MedWorm: Cardiology

Spotlight issue on signalling in cardiac metabolism.

Cardiovascular Research — Fri, 04 Jul 2008 10:30:01 +0100

SPOTLIGHT ISSUE ON Signalling in Cardiac Metabolism.

Cardiovasc Res. 2008 Jul 15;79(2):NP

Authors:

PMID: 18593692 [PubMed - in process]

(Source: Cardiovascular Research)

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Announcement: spotlight issue on lipid signalling pathways in the heart and vasculature.

Cardiovascular Research — Fri, 04 Jul 2008 10:29:58 +0100

Announcement: spotlight issue on lipid signalling pathways in the heart and vasculature.

Cardiovasc Res. 2008 Jul 15;79(2):NP

Authors:

PMID: 18593693 [PubMed - in process]

(Source: Cardiovascular Research)

Aims and scope.

Cardiovascular Research — Fri, 04 Jul 2008 10:29:56 +0100

Aims and scope.

Cardiovasc Res. 2008 Jul 15;79(2):NP

Authors:

PMID: 18593694 [PubMed - in process]

(Source: Cardiovascular Research)

Contents page.

Cardiovascular Research — Fri, 04 Jul 2008 10:29:54 +0100

Contents page.

Cardiovasc Res. 2008 Jul 15;79(2):NP

Authors:

PMID: 18593695 [PubMed - in process]

(Source: Cardiovascular Research)

Editorial board.

Cardiovascular Research — Fri, 04 Jul 2008 10:29:50 +0100

Editorial board.

Cardiovasc Res. 2008 Jul 15;79(2):NP

Authors:

PMID: 18593696 [PubMed - in process]

(Source: Cardiovascular Research)

Sibling death not a marker of serious lqts events

MedWire News - Cardiology — Fri, 04 Jul 2008 10:10:06 +0100

Individuals with long QT syndrome are not at increased risk for death or aborted cardiac arrest if they have a sibling who has died, study findings suggest. (Source: MedWire News - Cardiology)

Evaluation and management of the adult patient with transposition of the great arteries following atrial-level (senning or mustard) repair

Medscape Cardiology Headlines — Fri, 04 Jul 2008 02:04:34 +0100

Atrial-level repair of transposition of the great arteries was a significant advance in medicine that offered hope to patients and families when there was none before. However, many patients who received these procedures now have complications, and the current article describes these conditions and their management. Nature Clinical Practice Cardiovascular Medicine (Source: Medscape Cardiology Headlines)

Cardiac benefits with hypertension treatment vary by gender

MedPage Today Cardiovascular — Thu, 03 Jul 2008 23:54:30 +0100

NEW YORK -- In patients receiving treatment for hypertension, women have less improvement in left ventricular hypertrophy than men, a post hoc analysis revealed. (Source: MedPage Today Cardiovascular)

Combo no better than epinephrine alone for cardiac arrest

MedPage Today Cardiovascular — Thu, 03 Jul 2008 19:15:12 +0100

LYON, France -- For outcomes of cardiac arrest patients, epinephrine given alone during advanced life support was just as effective as combining it with vasopressin, a multicenter, randomized trial showed. (Source: MedPage Today Cardiovascular)

Does transfusion with "old" blood place the surgical patient at risk?

Medscape Cardiology Headlines — Thu, 03 Jul 2008 17:42:57 +0100

Commentary on a study on duration of stored transfusion blood and surgical outcomes, published March 20, 2008 in The New England Journal of Medicine Medscape General Surgery (Source: Medscape Cardiology Headlines)

Hyperglycemia and the pathobiology of diabetic complications.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Hyperglycemia and the pathobiology of diabetic complications.

Adv Cardiol. 2008;45:1-16

Authors: Aronson D

Both type I and type II diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke, and peripheral arterial disease. Atherosclerosis accounts for virtually 80% of all deaths among diabetic patients. Prolonged exposure to hyperglycemia is now recognized as a major factor in the pathogenesis of diabetic complications, including atherosclerosis. Hyperglycemia induces a large number of alterations at the cellular level of vascular tissue that potentially accelerates the atherosclerotic process. Animal and human studies have elucidated several major mechanisms that encompass most of the pathological alterations observed in the diabetic vasculture. These include: (1) Nonenzymatic glycosylation of proteins and lipids which can interfere with their normal function by disrupting molecular conformation, alter enzymatic activity, reduce degradative capacity, and interfere with receptor recognition. In addition, glycosylated proteins interact with a specific receptor present on all cells relevant to the atherosclerotic process, including monocyte-derived macrophages, endothelial cells, and smooth muscle cells. The interaction of glycosylated proteins with their receptor results in the induction of oxidative stress and proinflammatory responses. (2) Protein kinase C (PKC) activation with subsequent alteration in growth factor expression. (3) Shunting of excess intracellular glucose into the hexosamine pathway leads to O-linked glycosylation of various enzymes with perturbations in normal enzyme function. (4) Hyperglycemia increases oxidative stress through several pathways. A major mechanism appears to be the overproduction of the superoxide anion (O-2 ) by the mitochondrial electron transport chain. (5) Hyperglycemia promotes inflammation through the induction of cytokine secretion by several cell types including monocytes and adipocytes. Importantly, there appears to be a tight pathogenic link between hyperglycemia-induced oxidant stress and other hyperglycemia-dependent mechanisms of vascular damage described above, namely AGEs formation, PKC activation, and increased flux through the hexosamine pathway. For example, hyperglycemia-induced oxidative stress promotes both the formation of advanced glycosylation end products and PKC activation.

PMID: 18230953 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Endothelial dysfunction in normal and abnormal glucose metabolism.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Endothelial dysfunction in normal and abnormal glucose metabolism.

Adv Cardiol. 2008;45:17-43

Authors: Esper RJ, Vilariño JO, Machado RA, Paragano A

The endothelium is the common target of all cardiovascular risk factors, and functional impairment of the vascular endothelium in response to injury occurs long before the development of visible atherosclerosis. The endothelial cell behaves as a receptor-effector structure which senses different physical or chemical stimuli that occur inside the vessel and, therefore, modifies the vessel shape or releases the necessary products to counteract the effect of the stimulus and maintain homeostasis. The endothelium is capable of producing a large variety of different molecules which act as agonists and antagonists, therefore balancing their effects in opposite directions. When endothelial cells lose their ability to maintain this delicate balance, the conditions are given for the endothelium to be invaded by lipids and leukocytes (monocytes and T lymphocytes). The inflammatory response is incited and fatty streaks appear, the first step in the formation of the atheromatous plaque. If the situation persists, fatty streaks progress and the resultant plaques are exposed to rupture and set the conditions for thrombogenesis and vascular occlusion. Oxidant products are produced as a consequence of normal aerobic metabolism. These molecules are highly reactive with other biological molecules and are referred as reactive oxygen species (ROS). Under normal physiological conditions, ROS production is balanced by an efficient system of antioxidants, molecules that are capable of neutralizing them and thereby preventing oxidant damage. In pathological states, ROS may be present in relative excess. This shift of balance in favor of oxidation, termed 'oxidative stress', may have detrimental effects on cellular and tissue function, and cardiovascular risk factors generate oxidative stress. Both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetic patients have mostly been described under enhanced oxidative stress, and both conditions are known to be powerful and independent risk factors for coronary heart disease, stroke, and peripheral arterial disease. Hyperglycemia causes glycosylation of proteins and phospholipids, thus increasing intracellular oxidative stress. Nonenzymatic reactive products, glucose-derived Schiff base, and Amadori products form chemically reversible early glycosylation products which subsequently rearrange to form more stable products, some of them long-lived proteins (collagen) which continue undergoing complex series of chemical rearrangements to form advanced glycosylation end products (AGEs). Once formed, AGEs are stable and virtually irreversible. AGEs generate ROS with consequent increased vessel oxidative damage and atherogenesis.The impressive correlation between coronary artery disease and alterations in glucose metabolism has raised the hypothesis that atherosclerosis and diabetes may share common antecedents. Large-vessel atherosclerosis can precede the development of diabetes, suggesting that rather than atherosclerosis being a complication of diabetes, both conditions may share genetic and environmental antecedents, a 'common soil'.

PMID: 18230954 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Biomarkers in cardiovascular diabetology: interleukins and matrixins.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Biomarkers in cardiovascular diabetology: interleukins and matrixins.

Adv Cardiol. 2008;45:44-64

Authors: Fisman EZ, Adler Y, Tenenbaum A

The impressive correlation between cardiovascular disease and alterations in glucose metabolism has raised the likelihood that atherosclerosis and type 2 diabetes may share common antecedents. Inflammation is emerging as a conceivable etiologic mechanism for both. Interleukins are regulatory proteins with ability to accelerate or inhibit inflammatory processes, and matrixins are prepro enzymes responsible for the timely breakdown of extracellular matrix. Interleukins (ILs) are classified based on their role in diabetes and atherosclerosis, hypothesizing that each interleukin acts on both diseases in the same direction - regardless if harmful, favorable or neutral. They are clustered into three groups: noxious (the 'bad', 8 members), comprising IL-1, IL-2, IL-6, IL-7, IL-8, IL-15, IL-17 and IL-18; protective (the 'good', 5 members), comprising IL-4, IL-10, IL-11, IL-12 and IL-13; and 'aloof' , comprising IL-5, IL-9, IL-14, IL-16 and IL-19 through IL-29 (15 members). Each group presented converging effects on both diseases. IL-3 was reluctant to clustering and IL-30 through 33 were not included due to the scarce available data. It may be seen that (1) favorable effects of a given interleukin on either diabetes or atherosclerosis predicts similar effects on the other; (2) equally, harmful interleukin effects on one disease can be extrapolated to the other, and (3) absence of influence of a given interleukin on one of these diseases forecasts lack of effects on the other. Matrixins seem to present a similar pathophysiological pattern. These facts further support the unifying etiologic theory of diabetes and heart disease, emphasizing the importance of a cardiovascular diabetologic approach to these cytokines for future research. A pharmacologic simultaneous targeting of interleukins and matrixins might provide an effective means to concurrently control both atherosclerosis and diabetes.

PMID: 18230955 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Arterial elasticity in cardiovascular disease: focus on hypertension, metabolic syndrome and diabetes.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Arterial elasticity in cardiovascular disease: focus on hypertension, metabolic syndrome and diabetes.

Adv Cardiol. 2008;45:65-81

Authors: Cernes R, Zimlichman R, Shargorodsky M

Arterial stiffness is an independent risk factor for premature cardiovascular morbidity and mortality that can be evaluated by noninvasive methods and can be reduced by good clinical management. The present chapter examines the association between arterial stiffness and cardiovascular risk factors including hypertension, metabolic syndrome, diabetes, advanced renal failure, hypercholesterolemia and obesity. The mechanisms responsible for the structural and functional modifications of the arterial wall are also described. We deal with parameters related to arterial compliance, focusing on two of them, pulse wave velocity and the augmentation index, useful in rapid assessment of arterial compliance by the bedside. Data that highlight the role of aortic pulse wave velocity and the augmentation index as independent factors in predicting fatal and nonfatal cardiovascular events in different populations are briefly presented. A number of lifestyle changes and traditional antihypertensive agents that improve arterial compliance are finally discussed. Novel therapies, such as statins, thiazolidindinediones, phosphodiesterase inhibitors and inhibitors or breakers of advanced glycation end product cross-links between colagen and elastin hold substantial promise.

PMID: 18230956 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Hypertension and diabetes.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Hypertension and diabetes.

Adv Cardiol. 2008;45:82-106

Authors: Grossman E, Messerli FH

Both essential hypertension and diabetes mellitus affect the same major target organs. The common denominator of hypertensive/diabetic target organ-disease is the vascular tree. Left ventricular hypertrophy and coronary artery disease are much more common in diabetic hypertensive patients than in patients suffering from hypertension or diabetes alone. The combined presence of hypertension and diabetes concomitantly accelerates the decrease in renal function, the development of diabetic retinopathy and the development of cerebral diseases. Lowering blood pressure to less than 130/80 mm Hg is the primary goal in the management of the hypertensive diabetic patients. Beta-blockers have been reported to adversely affect the overall risk factor profile in the diabetic patient. In contrast, calcium antagonists, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been reported to be either neutral or beneficial with regard to the overall metabolic risk factor profile. Combination therapy is usually required to achieve blood pressure goal in diabetic patients. The addition of aldosterone antagonists may be beneficial in patients with resistant hypertension and low levels of serum potassium. Aggressive control of blood pressure, cholesterol and glucose levels should be attempted to reduce the cardiovascular risk of diabetic hypertensive patients.

PMID: 18230957 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Impaired glucose metabolism and cerebrovascular diseases.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Impaired glucose metabolism and cerebrovascular diseases.

Adv Cardiol. 2008;45:107-13

Authors: Tanne D

Ischemic stroke and vascular cognitive impairment are leading causes of long-term disability and constitute a major public health burden and a significant economic burden to health systems. An increasing body of evidence demonstrates that disorders of glucose metabolism including diabetes, and the intermediate states of impaired fasting glucose and impaired glucose tolerance, as well as the cluster of risk factors known as the metabolic syndrome, are important risk factors for ischemic stroke. The associations with accelerated cognitive decline and dementia are also discussed. Underlying pathogenetic mechanisms are myriad but include insulin resistance, endothelial dysfunction, dyslipidemia, chronic inflammation, procoagulability, and impaired fibrinolysis. The high risk associated with diabetes and other disorders of glucose metabolism carries important implications for preventive strategies for cerebrovascular disease and vascular cognitive impairment that are currently under investigation.

PMID: 18230958 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Impact of metabolic syndrome in patients with acute coronary syndrome.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Impact of metabolic syndrome in patients with acute coronary syndrome.

Adv Cardiol. 2008;45:114-26

Authors: Feinberg MS, Schwartz R, Behar S

The reported incidence of metabolic syndrome among patients with an acute coronary syndrome varies between 29 and 46%. The standard fasting cut-off levels for glucose and blood pressure cannot be applied on admission in patients with acute coronary syndrome and therefore modified criteria were used to define the metabolic syndrome. Patients with metabolic syndrome and acute coronary syndrome had increased incidence of heart failure, and worse long-term mortality compared to those without metabolic syndrome. However, they had less heart failure than those with known diabetes mellitus. Hyperglycemia as a risk factor for poor outcome is particularly significant in patients with metabolic syndrome. De novo identification of the metabolic syndrome on admission has the potential to improve risk stratification and management of patients with an acute coronary syndrome.

PMID: 18230959 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Optimal management of combined dyslipidemia: what have we behind statins monotherapy?

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Optimal management of combined dyslipidemia: what have we behind statins monotherapy?

Adv Cardiol. 2008;45:127-53

Authors: Tenenbaum A, Fisman EZ, Motro M, Adler Y

Evidence of the effectiveness of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) within continuum of atherothrombotic conditions and particularly in the treatment and prevention of coronary heart disease (CHD) is well established. Large-scale, randomized, prospective trials involving patients with CHD have shown that statins reduce the clinical consequences of atherosclerosis, including cardiovascular deaths, nonfatal myocardial infarction and stroke, hospitalization for acute coronary syndrome and heart failure, as well as the need for coronary revascularization. Direct testing of varying degrees of low-density lipoprotein (LDL)- cholesterol lowering has now been carried out in 4 large outcomes trials: PROVE IT-TIMI 22, A to Z, TNT and IDEAL. However, the question whether more aggressive LDL-cholesterol lowering by high-dose statins monotherapy is an appropriate strategy is still open: higher doses of statins are more effective mainly for the prevention of the nonfatal cardiovascular events but such doses are associated with an increase in hepatotoxicity, myopathy and concerns regarding noncardiovascular death. Moreover, despite the increasing use of statins, a significant number of coronary events still occur and many such events take place in patients presenting with type 2 diabetes and metabolic syndrome. More and more attention is now being paid to combined atherogenic dyslipidemia which typically presented in patients with type 2 diabetes and metabolic syndrome. This mixed dyslipidemia (or 'lipid quartet') - hypertriglyceridemia, low high-density lipoprotein (HDL)-cholesterol levels, a preponderance of small, dense LDL particles and an accumulation of cholesterol-rich remnant particles - emerged as the greatest 'competitor' of LDL-cholesterol among lipid risk factors for cardiovascular disease. Most recent extensions of the fibrates trials (BIP, HHS, VAHIT and FIELD) give further support to the hypothesis that patients with insulin-resistant syndromes such as diabetes and/or metabolic syndrome might be the ones to derive the most benefit from therapy with fibrates. However, different fibrates may have a somewhat different spectrum of effects. Other lipid-modifying strategies included using of niacin, ezetimibe, bile acid sequestrants, CETP inhibitors and omega-3 fatty acids. Particularly, ezetimibe/statins combinations provide superior lipid-modifying benefits compared Tenenbaum/Fisman/Motro/Adler 128 with any statins monotherapy in patients with atherogenic dyslipidemia. Atherogenic dyslipidemia is associated with increased levels of chylomicrons and their remnants containing 3 main components: apolipoprotein B-48, triglycerides and cholesterol ester of intestinal origin. Reduction in accessibility for one of them (specifically cholesteryl ester lessening due to ezetimibe administration) could lead to a decrease of the entire production of chylomicrons and result in a decrease of the hepatic body triglycerides pool as confirmed in number of clinical studies. However, the ENHANCE study showed no difference in the progression of carotid atherosclerosis between ezetimibe/simvastatin vs. simvastatin alone over a 2-year period. Conclusions regarding ezetimibe/statins combinations should not be made until the three large clinical outcome trials will be completed within the next 2-3 years. In addition, bezafibrate as a pan-PPAR activator has clearly demonstrated beneficial pleiotropic effects related to glucose metabolism, insulin sensitivity and pancreatic beta cell protection. Because fibrates, niacin, ezetimibe, omega-3 fatty acids and statins each regulate serum lipids by different mechanisms, combination therapy - selected on the basis of their safety and effectiveness, could be more helpful in achieving a comprehensive lipid control as compared with statins monotherapy.

PMID: 18230960 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Non-insulin antidiabetic therapy in cardiac patients: current problems and future prospects.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Non-insulin antidiabetic therapy in cardiac patients: current problems and future prospects.

Adv Cardiol. 2008;45:154-70

Authors: Fisman EZ, Motro M, Tenenbaum A

Five types of oral antihyperglycemic drugs are currently approved for the treatment of diabetes: biguanides, sulfonylureas, meglitinides, glitazones and alpha-glucosidase inhibitors. We briefly review the cardiovascular effects of the most commonly used antidiabetic drugs in these groups in an attempt to improve knowledge and awareness regarding their influences and potential risks when treating patients with coronary artery disease (CAD). Regarding biguanides, gastrointestinal disturbances such as diarrhea are frequent, and the intestinal absorption of group B vitamins and folate is impaired during chronic therapy. This deficiency may lead to increased plasma homocysteine levels which, in turn, accelerate the progression of vascular disease due to adverse effects on platelets, clotting factors, and endothelium. The existence of a graded association between homocysteine levels and overall mortality in patients with CAD is well established. In addition, metformin may lead to lethal lactic acidosis, especially in patients with clinical conditions that predispose to this complication, such as heart failure or recent myocardial infarction. Sulfonylureas avoid ischemic preconditioning. During myocardial ischemia, they may prevent opening of the ATP-dependent potassium channels, impeding the necessary hyperpolarization that protects the cell by blocking calcium influx. Meglitinides may exert similar effects due to their analogous mechanism of action. During treatment with glitazones, edema has been reported in 5% of patients, and these drugs are contraindicated in diabetics with NYHA class III or IV cardiac status. The long-term effects of alpha-glucosidase inhibitors on morbidity and mortality rates and on diabetic micro- and macrovascular complications is still unknown. Combined sulfonylurea/metformin therapy reveals additive effects on mortality. Four points should be mentioned: (1) the five oral antidiabetic drug groups present proven or potential cardiac hazards; (2) these hazards are not mere 'side effects' but are deeply rooted in the drugs' mechanisms of action; (3) current data indicate that combined glibenclamide/metformin therapy seems to present a special risk and should be avoided in the long-term management of type 2 diabetics with proven CAD, and (4) Non-Insulin Antidiabetic Therapy in Diabetic Cardiac Patients 155 customized antihyperglycemic pharmacological approaches should be investigated for the optimal treatment of diabetic patients with heart disease. New possibilities are represented by incretin mimetic compounds, dipeptidyl peptidase (DPP)-4 inhibitors, inhaled insulin and eventually oral insulin.

PMID: 18230961 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Cardiovascular diabetology: clinical, metabolic and inflammatory facets. preface.

Advances in Cardiology — Thu, 03 Jul 2008 17:03:46 +0100

Cardiovascular diabetology: clinical, metabolic and inflammatory facets. Preface.

Adv Cardiol. 2008;45:xi-xiii

Authors: Fisman EZ, Tenenbaum A

PMID: 18409234 [PubMed - indexed for MEDLINE]

(Source: Advances in Cardiology)

Arrhythmic acute coronary syndrome and anomalous left main stem artery: culprit or innocent bystander.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Arrhythmic acute coronary syndrome and anomalous left main stem artery: culprit or innocent bystander.

Acute Card Care. 2008;10(1):60-1

Authors: Crean AM, Kilcullen N, Younger JF

PMID: 17851975 [PubMed - in process]

(Source: Acute Cardiac Care)

High prevalence of gastroesophageal reflux in patients with clinical unstable angina and known coronary artery disease.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

High prevalence of gastroesophageal reflux in patients with clinical unstable angina and known coronary artery disease.

Acute Card Care. 2008;10(1):37-42

Authors: Schultz T, Mannheimer C, Dellborg M, Pilhall M, Börjesson M

OBJECTIVES: Esophageal disease may mimic acute anginal pain. However, the prevalence of gastroesophageal reflux in the acute setting of patients with clinically unstable angina (UA) pectoris is not known. The aim of this study was to determine the co-existence of coronary artery disease (CAD) and gastroesophageal reflux in UA, and to study the feasibility of esophageal investigation in the chest pain unit. DESIGN: 22 patients with clinical UA and confirmed CAD were monitored by continuous vector cardiography and pH-measurement during 24 h of observation. Symptoms of chest pain and episodes of ischemia and reflux were recorded. RESULTS: 11 patients (50%) showed abnormal gastroesophageal reflux and another three (14%) had an increased number of reflux episodes. pH-measurements and esophageal manometry were well tolerated. Few chest pain episodes were recorded during the study period, and no association between chest pain, reflux, and ischemia could be shown. CONCLUSION: Esophageal reflux is common in patients with UA and established CAD. As reflux-related chest pain may imitate angina pectoris, it is clinically important that gastroesophageal examination in patients with UA seems to be feasible and well tolerated in the 'acute setting'.

PMID: 17851977 [PubMed - in process]

(Source: Acute Cardiac Care)

Timi risk score underestimates prognosis in unstable angina/non-st segment elevation myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

TIMI risk score underestimates prognosis in unstable angina/non-ST segment elevation myocardial infarction.

Acute Card Care. 2008;10(1):26-9

Authors: Vorlat A, Claeys MJ, De Raedt H, Gevaert S, Vandekerckhove Y, Dubois P, De Meester A, Vrints C

OBJECTIVES: To determine the value of the TIMI risk score in the individual risk stratification of patients with unstable angina/non-ST segment elevation myocardial infarction (UA/NSTEMI). BACKGROUND: TIMI risk score is a validated tool to identify groups of patients at high risk for major cardiac events. Its prognostic value in individual patients with current diagnostic tools and therapy is unknown. METHODS: TIMI risk score was assessed in patients with UA/NSTEMI admitted to six Belgian hospitals and related to clinical outcome at 30 days. RESULTS: Of the 500 patients enrolled, 49.4% were placed in the low TIMI risk group (score = 0-3) and 50.6% in the high-risk group (score = 4-7). Multivariate analysis identified raised cardiac markers and invasive strategy, but not high TIMI risk score as independent predictors of death and new myocardial infarction (MI). Moreover, the incidence of death and MI in the low TIMI risk group with positive cardiac markers was not lower than in the high TIMI risk group with positive markers: 15.1% versus 17.8% (P = 0.7). CONCLUSIONS: TIMI risk score is of limited value for individual risk stratification. The presence of positive cardiac markers (troponin) appears to be a more powerful prognostic marker.

PMID: 17924227 [PubMed - in process]

(Source: Acute Cardiac Care)

In-hospital arrhythmias in patients with acute myocardial infarction - the relation to the reperfusion strategy and their prognostic impact.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

In-hospital arrhythmias in patients with acute myocardial infarction - the relation to the reperfusion strategy and their prognostic impact.

Acute Card Care. 2008;10(1):15-25

Authors: Osmancik PP, Stros P, Herman D

Arrhythmias are frequent complication in patients with acute myocardial infarction (MI). The importance of accelerated idioventricular rhythm (AIVR), ventricular fibrillation or tachycardia (VF, VT), atrial fibrillation or flutter (AF) and bradycardias is considered and discussed in this review article. The value of the presence of AIVR as a marker of reperfusion is small, but in combination with other non-invasive markers (ST-segment resolution), its presence is connected with a high probability of successful reperfusion. Early ventricular arrhythmias are a serious complication of MI. However, if they are revealed and treated in time, they apparently do not represent a negative prognostic factor. Later occurred VF or VT are more a symptom of larger MI. AF, which is not directly life-threatening for the patients, frequently occurs in patients with larger MI and it is an independent predictor of a poor long-term prognosis of these patients. The early and successful reperfusion therapy is the best anti-arrhythmic therapeutic method in patients with MI.

PMID: 17924228 [PubMed - in process]

(Source: Acute Cardiac Care)

Early and sustained haemodynamic improvement with levosimendan compared to intraaortic balloon counterpulsation (iabp) in cardiogenic shock complicating acute myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Early and sustained haemodynamic improvement with levosimendan compared to intraaortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction.

Acute Card Care. 2008;10(1):49-57

Authors: Christoph A, Prondzinsky R, Russ M, Janusch M, Schlitt A, Lemm H, Reith S, Werdan K, Buerke M

OBJECTIVE: To investigate the haemodynamic effects of levosimendan in patients with cardiogenic shock (CS) complicating acute myocardial infarction in comparison to the effects of intra-aortic balloon counterpulsation (IABP). METHODS: 10 patients with intractable CS under standard therapy (including the use of PCI, inotropes, and vasopressors) received i.v. infusion of levosimendan (bolus 12 microg/kg i.v., followed by continuous infusion 0.1 microg/kg/min for 24 h). Haemodynamic effects were compared to the effects of IABP-placement added to standard care in 12 patients with CS. RESULTS: Within 24 h, both levosimendan and IABP produced a significant increase in cardiac index (CI) and cardiac power index and a decrease in systemic vascular resistance (SVR) (CI [l/min/m2] baseline 1.97+/-0.15, at 24 h 2.82+/-0.22 for levosimendan; baseline 1.98+/-0.17, at 24 h 2.66+/-0.08 for IABP; SVR [dyn*s*cm-5] baseline 1353+/-106, at 24 h 846+/-69 for levosimendan; baseline 1311+/-214, at 24 h 853+/-63 for IABP, respectively). After 3 h of treatment, CI and SVR had significantly improved in patients treated with levosimendan but not in the IABP-group (CI [l/min/m2] at 3 h 2.72+/-0.28 (+38%) for levosimendan versus 2.18+/-0.15 (+10%) for IABP). CONCLUSION: Infusion of levosimendan in acute CS results in early and sustained haemodynamic improvement. Short-term haemodynamic effects compare favourably with those seen after invasive IABP placement.

PMID: 17924229 [PubMed - in process]

(Source: Acute Cardiac Care)

Procalcitonin in acute myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Procalcitonin in acute myocardial infarction.

Acute Card Care. 2008;10(1):30-6

Authors: Kafkas N, Venetsanou K, Patsilinakos S, Voudris V, Antonatos D, Kelesidis K, Baltopoulos G, Maniatis P, Cokkinos DV

OBJECTIVE: Procalcitonin (PCT) is released in severe bacterial infections, sepsis and in infection independent cases such as major surgery, multiple trauma, cardiogenic shock, burns, resuscitation, and after cardiac surgery. The aim of this study was to determine the levels and the kinetics of PCT in AMI and to investigate their possible correlation with the release of IL-6 and CRP. DESIGN-PATIENTS: The study included 60 patients (47 men, 63.2+/-14.8 years) with the diagnosis of AMI at admission. In all patients, serum levels of PCT, IL-6, CK-MB, TnI and CRP were measured at admission, at 3, 6, 12, 24, 48 and 72 h and at the seventh day. RESULTS: PCT was elevated in all patients with AMI. It was initially detected in serum approximately 2-3 h after the onset of the symptoms. The median value at admission was 1.3 ng/ml (95% CI: 0.89 to 1.80). The value of PCT showed an increase and reached a plateau after 12-24 h. The median value at 24 h was 3.57 ng/ml (95% CI: 2.89 to 4.55). PCT values fell to baseline (<0.5 ng/ml) by the seventh day. PCT was detected in serum earlier than CK-MB or TnI in 56 of the 60 patients (93.3%). The kinetics of PCT was similar to those of CK-MB and TnI. The maximal values of PCT were positively correlated with the maximal values of IL-6 (r = 0.59, P = 0.00) and of CRP (r = 0.65, P = 0.001). The maximal values of IL-6 were positively correlated with max CRP (r = 0.35, P = 0.045). CONCLUSIONS: PCT could be considered as a novel sensitive myocardial index. Its release in AMI is probably due to the inflammatory process that occurs during AMI.

PMID: 17924232 [PubMed - in process]

(Source: Acute Cardiac Care)

Clopidogrel in addition to aspirin reduces one-year major adverse cardiac and cerebrovascular events in unselected patients with non-st segment elevation myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Clopidogrel in addition to aspirin reduces one-year major adverse cardiac and cerebrovascular events in unselected patients with non-ST segment elevation myocardial infarction.

Acute Card Care. 2008;10(1):43-8

Authors: Zeymer U, Gitt AK, Zahn R, Jünger C, Bauer T, Köth O, Heer T, Wienbergen H, Gottwik M, Senges J

OBJECTIVES: We sought to assess the effect of clopidogrel on one-year ischemic events in unselected patients with NSTEMI. METHODS: We analysed data of consecutive patients with acute NSTEMI treated with aspirin or aspirin plus clopidogrel, who were prospectively enrolled in the ACOS registry. RESULTS: A total of 4290 patients were included, 2171 were treated with aspirin and 2119 with aspirin plus clopidogrel. In the univariate analysis in-hospital (13.7% versus 6.3%, P<0.001) and one-year (28.1% versus 15.6 %, P<0.001) mortality and the combined endpoint of death, non-fatal myocardial infarction and non-fatal stroke was significantly lower in the clopidogrel group. There was a significant increase in in-hospital bleeding complications with clopidogrel (5.4 % versus 3.3 %, P<0.05). In the multivariable propensity score analysis adjusted for baseline variables the odds ratio for the one-year combined endpoint was significantly reduced (odds ratio 0.69, 95% CI: 0.64-0.74) in the aspirin plus clopidogrel group. CONCLUSION: In clinical practice, early therapy with clopidogrel, in addition, to aspirin in patients with NSTEMI is associated with a significant reduction of the combined endpoint of death, non-fatal reinfarction and non-fatal stroke after one year. This advantage was associated with an increase in major in-hospital bleeding complications.

PMID: 17924233 [PubMed - in process]

(Source: Acute Cardiac Care)

Beneficial effect of post-procedural abciximab in patients undergoing primary coronary angioplasty and presenting with the no-reflow phenomenon.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Beneficial effect of post-procedural abciximab in patients undergoing primary coronary angioplasty and presenting with the no-reflow phenomenon.

Acute Card Care. 2008;10(2):100-3

Authors: Picchi A, Zaca V, Focardi M, Fineschi M, Sinicropi G, Casini S, Buti A, Pierli C, Mondillo S, Marzilli M

We sought to investigate the effect of post-procedural abciximab on clinical outcome of patients presenting the no-reflow phenomenon after primary angioplasty. We retrospectively selected 38 patients who developed the no-reflow phenomenon after primary angioplasty: 18 received post-procedural abciximab, 20 age- and sex-matched patients who did not receive abciximab were considered as concurrent controls. At 6 months follow-up, the clinical course was uneventful in the abciximab group while the composite end-point of major adverse cardiac events occurred in 8 patients (40%) in the control group (P=0.009). 'Rescue' administration of abciximab is an effective option for the treatment of the no-reflow phenomenon determining significant prognostic improvements.

PMID: 17926148 [PubMed - in process]

(Source: Acute Cardiac Care)

Acute coronary syndrome revisited - markers, interventions and complications.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Acute coronary syndrome revisited - markers, interventions and complications.

Acute Card Care. 2008;10(1):3-4

Authors: Beyar R

PMID: 18449812 [PubMed - in process]

(Source: Acute Cardiac Care)

Management of 'no-reflow' complicating reperfusion therapy.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Management of 'no-reflow' complicating reperfusion therapy.

Acute Card Care. 2008;10(1):5-14

Authors: Lee KW, Norell MS

No-reflow phenomenon, defined as inadequate myocardial perfusion of the adequately dilated target vessel without evidence of angiographic mechanical obstruction. It is a multifactorial, well-recognised, secondary phenomenon following reperfusion therapy such as thrombolysis or percutaneous coronary interventions (PCI). The pathophysiological mechanisms leading to the no-reflow state are incompletely understood. Embolization of the atheromatous material to the distal vasculature and intense arteriole vasospasm caused by microembolization of platelet-rich thrombi that release vasoactive agents resulting in microvascular obstructions are likely mechanisms. Current prophylaxis and management strategies are derived from limited clinical data. Intracoronary verapamil, adenosine and nitroprusside have been most frequently studied and administered for angiographic no-reflow during PCI for acute myocardial infarction or saphenous vein graft (SVG) lesions and have been shown to improve epicardial flow and microvascular perfusion. The use of distal embolic protection devices in SVG interventions also provide microvascular protection and improve clinical outcomes. However, by far the most important measures are prevention and anticipation during PCI as once no-reflow established, complete reversal of the situation may not be possible.

PMID: 18449813 [PubMed - in process]

(Source: Acute Cardiac Care)

Catheter induced aortocoronary dissection.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Catheter induced aortocoronary dissection.

Acute Card Care. 2008;10(1):58-9

Authors: Rao GK, Ayyanthan A, Davis G

Catheter induced coronary dissection is an uncommon and possibly an underreported complication. We report patient with dissection of left main coronary artery, extending into the ascending aorta following diagnostic angiography and discuss the possible mechanisms.

PMID: 18449814 [PubMed - in process]

(Source: Acute Cardiac Care)

Antiplatelet effects of licking an aspirin tablet can be detected by thrombelastography.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Antiplatelet effects of licking an aspirin tablet can be detected by thrombelastography.

Acute Card Care. 2008;10(1):62-3

Authors: Hobson AR, Dawkins KD, Curzen NP

Aspirin is a cornerstone of treatment in cardiovascular disease. However, individual responses vary and hyporesponsiveness has been associated with poor outcomes following percutaneous intervention. Point of care assays for detecting the effects of aspirin in individual patients would therefore be useful. Thrombelastography has been shown to correlate with optical aggregation in the assessment of antiplatelet therapies and is suitable for use as a point of care assay. We demonstrate the ability of thrombelastography to detect the profound effects of even the tiny doses of aspirin obtained by licking an aspirin tablet.

PMID: 18449815 [PubMed - in process]

(Source: Acute Cardiac Care)

Acute cardiac care - flow, function and beyond.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Acute cardiac care - flow, function and beyond.

Acute Card Care. 2008;10(2):67-8

Authors: Beyar R

PMID: 18568568 [PubMed - in process]

(Source: Acute Cardiac Care)

Loss of systemic endothelial function post-pci.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Loss of systemic endothelial function post-PCI.

Acute Card Care. 2008;10(2):79-87

Authors: Han B, Ghanim D, Peleg A, Uretzky G, Hasin Y

To investigate loss of systemic endothelial function post-PCI and evaluate the putative therapeutic effect of BNP. Loss of endothelial function (LEF) post-PCI may contribute to both acute and long-term complications. A protective effect of BNP on endothelium was suggested previously. Flow-mediated vasodilation (FMD) of the brachial artery, as well as plasma levels of endothelin, BNP, Pro BNP and corin were measured before and following routine PCI. 49 patients with normal baseline endothelial function were recruited. 30 patients developed LEF and were randomized to i.v. nesiritide (the commercially available recombinant form of human BNP) or saline infusion for 3 h. Patients who developed LEF post-PCI had reduced baseline plasma corin levels and their BNP/ProBNP ratio was reduced after the procedure. Nesiritide infusion significantly improved FMD both immediately (Nesiritide versus saline: 2.87+/-0.78% versus 0.51+/-0.25%, P=0.007) and 24 h after the treatment (2.52+/-0.69% versus 0.72+/-0.32%, P=0.025). The elevated plasma ET-1 was reduced by Nesiritide (0.38+/-0.11 fmol/ml 24 h post-PCI versus 0.16+/-0.02 fmol/ml 24 h post BNP, P=0.047), but remained unchanged in saline group (0.39+/-0.21 fmol/ml versus 0.42+/-0.23 fmol/ml, P=0.749). Systemic LEF post-PCI is a frequent event. It may be related to impaired cleavage of ProBNP to BNP. Short-term i.v. nesiritide improves systemic LEF post-PCI.

PMID: 18568569 [PubMed - in process]

(Source: Acute Cardiac Care)

Immediate procedural and long-term clinical outcomes following drug-eluting stent implantation to ostial saphenous vein graft lesions.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Immediate procedural and long-term clinical outcomes following drug-eluting stent implantation to ostial saphenous vein graft lesions.

Acute Card Care. 2008;10(2):88-92

Authors: Kaplan S, Barlis P, Kiris A, Dimopoulos K, Celik S, Di Mario C

Background: Ostial saphenous vein graft (OSVG) lesions were excluded from all the clinical trials demonstrating significantly lower restenosis rates with drug-eluting stents (DES) compared to bare metal stents (BMS). This study aimed to evaluate the efficacy of DES in OSVG lesions by assessing angiographic and 12-month clinical outcomes. Methods: 70 consecutive patients (70 OSVG lesions) underwent coronary stent implantation between May 2003 and April 2006: 37 lesions received DES and 33 lesions BMS. Endpoints were all cause and cardiovascular mortality, myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), examined separately and as a combined end-point (major adverse cardiac events, MACE). Results: Procedural (94.6% for DES and 87.9% for BMS) and angiographic (100% for DES and 100% for BMS) success did not differ between the two groups. The only in-hospital events were non-Q wave MI (DES 8.1% versus BMS 12.1%, P=0.69). At 30-day follow-up, there were no other events. Overall, at 1-year follow-up, the BMS group had a higher TLR (30.3% versus 5.4%, P=0.015), TVR (33.3% versus 10.8%, P=0.045) and MACE rate (36.4% versus 10.8%, P=0.024) compared to the DES group. Conclusions: Drug-eluting stent implantation to OSVG lesions achieves better clinical results than BMS but is still associated with a relatively high incidence (10.8%) of revascularization at 1-year follow-up.

PMID: 18568570 [PubMed - in process]

(Source: Acute Cardiac Care)

Impact of abciximab on coronary restenosis in diabetic patients undergoing elective paclitaxel-eluting stent implantation. a prospective, randomized, placebo-controlled study.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Impact of abciximab on coronary restenosis in diabetic patients undergoing elective paclitaxel-eluting stent implantation. A prospective, randomized, placebo-controlled study.

Acute Card Care. 2008;10(2):93-9

Authors: De Luca L, Sardella G, De Persio G, Petrolini A, Fedele F

AIMS: Recent studies suggested that abciximab reduces the risk of restenosis in diabetic patients receiving coronary bare metal stent. We sought to evaluate whether abciximab may reduce in-segment late luminal loss (LLL), in patients with diabetes mellitus undergoing elective drug-eluting stents (PES) implantation. METHODS and RESULTS: We conducted a prospective, randomized, double-blind study on diabetic patients after a paclitaxel-eluting stent (PES) implantation on de novo coronary artery lesions. 132 consecutive patients with diabetes (mean age 63.1+/-7.4 years, 82 males) were randomized to abciximab (n=66) or placebo (n=66). Among the 124 (93.9%) patients who underwent a 6-months angiographic follow-up, the mean difference in in-segment LLL between patients who received abciximab and placebo was 0.02 mm (P=0.8). In addition, the rates of angiographic in-segment restenosis were comparable between the two groups (14.3 versus 9.8%, P=0.5). Cumulative rates of clinical events did not differ (death: 1.5 versus 1.5, P=0.9 and MI: 1.5 versus 3%, P=0.8) between abciximab and placebo group, respectively. Similarly, the incidence of target lesion revascularization was 9.1% and 6.1% (P=0.7) at six months, in the two groups. CONCLUSIONS: Abciximab does not seem to have any impact on the extent of in-segment LLL in diabetic patients undergoing an elective PES implantation.

PMID: 18568571 [PubMed - in process]

(Source: Acute Cardiac Care)

Impact of vessel size, lesion length and diabetes mellitus on angiographic restenosis outcomes: insights from the nirtop study.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Impact of vessel size, lesion length and diabetes mellitus on angiographic restenosis outcomes: Insights from the NIRTOP study.

Acute Card Care. 2008;10(2):104-10

Authors: Kornowski R, Fort S, Almagor Y, Silber S, Lewis BS

Background: The primary objective of the current analysis was to define the impact of vessel size, lesion length, and diabetes on clinical and angiographic restenosis following implantation of the NIRFLEX stent. Methods and results: Clinical and angiographic restenosis outcomes and multivariate predictors were compared between patients treated in 'small' (<3 mm, n=113 pts/133 lesions) versus 'large' (>/=3 mm, n=41 pts/53 lesions) vessels; between 'tubular' (10-20 mm lesion length n=49 pts/51 lesions) versus 'discrete' (<10 mm lesion length n=103 pts/133 lesions) lesions; and between 'diabetic' (n=30/35 lesions) versus 'non-diabetic' (n=128/156 lesions) patients using the flexible closed-cell design 'bare-metal' NIRFLEX stent in patients with native coronary artery disease. At six month follow-up, target vessel revascularization (TVR) and target lesion revascularization (TLR) rates were significantly less frequent in the 'large' versus 'small' vessel group (2.4% versus 16.8% for TVR, P=0.016, 0% versus 12.4% for TLR, P=0.022). Likewise, angiographic late loss was lower in 'large' versus 'small' vessels (0.54 versus 0.70 mm, P=0.05). Lesion length affected MACE rates but not angiographic restenosis. Angiographic late loss was greater in diabetics compared to the non-diabetic group (0.89 versus 0.60 mm, P=0.003). Using a multivariate model, diabetes mellitus (odds ratio=2.65, P=0.047) and post-procedure in-stent MLD (mm) (odds ratio=0.178, P=0.0019) were major determinants of restenosis. Conclusion: Clinical and angiographic restenosis outcomes following NIRFLEX stent implantation were dependent upon vessel size, lesions length, post-procedural stent lumen dimensions, and the diabetic status.

PMID: 18568572 [PubMed - in process]

(Source: Acute Cardiac Care)

First use of a novel plug-and-play percutaneous circulatory assist device for high-risk coronary angioplasty.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

First use of a novel plug-and-play percutaneous circulatory assist device for high-risk coronary angioplasty.

Acute Card Care. 2008;10(2):111-5

Authors: Ferrari M, Poerner TC, Brehm BR, Schlosser M, Krizanic F, Schmidt R, Figulla HR

Objectives: Novel circulatory assist devices provide hemodynamic stability in high risk coronary interventions. They ensure sufficient organ perfusion during transfer in case of procedural failure or cardiogenic arrest. We describe the first human use of a novel plug-and-play circulatory assist device for high risk coronary angioplasty. Methods: An 84 year old lady suffered syncope with complex fracture of the left forearm. Her syncope was related to a subtotal stenosis of the left main coronary artery associated with an acute myocardial infarction. Additional risk factors were previous cardiac surgery, pulmonary disease, diabetes mellitus, and renal insufficiency. Coronary angiography revealed stenosis of both coronary ostia. The emergency assist device LIFEBRIDGE was connected with the patient's circulation by percutaneous cannulation (15F and 17F) of the femoral artery and vein. Results: Stent implantation was performed in both coronary ostia by Judkin's technique. The cannulas were removed two hours after the intervention by local compression. Osteosynthesis of the left radius and ulna was performed five days later under regional anesthesia. The patient was discharged without any complains on day 10. Conclusion: This case illustrates the safe and easy use of a novel plug-and-play percutaneous circulatory assist device for high risk interventions. It may be recommended for use in emergency situations.

PMID: 18568573 [PubMed - in process]

(Source: Acute Cardiac Care)

Oxidative stress and antioxidative defense parameters early after reperfusion therapy for acute myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Oxidative stress and antioxidative defense parameters early after reperfusion therapy for acute myocardial infarction.

Acute Card Care. 2008;10(2):121-6

Authors: Kaminski K, Bonda T, Wojtkowska I, Dobrzycki S, Kralisz P, Nowak K, Prokopczuk P, Skrzydlewska E, Kozuch M, Musial WJ

Reperfusion of ischemic myocardium evokes rapid release of free radicals in experimental models. The aim of the study was to investigate the oxidative stress and antioxidative defense during first minutes after reopening of the infarct related artery in patients treated for acute myocardial infarction. The study group consisted of 15 patients with first ST elevation myocardial infarction (STEMI) due to left anterior descending artery occlusion. The control group included ten patients with stable ischemic heart disease (IHD). Blood samples from coronary sinus were drawn before, immediately after and about 15 min after angioplasty. Activity of superoxide dysmutase (SOD), concentration of glutathione as well as the concentrations of lipid peroxides, malodialdehyde (MDA) and 4-hydroxy-2-nonenal (HNE) were measured. There was significantly higher concentration of MDA and HNE and higher SOD activity in STEMI patients before the reperfusion, as compared to the stable IHD group. After the reperfusion concentration of HNE in erythrocytes from STEMI patients was higher than in IHD group. At the same time the activity of SOD significantly decreased in patients with impaired tissue perfusion (myocardial blush grade <2). In conclusion, there is a slightly higher concentration of oxidative stress parameters in patients with STEMI. Diminished antioxidative defense after reperfusion is associated with impaired myocardial perfusion.

PMID: 18568574 [PubMed - in process]

(Source: Acute Cardiac Care)

Isolated right ventricular infarction during angioplasty mimicking anterior myocardial infarction.

Acute Cardiac Care — Thu, 03 Jul 2008 16:50:53 +0100

Isolated right ventricular infarction during angioplasty mimicking anterior myocardial infarction.

Acute Card Care. 2008;10(2):127-8

Authors: Karavolias GK, Georgiadou P, Adamopoulos S, Theodorakis GN

PMID: 18568575 [PubMed - in process]

(Source: Acute Cardiac Care)

Dementia in oldest-old twice as likely to affect women

MedPage Today Cardiovascular — Thu, 03 Jul 2008 14:41:58 +0100

IRVINE, Calif. -- The likelihood of women developing dementia as they age into their 90s is significantly greater than it is for men, according to researchers here. (Source: MedPage Today Cardiovascular)

Pharmacists should participate in care of patients with heart failure

Medscape Cardiology Headlines — Thu, 03 Jul 2008 12:49:43 +0100

Dr. George Lundberg talks about why it's important for pharmacists to get involved in the treatment of patients with heart failure. The Medscape Journal of Medicine (Source: Medscape Cardiology Headlines)

Bayesian meta-analysis of tissue angiotensin-converting enzyme inhibitors for reduction of adverse cardiovascular events in patients with diabetes mellitus and preserved left ventricular function.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

Bayesian meta-analysis of tissue angiotensin-converting enzyme inhibitors for reduction of adverse cardiovascular events in patients with diabetes mellitus and preserved left ventricular function.

J Cardiometab Syndr. 2008;3(1):45-52

Authors: Lang CD, Arora RR, Saha SA, Molnar J

The role of angiotensin-converting enzyme (ACE) inhibitors in diabetic patients with preserved ventricular function is uncertain. Tissue ACE inhibitors have been defined by increased lipophilicity and structural characteristics that result in greater tissue-specific ACE binding when compared with plasma ACE inhibitors. A Bayesian meta-analysis of randomized trials was conducted to evaluate tissue ACE inhibitors in prevention of cardiovascular disease among patients with diabetes mellitus and preserved left ventricular function. Four trials were selected that evaluated 2 different ACE inhibitors and included 10,328 patients (43,517 patient-years). The Perindopril Substudy in Coronary Artery Disease and Diabetes (PERSUADE) and the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) compared the effects of perindopril vs a placebo, and the Heart Outcomes Prevention Evaluation (HOPE) and the Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria, Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) study investigated the impact of ramipril vs a placebo. Bayesian meta-analysis of sequential trials and sensitivity analysis of therapeutic response were subsequently computed. Bayesian meta-analysis determined reduced risk of cardiovascular mortality (PB=.991), myocardial infarction (PB=.999), and the need for invasive coronary revascularization (PB=.995) when compared with placebo. Total mortality was also decreased (PB=.967), while the risk of stroke (PB=.907) and hospitalization for heart failure (PB=.923) were impacted. Bayesian meta-analysis of randomized trials suggests that tissue ACE inhibitors decrease the probability that diabetic patients with preserved left ventricular function will experience myocardial infarctions and cardiovascular death and reduce overall mortality.

PMID: 18326970 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

The endocannabinoid system: a promising novel mechanistic pathway in the cardiometabolic syndrome.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

The endocannabinoid system: a promising novel mechanistic pathway in the cardiometabolic syndrome.

J Cardiometab Syndr. 2008;3(1):40-4

Authors: Al-Jaghbeer E, Khraisat A, Singh SP

The endocannabinoid system (ECS) is a neuroendocrine system that modulates several cardiometabolic processes. An overactive ECS is implicated as a significant contributor to the cardiometabolic syndrome and obesity, in addition to a large number of other physiologic processes. Endocannabinoid receptors have been detected centrally and peripherally, regulating appetite, food intake, metabolism, and storage. ECS blockade is thought to be a promising new pharmacologic modality of improving the unfavorable metabolic risk profile in patients with the cardiometabolic syndrome and obesity.

PMID: 18326971 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

Reversal of diuretic-associated impaired glucose tolerance and new-onset diabetes: results of the star-let study.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

Reversal of diuretic-associated impaired glucose tolerance and new-onset diabetes: results of the STAR-LET study.

J Cardiometab Syndr. 2008;3(1):18-25

Authors: Bakris G, Molitch M, Zhou Q, Sarafidis P, Champion A, Bacher P, Sowers JR

Reversal of new-onset diabetes secondary to thiazide diuretic use remains questionable. STAR-LET was a 6-month extension of the Study of Trandolapril/Verapamil SR and Insulin Resistance (STAR), which assessed the effects of a fixed-dose renin-angiotensin system inhibitor (RASI)/hydrochlorothiazide (HCTZ) combination on changes in 2-hour oral glucose tolerance test (OGTT) results. STAR-LET explored whether the glycemic impact of HCTZ could be reversed by conversion to a RASI/verapamil combination. The primary outcome was change in 2-hour OGTT results. Fifty-one percent of the STAR patients were enrolled in STAR-LET. The 2-hour OGTT value (mmol/L) was unchanged from STAR baseline in the RASI/verapamil group (7.7+/-2.4 vs 8.1+/-3.3; P=.18) and improved in those who were switched from RASI/HCTZ to RASI/verapamil (8.5+/-3.0 vs 7.2+/-2.3; P<.001). This exploratory study suggests that the impairment in glycemic control seen with use of a thiazide diuretic combined with a RASI can be reversed by switching to a regimen that does not include a diuretic.

PMID: 18326972 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

The cardiometabolic syndrome and liver disease.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

The cardiometabolic syndrome and liver disease.

J Cardiometab Syndr. 2008;3(1):5-6

Authors: Sowers JR

PMID: 18326973 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

Ethnic gap in coronary artery disease: comparison of the extent, severity, and risk factors in arab and jewish middle-aged women.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

Ethnic gap in coronary artery disease: comparison of the extent, severity, and risk factors in Arab and Jewish middle-aged women.

J Cardiometab Syndr. 2008;3(1):26-9

Authors: Salameh S, Hochner-Celnikier D, Chajek-Shaul T, Manor O, Bursztyn M

The authors examined risk factors and extent of coronary artery disease (CAD) among Jewish and Arab women in Jerusalem, where Arab women were found to have worse outcome. All angiographically confirmed cases of CAD among women aged 45 to 65 years who were hospitalized during 1990 to 1995 consisted of 40 Arab and 179 Jewish patients. Arab women had more atypical clinical presentations (P<.0001) and more extensive CAD (P=.0016) despite younger age (53+/-3 vs 55+/-5 years; P<.0003) and lesser smoking (P<.0006). The Arab women, however, were more likely to be obese (80% vs 46%; P=.0002), be physically inactive (100% vs 89%; P=.0285), and have diabetes mellitus (73% vs 40%; P=.0004). Moreover, they were more likely to have 3 or more risk factors (45% vs 23%; P=.036). Thus, a combination of an atypical presentation and higher risk (ie, diabetes mellitus combined with hypertension and other risk factors) and much more extensive disease readily explains their worse outcome.

PMID: 18326974 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

Calciphylaxis: a severe complication of the cardiometabolic syndrome in patients receiving hemodialysis.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

Calciphylaxis: a severe complication of the cardiometabolic syndrome in patients receiving hemodialysis.

J Cardiometab Syndr. 2008;3(1):63-7

Authors: Verdalles U, Cueva Pde L, Verde E, Vinuesa SG, Goicoechea M, Mosse A, Lopez-Gomez JM, Luño J

PMID: 18326975 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

The apolipoprotein b/apolipoprotein ai ratio in the metabolic syndrome-should we start using it?

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

The apolipoprotein b/apolipoprotein AI ratio in the metabolic syndrome-should we start using it?

J Cardiometab Syndr. 2008;3(1):53-4

Authors: Sierra-Johnson J, Romero-Corral A, Somers VK, Lopez-Jimenez F

PMID: 18326976 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)

Calciphylaxis and the cardiometabolic syndrome: the emerging role of sodium thiosulfate as a novel treatment option.

Journal of the Cardiometabolic Syndrome — Thu, 03 Jul 2008 10:57:10 +0100

Calciphylaxis and the cardiometabolic syndrome: the emerging role of sodium thiosulfate as a novel treatment option.

J Cardiometab Syndr. 2008;3(1):55-9

Authors: Hayden MR

PMID: 18326977 [PubMed - indexed for MEDLINE]

(Source: Journal of the Cardiometabolic Syndrome)