Ruxolitinib is a highly potent
JAK2
inhibitor approved for the treatment of myelofibrosis (idiopathic or post-polycythemia vera or post-essential thrombocythemia) and, more recently, for polycythemia ...vera with an inadequate response to or intolerant of hydroxyurea. The most common adverse events of ruxolitinib include immunosuppression with an increased risk of reactivation of silent infections and increased non-melanoma skin cancer. The known neurological side effects of ruxolitinib are dizziness and headache, but no neurological paroxysmal episodes have been recorded. This report deals with an 80-year-old outpatient woman with polycythemia vera turned into myelofibrosis who experienced neurological episodes of hypoesthesia and weakness of right arm and leg during ruxolitinib treatment.
Methods We performed an updated systematic review and study-level meta-analysis of randomized controlled trials (RCTs) that investigated the efficacy and safety of TRA versus TFA for PCI in patients ...with ACS.
Percutaneous left atrial appendage (LAA) closure is currently utilized for the prophylaxis of thromboembolic cerebrovascular accidents in patients with non-valvular atrial fibrillation. The presence ...of LAA thrombus is usually considered a contraindication for the procedure, since there is a high risk of thrombus embolization. While reports in the literature have shown the feasibility of LAA closure in the presence of LAA thrombus with certain cerebral embolic protection devices, we present the first-in-man LAA closure of a patient with LAA thrombus using the TriGuard Embolic Protection Device.
This study aimed to characterize myocardial infarction after percutaneous coronary intervention (PCI) based on cardiac marker elevation as recommended by the new universal definition and on the ...detection of late gadolinium enhancement (LGE) by cardiovascular magnetic resonance (CMR). It is also assessed whether baseline inflammatory biomarkers are higher in patients developing myocardial injury.
Cardiovascular magnetic resonance accurately assesses infarct size. Baseline C-reactive protein (CRP) and neopterin predict prognosis after stent implantation.
Consecutive patients with baseline troponin (Tn) I within normal limits and no LGE in the target vessel underwent baseline and post-PCI CMR. The Tn-I was measured until 24 h after PCI. Serum high-sensitivity CRP and neopterin were assessed before coronary angiography.
Of 45 patients, 64 (53 to 72) years of age, 33% developed LGE with infarct size of 0.83 g (interquartile range: 0.32 to 1.30 g). A Tn-I elevation >99% upper reference limit (i.e., myocardial necrosis) (median Tn-I: 0.51 μg/l, interquartile range: 0.16 to 1.23) and Tn-I > 3× upper reference limit (i.e., type 4a myocardial infarction MI) occurred in 58% and 47% patients, respectively. LGE was undetectable in 42% and 43% of patients with periprocedural myocardial necrosis and type 4a MI, respectively. Agreement between LGE and type 4a MI was moderate (kappa = 0.45). The levels of CRP or neopterin did not significantly differ between patients with or without myocardial injury, detected by CMR or according to the new definition (p = NS).
This study reports the lack of substantial agreement between the new universal definition and CMR for the diagnosis of small-size periprocedural myocardial damage after complex PCI. Baseline levels of CRP or neopterin were not predictive for the development of periprocedural myocardial damage.
Abstract The completely absorbable stents represent one of the latest innovations in the field of interventional cardiology, prospecting the possibility of “vascular repair”. In the published trials ...(ABSORB Cohort A and B, ABSORB EXTEND, and ABSORB II, III and IV) chronic total occlusions (CTOs) were considered an exclusion criteria. More recently the CTO-ABSORB pilot study demonstrated the safety and feasibility of bioresorbable vascular scaffold (BVS) use in case of CTO recanalization. We present the first case, to our knowledge, of in-stent occlusion successfully treated with an everolimus-eluting BVS and discuss its potential advantages in such kind of lesions.
Abstract Although the rate of procedural complications during transcatheter aortic valve implantation has decreased due to technological advancement and increased operator experience, device ...embolization remains a rare but potentially fatal complication, even with new generation device. Here we report the first case of Portico (St. Jude Medical, Minneapolis, MN, USA) valve migration in spite of apparent optimal initial implantation depth, which was retrieved using a novel strategy and further to failure of traditional retrieval technique. We also describe a mechanism of left coronary artery systolic perfusion with diastolic back-flow leading to myocardial ischemia.
Acute coronary syndromes have been described as potential complications of any type of anaphylactic reaction. The real pathogenic mechanism inducing acute myocardial ischemia in the setting of ...anaphylaxis is not yet completely understood. Some pathogenic mechanisms, like coronary vasospasm, plaque activation and systemic hypotension, have been suggested. The hypothesis of a central role of mast cell and inflammatory cell activation and release of potent vasoactive mediators, inducing the mechanisms mentioned above, is the mainstay of so-called "cardiac anaphylaxis". We report two cases of anaphylaxis-induced acute ST-segment elevation myocardial ischemia which occurred during coronary angiography. The first one was probably related to contrast media contact, the second one to latex glove contact. Both of them were treated with percutaneous coronary intervention that immediately resolved the myocardial ischemia.
Background: Left bundle branch block (LBBB) is associated with impaired left ventricular (LV) function and increased morbidity and mortality, especially in patients with structural heart diseases. ...The mechanisms are poorly understood. Subjects and Methods: Subjects with isolated LBBB (n = 20), right bundle branch block (RBBB, n = 20), and controls (C, n = 20) were studied with standard two‐dimentional (2D), and color‐encoded tissue‐Doppler echocardiography (TDE). Inter‐ and intraventricular systolic and diastolic coordination were assessed from the TDE velocity profiles. LV function was assessed by 2D echocardiography, by TDE‐derived peak systolic velocities, and the atrioventricular (AV) plane displacement. Results: Subjects with LBBB had longer electromechanical delays and longer isovolumic relaxation times than did the C and RBBB groups (P < 0.001). For the LBBB subjects compared with the RBBB and C groups, ejection times were shorter, peak systolic velocities and AV plane displacements were lower, they had larger LV end‐systolic volumes and lower LV ejection fraction (all P < 0.001), and the atrial contribution to A‐V plane displacement was higher (P < 0.01). There were no differences in diastolic or filling times among the groups. Conclusions: In patients with LBBB, delayed regional electromechanical coupling and uncoupling leads to generalized intra‐ and interventricular asynchrony, thereby explaining the depressed regional and global LV functions. Assessment of the electromechanical coupling and uncoupling processes and their consequences on cardiac function in patients with BBB and structural heart diseases may be possible using TDE.
Transient loss of consciousness initially diagnosed as epileptic seizures and then documented as paroxysmal atrioventricular block. Cardiac resynchronization and defibrillator therapy guided by a ...multimodality approach.
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