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  • ISSN: 2333-6676
    Volume 1, Issue 2
    October-December 2013
    Editorial
    Ganesh V. Halade*
    Heart failure accounts for more than 34% of deaths in the US [1]. The pathogenesis of heart failure after myocardial infarction (MI) is served by changes in left ventricle size, shape and function, which are associated with molecular and functional changes in myocardium [2,3]. Multiples risk factors including obesity, diabetes and hypertension contribute in the development of MI. These risk factors are subsequently associated with heart failure related mortality and morbidity. MI initiates a rapid inflammatory response with both time and cell-type dependent entry of heterogeneous immune cells into the infarcted area,as well as remote areas. Collectively, the immune response and subsequent tissue remodeling leads to left ventricle dilation [4].
    Emad Rasoul-Arzrumly, Olivia Y. Hung, and Habib Samady*
    Shear stress results when fluids move along solid boundaries and is the tangential frictional force produced when fluid interacts with the boundary. In the human body, blood exerts shear stress on the arterial wall and its magnitude is dependent on regional geometry, blood flow, and blood viscosity. Given the complexity of these factors, measurement of coronary blood flow and viscosity, careful three dimensional reconstruction of vascular geometry, and computational fluid dynamics are required to calculate regional wall shear stress (WSS). WSS plays a crucial role in atherosclerotic plaque development, vascular remodeling, and endothelium maintenance [1,2].
    Charles Y. Lui*
    The incidence of stent thrombosis (ST) following elective, urgent or emergent percutaneous coronary stent implantation is quite low (1-4%) [1-5]. However, the risk of recurrent stent thrombosis (RST) is much higher (11-36%) [2,6-9] and not much is known about the pathobiology, predictors and clinical outcomes of RST. Thus, the optimal management of RST in terms of prevention and treatment approach is also lacking.
    Qinchuan Wang and Jim Jung-Ching Lin*
    Intercalated disc (ICD), a unique specialized structure in cardiac muscle, transmits mechanical force and electrical impulses among cardiomyocytes. Recent studies also suggest that ICD, via scaffolding/anchoring proteins, can spatially organize and maintain key ion channel assemblies required for controlling the cardiac action potential. Defects in these processes can lead to arrhythmias and cardiac sudden death. For example, human Nav1.5 E1053K missense mutation disrupts its binding to ankyrin G, a scaffolding protein required for targeting Nav1.5 to ICD and transverse (T) tubule/lateral membranes of cardiomyocytes. As a consequence, this mutation causes Brugada syndrome [1].
    Jane Nakibuuka1*, Wilson B Nyakoojo2, Alice Namale1, Edward Ddumba3, Elli Leontsini4 and Fred Nuwaha5
    Abstract:
    Objective: We sought to describe findings, diagnostic yield, cost effectiveness of transthoracic echocardiography (TEE) and Carotid doppler ultrasound (CDU) in ischemic stroke.
    Methods: Cross sectional study at Mulago hospital, Uganda. Institutional ethical approval, patient consent was obtained. Patients eighteen years and above with ischemic stroke confirmed by brain computerized tomography (CT) scan and met inclusion criteria were selected. TTE and CDU were done as part of comprehensive assessment for stroke risk factors. Data was analyzed using SPSS 14. Univariate analysis was done for social-demographics, abnormalities on cardiac imaging and diagnostic yield using TOAST criteria. Bivariate analysis for association between stroke risk factors, cardio-embolic stroke and other ischemic subtypes (diagnosed using clinical and CT scan features). Statistical significance was set at P<0.05.
    Results: Of 139 screened patients with suspected stroke, 127 underwent brain CT scan as 12 died before CT. Eighty five were confirmed stroke by CT scan with 66 (77.6%) ischemic stroke, mean age 62 years (SD+16.6), 53% were male. Out of 66, 62 (93.9%) underwent both TTE and CDU. Although only 7 (11.3%) reported history of heart disease, 43 (69.3%) had abnormal findings on TTE with left atrial enlargement commonest in 21 (48.8%). Thirty eight (61.3%) had abnormal finding on CDU with atherosclerosis commonest in 28 (45.2%). Using clinical and CT scan features, atherosclerotic stroke was the commonest subtype in 29 (46.8%) then cardio-embolic 18 (27.3%). Only 6 (9.7%) patients had abnormal findings on TTE suggesting possible cardio-embolism by TOAST criteria. None had stenosis >50% on CDU. Multiple valvular lesions P<0.001, severe valvular lesions P=0.001 were associated with cardio-embolic stroke.
    Conclusions: Majority of ischemic stroke patients without previous history of heart disease had abnormal findings on TTE and CDU. Diagnostic yield for cardio-embolic stroke by TOAST criteria was very low given the high cost involved for a developing country.
    Beili Zhu*
    Transcatheter aortic valve replacement (TAVR) is a treatment for aortic stenosis in patients who are inoperable or have high risk for surgery [1,2]. Since the first in-man TAVR was performed in France in 2002, this procedure has been practiced for 10 years, and over 50,000 patients received valve implantation in more than 40 countries [2,3]. The PARTNER Trial showed the survival rate of patients after TAVR and Surgery was similar at 1 year, and TAVR resulted in a significantly lower mortality rate than standard medical therapy [4,5].
    Research Article
    Anil Goli1*, Sujatha Goli2, Mohammed N Osman3, Ryland Byrd4, and Thomas M. Roy4
    Abstract:
    Background: Idiopathic nonischemic dilated cardiomyopathy (INIDCM) is associated with increased left ventricular diastolic volume and decreased left ventricular ejection fraction (LVEF). B-type natriuretic peptide (BNP) is secreted from the left ventricle in normal adults and patients who have left ventricular dysfunction and is useful in diagnosing acute heart failure from ischemic or nonischemic causes. Limited information is available about the association between intraventricular conduction delay (IVCD) and BNP levels in patients who have INIDCM.
    Methods: In patients evaluated in urgent care for chest pain and acute shortness of breath, there were 33 patients who had INIDCM and 39 patients who had idiopathic dyspnea. Evaluation included determination of plasma BNP level, LVEF, and presence of IVCD.
    Results: The mean BNP level was significantly greater in the INIDCM (947 ng/L) than idiopathic dyspnea group (43 ng/L; P ≤ .001). The mean LVEF was lower in the INIDCM (27%) than idiopathic dyspnea group (62%; P ≤ .001). There was high IVCD (QRS complex > 120 ms) in 10 patients (30%) who had INIDCM and none with idiopathic dyspnea. In the patients with INIDCM, patients who had high IVCD had greater mean BNP (initial and 3-mo follow-up) and lower LVEF than patients who had low IVCD (QRS duration ≤ 120 ms).
    Conclusions: Increased plasma BNP levels may facilitate the diagnosis of INIDCM and may be associated with high IVCD.
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