Effects of Ischemic Reperfusion Injury and Remote Conditioning on Passive Leg Raising-Induced Brachial-Artery Dilation.

OBJECTIVES: Passive leg raising (PLR) has been proposed to assess arterial vasodilator reserve and possibly endothelial function. Since endothelial function is sensitive to ischemic-reperfusion (I-R) injury, we determined the effects of I-R injury and ischemic conditioning on PLR-induced brachial-artery dilation (BAD), i.e. PLR-BAD. METHODS: We induced PLR-BAD before and after ipsilateral arm I-R injury (7.5 min of occlusion) in 20 healthy males aged 29 ± 6 years. The protocol was repeated in combination with remote conditioning stimuli (3 × 30 s of contralateral arm occlusions). RESULTS: PLR resulted in significant BAD (3.85%, p < 0.001) before but not after prolonged ischemia (0.25%, p = 0.38). I-R injury, along with either preischemic or postischemic conditioning restored the PLR-BAD response (before: 3.11%, p < 0.001 and after: 3.74%, p < 0.001). CONCLUSIONS: I-R injury blunts the BAD induced by PLR. Remote pre- and postconditioning restore this response. These findings are similar to those previously reported using hyperemia and ultrasound to assess BAD.

Arrhythmogenic biventricular cardiomyopathy: emerging findings on cardiac CT performed in the emergency department to evaluate chest pain.

We present multimodality imaging findings demonstrating arrhythmogenic biventricular cardiomyopathy initially observed on cardiac CT in a patient who presented to the emergency department with nonanginal chest pain. As the volume of patients referred for coronary CT angiography increases, structural pathology may emerge in previously unencountered diagnostic sequences. The high spatial resolution and volumetric coverage afforded by multidetector CT imaging remind us that cardiac pathology encompasses far more than atherosclerosis.