The Tree of Sirtuins and the Garden of Cardiovascular Youth.

Sirtuins (SIRTs) are a class of nicotine adenine dinucleotide (NAD+)-dependent proteins which participate in numerous molecular pathways involved in various age-related human diseases, such as type II diabetes, cardiovascular (CV) diseases and cancer. They have a major role in apoptosis, inflammation, oxidative stress and metabolism regulation, traits that have a great impact on CV physiology and pathology. Their unique profile of NAD+ energy dependency makes them an appealing target for human intervention in cellular and metabolic processes.

The Mystery of High-density Lipoprotein: Quantity or Quality? Update on Therapeutic Strategies.

This review summarizes the data challenging the concept that cardiovascular protection through high-density lipoprotein (HDL) is only associated with its serum concentration. This conventional impression about its protective role now appears obsolete. New aspects of its mechanisms are revealed and novel therapeutic strategies are based on them.

Balloon-assisted tracking during primary percutaneous coronary intervention.

Radial artery spasm is one of the most commonly encountered problems during transradial interventions with a reported incidence in the range of 6-10%. Balloon-assisted tracking (BAT) of guide catheter has recently been described as a novel technique to overcome difficult radial artery anatomies including tortuosity, loops and spasm. In this report, we describe the successful use of BAT in a patient with radial artery spasm during primary angioplasty.

Combined hemodynamic support with the Impella 2.5 device and intra-aortic balloon pump for management of refractory cardiogenic shock.

Cardiogenic shock (CS) during elective percutaneous coronary intervention (PCI) is a rare but potentially lethal clinical condition. Pharmacological inotropic support and mechanical circulatory assistance with intra-aortic balloon pump (IABP) counterpulsation remains the gold-standard treatment. We report the case of a patient who developed refractory CS during elective PCI and was successfully managed with concomitant use of IABP and the Impella 2.

Percutaneous bail-out treatment of vein graft rupture with a polytetrafluoroethylene-covered stent.

Vessel perforation is an undesirable and life-threatening complication during vein graft angioplasty. We report on a case of vein graft rupture during angioplasty, which was successfully managed with deployment of a polytetrafluoroethylene-covered stent.

Cardiovascular repercussions of the pseudoexfoliation syndrome.

Pseudoexfoliation syndrome is a primarily ophthalmological disorder caused by deposition of whitish-gray protein on the lens, iris, and multiple other eye tissues. There is increasing evidence over the previous years that pseudoexfoliation syndrome is a systemic disorder with various extraocular manifestations and has recently been linked to several cardiovascular disorders. The present article aims to summarize the current knowledge on cardiovascular implications of this well-described clinical entity.

Electrocardiographic changes in a patient with pulmonary embolism and septic shock.

Various electrocardiography (ECG) abnormalities have been reported in patients who present with pulmonary embolism (PE). Severe sepsis is also associated with ECG changes that may mimic ST elevation myocardial infarction. We report a case of an elderly patient with PE and septic shock associated with striking ECG changes.

Prognostic value of NT-proBNP at rest and peak exercise in patients with impaired left ventricular function.

We aimed to identify whether N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) at peak exercise can provide incremental clinical information over resting levels. A total of 90 patients with systolic heart failure were prospectively studied. Levels of plasma NT-proBNP were assessed at rest and at peak exercise during a cardiopulmonary exercise test.

Late traumatic aortic dissection.

Traumatic dissection of the aorta is a well-documented entity with poor prognosis and broad spectrum of clinical presentations. We report a rare case of an asymptomatic late presentation of aortic dissection after a high-speed vehicle accident. This case highlights the importance of high clinical suspicion for the diagnosis of aortic dissection.

Pacemaker extrusion in a severely demented patient. Device reimplantation via the femoral approach.

Extrusion of the generator is an infrequent complication following pacemaker implantation. Occlusion or stenosis of the deep venous system is common in elderly patients and can cause significant difficulties in transvenous pacing. The present study reports a rare case of pacemaker extrusion in an elderly patient with an inaccessible upper extremities deep venous system, requiring device reimplantation via the femoral route.

Native aortic valve endocarditis caused by Brevibacterium epidermidis in an immunocompetent patient.

Although Brevibacterium species used to be considered as nonpathogenic microorganisms until recently, it seems that they can cause a wide variety of clinical diseases by acting mostly as opportunistic pathogens. The present case is the second reported case of infective endocarditis by Brevibacterium species; however, it is the first reported infected native aortic valve in an immunocompetent patient.

Five-vessel aortic arch associated with a bicuspid aortic valve.

Little information exists regarding the prevalence of aberrant or ectopic aortic arch vessels in patients with different cardiovascular anomalies. We present a young patient with an aberrant right subclavian artery associated with an ectopic left vertebral artery and a bicuspid aortic valve.

Prognostic significance of blood pressure response to exercise in patients with systolic heart failure.

High systolic blood pressure (SBP) has been linked to worse cardiovascular outcomes. However, emerging data suggest that in patients with heart failure (HF), low SBP correlates with increased mortality. The purpose was to examine the impact of baseline and post-exercise systolic and diastolic blood pressure (DBP), as well as pulse pressure (PP), on cardiac mortality in patients with systolic HF.

Postprandial metabolic heterogeneity in men with primary dyslipidaemia.

Introduction: Familial combined hyperlipidaemia (FCH) and familial hypercholesterolaemia (FH) have been strongly linked to premature coronary artery disease. Postprandial hypertriglyceridaemia is also associated with atherosclerotic disease. We evaluated the postprandial lipaemia in men with FCH and FH and compared them to a group of healthy men.