A 50-year-old nonsmoker with paroxysmal atrial fibrillation was referred to our hospital for pulmonary vein isolation (PVI). He had a known 1-vessel coronary artery disease. Because of stable angina, a drug-eluting stent had been implanted into the midportion of the left anterior descending artery in 2010. Otherwise he was healthy. His medical treatment included warfarin, sotalol, an angiotensin-converting enzyme-inhibitor and a statin. Cryoballoon-PVI (Arctic Front Advance 28 mm; Medtronic) was scheduled under general anesthesia (international normalized ratio, 2-9; minimal activated clotting time, 300 s). After transseptal access, the left PV were targeted first, followed by the right inferior PV and right superior PV, respectively. PVI of all PVs could be visualized in real-time and gained within 40 s. Two freezethaw cycles were used for each PV, except for the left superior PV, which had to be treated 3×, because of an initially ineffective freeze (Table I in the Data Supplement ). The procedure had been uneventful, until a sudden blood pressure drop occurred (70/40 mm Hg), immediately after the second right superior PV-freeze. Cardiac tamponade was excluded. Twelve-lead ECG revealed global ST-depression and progressive ST-elevation in aVR, consistent with coronary main stem occlusion ( Figure 1). Pulseless electric activity developed rapidly, necessitating cardiopulmonary resuscitation. Coronary angiography showed a severe spasm of the left coronary main stem, without evidence for air-or thromboembolism (Figure 2A), which could be completely reverted by balloon dilatation and intracoronary nitroglycerine administration ( Figure 2B). The right coronary artery showed a less severe spasm, which was treated by nitroglycerine alone (Figure 3A and 3B). Immediately after coronary reperfusion, ventricular fibrillation occurred, affording several direct current shocks. Because of severe global myocardial stunning, without effective myocardial contractions, an extracorporeal cardiac life support system (veno-arterial extracorporeal cardiac life support system) had to be implanted. Myocardial stunning reverted completely during the following 5 days, and the patient could be weaned from the extracorporeal cardiac life support system. He survived without any major focal neurologic deficit, but impairment of short-term memory was apparent during follow-up. Predischarge echocardiography showed normal biventricular function without wall motion abnormalities. About the used cryoballoon device, the manufacturer excluded a technical malfunction. DiscussionIn this case report, to date, we describe an unreported serious complication of a near-fatal coronary artery main stem spasm during cryoballoon-PVI. We suspect cryoenergy-induced blood cooling, as the most likely trigger, rather than a direct ablation effect, given the distance between the pulmonary veins and the left main stem ( Figure I in the Data Supplement). Further evidence for this theory is provided in Figure 1, which retrospectively showed progressive development of...

Myocardial infarction (MI), Isoproterenol (ISO), Nitric oxide (NO), Neuronal NOS (nNOs), Endothelial NOs (eNOs), Gold nanoparticle (GNPs), Diamiobenzidine (DAB), Serum Creatine Kinase-MB (CK-MB), Alanine aminotransferase (ALT), Cardiac troponin T (cTnT), Electrochemiluminiscence (ECLIA), Cardiomyocytes (CMC), Peroxisomal proliferator activated receptor (PPARs), Reactive oxygen species (ROS).

Defects in cardiac contractility and heart failure (HF) are common following doxorubicin (DOX) administration. Different miRs play a role in HF, and their targeting was suggested as a promising therapy. We aimed to target miR-24, a suppressor upstream of junctophilin-2 (JP-2), which is required to affix the sarcoplasmic reticulum to T-tubules, and hence the release of Ca2+ in excitation–contraction coupling using pachymic acid (PA) and/or losartan (LN). HF was induced with DOX (3.5 mg/kg, i.p six doses, twice weekly) in 24 rats. PA and LN (10 mg/kg, daily) were administered orally for four weeks starting the next day of the last DOX dose. Echocardiography, left ventricle (LV) biochemical and histological assessment and electron microscopy were conducted. DOX increased serum BNP, HW/TL, HW/BW, mitochondrial number/size and LV expression of miR-24 but decreased EF, cardiomyocyte fiber diameter, LV content of JP-2 and ryanodine receptors-2 (RyR2). Treatment with either PA or LN reversed these changes. Combined PA + LN attained better results than monotherapies. In conclusion, HF progression following DOX administration can be prevented or even delayed by targeting miR-24 and its downstream JP-2. Our results, therefore, suggest the possibility of using PA alone or as an adjuvant therapy with LN to attain better management of HF patients, especially those who developed tolerance toward LN.

Over the last century, our understanding of selenium has progressed considerably and we have come to recognize it as an essential component or cofactor of enzymes throughout metabolism, such as glutathione peroxidase (GPx), thioredoxine reductase and iodine deiodinase. GPx acts against hydrogen peroxide and lipid peroxidation and is an important line of defense against free radicals; thioredoxine reductase is involved in nucleus redox status; and iodine deiodinase is involved in thyroid hormone metabolism, which is frequently impaired in critically ill patients. Selenium also has an anticarcinogenic effect that is thought to be induced by the production of methyselenol, a selenometabolite that affects gene expression and modifi es cell cycling and immune function. We review current knowledge concerning clinically relevant selenoproteins, discuss the potential role of these compounds in health and disease, review the epidemiology of selenium defi ciency and its clinical implications with a special emphasis on critically ill patients and discuss the role of selenium supplementation in critical care settings.

Background: Left ventricular ejection fraction (LVEF) is a strong prognostic parameter in patients with heart disease. The assessment of global longitudinal strain (GLS) from speckle-tracking analysis of 2-dimensional echocardiography has become a clinically feasible alternative to LVEF for the measurement of myocardial function. Objective: The aim of the current work was to compare between GLS speckle tracking echocardiography and Simpson's biplane methods for assessment of left ventricular function in non-STEMI patients. Patients and methods: This study was carried out in Cardiology Department, Faculty of Medicine, Zagazig University on 44 non-ST-elevation myocardial infarction (NSTEMI) patients scheduled for assessment of Left ventricular function by GLS and biplane Simpson method. Result: Mean systolic blood pressure was 122.05±18.37 mmHg. No statistically significant difference in systolic blood pressure was found across GLS groups (P= 0.17). Mean diastolic blood pressure was 73.41±12.00 mmHg. No statistically significant difference in diastolic blood pressure was found across GLS groups (P= 0.35). Mean heart rate was 68.84±7.13 bpm, and a statistically significant difference was found in heart rate across GLS groups (P= 0.039). Conclusion:It could be concluded that GLS speckle tracking echocardiography and Simpson's biplane methods can be used as alternative different parameters for assessment of left ventricular function in non-STEMI patients.