Statin-Associated Muscle Adverse Events: Update for clinicians.

Statins are potent medications which reduce low-density lipoprotein cholesterol (LDL-C) levels. Their efficacy in cardiovascular risk reduction is well established and indications for their use are expanding. While statins are generally well tolerated and safe, adverse events are relatively common, particularly statin-associated muscle adverse events (SaMAEs), which are the most frequently encountered type of adverse event.

A Plaque Disruption Index Identifies Patients with Non-STE-Type 1 Myocardial Infarction within 24 Hours of Troponin Positivity.

Background: Markers of plaque destabilization and disruption may have a role in identifying non-STE- type 1 Myocardial Infarction in patients presenting with troponin elevation. We hypothesized that a plaque disruption index (PDI) derived from multiple biomarkers and measured within 24 hours from the first detectable troponin in patients with acute non-STE- type 1 MI (NSTEMI-A) will confirm the diagnosis and identify these patients with higher specificity when compared to individual markers and coronary angiography.

Methods: We examined 4 biomarkers of plaque destabilization and disruption: myeloperoxidase (MPO), high-sensitivity interleukin-6, myeloid-related protein 8/14 (MRP8/14) and pregnancy-associated plasma protein-A (PAPP-A) in 83 consecutive patients in 4 groups: stable non-obstructive coronary artery disease (CAD), stable obstructive CAD, NSTEMI-A (enrolled within 24 hours of troponin positivity), and NSTEMI-L (Late presentation NSTEMI, enrolled beyond the 24 hour limit).

HeartWare ventricular assist device as a bridge to heart transplantation in a patient with congenitally corrected transposition of the great arteries and dextrocardia.

Congenitally corrected transposition of the great arteries (ccTGA) is a rare condition with prevalence of <0.5%. Dextrocardia is reported among 20% of them.

Contractile reserve induced with dobutamine echocardiography predicts outcome in patients with left ventricular dysfunction and mitral regurgitation.

Background And Aim Of The Study: The appropriate management of patients with mitral regurgitation (MR) and left ventricular dysfunction (LVD) is controversial. The study aim was to determine whether the presence of contractile reserve (CR) assessed by dobutamine stress echocardiography (DSE) was associated with improved outcomes.

Methods: Death and heart transplantation were analyzed as the primary outcomes associated with the presence of CR.

A successful 4S heart transplantation.

Donor recipient matching is paramount to successful heart transplantation. The presence of allosensitization decreases the transplant candidate's donor pool, prolongs the time to transplantation, and increases the post-transplant mortality and morbidity. Various strategies are applied to reduce antibody loads with mixed results being reported.

The impact of dietary changes and dietary supplements on lipid profile.

With a growing number of dietary interventions that claim to improve lipid profile, it is important to ensure that these claims are evidence based. The objective of this study was to make recommendations for dietary regimens by analyzing their effectiveness and the level of evidence. We searched MEDLINE as well as the Cochrane Database of Systematic Reviews for nutritional studies.

Elevated N-terminal pro-brain natriuretic peptide in Mycobacterium tuberculosis pulmonary infection without myocardial dysfunction.

Increased levels of N-terminal pro-brain natriuretic peptide (NT pro- BNP) in infectious settings may not reflect myocardial depression. In addition to NT pro-BNP measurement, clinical assessment remains a valuable tool for diagnosis and prognosis of heart failure. A case of excessively increased NT pro-BNP level associated with Mycobacterium tuberculosis infection that was not indicative of myocardial dysfunction is described.

Performance of limited sampling strategies for predicting mycophenolic acid area under the curve in thoracic transplant recipients.

Background And Methods: Eight limited sampling strategies (LSSs) for estimating mycophenolic acid area under the concentration-time curve (4 developed from lung transplant recipients at our center, 4 developed for heart transplant recipients from other research groups) were evaluated in 27 heart or heart-kidney transplant patients.

Results: The LSSs from our lung transplant patients performed well when applied to the heart transplant population, with percent bias and percent precision within the acceptable limit of +/-15%.

Conclusions: The LSSs developed at our center are robust enough to be applied to both lung and heart transplant populations.

Accuracy of a provincial prescription database for assessing medication adherence in heart failure patients.

Background: British Columbia's central prescription database, PharmaNet, is often used for both clinical and research applications. However, PharmaNet details prescription transactions, not actual medication consumption, resulting in many potential sources of inaccuracy when the information is assumed to reflect population or individual drug utilization.

Objective: To assess the accuracy of PharmaNet for adherence assessment in patients with heart failure who are taking beta-blockers.

Eosinophilic myocarditis: case series and review of literature.

Although the etiology of eosinophilic myocarditis (EM) is not always apparent, several causes are identified, including hypersensitivity to a drug or substance, with the heart as the target organ. However, symptoms and signs of hypersensitivity are not found in all patients. EM can lead to progressive myocardial damage with destruction of the conduction system and refractory heart failure.

Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease.

We found that interval training provides an effective means to improve the cardiovascular fitness and health status of highly functional patients with coronary artery disease. We also revealed that interval training improves anaerobic tolerance to a greater extent than the traditional exercise training model without increasing the risk to the patient. This research supports the implementation of interval training for highly functional patients with coronary artery disease.

Self-reported Morisky score for identifying nonadherence with cardiovascular medications.

Background: The Morisky medication adherence scale is a commonly used adherence screening tool. It is composed of 4 yes/no questions about past medication use patterns and is thus quick and simple to use during drug history interviews.

Objective: To evaluate the use of the self-reported Morisky score as a screening tool for identifying patients who have been nonadherent with chronic cardiovascular medications.

Novel mutations in the TRIM37 gene in Mulibrey Nanism.

Mulibrey nanism is an autosomal recessive prenatal-onset growth disorder of unknown pathogenesis. The main clinical features are pre- and postnatal growth failure, characteristic dysmorphic craniofacial features, heart disease, and hepatomegaly. Five truncating mutations in the TRIM37 gene have previously been reported in Mulibrey nanism patients.

Mycophenolate pharmacokinetics in early period following lung or heart transplantation.

Background: The available pharmacokinetic and pharmacodynamic data on mycophenolic acid (MPA), the pharmacologically active metabolite of mycophenolate mofetil (MMF), are derived largely from renal transplant patients, not thoracic transplant recipients.

Objective: To evaluate, in a pilot study, the pharmacokinetics of MPA at 3 different times in the early period (up to the first 9 mo) following lung or heart transplantation.

Methods: Nine patients were entered into this open-label study.

Churg-Strauss syndrome with myocarditis manifesting as acute myocardial infarction with cardiogenic shock: case report and review of the literature.

A patient with a two-year history of worsening asthma presented with chest pain and shortness of breath. She developed cardiogenic shock. Analysis of blood chemistry detected increased troponin I concentration.

Edge-to-edge repair for functional mitral regurgitation: an echocardiographic study of the hemodynamic consequences.

Background And Aim Of The Study: The study aim was to characterize changes in mitral valve area and flow, and left ventricular (LV) size and function, following edge-to-edge (E-E) repair for severe functional mitral regurgitation (MR). The possibility that preoperative dobutamine stress echocardiography (DSE) might be used to predict post-repair recovery in LV function was also examined.

Methods: Seventeen patients underwent preoperative transthoracic echocardiography (TTE) and DSE, intraoperative transesophageal echocardiography, and three-month postoperative TTE.