The significance of heart-rate turbulence (HRT) in patients with chronic heart failure (CHF) was evaluated to examine whether it is sensitive to the risk of ventricular tachycardia (VT). HRT is reported to predict the prognosis after myocardial infarction (MI), but its prognostic value in patients with CHF remains unknown. HRT was measured in 50 CHF patients (left ventricular ejection fraction <50% and/or left ventricular end-diastolic diameter >55 mm, 34 cardiomyopathy, 16 post-MI) and 21 patients without obvious heart diseases (control). HRT slope and HRT onset were measured by the original definitions using digitized Holter ECG recordings. Cardiac pump function was assessed by echocardiography. The value of the HRT slope was significantly lower in CHF than in control (3.7 +/- 1.7 vs 16.4 +/- 5.3, mean +/- SD, p < 0.01). The value of the HRT onset in patients with CHF was significantly higher than that in control patients (-1.1 +/- 1.9 vs -3.6 +/- 1.7, mean +/- SD, p < 0.05). The HRT slope and onset in CHF patients with VT were nearly identical to those without VT. The HRT slope appears to be a powerful prognostic marker that shows significant differences between CHF subgroups when divided by clinical events; that is, CHF death and CHF hospitalization. However, it has limited value for predicting fatal ventricular arrhythmias.

In HCM patients, a positive TWA test probably is related to abnormal myocardial arrangement (disarray) and/or fibrosis, and it may reflect electrical instability of the myocardium.

Patient: Female, 78Final Diagnosis: Acute myocardial infarctionSymptoms: Chest discomfortMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Unusual clinical courseBackground:Acute myocardial infarction (AMI) can be caused not only by plaque rupture/erosion, but also by many other mechanisms. Thromboembolism due to atrial fibrillation and coronary thrombosis due to coronary artery ectasia are among the causes. Here we report on a case of recurrent myocardial infarction with coronary artery ectasia.Case Report:Our case was a 78-year-old woman with hypertension. Within a one-month interval, she developed AMI twice at the distal portion of her right coronary artery along with coronary artery ectasia. On both events, emergent coronary angiography showed no obvious organic stenosis or trace of plaque rupture at the culprit segment after thrombus aspiration. After the second acute event, we started anticoagulation therapy with warfarin to prevent thrombus formation. In the chronic phase, we confirmed, by using coronary angiography, optimal coherence tomography and intravascular ultrasound, that there was no plaque rupture and no obvious thrombus formation along the coronary artery ectasia segment of the distal right coronary artery, which suggested effectiveness of anticoagulant. Furthermore, by Doppler velocimetry we found sluggish blood flow only in the coronary artery ectasia lesion but not in the left atrium which is generally the main site of systemic thromboembolism revealed by transesophageal echocardiography.Conclusions:These results suggest that the two AMI events at the same coronary artery ectasia segment were caused by local thrombus formation due to local stagnant blood flow.Although it has not yet been generally established, anticoagulation therapy may be effective to prevent thrombus formation in patients with coronary artery ectasia regardless of the prevalence of atrial fibrillation.

BackgroundChronic obstructive pulmonary disease (COPD), a known risk factor for the development of congestive heart failure (CHF), was recently shown to predict the prevalence of atrial fibrillation (AF). Here, we explore the influence of AF on cardiac prognosis in COPD patients.MethodsA total of 339 consecutive patients who underwent spirometry from 2010 to 2013 for various reasons were retrospectively examined. Based on the diagnostic criteria, patients were stratified into COPD and non-COPD groups, which were both further divided into those with AF (chronic AF or paroxysmal AF) or sinus rhythm (SR) based on previous electrocardiography results. Significances of differences in cardiac events were assessed by the chi-square test. Multivariate logistic regression analyses and Cox proportional hazard models were applied to evaluate the influence of AF on cardiac events.ResultsOf the 339 patients, 190 were diagnosed with COPD, with 42 of these were having AF. During the mean follow-up period of 7.4 ± 0.8 years, CHF developed more frequently in COPD patients with AF than in COPD patients without AF [50% vs 7%; odds ratio (OR) 12.4, 95% confidence interval (CI): 5.25–29.49, p < 0.05]. AF was an independent predictor of CHF development (OR 20.4, 95% CI: 6.55–79.80, p < 0.05) and cardiac mortality (OR 2.8, 95% CI: 1.79–4.72, p < 0.05). Moreover, positive correlations were found between the severity of pulmonary obstruction with AF and CHF development (R = 0.69, p < 0.05), as well as cardiac mortality (R = 0.78.p < 0.05).ConclusionsThese results suggest that AF may be strongly associated with cardiac mortality and CHF in COPD patients.

Background: Benzo[a] pyrene (BaP) is a high molecular weight polycyclic aromatic hydrocarbon (PAH) that have high carcinogenic effects. So, the aim of this study was to assess the effects of benzo [a] pyrene (BaP) on liver EROD enzyme activity induction and liver DNA breakage in Java Medaka. Materials and Methods: twenty three Java Medaka were transferred to 10 L glass aquarium and exposed to benzo [a] pyrene concentrations of 0.5 µg/L (Low concentration), 1.5 µg/L (median concentration), 5 µg/L and 0 µg/L (DMSO solvent control), with semi-static renewal technique during 7 days. Fish liver biopsy was performed in seventh day and a part of the samples was immediately homogenized and were used to measure EROD enzyme activity. Another part of the liver samples were transferred to-20 °C to use for DNA integrity assay. Data were analyzed by using ANOVA and Duncan tests. The p value ≤ 0.05 was considered as a level of statistical significance. Results: A significant increase in EROD anzyme activity was observed between the experimental treatments compared to the control group. Although the fishes that exposed to the highest concentration (5 micrograms per liter) of Benzo[a] pyrene had higher DNA breakage. Nevertheless, there was no significant difference between the treatment groups compared to the control group. Conclusion: benzo[a]pyrene combination increased hepatic EROD activity, the enzyme in the initial phase of PAH detoxification, in Java Medaka. However, it seems that Java Medaka fish have a DNA repair and preventive mechanisms from liver DNA breakage.