[The association between cardiac mr feature tracking strain and myocardial late gadolinium enhancement in patients with hypertrophic cardiomyopathy].

Aim    Hypertrophic cardiomyopathy (HCM) is a relatively common, heritable cardiomyopathy, and cardiac magnetic resonance (CMR) studies have been performed previously to evaluate different aspects of the disease. However, a comprehensive study, including all four cardiac chambers and analysis of left atrial (LA) function, is missing in the literature. The aim of this retrospective study was to analyze CMR-feature tracking (CMR-FT) strain parameters and atrial function of HCM patients and to investigate the association of these parameters with the amount of myocardial late gadolinium enhancement (LGE).Material and Methods    In this retrospective, cross-sectional study, we analyzed the CMR images (CMRI) of 58 consecutive patients, who from February 2020 to September 2022 were diagnosed with HCM at our tertiary cardiovascular center. Patients who were younger than 18 yrs or who had moderate or severe valvular heart disease, significant coronary artery disease, previous myocardial infarction, suboptimal image quality, or with contraindication to CMR were excluded. CMRI was performed at 1.5 T with a scanner, and all scans were assessed by an experienced cardiologist and then re-assessed by an experienced radiologist. SSFP 2-, 3- and 4­chamber, short axis views were obtained and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and mass were measured. LGE images were obtained using a PSIR sequence. Native T1 and T2 mapping and post-contrast T1 map sequences were performed and each patient's myocardial extracellular volume (ECV) was calculated. LA volume index (LAVI), LA ejection fraction (LAEF), LA coupling index (LACI) were calculated. The complete CMR analysis of each patient was performed with CVI 42 software (Circle CVi, Calgary, Canada), off-line.Results    The patients were divided into two groups, HCM with LGE (n=37, 64 %) and HCM without LGE (n=21, 36 %). The average patient age in the HCM patients with LGE was 50.8±14 yrs and 47±12.9 yrs in the HCM patients without LGE. Maximum LV wall thickness and basal antero-septum thickness were significantly higher in the HCM with LGE group compared to the HCM without LGE group (14.8±3.5 mm vs 20.3±6.5 mm (p<0.001), 14.2±3.2 mm vs 17.3±6.1 mm (p=0.015), respectively). LGE was 21.9±31.7 g and 15.7±13.4 % in the HCM with LGE group. LA area (22.2±6.1 vs 28.8±11.2 cm2; p=0.015) and LAVI (28.9±10.2 vs 45.6±23.1; p-0.004) were significantly higher in the HCM with LGE group. LACI was doubled in the HCM with LGE group (0.2±0.1 vs 0.4±0.2; p<0.001). LA strain (30.4±13.2 vs 21.3±16.2; p-0.04) and LV strain (15.2±3 vs 12.2±4.5; p=0.012) were significantly decreased in the HCM with LGE group.Conclusion    This study sheds light on the CMR-FT differences between HCM with and without LGE. We found a greater burden of LA volume but significantly lower LA and LV strain in the LGE patients. These findings highlight further the LA and LV remodeling in HCM. Impaired LA function appears to have physiological significance, being associated with greater LGE. While our CMR-FT findings support the progressive nature of HCM, beginning with sarcomere dysfunction to eventual fibrosis, further studies are needed to validate these results in larger cohorts and to evaluate their clinical relevance.

Devastating Consequences of a Jailed Knuckled Wire in CTO PCI of an Anomalous RCA.

A knuckled tip of a jailed guidewire may lead to distortion of the main branch stent when pulled back after balloon dilatation of the side branch ostium. The distorted stent can be crushed to the side of the vessel as a bail-out intervention. (Level of Difficulty: Advanced.).

Clinical and electrophysiological characteristics of typical atrioventricular nodal reentrant tachycardia in the elderly - changing of slow pathway location with aging.

BACKGROUND: The aim of this study was to retrospectively evaluate the clinical and electrophysiological characteristics of elderly patients with typical atrioventricular nodal reentrant tachycardia (AVNRT), and to assess the acute safety and efficacy of slow-pathway radiofrequency (RF) ablation in this specific group of patients. METHODS AND RESULTS: The present study retrospectively included a total of 1,290 patients receiving successful slow-pathway RF ablation for typical slow-fast AVNRT. Patients were divided into 2 groups: group I included 1,148 patients aged <65 years and group II included 142 patients aged >65 years. The required total procedure duration and total fluoroscopy exposure time were significantly higher in group II vs. group I (P=0.005 and P=0.0001, respectively). The number of RF pulses needed for a successful procedural end-point was significantly higher in group II than in group I (4.4 vs. 7.2, P=0.005). While the ratio of the anterior location near to the His-bundle region was significantly higher in group II, the ratio of posterior and midseptal locations were significantly higher in group I (P=0.0001). The overall procedure success rates were similar. There was no significant difference between the 2 groups in respect of the complications rates. CONCLUSIONS: This experience demonstrates that RF catheter ablation, targeting the slow pathway, could be considered as first-line therapy for typical AVNRT patients older than 65 years as well as younger patients, as it is very safe and effective in the acute period of treatment.

Myocardial infarction in a 17-year-old patient due to neurofibromatosis-associated coronary aneurysm.

Neurofibromatosis is an autosomal dominant multi-system genetic disorder. Extra-cardiac vascular manifestations of neurofibromatosis have been previously described in many reports. However, coronary arterial involvements have been rarely described. A 17-year-old girl with neurofibromatosis presented to our institute with subacute myocardial infarction. Coronary angiogram revealed an aneurysm with thrombus in the left anterior descending artery.

Acute ST segment elevation myocardial infarction after sulbactam-ampicilllin induced anaphylactic shock in an adult with significant coronary artery disease: a case report.

Myocardial injury may complicate allergic reactions caused by several medications. We evaluated a case of a myocardial injury with transient ST segment elevation in a 72 year-old man presenting with collapse caused by sulbactam-ampicilllin assumption. The purpose of this report is to present this interesting case and revise the classification of Kounis syndrome.

[Effect of angiotensin converting enzyme genotype on endothelial function in healthy subjects]. / Saglikli bireylerde endotel fonksiyonlari üzerine anjiyotensin dönüstürücü enzim genotipinin etkisi.

OBJECTIVE: Endothelial dysfunction is an early marker of atherosclerosis. Angiotensin II and nitric oxide have important roles in maintaining the vascular tone. The existence of the angiotensin converting enzyme (ACE) gene polymorphisms has been known, and deletion (D) of the allele has been associated with coronary artery disease. As ACE genotype affects endothelial functions in the patients with risk factors for coronary artery disease, it may also be a determinant of atherosclerosis. In this study, the relationship between endothelial function and ACE gene polymorphisms was investigated in healthy young subjects. METHODS: Forty-six healthy young subjects were included in this cross-sectional, randomized study. Participants were further divided into three groups according with ACE genotypes: DD genotype--24 subjects, DI genotype--13 subjects and II genotype--9 subjects. All patients underwent brachial artery ultrasonographic examination. We analyzed ACE insertion (I) and D allele frequencies in all subjects. Kruskal-Wallis test was used to compare continuous variables, and the Chi-square test was used to compare proportions among groups. RESULTS: Demographic features were similar except gender between the groups according to the ACE genotypes. Total cholesterol levels were lower in the DD genotype comparing with the others (p<0.05). High-density lipoprotein cholesterol levels, baseline brachial artery diameter, baseline blood flow and the increase in the blood flow during the reactive hyperemia were also similar. The changes in flow-mediated dilatation (endothelium dependent) were 4.9+/-1.3% in DD genotype, 5.5+/-1.7% in DI genotype and 5.5+/-1.9% in II genotype groups. Flow mediated dilatation was lower in DD genotype group as compared with ID and II genotype groups, however, this result did not reach statistical significance (p>0.05). Endothelium independent dilatations were similar among different ACE genotypes. CONCLUSION: Our data showed that ACE genotype has no effect on endothelial functions in patients without risk factors for coronary artery disease.