Cardiac amyloidosis prevalence and 1-year outcome in patients with aortic stenosis undergoing transaortic valve implantation: Findings from the CAMPOS-TAVI study.

BACKGROUND: Transthyretin amyloid cardiomyopathy (ATTR-CM) can manifest as rhythm disorders, heart failure, but also valvular degeneration. Despite aortic stenosis (AS) being prevalent among the elderly, data on ATTR-CM prevalence and outcome in patients with AS undergoing transaortic valve implantation (TAVI) remain scarce. AIM: To determine ATTR-CM prevalence and evaluate 1-year survival in patients undergoing TAVI. METHODS: Between December 2020 and September 2021, 100 consecutive patients underwent TAVI and were screened prospectively for ATTR-CM using bone scintigraphy (BS). Monoclonal gammopathy was ruled out in case of cardiac uptake on BS. All patients were followed prospectively for 1year after TAVI. RESULTS: The proportion of patients aged≥75years or with a EuroSCORE II>8% and possible femoral access was 99%. The abnormal cardiac uptake rate on BS was 7% (95% confidence interval: 2-12%); 86% of these patients were male. The RAISE (remodelling, age, injury, system and electrical) score, indicative of ATTR-CM risk, was higher in case of positive BS (P=0.04). Patients with positive BS were older and exhibited wider QRS complexes on electrocardiography (P=0.003), a higher frequency of reduced LVEF (57% vs. 17%), impaired basal LV strain (P=0.02) and a lower voltage/mass ratio (P=0.01). History of pacemaker implantation before TAVI was higher in the positive BS group (P=0.0004) and remained the only statistically significant factor after adjustment using the Holm-Bonferroni method. One-year survival of patients with positive BS did not differ from that of patients with isolated AS. CONCLUSIONS: Prevalence of ATTR-CM in patients treated with TAVI, underscoring the need for continued surveillance for potential development of ATTR-CM after TAVI. Caution is warranted regarding the 1-year survival because of the lack of study power. Further investigations are needed to define long-term prognosis of AS with ATTR-CM.

Beta-blocker exposure and survival outcomes in patients with advanced pancreatic ductal adenocarcinoma: a retrospective cohort study (BETAPANC).

Introduction: Preclinical studies have demonstrated the possible role of beta-adrenergic receptors in pancreatic ductal adenocarcinoma (PDAC) tumor invasion and migration. The current study aimed to explore the possible association between survival outcomes and beta-blocker (BB) exposure in patients with advanced PDAC. Methods: This retrospective single-center study included 182 patients with advanced PDAC. Clinical [age, sex, BMI, cardiovascular condition, presence (SBB) or absence (NSBB) of beta-1 selectivity of BB, exposure duration, and multimorbidity], oncological (stage and anticancer treatment regimen), and biological (renal and liver function) data were collected. The endpoints were overall survival (OS) and progression-free survival (PFS). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for survival outcomes associated with BB exposure were estimated using Cox regression model and propensity score (PS) methods. Results: Forty-one patients (22.5%) were exposed to BB. A total of 104 patients progressed (57.1%) to PDAC and 139 (76.4%) patients died at the end of follow-up (median, 320 days; IQR, 438.75 days). When compared to the non-exposed group, there was no increase in survival outcomes associated with BB use (OS: HR = 1.38, 95% CI = 0.80-2.39, p = 0.25; PFS: adjusted HR = 0.95, 95% CI = 0.48-1.88, p = 0.88). Similar results were obtained using the PS method. Compared to no BB usage, SBB use was associated with a significant decrease in OS (HR = 1.80, 95% CI = 1.16-2.80, p < 10-2). Conclusion: BB exposure was not associated with improved PDAC survival outcomes. Beta-1-selectivity was not independently associated with any differences.

The impact of transoesophageal echocardiography in elderly patients with infective endocarditis.

BACKGROUND: Infective endocarditis (IE) increasingly involves older patients. Geriatric status may influence diagnostic and therapeutic decisions. AIM: To describe transoesophageal echocardiography (TEE) use in elderly IE patients, and its impact on therapeutic management and mortality. METHODS: A multicentre prospective observational study (ELDERL-IE) included 120 patients aged ≥75 years with definite or possible IE: mean age 83.1±5.0; range 75-101 years; 56 females (46.7%). Patients had an initial comprehensive geriatric assessment, and 3-month and 1-year follow-up. Comparisons were made between patients who did or did not undergo TEE. RESULTS: Transthoracic echocardiography revealed IE-related abnormalities in 85 patients (70.8%). Only 77 patients (64.2%) had TEE. Patients without TEE were older (85.4±6.0 vs. 81.9±3.9 years; P=0.0011), had more comorbidities (Cumulative Illness Rating Scale-Geriatric score 17.9±7.8 vs. 12.8±6.7; P=0.0005), more often had no history of valvular disease (60.5% vs. 37.7%; P=0.0363), had a trend toward a higher Staphylococcus aureus infection rate (34.9% vs. 22.1%; P=0.13) and less often an abscess (4.7% vs. 22.1%; P=0.0122). Regarding the comprehensive geriatric assessment, patients without TEE had poorer functional, nutritional and cognitive statuses. Surgery was performed in 19 (15.8%) patients, all with TEE, was theoretically indicated but not performed in 15 (19.5%) patients with and 6 (14.0%) without TEE, and was not indicated in 43 (55.8%) patients with and 37 (86.0%) without TEE (P=0.0006). Mortality was significantly higher in patients without TEE. CONCLUSIONS: Despite similar IE features, surgical indication was less frequently recognized in patients without TEE, who less often had surgery and had a poorer prognosis. Cardiac lesions might have been underdiagnosed in the absence of TEE, hampering optimal therapeutic management. Advice of geriatricians should help cardiologists to better use TEE in elderly patients with suspected IE.

Exposure to Ionizing Radiation in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation.

Transcatheter aortic valve implantation (TAVI) is currently becoming an alternative to surgical valve replacement for patients at low risk, a population that is likely to experience an increase in the radiation-induced cancer risk following TAVI. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent transfemoral TAVI, including the procedure itself as well as the procedures performed in the preintervention work-up and the post-TAVI interventions. All patients who underwent transfemoral TAVI for symptomatic aortic stenosis in our center over a 26 months period were included. Dosimetric indicators from preprocedural coronary angiography and computed tomography (CT), the TAVI procedure, and any postprocedural interventions (electrophysiology study and/or pacemaker implantation) were collected and converted into an effective dose. A total of 119 transfemoral TAVI procedures were included. The mean cumulative effective dose (ED) was 37.3 mSv. Three irradiating procedures were necessary for 84 patients (71% of the population, i.e., coronary angiography, CT scan and the TAVI procedure itself), whereas 30 patients (25%) required a fourth procedure, and 5 required a fifth (4%). The majority of the dose was from the CT, while only 11% of the dose derived from the TAVI procedure itself. In conclusion, overall exposure to ionizing radiation for patients who underwent transfemoral TAVI seems acceptable, and the majority of the overall ED comes from the CT scan.

Impact of Obesity on Overall Radiation Exposure for Patients Who Underwent Radiofrequency Ablation of Atrial Fibrillation.

Patients who underwent radiofrequency ablation of atrial fibrillation are exposed to X-rays not only during the procedure but also during the preprocedural computed tomography. No study has investigated the cumulative effective dose received by patients who underwent atrial fibrillation ablation and identified factors influencing this dose. We aimed to evaluate the overall exposure to ionizing radiation in patients who underwent radiofrequency ablation of atrial fibrillation. The secondary objective was to estimate the impact of obesity on this exposure. All patients who underwent a first attempt of radiofrequency ablation of atrial fibrillation in our center over a 21 months period were included. Dosimetric indicators from preprocedural computed tomography and the ablation procedure were collected and converted into an effective dose. A total of 144 radiofrequency ablation of atrial fibrillation were included. The mean cumulative effective dose was 11.4 mSv, and 82% of the dose was from the computed tomography. Obese patients received a dose that was 75% higher than normal-weight patients, and this increase remained significant by multivariate analysis. In conclusion, overall exposure to ionizing radiation for patients who underwent radiofrequency ablation of atrial fibrillation seems acceptable, and the majority of the overall effective dose comes from the computed tomography. Obese patients are exposed to a 75% higher dose than normal-weight patients.

Physicians' exposure to radiation during electrophysiology procedures.

PURPOSE: Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no study comparing the level of exposure of physicians during different electrophysiology procedures. We aimed to measure and compare cardiologists' exposure to radiation during different electrophysiology procedures. METHODS: The study population comprised all electrophysiology procedures performed over a 6-month period in a large referral centre. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on the operator's left arm. RESULTS: In total, 150 electrophysiology procedures were analyzed. Compared with electrophysiology studies (reference category), physician radiation exposure was 3-fold greater during ablation of atrial fibrillation, 9-fold greater during ablation of atrioventricular nodal reentrant tachycardia (AVNRT)/atrioventricular reentrant tachycardia (AVNT), and 10-fold greater during ablation of atrial flutter (p < 0.001). Physician exposure was mainly related to X-ray time (R2 = 0.28). CONCLUSIONS: Our study showed significant differences in cardiologists' exposure to ionizing radiation depending on the type of electrophysiology procedure. Atrial flutter and AVNRT/AVNT ablations are the procedures in which operators are most exposed to ionizing radiation.

IMPACT OF THE TABLE HEIGHT AND THE OPERATOR'S HEIGHT ON THE LEVEL OF RADIATION DELIVERED TO INTERVENTIONAL CARDIOLOGISTS.

Interventional cardiologists count among the health professionals that are most exposed to ionising radiation. To minimise exposure, it is recommended that the patient be placed at the maximum distance possible from the X-ray source, but this recommendation has not been clinically validated. We aimed to investigate the impact of the average table height on the level of radiation delivered to cardiologists performing coronary interventions. The population for analysis included all invasive coronary procedures performed in our centre from March to June 2017. The primary endpoint was operator radiation exposure, as assessed using personal electronic dosimeters located on the operator's left arm. In total, 225 invasive coronary procedures were analysed. When the average table height was 1126 mm or more, the operators received a radiation dose that was, on average, 53% lower than when the table was lower than 1126 mm. This reduction remained significant by multivariate analysis adjusted for the operator.

Impact of cardiac resynchronisation therapy on cardiologists' exposure to radiation during implantation of pacemakers and implantable cardioverter-defibrillators.

Cardiologists are among the health professionals that are most exposed to ionizing radiation, but there is no recent study quantifying overexposure of physicians during cardiac resynchronisation therapy (CRT) procedures compared to 'classical' implantation of pacemakers (PMs) or implantable cardioverter-defibrillators (ICDs). We aimed to measure and compare operator exposure to radiation during implantation of PM and ICD with or without CRT. The study population comprised all PMs and ICDs implanted in a large referral centre over a six months period. The endpoint was operator radiation exposure, assessed using a personal electronic dosimeter located on operator's chest. In total, 169 PM/ICD implantations were analysed, 19 of which included CRT. Compared with 'classical' implantation, cardiologist radiation exposure was 9-fold greater during CRT procedures (p < 0.001). Physician exposure was related to dose-area product (R2 = 0.21 during 'classical' implantations and R2 = 0.57 during CRT procedures). Our study shows that cardiologists' exposure to radiation during CRT implantation was 9-fold greater than during procedures without CRT.

Factors influencing the use of the "not for generic substitution" mention for prescriptions in primary care: a survey with general practitioners.

BACKGROUND: Generic drug substitution is a public health policy challenge with high economic potential. Generic drugs are generally cheaper than brand-name drugs. Drugs are a significant part of the total health expenditure, especially in ambulatory care. We conducted a cross-sectional study with general practitioners in the Champagne-Ardenne region to determine physician-related factors and beliefs causing doctors to use the Not for Generic Substitution (NGS) mention. METHODS: Questionnaires were sent to General Practitioners (GPs) practicing in Champagne-Ardenne via 3 shipments, from January 2015 to May 2015. Prescriber characteristics and beliefs influencing the use of the NGS mention were assessed for frequent (≥ 5%) and less frequent (< 5%) users of the NGS mention. RESULTS: Factors associated with above average NGS mention use in bivariate analysis included patient comorbidity, polypharmacy, a concern that generic and brand-name drugs are not bioequivalent and belief in higher efficacy of the brand name drug. The use of an e-prescribing system (EPS) and medical practice in rural areas appeared to be associated with lower use of NGS mention in bivariate analysis but not in multivariable analysis. In multivariable analysis, patient request was associated with a higher use of the NGS mention (NGS ≥ 5%, adjusted Odds Ratio (aOR) = 2.52; 95% CI = [1.46-4.35]; p = 0.001), which was also linked to patient age over 65 (NGS ≥ 5%, aOR = 2.33; 95% CI = [1.03-5.30]; p = 0.04). The NGS mention was often used for drugs where substitution is debated in the literature (thyroid hormones, antiepileptic drugs). CONCLUSION: This work highlights the involvement of the doctor-patient pair for the use of the NGS mention. Patient request was the major reason for using the NGS mention, even though it was not always endorsed by prescribers. Further studies are needed to assess patient views on generic drugs and drug substitution, accounting for their health status and socio-economic condition, to help improve the relevance of the information available to them.

Reduction in exposure of interventional cardiologists to ionising radiation over a 10-year period.

Exposure of operators to ionising radiation in interventional cardiology has likely diminished, but data confirming the magnitude of the reduction are lacking. The aim of this study was to compare the dose of radiation received by interventional cardiology operators at 11 years interval (2006 vs 2017). The study population comprised all interventional coronary procedures performed by a single operator in one catheterization laboratory (cathlab) of a large university hospital in north-eastern France. Exposure was compared between two periods, namely period 1 (from October 2005 to March 2006) and period 2 (from March 2017 to June 2017). The primary endpoint was the dose of radiation received by the operator, measured using an electronic dosimeter placed on the operator's left arm. In 2017, the dose of radiation received by the operators was, on average, 95% lower than the dose received in 2006 (p < 0.0001), even though the average fluoroscopy time increased by 73% over the same period (p < 0.0001). By multivariable analysis including body mass index, fluoroscopy time and performance of at least one (1) coronary angioplasty, the reduction in the operator's exposure to radiation remained significant. The dose of radiation received by interventional cardiology operators has decreased by 95% over the last ten years.

Minimizing exposure to radiation in invasive cardiology using modern dose-reduction technology: Evaluation of the real-life effects.

OBJECTIVES: We aimed to measure the reduction in the estimated dose of radiation received by patients that can be achieved using dose-reduction technology (ClarityIQ, Philips Healthcare, The Netherlands), among all patients undergoing invasive cardiology procedures. BACKGROUND: Medical procedures remain the primary source of exposure to ionizing radiation in the general population. METHODS: The study population comprised all patients (without exclusion criteria) undergoing invasive coronary procedures over a 1-year study period in a large referral centre equipped with two catheterization laboratories (cathlabs). Both cathlabs (A and B) were equipped with the Allura Xper FD10 imaging system (Philips Healthcare, The Netherlands), but only Cathlab B was equipped with ClarityIQ technology. The primary endpoint was the estimated total dose of radiation received by the patient, as assessed by Air Kerma (AK) and dose area product (DAP). RESULTS: In total, 2095 invasive coronary procedures were analyzed. The patients who underwent procedures in Cathlab B received an average estimated dose that was 23% (AK) and 43% (DAP) lower than the dose received by patients undergoing procedures in Cathlab A (P < .0001). The reduction remained significant by multivariate analysis after adjustment for total X-ray time, body mass index, arterial approach, PCI of at least one lesion, sex, and patient age. CONCLUSION: In our study, the ClarityIQ technology reduced the estimated radiation dose received by patients by 23-43%, according to the method of measurement.

Trends in Patient Exposure to Radiation in Percutaneous Coronary Interventions Over a 10-Year Period.

Technological progress has made it possible to reduce the dose of radiation delivered by medical x-ray systems. In parallel, interventional coronary procedures have become increasingly complex and consequently, last longer. This study aimed to compare the estimated dose of radiation received by patients in interventional cardiology at 10 years interval (2006 vs 2016). The study population included all patients who underwent interventional coronary procedures in one of the catheterization laboratories of our institution during 2 periods, namely, period 1 from October 2005 to March 2006, and period 2 from November 2015 to October 2016. The primary end point was the estimated dose of radiation received by the patient as assessed by dose area product. In 2016, the estimated dose of radiation received by patients who underwent interventional coronary procedures was on average 78% lower than that received in 2006 (p <0.0001), whereas the fluoroscopy time increased by 54% on average over the same period (p <0.0001). By multivariate analysis, including age, approach, body mass index, fluoroscopy time, and performance of angioplasty, the reduction in radiation remained significant. The radial approach was significantly associated with an increased estimated dose of radiation received (p <0.0001). In conclusion, the estimated dose of radiation received by patients who underwent interventional cardiology procedures has been reduced by 78% over the last decade.

Risk Factors for Adverse Drug Reactions in Older Subjects Hospitalized in a Dedicated Dementia Unit.

OBJECTIVE: To identify risk factors for the occurrence of adverse drug reactions (ADRs) based on geriatric evaluation. DESIGN: Longitudinal prospective study from May 2010 to November 2011. SETTING: Dedicated acute geriatric care unit specializing in the management of patients with dementia syndrome (Alzheimer disease or related syndromes) at the University Hospital of Reims, France. PARTICIPANTS: Older patients with dementia syndrome (Alzheimer disease or related syndromes). MEASUREMENTS: Sociodemographic variables and comprehensive geriatric assessment were recorded. Occurrence of ADRs was noted. Risk factors for ADR were identified by multivariate logistic regression. RESULTS: During the study period, 293 patients were included; average age was 82 ± 8 years; the majority were women (61.4%). Average Mini-Mental State Examination score was 13 ± 8; average activities of daily living (ADL) score was 3.6 ± 2.1. Independent risk factors for occurrence of at least one ADR were polypharmacy (≥5 drugs/day) (OR: 4.0, 95% CI: 1.1-14.1) and dependence on at least 1 ADL (OR: 2.6, 95% CI: 1.1-6.5). CONCLUSIONS: Risk factors for ADRs were polypharmacy and dependence on at least one ADL. Our findings underline the importance of taking into consideration the characteristics of the patients when prescribing drugs in this specific population. Prescriptions should be re-evaluated at each follow-up.

Symptomatic and Asymptomatic Neurological Complications of Infective Endocarditis: Impact on Surgical Management and Prognosis.

OBJECTIVES: Symptomatic neurological complications (NC) are a major cause of mortality in infective endocarditis (IE) but the impact of asymptomatic complications is unknown. We aimed to assess the impact of asymptomatic NC (AsNC) on the management and prognosis of IE. METHODS: From the database of cases collected for a population-based study on IE, we selected 283 patients with definite left-sided IE who had undergone at least one neuroimaging procedure (cerebral CT scan and/or MRI) performed as part of initial evaluation. RESULTS: Among those 283 patients, 100 had symptomatic neurological complications (SNC) prior to the investigation, 35 had an asymptomatic neurological complications (AsNC), and 148 had a normal cerebral imaging (NoNC). The rate of valve surgery was 43% in the 100 patients with SNC, 77% in the 35 with AsNC, and 54% in the 148 with NoNC (p<0.001). In-hospital mortality was 42% in patients with SNC, 8.6% in patients with AsNC, and 16.9% in patients with NoNC (p<0.001). Among the 135 patients with NC, 95 had an indication for valve surgery (71%), which was performed in 70 of them (mortality 20%) and not performed in 25 (mortality 68%). In a multivariate adjusted analysis of the 135 patients with NC, age, renal failure, septic shock, and IE caused by S. aureus were independently associated with in-hospital and 1-year mortality. In addition SNC was an independent predictor of 1-year mortality. CONCLUSIONS: The presence of NC was associated with a poorer prognosis when symptomatic. Patients with AsNC had the highest rate of valve surgery and the lowest mortality rate, which suggests a protective role of surgery guided by systematic neuroimaging results.

Drug-induced aortic valve stenosis: An under recognized entity.

BACKGROUND: We have been intrigued by the observation that aortic stenosis (AS) may be associated with characteristic features of mitral drug-induced valvular heart disease (DI-VHD) in patients exposed to valvulopathic drugs, thus suggesting that beyond restrictive heart valve regurgitation, valvulopathic drugs may be involved in the pathogenesis of AS. METHODS: Herein are reported echocardiographic features, and pathological findings encountered in a series of patients suffering from both AS (mean gradient >15mmHg) and mitral DI-VHD after valvulopathic drugs exposure. History of rheumatic fever, chest radiation therapy, systemic disease or bicuspid aortic valve disease were exclusion criteria. RESULTS: Twenty-five (19 females, mean age 62years) patients having both AS and typical features of mitral DI-VHD were identified. Mean transaortic pressure gradient was 32+/-13mmHg. Aortic regurgitation was ≥ mild in 24 (96%) but trivial in one. Known history of aortic valve regurgitation following drug initiation prior the development of AS was previously diagnosed in 17 patients (68%). Six patients underwent aortic valve replacement and 3 both aortic and mitral valve replacement. In the 9 patients with pathology analysis, aortic valvular endocardium was markedly thickened by dense non-inflammatory fibrosis, a characteristic feature of DI-VHD. CONCLUSION: The association between AS and typical mitral DI-VHD after valvulopathic drug exposure may not be fortuitous. Aortic regurgitation was usually associated to AS and preceded AS in most cases but may be lacking. Pathology demonstrated the potential role of valvulopathic drugs in the development of AS.

Cardiovascular prognosis at 1-year of patients with acute coronary syndrome is related to abdominal aortic aneurysm despite small size of the aneurysm.

BACKGROUND: Global cardiovascular (CV) risk associated with abdominal aortic aneurysms (AAAs) has been poorly documented. The aim of this study was to evaluate whether the presence of AAA in patients hospitalized for acute coronary syndrome with coronary stenosis (≥50%) was associated with an increased CV risk at 1-year follow-up. METHODS: Between February 1, 2008 and March 30, 2009, 304 patients admitted for acute coronary syndrome with significant (≥50% stenosis) coronary lesions underwent echocardiography to check for presence of AAA. Twenty AAAs were diagnosed, of average (±standard deviation) diameter 33 ± 3.7 mm. Follow-up at 1 year was available for 288 patients (95%). Variables recorded at 1 year were death, cause of death, and occurrence of nonfatal CV events of cardiac or peripheral vascular origin. RESULTS: During follow-up, 65 patients (22.6%) experienced an event (all-cause death or nonfatal CV event), including 21 deaths (7.3%) and 44 nonfatal CV events (15.3%). The presence of AAA significantly increased the risk of any CV event (fatal or nonfatal) at 1 year (hazard ratio: 2.96, 95% CI: 1.49-5.89, p = 0.002) but did not influence overall mortality or CV mortality. CONCLUSION: Our results show that in patients with coronary artery disease already at high CV risk, the presence of AAA was associated with worse CV prognosis at 1 year, and incurred an increased risk of occurrence of any CV event (fatal and nonfatal).

Prevalence of abdominal aortic aneurysm and large infrarenal aorta in patients with acute coronary syndrome and proven coronary stenosis: a prospective monocenter study.

BACKGROUND: Little is known about the prevalence of abdominal aortic aneurysm (AAA) in patients with coronary heart disease. The aims of this prospective study were to evaluate the prevalence of AAA and of large abdominal aorta in patients hospitalized for acute coronary syndrome and coronary stenosis of 50% or greater. METHODS: AAA ultrasound screening was prospectively performed in 306 patients after they gave informed consent. AAA and large abdominal aorta were defined by maximum anteroposterior diameter of 30 mm or greater and of 20 to 29 mm, respectively. Patient characteristics were prospectively collected. Univariate and multivariate analyses were used to identify risk factors for AAA and large abdominal aorta. A p value <0.05 was considered statistically significant. RESULTS: AAAs were diagnosed in 20 patients (6.6%). Mean diameter was 33 +/- 3.7 mm, and median diameter [min--max] was 31 mm [30 - 45 mm]. All except one AAA were between 30 and 40 mm. No AAAs were detected in patients younger than 50 years. Prevalence reached 7.7% in patients older than 50 years. Using stepwise logistic regression analysis, age (odds ratio [OR] 1.04. 95% confidence [CI] 1.00-1.09 per year of age, p = 0.06) and previous coronary events (OR 2.44, 95% CI 0.96-6.25, p = 0.06) showed a borderline significant association with AAA. Large infrarenal aortic diameter was observed in 32% of patients. Age (OR 1.03, 95% CI 1.02-1.05 per year of age, p < 0.0001), male gender (OR 16.7, 95% CI 6.25-50.0, p < 0.0001), and overweight (OR 2.0, 95% CI 1.2-3.4, p = 0.01) showed a significant independent association with large aorta. CONCLUSION: AAA and large infrarenal aorta prevalence seems high in patients with acute coronary syndrome and proven coronary stenosis of 50% or greater. Previous coronary events and older age might be associated with higher risk of AAA, and age, male gender, and obesity are significantly associated with large infrarenal aorta. If these results are confirmed in larger studies, further guidelines concerning AAA screening in this well-defined population should be considered.

Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study.

AIM OF THE STUDY: To evaluate the short and long-term effects of anthracycline chemotherapy in adults using conventional echocardiography and pulsed tissue Doppler imaging (TDI). METHODS AND RESULTS: Twenty patients were included of which 16 had a complete follow up. They underwent an echocardiography before chemotherapy, 1-3 months and 3.5+/-0.6 years after the treatment. We recorded pulsed TDI at the mitral annulus, the basal segments of the left ventricular (LV) lateral and posterior walls; peak velocities in systole (Sm), early (Em) and late diastole and the isovolumic relaxation time (IVRT) were measured. The cumulative dose of doxorubicin was 211+/-82 g/m2. Early after anthracycline therapy, we observed changes in the diastolic LV function with a decrease of the mitral E peak velocity and TDI Em. At the late control, diastolic changes were more pronounced and associated with an alteration of the systolic function (LV ejection fraction and Sm). Four patients had a LV ejection fraction <50%; in these patients we observed a mitral annulus IVRT <80 ms at the early control; this could be of interest to predict later impairment of the LV ejection fraction. CONCLUSION: We found early changes in LV diastolic function and observed that late impairment of the LV ejection fraction occurred frequently after anthracycline therapy, despite normal systolic LV function during the first months of follow-up.

Characterization of cysteinyl leukotriene receptors on human saphenous veins: antagonist activity of montelukast and its metabolites.

The aims of this study were to determine the cysteinyl leukotriene (CysLT) receptors expressed in the human saphenous vein, to examine contractile response to LTC4 and LTD4, to evaluate antagonist activity of montelukast, a specific CysLT1 receptor antagonist used in asthma, and to characterize the CysLT receptors involved in the contractile response. The analysis by reverse-transcriptase polymerase chain reaction indicated that CysLT1 and CysLT2 receptors are expressed by saphenous veins. In varicose vein rings, the potencies (pD2) of LTC4 and LTD4 were similar: 7.4 +/- 0.2 and 7.4 +/- 0.1, respectively. Pretreatment with acivicin, a gamma-glutamyl transpeptidase (gamma-GT) inhibitor, to prevent potential metabolism of LTC4 to LTD4, did not alter the response to LTC4. In nondistended vein rings from patients undergoing arterial bypass, the LTC4 pD2 was 7.8 +/- 0.1, and pretreatment with S-hexyl-GSH, a potent gamma-GT inhibitor, caused a fourfold rightward shift of the LTC4 concentration-response curve. In varicose and nondistended saphenous vein rings, montelukast (10(-8) and 10(-7) M) exerted a potent activity against LTD4 and LTC4, in the presence or absence of gamma-GT inhibitors. In varicose vein rings, the two active metabolites of montelukast also exerted antagonist activities with potencies similar to montelukast. BAY u9773 (CysLT2 agonist/dual CysLT1/CysLT2 antagonist) did not cause contraction and inhibited the LTC4- and LTD4-induced contractions. In conclusion, human saphenous veins express CysLT1 and CysLT2 receptors, but only CysLT1 receptors are implicated in the contraction.