[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES: Neopterin, a marker of inflammation and monocyte activation, is found increased in patients with heart failure (HF). This study investigates whether neopterin levels correlate with left ventricular (LV) remodeling and brain natriuretic peptide (BNP), a marker of cardiac stress, in chronic HF (CHF) patients with different severity of disease. DESIGN AND METHODS: The relationship between neopterin and LV dimensions, NT-proBNP, and pro-inflammatory cytokines were studied in 98 CHF patients, while nineteen healthy subjects were enrolled as controls. Nineteen (19%) patients were in NYHA class I, 38 (39%) in NYHA class II, 27 (28%) in NYHA class III, and 14 (14%) in NYHA class IV. RESULTS: Neopterin levels were higher in CHF patients than in age- and gender-matched healthy controls, and related with indexed LV end-diastolic volume (LVEDVi). Prospectively CHF patients were separated into tertiles of low, medium and high neopterin levels. Among patients, male gender, LVEDVi, diuretic treatment, NYHA class I, NT-proBNP and IL-8 levels were significant determinants of urine neopterin levels by bivariate analysis. Neopterin levels were associated only to LV remodeling, as assessed by LVEDVi, and IL-8 levels, a crucial monocyte chemoattractant, by multivariate ordinal regression analysis. CONCLUSIONS: The relationship between elevated neopterin levels and LV enlargement in CHF patients suggests a crucial role of monocyte activation in the development of cardiac dysfunction in CHF patients. Assessment of neopterin levels are a potential biomarker to evaluate the progression of LV remodeling in CHF patients.
[Show abstract][Hide abstract] ABSTRACT: We present a case of "inverted Tako-Tsubo" syndrome in a woman sedated with meperidine before undergoing a colonscopy. We discuss possible etiology of this ventricular dysfunction.
The Medical journal of Malaysia 12/2011; 66(5):520-1.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study is to verify whether transcatheter aortic valve implantation (TAVI) determined changes in mitral valve (MV) function, in terms of mitral regurgitation (MR) and stenosis.
Little data is available regarding the effects of TAVI on global MV function, often derived from analysis primarily focused on clinical and aortic related outcomes.
From May 2008 to March 2010, 73 patients with severe symptomatic aortic stenosis underwent TAVI with the CoreValve ReValving System. The study population consisted of 58 patients (27 males, mean age 82 ± 7 years) who underwent transthoracic echocardiography at least ≥1 month after implantation (mean follow-up 7.8 ± 5.4 months).
In patients with a left ventricular dysfunction (ejection fraction, EF, <45%) at the baseline, EF significantly increased from 37 ± 6% to 48 ± 7% after TAVI (P = 0.003). Before TAVI, 42 patients had no or mild MR, 13 mild-to-moderate, and 3 moderate or moderate-to-severe. During follow-up, the MR degree was unchanged in the majority of patients (55%), 12% reduced, and 33% worsened. Variables associated with worsening in MR were depth of aortic prosthesis (P = 0.02 for the distance between the ventricular end and the right coronary cusp; P = 0.04 for mean distance right-left coronary cusps) and left atrium area at the baseline (P = 0.02). After TAVI, six patients (10%) developed mild or moderate mitral stenosis, often in a native valve with anterior calcifications.
In the majority of patients no significant changes occurred in the degree of MR in native valve, but we found that if the aortic valve was deeply implanted in the left ventricle outflow tract, a worsening in MR can be observed. A mitral stenosis development must be sought in patients with heavy calcifications of the anterior leaflet.
Catheterization and Cardiovascular Interventions 07/2011; 78(4):638-44. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Percutaneous aortic valve replacement (PAVR) has emerged as a valuable option to treat patients with symptomatic aortic stenosis at high surgical risk. There are few data available regarding the effects of PAVR on mitral valve (M V) function. Aim of this study was to verify whether PAVR determined changes in MV function, in terms of regurgitation and stenosis in native valve or dysfunction in prosthetic valve, early and during follow-up. Methods: The study population consisted of 42 patients (82±7 years) who underwent PAVR (CoreValve Revalving System) with a echocardiographic control at least ≥1 month after implantation (7±4months). Four patients had previously undergone mechanical MV replacement. The echocardiographic evaluation of native and prosthesis MV function was performed before and after the implantation, and during the follow-up. Results: All patients with mitral prosthesis showed a normally functioning prosthesis at baseline evaluation. After PAVR, no interference between the two prostheses occurred in terms of under-expansion or deformation of the aortic prosthesis, housing and mobility of occluder of the M V. MR in native valve before PAVR was none or mild in 30 (71 %) patients, mild-to-moderate in 10 (24%) and moderate in 2 (5%). MR was unchanged during the follow-up in the majority of patients (24,56%) and improved in 6 patients (14%) due to the decrease in pressure overload. 13 patients (30%) with a worsening in MR showed a moderate grade at most, with the exception of one who developed severe MR. In this patient the aortic prosthesis was deeply implanted in the left ventricle outflow tract significantly interfering with anterior mitral leaflet and altering the geometry of mitral annulus. In baseline, 3 patients had mild mitral stenosis (mean gradient <5 mmHg) and after PAVR transvalvular gradients remained stable. Nevertheless, 5 patients developed mild-to-moderate mitral stenosis. In these patients the aortic prosthesis was slightly low positioned in left ventricle and the MV showed heavy calcification of the anterior leaflet. Conclusions: Echocardiography provides useful data regarding the morphology and function of mitral valve after PAVR. In our experience no direct mechanical effect of PAVR on the mitral prostheses was observed, if the aortic valve was deeply implanted in the left ventricle outflow tract an interference with mitral leaflet and annulus can occur. In patients with heavy calcification of the anterior leaflet the left ventricle tract of the aortic prosthesis potentially limit the leaflet excursion.
Journal of the American Society of Echocardiography. 01/2010; Journal of the American Society of Echocardiography:B74.