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Study Identifies Key Factor that Links Metabolic Syndrome

A new study led by researchers at Joslin Diabetes Center has identified insulin resistance in the liver as a key factor in the cause of metabolic syndrome and its associated atherosclerosis Additional topics at Heart Disease More research-related news at Consumer Information

CT Scans Effective in Detecting Artery Disease

Additional topics at Heart Disease More research-related news at Consumer Information

Transient midventricular ballooning syndrome. an atypical presentation of takotsubo cardiomyopathy.

Transient midventricular ballooning syndrome. an atypical presentation of takotsubo cardiomyopathy. Acta Cardiol. 2011 Dec;66(6):811-3 Authors: Rademakers LM, Weijers RW, Wijnbergen IF Abstract A 72-year-old woman without cardiovascular history presented with acute substernal chest pain and dyspnoea. The electrocardiogram was normal, but the blood test analyses showed an elevated troponin T level. Emergency coronary angiography revealed normal epicardial coronary arteries, but the left ventriculogram demonstrated midventricular dilatation and akinesis with well-preserved contractility of the apex and base. The patient was diagnosed as having an atypical presentation of takotsubo cardiomyopathy. She was treated with a beta blocker and an ACE inhibitor and recovered well. A follow-up echocardiogram at 2 months showed normalization of the wall motion abnormality. PMID: 22299396 [PubMed - in process]

H1N1 virus infection associated with acute myocardial infarction in a young patient without coronary artery disease--first reported case.

H1N1 virus infection associated with acute myocardial infarction in a young patient without coronary artery disease--first reported case. Acta Cardiol. 2011 Dec;66(6):807-10 Authors: Arbit B, Gaultier CR, Schwarz ER Abstract Swine-origin influenza A (H1N1) virus was identified in March of 2009 in Mexico and the United States. The virus spread rapidly, becoming pandemic by June. Previous studies examined the role of influenza infection in cardiovascular disease, however, we present the first case of an acute myocardial infarction in a healthy patient specifically associated with the novel viral infection. This case underscores the importance of prompt diagnosis and treatment as well as vigilance on behalf of health care workers in treating patients affected with influenza A (H1N1). Consideration of this previously undescribed pathology may play a significant role in the coming debates over vaccines and access. PMID: 22299395 [PubMed - in process]

The anti-arrhythmic effects of prednisone in patients with sarcoidosis.

The anti-arrhythmic effects of prednisone in patients with sarcoidosis. Acta Cardiol. 2011 Dec;66(6):803-5 Authors: Mohsen A Abstract Atrial fibrillation (AF) affects 2.3 million people in the United States and is currently the most common cardiac arrhythmia. Its overall prevalence is only increasing as the population ages. The classical risk factors for developing AF include hypertension, valvular disease, ischemic cardiomyopathy, and thyroid disease. In some patients with AF, an underlying cardiovascular pathology is not identified and the etiology remains unknown. Treatment modalities for AF typically include rate control medications, antiarrhythmics and radio frequency ablation (RFA), each of which is accompanied by its own risk of complications. We report a case of symptomatic AF that was refractory to multiple antiarrhythmics and an RFA procedure which resolved with prednisone. In this case, AF was associated with cardiac sarcoidosis, a disorder that is thought to be due to granulomatous involvement of the myocardium and increased systemic inflammation. PMID: 22299394 [PubMed - in process]

Thoracoscopic left ventricular lead implantation.

Thoracoscopic left ventricular lead implantation. Acta Cardiol. 2011 Dec;66(6):797-801 Authors: Pojar M, Vojacek J, Tauchman M, Parizek P, Havlicek A, Belohlavek J, Haman L Abstract OBJECTIVE: Cardiac resynchronization therapy is a therapeutic option in patients with chronic heart failure. Epicardial lead implantation for biventricular pacing is usually the method of second choice after failed coronary sinus cannulation. The present study describes an initial experience with minimally invasive surgical lead implantation using thoracoscopy. METHODS: Since August 2008, a total of 17 patients (mean age 69.6 + 11.1 years) with congestive heart failure, NYHA functional class 3.1 +/- 0.4, and depressed ejection function (24.8% +/- 5.7%) were referred for surgery because of failed left ventricular lead implantation through the coronary sinus. Under single-lung ventilation and video-assisted thoracoscopy, epimyocardial steroid-eluting screw-in leads were implanted on the left ventricular free wall. RESULTS: There were no in-hospital deaths or major co-morbidities. The mean skin-to-skin operating time was 115.9 +/- 32.1 min, and the post-operative average length of stay was 8.4 +/- 2.5 days. Intraoperative acute threshold capture of the left ventricular lead was 0.88 +/- 0.54 V/0.5 ms, and the value of lead impedance was 434.7 +/- 110.8 Omega. Extension to a small thoracotomy was necessary in 1 patient to stop epicardial vein bleeding. CONCLUSION: Minimally invasive left ventricular lead implantation is a safe procedure with excellent acute threshold capture. PMID: 22299393 [PubMed - in process]

Lifestyle modifications after acute coronary syndromes in a subset of the AMI-Florence 2 Registry.

Lifestyle modifications after acute coronary syndromes in a subset of the AMI-Florence 2 Registry. Acta Cardiol. 2011 Dec;66(6):791-6 Authors: Sofi F, Fabbri A, Marcucci R, Gori AM, Balzi D, Barchielli A, Santoro GM, Marchionni N, Abbate R, Gensini GF Abstract OBJECTIVE: The aim of this study was to evaluate the adherence to recommendations for secondary prevention of cardiovascular diseases in patients with acute coronary syndromes (ACS). METHODS AND RESULTS: Physical examination, a careful medical interview with assessment for lifestyle habits, adherence to pharmacological therapy and blood analyses were performed in 130 patients at the time of the acute event and after 6 months of follow-up. At follow-up examination, 7 patients persisted to smoke (5.4%), 41 (31.5%) continued to have high blood pressure, 34 (26.1%) had high levels of total cholesterol, 38 (29.2%) high levels of triglycerides, 64 (49.2%) high levels of LDL-cholesterol and 46 (35.4%) low levels of HDL-cholesterol. Despite all treatments no significant change occurred. A high percentage of patients (47%) reported a lower daily consumption of fruit and vegetables with respect to the recommended daily portions, nearly the whole population (92.3%) did not reach the recommended portions of legumes per week recommended, and a consistent percentage of patients (81.5%) did not consume fish twice a week, as recommended. CONCLUSION: These findings demonstrate the difficulty of modifying the lifestyle habits in patients with ACS. PMID: 22299392 [PubMed - in process]

Analysis of beta1 and beta2-adrenergic receptors polymorphism in patients with apical ballooning cardiomyopathy.

Analysis of beta1 and beta2-adrenergic receptors polymorphism in patients with apical ballooning cardiomyopathy. Acta Cardiol. 2011 Dec;66(6):787-90 Authors: Vriz O, Minisini R, Citro R, Guerra V, Zito C, De Luca G, Pavan D, Pirisi M, Limongelli G, Bossone E Abstract OBJECTIVE: The aim of our study was to analyse the frequency of beta1 and/or beta2 adrenergic receptor polymorphisms in patients with takotsubo cardiomyopathy (TTC). METHODS AND RESULTS: beta1 and/or beta2 adrenergic receptor polymorphisms in 61 patients with TTC were compared with 109 controls. The beta1 adrenoreceptor (amino acid position 389) genotype frequencies were significantly different in the two groups; assuming a recessive model for the allelic variant coding for Arg on this position, the odds ratio was 3.14, 95% Cl 1.55-6.37 (P = 0.0015). The beta2 adrenoreceptor amino acid position 27 genotype was significantly different and assuming a recessive model for the allelic variant coding for Gln on this position, the odds ratio was 0.29, 95% Cl 0.12-0.74 (P = 0.009). CONCLUSIONS: This study showed for the first time an association between TTC phenotype and beta1 adrenoreceptor gene polymorphisms. Beta adrenoreceptors gene polymorphisms are probably disease modifiers, and any risk estimate should be based on a combination of genotypes and on interactions with other genes and environmental features. PMID: 22299391 [PubMed - in process]

The role of speckle tracking imaging in the noninvasive detection of acute rejection after heterotopic cardiac transplantation in rats.

The role of speckle tracking imaging in the noninvasive detection of acute rejection after heterotopic cardiac transplantation in rats. Acta Cardiol. 2011 Dec;66(6):779-85 Authors: Shi J, Pan C, Shu X, Sun M, Yang Z, Zhu S, Wang C Abstract OBJECTIVE: Acute cardiac allograft rejection continues to be the cause of graft loss and contributes to the morbidity and mortality after cardiac transplantation. Repetitive endomyocardial biopsies are necessary to monitor the effects of immunosuppressants after cardiac transplantation. In this study, we investigate whether speckle tracking imaging (STI) is a valuable method in assessing acute cardiac rejection. METHODS AND RESULTS: Hearts from Brown Norway rats or Lewis rats were transplanted into other Brown Norway rats. Isografts and groups of allografts, either untreated or treated with cyclosporine A (CsA) at a low dose (3 mg x kg(-1) x d(-1)) or a high dose (10 mg x kg(-1) x d(-1)), were compared 7 days after transplantation. Echocardiography-derived left ventricular post wall thickness was increased only in untreated allografts.The left ventricular ejection fraction was significantly lower in the allografts compared with the isografts, but allografts treated without or with low-dose CsA showed similar results. The radial velocity and systolic radial strain rate showed a lower value in untreated allografts than other grafts, but there is no significant difference between allografts treated with high- or low-dose CsA and isografts. The circumferential strain and circumferential strain rate were comparable among the 4 groups. However, the radial strain exhibited a clear gradient in these groups (2.8 +/- 1.3 in untreated allografts, 5.2 +/- 10.9 in allografts treated with low-dose CsA, 6.3 +/- 1.8 in allografts treated with high-dose CsA, and 12.7 +/- 7.9 in isografts, P < 0.001). CONCLUSIONS: STI is able to offer a noninvasive method for detecting transplant allograft rejection. PMID: 22299390 [PubMed - in process]

Endothelial progenitor cells are associated with plasma homocysteine in coronary artery disease.

Endothelial progenitor cells are associated with plasma homocysteine in coronary artery disease. Acta Cardiol. 2011 Dec;66(6):773-7 Authors: Huang C, Zhang L, Wang Z, Pan H, Zhu J Abstract OBJECTIVE: Little is known about the association between plasma homocysteine (Hcy) and endothelial progenitor cells (EPCs) in coronary artery disease (CAD). METHODS: Blood mononuclear cells were isolated from CAD (n = 30) patients and non-CAD controls (n = 30). Flow cytometric analysis and an in vitro culture system was used to evaluate the number and function of the EPC. Plasma homocysteine (Hcy) concentration was measured by an automated fluorescence polarization immunoassay. RESUITS: Hcy level was higher in CAD than in non-CAD (13.69 +/- 4.48 vs 9.34 + 2.31 pmol/L, P < 0.01). The number of circulating EPCs from CAD was decreased compared with non-CAD (58.7 +/- 10.6 vs. 94.3 +/- 15.1 cells/ml, P < 0.01). This decrease of EPCs in CAD was also detected (33.5 +/- 6.9 vs. 55.9 +/- 9.7 EPCs/x200 field; P < 0.01) in an in vitro culture system. The numbers of circulating and differentiated EPCs were both inversely correlated with Hcy. EPCs from CAD were significantly impaired in their migratory capacity and ability to adhere to fibronectin. CONCLUSIONS: We observed the correlation between Hcy level and EPC number, and also found an increased Hcy level in CAD patients. It will be interesting to reveal the underlying mechanisms contributing to the correlation and examine the possible causal relationship between Hcy levels and CAD. PMID: 22299389 [PubMed - in process]

Evaluation of a novel paclitaxel-eluting stent with a bioabsorbable polymeric surface coating in the porcine artery injury model.

Evaluation of a novel paclitaxel-eluting stent with a bioabsorbable polymeric surface coating in the porcine artery injury model. Acta Cardiol. 2011 Dec;66(6):765-72 Authors: Ding F, Lu Z, Zou R, Zhang Y, Guo Q, Li S, Yang J Abstract PURPOSE: Drug-eluting stents (DES) are unique in allowing sustained release after a single short intervention. The challenge with DES still remaining is the optimal combination of a biocompatible drug-eluting matrix including an antiproliferative drug. We studied the role of a novel paclitaxel-eluting stent with a bioabsorbable polymer coating in preventing vascular restenosis in the porcine artery injury model. MATERIAL AND METHODS: Bare metal stents (BMS); polymer-coated-only stents (POLY); and polymer-based paclitaxel-eluting stents (PACL) were randomly implanted in pig femoral arteries. The dose density of paclitaxel was 1 microg/mm2 with in vitro studies demonstrating a gradual elution over a course of 6 month. RESULTS: After 1-, 3- and 6-month follow-up, respectively, the animals underwent angiographic restudy and were terminated for histomorphometrical and histopathological analyses. At 1 month, the PACL group had the lowest histological percent stenosis when compared to the BMS and POLY groups (20 +/- 4% vs 39 +/- 6% and 41 +/- 6%, respectively, P < 0.05). At 3 months, the PACL group still presents the lowest level of histological percent stenosis among the three groups (27 +/- 6% vs 50 +/- 10% and 46 +/- 5%, respectively, P < 0.01). Six months later, the PACL group showed a similar histological percent stenosis as the BMS and POLY groups (44 +/- 9% vs 56 +/- 11% and 53 +/- 9%, respectively, P = 0.145). CONCLUSIONS: This study shows favourable vascular compatibility and efficacy for a novel DES to inhibit in-stent neointima formation and preserve lumen area in the porcine artery model. PMID: 22299388 [PubMed - in process]

Carotid intima media thickness and cardiometabolic risk associates in Turkish adults.

Carotid intima media thickness and cardiometabolic risk associates in Turkish adults. Acta Cardiol. 2011 Dec;66(6):759-64 Authors: Besir FH, Yazgan O, Ozhan H, Aydin Y, Basar C, Aydin M, Alemdar R, Bulur S, Abstract OBJECTIVE: Carotid intima media thickness (CIMT) is a strong predictor of future vascular events. However, data for Turkish individuals are limited and the association between cardiometabolic risk factors and CIMT has not been studied before.Therefore, we sought to investigate the CIMT and cardiometabolic risk associates in a large cohort of Turkish adults. METHODS AND RESULTS: The study was conducted on 2230 participants (1427 women, 803 men with a mean age of 49). The participants underwent a Doppler Ultrasound examination of CIMT. Mean CIMT was 0.61 +/- 0.19 mm. Age- and sex-adjusted partial correlation analysis revealed that only systolic blood pressure and smoking amount was significantly correlated with CIMT. Receiver operator characteristics (ROC) calculations showed that age had the best area under the curve (AUC = 0.84), smoking had the best sensitivity (86%) and diastolic blood pressure (> 88 mmHg) had the best specificity (74%) in predicting a person with thickened carotid intima media (> 0.8 mm). Independent predictors of thickened carotid intima media were hypertension [(odds ratio (OR) = 2.74; 95% confidence interval (CI) = 1.663-4.53; P value < or = 0.001)], systolic blood pressure [OR = 1.01; 95% CI = 1.002-1.022; P value = 0.022] and age [OR = 1.11; 95% CI = 1.079-1.136; P value < or = 0.001). CONCLUSION: Age, systolic blood pressure and smoking amount (pack/year) were the only age- and sex-adjusted associates of CIMT. Age had the best AUC in ROC analysis predicting thickened carotid artery intima media. Hypertension, systolic blood pressure and age were independent predictors of high CIMT in Turkish adults. PMID: 22299387 [PubMed - in process]

Determinants of mortality in patients with heart failure and atrial fibrillation during long-term follow-up.

Determinants of mortality in patients with heart failure and atrial fibrillation during long-term follow-up. Acta Cardiol. 2011 Dec;66(6):751-7 Authors: Boldt LH, Schwenke C, Parwani AS, Huemer M, Wutzler A, Haverkamp W Abstract BACKGROUND: Heart failure (HF) and atrial fibrillation (AF) often occur together. Both are independently associated with an increased mortality. Clinical parameters associated with mortality in patients with HF such as left ventricular ejection fraction (LV-EF) and New York Heart Association (NYHA) functional class are influenced by AF. If these parameters are still determinants of mortality when HF is complicated by AF, or if other parameters determine mortality in this case is unknown. METHODS AND RESULTS: We studied 173 consecutive HF patients (mean age 67 +/- 12 years, 30% female) in New York Heart Association (NYHA) functional class 2.6 +/- 0.8 with left ventricular systolic dysfunction (ejection fraction 45%) and AF. Mortality was 42% after a mean follow-up of 41 months. Age (OR 1.04, CI 1.01-1.07, P = 0.003), chronic obstructive pulmonary disease (OR 2.07, Cl 1.15-3.73, P = 0.015), elevated serum creatinine at admission (OR 1.25, Cl 1.01-1.54, P = 0.033), prolongation of QRS duration (OR 1.02, CI 1.01-1.54, P= 0.001), decreased serum sodium at admission (OR 0.94, Cl 0.89-0.99, P = 0.026) and oral anticoagulation (OR 0.59, Cl 0.36-0.99, P = 0.046) were independently associated with mortality when assessed with multivariable Cox proportional hazard analysis. Importantly, mortality was not associated with NYHA functional class or left ventricular ejection fraction (LVEF). CONCLUSIONS: Elevated creatinine levels, decreased serum sodium levels, prolongation of QRS duration and the presence of COPD are associated with long-term mortality after hospitalization in patients with HF and AF. Oral anticoagulation is associated with better survival. LVEF and NYHA functional class are no reliable mortality markers in this patient population. PMID: 22299386 [PubMed - in process]

Coronary flow reserve in patients with aortic stenosis and nonobstructed coronary arteries.

Coronary flow reserve in patients with aortic stenosis and nonobstructed coronary arteries. Acta Cardiol. 2011 Dec;66(6):743-9 Authors: Banovic MD, Vujisic-Tesic BD, Kujacic VG, Callahan MJ, Nedeljkovic IP, Trifunovic DD, Aleksandric SB, Petrovic MZ, Obradovic SD, Ostojic MC Abstract OBJECTIVE: Patients with moderate and severe aortic stenosis (AS) and without obstructive epicardial coronary disease have been shown to have an impairment of coronary flow velocity reserve (CFVR). Recently, it has been shown that CFVR is an independent predictor for future cardiovascular events in AS patients. We investigated parameters representing left ventricular (LV) mass and wall thickness, diastolic dysfunction, LV workload and haemodynamic indexes of AS severity to determine which contributes the most to impaired CFVR in patients with AS and a nonobstructed coronary angiogram. METHOD AND RESULTS: A total of 77 patients with moderate or severe AS, mean age 65.66 +/- 11.02 y (57.14% males), were enrolled in this prospective study. All patients had standard Doppler-echo study, coronary angiography and adenosine-stress transthoracic Doppler-echo for CFVR measurement. We took 2.5 as a cut-off value for impaired CFVR. Univariate analysis showed that aortic valve area (AVA), maximal velocity (Vmax), mean pressure gradient (Pmean), energy loss index (ELI), aortic valve resistance (AVR) and stroke work loss (SWL) were associated (P = 0.05) with impaired CFVR. Multivariate analysis showed that AVR was the best predictor of impaired CFVR (RR 0.900, Cl: 0.983-0.997, P = 0.007). Using ROC analysis, the AVR value of 211.22 dynes x s x cm(-5) had the highest accuracy in predicting the impaired CFVR (AUC-0.681, P=0.007, sensitivity 72%, specificity 52%, CI: 0.561-0.800). CONCLUSION: Haemodynamic indices of AS severity, together with LV workload parameters, are the main determinants of CFVR. Among all parameters, AVR is the strongest predictor of CFVR in patients with moderate or severe AS and a nonobstructed coronary angiogram. PMID: 22299385 [PubMed - in process]

Quantitative assessment of right atrial function by strain and strain rate imaging in patients with heart failure.

Quantitative assessment of right atrial function by strain and strain rate imaging in patients with heart failure. Acta Cardiol. 2011 Dec;66(6):737-42 Authors: Ojaghi Haghighi Z, Naderi N, Amin A, Taghavi S, Sadeghi M, Moladoust H, Maleki M, Ojaghi Haghighi H Abstract OBJECTIVES: We sought to evaluate the regional longitudinal strain/strain rate profiles in the right atrial wall to quantify right atrial function in systolic heart failure patients. BACKGROUND: According to previous studies on the deformational properties of the left atrium, the systolic strain and strain rates represent the atrial reservoir function and the early and late diastolic strain rates show the conduit and booster functions, respectively. METHODS: Thirty patients with a diagnosis of heart failure (left ventricular ejection fraction < or = 35%) scheduled for right heart catheterization were enrolled. Echocardiography was performed to obtain right atrial deformation indices just before the procedure. The control group consisted of 32 healthy adults matched for age and sex. The deformity indices obtained consisted of the right atrial peak systolic strain (RAS), right atrial peak systolic strain rate (RASSR), right atrial early diastolic strain rate (RAEDSR), and right atrial late diastolic strain rate (RALDSR). RESULTS: The right atrial deformation indices were significantly compromised in the heart failure patients versus the normal subjects (RAS: 68.5 +/- 53.9 vs 189.3 +/- 61.2, P = 0.000; RASSR: 2.9 +/- 1.9 vs. 5.3 +/- 1.5, P = 0.000).There was a significant correlation between the RAS and RASSR and cardiac output (RAS: r = 0.5, P = 0.005; RASSR: r = 0.5, P = 0.003), and cardiac index (RAS: r = 0.6, P = 0.001; RASSR: r = 0.6, P = 0.001). CONCLUSION: In light of our findings, we conclude that a diminished RA function, as assessed by strain imaging, plays a critical role in the pathophysiological process of heart failure patients. PMID: 22299384 [PubMed - in process]

Advantages and limitations of antihypertensive treatment for stroke risk in a general population: the Akita Stroke Registry.

Advantages and limitations of antihypertensive treatment for stroke risk in a general population: the Akita Stroke Registry. Acta Cardiol. 2011 Dec;66(6):729-35 Authors: Izumi M, Suzuki K, Sakamoto T, Hayashi M Abstract BACKGROUND: Although the association between stroke risk and blood pressure (BP) levels related to antihypertensive medication has been an object of study for a long time, there is little agreement as to the relationship in a general population study. METHODS AND RESULTS: We obtained mass health screening data regarding 156,847 (142,989 untreated and 13,858 treated) subjects from the Akita Prefectural Federation of Agricultural Cooperative for Health and Welfare from 1991 to 1998. Stroke events were determined from the Akita stroke registry between 1991 and 2001. A Poisson regression model, adjusting for possible confounding factors, was used to investigate the risk of first stroke among six BP-based categories (BP defined according to JNC-6), with or without antihypertensive medication. Stroke developed in 1,323 (0.8%) individuals in the study population within 3 years after the health examination. Among untreated groups, the relative hazard linearly increased with elevation of the BP grade. In the untreated group, stroke risk was significantly higher (relative hazard 2.1, 95% confidence interval (CI) 1.6-2.7) in the subjects with high-normal BP levels than with optimal BP levels. In the treated group, stroke risk was significantly higher in patients with high-normal BP levels (relative hazard 2.0, 95% CI 1.0-4.2) than with optimal BP levels. Furthermore, stroke risk was significantly higher in the treated groups with normal BP levels (relative hazard 3.1, 95% CI 2.0-4.9) compared with the untreated group with optimal BP levels. CONCLUSIONS: Although antihypertensive medication can reduce stroke risk, treated patients within non-hypertension levels may still have a higher risk compared with untreated subjects of the same categories. PMID: 22299383 [PubMed - in process]

Impact of fatty acid food reformulations on intake of Dutch young adults.

Impact of fatty acid food reformulations on intake of Dutch young adults. Acta Cardiol. 2011 Dec;66(6):721-8 Authors: Temme EH, Millenaar IL, Van Donkersgoed G, Westenbrink S Abstract BACKGROUND: The Dutch'Task Force for the Improvement of the Fatty Acid Composition' initiated fatty acid reformulations in branches using vegetable oils and fats to reduce the trans (TFA) and saturated fatty acid (SFA) content of foods. OBJECTIVE: This study estimates the impact of recent reformulations in the task force food groups by estimating changes in median intake of TFA and SFA in Dutch young adults. METHODS: This is a modelling study with food consumption data of young adults. Intakes were estimated before reformulation using food composition data of 2001 as a reference and while including most recent fatty acid composition of foods for task force food groups. Food composition of other foods and food consumption was assumed unchanged. RESULTS: Average TFA intake significantly decreased from 1.0 E% in the reference to 0.8 E% in the reformulation scenario. Pastry, cakes and biscuits, and snacks contributed most to the decrease of TFA. Estimated SFA intake did not change. When solid baking and spreading fats were additionally replaced with fluid ones, SFA intake decreases from 12.9 E% to 12.1 E%. CONCLUSION: Fatty acid reformulation in the task force food groups contributed to reductions in TFA intake. For further reductions in SFA intake a different food choice is primordial. PMID: 22299382 [PubMed - in process]

Screening for silent myocardial ischaemia in patients with type 2 diabetes mellitus: a quest to improve selection of the target screening population.

Screening for silent myocardial ischaemia in patients with type 2 diabetes mellitus: a quest to improve selection of the target screening population. Acta Cardiol. 2011 Dec;66(6):715-20 Authors: De Keyzer E, Kerkhove D, Van Camp G, De Sutter J, Achtergael W, Keymeulen B, Weytjens C Abstract OBJECTIVE: Despite the association of diabetes mellitus type 2 (DM2) with silent myocardial ischaemia (SMI) and a high prevalence of death due to coronary artery disease (CAD), screening for CAD in patients with DM2 remains controversial because of a lack of proof that it improves cardiac outcome. The aim of this study was to improve the diagnostic yield of the exercise stress test (EST) by introducing recently published life expectancy tables in selecting DM2 patients for coronary screening. METHODS: 359 patients with DM2 without history or symptoms of CAD were included to perform an EST after a clinical history and brief physical examination. Cardiovascular risk factor profiling was completed with blood and urine analysis. A lower heart rate was defined as bradycardia (heart rate less than 60 bpm), a higher blood pressure as a systolic blood pressure at rest of 130 mmHg of more. RESULTS: The prevalence of SMI was 14.5% (n = 52). The average number of additional cardiovascular risk factors per subject was 4. Multivariate logistic regression yields 4 significant predictors: (i) heart rate at rest (P= 0.015), (ii) a family history of cardiovascular disease (P = 0.017), (iii) systolic blood pressure at rest (P = 0.019), and, (iv) an LDL-c of 80 mg/dL or more (P = 0.021). CONCLUSION: Known risk factors for myocardial ischaemia were identified as significantly influencing the prevalence of SMI. No improvement in diagnostic yield could be identified by selecting the screening population using predicted life expectancy tables. PMID: 22299381 [PubMed - in process]

Ten years single-centre experience with intra-aortic balloon pump.

Ten years single-centre experience with intra-aortic balloon pump. Acta Cardiol. 2011 Dec;66(6):707-13 Authors: Vandenplas G, Bové T, Caes F, Van Belleghem Y, François K, De Somer F, Taeymans Y, Van Nooten G Abstract OBJECTIVES: The objective of this study was to investigate the patient characteristics and outcomes in 1406 patients undergoing intra-aortic balloon pump (IABP) counterpulsation. METHODS: Between 1998 and 2008, 1406 consecutive patients were recorded in a prospective database. Based on the main clinical indication for IABP use, we defined 3 groups: group A, 630 cases of coronary ischaemia or infarction without serious left ventricular (LV) dysfunction; group B, 466 patients with left ventricular failure or cardiogenic shock; group C, 310 patients where IABP was used for miscellaneous procedures such as weaning from cardiopulmonary bypass or during high-risk angioplasty or surgery. RESULTS: Global mortality was 28% (n = 390), with a significant difference between group A (15%, n = 95) and group B (41%, n = 191) (P < 0.001). Mortality in group C was 34% (n = 104). Most insertions were done in the catheterization laboratory (n = 943) with subsequent mortality of 23% whereas 199 balloons were inserted in the operation room with 34% mortality. 170 balloons inserted in the intensive care unit resulted in 46% mortality (P < 0.001). Major IABP-induced complications were 6.8% with no statistical differences between the three groups. Advanced age, left ventricular failure and low BMI were identified as prognostic risk factors for early mortality. CONCLUSIONS: IABP deployed at an early clinical stage yields the best results, especially for acute coronary patients with preserved LV function whereas LV failure and late insertion result in worse outcome. PMID: 22299380 [PubMed - in process]

Short-term blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO).

Short-term blood pressure variability in relation to outcome in the International Database of Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO). Acta Cardiol. 2011 Dec;66(6):701-6 Authors: Stolarz-Skrzypek K, Thijs L, Li Y, Hansen TW, Boggia J, Kuznetsova T, Kikuya M, Maestre G, Mena L, Kawecka-Jaszcz K, Staessen JA Abstract Ambulatory blood pressure monitoring not only provides information on the blood pressure level, but on the diurnal changes in blood pressure as well. The present review summarizes the main findings of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) with regard to risk stratification based on short-term blood pressure variability. An exaggerated morning surge, exceeding the 90th percentile of the population, is an independent risk factor for mortality and cardiovascular and cardiac events. Conversely, a sleep-through or pre-awakening morning surge less than 20 mm Hg in systolic blood pressure is probably not associated with an increased risk of death or cardiovascular events. Blood pressure variability represented by the average of the daytime and nighttime SD weighted for the duration of the daytime and nighttime interval (SDdn) and by average real variability (ARV24) predicted outcome, but only improved the prediction of the composite cardiovascular events by 0.1%. Overall, results of analyses using the IDACO support the concept that short-term blood pressure variability adds to risk stratification, but 24-hour ambulatory blood pressure level is the most valuable predictor for use in clinical practice. PMID: 22299379 [PubMed - in process]

Cardiogenic shock complicating acute myocardial infarction--a review.

Cardiogenic shock complicating acute myocardial infarction--a review. Acta Cardiol. 2011 Dec;66(6):691-9 Authors: Dubey L, Sharma S, Gautam M, Gautam S, Guruprasad S, Subramanyam G Abstract Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction and is the leading cause of death in patients hospitalized with acute myocardial infarction. Mortality from cardiogenic shock still remains high. The development of cardiogenic shock is rarely unexpected; most patients who develop cardiogenic shock do so within 48 hrs of admission, with only 10% shocked on arrival. Mortality rate is exceedingly high and reaches 70-80% in those treated conservatively. Early revascularization is the cornerstone treatment of acute myocardial infarction complicated by cardiogenic shock. According to the guidelines, revascularization is effective up to 36 hours after the onset of cardiogenic shock and performed within 18 hours after the diagnosis of cardiogenic shock. Primary percutaneous coronary intervention is the most efficient therapy to restore coronary flow in the infarct-related artery. However, invasive strategy in a developing country like ours is not only costly but also technically demanding. We present a case of acute myocardial infarction complicated with cardiogenic shock that underwent primary percutaneous coronary intervention and also review the incidence, pathophysiology, management and outcome of cardiogenic shock complicating acute myocardial infarction. PMID: 22299378 [PubMed - in process]

QTc prolongation as a surrogate for drug-induced arrhythmias: fact or fallacy?

QTc prolongation as a surrogate for drug-induced arrhythmias: fact or fallacy? Acta Cardiol. 2011 Dec;66(6):685-9 Authors: Hondeghem LM Abstract QTc prolongation is commonly used as a surrogate for drug-induced torsade de pointes (TdP) because it is frequently associated with TdP. However, TdP can also occur in the absence of QTc prolongation or even when QTc is shortened. In the absence of disturbances of lambda-TRIaD (lambda: cardiac wavelength, Triangulation, Reverse use dependence, Instability and Dispersion; TRIaD) QTc prolongation can be antiarrhythmic. In the presence of disturbances of lambda-TRIaD, QTc prolongation still reduces proarrhythmia but frequently cannot overcome the proarrhythmic effect induced by lambda-TRIaD disturbances. Safety evaluation focused upon QTc prolongation (antiarrhythmic parameter) instead of disturbances of lambda-TRIaD (proarrhythmic parameters), is scientifically incorrect. Such evaluation can impede the development of highly valuable drugs, while not recognizing agents that disturb lambda-TRIaD and hereby endanger patient safety. It must be concluded that the century old proposal by Lewis that prolongation of action potential duration and refractory period can be antiarrhythmic is still correct, provided it is not contaminated by disturbances of lambda-TRIaD. PMID: 22299377 [PubMed - in process]

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Cardiology jobs in "SOONER! Rather than later Cardiologist is Needed in This Oklahoma Town!" - OK

Job 94960 Looking for a board certified Invasive cardiologist to join an established physicianin warm and welcoming Oklahoma! Growing community supported hospital Established referral patterns. Great

Cardiology jobs in "Lucrative Cardiologist Opportunity in the Blue Ridge Mountains of NC" - NC

Job 941336 Opportunity for an Invasive Cardiologist in a hospital based position Employment Model w/ Competitive Base + Bonus Expect min of $500K 1st year 1 in 3 call schedule Service only 1 community

Cardiology jobs in "Interventional Cardiology Available in PA! Great Pay and Position" - PA

Job 941244 Exceptional hospital employed group practice in Metro PA! Join 7 other cardiologist, soon to be 13! This is great opportunity for a recently trained Interventional cardiologist to earn $550k

Cardiology jobs in "INTERVENTIONAL CARDIOLOGIST SOUGHT IN COLUMBUS, OHIO METRO AREA" - OH

Job 941271 Well established, 80 member physician owned and operated MSG One hour or less to Columbus High Volume of Interventions Join 2 non-invasive cards - Established patient base Production based

Cardiology jobs in "CARDIOLOGY Invasive or Non: Invasive in growing North Dakota!" - ND

Job 941183 Fantastic opportunity offered in the upper mid-west, university town offering more than you can imagine. Largest hospital in the state, largest not-for-profit rural health care provider in

Cardiology jobs in "Interventional Cardiologist Needed in Beautiful East Texas" - TX

Job 941339 Possible affiliation with one of the premier Cardiology groups of east Texas for the right BC/BE candidate: * Join nine Board Certified interventional cardiologists * Partnership

Cardiology jobs in "Interventional Cardiology in the Land O' Lakes, Minnesota!" - MN

Job 941187 Join another busy Interventionalist in this beautiful, small-town in Minnesota, surrounded by lakes, you can enjoy 4 season activities. Experienced Cardiologist's preferred. Work where others

Cardiology jobs in "Non Invasive Cardiology opportunity in Southern Utah" - UT

Job 94962 MSG seeking an aggressive Cardiologist to keep up with demand in Southern Utah Waiting patient base in this growing community. Be the first Cardiologist with this group, but share calls with

Cardiology jobs in "Non-Invasive Cardiologists - Beautiful NM needs you!" - NM

Job 941325 BC/BE Non-Invasive Cardiologist needed for a new Cardiologist group with 2 experienced cardiologists to serve Southeastern New Mexico Operates 24/7, offering a full range of diagnostic modalities,

Cardiology jobs in "Interventional Cardiology opportunity in Mississippi" - MS

Job 941063 Cardiology opportunity for a new practice in Mississippi Interventional Cardiologist needed for this growing Mississippi community, close to Memphis, TN Call schedule 1:4 Visa sponsorship

Cardiology jobs in "Non-Invasive Cardiology/Academics - North Carolina" - NC

111215-1821 Non-Invasive Cardiology/Academics - North Carolina NC Seeking BC/BE Non-Invasive Cardiologist to join faculty at the Assistant, Associate, or Professor level Service 850-bed, level

Cardiology jobs in "Cardiologist - Minnesota (One hour from Rochester)" - MN

110817-1667 Cardiologist - Minnesota (One hour from Rochester) MN Seeking BC/BE cardiologist for multi-specialty group affiliated with highly regarded, well-known health care system Responsibilities

Cardiology jobs in "Lucrative Non-Invasive Cardiology Opportunity in NC" - NC

Job 941337 Opportunity for a Non-Invasive Cardiologist in a hospital based position Employment Model w/ Competitive Base + Bonus Expect min of $480K 1st year 1 in 3 call schedule Service only 1 community

Cardiology jobs in "Rare Academic EP Cardiology Opportunity in Detroit!" - MI

Job 94982 Need is NOW for an Electrophysiologist in a ACADEMIC setting near Detroit, MI. Physician MUST have a MI license in hand and ready to start prior to 12/2011. Great opportunity in a city that's

Cardiology jobs in "Employed Invasive, Non-Interventional Cardiologist" - NC

Job 94983 New practice facility/office built approximately 6 years ago. This will be an employed position with pay based on WRVUs; and first year income guarantee. Join a group of 3 other cardiologists

Cardiology jobs in "Interventional Cardiologist needed in Delaware" - DE

Job 941238 Interventional Cardiologist needed in Delaware . Join a well established Single Speciality Group in SW Delaware Generous compensation Near ocean resorts of DE and MD Quick drive to Baltimore,

Cardiology jobs in "Cardiology Medical Director - North Carolina" - NC

110811-1642 Cardiology Medical Director - North Carolina NC Seeking board certified invasive or non-invasive cardiologist with leadership experience Incoming physician would assume role as director

Cardiology jobs in "Pittsburgh Area - Up to $500K Employed Base" - PA

Large State-of-the-Art Facility Being born and raised here, our cardiologists have the best reputations in the region. Ours is the dominant group in the area, and an extraordinary increase in volume

Cardiology jobs in "In Central PA, A Cardiologist is Needed" - PA

Job 921902 Exceptional opportunity to join a 2 person single-specialty group as employed physician for 2 years, then become a partner! Very stable hospital in a great community Easy drive to Pittsburgh

Cardiology jobs in "Live and Practice in Coastal Southeast" - GA

Job 941237 Interventional Cardiology in Southeast US Board Eligible or Board Certified Cardiology Interventional Cardiology training, experience preferred Easy access to Coastal Georgia Work in a brand

Cardiology jobs in "Alabama Cardiology opportunity" - AL

Job 941000 Lucrative partnership for Invasive, Non-Invasive or Interventional Board Certified or Board Eligible General Cardiologist south in Southeast Seeking Non-Invasive, Invasive or Interventional

Cardiology jobs in "30 Minutes from Baltimore" - MD

BC / BE Adult Cardiologist needed for a well respected primary care practice outside of Baltimore, MD. This private practice with multiple locations has been in business for over 30 years. Office

Cardiology jobs in "San Francisco/San Mateo" - CA

Immediate Opening make $75-$100/hr plus bonus! Job Description: No hospital rounds. No insurance billing. We offer specialized training and guaranteed hourly

Cardiology jobs in "Northwestern Georgia" - GA

Position Title : Interventional Cardiologist (full-time position with 100 call-day per year) Salary Range : Based on Qualifications (salary guarantee, great

Cardiology jobs in "Northeastern Nevada" - NV

Excellent Opportunity for Cardiology - Beautiful Location in Nevada - Surrounded by Majestic Mountain Ranges, Rivers, Ski Resorts, and Fishing. Cardiology New position is available. Currently the

Cardiology jobs in "Inquire for details" - MT

Work Schedule Days Monday Tuesday Thursday Friday Hours 8-5 Call Schedule Weekday call Call rotation per week (Monday through Friday) 1:4 Weekend call Call rotation per month

Cardiology jobs in "SW of San Antonio" - TX

We have an outstanding PERM opportunity for a BC/BE Cardiologist to join a solo hospital-sponsored practice located Southwest of San Antonio, TX. Board Certified is preferred

Cardiology jobs in "Southern Oregon" - OR

EXCELLENT OPPORTUNITY FOR A CARDIOLOGIST SOUTHERN OREGON - BEAUTIFUL LOCATION Community has a population of 23,000 with a service area of 88,000 Growing volumes and a retiring physician has prompted