Yin Huang   Ziqing Gao   Xiaobo Chen   and Yongquan Huang   

Objective: To evaluate the use of transesophogeal echocardiography (TEE) for percutaneous left atrial appendage (LAA) occlusion. Methods: LAA occlusion was performed in 20 atrial fibrillation (AF) patients with non-valvular lesions, including nine males and 11 females. TEE was used for the preoperative measurement of the maximal LAA orifice diameter and LAA depth and the guidance of atrial septum puncture. The release of the occluder during the occlusion procedure was also performed under TEE monitoring. Results: All 20 patients underwent successful occlusion of the LAA under the guidance of TEE. There were two (10.0%) cases with mild residual shunt after occlusion, among which only one (5.0%) patient still retained slight residual shunt at one month postoperative. All the other (95.0%) patients revealed no residual shunt. There was no difference between the maximal LAA orifice diameter (22.75 ± 4.85 mm vs. 22.15 ± 4.23) and LAA depth (36.60 ± 5.51 vs. 35.00 ± 4.76) derived from TEE and the digital subtraction angiography (DSA) measurement. Both the max orifice diameter and LAA depth measured by TEE were strongly correlated with that measured by DSA, with r = 0.75, P < 0.001 and r = 0.82, P < 0.001, respectively. Conclusions: TEE can accurately estimate the maximal LAA orifice diameter and LAA depth and provide an important reference for preoperative occluder size selection. It can also be used for intraoperative guidance and assessing results during the operation. TEE is of great importance for LAA occlusion.

M. Reshma   P. Gouthami   P. Tasleem   B. Shailaja   and J. Thipperudra   

Drug related problems in cardio vascular disease patients may lead to morbidity, mortality and the decreased quality of life. The main aim of the study is to assess, identify and resolve drug related problems in patients with Cardiovascular Diseases. A total of 150 cardiac patients were enrolled into the study. In our study, out of 150 we got 71 DRPs like Drug-Drug interactions 33(46.4%), ADRs 14(20%), indication without Drug 6(8.4%), drug use without indication 8(11.2%), sub therapeutic dose 10(14%). The association between risk factors like alcohol abuse, smoking, diabetes, hypertension increased risk of CVD. The P value was statistically significant in males than in females. In this study, for individuals with drug related problems of cardiovascular diseases, males were found to be more when compared with females due to risk factors such as smoking, alcoholism, life style etc. the drug related problems were high in patients aged between 40-60 years because of their multiple co-morbid conditions. Polypharmacy was the main predisposing factor for drug related problems.

Benjamin Griffiths   Jean-Paul Aben   and Aiden O’Loughlin   

This study aims to determine if measuring four-dimensional quantitative coronary artery motion (QCAM) and change in tortuosity (∆T) on invasive biplane coronary angiogram is predictive of the location of culprit lesions responsible for myocardial infarctions. Invasive coronary angiograms have no current clinical application for the prediction of future coronary events. Previous studies have shown promise in demonstrating the effects of coronary artery motion on plaque formation and location, but this has yet to fully translate into a directed diagnostic method. QCAM and ΔT were calculated with CAAS QCA4D prototype software (Pie Medical Imaging, the Netherlands) for sections of the culprit coronary artery using biplane coronary angiograms of fourteen patients undergoing percutaneous coronary intervention for myocardial infarction. Prediction of the artery section containing the culprit lesion was performed using one sample t-testing, generalised linear latent and mixed statistical modelling with grouping by patient, and logistic regression modelling. QCAM was a significant predictor of the location of culprit lesions (p = 0.047). ΔT was not a significant predictor of the location of culprit lesions (p=0.49). QCAM has a role in predicting the location of culprit lesions, and may allow for targeted local therapy to prevent future events.

Sheeza Imtiaz   Muhammad Kashif Shazlee   and Kamran Hameed   

Aortic dissection has an estimated incidence of 2.9 per 100,000 person years in general population. In pregnancy, acute type A aortic dissection has an overall incidence of 0.4 cases per 100,000 person years. In 14-50% of the cases it is associated with Marfan's syndrome. It is a complex clinical scenario, difficult to diagnose and difficult to treat, considering the survival of both mother and fetus. Pregnant women associated with aortic dissection are a special group of patients and a team with multidisciplinary expertise would be important to ensure the best clinical decisions for its treatment. Here in, we present a case of Stanford type "A" aortic dissection along with pulmonary embolism diagnosed in postpartum period in a young patient with Marfan's syndrome.

Yong-quan, Huang   Yin, Huang   Yuling, Wang   Ting, Xie   and Junyong, Han   

Objective: To analyze the relationship between Cystatin C and pulmonary arterial hypertension in patients with idiopathic pulmonary fibrosis. Methods: A clinical cohort of sixty-eight idiopathic pulmonary fibrosis patients and forty normal individuals was established. All the cases were obtained from department of respiratory in the fifth affiliated hospital of Sun Yat-Sen University from May 2009 to May 2017. Data including basic information, Cystatin C, echocardiography parameters of each patients were recorded. Then the serum Cystatin C between the two groups was compared. The correlation between Cystatin C and pulmonary arterial hypertension in patients with idiopathic pulmonary fibrosis was evaluated. Results: The serum Cystatin C level in IPF patients was observed higher than that in normal cases with significant difference (P＜0.001). Patients with increased level of serum Cystatin C had statistical significant higher (P＜0.05) Cystatin C and Echocardiography parameters including RAD, RVDd, PA, velocity of TR, and pulmonary arterial. The Cystatin C serum concentrations were positively correlated with RAD, RVDD, velocity of TR, and pulmonary arterial pressure. Multiple linear regression (stepwise method) analysis showed that the serum Cystatin C was positively correlated with pulmonary arterial pressure with the maximum impact, suggesting that the concentration of serum Cystatin C was one significant factor in PH of PIF patients(P <0.001). Conclusions: The serum Cystatin C level is found to be elevated in IPF patients. The serum Cystatin C concentration in IPF patients was positively correlated with pulmonary arterial pressure. Cystatin C may play a role in patients with IPF and it bears great potential to be exploited as a PH biomarker in IPF patients.

Omamo Eunice A.   

Background: Coronary CT angiography (CCTA) has in the recent past evolved rapidly due to development of sophisticated multi detector row CT (MDCT). The cardinal indication for CCTA is the evaluation of suspected or known coronary artery disease (CAD). Coronary CTA imaging can detect and characterize atherosclerotic plaques. In addition, it can confirm or exclude luminal stenosis. Other applications include identification and assessment of variations in coronary arterial circulation patterns, evaluation of isolated anomalous coronary vessels, by-pass grafts, coronary stents patency and assessment of left ventricular function. Study objective: This study was set to determine the spectrum, pattern and distribution of imaging findings at Coronary CT angiograms as detected by a 320 row MDCT in patients who had undergone coronary CTA. Study design: A cross sectional study. Setting: Plaza Imaging Solutions Limited, Nairobi, Kenya. Subjects: Patients imaged at Plaza Imaging Solutions Limited over a period of 6 months. Materials and methods: Study subjects: Consecutive patients referred for coronary CTA at Plaza Imaging Solutions Limited and met the inclusion criteria. Ethical considerations: Ethical approval and clearance was obtained from the KNH-UON Ethics Review Board. Written and verbal consent was obtained from the participating persons and/or their kin Tools: A two-part data collection form was used to manually record all the relevant data. The information included socio-demographics, clinical and imaging finding of Coronary CTA. A low dose calcium scan and a standard coronary CTA were performed. Each Coronary CTA study was reviewed by a radiologist together with the researcher. Statistical analysis: Data analysis was performed using the Statistical Package for Social Sciences (SPSS) employing relevant statistical tests. The results were presented in form of frequency tables, graphs and charts and discussed accordingly. Statistical significance was set at p < 0.05. Results: During the six-month period, 38 out of a total of 42 scanned patients were recruited into the study. The age distribution ranged from 21 to 89 years with a mean age of 56 years (SD 14.8-19.2). Male to female ratio was 5:4. Chest pain (angina) accounted for the commonest indication for imaging at 63.2%. Risk factors of hypertension and diabetes mellitus were noted in 39.5% of patients. More males reported a co- morbid state of diabetes mellitus (DM-Type II) while more females 50% had hypertension. Overall there were more patients with abnormal scans at 76% than the normal. Atherosclerotic coronary plaque lesions were the most commonly encountered abnormality accounting for 93.1%. The predominant plaque type was the non-calcified plaque seen in 50% of males and 61.5% of females. The total calcium scores (Agatston) ranged from 0 to 242. Calcified plaques were predominantly on the left anterior descending coronary artery (LAD), while the non-calcified plaques were significant on the right coronary artery (RCA). Conclusion: The study demonstrated common occurrence of coronary atherosclerotic plaques in the older age group with lower incidence seen in younger individuals aged less than 40 years of age. It also demonstrated the wide spectrum of luminal effect caused by the atherosclerotic plaques. Furthermore, it demonstrated the paucity of calcified atherosclerotic plaques amongst the local population undergoing coronary CTA highlighting the insignificant nature of coronary calcium score in this setting. Recommendations: Based on the findings and conclusions of this study, a recommendation is made for coronary CTA to be performed in the older age group of > 55 years of age with symptomatic features of ischemic heart disease. Coronary calcium scoring is not necessary in individuals undergoing coronary CTA in this setting (black race) as no correlation is found between total calcium score and atherosclerotic disease burden.

Prashant Kumar Dhakad   Pramod Kumar Sharma   Sokindra Kumar   Ashish Kr. Sharma   Raghav Mishra   and Aditya Dixit   

The cardio protective action of cilostazol, milrinone and their combination effect on myocardial infarction induced by isoproterenol subjected to Wistar rats was done by studying various parameters - heart rate, % infarct size change, LDH level, CPKMB level, ECG pattern. In the following research work effect of synthetic drugs cilostazol, milrinone and their combined effect were studied over various biochemical and cardiac parameters. Isoproterenol was used in inducing myocardial infarction to Wistar rats. Isoproterenol (15 mg/100g) administration, causes an increased levels of biochemical markers-lactate dehydrogenase (2546.25±1.38), creatine phosphokinase (1485.5±.80) in serum of rats indicating potential action of isoproterenol on myocardium. Due to necrosis of myocardium a marked increase of these enzymes was seen in blood. A significant decrease in heart rate (262±.96) in isoproterenol treated rats was observed. Infarct size in ISO group rats (41%±.008) increased to certain extent with promiscuous yellow colored non-viable cells visible indicating infarction. Statistical analysis done by one-way ANOVA followed by the Dunnett's multiple comparison test where ISO control group compared with other groups, p value < 0.001 indicating extremely significant results. The present study demonstrated pharmacological benefits of combination dose of cilostazol, milrinone as evidenced by improvement in heart rate, Lactate dehydrogenase level, Creatine phosphokinase MB level, Electrocardiogram pattern, % infarct size.

Kouame Yao Yves   Okpekon Aboua Timothée   and Yapi Houphouët Félix   

This study aims to evaluate Antihypertensive activity of aqueous and ethanolic extracts of Xylopia villosa stem bark. The induction of hypertension was made with adrenaline on albino rats of wistar strain. Treatments of hypertensive rats with aqueous and ethanolic extracts of Xylopia villosa at doses of 100 and 200 mg/kg bw and Atenolol (the reference molecule) at doses of 10 and 20 mg/kg bw have normalized cardiovascular parameters such as systolic blood pressure, diastolic blood pressure and heart rate. However, these doses all increased the blood concentration of Na⁺ of hypertensive rats. Only treatments with aqueous and ethanolic extracts at a dose of 200mg/kg bw were able to bring blood concentration in K⁺ of hypertensive rats to a concentration equivalent to that of normotensive rats.

Adnan Bashir Bhat   Kazi Ishraque Ahmed   Rubaiya Naushin Sharna   and Sreekanta Barman   

Background and Purpose: Stroke is one of the most commonly encountered neurological emergencies in Tertiary Care Hospitals and is one of the leading causes of death in Bangladesh. Poor knowledge of risk factors, symptoms and appropriate response are possible causes of poor outcome. There are no studies from Bangladesh regarding knowledge about warning symptoms and risk factors amongst stroke patients or their families. We aimed to assess the knowledge, attitude and practice regarding stroke amongst close relatives of stroke patients. Methods: We performed a descriptive cross-sectional questionnaire survey amongst close relatives of acute stroke cases who were admitted under various Medicine units in Shaheed Suhrawardy Medical College & Hospital. Stroke knowledge was excellent if a participant knew (1) at least 2 stroke symptoms (good symptom knowledge) and (2) at least 2 stroke risk factors (good risk factor knowledge), as well as knowing (3) that immediate hospital admission is necessary in case of stroke (good action knowledge). Participants who had studied up to elementary school were considered having lower educational qualification and participants who were under graduates or having higher qualification were considered having higher educational qualification. Results: One hundred and eighty six (186) acute stroke cases were admitted during our study period of which 110 cases matched our criteria and were willing to give informed written consent. Of the 110 participants interviewed, 45 (40.9%) were males and 65 (59.1%) were females. Mean age was 35.2 years (S.D 11.5 years). Good risk factor knowledge was seen in 63.6% while 73.6% had good symptom knowledge and 98.2% had good action knowledge. Stroke knowledge was excellent in 52.7% of subjects. The most common identified stroke risk factor was Stress (n=75, 80.6%) and the most common identified symptom was Weakness/paralysis of one side of body (n=67, 76.1%). Higher educational qualification was associated with good risk factor knowledge (P= 0.009) and excellent stroke knowledge (P= 0.020). Eighty-one (73.6%) participants had never heard about the importance of receiving therapy within the first four and half hours (golden hours) after the onset of symptoms of stroke. Stroke knowledge and perception was not significantly related to other variables of age, sex, religion and income (P >0.05). Conclusions: In this study, in general, there is lack of awareness of major risk factors, warning symptoms, organ involvement, treatment options and the importance of the golden hours. However, higher educational status was associated with better risk factor knowledge and excellent stroke knowledge. Educational strategies to increase stroke knowledge are definitely needed as a prelude to developing preventive programs. By using primary health care resources, public media and organizing health camps, it is possible to promote the level of knowledge, practice and attitude regarding stroke in Bangladeshi population.

Luo Liyun   Li Songbiao   Wang Chengshan   and Lin Xiufang   

Objective: Left ventricular diastolic dysfunction is a common cardiac condition in obese individuals. An updated review and meta-analysis focusing on this issue is lacking, we analyzed the literatures in order to conduct comprehensive information on the left ventricular diastolic function changes, as assessed by echocardiography, associated to obesity. Methods: A literature search using the keywords 'left ventricular diastolic dysfunction', 'diastolic dysfunction', 'obesity', 'obese' 'body mass index' and 'echocardiography' was performed in order to identify relevant papers. Full articles published in English in peer-reviewed journals in past 20 years reporting studies in adult obese individuals were considered. Results: A total of 11 studies including 5171 participants (2764 adults are obese patients) were considered. Obesity was defined as a BMI of ≥30kg/m².Meta-analysis of selected 11 studies (2764 obesity subjects and 2407 normal weight) found that there is no difference of peak late diastolic mitral flow velocity (A) and deceleration time of early diastolic flow wave (DT) between the two groups, while other related parameters such as peak late diastolic mitral flow velocity (A) and E/A ratio, isovolumic relaxation time (IVRT), early diastolic myocardial velocities (E') and E/E' ratio are significant different between obese individuals and non-obese controls, the values of A, IVRT and E/E' were higher in obesity group compared with that of in control group, while the values of E/A ratio and E' were lower in obesity group. Conclusions: Our study shows that left ventricular diastolic dysfunction is present in obese population, Body mass index was found as a significant predictor for DD.

Shahu Ingole   Rishi Jain   and Tushar Tamboli   

The US FDA in 2012 released a safety announcement of risk of cognitive impairment with statin use. However, because this probable adverse event is conflicting with findings of several studies that demonstrate a potential benefit on cognition with the use of statins, we thought to do further analysis to clear the confusion. Reports of statin-associated cognitive impairment were found principally in few observational studies (e.g., case reports/series) and occasionally in few randomised trials. On the contrary, in the majority of observational studies and randomized controlled clinical trials, statins were found to have either a no effects or rather beneficial effect on cognition. However, should it happens, switching from lipophilic to hydrophilic statins such as Rosuvastatin may resolve this issue of cognitive impairment. Therefore, in spite of some concerns of cognitive impairment with statins, the current evidences do not favour the changing practice with respect to statin use, though one needs to be vigilant and address efficiently if it occurs at all.

Yong-quan Huang   Yin Huang   Dan Huang   Mao Liu   Li-yun Luo   and Jian Chen   

Objective: To systematically evaluate the reliability of transthoracic echocardiographic (TTE) measurements of the narrowest diameter in patients with patent ductus arteriosus (PDA) in comparison to angiographic measurements. Methods: We searched articles published between January 1990 to August 2015 that compared diameters of PDA both measured by TTE and angiography in PubMed, Cochrane Library, Wanfang Data database, and CNKI. Two researchers screened the literature, extracted data and assess the quality independently. Weighted mean difference (WMD) and 95% confidence intervals (95% CI) were calculated, heterogeneity was evaluated, and publication bias was estimated. The correlation coefficients of the narrowest PDA diameter measured by echocardiography and angiography were merged by RevMan 5.2 and Stata 12.0 software. Results: 11 articles involving 870 patients are included. Meta-analysis demonstrated that measurement values of the minimum inner diameter by TTE were greater compared to angiography measurements (WMD = 0.86,95% CI: 0.71 ~ 1.02, P <0.001). Echocardiographic and angiographic measurements correlated closely with each other (R = 0.75,95% CI: 0.52 ~ 0.97). There was no evidence of publication bias. Conclusions Measurement of the minimum inner diameter of PDA by TTE has value for both the selection of therapeutic strategy and the PDA occluder model. Nevertheless, echocardiography overestimates minimum diameter in comparison to angiography.

Jian Chen   Shaoxin Zheng   Huibao Long   and Tong Wang   

Objective: To investigate whether cardiac stem cells (CSCs) can attenuate oxidative stress and improve sympathetic remodeling in rats following myocardial infarction (MI). Methods: Sprague-Dawley rats were randomly divided into three groups: 1) MI with CSCs transplantation (CSCs group, n=15); 2) MI control (Control group, n=15); 3) sham control group (Sham group, n=10). Two weeks after surgery, the animals were subjected to intramyocardial injection. Four weeks after injection, left ventricular function, level of oxidative stress, cardiac nerve sprouting and nerve growth factor (NGF) expression were determined. Results: At 4 weeks after intramyocardial injection, fractional shortening (FS) and left ventricular ejection fraction (LVEF) markedly decreased in CSCs and control groups. However, systolic function were partly preserved in CSCs group compared with control group (P<0.01). The myocardial malondialdehyde (MDA) content, MDA/Superoxide Dismutase (SOD) ratio, NGF expression and density of tyrosine hydroxylase (TH)-positive nerve in peri-infarct zone was significantly increased in the control group and CSCs group than the sham group (all P<0.01). However, all of these valuables were decreased in CSCs group when compared with control group (all P<0.01 except for NGF expression P< 0.05). Furthermore, a positive correlation was observed between the degree of sympathetic remodeling and the level of MDA/SOD ratio (r=0.86, R²=0.75). Conclusion: CSCs suppressed sympathetic remodeling after MI probably via attenuated oxidative stress and downregulated NGF expression, which in turn leads to a promising treatment for SCD post MI.

N.V. Sviridova   and V.D. Vlasenko   

The paper presents results of blood flow parameters numerical simulation in the coronal vessels of the left coronary artery. Described mathematical model characterizing the hemodynamics of the coronary artery blood vessels allows the simulation of blood flow parameters changes in the coronal vessels subjected to bypass surgery. On the basis of this model blood flow parameters of linear and sequential bypasses types were calculated and compared.

Ouseph, B   Mohidin, S   Tabsh, L   and Al-Hebshi, A   

Introduction: This paper discussed nurses' resuscitation trainings and their performance in a teaching hospital based on AHA guideline recommendations. The study explored the current standard practices and investigates the nurses' views on the effectiveness of the training, quality of equipment, familiarity and readiness of nurses in performing resuscitation. Methodology: A cross-sectional descriptive study conducted at teaching hospitals which mandate all nurses must be certified with the BLS and attends two code blue drill sessions per year. A self-administered questionnaire examined the support and guidance provided, the availability of resuscitation equipment and their quality/familiarity, the quality of training received in performing the resuscitation actions and finally explored the opinion in improving resuscitation. Results: The study revealed that the organization has established system to prepare the nurses adequately. Based on the 192 nurses, the total mean 2.63 supported that nurses are adequately trained with resuscitation knowledge and skills, 95% (n=171) of nurses were confident in announcing the code blue procedure, 93.3% (n=169) received appropriate training and 90% (n=162) found training instructors utilized standard method of simulation training which 90% (n=161) shared a real-life clinical scenarios are used in the training whilst 90.5% (n=162) stated SBAR is utilized as mode of communication and 66.6% (n=120) practiced post-procedure resuscitation debriefing. However, concerns were raised in three areas: availability of AEDs, cable and pad accessibility and permission to perform defibrillation procedures. In conclusion, study established nurses were well-prepared, trained and supported for resuscitation care.

Matllooba Al-Zadjali   

Introduction: To report a case of vasovagal syncope due to topical carbonic anhydrase inhibitors (Brinzolamide) this is one of the option used for treatment of glaucoma. Methods: Case report. Results: A 74 year old man was referred for tilt table testing for syncope. Symptoms coincided with commencement of brinzolamide eye drops and resolved with its cessation. Conclusion: To the authors' best knowledge, this is the first report of carbonic anhydrase inhibitor eye drops causing syncope.

Bairong Chen   Mao Liu   Liyun Luo   Yin Huang   Ani Wang   Xiufang Lin   and Songbiao Li   

Essential thrombocythemia (ET) is a proliferative disorder of mature myeloid which may lead to persistently elevated platelet count. The clinical manifestations of ET include hemorrhagic and thrombotic complications, especially thrombus in the cerebral and peripheral arteries. However, coronary artery thrombosis in ET patient is rare. In this article, we report a 78-year-old woman who presented with acute myocardial infarction (AMI) as the first clinical sign of ET. Diagnostic coronary angiography revealed acute occlusion of the right coronary artery and percutaneous aspiration thrombectomy was performed successfully. The patient then received hydroxycarbamide and prednisone under supervision of a haematologist. She recovered very well during a follow-up more than three months. With this case, we hope that clinicians would always keep in mind that ET is an unusual cause of AMI and the patients with ET should be informed about the risk of fatal cardiac events.

Rajshekhar I Koujalgi   Prem Krishna Anandan   Harsha Basappa   and Cholenahally Nanjappa Manjunath   

An inadvertent puncture during PTMC in the region where right atrium (RA) and left atrium (LA) have overlapping walls may lead the catheter/needle to perforate the right atrial wall, enter the pericardial space and then enter the LA leading to "stitching phenomenon". We describe a case of cardiac perforation resulting in cardiac tamponade during PTMC due to stitching phenomenon, promptly recognized and managed, completed PTMC and referred to surgery for cardiac perforation repair.

Rajshekhar. I. Koujalgi   Prem Krishna Anandan   Beeresha   B. Ramesh   Nagmani A C   and C N Manjunath   

Surviving a Left Main coronary artery (LMCA) total occlusion depends upon the presence of well-developed collaterals. We report a 44 year male patient, with past history of Ischemic heart disease, who underwent Angioplasty to Left Anterior Descending Artery (LAD) in 2009, and presented with Acute Coronary Syndrome (ACS)-Non ST Elevation of Myocardial Infarction (NSTEMI). Subsequently, cardiac catheterization revealed a total occlusion of the LMCA with dominant right coronary artery (RCA) giving collaterals to the left coronary arteries. The patient was immediately referred for coronary artery bypass surgery (CABG) and was symptom free on follow up. This case demonstrates the power of collateral circulation in protecting the patient from symptoms and death despite total occlusion of the LMCA.

Prem Krishna Anandan   Patel Jigarkumar shukkarbhai   Prabhavathi   Cholenahally Nanjappa Manjunath   and Dhanalakshmi. C.   

Aortic root abscess is one of the dreaded complications of aortic valve infective endocarditis. It carries a very high morbidity and mortality. Early diagnosis and surgical treatment is the main key. Echocardiography aids in early detection of this complication. We report a 22 year old male patient of bicuspid aortic valve with native aortic valve endocarditis complicated with formation of aortic root abscess and severe aortic regurgitation(AR) through an Left ventricular outflow tract(LVOT) tunnel.

Michiyasu Yamaki   Toshiaki Sato   and Hiromi Fujii   

An RR-interval fluctuation has been used as an important clinical tool for identifying a patient at risk in cardiovascular disease. However, the role of hypoxia on RR-interval fluctuations has not been determined. Methods and Results. We performed ambulatory ECGs monitoring and measured overnight arterial oxygen saturation (SpO₂) in 26 patients with obstructive sleep apnea syndrome in whom sever hypoxia occurred during sleep. By means of maximal entropy method, time series of ECG-RR intervals were transformed into frequencies. The minimal SpO₂ during sleep were compared with spectrum powers of the following frequency ranges; 1) 0.0001 - 0.05 Hz, 2) 0.05 - 0.1 Hz, 3) 0.1 - 0.15 Hz, 4) 0.15 - 0.2 Hz, 5) 0.2 - 0.25 Hz, 6) 0.25 - 0.3 Hz, and 7) 0.3 - 0.5 Hz. Among the seven analyzed frequencies, the increase in the 0.05 - 0.1 Hz power of RR-interval fluctuations was linearly correlated with the minimal SpO₂ during sleep (r=.80, p<.001). Conclusion. This study revealed that hypoxia contributes to 0.05 - 0.1 Hz RR-interval fluctuations in patients with obstructive sleep apnea syndrome. RR-interval fluctuations will provide important information about hypoxia.

Dan Huang   Jianting Ke   Anzhu Zhao   Zhisheng Yang   Diefei Liang   Jing Pan   Mao Liu   and Jian Chen   

Objective: To assess the efficacy of isoproterenol (ISO) in the establishment of chronic heart failure (CHF) and cardiac remodeling model in rats. Methods: Twelve Wistar rats were randomly divided into two groups: control group (n=3) and model group (n=9). Rats in model group were hypodermic injected with ISO 5mg/kg/d for 10 days. Ultrasonic cardiogram, HE staining，immunohistochemistry of collagen Ⅰ and Masson staining were performed to evaluate the cardiac function and myocardial fibrosis. Besides, ventricular mass/body mass ratio, collagen volume fraction (CVF), perivascular collagen area (PVCA), hydroxyproline (HYP) concentration and relative expression of transforming growth factor β1 (TGF-β1) mRNA were also detected. Results: Compared to the controls, rats in model group had a marked enlargement of cardiac dilatation and reduction of ejection fraction (57.00±3.61% vs. 44.67±3.06%, P=0.011). Ventricular mass/body mass ratio (3.60±0.31 vs. 4.88±0.34, P=0.020), CVF (5.65±0.68% vs. 27.62±4.89%，P=0.020), PVCA (11.22±3.40% vs. 28.50±4.52%, p=0.001) and HYP level (0.24±0.08μg/mg wet weight vs. 0.62±0.11μg/mg wet weight, P=0.001) were significantly increased in model group. Remarkably cardiac fibrosis were also observed in the Masson staining and immunohistochemistry. The expression of TGF-β1 mRNA was increased significantly in the model group (P=0.003). The mortality rate in the model group was 33.3% during the whole procedure. Conclusion: ISO can successfully induce a CHF and cardiac remodeling rat model with a low mortality rate.

Henry Chen   Timothy Fritz   Preeti Banga   David Wohns   Stephen Cohle   and Sandeep Banga   

Nonbacterial thrombotic endocarditis (NBTE) is rare and undoubtedly an under-recognized cause of cryptogenic stroke. Its diagnosis relies on a high index of clinical suspicion, particularly in patients with previous malignancy. We present a case of a young woman, with three neurologic events occurring in rapid succession over three weeks, ultimately resulting in her death. The echo imaging findings here appear relatively benign compared to the catastrophic consequences, and speaks of the aggressive fibrin and platelet deposition that can embolize widely in this condition, confirmed on the postmortem examination. We discuss the details of NBTE aiming to increase awareness while assessing patients with undetermined systemic embolization.

Aiden O’Loughlin   Samia Kazi   John K French   David AB Richards   A Robert Denniss   and Annemarie Hennessy   

Background: Coronary artery motion may contribute to the development of plaques that rupture and cause acute myocardial infarctions. This study evaluates whether a quantitative measure of the compression type of coronary artery motion obtained from analysis of coronary angiograms can predict the location of culprit lesions in patients who have subsequent myocardial infarction. Method: 28 patients were identified with coronary angiography performed on at least two occasions: related to primary or rescue percutaneous coronary intervention for a STEMI and coronary angiography before this that was available for review. These angiograms were used to determine a quantitative index of coronary artery motion (QCAM) (the ratio of the section lengths i.e. systolic length/diastolic length). The culprit section was subsequently identified and QCAM of this section was compared to non-culprit sections. Results: The two samples t-test comparing QCAM for the non-culprit and culprit sections was highly statistically significant with a p-value of 0.0004. The generalized linear mixed model with culprit section as the dependent variable and QCAM as the independent variable also showed a statistically significant result with a p-value of 0.026. Conclusion: QCAM is a predictor of the location of culprit lesions causing future ST segment elevation myocardial infarctions. Predicting the location of future culprit lesions using coronary angiography may allow targeted therapy to prevent myocardial infarctions.

Katelin Gresty   Celena Scheede-Bergdahl   and Andreas Bergdahl   

Despite growing popularity of carbohydrate restricted diets, consequences of long term use remain unknown. The current study evaluated the effects of low carbohydrate/high fat (LCHF) diets on heart size and cardiac glycogen content in young mice. Young mice (age 21 d, n = 24) and mature mice (age 84 d, n = 18) were placed on either a LCHF, a western (WD) or a control diet for 12 weeks. Upon completion of the dietary intervention, heart wet weights were measured to compute the weight-to-tibia length ratio. Sections of cardiac tissue were stained with periodic acid and Schiff reagent to visualize glycogen. Mice following the LCHF diet displayed smaller heart weight-to-tibia length ratio when compared to controls. The trend was observed in both young (p = 0.012) and mature (p = 0.024) mice. Cardiac tissue from mice consuming the LCHF diet had a reduced percentage of total area stained positive for glycogen when compared to mice following the WD diet (p = 0.016). This study shows that a LCHF diet reduces heart weight in young and mature mice. Alterations in intercellular cardiac glycogen content may contribute to differences observed in heart weight. LCHF diets should be recommended with caution as long term effects on the heart are unknown.

Tomoki Kitawaki   Hisao Oka   Shinichi Usui   Satoshi Hirohata   and Shozo Kusachi   

In this paper, we introduce a new estimation method for total creatine phosphokinase release based on a physiological model of the serum creatine phosphokinase (CPK) activity change that can be used to estimate the total CPK release accurately, as early as possible, without frequent blood sampling. The physiological model and a new calculation method were applied to the serum CPK activity change of patients who suffered acute myocardial infarction (AMI). According to the results, the physiological model showed good agreement with the serum CPK activity change and the estimated value of the total CPK release also agreed well with that calculated using the conventional technique with clinically acceptable accuracy.

Jubal R. Watts Jr.   Daniel J. Dauer   Naomi S. Fineberg   Matthew Budoff   and Hrudaya Nath   

Coronary artery calcification (CAC) is a well-known marker of subclinical coronary atherosclerosis, which is always detectable in non ECG-gated routine chest CT examinations, and its visual estimation is correlated to clinical outcomes. Agatston scoring is not routinely performed on these examinations. We sought to validate a visual scoring scheme we derived against ECG-gated CT’s and compare our system with another previously published visual scoring scheme in a different cohort of lung cancer screening participants. 50 COPDGene participants received, regular dose full inspiration (non-gated high mA), and low dose expiration CT (non-gated low mA) and ECG-gated CT’s at the same time. CAC was visually scored by 3 readers using our total visual scoring (TVS) method and compared to the Agatston score. The second portion of the study involved visual and Agatston scoring of a larger sample of 198 lung cancer screening patients, comparing visual scoring described by Shemesh et. al. and our TVS method. For the COPDGene participants, scores were highly correlated among readers (all ICC≥0.92), between the ECG-gated CT, non-gated high mA CT, and the non-gated low dose CT (all p<0.001), and with the Agatston score (all ICC≥0.90). For the cancer screening cohort there was very good agreement of our system and Shemesh scores. Correlations between reader scores, our system, Shemesh scores, and Agatston scores were also very good, ranging from 0.81-0.96. We derived cutoff values corresponding to Agatston risk quartiles for our system and Shemesh. There was excellent correlation of visual scoring with Agatston scoring on ECG-gated and non-gated CT. In lung cancer screening CT’s both ours and Shemesh visual scoring correlated well with Agatston scores and with each other. Visual scoring may predict clinically significant CAC in major Agatston categories.

Y. E. Ravovsky   

Background: Hypertension (HTN) is reported to be the leading contributor to premature death globally. It was repeatedly emphasized that excessive alcohol intake (binge drinking) is an independent risk factor for HTN. Recent research evidence suggests that the consumption of different types of alcoholic beverage may have a differential effect on HTN disease rate. Objective: The aim of this study was to examine the relation between the consumption of different beverage types and HTN mortality rates in Russia. Method: Time-series analytical modeling techniques (ARIMA) were used to examine the relation between the sales of different beverages and age-standardized sex-specific male and female HTN mortality data for the period 1980-2005. Results: Vodka consumption as measured by sales was significantly associated with both male and female HTN mortality rates: a 1 litre increase in vodka sales would result in a 10.8% increase in the male HTN mortality rate and 9.1% increase in the female rate. The consumption of beer and wine were not associated with HTN mortality rates. Conclusions: The present study suggests that HTN mortality tends to be more responsive to changes in spirits consumption per capita than to the wine or beer consumption. The findings from this study also suggest that public health efforts should focus on both reducing overall consumption and changing beverage preference away from distilled spirits in order to reduce cardiovascular mortality rates in Russia.

Aiden JC O’Loughlin   Linda Tang   Daniel Moses   Wisdom Tong DiagRad   John K French   David AB Richards   A. Robert Denniss   and Annemarie Hennessy   

Background: We describe a novel quantitative index of coronary artery motion (QCAM) from multislice computed tomography (MSCT) and test its association with the location of coronary artery disease. Methods: 25 patients with known or suspected coronary artery disease underwent ECG-gated MSCT. The coronary artery images were divided into 150 sections using landmarks that could be identified at time points at end-diastole and end-systole. QCAM was derived from the change in centerline length of the coronary sections between these time points. Plaques were identified and classified by type and severity of stenosis. Results: The mean QCAM was significantly less in the coronary sections with plaque (94.3%+/-8.1%) than those without (99.0%+/-10.2%) (p=0.023). There was a significant correlation between QCAM and plaque stenosis (Spearman’s rank correlation coefficient, ρ= -0.192, p=0.018). The correlation between QCAM and plaque type approached statistical significance (Spearman’s rank correlation coefficient, ρ= -0.156, p=0.057). Sensitivity, specificity, positive and negative predictive values for the identification of coronary plaque within a section for QCAM <100% were 80%, 46%, 27% and 90% respectively. Conclusions: QCAM is a novel quantitative measurement of coronary artery motion that correlates with the location of coronary artery disease. Quantitative evaluation of coronary artery motion provides a new approach to understanding the biomechanics of coronary artery disease.

Muhammad Asghar Nawaz   A. Javed   P. Curry   and A. Murday   

Smoking cessation intervention is a cost effective method of preserving life and reducing ill health and is believed to be the most effective lifestyle change after a myocardial event. The pre-operative period is particularly useful time to implement smoking cessation advice and to offer help. Smokers undergoing surgery have an increased risk of both intra and post-operative complications. Nearly a six-fold increase in post-operative pulmonary complications in current smokers was demonstrated in a study. There is much debate over the optimum time to stop smoking to reduce post-operative complications. The effects of smoking cessation prior to surgery may be dependent on the length of time cessation occurred before surgery. Our study investigates the smoking profiles of patients awaiting cardiac intervention for ischaemic heart disease and what advice and help these patients are offered. All patients randomly selected had established diagnosis of ischaemic heart disease needing cardiac intervention; either coronary artery graft bypass or angioplasty. This study shows different trends in methods used to successfully give up smoking in the ex-smoking group compared to the methods used in attempting to give up in the smoking group. Smoking cessation advice and the offer of additional services can never be more important in the time prior to cardiac surgery

Youfu Ke    Chun Xiang Li    Junxian Zheng   and Jinbao Pu   

Objective: To evaluate the efficacy and safety of wuling powder and modified tianma gouteng decoction as an add-on therapy for treating essential hypertension (EH). Methods: 116 cases of EH patients took wuling powder and modified tianma gouteng decoction for 2 weeks to treat EH without changing their former medication. New York Heart Association (NYHA) heart function classification, heart rate, blood pressure and 6-minute walking test were evaluated before and after treatment. Results: Wuling powder and modified tianma gouteng decoction decreased the EH patients’ heart rate, systolic pressure, diastolic pressure and increased the 6-minute walking distance very significantly (P<0.01). The total effective rate on blood pressure was 92.2%, and the total effective rate on NYHA heart function improvement was 95.1%. No serious side effect appeared. Conclusion: From this study, treating EH with wuling powder and modified tianma gouteng decoction as an add-on therapy seems to be effective and safe.

John Petrella Dalton Wolfe and Robert Petrella 

Inflammatory arthritis has been identified as a source of increased risk of cardiovascular disease (CVD) and patients with inflammatory arthritis face higher mortality compared to the general population. Hence, patients with inflammatory arthritis may require management of CVD that is different from the general population. Exercise has been described as a primary strategy for CVD risk management in the general population. However, it is unclear whether the presence of inflammatory arthritis and CVD risk factors requires different approaches to CVD risk management and in which aspects risk is changed (clinical or physiological). We conducted a scoping review of the literature to determine the association between inflammatory arthritis and CVD risk factors including prevention and treatment; specifically exercise treatment. Medical literature extracted using the databases SPORTDiscus, SCOPUS, and PUBMED, to determine the effect of exercise on the relationship between inflammatory arthritis and CVD was sought. We found 64 articles with relevant abstracts of studies and followed that by independent review by 2 reviewers. The majority of studies were excluded if the abstracts addressed an irrelevant study population, addressed only one of cardiovascular disease or inflammatory arthritis in isolation, did not provide a study design, or were lacking a complete abstract.

Y. E. Razvodovsky 

Background: Stroke is an international health problem with high associated human and economic costs. Stroke burden is expected to be rising, especially in developing countries. The mortality rate from stroke in Russia is one of the highest in the world. Epidemiological evidence suggests that binge drinking is an important determinant of high stroke mortality rate in Russia. In line with this evidence we assume that devastating combination of higher level of alcohol consumption per capita and binge drinking of vodka results in a close association between binge drinking and stroke mortality at the aggregate level in Russia. This paper was design to estimate the aggregate level effect of binge drinking on stroke mortality rate in Russian. Method: Trends in age-adjusted, sex-specific stroke mortality and fatal alcohol poisoning rate (as a proxy for binge drinking) from 1965 to 2005 were analyzed employing a distributed lags analysis in order to asses bivariate relationship between the two time series. Results: The results of the time series analysis indicates the presence of a statistically significant association between the two time series at zero lag for male (r = 0.76; S.E. = 0.17), and for female (r = 0.64; S.E. = 0.17). Conclusion: The results of present study support the hypothesis that alcohol played a crucial role in cerebrovascular mortality fluctuation in Russia over the past decades. This study also indicates that substantial proportion of stroke deaths in Russia is due to acute effect of binge drinking. The findings from the present study have important implications as regards cerebrovascular mortality prevention indicating that a restrictive alcohol policy can be considered as an effective measure of prevention in countries where higher rate of alcohol consumption and binge drinking pattern.

Kalpana  Saini M. L. Dewal and Manojkumar  Rohit 

It is to be investigated and verified that vena contracta width (VCW) obtained from color Doppler images and effective regurgitant orifice area (EROA) obtained from the VCW is capable of quantifying the severity of mitral regurgitation (MR). A mathematical expression has been developed between VCW and EROA. Vena contracta width is an efficient method for grading the severity of MR, but it is very difficult to locate this narrowest part exactly in transthoracic echocardiography as well as in transesophageal echocardiography. So, indeed, there is a need to develop a method which is capable of finding out the vena contracta width. A comparison has also been made between the results obtained using the proposed computing method and the results obtained by the clinicians, manually. For this analysis have been done from the results obtained with automatic VCW finding method and with clinical data for severity grading.

Sherryl  Gaston and Sarahlouise  White 

Aims: To examine compliance with Venous Thromboembolism clinical practice guidelines by health professionals and to identify barriers and facilitators in the acute healthcare setting. Background: Clinical practice guidelines for venous thromboembolism prevention are widely available, however not all patients with identifiable risk factors are receiving appropriate assessment or prophylaxis in the acute care setting. Design: Joanna Briggs Institute comprehensive systematic review methodology was utilised. Data Sources: A comprehensive, three-stage search strategy was conducted across six major databases. Review Methods: Retrieved papers were critically appraised by two independent reviewers prior to inclusion using standardised critical appraisal instruments. Results: Eighteen quantitative and two qualitative studies assessed compliance with venous thromboembolism clinical practice guidelines, and reported on facilitators and barriers to that compliance. Quantitative data was pooled using narrative summary due to heterogeneity of reporting. Qualitative data was aggregated using a process of meta-aggregation to generate synthesised findings based on similarity of meaning. Overall, nine barriers and nine facilitators were identified Conclusion: This systematic review has drawn together quantitative and qualitative data that highlights barriers to compliance and recommends that if an intervention is developed with these in mind they can improve compliance with clinical practice guidelines.