International journal of cardiology
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Comment Letter
Coronary allograft vasculopathy and coronary vasospasm in heart transplant recipients: a manifestation of Kounis syndrome?
The pathophysiology of vasculopathy of cardiac allografts is still unknown. Coronary vasospasm and thrombosis are some rare manifestations accompanying this entity. Hypersensitivity processes and the hypersensitivity coronary syndrome (Kounis syndrome) may be associated with this potentially fatal complication. Research efforts towards this direction may shed light for prevention and treatment of this disease.
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Randomized Controlled Trial Multicenter Study Comparative Study
Atrial septal defects versus ventricular septal defects in BREATHE-5, a placebo-controlled study of pulmonary arterial hypertension related to Eisenmenger's syndrome: a subgroup analysis.
Eisenmenger's syndrome (ES) is the most advanced form of pulmonary arterial hypertension related to congenital heart disease. Evolution of pulmonary vascular disease differs markedly between patients with atrial septal defects (ASD) versus ventricular septal defects (VSD), potentially affecting response to treatment. We compared the effects of bosentan and placebo in patients with isolated ASD (ASD subgroup) versus patients with isolated VSD or both defects (VSD subgroup). ⋯ Improvements in exercise capacity and cardiopulmonary hemodynamics, without desaturation, were observed in ES patients with both ASDs and VSDs. Although not reaching statistical significance, improvements were similar to those in the BREATHE-5 analyses, suggesting that the location of septal defects is not a key determinant of treatment response. These data further support the use of bosentan for the treatment of ES, independent of shunt location.
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Comment Letter
Is warfarin still underused in patients with atrial fibrillation? A major threat to treatment benefit.
Atrial fibrillation may cause thromboembolic events and the risk of thromboembolic events increase with the number of clinical and echocardiographic risk factors. Although the benefit of anticoagulant therapy in preventing thromboembolic events was clearly shown, a significant number of patients with atrial fibrillation were not under anticoagulant therapy. However, whatever the patient's reason for warfarin underutilisation, probably it is the main obstacle for reducing stroke risk in atrial fibrillation. Consequently, it makes the use of any risk factor calculation useless.
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Cardiac cachexia as a terminal stage of chronic heart failure carries a devastating prognosis. This article focuses on novel insights into the pathophysiology and on new treatment approaches to cardiac cachexia. Drugs that have been used in preclinical and clinical studies that may also confer beneficial effects in cardiac cachexia include but are not limited to the type 4 melanocortin receptor antagonist SNT 207979, the appetite promoting synthetic ghrelin SUN11031, the soluble myostatin decoy receptor ActRIIB-Fc, the fast skeletal muscle troponin activating substance CK-2017357, the anti-catabolic/anabolic transforming agent MT-102, the anti-inflammatory agent celecoxib, and testosterone supplementation.
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Letter Clinical Trial
Usefulness of left atrial volume for the diagnosis of diastolic heart failure: an echocardiographic-catheterization study.
The present study attempted to determine the accuracy of left atrial volume (LAVi) by transthoracic echocardiography in the diagnosis of diastolic heart failure (DHF) in patients presenting with chronic, isolated dyspnea. We included 28 consecutive patients with a left ventricular ejection fraction >50% without prior history of heart failure. ⋯ LAVi>38 ml/m(2) was a useful predictor of DHF (area under the ROC curve of 0.84 [0.65-0.95], p<0.001, sensitivity 60%, specificity 100%). The standard cut-off value of 34 ml/m(2) was 70% sensitive and 88% specific.