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  1. A case of chronic left ventricular thrombus with ischemic cardiomyopathy

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    Vikram Bhausaheb Vikhe

    2013-01-01

    Full Text Available Left ventricular (LV thrombus is a serious complication of anterior wall myocardial infarction (MI, especially in patients with severe LV dysfunction. LV thrombus carries a high risk of causing stroke and other thromboembolic complications despite adequate anticoagulation therapy. There is a benefit of anticoagulation in patients with ischemic cardiomyopathy to reduce thromboembolic events or in resolution of LV thrombus. Two-dimensional (2D echocardiography is the most commonly used technique for the diagnosis and follow-up of such cases. Our patient developed a chronic LV thrombus with ischemic cardiomyopathy post anterior wall MI and was managed well on anticoagulants to prevent the thromboembolic events under strict vigilance and follow-up.

  2. Outcome of Prolonged Ventricular Fibrillation and CPR in a Rat Model of Chronic Ischemic Left Ventricular Dysfunction

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    Xiangshao Fang

    2013-01-01

    Full Text Available Patients with chronic left ventricular (LV dysfunction are assumed to have a lower chance of successful CPR and lower likelihood of ultimate survival. However, these assumptions have rarely been documented. Therefore, we investigated the outcome of prolonged ventricular fibrillation (VF and CPR in a rat model of chronic LV dysfunction. Sprague-Dawley rats were randomized to (1 chronic LV dysfunction: animals underwent left coronary artery ligation; and (2 sham control. Echocardiography was used to measure cardiac performance before surgery and 4 weeks after surgery. Four weeks after surgical intervention, 8 min of VF was induced and defibrillation was delivered after 8 min of CPR. LV dilation and low ejection fraction were observed 4 weeks after coronary ligation. With optimal chest compressions, coronary perfusion pressure values during CPR were well maintained and indistinguishable between groups. There were no differences in resuscitability and numbers of shock required for successful resuscitation between groups. Despite the significantly decreased cardiac index in LV dysfunction animals before induction of VF, no differences in cardiac index were observed between groups following resuscitation, which was associated with the insignificant difference in postresuscitation survival. In conclusion, the outcomes of CPR were not compromised by the preexisting chronic LV dysfunction.

  3. Impaired mitochondrial function in chronically ischemic human heart

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    Stride, Nis Ottesen; Larsen, Steen; Hey-Mogensen, Martin;

    2013-01-01

    , and finally to assess myocardial antioxidant levels. Mitochondrial respiration in biopsies from ischemic and nonischemic regions from the left ventricle of the same heart was compared in nine human subjects. Maximal oxidative phosphorylation capacity in fresh muscle fibers was lower in ischemic compared.......05), and the levels of antioxidant protein expression was lower. Diminished mitochondrial respiration capacity and excessive ROS production demonstrate an impaired mitochondrial function in ischemic human heart muscle. No chronic ischemic preconditioning effect was found....

  4. Reverse left ventricular remodeling is more likely in non ischemic cardiomyopathy patients upgraded to biventricular stimulation after chronic right ventricular pacing

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    Morales Maria-Aurora

    2011-12-01

    Full Text Available Abstract Background Chronic right ventricular (RV apical pacing may lead to left ventricular (LV dyssynchrony and LV dysfunction. In heart failure due to RV pacing, upgrading to biventricular stimulation (CRT can improve NYHA Class and LV function. A proportion of patients do not respond to upgrading. Aim was to assess whether etiology of LV dysfunction accounts for responses to CRT in RV-paced patients. Methods Sixty-two patients treated by CRT, under RV pacing from 50.2 ± 5.4 months, were studied. Cause of LV dysfunction was non-ischemic (NIC in 28 and ischemic cardiomyopathy (IC in 34 patients. Clinical and conventional echocardiographic parameters were available within 1 month before RV pacing, within 1 month before CRT and at 12 ± 2 months of follow-up (FU. Results Decreased LVEF (from 37.0 ± 8.8 to 25.6 ± 6.1%, p 10% decrease in LVESD was observed in 24 patients: 5 with IC, 19 with NIC (p 10% decrease in LVESD remained highly significant (p Conclusions CRT improves functional class even after long-lasting pacing. Reverse remodeling is evident in a small population, more likely with NIC.

  5. Outcome of bypass surgery in patients with chronic ischemic left ventricular dysfunction. Predictive value of MR imaging

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    Kloew, N.E. [The National Hospital, Oslo (Norway). Dept. of Radiology; Smith, H.J. [The National Hospital, Oslo (Norway). Dept. of Radiology; Gullestad, L. [The National Hospital, Oslo (Norway). Dept. of Cardiology; Seem, E. [The National Hospital, Oslo (Norway). Dept. of Cardiovascular Surgery; Endresen, K. [The National Hospital, Oslo (Norway). Dept. of Cardiology

    1997-01-01

    Purpose: To determine the preoperative findings of MR imaging of the left ventricle (LV) that could best predict the functional outcome of the LV after surgical revascularization. Material and Methods: Patients with angina pectoris, previous myocardial infarction, and dysfunction of the LV, and who had a preoperative cine MR, were re-evaluated after bypass surgery with MR in a study on the effects of revascularization after mean 22 months. Results: Angina pectoris was relieved in all patients except one, but the maximum workload during the exercise test was increased in only 3 patients. Coronary angiography showed that 37 of 45 (82%) of the distal anastomoses were open. The LV ejection fraction was the same before and after operation both at angiography and MR imaging. MR showed LV end-diastolic volume to be increased from 190{+-}50 ml to 250{+-}70 ml. Compared to angiography, MR provided additional information regarding myocardial wall thickness and function, and the size of myocardial infarction. Improvement in systolic wall thickening was seen in 65% of the segments that had had an end-diastolic wall thickness (EDWT) greater than 15 mm before operation, while only 4% of the segments with EDWT<6 mm improved. In the wall thickness range of 6-15 mm, MR was unable to predict the functional outcome of the LV. Conclusion: Preoperative MR findings of thick myocardial walls with poor function seem predictive of improved function after revascularization. When the LV wall thickness is less than 6 mm, no improvement should be expected. (orig.).

  6. Rationale and Design for the Intramyocardial Injection of Autologous Bone Marrow Mononuclear Cells for Patients with Chronic Ischemic Heart Disease and Left Ventricular Dysfunction Trial (FOCUS)

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    Willerson, James T.; Perin, Emerson C.; Ellis, Stephen G.; Pepine, Carl J.; Henry, Timothy D.; Zhao, David X.M.; Lai, Dejian; Penn, Marc S.; Byrne, Barry J.; Silva, G; Gee, Adrian; Traverse, Jay H.; Hatzopoulos, Antonis K.; Forder, John R.; Martin, Daniel; Kronenberg, Marvin; Taylor, Doris A.; Cogle, Christopher R.; Baraniuk, Sarah; Westbrook, Lynette; Sayre, Shelly L.; Vojvodic, Rachel W.; Gordon, David J.; Skarlatos, Sonia I.; Moyé, Lemuel A.; Simari, Robert D.

    2010-01-01

    Background The increasing worldwide prevalence of coronary artery disease (CAD) continues to challenge the medical community. Management options include medical and revascularization therapy. Despite advances in these methods, CAD is a leading cause of recurrent ischemia and heart failure, posing significant morbidity and mortality risks along with increasing health costs in a large patient population worldwide. Trial Design The Cardiovascular Cell Therapy Research Network (CCTRN) was established by the National Institutes of Health to investigate the role of cell therapy in the treatment of chronic cardiovascular disease. FOCUS is a CCTRN-designed randomized Phase II, placebo-controlled clinical trial that will assess the effect of autologous bone marrow mononuclear cells delivered transendocardially to patients with left ventricular (LV) dysfunction and symptomatic heart failure or angina. All patients need to have limiting ischemia by reversible ischemia on SPECT assessment. Results After thoughtful consideration of both statistical and clinical principles, we will recruit 87 patients (58 cell treated and 29 placebo) to receive either bone marrow–derived stem cells or placebo. Myocardial perfusion, LV contractile performance, and maximal oxygen consumption are the primary outcome measures. Conclusions The designed clinical trial will provide a sound assessment of the effect of autologous bone marrow mononuclear cells in improving blood flow and contractile function of the heart. The target population is patients with CAD and LV dysfunction with limiting angina or symptomatic heat failure. Patient safety is a central concern of the CCTRN, and patients will be followed for at least 5 years. PMID:20691824

  7. Ischemic contracture of the left ventricle. Production and prevention.

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    MacGregor, D C; Wilson, G J; Tanaka, S; Holness, D E; Lixfeld, W; Silver, M D; Rubis, L J; Goldstein, W; Gunstensen, J; Bigelow, W G

    1975-12-01

    Ischemic contracture of the left ventricle ("stone heart") is a recognized complication of prolonged periods of interruption of the coronary circulation during open-heart surgery. We have examined the effects of moderate hypothermia (28 degrees C.) and preoperative beta-adrenergic blockade (propranolol, 0.5 mg. per kilogram; 1.0 mg. per kilogram) on contracture development during ischemic arrest of the heart. Four groups of 8 dogs each were placed on total cardiopulmonary bypass, and ischemic arrest of the heart was produced by cross-clamping the ascending aorta and venting the left ventricle. Intramyocardial carbon dioxide tension was continuously monitored by mass spectrometry. When anaerobic energy production ceased, as indicated by a final plateau in the intramyocardial carbon dioxide accumulation curve, the ischemic arrest was terminated and the contractile state of the heart observed. These results are given in the text. We conclude that beta-adrenergic blockade delays, but does not prevent, the onset of ischemic contracture of the left ventricle under normothermic conditions. Moderate hypothermia appears to prevent this complication completely.

  8. Echocardiographic evaluation of left ventricular function in ischemic heart disease

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    Mollema, Sjoerd Adriaan

    2010-01-01

    The presence of a decreased left ventricular (LV) function after myocardial infarction has demonstrated to be of considerable clinical importance. In this thesis, the role of 2D echocardiography to evaluate LV function in ischemic heart disease was investigated. In the first part of the thesis, rece

  9. Ischemic Colitis of the Left Colon in a Diabetic Patient

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    Anastasios J. Karayiannakis

    2011-04-01

    Full Text Available Diabetes mellitus may affect the gastrointestinal tract possibly as a result of autonomic neuropathy. Here we present a 68-year-old male with non-insulin-dependent diabetes mellitus who presented with prolonged watery diarrhea and in whom imaging studies demonstrated ischemic colitis of the left colon. Resection of the affected colon resulted in sustained disappearance of symptoms.

  10. Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction.

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    Fernández-Golfín, Covadonga; De Agustin, Alberto; Manzano, M Carmen; Bustos, Ana; Sánchez, Tibisay; Pérez de Isla, Leopoldo; Fuentes, Manuel; Macaya, Carlos; Zamorano, José

    2011-04-01

    Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction below 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.

  11. Acute Ischemic Stroke and Acute on Chronic Kidney Disease

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    Raja Ahsan Aftab

    2016-06-01

    Full Text Available Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity. Here wer present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden onset of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus(un controlled. He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis, acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and carefull selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition. Keywords: ischemic disease; chronic kidney disease; uncontrolled hypertension. | PubMed

  12. Extracellular matrix remodeling in patients with ischemic chronic heart failure with preserved ejection fraction

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    V. D. Syvolap

    2015-04-01

    Full Text Available Aim. To identify features, relationships between parameters of the extracellular matrix and renal function in 110 patients with ischemic chronic heart failure the activity of collagen metabolism markers (MMP-9, TIMP-1, PICP, cystatin C, structural and functional parameters of the heart were studied using ELISA, echocardiography. Results. It was established that imbalance in the system MMP/TIMP in ischemic heart failure with preserved left ventricular ejection fraction leads to disruption of the extracellular matrix structural functional sufficiency, increases functional failure and is associated with impaired renal function. Conclusion. Correlation analysis showed significant relationships between MMP/TIMP and GFR, cystatin C, indicating that the significant role of extracellular matrix imbalance in the development of renal dysfunction in patients with ischemic chronic heart failure.

  13. Risk factors of the renal dysfunction formation in patients with ischemic chronic heart failure

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    V. D. Syvolap

    2015-02-01

    Full Text Available The aim was to study prevalence of some risk factors of the renal dysfunction. Methods and results. 344 patients with ischemic chronic heart failure were included. Clinical, medical history, laboratory and instrumental data were analyzed. It was established that renal dysfunction is accompanied by traditional (age, hyperlipidemia, hypertension, myocardial infarction, obesity, left ventricular hypertrophy and non-traditional risk factors (hyperuricemia, atrial fibrillation, left ventricular ejection fraction, left atrial volume index, cystatin C whose role increases with a decrease in glomerular filtration rate. Conclusion. This shows the close relationship between traditional and non-traditional risk factors that contribute to the development of cardio-renal complications.

  14. Double valve replacement for acute spontaneous left chordal rupture secondary to chronic aortic incompetence

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    McLenachan Jim

    2006-10-01

    Full Text Available Abstract A 54 years old male with undiagnosed chronic calcific degenerative aortic valve incompetence presented with acute left anterior chordae tendinae rupture resulting in severe left heart failure and cardiogenic shock. He was successfully treated with emergency double valve replacement using mechanical valves. The pathogenesis of acute rupture of the anterior chordae tendinae, without any evidence of infective endocarditis or ischemic heart disease seems to have been attrition of the subvalvular mitral apparatus by the chronic regurgitant jet of aortic incompetence with chronic volume overload. We review the literature with specific focus on the occurrence of this unusual event.

  15. Analysis of circumferential and longitudinal left ventricular systolic function in patients with non-ischemic chronic heart failure and preserved ejection fraction (from the CARRY-IN-HFpEF study).

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    Cioffi, Giovanni; Senni, Michele; Tarantini, Luigi; Faggiano, Pompilio; Rossi, Andrea; Stefenelli, Carlo; Russo, Tiziano Edoardo; Alessandro, Selmi; Furlanello, Francesco; de Simone, Giovanni

    2012-02-01

    Heart failure with preserved left ventricular ejection fraction (HFpEF) is implicitly attributed to diastolic dysfunction, often recognized in elderly patients with hypertension, diabetes, and renal dysfunction. In these patients, left ventricular circumferential and longitudinal shortening is often impaired despite normal ejection fraction. The aim of this prospective study was to analyze circumferential and longitudinal shortening and their relations in patients with nonischemic HFpEF. Stress-corrected midwall shortening (sc-MS) and mitral annular peak systolic velocity (S') were measured in 60 patients (mean age 73 ± 13 years) with chronic nonischemic HFpEF in stable New York Heart Association functional class II or III and compared to the values in 120 healthy controls and 120 patients with hypertension without HFpEF. Sc-MS was classified as low if HFpEF, 27% of patients with hypertension, and 2% of controls; isolated low S' was detected in 11% of patients with HFpEF, 7% of patients with hypertension, and 5% of controls; and combined low sc-MS and low S' was detected in 26% of patients with HFpEF, 9% of patients with hypertension, and 5% of controls (HFpEF vs others, all p values HFpEF. The relation between sc-MS and S' was nonlinear (cubic). Changes in S' within normal values corresponded to negligible variations in sc-MS, whereas the progressive decrease below 8.5 cm/s was associated with substantial decrease in sc-MS. In conclusion, circumferential and/or longitudinal systolic dysfunction is present in most patients with HFpEF. Circumferential shortening normalized by wall stress identifies more patients with concealed left ventricular systolic dysfunction than longitudinal shortening.

  16. A Rare Cardiac Malformation in a Patient Presenting with Transient Ischemic Attack: Isolated Left Ventricular Diverticulum

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    Haldun Müderrisoğlu1

    2012-12-01

    Full Text Available Left ventricular diverticulum is a rare congenital malformation consisting of a localized protrusion of the endocardium and myocardium from the free wall of the left ventricle (LV. The prevalence of the disease is 0.26% in nonselected patients who underwent cardiac catheterization. It is believed that the etiology is an intrinsic abnormality developing during embryogenesis. It often does not cause any symptoms. We report a case of isolated left ventricular diverticulum with complaints of transient ischemic attack.

  17. Subendocardial contractile impairment in chronic ischemic myocardium: assessment by strain analysis of 3T tagged CMR

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    Nagao Michinobu

    2012-02-01

    Full Text Available Abstract Background The purpose of this study was to quantify myocardial strain on the subendocardial and epicardial layers of the left ventricle (LV using tagged cardiovascular magnetic resonance (CMR and to investigate the transmural degree of contractile impairment in the chronic ischemic myocardium. Methods 3T tagged CMR was performed at rest in 12 patients with severe coronary artery disease who had been scheduled for coronary artery bypass grafting. Circumferential strain (C-strain at end-systole on subendocardial and epicardial layers was measured using the short-axis tagged images of the LV and available software (Intag; Osirix. The myocardial segment was divided into stenotic and non-stenotic segments by invasive coronary angiography, and ischemic and non-ischemic segments by stress myocardial perfusion scintigraphy. The difference in C-strain between the two groups was analyzed using the Mann-Whitney U-test. The diagnostic capability of C-strain was analyzed using receiver operating characteristics analysis. Results The absolute subendocardial C-strain was significantly lower for stenotic (-7.5 ± 12.6% than non-stenotic segment (-18.8 ± 10.2%, p Conclusions Analysis of tagged CMR can non-invasively demonstrate predominant impairment of subendocardial strain in the chronic ischemic myocardium at rest.

  18. Effect of mobilization of bone marrow stem cells by granulocyte colony stimulating factor on clinical symptoms, left ventricular perfusion and function in patients with severe chronic ischemic heart disease

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    Wang, Yongzhong; Tägil, Kristina; Ripa, Rasmus S.

    2005-01-01

    OBJECTIVES: A phase I safety and efficacy study with granulocyte colony stimulating factor (G-CSF) mobilization of bone marrow stem cells to induce vasculogenesis in patients with severe ischemic heart disease (IHD) was conducted. DESIGN, PATIENTS AND RESULTS: 29 patients with IHD participated...... in 'mobilizers'. At the follow-up, G-CSF treated had improved in CCS classification, NTG consumption and angina attacks, but the controls only in CCS classification. No difference was seen between the two groups. The decline in NTG consumption tended to be significant in 'mobilizers' compared to controls...

  19. Acute anti-ischemic effects ef perindoprilat in men with coronary artery disease and their relation with left ventricular function

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    Bartels, GL; van den Heuvel, AFM; van Veldhuisen, DJ; van der Ent, M; Remme, WJ

    1999-01-01

    Long-term angiotensin-converting enzyme (ACE) inhibition may reduce ischemic events in patients with coronary artery disease, but whether it protects against acute ischemia or the effects of preexisting left ventricular (LV) dysfunction on potential anti-ischemic properties is unknown. We performed

  20. NATRIURETIC PEPTIDE AND HIS PROGENITORS AS PREDICTORS OF PROGRESSIVE POSTOPERATIVE LEFT VENTRICLE REMODELING IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY

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    S. S. Gutor

    2013-01-01

    Full Text Available The work is devoted to the study of atrial natriuretic peptide (ANP and its precursors as one of possible predictors of left ventricular repeated remodeling in patients with ischemic cardiomyopathy (ICMP in the follow-up (postoperative period. Objects of the study are venous blood and intraoperative samples of right atrial auricle. Precursors of NUP were identified in blood serum by the immuno-fluorescence test. Ultrathin slices of auricle biopsy samples were examined with electronmicroscopy with the use of image processing ImageJ software (program. The concentration of NUP precursors in blood plasma and relation of minimal diameter of secretory granules to maximal one in right auricle cardiomyocytes reflect pathological processes taking place in the myocardium of patients with ICMP. Ratio of minimal and maximal diameters of secretory granules is a predictor of chronic heart failure progressing.

  1. Lysophospholipids in coronary artery and chronic ischemic heart disease

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    Abdel-Latif, Ahmed; Heron, Paula M.; Morris, Andrew J.; Smyth, Susan S.

    2015-01-01

    Purpose of review The bioactive lysophospholipids, lysophosphatidic acid (LPA) and sphingosine 1 phosphate (S1P) have potent effects on blood and vascular cells. This review focuses their potential contributions to the development of atherosclerosis, acute complications, such as acute myocardial infarction, and chronic ischemic cardiac damage. Recent findings Exciting recent developments have provided insight into the molecular underpinnings of LPA and S1P receptor signaling. New lines of evidence suggest roles for these pathways in the development of atherosclerosis. In experimental animal models, the production, signaling and metabolism of LPA may be influenced by environmental factors in the diet that synergize to promote the progression of atherosclerotic vascular disease. This is supported by observations of human polymorphisms in the lysophospholipid metabolizing enzyme, PPAP2B, that are associated with risk of coronary artery disease and myocardial infarction. S1P signaling protects from myocardial damage that follows acute and chronic ischemia both by direct effects on cardiomyocytes and through stem cell recruitment to ischemic tissue. Summary This review will suggest novel strategies to prevent the complications of coronary artery disease by targeting LPA production and signaling. Additionally, ways in which S1P signaling pathways may be harnessed to attenuate ischemia-induced cardiac dysfunction will be explored. PMID:26270808

  2. Left ventricular geometry and white matter lesions in ischemic stroke patients.

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    Butenaerts, Demian; Chrzanowska-Wasko, Joanna; Slowik, Agnieszka; Dziedzic, Tomasz

    2016-06-01

    Abnormal left ventricular (LV) geometry is associated with extracardiac organ damage in patients with hypertension. The aim of this study was to determine the relationship between LV geometry and white matter lesions (WMLs) in ischemic stroke patients. We retrospectively analyzed data from 155 patients (median age 62; 49.8% male) with mild ischemic stroke (median National Institutes of Health Stroke Scale score 4) who underwent brain magnetic resonance imaging and echocardiography. Patients were categorized into four groups: normal LV geometry, concentric remodeling, eccentric left ventricular hypertrophy (LVH) and concentric LVH. WMLs were graded using the Fazekas scale on fluid-attenuated inversion recovery images. Extensive WMLs were defined as a Fazekas score > 2. Extensive WMLs were more prevalent in patients with concentric LVH, eccentric LVH and concentric remodeling than in those with normal LV geometry. After adjusting for hypertension, age, diabetes mellitus, hypercholesterolemia, glomerular filtration rate and ischemic heart disease, patients with concentric remodeling [odds ratio (OR) 3.94, 95% confidence interval (CI) 1.26-12.31, p = 0.02] and those with concentric LVH (OR 3.69, 95% CI 1.24-10.95, p = 0.02), but not patients with eccentric LVH (OR 2.44, 95% CI 0.72-8.29, p = 0.15), had higher risk of extensive WMLs than patients with normal LV geometry.

  3. Pentaerythritol Tetranitrate Targeting Myocardial Reactive Oxygen Species Production Improves Left Ventricular Remodeling and Function in Rats With Ischemic Heart Failure.

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    Fraccarollo, Daniela; Galuppo, Paolo; Neuser, Jonas; Bauersachs, Johann; Widder, Julian D

    2015-11-01

    Reduced nitric oxide bioavailability contributes to progression of cardiac dysfunction and remodeling in ischemic heart failure. Clinical use of organic nitrates as nitric oxide donors is limited by development of nitrate tolerance and reactive oxygen species formation. We investigated the effects of long-term therapy with pentaerythritol tetranitrate (PETN), an organic nitrate devoid of tolerance, in rats with congestive heart failure after extensive myocardial infarction. Seven days after coronary artery ligation, rats were randomly allocated to treatment with PETN (80 mg/kg BID) or placebo for 9 weeks. Long-term PETN therapy prevented the progressive left ventricular dilatation and improved left ventricular contractile function and relaxation in rats with congestive heart failure. Mitochondrial superoxide anion production was markedly increased in the failing left ventricular myocardium and nearly normalized by PETN treatment. Gene set enrichment analysis revealed that PETN beneficially modulated the dysregulation of mitochondrial genes involved in energy metabolism, paralleled by prevention of uncoupling protein-3, thioredoxin-2, and superoxide dismutase-2 downregulation. Moreover, PETN provided a remarkable protective effect against reactive fibrosis in chronically failing hearts. Mechanistically, induction of heme oxygenase-1 by PETN prevented mitochondrial superoxide generation, NOX4 upregulation, and ensuing formation of extracellular matrix proteins in fibroblasts from failing hearts. In summary, PETN targeting reactive oxygen species generation prevented the changes of mitochondrial antioxidant enzymes and progressive fibrotic remodeling, leading to amelioration of cardiac functional performance. Therefore, PETN might be a promising therapeutic option in the treatment of ischemic heart diseases involving oxidative stress and impairment in nitric oxide bioactivity.

  4. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

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    Hassager, C; Thygesen, K; Grande, P

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...

  5. Mental stress-induced left ventricular dysfunction and adverse outcome in ischemic heart disease patients.

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    Sun, Julia L; Boyle, Stephen H; Samad, Zainab; Babyak, Michael A; Wilson, Jennifer L; Kuhn, Cynthia; Becker, Richard C; Ortel, Thomas L; Williams, Redford B; Rogers, Joseph G; O'Connor, Christopher M; Velazquez, Eric J; Jiang, Wei

    2017-04-01

    Aims Mental stress-induced myocardial ischemia (MSIMI) occurs in up to 70% of patients with clinically stable ischemic heart disease and is associated with increased risk of adverse prognosis. We aimed to examine the prognostic value of indices of MSIMI and exercise stress-induced myocardial ischemia (ESIMI) in a population of ischemic heart disease patients that was not confined by having a recent positive physical stress test. Methods and results The Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment (REMIT) study enrolled 310 subjects who underwent mental and exercise stress testing and were followed annually for a median of four years. Study endpoints included time to first and total rate of major adverse cardiovascular events, defined as all-cause mortality and hospitalizations for cardiovascular causes. Cox and negative binomial regression adjusting for age, sex, resting left ventricular ejection fraction, and heart failure status were used to examine associations of indices of MSIMI and ESIMI with study endpoints. The continuous variable of mental stress-induced left ventricular ejection fraction change was significantly associated with both endpoints (all p values mental stress, patients had a 5% increase in the probability of a major adverse cardiovascular event at the median follow-up time and a 20% increase in the number of major adverse cardiovascular events endured over the follow-up period of six years. Indices of ESIMI did not predict endpoints ( ps > 0.05). Conclusion In patients with stable ischemic heart disease, mental, but not exercise, stress-induced left ventricular ejection fraction change significantly predicts risk of future adverse cardiovascular events.

  6. Cognitive alterations in motor imagery process after left hemispheric ischemic stroke.

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    Jing Yan

    Full Text Available BACKGROUND: Motor imagery training is a promising rehabilitation strategy for stroke patients. However, few studies had focused on the neural mechanisms in time course of its cognitive process. This study investigated the cognitive alterations after left hemispheric ischemic stroke during motor imagery task. METHODOLOGY/PRINCIPAL FINDINGS: Eleven patients with ischemic stroke in left hemisphere and eleven age-matched control subjects participated in mental rotation task (MRT of hand pictures. Behavior performance, event-related potential (ERP and event-related (desynchronization (ERD/ERS in beta band were analyzed to investigate the cortical activation. We found that: (1 The response time increased with orientation angles in both groups, called "angle effect", however, stoke patients' responses were impaired with significantly longer response time and lower accuracy rate; (2 In early visual perceptual cognitive process, stroke patients showed hypo-activations in frontal and central brain areas in aspects of both P200 and ERD; (3 During mental rotation process, P300 amplitude in control subjects decreased while angle increased, called "amplitude modulation effect", which was not observed in stroke patients. Spatially, patients showed significant lateralization of P300 with activation only in contralesional (right parietal cortex while control subjects showed P300 in both parietal lobes. Stroke patients also showed an overall cortical hypo-activation of ERD during this sub-stage; (4 In the response sub-stage, control subjects showed higher ERD values with more activated cortical areas particularly in the right hemisphere while angle increased, named "angle effect", which was not observed in stroke patients. In addition, stroke patients showed significant lower ERD for affected hand (right response than that for unaffected hand. CONCLUSIONS/SIGNIFICANCE: Cortical activation was altered differently in each cognitive sub-stage of motor imagery after

  7. [CHARACTERISTIC OF ALTERATIONS OF ARTERIES IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEPATITIS C].

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    Guliaev, N I; Kuznetsov, V V; Poltareĭko, D S; Qleksiuk, I B; Gordienko, A V; Barsukov, A V

    2015-01-01

    The article presents an assessment of degree and type of atherosclerosis of coronary and non-coronary vessels in old patients with ischemic heart disease associated with chronic viral hepatitis C (VHC), the incidence of myocardial infarction and the possibility of participation chronic VHC in atherogenesis. Patients with ischemic heart disease have correlation of atherosclerosis of arteries with age, hypercholesterinemia. Patients without chronic VHC more often give a higher risk of myocardial infarction, especially in early period (1-1,5 years) of onset of ischemic heart disease clinical implications. Patients with ischemic heart disease associated with chronic viral hepatitis C more often have generalized alterations in vessels, multifocal type of alteration. So, participation of VHC in atherogenesis is most probably connected with maintenance of chronic immune inflammation in vascular endothelium.

  8. Association between High Endocardial Unipolar Voltage and Improved Left Ventricular Function in Patients with Ischemic Cardiomyopathy.

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    Park, Ki; Lai, Dejian; Handberg, Eileen M; Moyé, Lem; Perin, Emerson C; Pepine, Carl J; Anderson, R David

    2016-08-01

    We know that endocardial mapping reports left ventricular electrical activity (voltage) and that these data can predict outcomes in patients undergoing traditional revascularization. Because the mapping data from experimental models have also been linked with myocardial viability, we hypothesized an association between increased unipolar voltage in patients undergoing intramyocardial injections and their subsequent improvement in left ventricular performance. For this exploratory analysis, we evaluated 86 patients with left ventricular dysfunction, heart-failure symptoms, possible angina, and no revascularization options, who were undergoing endocardial mapping. Fifty-seven patients received bone marrow mononuclear cell (BMC) injections and 29 patients received cell-free injections of a placebo. The average mapping site voltage was 9.7 ± 2 mV, and sites with voltage of ≥6.9 mV were engaged by needle and injected (with BMC or placebo). For all patients, at 6 months, left ventricular ejection fraction (LVEF) improved, and after covariate adjustment this improvement was best predicted by injection-site voltage. For every 2-mV increase in baseline voltage, we detected a 1.3 increase in absolute LVEF units for all patients (P=0.038). Multiple linear regression analyses confirmed that voltage and the CD34(+) count present in bone marrow (but not treatment assignment) were associated with improved LVEF (P=0.03 and P=0.014, respectively). In an exploratory analysis, higher endocardial voltage and bone marrow CD34(+) levels were associated with improved left ventricular function among ischemic cardiomyopathy patients. Intramyocardial needle injections, possibly through stimulation of angiogenesis, might serve as a future therapy in patients with reduced left ventricular function and warrants investigation.

  9. Diagnosing Paroxysmal Atrial Fibrillation in Patients With Ischemic Strokes and Transient Ischemic Attacks Using Echocardiographic Measurements of Left Atrium Function

    DEFF Research Database (Denmark)

    Skaarup, Kristoffer Grundtvig; Christensen, Hanne; Høst, Nis;

    2016-01-01

    AF in patients with ischemic stroke (IS) and transient ischemic attack (TIA). We retrospectively analyzed 219 patients who after acute IS or TIA underwent a transthoracic echocardiographic examination. Patients were designated as patients with paroxysmal AF if they had one or more reported incidents...

  10. Influence of Kinesitherapy on Gait in Patients with Ischemic Stroke in the Chronic Period

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    Danche Vasileva

    2015-10-01

    CONCLUSION: The applied specialized kinesitherapeutic methodology continued later as exercise program at home, which significantly improved gait cadence and speed of movement in patients with ischemic stroke in the chronic period and is with a supportive prolonged exposure.

  11. Noninvasive monitoring of cardiac function in a chronic ischemic heart failure model in the rat: Assessment with tissue Doppler and non-Doppler 2D strain echocardiography

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    Baumann Gert

    2011-05-01

    Full Text Available Abstract Objectives Feasibility of noninvasive monitoring of cardiac function after surgically induced ischemic cardiomyopathy with tissue Doppler and non-Doppler 2D strain echocardiography in rats. Background The optimal method for quantitative assessment of global and regional ventricular function in rats with chronic heart failure for research purposes remains unclear. Methods 20 rats underwent suture ligation of the left anterior descending coronary artery via a left thoracotomy to induce ischemic cardiomyopathy. Echocardiographic examination with estimation of left ventricular wall thickness, diameters, fractional shortening, ejection fraction, wall velocities as well as radial strain were performed before and 4 weeks after surgery. Results Mean LVEF decreased from 70 ± 6% to 40 ± 8% (p Conclusion It is feasible to assess dimensions, global function, and regional contractility with echocardiography in rats suffering from chronic heart failure after myocardial infarction. Particularly regional function can be exactly evaluated if tissue Doppler and 2D strain is used.

  12. Conduction Remodeling in Human End-Stage Non-Ischemic Left Ventricular Cardiomyopathy

    Science.gov (United States)

    Glukhov, Alexey V.; Fedorov, Vadim V.; Kalish, Paul W.; Ravikumar, Vinod K.; Lou, Qing; Janks, Deborah; Schuessler, Richard B.; Moazami, Nader; Efimov, Igor R.

    2012-01-01

    Background Several arrhythmogenic mechanisms have been inferred from animal heart failure (HF) models. However, the translation of these hypotheses is difficult due to lack of functional human data. We aimed to investigate the electrophysiological substrate for arrhythmia in human end-stage non-ischemic cardiomyopathy. Methods and Results We optically mapped the coronary-perfused left ventricular wedge preparations from human hearts with end-stage non-ischemic cardiomyopathy (HF, n=10) and non-failing hearts (NF, n=10). Molecular remodeling was studied with immunostaining, Western blotting, and histological analyses. HF produced heterogeneous prolongation of action potential duration (APD) resulting in the decrease of transmural APD dispersion (64±12 ms vs 129±15 ms in NF, P<0.005). In the failing hearts, transmural activation was significantly slowed from the endocardium (39±3 cm/s versus 49±2 cm/s in NF, P=0.008) to the epicardium (28±3 cm/s versus 40±2 cm/s in NF, P=0.008). Conduction slowing was likely due to Cx43 downregulation, decreased colocalization of Cx43 with N-cadherin (40±2% versus 52±5% in NF, P=0.02), and an altered distribution of phosphorylated Cx43 isoforms by the upregulation of the dephosphorylated Cx43 in both the subendocardium and subepicardium layers. Failing hearts further demonstrated spatially discordant conduction velocity alternans which resulted in nonuniform propagation discontinuities and wavebreaks conditioned by strands of increased interstitial fibrosis (fibrous tissue content in HF 16.4±7.7 versus 9.9±1.4% in NF, P=0.02). Conclusions Conduction disorder resulting from the anisotropic downregulation of Cx43 expression, the reduction of Cx43 phosphorylation, and increased fibrosis is likely to be a critical component of arrhythmogenic substrate in patients with non-ischemic cardiomyopathy. PMID:22412072

  13. MAGNESIUM METABOLISM AND CLINICAL CHARACTERISTICS OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE

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    A. V. Yezhov

    2010-01-01

    Full Text Available Aim. To study relationship of the clinical state and cardiac functional parameters with magnesium metabolism indices in patients with chronic ischemic heart disease (IHD.Material and methods. Patients with stable angina pectoris, II-III class (n=480 were involved into the study. Evaluation of the following items was performed: disease course, anxiodepressive syndrome intensity, exercise tolerance, blood and urine electrolyte profile, systolic and diastolic left ventricle function, endothelium-dependent and endotheliumnondependent vasodilatation, i/v magnesium load test, Holter electrocardiogram monitoring.Results. High prevalence of systemic magnesium deficiency (17.9 and 37.5% according to serum and erythrocyte levels, respectively was found in IHD patients. Severity of magnesium deficiency in IHD patients depended on duration of disease, experience of myocardial infarction, myocardial ischemia seriousness, disorders of endothelium vasodilating function and left ventricle diastolic function, severity of concomitant anxiety. Exercise tests were changed in IHD patients with magnesium deficiency.Conclusion. The study data let to consider that magnesium deficiency involves into the IHD pathogenesis.

  14. Autologous Intravenous Mononuclear Stem Cell Therapy in Chronic Ischemic Stroke

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    Bhasin A

    2012-01-01

    Full Text Available Background: The regenerative potential of brain has led to emerging therapies that can cure clinico-motor deficits after neurological diseases. Bone marrow mononuclear cell therapy is a great hope to mankind as these cells are feasible, multipotent and aid in neurofunctional gains in Stroke patients. Aims: This study evaluates safety, feasibility and efficacy of autologous mononuclear (MNC stem cell transplantation in patients with chronic ischemic stroke (CIS using clinical scores and functional imaging (fMRI and DTI. Design: Non randomised controlled observational study Study: Twenty four (n=24 CIS patients were recruited with the inclusion criteria as: 3 months–2years of stroke onset, hand muscle power (MRC grade at least 2; Brunnstrom stage of recovery: II-IV; NIHSS of 4-15, comprehendible. Fugl Meyer, modified Barthel Index (mBI and functional imaging parameters were used for assessment at baseline, 8 weeks and at 24 weeks. Twelve patients were administered with mean 54.6 million cells intravenously followed by 8 weeks of physiotherapy. Twelve patients served as controls. All patients were followed up at 24 weeks. Outcomes: The laboratory and radiological outcome measures were within normal limits in MNC group. Only mBI showed statistically significant improvement at 24 weeks (p<0.05 whereas the mean FM, MRC, Ashworth tone scores in the MNC group were high as compared to control group. There was an increased number of cluster activation of Brodmann areas BA 4, BA 6 post stem cell infusion compared to controls indicating neural plasticity. Cell therapy is safe and feasible which may facilitate restoration of function in CIS.

  15. Ischemic Left Ventricular Dysfunction: Severity of Remodeling, Myocardial Viability and Survival After Surgical Revascularization

    Science.gov (United States)

    Bonow, Robert O.; Castelvecchio, Serenella; Panza, Julio A.; Berman, Daniel S.; Velazquez, Eric J.; Michler, Robert E.; She, Lilin; Holly, Thomas A.; Desvigne-Nickens, Patrice; Kosevic, Dragana; Rajda, Miroslaw; Chrzanowski, Lukasz; Deja, Marek; Lee, Kerry L.; White, Harvey; Oh, Jae K.; Doenst, Torsten; Hill, James A; Rouleau, Jean L.; Menicanti, Lorenzo

    2015-01-01

    Objectives The objectives of this study were to test the hypothesis that end-systolic volume (ESV), as a marker of severity of left ventricular (LV) remodeling, influences the relationship between myocardial viability and survival in patients with coronary artery disease and LV systolic dysfunction. Background Retrospective studies of ischemic LV dysfunction suggest that severity of LV remodeling determines whether myocardial viability predicts improved survival with surgical (CABG) compared to medical (MED) therapy, with CABG only benefitting patients with viable myocardium who have smaller ESV. However, this has not been tested prospectively. Methods Interactions of ESV index (ESVI), myocardial viability and treatment with respect to survival were assessed in patients in the prospective randomized STICH trial of CABG vs MED who underwent viability assessment (n=601, age 61±9 years, ejection fraction ≤35%), median follow-up 5.1 years. Median ESVI was 84 ml/m2. Viability was assessed by SPECT or dobutamine echocardiography using prespecified criteria. Results Mortality was highest among patients with larger ESVI and non-viability (P84 ml/m2 (HR 0.87, 95% CI 0.57,1.31). Other ESVI thresholds yielded similar results, including ESVI ≤60 ml/m2 (HR 0.87, 95% CI 0.44,1.74). ESVI and viability assessed as continuous rather than dichotomous variables yielded similar results (P=0.562). Conclusions Among patients with ischemic cardiomyopathy, those with greater LVESVI and no substantial viability have worse prognosis. However, the effect of CABG relative to MED is not differentially influenced by the combination of these two factors. Lower ESVI does not identify patients in whom myocardial viability predicts better outcome with CABG relative to MED. PMID:26363840

  16. Relationship of left heart size and left ventricular mass with exercise capacity in chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    SHEN Yu-qin; WANG Le-min; CHE Lin; SONG Hao-ming; ZHANG Qi-ping

    2011-01-01

    Background Impaired exercise capacity is one of the most common clinical manifestations in patients with chronic heart failure (CHF). The severity of reduced exercise capacity is an indicator of disease prognosis. The aim of the current study was to investigate the association between left heart size and mass with exercise capacity.Methods A total of 74 patients were enrolled in the study, with 37 having congestive heart failure (left ventricular ejection fraction (LVEF) <0.45) and the other 37 with coronary heart disease (by coronary angiography) serving as the control group (LVEF >0.55). Echocardiography and cardiopulmonary exercise test were performed. The multiply linear regression model was used to evaluate the association between echocardiogrphic indices and exercise capacities.Results The study showed that left ventricular end diastolic / systolic diameter (LVEDD/LVESD), left atrial diameter (LAD) and left ventricular mass index (LVMI) were significantly enlarged in patients with chronic heart failure compared with controls (P <0.01). The VO2AT, Peak VO2, Load AT, and Load Peak in chronic heart failure patients were also significantly reduced compared with controls (P <0.05), VE/VCO2 slope was increased in patients with chronic heart failure (P <0.01). Multivariate linear regression analysis indicated that the patients' exercise capacity was significantly associated with the left heart size and mass, however, the direction and/or strength of the associations sometimes varied in chronic heart failure patients and controls. Load AT correlated negatively with LVEDD in chronic heart failure patients (P=0.012), while Load AT correlated positively with LVEDD in control patients (P=0.006). VE/VCO2 slope correlated positively with LAD (B=0.477, P <0.0001) in chronic heart failure patients, while the VE/VCO2 slope correlated negatively with LAD in control patients (P=0.009).Conclusion The study indicates that the size of LVEDD and LAD are important

  17. Prevalence, correlative and statistical relationships of renal dysfunction in patients with chronic ischemic heart failure

    Directory of Open Access Journals (Sweden)

    D. A. Lashkul

    2014-02-01

    detected change, the possibility of pharmacological correction in patients with ischemic chronic heart failure, depending on age, sex, functional class, left ventricular contractile ability.

  18. Motor imagery cognitive network after left ischemic stroke: study of the patients during mental rotation task.

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    Jing Yan

    Full Text Available Although motor imagery could improve motor rehabilitation, the detailed neural mechanisms of motor imagery cognitive process of stroke patients, particularly from functional network perspective, remain unclear. This study investigated functional brain network properties in each cognitive sub-stage of motor imagery of stroke patients with ischemic lesion in left hemisphere to reveal the impact of stroke on the cognition of motor imagery. Both stroke patients and control subjects participated in mental rotation task, which includes three cognitive sub-stages: visual stimulus perception, mental rotation and response cognitive process. Event-related electroencephalograph was recorded and interdependence between two different cortical areas was assessed by phase synchronization. Both global and nodal properties of functional networks in three sub-stages were statistically analyzed. Phase synchronization of stroke patients significantly reduced in mental rotation sub-stage. Longer characteristic path length and smaller global clustering coefficient of functional network were observed in patients in mental rotation sub-stage which implied the impaired segregation and integration. Larger nodal clustering coefficient and betweenness in contralesional occipitoparietal and frontal area respectively were observed in patients in all sub-stages. In addition, patients also showed smaller betweenness in ipsilesional central-parietal area in response sub-stage. The compensatory effects on local connectedness and centrality indicated the neuroplasticity in contralesional hemisphere. The functional brain networks of stroke patients demonstrated significant alterations and compensatory effects during motor imagery.

  19. Quality-of-Life Outcomes in Surgical Treatment of Ischemic Heart Failure Quality-of-Life Outcomes With Coronary Artery Bypass Graft Surgery in Ischemic Left Ventricular Dysfunction

    Science.gov (United States)

    Mark, Daniel B.; Knight, J. David; Velazquez, Eric J.; Wasilewski, Jaroslaw; Howlett, Jonathan G.; Smith, Peter K.; Spertus, John A.; Rajda, Miroslaw; Yadav, Rakesh; Hamman, Baron L.; Malinowski, Marcin; Naik, Ajay; Rankin, Gena; Harding, Tina M.; Drew, Laura A.; Desvigne-Nickens, Patrice; Anstrom, Kevin J.

    2014-01-01

    Background: The STICH (Surgical Treatment for Ischemic Heart Failure) trial compared a strategy of routine coronary artery bypass grafting (CABG) with guideline-based medical therapy for patients with ischemic left ventricular dysfunction. Objective: To describe treatment-related quality-of-life (QOL) outcomes, a major prespecified secondary end point in the STICH trial. Design: Randomized trial. (ClinicalTrials.gov: NCT00023595) Setting: 99 clinical sites in 22 countries. Patients: 1212 patients with a left ventricular ejection fraction of 0.35 or less and coronary artery disease. Intervention: Random assignment to medical therapy alone (602 patients) or medical therapy plus CABG (610 patients). Measurements: A battery of QOL instruments at baseline (98.9% complete) and 4, 12, 24, and 36 months after randomization (collection rates were 80% to 89% of those eligible). The principal prespecified QOL measure was the Kansas City Cardiomyopathy Questionnaire, which assesses the effect of heart failure on patients’ symptoms, physical function, social limitations, and QOL. Results: The Kansas City Cardiomyopathy Questionnaire overall summary score was consistently higher (more favorable) in the CABG group than in the medical therapy group by 4.4 points (95% CI, 1.8 to 7.0 points) at 4 months, 5.8 points (CI, 3.1 to 8.6 points) at 12 months, 4.1 points (CI, 1.2 to 7.1 points) at 24 months, and 3.2 points (CI, 0.2 to 6.3 points) at 36 months. Sensitivity analyses to account for the effect of mortality on follow-up QOL measurement were consistent with the primary findings. Limitation: Therapy was not masked. Conclusion: In this cohort of symptomatic high-risk patients with ischemic left ventricular dysfunction and multivessel coronary artery disease, CABG plus medical therapy produced clinically important improvements in several health status domains compared with medical therapy alone over 36 months. Primary Funding Source: National Heart, Lung, and Blood Institute. PMID

  20. Adrenomedulline improves ischemic left colonic anastomotic healing in an experimental rodent model

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    Oguzhan Karatepe

    2011-01-01

    Full Text Available BACKGROUND: Leakage from colonic anastomosis is a major complication causing increased mortality and morbidity. Ischemia is a well-known cause of this event. This study was designed to investigate the effects of adrenomedullin on the healing of ischemic colon anastomosis in a rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats that were divided into four groups. To mimic ischemia, the mesocolon was ligated 2 cm from either side of the anastomosis in all of the groups. The control groups (1 and 2 received no further treatment. The experimental groups (3 and 4 received adrenomedullin treatment. Adrenomedullin therapy was started in the perioperative period in group 3 and 4 rats (the therapeutic groups. Group 1 and group 3 rats were sacrificed on postoperative day 3. Group 2 and group 4 rats were sacrificed on postoperative day 7. After careful relaparotomy, bursting pressure, hydroxyproline, malondialdehyde, interleukin 6, nitric oxide, vascular endothelial growth factor, and tumor necrosis factor alpha levels were measured. Histopathological characteristics of the anastomosis were analyzed. RESULTS: The group 3 animals had a significantly higher bursting pressure than group 1 (p<0.05. Hydroxyproline levels in group 1 were significantly lower than in group 3 (p<0.05. The mean bursting pressure was significantly different between group 2 and group 4 (p<0.05. Hydroxyproline levels in groups 3 and 4 were significantly increased by adrenomedullin therapy relative to the control groups (p<0.05. When all groups were compared, malondialdehyde and nitric oxide were significantly lower in the control groups (p<0.05. When vascular endothelial growth factor levels were compared, no statistically significant difference between groups was observed. Interleukin 6 and tumor necrosis factor alpha were significantly decreased by adrenomedullin therapy (p<0.05. The

  1. Chronic hyperglycemia is related to poor functional outcome after acute ischemic stroke.

    Science.gov (United States)

    Luitse, Merel Ja; Velthuis, Birgitta K; Kappelle, L Jaap; van der Graaf, Yolanda; Biessels, Geert Jan

    2017-02-01

    Background Acute hyperglycemia is associated with poor functional outcome after ischemic stroke, but the association between chronic antecedent hyperglycemia and outcome is unclear. Aim We assessed the association between chronic hyperglycemia, measured by hemoglobin A1c, and functional outcome in patients with acute ischemic stroke. Methods We included 812 patients with acute ischemic stroke (mean age 66 ± 14 years; 61.5% male). Patients were categorized per hemoglobin A1c level: no (chronic hyperglycemia (>42 mmol/mol). Poor functional outcome was defined as modified Rankin Scale score > 2 after 3 months. The relation between chronic hyperglycemia and functional outcome was assessed with a Poisson regression analysis and expressed as risk ratios with 95% confidence intervals with no chronic hyperglycemia as the reference. Results Moderate chronic hyperglycemia was present in 234 (28.8%) patients and severe chronic hyperglycemia in 183 (22.5%) patients. Acute hyperglycemia on admission was present in 338 (41.6%) patients. Severe chronic hyperglycemia was associated with poor outcome (risk ratios 1.40; 95% confidence interval 1.09-1.79). After adjustment for age, sex, stroke severity, vascular risk factors, and acute hyperglycemia on admission the risk ratios was 1.35 (95% confidence interval 1.04-1.76). Moderate chronic hyperglycemia was not associated with poor outcome (risk ratios 1.12; 95% confidence interval 0.87-1.44). Conclusion Severe chronic hyperglycemia is associated with poor functional outcome in patients with acute ischemic stroke. This association is independent of hyperglycemia in the acute stage of stroke and of an unfavorable vascular risk factor profile.

  2. Sex differences in the hypertensive population with chronic ischemic heart disease.

    Science.gov (United States)

    Barrios, Vivencio; Escobar, Carlos; Bertomeu, Vicente; Murga, Nekane; de Pablo, Carmen; Calderón, Alberto

    2008-10-01

    Cardiopatía Isquémica Crónica e Hipertensión Arterial en la Práctica Clínica en España (CINHTIA) was a survey designed to assess the clinical management of hypertensive outpatients with chronic ischemic heart disease. Sex differences were examined. Blood pressures (BP) was considered controlled at levels of <140/90 or <130/80 mm Hg in diabetics (European Society of Hypertension/European Society of Cardiology 2003); low-density lipoprotein cholesterol (LDL-C) was considered controlled at levels <100 mg/dL (National Cholesterol Education Program Adult Treatment Panel III). In total, 2024 patients were included in the study. Women were older, with a higher body mass index and an increased prevalence of atrial fibrillation. Dyslipidemia, smoking, sedentary lifestyle, and peripheral arterial disease were more frequent in men. In contrast, diabetes, left ventricular hypertrophy, and heart failure were more common in women. BP and LDL-C control rates, although poor in both groups, were better in men (44.9% vs 30.5%, P<.001 and 33.0% vs 25.0%, P<.001, respectively). Stress testing and coronary angiography were more frequently performed in men.

  3. Establishment of a chronic left ventricular aneurysm model in rabbit

    Institute of Scientific and Technical Information of China (English)

    Cang-Song XIAO; Chang-Qing GAO; Li-Bing LI; Yao WANG; Tao ZHAO; Wei-Hua YE; Chong-Lei REN; Zhi-Yong LIU; Yang WU

    2014-01-01

    Objectives To establish a cost-effective and reproducible procedure for induction of chronic left ventricular aneurysm (LVA) in rabbits. Methods Acute myocardial infarction (AMI) was induced in 35 rabbits via concomitant ligation of the left anterior descending (LAD) coronary artery and the circumflex (Cx) branch at the middle portion. Development of AMI was co n-firmed by ST segment elevation and akinesis of the occluded area. Echocardiography, pathological evaluation, and agar i n-tra-chamber casting were utilized to validate the formation of LVA four weeks after the surgery. Left ventricular end systolic pressure (LVESP) and diastolic pressure (LVEDP) were measured before, immediately after and four weeks after ligation. D i-mensions of the ventricular chamber, thickness of the interventricular septum (IVS) and the left ventricular posterior wall (LVPW) left ventricular end diastolic volume (LVEDV) and systolic volume (LVESV), and ejection fraction (EF) were recorded by echo-cardiography. Results Thirty one (88.6%) rabbits survived myocardial infarction and 26 of them developed aneurysm (83.9%). The mean area of aneurysm was 33.4% ± 2.4% of the left ventricle. LVEF markedly decreased after LVA formation, whereas LVEDV, LVESV and the thickness of IVS as well as the dimension of ventricular chamber from apex to mitral valve annulus significantly increased. LVESP immediately dropped after ligation and recovered to a small extent after LVA formation. LVEDP progressively increased after ligation till LVA formation. Areas in the left ventricle (LV) that underwent fibrosis included the apex, anterior wall and lateral wall but not IVS. Agar intra-chamber cast showed that the bulging of LV wall was prominent in the area of aneurysm. Conclusions Ligation of LAD and Cx at the middle portion could induce develo pment of LVA at a mean area ratio of 33.4%±2.4%which involves the apex, anterior wall and lateral wall of the LV.

  4. Different effects of calcium antagonist and beta-blocker therapy on left-ventricular diastolic function in ischemic heart disease. A direct comparison of the impact of mibefradil and atenolol

    DEFF Research Database (Denmark)

    Hassager, C; Thygesen, K; Grande, P;

    2001-01-01

    OBJECTIVE: To compare the effect of a calcium antagonist and a beta-blocker on left-ventricular diastolic function in patients with ischemic heart disease. METHODS: 138 patients with chronic stable angina pectoris were randomized in a multicenter, double-blind trial to treatment with either...... mibefradil or atenolol for 6 weeks (50 mg once daily for 2 weeks followed by 100 mg once daily for 4 weeks). The ratio between early (E) and late (A) diastolic mitral flow velocities (E/A), the E wave deceleration time (DT) and the left ventricular isovolumetric relaxation time (IRT) were measured by Doppler...

  5. Computer-based assessment of left ventricular wall stiffness in patients with ischemic dilated cardiomyopathy

    Science.gov (United States)

    Su, Y.; Teo, S. K.; Tan, R. S.; Lim, C. W.; Zhong, L.

    2013-02-01

    Ischemic dilated cardiomyopathy (IDCM) is a degenerative disease of the myocardial tissue accompanied by left ventricular (LV) structural changes such as interstitial fibrosis. This can induce increased passive stiffness of the LV wall. However, quantification of LV passive wall stiffness in vivo is extremely difficult, particularly in ventricles with complex geometry. Therefore, we sought to (i) develop a computer-based assessment of LV passive wall stiffness from cardiac magnetic resonance (CMR) imaging in terms of a nominal stiffness index (E*); and (ii) investigate whether E* can offer an insight into cardiac mechanics in IDCM. CMR scans were performed in 5 normal subjects and 5 patients with IDCM. For each data sample, an in-house software was used to generate a 1-to-1 corresponding mesh pair of the LV from the ED and ES phases. The E* values are then computed as a function of local ventricular wall strain. We found that E* in the IDCM group (40.66 - 215.12) was at least one order of magnitude larger than the normal control group (1.00 - 6.14). In addition, the IDCM group revealed much higher inhomogeneity of E* values manifested by a greater spread of E* values throughout the LV. In conclusion, there is a substantial elevated ventricular stiffness index in IDCM. This would suggest that E* could be used as discriminator for early detection of disease state. The computational performance per data sample took approximately 25 seconds, which demonstrates its clinical potential as a real-time cardiac assessment tool.

  6. Chronic exposure to zinc oxide nanoparticles increases ischemic-reperfusion injuries in isolated rat hearts

    Science.gov (United States)

    Milivojević, Tamara; Drobne, Damjana; Romih, Tea; Mali, Lilijana Bizjak; Marin, Irena; Lunder, Mojca; Drevenšek, Gorazd

    2016-10-01

    The use of zinc oxide nanoparticles (ZnO NPs) in numerous products is increasing, although possible negative implications of their long-term consumption are not known yet. Our aim was to evaluate the chronic, 6-week oral exposure to two different concentrations of ZnO NPs on isolated rat hearts exposed to ischemic-reperfusion injury and on small intestine morphology. Wistar rats of both sexes ( n = 18) were randomly divided into three groups: (1) 4 mg/kg ZnO NPs, (2) 40 mg/kg ZnO NPs, and (3) control. After 6 weeks of treatment, the hearts were isolated, the left ventricular pressure (LVP), the coronary flow (CF), the duration of arrhythmias and the lactate dehydrogenase release rate (LDH) were measured. A histological investigation of the small intestine was performed. Chronic exposure to ZnO NPs acted cardiotoxic dose-dependently. ZnO NPs in dosage 40 mg/kg maximally decreased LVP (3.3-fold) and CF (2.5-fold) and increased the duration of ventricular tachycardia (all P < 0.01) compared to control, whereas ZnO NPs in dosage 4 mg/kg acted less cardiotoxic. Goblet cells in the small intestine epithelium of rats, treated with 40 mg ZnO NPs/kg, were enlarged, swollen and numerous, the intestinal epithelium width was increased. Unexpectedly, ZnO NPs in both dosages significantly decreased LDH. A 6-week oral exposure to ZnO NPs dose-dependently increased heart injuries and caused irritation of the intestinal mucosa. A prolonged exposure to ZnO NPs might cause functional damage to the heart even with exposures to the recommended daily doses, which should be tested in future studies.

  7. Novel approach for identification of left ventricle geometry in patients with chronic heart failure, AH and IHD in combination with COPD

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    Potabashniy V.A.

    2016-05-01

    Full Text Available The aim of this study was to examine the direction of change of left ventricle (LV geometry in patients with chronic heart failure (CHF, arterial hypertension (AH and ischemic heart disease (IHD in combination with chronic obstructive pulmonary disease (COPD in dependence on severity of clinical signs of CHF and COPD based on recommendation of American Society of Echocardiography and European Association of Cardiovascular Images (2015. We examined 67 patients with CHF, associated with AH and stable IHD and stable COPD. By the results of this study there were determined different types of left ventricle geometry: concentric LV hypertrophy (LVH, eccentric LVH, mixed LVH, dilated LVH, dependent on blood pressure level, fibrosic and ischemic myocardial changes,, primary predominant disease – AH, IHD or COPD.

  8. Ischemic colitis during interferon-ribavirin therapy for chronic hepatitis C: A case report

    Institute of Scientific and Technical Information of China (English)

    Su Jung Baik; Tae Hun Kim; Kwon Yoo; Il Hwan Moon; Min-Sun Cho

    2012-01-01

    Ischemic colitis is a rare complication of interferon administration.Only 9 cases in 6 reports have been described to-date.This report describes a case of ischemic colitis during pegylated interferon and ribavirin treatment for chronic hepatitis C,and includes a review of the relevant literature.A 48-year-old woman was treated with pegylated interferon α-2a and ribavirin for chronic hepatitis C,genotype Ib.After 19 wk of treatment,the patient complained of severe afebrile abdominal pain with hematochezia.Vital signs were stable and serum white blood cell count was within the normal range.Abdominal computed tomography showed diffuse colonic wall thickening from the splenic flexure to the proximal sigmoid colon,which is the most vulnerable area for the development of ischemic colitis.Colonoscopy revealed an acute mucosal hyperemic change,with edema and ulcerations extending from the proximal descending colon to the sigmoid colon.Colonic mucosal biopsy revealed acute exudative colitis.Polymerase chain reaction and culture for Mycobacterium tuberculosis were negative and the cultures for cytomegalovirus,Salmonella and Shigel/a species were negative.After discontinuation of interferon and ribavirin therapy,abdominal pain and hematochezia subsided and,following colonoscopy showed improvement of the mucosal ulcerations.Ischemic colitis cases during interferon therapy in patients with chronic hepatitis C reported so far have all involved the descending colon.Ischemic colitis is a rarely encountered complication of interferon administration in patients with chronic hepatitis C and should be considered when a patient complains of abdominal pain and hematochezia.

  9. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  10. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2014-07-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  11. Efficacy and safety of ivabradine as an add-on to atenolol in patients with chronic stable ischemic heart disease

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    Elavarasi Pichai

    2016-12-01

    Conclusions: Ivabradine is safe and effective in preventing and treating further anginal attacks in patients with chronic stable ischemic heart disease already on atenolol therapy. [Int J Basic Clin Pharmacol 2016; 5(6.000: 2546-2551

  12. Adjustment and Characterization of an Original Model of Chronic Ischemic Heart Failure in Pig

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    Laurent Barandon

    2010-01-01

    Full Text Available We present and characterize an original experimental model to create a chronic ischemic heart failure in pig. Two ameroid constrictors were placed around the LAD and the circumflex artery. Two months after surgery, pigs presented a poor LV function associated with a severe mitral valve insufficiency. Echocardiography analysis showed substantial anomalies in radial and circumferential deformations, both on the anterior and lateral surface of the heart. These anomalies in function were coupled with anomalies of perfusion observed in echocardiography after injection of contrast medium. No demonstration of myocardial infarction was observed with histological analysis. Our findings suggest that we were able to create and to stabilize a chronic ischemic heart failure model in the pig. This model represents a useful tool for the development of new medical or surgical treatment in this field.

  13. Aging aggravates ischemic stroke-induced brain damage in mice with chronic peripheral infection.

    Science.gov (United States)

    Dhungana, Hiramani; Malm, Tarja; Denes, Adam; Valonen, Piia; Wojciechowski, Sara; Magga, Johanna; Savchenko, Ekaterina; Humphreys, Neil; Grencis, Richard; Rothwell, Nancy; Koistinaho, Jari

    2013-10-01

    Ischemic stroke is confounded by conditions such as atherosclerosis, diabetes, and infection, all of which alter peripheral inflammatory processes with concomitant impact on stroke outcome. The majority of the stroke patients are elderly, but the impact of interactions between aging and inflammation on stroke remains unknown. We thus investigated the influence of age on the outcome of stroke in animals predisposed to systemic chronic infection. Th1-polarized chronic systemic infection was induced in 18-22 month and 4-month-old C57BL/6j mice by administration of Trichuris muris (gut parasite). One month after infection, mice underwent permanent middle cerebral artery occlusion and infarct size, brain gliosis, and brain and plasma cytokine profiles were analyzed. Chronic infection increased the infarct size in aged but not in young mice at 24 h. Aged, ischemic mice showed altered plasma and brain cytokine responses, while the lesion size correlated with plasma prestroke levels of RANTES. Moreover, the old, infected mice exhibited significantly increased neutrophil recruitment and upregulation of both plasma interleukin-17α and tumor necrosis factor-α levels. Neither age nor infection status alone or in combination altered the ischemia-induced brain microgliosis. Our results show that chronic peripheral infection in aged animals renders the brain more vulnerable to ischemic insults, possibly by increasing the invasion of neutrophils and altering the inflammation status in the blood and brain. Understanding the interactions between age and infections is crucial for developing a better therapeutic regimen for ischemic stroke and when modeling it as a disease of the elderly.

  14. Anemic syndrome in patients with ischemic heart disease and chronic heart failure (review

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    Shvarts Y.G.

    2011-12-01

    Full Text Available Anemic syndrome of different severity often accompanies ischemic heart disease (IHD and chronic heart failure (CHF. Anemia has association with unfavorable prognosis in patients with all forms of CVD — acute and chronic. In this article the authors summarize a literature review of English articles dedicated to the problem of anemia and ischemic heart disease (IHD and the results of original research on the relationship between anemic syndrome and prognosis in the hospitalized patients with IHD and chronic heart failure (CHF. Anemia is frequently observed in patients with CHF, and evidence suggests that anemia might be associated with an increased mortality in both systolic and diastolic chronic heart failure (CHF, morbidity and rate of hospitalization in CHF patients. Moreover, CHF itself could be involved in the pathogenesis of anemia. Early studies suggested a pathogenic role of inflammation mediators. The normalization of hemoglobin concentration by EPO and iron supply in patients with CHF and chronic renal insufficiency results in improved exercise capacity by increasing oxygen delivery and improving cardiac function. However, there is limited information concerning the association of hemoglobin concentration and new onset of clinically recognized coronary artery disease, and lack of information about the effect of anemia treatment on prognosis of acute forms of IHD

  15. [Transesophageal electric stimulation of the left atrium in the diagnosis of ischemic heart disease].

    Science.gov (United States)

    Liakishev, A A; Kozlov, S G; Grosu, A A; Kulikova, T V; Sidorenko, B A

    1984-10-01

    The clinical picture and the results of bicycle ergometry and selective coronarography were compared with the findings of electrical stimulation of the left atrium in 24 patients. It was demonstrated that transesophagus electric stimulation of the left atrium may serve as a diagnostic method in coronary heart disease.

  16. Chronic oral pathology and ischemic heart disease and its complications

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    Ivaschenko Y.Y.

    2013-09-01

    Full Text Available Objective: to establish the relationship of chronic generalized periodontitis, multiple cavities and dentofacial anomalies with various forms of coronary heart disease and its complications. Material and methods. The study included 294 patients with coronary heart disease and its complications. The patients were divided into two groups. Group I included 89 patients with acute Q-myocardial infarction, which was placed in the presence of at least 2 of the following criteria identified on the basis of a comprehensive clinical and instrumental examination: clinical, laboratory confirmation (CK-MB, electrocardiographic signs of damage or myocardial necrosis. The following statistical methods were used: multi-variate and univariate analysis of variance, non-parametric tests, crosstabulation, chi-square test, Fisher»s exact test. As a measure of variability of the normal distribution standard deviation was used. Results. It is noted that in patients with myocardial infarction more likely than in patients without coronary heart attack in history severe generalized periodontitis, dentofacial anomalies and multiple dental caries have appeared. In patients with acute myocardial infarction, severe periodontal disease has been associated with increased fibrinogen levels in the blood and an increase in the dispersion of the interval QT, which are known to be indicators of poor prognosis in acute coronary disease.

  17. Left ventricular geometric remodeling in relation to non-ischemic scar pattern on cardiac magnetic resonance imaging.

    Science.gov (United States)

    Kim, Jiwon; Kochav, Jonathan D; Gurevich, Sergey; Afroz, Anika; Petashnick, Maya; Volo, Samuel; Diaz, Belen; Okin, Peter M; Horn, Evelyn; Devereux, Richard B; Weinsaft, Jonathan W

    2014-12-01

    Left ventricular (LV) remodeling and myocardial fibrosis have been linked to adverse heart failure outcomes. Mid wall late gadolinium enhancement (MW-LGE) on cardiac magnetic resonance (CMR) imaging is well-associated with non-ischemic cardiomyopathy (NICM), but prevalence in ischemic cardiomyopathy (ICM) and association with remodeling are unknown. The population comprised patients with systolic dysfunction [LV ejection fraction (LVEF ≤ 40 %)]. CMR was used to identify MW-LGE, conventionally defined as fibrosis of the mid-myocardial or epicardial aspect of the LV septum. 285 patients were studied. MW-LGE was present in 12 %, and was tenfold more common with NICM (32 %) versus ICM (3 %, p MW-LGE had ICM. LV wall stress was higher (p = 0.02) among patients with, versus those without, MW-LGE despite similar systolic blood pressure (p = 0.24). In multivariate analysis, MW-LGE was associated with CMR-quantified LV end-diastolic volume (p = 0.03) independent of LVEF and mass. Incorporation of clinical and imaging variables demonstrated MW-LGE to be associated with higher LV end-diastolic volume (OR 1.13, CI 1.004-1.27 per 10 ml/m(2), p = 0.04) after controlling for presence of NICM (OR 16.0, CI 5.8-44.1, p MW-LGE can occur in ICM and is a marker of LV chamber dilation irrespective of cardiomyopathic etiology.

  18. A Novel Closed-Chest Porcine Model of Chronic Ischemic Heart Failure Suitable for Experimental Research in Cardiovascular Disease

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    Giuseppe Biondi-Zoccai

    2013-01-01

    Full Text Available Cardiac pathologies are among the leading causes of mortality and morbidity in industrialized countries, with myocardial infarction (MI representing one of the major conditions leading to heart failure (HF. Hitherto, the development of consistent, stable, and reproducible models of closed-chest MI in large animals, meeting the clinical realism of a patient with HF subsequent to chronic ischemic necrosis, has not been successful. We hereby report the design and ensuing application of a novel porcine experimental model of closed-chest chronic ischemia suitable for biomedical research, mimicking post-MI HF. We also emphasize the key procedural steps involved in replicating this unprecedented model, from femoral artery and vein catheterization to MI induction by permanent occlusion of the left anterior descending coronary artery through superselective deployment of platinum-nylon coils, as well as endomyocardial biopsy sampling for histologic analysis and cell harvesting. Our model could indeed represent a valuable contribution and tool for translational research, providing precious insights to understand and overcome the many hurdles concerning, and currently quenching, the preclinical steps mandatory for the clinical translation of new cardiovascular technologies for personalized HF treatments.

  19. Preliminary clinical study of left ventricular myocardial strain in patients with non-ischemic dilated cardiomyopathy by three-dimensional speckle tracking imaging

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    Duan Fengxia

    2012-03-01

    Full Text Available Abstract Background Non-ischemic dilated cardiomyopathy (DCM is the most common cardiomyopathy worldwide, with significant mortality. Correct evaluation of the patient's myocardial function has important clinical significance in the diagnosis, therapeutic effect assessment and prognosis in non-ischemic DCM patients. This study evaluated the feasibility of three-dimensional speckle tracking imaging (3D-STE for assessment of the left ventricular myocardial strain in patients with non-ischemic dilated cardiomyopathy (DCM. Methods Apical full-volume images were acquired from 65 patients with non-ischemic DCM (DCM group and 59 age-matched normal controls (NC group, respectively. The following parameters were measured by 3D-STE: the peak systolic radial strain (RS, circumferential strain (CS, longitudinal strain (LS of each segment. Then all the parameters were compared between the two groups. Results The peak systolic strain in different planes had certain regularities in normal groups, radial strain (RS was the largest in the mid region, the smallest in the apical region, while circumferential strain (CS and longitudinal strain (LS increased from the basal to the apical region. In contrast, the regularity could not be applied to the DCM group. RS, CS, LS were significantly decreased in DCM group as compared with NC group (P Conclusions 3D-STE is a reliable tool for evaluation of left ventricular myocardial strain in patients with non-ischemic DCM, with huge advantage in clinical application.

  20. CT Findings in Acute, Subacute, and Chronic Ischemic Colitis: Suggestions for Diagnosis

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    Francesca Iacobellis

    2014-01-01

    Full Text Available Purpose. This paper aims at evaluating CT findings of occlusive and nonocclusive ischemic colitis (IC, in correlation with the etiology and the different phases of the disease. Materials and Methods. CT examination and clinical history of 32 patients with proven IC were retrospectively reviewed. The CT findings were analyzed according to the different phases of the disease (acute, subacute, and chronic. Results. Among the 32 CT examinations performed in the acute phase, 62.5% did not present signs of occlusion of the superior mesenteric artery (SMA or inferior mesenteric artery (IMA, whereas IMA occlusion was detected in 37.5% of CT examinations. In the acute phase, the presence of pericolic fluid was found in 100% of patients undergoing progressive resorption from acute to subacute phase if an effective reperfusion occurred; the bowel wall thickening was observed in 28.1% patients in acute phase and in 86.4% patients evaluated in subacute phase. The unthickened colonic wall was found in all conditions where ischemia was not followed by effective reperfusion (71.9% of cases, and it was never found in chronic phase, when the colon appeared irregularly thickened. Conclusion. CT allows determining the morphofunctional alterations associated with the IC discriminating the occlusive forms from the nonocclusive forms. CT, furthermore, allows estimating the timing of ischemic damage.

  1. Left ventricular dysfunction in ischemic heart disease: fundamental importance of the fibrous matrix.

    Science.gov (United States)

    Swan, H J

    1994-05-01

    The contractile function of the myocardium is coordinated by a fibrous matrix of exquisite organization and complexity. In the normal heart, and apparently in physiological hypertrophy, this matrix is submicroscopic. In pathological states changes are frequent, and usually progressive. Thickening of the many elements of the fine structure is due to an increased synthesis of Type I collagen, This change, which affects the myocardium in a global manner, can be observed by light microscopy using special techniques. Perivascular fibrosis, with an increase in vascular smooth muscle, is accompanied by development of fibrous septa, with a decrease in diastolic compliance. These structural changes are believed to be due to increased activation of the renin-angiotensin-aldosterone system, and to be independent of the processes of myocyte hypertrophy. Reparative or replacement fibrosis is a separate process by means of which small and large areas of necrosis heal, with the development of coarse collagen structures, which lack a specific organizational pattern. Regarding ischemic heart disease, an increase in tissue collagenase is found in experimental myocardial "stunning" and in the very early phase of acute infarction. Absence of elements of the fibrous matrix allow for myocyte slippage, and--if the affected area is large--cardiac dilatation. If, subsequently, the necrosis becomes transmural, there is further disturbance of collagen due to both mechanical strain and continued autolysis, During healing collagen synthesis increases greatly to allow for reparative scarring in the available tissue matrix. In cases of infarction with moderate or severe initial dilatation, pathological hypertrophy of the spared myocardium is progressive, accounting for late heart failure and poor survival.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Five-year survival of patients with chronic systolic heart failure of ischemic and non-ischemic etiology: analysis of prognostic factors

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Zakliczyński, Michał; Rozentryt, Piotr; Partyka, Robert; Zembala, Marian; Poloński, Lech

    2014-01-01

    Introduction Despite advances in pharmacotherapy, electrotherapy and interventional treatment, chronic heart failure (HF) is still associated with poor long-term outcome. Aim of the study To determine the death rate and risk factors in patients with HF of ischemic and non-ischemic etiology in five-year follow-up. Material and methods Consecutive patients with chronic systolic HF hospitalized in the period 2006-2008 were analyzed retrospectively. Study exclusion criteria were: infections (< 3 months before hospitalization), hemodynamically significant valve disease, advanced chronic kidney disease, liver cirrhosis and neoplastic diseases (< 5 years before hospitalization). Results The analysis encompassed 266 patients divided into two groups: Group A, with HF of ischemic etiology (n = 157), and Group B, with HF of non-ischemic etiology (n = 109). Mortality was significantly higher in Group A than in Group B (49% vs. 28.4%, p = 0.001). The independent risk factors for death in Group A were: New York Heart Association (NYHA) class (HR = 1.81; p < 0.001); concentrations of high-sensitivity C-reactive protein (hs-CRP) (HR = 1.01; p < 0.05), fibrinogen (HR = 1.04; p < 0.001) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) (HR = 1.02; p < 0.001); and right ventricular end-diastolic diameter (RVEDd) (HR = 1.07; p < 0.01). In Group B they were age (HR = 1.07; p < 0.05) and NT-proBNP concentration (HR = 1.03; p < 0.001). Conclusions Mortality was significantly lower in Group B than in Group A. The independent risk factors for death in Group B were age and NT-proBNP serum concentration, whilst in Group A they were NYHA class, serum concentrations of hs-CRP, NT-proBNP and fibrinogen, and RVEDd. PMID:26336396

  3. Enhanced preservation of acutely ischemic myocardium with transseptal left ventricular assist.

    Science.gov (United States)

    Fonger, J D; Zhou, Y; Matsuura, H; Aldea, G S; Shemin, R J

    1994-03-01

    Mechanical support for acute regional ischemia without hemodynamic collapse may be achieved percutaneously with an intraaortic balloon pump (IABP) or with transseptal left ventricular assist (TLVA) while awaiting revascularization. The relative benefits of these two percutaneous transfemoral techniques for the treatment of ischemia were compared in a representative animal model. During 90 minutes of regional coronary occlusion, four groups of 8 pigs were treated with either no support (control), IABP, TLVA, or both IABP and TLVA. Cardioplegic arrest for 30 minutes to simulate coronary grafting was followed by 180 minutes of global reperfusion on bypass. In all groups regional wall motion and interstitial pH in the area at risk were significantly depressed with ischemia, but wall motion fully recovered after reperfusion. However, histochemical staining of the area of necrosis/area at risk was significantly reduced with IABP versus control (20.2% versus 34.1%; p < 0.05) and further significantly reduced with TLVA and IABP + TLVA (10.7% and 6.7% versus IABP alone; p < 0.05). We conclude that in supporting even a modest-sized myocardial region at risk (12% of the left ventricle) the area that went on to infarction was significantly reduced with the use of TLVA over IABP. Regional wall motion and myocardial pH measurements did not reflect this difference in the early reperfusion period. The benefit of TLVA over IABP during more extensive or prolonged ischemia may have real clinical significance.

  4. Novel topical formulation for ischemic chronic wounds. Technological design, quality control and safety evaluation.

    Science.gov (United States)

    Cabrera, Carla Agostina; Ramos, Alberto Nicolas; Loandos, María Del Huerto; Valdez, Juan Carlos; Sesto Cabral, Maria Eugenia

    2016-01-01

    Ulceration of the foot in diabetes is common and disabling, and frequently leads to amputation of the leg. The pathogenesis of foot ulceration is complex, clinical presentation variable and management requires early expert assessment. Despite treatment, ulcers readily become chronic wounds. Chronic wounds are those that remain in a chronic inflammatory state failing a normal healing process patterns. This is partially caused by inefficient eradication of opportunistic pathogens like Pseudomonas aeruginosa. We propose its control or eradication will promote wound healing. Lactobacillus plantarum cultures supernatants (LAPS) shows antipathogenic and pro-healing properties. The main objective was to design two pharmaceutical dosage forms by using LAPS as active pharmaceutical ingredient and to perform its quality control, in vitro activity conservation tests and human trials (safety evaluation). Both selected formulations reach the technological quality expected for 120 days, shows adequate occlusive characteristics and proper adhesion to human skin. From the in vitro release assays were found that LAPS shows adequate release from matrix and maintain its antimicrobial and anti-biofilm activity. First human trials were developed and neither edema nor erythema on healthy skin voluntaries was found. We conclude that C80 and C100 are adequate for their use in future clinical trials to demonstrate a comprehensive therapeutic effectiveness in ischemic chronic wounds.

  5. Chronically ischemic mouse skeletal muscle exhibits myopathy in association with mitochondrial dysfunction and oxidative damage.

    Science.gov (United States)

    Pipinos, Iraklis I; Swanson, Stanley A; Zhu, Zhen; Nella, Aikaterini A; Weiss, Dustin J; Gutti, Tanuja L; McComb, Rodney D; Baxter, B Timothy; Lynch, Thomas G; Casale, George P

    2008-07-01

    A myopathy characterized by mitochondrial pathology and oxidative stress is present in patients with peripheral arterial disease (PAD). Patients with PAD differ in disease severity, mode of presentation, and presence of comorbid conditions. In this study, we used a mouse model of hindlimb ischemia to isolate and directly investigate the effects of chronic inflow arterial occlusion on skeletal muscle microanatomy, mitochondrial function and expression, and oxidative stress. Hindlimb ischemia was induced by staged ligation/division of the common femoral and iliac arteries in C57BL/6 mice, and muscles were harvested 12 wk later. Muscle microanatomy was examined by bright-field microscopy, and mitochondrial content was determined as citrate synthase activity in muscle homogenates and ATP synthase expression by fluorescence microscopy. Electron transport chain (ETC) complexes I through IV were analyzed individually by respirometry. Oxidative stress was assessed as total protein carbonyls and 4-hydroxy-2-nonenal (HNE) adducts and altered expression and activity of manganese superoxide dismutase (MnSOD). Ischemic muscle exhibited histological features of myopathy and increased mitochondrial content compared with control muscle. Complex-dependent respiration was significantly reduced for ETC complexes I, III, and IV in ischemic muscle. Protein carbonyls, HNE adducts, and MnSOD expression were significantly increased in ischemic muscle. MnSOD activity was not significantly changed, suggesting MnSOD inactivation. Using a mouse model, we have demonstrated for the first time that inflow arterial occlusion alone, i.e., in the absence of other comorbid conditions, causes myopathy with mitochondrial dysfunction and increased oxidative stress, recapitulating the muscle pathology of PAD patients.

  6. Overlap and distinctiveness of psychological risk factors in patients with ischemic heart disease and chronic heart failure

    DEFF Research Database (Denmark)

    Pelle, Aline J; Denollet, Johan; Zwisler, Ann-Dorthe

    2009-01-01

    Growing evidence supports the importance of psychological factors in the etiology and progression of cardiovascular disease (CVD). However, this research has been criticized due to overlap between psychological constructs. We examined whether psychological questionnaires frequently used...... in cardiovascular research assess distinct constructs in a mixed group of ischemic heart disease (IHD) and chronic heart failure (CHF) patients....

  7. Angiogenesis effects of adenovirus-mediated gene transfer of VEGF-B on chronic ischemic myocardium

    Institute of Scientific and Technical Information of China (English)

    DONG Shu-qiang; ZHANG Bao-ren; MEI Ju; XU Zhi-yun; ZOU Liang-jian; HUANG Sheng-dong

    2002-01-01

    Objective: To study the angiogenesis effects of adenovirus-mediated gene transfer of VEGF-B on chronic ischemic myocardium. Methods: Domestic pigs underwent thoracotomy and placement of an ameroid constrictor on the circumflex coronary artery. Four weeks later, Ad. VEGF-B, Ad. LacZ or PBS were administrated directly into the myocardium at 10 sites in the circumflex distribution (109 PFU or 100 μl) according to groups. Echocardiography and ex vivo coronary angiography were performed. The injection sites around myocardium were harvested and subjected to histological analysis and immunochemical staining. Results: Echocardiography assessment 4 weeks after vector administration demonstrated significant improvement of regional wall systolic function. Collateral vesseldevelopment assessed by angiography was also significantly greater in Ad. VEGF-B animals than that in control animals. Vascular density analysis revealed a mean of 43±5 neovessels per high-power field in Ad.VEGF-B group versus 19±4 and 17±6 in Ad.LacZ and PBS group. Conclusion:Direct intramyocardial administration of Ad.VEGF-B can induce focal angiogenesis and result in improvement in regional myocardial function, which may be useful in patients with ischemic heart disease who are not eligible for conventional therapies.

  8. Pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction in dogs.

    Science.gov (United States)

    Stepien, Rebecca L

    2009-09-01

    Pulmonary arterial hypertension is a description of a physiological finding rather than a diagnosis. Pulmonary arterial pressure is the result of interactions among pulmonary blood flow (right ventricular cardiac output), pulmonary vascular impedance and post-capillary pressure (typically reflecting left atrial pressure). When elevations in pulmonary arterial pressure (systolic/diastolic pulmonary arterial pressure > approximately 30/19 mmHg at rest) are accompanied by increased left atrial pressure, pulmonary arterial hypertension may be considered secondary to left-heart failure. Introduction of Doppler methods to diagnose pulmonary arterial hypertension has increased the awareness of the prevalence and importance of pulmonary arterial hypertension dogs with left-heart failure. Increasing understanding of the mechanism of development of pulmonary venous hypertension and reactive pulmonary arterial hypertension in dogs with left-heart disease has led to the development of successful additive therapies for progressive clinical signs in the setting of chronic therapy for congestive heart failure due to left-sided valvular and myocardial dysfunction. Because effective therapies for pulmonary arterial hypertension secondary to chronic left-sided cardiac dysfunction are now available, screening for pulmonary arterial hypertension should be a regular part of the Doppler echocardiographic examination in a clinical setting of chronic therapy for left-sided congestive heart failure due to valvular or myocardial disease.

  9. [Ocular ischemic syndrome--a case report].

    Science.gov (United States)

    Zemba, M; Avram, Corina Ioana; Ochinciuc, Uliana; Stamate, Alina Cristina; Camburu, Raluca Lăcrămioara

    2013-01-01

    Ocular ischemic syndrome, also known as hypoperfusion/ hypotensive retinopathy or as ischemic oculopathy is a rare ocular disease determined by chronic arterial hypoperfusion through central retinal artery, posterior and anterior ciliary arteries. It is bilateral in 20% of the cases. Most often it appears due to severe occlusion of the carotid arteries (ICA, MCA>ECA), described in 1963 by Kearns and Hollenhorst. Occasionally it can be determined by the obstruction of ophtalmic artery or some arterities (Takayasu, giant cell arteritis). The risk factors are: age between 50-80 years, males (M:F = 2:1), arterial hypertension, diabetes, coronary diseases (5% of the cases develop ocular ischemic syndrome), vascular stroke, hemodialysis. The case we present is of an 63 years old man known with primary arterial hypertension, hypercholesterolemia, diabetes type 2 non insulin dependent and diagnosticated with ischemic cerebral stroke and bilateral obstruction of internal carotid arteries in march 2010, who is presenting for visual impairment in both eyes. The imaging investigations show important carotid occlusion and at the ophthalmologic evaluation there are ocular hypertension and rubeosis iridis at the right eye, optic atrophy at both eyes (complete in the right eye and partial in the left eye), with superior altitudinal visual field defect in left eye. The following diagnosis was established: Chronic ocular ischemic syndrome in both eyes with Neovascular glaucoma at the right eye, Anterior ischemic optic neuropathy at the left eye and laser panphotocoagulation at the right eye was started.

  10. The Correlation between Left and Right Ventricular Ejection Fractions in Patients with Ischemic Heart Disease, Documented by Cardiac Magnetic Resonance Imaging

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    Ali Eshraghi

    2016-03-01

    Full Text Available Introduction: The correlation between right and left ventricular ejection fractions (RVEF and LVEF, respectively has been studied in only a small number of patients with a marked decrease in RVEF and LVEF. The aim of the present study was to compare LVEF and RVEF in patients with ischemic heart disease. RVEF and LVEF were measured by Cardiovascular Magnetic Resonance (CMR imaging. Materials and Methods: This observational study was done in Ghaem general hospital in 2014.  LVEF and RVEF were measured in a series of 33 patients with ischemic heart disease, undergoing CMR for the evaluation of myocardial viability. The correlation between RVEF and LVEF in patients with ischemic heart disease was studied, using Pearson product-moment correlation coefficient analysis.   This study was done in Ghaem general hospital in 2014 with simple sapling. Results: Right ventricular end diastolic volume (186.33±58.90 and left ventricular end diastolic volume (121.72±61.64 were significantly correlated (r=0.223, P=0.005. Moreover, there was a significant correlation between right ventricular end systolic volume (88.18±40.90 and left ventricular end systolic volume (140.96±35.33 (r=0.329, P=0.000. The most significant association was observed between RVEF and LVEF (r=0.913, P=0.000. Conclusion: Based on the findings, RVEF and LVEF were significantly correlated in patients with ischemic heart disease, although this association was not always present in all cardiac patients. The cause of this discrepancy is still unknown.

  11. Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy

    Science.gov (United States)

    Fragata, Claudia da Silva; Matsumoto, Afonso Y.; Ramires, Felix J. A.; Fernandes, Fabio; Buck, Paula de Cássia; Salemi, Vera Maria C.; Nastari, Luciano; Mady, Charles; Ianni, Barbara Maria

    2015-01-01

    Background Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA) function in this disease still lacks. Objective To assess the different LA functions (reservoir, conduit and pump functions) and their correlation with the echocardiographic parameters of left ventricular (LV) systolic and diastolic functions. Methods 10 control subjects (CG), and patients with Chagas disease as follows: 26 with the indeterminate form (GI); 30 with ECG alterations (GII); and 19 with LV dysfunction (GIII). All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. Results Reservoir function (Total Emptying Fraction: TEF): (p <0.0001), lower in GIII as compared to CG (p = 0.003), GI (p <0.001) and GII (p <0.001). Conduit function (Passive Emptying Fraction: PEF): (p = 0.004), lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07). Pump function (Active Emptying Fraction: AEF): (p = 0.0001), lower in GIII as compared to CG (p = 0.05), GI (p<0.0001) and GII (p = 0.002). There was a negative correlation of E/e’average with the reservoir and pump functions (TEF and AEF), and a positive correlation of e’average with s’ wave (both septal and lateral walls) and the reservoir, conduit and pump LA functions. Conclusion An impairment of LA functions in Chagas cardiomyopathy was observed. PMID:25993486

  12. Left Atrial Function in Patients with Chronic Chagasic Cardiomyopathy

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    Claudia da Silva Fragata

    2015-01-01

    Full Text Available Background: Chagas disease is a cause of dilated cardiomyopathy, and information about left atrial (LA function in this disease still lacks. Objective: To assess the different LA functions (reservoir, conduit and pump functions and their correlation with the echocardiographic parameters of left ventricular (LV systolic and diastolic functions. Methods: 10 control subjects (CG, and patients with Chagas disease as follows: 26 with the indeterminate form (GI; 30 with ECG alterations (GII; and 19 with LV dysfunction (GIII. All patients underwent M-mode and two-dimensional echocardiography, pulsed-wave Doppler and tissue Doppler imaging. Results: Reservoir function (Total Emptying Fraction: TEF: (p <0.0001, lower in GIII as compared to CG (p = 0.003, GI (p <0.001 and GII (p <0.001. Conduit function (Passive Emptying Fraction: PEF: (p = 0.004, lower in GIII (GIII and CG, p = 0.06; GI and GII, p = 0.06; and GII and GIII, p = 0.07. Pump function (Active Emptying Fraction: AEF: (p = 0.0001, lower in GIII as compared to CG (p = 0.05, GI (p<0.0001 and GII (p = 0.002. There was a negative correlation of E/e’ average with the reservoir and pump functions (TEF and AEF, and a positive correlation of e’ average with s’ wave (both septal and lateral walls and the reservoir, conduit and pump LA functions. Conclusion: An impairment of LA functions in Chagas cardiomyopathy was observed.

  13. Impaired cerebral autoregulation is associated with brain atrophy and worse functional status in chronic ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Mikio C Aoi

    Full Text Available Dynamic cerebral autoregulation (dCA is impaired following stroke. However, the relationship between dCA, brain atrophy, and functional outcomes following stroke remains unclear. In this study, we aimed to determine whether impairment of dCA is associated with atrophy in specific regions or globally, thereby affecting daily functions in stroke patients.We performed a retrospective analysis of 33 subjects with chronic infarctions in the middle cerebral artery territory, and 109 age-matched non-stroke subjects. dCA was assessed via the phase relationship between arterial blood pressure and cerebral blood flow velocity. Brain tissue volumes were quantified from MRI. Functional status was assessed by gait speed, instrumental activities of daily living (IADL, modified Rankin Scale, and NIH Stroke Score.Compared to the non-stroke group, stroke subjects showed degraded dCA bilaterally, and showed gray matter atrophy in the frontal, parietal and temporal lobes ipsilateral to infarct. In stroke subjects, better dCA was associated with less temporal lobe gray matter atrophy on the infracted side ([Formula: see text] = 0.029, faster gait speed ([Formula: see text] = 0.018 and lower IADL score ([Formula: see text]0.002. Our results indicate that better dynamic cerebral perfusion regulation is associated with less atrophy and better long-term functional status in older adults with chronic ischemic infarctions.

  14. Identification of Bone Marrow Cell Subpopulations Associated With Improved Functional Outcomes in Patients With Chronic Left Ventricular Dysfunction: An Embedded Cohort Evaluation of the FOCUS-CCTRN Trial

    Science.gov (United States)

    Taylor, Doris A.; Perin, Emerson C.; Willerson, James T.; Zierold, Claudia; Resende, Micheline; Carlson, Marjorie; Nestor, Belinda; Wise, Elizabeth; Orozco, Aaron; Pepine, Carl J.; Henry, Timothy D.; Ellis, Stephen G.; Zhao, David X. M.; Traverse, Jay H.; Cooke, John P.; Schutt, Robert C.; Bhatnagar, Aruni; Grant, Maria B.; Lai, Dejian; Johnstone, Brian H.; Sayre, Shelly L.; Moyé, Lem; Ebert, Ray F.; Bolli, Roberto; Simari, Robert D.; Cogle, Christopher R.

    2016-01-01

    In the current study, we sought to identify bone marrow-derived mononuclear cell (BM-MNC) subpopulations associated with a combined improvement in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and maximal oxygen consumption (VO2 max) in patients with chronic ischemic cardiomyopathy 6 months after receiving transendocardial injections of autologous BM-MNCs or placebo. For this prospectively planned analysis, we conducted an embedded cohort study comprising 78 patients from the FOCUS-Cardiovascular Cell Therapy Research Network (CCTRN) trial. Baseline BM-MNC immunophenotypes and progenitor cell activity were determined by flow cytometry and colony-forming assays, respectively. Previously stable patients who demonstrated improvement in LVEF, LVESV, and VO2 max during the 6-month course of the FOCUS-CCTRN study (group 1, n = 17) were compared to those who showed no change or worsened in one to three of these endpoints (group 2, n = 61) and to a subset of patients from group 2 who declined in all three functional endpoints (group 2A, n = 11). Group 1 had higher frequencies of B-cell and CXCR4+ BM-MNC subpopulations at study baseline than group 2 or 2A. Furthermore, patients in group 1 had fewer endothelial colony-forming cells and monocytes/macrophages in their bone marrow than those in group 2A. To our knowledge, this is the first study to show that in patients with ischemic cardiomyopathy, certain bone marrow-derived cell subsets are associated with improvement in LVEF, LVESV, and VO2 max at 6 months. These results suggest that the presence of both progenitor and immune cell populations in the bone marrow may influence the natural history of chronic ischemic cardiomyopathy—even in stable patients. Thus, it may be important to consider the bone marrow composition and associated regenerative capacity of patients when assigning them to treatment groups and evaluating the results of cell therapy trials. PMID:26590374

  15. Cerebrolysin adjuvant treatment in Broca's aphasics following first acute ischemic stroke of the left middle cerebral artery

    OpenAIRE

    Jianu, DC; Muresanu, DF; Bajenaru, O; Popescu, BO; Deme, SM; Moessler, H; Meinzingen, SZ; Petrica, L; Serpe, M; Ursoniu, S.

    2010-01-01

    Background: The aim of our study was to assess the efficacy of Cerebrolysin administration in Broca's aphasics with acute ischemic stroke. Methods: We registered 2,212 consecutive Broca's aphasics following an acute ischemic stroke admitted in four departments of neurology in Romania, between September 2005 and September 2009. Language was evaluated with the Romanian version of the Western Aphasia Battery (WAB). The following inclusion criteria were used for this study: age 20%75 years, admis...

  16. Ivabradine improves left ventricular function during chronic hypertension in conscious pigs.

    Science.gov (United States)

    Rienzo, Mario; Melka, Jonathan; Bizé, Alain; Sambin, Lucien; Jozwiak, Mathieu; Su, Jin Bo; Hittinger, Luc; Berdeaux, Alain; Ghaleh, Bijan

    2015-01-01

    During chronic hypertension, increases in heart rate (HR) or adrenergic stimulation are associated with maladaptive left ventricular responses as isovolumic contraction and relaxation durations failed to reduce, impeding filling. We, therefore, investigated the effects of acute selective HR reduction with ivabradine on left ventricular dysfunction during chronic hypertension. Accordingly, chronically instrumented pigs received angiotensin II infusion during 4 weeks to induce chronic hypertension. Left ventricular function was investigated while angiotensin II infusion was stopped. A single intravenous dose of ivabradine was administered at days 0 and 28. Dobutamine infusion was also performed. HR was increased at day 28 versus day 0. Paradoxically, both isovolumic contraction and relaxation times failed to reduce and remained unchanged (57±3 versus 58±3 ms and 74±3 versus 70±3 at day 28 versus day 0, respectively). At day 28, ivabradine significantly reduced HR by 27%. Concomitantly, abnormal ventricular responses were corrected because both isovolumic contraction and relaxation times were significantly reduced while filling time was improved. Similarly at day 28, maladaptive responses of isovolumic contraction and relaxation to dobutamine were no longer observed during HR reduction with ivabradine. Correction of HR reduction with pacing showed that non-HR-related mechanisms also participated to these beneficial effects. In this model of chronic hypertension and left ventricular hypertrophy, acute HR reduction with ivabradine corrects the maladaptive responses of cardiac cycle phases by restoring a normal profile for isovolumic contraction and relaxation both at rest and under adrenergic stimuli, ultimately favoring filling.

  17. Paracrine Mechanisms of Intravenous Bone Marrow-Derived Mononuclear Stem Cells in Chronic Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Ashu Bhasin

    2016-10-01

    Full Text Available Background: The emerging role of stem cell technology and transplantation has helped scientists to study their potential role in neural repair and regeneration. The fate of stem cells is determined by their niche, consisting of surrounding cells and the secreted trophic growth factors. This interim report evaluates the safety, feasibility and efficacy (if any of bone marrow-derived mononuclear stem cells (BM-MNC in chronic ischemic stroke by studying the release of serum vascular endothelial growth factor (VEGF and brain-derived neurotrophic growth factor (BDNF. Methods: Twenty stroke patients and 20 age-matched healthy controls were recruited with the following inclusion criteria: 3 months to 1.5 years from the index event, Medical Research Council (MRC grade of hand muscles of at least 2, Brunnstrom stage 2-5, conscious, and comprehendible. They were randomized to one group receiving autologous BM-MNC (mean 60-70 million and to another group receiving saline infusion (placebo. All patients were administered a neuromotor rehabilitation regime for 8 weeks. Clinical assessments [Fugl Meyer scale (FM, modified Barthel index (mBI, MRC grade, Ashworth tone scale] were carried out and serum VEGF and BDNF levels were assessed at baseline and at 8 weeks. Results: No serious adverse events were observed during the study. There was no statistically significant clinical improvement between the groups (FM: 95% CI 15.2-5.35, p = 0.25; mBI: 95% CI 14.3-4.5, p = 0.31. VEGF and BDNF expression was found to be greater in group 1 compared to group 2 (VEGF: 442.1 vs. 400.3 pg/ml, p = 0.67; BDNF: 21.3 vs. 19.5 ng/ml without any statistically significant difference. Conclusion: Autologous mononuclear stem cell infusion is safe and tolerable by chronic ischemic stroke patients. The released growth factors (VEGF and BDNF in the microenvironment could be due to the paracrine hypothesis of stem cell niche and neurorehabilitation regime.

  18. [The features of myocardial deformation of left ventricle in patients with ischemic heart disease defined by the two dimensional strain method].

    Science.gov (United States)

    Galimskaia, V A; Donchenko, I A; Romanovskaia, E M; Oleĭnikov, V É

    2014-01-01

    Aim of this study was to assess qualitative and quantitative features of deformation parameters of left ventricular myocardium in patients with ischemic heart disease (IHD) with and without history of myocardial infarction (MI) using two-dimensional strain imaging. We examined 30 patients with clinical IHD with (group 1, n = 15) and without (group 2, n = 15) history of MI and 20 healthy volunteers. Compared with healthy subjects IHD patients of both groups had reduced longitudinal and circular myocardial deformation. There were no significant differences between patients with IHD and controls in parameters of radial, global, and regional deformation.

  19. [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

    Science.gov (United States)

    Genton, Audrey; Hullin, Roger; Tozzi, Piergiorgio; Cook, Stéphane; Liaudet, Lucas

    2012-12-12

    Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

  20. [Comparison of the results of transesophageal electrical stimulation of the left atrium, bicycle ergometry and selective coronary angiography in diagnosing ischemic heart disease].

    Science.gov (United States)

    Sidorenko, B A; Savchenko, A P; Liakishev, A A; Kozlov, S G; Klembovskiĭ, A A

    1985-11-01

    The clinical picture and results of bicycle ergometry and selective coronarography were compared with data obtained by esophageal electric stimulation of the left atrium in 108 patients with suspected coronary disease. It was demonstrated that esophageal left-atrial electrostimulation could be used as noninvasive load test for coronary disease. Ischemic electrocardiographic changes, induced by esophageal stimulation showed good correlation to the clinical manifestation of angina pectoris and the severity of coronary atherosclerosis. The sensitivity of esophageal stimulation in the diagnosis of hemodynamically-significant coronary atherosclerosis was 82%, its specificity was 76%, the predictive value of positive results was 82%, and the predictive value of negative results, 76%, that is, essentially the same as the respective parameters of bicycle ergometry.

  1. Compromised Blood-Brain Barrier Competence in Remote Brain Areas in Ischemic Stroke Rats at Chronic Stage

    Science.gov (United States)

    Garbuzova-Davis, Svitlana; Haller, Edward; Williams, Stephanie N.; Haim, Eithan D.; Tajiri, Naoki; Hernandez-Ontiveros, Diana G.; Frisina-Deyo, Aric; Boffeli, Sean M.; Sanberg, Paul R.; Borlongan, Cesario V.

    2014-01-01

    Stroke is a life threatening disease leading to long-term disability in stroke survivors. Cerebral functional insufficiency in chronic stroke might be due to pathological changes in brain areas remote from initial ischemic lesion, i.e. diaschisis. Previously, we showed that the damaged blood-brain barrier (BBB) was implicated in subacute diaschisis. The present study investigated BBB competence in chronic diaschisis using a transient middle cerebral artery occlusion (tMCAO) rat model. Our results demonstrated significant BBB damage mostly in the ipsilateral striatum and motor cortex in rats at 30 days after tMCAO. The BBB alterations were also determined in the contralateral hemisphere via ultrastructural and immunohistochemical analyses. Major BBB pathological changes in contralateral remote striatum and motor cortex areas included: (1) vacuolated endothelial cells containing large autophagosomes, (2) degenerated pericytes displaying mitochondria with cristae disruption, (3) degenerated astrocytes and perivascular edema, (4) Evans Blue extravasation, and (5) appearance of parenchymal astrogliosis. Importantly, discrete analyses of striatal and motor cortex areas revealed significantly higher autophagosome accumulation in capillaries of ventral striatum and astrogliosis in dorsal striatum in both cerebral hemispheres. These widespread microvascular alterations in ipsilateral and contralateral brain hemispheres suggest persistent and/or continued BBB damage in chronic ischemia. The pathological changes in remote brain areas likely indicate chronic ischemic diaschisis, which should be considered in the development of treatment strategies for stroke. PMID:24610730

  2. Long-term expression of periostin during the chronic stage of ischemic stroke in mice.

    Science.gov (United States)

    Shimamura, Munehisa; Taniyama, Yoshiaki; Nakagami, Hironori; Katsuragi, Naruto; Wakayama, Kouji; Koriyama, Hiroshi; Kurinami, Hitomi; Tenma, Akiko; Tomioka, Hideki; Morishita, Ryuichi

    2014-06-01

    Periostin is an extracellular matrix glycoprotein and has various cellular effects. Previously, we demonstrated the neuroprotective effects of periostin during the acute stage of cerebral ischemia. However, its expression during the chronic stage remains unknown. Herein, we examined the expression of full-length periostin (periostin 1; Pn1) and its splicing variant lacking exon 17 (periostin 2; Pn2) during the 28 days following transient middle cerebral artery occlusion in mice. Real-time reverse transcription-PCR showed that the expression of Pn2 was dramatically upregulated between days 3 and 28, and the highest expression was observed on day 7. The expression of Pn1 was also increased, but delayed compared with Pn2. Immunohistochemistry showed that periostin was weakly expressed in reactive astrocytes in the peri-infarct region and in microglia/macrophages in infarct regions, on days 3 and 7. Periostin was also expressed around CD31-positive cells in both the peri-infarct and the sub-ventricular zone (SVZ) on days 3 and 7. SOX-2 positive cells, which are neural stem cells, also expressed periostin on day 7. The highest periostin immunoreactivity that occurred co-localized with collagen I and fibronectin in the peri-infarct region between days 7 and 28. Thus, the expression pattern of periostin mRNA was dependent on the splicing variant, and it continued to be expressed up to 28 days after cerebral ischemia. As periostin was expressed in various cells, such as reactive astrocytes/microglia, fibroblasts and neuronal progenitor cells, periostin might be associated with pathophysiology in post-ischemic inflammation and neurogenesis.

  3. Anemia treatment and left ventricular hypertrophy in non-dialysis chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    Robert N. Foley; Peter A. McCullough

    2005-01-01

    @@ To this day, the target hemoglobin level that minimizes cardiovascular risk in chronic kidney disease (CKD) patients remains unclear. When one examines the many randomized trials of epoetin therapy in aggregate, enhanced quality of life provides the most cogent argument for hemoglobin levels above 110 g/L. It remains unclear whether treatment of anemia improves longevity, or even a surrogate marker (such as left ventricular [LV] mass index), especially when applied at earlier phases of CKD.

  4. Right hemisphere grey matter structure and language outcomes in chronic left hemisphere stroke.

    Science.gov (United States)

    Xing, Shihui; Lacey, Elizabeth H; Skipper-Kallal, Laura M; Jiang, Xiong; Harris-Love, Michelle L; Zeng, Jinsheng; Turkeltaub, Peter E

    2016-01-01

    The neural mechanisms underlying recovery of language after left hemisphere stroke remain elusive. Although older evidence suggested that right hemisphere language homologues compensate for damage in left hemisphere language areas, the current prevailing theory suggests that right hemisphere engagement is ineffective or even maladaptive. Using a novel combination of support vector regression-based lesion-symptom mapping and voxel-based morphometry, we aimed to determine whether local grey matter volume in the right hemisphere independently contributes to aphasia outcomes after chronic left hemisphere stroke. Thirty-two left hemisphere stroke survivors with aphasia underwent language assessment with the Western Aphasia Battery-Revised and tests of other cognitive domains. High-resolution T1-weighted images were obtained in aphasia patients and 30 demographically matched healthy controls. Support vector regression-based multivariate lesion-symptom mapping was used to identify critical language areas in the left hemisphere and then to quantify each stroke survivor's lesion burden in these areas. After controlling for these direct effects of the stroke on language, voxel-based morphometry was then used to determine whether local grey matter volumes in the right hemisphere explained additional variance in language outcomes. In brain areas in which grey matter volumes related to language outcomes, we then compared grey matter volumes in patients and healthy controls to assess post-stroke plasticity. Lesion-symptom mapping showed that specific left hemisphere regions related to different language abilities. After controlling for lesion burden in these areas, lesion size, and demographic factors, grey matter volumes in parts of the right temporoparietal cortex positively related to spontaneous speech, naming, and repetition scores. Examining whether domain general cognitive functions might explain these relationships, partial correlations demonstrated that grey matter

  5. Ischemic preconditioning

    Directory of Open Access Journals (Sweden)

    Ristić-Anđelkov Anđelka

    2005-01-01

    Full Text Available Background. Ischemic preconditioning is a phenomenon during which myocardium, subjected to brief episodes of ischemia followed by reperfusion, tolerates better the subsequent, more prolonged episode of this ischemia, thus reducing the infarction size substantially. Case report. Two patients with acute left anterior descendent artery occlusion received fibrinolytic therapy (alteplase within 6 hours of the onset of chest pain, but developed myocardial infarctions of different sizes. The first patient, without the history of preinfarction angina, developed large anterior infarct, because there was no time either for ischemic preconditioning or for the coronary collateral vessels development. In the second patient, with 4-day history of preinfarction angina, the more favorable outcome was seen he developed smaller apical necrosis, with the great degree of myocardial viability in the infarct-related area. Conclusion. Ischemic preconditioning in patients with acute myocardal infarction results in the reduction of mortality, infarction size, as well as in the frequency of malignant arrhythmias.

  6. Short-term effects of ivabradine in patients with chronic stable ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Hosam Zaky

    2013-01-01

    Full Text Available Introduction: Ivabradine is a novel selective If current inhibitor with anti-ischemic and antianginal activity. Objectives: To assess the effect of the selective If current inhibitor ivabradine on heart rate, angina pectoris, and functional capacity in stable patients with chronic coronary artery disease on maximally tolerated medical therapy. Materials and Methods: Consecutive patients from the out-patient cardiology clinic with stable coronary artery disease documented by coronary angiography were included. Patients had to be on maximally tolerated medical therapy with β-blockers, angiotensin-converting enzyme inhibitors or receptor blockers (ACE-I or ARB, antiplatelets, statins, nitrates, and anti-metabolics with a baseline heart rate of at least 70 beats per minute. All patients underwent assessment of angina (Canadian Cardiovascular Society Angina Class: CCS I to IV and functional capacity (using a validated self-administered questionnaire, at baseline and after 4 months of ivabradine therapy. Results: Twenty patients were enrolled (mean age 47 ± 7 years, all male, 60% with hypertension, 30% with diabetes mellitus. Patients were on optimal medical regimen of aspirin (100%, β-blocker (100%, statins (100%, clopidogrel (90%, nitrates (35%, anti-metabolics (90%, and ACE-I or ARB (95%. At baseline, the majority of patients (90% were in CCS class II-IV. All patients were started on ivabradine 5 mg twice daily, and in 12 patients the dose was increased to 7.5 mg twice daily. After 4 months of treatment, the heart rate was significantly reduced from an average of 82 ± 8 to 68 ± 6 bpm ( P < 0.001. The reduction in heart rate was accompanied by a significant improvement in functional capacity (score 3.5 ± 0.9 to 4.7 ± 0.7, P < 0.001 and angina classification; at baseline 10% of the patients were in CCS class I compared to 50% after 4 months of therapy ( P = 0.01. No symptomatic bradycardia was reported with ivabradine. Conclusion: The addition

  7. [Effect of complex therapy including ATP-long on left ventricular diastolic function in patients with ischemic heart disease at rest and under isometric load].

    Science.gov (United States)

    Amosova, E N; Bereza, N V; Potapkova, I V

    2002-01-01

    The study comprised 34 patients with ischemic heart disease (IHD) stable functional class I-II extertional angina with impaired relaxation type diastolic dysfunction of the left ventricle. Instituted in all patients before and after the combined treatment involving the use of ATP-Long (group I) or ATP solution injectable i.m. (group II) was dopplercardiometry in rest and at the peak of isometric load. The course of ATP treatments administration was ten days in duration. The use in a combined treatment IHD patients of ATP-Long, a new metabolic-action type drug preparation of Ukraine, permits improving parameters of the diastole temporal patterns, as evidenced by results of the studies made.

  8. Neuronal apoptosis and synaptic density in the dentate gyrus of ischemic rats' response to chronic mild stress and the effects of Notch signaling.

    Directory of Open Access Journals (Sweden)

    Shaohua Wang

    Full Text Available Our previous research highlighted an inconsistency with Notch1 signaling-related compensatory neurogenesis after chronic mild stress (CMS in rodents suffering from cerebral ischemia, which continue to display post-stroke depressive symptoms. Here, we hypothesize that CMS aggrandized ischemia-related apoptosis injury and worsened synaptic integrity via gamma secretase-meditated Notch1 signaling. Adult rats were exposed to a CMS paradigm after left middle cerebral artery occlusion (MCAO. Open-field and sucrose consumption testing were employed to assess depression-like behavior. Gene expression of pro-apoptotic Bax, anti-apoptotic Bcl-2, and synaptic density-related synaptophysin were measured by western blotting and real-time PCR on Day 28 after MCAO surgery. CMS induced depressive behaviors in ischemic rats, which was accompanied by an elevation in Bax/bcl-2 ratio, TUNEL staining in neurons and reduced synaptophysin expression in the dentate gyrus. These collective effects were reversed by the gamma-secretase inhibitor DAPT (N-[N-(3,5-difluorophenacetyl-L-alanyl]-S-phenyl-glycine t-butyl ester. We found that post-stroke stressors made neurons in the dentate gyrus vulnerable to apoptosis, which supports a putative role for Notch signaling in neural integrity, potentially in newborn cells' synaptic deficit with regard to preexisting cells. These findings suggest that post-stroke depression therapeutically benefits from blocking gamma secretase mediated Notch signaling, and whether this signaling pathway could be a therapeutic target needs to be further investigated.

  9. Veratridine-induced intoxication in the isolated left atrium of the rat: Effects of some anti-ischemic compounds

    NARCIS (Netherlands)

    Wermelskirchen, D.; Wilffert, B.; Nebel, U.; Wirth, A.; Peters, Thies

    1991-01-01

    Veratridine-induced Na+and Ca2+uptake was used as a simulation of ischemia-induced Na+and Ca2+uptake. Therefore, electrically driven (1 Hz) isolated left atria of the rat were intoxicated with veratridine and the45Ca2+uptake was determined. Veratridine (10-4mol/l) increased the45Ca2+uptake from 575

  10. Assessment of automatic quantification of myocardial perfusion and left ventricular function derived from ECG gated myocardial SPECT with {sup 99m}Tc-tetrofosmin in ischemic heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Mitsunori; Habara, Hirokazu; Tatsuno, Hironari; Fukuda, Hiroshi; Hamada, Noriko; Kazatani, Yukio [Ehime Prefectural Central Hospital (Japan)

    1999-09-01

    Non-invasive assessment of ischemic heart disease (IHD) requires information of both myocardial perfusion and left ventricular (LV) function. Recently, automatic quantification of ECG-gated myocardial scintigraphy with {sup 99m}Tc-tetrofosmin (QGS) can provide both of them. QGS, coronary angiograms (CAG) and left venticulograms (LVG) were performed in 83 patients with severe IHD in same period. Significant stenosis of coronary artery in CAG were assessed by QGS. The sensitivity, specificity and accuracy of significant stenosis by QGS was excellent (85%, 93% and 88%). The LV end-distolic and end-systolic volumes (EDV and ESV), LV ejection fraction (EF) and regional LV wall motion determined by QGS were compared to LVG. There was a good correlation between the values obtained from QGS and LVG (EDV: r=0.86, ESV: r=0.94, EF: r=0.84, p<0.0001), but QGS tended to underestimate EDV and EF. High complete agreement of regional LV wall motion was gained with 427 (74.0%) out of total 581 segments. In conclusion, QGS data was considered to be useful for assessment of determine significant stenosis and LV function in severe IHD. (author)

  11. Cytochrome P450 1B1 and 2C9 genotypes and risk of ischemic vascular disease, cancer, and chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Kaur-Knudsen, Diljit; Bojesen, Stig E; Nordestgaard, Børge G

    2012-01-01

    The aim of this review is to summarize present knowledge of genetic variation in cytochrome P450 1B1 (CYP1B1) and 2C9 (CYP2C9) genes and risk of tobacco-related cancer, female cancer, chronic obstructive pulmonary disease and ischemic vascular disease. The CYP1B1 and CYP2C9 enzymes metabolize...... between genetic variation in CYP1B1 and CYP2C9 and risk of disease with considerable statistical power rebutted the hypotheses that these genetic variants affect risk of tobacco-related cancer, female cancer, chronic obstructive pulmonary disease and ischemic vascular disease....... of female cancer or ischemic vascular disease. Genetic variation in genes coding for CYP1B1 and CYP2C9 enzymes have shown altered enzyme activity affecting levels of metabolites and thus potentially risk of disease. So far, however, findings have been inconsistent. Recently, large studies on the association...

  12. Prevalence of right-to-left shunts on transcranial Doppler in chronic migraine and medication-overuse headache

    DEFF Research Database (Denmark)

    Guo, Song; Shalchian, Sarvnaz; Gérard, Pascale;

    2014-01-01

    BACKGROUND: It was suggested that right-to-left shunt (RLS) may be highly prevalent in chronic migraine (CM) patients, indicating that patent foramen ovale (PFO) might be an aggravating and chronifying factor of migraine. Since a high proportion of chronic migraineurs also have medication...

  13. Left ventricular, systemic arterial, and baroreflex responses to ketamine and TEE in chronically instrumented monkeys

    Science.gov (United States)

    Koenig, S. C.; Ludwig, D. A.; Reister, C.; Fanton, J. W.; Ewert, D.; Convertino, V. A.

    2001-01-01

    Effects of prescribed doses of ketamine five minutes after application and influences of transesophageal echocardiography (TEE) on left ventricular, systemic arterial, and baroreflex responses were investigated to test the hypothesis that ketamine and/or TEE probe insertion alter cardiovascular function. Seven rhesus monkeys were tested under each of four randomly selected experimental conditions: (1) intravenous bolus dose of ketamine (0.5 ml), (2) continuous infusion of ketamine (500 mg/kg/min), (3) continuous infusion of ketamine (500 mg/kg/min) with TEE, and (4) control (no ketamine or TEE). Monkeys were chronically instrumented with a high fidelity, dual-sensor micromanometer to measure left ventricular and aortic pressure and a transit-time ultrasound probe to measure aortic flow. These measures were used to calculate left ventricular function. A 4-element Windkessel lumped-parameter model was used to estimate total peripheral resistance and systemic arterial compliance. Baroreflex response was calculated as the change in R-R interval divided by the change in mean aortic pressure measured during administration of graded concentrations of nitroprusside. The results indicated that five minutes after ketamine application heart rate and left ventricular diastolic compliance decreased while TEE increased aortic systolic and diastolic pressure. We conclude that ketamine may be administered as either a bolus or continuous infusion without affecting cardiovascular function 5 minutes after application while the insertion of a TEE probe will increase aortic pressure. The results for both ketamine and TEE illustrate the classic "Hawthorne Effect," where the observed values are partly a function of the measurement process. Measures of aortic pressure, heart rate, and left ventricular diastolic pressure should be viewed as relative, as opposed to absolute, when organisms are sedated with ketamine or instrumented with a TEE probe.

  14. Cytochrome P450 1B1 and 2C9 genotypes and risk of ischemic vascular disease, cancer, and chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Kaur-Knudsen, Diljit; Bojesen, Stig E; Nordestgaard, Børge G

    2012-01-01

    The aim of this review is to summarize present knowledge of genetic variation in cytochrome P450 1B1 (CYP1B1) and 2C9 (CYP2C9) genes and risk of tobacco-related cancer, female cancer, chronic obstructive pulmonary disease and ischemic vascular disease. The CYP1B1 and CYP2C9 enzymes metabolize pol...

  15. Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device.

    Science.gov (United States)

    Khan, Nadeem; Husain, Syed Arman; Husain, Syed Iman; Khalaf, Natalia; George, Joggy; Raissi, Farshad; Segura, Ana Maria; Kar, Biswajit; Bogaev, Roberta C; Frazier, O H

    2012-01-01

    We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.

  16. Antidepressant Effects of Aripiprazole Augmentation for Cilostazol-Treated Mice Exposed to Chronic Mild Stress after Ischemic Stroke

    Science.gov (United States)

    Kim, Yu Ri; Kim, Ha Neui; Hong, Ki Whan; Shin, Hwa Kyoung; Choi, Byung Tae

    2017-01-01

    The aim of this study was to determine the effects and underlying mechanism of aripiprazole (APZ) augmentation for cilostazol (CLS)-treated post-ischemic stroke mice that were exposed to chronic mild stress (CMS). Compared to treatment with either APZ or CLS alone, the combined treatment resulted in a greater reduction in depressive behaviors, including anhedonia, despair-like behaviors, and memory impairments. This treatment also significantly reduced atrophic changes in the striatum, cortex, and midbrain of CMS-treated ischemic mice, and inhibited neuronal cell apoptosis, particularly in the striatum and the dentate gyrus of the hippocampus. Greater proliferation of neuronal progenitor cells was also observed in the ipsilateral striatum of the mice receiving combined treatment compared to mice receiving either drug alone. Phosphorylation of the cyclic adenosine monophosphate response element binding protein (CREB) was increased in the striatum, hippocampus, and midbrain of mice receiving combined treatment compared to treatment with either drug alone, particularly in the neurons of the striatum and hippocampus, and dopaminergic neurons of the midbrain. Our results suggest that APZ may augment the antidepressant effects of CLS via co-regulation of the CREB signaling pathway, resulting in the synergistic enhancement of their neuroprotective effects. PMID:28208711

  17. Real-time myocardial contrast echocardiography can predict functional recovery and left ventricular remodeling after revascularization in patients with ischemic heart disease

    Institute of Scientific and Technical Information of China (English)

    ZENG Xin; SHU Xian-hong; PAN Cui-zhen; LI Qing; GUO Shi-zun; LIU Shi-zhen; CHEN Hao-zhu

    2007-01-01

    Background Previous studies showed that preservation of microvascular integrity after myocardial ischemia was associated with myocardial viability. Real-time myocardial contrast echocardiography (RT-MCE) is a promising modality for non-invasive evaluation of microcirculation perfusion. Thus, it provides a unique tool to detect myocardial viability. We sought in this study to investigate the role of RT-MCE in predicting left ventricular (LV) functional recovery and remodeling after revascularization in patients with ischemic heart disease.Methods Thirty-one patients with ischemic heart disease and resting regional LV dysfunction were included. LV volume,global and regional function were evaluated by echocardiography before and 6-9 months after revascularization.RT-MCE was performed before revascularization using low mechanical index power modulation imaging. Myocardial contrast opacification of dysfunctional segments was scored on a 3-point scale and mean contrast score in dysfunctional segments was calculated. Patients were divided into 2 groups according to mean contrast score in dysfunctional segments: group A, patients with mean contrast score ≥0.5 (n=19); group B, patients with mean contrast score < 0.5(n=12).Results Wall motion improvement was found to be 94.5%, 45.5% and 16.1% respectively (P<0.01) in homogenous,patchy and absent contrast opacification segments. At baseline, there was no significant difference in LV volume and global function between the two groups. After revascularization, group B had significantly larger LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV), lower LV ejection fraction (LVEF) and higher wall motion score index(WMSI) than those of group A (all P<0.05). Revascularization was followed by significant improvement of LV volume and recovery of global LV function in group A (all P<0.01); however, in group B, after revascularization, deterioration of LVEDV (P<0.05) was observed, moreover LVESV, WMSI and LVEF

  18. Impact of chronic kidney disease on long-term ischemic and bleeding outcomes in medically managed patients with acute coronary syndromes

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    Melloni, Chiara; Cornel, Jan H; Hafley, Gail

    2016-01-01

    AIMS: We aimed to study the relationship of chronic kidney disease stages with long-term ischemic and bleeding outcomes in medically managed acute coronary syndrome patients and the influence of more potent antiplatelet therapies on platelet reactivity by chronic kidney disease stage. METHODS...... disease vs. normal/mild chronic kidney disease were estimated. Platelet reactivity at 30 days was assessed in a subset of patients (n = 1947). The majority of patients were in the normal/mild chronic kidney disease group (67%), followed by moderate chronic kidney disease (29%) and severe chronic kidney.......26; 95% confidence interval 1.09-1.46; severe vs. normal/mild: hazard ratio 1.60; 95% confidence interval 1.25-2.04). Platelet reactivity was lower in patients treated with prasugrel compared with clopidogrel, across all three chronic kidney disease stages. CONCLUSIONS: Among medically managed acute...

  19. Sex-dependent effects of chronic psychosocial stress on myocardial sensitivity to ischemic injury.

    Science.gov (United States)

    Rorabaugh, Boyd R; Krivenko, Anna; Eisenmann, Eric D; Bui, Albert D; Seeley, Sarah; Fry, Megan E; Lawson, Joseph D; Stoner, Lauren E; Johnson, Brandon L; Zoladz, Phillip R

    2015-01-01

    Individuals with post-traumatic stress disorder (PTSD) experience many debilitating symptoms, including intrusive memories, persistent anxiety and avoidance of trauma-related cues. PTSD also results in numerous physiological complications, including increased risk for cardiovascular disease (CVD). However, characterization of PTSD-induced cardiovascular alterations is lacking, especially in preclinical models of the disorder. Thus, we examined the impact of a psychosocial predator-based animal model of PTSD on myocardial sensitivity to ischemic injury. Male and female Sprague-Dawley rats were exposed to psychosocial stress or control conditions for 31 days. Stressed rats were given two cat exposures, separated by a period of 10 days, and were subjected to daily social instability throughout the paradigm. Control rats were handled daily for the duration of the experiment. Rats were tested on the elevated plus maze (EPM) on day 32, and hearts were isolated on day 33 and subjected to 20 min ischemia and 2 h reperfusion on a Langendorff isolated heart system. Stressed male and female rats gained less body weight relative to controls, but only stressed males exhibited increased anxiety on the EPM. Male, but not female, rats exposed to psychosocial stress exhibited significantly larger infarcts and attenuated post-ischemic recovery of contractile function compared to controls. Our data demonstrate that predator stress combined with daily social instability sex-dependently increases myocardial sensitivity to ischemic injury. Thus, this manipulation may be useful for studying potential mechanisms underlying cardiovascular alterations in PTSD, as well as sex differences in the cardiovascular stress response.

  20. Effects of chronic inflammatory bowel diseases on left ventricular structure and function: a study protocol

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    Botti Fiorenzo

    2002-09-01

    Full Text Available Abstract Background Experimental evidences suggest an increased collagen deposition in inflammatory bowel diseases (IBD. In particular, large amounts of collagen type I, III and V have been described and correlated to the development of intestinal fibrotic lesions. No information has been available until now about the possible increased collagen deposition far from the main target organ. In the hypothesis that chronic inflammation and increased collagen metabolism are reflected also in the systemic circulation, we aimed this study to evaluate the effects on left ventricular wall structure by assessing splancnic and systemic collagen metabolism (procollagen III assay, deposition (ultrasonic tissue characterization, and cardiac function (echocardiography in patients with different long standing history of IBD, before and after surgery. Methods Thirty patients affected by active IBD, 15 with Crohn and 15 with Ulcerative Colitis, submitted to surgery will be enrolled in the study in a double blind fashion. They will be studied before the surgical operation and 6, 12 months after surgery. A control group of 15 healthy age and gender-matched subjects will also be studied. At each interval blood samples will be collected in order to assess the collagen metabolism; a transthoracic echocardiogram will be recorded for the subsequent determination of cardiac function and collagen deposition. Discussion From this study protocol we expect additional information about the association between IBD and cardiovascular disorders; in particular to address the question if chronic inflammation, through the altered collagen metabolism, could affect left ventricular structure and function in a manner directly related to the estimated duration of the disease.

  1. Cardiac output and associated left ventricular hypertrophy in pediatric chronic kidney disease.

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    Weaver, Donald J; Kimball, Thomas R; Koury, Phillip R; Mitsnefes, Mark M

    2009-03-01

    A significant number of children with chronic kidney disease (CKD) have eccentric left ventricular hypertrophy (LVH), suggesting the role of preload overload. Therefore, we hypothesized that increased cardiac output (CO) might be a contributing factor for increased left ventricular mass index (LVMI) in these children. Patients aged 6-20 years with CKD stages 2-4 were enrolled. Echocardiograms were performed to assess LV function and geometry at rest and during exercise. Heart rate, stroke volume, and CO were also assessed at rest and during exercise. Twenty-four-hour ambulatory blood pressure (AMBP) monitoring was performed. Of the patients enrolled in this study, 17% had LVH. Increased stroke volume and CO were observed in patients with LVH compared to patients without LVH. Univariate analysis revealed significant positive associations between LVMI and CO, stroke volume, body mass index, pulse pressure from mean 24-h AMBP, and mean 24-h systolic BP load. No association with heart rate, age, parathyroid hormone, glomerular filtration rate, or anemia was observed. Only CO (beta = 1.98, p = 0.0005) was independently associated with increased LVMI in multivariate modeling (model R (2) = 0.25). The results of this study suggest that increased CO might predispose to increased LVMI in pediatric patients with CKD. Adaptations may be required to meet increased metabolic demand in these patients.

  2. The role of secondary hyperparathyroidism in left ventricular hypertrophy of patients under chronic hemodialysis

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    Randon R.B.

    2005-01-01

    Full Text Available End-stage renal disease (ESRD patients frequently develop structural cardiac abnormalities, particularly left ventricular hypertrophy (LVH. The mechanisms involved in these processes are not completely understood. In the present study, we evaluated a possible association between parathyroid hormone (PTH levels and left ventricular mass (LVM in patients with ESRD. Stable uremic patients on intermittent hemodialysis treatment were evaluated by standard two-dimensional echocardiography and their sera were analyzed for intact PTH. Forty-one patients (mean age 45 years, range 18 to 61 years, 61% males, who had been on hemodialysis for 3 to 186 months, were evaluated. Patients were stratified into 3 groups according to serum PTH: low levels (280 pg/ml; group III = 21 patients. A positive statistically significant association between LVM index and PTH was identified (r = 0.34; P = 0.03, Pearson's correlation coefficient in the sample as a whole. In subgroup analyses, we did not observe significant associations in the low and intermediate PTH groups; nevertheless, PTH and LVM index were correlated in patients with high PTH levels (r = 0.62; P = 0.003. LVM index was also inversely associated with hemoglobin (r = -0.34; P = 0.03. In multivariate analysis, after adjustment for age, hemoglobin, body mass index, and blood pressure, the only independent predictor of LVM index was PTH level. Therefore, PTH is an independent predictor of LVH in patients undergoing chronic hemodialysis. Secondary hyperparathyroidism may contribute to the elevated cardiovascular morbidity associated with LVH in ESRD.

  3. [Biomarkers of iron metabolism and inflammation in patients with chronic heart failure and various types of left ventricular dysfunction].

    Science.gov (United States)

    Kazymyrko, V K; Kutovyĭ, V V; Ivanyts'ka, L M; Dubkova, A G; Silant'ieva, T S

    2013-09-01

    Study the level of some of the indicators of iron metabolism and inflammatory markers in patients with chronic heart failure due to hypertension and coronary heart disease. The results of the study in systolic and diastolic dysfunction of the left ventricle, the varying degrees of severity of heart failure. The level of the studied parameters determined by the severity of heart failure and does not depend on the nature of left ventricular dysfunction.

  4. Fibroblast growth factor-2 induced by enriched environment enhances angiogenesis and motor function in chronic hypoxic-ischemic brain injury.

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    Jung Hwa Seo

    Full Text Available This study aimed to investigate the effects of enriched environment (EE on promoting angiogenesis and neurobehavioral function in an animal model of chronic hypoxic-ischemic (HI brain injury. HI brain damage was induced in seven day-old CD-1® mice by unilateral carotid artery ligation and exposure to hypoxia (8% O2 for 90 min. At six weeks of age, the mice were randomly assigned to either EE or standard cages (SC for two months. Rotarod, forelimb-use asymmetry, and grip strength tests were performed to evaluate neurobehavioral function. In order to identify angiogenic growth factors regulated by EE, an array-based multiplex ELISA assay was used to measure the expression in frontal cortex, striatum, and cerebellum. Among the growth factors, the expression of fibroblast growth factor-2 (FGF-2 was confirmed using western blotting. Platelet endothelial cell adhesion molecule-1 (PECAM-1 and α-smooth muscle actin (α-SMA were also evaluated using immunohistochemistry. As a result, mice exposed to EE showed significant improvements in rotarod and ladder walking performances compared to SC controls. The level of FGF-2 was significantly higher in the frontal cortex of EE mice at 8 weeks after treatment in multiplex ELISA and western blot. On the other hand, FGF-2 in the striatum significantly increased at 2 weeks after exposure to EE earlier than in the frontal cortex. Expression of activin A was similarly upregulated as FGF-2 expression pattern. Particularly, all animals treated with FGF-2 neutralizing antibody abolished the beneficial effect of EE on motor performance relative to mice not given anti-FGF-2. Immunohistochemistry showed that densities of α-SMA(+ and PECAM-1(+ cells in frontal cortex, striatum, and hippocampus were significantly increased following EE, suggesting the histological findings exhibit a similar pattern to the upregulation of FGF-2 in the brain. In conclusion, EE enhances endogenous angiogenesis and neurobehavioral functions

  5. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava.

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    Lupattelli, T; Benassi, F; Righi, E; Bavera, P; Bellagamba, G

    2014-04-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses of the internal jugular veins (IJVs) and/or azygos veins and formation of collateral venous channels. A case of a 57-year-old patient with CCSVI in whom the venous outflow from the left IJV to the right atrium occurred through a venous anomaly, the persistent left superior vena cava (PLSVC), is reported. PLSVC is caused by persistence of the left anterior cardinal vein that drains blood from the limb effluent from the left and the left side of head and neck into coronary sinus (Type a), or in the left atrium (Type b). PLSVC can be associated either with innominate vein hypoplasia or other congenital heart abnormalities. Because of evidence of left innominate vein hypoplasia, angioplasty was not performed using the ordinary route but passing with the balloon directly through the PLSVC up to the left IJV. Finally, angioplasty was carried out in a standard manner in the right IJV as well as in the azygous vein. Confirmation angiogram revealed complete reopening of all treated vessels with no evidence of peri- and postoperative complications. The patient was discharged home the following day in good general conditions. PLSVC is a rare congenital vein anomaly but in case of concomitant innominate vein hypoplasia may prove to be a valuable alternative to treat patients with IJV diseases.

  6. No evidence for activated autophagy in left ventricular myocardium at early reperfusion with protection by remote ischemic preconditioning in patients undergoing coronary artery bypass grafting.

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    Nilgün Gedik

    Full Text Available Remote ischemic preconditioning (RIPC by repeated brief limb ischemia/reperfusion reduces myocardial injury in patients undergoing coronary artery bypass grafting (CABG. Activation of signal transducer and activator of transcription 5 (STAT5 in left ventricular (LV myocardium at early reperfusion is associated with such protection. Autophagy, i.e., removal of dysfunctional cellular components through lysosomes, has been proposed as one mechanism of cardioprotection. Therefore, we analyzed whether or not the protection by RIPC is associated with activated autophagy.CABG patients were randomized to undergo RIPC (3×5 min blood pressure cuff inflation/5 min deflation or placebo (cuff deflated before skin incision (n = 10/10. Transmural myocardial biopsies were taken from the LV before cardioplegia (baseline and at early (5-10 min reperfusion. RIPC-induced protection was reflected by decreased serum troponin I concentration area under the curve (194±17 versus 709±129 ng/ml × 72 h, p = 0.002. Western blotting for beclin-1-phosphorylation and protein expression of autophagy-related gene 5-12 (ATG5-12 complex, light chain 3 (LC3, parkin, and p62 was performed. STAT3-, STAT5- and extracellular signal-regulated protein kinase 1/2 (ERK1/2-phosphorylation was used as positive control to confirm signal activation by ischemia/reperfusion.Signals of all analyzed autophagy proteins did not differ between baseline and early reperfusion and not between RIPC and placebo. STAT5-phosphorylation was greater at early reperfusion only with RIPC (2.2-fold, p = 0.02. STAT3- and ERK1/2-phosphorylation were greater at early reperfusion with placebo and RIPC (≥2.7-fold versus baseline, p≤0.05.Protection through RIPC in patients undergoing CABG surgery does not appear to be associated with enhanced autophagy in LV myocardium at early reperfusion.

  7. Factors influencing recovery of left ventricular structure in patients with chronic heart failure

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    DUAN Hong-yan; WU Xue-si; HAN Zhi-hong; GUO Yong-fang; FANG Shan-juan; ZHANG Xiao-xia; WANG Chun-mei

    2011-01-01

    Background Angiotensin converting enzyme (ACE) inhibitors and β-blockers (βB) have beneficial effects on left ventricular (LV) remodeling, alleviate symptoms and reduce morbidity and mortality in patients with chronic heart failure (CHF). However the correlation between the d osages of ACE inhibitors, βB, and recovery of LV structure remains controversial. Clinical factors associated with recovery of normal ventricular structure in CHF patients receiving medical therapy are poorly defined. Here we aimed to identify variables associated with recovery of normal or near-normal structure in patients with CHF.Methods We recruited 231 consecutive CHF outpatients, left ventricular ejection fraction (LVEF) ≤40% and left ventricular end diastolic diameter (LVEDD) >55/50 mm (male/female), who were receiving optimal pharmacotherapy between January 2001 and June 2009, and followed them until December 31, 2009. They were divided into three groups according to LVEDD and whether they were still alive at final follow-up: group A, LVEDD <60/55 mm (male/female); group B, LVEDD >60/55 mm (male/female); and group C, those who died before final follow-up. Apart from group C, univariate analysis was performed followed by Logistic multivariate analysis to determine the predictors of recovery of LV structure.Results A total of 217 patients completed follow-up, and median follow-up time was 35 months (range 6-108).Twenty-five patients died during that period; the all-cause mortality rate was 11.5%. Group A showed clinical characteristics as follows: the shortest duration of disease and shortest QRS width, the lowest N-terminal brain natriuretic peptide (NT-proBNP) at baseline, the highest dose of βB usage, the highest systolic blood pressure (SBP), diastolic blood pressure (DBP) and the lowest New York Heart Association (NYHA) classification, serum creatinine, uric acid, total bilirubin and NT-proBNP after treatment. Logistic multivariate analysis was performed according to

  8. Chronic Calcific Pancreatitis Presenting as an Isolated Left Perinephric Abscess: A Case Report and Review of the Literature

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    Ragesh Babu Thandassery

    2011-09-01

    Full Text Available Context Acute and chronic pancreatitis may present with pseudocysts in atypical locations. Activated pancreatic enzymes track along anatomic fascial planes causing digestion of the surrounding tissues and resulting in distant pseudocysts. Pseudocysts at atypical locations pose significant diagnostic as well as therapeutic challenges. Case report We report an unusual presentation of a pancreatic pseudocyst in a young male who presented with a left perinephric abscess. Percutaneous drainage was not successful in resolving the abscess and he was subsequently diagnosed as having chronic pancreatitis together with a left perinephric abscess. Needle knife sphincterotomy of the ampulla of Vater resulted in the gradual resolution of the abscess. Conclusion We report a rare presentation of chronic pancreatitis with a perinephric abscess and its non-surgical management. This case report indicates that any patient presenting with a perinephric abscess of unknown etiology not responding to conventional treatment modalities should be investigated for underlying pancreatitis.

  9. DETERMINANTS OF PREVENTIVE BEHAVIOR REGARDING CARDIOVASCULAR DISEASES AND RISK FACTORS IN PATIENTS WITH ESSENTIAL HYPERTENSION AND CHRONIC ISCHEMIC HEART DISEASE

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    D. Yu. Platonov

    2011-01-01

    Full Text Available Aim. To analyze potential determinants of preventive behavior (PB in patients with essential hypertension (HT and chronic ischemic heart disease (CIHD, and to establish their significance and hierarchy. Material and methods. Patients with HT (n=285 and CIHD (n=223 were studied. Questioning of all patients was performed to assess the characteristics of their PB. Differentiated multivariate analysis of activity and efficacy of PB determinants was performed in HT and CIHD patients by the method of step-by-step backward logistic regression. Results. Awareness of the cardiovascular diseases (CVD and its prevention (odds ratio [OR] 6.08 as well as high level of general education (OR=2.29 were the most significant determinants of active PB in HT patients. Sufficient social support (OR=3.77, awareness of CVD and its prevention (OR=3.16 were the most significant determinants of active PB in patients with CIHD. Efficacy of PB in patients with HT and CIHD mostly depends on satisfaction of medical service (OR=10.2 and 6.63, respectively, social support (OR=6.25 and 10.5, respectively, adequate awareness of CVD and its prevention (OR, 6.92 and 6.64, respectively. Conclusion. PB activity and efficacy in patients with HT and CIHD depends on many contributing and impeding factors. Disregarding these factors can result in failure in preventive efforts at both individual and population levels.

  10. Quantification of late gadolinium enhanced CMR in viability assessment in chronic ischemic heart disease: a comparison to functional outcome

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    Afsharzada Farshid

    2009-03-01

    Full Text Available Abstract Background Quantification of late gadolinium enhanced cardiovascular magnetic resonance (LGE CMR by objective window setting increases reproducibility and facilitates multicenter comparison and cooperation. So far, quantification methods or models have only been validated to postmortem animal studies. This study was undertaken to evaluate quantification of LGE in relation to the clinical standard of viability, i.e. functional outcome after revascularization. Thirty-eight patients with chronic ischemic myocardial dysfunction underwent cine and LGE 1 month before and cine CMR 6 months after coronary revascularization. Enhancement was quantified by thresholding window setting at: 2-8SD above mean signal intensity of a remote normal region, and according to the full width at half maximum method (FWHM. Dysfunctional segments were divided in 5 groups according to segmental extent of enhancement (SEE: SEE 1 – no enhancement to SEE 5 – 76–100% with each quantification method. Results Quantification methods had a strong influence on SEE and total infarct size. Multilevel analysis showed that thresholding contrast images at 6SD best predicted segmental functional outcome after revascularization, but the difference with other methods was small and non-significant. Conclusion Simple thresholding techniques strongly influence global and segmental extent of LGE, but have relatively little influence on the accuracy to predict segmental functional improvement after revascularization.

  11. PREDICTIVE FACTORS FOR THE PROGRESSION OF CHRONIC CHAGAS CARDIOMYOPATHY IN PATIENTS WITHOUT LEFT VENTRICULAR DYSFUNCTION

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    Silvana de Araújo SILVA

    2015-04-01

    Full Text Available The identification of predictors for the progression of chronic Chagas cardiomyopathy (CCC is essential to ensure adequate patient management. This study looked into a non-concurrent cohort of 165 CCC patients between 1985 and 2010 for independent predictors for CCC progression. The outcomes were worsening of the CCC scores and the onset of left ventricular dysfunction assessed by means of echo-Doppler cardiography. Patients were analyzed for social, demographic, epidemiologic, clinical and workup-related variables. A descriptive analysis was conducted, followed by survival curves based on univariate (Kaplan-Meier and Cox’s univariate model and multivariate (Cox regression model analysis. Patients were followed from two to 20 years (mean: 8.2. Their mean age was 44.8 years (20-77. Comparing both iterations of the study, in the second there was a statistically significant increase in the PR interval and in the QRS duration, despite a reduction in heart rates (Wilcoxon < 0.01. The predictors for CCC progression in the final regression model were male gender (HR = 2.81, Holter monitoring showing pauses equal to or greater than two seconds (HR = 3.02 increased cardiothoracic ratio (HR = 7.87 and time of use of digitalis (HR = 1.41. Patients with multiple predictive factors require stricter follow-up and treatment.

  12. Left Ventricular Structure during Antihypertensive Treatment in Patients with Chronic Kidney Disease

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    Batir T. Daminov

    2016-03-01

    Full Text Available The aim of our study was to investigate the left ventricular (LV echocardiographic parameters and estimate the antiremodeling efficacy of eprosartan and lercanidipine in patients with CKD, depending on the presence or absence of diabetic nephropathy (DN. Materials and Methods: The study included 121 patients (mean age 52.4±5.7 years with CKD stage 3 (KDOQI, 2002. Patients were distributed in two groups according to the etiology of CKD. Group 1 consisted of 67 patients with non-diabetic CKD. Group 2 consisted of 54 CKD patients with DN. All patients had arterial hypertension grade 1 or 2 (ESH/ESC, 2013. All patients underwent clinical examination, echocardiography; GFR was estimated by the Cockcroft-Gault formula. Stages of chronic kidney disease (CKD were determined according to the KDOQI 2002 classification. Eprosartan and lercanidipine were prescribed to patients after one week of lavage from previous antihypertensive therapy. This 6-month follow-up study compared the effectiveness of two courses of treatment. Results: LVH was observed in all CKD patients regardless of the presence or absence of DN. Eprosartan and lercanidipine showed the high antihypertensive efficacy expressing a reliable decrease in absolute values of SBP and DBP. In CKD patients with DN, on the background of a comparable antihypertensive effect, eprosartan, in comparison with lercanidipine, showed a more pronounced effect on the LV echocardiographic parameters associated with LVH regression.

  13. Vitamin D deficiency aggravates chronic kidney disease progression after ischemic acute kidney injury.

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    Janaína Garcia Gonçalves

    Full Text Available Despite a significant improvement in the management of chronic kidney disease (CKD, its incidence and prevalence has been increasing over the years. Progressive renal fibrosis is present in CKD and involves the participation of several cytokines, including Transforming growth factor-β1 (TGF-β1. Besides cardiovascular diseases and infections, several studies show that Vitamin D status has been considered as a non-traditional risk factor for the progression of CKD. Given the importance of vitamin D in the maintenance of essential physiological functions, we studied the events involved in the chronic kidney disease progression in rats submitted to ischemia/reperfusion injury under vitamin D deficiency (VDD.Rats were randomized into four groups: Control; VDD; ischemia/reperfusion injury (IRI; and VDD+IRI. At the 62 day after sham or IRI surgery, we measured inulin clearance, biochemical variables and hemodynamic parameters. In kidney tissue, we performed immunoblotting to quantify expression of Klotho, TGF-β, and vitamin D receptor (VDR; gene expression to evaluate renin, angiotensinogen, and angiotensin-converting enzyme; and immunohistochemical staining for ED1 (macrophages, type IV collagen, fibronectin, vimentin, and α-smooth mucle actin. Histomorphometric studies were performed to evaluate fractional interstitial area.IRI animals presented renal hypertrophy, increased levels of mean blood pressure and plasma PTH. Furthermore, expansion of the interstitial area, increased infiltration of ED1 cells, increased expression of collagen IV, fibronectin, vimentin and α-actin, and reduced expression of Klotho protein were observed. VDD deficiency contributed to increased levels of plasma PTH as well as for important chronic tubulointerstitial changes (fibrosis, inflammatory infiltration, tubular dilation and atrophy, increased expression of TGF-β1 and decreased expression of VDR and Klotho protein observed in VDD+IRI animals.Through inflammatory

  14. Limited posterior left atrial linear radiofrequency ablation for patients with chronic atrial fibrillation undergoing rheumatic valvular heart surgery

    Institute of Scientific and Technical Information of China (English)

    王均志; 杜日映; 丁会霞; 柏本健; 王刚; 崔国方; 钟志欢

    2004-01-01

    @@ Since 1996, we have begun to successfully treat atrial fibrillation (AF) with the maze procedure, replacing surgical incisions with radiofrequency (RF) ablation.1,2 Recent data show that the posterior wall of the left atrium seems to be a critical area for the occurrence and the maintenance of AF in patients with valvular heart disease. The objective of this study was to evaluate whether limited surgical RF ablation of the posterior region of the left atrium is safe and effective in curing chronic AF in patients also suffering from valvular heart disease.

  15. Neurohormones as markers of right- and left-sided cardiac dimensions and function in patients with untreated chronic heart failure

    DEFF Research Database (Denmark)

    Kjaer, Andreas; Hildebrandt, Per; Appel, Jon;

    2005-01-01

    BACKGROUND: It is now well accepted that neuroendocrine activation is of pathophysiological and prognostic importance in patients with chronic heart failure (CHF). We hypothesized that the different neuroendocrine factors reflect different aspects of the cardiac dysfunction in CHF patients...... and that neuroendocrine profiling could be of value. In order to study this, we investigated the relationship between hormones and cardiac dimensions and function of both the right and left ventricle. METHODS: Twenty-three patients with newly diagnosed, untreated CHF were included. Right (RVEF) and left ventricular...

  16. Urinary corticosteroid excretion predicts left ventricular mass and proteinuria in chronic kidney disease.

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    McQuarrie, Emily P; Freel, E Marie; Mark, Patrick B; Fraser, Robert; Patel, Rajan K; Dargie, Henry G; Connell, John M C; Jardine, Alan G

    2012-09-01

    Blockade of the MR (mineralocorticoid receptor) in CKD (chronic kidney disease) reduces LVMI [LV (left ventricular) mass index] and proteinuria. The MR can be activated by aldosterone, cortisol and DOC (deoxycorticosterone). The aim of the present study was to explore the influence of mineralocorticoids on LVMI and proteinuria in patients with CKD. A total of 70 patients with CKD and 30 patients with EH (essential hypertension) were recruited. Patients underwent clinical phenotyping; biochemical assessment and 24 h urinary collection for THAldo (tetrahydroaldosterone), THDOC (tetrahydrodeoxycorticosterone), cortisol metabolites (measured using GC-MS), and urinary electrolytes and protein [QP (proteinuira quantification)]. LVMI was measured using CMRI (cardiac magnetic resonance imaging). Factors that correlated significantly with LVMI and proteinuria were entered into linear regression models. In patients with CKD, significant predictors of LVMI were male gender, SBP (systolic blood pressure), QP, and THAldo and THDOC excretion. Significant independent predictors on multivariate analysis were THDOC excretion, SBP and male gender. In EH, no association was seen between THAldo or THDOC and LVMI; plasma aldosterone concentration was the only significant independent predictor. Significant univariate determinants of proteinuria in patients with CKD were THAldo, THDOC, USod (urinary sodium) and SBP. Only THAldo excretion and SBP were significant multivariate determinants. Using CMRI to determine LVMI we have demonstrated that THDOC is a novel independent predictor of LVMI in patients with CKD, differing from patients with EH. Twenty-four hour THAldo excretion is an independent determinant of proteinuria in patients with CKD. These findings emphasize the importance of MR activation in the pathogenesis of the adverse clinical phenotype in CKD.

  17. Endothelial nitric oxide synthase single nucleotide polymorphism and left ventricular function in early chronic kidney disease.

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    Sourabh Chand

    Full Text Available Chronic kidney disease (CKD is associated with accelerated cardiovascular disease and heart failure. Endothelial nitric oxide synthase (eNOS Glu298Asp single nucleotide polymorphism (SNP genotype has been associated with a worse phenotype amongst patients with established heart failure and in patients with progression of their renal disease. The association of a cardiac functional difference in non-dialysis CKD patients with no known previous heart failure, and eNOS gene variant is investigated.140 non-dialysis CKD patients, who had cardiac magnetic resonance (CMR imaging and tissue doppler echocardiography as part of two clinical trials, were genotyped for eNOS Glu298Asp SNP retrospectively.The median estimated glomerular filtration rate (eGFR was 50 mls/min and left ventricular ejection fraction (LVEF was 74% with no overt diastolic dysfunction in this cohort. There were significant differences in LVEF across eNOS genotypes with GG genotype being associated with a worse LVEF compared to other genotypes (LVEF: GG 71%, TG 76%, TT 73%, p = 0.006. After multivariate analysis, (adjusting for age, eGFR, baseline mean arterial pressure, contemporary CMR heart rate, total cholesterol, high sensitive C-reactive protein, body mass index and gender GG genotype was associated with a worse LVEF, and increased LV end-diastolic and systolic index (p = 0.004, 0.049 and 0.009 respectively.eNOS Glu298Asp rs1799983 polymorphism in CKD patients is associated with relevant sub-clinical cardiac remodelling as detected by CMR. This gene variant may therefore represent an important genetic biomarker, and possibly highlight pathways for intervention, in these patients who are at particular risk of worsening cardiac disease as their renal dysfunction progresses.

  18. Functional versus Nonfunctional Rehabilitation in Chronic Ischemic Stroke: Evidences from a Randomized Functional MRI Study

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    Maristela C. X. Pelicioni

    2016-01-01

    Full Text Available Motor rehabilitation of stroke survivors may include functional and/or nonfunctional strategy. The present study aimed to compare the effect of these two rehabilitation strategies by means of clinical scales and functional Magnetic Resonance Imaging (fMRI. Twelve hemiparetic chronic stroke patients were selected. Patients were randomly assigned a nonfunctional (NFS or functional (FS rehabilitation scheme. Clinical scales (Fugl-Meyer, ARA test, and modified Barthel and fMRI were applied at four moments: before rehabilitation (P1 and immediately after (P2, 1 month after (P3, and three months after (P4 the end of rehabilitation. The NFS group improved significantly and exclusively their Fugl-Meyer scores at P2, P3, and P4, when compared to P1. On the other hand, the FS group increased significantly in Fugl-Meyer at P2, when compared to P1, and also in their ARA and Barthel scores. fMRI inspection at the individual level revealed that both rehabilitation schemes most often led to decreased activation sparseness, decreased activity of contralesional M1, increased asymmetry of M1 activity to the ipsilesional side, decreased perilesional activity, and decreased SMA activity. Increased M1 asymmetry with rehabilitation was also confirmed by Lateralization Indexes. Our clinical analysis revealed subtle differences between FS and NFS.

  19. Evaluation of left ventricular mechanical dyssynchrony in chronic heart failure patients by two-dimensional speckle tracking imaging.

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    Jiang, Feng-Xia; Guo, Rui-Qiang; Chen, Jin-Ling

    2013-07-01

    The purpose of this study was to evaluate left ventricular mechanical dyssynchrony (LVMD) in chronic heart failure (CHF) patients using two-dimensional speckle tracking imaging (2D-STI), and also to compare the usefulness of three patterns of myocardial deformation in mechanical dyssynchrony assessment. Furthermore, the relationships between left ventricular ejection fraction (LVEF), QRS duration (QRSd), and LVMD were explored. In total, 78 patients and 60 healthy individuals (group 3) were enrolled. The patients were classified into two subgroups: LVEF≤35% (group 1), 35%0.05). CHF patients have different extents of LVMD. Longitudinal deformation shows the best detectability of dyssynchrony motion. Left ventricular systolic function was closely related to mechanical dyssynchrony, whereas QRSd showed no significant correlation.

  20. Three-dimensional phase-sensitive inversion recovery sequencing in the evaluation of left ventricular myocardial scars in ischemic and non-ischemic cardiomyopathy: Comparison to three-dimensional inversion recovery sequencing

    Energy Technology Data Exchange (ETDEWEB)

    Kido, Tomoyuki, E-mail: tomozo0421@gmail.com [Department of Radiology, Ehime University Graduate School of Medicine (Japan); Kido, Teruhito; Nakamura, Masashi; Kawaguchi, Naoto; Nishiyama, Yoshiko [Department of Radiology, Ehime University Graduate School of Medicine (Japan); Ogimoto, Akiyoshi [Department of Cardiovascular Internal Medicine, Ehime University Graduate School of Medicine (Japan); Miyagawa, Masao; Mochizuki, Teruhito [Department of Radiology, Ehime University Graduate School of Medicine (Japan)

    2014-12-15

    Highlights: • We evaluate 3D PSIR compared with 3D IR for the detection of myocardial scars. • In image quality, there was no significant difference between IR and PSIR. • A quantitative analysis of LGE volume shows a strong correlation between PSIR and IR. • PSIR detected greater LGE volume in non-ischemic cardiomyopathy patients than IR. • PSIR may have a specific role in scar evaluation of non-ischemic cardiomyopathy. - Abstract: Background: Late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) is a useful technique for detecting myocardial fibrosis. LGE images are typically acquired using the inversion recovery (IR) method. Recently, phase-sensitive inversion recovery (PSIR) technology has been developed. The purpose of this study was to evaluate free-breathing 3D PSIR sequencing in comparison with breath-held 3D IR sequencing for the detection of myocardial fibrosis. Methods: One hundred twenty-three patients with suspected ischemic cardiac disease (n = 27) or non-ischemic cardiomyopathy (hypertrophic cardiomyopathy, n = 29; dilated cardiomyopathy, n = 22; sarcoidosis, n = 21; arrhythmia, n = 9; myocarditis, n = 4; amyloidosis, n = 3; and others, n = 8) were evaluated by LGE–MRI, which was performed first with the IR sequence and then with the PSIR sequence, using a 3 T MRI scanner. Image quality was scored by two independent readers using a four-point scale. The 3D LGE volume was analyzed quantitatively and compared between both sequencing methods. Results: There was no significant difference in overall image quality (p = 0.19). LGE was detected in 73 patients, who were evaluated visually. Ultimately, 58 patients with acceptable image quality were enrolled in further quantitative analyses (volume assessment). Although quantification of LGE volume revealed a strong correlation between both methods, larger LGE volumes were detected with PSIR compared to IR in patients suspected of non-ischemic cardiomyopathy (39.5 ± 25.9 cm{sup 3} for

  1. A left attentional bias in chronic neglect: a case study using temporal order judgments.

    Science.gov (United States)

    Dove, Mary E; Eskes, Gail; Klein, Raymond M; Shore, David

    2007-02-01

    Previous studies of left visuospatial neglect using temporal order judgments (TOJs) have reported a temporal advantage for a stimulus presented on the right of fixation. The present case study examines an individual who shows a left temporal advantage on TOJ tasks, despite classic left-sided neglect on other tasks and in self-report. Experiment 1 found a continued left advantage on TOJs when employing a novel red/blue TOJ task to reduce potential response bias. Phasic alerting tones presented prior to random trials in Experiment 2 did not improve the abnormal attentional bias, as has been reported in previous studies of neglect. The addition of unilateral trials mixed within bilateral trials in Experiment 3 reduced the observed left advantage, suggesting a flexible attentional focus and implicating a role for strategic endogenous attentional strategies in this individual. Some implications for our understanding of endogenous orienting and relevance to rehabilitation therapy are discussed.

  2. To the question on efficiency of rehabilitation sick of the chronic ischemic heart trouble with stable stenocardia II-IІІ FK of advanced age.

    Directory of Open Access Journals (Sweden)

    Kotko D.N.

    2010-11-01

    Full Text Available Methodical approaches of rehabilitation the patients of a chronic ischemic heart trouble to stable stenocardia II-IІІ FK are considered at senior 60 years to the chosen standard medical treatment in a combination to physical trainings. It is shown that inclusion of physical trainings in a complex of medical actions of patients increases efficiency of medicamentous treatment. It is defined that training programs should rest upon the general approaches of its implementation with a glance of age of sick.

  3. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

  4. Intravenous renal cell transplantation with SAA1-positive cells prevents the progression of chronic renal failure in rats with ischemic-diabetic nephropathy.

    Science.gov (United States)

    Kelly, Katherine J; Zhang, Jizhong; Han, Ling; Wang, Mingsheng; Zhang, Shaobo; Dominguez, Jesus H

    2013-12-15

    Diabetic nephropathy, the most common cause of progressive chronic renal failure and end-stage renal disease, has now reached global proportions. The only means to rescue diabetic patients on dialysis is renal transplantation, a very effective therapy but severely limited by the availability of donor kidneys. Hence, we tested the role of intravenous renal cell transplantation (IRCT) on obese/diabetic Zucker/SHHF F1 hybrid (ZS) female rats with severe ischemic and diabetic nephropathy. Renal ischemia was produced by bilateral renal clamping of the renal arteries at 10 wk of age, and IRCT with genetically modified normal ZS male tubular cells was given intravenously at 15 and 20 wk of age. Rats were euthanized at 34 wk of age. IRCT with cells expressing serum amyloid A had strong and long-lasting beneficial effects on renal function and structure, including tubules and glomeruli. However, donor cells were found engrafted only in renal tubules 14 wk after the second infusion. The results indicate that IRCT with serum amyloid A-positive cells is effective in preventing the progression of chronic kidney disease in rats with diabetic and ischemic nephropathy.

  5. Abnormal glucose metabolism is associated with reduced left ventricular contractile reserve and exercise intolerance in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Egstrup, M; Kistorp, C N; Schou, M;

    2013-01-01

    years, 69% male, 59% had ischaemic heart disease, mean LV ejection fraction (LVEF) 37 ± 9%). Thirty-four (21%) patients had known diabetes mellitus (DM). Oral glucose tolerance testing (OGTT) classified patients without a prior DM diagnosis as normal glucose tolerance (NGT), impaired glucose tolerance......AIMS: To investigate the associations between glucose metabolism, left ventricular (LV) contractile reserve, and exercise capacity in patients with chronic systolic heart failure (HF). METHODS AND RESULTS: From an outpatient HF clinic, 161 patients with systolic HF were included (mean age 70 ± 10...... detected by OGTT, is independently associated with reduced LV contractile reserve and exercise...

  6. Antiremodeling effects on the left ventricle during beta-blockade with metoprolol in the treatment of chronic heart failure

    DEFF Research Database (Denmark)

    Grønning, Bjørn Aaris; Nilsson, J C; Sondergaard, Lars

    2000-01-01

    index remained unchanged, whereas LV mass index decreased in both groups (175 g/m2 to 160 g/m2 in the placebo group [p = 0.005] and 179 g/m2 to 164 g/m2 in the metoprolol CR/XL group [p = 0.011). CONCLUSIONS: This study is the first randomized study to demonstrate that the beta1-blocker metoprolol CR......OBJECTIVES: The purpose of the study was to investigate the effects of beta1-blockade on left ventricular (LV) size and function for patients with chronic heart failure. BACKGROUND: Large-scale trials have shown that a marked decrease in mortality can be obtained by treatment of chronic heart...... failure with beta-adrenergic blocking agents. Possible mechanisms behind this effect remain yet to be fully elucidated, and previous studies have presented insignificant results regarding suspected LV antiremodeling effects. METHODS: In this randomized, placebo-controlled and double-blind substudy...

  7. Evaluation of the asynchronization and function of the left ventricle in patients with chronic pulmonary hypertension by velocity vector imaging

    Institute of Scientific and Technical Information of China (English)

    WANG Chao-hong; WANG Yue-heng; NIU Ning-ning; XIE Ying-xin; WANG Lin

    2013-01-01

    Background Pulmonary hypertension (PH) is a set of pathophysiological syndromes characterized by increased pulmonary artery pressure and pulmonary vascular resistance,resulting in increased right ventricular afterload.The left and right ventricles interact through hemodynamics.What impact will PH have on synchronization and function of the left ventricle (LV)? The aim of this study was to evaluate the synchronization of the left ventricular wall motion and left ventricular function in patients with varying degrees of PH using velocity vector imaging (Wl) technology.Methods Sixty patients with chronic PH served as the experimental group,and 20 healthy volunteers served as the control group.According to the different degrees of pulmonary artery systolic pressure,the experimental group was divided into three groups:mild,moderate,and severe PH groups.The time to peak systolic longitudinal velocity (Tvl),the peak systolic longitudinal velocity (Vsl),the peak diastolic longitudinal velocity (Vel),the peak systolic longitudinal strain (SI),and strain rate (SRI) in 18 segments were measured in each group.Results TvI in the control group and each group with PH was reduced from basal to apical segment,and in control group Tvl in various segments of the same wall and in different walls showed no significant difference (P >0.05).With increase in pulmonary artery pressure,Tvl values measured showed an increasing trend in groups with PH.In groups with PH,Vsl and Vel of each wall were reduced sequentially from basal to apical segments,showing gradient change; Vsl and Vel values measured showed a decreasing trend with increase in pulmonary artery pressure,in which the differences of Vel values measured in the control group and the mild PH group were statistically significant (P <0.01),and the differences between other groups were statistically significant (P <0.01).In groups with PH,SI and SRI in basal segment and the middle segment of each wall were decreased; the

  8. Evaluation of global longitudinal strain of left ventricle and regional longitudinal strain in the region of left ventricular leads predicts the response to cardiac resynchronization therapy in patients with ischemic heart failure.

    Science.gov (United States)

    Ma, Chun-Yan; Liu, Shuang; Yang, Jun; Tang, Li; Zhang, Li-Ming; Li, Nan; Yu, Bo

    2014-09-01

    Myocardium viability in ischemic heart failure (HF) may affect the effect of cardiac resynchronization therapy (CRT). We hypothesized that longitudinal strain of 2D-STE, which reflects myocardium viability, can predict the response to CRT in patients with ischemic HF. 2D-STE was performed in 42 patients with HF, 1 week before and 1 year after CRT. GLS, RLS, and the LV synchrony index (SI), defined as the difference in timing to peak radial strain between LV anterior septal and posterior wall in LV short axis view, were calculated. A decrease in the LV end-systolic volume (LVESV) value of ≥ 15 % 1 year after CRT was defined as response to CRT. Twenty-nine patients responded to CRT (CRT-R group), while 13 patients did not respond and were assigned as CRT-NR group. Pre-CRT RLS and GLS were higher, while SI is lower, in CRT-R patients compared with CRT-NR group (p < 0.001). The ROC curve revealed that RLS of -11.5 % predicted response to CRT with sensitivity of 80.0 % and specificity of 77.9 % (AUC = 0.84, p < 0.001). Further, GLS of -13 % predicted response to CRT with sensitivity of 73.0 % and specificity of 73.4 % (AUC = 0.79, p < 0.001). In conclusion, LV dyssynchrony, GLS, and RLS calculated by 2D-STE can predict long-term response to CRT in patients with ischemic HF.

  9. Development of nonfibrotic left ventricular hypertrophy in an ANG II-induced chronic ovine hypertension model

    DEFF Research Database (Denmark)

    Klatt, Niklas; Scherschel, Katharina; Schad, Claudia

    2016-01-01

    Hypertension is a major risk factor for many cardiovascular diseases and leads to subsequent concomitant pathologies such as left ventricular hypertrophy (LVH). Translational approaches using large animals get more important as they allow the use of standard clinical procedures in an experimental...

  10. Association of left ventricular mechanical dyssynchrony with survival benefit from revascularization: a study of gated positron emission tomography in patients with ischemic LV dysfunction and narrow QRS

    Energy Technology Data Exchange (ETDEWEB)

    AlJaroudi, Wael [Imaging Institute, Heart and Vascular, Cleveland, OH (United States); Sydell and Arnold Miller Family Heart and Vascular Institute, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Cleveland, OH (United States); Alraies, M.C. [Cleveland Clinic, Department of Hospital Medicine, Cleveland, OH (United States); Hachamovitch, Rory; Jaber, Wael A.; Brunken, Richard; Cerqueira, Manuel D.; Marwick, Thomas [Imaging Institute, Heart and Vascular, Cleveland, OH (United States)

    2012-10-15

    LV mechanical dyssynchrony (LVMD) is a risk marker in narrow QRS cardiomyopathy, but its association with treatment outcome is not well defined. We determined the incremental prognostic value of LVMD in ischemic cardiomyopathy, and assessed its interaction with scar, myocardium in jeopardy and subsequent revascularization. Stress and rest {sup 82}Rb gated PET were performed in 486 consecutive patients (66 {+-} 11 years of age, 82 % men, LV ejection fraction 26 {+-} 6 %) with ischemic cardiomyopathy and QRS <120 ms. LVMD was determined as the standard deviation (SD) of the regional time to minimum volume on phase analysis of the gated PET scan. A propensity score was determined to adjust for nonrandomized referral after imaging to coronary artery bypass grafting (CABG). In a Cox proportional hazards model used to determine the association between measures of LVMD and survival time, CABG was included as a time-dependent covariate and the use of an implantable cardiac defibrillator (ICD) after imaging was modeled as a stratification factor. Over 1.9 {+-} 1.4 years, 96 patients (20 %) underwent CABG and 108 (22 %) died. LVMD was a predictor of mortality (HR 1.16. 95 % CI 1.03;1.30, per 10 increase in phase SD, p = 0.02) after adjusting for baseline covariates, prior ICD use, the use of postimaging CABG, and other imaging data. There was a significant interaction between phase SD and CABG. Nested Cox models showed that LVMD carried prognostic information incremental to clinical variables, ejection fraction and CABG. LVMD is an independent predictor of all-cause mortality in ischemic cardiomyopathy, and may identify patients with a differential survival benefit from CABG versus medical therapy. (orig.)

  11. Chronic idiopathic intestinal pseudo-obstruction caused by acquired visceral neuropathy localised in the left colon: report of two cases.

    Science.gov (United States)

    Suzuki, H; Amano, S; Matsumoto, K; Kitagawa, T; Masuda, T

    1987-07-01

    Two cases of chronic idiopathic intestinal pseudo-obstruction (CIIP) are reported. One is a 51-year-old man, and the other is a 47-year-old woman. Both patients presented with severe constipation and barium enema showed a marked dilation of the right colon, and a narrowing in the left colon. Studies done on the motility of the colon and anorectum revealed normal resting pressure profiles of the anorectom, a normal recto-anal reflex, and a normal resting tone of the collapsed colon. Administration of methacholine chloride, however, provoked large, non-propulsive movements in the collapsed colon, which were inhibited by the administration of atropin sulfate. Histologic examination disclosed a marked decrease in neurons and an increase of Schwann cells in the myenteric plexus of the collapsed colon. CIIP due to acquired visceral neuropathy localised in the left colon, was diagnosed as a result of manometric and histologic findings. One case was cured surgically, by a left hemi-colectomy, and the other was cured medically using choline antagonists and laxatives.

  12. Chronic pseudo-angina left precordial chest pain caused by a thoracic meningioma

    OpenAIRE

    Azabou, Eric; Kumako, Vincent; Moussawi, Mahmoud; Berger, Colette; André-Obadia, Nathalie; Kocher, Laurence; Gonnaud, Pierre-Marie

    2013-01-01

    International audience; Left precordial chest pain (LPCP) evokes above all angina. Eliminating a cardiac origin is then always the first priority. When cardiac causes are eliminated, non-cardiac causes are sought in order to avoid leaving patients with undiagnosed or undifferentiated chest pain. There is a myriad of non-cardiac causes ranging from heartburn, panic attacks, pleurisy, pulmonary embolism, pneumothorax, Tietze syndrome, bruises and fractures of the ribs, to spine meningioma, neur...

  13. Serial evaluation of {sup 123}I-BMIPP/{sup 201}Tl myocardial single-proton emission computed tomography after coronary stent implantation in ischemic heart disease. Association with recovery of left ventricular function

    Energy Technology Data Exchange (ETDEWEB)

    Shimazu, Yoshihisa; Taniguchi, Ikuo; Wagatsuma, Kenji; Yamazaki, Tatsuo [Jikei Univ., Tokyo (Japan). School of Medicine

    2000-11-01

    Coronary stent implantation is often used to treat ischemic heart disease. However, few studies have evaluated myocardial viability with single-proton emission computed tomography (SPECT) and both thallium and {beta}-methyl-iodophenyl-pentadecanoic acid (BMIPP) after coronary stent implantation. Forty patients (30 men and 10 women, 64.8{+-}9.3 years old) who had undergone successful stent implantation were enrolled. Twenty-two patients had angina pectoris (AP) and 18 patients had acute myocardial infarction (AMI). We performed BMIPP and thallium SPECT immediately after coronary stent implantation and at 3 months follow-up and compared the results with left ventriculograms. Myocardial SPECT images were divided into 17 segments, after which defect scores (1 to 5) were assigned to each segment and summed to obtain a total defect score (TDS). Left ventriculograms were divided into 9 segments, each of which was given a wall motion score (WMS; 1 to 5). In patients with either AP or AMI, the TDS of BMIPP and thallium SPECT images were significantly better at 3 months follow-up than immediately after stent implantation. In patients with AP, improvements in TDS on BMIPP and thallium SPECT were not associated with improvements in WMS. In patients with AMI, improvements in TDS on BMIPP SPECT were correlated with improvements in WMS (r=0.69, p<0.01) and in left ventricular ejection fraction (r=0.70, p<0.01), and improvements in TDS on thallium SPECT were correlated with improvements in WMS (r=0.64, p<0.01) but were not associated with improvements in left ventricular ejection fraction. In conclusion, a decrease in BMIPP myocardial uptake in patients with AP suggests previous episodes of severe myocardial ischemia. Improvements in BMIPP uptake in patients with AMI may indicate recovery of left ventricular function. Coronary stent implantation for severe myocardial ischemia contributes to improvements in myocardial viability. (author)

  14. Chronic treatment with metformin suppresses toll-like receptor 4 signaling and attenuates left ventricular dysfunction following myocardial infarction.

    Science.gov (United States)

    Soraya, Hamid; Clanachan, Alexander S; Rameshrad, Maryam; Maleki-Dizaji, Nasrin; Ghazi-Khansari, Mahmoud; Garjani, Alireza

    2014-08-15

    Acute treatment with metformin has a protective effect in myocardial infarction by suppression of inflammatory responses due to activation of AMP-activated protein kinase (AMPK). In the present study, the effect of chronic pre-treatment with metformin on cardiac dysfunction and toll-like receptor 4 (TLR4) activities following myocardial infarction and their relation with AMPK were assessed. Male Wistar rats were randomly assigned to one of 5 groups (n=6): normal control and groups were injected isoproterenol after chronic pre-treatment with 0, 25, 50, or 100mg/kg of metformin twice daily for 14 days. Isoproterenol (100mg/kg) was injected subcutaneously on the 13th and 14th days to induce acute myocardial infarction. Isoproterenol alone decreased left ventricular systolic pressure and myocardial contractility indexed as LVdp/dtmax and LVdp/dtmin. The left ventricular dysfunction was significantly lower in the groups treated with 25 and 50mg/kg of metformin. Metfromin markedly lowered isoproterenol-induced elevation in the levels of TLR4 mRNA, myeloid differentiation protein 88 (MyD88), tumor necrosis factor-alpha (TNF-α), and interleukin 6 (IL-6) in the heart tissues. Similar changes were also seen in the serum levels of TNF-α and IL-6. However, the lower doses of 25 and 50mg/kg were more effective than 100mg/kg. Phosphorylated AMPKα (p-AMPK) in the myocardium was significantly elevated by 25mg/kg of metformin, slightly by 50mg/kg, but not by 100mg/kg. Chronic pre-treatment with metformin reduces post-myocardial infarction cardiac dysfunction and suppresses inflammatory responses, possibly through inhibition of TLR4 activities. This mechanism can be considered as a target to protect infarcted myocardium.

  15. Genetic Variants Are Not Associated with Outcome in Patients with Coronary Artery Disease and Left Ventricular Dysfunction: Results of the Genetic Sub-study of the Surgical Treatment for Ischemic Heart Failure (STICH) Trials

    Science.gov (United States)

    Feldman, Arthur M.; She, Lilin; McNamara, Dennis M.; Mann, Douglas L.; Bristow, Michael R.; Maisel, Alan S.; Wagner, Daniel R.; Andersson, Bert; Chiariello, Luigi; Hayward, Christopher S.; Hendry, Paul; Parker, John D.; Racine, Normand; Selzman, Craig H.; Senni, Michele; Stepinska, Janina; Zembala, Marian; Rouleau, Jean; Velazquez, Eric J.; Lee, Kerry L.

    2015-01-01

    Objectives and Background We evaluated the ability of 23 genetic variants to provide prognostic information in patients enrolled in the Genotype Sub-studies of the Surgical Treatment for Ischemic Heart Failure (STICH) trials. Methods Patients in STICH Hypothesis 1 were randomized to medical therapy with or without CABG (Coronary Artery Bypass Grafting). Those in STICH Hypothesis 2 were randomized to CABG or CABG with left ventricular reconstruction. Results In patients assigned to STICH Hypothesis 2 (n=714), no genetic variant met the pre-specified Bonferroni-adjusted threshold for statistical significance (p<0.002); however, several met nominal prognostic significance: variants in the β2-adrenergic receptor gene (β2-AR Gln27Glu) and in the A1-adenosine receptor gene (A1-717 T/G) were associated with an increased risk of a subject dying or being hospitalized for a cardiac problem (p=0.027 and 0.031, respectively). These relationships remained nominally significant even after multivariable adjustment for prognostic clinical variables. However, none of the 23 genetic variants influenced all-cause mortality or the combination of death or cardiovascular hospitalization in the STICH Hypothesis 1 population (n=532) by either univariate or multivariable analysis. Conclusion We were unable to identify the predictive genotypes in optimally treated patients in these two ischemic heart failure populations. PMID:25592552

  16. Characterization of pericardial and plasma ghrelin levels in patients with ischemic and non-ischemic heart disease.

    Science.gov (United States)

    Sax, Balazs; Merkely, Béla; Túri, Katalin; Nagy, Andrea; Ahres, Abdelkrim; Hartyánszky, István; Hüttl, Tivadar; Szabolcs, Zoltán; Cseh, Károly; Kékesi, Violetta

    2013-09-10

    Ghrelin is an endocrine regulatory peptide with multiple functions including cardioprotective effects. It is produced in various tissues among others in the myocardium. Pericardial fluid has been proven to be a biologically active compartment of the heart that communicates with the myocardial interstitium. Thus, pericardial level of certain agents may reflect their concentration in the myocardium well. In our study we measured acylated (active) and total (acylated and non-acylated) pericardial and plasma ghrelin levels of patients with ischemic and non-ischemic heart disease. Pericardial fluid and plasma samples were obtained from patients with coronary artery disease (ISCH, n=54) or valvular heart disease (VHD, n=41) undergoing cardiac surgery. Acylated pericardial ghrelin concentrations were found to be significantly higher in patients with ischemic heart disease (ISCH vs. VHD, 32±3 vs. 16±2pg/ml, pheart disease as compared to non-ischemic patients suggesting an increased ghrelin production of the chronically ischemic myocardium. According to our results, pericardial ghrelin content is negatively influenced by left ventricular hypertrophy and insulin resistance.

  17. EFFECTS OF Β-ADRENOBLOCKERS ON MYOCARDIAL REMODELING, IMMUNO-INFLAMMATORY REACTIONS AND ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AND CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. N. Zakirova

    2015-12-01

    Full Text Available Aim. To assess the effect of β-adrenoblockers (BAB on myocardial remodeling, immuno-inflammatory reactions and endothelial dysfunction in patients with ischemic heart disease and chronic heart failure (CHF.Material and methods. 84 patients with ischemic CHF of II-IV functional class were involved in the study. They were randomized in two groups. The first group was presented with 43 patients receiving carvedilol in addition to standard therapy for 24 weeks; the second group was presented with 41patients receiving metoprolol. Echocardiography, 6-minute walk test were applied. Blood levels of primary and secondary lipid peroxidation (LP products, cytokines, endothelin-1 (ET-1, intercellular adhesive molecule (VCAM-1 were determined.Results. Both of BAB improved the clinical condition and physical working ability of patients with CHF. Carvedilol in comparison with metoprolol was more effective in myocardial remodeling prevention, inhibition of pro-inflammatory cytokines [tumor necrosis factor alpha (TNF-α, interleukins (IL-1β IL-6] and LP. Besides carvedilol increased in endothelium-dependent vasodilatation and reduced in ET-1 and VCAM-1 levels.Conclusion. Long-term carvedilol treatment has anti-inflammatory, antioxidant and endothelium-protective effects as well as improves haemodynamics. 

  18. Changes in left ventricular systolic function in patients with chronic heart failure with preserved ejection fraction and cardiorenal anemic syndrome

    Directory of Open Access Journals (Sweden)

    Vasylenko V.A.

    2015-09-01

    Full Text Available The feature of chronic heart failure (CHF in elderly people is increasing incidence of heart failure with preserved left ventricular ejection fraction (LVEF which is associated with age. Such patients account for almost half of the total number of patients with heart failure. Cardiorenal syndrome (CRS is associated with an increased risk of mortality in patients with CHF. The impact of CRS on the structural and functional condition of the heart in these patients is studied insufficiently. The study involved 103 patients with CHF II-IV NYHA with preserved LVEF (>45% and CRS (hemoglobin <120 g/l and

  19. The hemodynamic effects of acute aortic regurgitation into a stiffened left ventricle resulting from chronic aortic stenosis.

    Science.gov (United States)

    Okafor, Ikechukwu; Raghav, Vrishank; Midha, Prem; Kumar, Gautam; Yoganathan, Ajit

    2016-06-01

    Acute aortic regurgitation (AR) post-chronic aortic stenosis is a prevalent phenomenon occurring in patients who undergo transcatheter aortic valve replacement (TAVR) surgery. The objective of this work was to characterize the effects of left ventricular diastolic stiffness (LVDS) and AR severity on LV performance. Three LVDS models were inserted into a physiological left heart simulator. AR severity was parametrically varied through four levels (ranging from trace to moderate) and compared with a competent aortic valve. Hemodynamic metrics such as average diastolic pressures (DP) and reduction in transmitral flow were measured. AR index was calculated as a function of AR severity and LVDS, and the work required to make up for lost volume due to AR was estimated. In the presence of trace AR, higher LVDS had up to a threefold reduction in transmitral flow (13% compared with 3.5%) and a significant increase in DP (2-fold). The AR index ranged from ∼42 to 16 (no AR to moderate AR), with stiffer LVs having lower values. To compensate for lost volume due to AR, the low, medium, and high LVDS models were found to require 5.1, 5.5, and 6.6 times more work, respectively. This work shows that the LVDS has a significant effect on the LV performance in the presence of AR. Therefore, the LVDS of potential TAVR patients should be assessed to gain an initial indication of their ability to tolerate post-procedural AR.

  20. Complex left profunda femoris vein to renal vein bypass for the management of progressive chronic iliofemoral occlusion.

    Science.gov (United States)

    Anaya-Ayala, Javier E; Adams, Matthew K; Telich-Tarriba, Jose E; Dresser, Kelly L; Ismail, Nyla; Peden, Eric K

    2013-01-01

    Chronic occlusions of the inferior vena cava (IVC) and iliofemoral veins are long-term sequelae of deep venous thrombosis (DVT) that can lead to postthrombotic syndrome (PTS). Patients may present with a wide spectrum of signs and symptoms, ranging from mild discomfort and swelling to severe venous hypertension and ulcerations. We report a 68-year-old man who had a history of left lower extremity DVT after a laminectomy and who developed PTS with nonhealing ulcers. The patient underwent a cross-pubic femorofemoral venous bypass that failed to improve his clinical status. After unsuccessful endovascular attempts for recanalization of the iliofemoral segment, a profunda femoris to IVC bypass was performed. The symptoms recurred 2 years later. Venography revealed restenosis at the caval anastomosis that did not resolve by endovascular means. A surgical revision was performed, and given the quality of the IVC, a jump bypass was created to the left renal vein. The swelling improved and the ulcers healed completely. Twenty-eight months after the complex reconstructions, he remains ulcer-free with mild edema controlled with stockings. Venous reconstructions remain a viable option for patients with symptomatic and recalcitrant nonmalignant obstruction of the large veins.

  1. The Relationship of Left Ventricular Remodeling and Cardiac Function with Ventricular Arrhythmia in Ischemic Cardiomyopathy%缺血性心肌病左室重构和心功能与室性心律失常的关系

    Institute of Scientific and Technical Information of China (English)

    楚涛

    2012-01-01

    目的:探讨缺血性心肌病(ICM)患者左心室重构和心功能与室性心律失常的关系.方法:120例ICM患者分别按左心功能和左心室舒张末期内径(left ventricle end diastolic dimension,LVEDd)分组,分析各组患者发生室性心律失常的情况.结果:ICM患者的复杂型室性早搏、室内传导阻滞、室性早搏并发室内传导阻滞的发生率与LVEDd有明显相关性,差异有显著性(P<0.05);复杂型室性早搏的发生率与左心功能有关,差异有显著性(P<0.05),而室内传导阻滞以及室性早搏并发室内传导阻滞的发生率与左心功能无关,差异无显著性(P>0.05);简单型室性早搏的发生率与LVEDd和左心功能无关,差异无显著性(P>0.05).结论:ICM患者复杂型室性早搏发生与LVEDd及心功能有明显相关性,LVEDd重度增大者更易发生室性早搏及室内传导阻滞.%Objective: To investigate the relationship of left ventricular remodeling and cardiac function with ventricular arrhythmias in patients with ischemic cardiomyopathy (ICM). Methods; Total 120 cases with ICM were divided into groups according to left ventricle end-diastolic dimension (LVEDd) and left ventricular function, and the occurrence of ventricular arrhythmias in each group was investigated. Results; The occurrence of complex ventricular premature beat, intraventricular block and ventricular premature beat complicated with intraventricular block was related to LVEDd ( P 0. 05). Simple type of ventricular premature beat was not related to LVEDd and left heart function (P > 0. 05). Conclusions: The occurrence of complex ventricular premature beat is related to LVEDd and left heart function. When LVEDd is severe enlargement, ventricular premature beat complicated with intraventricular block is more likely to occur.

  2. Xenotransplantation of Human Cardiomyocyte Progenitor Cells Does Not Improve Cardiac Function in a Porcine Model of Chronic Ischemic Heart Failure. Results from a Randomized, Blinded, Placebo Controlled Trial.

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    Sanne J Jansen of Lorkeers

    Full Text Available Recently cardiomyocyte progenitor cells (CMPCs were successfully isolated from fetal and adult human hearts. Direct intramyocardial injection of human CMPCs (hCMPCs in experimental mouse models of acute myocardial infarction significantly improved cardiac function compared to controls.Here, our aim was to investigate whether xenotransplantation via intracoronary infusion of fetal hCMPCs in a pig model of chronic myocardial infarction is safe and efficacious, in view of translation purposes.We performed a randomized, blinded, placebo controlled trial. Four weeks after ischemia/reperfusion injury by 90 minutes of percutaneous left anterior descending artery occlusion, pigs (n = 16, 68.5 ± 5.4 kg received intracoronary infusion of 10 million fetal hCMPCs or placebo. All animals were immunosuppressed by cyclosporin (CsA. Four weeks after infusion, endpoint analysis by MRI displayed no difference in left ventricular ejection fraction, left ventricular end diastolic and left ventricular end systolic volumes between both groups. Serial pressure volume (PV-loop and echocardiography showed no differences in functional parameters between groups at any timepoint. Infarct size at follow-up, measured by late gadolinium enhancement MRI showed no difference between groups. Intracoronary pressure and flow measurements showed no signs of coronary obstruction 30 minutes after cell infusion. No premature death occurred in cell treated animals.Xenotransplantation via intracoronary infusion of hCMPCs is feasible and safe, but not associated with improved left ventricular performance and infarct size compared to placebo in a porcine model of chronic myocardial infarction.

  3. 声学定量技术评价缺血性心肌病患者左心功能%Evaluation of left ventricular function in patients with ischemic cardiomyopathy by acoustic quantification

    Institute of Scientific and Technical Information of China (English)

    张棣; 李智贤; 朱性威; 龙伟吟; 郭盛兰

    2001-01-01

    目的 探讨声学定量(AQ)技术在测定缺血性心肌病(ICM)患者左心功能中的临床应用价值。方法 测量24例ICM患者和30例正常人的左室舒张末期容积(EDV)、收缩末期容积(ESV)、射血分数(EF)、峰值充盈率(PFR)、峰值排空率(PER)、峰值充盈时间(TPFR)。结果 ICM组左室EDV为(120.08±24.50)ml,ESV为(79.78±17.38)ml,明显高于正常组(P<0.001),ICM组左室收缩功能指标EF为(33.19±8.50)%,PER为(2.59±0.63)ml/s,较正常组明显降低(P<0.001)。ICM组的左室舒张功能指标PFR为(2.62±0.52)ml/s,较正常组明显降低;TPFR为(207.63±45.76)ms,较正常组明显延长(P<0.001 )。结论 AQ技术是测定ICM患者左心功能的一项简便实用的新方法。%Objective To evaluate the clinical application of acoustic quantification for detecting the left ventricular function in patients with ischemic cardiomyopathy (ICM).Methods The left ventricular function was detected in 24 patients with ischemic cardiomyopathy and 30 normal subjects.Left ventricular end diastolic volume(EDV),end systolic volume (ESV),ejection fraction (EF),peak filling rate (PFR),peak ejection rate (PER),time of peak filling rate (TPFR) were measured.Results In ICM group , EDV was (120.08±24.50)ml,ESV was (79.78±17.38)ml, EDV and ESV were markedly higher than those in normal group (P<0.001). Left ventricular systolic function indexes in ICM group: EF was (33.19±8.50)%, PER was (2.59±0.63)ml/s, EF and PER were obviously lower than those in normal group (P<0.001). Left ventricular diastolic function indexes in ICM group: PFR was (2.62±0.52)ml/s and TPFR was (207.63±45.76)ms, PFR was obviously lower than that in normal group ,TPFR was significantly longer than that in normal group (P<0.001).Conclusions Acoustic quantification is a new, simple, and useful method for the assessment of the left ventricular function in ICM patients.

  4. Assessment of Subclinical Left Ventricular Dysfunction in Patients with Chronic Mitral Regurgitation Using Torsional Parameters Described by Tissue Doppler Imaging

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    Zahra Ojaghi-Haghighi

    2015-10-01

    Full Text Available Background: Left ventricular (LV twist is due to oppositely directed apical and basal rotation and has been proposed as a sensitive marker of LV function. We sought to assess the impact of chronic pure mitral regurgitation (MR on the torsional mechanics of the left human ventricle using tissue Doppler imaging.Methods: Nineteen severe MR patients with a normal LV ejection fraction and 16 non-MR controls underwent conventional echocardiography and apical and basal short-axis color Doppler myocardial imaging (CDMI. LV rotation at the apical and basal short-axis levels was calculated from the averaged tangential velocities of the septal and lateral regions, corrected for the LV radius over time. LV twist was defined as the difference in LV rotation between the two levels, and the LV twist and twisting/untwisting rate profiles were analyzed throughout the cardiac cycle.Results: LV twist and LV torsion were significantly lower in the MR group than in the non-MR group (10.38˚ ± 4.04˚ vs.13.95˚ ± 4.27˚; p value = 0.020; and 1.29 ± 0.54 ˚/cm vs. 1.76 ± 0.56 ˚/cm; p value = 0.021, respectively, both suggesting incipient LV dysfunction in the MR group. Similarly, the untwisting rate was lower in the MR group (-79.74 ± 35.97 ˚/s vs.-110.96 ± 34.65 ˚/s; p value = 0.020, but there was statistically no significant difference in the LV twist rate.Conclusion: The evaluation of LV torsional parameters in MR patients with a normal LV ejection fraction suggests the potential role of these sensitive variables in assessing the early signs of ventricular dysfunction in asymptomatic patients

  5. IgG4-related pleural disease diagnosed by a re-evaluation of chronic bilateral pleuritis in a patient who experienced occasional acute left bacterial pleuritis.

    Science.gov (United States)

    Yamamoto, Hiroshi; Suzuki, Toshiro; Yasuo, Masanori; Kobayashi, Orie; Tsushima, Kenji; Ito, Michiko; Urushihata, Kazuhisa; Yamazaki, Yoshitaka; Hanaoka, Masayuki; Koizumi, Tomonobu; Uehara, Takeshi; Kawakami, Satoshi; Hamano, Hideaki; Kawa, Shigeyuki; Kubo, Keishi

    2011-01-01

    A 78-year-old man with cryptogenic chronic bilateral lymphoplasmacytic pleuritis, diagnosed based on left parietal pleural biopsy specimens obtained by pleuroscopy, developed acute left bacterial pleuritis. The left pleural effusion was neutrophil dominant, however, the right pleural effusion showed lymphoplasmacytic infiltration. Laboratory examinations revealed that his serum IgG4 concentration was increased, with a higher level of IgG4 in the right pleural effusion. Re-evaluation of the previous biopsy specimens using an immunostaining method revealed numerous IgG4-positive plasma cell infiltrations with IgG4-positive/IgG-positive plasma cells at 85.4%. Accordingly, the new diagnosis of this patient was considered to be chronic bilateral IgG4-related pleuritis.

  6. Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease.

    Science.gov (United States)

    Dong, Hao-jian; Huang, Cheng; Luo, De-mou; Ye, Jing-guang; Yang, Jun-qing; Li, Guang; Luo, Jian-fang; Zhou, Ying-ling

    2016-01-01

    Percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ventricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.

  7. Agreement of left ventricular mass in steady state free precession and delayed enhancement MR images: implications for quantification of fibrosis in congenital and ischemic heart disease

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    Olivecrona Goran

    2010-01-01

    Full Text Available Abstract Background Left ventricular mass (LVM is used when expressing infarct or fibrosis as a percentage of the left ventricle (LV. Quantification of LVM is interchangeably carried out in cine steady state free precession (SSFP and delayed enhancement (DE magnetic resonance imaging (MRI. However, these techniques may yield different LVM. Therefore, the aim of the study was to compare LVM determined by SSFP and DE MRI in patients and determine the agreement with these sequences with ex vivo data in an experimental animal model. Methods Ethics committees approved human and animal studies. Informed written consent was obtained from all patients. SSFP and DE images were acquired in 60 patients (20 with infarction, 20 without infarction and 20 pediatric patients. Ex vivo MRI was used as reference method for LVM in 19 pigs and compared to in vivo SSFP and DE. Results LVM was greater in SSFP than in DE (p 2 = 0.98, and a bias of 7.3 ± 6.7% (p 2 = 0.83. Bias for SSFP and DE images compared to ex vivo LVM was -0.2 ± 9.0% and -7.7 ± 8.5% respectively. Conclusions LVM was higher when measured with SSFP compared to DE. Thus, the percentage infarction of the LV will differ if SSFP or DE is used to determine LVM. There was no significant difference between SSFP and ex vivo LVM suggesting that SSFP is more accurate for LVM quantification. To avoid intrinsic error due to the differences between the sequences, we suggest using DE when expressing infarct as a percentage of LVM.

  8. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

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    R. N. Adzhiev

    2015-09-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  9. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

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    R. N. Adzhiev

    2013-01-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  10. Influence of Baseline Characteristics, Operative Conduct and Postoperative Course on 30-day Outcomes of Coronary Artery Bypass Grafting among Patients with Left Ventricular Dysfunction: Results from the Surgical Treatment for Ischemic Heart Failure (STICH) Trial

    Science.gov (United States)

    Wrobel, Krzysztof; Stevens, Susanna R.; Jones, Robert H.; Selzman, Craig H.; Lamy, Andre; Beaver, Thomas M.; Djokovic, Ljubomir T.; Wang, Nan; Velazquez, Eric J.; Sopko, George; Kron, Irving L.; DiMaio, J. Michael; Michler, Robert E.; Lee, Kerry L.; Yii, Michael; Leng, Chua Yeow; Zembala, Marian; Rouleau, Jean L.; Daly, Richard C.; Al-Khalidi, Hussein R.

    2015-01-01

    Background Patients with severe left ventricular (LV) dysfunction, ischemic heart failure and coronary artery disease (CAD) suitable for coronary artery bypass grafting (CABG) are at higher risk for surgical morbidity and mortality. Paradoxically, those patients with the most severe coronary artery disease and ventricular dysfunction who derive the greatest clinical benefit from CABG are also at the greatest operative risk, which makes decision-making regarding whether to proceed to surgery difficult in such patients. To better inform such decision-making, we analyzed the STICH CABG population for detailed information on perioperative risk and outcomes. Methods and Results In both STICH trials (hypotheses), 2136 patients with a left ventricular ejection fraction (LVEF) ≤ 35% and coronary artery disease were allocated to medical therapy, CABG plus medical therapy or CABG with surgical ventricular reconstruction (SVR). Relationships of baseline characteristics and operative conduct with morbidity and mortality at 30 days were evaluated. There were a total of 1460 patients who received surgery, and 346 of them (roughly, one-quarter) of these high-risk patients developed a severe complication within 30 days. Worsening renal insufficiency, cardiac arrest with cardiopulmonary resuscitation, and ventricular arrhythmias were the most frequent complications and those most commonly associated with death. Mortality at 30 days was 5.1% and was generally preceded by a serious complication (65 of 74 deaths). LV size, renal dysfunction, advanced age, and atrial fibrillation/flutter were significant preoperative predictors of mortality within 30 days. Cardiopulmonary bypass time was the only independent surgical variable predictive of 30-day mortality. Conclusions CABG can be performed with relatively low 30-day mortality in patients with LV dysfunction. Serious postoperative complications occurred in nearly 1 in 4 patients and were associated with mortality. Clinical Trial

  11. Association of N-Terminal Pro-B-Type Natriuretic Peptide with Left Ventricular Structure and Function in Chronic Kidney Disease (From the Chronic Renal Insufficiency Cohort [CRIC])

    Science.gov (United States)

    Mishra, Rakesh K.; Li, Yongmei; Ricardo, Ana C.; Yang, Wei; Keane, Martin; Cuevas, Magdalena; Christenson, Robert; DeFilippi, Christopher; Chen, Jing; He, Jiang; Kallem, Radhakrishna R.; Raj, Dominic S.; Schelling, Jeffrey R.; Wright, Jackson; Go, Alan S.; Shlipak, Michael G.

    2017-01-01

    We evaluated the cross-sectional associations of N-terminal pro-B-type natriuretic peptide (NT-proBNP) with cardiac structural and functional abnormalities in a cohort of chronic kidney disease (CKD) patients without clinical heart failure (HF), the Chronic Renal Insufficiency Cohort (n=3,232). Associations of NT-proBNP with echocardiographically determined left ventricular (LV) mass and LV systolic and diastolic function were evaluated by multivariable logistic and linear regression models. Reclassification of participants’ predicted risk of LV hypertrophy (LVH), systolic and diastolic dysfunction was performed using a category-free net reclassification improvement (NRI) index that compared a clinical model with and without NT-proBNP. The median (interquartile range) NT-proBNP was 126.6 pg/ml (55.5–303.7). The highest quartile of NT-proBNP was associated with nearly three-fold odds of LVH (odds ratio (OR) 2.7, 95% confidence interval (CI) 1.8–4.0) and LV systolic dysfunction (2.7, 1.7–4.5) and two-fold odds of diastolic dysfunction (2.0, 1.3–2.9) in the fully adjusted models. When evaluated alone as a screening test, NT-proBNP functioned modestly for the detection of LVH (area under the curve, AUC 0.66) and LV systolic dysfunction (AUC 0.62), and poorly for the detection of diastolic dysfunction (AUC 0.51). However, when added to the clinical model, NT-proBNP significantly reclassified participants’ likelihood of having LVH (NRI 0.14, 95% CI 0.13–0.15; p<0.001) and LV systolic dysfunction (0.28, 0.27–0.30; p<0.001), but not diastolic dysfunction (0.10, 0.10–0.11; p=0.07). In conclusion, in this large CKD cohort without HF, NT-proBNP had strong associations with prevalent LVH and LV systolic dysfunction. PMID:23178053

  12. Analysis of the stability of housekeeping gene expression in the left cardiac ventricle of rats submitted to chronic intermittent hypoxia.

    Science.gov (United States)

    Julian, Guilherme Silva; Oliveira, Renato Watanabe de; Tufik, Sergio; Chagas, Jair Ribeiro

    2016-01-01

    Obstructive sleep apnea (OSA) has been associated with oxidative stress and various cardiovascular consequences, such as increased cardiovascular disease risk. Quantitative real-time PCR is frequently employed to assess changes in gene expression in experimental models. In this study, we analyzed the effects of chronic intermittent hypoxia (an experimental model of OSA) on housekeeping gene expression in the left cardiac ventricle of rats. Analyses via four different approaches-use of the geNorm, BestKeeper, and NormFinder algorithms; and 2-ΔCt (threshold cycle) data analysis-produced similar results: all genes were found to be suitable for use, glyceraldehyde-3-phosphate dehydrogenase and 18S being classified as the most and the least stable, respectively. The use of more than one housekeeping gene is strongly advised. RESUMO A apneia obstrutiva do sono (AOS) tem sido associada ao estresse oxidativo e a várias consequências cardiovasculares, tais como risco aumentado de doença cardiovascular. A PCR quantitativa em tempo real é frequentemente empregada para avaliar alterações na expressão gênica em modelos experimentais. Neste estudo, analisamos os efeitos da hipóxia intermitente crônica (um modelo experimental de AOS) na expressão de genes de referência no ventrículo cardíaco esquerdo de ratos. Análises a partir de quatro abordagens - uso dos algoritmos geNorm, BestKeeper e NormFinder e análise de dados 2-ΔCt (ciclo limiar) - produziram resultados semelhantes: todos os genes mostraram-se adequados para uso, sendo que gliceraldeído-3-fosfato desidrogenase e 18S foram classificados como o mais e o menos estável, respectivamente. A utilização de mais de um gene de referência é altamente recomendada.

  13. Guidewires used in first intentional single wiring strategy for chronic total occlusions of the left anterior descending coronary artery

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    Yasser S Nassar

    2013-01-01

    Full Text Available Background: Percutaneous coronary intervention (PCI for chronic total occlusion (CTO of the left anterior descending (LAD specifically is associated with improved long-term 5 year survival as compared to PCI failure.The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. Aim: To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. Methods: A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. Results: A total of 30 patients with LAD CTO lesions (100%, were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%, 36% were Soft Non Tapered Pilot 50 (28%, whisper (8%, while 16% were Stiff Non tapered GWs; Miracle 12 (8%, Miracle 6 (4%, Miracle 3 (4%, and 4% were Stiff Tapered GWs; Progress 200 (4%. Conclusions: Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.

  14. Meta-analysis of randomized controlled trials comparing isolated left ventricular and biventricular pacing in patients with chronic heart failure.

    Science.gov (United States)

    Liang, Yixiu; Pan, Wenzhi; Su, Yangang; Ge, Junbo

    2011-10-15

    Cardiac resynchronization therapy (CRT) has been mostly achieved by biventricular pacing (BVP) in patients with chronic heart failure (CHF), although it can also be provided by left ventricular pacing (LVP). The superiority of BVP over LVP remains uncertain. The present meta-analysis of randomized controlled trials was performed to compare the effects of LVP to BVP in patients with CHF. Outcomes analyzed included clinical status (6-minute walk distance, peak oxygen consumption, quality of life, New York Heart Association class), LV function (LV ejection fraction), and LV remodeling (LV end-systolic volume). Five trials fulfilled criteria for inclusion in analysis, which included 574 patients with CHF indicated for CRT. After a midterm follow-up, pooled analysis demonstrated that LVP resulted in similar improvements in 6-minute walk distance (weighted mean difference [WMD] 11.25, 95% confidence interval [CI] -12.39 to 34.90, p = 0.35), quality of life (WMD 0.34, 95% CI -3.72 to 4.39, p = 0.87), peak oxygen consumption (WMD 1.00, 95% CI -0.84 to 2.85, p = 0.29), and New York Heart Association class (WMD -0.19, 95% CI -0.79 to 0.42, p = 0.54). There was a trend toward a superiority of BVP over LVP for LV ejection fraction (WMD 1.28, 95% CI -0.11 to 2.68, p = 0.07) and LV end-systolic volume (WMD -5.73, 95% CI -11.86 to 0.39, p = 0.07). In conclusion, LVP achieves similar improvement in clinical status as BVP in patients with CHF, whereas there was a trend toward superiority of BVP over LVP for LV reverse modeling and systolic function.

  15. Neurohumoral prediction of left-ventricular morphologic response to beta-blockade with metoprolol in chronic left-ventricular systolic heart failure

    DEFF Research Database (Denmark)

    Groenning, Bjoern A; Nilsson, Jens C; Hildebrandt, Per R;

    2002-01-01

    from metoprolol treatment in patients with chronic LV systolic heart failure. METHODS: Forty-one subjects randomised to placebo or metoprolol were studied with magnetic resonance imaging and blood samples to measure LV dimensions and ejection fraction, epinephrine, norepinephrine, plasma renin activity......LVESVI: r=-0.53, P=0.03) volumes during metoprolol treatment. Change in ANP during the study was an independent marker for deltaLVEDVI: r=0.66, P=0.004, and deltaLVESVI: r=0.69, P=0.002 in the entire metoprolol group, but at the individual patient level, results were less clear. CONCLUSION: The pre......-treatment plasma level of ANP may be a predictor of LV antiremodelling from treatment with metoprolol in patients with chronic heart failure. However, the potential for individual neurohumoral monitoring of the effects on LV dimensions during beta-blockade appears limited....

  16. Neurohumoral prediction of left-ventricular morphologic response to beta-blockade with metoprolol in chronic left-ventricular systolic heart failure

    DEFF Research Database (Denmark)

    Grønning, Bjørn Aaris; Nilsson, Jens C; Hildebrandt, Per R;

    2002-01-01

    from metoprolol treatment in patients with chronic LV systolic heart failure. METHODS: Forty-one subjects randomised to placebo or metoprolol were studied with magnetic resonance imaging and blood samples to measure LV dimensions and ejection fraction, epinephrine, norepinephrine, plasma renin activity......LVESVI: r=-0.53, P=0.03) volumes during metoprolol treatment. Change in ANP during the study was an independent marker for deltaLVEDVI: r=0.66, P=0.004, and deltaLVESVI: r=0.69, P=0.002 in the entire metoprolol group, but at the individual patient level, results were less clear. CONCLUSION: The pre......-treatment plasma level of ANP may be a predictor of LV antiremodelling from treatment with metoprolol in patients with chronic heart failure. However, the potential for individual neurohumoral monitoring of the effects on LV dimensions during beta-blockade appears limited...

  17. The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the PROGNOZ IBS register

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    S. N. Tolpygina

    2015-12-01

    Full Text Available Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD included into the PROGNOZ IBS Register.Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female was included in the analysis. 504 (93% patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma andchronic kidney disease (CKD.Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM increased the relative risk (RR of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (p<0.05; 2 and 3 heart diseases – respectively, by 2.3 and 3.2 times (p<0.05; a combination of chronic lung diseases and CKD stages 3-5 – by 1.4 times (p=0.06; the presence of 2, 3, 4 and 5 comorbidities – respectively, by 4, 5, 6.4 and 13 times (p<0.001. The risk of death from all causes was determined by the number of concomitant cardiovascular diseases: 2 diseases increased RR by 2.3 times, 3 diseases – by 4.6 times, a combination of any 4 diseases – by 3.5 times, of 5 diseases – by 5 times (p<0.05.Conclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension, cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.

  18. The influence of concomitant diseases on a long-term prognosis in patients with chronic ischemic heart disease according to the PROGNOZ IBS register

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    S. N. Tolpygina

    2015-01-01

    Full Text Available Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD included into the PROGNOZ IBS Register.Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female was included in the analysis. 504 (93% patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma andchronic kidney disease (CKD.Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM increased the relative risk (RR of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (p<0.05; 2 and 3 heart diseases – respectively, by 2.3 and 3.2 times (p<0.05; a combination of chronic lung diseases and CKD stages 3-5 – by 1.4 times (p=0.06; the presence of 2, 3, 4 and 5 comorbidities – respectively, by 4, 5, 6.4 and 13 times (p<0.001. The risk of death from all causes was determined by the number of concomitant cardiovascular diseases: 2 diseases increased RR by 2.3 times, 3 diseases – by 4.6 times, a combination of any 4 diseases – by 3.5 times, of 5 diseases – by 5 times (p<0.05.Conclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension, cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.

  19. Diabetes and ischemic heart disease

    DEFF Research Database (Denmark)

    Bergmann, Natasha; Ballegaard, Søren; Holmager, Pernille

    2014-01-01

    The aim of this study was to test i) whether patients having diabetes and ischemic heart disease (IHD), i.e., patients suffering from two chronic diseases, demonstrate a higher degree of chronic stress when compared with patients suffering from IHD alone, and ii) whether suffering from the two...... chronic diseases results in an elevation in specific elements of the chronic stress concept. A total of 361 participants with IHD were included, of whom 47 suffered from concomitant diabetes. Stress was measured by pressure pain sensitivity (PPS) and by the following questionnaires: the Major Depression...

  20. The 'silence' of silent brain infarctions may be related to chronic ischemic preconditioning and nonstrategic locations rather than to a small infarction size

    Directory of Open Access Journals (Sweden)

    Chao Feng

    2013-01-01

    Full Text Available OBJECTIVE: Silent brain infarctions are the silent cerebrovascular events that are distinguished from symptomatic lacunar infarctions by their 'silence'; the origin of these infarctions is still unclear. This study analyzed the characteristics of silent and symptomatic lacunar infarctions and sought to explore the mechanism of this 'silence'. METHODS: In total, 156 patients with only silent brain infarctions, 90 with only symptomatic lacunar infarctions, 160 with both silent and symptomatic lacunar infarctions, and 115 without any infarctions were recruited. Vascular risk factors, leukoaraiosis, and vascular assessment results were compared. The National Institutes of Health Stroke Scale scores were compared between patients with only symptomatic lacunar infarctions and patients with two types of infarctions. The locations of all of the infarctions were evaluated. The evolution of the two types of infarctions was retrospectively studied by comparing the infarcts on the magnetic resonance images of 63 patients obtained at different times. RESULTS: The main risk factors for silent brain infarctions were hypertension, age, and advanced leukoaraiosis; the main factors for symptomatic lacunar infarctions were hypertension, atrial fibrillation, and atherosclerosis of relevant arteries. The neurological deficits of patients with only symptomatic lacunar infarctions were more severe than those of patients with both types of infarctions. More silent brain infarctions were located in the corona radiata and basal ganglia; these locations were different from those of the symptomatic lacunar infarctions. The initial sizes of the symptomatic lacunar infarctions were larger than the silent brain infarctions, whereas the final sizes were almost equal between the two groups. CONCLUSIONS: Chronic ischemic preconditioning and nonstrategic locations may be the main reasons for the 'silence' of silent brain infarctions.

  1. Inhalation of diluted diesel engine emission impacts heart rate variability and arrhythmia occurrence in a rat model of chronic ischemic heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Anselme, Frederic [Rouen University Hospital, Service de Cardiologie, Rouen (France); Loriot, Stephane; Henry, Jean-Paul; Thuillez, Christian; Morin, Jean-Paul [University of Rouen France, INSERM U644, School of Medicine-Pharmacy, Rouen, Cedex (France); Dionnet, Frederic [Centre d' Etudes et de Recherches Technologiques en Aerothermique et Moteurs, Saint Etienne du Rouvray (France); Napoleoni, Jean-Gerard [EMKA Technologies, Paris (France)

    2007-04-15

    Both increase in cardiac arrhythmia incidence and decrease in heart rate variability (HRV) have been described following human and experimental animal exposures to air pollutants. However, the potential causal relationship between these two factors remains unclear. Incidence of ventricular arrhythmia and HRV were evaluated during and after a 3 h period of Diesel engine exhaust exposure in ten healthy and ten chronic ischemic heart failure (CHF, 3 months after coronary ligation) Wistar rats using implantable ECG telemetry. Air pollutants were delivered to specifically designed whole body individual exposure chambers at particulate matter concentrations similar to those measured inside cabins of cars inserted in congested urban traffic. Recordings were obtained from unrestraint and unsedated vigil rats. Immediate decrease in RMSSD was observed in both healthy (6.64 {+-} 2.62 vs. 4.89 {+-} 1.67 ms, P < 0.05) and CHF rats (8.01 {+-} 0.89 vs. 6.6 {+-} 1.37 ms, P < 0.05) following exposure. An immediate 200-500% increase in ventricular premature beats was observed in CHF rats only. Whereas HRV progressively returned to baseline values within 2.5 h after exposure start, the proarrhythmic effect persisted as late as 5 h after exposure termination in CHF rats. Persistence of ventricular proarrhythmic effects after HRV normalization suggests that HRV reduction is not the mechanism of cardiac arrhythmias in this model. Our methodological approach, closely reflecting the real clinical situations, appeared to be a unique tool to provide further insight into the pathophysiological mechanisms of traffic related airborne pollution health impact. (orig.)

  2. Surgical strategy for mild ischemic mitral insufficiency

    Institute of Scientific and Technical Information of China (English)

    GU Cheng-xiong; WEI Hua; YU Yang

    2010-01-01

    @@ To the Editor: We read with the interest the article by FAN Hong-guang and colleagues~1 having obtained outstanding early and long-term clinical outcomes of left ventricular restoration for the patients with postinfarction ventricular aneurysm and low left ventricular ejection fraction (LVEF) of mean 37.7%. We would like to comment on surgical strategy for mild ischemic mitral insufficiency.

  3. Gene expression profile of rat left ventricles reveals persisting changes following chronic mild exercise protocol: implications for cardioprotection

    Directory of Open Access Journals (Sweden)

    Esposito Fabio

    2009-07-01

    Full Text Available Abstract Background Epidemiological studies showed that physical exercise, specifically moderate lifelong training, is protective against cardiovascular morbidity and mortality. Most experimental work has focused into the effects and molecular mechanisms underlying intense, rather than mild exercise, by exploring the acute effect of training. Our study aims at investigating the cardioprotective effect of mild chronic exercise training and the gene expression profile changes at 48 hrs after the exercise cessation. Rats were trained at mild intensity on a treadmill: 25 m/min, 10%incline, 1 h/day, 3 days/week, 10 weeks; about 60% of the maximum aerobic power. By Affymetrix technology, we investigated the gene expression profile induced by exercise training in the left ventricle (LV of trained (n = 10 and control (n = 10 rats. Cardioprotection was investigated by ischemia/reperfusion experiments (n = 10 trained vs. n = 10 control rats. Results Mild exercise did not induce cardiac hypertrophy and was cardioprotective as demonstrated by the decreased infarct size (p = 0.02 after ischemia/reperfusion experiments in trained with respect to control rats. Ten genes and 2 gene sets (two pathways resulted altered in LV of exercised animals with respect to controls. We validated by real-time PCR the increased expression of four genes: similar to C11orf17 protein (RGD1306959, caveolin 3, enolase 3, and hypoxia inducible factor 1 alpha. Moreover, caveolin 3 protein levels were higher in exercised than control rats by immunohistochemistry and Western Blot analysis. Interestingly, the predicted gene similar to C11orf17 protein (RGD1306959 was significantly increased by exercise. This gene has a high homology with the human C11orf17 (alias: protein kinase-A interacting protein 1 or breast cancer associated gene 3. This is the first evidence that this gene is involved in the response to the exercise training. Conclusion Our data indicated that few, but significant

  4. Subacute gastric perforation caused by a left ventricular assist device

    Institute of Scientific and Technical Information of China (English)

    Demetris Yannopoulos

    2007-01-01

    This case report describes a rare complication of a left ventricular assist device (LVAD). A patient with ischemic cardiomyopathy had an LVAD placed due to intractable congestive heart failure following a large anterior myocardial infarction. The patient developed chronic bacteremia and multiple septic episodes. A gastric endoscopy revealed perforation of the anterior wall of the stomach by the LVAD. Gastric acid related erosions were present on the metallic surface suggesting prolonged exposure. This is the second case report of this rare complication and the first case report of a subacute course.

  5. Changes of resting cerebral activities in subacute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ping Wu

    2015-01-01

    Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

  6. Changes of resting cerebral activities in subacute ischemic stroke patients

    Institute of Scientific and Technical Information of China (English)

    Ping Wu; Fang Zeng; Yong-xin Li; Bai-li Yu; Li-hua Qiu; Wei Qin; Ji Li; Yu-mei Zhou; Fan-rong Liang

    2015-01-01

    This study aimed to detect the difference in resting cerebral activities between ischemic stroke pa-tients and healthy participants, deifne the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efifcacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunc-tion and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks) and 15 age-matched healthy participants. A rest-ing-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental ifndings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely po-tential targets for the neural regeneration of subacute ischemic stroke patients.

  7. Effects of Biventricular and Left Ventricular Assist Devices on Ischemic Myocardium%左心室及双心室辅助装置对缺血心肌的影响

    Institute of Scientific and Technical Information of China (English)

    杨敏; 王一山; 叶椿秀; 朱洪生; 陈长志

    2001-01-01

    目的 比较左心室辅助装置(LVAD)和双心室辅助装置(BVAD)对缺血心肌再灌注后心脏血流动力学、心肌能量代谢物质和心肌超微结构中线粒体形态的影响。 方法 将16只绵羊随机分为LVAD组和BVAD组,每组8只,常温阻断升主动脉25分钟,造成双心室缺血损伤的动物模型。结扎右颈内动脉远端,在心脏复跳后应用转子泵分别行LVAD(左心室-右颈内动脉径路)和BVAD(左心室-右颈内动脉和右心室-肺动脉径路)辅助循环120分钟。测定血流动力学、心肌三磷酸腺苷、磷酸肌酸,观察心肌超微结构变化。 结果 施行BVAD或LVAD辅助循环的同时增加容量负荷能够显著改善心脏血流动力学,但LVAD组右心房压显著高于BVAD组(P<0.05);BVAD组右心室心肌三磷酸腺苷、磷酸肌酸含量和心肌线粒体比表面值均高于LVAD组(P<0.05)。 结论 BVAD比LVAD更有助于促进双心室缺血损伤心肌的功能恢复。%Objective To compare the effects of biventricular assist devices (BVAD) and left ventricular assist devices(LVAD) on enhancing the myocardial recovery in an acute ovine model of global myocardial ischemia. Methods Sixteen adult sheep were randomly divided into LVAD group (n=8) and BVAD group (n=8). BVAD group consisted of left ventricle-right carotid artery bypass and right ventricle-pulmonary artery bypass. Two roller pumps with heat exchanger were used. LVAD group was connected from the apex of left ventricle and returned blood flow to the right carotid artery, and a roller pump. The aorta was clamped 25 minutes to produce a global ischemic injury after cross clamp was released. In both BVAD and LVAD group, the bypass was continued for an additional 120 minutes of reperfusion before further measurements were done. Hemodynamic changes, adenosine triphosphate and creatine phosphate were measured. Myocardial ultrastructure were observed. Results LVAD could maintain nearly

  8. LONG-TERM RESULTS OF TRANSMYOCARDIAL LASER REVASCULARIZATION COMBINED WITH IMPLANTATION OF AUTOLOGOUS BONE MARROW MONONUCLEAR FRACTION IN THE TREATMENT OF CHRONIC ISCHEMIC HEART DISEAS

    Directory of Open Access Journals (Sweden)

    A. M. Chernyavsky

    2016-01-01

    Full Text Available Aim. Clinical and instrumental assessment of long-term results of autologous bone marrow cells (BMC implantation in laser channels in surgery of ischemic heart disease with diffuse and distal coronary disease.Materials and Methods. In the period of 2007–2008 35 CHD patients with diffuse and distal coronary disease underwent BMC implantation in laser channels during coronary artery bypass grafting (CABG. The control group consisted of 29 patients. All patients in this group underwent only direct myocardial revascularization (DMR. In the long-term period we examined only 30 patients of the first group. Clinical and instrumental assessment of the method efficacy was carried out in 2 weeks, 6 months and 6 years after surgery.Results. FC (NYHA mean value in indirect revascularization group significantly decreased from 2.57 ± 0.61 preoperatively to 1.77 ±0.66 in6 months after surgery (p = 0.043. After 6 years FC (NYHA was not significantly changed – 1.84 ± 0.42 (p = 0.053. Perfusion scintigraphy revealed a slight decrease of stable perfusion defect (SPD in the immediate postoperative period, a more pronounced reduction of SPD in 6 months after surgery. The average value of SPD before surgery was 20.46 ± 10.75%, in 2 weeks after the operation – 19.07 ± 9.69%, in 6 months after surgery – 15.22 ± 9.49%. In the long-term period (6 years SPD was 14.8 ± 8.43% (p = 0.047. A similar pattern was observed in the analysis of transient perfusion defect: baseline – 30 ± 2.2%, in 6 months – 15 ± 1.3%, in the long term period – 20 ± 6.1% (p = 0.047. The average value of left ventricular ejection fraction (LVEF before surgery was 55 ± 10.4%, in 2 weeks after the operation – 55.7 ± 9.3%, in 6 months – 56.7 ± 10%, after 6 years – 54 ± 12%. The dynamics is unauthentic (p = 0.068.Conclusion. BMC implantation in laser channels in addition to CABG is a safe and effective method of surgical treatment in case of CABG inability. The effect of

  9. Retrograde Percutaneous Coronary Intervention for Left Anterior Descending Chronic Total Occlusion Via an Ipsilateral Intraseptal Collateral Channel Using a Single Guiding Catheter.

    Science.gov (United States)

    Chon, Min Ku; Kim, Jeong Su; Chun, Kook Jin

    2016-06-01

    Successful recanalization of chronic total occlusion (CTO) of coronary arteries has improved symptoms and mortality. In CTO cases, retrograde approach from opposite coronary artery has a better chance of procedural success. But the retrograde approach from opposite site is not always suitable. In certain CTO cases, the distal left anterior descending (LAD) artery is supplied from the intraseptal collateral channel. Controlled antegrade and retrograde tracking (CART) strategy has been developed to improve guidewire crossing and successful recanalization. We report a case of the retrograde percutaneous coronary intervention for the LAD CTO lesion via an ipsilateral intraseptal collateral channel, which was successfully revascularized with reverse CARTtechnique using a single 8-French guiding catheter.

  10. Association between left ventricular global longitudinal strain and natriuretic peptides in outpatients with chronic systolic heart failure

    DEFF Research Database (Denmark)

    Gaborit, F; Bosselmann, H; Tønder, N;

    2015-01-01

    BACKGROUND: Both impaired left ventricular (LV) global longitudinal strain (GLS) and increased plasma concentrations of natriuretic peptides(NP) are associated with a poor outcome in heart failure (HF). Increased levels of NP reflect increased wall stress of the LV. However, little is known about...... ventricular ejection fraction (LVEF) was 33 % and median LV GLS was -11 %. LV GLS was associated with increased plasma concentrations of NT-proBNP and proANP in multivariate logistic regression (NT-proBNP: Odds RatioGLS: 7.25, 95 %-CI: 2.48-21.1, P ....28-8.30, P = 0.013) and linear regression (NT-proBNP: βGLS: 1.19, 95 %-CI: 0.62-1.76, P fibrillation, renal function) and left atrial volume index...

  11. Relationship between the level of NT-proBNP and left ventricular diastolic function in chronic heart failure patients with preserved ejection fraction

    Institute of Scientific and Technical Information of China (English)

    Zhu Youfeng; Li Kong; Wei Jianrui; Yin Haiyan; Zhang Rui

    2014-01-01

    Objective To investigate the relationship between n-terminal pro-brain natriuretic peptide (NT-proBNP) level and echocardiographic parameter in patients with chronic heart failure with preserved ejection fraction (HFPEF) and evaluate the correlation,specificity and sensitivity on these indices.Methods Sixty-six symptomatic patients with isolated diastolic dysfunction and preserved left ventricular ejection fraction (LVEF) (≥ 50%) and forty-three people with normal left ventricular (LV) function were examined by conventional echocardiography,tissue Doppler imaging (TDI).Plasma NT-proBNP levels were determined simultaneously.Results Compared with control group,NT-proBNP,E/Em,LVMI were significantly higher in HFPEF (P < 0.01); NT-proBNP was significantly correlated with E/Em (correlation coefficient r =0.576).Conclusion NT-proBNP,E/Em,LVMI were significant markers for reflecting left ventricular diastolic function and good tools for diagnosing HFPEF.NT-proBNP had a significant negative predictive value (92.7%) when NT-proBNP < 90 pg/ml.

  12. Functional Magnetic Resonance Imaging of Chronic Dysarthric Speech after Childhood Brain Injury: Reliance on a Left-Hemisphere Compensatory Network

    Science.gov (United States)

    Morgan, Angela T.; Masterton, Richard; Pigdon, Lauren; Connelly, Alan; Liegeois, Frederique J.

    2013-01-01

    Severe and persistent speech disorder, dysarthria, may be present for life after brain injury in childhood, yet the neural correlates of this chronic disorder remain elusive. Although abundant literature is available on language reorganization after lesions in childhood, little is known about the capacity of motor speech networks to reorganize…

  13. Hemichorea after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Sadullah Saglam

    2016-03-01

    Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32

  14. Stromal Vascular Fraction Transplantation as an Alternative Therapy for Ischemic Heart Failure: Anti-inflammatory Role

    Directory of Open Access Journals (Sweden)

    Lin Xue

    2011-03-01

    Full Text Available Abstract Background The aims of this study were: (1 to show the feasibility of using adipose-derived stromal vascular fraction (SVF as an alternative to bone marrow mono nuclear cell (BM-MNC for cell transplantation into chronic ischemic myocardium; and (2 to explore underlying mechanisms with focus on anti-inflammation role of engrafted SVF and BM-MNC post chronic myocardial infarction (MI against left ventricular (LV remodelling and cardiac dysfunction. Methods Four weeks after left anterior descending coronary artery ligation, 32 Male Lewis rats with moderate MI were divided into 3 groups. SVF group (n = 12 had SVF cell transplantation (6 × 106 cells. BM-MNC group (n = 12 received BM-MNCs (6 × 106 and the control (n = 10 had culture medium. At 4 weeks, after the final echocardiography, histological sections were stained with Styrus red and immunohistochemical staining was performed for α-smooth muscle actin, von Willebrand factor, CD3, CD8 and CD20. Results At 4 weeks, in SVF and BM-MNC groups, LV diastolic dimension and LV systolic dimension were smaller and fractional shortening was increased in echocardiography, compared to control group. Histology revealed highest vascular density, CD3+ and CD20+ cells in SVF transplanted group. SVF transplantation decreased myocardial mRNA expression of inflammatory cytokines TNF-α, IL-6, MMP-1, TIMP-1 and inhibited collagen deposition. Conclusions Transplantation of adipose derived SVF cells might be a useful therapeutic option for angiogenesis in chronic ischemic heart disease. Anti-inflammation role for SVF and BM transplantation might partly benefit for the cardioprotective effect for chronic ischemic myocardium.

  15. [Normal tension glaucoma or syndrome of chronic ocular ischemia].

    Science.gov (United States)

    Mocanu, Carmen; Olaru, Andrei; Popa, Denissa; Deca, Andreea; Barascu, Doina

    2012-01-01

    Chronic ischemia related to a manifest ophthalmic artery stenosis, determines extremely rare ischemic chronic modifications at the level of the optic nerve, with progressive optic atrophy and visual fun ction alteration. It is presented the case of a 59 years patient, who was hospitalized in Clinic of Ophthalmology, Emergency Clinic Districtual Hospital, for decreased vision of the left eye. Fundus eye examination reveals normal aspect of papilla of the right eye and glaucomatous like modification of the left eye, confirmed by perimetry and OCT exams, which present typical glaucomatous lesions. Doppler examination revealed an enormous thrombus at the level of the left internal carotid, with more than 90% stenosis. In this context the diagnosis was chronic ocular ischemia, atypical form. lschemic ocular syndrome presents polymorphic clinic aspects, the most frequent are the ischemic lesions of posterior pole of the eye: retinal hemorrhages, neovascularization, ischemic edema, red cherry macula, cotton-wool spots. lschemic optic neuropathy is less frequent presented, and pseudo-glaucomatous lesion of optic nerve with papillary excavation is exceptional.

  16. Fetal stem cells in combined treatment of chronic heart failure and their effect on morphofunctional parameters of the left ventricle myocardium and cognitive functions

    Directory of Open Access Journals (Sweden)

    Klunnyk MO

    2014-08-01

    Full Text Available Mariya O Klunnyk, Nataliia S Sych, Irina G Matiyashchuk, Olena V Ivankova, Marina V Skalozub Cell Therapy Center EmCell, Kyiv, Ukraine Aim: To investigate the effect of combined treatment with the inclusion of fetal stem cells (FSCs on the morphology and functional dynamics of the left ventricle and cognitive functions in patients with chronic heart failure (CHF. Materials and methods: A comparative study was carried out on patients with CHF to examine the effect of combined treatment, including the experimental application of FSCs, on the morphofunctional parameters of the left ventricle and cognitive functions. Patients were examined before FSC treatment (FSCT, and 1 month, 3 months, and 6 months after treatment. The control group consisted of 20 CHF patients of similar age, sex, and New York Heart Association class. Results: It has been proven that FSCs positively affect objective and subjective clinical parameters. A significant reduction of serum type B brain natriuretic peptide was reported as early as 1 month after treatment. Significant increases in the left ventricle ejection fraction and decreases of the end diastolic volume were observed 6 months after treatment. Cognitive performance tests showed improvements on the Mini-Mental State Examination and Frontal Assessment Battery (conceptualization, mental flexibility, programming, sensitivity to interference, inhibitory control, and environmental autonomy scales. The treatment resulted in significant improvements in the general score and across all cognitive areas of the Mini-Mental State Examination (recall, orientation, attention, calculation, and complex commands after 3 months, and significant improvements across all Frontal Assessment Battery areas after 6 months. In the control group, these scores showed significant increases only at 6 months after the treatment. In the study group, depression was significantly reduced within 1 month after treatment versus 3 months in the control

  17. Gene expression profile of rat left ventricles reveals persisting changes following chronic mild exercise protocol: implications for cardioprotection

    OpenAIRE

    Giusti B; Marini M; Rossi L; Lapini I; Magi A; Capalbo A; Lapalombella R; di Tullio S; Samaja M; Esposito F; Margonato V; Boddi M; Abbate R; Velcsteinas A

    2009-01-01

    Abstract: Background: Epidemiological studies showed that physical exercise, specifically moderate lifelong training, is protective against cardiovascular morbidity and mortality. Most experimental work has focused into the effects and molecular mechanisms underlying intense, rather than mild exercise, by exploring the acute effect of training. Our study aims at investigating the cardioprotective effect of mild chronic exercise training and the gene expression profile changes at 48 hrs after ...

  18. Gene expression profile of rat left ventricles reveals persisting changes following chronic mild exercise protocol: implications for cardioprotection

    OpenAIRE

    Esposito Fabio; Samaja Michele; di Tullio Simona; Lapalombella Rosa; Capalbo Andrea; Magi Alberto; Lapini Ilaria; Rossi Luciana; Marini Marina; Giusti Betti; Margonato Vittoria; Boddi Maria; Abbate Rosanna; Veicsteinas Arsenio

    2009-01-01

    Abstract Background Epidemiological studies showed that physical exercise, specifically moderate lifelong training, is protective against cardiovascular morbidity and mortality. Most experimental work has focused into the effects and molecular mechanisms underlying intense, rather than mild exercise, by exploring the acute effect of training. Our study aims at investigating the cardioprotective effect of mild chronic exercise training and the gene expression profile changes at 48 hrs after th...

  19. The Appropriate Use of Neurostimulation of the Spinal Cord and Peripheral Nervous System for the Treatment of Chronic Pain and Ischemic Diseases : The Neuromodulation Appropriateness Consensus Committee

    NARCIS (Netherlands)

    Deer, Timothy R.; Mekhail, Nagy; Provenzano, David; Pope, Jason; Krames, Elliot; Leong, Michael; Levy, Robert M.; Abejon, David; Buchser, Eric; Burton, Allen; Buvanendran, Asokumar; Candido, Kenneth; Caraway, David; Cousins, Michael; de Jongste, Micheal; Diwan, Sudhir; Eldabe, Sam; Gatzinsky, Kliment; Foreman, Robert D.; Hayek, Salim; Kim, Philip; Kinfe, Thomas; Kloth, David; Kumar, Krishna; Rizvi, Syed; Lad, Shivanand P.; Liem, Liong; Linderoth, Bengt; Mackey, Sean; McDowell, Gladstone; McRoberts, Porter; Poree, Lawrence; Prager, Joshua; Raso, Lou; Rauck, Richard; Russo, Marc; Simpson, Brian; Slavin, Konstantin; Staats, Peter; Stanton-Hicks, Michael; Verrills, Paul; Wellington, Joshua; Williams, Kayode; North, Richard

    2014-01-01

    Introduction: The Neuromodulation Appropriateness Consensus Committee (NACC) of the International Neuromodulation Society (INS) evaluated evidence regarding the safety and efficacy of neurostimulation to treat chronic pain, chronic critical limb ischemia, and refractory angina and recommended approp

  20. Evaluation of left ventricular function by radionuclide angiography during exercise in normal subjects and in patients with chronic coronary heart disease.

    Science.gov (United States)

    Iskandrian, A S; Hakki, A H; DePace, N L; Manno, B; Segal, B L

    1983-06-01

    Radionuclide angiography permits evaluation of left ventricular performance during exercise. There are several factors that may affect the results in normal subjects and in patients with chronic coronary heart disease. Important among these are the selection criteria: age, sex, level of exercise, exercise end points, ejection fraction at rest and effects of pharmacologic agents. An abnormal ejection fraction response to exercise is not a specific marker for coronary heart disease but may be encountered in other cardiac diseases. In addition to the diagnostic considerations, important prognostic data can be obtained. Further studies are needed to determine the prognostic implications of anatomic findings versus the functional abnormalities induced by exercise in patients with coronary artery disease.

  1. The ischemic preconditioning effect of adenosine in patients with ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Berglund Margareta

    2009-11-01

    Full Text Available Abstract Introduction In vivo and in vitro evidence suggests that adenosine and its agonists play key roles in the process of ischemic preconditioning. The effects of low-dose adenosine infusion on ischemic preconditioning have not been thoroughly studied in humans. Aims We hypothesised that a low-dose adenosine infusion could reduce the ischemic burden evoked by physical exercise and improve the regional left ventricular (LV systolic function. Materials and methods We studied nine severely symptomatic male patients with severe coronary artery disease. Myocardial ischemia was induced by exercise on two separate occasions and quantified by Tissue Doppler Echocardiography. Prior to the exercise test, intravenous low-dose adenosine or placebo was infused over ten minutes according to a randomized, double blind, cross-over protocol. The LV walls were defined as ischemic if a reduction, no increment, or an increment of Results PSV increased from baseline to maximal exercise in non-ischemic walls both during placebo (P = 0.0001 and low-dose adenosine infusion (P = 0.0009. However, in the ischemic walls, PSV increased only during low-dose adenosine infusion (P = 0.001, while no changes in PSV occurred during placebo infusion (P = NS. Conclusion Low-dose adenosine infusion reduced the ischemic burden and improved LV regional systolic function in the ischemic walls of patients with exercise-induced myocardial ischemia, confirming that adenosine is a potential preconditioning agent in humans.

  2. Olanzapine-induced ischemic colitis

    Directory of Open Access Journals (Sweden)

    Esteban Sáez-González

    Full Text Available Background: Ischemic colitis (IC is an uncommon adverse event associated with antipsychotic agents, more commonly found with phenothiazine drugs and atypical neuroleptics such as clozapine. The risk of developing ischemic colitis increases when anticholinergic drugs are associated. Case report: We report the case of a 38-year-old woman with a history of schizoaffective disorder who had been on chronic quetiapine for 3 years, and presented to the ER because of diarrhea for 5 days. Four months previously, olanzapine had been added to her psychiatric drug regimen. Physical examination revealed abdominal distension with abdominal tympanic sounds and tenderness. Emergency laboratory tests were notable for increased acute phase reagents. Tomography revealed a concentric thickening of the colonic wall in the transverse, descending and sigmoid segments, with no signs of intestinal perforation. Colonoscopy demonstrated severe mucosal involvement from the sigmoid to the hepatic flexure, with ulcerations and fibrinoid exudate. Biopsies confirmed the diagnosis of ischemic colitis. The only relevant finding in her history was the newly added drug to her baseline regimen. An adverse effect was suspected because of its anticholinergic action at the intestinal level, and the drug was withdrawn. After 6 months of follow-up clinical, laboratory and endoscopic recovery was achieved. Discussion: Antipsychotic medication should be considered as a potential cause of ischemic colitis, particularly atypical antipsychotics such as clozapine and olanzapine; despite being uncommon, this adverse event may result in high morbidity and mortality.

  3. [Chronic aortic and mitral valve regurgitation. Effects of isosorbide dinitrate on systolic function and passive elastic properties of the left ventricle (author's transl)].

    Science.gov (United States)

    Herreman, F; Cosma, H; Degeorges, M

    1982-06-10

    A haemodynamic and cineangiographic study was conducted in 20 patients with chronic aortic regurgitation alone or associated with mitral regurgitation before and during i.v. administration of isosorbide dinitrate 5 mg/hour. Freedom from coronary disease had been ascertained. The heart rate and aortic pressure (initially normal), cardiac index (initially low), pulmonary pressures and pulmonary and systemic resistances (slightly raised initially) remained unchanged. On the other hand, the left ventricular (LV) filling pressure, distinctly raised before treatment, was reduced by 17% (p less than 0.05). There was also a 10% reduction in LV end-diastolic volume (from 204 +/- 60- cm3.m2 to 184 +/- 56 cm3,m2; p less than 0.001) and a 14% reduction in LV end-systolic volume (from 104 +/- 39 cm3.m2 to 89 +/- 40 cm3.m3; p less than 0.001). LV geometry, stroke volume and regurgitation volume were unmodified. There was a significant improvement in ventricular function indices, globally reduced before treatment: + 8% for the fiber shortening amplitude (p less than 0.025), + 6% for the ejection fraction (p fiber shortening (p less than 0.01), and + 15% for the ESP: ESV ratio (p less than 0.05). The passive elasticity indices, all increased before treatment, also improved. It is concluded that isosorbide dinitrate improves LV systolic and diastolic functions in patients with chronic valve disease.

  4. Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease.

    Science.gov (United States)

    Peterson, Gail E; de Backer, Tine; Contreras, Gabriel; Wang, Xuelei; Kendrick, Cynthia; Greene, Tom; Appel, Lawrence J; Randall, Otelio S; Lea, Janice; Smogorzewski, Miroslaw; Vagaonescu, Tudor; Phillips, Robert A

    2013-09-01

    African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (Pchronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.

  5. Cx40 mRNA expression in crista terminalis and left atrium of patients with rheumatic heart disease associated chronic atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    Zhao Feng; Li Li; Xu Zhiyun; Huang Xing; Zhou Yong

    2008-01-01

    Objectives: To explore possible mechanisms of connexin40 (Cx40) remodeling by detecting Cx40 mRNA expression of the crista terminalis and left atrium (LA) in patients with rheumatic heart disease (RHD) associated chronic atrial fibrillation (AF). Methods: Twenty patients were enrolled in this study, who underwent surgical operation for RHD-associated mitral disease, including 10 with sinus rhythms (rhythm group) and 10 with AF (AF group). Another 6 patients with non-RHD sinus rhythms were divided into the control group. A small amount of myocardial tissue was cut from the crista terminalis and the LA posterior wall during the valvular replacement operation. Cx40 mRNA expression was assayed by real-time fluorescent quantitation polymerase chain reaction (RT-PCR). Results: There was no significant difference in Cx40 mRNA expression in the crista terminalis and LA posterior wall between the 3 groups, and there was no significant difference in Cx40 mRNA expression between the crista terminalis and LA within each group. Conclusion: Based on the finding in previous studies that there existed evident remodeling of atrial Cx40 protein in patients with chronic RHD, the results of the present study suggest that the mechanism of Cx40 remodeling probably lies in the post transcriptional level.

  6. Patterns of delayed-enhancement in MRI of ischemic and non-ischemic cardiomyopathies; Muster der spaeten Kontrastmittelanreicherung in der MRT bei ischaemischen und nicht-ischaemischen Kardiomyopathien

    Energy Technology Data Exchange (ETDEWEB)

    Stork, A.; Bansmann, P.M.; Koops, A.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany); Muellerleile, K.; Meinertz, T. [Universitaeres Herzzentrum, Universitaetsklinikum Hamburg-Eppendorf (Germany); Lund, G.K. [Kardiovaskulaere Bildgebung, Roentgeninstitut Duesseldorf (Germany)

    2007-01-15

    Contrast-enhanced MRI using the delayed-enhancement technique (DE-MRI) is widely applied in the clinical work-up of myocardial diseases. Myocardial diseases of varying etiology result in myocardial changes, such as necrosis, fibrosis, edema and metabolite deposition, which can be visualized by DE-MRI. Acute and chronic ischemic diseases based on a coronary artery disease as well as non-ischemic cardiomyopathies display DE. Cardiomyopathies often show a characteristic enhancement pattern. While ischemic lesions are localized in the subendocardium, non-ischemic cardiomyopathies often display an intramyocardial or subepicardial pattern. The typical pattern for dilated cardiomyopathies is band-like and intramyocardial with septal involvement. Arrhythmogenic right-ventricular dysplasias/cardiomyopathies are frequently associated with right-ventricular DE. In the case of amyloid cardiomyopathies which are often restrictive cardiomyopathies, subendocardial and circular DE is typically observed. Hypertrophic cardiomyopathies display patchy intramyocardial DE usually in the anteroseptal region. Acute myocarditis is typically accompanied by intramyocardial or subepicardial DE affecting the lateral wall. In the case of chronic myocarditis, intramyocardial or subepicardial DE is observed most frequently. Cardiac sarcoidosis typically entails patchy subepicardial DE with right- and left-ventricular involvement. Since there is an overlap between the enhancement patterns of cardiomyopathies, the diagnostic accuracy of DE-MRI is limited and the diagnosis must be based on additional clinical and MRI findings. The amount of DE often corresponds with cardiac functional parameters as well as with the frequency of cardiac events so that DE-MRI may be useful for risk stratification. Furthermore, DE-MRI can be helpful in the planning and evaluation of myocardial biopsies and electrophysiological examinations. (orig.)

  7. Leukotriene C4 synthase and ischemic cardiovascular disease and obstructive pulmonary disease in 13,000 individuals

    DEFF Research Database (Denmark)

    Freiberg, Jacob J; Dahl, Morten; Tybjaerg-Hansen, Anne

    2009-01-01

    Ischemic cardiovascular disease and obstructive pulmonary disease involve inflammation. Leukotrienes may be important pro-inflammatory mediators. We tested the hypothesis that the (-1072)G > A and (-444)A > C promoter polymorphisms of leukotriene C4 synthase confer risk of transient ischemic attack...... (TIA), ischemic stroke, ischemic heart disease (IHD), asthma, and chronic obstructive pulmonary disease (COPD). We genotyped individuals from the Danish general population, the Copenhagen City Heart Study, and Danish patients with IHD/coronary atherosclerosis, the Copenhagen Ischemic Heart Disease...

  8. Spinal cord stimulation for ischemic heart disease

    NARCIS (Netherlands)

    DeJongste, MJL

    2000-01-01

    An increasing number of patients are suffering from angina pectoris that is chronically refractory to standard anti-ischemic treatment such as pharmacological and surgical strategies. To improve the quality of life of these severely disabled patients, without adversely affecting their prognosis, a n

  9. Renal Replacement Therapy in Congestive Heart Failure Requiring Left Ventricular Assist Device Augmentation

    OpenAIRE

    Thomas, Bernadette A.; Logar, Christine M.; Anderson, Arthur E.

    2012-01-01

    “Cardiorenal syndrome” is a term used to describe a dys-regulation of the heart affecting the kidneys, or vice versa, in an acute or chronic manner (1,2). Renal impairment can range from reversible ischemic damage to renal failure requiring short- or long-term renal replacement therapy (2). Patients who require mechanical circulatory support, such as a left ventricular assist device (LVAD), as definitive treatment for congestive heart failure or as a bridge to cardiac transplantation pose a u...

  10. TREATMENT OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN REAL CLINICAL PRACTICE ACCORDING TO THE DATA FROM PROGNOZ IBS REGISTER. (Part 1

    Directory of Open Access Journals (Sweden)

    S. N. Tolpygina

    2015-09-01

    Full Text Available According to the data from PROGNOZ IBS register drugs with proven efficacy in secondary prevention of cardiovascular complications (antiplatelets, β-blockers, ACE inhibitors, statins were not often prescribed in patients with stable ischemic heart disease prior to hospitalization. Significant improvement of the treatment quality was found during the cardiology hospital stay. The prescription rate of ACE inhibitors increased from 20% to 84.4%, statins - from 10% to 85.5%, β-blockers - from 20% to 91%, acetylsalicylic acid - from 74% to 96%. However, some drugs (statins have been used in inadequate doses. Low-density lipoprotein level <2.5 mmol/L was achieved at discharge only in 6.3% of patients.

  11. TREATMENT OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN REAL CLINICAL PRACTICE ACCORDING TO THE DATA FROM PROGNOZ IBS REGISTER. (Part 1

    Directory of Open Access Journals (Sweden)

    S. N. Tolpygina

    2013-01-01

    Full Text Available According to the data from PROGNOZ IBS register drugs with proven efficacy in secondary prevention of cardiovascular complications (antiplatelets, β-blockers, ACE inhibitors, statins were not often prescribed in patients with stable ischemic heart disease prior to hospitalization. Significant improvement of the treatment quality was found during the cardiology hospital stay. The prescription rate of ACE inhibitors increased from 20% to 84.4%, statins - from 10% to 85.5%, β-blockers - from 20% to 91%, acetylsalicylic acid - from 74% to 96%. However, some drugs (statins have been used in inadequate doses. Low-density lipoprotein level <2.5 mmol/L was achieved at discharge only in 6.3% of patients.

  12. Circulating Endothelial-Derived Apoptotic Microparticles in the Patients with Ischemic Symptomatic Chronic Heart Failure: Relevance of Pro-Inflammatory Activation and Outcomes

    Directory of Open Access Journals (Sweden)

    Alexander E. Berezin

    2014-09-01

    Full Text Available Background: Endothelial-derived apoptotic microparticles (EMPs play a pivotal role in endothelial dysfunction in hronic Heart Failure (CHF. Objectives: The present study aimed to evaluate the association between EMPs and pro-inflammatory biomarkers, clinical status, and outcomes in the patients with ischemic CHF. Patients and Methods: This study was conducted on 154 patients with ischemic symptomatic moderate-to-severe CHF on discharge from hospital. The observation period was up to 3 years. Circulating NT-pro-BNP, TNF-alpha, sFas, and sFas ligand were determined at baseline. Flow cytometry analysis was used for quantifying the number of EMPs. All-cause mortality, CHF-related death, and CHD-re-hospitalization rate were examined. The data were analyzed using descriptive statistics, Receive Operation Characteristic Curve (ROC, and logistic regression analysis. Besides, P 0.514 n/mL and those with a low level of the biomarker (< 0.514 n/mL regarding their survival. The number of circulating EPMs independently predicted all-cause mortality (OR = 1.58; 95% CI = 1.20 – 1.88; P = 0.001, CHF-related death (OR = 1.22; 95% CI: 1.12 – 1.36; P < 0.001, and CHF-related re-hospitalization (OR = 1.20; 95% CI: 1.11 – 1.32; P < 0.001. Conclusions: Among the patients with symptoms of CHF, increased number of circulating EMPs was associated with increased 3-year CHF-related death, all-cause mortality, and risk of recurrent hospitalization due to CHF.

  13. Cytoprotective roles of GSH, SOD and solcoseryl against ischemic damage and reperfusion injury to warm ischemic lung. Study of Canine warm ischemic lung.

    OpenAIRE

    Taniguchi, Hideki; Kawahara, Katsunobu; Nakasone, Tomonori; Ikari, Hideki; Honjoh, Seiji; Hisano, Hiroshi; Takahashi, Takao; Kusano, Hiroyuki; Ayabe, Hiroyoshi; Tomita, Masao

    1990-01-01

    This study was performed to clarify the roles of reduced glutathion (GSH), superoxide dismutase (SOD), and solcosaryl in ischemic damage and reperfusion injury to the warm ischemic lungs of experimental animals. Fifty-one warm ischemic canine lungs were made by hilar stripping and clamping of the left PA, PV and bronchus for 2-3 hours. In the Non-perfusion group, GSH (50mg/ kg, I. V.: Group II) and solcoseryl (50mg/kg, I. V.: Group III) were administered. In the perfusion group, Euro-Collins ...

  14. CLINIC-MORPHOLOGICAL ANALYSIS OF THE APPLICATION OF THE MONONUCLEAR FRACTION OF AUTOLOGOUS BONE MARROW CELLS IN ENDOMYOCARDIAL IMPLANTATION IN A PATIENT WITH SEVERE ISCHEMIC MYOCARDIAL DYSFUNCTION OF THE LEFT VENTRICLE

    Directory of Open Access Journals (Sweden)

    Ye. N. Kliever

    2015-01-01

    Full Text Available Aim. The purpose of this study is to conduct clinic-morphological analysis following intramyocardial administration of a mononuclear fraction of bone marrow stem cells in a CHF patient suffering from ischemic heart disease. In October 2007 the patient underwent surgery, with a mononuclear fraction of bone marrow stem cells implanted with the use of a NOGA system. The patient was then put on a waiting list for heart transplantation. After 2-year follow-up amelioration was observed, LVEF increased from 22 to 27%, LF end systolic volume dropped from 265 ml to 250 ml. All these positive developments indicated the stabilization of hemodynamic indicators and enabled to wait for orthotopic heart transplantation which was performed in December 2009. 

  15. Acute Ischemic Stroke and Transient Ischemic Attack

    OpenAIRE

    Staykov, Dimitre; Schwab, Stefan

    2014-01-01

    This short review focuses on recent practically relevant studies in stroke treatment and prevention and discusses their implications on clinical practice and future research, including 3 shortly published randomized controlled trials investigating interventional treatment in acute ischemic stroke (The Interventional Management of Stroke phase III trial [IMS III], Synthesis Expansion: A Randomized Controlled Trial on Intra-Arterial Versus Intravenous Thrombolysis in Acute Ischemic Stroke, and ...

  16. Left ventricular strain and strain rate by 2D speckle tracking in chronic thromboembolic pulmonary hypertension before and after pulmonary thromboendarterectomy

    Directory of Open Access Journals (Sweden)

    Waltman Thomas J

    2010-09-01

    Full Text Available Abstract Background Echocardiographic evaluation of left ventricular (LV strain and strain rate (SR by 2D speckle tracking may be useful tools to assess chronic thromboembolic pulmonary hypertension (CTEPH severity as well as response to successful pulmonary thromboendarterectomy (PTE. Methods We evaluated 30 patients with CTEPH before and after PTE using 2D speckle tracking measurements of LV radial and circumferential strain and SR in the short axis, and correlated the data with right heart catheterization (RHC. Results PTE resulted in a decrease in mean PA pressure (44 ± 15 to 29 ± 9 mmHg, decrease in PVR (950 ± 550 to 31 ± 160 [dyne-sec]/cm5, and an increase in cardiac output (3.9 ± 1.0 to 5.0 ± 1.0 L/min, p change in circumferential strain and change in posterior wall radial strain correlated moderately well with changes in PVR, mean PA pressure and cardiac output (r = 0.69, 0.76, and 0.51 for circumferential strain [p Conclusions LV circumferential and posterior wall radial strain change after relief of pulmonary arterial obstruction in patients with CTEPH, and these improvements occur rapidly. These changes in LV strain may reflect effects from improved LV diastolic filling, and may be useful non-invasive markers of successful PTE.

  17. Prognostic Significance of Left Ventricular Mass Index and Renal Function Decline Rate in Chronic Kidney Disease G3 and G4

    Science.gov (United States)

    Huang, Jiun-Chi; Chen, Szu-Chia; Tsai, Yi-Chun; Kuo, I-Ching; Chiu, Yi-Wen; Chang, Jer-Ming; Hwang, Shang-Jyh; Chen, Hung-Chun

    2017-01-01

    The effect of left ventricular mass index (LVMI) and estimated glomerular filtration rate (eGFR) decline rate on outcome prediction in patients with chronic kidney disease (CKD) remains unclear. We included 306 CKD G3 and G4 patients with LVMI assessed through echocardiography. Rapid decline in renal function was defined as the eGFR slope <−3 mL/min/1.73 m2/year. Patients were stratified into four groups using sex-specific median values of LVMI and rapid eGFR decline. The composite outcome was progression to maintenance dialysis or death. 32 patients had the composite outcome during a median follow-up of 2.7 years. In multivariate Cox analysis, compared with patients with non-rapid eGFR decline and lower LVMI, those with non-rapid eGFR decline and higher LVMI (hazard ratio [HR]: 5.908, 95% confidence interval [CI] = 1.304–26.780), rapid eGFR decline and lower LVMI (HR: 12.737, 95% CI = 2.297–70.636), and rapid eGFR decline and higher LVMI (HR: 15.249, 95% CI = 3.365–69.097) had an increased risk of progression to adverse outcomes. LVMI and eGFR decline synergistically effect the prognostic implications in CKD G3 and G4 patients. PMID:28195182

  18. Prediction of improvement in global left ventricular function in patients with chronic coronary artery disease and impaired left ventricular function: rest thallium-201 SPET versus low-dose dobutamine echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Pace, L.; Salvatore, M. [Ist. di Scienze Biomorfologiche e Funzionali, Univ. Federico II, Napoli (Italy); Centro C.N.R. Medicina Nucleare, Napoli (Italy); Perrone-Filardi, P.; Dellegrottaglie, S.; Prastaro, M.; Crisci, T.; Ponticelli, M.P.; Piscione, F.; Chiariello, M. [Ist. di Medicina Interna, Cardiochirurgia e Cardiologia, Univ. Federico II, Napoli (Italy); Storto, G.; Della Morte, A.M. [Ist. di Scienze Biomorfologiche e Funzionali, Univ. Federico II, Napoli (Italy)

    2000-12-01

    Accurate assessment of myocardial viability permits selection of patients who would benefit from myocardial revascularization. Currently, rest-redistribution thallium-201 scintigraphy and low-dose dobutamine echocardiography are among the most used techniques for the identification of viable myocardium. Thirty-one consecutive patients (all men, mean age 60{+-}8 years) with chronic coronary artery disease and reduced left ventricular ejection fraction (31%{+-}7%) were studied. Rest {sup 201}Tl single-photon emission tomography (SPET), low-dose dobutamine echocardiography and radionuclide angiography were performed before revascularization. Radionuclide angiography and echocardiography were repeated after revascularization. An a/dyskinetic segment was considered viable on {sup 201}Tl SPET when tracer uptake was >65%, while improvement on low-dose dobutamine echocardiography was considered a marker of viability. Increase in global ejection fraction was considered significant at {>=}5%. In identifying viable segments, rest {sup 201}Tl SPET showed higher sensitivity than low-dose dobutamine echocardiography (72% vs 53%, P<0.05), while specificity was not significantly different (86% vs 88%). In 17 patients, global ejection fraction increased {>=}5% (group 1) while in 14 it did not (group 2). A higher number of a/dyskinetic segments were viable on {sup 201}Tl SPET in group 1 than in group 2 (2.6{+-}1.9 vs 0.6{+-}1.2, P<0.005), while no significant differences were observed on low-dose dobutamine echocardiography (1.7{+-}1.6 vs 1.1{+-}1.6). A significant correlation was found between the number of a/dyskinetic segments viable on {sup 201}Tl SPET and post-revascularization changes in ejection fraction (r=0.52, P<0.05), but such a correlation was not observed for low-dose dobutamine echocardiography. Using as the cut-off the presence of at least one viable a/dyskinetic segment, rest {sup 201}Tl SPET had a higher sensitivity (82% vs 53%, P=0.07) and showed a trend towards

  19. Impacts of Abnormal Glucose Metabolism on Chronic Ischemic Leukoaraiosis%糖代谢异常对慢性缺血性脑白质疏松的影响

    Institute of Scientific and Technical Information of China (English)

    王君梅; 李静; 金桂花; 田沈

    2014-01-01

    目的:探究糖代谢异常对慢性缺血性脑白质疏松(LA)的影响。方法回顾性分析2013年6月~12月中国医科大学附属第四医院神经内科收治的258例缺血性脑血管疾病患者的临床资料。根据病史及化验结果将糖代谢情况分为正常糖代谢、2型糖尿病以及前驱期糖尿病,依据头MRI结果对LA严重程度进行分级,分析比较不同糖代谢情况以及不同血糖化验指标(包括FPG、2hPG及HbA1c)对慢性缺血性脑白质疏松及其严重程度的影响。结果单因素分析显示,慢性缺血性脑白质疏松的相关危险因素有年龄、高血压病史、糖尿病病史、糖代谢异常、甘油三酯、2hPG(OR>1,P<0.05)。Logistic回归分析显示脑白质疏松与年龄、高血压病史、2hPG相关(P<0.05)。Spearman秩相关检验显示LA严重程度分级与年龄大小、高血压病史时长、2hPG水平呈正相关,与HDL、apoA、腔梗病史呈负相关(P<0.05,r=0.402、0.227、0.135、-0.154、-0.147、-0.312)。结论年龄、高血压病史、糖尿病病史、糖代谢异常、2hPG、甘油三酯是脑白质疏松的危险因素;年龄越大、高血压病史时间越长、2hPG越高、HDL及apoA越低,脑白质疏松越严重;而FPG、HbA1c、前驱期糖尿病、糖尿病及其时长与脑白质疏松的严重程度无相关性。%Objective To explore the impacts of abnormal glucose metabolism on chronic ischemic leukoaraiosis (LA).Methods The clinical data of 258 patients with ischemic cerebrovascular disease were analyzed who were cured in the Fourth Affi liated Hospital of China Medical University from Jun to December in 2013. According to the medical history and laboratory reports, these patients were divided into normal glucose metabolism group, type 2 diabetes group and pre-diabetes group. Based on the results of head MRI, the severity of leukoaraiosis was graded. Then we compared and analyzed the impacts of

  20. Ischemic Gastropathic Ulcer Mimics Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Saleh Daher

    2016-01-01

    Full Text Available Gastric ulcer due to mesenteric ischemia is a rare clinical finding. As a result, few reports of ischemic gastric ulcers have been reported in the literature. The diagnosis of ischemic gastropathy is seldom considered in patients presenting with abdominal pain and gastric ulcers. In this case report, we describe a patient with increasing abdominal pain, weight loss, and gastric ulcers, who underwent extensive medical evaluation and whose symptoms were resistant to medical interventions. Finally he was diagnosed with chronic mesenteric ischemia, and his clinical and endoscopic abnormalities resolved after surgical revascularization of both the superior mesenteric artery and the celiac trunk.

  1. TREATMENT OF PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE IN REAL CLINICAL PRACTICE ACCORDING TO THE DATA FROM PROGNOZ IBS REGISTER (PART 2

    Directory of Open Access Journals (Sweden)

    S. N. Tolpygina

    2013-01-01

    Full Text Available Aim. To assess the quality of drug therapy and its correspondence with current clinical guidelines in patients with proven stable ischemic heart disease (IHD before admission, during inpatient stay in hospital and after hospital discharge.Material and methods. Data on 550 patients (from PROGNOZ IBS register with detected stenosis of at least one coronary artery ≥50% were included in the analysis. Assessment of the quality of drug therapy was conducted in patients who made a follow-up visit in 3.9 years after the reference hospitalization (n=303 using a specially designed questionnaire. Adherence to treatment was studied using a phone survey.Results. According to PROGNOZ IBS register data we revealed low prescription frequency of drugs with proven effects on the cardiovascular risk in patients with stable IHD prior to hospital admission and significant pharmacotherapy improvement in specialized cardiology hospital. In specialized hospital the rate of aspirin use increased by 30%, statins - by 80%, beta-blockers - by 70%, ACE inhibitors - by 60% (p<0.0001. These medications prescription frequency decreased by 15-20% on the average in 3.9 years after discharge.Conclusion. We found significant improvement in pharmacotherapy quality of patients with stable IHD during stay in cardiology hospital, and pharmacotherapy quality reduction after discharge.

  2. Deaths from ischemic disease, anthropometry and cardiac biometry

    OpenAIRE

    Leal, A; de Oliveira, J.; Amado, J.; Gomes, L.; Magalhaes, T.

    2005-01-01

    Rev Port Cardiol. 2005 Apr;24(4):521-30. Deaths from ischemic disease, anthropometry and cardiac biometry. [Article in English, Portuguese] Leal A, Oliveira J, Amado J, Gomes L, Magalhães T. Instituto de Ciencias Biomédicas Abel Salazar-Saúde Comunitária, Porto, Portugal. Abstract INTRODUCTION: The relation between body mass index (BMI)/obesity and left ventricular hypertrophy (LVH) in ischemic heart disease (IHD) has not been completely established, based o...

  3. Left Ventricular Global Longitudinal Strain (GLS Is a Superior Predictor of All-Cause and Cardiovascular Mortality When Compared to Ejection Fraction in Advanced Chronic Kidney Disease.

    Directory of Open Access Journals (Sweden)

    Rathika Krishnasamy

    Full Text Available Echocardiographic global longitudinal strain (GLS is increasingly recognised as a more effective technique than conventional ejection fraction (EF in detecting subtle changes in left ventricular (LV function. This study investigated the prognostic value of GLS over EF in patients with advanced Chronic Kidney Disease (CKD.The study included 183 patients (57% male, 63% on dialysis with CKD stage 4, 5 and 5Dialysis (D. 112 (61% of patients died in a follow up of 7.8 ± 4.4 years and 41% of deaths were due to cardiovascular (CV disease. GLS was calculated using 2-dimensional speckle tracking and EF was measured using Simpson's biplane method. Cox proportional hazard models were used to assess the association of measures of LV function and all- cause and CV mortality.The mean GLS at baseline was -13.6 ± 4.3% and EF was 45 ± 11%. GLS was a significant predictor of all-cause [Hazard Ratio (HR 1.09 95%; Confidence Interval (CI 1.02-1.16; p = 0.01] and CV mortality (HR 1.16 95%; CI 1.04-1.30; p = 0.008 following adjustment for relevant clinical variables including LV mass index (LVMI and EF. GLS also had greater predictive power for both all- cause and CV mortality compared to EF. Impaired GLS (>-16% was associated with a 5.6-fold increased unadjusted risk of CV mortality in patients with preserved EF.In this cohort of patients with advanced CKD, GLS is a more sensitive predictor of overall and CV mortality compared to EF. Studies of larger populations in CKD are required to confirm that GLS provides additive prognostic value in patients with preserved EF.

  4. A novel useful tool of computerized touch panel-type screening test for evaluating cognitive function of chronic ischemic stroke patients.

    Science.gov (United States)

    Deguchi, Kentaro; Kono, Syoichiro; Deguchi, Shoko; Morimoto, Nobutoshi; Kurata, Tomoko; Ikeda, Yoshio; Abe, Koji

    2013-10-01

    Cognitive and affective impairments are important non-motor features of ischemic stroke (IS) related to white-matter hyperintensity, including periventricular hyperintensity (PVH). To confirm the usefulness of a novel computerized touch panel-type screening test, we investigated cognitive and affective functioning among 142 IS patients and 105 age-and gender-matched normal control subjects. Assessment using the mini-mental state examination, Hasegawa Dementia Scale-Revised, and frontal assessment battery revealed reduced cognitive function in IS patients, with the most severe reduction exhibited by cardiogenic embolism patients, followed by lacunar infarction patients, and atherothrombotic infarction patients. Our novel touch panel screening test revealed a similar pattern of results. In addition, PVH grading, classified using Fazekas' magnetic resonance imaging method, was also correlated with cognitive decline and touch panel screening test performance. In contrast, affective function, assessed with the 15-item Geriatric Depression Scale, vitality index, and apathy scale, was not significantly decreased in IS, and did not correlate with touch panel screening test results or PVH, although the number of microbleeds was correlated with apathy scale results. The present findings revealed that IS and PVH grading were significantly correlated with decline in general cognitive status (mini-mental state examination and Hasegawa Dementia Scale-Revised) and frontal lobe function (frontal assessment battery). Performance on all touch panel screening tests was correlated with IS and PVH grading, but was largely independent of depression or apathy. Touch panel screening tests were easily understood and performed by almost all patients with mild cognitive and motor dysfunction, due to visually clear images and simple methods not involving detailed manual-handling tasks such as writing. Touch panel screening tests may provide a useful tool for the early screening of cognitive

  5. A survival case of painless chronic type A aortic dissection with a history of stroke and anticoagulant use.

    Science.gov (United States)

    Tugcu, Aylin; Yildirimturk, Ozlem; Demiroglu, I C Cemsid; Aytekin, Saide

    2010-10-01

    We report the case of a patient with completely painless chronic aortic dissection, who presented to another hospital with a left hemiparesia 3 months ago and received anticoagulation therapy with a diagnosis of ischemic stroke. Most of her symptoms had resolved when she presented to our outpatient clinic except for numbness of her left hand and dysphasia. Physical examination found a diastolic murmur at the left sternal border and a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection with extension into the internal right carotid artery and severe aortic regurgitation. Surgery was performed successfully and the patient was discharged. This case emphasizes that the diagnosis of a completely painless aortic dissection with only neurologic symptoms at presentation can be extremely difficult and should always be considered as a cause of ischemic stroke to avoid catastrophic antithrombolytic or anticoagulation therapy.

  6. Left ventricle function in patients with ischemic cardiopathy: determination of the expulsion fraction of the left ventricle with gated-SPECT. Experience in the CMN 20 de Noviembre ISSSTE; Funcion ventricular izquierda en pacientes con cardiopatia isquemica: determinacion de la fraccion de expulsion del ventriculo izquierdo con gated-SPECT. Experiencia en el CMN 20 de Noviembre ISSSTE

    Energy Technology Data Exchange (ETDEWEB)

    Mendoza, L.; Puente, A.; Hernandez, T.; Jimenez, L. [Departamento de Medicina Nuclear y Cardiologia, Hospital CMN 20 de Noviembre, ISSSTE, 03000 Mexico D.F. (Mexico)

    2007-07-01

    The objective of this work is to correlate the expulsion fraction of the left ventricle (FEVI) obtained by means of g-SPECT and other diagnostic methods: ECO 2D and ventriculography for heart catheterization (CTT). (Author)

  7. Relationship Between Renin-Angiotensin System Gene Polymorphism and Ischemic Chronic Heart Failure in Aged Coronary Artery Disease Patient%肾素-血管紧张素系统双基因多态性与老年人冠心病慢性心力衰竭的关系

    Institute of Scientific and Technical Information of China (English)

    彭健; 罗礼云; 李铁; 梅啸; 牛云茜; 龚五星

    2011-01-01

    Objective :To investigate the relationship between angiotensin-converting enzyme (ACE)gene insertion/deletion (l/D) and angiotensinogen (AGT) gene M235T polymorphism with the onset of ischemic chronic heart failure (CHF) in aged coronary artery disease (CAD) patients in South China.Methods: A total of 396 consecutive CAD patients with the age of (60 ~ 91 ) years were divided into two groups, CHF group,n = 196 ,and Control group,n = 200 ,the patients had stable angina pectoris and with the left ventricular ejection fraction ≥ 45%.Genotype distributions, ACE gene I/D and AGT gene M235T polymorphisms were analyzed by PCR and restriction fragment length polymorphism (RFLP) methods in both groups.Results:①The frequencies of DD genotype of ACE gene and D allele of ACE gene were higher in CHF group than that in Control group respectively. ②The frequencies of TI genotype and T allele of AGT gene were higher in CHF group than that in Control group. ③In combined genotype analysis,the genotype of DD in ACE + TI in AGT was significantly higher in CHF group than that in Control group (28. 6% vs. 15.0% ).Conclusion: ACE gene I/D polymorphism and AGT gene M235T polymorphisms are related to the onset of ischemic chronic heart failure in aged CAD patients in South China,ACE and AGT gene have an interaction role in the onset of CHF.%目的:探讨中国南方部分汉族人群的老年冠心病患者中,肾素-血管紧张素系统中的关键成分即血管紧张素转换酶(ACE)及血管紧张素原(AGT)双基因多态性与慢性心力衰竭(心衰)发病的关系.方法:应用聚合酶链反应及限制性片断长度多态性技术,对396例老年冠心病患者的ACE基因插入/缺失(I/D)及AGT基因M235T多态性进行检测.将其中196例合并慢性心衰患者作为病例组,其余200例心功能正常者作为对照组.结果:①病例组DD基因型频率及D等位基因频率均高于对照组;②病例组TT基因型频率及T等位基因频率均高

  8. Relation between regional distribution of /sup 201/Tl and myocardial blood flow in normal, acutely ischemic, and infarcted myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Chu, A.; Murdock, R.H. Jr.; Cobb, F.R.

    1982-11-01

    Myocardial localization of /sup 201/Tl was compared with direct measurements of myocardial perfusion in normal, acutely ischemic, and recently infarcted myocardium. Studies were performed in 6 chronically instrumented dogs that were subjected to myocardial infarction by occlusion of the proximal left circumflex coronary artery. Four days after myocardial infarction, /sup 201/Tl and 9 +/- 1 micrometer /sup 95/Nb-labelled microspheres were injected simultaneously after acute left anterior descending coronary arterial occlusion; the animals were killed 5 minutes later and the entire left ventricle was sectioned into 1 to 2 g samples. Regression analyses between /sup 201/Tl activity and regional myocardial blood flow using all myocardial samples demonstrated a very close linear relation in each dog; r values were 0.98 or greater, indicating that the initial localization of /sup 201/Tl in acutely ischemic and recently infarcted myocardium as a function of regional blood flow was essentially identical. Consequently, in each dog the regional distribution of /sup 201/Tl closely approximated myocardial perfusion over a wide range of blood flow and potentially different local metabolic conditions that may be encountered in the clinical use of the isotope.

  9. New strict left bundle branch block criteria reflect left ventricular activation differences

    DEFF Research Database (Denmark)

    Emerek, Kasper Janus Grønn; Risum, Niels; Hjortshøj, Søren Pihlkjær;

    2015-01-01

    applying new strict ECG criteria subsequent rates of response in DCM were 18/19 (95%) and in IHD of 18/23 (78%) respectively, p... ventricular electrical delay (RV-LV-IED) was measured. Response to CRT was defined as ≥15% decrease in left ventricular end-systolic volume. RESULTS: Eighteen of 20 (90%) patients with non-ischemic dilated cardiomyopathy (DCM) and 18 of 29 (62%) with ischemic heart disease (IHD) responded to CRT, p.... CONCLUSION: Interventricular electrical delay predicts left ventricular remodeling after CRT and new, strict ECG criteria of LBBB are superior in predicting remodeling....

  10. Diagnosis and managoment of chronic ischemic renal disease%重视对慢性缺血性肾病的诊治

    Institute of Scientific and Technical Information of China (English)

    刘必成; 汤日宁

    2007-01-01

    慢性缺血性肾病(chronic isehemic renal disease,CIRD)是指因双侧肾动脉狭窄或孤立肾动脉狭窄或阻塞(〉160%),引起肾血流动力学显著改变,从而导致肾功能不全的慢性肾脏疾病。引起CIRD的常见病因有:动脉粥样硬化、纤维肌性发育不良和大动脉炎等。随着人口老龄化,CIRD已经成为引起终末期肾病(end-stage renal disease,ESRD)的常见原因。

  11. Lubiprostone induced ischemic colitis.

    Science.gov (United States)

    Sherid, Muhammed; Sifuentes, Humberto; Samo, Salih; Deepak, Parakkal; Sridhar, Subbaramiah

    2013-01-14

    Ischemic colitis accounts for 6%-18% of the causes of acute lower gastrointestinal bleeding. It is often multifactorial and more commonly encountered in the elderly. Several medications have been implicated in the development of colonic ischemia. We report a case of a 54-year old woman who presented with a two-hour history of nausea, vomiting, abdominal pain, and bloody stool. The patient had recently used lubiprostone with close temporal relationship between the increase in the dose and her symptoms of rectal bleeding. The radiologic, colonoscopic and histopathologic findings were all consistent with ischemic colitis. Her condition improved without any serious complications after the cessation of lubiprostone. This is the first reported case of ischemic colitis with a clear relationship with lubiprostone (Naranjo score of 10). Clinical vigilance for ischemic colitis is recommended for patients receiving lubiprostone who are presenting with abdominal pain and rectal bleeding.

  12. Transient Ischemic Attack

    Medline Plus

    Full Text Available ... TIA , or transient ischemic attack, is a "mini stroke" that occurs when a blood clot blocks an ... a short time. The only difference between a stroke and TIA is that with TIA the blockage ...

  13. A good surgical option for ischemic mitral regurgitation in co-morbid patients: semicircular reduction annuloplasty

    Institute of Scientific and Technical Information of China (English)

    Bilgin Emrecan; Gokhan Onem; Ahmet Coskun Ozdemir; (I)smail Do(g)u K(i)l(i)(c); Yusuf (I)zzettin Alihano(g)lu

    2013-01-01

    Background Ring annuloplasty is the standard treatment of ischemic mitral regurgitation (MR), however, it has been associated with some drawbacks. It abolishes normal annular dynamics and freezes the posterior leaflet. In the present study, we evaluated Paneth suture annuloplasty in chronic ischemic MR and both early and mid-term outcomes of the technique on a selected population. Methods The study period was from June 2010 to June 2012. We operated on 21 patients who had the diagnosis of coronary artery disease and MR of grade 3 or 4. The patients had both a coronary artery bypass operation and the mitral semicircular reduction annuloplasty described by Paneth-Burr. The data on the patients were retrospectively collected. Patients were contacted by outpatient clinic controls for mid-term results. Results The male/female ratio was 10/11. The mean age of the patients was 71.0 ± 6.4 years. Preoperative and postoperative left ventricular ejection fraction was statistically similar (P = 0.973). Early postoperative MR grade (mean, 0.57 ± 0.51) was statistically lower than the preoperative MR grades (mean, 3.38 ± 0.50) (P < 0.001). There was no revision for excess bleeding. Two patients had prolonged hospitalization, one for sternal infection and the other for severe chronic obstructive pulmonary disease. No hospital or late postoperative deaths occurred. The mean late postoperative MR grade was 0.66 ± 0.97 degrees. One patient had progression of MR in the later follow-up, which was treated by mitral valve replacement. Conclusion Semicircular reduction annuloplasty is an effective, inexpensive and easy surgical annuloplasty technique with low mortality and morbidity in severe symptomatic ischemic MR.

  14. Turning Left

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    An increasing number of left-wing political figures are holding power in Latin America, raising eyebrows in Washington This is a banner election year in Latin America, with nine countries heading to the polls to select new leaders. But the succession of victories by left-leaning politicians, with more likely in the coming months, is expected to draw mounting concern from the United

  15. Study on the relation between ischemic chronic heart failure and anemia%缺血性慢性心力衰竭与贫血的相关性研究

    Institute of Scientific and Technical Information of China (English)

    黄自平; 郑刚; 王静; 李斌

    2011-01-01

    Objective To study the relation between ischemic chronic heart failure(CHF) and anemia. Methods 196 patients were divided into anemia group(54 cases) and non- anemia group(142 cases) according to hemoglobin levels. The clinical characteristics and prognosis between the two groups were compared. The incidence and hematological examination results of anemia between the patients with mild and severe CHF were compared. Results Fifty-four cases had anemia (27.6 %). There was significant difference in incidence rate of anemia between patients with mild and severe CHF(16.0% vs 39.6 %, P < 0.01). There were significant differences in the number of males,age, serum creatinine and the levels of LVEF between the two groups (P < 0.05, P <0.01). Compared with non-anemia group, the rehospitalization rate, average rehospitalization days and the mortality were higher in anemia group (P< 0.05). Compared with the patients with mild CHF,the level of Hb and MCHC was significantly lower in the patients with severe CHF (P <0.05). Conclusion The patients with ischemic heart disease complicated with chronic heart failure often suffer from anemia. The degree of anemia is correlated with serverity of heart failure.Patients with CHF complicated with anemia have bad outcomes.%目的 探讨缺血性慢性心力衰竭(CHF)与贫血的相关性.方法 根据血红蛋白水平将196例患者分为贫血组54例和非贫血组142例,比较2组临床特征、预后、不同程度CHF患者贫血患病率及各项生化指标.结果 196例患者中,有54例出现贫血,占27.6%;轻度心力衰竭贫血患病率16.0%.明显低于重度心力衰竭(39.6%,P<0.01).与非贫血组比较,贫血组年龄、男性比率及血肌酐明显升高,差异有统计学意义(P<0.05,P<0.01),LVEF明显降低(P<0.05);再次住院、再住院平均天数及随访期病死率明显升高(P<0.05).与轻度心力衰竭患者比较,重度心力衰竭患者血红蛋白、红细胞平均血红蛋

  16. Acute ischemic cerebral attack

    OpenAIRE

    Franco-Garcia Samir; Barreiro-Pinto Belis

    2010-01-01

    The decrease of the cerebral blood flow below the threshold of autoregulation led to changes of cerebral ischemia and necrosis that traduce in signs and symtoms of focal neurologic dysfunction called acute cerebrovascular symdrome (ACS) or stroke. Two big groups according to its etiology are included in this category the hemorragic that constitue a 20% and the ischemic a 80% of cases. Great interest has wom the ischemic ACS because of its high social burden, being the third cause of no violen...

  17. When the Left is left!

    Directory of Open Access Journals (Sweden)

    Asha J Mathew

    2014-09-01

    Full Text Available Persistent left superior vena cava is an uncommon vascular anomaly; however it is the most common anomaly of the thoracic venous system. It may be stand alone or associated with other congenital heart diseases and even other extracardiac anomalies. It is due to a lack of regression and adsorption of the left anterior cardinal vein. The persistence of this vessel renders a left subclavian approach for interventions on the right heart a challenge. It may be responsible for arrthymiias. We present a report of a persistent left superior vena cava draining into the coronary sinus with a coexisting normal right superior vena cava. Keeping in mind its widespread implications on cardiac procedures and a causative factor of cardiac disturbances we have considered its course, embryological source and clinical significance.

  18. Dobutamine stress echocardiographyin distinguishing ischemic from nonischemic dilated cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Miloradović Vladimir

    2005-01-01

    Full Text Available Introduction The aim of this study was to evaluate the diagnostic accuracy of dobutamine stress echocardiography for detection of coronary artery disease in patients with dilated cardiomyopathy. Detection of regional wall motion abnormalities at rest does not reliably distinguish ischemic from nonischemic cardiomyopathy. Material and methods To distinguish between ischemic and nonischemic dilated cardiomyopathy (DCM, we studied 50 patients with left ventricular dysfunction (20 ischemic and 30 nonischemic, detected by coronary angiography using dobutamine stress echocardiography. Echocardiographic images were obtained at baseline, low and paek dose of dobutamine. Rest and stress left ventricular wall motion scores were derived from analysis of regional wall motion. Results Dobutamine infusion was terminated after achievement of the target heart rate or maximal protocol dose in 16 (80% patients with ischemic heart disease and in 23 (73.3% patients with nonischemic heart disease. At rest, there were more normal segments (p<0.001 and a trend toward more akinetic segments (p, not significant per ischemic than per nonischemic DCM patients. However, either at rest or with low-dose dobutamine, individual data largely overlapped. At peak dose, in ischemic DCM, regional contraction worsened in many normal or dyssinergic regions at rest (in some cases after inprovement with low-dose dobutamine; in contrast, in nonischemic DCM, further mild impovement was observed in a variable number of left ventricular areas. Thus, with peak-dose dobutamine, more akinetic and less normal segments were present per ishemic than per nonischemic DCM patient (both, p<0.001. A value of six or more akinetic segments was 90% sensitive and 98% specific for ischemic DCM. Conclusions Our data show that analysis of regional contraction by dobutamine stress echocardiography can distinguish between.

  19. Hyperglycemia Increases Susceptibility to Ischemic Necrosis

    Directory of Open Access Journals (Sweden)

    D. Lévigne

    2013-01-01

    Full Text Available Diabetic patients are at risk for spontaneous foot ulcers, chronic wounds, infections, and tissue necrosis. Current theories suggest that the development and progression of diabetic foot ulcers are mainly caused by arteriosclerosis and peripheral neuropathy. Tissue necrosis plays a primordial role in the progression of diabetic foot ulcers but the underlying mechanisms are poorly understood. The aim of the present study was to investigate the effects of hyperglycemia per se on the susceptibility of ischemic tissue to necrosis, using a critical ischemic hind limb animal model. We inflicted the same degree of ischemia in both euglycemic and streptozotocin-induced hyperglycemic rats by resecting the external iliac, the femoral, and the saphenous arteries. Postoperative laser Doppler flowmetry of the ischemic feet showed the same degree of reduction in skin perfusion in both hyperglycemic and euglycemic animals. Nevertheless, we found a significantly higher rate of limb necrosis in hyperglycemic rats compared to euglycemic rats (71% versus 29%, resp.. In this study, we revealed that hyperglycemia per se increases the susceptibility to limb necrosis in ischemic conditions. Our results may help to better understand the physiopathology of progressive diabetic wounds and underline the importance of strict glycemic control in patients with critical limb ischemia.

  20. Development of acute ischemic heart failure in sheep

    NARCIS (Netherlands)

    Mihaylov, D; Reintke, H; Blanksma, P; De Jong, ED; Elstrodt, J; Rakhorst, G

    2000-01-01

    The goal of the present study was to develop a large animal model of acute ischemic left ventricular heart failure (LVHF) that can be used to assess the influence of the PUCA pump on the heart and circulatory system under realistic conditions. We tested the hypothesis that mild stenosis of the coron

  1. CT findings in isolated ischemic proctosigmoiditis

    Energy Technology Data Exchange (ETDEWEB)

    Wiesner, Walter; Mortele, Koenraad J.; Ji, Hoon; Khurana, Bharti; Ros, Pablo R. [Department of Radiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Glickman, Jonathan N. [Department of Pathology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States)

    2002-07-01

    The purpose of our study was to describe the CT features of ischemic proctosigmoiditis in correlation with clinical, laboratory, endoscopic, and histopathologic findings. Our study included seven patients with isolated ischemic proctosigmoiditis. Patients were identified by a retrospective review of all histopathologic records of colonoscopic biopsies performed during a time period of 4 years. All patients presented with left lower abdominal quadrant pain, bloody stools, and leukocytosis, and four patients had fever at the time of presentation. Four of seven patients suffered from diarrhea, one of seven was constipated and two of seven had normal stool consistency. The CT examinations were reviewed by two authors by consensus and compared with clinical and histopathologic results as well as with the initial CT diagnosis. The CT showed a wall thickening confined to the rectum and sigmoid colon in seven of seven patients, stranding of the pararectal fat in four of seven, and stranding of the perisigmoidal fat in one of seven patients. There were no enlarged lymph nodes, but five of seven patients showed coexistent diverticulosis and in three of these patients CT findings were initially misinterpreted as sigmoid diverticulitis. Endoscopies and histopathologic analyses of endoscopic biopsies confirmed non-transmural ischemic proctosigmoiditis in all patients. Isolated ischemic proctosigmoiditis often presents with unspecific CT features and potentially misleading clinical and laboratory findings. In an elderly patient or a patient with known cardiovascular risk factors the diagnosis of ischemic proctosigmoiditis should be considered when wall thickening confined to the rectum and sigmoid colon is seen that is associated with perirectal fat stranding. (orig.)

  2. High fat/low carbohydrate diet attenuates left ventricular hypertrophy and prevents myosin heavy chain isoform switching induced by chronic hypertenstion

    Science.gov (United States)

    A switch in the expression of myosin heavy chain isoform (MHC) alpha to beta is observed with left ventricular hypertrophy (LVH) and heart failure. This switch is associated with a defect in myocardial energy production and contractile dysfunction. Similar MHC isoform profile is observed in the fe...

  3. [Ischemic heart disease].

    Science.gov (United States)

    Yamamuro, Megumi; Ogawa, Hisao

    2009-04-01

    It has been reported that antihypertensive therapy reduces the risk of ischemic heart disease. Except for the antihypertensive effects, the angiotensin converting enzyme (ACE) inhibitors are proved to be very effective in primary and secondary event onset prophylaxis by many clinical trials. The angiotensin II receptor antagonists (ARBs) used briskly in recent years inhibits angiotensin II type 1 receptor alternatively. Although ARBs protect organs, especially blood vessel, heart, brain and kidney in sites of pharmacology, ARBs are still not much as effective results as ACE inhibitors for the patients with ischemic heart disease, by many clinical trials.

  4. [Cerebral infarction and transient ischemic attack].

    Science.gov (United States)

    Sahara, Noriyuki; Kuwashiro, Takahiro; Okada, Yasushi

    2016-04-01

    Japanese Guidelines for the Management of Stroke 2015 was published. Here, we describe several points revised from the 2009 edition about "Cerebral infarction and transient ischemic attack (TIA)". The revision points are as follows; 1. Extension of possible time window of intravenous recombinant tissue-plasminogen activator treatment (from within 3 hours to within 4.5 hours); 2. Antiplatelet therapy in acute stage (dual antiplatelet therapy (DAPT) for non-cardioembolic ischemic stroke or TIA); 3. Endovascular recanalization therapy in acute stage; 4. Antiplatelet therapy in chronic stage (Cilostazol is recommended similar to aspirin or clopidogrel); 5. Non-vitamin K antagonist oral anticoagulants (NOACs) for non-valvular atrial fibrillation (NVAF) stroke or TIA patients; 6. Management of TIA. We explain the revised points of the guideline in the text.

  5. Treatment of chronical myocardial ischemia by adenovirus-mediated hypatocyte growth factor gene transfer in minipigs

    Institute of Scientific and Technical Information of China (English)

    YUAN Biao; ZHANG YouRong; ZHAO Zhong; WU DanLi; YUAN LiZhen; WU Bin; WANG LiSheng; HUANG Jun

    2008-01-01

    Growth factor gene transfer-induced therapeutic angiogenesis has become a novel approach for the treatment of myocardial ischemia. In order to provide a basis for the clinical application of an adeno-virus with hepatocyte growth factor gene (Ad-HGF) in the treatment of myocardial ischemia, we estab-lished a minipig model of chronically ischemic myocardium in which an Ameroid constrictor was placed around the left circumflex branch of the coronary artery (LCX). A total of 18 minipigs were ran-domly divided into 3 groups: a surgery control group, a model group and an Ad-HGF treatment group implanted with Ameroid constrictor. Ad-HGF or the control agent was injected directly into the ischemic myocardium, and an improvement in heart function and blood supply were evaluated. The results showed that myocardial perfusion remarkably improved in the Ad-HGF group compared with that in both the control and model groups. Four weeks after the treatment, the density of newly formed blood vessels was higher and the number of collateral blood vessels was greater in the Ad-HGF group than in the model group. The area of myocardial ischemia reduced evidently and the left ventricular ejection fraction improved significantly in the Ad-HGF group. These results suggest that HGF gene therapy may become a novel approach in the treatment of chronically ischemic myocardium.

  6. Treatment of chronical myocardial ischemia by adenovirus-mediated hepatocyte growth factor gene transfer in minipigs

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Growth factor gene transfer-induced therapeutic angiogenesis has become a novel approach for the treatment of myocardial ischemia. In order to provide a basis for the clinical application of an adeno- virus with hepatocyte growth factor gene (Ad-HGF) in the treatment of myocardial ischemia, we estab- lished a minipig model of chronically ischemic myocardium in which an Ameroid constrictor was placed around the left circumflex branch of the coronary artery (LCX). A total of 18 minipigs were ran- domly divided into 3 groups: a surgery control group, a model group and an Ad-HGF treatment group implanted with Ameroid constrictor. Ad-HGF or the control agent was injected directly into the ischemic myocardium, and an improvement in heart function and blood supply were evaluated. The results showed that myocardial perfusion remarkably improved in the Ad-HGF group compared with that in both the control and model groups. Four weeks after the treatment, the density of newly formed blood vessels was higher and the number of collateral blood vessels was greater in the Ad-HGF group than in the model group. The area of myocardial ischemia reduced evidently and the left ventricular ejection fraction improved significantly in the Ad-HGF group. These results suggest that HGF gene therapy may become a novel approach in the treatment of chronically ischemic myocardium.

  7. Cardiogenic embolism producing crescendo transient ischemic attacks.

    Science.gov (United States)

    Geraghty, Patrick J; Oak, Jack; Choi, Eric T

    2005-09-01

    Lateralizing, repetitive transient ischemic attacks are characteristic of symptomatic carotid bifurcation atherosclerotic plaques. We report a case in which a cardiogenic embolus, after lodging at the left carotid bifurcation, produced crescendo episodes of expressive aphasia and mild right upper extremity weakness. Complete neurological recovery was achieved following emergent carotid embolectomy and endarterectomy. This case demonstrates that the laminar nature of internal carotid blood flow may result in the localization of embolic events to a single region of the cerebral vasculature, regardless of the source lesion in the carotid artery. The role of endoluminal techniques in the diagnosis and management of such lesions is discussed.

  8. Pharmacological Management of Chronic Stable Angina: Focus on Ranolazine.

    Science.gov (United States)

    Rosano, Giuseppe M C; Vitale, Cristiana; Volterrani, Maurizio

    2016-08-01

    Percutaneous coronary intervention and anti-anginal medications have similar prognostic effectiveness in patients with chronic stable angina. The choice of optimal medical therapy for the management of chronic angina is of pivotal importance in patients with stable ischemic heart disease. The most commonly used anti-anginal agents have demonstrated equivalent efficacy in improving patient reported ischemic symptoms and quantitative exercise parameters. With regards to mortality, beta-blockers are beneficial only in the setting of depressed left ventricular systolic function after a recent myocardial infarction. Recent evidence suggests the lack of any benefit of beta-blockers in patients with preserved systolic function, even in the setting of prior myocardial infarction.Ranolazine is a non-haemodynamic anti-anginal agent. It is effective as adjunctive therapy in patients with chronic stable angina whose symptoms are un-adequately controlled by conventional treatment. The clinical development program of ranolazine has shown that the drug improves exercise performance, decreases angina and use of sublingual nitrates, compared to placebo. Ranolazine is well tolerated with neutral effect on haemodynamics. Besides its role in chronic stable angina, ranolazine has the potential for development in a number of other cardiovascular and non-cardiovascular conditions in the future.

  9. Electrophysiologic Effects of Propafenone on Ischemic Ventricular Tachyarrhythmias

    Institute of Scientific and Technical Information of China (English)

    Liu Musheng; Ma Yanfeng; Guo Zhibin

    2006-01-01

    Objectives To observe the electrophysiologic effects of propafenone (Prop) on ischemic ventricular tachyarrhythmias. Methods A canine ischemic ventricular tachyarrhythmia model was established in open-chest dogs subjected to programmed electrical stimulation (PES) on 5~8 days after acute myocardial infarction. The electrophysiologic effects of propafenone were observed in the model. Results Propafenone distinctly lengthened the QTc interval (P> 0.01) and effective refractory period (ERP) of normal and ischemic ventricular myocardium (NERP and IERP) respectively (P > 0.01), decreased the dispersion of ERP in ischemic myocardium and in left ventricle (P > 0.01), and increased the diastolic excitability threshold of normal and ischemic ventricular myocardium remarkably (P > 0.01). Propafenone effectively prevented PES-induced ventricular tachycardia (VT) or ventricular fibrillation (VF)(P > 0.01) and ischemia-induced VT/VF (P > 0.05).Conclusions The results indicated that the canine model produced by our methods is a worthy and reliable one, propafenone may be effective in preventing the onset of VT/VF after myocardial ischemic damage in dogs, and deserve further attention as an antifibrillatory agent.

  10. Ischemic strokes and migraine

    Energy Technology Data Exchange (ETDEWEB)

    Bousser, M.G.; Baron, J.C.; Chiras, J.

    1985-11-01

    Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG).

  11. Coronary collaterals improve prognosis in patients with ischemic heart disease

    NARCIS (Netherlands)

    J.J. Regieli; J.W. Jukema; H.M. Nathoe; A.H. Zwinderman; S. ng; D.E. Grobbee; Y. van der Graaf; P.A. Doevendans

    2009-01-01

    BACKGROUND: The recruitment of coronary collateral vessels results from an endogenous adaptation to ischemic heart disease (IHD). Presence of collaterals may exert protection at the time of acute or chronic obstructive coronary disease. The protective role of collaterals in patients with extensive c

  12. TOWARD THE QUESTION OF ISCHEMIC MYOCARDIAL DYSFUNCTION

    Directory of Open Access Journals (Sweden)

    V. V. Kalyuzhin

    2014-01-01

    Full Text Available The authors of the review have analyzed papers published on the problem of ischemic myocardial dysfunction. They begin with a definition of the term “ischemia” (derived from two Greek words: ischō, meaning to hold back, and haima, meaning blood - a condition at which the arterial blood flow is insufficient to provide enough oxygen to prevent intracellular respiration from shifting from the aerobic to the anaerobic form. The poor rate of ATP generation from this process causes a decrease in cellular ATP, a concomitant rise in ADP, and ultimately, to depression inotropic (systolic and lusitropic (diastolic function of the affected segments of the myocardium. But with such simplicity of basic concepts, the consequences of ischemia so diverse. Influence of an ischemia on myocardial function so unequally at different patients, which is almost impossible to find two identical cases (as in the case of fingerprints. It depends on the infinite variety of lesions of coronary arteries, reperfusion (time and completeness of restoration of blood flow and reactions of a myocardium which, apparently, has considerable flexibility in its response. Ischemic myocardial dysfunction includes a number of discrete states, such as acute left ventricular failure in angina, acute myocardial infarction, ischemic cardiomyopathy, stunning, hibernation, pre- and postconditioning. There are widely differing underlying pathophysiologic states. The possibility exists that several of these states can coexist.

  13. In vivo characterization of ischemic small intestine using bioimpedance measurements.

    Science.gov (United States)

    Strand-Amundsen, R J; Tronstad, C; Kalvøy, H; Gundersen, Y; Krohn, C D; Aasen, A O; Holhjem, L; Reims, H M; Martinsen, Ø G; Høgetveit, J O; Ruud, T E; Tønnessen, T I

    2016-02-01

    The standard clinical method for the assessment of viability in ischemic small intestine is still visual inspection and palpation. This method is non-specific and unreliable, and requires a high level of clinical experience. Consequently, viable tissue might be removed, or irreversibly damaged tissue might be left in the body, which may both slow down patient recovery. Impedance spectroscopy has been used to measure changes in electrical parameters during ischemia in various tissues. The physical changes in the tissue at the cellular and structural levels after the onset of ischemia lead to time-variant changes in the electrical properties. We aimed to investigate the use of bioimpedance measurement to assess if the tissue is ischemic, and to assess the ischemic time duration. Measurements were performed on pigs (n = 7) using a novel two-electrode setup, with a Solartron 1260/1294 impedance gain-phase analyser. After induction of anaesthesia, an ischemic model with warm, full mesenteric arterial and venous occlusion on 30 cm of the jejunum was implemented. Electrodes were placed on the serosal surface of the ischemic jejunum, applying a constant voltage, and measuring the resulting electrical admittance. As a control, measurements were done on a fully perfused part of the jejunum in the same porcine model. The changes in tan δ (dielectric parameter), measured within a 6 h period of warm, full mesenteric occlusion ischemia in seven pigs, correlates with the onset and duration of ischemia. Tan δ measured in the ischemic part of the jejunum differed significantly from the control tissue, allowing us to determine if the tissue was ischemic or not (P < 0.0001, F = (1,75.13) 188.19). We also found that we could use tan δ to predict ischemic duration. This opens up the possibility of real-time monitoring and assessment of the presence and duration of small intestinal ischemia.

  14. Giant and thrombosed left ventricular aneurysm

    Institute of Scientific and Technical Information of China (English)

    Jose; Alberto; de; Agustin; Jose; Juan; Gomez; de; Diego; Pedro; Marcos-Alberca; Jose; Luis; Rodrigo; Carlos; Almeria; Patricia; Mahia; Maria; Luaces; Miguel; Angel; Garcia-Fernandez; Carlos; Macaya; Leopoldo; Perez; de; Isla

    2015-01-01

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur,including heart failure,thromboembolism,or tachyarrhythmias. We report the case of a 78-yearold male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded,and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm,causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  15. Giant and thrombosed left ventricular aneurysm.

    Science.gov (United States)

    de Agustin, Jose Alberto; de Diego, Jose Juan Gomez; Marcos-Alberca, Pedro; Rodrigo, Jose Luis; Almeria, Carlos; Mahia, Patricia; Luaces, Maria; Garcia-Fernandez, Miguel Angel; Macaya, Carlos; de Isla, Leopoldo Perez

    2015-07-26

    Left ventricular aneurysms are a frequent complication of acute extensive myocardial infarction and are most commonly located at the ventricular apex. A timely diagnosis is vital due to the serious complications that can occur, including heart failure, thromboembolism, or tachyarrhythmias. We report the case of a 78-year-old male with history of previous anterior myocardial infarction and currently under evaluation by chronic heart failure. Transthoracic echocardiogram revealed a huge thrombosed and calcified anteroapical left ventricular aneurysm. Coronary angiography demonstrated that the left anterior descending artery was chronically occluded, and revealed a big and spherical mass with calcified borders in the left hemithorax. Left ventriculogram confirmed that this spherical mass was a giant calcified left ventricular aneurysm, causing very severe left ventricular systolic dysfunction. The patient underwent cardioverter-defibrillator implantation for primary prevention.

  16. Effects of tetrandrine on left ventricular developed pressure,left ventricular compliance and (+)[3H]isradipine binding sites in ischemic rat hearts%粉防己碱对大鼠缺血心脏左室发展压,顺应性及(+)[3H]伊拉地平结合位点的影响

    Institute of Scientific and Technical Information of China (English)

    饶曼人; 刘秦越; 张晓文

    2002-01-01

    目的研究粉防己碱(Tet)对大鼠缺血再灌注心脏的左室发展压、左室顺应性和对二氢吡啶拮抗剂(+)[3H]伊拉地平结合位点的影响.以硝苯地平(Nif)作为已知药对照.方法建立离体大鼠心脏缺血(30 min)再灌注(15 min)模型.大鼠预先ip Tet 30 mg*kg-1, 每日2次,连续3 d,然后离体心脏给予Tet 0.18 mmol*L-1灌流, 缺血前灌流5 min,缺血后再灌流15 min.通过连接于压力传感器的乳胶气囊测定左室发展压(LVDP)和左室顺应性;放射配基结合法测定心脏细胞膜上的(+)[3H]伊拉地平结合位点.结果与正常对照组相比,缺血再灌注使LVDP降低(42±6)%, 而经Tet处理的心脏只降低(8.6±0.2)%;缺血再灌注后左室顺应性显著受损, 左室舒张末压-容积曲线左移,Tet处理的心脏顺应性改变很小, 接近正常组.Scatchard作图分析, 正常组大鼠心脏细胞膜与(+)[3H]伊拉地平有高度结合位点,KD 为(0.16±0.03)nmol*L-1,Bmax为(0.93±0.30)nmol*g-1蛋白, 缺血再灌组心脏结合位点的密度减少[Bmax为(0.48±0.14)nmol*g-1蛋白], Tet组的Bmax较缺血再灌组明显升高[(0.68±0.12)nmol*g-1蛋白].各组的KD值均无明显差别.结论 Tet与Nif相似, 保护离体大鼠心脏的收缩功能和左室顺应性, 减轻缺血所致的二氢吡啶结合位点密度降低.这些效应伴随能量需求的下降因而阻止胞内钙超载, 改善缺血.%AIM To investigate if tetrandrine(Tet) modifies the affinity(KD), density(Bmax) of cardiac dihydropyridine binding sites, left ventricular(LV) compliance and LV contractile force in rat hearts with ischemia-reperfusion(I-R) injury. METHODS I-R model was built by step perfusion to make global ischemia for 30 min and then reperfusing for 15 min. Tet 30 mg*kg-1 was administrated ip, twice daily for 3 d before ischemia, and then Tet 0.18 mmol*L-1 in K-H buffer was perfused for 5 min before ischemia and for 15 min after ischemia. Left ventricular developed pressure(LVDP), LV

  17. The tole of ischemic preconditioning in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Ristić Anđelka

    2005-01-01

    Full Text Available Introduction Ischemic preconditioning is a phenomenon in which brief episodes of ischemia and reperfusion increase myocardial tolerance and substantially reduce the infarction size. Case report Two patients with acute left anterior descending artery occlusion received fibrinolytic therapy within 6 hours of symptom onset, but nevertheless developed myocardial infarctions of different size. The first patient, without a history of preinfarction angina, developed a large anterior infarction, because there was no time for ischemic preconditioning or development of coronary collateral vessels. The second patient, with a 4-day history of preinfarction angina, had a more favorable outcome-he developed apical necrosis, with greater myocardial viability in the infarct-related area. Conclusion The beneficial effects of angina occurring 24-48h before infarction are resulting from ischemic preconditioning, which reduces cardiac mortality, infarct size and occurrence of life-threatening ventricular arrhythmias. .

  18. Abnormal organization of white matter network in patients with no dementia after ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Lin Shi

    Full Text Available Structural changes after ischemic stroke could affect information communication extensively in the brain network. It is likely that the defects in the white matter (WM network play a key role in information interchange. In this study, we used graph theoretical analysis to examine potential organization alteration in the WM network architecture derived from diffusion tensor images from subjects with no dementia and experienced stroke in the past 5.4-14.8 months (N = 47, Mini-Mental Screening Examination, MMSE range 18-30, compared with a normal control group with 44 age and gender-matched healthy volunteers (MMSE range 26-30. Region-wise connectivity was derived from fiber connection density of 90 different cortical and subcortical parcellations across the whole brain. Both normal controls and patients with chronic stroke exhibited efficient small-world properties in their WM structural networks. Compared with normal controls, topological efficiency was basically unaltered in the patients with chronic stroke, as reflected by unchanged local and global clustering coefficient, characteristic path length, and regional efficiency. No significant difference in hub distribution was found between normal control and patient groups. Patients with chronic stroke, however, were found to have reduced betweenness centrality and predominantly located in the orbitofrontal cortex, whereas increased betweenness centrality and vulnerability were observed in parietal-occipital cortex. The National Institutes of Health Stroke Scale (NIHSS score of patient is correlated with the betweenness centrality of right pallidum and local clustering coefficient of left superior occipital gyrus. Our findings suggest that patients with chronic stroke still exhibit efficient small-world organization and unaltered topological efficiency, with altered topology at orbitofrontal cortex and parietal-occipital cortex in the overall structural network. Findings from this study could

  19. A case of anterior ischemic optic neuropathy associated with uveitis

    Directory of Open Access Journals (Sweden)

    Sugahara M

    2013-05-01

    Full Text Available Michitaka Sugahara, Takayuki Fujimoto, Kyoko Shidara, Kenji Inoue, Masato Wakakura Inouye Eye Hospital, Tokyo, Japan Introduction: Here, we describe a patient who presented with anterior ischemic optic neuropathy (AION and subsequently developed uveitis. Case: A 69-year-old man was referred to our hospital and initially presented with best-corrected visual acuities (BCVA of 20/40 (right eye and 20/1000 (left eye and relative afferent pupillary defect. Slit-lamp examination revealed no signs of ocular inflammation in either eye. Fundus examination revealed left-eye swelling and a pale superior optic disc, and Goldmann perimetry revealed left-eye inferior hemianopia. The patient was diagnosed with nonarteritic AION in the left eye. One week later, the patient returned to the hospital because of vision loss. The BCVA of the left eye was so poor that the patient could only count fingers. Slit-lamp examination revealed 1+ cells in the anterior chamber and the anterior vitreous in both eyes. Funduscopic examination revealed vasculitis and exudates in both eyes. The patient was diagnosed with bilateral panuveitis, and treatment with topical betamethasone was started. No other physical findings resulting from other autoimmune or infectious diseases were found. No additional treatments were administered, and optic disc edema in the left eye improved, and the retinal exudates disappeared in 3 months. The patient's BCVA improved after cataract surgery was performed. Conclusion: Panuveitis most likely manifests after the development of AION. Keywords: anterior ischemic optic neuropathy, uveitis

  20. Risk factors of severe ischemic biliary complications after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    Ming-FengWang; Zhong-Kui Jin; Da-Zhi Chen; Xian-Liang Li; Xin Zhao; Hua Fan

    2011-01-01

    BACKGROUND: Ischemia-related biliary tract complications remain high after orthotopic liver transplantation. Severe ischemic biliary complications often involve the hepatic duct bifurcation and left hepatic duct, resulting finally in obstructive jaundice. Prevention and management of such complications remain a challenge for transplant surgeons. METHODS: All 160 patients were followed up for at least 180 days after transplantation. One-way analysis of variance (ANOVA) and comparative univariate analysis were made using 3 groups (no complications; mild complications;severe complications), to analyze risk factors associated with biliary complications. Multiple logistic regression and linear regression analysis were used to analyze independent risk factors for severe ischemic biliary complications, after excluding other confounding factors. RESULTS: By ANOVA and comparative univariate analysis, the risk factors associated with biliary complications were preoperative bilirubin level (P=0.007) and T-tube stenting of the anastomosis (P=0.016). Multiple logistic regression analysis showed that the use of T-tube and preoperative serum bilirubin were not independent risk factors for severe ischemic biliary complications after orthotopic liver transplantation. Chi-square analysis indicated that in the incidence of severe ischemic biliary lesions, bile duct second warm ischemic time longer than 60 minutes was a significant risk factor. Linear regression demonstrated a negative correlation between cold preservation time and warm ischemia time. CONCLUSIONS: Preoperative serum bilirubin level and the use of T-tube stenting of the anastomosis were independent risk factors for biliary complications after liver transplantation, but not for severe ischemic biliary complications. The second warm ischemia time of bile duct longer than 60 minutes and prolonged bile duct second warm ischemia time combined with cold preservation time were significant risk factors for severe

  1. ARE LEFT HANDED SURGEONS LEFT OUT?

    OpenAIRE

    SriKamkshi Kothandaraman; Balasubramanian Thiagarajan

    2012-01-01

    Being a left-handed surgeon, more specifically a left-handed ENT surgeon, presents a unique pattern of difficulties.This article is an overview of left-handedness and a personal account of the specific difficulties a left-handed ENT surgeon faces.

  2. Ranolazine preserves and improves left ventricular ejection fraction and autonomic measures when added to guideline-driven therapy in chronic heart failure

    Directory of Open Access Journals (Sweden)

    Murray, Gary

    2014-12-01

    Full Text Available Background Ranolazine (RAN reduces cardiac sodium channel 1.5’s late sodium current in congestive heart failure (CHF, reducing myocardial calcium overload, potentially improving left ventricular (LV function. RAN blocks neuronal sodium channel 1.7, potentially altering parasympathetic and sympathetic (P&S activity. The effects of RAN on LV ejection fraction (LVEF and P&S function in CHF were studied. Methods Matched CHF patients were given open-label RAN (1000 mg po-bid added to guideline-driven therapy (RANCHF, 41 systolic, 13 diastolic or no adjuvant therapy (control, NORANCHF, 43 systolic, 12 diastolic. Echocardiographic LVEF and P&S measures were obtained at baseline and follow-up (mean 23.7 months. Results LVEF increased in 70% of RANCHF patients, an average of 11.3 units. Mean LVEF remained unchanged in NORANCHF patients. P&S measures indicated cardiovascular autonomic neuropathy (P≤0.1 bpm2 in 20% of NORANCHF patients at baseline and in 29% at follow-up (increasing in both groups. At baseline, 28% of patients had high sympathovagal balance (SB, RAN normalized SB over 50% of these; in contrast, the NORANCHF group had a 20% increase in patients with high SB. Conclusions RAN preserves or improves LVEF and decreases high SB in CHF.

  3. The need for standardisation of cardiac FDG PET imaging in the evaluation of myocardial viability in patients with chronic ischaemic left ventricular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Kuuti, J. [Turku Univ. (Finland). Turku PET Centre; Schelbert, H.R. [UCLA School of Medicine, Los Angeles, CA (United States). Dept. of Molecular and Medical Pharmacology; Bax, J.J. [Leiden University Medical Center (Netherlands). Dept. of Cardilogy

    2002-09-01

    The evaluation of myocardial glucose utilisation with fluorine-18 fluorodeoxyglucose (FDG) and positron emission tomography is currently considered the most reliable tool for the identification of myocardial viability. However, the investigations using FDG imaging to predict improvement in left ventricular (LV) function after revascularisation have reported wide ranges for sensitivity (71%-100%) and, in particular, for specificity (33%-91%). The variable results may be related to differences in study populations but also to differences in the imaging protocols employed. Detailed analysis of the published studies has revealed differences in study populations, patient selection criteria, the methods for assessing changes in LV function post revascularisation and the timing of these assessments. Even more importantly, protocols have varied substantially with regard to imaging equipment, perfusion tracers, metabolic conditions, data analysis and interpretation of results. In addition, evaluation of patients with insulin resistance appears to represent a specific challenge. This review examines the different study protocols and methodologies used for myocardial FDG imaging in order to draw conclusions concerning optimal imaging protocols. It appears that the optimisation and standardisation of study protocols and analysis of FDG images for the assessment of myocardial viability are critical. In addition, multi-centre trials seem warranted on prediction of long-term function, congestive heart failure symptoms, survival and quality of life.

  4. Acute ischemic stroke in a child with cyanotic congenital heart disease due to non-compliance of anticoagulation

    Science.gov (United States)

    Mohammad, Misbahuddin; James, Anish F.; Qureshi, Raheel S.; Saraf, Sapan; Ahluwalia, Tina; Mukherji, Joy Dev; Kole, Tamorish

    2012-01-01

    BACKGROUND: Stroke is a common presentation in geriatric patients in emergency department but rarely seen in pediatric patients. In case of acute ischemic stroke in pediatric age group, management is different from that of adult ischemic stroke where thrombolysis is a good op. METHODS: We report a case of a 17-year-old male child presenting in emergency with an episode of acute ischemic stroke causing left hemiparesis with left facial weakness and asymmetry. The patient suffered from cyanotic congenital heart disease for which he had undergone Fontan operation previously. He had a history of missing his daily dose of warfarin for last 3 days prior to the stroke. RESULTS: The patient recovered from acute ischemic stroke without being thrombolyzed. CONCLUSION: In pediatric patients, acute ischemic stroke usually is evolving and may not require thrombolysis. PMID:25215056

  5. Investigation of PACAP Fragments and Related Peptides in Chronic Retinal Hypoperfusion

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    Dora Werling

    2014-01-01

    Full Text Available Pituitary adenylate cyclase activating polypeptide (PACAP has neuroprotective effects in different neuronal and retinal injuries. Retinal ischemia can be effectively modelled by permanent bilateral common carotid artery occlusion (BCCAO, which causes chronic hypoperfusion-induced degeneration in the entire rat retina. The retinoprotective effect of PACAP 1-38 and VIP is well-established in ischemic retinopathy. However, little is known about the effects of related peptides and PACAP fragments in ischemic retinopathy. The aim of the present study was to investigate the potential retinoprotective effects of different PACAP fragments (PACAP 4-13, 4-22, 6-10, 6-15, 11-15, and 20-31 and related peptides (secretin, glucagon in BCCAO-induced ischemic retinopathy. Wistar rats (3-4 months old were used in the experiment. After performing BCCAO, the right eyes of the animals were treated with PACAP fragments or related peptides intravitreal (100 pM, while the left eyes were injected with saline serving as control eyes. Sham-operated (without BCCAO rats received the same treatment. Routine histology was performed 2 weeks after the surgery; cells were counted and the thickness of retinal layers was compared. Our results revealed significant neuroprotection by PACAP 1-38 but did not reveal retinoprotective effect of the PACAP fragments or related peptides. These results suggest that PACAP 1-38 has the greatest efficacy in ischemic retinopathy.

  6. Investigation of PACAP Fragments and Related Peptides in Chronic Retinal Hypoperfusion

    Science.gov (United States)

    Werling, Dora; Reglodi, Dora; Kiss, Peter; Toth, Gabor; Szabadfi, Krisztina; Tamas, Andrea; Biro, Zsolt; Atlasz, Tamas

    2014-01-01

    Pituitary adenylate cyclase activating polypeptide (PACAP) has neuroprotective effects in different neuronal and retinal injuries. Retinal ischemia can be effectively modelled by permanent bilateral common carotid artery occlusion (BCCAO), which causes chronic hypoperfusion-induced degeneration in the entire rat retina. The retinoprotective effect of PACAP 1-38 and VIP is well-established in ischemic retinopathy. However, little is known about the effects of related peptides and PACAP fragments in ischemic retinopathy. The aim of the present study was to investigate the potential retinoprotective effects of different PACAP fragments (PACAP 4-13, 4-22, 6-10, 6-15, 11-15, and 20-31) and related peptides (secretin, glucagon) in BCCAO-induced ischemic retinopathy. Wistar rats (3-4 months old) were used in the experiment. After performing BCCAO, the right eyes of the animals were treated with PACAP fragments or related peptides intravitreal (100 pM), while the left eyes were injected with saline serving as control eyes. Sham-operated (without BCCAO) rats received the same treatment. Routine histology was performed 2 weeks after the surgery; cells were counted and the thickness of retinal layers was compared. Our results revealed significant neuroprotection by PACAP 1-38 but did not reveal retinoprotective effect of the PACAP fragments or related peptides. These results suggest that PACAP 1-38 has the greatest efficacy in ischemic retinopathy. PMID:24900914

  7. Analysis of a Mathematical Model of Ischemic Cutaneous wounds

    CERN Document Server

    Friedman, Avner; Xue, Chuan

    2009-01-01

    Chronic wounds represent a major public health problem affecting 6.5 million people in the United States. Ischemia represents a serious complicating factor in wound healing. In this paper we analyze a recently developed mathematical model of ischemic dermal wounds. The model consists of a coupled system of partial differential equations in the partially healed region, with the wound boundary as a free boundary. The extracellular matrix (ECM) is assumed to be viscoelastic, and the free boundary moves with the velocity of the ECM at the boundary of the open wound. The model equations involve the concentrations of oxygen, cytokines, and the densities of several types of cells. The ischemic level is represented by a parameter which appears in the boundary conditions, 0 <= gamma < 1; gamma near 1 corresponds to extreme ischemia and gamma = 0 corresponds to normal non-ischemic conditions. We establish global existence and uniqueness of the free boundary problem and study the dependence of the free boundary on...

  8. Three-dimensional segmentation of the left ventricle in late gadolinium enhanced MR images of chronic infarction combining long- and short-axis information.

    Science.gov (United States)

    Wei, Dong; Sun, Ying; Ong, Sim-Heng; Chai, Ping; Teo, Lynette L; Low, Adrian F

    2013-08-01

    Automatic segmentation of the left ventricle (LV) in late gadolinium enhanced (LGE) cardiac MR (CMR) images is difficult due to the intensity heterogeneity arising from accumulation of contrast agent in infarcted myocardium. In this paper, we present a comprehensive framework for automatic 3D segmentation of the LV in LGE CMR images. Given myocardial contours in cine images as a priori knowledge, the framework initially propagates the a priori segmentation from cine to LGE images via 2D translational registration. Two meshes representing respectively endocardial and epicardial surfaces are then constructed with the propagated contours. After construction, the two meshes are deformed towards the myocardial edge points detected in both short-axis and long-axis LGE images in a unified 3D coordinate system. Taking into account the intensity characteristics of the LV in LGE images, we propose a novel parametric model of the LV for consistent myocardial edge points detection regardless of pathological status of the myocardium (infarcted or healthy) and of the type of the LGE images (short-axis or long-axis). We have evaluated the proposed framework with 21 sets of real patient and four sets of simulated phantom data. Both distance- and region-based performance metrics confirm the observation that the framework can generate accurate and reliable results for myocardial segmentation of LGE images. We have also tested the robustness of the framework with respect to varied a priori segmentation in both practical and simulated settings. Experimental results show that the proposed framework can greatly compensate variations in the given a priori knowledge and consistently produce accurate segmentations.

  9. Beta-blocker therapy in patients with left ventricular systolic dysfunction and chronic obstructive lung disease in an ambulatory care setting

    Directory of Open Access Journals (Sweden)

    Billups SJ

    2009-12-01

    Full Text Available Objective: To evaluate beta blocker persistence six months after beta-blocker initiation or dose titration in heart failure (HF patients with COPD compared to those without COPD. Secondary objectives included comparison of beta-blocker dose achieved, changes in left ventricular ejection fraction (LVEF and incidence of hospitalizations or emergency department (ED visits during follow-up.Methods: We conducted a matched, retrospective, cohort study including 86 patients with COPD plus concomitant HF (LVEF ≤40% and 137 patients with HF alone. All patients were followed in an outpatient HF clinic. Eligible patients had a documented LVEF ≤40% and were initiated or titrated on a beta-blocker in the HF clinic. Patients were matched based on LVEF (categorized as ≤ 20% or 21-40%, gender, and age (> or ≤70 years. The primary outcome was beta blocker persistence at 6 months. Secondary outcomes were dose achieved, LVEF, and incidence of hospitalizations or ED visits. Results: There were no differences between the COPD and non-COPD groups in beta-blocker persistence at six-month follow-up (94.2% vs. 93.4% respectively, adjusted p=0.842. The proportion of patients who achieved a daily metoprolol dose equivalent of at least 100 mg was similar between the groups (adjusted p=0.188. The percent of patients with at least one ED visit or hospitalization in the six-month post-titration period was substantial but similar between the groups (53.5% and 48.2% for COPD and non-COPD patients, respectively, adjusted p=0.169. Conclusion: Our results support the use of beta-blockers in the population of heart failure patients with COPD and without reactive airway disease.

  10. Left ventricular thrombus formation after repair of anomalous left coronary artery from the pulmonary artery.

    Science.gov (United States)

    Freud, Lindsay R; Koenig, Peter R; Russell, Hyde M; Patel, Angira

    2014-04-01

    Although thrombus formation following myocardial infarction in adults is well known, intracardiac thrombosis in children is uncommon. We report the case of a large left ventricular thrombus in an infant with ischemic cardiomyopathy secondary to anomalous origin of the left coronary artery from the pulmonary artery. Given its mobility and protrusion across the aortic valve, the patient underwent urgent thrombus removal through a transaortic approach. There were no embolic or neurologic complications. This case highlights that thrombectomy may be performed safely and successfully in critically ill pediatric patients.

  11. Mitogen-Activated Protein Kinases and Hypoxic/Ischemic Nephropathy

    Directory of Open Access Journals (Sweden)

    Fengbao Luo

    2016-08-01

    Full Text Available Tissue hypoxia/ischemia is a pathological feature of many human disorders including stroke, myocardial infarction, hypoxic/ischemic nephropathy, as well as cancer. In the kidney, the combination of limited oxygen supply to the tissues and high oxygen demand is considered the main reason for the susceptibility of the kidney to hypoxic/ischemic injury. In recent years, increasing evidence has indicated that a reduction in renal oxygen tension/blood supply plays an important role in acute kidney injury, chronic kidney disease, and renal tumorigenesis. However, the underlying signaling mechanisms, whereby hypoxia alters cellular behaviors, remain poorly understood. Mitogen-activated protein kinases (MAPKs are key signal-transducing enzymes activated by a wide range of extracellular stimuli, including hypoxia/ischemia. There are four major family members of MAPKs: the extracellular signal-regulated kinases-1 and -2 (ERK1/2, the c-Jun N-terminal kinases (JNK, p38 MAPKs, and extracellular signal-regulated kinase-5 (ERK5/BMK1. Recent studies, including ours, suggest that these MAPKs are differentially involved in renal responses to hypoxic/ischemic stress. This review will discuss their changes in hypoxic/ischemic pathophysiology with acute kidney injury, chronic kidney diseases and renal carcinoma.

  12. Short-Term Effect of Right Atrial and Left Uni-Ventricular Pacing in Patients of Chronic Heart Failure With Left Bundle-Branch Block%右心房、左心室起搏治疗慢性心力衰竭伴左束支传导阻滞患者的短期疗效

    Institute of Scientific and Technical Information of China (English)

    邱春光; 王徐乐; 韩战营; 卢文杰; 陈晓杰

    2012-01-01

    目的:观察右心房、左心室起搏治疗慢性心力衰竭(心衰)伴左束支传导阻滞患者的短期疗效.方法:选择纽约心功能分级(NYHA)Ⅲ级~Ⅳ级、左心室射血分数≤0.35、体表心电图QRS时限≥120 ms、窦性心律的心衰患者26例,成功植入三腔起搏器后,以右心房、左心室起搏模式治疗7天,以起搏器植入术前及术后第7天的6分钟步行距离、明尼苏达生活质量评分、QRS波时限、左心室舒张末期内径、左心室射血分数、左心室室间隔部与侧壁基底段收缩期达峰时间差值、N末端脑钠肽为疗效评价指标,观察右心房、左心室起搏治疗慢性心衰的短期疗效.结果:右心房、左心室起搏治疗术后第7天较术前比较,6分钟步行距离由术前的( 279±46)m提高至(312±37)m;明尼苏达生活质量评分由术前的(28±7)下降至(22±5);体表心电图QRS波时限由术前的(167±22)ms缩短至(132±8)ms;左心室射血分数由术前的(0.29±0.07)提高至(0.33±0.05);左心室舒张末期内径由术前的(75±8)mm减小至(69±7)mm;左心室室间隔部与侧壁基底段收缩期达峰时间差值由术前的(105±29)ms下降至(62±8)ms;N末端脑钠肽由术前的(3 086±1 265)pg/ml下降至(1 976±760)pg/ml;患者的各疗效评价指标均得到明显改善,差异均有统计学意义(P<0.05).结论:对窦性心律、完全性左束支传导阻滞的慢性心衰患者右心房、左心室起搏的短期疗效确切.%Objective:To observe the short-term effect of right atrial and left uni-ventricular pacing in patients of chronic heart failure with left bundle-branch block.Methods; A total of 26 heart failure patients who had NYHA class III to IV .with sinus rhythm,left ventricular ejection fraction (LVEF) ≤ 0. 35, QRS duration ≥s 0. 12 ms were studied after successful implantation of CRT/CRTD. All patients received right atrial and left uni-ventricular pacing for 7 days. The therapeutic effects

  13. Intracoronary artery transplantation of cardiomyoblast-like cells from human adipose tissue-derived multi-lineage progenitor cells improve left ventricular dysfunction and survival in a swine model of chronic myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Okura, Hanayuki [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Saga, Ayami; Soeda, Mayumi [Department of Somatic Stem Cell Therapy and Health Policy, Institute of Biomedical Research and Innovation, Foundation for Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047 (Japan); Miyagawa, Shigeru; Sawa, Yoshiki [Department of Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Daimon, Takashi [Division of Biostatistics, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501 (Japan); Ichinose, Akihiro [Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); Matsuyama, Akifumi, E-mail: akifumi-matsuyama@umin.ac.jp [The Center for Medical Engineering and Informatics, Osaka University, 2-2 Yamada-oka, Suita, Osaka 565-0879 (Japan); Department of Plastic Surgery, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo (Japan); RIKEN Program for Drug Discovery and Medical Technology Platforms, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, Kanagawa 230-0045 (Japan)

    2012-09-07

    Highlights: Black-Right-Pointing-Pointer We administered human CLCs in a swine model of MI via intracoronary artery. Black-Right-Pointing-Pointer Histological studies demonstrated engraftment of hCLCs into the scarred myocardium. Black-Right-Pointing-Pointer Echocardiography showed rescue of cardiac function in the hCLCs transplanted swine. Black-Right-Pointing-Pointer Transplantation of hCLCs is an effective therapeutics for cardiac regeneration. -- Abstract: Transplantation of human cardiomyoblast-like cells (hCLCs) from human adipose tissue-derived multi-lineage progenitor cells improved left ventricular function and survival of rats with myocardial infarction. Here we examined the effect of intracoronary artery transplantation of human CLCs in a swine model of chronic heart failure. Twenty-four pigs underwent balloon-occlusion of the first diagonal branch followed by reperfusion, with a second balloon-occlusion of the left ascending coronary artery 1 week later followed by reperfusion. Four weeks after the second occlusion/reperfusion, 17 of the 18 surviving animals with severe chronic MI (ejection fraction <35% by echocardiography) were immunosuppressed then randomly assigned to receive either intracoronary artery transplantation of hCLCs hADMPCs or placebo lactic Ringer's solution with heparin. Intracoronary artery transplantation was followed by the distribution of DiI-stained hCLCs into the scarred myocardial milieu. Echocardiography at post-transplant days 4 and 8 weeks showed rescue and maintenance of cardiac function in the hCLCs transplanted group, but not in the control animals, indicating myocardial functional recovery by hCLCs intracoronary transplantation. At 8 week post-transplantation, 7 of 8 hCLCs transplanted animals were still alive compared with only 1 of the 5 control (p = 0.0147). Histological studies at week 12 post-transplantation demonstrated engraftment of the pre DiI-stained hCLCs into the scarred myocardium and their expression of

  14. [Cerebrolysin for acute ischemic stroke].

    Science.gov (United States)

    iganshina, L E; Abakumova, T R

    2013-01-01

    The review discusses existing evidence of benefits and risks of cerebrolysin--a mixture of low-molecular-weight peptides and amino acids derived from pigs' brain tissue with proposed neuroprotective and neurotrophic properties, for acute ischemic stroke. The review presents results of systematic search and analysis of randomised clinical trials comparing cerebrolysin with placebo in patients with acute ischemic stroke. Only one trial was selected as meeting quality criteria. No difference in death and adverse events between cerebrolysin and placebo was established. The authors conclude about insufficiency of evidence to evaluate the effect of cerebrolysin on survival and dependency in people with acute ischemic stroke.

  15. Scar dechanneling: new method for scar-related left ventricular tachycardia substrate ablation

    NARCIS (Netherlands)

    Berruezo, A.; Fernandez-Armenta, J.; Andreu, D.; Penela, D.; Herczku, C.; Evertz, R.; Cipolletta, L.; Acosta, J.; Borras, R.; Arbelo, E.; Tolosana, J.M.; Brugada, J.; Mont, L.

    2015-01-01

    BACKGROUND: Ventricular tachycardia (VT) substrate ablation usually requires extensive ablation. Scar dechanneling technique may limit the extent of ablation needed. METHODS AND RESULTS: The study included 101 consecutive patients with left ventricular scar-related VT (75 ischemic patients; left ven

  16. Hypoplastic left heart syndrome

    Science.gov (United States)

    HLHS; Congenital heart - hypoplastic left heart; Cyanotic heart disease - hypoplastic left heart ... Hypoplastic left heart is a rare type of congenital heart disease. It is more common in males than in ...

  17. Gender-specific changes in laboratory indexes and structural parameters of the left ventricle myocardium in chronic heart failure on the background of diabetes mellitus type 2 and obesity

    Directory of Open Access Journals (Sweden)

    P. P. Bidzilya

    2015-11-01

    Full Text Available Modern studies have shown that the prevalence of cardiovascular disease and chronic heart failure (CHF specifically, in patients with diabetes mellitus (DM is about 50%. Aim. To study gender-specific changes in laboratory indexes and structural myocardial parameters of left ventricle (LV in CHF on the background of diabetes mellitus (DM type 2. 111 patients with I–III functional class of disease with normal, overweight and abdominal obesity I–III degree were examined. Methods and results. Clinical and biochemical blood tests? glomerular filtration rate were used. Structural parameters of the myocardium were estimated with echocardiography. It is established that in CHF on the background of DM type 2 and obesity there is a tendency to develop anemia and renal dysfunction in women. Structural changes of the myocardium is more pronounced in men and presents the prevalence ofLV hypertrophy and dilatation of the heart cavities. Conclusion. This demonstrates different ways of negative impact of gender factor on the laboratory indexes and structural myocardial parameters in CHF on the background of DM type 2 and obesity.

  18. Pseudoaneurisma crônico do ventrículo esquerdo de etiologia indeterminada Pseudoaneurisma crónico del ventrículo izquierdo de etiología indeterminada Chronic left ventricular pseudoaneurism of undetermined etiology

    Directory of Open Access Journals (Sweden)

    Guilherme Loureiro Fialho

    2010-01-01

    Full Text Available Os pseudoaneurismas ocorrem como rara complicação do infarto do miocárdio, após rotura miocárdica, cujo processo hemorrágico é contido por aderências do pericárdio visceral, parietal - ou de ambos -, impedindo o desenvolvimento de tamponamento cardíaco. Relatamos o caso de um paciente de 55 anos, com pseudoaneurisma crônico do ventrículo esquerdo de etiologia indefinida, de longa evolução, que foi submetido a tratamento conservador.Los pseudoaneurismas ocurren como rara complicación del infarto de miocardio, tras rotura miocárdica, con detención del proceso hemorrágico por las adherencias del pericardio visceral, parietal - o de ambos -, impidiendo el desarrollo de taponamiento cardiaco. Relatamos el caso de un paciente de 55 años, con pseudoaneurisma crónico del ventrículo izquierdo de etiología indefinida, de larga evolución, que se sometió a tratamiento conservador.Pseudoaneurysms occur as a rare complication of the myocardial infarction, of which hemorrhagic process is contained by adherences of the visceral or parietal pericardium - or of both - preventing the development of cardiac tamponade. We report the case of a 55-year-old patient, with a chronic left ventricular pseudoaneurysm of undetermined etiology, who was submitted to a conservative treatment.

  19. Genistein: A Boon for Mitigating Ischemic Stroke.

    Science.gov (United States)

    Nabavi, Seyed Fazel; Daglia, Maria; Tundis, Rosa; Loizzo, Monica Rosa; Sobarzo-Sanchez, Eduardo; Orhan, Ilkay Erdogan; Nabavi, Seyed Mohammad

    2015-01-01

    In last decades, diet and dietary components have been regarded as important strategies to prevent the development or mitigate numerous chronic diseases, including inflammation, cardiovascular pathologies, cancer, etc. One of the most common dietary components of Asian population is soy. A plethora of research shows the promising effect of soy soy-based foodstuffs and genistein, which is one of the predominant isoflavone compounds, in the prevention and mitigation of stroke. Growing evidence shows that genistein, which is a selective estrogen receptor modulator, mitigates ischemic stroke-induced damages through the modification of oxidative stress and molecular pathways. The promising pharmacological role of genistein is attributed to its ability to suppress nuclear factor (NF)-kappa B and Akt signaling pathway, direct antioxidant action, and targeting estrogen and androgen-mediated molecular pathways which help to mitigate stroke damages and prolong cell survival. In this work, we systematically review the current reports on the therapeutic role of genistein against ischemic stroke and its molecular mechanism of actions.

  20. Evaluation of the quality of life of clients with chronic ischemic pain Evaluación de la calidad de vida en clientes con dolor crónico isquémico Avaliação da qualidade de vida em clientes com dor crônica isquêmica

    Directory of Open Access Journals (Sweden)

    Débora Fernanda Amaral Pedrosa

    2011-02-01

    Full Text Available The evaluation of quality of life (QOL faced with chronic ischemic pain involves the clients in their subjectivity and multidimensionality. This descriptive study aimed to evaluate the quality of life of clients who presented chronic ischemic pain. A total of 100 clients of hospital institutes participated in the study. The instrument used to assess pain was an 11 point numerical scale, and to assess the quality of life, the World Health Organization Quality of Life-abbreviated questionnaire. The arithmetic mean for chronic pain was 5.59±3.16 points. The means for quality of life were: in the physical domain, 44.75±16.98; in the overall domain, 50.0±22.40; in the environment, 55.06±13.51, in the psychological, 56.21±17.19 and in the social domain, 68.33±21.84. Thus, the physical domain was, among the areas analyzed, the one which presented a greater impact on the quality of life of the clients with chronic ischemic pain.La evaluación de la calidad de vida (CV frente al dolor crónico isquémico debe considerar la subjetividad del cliente y las múltiples dimensiones envueltas. Este estudio descriptivo tuvo como objetivo evaluar la calidad de vida de clientes que manifestaron dolor crónico isquémico. Participaron de la investigación 100 clientes de instituciones hospitalarias. El instrumento aplicado para evaluar el dolor fue la escala numérica de 11 puntos y para la calidad de vida, el cuestionario World Health Organization Quality of Life abreviado. El promedio aritmético para el dolor crónico fue de 5,59±3,16 puntos. Los promedios para la calidad de vida fueron: en el dominio físico, 44,75±16,98; en el global, 50,0±22,40; en el ambiental, 55,06±13,51; en el psicológico, 56,21±17,19 y en el social, 68,33±21,84. Así, el dominio físico fue, entre los dominios analizados, el que presentó un mayor impacto sobre la calidad de vida de los clientes con dolor crónico isquémico.A avaliação da qualidade de vida (QV, frente

  1. Magnetic Resonance Imaging of Non-ischemic Cardiomyopathies: A Pictorial Essay

    Directory of Open Access Journals (Sweden)

    Cristina I Olivas-Chacon

    2015-01-01

    Full Text Available Non-ischemic cardiomyopathies are defined as either primary or secondary diseases of the myocardium resulting in cardiac dysfunction. While primary cardiomyopathies are confined to the heart and can be genetic or acquired, secondary cardiomyopathies show involvement of the heart as a manifestation of an underlying systemic disease including metabolic, inflammatory, granulomatous, infectious, or autoimmune entities. Non-ischemic cardiomyopathies are currently classified as hypertrophic, dilated, restrictive, or unclassifiable, including left ventricular non-compaction. Cardiovascular Magnetic Resonance Imaging (CMRI not only has the capability to assess cardiac morphology and function, but also the ability to detect edema, hemorrhage, fibrosis, and intramyocardial deposits, providing a valuable imaging tool in the characterization of non-ischemic cardiomyopathies. This pictorial essay shows some of the most important non-ischemic cardiomyopathies with an emphasis on magnetic resonance imaging features.

  2. Magnetic Resonance Imaging of Non-ischemic Cardiomyopathies: A Pictorial Essay.

    Science.gov (United States)

    Olivas-Chacon, Cristina I; Mullins, Carola; Stewart, Kevan; Akle, Nassim; Calleros, Jesus E; Ramos-Duran, Luis R

    2015-01-01

    Non-ischemic cardiomyopathies are defined as either primary or secondary diseases of the myocardium resulting in cardiac dysfunction. While primary cardiomyopathies are confined to the heart and can be genetic or acquired, secondary cardiomyopathies show involvement of the heart as a manifestation of an underlying systemic disease including metabolic, inflammatory, granulomatous, infectious, or autoimmune entities. Non-ischemic cardiomyopathies are currently classified as hypertrophic, dilated, restrictive, or unclassifiable, including left ventricular non-compaction. Cardiovascular Magnetic Resonance Imaging (CMRI) not only has the capability to assess cardiac morphology and function, but also the ability to detect edema, hemorrhage, fibrosis, and intramyocardial deposits, providing a valuable imaging tool in the characterization of non-ischemic cardiomyopathies. This pictorial essay shows some of the most important non-ischemic cardiomyopathies with an emphasis on magnetic resonance imaging features.

  3. OCLUSIÓN TOTAL CRÓNICA DEL TRONCO CORONARIO IZQUIERDO Y ESTENOSIS DE LA CORONARIA DERECHA / Chronic total occlusion of the left main coronary artery and right coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Roberto Bermúdez Yera

    2012-01-01

    Full Text Available ResumenLa estenosis del tronco coronario izquierdo se encuentra entre el 3-5 % de los pacientes a los que se les realiza una coronariografía, pero su oclusión total es rara (0,05-0,1 %. En este artículo presentamos el caso de un paciente de 42 años con oclusión total de este vaso, que presentaba además, una estenosis de 85 % en la arteria coronaria derecha y fue revascularizado quirúrgicamente de forma exitosa. Se implantaron 3 injertos, mamaria a la descendente anterior, y vena safena a una obtusa marginal y a la descendente posterior. Se presentan las imágenes angiográficas y de la cirugía, y se comentan las alternativas terapéuticas, donde lo más importante es individualizar el tratamiento, con el objetivo de brindar la mejor opción a cada paciente en particular. Para lograrlo es imprescindible una excelente relación del equipo de trabajo donde, como en este caso, el cardiólogo intervencionista y el cirujano cardiovascular se complementen, para el bien del paciente. AbstractThe left main coronary artery stenosis is found in 3-5 % of patients who undergo coronary angiography, but total occlusion is rare (0,05-0,1 %. In this article, the case of a 42-year-old patient with chronic total occlusion of the left main coronary artery is presented. This patient, who also had 85 % stenosis of the right coronary artery, was surgically and successfully revascularized. 3 grafts were implanted: mammary artery to the anterior descending artery and saphenous vein to the obtuse marginal and posterior descending artery. The angiographic and surgery images are shown, and treatment options are discussed, where the most important thing is to individualize treatment in order to provide the best option for each patient. It order to achieve this, an excellent team work is essential, in which, as in this case, the interventional cardiologist and cardiovascular surgeon complement each other for the good of the patient.

  4. Magnetic resonance imaging of luxury perfusion of the optic nerve head in anterior ischemic optic neuropathy.

    Science.gov (United States)

    Yovel, Oren S; Katz, Miriam; Leiba, Hana

    2012-09-01

    A 49-year-old woman with painless reduction in visual acuity in her left eye was found to have nonarteritic anterior ischemic optic neuropathy (NAION). Fluorescein angiography revealed optic disc capillary leakage consistent with "luxury perfusion." Contrast-enhanced FLAIR magnetic resonance imaging (MRI) showed marked enhancement of the left optic disc. Resolution of the optic disc edema and the MRI abnormalities followed a similar time course. This report appears unique in documenting the MRI findings of luxury perfusion in NAION.

  5. Functional myocardial state and the special features of left ventricle remodeling at chronic heart failure with diabetes mellitus type 2 on the background of overweight and obesity based on gender factor

    Directory of Open Access Journals (Sweden)

    Петро Петрович Бідзіля

    2016-01-01

    Full Text Available Today chronic heart failure (CHF is one of the main causes of death of patients with obesity and at the growth of body mass index (BMI for every 1kg /m2 the risk of CHF increases by 5 % in men and by 7 % in women. There were proved that in the conditions of diabetes mellitus (DM type 2 the mortality from cardiovascular pathology and especially CHF increases in 2-3 times in men and in 3-5 times in women. The aim of research was to study the myocardium functional state and the special features of the left ventricle (LV remodeling at chronic heart failure (CHF with diabetes mellitus (DM type 2 on the background of overweight and obesity depending on gender factor.Methods: there were examined 97 patients with CHF of I-III functional class at DM type 2 on the background of the normal body mass, overweight and abdominal obesity of I-III stage. All patients underwent echocardiographic examination. The processing of received data was carried out by the methods of nonparametric statistics.Results: There was not revealed any reliable difference of index of LV ejection fraction that was a little less in men. The value of the mean pressure of pulmonary artery was almost equal and the prevalence of pulmonary hypertension unreliably predominated in men. The frequency of LV isolated systolic dysfunction (LVSD in both groups did not essentially differ and LV diastolic dysfunction (LVDD that was presented by myocardium relaxation disorder unreliably predominated in women. The percentage of combination of LVSD and LVDD had a tendency to increase in men. There was revealed reliable predominance of the frequency of LV hypertrophy (by 11 % in women that in most cases was presented by its concentric type. The concentric LV remodeling observed in minority of patients unreliably predominated in men.Conclusions: The myocardium functional changes at CHF with DM type 2 on the background of overweight and obesity are characterized with tendency to decrease of LV

  6. Role of nuclear medicine in ischemic heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Hayashida, Kohei; Nishimura, Tsunehiko; Uehara, Toshiisa; Naito, Hiroaki; Omine, Hiromi; Kozuka, Takahiro (National Cardiovascular Center, Suita, Osaka (Japan))

    1982-08-01

    With the progress in gamma camera and computer system, nuclear medicine has been applied for diagnostic tool in ischemic heart disease. There are two devices for cardiac images; (1) Radionuclide angiocardiography (RNA) by in vivo sup(99m)Tc-RBC labeling (2) Myocardial imaging by /sup 201/Tlcl. RNA can evaluate the kinesis of wall motion of left ventricle with gated pool scan and also detect reserve of cardiac function with exercise study. Myocardial imaging at rest can identify myocardial necrosis and the imaging in exercise can detect myocardial ischemia. The elaborateness and reproducibility of cardiac image in nuclear medicine will play the great role to evaluate clinical stage of ischemic heart disease by not only imaging but also functional diagnosis.

  7. Regional brain structural abnormality in ischemic stroke patients:a voxel-based morphometry study

    Institute of Scientific and Technical Information of China (English)

    Ping Wu; Lin Chen; Lin Bai; Juan Nie; San Zhang; Yan Xiong; Yu Bai; Can-xin Yin; Fan-rong Liang; Yu-mei Zhou; Fang Zeng; Zheng-jie Li; Lu Luo; Yong-xin Li; Wei Fan; Li-hua Qiu; Wei Qin

    2016-01-01

    Our previous study used regional homogeneity analysis and found that activity in some brain areas of patients with ischemic stroke changed signiifcantly. In the current study, we examined structural changes in these brain regions by taking structural magnetic resonance imaging scans of 11 ischemic stroke patients and 15 healthy participants, and analyzing the data using voxel-based morphometry. Compared with healthy participants, patients exhibited higher gray matter density in the left inferior occipital gyrus and right anterior white matter tract. In contrast, gray matter density in the right cerebellum, left precentral gyrus, right middle frontal gyrus, and left middle temporal gyrus was less in ischemic stroke patients. The changes of gray matter density in the middle frontal gyrus were negatively associated with the clin-ical rating scales of the Fugl-Meyer Motor Assessment (r = –0.609,P = 0.047) and the left middle temporal gyrus was negatively correlated with the clinical rating scales of the nervous functional deifciency scale (r = –0.737,P = 0.010). Our ifndings can objectively identify the functional abnormality in some brain regions of ischemic stroke patients.

  8. Regional brain structural abnormality in ischemic stroke patients: a voxel-based morphometry study

    Directory of Open Access Journals (Sweden)

    Ping Wu

    2016-01-01

    Full Text Available Our previous study used regional homogeneity analysis and found that activity in some brain areas of patients with ischemic stroke changed significantly. In the current study, we examined structural changes in these brain regions by taking structural magnetic resonance imaging scans of 11 ischemic stroke patients and 15 healthy participants, and analyzing the data using voxel-based morphometry. Compared with healthy participants, patients exhibited higher gray matter density in the left inferior occipital gyrus and right anterior white matter tract. In contrast, gray matter density in the right cerebellum, left precentral gyrus, right middle frontal gyrus, and left middle temporal gyrus was less in ischemic stroke patients. The changes of gray matter density in the middle frontal gyrus were negatively associated with the clinical rating scales of the Fugl-Meyer Motor Assessment (r = -0.609, P = 0.047 and the left middle temporal gyrus was negatively correlated with the clinical rating scales of the nervous functional deficiency scale (r = -0.737, P = 0.010. Our findings can objectively identify the functional abnormality in some brain regions of ischemic stroke patients.

  9. Prolonged ischemic heart disease and coronary artery bypass - relation to contractile reserve

    DEFF Research Database (Denmark)

    Kofoed, Klaus F; Bangsgaard, Regitze; Carstensen, Steen;

    2002-01-01

    OBJECTIVE: A major effect of coronary artery bypass grafting (CABG) in patients with ischemic heart disease and impaired left ventricular (LV) contractile function is believed to be an improvement in LV function due to recovery of dysfunctional, but viable myocardium. However, recent studies have...

  10. Use of susceptibility-weighted imaging in assessing ischemic penumbra

    Science.gov (United States)

    Wu, Xiujuan; Luo, Song; Wang, Ying; Chen, Yang; Liu, Jun; Bai, Jing; Feng, Jiachun; Zhang, Hongliang

    2017-01-01

    Abstract Rationale: The ischemic penumbra assessment is essential for the subsequent therapy and prediction of evolution in patients with acute ischemic infraction. Although controversial as a perfect equivalence to penumbra, perfusion-weighted imaging (PWI)-diffusion-weighted imaging (DWI) mismatch may predict the response to thrombolysis. Due to the reliance of PWI on contrast agents, noninvasive alternatives remain an unmet need. Patient concerns: We reported a 65-year-old man complained of paroxysmal hemiplegia of his right limbs and anepia for 2 days, whereas the symptoms lasted for about 12 hours when he admitted to the hospital. Diagnosis: We diagnosed it as acute ischemic stroke caused by the left middle cerebral artery stenosis. Interventions: Susceptibility-weighted imaging (SWI), multimodal magnetic resonance imaging (MRI) work-up which includes conventional MRI sequences (T1WI, T2WI, and FLAIR), DWI, PWI. Outcomes: His DWI-SWI mismatch was comparable to that of DWI-PWI at admission, suggesting that DWI-SWI could predict ischemic penumbra in patient with acute infarction. He refused the digital subtraction angiography examination or stenting, and he was treated with aspirin, atorvastain, and supportive treatment. The patient received a reexamination of the conventional MRI and SWI 11 days later. Expansion of the infarction in the affected MCA territory resulted from the penumbra indicated by the mismatch between DWI-SWI. Lessons: SWI can be used as a noninvasive alternative to evaluate the ischemic penumbra. Besides, SWI can provide perfusion information comparable to PWI and SWI is sufficient to identify occlusive arteries. PMID:28178170

  11. Chronic Losartan Treatment Up-Regulates AT1R and Increases the Heart Vulnerability to Acute Onset of Ischemia and Reperfusion Injury in Male Rats.

    Science.gov (United States)

    Song, Minwoo A; Dasgupta, Chiranjib; Zhang, Lubo

    2015-01-01

    Inhibition of angiotensin II type 1 receptor (AT1R) is an important therapy in the management of hypertension, particularly in the immediate post-myocardial infarction period. Yet, the role of AT1R in the acute onset of myocardial ischemia and reperfusion injury still remains controversial. Thus, the present study determined the effects of chronic losartan treatment on heart ischemia and reperfusion injury in rats. Losartan (10 mg/kg/day) was administered to six-month-old male rats via an osmotic pump for 14 days and hearts were then isolated and were subjected to ischemia and reperfusion injury in a Langendorff preparation. Losartan significantly decreased mean arterial blood pressure. However, heart weight, left ventricle to body weight ratio and baseline cardiac function were not significantly altered by the losartan treatment. Of interest, chronic in vivo losartan treatment significantly increased ischemia-induced myocardial injury and decreased post-ischemic recovery of left ventricular function. This was associated with significant increases in AT1R and PKCδ expression in the left ventricle. In contrast, AT2R and PKCε were not altered. Furthermore, losartan treatment significantly increased microRNA (miR)-1, -15b, -92a, -133a, -133b, -210, and -499 expression but decreased miR-21 in the left ventricle. Of importance, addition of losartan to isolated heart preparations blocked the effect of increased ischemic-injury induced by in vivo chronic losartan treatment. The results demonstrate that chronic losartan treatment up-regulates AT1R/PKCδ and alters miR expression patterns in the heart, leading to increased cardiac vulnerability to ischemia and reperfusion injury.

  12. The Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA: a Case Series and Brief Review

    Directory of Open Access Journals (Sweden)

    Aliasghar Moeinipour

    2016-02-01

    Full Text Available Background Anomalous left coronary artery from the pulmonary artery (ALCAPA is a rare congenital cardiovascular defect that occurs in approximately 1/300 000 live births or 0.5% of children with congenital heart disease. There are two types of ALCAPA syndrome: the infant type and the adult type. The most infants experience myocardial infarction and congestive heart failure, and approximately 90% die within the first year of life; also, without early surgical intervention they have a dismal prognosis. Materials and Methods We report 3- year experiences from January 2013 to January 2016 of Imam Reza Hospital center (a tertiary referral hospital North East of Iran that consist of all patients with ALCAPA syndrome. Results The Takeuchi procedure, were successfully performed in five children with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA. There was no death and significant mitral regurgitation postoperative (n=0 in this short study. All of patients (n=5 had evidence of improving ischemic myocardium status by increasing of ejection fraction and regional wall motion of left ventricular in follow up echocardiography. Conclusion The only cure treatment for ALCAPA syndrome is surgical intervention that needs to be performed immediately after diagnosis to prevent myocardial infarction and chronic heart failure. Today, establishing a system with two coronary arteries is the goal in definitive surgical repair. The Takeuchi procedure is a prefer method to establish a two-coronary repair for ALCAPA.

  13. Phosphoproteomic profiling of human myocardial tissues distinguishes ischemic from non-ischemic end stage heart failure.

    Science.gov (United States)

    Schechter, Matthew A; Hsieh, Michael K H; Njoroge, Linda W; Thompson, J Will; Soderblom, Erik J; Feger, Bryan J; Troupes, Constantine D; Hershberger, Kathleen A; Ilkayeva, Olga R; Nagel, Whitney L; Landinez, Gina P; Shah, Kishan M; Burns, Virginia A; Santacruz, Lucia; Hirschey, Matthew D; Foster, Matthew W; Milano, Carmelo A; Moseley, M Arthur; Piacentino, Valentino; Bowles, Dawn E

    2014-01-01

    The molecular differences between ischemic (IF) and non-ischemic (NIF) heart failure are poorly defined. A better understanding of the molecular differences between these two heart failure etiologies may lead to the development of more effective heart failure therapeutics. In this study extensive proteomic and phosphoproteomic profiles of myocardial tissue from patients diagnosed with IF or NIF were assembled and compared. Proteins extracted from left ventricular sections were proteolyzed and phosphopeptides were enriched using titanium dioxide resin. Gel- and label-free nanoscale capillary liquid chromatography coupled to high resolution accuracy mass tandem mass spectrometry allowed for the quantification of 4,436 peptides (corresponding to 450 proteins) and 823 phosphopeptides (corresponding to 400 proteins) from the unenriched and phospho-enriched fractions, respectively. Protein abundance did not distinguish NIF from IF. In contrast, 37 peptides (corresponding to 26 proteins) exhibited a ≥ 2-fold alteration in phosphorylation state (pfailure etiology examined. Proteins exhibiting phosphorylation alterations were grouped into functional categories: transcriptional activation/RNA processing; cytoskeleton structure/function; molecular chaperones; cell adhesion/signaling; apoptosis; and energetic/metabolism. Phosphoproteomic analysis demonstrated profound post-translational differences in proteins that are involved in multiple cellular processes between different heart failure phenotypes. Understanding the roles these phosphorylation alterations play in the development of NIF and IF has the potential to generate etiology-specific heart failure therapeutics, which could be more effective than current therapeutics in addressing the growing concern of heart failure.

  14. Autologous preconditioned mesenchymal stem cell sheets improve left ventricular function in a rabbit old myocardial infarction model

    Science.gov (United States)

    Tanaka, Yuya; Shirasawa, Bungo; Takeuchi, Yuriko; Kawamura, Daichi; Nakamura, Tamami; Samura, Makoto; Nishimoto, Arata; Ueno, Koji; Morikage, Noriyasu; Hosoyama, Tohru; Hamano, Kimikazu

    2016-01-01

    Mesenchymal stem cells (MSCs) constitute one of the most powerful tools for therapeutic angiogenesis in infarcted hearts. However, conventional MSC transplantation approaches result in insufficient therapeutic effects due to poor retention of graft cells in severe ischemic diseases. Cell sheet technology has been developed as a new method to prolong graft cell retention even in ischemic tissue. Recently, we demonstrated that hypoxic pretreatment enhances the therapeutic efficacy of cell sheet implantation in infarcted mouse hearts. In this study, we investigated whether hypoxic pretreatment activates the therapeutic functions of bone marrow-derived MSC (BM-MSC) sheets and improves cardiac function in rabbit infarcted hearts following autologous transplantation. Production of vascular endothelial growth factor (VEGF) was increased in BM-MSC monolayer sheets and it peaked at 48 h under hypoxic culture conditions (2% O2). To examine in vivo effects, preconditioned autologous BM-MSC sheets were implanted into a rabbit old myocardial infarction model. Implantation of preconditioned BM-MSC sheets accelerated angiogenesis in the peri-infarcted area and decreased the infarcted area, leading to improvement of the left ventricular function of the infarcted heart. Importantly, the therapeutic efficacy of the preconditioned BM-MSC sheets was higher than that of standardly cultured sheets. Thus, implantation of autologous preconditioned BM-MSC sheets is a feasible approach for enhancing therapeutic angiogenesis in chronically infarcted hearts. PMID:27347329

  15. THE IMPACT OF COMORBIDITY ON COGNITIVE PARAMETERS AFTER ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    Mirena Valkova

    2012-10-01

    Full Text Available Objective: The aim of our study is to examine the impact of comorbidity on cognitive parameters after the first ever ischemic stroke.Material and methods: We examined 112 patients (aged 46 to 84 (66.67± 5.96, 69 males and 43 females with first ever ischemic stroke. For cognitive assessment we used Mini Mental State Examination (MMSE, 10 word test (for short term memory and delayed recall, Isaack’s test for verbal fluency (VF, Geriatric depression scale (GDS, Hamilton depression scale (HDS, Blessed dementia information memory concentration test (revised, BDIMCT, Benton Visual Retention test (A,E; BVRT – number of corrects and number of errors and Wiskonsin Card Sorting Test (number of errors, WCST. The patients were examined on two step model. At acute stage, after collecting medical history, somatic and neurological examinations, MMSE, 10 words test and HDS were applied. At subacute stroke stage (90±5 days after first stroke symptoms, all cognitive tests were used. „STATGRAPHICS Plus 5.0 (free version” was used for statistical analysis.Results: Chronic ischemic heart disease and chronic obstructive pulmonary disease are the most important additional risk factors for cognitive decline. Thyroid pathology, renal failure and anemia are independently associated with poststroke depression.Conclusions: On the basis of these data we can conclude that vascular risk factors are independently associated with cognitive and emotional changes after stroke and their effects should be assessed and taken into account for subsequent treatment of stroke survivors.

  16. Relation between Tc-99m-PYP and Tl-201 scintigraphic findings and left ventricular function in acute myocardial infarction with early reperfusion

    Energy Technology Data Exchange (ETDEWEB)

    Mori, Takao; Fukuzaki, Hisashi; Igarashi, Yuuichirou; Minamiji, Katsumi; Takarada, Akira; Imai, Naoaki; Fujino, Motohiro; Kurogane, Hiroyuki; Yoshida, Yutaka.

    1988-07-01

    The purpose of this study was to examine the significance of Tc-99m PYP uptake in the evaluation of myocardial salvage and reperfusion injury during early reperfusion in acute myocardial infarction. The subjects were 54 patients with initial myocardial infarction attributable to left anterior descending branch lesion in whom early reperfusion was attained by spontaneous recanalization (SR), intracoronary thrombolysis (ICT), and percutaneous transluminal angioplasty (PTCA). The radionuclide imaging appearances of the myocardium fell into four categories : I) small Tl-201 defect and faint Tc-99m PYP uptake ; II) small Tl-201 defect and intense Tc-99m PYP uptake ; III) large Tl-201 defect and faint Tc-99m PYP uptake ; and IV) large Tl-201 defect and intense Tc-99m PYP uptake. The incidences of I and II were higher in the group of SR patients than the group of ICT and PTCA patients. Features of left ventricular ejection fraction (LVEF) from the acute through the chronic stages were as follows : Category I - favorable LVEF through the stages ; Category II - improvement at chronic stage ; Category III - no consistent tendency for LVEF ; and Category IV - aggravation at chronic stage. In cases of early recanalization of acute myocardial infarction, Tc-99m PYP images combined with Tl-201 images may provide useful information on changes of cardiac function and salvage of the ischemic myocardium. (Namekawa, K.).

  17. Ischemic postconditioning fails to protect against neonatal cerebral stroke.

    Directory of Open Access Journals (Sweden)

    Pierre-Louis Leger

    Full Text Available The lack of efficient neuroprotective strategies for neonatal stroke could be ascribed to pathogenic ischemic processes differentiating adults and neonates. We explored this hypothesis using a rat model of neonatal ischemia induced by permanent occlusion of the left distal middle cerebral artery combined with 50 min of occlusion of both common carotid arteries (CCA. Postconditioning was performed by repetitive brief release and occlusion (30 s, 1 and/or 5 min of CCA after 50 min of CCA occlusion. Alternative reperfusion was generated by controlled release of the bilateral CCA occlusion. Blood-flow velocities in the left internal carotid artery were measured using color-coded pulsed Doppler ultrasound imaging. Cortical perfusion was measured using laser Doppler. Cerebrovascular vasoreactivity was evaluated after inhalation with the hypercapnic gas or inhaled nitric oxide (NO. Whatever the type of serial mechanical interruptions of blood flow at reperfusion, postconditioning did not reduce infarct volume after 72 hours. A gradual perfusion was found during early re-flow both in the left internal carotid artery and in the cortical penumbra. The absence of acute hyperemia during early CCA re-flow, and the lack of NO-dependent vasoreactivity in P7 rat brain could in part explain the inefficiency of ischemic postconditioning after ischemia-reperfusion.

  18. [Pregnancy and acute ischemic stroke].

    Science.gov (United States)

    Bereczki, Dániel

    2016-05-15

    Pregnancy-related ischemic strokes play an important role in both maternal and fetal morbidity and mortality. Changes in hemostaseology and hemodynamics as well as risk factors related to or independent from pregnancy contribute to the increased stroke-risk during gestation and the puerperium. Potential teratogenic effects make diagnostics, acute therapy and prevention challenging. Because randomized, controlled trials are not available, a multicenter registry of patients with gestational stroke would be desirable. Until definite guidelines emerge, management of acute ischemic stroke during pregnancy remains individual, involving experts and weighing the risks and benefits.

  19. Salvia miltiorrhiza and ischemic diseases

    Institute of Scientific and Technical Information of China (English)

    Xin-Yan JI; Benny K-H TAN; Yi-Zhun ZHU

    2000-01-01

    The demonstration of beneficial effects of salvia miltiorrhiza (DanShen) on ischemic diseases has revolutionized the management of angina pectoris, myocardial infarction (MI) or stroke in Chinese society. Experimental studies have shown that DanShen dilated coronary arteries, increased coronary blood flow, and scavenged free radicals in ischemic diseases, so that it reduced the cellular damage from ischemia and improved heart functions. Clinical trials also indicated that DanShen was an effective medicine for angina pectoris, MI, and stroke. This review will focus on DanShen's effects in angina pectoris, MI and stroke.

  20. The iron-regulatory peptide hepcidin is upregulated in the ischemic and in the remote myocardium after myocardial infarction.

    Science.gov (United States)

    Simonis, Gregor; Mueller, Katrin; Schwarz, Peggy; Wiedemann, Stephan; Adler, Guido; Strasser, Ruth H; Kulaksiz, Hasan

    2010-09-01

    Recent evidence suggests that iron metabolism contributes to the ischemic damage after myocardial infarction. Hepcidin, a recently discovered peptide hormone, regulates iron uptake and metabolism, protecting the body from iron overload. In this study we analyzed the regulation of hepcidin in the heart and blood of rats after myocardial infarction. To induce a myocardial infarction in the rats, left anterior descending coronary artery ligation was performed. After 1-24h, biopsies from the ischemic and the non-ischemic myocardium were taken. In these biopsies, the mRNA levels and the protein expression of hepcidin were analyzed by quantitative RT-PCR and immunoblot analysis, respectively. In parallel, the serum levels of prohepcidin were measured by ELISA. Six hours after myocardial infarction, the hepcidin mRNA expression was temporally upregulated in the ischemic and in the non-ischemic myocardium. The upregulation was specific for hepcidin, since other iron-related genes (hemojuvelin, IREG-1) remained unchanged. Furthermore, the alteration of the hepcidin protein expression in the ischemic area was connected to the level of hepcidin in the serum of the infarcted rats, where hepcidin also raised up. Angiotensin receptor blockade with candesartan did not influence the mRNA regulation of hepcidin. Together, these data show a particular upregulation of the iron-regulatory peptide hepcidin in the ischemic and the non-ischemic myocardium after myocardial infarction. It is speculated that upregulation of hepcidin may reduce iron toxicity and thus infarct size expansion in an infarcted heart.

  1. Left Ventricular Hypertrophy

    Science.gov (United States)

    ... of left ventricular hypertrophy in hypertension. http://www.uptodate.com/home. Accessed April 6, 2015. Podrid PJ. Left ventricular hypertrophy and arrhythmia. http://www.uptodate.com/home. Accessed April 6, 2015. Chatterjee S, et ...

  2. Ischemic Colitis Secondary to Ergotamine Use: A Case Study

    Directory of Open Access Journals (Sweden)

    Regina E. Rodman

    2011-01-01

    Full Text Available A 48-year-old woman with a history of chronic migraines, initially admitted for inpatient management of intractable migraine headaches, developed new onset abdominal pain, hypotension, and diarrhea on hospital day number ten. In our institution’s headache unit, patients are treated by a multidisciplinary approach, including individualized drug therapy based on diagnosis and previous response to therapy. Given the patient’s hypotension and clinical appearance, she was transferred to the intensive care unit and treated for septic shock and metabolic acidosis. A bedside colonscopy revealed diffuse ischemic colitis. Final pathology after colon resection showed widespread, transmural necrosis of the colonic wall. We review the pathophysiology of ergotamine use and its potential association with ischemic colitis.

  3. Compromised Wound Healing in Ischemic Type 2 Diabetic Rats.

    Directory of Open Access Journals (Sweden)

    Peilang Yang

    Full Text Available Ischemia is one of the main epidemic factors and characteristics of diabetic chronic wounds, and exerts a profound effect on wound healing. To explore the mechanism of and the cure for diabetic impaired wound healing, we established a type 2 diabetic rat model. We used an 8 weeks high fat diet (HFD feeding regimen followed by multiple injections of streptozotocin (STZ at a dose of 10mg/kg to induce Wister rat to develop type 2 diabetes. Metabolic characteristics were assessed at the 5th week after the STZ injections to confirm the establishment of diabetes mellitus on the rodent model. A bipedicle flap, with length to width ratio 1.5, was performed on the back of the rat to make the flap area ischemic. Closure of excisional wounds on this bipedicle flap and related physiological and pathological changes were studied using histological, immunohistochemical, real time PCR and protein immunoblot approaches. Our results demonstrated that a combination of HFD feeding and a low dose of STZ is capable of inducing the rats to develop type 2 diabetes with noticeable insulin resistance, persistent hyperglycemia, moderate degree of insulinemia, as well as high serum cholesterol and high triglyceride levels. The excision wounds on the ischemic double pedicle flap showed deteriorative healing features comparing with non-ischemic diabetic wounds, including: delayed healing, exorbitant wound inflammatory response, excessive and prolonged ROS production and excessive production of MMPs. Our study suggested that HFD feeding combined with STZ injection could induce type 2 diabetes in rat. Our ischemic diabetic wound model is suitable for the investigation of human diabetic related wound repair; especically for diabetic chronic wounds.

  4. Status and risk factors of chronic kidney disease complicated by left ventricular hypertrophy%慢性肾脏病并发左室肥厚现况及其危险因素

    Institute of Scientific and Technical Information of China (English)

    彭道有; 岳华; 何卫; 关彦军; 赵龙

    2011-01-01

    Objective: To explore the prevalence of left ventricular hypertrophy (LVH) and risk factors among patients with chronic kidney disease (CKD) at ages 40-75years.Methods: The medical records of 210 patients with CKD at the stage of 2-5, who were nephrology inpatients in our hospital and 40-75 years old, were analyzed retrospectively.Results: (1) The incidence of diastolic dysfunction was significantly higher than systolic dysfunction (79.1% VS 20.3% P=0.000); The detection rate of left atrial enlargement was significantly higher than that of left ventricular enlargement (46.5% VS 19.8% P=0.000); The detection rate of interventricular septum thickening(IVSH) was significantly higher than that of left ventricular posterior wall thickening(LVPWH) (43.0% VS 21.1% P=0.000); LVH prevalence (according to the formula) was significantly higher than IVSH prevalence (47.9% VS 35% P=0.001), LVH in females had significantly difference than that in male (73.2% VS 31.0% P=0.000).However, if applying a different diagnostic criteria for LVH, no significant differences (50% VS 34.5% P=0.068).(2) The systolic blood pressure(SBP), pulse pressure(PP), serum creatinine (Scr) in IVSH group were higher than those in non-IVSH.The serum phosphate in LVPWH group in addition to the above factors was still higher than those non-LVPWH group, but by subgroup analysis in CKD5 ,only the SBP compared with the control group was significantly different.In LVH group SBP, PP were higher than those non-LVH, and hemoglobin(Hb), body mass index(BMI) were lower than the control group.Logistic regression analysis indicated that only gender, BMI were statistically significant.Conclusion:(1) 40-75 years old CKD patients with high risk of cardiovascular disease, diagnosed by echocardiography with different diagnostic criteria, different conclusions of LVH may be drawn,but the highest positive rate of LVH is from the formula.(2) 40-75 years CKD patients, SBP, PP, anemia, BMI, female are

  5. Free radical reaction in ischemic rat brain. ESR-CT imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kayama, Takamasa [Yamagata Univ. (Japan). School of Medicine

    1998-07-01

    Free radical change in images of rat brain during brain ischemia was observed by using a rapid scan L-band ESR-CT system. Male Wistar rats weighing 200 g were used. Rats were divided into three groups according to the duration of occlusion of 2, 4, and 8 hr as well as a control, sham-operated group. C-PROXYL dissolved in saline solution was used as an imaging agent and injected intraperitoneally in a volume of 3 ml at a concentration of 0.3 M at the beginning of reperfusion. ESR-CT imaging was performed 20 min after injection of C-PROXYL. In the sham-operated group, histological examination disclosed no ischemic lesion. Because C-PROXYL does not pass the blood-brain barrier, no brain image was obtained. In the 2 hr occlusion ischemic group, histological findings revealed spongioid change at the dorsal putamen. The ESR-CT image showed a small spot of uptake of nitroxide radicals in the area of the presumed left putamen which corresponded to the histological ischemic lesion. In the 8 hr occlusion group, the ischemic lesion was found even in the cerebral cortex. The image of nitroxide radical in the brain again closely corresponded to the histological ischemic area and occupied most of the left cerebral hemisphere. However, the area of ESR-CT image was wider than that of histological ischemic lesion. This may be because C-PROXYL leakage in the ischemic lesion diffuses and also because the extent of the efficiency of scavenging free radicals may decline. (K.H.)

  6. Hipertrofia ventricular esquerda em pacientes com doença renal crônica em tratamento conservador Left ventricular hypertrophy in patients with chronic kidney disease under conservative treatment

    Directory of Open Access Journals (Sweden)

    Rachel Bregman

    2010-03-01

    Full Text Available A doença cardiovascular (DCV permanece sendo uma das maiores causas de morte em pacientes com doença renal crônica (DRC. A hipertrofia ventricular esquerda (HVE está presente em 75% dos pacientes ao iniciarem diálise, sugerindo que esta deve estar presente precocemente no curso da DRC. Poucos estudos avaliaram a prevalência de HVE na pré-diálise. Foram avaliados 309 pacientes clinicamente estáveis em acompanhamento por pelo menos três meses em cinco Centros no Brasil. Perfil bioquímico e marcadores inflamatórios foram avaliados. Dados são apresentados como media ± DP. Observamos que a HVE esteve presente em 53% dos pacientes, idade = 60 ± 13 anos, e 55 ± 14 anos para aqueles sem HVE. Diabetes mellitus como doença de base esteve presente em 35% dos pacientes em ambos os grupos. Filtração glomerular estimada foi 30 ± 11 e 32 ± 12 mL/min para pacientes com HVE e sem, respectivamente (p = 0,19. A distribuição de pacientes mostrou que 60% com HVE se encontravam no estágio 4. Análise logística multivariada mostrou que eram determinantes independentes para HVE: idade (p Cardiovascular disease (CVD remains the major cause of death in patients with chronic kidney disease (CKD. Left ventricular hypertrophy (LVH is present in 75% of patients starting dialysis, suggesting that LVH might be present from an early stage of CKD. Few studies have addressed the predialysis prevalence of LVH. This study evaluated 309 clinically stable patients under treatment for at least three months at five Brazilian centers. Biochemical profile and inflammatory markers were assessed. Data were shown as mean ± SD. Left ventricular hypertrophy was present in 53% of the patients, whose mean age was 60 ± 13years. The mean age of those without LVH was 55 ± 14 years. Diabetes mellitus was the underlying disease in 35% of the patients in both groups. Estimated glomerular filtration rate was 30 ± 11 and 32 ± 12 mL/min for patients with and without LVH

  7. Ischemic glans penis after circumcision

    Institute of Scientific and Technical Information of China (English)

    Yuan-ShengTzeng; Shou-HungTang; EnMeng; Teng-FuLin; Guang-HuanSun

    2004-01-01

    A 33-year-old male receiving dorsal penile nerve block (DPNB) for circumcision exhibited a postoperative ischemic change over the glans penis. The event occurred nearly 24 hours after the procedure. The patient was treated with intravenous pentoxifyllin and hyperbaric oxygenation. Total reverse of the ischemia was observed. The complications associated with circumcision and DPNB were reviewed and discussed.

  8. Neuroprotection in acute ischemic stroke

    NARCIS (Netherlands)

    De Keyser, Jacques; Uyttenboogaart, Maarten; Koch, Marcus W; Elting, Jan Willem; Sulter, Geert; Vroomen, Patrick C; Luijckx, Gert Jan

    2005-01-01

    Neuroprotection of patients with acute ischemic stroke should start at the scene and continue in the ambulance with the assessment and treatment of the airway, breathing, circulation, body temperature, and blood glucose. The key goal in eligible patients should be fast vessel recanalization with int

  9. Sex Hormones and Ischemic Stroke

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Nordestgaard, Børge G; Jensen, Gorm B

    2016-01-01

    CONTEXT AND OBJECTIVE: Whether endogenous sex hormones are associated with ischemic stroke (IS) is unclear. We tested the hypothesis that extreme concentrations of endogenous sex hormones are associated with risk of IS in the general population. DESIGN, SETTING, AND PARTICIPANTS: Adult men (n...

  10. Transient Beneficial Effects of Excitatory Theta Burst Stimulation in a Patient with Phonological Agraphia after Left Supramarginal Gyrus Infarction

    Science.gov (United States)

    Nardone, Raffaele; De Blasi, Pierpaolo; Zuccoli, Giulio; Tezzon, Frediano; Golaszewski, Stefan; Trinka, Eugen

    2012-01-01

    We report a patient showing isolated phonological agraphia after an ischemic stroke involving the left supramarginal gyrus (SMG). In this patient, we investigated the effects of focal repetitive transcranial magnetic stimulation (rTMS) given as theta burst stimulation (TBS) over the left SMG, corresponding to the Brodmann area (BA) 40. The patient…

  11. Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors

    OpenAIRE

    Izquierdo, José Luis; Martínez, Arturo; Guzmán, Elizabet; Lucas, Pilar; Rodríguez, José Miguel

    2010-01-01

    The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic heart disease and whether this association is related with a greater prevalence of classical cardiovascular risk factors. Ours is a case-control cross-sectional study design. Cases were hospital patients with ischemic heart disease in stable phase, compared with control hospital patients. All patients underwent post-bronchodilator (PBD) spirometry, a standardize...

  12. Trends in Mortality from Ischemic Heart Disease, Stroke, and Stomach Cancer: from past to future

    NARCIS (Netherlands)

    M. Amiri (Masoud)

    2010-01-01

    textabstractThe common occurrence of chronic diseases – such as ischemic heart diseases (IHD, stroke, and stomach cancer in most populations and the attendant mortality, loss of independence, impaired quality of life, and social and economic costs are compelling reasons for public health concern. A

  13. CTS Trials Network: A paradigm shift in the surgical treatment of moderate ischemic mitral regurgitation?

    Science.gov (United States)

    Afifi, Ahmed

    2015-01-01

    The Cardiothoracic Surgery Trials Network has reported results of the one-year follow up of their randomized trial "Surgical Treatment of Moderate Ischemic Mitral Regurgitation". They studied 301 patients with moderate ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with or without mitral repair with the primary end-point of change in left ventricular end-diastolic volume index (LVEDVI) at one year and multiple clinical and echocardiographic secondary endpoints. Although their results were against repairing the mitral valve, the debate on surgical management of moderate IMR remains unsettled.

  14. Painless Legs and Moving Toes as an Initial Presentation of Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Se Mi Oh

    2009-05-01

    Full Text Available Painless legs and moving toes is an unusual syndrome, which has not previously been reported as an initial presentation of ischemic stroke. We encountered a 78-year-old woman who developed dysarthria and involuntary movement of her left toes that was clinically regarded as painless legs and moving toes. These symptoms appeared abruptly and simultaneously as the initial symptoms of stroke, and improved gradually with conservative management by intravenous hydration for a month. We suggest that, in our case, a cortical brain lesion caused by ischemic stroke might be associated with the development of painless legs and moving toes.

  15. Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke.

    Science.gov (United States)

    Meenakshi-Sundaram, S; Periakaruppan, A; Karuppiah, S N K P; Karthik, S N; Roopakumar, L; Thembavani, I

    2013-12-01

    A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.

  16. Do energy drinks cause epileptic seizure and ischemic stroke?

    Science.gov (United States)

    Dikici, Suber; Saritas, Ayhan; Besir, Fahri Halit; Tasci, Ahmet Hakan; Kandis, Hayati

    2013-01-01

    Energy drinks are popular among young individuals and marketed to college students, athletes, and active individuals between the ages of 21 and 35 years. We report a case that had ischemic stroke and epileptic seizure after intake of energy drink with alcohol. To the best of our knowledge, the following case is the first report of ischemic stroke after intake of energy drink. A previously healthy 37-year-old man was brought to the emergency department after a witnessed tonic-clonic seizure. According to his wife's testimony, just before loss of consciousness, the patient had been drinking 3 boxes of energy drinks (Redbull, Istanbul, Turkey, 250 mL) with vodka on an empty stomach. He did not have a history of seizures, head trauma, or family history of seizures or another disease. In cranial diffusion magnetic resonance imaging, there were hyperintense signal changes in bilateral occipital area (more pronounced in the left occipital lobe), right temporal lobe, frontal lobe, and posterior parietal lobe. All tests associated with possible etiologic causes of ischemic stroke in young patients were negative. Herein, we want to attract attention to adverse effect of energy drink usage.

  17. Posterior circulation ischemic stroke following Russell′s viper envenomation

    Directory of Open Access Journals (Sweden)

    Siddalingana Gouda

    2011-01-01

    Full Text Available Ischemic stroke following viper bite is rare. We report a case of posterior circulation ischemic infarction following viper bite in a previously healthy woman. Soon after being bitten by the snake on the left leg, she developed local redness, echymosis and one hour later became drowsy. On examination she had skew deviation of eyes and down gaze preference, generalized hypotonia. A CT scan of brain showed infarcts in cerebellar hemispheres and occipital lobes on both sides and that was confirmed on magnetic resonance imaging of brain. Her coagulation profile was deranged. Most common and serious central nervous system complication following snake bite is intracranial hemorrhage. Ischemic stroke commonly involves anterior circulation. Bilateral cerebellar and occipital infraction is not yet reported in literature. Exact cause for the development of infarction is not clear. The possible mechanisms of infarction in this scenario are discussed. Patient was treated with anti-snake venom and showed a good recovery. Early imaging and early treatment with anti-snake venom is important for a favorable outcome.

  18. Non-invasive measurement of stroke volume and left ventricular ejection fraction. Radionuclide cardiography compared with left ventricular cardioangiography

    DEFF Research Database (Denmark)

    Kelbaek, H; Svendsen, Jesper Hastrup; Aldershvile, J;

    2011-01-01

    The stroke volume (SV) was determined by first passage radionuclide cardiography and the left ventricular ejection fraction (LVEF) by multigated radionuclide cardiography in 20 patients with ischemic heart disease. The results were evaluated against those obtained by the invasive dye dilution...... or thermodilution and left ventricular cardioangiographic techniques. In a paired comparison the mean difference between the invasive and radionuclide SV was -1 ml (SED 3.1) with a correlation coefficient of 0.83 (p less than 0.01). Radionuclide LVEF values also correlated well with cardioangiographic measurements...

  19. Chronic aseptic meningitis in a patient with systemic lupus erythematosus.

    Science.gov (United States)

    Lancman, M E; Mesropian, H; Granillo, R J

    1989-08-01

    Chronic aseptic meningitis is a rare manifestation of systemic lupus erythematosus. It may occur early in the course of the disease and sometimes may be the initial symptom. We report a patient with chronic aseptic meningitis associated with systemic lupus erythematosus. Magnetic resonance imaging showed several ischemic lesions and an appearance which was compatible with chronic inflammation of the ependyma of the lateral ventricles.

  20. Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011

    Energy Technology Data Exchange (ETDEWEB)

    Gaui, Eduardo Nagib, E-mail: engaui@cardiol.br; Oliveira, Gláucia Maria Moraes de [Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Klein, Carlos Henrique [Escola Nacional de Saúde Pública Sérgio Arouca da Fundação Oswaldo Cruz, Rio de Janeiro, RJ (Brazil)

    2014-06-15

    Circulatory system diseases are the first cause of death in Brazil. To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast), from 1996 to 2011. Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011. Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005. Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes.

  1. Mortality by Heart Failure and Ischemic Heart Disease in Brazil from 1996 to 2011

    Directory of Open Access Journals (Sweden)

    Eduardo Nagib Gaui

    2014-06-01

    Full Text Available Background: Circulatory system diseases are the first cause of death in Brazil. Objective: To analyze the evolution of mortality caused by heart failure, by ischemic heart diseases and by ill-defined causes, as well as their possible relations, in Brazil and in the geoeconomic regions of the country (North, Northeast, Center-West, South and Southeast, from 1996 to 2011. Methods: Data were obtained from DATASUS and death declaration records with codes I20 and I24 for acute ischemic diseases, I25 for chronic ischemic diseases, and I50 for heart failure, and codes in chapter XIII for ill-defined causes, according to geoeconomic regions of Brazil, from 1996 to 2011. Results: Mortality rates due to heart failure declined in Brazil and its regions, except for the North and the Northeast. Mortality rates due to acute ischemic heart diseases increased in the North and Northeast regions, especially from 2005 on; they remained stable in the Center-West region; and decreased in the South and in the Southeast. Mortality due to chronic ischemic heart diseases decreased in Brazil and in the Center-West, South and Southeast regions, and had little variation in the North and in the Northeast. The highest mortality rates due to ill-defined causes occurred in the Northeast until 2005. Conclusions: Mortality due to heart failure is decreasing in Brazil and in all of its geoeconomic regions. The temporal evolution of mortality caused by ischemic heart diseases was similar to that of heart failure. The decreasing number of deaths due to ill-defined causes may represent the improvement in the quality of information about mortality in Brazil. The evolution of acute ischemic heart diseases ranged according to regions, being possibly confused with the differential evolution of ill-defined causes.

  2. Pig model of chronic myocardial ischemia and its investigation by ultrasonic integrated backscatter and Doppler tissue imaging

    Institute of Scientific and Technical Information of China (English)

    XU Jing; ZHAO Bao-zhen; WANG Zhong; GU Jun-yan; LU Shi-ping

    2004-01-01

    Objective: To construct an animal model of chronic ischemic myocardium, and evaluate it by ultrasonic integrated backscatter (IBS) and Doppler tissue imaging (DTI). Methods: An Ameroid constrictor was placed around the porcine left circumflex coronary artery (LCX). The calibrated average image intensity ( % AII), cyclic variation of IBS(CVIB), transmural gradient index (TGI) of CVIB in lateral- posterior wall (LPW), and DTI spectrum of LPW in left ventricular papillary muscle level short axis view (LVPM-SAM) and apical four chamber view (AP-4CV) at normal state, 2, 4,6 and 8 weeks postoperatively were measured. Results: Normal %AII, CVIB and TGI were 2.29 ± 0.32, 9.69 ± 2.22dB and 0.22 ± 0.08, respectively. The % AII increased gradually postoperatively. The CVIB decreased also gradually, and the decrease was higher in subepicardium than in subendocardium. Most of TGI decrease occurred from 2 to 4 weeks postoperatively and became zero at 8 weeks (P < O. 01 ); Normal Vs (peak systolic velocity) of AP-4CV was higher than that of LVPM-SAM ( P < 0.01 ). VE (peak early diastolic velocity) of AP-4CV was lower than that of LVPM-SAM ( P < 0.05). Vs and VE were all decreased after operation ( P < 0.01 ). The decrease of Vs in AP-4CV was greater than that in LVPM-SAM.Conclusion: The pathological changes of the myocardium in human ischemic heart disease (IHD) are similar to that of Ameriod model. IBS and DTI can detect echo changes and ventricular wall motion in chronic ischemic myocardium, and provide more information for clinical investigation and treatment of IHD.

  3. Therapeutic Potential of Non-Psychotropic Cannabidiol in Ischemic Stroke.

    Science.gov (United States)

    Hayakawa, Kazuhide; Mishima, Kenichi; Fujiwara, Michihiro

    2010-07-08

    Cannabis contains the psychoactive component delta⁸-tetrahydrocannabinol (delta⁸-THC), and the non-psychoactive components cannabidiol (CBD), cannabinol, and cannabigerol. It is well-known that delta⁸-THC and other cannabinoid CB₁ receptor agonists are neuroprotective during global and focal ischemic injury. Additionally, delta⁸-THC also mediates psychological effects through the activation of the CB₁ receptor in the central nervous system. In addition to the CB₁ receptor agonists, cannabis also contains therapeutically active components which are CB₁ receptor independent. Of the CB₁ receptor-independent cannabis, the most important is CBD. In the past five years, an increasing number of publications have focused on the discovery of the anti-inflammatory, anti-oxidant, and neuroprotective effects of CBD. In particular, CBD exerts positive pharmacological effects in ischemic stroke and other chronic diseases, including Parkinson's disease, Alzheimer's disease, and rheumatoid arthritis. The cerebroprotective action of CBD is CB₁ receptor-independent, long-lasting, and has potent anti-oxidant activity. Importantly, CBD use does not lead to tolerance. In this review, we will discuss the therapeutic possibility of CBD as a cerebroprotective agent, highlighting recent pharmacological advances, novel mechanisms, and therapeutic time window of CBD in ischemic stroke.

  4. Therapeutic Potential of Non-Psychotropic Cannabidiol in Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Michihiro Fujiwara

    2010-07-01

    Full Text Available Cannabis contains the psychoactive component delta9-tetrahydrocannabinol (delta9-THC, and the non-psychoactive components cannabidiol (CBD, cannabinol, and cannabigerol. It is well-known that delta9-THC and other cannabinoid CB1 receptor agonists are neuroprotective during global and focal ischemic injury. Additionally, delta9-THC also mediates psychological effects through the activation of the CB1 receptor in the central nervous system. In addition to the CB1 receptor agonists, cannabis also contains therapeutically active components which are CB1 receptor independent. Of the CB1 receptor-independent cannabis, the most important is CBD. In the past five years, an increasing number of publications have focused on the discovery of the anti-inflammatory, anti-oxidant, and neuroprotective effects of CBD. In particular, CBD exerts positive pharmacological effects in ischemic stroke and other chronic diseases, including Parkinson’s disease, Alzheimer’s disease, and rheumatoid arthritis. The cerebroprotective action of CBD is CB1 receptor-independent, long-lasting, and has potent anti-oxidant activity. Importantly, CBD use does not lead to tolerance. In this review, we will discuss the therapeutic possibility of CBD as a cerebroprotective agent, highlighting recent pharmacological advances, novel mechanisms, and therapeutic time window of CBD in ischemic stroke.

  5. Ischemic stroke and incomplete infarction

    DEFF Research Database (Denmark)

    Garcia, Javier; Lassen, N A; Weiller, C

    1996-01-01

    The concept of selective vulnerability or selective loss o f individual neurons, with survival of glial and vascular elements as one of the consequences of a systemic ischemic-hypoxic insult (eg, transient cardiac arrest or severe hypotension), has been recognized for decades. In contrast, select......, selective neuronal death as one of the lesions that may develop in the brain after occluding an intracranial artery is an idea not readily acknowledged in the current medical literature dealing with human stroke....

  6. Chronic total occlusion:To treat or not to treat

    Institute of Scientific and Technical Information of China (English)

    Alfredo; Bardají; Judit; Rodriguez-López; Mauricio; Torres-Sánchez

    2014-01-01

    Over the last two decades,there has been increasing interest in new techniques for the percutaneous treatment of coronary chronic total occlusions(CTO),which have a success rate that is much higher than that of a few years ago.The rise in percutaneous treatment for these lesions is due to its ability to improve the symptoms and prognosis of patients in the chronic and stable phase of coronary disease.Current data suggest that successful percutaneous coronary intervention for CTO is associated with improvement in patient symptoms,quality of life,left ventricular function,and survival,compared with those with unsuccessful CTO PCI.However,all the scientific evidence supporting this treatment comes from observational studies,and no randomized study comparing percutaneous treatment with medical treatment has yet been published.A major limitation of these studies is their observational design,with limited information with regard to potential baseline differences between the successful vs unsuccessful cohorts.Pending randomized studies,patients should be selected very carefully,especially if they are asymptomatic or very few symptoms,and the benefits obtained in terms of complications during the procedure,the quality of life obtained and further ischemic events avoided should be evaluated systematically.In this review,we will consider the available information supporting percutaneous treatment for chronic occlusions,as well as the areas of uncertainty where more research projects are required.

  7. Anterior Mitral Leaflet Augmentation for Ischemic Mitral Regurgitation Performed Via a Right Thoracotomy Approach.

    Science.gov (United States)

    Mihos, Christos G; Pineda, Andres M; Horvath, Sofia A; Santana, Orlando

    2016-01-01

    Ischemic mitral regurgitation (MR) after myocardial infarction is associated with poor long-term survival, and the optimal treatment strategy remains debated. The most common repair technique used is a restrictive annuloplasty. However, up to 15% to 30% of patients experience recurrent MR owing to progressive left ventricular remodeling and geometric distortion of the mitral valve apparatus. Anterior mitral leaflet augmentation using a pericardial patch, in combination with a true-sized mitral annuloplasty, has been proposed as an adjunctive technique to increase the durability of valve repair for ischemic MR. Herein, we describe 2 cases of anterior mitral leaflet augmentation with annuloplasty repair for severe ischemic MR via a minimally invasive right thoracotomy, and review the literature regarding patient selection and clinical outcomes of this technique.

  8. Early changes in left atrial volume after acute myocardial infarction

    DEFF Research Database (Denmark)

    Bakkestrom, R.; Andersen, Mads J; Ersboll, M.

    2016-01-01

    Background: Dilatation of left atrium (LA) reflects chronic LA pressure or volume overload that possesses considerable prognostic information. Little is known regarding the interaction between LA remodeling after acute myocardial infarction (MI) and left atrial pressure at rest and during exercise...

  9. Influence of Yishen Huazhuo Therapy on expression of HIF-1αand VEGF in hippocampus of rats with chronic ischemic vascular dementia%益肾化浊法对慢性脑缺血血管性痴呆大鼠脑组织海马HIF-1α和VEGF表达的影响

    Institute of Scientific and Technical Information of China (English)

    王建伟; 金香兰; 刘雪梅; 梁晓; 闫妍; 郑宏; 张允岭

    2015-01-01

    Objective To observe the influence of Yishen Huazhuo Therapy on expression of hy-poxia-inducible factor-1 ( HIF-1α) and vascular endothelial growth factor ( VEGF) in hippocampus of rats with chronic ischemic vascular dementia. Methods Vascular dementia rat models were established by u-sing bilateral carotid artery block method. 7 days after animal model establishment, rats were randomly di-vided into sham-operated group, model group, high, middle and low dosage of Shengcong Particle groups and nicergoline tablets group. After 60 days of treatment, the expression level of HIF-1αand VEGF in hip-pocampus of rats was tested by using Western blot and Real time PCR. Results Compared with sham-op-erated group, the protein and mRNA expression of HIF-1α and VEGF in hippocampus of rats in model group was increased significantly (P<0. 05). Compared with model group, the protein and mRNA expres-sion of HIF-1α and VEGF in hippocampus of rats in high and middle dosage of Shengcong Particle group was increased significantly (P<0. 05, P<0. 01). Conclusion Yishen Huazhuo therapy could improve the status of rats with chronic ischemic vascular dementia and the mechanism might be related with the reg-ulation on expression of HIF-1α and VEGF in hippocampus of rats.%目的:观察益肾化浊法对慢性脑缺血血管性痴呆大鼠脑组织海马低氧诱导因子-1α(hypoxia-inducible factor-1,HIF-1α)和血管内皮生长因子(vascular endothelial growth factor,VEGF)表达的影响。方法采用双侧颈总动脉永久性阻断法建立血管性痴呆大鼠模型,造模后7天随机分为假手术组,模型组和聪圣颗粒低、中、高剂量组和尼麦角林片组,给药治疗60天后,采用Western-blot及Real Time-PCR方法检测大鼠海马HIF-1α、VEGF表达水平。结果与假手术组比较,模型组大鼠HIF-1α和VEGF的蛋白表达量和mRNA的表达量均升高( P<0.05);与模型组比较,聪圣颗粒中、高剂量组可升高模型组HIF-1α

  10. Risk factors and prognosis of ischemic stroke in young patients in Uzbekistan

    Directory of Open Access Journals (Sweden)

    Khurshidakhon Rasulova

    2011-03-01

    Full Text Available Between 2004 and 2008, we studied reasons and risk factors of ischemic stroke in 150 young patients (aged between 17-44 years, compared with those in elderly patients (n=70. According to our data, heredity, arterial hypertension, cerebral vasculitis, thyroid diseases, chronic alcoholism, smoking and long-term use of oral contraceptives are main risk factors of ischemic stroke in the young in Uzbekistan. However, relative risk of stroke in this group of patients is less than in elder patients. In 16% cases, usage of standard diagnostic measures does not lead to identification of the disease cause.

  11. 老年慢性肾脏病患者左心室肥厚危险因素分析%The risk factors of left ventricular hypertrophy of the elderly with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    袁晓玲; 林利容; 何娅妮

    2016-01-01

    Objective To explore the risk factors of left ventricular hypertrophy (LVH)in elderly patients with chronic kidney disease (CKD)1 -4 stages.Methods 1 98 cases of hospitalized patients over 65 years old with CKD in 1 -4 stages were selected and divided into LVH group and non LVH group according to left ventricular mass index(LVMI).Collecting the 24 hours ambulatory blood pressure and laboratory indices to analyze risk factors of LVH in CKD 1 -2 stages and CKD 3-4 stages.Results (1 )In the 1 98 cases of elderly patients with CKD,58 cases with LVH accounted for 29.3%.The prevalence of LVH in CKD 1 -4 stages were 8.1 %,26.2%,36.8% and 60.0%,respectively(P <0.01 ). (2)Compared with non-LVH group,patients in CKD 1 -2 stages with LVH had higher diurnal and nocturnal systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure level (MBP)and nocturnal hypertension incidence.Patients in CKD 3-4 phstages with LVH had higher serum phosphorus, calcium phosphorus product,day and night SBP and non dipper blood pressure rhythm incidence(P <0.05). (3)Diurnal and nocturnal SBP,DBP,MBP and nocturnal hypertension had positive correlation with LVH in CKD 1 -2 stages.Diurnal and nocturnal SBP increasing,non dipper blood pressure rhythm and serum phosphorus,calcium phosphorus product had positively correlation with LVH in patients of CKD 3-4 stages (P <0.05).(4)Women,24h-MBP were the risk factors of LVH in patients with CKD 1 -2 stages.Blood phosphorus and nocturnal SBP were the risk factors of LVH in patients with CKD 3-4 stages.Conclusion LVH in elderly patients with CKD is common.SBP increasing,calcium and phosphorus metabolism,renal function impairment are the significant causes of LVH in the elderly with CKD.%目的:探讨老年慢性肾脏病(CKD)1~4期患者发生左心室肥厚(LVH)的危险因素。方法选取198例 CKD 1~4期年龄≥65岁患者,根据左心室质量指数(LVMI)分为 LVH 组与非 LVH 组。收集动态血压、

  12. Left atrial volume index

    DEFF Research Database (Denmark)

    Poulsen, Mikael K; Dahl, Jordi S; Henriksen, Jan Erik;

    2013-01-01

    To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease.......To determine the prognostic importance of left atrial (LA) dilatation in patients with type 2 diabetes (T2DM) and no history of cardiovascular disease....

  13. Carotid angioplasty with stenting for chronic internal carotid artery occlusion: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Kobayashi, Nozomu; Tanasawa, Toshihiko; Okada, Takeshi; Endo, Otone; Yamamoto, Naohito [Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives, Department of Neurosurgery, Aichi (Japan); Miyachi, Shigeru; Hattori, Kenichi [Nagoya University Graduate School of Medicine, Department of Neurosurgery, Nagoya (Japan)

    2006-11-15

    Carotid angioplasty with stenting (CAS) is becoming accepted as an effective and reliable treatment option for severe carotid artery stenosis. However, it is rarely applied for carotid occlusion, especially in its chronic stage. We report our experience of CAS for chronic internal carotid artery occlusion representing compromised cerebral blood flow using various protection methods. A 77-year-old woman, who was already diagnosed with severe left internal carotid artery stenosis, suddenly had right hemiparesis and aphasia. At that time, she was treated conservatively because her neurological status was quite good, in spite of left carotid artery occlusion. Her symptoms improved in the short term, except slight aphasia, but deteriorated again 18 days from the onset, and magnetic resonance imaging (MRI) showed new ischemic lesions. CAS was then performed for the occluded carotid artery on the 23rd day from the first onset. Using the proximal protection technique, the occluded lesion was crossed carefully with a microguidewire. Stents were also placed successfully with the distal protection technique. The occluded carotid artery was completely recanalized without any unfavorable events or neurological deterioration. In this patient, CAS was successfully to treat chronic carotid artery occlusion. These procedures and techniques are reviewed and discussed. (orig.)

  14. Phosphoproteomic profiling of human myocardial tissues distinguishes ischemic from non-ischemic end stage heart failure.

    Directory of Open Access Journals (Sweden)

    Matthew A Schechter

    Full Text Available The molecular differences between ischemic (IF and non-ischemic (NIF heart failure are poorly defined. A better understanding of the molecular differences between these two heart failure etiologies may lead to the development of more effective heart failure therapeutics. In this study extensive proteomic and phosphoproteomic profiles of myocardial tissue from patients diagnosed with IF or NIF were assembled and compared. Proteins extracted from left ventricular sections were proteolyzed and phosphopeptides were enriched using titanium dioxide resin. Gel- and label-free nanoscale capillary liquid chromatography coupled to high resolution accuracy mass tandem mass spectrometry allowed for the quantification of 4,436 peptides (corresponding to 450 proteins and 823 phosphopeptides (corresponding to 400 proteins from the unenriched and phospho-enriched fractions, respectively. Protein abundance did not distinguish NIF from IF. In contrast, 37 peptides (corresponding to 26 proteins exhibited a ≥ 2-fold alteration in phosphorylation state (p<0.05 when comparing IF and NIF. The degree of protein phosphorylation at these 37 sites was specifically dependent upon the heart failure etiology examined. Proteins exhibiting phosphorylation alterations were grouped into functional categories: transcriptional activation/RNA processing; cytoskeleton structure/function; molecular chaperones; cell adhesion/signaling; apoptosis; and energetic/metabolism. Phosphoproteomic analysis demonstrated profound post-translational differences in proteins that are involved in multiple cellular processes between different heart failure phenotypes. Understanding the roles these phosphorylation alterations play in the development of NIF and IF has the potential to generate etiology-specific heart failure therapeutics, which could be more effective than current therapeutics in addressing the growing concern of heart failure.

  15. Risk factors for ischemic stroke and transient ischemic attack in patients under age 50

    NARCIS (Netherlands)

    Janssen, A.W.M.; Leeuw, F.E. de; Janssen, M.C.H.

    2011-01-01

    To analyze risk factors for ischemic stroke and transient ischemic attack (TIA) in young adults under the age of 50. To make recommendations for additional research and practical consequences. From 97 patients with ischemic stroke or TIA under the age of 50, classical cardiovascular risk factors, co

  16. 应变/应变率成像技术评价冠心病慢性心力衰竭患者左心房功能%Strain and Strain Rate Imaging for Evaluating Left Atrial Function in Patients with Chronic Heart Failure Secondary to Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    刘佳

    2011-01-01

    Echocardiographic strain and strain rate imaging are new technologies used to evaluate myocardial function.Strain and strain rate derived from either tissue Doppler imaging ( TDI ) or two - dimensional speckle tracking have a high sensitivity for the early detection of myocardial dysfunction.Strain and strain rate imaging are used to evaluate left atrial local function of patients with chronic heart failure secondary to coronary artery disease.Left atrial local dysfunction of patients with chronic heart failure can be detected by strain and strain rate imaging in patients without other echocardiographic features of cardiac diastolic function compromise.This article reviews left atrial function, concepts and imaging characteristics of strain and strain rate imaging for evaluating left atrial function, limitations of these technologies, and development prospects.%超声心动图应变和应变率成像是一种评估心肌功能的新技术.源于组织多普勒和二维斑点跟踪的应变和应变率对及早发现心肌功能障碍具有很高的敏感性,可应用于评价冠心病慢性心力衰竭患者左心房的局部功能.应变率成像能够在左心室舒张功能尚无明显改变的情况下,早期发现慢性心力衰竭患者左心房局部功能的异常.现对左心房的功能及其评价价值,应变和应变率的基本概念、成像特点、对左心房功能的评价以及其存在的局限性和发展前景进行简要阐述.

  17. Isolated left posterior insular infarction and convergent roles in verbal fluency, language, memory, and executive function.

    Science.gov (United States)

    Julayanont, Parunyou; Ruthirago, Doungporn; DeToledo, John C

    2016-07-01

    The posterior insular cortex-a complex structure interconnecting various brain regions for different functions-is a rare location for ischemic stroke. We report a patient with isolated left posterior insular infarction who presented with multiple cognitive impairment, including impairment in semantic and phonemic verbal fluency.

  18. Ischemic Stroke and Its Risk Factors in a Registry-Based Large Cross-Sectional Diabetic Cohort in a Country Facing a Diabetes Epidemic

    Directory of Open Access Journals (Sweden)

    Khalid Al-Rubeaan

    2016-01-01

    Full Text Available The main aim of this study is to determine the prevalence and risk factors of ischemic stroke among diabetic patients registered in the Saudi National Diabetes Registry (SNDR database. A cross-sectional sample of 62,681 diabetic patients aged ≥25 years was used to calculate ischemic stroke prevalence and its risk factors. Univariate and multivariate logistic regression analyses were used to assess the roles of different risk factors. The prevalence of ischemic stroke was 4.42% and was higher in the older age group with longer diabetes duration. Poor glycemic control and the presence of chronic diabetes complications were associated with a high risk of ischemic stroke. History of smoking and type 2 diabetes were more frequent among stroke patients. Obesity significantly decreased the risk for ischemic stroke. Regression analysis for ischemic stroke risk factors proved that age ≥45 years, male gender, hypertension, coronary artery disease (CAD, diabetes duration ≥10 years, insulin use, and hyperlipidemia were significant independent risk factors for ischemic stroke. We conclude that ischemic stroke is prevalent among diabetic individuals, particularly among those with type 2 diabetes. Good glycemic, hypertension, and hyperlipidemia control, in addition to smoking cessation, are the cornerstones to achieve a significant reduction in ischemic stroke risk.

  19. Acute Myocardial Infarction: The First Manifestation of Ischemic Heart Disease and Relation to Risk Factors

    Directory of Open Access Journals (Sweden)

    Manfroi Waldomiro Carlos

    2002-01-01

    Full Text Available OBJECTIVE: To assess the association between cardiovascular risk factors and acute myocardial infarction as the first manifestation of ischemic heart disease, correlating them with coronary angiographic findings. METHODS: We carried out a cross-sectional study of 104 patients with previous acute myocardial infarction, who were divided into 2 groups according to the presence or absence of angina prior to acute myocardial infarction. We assessed the presence of angina preceding acute myocardial infarction and risk factors, such as age >55 years, male sex, smoking, systemic arterial hypertension, lipid profile, diabetes mellitus, obesity, sedentary lifestyle, and familial history of ischemic heart disease. On coronary angiography, the severity of coronary heart disease and presence of left ventricular hypertrophy were assessed. RESULTS: Of the 104 patients studied, 72.1% were males, 90.4% were white, 73.1% were older than 55 years, and 53.8% were hypertensive. Acute myocardial infarction was the first manifestation of ischemic heart disease in 49% of the patients. The associated risk factors were systemic arterial hypertension (RR=0.19; 95% CI=0.06-0.59; P=0.04 and left ventricular hypertrophy (RR=0.27; 95% CI=0,.8-0.88; P=0.03. The remaining risk factors were not statistically significant. CONCLUSION: Prevalence of acute myocardial infarction as the first manifestation of ischemic heart disease is high, approximately 50%. Hypertensive individuals more frequently have symptoms preceding acute myocardial infarction, probably due to ventricular hypertrophy associated with high blood pressure levels.

  20. Differential gene expression profile in ischemic myocardium of Wistar rats with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    GUO ChunYu; YIN HuiJun; JIANG YueRong; XUE Mei; SHI DaZhuo

    2008-01-01

    To determine the differential genes in ischemic myocardium of Wistar rats with acute myocardial in-farction (AMI),we constructed two differential gone expression profiles.AMI model was generated by ligation of the left anterior descending coronary artery in Wistar rats.Total RNA was extracted from the normal and the ischemic heart tissues under the ligation point at the 8th day after the operation.Dif-ferential gone expression profiles of the two samples were constructed by using long serial analysis of gone expression (LongSAGE).Real time fluorescence quantitative PCR (Q-PCR) was used to confirm the expression changes of partial target genes.The main results were as follows:a total of 15966 tags were screened from the normal and the ischemic LongSAGE maps,and 9646 tags in the normal tissue and 9563 tags in the ischemic tissue were obtained.Among them,7665 novel tags were identified by NCBI BLAST search.In the ischemic tissue,142 genes significantly changed compared to those in the normal tissue (P<0.05).These differentially expressed genes may play important roles in the pathways of oxidation and phosphoryiation,ATP synthesis and glycolysis and so on.Partial genes identified by the LongSAGE were confirmed by Q-PCR.The results show that AMI causes a series of gone expres-sion changes in the regulation of the pathways related to energy metabolism.

  1. ST/HR slope和功率踏车的慢性心肌缺血诊断系统的设计%Design of chronic myocardial ischemic diagnose system based on ST/HR slope and power test bicycle

    Institute of Scientific and Technical Information of China (English)

    罗小刚; 范超; 彭承琳; 郑小林; 王远亮

    2009-01-01

    针对传统的运用心电试验法诊断慢性心肌缺血时存在的一些缺陷:受试人员做运动试验时对于心电信号的干扰大、运动平板的适用人群有一定的限制、ST段压低的诊断指标敏感性和特异性都不高,设计了基于ST/HR slope诊断指标、功率踏车为运动试验装置的慢性心肌缺血诊断系统.ST/HR slope诊断指标通过计算机程序自动计算获得,免去了人工计算的繁琐与较大的误差;功率踏车能够有效的填补运动平板的应用空缺,降低运动时对心电采集的干扰.经过实验验证,证明该系统与传统系统相比较具有明显的优势,能够为运动心电试验法提供更高的诊断敏感性(93.8%)和特异性(94.5%).%There are some disadvantages in the traditional ECG exercise, such as noises in the acquired ECG, restrictions on the kind of patient who can use this method and the low sensitivity and specificity for the ST depression diagnostic metrics. New equipment for diagnosing Chronic Myocardial Ischemia based on ST/HR slope and power test bicycle is designed. The ST/HR slope is calculated with computer software, avoiding heavy burden and errors for human computation. The power test bicycle decreased noises and improved other disadvantages for treadmill. It is demonstrated with experiments that this system yields better performance with higher sensitivity (93.8%) and specificity (94.5%) than the traditional system does.

  2. Inflamação sistêmica causada pela periodontite crônica em pacientes vítimas de ataque cardíaco isquêmico agudo Systemic inflammation caused by chronic periodontitis in acute ischemic heart attack patients

    Directory of Open Access Journals (Sweden)

    Fernando José de Oliveira

    2010-03-01

    Full Text Available OBJETIVO: Processos inflamatórios e infecciosos mediados por bactérias em sítios distantes têm sido descritos como fator de risco à doença coronariana isquêmica aguda (DCIA. MÉTODOS: Cento e oitenta e um pacientes com DCIA, com e sem periodontites crônicas, foram incluídos neste estudo. Os pacientes foram admitidos no HC da UNICAMP e estratificados em três grupos: grupo 1 - pacientes com periodontite crônica grave (31 homens e 19 mulheres; média de idade 55,1 ± 11,29 anos; grupo 2 - pacientes com periodontite crônica leve (40 homens e 28 mulheres; média de idade 54,8 ± 10,37 anos; grupo 3 - pacientes desdentados (43 homens e 20 mulheres; média de idade 67,5 ± 8,55 anos. Amostras sanguíneas foram coletadas para mensurar os perfis lipídico, hematológico e glicêmico. Além disso, biópsias de 17 artérias coronárias com aterosclerose e igual número de artérias mamárias internas sem degeneração aterosclerótica no grupo 1 foram investigadas. Para análise estatística utilizou-se a análise de variância (ANOVA e o teste de Scheffé para comparações múltiplas. RESULTADOS: Triglicérides e LDL estavam elevados no grupo 1 em relação ao grupo 2. O HDL apresentou-se reduzido em 20% dos pacientes do grupo 1, e em 8% nos desdentados. A glicemia estava elevada no grupo 1. DNA de bactérias periodontais foram detectados em 58,8% das artérias coronárias. CONCLUSÕES: Pacientes com DCIA e periodontite crônica grave podem apresentar perfil lipídico alterado, como também microorganismos associados com as periodontites crônicas graves podem permear dentro de vasos coronarianos.OBJECTIVE: Infectious and inflammatory processes mediated by bacteria in distant sites have been described as a risk factor for acute ischemic heart disease (AIHD. METHODS: One hundred one patients with AIHD with and without chronic periodontitis (CP were included in this study. Patients were admitted to the HC UNICAMP and stratified into three

  3. Early feasibility testing and engineering development of a sutureless beating heart connector for left ventricular assist devices.

    Science.gov (United States)

    Koenig, Steven C; Jimenez, Jorge H; West, Seth D; Sobieski, Michael A; Choi, Young; Monreal, Gretel; Giridharan, Guruprasad A; Soucy, Kevin G; Slaughter, Mark S

    2014-01-01

    APK Advanced Medical Technologies (Atlanta, GA) is developing a sutureless beating heart (SBH) left ventricular assist device (LVAD) connector system consisting of anchoring titanium coil, titanium cannula with integrated silicone hemostatic valve, coring and delivery tool, and LVAD locking mechanism to facilitate LVAD inflow surgical procedures. Feasibility testing was completed in human cadavers (n = 4) under simulated normal and hypertensive conditions using saline to observe seal quality in degraded human tissue and assess anatomic fit; acutely in ischemic heart failure bovine model (n = 2) to investigate short-term performance and ease of use; and chronically for 30 days in healthy calves (n = 2) implanted with HeartWare HVAD to evaluate performance and biocompatibility. Complete hemostasis was achieved in human cadavers and animals at LV pressures up to 170 mm Hg. In animals, off-pump (no cardiopulmonary bypass) anchoring of the connector was accomplished in less than 1 minute with no residual bleeding after full delivery and locking of the LVAD; and implant of connector and LVAD were successfully completed in under 10 minutes with total procedure blood loss less than 100 ml. In chronic animals before necropsy, no signs of leakage or disruption at the attachment site were observed at systolic LV pressures >200 mm Hg.

  4. Left heart catheterization

    Science.gov (United States)

    Catheterization - left heart ... to help guide the catheters up into your heart and arteries. Dye will be injected into your ... in the blood vessels that lead to your heart. The catheter is then moved through the aortic ...

  5. Left-Handed Connections.

    Science.gov (United States)

    Lipson, Alice M.

    1984-01-01

    The following aspects of left-handedness are discussed: etiology and associated learning and developmental disorders; right-brain dominance and how to detect it; adaptations to the physical learning environment; behavior patterns; and teaching techniques. (JW)

  6. Persimmon leaf flavonoid promotes brain ischemic tolerance**

    Institute of Scientific and Technical Information of China (English)

    Mingsan Miao; Xuexia Zhang; Ming Bai; Linan Wang

    2013-01-01

    Persimmon leaf flavonoid has been shown to enhance brain ischemic tolerance in mice, but its mechanism of action remains unclear. The bilateral common carotid arteries were occluded using a micro clip to block blood flow for 10 minutes. After 10 minutes of ischemic preconditioning, 200, 100, and 50 mg/kg persimmon leaf flavonoid or 20 mg/kg ginaton was intragastrical y administered per day for 5 days. At 1 hour after the final administration, ischemia/reperfusion models were estab-lished by blocking the middle cerebral artery for 2 hours. At 24 hours after model establishment, compared with cerebral ischemic rats without ischemic preconditioning or drug intervention, plasma endothelin, thrombomodulin and von Wil ebrand factor levels significantly decreased and intercel-lular adhesion molecule-1 expression markedly reduced in brain tissue from rats with ischemic pre-conditioning. Simultaneously, brain tissue injury reduced. Ischemic preconditioning combined with drug exposure noticeably improved the effects of the above-mentioned indices, and the effects of 200 mg/kg persimmon leaf flavonoid were similar to 20 mg/kg ginaton treatment. These results indicate that ischemic preconditioning produces tolerance to recurrent severe cerebral ischemia. However, persimmon leaf flavonoid can elevate ischemic tolerance by reducing inflammatory reactions and vascular endothelial injury. High-dose persimmon leaf flavonoid showed an identical effect to ginaton.

  7. Genetically determined coagulation disorders in ischemic stroke

    NARCIS (Netherlands)

    M.P.J. van Goor (Marie-Louise)

    2004-01-01

    textabstractThe aim of the research described in this thesis was to investigate the role of genetically determined coagulation disorders in ischemic stroke. We therefore performed several retrospective studies and one prospective case-control study of patients with recent ischemic stroke (the COCOS

  8. Persistent cognitive impairment after transient ischemic attack

    NARCIS (Netherlands)

    Rooij, F.G. van; Schaapsmeerders, P.; Maaijwee, N.A.; Duijnhoven, D.A. van; Leeuw, F.E. de; Kessels, R.P.; Dijk, E.J. van

    2014-01-01

    BACKGROUND AND PURPOSE: By definition, the symptoms of a transient ischemic attack (TIA) subside completely within 24 hours. Imaging studies show signs of persistent ischemic tissue damage in a substantial amount of patients with TIA. Cerebral infarction can cause permanent cognitive impairment. Whe

  9. Persistent Cognitive Impairment After Transient Ischemic Attack

    NARCIS (Netherlands)

    Rooij, F.G. van; Schaapsmeerders, P.; Maaijwee, N.A.M.M.; Duijnhoven, D.A. van; de Leeuw, F.E.; Kessels, R.P.C.; Dijk, E.J. van

    2014-01-01

    Background and Purpose—By definition, the symptoms of a transient ischemic attack (TIA) subside completely within 24 hours. Imaging studies show signs of persistent ischemic tissue damage in a substantial amount of patients with TIA. Cerebral infarction can cause permanent cognitive impairment. Whet

  10. Remote Ischemic Conditioning: Its Benefits and Limitations.

    Science.gov (United States)

    Kloner, Robert A

    2016-03-01

    This editorial describes benefits and limitations of remote ischemic conditioning. Remote ischemic conditioning was shown to reduce myocardial intact size in at least 4 sizeable clinical trials of acute myocardial infarction. It was not effective in recent studies of cardiac surgery. Reasons for these differences are discussed.

  11. Effects of statins on the liver: clinical analysis of patients with ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    ZHANG Li-san; LIU Zheng-xia; L(U) Wen; HU Xing-yue

    2011-01-01

    Background Statins are one of the most common agents prescribed for ischemic stroke patients, but their side effects on the liver are worrisome to both physicians and patients. This study aimed to analyze the features and related factors of the hepatic side effects of, statins in patients with ischemic troke.Methods Four hundred and eighty-one patients with ischemic stroke who had been treated with statins at our department from July 1, 2008 to June 30, 2009 were investigated retrospectively. Liver function, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), within 6 months after they began to use statins and related factors were analyzed.Results The incidence of mild ALT and AST elevation, less than three times the upper limit of normal, and the incidence of moderate elevation, ALT and AST levels 3-10 times the upper limit of normal, in ischemic stroke patients who had been treated with statins were 2.3% and 2.1%, respectively. These incidences were higher than in patients with common hyperlipidemia or coronary heart disease. The relatively high incidence was associated with older age (>65 years) and chronic liver diseases, and was not related to the type of stroke, gender, and reduction of low-density lipoprotein. The levels of ALT and AST normalized after withdrawal of statins or lowering the dosage. None of the patients developed hepatic failure.Conclusions Asymptomatic elevation of ALT and AST after administration of statins is more likely to occur in ischemic stroke patients than in others, and the elevation is related to age and chronic liver diseases. However, statins are still safe for ischemic stroke patients.

  12. Diagnostic Value of Electrocardiographic T Wave Inversion in Lead aVL in Diagnosing Coronary Artery Disease in Patients with Chronic Stable Angina

    Directory of Open Access Journals (Sweden)

    Hatem L. Farhan

    2010-04-01

    Full Text Available Objectives: The clinical value of T wave inversion in lead aVL in diagnosing coronary artery disease (CAD remains unclear. This study aims to investigate the correlation between aVL T wave inversion and CAD in patients with chronic stable angina.Methods: Electrocardiograms (ECGs of 257 consecutive patients undergoing coronary angiography were analyzed. All patients had chronic stable angina. All patients with secondary T wave inversion had been excluded (66 patients. The remaining 191 patients constituted the study population. Detailed ECG interpretation and coronary angiographic findings were conducted by experienced cardiologists.Results: T wave inversion in aVL was identified in 89 ECGs (46.8% with definite ischemic Q-ST-T changes in different leads in 97 ECGs (50.8%. Stand alone aVL T wave inversion was found in 27 ECGs (14.1% while ischemic changes in other leads with normal aVL were identified in 36 ECGs (18.8%. The incidence of CAD was 86.3%. Single, two- and multi-vessel CAD were found in 38.8%, 28.5% and 32.7% of cases respectively. The prevalence of left main, left anterior descending, left circumflex and right coronary arteries were 4.7%, 61.2%, 29.3% and 44.5%, respectively. T wave inversion in aVL was found to be the only ECG variable significantly predicting mid segment left anterior descending artery (LAD lesions (Odds Ratio 2.93, 95% Confidence Interval 1.59-5.37, p=0.001.Conclusion: This study provides new information relating to T wave inversion in lead aVL to mid segment LAD lesions. Implication of this simple finding may help in bedside diagnosis of CAD typically mid LAD lesions. However, further studies are needed to corroborate this finding.

  13. [Acute ischemic proctitis following an epileptic attack

    DEFF Research Database (Denmark)

    Klintmann, C.K.; Hillingso, J.G.; Glenthøj, Andreas

    2008-01-01

    Acute ischemic proctitis is a rare diagnosis mainly because the rectum is supplied by an extensive arterial network. Consequently, in more than 90% of patients with ischemic colitis the rectum is spared. Previously reported cases are related to severe vascular insufficiency of the rectal circulat......Acute ischemic proctitis is a rare diagnosis mainly because the rectum is supplied by an extensive arterial network. Consequently, in more than 90% of patients with ischemic colitis the rectum is spared. Previously reported cases are related to severe vascular insufficiency of the rectal...... circulation caused by systemic atherosclerosis, usually following aortic or aortoiliac operations. We report one case of acute ischemic proctitis following an epileptic attack Udgivelsesdato: 2008/9/29...

  14. Expanding the treatment window with mechanical thrombectomy in acute ischemic stroke

    Energy Technology Data Exchange (ETDEWEB)

    Layton, Kennith F.; Cloft, Harry J.; Kallmes, David F. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); White, J. Bradley [Mayo Clinic, Department of Neurosurgery, Rochester, MN, (United States); Manno, Edward M. [Mayo Clinic, Department of Neurology, Rochester, MN, (United States)

    2006-06-15

    Acute ischemic stroke is a common disease associated with high mortality and significant long-term disability. Treatment options for acute ischemic stroke continue to evolve and include pharmaceutical and mechanical therapies. With the recent US Food and Drug Administration approval of a new device for mechanical thrombectomy, the options available for treatment of acute ischemic stroke have been expanded. Thrombolytic therapy is generally given intravenously in the first 3 h and up to 6 h via the intraarterial route for pharmacological clot disruption. The maximum time-frame for mechanical thrombectomy devices has yet to be determined. A 78-year-old female presented to the emergency room with a dense right hemiparesis, leftward gaze preference and dense global aphasia. Eight hours after symptom onset, left carotid angiography confirmed a left internal carotid artery terminus occlusion. A single pass was made through the clot with an X6 Merci Retriever device. After a single pass, the vessel was reopened and normal flow in the left internal carotid artery was demonstrated. At the time of discharge, her neurological deficits had improved significantly. Furthermore, the final infarct area, as demonstrated on magnetic resonance imaging, was probably much smaller than it would have been if the vessel had not been recanalized. (orig.)

  15. Morbidity predictors in ischemic stroke

    Directory of Open Access Journals (Sweden)

    Panicker J

    2003-01-01

    Full Text Available Background: Although ischemic CVA is one of the leading causes for death and disability, parameters for predicting long-term outcome in such patients have not been clearly delineated, especially in the Indian context. Methods: A prospective hospital-based study of 105 patients of ischemic stroke, focal neurological deficits and functional score was assessed and the C-reactive protein level (CRP was measured. A follow-up was done at 5 days and at 6 months and outcome variable was the functional status at 6 months using Barthel Index of Activities of Daily Living. Accordingly, patients were grouped into 3 - Barthel Index < 41: Severely disabled, Barthel Index 41-60: Moderately disabled and Barthel Index > 60: Mildly disabled. Results: At admission, if upper limb power was less than Medical Research Council (MRC grade 4, or aphasia was present or CRP assay was positive, then at 6 months, these patients most likely belonged to the severely disabled group. If upper limb or lower limb power was greater than MRC grade 3 or there was no aphasia or conjugate gaze deviation or CRP assay was negative, these patients most likely belonged to the mildly disabled group at 6 months. Follow-up rate was 86%. Conclusion: Patients can be stratified according to the predicted prognosis. The treatment and rehabilitation can be properly planned and strictly adhered to in patients predicted to have worse prognosis.

  16. Swallowing disorders after ischemic stroke

    Directory of Open Access Journals (Sweden)

    Gabriela Camargo Remesso

    2011-10-01

    Full Text Available OBJECTIVE: To investigate occurrences of swallowing disorders after ischemic stroke. METHOD: This was a retrospective study on 596 medical files. The inclusion criterion was that the patients needed to have been hospitalized with a diagnosis of ischemic stroke; the exclusion criteria were the presence of associated cardiac problems and hospital stay already more than 14 days. RESULTS: 50.5% were men and 49.5% women; mean age 65.3 years (SD=±11.7 (p<0.001. Among the risk factors, 79.4% had hypertension, 36.7% had diabetes (p<0.001 and 42.7% were smokers. 13.3% of the patients died. Swallowing disorders occurred in 19.6%, among whom 91.5% had mild difficulty and 8.5% had severe difficulty. 87.1% had spontaneous recovery after a mean of 2.4 months. A lesion in the brainstem region occurred in 6.8% (p<0.001. CONCLUSION: Swallowing disorders occurred in almost 20% of the population and most of the difficulty in swallowing found was mild. The predictors for swallowing disorders were older age, diabetes mellitus and lesions in the brainstem region.

  17. Cerebral perfusion SPECT in transient ischemic attack

    Energy Technology Data Exchange (ETDEWEB)

    You, D.-L. E-mail: dlyou@mail.kfcc.org.tw; Shieh, F.-Y.; Tzen, K.-Y.; Tsai, M.-F.; Kao, P.-F

    2000-04-01

    Purpose: The purpose of our study is to evaluate the efficacy of cerebral perfusion single photon emission computerized tomography (SPECT) in patients with transient ischemic attack (TIA). Methods: Thirty-seven patients with TIA were collected for study. All patients had transient focal neurological symptoms or signs with complete recovery within 24 h after onset. The patients underwent cerebral perfusion SPECT between 6 h and 11 days after onset, with 10 cases performed within 24 h (group A), nine cases performed between 1 and 3 days (group B), 11 cases performed between 3 and 5 days (group C), and seven cases performed after more than 5 days (group D). A semi-quantitative method was used for analyzing the SPECT data, and the difference ratios between lesion side and contralateral normal side were calculated on each pair of regions of interest. Results: In total, 78.4% (29/37) of patients had reduced perfusion in the cerebral cortical regions or deep nuclei, and the regions with reduced perfusion corresponded with clinical presentations of the patients. The abnormal rate with reduced perfusion was 90.0% in group A, 77.8% in group B, 72.7% in group C and 71.4% in group D. Cross cerebellar diaschisis (CCD) was present in seven patients, and all of the primary cerebral perfusion defects of these patients were located at the territory of left or right middle cerebral artery. Conclusion: Cerebral perfusion SPECT is a potential tool to detect cerebral perfusion defects and CCD in patients with TIA. Although the perfusion defect may persist more than 5 days after onset, we suggest cerebral perfusion SPECT should be performed as soon as possible.

  18. Vascular and cardiac contractile reserve in the dog heart with chronic multiple coronary occlusions.

    Science.gov (United States)

    Schwarz, F; Flameng, W; Mack, B; Türschmann, W; Schaper, W

    1976-11-01

    Nineteen mongrel dogs survived chronic occlusion of the left circumflex and of the right coronary artery without infarction due to the timely development of a collateral circulation. Only 38 per cent of the conductance of the arteries before occlusion was restored by collateral vessels. In these animals and in 15 control dogs with normal coronary arteries myocardial contractility, contractility reserve, and myocardial blood flow were studied. The same was done in dogs with chronic coronary artery occlusion after aortocoronary bypass. Myocardial blood flow was determined woth the tracer microsphere technique. Contractility reserve was tested and defined as isovolumetric left ventricular pressure and dp/dt max with norepinephrine infusion and cross-clamping of the aorta. Contractile reserve was not significantly different between normal dogs and dogs with chronic coronary artery occlusion before and after aortocoronary bypass. Myocardial blood flow during control conditions was homogenously distributed in all three groups studied. The ratio of blood flow to the endocardium and the epicardium was not significantly different from inity. Coronary reserve was determined at peak reactive hyperemia following a 20 second period of coronary artery occlusion, with ongoing norepinephrine infusion. Under these conditions subendocardial fow in normal dogs rose by a factor of 7.9 while subepicardial flow increased 7.4 times. In dogs with chronic occlusion of two coronary arteries the increase of myocardial flow was nonnomogenous; subendocardial flow to areas supplied by a normal coronary artery rose by a factor of 7.0 while subepicardial flow increased 5.7 times control. Subendocardial collateral flow rose by a factor of 2.4 and subepicardial collateral flow increased 3.5 times control. In normal dogs norepinephrine alone did not result in maximal coronary flow but only 57 per cent thereof. Dogs with chronic coronary occlusion, however, required the entire coronary reserve in

  19. Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Cilingiroglu, Mehmet, E-mail: mcilingiroglu@yahoo.com; Rollefson, William A.; Mego, David

    2013-07-15

    Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute{sup TM} device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation.

  20. Gene electro transfer of plasmid encoding vascular endothelial growth factor for enhanced expression and perfusion in the ischemic swine heart.

    Science.gov (United States)

    Hargrave, Barbara; Strange, Robert; Navare, Sagar; Stratton, Michael; Burcus, Nina; Murray, Len; Lundberg, Cathryn; Bulysheva, Anna; Li, Fanying; Heller, Richard

    2014-01-01

    Myocardial ischemia can damage heart muscle and reduce the heart's pumping efficiency. This study used an ischemic swine heart model to investigate the potential for gene electro transfer of a plasmid encoding vascular endothelial growth factor for improving perfusion and, thus, for reducing cardiomyopathy following acute coronary syndrome. Plasmid expression was significantly greater in gene electro transfer treated tissue compared to injection of plasmid encoding vascular endothelial growth factor alone. Higher gene expression was also seen in ischemic versus non-ischemic groups with parameters 20 Volts (ptransfer of plasmid encoding vascular endothelial growth factor had increased perfusion in the area at risk compared to control groups. Troponin and creatine kinase increased across all groups, suggesting equivalent ischemia in all groups prior to treatment. Echocardiography was used to assess ejection fraction, cardiac output, stroke volume, left ventricular end diastolic volume, and left ventricular end systolic volume. No statistically significant differences in these parameters were detected during a 2-week time period. However, directional trends of these variables were interesting and offer valuable information about the feasibility of gene electro transfer of vascular endothelial growth factor in the ischemic heart. The results demonstrate that gene electro transfer can be applied safely and can increase perfusion in an ischemic area. Additional study is needed to evaluate potential efficacy.

  1. 慢性脑缺血大鼠海马CA1区锥体细胞树突形态及树突棘密度的变化%Changes of dendritic morphology and spine density in hippocampal CA1 pyramidal cells of chronic cerebral ischemic rats

    Institute of Scientific and Technical Information of China (English)

    贾贺; 张博爱; 刘宇; 张小敏; 姬亚杰; 李星; 刘荣丽

    2012-01-01

    目的:研究慢性脑缺血大鼠海马CA1区锥体细胞树突形态及树突棘密度的变化.方法:对大鼠进行双侧颈总动脉永久性结扎(2VO)制备慢性脑缺血模型,分别于2周、4周、8周通过Morris水迷宫对各组大鼠进行行为学评价,筛选造模成功大鼠,进行Golgi染色,光镜下观察海马CA1区锥体细胞树突的分支、长度及树突棘密度的变化.结果:与对照组相比,4周、8周模型组树突的分支及长度显著减少(P<0.01),各周模型组树突棘的密度均有显著减少(P<0.01);模型组内随着缺血时间延长,树突的分支及长度、树突棘密度均显著减少(P<0.05).结论:慢性脑缺血可导致海马CA1区锥体细胞树突及树突棘损伤性变化,从而构成进展性认知功能障碍的病理生理学基础.%AIM:To investigate the changes of dendritic morphology and spine density in hippocampal CA1 pyramidal cells of the chronic cerebral ischemic rats. METHODS:The model of chronic cerebral ischemia was established by permanent occlusion of the bilateral common carotid arteries ( 2VO ) in rats. Two weeks, 4 weeks or 8 weeks later, the behavior of the rats in each group was evaluated through the Morris water maze to select the successful modeling, and the brains were collected for processing Golgi staining. The changes in dendritic branch and length, and spine density in hippocampal CA1 pyramidal cells were observed under optical microscope. RESULTS: Compared with sham - operated group, dendritic branch and length in model group was significantly reduced in 4 -week group and 8 -week group ( P <0. 01 ), and spine density in model group were significantly reduced in 2 -week, 4 -week and 8 -week groups ( P <0. 01 ). With prolonged ischemia, dendritic branch and length, and spine density in model group were all significantly reduced ( P < 0. 05 ). CONCLUSION: Chronic cerebral ischemia leads to traumatic changes in dendrites and spines in hippocampal CA1 pyramidal cells, which

  2. Our Experience in treating Ischemic Ulcer of a Lower Limb in 4 diabetic patients with Autologous Bone Marrow Stem Cells

    Directory of Open Access Journals (Sweden)

    Subrammaniyan SR

    2007-01-01

    Full Text Available Chronic limb ischemia is an outcome of peripheral arterial occlusive disease. When conventional medical and surgical treatments are not feasible, amputation is the only option left. Recent studies report that the injection of bone marrow mononuclear cells and Peripheral blood mononuclear cells rich in CD34+ cells have resulted in symptomatic recovery, improved functional activity of the ischemic limb as well as healing of the ulcers. Here we report our experience with 4 patients of such case where autologous bone marrow mononuclear cells were injected and the patient followed up for 6 months. Materials and Methods: Four patients with critical limb ischemia with ulcers were referred for amputation of their limb. A 68-year-old female with critical limb ischemia with an ulcer in the left leg measuring 30X12 cm over the posterior portion of the leg and extending to the medial aspect of the foot measuring 14X10 cm, a 65-year-old male with necrotic wound in his lower foot, a 69-year-old male with a deep wound in his lower foot and a 61-year-old male with ulcer in his toe amputated with all the toe fingers. The first two patients were given injections for more than one sitting at appropriate intervals specified by the clinician. Under short general anesthesia, 110 ml of Bone marrow was aspirated each time, transported in Acid Citrate Dextrose and was processed for mononuclear cells (MNC by Ficoll density gradient centrifugation, following the cGMP protocols. The MNC concentrate was injected at various sites in the Gastrocnemius muscle and the surrounding area after necessary debridement. Skin grafting was performed in the first two patients and followed up for a period of at regular intervals of 6 to 9 months. The patients have been followed up at regular intervals for six months after the treatment with investigations such as Ankle-Brachial Index, Doppler and Angiogram.Results: All the patients showed improvements with healthy granulation gradually

  3. Ischemic preconditioning reduces ischemic brain injury by suppressing nuclear factor kappa B expression and neuronal apoptosis

    Institute of Scientific and Technical Information of China (English)

    Songsheng Shi; Weizhong Yang; Xiankun Tu; Chunmei Chen; Chunhua Wang

    2013-01-01

    Ischemic stroke induces a series of complex pathophysiological events including blood-brain barrier disruption, inflammatory response and neuronal apoptosis. Previous studies demonstrate that ischemic preconditioning attenuates ischemic brain damage via inhibiting blood-brain barrier disruption and the inflammatory response. Rats underwent transient (15 minutes) occlusion of the bilateral common carotid artery with 48 hours of reperfusion, and were subjected to permanent middle cerebral artery occlusion. This study explored whether ischemic preconditioning could reduce ischemic brain injury and relevant molecular mechanisms by inhibiting neuronal apoptosis. Results found that at 72 hours following cerebral ischemia, myeloperoxidase activity was enhanced, malondialdehyde levels increased, and neurological function was obviously damaged. Simultaneously, neuronal apoptosis increased, and nuclear factor-κB and cleaved caspase-3 expression was significantly increased in ischemic brain tissues. Ischemic preconditioning reduced the cerebral ischemia-induced inflammatory response, lipid peroxidation, and neurological function injury. In addition, ischemic preconditioning decreased nuclear factor-κB p65 and cleaved caspase-3 expression. These results suggested that ischemic preconditioning plays a protective effect against ischemic brain injury by suppressing the inflammatory response, reducing lipid peroxidation, and neuronal apoptosis via inhibition of nuclear factor-κB and cleaved caspase-3 expression.

  4. Hypoplastic left heart syndrome (image)

    Science.gov (United States)

    Hypoplastic left heart syndrome is a congenital heart condition that occurs during the development of the heart in the ... womb. During the heart's development, parts of the left side of the heart (mitral valve, left ventricle ...

  5. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... alcohol abuse over many years. Repeated episodes of acute ... chronic pancreatitis. Genetics may be a factor in some cases. ...

  6. Mild hypothermia reduces cardiac post-ischemic reactive hyperemia

    Directory of Open Access Journals (Sweden)

    Van der Pals Jesper

    2007-02-01

    Full Text Available Abstract Background In experimentally induced myocardial infarction, mild hypothermia (33–35°C is beneficial if applied prior to ischemia or reperfusion. Hypothermia, when applied after reperfusion seems to confer little or no benefit. The mechanism by which hypothermia exerts its cell-protective effect during cardiac ischemia remains unclear. It has been hypothesized that hypothermia reduces the reperfusion damage; the additional damage incurred upon the myocardium during reperfusion. Reperfusion results in a massive increase in blood flow, reactive hyperemia, which may contribute to reperfusion damage. We postulated that hypothermia could attenuate the post-ischemic reactive hyperemia. Methods Sixteen 25–30 kg pigs, in a closed chest model, were anesthetized and temperature was established in all pigs at 37°C using an intravascular cooling catheter. The 16 pigs were then randomized to hypothermia (34°C or control (37°C. The left main coronary artery was then catheterized with a PCI guiding catheter. A Doppler flow wire was placed in the mid part of the LAD and a PCI balloon was then positioned proximal to the Doppler wire but distal to the first diagonal branch. The LAD was then occluded for ten minutes in all pigs. Coronary blood flow was measured before, during and after ischemia/reperfusion. Results The peak flow seen during post-ischemic reactive hyperemia (during the first minutes of reperfusion was significantly reduced by 43 % (p Conclusion Mild hypothermia significantly reduces post-ischemic hyperemia in a closed chest pig model. The reduction of reactive hyperemia during reperfusion may have an impact on cardiac reperfusion injury.

  7. Melatonin protects against ischemic heart failure in rats.

    Science.gov (United States)

    Şehirli, Ahmet Özer; Koyun, Derya; Tetik, Şermin; Özsavcı, Derya; Yiğiner, Ömer; Çetinel, Şule; Tok, Olgu Enis; Kaya, Zehra; Akkiprik, Mustafa; Kılıç, Ertugrul; Şener, Göksel

    2013-09-01

    Ischemic injury, which occurs as a result of sympathetic hyperactivity, plays an important role in heart failure. Melatonin is thought to have antiatherogenic, antioxidant, and vasodilatory effects. In this study, we investigated whether melatonin protects against ischemic heart failure (HF). In Wistar albino rats, HF was induced by left anterior descending (LAD) coronary artery ligation and rats were treated with either vehicle or melatonin (10 mg/kg) for 4 weeks. At the end of this period, echocardiographic measurements were recorded and the rats were decapitated to obtain plasma and cardiac tissue samples. Lactate dehydrogenase, creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lysosomal enzymes (β-D-glucuronidase, β-galactosidase, β-D-N-acetyl-glucosaminidase, acid phosphatase, and cathepsin-D) were studied in plasma samples, while malondialdehyde and glutathione levels and Na+, K+-ATPase, caspase-3 and myeloperoxidase activities were determined in the cardiac samples. Sarco/endoplasmic reticulum calcium ATPase (SERCA) and caveolin-3 levels in cardiac tissues were evaluated using Western blot analyses. Furthermore, caveolin-3 levels were also determined by histological analyses. In the vehicle-treated HF group, cardiotoxicity resulted in decreased cardiac Na+, K+-ATPase and SERCA activities, GSH contents and caveolin-3 levels, while plasma LDH, CK, and lysosomal enzyme activities and cardiac MDA and Myeloperoxidase (MPO) activities were found to be increased. On the other hand, melatonin treatment reversed all the functional and biochemical changes. The present results demonstrate that Mel ameliorates ischemic heart failure in rats. These observations highlight that melatonin is a promising supplement for improving defense mechanisms in the heart against oxidative stress caused by heart failure.

  8. Artificial Left Ventricle

    CERN Document Server

    Ranjbar, Saeed; Meybodi, Mahmood Emami

    2014-01-01

    This Artificial left ventricle is based on a simple conic assumption shape for left ventricle where its motion is made by attached compressed elastic tubes to its walls which are regarded to electrical points at each nodal .This compressed tubes are playing the role of myofibers in the myocardium of the left ventricle. These elastic tubes have helical shapes and are transacting on these helical bands dynamically. At this invention we give an algorithm of this artificial left ventricle construction that of course the effect of the blood flow in LV is observed with making beneficiary used of sensors to obtain this effecting, something like to lifegates problem. The main problem is to evaluate powers that are interacted between elastic body (left ventricle) and fluid (blood). The main goal of this invention is to show that artificial heart is not just a pump, but mechanical modeling of LV wall and its interaction with blood in it (blood movement modeling) can introduce an artificial heart closed to natural heart...

  9. Comparison of Benefits from Cardiac Resynchronization Therapy between Patients with Ischemic Cardiomyopathy and Patients with Idiopathic Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Talia Alenabi

    2009-06-01

    Full Text Available Background: Cardiac resynchronization therapy (CRT is an effective treatment for patients with moderate to severe heart failure. However, 20-30% of patients remain non-responders to CRT. We sought to identify which patients benefit the most from CRT in regard to the etiology of heart failure. Methods: Eighty-three consecutive patients (62 men who had a biventricular pacemaker inserted at Tehran Heart Center between May 2004 and March 2007 were evaluated retrospectively. The inclusion criteria were comprised of New York Heart Association (NYHA class III or IV, left ventricular ejection fraction120ms. After 6 months, response was defined as being alive, no hospitalization for cardiac decompensation, and an improvement in NYHA class>1 grade. Results: After 6 months, 60 patients out of the 83 patients were responders. Amongst the 83 patients, 48 had ischemic cardiomyopathy and 35 had non-ischemic cardiomyopathy. A cross-tabulation of response versus etiology showed no significant difference between ischemic versus non-ischemic cardiomyopathy with regard to response to CRT (P=0.322. Conclusion: According to our study, there was no difference in response to CRT between ischemic versus non-ischemic cardiomyopathy at six months’ follow-up.

  10. MYOCARDIAL DEFORMATION AND COMPLETE LEFT BUNDLE BRANCH BLOCK

    Directory of Open Access Journals (Sweden)

    E. N. Pavlyukova

    2015-12-01

    Full Text Available Tissue Doppler imaging is evolving as a useful echocardiographic tool for quantitative assessment of left ventricular systolic and diastolic function. Over the last 10 years, myocardial deformation imaging has become possible initially with tissue Doppler , and more recently with myocardial speckle-tracking using 2D echocardiography. Unlike simple tissue velocity measurements, deformation measurements are specific for the region of interest. Strain rate or strain measurements have been used as sensitive indicators for subclinical diseases, and it is the most widely used tool to assess mechanical dyssynchrony. Left bundle branch block is a frequent, etiologically heterogeneous, clinically hostile and diagnostically challenging entity. About 2% of patients underwent cardiac stress testing show stable or intermittent left bundle branch block. Presence of left bundle branch block is associated with a lower and slower diastolic coronary flow velocity especially during hyperemia. Stress echocardiography is the best option for the diagnosis of ischemic heart disease, albeit specificity and sensitivity reduce in patients with left bundle branch block in the territory of left anterior descending artery in presence of initial septum dyskinesia.

  11. Immune mechanisms in cerebral ischemic tolerance

    Directory of Open Access Journals (Sweden)

    Lidia eGarcia-Bonilla

    2014-03-01

    Full Text Available Stressor-induced tolerance is a central mechanism in the response of bacteria, plants, and animals to potentially harmful environmental challenges. This response is characterized by immediate changes in cellular metabolism and by the delayed transcriptional activation or inhibition of genetic programs that are not generally stressor specific (cross-tolerance. These programs are aimed at countering the deleterious effects of the stressor. While induction of this response (preconditioning can be established at the cellular level, activation of systemic networks is essential for the protection to occur throughout the organs of the body. This is best signified by the phenomenon of remote ischemic preconditioning, whereby application of ischemic stress to one tissue or organ induces ischemic tolerance in remote organs through humoral, cellular and neural signaling. The immune system is an essential component in cerebral ischemic tolerance acting simultaneously both as mediator and target. This dichotomy is based on the fact that activation of inflammatory pathways is necessary to establish ischemic tolerance and that ischemic tolerance can be, in part, attributed to a subdued immune activation after index ischemia. Here we describe the components of the immune system required for induction of ischemic tolerance and review the mechanisms by which a reprogrammed immune response contributes to the neuroprotection observed after preconditioning. Learning how local and systemic immune factors participate in endogenous neuroprotection could lead to the development of new stroke therapies.

  12. Characteristics of Misclassified CT Perfusion Ischemic Core in Patients with Acute Ischemic Stroke.

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    Ralph R E G Geuskens

    Full Text Available CT perfusion (CTP is used to estimate the extent of ischemic core and penumbra in patients with acute ischemic stroke. CTP reliability, however, is limited. This study aims to identify regions misclassified as ischemic core on CTP, using infarct on follow-up noncontrast CT. We aim to assess differences in volumetric and perfusion characteristics in these regions compared to areas that ended up as infarct on follow-up.This study included 35 patients with >100 mm brain coverage CTP. CTP processing was performed using Philips software (IntelliSpace 7.0. Final infarct was automatically segmented on follow-up noncontrast CT and used as reference. CTP and follow-up noncontrast CT image data were registered. This allowed classification of ischemic lesion agreement (core on CTP: rMTT≥145%, aCBV<2.0 ml/100g and infarct on follow-up noncontrast CT and misclassified ischemic core (core on CTP, not identified on follow-up noncontrast CT regions. False discovery ratio (FDR, defined as misclassified ischemic core volume divided by total CTP ischemic core volume, was calculated. Absolute and relative CTP parameters (CBV, CBF, and MTT were calculated for both misclassified CTP ischemic core and ischemic lesion agreement regions and compared using paired rank-sum tests.Median total CTP ischemic core volume was 49.7ml (IQR:29.9ml-132ml; median misclassified ischemic core volume was 30.4ml (IQR:20.9ml-77.0ml. Median FDR between patients was 62% (IQR:49%-80%. Median relative mean transit time was 243% (IQR:198%-289% and 342% (IQR:249%-432% for misclassified and ischemic lesion agreement regions, respectively. Median absolute cerebral blood volume was 1.59 (IQR:1.43-1.79 ml/100g (P<0.01 and 1.38 (IQR:1.15-1.49 ml/100g (P<0.01 for misclassified ischemic core and ischemic lesion agreement, respectively. All CTP parameter values differed significantly.For all patients a considerable region of the CTP ischemic core is misclassified. CTP parameters significantly

  13. Amelioration of myocardial ischemic reperfusion injury with Calendula officinalis.

    Science.gov (United States)

    Ray, Diptarka; Mukherjee, Subhendu; Falchi, Mario; Bertelli, Aldo; Das, Dipak K

    2010-12-01

    Calendula officinalis of family Asteraceae, also known as marigold, has been widely used from time immemorial in Indian and Arabic cultures as an anti-inflammatory agent to treat minor skin wound and infections, burns, bee stings, sunburn and cancer. At a relatively high dose, calendula can lower blood pressure and cholesterol. Since inflammatory responses are behind many cardiac diseases, we sought to evaluate if calendula could be cardioprotective against ischemic heart disease Two groups of hearts were used: the treated rat hearts were perfused with calendula solution at 50 mM in KHB buffer (in mM: sodium chloride 118, potassium chloride 4.7, calcium chloride 1.7, sodium bicarbonate 25, potassium biphosphate 0.36, magnesium sulfate 1.2, and glucose 10) for 15 min prior to subjecting the heart to ischemia, while the control group was perfused with the buffer only. Calendula achieved cardioprotection by stimulating left ventricular developed pressure and aortic flow as well as by reducing myocardial infarct size and cardiomyocyte apoptosis. Cardioprotection appears to be achieved by changing ischemia reperfusion-mediated death signal into a survival signal by modulating antioxidant and anti-inflammatory pathways as evidenced by the activation of Akt and Bcl2 and depression of TNFα. The results further strengthen the concept of using natural products in degeneration diseases like ischemic heart disease.

  14. Cardioprotection of ischemic preconditioning in rats involves upregulating adiponectin.

    Science.gov (United States)

    Wang, Hui; Wu, Wenjing; Duan, Jun; Ma, Ming; Kong, Wei; Ke, Yuannan; Li, Gang; Zheng, Jingang

    2017-02-20

    It has been reported that ischemic preconditioning (IPC) and adiponectin (APN) are cardioprotective in many cardiovascular disorders. However, whether APN mediates the effect of IPC on myocardial injury has not been elucidated. This study was conducted to investigate whether IPC affects myocardial ischemic injury by increasing APN expression. Male adult rats with cardiac knockdowns of APN and its receptors via intramyocardial small-interfering RNA injection were subjected to IPC and then myocardial infarction (MI) at 24 h post-IPC. Globular APN (gAd) was injected at 10 min before MI. APN mRNA and protein levels in myocardium as well as the plasma APN concentration were markedly high at 6 and 12 h after IPC. IPC ameliorated myocardial injury as evidenced by improved cardiac functions and a reduced infarct size. Compared with the control MI group, rats in the IPC + MI group had elevated levels of left ventricular ejection fraction and fractional shortening, and a smaller MI size (PIPC are partially due to upregulation of APN, and provide a further insight into IPC-mediated signaling effects.

  15. Foot Skin Ischemic Necrosis following Heel Prick in a Newborn

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    Esad Koklu

    2013-01-01

    Full Text Available There are only a few reports on side effects after heel prick in neonates although heel prick has been performed all over the world for many years. The medicine staff had obtained only a drop of blood by pricking the baby’s heel using a lancet without compressing the heel or foot to measure his blood glucose level 3 hours after birth. However he developed a severe and hemorrhagic skin reaction on his entire left foot, beginning 30 minutes after obtaining the drop of blood by pricking the baby’s heel using a lancet. The lesion, which was treated with topical mupirocin and povidone-iodine solution daily, slowly decreased in size and had almost fully resolved within 3 weeks. He was healthy and 9 months old at the time of writing this paper. We herein report a case of foot skin ischemic necrosis following heel prick in a newborn. To our knowledge this patient is the first case of foot skin ischemic necrosis due to heel prick in newborns.

  16. PERSISTENT LEFT SUPERIOR VENACAVA

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    Devinder Singh

    2014-05-01

    Full Text Available A Persistent Left Superior Venacava (PLSVC is the most common variation of the thoracic venous system and rare congenital vascular anomaly and is prevalent in 0.3% of the population. It may be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. Incidental rotation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography. Condition is usually asymptomatic. Here we present a rare case of persistent left superior vena cava presented in OPD with dyspnoea & palpitations.

  17. Cardiovascular complications of chronic renal failure - an updated review.

    Science.gov (United States)

    Roy, G C; Sutradhar, S R; Barua, U K; Datta, N C; Debnath, C R; Hoque, M M; Hossain, A S; Haider, M S; Das, M

    2012-07-01

    Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.

  18. Delayed reflow of an ischemic infarct after spontaneous thrombolysis studied by CBF tomography using SPECT and Tc-99m HMPAO

    DEFF Research Database (Denmark)

    Companioni, J M; Lassen, N A; Tfelt-Hansen, P

    1991-01-01

    A patient with a large ischemic infarct in the left middle cerebral artery territory was studied six times in the acute/subacute phase by cerebral blood flow (CBF) tomography using Tc-99m-HMPAO. The SPECT instrument used was a brain dedicated highly sensitive four-camera system (TOMOMATIC 232) th...... of the occlusion with flows reaching levels above that of the opposite non-affected side ("Luxury Perfusion"). The delayed reflow implies, that SPECT may not constitute a reliable tool for evaluating the success or failure of thrombolytic treatment in ischemic stroke....

  19. Adenosine Preconditioning versus Ischemic Preconditioning in Patients undergoing Off-Pump Coronary Artery Bypass (OPCAB

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    SeyedKhalil Forouzannia

    2015-10-01

    Full Text Available Background: During off-pump coronary artery bypass (OPCAB, the heart is subjected to ischemic and reperfusion injury. Preconditioning is a mechanism that permits the heart to tolerate myocardial ischemia. The aim of this study was to compare the effects of Adenosine preconditioning with ischemic preconditioning on the global ejection fraction (EF in patients undergoing OPCAB.Methods: In this single-blind, randomized controlled trial, sixty patients undergoing OPCAB were allocated into three equally-numbered groups through simple randomization: Adenosine group, ischemic group, and control group. The patients in the Adenosine group received an infusion of Adenosine. In the ischemic group, ischemic preconditioning was induced by the temporary occlusion of the left anterior descending coronary artery twice for a 2-minute period, followed by 3-minute reperfusion before bypass grafting of the first coronary vessel. The control group received an intravenous infusion of 0.9% saline. Blood samples at different times were sent for the measurement of creatine kinase isoenzyme MB (CK-MB and cardiac troponin I (cTnI. We also recorded electrocardiographic indices and clinical parameters, including postoperative use of inotropic drugs and preoperative and postoperative EF.Results: History of myocardial infarction, hyperlipidemia, diabetes mellitus, kidney disease, preoperative arrhythmias, and utilization of postoperative inotrope was the same between the three groups. The incidence of postoperative arrhythmias was not significant between the three groups. Also, there were no significant differences in preoperative and postoperative EF and the serum levels of enzymes (cTnI and CK-MB between the groups.Conclusion: Based on the findings of this study, there was no significant difference in the postoperative EF between the groups. Although the incidence of arrhythmias was higher in the ischemic preconditioning group than in the other groups, the difference

  20. Assessment of left ventricular function by two-dimensional strain imaging in patients with different-stage chronic renal disease%二维应变技术对不同分期慢性肾脏病患者左室功能的评价

    Institute of Scientific and Technical Information of China (English)

    张丽; 林萍; 于妍洁; 赵久阳

    2012-01-01

    目的:探讨二维应变技术(2DS)评价不同分期慢性肾脏病患者左室收缩功能的价值.方法:100名慢性肾脏病患者按肾小球滤过率分为3组,A组(n=30)、B组(n=30)及C组(n=40),同时选取30名健康志愿者为正常对照组,分别取二维条件下心尖四腔切面、心尖两腔切面、心尖长轴切面3个连续心动周期图像.应用2DS获取左室18个节段心肌应变(s)及舒张早期应变率(SRe),并计算整体应变(GLS).结果:A组左室壁部分节段应变、应变率低于正常组.B组除间隔心尖段、下壁基底段、中间段以外,其余各节段收缩期应变均低于正常组,B组、C组各节段舒张早期应变率均低于正常组.其中,C组除前壁中间段、后壁心尖段以外,其他节段均较A组降低.B组、C组整体应变低于正常.结论:二维应变技术可以早期发现慢性肾脏病患者左室心肌收缩及舒张功能的异常.%AIM: To evaluate the application of two-dimensional strain imaging (2DS) in assessing the left ventricular function in patients with chronic renal diseases. METHODS: One hundred patients with chronic renal diseases were divided into three groups: group A (n=30) , group B (n=30) and group C (n=40) according to the severity of the renal disease and underwent 2DS. Thirty two healthy subjects were recruited as control group. Four-chamber apical views, two-chamber apical views and left ventricular long-axis views of two-dimensional images were stored. Longitudinal strain (S) and early diastolic strain rate (SRe) of left ventricular segments were obtained by 2DS software. RESULTS; Compared with those in the control group, the S and SRe in some segments in group A decreased and except for the S of the apical anteroseptum and the basal and middle segments of inferior wall, the S and SRe of each wall of left ventricle in group B also decreased. The S and SRe of all segments in group C significantly decreased compared with those in the control group. Except

  1. Ischemic heart disease in women

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    Stella Iraklianou

    2009-10-01

    Full Text Available Coronary heart disease has long been recognized as the leading cause of death among middle-aged men and an equally important cause of death and disability among older women. Women with acute ischemic syndromes tend to be older than men with such syndromes. This is considered to be attributed to the protective effects of female ovarian sex hormones. Estrogen express an antiatherogenic profile via mechanisms that cause favorable modifications of lipoprotein levels, coagulation and fibrolytic system and alterations in the wall of vessels that cause vasodilation. Women are susceptible to coronary heart disease because of differences in the anatomy and physiology of their vessels. Women's coronary arteries are smaller and have more diffuse disease than men's. Ischemia can be induced in women without flow limiting stenosis because of endothelial dysfunction or coronary spasm. Usually, the way of manifestation of the disease and ECG abnormalities are not typical in women. Female patients usually delay to seek treatment for their symptoms .The way of evaluation and treatment is usually conservative in women than male counterparts. The diagnosis of the disease is overestimated in men and the treatment is more often invasive, even in the category of low risk. Reversely, women of high risk are less likely to undergo a full assessment and invasive diagnostic and therapeutic interventions are seldom. Recommendations of the American Heart Association for ischemic heart disease in women are in accordance to alterations in the way of life interventions in major risk factors such as arterial hypertension, dyslipidemia and diabetes mellitus, preventive use of medications and drugs that are not recommended. In this category of medications belong hormone replacement therapy (HRT.The last is not recommended for primary and secondary prevention of coronary heart disease in women.

  2. A protocol for a randomised, double-blind, placebo-controlled study of the effect of LIraglutide on left VEntricular function in chronic heart failure patients with and without type 2 diabetes (The LIVE Study)

    DEFF Research Database (Denmark)

    Jorsal, Anders; Wiggers, Henrik; Holmager, Pernille;

    2014-01-01

     weeks. The effect of liraglutide on left ventricular function will be evaluated by advanced echocardiography, including three-dimensional contrast echocardiography. ETHICS AND DISSEMINATION: The study will be performed and monitored according to the Good Clinical Practice-International Conference...... on Harmonisation (GCP-ICH) regulations and conducted according to the principles of the Helsinki Declaration. The Danish Medicines Agency, the local Research Ethics Committee and the Danish Data Protection Agency have approved the study. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Identifier: NCT01472640....

  3. Quantitative Measurement of Physical Activity in Acute Ischemic Stroke and Transient Ischemic Attack

    DEFF Research Database (Denmark)

    Strømmen, Anna Maria; Christensen, Thomas; Jensen, Kai

    2014-01-01

    BACKGROUND AND PURPOSE: The purpose of this study was to quantitatively measure and describe the amount and pattern of physical activity in patients within the first week after acute ischemic stroke and transient ischemic attack using accelerometers. METHODS: A total of 100 patients with acute is...... ischemic stroke. The method offers a low cost and noninvasive tool for future clinical interventional physiotherapeutic and early mobilization studies. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01560520....

  4. ISCHEMIA in chronic kidney disease: improving the representation of patients with chronic kidney disease in cardiovascular trials.

    Science.gov (United States)

    Wyatt, Christina M; Shineski, Matthew; Chertow, Glenn M; Bangalore, Sripal

    2016-06-01

    Despite the high cardiovascular risk associated with chronic kidney disease, a recent systematic review confirmed that patients with kidney disease remain underrepresented in cardiovascular trials. Two ongoing trials are assessing the risk:benefit of aggressive evaluation and intervention for ischemic heart disease in patients with advanced chronic kidney disease.

  5. Left or Right

    Institute of Scientific and Technical Information of China (English)

    常厚飞

    2007-01-01

    In Europe people hold the fork in the left hand and the knife in the right throughout the meal, a system that is generally agreed to be more efficient than the American zigzag method. Americans hold both the fork and the knife in their right hands throughout the meal,

  6. Left atrial appendage occlusion

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    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  7. Diagnosis and treatment analysis of elderly chronic pulmonary heart disease combined with left heart failure in 60 cases%老年慢性肺源性心脏病合并左心衰60例诊治探析

    Institute of Scientific and Technical Information of China (English)

    王建仙

    2016-01-01

    目的:分析老年慢性肺源性心脏病合并左心衰的诊治。方法:收治慢性肺源性心脏病合并左心衰老年患者60例,对患者的超声心动图、临床特点、具体治疗资料、胸部X线以及心电图进行回顾性分析。结果:52例治疗好转出院,5例患者病情危重转上级医院治疗,3例患者放弃继续抢救主动出院,1例患者呼吸衰竭死亡。结论:对于慢性肺源性心脏病合并左心衰老年患者,临床治疗中需要高度重视血管扩张剂、利尿剂和相应胶体的使用。%Objective:To analyze the diagnosis and treatment of elderly chronic pulmonary heart disease combined with left heart failure.Methods:60 elderly patients with chronic pulmonary heart disease combined with left heart failure were selected.The echocardiography,clinical features,specific treatment data,chest X-ray and electrocardiogram of patients were retrospectively analyzed.Results:52 cases were treatment improved and discharged.5 patients were transferred to higher level hospitals for treatment due to serious illness.3 patients given up continue to rescue and actively discharged.1 patient was died due to respiratory failure.Conclusion:For the elderly patients with chronic pulmonary heart disease combined with left heart failure,the clinical treatment needs to pay great attention to the use of vascular dilation agents,diuretics and the corresponding colloid.

  8. Enhanced Myocardial Vascularity and Contractility by Novel FGF-1 Transgene in a Porcine Model of Chronic Coronary Occlusion

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    Janet L. Parker

    2008-12-01

    Full Text Available Background: Angiogenesis gene therapy has long been sought as a novel alternative treatment for restoring the blood flow and improving the contractile function of the ischemic heart in selected clinical settings. Angiogenic fibroblast growth factor-1 (FGF-1 is a promising candidate for developing a promising gene therapy protocol due to its multipotent ability to stimulate endothelial cell (EC growth, migration, and tube formation. Despite these advantages, however, FGF gene therapy has suffered setbacks mainly due to the inefficient delivery rate of the growth factor in vivo. Given the potent angiogenic effect of FGF-1, we reasoned that constitutively synthesized minute quantities of this polypeptide hormone, when empowered with the ability to escape the cellular constraint, could freely act in a paracrine/autocrine fashion on nearby existing capillary plexuses and lead to neovascularization and restoration of the blood flow to ischemic tissues for reparative purpose. Methods: We report the direct gene transfer of a retroviral-based mammalian expression vector encoding a secreted form of FGF-1 (sp-FGF-1 for the purpose of therapeutic angiogenesis into the porcine myocardium subjected to the surgical placement of an ameroid occluder to induce the chronic coronary occlusion of the left circumflex coronary artery (LCx and regional myocardial ischemia. Coronary angiography, performed 3 weeks after surgery, confirmed the interruption of the blood flow in the LCx distal to the site of ameroid placement. Results: Immunohistochemical analysis using antibody specific to von Willebrand factor (vWF, an endothelial marker, showed a significant increase (p<0.05 in myocardial vascularity in the sp-FGF-1 hearts compared to the control (vector alone. Importantly, an assessment of the cardiac function by echocardiography, performed 3 weeks after surgery, demonstrated improved cardiac contractility due to increased left ventricular free wall contraction in the

  9. The Clinical Use of Left Ventricular Twist Degree in Chronic Heart Failure Subjects by Three-dimensional Ultrasound Speckle Tracking Imaging%三维斑点追踪技术在慢性心力衰竭患者左室扭转运动中的应用研究

    Institute of Scientific and Technical Information of China (English)

    张艳丽; 王小丛; 赵丽荣; 装莉平; 于微

    2012-01-01

    Objective This study was performed to assess left ventricle twist degree in patients with chronic heart failure by three-dimensional ultrasound speckle tracking imaging. Methods The apical 4-chamber and 2-chamber views were acquired in thirty-two patients with chronic heart failure and thirty-three healthy volunteers .using 3D-trace software to measure values of left ventricle end-diastolic volumes (LVEDV) , end-systolic volumes(LVESV) ,left ventricular ejection fraction (LVEF),basal segment twist degree(BTW),middle segment twist degree(MTW) .apical segment twist degree( ATW) ,left ventricular global twist degree(LVTW). Values were compared in two groups, the correlations between LVEF and LVTW,BTW,MTW, ATW were analyzed respectively. Results LVEF,LVTW,MTW, ATW in CHF patients were lower than the control group .the correlations between BTW,MTW, ATW,LVTW and LVEF were found (0. 557,0. 926,0. 932,0. 945. P<0. 01 for all). Conclusions The left ventricular function was impaired in patients with CHF. The left ventricular twist can be studied by three-dimensional ultrasound speckle tracking imaging, which would be a new tool for the evaluation of left ventricular systolic function.%目的 应用三维斑点追踪显像技术研究慢性心力衰竭患者(CHF)左室扭转的运动特征,探讨其临床价值.方法 CHF组患者30例,年龄匹配的健康志愿者(对照组)33例,采集标准的四腔心及两腔心切面,进行全容积图像存储,应用3D-trace软件进行脱机分析,软件自动分析计算左心室舒张末期容积(LVEDV),左室收缩末期容积(LVESV),左室射血分数(LVEF),左室基底段收缩期扭转角度峰值(BTW),中间段收缩期扭转角度峰值(MTW),心尖段收缩期扭转角度峰值(ATW),左室整体收缩期扭转角度峰值(LVTW).结果 CHF组LVEF,LVTW,MTW,ATW均较正常组减低,BTW、MTW、ATW、LVTW与LVEF之间有明显的相关性,相关系数分别为0.557,0.926,0.932,0.945.结论 CHF患者左心收缩功能明显降

  10. Hypoplastic left heart syndrome

    Directory of Open Access Journals (Sweden)

    Thiagarajan Ravi

    2007-05-01

    Full Text Available Abstract Hypoplastic left heart syndrome(HLHS refers to the abnormal development of the left-sided cardiac structures, resulting in obstruction to blood flow from the left ventricular outflow tract. In addition, the syndrome includes underdevelopment of the left ventricle, aorta, and aortic arch, as well as mitral atresia or stenosis. HLHS has been reported to occur in approximately 0.016 to 0.036% of all live births. Newborn infants with the condition generally are born at full term and initially appear healthy. As the arterial duct closes, the systemic perfusion becomes decreased, resulting in hypoxemia, acidosis, and shock. Usually, no heart murmur, or a non-specific heart murmur, may be detected. The second heart sound is loud and single because of aortic atresia. Often the liver is enlarged secondary to congestive heart failure. The embryologic cause of the disease, as in the case of most congenital cardiac defects, is not fully known. The most useful diagnostic modality is the echocardiogram. The syndrome can be diagnosed by fetal echocardiography between 18 and 22 weeks of gestation. Differential diagnosis includes other left-sided obstructive lesions where the systemic circulation is dependent on ductal flow (critical aortic stenosis, coarctation of the aorta, interrupted aortic arch. Children with the syndrome require surgery as neonates, as they have duct-dependent systemic circulation. Currently, there are two major modalities, primary cardiac transplantation or a series of staged functionally univentricular palliations. The treatment chosen is dependent on the preference of the institution, its experience, and also preference. Although survival following initial surgical intervention has improved significantly over the last 20 years, significant mortality and morbidity are present for both surgical strategies. As a result pediatric cardiologists continue to be challenged by discussions with families regarding initial decision

  11. The comparison of the curative effect between the left univentricular pacing and the biventricular pacing in patients with chronic heart failure%单纯左室起搏与双心室起搏治疗慢性心力衰竭的疗效比较

    Institute of Scientific and Technical Information of China (English)

    王徐乐; 邱春光; 韩战营; 卢文杰; 陈晓杰; 秦石诚; 张瑞芳

    2011-01-01

    目的比较单纯左室起搏与双心室起搏治疗慢性心力衰竭(CHF)的可行性及临床效果.方法选择窦性心律、NYHA心功能分级Ⅲ~Ⅳ级、左室射血分数(LVEF)≤0.35、QRS波时限≥120 ms的CHF患者36例,成功植入心脏再同步化(CRT)起搏器后,随机分为两组,第一组先以右房左室起搏模式治疗(LV起搏模式)7天,然后以右房双室起搏模式治疗(Biv起搏模式)7天;第二组先以Biv治疗7天,然后以LV治疗7天.收集术前、术后第7天、第14天的临床资料,所有数据应用交叉设计资料方差分析及单变量一般线性模型分析.结果6 min步行距离、明尼苏达生活质量评分、体表心电图QRS波时限、左室舒张末期内径、左室射血分数、左室间隔部与侧壁基底段收缩期达峰时间差值等6种评价指标的结果相似:评价指标测量值在处理效应即LV、Biv两种起搏模式上、在顺序效应即两种起搏模式顺序上的差异均无统计学意义(P均>0.05);但在阶段效应即术后第7天、第14天两阶段上的差异有统计学意义(P<0.05).结论单纯左室起搏与双心室起搏治疗CHF的疗效相仿;对窦性心律、完全性左束支传导阻滞的CHF患者,单纯左室起搏可作为CRT的一种选择.%Objective To compare the curative effect of the left univentricular pacing with that of the biventricular pacing in patients with chronic heart failure(CHF). Methods Thirty-six patients who had left ventricular ejection fraction (LVEF) less than or equal to 0.35, a QRS duration greater than or equal to 0.12 seconds, sinus rhythm and New York Heart Association (NYHA) function Class Ⅲ or ambulatory Class Ⅳ heart failure symptoms with optimal medical therapy were divided into two groups randomly after the successful implantation of CRT/CRTD. The first group was wroking first with left univentricular pacing for 7 days, then the biventricular pacing for the next 7 days, and the second group was just the

  12. 25-Hydroxyvitamin D and symptomatic ischemic stroke

    DEFF Research Database (Denmark)

    Brøndum-Jacobsen, Peter; Nordestgaard, Børge G; Schnohr, Peter;

    2013-01-01

    OBJECTIVE: We tested the hypothesis that low plasma concentrations of 25-hydroxyvitamin D are associated with increased risk of symptomatic ischemic stroke in the general population. METHODS: We measured plasma 25-hydroxyvitamin D in 10,170 individuals from the general population, the Copenhagen...... City Heart Study. During 21 years of follow-up, 1,256 and 164 persons developed ischemic and hemorrhagic stroke, respectively. In a meta-analysis of ischemic stroke, we included 10 studies, 58,384 participants, and 2,644 events. RESULTS: Stepwise decreasing plasma 25-hydroxyvitamin D concentrations...... were associated with stepwise increasing risk of ischemic stroke both as a function of seasonally adjusted percentile categories and as a function of clinical categories of 25-hydroxyvitamin D (p for trend ≤ 2 × 10(-3) ). In a Cox regression model comparing individuals with plasma 25-hydroxyvitamin D...

  13. Stuttering Due To Ischemic Stroke

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    Huseyin Alparslan Sahin

    2005-01-01

    Full Text Available Acquired stuttering is a disorder of the fluency of speech. The mechanism underlying stuttering is unknown. It may occur after bilateral and unilateral cortical or subcortical brain damage. We report two cases who had stuttering resulting from left parietal infarction.

  14. Kappa-opioid receptor antagonism improves recovery from myocardial stunning in chronically instrumented dogs.

    Science.gov (United States)

    Grosse Hartlage, Maike A; Theisen, Marc M; Monteiro de Oliveira, Nelson P; Van Aken, Hugo; Fobker, Manfred; Weber, Thomas P

    2006-10-01

    We tested the hypothesis that the selective kappa-opioid receptor antagonist nor-binaltorphimine (nor-BNI) improves recovery from myocardial stunning. Ten dogs were chronically instrumented for measurement of heart rate, left atrial, aortic and left ventricular pressure (LVP), and the maximum rate of LVP increase (LV dP/dt(max)) and decrease (LV dP/dt(max)), coronary blood flow velocity and myocardial wall-thickening fraction. Regional myocardial blood flow was determined with fluorescent microspheres. Catecholamine plasma levels were measured by high-performance liquid chromatography, and beta-endorphin and dynorphin plasma levels by radioimmunoassay. An occluder around the left anterior descending artery (LAD) allowed induction of a reversible LAD-ischemia. Animals underwent two experiments in a randomized crossover fashion on separate days: (a) 10 min LAD-occlusion (control experiment), (b) second ischemic episode 24 h after nor-BNI (2.5 mg/kg IV) (intervention). Dogs receiving nor-BNI showed an increase in wall-thickening fraction, LV dP/dt(max) and LV dP/dt(min) before ischemia and during the whole reperfusion (P < 0.05 versus control experiment). After nor-BNI pretreatment, dynorphin levels increased after induction of ischemia to a peak level of 15.1 +/- 3.6 pg/mL (P < 0.05 versus control experiment). The increase in plasma beta-endorphin during ischemia and early reperfusion was attenuated after nor-BNI. Compared with the control experiment, nor-BNI left global hemodynamics, regional myocardial blood flow, and catecholamine levels unchanged. In conclusion, nor-BNI improves recovery from myocardial stunning after regional myocardial ischemia in chronically instrumented dogs.

  15. Modifiable risk factors for ischemic stroke

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    Alexandros Gianoulakis

    2010-07-01

    Full Text Available Ischemic stroke is the third leading cause of death after cardiac disease and cancer in the developed countries. In patients older than 65 years old, ischemic stroke is one of the main causes of disability. They are also responsible for approximately 4.5 million deaths each year globally.The aim of the present study was to review the literature about the modifiable risk factors related to the development of ischemic stroke.The method οf this study included bibliographic research from both reviews and researches from literature, mainly of the last 8 years. The words used in pub med data base, referred to the modifiable risk factors related to the development of ischemic stroke.Results: In the majority of research studies, responsible risk factors for ischemic stroke are classified according to their ability of modification, in modifiable and non–modifiable risk factors. Some of the modifiable risk factors have been fully documented whereas some others need further research. The main modifiable risk factor is hypertension because on the one hand it promotes atherosclerosis and, on the other hand, leads to deteriorative changes and constrictions of small brain vessels. Atrial fibrillation is the most significant risk factor for ischemic stroke, since it is responsible for more than 50% of thromboembolic cases. Also, patients with diabetes mellitus are in higher risk for developing ischemic stroke compared to healthy population, whereas the danger is increasing in insuline-depented individuals. Increase of lipids in blood and disorders of cholesterol are responsible for atherosclerosis in coronary vessels and carotid. More in detail, carotid stenosis >50% in individuals over than 65 years old consist a significant risk factor for ischemic stroke. Though, the relation of smoking to ischemic stroke is still not fully understood, however smokers are in high risk for developing ischemic stroke for the reason that smoking is significantly related to

  16. Beneficial effect of prolonged heme oxygenase 1 activation in a rat model of chronic heart failure

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    Massimo Collino

    2013-07-01

    We and others have previously demonstrated that heme oxygenase 1 (HO-1 induction by acute hemin administration exerts cardioprotective effects. Here, we developed a rat model of heart failure to investigate whether a long-term induction of HO-1 by chronic hemin administration exerted protective effects. Sprague Dawley rats that underwent permanent ligation of the left coronary artery were closely monitored for survival rate analysis and sacrificed on day 28 post-operation. Administration of hemin (4 mg/kg body weight every other day for 4 weeks induced a massive increase in HO-1 expression and activity, as shown by the increased levels of the two main metabolic products of heme degradation, bilirubin and carbon monoxide (CO. These effects were associated with significant improvement in survival and reduced the extension of myocardial damage. The ischemic hearts of the hemin-treated animals displayed reduced oxidative stress and apoptosis in comparison with the non-treated rats, as shown by the decreased levels of lipid peroxidation, free-radical-induced DNA damage, caspase-3 activity and Bax expression. Besides, chronic HO-1 activation suppressed the elevated levels of myeloperoxidase (MPO activity, interleukin 1β (IL-1β production and tumor necrosis factor-α (TNFα production that were evoked by the ischemic injury, and increased the plasma level of the anti-inflammatory cytokine IL-10. Interestingly, HO-1 inhibitor zinc protoporphyrin IX (ZnPP-IX; 1 mg/kg lowered bilirubin and CO concentrations to control values, thus abolishing all the cardioprotective effects of hemin. In conclusion, the results demonstrate that chronic HO-1 activation by prolonged administration of hemin improves survival and exerts protective effects in a rat model of myocardial ischemia by exerting a potent antioxidant activity and disrupting multiple levels of the apoptotic and inflammatory cascade.

  17. Evaluation of passive cardiomyoplasty using left- and right-ventricular volume measurements by EBCT and MRI in patients with chronic congestive heart failure; Evaluierung der passiven Kardiomyoplastie mittels links- und rechtsventrikulaerer EBCT- und MRT-Volumetrie bei Patienten mit chronischer Herzinsuffizienz

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, A.; Enzweiler, C.N.H.; Wiese, T.H.; Kivelitz, D.E.; Rogalla, P.; Hamm, B. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany); Hotz, H.; Dushe, S.; Konertz, W. [Klinik fuer Kardiovaskulaere Chirurgie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany)

    2003-08-01

    Purpose: To evaluate the efficacy of passive cardiomyoplasty with the determination of biventricular volumes, global systolic function as well as left-ventricular muscle mass. Materials and Methods: In 19 patients with congestive heart failure of idiopathic or ischemic origin, a polyester mesh-graft was implanted around both ventricles for stabilization and functional support. Before and three months after surgery, 15 patients underwent EBCT and 4 patients with impaired renal function underwent MRI, for the evaluation of the volume and ejection fraction of both ventricles. Results: EBCT demonstrated a decrease from 385 to 310 ml in LV-EDV, from 312 to 242 ml in LV-ESV, from 209 to 160 ml in RV-EDV and from 149 to 87 ml in RV-ESV, and an increase from 20 to 26% in LV-EF and from 37 to 50% in RV-EF as well as a reduction of LV-MM from 300 to 274 g (p < 0.05 each). Similar results were obtained by MRI. Conclusion: Following passive cardiomyoplasty, EBCT and MRI revealed an improvement of the global systolic function as well as a reduction of biventricular volumes and left-ventricular muscle mass. (orig.) [German] Ziel: Evaluierung des Therapieerfolges der passiven Kardiomyoplastie durch Bestimmung der biventrikulaeren Volumina und global systolischen Funktion sowie der linksventrikulaeren Muskelmasse. Methoden: Bei 19 Patienten mit idiopathisch und ischaemisch bedingter Herzinsuffizienz erfolgte die Implantation eines Polyesternetzes um die Ventrikel zu deren Stabilisierung und funktioneller Unterstuetzung. Praeoperativ sowie drei Monate postoperativ wurden bei 15 Patienten durch EBCT und bei 4 Patienten mit eingeschraenkter Nierenfunktion durch MRT die Volumina und Ejektionsfraktion beider Ventrikel sowie die linksventrikulaere Muskelmasse bestimmt. Ergebnisse: Die EBCT zeigte eine Abnahme des LV-EDV von 385 auf 310 ml, des LV-ESV von 312 auf 242 ml, des RV-EDV von 209 auf 160 ml und des RV-ESV von 149 auf 87 ml, eine Zunahme der LV-EF von 20 auf 26% und der RV

  18. Effects of topical melatonin and vitamin E in a rat ischemic wound model

    Directory of Open Access Journals (Sweden)

    Turgut Topal

    2011-04-01

    Full Text Available Objective: Reactive oxygen species are known to increase on a chronic wound background. We therefore investigated the possible efficacy of the topical administration of melatonin and vitamin E, known to have radical scavenging properties, in the ischemic wound model. Methods: Forty Sprague-Dawley type adult male rats were divided into 4 groups as normal wound, ischemic group, and with vitamin E or melatonin applied to the ischemic wound. Bipedicular flap surgery to the shaved back of the rats was used to induce ischemia. A full-thickness skin lesion was produced by punch biopsy in each animal 3 days after this procedure. The punch biopsy procedure was performed without the flap surgery in the normal wound group. The vitamin E and melatonin administration continue twice a day for a total of 7 days after the wound was formed. Results: Hydroxyproline (OH-proline and malonyldialdehyde (MDA levels and superoxide dismutase (SOD and glutathione peroxidase (GSH-Px enzyme activities were measured on the wound tissues removed by excisional biopsy at the end of the procedure. The MDA levels were significantly decreased in the groups receiving vitamin E and melatonin compared to the ischemic wound group. Vitamin E application also significantly increased OH-proline levels in the ischemic wounds. The antioxidant enzyme activities were not seen to be affected by the treatment procedures used. Conclusion: We concluded that the collagen synthesis decreased together with increased oxidative stress in the induced ischemic wound model; topical vitamin E application could reverse both states and melatonin could not support collagen synthesis although it had an antioxidant effect. [J Exp Integr Med 2011; 1(2.000: 123-129

  19. Intracranial transplantation of monocyte-derived multipotential cells enhances recovery after ischemic stroke in rats.

    Science.gov (United States)

    Hattori, Hidenori; Suzuki, Shigeaki; Okazaki, Yuka; Suzuki, Norihiro; Kuwana, Masataka

    2012-02-01

    Cell transplantation has emerged as a potential therapy to reduce the neurological deficits caused by ischemic stroke. We previously reported a primitive cell population, monocyte-derived multipotential cells (MOMCs), which can differentiate into mesenchymal, neuronal, and endothelial lineages. In this study, MOMCs and macrophages were prepared from rat peripheral blood and transplanted intracranially into the ischemic core of syngeneic rats that had undergone a left middle cerebral artery occlusion procedure. Neurological deficits, as evaluated by the corner test, were less severe in the MOMC-transplanted rats than in macrophage-transplanted or mock-treated rats. Histological evaluations revealed that the number of microvessels that had formed in the ischemic boundary area by 4 weeks after transplantation was significantly greater in the MOMC-transplanted rats than in the control groups. The blood vessel formation was preceded by the appearance of round CD31(+) cells, which we confirmed were derived from the transplanted MOMCs. Small numbers of bloodvessels incorporating MOMC-derived endothelial cells expressing a mature endothelial marker RECA-1 were detected at 4 weeks after transplantation. In addition, MOMCs expressed a series of angiogenic factors, including vascular endothelial growth factor, angiopoetin-1, and placenta growth factor (PlGF). These findings provide evidence that the intracranial delivery of MOMCs enhances functional recovery by promoting neovascularization in a rat model for ischemic stroke.

  20. Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease%冠脉合并肾动脉狭窄同期血运重建术比单纯冠脉介入更能减轻左室肥厚

    Institute of Scientific and Technical Information of China (English)

    Hao-jian DONG; Cheng HUANG; De-mou LUO; Jing-guang YE; Jun-qing YANG; Guang LI; Jian-fang LUO; Ying-ling ZHOU‡

    2016-01-01

    Percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ven-tricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is stil unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year folow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the folow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.%目的:研究经皮肾动脉支架术(PTRAS)能否在冠脉介入(PCI)基础上进一步改善冠心病合并肾动脉狭窄患者的左室肥厚(LVH)及减少主要心血管不良事件的发生。  创新点:本研究对集中入选全身动脉粥样硬化这类高危患者(冠心病合并肾动脉狭窄(CAD & ARAS))临床

  1. Left musculus sternalis.

    Science.gov (United States)

    Arráez-Aybar, L A; Sobrado-Perez, J; Merida-Velasco, J R

    2003-07-01

    During routine dissection in the Morphological Sciences Department II of the Universidad Complutense de Madrid, the presence of a sternalis muscle was observed in the left hemithorax of a 70-year-old male cadaver. We report on its position, relationships, and innervation, as well as its clinical relevance, indicating some guidelines for its physical examination. We also present a brief overview of the existing literature regarding the nomenclature, historical reports, and incidence of this muscle.

  2. Dilated cardiomyopathy and hypothyroidism associated with pegylated interferon and ribavirin treatment for chronic hepatitis C: case report and literature review

    Directory of Open Access Journals (Sweden)

    Wenxue Zhao

    2014-01-01

    Full Text Available Pegylated interferon alpha (Peg IFN-α in combination with ribavirin is the backbone of treatment in chronic hepatitis C (CHC. Cardiotoxicity due to interferon therapy is rare. The most frequent cardiovascular complications are arrhythmias and ischemic manifestations. Cardiomyopathy is extremely rare but can be life threatening. We present the case of a 41-year-old female patient with CHC in whom Peg IFN-α induced dilated cardiomyopathy and hypothyroidism. Chest radiography showed an enlarged and globular cardiac silhouette and pulmonary congestion. Echocardiography showed decreased left ventricular systolic function with an ejection fraction of 32% and fractional shortening of 15%. Cardiomyopathy had a complete remission after cessation of antiviral therapy with short-term heart failure medications and supportive care. Then we review the current literature about interferon induced cardiomyopathy in patients with HCV infection, as well as share our clinical experience in diagnosing and managing this rare complication.

  3. Clinical experience with ceraxon used in ischemic stroke

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    Vladimir Anatolyevich Parfenov

    2010-01-01

    Full Text Available Citicoline (Ceraxon is a neuroprotective agent used in acute ischemic stroke (IS and chronic cerebrovascular diseases. The efficiency and safety of Ceraxon intravenously in a dose of2000 mg/day for 10 days, then orally for 35 days with evaluation of its effect on cognitive functions were studied in 24 patients (13 men, 11 women; mean age 68.2+9.3 years with IS. During treatment, none of the patients died or developed recurrent stroke, myocardial infarction, or other vascular events. A gradual regression of neurological disorders and a lower degree of disability were observed in most patients (18/24. Ceraxon was found to have a positive effect on cognitive function and their improvement on day 45 after disease onset. The findings agree with the results of the multicenter studies showing the efficacy and safety of citicoline in IS.

  4. Revascularization in severe left ventricular dysfunction.

    Science.gov (United States)

    Velazquez, Eric J; Bonow, Robert O

    2015-02-17

    The highest-risk patients with heart failure with reduced ejection fraction are those with ischemic cardiomyopathy and severe left ventricular systolic dysfunction (ejection fraction≤35%). The cornerstone of treatment is guideline-driven medical therapy for all patients and implantable device therapy for appropriately selected patients. Surgical revascularization offers the potential for improved survival and quality of life, particularly in patients with more extensive multivessel disease and the greatest degree of left ventricular systolic dysfunction and remodeling. These are also the patients at greatest short-term risk of mortality with coronary artery bypass graft surgery. The short-term risks of surgery need to be balanced against the potential for long-term benefit. This review discusses the evolving data on the role of surgical revascularization, surgical ventricular reconstruction, and mitral valve surgery in this high-risk patient population.

  5. Lesson Eleven Transient and intermittent left bundle branch block

    Institute of Scientific and Technical Information of China (English)

    鲁端; 王劲

    2004-01-01

    @@ In transient left bundle branch block,normal intraventricular conduction subsequently returns,if only1temporarily.The condition has also been called paroxysmal,unstable,or temporary left bundle branch block. Its etiology is similar to that of the stable variety2, with the great majority of the patients having ischemic or hypertensive heart disease or both. Transient bundle branch block may complicate acute myocardial infarction or may occur during attacks of angina. It may appear during an episode of congestive heart failure and disappear with improvement of the cardiac status. Most patients eventually develop permanent block. Occasionally,however, the patient may revert to normal conduction even years after consistently demonstrating the block.

  6. Occurrence and predictors of persistent impaired glucose tolerance after acute ischemic stroke or transient ischemic attack

    NARCIS (Netherlands)

    S. Fonville (Susanne); H.M. den Hertog (Heleen); A.A.M. Zandbergen (Adrienne); P.J. Koudstaal (Peter Jan); H.F. Lingsma (Hester)

    2014-01-01

    textabstractBackground Impaired glucose tolerance is often present in patients with a transient ischemic attack (TIA) or ischemic stroke and doubles the risk of recurrent stroke. This impaired glucose tolerance can be transient, reflecting an acute stress response, or persistent, representing undiag

  7. Long-term survival and regeneration of neuronal and vasculature cells inside the core region after ischemic stroke in adult mice.

    Science.gov (United States)

    Jiang, Michael Qize; Zhao, Ying-Ying; Cao, Wenyuan; Wei, Zheng Zachory; Gu, Xiaohuan; Wei, Ling; Yu, Shan Ping

    2016-08-11

    Focal cerebral ischemia results in an ischemic core surrounded by the peri-infarct region (penumbra). Most research attention has been focused on penumbra while the pattern of cell fates inside the ischemic core is poorly defined. In the present investigation, we tested the hypothesis that, inside the ischemic core, some neuronal and vascular cells could survive the initial ischemic insult while regenerative niches might exist many days after stroke in the adult brain. Adult mice were subjected to focal cerebral ischemia induced by permanent occlusion of distal branches of the middle cerebral artery (MCA) plus transient ligations of bilateral common carotid artery (CCA). The ischemic insult uniformly reduced the local cerebral blood flow (LCBF) by 90%. Massive cell death occurred due to multiple mechanisms and a significant infarction was cultivated in the ischemic cortex 24 h later. Nevertheless, normal or even higher levels of brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) persistently remained in the core tissue, some NeuN-positive and Glut-1/College IV-positive cells with intact ultrastructural features resided in the core 7-14 days post stroke. BrdU-positive but TUNEL-negative neuronal and endothelial cells were detected in the core where extensive extracellular matrix infrastructure developed. Meanwhile, GFAP-positive astrocytes accumulated in the penumbra and Iba-1-positive microglial/macrophages invaded the core several days after stroke. The long term survival of neuronal and vascular cells inside the ischemic core was also seen after a severe ischemic stroke induced by permanent embolic occlusion of the MCA. We demonstrate that a therapeutic intervention of pharmacological hypothermia could save neurons/endothelial cells inside the core. These data suggest that the ischemic core is an actively regulated brain region with residual and newly formed viable neuronal and vascular cells acutely and chronically after at

  8. COMPARACIÓN DE ESTRATEGIAS TERAPÉUTICAS PARA EL CONTROL DE LA TENSIÓN ARTERIAL Y LA ANGINA DE PECHO EN PACIENTES CON HIPERTENSIÓN ARTERIAL Y CARDIOPATÍA ISQUÉMICA CRÓNICA EN LA PROVINCIA DE VILLA CLARA. APÉNDICE DEL ESTUDIO INVEST / Comparison of therapeutic strategies for the control of blood pressure and angina in patients with hypertension and chronic ischemic heart disease in the province of Villa Clara. Appendix of INVEST study

    Directory of Open Access Journals (Sweden)

    Omaida J. López Bernal

    2011-06-01

    Full Text Available Background and Objectives: The treatment of hypertension and its complications are a worldwide problem. In our country nearly 25 % of the population over 15 years old is hypertensive, and this figure nearly doubles in those over 60. This research aims to compare two treatment strategies for controlling hypertension in outpatients with chronic coronary ischemic syndrome. Method: A total of 150 patients was included, 73 were randomized to receive calcium antagonist and non-calcium antagonist respectively, as 4 patients were subsequently excluded. Each was asked to sign consent, underwent clinical examination and a 12-lead, conventional electrocardiogram. Blood pressure and episodes of angina were evaluated at 6 months and one year. All variables were entered into a database and statistical analysis was performed using Student's t and Chi square. Results: The mean age was 61,5 years. Women and white skin color were predominant. At 12 months of treatment, blood pressure normalized in more than 80 % of patients without significant differences between the two treatment strategies. Over 75 % of patients in both groups controlled the angina episodes and more than 85 % said the quality of life was good. Conclusions: Control of blood pressure and angina was achieved and there were no significant differences between the two treatment strategies.

  9. Left-sided gall bladder: Report of two cases

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    Chrungoo R

    2007-01-01

    Full Text Available Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.

  10. Free radical scavenger, edaravone, reduces the lesion size of lacunar infarction in human brain ischemic stroke

    Science.gov (United States)

    2011-01-01

    Background Although free radicals have been reported to play a role in the expansion of ischemic brain lesions, the effect of free radical scavengers is still under debate. In this study, the temporal profile of ischemic stroke lesion sizes was assessed for more than one year to evaluate the effect of edaravone which might reduce ischemic damage. Methods We sequentially enrolled acute ischemic stroke patients, who admitted between April 2003 and March 2004, into the edaravone(-) group (n = 83) and, who admitted between April 2004 and March 2005, into the edaravone(+) group (n = 93). Because, edaravone has been used as the standard treatment after April 2004 in our hospital. To assess the temporal profile of the stroke lesion size, the ratio of the area [T2-weighted magnetic resonance images (T2WI)/iffusion-weighted magnetic resonance images (DWI)] were calculated. Observations on T2WI were continued beyond one year, and observational times were classified into subacute (1-2 months after the onset), early chronic (3-6 month), late chronic (7-12 months) and old (≥13 months) stages. Neurological deficits were assessed by the National Institutes of Health Stroke Scale upon admission and at discharge and by the modified Rankin Scale at 1 year following stroke onset. Results Stroke lesion size was significantly attenuated in the edaravone(+) group compared with the edaravone(-) group in the period of early and late chronic observational stages. However, this reduction in lesion size was significant within a year and only for the small-vessel occlusion stroke patients treated with edaravone. Moreover, patients with small-vessel occlusion strokes that were treated with edaravone showed significant neurological improvement during their hospital stay, although there were no significant differences in outcome one year after the stroke. Conclusion Edaravone treatment reduced the volume of the infarct and improved neurological deficits during the subacute period, especially

  11. Recombinant human erythropoietin increases cerebral cortical width index and neurogenesis following ischemic stroke

    Institute of Scientific and Technical Information of China (English)

    Zhongmin Wen; Peiji Wang

    2012-01-01

    The cerebral cortical expansion index refers to the ratio between left and right cortex width and is recognized as an indicator for cortical hyperplasia. Cerebral ischemia was established in CB-17 mice in the present study, and the mice were subsequently treated with recombinant human erythropoietin via subcutaneous injection. Results demonstrated that cerebral cortical width index significantly increased. Immunofluorescence detection showed that the number of nuclear antigen antibody/5-bromodeoxyuridine-positive cells at the infarction edge significantly increased. Correlation analysis revealed a negative correlation between neurological scores and cortical width indices in rats following ischemic stroke. These experimental findings suggested that recombinant human erythropoietin promoted cerebral cortical hyperplasia, increased cortical neurogenesis, and enhanced functional recovery following ischemic stroke.

  12. 血清 B 型钠尿肽水平评估早期慢性阻塞性肺疾病对左心功能的影响%Serum level of B-type natriuretic peptide and its impact on left ventricular function in patients with early chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    廖砲能

    2016-01-01

    目的:探讨血清 B 型钠尿肽水平评估早期慢性阻塞性肺疾病(COPD)对左心功能的影响。方法选取我院2013年1月~2015年7月收治的32例早期 COPD 患者(观察组)以及同期在本院进行健康体检的32例健康人(对照组),对比两组血清 B 型钠尿肽水平与左心室射血分数间的关系。结果本研究中,观察组血清 B 型钠尿肽水平高于对照组(P <0.05),左心室射血分数低于对照组(P <0.05);观察组患者血清 B 型钠尿肽水平与左心室射血分数间呈负相关(P <0.01)。结论早期 COPD 患者随着血清 B 型钠尿肽水平的升高,其左心室射血分数逐渐降低,两者间具有显著相关性。血清 B 型钠尿肽水平可作为早期 COPD 对左心功能影响的评估指标,轻症 COPD 患者左心功能已受影响,在早期治疗 COPD 的同时应及时对患者给予保护左心的治疗。%Objective To explore the impact of serum level of B-type natriuretic peptide on left ventricular function in patients with early chronic obstructive pulmonary disease(COPD).Methods Thirty two patients with early COPD in our hospital from January 2013 to July 2015 were selected as the observation group and 32 healthy persons were chosen as the control group.The relationship be-tween serum B-type natriuretic peptide levels and left ventricular ejection fraction in the two groups were analyzed.Results Serum B-type natriuretic peptide of patients in the observation group was higher than that of the control group(P <0.05)and left ventricular ejec-tion fraction in the observation group was lower than that in the control group(P <0.05).There was a negative correlation between the levels of serum B natriuretic peptide and left ventricular ejection fraction in the observation group(P <0.01).Conclusion With the increase of serum B-type natriuretic peptide levels of patients with early COPD,their left ventricular ejection fraction

  13. Mobilization of bone marrow stem cells by G-CSF in patients with chronic ischemic heart disease after revascularization%骨髓干细胞动员结合冠状动脉介入在慢性缺血性心脏病患者中的疗效观察

    Institute of Scientific and Technical Information of China (English)

    郭士遵; 王宁夫; 叶显华; 周亮; 潘浩; 李虹; 童国新

    2014-01-01

    目的:探究骨髓干细胞动员结合冠状动脉介入(PCI)治疗对慢性缺血性心脏病患者心功能的影响及其安全性。方法收集41例合并有粒细胞减少的慢性缺血性心脏病患者。随机将患者分入对照组和粒细胞集落刺激因子(G- CSF)组。在规范药物治疗和成功进行PCI治疗基础上,G- CSF组接受G- CSF皮下注射。住院及随访期间进行血液学检查、超声心动图检查并进行6min步行试验。结果治疗前两组基线资料、冠状动脉造影以及PCI相关参数差异均无统计学意义(均P>0.05)。在6个月随访时,两组患者缺血节段室壁增厚率、LVEF均较治疗前增加,而Tei指数较治疗前降低(均P<0.05);两组室壁运动评分指数均在随访时得到改善,但与治疗前比较差异无统计学意义,随访变化值差异亦无统计学意义(均P>0.05)。6个月随访时两组LVEDV、Tei指数差异有统计学意义,随访变化值差异亦有统计学意义(均P<0.05)。两组患者6min步行距离的随访变化值无统计学意义(P>0.05)。住院及随访期间两组患者均未出现严重不良心脏事件。结论对慢性缺血性心脏病患者在成功地进行PCI治疗后利用G- CSF进行干细胞动员是安全的,对心功能的改善有一定的积极作用。%Objective To evaluate the efficacy of bone marrow stem cellmobilization by G- CSF in patients with chronic ischemic heart disease (CIHD) after revascularization. Methods Forty one patients with CIHD and granulopenia who had suc-cessful fractional Percutaneous coronary intervention (PCI) were included in the study. Patients were randomized into G- CSF group (G- CSF10μg/kg for 7d) and control group (no G- CSF was given). Patients were fol owed up for 6 months. Results De-mographics, clinical characteristics, and parameter of CAG and PCI were homogeneous between two groups (P>0.05). The wal thickening in severe impaired segment

  14. Neutrosophic Left Almost Semigroup

    Directory of Open Access Journals (Sweden)

    Mumtaz Ali

    2014-06-01

    Full Text Available In this paper we extend the theory of neutrosophy to study left almost semigroup shortly LAsemigroup. We generalize the concepts of LA-semigroup to form that for neutrosophic LA-semigroup. We also extend the ideal theory of LA-semigroup to neutrosophy and discuss different kinds of neutrosophic ideals. We also find some new type of neutrosophic ideal which is related to the strong or pure part of neutrosophy. We have given many examples to illustrate the theory of neutrosophic LA-semigroup and display many properties of neutrosophic LA-semigroup in this paper.

  15. Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

    Institute of Scientific and Technical Information of China (English)

    Junqi Chen; Yong Huang; Xinsheng Lai; Chunzhi Tang; Junjun Yang; Hua Chen; Tongjun Zeng; Junxian Wu; Shanshan Qu

    2013-01-01

    In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan (TE5). In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamillary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11, 20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.

  16. Effect of Gαq/11 Protein and ATP-sensitive Potassium Channels on Ischemic Preconditioning in Rat Hearts

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objectives To investigate the effect of Gαq/11 signaling pathway and ATP-sensitive potassium channel ( KATP channel ) on ischemic preconditioning (IPC) protection in rat hearts.Methods Two series of experiments were performed in Wistar rat hearts. In the first series of experiment,ischemic preconditioning was induced by left anterior descending occlusion (three, 5 min episodes separated by 5 min of reperfusion), ischemia-reperfusion injury was induced by 30 min coronary artery occlusion followed by 90 min reperfusion. Hemodynamics,infarct size and scores of ventricular arrhythmias were measured. The expression of Gαq/11 protein in the heart was measured by Western blot analysis in the second series. Results Ischemic preconditioning rats showed decreased infarct size and scores of ventricular arrhythmia vs non-IP control rats. The effect of IPC was significantly attenuated by glibenclamide (1 mg/kg, ip), a nonselective KATP channel inhibitor. IPC caused a significant increase in the expression of Gαq/11 protein. Conclusions Activations of Gαq/11 signal pathway and KATP channel played significant roles in the classical cardioprotection of ischemic preconditioning rat heart and might be an important mechanism of signal transduction pathway during the ischemic preconditioning.

  17. Thrombophilia And Arterial Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    A.A. Abrishamizadeh

    2017-02-01

    Full Text Available Ischemic stroke (IS is a common cause of morbidity and mortality with significant socioeconomic impact especially when it affects young patients. Compared to the older adults, the incidence, risk factors, and etiology are distinctly different in younger IS. Hypercoagulable states are relatively more commonly detected in younger IS patients. Thrombophilic states are disorders of hemostatic mechanisms that result in a predisposition to thrombosis .Thrombophilia is an established cause of venous thrombosis. Therefore, it is tempting to assume that these disorders might have a similar relationship with arterial thrombosis. Despite this fact that 1-4 % of ischemic strokes are attributed to Thrombophillia, this   alone rarely causes arterial occlusions .Even in individuals with a positive thrombophilia screen and arterial thrombosis, the former might not be the primary etiological factor. Thrombophilic   disorders can be broadly divided into inherited or acquired conditions. Inherited thrombophilic states include deficiencies of natural anticoagulants such as protein C, protein S, and antithrombin III (AT III deficiency, polymorphisms causing resistance to activated protein C(Factor V Leiden mutation, and disturbance in the clotting balance (prothrombin gene 20210G/A variant. Of all the inherited  thrombophilic disorders, Factor V Leiden mutation is perhaps the commonest cause. On the contrary, acquired thrombophilic disorders are more common and include conditions such as the antiphospholipid syndrome, associated with lupus anticoagulant and anticardiolipin antibodies. The more useful and practical approach of ordering various diagnostic tests for the uncommon thrombophilic states tests should be determined by a detailed clinical history, physical examination, imaging studies and evaluating whether an underlying hypercoagulable state appears more likely. The laboratory thrombophilia   screening should be comprehensive and avoid missing the

  18. Recurrent ischemic strokes in a young celiac woman with MTHFR gene mutation

    Institute of Scientific and Technical Information of China (English)

    Elisa Fabbri; Lisa Rustignoli; Antonio Muscari; Giovanni M Puddu; Maria Guarino; Rita Rinaldi; Elena Minguzzi

    2012-01-01

    Celiac disease (CD) is frequently associated with neurological disorders,but very few reports concern the association with ischemic stroke.A 26-year-old woman affected by CD with secondary amenorrhea,carrier of a homozygous 5,10-methylenetetrahydrofolate reductase mutation with hyperhomocysteinemia,was affected by two occipital ischemic strokes within a period of 5 mo.At the time of the second stroke,while she was being treated with folic acid,acetylsalicylic acid and a gluten-free diet,she had left hemianopsia,left hemiparesthesias,and gait imbalance.Brain magnetic resonance imaging showed a subacute right occipital ischemic lesion,which was extended to the dorsal region of the right thalamus and the ipsilateral thalamocapsular junction.Antitransglutaminase and deamidated gliadin peptide antibodies were no longer present,while antinuclear antibodies,antineuronal antibodies and immune circulating complexes were only slightly elevated.Since the patient was taking folic acid,her homocysteine levels were almost normal and apparently not sufficient alone to explain the clinical event.A conventional cerebral angiography showed no signs of vasculitis.Finally,rare causes of occipital stroke in young patients,such as Fabry's disease and mitochondrial myopathy,encephalomyopathy,lactic acidosis and stroke-like symptoms,were also excluded by appropriate tests.Thus,the most probable cause for the recurrent strokes in this young woman remained CD,although the mechanisms involved are still unknown.The two main hypotheses concern malabsorption (with consequent deficiency of vitamins known to exert neurotrophic and neuroprotective effects) and immunemediated mechanisms.CD should be kept in mind in the differential diagnosis of ischemic stroke in young patients.

  19. Effect of zinc supplements in the attenuated cardioprotective effect of ischemic preconditioning in hyperlipidemic rat heart.

    Science.gov (United States)

    Kansal, Sunil Kumar; Jyoti, Uma; Sharma, Samridhi; Kaura, Arun; Deshmukh, Rahul; Goyal, Sandeep

    2015-06-01

    Hyperlipidemia is regarded as independent risk factor in the development of ischemic heart disease, and it can increase the myocardial susceptibility to ischemia-/reperfusion (I/R)-induced injury. Hyperlipidemia attenuates the cardioprotective response of ischemic preconditioning (IPC). The present study investigated the effect of zinc supplements in the attenuated cardioprotective effect of ischemic preconditioning in hyperlipidemic rat hearts. Hyperlipidemia was induced in rat by feeding high-fat diet (HFD) for 6 weeks then the serum lipid profile was observed. In experiment, the isolated Langendorff rat heart preparation was subjected to 4 cycles of ischemic preconditioning (IPC), then 30 min of ischemia followed by 120 min of reperfusion. Myocardial infarct size was elaborated morphologically by triphenyltetrazolium chloride (TTC) staining and biochemically by lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) release from coronary effluent and left ventricular collagen content. However, the effect of zinc supplement, i.e., zinc pyrithione (10 μM) perfused during reperfusion for 120 min, significantly abrogated the attenuated cardioprotective effect of ischemic preconditioning in hyperlipidemic rat heart whereas administration of chelator of this zinc ionophore, i.e., N,N,N',N'-tetrakis(2-pyridylmethyl)ethylene diamine (TPEN; 10 μM), perfused during reperfusion 2 min before the perfusion of zinc pyrithione abrogated the cardioprotective effect of zinc supplement during experiment in hyperlipidemic rat heart. Thus, the administration of zinc supplements limits the infarct size, LDH, and CK-MB and enhanced the collagen level which suggests that the attenuated cardioprotective effect of IPC in hyperlipidemic rat is due to zinc loss during reperfusion caused by ischemia/reperfusion.

  20. Bioluminescence imaging of transplanted human endothelial colony-forming cells in an ischemic mouse model.

    Science.gov (United States)

    Ding, Jie; Zhao, Zhen; Wang, Chao; Wang, Cong-Xiao; Li, Pei-Cheng; Qian, Cheng; Teng, Gao-Jun

    2016-07-01

    Ischemic strokes are devastating events responsible for high mortality and morbidity worldwide each year. Endothelial colony-forming cell (ECFC) therapy holds promise for stroke treatment; however, grafted ECFCs need to be monitored better understand their biological behavior in vivo, so as to evaluate their safety and successful delivery. The objectives of this study are to visualize the fate of infused human cord blood derived ECFCs via bioluminescence imaging (BLI) in an ischemic stroke mouse model and to determine the therapeutic effects of ECFC transplantation. ECFCs derived from human umbilical cord blood were infected with lentivirus carrying enhanced green fluorescent protein (eGFP) and firefly luciferase (Luc2) double fusion reporter gene. Labeled ECFCs were grafted into a photothrombotic ischemic stroke mouse model via intra-arterial injection though the left cardiac ventricle. The homing of infused cells and functional recovery of stroke mice were evaluated using BLI, neurological scoring, and immunohistochemistry. Significantly, BLI signals were highest in the brain on day 1 and decreased steadily until day 14. GFP-positive cells were also found surrounding infarct border zones in brain sections using immunohistochemical staining, suggesting that ECFCs properly homed to the ischemic brain tissue. Using a modified neurological severity score assay and histological analysis of brain slices with CD31 immunostaining in brain tissue, double cortin analysis, and the TdT-mediated dUTP nick end labeling (TUNEL) assay, we demonstrated functional restoration, improved angiogenesis, neurogenesis, and decreased apoptosis in ischemic mice after ECFC infusion. Collectively, our data support that ECFCs may be a promising therapeutic agent for stroke.

  1. Changes in cardiovascular function induced by verapamil in healthy subjects and in patients with ischemic heart disease.

    Science.gov (United States)

    Vincenzi, M; Morlino, T; Allegri, P; Barbieri, E; Cappelletti, F; De Lio, U; Ometto, R; Maiolino, P

    1981-01-01

    Alterations in cardiovascular function induced by the acute intravenous administration of verapamil (5 or 10 mg) in 52 patients (29 with ischemic heart disease and 23 without heart disease) were evaluated with use of invasive techniques (right and left heart catheterization, left ventricular cineangiography, and coronary arteriography). The most significant changes were represented by a decrease in systemic vascular resistance and systemic arterial pressure, and an increase in heart rate and cardiac output. Contractility indexes were not depressed in either group, and altered ventricular wall motion tended to improve to a slightly smaller degree than in patients treated with nitroglycerin. The use of verapamil in patients with ischemic heart disease appears to be safe, and concern about the negative inotropic influences in humans no longer seems justified.

  2. Caffeine prevents protection in two human models of ischemic preconditioning.

    NARCIS (Netherlands)

    Riksen, N.P.; Zhou, Z.; Oyen, W.J.G.; Jaspers, R.A.; Ramakers, B.P.; Brouwer, R.M.H.J.; Boerman, O.C.; Steinmetz, N.; Smits, P.; Rongen, G.A.

    2006-01-01

    OBJECTIVES: We studied whether caffeine impairs protection by ischemic preconditioning (IP) in humans. BACKGROUND: Ischemic preconditioning is critically dependent on adenosine receptor stimulation. We hypothesize that the adenosine receptor antagonist caffeine blocks the protective effect of IP. ME

  3. Digital Ischemic Loss in Systemic Sclerosis

    Directory of Open Access Journals (Sweden)

    Umaima Marvi

    2010-01-01

    Full Text Available Digital ischemic loss is a cause of significant morbidity in patients with systemic sclerosis (SSc. Microvascular disease with intimal proliferation and luminal narrowing of small digital arteries, as well as macrovascular disease with narrowing or occlusion of larger digital arteries, contribute to the perfusion defects involved in digital ischemic loss. Immediate clinical evaluation and treatment are mandatory at the onset of critical digital ischemia to prevent digital loss. Hospitalization for medical therapies including intravenous prostacyclin therapy should be considered for all SSc patients who present with critical digital ischemia. Surgical interventions are typically reserved for patients who fail medical therapies and for those with late stage, necrotic tissue. This paper summarizes the current knowledge regarding the risk factors, pathogenesis, evaluation, and treatment of digital ischemic loss in SSc.

  4. Cerebrovascular arteriopathy (arteriosclerosis) and ischemic childhood stroke.

    Science.gov (United States)

    Daniels, S R; Bates, S; Lukin, R R; Benton, C; Third, J; Glueck, C J

    1982-01-01

    The aim of this report is to describe the intracranial cerebrovascular abnormalities and clinical status of 8 children who had familial lipoprotein disorders and evidence of thromboembolic cerebrovascular disease. Six of the 8 children had low levels of plasma high density lipoprotein cholesterol, two had high triglyceride levels, and all came from kindreds characterized by familial lipoprotein abnormalities and premature cardio- and/or cerebrovascular atherosclerosis. Vascular occlusion, irregularities of the arterial lumen, beading, tortuosity, and evidence of collateralization were consistently noted. We speculate that cerebrovascular arteriosclerosis in pediatric ischemic stroke victims who have familial lipoprotein abnormalities may be related to lipoprotein-mediated endothelial damage and thrombosis formation, or to the failure to restore endothelial cells' integrity following damage. The apparent association of lipoproteins and strokes in children and their families merits further exploration, particularly when assessing cerebral angiograms in pediatric ischemic stroke victims. In children with unexplained ischemic cerebrovascular accidents, the diagnostic possibility of occlusive arteriosclerosis with thrombosis must be entertained.

  5. Short Telomere Length and Ischemic Heart Disease

    DEFF Research Database (Denmark)

    Scheller Madrid, Alexander; Rode, Line; Nordestgaard, Børge Grønne

    2016-01-01

    BACKGROUND: Short telomeres are associated with aging and have been associated with a high risk of ischemic heart disease in observational studies; however, the latter association could be due to residual confounding and/or reverse causation. We wanted to test the hypothesis that short telomeres...... are associated with high risk of ischemic heart disease using a Mendelian randomization approach free of reverse causation and of most confounding. METHODS: We genotyped 3 genetic variants in OBFC1 (oligonucleotide/oligosaccharide binding fold containing 1), TERT (telomerase reverse transcriptase), and TERC...... logistic and instrumental variable analysis for genetic estimates. RESULTS: Observationally, a 200-bp-shorter telomere length was associated with a multivariable adjusted hazard ratio for ischemic heart disease of 1.02 (95% CI, 1.01-1.03). Per allele, telomeres were shorter by 67 bp (73-60). In meta...

  6. Spectroscopic Monitoring of Kidney Tissue Ischemic Injury

    Energy Technology Data Exchange (ETDEWEB)

    Demos, S G; Fitzgerald, J T; Michalopoulou, A P; Troppmann, C

    2004-03-11

    Noninvasive evaluation of tissue viability of donor kidneys used for transplantation is an issue that current technology is not able to address. In this work, we explore optical spectroscopy for its potential to assess the degree of ischemic damage in kidney tissue. We hypothesized that ischemic damage to kidney tissue will give rise to changes in its optical properties which in turn may be used to asses the degree of tissue injury. The experimental results demonstrate that the autofluorescence intensity of the injured kidney is decreasing as a function of time exposed to ischemic injury. Changes were also observed in the NIR light scattering intensities most probably arising from changes due to injury and death of the tissue.

  7. A dose-dependent perturbation in cardiac energy metabolism is linked to radiation-induced ischemic heart disease in Mayak nuclear workers.

    Science.gov (United States)

    Azimzadeh, Omid; Azizova, Tamara; Merl-Pham, Juliane; Subramanian, Vikram; Bakshi, Mayur V; Moseeva, Maria; Zubkova, Olga; Hauck, Stefanie M; Anastasov, Nataša; Atkinson, Michael J; Tapio, Soile

    2017-02-07

    Epidemiological studies show a significant increase in ischemic heart disease (IHD) incidence associated with total external gamma-ray dose among Mayak plutonium enrichment plant workers. Our previous studies using mouse models suggest that persistent alteration of heart metabolism due to the inhibition of peroxisome proliferator-activated receptor (PPAR) alpha accompanies cardiac damage after high doses of ionising radiation. The aim of the present study was to elucidate the mechanism of radiation-induced IHD in humans. The cardiac proteome response to irradiation was analysed in Mayak workers who were exposed only to external doses of gamma rays. All participants were diagnosed during their lifetime with IHD that also was the cause of death. Label-free quantitative proteomics analysis was performed on tissue samples from the cardiac left ventricles of individuals stratified into four radiation dose groups (0 Gy, 500 mGy). The groups could be separated using principal component analysis based on all proteomics features. Proteome profiling showed a dose-dependent increase in the number of downregulated mitochondrial and structural proteins. Both proteomics and immunoblotting showed decreased expression of several oxidative stress responsive proteins in the irradiated hearts. The phosphorylation of transcription factor PPAR alpha was increased in a dose-dependent manner, which is indicative of a reduction in transcriptional activity with increased radiation dose. These data suggest that chronic external radiation enhances the risk for IHD by inhibiting PPAR alpha and altering the expression of mitochondrial, structural, and antioxidant components of the heart.

  8. [Nonfasting triglycerides and risk of ischemic stroke--secondary publication

    DEFF Research Database (Denmark)

    Freiberg, J.J.; Tybjaerg-Hansen, A.; Jensen, J.S.;

    2009-01-01

    The role of triglycerides in the risk of ischemic stroke remains controversial. We tested the hypothesis that increased levels of nonfasting triglycerides are associated with ischemic stroke in the general population. Men with a nonfasting triglyceride level 5 mmol/l had a multivariable, adjusted...... hazard ratio for ischemic stroke of 2.5 (95% confidence interval: 1.3-4.8) compared with men with a nonfasting triglyceride level triglycerides is associated with risk of ischemic stroke Udgivelsesdato...

  9. Polymorphisms in apolipoprotein B and risk of ischemic stroke

    DEFF Research Database (Denmark)

    Benn, Marianne; Nordestgaard, Børge G; Jensen, Jan Skov;

    2007-01-01

    Apolipoprotein B levels associate with risk of ischemic stroke. APOB polymorphisms may influence levels of apolipoprotein B and low-density lipoprotein (LDL), but whether they associate with risk of ischemic stroke is unknown.......Apolipoprotein B levels associate with risk of ischemic stroke. APOB polymorphisms may influence levels of apolipoprotein B and low-density lipoprotein (LDL), but whether they associate with risk of ischemic stroke is unknown....

  10. 应用左向右分流建立大鼠慢性肺动脉高压模型及其特征%Establishment and characteristics of chronic pulmonary arterial hypertension rat models subjected to left-to-right shunting

    Institute of Scientific and Technical Information of China (English)

    汪健春; 钟前进

    2009-01-01

    背景:应用左向右分流大鼠模型可以研究慢性肺血管重构在成人型先天性心脏病中的发病机制.目的:观察慢性左向右分流大鼠模型慢性肺动脉高压形成的特点.设计、时间及地点:随机对照动物实验,于2008-04/2009-04在解放军第三军医大学新桥医院动物实验中心完成.材料:4周龄SPF级纯系健康SD大鼠80只,体质量95-110 g.随机分为对照组、分流组,每组40只.自制改良聚乙烯血管连接套管,近心端内外径分别为0.6 mm和0.8 mm,远心端内外径分别为0.8 mm和1.0mm,长1.6mm.方法:分流组大鼠:行左向右分流术,运用收缩型聚乙烯血管连接器建立右颈总动脉-颈外静脉连接.对照组行假手术.手术后在第4,8,12,16周(每个时相点10只大鼠),通过血流动力学检查、病理标本制作、苏木精-伊红染色、图像分析等一系列步骤对该模型进行评价.主要观察指标:分流组和对照组大鼠右室收缩压、右心肥大比率[右室/(左室+室间隔)],各级肺小动脉相对中膜厚度改变.结果:全部实验动物存活.分流组肺循环血流量明显高于对照组(P<0.01).与对照组相比,分流12,16周右室收缩压明显增高(P<0.01),分流12,16周时右心肥大比率显著增加(P<0.01).与对照组相比,分流12周和16周组肺动脉相对中膜厚度明显增加(P<0.01).结论:左向右的持续低分流,能有效引起慢性肺血管重构,颈总动脉-颈外静脉连接建立慢性肺动脉高压模型操作简便,稳定性好,对实验动物损伤小,是研究低分流引起的慢性肺动脉高压形成的有用工具.%BACKGROUND: A left-to-right shunting animal model is needed to study chronic pulmonary vascular remodeling of congenital heart attachment disease in adult.OBJECTIVE: To observe the characteristics of chronic pulmonary arterial hypertension in rat models subjected to left-to-right shunting.DESIGN, TIME AND SETTING: Randomized controlled animal modeling observation

  11. Anticoagulant Therapy In Ischemic Stroke Or TIA

    Directory of Open Access Journals (Sweden)

    Kaveh Mehrvar

    2017-02-01

    Full Text Available Stroke is the leading cause of disability and the third leading cause of death  . Anticoagulants   have been used to treat patients with acute ischemic stroke for many years. Despite their widespread use, the usefulness of emergency anticoagulation is a subject of debate. Disagreements exist about the best agent to administer, the route of administration, the use of a bolus dose to start treatment, the level of anticoagulation required, and the duration of treatment. There are 2 types of anticoagulants: Parenteral and oral. Heparin is an anticoagulant that used parenteral. Oral anticoagulants are including Warfarin and new anticoagulants such as Dabigatrn,Rivaroxaban ,Apixaban and other newer drugs. In patients with noncardioembolic  ischemic stroke or TIA antiplatelet agents are treatment of choice and preferred to anticoagulants. In cardioembolic  ischemic stroke or TIA with high risk of reembolization  anticoagulants  are considered as preferred treatment.  Warfarin, apixaban10mg/d ,Rivaroxaban20mg/d, and dabigatran 150 mg/d are all indicated for the prevention of recurrent stroke in patients with nonvalvular AF, whether paroxysmal or permanent.Also anticoagulant therapy is recommended for ischemic stroke or TIA patients in the setting of acute MI, atrial or ventricular thrombosis or dilated and restricted cardiomyopathy. Some valvular heart diseases are other indication for anticoagulant therapy in ischemic stroke or TIA patients. Ischemic  Stroke or TIA in patients with Cerebral vein thrombosis and  known hypercoagulable state specially anti phospholipid antibody syndrome are other indications for anticoagulant treatment.

  12. Your left-handed brain

    OpenAIRE

    2014-01-01

    While most people prefer to use their right hand to brush their teeth, throw a ball, or hold a tennis racket, left-handers prefer to use their left hand. This is the case for around 10% of all people. There was a time (not so long ago) when left-handers were stigmatized (see Glossary) in Western (and other) communities: it was considered a bad sign if you were left-handed, and left-handed children were often forced to write with their right hand. This is nonsensical: there is nothing wrong wi...

  13. Assessment on left ventricular systolic function with tissue tracking derived mitral annular displacement and the impact factors in patients with chronic heart failure%组织追踪技术测量二尖瓣环位移评价慢性心力衰竭患者左心室收缩功能及其影响因素

    Institute of Scientific and Technical Information of China (English)

    商志娟; 王珂; 孙颖慧; 丛涛; 安乐

    2012-01-01

    Objective To observe the value of systolic mitral annular displacement (MADs) based on tissue tracking in patients with chronic heart failure (CHF), and to investigate the relation between MADs and left ventricular ejection fraction (LVEF). Methods Forty-six patients with CHF (CHF group) and 20 normal subjects (control group) were enrolled. Left ventricular end-diastolic diameter (LVEDD), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were measured with two-dimensional echocardiography, while left ventricular ejection fraction (LVEF) was calculated with biplane Simpson's method. MADs was obtained from apical 4-chamber view and 2-chamber view using M-mode imaging and tissue tracking (TT). Correlation and agreement between M-mode imaging and TT derived MADs were analyzed. The impact of age, LVEDD and body surface area on the relation between LVEF and MADs was analyzed using multiple linear regression in CHF group. Results Compared with control group, LVEDD, LVEDV, LVESV increased significantly (all P<0. 01), and LVEF decreased significantly (P<0. 01) in CHF group. Mean MADs of four sites decreased significantly (all P<0. 01) in CHF group. Correlation and agreement between M-mode imaging and TT derived MADs were well (r=0. 97, P<0. 01). The relation between LVEF and MADs was influenced by LVEDD significantly (r2 =0. 69, P<0. 01). Conclusion TT derived MADs in combination with LVEDD can be used to evaluate left ventricular systolic function in patients with HF briefly and accurately.%目的 探讨组织追踪技术(TT)测量收缩期二尖瓣环位移(MADs)在评价慢性心力衰竭患者左心室收缩功能中的作用及其影响因素.方法 选取慢性心力衰竭患者46例(心衰组)及健康志愿者20名(对照组).以二维超声测量左心室舒张末期内径(LVEDD)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV),采用双平面Simpson法测量左心室射血分数(LVEF).在心尖

  14. Proposed mechanism(s) of transitory ischemic injury to myocardium

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, M.D.; Kelman, B.J.

    1979-01-01

    The main objective of this study was to produce primary acute ischemic injury to myocardium in a live animal. In vitro, guinea pig platelets were sensitive to perturbation and aggregation by a suspension of ultrafine fibrillary collagen material isolated from the aorta of an aged burro (Equus asinus). The platelets responded to this material down to 100 to 200 ng (dry weight) added to 0.45 ml of platelet-rich plasma, as determined by aggregometric technique. Aortic fibrillary collagen material injected IV into guinea pigs circulating platelets within 5 minutes. In blood samples taken 2.5 hours after injection, 50 to 75% of control levels of platelets were found. In other experiments, 3 anesthetized animals were injected by jugular vein with active fibrillary collagen material. Two control animals were injected with the same dose of the material that had been inactivated (15 minutes at 100 C). Intraventricular pressures and electrocardiographs (ECG) were monitored continuously for the first 30 minutes. The injection of the active fibrillary collagen material caused a large ventricular pressure elevation in approximately 40 s. Within 60 s, there was a reduction in the absolute platelet number in the peripheral circulation. The elevation of ventricular pressure persisted for approximately 5 minutes and was followed within 30 minutes by a set of ECG events suggestive of acute myocardial ischemic injury. The ECG changes seemed to be subsequent to platelet microthrombus formation in the pulmonary arterial microcirculation. By 2.5 hours after the treatment, platelets rebounded into the circulation in 2 surviving guinea pigs, and left ventricular pressures and ECG profiles returned to the preinfusion base lines. Guinea pigs IV infused with similar amounts of inactivated fibrillary collagen material did not show changes.

  15. Increased risk of ischemic stroke after hyperosmolar hyperglycemic state: a population-based follow-up study.

    Directory of Open Access Journals (Sweden)

    Jen-Yu Wang

    Full Text Available BACKGROUND: Although much attention has been focused on the association between chronic hyperglycemia and cerebrovascular diseases in type 2 diabetes mellitus (DM patients, there is no data regarding the risk of ischemic stroke after a hyperosmolar hyperglycemic state (HHS attack. The objective of this study was to investigate the risk of ischemic stroke in type 2 DM patients after an HHS attack. METHODS: From 2004 to 2008, this retrospective observational study was conducted on a large cohort of Taiwanese using Taiwan's National Health Insurance Research Database (NHIRD. We identified 19,031 type 2 DM patients who were discharged with a diagnosis of HHS and 521,229 type 2 DM patients without an HHS diagnosis. Using the propensity score generated from logistic regression models, conditional on baseline covariates, we matched 19,031 type 2 DM patients with an HHS diagnosis with the same number from the comparison cohort. The one-year cumulative rate for ischemic stroke was estimated using the Kaplan-Meier method. After adjusting covariates, Cox proportional hazard regression was used to compute the adjusted one-year rate of ischemic stroke. RESULTS: Of the patients sampled, 1,810 (9.5% of the type 2 DM patients with HHS and 996 (5.2% of the comparison cohort developed ischemic stroke during the one-year follow-up period. After adjusting for covariates, the adjusted HR for developing ischemic stroke during the one-year follow-up period was 1.8 (95% C.I., 1.67 to 1.95, P<0.001 for type 2 DM patients with HHS compared with those without HHS. CONCLUSION: Although DM is a well-recognized risk factor for atherosclerosis, type 2 DM patients that have suffered a HHS attacks are at an increased risk of developing ischemic stroke compared with those without HHS.

  16. Estrogen inhibits lipid peroxidation after hypoxic-ischemic brain damage in neonatal rats

    Institute of Scientific and Technical Information of China (English)

    Hui Zhu; Xiao Han; Dafeng Ji; Guangming Lv; Meiyu Xu

    2012-01-01

    Sprague-Dawley neonatal rats within 7 days after birth were used in this study. The left common carotid artery was occluded and rats were housed in an 8% O2 environment for 2 hours to establish a hypoxic-ischemic brain damage model. 17β-estradiol (1 × 10-5 M) was injected into the rat abdominal cavity after the model was successfully established. The left hemisphere was obtained at 12, 24, 48, 72 hours after operation. Results showed that malondialdehyde content in the left brain of neonatal rats gradually increased as modeling time prolonged, while malondialdehyde content of 17β-estrodial-treated rats significantly declined by 24 hours, reached lowest levels at 48 hours, and then peaked at 72 hours after injury. Nicotinamide-adenine dinucleotide phosphate histochemical staining showed the nitric oxide synthase-positive cells and fibers dyed blue/violet and were mainly distributed in the cortex, hippocampus and medial septal nuclei. The number of nitric oxide synthase-positive cells peaked at 48 hours and significantly decreased after 17β-estrodial treatment. Our experimental findings indicate that estrogen plays a protective role following hypoxic-ischemic brain damage by alleviating lipid peroxidation through reducing the expression of nitric oxide synthase and the content of malondialdehyde.

  17. Anterior ischemic optic neuropathy following dengue fever.

    Science.gov (United States)

    Ramakrishnan, Reshma; Shrivastava, Saurabh; Deshpande, Shrikant; Patkar, Priyanka

    2016-01-01

    Dengue fever is caused by a flavivirus. This infection is endemic in the tropics and warm temperate regions of the world. Ocular manifestations of dengue fever include subconjunctival, vitreous, and retinal haemorrhages; posterior uveitis; optic neuritis; and maculopathies, haemorrhage, and oedema. However anterior ischemic optic neuropathy is a rare presentation. Optic nerve ischemia most frequently occurs at the optic nerve head, where structural crowding of nerve fibers and reduction of the vascular supply may combine to impair perfusion to a critical degree and produce optic disc oedema. Here we present a case of anterior ischemic optic neurapathy associated with dengue fever.

  18. Left Artinian Algebraic Algebras

    Institute of Scientific and Technical Information of China (English)

    S. Akbari; M. Arian-Nejad

    2001-01-01

    Let R be a left artinian central F-algebra, T(R) = J(R) + [R, R],and U(R) the group of units of R. As one of our results, we show that, if R is algebraic and char F = 0, then the number of simple components of -R = R/J(R)is greater than or equal to dimF R/T(R). We show that, when char F = 0 or F is uncountable, R is algebraic over F if and only if [R, R] is algebraic over F. As another approach, we prove that R is algebraic over F if and only if the derived subgroup of U(R) is algebraic over F. Also, we present an elementary proof for a special case of an old question due to Jacobson.

  19. Left ventricular apical diseases.

    Science.gov (United States)

    Cisneros, Silvia; Duarte, Ricardo; Fernandez-Perez, Gabriel C; Castellon, Daniel; Calatayud, Julia; Lecumberri, Iñigo; Larrazabal, Eneritz; Ruiz, Berta Irene

    2011-08-01

    There are many disorders that may involve the left ventricular (LV) apex; however, they are sometimes difficult to differentiate. In this setting cardiac imaging methods can provide the clue to obtaining the diagnosis. The purpose of this review is to illustrate the spectrum of diseases that most frequently affect the apex of the LV including Tako-Tsubo cardiomyopathy, LV aneurysms and pseudoaneurysms, apical diverticula, apical ventricular remodelling, apical hypertrophic cardiomyopathy, LV non-compaction, arrhythmogenic right ventricular dysplasia with LV involvement and LV false tendons, with an emphasis on the diagnostic criteria and imaging features. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s13244-011-0091-6) contains supplementary material, which is available to authorized users.

  20. Left atrial calcification in a hemodialysis patient with cor triatriatum.

    Science.gov (United States)

    Peces, R; Pobes, A; Rodriguez, M; Simarro, C; Iglesias, G; Simarro, E

    2000-05-01

    Myocardial calcification is a rare manifestation of abnormal calcium metabolism seen in some patients with chronic renal failure. This report describes the transesophageal echocardiographic and spiral computed tomography (CT) findings in a young hemodialysis female with severe secondary hyperparathyroidism. These findings included calcification of the multiperforated membrane of a cor triatriatum and the wall of the left atrium.

  1. Eccentric pericardial effusion after radiation therapy of left breast carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Green, B.; Zornoza, J.; Ricks, J.P.

    1977-01-01

    Pericardial damage is one of the consequences of cardiac radiation and may lead to chronic pericarditis and/or tamponade. In three patients treated with radiation for carcinoma of the left breast, the effusions were loculated on the right side of the pericardium resulting in a peculiar cardiac silhouette. The importance of recognizing this entity and possible treatment is stressed.

  2. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies.

    NARCIS (Netherlands)

    Detaille, S.I.; Heerkens, Y.F.; Engels, J.A.; Gulden, J.W.J. van der; Dijk, F.J. van

    2009-01-01

    OBJECTIVE: Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD

  3. Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies

    NARCIS (Netherlands)

    S.I. Detaille; Y.F. Heerkens; J.A. Engels; J.W.J. van der Gulden; F.J.H. van Dijk

    2009-01-01

    Objective Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD)

  4. Exhaustion of the Frank-Starling mechanism in conscious dogs with heart failure induced by chronic coronary microembolization.

    Science.gov (United States)

    Gill, Robert M; Jones, Bonita D; Corbly, Angela K; Ohad, Dan G; Smith, Gerald D; Sandusky, George E; Christe, Michael E; Wang, Jie; Shen, Weiqun

    2006-07-04

    The role of the Frank-Starling mechanism in the regulation of cardiac systolic function in the ischemic failing heart was examined in conscious dogs. Left ventricular (LV) dimension, pressure and systolic function were assessed using surgically implanted instrumentations and non-invasive echocardiogram. Heart failure was induced by daily intra-coronary injections of microspheres for 3-4 weeks via implanted coronary catheters. Chronic coronary embolization resulted in a progressive dilation of the left ventricle (12+/-3%), increase in LV end-diastolic pressure (118+/-19%), depression of LV dP/dt(max) (-19+/-4%), fractional shortening (-36+/-7%), and cardiac work (-60+/-9%), and development of heart failure, while the LV contractile response to dobutamine was depressed. A brief inferior vena caval occlusion in dogs with heart failure decreased LV preload to match the levels attained in their control state and caused a further reduction of LV dP/dt(max), fractional shortening, stroke work and cardiac work. Moreover, in response to acute volume loading, the change in the LV end-diastolic dimension-pressure (DeltaLVEDD-DeltaLVEDP) curve in the failing heart became steeper and shifted significantly to the left, while the increases in LV stroke work and cardiac work were blunted. Thus, our results suggest that the Frank-Starling mechanism is exhausted in heart failure and unable to further respond to increasing volume while it plays an important compensatory role in adaptation to LV dysfunction in heart failure.

  5. The stem-cell application in ischemic heart disease: Basic principles, specifics and practical experience from clinical studies

    Directory of Open Access Journals (Sweden)

    Banović Marko

    2015-01-01

    Full Text Available Longer life duration, different clinical presentations of coronary disease, as well as high incidence of comorbidity in patients with ischemic heart disease have led to an increase in the incidence of ischemic heart failure. Despite numerous and new treatment methods that act on different pathophysiological mechanisms that cause heart failure, and whose aim is to slowdown or stop the progression of this devastating disease, morbidity and mortality in these patients remain high. These facts have firstly led to the introduction of the experimental, and then clinical studies with the application of stem cells in patients with ischemic heart disease. Previous studies have shown that the application of stem cells is a feasible and safe method in patients with acute coronary syndrome, as well as in patients with chronic ischemic cardiomyopathy, but the efficacy of these methods in both of the abovementioned clinical syndromes has yet to be established. This review paper outlines the basic principles of treatment of ischemic heart disease with stem cells, as well as the experience and knowledge gained in previous clinical studies.

  6. Periodic 17β-estradiol pretreatment protects rat brain from cerebral ischemic damage via estrogen receptor-β.

    Directory of Open Access Journals (Sweden)

    Ami P Raval

    Full Text Available Although chronic 17β-estradiol (E2 has been shown to be a cognition-preserving and neuroprotective agent in animal brain injury models, concern regarding its safety was raised by the failed translation of this phenomenon to the clinic. Previously, we demonstrated that a single bolus of E2 48 hr prior to ischemia protected the hippocampus from damage in ovariectomized rats via phosphorylation of cyclic-AMP response element binding protein, which requires activation of estrogen receptor subtype beta (ER-β. The current study tests the hypothesis that long-term periodic E2-treatment improves cognition and reduces post-ischemic hippocampal injury by means of ER-β activation. Ovariectomized rats were given ten injections of E2 at 48 hr intervals for 21 days. Hippocampal-dependent learning, memory and ischemic neuronal loss were monitored. Results demonstrated that periodic E2 treatments improved spatial learning, memory and ischemic neuronal survival in ovariectomized rats. Additionally, periodic ER-β agonist treatments every 48 hr improved post-ischemic cognition. Silencing of hippocampal ER-β attenuated E2-mediated ischemic protection suggesting that ER-β plays a key role in mediating the beneficial effects of periodic E2 treatments. This study emphasizes the need to investigate a periodic estrogen replacement regimen to reduce cognitive decline and cerebral ischemia incidents/impact in post-menopausal women.

  7. Long-term window of ischemic tolerance: An evolutionarily conserved form of metabolic plasticity regulated by epigenetic modifications?

    Science.gov (United States)

    Khoury, Nathalie; Koronowski, Kevin B.; Perez-Pinzon, Miguel A.

    2016-01-01

    In the absence of effective neuroprotective agents in the clinic, ischemic and pharmacological preconditioning are gaining increased interest in the field of cerebral ischemia. Our lab recently reported that resveratrol preconditioning affords tolerance against a focal cerebral ischemic insult in mice that can last for at least 14 days in vivo making it the longest window of ischemic tolerance discovered to date by a single administration of a pharmacological agent. The mechanism behind this novel extended window of ischemic tolerance remains elusive. In the below commentary we discuss potential mechanisms that could explain this novel extended window of ischemic tolerance in the context of previously identified windows and the known mechanisms behind them. We also draw parallels from the fields of hibernation and hypoxia-tolerance, which are chronic adaptations to severe conditions of hypoxia and ischemia known to be mediated by a form of metabolic depression. We also briefly discuss the importance of epigenetic modifications in maintaining this depressed state of metabolism. PMID:27796011

  8. Blood pressure, risk of ischemic cerebrovascular and ischemic heart disease, and longevity in alpha(1)-antitrypsin deficiency

    DEFF Research Database (Denmark)

    Dahl, Morten; Tybjaerg-Hansen, Anne; Sillesen, Henrik

    2003-01-01

    Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity.......Because elastase in alpha(1)-antitrypsin deficiency may attack elastin in the arterial wall, we tested whether alpha(1)-antitrypsin deficiency is associated with reduced blood pressure, risk of ischemic cerebrovascular (ICVD) and ischemic heart disease (IHD), and longevity....

  9. Role of IL-1alpha and IL-1beta in ischemic brain damage.

    Science.gov (United States)

    Boutin, H; LeFeuvre, R A; Horai, R; Asano, M; Iwakura, Y; Rothwell, N J

    2001-08-01

    The cytokine interleukin-1 (IL-1) has been strongly implicated in the pathogenesis of ischemic brain damage. Evidence to date suggests that the major form of IL-1 contributing to ischemic injury is IL-1beta rather than IL-1alpha, but this has not been tested directly. The objective of the present study was to compare the effects of transient cerebral ischemia [30 min middle cerebral artery occlusion (MCAO)] on neuronal injury in wild-type (WT) mice and in IL-1alpha, IL-1beta, or both IL-1alpha and IL-1beta knock-out (KO) mice. Mice lacking both forms of IL-1 exhibited dramatically reduced ischemic infarct volumes compared with wild type (total volume, 70%; cortex, 87% reduction). Ischemic damage compared with WT mice was not significantly altered in mice lacking either IL-1alpha or IL-1beta alone. IL-1beta mRNA, but not IL-1alpha or the IL-1 type 1 receptor, was strongly induced by MCAO in WT and IL-1alpha KO mice. Administration (intracerebroventricularly) of recombinant IL-1 receptor antagonist significantly reduced infarct volume in WT (-32%) and IL-1alpha KO (-48%) mice, but had no effect on injury in IL-1beta or IL-1alpha/beta KO mice. These data confirm that IL-1 plays a major role in ischemic brain injury. They also show that chronic deletion of IL-1alpha or IL-1beta fails to influence brain damage, probably because of compensatory changes in the IL-1 system in IL-1alpha KO mice and changes in IL-1-independent mediators of neuronal death in IL-1beta KO mice.

  10. Quantification of Regional Left Ventricular Systolic Dysfunction in Patients With Coronary Artery Disease by Strain Rate Imaging

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    To detect and compare the systolic strain rate (SR) and strain in the infarct and ischemic myocardiu mby strain rate imaging ( SRI), in order to explore the clinical value of SRI in evaluating regional left ventricular systolic dysfunction. Methods Patients with coronary artery disease were divided into angina pectoris ( 11 cases) and myocardial infarction (21 cases) groups. Twenty age-matched normal subjects served as the control group. Septal, lateral, anterior, inferior, anteroseptal and posterior walls of the left ventricle were respectively scanned using color tissue Doppler imaging (TDI). Then SR and strain curves were derived from TDI for basal, middle and apical segments of each wall.SRI parameters were: Systolic SR ( Srsys), systolic strain (εsys) and maximum strain (εmax). Results Compared with normal segments, Srsys, εsys and εmax decreased significantly in the infarct and ischemic segments ( P < 0.01 ). Compared with ischemic segments, Srsys, εsys and εmax decreased significantly in the infarct segments ( P <0.05 ). Conclusions Srsys, εsys and εmax measured by SRI can be used to quantitatively analyze regional left ventricular systolic dysfunction in patients with coronary artery disease, and aid in differentiating infarct from ischemic myocardium.

  11. Erythropoietin improves left ventricular function and coronary flow in an experimental model of ischemia-reperfusion injury

    NARCIS (Netherlands)

    van der Meer, P; Lipsic, E; Henning, RH; de Boer, RA; Suurmeijer, AJH; van Veldhuisen, DJ; van Gilst, WH

    2004-01-01

    Recent studies show that erythropoietin (EPO) plays a protective role in brain ischemia. In this condition, administration of EPO protects neurons from ischemic damage. Recently, it has been shown that in patients with chronic heart failure (CHF), EPO treatment improved cardiac function. In the pres

  12. [Left-handedness and health].

    Science.gov (United States)

    Milenković, Sanja; Belojević, Goran; Kocijancić, Radojka

    2010-01-01

    Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome), developmental disorders (autism, dislexia and sttutering) and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about "anomalous" cerebral domination, as a consequence of hormonal disbalance.

  13. Does intravenous administration of recombinant tissue plasminogen activator for ischemic stroke can cause inferior myocardial infarction?

    Directory of Open Access Journals (Sweden)

    Mostafa Almasi

    2016-06-01

    Full Text Available Recombinant tissue plasminogen activator (rTPA is one of the main portions of acute ischemic stroke management, but unfortunately has some complications. Myocardial infarction (MI is a hazardous complication of administration of intravenous rTPA that has been reported recently. A 78-year-old lady was admitted for elective coronary artery bypass graft surgery. On the second day of admission, she developed acute left hemiparesis and intravenous rTPA was administered within 120 minutes. Three hours later, she has had chest pain. Rescue percutaneous coronary intervention was performed on right coronary artery due to diagnosis of inferior MI, and the symptoms were resolved.

  14. Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

    Directory of Open Access Journals (Sweden)

    Stéphane Mathis

    2014-01-01

    Full Text Available Sneezing can at times be associated with neurological disorders. The “sneeze center” is localized in the lateral medulla. We report the case of a 50-year-old man who presented three episodes of sneezing, two of them followed by an episode of transient gait instability and dizziness and the third one followed by an episode of transient left hemiparesis due to fibroelastoma of the aortic cardiac valve. To the best of our knowledge, this is the first description of a transient ischemic attack due to cardiac papillary fibroelastoma and revealed by violent episodes of sneezing.

  15. Ischemic stroke secondary to aortic dissection following rifle butt recoil chest injury: a case report.

    Science.gov (United States)

    Rao, Mamatha; Panduranga, Prashanth; Al-Mukhaini, Mohammed; Al-Jufaili, Mahmood; Valiath, John

    2011-11-01

    Ischemic stroke secondary to aortic dissection is not uncommon. We present a patient with left hemiplegia secondary to Stanford type A aortic dissection extending to the supra-aortic vessels, which was precipitated by rifle butt recoil chest injury. The diagnosis of aortic dissection was delayed due to various factors. Finally, the patient underwent successful Bentall procedure with complete resolution of symptoms. This case emphasizes the need for caution in the use of firearms for recreation and to take precautions in preventing such incidents. In addition, this case illustrates the need for prompt cardiovascular physical examination in patients presenting with stroke.

  16. Retroaortic left renal vein joining the left common iliac vein

    Energy Technology Data Exchange (ETDEWEB)

    Brancatelli, G.; Galia, M.; Finazzo, M.; Sparacia, G.; Pardo, S.; Lagalla, R. [Dept. of Radiology ' ' P. Cignolini' ' , Univ. of Palermo (Italy)

    2000-11-01

    Retroaortic left renal vein joining the left common iliac vein is a rare congenital anomaly in the development of the inferior vena cava. To our knowledge, only one case has been reported in the literature; however, its imaging features have never been described. A 27-year-old male presented with a 1-year history of recurrent right flank pain, dysuria, hematuria, and fever (39 C). Computed tomography and MR venography showed a retroaortic left renal vein joining the left common iliac vein. We present the CT and MR venography findings and discuss their feasibility in showing this congenital anomaly. (orig.)

  17. The neuroprotective mechanism of brain ischemic preconditioning

    Institute of Scientific and Technical Information of China (English)

    Xiao-qian LIU; Rui SHENG; Zheng-hong QIN

    2009-01-01

    Brain ischemia is one of the most common causes of death and the leading cause of adult disability in the world. Brain ischemic pre- conditioning (BIP) refers to a transient, sublethal ischemia which results in tolerance to later, otherwise lethal, cerebral ischemia. Many attempts have been made to understand the molecular and cellular mechanisms underlying the neuroprotection offered by ischemic preconditioning. Many studies have shown that neuroprotective mechanisms may involve a series of molecular regulatory pathways including activation of the N-methyI-D-aspartate (NMDA) and adenosine receptors; activation of intracellular signaling pathways such as mitogen activated protein kinases (MAPK) and other protein kinases; upregulation of Bcl-2 and heat shock proteins (HSPs); and activation of the ubiquitin-proteasome pathway and the autophagic-lysosomal pathway. A better understanding of the processes that lead to cell death after stroke as well as of the endogenous neuroprotective mechanisms by which BIP protects against brain ischemic insults could help to develop new therapeutic strategies for this devastating neurological disease. The purpose of the present review is to summarize the neuroprotective mechanisms of BIP and to discuss the possibility of mimicking ischemic preconditioning as a new strategy for preventive treatment of ischemia.

  18. The diagnosis of transient ischemic attacks

    NARCIS (Netherlands)

    P.J. Koudstaal (Peter Jan)

    1989-01-01

    textabstractThe diagnosis of transient ischemic attack (TIA) is fraught with difficulty, since the diagnosis rests entirely upon the history of the patient's symptoms and the neurologist's skill in questioning the patient. The aim of this thesis is to investigate various measures to improve the reli

  19. Ischemic Stroke during Pregnancy and Puerperium

    Directory of Open Access Journals (Sweden)

    Elisabetta Del Zotto

    2011-01-01

    Full Text Available Ischemic stroke during pregnancy and puerperium represents a rare occurrence but it could be a serious and stressful event for mothers, infants, and also families. Whenever it does occur, many concerns arise about the safety of the mother and the fetus in relation to common diagnostic tests and therapies leading to a more conservative approach. The physiological adaptations in the cardiovascular system and in the coagulability that accompany the pregnant state, which are more significant around delivery and in the postpartum period, likely contribute to increasing the risk of an ischemic stroke. Most of the causes of an ischemic stroke in the young may also occur in pregnant patients. Despite this, there are specific conditions related to pregnancy which may be considered when assessing this particular group of patients such as pre-eclampsia-eclampsia, choriocarcinoma, peripartum cardiomiopathy, amniotic fluid embolization, and postpartum cerebral angiopathy. This article will consider several questions related to pregnancy-associated ischemic stroke, dwelling on epidemiological and specific etiological aspects, diagnostic issue concerning the use of neuroimaging, and the related potential risks to the embryo and fetus. Therapeutic issues surrounding the use of anticoagulant and antiplatelets agents will be discussed along with the few available reports regarding the use of thrombolytic therapy during pregnancy.

  20. Rehabilitation Outcomes: Ischemic versus Hemorrhagic Strokes

    Directory of Open Access Journals (Sweden)

    Robert Perna

    2015-01-01

    Full Text Available Background. Ischemic and hemorrhagic strokes have different pathophysiologies and possibly different long-term cerebral and functional implications. Hemorrhagic strokes expose the brain to irritating effects of blood and ischemic strokes reflect localized or diffuse cerebral vascular pathology. Methods. Participants were individuals who suffered either an ischemic (n=172 or hemorrhagic stroke (n=112 within the past six months and were involved in a postacute neurorehabilitation program. Participants completed three months of postacute neurorehabilitation and the Mayo Portland Adaptability Inventory-4 (MPAI-4 at admission and discharge. Admission MPAI-4 scores and level of functioning were comparable. Results. Group ANOVA comparisons show no significant group differences at admission or discharge or difference in change scores. Both groups showed considerably reduced levels of productivity/employment after discharge as compared to preinjury levels. Conclusions. Though the pathophysiology of these types of strokes is different, both ultimately result in ischemic injuries, possibly accounting for lack of findings of differences between groups. In the present study, participants in both groups experienced similar functional levels across all three MPAI-4 domains both at admission and discharge. Limitations of this study include a highly educated sample and few outcome measures.

  1. Molecular Mechanisms of Renal Ischemic Conditioning Strategies

    NARCIS (Netherlands)

    Kierulf-Lassen, Casper; Nieuwenhuijs-Moeke, Gertrude J.; Krogstrup, Nicoline V.; Oltean, Mihai; Jespersen, Bente; Dor, Frank J. M. F.

    2015-01-01

    Ischemia-reperfusion injury is the leading cause of acute kidney injury in a variety of clinical settings such as renal transplantation and hypovolemic and/or septic shock. Strategies to reduce ischemia-reperfusion injury are obviously clinically relevant. Ischemic conditioning is an inherent part o

  2. Chronic ulcers: MATRIDERM® system in smoker, cardiopathic, and diabetic patients

    Directory of Open Access Journals (Sweden)

    Barbara De Angelis

    2013-08-01

    Full Text Available Diabetic ulcers and pressure ulcers represent a more frequent cause of chronic wounds in aging populations. It is estimated that approximately 15% of the diabetic population will develop diabetic ulcers during their life and over half of these patients develop an infection, often osteomyelitis, with 20% requiring amputation. The authors report a case of a 65-year-old woman affected by a post-traumatic loss of substance due to road accidents with soft tissue exposure (comprising muscle tendon of the left knee combined with the fracture of the right fibula previously subjected to surgery and reconstruction of muscle tendon. The patient was affected by diabetes type II, hypertension, and ischemic heart disease. In 2008, she underwent a double bypass surgery and coronary angioplasty. Initially, the patient was treated with cycles of advanced dressings, with fibrinolytic ointments, hydrocolloid, and subsequently, when the bottom began granulated with fibrinolytic and idrocellulosa, Hydrofibra-Ag, and Ag-alginate, three times a week for 30 days. In the second step, the authors decided to treat the ulcer with the MATRIDERM system and auto skin graft. Following the first treatment, 7 days after the procedure, the authors found the reduction of the loss of substance until its complete closure. The wound’s infection was evaluated by a buffer negative confirmation performed every 2 weeks four times. We obtained decrease of limb edema and full functional rehabilitation. The skin appeared renovated, with volume restoration and an improvement of the texture.

  3. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure

    Directory of Open Access Journals (Sweden)

    Ilonka Rohm

    2016-01-01

    Full Text Available Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF. Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC. A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  4. Impact of Ivabradine on Inflammatory Markers in Chronic Heart Failure.

    Science.gov (United States)

    Rohm, Ilonka; Kretzschmar, Daniel; Pistulli, Rudin; Franz, Marcus; Schulze, P Christian; Stumpf, Christian; Yilmaz, Atilla

    2016-01-01

    Background. Inflammation plays a crucial role in the progression of chronic heart failure (CHF). Ivabradine is known to reduce the morbidity and mortality of patients with CHF under certain conditions. Beyond the reduction of heart rate, only limited knowledge exists about potential anti-inflammatory effects of ivabradine that might contribute to its benefit in CHF. Thus, the present study aimed to investigate the effect of ivabradine on systemic inflammation. Methods. In the present study, 33 patients with CHF due to dilated, ischemic, and hypertensive cardiomyopathy were treated with ivabradine according to the guidelines of the European Society of Cardiology (ESC). A number of circulating dendritic cells as well as inflammatory mediators were investigated using FACS analysis and ELISA, respectively, before and during ivabradine therapy. Results. Treatment with ivabradine resulted in a significant improvement of CHF symptoms as well as an increase in left ventricular ejection fraction. Moreover, ivabradine treatment led to a significant reduction of TNF-alpha (TNF-α) serum levels and a reconstitution of circulating dendritic cells which are known to be reduced in patients with CHF. Conclusion. We show that treatment with ivabradine in patients with CHF resulted in an improvement of HF symptoms and ejection fraction as well as a normalization of inflammatory mediators.

  5. Chronic administration of angiotensin-(1-7) attenuates pressure-overload left ventricular hypertrophy and fibrosis in rats%血管紧张素-(1-7)对腹主动脉缩窄大鼠心肌肥厚和纤维化的影响

    Institute of Scientific and Technical Information of China (English)

    王立军; 何建桂; 马虹; 蔡乙明; 廖新学; 曾武涛; 柳俊; 王礼春

    2005-01-01

    Background To test the hypothesis that chronic administration of angiotensin-(1-7) [Ang-(1-7)] attenuates cardiac hypertrophy in rats in vivo. Methods Coarctation of the suprarenal abdominal aorta was performed in 41 8-week-old male Sprague Dawley rats. Twenty-four hours after the operation, osmotic minipumps were surgically implanted subcutaneously in the rats, which were randomly divided into 3 groups, including a sham-operation group (n=15) receiving infusion with normal saline, a suprarenal aortic coarctation group (n=12), and a suprarenal aortic coarctation group (n=14) with Ang-(1-7) treatment at the dose of 25 μg.kg-1 .h-1. Four weeks later, the systolic and diastolic blood pressures were measured and the left ventricular mass index (LVMI, mg/g) was calculated from the ratio of left ventricular weight to body weight. The concentrations of Ang Ⅱ in the plasma and myocardium were measured by radioimmunoassay, and myocardial interstitial collagen volume fraction (ICVF) was determined by quantitative morphometry of the sections with Picrosirius red staining using an automated image analyzer. Results Suprarenal abdominal aortic coarctation induced a significant increase in carotid artery systolic and diastolic blood pressure, heart weight, LVMI, ICVF, and the concentration of Ang Ⅱ in the myocardium (P<0.01). Chronic administration of Ang-(1-7) attenuated the increase in the heart weight, LVMI, ICVF and left ventricular diastolic end pressure (LVEDP) caused by suprarenal abdominal aortic coarctation (P<0.05). Ang-(1-7) also increased the formerly decreased maximum left ventricular pressure reduction rate (-dP/dtmax) (P<0.05), but had no effect on blood pressure and the concentration of Ang Ⅱ in the myocardium. No difference was noted in plasma concentration of Ang Ⅱ between the 3 groups. Conclusions Ang-(1-7) attenuates cardiac hypertrophy and fibrosis and preserved the impaired left ventricular function induced by left ventricular pressure

  6. Regional cerebral blood flow in acute stage ischemic cerebrovascular disease by xenon-133 inhalation and single photon emission computerized tomography

    Energy Technology Data Exchange (ETDEWEB)

    Kurokawa, Hiroyuki (Akita Univ. (Japan). School of Medicine)

    1989-03-01

    During the period from February 1984 through June 1985, single photon emission computerized tomography (SPECT) with xenon-133 inhalation method has been performed for the measurement of regional cerebral blood flow (rCBF) during the first 48 hours of onset of cerebral infarction (n=71) and transient ischemic attack (n=21). X-ray CT (CT) and carotid arteriography were concurrently performed in all the patients. In repeated studies performed for 15 normal volunteers, rCBF measurement by SPECT was found reproducible. Mean values of rCBF for the right and left cerebral hemispheres were 60.3{plus minus}6.52 and 61.8{plus minus}6.91 ml/100 g/min, respectively. For cerebral infarction, ischemic foci corresponding to clinical symptoms were detected more frequently on SPECT than on CT (93% vs 63%). In all of the evaluable 35 patients with cerebral infarction, rCBF within the first 8 hours of onset was decreased: 31.0 ml/100 g/min for the internal carotid artery (ICA) occlusion and 36.0 ml/100 g/min for the middle cerebral artery (MCA) occlusion. Crossed cerebellar diaschisis was observed in 50% (9/18) for ICA occlusion and 37% (14/38) for MCA occlusion. For transient ischemic attack, there was no significant difference in the detection of ischemic foci between SPECT and CT (38% vs 43%). In detecting small foci especially in the deep regions such as the basal ganglia, SPECT was inferior to CT. Mean rCBF for transient ischemic attack tended to be lower than the normal rCBF (50.7 ml/100 g/min for the right cerebral hemisphere and 50.6 ml/100 g/min for the left cerebral hemisphere). SPECT may aid in predicting prognosis and chosing treatment strategy, as well as in determining cerebral hemodynamics. (N.K.).

  7. Digital ischemic necrosis caused by pegylated interferon in a patient with hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Jana; G; Hashash; Sean; A; Tackett; David; J; McAdams

    2011-01-01

    Pegylated interferon plus ribavirin remains the firstline treatment for patients with hepatitis C virus(HCV) . Interferonαhas the most extensive clinical application and is used for the treatment of chronic hepatitis B virus and hepatitis D virus as well as acute and chronic HCV infections.The attachment of polyethylene glycol to interferon increases its half-life by reducing the rate of absorption after injection,reducing renal and cellular clearance and also decreasing immunogenicity.In this case report,we have described a patient with chronic hepatitis C who developed ischemic necrosis of her fingertips after completing her third course of pegylated interferon and ribavirin.The patient underwent a very extensive workup in order to determine the underlying cause of her digital ischemia which was finally determined to be secondary to the use of pegylated interferon.

  8. Left atrial systolic force and outcome in asymptomatic mild to moderate aortic stenosis

    DEFF Research Database (Denmark)

    Cioffi, Giovanni; Cramariuc, Dana; Dalsgaard, Morten

    2012-01-01

    In patients with chronic pressure overload due to hypertension or aortic valve stenosis (AS), higher left atrial systolic force (LASF) is associated with a high-risk cardiovascular (CV) phenotype. We tested LASF as prognostic marker in patients with AS.......In patients with chronic pressure overload due to hypertension or aortic valve stenosis (AS), higher left atrial systolic force (LASF) is associated with a high-risk cardiovascular (CV) phenotype. We tested LASF as prognostic marker in patients with AS....

  9. Chronic complete thrombosis of abdominal aortic aneurysm: an unusual presentation of an unusual complication.

    Science.gov (United States)

    Pejkic, Sinisa; Opacic, Dragan; Mutavdzic, Perica; Radmili, Oliver; Krstic, Nevena; Davidovic, Lazar

    2015-02-01

    Although mural thrombosis frequently accompanies aneurysmal disease, complete thrombosis is distinctly unusual complication of abdominal aortic aneurysm (AAA). A case study of a patient with chronic, asymptomatic complete thrombosis of a large juxtarenal AAA is presented along with a literature review and discussion of the potential secondary complications, mandating aggressive management of this condition. A 67-year-old man with multiple atherogenic risk factors and unattended complaints consistent with a recent episode of a transient right hemispheric ischemic attack was referred to our clinic with a diagnosis of a thrombosed AAA established by computed tomography. Duplex ultrasonography and aortography confirmed the referral diagnosis and also revealed near occlusion of the left internal carotid artery. The patient underwent a two-stage surgery, with preliminary left-sided carotid endarterectomy followed three days later by an aneurysmectomy and aortobifemoral reconstruction. He had an uncomplicated recovery and was discharged home on postoperative day 7, remaining asymptomatic at the 42-month follow-up. Complete thrombosis is an uncommon presentation of AAA and may be clinically silent. It is frequently associated with other manifestations of generalized atherosclerosis. Radical open repair yields durable result and is the preferred treatment modality.

  10. Retinal vein thrombosis associated with pegylated-interferon and ribavirin combination therapy for chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Iman Zandieh; Mohamed Adenwalla; Cindy Cheong-Lee; Patrick E Ma; Eric M Yoshida

    2006-01-01

    An estimated 300 million people worldwide suffer fromchronic hepatitis C with a prevalence of 0.8%-1.0% of the general population in Canada. An increasing pool of evidence exists supporting the use of pegylatedinterferon (pegIFN) and ribavirin combination therapy for hepatitis C. We report a 49-year old male of North American aboriginal descent with chronic hepatitis C (genotype 2b). Biopsy confirmed that he had cirrhosis with a 2-wk history of left eye pain and decreased visual acuity. He developed retinal vein thrombosis after 16 of 24 wk of pegIFN-α 2a and ribavirin combination therapy. He was urgently referred to a retinal specialist and diagnosed with non-ischemic central retinal vein occlusion of the left eye. PegIFN and ribavirin combination therapy was discontinued and HCV RNA was undetectable after 16 wk of treatment. Hematologic investigations revealed that the patient was a factor V Leiden heterozygote with mildly decreased protein C activity. Our patient had a number of hypercoagulable risk factors, including factor V Leiden heterozygosity, cirrhosis, and hepatitis C that alone would have most likely remained clinically silent. We speculate that in the setting of pegIFN treatment, these risk factors may coalesce and cause the retinal vein thrombosis.

  11. Orchiectomy as a result of ischemic orchitis after laparoscopic inguinal hernia repair: case report of a rare complication

    Directory of Open Access Journals (Sweden)

    Moore John B

    2007-11-01

    Full Text Available Abstract Background Ischemic orchitis is an established complication after open inguinal hernia repair, but ischemic orchitis resulting in orchiectomy after the laparoscopic approach has not been reported. Case presentation The patient was a thirty-three year-old man who presented with bilateral direct inguinal hernias, right larger than left. He was a thin, muscular male with a narrow pelvis who underwent bilateral extraperitoneal mesh laparoscopic inguinal hernia repair. The case was complicated by pneumoperitoneum which limited the visibility of the pelvic anatomy; however, the mesh was successfully deployed bilaterally. Cautery was used to resect the direct sac on the right. The patient was discharged the same day and doing well with minimal pain and swelling until the fourth day after surgery. That night he presented with sudden-onset pain and swelling of his right testicle and denied both trauma to the area and any sexual activity. Ultrasound of the testicle revealed no blood flow to the testicle which required exploration and subsequent orchiectomy. Conclusion Ischemic orchitis typically presents 2–3 days after inguinal hernia surgery and can progress to infarction. This ischemic injury is likely due to thrombosis of the venous plexus, rather than iatrogenic arterial injury or inappropriate closure of the inguinal canal. Ultrasound/duplex scanning of the postoperative acute scrotum can help differentiate ischemic orchitis from infarction. Unfortunately, testicular torsion cannot be ruled out and scrotal exploration may be necessary. Although ischemic orchitis, atrophy, and orhiectomy are uncommon complications, all patients should be warned of these potential complications and operative consent should include these risks irrespective of the type of hernia or the surgical approach.

  12. Anti-anginal and anti-ischemic effects of late sodium current inhibition.

    Science.gov (United States)

    Wimmer, Neil J; Stone, Peter H

    2013-02-01

    The effective treatment of coronary artery disease targets two distinct goals, controlling symptomatic angina and decreasing the adverse events associated with ischemia. Traditional anti-anginal and anti-ischemic drugs function by altering the determinants of myocardial oxygen supply or demand, usually by altering loading conditions, changing the heart rate, or impacting contractility. Blockade of the late inward sodium current, late I(Na), offers another target for the treatment of ischemia. Blockade of late I(Na) reduces the sodium and calcium overload that follows ischemia. This improves myocardial relaxation and reduces left ventricular diastolic stiffness, in turn enhancing myocardial contractility and perfusion. Ranolazine, a late I(Na) inhibitor, has been shown to provide both anti-anginal and anti-ischemic benefits without significant alterations in the heart rate and blood pressure in patients with stable coronary artery disease. When evaluated in patients with acute coronary syndrome, ranolazine has been shown to decrease recurrent ischemia, but not significantly reduce the risk of death or myocardial infarction. This review will address the rationale that inhibition of the late sodium current is beneficial in reducing cardiac dysfunction during ischemia, and discuss the clinical studies supporting the use of ranolazine for its anti-anginal and anti-ischemic effects.

  13. Memory deficit associated with increased brain proinflammatory cytokine levels and neurodegeneration in acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Bruno Silva

    2015-08-01

    Full Text Available The present study aimed to investigate behavioral changes and neuroinflammatory process following left unilateral common carotid artery occlusion (UCCAO, a model of cerebral ischemia. Post-ischemic behavioral changes following 15 min UCCAO were recorded 24 hours after reperfusion. The novel object recognition task was used to assess learning and memory. After behavioral test, brains from sham and ischemic mice were removed and processed to evaluate central nervous system pathology by TTC and H&E techniques as well as inflammatory mediators by ELISA. UCCAO promoted long-term memory impairment after reperfusion. Infarct areas were observed in the cerebrum by TTC stain. Moreover, the histopathological analysis revealed cerebral necrotic cavities surrounded by ischemic neurons and hippocampal neurodegeneration. In parallel with memory dysfunction, brain levels of TNF-a, IL-1b and CXCL1 were increased post ischemia compared with sham-operated group. These findings suggest an involvement of central nervous system inflammatory mediators and brain damage in cognitive impairment following unilateral acute ischemia.

  14. An emboligenic pulmonary abscess leading to ischemic stroke and secondary brain abscess

    Directory of Open Access Journals (Sweden)

    Albrecht Philipp

    2012-11-01

    Full Text Available Abstract Background Ischemic stroke by septic embolism occurs primarily in the context of infective endocarditis or in patients with a right-to-left shunt and formation of a secondary cerebral abscess is a rare event. Erosion of pulmonary veins by a pulmonary abscess can lead to transcardiac septic embolism but to our knowledge no case of septic embolic ischemic stroke from a pulmonary abscess with secondary transformation into a brain abscess has been reported to date. Case presentation We report the case of a patient with a pulmonary abscess causing a septic embolic cerebral infarction which then transformed into a cerebral abscess. After antibiotic therapy and drainage of the abscess the patient could be rehabilitated and presented an impressive improvement of symptoms. Conclusion Septic embolism should be considered as cause of ischemic stroke in patients with pulmonary abscess and can be followed by formation of a secondary cerebral abscess. Early antibiotic treatment and repeated cranial CT-scans for detection of a secondary abscess should be performed.

  15. Principally Left Hereditary and Principally Left Strong Radicals

    Institute of Scientific and Technical Information of China (English)

    S. Tumurbat; R. Wiegandt

    2001-01-01

    A radical γ is normal if and only if γ is principally left hereditary and principally left strong (i.e., γ(L) = L e A and Lz ∈γ for all z ∈ L imply L γ(A)). Let a radical γ satisfy that A°∈γ and S° A° imply S°∈γ.Then γ is a hereditary normal radical if and only if γ is principally left strong and γ {A | (A, +,◇a) ∈γ a ∈ A}, where the multiplication ◇a is defined by x ◇a y = xay. The Behrens radical class B is the largest principally left hereditary subclass of the Brown-McCoy radical class G. Neither3 nor G is principally left strong.

  16. 慢性心力衰竭患者AngⅡ、Ald水平与左室平均室壁应力的关系%Relationships between Left Ventricular Mean Wall Stress and Plasma level of Angiotensin Ⅱ and Aldosterone and in Patients with Chronic Heart Failure

    Institute of Scientific and Technical Information of China (English)

    杨建峰; 石亮; 魏经汉

    2011-01-01

    Objective To investigate relationships between the left ventricular mean wall stress (MWS) and levels of plasma angiotensin Ⅱ ,aldosterone in the patients with chronic heart failure (CHF).Methods CHF group include 61 patients, healthy control group include 20 healthy volunteers.plasma concentration of angiotensin Ⅱ and aldosterone were measured by specific radioimmunoassays.LYDd, LVDs, IVSd, IVSs, LVPWd and LVPWs were determined by two-dimensional echocardiography, and MWS was calculated.Results The plasma angiotensin Ⅱ, aldosterone and MWS in the patients with CHF were significantly higher than these in healthy control group;the plasma angiotensin Ⅱ and aldosterone were positively with MWS( r =0.4658,r=0.4367 ,P < 0.001 ).Conclusion Changes of plasma concentration of angiotensin Ⅱ ,aldosterone and MWS in the patients with CHF may play a role in the pathogenic mechanism of chronic heart failure,they may interact and influence each other in the pathogenic mechanism of chronic heart failure.%目的 探讨慢性心力衰竭(CHF)患者血浆血管紧张素Ⅱ(AngⅡ)、醛固酮水平(Ald)含量变化与左室平均室壁应力(mean wall stress,MWS)的相关性分析及临床意义.方法 应用放射免疫法测定20例正常人和61例慢性充血性心力衰竭患者血浆血管紧张素Ⅱ、醛固酮含量,心脏超声测定左室收缩/舒张内径及室壁厚度并计算平均室壁应力.结果 CHF患者血浆血管紧张素Ⅱ、醛固酮含量较正常对照组明显升高,并随着心功能等级的增加而有升高趋势.血浆血管紧张素Ⅱ、醛固酮含量与左室平均室壁应力呈正相关.结论 慢性心力衰竭患者血清血浆血管紧张素Ⅱ、醛固酮含量的变化及室壁应力增加参与慢性心力衰竭致病机制,它们之间可能还有相互作用及影响,共同参与慢性心力衰竭的致病机制.

  17. 甲状腺功能与老年慢性充血性心力衰竭患者心功能、左心室重构的关系研究%Relationship Between Thyroid Function and Cardiac Function/Left Ventricular Remodeling of Elderly Patients With Chronic Congestive Heart Failure

    Institute of Scientific and Technical Information of China (English)

    张萍; 赵东升

    2016-01-01

    with chronic congestive heart failure. Methods A total of 90 elderly patients with chronic congestive heart failure(equal or over 60 years old)admitted to the Second People′s Hospital of Hengshui from January 2013 to January 2015 were selected as A group,77 elderly patients without chronic congestive heart failure were selected as B group at the same time. Index of thyroid function,cardiac function and left ventricular remodeling were compared between the two groups, index of thyroid function was compared in elderly chronic congestive heart failure patients with different NYHA cardiac function grades,the correlation between index of thyroid function and cardiac function was analyzed. Results The NYHA cardiac function grades of B group were all Ⅰ - grade;of A group,37 cases′ NYHA cardiac function grades were Ⅱ - grade,36 cases′were Ⅲ - grade,17 cases′ were Ⅳ - grade. TSH,TT3 ,TT4 ,FT3 ,FT4 and LVEF of A group were statistically significantly lower than those of B group,while LVESD,LVEDD and LVMI of A group were statistically significantly lower than those of B group(P < 0. 05). TSH,TT3 and FT3 of chronic congestive heart failure patients with Ⅲ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅱ - grade NYHA cardiac function grades(P < 0. 05);TSH,TT3 ,TT4 ,FT3 and FT4 of chronic congestive heart failure patients with Ⅳ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅱ - grade NYHA cardiac function grades,TT3 ,FT3 and FT4 of chronic congestive heart failure patients with Ⅳ - grade NYHA cardiac function grades were statistically significantly lower than those of chronic congestive heart failure patients with Ⅲ - grade NYHA cardiac function grades. Of patients with chronic congestive heart failure,TSH was negatively correlated with LVEDD( r = - 0. 598) and LVMI(r = - 0

  18. Effect of High-Dose Atorvastatin on Renal Function in Subjects With Stroke or Transient Ischemic Attack in the SPARCL Trial

    DEFF Research Database (Denmark)

    Amarenco, Pierre; Callahan, Alfred, III; Campese, Vito M.

    2014-01-01

    BACKGROUND AND PURPOSE: Higher low-density lipoprotein cholesterol is associated with more rapid chronic kidney disease progression; reduction in cholesterol with statins, in conjunction with statins' pleiotropic effects, such as decreasing inflammation, may be renoprotective. The Stroke Preventi...... ischemic attack with and without chronic kidney disease, and that atorvastatin treatment may prevent eGFR decline in patients with stroke and diabetes mellitus. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00147602....

  19. Prediction of functional recovery after revascularization in patients with chronic ischaemic left ventricular dysfunction: head-to-head comparison between {sup 99m}Tc-sestamibi/{sup 18}F-FDG DISA SPECT and {sup 13}N-ammonia/{sup 18}F-FDG PET

    Energy Technology Data Exchange (ETDEWEB)

    Slart, Riemer H.J.A.; Dierckx, Rudi A.; Jager, Pieter L. [University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30001, Groningen (Netherlands); Bax, Jeroen J.; Wall, Ernst E. van der [Leiden University Medical Center, Department of Cardiology, Leiden (Netherlands); Veldhuisen, Dirk J. van [University Medical Center Groningen, Department of Cardiology, Groningen (Netherlands); Irwan, Roy [University Medical Center Groningen, Department of Radiology, Groningen (Netherlands); Sluiter, Wim J. [University Medical Center Groningen, Department of Endocrinology, Groningen (Netherlands); Boer, Jaep de [Diaconessenhuis Meppel, Department of Nuclear Medicine, Meppel (Netherlands)

    2006-06-15

    {sup 18}F-FDG PET is an important modality for myocardial viability assessment in patients with left ventricular (LV) dysfunction. Dual-isotope simultaneous acquisition (DISA) SPECT may be an alternative to PET. The aim of this study was to compare the diagnostic performance of PET and DISA SPECT for the prediction of improvement in regional and global LV function as well as LV reverse remodelling after revascularization. Patients (n=47) with chronic coronary artery disease and LV dysfunction underwent DISA SPECT (with {sup 99m}Tc-sestamibi and {sup 18}F-FDG) and PET (with {sup 13}N-ammonia and {sup 18}F-FDG) on the same day to assess viability. All patients underwent revascularization and recovery of function was derived from serial magnetic resonance imaging studies. Of 264 revascularized, dysfunctional segments, 143 (54%) improved in function. For prediction of improvement in regional LV function, PET and DISA SPECT had similar sensitivity (90% versus 89%, NS) and specificity (86% versus 86%, NS). For prediction of improvement in global LV function, sensitivity was 83% for DISA SPECT and 86% for PET (p=NS), whereas both modalities had a specificity of 100%. Finally, sensitivity and specificity for the prediction of LV reverse remodelling were also similar for DISA SPECT and PET. (orig.)

  20. Left and right ventricular diastolic function in hemodialysis patients

    Directory of Open Access Journals (Sweden)

    Rudhani Ibrahim

    2010-01-01

    Full Text Available The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD and the correlation of this func-tion with the duration of HD. The study included 42 patients (22 females and 20 males with chro-nic renal failure (CRF, treated with HD, and 40 healthy subjects (24 females and 16 males with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects under-went detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the inter-ventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E, acceleration time of E wave (AT-E, tricuspid E and A waves (E tr and A tr and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  1. Left and right ventricular diastolic function in hemodialysis patients.

    Science.gov (United States)

    Rudhani, Ibrahim Destan; Bajraktari, Gani; Kryziu, Emrush; Zylfiu, Bejtush; Sadiku, Shemsedin; Elezi, Ymer; Rexhepaj, Nehat; Vitia, Arber; Emini, Merita; Abazi, Murat; Berbatovci-Ukimeraj, M; Kryeziu, Kaltrina; Hsanagjekaj, Venera; Korca, Hajrije; Ukimeri, Aferdita

    2010-11-01

    The aim of this prospective study was the assessment of left ventricular and right ventricular diastolic function in patients on hemodialysis (HD) and the correlation of this function with the duration of HD. The study included 42 patients (22 females and 20 males) with chronic renal failure (CRF), treated with HD, and 40 healthy subjects (24 females and 16 males) with no history of cardiovascular disease and with normal renal function, who constituted the control group. The groups were matched for age and sex. All study patients and control subjects underwent detailed history taking and physical examination. They also underwent electrocardiogram, echocardiography and biochemical and hematological blood analyses. Significant differences were noted between the two groups in the two-dimensional and M-mode echocardiography findings concerning aortic root dimension, transverse diameter of the left atrium, thickness of the interventricular septum, thickness of the left ventricular posterior wall, left ventricular diastolic diameter, left ventricular systolic diameter, shortening fraction, ejection fraction as well as findings from the pulse Doppler study, including E wave, A wave, E/A ratio, deceleration time of E wave (DT-E), acceleration time of E wave (AT-E), tricuspid E and A waves (E tr and A tr ) and E tr /A tr , ratio. There were significant changes in HD patients without arterial hypertension as well in the control group subjects. Our study suggests that the left ventricular and left atrial dimensions as well as the left ventricular wall thickness are augmented in patients with CRF treated with HD compared with the control group. Additionally, the left and right ventricular diastolic function is also reduced in these patients. These differences were also noted in patients with CRF without arterial hypertension. Left ventricular diastolic dysfunction had no correlation with the duration of HD.

  2. Echocardiographic diagnosis of left ventricular outflow tract obstruction after mitral valve replacement with subvalvular preservation

    NARCIS (Netherlands)

    Rietman, GW; van der Maaten, JMAA; Douglas, YL; Boonstra, PW

    2002-01-01

    We describe two cases of left ventricular outflow tract obstruction after mitral valve replacement with complete retention of the subvalvular apparatus. The first patient deteriorated immediately after insertion of a high-profile bioprosthesis. In the second patient, chronic left ventricular outflow

  3. Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors

    OpenAIRE

    José Luis Izquierdo; Arturo Martínez; Elizabet Guzmán; et al

    2010-01-01

    José Luis Izquierdo, Arturo Martínez, Elizabet Guzmán, Pilar de Lucas, José Miguel RodríguezPulmonology Department, Hospital Universitario, Guadalajara, Spain; Pulmonology Department, Hospital Gregorio Marañón, Madrid, SpainAbstract: The aim of our study is to determine whether chronic obstructive pulmonary disease (COPD) is an independent risk factor for ischemic heart disease and whether this association is related...

  4. The Curative Effect of Salmeterol and Fluticasone Propionate Combine With Bailing Pian in Treatment of Elderly With Chronic Obstructive Pulmonary Disease With Left Heart Failure%沙美特罗替卡松联合百令片治疗稳定期老年慢性阻塞性肺疾病合并左心衰竭的疗效

    Institute of Scientific and Technical Information of China (English)

    张立艳

    2015-01-01

    Objective To analysis stable chronic obstructive pulmonary disease combined with left heart failure patients receiving salmeterol and lfuticasone propionate clinical results combine with bailing pian treatment. Methods Selected 154 cases of heart failure patients with geriatric stable chronic obstructive pulmonary disease as object, were divided into three groups, A group had 53 cases used of salmeterol and lfuticasone propionate in the treatment of joint bailing, Group B had 51 cases embodiment used salmeterol and fluticasone propionate therapy, group C had 50 cases embodiment used bailing tablets in the treatment, compared to the three treatment groups.Results Before treatment, compared group FEV 1, FVC, FEV 1 / FVC, PaO2, PaCO2 and BODE index score,P>0.05, had no difference statistically significance. After treatment, A group FEV 1, FVC, FEV 1 / FVC, PaO2 were higher than before treatment and group B, C, PaCO2 and BODE index score was lower than before treatment and B, and group C,P0.05, had no difference statistically significance.Conclusion The stability of elderly patients with chronic obstructive pulmonary disease with left heart failure patients receiving treatment with salmeterol lfuticasone propionate and bailing sheet for use in combination with very good results, safe and reliable, lung function and blood gas analysis in patients with test results improved quality of life gained promotion.%目的:分析稳定期老年慢性阻塞性肺病合并左心衰患者接受沙美特罗替卡松联合百令片治疗的临床效果。方法选取我院内科老年稳定期慢性阻塞性肺疾病合并左心衰患者154例来进行研究分析,将这些患者分成3组,A组53例使用沙美特罗替卡松联合百令片治疗;B组51例使用沙美特罗替卡松治疗;C组50例使用百令片治疗,对比3组的治疗效果。结果治疗前,组间FEV 1、FVC、FEV 1/FVC、PaO2、PaCO2和BODE指数评分比较,P>0.05,差异不具有统计

  5. The Left-Handed Writer.

    Science.gov (United States)

    Bloodsworth, James Gaston

    Contrary to the beliefs of many, right-handedness is not a single factor existing in almost all people, with a few exceptions termed left-handed: neither extreme exists independently of the other. During the first 4 years of life there is a period of fluctuation between right and left-handed dominance. Statistics and findings vary in determining…

  6. Two Lefts in Latin America?

    DEFF Research Database (Denmark)

    Christensen, Steen Fryba

    In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given.......In this working paper I list five researchers' categorizations of the Latin American left in power (april 2006) in a schematic form. The most important criteria for the categorizations are given....

  7. Vacuum-assisted closure for bilateral severe ischemic foot after revascularization: a case report.

    Science.gov (United States)

    Nishimura, K; Kanaoka, Y; Ishiguro, S; Harada, S; Shiraya, S; Fujiwara, Y; Nakamura, Y; Kamihira, S; Nishimura, M

    2009-08-01

    Vacuum-assisted closure (VAC) therapy is a unique system that helps promote wound healing. We report a case of severe ischemic foot in which VAC therapy markedly improved wound healing. A 73-year-old man underwent left axillopopliteal bypass and left 3rd, 4th , and 5th digital amputations for gangrene. Although his amputation stumps were complicated with methicillin-resistant Staphylococcus aureus (MRSA) infection, the stumps were successfully healed by VAC. He also had gangrene in his right 1st toe, which could not healed by VAC alone, and we performed right femoropopliteal bypass and right 1st digital amputation. The stump with MRSA infection was also successfully healed by VAC. Histopathologic examination revealed a lot of microvessels in the increased granulation tissue.

  8. Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Mady Charles

    2007-09-01

    Full Text Available Abstract Background In patients with advanced non-ischemic cardiomyopathy (NIC, right-sided cardiac disturbances has prognostic implications. Right coronary artery (RCA flow pattern and flow reserve (CFR are not well known in this setting. The purpose of this study was to assess, in human advanced NIC, the RCA phasic flow pattern and CFR, also under right-sided cardiac disturbances, and compare with left coronary circulation. As well as to investigate any correlation between the cardiac structural, mechanical and hemodynamic parameters with RCA phasic flow pattern or CFR. Methods Twenty four patients with dilated severe NIC were evaluated non-invasively, even by echocardiography, and also by cardiac catheterization, inclusive with Swan-Ganz catheter. Intracoronary Doppler (Flowire data was obtained in RCA and left anterior descendent coronary artery (LAD before and after adenosine. Resting RCA phasic pattern (diastolic/systolic was compared between subgroups with and without pulmonary hypertension, and with and without right ventricular (RV dysfunction; and also with LAD. RCA-CFR was compared with LAD, as well as in those subgroups. Pearson's correlation analysis was accomplished among echocardiographic (including LV fractional shortening, mass index, end systolic wall stress more hemodynamic parameters with RCA phasic flow pattern or RCA-CFR. Results LV fractional shortening and end diastolic diameter were 15.3 ± 3.5 % and 69.4 ± 12.2 mm. Resting RCA phasic pattern had no difference comparing subgroups with vs. without pulmonary hypertension (1.45 vs. 1.29, p = NS either with vs. without RV dysfunction (1.47 vs. 1.23, p = NS; RCA vs. LAD was 1.35 vs. 2.85 (p Conclusion In patients with chronic advanced NIC, RCA phasic flow pattern has a mild diastolic predominance, less marked than in LAD, with no effects from pulmonary artery hypertension or RV dysfunction. There is no significant correlation between any cardiac mechanical-structural or

  9. A Procedure of Combination of Sequential Internal Thoracic Artery Grafting and Cooley's Technique for Complicated Case With Multi-vessel Disease,Left Ventricular Aneurysm and Mitral Regurgitation

    Institute of Scientific and Technical Information of China (English)

    Meng-ya LIANG; Guang-xian CHEN; Zhong-kai WU; Xi ZHANG

    2009-01-01

    @@ INTRODUCTION Left ventricular aneurysm and ischemic mitral regurgitation are two of most common complications of acute myocardial infarction (AMI).Combination of both these two fatal complications is not rare and the management of these complicated cases is always a challenge to cardiac surgeon because of its relatively high mortality[1]. We reported a rare case of AMI in which a singlestage correction of mitral valve replacement with preservation of mitral apparatus, sequential left internal thoracic artery (ITA) grafting and Cooley's technique.

  10. Left-handedness and health

    Directory of Open Access Journals (Sweden)

    Milenković Sanja

    2010-01-01

    Full Text Available Hand dominance is defined as a proneness to use one hand rather than another in performing the majority of activities and this is the most obvious example of cerebral lateralization and an exclusive human characteristic. Left-handed people comprise 6-14% of the total population, while in Serbia, this percentage is 5-10%, moving from undeveloped to developed environments, where a socio-cultural pressure is less present. There is no agreement between investigators who in fact may be considered a left-handed person, about the percentage of left-handers in the population and about the etiology of left-handedness. In the scientific literature left-handedness has been related to health disorders (spine deformities, immunological disorders, migraine, neurosis, depressive psychosis, schizophrenia, insomnia, homosexuality, diabetes mellitus, arterial hypertension, sleep apnea, enuresis nocturna and Down Syndrome, developmental disorders (autism, dislexia and sttutering and traumatism. The most reliable scientific evidences have been published about the relationship between left-handedness and spinal deformities in school children in puberty and with traumatism in general population. The controversy of other results in up-to-now investigations of health aspects of left-handedness may partly be explained by a scientific disagreement whether writing with the left hand is a sufficient criterium for left-handedness, or is it necessary to investigate other parameters for laterality assessment. Explanation of health aspects of left-handedness is dominantly based on Geschwind-Galaburda model about 'anomalous' cerebral domination, as a consequence of hormonal disbalance. .

  11. Left ventricular wall stress compendium.

    Science.gov (United States)

    Zhong, L; Ghista, D N; Tan, R S

    2012-01-01

    Left ventricular (LV) wall stress has intrigued scientists and cardiologists since the time of Lame and Laplace in 1800s. The left ventricle is an intriguing organ structure, whose intrinsic design enables it to fill and contract. The development of wall stress is intriguing to cardiologists and biomedical engineers. The role of left ventricle wall stress in cardiac perfusion and pumping as well as in cardiac pathophysiology is a relatively unexplored phenomenon. But even for us to assess this role, we first need accurate determination of in vivo wall stress. However, at this point, 150 years after Lame estimated left ventricle wall stress using the elasticity theory, we are still in the exploratory stage of (i) developing left ventricle models that properly represent left ventricle anatomy and physiology and (ii) obtaining data on left ventricle dynamics. In this paper, we are responding to the need for a comprehensive survey of left ventricle wall stress models, their mechanics, stress computation and results. We have provided herein a compendium of major type of wall stress models: thin-wall models based on the Laplace law, thick-wall shell models, elasticity theory model, thick-wall large deformation models and finite element models. We have compared the mean stress values of these models as well as the variation of stress across the wall. All of the thin-wall and thick-wall shell models are based on idealised ellipsoidal and spherical geometries. However, the elasticity model's shape can vary through the cycle, to simulate the more ellipsoidal shape of the left ventricle in the systolic phase. The finite element models have more representative geometries, but are generally based on animal data, which limits their medical relevance. This paper can enable readers to obtain a comprehensive perspective of left ventricle wall stress models, of how to employ them to determine wall stresses, and be cognizant of the assumptions involved in the use of specific models.

  12. Limb apraxia in acute ischemic stroke: a neglected clinical challenge?

    Science.gov (United States)

    Schell, Caroline; Suchan, Julia; Himmelbach, Marc; Haarmeier, Thomas; Borchers, Svenja

    2014-04-01

    Symptoms of limb apraxia and executive dysfunctions are currently not explicitly considered by the National Institutes of Health Stroke Scale and, thus, not routinely tested by clinicians in the acute care of patients with suspected stroke. Neuropsychological testing, clinical examination, MRI, and functional magnetic resonance imaging (fMRI) were performed in a right-handed patient with acute onset of left-sided sensorimotor hemiparesis due to a right hemisphere ischemic stroke. Deficits in the execution of meaningless and meaningful gestures were not detected properly on initial clinical examination but were revealed later on through neuropsychological testing. Instead, the patient's inability to respond to specific instructions in the acute care setting was mistaken to reflect severe deficits in auditory comprehension. fMRI revealed right-hemispheric localization of language in the right-handed patient. We suggest including a bedside test for limb apraxia symptoms in acute clinical care of stroke patients. The distinction between deficits in limb praxis and impairments of language can be complicated owing to the common hemispheric co-localization of the two functions.

  13. Granulocyte-colony stimulating factor therapy to induce neovascularization in ischemic heart disease

    DEFF Research Database (Denmark)

    Ripa, Rasmus Sejersten

    2012-01-01

    Cell based therapy for ischemic heart disease has the potential to reduce post infarct heart failure and chronic ischemia. Treatment with granulocyte-colony stimulating factor (G-CSF) mobilizes cells from the bone marrow to the peripheral blood. Some of these cells are putative stem or progenitor...... cells. G-CSF is injected subcutaneously. This therapy is intuitively attractive compared to other cell based techniques since repeated catheterizations and ex vivo cell purification and expansion are avoided. Previous preclinical and early clinical trials have indicated that treatment with G-CSF leads...

  14. Nanosecond pulse electric field activation of platelet-rich plasma reduces myocardial infarct size and improves left ventricular mechanical function in the rabbit heart.

    Science.gov (United States)

    Hargrave, Barbara; Li, Francis

    2012-12-01

    In the current study, we used the novel, nonchemical method of nanosecond pulsed electric fields (nsPEF) to investigate the efficiency of a protocol involving the in vivo treatment of the ischemic and reperfused heart and heart cells in culture with platelet-rich plasma (PRP). Associated with the restoration of blood flow to the ischemic tissue is a phenomenon referred to as "ischemic reperfusion injury." Clinically a type of reperfusion injury occurs during coronary bypass surgery once blood perfusion to the heart is restarted. Although the restoration of oxygen to ischemic myocardial cells is critical for tissue survival, reperfusion causes myocardial oxidative stress, attributable in part to the increased production of reactive oxygen species (ROS). Enhanced ROS production is associated with mitochondrial damage. Adult female New Zealand white rabbits were anesthetized and a left thoracotomy performed to expose the heart. The distal segment of the left anterior descending coronary artery was occluded for 15 minutes and then released so reperfusion of the tissue could occur. PRP (.21 mg/heart) or saline was injected into the ischemic area of the myocardium. Mechanical function of the left ventricle was analyzed using a Millar catheter attached to a Micro-Med Analysis System. H9c2 cells in culture were treated with 1 mL of nsPEF activated PRP (1.05 mg/flask) for 24 hours before analysis for ROS production or mitochondrial depolarization damage). The left ventricle contracted and relaxed faster and infarct size was reduced in hearts treated with PRP compared with saline. ROS production and mitochondrial depolarization were reduced in H9c2 cells treated with PRP and stimulated with hydrogen peroxide. These results provide evidence that nsPEFs can successfully be used to prepare PRP and that the PRP is functional in heart protection possibly by reducing ROS generation and stabilizing the mitochondria of the ischemic/reperfused heart.

  15. Genetics of ischemic stroke: Indian perspective

    Directory of Open Access Journals (Sweden)

    Subhash Kaul

    2012-01-01

    Full Text Available A stroke is still a major cause of long-term disability and the third largest killer in the world after heart attack and cancer. Inherited genetic variation has been shown to play a role in its pathogenesis and therefore, there is a need to identify the culprit genetic variants. They may provide novel targets for preventive therapeutics. The most intensively investigated candidate gene is PDE4D. There are several positive replication studies of PDE4D gene with stroke. The genetic contribution to ischemic stroke risk in India has not been explored adequately. Reports on few candidate genes are available but we are still lagging behind in this aspect. Most of the reports are from Andhra Pradesh, a province in south India and a few parts of north India. PDE4D has been identified as a predisposition gene for ischemic stroke in Southern as well as the Northern population of India.

  16. Ischemic stroke: carotid and vertebral artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Vilela, P.; Goulao, A. [Hospital Garcia de Orta, Servico de Neurorradiologia, Almada (Portugal)

    2005-03-01

    Ischemic strokes may have distinct aetiologies, including several different intrinsic arterial pathological disorders. The diagnosis and understanding of these arterial diseases is critical for the correct management of stroke as different treatment approaches are undertaken according to the aetiology. Atherosclerosis is by far the most common arterial disease among adults, and other pathological processes include arterial dissection, small vessel disease, inflammatory and non-inflammatory vasculopathy and vasomotor disorders. In children, there are several vasculopathies responsible for vaso-occlusive disease such as sickle-cell anemia, acute regressive angiopathy and Moya-Moya disease, neurofibromatosis, dissections, vasculitis associated with intracranial and systemic infections. An overview of the major carotid and vertebral pathological diseases responsible for ischemic stroke in adults and children, highlighting the accuracy of the different imaging modalities for its diagnosis and the imaging appearance of these diseases, is given. (orig.)

  17. Cardiac Connexin 43 and Ischemic Cardioprotection

    Institute of Scientific and Technical Information of China (English)

    Jin-yi LI; Guo-qiang ZHONG; Yan HE; Yun LING

    2009-01-01

    The connexin 43 (Cx43) proteins, which is the predominant protein that can form gap junctions and non-junctional hemichannels in ventricular myocardium, are central to the cardioprotection afforded by ischemic precondi-tioning (IP) and maybe ischemic postconditioning (PC) too. Recent studies showed that recruitment of Cx43 to the mitochondria in IP might play a role in the production of reactive oxygen species (ROS) that mediates IP. The localiza-tion of Cx43 at mitochondria appears to be important for the achieved cardioprotection and opens a new door for us to reveal the exact mechanisms of ischemia/reperfusion (I/R) injury and cardioprotection, and it might be new targets of pharmacological modulator to achieved cardioprotection.

  18. [Ischemic cholangiopathy induced by extended burns].

    Science.gov (United States)

    Cohen, Laurence; Angot, Emilie; Goria, Odile; Koning, Edith; François, Arnaud; Sabourin, Jean-Christophe

    2013-04-01

    Ischemic cholangiopathy is a recently described entity occurring mainly after hepatic grafts. Very few cases after intensive care unit (ICU) for extended burn injury were reported. We report the case of a 73-year-old woman consulting in an hepatology unit, for a jaundice appearing during a hospitalisation in an intensive care unit and increasing from her leaving from ICU, where she was treated for an extended burn injury. She had no pre-existing biological features of biliary disease. Biological tests were normal. Magnetic resonance imaging acquisitions of biliary tracts pointed out severe stenosing lesions of diffuse cholangiopathy concerning intrahepatic biliary tract, mainly peri-hilar. Biopsie from the liver confirmed the diagnosis, showing a biliary cirrhosis with bile infarcts. This case is the fourth case of ischemic cholangiopathy after extended burn injury, concerning a patient without a prior history of hepatic or biliary illness and appearing after hospitalisation in intensive care unit.

  19. Cost and Outcome in Pediatric Ischemic Stroke.

    Science.gov (United States)

    Hamilton, William; Huang, Haijuan; Seiber, Eric; Lo, Warren

    2015-10-01

    The cost of childhood stroke receives little notice. The authors examined potential drivers of cost and outcome to test whether (1) neonatal strokes cost less than childhood strokes, (2) associated diseases influence cost, (3) arterial ischemic stroke is more costly than sinovenous thrombosis, and (4) cost correlates with outcome. The authors reviewed records of 111 children who sustained arterial ischemic stroke or sinovenous thrombosis between 2005 and 2010 to identify costs for the following year. They assessed outcomes in 46 with the Recovery and Recurrence Questionnaire and the Pediatric Quality of Life Inventory. Neonatal strokes cost less than childhood stroke. Strokes associated with congenital heart disease or vasculopathy cost the most, while perinatal or idiopathic strokes cost the least. Higher costs are correlated with worse impairment and poorer quality of life. Stroke etiology significantly influences the cost of pediatric stroke. Future cost-benefit studies must consider etiology when estimating the incremental costs associated with stroke.

  20. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A;

    2009-01-01

    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care...... and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation. METHODS: Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003......-2007 and prospectively registered in the Danish National Indicator Project. RESULTS: Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days), and were...

  1. 慢性肾功能衰竭患者血清 FGF-23、血钙及血磷水平对左心功能的影响%Effect of FGF-23,serum calcium and phosphorus levels of patients with chronic renal failure on the left ventricular function

    Institute of Scientific and Technical Information of China (English)

    郭鹏

    2016-01-01

    Objective To study the effect of FGF-23,serum calcium and phosphorus levels of patients with chronic renal failure on the left ventricular function. Methods From June 2012 to June 2015,148 patients with chronic renal failure were selected randomly,and divided into dialysis group with 88 cases and non-dialysis group with 60 cases. The differences of biochemical indicators and left heart function indicators between the two groups were compared. Then all patients were divided into four levels based on the serum level of FGF-23 by the quartile method,the difference of left cardiac function indicators between the four levels were compared,and the correlation between serum FGF-23 and cardiac function was investigated. Results FGF-23 of dialysis group was(199. 9 ± 60. 2)pg / ml,serum calcium was(2. 2 ± 0. 2)mmol/ L,serum phosphorus was(2. 5 ± 0. 7)mmol/ L,in comparation with non-dialysis group,the differences were significant(P < 0. 05). The difference of LVEF,MPI,LVH between 4 levels patients showed significant difference(P < 0. 05). There were significant negative correlation of serum FGF-23 with LVEF(r = - 0. 623,P < 0. 05),and positive correlation of serum FGF-23 with MPI(r =0. 503,P < 0. 05). Conclusions FGF-23,serum calcium and phosphorus levels of patients with chron-ic renal failure has remarkable effects on LVEF,MPI and LVH,and has effect on the left ventricular function.%目的:探讨慢性肾功能衰竭(CRF)患者血清成纤维细胞生长因子-23(FGF-23)、血钙及血磷水平对左心功能的影响。方法随机选择2012年6月至2015年6月慢性肾功能衰竭患者148例,分为透析组88例和非透析组60例,比较两组间各生化指标及左心功能指标的差异,按四分位数法将所有患者血清 FGF-23水平分为4个等级,比较各等级间心功能指标的差异,分析血清 FGF-23与心功能间的相关性。结果透析组 FGF-23[(199.9±60.2)pg/ ml]、血钙[(2.2±0.2)mmol/ L]、血磷[(2.5±0

  2. Left bundle branch block: a rare ECG manifestation of hyperkalemia

    Directory of Open Access Journals (Sweden)

    Venkata Madhav M

    2015-04-01

    Full Text Available A 20-year-old female patient with chronic kidney disease was brought to our emergency medical department with symptoms of pain in chest and abdomen, vomitings. Laboratory testing revealed serum potassium 7.7 mEq/L, serum creatinine 9.1 mg/dL. Electrocardiogram (ECG showed left bundle branch block (LBBB pattern with left axis deviation, tall T waves and ST elevation. Among ECG alterations in hyperkalemia, LBBB is rare and is being reported in our case.

  3. Reconstitution of coronary vasculature by an active fraction of Geum japonicum in ischemic hearts

    Science.gov (United States)

    Chen, Hao; Cheng, Lei; Lin, Xiaoli; Zhou, Xiaping; Cai, Zhiming; Li, Ming

    2014-02-01

    Chronic coronary heart disease (cCHD) is characteriz