James Wever-Pinzon

Recurrent Takotsubo cardiomyopathy presenting with different morphologic patterns

ing intestinal angioedema: CT appearance. AJR Am J Roentgenol Dec 1993;161(6): 1215–6. [36] Orr KK, Myers JR. Intermittent visceral edema induced by long-term enalapril administration. Ann Pharmacother May 2004;38(5):825–7. [37] Spahn TW, Grosse-Thie W, Mueller MK. Endoscopic visualization of angiotensinconverting enzyme inhibitor-induced small bowel angioedema as a cause of relapsing abdominal pain using double-balloon enteroscopy. Dig Dis Sci May 2008;53(5):1257–60. [38] Byrne TJ, Douglas DD, Landis ME, Heppell JP. Isolated visceral angioedema: an underdiagnosed complication of ACE inhibitors?Mayo Clin Proc Nov 2000;75(11): 1201–4. [39] Troy DSKM. ACE inhibitor angioedema of the intestine: a case report and review of literature. Am J Med Sci 2002;324(2):106–8. [40] KarimMY, Masood A. Fresh-frozen plasma as a treatment for life-threatening ACEinhibitor angioedema. J Allergy Clin Immunol Feb 2002;109(2):370–1. [41] Warrier MRCC, Dykewicz MS, Slavin RG. Fresh frozen plasma in the treatment of resistant angiotensin converting enzyme inhibitor angioedema. Ann Allergy Asthma Immunol 2004(92):573–5. [42] Bas M, Adams V, Suvorava T, Niehues T, Hoffmann TK, Kojda G. Nonallergic angioedema: role of bradykinin. Allergy Aug 2007;62(8):842–56. [43] Shewan LG, Coats AJ. Ethics in the authorship and publishing of scientific articles. Int J Cardiol 2010;144:1–2.

Clinical and histopathological effects of heart failure drug therapy in advanced heart failure patients on chronic mechanical circulatory support

Adjuvant heart failure (HF) drug therapy in patients undergoing chronic mechanical circulatory support (MCS) is often used in conjunction with a continuous‐flow left ventricular assist device (LVAD), but its potential impact is not well defined. The objective of the present study was to examine the effects of conventional HF drug therapy on myocardial structure and function, peripheral organ function and the incidence of adverse events in the setting of MCS.

Cardiac Rotational Mechanics As a Predictor of Myocardial Recovery in Heart Failure Patients Undergoing Chronic Mechanical Circulatory Support: A Pilot Study

Background: Impaired qualitative and quantitative left ventricular (LV) rotational mechanics predict cardiac remodeling progression and prognosis after myocardial infarction. We investigated whether cardiac rotational mechanics can predict cardiac recovery in chronic advanced cardiomyopathy patients. Methods and Results: Sixty-three patients with advanced and chronic dilated cardiomyopathy undergoing implantation of LV assist device (LVAD) were prospectively investigated using speckle tracking echocardiography. Acute heart failure patients were prospectively excluded. We evaluated LV rotational mechanics (apical and basal LV twist, LV torsion) and deformational mechanics (circumferential and longitudinal strain) before LVAD implantation. Cardiac recovery post-LVAD implantation was defined as (1) final resulting LV ejection fraction ≥40%, (2) relative LV ejection fraction increase ≥50%, (iii) relative LV end-systolic volume decrease ≥50% (all 3 required). Twelve patients fulfilled the criteria for cardiac recovery (Rec Group). The Rec Group had significantly less impaired pre-LVAD peak LV torsion compared with the Non-Rec Group. Notably, both groups had similarly reduced pre-LVAD LV ejection fraction. By receiver operating characteristic curve analysis, pre-LVAD peak LV torsion of 0.35 degrees/cm had a 92% sensitivity and a 73% specificity in predicting cardiac recovery. Peak LV torsion before LVAD implantation was found to be an independent predictor of cardiac recovery after LVAD implantation (odds ratio, 0.65 per 0.1 degrees/cm [0.49–0.87]; P=0.014). Conclusions: LV rotational mechanics seem to be useful in selecting patients prone to cardiac recovery after mechanical unloading induced by LVADs. Future studies should investigate the utility of these markers in predicting durable cardiac recovery after the explantation of the cardiac assist device.

Recovery of Myocardial Capillary Bed (Microvascular) Density Persists in Long Term Follow Up of CAV Patients Treated With Sirolimus

(r= 0.45, p< 0.001), age (r= 0.33, p< 0.01), time after transplantation (r= 0.23, p< 0.05), copeptin (r= -0.42, p< 0.001), sTfR (r= 0.24, p< 0.05), hemoglobin (r= -0.42, p< 0.001), transferrin (r= -0.31, p< 0.01) haptoglobin (r= 0.39, p< 0.001), cystatin C (r= 0.55, p< 0.001), ejection fraction-EF (r= -0.28, p< 0.05), NYHA class (r= -0.41, p< 0.01) hsCRP (r= 0.26, p< 0.05), IL-6 (r= 0.23, p< 0.05), vWF (r= -0.40, p< 0.001) and midkine (r= 0.33, p< 0.01). In multivariate analysis, only creatinine was found to be predictor of YKL-40 (beta value 0.59, p= 0.02), explaining 56% of the variation in YKL-40 levels in heart allograft recipients. Conclusion: YKL-40 may contribute to the enhanced risk of cardiovascular complications mainly due to impaired renal function in patients after heart transplantation.