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Left atrial (LA) myopathy is an established component of hypertrophic cardiomyopathy (HCM); however, the data about its association with exercise incapacity or ventilatory inefficiency that may be seen in HCM patients are limited. This study aimed to explore the association between LA myopathy, evaluated by echocardiography LA strain, and exercise capacity and ventilatory efficiency, evaluated by cardiopulmonary exercise testing (CPET), in HCM patients.This study included 241 consecutive HCM patients (aged 51.2±15.7 years 67.2% male) in sinus rhythm who underwent CPET and transthoracic echocardiography at the same visit. Exercise incapacity (maximal/predicted oxygen consumption [%peakVOAll three LA strain values were univariate predictors of exercise capacity and ventilatory efficiency. Among them, LA reservoir strain had the higher r correlation coefficient for predicting both %peakVOLeft atrial myopathy, as reflected by the LA strain values, was associated with exercise incapacity and ventilatory inefficiency in HCM individuals. Left atrial reservoir strain was the only common independent predictor of %peakVO

Disturbances in homocysteine metabolism may lead to hyperhomocysteinemia. This condition has been associated with vascular atheromatosis leading to coronary artery disease (CAD) as well as myocardial infarction. One hundred patients with CAD who underwent coronary artery bypass grafting (CABG) were enrolled. The study aimed to evaluate cardiac enzymes and electrocardiogram of each patient postoperatively so as to diagnose perioperative myocardial infarction (PMI). An initial decrease of homocysteine immediately postoperatively followed by a progressive increase was recorded. Mild hyperhomocysteinemia preoperatively was more frequent among the patients who developed PMI. A correlation of preoperative homocysteine with troponin in the PMI group was also noted. Homocysteine levels were a prognostic factor for the occurrence of PMI in CABG procedures. © 2008 Bentham Science Publishers Ltd.

Beating heart coronary artery bypass grafting (CABG) improves early post-operative cardiac function in patients with at least moderate ventricular function but its effects in patients with significantly impaired ventricular function is uncertain. We compared a novel hybrid technique of on-pump beating heart (ONBEAT) to conventional cardioplegic arrest (ONSTOP) in CABG patients with impaired ventricular function using cardiac magnetic resonance (CMR) and biochemical markers. In a single centre randomized trial, 50 patients with impaired ventricular function undergoing CABG were randomly assigned to ONBEAT or ONSTOP. Patients underwent CMR assessment for function and delayed hyperenhancement (HE) for irreversible injury pre-operatively and early post operatively; in addition serum was taken for cTn I and CKMB (0,1,6,24,48 and 120 hours) after surgery. Forty-five patients completed surgery with follow up imaging. Pre-operative characteristics were well matched except for a higher incidence of renal impairment in ONBEAT patients (glomerular filtration rate 58 versus 68 ml.min−1, p=0.02). Mean ± SD cardiac index (CI): ONBEAT 2.85±0.53 and ONSTOP 2.62±0.59L.min−1.m−2. After surgery both groups sustained minor changes to CI (4% reduction ONBEAT, p = 0.43 versus 1% increase ONSTOP, p = 0.97) without significant inter-group difference. The incidence of new HE was significantly higher in the ONBEAT group (p = 0.04) with 6/17 patients (35%) sustaining 8.2 ± 5.2 g of new HE each compared with 2/23 patients (9%) in the ONSTOP group each with 9.8 ± 9.0 g of new HE, p = 0.86. Furthermore serum markers of myocardial injury were higher in ONBEAT patients; median AUC for Troponin I 461[226 – 1141]μg/L versus 160[98 – 357]μg/L, p=0.002 and CKMB 862[499 – 1768]ng/mL versus 549[447–704]ng/mL p=0.004. The incidence of new irreversible myocardial injury was significantly higher in ONBEAT patients, although there was no effect on global cardiac function. Inadequate coronary perfusion in patients with severe proximal coronary disease and low cardiac output may render distal coronary territories ischemic in the absence of formal myocardial protection.