Effect of cryoballoon and radiofrequency ablation for pulmonary vein isolation on left atrial function in patients with nonvalvular paroxysmal atrial fibrillation: A prospective randomized study (Cryo-LAEF study).

Background: Isolation of the pulmonary veins (PVI) has become a mainstay in atrial fibrillation (AFib) therapy. Lesions in left atrial tissue lead to scar formation and this may affect left atrial function.

Methods: Patients with paroxysmal AFib were randomly assigned in a 1:2 allocation scheme to radiofrequency (RF) ablation or cryoballoon.

Severe mitral regurgitation coexisting with descending thoracic aorta aneurysm: staged approach using endovascular repair.

We describe the case of a 67-year-old man who was referred for the management of severe mitral valve regurgitation and coronary artery disease. Further workup revealed a descending thoracic aorta aneurysm. He underwent mitral valve replacement with coronary artery bypass surgery and, at a second stage, endovascular stent graft repair of the descending thoracic aorta aneurysm.

Diagnostic approach in symptomatic or asymptomatic aneurismal disease of the coronary arteries: a case report and five-year angiographic follow up.

Coronary artery aneurysms are rare anomalies that are usually incidental findings in coronary angiography. We present the case of a 64-year-old male patient with a recent episode of epigastric pain, nausea and vomiting, accompanied by electrocardiographic alterations and positive troponin I. As the symptoms persisted, the patient was referred for coronary angiography, during which a significant degree of aneurysmal dilatation was found in all three coronary vessels along their length.

Estimation of atrial fibrillation recency of onset and safety of cardioversion using NTproBNP levels in patients with unknown time of onset.

Objective: As shown previously in patients with new-onset atrial fibrillation (AF) without symptoms or signs of heart failure, N-terminal pro-brain natriuretic peptide (NTproBNP) increases rapidly, reaching a maximum within 24-36 h, and then decreases even if AF persists. A study was undertaken to use NTproBNP measurements in patients with AF of unknown time of onset to identify patients with presumed recent onset of the arrhythmia.

Design: Two-group open cross-sectional study.

The impact of moderate aerobic physical training on left ventricular mass, exercise capacity and blood pressure response during treadmill testing in borderline and mildly hypertensive males.

Introduction: We sought to investigate the effect of moderate physical exercise on left ventricular mass, exercise tolerance and blood pressure response during treadmill testing, in middle-aged pre-hypertensive and mildly hypertensive men without any evidence of coronary heart disease.

Methods: Forty of 52 male borderline and mildly hypertensive subjects (mean age 53 ± 7 years old) with a normal treadmill exercise test and echocardiographic evaluation were randomly assigned to an exercise rehabilitation programme. Patients in the exercise group participated in an aerobic exercise program for 16 weeks, three times per week, at 60 to 80 percent of the maximum heart rate achieved during the preceding exercise test.

Comparison of muscle functional electrical stimulation to conventional bicycle exercise on endothelium and functional status indices in patients with heart failure.

The aim of this prospective, open-label, cohort study was to compare the effect of muscle functional electrical stimulation (FES) on endothelial function to that of conventional bicycle training. Eligible patients were those with New York Heart Association class II or III heart failure symptoms and ejection fractions ≤ 0.35.

Adverse bioeffects of ultrasound contrast agents used in echocardiography: true safety issue or "much ado about nothing"?

Ultrasound contrast agents, consisting of gas-filled microbubbles, have long been used to enhance ultrasonographic imaging of various organs and in several settings. In echocardiography, after their first use for Doppler signal enhancement, their applications have expanded and several studies, combining a range of stress modalities with myocardial contrast echocardiography have shown the clinical utility of these agents. In experimental isolated heart animal models, the interaction of ultrasound with echo-contrast microbubbles was shown to have significant biologic effects when the acoustic energy of the beam exceeded a threshold, leading them to rupture and causing cavitation phenomena; the observed consequences in the experimental setting included microvascular damage, transient decrease of contractile performance and increased lactate production.

Effect of biventricular pacing on ventricular repolarization and functional indices in patients with heart failure: lack of association with arrhythmic events.

Aims: We prospectively assessed the effects of biventricular (BiV) pacing on electrocardiographic (ECG) and vectorcardiographic (VCG) descriptors of ventricular depolarization and repolarization and their association with appropriate implantable cardioverter defibrillator (ICD) activation.

Methods And Results: We studied 70 consecutive heart failure (HF) (37 ischaemic) patients (64 males, age 66.3 years) with a history of syncope or sustained ventricular tachycardia (VT) who underwent implantation of a BiV-ICD.

The role of sex and biochemical markers of inflammation in left ventricular remodelling, before and after surgery, in elderly patients with aortic valve stenosis.

Introduction: The aim of this study was to determine whether sex and biochemical markers of inflammation have a role in left ventricular (LV) remodelling after aortic valve replacement in elderly patients with aortic valve stenosis.

Methods: We studied 52 elderly patients with aortic valve stenosis (32 men, mean age 65 +/- 11 years and 20 women, mean age 68 +/- 9 years). Body surface area did not differ between men and women (1.

Atherosclerosis of the aorta in patients with acute thoracic aortic dissection.

Background: The role of atherosclerosis in thoracic aortic dissection has not been established yet. Transesophageal echocardiography (TEE) is an imaging modality widely used in the diagnostic evaluation of thoracic aortic dissection, and it can detect aortic atherosclerotic plaques and assess their size and specific characteristics.

Methods And Results: One hundred consecutive patients with thoracic aortic dissection and adequate imaging of the thoracic aorta by TEE were studied.

Dobutamine stress echocardiography for the evaluation of cardiac reserve late after Fontan operation.

Introduction: This study aimed to assess the potential role and safety of dobutamine stress echocardiography (DSE) in the evaluation of cardiac reserve in asymptomatic patients several years after a Fontan operation.

Methods: We studied 10 asymptomatic patients, 28 +/- 5 years old, 14 +/- 6 years after their Fontan operation. All patients and 10 healthy, matched controls underwent two-dimensional and Doppler echocardiography at baseline and throughout dobutamine infusion (given in 3-minute increments of 5, 10, 20, 30, and 40 microg/kg/min).

Thoracic aorta atherosclerosis burden index predicts coronary artery disease in patients undergoing transesophageal echocardiography.

Aims: The severity of thoracic aortic atherosclerosis (TAA) is associated with the extent of coronary artery disease (CAD). The aim of this study is to quantitative this relationship by developing a novel atherosclerotic index.

Methods And Results: Two hundred and forty six consecutive patients underwent transesophageal echocardiography (TEE) and coronary angiography.

The diagnostic value of adenosine stress-contrast echocardiography for diagnosis of coronary artery disease in hypertensive patients: comparison to Tl-201 single-photon emission computed tomography.

Background: The use of the vasodilating agent adenosine as stressor in conjunction with myocardial contrast echocardiography has not been extensively evaluated in hypertensive patients. Our aim was to evaluate the diagnostic value of adenosine myocardial contrast echocardiography (MCE) in comparison to single-photon emission computed tomography (SPECT), with reference to angiographic findings, in a hypertensive population.

Methods: Fifty hypertensive subjects, treated with standard antihypertensive treatment, were submitted to adenosine stress MCE, adenosine SPECT, and coronary angiography within a 1-month period, without any intervening events.

Pre-ejection tissue-Doppler velocity changes during low dose dobutamine stress predict segmental myocardial viability.

Introduction: We tested the hypothesis that low dose dobutamine stress echocardiography (LDDSE) combined with tissue Doppler imaging (TDI) can be used for the quantitative assessment of the content of viable myocardium.

Methods: Forty-one patients with coronary artery disease and left ventricular dysfunction (ejection fraction < or =40%), already scheduled for revascularisation, underwent echocardiographic assessment of viability at rest and during low-dose dobutamine infusion (2.5 microg/kg/min up to 10 micro/kg/min) at two time points, 2 days before and 3 months after revascularisation.

Time course of C-reactive protein, tumour necrosis factor-alpha and monocyte chemoattractant protein-1 following the surgical treatment of patients with aortic valve stenosis.

Introduction: Patients with aortic valve stenosis show elevated levels of inflammatory markers in peripheral blood. The aim of this study was to investigate the time course of changes in these markers and to look for sex-related changes in their biological behaviour following aortic valve replacement.

Methods: We studied 52 patients (32 men, 20 women) who underwent aortic valve replacement and had no concomitant coronary artery disease.

Real-time three-dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography.

Objective: To compare real-time three-dimensional echocardiography (RT3DE) with two-dimensional dobutamine stress echocardiography (2DE) for the detection of myocardial ischaemia, with angiographic validation of the results.

Methods: 56 patients (mean (SD) age 64.5 (6.

Tissue Doppler imaging and brain natriuretic peptide levels in adults with repaired tetralogy of Fallot.

Background: Accurate estimation of right ventricular (RV) function in patients with repaired tetralogy of Fallot (RTOF) is difficult, partly due to the presence of tricuspid regurgitation and pulmonary regurgitation and/or stenosis. The aim of the present study was to evaluate RV systolic and diastolic function of adult asymptomatic patients with RTOF by means of tissue Doppler imaging (TDI) and brain natriuretic peptide (BNP) values.

Methods: 25 adult patients with RTOF and 25 healthy controls were studied.

Changes in aortic root function after valve replacement in patients with aortic stenosis.

Background: Aortic elastic properties are compromised in various states that induce functional and histological changes in the aortic wall. Aortic stenosis is frequent and often requires replacement of the stenotic valve. The purpose of this study was to examine the effect of aortic valve replacement on the aortic root function.

Endothelial dysfunction and inflammatory process in transfusion-dependent patients with beta-thalassemia major.

Background: Beta-thalassemia major is associated with increased cardiovascular risk, although the underlying mechanisms remain unclear. We examined endothelial function and serum levels of inflammatory mediators in transfusion-dependent patients with beta-thalassemia major.

Methods: The study population consisted of 67 patients with homozygous beta-thalassemia major, (aged 24.

Acute systemic inflammation increases arterial stiffness and decreases wave reflections in healthy individuals.

Background: Aortic stiffness is a marker of cardiovascular disease and an independent predictor of cardiovascular risk. Although an association between inflammatory markers and increased arterial stiffness has been suggested, the causative relationship between inflammation and arterial stiffness has not been investigated.

Methods And Results: One hundred healthy individuals were studied according to a randomized, double-blind, sham procedure-controlled design.

Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study.

Objectives: Erectile dysfunction (ED) shares common risk factors with coronary artery disease (CAD). It has been suggested that ED may be considered a clinical manifestation of a generalized vascular disease affecting also the penile arteries. The aim of this prospective study was to evaluate angiographically the incidence of asymptomatic CAD in men with ED of vascular origin.

Potential clinical applications of myocardial contrast echocardiography in evaluating myocardial perfusion in coronary artery disease.

Myocardial contrast echocardiography (MCE) is a relatively new technique that uses microbubbles to produce myocardial opacification. Recent advances in echocardiography have resulted in improved detection of microbubbles within the myocardium allowing combined acquisition of function and perfusion data, thus making MCE suitable for bedside use. Regardless of the imaging modality chosen or the type of stress used, MCE detects changes developing in the coronary microcirculation, providing important information for the evaluation of severity of coronary artery disease and for the detection of viable myocardial tissue in acute or chronic coronary artery disease.

Acute thoracic aortic thrombosis after intra-aortic balloon pumping.

We present two transesophageal echocardiographic images of a patient with acute myocardial infarction, demonstrating a large thrombus attached to the thoracic aortic wall, considered to be a complication of intra-aortic balloon pumping. The patient had received the device because of hemodynamic instability due to an infarct-related ventricular septal defect. Clinical manifestations which led to the diagnosis of thromboembolism were abdominal pain and deterioration of renal function, without signs of limb ischemia.