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Background: Type D personality has been previously shown to increase the risk for mortality in patients with acquired heart disease. Objective: We aimed to compare mortality in adult patients with congenital heart disease (CHD) with and without type D. Methods : Survival was assessed using prospective data from the Dutch national Congenital Corvitia registry for adults with CHD. Patients were randomly selected from the registry and characterized at inclusion in 2009 for the presence of type D using the DS14 questionnaire. Results : One thousand fifty-five patients, with 484 (46%) males, a mean (SD) age of 41 (14) years, 613 (58%) having mild CHD, 348 (33%) having moderate CHD, and 94 (9%) having severe CHD, were included. Type D personality was present in 225 patients (21%). Type D was associated with an increased risk for all-cause mortality independent of age, sex, New York Heart Association class, number of prescribed medications, depression, employment status, and marital status (hazard ratio, 1.94; 95% confidence interval, 1.05-3.57; P =.033). Conclusion : Type D personality was associated with an increased risk for all-cause mortality in adult patients with CHD. [ABSTRACT FROM AUTHOR]

Background Aortitis is a rare condition that can be caused by inflammatory or infectious aetiologies. The clinical presentation of aortitis includes a heterogeneous range of symptoms and clinical signs. Case summary We present a 53-year-old man whose medical history included presence of a ventricular septal defect, a bicuspid aortic valve, and coarctation of the aorta. The coarctation was treated with percutaneous stent implantation. One and a half years later, he presented to our hospital with complaints of fatigue, night sweats, and shivers. Physical examination revealed a fever, tachycardia, and hypertension. Imaging studies showed no signs of endocarditis. Positron emission tomography–computed tomography (PET–CT) showed an increase in 18F-fluorodeoxyglucose uptake at the distal end of the stent in the descending aorta. Blood cultures revealed a Streptococcus gordonii and antibiotic treatment was adjusted accordingly. The patients' functional status improved quickly, the fever resolved, and the laboratory markers of inflammation returned to normal. Discussion Aortitis is extremely rare after stent implantation. Risk factors for aortitis include congenital vascular malformation and stent implantation. Computed tomography is currently the imaging study of choice for aortitis, while PET–CT seems ideal for identification of stent infection. Mortality associated with infectious aortitis ranges from 21% to 44%, with generally higher mortality if managed with antibiotics alone. The differential diagnosis of stent infection should be taken into account in patients presenting with fever and chills after previous stent procedures. [ABSTRACT FROM AUTHOR]

Background: To deliver adequate care to patients with congenital heart disease (CHD), it is important to know which patients use what type of care. This knowledge is valuable, as modification of these factors may be used as means to regulate healthcare use. Our objective was to examine the predictive value of psychological characteristics for future healthcare use, independent of clinical characteristics. Methods: In total 845 adult CHD-patients participated in a longitudinal questionnaire study, with a two-year follow-up period. Linear regression analyses with negative binomial log link function were performed predicting healthcare used during the previous year. Psychological predictors were Type D personality, quality of life (QoL), depressive symptoms, trait-anxiety, happiness, optimism, and illness perceptions, independent of the number of co-morbidities, disease complexity and functional status. To control for clustering we included the variable type of centre (regional versus tertiary referral). Results: Patients who reported more healthcare use had a complex defect, a poor functional status, no Type D personality, and a poor QoL. They moreover felt their CHD had a severe impact on their life and believed their CHD could be managed by themselves or treatment. Conclusions: Healthcare use is not entirely determined by disease complexity and functional status but also by psychological patient characteristics. It can by hypothesised that reducing the negative impact experienced and informing patients about strategies to manage their CHD, will modify their future healthcare use. Additional research is necessary to examine this possibility. [ABSTRACT FROM AUTHOR]

Aims: This two-center study compared quantitative segmental perfusion mapping by intravenous myocardial contrast echocardiography (ivMCE) and scintigraphy (SPECT) in patients in the subacute phase of myocardial infarction (AMI).Methods and results: Sixteen patients underwent ivMCE using 1:1 intermittent harmonic imaging 24 h after first AMI treated with PTCA and stenting. Apical contrast echocardiograms were obtained after the injections of Sonazoid™. Baseline-corrected peak myocardial videointensity (bcPMVI) was determined automatically in 16 segments. Resting 99mTc-sestamibi SPECT was performed within one day after ivMCE. SPECT images were reoriented matching the ivMCE views, and divided into the same segments as in ivMCE, from which mean count rate values were obtained. After exclusion due to artifacts or attenuation, 208/256 (82%) segments remained for analysis. Normalized SPECT count rate and bcPMVI correlated linearly: bcPMVI=1.237×SPECT−35; r = 0.74, p<0.0001. The relation remained identical in subgroup analysis based on participating center, echocardiographic view, perfusion territory, infarct zone, or function. Using SPECT as reference, mean bcPMVI was 77±19% in normal segments, 53±29% in mild–moderate defects and 25±18% in severe defects (p<0.001 for all comparisons).Conclusion: The videointensity increase observed in quantitative ivMCE clearly correlated with SPECT tracer uptake. This further substantiates the use of ivMCE as a valid technique for myocardial perfusion imaging. [ABSTRACT FROM AUTHOR]

: ObjectivesThe aim of this study was to evaluate the coronary blood flow velocity pattern immediately and 24 h after percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) in relation to myocardial reperfusion and follow-up left ventricular (LV) function.: BackgroundAnalysis of coronary blood flow velocity pattern after AMI may provide information about microvascular damage and the occurrence of a reperfusion injury.: MethodsMeasurement of coronary blood flow velocity pattern was performed immediately after PTCA and after 24 h in 25 patients with first AMI using a Doppler guidewire. Measurements were related to reperfusion determined by intravenous myocardial contrast echocardiography (MCE) performed before PTCA and at 24 h and to LV function at four weeks.: ResultsUsing MCE, 13 patients showed reperfusion and 12 patients showed nonreperfusion. Compared with patients with reperfusion, patients with MCE nonreperfusion had a lower systolic peak flow velocity immediately after PTCA (10.0 ± 0.3 cm/s vs. 19.3 ± 0.8 cm/s, respectively) and after 24 h (12.3 ± 0.4 cm/s vs. 21.3 ± 0.1 cm/s, respectively, p = 0.0022), more frequent early systolic retrograde flow (6/12 vs. 0/13, p = 0.0052 immediately after PTCA and 24 h later) and a shorter diastolic deceleration time immediately after PTCA (483 ± 6 ms vs. 737 ± 0 ms, respectively) and after 24 h (551 ± 9 ms vs. 823 ± 2 ms, respectively, p = 0.0091). Similarly, patients with impaired LV function at four weeks had altered coronary flow pattern compared with patients with preserved function. The coronary flow velocity pattern showed a tendency for improvement after 24 h in the reperfusion and the nonreperfusion groups.: ConclusionsThe coronary flow velocity pattern immediately and 24 h after PTCA for AMI relates to myocardial perfusion determined by MCE and LV function at four weeks. The flow velocity pattern shows slight improvement during the first 24 h after revascularization, indicating the absence of a major reperfusion injury. [Copyright &y& Elsevier]