Previous History Of Heart Disease Research Articles

Initial Phase NT-proBNP, but Not Copeptin and High-Sensitivity Cardiac Troponin-T Yielded Diagnostic and Prognostic Information in Addition to Clinical Assessment of Out-of-Hospital Cardiac Arrest Patients With Documented Ventricular Fibrillation.

AimSudden cardiac arrest (SCA) secondary to ventricular fibrillation (VF) may be due to different cardiac conditions. We investigated whether copeptin, hs-cTnT and NT-proBNP in addition to clinical assessment may help to identify the etiology of SCA and yield prognostic information.Methods and ResultsEDTA-blood was collected prior to or at hospital admission from patients with SCA of assumed cardiac origin. Clinical data were obtained from hospital records. VF was the primary heart rhythm in 77 patients who initially were divided into 2 groups based on whether they had an ischemic or non-ischemic mechanism as the most likely cause of SCA. They were further divided into 4 groups according to whether or not they had a history of previous heart disease. The patients were categorized by baseline clinical information, ECG, echocardiography and coronary angiography; Group 1 (n = 43): SCA with first AMI, Group 2 (n = 10): SCA with AMI and previous MI, Group 3 (n = 3): SCA without AMI and without former heart disease, Group 4 (n = 18): SCA without AMI and with known heart disease. Copeptin and hs-cTNT did not differ between patient groups, whereas NT-proBNP was significantly higher in patients with established heart disease without AMI and differed between non-AMI and AMI. Furthermore, NT-proBNP was significantly elevated in non-survivors as compared to survivors.ConclusionNT-proBNP provided both diagnostic and prognostic information in blood samples collected close to out-of-hospital resuscitation of VF patients, whereas copeptin and hs-cTnT failed to do so.Clinical Trial RegistrationClinicalTrials.gov, NCT02886273.

Peripartum Cardiomyopathy (PPCM) : Case Report and Review of Literatures

Introduction: Peripartum cardiomyopathy (PPCM) is a disease characterized by an enlargement of the heart muscle wall. The disease occurs in the last month of pregnancy up to 5 months postpartum, with no previous history of heart disease. The etiology of the disease is unclear. Early recognition of this case can lead to decrease in morbidiy and mortality. Case: A 20-year-old woman came to the Emergency Unit with a shortness of breath. There is a history of give birth about 4 months ago. Physical examination shows a regular heart rhythm accompanied by rhonchi sound in the basal aspect of lung. In the M-mode analysis of ECG showed left ventricular systolic ejection function is decrease (56.5%) while the right ventricle is normal. In the Hospital, patient get treated with diuretics, aldosterone antagonist, angiotensin II receptor blocker and fluid management. Patient gave good responsed to the therapy regiment. Discussion: The early clinical manifestations of PPCM are difficult to recognize. In the majority of patients, 78% of symptoms are found at 4 months after delivery, only 9% of patients show symptoms in the last month of pregnancy. Clinical symptoms include atypical chest pain, abdominal discomfort, signs of pulmonary edema, orthopnea and paroxysmal nocturnal dyspnea. In the management of patients with PPCM is almost similar to management in other congestive heart disease.

Prolonged fever and involuntary weight loss as manifestations of bacterial endocarditis: A case report

We reported an unusual presentation of prolonged fever and involuntary weight loss in older adult as a manifestation of infective bacterial endocarditis. The patient had pre-existing compensated asymptomatic valvular heart disease without treatment. A positive fecal occult blood test is prompting an investigation of malignancy of gastrointestinal as one of other possible cause of prolonged fever with wasting, evaluation of HIV serostatus shows seronegative. The case fulfilled criteria for definitive infective endocarditis: one major criterion of positive blood culture for Streptococcus mitis, which was one of viridans group streptococci and three minor criteria of fever at least 38°Celsius, immunologic phenomena in the form of glomerulonephritis, and a predisposing heart condition. One course of third-generation cephalosporin successfully cleared the Streptococcus mitis infection proven by culture. Infective endocarditis should be considered as one of the causes of prolonged fever with wasting, especially in cases with the previous history of heart disease.

Risk prediction model for heart disease among endometrial cancer survivors.

120 Background: There are an estimated 760,000 endometrial cancer survivors alive in the US today. We previously reported on increased heart disease (HD) risk among endometrial cancer survivors from our population-based cohort study. Although there are many risk prediction models for the risk of endometrial cancer, there are none to our knowledge for endometrial cancer survivors. Methods: We identified 2,994 endometrial cancer patients in the Utah Population Database, which links data from multiple statewide sources. We estimated hazard ratios with the Cox proportional hazards model for predictors of five-, ten- and fifteen-year risks. The Harrell’s C statistic was used to evaluate the model performance. We used 70% of the data randomly selected to develop the model and the rest of the data to validate the model. Results: A total of 1,591 patients were diagnosed with HD. Increased risks of HD among endometrial cancer patients were observed for older age, obesity at baseline, family history of HD, previous disease diagnosis (hypertension, diabetes, high cholesterol, COPD), distant stage, grade, histology, chemotherapy, and radiation therapy. The C-statistics for the risk prediction model were 0.69 for the hypothesized risk factors for HD, 0.56 for clinical factors, and 0.71 when statistically significant risk factors were included. With the final model selected, as one example, the absolute risks of HD were 17.6% at 5-years, 24.0% at 10-years and 32.0% at 15 years for a woman diagnosed with regional stage, grade I endometrial cancer in her fifties, was white, was obese at cancer diagnosis, had a family history of HD but no previous history of HD herself, had hypertension, but no history of diabetes or high cholesterol or COPD, and had radiation therapy treatment but no chemotherapy. The AUCs were 0.79 for the 5-year, 0.78 for the 10-year and 0.78 for the 15-year predictions. Conclusions: We developed the first risk prediction model for HD among endometrial cancer survivors within a population-based cohort study. Risk prediction models for cancer survivors are important in understanding long-term disease risks after cancer treatment is complete. Such models may contribute to management plans for treatment and individualized prevention efforts.

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction.

BackgroundIn patients with acute ST-segment elevation myocardial infarction (STEMI), the time elapsed from symptom onset to receiving medical care is one of the main mortality predictors.ObjectiveTo identify independent predictors of late presentation in patients STEMI representative of daily clinical practice.MethodsAll patients admitted with a diagnosis of STEMI in a reference center between December 2009 and November 2014 were evaluated and prospectively followed during hospitalization and for 30 days after discharge. Late presentation was defined as a time interval > 6 hours from chest pain onset until hospital arrival. Multiple logistic regression analysis was used to identify independent predictors of late presentation. Values of p < 0.05 were considered statistically significant.ResultsA total of 1,297 patients were included, with a mean age of 60.7 ± 11.6 years, of which 71% were males, 85% Caucasians, 72% had a mean income lower than five minimum wages and 66% had systemic arterial hypertension. The median time of clinical presentation was 3.00 [1.40-5.48] hours, and approximately one-quarter of the patients had a late presentation, with their mortality being significantly higher. The independent predictors of late presentation were Black ethnicity, low income and diabetes mellitus, and a history of previous heart disease was a protective factor.ConclusionBlack ethnicity, low income and diabetes mellitus are independent predictors of late presentation in STEMI. The identification of subgroups of patients prone to late presentation may help to stimulate prevention policies for these high-risk individuals.

A Prospective Study of Different Types of Dietary Fiber and Risk of Cardiovascular Disease: Tehran Lipid and Glucose Study.

Background and aim: This study was designed to examine the hypothesis that dietary of intake different types of fiber could modify the risk of cardiovascular disease (CVD) in a large prospective cohort among Iranian adults. Methods: In 2006–2008, we used a validated food frequency questionnaire to assess dietary fiber intake among 2295 health professionals with no previous history of heart disease. Subjects were subsequently followed until 2012 for incidence of CVD events. Multivariate Cox proportional hazard regression models, adjusted for potential confounders were used to estimate the risk of CVD across tertiles of total dietary fiber and different types of fiber. Linear regression models were also used to indicate the association of dietary fiber intakes with changes of cardiovascular risk factors during the follow-up. Results: Mean age of participants (42.8% men) was 38.2 ± 13.4, at baseline. Mean (SD) dietary intake of total fiber was 23.4 (8.9) g/day. After adjustment for cardiovascular risk score and dietary confounders, a significant inverse association was observed between intakes of total, soluble and insoluble dietary fiber and CVD risk, in the highest compared to the lowest tertiles (HR = 0.39, 95% CI = 0.18–0.83, HR = 0.19, 95% CI = 0.09–0.41, and HR = 0.31, 95% CI = 0.14–0.69, respectively). Inverse relations were observed between risk of CVD and dietary fiber from legumes, fruits and vegetables; however, dietary fiber intake from grain and nut sources was not related to risk of CVD. Conclusion: Our findings confirmed that higher intakes of dietary fiber from different sources is associated with CVD events and modify its major risk-related factors.

Organization and implementation of a cardio-oncology program

Considerable advances in cancer therapies in recent decades have reshaped the prognosis of cancer patients. There are now estimated to be over 20 million cancer survivors in the USA and Europe, numbers unimaginable a few years ago. However, this increase in survival, along with the aging of the patient population, has been accompanied by a rise in adverse cardiovascular effects, particularly when there is a previous history of heart disease. The incidence of cardiotoxicity continues to grow, which can compromise the effectiveness of cancer therapy. Cardiotoxicity associated with conventional therapies, especially anthracyclines and radiation, is well known, and usually leads to left ventricular dysfunction. However, heart failure represents only a fraction of the cardiotoxicity associated with newer therapies, which have diverse cardiovascular effects. There are few guidelines for early detection, prevention and treatment of cardiotoxicity of cancer treatments, and no well-established tools for screening these patients. Echocardiography is the method of choice for assessment of patients before, during and after cancer treatment.It therefore makes sense to adopt a multidisciplinary approach to these patients, involving cardiologists, oncologists and radiotherapists, collaborating in the development of new training modules, and performing clinical and translational research in a cardio-oncology program. Cardio-oncology is a new frontier in medicine and has emerged as a new medical subspecialty that concentrates knowledge, understanding, training and treatment of cardiovascular comorbidities, risks and complications in patients with cancer in a comprehensive approach to the patient rather than to the disease.

Organização e implementação de uma consulta de cardio‐oncologia

Considerable advances in cancer therapies in recent decades have reshaped the prognosis of cancer patients. There are now estimated to be over 20 million cancer survivors in the USA and Europe, numbers unimaginable a few years ago. However, this increase in survival, along with the aging of the patient population, has been accompanied by a rise in adverse cardiovascular effects, particularly when there is a previous history of heart disease. The incidence of cardiotoxicity continues to grow, which can compromise the effectiveness of cancer therapy. Cardiotoxicity associated with conventional therapies, especially anthracyclines and radiation, is well known, and usually leads to left ventricular dysfunction. However, heart failure represents only a fraction of the cardiotoxicity associated with newer therapies, which have diverse cardiovascular effects. There are few guidelines for early detection, prevention and treatment of cardiotoxicity of cancer treatments, and no well‐established tools for screening these patients. Echocardiography is the method of choice for assessment of patients before, during and after cancer treatment.It therefore makes sense to adopt a multidisciplinary approach to these patients, involving cardiologists, oncologists and radiotherapists, collaborating in the development of new training modules, and performing clinical and translational research in a cardio‐oncology program. Cardio‐oncology is a new frontier in medicine and has emerged as a new medical subspecialty that concentrates knowledge, understanding, training and treatment of cardiovascular comorbidities, risks and complications in patients with cancer in a comprehensive approach to the patient rather than to the disease.

Identifying the progression of coronary artery disease: prediction of cardiac events

AbstractCoronary artery disease (CAD) remains as a principal cause of morbidity and mortality worldwide. Despite the advancements in medical therapy and interventional procedures during the past years, the rate of major adverse cardiac events remains high both in individuals without previous history of heart disease and in patients with known CAD. Improved strategies of risk stratification for identifying subclinical atherosclerosis and asymptomatic individuals at high risk for cardiac events may help in intensifying treatment at targeted population groups, thereby providing enhanced primary prevention. Latest technological progress has made available new methodologies (e.g., fractional flow reserve and virtual surrogates) for assessing coronary anatomy and obstructive lesions precipitating acute cardiac events. Coronary imaging using either invasive (e.g., intravascular ultrasound, optical coherence tomography) or noninvasive (e.g., multislice computed tomography) modalities has enabled the detailed identification of atherosclerotic plaque features and inflammatory processes, thereby providing a “histology‐like” quantification of the disease burden within coronary arteries. Additionally, the local hemodynamic environment, in particular endothelial shear stress, is considered as a primary stimulus for plaque development and progression. In vivo assessment of endothelial shear stress in humans has been made possible using three‐dimensional coronary imaging and computational fluid dynamics techniques, and could potentially provide a more comprehensive evaluation of the risk for disease progression. Combined assessment of cardiovascular burden focusing on the functional significance of obstructive CAD, the anatomic features of plaque vulnerability, and the local hemodynamic milieu could yield an increased predictive capacity for prognostication, and thus enable preemptive strategies that could avert cardiac events.Answer Questions and Earn CME: https://wileyhealthlearning.com/Activity2/4279913/Activity.aspx

A left atrial calcified amorphous tumor

In this article, we present a 82-year-old female case without any previous history of heart disease diagnosed with a hyperdense mass originating in left atrial side of the interatrial septum on echocardiography. The patient was scheduled for surgery. Left atrium was entered through the interatrial groove. The tumor was found attached to the interatrial septum. It was macroscopically creamish-yellow colored, 20x10 mm in size and solid in texture. It was totally resected from its attachments to the interatrial septum. Light microscopy showed polypoid formations with prominent papillary structures including scattered hyalinized areas and large areas of calcification. The mass was pathologically diagnosed as cardiac calcified amorphous tumor. She was discharged under medical treatment on seventh day after surgery.

Reference values for regional and global myocardial T2 mapping with cardiovascular magnetic resonance at 1.5T and 3T

Methods Between April and July 2014 we recruited 32 healthy subjects (no known cardiovascular risk factors, no previous history of heart disease), aged between 20 and 80yrs. All of them underwent a cardiovascular magnetic resonance (CMR at 1.5T, n=19; CMR at 3T, n= 13) protocol that included steady state free precession (SSFP) cines for measuring ventricular dimensions and function, TFisp 2D T2 mapping, dipyridamole stress myocardial perfusion study and late gadolinium enhancement study. T2 maps were obtained in three short axis orientations (basal, midventricular and apical). Regional myocardial T2 values were measured in a 16 segment model and global T2 values were also obtained per slice. A multifactorial ANOVA design was used for the statistical analysis.

Predictive factors of supraventricular arrhythmias after noncardiac thoracic surgery: a multicenter study.

Supraventricular cardiac arrhythmias are the most common rhythm disturbances in patients following thoracic surgery. The purpose of our study was to determine which of the clinical parameters are the most valuable in predicting postoperative atrial fibrillation (AF) after lung surgery. Retrospective analysis was carried out on 987 patients after noncardiac thoracic surgery to define the prevalence, associated risk factors, and clinical course of postoperative arrhythmias. There were 822 men and 165 women, age 34 to 78 years (mean age: 61 ± 8 years). The patients were divided into two groups depending on the occurrence or absence of supraventricular arrhythmia. Group I consisted of 876 patients who were free from rhythm disturbances. The remaining 111 patients exhibited episodes of supraventricular arrhythmia (29 supraventricular tachycardia; 82 AF). These 111 patients were placed in Group II. Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. A statistically significant difference was found between the two groups in age, previous history of heart disease, and lung resection, especially pneumonectomy. Age, history of prior heart disease, lung resection, and the extent of pulmonary resection are the main risk factors for postoperative supraventricular arrhythmia in patients undergoing major thoracic operations.

Infective endocarditis involving an apparently structurally normal valve: new epidemiological trend?

Infective endocarditis (IE) has been increasingly diagnosed in patients without previously detected predisposing heart disease, but its clinical features have yet to be fully determined. A recent single-center study including echocardiographic images and surgical findings investigated the incidence of undiagnosed, clinically silent valvular or congenital heart diseases and healthcare-associated infective endocarditis (HAIE). The study confirmed that a large proportion of patients with IE have no previous history of heart disease. Analysis of underlying disease in these patients showed that undetected mitral valve prolapse was the most common disease, followed by an apparently structurally normal valve. The patients who developed IE of apparently structurally normal valves had different clinical characteristics and worse outcomes. IE involving a structurally normal valve was associated with both nosocomial and non-nosocomial HAIE, whereas community-acquired IE was more frequent than HAIE. The pathophysiologic mechanism involving the development of non-HAIE or community-acquired IE due to predominantly staphylococcal infection in an apparently structurally normal valve is not yet clearly understood. Structurally normal valves are not necessarily free of regurgitation or abnormal turbulence and, given the dynamic nature and fluctuating hemodynamic effects of conditions such as poorly controlled hypertension, end-stage renal disease, and sleep apnea, further investigation is necessary to evaluate the potential role of these diseases in the development of IE. An apparently normal-looking valve is associated with IE development in patients without previously recognized predisposing heart disease, warranting repartition of at-risk groups to achieve better clinical outcomes.

Independent external validation of cardiovascular disease mortality in women utilising Framingham and SCORE risk models: a mortality follow-up study.

BackgroundWe conducted an independent external validation of three cardiovascular risk score models (Framingham risk score model and SCORE risk charts developed for low-risk regions and high-risk regions in Europe) on a prospective cohort of 4487 Australian women with no previous history of heart disease, diabetes or stroke. External validation is an important step to evaluate the performance of risk score models using discrimination and calibration measures to ensure their applicability beyond the settings in which they were developed.MethodsTen year mortality follow-up of 4487 Australian adult women from the National Heart Foundation third Risk Factor Prevalence Study with no baseline history of heart disease, diabetes or stroke. The 10-year risk of cardiovascular mortality was calculated using the Framingham and SCORE models and the predictive accuracy of the three risk score models were assessed using both discrimination and calibration.ResultsThe discriminative ability of the Framingham and SCORE models were good (area under the curve > 0.85). Although all models overestimated the number of cardiovascular deaths by greater than 15%, the Hosmer-Lemeshow test indicated that the Framingham and SCORE-Low models were calibrated and hence suitable for predicting the 10-year cardiovascular mortality risk in this Australian population. An assessment of the treatment thresholds for each of the three models in identifying participants recommended for treatment were found to be inadequate, with low sensitivity and high specificity resulting from the high recommended thresholds. Lower treatment thresholds of 8.7% for the Framingham model, 0.8% for the SCORE-Low model and 1.3% for the SCORE-High model were identified for each model using the Youden index, at greater than 78% sensitivity and 80% specificity.ConclusionsFramingham risk score model and SCORE risk chart for low-risk regions are recommended for use in the Australian women population for predicting the 10-year cardiovascular mortality risk. These models demonstrate good discrimination and calibration performance. Lower treatment thresholds are proposed for better identification of individuals for treatment.

Survey of the relationship between metabolic syndrome and myocardial infarction in hospitals of Urmia University of medical sciences.

Background and Aim:The aim of this study was to determine the relationship between metabolic syndrome and myocardial infarction in patients admitted to the hospitals of Urmia University of medical sciences.Methods:A case-control study population consisted of 172 patients with heart failure who were admitted to Seyedolshohada Hospital. In this method, the researchers present in the units and along with demographic questionnaire of patients, laboratory results needed for the survey (fasting blood glucose, triglycerides and HDL) with waist circumference size, blood pressure, height and weight were examined. Data after collection were analyzed using SPSS statistical software.Results:In this study of 172 patients with myocardial infarction, 56 patients (38.4%) patients were females and 112 (17.9%) were males. 1.2% of the patients were single, 84.8% were married, 0.6 were divorced and 13.5% were widowed, 116 patients (67.4%) with features of metabolic syndrome and 56 patients (32.6%) were lacking. In this study, females with myocardial infarction had more metabolic syndrome than males and in people whom relatives have a history of heart disease and also people who are overweight as well as obesity and also have features of metabolic syndrome and mean profiles of HDL, LDL, BMI, fasting blood glucose, triglyceride and waist circumference in males compared to males is higher. However, history of smoking, average number of cigarettes used per day, height and weight of males is higher than females.Other findings indicate a significant relationship between age and sex and having or not having a family history of heart failure, having or not having history of certain drugs and BMI of patient with metabolic syndrome. But a significant relationship was not found between the marital status, education, residence, income, previous history of heart disease, PCI, LDL, history of drug use, type of infarction, the extent of ejection and location with syndrome patients. In terms of survival, because none of the subjects in the study period had expired, this extent was not quantifiable.Conclusion:Considering the high prevalence of this disorder in Iran and that the high incidence of serious effects imposes on the health care system and that these disorders are somewhat flexible, effort towards lifestyle changes particularly healthy diets, physical activity, weight management and blood pressure, especially in women should be considered.

English

Peripartum cardiomyopathy (PPCM) is a form of dilated cardiomyopathy of unclear etiology, affecting women without pre-existing cardiac diseases, during the last month of pregnancy or up to five postpartum months 1 As with other form of dilated cardiomyopathies, PPCM involves the systolic dysfunction of the heart with a decrease in Left Ventricular Ejection Fraction (LVEF) <40, associated with congestive heart failure and with an increased risk of supra ventricular or ventricular arrhythmias, thromboembolism and even sudden cardiac death. PPCM is diagnosed by exclusion, where the patient has no history of previous heart disease, coincides with the pregnancy period (one month pre-operative to five months post- operative), and where no other possible cause of heart failure present. Diagnosis of Peripartum cardiomyopathy is a dilemma for the obstetricians, physicians, cardiologists, and the general physicians, as most of these patients are hurriedly diagnosed and treated first as a case of Left Ventricular Failure (LVF) of some cardiac origin. Specific treatment is started late or not at all. So, relapses are very common with the treatment line of Left Ventricular Failure of cardiac origin only without any specific treatment and no precautions taken, thereafter. Although the exact cause of PPCM is unknown, yet (a) some cardio tropic virus (b) immune system dysfunction8, (c) genetic factors 1, (d) deficiency of micro-nutrients or trace elements (e) some cardio-toxins may serve as a trigger to malfunction of immune system that may be responsible in the development of PPCM. Recently two cases of PPCM were transferred to our ICU from the obstetrics and gynecology department immediately after deliveries for acute left ventricular failure in quick succession and were diagnosed as PPCM and successfully managed with Diuretic, ACE inhibitor, Beta blocker and Nitrates with mechanical ventilation. After discharge from the hospital they are being followed up and are put on Hydralazine with ACE inhibitor and beta blocker since last three months and they are reported doing well.

MDCT calcium score as a tool for risk stratification of coronary disease in asymptomatic type II diabetic patients

Purposes: We assessed the association between arterial stiffness, as determined by brachial ankle pulse wave velocity (baPWV), and the extent of coronary artery disease (CAD) by conventional coronary angiography (CAG) in patients who visited outpatient clinic for angina without any previous history of heart disease. Method: We retrospectively analyzed the data of 583 consecutive patients who had undergone baPWVand elective CAG for suspected CAD between January 2012 and November 2013 in single cardiovascular center. Results: The baPWV was one of the statistically meaningful predictors of significant CAD (diameter of stenosis >50%) in addition to male gender, age, the level of HDL-cholesterol and HbA1c in multivariate analysis. However, baPWV was not the significant predictor of revascularization. When the extent of CAD was classified into following 4 groups; no significant CAD, 1-, 2and 3-vessel disease, there was significant difference of baPWV between the significant and non significant CAD group, but there was no difference of baPWV among the three significant CAD groups, although there was trend toward the positive correlation. Conclusion: Although baPWV was an independent predictor of significant CAD, it was not significantly associated with the extent of CAD.

Association between brachial-ankle pulse wave velocity and the extent of coronary artery disease

Purposes: We assessed the association between arterial stiffness, as determined by brachial ankle pulse wave velocity (baPWV), and the extent of coronary artery disease (CAD) by conventional coronary angiography (CAG) in patients who visited outpatient clinic for angina without any previous history of heart disease. Method: We retrospectively analyzed the data of 583 consecutive patients who had undergone baPWVand elective CAG for suspected CAD between January 2012 and November 2013 in single cardiovascular center. Results: The baPWV was one of the statistically meaningful predictors of significant CAD (diameter of stenosis >50%) in addition to male gender, age, the level of HDL-cholesterol and HbA1c in multivariate analysis. However, baPWV was not the significant predictor of revascularization. When the extent of CAD was classified into following 4 groups; no significant CAD, 1-, 2and 3-vessel disease, there was significant difference of baPWV between the significant and non significant CAD group, but there was no difference of baPWV among the three significant CAD groups, although there was trend toward the positive correlation. Conclusion: Although baPWV was an independent predictor of significant CAD, it was not significantly associated with the extent of CAD.

Successful treatment of infectious endocarditis associated glomerulonephritis mimicking c3 glomerulonephritis in a case with no previous cardiac disease.

We report a 42-year-old man with subacute infectious endocarditis (IE) with septic pulmonary embolism, presenting rapidly progressive glomerulonephritis and positive proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA). He had no previous history of heart disease. Renal histology revealed diffuse endocapillary proliferative glomerulonephritis with complement 3- (C3-) dominant staining and subendothelial electron dense deposit, mimicking C3 glomerulonephritis. Successful treatment of IE with valve plastic surgery gradually ameliorated hypocomplementemia and renal failure; thus C3 glomerulonephritis-like lesion in this case was classified as postinfectious glomerulonephritis. IE associated glomerulonephritis is relatively rare, especially in cases with no previous history of valvular disease of the heart like our case. This case also reemphasizes the broad differential diagnosis of renal involvement in IE.

Recreational Physical Activity as an Independent Predictor of Multivariable Cardiovascular Disease Risk

The role of physical activity in preventing CVD has been highlighted by Professor Jerry Morris in the 1950’s. We report outcome of a 15-year prospective study with the aim to identify whether physical activity showed cardiovascular benefit independent of common risk factors and of central obesity. Baseline data of 8662 subjects, with no previous history of heart disease, diabetes or stroke, were obtained from an age- and gender- stratified sample of adults in Australian capital cities and were linked with the National Death Index to determine the causes of death of 610 subjects who had died to 31 December 2004. The study consisted of 4175 males (age 42.3±13.1 years) and 4487 females (age 42.8±13.2 years). Fasting serum lipid levels, systolic and diastolic blood pressure and smoking habits at baseline were recorded. The Framingham Risk Scores of 15-year mortality due to CHD and CVD were calculated using established equations. Subjects were also asked if they engaged in vigorous exercise, less vigorous exercise or walk for recreation and exercise in the past 2 weeks. Subjects in the high recreational physical activity category were 0.16 (0.06–0.43; p<0.001) and 0.12 (0.03–0.48; p = 0.003) times as likely as subjects in the low category for CVD and CHD mortality respectively. After adjusting for both the Framingham Risk Score and central obesity (Waist circumference to Hip circumference Ratio), those in the high recreational physical activity group were 0.35 (0.13–0.98) times less likely compared to the low category for CVD mortality. Recreational physical activity independently predicted reduced cardiovascular mortality over fifteen years. A public health focus on increased physical activity and preventing obesity is required to reduce the risk of CVD and CHD.