Amir Aslani

Short QT Interval: A Novel Predictor of Androgen Abuse in Strength Trained Athletes

Objectives: To find the relationship between anabolic androgenic steroids (AAS) using and QT interval in athletes.

Left atrial volume: a novel predictor of hepatopulmonary syndrome.

OBJECTIVES:We studied patients with hepato-pulmonary syndrome (HPS). We found that HPS is frequently present in patients with left atrial enlargement. The aim of this prospective study was to evaluate the possible correlation between left atrial volume and HPS.METHODS:Adult patients (>18 yr old) with biopsy proven liver cirrhosis who were referred for liver transplantation were enrolled in the study. Diagnosis of HPS was established when the following points were fulfilled: (a) the presence of chronic liver disease, (b) increased alveolar-arterial difference (AaDO2), (c) intrapulmonary vascular dilatation, and (d) absence of primary cardiac or pulmonary disease.RESULTS:We enrolled 41 patients (mean age 47.1 ± 10.6 yr) diagnosed with HPS. Also 108 Child-Pugh score matched cirrhotic patients (mean age 49.2 ± 9.3 yr) who have negative contrast echocardiography and normal age-related AaDO2 were selected as a control group for the purpose of comparison of left atrial volume (LAV). LAV was significantly greater in patients with HPS compared to the control group (55.1 ± 7.5 mL vs 37.1 ± 9.3 mL, P < 0.05). The area under the receiver-operating characteristic (ROC) curve for LAV was 0.903 (Cut point ≥ 50 mL, sensitivity 86.3%, specificity 81.2%).CONCLUSION:In the context of liver cirrhosis, LAV ≥ 50 mL is a simple and feasible parameter to detect HPS.

The effect of left ventricular (LV) remodeling on ventricular arrhythmia in cardiac resynchronization therapy (CRT-D) patients (antiarrhythmic effect of CRT).

Background: In patients with low ejection fraction and ventricular dyssynchrony, cardiac resynchronization therapy (CRT) is an accepted therapeutic modality. In these patients, CRT can improve the quality of life and exercise tolerance in addition to improved survival. On the other hand, antiarrhythmic effects of CRT is a place of debate.

Significance of aortic atheroma in elderly patients with ischemic stroke. A hospital-based study and literature review.

OBJECTIVES Cardioembolism accounts for 15-30% of ischemic strokes. Transesophageal echocardiography (TEE) is useful in detecting potential sources of cardiac embolism. Aortic atheromas have recently been recognized as important causes of stroke. The aim of this study was to evaluate TEE findings in elderly patients with ischemic stroke. A review of literature was done to highlight the significance of aortic atherosclerotic disease in patients with ischemic stroke. METHODS One hundred consecutive patients with ischemic stroke aged > or =55 years underwent TEE for evaluation of cardiac sources of embolism. Patients with significant carotid artery stenosis (stenosis of >50% in common or internal carotid arteries) were excluded. RESULTS The most noteworthy finding was the high prevalence of complex atheromatous plaques in the ascending aorta and/or aortic arch (25%). CONCLUSION The present study demonstrates that TEE is helpful to detect cardiovascular sources of embolism in elderly patients with ischemic stroke. Aortic atheroma is present in 25% of elderly patients with ischemic stroke and without significant carotid artery stenosis. Aortic atherosclerosis may be an important cause of ischemic stroke in this population.

Endocardial hydatid cyst: a rare presentation of echinococcal infection

A previously well 45-year-old male presented with 20 days of being generally unwell with a fever and dyspnoea on exertion. Transthoracic echocardiography was done and revealed a round cystic structure (3 x 3 cm) attached to the tricuspid valve. Multiple small calcified particles (daughter cysts) were also seen in the cyst which was most consistent with the diagnosis of Hydatid cyst. The serology for Echinococcus granulosus antibody was positive and confirmed the diagnosis. The patient was sent for cardiac surgery and hydatid cyst which was endocardial in location, and adherent to the tricuspid valve leaflets was the intraoperative finding. The patient improved and was discharged on long-term chemotherapy. The most common cite of cardiac involvement is the myocardium followed by the pericardium, whereas endocardial involvement is extremely rare. In the present study, we demonstrated a very rare case of endocardial hydatid cyst with attachment to the tricuspid valve.

Effect of endurance and strength exercise on release of brain natriuretic peptide

Objectives: The aim of this study was to investigate the effects of 8-week endurance and resistance exercise training on release of brain natriuretic peptide. Materials and Methods: Study population was categorized into 4 groups: Group-1 (n = 6) consisted of sedentary individuals who volunteered to complete 8-weeks of endurance exercise; Group-2 (n=6) consisted of sedentary individuals who volunteered to complete 8-weaks of resistance exercise. Three blood samples [for Terminal pro BNP (NT-Pro-BNP)] were taken before, immediately after exercise and after 8 weeks of exercise training. Results: NT-Pro BNP was significantly increased immediately after endurance exercise [from 37.9 ± 1.4 pg/ml to 52.1 ±1.5 pg/ml; P = 0.002] and was decreased to 23.2 ± 9.3 pg/ml after 8 weeks of endurance exercise [P = 0.013]. On the other hand, NT-Pro BNP showed no significant changes immediately after resistance exercise [from 26.6 ± 4.9 pg/ml to 24.1 ±4.5 pg/ml; P = 0.553]. In contrast, NT-Pro BNP was significantly increased to 39.5 ±1.6 pg/ml after 8 weeks of resistance exercise [P = 0.012]. Conclusion: Endurance exercise training reduces circulating NT-Pro BNP concentration, which is likely a marker of reduced ventricular wall tension and improved myocardial function. In contrast, strength exercise induces significant increase in NT-Pro BNP, which could be partially attributed to myocardial damage.

Effect of chronic cocaine abuse on the elastic properties of aorta.

Background: Any unfavorable effect of cocaine on aortic elastic properties will contribute to the adverse effects of cocaine on the cardiovascular system. Objectives: The aim of this study was to evaluate the aortic elastic properties in long‐term crack cocaine abusers. Methods: Twenty‐eight consecutive chronic cocaine abusers and 36 control subjects with similar age, gender, cholesterol, and triglyceride plasma levels, as well as incidence of cigarette smoking, hypertension, and diabetes mellitus were enrolled in the study. Results: The average duration of cocaine abuse was 10 ± 3.2 years. Diastolic thoracic aortic diameter was increased in cocaine users compared with control subjects (P < 0.05). Aortic strain and distensibility were approximately twofold lower and aortic stiffness index approximately threefold higher in patients compared with control subjects (P < 0.01). The duration of cocaine abuse was related to low aortic strain and distensibility as well as increased aortic stiffness index (R =−0.32, R =−0.38, and R = 0.28, respectively, weighted for age; P < 0.01). When the cocaine abusers were divided into quartiles of duration of cocaine using (first quartile: <5 years; second quartile: >5 and <8 years; third quartile: >8 and <11 years; and fourth quartile: >11 years), progressive increase was found in aortic stiffness index. Conclusion: The present study demonstrates that chronic cocaine abuse clearly produces significant decrease in the elastic properties of aorta. This effect of cocaine is related to the duration of cocaine abuse.

Cardiac findings in Weill-Marchesani syndrome.

Weill-Marchesani syndrome (WMS) is a rare inherited disorder of connective tissue first described by Weill in 1932 [Weill, 1932] and further delineated by Marchesani [1939]. It is characterized by short stature, brachydactyly, joint stiffness, broad skull, heart defects and characteristic eye abnormalities including shallow orbits, microspherophakia, ectopia lentis, high myopia, and glaucoma [Faivre et al., 2003a; Harasymowycz and Wilson, 2004; Razeghinejad and Safavian, 2006]. Two modes of inheritance have been reported: autosomal dominant (OMIM #608328) and autosomal recessive (OMIM #277600) [Faivre et al., 2003a]. The diagnosis is based on the clinical manifestations since there is no biochemical test or histological marker [Dietlein et al., 1998; Asaoka et al., 2003]. Recently, mutations in ADAMTS10 (in autosomal recessive cases) and in FBN1 (in autosomal dominant cases) have been reported in some WMS patients [Dagoneau et al., 2004]. Mutations in ADAMTS10 are responsible for major impairment of the extracellular matrix not only in skin development but also in growth, lens, and heart development [Dagoneau et al., 2004]. Since only limited published data exist regarding cardiac manifestations in WMS, we evaluated electrocardiographic and echocardiographic features of six patients with WMS. Six patients with WMS, belonging to four independent families, were referred by an ophthalmologist for evaluation of the cardiovascular system. Patients 3, 4, and 5 are siblings. Parents were not related. All patients fulfilled the criteria [Megarbane et al., 2000] for WMS including short stature, brachydactyly, limitation of joint movement, enlarged interphalangeal joints, severe myopia, and glaucoma. Table I summarizes the clinical features of each patient (editorial note: full facial photographs could not be obtained because of cultural/religious sensitivities). There were no cardiac problems, brachydactyly or short stature in the parents. A 12-lead electrocardiogram was recorded from each patient. Baseline cardiac rhythm, PR interval, QRS duration, QRS axis, QTc interval (corrected QT interval) and ST-T changes were determined. Both a junior and a senior investigator examined each ECG and recorded the results separately. Any discrepancies between the junior and senior investigators were resolved by joint re-review of the findings. Participating patients underwent transthoracic echocardiography. The most noteworthy ECG abnormality was prolonged QTc (QTc> 0.46 sec) which was detected in three patients (50%) (Table II). The most common echocardiographic abnormality was mitral valve prolapse (MVP) which was detected in three patients (50%), two of whom also had prolonged QTc (Table III). The criterion for the diagnosis of MVP was systolic displacement of the mitral valve leaflets by more than 2 mm above the plane of the annulus in the parasternal view [Freed et al., 2002]. Patient 2 had severe congenital valvular aortic stenosis (maximum gradient1⁄4 107 mmHg) and was scheduled for aortic valve replacement. Tricuspid and pulmonary valve, aortic root diameter, and left ventricular ejection fraction were normal. ECG studies have not been previously reported in WMS syndrome. Although there are many other causes of long QT interval, such as electrolyte disturbances (notably hypokalemia); antiarrhythmic agents and various non-antiarrhythmic drugs (tricyclic antidepressants, antimicrobial, antifungal, and antihistaminic agents), these patients had not been known to use such medications, nor were electrolyte imbalances present. Because QT interval prolongation can be associated with serious

A Current Problem in Cardiology: Very Late Thrombosis after Implantation of Sirolimus Eluting Stent

Discontinuation of antiplatelet medications has been strongly associated with coronary stent thrombosis. The first reported cases have been documented at 6 h to 6 weeks after stent implantation. This article presents a case of very late stent thrombosis 24 months after sirolimus eluting stent implantation and 18 months after clopidogrel discontinuation, despite aspirin continuation, and argues in favor of prolonging dual antiplatelet medication including clopidogrel in this setting, at least until data from randomized trials address this important issue.

Aquarium sign in the left atrium.

A 50-year-old man presented with fever and chest pain. Later on the same day, he developed ischemic stroke and deteriorated into loss of consciousness. A trans-thoracic echocardiography showed air bubbles in the left atrium, resembling the floating bubbles in an aquarium. After further workups, atrio-esophageal fistula was diagnosed. To the best of our knowledge visualization of atrio-esophageal fistula by echocardiography has never been described previously.