Correlation of heart-type fatty acid-binding protein with mortality and echocardiographic data in patients with pulmonary embolism at intermediate risk.

BACKGROUND: The management strategy in patients presenting with pulmonary embolism at intermediate risk still remains controversial. Our aim was to determine the role of heart-type fatty acid-binding protein (H-FABP) in this patient population. METHODS: One hundred one consecutive patients with confirmed pulmonary embolism and echocardiographic signs of right ventricular overload but without evidence for hypotension or shock, referred to as pulmonary embolism at intermediate risk, were included in the study. Heart-type fatty acid-binding protein and other biomarkers were measured in all patients upon arrival in the emergency department. RESULTS: Of the included 101 patients, 14 had positive H-FABP tests. Ten patients with positive H-FABP (71%) had clinical deterioration during the hospital course and required inotropic support and 8 of these patients died. None of the 87 patients with a negative test worsened or needed inotropic support or died during hospital stay (P < .005). In the H-FABP-positive group, right ventricular function on echocardiography was more impaired (tricuspid annular plane systolic excursion 13 +/- 4 vs 18 +/- 4 mm, RV/LV ratio 1.1 +/- 0.2 vs 0.9 +/- 0.2, presence of paradoxical septal movement 79% vs 46%, presence of McConnell sign 100% vs 60%, respectively, all P < .05) compared to the H-FABP-negative group. After adjusting for potential confounding parameters, in multivariate analysis, H-FABP was the only independent predictor of mortality. CONCLUSIONS: Heart-type fatty acid-binding protein significantly predicts mortality in patients with pulmonary embolism at intermediate risk. Furthermore, it is significantly associated with impaired right ventricular function and shows better correlation with mortality than troponin I. It may be a novel prognostic parameter enabling the optimization of management strategy in the very difficult population of pulmonary embolism at intermediate risk.

Broken heart syndrome: Tako Tsubo cardiomyopathy associated with an overdose of the serotonin-norepinephrine reuptake inhibitor Venlafaxine.

OBJECTIVE: To describe a case of Tako Tsubo cardiomyopathy [TTC] in a patient after an overdose of the serotonin-norepinephrine reuptake inhibitor [SNRI] Venlafaxine. METHODS: We present a case study including clinical and laboratory data. Current relevant literature is reviewed and summarized in regard to Tako Tsubo syndrome and SNRI. RESULTS: A 43year-old woman was admitted with acute angina pectoris after accidentally taking an overdose on Venlafaxine in order to treat major depression. Because of the ECG-T-wave-inversions in the precordial leads, the slightly increased Troponin/Creatine kinase levels and the apical systolic dysfunction of the left ventricle in echocardiogram a cardiac catheterization was performed. Coronary artery disease could be excluded by coronary angiography. The followed laevocardiography and cardiac MRI scan showed apical akinesis and basal hypercontractibility typical for apical ballooning (Tako Tsubo cardiomyopathy). Urine analysis revealed elevated normetanephrine level potentially caused by Venlafaxine. Six weeks after the first admission the echocardiogram showed a complete recovery to normal left ventricular function. CONCLUSIONS: To our knowledge this is the first reported case of an overdose of Venlafaxine (SNRI) associated Tako Tsubo cardiomyopathy.

Nomograms for severity of aortic valve stenosis using peak aortic valve pressure gradient and left ventricular ejection fraction.

AIMS: Continuity equation to evaluate aortic valve area (AVA(CE)) is critically dependent on accurate measurement of left ventricular outflow tract diameter and velocity. To circumvent these limitations, the present study aimed to generate nomograms for a facilitated estimation of aortic valve area using peak aortic valve pressure gradient (DeltapAv) and left ventricular ejection fraction (LVEF). METHODS AND RESULTS: Two hundred and fifty-five subjects with non-invasively and invasively defined aortic valve stenosis (AS) formed the basis of this study. Basis of the nomograms was the correlation analysis between DeltapAv and AVA as estimated by AVA(CE) within different LVEF groups. LVEF differed from 65.6 +/- 1.8% (Group I, LVEF > 60%) to 34.5 +/- 4.3% (Group IV, LVEF > or = 30%). DeltapAv and AVA varied from 85.6 +/- 19.5 mmHg and 0.69 +/- 0.16 cm2 in Group I to 58.5 +/- 15.9 mmHg and 0.73 +/- 0.23 cm2 in Group IV (DeltapAv: P < 0.001). Mean AVA(CE) showed no significant difference between the groups. Correlation between DeltapAv and AVA(CE) was statistically significant with P < 0.001 in all subgroups (R2 between 0.72 and 0.76). Furthermore, a prospective estimation of AVA using the developed nomograms correlated very well with invasively determined AS using the Gorlin formula (R2 = 0.76, SEE = 0.21 cm2, bias 0.04 cm2). CONCLUSION: The present study has established and confirmed a solid, easy to use nomogram-based method to accurately quantify severe AS.

Single coronary artery with anomalous origin from the right sinus Valsalva.

A single coronary artery is a rare congenital anomaly with an incidence of 0.02-0.04%. We report on a 65-year-old male presenting with atypical chest pain and a history of hypertension and hypercholesterinemia, having diagnosed a very rare variant of a single coronary artery arising from the right sinus of Valsalva continuing as circumflex coronary artery (LCX) and thereafter as left anterior descending artery (LAD). Because the patient was asymptomatic on antiischemic medication and had a proposed relative benign course, we recommended medical treatment without coronary artery bypass surgery, and the patient has been in fine condition up to now (11 months after angiography).