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The article focuses on the researches that were published in the 2010 issue of the "European Journal of Clinical Investigation." The study by David L. Vesely shows that three of the four cardiovascular hormones synthesized by atrial natriuretic peptide gene can prevent squamous cell carcinomas in athymic mice. The study by Choitsu Sakamoto and Shunji Fujimori demonstrates the ability of lansoprazole and omeprazole to impair the proton pump inhibitors (PPI)-induced low acid gastric condition.

Eur J Clin Invest 2012; 42 (5): 541-547 Abstract Background There is limited insight into the association of electrocardiographic interpretability with outcome in patients referred for stress testing. Methods Exercise echocardiography was performed in 8226 patients with known or suspected coronary artery disease. Electrocardiograms were considered uninterpretable in the presence of left bundle-branch block (LBBB), left ventricular hypertrophy (LVH) with strain, repolarization abnormalities because of digitalis therapy, ventricular paced rhythm, preexcitation or ST depression ≥ 0·1 mV because of other causes. End points were all-cause mortality, cardiac death and hard cardiac events (i.e. cardiac death or nonfatal myocardial infarction). Results A total of 2450 patients had uninterpretable electrocardiograms. During a follow-up period of 4·1 ± 3·5 years, there were 1011 deaths (of which 478 were cardiac deaths) and 1069 patients experienced a hard cardiac event. The 5-year rates of death, cardiac death and hard cardiac events were, respectively, 18·7%, 10·9% and 18·8% in patients with uninterpretable ECGs, compared with 9·5%, 4·1% and 10·9% in those with interpretable ECGs ( P < 0·001). After covariate adjustment, lack of ECG interpretability remained an independent predictor of all-cause mortality (hazard ratio [HR] 1·25, 95% confidence interval [CI] 1·08-1·44, P = 0·002), cardiac death (HR 1·63, 95% CI 1·32-2·01, P < 0·001) and hard cardiac events (HR 1·28, 95% CI 1·11-1·47, P < 0·001). When the specific ECG abnormalities were included as covariates, LBBB, LVH and digitalis therapy remained predictors of cardiac death; LBBB and LVH were predictors of hard cardiac events, and LVH remained predictive of all-cause mortality. Conclusion Uninterpretable ECGs portend a worse prognosis in patients referred for stress testing. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on the relation between left atrial size and outcome among patients referred for clinically indicated echocardiograms. Our aim was to assess the association of left atrial size with all-cause mortality and ischemic stroke in a large cohort of patients referred for echocardiography. Methods: Left atrial diameter was measured in 52 639 patients aged 18 years or older (mean age 61.8 [standard deviation (SD) 16.3] years; 52.9% men) who underwent a first transthoracic echocardiogram for clinical reasons at our institution between April 1990 and March 2008. The outcomes were all-cause mortality and nonfatal ischemic stroke. Results: Based on the criteria of the American Society of Echocardiography, 50.4% of the patients had no left atrial enlargement, whereas 24.5% had mild, 13.3% had moderate and 11.7% had severe left atrial enlargement. Over a mean follow-up period of 5.5 (SD 4.1) years, 12 527 patients died, and 2314 patients had a nonfatal ischemic stroke. Cumulative 10-year survival was 73.7% among patients with normal left atrial size, 62.5% among those with mild enlargement, 54.8% among those with moderate enlargement and 45% among those with severe enlargement (p < 0.001). After adjustment in multivariable Cox proportional hazard analysis, left atrial diameter remained a predictor of all-cause mortality in both sexes (hazard ratio [HR] per 1-cm increment in left atrial size 1.17, 95% confidence interval [CI] 1.12--1.22, p < 0.001 in women, and HR 1.09, 95% CI 1.05--1.13, p < 0.001 in men) and of ischemic stroke in women (HR 1.25, 95% CI 1.14--1.37, p < 0.001). Interpretation: Left atrial diameter has a graded and independent association with all-cause mortality in both sexes and with ischemic stroke in women. [ABSTRACT FROM AUTHOR]

Background Elderly patients with suspected or known coronary artery disease are often referred for pharmacological stress testing. Data on the value of exercise echocardiography (ExEcho) for predicting outcome (particularly all- cause mortality) in these patients are scarce. Methods Peak treadmill ExEcho was performed in 2159 patients ‡ 70 years of age with known or suspected coronary artery disease. Left ventricular wall motion was evaluated at baseline and with exercise, and the increase in wall motion score index from rest to peak exercise (DWMSI) was calculated. Ischaemia was diagnosed when new or worsening wall motion abnormalities developed with exercise. The end points were all-cause mortality and major cardiac events (cardiac death or myocardial infarction). Results Ischaemia developed in 844 patients (38Æ6%) during exercise. Over a mean follow-up of 3Æ5 ± 3Æ1 years, 439 deaths occurred. The cumulative 5-year mortality rate was 29Æ3% in patients with ischaemia versus 16Æ8% in those without ischaemia (P < 0Æ001). After covariate adjustment, DWMSI remained an independent predictor of mortality [hazard ratio (HR) 2Æ37, 95% confidence interval (CI) 1Æ66–3Æ39, P < 0Æ001] and major cardiac events (HR 3Æ48, 95% CI 2Æ11–5Æ74, P < 0Æ001). These results remained significant even in patients with chronotropic incompetence. When added to a model with clinical, resting echocardiographic and exercise electrocardiogram variables, ExEcho results provided incremental value for the prediction of both end points (P < 0Æ001). Conclusions ExEcho is feasible in elderly patients with suspected or known coronary artery disease and provides useful information for risk stratification in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The prognostic value of exercise echocardiography (ExE) in patients with left ventricular systolic dysfunction (LVSD) has not been characterized. We sought to assess the value of ExE for predicting outcome in patients with LVSD and known/suspected coronary artery disease. Methods: This study is a retrospective analysis of a prospectively collected database of 1,107 patients who underwent treadmill ExE and had resting LVSD (left ventricular ejection fraction <50%). Ischemia was defined as an increase in wall motion score index from rest to exercise. The end points were all-cause mortality and major cardiac events (MACE). Results: Overall, 494 patients (44.6%) developed new or worsening wall motion abnormalities. During a mean follow-up of 4.1 ± 3.4 years, 301 patients died and 166 had a MACE. In patients with mild LVSD, the 5-year mortality rate was 8.8% in those without ischemia and 21% in those with ischemia (P < .001). For patients with moderate LVSD without ischemia, the 5-year mortality rate was 18.3%, whereas it was 29.2% when ischemia was present (P = .009). In those with severe LVSD, the 5-year mortality rate was 23.9% without ischemia and 35.7% with ischemia (P = .03). In the multivariate analysis, increase in wall motion score index was an independent predictor of mortality (hazard ratio 2.25, 95% CI 1.26-2.06, P = .001) and MACE (hazard ratio 2.60, 98% CI 1.34-5.04, P = .005). The addition of the ExE results to clinical, resting echocardiography and exercise variables provided significant incremental prognostic information for predicting mortality (P = .001) and MACE (P = .005). Conclusions: The ExE provides significant information for predicting outcome in patients with LVSD and known/suspected coronary artery disease. [ABSTRACT FROM AUTHOR]

BackgroundExercise echocardiography (EE) is recommended for patients with known/suspected coronary artery disease (CAD) and electrocardiogram (ECG) abnormalities. Left ventricular hypertrophy (LVH) is associated with worse outcome and patients with LVH have frequently resting ECG abnormalities. We sought to assess the value of EE for predicting outcome in patients with known/suspected CAD and LVH.MethodsRetrospective analysis over 1,058 patients, classified according to the presence (n = 557) or absence (n = 501) of LVH (LV mass ≥163 g for women, ≥225 g for men) who underwent EE. Wall motion score index (WMSI) was evaluated at rest and with exercise. Ischemia was defined as the development of new or worsening wall motion abnormalities (WMA) with exercise. The endpoints were all-cause mortality and major cardiac events (MACE). Overall, 352 patients (33%) developed new/worsening WMA.ResultsDuring a follow-up of 4.6 ± 4.0 years, 178 patients died and 129 had a MACE. The 5-year mortality and MACE rates were 6.4 and 7.1% in patients without ischemia vs. 15.3 and 13.6% in those with ischemia, respectively (P < 0.001). In the multivariable analysis, LV mass (hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.02–1.04, P = 0.008) and ΔWMSI (HR 1.94, 95% CI 1.12–3.35, P = 0.02) were independent predictors of mortality. ΔWMSI was also an independent predictor of MACE in the overall population (P = 0.002) and in patients with LVH (P = 0.04).ConclusionLV mass independently predicts mortality, even when EE data are considered. EE provides significant information for predicting events in patients with LVH and known/suspected CAD.American Journal of Hypertension 2010; doi:10.1038/ajh.2010.68 [ABSTRACT FROM AUTHOR]

The association of atrial fibrillation (AF) with coronary artery disease (CAD) remains controversial. In addition, the relation of AF to myocardial ischemia and outcomes in patients with known or suspected CAD referred for exercise stress testing has been poorly explored. In this study, 17,100 patients aged ≥50 years with known or suspected CAD who underwent exercise electrocardiography (n = 11,911) or exercise echocardiography (n = 5,189) were evaluated. End points were all-cause mortality, nonfatal myocardial infarction, and coronary revascularization. Overall, 619 patients presented with AF at the time of the tests. Patients with AF who had interpretable electrocardiograms had a lower likelihood of exercise-induced ischemic ST-segment abnormalities (adjusted odds ratio 0.51, 95% confidence interval 0.34 to 0.76, p = 0.001), and those with AF who underwent exercise echocardiography had a lower likelihood of new or worsening exercise-induced wall motion abnormalities (adjusted odds ratio 0.62, 95% confidence interval 0.44 to 0.87, p = 0.006). During a mean follow-up period of 6.5 ± 3.9 years, 2,364 patients died, 1,311 had nonfatal myocardial infarctions, 1,615 underwent percutaneous coronary intervention, and 922 underwent coronary artery bypass surgery. The 10-year mortality rate was 43% in patients with AF compared to 19% in those without AF (p <0.001). In multivariate analysis, AF remained an independent predictor of all-cause mortality (adjusted hazard ratio 1.45, 95% confidence interval 1.20 to 1.76, p <0.001), but not of nonfatal myocardial infarction or coronary revascularization. In conclusion, despite being associated with an apparently lower likelihood of myocardial ischemia, AF was an independent predictor of all-cause mortality in patients with known or suspected CAD referred for exercise stress testing. [Copyright &y& Elsevier]

Aims: Non-invasive imaging techniques for the detection of coronary artery disease (CAD) may have technical problems in patients with atrial fibrillation (AF). Although the prognostic value of exercise echocardiography (ExEcho) has been well established in several subgroups of patients, it has not yet been specifically evaluated in these patients. [ABSTRACT FROM PUBLISHER]

The prognostic value of an exaggerated exercise systolic blood pressure response (EESBPR) remains controversial. Our aim was to assess whether an EESBPR is associated with the long-term outcome in patients with diabetes mellitus and known or suspected coronary artery disease (CAD). From an initial population of 22,262 patients with known or suspected CAD who underwent treadmill exercise electrocardiography or exercise echocardiography at our institution, 2,591 patients with a history of diabetes mellitus were selected for the present study. EESBPR was defined as systolic blood pressure >220 mm Hg during exercise. The end points were all-cause mortality and hard events (ie, death or myocardial infarction). A total of 236 patients (9.1%) developed an EESBPR during the tests. During a mean follow-up of 6.5 ± 3.9 years, 484 patients died and 646 experienced hard events. The 10-year mortality rate was 16.6% in patients with an EESBPR compared to 30.9% in those without an EESBPR (p <0.001). The 10-year hard event rate was also lower in patients with an EESBPR (23.2% vs 38.9% in patients without an EESBPR; p <0.001). On multivariate analysis, an EESBPR remained independently associated with a lower risk of all-cause mortality (hazard ratio 0.53, 95% confidence interval 0.36 to 0.78, p = 0.001) and hard events (hazard ratio 0.57, 95% confidence interval 0.41 to 0.79; p <0.001). These results remained consistent in the subgroup of patients without a known history of CAD. In conclusion, an EESBPR was associated with improved survival and a lower rate of death or myocardial infarction in patients with diabetes mellitus and known or suspected CAD. [Copyright &y& Elsevier]

Aims: Although peak may have higher sensitivity than post-treadmill exercise echocardiography (EE) for the detection of coronary artery disease (CAD), its prognostic value remains unknown. We sought to assess the relative values of peak and post-EE for predicting outcome in patients with known/suspected CAD. [ABSTRACT FROM PUBLISHER]

The article discusses research being done on the use of transthoracic echocardiography (TTE) in chest pain. It references the study "The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Registry," by F. Breuckmann et al. in the 2016 issue. The variables considered include patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), patients with ST-elevation myocardial infarction (NSTEMI) and patients with percutaneous coronary intervention (PCI).

A letter to the editor is presented discussing a study exploring the association between an exaggerated exercise blood pressure response and mortality and cardiovascular events in older adults with coronary artery disease.

A letter to the editor is presented discussing a study on the effect of age on the need for pacemaker implantation in patients with syncope.

The primary study aim was to determine whether ischemia-modified albumin (IMA) predicts adverse outcome in patients attending the emergency department (ED) with acute chest pain. Ischemia-modified albumin is a sensitive marker of myocardial ischemia. However, little is known about its ability to predict outcome in patients presenting to the ED with acute chest pain. We prospectively studied 207 patients who presented to the ED with acute chest pain suggestive of acute coronary syndrome within 3 h of the onset of symptoms. Blood samples for IMA assessment were obtained on admission. We evaluated a 30-day combined end point (cardiac death, myocardial infarction, recurrent angina) and 1-year all-cause mortality. A total of 31 (15%) patients experienced the 30-day composite end point and 16 patients (7.7%) died during the 1-year follow-up. Short-term combined end point (9.6% vs 20.4%, P = 0.03) and 1-year mortality rate (11.7% vs 3.8%, log rank 3.978, P = 0.046) were significantly higher in patients with IMA levels >93.3 U/ml compared to patients with lower IMA. On multivariate analysis, IMA remained an independent predictor of both 30-day combined end point (odds ratio 1.04, 95% confidence interval [CI] 1.01–1.07, P = 0.01) and 1-year mortality (hazard ratio 1.038, 95% CI 1.006–1.070, P = 0.018). Ischemia-modified albumin is an independent predictor of short-and long-term adverse outcomes in patients presenting to the ED with typical acute chest pain. [ABSTRACT FROM AUTHOR]

Despite treatment with conventional agents, a high proportion of patients with ischemic cardiomyopathy continue to have symptoms. Moreover, a substantial proportion shows progressive contractile dysfunction leading to left ventricular (LV) enlargement and heart failure. Therefore, a need exists for new treatments for ischemic cardiomyopathy that tackle mechanisms other than those already addressed by conventional agents. Emerging evidence suggests that in patients with ischemic cardiomyopathy, LV dysfunction develops as a result of alterations in substrate metabolism, which contribute to contractile dysfunction and the progression of LV remodeling. Trimetazidine, a novel pharmacologic agent that acts on myocardial metabolic pathways, appears to protect the heart from the deleterious effects of ischemia, and it has been shown to enhance LV contractility in patients with stunned or hibernating myocardium. This article reviews recent clinical trials that have assessed the therapeutic role of trimetazidine in patients with ischemic cardiomyopathy. Trimetazidine has been shown to improve symptoms and LV ejection fraction and to have a beneficial effect on the inflammatory profile and endothelial function in these patients. These results suggest that trimetazidine is a useful adjunct to our current armamentarium for the treatment of patients with ischemic cardiomyopathy. [Copyright &y& Elsevier]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present the case of a 63-year-old man who underwent surgical closure of a paravalvular mitral leak. Immediately after surgery, transesophageal echocardiography revealed the appearance of a mediastinal hematoma encroaching on the left atrium and separating the esophageal probe from the posterior left atrial wall. The cause was an inadvertent puncture of the carotid artery, presumably during central venous line insertion prior to surgery. [ABSTRACT FROM AUTHOR]

The differential diagnosis of masses encroaching on the left atrium may be challenging. We describe a case in which contrast echocardiography using a carbonated drink provided a rapid and simple way to clarify the diagnosis of an incidental mass causing extrinsic compression of the left atrium. Given its simplicity and availability, we believe that it should be considered as a first line tool for clarifying the diagnosis in cases of echocardiographic evidence of left atrial encroachment of unknown origin. [ABSTRACT FROM AUTHOR]