Sulfido-peptide leukotrienes in coronary heart disease - relationship with disease instability and myocardial ischaemia.

BACKGROUND: Urinary excretion of leukotriene (LT) E(4) is an index of LTC(4) biosynthesis and platelet-neutrophil interactions, which may occur in coronary heart disease and contribute to myocardial ischaemia. Enhanced LTC(4) biosynthesis may be a consequence of myocardial ischaemia or be linked to its pathogenetic substrate. METHODS AND RESULTS: Overnight urine collections were obtained from 17 patients with chronic stable angina, three patients with Prinzmetal's angina, 16 patients with non ST-elevation acute coronary syndromes (NSTE-ACS) and six patients with acute ST-elevation myocardial infarction (STEMI). LTE(4) excretion was measured by enzyme immunoassay after HPLC separation. Compared with healthy controls (51.1 +/- 21.3 pg mg(-1) creatinine, mean +/- SD, n = 11) and with non-coronary cardiac controls (36.6 +/- 9.8 pg mg(-1) creatinine, n = 9), LTE(4) excretion was unchanged in stable angina (40.5 +/- 25.8 pg mg(-1) creatinine), but significantly (P < 0.01) increased in NSTE-ACS (122.7 +/- 137.2 pg mg(-1) creatinine) and STEMI (213.4 +/- 172.4 pg mg(-1) creatinine). In these patients, LTE(4) excretion rapidly dropped after day 1, consistent with effective coronary reperfusion. In patients with NSTE-ACS, the increase in LTE(4) excretion was entirely restricted to patients with recent (< 48 h) spontaneous anginal episodes. Myocardial ischaemia elicited by a positive exercise stress test was not accompanied by any detectable increase in LTE(4) excretion, while a significant (P < 0.01) increase was detected after a single-vessel percutaneous coronary interventions (PCI) procedure (n = 10), as compared with diagnostic angiography (n = 9). CONCLUSIONS: In coronary heart disease, increased LTC(4) biosynthesis is restricted to ACS and not linked to myocardial ischaemia per se, but likely to the occurrence of plaque disruption.

Rapid assessment of cardiac anatomy and function with a new hand-carried ultrasound device (OptiGo): a comparison with standard echocardiography.

AIMS: The aim of this study was to evaluate image quality and accuracy of a new hand-carried ultrasound device, OptiGo (Agilent Technologies) when compared to standard echocardiography in the setting of a focused examination in the assessment of cardiac anatomy and function. METHODS AND RESULTS: One-hundred and twenty-one patients were prospectively enrolled. Image quality and accuracy in assessment of chamber sizes, left ventricular (LV) wall thickness and contractility, right ventricular (RV) function, mitral and aortic leaflet thickening, mitral annular calcification, pericardial effusion and valvular regurgitation were assessed. Two-dimensional (2D) findings were graded on a four-point scale, except for LV function (six-point) and valvular leaflet opening (two-point). Colour Doppler assessment of valvular regurgitation was graded on a seven-point scale. A one-point difference was considered minor; a two or more point difference was considered major. There was no statistically significant difference in image quality between the two devices. For 2D data, the number of total (minor and major) differences between the hand-carried and standard echocardiograph examinations was significantly greater than the inter-observer variability (14.3% vs 10.7%, P< 0.05), however, major differences alone were not statistically different. For the colour Doppler assessment of regurgitation there was a significant difference between the devices for total (minor and major) differences, (40.0% vs 31.8%,P < 0.007) however, the number of major differences is explained by inter-observer variability. CONCLUSIONS: Image quality and diagnostic accuracy of the hand-carried device, OptiGo, was adequate for the purpose of performing a focused assessment of a limited number of 2D and Doppler parameters for the evaluation of cardiac anatomy and function.

[Extensive cardiac angiosarcoma in the course of immunosuppressive therapy after kidney transplant]. / Esteso angiosarcoma cardiaco in corso di terapia immunosoppressiva post-trapianto renale.

We present a case of a 49-year-old man who underwent a kidney transplant. Treatment with azathioprine and steroid was increased due to an initial rejection of the allograft. Six months later, the patient experienced palpitations and precordial pain: the electrocardiogram recorded atrial fibrillation and the echocardiogram showed moderate pericardial effusion and the presence of a right atrial mass with infiltration into the interatrial septum and right ventricle. Computed tomography imaging confirmed the tumoral mass and magnetic resonance imaging revealed the extensive involvement of the right atrium, right ventricle and superior vena cava, suggesting the presence of an angiosarcoma of the heart. Despite chemotherapy the patient died within 1 month. The diagnosis was confirmed by autopsy, histological section, and electron microscopy examination.

[Deep venous thrombosis: epidemiologic, diagnostic and therapeutic aspects]. / Trombosi venose profonde: aspetti epidemiologici, diagnostici e terapeutici.

Deep vein thrombosis (DVT) has a high social and economic cost disease being its prevalence in the general population elevated and producing possibly fatal (pulmonary embolism) or disabling (post-thrombotic syndrome) complications. Thus, it appears of great importance to know the epidemiological and clinical characteristics of DVT in order to perform the best diagnosis, therapy and prophylaxis. The study population is composed by 146 patients (84 males and 62 females, mean age 60.9 +/- 15.3 years, range 19.92 years), arrived in our Vascular Echography Laboratory with the clinical suspect of DVT confirmed by means of echo color Doppler. The most frequent clinical signs were skin hyperthermia in 118 patients (80.8%) and edema in 116 patients (79.5%), while the most common symptom was pain, 89 patients (61.0%). Eleven patients (7.5%) were asymptomatic. The echo criteria utilized were direct thrombus visualization, vessel diameter higher than the contralateral, reduced or absent vessel wall ability to be compressed, reduced or absent color Doppler venous flow, lack or reduction of respiratory flow modulation, visualization of collateral circulation. DVT was located in 131 patients (89.7%) in inferior limbs (proximal in 122 patients, isolated distal in 9 patients), in 14 patients (9.6%) in superior limbs and in 3 patients (2.1%) in the internal jugular vein. In 130 patients a risk factor or a predisposing condition was identified: secondary DVT; in 16 patients the DVT was considered idiopathic. The most frequent risk factors were: previous surgery 28.1%, immobilization 19.9% trauma 17.1%, tumors 9.6%. A hypercoagulation was detected in 4 patients: antithrombin III deficit in 2, post-splenectomy thrombocytosis in 1 and antiphospholipid antibodies syndrome in the last one. The Pisa territory epidemiologic data showed a male 0.51 and female 0.38/1000 subject/year DVT incidence, with significantly higher values in older than 45-54 males and 55-64 females. One hundred and thirty one patients were treated with 5-11 day heparin infusion and thereafter with warfarin at least for 6 months, 1 year or indefinitely depending on thromboembolic risk. Six patients with distal DVT and 9 patients with hemorrhagic risk were treated with subcutaneous calcic or low weight heparin. In 1 patient with a mobile thrombus judged as at very high risk of embolization, a caval filter was positioned. Anticoagulant therapy complications were: 2 minor bleedings, 1 alopecia, 1 thrombocytopenia. Two patients died for neoplastic complications. Fifty-seven patients completed a 6-month follow-up and were submitted to a control each study that evidenced: total recanalization in 15 (26.3%), partial recanalization in 25 (43.9%) and no recanalization in 17 patients (29.8%). In 6 patients there was a DVT relapse and in 9 pulmonary embolization: almost all these patients were in the partial recanalization group.