Resolution of a Giant Atrial Thrombus Following Anticoagulation Therapy : Case Report

We report on a patient in whom a giant thrombus in the left atrium was detected by transthoracic echocardiography. Anticoagulant theraphy was started. After two months of therapy; repeat echocardiography showed complete resolution of the thrombus. This case indicates that large and presumably organised thrombi may be treated with anticoagulant the

Lipid peroxides in obese patients and effects of weight loss with orlistat on lipid peroxides levels.

OBJECTIVE: Obesity is a well-known risk factor of atherosclerosis. Recent studies showed that obesity is associated with enhanced lipid peroxidation. The aim of this study is to investigate the effect of weight reduction with orlistat treatment on lipid peroxidation levels. We assessed lipid peroxidation by measuring the concentration of plasma malondialdehyde (MDA). DESIGN: A randomized, controlled, open-label 6-month study. SUBJECTS: In total, 36 obese (body mass index (BMI) >30 kg/m2) and 11 healthy age-matched control subjects were enrolled in the study. MEASUREMENTS: Fasting glucose, triglyceride, total cholesterol, HDL cholesterol and LDL cholesterol and MDA levels were measured in both groups. Obese subjects received orlistat, 120 mg three times daily together with hypocaloric diet. After 6 months of treatment laboratory tests were repeated. RESULTS: MDA levels were significantly higher in obese patients than the control group (P<0.0001). After 6 months of treatment in obese subjects, the mean weight of the patients decreased by 6.8 kg, the BMI by 3.2 kg/m2. Plasma MDA levels were significantly reduced by weight loss from 2+/-0.77 to 0.89+/-0.41 nmol/ml (P<0.001). BMI correlated with MDA levels at baseline (r=0.6, P<0.0001). Changes in BMI was positively associated with plasma MDA level reduction (r=0.36, P<0.05). CONCLUSION: These results indicate that obesity is associated with increases in endogenous lipid peroxides. Our data show that the indicator of lipid peroxidation-MDA-falls markedly in association with weight loss with orlistat. The demonstration of decreased free radical generation has important implications for oxidative mechanism underlying obesity-associated disorders.

[Lipoprotein (a) as a risk factor for coronary artery disease in women and elderly patients]. / Koroner arter hastaligi risk faktörü olarak kadinlarda ve yaslilarda lipoprotein (a).

OBJECTIVE: The role of lipoprotein (a) [Lp(a)] as a risk factor for coronary artery disease (CAD) in women and elderly is not clear. In this study we assessed the relation between serum Lp (a) levels and CAD, taking into account the differences in sex and age. METHODS: Lp (a) levels and other lipid variables were determined in 535 consecutive patients undergoing coronary angiography for chest pain evaluation. Among 535 patients, 163 patients had angiographically normal coronary arteries (70 men and 93 women) and 372 patients had significant coronary lesions at least one coronary artery (300 men and 72 women). RESULTS: After adjustment for hypertension, smoking, diabetes, low density lipoprotein-cholesterol (LDL-C), triglycerides and high density lipoprotein-cholesterol (HDL-C), elevated Lp (a) was independently predictive for CAD in both sexes under 55 years old (odds ratio [OR]: 5.1, p < 0.01 for men and OR: 2.3, p < 0.05 for women). In patients more than 55 years old elevated Lp (a) was not associated with CAD for both sexes (OR: 1.3, p = NS for men and OR: 1.2, p = NS for women). CONCLUSION: We did not find any relation between elevated Lp (a) concentrations and presence of angiographically detectable CAD both in men and women aged more than 55 years old. Our results suggest that elevated Lp (a) is an independent risk factor for premature CAD for both men and women.

Relation of functional capacity with the oxidative stress and antioxidants in chronic heart failure.

Chronic heart failure is a common, disabling disorder with high mortality. Oxidative stress may have both functional and structural effects on the myocardium, leading to myocardial decompensation. In this study, the authors examined the relationship of oxidative stress and functional capacity in patients with varying degrees of heart failure. Fifty-one patients with chronic heart failure and 31 control subjects were studied. The functional capacity of patients was determined. Plasma malondialdehyde, vitamin E, and beta-carotene levels were measured. The malondialdehyde levels were significantly different between control subjects and heart failure patients (p=0.03). There was a positive correlation between patients' malondialdehyde levels and New York Heart Association functional class (r=0.59; p<0.0001). There was a negative correlation between the functional class and vitamin E and beta-carotene levels (r=20.43; p<0.0001 and r=20.25; p<0.01, respectively). These data demonstrate that oxidative stress is increased systemically in patients with chronic heart failure. It seems that this increase correlates with functional class. (c)2001 CHF, Inc.

Fibrotic aortic stenosis in a patient with dwarfism.

In this report, we present an adult patient with dwarfism who had severe aortic stenosis with markedly thickened fibrotic valve leaflets without calcification. These findings were well demonstrated by both two- and three-dimensional transesophageal echocardiography and confirmed at surgery and by pathological examination.

Susceptibility of apolipoprotein B-containing lipoproteins to oxidation and antioxidant status in acute coronary syndromes.

BACKGROUND: Oxidized lipoproteins may play an important role in the pathogenesis of atherosclerosis, and it has been shown that antioxidants have a protective effect against the progression of atherosclerosis. HYPOTHESIS: The aim of this study was to investigate the oxidative susceptibility of apolipoprotein B-containing lipoproteins and antioxidant status in patients with acute coronary syndromes and chronic stable angina pectoris. METHODS: The study population included 70 patients with acute coronary syndromes (14 with recent acute myocardial infarction and 56 with unstable angina pectoris), 105 patients with stable angina pectoris, and 75 control subjects. In addition to conventional lipid and lipoprotein analysis, the susceptibility of apolipoprotein B-containing lipoproteins to in vitro oxidation (lag phase) and plasma vitamin E and total carotene levels was measured. RESULTS: The lag phase was significantly shorter in patients with acute coronary syndromes (45 +/- 12 min) than in patients with stable angina pectoris (51 +/- 10 min) and in control subjects (58 +/- 9 min) (p < 0.0001). Both plasma vitamin E and total carotene levels were lowest in patients with acute coronary syndromes (1.11 +/- 0.32 mg/dl and 119 +/- 32 micrograms/dl, respectively), followed by patients with stable angina pectoris (1.25 +/- 0.37 mg/dl and 132 +/- 37 micrograms/dl) and then controls (1.52 +/- 0.31 mg/dl and 167 +/- 41 micrograms/dl). CONCLUSIONS: These data suggest that there is an intense oxidative process and a lower antioxidant status in acute coronary syndromes. This may lead to plaque instability due to the activation of the inflammatory response in coronary atherosclerotic lesions.

Transesophageal three-dimensional echocardiographic assessment of anomalous coronary arteries.

We describe the usefulness of transesophageal three-dimensional echocardiography in the evaluation of anomalously arising coronary arteries in four adult patients recently studied by us.

Transesophageal echocardiographic identification of left subclavian artery stenosis with steal phenomenon.

In this report, we present the first case of the transesophageal echocardiographic identification of left subclavian artery stenosis and steal phenomenon.

Echocardiographic diagnosis of a stenotic double orifice parachute mitral valve with a single papillary muscle.

We present the case of a patient with a single papillary muscle that is supporting both orifices of a stenotic double orifice mitral valve. With the use of both transthoracic and transesophageal echocardiography, we were able to prospectively define this entity, which was confirmed at surgery.

Relation between lipoprotein (a) and in vitro oxidation of apolipoprotein B-containing lipoproteins.

OBJECTIVES: To assess the relationship between lipoprotein (a) [Lp (a)] and lipoprotein oxidation in patients with coronary artery disease (CAD). DESIGN AND METHODS: Oxidation of apolipoprotein (apo)B-containing lipoproteins, vitamin E, carotenoids, lipid-lipoprotein levels were determined in 171 CAD and 70 non-CAD subjects. RESULTS: In CAD patients with Lp (a) concentrations >/= 30 mg/dL; total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), malondialdehyde (MDA), and apo B levels were significantly higher and lag-time and age were significantly lower than those of CAD patients with Lp (a) concentrations < 30 mg/dL. In non-CAD subjects with Lp (a) concentrations >/= 30 mg/dL; TC, LDL-C, and vitamin E levels were significantly higher and lag-time was significantly lower than those of non-CAD subjects with Lp (a) concentrations < 30 mg/dL. In CAD patients, Lp (a) correlated negatively with lag-time and positively with MDA levels. Lp (a) correlated negatively with lag-time and vitamin E levels in non-CAD subjects. CONCLUSIONS: We have shown that plasma apo B-containing lipoproteins of both CAD and non-CAD subjects with Lp (a) levels >/= 30 mg/dL are more susceptible to in vitro oxidative modification than those of subjects with Lp (a) levels < 30 mg/dL. The relationship between Lp (a) and enhanced susceptibility of apo B-containing lipoproteins to oxidation, appears to support routine investigation of Lp (a).

Effect of successful coronary angioplasty and stent implantation on QT dispersion.

BACKGROUND: QT dispersion (defined as maximal QT interval minus minimal QT interval), as assessed using the surface ECG, has been shown to reflect regional inhomogeneities in ventricular repolarization. The aim of this study was to show the effect of coronary revascularization, by successful coronary angioplasty or stent implantation, on QT dispersion. METHODS: QT dispersion was defined on each ECG as the difference between the maximal and minimal measurements of QT interval. Of 135 patients studied, 52 patients underwent coronary angioplasty and 84 patients underwent stent implantation. Maximum and minimal QT interval and QT dispersion were measured using 12-lead electrocardiography before and 24 h after each successful procedure. RESULTS: QT dispersion decreased from 51 +/- 12 ms at baseline to 37 +/- 10 ms 24 after the procedure (P < 0.001). Before the procedure, the QT dispersion of patients undergoing angioplasty and stent implantation was 50 +/- 13 and 52 +/- 10 ms, respectively. After the procedure, the QT dispersions were 34 +/- 9 and 38 +/- 10 ms, respectively (P < 0.001). QT dispersion was significantly lower in both groups after the procedure. No differences were observed between the QT dispersions of patients undergoing angioplasty and of those undergoing stent implantation. CONCLUSIONS: Successful coronary angioplasty and stent implantation significantly reduced QT dispersion. The decreased QT dispersion may have been caused by improvements in myocardial perfusion and may be beneficial in reducing the likelihood of arrhythmias occurring.

Effects of fosinopril treatment on blood pressure during physical and mental stress test in essential hypertension.

In this study the effects of once daily administration of 10 mg fosinopril on blood pressure response to mental and physical stress were evaluated in mild to moderate essential hypertension. A total of 25 patients (14 women, 9 men) with mild to moderate essential hypertension were enrolled in this study. Before the treatment and after 10 mg/day fosinopril treatment for 2 months, systolic and diastolic blood pressure and heart rate were recorded at rest and while performing a mental arithmetic test. In addition, exercise stress testing with Bruce protocol were performed before and after the treatment and systolic and diastolic blood pressure and heart rate were recorded at rest and during peak exercise. Statistical analysis were done by using the paired t-test. During the mental arithmetic test, systolic and diastolic blood pressure were significantly reduced (p < 0.005 and p < 0.001, respectively) after 2 months fosinopril treatment. Systolic and diastolic blood pressure were also significantly reduced during the exercise stress test (p < 0.005 and p < 0.05) after the treatment. Heart rate did not change during either the mental arithmetic or the exercise test. As a result, once daily 10 mg fosinopril may be effective in reducing blood pressure, not only at rest, but also during stressful situations.

The Effects of Sublingual Administration of Captopril on Parameters of Exercise Test and Neurohormonal Activation in Patients With Stable Angina Pectoris

A prospective randomized, double-blind, and placebo-controlled study was designed to investigate the effects of sublingual administration of captopril on the parameters of exercise test and neurohormonal activation in patients with stable angina pectoris. A total of 31 patients (28 male, 3 female; mean age 55.4 +/- 9.4 years) took part in the study. Coronary angiography and left ventriculography were performed in all cases and the patients were classified according to the ejection fraction (EF). Following sublingual placebo or 25 mg captopril, plasma levels of renin, angiotensin II, norepinephrine, and serum aldosterone levels were measured at rest and maximal exercise. test was performed. Hormone levels were remeasured immediately after the exercise. The same procedure was repeated the next day using captopril or placebo. Sublingual captopril administration increased the time to angina, the time to 1 mm ST depression, maximal exercise capacity, maximal exercise duration and decreased maximal ST depression, maximal systolic blood pressure, and maximal double product (p < 0.001-0.01). After the maximal exercise test following captopril, the % difference of angiotensin II, aldosterone, and norepinephrine levels was found to be significant lower and the % difference of the renin level was found to be significantly higher than those of placebo (p < 0.001). The effects of sublingual captopril on exercise parameters were additionally assessed in different left ventricular systolic function subgroups. The favorable effects were more prominent in cases with left ventricular systolic dysfunction. There were no adverse effects related to sublingual captopril use. As a result, sublingual administration of captopril improved the parameters of maximal exercise test and suppressed the neurohormonal activation during exercise. We suggest that sublingual captopril may be used effectively before planned daily activities in patients with stable angina pectoris.