What Do We Know So Far About Ventricular Arrhythmias and Sudden Cardiac Death Prediction in the Mitral Valve Prolapse Population? Could Biomarkers Help Us Predict Their Occurrence?

PURPOSE OF THE REVIEW: To summarize currently available data on the topic of mitral valve prolapse (MVP) and its correlation to the occurrence of atrial and ventricular arrhythmias. To assess the prognostic value of several diagnostic methods such as transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance, cardiac computed tomography, electrocardiography, and electrophysiology concerning arrhythmic episodes. To explore intra and extracellular biochemistry of the cardiovascular system and its biomarkers as diagnostic tools to predict rhythm disturbances in the MVP population. RECENT FINDINGS: MVP is a common and mainly benign valvular disorder. It affects 2-3% of the general population. MVP is a heterogeneous and highly variable phenomenon with three structural phenotypes: myxomatous degeneration, fibroelastic deficiency, and forme fruste. Exercise intolerance, supraventricular tachycardia, and chest discomfort are the symptoms that are often paired with psychosomatic components. Though MVP is thought to be benign, the association between isolated MVP without mitral regurgitation (MR) or left ventricle dysfunction, with ventricular arrhythmia (VA) and sudden cardiac death (SCD) has been observed. The incidence of SCD in the MVP population is around 0.6% per year, which is 6 times higher than the occurrence of SCD in the general population. Often asymptomatic MVP population poses a challenge to screen for VA and prevent SCD. Therefore, it is crucial to carefully assess the risk of VA and SCD in patients with MVP with the use of various tools such as diagnostic imaging and biochemical and genetic screening.

The impact of various protective tools on the dose reduction in the eye lens in an interventional cardiology-clinical study.

The aim of the study was to check, in clinical practice, the potential for the dose reduction of lead eyewear and a ceiling-suspended shield used to protect the eye lens of physicians working in interventional cardiology. To this end, for the lead eyewear, the dose reduction factors were derived to correct the readings from a dosimeter used routinely outside the glasses. Four types of lead eyewear with attached loose thermoluminescent dosimeters and EYE-D dosimeters were worn by physicians in two clinical centres, for two-month periods, during coronary angiography (CA), percutaneous coronary intervention (PCI), and pacemaker procedures. In order to analyse, separately, how a ceiling-suspended lead screen absorbs the scattered radiation, a series of measurements was carried out during single CA/PCI procedures performed with and without the protection. The lead eyewear may reduce the doses to the eye closest to the x-ray tube by a factor between 1.1 and 3.4, depending on its model and the physician's position. The effectiveness of the eyewear may, however, vary-even for the same model and physician-almost twofold between different working periods. The ceiling-suspended shield decreases the doses in clinical practice by a factor of 2.3. The annual eye lens doses without the eyewear estimated from routine measurements are high-above or close to the new eye lens dose limit established by the recent EU Basic Safety Standards, even though the ceiling-suspended shield was used. Therefore, to comply with the new dose limit that is set in the Directive, protection of the eyes of physicians with high workloads might require the use of both the eyewear and the ceiling-suspended shield.

Use of medical resources and quality of life of patients with chronic heart failure: a prospective survey in a large Italian community hospital.

AIMS: To assess the prevalence, clinical characteristics, use of medical resources and quality of life in consecutive patients with chronic heart failure (CHF) hospitalized in a large community hospital during 3 months. METHODS AND RESULTS: The study group included 354 patients with CHF, admitted in the Departments of Internal Medicine (97%) and Cardiology. Median age was 78 years [72;85], 45% were males. CHF was the main diagnosis in 72%; 28% were in NYHA class III and 49% in class IV; 42% had atrial fibrillation. The median hospital stay was 8 days [5;14], in-hospital mortality 9% in those admitted for CHF and 19% in those admitted primarily for other diseases. Patients with CHF occupied 15% of the beds; 1330 ECGs, 389 chest X-rays, 112 echocardiograms and 10 coronary angiograms were performed. A quality of life questionnaire revealed that 82% had problems with mobility, 54% with self-care and 88% with everyday activity. Thirty-nine percent of patients had at least one hospitalization during the previous year. CONCLUSIONS: Ninety-seven percent of hospitalized patients with CHF are admitted in the Internal Medicine wards and occupy 15% of beds. The majority of the patients are 72 years or older, with severe heart failure. The frequency of rehospitalization(s) and mortality rate in this population remains high. Echocardiography is performed only in 27% of patients.

Systolic anterior movement of mitral valve during acute apical myocardial infarction: An unusual mechanism of acute mitral regurgitation.

We describe a singular case of a 75-year-old woman affected by an anterior acute myocardial infarction in the subset of a very recent orthopaedic surgery. She had had severe mitral regurgitation on coronary angiography. A thorough cardiac echocardiographic examination revealed the particular mechanism of mitral incompetence, consisting of a dynamic anterior mitral leaflet displacement caused by a sustained compensatory left ventricle hypercontractility and favored by postsurgical moderate anemia and mild hypertensive hypertrophy. The use of beta-blockers and the avoidance of pure vasodilators permitted complete reversal of such mechanisms during the clinical course.

Mechanical resistance of reefbuilders through time.

Comparative studies on the mechanical properties of calcium carbonate skeletons suggest that reefbuilders adopted contrasting strategies through the ages to cope with hydrodynamic forces. From the superior mechanical strength of the coralline sponge Ceratoporella nicholsoni it is concluded that its forebears, the stromatoporoids, built a very resistant framework in Paleozoic/Mesozoic reefs. Scleractinians and other modern reefbuilders, however, are comparatively fragile. They compensate breakage and wear by rapid growth due to zooxanthellae-enhanced calcification.

[Use of harmonic echocardiographic contrast imaging and intravenous bolus of Levovist for evaluation of the left ventricle]. / Zastosowanie harmonicznej echokardiografii kontrastowej z dozylnym podaniem Levovistu do oceny lewej komory serca.

Harmonic imaging is a new imaging modality using nonlinear acoustic response, which is particularly sensitive for the particles of contrast agents. Our study was designed to compare the potential of harmonic echocardiographic imaging of the left ventricle using a contrast agent, Levovist to improve the detection of endocardium in patients with suboptimal image quality. 40 patients were studied using standard transthoracic apical views of the left ventricle patients using fundamental frequency and second harmonic frequency after and intravenous injection of 2.5 g Levovist. The quality of endocardial delineation in 16 standard segments was scored from 0 to 2. Endocardial visualization index was calculated as a mean of the scores to express overall diagnostic quality. Harmonic imaging with contrast significantly improved left ventricular endocardial border detection (endocardial visualization index at baseline 1.24 +/- 0.41, with contrast 1.63 +/- 0.38; p < 0.001). The improvement was qualitatively observed in all parts of the left ventricle: in apex (2.4 +/- 0.8), in the middle part (2.5 +/- 0.9) and slightly less in the basal part (2.1 +/- 1.1) as scored on a 0-3 scale. The number of invisible segments decreased from 124 (fundamental) to 50 in contrast harmonic mode. The persistence of the contrast enhancement, prolonged in harmonic as compared to fundamental imaging (284 +/- 136s vs 117 +/- 87s; p < 0.001) enabled convenient recording of all necessary views. Harmonic imaging after an intravenous injection of Levovist significantly improves the visualization of left ventricular endocardial border. Prolonged contrast effect after a single bolus enhances the pertinence of the method in clinical practice.

[Which medical treatment can minimize late complications after pharmacologic treatment of unstable angina?]. / Jakie leczenie farmakologiczne minimalizuje odlegle powiklania po zachowawczym leczeniu niestabilnej choroby wiencowej?

UNLABELLED: Current pharmacological treatment of unstable coronary diseases has significantly reduced the rate of early and late complications. Aim of this study was to investigate the impact of in-hospital and ambulatory treatment on the occurrence of late complications in patients with unstable angina treated conservatively. The study group consisted of consecutive 79 patients hospitalized in our Department on the turn of years 1998-1999 (48 men--age 62 +/- 11 years), followed up by at least 1 year. We analyzed the administered agents on the first day of hospitalization: acetylsalicylic acid, heparin, nitroglycerin, beta-adrenergic agents, calcium channels blockers, statins and ACE inhibitors, as well these drugs prescribed for ambulatory management. At least one complication (recurrent hospitalization due to coronary artery disease, unstable angina pectoris, myocardial infarction, need for revascularization or death) occurred in 57 patients (72%) in a follow-up of 16 +/- 3 months. The following drugs significantly reduced rate of late complications (OR--odds ratio, CI--confidence interval, p--significance level):--intravenous heparin during hospitalization: OR = 0.22; CI = 0.12-0.42; p = 0.007;--acetylsalicylic acid administration during hospitalization: OR = 0.42; CI = 0.22-0.77; p = 0.03;--acetylsalicylic acid prescribed for ambulatory treatment: OR = 0.24; CI = 0.13-0.46; p = 0.05. CONCLUSIONS: Heparin and acetylsalicylic acid treatment seems to reduce the number of late complications in patients treated conservatively for the episode of unstable angina.