Cardiovascular Medicine

3 pages, 511 KB

Open AccessInteresting Images

The Athlete's ECG

by Jose David Arroja, Mehdi Namdar, Dipen Shah and Philippe Meyer

Cardiovasc. Med. 2015, 18(9), 263; https://doi.org/10.4414/cvm.2015.00351 - 23 Sep 2015

Cited by 1 | Viewed by 15

As part of the Union Cycliste Internationale (UCI) medical monitoring programme, we perform each year a standard cardiovascular examination including a 12- lead resting electrocardiogram (ECG) in all members of a professional cycling team.[...] Full article

2 pages, 238 KB

Open AccessInteresting Images

Intermittent AV Block After Slow Pathway Ablation for AVNRT

by Patrick Badertscher, Tobias Reichlin and Christian Sticherling

Cardiovasc. Med. 2015, 18(9), 261; https://doi.org/10.4414/cvm.2015.00350 - 23 Sep 2015

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Abstract

A 61-year-old woman with a 20-year history of paroxysmal tachycardia was referred for ablation.[...] Full article

3 pages, 360 KB

Open AccessCase Report

Basal Tako-Tsubo Cardiomyopathy

by Mattia Cattaneo, Alessandra Pia Porretta, Carlo Cereda, Marco Moccetti, Claudio Gobbi, Elena Pasotti, Daniel Sürder, Claudio Städler and Augusto Gallino

Cardiovasc. Med. 2015, 18(9), 258; https://doi.org/10.4414/cvm.2015.00359 - 23 Sep 2015

Cited by 1 | Viewed by 9

Abstract

Tako-Tsubo cardiomyopathy (TTC) is an infrequent, mostly stress-related transient cardio myopathy, which mainly affects postmenopausal women. Inverted or basal TTC (B-TTC) episodes are rarer. Our case illustrates a rare example of B-TTC in a 30-year-old woman with an acute multiple sclerosis relapse as [...] Read more.

Tako-Tsubo cardiomyopathy (TTC) is an infrequent, mostly stress-related transient cardio myopathy, which mainly affects postmenopausal women. Inverted or basal TTC (B-TTC) episodes are rarer. Our case illustrates a rare example of B-TTC in a 30-year-old woman with an acute multiple sclerosis relapse as the associated stressor, possibly providing a hypothetical pathological substrate for this TTC episode. This uncommon case suggests that both factors of young age or neurological events may affect TTC pattern during one episode. Moreover, this case raises the question as to whether researchers on T TC should adopt a new perspective, embracing cardiovascular as well as neuroanatomical and -functional features. Full article

7 pages, 267 KB

Open AccessArticle

Copeptin for Early Diagnosis of Myocardial Infarction

by Victorine Walter, Jean-Luc Magnin, Jean-Jacques Goy, Wenceslao Garcia, Daniel Hayoz, Vincent Ribordy, Yves Allemann and Stéphane Cook

Cardiovasc. Med. 2015, 18(9), 252; https://doi.org/10.4414/cvm.2015.00355 - 23 Sep 2015

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Abstract

Background: Early identification of myocardial infarction is crucial in chest pain patients. Objective: Our goal was to evaluate if copeptin allows the ruling out of myocardial infarction (AMI) when used with cardiac troponin Ic (troponin) in the emergency department. Methods: Patients with suspected [...] Read more.

Background: Early identification of myocardial infarction is crucial in chest pain patients. Objective: Our goal was to evaluate if copeptin allows the ruling out of myocardial infarction (AMI) when used with cardiac troponin Ic (troponin) in the emergency department. Methods: Patients with suspected acute coronary syndrome (ACS) were enrolled in this pilot trial. Copeptin and troponin were determined at admission, and 6 h later for troponin. Results: A total of 125 patients with a mean age of 60 ± 15 years were enrolled. Chest pain was present in 94 patients (75%) and other symptoms compatible with cardiac ischaemia in 25 (20%). Four groups were identified: 15 patients in group 1 had positive copeptin and positive troponin, 29 patients in group 2 had positive copeptin and negative troponin, 7 patients in group 3 had negative copeptin and positive troponin, and 74 patients in group 4 had both copeptin and troponin negative. Patients in group 1, 2 and 3 had a high incidence of STEMI and NSTEMI. In group 4, no patient experienced adverse events. Negative predictive value was 100% for the combined measurement of troponin and copeptin. A 3-month follow-up was completed without adverse events for patients of group 4. Conclusion: Combined determination of troponin and copeptin on admission in patients presenting early (<3 hours but >30 minutes) after onset of symptoms suspect of AMI provides a high negative predictive value. This combination might improve early rule-out of AMI and makes copeptin a useful complement to conventional troponin in the emergency department. Full article

6 pages, 296 KB

Open AccessArticle

Clinical Determinants of Adrenal Vein Sampling Success

by Maxime Berney, Marc Maillard, Francesco Doenz, Maurice Matter, Antoinette Pechère-Bertschi, Michel Burnier and Gregoire Wuerzner

Cardiovasc. Med. 2015, 18(9), 246; https://doi.org/10.4414/cvm.2015.00352 - 23 Sep 2015

Cited by 3 | Viewed by 8

Abstract

Background: Primary aldosteronism (PA) is one of the most prevalent forms of secondary hypertension, which may be cured by unilateral adrenalectomy. Adrenal vein sampling (AVS) is considered the gold-standard procedure for distinction between bilateral and unilateral aldosterone hypersecretion. However, the procedure is viewed [...] Read more.

Background: Primary aldosteronism (PA) is one of the most prevalent forms of secondary hypertension, which may be cured by unilateral adrenalectomy. Adrenal vein sampling (AVS) is considered the gold-standard procedure for distinction between bilateral and unilateral aldosterone hypersecretion. However, the procedure is viewed as a technical challenge. The objectives of this study were to define the success rate of AVS, and its clinical determinants, and to compare the accuracy of high-resolution adrenal computed tomography (CT) with AVS. Methods: In this single-centre retrospective study, patients with biologically proven PA who were referred for AVS between 2009 and 2014 were included. Adrenal vein catheterisation was considered selective if the selectivity index (adrenal vein / inferior vena cava cortisol) was ≥2. Results: Data from 68 patients (48% women) were available. The success rate of catheterisation in bilateral AVS was 60% (41/68). The significant clinical determinants of success were male sex (r = 0.35, p = 0.004), a higher body mass index (BMI) (r = 0.54, p = 0.001) and plasma creatinine (r = 0.25, p = 0.048) in univariate analysis. In multivariate linear regression analysis, only BMI was associated with success (coefficient  = 0.049, p = 0.004). CT was discordant with AVS in 53% of patients, and would have resulted in inappropriate adrenalectomy in 43% of the patients and inappropriate exclusion from surgery in 10% of the cases. Conclusion: Clinical characteristics such as BMI and sex may influence the success rate of AVS. The inaccuracy of CT may result in inappropriate treatment proposals if the indication for surgical intervention is based on CT only. Full article

9 pages, 449 KB

Open AccessReview

PCSK9 Inhibitors: A New Era for Lipid-Targeted Therapies?

by Isabella Sudano, Arnold von Eckardstein, Christian M. Matter, Ulf Landmesser and Thomas F. Lüscher

Cardiovasc. Med. 2015, 18(9), 239; https://doi.org/10.4414/cvm.2015.00354 - 23 Sep 2015

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Abstract

Mutations in proprotein convertase subtilisin/kexin type 9 (PCSK9) were first described in 2003 as a cause of autosomal dominant hypercholesterolaemia. Moreover, genetic studies have indicated that some PCSK9 lossoffunction mutations are associated with a markedly reduced risk of coronary artery disease (CAD), suggesting [...] Read more.

Mutations in proprotein convertase subtilisin/kexin type 9 (PCSK9) were first described in 2003 as a cause of autosomal dominant hypercholesterolaemia. Moreover, genetic studies have indicated that some PCSK9 lossoffunction mutations are associated with a markedly reduced risk of coronary artery disease (CAD), suggesting that PCSK9 represents a promising novel target for the prevention and management of CAD. Already, PCSK9 inhibition using monoclonal antibodies is entering the clinical management of familial hypercholesterolaemia and largescale clinical outcome programmes have been started to evaluate the impact of PCSK9 inhibition on cardiovascular events in highrisk patients. Both the refinement of monoclonal antibodybased therapies and the identification of this novel target represent an impressive example of the rapid translation of research to prevention of coronary disease, and may allow further reduction in lowdensity lipoprotein cholesterol levels to decrease progression or even reverse atherosclerosis. Full article

4 pages, 157 KB

Open AccessEditorial

Cardiac Surgery: Where Are We Going?

by Ottavio Alfieri

Cardiovasc. Med. 2015, 18(9), 235; https://doi.org/10.4414/cvm.2015.00358 - 23 Sep 2015

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Abstract

Ake Senning, Professor of Surgery at the University of Zurich from 1961 to 1985, was a great protagonist of the pioneering phase of cardiac surgery. His work reflects great versatility, multiplicity of interests, extremely wide knowledge, and rigorous scientific background. Already at that [...] Read more.

Ake Senning, Professor of Surgery at the University of Zurich from 1961 to 1985, was a great protagonist of the pioneering phase of cardiac surgery. His work reflects great versatility, multiplicity of interests, extremely wide knowledge, and rigorous scientific background. Already at that time he definitely applied an attitude of multidisciplinary approach in treating patients with heart diseases. Where are we going? Prediction can be relatively easy regarding some aspects of our profession, because of a number of well established and irreversible trends. There is no question that the treatment modality will be chosen according to risk assessment, clinical characteristics, anatomical features and wishes of the individual patient (personalised care). Optimal care can only be offered in institutions where the largest spectrum of therapeutic options is available. The cardiac surgeon of the future is therefore likely to be different in many aspects from the specialist who has been the product of conventional training. First of all, the new specialist will necessarily work in a multidisciplinary environment, continuously interacting with colleagues who have different competences and skills (teamwork). Full article

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Cardiovasc. Med., Volume 18, Issue 9 (09 2015) – 7 articles

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