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Hypertrophic cardiomyopathy is characterized by the idiopathic hypertrophy of the left ventricle (and occasionally right ventricle). HCM is an autosomal dominant disease, with variable penetration. In Asian population, apical hypertrophic cardiomyopathy is relatively common (25%). However, this is relatively rare in Caucasian population (0.2%). Patients with HCM, often presents with typical exertional chest pain and shortness of breath. Apical HCM patients tend to have milder symptoms. However, the clinical presentation and electrocardiographic features of Apical HCM often mimic acute coronary syndrome and high index of suspicion is warranted in differentiating this condition. Patients with apical HCM have relatively better prognosis when compare to the other varieties. Here, we are presenting a patient who presented with typical exertional chest pain whose electrocardiographic changes are concerning for acute ischemic changes.

The fields of interventional cardiology and cardiac surgery have witnessed remarkable technological achievements. We describe the case of a patient who underwent several such milestones over a period of nearly five decades. From a Vineberg operation in 1969, to coronary artery bypass graft surgery in 2000, and finally, transcatheter aortic valve replacement in 2013, her medical history illustrates the impact of such landmarks, at times when few other options existed.

To study the effect of gender on outcome following renal artery stent placement for renovascular hypertension, we prospectively followed 66 patients (30 males, 36 females) who underwent Palmaz stent placement in 88 renal arteries. There was no difference in the incidence of procedure-related complications between males and females. At 6-mo follow-up, the decrease in systolic (35 ± 30 mm Hg and 27 ± 25 mm Hg) and diastolic (15 ± 23 mm Hg and 14 ± 14 mm Hg) blood pressures was similar in female and male patients, respectively. Late follow-up at 19 ± 11 mo also showed no difference in blood pressure response. In 44 patients who underwent repeat angiography at a mean duration of 9.1 ± 5.6 mo after stent deployment, the incidence of restenosis was 26% in females and 24% in males (P = 0.85). We conclude that gender has no effect on the incidence of complications, blood pressure response, or angiographic restenosis in patients undergoing renal artery stent placement. Cathet. Cardiovasc. Diagn. 42:381–386, 1997. © 1997 Wiley-Liss, Inc.

Previous publications have described thrombotic events with unclear causes in individuals infected with the human immunodeficiency virus (HIV). We stratified the cases of 52 individuals infected with HIV by degree of immunosuppression and the presence of complicating illnesses. Plasma from these individuals was screened for abnormalities that might predispose to thromboses. We found statistically significant differences between patients with CD4 counts200/mm3 and those whose CD4 counts were400/mm3 in the following: d-dimers, functional protein C, antigenic protein C, total protein S antigen, free protein S antigen, C4b-binding protein (C4b-BP), and von Willebrand antigen (vWD). Free protein S correlated inversely with C4b-BP; vWD directly with total protein S; and protein C inversely with d-dimers. D-dimers were significantly elevated only in immunosuppressed patients with complicating neoplastic/inflammatory disease. We propose that low-grade disseminated intravascular coagulopathy in severely immunosuppressed individuals with HIV and infectious, inflammatory, or neoplastic complications is responsible for depressed protein C, which, together with elevations in total protein S and vWD (markers of endothelial injury), indicates a thrombotic predisposition.

Background: Indeterminate troponins (IT) are known to be associated with worse in-hospital and short-term clinical outcomes. However the effect of IT on long-term clinical outcomes has not been studied. Methods: We included all patients with unstable angina (USA) who underwent PCI at a tertiary multi-specialty hospital. Indeterminate and negative troponins were defined as per the troponin assay manufacturer’s recommendation. Patients were classified into indeterminate troponins (IT) group and negative troponins (NT) group. We compared long-term clinical outcomes (Death, MI, Death/MI, Target Vessel Revascularization [TVR], Major Adverse Cardiac Events [MACE- death, MI and TVR] and Stent Thromosis [ST]) between the two groups. Results: We had 94 patients in the IT group and 853 patients in the NT group. Mean follow up duration was 1422 ± 664 days. Kaplan Meier analysis showed that IT were associated with more death (p=0.0012), MI (p=0.0003), death /MI (p=0.0001) and MACE (p=0.0025) at long-term follow up. After multi-variate adjustment for all the statistically different baseline clinical and angiographic characteristics between the two groups, IT remained an independent predictor of death, MI, death/MI and MACE in long-term follow up. Conclusions: Indeterminate troponins are associated with significantly worse clinical outcomes in long-term follow up. Indeterminate troponins add incremental prognostic information in patients with USA and should be factored in risk stratification and management of these patients.

Background: Although cardiac CT derived calcium score (CCS) predicts cardiovascular events in individuals with intermediate CAD risk, its role in predicting the degree of obstructive CAD noted on coronary angiogram (CAG) has not been studied. The SYNTAX score (SS) derived from CAG is useful in grading of obstructive CAD. We performed this study to evaluate the relation between CCS and SS. Methods: Seventy two patients who underwent cardiac CT as well as CAG within 6 months were included. We excluded 9 patients with zero calcium scores. All CAG were reviewed in a blinded fashion by an experienced interventional cardiologist and SS was calculated. Using Pearson’s correlation analysis, we studied the relation between CCS and SS in all patients (n=72), those with low CCS (CCS=1–400; n=33), intermediate CCS (CCS=401–1000; n=16) and high CCS (CCS>1000; n=23). Results: There were significant moderate correlations between CCS and SS in all patients (r=0.54; P Conclusions: CCS greater than 400 has a significant moderate correlation with SS. Intermediate and high CCS may be useful in predicting the extent of angiographic CAD.

Background: The safety and efficacy of drug-eluting stents (DES) among more generalized patient populations than typically enrolled in pivotal randomized controlled trials (RCTs), including for “off-label” indications, is controversial. Objectives: We sought to perform a systematic review and meta-analysis of published/presented DES studies in order to estimate the relative impact of DES vs. BMS particularly outside of USFDA labeled indications, and to specifically assess differences between data derived from RCTs and observational (Obs) analyses. Methods: Studies with >=100 total pts comparing DES to BMS and reporting mortality data with cumulative follow-up of >=1 year that were published and/or presented through 2/2008 were abstracted. Fixed effects and random effects models were used to generate summary estimates of the relative impact of DES vs. BMS upon all-cause mortality, myocardial infarction (MI), and target vessel revascularization (TVR). Data from 9,470 pts enrolled in 22 RCTs and from 182,901 pts studied in 34 Obs studies were included; RCT and Obs data were analyzed separately. Results: Data from “off-label” RCTs demonstrated non-significant reductions in mortality with DES vs. BMS, with a significant reduction in TVR (Table ). The Obs studies (in which pts were treated for both on-label and off-label indications) demonstrated significant reductions in mortality and TVR with DES vs. BMS use (Table ). Conclusions: Use of DES compared to BMS does not appear to be associated with adverse safety outcomes such as death or MI in either off-label RCTs or non-randomized Obs studies, and was associated with a significant and comparable reduction in TVR. In the absence of definitive large-scale randomized data directly comparing DES to BMS in unselected pts, these findings, derived from more than 190,000 total pts treated in 56 studies, suggest that DES are safe and have comparable efficacy in both RCTs and in the “real-world”.