Search

European Heart Journal, 36 (16), ISSN:1522-9645, ISSN:0195-668X

To evaluate the impact of obstructive sleep apnea syndrome (OSAS) on serum creatine phosphokinase (CK) levels.Single-center prospective cross-sectional study.Academic sleep disorder center.Two hundred one consecutive patients (mean [+/- SD] age, 54.9 +/- 11.0 years; 155 men and 46 women; mean body mass index, 31.3 +/- 6.9 kg/m(2)) with suspected sleep-disordered breathing.OSAS was confirmed in182 patients (apnea-hypopnea index [AHI],5 events per hour) and was ruled out in 19 patients (control subjects) by standard polysomnography. Sixty-six OSAS patients and 1 control patient showed an unexplained CK elevation. The mean baseline CK level was significantly higher in patients with severe OSAS (AHI,30 event per hour; n = 89) compared to those with mild-to-moderate OSAS (AHI, 5 to 30 events per hour; n = 93) and control subjects (191.4 +/- 12.9 vs 134.3 +/- 7.5 vs 107.1 +/- 7.9 U/L, respectively; p0.01). Receiver operating curve analysis identified an optimal cutoff value of148 U/L (r = 0.660) for CK, which yielded a positive predictive value of 99%, a sensitivity of 43%, and a specificity of 95% for the diagnosis of OSAS. The mean nocturnal oxyhemoglobin saturation was the main predictor of CK level (r = 0.47; p0.001). Continuous positive airway pressure (CPAP) treatment resulted in a significant decline of CK levels both in patients with mild-to-moderate OSAS (n = 38; 129.7 +/- 13.4 vs 96.7 +/- 7.6 U/L, respectively; p0.001) and in patients with severe OSAS (n = 39; 187.7 +/- 18.9 vs 132.2 +/- 12.9 U/L, respectively; p0.001).One third of our study population showed a mild-to-moderate elevation in CK level, which was highly predictive of OSAS. The application of CPAP therapy in OSAS patients resulted in a significant decrease in CK level. We speculate that OSAS may account for a substantial number of cases of unexplained CK elevation (ie, hyperCKemia). Further studies should address the prevalence of OSAS in patients with mild-to-moderate hyperCKemia.

The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) on B-type natriuretic peptide (BNP) and to determine the effect of nasal continuous positive airway pressure (nCPAP) treatment on BNP levels.Increased sympathetic activity, repetitive rises in blood pressure, and apnea-induced wall stress may contribute as a trigger to release BNP in OSAS. However, there is uncertainty about whether OSAS affects BNP and whether application of nasal continuous positive airway pressure (nCPAP) ventilation affects release of BNP.A prospective study in 69 consecutive patients with suspected sleep disordered breathing referred to our sleep laboratory was conducted. OSAS was confirmed in 26 normotensive and 34 hypertensive patients and ruled out in nine normotensive patients (controls) by polysomnography (PSG).Baseline N-terminal fragment of BNP prohormone (NT-pro-BNP) did not differ significantly between OSAS patients (hypertensive: mean +/-SEM 60.8+/-9.9 pg/ml, normotensive: 43.2+/-6.8 pg/ml) and controls (36.5+/-8.5 pg/ml). Application of CPAP resulted in a significant decrease of NT-pro-BNP in hypertensive (60.8+/-9.9 pg/ml to 47.6+/-7.4 pg/ml, p=0.023) and normotensive OSAS (43.2+/-6.8 pg/ml to 29.6+/-5.3 pg/ml, p=0.0002). In contrast, controls showed no significant differences in NT-pro-BNP after a second PSG (36.5+/-8.5 pg/ml to 40.7+/-12.3 pg/ml, p=0.597).Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP. Application of nCPAP decreased NT-pro-BNP levels significantly in normotensive and, in particular, hypertensive OSAS. These findings may provide further evidence of the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.

Miliary tuberculosis is a rare manifestation of tuberculosis with a high mortality rate. Diagnosis may easily be missed when severe neurologic symptoms are the first clinical manifestation. A typical case of miliary tuberculosis is reported, with special regard to the problems of diagnostic work-up. The need for an early empirical therapy for suspected military tuberculosis is emphasized in particular.A 32-year-old Moroccan woman was admitted to the hospital with aphasia and a hemiparesis due to an intracerebral hemorrhage caused by a ruptured septic A. cerebri media aneurysm. Despite intensive work-up no septic focus could be found. Chest radiograph and computerized tomography (CT) showed miliary consolidations in the lungs. Skin testing (Tuberkulin Behring GT5) and smears for acid-fast bacilli and polymerase chain reaction (PCR) for tuberculosis of bronchoalveolar lavage (BAL) were negative. A four-drug antituberculous regimen (rifampicin [RMP], isoniazid [INH], pyrazinamide [PZA], ethambutol [EMB]) was initiated, and resulted in normalization of temperature, blood pressure, and C-reactive protein. Subsequently, cultures of BAL yielded Mycobacterium tuberculosis. The patient was discharged, a two-drug regimen was conducted (RMP, INH) after 2 months. Follow-up of the patient showed a significant improvement of the miliary lung consolidations after 5 months in CT of the lung. Only minor neurologic symptoms persisted after cessation of the therapy.In developed countries, miliary tuberculosis is a very rare cause of septic infiltrative lung disease. However, due to the nonspecific nature of the presentation and despite improved diagnostic techniques, a high clinical suspicion is essential for successful treatment.

Right ventricular infarction (RVI) occurs in approximately 50% of patients with inferior myocardial infarction (MI). The assessment of RVI is important for identifying patients being at increased risk of in hospital mortality and poorer prognosis if impaired right ventricular (RV) systolic function is present. We report the case of an asymptomatic 38-year-old male who sustained a silent inferior myocardial infarction with extensive RV involvement. There was no history of myocardial ischemia and cardiovascular risk factors. Therefore, first cardiac magnetic resonance (CMR) imaging using delayed enhancement (DE) was performed and revealed a transmural inferior wall myocardial infarction of LV with extensive involvement of RV. This case illustrates the difficulties of conventional imaging modalities and invasive coronary angiography to depict an inferior myocardial infarction with RV involvement.

Background LGE is widely used as a means to quantify scar or fibrotic tissue in patients suffering from cardiomyopathies. In clinical routine 2D data acquisition is most commonly practiced, albeit having the drawback of multiple breath-holds and long acquisition times. 3D acquisition can significantly reduce acquisition time. This leads to shortened scan time and a more efficient use of available MRI resources. So our purpose was to determine whether the quantification of myocardial fibrosis in patients with Fabry disease and hypertrophic cardiomyopathy (HCM) using a late gadolinium enhancement (LGE) single-breath-hold threedimensional (3D) inversion recovery magnetic resonance (MR) imaging sequence is comparable with a clinically established two-dimensional (2D) multi-breath-hold sequence.

A B S T R A C T S Methods: Consecutive patients with acute myocardial infarction (n1⁄4137) who received aspiration thrombectomy and coronary intervention with filter-type distal protection device (Filtrap) were prospectively enrolled. We classified them into two groups by the number of aspirations required to achieve TIMI III coronary flow: single aspiration (Group A, n1⁄493) and multiple aspirations (Group B, n1⁄444). We compared between the groups the frequency of filter slow flow/ no-reflow phenomenon and of distal embolization captured by filter device. Results: Although the distal embolizatioin of thrombus was not deferent between the groups (100% vs. 96%, p1⁄40.16), that of plaque debris was more frequent in Group B than in Group A (95% vs. 18%, p

Findings in a 71-year-old male patient are reported who presented with an aneurysm of the ascending aorta and a heavily calcified bicuspid aortic valve with severe stenosis and mild regurgitation. Transthoracic echocardiography and invasive assessment showed normal left ventricular function, a severely reduced valve area of 0.77 cm2, and a dilation of the ascending aorta of 52 mm. To further investigate the haemodynamic …

An approach to efficiently measure three dimensional velocity vector fields and turbulent kinetic energy of blood flow is presented. Multipoint phase contrast imaging is used in combination with Bayesian analysis to map both mean and fluctuating velocities over a large dynamic range and for practically relevant signal to noise ratios. It is demonstrated that the approach permits significant spatiotemporal undersampling to allow for clinically acceptable scan times. Using numerical simulations and in vitro measurements in aortic valve phantoms it is shown that for given scan time Bayesian multipoint velocity encoding provides consistently lower errors of velocity and turbulent kinetic energy over a larger dynamic range relative to previous methods. In vitro significant differences in both peak velocity and turbulent kinetic energy between the aortic CoreValve (150 cm/s 293 J/m(3) ) and the St. Jude Medical mechanical valve (120 cm/s 149 J/m(3) ) were found. Comparison of peak turbulent kinetic energy measured in a patient with aortic stenosis (950 J/m(3) ) and in a patient with an implanted aortic CoreValve (540 J/m(3) ) revealed considerable differences relative to the values detected in healthy subjects (149 ± 12 J/m(3) ) indicating the potential of the method to provide a comprehensive hemodynamic assessment of valve performance in vivo.

This paper was guest edited by Prof. Frank E. Rademakers, University Hospital Gasthuisberg, Leuven, Belgium A 65-year-old male patient with typical chest pain underwent low-dose coronary computed tomographic (CT) angiography (CCTA) with 1.4 mSv for evaluation of coronary artery disease (CAD). Panel A shows a curved multiplanar reformation of the left circumflex artery with a high-grade …

Methods Ninety patients (84 men, age 54.4±10.8y, BMI 27.8±4.5 kg/m) with acute (n=30), subacute (n=30) and chronic (n=30) myocardial infarction were included in the study. All imaging was performed on a 1.5-T clinical MR system (Achieva, Philips Medical Systems, Best, the Netherlands). Spatial resolution was identical for 3D and 2D images (1.5 x 1.5 mm, slice thickness 8 mm, no slice gap). Image quality was graded on a five-point scale (1: excellent, 5: non-diagnostic). Quantitative analyses of myocardial mass (g), scar mass (g) and scar transmurality (five-point scale: 0: 0%; 1

Background Cardiac magnetic resonance (CMR) perfusion imaging yields high diagnostic accuracy for the detection of coronary artery disease (CAD) [1]. However, standard 2D multislice CMR perfusion techniques only provide limited coverage and hence prohibit computation of myocardial ischemic burden. Recently, two single-center 3D CMR perfusion studies have proven highly diagnostic for the detection of CAD relative to quantitative coronary angiography (QCA) [2] and fractional flow reserve (FFR) [3]. The aim of our prospective multicenter study is to assess the diagnostic performance of 3D CMR perfusion imaging in comparison with FFR.

Journal of Cardiovascular Magnetic Resonance, 17 (S1), ISSN:1097-6647, ISSN:1532-429X