Myocardial Extracellular Volume Is Not Associated With Malignant Ventricular Arrhythmias in High-risk Hypertrophic Cardiomyopathy.

INTRODUCTION AND OBJECTIVES: Myocardial interstitial fibrosis, a hallmark of hypertrophic cardiomyopathy (HCM), has been proposed as an arrhythmic substrate. Fibrosis is associated with increased extracellular volume (ECV), which can be quantified by computed tomography (CT). We aimed to analyze the association between CT-determined ECV and malignant ventricular arrhythmias. METHODS: A retrospective case-control observational study was conducted in HCM patients with implantable cardioverter-defibrillator, undergoing a CT-protocol with continuous iodine contrast infusion to determine equilibrium ECV. Left ventricular septal and lateral CT-determined ECV was compared between prespecified cases (malignant arrhythmia any time before CT scan) and controls (no prior malignant arrhythmias) and among ECV tertiles. RESULTS: A total of 78 implantable cardioverter-defibrillator HCM patients were included; 24 were women, with a mean age of 52.1 ± 15.6 years. Mean ECV ± standard deviation in the septal left ventricular wall and was 29.8% ± 6.3% in cases (n = 24) vs 31.9% ± 8.5% in controls (n = 54); P = .282. Mean ECV in the lateral wall was 24.5% ± 6.8% in cases vs 28.2% ± 7.4% in controls; P = .043. On comparison of the entire population according to septal ECV tertiles, no significant differences were found in the number of patients receiving appropriate shocks. Conversely, we found a trend (P = .056) for a higher number of patients receiving appropriate shocks in the lateral ECV lowest tertile. CONCLUSIONS: Extracellular volume was not increased in implantable cardioverter-defibrillator HCM patients with malignant ventricular arrhythmias vs those without arrhythmias. Our findings do not support the use of ECV (a surrogate of diffuse fibrosis) as a predictor of arrhythmias in high-risk HCM patients.

The upper airway and obstructive sleep apnea in morbidly obese women.

STUDY OBJECTIVES: We are currently carrying out a study on the changes of the upper airway in morbidly obese women and the relationship of the upper airway with the severity of obstructive sleep apnea syndrome (OSAS). This study is similar to the study by Fogel RB et al, which appeared in Sleep 2003;2:150-5. DESIGN: Patients underwent a cardiorespiratory polygraphic sleep study, respiratory function test (spirometry, plethysmography, arterial blood gas analysis), and computed tomographic studies of the upper airway. PATIENTS: Thirteen morbidly obese women being evaluated for weight-reduction surgery. RESULTS: OSAS was present in all the patients. We found a positive correlation between the uvula diameter and age (r = 0.63, P = .02) and a negative correlation between the area of the oropharynx at the end of maximal expiration and the number of desaturations greater than 4% per hour (r = -0.58, P = .03). In the subgroup of patients with severe OSAS (7 cases), the area of the oropharynx at maximal inspiration had a negative correlation with the apnea-hypopnea index (r = -0.78, P = .03). The resistances of the airway positively correlated with apnea-hypopnea index (r = 0.89, P = .003), apnea index (r = 0.90, P = .03), and desaturation index (r = 0.91, P = .02). The Pao2 had a negative correlation with apnea-hypopnea index (r = -0.63, P = .02), apnea index (r = -0.65, P = .02), and desaturation index (r = -0.66, P = .02). CONCLUSIONS: Our results confirm that, in morbid obese women, airway resistance is higher in those patients with OSAS. We propose that airway resistance and Pao2 can also constitute a good predictor of apnea severity and that a reduction in the cross-sectional area of the airway at the level of the nasopharynx could be related to the severity of OSAS.

Behçet's disease involving the breast.

Behçet's disease is a vasculitis of unknown origin that was traditionally defined by oral and genital ulcers and uveitis. We describe a case of a patient with a diagnosis of Behçet's syndrome who presented a palpable lesion in the right breast with inflammatory signs. X-ray findings posed a differential diagnosis between tumoral and inflammatory pathology. The pathological findings confirmed a small-vessel vasculitis. We found two reports of breast involvement by this disease in the literature. Our patient was studied by mammogram and sonogram which together with clinical history are important to prevent delay in diagnosis and unnecessary therapeutic procedures.