bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Trimetazidine on Heart Rate Variability and Left Ventricular Systolic Performance in Patients with Coronary Artery Disease After Percutaneous Transluminal Angioplasty
Authors: Birand Ahmet , Kudaiberdieva Gulmira Z. , Batyraliev Talantbek A. , Akgul Ferit , Usal Ayhan
Published: July 2008

Fifty-one patients (mean age 51.6 ± 7.1 years) with angiographically proven coronary artery disease (CAD) entered the study. In 26 patients (Group I), trimetazidine treatment started twenty-four hours after percutaneous transluminal coronary angioplasty (PTCA). Another 25 patients (Group II) without trimetazidine treatment were kept as controls. The groups were comparable by age, gender, risk factors of CAD, coronary anatomy, left ventricular performance, and heart rate variability indices at baseline state.

Power spectral analysis of heart rate variability and two-dimensional and Doppler echocardiographic examinations were performed before PTCA, and twenty-four hours, ten days, thirty days, and three months after PTCA.

A statistically significant improvement of left ventricular systolic performance (P<0.001), augmentation of the parasympathetic band of heart rate variability (P<0.001), and decline of P1/P2 ratio (P<0.01) were evident in patients treated with trimetazidine, while no apparent changes were observed in controls. The intergroup analysis also showed marked difference between groups as recorded on the day 30 and month 3 of observation (P<0.001). During follow-up period recurrences of angina pectoris and ischemia were registered in Group II, while no evidence of ischemia was discerned in Group I patients.

In conclusion, trimetazidine modulates the autonomic control of heart rate, ie, reduces sympathetic overactivity and augments vagal influences, improves left ventricular contractility, and diminishes the clinical manifestations of ischemia in patients with CAD after PTCA.
Cardiac Trauma
Authors: Olsovsky Mary R. , Wechsler Andrew S. , Topaz On
Published: July 2008

In cardiac trauma the two main mechanisms of injury are blunt and penetrating trauma. Common cardiac effects of trauma include myocardial rupture, contusion, laceration, pericardial insult, coronary injury, valvular damage, arrhythmias, and conduction abnor malities. Hemodynamic instability can develop rapidly and pose marked risk to patient survival. An adequate level of clinical awareness and timely use of diagnostic techniques such as echocardiography, aortography, and cardiac angiography are essential for rapid identification of cardiac trauma. Once the diagnosis is made, prompt surgical intervention is often the key to survival.
Successful Treatment of Intermittent Claudication Due to Spinal Canal Stenosis Using Beraprost Sodium, a Stable Prostaglandin I2 Analogue
Authors: Kato Hiroyuki , Emura Sei , Ngashima Kiyoko , Kishikawa Hayato , Takashima Toshinobu , Ohmori Keizo
Published: July 2008

The syndrome of intermittent claudication can be induced not only by vascular insuffi ciency of the lower limbs but also by diseases of the spinal cord and cauda equina. The authors describe a sixty-year-old man with intermittent claudication due to spinal canal stenosis who was successfully treated with beraprost sodium, a stable prostaglandin I2 analogue. This drug has a long biological half-life and is orally effective in vasodilation, which is suggested to be beneficial in treating this syndrome. Beraprost sodium may become one of the major drugs for conservative therapy of intermittent claudication induced by spinal canal stenosis.
Acute Rheumatic Fever in an Arabian Gulf Country Effect of Climate, Advantageous Socioeconomic Conditions, and Access to Medical Care
Authors: Eltohami Eltohami Ahmed , Hajar Hajar Ahmed , Folger Gordon M. , Eltohami Eltohami Ahmed
Published: July 2008

An eleven-year study of the incidence and consequences of acute rheumatic fever was carried out in a country in which a uniform climate together with national characteristics of insularity, wealth, and unrestricted access to free medical care contribute prominently to the epidemiologic milieu. Study subjects were 86 children, aged four to fourteen years, satisfying criteria for acute rheumatic fever. Study methods included clinical evaluation, standard laboratory studies, and echocardiography. A declining incidence of rheumatic episodes, ranging from 1.06 to 18.6/100,000 population (average 11.2/100,000), was identified. The course of the episode was generally mild. Arthritic findings predominated (92%), followed by carditis identified clinically in 43% and, with the addition of echocar diography, in 71%. Residual valvular regurgitation, as a longer term consequence, persisted in 46% of those with auscultatory confirmation of valvulitis. No recurrences were identified. Comparison with countries of similar socioeconomic status revealed rela tively unimportant differences. Comparison with nearby disadvantaged countries identi fied striking contrast. It may be concluded that among the contributing factors, for the improvement in the incidence and sequelae of a rheumatic episode, are an advantaged socioeconomic environment and accessibility to unlimited medical care.
Management of Abdominal Aortic Prosthetic Graft Infection Requiring Emergent Treatment
Authors: Mingoli Andrea , Sapienza Paolo , di Marzo Luca , Sgarzini Giovanna , Burchi Claudia , Modini Claudio , Cavallaro Antonino , Mingoli Andrea
Published: July 2008

The purpose of this study was to investigate mortality and morbidity rates and long-term outcome of patients who underwent emergency treatment of abdominal aortic prosthetic graft infection.

Between January 1984 and December 1993, 18 men aged fifty-nine ±sixteen years were operated on as an emergency for an acute life-threatening complication of aortic prosthetic graft infection. The grafts had been implanted for abdominal aortic aneurysm in 9 patients and aortoiliac occlusive disease in 9, from one to one hundred seventy months previously. Five (28%) patients presented with a hemorrhagic shock due to a fistula between the vascular reconstruction and the small bowel (4 patients) or the right ureter (1 patient) and 13 (72%) had generalized sepsis. The grafts were always radically explanted. Extraanatomic revascularization procedures included 6 axillopopliteal and 12 axillofemoral bypass grafts. Operative mortality was 39% (7 patients), and 3 (9%) limbs were amputated within thirty days. Two (11%) patients died after seven and twelve months, respectively, of septic complications, and 1 (5%) patient died after six months from an unrelated cause. Eight (73%) patients are still alive at a mean follow-up of fifty ±thirty-four months, but in 3 the extraanatomic bypass was removed for infection and 5 major amputations were performed. Two-year survival and limb salvage rates were 44% and 50%, respectively.

Aortic prosthetic graft infections that require emergent treatment continue to demon strate high early and late mortality and limb loss rates despite aggressive intervention and limb salvage procedures. Newer methods of managing these complications should continue to be investigated.
Predictive Value of Left Ventricular Response to Exercise in Patients with Dilated Cardiomyopathy
Authors: Suzuki Tadashi , Kanda Tsugiyasu , Nagaoka Hideki , Kubota Sachio , Iizuka Toshio , Nagai Ryozo , Kobayashi Isao , Suzuki Tadashi
Published: July 2008

The objective of this study was to determine noninvasively the likelihood of recovery of the left ventricular ejection fraction (LVEF) in patients with dilated cardiomyopathy (DCM) verified by radionuclide ventriculography. Twenty patients with DCM were clas sified into two groups according to the LVEF by M-mode echocardiographic findings two years after ventriculographic examination. The LVEF recovered to ≥ 50% in 10 patients (Group A), while it was sustained at < 50% in 10 patients (Group B). The clinical features of each group were compared, based on results of physical examination, radionuclide ventriculography, and other diagnostic tests performed on their referral to hospital. Only the systolic blood pressure differed significantly between the two groups, being slightly, but significantly, increased in Group A over that in Group B (P < 0.05). LVEF at rest by radionuclide did not differ (Group A: 31.5 ±10.3% vs Group B: 26.5 ±9.4%). Peak exercise EF-EF at rest (peak Δ EF) in Group A was apparently increased (3.4 ±4.0%), while that in Group B was decreased (-4.4 ±5.2%). The positive peak Δ EF had a highly predictive value of 90% for patients with DCM whose LVEF will recover to more than 50%. The recovery EF-EF at rest did not differ significantly between groups (Group A: 8.4 ±4.7 vs Group B: 3.9 ±2.3, P < 0.05). Other clinical parameters such as functional class, cardiothoracic ratio, LVEF by echocardiography, cardiac index by Swan-Ganz catheter examination, and histologic examination of biopsied endocardium were indistinguish able in the two groups. The authors conclude that peak Δ EF of radionuclide ventricu lography on exercise indicates a preservation of LVEF and predicts a good clinical recovery in patients with DCM.
Transcranial Doppler Velocities in Patients with Thromboangiitis Obliterans
Authors: Matchev Stefan , Petrov Vesselin , Batchvarova Vera , Maljakova Anastasia , Doneva Svetlana , Matchev Stefan
Published: July 2008

The idea of cerebrovascular injury in cases of thromboangiitis obliterans was not strange to Leo Buerger, but Jäger (1932), as well Lindenberg and Spatz (1939), first established it.

The aim of this study was to investigate the hemodynamics in the basal cerebral arteries by means of transcranial Doppler in patients with thromboangiitis obliterans. Thirty patients (all men; average age 40.03 ±16.4 years) were included—one group twenty-four to forty years of age and another group forty-one to fifty years of age.

The results show that the blood flow velocities in middle and anterior cerebral arteries in both groups of patients were significantly lower than in healthy persons. The trends towards reduction of blood flow velocity were also evident in posterior cerebral arteries. The authors describe in detail 2 patients who suffered major ischemic stroke.

Cerebrovascular disorders in Buerger's disease are probably more frequent than supposed and have to be taken into account.
Predictive Validity of the Braunwald Classification of Unstable Angina for Angiographic Findings, Short-Term Prognoses, and Treatment Selection
Authors: Owa Mafumi , Origasa Hideki , Saito Muneyasu , Owa Mafumi
Published: July 2008

The authors tested the Braunwald classification for its predictive validity for underlying coronary conditions, clinical courses, and responses to treatment. A reliable definition and classification of unstable angina is needed to help physicians make correct diagnoses of patients' conditions and to appraise findings from clinical trials critically. Many clinical trials have been conducted, but it is difficult to compare the results because of different entry criteria. Of 113 consecutive patients admitted with unstable angina, 89 who had primary angina were studied. Braunwald's classification was applied at admission: The outcomes of interest during hospitalization were coronary angiographic findings, short- term prognoses, and the treatment selected. Multivariate analysis showed that the severity class expressed significant positive predictivity for coronary thrombi (adjusted odds ratio [OR], 6.53; 95% confidence interval [CI], 2.82 to 15.1) and progress to impending infarction (OR, 10.43; CI, 3.35 to 32.49). The treatment (OR, 0.02; CI, 0.004 to 0.08) and electrocardiographic (OR, 0.22; CI 0.10 to 0.49) classes showed independent negative predictivity for coronary vasospasm. The treatment (OR, 3.50; CI, 1.94 to 6.33) and electrocardiographic (odds ratio, 3.27; CI, 1.87 to 5.71) classes showed positive predictivity for the necessity for recanalization treatment with coronary angioplasty or bypass grafting. The Braunwald classification used at admission is highly predictive of underlying coronary conditions, progression to impending infarction, and the final selection of treatment. This classification should be considered in determining patient eligibility in clinical trials and studies.
Posterior Right Diagonal Artery
Authors: Margaris Nikolaos G. , Kostopoulos Konstantinos G. , Nerantzis Christos E. , Filippatos Gerasimos S. , Kardaras Fotis G. , Salahas Anastasios I. , Antonellis John P. , Ifandis George P. , Kranidis Athanassios I. , Tavernarakis Anthony G. , Margaris Nikolaos G.
Published: July 2008

The purpose of this prospectively performed study was the angiographic visualization of the posterior right diagonal artery (PRDA) and its differentiation from the epicardial branches of the right coronary artery (RCA), that is, the right marginal artery and the posterior descending artery (PDA).

The authors prospectively studied the angiographic findings of 607 patients who underwent coronary angiography. The incidence of the angiographically demonstrated PRDA and its distinction from other epicardial branches arising from the distal third of the RCA was the main point of interest. Two types of PDA in those cases where PRDA was present were also demonstrated.

Of the patients examined, 535 had dominant right coronary circulation, 59 had left dominant coronary circulation, and 13 had balanced coronary circulation. PRDA was present in 81 patients with right dominant coronary circulation (15.1%), in 2 patients with balanced coronary circulation (15.4%), and in none with left dominant coronary circulation. PRDA was revealed in 48 (40%) of 120 patients with a short PDA and in only 33 (8%) of 415 patients having long PDA.

It is imperative to search always for the PRDA, when one is studying coronary arte riographies, bearing in mind that this artery may perfuse the inferior part of the posterior interventricular septum and the adjoining area, depending on the type of PDA.
An Ovine Model of Acute Myocardial Infarction and Chronic Left Ventricular Dysfunction
Authors: Rogers Sandra Jane , Charles Christopher John , Sands Jennifer , Richards Arthur Mark , Bridgman Paul Gavin , Gooneratne Ravi , Ikram H.
Published: July 2008

In order to develop and validate an ovine model of myocardial infarction with subse quent impairment of left ventricular function, 15 instrumented sheep underwent selective microembolization of the left coronary arteries with 0.5 mL 90 micron polystyrene beads. Hemodynamics and plasma hormones were measured preembolization (baseline) and then at hours 2, 4, 6, and 12 and days 1, 2, 3, 5 and 7 postembolization. Of the 15 sheep studied, 2 (13%) died on the day of embolization from arrhythmias. In the remaining sheep, left ventricular systolic pressure and stroke work (both P<0.001 ) were reduced promptly and remained below basal levels. Mean arterial pressure (P<0.001) increased initially, then decreased to below basal levels by hour 6. Heart rate (P<0.001) and left atrial pressure (P<0.05) were increased while cardiac output was decreased (P<0.05). Left ventricular ejection fraction at day 7 was reduced (38.8 ±3.5 vs 46.0 ±3.9% preem bolization ; P<0.05). The cardiac enzymes creatine kinase (P<0.001) and troponin-T (P< 0.001) were increased following microembolization and returned to basal levels by days 2 and 5 respectively. Plasma atrial and brain natriuretic peptides (both P< 0.001) and plasma renin activity (P<0.005) were all increased following embolization. This ovine model mimics the hemodynamic and neurohumoral features of acute myocardial infarction, resulting in left ventricular dysfunction, and should prove suitable for the study of interventions in a number of these conditions.
Effect of Thromboxane A2 Synthetase Inhibitor on Metabolism and Contractility in Ischemic Reperfused Rabbit Heart
Authors: Kawabata Hitoshi , Ryomoto Teruhiko , Katori Ryo , Kawabata Hitoshi
Published: July 2008

The effect of thromboxane A2 synthetase inhibitor (OKY-046) on myocardial metabolism and contractility during ischemia and reperfusion was examined by the phosphorus 31- nuclear magnetic resonance (31P-NMR) in Langendorff rabbit hearts with use of an arti ficial blood substitute, perfluorochemical emulsion Fluosol-43. After normothermic fifteen-minute global zero-flow ischemia or fifteen-minute global low-flow ischemia (coronary perfusion pressure = 20 mmHg), reperfusion of sixty minutes was carried out. OKY-046 was administered from forty-five minutes prior to the global ischemia. Adenosine triphosphate (ATP), creatine phosphate (CrP), inorganic phosphate (Pi), pH, left ventricular systolic developed pressure (LV Dev.P) and coronary flow were continu ously measured. Twenty-eight hearts were divided into four experimental groups consisting of 7 hearts each; Group I consisted of controls with zero-flow ischemia; Group II, perfusion with OKY-046 (10-6 M) in zero-flow ischemia; Group III, controls with low- flow ischemia; and Group IV, perfusion with OKY-046 in low-flow ischemia. Group II showed a significant inhibition of the increase in Pi and of the decrease in ATP, CrP, and pH during global ischemia compared with Group I, and a suppression of the overshoot of CrP observed after postischemic reperfusion. Group IV also showed a significantly marked improvement of ATP, CrP, and pH and significant suppression in Pi during low-flow ischemia compared with Group III. There were no differences in LV Dev.P and coronary flow among any groups. In conclusion, OKY-046 has a significantly beneficial effect on metabolism during both myocardial ischemia and reperfusion.
Postoperative Mitral Valve Abscess
Authors: Pamidi Srinivas , Leo Paul J. , Saul Barry , Gelles Jeremiah , Chu David , Leo Paul J.
Published: July 2008

The authors report a case of a patient with postoperative perimitral bioprosthetic abscess and probable systemic embolization. The location of the abscess is not common and the use of porcine bioprostheses is supposedly associated with a low rate of embolic compli cations. Because of the high mortality and morbidity, it is stressed that patients with prosthetic valve endocarditis should be managed aggressively with surgery.
Hemodynamic Changes in the Lower Limbs During Treadmill Walking in Normal Subjects and in Patients with Arteriosclerosis Obliterans
Authors: Baccelli Giorgio , Reggiani Paolo , Mattioli Alessandro , Corbellini Ezio , Garducci Stefano , Catalano Michele , Omboni Stefano , Baccelli Giorgio
Published: July 2008

The effects of arteriosclerosis obliterans on the hemodynamic changes that occur during walking are largely unknown. For this reason, the authors measured blood pressure by transducer from the posterior tibial artery and vein at both ankles in 23 patients with arteriosclerosis obliterans of different severity and at the left ankle in 8 normal subjects. Radial artery pressure was also measured, and the differences between mean radial and ankle arterial pressures (pressure gradient) and between mean arterial and venous ankle pressures (foot perfusion pressure) were calculated. All measurements were made simul taneously and continuously during standing, treadmill walking at five different speeds, and during recovery. Compared with the normal subjects, the patients exhibited a greater pressure gradient and lower ankle arterial pressure and foot perfusion pressure at rest. During walking and recovery these intergroup hemodynamic differences were markedly enhanced, and ankle venous pressure was lower in the patients than in the normal subjects. In the patients the hemodynamic pattern depended on disease severity at rest and on both disease severity and walking speed during walking and recovery.
Physical Activity is Related to Ankle/Brachial Index in Subjects Without Peripheral Arterial Occlusive Disease
Authors: Gardner Andrew W. , Sieminski Debra J. , Montgomery Polly S. , Gardner Andrew W.
Published: July 2008

The purpose of this study was to determine whether physical activity level was directly and independently related to the ankle/brachial systolic blood pressure index (ABI) in subjects without peripheral arterial occlusive disease (PAOD). A total of 353 subjects between the ages of 38 and 88 years (63.7 ±9.1 years; mean ±standard deviation) who had ABI values ≥1.00 were studied. The sample consisted of 230 men and 123 women, of whom 274 were caucasian and 79 were African-American. Subjects were characterized on blood pressure, physical activity level from validated questionnaires, anthropometry, plasma lipoprotein lipids, and smoking history. The ABI (1.16 ±0.13) was related to physical activity obtained from the Minnesota Leisure Time Physical Activity (LTPA) ques tionnaire (r=0.413, P<0.001). Multiple regression analysis identified race, hyperten sion, current smoking status, and body mass index (BMI) as cardiovascular risk factors that were independently related to ABI. After controlling for these variables, the rela tionship between ABI and physical activity persisted (partial r=0.329, P<0.001). Thus, physical activity was positively related to ABI in subjects free of PAOD, and the relation ship between physical activity and ABI persisted after controlling for race, hypertension, current smoking status, and BMI. It is concluded that adopting a physically active lifestyle is associated with a reduced risk of developing PAOD.
Relationship Between Ultrasound Assessment of Arterial Wall Properties and Blood Pressure
Authors: Wada Takashi , Fujishiro Kentaro , Fukumoto Tsutomu , Yamazaki Sayaka , Wada Takashi
Published: July 2008

Physical properties of an artery can be described in terms of stiffness, distensibility, and compliance. Changes in these properties can predict atherosclerosis disease, but it is necessary to identify an index that is independent of changes in blood pressure. We measured common carotid artery diameter and pulsatile change with an ultrasonic phase- locked, echo-tracking system in 7 subjects whose mean brachial blood pressure had varied 15 mm Hg or more within a month. Patients taking antihypertensive agents were excluded from the study. We measured changes in arterial diameter (n=41) at least four times during the study period and calculated the pressure-strain elastic modulus (Ep), distensibility coefficient (DC), cross-sectional compliance (CC) and stiffness parameter (β) from inner diameter, its pulsatile change, and blood pressure. The correlation coeffi cients of mean blood pressure with each index are as follows: Ep, 0.53; DC, 0.58; CC, 0.63; β, 0.21. When mean blood pressure increased 1 mm Hg, the change in each index at 100 mm Hg was as follows: Ep, 1.48 ±1.30%; DC, -1.05 ±0.97%; CC, -0.69 ±0.90%; β, 0.45 ±1.11%. Among the four indices that measure the properties of the arterial walls, stiffness parameter β was the least dependent on blood pressure. Thus, it appears to have usefulness as an index of arterial wall sclerosis.
ET-1 Plasma Levels During Cold Stress Test in Sclerodermic Patients
Authors: Danese Chiara , Parlapiano Claudio , Zavattaro Emilia , Di Prima MariaAnna , Campana Elisabetta , Rota Cinzia , Tonnarini Gianfranco , Di Siena GianLuca , Borgia M.C.
Published: July 2008

Endothelial cell injury in blood vessels of small arteries and capillaries is considered the primary event in the pathogenesis of systemic sclerosis (SSc). Because endothelin-1 (ET-1) is mainly released in the site of endothelial cell damage, thereby inducing a potent vasoconstriction, it was our intention to study ET-1 release in a group of SSc patients during a cold pressor test (CPT). Twelve SSc patients and a control group of 10 healthy subjects underwent CPT. Blood samples for ET-1 assay were collected at 90 and 180 seconds of exposure to cold stress. Heart rate and blood pressure were recorded at the same intervals. A capillaroscopic examination was performed in both groups before and after CPT.

We observed significantly higher levels of plasma ET-1 in SSc patients compared with those of the control group at baseline (P=0.007) and at 90 (P=0.006) and 180 seconds (P=0.03) of CPT. During the test, the capillaroscopic examination showed a dramatic worsening of the vascular picture that was parallel to the increase in ET-1 plasma levels. This suggests that higher ET-1 plasma levels can have a part in the acute vascular reac tivity of SSc patients undergoing CPT.
The Coronary Angiogenetic Effect of Heparin: Experimental Basis and Clinical Evidence
Authors: Bombardini Tonino , Picano Eugenio , Bombardini Tonino
Published: July 2008

Heparin is a highly sulfated polysaccharide consisting of a repeating disaccharide structure as found in other glycosaminoglycanes. The intravenous and subcutaneous formulation of the drug is routinely used for its well-known, time-honored antithrombotic effect. However, available evidences linking heparin to angiogenesis raise the possibility of a therapeutically relevant antiischemic effect of the drug. Molecular biology data show that in a hypoxic milieu heparin could facilitate angiogenesis through interactions with a family of polypeptide growth factor mitogens that stimulate endothelial cell prolifera tion. Experimental data suggest that heparin can augment collateral circulation when combined with other potentially angiogenetic factors, such as repeated ischemia, coronary occlusion, or physical exercise. Clinical data, although very initial, encompassing a total of only 41 heparin-treated patients with coronary artery disease, suggest that heparin facilitates collateral development stimulated by exercise-induced myocardial ischemia in humans.

According to the heparin-collateral hypothesis, the mechanism of action of heparin as an antiischemic medication would be independent of its anticoagulant action. The molecular targets of heparin are Factor Xa and IIa for antithrombotic action, heparin- binding growth factors (including fibroblast growth factor and vascular endothelial growth factor) for angiogenesis. The antithrombotic effect is not linked to a cellular target, whereas the angiogenetic effect directly stimulates endothelial cells. The molecular cofactor required for effect is antithrombin III for antithrombosis, and possibly endogenous adenosine for angiogenesis. The therapeutic effect is achieved within minutes or hours for antithrombosis, and within weeks or months for angiogenesis.
Symptomatic Reinfarction of a Previously Silent Myocardial Region Four Months After Successful Reperfusion
Authors: Vrachatis Antony D. , Alpert Martin A. , Nikas Dimitris J. , Papapanyiotou Vasilis A. , Deftereos Spiros G. , Zacharoulis Apostolos A. , Alpert Martin A.
Published: July 2008

Coronary collateral circulation helps to preserve myocardial perfusion distal to severely stenotic or totally obstructed coronary arteries. The presence or absence of angina pectoris and the state of myocardial function depend on the extent of collateralization and its functional contribution to myocardial blood flow. Clinical and experimental obser vations have suggested that newly developed collaterals usually remain even after successful revascularizaton. The authors present a case of a patient with extensive inter- coronary collaterals and hibernating myocardium after an acute inferior wall myocar dial infarction who underwent successful percutaneous transluminal coronary angio plasty of a totally obstructed, dominant right coronary artery and then experienced extensive reinfarction following reocclusion 4 months later. This case demonstrates failure of extensive collaterals to prevent acute myocardial infarction.
Acetylcholine-Induced Coronary Microvascular Vasospasm in a Patient with Angina Pectoris and Normal Coronary Angiogram
Authors: Maeda Norikazu , Hiraoka Hisatoyo , Nakamura Tadashi , Matsuura Fumihiko , Ouchi Noriyuki , Nakata Atsuyuki , Kobayashi Hitoshi , Yamashita Shizuya , Kameda-Takemura Kaoru , Matsuzawa Yuji , Nakamura Tadashi
Published: July 2008

We demonstrated a continuous intracoronary infusion of acetylcholine-induced marked decrease of coronary blood flow estimated by intracoronary Doppler flow wire without significant epicardial coronary narrowing. This case can be called a patient with microvas cular vasospastic angina.
Simultaneous Presence of a Large Coronary Aneurysm and Ectasia in a Young Patient with Myocardial Infarction
Authors: Sharifi Mohsen , Murdock David K. , Engelmeier Richard S. , Logemann Timothy N. , Hoffmann Mark T. , Olson Karen
Published: July 2008

Idiopathic or congenital coronary artery ectasias and aneurysms are uncommon forms of coronary artery disease. The prognosis and optimal management of such patients remains unknown. The authors describe the case of an otherwise healthy 30-year-old man with concomitant severe right coronary artery ectasia and left main coronary artery aneurysm who sustained a mild anterior myocardial infarction. There was no obstructive coronary artery disease, and no cause for the lesions could be identified. Chronic anticoagulation and antiplatelet therapy were initiated with resolution of symptoms.
Eosinophilic Myocarditis Complicated by Acute Myocardial Infarction
Authors: Yamashita Kazuhito , Nakamura Tsugihiro , Iio Katsumi , Nakashima Yasuhide , Yamashita Kazuhito
Published: July 2008

The authors report a patient with eosinophilic myocarditis who developed severe chest pain with marked elevation of the ST segment on the electrocardiogram, which led them to suspect the presence of acute myocardial infarction. Emergency coronary angiography showed numerous occlusions and stenoses at the distal right and left coronary arteries, especially affecting the latter, owing probably to thrombus. The angiographic findings in this case demonstrate the formation and obstruction of thrombus in the small coronary arteries in a patient in the acute necrotic stage of eosinophilic myocarditis, believed to be the first such case reported.
Heparin-Induced Extracorporeal Fibrinogen/LDL Precipitation (HELP): A Promising Regimen for the Treatment of Vascular Diseases
Authors: Walzl Manfred , Walzl Berengaria , Haas Anton , Walzl Manfred
Published: July 2008

Current management of atherosclerotic diseases consists primarily of medical therapy designed to increase oxygen supply to the heart, the brain, retinal vessels, or lower limbs. The development of these diseases is based on atherosclerotic changes induced by risk factors such as elevated levels of fibrinogen and lipoproteins. These risk factors are related to a dramatic deterioration of the hemorrheologic pattern, which reduces perfusion. Consequently, attempts are now being made to treat ischemia via hemorrhe ological intervention. A new treatment modality utilizing the heparin-induced extracor poreal low-density lipoprotein (LDL) precipitation (HELP), offers the possibility of obtaining therapeutic success not only in cases of severe hypercholesterolemia but also in the field of hemorrheology. With HELP a safe and rapid reduction of fibrinogen and lipid fractions has become feasible, thus providing acute improvements of red cell aggregation, of the filterability of blood cells, of whole-blood and plasma viscosity, and thereby of microcirculation. Because cerebrovascular diseases are known to be related to distur bances of the hemorrheological situation, the HELP system is used in the Department of Electrobiology of Graz for the treatment of acute stroke, cerebral multiinfarct disease, and occlusions of retinal arteries.
Evaluation of Normal Hemodynamic Profile of Carbomedics Prosthetic Valves by Doppler Echocardiography
Authors: Chakraborty Barendra , Quek Susan , Ding Zee Pin  , Chee Tek Siong  , Tan Ley Kheng  , Chakraborty Barendra
Published: July 2008

The authors investigated 163 CarboMedics bileaflet prosthetic valves—81 mitral pros theses (MP), and 82 aortic prostheses (AP)—to determine acceptable pressure gradients across normally functioning prostheses and effective mitral valve orifice (MVO) area by Doppler echocardiography. In MP, the mean gradient was 3.6 ± 1.7 mm Hg, peak trans- mitral gradient was 8.7 ±3.7 mm Hg, and mean effective valve area was 2.3 ±0.7 cm2. There was a significant overlap in mean and peak transaortic gradients even with valves of the same size. In AP, the mean gradient was 14.7 ±5.1 mm Hg and peak pressure gradient was 26.1 ±8.2 mm Hg. They observed a weak inverse correlation between valve size and gradients in AP. Mean and peak pressure gradients tended to be higher with smaller valve sizes, but differences were statistically significant (P < 0.5) only when they compared the smallest vs the largest valves. Trivial to mild regurgitation was detected in 28.4% of MP and 54.8% of AP. From the data they conclude that CarboMedics valves offer relatively little resistance to forward flow, both in the mitral and aortic positions, and their hemodynamic profile is comparable to that of the St. Jude bileaflet valves described in published literature.
Brachial Artery Flow Pattern and Clinical Backgrounds in Patients with Angina Pectoris
Authors: Sugawara Hirobumi , Kubota Isao , Tomoike Hitonobu , Kubota Isao
Published: July 2008

Blood flow velocity of the brachial artery was measured noninvasively by ultrasound pulsed Doppler technique under the guidance of a B-mode ultrasound image in 56 patients with angina pectoris. There was no significant stenosis along the brachial artery on a B-mode image. The authors investigated seven clinical backgrounds for each patient, ie, age, gender, absence or presence of smoking, hyperlipidemia, diabetes mellitus, hyper tension, and the number of significantly stenosed (≥50%) coronary arteries. Among these variables, the determinants of the brachial artery velocity profile were selected by stepwise multiple regression analysis. Selected variables were the presence of hyperten sion for peak systolic velocity (R=0.276), age and the number of diseased vessels for peak reverse velocity (R=0.624), and age for peak diastolic velocity (R=0.609). The peak systolic velocity was larger in patients with hypertension than in those without it (0.565 ±0.023 vs 0.490 ±0.013 m/see, P<0.05), and the peak reverse velocity was larger in patients with multivessel disease than those without it (-0.117 ±0.071 vs -0.053 ±0.081 m/sec, P<0.01). Thus, the level of flow velocity of the brachial artery in patients with angina pectoris was partly determined by age, hypertension, and severity of coronary artery disease. The simple measurement of brachial artery flow velocity suggests changes in peripheral vasculature related to atherosclerosis.
Vasoconstriction During Acute Hypervolemic Hemodilution in Hypertensive Patients is Not Prevented by Calcium Blockade
Authors: Wysocki Marian , Andersson Ove K. , Persson Bengt , Bagge Ulf
Published: July 2008

The reduction of blood viscosity by moderate acute hypervolemic hemodilution in untreated hypertensives can be associated with a secondary vasoconstriction. The aim of this study was to examine whether a vasodilating therapy prevents this hemodynamic reaction.

Twelve hypertensive patients (WHO stage II) were treated with the vasoselective calcium channel blocker isradipine in a placebo-controlled, double-blind, crossover study. Acute hypervolemic hemodilution was performed twice: at the end of the placebo period and after two months of treatment. Hemodilution was achieved by the intravenous infusion of 1000 mL saline over a 10- to 15-minute period. Arterial blood pressure, heart rate, cardiac output (dye dilution), renal blood flow, glomerular filtration, natriuresis, hemat ocrit, whole blood, and plasma viscosity were assessed before and after infusion. Flow resis tance and vascular hindrance in the central and renal circulation were calculated.

Acute hemodilution associated with a significant reduction of blood (P<0.01) and plasma (P<0.01) viscosity did not influence the mean arterial pressure and cardiac output. Consequently, the total flow resistance remained unchanged. However, as a result of hemodilution, the calculated vascular hindrance index in the systemic circulation increased, indicating a vasoconstrictive reaction, both with placebo (from 5.22 to 6.07 U x mPa-1 x s-1, P < 0.05) and during chronic treatment with calcium blockade (from 3.75 to 4.22 U x mPa-1 x s-1, P<0.02). Vasoconstriction was not observed in the renal circula tion, either during the placebo or active treatments.

The results of this study indicate that the systemic vasoconstriction evoked by the acute moderate hypervolemic hemodilution in hypertensive patients was not prevented by a calcium channel blockade.
Anticoagulants in Takayasu's Arteritis Associated with Crescentic Glomerulonephritis and Nephrotic Syndrome
Authors: Iwane Masataka , Nakamura Yasuko , Nishio Ichiro , Arita Mikio
Published: July 2008

The authors describe a 46-year-old Japanese woman who had Takayasu's arteritis asso ciated with nephrotic syndrome due to mesangial proliferative glomerulonephritis with crescent. Although a few cases of focal and segmental mesangial proliferative glomeru lonephritis associated with Takayasu's arteritis have been reported, nephrotic syndrome has not been reported previously in this situation.
Percutaneous Excimer Laser Angioplasty of Lower Limb Vessels: Results of a Prospective 24-Month Follow-up
Authors: Visonà Adriana , Perissinotto Claudio , Lusiani Luigi , Bonanome Andrea , Pesavento Raffaele , Miserocchi Luigi , Liessi Guido , Pagnan Antonio
Published: July 2008

The aim of this prospective study was to assess the effectiveness and the long-term patency effect of excimer laser angioplasty in peripheral arterial obstructive disease. Seventy-eight patients referred for excimer laser angioplasty of lower limbs have been followed up for up to 24 months. Ankle/brachial systolic pressure index, color Doppler mapping, and arterial digital subtraction angiography were performed. Immediate proce dural success was achieved in a high percentage of patients (97%). Balloon angioplasty was also used in 85% of patients. Early reocclusions occurred in 8% of patients. The cumulative patency rate was 47% at the 12-month interval and 40% at the 24-month interval. Poor runoff and the length of the lesions negatively influenced the outcome. Excimer laser angioplasty is an effective procedure, indicated in selected patients showing < 10 cm occlusions and good runoff.
Hepatic Infarction Caused by an Embolus from an Atherosclerotic Lesion
Authors: Ueda Takashi , Mizushige Katsufumi , Izumi Yoshinari , Tsuda Yoshiyashu , Sakamoto Haruhiko , Matsuo Hirohide
Published: July 2008

Although it has been reported that emboli from atherosclerotic disease may be more frequent than commonly appreciated, hepatic infarction caused by an arterial embolus is an unusual but serious complication. The authors describe a patient who had a secondary liver infarct during anticoagulant treatment for cerebral infarction. The thrombus causing the liver infarction was detected as a low echoic mass by transesophageal echocardiog raphy at the right coronary sinus.
Reliability Study of the Leg-O-Meter, an Improved Tape Measure Device, in Patients with Chronic Venous Insufficiency of the Leg
Authors: Berard Anick , Kurz Xavier , Zuccarelli Francois , Ducros Jean-Jacques , Abenhaim Lucien
Published: July 2008

The objective of this study was to evaluate the inter-rater reliability of the Leg-O-Meter, an instrument designed to measure the ankle or calf circumference. The Leg-O-Meter consists of a tape measure fixed to a stand attached to a small board on which the patient is in standing position. For this study the tape measure of the Leg-O-Meter was fixed at 10 cm from the board in order to standardize all measurements. Informed consent to participate in the study was obtained from 39 patients consulting the phlebology clinic of Hôpital St-Michel, Paris, France. Participants were asked to enter a closed room where four independent and blinded observers consecutively took measurements of both legs with the Leg-O-Meter. The order of the observers was randomized between patients. Under the assumption of a two-way random effects model an intraclass correlation coef ficient (ICC) was used to determine the reliability or reproducibility of a measure with the Leg-O-Meter. The overall reliability coefficient calculated by the ICC for the right and left leg were estimated at 97.09% [95.52%;100%] 950,o and 97.08% [95.86%;100%]95%, respectively. The authors conclude that the Leg-O-Meter gives a standardized and reliable measure of the circumference of the ankle. Furthermore, it is not invasive or costly.
Plasma Leukocyte Elastase Concentration and Coronary Artery Disease
Authors: Koşar Feridun , Varol Ercan , Ayaz Selime , Kütük Emine , Oguzhan Abdurrahman , Diker Erdem
Published: July 2008

It has previously been shown that leukocyte elastase is involved in the pathogenesis of atherosclerosis. Few studies have addressed the relation between leukocyte elastase concentrations and coronary artery disease (CAD).

The authors investigated (1) the clinical significance of leukocyte elastase determi nation in the diagnosis of CAD and (2) the relation between plasma leukocyte elastase concentration and lesion morphology. The study included 185 subjects (140 men, 45 women) who underwent coronary angiography during investigation of chest pain; 135 had coronary stenosis (Group I) and 50 had nonstenotic coronaries (Group II). Among Group I patients, those with simple atheromatous plaques were distinguished from those with complex plaques.

Elastase concentrations in Group I were greater than in Group II (57.1 ± 1.16 μg I-1 vs 27.6 ± 1.0 μg I-1, P < 0.001), and greater in complex plaque patients than in those with simple plaques (64.5 ± 1.24 μg I- 1 vs 45.9 ±1.01 μg I-1, P < 0.001 ) . Logistic regression analysis showed (1) that elastase concentration, age, and sex had independent value for prediction of CAD and (2) that among Group I patients, the risk of complex plaques was greatest for those with high elastase concentration.

These results suggest that plasma leukocyte elastase concentration is a sensitive diag nostic marker of CAD and that high values of elastase may indicate the presence of complex atheromatous plaques.
Evaluation of Polarographic Measurements of Basal Muscle Oxygen Tension in Type I Diabetic Patients
Authors: Maisch Christine , Hofmann Valerie , Benda Norbert , Luft Dieter
Published: July 2008

Microcirculatory changes occur early in insulin-dependent diabetes mellitus (IDDM) and are believed to be an early feature of late diabetic complications, leading to reduced oxygen pressure and hypoxia in the skin and other tissues. Whether muscle oxygen supply is also altered is unknown. Therefore, the authors analyzed polarographic measurements of muscle oxygen tension in 44 healthy type I diabetic patients (mean age 28 years; mean diabetes duration 7 years) and in 57 healthy controls, matched for age, sex, and body mass index, and the corresponding influencing factors. Two measurements were taken at rest 60 minutes apart in the anterior tibial muscle.

Muscle oxygen tensions did not differ between IDDM patients and controls (23.0 ±8.6 vs 25.3 ±9.0 mmHg) and were reproducible on repeated measurements (25.3 ±9.7 vs 25.5 ± 7.4 mmHg). Coefficients of variation were 13.5 ±10.8% in IDDM patients and 13.1 ±9.3% in controls. Compared with controls, in IDDM patients hemoglobin A1c (HbA1c) and blood glucose concentrations were elevated, and arterial oxygen pressure was significantly lower. Muscle oxygen tensions were positively correlated with blood glucose concentrations in IDDM patients (Rho=0.48, P=0.002) but not with HbA1c or with insulin concentrations.

The authors conclude that the polarographic measurement of muscle oxygen tension is a reliable method with good reproducibility. Hypoxia in the anterior tibial muscle of type I diabetic patients can be excluded. In IDDM patients the level of muscle oxygen tension is correlated with the level of blood glucose concentration.
Anomalous Course of the Common Carotid Arteries: CT and MRA Illustration
Authors: Ho Vincent B. , Borke Rosemary C. , Rovira Miguel J. , Walsh Daniel W.
Published: July 2008

Recognition of normal vascular variations is tantamount to accurate diagnosis and inter vention. The authors describe an unusual course for the common carotid arteries that was incidentally identified on routine cervical spine x-ray films. The embryonic events leading to this normal variant are reviewed.
Use of Nuclear Magnetic Resonance Imaging Angiography to Follow-Up Arterial Remodeling in an Animal Model
Authors: Nikol Sigrid , Esin Serap , Nekolla Stephan , Huehns Tanya Y. , Schirmer Johannes , Schwaiger Markus , Höfling Berthold
Published: July 2008

Appropriately sized arteries in small animals may be possible models for studying the remodeling process as occurs after arterial balloon injury in humans. Magnetic resonance imaging (MRI) is able to noninvasively image tissue in vivo. To date, small animal angiog raphy models have mostly used research-dedicated instruments and resolution, which are not universally available.

Experiments were carried out on a rat aorta model of remodeling in vivo (n=40). Arteries were injured by oversized balloon dilation; control arteries were uninjured. Angiography imaging was performed immediately before sacrifice with an unmodified clinical MRI unit, a 1.5 Tesla MR tomograph with a 20-cm-diameter coil. Longitudinal MRI pictures of the aorta and morphometry of tissue sections to measure luminal and arterial wall areas were analyzed with use of computer-assisted techniques.

Comparison of dimensions demonstrated correlation between MRI and histology measurements of the lumen. MRI and morphometry showed a gradual increase in mean luminal area over 6 weeks following injury. The lumen increase correlated with total arterial area and thickness.

In this rat aorta model, remodeling documented at histology was followed-up in vivo. The use of such clinical MRI scanners has potential to reduce animal numbers needed to follow-up the remodeling process after therapeutic intervention.
Tortuosity, Kinking, and Coiling of the Carotid Artery: Expression of Atherosclerosis or Aging?
Authors: Del Corso Laura , Moruzzo Daniela , Conte Biagio , Agelli Maria , Romanelli Anna Maria , Pastine Fabrizio , Protti Mariangela , Pentimone Ferdinando , Baggiani Giovanni
Published: July 2008

The etiology of carotid abnormalities is both congenital than acquired. The aim of this study was to clarify the role of aging and atherosclerosis in the acquired cases, and the role of these abnormalities in hemodynamic alterations and neurologic symptoms.

Over a 1-year period the authors studied all the subjects undergoing carotid exami nation by continuous-wave and color-coded Doppler sonography at an Angiology Unit. They evaluated neurologic symptoms; risk factors for atherosclerosis; number, sites, and kinds of carotid abnormalities; atherosclerotic lesions; stenosis; hemodynamic alterations of the carotid; and other localizations of atherosclerotic diseases.

There were 469 subjects: 272 (58%) with abnormalities (group 1) and 197 (42%) without abnormalities (group 2). The total number of abnormalities was 479 (104 tortu osities, 262 kinkings, and 113 coilings). The abnormalities were more prevalent in the elderly (P<0.001) and in women (P< 0.001). In group 1 they found significant preva lences of hyperlipemia (P<0.001), hypertension (P<0.01), chronic cigarette smoking (P<0.01), and ischemic heart disease (P<0.05). (continued on next page) Carotid atherosclerotic lesions were more prevalent in group 1 than in group 2 (P<0.001); among the patients with atherosclerotic carotid lesions, those in group 1 were older than those in group 2 (P<0.001). Tortuosity seemed to be associated with fewer hemodynamic alterations.

The authors conclude that atherosclerosis, hypertension, and aging may play an important role in producing carotid abnormalities. The aging seemed more important than atherosclerosis.

Only a prospective study of patients with carotid abnormalities and no atherosclerotic lesion will clarify the role of hemodynamics and neurologic symptomatology.