P Rocca

The role of plasma biomarkers in acute heart failure. Serial changes and independent prognostic value of NT‐proBNP and cardiac troponin‐T

Brain natriuretic peptide (BNP), NT‐proBNP and troponins are useful for the assessment of patients with heart failure. Few data exist about their serial changes and their prognostic value in patients with acute heart failure (AHF).

Right Ventricular Thrombus and Pulmonary Thromboembolism/Thrombosis in Behçet's Disease: A Case Report

Behçets disease (BD) is a multisystemic, chronic, inflammatory disease of unknown origin characterized by alternation of exacerbation and quiescence phases. Cardiac involvement in BD is infrequent. We report a case of a young man with BD with right ventricular thrombus and pulmonary thromboembolism. A 20-year-old man was admitted to our hospital with a 6-month history of dyspnea at rest, asthenia, and fever. Transthoracic echocardiography showed right wall thickened and presence of floating masses in the right outflow tract. Transesophageal echocardiography confirmed the presence of diffuse thrombosis in the right ventricle, with mobile ramifications in its outflow tract. Cardiovascular magnetic resonance and computed tomography of heart confirmed the presence of thrombi, the increased thickness of endocardiac tissue, and altered cardiac wall signal transmission. Computed tomography scan showed multiple pulmonary thrombi. Myocardial biopsy specimen showed diffused subendocardial thrombosis with damage of cardiac myocytes and presence of granulocytes. Six months after discharge, no cardiac masses were detected by transthoracic echocardiography. However, a few weeks after this last echocardiogram, the patient was again hospitalized for a new episode of acute pulmonary embolism. The patient was discharged with increasing dose of oral anticoagulant, with no evidence of cardiac masses at transthoracic echocardiography and thrombosis at computed tomography. The patient is still healthy on anticoagulant, immunosuppressive, and steroid therapy. This case provides a rare example of BD, in which we found-at the same time-heart and pulmonary manifestations, with the presence of right ventricular thrombus and pulmonary thrombi in situ.

The combination of Ezetimibe and Statin: a new treatment for hypercholesterolemia.

The combination of Simvastatin and Ezetimibe allows dual inhibition of both cholesterol production and absorption. This treatment approach allows achieving same low serum cholesterol levels with the administration of much lower doses of statins. This should reduce side effects, compared to statin only therapy, enabling more patients to achieve their LDL cholesterol treatment goals. With ezetimibe/simvastatin therapy, reductions of about 60% from baseline in LDL cholesterol have been shown. Concomitant improvement in other lipid fractions have also been demonstrated. The ezetimibe/simvastatin combination has been well tolerated, with a safety profile similar to that of statin therapy. This article will review clinical experience with ezetimibe/simvastatin combination, commenting upon its place and potential value in the prevention of cardiovascular disease.

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. Figure 1 Quadricuspid aortic valve in diastole Figure 2 Quadricuspid aortic valve in systole QAV 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).