SummaryElderly people represent the fastest growing portion of cardiovascular patients. We aimed to analyze the clinical presentation, risk factors, co-morbidities, complications, and mortality in patients 90 years or more who underwent coronary angiography and intervention.We retrospectively studied 108 (0.25% of 43,385) consecutive patients ≥ 90 years undergoing cardiac catheterization and/or intervention in a tertiary specialist hospital between 2003 and 2014.Most patients (68.5%) were introduced on an emergency basis, especially with acute coronary syndrome (ACS) (63.8%). Non-STEMI accounted for two-thirds of the myocardial infarctions. We found higher prevalences of previous coronary artery disease (CAD) (38%), other atherosclerotic diseases (20.4%), cardiac risk factors such as hypertension (84.3%), diabetes (49.1%), hyperlipidemia (50.9%), heart failure (42.6%), atrial fibrillation (AF) (25.0%), severe aortic stenosis (13.0%), severe mitral regurgitation (3.7%), and implantable devices (25.0%), and co-morbidities such as renal impairment (48.1%), COPD (12.0%), and previous stroke (6.5%). Three-vessel disease was present in 34.6% of the patients. The left anterior descending artery (LAD) was the most affected coronary artery (67.6%). Percutaneous coronary intervention (PCI), mostly with bare metal stents (BMS), was used to manage 54.6% of the patients, and it failed in 4 of the patients. Conservative treatment was used in 39.8% of the patients and 15.7% had no significant CAD.The incidences of vascular complications, such as bleeding (6.5%), bleeding in other organs (6.5%), blood transfusion (6.5%), in-hospital paroxysmal atrial fibrillation (7.4%), in-hospital successful reanimation (2.8%), complete heart block (5.6%), acute renal impairment (23.1%), associated infection (25.9%), cardiogenic shock (14.8%), and death (15.7%) were high.Considering the more extensive risk factors, CAD and co-morbidities, acute presentation and age per se, we believe that the reported higher rates of complications and mortality are still acceptable. (Int Heart J 2017; 58: 180-184)

Introduction. Left ventricular outflow obstruction might be part of the pathophysiological mechanism of Tako-tsubo cardiomyopathy. This obstruction can be masked by Tako-tsubo cardiomyopathy and diagnosed only by followup. Case Presentation. A 70-year-old female presented with Tako-tsubo cardiomyopathy and masked obstructive hypertrophic cardiomyopathy at presentation. Conclusion. Tako-tsubo cardiomyopathy typically presents like an acute MI and is characterized by severe, but transient, regional left ventricular systolic dysfunction. Prompt evaluation of the coronary status is, therefore, mandatory. The prognosis under medical treatment of heart failure symptoms and watchful waiting is favourable. Previous studies showed that LVOT obstruction might be part of the pathophysiological mechanism of TCM. This paper supports this theory. However, TCM may also mask any preexisting LVOT obstruction.

Background SLE is associated with high cardiovascular (CV) morbidity and mortality. Patients have increased exposure to traditional and lupus specific risk factors, which accelerate plaque formation. Recurrent disease flares may facilitate vascular damage and inflammation, decreasing arterial compliance and increasing arterial impulse that transmits across the artery. Arterial stiffness is a recognised surrogate marker for CV disease and enables assessment of preclinical disease. Objectives In this pilot study, our aim was to determine if SLE patients have significantly different pulse wave velocity (PWV), augmentation index (AI) and augmentation pressure (AP) compared to healthy controls in a cross-sectional study and to assess risk factors and whether these abnormalities are altered by administration of iv methylprednisolone(ivMP) in patients with active SLE (new BILAG A/B). Methods SLE patients were recruited from established lupus clinics and consented. Healthy volunteers were recruited as controls. Lupus disease activity was measured using classic BILAG index. PWV, AI and augmentation pressure were measured in SLE patients and healthy controls. In 5 patients with disease flares, arterial stiffness measurements were repeated at 12 weeks following treatment with ivMP. Data that was normally distributed was analysed by student’s T test and for non parametric data, Mann Whitney U test was used. Results There were 67 SLE patients with mean disease duration ±sd of 10±7.4 years. The average age in SLE patients was 46±13.1 Vs 42±10.9 years in 45 controls who were gender and age matched (t test, p value=0.65). Participants in both groups were 91% female. The patients had significantly increased PWV at baseline 8.7±4.8m/s vs 6.2±1.2m/s, (t test p<0.001) compared to controls. AP was significantly higher in SLE group (IQR), 10 (7.5-19) Vs 8.5 (5.4-13) (Mann Whitney analysis p=0.029). AI were also higher in SLE patients compared to the control group on t test 29.6±12.1% vs 25±10% (t test p=0.02). There was a reduction in PWV in patients with active disease (BILAG≥5) at 12 weeks post treatment with ivMP compared to baseline (7.6±1.3m/s vs 10.6±7.5m/s p0.29). Multivariate analysis demonstrated that age and systolic blood pressure had the strongest association with PWV, AP and AI (p<0.001) and BMI correlates with AP and AI, (p=0.02 and <0.01) respectively. Conclusions There was a statistically significant difference in arterial stiffness between SLE patients denoting the presence of early cardiovascular disease compared to healthy controls. There was a trend to increased arterial stiffness measurements in patients with active disease (BILAG≥5) however this was not statistically significant in this small pilot study. Treating acute flares led to an improvement in AP, AI and BILAG scores, suggesting that aggressive treatment with immunosuppression may dampen inflammatory burden, slowing down progression of CVD. SLE patients had increased arterial stiffness, which was not fully explained by systolic blood pressure, BMI and ...

ZUSAMMENFASSUNGKardiale Embolien sind nach wie vor eine weltweit führende Ätiologie ischämischer Schlaganfälle. Obwohl sich die Pathologien, die zu den Embolien führen, in den letzten 10 Jahren nicht geändert haben, wurden bedeutende Fortschritte bei den Behandlungs- und Schlaganfallverhütungsmethoden für diese Krankheitsbilder erzielt. Vorhofflimmern (VHF) gilt mit einem Anteil von 20–30 % als die häufigste Ursache kardioembolischer Schlaganfälle. Goldstand zur Schlaganfallprophylaxe bei VHF bleibt nach wie vor die orale Antikoagulation (OAK). Hier hat sich in den letzten Jahren bei geeigneten Patienten eine Überlegenheit der nicht-Vitamin-K-abhängigen oralen Antikoagulanzien (NOAK) gegenüber den Vitamin-K-Antagonisten (VKA) gezeigt. Fortschritte beim Verschluss des linken Herzohrs als Schlaganfallprävention bei VHF-Patienten mit Kontraindikationen für eine OAK haben das Feld revolutioniert und eine Möglichkeit für Patienten mit höherem Blutungsrisiko geschaffen. Aktuelle Studien zeigen, dass diese Maßnahme, verglichen mit den VKA, einen ähnlichen Schutz vor Schlaganfall bietet – bei weniger Blutungskomplikationen im Langzeitverlauf. Darüber hinaus konnte die initial relativ hohe periprozedurale Komplikationsrate in den letzten Jahren deutlich gesenkt werden. Ein direkter Vergleich zwischen NOAK und dem interventionellen Vorhofohrverschluss steht noch aus. Daher wird von den Leitlinien empfohlen, den Verschluss des linken Vorhofohrs nur bei Patienten mit eindeutiger Kontraindikation gegen eine OAK in Erwägung zu ziehen (Empfehlungsgrad IIb, Evidenzgrad B).Die Rolle des Foramen-ovale-Verschlusses für die Sekundärprävention bei ausgewählten Patienten mit kryptogenem ischämischem Schlaganfall in einem relativ jungen Alter ist dank der jüngsten Veröffentlichung der Langzeitergebnisse aus 3 großen Studien klarer geworden. Daher wird von den neuen Leitlinien empfohlen, dass bei Patienten zwischen 16 und 60 Jahren mit einem (nach neurologischer und kardiologischer Abklärung) kryptogenen ischämischen Schlaganfall und offenem Foramen ovale mit moderatem oder ausgeprägten Rechts-links-Shunt ein interventioneller PFO-Verschluss durchgeführt werden soll (Empfehlungsgrad I Evidenzgrad A).

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