Electrocardiographic evidence of left ventricular hypertrophy (LVH) was diagnosed in 95 of 1,174 patients with acute myocardial infarction (AMI) (8%) receiving thrombolytic therapy, and was ...associated with a lower, although not statistically significant, mortality (3% vs 5%, p=0.38, odds ratio 0.45, 95% confidence interval 0.12 to 1.79), but with an increase in the risk of death at 1 year (16% vs 8%, p=0.014, odds ratio 1.96, 95% confidence interval 0.97 to 3.78).
Patients in cardiogenic shock (CS) or with terminal heart failure (THF) are at imminent risk of death while waiting for heart transplantation (HTx). Implantation of left or bi-ventricular assist ...device (LVAD/BiVAD) as a bridge to HTx may save many of these doomed patients' lives.
Between March 1994 and December 2006, 29 terminally ill patients (age 2.5-65 years, mean 48 years) underwent VADs implantation as bridge to HTx. The HeartMate VE LVAD was used in 18 patients, Thoratec pneumatic BiVAD in 7, Berlin Heart Excor BiVAD in one, and HeartMate II axial flow, Thoratec pneumatic and Biomedicus centrifugal LVADs in one each. Indications for VADs implantation were CS in 16 patients (55%) and intractable THF in 13 pts (45%). Etiologies were ischemic in 20 patients, idiopathic dilated, myocarditis and congenital in 2 patients each, and valvular, post partum and HTx graft vasculopathy in one patient each.
Seventeen patients (59%) survived VADs implantation and underwent HTx or are ongoing. Mean survival on VADs was 72 days (range 1-353 days, total 5.2 patient years). Seven patients (24%) were discharged home while on LVAD support for a mean of 146 days. Nine of the transplanted patients (64%) were discharged home. In 4 LVAD patients the cause of death was RV failure necessitating later implantation of RVAD.
VADs implantation as bridge to HTx in CS or THF saves many of these doomed patients, sometimes providing quality out-of-hospital life while waiting for HTx. Early recognition of RV failure and liberal use of BiVAD is important.
Platelet adhesion and aggregation are mediated by specific platelet membrane glycoproteins GPla/IIa, GPlb alpha, and GPIIb/IIIa, and are essential steps in thrombus formation and development of acute ...myocardial infarction.
To evaluate the risks exerted by each of the following polymorphisms in young males with AMI: HPA-1a/b in GPIIIa: 807C/T in GPIa; and HPA-2a/b. VNTR and Kozak C/T in GPlb alpha.
We conducted a case-control study of 100 young males with first AMI before the age of 53 and 119 healthy controls of similar age. All subjects were tested for the above polymorphisms.
The allele frequencies of each of the platelet polymorphisms were not significantly different between the young man with AMI and the controls. Smoking alone was associated with a 9.97-fold risk, and the presence of at least one metabolic risk factor resulted in a 2.57-fold risk of AMI.
The platelet glycoproteins polymorphisms studied are not an independent risk factor for AMI.
Cheyne-Stokes respiration is a breathing disorder characterized by recurrent central sleep apneas, mainly during sleep, alternating with a crescendo-decrescendo pattern of tidal volume. ...PATHOPHYSIOLOGY AND PROGNOSIS: The pathophysiology of Cheyne-Stokes respiration, involving the cardiovascular, pulmonary and sympathetic nervous systems, is still not well understood. Although 50% of moderate to severe congestive heart failure patients suffer from significant Cheyne-Stokes respiration, studies been undertaken to determine the prevalence of this phenomenon and its implications regarding patients' life expectancy and quality of life were conducted only in recent years. Other studies suggest that Cheyne-Stokes respiration has a negative prognostic value upon congestive heart failure patients.
Novel therapeutic approaches have been attempted in order to treat Cheyne-Stokes respiration; they include oxygen delivery, various pharmaceutical treatments aimed to stabilize the ventilatory system and other pharmaceutical treatments aimed to improve the left ventricular ejection fraction. However, none of them was effective.
This review summarizes some of the current knowledge regarding Cheyne-Stokes respiration pathophysiology, prevalence, prognostic implication and available treatments.
The shortage of available donor hearts limits the number of cardiac transplantations worldwide and in Israel as well. This organ shortage results in 15%-20% annual mortality of heart transplant ...candidates. For the sub-group of hospitalized decompensated heart failure patients depending on continuous inotropic support (Status I), the annual mortality is over 50%. Suboptimal utilization of donor hearts has been one of the reasons for the organ shortage. In 2004, only 42% of the potential donor hearts in Israel were eventually transplanted. The objective of this report is to define guidelines regarding the suitability of potential cardiac donors allowing more liberal criteria for accepting borderline donor hearts. Implementing the new guidelines will permit the utilization of organs that otherwise would have been discarded.
Cheyne-Stokes breathing (CSB), which is a prevalent finding in congestive heart failure (CHF) patients, has been shown to be of prognostic value. The oscillations in respiration were shown to be ...associated with oscillations in sympathetic nerve activation. We tested the hypothesis that the peripheral arterial tone (PAT) as measured by a novel finger plethysmograph can be used to detect CSB. Using a novel technique to measure the PAT, we monitored 10 patients with advanced CHF simultaneously with conventional polysomnographic recordings for either 1 or 2 nights. Records were scored for CSB during 3-min periods based on either respiratory effort and nasal-buccal airflow or on the PAT signal alone. The PAT sensitivity and specificity for the detection of periods containing CSB were 91 and 91% for the entire recording, 90.7 and 92.9% for non-REM sleep, 90.7 and 70% for REM sleep, and 73 and 97.3% for awake periods, respectively. PAT is a reliable marker of CSB in CHF patients. The novel finger plethysmograph can be used for screening and monitoring CSB.
BACKGROUND Despite the prothrombotic and proinflammatory effects associated with elevated homocysteine levels, only limited data exist regarding the effect of homocysteine levels on outcome of ...patients with acute myocardial infarction. METHODS Homocysteine levels were determined within 24 hours of presentation in 157 consecutive patients with acute myocardial infarction. Patients were allocated to 2 groups: those with homocysteine levels of 2.7 mg/L (20 µmol/L) or more (n = 22 14%) and those with homocysteine levels of less than 2.7 mg/L (n = 135 86%). RESULTS Female and diabetic patients had significantly lower homocysteine levels than males (P<.01) and nondiabetic patients (P = .005), respectively, with no significant correlation with age (r = 0.07, P = .42) or other risk factors. Patients with homocysteine levels greater than or equal to 2.7 mg/L and less than 2.7 mg/L did not differ significantly regarding extent of coronary artery disease as reflected by prevalence of multivessel disease (54% vs 61%; P = .87), and their in-hospital course. However, in a mean ±SD follow-up of 30 ± 10 months, patients with homocysteine levels greater than or equal to 2.7 mg/L had a higher incidence of recurrent coronary events (36% vs 17%; P = .04) and death (18% vs 5%; P<.05). Homocysteine levels greater than or equal to 2.7 mg/L remain a significant determinant of recurrent coronary event and/or death after controlling for potential cofounders by multivariate analysis (odds ratio, 3.8; 95% confidence interval, 1.3-11.0). CONCLUSIONS In patients with acute myocardial infarction, elevated homocysteine levels are associated with a higher risk of recurrent coronary events and death, independent of other risk factors and the extent of coronary artery disease.Arch Intern Med. 2003;163:1933-1937-->
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