No abstract

Diabetic individuals are at significantly greater risk of developing heart failure (HF) independent from other risk factors such as coronary artery disease (CAD) and hypertension. Diabetic cardiomyopathy (DCP) is defined as ventricular dysfunction in the absence of hypertension, coronary artery and valvular heart disease, which increases the risk of HF. Due to better understanding of its pathophysiology and clinical importance, DCP is more frequently recognized in daily practice. The most important mechanisms of DCP are hyperglycemia, insulin resistance/hyperinsulinemia, abnormal fatty acid metabolism, increased apoptosis, cardiac autonomic neuropathy and local renin-angiotensin-aldosterone system (RAAS) overactivation. Echocardiography is the most frequently used diagnostic method for the detection of this pathology. Currently, although there is no specific treatment for DCP, strict glycemic and concomitant risk factor controls seems to be the most important target strategy for prevention of the progression and treatment of DCP. In this article, we aim to provide an extensive review on the pathophysiology, diagnosis, management of DCP. (Anadolu Kardiyol Derg 2011; 11: 732-7)

Purpose: The aim of this study was to investigate the long-term prognosis of non-interventionally followed patients with myocardial bridge and angiographic milking of the left anterior descending (LAD) coronary artery. Methods: All of the coronary angiography records from May 2000 to November 2007 were reevaluated and patients who had more than 70% narrowing during systole on LAD were eligible for the present study. Follow-up was carried out by physical examination, echocardiography, and treadmill exercise testing. The clinical situations of the patients, medical treatment at the time of follow-up, and experienced events (death, myocardial infarction, or revascularization) were recorded. Results: There were 59 eligible patients (44 male, 74.6%). The mean age of the patients was 54 ± 11 years. The bridges were located in the proximal, mid, and distal portion of the LAD in 17 (28.8%), 20 (33.9%), and 22 (37.3%) patients, respectively. Distributions of the narrowing degree were as follows: between 70% to 89% in 33 (56%) patients and 90% to 100% in 26 (44%) patients. Mean follow-up duration of the group was 37 ± 13 months (range 15-65 mo). The clinical presentation during follow-up was stable angina in 9 (15.3%) cases, atypical angina in 12 (20.3%), atypical chest pain in 13 (22%), dyspnea in 3 (5.1%), and syncope in 3 (5.1%) cases. There were no experienced events and/or hospitalizations related to cardiac disease. Echocardiographic examination revealed normal systolic ventricular function. Only 17 (28.8%) patients continued to use medication. Most of them were on β-blocker therapy. Conclusion: Patients with myocardial bridges and angiographic milking of the LAD coronary artery have a good long-term prognosis. IntroductionMyocardial bridging is anatomically defined as the muscle overlying the intramural segment of a major epicardial coronary artery. A myocardial bridge is the most common congenital coronary anomaly, with an incidence of between 1.5% and 16% as assessed on coronary angiography and up to 80% as assessed at necroscopy. 1 -3 It is usually considered an innocent anomaly. 4 -6 Although it is rare, myocardial infarction, left ventricular dysfunction, paroxysmal atrioventricular block, as well as exercise-induced ventricular tachycardia and sudden cardiac death are accused sequela of this pathology. 4 -12 The aim of this study was to investigate the prognosis of non-interventionally followed patients with myocardial bridge and angiographic milking of the left anterior descending (LAD) coronary artery.

In patients with permanent AF, impairment of RAA function and development of right atrial SEC-thrombus are closely related to the underlying etiology. These results suggested that evaluation of RAA functions may have an incremental value over the assessment of the LAA for determining thromboembolic risk.

LAA function deteriorated most severely in mitral stenosis and least in hyperthyroidism. The LAA area change and PW-Doppler emptying velocity were important predictors for SEC or thrombi. Although TDI was not superior to classical methods, it provided complementary data to PW-Doppler velocities for predicting SEC and thrombi.