Search

Weight loss surgery is accompanied by profound/structural and molecular changes in heart and vessels. The use of biomarkers is increasingly employed for long term monitoring of surgical results. Growth differentiation factor 15 (GDF15) has been associated to mitochondrial stress, non-alcoholic fatty liver, cardiovascular disease as well as diabetes and atherosclerosis. The GDF-GRAL signalling axis pathway is independent of leptin levels- playing an important role in food intake and obesity. Preclinical studies have shown that metformin and physical activity increase GDF15 levels in a cardioprotective way. As the mediating mechanisms are unelucidated, we designed a prospective study including 16 bariatric patients (body mass index > 40), investigating intima medial thickness (IMT) – as surrogate marker of atherosclerosis before and after weight loss surgery, as well as baseline blood leptin (167.92 ± 115.22) – as marker of diabetes and cardiometabolism, and baseline blood GDF15 levels (578.5 ± 157.96) -as marker of oxidative stress. IMT showed limited decrease 6 months after surgery (Mann-Whitney U = 72, P = 0.057). More importantly, limited positive correlation was observed between IMT after weight loss and GDF15 (r = 0.495, P = 0.051) (Figure 1). Still, contrary to the preclinical animal studies reports, a significant Spearman negative correlation of leptin with GDF15 was observed in these pathogenic obesity sufferers (r = –0.612, P = 0.012). These surprising findings suggest that the atherosclerosis decrease after surgery depends on GDF15 levels before surgery in some but not all patients. The use of surrogate markers after weight loss surgery can be very helpful for evaluating the structural and molecular improvement of the cardiovascular system. The physiology mechanisms during weight loss are closely inter-related. [ABSTRACT FROM AUTHOR]

Myocardial infarction, or heart attack, involves the deterioration of heart tissue due to cessation of blood supply. It is often complicated by the formation of thrombi or blood clots in the left ventricle, which are usually found at autopsy in 20 to 60 percent of patients who die from this cause. Echocardiography, the use of sound waves to visualize internal structures such as the heart, can be used to detect the blood clots. However, the optimal treatment for ventricular thrombi after myocardial infarction has not been adequately investigated. Sixty patients with myocardial infarction and thrombi in their left ventricles were given either anticoagulant drugs, aspirin, or no drug treatment. Echocardiography was performed every three months for an average period of 16 months. Among patients receiving anticoagulants, the clot was eliminated in 12 patients and reduced in size in three patients. In patients receiving aspirin, the thrombus was eliminated in nine patients and decreased in four patients. Among patients receiving no antithrombotic treatment, the thrombus was eliminated in two patients and reduced in size in another two patients; in addition, two patients suffered ischemic attacks of the brain, and one patient had an embolus, a mass of undissolved matter, in a leg blood vessel. The results show that anticoagulants and aspirin are equally effective, especially in comparison with no treatment, in the elimination of left ventricular thrombosis and prevention of emboli after myocardial infarction. (Consumer Summary produced by Reliance Medical Information, Inc.)

There is accumulating evidence showing that ischemic preconditioning (PC) may lose its cardioprotective effect in the diseased states. The present study investigated whether PC can be effective in hypothyroidism, a clinical condition which is common and often accompanies cardiac diseases such as heart failure and myocardial infarction. Hypothyroidism was induced in rats by 3-week administration of 6n-propyl-2-thiouracil in water (0.05 %). Normal and hypothyroid hearts (HYPO) were perfused in Langendorff mode and subjected to 20 min of zero-flow global ischemia and 45 min of reperfusion. A preconditioning protocol (PC) was also applied prior to ischemia. HYPO hearts had significantly improved post-ischemic recovery of left ventricular developed pressure, end-diastolic pressure and reduced lactate dehydrogenase release. Furthermore, phospho-JNK and p38 MAPK levels after ischemia and reperfusion were 4.0 and 3.0 fold lower in HYPO as compared to normal hearts (P<0.05). A different response to PC was observed in normal than in HYPO hearts. PC improved the post-ischemic recovery of function and reduced the extent of injury in normal hearts but had no additional effect on the hypothyroid hearts. This response, in the preconditioned normal hearts, resulted in 2.5 and 1.8 fold smaller expression of the phospho-JNK and phospho-p38 MAPK levels at the end of reperfusion, as compared to non-PC hearts (P<0.05), while in HYPO hearts, no additional reduction in the phosphorylation of these kinases was observed after PC. Hypothyroid hearts appear to be tolerant to ischemia-reperfusion injury. This response may be, at least in part, due to the downregulation of ischemia-reperfusion induced activation of JNKs and p38 MAPK kinases. PC is not associated with further reduction in the activation of these kinases in the hypothyroid hearts and fails to confer added protection in those hearts. [ABSTRACT FROM AUTHOR]

To map time-structures is a burgeoning scientific field enriching the (P4) medicine models. Relevant local evidence in Mediterranean populations is poorly investigated. Myocardial infarctions (MI) incidence and fatality rate is high, whilst its statistics fail to cover full etiology risk factors. This pilot study extents our previous work on stroke mortality variations [1] to MIs and aims to evaluate historical data of MI mortality events a. from Aghios Pavlos General Hospital in Thessaloniki (1955–1962) b. in Tel-Aviv (1972–1988) – periods free of confounding factors like life-style, pollution, stress. Sunspot numbers (Rz) were derived from the archives of measurements published by Solar Geographical Data. 930 Death events of myocardial infarctions from the archives of Aghios Pavlos General Hospital archives were collected and been evaluated by Δstatistics, while, 5667 publicly available MI deaths from Tel-Aviv hospitals were evaluated by correlation coefficient (r). MI variations and solar activity levels. Common cyclic variations of 2 and 4 years of sunspot numbers (as established marker of solar activity) and MI incidence was observed. The Correlation coefficient of Rz and monthly MI for Thessaloniki was r a = 0.402 P < 0.001, whilst for Tel-Aviv it was calculated as high as r b = 0.44 P < 0.001. Time structure patterns may provide novel insight in MI epidemic and, thus, contribute to future sophisticated public health planning and chronotherapy evaluations. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to define predictors of the kerma-area product (KAP) in percutaneous coronary intervention (PCI). Two new digital X-ray interventional cardiology systems recently installed were included. A total of 398 PCI procedures were carried out by 6 board-certified senior interventional cardiologists with more than 15 years' experience and good knowledge of radiation protection measures. Clinical, radiation and procedural data were collected based on a detailed protocol developed by the SENTINEL cardiology subgroup. Correlation with clinical and procedure factors was then investigated. A significant correlation was found between fluoroscopy time and (i) lesion classification, (ii) the level of tortuosity and (iii) the number of vessels treated. No statistically significant differences were observed in the complexity of the case between operators. However, large differences were found in the KAP among operators, which were mostly attributed to the different number of frames taken by each operator. There was no statistically significant correlation between complexity and the total number of frames. The study showed that, in certain circumstances, the clinical need to successfully perform PCI takes precedence over radiation safety concerns. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical, exercise, and haemodynamic effects of chronic oral administration of the non-selective endothelin receptor antagonist bosentan on patients with pulmonary arterial hypertension (PAH) related to congenital heart disease (CHD). Design: Prospective non-randomised open clinical study. Setting: Cardiology tertiary referral centre. Patients: 21 patients with a mean (SEM) age of 22 (3) years with chronic PAH related to CHD (15 with Eisenmenger's syndrome). Patients were in World Health Organization (WHO) class II to IV with oxygen saturation 87 (2)%. Intervention: Patients underwent clinical, exercise, and haemodynamic evaluations at baseline and after 16 weeks of treatment. Results: Bosentan improved (p < 0.01) WHO class, peak oxygen consumption from 16.8 (1.4) to 18.3 (1.4) ml/kg/min, exercise duration from 9.0 (0.8) to 10.7 (0.6) minutes during the treadmill test, walking distance from 416 (23) to 459 (22) m, and Borg dyspnoea index from 2.8 (0.2) to 2.0 (0.1) during the six minute walk test. Bosentan treatment improved (p < 0.05) mean pulmonary artery pressure from 87(4) to 81(4) mm Hg, pulmonary blood flow index from 3.2 (0.4) to 3.7 (0.5) I/min/m2, pulmonary to systemic blood flow ratio from 1.2 (0.2) to 1 .4 (0.2), and pulmonary vascular resistance index from 2232 (283) to 1768 (248) dyn·s·cm-5. Two patients died, presumably of arrhythmic causes, who were in WHO class IV at baseline and who had improved during treatment. Conclusions: Bosentan induces short and mid term clinical, exercise, and haemodynamic improvements in patients with PAH related to CHD. Larger studies with tong term endothelin receptor antagonism are needed to assess the safety and possible treatment role of bosentan in this population. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that patients undergoing acute intervention for coronary syndromes may not receive adequate secondary prevention.Objective: To analyse the impact of availability and use of coronary interventions on the prescription of secondary prevention after acute coronary syndromes.Design: Analysis of a prospective multicentre register of patients admitted to hospital for acute coronary syndromes.Setting: A 1999 pan-European survey in 390 hospitals.Patients: 3092 patients admitted to hospital with acute coronary syndromes (including 777 for ST elevation myocardial infarction within 12 hours of onset).Main Outcome Measures: Rates of prescription of aspirin and lipid lowering agents.Results: Performance of coronary angiography and percutaneous coronary interventions (PCI) during the hospital stay were independent predictors of prescription of aspirin at discharge (odds ratio (OR) 1.29 and 1.89, p = 0.053 and p < 0.0001, respectively). Lipid lowering agents were prescribed more often on discharge in patients admitted to hospitals with catheterisation laboratories than without (for infarction with ST elevation, 45% v 40% (NS); for other acute coronary syndromes, 46% v 36%; p < 0.05). Prescription rates were higher among patients undergoing coronary angiography or PCI than in those treated conservatively (for infarction with ST elevation, 49%, 53%, and 39%, p < 0.05; for other acute coronary syndromes, 50%, 54%, and 34%, p < 0.05). Logistic regression analysis showed that PCI was an independent predictor of prescription of lipid lowering agents at discharge (OR 1.48, p < 0.0002).Conclusions: Contrary to expectations, invasive procedures for acute coronary syndromes are associated with higher rates of prescription of pharmacological secondary prevention. [ABSTRACT FROM AUTHOR]

The treatment of acute myocardial infarction (MI) constitutes a significant problem in remote geographical areas of Greece. Furthermore, thrombolysis, the treatment of choice in the early phase of acute MI, requires the supervision of an expert. We have used thrombolytic treatment, using telemedicine, in remote medical centres. The Onassis Cardiac Surgery Centre was linked to six remote Aegean islands via telemedicine systems which permitted the transmission of 12-lead electrocardiograms (ECGs). The thrombolytic agent anistreplase was administered to patients with acute MI. Supervision, including consultation for treatment of complications, was achieved using the telemedicine system. One hundred and fifty-two ECGs were transmitted during 24 months, of which 108 (71%) indicated specific treatment of a cardiac condition. Ten cases were diagnosed as having acute MI and eight of these were treated with anistreplase. All patients survived acute MI and complications were treated locally. The application of thrombolytic treatment in acute MI is feasible in remote areas, with the use of a telemedicine system. [ABSTRACT FROM AUTHOR]

The authors identified 160 men and women from all 3,700 patients with anginal pain between 1990 and 1994 who were subsequently found to have normal coronary arteries at diagnostic cardiac catheterization with follow-up to the present (mean follow-up 2.5 years). The group comprised 50 women and 110 men. Mean age was significantly greater in women (53.1 ±7.7 vs 47.2 ±9.2 years, p<0.001). Forty percent of the women but only 10% of the men had a positive exercise test. At follow-up, a larger proportion of patients continue to experience chest pain (95 patients, 59%) of whom 65 patients (41%) continue antianginal therapy. Furthermore one patient suffered a sudden cardiac death and two patients had a nonfatal myocardial infarction. Of patients referred with chest pain, women were more likely to have normal coronary arteries, compared with men. All patients have an excellent prognosis. A large proportion of women had a positive exercise test in the absence of coronary artery disease. On the other hand, morbidity remains high in these patients, despite the reassurance of a normal-appearing coronary arteriogram. [ABSTRACT FROM AUTHOR]

The ST segment electrical axis in the frontal plane was calculated in 20 patients with an acute inferior myocardial infarction (AIMI) and another 20 patients with the acute phase of pericarditis (AP). The ST segment axis of patients with AIMI ranged from 100°-120° (mean 114°). The ST segment axis of patients with 4P ranged from 30°-60° (mean 45°). Thus, the ST segment axis can be used for the differential diagnosis in the early acute phase, especially when there are no other important distinguishing factors between these two conditions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the contribution of coronary artery ectasia, either isolated or in association with obstructive coronary artery disease, to morbidity and mortality from ischaemic heart disease. DESIGN: A retrospective study of patients undergoing coronary arteriography at a tertiary cardiac centre. PATIENTS AND METHODS: The epidemiological, clinical, arteriographic, and follow up characteristics of three groups of patients were examined: group A, 172 patients with coronary artery ectasia and coexisting significant coronary artery disease; group B, 31 patients with coronary artery ectasia only; group C, 165 patients with significant coronary artery disease but without ectasia, matched for sex and age with group A. RESULTS: Group A patients had a similar incidence of a previous myocardial infarction to group C patients (61.6% v 64.2%), exercise performance, severity of obstructive lesions (CASS score 2.19 v 2.14), and similar distribution of diseased vessels. At follow up of approximately two years they experienced a similar incidence of unstable angina (7.5% v 4.4%) and myocardial infarction plus cardiac death (4.9% v 6.1%). They underwent bypass surgery with similar frequency (39% v 42%) but there was a lower frequency of percutaneous transluminal coronary angioplasty (5.8% v 17%, P < 0.01). Patients with pure coronary ectasia (group B) had a lower incidence of a previous myocardial infarction (38.7%, 12/31, P < 0.05) than the two other groups. The infarct in all cases was related to an ectatic artery. Their exercise performance and ejection fraction (9 (SD 3) minutes and 56.5(9)%) were higher (P < 0.01) than group A (5 (2) minutes, 48.3(10)%) and group C (5.3 (2) minutes, 49.3(10)%). Group B had no myocardial infarctions, cardiac death, surgery, or intervention at follow up; 4.4% (5/115) developed unstable angina. The incidence of angina at study entry was similar in all three groups (38.7-49.7%). CONCLUSIONS: Coronary artery ectasia does not confer added risk in patients with coexisting obstructive coronary artery disease. Although there is a measurable incidence of previous myocardial infarction, patients with pure ectasia have a good prognosis. The wisdom of giving oral anticoagulants to such patients is questioned. [ABSTRACT FROM PUBLISHER]

In order to determine whether the electrocardiographic criteria of left ventricular hypertrophy apply in the presence of left bundle-branch block we studied 79 cases of intermittent left bundle-branch block and compared the QRS voltage and axis before and after its onset. Cases of incomplete left bundle-branch block were excluded. There was a statistically significant correlation between pre- and post-left bundle-branch block values of R or S wave voltage in leads I, V1, V2, V5, and V6, the Sokolow index (R V5 or V6 + S V1), and the QRS axis. There was a statistically significant reduction in R wave voltage in leads I, V5, and V6, an increase in S wave voltage in V1 and V2, and leftward shift of QRS axis, but the Sokolow index remained unchanged, after the onset of left bundle-branch block. The Sokolow criteria for left ventricular hypertrophy apply satisfactorily even in the presence of left bundle-branch block, though specificity is low, but QRS axis is unhelpful. [ABSTRACT FROM PUBLISHER]

In 26 normal volunteers, increase in heart rate from mean 73-94 +/- 1-97 to 103-61 +/- 2-72/min, by either intravenous atropine administration or rapid right atrial pacing, produced definite changes in the uncorrected systolic time intervals. As expected, total electromechanical systole (QS2) and left ventricular ejection time (LVET) were shortened, while the pre-ejection period (PEP) was unaffected. There was a consistent and significant increase of the PEP/LVET ratio (P less than 0-001). It is postulated that when this ratio is taken to express left ventricular contractility, it should probably be corrected for heart rate. Appropriate regression equations for such a correction were calculated (PEP/LVET=0-249 + 0-0168 HR). [ABSTRACT FROM PUBLISHER]

The pressure-rate product during anginal pain produced by right atrial pacing was studied in 12 patients before, during, and after an angiotensin infusion sufficient to produce a significant rise in blood pressure. During the infusion the pain occurred at a significantly lower heart rate (P less than 0.001). However, the pressure-rate product was similar during anginal pain before and during the angiotensin-induced hypertension and after it wore off. Our studies support the concept that in each individual there is a constant level of myocardial oxygen consumption, as expressed by the pressure-rate product, at which anginal pain occurs. [ABSTRACT FROM PUBLISHER]

To study the electrophysiological effects of oral propafenone on accessory pathways and determine the potential for catecholamine-mediated reversal of these effects, comprehensive electrophysiology studies (EPS) were conducted in 11 patients with manifest (n = 9) or concealed (n = 2) pre-excitation syndrome. EPS were performed at baseline (in the drug-free state), after oral propafenone loading, and with isoproterenol infusion during propafenone therapy. The study group included 10 men and 1 woman with a mean age of 39±13 years, who presented with symptoms of palpitations (n = 6), presyncope (n = 3) and syncope (n = 2). The clinical arrhythmia was atrioventricular reciprocating tachycardia (n = 6), atrial flutter/fibrillation (n = 3), or both (n = 2). During the baseline EPS the accessory pathway location was identified as left (n = 6) or septa (n = 5). The mean anterograde effective refractory period was 265±42 ms, the shortest pre-excited RR interval 259 ± 20 ms and the retrograde refractory period 258 ± 39 ms. Orthodromic atrioventricular reciprocating tachycardia was induced in 10 patients (mean cycle length = 324±31 ms). Antidromic reciprocating tachycardia was induced in one patient (cycle length = 340 ms). In all the 11 patients EPS were repeated after 4 days of oral propafenone loading (668 ± 226 mg daily) when drug steady state was expected to have been achieved. One additional patient had baseline EPS but developed clinical arrhythmia recurrences after propafenone loading and thus he was excluded from the study; follow-up EPS were conducted on procainamide. Propafenone caused complete anterograde block in the accessory pathway in four patients and increased the anterograde refractory period from 270 ±24 ms to 393 ± 124 ms in the other patients, with resultant anterograde conduction occurring exclusively via the atrioventricular node during atrial fibrillation in another three patients. The drug caused retrograde block in three patients, and significantly increased the retrograde refractory period in the other patients (from 248±33 ms to 353±96ms) (P = 0·015). Orthodromic reciprocating tachycardia was rendered non-inducible in six patients or slower and/or non-sustained in the other five patients (cycle length = 400±19 ms, P = 0·012). Isoproterenol infusion testing (3·6±1·6 μg . min) was performed in nine patients during the follow-up EPS. Among the four patients with anterograde block and one of two patients with retrograde block in the accessory pathway, isoproterenol did not restore conduction. However, the anterograde refractory period in three patients decreased from 430 ± 121 to 270±61 ms (P>0·05) and retrograde conduction that was blocked by propafenone was now restored in one patient, while the retrograde refractory period in six patients decreased from 358 ± 106 ms to 295 ±89 ms (P = 0·004). Furthermore, atrial fibrillation rendered non-inducible or non-sustained by propafenone was sustained during isoproterenol infusion, and in four patients in whom reciprocating tachycardia had been rendered slower (cycle length = 405±17 ms) or non-sustained by propafenone, a faster (cycle length = 338 ± 13 ms, P = 0·004) and sustained tachycardia was induced during isoproterenol testing. At a mean long-term follow-up period of 9±6 months, among 10 patients discharged on a combined regimen of propafenone and β-blocker, there have been no supraventricular arrhythmia recurrences and no major drug side-effects. The patient who had no follow-up EPS on propafenone due to clinical arrhythmia recurrences, underwent radiofrequency ablation of his left-sided bypass tract. In conclusion, propafenone constitutes effective drug therapy for patients with pre-excitation syndrome. Its electrophysiological effects on accessory pathways can be partially or completely reversed with acute ... [ABSTRACT FROM PUBLISHER]