Evaluation of In Vitro Immunomodulatory Activity of Withania somnifera Roots on Human Neutrophils.

The present study encompasses in vitro immunomodulatory activity of Withania somnifera WS (Solanaceae) examined on human neutrophils. The isolated compound of Withania somnifera roots was screened for its possible immunomodulatory activity by nitro blue tetrazolium test, phagocytosis of killed Candida albicans, neutrophil locomotion and chemotaxis. The extracted compound was examined at concentrations, viz. 10 µg/ml, 20 µg/ml, 40 µg/ml, 100 µg/ml and 1000 µg/ml. The activity expressed by the compound on human neutrophils was found to be significant for examined parameters.

Unicuspid unicommissural aortic valve: an extremely rare congenital anomaly.

Unicuspid aortic valve is a rare congenital malformation that usually presents in the 3rd to 5th decade of life-and usually with severe aortic stenosis or regurgitation. It often requires surgical correction. Diagnosis can be made with 2- or 3-dimensional transthoracic or transesophageal echocardiography, cardiac computed tomography, or cardiac magnetic resonance imaging. We report the case of a 31-year-old man who presented with dyspnea on exertion due to severe aortic stenosis secondary to a unicuspid unicommissural aortic valve. After aortic valve replacement, this patient experienced complete heart block that required the placement of a permanent pacemaker.

Blockade of EMAP II protects cardiac function after chronic myocardial infarction by inducing angiogenesis.

Promoting angiogenesis is a key therapeutic target for protection from chronic ischemic cardiac injury. Endothelial-Monocyte-Activating-Polypeptide-II (EMAP II) protein, a tumor-derived cytokine having anti-angiogenic properties in cancer, is markedly elevated following myocardial ischemia. We examined whether neutralization of EMAP II induces angiogenesis and has beneficial effects on myocardial function and structure after chronic myocardial infarction (MI). EMAP II antibody (EMAP II AB), vehicle, or non-specific IgG (IgG) was injected ip at 30 min and 3, 6, and 9 days after permanent coronary artery occlusion in mice. EMAP II AB, compared with vehicle or non-specific antibody, significantly, p<0.05, improved the survival rate after MI, reduced scar size and attenuated the development of heart failure, i.e., left ventricular ejection fraction was significantly higher in EMAP II AB group, fibrosis was reduced by 24%, and importantly, more myocytes were alive in EMAP II AB group in the infarct area. In support of an angiogenic mechanism, capillary density (193/HPF vs. 172/HPF), doubling of the number of proliferating endothelial cells, and angiogenesis related biomarkers were upregulated in mice receiving EMAP II AB treatment as compared to IgG. Furthermore, EMAP II AB prevented EMAP II protein inhibition of in vitro tube formation in HUVECs. We conclude that blockade of EMAP II induces angiogenesis and improves cardiac function following chronic MI, resulting in reduced myocardial fibrosis and scar formation and increased capillary density and preserved viable myocytes in the infarct area.

Hypertension in African Americans with heart failure: progression from hypertrophy to dilatation; perhaps not.

AIM: Concentric hypertrophy is thought to transition to left ventricular (LV) dilatation and systolic failure in the presence of long standing hypertension (HTN). Whether or not this transition routinely occurs in humans is unknown. METHODS: We consecutively enrolled African American patients hospitalized for acute decompensated volume overload heart failure (HF) in this retrospective study. All patients had a history of HTN and absence of obstructive coronary disease. Patients were divided into those with normal left ventricular ejection fraction (LVEF) and reduced LVEF. LV dimensions were measured according to standard ASE recommendations. LV mass was calculated using the ASE formula with Devereux correction. RESULTS: Patients with normal LVEF HF were significantly older, female and had a longer duration of HTN with higher systolic blood pressure on admission. LV wall thickness was similarly elevated in both groups. LV mass was elevated in both groups however was significantly greater in the reduced LVEF HF group compared to the normal LVEF HF group. Furthermore, gender was an independent predictor for LV wall thickness in normal LVEF HF group. CONCLUSION: In African American patients with HF our study questions the paradigm that concentric hypertrophy transitions to LV dilatation and systolic failure in the presence of HTN. Genetics and gender likely play a role in an individual's response to long standing hypertension.

Aortic counterpulsation: C-pulse and other devices for cardiac support.

Heart failure is the leading cause of hospitalization in the USA. Despite major advances in the medical and device-related therapy including chronic resynchronization therapy for management of heart failure, significant number of patients eventually require advanced cardiac therapy including mechanical circulatory support or heart transplant. Heart transplant is a gold standard for end-stage heart failure but is limited by the donor heart shortage creating a definite need for alternative effective therapies. The earliest and most common form of mechanical circulatory support is counterpulsation therapy. Annually, more than 150,000 patients worldwide receive counterpulsation therapy for various indications including cardiogenic shock or severe left ventricular dysfunction (Nanas and Moulopoulos in Cardiology, 84:156-167, 1994) and many thousands of lives are saved each year (65 % survival) (Torchiana et al. in Journal of Thoracic and Cardiovascular Surgery, 113(4):758-764, 1997). There are different types of aortic counterpulsation devices. Here, we will give an overview of different counterpulsation devices with focus on C-Pulse device. Extra-aortic balloon counterpulsation, C-Pulse (Sunshine Heart Inc., Eden Prairie, MN), is an important and novel approach in the management of patients with advanced heart failure who remain symptomatic despite optimum medical and device-based therapy. C-Pulse is designed to provide permanent, long-term, continuous partial circulatory support for New York Heart Association class III and ambulatory class IV heart failure patients. C-Pulse is a nonblood-contacting counterpulsation using an inflatable cuff around the ascending aorta, extra-aortic balloon (EAB) counterpulsation device. A pivotal, multicenter US study to assess the safety and efficacy of C- Pulse in patient with Stage C and NYHA Class III or ambulatory Class IV heart failure is in progress.

Rapid Resolution of Acute Fulminant Myocarditis after IVIG and Steroid Treatment.

We report a case of a 59-year-old woman who presented with worsening dyspnea which rapidly progressed to severe heart failure. Coronary arteries showed no obstruction. Supportive measures stabilized the patient's hemodynamics. Initially intravenous solumedrol was given, but when the patient's condition continued to deteriorate, intravenous immunoglobulin (IVIG) was added to the treatment regimen and her condition improved. Studies show no benefit to using immunosuppressive agents in viral myocarditis, but benefits have been demonstrated in other etiologies. Patients presenting with acute fulminant myocarditis with unknown etiology that continue to deteriorate with aggressive heart failure treatment may benefit from steroids and IVIG.

Anteriorly displaced right coronary artery in acute myocardial infarction: what should every cardiologist know.

Anteriorly displaced right coronary artery (RCA) and anomalous origin RCAs occur in ≈ 1% and 0.1% of adult patients, respectively, and are the leading cause of incomplete coronary angiography and prolonged procedure times. We present a case in which anteriorly displaced RCA occlusion resulted in an acute inferior-posterior-right ventricular myocardial infarction complicated by complete atrioventricular block and hypotension. Failure to image the RCA resulted in considerable delay in reperfusion time with fibrinolysis. The authors discuss the most frequent anatomic locations of ectopic RCAs and suggest an algorithm to be employed when an ectopic RCA cannot be imaged with conventional diagnostic catheters. Contrary to popular belief, the search for an ectopic RCA has <90° boundaries limited to the anterior third of the right sinus and anterior half of the left sinus.

An unusual combination of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) and a right coronary artery system with two separate ostia from the aorta in an adult.

We describe a patient with an infrequent combination of variants in both the right and the left coronary arterial ostia, namely a combination of two separate right coronary artery (RCA) ostia from the aorta, and an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). To our knowledge, such a combination has not been previously reported. Based on published statistics for individual variants, such a combination is expected to occur approximately once for every 500,000 to one million live births. ALCAPA and dual RCA anatomy was characterized in our patient by echocardiography, conventional angiography, and multidetector computed tomography before and after Takeuchi repair.

Right coronary artery anatomical variants: where and how?

BACKGROUND: Ectopic origin of the right coronary artery (RCA) occurs in approximately 1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization. METHODS: Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. "Ectopic RCA" was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus. RESULTS: The study population included 2,120 patients, of which 23 (1.1%) had ectopic RCAs. Of these, 15 (65%) originated from the anterior third of the right sinus, while 8 (35%) originated from the anterior half of the left sinus. Mean procedure and fluoroscopy times were 60 +/- 33 and 15 +/- 12 minutes (min) for the former, and 78 +/- 35 and 31 +/- 20 min for the latter, while mean contrast volume for CA was 112 +/- 62 ml and 192 +/- 85 ml, respectively. 26% required a second CA or a second intervention to image the RCA. CONCLUSION: Ectopic RCAs pose a clinical problem, consuming time and resources. The search for an ectopic RCA should have < 90 degree boundaries limited to the anterior third of the right sinus and anterior half of the left sinus.