To test safety and feasibility of intramyocardial cell injection and left ventricular electromechanical mapping (EMM) early after AMI.

On day 10.5 (5) (mean (SD)) after AMI and percutaneous coronary intervention with stent implantation (culprit lesion: 15 LAD, 3 circumflex and 2 right coronary arteries) 20 patients (mean (SD) 60.4 (11.4) years) received bone marrow derived mononuclear cells in the low-voltage area using EMM-guided percutaneous intramyocardial injection. EMM and coronary angiography were performed in 15 patients at 6-months’ follow-up. Echocardiography, recording of laboratory data and clinical assessment (6-month and 12-month follow-up) were carried out in all 20 patients.

None of the patients showed periprocedural complications. Three patients received an implantable cardioverter-defibrillator for primary prevention of sudden cardiac death and 6 (30%) patients showed in-stent restenosis. One patient underwent bypass surgery owing to chronic stent occlusion after 6 months. 2.0 (0.6)x10⁸ cells, including 1.0 (0.3)x10⁶ CD45^dim/CD34^hi stem cells, were injected in each patient. EMM showed a mean (SD) improvement from a baseline unipolar voltage of 45.5 (14.3)% to 59.3 (19.8)% of normal voltage (p = 0.002) and reduction of the low-voltage area from 28.7 (12.1)% to 20.3 (13.5)%; (p = 0.016). During the 12-month follow-up, the left ventricular ejection fraction (LVEF) improved from 40.8 (6.9)% to 47.1 (10.6)%; (p = 0.037).

Left ventricular EMM and percutaneous intramyocardial cell injection in patients with AMI was shown to be a safe procedure. It is associated with improved LVEF and electromechanical parameters after 12-months’ follow-up.

Eudra-CT-No 2005-003629-19.

To evaluate whether cTnT elevations occurring after ICD discharges have an impact on survival.

Prospective observational study.

174 patients (mean (SD) age 68 (12) years, 32 women) who received spontaneous (n = 66) or induced (n = 108) ICD discharges were studied. The mean (SD) left ventricular ejection fraction was 29 (11)%.

Troponin T was measured between 12 and 24 h after ICD discharge. Patients received between 1 and 19 discharges (mean (SD) 2.4 (2.4)), with total delivered energy ranging from 6 to 288 J (mean (SD) 41 (63) J). The relationship between cTnT levels and all-cause mortality was assessed in univariate and multivariate analyses.

During a median follow-up period of 41.8 months (range 3–123), 56 patients died. Patients with a post-discharge cTnT level of >=0.05 ng/ml had worse survival than those with cTnT <0.05 ng/ml. The significant relationship between raised cTnT and survival was retained in Cox multivariate analysis adjusted for total ICD energy delivered during an arrhythmia episode, age, sex, presence of coronary artery disease, left ventricular ejection fraction and serum creatinine.

Elevation of troponin T after ICD discharge, even when it occurs after device testing, is a risk factor for mortality that is independent of other common clinical factors that predict survival in such patients.

To determine whether the altered remodelling results in improved cardiac function in the MHC-1152stop mice after MI, as compared with non-transgenic mice.

MHC-1152stop mice and non-transgenic littermates were subjected to experimental MI via permanent occlusion of the coronary artery. Infarct size was determined at 24 h and at 4 weeks after MI, and left ventricular pressure–volume measurements were performed at 4 weeks after MI in infarcted and sham-operated animals.

Infarct size in MHC-1152stop mice and non-transgenic littermates was not statistically different at 24 h after MI, as measured by tetrazolium staining. Morphometric analysis showed that infarct scar expansion at 4 weeks after MI was reduced by 10% in the MHC-1152stop mice (p<0.05). No differences in cardiac function were detected between sham-operated MHC-1152stop mice and their non-transgenic littermates. However, at 4 weeks after MI, the ventricular isovolumic relaxation time constant () was decreased by 19% (p<0.05), and the slope of the dP/dt_max–EDV relationship was increased 99% (p<0.05), in infarcted MHC-1152stop mice as compared with infarcted non-transgenic littermates.

Expression of the dominant interfering p193 transgene results in a decrease in infarct scar expansion and preservation of myocardial function at 4 weeks after MI. Antagonism of p193 activity may represent an important strategy for the treatment of MI.

To record current practice and results of CRT in paediatric and congenital heart disease.

Retrospective multicentre European survey.

Paediatric cardiology and cardiac surgery centres.

One hundred and nine patients aged 0.24–73.8 (median 16.9) years with structural congenital heart disease (n = 87), congenital atrioventricular block (n = 12) and dilated cardiomyopathy (n = 10) with systemic left (n = 69), right (n = 36) or single (n = 4) ventricular dysfunction and ventricular dyssynchrony during sinus rhythm (n = 25) or associated with pacing (n = 84).

CRT for a median period of 7.5 months (concurrent cardiac surgery in 16/109).

Functional improvement and echocardiographic change in systemic ventricular function.

The z score of the systemic ventricular end-diastolic dimension decreased by median 1.1 (p<0.001). Ejection fraction (EF) or fractional area of change increased by a mean (SD) of 11.5 (14.3)% (p<0.001) and New York Heart Association (NYHA) class improved by median 1.0 grade (p<0.001). Non-response to CRT (18.5%) was multivariably predicted by the presence of primary dilated cardiomyopathy (p = 0.002) and poor NYHA class (p = 0.003). Presence of a systemic left ventricle was the strongest multivariable predictor of improvement in EF/fractional area of change (p<0.001). Results were independent of the number of patients treated in each contributing centre.

Heart failure associated with ventricular pacing is the largest indication for CRT in paediatric and congenital heart disease. CRT efficacy varies widely with the underlying anatomical and pathophysiological substrate.

To assess the value of LAVI for the prediction of mortality independently of clinical, electrocardiographic (ECG) and echocardiographic prognostic parameters in patients with suspected HF referred from the community.

356 (mean (SD) age 72 (13) years) patients with suspected HF referred from the community were followed up for mortality after undergoing clinical assessment, ECG and echocardiography, including Doppler, to assess LV filling.

Data were obtained for 335/356 (94%) patients (162 male, 173 female) over a mean (SD) follow-up period of 30 (10) months, during which 38 (11.3%) died. The univariate predictors for all-cause mortality were age, symptom of leg swelling, clinical signs of HF, abnormal ECG, LV ejection fraction, LAVI, LV end-systolic (LVESD) and diastolic dimension, septal wall thickness and the presence of other significant cardiac abnormalities. The only independent predictors of mortality were age (hazard ratio (HR) = 2.15, 95% CI 1.42 to 3.25, p<0.001), symptom of leg swelling (HR = 2.83, 95% CI 1.43 to 5.59, p = 0.005), LAVI (HR = 1.25, 95% CI 1.01 to 1.54, p = 0.04) and LVESD (HR = 1.32, 95% CI 1.02 to 1.70, p = 0.04).

LAVI provided independent information over clinical and other echocardiographic variables for predicting mortality in patients with suspected HF referred from the community.

Questionnaire-based survey.

Tertiary care centre.

Consecutive sample of 332 men with congenital heart disease (age 18–59 years; median 23).

Besides various components concerning sexuality, the International Index of Erectile Function, a generic health-related quality-of-life instrument (SF-12) and a depression scale (ADS) were included.

Men under the age of 40 engage less frequently in sexual relationships than their peers from the general population. Fears before or during sexual intercourse (9.9%), as well as physical symptoms such as dyspnoea (9.0%), feelings of arrhythmia (9.0%) or chest pain (5.1%) are common. 10.0% reached a score on the International Index of Erectile Function indicative of an erectile dysfunction. Men with erectile dysfunction scored significantly worse on the SF-12 mental (43.5 vs 51.8, p<0.001) as well as on the physical sum scale (46.3 vs 52.6, p = 0.002) than patients without erectile problems. Additionally, in the group of men without erectile dysfunction only 3.2% showed signs of depressive symptoms, whereas among men with erectile dysfunction this figure increased to 33.3% (p<0.001)

The concern of sexuality should be integrated into the regular consultations of these patients. The strong association between sexual health and subjective wellbeing emphasises the need for diagnosis and, if necessary, treatment of these problems.

To examine the feasibility of using SI and SR to evaluate phasic atrial function in patients with mild hypertension (HT).

The study group comprised 54 patients with mild essential HT (29 women) and 80 age-matched normal controls (47 women). Standard two-dimensional and Doppler echocardiography was performed as well as Doppler tissue imaging. The following left atrial (LA) volumes were measured: (a) maximal LA volume or Vol_max; (b) minimal LA volume or Vol_min; (c) just before the "p" wave on ECG (Vol_p). Phasic LA volumes were also calculated. Systolic (S-Sr), early diastolic (E-Sr), late diastolic (A-Sr) strain rate and SI were measured.

Despite no differences in indexed maximal LA volume with only mild increases in left ventricular mass in the HT cohort compared with normal subjects (mean (SD) 86 (18) g/m² vs 67 (14) g/m²; p = 0.001), E-Sr was significantly lower in the HT cohort. There was a corresponding reduction in indexed conduit volume in the HT cohort compared with normal subjects (10.5 (7.5) ml/m² vs 13.8 (6.1) ml/m²; p = 0.006). Global E-Sr showed modest negative correlations with LA Vol_max and LA ejection fraction. No significant difference was present in S-Sr, A-Sr or global atrial strain between the normal and HT cohorts.

Mild HT results in a reduction in LA conduit volume, although maximal LA volume is unchanged. This is reflected by a reduction in E-Sr with preserved S-Sr and A-Sr.