Cardiology

doi: 10.1159/000177395pmid: N/A

Siegel, Arthur J; Sholar, Michelle; Yang, Jane; Dhanak, Ela; Lewandrowski, Kent B

doi: 10.1159/000177396pmid: 9397299

Prolonged strenuous exercise may trigger acute myocardial infarction (AMI), as exemplified by the occurrence of sudden cardiac death during marathon running. Serum creatine kinase MB (CK-MB) may be elevated in asymptomatic marathon runners after competition from exertional rhabdomyolysis of skeletal muscle altered by training, limiting its utility for evaluating acute cardiac injury in such athletes. Myoglobin and CK-MB2 isoform levels are emerging as earlier markers of AMI and troponin subunits as more specific than serum CK-MB mass. We tested runners before and sequentially after the 1995 Boston Marathon for conventional and newer markers including myoglobin, CK-MB mass and isoforms, cardiac troponin T, and cardiac troponin I using standard laboratory methods and rapid format assays if available. The mean serum values for myoglobin, CK-MB mass, CK-MB/myoglobin rapid panel tests, and CK-MB2 isoforms were normal or negative pre-race and elevated or positive 4 and 24 h after competition. These markers lack specificity for acute cardiac injury in trained runners. While the mean serum values for cardiac troponins T and I remained normal, 9 of 45 runners (20%) showed an increase in subunits by first-generation assays. All runners remained asymptomatic for cardiac disease and completed subsequent marathons 1 year later, making reversible myocardial injury or stunning unlikely. Elevated values of serum markers for AMI, including first-generation assays for both troponin subunits should be interpreted with caution in trained runners.

Herlitz, Johan; Haglid, Maria; Albertsson, Per; Westberg, Staffan; Karlson, Björn W; Hartford, Marianne; Lurje, Leon; Caidahl, Kenneth

doi: 10.1159/000177397pmid: 9397300

We describe the 2- and 5-year prognoses following coronary artery bypass grafting (CABG) in relation to smoking habits among consecutive patients being operated on in western Sweden during a 3-year period. Among the 2,121 patients, 10.2% admitted smoking at coronary angiography as compared with 7.5% 2 years after CABG (NS). Among smokers, the mortality during the subsequent 2 years was 8.9% as compared with 6.5% for exsmokers and 7.3% for never smokers (NS). During the 5-year follow-up, smokers had a mortality of 18.8% as compared with 13.6% for exsmokers and 12.5% for never smokers (p = 0.03). When correcting for dissimilarities in previous history, smoking was a strongly significant independent (p < 0.0001) predictor of 5-year mortality.

Vincenzo Fragola, Pietro; Caló, Leonardo; Luzi, Mario; Mammarella, Antonio; Antonini, Giovanni

doi: 10.1159/000177398pmid: 9397301

We utilized Doppler echocardiography to characterize left ventricular diastolic function in 42 patients with myotonic dystrophy (mean age 37 ± 12 years, 64% male) who had no symptoms of heart failure and had normal left ventricular systolic function. Data were compared with those in 41 normal control subjects of similar age and gender. Heart rate, systemic blood pressure, and cardiac dimensions (wall thickness, left atrial and left ventricular cavity dimensions) were similar and not significantly different in patients and controls. As a group, patients showed significantly increased deceleration time and decreased rate of decline of flow velocity in early diastole (p < 0.0001 and p < 0.01, respectively) when compared to controls. Individual patient analysis showed that 10 (24%) of the 42 patients with myotonic dystrophy had 2 or more abnormal Doppler indexes of diastolic function consistent with a pattern of impaired left ventricular relaxation. The most common abnormalities were increased deceleration time ( > 224 ms; 9 patients), prolonged isovolumic relaxation time ( > 103 ms; 8 patients) and reduced rate of decline of flow velocity in early diastole ( < 2.1 m/s²; 5 patients). In addition, peak early diastolic flow velocity was reduced ( < 43 cm/s) in 3 patients and early to atrial peak flow velocity ratio was reduced ( < 1) in 2 patients. Comparison of subgroups of patients with and without abnormal Doppler indexes showed no significant differences with regard to age, gender, heart rate, systemic blood pressure, severity of neuromuscular disease, and cardiac dimensions. After study, patients were clinically followed up for a mean period of 20 ± 7 months (range 12-35). During observation no patients died and none experienced symptoms of heart failure. This Doppler echocardiographic analysis demonstrates that diastolic abnormalities may be present in patients with myotonic dystrophy, even in the absence of symptoms of cardiac failure or left ventricular systolic dysfunction. These diastolic abnormalities suggest an intrinsic myocardial abnormality in patients with myotonic dystrophy; however, whether they represent a preclinical phase of myocardial involvement or an intrinsic feature of the primary myocardial disease process in myotonic dystrophy remains to be elucidated.

Miyawaki, Ryuichiro; Urabe, Yoshio; Furuki, Takayuki; Miyoshi, Kei; Wakiyama, Tetsushi; Moroe, Kazuo; Hiroki, Tadayuki

doi: 10.1159/000177399pmid: 9397302

We evaluated the association between coronary spasm and hyperinsulinemia (high immunoreactive insulin, IRI) in patients with angina pectoris. The study cohort comprised 30 patients with spastic angina pectoris, 30 patients with angina pectoris showing fixed-obstructive coronary sclerosis and 30 control subjects who were matched for body mass index, age and sex. A 75-gram oral glucose test was performed, and blood sugar and IRI were serially measured concomitant with serum total cholesterol, triglyceride and HDL cholesterol. The IRI level at 60 min, the peak IRI during the test, Σ IRI and ΣIRI/Σ blood sugar were significantly higher in the patients than in the controls. Total cholesterol and LDL cholesterol levels were significantly increased in patients showing fixed-obstructive coronary sclerosis compared to controls.

Pasqualetti, Paolo; Casale, Raffaele

doi: 10.1159/000177400pmid: 9397303

Many fatal or potentially fatal cardio-cerebrovascular diseases present a definite circadian distribution in their onset. In order to verify if episodes of acute cardiogenic pulmonary edema have a significant daily periodicity in their occurrence, a retrospective analysis of 1,204 episodes has been conducted. In all cases, the hour of the day of onset has been identified with certainty; all episodes occurred in hospitalized patients. The rhythmometric circadian inferential statistical analysis by means of the single cosinor method demonstrates that the episodes of acute cardiogenic pulmonary edema present a significant (p < 0.002) circadian distribution, with a peak at 1:00 a.m. (from 10:00 p.m. to 4:00 a.m.). No significant differences (p > 0.05) were found in the circadian distribution regarding sex, age (less or more than 60 years), absence or presence of arterial hypertension and coronary artery disease. Several factors may contribute to this behavior, especially the relationships between several endogenous circadian rhythms, sleep and disease. The knowledge that acute pulmonary edema is a high chronorisk disease could be of interest for the better understanding of its pathophysiology and for a better causative control and prevention.

Morelli, Sergio; Perrone, Claudio; Ferrante, Luigi; Sgreccia, Alessandro; Priori, Roberta; Voci, Paolo; Accorinti, Massimo; Pivetti-Pezzi, Paola; Valesini, Guido

doi: 10.1159/000177401pmid: 9397304

To assess the prevalence and the extent of cardiac involvement in patients with Behçet’s disease and to investigate the possible causes that may predispose to this involvement, 30 patients affected by Behçet’s disease and 30 normal control subjects were submitted to M-mode, two-dimensional, and Doppler echocardiographic evaluation. Moreover, antinuclear and anticardiolipin autoantibodies were determined in the sera of both patients and control subjects. Finally, HLA-B51 positivity was assessed in the patients and in a historical control group. Mitral valve prolapse was observed in 50% and proximal aorta dilatation in 30% of the patients. There was a significant difference in the rate of these abnormalities in comparison with the control group. Left ventricular function parameters were similar between the two groups. The positivity rate of antinuclear and anticardiolipin autoantibodies was very low (7%), without differences between the groups. HLA-B51 was detected in 82.7% of the patients versus 21.7% in the control group (p < 0.00001). In conclusion, this study demonstrates a high rate of cardiac abnormalities in patients with Behçet’s disease.

King, Roderick K; Magid, Norman M; Opio, George; Borer, Jeffrey S

doi: 10.1159/000177402pmid: 9397305

We recently demonstrated dynamic alterations in protein turnover 3 days and 1 month after surgical induction of aortic regurgitation (AR). To characterize protein synthesis and degradation during the long-term plateau phase, we performed [³H]-leucine infusion 2.5 years after induction of AR in 10 New Zealand White rabbits and 12 sham-operated controls. Protein fractional synthesis rates were obtained by analyses of plasma and protein hydrolysates, growth rates from protein concentration and heart weight measurements, and degradation rates by subtraction of growth from synthesis rates. AR (regurgitant fraction 25 ± 11%) caused a 57% increase in left ventricular (LV) weight in comparison with controls (7.4 ± 1.7 vs. 4.7 ± 0.6 g, p < 0.001) and no evidence of heart failure. Although concentrations of total cardiac protein, myosin heavy chain and actin were similar, the enlarged AR hearts had increased amounts of total cardiac protein (1,009 ± 312 vs. 682 ± 120mg/LV, p < 0.05), myosin heavy chain (148 ± 91 vs. 81 ± 29 mg/LV, p < 0.05), and actin (73 ± 42 vs. 44 ± 16 mg/LV, p < 0.06). Individual protein fractional synthesis and degradation rates were closely balanced. However, myosin fractional synthesis rates were 152% (p < 0.01) greater than those of total cardiac protein in AR animals, while only 52% (p < 0.05) greater in controls (AR vs. controls, p = 0.05). Variations in actin turnover between AR and control animals did not attain statistical significance. Myosin and actin fractional synthesis rates correlated closely in AR rabbits (R = 0.81 p < 0.02), but not among controls (R = 0.41, NS). Thus, selective alterations in myofibrillar protein turnover contribute to the maintenance of increased myofibrillar protein content in the ‘compensatory’ LV hypertrophy of chronic AR.

Chouraqui, Pierre; Rabinowitz, Babeth; Livschitz, Shy; Horoszowsky, David; Kaplinsky, Elieser; Smolinsky, Aram

doi: 10.1159/000177403pmid: 9397306

To evaluate the influence of two techniques of myocardial protection on septal wall motion (SWM) and left ventricular ejection fraction, 21 patients with a normal SWM underwent surgery using either conventional antegrade cardioplegia (group I, n = 9) or combined antegrade/retrograde cardioplegia (group II, n = 12). The patients were assessed pre- and postoperatively by radionuclide ventriculography. A resting thallium-201 study was performed in patients (n = 6) with a postoperatively abnormal SWM: in 2 of 9 (22%) in group I and in 4 of 12 (33%) in group II (p = NS). The left ventricular ejection fraction was similar in both groups before surgery (57 ± 3% in group I vs. 57 ± 8% in group II; p = NS) and did not change significantly after surgery. All 6 patients with an abnormal SWM had a normal septal thallium-201 uptake. Thus, (1) an abnormal SWM after cardiac surgery is common; (2) it is not due to perioperative ischemia or infarction, and (3) neither the incidence of an abnormal SWM not the global left ventricular function is influenced by the addition of retrograde cardioplegia during open heart surgery.

Sturm, Matthias; Hausmann, Dirk; Mügge, Andreas; Blessing, Erwin; Amende, Ivo

doi: 10.1159/000177404pmid: 9397307

We report a case of stent dislodgement complicating adjuvant intracoronary ultrasound (ICUS) imaging that required emergency coronary bypass grafting. This probably very rare complication gains importance since ICUS is increasingly used to confirm adequate stent expansion and full coverage of the lesion.