-cause mortality. RESULTS: After a median follow-up of 31 days (interquartile range 14-42 days), 66 (40%) patients had died. The right ventricle was dilated in 62 (38%) patients, and 58 (35%) patients had right ventricular (RV) systolic dysfunction. Only 2 (1%) patients had left ventricular (LV) dilatation, and 133 (81%) had normal or hyperdynamic LV systolic function. Reduced tricuspid annulus planar systolic excursion was associated with elevated D-dimer (ρ = -0.18, P = 0.025) and high-sensitivity cardiac Troponin (ρ = -0.30, P < 0.0001). Reduced RV systolic function (hazard ratio 1.80; 95% confidence interval, 1.05-3.09; P = 0.032) was an independent predictor of all-cause mortality after adjustment for demographic and clinical risk factors. Comparing white and BAME individuals, there were no differences in echocardiography findings, biomarkers, or mortality. CONCLUSIONS: In patients hospitalized with COVID-19 pneumonia, reduced RV systolic function is prevalent and associated with all-cause mortality. There is, however, no racial variation in the early findings on echocardiography, biomarkers, or mortality.

CONTEXTE: Des études épidémiologiques suggèrent que les patients noirs, asiatiques et appartenant à des minorités ethniques (BAME) auraient un risque accru d'aggravation de la maladie à coronavirus 2019 (COVID-19), mais les facteurs physiopathologiques de cette association sont inconnus. Cette étude a cherché à étudier la relation entre les données d'échocardiographie, de mortalité, de l'origine ethnique avec la pneumonie associée à la COVID-19. MÉTHODES: Il s'agit d'une étude observationnelle rétrospective multicentrique portant sur 164 adultes (âgés de 61 ± 13 ans; 78 % d'hommes; 36 % de BAME) hospitalisés pour la COVID-19 et soumis à une échocardiographie entre le 16 mars et le 9 mai 2020, trois jours (écart interquartile 2-5) après leur admission. Le critère principal d'évaluation était la mortalité, toutes causes confondues. RÉSULTATS: Après un suivi médian de 31 jours (intervalle interquartile 14-42 jours), 66 (40 %) patients sont décédés. Le ventricule droit était dilaté chez 62 (38 %) des patients, et 58 (35 %) patients présentaient une dysfonction systolique du ventricule droit (VD). Seuls deux (1 %) patients présentaient une dilatation du ventricule gauche (VG), et 133 (81 %) avaient une fonction systolique VG normale ou en état hyperdynamique. Une réduction du déplacement systolique de l'anneau tricuspide a été associée à un taux de D-dimère élevé (ρ = -0,18, P = 0,025) et à une Troponine cardiaque de haute sensibilité (ρ = -0,30, P < 0,0001). Une fonction systolique VD réduite (rapport de risque de 1,80; intervalle de confiance à 95 %, 1,05-3,09 ; P = 0,032) était un facteur prédicteur indépendant pour la mortalité, toutes causes confondues, après ajustement pour les facteurs de risque démographiques et cliniques. En comparant les individus blancs et BAME, aucune différence n'a été constatée concernant les résultats d'échocardiographie, les biomarqueurs ou la mortalité. CONCLUSIONS: Chez les patients hospitalisés pour une pneumonie liée à la COVID-19, une réduction de la fonction systolique VD est apparue comme prévalente et associée à la mortalité, toutes causes confondues. Il n'y a cependant aucune influence de l'ethnicité en rapport avec les premiers résultats d'échocardiographie, des biomarqueurs ou de la mortalité.

Everolimus-eluting bioresorbable coronary scaffold in Asian patients: A 2-year follow-up.

Indo-Pakistan population has one of the highest risk of coronary artery disease (CAD) in the world. Percutaneous interventions with the use of stents has been the mainstay of treatment for CAD, evolving from balloon angioplasty to bare metal stents and then to drug eluting stents. However, there are a few drawbacks related to the metal implant in the coronary, leading to the development of bio-resorbable vascular scaffolds (BVS). This case series studies the implantation techniques and 24 month clinical outcome of bioresorbable stent Absorb at Rawalpindi Institute of Cardiology. From November 1, 2013 till June 30, 2018. Fifty patients undergoing angioplasty with Absorb BVS as elective or primary PCI were enrolled. Case selection was at the discretion of the operator. Patients were followed up clinically. Repeat angiogram was conducted if clinically indicated. The study population involved patients with mean age of 42±8.82. Fourty three (86%) were male and most had single or double vessel disease. The most common treated coronary was left anterior descending. Most of the lesions were predilated with 1:1 sizing. Most scaffolds were post dilated with 0.5mm larger diameter non-compliant balloon at nominal pressure. Angiographic success rate was 92%. On follow up, 4% had stent thrombosis (ST) (compared to <1% for latest generation drug eluting stents (DES) as per available literature). No death was reported. Majority of those with ST had longer median treated lesion length than those without stent thrombosis (32mm versus 28mm). Stent thrombosis occurred in 7.7% of cases with overlapping BVS while 2.8% in single BVS patients. To conclude, current generation Biovascular scaffold has higher thrombosis rates as compared to latest generation DES. Procedure/lesion related risk factors may predispose in addition to the thick stent struts.

Coronary Artery Ectasia: Clinical and Angiographic Features.

OBJECTIVE: To investigate the clinical and angiographic characteristics of coronary artery ectasia (CAE) and its relation with the inflammatory marker, HsCRP. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Rawalpindi Institute of Cardiology, Rawalpindi, from April 2015 till November 2016. METHODOLOGY: Eighty-one patients with CAE and 57 age matched patients with stenotic coronary artery disease (CAD), but without CAE, were included in the study. Clinical, angiographic, and laboratory data were documented. Chi-square test was used to compare coronary risk factors between two groups. T test was used to compare means between the groups. Analysis of variance was used to analyse HsCRP levels among various types of ectasia. Correlation analysis was used to study association of ectasia with different risk factors. RESULTS: Males were predominant in both with & without CAE. Hypertension, smoking and obesity were significantly more common among CAE patients than those without (60.5% vs. 52.6%, 56.8% vs. 43.9% and 80.2% vs. 14%, respectively). Diabetes was much less in CAE group (32.1% vs. 42.1%). HsCRP was higher in patients with CAE than those without and was significantly higher in patients with more extensive ectasia. Majority (65.4%) of CAE patients had significant CAD; whereas, only 7.4% had isolated CAE. Most common artery involved was RCA (70.4% of total) and most common pattern was single ectatic vessel. CONCLUSION: Obesity and smoking predispose to CAE, along with male sex and hypertension. While diabetes is negatively associated with CAE. HsCRP levels tend to be higher in ectasia patients, especially those with severe forms. Finally, CAE has a predilection for RCA.

Neutrophil Lymphocyte Ratio: APrognostic Marker in Acute ST Elevation Myocardial Infarction.

OBJECTIVE: To investigate if neutrophil lymphocyte ratio (NLR) predicts in-hospital adverse events and mortality, and shortterm (30-day) mortality in ST-elevated myocardial infarction (STEMI) patients thrombolysed with streptokinase (SK). STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Rawalpindi Institute of Cardiology, from June 2014 till January 2015. METHODOLOGY: The STEMI patients, thrombolysed with SK had blood samples at admission, analysed for complete blood counts and NLR calculated. They were grouped into two, low and high NLR, taking 4.50 as cut-off. Chi square test was used to compare rate of adverse events and death in hospital stay. Mann-Whitney test was used to compare median NLR between patients died and discharged alive. Logistic regression analysis was used to estimate predictive ability of NLR for 30-day mortality. RESULTS: Atotal of 145 (45.3%) patients had complications; 49 (15.3%) died in hospital, and 13 (4.06%) died in 30 days. Patients in high NLR group had higher rate of complications (63.5% vs. 25.5%, p <0.0001) and death (19.2% vs. 11.1%, p=0.046) in hospital than those in low NLR group. Cardiogenic shock (27.5% vs.11.1%, p <0.0001), heart failure (19.2% vs. 7.2%, p=0.002), arrhythmias (18% vs. 6.5%, p <0.0001), reinfarct/angina (9.6% vs.2% p=0.004) occurred more in high NLR group. Median NLR in patients died was higher than those discharged alive (7.46 vs. 4.70, p <0.0001). Regression analysis showed NLR an independent predictor of mortality (OR 1.131 at 95% CI, p = 0.029). Age, serum creatinine, Killip class were other predictors (p=0.002 and p=0.02, respectively). ROC curve showed AUC 0.908 (p <0.0001). CONCLUSION: Ahigh NLR predicted increased in hospital complication rate, and in-hospital as well as 30-day mortality in STEMI patients thrombolysed with streptokinase.