Evaluation of arterial stiffness for predicting future cardiovascular events in patients with ST segment elevation and non-ST segment elevation myocardial infarction.

BACKGROUND: Arterial stiffness parameters in patients who experienced MACE after acute MI have not been studied sufficiently. We investigated arterial stiffness parameters in patients with ST segment elevation (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI). METHODS: Ninety-four patients with acute MI (45 STEMI and 49 NSTEMI) were included in the study. Arterial stiffness was assessed noninvasively by using TensioMed Arteriograph. RESULTS: Arterial stiffness parameters were found to be higher in NSTEMI group but did not achieve statistical significance apart from pulse pressure (P = 0.007). There was no significant difference at MACE rates between two groups. Pulse pressure and heart rate were also significantly higher in MACE observed group. Aortic pulse wave velocity (PWV), aortic augmentation index (AI), systolic area index (SAI), heart rate, and pulse pressure were higher; ejection fraction, the return time (RT), diastolic reflex area (DRA), and diastolic area index (DAI) were significantly lower in patients with major cardiovascular events. However, PWV, heart rate, and ejection fraction were independent indicators at development of MACE. CONCLUSIONS: Parameters of arterial stiffness and MACE rates were similar in patients with STEMI and NSTEMI in one year followup. The independent prognostic indicator aortic PWV may be an easy and reliable method for determining the risk of future events in patients hospitalized with acute MI.

Electrocardiographic right ventricular hypertrophy predicts the severity of pulmonary hypertension in patients with mitral stenosis.

OBJECTIVES: Rheumatic heart disease is still common in developing countries. Mitral stenosis impedes left atrial emptying, increases left atrial and pulmonary venous pressure, and thus causes pulmonary hypertension. Pulmonary hypertension results in right ventricular hypertrophy (RVH), implying that the disease is long lasting and needs interventional treatment. The aim of our study was to predict the severity of pulmonary hypertension in patients with mitral stenosis by evaluating electrocardiographic RVH. STUDY DESIGN: Patients admitted to our hospital with mitral stenosis were evaluated. Their clinical, electrocardiographic, and echocardiographic parameters were recorded. Electrocardiographic RVH was diagnosed when at least 2 of the following criteria were present at the same time: V1R+V5S or V6S >10.5 mm, V1R >6 mm, R >S in V1, V1 S <2 mm, V6 R/S <0.4, V5.6 R <3 mm, aVR R >4 mm, and right axis deviation. RESULTS: Sixty-seven patients (13 males, 54 females; mean age: 44.9±14.5 years; range 18 to 80 years) were included in the study. One male patient and 14 female patients were diagnosed as having electrocardiographic RVH. Pulmonary arterial pressure, right atrial and ventricular dimensions, peak and mean transmitral gradients were higher, and mitral valve area was lower in patients with RVH. The presence of RVH predicted pulmonary arterial pressure as 60 mmHg or higher with the sensitivity of 93% and specificity of 92%. CONCLUSION: Electrocardiographic RVH was found to be related to more severe mitral stenosis, higher pulmonary arterial pressure, and larger right heart chambers. RVH can be a simple and useful parameter to predict the severity of pulmonary hypertension.

The treatment of heart failure-related symptoms with ivabradine in a case with peripartum cardiomyopathy.

ABSTRACT: Peripartum cardiomyopathy is a form of dilated cardiomyopathy that is defined as deterioration in cardiac function presenting typically between the last month of pregnancy and up to five months postpartum. As with other forms of dilated cardiomyopathy, PPCM involves systolic dysfunction of the heart with a decrease of the left ventricular ejection fraction with associated congestive heart failure. In heart failure sinus tachycardia is a poor prognostic factor and the common symptom. In this paper, we presented a case treated with ivabradine which provided additional benefit in patient with acute heart failure.

Coronary artery fistula presenting as unstable angina pectoris in patients with antiphospholipid syndrome.

The cardiovascular system is one of the primary targets in patients with antiphospholipid syndrome. The valves are the most frequently affected. Atherosclerosis and coronary thrombosis are also seen. The risk of acute coronary syndrome is 10 times higher in patients with APS. We present an APS patient case who was hospitalized with acute coronary syndrome and who was later found to have coronary artery fistula.