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Twenty-six fetuses with prenatal diagnosis of LVA (50% male subjects) and 16 with LVD (38% male subjects) were identified. Fetal age at diagnosis was 23.8 ± 6.1 weeks. Mean maternal age was 30.6 ± 6.1 years old. LVA was larger (375 ± 237 vs 60 ± 71 mm(2); p = 0.002), and LVA/LVD was frequently observed in an apical location (62%). Associated cardiac/extracardiac defects were reported in 13/42 (31%). Symptomatic patients presented with arrhythmias (LVA 16% vs LVD 0%), hydrops fetalis (LVA 27% vs LVD 18.8%), or rupture (LVA 4% vs LVD 38%; p = 0.02). Size changes of the LVA/LVD during pregnancy were reported in 17%. Fetal death occurred in nine cases (21.4%); termination of pregnancy was performed in six cases (14.3%). All other babies were delivered at term. During follow-up (mean 29.1 ± 38.2 months), the rate of adverse events was significantly increased in patients with LVA (40 vs 0%; p = 0.04) CONCLUSION: The rate of fetal complications including fetal death is high. Long-term outcome among the survivors is significantly worse in patients with LVA.

Background: specific polymorphisms of genes regulating intracellular redox balance and oxidative stress are related to atherogenesis. Some studies have identified a relationship between progression of atherosclerosis and C242T mutation in CYBA gene coding for p22phox, a subunit of the NADH/NADPH oxidase system. Design: we investigated whether the C242T nucleotide transition is associated with the presence of coronary artery disease (CAD) in a population of 494 Caucasian Italians undergoing coronary angiography to diagnose the cause of chest pain. Results: the frequency of the T mutant allele that we found in 276 patients with angiographically documented CAD was significantly higher compared to what we observed in 218 subjects with normal coronary arteries (Controls) (respectively: 0.400 and 0.332, p < 0.01). The prevalence of the T allele was even stronger when we compared: 1) early onset (age ≤55) vs late onset (age ≥65) single-vessel CAD patients (respectively: 0.75 and 0.48, p < 0.05), and 2) the subgroup of CAD patients with at least one ≥98% stenosis in a coronary vessel vs those with no ≥98% stenosis in a coronary vessel (respectively: 0.425 and 0.365, p < 0.05). Conclusions: these results support the increased risk of developing early CAD and of having rapid progression of coronary stenosis in subjects carrying the C242T nucleotide transition among the Italian population.

Dilated cardiomyopathy (DCM) and inflammatory DCM (DCMi) refer to a heterogeneous group of conditions in which autoimmunity plays a major role and progressive cardiac chamber dilatation and remodeling finally leads to congestive heart failure [1]. Numerous autoantibodies against myocyte structural and functional proteins, muscarinic and b1-adrenergic receptors have been detected in patients affected from DCM/DCMi [1,2], and animal models have proved the pathogenic roles of autoantibodies [3,4]. In addition, plasmapheresis of cardiac autoantibodies in patients with DCM/DCMi and subsequent immunoglobulin (Ig) G substitution resulted in significant increase in cardiac index, left ventricular ejection fraction (LVEF), improvement in endothelial function [5], and symptom relief [6][7][8][9].Because immunoadsorption (IA) outcomes on patients' physical status perception and emotional well-being has never been investigated, this observational study was aimed to prospectively assess the effects of IA on heart-related quality of life (QOL), cardiac performance, and clinical parameters in a large cohort of unselected patients.

AimsCongestive heart failure (CHF) can be thought of as a state of chronic immune activation. Polymorphonuclear neutrophil (PMN) apoptosis is one of the mechanisms responsible for the resolution of inflammation. A reduced PMN apoptotic rate in CHF patients may generate a persistent inflammatory response and hence mediate tissue damage in this group of patients. We aimed to measure levels of spontaneous apoptosis of circulating PMNs in CHF patients and in controls, and to examine whether NYHA class, left ventricular ejection fraction (LV-EF), and laboratory parameters of inflammation, endothelial damage, and of liver and renal function, could predict the rate of PMN apoptosis in CHF patients. Methods and resultsA total of 29 CHF patients and 26 controls were studied. Propidium iodide and flow cytometry were used to assess PMN apoptosis. Delay in PMN apoptosis was expressed as percentage (expressed as median, first and third quartiles) of surviving PMNs in the study subjects. We found an increased percentage of surviving PMNs [38(27.1 -47.1)] in CHF patients compared with controls [19.4 (15.8-25.2)] (P , 0.05). The PMN survival rate in the CHF group was correlated to NYHA class, and plasma levels of C-reactive protein and alkaline phosphatase, while it was inversely correlated to LV-EF and protein levels. A positive relationship between PMN survival and increased ex vivo endothelial apoptosis was found. ConclusionIncreased PMN lifespan in patients with worsening CHF could be used as a novel measurement of tissue and endothelial damage in this group of patients.--

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ongenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare malformations and approximately 500 cases have been published in the literature since the first description in 1816. 1 A recent study found a prevalence of 0.76% in adult patients undergoing coronary angiography. 2 Although most investigators distinguish between LVA and LVD, the cause, histopathology, and clinical implications remain controversial. 3-7 The advent of echocardiography and magnetic resonance imaging has led to earlier diagnosis, including prenatal detection. 8-10 The published research on these anomalies consists, beside 1 large single center study, 2 of case reports and small case series, mostly on infants and young children with large aneurysms and poor clinical outcome. 10-16 High morbidity and mortality rates due to heart failure, aneurysm rupture, thromboembolism, and sudden death of unclear cause have been reported. 3,4 More recent published data demonstrated a more favorable course with no cardiac mortality in adults with congenital LVA and LVD. 2,8 A significant proportion of the published literature report arrhythmias in patients with these anomalies. 2,3,17-25 Recently, our own group was able to demonstrate that patients with congenital LVA/ LVD had a high incidence of distinctly abnormal electrocardiograms (ECGs) compared to an age-and gender-matched control group. 26 The purpose of the present study was to evaluate the prognosis and risk factors of patients with a diagnosis of isolated congenital LVA or LVD, having ECG abnormalities. Methods DefinitionThe diagnosis of congenital LVA or LVD was established after angiographic exclusion of coronary artery disease. Clinical and ECG local or systemic inflammation, traumatic causes and car- Background: Congenital left ventricular aneurysm (LVA) and diverticulum (LVD) are rare cardiac anomalies frequently associated with electrocardiogram (ECG) abnormalities. The aim of this study was to evaluate the long-term prognosis in such patients.

BackgroundPhrenic nerve stimulation (PNS) and high pacing thresholds (HPT) hinder biventricular stimulation in patients (pts) undergoing cardiac resynchronization therapy (CRT). A new quadripolar left ventricular (LV) lead (Quartet 1458Q, St. Jude Medical) with increased number of pacing configuration, might overcome this problem.MethodsAll consecutive pts in whom a standard bipolar lead intraoperatively resulted in PNS and/or HPT (≥4.00V/1mV), received, during the same implant, a quadripolar LV lead. Aim of the study was to evaluate acute and short term outcome.Results26 pts [24 (92%) male, mean age 74±6 years)] with PNS (22 pts; 85%) and HPT (4 pts; 15%) were included. Permanent right ventricular pacing was the reason for broad QRS complex in 4 (15%) pts, whereas all other pts had a left bundle branch block. Severely symptomatic (NYHA Class ≥3) heart failure with reduced ejection fraction (EF 31±9%) was mostly caused by ischemic heart disease (14 pts; 54%). Idiopathic dilated cardiomyopathy and valvular heart disease were diagnosed in 6 (23%) pts each. In most (24/26, 92%) pts the use of the Quartet lead led to successful biventricular pacing due to a significant reduction in intraoperative pacing threshold (5.2V/1.0ms vs. 1.4V/0.8ms; p=0.03), which was maintained (1.2V/0.7ms) at follow-up. PNS never represented reason for failed LV pacing, neither acutely nor during follow-up.ConclusionExcessively HPT and/or PNS are frequently encountered when conventional bipolar leads are used for CRT. A new quadripolar LV lead increases the rate of successful biventricular stimulation. Lower pacing threshold and freedom from PNS are maintained at follow-up.

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