Endocarditis por Erysipelothrix rhusiopathiae en válvula tricúspide nativa / Native tricuspid valve endocarditis caused by Erysipelothrix rhusiopathiae

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Association between the NOS3 (-786 T/C) and the ACE (I/D) DNA genotypes and early coronary artery disease.

DNA polymorphisms at the endothelium constitutive nitric oxide synthase gene (NOS3) have been linked to the risk of developing coronary artery disease (CAD). In vitro, a polymorphism in the 5' region of the NOS3 gene (-786 T/C) influences promoter activity. This polymorphism has been associated with coronary spasms among Japanese. The genetic variation at the angiotensin-converting enzyme (ACE) is associated with plasma ACE activities and has also been linked with susceptibility to cardiovascular disease. Our objective was to determine if DNA polymorphisms in the NOS3 and ACE genes were associated with early CAD. We analyzed the -786 T/C polymorphism in the 5' flanking region and the 27-bp repeat polymorphism in NOS3 intron 4, as well as the ACE-I/D polymorphism. A total of 170 male smokers (CAD patients) younger than 50 years and 300 male smokers (healthy controls) were genotyped. Frequencies were compared by the chi(2) test, and odds ratios (ORs) and their 95% confidence intervals (CI) were also calculated. Only the -786 T/C polymorphism in the 5' flanking region of the NOS3 gene was significantly associated with early CAD in our population. The frequency of the CC genotype was significantly increased (P = 0.039) in patients compared to controls (OR = 1.67; 95% CI = 1.01, 2.72). We found a synergistic effect between the NOS3-CC and the ACE-DD genotypes in the risk of developing early CAD. The frequency of CC + DD was significantly increased among patients (P = 0.002). Thus, those with a NOS3-CC and an ACE-DD genotype would have a significantly increased risk of suffering an early episode of coronary artery disease (OR = 2.82; 95% CI = 1.40, 5.70). Although based on a limited number of patients, our work suggests that individuals who are NOS3-CC + ACE-DD are at a higher risk for early CAD, probably as a consequence of increased endothelial dysfunction.

Synergistic effect between apolipoprotein E and angiotensinogen gene polymorphisms in the risk for early myocardial infarction.

BACKGROUND: Several studies based on different populations worldwide have described an association between cardiovascular diseases and genetic variations in the apolipoprotein E (A:POE), angiotensinogen (A:GT), angiotensin receptor type 1 (A:T1R), and angiotensin-converting enzyme (A:CE) genes. In addition, there is growing evidence of an interaction between hypercholesterolemia and the renin-angiotensin system in the risk for hypertension and atherosclerosis. METHODS: To determine whether the DNA polymorphisms in A:POE (epsilon2, epsilon3, and epsilon4 alleles), A:GT (M235T), A:T1R (1166 A:/C:), and ACE (I:/D:) are associated with early onset of myocardial infarction (MI), we genotyped 220 patients and 200 controls <55 years of age. Patients and controls were males from the same homogeneous Caucasian population. Data concerning hypertension, diabetes, and tobacco consumption were recorded. The lipid profiles of patients and controls were also determined. RESULTS: APOE, ACE, AGT, and AT1R allele and genotype frequencies did not differ between patients and controls. None of these polymorphisms was related to the biochemical values in patients or controls. The frequency of individuals who were both APOE epsilon4 allele carriers and AGT-TT homozygotes was significantly higher in patients than in controls (11% vs 3.5%; P: = 0.0037). In patients, the frequency of epsilon4 carriers was significantly higher (P: <0.00001) in those who were AGT-TT (46%) than those who were AGT-MT/MM (14%). Mean cholesterol was significantly higher in AGT-TT + APOE epsilon34/44 patients than in the TM/MM + epsilon34/44 or TT + epsilon23/33 genotypes (P: = 0. 029). CONCLUSIONS: Our data suggest a synergistic effect between the APOE and AGT polymorphisms and early MI. The increased risk could be mediated in part through higher cholesterol concentrations among individuals who are AGT-TT + APOE epsilon4 allele carriers.

Left ventricular mass index and sports: the influence of different sports activities and arterial blood pressure.

BACKGROUND: The mechanisms by which endurance training produces physiological hypertrophy have been thoroughly investigated but not with young athletes. The aim of our study was to investigate arterial blood pressure exercise responses in young athletes who started heavy training by the age of 11, participating in metabolically different sports (cycling, kayaking, and soccer) and to analyse the influence that arterial blood pressure at maximum exercise and VO(2) max could have on the development of cardiac mass in these subjects. SUBJECTS AND METHODS: We studied a group of well trained normotensive male subjects, comprising 37 cyclists, 15 soccer players and 12 canoeists (mean age, 16+/-1 years). Evaluation included a clinical history and physical examination, M-mode and two-dimensional echocardiography, 12-lead resting electrocardiogram and a graded exercise test with direct determination of VO(2) max. Systolic and diastolic blood pressure were measured at rest and maximum exercise. Determination of the left ventricular mass index (LVMI) was performed using Devereux's formula with correction for the body surface area. RESULTS: Cyclists showed values of LVMI in g m(-2) significantly higher than those of other subjects (123 vs. 92 and 113). Canoeists showed the maximal arterial blood pressure at maximum exercise in mmHg (190 vs. 172 and 170) and cyclists showed the maximal VO(2) ml kg(-1) min(-1) uptake (57.6 vs. 48.5 and 53.3). A linear correlation was found between LVMI and VO(2) max (r=0.4727, P<0.001) and this correlation was also significant with systolic blood pressure at maximum exercise (r=0.2909, P<0.01). No differences in LVMI were found when comparing those subjects who presented systolic blood pressure at maximum exercise equal or greater than 195 mmHg with those who presented less than this value. CONCLUSIONS: It can be concluded that VO(2) max is the variable that better correlates with the LVMI. Athletes who reach greater systolic blood pressures at peak exercise have a tendency to develop greater LVMI. In comparison with soccer players and canoeists, cyclists are the sportsmen who develop a greater LVMI and VO(2) max.

[Lipoprotein (a) as a predictor of severity of coronary artery stenosis documented by angiography in male coronary patients under 50 years old]. / La lipoproteína (a) es predictora de severidad angiográfica en varones menores de 50 años con inicio clínico de enfermedad coronaria.

OBJECTIVE: To determine the relationship between lipoprotein (a) seric levels with the age of coronary artery disease debut and the severity of coronary lesions in a group of male patients less than 50 years old. PATIENTS AND METHODS: We studied a group of 230 male patients, younger than 50 who were consecutively admitted to the hospital because of an ischemic coronary event. During hospitalization, the lipoprotein (a) in plasma was measured in all patients. They were distributed in two groups according to age at time of coronary disease clinical presentation with a cut off age of 40. A group of 142 patients underwent a cardiac catheterism and coronariography due to clinical or electrical unstability. RESULTS: The lipoprotein (a) levels were related with the number of diseased vessels. In this way lipoprotein (a) levels were 12 mg/dl (1.5-75) in those patients showing a normal coronariography; 27 mg/dl (2. 5-96) in those with one vessel disease; 34 mg/dl (7-90) in those with two vessels affected and 63 mg/dl (2-116) in the case of three-vessel disease, with statistical significance of p = 0.003. No significant differences in lipoprotein (a) levels were found when the age of coronary artery disease presentation was taken into account. In this way lipoprotein (a) levels were 31 mg/dl (2-97) in patients younger than 40 years of age, in comparison to 33 mg/dl (2-94) in those older than 40. CONCLUSIONS: In our community male patients with a diagnosis of coronary artery disease and less than 50 years old showed a relationship between lipoprotein (a) levels and the severity and number of coronary vessel diseases. However, an association between lipoprotein (a) levels with the age of coronary disease presentation was not evident.

Genetic variation in the renin-angiotensin system and athletic performance.

The D allele at the angiotensin-I-converting enzyme (ACE)-insertion/deletion polymorphism has been associated with an increased risk of developing several pathological processes, such as coronary heart disease and ventricular hypertrophy. Individuals with the DD genotype show a significantly increased left-ventricular mass in response to physical training, compared to the II genotype (which would be associated with the lowest plasma ACE levels) and the ID genotype. The II genotype has been linked to a greater anabolic response. In accordance with a role for ACE in the response to rigorous physical training, a higher frequency of the I allele has been reported to exist among elite rowers and high-altitude mountaineers. Sixty elite (professional) athletes (25 cyclists, 20 long-distance runners, and 15 handball players), and 400 healthy controls were genotyped for the DNA polymorphisms of the ACE, angiotensinogen (Ang) and angiotensin receptor type 1 (AT1) genes. Plasma ACE levels showed a strong correlation with the I/D genotype in our population. The I-allele occurred at a significantly higher frequency in athletes compared to controls (P = 0.0009). Gene and genotype frequencies for the Ang and AT1 polymorphisms did not differ between athletes and controls. Since the frequency of the ACE I allele was significantly increased among our elite athletes, we conclude that the ACE polymorphism represents a genetic factor that contributes to the development of an elite athlete.

[Acute myocardial infarction related to cocaine use]. / Infarto agudo de miocardio en relación con consumo de cocaína.

Cocaine is a drug capable of potentiating the response to catecholamines. Acute myocardial infarction is the most frequently reported cardiac consequence of cocaine abuse, usually in those patients who had used cocaine in a habitual basis. We report a 30-year-old man, first-time cocaine user, that suffered an acute myocardial infarction.

Infarto agudo de miocardio en relación con consumo de cocaína / Acute myocardial infarction related to cocaine use

La cocaína es una droga capaz de potenciar la respuesta de las catecolaminas. El infarto agudo de miocardio es la patología cardíaca más frecuentemente asociada al uso de cocaína, normalmente en aquellos pacientes con hábito cocainómano. Presentamos un varón de 30 años, consumidor por primera vez de cocaína, que sufrió un infarto agudo de miocardio (AU)

Angiotensin-converting enzyme and angiotensin II receptor 1 polymorphisms: association with early coronary disease.

OBJECTIVE: To examine the association between coronary artery disease and polymorphisms at the angiotensin-converting enzyme (ACE) and angiotensin II type 1 receptor (AT1R) genes. METHODS: A total of 181 patients younger than 50 years and 240 controls from the same homogeneous Caucasian population (Asturias, Northern Spain) were genotyped (using polymerase chain reaction) for the ACE insertion/deletion (ACE-I/D) and the AT1R A/C transversion (AT1R-A/C) (3-untranslated region) polymorphisms. RESULTS: The DD-genotype was at a non-significant higher frequency among patients (50%) than in controls (41%). No difference between the two groups was found for the AT1R-genotypes. Distribution of ACE-genotypes according to AT1R-genotypes showed a significant association between ACE-DD and AT1R-CC and early coronary disease. Among the CC patients 58% were DD, compared to 21% among the controls (p = 0.02; OR = 5.32, 95% CI = 1.45, 19.51). We determined the distribution of these genotypes among the hypertensive and non-hypertensive patients. Frequencies of ACE- or AT1R-genotypes did not differ between the two groups. However, we found an interaction between the DD- and CC-genotypes in the group of normotensives. Among the CC patients, 13% of the hypertensives and 75% of the normotensives were DD (p = 0.014). CONCLUSIONS: Our results indicate a synergistic contribution of ACE and AT1R polymorphisms to the risk of coronary artery disease. This gene-gene interaction could have clinical implications. Approximately 2% of individuals in our population are CC + DD, and the genotyping of both polymorphisms could identify those with a high relative risk for coronary artery disease.

Primary amyloidosis and syncope.

A 59-year-old caucasian consulted our clinic with symptoms of dizziness and exertional syncope. The combination of myocardial hypertrophy diagnosed by echocardiography, together with a history of peripheral neuropathy made us suspect cardiac amyloidosis which was later proven by endomyocardial biopsy. A graded exercise test and two Holter monitoring studies revealed neither rhythm nor conduction abnormalities. A head-up tilt test revealed a vasovagal vasodepressor response.

Variation in plasma lipid and lipoprotein concentrations in community-acquired pneumonia a six-month prospective study.

The nature of changes in the lipid profile caused by an acute infection is controversial. The aims of the present study were to study the changes in plasma lipids and lipoproteins in community-acquired pneumonia, to determine whether these changes differ according to the aetiologica/agents, and finally to observe the behaviour of these lipoproteins six months later. Sixty patients, aged between 18 and 87 years, admitted during the period September 1992 and April 1993 with suspected community-acquired pneumonia, were included in the study. Fifty-three of the patients completed the 15-day follow-up investigation, and 37 remained available for study for up to 6 months. On admission and at 15 and 180 days, analyses were carried out for total cholesterol, HDL cholesterol, apolipoproteins A1 and B, triacylglycerols and transaminases. Student's t test for parametric variables was used for statistical analysis, and the Mann-Whitney test for non-parametric variables. The concentrations of total cholesterol (4.2 +/- 1.0 vs 5.5 +/- 1.3 mmol/1), HDL cholesterol (0.9 +/- 0.4 vs 1.2 +/- 0.3 mmol/l), apolipoprotein A1 (0.80 +/- 0.25 vs 1.15 +/- 0.28 g/l) and apolipoprotein B (0.77 +/- 0.28 vs 0.95 +/- 0.28 g/l) showed significantly lower values during the acute infectious process. These analyte concentrations became stable after 15 days with the exception of HDL cholesterol which continued to increase until 6 months (1.2 +/- 0.3 vs 1.3 +/- 0.3 mmol/l, p < 0.01). Patients with non-viral atypical pneumonia showed, on admission, higher triacylglycerol values (1.8 +/- 0.8 vs 1.3 +/- 0.9 mmol/l, p < 0.01) and lower HDL cholesterol values (0.6 +/- 0.3 vs 1.0 +/- 0.4 mmol/l, p < 0.03). Values of aspartate aminotransferase (112 +/- 117 vs 23 +/- 11 U/l, p < 0.001), alanine aminotransferase (127 +/- 141 vs 24 +/- 16 U/l, p < 0.02) and gamma-glutamyl transferase (113 +/- 158 vs 33 +/- 25 U/l, p < 0.03) were higher in the subgroup of non-viral atypical pneumonia. In conclusion, patients with community-acquired pneumonia present a significant decline in total cholesterol, HDL cholesterol and apolipoprotein A1 and B concentrations. Lower concentrations of HDL cholesterol are maintained up 15 days. Patients with non-viral atypical pneumonia present on admission significantly higher triacylglycerol and lower HDL cholesterol values. Those with non-viral atypical pneumonia also present higher transaminase values.

[Ventricular tachycardia secondary to phenylpropanolamine poisoning: apropos a case]. / Taquicardia ventricular secundaria a intoxicación por fenilpropanolamina: a propósito de un caso.

We report a case of a 17-years-old patient with an accidental ingestion of high doses of phenylpropanolamine. Nine hours after the ingestion she presented ventricular bigeminy and an episode of non sustained ventricular tachycardia. No cardiovascular disease was demonstrated.

Aldosterone levels and cardiac hypertrophy in professional cyclists.

Aldosterone has been associated with the development of cardiac hypertrophy and a correlation has been found between levels of aldosterone and the degree of cardiac hypertrophy in hypertensive patients. Our study aimed to test the relation between physiologic cardiac hypertrophy and serum aldosterone in a group of highly trained cyclists. Determination of the left ventricular mass index (LVMI) was performed in a group of 40 professional cyclists by using Devereux's formula with correction for body surface area. After an overnight fast, blood samples were collected and serum aldosterone levels were measured using RIA. LVMI and serum aldosterone were intercorrelated using linear regression analysis. Twenty-three of the 40 cyclists (58%) presented an LVMI > 130 g.m-1 and the other 17 subjects (42%) presented an LVMI < 130 g.m-1. Serum aldosterone levels did not correlate with LVMI in either of the groups (LVMI > 130 g.m-1, r = -0.089; LVMI < 130 g.m-1, r = 0.146). The lack of correlation of this hypertrophy with serum aldosterone levels suggests that physiologic hypertrophy of the athlete's heart could be caused by a different stimulus to that seen in pathologic hypertrophy of hypertensives.

Interrelationships between lipoprotein(a) and other cardiovascular risk factors.

Lipoprotein(a) [Lp(a)] had been shown to be a strong independent risk factor for ischaemic heart disease. Our aim was to investigate the relationships between Lp(a) and other cardiovascular risk factors. 423 male miners (age 40 +/- 8 years) were analysed according to the following variables: age, arterial blood pressure, alcohol and cigarette consumption, total cholesterol and Lp(a). Analysis of the data was performed using the Kruskal-Wallis and Spearman tests. Analysis of variance showed statistical differences in Lp(a) levels with cigarette consumption (p < 0.02) and age (p < 0.001). No differences with corrected total cholesterol, blood pressure and alcohol consumption were found. Lp(a) and total cholesterol were correlated (p < 0.0001), but after correction for the estimated contribution of Lp(a) cholesterol this significant correlation disappeared. We conclude that male smokers have significantly lower Lp(a) values than non-smokers and those who quit. Our findings suggest that cigarette consumption is a probable environmental factor that might influence Lp(a) levels.

Prevalence and upper limit of cardiac hypertrophy in professional cyclists.

The term athlete's heart refers to an increased left ventricular mass. Few studies have assessed the prevalence and normal upper limit of cardiac hypertrophy in highly trained cyclists and this was the aim of this study. A group of 40 professional road cyclists [mean age 26 (SD 3) years] who had participated in European competitions for 3-10 years, were evaluated at the beginning of the 1992-93 season. Evaluation included a clinical history and physical examination, one and two-dimensional echocardiography, 12-lead resting electrocardiogram and a graded exercise test. Determination of the left ventricular mass index (LVMI) was performed using Devereux's formula with correction for the body surface area. Systolic and diastolic blood pressure were measured at rest and at peak exercise. Of the group 23 cyclists (58%) presented a LVMI greater than 130 g.m-2, 21 cyclists presented a diastolic ventricular thickness equal to or greater than 13 mm, with a superior limit of 19 mm; 3 cyclists presented asymmetrical septum hypertrophy; and the relationship between posterior wall and left ventricular diastolic radius was equal to or greater than 0.45 in 14 cases (35%). Electrocardiographic abnormalities of ST-T segment were seen in only 1 subject. No correlation was found between the degree of ventricular hypertrophy and arterial blood pressure. We concluded that these professional cyclists showed a high prevalence of cardiac hypertrophy (58%). The distribution of this hypertrophy was concentric in 20/33 and asymmetric in 3/23 of the subjects with left ventricular hypertrophy. The electrocardiograms were normal in 98% of the subjects.

Restrictive cardiomyopathy caused by chloroquine.

A 59 year old white woman who had been treated with chloroquine phosphate for 25 years presented with signs of congestive heart failure and was diagnosed as having restrictive cardiomyopathy by non-invasive methods. Electron microscopy of a biopsy specimen of skeletal muscle showed lesions compatible with chloroquine myopathy. The patient died five weeks after presentation. Electron microscopy of heart tissue showed similar lesions to those of the skeletal muscle.

Electrocardiographic patterns in V4R lead in experimental right ventricular infarction of rats.

Twenty-four male rats that became hypertensive after complete ligature of the abdominal aorta, just above the origin of the left renal artery, showed combined myocardial infarction. To study the electrocardiographic patterns of the experimental right ventricular infarction, the V4R right thoracic lead was recorded at different time intervals after aortic ligature. The patterns recorded were as follows: Q waves in 23 cases (95.8%), ST-T segment elevation in 11 cases (45.8%), ST-T segment depression in two cases (8.3%), and decrease in voltage of R wave in four cases (16.6%), with a predominance of the alterations of the ST-T segment in the acute phase and the appearance of Q waves during the subacute phase.