A Prospective Pilot Study to Identify a Myocarditis Cohort who may Safely Resume Sports Activities 3 Months after Diagnosis.

International cardiovascular society recommendations to return to sports activities following acute myocarditis are based on expert consensus in the absence of prospective studies. We prospectively enrolled 30 patients with newly diagnosed myocarditis based on clinical parameters, laboratory measurements and cardiac magnetic resonance imaging with mildly reduced or preserved left ventricular ejection fraction (LVEF) with a follow-up of 12 months. Cessation of physical activity was recommended for 3 months. The average age was 35 (19-80) years with 73% male patients. One case of non-sustained ventricular tachycardia was recorded during 48-h-Holter electrocardiogram. Except for this case, all patients were allowed to resume physical exercise after 3 months. At 6- (n = 26) and 12-month (n = 19) follow-up neither cardiac events nor worsening LVEF were recorded. The risk of cardiac events at 1 year after diagnosis of myocarditis appears to be low after resumption of exercise after 3 months among patients who recover from acute myocarditis.

Heart transplantation in adolescent and adult patients with congenital heart disease: a case-control study.

BACKGROUND: The number of adolescent and adult patients with congenital heart disease undergoing heart transplantation is increasing. We aimed to better define the characteristics of these patients and their survival after transplantation. METHODS: We describe a group of patients with end-stage heart failure owing to congenital heart disease undergoing heart transplantation at a single tertiary center and compare their short- and long-term survival with a group of matched controls with dilated cardiomyopathy and the entire cohort of transplanted patients at our center. RESULTS: Between 1985 and 2006, a total of 322 orthotopic heart transplantations were performed at our center. Thirteen patients (mean age, 27.5 years) had a diagnosis of congenital heart disease with a wide spectrum of lesions. The survival of these 13 patients was 85% at 30 days, 1, 5, and 10 years and 77% at 20 years, which did not differ significantly to the short- and long-term survival of the entire cohort of patients with heart transplantation and to the survival of age-matched controls with dilated cardiomyopathy. CONCLUSION: In our single-center experience, short- and long-term survival after heart transplantation in a selected, small group of patients with end-stage heart failure owing to congenital heart disease did not differ significantly compared with a group of age-matched controls and the entire cohort.

Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance.

OBJECTIVE: To investigate the performance of low-dose, dual-source computed tomography (DSCT) coronary angiography in the step-and-shoot (SAS) mode for the diagnosis of significant coronary artery stenoses in comparison with conventional coronary angiography (CCA). DESIGN, SETTING AND PATIENTS: Prospective, single-centre study conducted in a referral centre enrolling 120 patients (71 men, mean (SD) age 68 (9) years, mean (SD) body mass index 26.2 (3.2) kg/m2). All study participants underwent DSCT in the SAS mode and CCA within 14 days. Twenty-seven patients were given intravenous beta blockers for heart rate reduction before CT. Patients were excluded if a target heart rate 50%) stenoses. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) were determined, with CCA being the standard of reference. Radiation dose values were calculated. RESULTS: DSCT coronary angiography in the SAS mode was successfully performed in all 120 patients. Mean (SD) heart rate during scanning was 59 (6) bpm (range 44-69). 1773/1803 coronary segments (98%) were depicted with a diagnostic image quality in 109/120 patients (91%). The overall patient-based sensitivity, specificity, PPV and NPV for the diagnosis of significant stenoses were 100%, 93%, 94% and 100%, respectively. The mean (SD) effective dose of the CT protocol was 2.5 (0.8) mSv (range 1.2-4.4). CONCLUSIONS: DSCT coronary angiography in the SAS mode allows, in selected patients with a regular heart rate, the accurate diagnosis of significant coronary stenoses at a low radiation dose.

Magnetic resonance myocardial first-pass perfusion imaging: parameter optimization for signal response and cardiac coverage.

Fast imaging techniques allow monitoring of contrast medium (CM) first-pass kinetics in a multislice mode. Employing shorter recovery times improves cardiac coverage during first-pass conditions, but potentially flattens signal response in the myocardium. The aim of this study was therefore to compare in patients with suspected coronary artery disease (CAD) two echo-planar imaging strategies yielding either extended cardiac coverage or optimized myocardial signal response (protocol A/B, six/four slices; preparation pulse, 60 degrees /90 degrees; delay time, 10/120 msec; readout flip angle, 10 degrees /50 degrees; respectively). In phantoms and myocardium of normal volunteers (N= 10) the CM-induced signal increase was 2.5-3 times higher with protocol B (P < 0.005) than with protocol A. For the detection of individually diseased coronary arteries (> or =1 stenosis with > or =50% diameter reduction on quantitative coronary angiography (QCA)), receiver-operator characteristics of protocol B (signal upslope in 32 sectors/heart) yielded a sensitivity/specificity of 82%/73%, which was superior to protocol A (P < 0.05, N= 14). For the overall detection of CAD, the sensitivity/specificity of protocol B was 85%/81%. An adequate signal response in the myocardium is crucial for a reliable detection of perfusion deficits during first-pass conditions. The presented protocol B detects CAD with a sensitivity and specificity similar to scintigraphic techniques.

Phorbol ester downregulates PDGFbeta receptor via PKCbeta1 in vascular smooth muscle cells.

The role of protein kinase C (PKC) and their isoforms in cell growth regulation remains elusive. Here we showed that in cultured human vascular smooth muscle cells (SMC), the PKC stimulator phorbol 12-myristate 13-acetate (PMA) inhibited [(3)H]thymidine incorporation in response to the growth factor PDGF associated with downregulation of PDGFbeta (but not alpha) receptors, which was recovered to normal level after PKC was depleted. The changes in PDGFbeta receptor were inversely correlated with PKCbeta1 protein levels regulated by PMA. The downregulation of PDGFbeta receptor by PMA was fully prevented by the PKCbeta inhibitor LY379196, however, without recovery of [(3)H]thymidine incorporation to PDGF. In contrast, [(3)H]thymidine incorporation was fully recovered after depletion of PKCs. These results indicate that in human SMC PKCbeta1 mediates PDGFbeta receptor downregulation. Other PKC isoforms activated by phorbol ester also contribute to the inhibitory effects on cell growth.