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Abstract Background Tako-tsubo syndrome (TTS) in its typical (apical) and atypical (non-apical) forms is being increasingly recognized in the West owing to early systematic coronary angiography in acute coronary syndromes (ACS). Aim of the study To assess the incidence, the clinical characteristics and the outcome of TTS in a single high volume cath lab in Southern Italy over the last 6 years. Methods Among 1674 consecutive patients (pts) referred to our coronary care units in the last 6 years (2001–2006) for ACS we selected 6 (0.5%) pts (6 women; age 57 ± 6 years) who fulfilled the following 4 criteria: 1) transient left ventricular wall motion abnormalities resulting in ballooning at contrast ventricolographic or echocardiographic evaluation; 2) normal coronary artery on coronary angiography performed 5 ± 9 hours from hospitalization; 3) new electrocardiographic ischemic-like abnormalities (either ST-segment elevation or T-wave inversion) and 4) emotional or physical trigger event. Results At admission all pts had presumptive diagnosis of ACS and ECG revealed ST elevation in 3 (50%) and T wave inversion with QT elongation in 3 (50%). In the acute phase cardiogenic shock occurred in 2 (33%) and heart failure in 1(16%). Presenting symptoms were chest pain in 6 (100%), dyspnoea in 2 (33%) and lipotimia in 1 (16%). At echocardiographic-ventricolographic assessment, the mechanical dysfunction (ballooning) was apical in all 6 pts ("classic" TTS). In all patients wall motion abnormalities completely reversed within 4.5 ± 1.5 days. The region of initial recovery was the anterior and lateral wall in 4 cases and the lateral wall in 2 cases. Ejection fraction was 35 ± 8% in the acute phase and increased progressively at discharge (55 ± 6%) and at 41 ± 20 months follow-up (60 ± 4%, p < 0.001 vs. baseline). All patients remained asymptomatic with minimal (aspirin, beta blockers, antihypertensive and antidislipidemic therapy) treatment. Conclusion Classic TTS is a frequent serendipitous diagnosis after coronary angiography showed "surprisingly" normal findings in a clinical setting mimicking an ACS. Despite its long-term good prognosis life threatening complications in the acute phase can occur.

Abstract Background Ultrasound lung comets (ULCs) are a clinically useful sign of extravascular lung water. They require very limited technology (2 D-echo), and a short learning curve. The aim of the present study is to compare ULCs information obtained by experienced echocardiologists using a full feature echocardiographic platform and by inexperienced sonographers using a hand-held echocardiography system. Methods 20 consecutive in-hospital patients underwent, within 15' and in random order, 2 ultrasound examinations for ULCs by 2 observers with different specific expertise and different technology: 1) "high-tech veteran": ULCs assessment with full feature echocardiographic platform (HP Sonos 7500 Philips Medical Systems, Andover, MA, USA) by a trained echocardiologist, with ≥2 years expertise in ULCs assessment and accredited by the European Association of Echocardiography; 2) and a "low-tech beginner": ULCs assessment with hand-held echocardiography (Optigo; Philips, Andover, MA) by an echocardiographer with very limited (30') dedicated training on ULCs assessment. In each patient, ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithorax, from the second to the fifth intercostal space. Results There was a significant, tight correlation (r = .958, p < 0.001) between the 2 observations in the same patient by "high-tech veteran" and "low-tech beginner". Conclusion ULCs are equally reliable in the hands of highly experienced echocardiologists using full feature echocardiographic platforms and in the hands of absolute beginners with miniaturized, compact, and battery-equipped echocardiographic systems. From the technological and expertise viewpoint, ULCs are the "kindergarten" of echocardiography, ideally suited for bedside evaluation of patients with both known or suspected heart failure.

© 2014 Chatterjee et al.Objective: Inflammation and its resolution are central to vascular injury and repair. Maresins comprise a new family of bioactive lipid mediators synthesized from docosahexaenoic acid, an ω-3 polyunsaturated fatty acid. They have be

The role of hyperhomocysteinemia in coronary artery disease (CAD) patients remains unclear. The present study evaluated the relationship between homocysteine (HCys), adenosine plasma concentration (APC), plasma uric acid, and CAD severity evaluated using the SYNTAX score. We also evaluated in vitro the influence of adenosine on HCys production by hepatoma cultured cells (HuH7). Seventy-eight patients (mean age ± SD: 66.3 [+ or -] 11.3; mean SYNTAX score: 19.9 ± 12.3) and 30 healthy subjects (mean age: 61 ± 13) were included. We incubated HuH7 cells with increasing concentrations of adenosine and addressed the effect on HCys level in cell culture supernatant. Patients vs. controls had higher APC (0.82 [+ or -] 0.5 µmol/L vs 0.53 ± 0.14 µmol/L; p < 0.01), HCys (15 ± 7.6 µmol/L vs 6.8 ± 3 µmol/L, p < 0.0001), and uric acid (242.6 ± 97 vs 202 ± 59, p < 0.05) levels. APC was correlated with HCys and uric acid concentrations in patients (Pearson's R = 0.65 and 0.52; p < 0.0001, respectively). The SYNTAX score was correlated with HCys concentration. Adenosine induced a time- and dose-dependent increase in HCys in cell culture. Our data suggest that high APC is associated with HCys and uric acid concentrations in CAD patients. Whether the increased APC participates in atherosclerosis or, conversely, is part of a protective regulation process needs further investigations. Key words: adenosine, homocysteine, coronary artery disease. Le role de l'hyperhomocysteinemie dans la coronaropathie n'a toujours pas ete precise. La presente etude vise a evaluer le lien entre les concentrations plasmatiques d'homocysteine (HCys), d'adenosine (CPA), d'acide urique et la gravite de la coronaropathie a l'aide du score SYNTAX. Nous avons aussi evalue in vitro l'influence de l'adenosine sur la production d'HCys par les cellules d'hepatome en culture (HuH7). Nous avons inscrit a l'etude 78 patients (moyenne d'age ± E-T : 66,3 ± 11,3; score SYNTAX moyen: 19,9 ± 12,3) et 30 sujets en bonne sante (moyenne d'age : 61 ± 13). Par ailleurs, nous avons fait incuber des cellules HuH7 en presence d'adenosine a des concentrations croissantes et evalue son effet sur la concentration d'HCys dans le surnageant de culture cellulaire. Les concentrations plasmatiques des elements suivants etaient plus elevees chez les patients que chez les temoins: adenosine (0,82 ± 0,5 µmol/L p/r a 0,53 ± 0,14 µmol/L, p < 0,01), HCys (15 ± 7,6 µmol/L p/r a 6,8 [+ or -] 3 µmol/L, p < 0,0001) et acide urique (242,6 ± 97 p/r a 202 ± 59, p < 0,05). L'augmentation de la CPA etait proportionnelle a celles des concentrations d'HCys et d'acide urique chez les patients (R de Pearson : 0,65 et 0,52, respectivement; p < 0,0001) et l'augmentation du score SYNTAX etait proportionnelle a celle des concentrations d'HCys. En culture cellulaire, nous avons observe une augmentation, dependante du temps et de la dose, des concentrations d'HCys en presence d'adenosine. Nos donnees laissent entendre que la CPA est associee aux concentrations d'HCys et d'acide urique chez les patients presentant une coronaropathie. Par ailleurs, d'autres etudes seraient necessaries pour savoir si la CPA participe a l'atherosclerose ou si, inversement, elle contribue a un processus de protection regulateur. [Traduit par la Redaction] Mots-cles: adenosine, homocysteine, coronaropathie., Introduction Hyperhomocysteinemia is associated with cardiovascular disease (Hoogeveen et al. 2000; Kumakura et al. 2015; McCully 1969; Refsum et al. 1998; Riksen et al. 2003) and a predictor for death [...]

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Background: Tako-tsubo syndrome (TTS) in its typical (apical) and atypical (non-apical) forms is being increasingly recognized in the West owing to early systematic coronary angiography in acute coronary syndromes (ACS). Aim of the study: To assess the incidence, the clinical characteristics and the outcome of TTS in a single high volume cath lab in Southern Italy over the last 6 years. Methods: Among 1674 consecutive patients (pts) referred to our coronary care units in the last 6 years (2001-2006) for ACS we selected 6 (0.5%) pts (6 women; age 57 ± 6 years) who fulfilled the following 4 criteria: 1) transient left ventricular wall motion abnormalities resulting in ballooning at contrast ventricolographic or echocardiographic evaluation; 2) normal coronary artery on coronary angiography performed 5 ± 9 hours from hospitalization; 3) new electrocardiographic ischemic-like abnormalities (either ST-segment elevation or T-wave inversion) and 4) emotional or physical trigger event. Results: At admission all pts had presumptive diagnosis of ACS and ECG revealed ST elevation in 3 (50%) and T wave inversion with QT elongation in 3 (50%). In the acute phase cardiogenic shock occurred in 2 (33%) and heart failure in 1(16%). Presenting symptoms were chest pain in 6 (100%), dyspnoea in 2 (33%) and lipotimia in 1 (16%). At echocardiographic-ventricolographic assessment, the mechanical dysfunction (ballooning) was apical in all 6 pts ("classic" TTS). In all patients wall motion abnormalities completely reversed within 4.5 ± 1.5 days. The region of initial recovery was the anterior and lateral wall in 4 cases and the lateral wall in 2 cases. Ejection fraction was 35 ± 8% in the acute phase and increased progressively at discharge (55 ± 6%) and at 41 ± 20 months follow-up (60 ± 4%, p < 0.001 vs. baseline). All patients remained asymptomatic with minimal (aspirin, beta blockers, antihypertensive and antidislipidemic therapy) treatment. Conclusion: Classic TTS is a frequent serendipitous diagnosis after coronary angiography showed "surprisingly" normal findings in a clinical setting mimicking an ACS. Despite its long-term good prognosis life threatening complications in the acute phase can occur. [ABSTRACT FROM AUTHOR]