Enrico Vizzardi

Effects of Oral Amino Acid Supplements on Functional Capacity in Patients with Chronic Heart Failure

Amino acids (AAs) availability is reduced in patients with heart failure (HF) leading to abnormalities in cardiac and skeletal muscle metabolism, and eventually to a reduction in functional capacity and quality of life. In this study, we investigate the effects of oral supplementation with essential and semi-essential AAs for three months in patients with stable chronic HF. The primary endpoints were the effects of AAs supplementation on exercise tolerance (evaluated by cardiopulmonary stress test and six minutes walking test (6MWT)), whether the secondary endpoints were change in quality of life (evaluated by Minnesota Living with Heart Failure Questionnaire—MLHFQJ and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. We enrolled 13 patients with chronic stable HF on optimal therapy, symptomatic in New York Heart Association (NYHA) class II/III, with an ejection fraction (EF) <45%. The mean age was 59 ± 14 years, and 11 (84.6%) patients were male. After three months, peak VO2 (baseline 14.8 ± 3.9 mL/minute/kg vs follow-up 16.8 ± 5.1 mL/minute/kg; P = 0.008) and VO2 at anaerobic threshold improved significantly (baseline 9.0 ± 3.8 mL/minute/kg vs follow-up 12.4 ± 3.9 mL/minute/kg; P = 0.002), as the 6MWT distance (baseline 439.1 ± 64.3 m vs follow-up 474.2 ± 89.0 m; P = 0.006). However, the quality of life did not change significantly (baseline 21 ± 14 vs follow-up 25 ± 13; P = 0.321). A non-significant trend in the reduction of NT-proBNP levels was observed (baseline 1502 ± 1900 ng/L vs follow-up 1040 ± 1345 ng/L; P = 0.052). AAs treatment resulted safe and was well tolerated by all patients. In our study, AAs supplementation in patients with chronic HF improved exercise tolerance but did not change quality of life.

Tako-tsubo-like left ventricular dysfunction: transient left ventricular apical ballooning syndrome

Aims/objectives:u2002 This review examines the ‘tako‐tsubo‐like’ syndrome or transient left ventricular apical ballooning. The aim of this review is a complete evaluation of epidemiology, clinical and instrumental features, pathophysiological mechanisms, therapy and prognosis of this syndrome.

A quadricuspid aortic valve associated with severe aortic regurgitation and left ventricular systolic dysfunction

We report a case of a quadricuspid aortic valve associated with severe aortic regurgitation and left ventricular systolic dysfunction.

Thrombus or tumor? a case of fibroelastoma as indicated during the submission process

We describe the case of a 50-year-old woman who was admitted to a pheriferal department for heart failure. The echocardiography revealed a small mass measuring about 1.3 × 1.0 cm adhering to the non-coronary cusp of the aortic valve, mild dilated cardiomiopathy and severe biventricular dysfunction. This mass had erroneously been considered a thrombotic lesion, so the patient was treated with thrombolysis and heparin e.v. Only after a transoesophageal echocardiography a tumour cardiac mass was suspected. The diagnosis of fibroelastoma was confirmed by MRI and then from the anatomic and histoligical definition after surgery.

Aortic stiffness and left ventricular hypertrophy in rheumatoid arthritis: comment on the article by Rudominer et al.

ation. The data from our meta-analysis support the findings of Rudominer et al, and help to describe the effect of RA on the heart. In conclusion, we believe that left ventricular structural and functional changes are one of the established clinical features of RA, and the challenge will now be to find ways to utilize this information both to optimize clinical monitoring and to reduce cardiovascular mortality in RA patients.

Rheumatoid arthritis and diabetes mellitus: Two faces of one coin? Comment on the article by Peters et al

tion in our study may be due to the small sample size. However, in the larger study by Impens et al, the same lack of correlation was found (1). Considering the growing evidence discussed previously, we believe that a health professional’s simple question (e.g., Are problems in sexual functioning present?) would be acceptable for most patients. Moreover, considering the frequently mentioned scleroderma-specific complaints (1), it is very likely that a considerable number of female patients may benefit from simple health interventions (vaginal lubricants, medication advice, relaxation techniques, and energy conservation) provided by either their rheumatologist or another consulted health professional. In other chronic impairments, it has been recognized that dealing with sexual problems should be addressed in medical rehabilitation (2,3), although reluctance of both patients and health professionals to discuss sexuality is known. The low percentage (16%) of our patients indicating a need to talk about possible sexual problems cannot be explained easily and demonstrates the need for further studies. The reported proportion pertains to the whole group we studied, and not to the subgroup of patients with sexual impairments. Moreover, there is research illustrating that patients expect sexual issues to be brought up by the health professional and not by themselves (4). Although basic patient education through pamphlets (as advocated by Knafo et al) contributes to open communication, it also leaves the initiative with the patient and creates a risk of avoidance of the subject. We agree with Knafo and colleagues that an important condition for discussing matters of sexuality is a health professional who is comfortable with the subject. In a large British survey, it was found that doctors discussed sexual issues significantly more often than other health professionals (n 813) (5). The self-rated sexologic competence (scale of 0–10 with 10 being excellent) of 42 physicians in the Netherlands (6) was found to be less than sufficient before training (mean SD 5.8 1.1) and sufficient after a training (mean SD 6.7 1.2), which illustrates the need for improvement of competences.

Acute thrombosis in mitralic mechanical prosthesis: a case report

We describe a case of a man, 42 years old, submitted to successful fibrinolitic strategy with rTPA in acute mitralic prosthesis valve thrombosis and ipomobility of one emidisk. There arent a consensus agreement in therapeutic strategy but we may support the approach of some authors that employ fibrinolisis in patients without absolute or relative controindications and if thrombus dimension is less than 1 cm otherwise they make use of heparin therapy in non obstructive thrombosis with successive transesophageal echocardiography evaluation for the efficacy and the later indication for thrombolisis or surgery treatment.

Asymptomatic quadricuspid aortic valve

A 45-year-old man with isolated hypertension underwent routine echocardiography. Transthoracic examination revealed left ventricular concentric hypertrophy, mild tricuspid regurgitation and images suggestive of a bicuspid aortic valve. Transesophageal examination revealed a quadricuspid aortic valve (QAV) with normal coronary origin (four sinuses of Valsalva and four aortic cusps), x-configuration, a Greek cross appearance in diastole (Figure 1) and a rhomboidal shape in systole (Figure 2). Mild aortic regurgitation was present, but had no hemodynamic significance. Considering the absence of symptoms and valvular lesions, we recommended only endocarditis prophylaxis. n n n nFigure 1 n nQuadricuspid aortic valve in diastole n n n n n nFigure 2 n nQuadricuspid aortic valve in systole n n n nQAV is a very uncommon congenital anomaly, with an incidence of 0.008% to 0.033% (1) and equal sex distribution (2). QAV is usually diagnosed during autopsy or vascular surgery, and less frequently diagnosed with echocardiography or aortography (1). QAV may be found as an isolated lesion or in association with aortic valvular disease, usually regurgitation. In the literature, we found associations with other congenital anomalies such as ventricular septal defect (2), hypoplasia of the anterior mitral leaflet, subaortic fibromuscular stenosis, patent ductus arteriosus (2), pulmonary artery stenosis (3), supraventricular arrhythmias (4), complete atrioventricular block and coronary artery anomalies (2,4). Hurwitz and Roberts (2) classified QAV into seven anatomical variations related to cusp dimensions. Asymmetrical QAV appears to be more associated with valvular disease (regurgitation or stenosis) as a consequence of turbulence flow through the valve and shear stress, leading to fibrotic thickening of the cusps (1).