Gheorghe Pop

Cardiac complication after experimental human malaria infection: a case report

A 20 year-old healthy female volunteer participated in a clinical Phase I and IIa safety and efficacy trial with candidate malaria vaccine Pf LSA-3-rec adjuvanted with aluminium hydroxide. Eleven weeks after the third and last immunization she was experimentally infected by bites of Plasmodium falciparum- infected mosquitoes. When the thick blood smear became positive, at day 11, she was treated with artemether/lumefantrine according to protocol. On day 16 post-infection i.e. two days after completion of treatment, she woke up with retrosternal chest pain. She was diagnosed as acute coronary syndrome and treated accordingly. She recovered quickly and her follow-up was uneventful. Whether the event was related to the study procedures such as the preceding vaccinations, malaria infection or antimalarial drugs remains elusive. However, the relation in time with the experimental malaria infection and apparent absence of an underlying condition makes the infection the most probable trigger. This is in striking contrast, however, with the millions of malaria cases each year and the fact that such complication has never been reported in the literature. The rare occurrence of cardiac events with any of the preceding study procedures may even support a coincidental finding.Apart from acute coronary syndrome, myocarditis can be considered as a final diagnosis, but the true nature and patho-physiological explanation of the event remain unclear.

Improved neurocognitive functions correlate with reduced inflammatory burden in atrial fibrillation patients treated with intensive cholesterol lowering therapy.

BackgroundAtrial fibrillation (AF) is associated with increased mortality and morbidity, including risk for cerebral macro- and microinfarctions and cognitive decline, even in the presence of adequate oral anticoagulation. AF is strongly related to increased inflammatory activity whereby anti-inflammatory agents can reduce the risk of new or recurrent AF. However, it is not known whether anti-inflammatory therapy can also modify the deterioration of neurocognitive function in older patients with AF. In the present study, older patients with AF were treated with intensive lipid-lowering therapy with atorvastatin 40 mg and ezetimibe 10 mg, or placebo. We examined the relationship between neurocognitive functions and inflammatory burden.FindingsAnalysis of inflammatory markers revealed significant reductions in high sensitivity C-reactive protein (hs-CRP), fibroblast growth factor (FGF), granulocyte colony-stimulating factor (G-CSF), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-1 receptor antagonist (IL-1RA), interleukin (IL)-9, IL-13 and IL-17, and interferon-γ (IFNγ) in the treatment group compared to placebo. Reduction in plasma concentration of IL-1RA, IL-2, IL-9 and IL-12, and macrophage inflammatory protein-1β (MIP-1β) correlated significantly with improvement in the neurocognitive functions memory and speed. Loss of volume in amygdala and hippocampus, as determined by magnetic resonance imaging (MRI), was reduced in the treatment arm, statistically significant for left amygdala.ConclusionsAnti-inflammatory therapy through intensive lipid-lowering treatment with atorvastatin 40 mg and ezetimibe 10 mg can modify the deterioration of neurocognitive function, and the loss of volume in certain cerebral areas in older patients with AF.Trial registration Clinical Trials.govNCT00449410

Atrial Fibrillation: Inflammation in Disguise?

Atrial fibrillation is highly prevalent, and affected patients are at an increased risk of a number of complications, including heart failure and thrombo‐embolism. Over the past years, there has been increasing interest in the role of inflammatory processes in atrial fibrillation, from the first occurrence of the arrhythmia to dreaded complications such as strokes or peripheral emboli. As the standard drug combination which aims at rate control and anticoagulation only offers partial protection against complications, newer agents are needed to optimize treatment. In this paper, we review recent knowledge regarding the impact of inflammation on the occurrence, recurrence, perpetuation and complications of the arrhythmia, as well as the role of anti‐inflammatory therapies in the treatment for the disease.

Safety of the combination of intensive cholesterol-lowering therapy with oral anticoagulation medication in elderly patients with atrial fibrillation: a randomized, double-blind, placebo-controlled study.

BackgroundThe incidence of atrial fibrillation (AF) is very high in the elderly, and often oral anticoagulation (OAC) is indicated to prevent thromboembolism.ObjectiveThe aim of this study was to evaluate the safety of combining intensive cholesterol-lowering therapy with OAC in elderly patients with AF.MethodsIn a randomized, double-blind trial, 34 patients received OAC plus atorvastatin 40 mg/day and ezetimibe 10 mg/day versus placebo over 1 year. Dose adjustments of OAC served as an indicator of an interaction between HMG-CoA reductase inhibitors (statins) and OAC. Safety was evaluated by the occurrence of bleeding and a rise in AST, ALT and creatine phosphokinase.ResultsCompared with a 6-month pre-intervention period, the mean daily dose±standard error of OAC was 4.4±1.5% lower in the treatment group (p=0.003) and virtually the same in the placebo group (change from baseline: −0.1±1.3%, p=0.96). The mean daily dose of OAC stabilized after 3 months. In the 6-month post-intervention period, OAC dosing showed no statistically significant change from baseline: −1.9±1.9% in the placebo arm and −2.6±2.1% in the intervention arm.ConclusionWe conclude that in elderly AF patients treated with OAC, intensive cholesterol-lowering therapy (atorvastatin 40 mg/day and ezetimibe 10 mg/day) is well tolerated. No increased risk in bleeding was found.

Dual Site Coronary Sinus Pacing in a Patient with an Artificial Tricuspid Valve Prosthesis

For safety reasons, two leads for left ventricular pacing were implanted in the coronary sinus of a pacemaker dependent patient with an artificial tricuspid valve prosthesis.

Inverse Correlation Between Cardiac Injury and Cardiac Anxiety A Potential Role for Communication

Objective:General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. Methods:We assessed cardiac anxiety in 237 patients admitted with ACS using the Cardiac Anxiety Questionnaire and gathered information on sociodemographic, psychological, and cardiac disease characteristics. Univariate, multivariate logistic, and linear regression analyses were used to determine which characteristics were associated with cardiac anxiety. Results:Cardiac anxiety was not associated with sociodemographic variables. More severe cardiac injury, as indicated by ST-elevated myocardial infarction and troponin level, was associated with less cardiac anxiety. Psychological variables (depressive symptoms, agoraphobic cognitions, avoidance behavior) were associated with more cardiac anxiety. Discussion:Cardiac anxiety in ACS patients is associated with more psychological distress but lower severity of cardiac injury as indicated by ST-elevated myocardial infarction and troponin level. Two explanations seem likely for this latter finding. First, anxious persons might seek help earlier, thus being diagnosed more often with minor cardiac pathology. Second, cardiac anxiety might partly be caused by diagnostic uncertainty. Future research should focus on communication strategies to reassure patients more efficiently.