Self-expanding stent for spontaneous coronary artery dissection: a rational choice.

: Spontaneous coronary artery dissection (SCAD) is a rare and poorly understood cause of acute coronary syndrome in relatively young patients. Nowadays, the optimal treatment of SCAD is uncertain. A conservative approach seems to be preferable, but in particular conditions, an invasive strategy is necessary. The poor rate of procedural success, the high risk of procedural complications and the uncertain long and mid-term results make the interventional treatment of SCAD a challenge. We report a case of a young male patient presenting with SCAD successfully treated with a sirolimus-eluting self-expanding coronary stent. To our knowledge, the use of self-expanding coronary stent for SCAD has never been described yet and we discuss about the rationale of a possible larger use in clinical practice.

Exercise and cardiovascular diseases.

Exercise is a physiologic stressor that has multiple beneficial effects on cardiovascular system. Currently exercise training is a class I intervention as part of a multifactorial long-term process that includes: clinical assistance, assessment of global cardiovascular risk, identification of specific objective for each cardiovascular risk factor, formulation of an individual treatment plan with multiple intervention aimed at reduction of the risk, educational programs, planning of long term follow-up. This paper reviews the evidences of benefit of exercise in the most common heart diseases and describes the role of exercise training in the cardiac rehabilitation programs.

Assessment of ultrasound acoustic artifacts in patients with acute dyspnea: a multicenter study.

BACKGROUND: Recent reports indicate that numerical assessment of B-lines during transthoracic ultrasound may aid the differential diagnosis of acute diffuse pleuropulmonary disorders. PURPOSE: To determine whether B-lines are different in normal and diseased lungs and whether they can be used to discriminate between different types of pulmonary disorders in acutely ill patients. MATERIAL AND METHODS: In this multicenter study, transthoracic ultrasonography was performed on 193 patients with acute dyspnea, 193 healthy non-smokers, and 58 patients who had undergone pneumonectomy for lung cancer. Examinations were done with a low-medium frequency (3.5-5.0 MHz) convex probe and a high-frequency (8-12.5 MHz) linear probe. Video recordings were re-examined by a second set of examiners. In each participant, we measured the number of B-lines observed per scan. RESULTS: B-lines counts were higher in dyspnoic patients (means: 3.11 per scan per linear probe scan vs. 1.93 in healthy controls and 1.86 in pneumonectomized patients; P < 0.001 for all); all counts were higher when convex probes were used (5.4 in dyspnoic patients and 2 in healthy controls; P < 0.001 vs. the linear probe). Subgroups of dyspnoic patients defined by cause of dyspnea displayed no significant differences in the number of B-lines. CONCLUSION: Our results demonstrate that there are a significant higher number of B-lines in the lungs of patients with dyspnea compared to healthy subjects and to pneumonectomized patients. Nevertheless, the quantification of B-lines does not make any significant contribution to the differential diagnosis of dyspnea.

Influence of pentraxin 3 (PTX3) genetic variants on myocardial infarction risk and PTX3 plasma levels.

PTX3 is a long pentraxin of the innate immune system produced by different cell types (mononuclear phagocytes, dendritic cells, fibroblasts and endothelial cells) at the inflammatory site. It appears to have a cardiovascular protective function by acting on the immune-inflammatory balance in the cardiovascular system. PTX3 plasma concentration is an independent predictor of mortality in patients with acute myocardial infarction (AMI) but the influence of PTX3 genetic variants on PTX3 plasma concentration has been investigated very little and there is no information on the association between PTX3 variations and AMI. Subjects of European origin (3245, 1751 AMI survivors and 1494 controls) were genotyped for three common PTX3 polymorphisms (SNPs) (rs2305619, rs3816527, rs1840680). Genotype and allele frequencies of the three SNPs and the haplotype frequencies were compared for the two groups. None of the genotypes, alleles or haplotypes were significantly associated with the risk of AMI. However, analysis adjusted for age and sex indicated that the three PTX3 SNPs and the corresponding haplotypes were significantly associated with different PTX3 plasma levels. There was also a significant association between PTX3 plasma concentrations and the risk of all-cause mortality at three years in AMI patients (OR 1.10, 95% CI: 1.01-1.20, p = 0.02). Our study showed that PTX3 plasma levels are influenced by three PTX3 polymorphisms. Genetically determined high PTX3 levels do not influence the risk of AMI, suggesting that the PTX3 concentration itself is unlikely to be even a modest causal factor for AMI. Analysis also confirmed that PTX3 is a prognostic marker after AMI.

Ergometric score systems after myocardial infarction: prognostic performance of the Duke Treadmill Score, Veterans Administration Medical Center Score, and of a novel score system, GISSI-2 Index, in a cohort of survivors of acute myocardial infarction.

BACKGROUND: The aims of the study were to evaluate the performance of the Duke Treadmill Score (DTS) and the Veteran Affairs Medical Center Score (VAMCS) in predicting 6-month death in GISSI-2 study survivors of acute myocardial infarction treated with thrombolytic agents, and to develop a simple predictive scoring system from the same database. METHODS: Patients of the GISSI-2 study (n = 6251) performed a maximal symptom-limited exercise test 1 month after myocardial infarction. We calculated for each patient the DTS and the VAMCS. Based on the coefficients of a multivariate analysis of our database, we developed a simple predictive scoring system and performed an internal validation. The prognostic value of each scoring system was assessed by multivariate analysis. RESULTS: Six-month mortality rates in the subgroups of each scoring system were as follows: DTS: low risk 0.6%, moderate risk 1.8%, high risk 3.4% (P < or =.0001); VAMCS: low risk 0.6%, moderate risk 1.9%, high risk 4.7% (P < or =.0001); GISSI-2 Index: low risk 0.5%, moderate risk 1.9%, high risk 6.1% (P < or =.0001). The results of multivariate analysis (relative risk [RR] and 95% CI) were as follows: DTS: moderate risk 2.50 (1.47-12.59), high risk 5.13 (3.61-15.55); VAMCS: moderate risk 2.65 (1.53-4.59), high risk 5.97 (3.10-11.49); GISSI-2 Index: moderate risk 3.16 (1.81-5.52), high risk 8.65 (4.36-17.18). CONCLUSIONS: The use of ergometric-derived prognostic score systems in a population of survivors of acute myocardial infarction treated with thrombolytic drugs distinguishes subgroups at different risks of death and allows an appropriate recourse to more costly procedures.