Frontal QRS - T angle is associated with severity and prognosis of acute pulmonary embolism.

INTRODUCTION: The pathological effects of acute pulmonary embolism (APE) on the right ventricle are one of the most important determinants of mortality in patients with APE. Frontal QRS-T angle (fQRSTa) predicts ventricular pathology and poor prognosis in many different cardiovascular diseases. In this study, we investigated whether there is a significant relationship between fQRSTa and APE severity. MATERIAL AND METHODS: A total of 309 patients were included in this retrospective study. The severity of APE was classified as massive (high risk), submassive (intermediate risk), or nonmassive (low risk). fQRSTa calculated from standard ECGs. RESULTS: fQRSTa was significantly higher in massive APE patients (p < 0.001). fQRSTa was also found to be significantly higher in the in-hospital mortality group (p < 0.001). fQRSTa was an independent risk factor for the development of massive APE (odds ratio:1.033; 95% CI: 1.012-1.052; p < 0.001). CONCLUSION: Our study showed that increased fQRSTa predicts high-risk APE patients and mortality in APE patients.

The role of prognostic nutritional index in patients with non-ST segment elevation acute coronary syndrome.

Objective The importance of nutritional status in non-ST segment elevated acute coronary syndrome (NSTE-ACS) is not clear. In this study, the importance of prognostic nutritional index (PNI) in terms of in-hospital mortality in patients with NSTE-ACS and its relationship with the Global Record of Acute Coronary Events (GRACE) risk score were investigated.Material and methods A total of 498 consecutive NSTE-ACS patients were recorded retrospectively. PNI for nutritional status assessment of patients with NSTE-ACS. PNI was calculated as 10 × serum albumin (g / dL) + 0.005 × total lymphocyte count (per mm3). The association between PNI and GRACE risk score was assessed.Results Patients were classified as low-risk group (≤108 points, n=222), medium-risk group (109-140 points, n=161) and high-risk group (>140 points, n=115) according to the GRACE score. The mean PNI value was found to be the lowest in the high-risk group compared to other risk groups. There was a significant negative correlation between GRACE risk score and PNI (p<0.001). In multivariate analysis, PNI resulted as a predictor of in-hospital mortality independent of GRACE risk score (OR=0.909; 95 % CI: 0.842-0.981; p=0.01). PNI value in the high risk group for in-hospital mortality was determined to have significant predictive ability (AUC=0.710; 95 % CI: 0.61-0.80; p<0001).Conclusions PNI evaluation is a useful and easy method to evaluate the nutritional status of patients with NSTE-ACS. Our study suggests that the PNI is significantly associated with in-hospital mortality, and GRACE risk score in patients with NSTE-ACS. This study is the basis for new studies to investigate whether PNI contributes additional prognostic to the GRACE risk score.

Cryoballoon ablation of focal atrial tachycardia originating from right atrial appendage: Case report and review of the literature.

The right atrial appendage (RAA) is a rare site of focal atrial tachycardia (AT). Sometimes, catheter ablation cannot successfully be accomplished at this location due to the difficulty in reaching the exact ablation site as well as the associated possible life-threatening complications like pericardial tamponade or perforation. Although radiofrequency (RF) ablation is preferred for the treatment of RAA tachycardias, alternative tools may be required in rare instances. This report presents a case of RAA tachycardia that was not terminated by RF ablation, instead, has been successfully ablated using cryoballoon. In addition, an overview of the literature and therapeutic options for the AT originating from RAA have also been included.

Comparison of atrial fibrillation predictors in patients with acute coronary syndrome using ticagrelor or clopidogrel

Background/aim: Ticagrelor is a drug widely used in patients with acute coronary syndromes (ACS) that specifically increases the plasma level of adenosine, which is likely to cause atrial fibrillation (AF). Therefore, in this study we aimed to investigate the electrocardiographic and echocardiographic predictors of AF development after P2Y12 receptor antagonists in ACS patients. Materials and methods: This cross-sectional study included 831 patients with ACS (486 [58.5%] with ST elevated myocardial infarction [STEMI] and 345 [41.5%] with non-ST elevated myocardial infarction [NSTEMI]). Patients were divided into ticagrelor (n = 410) and clopidogrel (n = 421) groups. P wave properties including P wave dispersion and atrial electromechanical conduction properties were measured as AF predictors with surface ECG and tissue Doppler imaging. Results: Baseline characteristics such as age, sex, heart rate, blood pressure, and laboratory parameters were almost the same in the ticagrelor and clopidogrel groups. The statistical analysis showed no significant difference in P wave dispersion (PWD) between ticagrelor and clopidogrel groups (40.98 ± 12 ms versus 40.06 ± 12 ms, P = 0.304). Subgroups analysis according to ACS types also showed no significant difference in PWD (NSTEMI: 41.16 ± 13.8 ms versus 40.76 ± 13.55 ms, P = 0.799; STEMI: 40.9 ± 12.62 ms versus 39.19 ± 11.18 ms, P = 0.132). In addition, we did not find significant difference in atrial electromechanical delay (EMD) with tissue Doppler imaging (interatrial EMD 24.11 ± 3.06 ms versus 24.46 ± 3.23 ms, P = 0.279). Conclusion: In conclusion, we did not find any difference in detailed electrocardiographic and echocardiographic parameters as AF predictors between ticagrelor and clopidogrel groups in patients with ACS

Evaluating the Efficacy and Safety of Internal Cardioversion with Implantable Cardioverter Defibrillator Device for Atrial Fibrillation in Systolic Heart Failure Patients.

BACKGROUND: Atrial fibrillation (AF) commonly observed in patients with heart failure and cardioversion was often needed to restore the sinus rhythm. Previously, there is no study evaluating usefulness of internal cardioversion with implantable cardioverter defibrillator (ICD) device. In this study, we aimed to compare the efficacy and long-term effects of internal cardioversion with ICD devices compared to conventional external cardioversion in patients with AF and heart failure. METHODS: Seventy patients with AF and heart failure who underwent electrical cardioversion were enrolled in the study. Forty patients (mean age 65.36 ± 10.37, 35 male) were assigned to undergo internal cardioversion with approximately 35 J shocks delivered through the ICD electrode. Standard external cardioversion was performed for the remaining patients (30 patients; mean age 66.20 ± 11.89; 24 male) that were similar with regard to baseline, and electrocardiographic characteristics. RESULTS: Sinus rhythm was restored in 32 of 40 patients (80.0%) assigned to internal cardioversion compared with 25 of 30 patients (83.3%) assigned to external cardioversion (P = 0.725). We did not witness any serious complication during the procedure and hospitalization. On the follow-up, there was no statistically significant difference in recurrence of AF and incidence of major cardiovascular events between the internal and external cardioversion groups. CONCLUSIONS: Internal cardioversion with ICD device is an effective and safe method to restore sinus rhythm in heart failure patients with AF.

Atrial Electromechanical Properties in Inflammatory Bowel Disease.

BACKGROUND: There is much evidence linking inflammation to the initiation and continuation of atrial fibrillation (AF). Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), are chronic systemic inflammatory disorders. Atrial electromechanical delay (EMD) has been known as an early marker of AF. The objectives of this study were to evaluate the atrial electromechanical properties in patients with IBD. METHODS: Fifty-two patients with IBD and 26 healthy controls were recruited in the study. Twenty-five of patients with IBD were on active period, and the remaining 27 were on remission period. Atrial electromechanical properties were measured by using transthoracic echocardiography and tissue Doppler imaging and simultaneous surface ECG recording. Interatrial EMD, left intraatrial EMD, and right intraatrial EMD were calculated. RESULTS: Patients on activation with IBD had significantly prolonged left and right intraatrial EMDs and interatrial EMD compared to patients on remission (P = 0.048, P = 0.036, P < 0.001, respectively) and healthy controls (P < 0.001, for all comparisons). Left and right intraatrial EMDs and interatrial EMD were also found to be higher when patients on remission with IBD compared with healthy controls. No statistical difference was observed between UC and CD in terms of inter- and intraatrial EMDs. CONCLUSIONS: Atrial electromechanical conduction is prolonged in IBD, and exposure to chronic inflammation may lead to structural and electrophysiological changes in the atrial tissue that causes slow conduction. Measurement of atrial EMD parameters might be used to predict the risk for the development of AF in patients with IBD.

A prospective DE-MRI study evaluating the role of TGF-ß1 in left atrial fibrosis and implications for outcomes of cryoballoon-based catheter ablation: new insights into primary fibrotic atriocardiomyopathy.

BACKGROUND: Transforming growth factor (TGF)-ß1 mediated atrial fibrosis plays a major role in the development of vulnerable atrial substrate for atrial fibrillation (AF). Although cryoablation effectively eliminates the triggers for AF, the impact of atrial substrate on the success of cryoablation remains unclear. OBJECTIVE: We aimed to investigate the association of plasma TGF-ß1 level with extent of left atrium (LA) fibrosis using delayed-enhanced magnetic resonance imaging (DE-MRI) and also effects of LA fibrosis on the success of cryoablation. METHODS: A total of 41 symptomatic lone paroxysmal AF patients (58.5% male; age: 49.2 ± 7.6 years) underwent initial cryoablation. Cardiac DE-MRI at 1.5-Tesla scanner to quantify atrial fibrosis, plasma TGF-ß1, clinical and echocardiographic data were collected before cryoablation. Postablation blanking period was observed for 3 months. RESULTS: DE-MRI revealed LA fibrosis in 27 (65.9%) patients with a median enhancement of 5% of the LA surface area. A total of 179 pulmonary veins (PV) were successfully isolated without any major complication. At median 18 months follow-up, 32 patients (78.1%) remained free of AF recurrence. Only plasma TGF-ß1 level (P = 0.001) was found to be the predictor of the extent of LA fibrosis. Multivariate Cox regression analysis pointed out that the extent of LA fibrosis (HR: 1.127, P = 0.007) and early AF recurrence (HR: 1.442, P = 0.011) were the independent predictors of AF recurrence in late follow-up. CONCLUSION: Higher levels of TGF-ß1 are associated with more extensive LA fibrosis and extent of LA fibrosis predict recurrences in patients undergoing cryoablation for lone AF.

Does coronary calcium scoring with a SCORE better predict significant coronary artery stenosis than without? Correlation with computed tomography coronary angiography.

OBJECTIVE: To determine effectiveness of coronary artery calcium score (CACS) alone and combined with Systematic Coronary Risk Evaluation (SCORE) in adult patients for significant coronary artery stenosis by using computed tomography coronary angiography (CTCA) as reference standard. METHODS: Two thousand twenty-one patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA. Patients were examined with dual-source CT and were grouped according to their age, gender, CACS, and estimated SCORE risk. Coronary plaque existence and degree of stenosis were assessed with CTCA. Sensitivity, specificity, and ROC curves were analyzed. RESULTS: CACS was the single independent variable in estimating relative risk of critical stenosis and had superior outcome when compared with SCORE risk in logistic regression and ROC curve. Area under the ROC curve was greatest in the interval between 50-59 years. When SCORE was combined with CACS in patients with zero CACS, percentage of significant stenosis increased from 1.4% to 7.0% in patients with high or very high SCORE risk, and decreased to 0.9 % in patients with low or moderate SCORE risk. CONCLUSIONS: CACS combination with SCORE risk predicts coronary artery stenosis. When CACS is zero, CTCA can be performed in patients with high or very high SCORE risk.

Relationship between Epicardial Adipose Tissue Thickness and Atrial Electromechanical Delay in Hypertensive Patients.

OBJECTIVES: Epicardial adipose tissue (EAT) and atrial electromechanical delay (AEMD) have been shown to be closely linked with atrial fibrillation. In this study, we aimed to investigate the relationship between EAT and AEMD. METHODS: Ninety-six patients were included in this study. Echocardiographic measurements were performed, and laboratory parameters were recorded. Patients were divided into two groups according to their inter-AEMD values. Patients with an inter-AEMD value of <42.6 msec formed group 1 and patients with an inter-AEMD value of ≥42.6 msec formed group 2. RESULTS: The EAT thickness (3.7 ± 1.2 vs. 5.0 ± 1.6, P < 0.001) and LAVI (20.4 ± 2.9 vs. 24.5 ± 6.7, P = 0.001) were significantly higher in group 2. There was a significant positive correlation between AEMD parameters with EAT and LAVI. After multivariate logistic regression analysis, EAT (OR: 1.505; 95% CI: 1.056-2.143, P = 0.023) and LAVI (OR: 1.140; 95% CI: 1.018-1.277, P = 0.023) were found as independent predictors of prolonged AEMD. CONCLUSIONS: We found that EAT thickness was closely related with AEMD, and we also found that EAT and LAVI were independent predictors of prolonged AEMD. These findings may be helpful to explain some pathogenic mechanisms in the development of AF.

[Association of plasma fibronectin level with left atrial electrical and structural remodelling in lone paroxysmal atrial fibrillation: a cross-sectional study]. / "Tek basina" paroksismal atriyum fibrilasyonunda plazma fibronektin düzeyi ile sol atriyumun elektriksel ve yapisal yeniden sekillenmesi arasindaki iliski: Kesitsel bir çalisma.

OBJECTIVE: Atrial fibrosis is one of the main components of atrial fibrillation (AF) pathophysiology and culminates in structural, electrical and contractile remodelling. Fibronectin is one of the well-known mediators of fibrogenesis. However, the association of plasma fibronectin with atrial remodelling has not been studied previously. Therefore, the aim of this study was to assess the relationship between plasma fibronectin level and atrial electrical and structural remodelling in patients with lone paroxysmal AF. METHODS: A total of 51 lone paroxysmal AF patients and 40 age-, gender- and body mass index-matched healthy control subjects were enrolled. Plasma levels of fibronectin and high sensitive C-reactive protein (hs-CRP) were measured and transthoracic echocardiography for assessment of total atrial conduction time (TACT) and left atrial (LA) volume index was performed on all study participants. RESULTS: Plasma fibronectin, hs-CRP, TACT, LA diameter and LA volume index were significantly higher in lone paroxysmal AF group compared to healthy controls (p<0.05). Also, there was a positive correlation between plasma fibronectin level and TACT (r=0.362, p<0.001) and LA volume index (r=0.371, p<0.001). In multivariate logistic regression analysis, age, plasma fibronectin level (Odds ratio - OR: 1.003, 95% CI: 1.001-1.005, p=0.026) and hs-CRP (OR: 2.312, 95% CI: 1.503-6.459, p=0.017) were found to be the predictors of LA structural remodelling; however, only plasma fibronectin level (OR: 1.003, 95% CI: 1.001-1.005, p=0.032) and hs-CRP (OR: 3.212, 95% CI: 1.214-5.752, p=0.033) were found as the predictors of LA electrical remodelling. CONCLUSION: Our study results showed that profibrotic and proinflammatory biomarkers were associated with left atrial structural and electrical remodelling in lone paroxysmal AF patients.

Prevention of recurrent cryptogenic stroke with percutaneous closure of patent foramen ovale; one year follow-up study with magnetic resonance imaging and Holter monitoring.

OBJECTIVES: In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring. STUDY DESIGN: Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure. RESULTS: Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917). CONCLUSION: One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

Increased epicardial adipose tissue thickness is linked to aortic stiffness in patients with primary hypertension.

AIMS: In patients with hypertension (HT), increased aortic stiffness is related to higher cardiovascular morbidity and mortality. Recent investigations have shown that epicardial adipose tissue (EAT) is a new potential cardiometabolic risk factor. The aim of our study was to examine the relation between echocardiographically measured EAT thickness and aortic stiffness in patients with primary HT. METHODS: The study included 144 newly diagnosed and untreated essential hypertensive outpatients. Transthoracic echocardiographic EAT thickness and aortic stiffness measurements were performed for all study participants. Afterwards patients were divided in two groups according to their median EAT thickness values. The patients with EAT thickness of < 7 mm were included in group 1 and patients with EAT thickness of ≥ 7 mm were included in group 2. RESULTS: Aortic strain and distensibility parameters of group 2 were lower than in group 1. The aortic stiffness index of group 2 was found to be higher than group 1. Multivariate regression analysis revealed that EAT thickness was the only independent variable for all three parameters of aortic stiffness index, aortic strain and aortic distensibility. CONCLUSION: In patients with newly diagnosed primary HT, increased EAT thickness was significantly linked to impaired aortic elastic properties independently of other conventional adiposity measurements.

Acute coronary syndrome secondary to clarithromycin: the first case and review of the literature.

Kounis syndrome (KS) is characterized by concurrent acute coronary syndrome and allergic reaction, in which acute inflammatory mediators cause spasm and/or erosion and rupture of coronary atheromatous plaque. In this report, we remind clinicians to consider KS in patients who are subjected to allergenic substances and demonstrate acute chest pain. A 36-year-old woman had chest pain, severe dyspnea, hypotension, and symmetrical negative T waves on the anterior leads during electrocardiography approximately two hours after the use of clarithromycin. KS was considered as a possible diagnosis based on the presentation. Laboratory tests revealed an elevated level of troponin I, suggesting myocardial infarction, and an elevated level of serum tryptase level, suggesting an allergic reaction. The patient promptly underwent coronary angiography, which revealed only plaques in all main coronary arteries without any obstructive lesion. To the best of our knowledge, we report herein the first case in the literature describing an association between clarithromycin and KS.

[Prevalence and clinical features of microfistulas between the coronary artery and left ventricle: single-center experience]. / Koroner arter ile sol ventrikül arasindaki mikrofistüllerin sikligi ve klinik özellikleri: tek merkez deneyimi.

OBJECTIVES: Coronary artery fistula is an infrequent malformation, and the prevalence was reported as approximately 0.1-0.4% in previous studies. However, the number of studies about microfistulas from coronary arteries to the left ventricle is inadequate, especially in the Turkish population. The purpose of this study was to evaluate the prevalence and clinical features of microfistulas in subjects undergoing coronary angiography for the assessment of coronary artery disease. STUDY DESIGN: In this retrospective study, we researched the cardiac catheterization laboratory database between January 2008 and July 2013. The presence of microfistulas was established according to the following criteria: 1) direct filling of the heart cavity during selective coronary injection without interposing "capillary" phase or venous filling, and 2) visualization of small vessels interposed between the epicardial coronary vessels and the heart cavity and emptying into the heart. RESULTS: Microfistulas were found in 12 (0.11%) of the 11403 coronary angiographies. There were 7 (58.3%) female patients (mean age, 70.2±10.8 years), and contemporary severe coronary artery stenosis was noted in 2 (16.7%) patients. Chest pain was the most frequently encountered complaint, followed by dyspnea. Microfistulas originated from the left anterior descending artery (100%), circumflex artery (66.7%), and right coronary artery (58.3%). In addition, multiple microfistulas were seen in 6 (50%) patients, bilateral microfistulas in 3 (25%) patients and unilateral microfistula in 3 (25%) patients, and all of them terminated in the left ventricle. CONCLUSION: Our study found an overall incidence of microfistulas of 0.11%. Microfistula is a rare cardiac anomaly that sometimes causes cardiac symptoms; otherwise, it is detected during routine coronary angiography.

Fragmented QRS complex predicts the arrhythmic events in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia.

BACKGROUND: Fragmented QRS (frQRS) complex, with various morphology, has been recently described as a diagnostic criterion of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, there are little data regarding the prognostic role of frQRS in these patients. Therefore, we aimed to investigate the association of frQRS with arrhythmic events in patients with ARVC/D. METHODS: Seventy-eight patients (51 men, 65.4%; mean age: 31.25 ± 11.5 years) with the diagnosis of ARVC/D according to 2010 modified Task Force Criteria were analyzed retrospectively. Baseline ECG evaluation revealed frQRS complex in 46 patients (59%). Eleven patients with complete/incomplete right bundle branch block were excluded from the study. The phenomenon of frQRS was defined as deflections at the beginning of the QRS complex, on top of the R-wave, or in the nadir of the S-wave similar to the definition in CAD in either one right precordial lead or in more than one lead including all standard ECG leads. RESULTS: During 38 ± 14 months follow-up period, 3 patients (3.8%) died suddenly, 36 patients (46.1%) experienced arrhythmic events (32 ventricular tachycardias [VTs] and 4 ventricular fibrillation [VF], 30 in the ICD group). The frQRS was significantly associated with arrhythmic events (P < 0.001). Also, the number of ECG leads with frQRS complex was higher in patients with arrhythmic events (5.08 ± 2.5 vs 1.14 ± 1.7, P < 0.001, respectively). CONCLUSION: The frQRS complex on standard 12-lead ECG predicts fatal and nonfatal arrhythmic events in patients with ARVC/D. Therefore, large scale and prospective studies are needed to confirm those findings.

Inoperable isolated cardiac hydatid cyst controlled with albendazole in an older adult with dementia.

Hydatid cyst, a human parasitic disease, remains a clinical problem in undeveloped and developing countries. Although liver and lungs are regular sites of infection, rarely other organs such as the heart can be involved. Herein, we report an isolated cardiac hydatid cyst in an 87-year-old man. He had a history of dementia for 5 years and no history for cardiac or pulmonary disease. He presented with exertional dyspnoea which continued up to 6 months. The diagnosis was made by echocardiography and computed tomography (CT). The patient was inoperable and was treated with albendazole 10 mg/kg for 6 months. After a 6-month follow-up, echocardiography revealed reduction in the size of the cyst. We believe this is the first documented case of cardiac hydatid cyst which regressed with only medical treatment in an older adult with dementia.

Cryoballoon pulmonary vein isolation prior to percutaneous atrial septal defect closure: a case report.

We report the case of a 61-year-old female who was admitted to our department with progressive dyspnea and palpitation. Transthoracic echocardiography and transesophageal echocardiography showed a small atrial septal defect (ASD, 8x7 mm). Paroxysmal atrial fibrillation (AF) was detected in Holter monitoring. As repair of ASD does not significantly reduce the risk of arrhythmias, cryoablation of AF was performed prior to ASD closure. On cardiac examination at one year, this combined intervention improved right ventricular function and prevented AF episodes.

Stress Hyperglycemia Ratio Is Associated With High Thrombus Burden in Patients With Acute Coronary Syndrome.

The blood glucose level at admission indicates (with some limitations) poor prognosis and thrombus burden in patients with the acute coronary syndrome (ACS). Our study aimed to measure the predictive value of the stress hyperglycemia ratio (SHR), an indicator of stress hyperglycemia, showing increased thrombus burden in patients with ACS. Patients (n = 1222) with ACS were enrolled in this cross-sectional study. Coronary thrombus burden was classified as high and low. SHR was calculated by dividing the admission serum glucose by the estimated average glucose derived from HbA1c. Low thrombus burden was detected in 771 patients, while high thrombus burden (HTB) was detected in 451 patients. SHR was found to be significantly higher in patients with HTB (1.1 ± .3 vs 1.06 ± .4; P = .002). SHR was determined as a predictor of HTB (odds ratio (OR) 1.547 95% CI (1.139-2.100), P < .001) as a result of univariate analysis. According to multivariate analysis, SHR was determined as an independent risk factor for HTB (OR 1.328 CI (1.082-1.752), P = .001). We found that SHR predicted thrombus burden with higher sensitivity than admission glucose level in patients with ACS.

Use of fenofibrate during the first trimester of unplanned pregnancy in a patient with hypertriglyceridemia.

OBJECTIVE: To describe a successful pregnancy in a patient who used fenofibrate during the first trimester. CASE SUMMARY: A 30-year-old female with a history of polycystic ovarian syndrome was referred to our department for evaluation of hypertriglyceridemia, and fenofibrate treatment was initiated. After 1 year of therapy, a gynecologic visit for menstrual cycle abnormalities revealed an unplanned pregnancy at 8 weeks of gestation (dating from the first day of the last menstrual period). Fenofibrate was discontinued and the pregnancy was continued despite the potential risks involved with the use of fibrates during early pregnancy. Fetal ultrasound performed routinely during each trimester showed normal fetal growth with no malformation. The patient delivered a healthy male infant at 36 weeks of gestation. No congenital malformation was recorded. The baby was healthy on pediatrician examination at 1 year. DISCUSSION: Fibrates have good efficacy in lowering fasting triglyceride (TG) levels as well as postprandial TG and TG-rich lipoprotein remnant particles. Previous reports showed that fibrates have been administered cautiously in pregnant women after embryogenesis if their use is necessary; however, in our case, the embryo had been exposed to fenofibrate from the beginning of fertilization. Nevertheless, fenofibrate did not cause significant damage, such as external, skeletal, and visceral abnormalities, to the developing embryo. CONCLUSIONS: In this case, no harmful effects on fetal development were observed after exposure to fenofibrate during organogenesis.

Association of type 2 diabetes mellitus with coronary atherosclerotic plaque burden and morphology measured by multidetector computed tomography coronary angiography.

AIMS: Diabetes mellitus (DM) is strongly associated with increased risk of coronary artery disease (CAD). The aim of this study was to determine differences in presence, extent and morphology of coronary atherosclerotic plaques (CAP) detected by multidetector computed tomography (MDCT) between symptomatic patients with and without diabetes. METHODS: The CAPs (calcified, non-calcified, mixed) were compared between patients with/without diabetes (104/257 DM; mean age 58.6 +/- 11 y; 46.3% male) who underwent dual-source 64-slice MDCT for evaluation of CAD. Severity, extent and morphology of CAPs were determined per each segment. RESULTS: Critical coronary stenosis was higher in patients with diabetes (33.7% vs. 19.6%) after adjustment for all risk factors (P = 0.022). Patients with DM had a higher prevalence and extent of CAP compared to non-diabetic subjects (87.5% vs. 43.8%, 4.8 +/- 3.5 vs. 1.9 +/- 2.7, respectively; P < 0.001). Noncalcified and mixed CAP were more prevalent in patients with diabetes as compared to those without diabetes (2.61 +/- 2.63 vs. 0.86 +/- 1.69, 0.81 +/- 1.6 vs. 0.35 +/- 0.96, respectively, P < 0.001). Patients with DM tended to have higher prevalence of significant 1-, 2- and 3-vessel disease (P = 0.006). CONCLUSIONS: Among individuals referred for the evaluation of CAD, those with DM had a higher risk of coronary stenosis and overall increased CAP burden independent from other cardiovascular risk factors shown by MDCT. Further studies are needed to evaluate the prognostic value of different plaque compositions observed in patients with diabetes.