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Renal sympathetic denervation restores aortic distensibility in patients with resistant hypertension: data from a multi-center trial.

Clin Res Cardiol. 2018 Aug;107(8):642-652

Authors: Stoiber L, Mahfoud F, Zamani SM, Lapinskas T, Böhm M, Ewen S, Kulenthiran S, Schlaich MP, Esler MD, Hammer T, Stensæth KH, Pieske B, Dreysse S, Fleck E, Kühne T, Kelm M, Stawowy P, Kelle S

Renal sympathetic denervation (RDN) is under investigation as a treatment option in patients with resistant hypertension (RH). Determinants of arterial compliance may, however, help to predict the BP response to therapy. Aortic distensibility (AD) is a well-established parameter of aortic stiffness and can reliably be obtained by CMR. This analysis sought to investigate the effects of RDN on AD and to assess the predictive value of pre-treatment AD for BP changes. We analyzed data of 65 patients with RH included in a multicenter trial. RDN was performed in all participants. A standardized CMR protocol was utilized at baseline and at 6-month follow-up. AD was determined as the change in cross-sectional aortic area per unit change in BP. Office BP decreased significantly from 173/92 ± 24/16 mmHg at baseline to 151/85 ± 24/17 mmHg (p < 0.001) 6 months after RDN. Maximum aortic areas increased from 604.7 ± 157.7 to 621.1 ± 157.3 mm2 (p = 0.011). AD improved significantly by 33% from 1.52 ± 0.82 to 2.02 ± 0.93 × 10-3 mmHg-1 (p < 0.001). Increase of AD at follow-up was significantly more pronounced in younger patients (p = 0.005) and responders to RDN (p = 0.002). Patients with high-baseline AD were significantly younger (61.4 ± 10.1 vs. 67.1 ± 8.4 years, p = 0.022). However, there was no significant correlation of baseline AD to response to RDN. AD is improved after RDN across all age groups. Importantly, these improvements appear to be unrelated to observed BP changes, suggesting that RDN may have direct effects on the central vasculature.

PMID: 29520698 [PubMed - indexed for MEDLINE]

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Preprocedural Utility of the Echocardiographic Retroaortic Anomalous Coronary Sign.

J Invasive Cardiol. 2018 08;30(8):E73-E74

Authors: Slostad BD, Witt CM, El Sabbagh A, Foley TA

Imaging series highlighting echocardiographic findings associated with the retroaortic anomalous coronary sign and its utility as a non-invasive modality to recognize technically complex and high-risk retroaortic coronary anomalies prior to intervention.

PMID: 30068791 [PubMed - indexed for MEDLINE]

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Ambulatory Fontan pressure monitoring: Results from the implantable hemodynamic monitor Fontan feasibility cohort (IHM-FFC).

Int J Cardiol. 2018 Oct 28;:

Authors: Bradley EA, Jassal A, Moore-Clingenpeel M, Abraham WT, Berman D, Daniels CJ

BACKGROUND: Implantable invasive hemodynamic monitoring (IHM) using the CardioMEMS™ HF system has been shown to reduce heart failure (HF) hospitalizations. IHMs have not yet been used in congenital heart disease (CHD). We aimed to evaluate feasibility and mid-term outcomes of IHM use in the single ventricle/Fontan population.
METHODS: Six adult Fontan patients (>1 HF admission, NYHA FC >3) were enrolled (30 ± 7 years old, mean pulmonary artery pressure (mPA) 16 ± 4.7 mm Hg). Heart failure mediated events (HFME) were evaluated for 12 months: CV medication change, hospital admission, paracentesis, and change in orthotopic heart transplant (OHT) listing status.
RESULTS: The IHM device was successfully placed in all participants. In total there were 671 IHM transmissions and 25(3.7%) HFME. The mean PA pressure across all episodes was 18.2 ± 6.6 mm Hg (range 6-40 mm Hg). Higher mPA pressures were associated with greater odds of having a HFME (OR 1.17 [1.09, 1.25], p < 0.0001). Mean PA pressure had good ability to discriminate transmissions associated with HFME (AUC 0.76 [0.654, 0.866]), with mean PA pressures >24 mm Hg or individual mPA change >4 mm Hg, best discriminating transmissions associated with HFME.
CONCLUSIONS: In the first feasibility series of adult Fontan patients undergoing CardioMEMS™ implantation we demonstrate early technical success and no device-related adverse events. We propose that ambulatory mean PA pressures >24 mm Hg or individual mPA change >4 mm Hg may be associated with more HFME. Further large-scale studies in this population are recommended.

PMID: 30420147 [PubMed - as supplied by publisher]

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Prevalence of Neuroendocrine Tumors in Patients With Cyanotic Congenital Heart Disease.

Rev Esp Cardiol (Engl Ed). 2017 Aug;70(8):673-675

Authors: Ponz de Antonio I, Ruiz Cantador J, González García AE, Oliver Ruiz JM, Sánchez-Recalde Á, López-Sendón JL

PMID: 28094126 [PubMed - indexed for MEDLINE]

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Left ventricular thrombus or pseudothrombus? A rare cardiac CT artifact.

Eur Heart J Cardiovasc Imaging. 2017 10 01;18(10):1186

Authors: Rodrigues JCL, Yeong M, Curtis SL, Lyen SM

PMID: 28586404 [PubMed - indexed for MEDLINE]

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Impact of presynaptic sympathetic imbalance in long-QT syndrome by positron emission tomography.

Heart. 2018 02;104(4):332-339

Authors: Zumhagen S, Vrachimis A, Stegger L, Kies P, Wenning C, Ernsting M, Müller J, Seebohm G, Paul M, Schäfers K, Stallmeyer B, Schäfers M, Schulze-Bahr E

OBJECTIVE: We investigated the impact of cardiac presynaptic norepinephrine recycling in patients with long-QT syndrome (LQTS) using positron emission tomography (PET) with 11C-meta-hydroxyephedrine ([11C]mHED-PET).
METHODS: [11C]mHED-PET was performed in 25 patients with LQTS (LQT1: n=14; LQT2: n=11) and 20 healthy controls and correlated with clinical parameters. [11C]mHED-PET images were analysed for global and regional retention indices (RI) and washout rates (WO) reflecting dynamic parameters of the tracer activity.
RESULTS: Global and regional RI values were similar between patients with LQTS and controls. Although the global WO rates were similar between these groups, regional WO rates were on average higher in the lateral left ventricle (LV) wall in patients with LQTS (dose, mean ±SD; 0.08±0.14 vs 0.00%±0.09% min-1; p=0.033). In addition, patients with LQTS with a longer QTc interval showed a higher global WO rate. Clinical symptoms correlated with higher global WO rates. In the presence of normal global WO rates, asymptomatic LQTS patients showed higher global RI values.
CONCLUSION: The increased regional WO rate of [11C]mHED in the lateral LV suggests an imbalance of presynaptic catecholamine reuptake and release, resulting in a higher synaptic catecholamine concentration, in particular in LQT1 patients. This might enhance β-adrenoceptor signalling and thereby aggravate inherited ion channel dysfunction and may facilitate occurrence of ventricular tachyarrhythmias. Detection of regional differences in LV sympathetic nervous function may modify disease expression and potentially serve as a non-invasive risk marker in congenital LQTS.
TRIAL REGISTRATION NUMBER: 2006-002767-41;Results.

PMID: 28864717 [PubMed - indexed for MEDLINE]

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Persistent left superior vena cava: An unusual cause of curable pulmonary hypertension.

Diagn Interv Imaging. 2018 Jan;99(1):47-48

Authors: Demeyere M, Delacour D, Bouchart F, Michelin P, Bauer F, Dubourg B, Dacher JN

PMID: 28919169 [PubMed - indexed for MEDLINE]

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Echogenic intracardiac foci and fetal cardiac anomalies: A review of cases from a tertiary care center in China.

J Clin Ultrasound. 2018 Feb;46(2):103-107

Authors: Guo Y, He Y, Gu X, Zhang Y, Sun L, Liu X, Zhao Y, Han J

PURPOSE: To investigate the relationship between the location of echogenic intracardiac foci (EIFs) and fetal cardiac anomalies in our patient population.
METHODS: We performed a retrospective study of the clinical files of fetuses who underwent an echocardiographic examination at our fetal cardiac medical center from August 2010 to August 2016. Fetuses were grouped by EIF location (left ventricle [LV], right ventricle [RV], or bilateral ventricles [BVs]). The maternal age, reason for referral, and cardiac anomalies in the three groups were analyzed.
RESULTS: We enrolled 2647 fetuses with an EIF. Of these, 2498 (94.4%) were in the LV group, while 45 (1.7%) and 104 (3.9%) were in the RV and BV groups, respectively. Aneuploidy was found in 3 fetuses, and all of these had a left-sided EIF. Cardiac anomalies were found in 93/2498 (3.7%) fetuses with a left-sided EIF, 5/45 (11.1%) of those with a right-sided EIF, and 3/104 (2.9%) of those with bilateral EIFs. The prevalence of congenital heart disease was significantly higher in fetuses with a right-sided EIF than in those with left-sided or bilateral EIFs (P < .05).
CONCLUSIONS: Right-sided EIFs were more frequently associated with fetal cardiac anomalies than were left-sided or bilateral EIFs.

PMID: 28961313 [PubMed - indexed for MEDLINE]

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Histopathological abnormalities in the central arteries and veins of Fontan subjects.

Heart. 2018 02;104(4):324-331

Authors: Hays BS, Baker M, Laib A, Tan W, Udholm S, Goldstein BH, Sanders SP, Opotowsky AR, Veldtman GR

OBJECTIVE: Fontan circulations have obligatory venous hypertension, depressed cardiac output and abnormal arterial elastance. Ventriculovascular coupling is known to be abnormal, but the underlying mechanisms are poorly defined. We aim to describe the histopathological features of vascular remodelling encountered in the central arteries and veins in the Fontan circulation as a possible underlying pathological representation of abnormal ventriculovascular coupling.
METHODS: Postmortemvasculature (inferior vena cava (IVC), superior vena cava (SVC), pulmonary artery (PA), pulmonary vein (PV) and aorta) of 13 patients with a Fontan circulation (mean age 29.9 years, range 9.0-59.8 years) and 2 biventricular controls (ages 17.9 and 30.2 years) was examined.
RESULTS: IVC and SVC: Eccentric and variable intimal fibromuscular proliferation occurred in 11 Fontan subjects. There was variable loss of medial smooth muscle bundles with reciprocal replacement with dense collagenous tissue.PA: Similar intimal fibromuscular proliferation was seen; however, these intimal changes were accompanied by medial thinning rather than expansion, medial myxoid degeneration and elastic alteration.PV: The PVs demonstrated intimal fibroproliferation and disorganisation of the muscular media.Aorta: The aortic lamina intima was thickened, with associated fibromuscular proliferation and elasticisation. There was also moderate lymphocytic inflammation in the aortic wall.
CONCLUSIONS: Vascular architectural remodelling is common in Fontan patients. The central veins demonstrate profound changes of eccentric intimal expansion and smooth muscle replacement with collagen. The pulmonary demonstrated abnormal intimal proliferation, and aortic remodelling was characterised by intima lamina thickening and a moderate degree of aortic wall inflammation.

PMID: 28970278 [PubMed - indexed for MEDLINE]

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Strength training in congenital heart disease: A way to boost respiratory function?

Eur J Prev Cardiol. 2018 Nov 14;:2047487318812505

Authors: Ntelios D, Giannakoulas G, Dimopoulos K

PMID: 30426770 [PubMed - as supplied by publisher]