Coagulase-negative staphylococcal prosthetic valve endocarditis--a contemporary update based on the International Collaboration on Endocarditis: prospective cohort study.

OBJECTIVE: To describe the contemporary features of coagulase-negative staphylococcal (CoNS) prosthetic valve endocarditis (PVE). DESIGN: Observational study of prospectively collected data from a multinational cohort of patients with infective endocarditis. Patients with CoNS PVE were compared to patients with Staphylococcus aureus and viridans streptococcal (VGS) PVE. SETTING: The International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) is a contemporary cohort of patients with infective endocarditis from 61 centres in 28 countries. PATIENTS: Adult patients in the ICE-PCS with definite PVE and no history of injecting drug use from June 2000 to August 2005 were included. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Heart failure, intracardiac abscess, death. RESULTS: CoNS caused 16% (n = 86) of 537 cases of definite non-injecting drug use-associated PVE. Nearly one-half (n = 33/69, 48%) of patients with CoNS PVE presented between 60 days and 365 days of valve implantation. The rate of intracardiac abscess was significantly higher in patients with CoNS PVE (38%) than in patients with either S aureus (23%, p = 0.03) or VGS (20%, p = 0.05) PVE. The rate of abscess was particularly high in early (50%) and intermediate (52%) CoNS PVE. In-hospital mortality was 24% for CoNS PVE, 36% for S aureus PVE (p = 0.09) and 9.1% for VGS PVE (p = 0.08). Meticillin resistance was present in 68% of CoNS strains. CONCLUSIONS: Nearly one-half of CoNS PVE cases occur between 60 days and 365 days of prosthetic valve implantation. CoNS PVE is associated with a high rate of meticillin resistance and significant valvular complications.

Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles.

OBJECTIVE: To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. DESIGN: Prospective cohort study. SETTING: Study at two centres (a tertiary care centre and a community hospital). PATIENTS: 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. METHODS: Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003. MAIN OUTCOME MEASURES: Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. RESULTS: 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. CONCLUSIONS: S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

Sudden death in Staphylococcus aureus-associated infective endocarditis due to perforation of a free-wall myocardial abscess.

Free-wall myocardial abscess perforation with hemopericardium and sudden death is an extremely infrequent complication of infective endocarditis (IE). We describe a case of Staphylococcus aureus-associated native aortic and tricuspid valve endocarditis complicated by a septic myocardial infarction and abscess formation of embolic origin, with fatal rupture into the pericardium. To our knowledge, only 2 cases of myocardial abscess rupture have previously been reported in relation to IE.

Outcomes after radiofrequency catheter ablation of atrial tachycardia.

The purpose of this study was to evaluate the efficacy, safety, and clinical benefit of radiofrequency catheter ablation (RFCA) in a large series of patients with atrial tachycardia (AT). The determinants of success or failure of RFCA in AT remain unclear. We evaluated the results of radiofrequency ablation in 73 women and 32 men (mean age 48 +/- 19 years) with AT. Mapping techniques were based on identification of the earliest endocardial atrial electrogram recorded during AT. AT originated from the right atrium in 91 patients and from the left atrium in 14. The cardiac ventricles were dilated in 12 patients. AT ablation was successful in 80 patients (77%) regardless of the site of origin. Age, gender, rate of tachycardia, temperature achieved during application, or presence of tachycardiomyopathy were not significant determinants of acute success by univariate analysis. There was a significantly higher acute success rate of ablation in patients with paroxysmal (88%, 45 of 51) and permanent (71%, 30 of 42) forms than in patients with repetitive forms of AT (41%, 5 of 12) (p <0.005). The mean local endocardial electrogram time (relative-to-surface P-wave onset) was -47 +/- 17 ms at successful ablation sites and -29 +/- 21 ms at unsuccessful sites (p <0.03). Ablation was unsuccessful in 25 cases. Thus, RFCA of AT can be performed with a high acute success rate. Patients with repetitive forms and those with multifocal origin had a lower acute success rate. The highest incidence of recurrences was found in anterior right atrial foci.

Aortocardiac fistulas complicating infective endocarditis.

This study sought to determine the clinical and echocardiographic features, surgical approach, and outcome of patients with infective endocarditis complicated with aortocardiac fistulas among a series of 346 consecutive cases between 1988 and 1998. Nine patients (2%) were found to have aortocardiac fistulas complicating infective endocarditis caused by highly pyogenic pathogens (4 patients had ruptured abscesses of the right sinus of Valsalva, 3 had fistulous communications from the left coronary sinus, and 1 had a fistulized abscess in the noncoronary sinus). Mortality in these patients was very high (55%), even when surgery was attempted early in the course of the disease and reconstructive procedures were implemented.

[In-hospital evolution and current prognosis of unstable angina]. / Evolución hospitalaria y pronóstico actual de la angina inestable.

INTRODUCTION AND PROGNOSIS: The prognosis of patients with unstable angina has improved in recent years resulting in a progressive reduction in hospital stay and treatment. The aim of this study was to know the current prognosis of patients with unstable angina in a non-selected population followed for up to 3 months. PATIENTS AND METHODS: 478 consecutive patients with unstable angina were studied. They were treated following a strict protocol and a management policy guided by symptoms and the results of an exercise test or a pharmacological stress test performed before hospital discharge. RESULTS: The mean age was 66 +/- 11 years with 30% being females. Thirty-five percent had a prior history of myocardial infarction, 61% presented ischemic changes on the admission ECG, and 16% had elevation of the CK-MB plasma levels. An echocardiogram was performed in 80% of the patients, a stress test in 62%, coronary angiography in 51%, and a revascularization procedure in 27% of the patients. During hospitalization, the incidence of mortality or myocardial infarction, refractory angina or ischemic complications was of 3.6%, 11% and 13%, respectively. After hospital discharge and during a 3-month follow-up, the incidence of these complications was of 3.3%, 9% and 10% (NS compared to the in-hospital period). Overall, from the time of hospital admission to the 3-month follow-up, 4.2% of the patients died, 7% died or had an infarction, 20% had refractory angina, and 26% had some ischemic complication. CONCLUSION: The in-hospital prognosis of unstable angina is currently good. However, patients discharged from hospital after stabilization, present an important number of ischemic complications during the following 3 months, similar to that presented by all patients during the acute phase.

Left internal mammary artery to innominate vein fistula complicating pacemaker insertion. Treatment with endovascular transarterial coil embolization.

Arteriovenous fistula (AVF) is rarely encountered as a complication of pacemaker insertion. Percutaneous angiographic therapy of such iatrogenic fistulas can be both safe and effective, leading to important reductions in costs. A 60-year-old woman was admitted to the hospital four weeks after left subclavian pacemaker insertion complaining of signs of congestive heart failure. A loud continuous machinery bruit was heard over the left upper chest. An arteriogram revealed a false aneurysm from the LIMA, 6 mm in-diameter, with formation of an AVF between the LIMA and the left innominate vein. Embolization of the LIMA was carried out using seven Platinum coils at the level of the AVF and the false aneurysm was embolized with 3 controlled-release IDC coils. The complete occlusion of the fistula was achieved and the distal LIMA persisted patent due to the opening of collateral vessels from the intercostal arteries. AVF between the subclavian artery or its branches and the subclavian or innominate veins have been reported to be congenital, traumatic and iatrogenic (associated to central venous access to hemodynamic monitoring, dialysis, and very infrequently to pacemaker insertion) but the internal mammary arteries are only rarely involved. The course of AVF is undefined, but generally, surgical or percutaneous embolization is warranted because of the potential appearance of a great number of complications. Surgical repair is associated with significant morbidity and mortality. Whenever possible, percutaneous nonsurgical occlusion of the AVF with coil embolization is the procedure of choice, because of its high success rate and low morbidity.

Captopril administration reduces thrombus formation and surface expression of platelet glycoprotein IIb/IIa in early postmyocardial infarction stage.

Long-term administration of the angiotensin-converting enzyme inhibitor captopril in survivors of myocardial infarction (MI) reduces the risk of cardiovascular death, recurrence of MI, and unstable angina, suggesting that captopril may possess antithrombotic properties that have not been clearly elucidated. We assessed the short-term antithrombotic effects of captopril on platelet aggregation, platelet-subendothelium interaction, and the expression of major glycoproteins on platelet surface. A double-blind study was carried out in 25 patients with MI. Blood samples were taken before (baseline) and 12 days after treatment in both the control and captopril groups. Platelet aggregation was tested by conventional aggregometry using common activating agents. Platelet interaction with deeply damaged subendothelial surface was evaluated in a perfusion model, with blood maintained under flow conditions. Deposition of platelets was quantified by using computer-assisted morphometric techniques on histological sections, and it was expressed as a percentage of total vessel surface covered by platelets (CS) and as a ratio between large aggregates (T) and surface covered by platelets (100XT/CS). Glycoprotein expression was measured using flow cytometric techniques. Aggregometric responses showed no significant variations; however, in the captopril group, 100XT/CS decreased after 12 days of treatment (100XT/CS: 36+/-12.1% captopril versus 64+/-8.0% baseline; P=0.005). This parameter was also significantly decreased from that found in control group patients (100XT/CS:67=/-4.5%, P=0.008). Flow cytometry showed a 30% reduction in glycoprotein IIb/IIIa expression (P=0.02). Captopril reduced the formation of large aggregates in a perfusion system, which might be related to a down-regulation of glycoprotein IIb/IIIa complex on the platelet surface. These results suggest that captopril exerts an antiplatelet effect that may contribute to its beneficial action in MI.

[Improvement in the treatment of acute myocardial infarct by the establishment of a thrombolysis unit in a cardiology servic]. / Mejoría del tratamiento del infarto agudo de miocardio mediante la creación de una unidad de trombólisis en el servicio de cardiología.

INTRODUCTION AND OBJECTIVES: Lack of available beds in the coronary care unit, makes time to thrombolysis still too long. Although fibrinolytic therapy is administered in the emergency department in most hospitals, mean in-hospital delay continues to be long. Our purpose was to improve the treatment of these patients and to evaluate if this delay could be shortened by creating a thrombolysis unit for the treatment of patients with acute myocardial infarction. METHODS: A thrombolysis unit in the cardiology department was set up to treat patients with acute myocardial infarction who couldn't be admitted directly in the coronary care unit because of lack of available beds. Time to treatment in both groups of patients were compared. RESULTS: Two hundred twenty-five patients with acute myocardial infarction and ST-segment elevation were included: 86 (38%) of them were admitted to the thrombolysis unit and the other 139 (62%) to the coronary care unit. There were no differences in baseline characteristics or in the pre-hospital delay between both groups. Time from hospital admission to thrombolysis was 59 minutes in patients treated in the thrombolysis unit versus 70 minutes in those treated in the coronary care unit (p < 0.001), and time from the admission to both units to fibrinolytic therapy was of 20 minutes versus 30 minutes respectively (p < 0.0001). There were no differences between both groups in the incidence of complications. CONCLUSIONS: In-hospital delay in thrombolysis remains too long. Implementation of a thrombolysis unit in the cardiology department shortens this delay and offers the possibility to treat patients with acute myocardial infarction at least as well as in the coronary care unit, without dependence on the availability of free beds in this unit.

Long-term follow-up in patients with the permanent form of junctional reciprocating tachycardia treated with radiofrequency ablation.

This study sought to determine the long-term follow-up, safety, and efficacy of radiofrequency catheter ablation of patients with the permanent form of junctional reciprocating tachycardia (PJRT). We assessed the reversibility of tachycardia induced LV dysfunction and we detailed the location and electrophysiological characteristics of these retrograde atrioventricular decremental pathways. PJRT is an infrequent form of reciprocating tachycardia, commonly incessant, and usually drug refractory. The ECG hallmarks include an RP interval > PR with inverted P waves in leads II, III, a VF, and V3-V6. During tachycardia, retrograde VA conduction occurs over an accessory pathway with slow and decremental conduction properties, located predominantly in the posteroseptal zone. It is known that long-lasting and incessant tachycardia may result in tachycardia induced severe ventricular dysfunction. We included 36 patients (13 men, 23 women, mean +/- SD, aged 44 +/- 22 years) with the diagnosis of PJRT. Seven patients had tachycardia induced left ventricular dysfunction. Radiofrequency energy was delivered at the site of earliest retrograde atrial activation during ventricular pacing or during reciprocating tachycardia. All patients were followed at the outpatient clinic and serial echocardiograms were performed in those who presented with depressed LV function. Radiofrequency ablation was performed in 36 decremental accessory pathways. Earliest retrograde atrial activation was right posteroseptal in 32 patients (88%), right mid-septal in 2 (6%), right posterolateral in 1 (3%), and left anterolateral in 1 (3%). Thirty-five accessory pathways were successfully ablated with a mean of 5 +/- 3 applications. A mid-septal accessory pathway could not be ablated. After a mean follow-up of 21 +/- 16 months (range 1-64) 34 patients are asymptomatic. There were recurrences in 8 patients after the initial successful ablation (mean of 1.2 months), 5 were ablated in a second ablation procedure, 2 patients required a third procedure, and 1 patient required four ablation sessions. All patients with LV dysfunction experienced a remarkable improvement after ablation. Mean preablation LV ejection fraction in patients with tachycardiomyopathy was 28% +/- 6% and rose to 51% +/- 16% after ablation (P < 0.02). Our study supports the concept that radiofrequency catheter ablation is a safe and effective treatment for patients with PJRT. Radiofrequency ablation should be the treatment of choice in these patients because this arrhythmia is usually drug refractory. The majority of accessory pathways are located in the posteroseptal zone. Cessation of the arrhythmia after successful ablation results in recovery of LV dysfunction.

[Patients with structural heart disease, syncope of unknown etiology and inducible ventricular arrhythmias treated with implantable defibrillators]. / Pacientes con cardiopatía estructural, síncope de etiología desconocida y arritmias ventriculares inducibles tratados con desfibrilador implantable.

OBJECTIVES: This study evaluates the hypothesis that in patients with syncope of unknown origin and heart anomalies, inducible ventricular arrhythmias are specific arrhythmias and therefore should be treated as such. BACKGROUND: Although syncope is a frequent clinical entity, the evaluation and treatment of patients with syncope without a clear etiology still remains undefined. Many patients with syncope of undetermined origin undergo invasive electrophysiologic evaluation. Abnormalities of the sinus node, prolongation of conduction times or inducible arrhythmias found during these evaluations are usually assumed to be the cause of syncope, and are consequently treated. However, whether tachyarrhythmias are truly the cause of syncope, and whether treatment of these tachyarrhythmias can prevent recurrent syncope and arrhythmic death, is unknown. PATIENTS AND METHODS: An electrophysiological study was performed on 160 patients with structural heart disease and syncope of unknown origin. In 23 out of the 160 patients (16%), programmed electrical stimulation induced sustained ventricular arrhythmias. In 18 out of the 23 patients an automatic defibrillator was implanted and they form the study group. RESULTS: In these 18 patients, programmed ventricular stimulation induced sustained monomorphic ventricular tachycardia in 12, sustained polymorphic ventricular tachycardia in 2 and ventricular fibrillation in 4. During a mean follow-up of 14 months, 9 patients received 81 appropriate therapies from the device (53 because of ventricular tachycardia and 23 because of ventricular fibrillation). The probability of appropriate therapy was 100% at 1 year follow-up. There were no episodes of sudden death and 1 patient died of congestive heart failure. CONCLUSIONS: In patients with syncope of undetermined origin, heart disease and inducible ventricular tachyarrhythmias treated with a implantable cardioverter defibrillator, there is a high incidence of appropriate therapies. Our results support the practice of using implantable cardioverter defibrillators in patients with syncope of unknown origin, heart disease and inducible ventricular arrhythmias.

[Radiofrequency ablation of multiple atrioventricular accessory pathways in a patient with syncope, atrial fibrillation and fasciculoventricular fibers]. / Ablación por radiofrecuencia de múltiples vías accesorias auriculoventriculares en un paciente con fibrilación auricular sincopal y presencia de fibras fascículo-ventriculares.

Multiple accessory pathways in patients with the Wolff-Parkinson-White syndrome are infrequent and are associated with a higher risk of ventricular fibrillation. We present an exceptional case of a patient with four accessory pathways with anterograde conduction and a fasciculo-ventricular fiber in whom we performed a radiofrequency ablation. A 20 year old healthy male patient was seen at the emergency room after suffering syncope. The electrocardiogram showed atrial fibrillation with wide QRS complex suggestive of preexcitation. The electrophysiologic study demonstrated the presence of four atrio-ventricular accessory pathways with antegrade conduction (left lateral, right posteroseptal, right midseptal and right posterolateral). After ablation of the fourth accessory pathway, the electrocardiogram showed a persistent delta wave with a short HV interval. Atrial stimulation demonstrated decremental conduction, progressive lengthening of the AH interval and no modification in the HV interval nor in the preexcitation pattern, suggestive of the presence of a fasciculo-ventricular fiber. This exceptional case report is demonstrative of the complexity of the Wolff-Parkinson-White syndrome, and the feasibility and efficacy of radiofrequency catheter ablation in a single procedure.

[Hemodynamic deterioration in patients submitted to ablation of the atrioventricular node]. / Deterioro hemodinámico en pacientes sometidos a ablación del nodo auriculoventricular.

INTRODUCTION: Radiofrequency ablation of the atrioventricular conduction system has become an established therapy for patients with drug-refractory atrial fibrillation. We observed 14 patients with hemodynamic deterioration related to worsening of mitral regurgitation after the procedure. PATIENTS AND METHODS: We retrospectively evaluated 256 consecutive patients with drug-refractory atrial fibrillation referred for radiofrequency ablation of the AV node and implantation of a pacemaker. Because we found hemodynamic deterioration related to worsening mitral regurgitation, we compared the clinical history, electrophysiologic and echocardiographic data from the patients with hemodynamic deterioration and worsening mitral regurgitation (group A) with those without hemodynamic deterioration (group B). RESULTS: Fourteen out of 256 patients (group A) undergoing ablation of the atrioventricular conduction system deteriorated with acute pulmonary edema (3 patients) or congestive heart failure (11 patients) at a mean of 6 weeks after the ablation procedure. Four of these patients were referred for mitral valve surgery. The length of the procedure and the number of applications during ablation were similar in both groups. Compared with group B patients, group A patients had significantly higher left ventricular end-diastolic diameters (64 +/- 6 mm vs 56 +/- 9 mm; p < 0.05) at baseline despite similar left ventricular end-systolic diameters, fractional shortening and grade of mitral regurgitation (1.15 +/- 1.05 vs 1.11 +/- 0.97). Moreover, whereas no change was observed in left ventricular end-diastolic diameter, left ventricular end-systolic diameter, fractional shortening and grade of mitral regurgitation in group B patients after ablation, group A patients experienced a significant increase in left ventricular end-diastolic diameter (64 +/- 6 mm vs 72 +/- 9 mm; p < 0.01) and grade of mitral regurgitation (1.15 +/- 1.05 vs 2.90 +/- 1.15; p < 0.01). In patients operated on no ablation related structural damage to the mitral valve apparatus could be detected. The worsening of the mitral regurgitation was related to dilation of the mitral valve annulus. CONCLUSIONS: Hemodynamic deterioration together with progression of mitral regurgitation is a potential complication of ablation of the atrioventricular conduction system.

[Long-term follow up of patients with nodal reentry tachycardia who had undergone radiofrequency ablation]. / Seguimiento a largo plazo de pacientes con taquicardia por reentrada nodal a quienes se les realizó una ablación por radiofrecuencia.

INTRODUCTION: The aim of this study was to assess the long term results (minimum of 3 years) of radiofrequency catheter ablation in patients with common (slow-fast) atrioventricular nodal reentrant tachycardia. PATIENTS AND METHODS: Sixty consecutive patients (mean age 56 +/- 16 years, range 14 to 83, 16 men and 44 women) underwent slow pathway (n = 51, Group A) or fast pathway (n = 9, Group B) radiofrequency catheter ablation between January 1992 and March 1994. All patients were followed at 1, 3, 6 and 12 months after ablation with serial examinations and electrocardiograms and the last follow-up was made on April 1997. RESULTS: During a mean follow-up period of 48 +/- 7 months (range 38 to 63) all evaluated patients remained asymptomatic. Eight recurrences were observed at a mean of 1 +/- 2 months (range, 0.5 to 7) after a successful ablation procedure. A second procedure was effective in eliminating the dual atrioventricular nodal pathway in each of them. In Group A patients, the pre-ablation PR interval, at 12 months after ablation and at last follow-up were 122 +/- 11, 124 +/- 13 and 124 +/- 15 ms, respectively. In Group B patients, the pre-ablation PR interval, at 12 months after ablation and at last follow-up were 130 +/- 24, 200 +/- 12, 200 +/- 24 ms, respectively. No significant atrioventricular conduction disturbances in any patient were observed. One patient developed a new onset left bundle branch block and 4 patients died of noncardiac causes. CONCLUSIONS: In patients with atrioventricular nodal reentrant tachycardia, radiofrequency catheter ablation is a safe and effective therapy, with substantial good results that persist during long term follow-up, with a low recurrence rate and without complications during short and long term outcome.

[Anatomopathological bases of latent ventricular dysfunction in insulin-dependent diabetics]. / Bases anatomopatológicas de la disfunción ventricular latente en diabéticos insulinodependientes.

INTRODUCTION AND OBJECTIVES: The natural history of diabetic cardiomyopathy remains unclear, mainly due to concurrent coronary disease or hypertension. Since the presence of confounding factors is less likely in youngsters, they constitute a suitable study model to analyze early stages of diabetic cardiomyopathy. PATIENTS AND METHODS: We screened 33 young normotensive asymptomatic patients with type I diabetes mellitus. Mean age was 28 +/- 8 y (range 18 to 46 y) and there were 14 men. RESULTS: 2-D Echo showed normal left ventricular size and wall motion in all patients but one. Radionuclide basal ejection fraction was 56.5 +/- 6.6% and increased to 63 +/- 7.4% (p < 0.02) on exercise. According to Rozansky criteria, 16 patients had an abnormal response. Abnormal stress sestamibi was detected in 18 patients and only 3 had reversible defects. Coronary angiography was performed in 11 patients with at least one abnormal non-invasive study response. Coronary angiography revealed normal vessels in all patients and left anterior descending blood flow velocity (Doppler) increased 4 fold after papaverine infusion. Left ventricular biopsies showed hypertrophy (either nuclear or cellular) in 11, myocytolysis in 6, interstitial fibrosis in 9 and lipid deposits in 4. Morphometric analysis of cardiac samples comparing the diabetic group and a control group showed that the volume fraction of fibrosis (0.19 +/- 0.06 vs 0.10 +/- 0.06; p < 0.01), fiber area -mu2- (1,062 +/- 547 vs 600 +/- 167; p < 0.02) and fiber diameter -mu- (24.2 +/- 3.3 vs 15.1 +/- 3.4; p < 0.001) were higher in the former; and volume fraction of the myocytes was higher in the latter (0.71 +/- 0.006 vs 0.89 +/- 0.07; p < 0.001). CONCLUSIONS: Left ventricular dysfunction, not related to coronary atherosclerosis or small vessel disease, is frequent in asymptomatic young diabetic patients. Abnormal pathologic findings are common in the type of cell hypertrophy, interstitial fibrosis, myocytolysis and lipid deposits.