Acute heart failure due to COVID-19 related myocardial injury and de novo hypertensive cardiomyopathy: a challenging diagnosis

We report a COVID-19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.

Takotsubo syndrome following pericardiectomy

Background: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle’s apical area resembling myocardial infarction (MI) in the nonexistence of coronary artery disease (CAD)[1].Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aims: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and methods: A-66-year old man underwent pericardiectomy.Postoperative he endured TC and progressed exacerbation of hemodynamic instability.finally, he had to be supported by intra-aortic balloon pump（IABP),extracorporeal membrane oxygenation（ECMO). Results: Patient’s left ventricle function recovered fully in two weeks. Discussion: we discussed the pathogenesis and treatment of postoperative TC. Conclusion:TC has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery. Keywords: pericardiectomy; takotsubo cardiomyopathy.

Exercise-Induced NT-pro BNP Secretion in Hypertensive Patients Without Heart Failure Can Diagnose the Subclinical Left Ventricle Dysfunction

Hypertension is one of the main risk factors for developing left ventricle failure. The study was conducted at outpatient Clinic – Medlife, Memorial Hospital. It was an observational study. We analyzed the exercise-induced secretion of NT-pro BNP in hypertensive patients with normal ejection fraction and no symptoms or signs of heart failure. Comparing the levels of NT-pro BNP before and after exercise proved to be a good mean for diagnosing left ventricular dysfunction (LVD) in hypertensive patients with left ventricular remodeling.

Stress-induced cardiomyopathy after nephrectomy in a patient with a kidney cancer: a case report

Stress-induced (takotsubo) cardiomyopathy is a rare disease, which characterized by transient left ventricle dysfunction in response to a trigger factor (stress or severe somatic disease with surgical intervention) and is manifested by symptoms of acute coronary syndrome, but without significant coronary artery damage. In the population, the disease most often observes in postmenopausal women. Every year, more and more cases of takotsubo cardiomyopathy described in the literature, mainly after a severe stress. The presented article describes a case report of takotsubo cardiomyopathy after nephrectomy in a patient with comorbidity.

High levels of frataxin overexpression leads to mitochondrial and cardiac toxicity in mouse models

ABSTRACTFriedreich ataxia (FA) is currently an incurable inherited mitochondrial disease caused by reduced levels of frataxin (FXN). Cardiac dysfunction is the main cause of premature death in FA. AAV-mediated gene therapy constitutes a promising approach for FA, as demonstrated in cardiac and neurological mouse models. While the minimal therapeutic level of FXN protein to be restored and biodistribution have recently been defined for the heart, it is unclear if FXN overexpression could be harmful. Indeed, depending on the vector delivery route and dose administrated, the resulting FXN protein level could reach very high levels in the heart, cerebellum, or in off-target organs such as the liver. The present study demonstrates safety of FXN cardiac overexpression up to 9-fold the normal endogenous level, but significant toxicity to the mitochondria and heart above 20-fold. We show gradual severity with increasing FXN overexpression, ranging from subclinical cardiotoxicity to left ventricle dysfunction. This appears to be driven by impairment of mitochondria respiratory chain, ultrastructure and homeostasis, which lead to myofilaments alteration, cell death and fibrosis. Overall, this study underlines the need, during the development of gene therapy approaches, to consider appropriately vector potency, long term safety and biomarkers to monitor such events.

CT-Derived Pulmonary Artery Diameters to Preselect for Echocardiography in COPD Patients Eligible for Bronchoscopic Treatments

<b><i>Background:</i></b> Currently, patients with COPD who are evaluated for bronchoscopic treatments are routinely screened for pulmonary hypertension (PH) and systolic left ventricle dysfunction by echocardiography. <b><i>Objectives:</i></b> We evaluated the prevalence of PH and systolic left ventricle dysfunction in this patient group and investigated if the previously proposed CT-derived pulmonary artery to aorta (PA:A) ratio &#x3e;1 and PA diameter measurements can be used as alternative screening tools for PH. <b><i>Methods:</i></b> Two hundred fifty-five patients were included in this retrospective analysis (FEV₁ 25%pred, RV 237%pred). All patients received transthoracic echocardiography and chest CT scans on which diameters of the aorta and pulmonary artery were measured at the bifurcation and proximal to the bifurcation. <b><i>Results:</i></b> Following echocardiography, 3 patients (1.2%) had PH and 1 (0.4%) had systolic left ventricle dysfunction. Using a PA:A ratio &#x3e;1, only 10.3% of the patients with a right ventricular systolic pressure (RVSP) ≥35 mm Hg were detected and none of the patients with an RVSP &#x3e;50 mm Hg were detected. Patients with an RVSP ≥35 mm Hg had significantly higher PA diameters (29.5 vs. 27.5 mm; <i>p</i> = 0.02) but no significantly different PA:A ratios. All patients with an RVSP &#x3e;50 mm Hg had PA diameters &#x3e;30 mm. <b><i>Conclusions:</i></b> The prevalence of PH and systolic left ventricle dysfunction is low in this preselected cohort of patients with severe COPD. In this population, a PA:A ratio &#x3e;1 is not a useful cardiac screening tool for PH. A PA diameter &#x3e;30 mm could substitute for routinely performed echocardiography in the screening for PH in this patient group.

P200 The impact of left venticule ejection fraction on long-term outcome in patients with high- and low-gradient severe aortic stenosis - data from ASRegistry

Background Aortic stenosis (AS) is the most common primary valve disease leading to surgery or catheter intervention with a growing prevalence due to the ageing population. Severe aortic stenosis with reduced transaortic flow and gradient although it is a common finding still remains diagnostic challenge. Purpose The aim of study was to analyse the outcomes of patients with high- and low-gradient aortic stenosis depending on the ejection fraction. Methods 621 patients hospitalized in the First Department of Cardiology, with severe aortic stenosis defined as aortic valve area &lt;1cm2 were enrolled to the Aortic Stenosis Registry (ASRegistry). The high-gradient aortic stenosis (HG-AS) [mean transvalvular pressure gradient (PGmean) ≥40mmHg and peak transvalvular velocity (Vmax) ≥ 4 m/s] and low-gradient aortic stenosis (LG-AS) [mean transvalvular pressure gradient (PGmean) &lt;40mmHg and peak transvalvular velocity (Vmax) &lt;4 m/s] were observed in 54%(n = 340) and 45% (n = 281) patients, respectively. In the subgroup of HG-AS were 80% (n = 275) and in the subgroup of LG-AS were 61%(n = 174) of patients with preserved left ventricle ejection fraction (LVEF &gt; 50%). The patients were observed for a period of 6 years (2012-2018). The primary end-point, all-cause mortality, was obtained from Nation Health Registry. Results Patients with LG-AS had a significantly higher risk of mortality compared to patients with HG-AS: 35% (n = 101) vs 26% (n = 87), p &lt; 0,05. Mortality in both group with HG-AS and LG-AS was significantly higher in the subgroup with diminished left ventricle dysfunction than in the subgroup with preserved ejection fraction: HG-AS: 44%(n = 29) vs 21%(n = 58), p &lt; 0,05 and LG-AS: 53%(n = 57) vs 25%(n = 44), p &lt; 0,05. The highest mortality rates was observed in the LG-AS group with left ventricule dysfunction, p &lt; 0,001. Conclusions The study shows the negative impact of left ventricle dysfunction in both groups of patients: high- and low-gradient severe aortic stenosis. The worst prognosis is in patients with LG-AS and low LVEF.