Abstract:We examined whether an increase in high-sensitivity C-reactive protein (hs-CRP) after percutaneous coronary intervention (PCI) predicts long-term prognosis in patients with stable angina pectoris. hs-CRP is an inflammatory marker that predicts future cardiovascular events in healthy subjects and patients with unstable and stable coronary syndromes. Long-term evaluation of pre-and postprocedural inflammatory markers has not been widely reported. In particular, the effect of the magnitude of increase in hs-CRP after PCI in stable patients is unknown. We prospectively analyzed 89 stable patients treated by PCI for stable angina pectoris. Patients were recruited between August 1998 and May 1999, and the population was followed until August 2005 (mean follow-up 79.5 ± 10.3 months). A major adverse cardiac event (MACE) was defined as the occurrence of cardiac death, myocardial infarction, or recurrent angina requiring repeat PCI or coronary artery bypass grafting. During the follow-up period, 36 patients presented with 1 MACE. In multivariate analysis, independent predictors of the occurrence of MACEs were previous myocardial infarction and a significant increase in hs-CRP after PCI (p = 0.004 and 0.003, respectively). A significant increase in hs-CRP after PCI was found to be more predictive of MACEs than hs-CRP before and after PCI. In conclusion, in stable coronary artery disease, inflammation is associated with long-term adverse events, but the magnitude of the inflammatory reaction after PCI appears more predictive than the baseline value.A previous study 1 has reported that high-sensitivity C-reactive protein (hs-CRP) increases after percutaneous coronary intervention (PCI) in patients with unstable angina pectoris and high baseline hs-CRP levels, but not in those with normal baseline hs-CRP. An increase in hs-CRP levels after PCI in this unstable condition does not seem to be related to the treated plaque but may rather be a marker of the inflammatory state. In stable coronary artery disease, it is unknown whether the magnitude of increase in hs-CRP after PCI provides independent prognostic information. The purposes of this study were to analyze the long-term prognostic importance of preand postprocedural hs-CRP and of the magnitude of hs-CRP increase in patients treated by elective PCI for stable angina pectoris. Methods and ResultsBetween August 1998 and May 1999, we prospectively analyzed 89 consecutive patients who were referred for coronary angiography for stable angina and exercise-induced ischemia. They underwent PCI of 1 coronary stenosis. Exclusion criteria were age 80 years, history of acute coronary syndrome with or without ST-segment elevation within the previous year, treatment for restenosis, coronary artery bypass grafting, or PCI within the previous 6 months, heart failure of New York Heart Association class 3, or known malignant or inflammatory disorders. Six-year follow-up was obtained in all patients by inspection of medical records. To ensure that no deaths were missed, the general ...

Popliteal vein aneurysm is a rare cause of pulmonary embolism. We present the case of a 39-year-old man with multiple pulmonary emboli. Subsequent investigation revealed a saccular aneurysm of the right popliteal vein containing large clots. The presence of fresh thrombus was confirmed at surgery which consisted in excision of the saccular aneurysm with vein patch closure. Primary popliteal venous aneurysms are probably congenital in origin. Phlebography is diagnostic. Surgery is recommended.

MAHAUX, V., ET AL.: Heart Graft Monitoring by the Ventricular Evoked Response. Monitoring of the neg ative slew rate of the evoked T wave has been proposed as a noninvasive diagnostic tool to follow heart transplant recipients. The clinical contribution of this measurement on telemetrically recorded, paced unipolar ventricular electrograms was evaluated in the detection of grade 3 acute allograft rejection. Thir teen patients undergoing heart transplantation received a DDD pacemaker connected to two epimyocardial leads. Electrograms were recorded and digitized after each endomyocardial biopsy (EMB). The max imum slew rate of the descending slope of the repolarization phase (RSP) was extracted and normalized. A 20% downward shift of RSP from the reference value was considered abnormal. Results of signal pro cessing were blinded during the first 6 months. Eleven patients completed the 6 months blinded period and two patients died. A total of 101 EMB were graded according to the International Society for Heart and Lung Transplantation classification. Grade 3 was assigned to 9 EMB. A significant difference was found between RSP values measured during grade 3 rejection episodes and other RSP values (P < 0.001). A diagnostic model consisting of a single threshold test confirmed the ability ofRSP to predict significant signs of rejection on EMB (P < 0.0001). The sensitivity of RSP in detecting grade 3 rejections was 100%, specificity was 81 %, negative predictive value 100%o, and positive predictive value 35%. The use ofRSP as a noninvasive monitoring tool to pose the indication for a biopsy would avoid 73% of EMB. Monitor ing of transplanted hearts based on the analysis of the ventricular evoked response is promising and may markedly reduce the number

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We report the diagnosis of hereditary amyloidosis that affected a Belgian family that was initially diagnosed in a 73 year old woman. This patient was admitted with complaints of congestive heart failure. Cardiac work-up showed myocardial hypertrophy with zones of hyperintensity, suggestive for amyloidosis that was confirmed on a rectal biopsy. A hereditary form of amyloidosis was found by showing the Val30Met mutation within the transthyretin gene, that was also found in her asymptomatic son. This case shows that genetic testing is crucial in cases of unexplained amyloidosis and can help in the diagnosis and follow-up of patients and family members.