Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload.

BACKGROUND: Myocardial iron overload in patients with thalassemia major (TM) is one of the most important complications. The purpose of the study was to identify advanced echocardiography parameters for early identification of myocardial dysfunction during follow-up of patients with TM. METHODS: Forty TM patients who were 41 ± 5 years old were included in the study and divided into two groups according to cardiac magnetic resonance T2* results (Group 1: Τ2* > 25 ms, Group 2: Τ2* ≤ 25 ms). Liver T2* parameters were also measured. Conventional and deformational echocardiographic parameters were measured at baseline and approximately 2 years later. RESULTS: Thirty-two patients had Τ2* = 34 ± 4 ms (Group 1), and 8 had Τ2* = 17 ± 9 ms (Group 2). Blood consumption was 185 ± 60 and 199 ± 37 ml/kg/yr (p = 0.64), and liver T2* was 4 ± 5 and 17 ± 21 ms (p = 0.01) in Groups 1 and 2, respectively. At baseline, Group 1 had better left ventricular global longitudinal strain (GLS) (- 22 ± 3 vs. - 18 ± 5, p = 0.01) and similar left ventricular ejection fraction (LVEF) (62 ± 5% vs. 58 ± 10%, p = 0.086) than Group 2. At the 28 ± 11-month follow-up, LVEF, GLS, and T2* values in Group 1 (63 ± 3%, - 21 ± 3%, 34 ± 4 ms) and Group 2 (56 ± 11%, - 17 ± 4%, 17 ± 9 ms) did not change significantly compared to their corresponding baseline values. In 8 patients from Group 1, a worsening (> 15%) in LS (p = 0.001) was detected during follow-up, with a marginal reduction in LVEF. CONCLUSIONS: GLS seems to be an efficient echocardiographic parameter for detecting hemochromatosis-related cardiac dysfunction earlier than LVEF. It also seems to be affected by other factors (free radical oxygen, immunogenetic mechanisms or viral infections) in a minority of patients, underscoring the multifactorial etiology of cardiomyopathy.

Ultrasound guidance for volume management in patients with heart failure.

Congestion is one of the most prominent characteristics of patients presented with decompensated heart failure and it implies unfavorable prognosis for the heart failure patient. Neurohumoral and immuno-inflammatory activation secondary to cardiac dysfunction constitute the pivotal mechanisms driving the heart failure syndrome that results in progressive fluid accumulation. In addition, fluid redistribution between different vascular compartments in human body guided from sympathetic activity constitutes another mechanism for heart failure decompensation. Ultrasound applied in the form of echocardiography provides invaluable data for the assessment of intracardiac filling pressures. The type of renal venous flow can provide the degree of renal congestion and probably insight into the pathophysiology of the decompensation of heart failure. Assessment of lung congestion in the patient with heart failure can be accomplished by lung ultrasonography. Additionally, clinical studies on the role of ultrasound in the management and prognosis of the congested patient are reviewed. Special heart failure population supported with left ventricular assist devices and extracorporeal membrane oxygenation support constitute an area where ultrasound guidance of fluid management has gained important role.

Acute effects of using an electronic nicotine-delivery device (electronic cigarette) on myocardial function: comparison with the effects of regular cigarettes.

BACKGROUND: Electronic cigarettes have been developed and marketed in recent years as smoking substitutes. However, no studies have evaluated their effects on the cardiovascular system. The purpose of this study was to examine the immediate effects of electronic cigarette use on left ventricular (LV) function, compared to the well-documented acute adverse effects of smoking. METHODS: Echocardiographic examinations were performed in 36 healthy heavy smokers (SM, age 36 ± 5 years) before and after smoking 1 cigarette and in 40 electronic cigarette users (ECIG, age 35 ± 5 years) before and after using the device with "medium-strength" nicotine concentration (11 mg/ml) for 7 minutes. Mitral flow diastolic velocities (E, A), their ratio (E/A), deceleration time (DT), isovolumetric relaxation time (IVRT) and corrected-to-heart rate IVRT (IVRTc) were measured. Mitral annulus systolic (Sm), and diastolic (Em, Am) velocities were estimated. Myocardial performance index was calculated from Doppler flow (MPI) and tissue Doppler (MPIt). Longitudinal deformation measurements of global strain (GS), systolic (SRs) and diastolic (SRe, SRa) strain rate were also performed. RESULTS: Baseline measurements were similar in both groups. In SM, IVRT and IVRTc were prolonged, Em and SRe were decreased, and both MPI and MPIt were elevated after smoking. In ECIG, no differences were observed after device use. Comparing after-use measurements, ECIG had higher Em (P = 0.032) and SRe (P = 0.022), and lower IVRTc (P = 0.011), MPI (P = 0.001) and MPIt (P = 0.019). The observed differences were significant even after adjusting for changes in heart rate and blood pressure. CONCLUSIONS: Although acute smoking causes a delay in myocardial relaxation, electronic cigarette use has no immediate effects. Electronic cigarettes' role in tobacco harm reduction should be studied intensively in order to determine whether switching to electronic cigarette use may have long-term beneficial effects on smokers' health. TRIAL REGISTRATION: Current Controlled Trials ISRCTN16974547.

Acute and chronic effects of smoking on myocardial function in healthy heavy smokers: a study of Doppler flow, Doppler tissue velocity, and two-dimensional speckle tracking echocardiography.

BACKGROUND: The purpose of the study was to evaluate the acute and chronic effect of smoking on left ventricular function in healthy heavy smokers by conventional Doppler flow, tissue Doppler, and two-dimensional speckle tracking echocardiography (2D-STE). METHODS: Echocardiograms were performed in 42 healthy heavy (>20 cigarettes/day) smokers (age 34 ± 5 years), before (group SM-1), 15 minutes (SM-2) and 30 minutes (SM-3) after starting smoking 2 cigarettes. Nonsmokers (n = 41, age 33 ± 4 years) served as controls. Transmitral flow, isovolumetric relaxation time (IVRT), and myocardial performance index (MPI) were measured. Tissue velocity measurements were averaged from lateral and septal mitral annulus. Longitudinal strain (GS), systolic (SRs), early diastolic (SRe), late diastolic (SRa), and isovolumetric relaxation (SRivr) strain rate were measured. The percent change in strain from end-systole to the first one-third of diastole (SI-DI = [(GS - strain at one-third diastole)/GS] × 100) was also measured. RESULTS: IVRT and MPI were increased and early diastolic mitral annular velocity was decreased in SM-2; they returned to baseline in SM-3. There was no difference in GS and SRs. SRe and SRivr were reduced in SM-1 (P < 0.05), and remained significantly reduced in SM-2 and SM-3. SI-DI was lower in SM-1 (P = 0.011) and was further reduced in SM-2 and SM-3 (P < 0.001). CONCLUSION: Acute and chronic smoking inhalation has adverse effects on myocardial function in healthy heavy smokers. 2D-STE is able to detect both baseline differences and late acute effects of smoking.

Inappropriate shocks from a transvenous implantable defibrillator caused by atrial fibrillation and a missed atrial septal defect in a patient with a modified Bentall procedure.

BACKGROUND: Inappropriate shocks have been reported in ∼1/3 of patients with implantable cardiac defibrillators (ICDs). We report an unusual case of inappropriate ICD shocks due to atrial fibrillation (AF) caused by a missed atrial septal defect (ASD) in a patient with a modified Bentall procedure. CASE SUMMARY: A 67-year-old Caucasian male, with an ICD and a history of a modified Bentall procedure 24 years ago, reported to our outpatient clinic with recurrent inappropriate ICD shocks due to episodes of fast AF. The transthoracic echocardiographic exam revealed two large aneurysms at the ostia of the coronary arteries. We performed further evaluation with transoesophageal echocardiogram and computed tomography (CT) angiography. The aneurysms measured on CT were 3.14 cm × 2.29 cm on the right ostium and 1.9 cm × 0.99 cm on the left. A large secundum type ASD of 1.5 cm, missed in all previous echocardiographic studies, was revealed. The therapeutic options of surgical closure of the ASD and repair of the aneurysms or a more conservative approach with percutaneous closure of the ASD and closer follow-up were discussed with the patient. The patient declined the surgical option due to high complication risk, and closure of the ASD with an Amplatzer device was performed 3 months later. A 3-year follow-up was uneventful. CONCLUSION: It is of major importance to comprehensively and thoroughly assess patients before and after a surgical intervention to not miss other treatable conditions preoperatively and complications in the postoperative period.

Preserved diagnostic performance of dual-source CT coronary angiography with reduced radiation exposure and cancer risk.

PURPOSE: To evaluate the effects of standard and optimal electrocardiographic (ECG) pulsing on diagnostic performance, radiation dose, and cancer risk in symptomatic patients in a "real-world" clinical setting. MATERIALS AND METHODS: The institutional review board approved the study, and all patients gave informed consent. Dual-source computed tomographic (CT) coronary angiography was performed in 436 symptomatic patients (301 men, 135 women; mean age, 61.6 years +/- 10.6 [standard deviation]; age range, 23-89 years) referred for conventional coronary angiography. Standard and optimal ECG pulsing was performed in 327 and 109 patients, respectively. The diagnostic performance of dual-source CT coronary angiography for detection of significant stenosis (>or=50 luminal diameter reduction), with quantitative coronary angiography as the reference standard, was reported as sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios. The mean effective radiation dose, additional fatal cancer risk, and age- and sex-specific cancer risks related to one CT coronary angiographic examination were determined from data averaged over the study population. RESULTS: Mean effective doses with standard and optimal ECG pulsing were 14.2 mSv +/- 3.2 and 10.7 mSv +/- 3.6, respectively. Optimal ECG pulsing resulted in a 43% overall reduction in mean effective radiation dose and cancer risk compared with a nonpulsing protocol (18.8 mSv +/- 3.5) and a 25% overall reduction in mean effective dose compared with the standard pulsing protocol. At patient-by-patient analysis, CT coronary angiography with standard ECG pulsing yielded sensitivity, specificity, and positive and negative predictive values of 100% (95% confidence interval [CI]: 99%, 100%), 85% (95% CI: 81%, 88%), 94% (95% CI: 91%, 96%), and 99% (95% CI: 98%, 100%), respectively, for detection of significant stenosis. Optimal ECG pulsing yielded similar results: Sensitivity, specificity, and positive and negative predictive values were 100% (95% CI: 100%, 100%), 88% (95% CI: 82%, 94%), 97% (95% CI: 93%, 100%), and 100%, respectively. CONCLUSION: Compared with a nonpulsing protocol, optimal ECG pulsing resulted in significant (P < .001) reductions in patient radiation dose and cancer risk (up to 55% reduction in patients with high heart rates) while preserving the diagnostic performance of dual-source CT coronary angiography.

Impact of heart rate frequency and variability on radiation exposure, image quality, and diagnostic performance in dual-source spiral CT coronary angiography.

PURPOSE: To investigate the effect of heart rate frequency (HRF) and heart rate variability (HRV) on radiation exposure, image quality, and diagnostic performance to help detect significant stenosis (> or =50% lumen diameter reduction) by using adaptive electrocardiographic (ECG) pulsing at dual-source (DS) spiral computed tomographic (CT) coronary angiography. MATERIALS AND METHODS: Institutional review committee approval and informed consent were obtained. No prescan beta-blockers were applied. Unenhanced CT and CT coronary angiography with adaptive ECG pulsing were performed in 927 consecutive patients (600 men, 327 women; mean age, 60.3 years +/- 11.0 [standard deviation]) divided in three HRF groups: low, intermediate, and high (< or =65, 66-79, and > or =80 beats/min, respectively), and four HRV groups given mean interbeat difference (IBD) during CT coronary angiography: normal, minor, moderate, and severe (IBDs of 0-1, 2-3, 4-10, and >10, respectively). Radiation exposure and image quality were also evaluated. In 444 of these, diagnostic performance was presented as sensitivity, specificity, positive predictive values (PPVs), and negative predictive values and likelihood ratios with corresponding 95% confidence intervals by using quantitative coronary angiography as the reference standard. RESULTS: CT coronary angiography yielded good image quality in 98% of patients and no significant differences in image quality were found among HRF and HRV groups. Radiation exposure was significantly higher in patients with low versus high HRF and in patients with severe versus normal HRV. No significant differences among HRF and HRV groups in image quality and diagnostic performance were found. A nonsignificant trend was found toward a lower specificity and PPV in patients with a high HRF or severe HRV when compared with low HRF or normal HRV in patients with a low calcium score (Agatston score <100). CONCLUSION: DS spiral CT coronary angiography performed with adaptive ECG pulsing results in preserved diagnostic image quality and performance independent of HRF or HRV at the cost of limited dose reduction in arrhythmic patients.

Expression profile of total VEGF, VEGF splice variants and VEGF receptors in the myocardium and arterial vasculature of diabetic and non-diabetic patients with coronary artery disease.

BACKGROUND: Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis and is implicated in the development of diabetic microvascular and macrovascular disease. METHODS: The expression of total VEGF, VEGF splice variants (VEGF(121), VEGF(145), VEGF(148), VEGF(165), VEGF(183) and VEGF(189)), VEGFR-1 and VEGFR-2, was investigated in biopsies from the right atrium and left internal mammary artery (LIMA) of 32 non-diabetic and 20 diabetic patients undergoing coronary artery bypass grafting. RESULTS: Diabetes was independently negatively correlated to total VEGF mRNA expression in atrium. Total VEGF, VEGF(121) and VEGF(165) mRNA levels were upregulated in the LIMA of diabetics vs. non-diabetics. The expression of VEGF receptors in atrium and LIMA was similar between these groups. VEGF(121) and VEGF(165) were the major variants expressed, followed by VEGF(189) and VEGF(183), while VEGF(148) and VEGF(145) were detected in small amounts. The expression profile of VEGF splice variants displayed significant heterogeneity between the examined tissues. CONCLUSIONS: This is the first study to quantify VEGF splice variants expression in cardiac and vascular tissue. Our results could help elucidate the role of VEGF splice variants in diabetic complications.

Ischemia modified albumin in relation to pharmacologic stress testing in coronary artery disease.

BACKGROUND: Ischemia modified albumin (IMA) is considered a biomarker of myocardial ischemia. We sought to investigate whether IMA plasma levels change during pharmacological stress test, in patients with stable coronary artery disease. METHODS: We studied 37 patients undergoing non-invasive evaluation with a pharmacological stress test, either with radionuclide myocardial perfusion imaging with adenosine or stress echocardiography with dobutamine. Peripheral venous samples were collected before the stress test (baseline), at the end of adenosine infusion or at the peak dose of dobutamine and 60 min after the completion of the stress test for IMA measurement. RESULTS: IMA plasma levels significantly increased at peak vs. baseline (91.28+/-9.59 U/ml vs. 97.97+/-9.69 U/ml, p<0.0001) and subsequently, decreased significantly at 60 min compared to peak (97.97+/-9.69 U/ml vs. 94+/-15.22 U/ml, p=0.016), returning to values similar to those at baseline (p=0.134). Similarly, in patients with a negative stress test, IMA significantly increased at peak compared to baseline (91.08+/-10.03 U/ml vs. 99.58+/-8.43 U/ml, p=0.006) and returned to baseline at 60 min (99.58+/-8.43 U/ml vs. 91.83+/-7.93 U/ml, p=0.019), the 60 minute levels being similar to baseline values (p=0.212). Conversely, in patients with a positive stress test, IMA significantly increased at peak compared to baseline (91.38+/-10.13 U/ml vs. 97.17+/-10.34 U/ml, p=0.006) and although decreased at 1 h, this did not reach statistical significance compared either to the baseline or to the peak values (95.04+/-17.76 U/ml vs. 91.38+/-10.13 U/ml, p=0.315 and 95.04+/-17.76 U/ml vs. 97.17+/-10.34 U/ml, p=0.235, respectively). CONCLUSION: IMA plasma levels change significantly during pharmacologic stress testing, in patients with coronary artery disease, but with no difference between the positive and the negative tests.

Endothelin system and atrial fibrillation post-cardiac surgery.

OBJECTIVE: We investigated the relation between the endothelin system and atrial fibrillation. BACKGROUND: Endothelin has been implicated in the pathophysiology of atrial fibrillation, but the exact role of A- and B-receptors is unknown. METHODS: We obtained right atrial biopsies from patients in sinus rhythm and preserved left ventricular function, undergoing off-pump coronary artery bypass grafting. The expression of endothelin, A- and B-receptors was measured using real time reverse-transcribed polymerase chain reaction. RESULTS: We studied 52 patients (45 male, mean age 66+/-1 years, mean ejection fraction 52+/-1%). During a 5-day post-operative period, persistent atrial fibrillation occurred in 15 patients (28.8%). Endothelin mRNA expression was comparable in patients who subsequently developed atrial fibrillation and in those maintaining sinus rhythm. However, the former group displayed down-regulation of endothelin A- (by approximately 60%, p=0.0059) and of B-receptors (by approximately 40%, p=0.0084). The decreased endothelin A-receptor expression could predict atrial fibrillation occurrence (Wilks lambda=0.86, F=6.16, p=0.017). CONCLUSION: Decreased endothelin A- and B-receptor expression is associated with atrial fibrillation after bypass surgery.

Ventricular long-axis contraction as an earlier predictor of outcome in asymptomatic aortic regurgitation.

The long-term prognostic significance of left ventricular (LV) long-axis contraction was investigated prospectively in 65 consecutive patients aged 58+/-15 years with asymptomatic aortic regurgitation, normal LV ejection fraction at rest, and no coronary artery or aortic root disease. A complete transthoracic echocardiographic study was performed at baseline and 12 months later. In 24 of 65 patients with peak systolic wave velocity at the lateral mitral annulus (LatS)<9 cm/s, LV diameter (p<0.01), volume (por=9 cm/s, none of these parameters was significantly affected during follow-up. Aortic valve replacement was performed in 6 of 24 patients (25%) with peak systolic wave velocity at the lateral mitral annulus<9 cm/s and none with peak systolic wave velocity at the lateral mitral annulus>or=9 cm/s. In patients with peak systolic wave velocity at the lateral mitral annulus<9 cm/s, a cut-off value of 6.25 cm/s predicted aortic valve replacement within the next year with 97% sensitivity and 83% specificity. In conclusion, ventricular long-axis contraction seems to be a reliable indicator for outcome prediction in patients with asymptomatic aortic regurgitation.

The effects of tirofiban on peripheral markers of oxidative stress and endothelial dysfunction in patients with acute coronary syndromes.

BACKGROUND: Endothelial dysfunction and oxidative stress are believed to be central mechanisms in atherogenesis. We aimed to determine the effects of tirofiban on oxidative stress and neutrophil-endothelium interaction markers in patients with acute coronary syndromes (ACS). MATERIALS AND METHODS: We measured malondialdehyde (MDA), interleukin-6 (IL-6) and soluble endothelial intercellular and vascular adhesion molecules (sICAM-1 and sVCAM-1) on admission, at 48 and 72 h and on 5th day of hospitalization in 34 patients (age 66.5+/-1.8 years) with ACS. Patients with recurrent angina, changes on the electrocardiogram and/or elevated troponin I received intravenously tirofiban for 48 h and the others received normal saline. RESULTS: Baseline concentrations of all markers did not differ significantly and compared with placebo, tirofiban infusion markedly reduced MDA, IL-6, sICAM-1 and sVCAM-1 at 48 h (-31+/-6% vs. 84+/-49%, p=0.007, -12+/-14% vs. 23+/-10%, p=0.05, -20+/-6% vs. 36+/-25%, p=0.04 and -10+/-5% vs. 6+/-5%, p=0.02, respectively). Relative to baseline, significant reductions were observed for all 4 markers at 72 h and day 5 (p<0.05). CONCLUSION: Tirofiban potentiates the decline in oxidative stress and may reverse abnormal endothelial activation in patients with ACS. This benefit seems to remain over the following 5 days.

Repeated balloon inflations do not diminish ST segment elevation even though coronary collateral recruitment is promoted in pigs.

OBJECTIVE: Attempts to demonstrate preconditioning during repeated angioplasty balloon inflations (BIs) have not been universally successful. The main obstacle is that the first BI is unreliable, due to the variable degrees of occlusion by the deflated balloon. In the present study, we examined whether ST segment elevation decreases and evaluated its relation to collateral recruitment during repeated angioplasty BIs in the pig. METHODS AND RESULTS: Twenty male pigs, 7 months old, under general anesthesia, underwent 3 repeated BIs of 120 s, with a 5-min interval between them, in the left anterior descending artery or the right coronary artery. A pressure wave wire was used for the measurement of coronary wedge pressure and to obtain the intracoronary ST segment elevation. Intracoronary ST segment elevation was 1.97 +/- 0.76 mV during the 1st BI, 2.09 +/- 0.82 mV during the 2nd BI and 1.84 +/- 0.82 mV during the 3rd BI (p = n.s.). Coronary wedge pressure was 12 +/- 6, 18 +/- 18 and 20 +/- 20 mm Hg (p < 0.05 vs. 1st BI) during the 3 BIs, respectively. CONCLUSION: Repeated BIs do not diminish ST segment elevation in the pig model, even though coronary collateral recruitment is promoted.

Familial origin of atrial septal aneurysm.

The familial origin of atrial septal defects has been previously reported. This is the first study describing 2 families with atrial septal aneurysm of familial origin. The present study represents both clinically manifested and silent atrial septal aneurysms. Moreover, female gender predominance is also reported. Based on the presented data it could be suggested that all first-degree relatives of affected patients should be screened by cross-sectional echocardiography, particularly if they are women. In these patients, the use of aspirin might be the first line of treatment.

Ascorbic acid prevents contrast-mediated nephropathy in patients with renal dysfunction undergoing coronary angiography or intervention.

BACKGROUND: Contrast agents can cause a reduction in renal function that may be due to the generation of reactive oxygen species. Conflicting evidence suggests that administration of the antioxidant acetylcysteine prevents this renal impairment. The action of other antioxidant agents has not been investigated. METHODS AND RESULTS: We conducted a randomized, double-blind, placebo-controlled trial of ascorbic acid in 231 patients with a serum creatinine concentration > or =1.2 mg/dL who underwent coronary angiography and/or intervention. Ascorbic acid, 3 g at least 2 hours before the procedure and 2 g in the night and the morning after the procedure, or placebo was administered orally. Contrast-mediated nephropathy was defined by an absolute increase of serum creatinine > or =0.5 mg/dL or a relative increase of > or =25% measured 2 to 5 days after the procedure. Contrast-mediated nephropathy occurred in 11 of the 118 patients (9%) in the ascorbic acid group and in 23 of the 113 patients (20%) in the placebo group (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.17 to 0.85; P=0.02). The mean serum creatinine concentration increased significantly in the placebo group (from 1.36+/-0.50 to 1.50+/-0.54 mg/dL, P<0.001) and nonsignificantly in the ascorbic acid group (from 1.46+/-0.52 to 1.52+/-0.64 mg/dL, P=0.07). The mean increase in serum creatinine concentration was greater in the placebo group than in the ascorbic acid group (difference of 0.09 mg/dL; 95% CI, 0.00 to 0.17; P=0.049). CONCLUSIONS: Prophylactic oral administration of ascorbic acid may protect against contrast-mediated nephropathy in high-risk patients undergoing a coronary procedure.

Corrigendum: Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers).

This Article contains a typographical error in the Methods section under the subheading "Materials and clinical procedure". "The results of the two tests after excluding the question on cigarette and EC consumption were also reported (as FTCD-modified and CDS-modified, Table 1)." should read: "The results of the two tests after excluding the question on cigarette and EC consumption were also reported (as FTCD-modified and CDS-modified, Table 2)."

Nicotine absorption from electronic cigarette use: comparison between experienced consumers (vapers) and naïve users (smokers).

Electronic cigarettes (ECs) are nicotine delivery devices that are proposed as tobacco harm reduction products to smokers. Nicotine delivery from ECs is potentially important in their efficacy as smoking substitutes. Herein, nicotine delivery from using a new-generation EC device (variable-wattage, set at 9 W) was evaluated, comparing experienced (vapers) with naïve users (smokers). Twenty-four vapers and 23 smokers participated to the study. They were asked to obtain 10 puffs in 5 minutes and then use the EC ad lib for 60 more minutes (total duration of use: 65 minutes). An 18 mg/mL nicotine-containing liquid was used. Blood samples were obtained at baseline, 5-minutes and every 15 minutes thereafter, while number of puffs and average puff duration were recorded. Although at baseline both groups had similar plasma nicotine levels, smokers consistently exhibited lower levels at all time-periods; at 5-minutes the levels were lower by 46%, while during the subsequent period they were lower by 43% (at 65-minutes) to 54% (at 20-minutes). Both groups took similar number of puffs, but smokers had average puff duration of 2.3 s compared to 3.5 s in vapers. Even in vapers, plasma nicotine levels at 5 minutes were lower than those observed after smoking 1 tobacco cigarette.

Endothelin-A receptor antagonism promotes decreased vasodilation but has no differential effect on coronary artery compliance in hypertensive patients.

The importance of endothelin-1 in the pathophysiology of essential hypertension is unclear. We therefore examined whether there is a differential effect of endothelin-A antagonism on vasodilation and coronary artery compliance in hypertensive compared to normotensive patients. We examined atherosclerotic non-stenotic arteries from 18 non-diabetic, 10 normotensive patients and eight hypertensive patients, before and after intracoronary infusion of BQ-123 (6 mumol), an endothelin-A receptor antagonist. The systolic and diastolic artery lumen area in the proximal segment was measured using an intravascular ultrasound catheter. Systolic blood pressure decreased only in hypertensive patients (F = 5.44, P = 0.03), after BQ-123 administration. The diastolic artery lumen increased from 8.9 +/- 2.9 mm at baseline to 10.8 +/- 3.0 mm after BQ-123 administration (P < 0.05) in normotensive patients and from 10.6 +/- 4.6 mm to 10.8 +/- 4.0 mm (P = NS) in the hypertensive patients (F = 3.98, P = 0.01). The respective values for the systolic artery lumen, in the two groups, before and after BQ-123 were: 10.2 +/- 3.4 mm and 12.7 +/- 3.2 mm (P < 0.01) in the normotensive group and 12.0 +/- 5.5 mm and 12.8 +/- 5.0 mm (P = NS) in the hypertensive group (F = 3.37, P = 0.08). Artery compliance did not have a differential response to BQ-123. In conclusion, endothelin-A antagonism causes decreased vasodilation but does not have a differential effect on coronary artery compliance in hypertensive patients.

Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers.

BACKGROUND: Electronic cigarette (EC) use has grown exponentially over the past few years. The purpose of this survey was to assess the characteristics and experiences of a large sample of EC users and examine the differences between those who partially and completely substituted smoking with EC use. METHODS: A questionnaire was prepared, translated into 10 different languages and uploaded in an online survey tool. EC users were asked to participate irrespective of their current smoking status. Participants were divided according to their smoking status at the time of participation in two subgroups: former smokers and current smokers. RESULTS: In total, 19,414 participants were included in the analysis, with 88 of them (0.5%) reported not being smokers at the time of EC use initiation. Complete substitution of smoking was reported by 81.0% of participants (former smokers) while current smokers had reduced smoking consumption from 20 to 4 cigarettes per day. They were using ECs for a median of 10 months. They initiated EC use with a median of 18 mg/mL nicotine-concentration liquids; 21.5% used higher than 20 mg/mL. Only 3.5% of participants were using 0-nicotine liquids at the time of the survey. Former smokers were highly dependent (Fagerström Test for Cigarette Dependence = 7) and were heavier smokers (21 cigarettes per day when smoking) compared to current smokers. The most important reasons for initiating EC use for both subgroups was to reduce the harm associated with smoking and to reduce exposure of family members to second-hand smoking. Most considered ECs as less harmful than tobacco cigarettes, while 11.0% considered them absolutely harmless. Side effects were reported by more than half of the participants (59.8%), with the most common being sore/dry mouth and throat; side effects were mild and in most cases were subsequently resolved (partially or completely). Participants experienced significant benefits in physical status and improvements in pre-existing disease conditions (including respiratory disease such as asthma and chronic obstructive lung disease). Being former smoker was independently associated with positive effects in health and improvements in disease conditions. CONCLUSIONS: The results of this worldwide survey of dedicated users indicate that ECs are mostly used to avoid the harm associated with smoking. They can be effective even in highly-dependent smokers and are used as long-term substitutes for smoking. High levels of nicotine are used at initiation; subsequently, users try to reduce nicotine consumption, with only a small minority using non-nicotine liquids. Side effects are minor and health benefits are substantial, especially for those who completely substitute smoking with EC use. Further population and interventional studies are warranted.

Growth rate of an apical left ventricular myxoma using serial two dimensional echocardiographic and computed tomography observations over twelve months: a case report.

INTRODUCTION: Myxomas are the most common benign tumors of the heart. They vary widely in size, and little is known about their growth rate. The present case report is, we believe the first in bibliography that provides images of an apical left ventricular myxoma from transthoracic echocardiography and computed tomography scans taken a year apart. CASE PRESENTATION: We present the rare case of a 65-year-old asymptomatic Caucasian man with an apical left ventricular myxoma that grew over a 12-month period. Our patient underwent successful surgical excision of the tumor and had an uneventful postsurgical recovery period. CONCLUSIONS: Left ventricular myxomas are benign and curable tumors. They do not usually present with systemic symptomatology and most of them are diagnosed as sequelae of syncope caused by left ventricular outflow tract obstruction or systemic embolization. Because they are usually removed after diagnosis, the growth rate of myxomas is generally unknown. We present a rare case of the asymptomatic presentation of a left ventricular myxoma and its documented growth during a 12-month period.