Rafique Essop

Therapy of ischemic cardiomyopathy with the immunomodulating agent pentoxifylline: results of a randomized study.

Background—Inflammatory immune activation commonly occurs in heart failure and may perpetuate this syndrome. We sought to determine whether the immunomodulating agent pentoxifylline enhances left ventricular function in patients with ischemic cardiomyopathy. We also investigated the effect of therapy on levels of brain natriuretic peptide (NT-pro BNP), C-reactive protein (CRP), tumor necrosis factor-&agr; (TNF-&agr;), and the marker of apoptosis, Fas/Apo-1. Methods and Results—In a single-center, prospective, randomized, double-blind, placebo-controlled study, 38 patients with ischemic cardiomyopathy received pentoxifylline 400 mg TID or placebo in addition to standard therapy. Clinical assessment, radionuclide ventriculography, echocardiography, and blood analyses were performed at baseline and after 6 months. There were no differences in baseline characteristics between the groups. Five patients died (4 in the placebo group). Pentoxifylline treatment resulted in an improvement in functional class (P <0.005) and an increase in systolic blood pressure (P <0.05) and left ventricular radionuclide ejection fraction (P <0.05) compared with the placebo-treated group. There were reductions in plasma concentrations of CRP, NT-pro BNP, TNF-&agr;, and Fas/Apo-1 in the pentoxifylline compared with the placebo-treated group. Conclusions—In patients with heart failure due to ischemic left ventricular dysfunction, the addition of pentoxifylline to standard therapy results in improvements in clinical status and radionuclide ejection fraction, which are accompanied by reductions in plasma markers of inflammation, prognosis, and apoptosis.

C-reactive protein predicts response to pentoxifylline in patients with idiopathic dilated cardiomyopathy.

We have previously reported that the addition of pentoxifylline to standard heart failure therapy results in improvements in systolic function in patients with idiopathic dilated cardiomyopathy (IDC) [1–3]. However, these improvements, which are associated with a reduction in inflammatory cytokines [4–7] and Fas/Apo-1 [8] only occur in some patients. C-reactive protein (CRP) is an inflammatory marker which is associated with adverse prognosis in patients with IDC [9,10]. It is therefore possible that elevations of CRP at baseline may predict the response of patients with IDC to the immuno-modulating agent pentoxifylline.

Congenital submitral aneurysm with rupture into the left atrium: assessment by 2D and 3D transesophageal echocardiography.

We describe two cases of congenital submitral aneurysms (SMAs) in which three‐dimensional transesophageal echocardiography (3D TEE) proved useful to define the spatial extent of these aneurysms. In both cases, rupture into the left atrium was accurately delineated. 3D TEE was useful in case 1 as it depicted the precise site of rupture into the left atrium as well as pseudoprolapse of the P2 segment of the mitral valve. In case 2 it also localized the rupture into the left atrium in relation to the annulus to be adjacent to the anterolateral commissure. In addition, a cleft between the A1 and A2 scallops were identified and together with failure of the leaflets to coapt enabled the mechanisms contributing to the mitral regurgitation to be elucidated. Thus, imaging from the left atrial perspective using 3D TEE provided superior spatial anatomical delineation of the rupture and its relationship to the mitral valve, as well as accurate anatomical definition of the mitral leaflets. This information provides added benefit to the surgeon in planning a transatrial surgical repair of the SMAs. 3D TEE is superior to conventional 2D TEE in defining the spatial anatomy of SMAs as well as the mechanisms contributing to mitral regurgitation. (Echocardiography 2011;28:E121‐E124)

Coarctation of the Aorta With Visible Palpable Collaterals Over the Scapular and Anterior Abdominal Wall

![Figure][1] A 37-year-old man presented with resistant hypertension on 4 drugs. Physical examination revealed radio femoral delay and clinical left ventricular hypertrophy. Very distinct palpable pulsatile collateral vessels were discovered over his left scapular, left chest wall, and

Abstracts of the SA Heart Congress 2010

Introduction: The pathophysiology of left ventricular (LV) remodelling in patients with hypertension (HT) is unclear. Aim: To evaluate the impact of four different types of geometric adaptations to hypertension on left ventricular ejection fraction (LVEF). Methods: A prospective single-centre study of 175 Black African patients (55% female, age = 53.1 ± 10.1 years) with moderate-to-severe HT was performed. HT was defined as systolic or diastolic daytime ambulatory BP (ABPM) >140mmHg or 95mmHg respectively. Echocardiography was performed using a HP 1 500 machine connected to 2.5 MHZ transducer. LV dimensions (LVEDD, LVESD, LVEF) were measured using standard American Society of Echocardiography definitions. Comparisons between the four geometric patterns were analysed using the Kruskal-Wallis test. Conclusion: Patients with eccentric LVH have the lowest systolic performance as measured by LVEF. These results suggest that patients with eccentric LVH need more aggressive therapy for heart failure.