Assessment of Mitochondrial Dysfunction and Monoamine Oxidase Contribution to Oxidative Stress in Human Diabetic Hearts.

Mitochondria-related oxidative stress is a pathomechanism causally linked to coronary heart disease (CHD) and diabetes mellitus (DM). Recently, mitochondrial monoamine oxidases (MAOs) have emerged as novel sources of oxidative stress in the cardiovascular system and experimental diabetes. The present study was purported to assess the mitochondrial impairment and the contribution of MAOs-related oxidative stress to the cardiovascular dysfunction in coronary patients with/without DM. Right atrial appendages were obtained from 75 patients randomized into 3 groups: (1) Control (CTRL), valvular patients without CHD; (2) CHD, patients with confirmed CHD; and (3) CHD-DM, patients with CHD and DM. Mitochondrial respiration was measured by high-resolution respirometry and MAOs expression was evaluated by RT-PCR and immunohistochemistry. Hydrogen peroxide (H2O2) emission was assessed by confocal microscopy and spectrophotometrically. The impairment of mitochondrial respiration was substrate-independent in CHD-DM group. MAOs expression was comparable among the groups, with the predominance of MAO-B isoform but no significant differences regarding oxidative stress were detected by either method. Incubation of atrial samples with MAOs inhibitors significantly reduced the H2O2 in all groups. In conclusion, abnormal mitochondrial respiration occurs in CHD and is more severe in DM and MAOs contribute to oxidative stress in human diseased hearts with/without DM.

Pre-operative transthoracic real-time three-dimensional echocardiography for a better surgical strategy.

UNLABELLED: In this study we aimed to evaluate the three-dimensional (3D) transthoracic echocardiography (TTE) in the assessment of cardiac valve morphology. METHODS: Bidimensional (2D) and real-time 3D TTE was performed in 104 patients consecutive with cardiac catheterisation, prior to valve surgery. Using surgical findings as the gold standard, 2D and 3D TTE were compared for adequate recognition and accurate detection of morphology. A scoring protocol was used for recognition of the valvular segments (0= inadequate, 1 = adequate). RESULTS: Adequate echographic visualization of the valve segments was more frequently obtained by 3D than 2D TTE imaging (731/770 by 3D TTE vs. 693/770 by 2D TTE, p < 0.01). The valve leaflets segments were more clearly identified by 3D TTE rather than by 2D TTE (502/531 vs. 471/531, p <0.01). The assessment of commissures was similar by both methods (229/239 vs. 222/239, p=0.09). Total 3D TTE scores for mitral and aortic valves were significantly better than 2D ITE scores (mean score 12.91+/-1.62 by 3D vs 11.58+/-1.02 by 2D, p=0.02). This superiority of 3D TTE was irrespective of rhythm (p <0.05 for both sinus rhythm and atrial fibrillation). Using surgical classification of valvular disease as gold standard, the sensibility and specificity were 91% and 84 % for 3D TTE, and 85% and 77% for 2D TTE, respectively. CONCLUSIONS: Real-time 3D was superior to 2D TTE forthe accurate localization and identification of valvular pathology, irrespective of heart rhythm.

Assessment of treatment with orotate magnesium in early postoperative period of patients with cardiac insufficiency and coronary artery by-pass grafts (ATOMIC).

The benefit of the treatment with magnesium orotate (magnerot) was assessed in a randomised, single blind and placebo controlled study. Respecting the inclusion criteria were selected 32 patients with ischemia chronic failure in early postoperative period after CABG. The main improvements induced by magnesium orotate are the increase in exercise capacity (distance ambulated during 6 minutes walk test and ergospirometric parameters) and the reduction of ventricular premature beats. The treatment was well tolerated and the adverse reactions were not significant. The study strongly suggests the benefit of magnesium orotate added to classical antiischemic therapy in the complex management of coronary patients after CABG.

Left atrial spontaneous echo contrast as a predictor of systemic arterial embolization in rheumatic mitral valve disease: a transesophageal echocardiographic study.

The relationship between systemic arterial embolization and left atrial spontaneous echo contrast (LASEC) was investigated in 90 consecutive patient with rheumatic mitral valve disease (52 patients had predominant mitral stenosis, 14 had significant mitral regurgitation and 24 with xenograft mitral valve replacement), during a 2-year period. LASEC was defined as the presence of dynamic echos (smoke-like) curling up in a circular pattern within the left atria, by transesophageal echocardiography (TEE). LASEC was observed in 27 patients (group A) and was absent in 63 patients (group B). Group A patients showed a higher frequency of left atrial thrombi or history of previous embolization than those in group B (59.2% vs. 7.3%; p < 0.001). Group A patients also had a higher frequency of recent (10 days before TEE study) and remote (more than 10 days before TEE study) embolization than did group B patients (recent: 22.2% vs. 1.6%; p < 0.001; remote: 11.1% vs. 4.7%, p < 0.001). Thus patients with LASEC had a significantly higher risk for thromboembolism and TEE is a useful modality to identify this subset of patients with rheumatic mitral valve disease.

Doppler echocardiographic parameters of evaluation of left ventricular systolic function.

The authors suggest a new method using Doppler echocardiography for the evaluation of cardiac performance. Doppler echocardiography permits the calculation of left ventricular (LV) ejection force (according to Newton's second law of motion). The ejection force was calculated in 36 patients with heart failure subgrouped into 3 groups based on ejection fraction (EF) (> 60%; 41-60%; < 40%) compared to 11 normal subjects. The LV ejection force showed a good linear correlation with LV ejection fraction (r = 0.86). Data of the study suggest that the LV ejection force is a valuable and accurate index for the assessment of cardiac performance, especially in early stages of disease.