[Inconsistency between voltage of the electrocardiogram and the left ventricular wall thickness. diagnostic key in cardiac amyloidosis]. / Discordancia entre el voltaje del electrocardiograma y el grosor parietal del ventículo izquierdo. clave diagnóstica en amiloidosis cardíaca.

Restrictive cardiomyopathy is the least common form of cardiomyopathy, and the disease that most often cause it, is the system amyloidosis. We present a 62-year-old with a history of heart failure, which in its assessment highlights the discrepancy between the low voltage ventricular complexes in the electrocardiogram and the severity of left ventricular wall thickness on echocardiography. This discrepancy was the source of suspicion and subsequent confirmation of systemic amyloidosis with cardiac involvement.

La miocardiopatía restrictiva es la forma menos frecuente de cardiomiopatía, y la enfermedad que con mayor frecuencia la origina, es la amiloidosis sistema. Presentamos un paciente de 62 años, con antecedentes de insuficiencia cardiaca, que en su evaluación, destaca la discordancia entre el escaso voltaje de los complejos ventriculares en el electrocardiograma y la severidad del grosor parietal del ventrículo izquierdo en el ecocardiograma, siendo dicha discordancia, la fuente de sospecha y posterior confirmación de amiloidosis sistémica con compromiso cardiaco.

Discordancia entre el voltaje del electrocardiograma y el grosor parietal del ventículo izquierdo. clave diagnóstica en amiloidosis cardíaca / [Inconsistency between voltage of the electrocardiogram and the left ventricular wall thickness. diagnostic key in cardiac amyloidosis].

Restrictive cardiomyopathy is the least common form of cardiomyopathy, and the disease that most often cause it, is the system amyloidosis. We present a 62-year-old with a history of heart failure, which in its assessment highlights the discrepancy between the low voltage ventricular complexes in the electrocardiogram and the severity of left ventricular wall thickness on echocardiography. This discrepancy was the source of suspicion and subsequent confirmation of systemic amyloidosis with cardiac involvement.

Discordancia entre el voltaje del electrocardiograma y el grosor parietal del ventículo izquierdo. clave diagnóstica en amiloidosis cardíaca. / [Inconsistency between voltage of the electrocardiogram and the left ventricular wall thickness. diagnostic key in cardiac amyloidosis].

Restrictive cardiomyopathy is the least common form of cardiomyopathy, and the disease that most often cause it, is the system amyloidosis. We present a 62-year-old with a history of heart failure, which in its assessment highlights the discrepancy between the low voltage ventricular complexes in the electrocardiogram and the severity of left ventricular wall thickness on echocardiography. This discrepancy was the source of suspicion and subsequent confirmation of systemic amyloidosis with cardiac involvement.

Risk progression to chronic Chagas cardiomyopathy: influence of male sex and of parasitaemia detected by polymerase chain reaction.

BACKGROUND: Polymerase chain reaction (PCR) allows detection of Trypanosoma cruzi in blood throughout the course of Chagas' disease. OBJECTIVE: To determine whether T cruzi DNA detected by PCR is associated with progression to chronic Chagas cardiomyopathy. DESIGN: Prospective cohort study. SETTING: A tertiary care centre in Argentina. PATIENTS: 56 consecutive patients with chronic T cruzi infection. METHODS: Clinical examination, ECG, and Doppler echocardiography were carried out at baseline and at the end of the follow up. Detection of T cruzi DNA by PCR amplifying a nuclear sequence was undertaken in all patients at baseline. MAIN OUTCOME MEASURES: Progression was defined as death from chronic cardiomyopathy or the presence of a new ECG or left ventricular echocardiographic abnormality at the end of follow up. RESULTS: The 56 patients (21 male, 35 female; mean (SD) age, 56.0 (11.3) years) were followed for a mean 936.3 (244.39) days. Progression to cardiomyopathy was detected in 12 patients (21.4%). Three of these patients died after baseline evaluation. Univariate analysis showed that a positive PCR (relative risk 4.09, 95% confidence interval (CI) 1.60 to 9.85) and male sex (5.00, 95% CI 1.65 to 15.73) were associated with progression. Multivariable logistic regression indicated that both sex and PCR were independent variables affecting the outcome. CONCLUSIONS: In a cohort of seropositive individuals, patients with T cruzi DNA detected by PCR and male patients were at higher risk of progression. These results highlight the importance of T cruzi in the pathophysiology of chronic cardiomyopathy.

Serum sialic acid concentration is not associated with the extent or severity of coronary artery disease in patients with stable angina pectoris.

BACKGROUND: Total serum sialic acid concentration has been reported to predict death from cardiovascular disease. This study was performed to assess the relation between serum sialic acid concentration and the angiographic extent and severity of coronary atheroma in patients with stable angina. METHODS: Quantitative coronary angiography was performed in 40 patients with stable angina with either triple-vessel disease (23 patients) or normal/nearly normal coronary arteries (17 patients). A colorimetric assay for the enzymatic determination of serum sialic acid was used. RESULTS: Serum sialic acid concentration was not significantly different in patients with normal or nearly normal coronary angiograms compared with those with triple-vessel disease (68+/-10 mg/100 mL and 68+/-11 mg/100 mL, respectively). Neither was there any association between the extent or severity of coronary disease and serum sialic acid levels. CONCLUSIONS: Serum sialic acid concentration does not appear to be associated with the extent or severity of coronary artery disease in patients with stable angina pectoris. Thus the previously described association between serum sialic acid and cardiovascular death may reflect the role of mechanisms other than the severity of coronary artery narrowings.

Differential plasma endothelin levels in subgroups of patients with angina and angiographically normal coronary arteries. Coronary Artery Disease Research Group.

BACKGROUND: Raised plasma endothelin concentrations have previously been reported in patients with cardiac syndrome X, but it is not known whether these levels vary between clinically distinct subgroups in this heterogeneous condition. METHODS AND RESULTS: We compared plasma immunoreactive endothelin levels in 54 patients with angina pectoris and normal coronary angiograms and 21 healthy control subjects. The patient group was divided into 4 clinically distinct subgroups: 7 with left bundle branch block (group A); 7 with previous myocardial infarction (group B); 24 with positive exercise electrocardiography (group C); and 16 with negative exercise electrocardiography (group D). The plasma endothelin concentration was significantly higher in patients compared with control subjects (3.7 [2.9 to 4.3] vs 2.96 [2.4 to 3.4] pg/mL, respectively, median [interquartile range]; P=0.002). Endothelin concentrations were most significantly elevated in group A and group B (4.5 [3.6 to 5.2] pg/mL; P=0.005 and 4.1 [3.9 to 4.5] pg/mL; P=0.001, respectively). Plasma endothelin concentrations were also significantly elevated in group C (3.7 [2.8 to 4.1] pg/mL; P=0.02) but not in group D (3.0 [2.5 to 3.8] pg/mL; P=0.3). CONCLUSIONS: Plasma endothelin concentration is elevated in patients with angina pectoris and angiographically normal coronary arteries, particularly those with left bundle branch block or previous myocardial infarction.

Serum endothelin levels and pain perception in patients with cardiac syndrome X and in healthy controls.

The possible algogenic effects of elevated serum endothelin levels in cardiac syndrome X were investigated in a case-control study that examined somatic pain perception in the forearm during submaximal effort tourniquet and cold immersion tests. Pain threshold to both ischemic and cold stimulation of the forearm was demonstrated to be significantly lower in patients with syndrome X than in matched healthy controls, and a negative correlation between ischemic pain threshold and endothelin levels was demonstrated.

Heart rate-independent prolongation of QTc interval in women with syndrome X.

BACKGROUND: Cardiac syndrome X is usually diagnosed in the presence of typical exertional chest pain, a positive response to exercise testing, and normal coronary angiograms. The underlying pathogenic mechanisms are speculative, but myocardial ischemia and increased sympathetic activity have been implicated. HYPOTHESIS: The present study examined whether QTc interval is prolonged in women with syndrome X when confounding factors such as heart rate, gender, and environmental conditions are accounted for. METHODS: Maximum QTc interval and its relationship to clinical and exercise variables were evaluated in 32 women with syndrome X (exertional chest pain, positive exercise testing, and completely normal coronary arteries) and 34 normal controls. RESULTS: Patients with syndrome X had significantly longer QTc interval (440 +/- 24 ms) than normal subjects (410 +/- 26 ms, p < 0.004). However, this QTc prolongation appears to be heart rate-independent as patients with syndrome X showed longer QT and QTc intervals than controls despite an identical heart rate. No relation was found between QTc prolongation and clinical or exercise test variables in patients with syndrome X. CONCLUSION: Although increased sympathetic drive is present in syndrome X, and this variable is likely to modulate QTc duration, the mechanism and clinical implications of QTc interval prolongation in syndrome X remain speculative.

Human chagasic disease is not associated with an antiheart humoral response.

An inflammatory cardiomyopathy occurs in humans with chronic Trypanosoma cruzi infection (Chagas' disease). This study finds that T. cruzi infection is not associated with the production of cardiac-specific autoantibodies in humans with cardiac manifestations.

Plasma immunoreactive endothelin concentration correlates with severity of coronary artery disease in patients with stable angina pectoris and normal ventricular function.

OBJECTIVES: The present study tested the hypothesis that plasma immunoreactive endothelin concentration correlates with the severity and extent of coronary atherosclerosis. BACKGROUND: Plasma endothelin-1 concentration is increased in patients with unstable coronary syndromes and advanced atherosclerosis. This finding, together with other clinicopathologic observations, suggests that endothelins may participate in the atherogenic process. However, the relation between plasma immunoreactive endothelin and coronary artery disease in patients with stable angina pectoris remains controversial. METHODS: Ninety consecutive patients undergoing coronary angiography for the investigation of exertional chest pain and 49 normal control subjects were prospectively studied. Eleven patients had normal coronary angiographic findings (group I), 65 had coronary artery stenoses (group II), and 14 had coronary artery disease plus symptoms indicating atheroma in other vascular territories (group III). Computerized angiography was used to determine the extent, severity and morphology of coronary stenoses. Plasma immunoreactive endothelin was measured by radioimmunoassay. RESULTS: Mean (+/- SD) plasma endothelin concentration (pg/ml) was significantly higher in patients than in control subjects (7.29 +/- 4.07 vs. 3.48 +/- 1.29, p < 0.0001). Endothelin levels were higher in patients of group III than in those of groups II and I (9.43 +/- 5.48, 7.20 +/- 3.72 and 4.94 +/- 2.89, respectively, p = 0.02). In patients of group II, plasma endothelin correlated with the maximal degree of stenosis in each patient (r = 0.25, p = 0.04) and with the number of stenoses with > or = 70% diameter narrowing (r = 0.36, p = 0.002). The highest plasma endothelin levels were found in patients with total occlusions (8.65 +/- 3.78 vs. 6.46 +/- 3.51 p = 0.02). CONCLUSIONS: Plasma immunoreactive endothelin concentration is increased in patients with chronic stable angina. The higher levels occur in patients with severe stenoses and total coronary occlusion.

[Regional changes of ventricular motility in patients with positive serology for Chagas disease]. / Alteraciones regionales de la motilidad ventricular en pacientes con serología positiva para la enfermedad de Chagas.

The aim of the present study was to carry out a quantitative assessment of the regional left ventricular wall motion and diastolic function of patients with Chagas disease in different clinical stages. Twenty patients with positive immunofluorescence tests for Chagas disease were studied. Eight patients were asymptomatic (class I), 9 patients had electrocardiographic abnormalities (class II) and 3 patients had heart failure (class III). The control group consisted of 10 normal subjects. 2D echocardiographic images from parasternal and apical views were analysed quantitatively using a previously validated method for the assessment of the regional wall motion of the left ventricle. Diastolic flow velocities and times at mitral valve level were analysed using pulsed wave Doppler. Patients with Chagas disease showed marked wall motion abnormalities in the posterobasal segment compared with controls. These abnormalities were evident even in class I patients. The number of affected segments was higher in class II and class III. "A" wave velocity was greater in patients than in controls (0.67 +/- 0.17 and 0.49 +/- 0.08 m/s, p = 0.01 respectively) but the pattern of diastolic flow velocity was non specific. In conclusion, regional left ventricular wall motion abnormalities are common in early stages of Chagas disease suggesting that myocardial activity of the disease is present even during the asymptomatic period.

Concentration of circulating plasma endothelin in patients with angina and normal coronary angiograms.

BACKGROUND: Some patients with angina pectoris and normal coronary arteriograms have reduced coronary flow reserve and abnormal endothelium dependent vasodilator responses. Endothelin-1 (ET-1), a potent vasoconstrictor, is an important modulator of microvascular function and may also have algogenic properties. METHOD: Plasma ET-1 was measured in peripheral venous blood in 40 patients (30 women) (mean (SD) age 56 (8) years) with angina and normal coronary arteriograms and 21 normal controls (17 women) (mean (SD) age 53 (7) years). Patients with systemic hypertension, left ventricular hypertrophy, or coronary spasm were excluded. Plasma ET-1 was measured using radioimmunoassay. RESULTS: Thirty five patients had > or = 1 mm ST segment depression during exercise. Left bundle branch block was present in four patients at rest and in one during exercise. Mean (SD) (range) concentration of ET-1 (pg/ml) was higher in patients than in controls (3.84 (1.25) (1.97-7.42) v 2.88 (0.71) (1.57-4.48) P < 0.0001). In patients with "high" (> control mean (one SD)) ET-1 concentrations (n = 23), the time to onset of chest pain during exercise was significantly shorter (6.21 (3.9) v 9.03 (3.9) min; p = 0.01) than in patients with "low" ET-1 concentrations. Of the five patients with left bundle branch block, four had plasma ET-1 concentration > 4.0 pg/ml. CONCLUSION: Plasma endothelin is raised in patients with angina and normal coronary arteriograms and is consistent with the demonstration of endothelial dysfunction in such patients. The association between "high" plasma ET-1 and an earlier onset of chest pain during exercise suggests that endothelin may also have a role in the genesis of chest pain in patients with normal coronary arteries.