The usefulness of proximal anchor balloon technique during implantation of a cardiac resynchronization therapy device in a patient with complex coronary venous anatomy: a case report.

BACKGROUND: Cardiac resynchronization therapy (CRT) is an accepted device treatment in stable heart failure (HF) patients. In recent years increased awareness of coronary anatomy and implantation techniques have significantly impacted this evolving therapy. CASE PRESENTATION: In this article, we present a case describing the usefulness of the proximal balloon anchoring technique to enable initial coronary sinus (CS) cannulization and left ventricular (LV) lead placement in the tortuous coronary sinus during CRT implantation. CONCLUSIONS: The proximal anchor balloon technique can easily enable coronary sinus cannulization and left ventricular lead placement in patients with complex venous anatomy.

Large Magnetic Moment in Flexoelectronic Silicon at Room Temperature.

Time-dependent rotational electric polarizations have been proposed to generate temporally varying magnetic moments, for example, through a combination of ferroelectric polarization and optical phonons. This phenomenon has been called dynamical multiferroicity, but explicit experimental demonstrations have been elusive to date. Here, we report the detection of a temporal magnetic moment as high as 1.2 µB/atom in a charge-doped thin film of silicon under flexural strain. We demonstrate that the magnetic moment is generated by a combination of electric polarization arising from a flexoelectronic charge separation along the strain gradient and the deformation potential of phonons. The effect can be controlled by adjusting the external strain gradient, doping concentration, and dopant and can be regarded as a dynamical multiferroic effect involving flexoelectronic polarization instead of ferroelectricity. The discovery of a large magnetic moment in silicon may enable the use of nonmagnetic and nonferroelectric semiconductors in various multiferroic and spintronic applications.

Usefulness of right ventricular strain assessment in submassive pulmonary thromboembolism undergoing ultrasound-facilitated thrombolysis.

Massive and submassive pulmonary thromboembolism carry significant morbidity and mortality. We present an elderly female who was diagnosed with a submassive pulmonary embolism by computed tomographic angiography and treated with ultrasound-facilitated thrombolysis (UFT). This case demonstrates the usefulness of right ventricular longitudinal strain measurements by two-dimensional speckle tracking echocardiography in the evaluation of right ventricular function before and after UFT. Evaluation of right ventricle longitudinal strain by speckle tracking echocardiography may supplement other parameters in the assessment of right ventricular function in these patients.

Endovascular Repair of Lacerated Profunda Femoris Artery Using Jomed Covered Stent Graft.

PURPOSE: This report highlights the significance of endovascular training for invasive cardiologists. CASE REPORT: 78-year-old morbidly obese male with an inferior wall myocardial infarction underwent primary percutaneous coronary intervention (PCI) which was complicated by laceration of the profunda femoris artery. Endovascular repair of the profunda femoris artery was performed by using Jomed covered stents. CONCLUSION: This case report of endovascular repair of lacerated profunda femoris artery signifies the importance of endovascular training for invasive cardiologist.

Evaluation of Safety and Feasibility of Percutaneous Balloon Pericardiotomy in Hemodynamically Significant Pericardial Effusion (Review of 10-Years Experience in Single Center).

BACKGROUND: Percutaneous balloon pericardiotomy (PBP) has been successful in managing large pericardial effusions, particularly in patients with malignant conditions. The objective of this study was to evaluate safety and feasibility of this procedure (PBP) in patients who had recurrent life threatening pericardial effusion at West Virginia University Hospital (WVUH). METHODS: This is retrospective review of consecutive series of pericardial windows by PBP. This report entails our experience of 36 procedures performed from November 2002 to November 2012 by PBP. RESULTS: Thirty-six percutaneous balloon pericardiotomies were performed (20 males and 16 females) with a mean age of 58 ± 15 years. Lung cancer (50%) was the most common diagnosis with small cell type (29%) being most frequent. Other causes of pericardial effusion requiring PBP procedure included breast cancer (13.2%) and gastrointestinal cancer (15.7). Five patients had previously required pericardiocentesis in the past, and 31 patients had PBP as the first treatment for the pericardial effusion. There were no acute complications. The procedures were successful and well tolerated. Technical success of procedure was 100%. The 30-day survival was 81 percent and there were no infectious complications during follow-up. CONCLUSION: Percutaneous balloon pericardiotomy is safe and effective technique for the management of patients with severe recurrent life threatening pericardial effusion.

Unusual distribution of noncompaction of left ventricular myocardium.

This case report highlights a rare case of isolated septal noncompaction of the left ventricle, a congenital condition, in a previously asymptomatic adult patient who presented with syncope. Management of left ventricular noncompaction (LVNC) includes treatment for heart failure, arrhythmias, and thromboembolic events; but no criteria exist for primary prophylaxis in patients that might be at high risk. To our knowledge this is the first report of isolated septal noncompaction in a previously asymptomatic adult patient.

Design of hACE2-based small peptide inhibitors against spike protein of SARS-CoV-2: a computational approach.

COVID-19 which is caused by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has been declared pandemic in 2019. Though there is development of vaccines but there is an emergence requirement of drugs against SARS-CoV-2. Antiviral peptides can be rationally created and improved based on the known structures of viral proteins and their biological targets. In the given study, small peptide inhibitors with three amino acids are designed and docked against SARS-CoV-2 coronavirus using molecular docking approach. All the designed peptides bind at the active site but the highest binding affinity was observed for HisGluAsp. Molecular dynamics was performed to validate the stability and interactions of compound. The molecule has followed the druglikeness properties and with highest probability of being absorbed by the gastrointestinal tract. The results of the current investigation point to the possibility that the identified small peptides may prevent SARS-CoV-2 infection, although additional wet-lab tests are still required to confirm these results.

Left atrial volume by echocardiography in patients with false positive myocardial perfusion scans.

A stress-induced myocardial perfusion abnormality (MPS), in the absence of angiographically significant epicardial coronary artery disease, is considered a "false-positive" test result. We hypothesized that echocardiography would provide complementary prognostic and pathophysiologic data relevant to the management of patients with MPS and normal coronary angiograms. Accordingly, left atrial volume index (LAVi) was assessed by echocardiography in 38 patients with false positive MPS as defined by normal coronary angiograms and 26 patients with true negative MPS from a total of 1,356 patients stressed from July 2006-May 2008. Pathologically abnormal elevation of LAVi (≥ 32 mL/m(2)) was observed in 16 of 19 women (84%) and 11 of 19 men (58%) in the false positive MPS (FPMPS) group while none of the patients in the true negative MPS (TNMPS) group had elevated LAVi. In the FPMPS group mean LAVi was significantly higher in women than men (40.64 ± 11.4 mL/m(2) versus 32.6 ± 10.5 mL/m(2), P = 0.01). The mean LAVi in the FPMPS group was significantly different from the TNMPS group (36.6 ± 11.6 versus 21 ± 7 mL/m(2), P = 0.000). A stepwise logistic regression determined BSA, LAV and LAVi as useful in predicting false positive and true negative MPS. All three were significant predictors (P < 0.01) and the area under the ROC curve was 0.91. Our findings in this relatively small cohort suggest that patients with false positive MPS have a greater increased LAVi.

Chronic pulmonary dysfunction following acute inhalation of butyl acrylate.

Butyl Acrylate (BA) (2-propionic acid; CH2 = CHCOOC4H9) is a colorless liquid commonly used in impregnation agents and adhesives. Dermal contact with BA has previously been reported to cause moderate skin irritation with skin sensitizing potential in humans. Health effects of inhalation of BA have not been previously reported. Accordingly, we document the health conditions of a bystander, first responder and landfill worker exposed to butyl acrylate (BA) released to the atmosphere following a collision and roadside spill in October 1998. Retrospective data were collected via chart review and analyzed for exposure, symptoms, physical findings and radiological, laboratory and spirometry results over a ten-year period. All three patients had similar respiratory symptoms including a dramatic hacking cough and dyspnea. Findings included abnormal pulmonary function tests and breath sounds. These data underscore the potential hazards of BA inhalational exposure and the need to wear additional protective equipment.

Gender and geographic differences in CAD risk factors and CHADS2 scores in atrial fibrillation patients.

Atrial fibrillation (AF) is a cardiac arrhythmia associated with a wide range of other co-morbid medical conditions. The state of West Virginia has a higher prevalence of coronary artery disease (CAD) and CAD risk factors compared to the national average. We hypothesized that West Virginians with atrial fibrillation would also have a higher prevalence of CAD risk factors and higher CHADS2 stroke risk scores. This is particularly important since Louisiana is the only high CAD risk southern state included in the original verification of the CHADS2 risk scoring system (i.e. California, Connecticut, Louisiana, Maine, Missouri, New Hampshire, and Vermont). Accordingly, we performed a retrospective analysis of the association between AF and CAD, CAD risk factors and CHADS2 scores in a cohort of men and women in the West Virginia University Hospital population. We report a greater positive association between AF and hypertension, diabetes mellitus and obesity than the national average. AF was seen more commonly among men. But, CHADS2 scores were higher among women as a result of a higher prevalence of diabetes mellitus. This study indicates that AF is associated with a greater prevalence of CAD risk factors and higher CHADS2 scores among West Virginians in comparison with the rest of the nation.

Probing the Polysulfide Confinement in Two Different Sulfur Hosts for a Mg|S Battery Employing Operando Raman and Ex-Situ UV-Visible Spectroscopy.

We study here the Mg-polysulfide confinement inside two structurally different model porous materials, viz., toray carbon paper (TC) and multiwalled carbon nanotubes (CNT), using operando Raman and postcycling ex-situ UV-vis spectroscopy. Sulfur encapsulated inside CNT (CNT-S) and TC (TC-S) serves as S-cathodes in a rechargeable room temperature Mg|S battery. Operando Raman spectroscopy indicates the presence of higher-order Mg-polysulfides at the CNT cathode. This is due to the combination of their entrapment inside CNT and also possibly to their localization in the liquid electrolyte in the vicinity of CNT-S. This finding is directly correlated to the ex-situ UV-vis spectroscopy, which shows a lesser degree of Mg-polysulfide dissolution into the electrolyte solution. In comparison, TC-S, where sulfur is encapsulated within the open matrix formed by the nanofiber network of the carbon paper, displays poorer polysulfide confinement. The distinct differences in their abilities to confine the Mg-polysulfides are corroborated by battery performance. In the current density range (0.05-1) C, the battery with CNT-S displays much higher specific capacities, being nearly two times that of TC-S at 1 C.

Left ventricular noncompaction: a rare disorder in adults and its association with 1p36 chromosomal anomaly.

We report on a case of a 25-year-old male with 1p36 deletion syndrome, who was diagnosed with left ventricular noncompaction (LVNC). The association of this rare chromosomal abnormality with LVNC is reported in the pediatric literature, but it has not previously been specifically reported in adults. It is important to diagnose this unclassified cardiomyopathy in the adult population with this chromosomal abnormality for appropriate management and treatment as highlighted in our case.

Probing the Extent of Polysulfide Confinement Using a CoNi2S4 Additive Inside a Sulfur Cathode of a Na/Li-Sulfur Rechargeable Battery.

The extent of confinement of soluble metal polysulfides inside a sulfur cathode strongly determines the performance of metal-sulfur rechargeable batteries. This challenge has been largely tackled by loading sulfur inside various conducting porous scaffolds. However, this approach has not proven to be fully effective because of poor chemical interaction between the scaffold and polysulfides. Here, we demonstrate an excellent strategy of using a sulfide additive in the sulfur cathode, viz., cobalt nickel sulfide (CoNi2S4), to efficiently trap the soluble polysulfides inside the sulfur cathode. In situ Raman and ex situ UV-vis spectroscopies clearly reveal higher retention of polysulfides inside CoNi2S4/S compared to bare sulfur and carbon-sulfur mixture cathodes. Against sodium, the CoNi2S4/S assembly showed remarkable cyclability both as a function of current density (at room temperature) and temperature (at constant current density). The versatility of CoNi2S4 is further proven by the exemplary cyclability at various current densities at room temperature against lithium.

Embolization of atrial septal occluder device into the pulmonary artery: a rare complication and usefulness of live/real time three-dimensional transthoracic echocardiography.

Percutaneous closure of atrial septal defects (ASD) in adults has emerged as an alternative to surgery. We report a rare complication of an atrial septal occluder device embolization into the pulmonary artery which was detected by fluoroscopy and echocardiography. The potential usefulness of live/real time three-dimensional transthoracic echocardiography in the management of patients undergoing percutaneous ASD occlusion is described.

Two-dimensional echocardiographic findings of pulmonary valve cyst secondary to pulmonary valvuloplasty.

Real time two-dimensional transthoracic and transesophageal echocardiography demonstrated a mobile echolucent mass attached to the pulmonary valve in a 25-year-old adult, 20 years following balloon pulmonary valvuloplasty. The mass was surgically excised and pathology showed it to be a cyst.

Incremental value of live/real time three-dimensional transthoracic echocardiography in the assessment of right ventricular masses.

This case series demonstrates the incremental value of three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional transthoracic echocardiography (2D TTE) in the assessment of 11 patients with right ventricular (RV) masses or mass-like lesions (three cases of RV thrombus, one myxoma, one fibroma, one lipoma, one chordoma, and one sarcoma and three cases of RV noncompaction, which are considered to be mass-like in nature). 3D TTE was of incremental value in the assessment of these masses in that 3D TTE has the capacity to section the mass and view it from multiple angles, giving the examiner a more comprehensive assessment of the mass. This was particularly helpful in the cases of thrombi, as the presence of echolucencies indicated clot lysis. In addition, certainty in the number of thrombi present was an advantage of 3D TTE. Also, sectioning of cardiac tumors allowed more confidence in narrowing the differential diagnosis of the etiology of the mass. In addition, 3D TTE allowed us to identify precise location of the attachments of the masses as well as to determine whether there were mobile components to the mass. Another noteworthy advantage of 3D TTE was that the volumes of the masses could be calculated. Additionally, the findings by 3D TTE correlated well with pathologic examination of RV tumors, and some of the masses measured larger by 3D TTE than by 2D TTE, which was also validated in one case by surgery. As in the case of RV fibroma, another advantage was that 3D TTE actually identified more masses than 2D TTE. RV noncompaction was also well studied, and the assessment with 3D TTE helped to give a more definitive diagnosis in these patients.

Acute effects of diets rich in almonds and walnuts on endothelial function.

OBJECTIVE: Omega-3 fatty acids, especially alpha-linolenic acid (ALA), which are present in nuts may reduce cardiovascular disease (CVD) risk, by changing vascular inflammation and improving endothelial dysfunction. The objective of the study was to evaluate the acute effects of two different diets, one containing walnuts and the other almonds on endothelial function. METHODS: Twenty-seven overweight volunteers underwent a randomized 2-period, crossover, controlled intervention study. The subjects were given either walnut or almond diets which varied in monounsaturated fatty acid (MUFA) and polyunsaturated fatty acid (PUFA) content. The walnut diet provided 23.1% energy from PUFA and the almond diet provided 7.6% energy from PUFA. Endothelial function was assessed physiologically by flow-mediated dilation (FMD) and biochemically by sVCAM (soluble vascular cell adhesion molecules). RESULTS: The walnut diet significantly improved FMD (p=0.004) and decreased sVCAM (p=0.009) whereas the almond diet tended to improve FMD (p=0.06) and significantly decreased sVCAM (p=0.004). CONCLUSION: Both walnut and almond diets improved FMD and sVCAM and there was no significant difference in physiological and biochemical markers between the two diets.

Comorbidities of Chronic Complete Right Bundle Branch Block and Correlations With Coronary Angiographic Findings.

BACKGROUND: This is a prospective, observational review of medical records to investigate the associated comorbidities and angiographic anatomy in patients with chronic right bundle branch block (RBBB). METHODS: The analyses of 32,345 consecutive electrocardiograms (EKGs) between October 2010 and January 2012 revealed 583 patients with RBBB. The common comorbidities associated with RBBB were hypertension (82%), diabetes (42%), coronary artery disease (CAD) (44%), valvular heart disease (aortic--16% and mitral--17%) and pulmonary disease (33%). Demographic data including age, sex, EKG and associated comorbidities were analyzed from the medical records. Coronary angiograms within 6 months of EKG in patients with RBBB were available for 184 patients and were accordingly analyzed for significant obstructive CAD. RESULTS: In all, 33 patients had single-vessel disease, 52 patients had 2-vessel disease, and 87 patients had multivessel disease whereas 12 patients had no significant disease. Left anterior descending artery was the most frequent vessel involved (72%) followed by left circumflex (58%) and right coronary artery (53%). CONCLUSIONS: In conclusion, in chronic RBBB, wherever the angiograms were available, CAD predominantly involved left anterior descending artery. Most common associated comorbidities in chronic RBBB were systemic hypertension and CAD.

Differential diagnosis of acute pericarditis from normal variant early repolarization and left ventricular hypertrophy with early repolarization: an electrocardiographic study.

BACKGROUND: Differentiation of ST-segment elevation on electrocardiogram (ECG) from acute pericarditis (AP), normal variant early repolarization (ER) and early repolarization of left ventricular hypertrophy (ERLVH) can be problematic. Hence, the authors evaluated the accuracy of the ST/T ratio in ECG to more optimally differentiate between AP, ST-segment elevation, ER and ERLVH. METHODS: Between September 2006 and July 2010, 80 patients were enrolled in this study consisting of 25 individuals with AP, 27 with ER and 28 with ERLVH. Each ECG was analyzed in a systematic manner including the measurement of PR interval, QRS duration, QT-segment duration, PR-segment deviation, ST-segment deviation and the height of T wave. The ratio of the height of ST segment to the height of T wave was measured in leads I, II, III, aVF and V2 through V6. RESULTS: The mean ages of the patients with AP, ER and ERLVH were 32 ± 16.5, 36 ± 15.4 and 53 ± 16 years, respectively. The ratio of the amplitude of ST segment to the amplitude of the T wave in leads I, V4, V5 and V6 proved to be a significant discriminator at a value of ≥0.25 (P < 0.05 for all). CONCLUSIONS: Leads I, V4, V5 and V6 can all be used to differentiate AP from ER and ERLVH. When ST elevation is present in lead I, the ST/T ratio has the best predictive value (0.82) to more accurately discriminate between AP, ER and ERLVH.

Effect of intensive lifestyle changes on endothelial function and on inflammatory markers of atherosclerosis.

Intensive lifestyle changes have been shown to regress atherosclerosis, improve cardiovascular risk profiles, and decrease angina pectoris and cardiac events. We evaluated the influence of the Multisite Cardiac Lifestyle Intervention Program, an ongoing health insurance-covered lifestyle intervention conducted at our site, on endothelial function and inflammatory markers of atherosclerosis in this pilot study. Twenty-seven participants with coronary artery disease (CAD) and/or risk factors for CAD (nonsmokers, 14 men; mean age 56 years) were enrolled in the experimental group and asked to make changes in diet (10% calories from fat, plant based), engage in moderate exercise (3 hours/week), and practice stress management (1 hour/day). Twenty historically (age, gender, CAD, and CAD risk factors) matched participants were enrolled in the control group with usual standard of care. At baseline endothelium-dependent brachial artery flow-mediated dilatation (FMD) was performed in the 2 groups. Serum markers of inflammation, endothelial dysfunction, and angiogenesis were performed only in the experimental group. After 12 weeks, FMD had improved in the experimental group from a baseline of 4.23 + or - 0.13 to 4.65 + or - 0.15 mm, whereas in the control group it decreased from 4.62 + or - 0.16 to 4.48 + or - 0.17 mm. Changes were significantly different in favor of the experimental group (p <0.0001). Also, significant decreases occurred in C-reactive protein (from 2.07 + or - 0.57 to 1.6 + or - 0.43 mg/L, p = 0.03) and interleukin-6 (from 2.52 + or - 0.62 to 1.23 + or - 0.3 pg/ml, p = 0.02) after 12 weeks. Significant improvement in FMD, C-reactive protein, and interleukin-6 with intensive lifestyle changes in the experimental group suggests > or = 1 potential mechanism underlying the clinical benefits seen in previous trials.