The Biplane Modified Simpson's Method Accurately Estimates Pericardial Effusion Volume: A Comparison with Pericardiocentesis.

BACKGROUND: Pericardial effusion (PE) volume is often assessed semiqualitatively by echocardiography and categorized into minimal, small, moderate, or large. Several methods of echocardiographic quantification have been proposed, but their application is limited either by complexity or inaccuracy. We evaluated the accuracy of PE volume quantification by two-dimensional transthoracic echocardiogram (2DTTE) and commercially available volume quantification software in patients undergoing pericardiocentesis. METHODS: In a retrospective case series, immediate preprocedure echocardiograms of 33 patients for pericardiocentesis were analyzed. 2DTTE using the Simpson's method was adopted for volume measurement in the apical two- and four-chamber views. Pericardial fluid volume was calculated by taking the difference between volumes obtained by tracing the epicardial border of the heart and the pericardium. Postprocedure echocardiograms were performed to verify adequate pericardiocentesis. RESULTS: The mean pericardiocentesis fluid volume was 725.1 ± 299.5 mL (range, 250-1420 mL). The average volume estimated echocardiographically by the Simpson's method was 657.5 ± 276.9 mL (range, 205.7-1193.2 mL). There was strong direct linear correlation between echocardiographic and pericardiocentesis-derived volumes (P < 0.001, r = +0.823). Echocardiography underestimated PE volume by a mean of 9.3%. CONCLUSION: Two-dimensional transthoracic echocardiography using biplane Simpson's method of disks can simply and accurately estimate PE volume.

CAC score as a possible criterion for administration of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers: the MultiEthnic Study of Atherosclerosis.

INTRODUCTION: Several trials have demonstrated that angiotensin converting enzyme inhibitors (ACEIs) decrease cardiovascular (CV) mortality rates in patients with heart failure; however, the Prevention of Events with Angiotensin-Converting Enzyme Inhibition (PEACE) and European Trial on Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease (EUROPA) trials failed to show significant similar preventive effects in normal ejection fraction patients. We evaluated the baseline coronary artery calcium (CAC) score as a predictor of the effects of ACEIs/angiotensin receptor blockers (ARBs) on outcomes among normal ejection fraction participants. METHODOLOGY: Of 6814 MultiEthnic Study for Atherosclerosis population participants (after exclusion of the patients temporarily using ACEIs and/or ARBs during follow-up), we evaluated 2906 participants who never used ACEIs/ARBs and 368 (8.7%) participants who constantly used them during all baseline and follow-up examinations. In the population studied, 53.9% were men, aged 60.8±10.0 years, who had no apparent clinical CV disease. We compared CV event rates and multivariable-adjusted hazard ratios after stratifying by ACEI/ARB use and stratifying CAC scores by category (0, 1-399, and ≥400). RESULTS: The event rates varied from 1.8 to 41.2/1000 person years among the CAC groups. Among the participants with a 1-399 CAC score, ACEI/ARB users had significantly lower event rates than nonusers (4.9 vs. 8.2, respectively). Hazard ratio in the adjusted model was 3.1 (95% confidence interval 1.14-8.78, P<0.05). There was no significant event rate difference between ACEI/ARB users and nonusers among other CAC groups. CONCLUSION: The use of ACEIs/ARBs was associated with significantly fewer CV events in asymptomatic participants with low to intermediate CAC scores. Thus, better risk stratification in asymptomatic individuals (such as using CAC scores) may assist in proper selection of patients for further CV risk reduction strategies.

Incidentally detected right pulmonary artery agenesis with right coronary artery collateralization.

Unilateral pulmonary artery agenesis (UPAA) with pulmonary hypoplasia is a rare congenital anomaly. We describe a 71-year old male who was incidentally diagnosed with the right UPAA and a hypoplastic right lung supplied by collateralized right coronary.

Classic pneumatosis intestinalis and hepatic portal venous gas in setting of severe abdominal aorta atherosclerosis.

An 86-year-old man with extensive past medical history was referred to Emergency Department for evaluation of dehydration, hyperkalemia and worsening of mental status. In physical examination, abdomen was distended and tender with no bowel sounds. Abdominal computed tomographic imaging revealed pneumatosis intestinalis (PI) and hepatic portal venous gas (HPVG) in presence of severe atherosclerotic calcification of abdominal aorta.

Effect of lovastatin therapy and withdrawal on serum uric acid level in people with type 2 diabetic nephropathy.

BACKGROUND/AIM: A high uric acid (UA) level is demonstrated as a major risk factor of nephropathy and cardiovascular events in people with type 2 diabetes (T2D). This study aimed to evaluate the lovastatin effect on serum UA levels in people with type 2 diabetic nephropathy (T2DN). METHODS: Thirty patients completed the study course, out of 38 adult male patients with T2DN who were initially enrolled. Lovastatin, 20 mg/d, was administered for 90 days. Afterwards, lovastatin was withdrawn for the next 30 days. Blood samples were obtained at baseline, after 45 and 90 days of intervention, and 30 days after the withdrawal of lovastatin. The serum level of UA was assessed by the uricase/PAP method. The lipid profile and high-sensitivity C-reactive protein (hs-CRP) were determined using commercial reagents and the ELISA method. RESULTS: After 90 days of lovastatin intervention, cholesterol (Chol) and low-density lipoprotein cholesterol (LDL-C) levels significantly decreased and the high-density lipoprotein cholesterol (HDL-C) level increased significantly, despite the unchanged level of triglyceride (TG). After withdrawal, Chol, TG, and LDL-C levels were significantly increased, without any change in the HDL-C level. The baseline serum UA level was 5.94 ± 2.02 mg/dL and not changed after the intervention (5.95 ± 2.21 mg/dL; p = 0.969) and withdrawal period (5.80 ± 1.51 mg/dL; p = 0.647). The changes of serum UA levels were not correlated with the changes of serum hs-CRP levels, both after intervention and withdrawal (p = 0.963 & p = 0.835). CONCLUSIONS: Lovastatin does not have any effect on the serum UA level in people with T2DN. There is no correlation between the anti-lipidemic and anti-inflammatory effects of lovastatin and its effect on serum UA.

Lovastatin raises serum osteoprotegerin level in people with type 2 diabetic nephropathy.

OBJECTIVES: Osteoprotegerin (OPG), a glycoprotein, is a member of the tumor necrotizing factor alpha receptor super-family. By considering the possible role of OPG in cardiovascular disease (CVD), higher incidence of CVD in people with type 2 diabetic nephropathy (T2DN), and anti-atherosclerotic effects of statins, the present study aimed to investigate the effects of lovastatin on serum levels of OPG and soluble receptor activator of nuclear factor-κB ligand (sRANKL) in people with T2DN. DESIGN AND METHODS: Thirty patients completed the study course, out of 38 adult male patients with T2DN who were initially enrolled. Lovastatin, 20mg/d, was administered for 90 days. Afterwards, lovastatin was withdrawn for the next 30 days. Serum levels of OPG and sRANKL were measured using commercial ELISA kits at baseline, after 90 days of intervention, and after 30 days of withdrawal of lovastatin. RESULTS: Serum level of OPG was significantly increased (10.76 ± 16.44) and decreased (-7.38 ± 11.98) during 90 days of intervention and 30 days of withdrawal periods, respectively, while, sRANKL level was significantly decreased (-1192.08 ± 578.20) and increased (4418.67 ± 2124.66) during the same periods, respectively. CONCLUSIONS: Lovastatin therapy increased serum OPG level and decreased sRANKL level in people with T2DN. The withdrawal of lovastatin decreased serum OPG level, while sRANKL level was extensively increased.