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Heart failure (HF) is, after cirrhosis, the second-most common cause of ascites. Serum B-type natriuretic peptide (BNP) plays an important role in the diagnosis of HF. Therefore, we hypothesized that BNP would be useful in the differential diagnosis of ascites. Consecutive patients with new onset ascites were prospectively enrolled in this cross-sectional study. All patients had measurements of serum-ascites albumin gradient (SAAG), total protein concentration in ascitic fluid, serum, and ascites BNP. We enrolled 218 consecutive patients with ascites resulting from HF (n = 44), cirrhosis (n = 162), peritoneal disease (n = 10), and constrictive pericarditis (n = 2). Compared to SAAG and/or total protein concentration in ascites, the test that best discriminated HF-related ascites from other causes of ascites was serum BNP. A cutoff of >364 pg/mL (sensitivity 98%, specificity 99%, and diagnostic accuracy 99%) had the highest positive likelihood ratio (168.1); that is, it was the best to rule in HF-related ascites. Conversely, a cutoff ≤182 pg/mL had the lowest negative likelihood ratio (0.0) and was the best to rule out HF-related ascites. These findings were confirmed in a 60-patient validation cohort. Conclusions: Serum BNP is more accurate than ascites analyses in the diagnosis of HF-related ascites. The workup of patients with new onset ascites could be streamlined by obtaining serum BNP as an initial test and could forego the need for diagnostic paracentesis, particularly in cases where the cause of ascites is uncertain and/or could be the result of HF. (Hepatology 2014;59:1043–1051)

Background. The link between endogenous estrogen, coronary artery disease (CAD), and death in postmenopausal women is uncertain. We analyzed the association between death and blood levels of estrone in postmenopausal women with known coronary artery disease (CAD) or with a high-risk factor score for CAD. Methods. 251 postmenopausal women age 50–90 years not on estrogen therapy. Fasting blood for estrone and heart disease risk factors were collected at baseline. Women were grouped according to their estrone levels ( 5 . 8 ± 1 . 4 years of followup. Results. The Kaplan-Meier survival curve showed a significant trend ( 𝑃 = 0 . 0 3 9 ) of greater all-cause mortality in women with low estrone levels ( O R = 0 . 4 5 ; 𝑃 = 0 . 0 3 8 ) as the only independent variable for all-cause mortality. Multivariate regression model adjusted for age, body mass index, hypertension, diabetes, dyslipidemia, family history, and estrone showed that only age ( O R = 1 . 0 6 ; 𝑃 = 0 . 0 1 7 ) was an independent predictor of all-cause mortality. Conclusions. Postmenopausal women with known CAD or with a high-risk factor score for CAD and low estrone levels (

OBJECTIVE: Anticoagulation is a challenge for the prophylaxis of thromboembolic events in elderly patients with chronic atrial fibrillation. Stable anticoagulation is defined as the time within >70% of the therapeutic range. However, the dosage required to achieve stable anticoagulation remains unknown. The aim of this study was to analyze the warfarin dose necessary for the maintenance of stable oral anticoagulation therapy in elderly patients. METHODS: We analyzed 112 consecutive outpatients with atrial fibrillation who were >65 years of age, had received anticoagulation therapy with warfarin for more than 1 year and had a stable international normalized ratio between 2.0 and 3.0 for >6 months. The international normalized ratio was measured in the central laboratory using the traditional method. RESULTS: The patients were stratified according to the following age groups: 75 years and 80 years. The mean daily doses of warfarin were similar for patients 75 years (3.34+1.71 versus 3.26 +1.27 mg/ day, p = 0.794) and 80 years (3.36+ 1.49 versus 3.15 + 1.23 mg/day, p = 0.433). In 88 (79%) patients, the daily warfarin dose was between 2 and 5 mg/day; in 13 (11%) patients, the daily warfarin dose was 5.0 mg/day. The correlation between the daily warfarin dose and the international normalized ratio was 0.22 (p = 0.012). CONCLUSION: Stable anticoagulation was achieved in 80% of patients who received doses of 2 to 5 mg/day of warfarin, and the mean daily dose was similar across the age groups analyzed.

OBJECTIVE: Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory. METHODS: This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed. RESULTS: The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 – 8.53); P = 0.002] in non-ST-elevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 – 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 – 3.04); P = 0.032]. CONCLUSIONS: B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.

The creatine kinase-isoenzyme MB (CK-MB) mass assay is one of the laboratory tests used for the diagnosis of myocardial infarction. It is recommended, however, that reference limits should take gender and race into account. In the present study, we analyzed the plasma CK-MB mass and troponin levels of 244 healthy volunteers without a personal history of coronary artery disease and with no chronic diseases, muscular trauma or hypothyroidism, and not taking statins. The tests were performed with commercial kits, CK-MB mass turbo kit and Troponin I turbo kit, using the Immulite 1000 analyzer from Siemens Healthcare Diagnostic. The values were separated according to gender and showed significant differences by the Mann-Whitney test. Mean (± SD) CK-MB mass values were 2.55 ± 1.09 for women (N = 121; age = 41.20 ± 10.13 years) and 3.49 ± 1.41 ng/mL for men (N = 123; age = 38.16 ± 11.12 years). Gender-specific reference values at the 99th percentile level, according to the Medicalc statistical software, were 5.40 ng/mL for women and 7.13 ng/mL for men. The influence of race was not considered because of the high miscegenation of the Brazilian population. The CK-MB values obtained were higher than the 5.10 mg/mL proposed by the manufacturer of the laboratory kit. Therefore, decision limits should be related to population and gender in order to improve the specificity of this diagnostic tool, avoiding misclassification of patients.

The relationship between inflammatory and prothrombotic activity in chagas cardiomyopathy and in other etiologies is unclear.To study the profile of pro-thrombotic and pro-inflammatory markers in patients with Chagas' heart failure and compare them with patients of non-chagas etiology.Cross-sectional cohort.left ventricle ejection fraction (LVEF)45% and onset time to symptomsone month. The patients were divided into two groups: group 1 (G1) - seropositive for Chagas - and group 2 (G2) - seronegative for Chagas. Pro-inflammatory factor: Ultra-sensitive CRP. Pro-thrombotic factors: thrombin-antithrombin factor, fibrinogen, von Willebrand factor antigen, plasma P-selectin and thromboelastography. Sample calculated for 80% power, assuming a standard deviation difference of 1/3; significant p if it is0.05.Fisher's exact test for categorical variables; unpaired Student's t-test for parametric continuous variables and Mann-Whitney test for nonparametric continuous variables.Between January and June 2008, 150 patients were included, 80 in G1 and 70 in G2. Both groups maintained the averages of high sensitivity CRP above baseline values, however, there was no significant difference (p = 0.328). The fibrinogen levels were higher in G2 than in G1 (p = 0.015). Among the thromboelastography variables, the parameters MA (p=0.0013), G (p=0.0012) and TG (p =0.0005) were greater in G2 than in G1.There is no evidence of greater pro-thrombotic status among patients with Chagas disease. The levels of fibrinogen and the MA, G and TG parameters of the thromboelastography point to pro-thrombotic status among non-chagas patients. Both groups had increased inflammatory activity.

FUNDAMENTO: Os neuro-hormônios estão envolvidos na fisiopatologia da insuficiência cardíaca, mas pouco se sabe sobre seu comportamento na insuficiência aórtica crônica importante (IAo). OBJETIVO: Analisar o comportamento desses mediadores na IAo. MÉTODOS: Analisamos 89 pacientes com IAo, com média etária de 33,6±11,5 anos, 84,6% do sexo masculino, 60% assintomáticos, todos de etiologia reumática. Após avaliação clínica e ecocardiográfica, realizaram-se dosagens plasmáticas de fator de necrose tumoral (TNF), seus antagonistas receptores solúveis tipos I e II (sTNFRI e sTNFRII), interleucina-6 (IL-6), seu receptor solúvel, endotelina-1 e peptídeo natriurético tipo B (BNP). Doze indivíduos saudáveis serviram como controle. RESULTADOS: O valor médio de diâmetro diastólico (DD) do ventrículo esquerdo (VE) foi de 71,9±8,3 mm, e o do diâmetro sistólico (DS) do VE, de 50,4±9,3 mm. Os níveis de neuro-hormônios estavam elevados nos pacientes com IAo: TNF 92,65±110,24 pg/ml vs. 1,67±1,21 pg/ml nos controles, p

Serum levels of troponin and heart-related fraction of creatine kinase (CK-MB) mass are used as diagnostic and prognostic criteria in myocardial infarction, but the relation between those levels and the necropsy-determined size of necrosis has not been tested in human beings. In this retrospective study, 1-cm-thick transverse sections of the ventricles were cut from the base to the apex in the necropsy hearts of 27 patients aged 47 to 86 years (mean 66, median 69; 19 men). Total and necrotic areas were measured using a computer-linked image analysis system. The weights of the necrotic areas were also calculated. The correlations of the areas and weights of necrotic myocardium with the highest serum values of CK-MB mass and troponin I, which had been quantified during life by chemiluminescence immunoassays, were verified by Pearson's test; results were considered significant at p

OBJETIVO: O objetivo deste estudo foi avaliar o efeito do polimorfismo S447X sobre os lípides plasmáticos em pacientes com doença arterial coronariana (DAC) prematura. MÉTODOS: Os lípides plasmáticos e a genotipagem foram determinados em 2 grupos: 313 pacientes com DAC prematura (

OBJETIVO: Comparar os resultados do Índice de Normalização Internacional (INR) obtidos pelo teste rápido com os do método convencional nos pacientes em terapia de anticoagulação oral com varfarina sódica. MÉTODOS: Para 383 pacientes tratados com varfarina (idade média: 56,5 anos; 207 mulheres), o INR foi determinado em sangue capilar pelo equipamento Hemochron Jr. e comparado com os resultados de amostras de plasma venoso analisadas pelo teste convencional realizado em equipamento Coag-A-Mate. Foram avaliados os resultados do desempenho global das amostras e dos seguintes subgrupos: INR < 2,0, entre 2,0 a 3,5 e > 3,5. RESULTADOS: A comparação entre os valores de INR dos dois métodos resultou em um coeficiente de correlação (r) de 0,86. Entretanto, a análise das diferenças médias entre os resultados dos dois testes, considerando os três subgrupos, apresentou diferenças estatisticamente significativas (p < 0,001): 0,14 ± 0,21 (INR < 2,0); 0,54 ± 0,31 (2,0 < INR < 3,5) e 1,64 ± 1,10 (INR> 3,5). O cálculo do teste t-pareado de Student resultou em um p < 0,001 para os três subgrupos analisados. CONCLUSÃO: A adoção do teste rápido para monitoramento da anticoagulação oral apresenta restrições. Esse método subestimou a intensidade da anticoagulação nos três subgrupos estudados. OBJECTIVE: to compare the international normalized ratio (INR) measured by a point-of-care (POC) testing device with that measured by the conventional method in patients undergoing anticoagulation therapy with warfarin sodium. METHODS: The INR of 383 warfarin-treated patients (mean age: 56.5 years; 207 female) was measured in capillary blood using the Hemochron Jr. device and compared with that of venous plasma samples determined by the conventional method performed in a Coag-A-Mate analyzer. Results were evaluated globally and for the following subgroups: INR < 2.0, from 2.0 to 3.5, and > 3.5. RESULTS: Using both methods, the comparison between INR values yielded a correlation coefficient (r) of 0.86. However, mean differences in INR in both tests, considering the three subgroups, proved to be statistically significant (p 3.5). Paired Student’s t-test analysis revealed a p value < 0.001 for the three subgroups studied. CONCLUSION: The use of point-of-care testing for monitoring oral anticoagulation has some limitations. Anticoagulation intensity was underestimated by this method in the three subgroups studied.

e20648 Background: vein thromboembolic events (VTE) significantly affect oncological patients, leading to increased morbidity and mortality. Early diagnosis could reduce these complications. Method...

Objective—To evaluate correlations between plasma concentrations of norepinephrine and Doppler echocardiographic variables for dogs with degenerative mitral valve disease (DMVD) or dilatative cardiomyopathy (DCM) to better understand the time course and magnitude of sympathetic activation in dogs with heart failure (HF). Animals—15 healthy dogs, 15 dogs with DMVD, and 15 dogs with DCM. Procedures—Dogs were positioned in lateral recumbency with minimal restraint for at least 20 minutes. Plasma samples were obtained and assayed by use of high-performance liquid chromatography. Concentrations were correlated with HF classification and with the main Doppler echocardiographic variables for each group. Results—Mean ± SD norepinephrine concentration was significantly higher in dogs with DMVD (494.4 ± 204.8 pg/mL) or DCM (655.7 ± 652.5 pg/mL) than in healthy dogs (205.8 ± 78.9 pg/mL), but concentrations did not differ significantly between the 2 groups with HF. Correlations were not detected between norepinephrine and heart rate or any M-mode echocardiographic variables evaluated, except for fractional shortening (FS) in DCM dogs. In that group, norepinephrine was inversely correlated with FS values. In DMVD dogs, no significant correlation was found between norepinephrine and the left atrium-to-aortic root ratio or mitral regurgitation. Conclusions and Clinical Relevance—A proportional inverse correlation exists between norepinephrine and FS values in dogs with DCM. However, norepinephrine concentration was not correlated with the evaluated echocardiographic variables in dogs with DMVD. Sympathetic antagonists should be evaluated as a treatment option because of the increased plasma concentrations of norepinephrine detected in dogs with HF.

Background The effect of home-based exercise training on neurovascular control in heart failure patients is unknown. Aims To test the hypothesis that home-based training would maintain the reduction in muscle sympathetic nerve activity (MSNA) and forearm vascular resistance (FVR) acquired after supervised training. Methods and results Twenty-nine patients (54±1.9 years, EF

After injury to the adult central nervous system (CNS), numerous cytokines and growth factors are released that contribute to reactive gliosis and extracellular matrix production. In vitro examination of these cytokines revealed that the presence of transforming growth factor-beta1 (TGF-beta1) and epidermal growth factor (EGF) greatly increased the production of several chondroitin sulfate proteoglycans (CSPG) by astrocytes. Treatment of astrocytes with other EGF-receptor (ErbB1) ligands, such as TGF-alpha and HB-EGF, produced increases in CSPG production similar to those observed with EGF. Treatment of astrocytes, however, with heregulin, which signals through other members of the EGF-receptor family (ErbB2, ErbB3, ErbB4), did not induce CSPG upregulation. The specificity of activation through the ErbB1 receptor was further verified by using a selective antagonist (AG1478) to this tyrosine kinase receptor. Western blot analysis of astrocyte supernatant pre-digested with chondroitinase ABC indicated the presence of multiple core proteins containing 4-sulfated or 6-sulfated chondroitin. To identify some of these CSPGs, Western blots were screened using antibodies to several known CSPG core proteins. These analyses showed that treatment of astrocytes with EGF increased phosphacan expression, whereas treatment with TGF-beta1 increased neurocan expression. Reverse transcription-polymerase chain reaction (RT-PCR) was used to examine the expression of these molecules in vivo, which result in increased expression of TGF-beta1, EGF-receptor, neurocan, and phosphacan after injury to the brain. These data begin to elucidate some of the injury-induced growth factors that regulate the expression of CSPGs which could be targeted in the future to modulate CSPG production after injury to the central nervous system.

Background Estrogen protects against atherosclerosis through its genomic/nongenomic effects. Estrogen receptors (ESR) α (1) and β (2) mediate much estrogen action. Both receptors exist in the arterial wall, but the extent of their distribution in arterial layers is unknown. Allelic variants of the gene encoding ESR1 and ESR2 may alter their expression and function, resulting in genetic variability. Methods In the present age-adjusted, case-control study, the prevalence of four mutations in estrogen receptors was analyzed in patients with premature CAD and controls. Results Mutation in the ESR1 ( Pvu II) was more prevalent in the controls (18 vs. 11%; p =0.062) than in CAD patients, and the mutation identified by the Xba I enzyme in the same receptor was associated with reduced apolipoprotein B levels and low body mass index. Mutation of the ESR2 ( Alu I) was more prevalent in CAD patients (0.6 vs. 18%; p =0.008). Homozygosis for this mutation involved increased body mass index, elevated serum triglycerides and apolipoprotein B, and reduced HDL-cholesterol. Multivariate logistic regression analysis showed dyslipidemia, low serum HDL levels, and ESR2 polymorphism ( Alu I) [OR=1.89 (95% CI: 1.08–3.34); p =0.034] to be independent risk factors for CAD. Conclusions Our data suggest that mutation of the ESR2 is an independent risk marker for premature CAD.

We investigated whether 2,3-diphosphoglycer- ate (2,3-DPG) is altered in patients with low cardiac output and the influence of its concentration on the calculation of in vivo P50. Biochemical and blood gas analysis were per- formed along with the measurement of cardiac output and body temperature in 13 patients submitted to cardiopul- monary bypass surgeries without the use of donor blood. In vivo P50 was calculated using the measured (P50m) and the estimated 2,3-DPG (P50e). 2,3-DPG concentration was lower in these patients when compared to the values obtained in normal volunteers (6.9 ± 2.2 vs. 11.9 ± 2.4 mmol/gHb). P50m was lower than P50e (21.6 ± 1.1 vs. 30.1 ± 1.2 mm Hg) at all time points. Our data show that in patients with low cardiac output, 2,3-DPG concentration is reduced. Therefore, in these patients, the use of standard values for this variable may introduce an error in the cal- culation of in vivo P50. Key Words: 2,3-Diphosphoglycer- ate—In vivo P50.

In patients taking dual antiplatelet therapy with acetylsalycilic acid (ASA) and clopidogrel, proton-pump inhibitors are often utilized for gastrointestinal (GI) bleeding prophylaxis. However, this class of medication has been associated with reduction of the antiplatelet potency of clopidogrel. The

Glycosaminoglycan composition of normal saphenous veins and atherosclerotic saphenous vein grafts is reported. Dermatan sulfate is the main glycosaminoglycan present in both normal saphenous veins and saphenous vein grafts. These tissues also contain chondroitin sulfate and heparan sulfate. Although the total amount of glycosaminoglycans decreased in the grafts (compared with normal saphenous veins), the grafts showed an increase in the relative amounts of dermatan sulfate and chondroitin sulfate. Heparan sulfate was decreased, compared with normal controls. These findings suggest the involvement of blood vessel glycosaminoglycans (not only the arterial glycosaminoglycans) in the process of atherosclerosis.

Dahia PLM, Hayashida CY, Strunz C, Abelin N, Toledo SPA. Low cord blood levels of catecholamine from a newborn of a pheochromocytoma patient. Eur J Endocrinol 1994;130:217–19. ISSN 0804–4643 Association of pheochromocytoma and pregnancy is rare and usually related to high maternal and fetal mortality rates. Maternal effects of the tumor have been studied extensively and the clinical outcome has markedly improved during the last decade. However, the role of excess catecholamines on fetal development has been discussed very little. We report here a case of pheochromocytoma during pregnancy, in which catecholamine levels from the cord blood were low despite simultaneous elevated maternal values (1.93 and 29.46 nmol/l norepinephrine, respectively), possibly owing to the high activity of the catecholamine degradative enzymes monoamine oxidase and COMT at the placental level. We suggest that in pregnancies complicated by pheochromocytoma, fetal well-being may be related mainly to good control of maternal blood pressure instead of to the amount of catecholamines in the fetal circulation, because the placenta performs a protective role through an effective process of hormone inactivation. Patricia LM Dahia, Endocrine Genetics Unit, University of ã Paulo School of Medicine, 455 Dr. Arnaldo Ave, 4th Floor, Room 50, 01246–913 São Paulo, Brazil

Background Changes in the proteoglycans glypican and syndecan-4 have been reported in several pathological conditions, but little is known about their expression in the heart during diabetes. The aim of this study was to investigate in vivo heart function changes and alterations in mRNA expression and protein levels of glypican-1 and syndecan-4 in cardiac and skeletal muscles during streptozotocin (STZ)-induced diabetes. Methods Diabetes was induced in male Wistar rats by STZ administration. The rats were assigned to one of the following groups: control (sham injection), after 24 hours, 10 days, or 30 days of STZ administration. Echocardiography was performed in the control and STZ 10-day groups. Western and Northern blots were used to quantify protein and mRNA levels in all groups. Immunohistochemistry was performed in the control and 30-day groups to correlate the observed mRNA changes to the protein expression. Results In vivo cardiac functional analysis performed using echocardiography in the 10-day group showed diastolic dysfunction with alterations in the peak velocity of early (E) diastolic filling and isovolumic relaxation time (IVRT) indices. These functional alterations observed in the STZ 10-day group correlated with the concomitant increase in syndecan-4 and glypican-1 protein expression. Cardiac glypican-1 mRNA and skeletal syndecan-4 mRNA and protein levels increased in the STZ 30-day group. On the other hand, the amount of glypican in skeletal muscle was lower than that in the control group. The same results were obtained from immunohistochemistry analysis. Conclusion Our data suggest that membrane proteoglycans participate in the sequence of events triggered by diabetes and inflicted on cardiac and skeletal muscles.

High renin hypertension is usually accompanied by impairment of the baroreceptor reflexes. This feature has been mostly ascribed to overactivity of the renin-angiotensin system. However, renal nerves could also modulate the baroreceptor reflexes. In the present experiments, the effect of renal denervation on the depressed baroreceptor reflexes was studied in rats subjected to aortic ligation between the renal arteries. Renal denervation of the ischemic kidney was performed at the same time as aortic ligation. The resulting effects on arterial pressure, heart rate, plasma renin activity, and baroreceptor reflex control of heart rate were studied 10-12 days after ligation and denervation. Aortic ligation induced high levels of mean arterial pressure (166 +/- 6 versus 110 +/- 3 mm Hg in controls), heart rate (380 +/- 9 versus 352 +/- 8 beats per minute in controls), and plasma renin activity (44 +/- 5 versus 6 +/- 1.2 ng angiotensin I/ml/hr). The baroreceptor reflex sensitivity for bradycardia and tachycardia was significantly reduced (-0.18 +/- 0.04 and -0.18 +/- 0.05, respectively, versus -2.3 +/- 0.01 and -2.4 +2- 0.1 beats per minute per mm Hg in controls). Denervation of the ischemic kidney attenuated the development of hypertension in aortic-ligated rats (122 +/- 3 mm Hg), lowering heart rate (319 +/- 8 beats per minute) and normalizing baroreceptor reflex sensitivity to bradycardia (-2.0 +/- 0.2 beats per minute per mm Hg) and to tachycardia (-4.0 +/- 0.1 beats per minute per mm Hg). Plasma renin activity was also normalized (4.3 +/- 2.4 ng angiotensin I/ml/hr).(ABSTRACT TRUNCATED AT 250 WORDS)

With the aim of determining maternal and newborn levels of catecholamines during birth, we measured simultaneously samples from mother's peripheral vein and umbilical cord in 20 cases. Fifteen births resulted from ceasarean. sections and 5 had vaginal delivery. Maternal age ranged from 20 to 42 years and gestational age varied from 35 weeks. Maternal and newborn outcomes were uneventful. Mean levels of catecholamines (and SD)are shown in the Table below: Obs: Catecholamines were measured by HPLC, * reference range for normal adult controls. According to literature and our own findings, we may conclude that: 1) Fetal sympathoadrenal system is fully mature by birth; 2) The high levels of cord catecholamines sometimes found are the result of adaptative stress to extrauterine life. Instead of representing maternal transfer of catecholamines. The authors acknowledge Hospital Fernando Mauro Pires da Rocha and Hospital e Maternidade Leonor Mendes de Barros for providing the samples.

Background The MASS IV-DM Trial is a large project from a single institution, the Heart Institute (InCor), University of São Paulo Medical School, Brazil to study ventricular function and coronary arteries in patients with type 2 diabetes mellitus. Methods/Design The study will enroll 600 patients with type 2 diabetes who have angiographically normal ventricular function and coronary arteries. The goal of the MASS IV-DM Trial is to achieve a long-term evaluation of the development of coronary atherosclerosis by using angiograms and coronary-artery calcium scan by electron-beam computed tomography at baseline and after 5 years of follow-up. In addition, the incidence of major cardiovascular events, the dysfunction of various organs involved in this disease, particularly microalbuminuria and renal function, will be analyzed through clinical evaluation. In addition, an effort will be made to investigate in depth the presence of major cardiovascular risk factors, especially the biochemical profile, metabolic syndrome inflammatory activity, oxidative stress, endothelial function, prothrombotic factors, and profibrinolytic and platelet activity. An evaluation will be made of the polymorphism as a determinant of disease and its possible role in the genesis of micro- and macrovascular damage. Discussion The MASS IV-DM trial is designed to include diabetic patients with clinically suspected myocardial ischemia in whom conventional angiography shows angiographically normal coronary arteries. The result of extensive investigation including angiographic follow-up by several methods, vascular reactivity, pro-thrombotic mechanisms, genetic and biochemical studies may facilitate the understanding of so-called micro- and macrovascular disease of DM.

OBJECTIVES: Ischemic stroke (IS) or transient ischemic attack (TIA) history is present in 4-17% of patients with coronary artery disease (CAD). This subgroup of patients is at high risk for both ischemic and bleeding events. The aim of this study was to determine the role of platelet aggregability, coagulation and endogenous fibrinolysis in patients with CAD and previous IS or TIA. METHODS: A prospective case-control study that included 140 stable CAD patients divided into two groups: the CASE group (those with a previous IS/TIA, n=70) and the CONTROL group (those without a previous IS/TIA, n=70). Platelet aggregability (VerifyNow Aspirin® and VerifyNow P2Y12®), coagulation (fibrinogen and thromboelastography by Reorox®) and endogenous fibrinolysis (D dimer and plasminogen activator inhibitor-1) were evaluated. RESULTS: Patients in the CASE group presented significantly higher systolic blood pressure levels (135.84±16.09 vs 123.68±16.11, p

The recent emergence of several high sensitivity troponin (hsTroponin) assays has shown that cardiac troponins can be chronically elevated in response to cardiovascular comorbidities and that they confer important prognostic information. In the absence of unstable coronary artery disease