bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of conventional and aggressive statin treatment on markers of endothelial function and inflammation
Authors: Hognestad Aina , Aukrust Pål , Wergeland Ragnhild , Stokke Oddvar , Gullestad Lars , Semb Annegrete , Holm torbjørn , Andreassen Arne K. , Kjekshus John K.
Published: June 2007

Background: Atherosclerosis is considered to be a chronic inflammatory disorder. Several large‐scale clinical studies demonstrate that markers of inflammation, such as high‐sensitivity C‐reactive protein (hsCRP), fibrinogen, and soluble CD40 ligand, are potent and independent predictors of vascular risk.

Hypothesis: The study was undertaken to investigate the effect of increasing the statin dose from conventional to aggressive treatment on lipids levels, inflammation, and endothelial function in patients with coronary artery disease (CAD).

Methods: We randomized 97 patients to either 20 mg simvastatin or 80 mg atorvastatin. Plasma levels of lipids, hsCRP, fibrinogen, soluble adhesion molecules, and nitric oxide‐total were analyzed at baseline and after 6 months of treatment.

Results: Lipid values were significantly reduced in both treatment groups, but with significantly greater reduction in the aggressively treated group. Furthermore, aggressive statin treatment significantly decreased hsCRP and fibrinogen, while only small reductions were seen in the conventionally treated group, resulting in significant differences between the two treatment groups (p < 0.001). Nitric oxide‐total increased significantly in both treatment groups, although the increase was more pronounced in the aggressively treated group (22.6 vs. 15.6%).

Conclusion: Aggressive statin treatment significantly improved lipid status and reduced markers of inflammation and improved endothelial function compared with conventional treatment in patients with CAD. No interaction was observed, and high‐dose treatment did not offer additional benefit compared with standard‐dose treatment with respect to soluble adhesion molecules.
Dynamic 123I‐BMIPP single‐photon emission computed tomography in patients with congestive heart failure: Effect of angiotensin ii type‐1 receptor blockade
Authors: Takeishi Yasuchika , Minamihaba Osamu , Yamauchi Sou , Arimoto Takanori , Hirono Osamu , Takahashi Hiroki , Akiyama Hideyuki , Miyamoto Takuya , Nitobe Joji , Nozaki Naoki , Tachibana Hidetada , Okuyama Masaki , Fukui Akio , Kubota Isao , Okada Akio , Takahashi Kazuei
Published: June 2007

Background: Heart failure is a major and growing public health problem with a high mortality rate. Although recent studies have demonstrated that a variety of metabolic and/or neurohumoral factors are involved in the progression of this syndrome, the precise mechanisms responsible for this complex condition are poorly understood.

Hypothesis: To examine 123I‐β‐methyl‐iodophenylpentadecanoic acid (BMIPP) kinetics in the early phase soon after tracer injection in patients with congestive heart failure (CHF), we performed dynamic single‐photon emission computed tomography (SPECT).

Methods: Twenty‐six patients with CHF and eight control subjects were examined. The consecutive 15 images of 2‐min dynamic SPECT were acquired for 30 min after injection. In the early phase after injection (0‐4 min), a significant amount of radioactivity existed in the blood pool. After 6 min, the myocardial 123I‐BMIPP image was clear and thus the washout rate of 123I‐BMIPP from 6 to 30 min was calculated.

Results: The washout rate of 123I‐BMIPP from the myocardium was faster in patients with CHF than in the controls (8 ± 4 vs. −5 ± 3%, p<0.01). The washout rate of 123I‐BMIPP demonstrated positive correlation with left ventricular (LV) end‐diastolic volume index (R = 0.54, p < 0.02) and inverse correlation with LV ejection fraction (R = 0.53, p < 0.02). Patients were given the angiotensin II type‐1 receptor antagonist candesartan for 6 months, and dynamic SPECT was repeated. The enhanced washout rate of 123I‐BMIPP in CHF was reduced after treatment with candesartan (p < 0.05).

Conclusion: These data suggest that (1) enhanced washout of 123I‐BMIPP was observed soon after injection in patients with CHF, (2) the activation of angiotensin II signaling pathway is involved as an intracellular mechanism for enhanced 123I‐BMIPP washout in heart failure, and (3) improvement in fatty acid metabolism may represent a new mechanism for beneficial effects of angiotensin II receptor blockade on cardiac function and survival in patients with heart failure. 123I‐BMIPP washout in the early phase obtained from dynamic SPECT may be a new marker for evaluating the severity of heart failure and the effects of medical treatment.
C‐reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective coronary intervention
Authors: Grander Wilhelm , Dichtl Wolfgang , Prokop Wolfgang , Roithinger Franz X. , Moes Nicolas , Friedrich Guy , Weidinger Franz , Pachinger Otmar
Published: June 2007

Background: Both vascular inflammation as determined by C‐reactive protein (CRP) and extrinsic coagulation as measured by factor VII activity (F VII) may predict clinical restenosis rate in patients with stable angina pectoris undergoing elective percutaneous coronary intervention (PCI).

Hypothesis: The primary objective of this study was to investigate the associations between baseline CRP levels, F VII activity, and restenosis rate after elective PCI in a 6‐month follow‐up period.

Methods: This prospective study included 81 patients aged ≥19 years undergoing PCI for angiographically significant (⩾70%) stenosis, with or without stenting, and 49 controls. Factor VII activity and CRP were measured in samples collected at angiography and 16‐24 h post procedure after overnight fast. Successful PCI was defined as final diameter of < 50% with TIMI 3 flow and no complication within 1 h. After 6 months all patients who had undergone PCI were evaluated via a standardized questionnaire. Clinical restenosis was defined as the occurrence of a major adverse coronary events (MACE), within the follow‐up period.

Results: Diagnostic angiography led to a significant increase in CRP levels after 16–20 h in patients with discrete CAD (n = 22) but not in patients without any signs of coronary atherosclerosis (n = 27). During a 6‐month follow‐up after PCI, 17 of 81 (21%) patients developed MACE. Tertiles of CRP levels independently predicted clinical restenosis, as it developed in 33.3% of patients with the highest CRP levels (0.7–4.8 mg/dl), in 16.6% of patients with second tertile CRP levels (0.23–0.69 mg/dl), and in 7.4% of patients with lowest tertile CRP levels (0.0–0.22 mg/dl). There was a significant difference in the restenosis rate between patients from the first and the third tertiles (p = 0.018). Successful PCI was associated with a significant decrease of mean CRP levels after 6 months, whereas PCI in patients suffering from MACE led to no change in CRP levels. There was no association between factor VII activity and clinical outcome after PCI, and F VII activity did not change over a 6‐month period.

Conclusions: In patients with stable angina pectoris undergoing elective PCI, increased preprocedural and 6‐month follow‐up CRP plasma levels are associated with clinical restenosis. Factor VII plasma activity lacks such correlations.
Ventricular tachyarrhythmia associated with cardiac sarcoidosis: Its mechanisms and outcome
Authors: Furushima Hiroshi , Chinushi Masaomi , Sugiura Hirotaka , Kasai Hidehiro , Washizuka Takashi , Aizawa Yoshifusa
Published: June 2007

Background: Cardiac sarcoidosis is increasingly recognized and is associated with poor prognosis. Ventricular tachycardia (VT) associated with cardiac sarcoidosis is the most likely cause of sudden death in most patients, but the mechanism has not been well established.

Hypothesis: This study investigated the mechanisms and outcome of VT associated with cardiac sarcoidosis.

Methods: The study included eight consecutive patients (five men, three women, aged 54 ± 19 years) who had sustained monomorphic VT associated with cardiac sarcoidosis in our hospital.

Results: The average ejection fraction was 43 ± 11%. Twenty‐two VTs were observed in these patients, and mean heart rate during VT was 192 ± 29 beats/min (range 144–259). The phenomenon of transient entrainment was documented in 10 of 22 (45%) VTs by ventricular pacing (eight in the active phase). Another five (23%) VTs could not be entrained, but could be initiated by programmed stimulation and terminated by rapid pacing, reproducibly. In 3 of the 22 (14%) VTs, cardioversion was required urgently because of the fast rate, while the remaining 4 (18%) could be induced during electrophysiologic study.

Conclusions: In this study, there was a high possibility that the mechanism of 15 (68%) VTs was reentry. Reentrant substrate is formed not only in association with the healing of cardiac granulomas in the inactive phase of cardiac sarcoidosis but also in the active phase. Ventricular tachycardia with cardiac sarcoidosis, even if this mechanism is reentry, has different inducibility between the active and inactive phases in an electrophysiologic study. This makes the therapy for cardiac sarcoidosis (e.g., corticosteroids, antiarrhythmic agents, and catheter ablation) difficult. The implantable cardioverter‐defibrillator is an effective treatment for ventricular tachyarrythmia with cardiac sarcoidosis.
Effect of chronic stress and sleep deprivation on both flow‐mediated dilation in the brachial artery and the intracellular magnesium level in humans
Authors: Takase Bonpei , Akima Takashi , Uehata Akimi , Ohsuzu Fumitaka , Kurita Akira
Published: June 2007

Background: Chronic mental and physical stress has been suggested to be a trigger for cardiovascular events. In addition, a reduction in levels of intracellular magnesium has been reported to cause vasoconstriction while enhancing platelet‐dependent thrombosis.

Hypothesis: The purpose of this study was to investigate whether chronic stress affects endothelial function and intra‐cellular magnesium levels in humans.

Methods: Flow‐mediated dilation (endothelium‐dependent vasodilation) and sublingual nitroglycerin‐induced dilation (0.3 mg, endothelium‐independent vasodilation) were measured in the brachial artery in 30 healthy male college students, aged 22 ± 1 years, using high‐resolution ultrasound both before and immediately after a 4‐week final term examination period. Erythrocyte magnesium concentration was measured simultaneously. All students had chronic sleep deprivation for 4 weeks, during which sleep lasted < 80% of that on ordinary days; in addition, the students were under great stress to pass the examination. This condition was considered to be chronic stress.

Results: Chronic stress decreased flow‐mediated dilation and erythrocyte magnesium concentration (from 7.4 ± 3.0 to 3.7 ± 2.3%, p < 0.05; from 5.7 ± 0.4 to 5.5 ± 0.4 mg/ml, p < 0.05, respectively). The change in flow‐mediated dilation correlated significantly with that of the erythrocyte magnesium concentration (r = 0.43, p < 0.05), but not with nitroglycerin‐induced dilation.

Conclusions: Chronic stress was found to attenuate endo‐thelial function, which may also be associated with a reduction in the intracellular magnesium level in humans.
Rapid screening of cardiac patients with a miniaturized hand‐held ultrasound imager‐comparisons with physical examination and conventional two‐dimensional echocardiography
Authors: Xie Tianrong , Chamoun Antonio J. , McCulloch Marti , Tsiouris Nick , Birnbaum Yochai , Ahmad Masood
Published: June 2007

Background: Rapid screening of cardiac patients with a hand‐held ultrasound imager (SonoHeart™ [SH]) could provide valuable clinical information.

Hypothesis: Whether the use of this device yields additional information to a carefully conducted physical examination and comparable findings to those of conventional two‐dimensional echocardiography (2‐D) during inpatient rounds is not well established and is the subject of this study.

Methods: In all, 100 consecutive telemetry patients underwent rapid screening with 2‐D and color Doppler SH during inpatient rounds. SonoHeart findings were compared with results from conventional 2‐D and physical examination conducted by an attending cardiologist.

Results: All patients had interpretable images. Mean scanning time with SH was 5.0 ± 1.2 min; 2‐D and SH findings were comparable. The parameters studied included chamber sizes, left ventricular (LV) systolic function, presence of LV hypertrophy (LVH), wall motion abnormalities (WMA), peri‐cardial effusion (PE), and valvular regurgitations. Mild to moderate valvular regurgitation and LV systolic dysfunction were reliably diagnosed by SH in a number of patients whose symptoms were unrelated to the abnormalities detected.

Conclusions: Rapid screening with SH provides accurate and valuable information that would otherwise be undetected during physical examination. Its introduction into clinical practice may redefine the initial approach to patients with cardiovascular disease.
Importance of a history of hypertension for the prognosis after acute myocardial infarction‐‐‐for the bucindolol evaluation in acute myocardial infarction trial (BEAT) study group
Authors: Ali Irma , Akman Dilek , Bruun Niels Eske , Køber Lars , Brendorp Bente , Ottesen Michael , Møller Jacob , Torp‐Pedersen Christian
Published: June 2007

Background: Arterial hypertension is a major risk factor for cardiovascular events. The prognosis for hypertensive patients after acute myocardial infarction (MI) is uncertain because of the sparse and somewhat contradictionary data.

Hypothesis: Our study aimed to investigate the importance of hypertension to prognosis after an MI in patients receiving contemporary medical therapy.

Methods: We performed a retrospective study using a large register from the Bucindolol Evaluation in Acute myocardial infarction Trial (BEAT). The register comprised 3,326 patients admitted between June 1998 and August 1999 with an enzyme‐verified MI to 33 Danish coronary care units. Hypertension was considered present when a previous diagnosis of hypertension was accompanied by relevant medical therapy. Survival information for all patients was obtained in January 2002.

Results: Of the 3,326 patients studied, 825 were hypertensive. Overall, 28.4% had died by January 2002. The unadjusted hazard ratio associated with hypertension was 1.2 (95% confidence limit [CI] 1.1‐‐1.4, p = 0.004). Hypertensive patients were older, and after adjustment for age the hazard ratio associated with hypertension was 1.04 (CI 0.9‐‐1.2, p = 0.6). Adjustment for further covariates did not change the result.

Conclusion: Our study showed that after an acute MI the survival rate of patients with and without a history of hypertension was identical when they received contemporary medical therapy.
Beneficial effect of candesartan treatment on cardiac autonomic nervous activity in patients with chronic heart failure: Simultaneous recording of ambulatory electrocardiogram and posture
Authors: Tambara Keiichi , Fujita Masatoshi , Sumita Yoshiyuki , Miyamoto Shoichi , Sekiguchi Hiroyuki , Eiho Shigeru , Komeda Masashi
Published: June 2007

Background: Reclining in the right lateral decubitus position in chronic heart failure (CHF) is a self‐protective mechanism for normalizing impaired cardiac autonomic nervous activity (CANA).

Hypothesis: Candesartan, an angiotensin II receptor blocker, exerts beneficial effects on CANA and postural preferences in patients with CHF.

Methods: We studied 15 patients with CHF due to coronary artery disease. Cardiac autonomic nervous activity was assessed using spectral heart rate variability (HRV) analysis based on 24‐h ambulatory electrocardiogram monitoring before and after an 8‐week treatment with candesartan. The patients' posture was simultaneously recorded using a specially devised detector, as the right (R) or left (L) lateral decubitus or supine (S) positions, to evaluate postural modulations of CANA. Normalized high‐frequency (0.15 to 0.40 Hz) power (nHF) and the low‐frequency (0.04 to 0.15 Hz)/high‐frequency power ratio (LF/HF) were used as indices of vagal activity and sympathovagal balance, respectively.

Results: When HRV was analyzed in each position, CANA was changed in L and S, but not in R, from sympathetic to parasympathetic prevalence by the treatment (R, nHF, 50 ± 20 vs. 52 ± 19 nu, p = 0.87; LF/HF, 1.39 ± 1.11 vs. 1.32 ± 1.32, p = 0.93; L, nHF, 28 ± 13 vs. 47 ± 19 nu, p = 0.019; LF/HF, 3.34 ± 2.48 vs. 1.56 ± 1.39, p = 0.029; S, nHF, 38 ± 17 vs. 53 ±16 nu, p = 0.0023; LF/HF, 2.43 ± 2.21 vs. 1.03 ± 0.59, p = 0.025). The fractions of the time in R and L were decreased and increased, respectively, by the treatment (R, 40 ± 30 vs. 18 ± 24%, p = 0.0018; L, 11 ± 20vs. 27 ± 26%, p = 0.025).

Conclusions: In patients with CHF, candesartan treatment improves cardiac autonomic balance, and the preference for the right lateral decubitus position disappears afterthe treatment.
Keeping the autopsy alive
Authors: Vlietstra Ronald E.
Published: June 2007

The recent decline in autopsy rates has many causes and has been the subject of vigorous debate amongst clinicians, pathologists, and investigators. For cardiologists, the lack of direct information on the vessel wall may impede the ability to develop and interpret new imaging methods and to understand the effects of the newest interventions.
Serum levels of cardiac enzymes before and after renal transplantation
Authors: Bozbas Huseyin , Korkmaz Mehmet Emin , Atar Ilyas , Eroglu Serpil , Ozin Bülent , Yildirir Aylin , Muderrisoglu Haldun , Colak Turan , Karakayali Hamdi , Haberal Mehmet
Published: June 2007

Background: Cardiac troponins are very sensitive and specific indicators of myocardial damage; however, they are sometimes found to be increased in patients with end‐stage renal disease (ESRD).

Hypothesis: The aim of this study was to determine cardiac troponin I (cTpI) and creatine kinase myocardial isoform (CK‐MB) levels and to assess their diagnostic and prognostic importance before and after renal transplantation.

Methods: Thirty‐four patients with ESRD (mean age 31.8 ± 8.6 years, 11 women) were enrolled. Serum levels of cTpI and CK‐MB were measured pre‐ and postoperatively on Days 1, 7, and 30. Patients were followed up for cardiac events, and possible myocardial damage was investigated by exercise thalli‐um‐201‐labeled myocardial perfusion scintigraphy. Mean cTpI levels were 0.24 ± 0.11 ng/ml (preoperative), and 0.34 ± 0.27 ng/ml (Day 1), 0.26 ± 0.11 ng/ml (Day 7), and 0.28 ± 0.30 ng/ml (Day 30).

Results: Compared with preoperative levels, cTpI was increased in 16 (47%), decreased in 6 (17.6%), and did not change in 12 (35.4%) patients. However, the increase did not exceed the myocardial infarction reference level of 2.3 ng/ml in any patient. Mean CK‐MB levels were 12.6 8.7U/l (preoperative), and 16.8 ± 9.2U/l (Day 1), 16.3 ± 8.1U/l (Day 7), and 13.3 ± 6.6U/l (Day 30). Creatine kinase‐MB was increased to above normal levels of 24 U/l in 13 (38.2%) patients on postoperative Days 1 or 7, and decreased to normal at the end of Month 1. No cardiac events occurred, and there was no abnormality in any patient on thallium scintigraphy.

Conclusion: There was no significant difference in the levels of cTpI in patients with ESRD without cardiac events before and after renal transplantation (p > 0.05). Our findings show that cTpI has very high sensitivity and specificity for detecting cardiac damage in patients with ESRD after renal transplantation.
A low‐carbohydrate diet in overweight patients undergoing stable statin therapy raises high‐density lipoprotein and lowers triglycerides substantially
Authors: Gann Dietmar
Published: June 2007

Background: A low‐carbohydrate diet remains controversial, especially in patients with arteriosclerotic heart disease.

Hypothesis: This study was undertaken to evaluate the effect of a low‐carbohydrate diet on the lipid levels in obese patients with known arteriosclerotic heart disease on chronic statin therapy.

Methods: Thirty‐eight overweight patients with angiographically documented arteriosclerotic heart disease were followed in a private cardiology practice setting. All patients were undergoing stable statin therapy. Patients received a 15‐min consultation and a 4‐page pamphlet explaining a low‐carbohydrate diet; no other diet instruction was given. Patients were followed weekly for 2 weeks, then monthly for 3 months, then every third month. A fasting finger stick lipid panel (cholesterol, high‐density and low‐density lipoprotein [HDL/ LDL], triglycerides, and glucose) was obtained with each visit and patients were weighed in street clothes.

Results: The 38 patients were followed for a average of 11.8 months (range 6‐22 months). Average body mass index declined from 33.5 kg/m2 before to 27.9 kg/m2 at the end of the study. Weight loss averaged 31 lbs (range 16‐107 lbs). Tri‐glyceride levels were lowered by 29.5%, HDL raised by 17.6%, and cholesterol decreased by 8.4%. The cholesterol/ HDL ratio changed from 5.31 to 3.78 and LDL cholesterol decreased by 5%.

Conclusion: The addition of a low‐carbohydrate diet for overweight patients with known coronary artery disease undergoing stable statin therapy causes significant weight loss and a favorable change in the lipid panel.
Aortic valve replacement in patients 70 years and older
Authors: Salazar Eduardo , Torres Jorge , Barragán Rodolfo , López Mauricio , Lasses Luis Alberto
Published: June 2007

Background: Aortic valvular disease is the most common valvular lesion among elderly patients. Because of changing demographics, it has become increasingly frequent. Aortic valve replacement (AVR) is the only effective treatment for aortic valvular disease.

Hypothesis: This study was undertaken to evaluate the results of AV R in an elderly population.

Methods: Data were retrospectively analyzed in 117 consecutive patients (mean age 73.8 years) who underwent AV R between 1991 and 2002.

Results: Pure or predominant severe aortic stenosis was present in 108 patients. Nine patients had severe aortic regurgitation. Before valve replacement, 62.4% of the patients were in New York Heart Association (NYHA) functional class III‐IV. A bioprosthesis was implanted in 62.4% of the patients, and 37.6% received a mechanical valve. Concomitant cardiac surgical procedures were performed in 25 patients (coronary artery bypass graft in 22, mitral valve replacement in 3). There were 17 deaths, giving a perioperative mortality rate of 14.5%. Multivariate logistic regression showed that repeat surgery for bleeding, prolonged cardiopulmonary bypass time, postoperative respiratory failure, and postoperative acute renal insufficiency were significant independent predictors of operative mortality. Of the 100 hospital survivors, 78 were followed for a mean of 42.9 months. There were six deaths during follow‐up; only two of these were cardiac related. Five‐year actuarial survival for all patients and for hospital survivors were 70 and 91.1%, respectively. One year post surgery, all patients were in NYHA functional class I‐II.

Conclusion: In a selected patient population, AV R in the elderly is associated with acceptable mortality and morbidity. The outlook for hospital operative survivors is excellent with improved quality of life and an expected survival normal for this particular age.
Role of N‐acetylcysteine in prevention of contrast‐induced nephropathy after cardiovascular procedures: A meta‐analysis
Authors: Misra Deepika , Leibowitz Keith , Gowda Ramesh M. , Shapiro Michael , Khan Ijaz A.
Published: June 2007

Background: Contrast‐induced nephropathy is one of the common causes of acute renal insufficiency after cardiovascular procedures.

Hypothesis: The objective of this paper was to analyze the published data on the usefulness of N‐acetylcysteine in the prevention of contrast‐induced nephropathy after these procedures.

Methods: Trials were selected if they were prospective, randomized, controlled, had selected patients with impaired renal function, used low‐osmolality, nonionic contrast media intra‐arterially, administered a total of four doses of N‐acetyl‐cysteine in addition to intravenous saline hydration, and had contrast‐induced nephropathy as their primary outcome. Contrast‐induced nephropathy was defined as an increase in serum creatinine concentration by > 0.5 mg/dl or a 25% increase above baseline at or within 48 h post procedure. Meta‐analysis was performed using the Fisher's Combined Test with a measure of effect size. The magnitude of the N‐acetyl‐cysteine effect was estimated using random‐effects models. Homogeneity was evaluated using the chi‐square test of homogeneity and standard Q statistic. Reporting bias was explored by the Rosenthal method.

Results: The Fisher's Combined Test was significant at p < 0.005 in favor of N‐acetylcysteine. The size of the N‐acetylcysteine effect was to reduce contrast‐induced nephropathy by 20%. There was a 62% relative risk reduction in contrast‐induced nephropathy with N‐acetylcysteine using a fixed‐effects model, and a 70% relative risk reduction using the random‐effects model. In addition, we found that 27 unpublished trials showing no effects of N‐acetylcysteine would exist to overturn the combined significance of p < 0.005 of the five trials in our meta‐analysis.

Conclusion: Oral administration of N‐acetylcysteine in addition to intravenous saline hydration has a beneficial effect in the prevention of contrast‐induced nephropathy after cardiovascular procedures in patients with impaired renal function.
Long‐term outcome after senning operation for transposition of the great arteries
Authors: Agnetti A. , Carano N. , Cavalli C. , Tchana B. , Bini M. , Squarcia U. , Frigiola A.
Published: June 2007

Background: The Senning operation for transposition of the great arteries (TGA) was first introduced by Senning in 1959 and was revived by Quaegebeur et al. in the late 1970s, thus becoming the intervention of choice for the correction of TGA in many centers.

Hypothesis: The purpose of this study was to evaluate the long‐term follow‐up of a group of patients undergoing surgery with the Senning procedure for TGA.

Methods: From November 1978 to November 1987, 73 consecutive patients underwent the Senning operation. The 70 survivors had an average follow‐up of 19 years (16‐25 years).

Results: (1) Cardiac rhythm: with time there was a progressive decrease in stable sinus rhythm (60% after 20 years) and a progressive increase of supraventricular tachyarrhythmias requiring therapy (10% after 20 years). (2) Right ventricular function: 20% of the patients had reduced ejection fraction. (3) Late mortality: in the last 12 years of follow‐up years there were two sudden deaths (2.8%). (4) Functional status: 80% of patients were in NYHA class I, 17% in class II, and 3% in class III.

Conclusions: Our results confirm that the patients who undergo the Senning procedure have a progressive loss of sinus rhythm, an increase in active arrhythmias, and other important adverse outcomes such as late sudden death and a decrease in right ventricular function; however, most patients (93% in our series) are alive and in good functional status.
Impact of left ventricular diastolic function on exercise capacity in patients with chronic mitral regurgitation: An exercise echocardiography study
Authors: Kim Hyung‐Kwan , Kim Yong‐Jin , Chung Joong‐Wha , Sohn Dae‐Won , Park Young‐Bae , Choi Yun‐Shik
Published: June 2007

Background: Mitral regurgitation (MR) is known as one of the most frequent causes of heart failure and sudden death. In spite of increasing prevalence of MR, there have been no available data on cardiac determinants of exercise capacity in patients with chronic MR.

Hypothesis: This study aimed to investigate cardiac determinants of exercise capacity in patients with chronic MR.

Methods: We consecutively enrolled 32 patients (11 men, mean age: 44 ± 14 years) who had greater than moderate MR with normal left ventricular (LV) systolic function (LV ejection fraction > 50%). Conventional echocardiographic indices and parameters measured by Doppler tissue imaging at septal side of mitral annulus were obtained before exercise. Mitral regurgitation fraction, forward stroke volume, pulmonary venous flow velocities, and systolic pulmonary artery pressure (sPAP) were also obtained with standard methods.

Results: Left ventricular ejection fraction was 61 ± 6% and MR fraction was 48 ± 13%. All patients finished a symptom‐limited treadmill exercise test with a peak heart rate of > 85% of predicted maximum heart rate. Mean exercise time was 9.95 ± 2.17 min, corresponding to 11 ± 2 metabolic equivalents. Among pre‐exercise echocardiographic variables, only early diastolic mitral annulus velocity (E') and pulmonary venous reversal flow velocity (PVa) showed a significant correlation with exercise time (r = 0.44, p = 0.011, and r = −0.40, p = 0.040, respectively), which persisted after multivariate analysis (p = 0.011 and 0.038, respectively). Other parameters such as systolic mitral annulus velocity, resting and post‐exercise sPAP, forward stroke volume, LV size, LV ejection fraction, left atrial size, and regurgitant fraction showed no significant correlation.

Conclusions: Left ventricular diastolic function is an important determinant of exercise capacity in patients with chronic MR. Both E' and PVa, accepted surrogate estimates for LV diastolic function, may be useful for identifying patients with chronic MR and with poor exercise capacity.
Relationship of carotid intima‐media thickness, pulse wave velocity, and ankle brachial index to the severity of coronary artery atherosclerosis
Authors: Matsushima Yoshihiro , Kawano Hiroaki , Koide Yuji , Baba Takeshi , Toda Genji , Seto Shinji , Yano Katsusuke
Published: June 2007

Background: Carotid intima‐media thickness (IMT), pulse wave velocity (PWV), and the ankle brachial index (ABI) are widely used noninvasive modalities for evaluating atherosclerosis.

Hypothesis: The aim of this study was to determine the relationship of carotid IMT, PWV, and ABI with the severity of coronary artery disease (CAD), expressed as the Gensini score, and the presence of coronary risk factors.

Methods: We examined 205 consecutive patients (mean age 65 ± 12 years) who were clinically suspected of having CAD and were scheduled to undergo coronary angiography. Carotid intima‐media thickness, brachial‐ankle PWV (baPWV), and ABI were measured in all subjects before they underwent coronary angiography.

Results: Of the 205 patients, 124 patients were diagnosed as having CAD based on the presence of > 50% stenosis in a major coronary artery; the remaining 81 patients did not have CAD. A relatively good correlation was obtained between carotid IMT and the Gensini score (R = 0.411, p < 0.0001), whereas baPWV correlated only weakly with the Gensini score (R = 0.203, p = 0.0035), and ABI did not correlate with it. A multiple regression analysis revealed that the Gensini score correlated significantly and independently with age, male gender, and carotid IMT.

Conclusions: Of the three noninvasive methods, carotid IMT may be more useful for determining coronary artery atherosclerosis than baPWV or ABI.
Critical pathways in the emergency department improve treatment modalities for patients with ST‐elevation myocardial infarction in a European hospital
Authors: Pelliccia Francesco , Cartoni Domenico , Verde Monica , Salvini Paolo , Mercuro Giuseppe , Tanzi Pietro
Published: June 2007

Background:The use of protocols for patients with ST‐elevation myocardial infarction (MI) is growing, but no definite conclusion regarding the value of critical pathways in Europe has been drawn.

Hypothesis:The aim of this study was to investigate the impact of critical pathway on processes of care and outcome for patients presenting to the emergency department (ED) of a large urban European hospital because of possible ST‐elevation MI.

Methods:Critical pathways for management of acute chest pain at our ED were developed in 1998 and have been revised every year. Accordingly, the records of all patients referred in 1997 to the ED because of chest pain (before pathway implementation) and in 2001 (after last pathway revision) were reviewed. An ST‐elevation MI was diagnosed at ED in 520 of 5,066 (10.3%) patients with chest pain in 1997, and in 452 of 4,843 (9.3%) patients with chest pain in 2001. Patients were managed according to the ED cardiologists' decisions in 1997, whereas they entered the pathways for ST‐elevation MI in 2001, with predefined criteria for diagnosis, thrombolysis, percutaneous coronary intervention, and admission to the coronary care unit.

Results:Comparison of treatment modalities disclosed that more patients were given thrombolysis in 1997 (49 vs. 16%, p < 0.05), whereas in 2001 more patients were sent to primary angioplasty (63 vs. 11%, p < 0.05). Also in 2001, patients more often received aspirin (90 vs. 61%, p < 0.05) and intravenous beta blockers (60 vs. 35%, p < 0.05) soon after arrival at the ED. Comparison between 1997 and 2001 revealed that admission rates to the coronary care unit (69 vs. 78%, NS) and cardiac wards were similar (19 vs. 10%, NS). Conversely, compared with 1997, patients hospitalized in 2001 had a shorter length of stay (12 ± 5 vs. 18 ± 6 days, p < 0.05), as well as fewer major adverse coronary events (21 vs. 30%, p < 0.05) and lower all‐cause in‐hospital mortality (12 vs. 20%, p < 0.05). The quality of care indicators improved with time, as door‐to‐electrocardiogram interval (10 ± 6 vs. 19 ± 9 min, p < 0.05), door‐to‐needle time (25 ± 10 vs. 35 ± 10 min, p < 0.05), and door‐to‐balloon interval (70 ± 15 vs. 99 ± 20 min, p < 0.05) were shorter in 2001 than in 1997.

Conclusions:A critical pathway for ST‐elevation MI at the ED increases the use of evidence‐based treatment strategies and improves outcome and quality of care of patients presenting to a European hospital because of acute chest pain.
Cardiac troponins T and I in patients with end‐stage renal disease: The relation with left ventricular mass and their prognostic value
Authors: Abaci Adnan , Ekici Eyup , Oguzhan Abdurrahman , Tokgoz Bulent , Utas Cengiz
Published: June 2007

Background:Cardiac troponins are frequently elevated in patients with end‐stage renal disease (ESRD) in the absence of acute myocardial ischemia. The cause and prognostic value of cardiac troponin elevations in such patients are controversial.

Hypothesis:The aims of this study were (1) to define the incidence of cTnT and cTnI elevations in patients with ESRD, (2) to evaluate the relationship between troponin elevations and leftventricularmass index (LVMI), and (3) to evaluate the prognostic value of elevations in cTnT and cTnI prospectively.

Methods:We included 129 patients with ESRD (71 men, age 44 ± 16 years) with no clinical evidence of coronary artery disease. All patients underwent cardiac examinations, including medical history, physical examination, electrocardiogram, andtransthoracic echocardiography. Left ventricular mass index was calculated and all patients were followed for 2 years.

Results:The cTnT concentration was > 0.03–0.1 ng/ml in 27 (20.9%) and > 0.1 ng/ml in 27 (20.9%) of the 129 patients. The cTnI concentration was > 0.5 ng/ml in 31 (24%) of 129 patients. Multiple logistic regression analysis identified LVMI (p < 0.001), diabetes (p = 0.001), and serum albumin level (p= 0.009) as a significant independent predictor for elevated cTnT. Left ventricular mass index was the only significant independent predictor for elevated cTnI (p = 0.002). There were 25 (19.4%) deaths during follow‐up. Multivariable analysis showed that elevation of cTnT and cTnI did not emerge as an independent predictor for death. Serum albumin level (p < 0.001) was the strongest predictor of mortality, followed by age (p = 0.002) and LVMI (p = 0.005).

Conclusions:Cardiac troponin T and I related significantly to the LVMI. The increased serum concentration of cardiac troponins probably originates from the heart; however, they are not independent predictors for prognosis.
HIV‐1 induced generation of C5a attracts immature dendriticcells and promotes infection of autologous T cells
Authors: Soederholm Anna , Bánki Zoltán , Wilflingseder Doris , Gassner Christoph , Zwirner Joerg , López‐Trascasa Margarita , Falkensammer Barbara , Dierich Manfred P. , Stoiber Heribert
Published: June 2007

For the recruitment of dendritic cells (DC) to the site of infection, DC express several sensors for danger signals, such as receptors for C5a. This anaphylatoxin is generated upon complement activation. As HIV‐1 triggers the complement cascade, we determined whether C5a is generated by the virus and tested the functional activity of C5a in migration and infection assays. The immature (i)DC responded in migration assays to recombinant C5a and native C5a, which was generated in situ upon activation of the complement system by HIV‐1. In combined migration and infection assays, a C5a‐dependent enhancement of HIV‐1 infection in DC‐T cell cocultures was observed. These results indicate that HIV induces generation of C5a and thereby attracts iDC, which in turn promote the productive infection of autologous primary T cells.
Synthesis and Coordination Behavior of Symmetrical Tetraamine Phosphinic Acids
Authors: Kubíček Vojtěch , Řehoř Ivan , Havlíčková Jana , Kotek Jan , Císařová Ivana , Hermann Petr , Lukeš Ivan
Published: June 2007

Two new tetraamine ligands, bis[N‐(2‐aminoethyl)aminomethyl]phosphinic acid (Hen2p) and bis[N‐(3‐aminopropyl)aminomethyl]phosphinic acid (Hpn2p), were synthesized from the corresponding diaminoalkanes and bis(chloromethyl)phosphinic acid. Their acid–base properties and complexation with Cu2+, Ni2+, and Zn2+ ions were studied by potentiometric titrations. Different chain lengths of the ligands result in significantly different coordination abilities. The five‐membered chelate ring of Hen2p leads to a higher stability of its complexes. In comparison with tetraamines having the same number of the bridging atoms separating the amino groups, the presence of the phosphinic acid moiety decreases the basicity of the amine groups, and consequently, the stability of their complexes. Several solid‐state structures were determined by X‐ray diffraction analysis. Four nitrogen atoms coordinate the Cu2+ or Zn2+ ion in a square‐planar fashion, whereas the phosphinic acid group is not coordinated or acts as a bridging unit between neighboring metal ions. The unexpectedly high stability of the Ni2+/Hpn2p complex can be explained by the possible presence of a tetramer in solution as was found in the solid state.(© Wiley‐VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2007)
Acceleration response modification factors for nonstructural components attached to inelastic moment‐resisting frame structures
Authors: Sankaranarayanan Ragunath , Medina Ricardo A.
Published: June 2007

A statistical analysis of the peak acceleration demands for nonstructural components (NSCs) supported on a variety of stiff and flexible inelastic regular moment‐resisting frame structures with periods from 0.3 to 3.0 s exposed to 40 far‐field ground motions is presented. Peak component acceleration (PCA) demands were quantified based on the floor response spectrum (FRS) method without considering dynamic interaction effects. This study evaluated the main factors that influence the amplification or decrease of FRS values caused by inelasticity in the primary structure in three distinct spectral regions namely long‐period, fundamental‐period, and short‐period region. The amplification or decrease of peak elastic acceleration demands depends on the location of the NSC in the supporting structure, periods of the component and building, damping ratio
of the component, and level of inelasticity of the supporting structure. While FRS values at the initial modal periods of the supporting structure are reduced due to inelastic action in the primary structure, the region between the modal periods experiences an increase in PCA demands. A parameter denoted as acceleration response modification factor (Racc) was proposed to quantify this reduction/increase in PCA demands. Copyright © 2007 John Wiley & Sons, Ltd.
A three‐dimensional non‐hydrostatic vertical boundary fitted model for free‐surface flows
Authors: Badiei Peyman , Namin Masoud M. , Ahmadi Afshin
Published: June 2007

A non‐hydrostatic finite volume model is presented to simulate three‐dimensional (3D) free‐surface flows on a vertical boundary fitted grid system. The algorithm, which is an extension to the previous two dimensional vertical (2DV) model proposed by Ahmadi et al. (Int. J. Numer. Meth. Fluids 2007; 54(9):1055–1074), solves the complete 3D Navier–Stokes equations in two major steps based on projection method. First, by excluding the pressure terms in momentum equations, a set of advection–diffusion equations are obtained. In the second step, the continuity and the momentum equations with the remaining pressure terms are solved which yields a block tri‐diagonal system of equations with pressure as the
unknown. In this step, the 3D system is decomposed into a series of 2DV plane sub‐systems which are solved individually by a direct matrix solver. Iteration is required to ensure convergence of global 3D system. To minimize the number of vertical layers and subsequently the computational cost, a new top‐layer pressure treatment is proposed which enables the model to simulate a range of surface waves using only 2–5 vertical layers. Copyright © 2007 John Wiley & Sons, Ltd.
Mathematical Modelling of Proton‐Conducting Solid Oxide Fuel Cells and Comparison with Oxygen‐Ion‐Conducting Counterpart
Authors: Ni M. , Leung M. K. H. , Leung D. Y. C.
Published: June 2007

Proton‐conducting solid oxide fuel cells (H‐SOFC), using a proton‐conducting electrolyte, potentially have higher maximum energy efficiency than conventional oxygen‐ion‐conducting solid oxide fuel cells (O‐SOFC). It is important to theoretically study the current–voltage (J–V) characteristics in detail in order to facilitate advanced development of H‐SOFC. In this investigation, a parametric modelling analysis was conducted. An electrochemical H‐SOFC model was developed and it was validated as the simulation results agreed well with experimental data published in the literature. Subsequently, the analytical comparison between H‐SOFC and O‐SOFC was made to evaluate how the use of different electrolytes could affect the SOFC performance. In addition to different ohmic overpotentials at the electrolyte, the concentration overpotentials of an H‐SOFC were prominently different from those of an O‐SOFC. H‐SOFC had very low anode concentration overpotential but suffered seriously from high cathode concentration overpotential. The differences found indicated that H‐SOFC possessed fuel cell characteristics different from conventional O‐SOFC. Particular H‐SOFC electrochemical modelling and parametric microstructural analysis are essential for the enhancement of H‐SOFC performance. Further analysis of this investigation showed that the H‐SOFC performance could be enhanced by increasing the gas transport in the cathode with high porosity, large pore size and low tortuosity.
A mouse embryonic stem cell model of Schwann cell differentiation for studies of the role of neurofibromatosis type 1 in Schwann cell development and tumor formation
Authors: Roth Therese M. , Ramamurthy Poornapriya , Ebisu Fumi , Lisak Robert P. , Bealmear Beverly M. , Barald Kate F.
Published: June 2007

The neurofibromatosis Type 1 (NF1) gene functions as a tumor suppressor gene. One known function of neurofibromin, the NF1 protein product, is to accelerate the slow intrinsic GTPase activity of Ras to increase the production of inactive rasGDP, with wide‐ranging effects on p21ras pathways. Loss of neurofibromin in the autosomal dominant disorder NF1 is associated with tumors of the peripheral nervous system, particularly neurofibromas, benign lesions in which the major affected cell type is the Schwann cell (SC). NF1 is the most common cancer predisposition syndrome affecting the nervous system. We have developed an in vitro system for differentiating mouse embryonic stem cells (mESC) that are NF1 wild type (+/+), heterozygous (+/−), or null (−/−) into SC‐like cells to study the role of NF1 in SC development and tumor formation. These mES‐generated SC‐like cells, regardless of their NF1 status, express SC markers correlated with their stage of maturation, including myelin proteins. They also support and preferentially direct neurite outgrowth from primary neurons. NF1 null and heterozygous SC‐like cells proliferate at an accelerated rate compared to NF1 wild type; this growth advantage can be reverted to wild type levels using an inhibitor of MAP kinase kinase (Mek). The mESC of all NF1 types can also be differentiated into neuron‐like cells. This novel model system provides an ideal paradigm for studies of the role of NF1 in cell growth and differentiation of the different cell types affected by NF1 in cells with differing levels of neurofibromin that are neither transformed nor malignant. © 2007 Wiley‐Liss, Inc.
α7β1 integrin is a receptor for laminin‐2 on Schwann cells
Authors: Chernousov Michael A. , Kaufman Stephen J. , Stahl Richard C. , Rothblum Katrina , Carey David J.
Published: June 2007

The Schwann cell basal lamina acts as an organizer of peripheral nerve tissue and influences many aspects of cell behavior during development and regeneration. A principal component of the Schwann cell basal lamina is laminin‐2. This study was undertaken to identify Schwann cell receptors for laminin‐2. We found that among several Schwann cell integrins that can potentially interact with laminin‐2, only α7β1 bound to laminin‐2‐Sepharose. Dystroglycan, a non‐integrin Schwann cell receptor for laminin‐2 identified previously, was also found to bind to laminin‐2‐Sepharose. Antibody to the α7 integrin subunit partially inhibited Schwann cell adhesion to laminin‐2. Small interfering RNA‐mediated suppression of either α7 integrin or dystroglycan expression decreased adhesion and spreading of Schwann cells on laminin‐2, whereas knocking down both proteins together inhibited adhesion and spreading on laminin‐2 almost completely. α7 integrin and dystroglycan both colocalized with laminin‐2 containing basal lamina tubes in differentiating neuron–Schwann cell cocultures. The α7β1 integrin also coprecipitates with focal adhesion kinase in differentiating cocultures. These findings strongly suggest that α7β1 integrin is a Schwann cell receptor for laminin‐2 that provides transmembrane linkage between the Schwann cell basal lamina and cytoskeleton. © 2007 Wiley‐Liss, Inc.
Phenotypic characterization of neural stem cells from human fetal spinal cord: Synergistic effect of LIF and BMP4 to generate astrocytes
Authors: Weible Michael W. , Chan‐Ling Tailoi
Published: June 2007

If cell based therapy for spinal cord injury is to become a reality, greater insights into the biology of human derived spinal cord stem cells are a prerequisite. Significant species differences and regional specification of stem cells necessitates determining the effects of growth factors on human spinal cord stem cells. Fetal spinal cords were dissociated and expanded as neurospheres in medium with bone morphogenetic protein 4 (BMP4), leukemia inhibitory factor (LIF) or BMP4 and LIF. First‐generation neurospheres comprised a heterogeneous population of neural cell types and after plating emergent cells included neurons, oligodendrocytes and GFAP+ cells which coexpressed stem cells markers and those of the neuronal lineage and were thus identified as GFAP+ neural precursor cells (NPC). When plated, neurospheres maintained in BMP4 demonstrated a reduced proportion of emergent oligodendrocytes from 13 to 4%, whereas LIF had no statistically significant effect on cell type distribution. Combining BMP4 and LIF reduced the proportion of oligodendrocytes to 3% and that of neurons from 37 to 16% while increasing the proportion of GFAP+ NPC from 45 to 79%. After 10 passages in control media aggregates gave rise to multiple neural phenotypes and only continued passage of neurospheres in the presence of BMP4 and LIF resulted in unipotent aggregates giving rise to only astrocytes. These results provide a means of obtaining pure populations of human spinal‐cord derived astrocytes, which could be utilized for further studies of cell replacement strategies or in vitro evaluation of therapeutics. © 2007 Wiley‐Liss, Inc.