Surgical aortic valve replacement and left ventricular remodeling: Survival and sex-related differences.

OBJECTIVES: To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex-related differences and implications for long-term outcomes. METHODS: In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post-SAVR. The six-year outcomes were evaluated. RESULTS: Pre-SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre-SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long-term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men. CONCLUSIONS: The long-term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow-up shifts help explain the sex differences in long-term outcomes post-SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.

Determination of bisphenol A in red wine using a double vortex-ultrasound-assisted microextraction assay: Role of the interfacial properties.

Bisphenol A (BPA) is a synthetic compound broadly used in medical devices as well as in packaging of food and drinks. Recently, BPA toxicity has become of concern to environmental public health. Red wine that is susceptible to BPA contamination is an alcoholic beverage made from yeast fermentation of grapes in the presence of grape skins so as to extract phenolic compounds. The aim of this study was to validate an efficient, low cost, and time-saving method for BPA determination in red-wine beverage. To this end, a rapid and simple microextraction method is here proposed consisting in liquid-liquid separation assisted by a vortex-ultrasound-vortex procedure combined with gas chromatographic analysis (GC-Fid or GC-IT/MS). By means of a comparative study between real red-wine matrix and synthetic hydroalcoholic solutions, different parameters related to the microextraction steps were investigated. The minimal amount of extraction solvent for a given volume of sample was calculated for both the systems. It was demonstrated that for red-wine matrix, the extent of phase separation is strongly affected by some wine constituents and that separation can be tuned by varying the amount of the extraction solvent. This double vortex-ultrasound-assisted method achieved high recovery of BPA and enrichment factor compared with other microextraction methods.

Left ventricular mass regression after aortic valve replacement: Sex differences or effect of different methods of indexation?

BACKGROUND: The influence of sex on regression of left ventricular (LV) hypertrophy (LVH) after aortic valve replacement (AVR) for aortic stenosis (AS) remains elusive. The lack of consensus on how to correct LV mass (LVM) for body size, and different normalcy values, contribute to inconclusive results. METHODS: In 164 consecutive patients (mean age 80 ± 4 years, 59% females) with AS, we analyzed LVM (Devereux formula) before and 1 year after AVR (St.Jude Trifecta bio-prosthesis). LVM was indexed to BSA (Du Bois and Gehan formulas), to height1.7 and height2.7 . Limits of normalcy were (women and men, respectively): <95 and <115 g/m², BSA-indexed LVM; <60 and <81 g/m, LVM/height1.7 ; <44 and <48 g/m, LVM/height2.7 . RESULTS: Women had smaller BSA, but not body mass index, than men. AS severity and incidence of hypertension did not differ. LVM indexed to height2.7 was greater in women. LVH incidence was similar in males and females. Independently of the indexation method, LVH reduced significantly (P < 0.0001). LVM reduction was greater in women (P < 0.05 for all methods). At follow-up, nearly half the patients, irrespective of sex, showed residual LVH, and diastolic dysfunction. CONCLUSIONS: We tested different methods of LVM indexation in AS patients. LVM was similar between men and women. Indexation to height2.7 gives higher LVM in women because of their shorter stature. LVH prevalence is independent of sex. Irrespective of the indexation method, LVM reduction is greater in females, whereas LVM normalization occurs in equal proportion. Persistent LVH and diastolic dysfunction suggest earlier AVR in elderly.

Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis.

BACKGROUND: Aortic prosthesis area (EOA) is computed by continuity equation from left ventricular (LV) stroke volume (SV) derived from LV outflow tract diameter (LVOTD ) or, when unmeasurable, from LV volumes (SVV ). There is evidence to suggest LVOT ellipticity and recommend 3D LVOT area (LVOTCSA ) adoption in aortic stenosis. We sought to evaluate if the same concept applies to supra-annular aortic prosthesis comparing SV and EOA derived from LVOTD (EOAD ) and from LVOTCSA (EOACSA ). EOA computed from SVV (EAOV ) accuracy was evaluated in this setting. Patient-prosthesis mismatch (PPM) was compared among different EOA computations. METHODS: A consecutive series of 202 patients (aged 81 ± 4 years, 43% males) underwent St.Jude Trifecta aortic valve replacement (AVR) and were followed up with echocardiography at one-year (335 ± 31 days). All measurements followed the EACVI or ASE guidelines, 3D X-plane modality was used to compute SVv and measure LVOTCSA ; SV was calculated from LVOTD (SVD ) and LVOTCSA (SVCSA ). PPM was indexed EOA <0.65 cm²/m². RESULTS: LVOT showed a significant ellipticity index (1.17 ± .27), independent of prosthesis size. EOAD (1.70 ± 0.55 cm²) was less than EOACSA (1.95 ± 0.62 cm²) (P < .0001). SVV was significantly lower than SVD and SVCSA . Bland-Altman analysis showed a significant correlation between SVV and SVD or SVCSA although with large bias and imprecision. The correlations improved reducing bias and imprecision when LVOT time-velocity integral was <20 cm. PPM incidence was higher in EOAV (15.6%) compared to EOAD (P = .04) or EOACSA (P < .001). CONCLUSIONS: In supra-annular AVR, LVOT retains its elliptical shape and LVOTCSA yielded larger prosthesis EOA with lower PPM incidence. PPM may be overestimated by EOAV .

In-vitro digestion of curcumin loaded chitosan-coated liposomes.

Liposomes are considered a major route for encapsulation of hydrophilic and hydrophobic molecules. Chitosan coated liposomes could represent an alternative way as a carrier for delivery of drugs in human body. In this study the preparation and applicability of chitosan-coated liposomes containing curcumin as well as curcumin loaded anionic liposomes were evaluated. The applicability of the carriers was tested by means of an in-vitro digestion procedure allowing for measurement of the bioaccessibility of ingested curcumin. Values of diameter, polydispersity index and surface charge for curcumin loaded anionic liposomes obtained through dynamic light scattering and ζ-potential measurements were 129nm, 0.095 and -49mV, respectively. After chitosan-coating, diameter and polydispersity index remain unvaried while the surface charge gets positive. Slightly higher curcumin concentrations were found after the mouth and the stomach digestion phases when curcumin was loaded in anionic liposomes. On the contrary, after the intestinal phase, a higher percentage of curcumin was found when chitosan-coated liposomes were used as carrier, both in the raw digesta and in the bile salt micellar phase. It was shown that the presence of a positively charged surface allows a better absorption of curcumin in the small intestine phase, which increases the overall curcumin bioavailability. The mechanism behind these results can be understood from the composition of the different environments generated by the digestive fluids that differently interact with anionic or cationic surfaces.

Visible light caffeic acid degradation by carbon-doped titanium dioxide.

The removal of the phenolic compound, caffeic acid, by photodegradation has been investigated using carbon-doped titanium dioxide particles as a photocatalyst under visible light. UV-vis absorption spectroscopy and gas chromatography-ion trap mass spectrometry analyses revealed a substrate concentration dependence of the removal of caffeic acid from a water solution. The k2 and t(0.5) parameters of each reaction were calculated by fitting kinetics data to a second-order kinetic adsorption model. To evaluate the photodegradation event, the effect of the adsorption process on the whole degradation was also monitored in the absence of light. Adsorption isotherm studies supported by ζ potential and scanning electron microscopy data demonstrated the pivotal role of the absorption mechanism. It was found that the whole photodegradation process is governed by a synergic mechanism in which adsorption and photodegradation are involved. This study, centered on the removal of caffeic acid from aqueous solutions, highlights the potential application of this technology for the elimination of phenolic compounds from olive mill wastewater, a fundamental goal in both the agronomical and environmental fields.

Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty.

Despite optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim the current study was to evaluate the impact of preprocedural TIMI flow on myocardial scintigraphic infarct size among STEMI undergoing primary angioplasty. Our population is represented by 793 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Poor preprocedural TIMI flow (TIMI 0-1) was observed in 645 patients (81.3%). Poor preprocedural TIMI flow was associated with more hypercholesterolemia (p = 0.012), and a trend in lower prevalence of diabetes (p = 0.081). Preprocedural TIMI flow significantly affected scintigraphic and enzymatic infarct size. Similar findings were observed in the analysis restricted to patients with postprocedural TIMI 3 flow. The impact of preprocedural TIMI flow on scintigraphic infarct size was confirmed when the analysis was performed according to the percentage of patients above the median (p < 0.001) and after adjustment for baseline confounding factors (Hypercholesterolemia and diabetes) [adjusted OR (95% CI) for pre preprocedural TIMI 3 flow = 0.59 (0.46-0.75), p < 0.001]. This study shows that among patients with STEMI undergoing primary angioplasty, poor preprocedural TIMI flow is independently associated with larger infarct size.

Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty.

BACKGROUND: Several reports have shown that in patient with ST-segment elevation acute myocardial infarction (STEMI) longer ischemia time is associated with impaired reperfusion and higher mortality. However, there is still some doubts with regards time to reperfusion role in patients treated with primary percutaneous coronary intervention (PCI). Therefore, the aim of the current study was to evaluate the impact of time-to-treatment on infarct size as evaluated by myocardial scintigraphy in a large cohort of STEMI patients undergoing primary PCI. METHODS: Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. RESULTS: Time-to-treatment was significantly associated with age and dyslipidemia. Time-to-treatment linearly affected the rate of postprocedural TIMI 3 flow (p<0.0001) and scintigraphic infarct size (p<0.001). The impact of time-to-treatment on infarct size persisted in the analysis restricted to patients with postpocedural TIMI 3 flow, and after correction for confounding factors such as age, dyslipidemia, postprocedural TIMI 3 flow (OR [95% CI]=1.26 [1.14-1.39], p<0.001). CONCLUSIONS: This study shows in a large population of STEMI patients undergoing primary PCI that time-to-treatment is linearly associated with infarct size.

[Epidemiology of Tako-tsubo cardiomyopathy: the Tuscany Registry for Tako-tsubo Cardiomyopathy ]. / Epidemiologia della sindrome di tako-tsubo nel mondo reale: dati del Registro Toscano della Miocardiopatia da stress tipo Tako-tsubo.

BACKGROUND: Tako-tsubo (stress) cardiomyopathy (TTC) is a recently described acute cardiac syndrome that mimics ST-segment elevation myocardial infarction. The TTC Tuscany Registry is an observational prospective multicenter registry established to define the prevalence, epidemiology and prognosis of TTC in the Tuscany area. METHODS: From January 1 to December 31, 2009, 105 consecutive patients hospitalized in the 14 Cardiology Units of the Tuscany Region with a diagnosis of TTC, were enrolled in the registry. TTC diagnosis was made using the Mayo Clinic modified criteria. Clinical, instrumental, laboratory and 6-month follow-up data were collected. Results. TTC represented 1.2% of all myocardial infarctions in the Tuscany Region during 2009, and it was diagnosed in 0.6% of the angiographic exams performed during the same year. The data collected showed that TTC affects mainly the female gender (91%) in the post-menopausal period (70 ± 11 years), though 5% of patients were ≤50 years old. An antecedent stressful event was frequently detected (74%). The main clinical presentation was chest pain (86%), associated with ST-segment elevation (59%). Mean left ventricular ejection fraction on admission was 40 ± 9%, and was associated with apical (37%), midapical (49%) or midventricular (5%) wall motion abnormalities. Left ventricular ejection fraction recovered to 51 ± 9% in 7 ± 9 days. Heart failure was the most common complication in the acute phase (14%), and 4 patients presented with cardiogenic shock. No patient died during the index hospitalization. At 6-month follow-up, no patient had TTC recurrence, 9 patients were rehospitalized (7 for noncardiac disease) and 2 patients died of noncardiac causes. CONCLUSIONS: Our data, which represent the largest prospective series of patients with a diagnosis of TTC, show that the prevalence of TTC in Tuscany is similar that described in other national and international studies. Moreover, the data highlight that TTC may occur also in male patients and in patients aged <50 years. The mid-term prognosis is good, but the risk of acute complications related to heart failure cannot be neglected.

Residual platelet reactivity, bleedings, and adherence to treatment in patients having coronary stent implantation treated with prasugrel.

Recent guidelines have recommended the use of aspirin and prasugrel in patients with acute coronary syndromes undergoing percutaneous coronary intervention. However, prasugrel use has been evaluated only in randomized trials. This study sought to evaluate bleeding rates and adherence to treatment in "real-world" patients treated with prasugrel. In total 298 consecutive patients 68 ± 10 years old (31% >75 years old) underwent stent implantation and received prasugrel therapy. Indications to prasugrel therapy were (1) ST-elevation acute myocardial infarction (41%), (2) drug-eluting stent implantation in diabetics (24%), (3) stent thrombosis (3%), (4) left main coronary artery drug-eluting stent implantation (6%), and (5) percutaneous coronary intervention in patients with high residual platelet reactivity on clopidogrel therapy (26%). All patients received a loading of prasugrel 60 mg. Patients ≥75 years old and with body weight ≤60 kg received a maintenance dose of 5 mg/day (10 mg/day for all the other patients). Follow-up data including adherence to prasugrel therapy were collected by telephone interviews or outpatient visits. Minimal follow-up length was 6 months (mean 9 ± 3). Major, minor, and minimal bleedings (Thrombolysis In Myocardial Infarction criteria) occurred in 2.7%, 4.7%, and 15.1% of enrolled patients. Low residual platelet reactivity (p = 0.001) and female gender (p = 0.29) were independent predictors of bleeding events. The most frequent minimal bleeding event was epistaxis. Only 8 patients (2.7%) permanently discontinued prasugrel therapy because of bleeding events (n = 4), possible side effects (n = 2), or medical decisions not associated with bleeding or side effects (n = 2). Fourteen patients (4.7%) temporarily discontinued prasugrel (average 6.5 days) mainly because of surgical procedures. No definite or probable stent thrombosis occurred, although 3 patients develop de novo myocardial infarction and 1 an ischemic stroke. There were 11 deaths because of heart failure or refractory cardiogenic shock in 9, pulmonary embolism in 1, and cancer in 1. In conclusion, in clinical practice, major and minor bleeding event rates associated with prasugrel therapy are comparable to those reported in controlled randomized trials. The minimal bleeding event rate is higher than reported but does not seem to affect adherence to treatment.

Characterization of Löeffler eosinophilic myocarditis by means of real time three-dimensional contrast-enhanced echocardiography.

Löeffler endocarditis is a rare myocardial disease often due to eosinophil leukemia or idiopathic hypereosinophilic syndrome. Degranulation of eosinophils within the eosinophil infiltrated myocardium is associated with myocardial necrosis due to the release of toxic cationic proteins, and with mural thrombi formation, which can occur anywhere in the ventricles. Thrombus formed on denuded myocardium is replaced by fibrosis as the final pathological stage of the disease, eventually leading to restrictive cardiomyopathy. We describe a multimodality imaging approach to the diagnosis and follow-up evaluation of Löeffler disease complicated by thrombus formation and neoangiogenesis of LV apex.

Anxiety trait in patients with stress-induced cardiomyopathy: a case-control study.

BACKGROUND: Stress-induced Tako-tsubo cardiomyopathy (TTC) is an acute cardiac syndrome, mimics ST elevation myocardial infarction (STEMI), largely confined to postmenopausal women, frequently precipitated by a stressful event. The pathogenesis of TTC is still unknown. Some authors hypothesized a possible connection between TTC and anxiety disease, but no previous study analyzed the relationship between anxiety trait and TTC. This study sought to assess the potential role of anxiety trait in the development and clinical course of TTC. METHODS: We included in the present prospective case-control study 50 consecutive patients admitted to our Hospital with a diagnosis of TTC according to the Mayo Clinic criteria. Fifty control patients with anterior STEMI matched for clinical characteristics such as age, gender, and hypertension were selected. During the hospitalization, all patients were asked to complete the Spielberger Trait Anxiety Inventory (STAI) scale for measuring self-reported trait anxiety (Trait-A). Outcome measures at follow-up were death, TTC recurrence, and rehospitalization. RESULTS: The mean value of STAI scale was 46 ± 12 in TTC patients and 45 ± 14 in STEMI patients (p = 0.815). High-anxiety trait (STAI scale value ≥ 40) was documented in 30 (60%) TTC patients and in 26 (52%) STEMI patients (p = 0.387). At multivariate analysis, predictors of TTC were lower peak creatine kinase value (HR 0.999; 95% CI 0.998-0.999; p = 0.018) and an antecedent stressful trigger event (HR 45.487; 95% CI 6.471-319.759; p = 0.001), but anxiety trait was not. There were no differences in outcome measures between TTC patients with or without high-anxiety trait. CONCLUSION: In TTC patients, high-anxiety trait is a common finding but it is not significantly more frequent than in patients with STEMI. Moreover, a high-anxiety trait seems to be neither associated with a worse clinical outcome nor a predictor of TTC. Our study do not support the routine evaluation of anxiety trait in patients with TTC.

Effects of sulfate ions and slightly acidic pH conditions on Cr(VI) adsorption onto silica gelatin composite.

The feasibility of utilizing CTAB-silica gelatin composite (C-SGC) to remove hexavalent chromium from aqueous solutions under different conditions was investigated. Removal of chromate was assessed through evaluation of the adsorption kinetics of chromate ions on the composite under equilibrium conditions in the presence of sulfate ions and at a slightly acidic pH condition (pH 5.8). Adsorption competition tests in the presence of sulfate ions showed that Cr(VI) was still effectively adsorbed from aqueous solution regardless of the presence of the competing anions. In fact, the adsorption kinetics performed at different initial chromate concentrations were unaffected by the presence of 100 mg L(-1) sulfate ions (pH 7.5). The equilibrium adsorption data were fitted by Freundlich adsorption isotherms which confirmed that the adsorption efficiency of chromium on the CTAB-silica gelatin composite was unchanged in the presence of sulfate ions. Further, the adsorption process was shown to be pH dependent and more efficient at slightly acidic pH (5.8). These findings demonstrated a high specificity of the CTAB-silica gelatin composite for chromium, and highlight the possibility of using this matrix for efficient removal of chromium from industrial wastewater without the need to eliminate contaminant sulfate ions.

Preparation of nanosize silica in reverse micelles: ethanol produced during TEOS hydrolysis affects the microemulsion structure.

Microemulsions have been widely used as microreactors for the synthesis of nanoparticles and mesoporous materials. The correlation between the microstructure of a microemulsion and the features of the obtained materials is the most intriguing problem. On this point, many investigations have their ground on the structure of the precursor microemulsion, i.e., the system before the reaction takes place. Nevertheless, any reactions usually involve the formation of byproducts (aside from the nanoparticles). Several of these byproducts (e.g., ions, amphiphilic molecules) could modify the microemulsion structure during the course of the reaction. Here we examine the hydrolysis of tetraethoxysilane (TEOS) in the water-in-oil microemulsion hexadecyl-trimethylammonium bromide (CTAB)/pentanol/hexane/water. Conductivity and NMR measurements performed during the course of the reaction, in combination with dynamic light scattering and pulsed field gradient spin-echo NMR investigation performed on the microemulsion upon the addition of ethanol, indicate that a byproduct (ethanol) modifies the microreactor structure. The ethanol produced by the TEOS hydrolysis drives the microemulsion structure from small disconnected reverse micelles toward large connected aggregates until (for high enough ethanol loading) the system phase separates into two coexisting liquid phases (a dense interconnected network and a dilute reverse micellar phase).

Removal of chromate from water by a new CTAB-silica gelatin composite.

A novel composite able to remove hexavalent chromium Cr(VI) from aqueous solutions was obtained by adding the silica precursor tetraethoxysilane (TEOS) to the hexadecyltrimethylammonium bromide (CTAB) microemulsion-based gel. A physical characterization of the new matrix revealed high stability of the silica gelatin composite in water at high temperatures and at neutral pH. Good efficiency in removing chromate from neutral solutions was also demonstrated by the adsorption kinetics. In particular, the adsorption data of chromate obtained with the CTAB-silica gelatin composite at 25 degrees C and pH 7.5 are described by the Freundlich isotherm model. The specific role of CTAB in the silica gelatin composite was also evaluated by comparing the kinetics of the anionic AOT-silica gelatin composite to the CTAB one. The data collected clearly showed that the positively charged surfactant was necessary to efficiently adsorb Cr(VI) from aqueous solutions. SEM and pulsed gradient spin-echo NMR analysis of the composite demonstrated that the silicon is well assembled in the gelatin network, in which water molecules maintain a high mobility. The diffusion coefficient of water in this system was shown to remain close to the value of pure water. Finally, X-ray analyses of the elemental content in the CTAB-silica gelatin composite indicated no difference in terms of percentage of silica distributions in different areas of the matrix and suggested that chromium adsorption could take place in internal areas.

Gelatin microemulsion-based gels with the cationic surfactant cetyltrimethylammonium bromide: a self-diffusion and conductivity study.

In this contribution we demonstrate that gelatin can jellify also water-in-oil microemulsions based on the cationic surfactant cetyltrimethylammonium bromide (CTAB). The partial stability diagram of the system CTAB + 1-pentanol + water + hexane + gelatin was determined. The resulting microemulsion-based gels (MBGs) were characterized by means of conductivity and pulsed gradient spin-echo NMR. For the first time the water self-diffusion coefficient was measured in gelatin MBGs, and the results were successfully analyzed in terms of diffusion in an interconnected network of aqueous channels.