The Fundamental Role of Stress Echo in Evaluating Coronary Artery Disease in Specific Patient Populations.

Stress echocardiography (SE) was initially used for assessing patients with known or suspected coronary heart disease by detecting and evaluating myocardial ischemia and viability. The implementation of SE has gradually been extended to several cardiovascular diseases beyond coronary artery disease, and SE protocols have been modified and adapted for the detection of coronary artery disease (CAD) or other cardiovascular diseases in specific patient populations. This review attempts to summarize current data concerning SE implementation and clinical value in these specific and diverse populations: patients with an intramural course of a coronary artery, known as a myocardial bridge, chronic severe or end-stage hepatic disease, chronic severe or end-stage kidney disease, cardiac allograft vasculopathy, patients scheduled for solid-organ transplantation and other intermediate and high-risk surgery and, finally, patients treated with anticancer drugs or radiotherapy.

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.

Epigenetics, the missing link in hypertension.

Epigenetics refers to functional alterations in gene expression or phenotype without any change of the underlying DNA sequence. It is the study of the potential of a cell or organism to express different traits through functional regulation of its gene transcription. Though it is met as a necessary process in biology, epigenetics may often play a crucial part in the development of specific pathologic conditions, including cardiovascular diseases and hypertension.

Correlation of arm position and exercise test interpretation.

ST-segment changes during exercise testing can be attributed mainly to ischemia, but also, in some patients, to other physiological parameters, such as body position or hyperventilation, making ECG exercise test interpretation more complex. Here we describe the case of a patient who had an electrocardiographically positive exercise test, in order to illustrate the correlation between arm position and ST changes during exercise testing.

Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis.

Left ventricular diastolic dysfunction (DDF) has been considered as a component of cirrhotic cardiomyopathy. The clinical significance of DDF in cirrhotics has not been clarified. We prospectively evaluated the echocardiographic-Doppler, tissue-Doppler (TDI) findings of left ventricular function and survival in cirrhotics with or without DDF.

Tricuspid regurgitation after successful mitral valve surgery.

The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction.

Left ventricle enlargement and increased systolic velocity in the mitral valve are indirect markers of the hepatopulmonary syndrome.

Background And Aims: Hepatopulmonary syndrome (HPS) has been associated with left atrial enlargement, but the presence of other markers of left and right diastolic and/or systolic cardiac dysfunction has not been clarified. We prospectively evaluated the possible associations between echocardiographical-Doppler findings and HPS.

Methods: Seventy-nine cirrhotic patients without endogenous heart or pulmonary disease were included.

Clinical determinants of electrocardiographic and spatial vectorcardiographic descriptors of ventricular repolarization in healthy children.

Background: Although the association of repolarization alterations to the development of life-threatening ventricular arrhythmias has received considerable research attention, there is paucity of data regarding what may be considered as normal, especially in children.

Methods: To define electrocardiographic (ECG) and vectorcardiographic (VCG) descriptors of ventricular repolarization in healthy school-age children, 12-lead digital ECGs were obtained from 646 children (348 males/298 females, mean age 8.54 ± 1.

Novel methodology for the detection of exercise-induced myocardial wall motion abnormalities by surface electrocardiogram during exercise test.

Background: We investigated whether ischemia-induced wall motion abnormalities during exercise test modify electrical vector variation.

Methods: We performed treadmill exercise test and thallium 201 scintigraphy in 150 normotensives. Beat-to-beat change of direction of S wave in V(1) (reference lead) was compared with that of R wave in V(5) and aVF, representative of anterior and inferior walls, respectively.

The impact of novel exercise criteria and indices for the diagnostic and prognostic ability of exercise testing.

Exercise testing (ET) stands as one of the most easy, affordable, cost effective, non invasive methods for diagnosing coronary heart disease. Its sensitivity, specificity and prognostic value, especially in the prime era of its implementation in the cardiac diagnostic procedure, is relatively limited. Novel exercise criteria and indices based either on ST segment changes or ST segment independent parameters, such as "Athens QRS score", have greatly improved the diagnostic ability and accuracy of ET.

Right-sided chest leads in exercise testing for detection of coronary restenosis.

Background: The incorporation of right-sided chest leads (V(3)R through V(5)R) into standard exercise testing has been reported to improve its diagnostic utility.

Hypothesis: The purpose of this study was to evaluate any improvement in the ability of exercise testing in detecting restenosis, using additional V(3)R through V(5)R leads, in asymptomatic patients undergoing percutaneous coronary intervention (PCI) in the right coronary artery (RCA) or/and left circumflex (LCX).

Methods: We studied 172 consecutive patients (54 +/- 7 years old, 106 males) undergoing PCI in RCA or/and LCX.

Prevalence of interatrial block in healthy school-aged children: definition by P-wave duration or morphological analysis.

Background: P waves > or = 110 ms in adults and > or = 90 ms in children are considered abnormal, signifying interatrial block, particularly in the first case.

Methods: To evaluate the prevalence of interatrial block in healthy school-aged children, we obtained 12-lead digital ECGs (Cardioperfect 1.1, CardioControl NV, Delft, The Netherlands) of 664 healthy children (349 males/315 females, age range 6-14 years old).

Correlation of ST-segment "hump sign" during exercise testing with impaired diastolic function of the left ventricle.

Background: The appearance of a discrete upward deflection of the ST segment, termed the ST hump sign during exercise testing has been associated with resting hypertension and exaggerated blood pressure response to exercise.

Objective: We investigated the correlation between the presence of hump sign during exercise testing with coexisting impaired diastolic function of the left ventricle (LV) at these patients.

Methods: We formed a cohort of 237 nonconsecutive patients (140 males, 41 +/- 5 years old) having undergone a treadmill test, according to the Bruce protocol, which divided into 2 groups: group A, including 130 patients which presented ST-segment hump sign at any of the leads of the electrocardiograms recorded during exercise, and group B, including 107 patients that didn't.

The significance of right-sided chest leads in exercise testing for the detection of right ventricular dysfunction post myocardial infarction of the inferior wall.

Background: The incorporation of right-sided chest leads (V(3)R-V(5)R) into the standard exercise testing has been reported to improve its diagnostic accuracy. The purpose of this study was to evaluate the ability of exercise testing in detecting right ventricular (RV) dysfunction post myocardial infarction (MI) of the inferior wall, using additional V(3)R-V(5)R leads.

Methods: We studied 133 patients (59 ± 5 years, 81 males) with a history of inferior MI due to right coronary artery obstruction (affirmed with coronary angiography).

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.

Electrocardiographic criteria for detecting coronary artery disease in hypertensive patients with ST-segment changes during exercise testing.

Purpose: It is well known that patients with arterial hypertension frequently present with ischemic electrocardiographic changes during exercise testing without actually having coronary artery disease (CAD). The purpose of this study was to establish additional electrocardiographic criteria during exercise testing for detecting CAD in hypertensive patients with ischemic ST-segment response.

Methods: Three hundred eighty-two consecutive hypertensive patients (224 males, 58 +/- 8 years) who presented with ischemic electrocardiographic changes during exercise testing and agreed to undergo coronary arteriography were included in the study.

A case of pseudomembranous colitis presenting with massive ascites.

Clostridium difficile-associated disease seems to be increasing worldwide. A wide spectrum of clinical manifestations, ranging from asymptomatic to life-threatening disease, has been described. A case of pseudomembranous colitis with massive ascites as the main presenting manifestation is described in order to illustrate the changing clinical pattern of antibiotic-associated colitis.