P871Coronary artery aneurysms: clinical features, management and long-term outcomes, insights from the international coronary artery aneurysm registry (CAAR)

Background

Coronary Aneurysms are a focal dilatation of an artery segment of >1.5-fold the normal size of adjacent segments. Some limited series suggested an incidence of 0.3–12%. However, coronary aneurysms are not mentioned in practice guidelines and several questions remain unanswered.

Purpose

To investigate its clinical profile, prognostic predictors, and long term outcomes.

Methods

The coronary artery aneurysm registry (CAAR, NCT02563626) is a collaborative effort involving 32 hospitals across 9 countries (Canada, Cuba, Czech Republic, Germany, Italy, Netherlands, Spain, USA and Uruguay). When eligibility was uncertain, cases were reviewed by a core lab.

Results

We reviewed 436,467 consecutive angiographies between 2004–2016. 1,565 patients were ambispectively included. Global incidence was 0.35%. Most were male (78.5%) with a mean age of 65 years. Cardiovascular risk factors were frequent. An aortopathy history was present in 8.7% but a Kawasaki antecedent was unfrequent (0.3%).

The main indication for cath was an ACS in 966 cases. Most aneurysms were saccular and 82 giant. The number of aneurisms was low, mainly with 1–2 (95.8%) and only 3 patients with ≥6, proportionally with more coronary stenosis. The most affected artery was the LAD. Aortopathy was related with higher number of aneurysms. Most received any revascularization, commonly percutaneous (PCI). During a follow-up of 37.2 months, 485 suffered a MACE, (death/heart failure/unstable angina/reinfarction) and 240 died. Age, race, diabetes, renal failure, peripheral disease, acute cath, coronary stenosis, LVEF and anticoagulation remained as predictors of death/MACE after multivariate adjustments, without no major differences comparing CABG vs PCI. No restenosis was found in aneurysm with DES but those with BMS suffered 4 (p=0.002). MACE and death were more frequent in patients who received BMS.

Figure 1

Conclusions

Coronary aneurysmal disease is not uncommon. It is associated with severe coronary stenosis and a high cardiovascular risk burden, pointing out an aggressive atherosclerotic status. Antiplatelet therapy is a reasonable option and interventional procedures safe and effective, compared with surgery. Drug eluting stents should be preferred as the default strategy.

Acknowledgement/Funding

None

Identification of the novel HLA-DRB1 allele, DRB1*14:183, in a Colombian umbilical cord blood bank donor

HLA-DRB1*14:183 has two nucleotide changes from HLA-DRB1-13:44, D to E and F to Y.

Prevalence of honeybee viruses in different regions of China and Argentina

Honeybees are threatened by various pathogens and parasites. More than 18 viruses have been described in honeybees and many of them have been detected in China and Argentina. In China, both Apis cerana and Apis mellifera are raised. In Argentina, beekeepers raise different ecotypes of A. mellifera: European honeybees (in both temperate and subtropical regions) and Africanised honeybees (in subtropical areas only). A thorough study was carried out in both China and Argentina to analyse the current virus presence and distribution in different climatic zones and gather information on different bee species/subspecies. Adult honeybees were collected from apiaries in temperate and subtropical regions of China (including areas with exclusive populations of A. mellifera, areas where A. mellifera and A. cerana co-exist, and areas with exclusive populations of A. cerana) and Argentina. Six viruses, namely, deformed wing virus (DWV), black queen cell virus (BQCV), sacbrood virus (SBV), chronic bee paralysis virus (CBPV), acute bee paralysis virus (ABPV) and Israeli acute paralysis virus (IAPV) were detected in China, both in A. cerana and in A. mellifera, while four viruses (DWV, BQCV, CBPV and ABPV) were present in Argentina. Interestingly, multiple infections were commonly found in China, with up to five different viruses co-circulating in some colonies without apparent abnormalities. In this study, no Chinese samples were positive for slow bee paralysis virus. The most prevalent viruses were BQCV (China) and DWV (Argentina). Kashmir bee virus was absent from samples analysed for both countries.

[Renal cell carcinoma presenting as paraneoplastic neurological dysfunction]

INTRODUCTION

Malignant tumors sometimes initiate as paraneoplastic syndromes even years before the most common symptoms appear. These first manifestations could be the key for the diagnosis of "occult" malignancy.

METHODS

We report the case of a 66 year old man with a renal cell carcinoma. The first symptom was a paraneoplastic cerebellar degeneration appeared 6 years before the first urologic manifestations.

CONCLUSIONS

A progressive cerebellar syndrome could be the first manifestation of a renal cell carcinoma, even years before the first urologic symptoms. We must suspect an occult neoplasia in such patients.

Synthesis and antihypertensive effects of new methylthiomorpholinphenol derivatives

We present in this work the synthesis and cardiovascular effects of new methylthiomorpholine compounds and they were compared with cardiovascular drugs such as captopril, losartan and omapatrilat.

Chronic ethanol intake modifies renin-angiotensin system-regulating aminopeptidase activities in mouse cerebellum

In developing cerebellum, where critical periods of vulnerability have been established for several basic substances, it has been extensively studied the wide array of abnormalities induced by exposure to ethanol (EtOH). However, little is known about the effects of EtOH consumption on cerebellar functions in adult individuals. Several studies show participation in cognitive activities to be concentrated in the lateral cerebellum (hemispheres), whereas basic motor functions such as balance and coordination are represented in the medial parts of the cerebellum (vermis and paravermis). In addition to the circulating renin angiotensin system (RAS), a local system has been postulated in brain. The effector peptides of the RAS are formed via the activity of several aminopeptidases (AP). The present work analyses the effect of chronic EtOH intake on the RAS-regulating AP activities in the soluble and membrane-bound fractions of two cerebellar locations: the hemispheres and the vermis. We hypothesize that cerebellar RAS is involved in basic motor functions rather than in cognitive activities.

[Arteriosclerosis obliterans. Treatment with angiotensin-converting enzyme inhibitors]

We compare the effects of two of the main angiotensin convertase enzyme inhibitors, captopril and enalapril, aiming to evaluate their effects in the arterial circulation performance, micro-circulation, and changes in regional blood flow, assuming their property of lowering the angiotensin II blood levels, a very strong peripheral vasoconstrictor. We studied 22 patients: all of them with hypertension and/or skin ulcerations, dropping out those who had venous. They were evaluated periodically, clinically and with photoelectric plethysmography of lower extremities. To interpret the traces we designed an ideogram which gathered the plethysmographic behavior before and after the treatment. Nearly 80% showed considerable improvement in pain, functional capacity and plethysmographic traces patterns. healing of the ulcerations was achieved in all case. We propose some hypothesis to explain the good effect that we have observed.

[Continuous electrocardiographic recording during a first parachute jump]

The behavior of the cardiac rhythm under intense stress was studied with continuous electrocardiographic recording during the first jump with an automatic parachute in 13 members of the Universidad Nacional Autónoma de México sky diving club. There were 12 male (92.3%) and one female (7.68) with an average age of 22.8 years. A complete clinical history, 12 lead electrocardiogram and a treadmill stress test were performed two weeks before jumping. A two-channel Holter recording system was hooked up 30 min. before boarding the airplane and was turned off one hour later. The heart rate values were compared two weeks prior (64.5 beats/min), before (112.8 beats/min), during (170 beats/min) and after the jump (122.8 beats/min). The mean difference between each phase was statistically significant with p less than 0.001 values. The observed cardiac rhythm was sinus tachycardia in each case. In six cases (43.6%) 22 episodes of sudden decrease of the heart rate were seen and there were no major rhythm or conduction disturbances. The urinary catecholamines were similar in nine cases (69.2%) after the jump (x 51.2 micrograms/100 ml) and two weeks later in four control cases (x 10.3 micrograms/100 ml). We concluded there were no significant rhythm disturbances in the presence of an intense but brief stress condition in young healthy people. This study was classified as longitudinally, descriptive, experimental and projective.

[Chronic cardiac actinomycosis. Case report and review of the literature]

We report the case of a young man in whom a right paracardiac mass was resected. The histopathologic study was compatible with actinomycosis. He developed severe cardiac failure, pulmonary edema and pericardial effusion. He was treated with penicillin, during 12 months. He did well afterwards, however, the echocardiographic follow-up revealed chronic pericardial effusion and thickening and fusion of the pericardium to the epicardial wall.

[Multiple paragangliomas. The problem of its localization. Report of the first case studied with 131I meta-iodobenzylguanidine in our milieu and review of the literature]

We report the case of a young woman, with an 8 year history of paroxysmal episodes of dyspnea, palpitations, blurred vision, tremors, precordial oppression and hypertension; the diagnosis of a chromaffin tumor was established, with an increase in serum and urine catecholamines level. She had three surgical interventions and also the following studies: abdominal and pelvic ultrasound, computed tomography, cavography; selective arteriography, and infusion of the meta iodobenzyl-guanidine 131, which localizes tissues hypersecretors rich in catecholamines.