1241
Prospective validation of the SYNTAX Score II
Investigators FT. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012;367:2375 –2384. 28. Tonelli M, Muntner P, Lloyd A, Manns BJ, Klarenbach S, Pannu N, James MT, Hemmelgarn BR, Alberta Kidney Disease N. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet 2012;380:807–814. 29. Mahmoodi BK, Matsushita K, Woodward M, Blankestijn PJ, Cirillo M, Ohkubo T, Rossing P, Sarnak MJ, Stengel B, Yamagishi K, Yamashita K, Zhang L, Coresh J, de Jong PE, Astor BC, Chronic Kidney Disease Prognosis C. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet 2012;380:1649 –1661. 30. Capodanno D, Capranzano P, La Manna A, Tamburino C. Meta-analysis of everolimus-eluting stents versus first-generation drug-eluting stents in patients with left main coronary artery undergoing percutaneous coronary intervention. Int J Cardiol 2013;168:1718 –1719.
CARDIOVASCULAR FLASHLIGHT
31. Moynagh A, Salvatella N, Harb T, Darremont O, Boudou N, Dumonteil N, Lefevre T, Carrie D, Louvard Y, Leymarie JL, Chevalier B, Morice MC, Garot P. Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries. EuroIntervention 2013;9:452 –462. 32. Farooq V, Serruys PW. Complex coronary artery disease: would outcomes from the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) trial have differed with newer-generation drug-eluting stents? JACC Cardiovasc Interv 2013;6:1023 –1025. 33. Farooq V, Serruys PW, Zhang Y, Mack M, Stahle E, Holmes DR, Feldman T, Morice MC, Colombo A, Bourantas CV, de Vries T, Morel MA, Dawkins KD, Kappetein AP, Mohr FW. Short-term and long-term clinical impact of stent thrombosis and graft occlusion in the SYNTAX trial at 5 years: synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. J Am Coll Cardiol 2013;62:2360–2369.
doi:10.1093/eurheartj/ehv030 Online publish-ahead-of-print 24 February 2015
.............................................................................................................................................................................
A rare cause of cardiogenic shock Corstiaan A. den Uil1,2* and Jelle L. Epker2 1 Department of Cardiology, Erasmus Medical Center, Thoraxcenter, ‘s-Gravendijkwal 230, Room Ba-316, Rotterdam NL-3015 CE, the Netherlands; and 2Department of Intensive Care Medicine, Erasmus Medical Center, ‘s-Gravendijkwal 230, Rotterdam NL-3015 CE, the Netherlands
* Corresponding author. Email: [email protected]
A 49-year-old woman without medical history was admitted following out-of-hospital cardiac arrest. She had complained of chest pain and EKG demonstrated sinus rhythm with ST-elevation in lead AVR and diffuse ST-depression. She than developed ventricular fibrillation, and received CPR and urgent cardiac catheterization. In the laboratory, she was in cardiogenic shock for which inotropes and IABP support were started. Angiography demonstrated normal coronary arteries. Left ventricular enddiastolic pressure was 16 mmHg and there was no gradient between LV and aorta. Left ventricular angiography demonstrated a poor left ventricular function, and aortography was normal. Echocardiography was not informative (TTE: poor windows, TEE impossible due to traumatic tongue swelling). She died 7 h after admission because of refractory shock. Autopsy demonstrated a 2 cm large papillary tumour located on the arterial side of the aortic valve, attached by a pedicle stuck to the left- to noncoronary cusp commissure (Panel A, left main ostium shown at the calliper’s right lower angle). We found no coronary embolic material. Light microscopy of the tumour showed multiple papillary fronds, consisting of a central core of dense and surrounded by a layer of loose connective tissue and covered by endothelial cells, confirming papillary fibro-elastoma (Panel B, ×6.25, H&E). Review of the LV angiogram demonstrated an oscillating structure in the aortic root (Panels C and D, Supplementary material online, Movie, RAO view). Cardiac papillary fibro-elastomas are usually an incidental finding, but may present with thrombo-embolism or, in this case, mechanical obstruction of a (left main) coronary ostium. Timely recognition might prevent poor outcome. EKG, electrocardiogram; CPR, cardiopulmonary resuscitation; IABP, intra-aortic balloon pump, LVEDP, left ventricular end-diastolic pressure; LV, left ventricle; TTE, transthoracic echocardiography; TEE, transoesophageal echocardiography; H&E: haematoxylin & eosin (stain). Supplementary Material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
Prospective validation of the SYNTAX Score II
Investigators FT. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med 2012;367:2375 –2384. 28. Tonelli M, Muntner P, Lloyd A, Manns BJ, Klarenbach S, Pannu N, James MT, Hemmelgarn BR, Alberta Kidney Disease N. Risk of coronary events in people with chronic kidney disease compared with those with diabetes: a population-level cohort study. Lancet 2012;380:807–814. 29. Mahmoodi BK, Matsushita K, Woodward M, Blankestijn PJ, Cirillo M, Ohkubo T, Rossing P, Sarnak MJ, Stengel B, Yamagishi K, Yamashita K, Zhang L, Coresh J, de Jong PE, Astor BC, Chronic Kidney Disease Prognosis C. Associations of kidney disease measures with mortality and end-stage renal disease in individuals with and without hypertension: a meta-analysis. Lancet 2012;380:1649 –1661. 30. Capodanno D, Capranzano P, La Manna A, Tamburino C. Meta-analysis of everolimus-eluting stents versus first-generation drug-eluting stents in patients with left main coronary artery undergoing percutaneous coronary intervention. Int J Cardiol 2013;168:1718 –1719.
CARDIOVASCULAR FLASHLIGHT
31. Moynagh A, Salvatella N, Harb T, Darremont O, Boudou N, Dumonteil N, Lefevre T, Carrie D, Louvard Y, Leymarie JL, Chevalier B, Morice MC, Garot P. Two-year outcomes of everolimus vs. paclitaxel-eluting stent for the treatment of unprotected left main lesions: a propensity score matching comparison of patients included in the French Left Main Taxus (FLM Taxus) and the LEft MAin Xience (LEMAX) registries. EuroIntervention 2013;9:452 –462. 32. Farooq V, Serruys PW. Complex coronary artery disease: would outcomes from the SYNTAX (synergy between percutaneous coronary intervention with taxus and cardiac surgery) trial have differed with newer-generation drug-eluting stents? JACC Cardiovasc Interv 2013;6:1023 –1025. 33. Farooq V, Serruys PW, Zhang Y, Mack M, Stahle E, Holmes DR, Feldman T, Morice MC, Colombo A, Bourantas CV, de Vries T, Morel MA, Dawkins KD, Kappetein AP, Mohr FW. Short-term and long-term clinical impact of stent thrombosis and graft occlusion in the SYNTAX trial at 5 years: synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. J Am Coll Cardiol 2013;62:2360–2369.
doi:10.1093/eurheartj/ehv030 Online publish-ahead-of-print 24 February 2015
.............................................................................................................................................................................
A rare cause of cardiogenic shock Corstiaan A. den Uil1,2* and Jelle L. Epker2 1 Department of Cardiology, Erasmus Medical Center, Thoraxcenter, ‘s-Gravendijkwal 230, Room Ba-316, Rotterdam NL-3015 CE, the Netherlands; and 2Department of Intensive Care Medicine, Erasmus Medical Center, ‘s-Gravendijkwal 230, Rotterdam NL-3015 CE, the Netherlands
* Corresponding author. Email: [email protected]
A 49-year-old woman without medical history was admitted following out-of-hospital cardiac arrest. She had complained of chest pain and EKG demonstrated sinus rhythm with ST-elevation in lead AVR and diffuse ST-depression. She than developed ventricular fibrillation, and received CPR and urgent cardiac catheterization. In the laboratory, she was in cardiogenic shock for which inotropes and IABP support were started. Angiography demonstrated normal coronary arteries. Left ventricular enddiastolic pressure was 16 mmHg and there was no gradient between LV and aorta. Left ventricular angiography demonstrated a poor left ventricular function, and aortography was normal. Echocardiography was not informative (TTE: poor windows, TEE impossible due to traumatic tongue swelling). She died 7 h after admission because of refractory shock. Autopsy demonstrated a 2 cm large papillary tumour located on the arterial side of the aortic valve, attached by a pedicle stuck to the left- to noncoronary cusp commissure (Panel A, left main ostium shown at the calliper’s right lower angle). We found no coronary embolic material. Light microscopy of the tumour showed multiple papillary fronds, consisting of a central core of dense and surrounded by a layer of loose connective tissue and covered by endothelial cells, confirming papillary fibro-elastoma (Panel B, ×6.25, H&E). Review of the LV angiogram demonstrated an oscillating structure in the aortic root (Panels C and D, Supplementary material online, Movie, RAO view). Cardiac papillary fibro-elastomas are usually an incidental finding, but may present with thrombo-embolism or, in this case, mechanical obstruction of a (left main) coronary ostium. Timely recognition might prevent poor outcome. EKG, electrocardiogram; CPR, cardiopulmonary resuscitation; IABP, intra-aortic balloon pump, LVEDP, left ventricular end-diastolic pressure; LV, left ventricle; TTE, transthoracic echocardiography; TEE, transoesophageal echocardiography; H&E: haematoxylin & eosin (stain). Supplementary Material is available at European Heart Journal online. Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2015. For permissions please email: [email protected].
