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OBJECTIVE: Aortic rupture is a rare and catastrophic emergency. Prompt diagnosis and treatment are the primary determinants of mortality. During follow-up, the majority of patients who have been effectively treated die from hypovolemic shock and multiorgan failure. This article describes the clinical and procedural details of sixteen patients with ruptured aortic aneurysms treated endovascularly. In addition, it discusses the main factors contributing to the mortality of these patients. METHOD: Patients who underwent endovascular treatment for acute aortic rupture at our center from October 2016 to March 2023 were included in this retrospective study. RESULTS: A total of 16 patients underwent endovascular aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) for acute aortic rupture. The patients' mean age was 73.06 years (range: 52-92), and 15 of them were male. The ruptures occurred in the abdominal aortic aneurysm in ten patients, in thoracic aortic aneurysm in three patients, in the isolated iliac artery aneurysm in two patients, and there was one case of non-aneurysmal aortic rupture. In our series, patients who presented with an impending, self-limited rupture and stable hemodynamic status had good prognostic outcomes. However, eight patients died due to multiorgan failure, hemorrhagic shock, disseminated intravascular coagulopathy, renal failure, or abdominal compartment syndrome. These patients generally had poor admission vital signs and low hemoglobin values. The most critical determinants for the success of the procedure are promptly stopping the bleeding, avoiding general anesthesia, and opting for blood product replacement instead of fluid replacement. CONCLUSION: Each patient with ruptured aortic aneurysm should be managed according to the patient's hemodynamics at presentation, the size of the aneurysm, the suitability for percutaneous procedure, logistical factors, and the operator-center's experience.
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Aneurisma de la Aorta Abdominal , Rotura de la Aorta , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Anciano , Femenino , Humanos , Masculino , Aneurisma de la Aorta Abdominal/complicaciones , Aneurisma de la Aorta Abdominal/cirugía , Rotura de la Aorta/cirugía , Implantación de Prótesis Vascular/efectos adversos , Procedimientos Endovasculares/métodos , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Persona de Mediana Edad , Anciano de 80 o más AñosRESUMEN
Periodical health examination is one of the important factors influencing a healthy lifestyle. Patients undergoing routine physical examination in primary care are included in the scope of preventive medical services, which is the most basic principle of primary care. Identifying the risk factors enables individuals to adopt healthier lifestyle practices. In our study, we examined the correlation between patients undergoing coronary angiography for suspected coronary stenosis and the extent of primary care services they had received in their medical history, along with the severity of stenosis observed during the angiography. Patients were interviewed using a pre-structured questionnaire to gather information about their past utilization of primary healthcare services related to coronary matters and their cardiovascular (CV) risk profile as documented in their medical history. The necessary standard tests for angiography procedures were retrieved from patient records. The SYNTAX score, a tool that aids in the objective assessment of the severity of coronary artery disease (CAD), was computed and documented. This score was then compared with the history of primary care utilization. The patients' utilization of services from the Primary Healthcare Center (PHC) was evaluated using a scoring system, with an average score of 29.27â ±â 11.27 out of 100 points (minimum: 20; maximum: 60). The average SCORE Türkiye indicating the 10-year risk of CV events for all patients was calculated as 14.31%â ±â 8.65% (high-very high risk), while the average SYNTAX score was 15.20â ±â 9.97. There was a positive and significant correlation found between fasting blood glucose and creatinine values with both SYNTAX score and SCORE Türkiye (respectively; Râ =â 0.238, Pâ =â .013; Râ =â 0.289, Pâ =â .002). Factors such as smoking and metabolic syndrome were associated with CAD severity. It important to highlight that individual recommended for angiography had a notably lower utilization of healthcare services from the PHC based on their medical histories. This circumstance has resulted in individuals who do not undergo CV event screenings at PHCs having higher SYNTAX scores, indicating more severe CAD that necessitates angiography. Conducting regular periodical health examinations at PHCs can help mitigate these statistics.
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Enfermedad de la Arteria Coronaria , Estenosis Coronaria , Humanos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Angiografía Coronaria , Estenosis Coronaria/complicaciones , Factores de Riesgo , Constricción Patológica/complicaciones , Índice de Severidad de la Enfermedad , Valor Predictivo de las PruebasRESUMEN
During hyperbaric oxygen (HBO2) therapy in humans, there are changes in cardiovascular physiology due to high pressure and hyperoxygenation. Peripheral vasoconstriction, bradycardia, and a decrease in cardiac output are observed during HBO2 therapy. These physiological effects of HBO2 therapy on the cardiovascular system are tolerated in healthy people. However, patients with underlying cardiac disease may experience severe problems during HBO2 therapy, such as pulmonary edema and death. In addition, cardiac complications may occur in patients with diabetes mellitus (DM). Therefore, HBO2 therapy may negatively affect cardiovascular physiology in patients with DM. The present study aimed to examine the cardiovascular effects of HBO2 therapy in diabetic patients. The findings of NT-ProBNP, troponin I, and electrocardiography (ECG) of diabetic patients who applied to the Ministry of Health University Gülhane Training Research Underwater and Hyperbaric Medicine Clinic were compared before and after the first HBO2 therapy session. When ECG findings were analyzed at the end of a session of HBO2 exposure, a statistically significant increase was observed in the QTc and QTc dispersion measurements (pâº0.001 and p = 0.02, respectively). In cardiac enzymes, there was a statistically significant increase in troponin I values after an HBO2 therapy session, but no statistically significant change was observed in Pro-BNP (p = 0.009, p = 0.3, respectively). Short-term exposure to HBO2 therapy had statistically significant changes in troponin I, QT, and QTc in patients with DM, which did not reach clinical significance. Despite very little evidence of cardiac dysfunction, we recommend caution in using HBO2 therapy in patients with DM and emphasize the need for further investigation of these measurements.
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Sistema Cardiovascular , Diabetes Mellitus , Oxigenoterapia Hiperbárica , Humanos , Oxigenoterapia Hiperbárica/efectos adversos , Troponina I , OxígenoRESUMEN
BACKGROUND: Optimal valve sizing provides improved results in transcatheter aortic valve replacement. Operators hesitate about the valve size when the annulus measurements fall into borderline area. Our purpose was to compare the results of borderline versus non-borderline annulus and to understand the impact of valve type and under or oversizing. METHODS: Data from 338 consecutive transcatheter aortic valve replacement procedures were analyzed. The study population was divided into 2 groups as 'borderline annulus' and 'non-borderline annulus.' Balloon expandable valves already have a grey zone definition. Similar to balloon expandable valves, annulus sizes that are within 15% above or below the upper or lower limit of a particular self-expandable valve size are defined as the 'borderline annulus' for self-expandable valves. The borderline annulus group was also divided into 2 subgroups according to the smaller or larger valve selection as 'undersizing' and 'oversizing.' Comparisons were made regarding the paravalvular leakage and residual transvalvular gradient. RESULTS: Of these 338 patients, 102 (30.1%) had a borderline and 226 (69.9%) had a non-borderline annulus. Both the transvalvular gradient (17.81 ± 7.15 vs. 14.44 ± 6.27) and the frequency of paravalvular leakage (for mild, mild to moderate, and moderate, 40.2%, 11.8%, and 2.9% vs., 18.8%, 6.7%, and 0.4%, respectively) were significantly higher in the borderline annulus than the non-borderline annulus group (P <.001). There were no significant differences between the groups balloon expandable versus self-expandable valves and oversizing versus undersizing regarding the transvalvular gradient and paravalvular leakage in patients with borderline annulus (P >.05). CONCLUSION: Regardless of the valve type and oversizing or undersizing, borderline annulus is related to significantly higher transvalvular gradient and paravalvular leakage when compared to the non-borderline annulus in transcatheter aortic valve replacement.
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Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Resultado del TratamientoRESUMEN
BACKGROUND: Menopause is an important life stage for women, which can bring along sex- ual and cardiac problems. Increased heart rate variability is an indicator of parasympa- thetic activity and is associated with mental and physical health and life expectancy. This study aimed to evaluate the effect of sexual activity (only penile-vaginal intercourse but not masturbation or non-coital sex with a partner) on heart rate variability in healthy menopausal women. METHODS: We evaluated 130 menopausal patients aged 45-60 years, without chronic dis- ease. The average weekly sexual activity numbers remembered in the last 1 year were questioned. The patients were divided into 2 groups according to the presence of sexual activity. The sexually active group was divided into subgroups as 1 per week and 2 or more per week. Menopause Rating Scale was applied for menopausal symptoms. Heart rate variability was analyzed from the 24-hour electrocardiography Holter recording. RESULTS: Heart rate variability parameters were higher in the sexually active group than in the sexually inactive group (mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording: P = .004; root mean square of differences between adjacent normal RR intervals, expressed in ms: P=.001; number of NN intervals exceeding 50 milliseconds: P = .011; percentage of adjacent RR intervals with a difference of duration >50 ms: P = .009; low frequency: P = .011; high fre- quency: P=.008, low frequency/high frequency: P=.018). When assessed by multiple linear regression analysis by adjusting for age, body mass index, and menopause dura- tion, the variables mean of the standard deviations of all the NN intervals for each 5 min segment of a 24-hour heart rate variability recording, root mean square of differences between adjacent normal RR intervals, expressed in ms, and low frequency were inde- pendently associated with the number of sexual activities per week (B = 2.89 ± 1.02, 95% CI = 0.866-4.91, P = .005; B = 4.57 ± 1.83, 95% CI = 0.94-8.2, P = .014; and B = 1174.9 ± 592.2, 95% CI = 2.9-2346.9, P = .049, respectively). CONCLUSION: In healthy menopausal women, continued sexual activity with penile-vagi- nal intercourse is associated with better health outcomes on cardiac autonomic function through higher heart rate variability, an index of parasympathetic activity.
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Sistema Nervioso Autónomo , Menopausia , Electrocardiografía , Femenino , Frecuencia Cardíaca/fisiología , Humanos , Conducta SexualRESUMEN
OBJECTIVE: The management of severe functional mitral regurgitation (FMR) in patients with heart failure (HF) and low ejection fraction is controversial, but percutaneous transcatheter procedures are promising. In this retrospective analysis, we aimed to assess the efficacy of the Carillon Mitral Contour System in patients with "inoperable" severe FMR. METHODS: Seventy three patients (mean age 66.89, range 31-90 years) with congestive heart failure (CHF), severe FMR, and reduced ejection fraction (<35%) who underwent Carillon device implantation were examined. The study group consisted of patients with successfully implanted devices whereas the control group comprised patients in whom the device could not be deployed. The primary endpoint was combined all-cause mortality and first hospitalization for HF (whichever came first). RESULTS: The median (Q1, Q3) follow-up was 31 (11-49) months. The device was deployed successfully in 50 patients (implant group) and not in 23 patients (non-implant group). Both the primary endpoint and all-cause mortality were lower in the "implant" group, but the differences were not significant. The median to primary endpoint was 21 [95% confidence interval (CI) 8.8-33.2] and six (95% CI 0.1-11.9) months for the implant group and the non-implant group, respectively (p=0.078). CONCLUSION: Carillon Mitral Contour System implantation is a safe procedure and results in the reduction of all-cause mortality and combined endpoint of mortality and hospitalizations for HF in inoperable patients with severe FMR and low ejection fraction, although the difference did not meet the significance level.
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Implantación de Prótesis de Válvulas Cardíacas , Anuloplastia de la Válvula Mitral , Insuficiencia de la Válvula Mitral , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Persona de Mediana Edad , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Aneurisma Coronario/diagnóstico por imagen , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Arteria Pulmonar/anomalías , Arteria Pulmonar/diagnóstico por imagen , Aneurisma Coronario/complicaciones , Angiografía Coronaria , Anomalías de los Vasos Coronarios/complicaciones , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XAsunto(s)
Estenosis Coronaria/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico , Anciano , Fibrilación Atrial , Puente de Arteria Coronaria Off-Pump/métodos , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/cirugía , Diagnóstico Diferencial , Insuficiencia Cardíaca , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/cirugía , Infarto del Miocardio , UltrasonografíaRESUMEN
Transcatheter aortic valve implantation (TAVI) is a new and hopefully therapeutic option in patients with symptomatic severe calcific aortic valve stenosis and multiple comorbidities who are not eligible for open-heart surgery due to unacceptable conventional surgical risks. Herein is reported the case of a patient who underwent TAVI in whom an unusual CoreValve bioprosthesis embolization occurred into the abdominal aorta. While attempting to retrieve the whole system, the conical tip of the catheter delivery system also became embolized into the right iliac artery. Importantly, this case demonstrated a rare complication of CoreValve bioprosthesis embolization which was managed without surgical intervention. Video 1: Peripheral angiography demonstrating the embolized CoreValve bioprosthesis. Video 2: Fluoroscopy demonstrating completely opened CoreValve bioprosthesis at a level above the iliac artery bifurcation and the mobile conical tip in the valve system. Video 3: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 4: Peripheral angiography demonstrating prosthetic valve without any flow limitation and embolized conical tip into the right internal iliac artery. Video 5: Aortography demonstrating the successfully implanted second CoreValve bioprosthesis in an optimal aortic position, with no paravalvular leak. Video 6: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow. Video 7: Peripheral angiography demonstrating the embolized conical tip into the right iliac artery with a normal external iliac artery flow.
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OBJECTIVE: Mean platelet volume (MPV), one of the indices of platelet reactivity has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty or thrombolytics. However data regarding MPV and its association with ST-segment resolution; an indicator of epicardial and tissue level reperfusion in the setting of STEMI are limited. In this study, we aimed to investigate whether MPV on admission is associated with ST-segment resolution in STEMI patients treated with thrombolytics. METHODS: We retrospectively evaluated 232 consecutive patients with a diagnosis of first STEMI who were administered thrombolytic therapy within 12 hours of onset of chest pain. ST segment resolution based on baseline and 90 minute electrocardiographies were measured. Patients were grouped into two as with <50% and ≥50% ST-segment resolution. Admission MPV was measured and compared between two groups. RESULTS: Admission MPV was higher in patients with <50% ST-segment resolution than patients with ≥50% ST-segment resolution (9.9±1.3 fL vs. 8.5±1.1 fL respectively, p<0.001). The receiver operating characteristic analysis yielded a cut-off value of 9.3 fL to predict ST-segment resolution, with sensivity and specifity being 66.7% and 77.9%, respectively. In-hospital mortality rate was high in patients with <50% ST -segment resolution (p=0.002). CONCLUSION: High MPV on admission in STEMI patients treated with thrombolytics is associated with impaired ST segment resolution.
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Plaquetas/patología , Infarto del Miocardio/cirugía , Angiografía , Electrocardiografía , Humanos , Infarto del Miocardio/sangre , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Admisión del Paciente , Intervención Coronaria Percutánea , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Terapia TrombolíticaAsunto(s)
Tabiques Cardíacos/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Insuficiencia de la Válvula Mitral/terapia , Intervención Coronaria Percutánea/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Trombosis/diagnóstico , Ecocardiografía Doppler en Color , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Trombosis/diagnóstico por imagen , Trombosis/etiologíaAsunto(s)
Cateterismo Cardíaco/instrumentación , Rotura Cardíaca/diagnóstico , Insuficiencia de la Válvula Mitral/diagnóstico , Diagnóstico Diferencial , Rotura Cardíaca/complicaciones , Humanos , Insuficiencia de la Válvula Mitral/etiología , Músculos Papilares/diagnóstico por imagen , Intervención Coronaria Percutánea , UltrasonografíaAsunto(s)
Estenosis de la Válvula Aórtica/cirugía , Cateterismo Cardíaco , Anciano , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/patología , Ecocardiografía Transesofágica , Femenino , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Persona de Mediana Edad , Diseño de PrótesisRESUMEN
OBJECTIVE: We aimed to evaluate coronary blood flow by means of the TIMI (Thrombolysis in Myocardial Infarction) frame count in patients with idiopathic dilated cardiomyopathy who had angiographically proven normal coronary arteries and compare the results with those of healthy subjects. METHODS: This retrospective study included 62 patients with idiopathic dilated cardiomyopathy (34 men, 28 women; mean age 59.7 ± 10.6 years) and 62 control subjects without dilated cardiomyopathy (28 men, 34 women; mean age 56.6 ± 9.8 years). All patients and control subjects had angiographically proven normal coronary arteries. Dilated cardiomyopathy patients had a left ventricular ejection fraction =45%. The TIMI frame count was determined for each major coronary artery in each patient. Statistical analysis was performed using Student's t test, Chi-square test and Pearson correlation analysis. RESULTS: The TIMI frame counts for each major epicardial coronary artery were found to be significantly higher in patients with idiopathic dilated cardiomyopathy compared to control subjects (corrected TIMI frame count for left anterior descending coronary artery: 37.0 ± 12.5 vs 28.7 ± 11.6, respectively, p=0.001; left circumflex coronary artery: 37.7 ± 12.1 vs 31.0 ± 12.5, respectively, p=0.003; right coronary artery: 37.4 ± 12.6 vs 30.7 ± 11.6, respectively, p=0.003). Mean TIMI frame count had significant although weak positive correlation with left ventricular end-diastolic diameter (r=0.350, p=0.001) and left ventricular end-systolic diameter (r=0.358, p=0.001). CONCLUSION: We have shown that patients with idiopathic dilated cardiomyopathy and angiographically normal coronary arteries have higher TIMI frame counts for all three coronary vessels, indicating impaired coronary blood flow, compared to control subjects without dilated cardiomyopathy.
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Cardiomiopatía Dilatada/fisiopatología , Circulación Coronaria/fisiología , Vasos Coronarios/fisiología , Pruebas de Función Cardíaca/métodos , Flujo Sanguíneo Regional/fisiología , Anciano , Cardiomiopatía Dilatada/diagnóstico por imagen , Ecocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVE: High sensitivity C-reactive protein (hsCRP) and neopterin are associated with atherosclerosis. We aimed to evaluate the association between hsCRP and neopterin, and myocardial ischemia during exercise stress test (EST) in patients with stable angina pectoris (SAP) and to assess the predictive value of these mediators in obstructive coronary artery disease. METHODS: Forty-five patients with SAP were included in this prospective observational study. EST- positive group included 23 patients (15 males, mean age 54 ± 10 years) and EST-negative group-22 patients (14 males, mean age 52 ± 9 years). In each patient, blood samples were obtained 1 hour before and 30 minutes after EST. In EST-positive group, coronary angiography was performed to determine the presence and severity of coronary artery lesions as assessed by Gensini score. Statistical analysis was performed using Chi-square, unpaired t, Mann-Whitney U and Wilcoxon rank tests. Logistic regression analysis was used to establish the predictive value of tests. RESULTS: Before EST, hsCRP and neopterin levels were similar between the two groups, however, hsCRP levels were higher in EST-positive group after EST (p=0.03). There was no significant difference between the two groups with respect to neopterin levels after EST (p=0.4). In EST-positive group, EST resulted in significant increases in both hsCRP and neopterin levels (from 3.8 ± 2.8 mg/L to 4.3 ± 3.1 mg/L, p=0.001; from 8.7 ± 4.0 nmol/L to 13.1 ± 10.0 nmol/L, p=0.001, respectively). In EST-negative group only neopterin levels significantly increased after EST (from 6.9 ± 1.8 nmol/L to 9.0 ± 3.9 nmol/L, p=0.001). No relation was observed between the obstructive coronary lesions and the levels of hsCRP or neopterin at any point. CONCLUSION: In SAP patients, independent with the existence of obstructive coronary lesion, elevated levels of hsCRP after EST might be an indicator of immune activation caused by myocardial ischemia.
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Proteína C-Reactiva/metabolismo , Ejercicio Físico/fisiología , Isquemia Miocárdica/metabolismo , Neopterin/sangre , Adulto , Angina de Pecho/sangre , Angina de Pecho/metabolismo , Arteriopatías Oclusivas/sangre , Arteriopatías Oclusivas/metabolismo , Biomarcadores/sangre , Biomarcadores/metabolismo , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Estrés FisiológicoRESUMEN
Stent fracture (SF) was suggested to be an unusual cause of restenosis after drug eluting-stent implantation. However, angiographically visible complete SF after bare metal stent (BMS) implantation is extremely rare. Here we report a case of SF of a BMS representing with acute coronary syndrome (ACS). To our knowledge, this is the first report of early fracture of a BMS in the right coronary artery, resulting in ACS.
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Síndrome Coronario Agudo/diagnóstico por imagen , Síndrome Coronario Agudo/etiología , Angiografía Coronaria , Falla de Prótesis/efectos adversos , Stents/efectos adversos , Vasos Coronarios/patología , Vasos Coronarios/cirugía , Humanos , Masculino , Metales , Persona de Mediana EdadRESUMEN
BACKGROUND: P-wave dispersion (PWD) has been reported to be associated with inhomogeneous and discontinuous propagation of sinus impulses. In the present study, we aimed to investigate PWD in patients with dilated cardiomyopathy. METHOD: The study population consisted of 72 patients with dilated cardiomyopathy and 72 healthy control subjects. Left atrial diameter, left ventricular end-diastolic and end-systolic diameters and left ventricular ejection fraction of all patients and control subjects were measured by means of transthoracic echocardiography. Maximum P-wave duration (Pmaximum) and minimum P-wave duration (Pminimum) were measured from the 12-lead surface electrocardiogram. PWD was calculated as the difference between Pmaximum and Pminimum. RESULTS: Pmaximum and PWD of patients with dilated cardiomyopathy were significantly higher than those of control subjects (Pmaximum: 126+/-12 ms vs. 116+/-10 ms, PWD: 47+/-6 ms vs. 38+/-7 ms, respectively, P<0.001 for all). However, there was no statistically significant difference between patient group and control group regarding Pminimum (79+/-7 ms vs. 78+/-6 ms, respectively, P=0.27). Left atrial diameter was significantly higher in patients with dilated cardiomyopathy compared to control subjects (4.51+/-0.62 cm vs. 3.60+/-0.43 cm, respectively, P<0.001). Left ventricular ejection fraction was found to be significantly lower in patients with dilated cardiomyopathy compared to control subjects (33+/-5% vs. 63+/-7%, respectively, P<0.001). CONCLUSION: PWD was found to be significantly higher in patients with dilated cardiomyopathy than in healthy control subjects.