Ignacio Laynez

The ACE/DD Genotype Is Associated With the Extent of Exercise-Induced Left Ventricular Growth in Endurance Athletes

OBJECTIVES We studied the impact of the angiotensin-converting enzyme (ACE)/DD genotype on morphologic and functional cardiac changes in adult endurance athletes. BACKGROUND Trained athletes usually develop adaptive left ventricular hypertrophy (LVH), and ACE gene polymorphisms may regulate myocardial growth. However, little is known about the impact of the ACE/DD genotype and D allele dose on the cardiac changes in adult endurance athletes. METHODS; Echocardiographic studies (including tissue Doppler) were performed in 61 male endurance athletes ranging in age from 25 to 40 years, with a similar period of training (15.6 +/- 4 h/week for 12.6 +/- 5.7 years). The ACE genotype (insertion [I] or deletion [D] alleles) was ascertained by polymerase chain reaction (DD = 27, ID = 31, and II = 3). Athletes with the DD genotype were compared with their ID counterparts. RESULTS The DD genotype was associated with a higher left ventricular mass index (LVMI) than the ID genotype (162.6 +/- 36.5 g/m(2) vs. 141.6 +/- 34 g/m(2), p = 0.031), regardless of other confounder variables. As a result, 70.4% of DD athletes and only 42% of ID athletes met the criteria for LVH (p = 0.037). Although systolic and early diastolic myocardial velocities were similar in DD and ID subjects, a more prolonged E-wave deceleration time (DT) was observed in DD as compared with ID athletes, after adjusting for other biologic variables (210 +/- 48 ms vs. 174 +/- 36 ms, respectively; p = 0.008). Finally, a positive association between DT and myocardial systolic peak velocity (medial and lateral peak S(m)) was only observed in DD athletes (p = 0.013, r = 0.481). CONCLUSIONS The ACE/DD genotype is associated with the extent of exercise-induced LVH in endurance athletes, regardless of other known biologic factors.

Prognostic Value of Echocardiographic‐Derived Calcium Index in Coronary Artery Disease Diagnosed by 64‐Multidetector Computed Tomography

Purpose: To determine whether echocardiographic calcium index (ECI) calculated using transthoracic echocardiography (TTE) predicts coronary ischemic events. We also wished to determine coronary artery calcium score (CACS), the presence of obstructive coronary artery disease (CAD) and plaque composition, all of which were assessed by multidetector computed tomography (MDCT). Methods: We carried out a prospective cohort study of 82 consecutive outpatients with chest pain and low‐moderate risk of CAD, referred for noninvasive coronariography by MDCT. ECI was blindly assessed by TTE and correlated with subsequent cardiovascular events during a follow up period of 36 months. Results: ECI values of ≥7 had a sensitivity of 77.3%, a specificity of 90%, positive predictive value of 73.9%, and negative predictive value of 91.5% with respect to future coronary ischemic events. In addition, patients with ECI ≥ 7 showed a greater presence of severe calcified and obstructive CAD and a linear increase of obstructed vessels and mixed and calcified plaques, with a linear trend according to ECI values. Conclusion: ECI values of ≥7 determine poor CAD prognosis in relation to ischemic events. Furthermore, ECI ≥ 7 may serve as a marker of content of coronary artery calcium, intraluminal obstruction, and plaque composition. Therefore, ECI seems to provide prognostic information as well as information about the characteristics of the plaque of atheroma.

Pulmonary valve infective endocarditis in an adult patient with severe congenital pulmonary stenosis and ostium secundum atrial septal defect.

A hypertensive 76-year-old man with severe pulmonary valve stenosis (PVS) and recent initiation of haemodialysis was referred with fever, chills, and asthenia. One month prior, he had been admitted with similar symptoms. Transthoracic echocardiography (TTE) had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and blood cultures positive for Staphylococcus haemolyticus. A new TTE revealed two pulmonary valve vegetations and a previously undetected ostium secundum-type atrial septal defect (ASD), confirmed by transesophageal echocardiography. The clinical course was uneventful with intravenous antibiotic treatment and the patient was safely discharged. This is a case of pulmonary valve infective endocarditis (IE). The incidence of right-sided IE is on the rise due to the increased number of patients using central venous lines, pacing, haemodialysis and other intravascular devices. Pulmonary valve IE is extremely rare, especially in structurally normal hearts. The case reported here, presents a combination of predisposing factors, such as severe congenital PVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVS and associated with a previously undiagnosed ASD, is also an unusual feature of this case, making it even more interesting.

Posterior Descending Artery Milking-Like Effect Caused by Ventricle Pseudoaneurysm Compression

A 78-year-old man with a history of smoking, hypertension, and peripheral vascular disease presented with prolonged chest pain during the previous 48 hours. On admission, he was still symptomatic and the ECG showed Q waves and 2-mm ST elevation in leads II, III, and aVF, with a 2-mm persistent ST depression in leads C2 to C5 (Figure 1). Serial cardiac enzymes were positive for myocardial necrosis. Cardiac catheterization showed …

Early Transthoracic Echocardiography after Cardiac Surgery Predicts Postoperative Atrial Fibrillation.

Postoperative atrial fibrillation (POAF) is frequent after cardiac surgery. We aimed to establish a predictive model of POAF based on postoperative transthoracic echocardiography (TTE) findings.

Left Atrial Dysfunction and New-Onset Atrial Fibrillation After Cardiac Surgery

INTRODUCTION AND OBJECTIVES Postoperative atrial fibrillation is a common complication of carrying out cardiac surgery with extracorporeal circulation (ECC). The aim of this study was to determine whether preoperative left atrial contractile dysfunction, as assessed by tissue Doppler echocardiography, is associated with the development of postoperative new-onset atrial fibrillation (PAF). METHODS Transthoracic Doppler echocardiography was performed preoperatively in patients undergoing elective cardiac surgery. Left atrial contractile function was evaluated by tissue Doppler imaging (TDI) of the mitral annulus. RESULTS The study included 92 patients in sinus rhythm preoperatively who underwent elective cardiac surgery with ECC: 73 (79%) were male and 19 (21%) were female, and their mean age was 67 (10) years. Of these, 19 (20.6%) developed PAF 34 (12) h postoperatively. Bivariate analysis showed that PAF was associated with older age (71 [7] years vs 66 [10] years; P=.034), a large left atrial diameter (LAD), and a low peak atrial systolic mitral annular velocity (A velocity) and a high mitral E/A ratio on TDI. Logistic regression analysis showed that PAF was independently associated with a large LAD (odds ratio [OR] =2.23; 95% confidence interval [CI], 1.05-4.76; P=.033) and a low A velocity (OR=0.70; 95% CI, 0.55-0.99; P=.034). CONCLUSIONS Preoperative left atrial dysfunction, as assessed by TDI, was associated with an increased risk of PAF.

Ventricular Late Potentials and Degree of Reperfusion of the Infarct-Related Artery

Background: Patency of the infarct‐related artery is known to be a powerful determinant of the prognosis after AMI. Most studies have reported a lower incidence of late potentials from patients treated with thrombolytic agents than patients not so treated. The purpose of this study was to evaluate the use of ventricular late potentials in the first week after AM1 to differentiate patients according to the TIMI flow in the infarct‐related artery.

Myocardial Infiltration by Oxalate: A Rare Case of Cardiomyopathy by Accumulation of Oxalate in a 53-Year-Old Woman

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4][![Graphic][5] ][5] A 53-year-old woman had a cardiac deposit of oxalate due to primary hyperoxaluria causing progressive dilated and restrictive cardiomyopathy, with some admissions for heart failure. Primary hyperoxaluria

Infectious endocarditis due to Streptococcus pneumoniae in a cardiac surgery patient: a new form of clinical presentation

High mortality associated with pneumococcal endocarditis is due to late diagnosis and the frequency of complications, which usually require early diagnostic and intensive therapeutic measures. We present the first reported case of pneumococcal endocarditis with simultaneous infection of an aortic prosthetic valve, native tricuspid valve, and permanent pacemaker lead.

An Unusual Appearance of Fibrin Sheaths after Implantable Cardioverter‐Defibrillator Removal Because of Infective Endocarditis

We report the case of a 26-year-old woman with dilated cardiomyopathy bearing an implantable cardioverter-defibrillator (ICD) who developed infective endocarditis. Transesophageal echocardiography (TEE) (Philips iE33, Advanced Diagnostics, Palo Alto, CA, USA) showed a vegetation attached to an electrode lead with a typical morphology and motion (Fig. 1, arrow, see movie clip S1). The ICD and 2 electrode leads were removed. A new TEE (Fig. 2, arrows, see movie clip S2) showed a bright linear calcific density in the superior vena cava (SVC), which was suggestive of a retained fibrin “sleeve.” A computed tomography scan (Aquilon, Toshiba Medical Systems, Tokyo, Japan) with contrast (Fig. 3, arrow) showed the filling defect caused by “fibrin