The prevalence of heart failure with preserved ejection fraction (HFpEF) accounts for more than 50% of patients with heart failure (HF) and tends to increase with a prognosis as bad as that of HF with reduced ejection fraction (HFrEF) (1-6). Till date, no therapy has been demonstrated to improve mortality in patients with HFpEF including several large prospective, randomized controlled trial such as angiotensin converting enzyme inhibitor (ACE-I) perindopril (PEP-CHF) (7), angiotensin II receptor blockers (ARBs) candesartan (CHARM-Preserved) (8) and irbesartan (I-PRESERVE) (9), aldosterone receptor blockers spironolactone (TOPCAT (10) and Aldo-DHF (11)), and beta blocker (SENIORS) (12). Recent studies have shown that bioenergetic deficiency is involved in the pathophysiology of HFpEF and that these changes lead to myocardial remodeling and dysfunction (13). Patients with HFpEF show abnormalities in myocardial energetics in the formation of adenosine triphosphate (ATP) and movement between phosphocreatine and ATP through creatine kinase reactions. Phan et al. (14,15) found a significant reduction in the phosphocreatine/ATP ratio of patients with HFpEF compared to that in controls. Summary Heart failure with preserved ejection fraction (HFpEF) is a leading cause of morbidity and mortality without an established treatment. Diastolic dysfunction, the hallmark of HFpEF, is associated with altered myocardial bioenergetics. No previous study has examined the effects of coenzyme Q10 (CoQ10) on left ventricle (LV) diastolic function in patients with HFpEF. We investigated whether CoQ10 could improve LV diastolic function in patients with HFpEF. We performed a randomized controlled trial (RCT) using pretest and posttest control groups of 30 patients with HFpEF. The patients received either CoQ10 100 mg three times a day or no CoQ10 in addition to routine treatment for 30 days. Echocardiographic study was performed at baseline and follow-up. LV diastolic function was evaluated by two dimensional and Doppler echocardiography as follows; average E/e‫,׳‬ septal and lateral e‫׳‬ velocity, and left atrium volume index (LAVI). A total of 28 patients completed the study. A statistically significant improvement was observed in the CoQ10 treatment group in terms of average E/e‫׳‬ (18.9 (3.8) vs. 15.1 (4.3); p < 0.01) and LAVI (32 (9) mL/m 2 vs. 26 (7) mL/m 2 ; p < 0.05) and in the control group (18.4 (3.1) vs. 15.8 (5.6); p < 0.05) and (33 (7) mL/m 2 vs. 30 (8) mL/m 2 ; p < 0.05, respectively). However, there was no difference in change reduction between groups (∆E/e‫׳‬-3.6 vs.-2.4; p = 0.28) and (∆LAVI-5.4 vs.-4.4; p = 0.83). Short term CoQ10 supplementation provided no additional benefits in improving LV diastolic function in patients with HFpEF.

Spontaneous coronary artery dissection (SCAD), an uncommon cause of myocardial infarction, typically affects a younger, otherwise healthy population. There are currently no known direct causes of this condition, although some correlations have been noted. Commonly found in women, the asymptomatic presentation in men is very rare. Herein, we report the case of an 18-year-old man who presented to our institution with asymptomatic myocardial infarction secondary to a spontaneous dissection of the left anterior descending coronary artery. Until now, there is no specific guideline for SCAD. Choice of treatment should be tailored to the clinical condition of each individual patient.

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Background: Coronary collateral circulation (CCC) is linked to myocardial remodeling severity in patients with chronic ischaemic heart disease (IHD). However its effect on left ventricular reverse remodeling (LVRR) in patients with chronic IHD underwent coronary artery bypass surgery (CABG) has never been reported. Purpose of this study was to investigate the effect of CCC grade on the LVRR event in patients with chronic IHD underwent CABG. Methods: This prospective cohort study was performed in patients with chronic IHD underwent CABG. The CCC was classified using Rentrop collateral score, i.e low CCC grade (Rentrop score 0 and 1) and high CCC grade (Rentrop score 2 and 3).  LVRR event was defined as a reduction in left ventricular end systolic volume (LVESV) of 10% or more, measured by a 3D echocardiography at 1.5 months post CABG compared to the baseline before CABG. Results: A total of 22 patients (81.8% male) with mean of age 58.6 years old were enrolled. LVRR occurred in 50% patients. LVRR event was significantly higher in the patients with high CCC grade than the low CCC grade patients (p=0.009). The high CCC grade increased LVRR event independently (odds ratio=26.67; relative risk=6.93). Conclusions: High coronary collateral circulation may increase left ventricular reverse remodeling event in patients with chronic ischemic heart disease underwent coronary artery bypass surgery. Keywords: coronary collateral circulation; left ventricular reverse remodeling; chronic ischaemic heart disease; coronary artery bypass surgery; 3D echocardiography.