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  • ISSN: 2333-6676
    Volume 5, Issue 6
    Research Article
    Amit Sharma*, Ata Bajwa, Udit Bhatnagar, Elaine C. Thompson, and Randall C Thompson
    Purpose: To determine the optimal approach for measuring aortic valve calcification (AVC) on CT scan for the diagnosis of severe aortic stenosis (AS) as assessed by transthoracic echocardiogram (TTE).
    Methods: We retrospectively studied 84 patients with mild to severe as who underwent TTE and multi detector gated x-ray computed tomography (MDCT) for coronary calcium scoring. Aortic valve calcium was scored independently and relationships between TTE severity of AS and AVC were identified. Linear regression modeling was performed with aortic valve stenosis as the independent variable, and various aortic calcium scoring methods as predictors.
    Results: There was good correlation between AVC and TTE mean gradient (r=0.66, p<0.0001), peak velocity (r=0.60, p<0.0001), and valve area (r=-0.47, p<0.001). The Agatston method for scoring AVC performed as well or better in predicting severe aortic stenosis than aortic valve calcium volume and aortic valve calcium mass scores. There was no improvement in the predictive model after indexing for aortic valve size or body size. A score of 1850 AU captured 96% of patients with severe aortic stenosis (iAVA <.6 cm2 / m2) and 20/22 (90%) of patients with low gradient, severe aortic stenosis (iAVA < .6 cm2 / m2 and mean gradient < 40 mm hg).
    Conclusion: Aortic valve calcium assessed on MDCT correlates reasonably well with aortic stenosis by echo. The use of the straightforward Agatston method for scoring without indexing appears to be the optimal approach. Aortic valve calcium scoring may be a particularly attractive modality for aiding the diagnosis in the subgroup of patients with low gradient, severe aortic stenosis.
    Marnix W van Bemmel, Ahmet Adiyaman, and Peter Paul HM Delnoy*
    This case describes how air entrapment around the generator can result in an inappropriate shock shortly after implantation of a subcutaneous ICD. The artifacts resulting in the inappropriate shock are caused by changes in tissue contact of the generator, causing changes in electrical resistance between the two electrical poles leading to a change in amplitude on the device’s electrogram.
    Abha Pandit*
    Aim: Regional pattern and significance of risk determinants paving the way to incidence and fate of myocardial infarction (MI) in hypertensive subjects is attempted elaboration through comparison with contemporary cases of MI in normotensive patients in an 18 month long study at medical college hospital setting in central India.
    Method: MI cases in 35 to 75 year age range without major unrelated systemic diseases were studied in hypertensive and normotensive categories. Demographic, clinical and laboratory information, as well as complications and outcome, were examined.
    Results: MI in hypertension associated earlier age, more with positive family history of ischaemic heart disease, overweight, poor physical activity, deficient fresh fruit intake and the smoking habit. Uncontrolled diabetes significantly associated MI in hypertension as also deficient plasma antioxidant capacity. Hypertensive MI also had marginally increased rates of dyslipidaemia, and renal function declines. Incidence of various cardiac complications were insignificantly higher hospital stay was prolonged in hypertensive MI.
    Conclusion: Pattern of risk factors and clinical course of MI in studied categories emphasized preventive dietary and physical activity measures for weight reduction, deterrence of smoking and good control of co-existing diabetes as most pertinent to bring down incidence and possibly severity of MI in hypertension, in central Indian context. Particular reference to antihypertensive cum cardioprotective drug classes angiotensin converting enzyme (ACE) inhibitors and angiotensin (AT)-II receptor blockers, beta blockers and calcium channel blockers is made in the context.
    Case Report
    Ramon F. Maruri Sanchez, Pablo Diez-Villanueva*, Jacobo Rogado Revuelta, and Fernando Alfonso
    A 55-year-old female, smoker, with no previous family or personal history of heart disease, treated with capecitabine due to metastatic breast cancer, was admitted to our hospital due to typical chest pain, with electrocardiographic changes and slight elevation of markers of myocardial damage. Diagnosis of non ST elevation myocardial infarction was achieved. Coronary angiography revealed no significant coronary lesions, and coronary vasospasm test was negative. Cardiac MRI showed normal ventricular ejection fraction, and no macroscopic myocardial fibrosis was observed. The event was attributed to capecitabine, although the mechanism by which it occurred remains unknown.
    Sridhar Amalakanti*, Sundarachary Nagarjunakonda, and Sristi Ram Dhishana
    We present a case of Lupus with cardiac involvement and review the recent understanding of the molecular mechanisms of the disease. A young woman presented with seizures, sudden right sided painful loss of vision and ulcers on the feet. On examination there was pansystolic murmur suggestive of mitral regurgitation and transesophageal echocardiography showed the presence of large sessile mass over the base of anterior leaflet on the left atrial side suggestive of Libman-Sacks endocarditis. In a young female with manifestations of multiple organ system failure, with cardiac murmurs, we should beware of Libman-Sacks endocarditis. Transoesophageal echocardiography is an important tool for early diagnosis and prompt treatment. Recent concepts of SLE pathogenesis centered around Apoptosis and NETosis help to understand the cardiovascular manifestations of this disorder.
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