Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes.

AIMS: Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes. METHODS AND RESULTS: Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy. CONCLUSION: Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE.

Determinants of pulmonary hypertension in young adults.

BACKGROUND: Risk factors of pulmonary hypertension (PH) are poorly understood. The objective of this study was to identify the determinants of PH in young adults. METHODS: We analysed a limited access dataset from the CARDIA (Coronary Artery Risk Development in Young Adults) study provided by the National Heart, Lung and Blood Institute. Pulmonary arterial pressure was assessed by the Doppler pulmonary artery acceleration time (PAAT). Socio-demographic characteristics, self-reported clinical variables, echocardiographic variables, pulmonary function tests, systemic blood pressure and body mass index calculated from height and weight were used in multivariate analysis. RESULTS: There were 4171 study subjects, mean age 24.9 ± 3.6 years, retained in year five with echocardiographic data available after five years of follow-up. The prevalence of severe PH (PAAT ≤ 70 ms) and mild to moderate PH (PAAT = 109.9-70.01 ms) was 1.1% and 14% respectively. Multivariate analysis revealed that body mass index (ß = -1.09, p < 0.0001), female gender (ß = 6.25, p < 0.0001), age (ß = -0.30, p = 0.02), African American race (ß = -2.57, p = 0.007), physical activity (ß = 0.005, p = 0.002), current smoking (ß = -3.42, p = 0.001), left atrial dimension (ß = -2.97, p = 0.009) and diastolic dysfunction (ß = -13.06, p = 0.006) were statistically significant variables predicting PH. CONCLUSION: In this large, observational study of young adults, pulmonary hypertension, as assessed by echocardiography, is common. Diastolic dysfunction, obesity, physical inactivity and smoking are associated with elevated pulmonary arterial pressure in young adults.

Variations in the risk for cerebrovascular events after kidney transplant compared with experience on the waiting list and after graft failure.

BACKGROUND AND OBJECTIVES: This study examined the risks, predictors, and mortality implications of cerebrovascular disease events after kidney transplantation in a national cohort. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This analysis used United States Renal Data System registry data to study retrospectively Medicare-insured kidney transplant candidates (n = 51,504), recipients (n = 29,614), and recipients with allograft failure (n = 2954) in 1995 through 2002. New-onset cerebrovascular disease events including ischemic stroke, hemorrhagic stroke, and transient ischemic attacks were ascertained from billing records, and participants were followed until Medicare-end or December 31, 2002. Multivariable survival analysis was used to compare cerebrovascular disease event incidence and risk profiles among the study samples. RESULTS: The cumulative, 3-yr incidence of de novo cerebrovascular disease events after transplantation was 6.8% and was lower than adjusted 3-yr estimates of 11.8% on the waiting list and 11.2% after graft loss. In time-dependent regression, transplantation predicted a 34% reduction in subsequent, overall cerebrovascular disease events risk compared with remaining on the waiting list, whereas risk for cerebrovascular disease events increased >150% after graft failure. Similar relationships with transplantation and graft loss were observed for each type of cerebrovascular disease event. Smoking was a potentially preventable correlate of posttransplantation cerebrovascular disease events. Women were not protected. All forms of cerebrovascular disease event diagnoses after transplantation predicted increased mortality. CONCLUSIONS: Along with known benefits for cardiac complications, transplantation with sustained graft function seems to reduce risk for vascular disease events involving the cerebral circulation.

Myofibroblastic sarcoma of mitral valve: a case report.

We report a patient with symptoms of congestive heart failure whose workup revealed a myofibroblastic sarcoma of mitral valve.