Right ventricular dysfunction in stress cardiomyopathy: The prognostic value of fractional area change.

BACKGROUND: There are limited data on the impact of right ventricular dysfunction (RVD) on the clinical outcomes in patients with stress cardiomyopathy (SC). The purpose of this study was to evaluate the impact of RVD on outcomes and to characterize the prognostic value of RV fractional area change (FAC). METHODS: This study retrospectively analyzed data from 111 consecutive patients with SC. The primary endpoint, major cardiac events (MCE), was a composite of 30-day mortality, cardiogenic shock, life threatening arrhythmias, and stroke. Regression analysis was used to identify independent predictors of short (30 days)- and long-term MCE. RESULTS: Among the 111 patients (80.2% females, mean age 45.8 ± 11.5 years), RVD was present in 17(15.3%) patients. MCE occurred in 18(16.2%) and 22(19.8%) patients at 30 days and during long-term follow-up, respectively. RVD was an independent predictor of short (HR 1.88(1.21-15.67), P = .036)- and long (HR 1.65(1.11-9.67), P = .016)-term MCE. Compared with tricuspid annular plane systolic excursion < 15 mm (TAPSE) (sens 72.2%, spec 94.1%, AUC 0.75) and tricuspid annulus pulsed TDI-derived peak systolic velocity (S') < 9.5 cm/s (sens 67.2%, spec 94.5%, AUC 0.72), RV FAC < 30% (sens 89.1%, spec 100%, AUC 0.92) had the highest accuracy and discriminative ability to predict MCE. Furthermore, RV FAC < 30% was a significant predictor of recurrence (29.4% vs 2.1%, P = .002) and delayed recovery time (21.4 ± 6.8 vs 8.5 ± 4.3 days, P < .001). CONCLUSIONS: The presence of RVD in stress cardiomyopathy identifies patients at higher risk of mortality, complications, delayed recovery, and recurrence. Compared with other indices, RV FAC has the highest prognostic ability to predict these outcomes.

Primary transcatheter closure of post-myocardial infarction ventricular septal rupture using amplatzer atrial septal occlusion device: A study from tertiary care in South India.

OBJECTIVE: The study investigated effectiveness of transcatheter closure of post-myocardial infarction (MI) ventricular septal rupture (VSR) using atrial septal device (ASD) occluder in a cohort of patients admitted at our institute. METHOD: This was a retrospective, observational and single center study, which included patients who were treated with transcatheter closure for post-MI VSR at our tertiary care center between May 2000 and August 2014 depending upon inclusion and exclusion criteria. Primary outcome was all-cause mortality at 30-days follow-up. The MELD-XI (Model for End Stage Liver Disease) score was used as a predictor for poor outcome in these patients. RESULTS: A total of 21 patients (mean age 66.4±5.9years) were included in the study. Study cohort predominantly included male patients (n=15; 71.4%) and patients with single vessel disease (n=15; 71.4%). Revascularization of the culprit lesion, before VSR closure, was attempted in 6 patients. Except one patient (treated with Cera® occluder), all patients were treated with Amplatzer® ASD occluders. Average diameter of VSR was 20.8±6.9mm. Diameter of the device used in the study ranged from 10mm to 30mm. Residual defect was detected in 13 patients (62%). All-cause mortality at 30-day follow-up was observed in 9 (42.9%) patients. Time to VSR closure, diameter of VSR, and serum creatinine levels were significantly related to the 30-day mortality. MELD-XI score was found to be strongly associated with increased risk of mortality. CONCLUSION: Primary transcatheter VSR closure using ASD occluders is a feasible approach which can provide reasonable survival outcomes along with equitable mortality rates.

A randomized study of coconut oil versus sunflower oil on cardiovascular risk factors in patients with stable coronary heart disease.

BACKGROUND AND RATIONALE: Coronary artery disease (CAD) and its pathological atherosclerotic process are closely related to lipids. Lipids levels are in turn influenced by dietary oils and fats. Saturated fatty acids increase the risk for atherosclerosis by increasing the cholesterol level. This study was conducted to investigate the impact of cooking oil media (coconut oil and sunflower oil) on lipid profile, antioxidant mechanism, and endothelial function in patients with established CAD. DESIGN AND METHODS: In a single center randomized study in India, patients with stable CAD on standard medical care were assigned to receive coconut oil (Group I) or sunflower oil (Group II) as cooking media for 2 years. Anthropometric measurements, serum, lipids, Lipoprotein a, apo B/A-1 ratio, antioxidants, flow-mediated vasodilation, and cardiovascular events were assessed at 3 months, 6 months, 1 year, and 2 years. RESULTS: Hundred patients in each arm completed 2 years with 98% follow-up. There was no statistically significant difference in the anthropometric, biochemical, vascular function, and in cardiovascular events after 2 years. CONCLUSION: Coconut oil even though rich in saturated fatty acids in comparison to sunflower oil when used as cooking oil media over a period of 2 years did not change the lipid-related cardiovascular risk factors and events in those receiving standard medical care.