Giovanni Bertero

CD14CD16 Monocyte Subset Levels in Heart Failure Patients

Our aim was to define the distribution of monocyte subsets in a cohort of congestive heart failure (CHF) patients, to verify whether increased severity of CHF is linked to the expansion of specific monocyte subsets, and finally to investigate the relationship between monocyte subset relative frequencies, laboratory parameters of inflammation, and monocyte ACE expression. Thirty consecutive CHF patients and 26 healthy control subjects were evaluated for peripheral blood monocyte expression of CD14, CD16 and CD143 (ACE) by flow-cytometry, and for endothelial-derived soluble CD146 levels by ELISA. CD14++CD16+ frequency was significantly higher in CHF patients than in Controls (%, median value and IQ) (12.3, 8.7–14.8 vs 5.9, 4.7–6.9, p++CD16+ levels. Frequencies of CD14+CD16+ monocytes were significantly lower in CHF patients as compared to Controls, and negatively correlated with levels of soluble CD146 (r = −0.529; p 0.048). In conclusion, monocytic CD14++CD16+ frequency and CD143 levels are increased and reflect disease status and progressive cardiac deterioration in CHF patients. The CD14+CD16+ subset is depleted in CHF and is linked to endothelial damage in this group of patients. Although the question of whether differences in monocyte CD14CD16 expansion are causal or whether they represent a marker of HF progression which is potentially relevant for risk prediction remains unanswered, we believe that our data represent an important tool for exploring the role of selective inflammatory pathways in CHF progression.

Adipose replacement and wall motion abnormalities in right ventricle arrhythmias: evaluation by MR imaging. Retrospective evaluation on 124 patients

We reevaluated the magnetic resonance (MR) examinations of 38 healthy volunteers (control group, CG) and of 124 patients with RV arrhythmia with left bundle branch block (LBBB) morphology: 45 with episodes of RV sustained tachycardia and of polymorphic RV premature beats (RVST-PPB group); 36 with only RV outflow tract sustained or not sustained tachycardia (RVOTT group); 43 with RV monomorphic premature beats (RVMPB group). All the examinations were reevaluated in a blinded fashion for detecting myocardial adipose replacement (AR) and wall bulges or aneurysms. In RVST-PPB patients, no AR was observed in 9%; 1 RV region involvement, 0%; 2 regions, 4%; ≥ 3 regions, 87%; left ventricle (LV), 15%. RVOTT patients: 28%, 53%, 14%, 5%, and 0%, respectively. RVMPB patients: 33%, 46%, 19%, 2%, and 0%, respectively. In CG, AR was observed in 11% (in RV outflow tract). RV bulges were detected in 75% of RVST-PPB , 39% of RVOTT, and 14% of RVMPB patients, none of the CG; RV aneurysms in 33% of RVST-PPB patients, none of RVOTT patients, RVMBP patients, and CG. A significant difference among groups for RV and LV AR as well as RV bulges and aneurysms was found (p < 0.0001). In the direct comparisons, significant differences were found for: disease duration (RVST-PPB vs. RVMPB, p = 0.0396); RV AR (all the patients groups vs. CG, RVST-PPB vs. RVOTT or RVMPB, p < 0.0001); RV aneurysms (RVST-PPB vs. CG. RVST-PPB vs. RVOTT or RVMPB, p < 0.0002); bulges (all comparisons, p < 0.0174). AR is confirmed as a structural substrate in RV arrhythmias. Number and extension of MR abnormalities are correlated to different degrees of RV arrhythmias.

Percutaneous treatment of left main coronary stenosis as a late complication of bentall operation for acute aortic dissection.

Severe ostial left main coronary stenosis developed 35 days after successful Bentall‐type operation for acute aortic dissection. Treatment of this kind of complication is usually performed with open chest coronary artery bypass grafting. In our case, treatment with percutaneous transluminal coronary angioplasty and stenting of the lesion immediately after diagnostic coronary angiography was performed successfully, with persisting good results at 9‐month clinical follow‐up. Catheter Cardiovasc Interv 2004;62:343–345.

Zero-Fluoroscopy Ablation of Accessory Pathways in Children and Adolescents: CARTO3 Electroanatomic Mapping Combined with RF and Cryoenergy.

Fluoroscopic catheter ablation of cardiac arrhythmias in pediatric patients exposes the patients to the potential risk of radiation considering the sensitivity of this population and its longer life expectancy. We evaluated the feasibility, safety, and efficacy of accessory pathway (AP) ablation guided by CARTO3 electroanatomic mapping (EAM) system with both cryoenergy and radiofrequency (RF) energy in order to avoid x‐ray exposure in pediatric patients.

Association between plasma insulin and angiographically documented significant coronary artery disease

Abstract The positive association we found between plasma insulin levels and angiographically documented significant CAD strengthens the epidemiologic view that hyperinsulinemia may be associated with an increased risk for CAD mortality and nonfatal myocardial infarction.

A dangerous fruit juice

We report the case of a female patient presenting to the emergency department with postprandial syncope and atrial fibrillation. After amiodarone administration, the electrocardiogram showed marked QT prolongation associated with ventricular arrhythmias, including an episode of torsade de pointes requiring immediate electrical cardioversion. During history taking, the patient reported that she had been drinking large amounts of grapefruit juice regularly. The inhibition of amiodarone metabolism induced by grapefruit juice was responsible for enhancing the proarrhythmic effects of the drug with development of electrical storm.

Magnetic resonance imaging in Bland-White-Garland syndrome

postoperative course was uneventful. The patient was discharged on the twelfth postoperative day and remained well3 months later. This case of ventricular septal defect is unique in that no direct perforation of the interventricular septum occurred. I t can be speculated that incomplete rupture originating from the left ventricular side of the posterior septum led to the dissection, with consecutive perforations toward the right ventricular side. This is supported by the finding that the sites of the perforations do not lay adjacent to each other as would otherwise be expected. It is surprising that the extent of the defect did not correlate with the severity of the symptoms and the only moderately elevated right ventricula~ pressures. Three-dimensional echo CT provided a better appreciation of the pathomorphologic mechanism (Fig. 1, right) and helped to explain this phenomenon by documenting only a small defect toward the right ventricle (Fig. 2), thus permitting only moderate left-toright shunting. The third chamber, which showed systolic enlargement, therefore acted as a pressure and volume reservoir. In conclusion, this case report documents for the first time a postischemic dissection of the interventricular septum with the development of a third chamber that communicates with both ventricles. The use of echo CT allowed complete three-dimensional representation of this defect.and provided both morphologic and functional clues that were not available by conventional echocardiographic imaging techniques. Further studies are necessary to delineate other potential implications of three-dimensional echocardiography.

Ranolazine for the treatment of atrial fibrillation

Introduction: Atrial fibrillation (AF) is a frequent occurrence with advancing age and is associated with increased morbidity and mortality. Unfortunately, the currently available AF therapies have a great deal of side effects. Areas covered: In this review, the authors discuss the evidence upon which the use of Ranolazine as an anti-arrhythmic drug is based. Specifically, the authors review the Phase I–III trials that studied ranolazine as potential treatment for AF. They also discuss the efficacy, safety, tolerability and side effects and compare the MERLIN TIMI 36, HARMONY and ROLE trials. Expert opinion: Although ranolazine is considered an anti-angina drug, it may also be, according to the available data, used in patients with AF. Ranolazine has anti-AF efficacy, both alone or in combination with other drugs such as amiodarone and dronedarone. Indeed, its efficacy has been demonstrated in various settings such as the termination of paroxysmal AF, the facilitation of AF electrical cardioversion, and postoperative AF prevention. Although there is a great deal of evidence from pioneering experimental studies, the clinical evidence of the AF-suppressing effect of ranolazine is derived from studies with small sample size or from secondary analyses. A better understanding of the role of ranolazine as an anti-AF drug will be obtained through larger, prospective, placebo-controlled clinical trials in different populations.

Biventricular Pacemaker Implantation via the Femoral Vein

We report the case of biventricular pacemaker implantation via the femoral vein, in a patient with impossibility of using standard superior vein approach and a contraindication to epicardial lead placement.

Citalopram and levosulpiride: a dangerous drug combination for QT prolongation.

We report the case of an 89-year-old female patient who presented to the emergency department after out-of-hospital cardiac arrest due to polymorphic ventricular tachycardia treated by public access defibrillation. The admission electrocardiogram (ECG) showed extreme QT prolongation (650 milliseconds) with recurrent episodes of nonsustained polymorphic ventricular tachycardia. Intravenous magnesium sulfate therapy was instituted. After history taking, it was found that the patient was on citalopram and that, 2 days prior to admission, she had begun treatment with levosulpiride. This drug combination resulted in marked prolongation of the QT interval that triggered the electrical storm.