RESUMEN
To evaluate the association between angiotensin I-converting enzyme insertion/deletion (ACE I/D) gene polymorphism and retinal vein occlusion (RVO). A total of 80 patients with retinal vein occlusion who was admitted to the Eye Department of Kartal Training and Research Hospital between 2008 and 2011, and 80 subjects were enrolled in this retrospective case-control study. Patients who experienced RVO within one week to six months of study enrolment were included, and those with coronary artery diseases, prior myocardial infarction history and coagulation disturbances were excluded from the study. The diagnosis was made by ophthalmoscopic fundus examination and fluorescein angiography. The ACE gene I/D polymorphism was determined by polymerase chain reaction, and the ACE gene was classified into three types: I/I, I/D and D/D. In multivariate logistic regression analysis, ACE D/D genotype (p = 0.035), diabetes-mellitus (p = 0.019) and hypertension (p = 0.001) were found to be independent predictive factors for RVO. The results of the present study reveal that ACE D/D polymorphism is an independent predictive factor for RVO. However, one cannot definitely conclude that ACE gene polymorphism is a risk factor for retinal vein occlusion.
RESUMEN
Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly in which a fibromuscular membrane divides the atrium into two chambers. As CTS can occur as an isolated anomaly, it is frequently associated with other cardiac anomalies. Although symptoms are usually encountered in infancy, CTS may rarely present in adulthood when the membrane contains large fenestration or other escape drainage exists. We herein, present an 82-year-old patient with a typical late diagnosis of asymptomatic CTS.
Asunto(s)
Corazón Triatrial/diagnóstico por imagen , Ecocardiografía Doppler en Color/métodos , Ecocardiografía Tridimensional/métodos , Ecocardiografía Transesofágica/métodos , Imagen Multimodal/métodos , Anciano de 80 o más Años , Femenino , HumanosRESUMEN
Congenital anomalies of the mitral valve apparatus are rare. Of such cases, congenital mitral stenosis, atresia, accessory valvular tissue, and cleft mitral valve are more common. Descriptions of unileaflet mitral valves (either partial or complete leaflet agenesis/hypoplasia) are extremely rare and largely limited to a few case reports. We report herein a 45-year-old nulliparous woman presenting to our outpatient clinic with chest discomfort and dyspnea on minimal exertion. Mitral valve with a single leaflet leading to a significant obstruction in left ventricular outflow was seen on transthoracic echocardiography and confirmed with transesophageal two- (2D) and three-dimensional (3D) echocardiography. Metoprolol was prescribed to relieve obstruction and symptoms.
Asunto(s)
Cardiopatías Congénitas , Válvula Mitral/anomalías , Obstrucción del Flujo Ventricular Externo , Antagonistas de Receptores Adrenérgicos beta 1/uso terapéutico , Ecocardiografía Transesofágica , Femenino , Humanos , Metoprolol/uso terapéutico , Persona de Mediana EdadRESUMEN
BACKGROUND: Cardiac troponin T is a marker of myocardial injury, especially when measured by means of the high-sensitivity assay (hs-cTnT). The echocardiographic and clinical predictors of hs-cTnT may be different in ischemic heart failure (IHF) and non-ischemic dilated cardiomyopathy (DCM). METHODS: Sixty consecutive patients (19 female, 41 male; mean age 56.3 ± 13.9 years) with stable congestive heart failure (33 patient with IHF and 27 patients with DCM), with New York Heart Association functional class I-II symptoms, and left ventricular ejection fraction < 40% were included. RESULTS: In patients with IHF peak early mitral inflow velocity (E), E/peak early diastolic mitral annular tissue Doppler velocity (Em) lateral, peak systolic mitral annular tissue Doppler velocity (Sm) lateral and logBNP were univariate predictors of hs-cTnT above median. But only E/Em lateral was an independent predictor of hs-cTnT above median (p = 0.04, HR: 1.2,CI: 1-1.4). In patients with DCM; left atrial volume index, male sex, Sm lateral and global longitudinal strain (LV-GLS) were included in multivariate model and LV-GLS was detected to be an independent predictor for hs-cTnT above median (p < 0.05, HR: 0.7, CI: 0.4-1.0). CONCLUSIONS: While LV-GLS is an independent predictor of hs-cTnT concentrations in patients with DCM, E/Em lateral predicted hs-TnT concentrations in patients with IHF.
Asunto(s)
Cardiomiopatía Dilatada/sangre , Insuficiencia Cardíaca/sangre , Ventrículos Cardíacos/diagnóstico por imagen , Isquemia Miocárdica/sangre , Troponina T/sangre , Función Ventricular Izquierda/fisiología , Biomarcadores/sangre , Cardiomiopatía Dilatada/complicaciones , Cardiomiopatía Dilatada/fisiopatología , Ecocardiografía Doppler , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/fisiopatología , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/fisiopatología , Pronóstico , Volumen SistólicoRESUMEN
Acute myocardial infarction (AMI) is a rare but often catastrophic event during pregnancy, delivery or puerperium, leading to a high mortality rate. It has different pathogenic mechanisms, such as atherosclerosis, vasospasm, thrombosis and coronary dissection. Although MI has been reported in pregnant women at all stages of pregnancy and postpartum, it occurs more commonly in the third trimester and most commonly involves the anterior wall. Evidence suggests that pregnancy itself is an independent risk factor for MI, conferring a three- to four-fold higher risk than that of nonpregnant women matched for age, possibly due to the unique physiological changes required to meet the demands of a growing foetus. We report a case of a 27-year-old woman with familial hyperlipidaemia presenting with myocardial infarction six days after caesarean delivery, secondary to severe left main coronary stenosis (LMCA), who was treated with emergency coronary artery bypass grafting (CABG).
Asunto(s)
Estenosis Coronaria/etiología , Hiperlipoproteinemia Tipo II/complicaciones , Infarto del Miocardio/etiología , Periodo Posparto , Complicaciones Cardiovasculares del Embarazo/etiología , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Cesárea , Angiografía Coronaria , Puente de Arteria Coronaria , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/cirugía , Electrocardiografía , Urgencias Médicas , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/tratamiento farmacológico , Hiperlipoproteinemia Tipo II/genética , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugía , Inhibidores de Agregación Plaquetaria/uso terapéutico , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/cirugía , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Acute type II aortic dissection and aortic coarctation are rare combined disorders. This report is of a patient with coarctation, a bicuspid aortic valve and type II dissection, who underwent emergency repair for the dissection, with aortic valve preservation. Repair of the coarctation was planned for a future occasion. The optimal sequence and timing of the repair, the best surgical technique, adequacy of blood perfusion, and the most appropriate arterial cannulation site are important issues in the repair of aortic dissection secondary to aortic coarctation.
Asunto(s)
Aneurisma de la Aorta/etiología , Coartación Aórtica/complicaciones , Disección Aórtica/etiología , Válvula Aórtica/anomalías , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedad Aguda , Adolescente , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/cirugía , Coartación Aórtica/diagnóstico , Coartación Aórtica/cirugía , Aortografía/métodos , Enfermedad de la Válvula Aórtica Bicúspide , Implantación de Prótesis Vascular , Ecocardiografía , Enfermedades de las Válvulas Cardíacas/diagnóstico , Humanos , Masculino , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: High levels of lipoprotein(a) [Lp(a)] are known to be a cardiovascular risk factor associated with premature coronary artery disease. In predicting the long term prognosis in acute coronary syndromes (ACS), the relationship between Lp(a) and risk scoring systems remains unclear. AIM: We investigated whether adding Lp(a) to the GRACE scoring system has an incremental value in predicting prognosis in ACS. METHODS: 115 patients (mean age 64 ± 11 years) with non-ST elevation acute coronary syndromes (NSTE-ACS) were enrolled in this prospective study. Patients were categorised into quartiles according to the Lp(a) levels. Statistically significant variables in the univariate analysis (haemoglobin, creatinine, age, left ventricular ejection fraction, previous myocardial infarction (MI) history, Killip class) were included in the multivariate analysis to determine the independent predictors of cardiovascular outcomes (mortality, rehospitalisation) with and without Lp(a) quartiles for one year follow-up. RESULTS: Previous MI history and Lp(a) quartile were detected as independent predictors of combined cardiovascular events (OR: 2.969 [95% CI 1.413-6.240] and OR: 6.279 [95% Cl 1.363-28.927] respectively). Lp(a) quartile also remained as an independent predictor for prognosis when added to a model based on GRACE risk score (OR: 2.589 [95% CI 1.402-4.780]). Serum Lp(a) levels were moderately correlated with GRACE risk score (r = 0.371; p < 0.001). CONCLUSIONS: Lipoprotein(a) has an additional prognostic value over GRACE risk score in predicting one-year adverse outcomes in NSTE-ACS. The combination of serum Lp(a) with GRACE risk score could provide enhanced risk stratification in patients with ACS.