International journal of cardiology
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Letter Comparative Study
Accuracy of Doppler-derived pulmonary artery hypertension to predict heart failure with normal ejection fraction.
Recent advances have highlighted the clinical relevance of pulmonary artery hypertension in terms of diagnosis and prognosis in heart failure with normal ejection fraction. We addressed the usefulness of Doppler-derived pulmonary artery systolic pressure to predict heart failure with normal ejection fraction in stable patients with exertional dyspnea. 25 patients referred for clinically indicated catheterism with evidence of heart failure according to the European diagnostic flowchart on "how to diagnose heart failure with normal ejection fraction" and 12 controls referred for clinically indicated catheterism without this condition according to the diagnostic flowchart on "how to exclude heart failure with normal ejection fraction" were included. ⋯ Positive and negative predictive values were 93 and 50% for the cut-off value of 40 mmHg. Doppler-derived pulmonary artery hypertension is a landmark of heart failure with normal ejection fraction in patients without severely increased pulmonary vascular resistance and deserves further attention in upcoming international recommendations.
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Letter Case Reports
Tako-tsubo cardiomyopathy mimicking acute aortic dissection: a case report.
Tako-Tsubo cardiomyopathy is characterized by a transient and reversible left ventricular dysfunction possibly due to a catecholamine-mediated myocardial stunning. This form of cardiomyopathy is rarely associated with cardiogenic shock. Here we report on a patient with Tako-Tsubo cardiomyopathy induced low output failure in which blood flow disturbances in the thoracic aorta mimicked an acute type A aortic dissection.
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Letter Case Reports
Revelation of an obstructive hypertrophic cardiomyopathy in an elderly patient.
Hypertrophic cardiomyopathy (HCM) is classified as a primary cardiomyopathy. HCM is a clinically heterogeneous but relatively common autosomal dominant genetic heart disease that probably is the most frequently occurring cardiomyopathy. HCM is characterized morphologically and defined by a hypertrophied, nondilated left ventriculum (LV) in the absence of another systemic or cardiac disease that is capable of producing the magnitude of wall thickening evident (e.g., systemic hypertension, aortic valve stenosis). ⋯ Determination of the exact site of the hypertrophy and of the obstruction of the left ventricular outflow tract, in asymmetric septal hypertrophy, establishes which is the best treatment strategy. In the treatment of HOCM, drug therapy with negatively inotropic drugs, percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion, surgical myectomy and DDD pacemaker therapy are considered the therapeutical options. We present a case of an obstructive hypertrophic cardiomyopathy in an 84-year-old Italian woman with a left ventricular outflow tract (LVOT) peak gradient with the Valsalva maneuver of 188 mm Hg and with a history of first episode of syncope.
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Comment Letter
The effects of achieving hypothermia early in a heterogeneous population of patients with cardiac arrest.
In a recent article Wolff et al. (2009) present highly interesting results bearing on how timing of therapeutic hypothermia might affect outcome. However, some of their analyses are unadjusted for heterogeneities in the patient population, while others indicate a statistical model break-down. ⋯ It is well-known that in observational studies it is important to adjust for all important covariates, not only statistically significant ones. Hence, we caution against drawing firm conclusions from this study.
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Comment Letter
Red cell distribution width and acute coronary syndromes.
It is well known that red cell distribution width (RDW) levels are affected by various clinical manifestations such as iron deficiency, thrombocytopenia, and inflammatory diseases. In the present study, the authors investigated to examine the prognostic significance of various plasma biomarkers in patients with known or suspected coronary artery disease. ⋯ They did not measure other factors including iron, vitamin B12, folate, and platelet count. In this study, because of all these causes, high RDW levels are unavailable as an independent predictor of mortality in patients with acute coronary syndromes.