Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction.

Background: In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.

Aims: To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.

Methods: A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.

Improved Clinical Risk Stratification in Patients with Long QT Syndrome? Novel Insights from Multi-Channel ECGs.

Background: We investigated whether multichannel ECG-recordings are useful to risk-stratify patients with congenital long-QT syndrome (LQTS) for risk of sudden cardiac death under optimized medical treatment.

Methods: In 34 LQTS-patients (11 male; age 31±13 years, QTc 478±51ms; LQT1 n = 8, LQT2 n = 15) we performed a standard 12-channel ECG and a 120-channel body surface potential mapping. The occurrence of clinical events (CE; syncope, torsade de pointes (TdP), sudden cardiac arrest (SCA)) was documented and correlated with different ECG-parameters in all lead positions.

T-wave integral: an electrocardiographic marker discriminating patients with arrhythmogenic right ventricular cardiomyopathy from patients with right ventricular outflow tract tachycardia.

Aims: Clinical and electrocardiographic (ECG) presentation of patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) and idiopathic right ventricular outflow-tract tachycardia (RVOT) may be similar. The aim of the study was to assess the validity and utility of T-wave integral measurement as an ECG discriminator of patients with ARVC and RVOT using a body surface mapping (BSM).

Methods And Results: A 120-channel BSM with quantitative signal analysis of the T-wave integral was performed in 10 patients with ARVC.

Prospective study of everolimus with calcineurin inhibitor-free immunosuppression in maintenance heart transplant patients: results at 2 years.

Background: Few studies have examined everolimus therapy with calcineurin inhibitor (CNI) withdrawal in maintenance heart transplant patients.

Methods: In a prospective, single-arm, single-center study, CNI-treated heart transplant patients were converted to everolimus and were followed up for 24 months. The primary endpoints were kidney function and arterial hypertension at 12 and 24 months after conversion.

Cardiomyocyte survivin protein expression is associated with cell size and DNA content in the failing human heart and is reversibly regulated after ventricular unloading.

Background: Mechanical support in congestive heart failure (CHF) by a left ventricular assist device (LVAD) is associated with decreased cardiac hypertrophy and altered cardiomyocyte molecular pathways. Survivin initiates cell cycle progression by increased cyclinD1/cdk4 complexes by abrogation of the inhibitory effect of p16(INK4a) on cdk4. Accordingly, the role of survivin in CHF and after unloading was explored.

Aortic dissection associated with Cogans's syndrome: deleterious loss of vascular structural integrity is associated with GM-CSF overstimulation in macrophages and smooth muscle cells.

Background: Cogan's syndrome is a rare disorder of unknown origin characterized by inflammatory ocular disease and vestibuloauditory symptoms. Systemic vasculitis is found in about 10% of cases.

Case Presentation: A 46-year-old female with Cogans's syndrome and a history of arterial hypertension presented with severe chest pain caused by an aneurysm of the ascending aorta with a dissection membrane located a few centimeters distal from the aortic root.

Hemodynamic support by left ventricular assist devices reduces cardiomyocyte DNA content in the failing human heart.

Background: Whether adult cardiomyocytes have the capacity to regenerate in response to injury and, if so, to what extent are still issues of intense debate. In human heart failure, cardiomyocytes harbor a polyploid genome. A unique opportunity to study the mechanism of polyploidization is provided through the setting of hemodynamic support by left ventricular assist devices.

Reversible regulation of the retinoblastoma protein/E2F-1 pathway during "reverse cardiac remodelling" after ventricular unloading.

Background: Cyclin D1, the retinoblastoma (Rb) protein, and the E2F transcription factors are involved in the pathogenesis of cardiac hypertrophy. Cyclin D1/cdk4 complexes, by phosphorylation, inactivate Rb, thereby abrogating its growth-inhibitory effect. Ventricular unloading is associated with reversible regulation of numerous cardiomyocyte molecular systems and decreased hypertrophy.

QRS integral: an electrocardiographic indicator of mechanical interventricular asynchrony.

Aim: The aim of this study was to investigate whether interventricular asynchrony (IVA) can be measured by electrocardiography.

Methods: Sixty-two patients (New York Heart Association heart failure functional class III: age, mean +/- SD: 64 +/- 9 years; ejection fraction, mean +/- SD: 24% +/- 8%; dilative cardiomyopathy/ischemic cardiomyopathy, n = 39/23) with left bundle branch block (QRS duration, mean +/- SD: 165 +/- 21 milliseconds) underwent a 120-channel body surface mapping. QRS integral was analyzed and compared with IVA (echo).

Ventricular unloading is associated with increased 20s proteasome protein expression in the myocardium.

Background: The ubiquitin-proteasome system (UPS) breaks down misfolded and normal proteins, including cell cycle regulatory proteins involved in cardiac hypertrophy. Because congestive heart failure (CHF) increases cardiomyocyte cellular mass, indicative of increased protein synthesis and/or impaired breakdown, and ventricular unloading decreases cardiac hypertrophy and changes regulation of multiple molecular systems ("reverse cardiac remodeling"), we tested the hypothesis that ventricular unloading alters myocardial UPS.

Methods: In 23 paired myocardial specimens (before and after unloading) ubiquitin, 20S proteasome, and cyclin D1 were investigated immunohistochemically and morphometrically quantified in relation to cardiomyocyte hypertrophy, DNA content, nuclear profile area and perimeter, and cyclin D1 protein expression.

Pre-operative prediction of post-VAD implant mortality using easily accessible clinical parameters.

Background: Mortality rates are high after implantation of a ventricular assist device (VAD), occurring mainly in the early phase post-implant during the time in the intensive care unit (ICU). Pre-operative selection criteria, which predict successful outcome, are difficult to evaluate. We implemented a pre-operative risk score to predict mortality in the ICU after VAD implantation by using easily obtained and quickly accessible clinical parameters.

Successful management of MRSA sepsis in a patient with left ventricular assist device.

Left ventricular assist devices (LVADs) offer the opportunity to substantially improve the clinical conditions and to interrupt hospitalization of patients suffering from end-stage heart failure awaiting heart transplantation. The authors report a case of a 66-year old patient suffering from end-stage idiopathic dilative cardiomyopathy who needed the implantation of a LVAD and later developed a sepsis with a methicillin resistant Staphylococcus aureus (MRSA) which could be recovered by a differentiated antibiotic regimen.

Magnetic resonance imaging in individuals with cardiovascular implantable electronic devices.

Magnetic resonance (MR) imaging has unparalleled soft-tissue imaging capabilities. The presence of devices such as pacemakers and implantable cardioverter-defibrillators (ICDs), however, was historically considered a contraindication to MR imaging. We summarize the potential hazards of the device-MR environment interaction, and present updated information regarding in vitro and in vivo experiments suggesting that certain pacemaker and ICD systems may indeed be MR-safe.

Optimal systolic and diastolic reconstruction windows for coronary CT angiography using dual-source CT.

Objective: The purpose of this study was to determine the position of the optimal systolic and diastolic reconstruction intervals for coronary CT angiography using dual-source CT.

Subjects And Methods: In 90 patients, coronary dual-source CT angiography was performed without beta-blocking agents. Data were reconstructed in 5% steps throughout the R-R interval.

Diastolic filling pattern and left ventricular diameter predict response and prognosis after cardiac resynchronisation therapy.

Objective: To investigate predisposing factors for cardiac resynchronisation therapy (CRT) response.

Design: Single-centre study.

Setting: University hospital in Germany.

Role of programmed ventricular stimulation in patients with Brugada syndrome: a meta-analysis of worldwide published data.

Aims: Brugada syndrome (BS) is an ion channelopathy with the risk of sudden cardiac death. The role of programmed ventricular stimulation (PVS) in risk stratification has been controversially discussed. Therefore, we performed a meta-analysis on the prognostic role of PVS in BS.

Roles of cyclooxygenase-2 and phosphorylated Akt (Thr308) in cardiac hypertrophy regression mediated by left-ventricular unloading.

Objectives: Cyclooxygenase-2 is associated with cardiac hypertrophy during chronic heart failure and is regulated through the PI3K/Akt pathway. Cyclooxygenase-2-induced cell growth through Akt phosphorylation was demonstrated in vitro. In chronic heart failure, left ventricular assist devices lead to hypertrophy regression and molecular changes.

Strategy for safe performance of extrathoracic magnetic resonance imaging at 1.5 tesla in the presence of cardiac pacemakers in non-pacemaker-dependent patients: a prospective study with 115 examinations.

Background: The purpose of the present study was to evaluate a strategy for safe performance of extrathoracic magnetic resonance imaging (MRI) in non-pacemaker-dependent patients with cardiac pacemakers.

Methods And Results: Inclusion criteria were presence of a cardiac pacemaker and urgent clinical need for an MRI examination. Pacemaker-dependent patients and those requiring examinations of the thoracic region were excluded.

Ischemic preconditioning by unstable angina reduces the release of CK-MB following CABG and stimulates left ventricular HSP-72 protein expression.

Background And Aim: Whether the CK-MB reducing effect of ischemic preconditioning (IP) by unstable angina within 24 to 48 hours before CABG is achieved by early or by delayed preconditioning of left ventricular myocardium in humans is unknown. We investigated whether IP is associated with phosphorylation of p38 MAPK (characteristic for early preconditioning) or with increased protein expression of HSP-72 (characteristic for delayed preconditioning) at the time of CABG in patients.

Methods: Nineteen patients were grouped according to the occurrence of ischemic episodes within 48 hours before CABG.