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ABSTRACT: Despite the association of diabetes mellitus type 2 (DM2) with silent myocardial ischaemia (SMI) and a high prevalence of death due to coronary artery disease (CAD), screening for CAD in patients with DM2 remains controversial because of a lack of proof that it improves cardiac outcome. The aim of this study was to improve the diagnostic yield of the exercise stress test (EST) by introducing recently published life expectancy tables in selecting DM2 patients for coronary screening.
359 patients with DM2 without history or symptoms of CAD were included to perform an EST after a clinical history and brief physical examination. Cardiovascular risk factor profiling was completed with blood and urine analysis. A lower heart rate was defined as bradycardia (heart rate less than 60 bpm), a higher blood pressure as a systolic blood pressure at rest of 130 mmHg of more.
The prevalence of SMI was 14.5% (n = 52). The average number of additional cardiovascular risk factors per subject was 4. Multivariate logistic regression yields 4 significant predictors: (i) heart rate at rest (P= 0.015), (ii) a family history of cardiovascular disease (P = 0.017), (iii) systolic blood pressure at rest (P = 0.019), and, (iv) an LDL-c of 80 mg/dL or more (P = 0.021).
Known risk factors for myocardial ischaemia were identified as significantly influencing the prevalence of SMI. No improvement in diagnostic yield could be identified by selecting the screening population using predicted life expectancy tables.
Acta cardiologica 12/2011; 66(6):715-20. · 0.61 Impact Factor
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European Heart Journal – Cardiovascular Imaging 03/2011; 12(8):641. · 2.32 Impact Factor
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Gian Battista Chierchia,
Lucio Capulzini,
Steven Droogmans,
Antonio Sorgente,
Andrea Sarkozy,
Andreas Müller-Burri,
Gaetano Paparella,
Carlo de Asmundis,
Yoshinao Yazaki, Dirk Kerkhove,
Guy Van Camp,
Pedro Brugada
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ABSTRACT: Atrial fibrillation (AF) ablation is increasingly being performed in electrophysiology laboratories. Pericardial effusion (PE) is certainly one of the most frequently observed complications during AF ablation. The aim of our study was to investigate the incidence and outcome of PE following cryothermal energy balloon ablation (CBA) in comparison with conventional circumferential pulmonary vein isolation with a focal radiofrequency (RF) catheter.
A total of 133 consecutive patients (105 males) with paroxysmal AF were included in this study. Forty-six patients (36 males) underwent CBA (Arctic Front, Medtronic, USA) and 87 (69 males) point-by-point RF ablation guided by electroanatomical mapping (Carto, Biosense Webster, Diamond Bar, CA, USA). Ablation was performed under general anaesthesia with both techniques. All patients underwent a 2D transthoracic echocardiogram within 24 h before and after the procedure as routinely performed in our centre. Pericardial effusion was detected in 19 (14.2%) of 133 patients. Sixteen patients presented mild effusion, one moderate effusion, and two pericardial tamponades. There was no significant difference in the incidence of PE between the cryoballoon and the RF group (11 vs. 16%). A longer procedural time, coronary artery disease, and arterial hypertension were found to be independent predictors of PE during AF ablation.
Pericardial effusion occurred in a similar proportion following CBA and RF ablation for AF. Pericardial effusion was mostly mild and asymptomatic, with benign clinical outcome not requiring additional hospitalization days.
Europace 03/2010; 12(3):337-41. · 1.98 Impact Factor
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ABSTRACT: The notion that drugs can induce valvular heart disease (VHD) has occurred since the 1960s and has received a lot of attention in recent years. This review focuses on different aspects of this distinct valvulopathy in seven sections: (i) historical background, (ii) drug-induced VHD, is this a real entity?, (iii) its morphological and echocardiographic features, (iv) drugs associated with VHD, (v) the influence of cumulative drug dose and risk factors, (vi) the natural course of toxic valvulopathy, and (vii) practical recommendations when using potential valvulopathic drugs.
European Heart Journal – Cardiovascular Imaging 04/2009; 10(4):467-76. · 2.32 Impact Factor
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ABSTRACT: Transseptal (TS) puncture during atrial fibrillation (AF) ablation is a relatively safe procedure in experienced hands. However, major and minor complications cannot be completely ruled out. Real-time three-dimensional transeosophageal echocardiography (RT 3D TEE) is a novel imaging technology that permits direct visualization of the fossa ovalis in a 3D perspective, thereby sensibly lowering the likelihood of potential adverse effects during TS. In our study, we describe the technique and assess the feasibility, advantages, and safety of this novel imaging method in guiding TS puncture in a series of consecutive patients undergoing AF ablation.
We performed TS puncture guided by RT 3D TEE under general anaesthesia in 24 consecutive patients (16 male, 55.4 +/- 8.1 years) undergoing ablation for drug refractory AF. The fossa ovalis could clearly be seen and easily be distinguished from surrounding anatomical structures in all 24 patients. All punctures required a single attempt to access left atrium. Mean orientation of the needle hub when puncturing was 4.30 o'clock (ranging from 3 o'clock to 6.30 o'clock), and mean distances from the needle tip to the aortic and to the posterior wall were, respectively, 13.5 +/- 7 and 35 +/- 7.3 mm. Total fluoroscopic time was 120.6 +/- 34 s. No major or minor complications were experienced.
Real-time three-dimensional transeosophageal is a very useful tool in guiding TS puncture in patients undergoing AF ablation with the invaluable advantage of the 3D direct visualization of the fossa ovalis. This permits fast and safe transatrial access with a single puncture attempt.
Europace 11/2008; 10(11):1325-8. · 1.98 Impact Factor
