Comparison of Clinical Features between Typical and Atypical Takotsubo Cardiomyopathy: A Single Center, Retrospective, Case-Controlled Study.

BACKGROUND: The incidence and possible differences between typical and atypical Takotsubo cardiomyopathy (TTC) in Taiwanese patients have not yet been assessed. METHODS: We reviewed the records of 2171 patients who underwent left heart catheterization for suspected acute coronary syndrome (ACS) between January 2003 and March 2011 to identify TTC. Demographic, clinical presentations, laboratory data, and electrocardiographic, echocardiographic and angiographic findings were assessed in all patients. RESULTS: We found that fourteen patients had typical TTC, and six had atypical TTC. There were no differences in the clinical presentations, ejection fraction and in-hospital course of illness between patients with typical TTC (the TT group) and patients with atypical TTC (the AT group). However, the patients in the AT group were relatively younger than those in the TT group (mean ages 60 vs. 73 years, respectively, p = 0.018), and fewer patients had hypertension in the AT group than in the TT group (33% vs. 86%, respectively, p = 0.037). In electrocardiography, ST segment elevation was noted less frequently in the AT group than in the TT group (33% vs. 86%, respectively, p = 0.037). CONCLUSIONS: Atypical TTC and typical TTC may be the same syndrome with different manifestations. They seemed to have different patient characteristics and electrocardiographic changes. KEY WORDS: Acute coronary syndrome; Takotsubo cardiomyopathy; Transient left ventricular apical ballooning.

[Research Status and Trend Analysis of Environmental and Health Risk and Control of Persistent, Mobile, and Toxic Chemicals].

Persistent, mobile, and toxic or very persistent and very mobile (PMT/vPvM) chemicals have been widely detected in surface water, groundwater, and drinking water around the world and are important emerging contaminants that may significantly affect human health and the environment in the future. According to the identification criteria proposed by the European Union, there are thousands of PMT/vPvM substances in existing chemicals, covering a wide range of applications, including dozens of high-yield industrial chemicals such as melamine. PMT/vPvM chemicals can be discharged into the environment through farmland runoff, industrial wastewater, and domestic sewage, and sewage treatment plants are currently considered to be their main discharge route. It is difficult to effectively remove PMT/vPvM chemicals through the current conventional water treatment technology; they can exist in the water circulation system of the urban human settlement environment for a long time, endangering the safety of drinking water and the ecosystem. The European Union has taken the lead in introducing PMT/vPvM chemicals specifically into the priority areas of the current chemical risk management system. At present, there are still many potential PMT/vPvM chemicals in the environment, and their monitoring methods need to be further improved. It will take time for the identification of substances, the scope of categories, and the establishment of lists. Studies on the environmental fate and exposure of PMT/vPvM in various regions of the world are still very limited, and research on the potential, long-term ecotoxicity, and human health hazard effects remains scarce. At the same time, the research and development of substitute or alternative technologies, as well as environmental engineering treatment technologies such as sewage treatment and contaminated site remediation, will become an urgent need for future PMT/vPvM risk scientific research and management decisions.

Takotsubo cardiomyopathy as an underlying mediator of myocardial infarction with normal coronary arteries.

OBJECTIVE: The purpose of the present study was to describe our experience with myocardial infarction with normal coronary arteries (MINCA) with regards to the prevalence, clinical characteristics, possible underlying etiologies (including Takotsubo cardiomyopathy, TCM) and the short- and long-term outcomes associated with this condition. METHODS: We retrospectively analyzed the records of 596 consecutive patients presenting with acute myocardial infarction over a 4-year period and identified 24 patients (14 female, 10 male) with angiographically normal coronary arteries. Demographic and clinical variables and outcomes were reviewed. RESULTS: Mean patient age was 59 +/- 20 years. The presumed MINCA mechanism was TCM in 10 patients (41.7%), probable myocarditis in 5 (20.8%), coronary spasm in 4 (16.7%), coronary thrombus in 3 (12.5%) and aortic dissection in 2 patients (8.3%). After a mean follow-up of 19 +/- 14 months, 2 patients with probable myocarditis had died of cardiovascular causes, 1 patient with aortic dissection had died due to sepsis after surgery and 1 patient with TCM had died of noncardiovascular causes 2 years after discharge. CONCLUSION: In this study, we found that MINCA occurred in 4% of patients with acute myocardial infarction undergoing emergent coronary angiography, with the most frequent underlying mechanism being TCM.

Isolated right ventricular intracavitary metastasis of hepatocellular carcinoma in a 74-year-old woman.

A 74-year-old woman with a history of chronic hepatitis C and transcatheter arterial chemoembolization for an unresectable hepatocellular carcinoma (HCC) 2 years previously presented with progressive exertional dyspnea of 1 month's duration. Two-dimensional echocardiography revealed a huge right ventricular mass with right atrial and right ventricular outflow tract extension. Palliative resection of the tumor and adjunctive chemotherapy was performed. However, the right ventricular mass recurred 1 month later and the patient died 4 months after the operation. To our knowledge, this is the oldest patient reported with isolated right ventricular intracavitary metastasis of HCC, and this report reemphasizes the lower surgical indication in patients with metastatic cardiac tumors.

Effects of habitual t'ai chi exercise on adiponectin, glucose homeostasis, lipid profile, and atherosclerotic burden in individuals with cardiovascular risk factors.

OBJECTIVES: A single bout of t'ai chi (TC) exercise was previously found to be associated with a significant increase in post-exercise adiponectin levels in individuals with cardiovascular risk factors. The objective of this study was to examine the long-term effects of 24-month habitual TC exercise on adiponectin levels, glucose homeostasis, lipid profile, and atherosclerotic burden in individuals with cardiovascular risk factors. DESIGN: This was a prospective observational study. SETTINGS/LOCATION: The study was conducted at a regional hospital in south Taiwan. SUBJECTS: Participants of a TC exercise program held by the clinics of cardiology and cardiovascular surgery for individuals with cardiovascular diseases were recruited to the TC group. Individuals who did not join the program were recruited as controls. All study subjects had at least one cardiovascular risk factor. INTERVENTIONS: Ninety-minute session of Yang's style TC at least once a week. OUTCOME MEASURES: Measurements on adiponectin, glucose homeostasis, lipid profile, and atherosclerotic burden were made at three time points-baseline, 12 months, and 24 months. Two-way repeated-measures general linear model was used to assess the changes over the study period between the TC and control groups. RESULTS: Thirty-seven patients in both the TC and control groups completed the study. The TC group showed a greater increase in natural logarithmic transformed (Ln) adiponectin values than the control group over the study period (interaction effect p=0.009). Glucose homeostasis, lipid profile, risk of atherosclerosis, and atherosclerotic burden did not showed significant changes with TC compared with the controls over the 24-month period. CONCLUSIONS: The results of the present study indicate that for individuals with at least one cardiovascular risk factor, engaging in habitual TC exercise could lead to favorable changes in levels of adiponectin. The association between habitual TC and cardiovascular events and diabetic complications will require further investigations.