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Background. An active lifestyle is associated with a reduced cardiovascular risk in middle-aged as well as in elderly patients. In the present study, we investigated the association between physical activity habits of elderly participants prior to coronary artery bypass grafting (CABG) and survival free from both all-cause and cardiac death. Methods and Results. Study population consisted of 587 elderly patients ([greater than or equal to]70 years) CABG patients stratified, according to the Physical Activity Scale for the Elderly (PASE), into less active (low PASE) and exercised (high PASE) groups. At follow-up (mean: 44.3 [+ or -] 21.0 months), 33 (37.1%) of 89 total deaths occurred for cardiac causes. Sixty-month survival rate was 65% and 96% for low-PASE and high-PASE groups, respectively (log rank = 49.460. p < .0001). Cox survival analysis indicated a significant (p < .0001) nonlinear association between PASE score increments and improved survival with the most evident differences in the lowest score categories. A robust association was also found between low PASE score and increased cardiac-related mortality (p < .0001). Conclusions. Our data indicate that a more active lifestyle is significantly associated with improved survival in elderly CABG patients. The nonlinearity of the relation suggests that more sedentary patients could have the most benefit on survival by increasing their exercise lifestyle habits. The improved outcome is explained by both cardiac and overall mortality reduction. Key Words: Coronary surgery--Elderly Patients--Physical activity--Prognosis--Physical Activity Scale for the Elderly. doi: 10.1093/gerona/glp216

Downregulation of hypoxia-inducible factor 1 (HIF-1) and vascular endothelial growth factor (VEGF) are shown to be involved in age-dependent impairment of angiogenesis. In this study, we explore whether prior exercise is able to affect these molecular patterns favorably and to enhance neoangiogenesis in old Wistar rats with hind-limb ischemia. At day 7 after surgery, HIF-l[alpha] and VEGF expression increased in the ischemic muscle of trained animals. Exercise increased capillary density and limb perfusion as revealed by histologic, angiographic, and dyed bead techniques. Furthermore, exercise capacity and limb trophism have significantly improved in trained aged rats. In these animals, the reduction of VEGF serum levels has reflected the comprehensive improvement in local ischemia evoked by exercise. In conclusion, prior exercise represents a valid tool to counteract age-related molecular alterations resulting in impaired angiogenesis in response to ischemia.

Serotonin appears to be released during coronary angioplasty and may play a part in blood vessel constriction that occurs in the segment of the artery farthest from the surgery site. Coronary angioplasty is a method of dilating a blocked blood vessel in the heart. Serotonin is a blood vessel constrictor found in blood platelets. Blood samples were taken from 15 patients having coronary angioplasty. Seven of the patients also received ketanserin, which inhibits the action of serotonin. Serotonin levels before surgery averaged 2.3 nanograms per milliliter (ng/ml) in the coronary sinus, a venous channel in the heart, and 2.5 ng/ml in the ascending aorta. Serotonin concentrations in the ascending aorta did not change during surgery. However, serotonin levels increased significantly in the coronary sinus. In the patients not treated with ketanserin, dilation of the segment of the artery farthest from the angioplasty site decreased by 23% after five minutes. In those treated with ketanserin, constriction of the arterial segment farthest from the angioplasty site occurred but to a lesser degree than in those patients not given ketanserin.

To investigate a possible role for serotonin, a substance released from platelets (blood cells essential for clotting), in coronary artery disease, seven patients with coronary artery atherosclerosis (narrowing of the arteries because of the deposition of fatty plaque in the lumen) and seven control patients were studied. Under angiographic guidance (in which X-rays are taken of the vessels after a dye is injected), several variables related to blood flow within a coronary artery were measured before and after the infusion of serotonin or ketanserin (a substance that blocks the effects of serotonin by interfering with its molecular receptor). Results showed that the coronary arteries of patients without atherosclerosis responded to serotonin by dilating, with an increase in cross-sectional area of 52 percent at the highest dose. This was associated with a 58 percent increase in the coronary blood flow. However, arteries of patients with atherosclerotic lesions constricted in response to serotonin, decreasing their cross-sectional area by an average of 64 percent. This response was associated with decreased coronary blood flow. Hypotheses are presented concerning the ways these effects might be mediated: data from the ketanserin trials helped determine which subtypes of serotonin receptor mediate the vasodilating and vasoconstrictive effects. It seems likely that vasodilation in the nondiseased arteries is the consequence of type 1 receptor activation, while vasoconstriction in damaged atherosclerotic arteries results from activation of type 2 receptors. One clinical implication of these results is that serotonin and other substances derived from platelets may play a role in some acute coronary ischemic disorders (disorders where the heart does not receive enough blood). Treatment could include drugs that antagonize type 2 serotonin receptors. (Consumer Summary produced by Reliance Medical Information, Inc.)

Contrast agents are compounds used to enhance the contrast of images obtained with angiography, X-ray imaging of blood vessels. Formerly, hyperosmolar agents, which had high levels of dissolved substances, were associated with harmful effects on blood pressure and heart muscle contractility. New, low-osmolar agents have been developed; some are ionized, or charged, and paired with sodium ions, while others are nonionic. Some studies suggest that ionized low-osmolar agents such as ioxaglate produce fewer disturbances in the rhythm of heart beat than nonionic contrast agents such as iopamidol. Ioxaglate contains levels of sodium ions which are similar to physiological levels. The effectiveness and side effects of ioxaglate and iopamidol were evaluated in 50 patients who had symptoms of ischemic heart disease. Hemodynamic (blood vessel and heart pumping parameters) changes, diagnostic effectiveness, and side effects were similar in groups given either agent. However, patients given iopamidol developed significantly more arrhythmias in ventricular beats. The study suggests that both agents are safe and effective contrast agents, but iopamidol is associated with a greater risk of ventricular arrhythmias, possibly due to its lack of sodium ions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Abstract Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography.