[Differentiation between vegetation and lead associated thrombus - role of PET scan in difficult diagnostic process]. / Roznicowanie wegetacji ze skrzeplina na elektrodzie kardiowertera-defibrylatora-rola PET w trudnym procesie diagnostycznym.

We report a case of a 59 year-old man with hypertrophic cardiomyopathy who developed a pathological structure attached to the lead of cardioverter-defibrillator that has been detected by echocardiography. The authors describe a difficult differential diagnostic process aiming at the differentiation between cardiac device-related infective endocarditis and lead-associated thrombus. Imaging of the heart with a pathological structure using PET scan seems to be useful in these clinical circumstances.

Bone mineral status and bone loss over time in men with chronic systolic heart failure and their clinical and hormonal determinants.

AIMS: Bone status has not been comprehensively studied in chronic heart failure (CHF). In CHF men, we evaluated bone status, bone loss over time, and their clinical and hormonal determinants. METHODS AND RESULTS: Bone mineral content (BMC) and bone mineral density (BMD) of arms, legs, trunk, and total body were examined using dual-energy X-ray absorptiometry in 187 men with CHF [age: 60+/-11 years, left ventricular ejection fraction (LVEF): 32+/-7%, New York Heart Association (NYHA) class (I/II/III/IV): 20/76/76/15] and in 21 age-matched male controls without CHF. Men with CHF had reduced BMD and BMC compared with controls (P < 0.05). Reduced BMD and BMC were independently determined by CHF severity (high NYHA class and impaired LVEF), reduced lean tissue mass, low serum dehydroepiandrosterone sulphate, total testosterone (TT), and estimated free testosterone (eFT) (all P < 0.05). Bone status was reassessed in 60 patients who survived >2 years from the initial evaluation. Significant bone loss over time (a reduction in BMC total > or = 1%/year) occurred in 35% of CHF men. Advanced NYHA class (P < 0.05) and reduced serum TT and eFT (P < 0.0001) at baseline predicted augmented bone loss. CONCLUSION: In CHF men, reduced BMD and BMC constitute an element of generalized body wasting, determined mainly by advanced heart failure and androgen deficiencies. Significant bone loss over time frequently occurs in CHF men and is related to testosterone depletion and disease severity.