BACKGROUND Patients with stable coronary artery disease and diabetes with previous percutaneous c... more BACKGROUND Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. METHODS The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). FINDINGS Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8-3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74-0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, pinteraction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78-1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75-1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48-2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36-3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74-1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75-0·95, p=0·005, in contrast to patients without PCI where it did not, pinteraction=0·012. Benefit was present irrespective of time from most recent PCI. INTERPRETATION In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk. FUNDING AstraZeneca.
Journal of the American Heart Association, Jan 8, 2016
Atrial fibrillation is associated with higher mortality. Identification of causes of death and co... more Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or syste...
Summary Cardiac toxicity of 5-fluorouracil has been described in several medical reports includin... more Summary Cardiac toxicity of 5-fluorouracil has been described in several medical reports including arrhythmias, angina pectoris, and myocardial infarction. The moni tor ization of the cardiac changes only by means of clinical signs, ECG and blood pressure leads to ...
Journal of the American College of Cardiology, 2013
Aim: In recent literature only two data exist whether the CHADS2 and CHA2DS2VASc scores can be us... more Aim: In recent literature only two data exist whether the CHADS2 and CHA2DS2VASc scores can be used for the risk assessment of new-onset atrial fibrillation (AF) or AF after coronary artery bypass graft (CABG) surgery. Methods: We retrospectively analyzed 133 consecutive patients (42 patients with AF after CABG surgery and 91 patients without AF) who were undergoing CABG between January 2011 and January 2013 at our department. Complete medical records were retrospectively collected to investigate, congestive heart failure, hypertension, age 75 years, diabetes, previous stroke (CHADS2) and CHA2DS2-vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) scores. The primary end point of this study was the development of AF after CABG surgery in hospital. Results: Only age (67.6+9.7 vs 62.4+10.6 years, p1⁄40.008) was significantly higher in AF group. Mean CHADS2 and CHA2DS2-VASc scores were 1.53+0.97 and 3.23+1.25 respectively. CHADS2 (1.62+0.91 vs 1.48+1.00, p1⁄40.34) and CHA2DS2VASc (3.43+1.17 vs 3.13+1.28, p1⁄40.22) scores were higher in AF group but it was not statistically significant. When patients divided into two groups according to CHADS2 and CHA2DS2-VASc scores at the cuttof point of 2, no significant difference was detected in AF rate (31.9% vs 30.0%, p1⁄40.55 and 34.4% vs 24.3%, p1⁄40.18 respectively). In univariate and multivariate analysis only age was independent predictor of AF after CABG surgery (Table 1). Conclusion: CHADS2 and CHA2DS2-VASc scores were not independent predictors of AF after CABG surgery. Further prospective, randomized, controlled trials are necessary to make healthier interpretations on this issue.
Ultrasound tissue characterization studies realized through integrated backscatter analysis with ... more Ultrasound tissue characterization studies realized through integrated backscatter analysis with end-diastolic sampling in hypertensive cardiopathy have demonstrated that abnormalities in the left ventricular myocardial ultrasonic texture are present in extreme forms of left ventricular hypertrophy (LVH). Such abnormalities are not evident in the athlete&#39;s heart. The aim of the present study was to analyze the ultrasonic backscatter myocardial indexes both as peak end-diastolic signal intensity and as cardiac-cyclic variation in two models of LVH: hypertensive cardiopathy and athlete&#39;s heart. Three groups of 10 subjects each, all men of mean age (31.6+/-3.5 years), and of comparable weight and height, were analyzed. Group A comprised 10 cyclists of good professional level, while hypertensive patients were grouped in Group H. Both groups presented a comparable left ventricular mass (LVM). Group C included 10 healthy subjects acting as controls. The men with hypertension were selected on the basis of the results of ambulatory monitoring of the blood pressure according to ISH-World Health Organization guidelines (International Society of Hypertension). A 2D-color Doppler echocardiography with a digital echograph Sonos 5500 (Agilent Technologies, Andover, Massachusetts, USA), was carried out on all the subjects in the study for conventional analysis of the LVM and function. The ultrasonic myocardial integrated backscatter signal (IBS) was analyzed with an &#39;acoustic densitometry&#39; module implemented on a AT echograph. The signal was also sampled with a region of interest (ROI) placed at interventricular septum and at posterior left ventricular wall level. The systo-diastolic variation of the backscatter was also considered, as cyclic variation index (CVIibs). According to the inclusion criteria, the LVM was comparable in groups A and H, but it was significantly higher than group C (left ventricular mass (body surface) (LVMbs)=154.5+/-18.7 (A), 146.8+/-25.5 (H), 101.4+/-12.4 (C), p &lt; 0.001). The end-diastolic IBS did not show significant statistical differences among the three groups. The CVI(IBS) both at septum (30.5+/-5.3 (A), 13.2+/-13.1 (H), 27.2+/-7.3(C), p &lt; 0.002) and posterior wall level (43.7+/-9.1 (A), 16.5+/-12.1 (H), 40.7+/-9.1 (C), p &lt; 0.001) though, was significantly lower in the hypertensive patients than in both the athletes and the control group, where the results were comparable. A significant alteration of the myocardial CVIibs (both for septum and posterior wall) was found in the hypertensive model. This was probably the expression of an alteration in the intramural myocardial function.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2002
Ultrasonic tissue characterization, based on the measurements of integrated backscatter (IBS) ana... more Ultrasonic tissue characterization, based on the measurements of integrated backscatter (IBS) analysis, has the potential to provide quantitative information which could characterize the functional and structural state of cardiac muscle. In this study we aimed to determine whether the integrated backscatter is measurable and quantifiable in left ventricular walls in patients with dilated cardiomyopathy (DCMP) and can be used to identify changes in myocardial structure and contractility. We studied 32 subjects: 16 patients with idiopathic dilated cardiomyopathy who were free of atrial fibrillation, bundle branch block and valvular heart disease (12 male, 4 female, mean age 48 +/- 18) and 16 healthy volunteers (10 male, 6 female, mean age 46 +/- 8). Left ventricular diastolic and systolic diameters, septum and posterior wall (PW) systolic and diastolic thickness were measured in the parasternal long axis view with M-mode echocardiography. Ejection fraction (EF), fractional shortening ...
The international journal of cardiovascular imaging, 2004
Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Va... more Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare. We presented a case with anomalous origin of the RCA above the left sinus of Valsalva with inferior wall myocardial infarction and successful primary percutaneous coronary intervention to this artery which is the first report in the literature.
Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial co... more Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial contractile performance assessment. There is limited data concerning CV-IB in end-stage renal disease (ESRD) patients. Forty essential hypertensive (EH) patients (mean age 51+/-8 yrs) and 24 ESRD patients (mean age 49+/-14 yrs) were compared to 10 healthy controls (mean age 45+/-10 yrs). A 2D-Doppler echocardiography with digitized imaging was performed to characterize myocardial ultrasonic tissue by CV-IB between systole and diastole at the interventricular septum (IVS) and left ventricular (LV) posterior wall (PW). There was no significant difference between age and sex among groups. Systolic and diastolic blood pressures (BP) were both higher in EH patients (157/96 mmHg in EH, 129/81 mmHg in ESRD and 115/77 mmHg in controls, p<0.001). Left ventricular mass index (LVMI) was higher in EH and ESRD patients than in controls (respectively, 119+/-37, 130+/-46, 87+/-12 g/m2, p<0.05), whi...
Journal of the American Society of Echocardiography, 2002
Identical twin boys presented with exercise-induced syncope. Echocardiographic examination reveal... more Identical twin boys presented with exercise-induced syncope. Echocardiographic examination revealed severe calcification at aortic valves, mitral anterior leaflets, and mitral annuli in both patients. In addition, basal interventricular septum was also involved in 1 patient. Doppler evaluation demonstrated severe aortic stenosis with a peak gradient of 112 and 118 mm Hg in both patients. Moderate mitral stenosis was also detected in one of them. Patients underwent operation for valve replacement.
Journal of Clinical Pharmacy and Therapeutics, 2004
Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a pote... more Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a potentially serious complication has not been studied in detail. The aim of this study was to determine the P max and Pd in the electrocardiograms (ECG) of patients receiving 5-FU treatment. Twenty-five patients (mean age: 62 years) receiving a 5-FU bolus plus continuous infusion with calcium leucovorin over 48 h and with normal pre-treatment cardiac physical examinations, ECG and echocardiography were enrolled. P maximum (P max), P minimum (P min) and P dispersion (Pd) (maximum minus minimum P wave duration) were measured from the 12-lead ECG at the 0th and 48th hour of the first chemotherapy cycle. Echocardiography was also obtained in all patients at the same times. Clinical cardiotoxicity was observed in two patients. P max and Pd were both significantly longer after 5-FU treatment at the 48th hour (P &lt; 0.001). P min did not change (P &gt; 0.05). Treatment with 5-FU based regimens may increase Pd and prolong the P max in cancer patients. These alterations may be predictive of patients at risk of atrial arrhythmias during 5-FU treatment.
We described here a patient envenomated by a bee sting that caused myocardial damage compatible w... more We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be the underlying factor.
BACKGROUND Patients with stable coronary artery disease and diabetes with previous percutaneous c... more BACKGROUND Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. METHODS The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). FINDINGS Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8-3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74-0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, pinteraction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78-1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75-1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48-2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36-3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74-1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75-0·95, p=0·005, in contrast to patients without PCI where it did not, pinteraction=0·012. Benefit was present irrespective of time from most recent PCI. INTERPRETATION In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk. FUNDING AstraZeneca.
Journal of the American Heart Association, Jan 8, 2016
Atrial fibrillation is associated with higher mortality. Identification of causes of death and co... more Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS2 score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or syste...
Summary Cardiac toxicity of 5-fluorouracil has been described in several medical reports includin... more Summary Cardiac toxicity of 5-fluorouracil has been described in several medical reports including arrhythmias, angina pectoris, and myocardial infarction. The moni tor ization of the cardiac changes only by means of clinical signs, ECG and blood pressure leads to ...
Journal of the American College of Cardiology, 2013
Aim: In recent literature only two data exist whether the CHADS2 and CHA2DS2VASc scores can be us... more Aim: In recent literature only two data exist whether the CHADS2 and CHA2DS2VASc scores can be used for the risk assessment of new-onset atrial fibrillation (AF) or AF after coronary artery bypass graft (CABG) surgery. Methods: We retrospectively analyzed 133 consecutive patients (42 patients with AF after CABG surgery and 91 patients without AF) who were undergoing CABG between January 2011 and January 2013 at our department. Complete medical records were retrospectively collected to investigate, congestive heart failure, hypertension, age 75 years, diabetes, previous stroke (CHADS2) and CHA2DS2-vascular disease, age 65-74 years, sex category (CHA2DS2-VASc) scores. The primary end point of this study was the development of AF after CABG surgery in hospital. Results: Only age (67.6+9.7 vs 62.4+10.6 years, p1⁄40.008) was significantly higher in AF group. Mean CHADS2 and CHA2DS2-VASc scores were 1.53+0.97 and 3.23+1.25 respectively. CHADS2 (1.62+0.91 vs 1.48+1.00, p1⁄40.34) and CHA2DS2VASc (3.43+1.17 vs 3.13+1.28, p1⁄40.22) scores were higher in AF group but it was not statistically significant. When patients divided into two groups according to CHADS2 and CHA2DS2-VASc scores at the cuttof point of 2, no significant difference was detected in AF rate (31.9% vs 30.0%, p1⁄40.55 and 34.4% vs 24.3%, p1⁄40.18 respectively). In univariate and multivariate analysis only age was independent predictor of AF after CABG surgery (Table 1). Conclusion: CHADS2 and CHA2DS2-VASc scores were not independent predictors of AF after CABG surgery. Further prospective, randomized, controlled trials are necessary to make healthier interpretations on this issue.
Ultrasound tissue characterization studies realized through integrated backscatter analysis with ... more Ultrasound tissue characterization studies realized through integrated backscatter analysis with end-diastolic sampling in hypertensive cardiopathy have demonstrated that abnormalities in the left ventricular myocardial ultrasonic texture are present in extreme forms of left ventricular hypertrophy (LVH). Such abnormalities are not evident in the athlete&#39;s heart. The aim of the present study was to analyze the ultrasonic backscatter myocardial indexes both as peak end-diastolic signal intensity and as cardiac-cyclic variation in two models of LVH: hypertensive cardiopathy and athlete&#39;s heart. Three groups of 10 subjects each, all men of mean age (31.6+/-3.5 years), and of comparable weight and height, were analyzed. Group A comprised 10 cyclists of good professional level, while hypertensive patients were grouped in Group H. Both groups presented a comparable left ventricular mass (LVM). Group C included 10 healthy subjects acting as controls. The men with hypertension were selected on the basis of the results of ambulatory monitoring of the blood pressure according to ISH-World Health Organization guidelines (International Society of Hypertension). A 2D-color Doppler echocardiography with a digital echograph Sonos 5500 (Agilent Technologies, Andover, Massachusetts, USA), was carried out on all the subjects in the study for conventional analysis of the LVM and function. The ultrasonic myocardial integrated backscatter signal (IBS) was analyzed with an &#39;acoustic densitometry&#39; module implemented on a AT echograph. The signal was also sampled with a region of interest (ROI) placed at interventricular septum and at posterior left ventricular wall level. The systo-diastolic variation of the backscatter was also considered, as cyclic variation index (CVIibs). According to the inclusion criteria, the LVM was comparable in groups A and H, but it was significantly higher than group C (left ventricular mass (body surface) (LVMbs)=154.5+/-18.7 (A), 146.8+/-25.5 (H), 101.4+/-12.4 (C), p &lt; 0.001). The end-diastolic IBS did not show significant statistical differences among the three groups. The CVI(IBS) both at septum (30.5+/-5.3 (A), 13.2+/-13.1 (H), 27.2+/-7.3(C), p &lt; 0.002) and posterior wall level (43.7+/-9.1 (A), 16.5+/-12.1 (H), 40.7+/-9.1 (C), p &lt; 0.001) though, was significantly lower in the hypertensive patients than in both the athletes and the control group, where the results were comparable. A significant alteration of the myocardial CVIibs (both for septum and posterior wall) was found in the hypertensive model. This was probably the expression of an alteration in the intramural myocardial function.
Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology, 2002
Ultrasonic tissue characterization, based on the measurements of integrated backscatter (IBS) ana... more Ultrasonic tissue characterization, based on the measurements of integrated backscatter (IBS) analysis, has the potential to provide quantitative information which could characterize the functional and structural state of cardiac muscle. In this study we aimed to determine whether the integrated backscatter is measurable and quantifiable in left ventricular walls in patients with dilated cardiomyopathy (DCMP) and can be used to identify changes in myocardial structure and contractility. We studied 32 subjects: 16 patients with idiopathic dilated cardiomyopathy who were free of atrial fibrillation, bundle branch block and valvular heart disease (12 male, 4 female, mean age 48 +/- 18) and 16 healthy volunteers (10 male, 6 female, mean age 46 +/- 8). Left ventricular diastolic and systolic diameters, septum and posterior wall (PW) systolic and diastolic thickness were measured in the parasternal long axis view with M-mode echocardiography. Ejection fraction (EF), fractional shortening ...
The international journal of cardiovascular imaging, 2004
Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Va... more Anomalous origin of the right coronary artery from the ascending aorta above the left sinus of Valsalva is exceedingly rare. We presented a case with anomalous origin of the RCA above the left sinus of Valsalva with inferior wall myocardial infarction and successful primary percutaneous coronary intervention to this artery which is the first report in the literature.
Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial co... more Cyclic variation of myocardial-integrated backscatter (CV-IB) offers a non-invasive myocardial contractile performance assessment. There is limited data concerning CV-IB in end-stage renal disease (ESRD) patients. Forty essential hypertensive (EH) patients (mean age 51+/-8 yrs) and 24 ESRD patients (mean age 49+/-14 yrs) were compared to 10 healthy controls (mean age 45+/-10 yrs). A 2D-Doppler echocardiography with digitized imaging was performed to characterize myocardial ultrasonic tissue by CV-IB between systole and diastole at the interventricular septum (IVS) and left ventricular (LV) posterior wall (PW). There was no significant difference between age and sex among groups. Systolic and diastolic blood pressures (BP) were both higher in EH patients (157/96 mmHg in EH, 129/81 mmHg in ESRD and 115/77 mmHg in controls, p<0.001). Left ventricular mass index (LVMI) was higher in EH and ESRD patients than in controls (respectively, 119+/-37, 130+/-46, 87+/-12 g/m2, p<0.05), whi...
Journal of the American Society of Echocardiography, 2002
Identical twin boys presented with exercise-induced syncope. Echocardiographic examination reveal... more Identical twin boys presented with exercise-induced syncope. Echocardiographic examination revealed severe calcification at aortic valves, mitral anterior leaflets, and mitral annuli in both patients. In addition, basal interventricular septum was also involved in 1 patient. Doppler evaluation demonstrated severe aortic stenosis with a peak gradient of 112 and 118 mm Hg in both patients. Moderate mitral stenosis was also detected in one of them. Patients underwent operation for valve replacement.
Journal of Clinical Pharmacy and Therapeutics, 2004
Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a pote... more Although 5-fluorouracil (5-FU)-related cardiotoxicity is well known, atrial arrhythmia, as a potentially serious complication has not been studied in detail. The aim of this study was to determine the P max and Pd in the electrocardiograms (ECG) of patients receiving 5-FU treatment. Twenty-five patients (mean age: 62 years) receiving a 5-FU bolus plus continuous infusion with calcium leucovorin over 48 h and with normal pre-treatment cardiac physical examinations, ECG and echocardiography were enrolled. P maximum (P max), P minimum (P min) and P dispersion (Pd) (maximum minus minimum P wave duration) were measured from the 12-lead ECG at the 0th and 48th hour of the first chemotherapy cycle. Echocardiography was also obtained in all patients at the same times. Clinical cardiotoxicity was observed in two patients. P max and Pd were both significantly longer after 5-FU treatment at the 48th hour (P &lt; 0.001). P min did not change (P &gt; 0.05). Treatment with 5-FU based regimens may increase Pd and prolong the P max in cancer patients. These alterations may be predictive of patients at risk of atrial arrhythmias during 5-FU treatment.
We described here a patient envenomated by a bee sting that caused myocardial damage compatible w... more We described here a patient envenomated by a bee sting that caused myocardial damage compatible with non-ST elevation acute myocardial infarction. She developed a typical course of myocardial infarction; the ECG changes were reversed to almost all normal limits. She had normal coronary angiography and reversible wall motion abnormalities. Myocardial damage following prolonged spasm in the coronary arteries may be the underlying factor.
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