Cardiology (Cardiology )

Publisher: Karger


Cardiologyí features high-quality papers from all over the world to keep its readers regularly informed of current strategies in the prevention, diagnosis and treatment of heart disease. These papers not only describe but offer critical appraisals of new developments in non-invasive, invasive, diagnostic and therapeutic methods. The importance of experimental work is also acknowledged through reports covering the function and metabolism of the heart and the morphology and physiology of cardiovascular disease. Special sections in a variety of subspecialty areas reinforce the journalís value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons and clinical physiologists.

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Publications in this journal

  • Cardiology 08/2014; 129(1):46-54.
  • Cardiology 07/2014; 129(1):36-38.
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    ABSTRACT: We report a case of amiodarone-induced epididymitis and review the pertinent literature. This disease is currently a diagnosis of exclusion and is believed to be self-limiting. We found new evidence for the pathological diagnosis and identified amiodarone-like crystals in the epididymis as a pathological mechanism of this disease. This case also suggests that amiodarone-induced epididymitis is not self-limiting. Continued use of amiodarone according to the current guidelines led to a bilateral epididymectomy. We recommend withdrawal or reduction of amiodarone dosage immediately once the signs and symptoms of epididymitis present in this population of patients. When epididymitis does not seem to be caused by an infection or any other identifiable etiology, this should not be overlooked by the cardiologist, urologist or general practitioner. These findings and recommendations should help reduce the suffering of patients and improve their clinical outcomes. © 2014 S. Karger AG, Basel.
    Cardiology 06/2014; 128(4):349-351.
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    ABSTRACT: Objectives: Recent studies have reported increased red blood cell distribution width (RDW) has been associated with adverse outcomes in heart failure and stable coronary disease. We investigated the association between RDW and risk of all-cause mortality in patients with ST-elevation myocardial infarction (STEMI) who were free of heart failure at baseline. Methods: We enrolled 691 patients with STEMI who were free of heart failure at baseline confirmed by coronary angiography in Beijing Friendship Hospital from January 2007 to December 2008. According to the median RDW at baseline (13.0%) on admission, the patients were divided into two groups: a low-RDW group (RDW <13.0%, n = 329) and a high-RDW group (RDW ≥13.0%, n = 362). All-cause mortality rates were compared between groups. Mean duration of follow-up was 41.8 months. The relation between RDW and clinical outcomes after hospital discharge were tested using Cox regression models, adjusting for clinical variables. At the same time, the sensitivity and specificity of RDW were analyzed by ROC analysis. Results: Forty-seven patients (6.8%) died during follow-up. The cumulative incidence of all-cause death was significantly higher in the high-RDW group than in the low-RDW group (log-rank p = 0.007). Multivariate analysis revealed that high RDW was associated with all-cause mortality (hazard ratio: 3.43; 95% confidence interval: 1.17-8.32; p = 0.025). The area under the ROC curve was 0.562. Conclusion: From the statistical point of view, increased RDW is associated with all-cause and cardiac mortality rates in patients with STEMI who were free of heart failure at baseline. But RDW is a marker with a very low prognostic accuracy that does not seem to be clinically helpful. © 2014 S. Karger AG, Basel.
    Cardiology 06/2014; 128(4):343-348.
  • Cardiology 06/2014; 128(4):317-319.
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    ABSTRACT: Objective: To assess the prognostic significance of iron deficiency (ID) in a chronic heart failure (CHF) outpatient population. Methods and Results: We prospectively evaluated 127 patients with stable CHF and left ventricular ejection fraction ≤45%. Clinical and analytical data as well as information regarding the occurrence of the composite endpoint of overall mortality and nonfatal cardiovascular events were assessed. Among the 127 patients enrolled [81% men, median age: 62 years (25th-75th percentile: 53-68)], 46 (36%) patients had ID. Women, patients with higher plasma brain natriuretic peptide levels (>400 pg/ml) and with right ventricular systolic dysfunction presented ID more frequently (p < 0.05 for all). At 225 ± 139 days of follow-up, the composite endpoint occurred in 15 (12%) patients. It was more frequent in ID (24 vs. 5%, p = 0.001) and anemic patients (25 vs. 8%, p = 0.014). In a Cox regression analysis, ID was associated with a higher likelihood of composite endpoint occurrence (HR 5.00, 95% CI 1.59-15.78, p = 0.006). In a multivariable analysis adjusted for clinical variables, including the presence of anemia, ID remained a significant predictor of the composite endpoint (HR 5.38, 95% CI 1.54-18.87, p = 0.009). Conclusion: In a CHF outpatient population, ID carried a higher risk of unfavorable outcome, irrespectively of the presence of anemia. © 2014 S. Karger AG, Basel.
    Cardiology 06/2014; 128(4):320-326.
  • Cardiology 06/2014; 128(4):301-303.
  • Cardiology 06/2014; 128(4):314-315.
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    ABSTRACT: Objectives: The diagnostic accuracy of cardiac computed tomography angiography (CCTA) is well reported. The prognostic value of CCTA has been described in several studies, but many of these were underpowered and an update of the meta-analysis is necessary to increase the power to predict rare events. The purpose of this study was to perform a meta-analysis of the ability of CCTA to predict future cardiovascular events. Methods: We searched multiple databases for longitudinal studies of CCTA with a follow-up of at least 12 months of symptomatic patients with suspected coronary artery disease (CAD) reporting major adverse cardiovascular events (MACE), death, myocardial infarction and revascularization. Summary test parameters and receiver-operating characteristic curves were calculated. Results: Eighteen studies evaluated 29,243 patients with a median follow-up of 25 months. For MACE in patients with negative findings on CCTA, there was a pooled negative likelihood ratio (LR) of 0.01 [95% confidence interval (CI) 0.00-0.08], a positive LR of 1.72 (95% CI 1.54-1.91), a sensitivity of 1.00 (95% CI 0.97-1.00), a specificity of 0.42 (95% CI 0.36-0.48) and a diagnostic odds ratio of 159.07 (95% CI 22.20-1,139.80). The weighted average annualized MACE rate for positive versus negative CCTA findings was 3.49 versus 0.21%. Stratifying by no CAD, nonobstructive CAD or obstructive CAD, there were incrementally increasing adverse events. Conclusions: Adverse cardiovascular events among patients with normal findings on CCTA are rare. There are incrementally increasing future MACE with increasing CAD by CCTA. © 2014 S. Karger AG, Basel.
    Cardiology 06/2014; 128(4):304-312.
  • Cardiology 06/2014; 128(4):313.
  • Cardiology 06/2014; 128(4):316.
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    ABSTRACT: Objective: This study was designed to investigate whether patients with stable coronary artery disease (CAD) receiving chronic statin treatment who are undergoing noncardiac emergency surgery benefit from acute atorvastatin reload. Methods: A total of 500 patients with stable CAD and regular administration of statin before noncardiac emergency surgery were randomized to atorvastatin reload (n = 250) or placebo (n = 250). All patients received atorvastatin treatment thereafter. The primary end point was a 30-day incidence of major adverse cardiac events (MACE). Secondary end points were the incidence of atrial fibrillation (AF) during hospitalization and length of hospital stay. Results: The primary end point occurred in 2.4% of patients treated with atorvastatin reload and in 8% in the placebo arm (p = 0.0088). The incidence of AF during hospitalization was 6.8% in patients treated with atorvastatin reload and 17% in the placebo arm (p = 0.0003). Compared with the placebo arm, the atorvastatin reload arm shortened the length of stay (9.8 ± 3.3 vs. 10.6 ± 3.5 days, p = 0.009). Multivariable analysis suggested that atorvastatin reload conferred a 65% risk reduction of 30-day MACE (odds ratio 0.35, 95% confidence interval 0.18-0.86; p = 0.005). Conclusion: The trial suggests that atorvastatin reload may improve the clinical outcome of patients with stable CAD receiving chronic statin treatment who are undergoing noncardiac emergency surgery. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):285-292.
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    ABSTRACT: Objectives: To elucidate the feasibility and treatment effects of transcatheter occlusion of the azygos/hemiazygos vein in patients with progressive cyanosis after performing the bidirectional Glenn procedure. Methods: From January 2007 to May 2011, transcatheter closure was performed on 9 patients (7 males and 2 females) aged 5-15 years (median 9 years). Results: A total of 7 azygos veins and 3 hemiazygos veins were occluded successfully. Coils were employed in 4 of the procedures, patent ductus arteriosus (PDA) occluders in 3, atrial septal defect occluders in 2 and a PDA occluder together with coils in 1 procedure. Immediate complete occlusions were achieved in 9 (81.8%) procedures and trivial residual shunt in 2 (18.2%). The femoral artery oxygen saturation (SaO2) rose from 81 [interquartile range (IQR) 75-86%] to 88% (IQR 84-91%). Conclusions: Patients with superior vena cava azygos vein collateral channels can be treated successfully by transcatheter occlusion with multiple devices. The device for embolization depends on the extent of the severity of the shunt, the size of the lumen of the azygos vein/hemiazygos vein and the candidate location for occlusion. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):293-300.
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    ABSTRACT: Objectives: Some patients with suspected ST-segment elevation (STE) myocardial infarction (STEMI) show STE that does not fulfill the current criteria for STEMI. The purpose of this study was to investigate the characteristics and prognoses of patients with minimal STEMI. Methods: Between November 2007 and December 2011, 546 patients who underwent primary percutaneous coronary intervention (PCI) for STEMI were enrolled. Results: The minimal STE group had a higher proportion of women (30.2 vs. 21.0%, p = 0.031), better pre-PCI antegrade flow (Thrombolysis in Myocardial Infarction flow 2-3, 30.2 vs. 18.8%, p = 0.006) and better collateralization (Rentrop score 2-3, 27.4 vs. 18.1%, p = 0.024) compared to the definite STE group. Multivariate analysis showed that each of them were independent predictors for minimal STE. However, 1-year mortality of the minimal STE group did not differ from that of the definite STE group (7.1 vs. 9.3%, log-rank p = 0.315). Conclusions: Female gender, good collateral flow and good pre-PCI antegrade flow were independent predictors for minimal STE in patients with STEMI. However, minimal STE was not related to a good prognosis in patients with STEMI. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):273-281.
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    ABSTRACT: Spontaneous subclavian artery dissection is rarely reported. We report the case of a 55-year-old female who presented as an non-ST elevation myocardial infarction (NSTEMI) and was found to have a proximal left subclavian dissection. We provide an overview of current articles addressing the clinical features and treatments of subclavian dissection. To our knowledge, this is the first report of subclavian dissection presenting as an NSTEMI. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):282-284.
  • Cardiology 05/2014; 128(3):241-242.
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    ABSTRACT: Objectives: The alteration of the Toll-like receptor/nuclear factor-kappa B (TLR4/NF-κB) signaling pathway during deep hypothermia circulatory arrest (DHCA) has not yet been defined. The aim of this study was to explore the expression of the TLR4/NF-κB pathway cytokine in cerebral injury resulting from DHCA as well as the effect of selective antegrade cerebral perfusion (SACP) on TLR4/NF-κB pathway expression. Methods: Twelve pigs were randomly assigned to DHCA alone (n = 6) or DHCA with SACP (n = 6) at 18°C for 80 min. Serum interleukin (IL)-6 was assayed by ELISA. Apoptosis and NF-κB proteins were detected by fluorescence TUNEL and Western blot, respectively. The level of TLR4 mRNA and protein were determined through qRT-PCR and Western blot. Results: The serum IL-6 level of the SACP group was significantly lower than that of the DHCA group at the end of circulation arrest and experimentation. Apoptotic index and NF-κB protein were apparently lower in SACP animals (p < 0.05). Compared to the DHCA group, the levels of TLR4 protein and mRNA in the SACP group were lower with significance (p < 0.05). Conclusions: The TLR4/NF-κB signaling pathway plays a critical role in the pathogenesis of DHCA cerebral injury. Attenuation of the TLR4/NF-κB inflammatory cytokines probably contributes to the neuroprotective effect of SACP. The TLR4/NF-κB inflammatory signaling pathway may be a novel therapeutic target for developing a new strategy for neuroprotection in DHCA. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):243-250.
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    ABSTRACT: Objectives: Atrial fibrillation (AF) is rare during childhood and usually associated with other cardiovascular pathology. In lone AF, the ventricular response rate is usually rapid. We sought to describe a subset of children who present with early-onset AF and a slow ventricular response rate who were found to have the short QT syndrome (SQTS). Methods: Using a MEDLINE/PubMed search, children with AF, a structurally normal heart and bradycardia were identified. Demographics, clinical presentation, electrocardiographic (ECG) findings, electrophysiologic testing, genetic analysis and follow-up assessment were collected on each child for analysis. Results: Four children were identified in the literature and combined with 2 other children followed by the authors. All had a short QT interval and those who were tested were found to have a gain-of-function mutation in the KCNQ1 gene. Conclusions: We describe a subclass of children with SQTS who present with AF and a slow ventricular response. Medical therapy has not been effective in maintaining sinus rhythm. The long-term outcome remains unknown for these children. This condition may present in utero as persistent bradycardia with postnatal ECG showing a very short QT interval. © 2014 S. Karger AG, Basel.
    Cardiology 05/2014; 128(3):236-240.

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