Prevalence and risk factors of prolonged QTc interval in HIV-infected patients: results of the HIV-HEART study.

BACKGROUND: Corrected QT (QTc) prolongation is predictive of cardiovascular mortality in both the general and human immunodeficiency virus (HIV) populations. OBJECTIVE: As part of the HIV-HEART study, we assessed the prevalence and risk factors of a prolonged QTc interval in patients with HIV infection. METHODS: In this cross-sectional cohort study, 802 unselected HIV-infected patients were included. Data were analyzed by the use of gender-specific QTc categories (men abnormal at > 440 ms and women abnormal at >460 ms). Multiple variables related to infection and treatment were collected. Results were analyzed with a multivariable model. RESULTS: The QTc interval was found to be prolonged in 154 patients (19.8%; 95% CI 17-23). The mean (+/-SD) QTc in men (n = 142) presenting with a prolonged QTc interval was 456 +/- 16.3 ms (range 441-548 ms). The mean (+/-SD) QTc in women (n = 12) presenting with a prolonged QTc interval was 479 +/- 9 ms (range 465-498 ms). In the multivariable model, female gender, diabetes mellitus, and arterial hypertension were associated with prolonged QTc. There were no parameters related to HIV independently associated with QT interval prolongation. In particular, no anti-HIV drug was associated with QTc prolongation. CONCLUSIONS: Our study demonstrated that in an HIV-infected population, QTc prolongation had a high prevalence of nearly 20% compared to the general population and was possibly influenced by common factors like gender, diabetes, and arterial hypertension.

Regadenoson in the detection of coronary artery disease.

Myocardial perfusion studies use either physical exercise or pharmacologic vasodilator stress to induce maximum myocardial hyperemia. Adenosine and dipyridamole are the most commonly used agents to induce coronary arterial vasodilation for myocardial perfusion imaging. Both cause frequent undesirable side-effects. Because of its ultrashort half-life, adenosine must be administered by constant intravenous infusion during the examination. A key feature of an ideal A2A agonist for myocardial perfusion imaging studies would be an optimal level and duration of hyperemic response. Drugs with a longer half-time and more selective A2A adenosine receptor agonism, such as regadenoson, should theoretically result in a similar degree of coronary vasodilation with fewer or less severe side-effects than non-selective, ultrashort-lasting adenosine receptor stimulation. The available preclinical and clinical data suggest that regadenoson is a highly subtype-selective, potent, low-affinity A2A adenosine receptor agonist that holds promise for future use as a coronary vasodilator in myocardial perfusion imaging studies. Infusion of regadenoson achieves maximum coronary hyperemia that is equivalent to adenosine. After a single bolus infusion over 10 s, hyperemia is maintained significantly longer (approximately 2-5 min) than with adenosine, which should facilitate radionuclide distribution for myocardial perfusion imaging studies. In comparison with the clinically competitive A2A adenosine receptor agonist binodenoson, regadenoson has a several-fold shorter duration of action, although the magnitude of hyperemic response is comparable between the two. The more rapid termination of action of regadenoson points to an advantage of enhanced control for the clinical application. Regadenoson selectively causes vasodilation of the coronary circulation, whereas effects on systemic blood pressure are only mild. The clinical adverse effect profile of regadenoson appears to be favorable, particularly with respect to dreaded atrioventricular conduction disturbances and bronchospasm.

[Cardiac magnetic resonance imaging in the diagnosis of acute coronary syndrome. Basics and clinical value]. / Kardiale Magnetresonanztomographie in der Diagnostik des akuten Koronarsyndroms. Grundlagen und klinische Anwendungsmöglichkeiten.

In contrast to chronic myocardial infarction, data concerning the value of cardiac magnetic resonance imaging in patients with acute onset of chest pain are still rare. Even in the presence of characteristic clinical parameters, cardiac magnetic resonance imaging might provide independent evidence especially in the absence of typical ECG alterations and prior to biomarker elevation. Besides the ability to demonstrate wall motion abnormalities cardiac magnetic resonance imaging gains additional potential as to the detection of myocardial edema, microvascular obstruction (no-reflow) and myocardial necrosis. However, cardiac magnetic resonance imaging is expensive and time-consuming, and therefore may not be cost-effective. At present, a lack of sufficient diagnostic and prognostic data would make cardiac magnetic resonance imaging unsuitable for routine stratification of chest pain patients in an emergency department.

[New models to improve supply in patients with chronic heart failure]. / Neue Versorgungsstrukturen für Patienten mit chronischer Herzinsuffizienz.

Frequency of chronic heart failure still increases. More and more resources have been required for the diagnosis and therapy of this disease. This burden for health-care systems will grow in the near future. In particular, clinical treatment has a major impact. New approaches are essential to ensure an efficient supply of patients with chronic heart failure in the next years. Models to improve the supply give the opportunity to optimize the medical workflow and involve the patient into the concept of care. Therefore, a variety of models have been developed and up to now tested concerning benefit and applicability in western industrial countries. The present article focuses on the fundamental models to improve the supply of patients with chronic heart failure.

Percutaneous occlusion of posttraumatic aortic arch pseudoaneurysm by catheter-based delivery of thrombin.

PURPOSE: To report a patient in whom a posttraumatic pseudoaneurysm of the aortic arch was successfully treated by catheter-based delivery of thrombin with balloon occlusion of the entry tear. CASE REPORT: A 63-year-old male presented with pseudoaneurysm of the aortic arch after blunt chest trauma which was detected incidentally during routine chest X-ray. Using a percutaneous transfemoral approach, a 5 French Swan-Ganz catheter could be positioned into the aneurysm sac. Under balloon occlusion of the entry tear in order to prevent systemic embolization, 1,000 units of bovine thrombin were injected into the aneurysm sac resulting in complete occlusion of the aneurysm. Contrast-enhanced computed tomographic control showed complete thrombosis of the aneurysm over a follow-up period of 12 months. CONCLUSION: Percutaneous catheter-based delivery of thrombin is a feasible and effective minimally-invasive treatment alternative for patients with thoracic aortic pseudoaneurysms.

Comparison of magnetic resonance perfusion imaging versus invasive fractional flow reserve for assessment of the hemodynamic significance of epicardial coronary artery stenosis.

This study evaluated whether first-pass perfusion cardiovascular magnetic resonance (FP-CMR) could predict the hemodynamic significance of epicardial coronary artery stenosis as defined by invasively determined fractional flow reserve at coronary angiography. In 19 patients with known coronary artery disease (CAD), the hemodynamic relevance of 22 stenoses (mean angiographic severity 73 +/- 9%) was determined using fractional flow reserve measurements (cutoff 0.75). Results were compared with a territorial index of myocardial perfusion reserve (MPR) derived from FP-CMR. In addition, 9 age-matched patients with low prevalence of risk factors and without CAD at angiography served as a control group. A cutoff of 1.5 for MPR separated hemodynamically relevant from nonrelevant stenoses with a sensitivity and specificity of 92% and 92%, respectively. The area under the receiver-operator characteristic curve was 0.97. In the patient group, territories supplied by arteries without significant stenosis (