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Sample records for coronary microvascular function

  1. A randomised trial comparing the effect of exercise training and weight loss on microvascular function in coronary artery disease

    DEFF Research Database (Denmark)

    Olsen, Rasmus Huan; Pedersen, Lene Rørholm; Jürs, Anders

    2015-01-01

    BACKGROUND: Coronary microvascular function is associated with outcome and is reduced in coronary artery disease (CAD) and obesity. We compared the effect of aerobic interval training (AIT) and weight loss on coronary flow reserve (CFR) and peripheral vascular function in revascularised obese CAD...... might impact prognosis of CAD through improvement of coronary microvascular function. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01724567....

  2. Coronary microvascular function, insulin sensitivity and body composition in predicting exercise capacity in overweight patients with coronary artery disease

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    Jürs, Anders; Pedersen, Lene Rørholm; Olsen, Rasmus Huan

    2015-01-01

    BACKGROUND: Coronary artery disease (CAD) has a negative impact on exercise capacity. The aim of this study was to determine how coronary microvascular function, glucose metabolism and body composition contribute to exercise capacity in overweight patients with CAD and without diabetes. METHODS......: Sixty-five non-diabetic, overweight patients with stable CAD, BMI 28-40 kg/m(2) and left ventricular ejection fraction (LVEF) above 35 % were recruited. A 3-hour oral glucose tolerance test was used to evaluate glucose metabolism. Peak aerobic exercise capacity (VO2peak) was assessed...... by a cardiopulmonary exercise test. Body composition was determined by whole body dual-energy X-ray absorptiometry scan and magnetic resonance imaging. Coronary flow reserve (CFR) assessed by transthoracic Doppler echocardiography was used as a measure of microvascular function. RESULTS: Median BMI was 31.3 and 72...

  3. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

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    Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

    2016-01-01

    artery stenosis (coronary flow velocity reserve......BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary...... microvascular dysfunction and the association with symptoms, cardiovascular risk factors, psychosocial factors, and results from diagnostic stress testing. METHODS AND RESULTS: After screening 3568 women, 963 women with angina-like chest pain and a diagnostic coronary angiogram without significant coronary...

  4. Plasma soluble urokinase-type plasminogen activator receptor level is independently associated with coronary microvascular function in patients with non-obstructive coronary artery disease

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    Mekonnen, Girum; Corban, Michel T; Hung, Olivia Y;

    2015-01-01

    , medications profiles and hs-CRP, suPAR remained an independent predictor of CFR (B = -0.30, p = 0.04), indicating an independent association between suPAR level and coronary microvascular function. CONCLUSIONS: In this cross-sectional study, plasma suPAR level was an independent predictor of coronary......BACKGROUND: Soluble urokinase-type plasminogen activator receptor (suPAR) is a novel biomarker released from leukocytes and endothelial cells that has been associated with atherosclerotic cardiovascular disease. We hypothesized that plasma suPAR level is an independent predictor of coronary...... microvascular function. METHODS: Coronary blood flow velocity and plasma suPAR levels were evaluated in patients with non-obstructive coronary artery disease. Coronary flow reserve (CFR) was calculated as the ratio of hyperemic to basal average peak blood flow velocity and coronary microvascular dysfunction...

  5. Coronary microvascular dysfunction: an update

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    Crea, Filippo; Camici, Paolo G.; Bairey Merz, Cathleen Noel

    2014-01-01

    Many patients undergoing coronary angiography because of chest pain syndromes, believed to be indicative of obstructive atherosclerosis of the epicardial coronary arteries, are found to have normal angiograms. In the past two decades, a number of studies have reported that abnormalities in the function and structure of the coronary microcirculation may occur in patients without obstructive atherosclerosis, but with risk factors or with myocardial diseases as well as in patients with obstructive atherosclerosis; furthermore, coronary microvascular dysfunction (CMD) can be iatrogenic. In some instances, CMD represents an epiphenomenon, whereas in others it is an important marker of risk or may even contribute to the pathogenesis of cardiovascular and myocardial diseases, thus becoming a therapeutic target. This review article provides an update on the clinical relevance of CMD in different clinical settings and also the implications for therapy. PMID:24366916

  6. Coronary Microvascular Function and Cardiovascular Risk Factors in Women With Angina Pectoris and No Obstructive Coronary Artery Disease

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    Mygind, Naja Dam; Michelsen, Marie Mide; Pena, Adam;

    2016-01-01

    BACKGROUND: The majority of women with angina-like chest pain have no obstructive coronary artery disease when evaluated with coronary angiography. Coronary microvascular dysfunction is a possible explanation and associated with a poor prognosis. This study evaluated the prevalence of coronary.......01), hypertension (P=0.02), current smoking (Pheart rate (P.... CONCLUSION: Impaired CFVR was detected in a substantial proportion, which suggests that coronary microvascular dysfunction plays a role in the development of angina pectoris. CFVR was associated with few cardiovascular risk factors, suggesting that CFVR is an independent parameter in the risk evaluation...

  7. Peripheral Reactive Hyperemia Index and Coronary Microvascular Function in Women With no Obstructive CAD

    DEFF Research Database (Denmark)

    Michelsen, Marie Mide; Mygind, Naja Dam; Peña, Adam

    2016-01-01

    OBJECTIVES: This study investigated whether digital reactive hyperemia index (RHI) measured by digital pulse amplitude tonometry is a sensitive indicator of coronary microvascular dysfunction (CMD). BACKGROUND: CMD is an early marker of cardiovascular disease. However, CMD is a complex diagnosis ...

  8. Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters.

    Science.gov (United States)

    Dal Lin, Carlo; Tona, Francesco; Osto, Elena

    2015-01-01

    Beyond its hemodynamic function, the heart also acts as a neuroendocrine and immunoregulatory organ. A dynamic communication between the heart and other organs takes place constantly to maintain cardiovascular homeostasis. The current understanding highlights the importance of the endocrine, immune, and nervous factors to fine-tune the crosstalk of the cardiovascular system with the entire body. Once disrupted, this complex interorgan communication may promote the onset and the progression of cardiovascular diseases. Thus, expanding our knowledge on how these factors influence the cardiovascular system can lead to novel therapeutic strategies to improve patient care. In the present paper, we review novel concepts on the role of endocrine, immune, and nervous factors in the modulation of microvascular coronary function.

  9. Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters

    Science.gov (United States)

    Dal Lin, Carlo; Tona, Francesco

    2015-01-01

    Beyond its hemodynamic function, the heart also acts as a neuroendocrine and immunoregulatory organ. A dynamic communication between the heart and other organs takes place constantly to maintain cardiovascular homeostasis. The current understanding highlights the importance of the endocrine, immune, and nervous factors to fine-tune the crosstalk of the cardiovascular system with the entire body. Once disrupted, this complex interorgan communication may promote the onset and the progression of cardiovascular diseases. Thus, expanding our knowledge on how these factors influence the cardiovascular system can lead to novel therapeutic strategies to improve patient care. In the present paper, we review novel concepts on the role of endocrine, immune, and nervous factors in the modulation of microvascular coronary function. PMID:26124827

  10. Coronary Microvascular Function and Beyond: The Crosstalk between Hormones, Cytokines, and Neurotransmitters

    Directory of Open Access Journals (Sweden)

    Carlo Dal Lin

    2015-01-01

    Full Text Available Beyond its hemodynamic function, the heart also acts as a neuroendocrine and immunoregulatory organ. A dynamic communication between the heart and other organs takes place constantly to maintain cardiovascular homeostasis. The current understanding highlights the importance of the endocrine, immune, and nervous factors to fine-tune the crosstalk of the cardiovascular system with the entire body. Once disrupted, this complex interorgan communication may promote the onset and the progression of cardiovascular diseases. Thus, expanding our knowledge on how these factors influence the cardiovascular system can lead to novel therapeutic strategies to improve patient care. In the present paper, we review novel concepts on the role of endocrine, immune, and nervous factors in the modulation of microvascular coronary function.

  11. Coronary microvascular obstruction in acute myocardial infarction.

    Science.gov (United States)

    Niccoli, Giampaolo; Scalone, Giancarla; Lerman, Amir; Crea, Filippo

    2016-04-01

    The success of a primary percutaneous intervention (PCI) in the setting of ST elevation myocardial infarction depends on the functional and structural integrity of coronary microcirculation. Coronary microvascular dysfunction and obstruction (CMVO) occurs in up to half of patients submitted to apparently successful primary PCI and is associated to a much worse outcome. The current review summarizes the complex mechanisms responsible for CMVO, including pre-existing coronary microvascular dysfunction, and highlights the current limitations in the assessment of microvascular function. More importantly, at the light of the substantial failure of trials hitherto published on the treatment of CMVO, this review proposes a novel integrated therapeutic approach, which should overcome the limitations of previous studies.

  12. The impact of obesity on the relationship between epicardial adipose tissue, left ventricular mass and coronary microvascular function

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    Bakkum, M.J.; Danad, I.; Romijn, M.A.J.; Stuijfzand, W.J.A.; Leonora, R.M.; Rossum, A.C. van; Knaapen, P. [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Tulevski, I.I.; Somsen, G.A. [Cardiology Centers of the Netherlands, Amsterdam (Netherlands); Lammertsma, A.A.; Kuijk, C. van; Raijmakers, P.G. [VU University Medical Center, Department of Radiology and Nuclear Medicine, Amsterdam (Netherlands)

    2015-09-15

    Epicardial adipose tissue (EAT) has been linked to coronary artery disease (CAD) and coronary microvascular dysfunction. However, its injurious effect may also impact the underlying myocardium. This study aimed to determine the impact of obesity on the quantitative relationship between left ventricular mass (LVM), EAT and coronary microvascular function. A total of 208 (94 men, 45 %) patients evaluated for CAD but free of coronary obstructions underwent quantitative [{sup 15}O]H{sub 2}O hybrid positron emission tomography (PET)/CT imaging. Coronary microvascular resistance (CMVR) was calculated as the ratio of mean arterial pressure to hyperaemic myocardial blood flow. Obese patients [body mass index (BMI) > 25, n = 133, 64 % of total] had more EAT (125.3 ± 47.6 vs 93.5 ± 42.1 cc, p < 0.001), a higher LVM (130.1 ± 30.4 vs 114.2 ± 29.3 g, p < 0.001) and an increased CMVR (26.6 ± 9.1 vs 22.3 ± 8.6 mmHg x ml{sup -1} x min{sup -1} x g{sup -1}, p < 0.01) as compared to nonobese patients. Male gender (β = 40.7, p < 0.001), BMI (β = 1.61, p < 0.001), smoking (β = 6.29, p = 0.03) and EAT volume (β = 0.10, p < 0.01) were identified as independent predictors of LVM. When grouped according to BMI status, EAT was only independently associated with LVM in nonobese patients. LVM, hypercholesterolaemia and coronary artery calcium score were independent predictors of CMVR. EAT volume is associated with LVM independently of BMI and might therefore be a better predictor of cardiovascular risk than BMI. However, EAT volume was not related to coronary microvascular function after adjustments for LVM and traditional risk factors. (orig.)

  13. A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

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    Borges, J.P. [Laboratório de Atividade Física e Promoção è Saúde, Departamento de Desporto Coletivo, Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Lopes, G.O. [Laboratório de Atividade Física e Promoção è Saúde, Departamento de Desporto Coletivo, Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Verri, V.; Coelho, M.P.; Nascimento, P.M.C.; Kopiler, D.A. [Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Tibirica, E. [Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Laboratório de Investigação Cardiovascular, Departamento Osório de Almeida, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ (Brazil)

    2016-09-01

    Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01). With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

  14. A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

    Directory of Open Access Journals (Sweden)

    J.P. Borges

    2016-01-01

    Full Text Available Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61 and healthy age-matched subjects (n=24. Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01. With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04. In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

  15. A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging.

    Science.gov (United States)

    Borges, J P; Lopes, G O; Verri, V; Coelho, M P; Nascimento, P M C; Kopiler, D A; Tibirica, E

    2016-09-01

    Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; PAPU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

  16. Coronary microvascular function and myocardial fibrosis in women with angina pectoris and no obstructive coronary artery disease

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    Mygind, Naja Dam; Michelsen, Marie Mide; Peña, Adam

    2016-01-01

    had focal fibrosis. Median (IQR) CFVR was 2.3 (1.9; 2.7), 23 (36 %) had CFVR 2)  = 0.02; p = 0.......27 and R (2)  = 0.004; p = 0.61, respectively). There were also no correlations between MBFR and ECV or native T1 (R (2)  = 0.1; p = 0.13 and R (2)  = 0.004, p = 0.64, respectively). CFVR and MBFR were correlated to hypertension and heart rate. CONCLUSION: In women with angina and no obstructive coronary...

  17. Microvascular Coronary Artery Spasm Presents Distinctive Clinical Features With Endothelial Dysfunction as Nonobstructive Coronary Artery Disease

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    Ohba, Keisuke; Sugiyama, Seigo; Sumida, Hitoshi; Nozaki, Toshimitsu; Matsubara, Junichi; Matsuzawa, Yasushi; Konishi, Masaaki; Akiyama, Eiichi; Kurokawa, Hirofumi; Maeda, Hirofumi; Sugamura, Koichi; Nagayoshi, Yasuhiro; Morihisa, Kenji; Sakamoto, Kenji; Tsujita, Kenichi; Yamamoto, Eiichiro; Yamamuro, Megumi; Kojima, Sunao; Kaikita, Koichi; Tayama, Shinji; Hokimoto, Seiji; Matsui, Kunihiko; Sakamoto, Tomohiro; Ogawa, Hisao

    2012-01-01

    Background Angina without significant stenosis, or nonobstructive coronary artery disease, attracts clinical attention. Microvascular coronary artery spasm (microvascular CAS) can cause nonobstructive coronary artery disease. We investigated the clinical features of microvascular CAS and the therapeutic efficacy of calcium channel blockers. Methods and Results Three hundred seventy consecutive, stable patients with suspected angina presenting nonobstructive coronary arteries (<50% diameter) in coronary angiography were investigated with the intracoronary acetylcholine provocation test, with simultaneous measurements of transcardiac lactate production and of changes in the quantitative coronary blood flow. We diagnosed microvascular CAS according to lactate production and a decrease in coronary blood flow without epicardial vasospasm during the acetylcholine provocation test. We prospectively followed up the patients with calcium channel blockers for microvascular coronary artery disease. We identified 50 patients with microvascular CAS who demonstrated significant impairment of the endothelium-dependent vascular response, which was assessed by coronary blood flow during the acetylcholine provocation test. Administration of isosorbide dinitrate normalized the abnormal coronary flow pattern in the patients with microvascular CAS. Multivariate logistic regression analysis indicated that female sex, a lower body mass index, minor–borderline ischemic electrocardiogram findings at rest, limited–baseline diastolic-to-systolic velocity ratio, and attenuated adenosine triphosphate–induced coronary flow reserve were independently correlated with the presence of microvascular CAS. Receiver-operating characteristics curve analysis revealed that the aforementioned 5-variable model showed good correlation with the presence of microvascular CAS (area under the curve: 0.820). No patients with microvascular CAS treated with calcium channel blockers developed cardiovascular

  18. Transthoracic Doppler echocardiography compared with positron emission tomography for assessment of coronary microvascular dysfunction

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    Michelsen, Marie Mide; Mygind, Naja Dam; Pena, Adam

    2017-01-01

    stenosis at invasive coronary angiography, TTDE CFVR by dipyridamole induced stress and MBFR by rubidium-82 PET with adenosine was successfully measured in 107 subjects. Repeatability of TTDE CFVR was assessed in 10 symptomatic women and in 10 healthy individuals. RESULTS: MBFR was systematically higher......BACKGROUND: Coronary microvascular function can be assessed by transthoracic Doppler echocardiography as a coronary flow velocity reserve (TTDE CFVR) and by positron emission tomography as a myocardial blood flow reserve (PET MBFR). PET MBFR is regarded the noninvasive reference standard...... for measuring coronary microvascular function but has limited availability. We compared TTDE CFVR with PET MBFR in women with angina pectoris and no obstructive coronary artery disease and assessed repeatability of TTDE CFVR. METHODS: From a cohort of women with angina and no obstructive coronary artery...

  19. Invasive assessment of coronary microvascular dysfunction in hypertrophic cardiomyopathy: the index of microvascular resistance

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    Gutiérrez-Barrios, Alejandro, E-mail: aleklos@hotmail.com [Cardiology Department, Jerez Hospital, Jerez (Spain); Camacho-Jurado, Francisco [Cardiology Department, Punta Europa Hospital, Algeciras (Spain); Díaz-Retamino, Enrique; Gamaza-Chulián, Sergio; Agarrado-Luna, Antonio; Oneto-Otero, Jesús; Del Rio-Lechuga, Ana; Benezet-Mazuecos, Javier [Cardiology Department, Jerez Hospital, Jerez (Spain)

    2015-10-15

    Summary: We present a review of microvascular dysfunction in hypertrophic cardiomyopathy (HCM) and an interesting case of a symptomatic familial HCM patient with inducible ischemia by single photon emission computed tomography. Coronary angiography revealed normal epicardial arteries. Pressure wire measurements of fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microvascular resistance (IMR) demonstrated a significant microcirculatory dysfunction. This is the first such case that documents this abnormality invasively using the IMR. The measurement of IMR, a novel marker of microcirculatory dysfunction, provides novel insights into the pathophysiology of this condition. - Highlights: • Microvascular dysfunction is a common feature in hypertrophic cardiomyopathy (HCM) and represents a strong predictor of unfavorable outcome and cardiovascular mortality. • The index of microvascular resistance (IMR) is a new method for invasively assessing the state of the coronary microcirculation using a single pressure-temperature sensor-tipped coronary wire. • However assessment of IMR in HCM has not been previously reported. We report a case in which microvascular dysfunction is assessed by IMR. This index may be useful in future researches of HCM.

  20. Coronary microvascular dysfunction in overt diabetic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    K. Bratis

    2014-11-01

    Conclusion: In patients with DM2 myocardial perfusion reserve is markedly decreased, suggestive of microvascular disease. In this small cohort MPRI impairment did not correlate to the LV EF deterioration.

  1. Treatment of Angina Pectoris Associated with Coronary Microvascular Dysfunction.

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    Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

    2016-08-01

    Treatment of angina pectoris associated with coronary microvascular dysfunction is challenging as the underlying mechanisms are often diverse and overlapping. Patients with type 1 coronary microvascular dysfunction (i.e. absence of epicardial coronary artery disease and myocardial disease) should receive strict control of their cardiovascular risk factors and thus receive statins and ACE-inhibitors in most cases. Antianginal medication consists of ß-blockers and/or calcium channel blockers. Second line drugs are ranolazine and nicorandil with limited evidence. Despite individually titrated combinations of these drugs up to 30 % of patients have refractory angina. Rho-kinase inhibitors and endothelin-receptor antagonists represent potential drugs that may prove useful in these patients in the future.

  2. Mst1 inhibits CMECs autophagy and participates in the development of diabetic coronary microvascular dysfunction

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    Lin, Jie; Zhang, Lei; Zhang, Mingming; Hu, Jianqiang; Wang, Tingting; Duan, Yu; Man, Wanrong; Wu, Bin; Feng, Jiaxu; Sun, Lei; Li, Congye; Zhang, Rongqing; Wang, Haichang; Sun, Dongdong

    2016-01-01

    Cardiovascular complications account for a substantial proportion of morbidity and mortality in diabetic patients. Abnormalities of cardiac microvascular endothelial cells (CMECs) lead to impaired cardiac microvascular vessel integrity and subsequent cardiac dysfunction, underlining the importance of coronary microvascular dysfunction. In this study, experimental diabetes models were constructed using Mst1 transgenic, Mst1 knockout and sirt1 knockout mice. Diabetic Mst1 transgenic mice exhibited impaired cardiac microvessel integrity and decreased cardiac function. Mst1 overexpression deceased CMECs autophagy as evidenced by decreased LC3 expression and enhanced protein aggregation when subjected to high glucose culture. Mst1 knockout improved cardiac microvessel integrity and enhanced cardiac functions in diabetic mice. Mst1 knockdown up-regulated autophagy as indicated by more typical autophagosomes and increased LC3 expression in CMECs subjected to high glucose cultures. Mst1 knockdown also promoted autophagic flux in the presence of bafilomycin A1. Mst1 overexpression increased CMECs apoptosis, whereas Mst1 knockout decreased CMECs apoptosis. Sirt1 knockout abolished the effects of Mst1 overexpression in cardiac microvascular injury and cardiac dysfunction. In conclusion, Mst1 knockout preserved cardiac microvessel integrity and improved cardiac functions in diabetic mice. Mst1 decreased sirt1 activity, inhibited autophagy and enhanced apoptosis in CMECs, thus participating in the pathogenesis of diabetic coronary microvascular dysfunction. PMID:27680548

  3. Dysregulation of coronary microvascular reactivity in asymptomatic patients with type 2 diabetes mellitus

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    Momose, Mitsuru; Neverve, Jodi; Nekolla, Stephan G.; Schwaiger, Markus; Bengel, Frank M. [Nuklearmedizinische Klinik und Poliklinik der Technischen Universitaet Muenchen, Klinikum rechts der Isar, Ismaninger Strasse 22, 81675 Munich (Germany); Abletshauser, Claudia [Department of Medicine, Novartis Pharma GmbH, Nuernberg (Germany); Schnell, Oliver; Standl, Eberhard [Institut fuer Diabetesforschung, Munich (Germany)

    2002-12-01

    In diabetic patients, a number of studies have suggested an impairment of vascular reactivity in response to vasodilatory stimuli. The pattern of dysregulation at the coronary microcirculatory level, however, has not been clearly defined. Thus, it was the aim of this study to characterise coronary microvascular function non-invasively in a homogeneous group of asymptomatic type 2 diabetic patients. In 46 patients with type 2 diabetes, myocardial blood flow (MBF) was quantified at baseline, in response to cold pressor test (CPT) and during adenosine-mediated vasodilation using positron emission tomography and nitrogen-13 ammonia. None of the patients had been treated with insulin, and none had symptoms of cardiac disease. Decreased MBF during CPT, indicating microvascular dysregulation, was observed in 16 patients (CPT-), while 30 patients demonstrated increased MBF during CPT (CPT+). Response to CPT was mildly, but significantly correlated with response to adenosine (r=0.44, P=0.0035). There was no difference in HbA1c, serum lipid levels or serum endothelial markers between the groups. Microvascular dysregulation in the CPT- group was associated with elevated baseline MBF (P<0.0001), reduced baseline vascular resistance (P=0.0026) and an abnormal increase in resistance during CPT (P=0.0002). In conclusion, coronary microvascular dysregulation is present in approximately one-third of asymptomatic, non-insulin-treated type 2 diabetic patients. Elevated baseline blood flow and reduced microvascular resistance at rest are characteristics of this dysregulation. These data suggest a state of activation of endothelial-dependent vasodilation at baseline which appears to limit the flow response to stress conditions. (orig.)

  4. Obesity and coronary microvascular disease - implications for adipose tissue-mediated remote inflammatory response.

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    Bagi, Zsolt; Broskova, Zuzana; Feher, Attila

    2014-05-01

    It is believed that obesity has detrimental effects on the coronary circulation. These include immediate changes in coronary arterial vasomotor responsiveness and the development of occlusive large coronary artery disease. Despite its critical role in regulating myocardial perfusion, the altered behavior of coronary resistance arteries, which gives rise to coronary microvascular disease (CMD) is poorly understood in obesity. A chronic, low-grade vascular inflammation has been long considered as one of the main underlying pathology behind CMD. The expanded adipose tissue and the infiltrating macrophages are the major sources of pro-inflammatory mediators that have been implicated in causing inadequate myocardial perfusion and, in a long term, development of heart failure in obese patients. Much less is known the mechanisms regulating the release of these cytokines into the circulation that enable them to exert their remote effects in the coronary microcirculation. This mini review aims to examine recent studies describing alterations in the vasomotor function of coronary resistance arteries and the role of adipose tissue-derived pro-inflammatory cytokines and adipokines in contributing to CMD in obesity. We provide examples of regulatory mechanisms by which adipokines are released from adipose tissue to exert their remote inflammatory effects on coronary microvessels. We identify some of the important challenges and opportunities going forward.

  5. Coronary microvascular rarefaction and myocardial fibrosis in heart failure with preserved ejection fraction.

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    Mohammed, Selma F; Hussain, Saad; Mirzoyev, Sultan A; Edwards, William D; Maleszewski, Joseph J; Redfield, Margaret M

    2015-02-10

    Characterization of myocardial structural changes in heart failure with preserved ejection fraction (HFpEF) has been hindered by the limited availability of human cardiac tissue. Cardiac hypertrophy, coronary artery disease (CAD), coronary microvascular rarefaction, and myocardial fibrosis may contribute to HFpEF pathophysiology. We identified HFpEF patients (n=124) and age-appropriate control subjects (noncardiac death, no heart failure diagnosis; n=104) who underwent autopsy. Heart weight and CAD severity were obtained from the autopsy reports. With the use of whole-field digital microscopy and automated analysis algorithms in full-thickness left ventricular sections, microvascular density (MVD), myocardial fibrosis, and their relationship were quantified. Subjects with HFpEF had heavier hearts (median, 538 g; 169% of age-, sex-, and body size-expected heart weight versus 335 g; 112% in controls), more severe CAD (65% with ≥1 vessel with >50% diameter stenosis in HFpEF versus 13% in controls), more left ventricular fibrosis (median % area fibrosis, 9.6 versus 7.1) and lower MVD (median 961 versus 1316 vessels/mm(2)) than control (Pcoronary microvascular rarefaction, and myocardial fibrosis than controls. Each of these findings may contribute to the left ventricular diastolic dysfunction and cardiac reserve function impairment characteristic of HFpEF. © 2014 American Heart Association, Inc.

  6. Improved myocardial perfusion after transmyocardial laser revascularization in a patient with microvascular coronary artery disease

    Directory of Open Access Journals (Sweden)

    Peyman Mesbah Oskui

    2014-03-01

    Full Text Available We report the case of a 59-year-old woman who presented with symptoms of angina that was refractory to medical management. Although her cardiac catheterization revealed microvascular coronary artery disease, her symptoms were refractory to optimal medical management that included ranolazine. After undergoing transmyocardial revascularization, her myocardial ischemia completely resolved and her symptoms dramatically improved. This case suggests that combination of ranolazine and transmyocardial revascularization can be applied to patients with microvascular coronary artery disease.

  7. Effect of the glucagon-like peptide-1 analogue liraglutide on coronary microvascular function in patients with type 2 diabetes – a randomized, single-blinded, cross-over pilot study

    DEFF Research Database (Denmark)

    Faber, Rebekka; Zander, Mette; Pena, Adam

    2015-01-01

    33.1 ± 4.4, mean baseline CFR 2.35 ± 0.45). There was a small increase in CFR following liraglutide treatment (change 0.18, CI95% [-0.01; 0.36], p = 0.06) but no difference in effect in comparison with no treatment (difference between treatment allocation 0.16, CI95% [-0.08; 0.40], p = 0......-1 (GLP-1) on the cardiovascular system. The aim of the study was to explore the short-term effect of GLP-1 treatment on coronary microcirculation estimated by CFR in patients with type 2 diabetes. METHODS: Patients with type 2 diabetes and no history of coronary artery disease were treated...... dipyridamole induced stress. Peripheral microvascular endothelial function was assessed by Endo-PAT2000®. Interventions were compared by two-sample t-test after ensuring no carry over effect. RESULTS: A total of 24 patients were included. Twenty patients completed the study (15 male; mean age 57 ± 9; mean BMI...

  8. Obesity is associated with lower coronary microvascular density.

    Directory of Open Access Journals (Sweden)

    Duncan J Campbell

    Full Text Available BACKGROUND: Obesity is associated with diastolic dysfunction, lower maximal myocardial blood flow, impaired myocardial metabolism and increased risk of heart failure. We examined the association between obesity, left ventricular filling pressure and myocardial structure. METHODS: We performed histological analysis of non-ischemic myocardium from 57 patients (46 men and 11 women undergoing coronary artery bypass graft surgery who did not have previous cardiac surgery, myocardial infarction, heart failure, atrial fibrillation or loop diuretic therapy. RESULTS: Non-obese (body mass index, BMI, ≤ 30 kg/m(2, n=33 and obese patients (BMI >30 kg/m(2, n=24 did not differ with respect to myocardial total, interstitial or perivascular fibrosis, arteriolar dimensions, or cardiomyocyte width. Obese patients had lower capillary length density (1145 ± 239, mean ± SD, vs. 1371 ± 333 mm/mm(3, P=0.007 and higher diffusion radius (16.9 ± 1.5 vs. 15.6 ± 2.0 μm, P=0.012, in comparison with non-obese patients. However, the diffusion radius/cardiomyocyte width ratio of obese patients (0.73 ± 0.11 μm/μm was not significantly different from that of non-obese patients (0.71 ± 0.11 μm/μm, suggesting that differences in cardiomyocyte width explained in part the differences in capillary length density and diffusion radius between non-obese and obese patients. Increased BMI was associated with increased pulmonary capillary wedge pressure (PCWP, P<0.0001, and lower capillary length density was associated with both increased BMI (P=0.043 and increased PCWP (P=0.016. CONCLUSIONS: Obesity and its accompanying increase in left ventricular filling pressure were associated with lower coronary microvascular density, which may contribute to the lower maximal myocardial blood flow, impaired myocardial metabolism, diastolic dysfunction and higher risk of heart failure in obese individuals.

  9. The role of coronary microvascular dysfunction in the genesis of cardiovascular diseases

    Energy Technology Data Exchange (ETDEWEB)

    Parodi, O.; Sambuceti, G. [CNR, Milan (Italy). Inst. of Clinical Physiology Section

    1996-03-01

    Positron emission tomography (PET) offers the unique capability of measuring specific flow (flow per unit of mass) in man by means of a regional, tridimensional, noninvasive approach. Using PET, myocardial perfusion abnormalities secondary to microvascular disorders have beeen investigated in arterial hypertension (AH), dilated and hypertrophic cardiomyopathy (CM), as well as in ischemic heart disease (CAD). In AH, regional perfusion at rest is within the normal range, while the coronary reserve and flow response to increase in metabolic demand are blunted. These flow abnormalities are independent of the degree of cardiac hypertrophy and the severity of AH; appropriate anti-ipertensive therapy is able to improve the perfusion abnormalities after long term treatment, independently of the effect on myocard ial hypertrophy. Both dilated and hypertrophic CM demonstrate abnormal vasodilaing capability, wich as bee schown to be presented in the subclinical form of dilated DM; the reduction of coronary reserve is not related to the presence and extent of the hemodynamic impairment in dilated CM, and involved also nonhypertropied myocardium in asymmetric hypertropic CM. These finding indicate a primary involvement of coronary microcirculation in non advanced forms of dilated and hypertrophic CM. Finally, in patients with CAD, myocardia teritories supplied by angiographically normal coronary arteries schow abnormal coronary reserve and flow during pacing, tachycardia, indicating that, even in absence of epicardial coronary artery obstruction, microcirculation is impaired in subject with coronary atherosclerosis. this abnormally can smooth perfusion differences, between control andd jeopardized regions. Accordingly, the absenca of a perfusion defect during stress might indicate the presence of either a non significant stenosis or a diffuse impairment in microcirculatory function. (Abstract Truncated)

  10. Translational Medicine Study on Cardiac Microvascular Endothelial Barrier Function and Myocardial Ischemia/Re-perfusion Injury

    Institute of Scientific and Technical Information of China (English)

    Yeong Yeh Lee

    2015-01-01

    Vascular endothelial barrier is defined as the ability of endothelial cells and their components that make up the microvascular wall structure in controlling the cellular components and marco-molecular substances in blood from penetrating vascular walls. It is the place for the selective exchange of oxygen, nutrients and metabolites, and has kernel effect in maintaining myocardial micro-environmental homeostasis. In clinic, microvascular permeability is commonly used as the index for evaluating endothelial barrier function. Myocardial microvascular endothelial cells, inter-endothelial connexin and basilar membrane (BM) interact synergically to constitute the basis for barrier function, which has a selective permeability effect on interaction between nutrient substances and other myocardial cell molecules. Increase of microvascular permeability is closely associated with cardiovascular events like coronary heart disease (CHD) and myocardial ischemia, and is the risk factor for CHD attack. And deep exploration of the mechanism of endothelial permeability and positive selection of new-type re-perfusion complementary drugs for alleviating endothelial permeability can be beneifcial in improving the prognosis of patients with acute myocardial infarction (AMI). Therefore, from the view of translational medicine, this study mainly summarized the increase of microvascular permeability and its pathological signiifcance after AMI, physiological and pathological mechanisms of regulating microvascular permeability and complementary therapies for AMI re-perfusion as well as microvascular endothelial barrier function, hoping to provide a basis for improving the prognosis of patients with AMI.

  11. Translational Medicine Study on Cardiac Microvascular Endothelial Barrier Function and Myocardial Ischemia/Re-perfusion Injury

    Directory of Open Access Journals (Sweden)

    Yeong Yeh Lee

    2015-09-01

    Full Text Available Vascular endothelial barrier is defined as the ability of endothelial cells and their components that make up the microvascular wall structure in controlling the cellular components and marco-molecular substances in blood from penetrating vascular walls. It is the place for the selective exchange of oxygen, nutrients and metabolites, and has kernel effect in maintaining myocardial micro-environmental homeostasis. In clinic, microvascular permeability is commonly used as the index for evaluating endothelial barrier function. Myocardial microvascular endothelial cells, inter-endothelial connexin and basilar membrane (BM interact synergically to constitute the basis for barrier function, which has a selective permeability effect on interaction between nutrient substances and other myocardial cell molecules. Increase of microvascular permeability is closely associated with cardiovascular events like coronary heart disease (CHD and myocardial ischemia, and is the risk factor for CHD attack. And deep exploration of the mechanism of endothelial permeability and positive selection of new-type re-perfusion complementary drugs for alleviating endothelial permeability can be beneficial in improving the prognosis of patients with acute myocardial infarction (AMI. Therefore, from the view of translational medicine, this study mainly summarized the increase of microvascular permeability and its pathological significance after AMI, physiological and pathological mechanisms of regulating microvascular permeability and complementary therapies for AMI re-perfusion as well as microvascular endothelial barrier function, hoping to provide a basis for improving the prognosis of patients with AMI.

  12. Coronary microvascular dysfunction in a porcine model of early atherosclerosis and diabetes

    NARCIS (Netherlands)

    Heuvel, van den M.; Sorop, O.; Koopmans, S.J.; Dekker, R.A.; Vries, de R.; Beusekom, H.M.M.; Eringa, E.C.; Duncker, D.J.; Danser, A.H.J.; Giessen, W.J.

    2012-01-01

    Detailed evaluation of coronary function early in diabetes mellitus (DM)-associated coronary artery disease (CAD) development is difficult in patients. Therefore, we investigated coronary conduit and small artery function in a preatherosclerotic DM porcine model with type 2 characteristics.

  13. Myocardial steatosis as a possible mechanistic link between diastolic dysfunction and coronary microvascular dysfunction in women.

    Science.gov (United States)

    Wei, Janet; Nelson, Michael D; Szczepaniak, Edward W; Smith, Laura; Mehta, Puja K; Thomson, Louise E J; Berman, Daniel S; Li, Debiao; Bairey Merz, C Noel; Szczepaniak, Lidia S

    2016-01-01

    Women with coronary microvascular dysfunction (CMD) and no obstructive coronary artery disease (CAD) have increased rates of heart failure with preserved ejection fraction (HFpEF). The mechanisms of HFpEF are not well understood. Ectopic fat deposition in the myocardium, termed myocardial steatosis, is frequently associated with diastolic dysfunction in other metabolic diseases. We investigated the prevalence of myocardial steatosis and diastolic dysfunction in women with CMD and subclinical HFpEF. In 13 women, including eight reference controls and five women with CMD and evidence of subclinical HFpEF (left ventricular end-diastolic pressure >12 mmHg), we measured myocardial triglyceride content (TG) and diastolic function, by proton magnetic resonance spectroscopy and magnetic resonance tissue tagging, respectively. When compared with reference controls, women with CMD had higher myocardial TG content (0.83 ± 0.12% vs. 0.43 ± 0.06%; P = 0.025) and lower diastolic circumferential strain rate (168 ± 12 vs. 217 ± 15%/s; P = 0.012), with myocardial TG content correlating inversely with diastolic circumferential strain rate (r = -0.779; P = 0.002). This study provides proof-of-concept that myocardial steatosis may play an important mechanistic role in the development of diastolic dysfunction in women with CMD and no obstructive CAD. Detailed longitudinal studies are warranted to explore specific treatment strategies targeting myocardial steatosis and its effect on diastolic function.

  14. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings

    DEFF Research Database (Denmark)

    Pries, A.R.; Habazettl, H.; Ambrosio, G.

    2008-01-01

    with abnormalities of the coronary microcirculation and may thus represent a manifestation of coronary microvascular disease (CMD). Elucidation of the role of the microvasculature in the genesis of myocardial ischaemia and cardiac damage-in the presence or absence of obstructive coronary atherosclerosis......-will certainly result in more rational diagnostic and therapeutic interventions for patients with ischaemic heart disease. Specifically targeted research based on improved assessment modalities is needed to improve the diagnosis of CMD and to translate current molecular, cellular, and physiological knowledge...

  15. Coronary microvascular dysfunction in a porcine model of early atherosclerosis and diabetes

    NARCIS (Netherlands)

    Heuvel, van den M.; Sorop, O.; Koopmans, S.J.; Dekker, R.A.; Vries, de R.; Beusekom, H.M.M.; Eringa, E.C.; Duncker, D.J.; Danser, A.H.J.; Giessen, W.J.

    2012-01-01

    Detailed evaluation of coronary function early in diabetes mellitus (DM)-associated coronary artery disease (CAD) development is difficult in patients. Therefore, we investigated coronary conduit and small artery function in a preatherosclerotic DM porcine model with type 2 characteristics. Streptoz

  16. Quantification of coronary microvascular resistance using angiographic images for volumetric blood flow measurement: in vivo validation.

    Science.gov (United States)

    Zhang, Zhang; Takarada, Shigeho; Molloi, Sabee

    2011-06-01

    Structural coronary microcirculation abnormalities are important prognostic determinants in clinical settings. However, an assessment of microvascular resistance (MR) requires a velocity wire. A first-pass distribution analysis technique to measure volumetric blood flow has been previously validated. The aim of this study was the in vivo validation of the MR measurement technique using first-pass distribution analysis. Twelve anesthetized swine were instrumented with a transit-time ultrasound flow probe on the proximal segment of the left anterior descending coronary artery (LAD). Microspheres were injected into the LAD to create a model of microvascular dysfunction. Adenosine (400 μg·kg(-1)·min(-1)) was used to produce maximum hyperemia. A region of interest in the LAD arterial bed was drawn to generate time-density curves using angiographic images. Volumetric blood flow measurements (Q(a)) were made using a time-density curve and the assumption that blood was momentarily replaced with contrast agent during the injection. Blood flow from the flow probe (Q(p)), coronary pressure (P(a)), and right atrium pressure (P(v)) were continuously recorded. Flow probe-based normalized MR (NMR(p)) and angiography-based normalized MR (NMR(a)) were calculated using Q(p) and Q(a), respectively. In 258 measurements, Q(a) showed a strong correlation with the gold standard Q(p) (Q(a) = 0.90 Q(p) + 6.6 ml/min, r(2) = 0.91, P measure NMR without using a velocity wire, which can potentially be used to evaluate microvascular conditions during coronary arteriography.

  17. Tetrahydrobiopterin restores impaired coronary microvascular dysfunction in hypercholesterolaemia

    Energy Technology Data Exchange (ETDEWEB)

    Wyss, Christophe A.; Koepfli, Pascal; Namdar, Mehdi; Siegrist, Patrick T.; Kaufmann, Philipp A. [University Hospital, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Luscher, Thomas F. [University Hospital, Division of Cardiology, Cardiovascular Center, Zurich (Switzerland); Camici, Paolo G. [Hammersmith Hospital, MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College of Science, Technology and Medicine, London (United Kingdom)

    2005-01-01

    Tetrahydrobiopterin (BH{sub 4}) is an essential co-factor for the synthesis of nitric oxide (NO), and BH{sub 4} deficiency may cause impaired NO synthase (NOS) activity. We studied whether BH{sub 4} deficiency contributes to the coronary microcirculatory dysfunction observed in patients with hypercholesterolaemia. Myocardial blood flow (MBF; ml min{sup -1} g{sup -1}) was measured at rest, during adenosine-induced (140 {mu}g kg{sup -1} min{sup -1} over 7 min) hyperaemia (mainly non-endothelium dependent) and immediately after supine bicycle exercise (endothelium-dependent) stress in ten healthy volunteers and in nine hypercholesterolaemic subjects using {sup 15}O-labelled water and positron emission tomography. Measurements were repeated 60 min later, after intravenous infusion of BH{sub 4} (10 mg kg{sup -1} body weight over 30 min). Adenosine-induced hyperaemic MBF is considered to represent (near) maximal flow. Flow reserve utilisation was calculated as the ratio of exercise-induced to adenosine-induced hyperaemic MBF and expressed as percent to indicate how much of the maximal (adenosine-induced) hyperaemia can be achieved by bicycle stress. BH{sub 4} increased exercise-induced hyperaemia in controls (2.96{+-}0.58 vs 3.41{+-}0.73 ml min{sup -1} g{sup -1}, p<0.05) and hypercholesterolaemic subjects (2.47{+-}0.78 vs 2.70{+-}0.72 ml min{sup -1} g{sup -1}, p<0.01) but had no influence on MBF at rest or during adenosine-induced hyperaemia in controls (4.52{+-}1.10 vs 4.85{+-}0.45 ml min{sup -1} g{sup -1}, p=NS) or hypercholesterolaemic subjects (4.86{+-}1.18 vs 4.53{+-}0.93 ml min{sup -1} g{sup -1}, p=NS). Flow reserve utilisation remained unchanged in controls (70{+-}17% vs 71{+-}19%, p=NS) but increased significantly in hypercholesterolaemic subjects (53{+-}15% vs 66{+-}14%, p<0.05). BH{sub 4} restores flow reserve utilisation of the coronary microcirculation in hypercholesterolaemic subjects, suggesting that BH{sub 4} deficiency may contribute to coronary

  18. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation.

    Science.gov (United States)

    Paulus, Walter J; Tschöpe, Carsten

    2013-07-23

    Over the past decade, myocardial structure, cardiomyocyte function, and intramyocardial signaling were shown to be specifically altered in heart failure with preserved ejection fraction (HFPEF). A new paradigm for HFPEF development is therefore proposed, which identifies a systemic proinflammatory state induced by comorbidities as the cause of myocardial structural and functional alterations. The new paradigm presumes the following sequence of events in HFPEF: 1) a high prevalence of comorbidities such as overweight/obesity, diabetes mellitus, chronic obstructive pulmonary disease, and salt-sensitive hypertension induce a systemic proinflammatory state; 2) a systemic proinflammatory state causes coronary microvascular endothelial inflammation; 3) coronary microvascular endothelial inflammation reduces nitric oxide bioavailability, cyclic guanosine monophosphate content, and protein kinase G (PKG) activity in adjacent cardiomyocytes; 4) low PKG activity favors hypertrophy development and increases resting tension because of hypophosphorylation of titin; and 5) both stiff cardiomyocytes and interstitial fibrosis contribute to high diastolic left ventricular (LV) stiffness and heart failure development. The new HFPEF paradigm shifts emphasis from LV afterload excess to coronary microvascular inflammation. This shift is supported by a favorable Laplace relationship in concentric LV hypertrophy and by all cardiac chambers showing similar remodeling and dysfunction. Myocardial remodeling in HFPEF differs from heart failure with reduced ejection fraction, in which remodeling is driven by loss of cardiomyocytes. The new HFPEF paradigm proposes comorbidities, plasma markers of inflammation, or vascular hyperemic responses to be included in diagnostic algorithms and aims at restoring myocardial PKG activity.

  19. Absolute coronary blood flow measurement and microvascular resistance in ST-elevation myocardial infarction in the acute and subacute phase

    Energy Technology Data Exchange (ETDEWEB)

    Wijnbergen, Inge; Veer, Marcel van ' t [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven (Netherlands); Lammers, Jeroen; Ubachs, Joey [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Pijls, Nico H.J., E-mail: nico.pijls@cze.nl [Department of Cardiology, Catharina Hospital, Eindhoven (Netherlands); Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven (Netherlands)

    2016-03-15

    Background/Purpose: In a number of patients with acute myocardial infarction (AMI), myocardial hypoperfusion, known as the no-reflow phenomenon, persists after primary percutaneous intervention (PPCI). The aim of this study was to evaluate the feasibility and safety of a new quantitative method of measuring absolute blood flow and resistance within the perfusion bed of an infarct-related artery. Furthermore, we sought to study no-reflow by correlating these measurements to the index of microvascular resistance (IMR) and the area at risk (AR) as determined by cardiac magnetic resonance imaging (CMR). Methods: Measurements of absolute flow and myocardial resistance were performed in 20 patients with ST-segment elevation myocardial infarction (STEMI), first immediately following PPCI and then again after 3–5 days. These measurements used the technique of thermodilution during a continuous infusion of saline. Flow was expressed in ml/min per gram of tissue within the area at risk. Results: The average time needed for measurement of absolute flow, resistance and IMR was 20 min, and all measurements could be performed without complication. A higher flow supplying the AR correlated with a lower IMR in the acute phase. Absolute flow increased from 3.14 to 3.68 ml/min/g (p = 0.25) and absolute resistance decreased from 1317 to 1099 dyne.sec.cm-5/g (p = 0.40) between the first day and fifth day after STEMI. Conclusions: Measurement of absolute flow and microvascular resistance is safe and feasible in STEMI patients and may allow for a better understanding of microvascular (dys)function in the early phase of AMI. - Highlights: • We measured absolute coronary blood flow and microvascular resistance in STEMI patients in the acute phase and in the subacute phase, using the technique of thermodilution with low grade intracoronary continuous infusion of saline. • These measurements are safe and feasible during PPCI in STEMI patients. • In STEMI patients, absolute flow

  20. Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI.

    Science.gov (United States)

    Amier, Raquel P; Teunissen, Paul F A; Marques, Koen M; Knaapen, Paul; van Royen, Niels

    2014-01-01

    Up to 40% of patients with acute myocardial infarction develop microvascular obstruction (MVO) despite successful treatment with primary percutaneous coronary intervention (PCI). The presence of MVO is linked to negative remodelling and left ventricular dysfunction, leading to decreased long-term survival, increased morbidity and reduced quality of life. The acute obstruction and dysfunction of the microvasculature can potentially be reversed by pharmacological treatment in addition to the standard PCI treatment. Identifying patients with post-PCI occurrence of MVO is essential in assessing which patients could benefit from additional treatment. However, at present there is no validated method to identify these patients. Angiographic parameters like myocardial blush grade or corrected Thrombolysis In Myocardial Infarction (TIMI) flow do not accurately predict the occurrence of MVO as visualised by MRI in the days after the acute event. Theoretically, acute MVO can be detected by intracoronary measurements of flow and resistance directly following the PCI procedure. In MVO the microvasculature is obstructed or destructed and will therefore display a higher coronary microvascular resistance (CMVR). The methods for intracoronary assessment of CMVR are based on either thermodilution or Doppler-flow measurements. The aim of this review is to present an overview of the currently available methods and parameters for assessing CMVR, with special attention given to their use in clinical practice and information provided by clinical studies performed in patients with acute myocardial infarction.

  1. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... early (E) and late (A) inflow velocities, and tissue Doppler diastolic (e′) and systolic (s′) velocities. Peak coronary flow velocity (CFV) was measured in the LAD using pulse-wave Doppler. CFR was calculated as the ratio between peak CFV at rest and during vasodilator stress. Median CFR was 2.22 (1....... Conclusions Coronary flow reserve measured noninvasively predicts cardiopulmonary fitness independently of resting systolic and diastolic function in CAD patients, indicating that cardiac output during maximal exercise is dependent on the ability of the coronary circulation to adapt to the higher metabolic...

  2. Angiographic Evaluation of Coronary Microvascular Dysfunction in Patients with Heart Failure and Preserved Ejection Fraction.

    Science.gov (United States)

    Sucato, Vincenzo; Evola, Salvatore; Novo, Giuseppina; Sansone, Angela; Quagliana, Angelo; Andolina, Giuseppe; Assennato, Pasquale; Novo, Salvatore

    2015-10-01

    The aim of this study was to evaluate myocardial perfusion and coronary blood flow through validated angiography indices to assess whether there is greater MVD in patients with microvascular angina and HFPEF compared to those who do not have. Our study was performed on a population of 286 patients with stable angina that underwent coronary angiography and echocardiography. They showed epicardial coronary arteries free from stenosis. We divided the sample into two categories: patients with HFPEF and those without. We calculated indices for each patient based on angiographic images, including TFC, MBG, and TMBS. Our sample compared two groups: HFPEF (n = 155) and non-HFPEF (n = 135) patients. We showed that patients with HFPEF had a longest TFC of three major coronary arteries (TFC LAD 44.7 ± 12.5; TFC RCA 26.2 ± 6.9; TFC CX 27 ± 5.9) than non-HFPEF patients (TFC LAD 40.7 ± 11.6; TFC RCA 25 ± 6.3; TFC CX 21 ± 4.7). On the other hand, we found lower MBG on three coronary arteries (MBG LAD 2.1 ± 0.3; MBG RCA 2.1 ± 0.3; MBG CX 2.0 ± 0.32) in HFPEF than non-HFPEF patients (MBG LAD 2.6 ± 0.5; MBG RCA 2.2 ± 0.47; MBG CX 2.3 ± 0.4). Analysis of microcirculation through angiography indices in patients with and without HFPEF has led to assess that the HFPEF population has a greater involvement of microcirculation than patients without HFPEF. © 2015 John Wiley & Sons Ltd.

  3. Role of genetic polymorphisms of ion channels in the pathophysiology of coronary microvascular dysfunction and ischemic heart disease.

    Science.gov (United States)

    Fedele, Francesco; Mancone, Massimo; Chilian, William M; Severino, Paolo; Canali, Emanuele; Logan, Suzanna; De Marchis, Maria Laura; Volterrani, Maurizio; Palmirotta, Raffaele; Guadagni, Fiorella

    2013-11-01

    Conventionally, ischemic heart disease (IHD) is equated with large vessel coronary disease. However, recent evidence has suggested a role of compromised microvascular regulation in the etiology of IHD. Because regulation of coronary blood flow likely involves activity of specific ion channels, and key factors involved in endothelium-dependent dilation, we proposed that genetic anomalies of ion channels or specific endothelial regulators may underlie coronary microvascular disease. We aimed to evaluate the clinical impact of single-nucleotide polymorphisms in genes encoding for ion channels expressed in the coronary vasculature and the possible correlation with IHD resulting from microvascular dysfunction. 242 consecutive patients who were candidates for coronary angiography were enrolled. A prospective, observational, single-center study was conducted, analyzing genetic polymorphisms relative to (1) NOS3 encoding for endothelial nitric oxide synthase (eNOS); (2) ATP2A2 encoding for the Ca²⁺/H⁺-ATPase pump (SERCA); (3) SCN5A encoding for the voltage-dependent Na⁺ channel (Nav1.5); (4) KCNJ8 and KCNJ11 encoding for the Kir6.1 and Kir6.2 subunits of K-ATP channels, respectively; and (5) KCN5A encoding for the voltage-gated K⁺ channel (Kv1.5). No significant associations between clinical IHD manifestations and polymorphisms for SERCA, Kir6.1, and Kv1.5 were observed (p > 0.05), whereas specific polymorphisms detected in eNOS, as well as in Kir6.2 and Nav1.5 were found to be correlated with IHD and microvascular dysfunction. Interestingly, genetic polymorphisms for ion channels seem to have an important clinical impact influencing the susceptibility for microvascular dysfunction and IHD, independent of the presence of classic cardiovascular risk factors.

  4. Skeletal muscle microvascular function in girls with Turner syndrome

    OpenAIRE

    West, Sarah L.; Clodagh S. O'Gorman; Alyaa H. Elzibak; Jessica Caterini; Noseworthy, Michael D; Tammy Rayner; Jill Hamilton; Wells, Greg D.

    2014-01-01

    Background: Exercise intolerance is prevalent in individuals with Turner Syndrome (TS). We recently demonstrated that girls with TS have normal aerobic but altered skeletal muscle anaerobic metabolism compared to healthy controls (HC). The purpose of this study was to compare peripheral skeletal muscle microvascular function in girls with TS to HC after exercise. We hypothesized that girls with TS would have similar muscle blood-oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) s...

  5. Functional adaptations of the coronary microcirculation to anaemia in fetal sheep.

    Science.gov (United States)

    Jonker, Sonnet S; Davis, Lowell; Soman, Divya; Belcik, J Todd; Davidson, Brian P; Atkinson, Tamara M; Wilburn, Adrienne; Louey, Samantha; Giraud, George D; Lindner, Jonathan R

    2016-11-01

    In fetuses, chronic anaemia stimulates cardiac growth; simultaneously, blood flow to the heart muscle itself is increased, and reserve blood flow capacity of the coronary vascular bed is preserved. Here we examined functional adaptations of the capillaries and small blood vessels responsible for delivering oxygen to the anaemic fetal heart muscle using contrast-enhanced echocardiography. We demonstrate that coronary microvascular flux rate doubled in anaemic fetuses compared to control fetuses, both at rest and during maximal flow, suggesting reduced microvascular resistance consistent with capillary widening. Cardiac fractional microvascular blood volume was not greater in anaemic fetuses, suggesting that growth of new microvascular vessels does not contribute to the increased flow per volume of myocardium. These unusual changes in microvascular function during anaemia may indicate novel adaptive strategies in the fetal heart. Fetal anaemia causes cardiac adaptations that have immediate and life-long repercussions on heart function and health. It is known that resting and maximal coronary conductance both increase during chronic fetal anaemia, but the coronary microvascular changes responsible for the adaptive response are unknown. Until recently, technical limitations have prevented quantifying functional capillary-level adaptations in the in vivo fetal heart. Our objective was to characterise functional microvascular adaptations in chronically anaemic fetal sheep. Chronically instrumented fetuses were randomized to a control group (n = 11) or were made anaemic by isovolumetric haemorrhage (n = 12) for 1 week prior to myocardial contrast echocardiography at 85% of gestation. Anaemia augmented cardiac mass by 23% without changing body weight. In anaemic fetuses, microvascular blood flow per volume of myocardium was twice that of control fetuses at rest, during vasodilatory hyperaemia, and during hyperaemia plus increased aortic pressure. The elevated blood

  6. Angiography and coronary function, a clinical approach

    NARCIS (Netherlands)

    Stoel, Martin Gerrit

    2013-01-01

    Coronary angiography has the potential to determine coronary function in addition to merely showing coronary anatomy. In this thesis, we describe several facets of angiographic evaluation of coronary flow velocity and function. Measurement of the length of the coronary vessels by means of a guide

  7. Attenuation of microvascular function in those with cardiovascular disease is similar in patients of Indian Asian and European descent

    Directory of Open Access Journals (Sweden)

    Chaturvedi Nish

    2010-01-01

    Full Text Available Abstract Background Indian Asians are at increased risk of cardiovascular death which does not appear to be explained by conventional risk factors. As microvascular disease is also more prevalent in Indian Asians, and as it is thought to play a role in the development of macrovascular disease, we decided to determine whether impaired microcirculation could contribute to this increased cardiovascular risk in Indian Asians. Methods Forearm skin laser Doppler fluximetry in response to heating and ischaemia was assessed in 83 Europeans (41 with angiographically confirmed atherosclerotic coronary artery disease (CAD and 42 from the general population and 84 Indian Asians (41 with CAD. Explanations for differences in microvascular function were sought using multivariate analysis including conventional cardiovascular risk factors. Results Compared to ethnically matched control populations both Europeans and Indian Asians with CAD had poorer microvascular responses to heating than those without (117(95% CI 105-131 vs. 142(130-162 arbitrary units, (au for Europeans and 111(101-122 vs. 141(131-153au for Indian Asians and to ischaemia (44(38-50 vs. 57(49-67au & 39(34-45 vs. 49(43-56au respectively. These differences were not accounted for by conventional cardiovascular risk factors. There was no ethnic difference in the attenuation of microvascular function associated with CAD. Conclusion Patients of European and Indian Asian descent with symptomatic CAD have poorer microvascular maximal tissue perfusion and reactive hyperaemia in the skin compared to ethnically matched asymptomatic control populations. Despite the increased cardiovascular risk in Indian Asians, the attenuation of microvascular function associated with CAD was equivalent in the ethic groups. This suggests that in Indian Asians microcirculation does not explain the increased susceptibility to CAD.

  8. Skeletal muscle microvascular function in girls with Turner syndrome

    Science.gov (United States)

    West, Sarah L.; O'Gorman, Clodagh S.; Elzibak, Alyaa H.; Caterini, Jessica; Noseworthy, Michael D.; Rayner, Tammy; Hamilton, Jill; Wells, Greg D.

    2014-01-01

    Background Exercise intolerance is prevalent in individuals with Turner Syndrome (TS). We recently demonstrated that girls with TS have normal aerobic but altered skeletal muscle anaerobic metabolism compared to healthy controls (HC). The purpose of this study was to compare peripheral skeletal muscle microvascular function in girls with TS to HC after exercise. We hypothesized that girls with TS would have similar muscle blood-oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) signal responses during recovery from exercise compared to HC. Methods Thirteen TS participants and 8 HC completed testing. BOLD MRI was used to measure skeletal muscle microvascular response during 60 second recovery, following 60 s of exercise at 65% of maximal workload. Exercise and recovery were repeated four times, and the BOLD signal time course was fit to a four-parameter sigmoid function. Results Participants were 13.7 ± 3.1 years old and weighed 47.9 ± 14.6 kg. The mean change in BOLD signal intensity following exercise at the end of recovery, the mean response time of the function/the washout of deoxyhemoglobin, and the mean half-time of recovery were similar between the TS and HC groups. Conclusions Our results demonstrate that compared to HC, peripheral skeletal muscle microvascular function following exercise in girls with TS is not impaired. General significance This study supports the idea that the aerobic energy pathway is not impaired in children with TS in response to submaximal exercise. Other mechanisms are likely responsible for exercise intolerance in TS; this needs to be further investigated. PMID:26676172

  9. Very rapid effect of pitavastatin on microvascular function in comparison to rosuvastatin: reactive hyperemia peripheral arterial tonometric study

    Directory of Open Access Journals (Sweden)

    Kono Y

    2013-05-01

    Full Text Available Yasushi Kono,1 Shota Fukuda,1 Kenei Shimada,2 Koki Nakanishi,2 Kenichiro Otsuka,2 Tomoichiro Kubo,1 Satoshi Jissho,1 Haruyuki Taguchi,1 Junichi Yoshikawa,3 Minoru Yoshiyama21Department of Medicine, Osaka Ekisaikai Hospital, Nishi-ku, Osaka, Japan; 2Department of Internal Medicine and Cardiology, Osaka City University School of Medicine, Abeno-ku, Osaka, Japan; 3Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, JapanBackground: It has been reported that pitavastatin improves endothelial function faster than other statins. Recently introduced reactive hyperemia peripheral arterial tonometry (RH-PAT provides objective and quantitative assessment of peripheral microvascular function.Purpose: This study aimed to investigate whether peripheral microvascular function improved 2 hours after pitavastatin in subjects with coronary artery disease (CAD using RH-PAT, and the results were compared with those of rosuvastatin.Methods: This study included 94 subjects with CAD, assigned to a group given 2 mg of pitavastatin (n = 36, a group given 2.5 mg of rosuvastatin (n = 38, and a control group (n = 20. RH-PAT examinations were performed before and 2 hours after statin administration.Results: The RH-PAT index increased 2 hours after pitavastatin administration from 1.82 ± 0.45 to 2.16 ± 0.62 (P = 0.02, whereas there were no differences in the RH-PAT index in the rosuvastatin group (1.79 ± 0.71 to 1.91 ± 0.53, P = 0.09 and the control group (1.68 ± 0.36 to 1.84 ± 0.58, P = 0.4. No significant changes were observed at 2 hours in serum cholesterol levels in each group.Conclusion: The present study demonstrated that peripheral microvascular function improved 2 hours after a single clinical dose of pitavastatin, but not after rosuvastatin.Keywords: coronary artery disease, statin, microvascular function

  10. Wave speed in human coronary arteries is not influenced by microvascular vasodilation: implications for wave intensity analysis.

    Science.gov (United States)

    Rolandi, M Cristina; De Silva, Kalpa; Lumley, Matthew; Lockie, Timothy P E; Clapp, Brian; Spaan, Jos A E; Perera, Divaka; Siebes, Maria

    2014-03-01

    Wave intensity analysis and wave separation are powerful tools for interrogating coronary, myocardial and microvascular physiology. Wave speed is integral to these calculations and is usually estimated by the single-point technique (SPc), a feasible but as yet unvalidated approach in coronary vessels. We aimed to directly measure wave speed in human coronary arteries and assess the impact of adenosine and nitrate administration. In 14 patients, the transit time Δt between two pressure signals was measured in angiographically normal coronary arteries using a microcatheter equipped with two high-fidelity pressure sensors located Δs = 5 cm apart. Simultaneously, intracoronary pressure and flow velocity were measured with a dual-sensor wire to derive SPc. Actual wave speed was calculated as DNc = Δs/Δt. Hemodynamic signals were recorded at baseline and during adenosine-induced hyperemia, before and after nitroglycerin administration. The energy of separated wave intensity components was assessed using SPc and DNc. At baseline, DNc equaled SPc (15.9 ± 1.8 vs. 16.6 ± 1.5 m/s). Adenosine-induced hyperemia lowered SPc by 40 % (p DNc remained unchanged, leading to marked differences in respective separated wave energies. Nitroglycerin did not affect DNc, whereas SPc transiently fell to 12.0 ± 1.2 m/s (p < 0.02). Human coronary wave speed is reliably estimated by SPc under resting conditions but not during adenosine-induced vasodilation. Since coronary wave speed is unaffected by microvascular dilation, the SPc estimate at rest can serve as surrogate for separating wave intensity signals obtained during hyperemia, thus greatly extending the scope of WIA to study coronary physiology in humans.

  11. Sleep quality and duration are related to microvascular function: the Amsterdam Growth and Health Longitudinal Study.

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    Bonsen, Thomas; Wijnstok, Nienke J; Hoekstra, Trynke; Eringa, Etto C; Serné, Erik H; Smulders, Yvo M; Twisk, Jos W R

    2015-04-01

    Sleep and sleep disorders are related to cardiovascular disease, and microvascular function is an early cardiovascular disease marker. Therefore, the relationship of sleep (measured in sleep quality and duration) with microvascular function was examined in healthy adults. Sleep quality was assessed with the validated Sleep Wake Experience List (SWEL) questionnaire. Duration of sleep was self-reported in an additional question. Microvascular function was measured using nailfold capillaroscopy. Linear regression analyses were used to examine the relationship between sleep and microvascular function. Potential confounders included physical activity, smoking, blood pressure, body mass index and several biochemical parameters. Analyses were performed in 259 participants (116 men). For women reporting insufficient (sleep duration, microvascular function (post-ischaemic capillary recruitment) was significantly lower (b = -11.17; P = 0.04) compared to women reporting sufficient sleep duration. There was no relationship between sleep quality and microvascular function in females. In males, a trend towards lower capillary recruitment was found in those reporting a combination of poor sleep quality and insufficient duration (b = -7.54; P = 0.09), compared to those reporting good sleep quality as well as sufficient duration. This study suggests an association between sleep and microvascular function. Which aspects of sleep exactly affect microvascular function, and if indeed the association is different between males and females in other samples, needs further research.

  12. Diabetic Peripheral Microvascular Complications: Relationship to Cognitive Function

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    Lorraine Ba-Tin

    2011-01-01

    Full Text Available Peripheral microvascular complications in diabetes are associated with concurrent cerebrovascular disease. As detailed cognitive assessment is not routinely carried out among diabetic patients, the aim was to establish whether the presence of clinical “peripheral” microvascular disease can identify a subgroup of patients with early evidence of cognitive impairment. Detailed psychometric assessment was performed in 23 diabetic patients with no microvascular complications (Group D, 27 diabetic patients with at least one microvascular complication: retinopathy, neuropathy, and/or nephropathy (Group DC, and 25 healthy controls (Group H. Groups D and DC participants had significantly lower scores on reaction time (P=0.003 and 0.0001, resp. compared to controls. Similarly, groups D and DC participants had significantly lower scores on rapid processing of visual information (P=0.034 and 0.001, resp. compared to controls. In contrast, there was no significant difference between Groups D and DC on any of the cognitive areas examined. The results show that diabetes, in general, is associated with cognitive dysfunction, but the additional presence of peripheral microvascular disease does not add to cognitive decline. The study, however, indirectly supports the notion that the aetiology of cognitive impairment in diabetes may not be restricted to vascular pathology.

  13. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap

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    TARSITANO, A.; VIETTI, M.V.; Cipriani, R; MARCHETTI, C.

    2013-01-01

    SUMMARY The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy ...

  14. ACTOVEGIN INFLUENCE ON METABOLIC AND VASOMOTOR FUNCTION OF MICROVASCULAR ENDOTHELIAL OF HUMAN SKIN

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    A. A. Fedorovich

    2010-01-01

    Full Text Available Aim. To evaluate effects of Actovegin (deproteinized hemoderivative on vasomotor and metabolic functions of microvascular skin endothelium in healthy volunteers during acute pharmacological test.Material and methods. 24 healthy male volunteers, aged 18-26 years (21,9±2,7, received Actovegin i.v. during 2 hour infusion through the left cubital vein. Right forearm skin laser Doppler flowmetry (LDF with wavelet analysis of the microcirculatory oscillations was used initially and after 2 hour Actovegin infusion to assess microvascular endothelial responses (microcirculatory blood flow changes to Actovegin. Saline infusion in 5 subjects used for control data receiving.Results. Actovegin significantly increased in maximal amplitude endothelial rhythm (at a frequency of 0.01 Hz by 76% (p<0,001 and functional contribution of microvascular endothelium in the overall level of tissue perfusion by 79% (p<0,001. Control saline infusion resulted in reduction of these indices by 52 and 54%, respectively. Actovegin also increased significantly myogenic rhythm amplitude (vascular tone reduction by 35% (p<0,05 and decreased diastolic blood pressure by 3 mm Hg (p=0,076, which is likely result of increased endothelium nitric oxide release.Conclusion. Microcirculatory oscillations at the frequency of 0.01 Hz reflect both vasomotor and metabolic function of microvascular endothelium. Actovegin improves oxygen and glucose tissue utilization as well as increases nitric oxide production with microvascular smooth muscle tone reduction.

  15. Acute limb heating improves macro- and microvascular dilator function in the leg of aged humans.

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    Romero, Steven A; Gagnon, Daniel; Adams, Amy N; Cramer, Matthew N; Kouda, Ken; Crandall, Craig G

    2017-01-01

    Local heating of an extremity increases blood flow and vascular shear stress throughout the arterial tree. Local heating acutely improves macrovascular dilator function in the upper limbs of young healthy adults through a shear stress-dependent mechanism but has no such effect in the lower limbs of this age group. The effect of acute limb heating on dilator function within the atherosclerotic prone vasculature of the lower limbs of aged adults is unknown. Therefore, the purpose of this study was to test the hypothesis that acute lower limb heating improves macro- and microvascular dilator function within the leg vasculature of aged adults. Nine young and nine aged adults immersed their lower limbs at a depth of ~33 cm into a heated (~42°C) circulated water bath for 45 min. Before and 30 min after heating, macro (flow-mediated dilation)- and microvascular (reactive hyperemia) dilator functions were assessed in the lower limb, following 5 min of arterial occlusion, via Doppler ultrasound. Compared with preheat, macrovascular dilator function was unchanged following heating in young adults (P = 0.6) but was improved in aged adults (P = 0.04). Similarly, microvascular dilator function, as assessed by peak reactive hyperemia, was unchanged following heating in young adults (P = 0.1) but was improved in aged adults (P < 0.01). Taken together, these data suggest that acute lower limb heating improves both macro- and microvascular dilator function in an age dependent manner. We demonstrate that lower limb heating acutely improves macro- and microvascular dilator function within the atherosclerotic prone vasculature of the leg in aged adults. These findings provide evidence for a potential therapeutic use of chronic lower limb heating to improve vascular health in primary aging and various disease conditions. Copyright © 2017 the American Physiological Society.

  16. Absolute coronary blood flow measurement and microvascular resistance in ST-elevation myocardial infarction in the acute and subacute phase.

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    Wijnbergen, Inge; van 't Veer, Marcel; Lammers, Jeroen; Ubachs, Joey; Pijls, Nico H J

    2016-03-01

    In a number of patients with acute myocardial infarction (AMI), myocardial hypoperfusion, known as the no-reflow phenomenon, persists after primary percutaneous intervention (PPCI). The aim of this study was to evaluate the feasibility and safety of a new quantitative method of measuring absolute blood flow and resistance within the perfusion bed of an infarct-related artery. Furthermore, we sought to study no-reflow by correlating these measurements to the index of microvascular resistance (IMR) and the area at risk (AR) as determined by cardiac magnetic resonance imaging (CMR). Measurements of absolute flow and myocardial resistance were performed in 20 patients with ST-segment elevation myocardial infarction (STEMI), first immediately following PPCI and then again after 3-5days. These measurements used the technique of thermodilution during a continuous infusion of saline. Flow was expressed in ml/min per gram of tissue within the area at risk. The average time needed for measurement of absolute flow, resistance and IMR was 20min, and all measurements could be performed without complication. A higher flow supplying the AR correlated with a lower IMR in the acute phase. Absolute flow increased from 3.14 to 3.68ml/min/g (p=0.25) and absolute resistance decreased from 1317 to 1099 dyne.sec.cm-5/g (p=0.40) between the first day and fifth day after STEMI. Measurement of absolute flow and microvascular resistance is safe and feasible in STEMI patients and may allow for a better understanding of microvascular (dys)function in the early phase of AMI. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Optimization of flow reserve measurement using SPECT technology to evaluate the determinants of coronary microvascular dysfunction in diabetes

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    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology, Milan, Section of Genoa (Italy); Bezante, GianPaolo; Modonesi, Elisa; Rollando, Daniela; Balbi, Manrico; Brunelli, Claudio [University of Genoa, Department of Internal Medicine, Cardiology, Genoa (Italy); Gandolfo, Patrizia; Morbelli, Silvia D.; Armonino, Riccardo [University of Genoa, Department of Internal Medicine, Nuclear Medicine, Genoa (Italy); DePascale, Angelo; Maggi, Davide; Albertelli, Manuela; Cordera, Renzo [University of Genoa, Department of Endocrinological Metabolic Sciences, Diabetology, Genoa (Italy); Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Nuclear Medicine, Genoa (Italy); Advanced Biotechnology Center, Genoa (Italy)

    2010-02-15

    The aim of this study was to validate a new method to measure regional myocardial perfusion reserve (MPR) with technetium-labelled tracers in patients with type 2 diabetes mellitus (DM2). A total of 40 consecutive DM2 patients without history of coronary artery disease (CAD) and 7 control subjects were recruited. Dipyridamole myocardial blood flow index (MBF) was assessed by measuring first transit counts in the pulmonary artery and myocardial count rate from gated SPECT images using {sup 99m}Tc-labelled tracers. The corresponding MBF index was estimated 2 h later according to the same procedure. Regional myocardial perfusion reserve (MPR) was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular (LV) model. Coronary flow reserve (CFR) was estimated by transthoracic contrast echo Doppler monitoring of flow velocity in the left anterior descending coronary artery (LAD) during the same session. Estimated MPR was higher in control subjects than in patients (3.36 {+-} 0.66 vs 1.91 {+-} 0.61, respectively, p < 0.01). In patients, LAD CFR and LAD MPR were 2.01 {+-} 0.78 vs 1.93 {+-} 0.63, respectively (p = ns). The agreement between the two techniques was documented by their close correlation (r = 0.92, p < 0.001) and confirmed by the Bland-Altman analysis. Reversible perfusion defects occurred in 13 patients (32%) who showed similar MPR values as the remaining 27 (2.10 {+-} 0.71 vs 1.83 {+-} 0.71, respectively, p = ns). Finally, MPR was closely correlated with age (r = -0.50, p < 0.01) and time elapsed from the diagnosis of DM2 (r = -0.51, p < 0.01). LV regional MPR can be accurately estimated with the broadly available single photon technology. Application of this method to DM2 patients documents the presence of a microvascular dysfunction homogeneously distributed throughout the LV walls and most frequently not associated with reversible perfusion defects. (orig.)

  18. Coronary flow reserve in hypertrophic cardiomyopathy: relation with microvascular dysfunction and pathophysiological characteristics.

    Science.gov (United States)

    Kofflard, M J; Michels, M; Krams, R; Kliffen, M; Geleijnse, M L; Ten Cate, F J; Serruys, P W

    2007-01-01

    BACKGROUND.: The decrease in coronary flow reserve (CFR) in hypertrophic cardiomyopathy (HCM) predisposes to myocardial ischaemia, systolic dysfunction and cardiac death. In this study we investigate to which extent haemodynamic, echocardiographic, and histological parameters contribute to the reduction of CFR. METHODS.: In ten HCM patients (mean age 44+/-14 years) and eight heart transplant (HTX) patients (mean age 51+/-6 years) CFR was calculated in the left anterior descending coronary artery. In all subjects haemodynamic, echocardiographic and histological parameters were assessed. The relationship between these variables and CFR was determined using linear regression analysis. RESULTS.: CFR was reduced in HCM compared with HTX patients (1.6+/-0.7 vs. 2.7+/-0.8, p<0.01). An increase in septal thickness (p<0.005), indexed left ventricular (LV) mass (p<0.005), LV end-diastolic pressure (p<0.001), LV outflow tract gradient (p<0.05) and a decrease in arteriolar lumen size (p<0.05) were all related to a reduction in CFR. CONCLUSION.: In HCM patients haemodynamic (LV end-diastolic pressure, LV outflow tract gradient), echocardiographic (indexed LV mass) and histological (% luminal area of the arterioles) changes are responsible for a decrease in CFR. (Neth Heart J 2007;15:209-15.).

  19. Hyperosmolality-mediated peritoneal microvascular vasodilation is linked to aquaporin function.

    Science.gov (United States)

    Zakaria, El Rasheid; Althani, Asma; Fawzi, Ashraf A; Fituri, Omar M

    2014-01-01

    Glucose-based peritoneal dialysis (PD) solutions dilate the parietal and visceral peritoneal microvasculature by endothelium-dependent mechanisms that primarily involve hyperosmolality. This PD-mediated dilation occurs by active intracellular glucose uptake and adenosine Al receptor activation, and by hyperosmolality-stimulated glibenclamide-sensitive potassium channels. Both pathways invoke NO as a second messenger for vasodilation. We hypothesized that during crystalloid-induced osmosis, the osmotic water flux through the transendothelial water-exclusive aquaporin 1 (AQP1) channels is the primary mechanism whereby the endothelium is being stimulated to instigate hyperosmolality-driven vasodilation. Four microvascular levels (diameters in the range 6 - 100 microm) were visualized by intravital videomicroscopy of the terminal ileum in anesthetized rats. Microvascular diameters and flow were measured after topical exposure to a 5% hypertonic mannitol or 2.5% glucose-based PD solution, at baseline and after brief tissue pre-treatment (with 0.1% glutaraldehyde for 10 seconds) or after combined tissue pre-treatment and pharmacologic blockade of AQP1 with HgCl2 (100 micromol/L). Vascular endothelial integrity was verified by the response to acetylcholine (10(-4) mol/L) and sodium nitroprusside (10(-4) mol/L). The hyperosmolar solutions both caused rapid and sustained vasodilation at all microvascular levels, which was not altered by tissue pre-treatment. Inhibition of AQP1 completely abolished the mannitol-induced vasodilation and markedly attenuated the PD fluid-mediated vasodilation. Neither glutaraldehyde pre-treatment nor HgCl2 affected tissue integrity or endothelial cell function. We conclude that the peritoneal microvascular vasodilation caused by hyperosmolar PD fluid is instigated by the osmotic water flux through AQP1. Clinical PD solutions have components other than hyperosmolality that can induce endothelium-dependent peritoneal microvascular vasodilation

  20. Functional results of microvascular reconstruction after hemiglossectomy: free anterolateral thigh flap versus free forearm flap.

    Science.gov (United States)

    Tarsitano, A; Vietti, M V; Cipriani, R; Marchetti, C

    2013-12-01

    The aim of the present study is to assess functional outcomes after hemiglossectomy and microvascular reconstruction. Twenty-six patients underwent primary tongue microvascular reconstruction after hemiglossectomy. Twelve patients were reconstructed using a free radial forearm flap and 14 with an anterolateral thigh flap. Speech intelligibility, swallowing capacity and quality of life scores were assessed. Factors such as tumour extension, surgical resection and adjuvant radiotherapy appeared to be fundamental to predict post-treatment functional outcomes. The data obtained in the present study indicate that swallowing capacity after hemiglossectomy is better when an anterolateral thigh flap is used. No significant differences were seen for speech intelligibility or quality of life between free radial forearm flap and anterolateral thigh flap.

  1. Effect of Tea Theaflavins and Catechins on Microvascular Function

    Science.gov (United States)

    Fuchs, Dagmar; de Graaf, Young; van Kerckhoven, Roeland; Draijer, Richard

    2014-01-01

    Beneficial effects of flavonoid-rich black and green tea on macrocirculation have been well established. Theaflavins are unique to black tea as they are formed from catechins during the enzymatic oxidation of tea leaves. The study was performed to gain more insight into the effects of theaflavins on microcirculation and to compare effects with another important flavonoid class, the green tea derived catechins, which have been reported to improve vascular function. Twenty-four healthy subjects were included in a double-blind, placebo-controlled, randomised, cross-over study. On six different days, subjects received capsules with a single dose of catechins (500 mg), four varying doses of theaflavins (100 to 500 mg) or placebo. Microcirculation was assessed after each treatment by Pulse Amplitude Tonometry (EndoPAT) at baseline and 2, 4 and 6 h after test product intake. The EndoPAT reactive hyperemia response was improved by 500 mg catechins (reactive hyperemia index (RHI): 0.2; p = 0.04) and by 500 mg theaflavins (RHI: 0.19; p = 0.06) compared to placebo. Also, 300 mg theaflavins increased the RHI (0.28; p = 0.02), but no effects were observed at lower doses. The study suggests moderate effects of single doses of catechins and theaflavins on peripheral microcirculation. PMID:25514559

  2. Effect of Tea Theaflavins and Catechins on Microvascular Function

    Directory of Open Access Journals (Sweden)

    Dagmar Fuchs

    2014-12-01

    Full Text Available Beneficial effects of flavonoid-rich black and green tea on macrocirculation have been well established. Theaflavins are unique to black tea as they are formed from catechins during the enzymatic oxidation of tea leaves. The study was performed to gain more insight into the effects of theaflavins on microcirculation and to compare effects with another important flavonoid class, the green tea derived catechins, which have been reported to improve vascular function. Twenty-four healthy subjects were included in a double-blind, placebo-controlled, randomised, cross-over study. On six different days, subjects received capsules with a single dose of catechins (500 mg, four varying doses of theaflavins (100 to 500 mg or placebo. Microcirculation was assessed after each treatment by Pulse Amplitude Tonometry (EndoPAT at baseline and 2, 4 and 6 h after test product intake. The EndoPAT reactive hyperemia response was improved by 500 mg catechins (reactive hyperemia index (RHI: 0.2; p = 0.04 and by 500 mg theaflavins (RHI: 0.19; p = 0.06 compared to placebo. Also, 300 mg theaflavins increased the RHI (0.28; p = 0.02, but no effects were observed at lower doses. The study suggests moderate effects of single doses of catechins and theaflavins on peripheral microcirculation.

  3. Effect of tea theaflavins and catechins on microvascular function.

    Science.gov (United States)

    Fuchs, Dagmar; de Graaf, Young; van Kerckhoven, Roeland; Draijer, Richard

    2014-12-11

    Beneficial effects of flavonoid-rich black and green tea on macrocirculation have been well established. Theaflavins are unique to black tea as they are formed from catechins during the enzymatic oxidation of tea leaves. The study was performed to gain more insight into the effects of theaflavins on microcirculation and to compare effects with another important flavonoid class, the green tea derived catechins, which have been reported to improve vascular function. Twenty-four healthy subjects were included in a double-blind, placebo-controlled, randomised, cross-over study. On six different days, subjects received capsules with a single dose of catechins (500 mg), four varying doses of theaflavins (100 to 500 mg) or placebo. Microcirculation was assessed after each treatment by Pulse Amplitude Tonometry (EndoPAT) at baseline and 2, 4 and 6 h after test product intake. The EndoPAT reactive hyperemia response was improved by 500 mg catechins (reactive hyperemia index (RHI): 0.2; p = 0.04) and by 500 mg theaflavins (RHI: 0.19; p = 0.06) compared to placebo. Also, 300 mg theaflavins increased the RHI (0.28; p = 0.02), but no effects were observed at lower doses. The study suggests moderate effects of single doses of catechins and theaflavins on peripheral microcirculation.

  4. The association of systemic microvascular changes with lung function and lung density: a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Bianca Harris

    Full Text Available Smoking causes endothelial dysfunction and systemic microvascular disease with resultant end-organ damage in the kidneys, eyes and heart. Little is known about microvascular changes in smoking-related lung disease. We tested if microvascular changes in the retina, kidneys and heart were associated with obstructive spirometry and low lung density on computed tomography. The Multi-Ethnic Study of Atherosclerosis recruited participants age 45-84 years without clinical cardiovascular disease. Measures of microvascular function included retinal arteriolar and venular caliber, urine albumin-to-creatinine ratio and, in a subset, myocardial blood flow on magnetic resonance imaging. Spirometry was measured following ATS/ERS guidelines. Low attenuation areas (LAA were measured on lung fields of cardiac computed tomograms. Regression models adjusted for pulmonary and cardiac risk factors, medications and body size. Among 3,397 participants, retinal venular caliber was inversely associated with forced expiratory volume in one second (FEV(1 (P<0.001 and FEV(1/forced vital capacity (FVC ratio (P = 0.04. Albumin-to-creatinine ratio was inversely associated with FEV(1 (P = 0.002 but not FEV(1/FVC. Myocardial blood flow (n = 126 was associated with lower FEV(1 (P = 0.02, lower FEV(1/FVC (P = 0.001 and greater percentage LAA (P = 0.04. Associations were of greater magnitude among smokers. Low lung function was associated with microvascular changes in the retina, kidneys and heart, and low lung density was associated with impaired myocardial microvascular perfusion. These cross-sectional results suggest that microvascular damage with end-organ dysfunction in all circulations may pertain to the lung, that lung dysfunction may contribute to systemic microvascular disease, or that there may be a shared predisposition.

  5. Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity.

    Science.gov (United States)

    Casadonte, Lorena; Verhoeff, Bart-Jan; Piek, Jan J; VanBavel, Ed; Spaan, Jos A E; Siebes, Maria

    2017-09-13

    Baseline assessment of functional stenosis severity has been proposed as a practical alternative to hyperemic indices. However, intact autoregulation mechanisms may affect intracoronary hemodynamics. The aim of this study was to investigate the effect of changes in aortic pressure (Pa) and heart rate (HR) on baseline coronary hemodynamics and functional stenosis assessment. In 15 patients (55 ± 3% diameter stenosis) Pa, intracoronary pressure (Pd) and flow velocity were obtained at control, and during atrial pacing at 120 bpm, increased Pa (+30 mmHg) with intravenous phenylephrine (PE), and elevated Pa while pacing at sinus heart rate (PE + sHR). We derived rate pressure product (RPP = systolic Pa × HR), baseline microvascular resistance (BMR = Pd/velocity), and stenosis resistance [BSR = (Pa - Pd)/velocity] as well as whole-cycle Pd/Pa. Tachycardia (120 ± 1 bpm) raised RPP by 74% vs. Accordingly, BMR decreased by 27% (p stenosis severity, causing Pd/Pa and BSR of borderline lesions to cross the diagnostic threshold. In conclusion, coronary microvascular adaptation to physiological conditions affecting metabolic demand at rest influences intracoronary hemodynamics, which may lead to altered basal stenosis indices used for clinical decision-making.

  6. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

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    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  7. Functional results of speech and swallowing after oral microvascular free flap reconstruction.

    Science.gov (United States)

    Archontaki, Maria; Athanasiou, Athanasios; Stavrianos, Spyros D; Korkolis, Dimitris P; Faratzis, Gregory; Papadopoulou, Flora; Kokkalis, Georgios; Rapidis, Alexander D

    2010-11-01

    To study speech and swallowing in patients who underwent microvascular free flap reconstruction after major surgery of the oral cavity. Twenty patients, 17 men and 3 women, with a mean age of 58.5 years (range 27-79 years) were included in the study. Squamous cell carcinoma was the most common malignancy. Swallowing assessment was performed through videofluoroscopy, using three consistencies of barium meal. The recorded swallows were assessed for the ability to hold the bolus during the oral phase, lip seal, tongue movement, residue in the floor of the mouth, laryngeal penetration and aspiration. Speech function regarding intelligibility and articulation was objectively assessed. Fifteen out of 20 patients (75%) had a good lip seal. Fourteen patients (73.6%) had adequate control of bolus, while in 89.4% the neotongue motility was satisfactory. Vallecular residue was noted in 25% of patients, laryngeal penetration in two (10%), while three patients (15%) continued to have significant aspiration, which necessitated continuous feeding through a gastrostomy. Postoperative speech intelligibility and articulation was satisfactory in 75 and 62.5% of the patients, respectively. Microvascular free flap reconstruction of major defects after oral resections rehabilitates the functions of swallowing and speech in acceptable levels, improving quality of life in these patients.

  8. Inhibition of Murine Pulmonary Microvascular Endothelial Cell Apoptosis Promotes Recovery of Barrier Function under Septic Conditions

    Directory of Open Access Journals (Sweden)

    Lefeng Wang

    2017-01-01

    Full Text Available Sepsis is characterized by injury of the pulmonary microvasculature and the pulmonary microvascular endothelial cells (PMVEC, leading to barrier dysfunction and acute respiratory distress syndrome (ARDS. Our recent work identified a strong correlation between PMVEC apoptosis and microvascular leak in septic mice in vivo, but the specific role of apoptosis in septic PMVEC barrier dysfunction remains unclear. Thus, we hypothesize that PMVEC apoptosis is likely required for PMVEC barrier dysfunction under septic conditions in vitro. Septic stimulation (mixture of tumour necrosis factor α, interleukin 1β, and interferon γ [cytomix] of isolated murine PMVEC resulted in a significant loss of barrier function as early as 4 h after stimulation, which persisted until 24 h. PMVEC apoptosis, as reflected by caspase activation, DNA fragmentation, and loss of membrane polarity, was first apparent at 8 h after cytomix. Pretreatment of PMVEC with the pan-caspase inhibitor Q-VD significantly decreased septic PMVEC apoptosis and was associated with reestablishment of PMVEC barrier function at 16 and 24 h after stimulation but had no effect on septic PMVEC barrier dysfunction over the first 8 h. Collectively, our data suggest that early septic murine PMVEC barrier dysfunction driven by proinflammatory cytokines is not mediated through apoptosis, but PMVEC apoptosis contributes to late septic PMVEC barrier dysfunction.

  9. Diagnostic ultrasound induced inertial cavitation to non-invasively restore coronary and microvascular flow in acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Feng Xie

    Full Text Available Ultrasound induced cavitation has been explored as a method of dissolving intravascular and microvascular thrombi in acute myocardial infarction. The purpose of this study was to determine the type of cavitation required for success, and whether longer pulse duration therapeutic impulses (sustaining the duration of cavitation could restore both microvascular and epicardial flow with this technique. Accordingly, in 36 hyperlipidemic atherosclerotic pigs, thrombotic occlusions were induced in the mid-left anterior descending artery. Pigs were then randomized to either a ½ dose tissue plasminogen activator (0.5 mg/kg alone; or same dose plasminogen activator and an intravenous microbubble infusion with either b guided high mechanical index short pulse (2.0 MI; 5 usec therapeutic ultrasound impulses; or c guided 1.0 mechanical index long pulse (20 usec impulses. Passive cavitation detectors indicated the high mechanical index impulses (both long and short pulse duration induced inertial cavitation within the microvasculature. Epicardial recanalization rates following randomized treatments were highest in pigs treated with the long pulse duration therapeutic impulses (83% versus 59% for short pulse, and 49% for tissue plasminogen activator alone; p<0.05. Even without epicardial recanalization, however, early microvascular recovery occurred with both short and long pulse therapeutic impulses (p<0.005 compared to tissue plasminogen activator alone, and wall thickening improved within the risk area only in pigs treated with ultrasound and microbubbles. We conclude that although short pulse duration guided therapeutic impulses from a diagnostic transducer transiently improve microvascular flow, long pulse duration therapeutic impulses produce sustained epicardial and microvascular re-flow in acute myocardial infarction.

  10. Haemostatic function in coronary artery disease (CAD).

    Science.gov (United States)

    Gupta, A; Sikka, M; Madan, N; Dwidedi, S; Rusia, U; Sharma, S

    1997-04-01

    Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.

  11. Cardiopulmonary bypass reduces peripheral microvascular contractile function by inhibition of mitogen-activated protein kinase activity.

    Science.gov (United States)

    Khan, Tanveer A; Bianchi, Cesario; Araujo, Eugenio G; Ruel, Marc; Voisine, Pierre; Li, Jianyi; Liddicoat, John R; Sellke, Frank W

    2003-08-01

    Mitogen-activated protein kinases (MAPK) have been implicated in pathophysiologic responses to cardiopulmonary bypass (CPB). MAPK are deactivated by phosphatases, such as MAPK phosphatase-1 (MKP-1). We hypothesized that MAPK mediate peripheral microvascular contractile dysfunction caused by CPB in humans. Skeletal muscle was harvested before and after CPB. Protein levels of MKP-1 and activated extracellular signal-regulated kinase 1/2 (ERK1/2) and p38 were measured. MKP-1 gene expression was measured. Peripheral microvessel responses to vasopressors were studied by videomicroscopy. Contractile function also was measured after MAPK inhibition with PD98059 (ERK1/2) and SB203580 (p38). ERK1/2, p38, and MKP-1 were localized by immunohistochemistry and in situ hybridization. ERK1/2 and p38 activity was decreased in peripheral tissue after CPB. MKP-1 was increased after CPB. Contractile responses of peripheral arterioles to phenylephrine and vasopressin were decreased after CPB. Microvessel reactivity also was reduced after treatment with PD98059 and SB203580. ERK1/2, p38, and MKP-1 localized to peripheral arterioles in tissue sections. CPB reduces ERK1/2 and p38 activity in peripheral tissue, potentially by MKP-1. Contractile responses of peripheral arterioles to phenylephrine and vasopressin are dependent on ERK1/2 and p38 and are decreased after CPB. These results suggest that alterations in MAPK pathways in part regulate peripheral microvascular dysfunction after CPB in humans.

  12. Rescue of Brain Function Using Tunneling Nanotubes Between Neural Stem Cells and Brain Microvascular Endothelial Cells.

    Science.gov (United States)

    Wang, Xiaoqing; Yu, Xiaowen; Xie, Chong; Tan, Zijian; Tian, Qi; Zhu, Desheng; Liu, Mingyuan; Guan, Yangtai

    2016-05-01

    Evidence indicates that neural stem cells (NSCs) can ameliorate cerebral ischemia in animal models. In this study, we investigated the mechanism underlying one of the neuroprotective effects of NSCs: tunneling nanotube (TNT) formation. We addressed whether the control of cell-to-cell communication processes between NSCs and brain microvascular endothelial cells (BMECs) and, particularly, the control of TNT formation could influence the rescue function of stem cells. In an attempt to mimic the cellular microenvironment in vitro, a co-culture system consisting of terminally differentiated BMECs from mice in a distressed state and NSCs was constructed. Additionally, engraftment experiments with infarcted mouse brains revealed that control of TNT formation influenced the effects of stem cell transplantation in vivo. In conclusion, our findings provide the first evidence that TNTs exist between NSCs and BMECs and that regulation of TNT formation alters cell function.

  13. Endothelial progenitor cells, microvascular obstruction, and left ventricular remodeling in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Porto, Italo; De Maria, Giovanni Luigi; Leone, Antonio Maria; Dato, Ilaria; D'Amario, Domenico; Burzotta, Francesco; Niccoli, Giampaolo; Trani, Carlo; Biasucci, Luigi Marzio; Bolognese, Leonardo; Crea, Filippo

    2013-09-15

    Endothelial progenitor cells (EPCs) are released from the bone marrow during cardiac ischemic events, potentially influencing vascular and myocardial repair. We assessed the clinical and angiographic correlates of EPC mobilization at the time of primary percutaneous coronary intervention in 78 patients with ST elevation myocardial infarction and the impact of both baseline and follow-up EPC levels on left ventricular (LV) remodeling. Blood samples were drawn from the aorta and the culprit coronary artery for cytofluorimetric EPC detection (CD34+CD45dimKDR+ cells, in percentage of cytofluorimetric counts). Area at risk was assessed by Bypass Angioplasty Revascularization Investigation myocardial jeopardy index, thrombotic burden as thrombus score and microvascular obstruction (MVO) as a combination of ST segment resolution and myocardial blush grade. Echocardiographic evaluation of LV remodeling was performed at 1-year follow-up in 54 patients, whereas peripheral EPC levels were reassessed in 40 patients. EPC levels during primary percutaneous coronary intervention were significantly higher in intracoronary than in aortic blood (0.043% vs 0.0006%, p <0.001). Both intracoronary and aortic EPC were related to area at risk extent, to intracoronary thrombus score (p <0.001), and inversely to MVO (p = 0.001). Peripheral EPC levels at 1-year follow-up were lower in patients with LV remodeling than in those without (0.001% [0.001 to 0.002] vs 0.003% [0.002 to 0.010]; p = 0.01) and independently predicted absence of remodeling at multivariate analysis. In conclusion, a rapid intracoronary EPC recruitment takes place in the early phases of ST elevation myocardial infarction, possibly reflecting an attempted reparative response. The extent of this mobilization seems to be correlated to the area at risk and to the amount of MVO. Persistently low levels of EPC are associated to LV remodeling.

  14. Evidence of myocardial scarring and microvascular obstruction on cardiac magnetic resonance imaging in a series of patients presenting with myocardial infarction without obstructed coronary arteries.

    Science.gov (United States)

    Hermens, Jeannine A J M; van Es, Jan; von Birgelen, Clemens; Op den Akker, Jeroen W; Wagenaar, Lodewijk J

    2014-08-01

    Patients with acute chest pain, electrocardiographic ST-elevation and significant elevation of cardiac troponin but without obstructive coronary artery disease represent a diagnostic and therapeutic dilemma. Cardiac magnetic resonance imaging (CMR) can elucidate underlying alternative causes of troponin elevation including detection of (minor) myocardial infarction (MI) by identifying myocardial scarring as delayed enhancement. Of 77 patients, who were admitted between March 2009 and December 2012 with electrocardiographic (ECG) and biochemical evidence of acute MI without obstructive coronary artery disease, 45 patients underwent CMR that showed in 11/77 (14%) late gadolinium enhancement (LGE), compatible with myocardial scarring. We analyzed clinical, echocardiographic, and CMR data of these patients. Elevated troponin I levels were observed in all patients (median 1.3 ng/l, IQR 0.44-187) with median peak creatinine phosphokinase of 485 U/l (IQR 234-618). Echocardiographic wall motion abnormalities were detected in 8/11 (73%) patients; in 75% of these segments, ECG abnormalities were observed in corresponding leads. CMR detected LGE in the inferior (4/11), the inferolateral (5/11), the inferoseptal (2/11), the anterior (3/11), apical (3/11) and in the lateral segments (2/11). In addition, in all but two patients, these segments matched ECG abnormalities in corresponding leads. CMR identified microvascular obstruction in 4/11 (36%) patients. Patients with clinical, ECG, and biochemical signs of acute MI but unobstructed coronary arteries may have CMR-detectable myocardial scars. Information on myocardial scarring may help to make the diagnosis and draw therapeutic consequences. This case series underlines the value of contrast-enhanced CMR for myocardial tissue characterization.

  15. Coronary vasomotor function assessed by positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo, Hokkaido (Japan); Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Molecular Imaging, Sapporo (Japan); Naya, Masanao [Hokkaido University Graduate School of Medicine, Department of Cardiovascular Medicine, Sapporo (Japan)

    2010-06-15

    Cardiac PET has the unique ability to assess coronary flow reserve and coronary endothelial function on the basis of response of blood flow to pharmacological stress and the cold pressor test. Quantitative analysis of coronary vasomotor function is valuable for precise assessment of function and treatment monitoring in the presence of various coronary risk factors. In addition, recent data have shown prognostic value of PET assessment of coronary vasomotor imaging in patients with suspected coronary artery disease. Thus, quantitative analysis of PET has a great potential for wide application in identifying microcirculatory dysfunction and ''individualized'' monitoring of the effects of primary or preventive medical intervention to optimize cardiovascular outcome. (orig.)

  16. Functional Response of Tumor Vasculature to PaCO2: Determination of Total and Microvascular Blood Volume by MRI

    Directory of Open Access Journals (Sweden)

    Scott D. Packard

    2003-07-01

    Full Text Available In order to identify differences in functional activity, we compared the reactivity of glioma vasculature and the native cerebral vasculature to both dilate and constrict in response to altered PaCO2. Gliomas were generated by unilateral implantation of U87MGdEGFR human glioma tumor cells into the striatum of adult female athymic rats. Relative changes in total and microvascular cerebral blood volume were determined by steady state contrast agent-enhanced magnetic resonance imaging for transitions from normocarbia to hypercarbia and hypocarbia. Although hypercarbia induced a significant increase in both total and microvascular blood volume in normal brain and glioma, reactivity of glioma vasculature was significantly blunted in comparison to normal striatum; glioma total CBV increased by 0.6±0.1%/mm Hg CO2 whereas normal striatum increased by 1.5±0.2%/mm Hg CO2, (P < .0001, group t-test. Reactivity of microvascular blood volume was also significantly blunted. In contrast, hypocarbia decreased both total and microvascular blood volumes more in glioma than in normal striatum. These results indicate that cerebral blood vessels derived by tumor-directed angiogenesis do retain reactivity to CO2. Furthermore, reduced reactivity of tumor vessels to a single physiological perturbation, such as hypercarbia, should not be construed as a generalized reduction of functional activity of the tumor vascular bed.

  17. Rab5-mediated VE-cadherin internalization regulates the barrier function of the lung microvascular endothelium.

    Science.gov (United States)

    Yang, Junjun; Yao, Wei; Qian, Guisheng; Wei, Zhenghua; Wu, Guangyu; Wang, Guansong

    2015-12-01

    The small GTPase Rab5 has been well defined to control the vesicle-mediated plasma membrane protein transport to the endosomal compartment. However, its function in the internalization of vascular endothelial (VE)-cadherin, an important component of adherens junctions, and as a result regulating the endothelial cell polarity and barrier function remain unknown. Here, we demonstrated that lipopolysaccharide (LPS) simulation markedly enhanced the activation and expression of Rab5 in human pulmonary microvascular endothelial cells (HPMECs), which is accompanied by VE-cadherin internalization. In parallel, LPS challenge also induced abnormal cell polarity and dysfunction of the endothelial barrier in HPMECs. LPS stimulation promoted the translocation of VE-cadherin from the plasma membrane to intracellular compartments, and intracellularly expressed VE-cadherin was extensively colocalized with Rab5. Small interfering RNA (siRNA)-mediated depletion of Rab5a expression attenuated the disruption of LPS-induced internalization of VE-cadherin and the disorder of cell polarity. Furthermore, knockdown of Rab5 inhibited the vascular endothelial hyperpermeability and protected endothelial barrier function from LPS injury, both in vitro and in vivo. These results suggest that Rab5 is a critical mediator of LPS-induced endothelial barrier dysfunction, which is likely mediated through regulating VE-cadherin internalization. These findings provide evidence, implicating that Rab5a is a potential therapeutic target for preventing endothelial barrier disruption and vascular inflammation.

  18. Metformin improves endothelial function in aortic tissue and microvascular endothelial cells subjected to diabetic hyperglycaemic conditions.

    Science.gov (United States)

    Ghosh, Suparna; Lakshmanan, Arun P; Hwang, Mu Ji; Kubba, Haidar; Mushannen, Ahmed; Triggle, Chris R; Ding, Hong

    2015-12-01

    The cellular mechanisms whereby metformin, the first line drug for type 2 diabetes (T2DM), mediates its antidiabetic effects remain elusive, particularly as to whether metformin has a direct protective action on the vasculature. This study was designed to determine if a brief 3-h exposure to metformin protects endothelial function against the effects of hyperglycaemia. We investigated the protective effects of metformin on endothelial-dependent vasodilatation (EDV) in thoracic aortae from T2DM db/db mice and on high glucose (HG, 40 mM) induced changes in endothelial nitric oxide synthase (eNOS) signaling in mouse microvascular endothelial cells (MMECs) in culture. Exposure of aortae from db+/? non-diabetic control mice to high glucose (HG, 40 mM) containing Krebs for 3-h significantly (Pmetformin; metformin also improved ACh-induced EDV in aortae from diabetic db/db mice. Immunoblot analysis of MMECs cultured in HG versus NG revealed a significant reduction of the ratio of phosphorylated (p-eNOS)/eNOS and p-Akt/Akt, but not the expression of total eNOS or Akt. The 3-h exposure of MMECs to metformin significantly (Pmetformin can reverse/reduce the impact of HG on endothelial function, via mechanisms linked to increased phosphorylation of eNOS and Akt.

  19. Skin microvascular function in patients with type 1 diabetes: An observational study from the onset of diabetes.

    Science.gov (United States)

    Santesson, Pia; Lins, Per-Eric; Kalani, Majid; Adamson, Ulf; Lelic, Isak; von Wendt, Gunvor; Fagrell, Bengt; Jörneskog, Gun

    2017-05-01

    The development of disturbances in skin microcirculation in type 1 diabetes is not well characterised. We assessed skin microcirculation longitudinally from the onset of diabetes up to 29 years of duration to investigate when such disturbances start. Seventeen adult patients with type 1 diabetes participated. Skin microvascular function in digit IV of the left hand was investigated by laser Doppler fluxmetry (LDF, arbitrary units [AU]). LDF was carried out at rest and following one-min arterial occlusion. Time to peak LDF (s) and percentage increase of LDF (post-occlusive reactive hyperaemia, PRH%) were determined. Retinopathy was assessed from fundus photographs or ophthalmoscopic recordings. Skin microvascular function remained normal during the first five years. Compared with baseline and a non-diabetic reference group, time to peak LDF was prolonged after 7-9 years of diabetes ( p type 1 diabetes and preceded diabetic complications such as retinopathy.

  20. Functional testing or coronary computed tomography angiography in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Jørgensen, Mads E.; Andersson, Charlotte; Nørgaard, Bjarne Linde

    2017-01-01

    BACKGROUND: The choice of either anatomical or functional noninvasive testing to evaluate suspected coronary artery disease might affect subsequent clinical management and outcomes. OBJECTIVES: This study analyzed the association of initial noninvasive cardiac testing in outpatients with stable...... symptoms, with subsequent use of medications, invasive procedures, and clinical outcomes. METHODS: We studied patients enrolled in a Danish nationwide register who underwent initial noninvasive cardiac testing with either coronary computed tomography angiography (CTA) or functional testing (exercise.......05), and a lower risk of MI (hazard ratio: 0.71; 95% confidence interval: 0.61 to 0.82). CONCLUSIONS: In stable patients undergoing initial evaluation for suspected coronary artery disease, coronary CTA was associated with greater use of statins, aspirin, and invasive procedures, and higher costs than functional...

  1. Acute Thermotherapy Prevents Impairments in Cutaneous Microvascular Function Induced by a High Fat Meal

    Science.gov (United States)

    Harvey, Jennifer C.; Roseguini, Bruno T.; Goerger, Benjamin M.; Fallon, Elizabeth A.

    2016-01-01

    We tested the hypothesis that a high fat meal (HFM) would impair cutaneous vasodilation, while thermotherapy (TT) would reverse the detrimental effects. Eight participants were instrumented with skin heaters and laser-Doppler (LD) probes and tested in three trials: control, HFM, and HFM + TT. Participants wore a water-perfused suit perfused with 33°C (control and HFM) or 50°C (HFM + TT) water. Participants consumed 1 g fat/kg body weight. Blood samples were taken at baseline and two hours post-HFM. Blood pressure was measured every 5–10 minutes. Microvascular function was assessed via skin local heating from 33°C to 39°C two hours after HFM. Cutaneous vascular conductance (CVC) was calculated and normalized to maximal vasodilation (%CVCmax). HFM had no effect on initial peak (48 ± 4 %CVCmax) compared to control (49 ± 4 %CVCmax) but attenuated the plateau (51 ± 4 %CVCmax) compared to control (63 ± 4 %CVCmax, P < 0.001). Initial peak was augmented in HFM + TT (66 ± 4 %CVCmax) compared to control and HFM (P < 0.05), while plateau (73 ± 3 % CVCmax) was augmented only compared to the HFM trial (P < 0.001). These data suggest that HFM negatively affects cutaneous vasodilation but can be minimized by TT. PMID:27595112

  2. Acute Thermotherapy Prevents Impairments in Cutaneous Microvascular Function Induced by a High Fat Meal

    Directory of Open Access Journals (Sweden)

    Jennifer C. Harvey

    2016-01-01

    Full Text Available We tested the hypothesis that a high fat meal (HFM would impair cutaneous vasodilation, while thermotherapy (TT would reverse the detrimental effects. Eight participants were instrumented with skin heaters and laser-Doppler (LD probes and tested in three trials: control, HFM, and HFM + TT. Participants wore a water-perfused suit perfused with 33°C (control and HFM or 50°C (HFM + TT water. Participants consumed 1 g fat/kg body weight. Blood samples were taken at baseline and two hours post-HFM. Blood pressure was measured every 5–10 minutes. Microvascular function was assessed via skin local heating from 33°C to 39°C two hours after HFM. Cutaneous vascular conductance (CVC was calculated and normalized to maximal vasodilation (%CVCmax. HFM had no effect on initial peak (48 ± 4 %CVCmax compared to control (49 ± 4 %CVCmax but attenuated the plateau (51 ± 4 %CVCmax compared to control (63 ± 4 %CVCmax, P < 0.001. Initial peak was augmented in HFM + TT (66 ± 4 %CVCmax compared to control and HFM (P < 0.05, while plateau (73 ± 3 % CVCmax was augmented only compared to the HFM trial (P < 0.001. These data suggest that HFM negatively affects cutaneous vasodilation but can be minimized by TT.

  3. Lesion flow coefficient: a combined anatomical and functional parameter for detection of coronary artery disease--a clinical study.

    Science.gov (United States)

    Peelukhana, Srikara V; Effat, Mohamed; Kolli, Kranthi K; Arif, Imran; Helmy, Tarek; Leesar, Massoud; Kerr, Hanan; Back, Lloyd H; Banerjee, Rupak

    2015-01-01

    Invasive diagnosis of coronary artery disease utilizes either anatomical or functional measurements. In this study, we tested a futuristic parameter, lesion flow coefficient (LFC, defined as the ratio of percent coronary area stenosis (%AS) to the square root of the ratio of the pressure drop across the stenosis to the dynamic pressure in the throat region), that combines both the anatomical (%AS) and functional measurements (pressure and flow) for application in a clinical setting. In 51 vessels, simultaneous pressure and flow readings were obtained using a 0.014" Combowire (Volcano Corporation). Anatomical details were assessed using quantitative coronary angiography (QCA). Fractional flow reserve (FFR), coronary flow reserve (CFR), hyperemic stenosis resistance index (HSR), and hyperemic microvascular index (HMR) were obtained at baseline and adenosine-induced hyperemia. QCA data were corrected for the presence of guidewire and then the LFC values were calculated. LFC was correlated with FFR, CFR, HSR, and HMR, individually and in combination with %AS, under both baseline and hyperemic conditions. Further, in 5 vessels, LFC group mean values were compared between pre-PCI and post-PCI groups. Panatomically measured %AS were combined (r = 0.64; Panatomical and functional endpoints, has potential for application in a clinical setting for stenosis evaluation, under both hyperemic and baseline conditions.

  4. Controlled human wood smoke exposure: oxidative stress, inflammation and microvascular function

    Directory of Open Access Journals (Sweden)

    Forchhammer Lykke

    2012-03-01

    Full Text Available Abstract Background Exposure to wood smoke is associated with respiratory symptoms, whereas knowledge on systemic effects is limited. We investigated effects on systemic inflammation, oxidative stress and microvascular function (MVF after controlled wood smoke exposure. Methods In a randomised, double-blinded, cross-over study 20 non-smoking atopic subjects were exposed at rest to 14, 220, or 354 μg/m3 of particles from a well-burning modern wood stove for 3 h in a climate controlled chamber with 2 week intervals. We investigated the level of oxidatively damaged DNA, inflammatory markers and adhesion molecules before and 0, 6 and 20 h after exposure. Six h after exposure we measured MVF non-invasively by digital peripheral artery tonometry following arm ischemia. Results The MVF score was unaltered after inhalation of clean air (1.58 ± 0.07; mean ± SEM, low (1.51 ± 0.07 or high (1.61 ± 0.09 concentrations of wood smoke particles in atopic subjects, whereas unexposed non-atopic subjects had higher score (1.91 ± 0.09. The level of oxidatively damaged DNA, mRNA of ITGAL, CCL2, TNF, IL6, IL8, HMOX1, and OGG1 and surface marker molecules ICAM1, ITGAL and L-selectin in peripheral blood mononuclear cells were not affected by inhalation of wood smoke particles. Conclusions Exposure to wood smoke had no effect on markers of oxidative stress, DNA damage, cell adhesion, cytokines or MVF in atopic subjects.

  5. Lymphatic Vessel Function and Lymphatic Growth Factor Secretion after Microvascular Lymph Node Transfer in Lymphedema Patients

    Directory of Open Access Journals (Sweden)

    Tiina P. Viitanen, MD

    2013-05-01

    Conclusions: Reconstructing the lymphatic anatomy of the axilla with a lymph node flap may offer possibilities that other reconstructive options are lacking. However, we will need further reports and comparative studies about the clinical efficacy of this new promising technique. In addition to the transferred lymph nodes, lymphatic growth factor production may also be induced by other factors related to microvascular breast reconstruction.

  6. Birth weight relates to blood pressure and microvascular function in normal subjects

    NARCIS (Netherlands)

    Serne, EH; Stehouwer, CDA; ter Maaten, JC; ter Wee, PM; Gans, ROB

    2000-01-01

    Objective The relationship between low birth weight and elevated blood pressure in adult life is well established but presently unexplained. Both microvascular dysfunction and insulin resistance have been proposed as a possible explanation. We have examined the relation between birth weight and bloo

  7. Microvascular function relates to insulin sensitivity and blood pressure in normal subjects

    NARCIS (Netherlands)

    Serne, EH; Stehouwer, CDA; ter Maaten, JC; ter Wee, PM; Rauwerda, JA; Gans, ROB

    1999-01-01

    Background-A strong but presently unexplained inverse association between blood pressure and insulin sensitivity has been reported. Microvascular vasodilator capacity may be a common antecedent linking insulin sensitivity to blood pressure. To test this hypothesis, we studied LX normotensive and glu

  8. An Unusual Case of Suspected Microvascular Angina in a Newborn

    Directory of Open Access Journals (Sweden)

    Stefania Cataldo

    2012-01-01

    Full Text Available Myocardial ischemia in pediatric population is uncommon and usually due to congenital heart disease or extracardiac conditions leading to poor coronary perfusion. A 6-day-old newborn presented with respiratory distress and signs of heart failure. ECG, echocardiography, and laboratory results were consistent with myocardial ischemia. Coronary angiography was performed to exclude anomalous origin of coronary arteries, showing normal coronary artery origin and course. Thrombophilia and extra-cardiac causes were ruled out. Clinical conditions improved with mechanical ventilation and diuretics, enzyme levels lowered, repolarisation and systolic function abnormalities regressed, but ischemic electrocardiographic and echocardiographic signs still presented during intense crying. Becaues of suspicion of microvascular angina, therapy with ASA and beta-blocker was started. At 5 month followup, the baby was in good clinical condition and no more episodes were recorded. We believe it is an interesting case, as no similar cases have been recorded till now.

  9. Folic acid supplementation improves microvascular function in older adults through nitric oxide-dependent mechanisms.

    Science.gov (United States)

    Stanhewicz, Anna E; Alexander, Lacy M; Kenney, W Larry

    2015-07-01

    Older adults have reduced vascular endothelial function, evidenced by attenuated nitric oxide (NO)-dependent cutaneous vasodilatation. Folic acid and its metabolite, 5-methyltetrahydrofolate (5-MTHF), are reported to improve vessel function. We hypothesized that (i) local 5-MTHF administration and (ii) chronic folic acid supplementation would improve cutaneous microvascular function in ageing through NO-dependent mechanisms. There were two separate studies in which there were 11 young (Y: 22 ± 1 years) and 11 older (O: 71 ± 3 years) participants. In both studies, two intradermal microdialysis fibres were placed in the forearm skin for local delivery of lactated Ringer's solution with or without 5 mM 5-MTHF. Red cell flux was measured by laser-Doppler flowmetry. Cutaneous vascular conductance [CVC=red cell flux/mean arterial pressure] was normalized as percentage maximum CVC (%CVCmax) (28 mM sodium nitroprusside, local temperature 43°C). In study 1 after CVC plateaued during local heating, 20 mM NG-nitro-L-arginine methyl ester (L-NAME) was perfused at each site to quantify NO-dependent vasodilatation. The local heating plateau (%CVCmax: O = 82 ± 3 vs Y = 96 ± 1, P = 0.002) and NO-dependent vasodilatation (%CVCmax: O = 26 ± 6% vs Y = 49 ± 5, P = 0.03) were attenuated in older participants. 5-MTHF augmented the overall (%CVCmax = 91 ± 2, P = 0.03) and NO-dependent (%CVCmax = 43 ± 9%, P = 0.04) vasodilatation in older but not young participants. In study 2 the participants ingested folic acid (5 mg/day) or placebo for 6 weeks in a randomized, double-blind, crossover design. A rise in oral temperature of 1°C was induced using a water-perfused suit, body temperature was held and 20 mM L-NAME was perfused at each site. Older participants had attenuated reflex (%CVCmax: O = 31 ± 8 vs Y = 44 ± 5, P = 0.001) and NO-dependent (%CVCmax: O = 9 ± 2 vs Y = 21 ± 2, P = 0.003) vasodilatation. Folic acid increased CVC (%CVCmax = 47 ± 5%, P = 0.001) and NO

  10. Brazil nuts intake improves lipid profile, oxidative stress and microvascular function in obese adolescents: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Koury Josely C

    2011-05-01

    Full Text Available Abstract Background Obesity is a chronic disease associated to an inflammatory process resulting in oxidative stress that leads to morpho-functional microvascular damage that could be improved by some dietary interventions. In this study, the intake of Brazil nuts (Bertholletia excelsa, composed of bioactive substances like selenium, α- e γ- tocopherol, folate and polyunsaturated fatty acids, have been investigated on antioxidant capacity, lipid and metabolic profiles and nutritive skin microcirculation in obese adolescents. Methods Obese female adolescents (n = 17, 15.4 ± 2.0 years and BMI of 35.6 ± 3.3 kg/m2, were randomized 1:1 in two groups with the diet supplemented either with Brazil nuts [BNG, n = 08, 15-25 g/day (equivalent to 3 to 5 units/day] or placebo [PG (lactose, n = 09, one capsule/day] and followed for 16 weeks. Anthropometry, metabolic-lipid profiles, oxidative stress and morphological (capillary diameters and functional [functional capillary density, red blood cell velocity (RBCV at baseline and peak (RBCVmax and time (TRBCVmax to reach it during post-occlusive reactive hyperemia, after 1 min arterial occlusion] microvascular variables were assessed by nailfold videocapillaroscopy at baseline (T0 and after intervention (T1. Results T0 characteristics were similar between groups. At T1, BNG (intra-group variation had increased selenium levels (p = 0.02, RBCV (p = 0.03 and RBCVmax (p = 0.03 and reduced total (TC (p = 0.02 and LDL-cholesterol (p = 0.02. Compared to PG, Brazil nuts intake reduced TC (p = 0.003, triglycerides (p = 0.05 and LDL-ox (p = 0.02 and increased RBCV (p = 0.03. Conclusion Brazil nuts intake improved the lipid profile and microvascular function in obese adolescents, possibly due to its high level of unsaturated fatty acids and bioactive substances. Trial Registration Clinical Trials.gov NCT00937599

  11. Vascular function and mild renal impairment in stable coronary artery disease

    NARCIS (Netherlands)

    van der Harst, P; Smilde, TDJ; Buikema, H; Voors, AA; Navis, G; van Veldhuisen, DJ; van Gilst, WH

    2006-01-01

    Objective - In patients with coronary artery disease, the concomitant presence of renal function impairment is associated with decreased survival. We aimed to assess whether in coronary artery diseased patients renal function impairment is associated with systemic vascular function, functional param

  12. The Balance Between Metalloproteinases and TIMPs: Critical Regulator of Microvascular Endothelial Cell Function in Health and Disease.

    Science.gov (United States)

    Masciantonio, Marcello G; Lee, Christopher K S; Arpino, Valerie; Mehta, Sanjay; Gill, Sean E

    2017-01-01

    Endothelial cells (EC), especially the microvascular EC (MVEC), have critical functions in health and disease. For example, healthy MVEC provide a barrier between the fluid and protein found within the blood, and the surrounding tissue. Following tissue injury or infection, the microvascular barrier is often disrupted due to activation and dysfunction of the MVEC. Multiple mechanisms promote MVEC activation and dysfunction, including stimulation by cytokines, mechanical interaction with activated leukocytes, and exposure to harmful leukocyte-derived molecules, which collectively result in a loss of MVEC barrier function. However, MVEC activation is also critical to facilitate recruitment of inflammatory cells, such as neutrophils (PMNs) and monocytes, into the injured or infected tissue. Metalloproteinases, including the matrix metalloproteinases (MMPs) and the closely related, a disintegrin and metalloproteinases (ADAMs), have been implicated in regulating both MVEC barrier function, through cleavage of adherens and tight junctions proteins between adjacent MVEC and through degradation of the extracellular matrix, as well as PMN-MVEC interaction, through shedding of cell surface PMN receptors. Moreover, the tissue inhibitors of metalloproteinases (TIMPs), which collectively inhibit most MMPs and ADAMs, are critical regulators of MVEC activation and dysfunction through their ability to inhibit metalloproteinases and thereby promote MVEC stability. However, TIMPs have been also found to modulate MVEC function through metalloproteinase-independent mechanisms, such as regulation of vascular endothelial growth factor signaling. This chapter is focused on examining the role of the metalloproteinases and TIMPs in regulation of MVEC function in both health and disease. © 2017 Elsevier Inc. All rights reserved.

  13. Effect of Carvedilol on the Coronary Vascular Endothelial Function after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    苏显明; 马奕; 崔长琮

    2003-01-01

    Objectives To understand the effect of carvedilol on the coronary vascular endothelial function of the patients with coronary heart disease after percutaneous transluminal coronary angioplasty (PTCA). Methods 51cases, having one or more than two branches narrow ( ≥ 70% ) , were diagnosed by coronary angiography. These patients were divided randomly into carvedilol group (n = 28 ) and control group (n = 23) who did not take carvedilol.Endothelin (ET) and nitro dioxide (NO) levels of peripheral blood were measured before and after PTCA,before and after two weeks by taking carvedilol. Results Compared with the ET and NO levels before PTCA, ET were markedly increased and NO were decreased after PTCA (p < 0.05); compared with the ET and NO levels before taking carvedilol, ET were decreased and NO were increased after two week (p <0.05) , but the ET and NO levels of the control group did not change in the period of two weeks observation (p > 0.05). Conclusions Carvedilol may improve the coronary vascular endothelial function after PTCA.

  14. ‘Short-term treatment with methotrexate does not affect microvascular endothelial function in patients with psoriasis’

    DEFF Research Database (Denmark)

    Gyldenløve, M; Jensen, Peter; Løvendorf, M B

    2015-01-01

    influences microvascular endothelial function (MEF), an early surrogate marker of atherosclerosis, in patients with psoriasis. METHODS: We prospectively studied a hospital cohort of patients with psoriasis. Measurements of MEF were performed with the Endo-PAT2000© device at baseline and after 8-10 weeks...... by 7 (from 9 to 2). No significant changes were observed in MEF, expressed by reactive hyperaemia index and augmentation index. Also, we saw no significant changes in BMI, waist-hip ratio, blood pressure and blood samples. CONCLUSION: Short-term treatment with methotrexate did not affect MEF...

  15. Number and function of bone-marrow derived angiogenic cells and coronary flow reserve in women without obstructive coronary artery disease: a substudy of the NHLBI-sponsored Women's Ischemia Syndrome Evaluation (WISE.

    Directory of Open Access Journals (Sweden)

    Rajesh Mohandas

    Full Text Available BACKGROUND: In women with ischemia and no obstructive coronary artery disease, the Women's Ischemic Syndrome Evaluation (WISE observed that microvascular coronary dysfunction (MCD is the best independent predictor of adverse cardiovascular events. Since coronary microvascular tone is regulated in part by endothelium, we hypothesized that circulating endothelial cells (CEC, which reflect endothelial injury, and the number and function of bone-marrow derived angiogenic cells (BMDAC, which could help repair damaged endothelium, may serve as biomarkers for decreased coronary flow reserve (CFR and MCD. METHODS: We studied 32 women from the WISE cohort. CFR measurements in response to intracoronary adenosine were taken as an index of MCD. We enumerated BMDAC colonies and CEC in peripheral blood samples. BMDAC function was assessed by assay of migration of CD34+ cells toward SDF-1 and measurement of bioavailable nitric oxide (NO. These findings were compared with a healthy reference group and also entered into a multivariable model with CFR as the dependent variable. RESULTS: Compared with a healthy reference group, women with MCD had lower numbers of BMDAC colonies [16 (0, 81 vs. 24 (14, 88; P = 0.01] and NO [936 (156, 1875 vs. 1168 (668, 1823; P = 0.02]. Multivariable regression analysis showed strong correlation of CFR to the combination of BMDAC colony count and CD34+ cell function (migration and NO (R(2 = 0.45; P<0.05. CONCLUSIONS: The BMDAC function and numbers of BMDAC colonies are decreased in symptomatic women with MCD and are independently associated with CFR. These circulating cells may provide mechanistic insights into MCD in women with ischemia.

  16. Relationship between dyslipidemia and vascular endothelial function in patients with coronary artery spasm

    Institute of Scientific and Technical Information of China (English)

    向定成

    2006-01-01

    Objectives To investigate the effects of dyslipidemia on vascular endothelial function in patients with coronary artery spasm. Methods Sixty-four patients with chest pain but without significant angiographic stenosis were divided into coronary spasm group (n=46 with coronary spasm) and control group (n=18 without coronary spasm) according to acetylcholine provoking test. Endothelin-1 (ET-1), nitric oxide (NO) and lipids were

  17. Coronary Flow Velocity Reserve Assessed by Transthoracic Doppler

    DEFF Research Database (Denmark)

    Michelsen, Marie M; Peña, Adam; Mygind, Naja D

    2016-01-01

    the feasibility and factors associated with the quality of CFVR obtained in a large prospective study of women suspected of having microvascular disease. METHODS: Women with angina-like chest pain and no obstructive coronary artery disease on coronary angiography (stenosis) were consecutively examined......BACKGROUND: Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography is a noninvasive measure of microvascular function, but it has not achieved widespread use, mainly because of concerns of validity and feasibility. The aim of this study was to describe...... by transthoracic Doppler echocardiography of the left anterior descending coronary artery to measure CFVR (n = 947). Quality was evaluated on the basis of (1) identification of the left anterior descending coronary artery, (2) maintained probe position throughout the examination, (3) visibility and configuration...

  18. Vasoconstrictor eicosanoids and impaired microvascular function in inactive and insulin-resistant primates.

    Science.gov (United States)

    Chadderdon, S M; Belcik, J T; Bader, L; Kievit, P; Grove, K L; Lindner, J R

    2016-10-01

    The inability to augment capillary blood volume (CBV) in response to insulin or glucose is thought to contribute to insulin resistance (IR) by limiting glucose uptake in key storage sites. Understanding the mechanisms that contribute to impaired CBV augmentation early in the onset of IR may lead to new future therapies. We hypothesized that inactivity alters the balance of vasoactive eicosanoids and contributes to microvascular IR. In ten activity-restricted (AR) and six normal activity adult male rhesus macaques, contrast-enhanced ultrasound of skeletal muscle blood flow and CBV was performed at baseline and during intravenous glucose tolerance test (IVGTT). Plasma was analyzed for vasoconstrictor hydroxyeicosatetraenoic acids (HETEs) and the ratio of vasodilatory epoxyeicosatrienoic acids (EETs) to their less biologically active dihydroxyeicosatrienoic acids (DHETs) as an indirect measure of soluble epoxide hydrolase activity. AR primates were IR during IVGTT and had a 45% lower glucose-stimulated CBV response. Vasoconstrictor 18-HETE and 19-HETE and the DHET/EET ratio were markedly elevated in the AR group and correlated inversely with the CBV response. In addition, levels of 18-HETE and 19-HETE correlated directly with microvascular IR. We conclude that a shift toward increased eicosanoid vasoconstrictor tone correlates with abnormal skeletal muscle vascular recruitment and may contribute to IR.

  19. What Causes Coronary Microvascular Disease?

    Science.gov (United States)

    ... inside the arteries. Risk factors for atherosclerosis include: Diabetes . It is a disease in which the body’s blood sugar level is too high because the body doesn’t make enough insulin or doesn’t use its insulin properly. Family history of early heart disease . Your risk of atherosclerosis ...

  20. Relationship between glycosylated hemoglobin A1c and coronary flow reserve in patients with Type 2 diabetes mellitus.

    Science.gov (United States)

    Huang, Runqing; Abdelmoneim, Sahar S; Nhola, Lara F; Basu, Rita; Basu, Ananda; Mulvagh, Sharon L

    2015-04-01

    Type 2 diabetes mellitus patients are at increased risk for macrovascular and microvascular complications. Both in vivo and in vitro studies of small arteries and arterioles of diabetic subjects demonstrate impaired endothelial function without anatomic lesions. Coronary flow reserve (CFR) is a surrogate marker of coronary microcirculatory endothelial function in diabetic patients without significant stenosis of the associated epicardial coronary artery. Glycosylated hemoglobin A1c is related to likelihood of occurrence of microvascular events. The objective of this article is to report on recent developments in multiple noninvasive techniques to assess CFR and their use in aiding the understanding of the relationship of CFR, glycemic control and cardiovascular outcomes.

  1. Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test

    NARCIS (Netherlands)

    J.M.P. Baptista da Silva (José); M. Arnese (Mariarosaria); J.R.T.C. Roelandt (Jos); P.M. Fioretti (Paolo); D.T.J. Keane (David); J. Escaned (Javier); C. di Mario (Carlo); P.W.J.C. Serruys (Patrick); H. Boersma (Eric)

    1994-01-01

    textabstractOBJECTIVES. The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine

  2. Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: correlations with dobutamine-atropine stress test

    NARCIS (Netherlands)

    J.M.P. Baptista da Silva (José); M. Arnese (Mariarosaria); J.R.T.C. Roelandt (Jos); P.M. Fioretti (Paolo); D.T.J. Keane (David); J. Escaned (Javier); C. di Mario (Carlo); P.W.J.C. Serruys (Patrick); H. Boersma (Eric)

    1994-01-01

    textabstractOBJECTIVES. The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine s

  3. Therapeutic effect of nicorandil on coronary slow flow intervention and endothelial function in elderly patients

    Institute of Scientific and Technical Information of China (English)

    王涛

    2013-01-01

    Objective To observe the effects of nicorandil on coronary slow flow phenomenon (CSFP) and endothelial function in elderly patients.Methods Totally 76 elderly patients diagnosed angiographically as coronary slow flow phenomenon were enrolled.All patients were randomly

  4. Functional expression of choline transporter like-protein 1 (CTL1) and CTL2 in human brain microvascular endothelial cells.

    Science.gov (United States)

    Iwao, Beniko; Yara, Miki; Hara, Naomi; Kawai, Yuiko; Yamanaka, Tsuyoshi; Nishihara, Hiroshi; Inoue, Takeshi; Inazu, Masato

    2016-02-01

    In this study, we examined the molecular and functional characterization of choline transporter in human brain microvascular endothelial cells (hBMECs). Choline uptake into hBMECs was a saturable process that was mediated by a Na(+)-independent, membrane potential and pH-dependent transport system. The cells have two different [(3)H]choline transport systems with Km values of 35.0 ± 4.9 μM and 54.1 ± 8.1 μM, respectively. Choline uptake was inhibited by choline, acetylcholine (ACh) and the choline analog hemicholinium-3 (HC-3). Various organic cations also interacted with the choline transport system. Choline transporter-like protein 1 (CTL1) and CTL2 mRNA were highly expressed, while mRNA for high-affinity choline transporter 1 (CHT1) and organic cation transporters (OCTs) were not expressed in hBMECs. CTL1 and CTL2 proteins were localized to brain microvascular endothelial cells in human brain cortical sections. Both CTL1 and CTL2 proteins were expressed on the plasma membrane and mitochondria. CTL1 and CTL2 proteins are mainly expressed in plasma membrane and mitochondria, respectively. We conclude that choline is mainly transported via an intermediate-affinity choline transport system, CTL1 and CTL2, in hBMECs. These transporters are responsible for the uptake of extracellular choline and organic cations. CTL2 participate in choline transport mainly in mitochondria, and may be the major site for the control of choline oxidation. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Evaluation value of coronary CTA for coronary plaque features and its correlation with platelet function and serum biochemical indexes

    Institute of Scientific and Technical Information of China (English)

    Jin-Xia Yang

    2017-01-01

    Objective:To analyze the evaluation value of coronary CT angiography for coronary plaque features and its correlation with platelet function and serum biochemical indexes.Methods:A total of 450 patients with coronary heart disease were divided into calcified plaque group (CT value≥130HU) (n=117), soft plaque group (CT value≤60HU) (n=150) and mixed plaque group (CT value 60-130HU) (n=183) by coronary CT angiography (CTA), and 100 healthy subjects who received physical examination in our hospital during the same period were selected as control group. Differences in platelet function and serum biochemical indexes were compared among four groups of patients, and the judgment value of atheromatous plaque CT value from CTA for the severity of coronary heart disease was analyzed.Results: Platelet function parameters MPV, TEG-MA, P-selectin, PDGF-BB and vWF levels in peripheral blood of soft plaque group were higher than those of the other three groups; inflammatory factors CRP, IL-6, IL-12, IL-18 and IL-23 content in serum were higher than those of the other three groups; chemokines MCP-1, CXCL16, Fractalkine and RANTES content in serum were higher than those of the other three groups; adipocytokines Leptin and RBP4 content in serum were higher than those of the other three groups while SFRP5 content was lower than those of the other three groups. Atheromatous plaque CT value in patients with coronary heart disease was directly correlated with platelet function and the content of serum biochemical indexes. Conclusions: Coronary CTA can accurately assess coronary atheromatous plaque features, and can also be a reliable noninvasive method to judge coronary heart disease severity, treatment prognosis and so on.

  6. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

    Institute of Scientific and Technical Information of China (English)

    Chuang Zhang; Shuang Yang; Lu-Yue Gai; Zhi-Qi Han; Qian Xin; Xiao-Bo Yang; Jun-Jie Yang

    2016-01-01

    Background:The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies.However,few studies have used the rich information available from CCTA to detect functionally significant coronary lesions.We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions,using fractional flow reserve (FFR) as the gold standard.Methods:We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age,59.6 ± 10.2 years;76.14% of males) who underwent CCTA,invasive coronary angiography,and invasive FFR measurement.An FFR <0.80 indicated hemodynamically significant coronary stenosis.Lesions were divided into two groups using an FFR cutoff value of 0.80.We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR.The statistical methods included unpaired t-test,Mann-Whitney U-test,and Spearman's correlation coefficients.Results:Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80.Gai's score had the strongest correlation with FFR (r =-0.48,P < 0.01) and had a greater area under the curve =0.72 (95% confidence interval:0.61-0.82;P < 0.01) than the CACS of whole arteries and a single artery.Conclusions:Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR.However,Gai's plaque score was more predictive of FFR <0.80.Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization.

  7. Functional hierarchy of coronary circulation: direct evidence of a structure-function relation.

    Science.gov (United States)

    Kassab, Ghassan S

    2005-12-01

    The heart muscle is nourished by a complex system of blood vessels that make up the coronary circulation. Here we show that the design of the coronary circulation has a functional hierarchy. A full anatomic model of the coronary arterial tree, containing millions of blood vessels down to the capillary vessels, was simulated based on previously measured porcine morphometric data. A network analysis of blood flow through every vessel segment was carried out based on the laws of fluid mechanics and appropriate boundary conditions. Our results show an abrupt change in cross-sectional area that demarcates the transition from epicardial (EPCA) to intramyocardial (IMCA) coronary arteries. Furthermore, a similar pattern of blood flow was observed with a corresponding transition from EPCA to IMCA. These results suggest functional differences between the two types of vessels. An additional abrupt change occurs in the IMCA in relation to flow velocity. The velocity is fairly uniform proximal to these vessels but drops significantly distal to those vessels toward the capillary branches. This finding suggests functional differences between large and small IMCA. Collectively, these observations suggest a novel functional hierarchy of the coronary vascular tree and provide direct evidence of a structure-function relation.

  8. Assessment of myocardial segmental function with coronary artery stenosis in multi-vessel coronary disease patients with normal wall motion.

    Science.gov (United States)

    Xie, M-Y; Lv, Q; Wang, J; Yin, J-B

    2016-04-01

    To discover the impact of the various degrees of coronary artery stenosis (CAD) on the left ventricular systolic dysfunction in steady state with quantitative analysis of the regional systolic myocardium in longitudinal, radial and circumferential direction in patients with coronary artery disease by two-dimensional speckle tracking imaging (STI). Forty-three normal wall motion-multi vessel coronary artery disease (NWM-MVD) patients labeled as the experimental groups and forty-two subjects with little risk of CAD marked as the control group were enrolled in this study. The two-dimensional STI was obtained in the apical long axis and three levels of the short axis of the left ventricle. The left ventricular wall was divided into 18 segments. The affected myocardia were divided into three groups: group B (coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%). Using the Q-analysis software, the longitudinal, radial and circumferential systolic strain (SL, SR, SC) and strain ratio (SrL, SrR, SrC) of the myocardium were analyzed. The bradycardia in the NWM-MVD group is greater than that in the control group (16/43 vs. 7/42, p coronary stenosis degree ≤50%), group C (coronary stenosis degree 50%-99%)and group D (coronary stenosis degree ≥99%), especially the longitudinal and radial systolic function, even though they had normal wall motion. The SrL equaled 1.085 for the cut-off value, and the sums (1.348) of sensitivity (0.673) and specificity (0.675) were the greatest. Bradycardia might be a compensatory mechanism in NWM-MVD patients.

  9. 老年人眼底微血管病变与急性冠脉事件发生的关系%Retinal microvascular disease and acute coronary event risk in aged Chinese cohort

    Institute of Scientific and Technical Information of China (English)

    徐扬; 闫中瑞; 孙树印

    2015-01-01

    目的:探讨老年人眼底微血管病变与急性冠脉事件( ACE)发生的关系。方法采用前瞻性社区研究方法,对济宁市兴隆庄煤矿社区年龄≥60岁的居民(排除ACE病史)进行问卷调查、体格检查和实验室检查,并进行眼底照相。按照统一的随访方案和诊断标准对心脑血管病事件及死亡事件的发生情况进行随访登记。应用Cox比例风险模型对眼底微血管病变与ACE发病危险进行多因素分析。结果对1370例调查对象随访3 a,随访结束时发生终点事件256例,主要终点事件101例,ACE的发病率为292.5/万人年。其中眼底血管正常、轻度异常、中重度异常者的ACE发病率分别为242.8/万人年、293.2/万人年、640.8/万人年。多因素Cox回归分析显示,年龄、吸烟、眼底微血管病变、高血压是ACE发生的独立危险因素。结论眼底微血管病变是ACE发生的独立危险因素;眼底微血管病变病情越重,ACE发病率越高。%Objective To evaluate the association between retinal microvascular disease and acute coronary event in aged.Methods A 3-year prospective study was conducted among aged people who were taken physical examination , reti-nal vasography and a baseline examination by study physicians .Cox multivariate proportional hazards regression 1 was ap-plied to explore various factors to ACE .Results During the 3 years follow-up, there were 256 incidences of endpoint e-vent and 101 incidences of major endpoint event observed .The morbidity of ACE were 292.5/10 000 person-years.In reti-nal microvascular normal group , mildly abnormal group and moderate-severe group, the morbidity of ACE were 242.8, 293.2, 640.8/10 000 person-years.The Cox multivariate proportional hazards regression showed smoking , retinal micro-vascular disease , hypertension and age were found to be the influencing factors for the occur of ACE .Conclusions In the aged Chinese cohort

  10. Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Pardo Moira

    2004-12-01

    Full Text Available Abstract After percutaneous transluminal coronary angioplasty (PTCA, stress-echocardiography and gated single photon emission computerized tomography (g-SPECT are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR and color Tissue Doppler (C-TD dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm and diastolic (Em and Am, Em/Am ratio peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p m at high-dose dobutamine (p m of middle septum (r = 0.55, p In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.

  11. Assessing the effects of a short-term green tea intervention in skin microvascular function and oxygen tension in older and younger adults.

    Science.gov (United States)

    Wasilewski, Rebecca; Ubara, Emmanuel O; Klonizakis, Markos

    2016-09-01

    Green tea consumption has been associated with a reduction in cardiovascular disease risk factors. However, there is little evidence examining its potential differing effect between younger and older populations, whilst little is known on its effect on the circulatory system when oxygen demand is higher. Therefore the aim of this study was to evaluate the short-term effects of green tea consumption on microvascular functioning in both an older and younger population. Fifteen young [24 (4.0)] and fifteen older [61 (4.0)] participants, consumed two cups of green tea daily for 14days. We used Laser Doppler Flowmetry (LDF) to assess cutaneous microvascular function and Transcutaneous Oxygen monitoring (TcPO2) to assess skin oxygen tension. Systolic and diastolic blood pressure were also assessed on both visits. We observed significant improvements in axon-mediated microvascular vasodilation for the younger group [1.6 (0.59) vs 2.05 (0.72), p<0.05] and the older group [1.25 (0.58) vs 1.65 (0.5) p<0.05]. Improvements in skin oxygen tension were also noted for both groups in both noted TcPO2 measures (i.e. 1.25 (0.58) vs 1.65 (0.5) (p<0.05), for ΔTcPO2max for the older group, between visits) respectively. Improvements were also observed for systolic blood pressure in both the younger [120 (10) vs 112 (10), p<0.05] and older group [129 (12) v 124 (11), p<0.001]. In conclusion, we observed statistically-significant improvements in microvascular function and skin oxygen tension. Our results suggest that green tea may prove beneficial as a dietary element in lifestyle interventions aiming to lower cardiovascular disease risk, in both older and younger populations.

  12. Altered islet morphology but normal islet secretory function in vitro in a mouse model with microvascular alterations in the pancreas.

    Directory of Open Access Journals (Sweden)

    Elena Kostromina

    Full Text Available BACKGROUND: Our previous studies have shown that signal transducer and activator of transcription 3 (STAT3 signaling is important for the development of pancreatic microvasculature via its regulation of vascular endothelial growth factor-A (VEGF-A. Pancreas-specific STAT3-KO mice exhibit glucose intolerance and impaired insulin secretion in vivo, along with microvascular alterations in the pancreas. However, the specific role of STAT3 signaling in the regulation of pancreatic islet development and function is not entirely understood. METHODOLOGY/PRINCIPAL FINDINGS: To investigate the role of STAT3 signaling in the formation and maintenance of pancreatic islets, we studied pancreas-specific STAT3-KO mice. Histological analysis showed that STAT3 deficiency affected pancreatic islet morphology. We found an increased proportion of small-sized islets and a reduced fraction of medium-sized islets, indicating abnormal islet development in STAT3-KO mice. Interestingly, the islet area relative to the whole pancreas area in transgenic and control mice was not significantly different. Immunohistochemical analysis on pancreatic cryosections revealed abnormalities in islet architecture in STAT3-KO mice: the pattern of peripheral distribution of glucagon-positive α-cells was altered. At the same time, islets belonging to different size categories isolated from STAT3-KO mice exhibited normal glucose-stimulated insulin secretion in perifusion experiments in vitro when compared to control mice. CONCLUSIONS: Our data demonstrate that STAT3 signaling in the pancreas is required for normal islet formation and/or maintenance. Altered islet size distribution in the KO mice does not result in an impaired islet secretory function in vitro. Therefore, our current study supports that the glucose intolerance and in vivo insulin secretion defect in pancreas-specific STAT3-KO mice is due to altered microvasculature in the pancreas, and not intrinsic beta-cell function.

  13. [Functional long-term results following hemipharyngo-hemilaryngectomy and microvascular reconstruction using the radial forearm flap].

    Science.gov (United States)

    Hagen, R

    2002-03-01

    The surgical treatment of advanced hypopharyngeal carcinomas with infiltration of the laryngeal skeleton often includes total laryngectomy for functional reasons, although tumor infiltration is limited to only one half of the larynx. When not only the infiltrated half of the thyroid cartilage but also the cricoid cartilage of the involved side has to be removed, in spite of adequate reconstruction using local or pedicled flaps (f. e. pectoralis major flap) persistent dysphagia and aspiration prevent oral food intake and closure of the tracheostoma. These functional disturbances are increased by the negative effects of postoperative radiotherapy, which has to be applied in most of the cases for oncological reasons. The routine use of free, microvascularly anastomosed flaps for reconstruction of defects following removal of extended carcinomas of the mouth, the tongue or the oropharynx as well as in total pharyngolaryngectomy led to considerable improvements in functional rehabilitation of swallowing and speech. An improved functional outcome is also reported following partial resections of the hypopharynx and reconstruction by means of these thin and pliable transplants (f. e. replacement of the entire posterior hypopharyngeal wall). Since 1991 in 30 patients with a T3 or T4 squamous cell carcinoma of the piriform sinus a complete hemipharyngo-hemilaryngectomy including resection of the involved thyroid and cricoid cartilage was carried out. For reconstruction a radial forearm flap was dissected with two separate epithelial islands: The smaller island was used to create an epithelialized endolarynx, which allows complete closure of the glottis by the healthy vocal chord. With the bigger second island the hypopharynx was replaced, creating a highly mobile, adaptable neo-piriform-sinus, which was suspended to the ipsilateral half of the hyoid bone. Parts of the both islands were sutured together to create a new aryepiglottic fold. The laryngeal skeleton intentionally

  14. Coronary flow reserve : a functional measure of stenosis severity

    NARCIS (Netherlands)

    F. Zijlstra (Felix)

    1988-01-01

    textabstractIn 1959 Sones developed selective coronary cineangiography. To date, this technique has remained the only means available for the visualization of the coronary arterial system with such image contrast and resolution, that the presence and severity of coronary stenosis can be

  15. Changes in microvascular permeability of the middle ear mucosa following the occulsion of the eustachian tube of rabbits. The functional investigation using radioisotope

    Energy Technology Data Exchange (ETDEWEB)

    Kikuchi, Yasutaka

    1988-12-01

    Serial changes in submucosal microvascular permeability of the middle ear and the response to histamine after occlusion of the eustachian tube were functionally investigated using radioisotope in rabbits with experimentally induced otitis media with effusion. Tritium water was administered through intravenous injection and transference of tritium water into the middle ear cavity was measured by radioactivity of the middle ear perfusate. Morphological changes were concurrently examined for comparison. Vascular permeability, as measured one, 7, and 14 days after occlusion of the eustachian tube, increased with time. A histological study showed an edematous hypertrophy of the submucosal tissue of the middle ear, suggesting a noticeable increase in microvascular permeability. The response of the middle ear mucosa to histamine, which was added to the fluid for perfusion, gradually decreased after occlusion of the eustachian tube, although the effect of histamine tended to persist for a long time, irrespective of the amount of administration. The results indicated that the mucosal membrane of the middle ear has a noticeable permeability at least up to 14 days after occlusion, and that histamine may be responsible for the increase of submucosal microvascular permeability not only in the normal middle ear cavity but also in otitis media with effusion which results in the persistance of the disease. The presence of factors permeable to the blood, other than histamine, caused microvascular peameability to increase, probably resulting in chronic or irreversible inflammation. This may be explained by markedly proliferative or parenchymatous connective tissues observed 7 and l0 weeks after occlusion. It should be noted that surgical treatment be performed as early as possible in the case of otitis media with effusion. (Namekawa, K) 80 refs.

  16. Exposure to lipopolysaccharide and/or unconjugated bilirubin impair the integrity and function of brain microvascular endothelial cells.

    Directory of Open Access Journals (Sweden)

    Filipa L Cardoso

    Full Text Available BACKGROUND: Sepsis and jaundice are common conditions in newborns that can lead to brain damage. Though lipopolysaccharide (LPS is known to alter the integrity of the blood-brain barrier (BBB, little is known on the effects of unconjugated bilirubin (UCB and even less on the joint effects of UCB and LPS on brain microvascular endothelial cells (BMEC. METHODOLOGY/PRINCIPAL FINDINGS: Monolayers of primary rat BMEC were treated with 1 µg/ml LPS and/or 50 µM UCB, in the presence of 100 µM human serum albumin, for 4 or 24 h. Co-cultures of BMEC with astroglial cells, a more complex BBB model, were used in selected experiments. LPS led to apoptosis and UCB induced both apoptotic and necrotic-like cell death. LPS and UCB led to inhibition of P-glycoprotein and activation of matrix metalloproteinases-2 and -9 in mono-cultures. Transmission electron microscopy evidenced apoptotic bodies, as well as damaged mitochondria and rough endoplasmic reticulum in BMEC by either insult. Shorter cell contacts and increased caveolae-like invaginations were noticeable in LPS-treated cells and loss of intercellular junctions was observed upon treatment with UCB. Both compounds triggered impairment of endothelial permeability and transendothelial electrical resistance both in mono- and co-cultures. The functional changes were confirmed by alterations in immunostaining for junctional proteins β-catenin, ZO-1 and claudin-5. Enlargement of intercellular spaces, and redistribution of junctional proteins were found in BMEC after exposure to LPS and UCB. CONCLUSIONS: LPS and/or UCB exert direct toxic effects on BMEC, with distinct temporal profiles and mechanisms of action. Therefore, the impairment of brain endothelial integrity upon exposure to these neurotoxins may favor their access to the brain, thus increasing the risk of injury and requiring adequate clinical management of sepsis and jaundice in the neonatal period.

  17. Residual ß-cell function and microvascular complications in type 1 diabetic patients

    Directory of Open Access Journals (Sweden)

    Gomes M.B.

    2000-01-01

    Full Text Available To determine the influence of residual ß-cell function on retinopathy and microalbuminuria we measured basal C-peptide in 50 type 1 diabetic outpatients aged 24.96 ± 7.14 years, with a duration of diabetes of 9.1 ± 6.2 years. Forty-three patients (86% with low C-peptide (<0.74 ng/ml had longer duration of diabetes than 7 patients (14% with high C-peptide (³0.74 ng/ml (9 (2-34 vs 3 (1-10 years, P = 0.01 and a tendency to high glycated hemoglobin (HBA1 (8.8 (6-17.9 vs 7.7 (6.9-8.7%, P = 0.08. Nine patients (18% had microalbuminuria (two out of three overnight urine samples with an albumin excretion rate (AER ³20 and <200 µg/min and 13 (26% had background retinopathy. No association was found between low C-peptide, microalbuminuria and retinopathy and no difference in basal C-peptide was observed between microalbuminuric and normoalbuminuric patients (0.4 ± 0.5 vs 0.19 ± 0.22 ng/ml, P = 0.61 and between patients with or without retinopathy (0.4 ± 0.6 vs 0.2 ± 0.3 ng/ml, P = 0.43. Multiple regression analysis showed that duration of diabetes (r = 0.30, r2 = 0.09, P = 0.031 followed by HBA1 (r = 0.41, r2 = 0.17, P = 0.01 influenced basal C-peptide, and this duration of diabetes was the only variable affecting AER (r = 0.40, r2 = 0.16, P = 0.004. In our sample of type 1 diabetic patients residual ß-cell function was not associated with microalbuminuria or retinopathy.

  18. Cardiac Autonomic Function Is Associated With the Coronary Microcirculatory Function in Patients With Type 2 Diabetes

    DEFF Research Database (Denmark)

    von Scholten, Bernt Johan; Hansen, Christian Stevns; Hasbak, Philip

    2016-01-01

    Cardiac autonomic dysfunction and cardiac microvascular dysfunction are diabetic complications associated with increased mortality, but the association between these has been difficult to assess. We applied new and sensitive methods to assess this in patients with type 2 diabetes mellitus (T2DM...... (123)I-metaiodobenzylguanidine scintigraphy was conducted in a subgroup of 29 patients and 14 control subjects and evaluated as the late heart-to-mediastinum ratio and washout rate. Impaired function of all the cardiac autonomic measures (except the washout rate) was associated with reduced CFR....... A heart rate variability index, reflecting sympathetic and parasympathetic function (low-frequency power), and the late heart-to-mediastinum ratio, reflecting the function of adrenergic receptors and sympathetic activity, were positively correlated with CFR after adjustment for age and heart rate...

  19. Outcomes of anatomical versus functional testing for coronary artery disease.

    Science.gov (United States)

    Douglas, Pamela S; Hoffmann, Udo; Patel, Manesh R; Mark, Daniel B; Al-Khalidi, Hussein R; Cavanaugh, Brendan; Cole, Jason; Dolor, Rowena J; Fordyce, Christopher B; Huang, Megan; Khan, Muhammad Akram; Kosinski, Andrzej S; Krucoff, Mitchell W; Malhotra, Vinay; Picard, Michael H; Udelson, James E; Velazquez, Eric J; Yow, Eric; Cooper, Lawton S; Lee, Kerry L

    2015-04-02

    Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P=0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P=0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the National Heart, Lung, and Blood Institute

  20. Outcomes of Anatomical versus Functional Testing for Coronary Artery Disease

    Science.gov (United States)

    Douglas, Pamela S.; Hoffmann, Udo; Patel, Manesh R.; Mark, Daniel B.; Al-Khalidi, Hussein R.; Cavanaugh, Brendan; Cole, Jason; Dolor, Rowena J.; Fordyce, Christopher B.; Huang, Megan; Khan, Muhammad Akram; Kosinski, Andrzej S.; Krucoff, Mitchell W.; Malhotra, Vinay; Picard, Michael H.; Udelson, James E.; Velazquez, Eric J.; Yow, Eric; Cooper, Lawton S.; Lee, Kerry L.

    2015-01-01

    BACKGROUND Many patients have symptoms suggestive of coronary artery disease (CAD) and are often evaluated with the use of diagnostic testing, although there are limited data from randomized trials to guide care. METHODS We randomly assigned 10,003 symptomatic patients to a strategy of initial anatomical testing with the use of coronary computed tomographic angiography (CTA) or to functional testing (exercise electrocardiography, nuclear stress testing, or stress echocardiography). The composite primary end point was death, myocardial infarction, hospitalization for unstable angina, or major procedural complication. Secondary end points included invasive cardiac catheterization that did not show obstructive CAD and radiation exposure. RESULTS The mean age of the patients was 60.8±8.3 years, 52.7% were women, and 87.7% had chest pain or dyspnea on exertion. The mean pretest likelihood of obstructive CAD was 53.3±21.4%. Over a median follow-up period of 25 months, a primary end-point event occurred in 164 of 4996 patients in the CTA group (3.3%) and in 151 of 5007 (3.0%) in the functional-testing group (adjusted hazard ratio, 1.04; 95% confidence interval, 0.83 to 1.29; P = 0.75). CTA was associated with fewer catheterizations showing no obstructive CAD than was functional testing (3.4% vs. 4.3%, P = 0.02), although more patients in the CTA group underwent catheterization within 90 days after randomization (12.2% vs. 8.1%). The median cumulative radiation exposure per patient was lower in the CTA group than in the functional-testing group (10.0 mSv vs. 11.3 mSv), but 32.6% of the patients in the functional-testing group had no exposure, so the overall exposure was higher in the CTA group (mean, 12.0 mSv vs. 10.1 mSv; P<0.001). CONCLUSIONS In symptomatic patients with suspected CAD who required noninvasive testing, a strategy of initial CTA, as compared with functional testing, did not improve clinical outcomes over a median follow-up of 2 years. (Funded by the

  1. 冠心病稳定性心绞痛与微血管性心绞痛中医证候要素调查%Expert Investigation of Traditional Chinese Medical Syndrome Elements of Microvascular Angina Pectoris and Stable Angina Pectoris Induced by Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    毕颖斐; 毛静远

    2012-01-01

    [目的]对冠心病稳定性心绞痛与微血管性心绞痛的中医证候要素进行专家调查.[方法]运用专家调查( Delphi)法在全国范围内对冠心病稳定性心绞痛与微血管性心绞痛的中医证候要素及证候类型进行专家咨询和调查.[结果]冠心病稳定性心绞痛与微血管性心绞痛的中医证候要素及证候类型分布基本一致,但也存在一定差异,微血管性心绞痛较稳定性心绞痛多见气滞、血虚等证素及气滞心胸证.[结论]本调查结果可为冠心病稳定性心绞痛与微血管性心绞痛的中医临床辨证提供一定的参考.%Objective To investigate the traditional Chinese medical syndrome elements of microvascular angina pectoris and stable angina pectoris induced by coronary artery disease. Methods Delphi method was adopted for the investigation of traditional Chinese medical syndrome elements and syndrome patterns of microvascular angina pectoris and stable angina pectoris induced by coronary artery disease by experts overall the country. Results Syndrome elements and syndrome patterns were similar in patients with microvascular angina pectoris and stable angina pectoris induced by coronary artery disease. However, some differences existed in the two kinds of angina pectoris, microvascular angina pectoris patients were characterized with syndrome elements of Qi stagnation and blood deficiency, and with syndrome pattern of Qi stagnation in heart and chest. Conclusion The results of the investigation will supply certain evidence for syndrome differentiation of microvascular angina pectoris and stable angina pectoris induced by coronary artery disease.

  2. Circulating MicroRNAs Characterizing Patients with Insufficient Coronary Collateral Artery Function

    NARCIS (Netherlands)

    Hakimzadeh, Nazanin; Nossent, A Yaël; van der Laan, Anja M; Schirmer, Stephan H; de Ronde, Maurice W J; Pinto-Sietsma, Sara-Joan; van Royen, Niels; Quax, Paul H A; Höfer, Imo E.|info:eu-repo/dai/nl/267105649; Piek, Jan J

    2015-01-01

    BACKGROUND: Coronary collateral arteries function as natural bypasses in the event of coronary obstruction. The degree of collateral network development significantly impacts the outcome of patients after an acute myocardial infarction (AMI). MicroRNAs (miRNAs, miRs) have arisen as biomarkers to ide

  3. Circulating MicroRNAs Characterizing Patients with Insufficient Coronary Collateral Artery Function

    NARCIS (Netherlands)

    Hakimzadeh, Nazanin; Nossent, A Yaël; van der Laan, Anja M; Schirmer, Stephan H; de Ronde, Maurice W J; Pinto-Sietsma, Sara-Joan; van Royen, Niels; Quax, Paul H A; Höfer, Imo E.; Piek, Jan J

    2015-01-01

    BACKGROUND: Coronary collateral arteries function as natural bypasses in the event of coronary obstruction. The degree of collateral network development significantly impacts the outcome of patients after an acute myocardial infarction (AMI). MicroRNAs (miRNAs, miRs) have arisen as biomarkers to ide

  4. Renal Function Is Related to Severity of Coronary Artery Calcification in Elderly Persons : The Rotterdam Study

    NARCIS (Netherlands)

    el Barzouhi, Abdelilah; Elias-Smale, Suzette; Dehghan, Abbas; Vliegenthart-Proenca, Rozemarijn; Oudkerk, Matthijs; Hofman, Albert; Witteman, Jacqueline C. M.

    2011-01-01

    Background: Coronary artery calcification (CAC) has been proposed to be the underlying mechanism of the increased risk of coronary heart disease with reductions in glomerular filtration rate (GFR). Since renal function diminishes with aging we examined the association between GFR and CAC in the Rott

  5. Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

    Institute of Scientific and Technical Information of China (English)

    Xiao Yanyan; Jin Mei; Han Ling; Ding Wenhong; Zheng Jianyong; Sun Chufan; Lyu Zhenyu

    2014-01-01

    Background The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients (13 males and 10 females,aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months,16 cases) and adult type (age of onset older than 12 months,7 cases).Four patients were diagnosed with CLMCA-A (three males and one female,aged ranging from 3 months to 2 years).The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination:Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography:pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in

  6. RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

    Institute of Scientific and Technical Information of China (English)

    孙寅光; 沈卫峰; 施仲伟; 张大东

    2003-01-01

    Objective To determine the relations between endothelium dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.MethodsTwenty eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high resolution B mode ultrasound before coronary angiography (CAG) and coronary flow reserve (CFR) test by using intracoronary Doppler technique. The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow mediated dilatation (FMD) following reactive hyperemia was evaluated. The relation between the change of brachial artery blood flow and CFR was also studied.ResultsThere was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion (12.50%±9.35% vs 11.38%±7.55%, r=0.425,P=0.02). There was also a weak negative relation between brachial flow change following reactive hyperemia and CFR (r=0.397, P=0.04).ConclusionThere is a correlation between the coronary endothelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

  7. Symptoms of Raynaud's phenomenon (RP) in fibromyalgia syndrome are similar to those reported in primary RP despite differences in objective assessment of digital microvascular function and morphology.

    Science.gov (United States)

    Scolnik, M; Vasta, B; Hart, D J; Shipley, J A; McHugh, N J; Pauling, J D

    2016-10-01

    Symptoms of Raynaud's phenomenon (RP) are common in fibromyalgia syndrome (FMS). We compared symptom characteristics and objective assessment of digital microvascular function using infrared thermography (and nailfold capillaroscopy where available) in patients with FMS (reporting RP symptoms) and primary RP. We retrospectively reviewed the outcome of microvascular imaging studies and RP symptom characteristics (captured using patient-completed questionnaire at the time of assessment) for patients with FMS (reporting RP symptoms) and patients with primary RP referred for thermographic assessment of RP symptoms over a 2-year period. Of 257 patients referred for thermographic assessment of RP symptoms between 2010 and 2012, we identified 85 patients with primary RP and 43 patients with FMS. There were no differences in RP symptom characteristics between FMS and primary RP (p > 0.05 for all comparisons). In contrast, patients with FMS had higher baseline temperature of the digits (32.1 vs. 29.0 °C, p = 0.004), dorsum (31.9 vs. 30.2 °C, p = 0.005) and thermal gradient (temperature of digits minus temperature of dorsum; +0.0 vs. -0.9 °C, p = 0.03) compared with primary RP. Significant differences between groups persisted following local cold challenge. In primary RP, patient reporting "blue" digits, bi-phasic and tri-phasic RP was associated with lower digital perfusion. In contrast, no associations between skin temperature and RP digital colour changes/phases were identified in FMS. Our findings suggest that symptoms of RP in FMS may have a different aetiology to those seen in primary RP. These findings have potential implications for both the classification of RP symptoms and the management of RP symptoms in the context of FMS. Digital colour changes reported by patients might reflect the degree of digital microvascular compromise in primary RP.

  8. Microvascular inflammation in atherosclerosis

    Directory of Open Access Journals (Sweden)

    Laura Vitiello

    2014-06-01

    Full Text Available Atherogenesis is the pathogenetic process leading to formation of the atheroma lesion. It is associated to a chronic inflammatory state initially stimulated by an aberrant accumulation of lipid molecules beyond the endothelial barrier. This event triggers a cascade of deleterious events mainly through immune cell stimulation with the consequent liberation of potent pro-inflammatory and tissue damaging mediators. The atherogenetic process implies marked modifications of endothelial cell functions and a radical change in the endothelial–leukocyte interaction pattern. Moreover, accumulating evidence shows an important link between microvascular and inflammatory responses and major cardiovascular risk factors. This review illustrates the current knowledge on the effects of obesity, hypercholesterolemia and diabetes on microcirculation; their pathophysiological implications will be discussed.

  9. Effects of trimetazidine therapy on left ventricular function after percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    许晓晗

    2013-01-01

    Objective To explore the effects of trimetazidine therapy on left ventricular(LV)function after percutaneous coronary intervention(PCI).Methods A total of 106 patients with unstable angina pectoris undergoing successful

  10. Cardiac (82)Rb PET/CT for fast and non-invasive assessment of microvascular function and structure in asymptomatic patients with type 2 diabetes

    DEFF Research Database (Denmark)

    von Scholten, Bernt J; Hasbak, Philip; Christensen, Thomas E

    2016-01-01

    AIMS/HYPOTHESIS: Coronary flow reserve (CFR) and coronary artery calcium (CAC) represent functional and structural aspects of atherosclerosis. We examined the prevalence of reduced CFR and high CAC scores in three predefined groups of participants without known cardiovascular disease: (1) patients.......026). In multivariate regression analysis, a higher urinary albumin excretion rate (UAER) tended to predict reduced CFR in the total population (p = 0.045). When the CAC score was added, there was also a trend (p = 0.032) towards an inverse association with reduced CFR. CONCLUSIONS/INTERPRETATION: Type 2 diabetic...

  11. Microvascular dysfunction in nonfailing arrhythmogenic right ventricular cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Paul, Matthias [University Hospital Muenster, Department of Cardiology and Angiology, Muenster (Germany); University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany); Rahbar, Kambiz; Kies, Peter; Schober, Otmar [University Hospital Muenster, Department of Nuclear Medicine, Muenster (Germany); Gerss, Joachim [University of Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany); Schaefers, Klaus; Schaefers, Michael [University of Muenster, European Institute for Molecular Imaging - EIMI, Muenster (Germany); Breithardt, Guenter [University Hospital Muenster, Department of Cardiology and Angiology, Muenster (Germany); Schulze-Bahr, Eric [University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany); Wichter, Thomas [Marienhospital Osnabrueck, Department of Cardiology, Niels-Stensen-Kliniken, Osnabrueck (Germany)

    2012-03-15

    Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a nonischaemic cardiomyopathy and leading cause of sudden death in the young. It has been shown that microvascular dysfunction reflected by an impaired myocardial blood flow (MBF) response to stress is present in patients with other forms of nonischaemic cardiomyopathy, e.g. dilated cardiomyopathy, and that the reduced MBF may be related to a poor prognosis. Therefore, we quantified MBF, coronary flow reserve and coronary vascular resistance in patients with nonfailing ARVC using H{sub 2}{sup 15} O and PET. In ten male patients with ARVC (mean age 49 {+-} 14 years), MBF was quantified at rest and during adenosine-induced hyperaemia using H{sub 2}{sup 15} O PET. Results were compared with those obtained in 20 age-matched healthy male control subjects (mean age 46 {+-} 14 years). Resting MBF was not significantly different between patients with ARVC and controls (MBF{sub rest} 1.19 {+-} 0.29 vs. 1.12 {+-} 0.20 ml/min/ml). However, hyperaemic MBF was significantly lower in patients with ARVC than in controls (2.60 {+-} 0.96 vs. 3.68 {+-} 0.84 ml/min/ml; p = 0.005). Consequently, patients with ARVC had a significantly lower coronary flow reserve than control subjects (2.41 {+-} 1.34 vs. 3.39 {+-} 0.93; p = 0.030). In addition, hyperaemic coronary vascular resistance was increased in patients with ARVC (36.79 {+-} 12.91 vs. 26.31 {+-} 6.49 mmHg x ml{sup -1} x min x ml; p = 0.007), but was found to be unchanged at rest. In this small well-characterized cohort of patients with nonfailing ARVC, we found a significantly reduced hyperaemic MBF and increased coronary vascular resistance. Further studies are necessary to corroborate this potential new functional aspect of the pathophysiological mechanisms underlying ARVC. (orig.)

  12. Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Orzan Marius

    2016-06-01

    Full Text Available Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

  13. Protective effects of simvastatin on coronary artery function in swine with acute infection

    DEFF Research Database (Denmark)

    Liuba, Petru; Pesonen, Erkki; Forslid, Anders

    2006-01-01

    BACKGROUND:: The risk for coronary events may rise during acute infection. Perturbation in coronary endothelial function emerges as one important link. We investigated whether simvastatin could protect the coronary arterial function from the adverse effects of acute infection in swine. METHODS......:: Coronary endothelium-dependent and -independent vasomotor responses were assessed by Doppler velocimetry in 12 Chlamydia pneumoniae-infected and 6 sham-infected swine 2 weeks after intratracheal inoculation. Half of animals from the infection group were pre-treated with simvastatin (80mg daily), while...... the remaining animals received placebo. The treatment was started 2 weeks prior to inoculation and continued until the end of the study. ANOVA was used for statistical calculations. Data are mean+/-S.D. RESULTS:: All animals inoculated with C. pneumoniae developed IgM antibodies against this organism...

  14. Microvascular responsiveness in obesity: implications for therapeutic intervention.

    Science.gov (United States)

    Bagi, Zsolt; Feher, Attila; Cassuto, James

    2012-02-01

    Obesity has detrimental effects on the microcirculation. Functional changes in microvascular responsiveness may increase the risk of developing cardiovascular complications in obese patients. Emerging evidence indicates that selective therapeutic targeting of the microvessels may prevent life-threatening obesity-related vascular complications, such as ischaemic heart disease, heart failure and hypertension. It is also plausible that alterations in adipose tissue microcirculation contribute to the development of obesity. Therefore, targeting adipose tissue arterioles could represent a novel approach to reducing obesity. This review aims to examine recent studies that have been focused on vasomotor dysfunction of resistance arteries in obese humans and animal models of obesity. Particularly, findings in coronary resistance arteries are contrasted to those obtained in other vascular beds. We provide examples of therapeutic attempts, such as use of statins, ACE inhibitors and insulin sensitizers to prevent obesity-related microvascular complications. We further identify some of the important challenges and opportunities going forward. This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-3. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

  15. Detection of microvascular and tri-truncal coronaries injuries by quantitative cardiac PET/CT with Rb-82;Detection des lesions coronaires microvasculaires et tritronculaires par TEP-CT cardiaque quantitative au Rb-82

    Energy Technology Data Exchange (ETDEWEB)

    Dunet, V.; Allenbach, G.; Soubeyran, V.; Kosinski, M.; Bischof-Delaloye, A.; Prior, J. [CHU de Vaudois, Departement de medecine nucleaire, Lausanne (Switzerland); Camus, F. [CHU de Vaudois, institut de radiophysique appliquee, Lausanne (Switzerland)

    2010-05-15

    The results show that up to 1 in 5 investigated by PET / CT with Rb-82 with myocardium blood rate quantification shows affected myocardium flux reserve linked to microvascular or tri-truncal affect undiagnosed by semi-quantitative analysis

  16. Carotid Artery Intima-Media Thickness and Cutaneous Microvascular Function are Associated With Vitamin C Levels in Young Patients With Type 1 Diabetes

    DEFF Research Database (Denmark)

    Odermarsky, Michal; Lykkesfeldt, Jens; Liuba, Petru

    2008-01-01

    Background: Vascular endothelial dysfunction and accelerated thickening of arterial intima contribute to increased cardiovascular morbidity in type 1 diabetes. Although vitamin C has important antioxidant functions, and increased oxidative stress is a central mechanism of vascular abnormalities......, and the measured skin perfusion was expressed as % maximal increase from baseline. Markers of systemic inflammation (C-reactive protein, fibrinogen and orosomucoid), lipids (total, LDL and HDL cholesterol) and glycosylated hemoglobin (HbA1c) were measured in EDTA plasma. Ascorbate was analyzed in meta......-phosphoric acid-stabilized EDTA-plasma by high-performance liquid chromatography. Results: In univariate regression analysis, both cIMT and skin microvascular response to ACH correlated with ascorbate levels (r=-0.29; p=0.04, and r=0.43; p=0.004 respectively). The relationships between these vascular indexes...

  17. Severe familial hypercholesterolemia impairs the regulation of coronary blood flow and oxygen supply during exercise.

    Science.gov (United States)

    Bender, Shawn B; de Beer, Vincent J; Tharp, Darla L; Bowles, Douglas K; Laughlin, M Harold; Merkus, Daphne; Duncker, Dirk J

    2016-11-01

    Accelerated development of coronary atherosclerosis is a defining characteristic of familial hypercholesterolemia (FH). However, the recent data highlight a significant cardiovascular risk prior to the development of critical coronary stenosis. We, therefore, examined the hypothesis that FH produces coronary microvascular dysfunction and impairs coronary vascular control at rest and during exercise in a swine model of FH. Coronary vascular responses to drug infusions and exercise were examined in chronically instrumented control and FH swine. FH swine exhibited ~tenfold elevation of plasma cholesterol and diffuse coronary atherosclerosis (20-60 % plaque burden). Similar to our recent findings in the systemic vasculature in FH swine, coronary smooth muscle nitric oxide sensitivity was increased in vivo and in vitro with maintained endothelium-dependent vasodilation in vivo in FH. At rest and during exercise, FH swine exhibited increased myocardial O2 extraction resulting in reduced coronary venous SO2 and PO2 versus control. During exercise in FH swine, the transmural distribution of coronary blood flow was unchanged; however, a shift toward anaerobic cardiac metabolism was revealed by increased coronary arteriovenous H(+) concentration gradient. This shift was associated with a worsening of cardiac efficiency (relationship between cardiac work and O2 consumption) in FH during exercise owing, in part, to a generalized reduction in stroke volume which was associated with increased left atrial pressure in FH. Our data highlight a critical role for coronary microvascular dysfunction as a contributor to impaired myocardial O2 balance, cardiac ischemia, and impaired cardiac function prior to the development of critical coronary stenosis in FH.

  18. Molecular and Cellular Characterization of Space Flight Effects on Microvascular Endothelial Cell Function - PreparatoryWork for the SFEF Project

    Science.gov (United States)

    Balsamo, Michele; Barravecchia, Ivana; Mariotti, Sara; Merenda, Alessandra; De Cesari, Chiara; Vukich, Marco; Angeloni, Debora

    2014-12-01

    Exposure to microgravity during space flight (SF) of variable length induces suffering of the endothelium (the cells lining all blood vessels), mostly responsible for health problems found in astronauts and animals returning from space. Of interest to pre-nosological medicine, the effects of microgravity on astronauts are strikingly similar to the consequences of sedentary life, senescence and degenerative diseases on Earth, although SF effects are accelerated and reversible. Thus, microgravity is a significant novel model for better understanding of common pathologies. A comprehensive cell and molecular biology study is needed in order to explain pathophysiological findings after SFs. This project will study the effects of microgravity and cosmic radiation on endothelial cells (ECs) cultured on the International Space Station through analysis of 1) cell transcriptome, 2) DNA methylome, 3) DNA damage and cell senescence, 4) variations in cell cycle and cell morphology. This project has been selected by the European Space Agency and the Italian Space Agency and is presently in preparation. The ground study presented here was performed to determine the biological and engineering requirements that will allow us to retrieve suitable samples after culturing, fixing and storing ECs in space. We expect to identify molecular pathways activated by space microgravity in microvascular ECs, which may shed light on pathogenic molecular mechanisms responsible for endothelial suffering shared by astronauts and individuals affected with aging, degenerative and sedentary life-associated pathologies on Earth.

  19. Decreased Renal Function Is a Risk Factor for Subclinical Coronary Atherosclerosis in Korean Postmenopausal Women

    Science.gov (United States)

    Yun, Bo Hyon; Chon, Seung Joo; Cho, Si Hyun; Choi, Young Sik; Lee, Byung Seok

    2016-01-01

    Objectives Decreased renal function is associated with increased cardiovascular risk. Our study was planned to verify the association of decreased renal function and subclinical coronary atherosclerosis in postmenopausal women. Methods We performed a retrospective review of 251 Korean postmenopausal women who visited the health promotion center for a routine health checkup. Estimated glomerular filtration rate (eGFR) was used to show renal function, which was estimated by calculated using the Cockcroft-Gault (CG) and the modification of diet in renal disease (MDRD) formulas. Coronary atherosclerosis was assessed by 64-row multidetector computed tomography. Results Women with reduced eGFR (menopausal hormone therapy before atherosclerosis development. PMID:28119897

  20. Comparison of Functional Capacity using Primary Percutaneous Coronary Intervention with Pharmacological Therapy on ST Elevation Acute Coronary Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Andini Nurkusuma Wardhani

    2015-06-01

    Full Text Available Background: Acute Coronary Syndrome (ACS is a shift manifestations pattern of ischemic myocardium. Revascularization either with Primary Percutaneous Coronary Intervention (PCI or pharmacological therapy is an optional treatment for ST Elevation Acute Coronary Syndrome (STEACS patients. The aim of the study was to compare the functional capacity using six-minute walking test on STEACS patients who underwent Primary PCI or pharmacological therapy. Methods: A cross sectional study was conducted from September to October 2012 to 35 STEACS patients who were treated after two years. The samples were obtained from the list of patients at Dr. Hasan Sadikin General Hospital. Inclusion criteria consisted of patients diagnosed as STEACS, cooperative and not experiencing cognitive disturbance. The exclusion criteria were STEACS patients with unstable angina or myocardial infarct in the last month, stable exertional angina, and pregnant women. The patients underwent 6 minutes walking test,VO2max was measured using theCalahin and Cooper formula, then Metabolic Equation Task (METs was calculated. Data were analyzed by unpaired T-test. Results: There were 19 Primary PCI and 16 pharmacological therapy patients. The average of age between the two groups was distributed evenly. Most of the STEACS patients were male, had a college/academic degree and were retired. Patients treated with pharmacological therapy had higher average of VO2 max and METs than patients with Primary PCI. There was no significantly differences of METs between those groups (p>0.05 Conclusions: There were no significantly differences of functional capacity in STEACS patients treated with Primary PCI or Pharmacological therapy.

  1. Effects of cranberry juice consumption on vascular function in patients with coronary artery disease

    Science.gov (United States)

    Cranberry juice contains polyphenolic compounds that could improve endothelial function and reduce cardiovascular disease risk. The objective was to examine the effects of cranberry juice on vascular function in subjects with coronary artery disease. We completed an acute pilot study with no placebo...

  2. Impact of obesity and bariatric surgery on metabolism and coronary circulatory function.

    Science.gov (United States)

    Valenta, Ines; Dilsizian, Vasken; Quercioli, Alessandra; Jüngling, Freimut D; Ambrosio, Giuseppe; Wahl, Richard; Schindler, Thomas H

    2014-01-01

    Increases in intra-abdominal visceral adipose tissue have been widely appreciated as a risk factor for metabolic disorders such as dyslipidemia, hypertension, insulin resistance, and type 2 diabetes, whereas this is not the case for peripheral or subcutaneous obesity. While the underlying mechanisms that contribute to these differences in adipose tissue activity remain uncertain, increases in visceral fat commonly induce metabolic dysregulation, in part because of increased venous effluent of fatty acids and/or adipokines/cytokines to the liver. Increased body weight, paralleled by an increase in plasma markers of the insulin-resistance syndrome and chronic inflammation, is independently associated with coronary circulatory dysfunction. Recent data suggest that plasma proteins originating from the adipose tissue, such as endocannabinoids (EC), leptin, and adiponectin (termed adipocytes) play a central role in the regulation and control of coronary circulatory function in obesity. Positron emission tomography (PET) in concert with tracer kinetic modeling is a well established technique for quantifying regional myocardial blood flow at rest and in response to various forms of vasomotor stress. Myocardial flow reserve assessed by PET provides a noninvasive surrogate of coronary circulatory function. PET also enables the monitoring and characterization of coronary circulatory function in response to gastric bypass-induced weight loss in initially morbidly obese individuals, to medication and/or behavioral interventions related to weight, diet, and physical activity. Whether the observed improvement in coronary circulatory dysfunction via weight loss may translate to diminution in cardiovascular events awaits clinical confirmation.

  3. Repeatability of the evaluation of systemic microvascular endothelial function using laser doppler perfusion monitoring: clinical and statistical implications

    Directory of Open Access Journals (Sweden)

    Eduardo Tibiriçá

    2011-01-01

    Full Text Available OBJECTIVE: An awareness of the repeatability of biological measures is required to properly design and calculate sample sizes for longitudinal interventional studies. We investigated the day-to-day repeatability of measures of systemic microvascular reactivity using laser Doppler perfusion monitoring. METHODS: We performed laser Doppler perfusion monitoring in combination with skin iontophoresis using acetylcholine and sodium nitroprusside as well as post-occlusive reactive and thermal hyperemia twice within two weeks. The repeatability was assessed by calculating the within-subject standard deviations, limits of agreement, typical errors and intra-class correlation coefficients between days 1 and 2. The ratio of the within-subject standard deviation to the mean values obtained on days 1 and 2 (within-subject standard deviation/GM was used to determine the condition with the best repeatability. RESULTS: Twenty-four healthy subjects, aged 24.6 + 3.8 years, were recruited. The area under the curve of the vasodilatory response to post-occlusive reactivity showed marked variability (within-subject standard deviation/GM = 0.83, while the area under the curve for acetylcholine exhibited less variability (within-subject standard deviation/ GM = 0.52 and was comparable to the responses to sodium nitroprusside and thermal treatment (within-subject standard deviations/GM of 0.67 and 0.56, respectively. The area under the blood flow/time curve for vasodilation during acetylcholine administration required the smallest sample sizes, the area under the blood flow/time curve during post-occlusive reactivity required the largest sample sizes, and the area under the blood flow/time curves of vasodilation induced by sodium nitroprusside and thermal treatment required intermediate sizes. CONCLUSIONS: In view of the importance of random error related to the day-to-day repeatability of laser Doppler perfusion monitoring, we propose an original and robust statistical

  4. Phosphorus is associated with coronary artery disease in patients with preserved renal function.

    Directory of Open Access Journals (Sweden)

    Ana Ludimila Cancela

    Full Text Available High serum phosphorus levels have been associated with mortality and cardiovascular events in patients with chronic kidney disease and in the general population. In addition, high phosphorus levels have been shown to induce vascular calcification and endothelial dysfunction in vitro. The aim of this study was to evaluate the relation of phosphorus and coronary calcification and atherosclerosis in the setting of normal renal function. This was a cross-sectional study involving 290 patients with suspected coronary artery disease and undergoing elective coronary angiography, with a creatinine clearance >60 ml/min/1.73 m(2. Coronary artery obstruction was assessed by the Friesinger score and coronary artery calcification by multislice computed tomography. Serum phosphorus was higher in patients with an Agatston score >10 than in those with an Agatston score ≤ 10 (3.63 ± 0.55 versus 3.49 ± 0.52 mg/dl; p = 0.02. In the patients with Friesinger scores >4, serum phosphorus was higher (3.6 ± 0.5 versus 3.5 ± 0.6 mg/dl, p = 0.04 and median intact fibroblast growth factor 23 was lower (40.3 pg/ml versus 45.7 pg/ml, p = 0.01. Each 0.1-mg/dl higher serum phosphate was associated with a 7.4% higher odds of having a Friesinger score >4 (p = 0.03 and a 6.1% greater risk of having an Agatston score >10 (p = 0.01. Fibroblast growth factor 23 was a negative predictor of Friesinger score (p = 0.002. In conclusion, phosphorus is positively associated with coronary artery calcification and obstruction in patients with suspected coronary artery disease and preserved renal function.

  5. Functional assessment of lesion severity without using the pressure wire: coronary imaging and blood flow simulation.

    Science.gov (United States)

    Papafaklis, Michail I; Mavrogiannis, Michail C; Siogkas, Panagiotis K; Lakkas, Lampros S; Katsouras, Christos S; Fotiadis, Dimitrios I; Michalis, Lampros K

    2017-09-19

    Hemodynamic indices derived from measurements with the pressure wire (primarily fractional flow reserve [FFR]) have been established as a reliable tool for assessing coronary stenoses and improving clinical decision making. However, the use of the pressure wire constitutes a hurdle for the universal adoption of physiology-guided patient management. Technological advancements have enabled the large-scale application of blood flow simulation (computational fluid dynamics [CFD]) to medical imaging, thereby enabling the virtual assessment of coronary physiology. Areas covered: This review summarizes the stand-alone non-invasive (coronary computed tomographic imaging) and invasive (coronary angiography) imaging approaches which were initially used for predicting FFR, and focuses on the use of blood flow modeling for functional assessment of coronary lesions in clinical practice. Expert commentary: Validation studies of CFD-derived methodologies for functional assessment have shown that virtual indices correlate well and have good diagnostic accuracy compared to pressure wire-FFR despite inherent limitations of spatial resolution and assumptions regarding boundary conditions in flow modeling. Beyond point-to-point agreement with FFR, further studies are needed to demonstrate the clinical safety/efficacy of these computational tools regarding patient outcomes. Such evidence base could support the incorporation of these methodologies into routine patient management for decision making and reliable risk stratification.

  6. Assessment of Myocardial Perfusion and Systolic Function in Patients with Coronary Artery Disease after Coronary Artery Bypass Surgery by Myocardial Contrast Echocardiography and Two-dimensional Strain Echocardiography

    Institute of Scientific and Technical Information of China (English)

    Rong LIU; Youbin DENG; Xiaojun BI; Yani LIU; Li XIONG; Liuping CHEN

    2009-01-01

    The clinically applied value of myocardial perfusion and systolic function in patients with coronary artery disease after coronary artery bypass surgery using real-time myocardial contrast echo-cardiography (RT-MCE) combined with two-dimensional strain echocardiography was assessed.Twenty patients underwent intravenous RT-MCE by intravenous injections of Sono Vue before and after coronary artery bypass surgery. Two-dimensional images were recorded from the left ventricular four-chamber view, two-chamber view and the apical view before, and two weeks and three months af-ter coronary artery bypass surgery, and the peak systolic longitudinal strain was measured. The results showed that myocardial perfusion was significantly increased after coronary artery bypass surgery in about 71.6% segments. In the group that myocardial perfusion was improved, the peak systolic longitu-dinal strain three months after bypass surgery was significantly higher than that before operation [(-15.78±5.91)% vs (-10.45±8.31)%, P0.05]. It was con-cluded that whether or not the improvement of myocardial perfusion can mirror the recovery trend of regional systolic function, two-dimensional strain echocardiography can observe dynamic change of re-gional systolic function. The combination of myocardial perfusion with two-dimensional strain echocar-diography can more accurately assess the curative effectiveness of coronary artery bypass surgery.

  7. Noninvasive quantification of coronary endothelial function by SPECT imaging in children with a history of Kawasaki disease

    Energy Technology Data Exchange (ETDEWEB)

    Cicala, Silvana; Paladini, Rodolfo; Leva, Francesco de [Santobono-Pausilipon Children Medical Hospital, Division of Cardiology, Department of Paediatrics, Naples (Italy); Pellegrino, Teresa; Caprio, Maria Grazia [Institute of Diagnostic and Nuclear Development, SDN Foundation, Naples (Italy); Storto, Giovanni [IRCCS, CROB, Rionero in Vulture (Italy); Mainolfi, Ciro; Cuocolo, Alberto [Federico II University, Department of Biomorphological and Functional Sciences, Naples (Italy); National Council of Research, Institute of Biostructures and Bioimages, Naples (Italy)

    2010-12-15

    The feasibility of coronary function estimation by single photon emission computed tomography (SPECT) has been recently demonstrated. The aim of this study was to apply SPECT imaging in patients with previous Kawasaki disease (KD) to assess the coronary functional status at long-term follow-up of the acute phase of the disease. Sixteen children with a history of KD underwent {sup 99m}Tc-sestamibi imaging at rest and during the cold pressor test (CPT). Myocardial blood flow (MBF) was estimated by measuring first transit counts in the pulmonary artery and myocardial counts from SPECT images. Coronary endothelial function was expressed as the ratio of the CPT to rest MBF. Six KD patients without coronary artery lesions served as controls and ten with coronary artery aneurysms during the acute phase of the disease were separated into two groups: group 1 (n = 4) with regressed and group 2 (n = 6) with persistent aneurysm at follow-up. The estimated coronary endothelial function was higher in controls compared to patients with coronary artery aneurysms (2.5 {+-} 0.3 vs 1.7 {+-} 0.7, p < 0.05). A significant difference in coronary endothelial function among groups was found (F = 5.21, p < 0.02). Coronary endothelial function was higher in patients of group 1 than in those of group 2 (1.9 {+-} 0.6 vs 1.4 {+-} 0.7, p < 0.02). SPECT may be applied as a noninvasive method for assessing coronary vascular function in children with a history of KD, demonstrating an impaired response to the CPT, an endothelial-dependent vasodilator stimulus. These findings reinforce the concept that coronary endothelial dysfunction may represent a long-term sequela of KD. (orig.)

  8. Effect of age on left ventricular function during exercise in patients with coronary artery disease.

    Science.gov (United States)

    Hakki, A H; DePace, N L; Iskandrian, A S

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  9. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  10. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion

    NARCIS (Netherlands)

    de Groot, Daphne; Grundmann, Sebastian; Timmers, Leo; Pasterkamp, Gerard; Hoefer, Imo E.

    2011-01-01

    de Groot D, Grundmann S, Timmers L, Pasterkamp G, Hoefer IE. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion. Am J Physiol Heart Circ Physiol 300: H408-H414, 2011. First published October 15, 2010; doi: 10.1152/ajpheart.00070.2010.-Therapeutic stimul

  11. Targeting brain microvascular endothelial cells: a therapeutic approach to neuroprotection against stroke

    Directory of Open Access Journals (Sweden)

    Qi-jin Yu

    2015-01-01

    Full Text Available Brain microvascular endothelial cells form the interface between nervous tissue and circulating blood, and regulate central nervous system homeostasis. Brain microvascular endothelial cells differ from peripheral endothelial cells with regards expression of specific ion transporters and receptors, and contain fewer fenestrations and pinocytotic vesicles. Brain microvascular endothelial cells also synthesize several factors that influence blood vessel function. This review describes the morphological characteristics and functions of brain microvascular endothelial cells, and summarizes current knowledge regarding changes in brain microvascular endothelial cells during stroke progression and therapies. Future studies should focus on identifying mechanisms underlying such changes and developing possible neuroprotective therapeutic interventions.

  12. Functional Outcome of CAD/CAM-Assisted versus Conventional Microvascular, Fibular Free Flap Reconstruction of the Mandible: A Retrospective Study of 30 Cases.

    Science.gov (United States)

    Ritschl, Lucas M; Mücke, Thomas; Fichter, Andreas; Güll, Florian D; Schmid, Christopher; Duc, Jean Marc Pho; Kesting, Marco R; Wolff, Klaus-Dietrich; Loeffelbein, Denys J

    2017-01-18

    Background Different advantages of virtually planned and guided mandibular reconstructions have been described. Functional analyses and comparisons with conventionally reconstructed patients. Methods We retrospectively analyzed 30 cases of mandibular reconstructions that involved virtually planned or conventional microvascular, fibular free flaps that occurred between April 2011 and December 2014 at a single center. The results were also compared with a healthy cohort of 30 participants. Axiographic measurements were performed postoperatively, and uni- and multivariate regressions analyses were performed to determine the association between possible predictor variables on functional outcome. Results Operation time, hospital stay, number of osteotomies, incidence of postoperative temporomandibular joint pain, noise, and tension did not differ significantly between the conventional and computer-aided design/computer-aided manufacturing (CAD/CAM) groups (each p > 0.05). Mouth opening and protrusion and laterotrusion also did not differ significantly (each p > 0.05) but were significantly reduced compared with the healthy group. Univariate analysis showed a significant influence of postoperative irradiation on mouth opening and laterotrusion in the conventional group (p = 0.047 and p = 0.028). In addition, multivariate analysis showed a significant influence of indication and number of osteotomies on laterotrusion (p = 0.005 and p = 0.043). Uni and multivariate analyses revealed a significant influence of indication, preoperative irradiation, and number of osteotomies on protrusion and mouth opening in the CAD/CAM group (p = 0.016, p = 0.044, and p = 0.028). Conclusion CAD/CAM-assisted reconstructions of the mandible give comparable functional results with those of the conventional technique, but no functional superiority has been established. Nevertheless, the integration of virtual planning and guided surgery is definitely

  13. Association analysis between endothelial function related factors and coronary artery stenosis degree in coronary heart disease patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Li, Quanmin; Zhang, Zhifang; Du, Ruiqin; Hu, Xiaoqiang; Yan, Yan; Gao, Qing; Fan, Yanting

    2012-01-01

    To investigate the relationship between soluble intercellular adhesion molecule (sICAM-1), vascular endothelial cell adhesion molecule (VCAM-1), monocytes chemotactic protein (MCP-1), von Willebrand factor (vWF), and coronary artery stenoses degree in coronary heart disease (CHD) within type 2 diabetes mellitus (T2DM) patients. A total of 92 subjects were treated with coronary angiography (CAG), including 62 subjects with CHD. The individuals were divided into three groups, group A (32 patients with CHD and T2DM), group B (30 patients with CHD but no T2DM) and group C (30 patients with no CHD and T2DM). All patients were treated with a Gensini coronary angiography check. The correlations between sICAM-1, VCAM-1, MCP-1 and vWF in peripheral blood and coronary artery stenosis degree were analyzed. The average score of coronary artery stenosis degree was 30.75 +/-12.67 in group A, which was significantly higher than group B (11.20 +/-7.51) and group C (2.40 +/- 1.23) (p coronary artery stenosis and the mean level of sICAM-1, VCAM-1, MCP-1, vWF in group A (p 0.05). Association analysis shown that the level of sICAM-1, VCAM-1, MCP-1 and vWF elevated in CHD with T2DM patients. Vascular endothelial dysfunction could be caused to the coronary artery stenosis pathophysiological process. Results from this study suggested that sICAM-1, VCAM-1, MCP-1 and vWF may contribute to the occurrence and development of vascular lesions in T2DM. These endothelial function related factors could be acceptable as a prediction and testing index of vascular complications in T2DM.

  14. Effect of Coronary Slow Flow on the Longitudinal Left Ventricular Function Assessed by 2-Dimensional Speckle-Tracking Echocardiography.

    Science.gov (United States)

    Narimani, Sima; Hosseinsabet, Ali; Pourhosseini, Hamidreza

    2016-04-01

    The coronary slow flow phenomenon is defined as the slow progression of an angiographic contrast agent to the distal part of the coronary arteries on selective coronary angiography in the absence of stenosis. There are some studies with different results about the effect of this phenomenon on left ventricular (LV) function. The aim of our study was to evaluate the longitudinal LV function in the coronary slow flow phenomenon using 2-dimensional (2D) speckle-tracking echocardiography. In a study with a patient-to-patient matched design, 36 patients with the coronary slow flow phenomenon and 36 individuals with normal coronary flow matched for age (±5 years), sex, hypertension, and diabetes mellitus were compared in terms of the longitudinal LV systolic and diastolic functions by pulsed wave tissue Doppler echocardiography and 2D speckle-tracking echocardiography-derived indices. Lateral s' and e' waves were lower in the patients with the coronary slow flow phenomenon, but there were no statistically significant differences between the groups regarding the other tissue Doppler echocardiographic indices and longitudinal systolic strain and systolic and diastolic strain rates derived by 2D speckle-tracking echocardiography. Our results showed that the coronary slow flow phenomenon could not impair the longitudinal LV systolic and diastolic functions. © 2016 by the American Institute of Ultrasound in Medicine.

  15. Protection of Coronary Endothelial Function during Cardiac Surgery: Potential of Targeting Endothelial Ion Channels in Cardioprotection

    Directory of Open Access Journals (Sweden)

    Qin Yang

    2014-01-01

    Full Text Available Vascular endothelium plays a critical role in the control of blood flow by producing vasoactive factors to regulate vascular tone. Ion channels, in particular, K+ channels and Ca2+-permeable channels in endothelial cells, are essential to the production and function of endothelium-derived vasoactive factors. Impairment of coronary endothelial function occurs in open heart surgery that may result in reduction of coronary blood flow and thus in an inadequate myocardial perfusion. Hyperkalemic exposure and concurrent ischemia-reperfusion during cardioplegic intervention compromise NO and EDHF-mediated function and the impairment involves alterations of K+ channels, that is, KATP and KCa, and Ca2+-permeable TRP channels in endothelial cells. Pharmacological modulation of these channels during ischemia-reperfusion and hyperkalemic exposure show promising results on the preservation of NO and EDHF-mediated endothelial function, which suggests the potential of targeting endothelial K+ and TRP channels for myocardial protection during cardiac surgery.

  16. Resolution of Angina Pectoris and Improvement of the Coronary Flow Reserve after Ranolazine Treatment in a Woman with Isolated Impaired Coronary Microcirculation

    Directory of Open Access Journals (Sweden)

    Alessandro Santoro

    2013-01-01

    Full Text Available In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR. The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

  17. Structural and functional changes of the coronary arteries in elderly senile patients with essential hypertension.

    Science.gov (United States)

    Hu, Jun; Zhu, Fu; Xie, Jun; Cheng, Xinhai; Chen, Guiyu; Tai, Haifen; Fan, Shaohua

    2013-11-01

    The aim of this study was to evaluate the effect of aging on the changes to the structure and function of coronary arteries in senile elderly patients with essential hypertension. Patients (aged 60-80 years) were divided into three groups. The 195 hypertensive patients were divided into four sub-groups according to the duration of hypertension. The changes to the coronary arteries (left and right) of all those patients were tested using the following index by 64 coronary computed tomography (CT) scans. The 24 h systolic blood pressure (SBP) and other blood biochemical parameters were assayed for all patients. We found that the value of the body mass index (BMI), total cholesterol (TC) and low density lipoproteins (LDL) were lower, but age and high density lipoproteins (HDL) were higher in the group of very elderly patients with hypertension (Group I; Phypertension (Group III). The left anterior descending branch calcification score (CSLAD), total calcification score (CST), pulse pressure (PP), the left main branch calcification score (CSLM), the left circumflex branch calcification score (CSLCX) were significantly increased in Group I compared with Group III (Phypertension' group (Group II). Hence, in elderly patients, a decrease in the levels of BMI, HDL, TC and LDL accompanies aging. Furthermore, the decline of arterial compliance and increase in arterial stiffness develops with age. Aging is more likely to lead to atherosclerosis in the coronary arteries, particularly in the left main coronary artery and its main branches. Aging is an uncontrollable risk factor, which plays a crucial role in coronary artery atherosclerosis.

  18. Progress in the Study of Microvascular Pericytes Contractile Function%微血管周细胞收缩功能的研究进展

    Institute of Scientific and Technical Information of China (English)

    鹿文葆

    2012-01-01

    周细胞定位在微血管壁外侧,是微血管的重要组成细胞之一,它在微血管的形成及局部血流调节中发挥重要作用.周细胞是类似平滑肌细胞的一类细胞,表达多种收缩蛋白,具有收缩性.周细胞收缩可调节微血管管径及血流,控制局部微血流的灌流量.近年,越来越多的研究表明周细胞的收缩功能与多种微血管疾病的病变过程有关,因此日益受到关注.对其收缩功能的进一步理解,可能为治疗微血管疾病提供新的方法.%Pericytes, as one of the components of microvessels,are considered to play an important role in the generation of microvessels and the regulation of local blood flow. Pericytes are similar to the smooth muscle cells,which express several kinds of contractile protein and have contractility,regulating the microvessels diameter and blood flow perfusion. More and more studies indicate that pericytes' contractile function is related to the pathological progress of several diseases,which has been paid much attention to recently. Further understanding of the contractile function of pericytes might provide new strategy for the treatment of mi-crovascular diseases.

  19. Differential anti-ischaemic effects of muscarinic receptor blockade in patients with obstructive coronary artery disease; impaired vs normal left ventricular function.

    NARCIS (Netherlands)

    A.F. van den Heuvel; D.J. van Veldhuisen (Dirk); G.L. Bartels; M. van der Ent (Martin); W.J. Remme (Willem)

    1999-01-01

    textabstractAIMS: In patients with coronary artery disease acetylcholine (a muscarinic agonist) causes vasoconstriction. The effect of atropine (a muscarinic antagonist) on coronary vasotone in patients with normal or impaired left ventricular function is unknown. METHO

  20. Correlation of coronary artery stenosis evaluation with left heart structure and function by multi-slice computed tomography.

    Science.gov (United States)

    Song, L N; Cao, A D; Niu, Y J; Liu, N

    2014-08-07

    The aim of this study was to determine the impact of multi-slice computed tomography (MSCT) evaluation of coronary artery stenosis on left heart structure and systolic function. Coronary artery CT angiography was performed in 200 patients diagnosed with coronary heart disease, and then according to the AHA coronary artery 17-segment fractionation method, the Gensini score (GS) was determined for every narrow segment, and one-stop assessment of the correlation between left heart structure and function was performed. After the grouping of GS quartiles from low to high, there were differences between different patients with regard to LVDD, LADD, LVEDV, LVESV, MM, LVEF, and FS, while no difference in SV and CO. GS showed linear negative correlation with LVEF and FS, and linear positive correlation with LVDD, LADD, LVEDV, LVESV, and MM, while no correlation with SV and CO. That is, GS of coronary artery stenosis was negatively correlated with left ventricular systolic function and positively correlated with myocardial mass. The narrower the coronary artery, the worse the cardiac function and the higher the myocardial hypertrophy. Coronary artery stenosis was one of the important causes of the decrease in left ventricular systolic function and cardiac remodeling.

  1. The effect of coronary angiography on residual renal function in patients on peritoneal dialysis.

    Science.gov (United States)

    Weisbord, Steven D; Bernardini, Judith; Mor, Maria K; Hartwig, Kathryn C; Nicoletta, Patricia J; Palevsky, Paul M; Piraino, Beth

    2006-11-01

    The risk of intravascular radiocontrast to residual renal function (RRF) in patients on peritoneal dialysis (PD) remains largely unknown. This study sought to estimate the effect of coronary angiography on RRF in patients on PD. All patients at the VA Pittsburgh Healthcare System and University of Pittsburgh who underwent coronary angiography between 1993 and 2005 while on PD and who had RRF measured prior to angiography were identified retrospectively. For patients without a postprocedure RRF recorded, medical records were reviewed to determine whether anuria had developed. The longer-term rate of loss of RRF among cases was compared with a composite rate of decline in RRF among cases before angiography and matched controls. Twenty-nine patients with a mean preprocedure RRF of 4.4+/-3.2 ml/min/1.73m(2) were evaluated. Of these patients, 23 (79%) had postangiography RRF assessments (mean clearance 3.4+/-3.0 ml/min/1.73m(2)). One of the remaining six patients definitely became permanently anuric following angiography, one was lost to follow-up, and there was no postprocedure RRF assessment in four others. The rate of decline in RRF in the cases was similar to the composite rate (0.07 ml/min/1.73m(2)/month vs. 0.09 ml/min/1.73m(2)/month, p=0.53) The risk for permanent anuria in patients on PD undergoing coronary angiography appears to be quite small. Patients who do not develop anuria following coronary angiography have the same gradual rate of loss of RRF as other patients on PD. Providers should be vigilant in protecting RRF in patients on PD undergoing coronary angiography.

  2. Rapid functional upregulation of vasocontractile endothelin ETB receptors in rat coronary arteries

    DEFF Research Database (Denmark)

    Skovsted, Gry Freja; Pedersen, Anne Fog; Larsen, Rikke;

    2012-01-01

    Endothelin ET(B) receptors mediate under normal physiological conditions vasorelaxation in coronary arteries. However, vasocontractile ET(B) receptors appear in coronary arteries of ischemic heart disease patients. Interestingly, organ culture of isolated coronary arteries also induces upregulati...

  3. Transthoracic Doppler echocardiography – noninvasive diagnostic window for coronary flow reserve assessment

    Directory of Open Access Journals (Sweden)

    Dimitrow Paweł

    2003-04-01

    Full Text Available Abstract This review focuses on transthoracic Doppler echocardiography as noninvasive method used to assess coronary flow reserve (CFR in a wide spectrum of clinical settings. Transthoracic Doppler echocardiography is rapidly gaining appreciation as popular tool to measure CFR both in stenosed and normal epicardial coronary arteries (predominantly in left anterior descending coronary artery. Post-stenotic CFR measurement is helpful in: functional assessment of moderate stenosis, detection of significant or critical stenosis, monitoring of restenosis after revascularization. In the absence of stenosis in the epicardial coronary artery, decreased CFR enable to detect impaired microvascular vasodilatation in: reperfused myocardial infarct, arterial hypertension with or without left ventricular hypertrophy, diabetes mellitus, hypercholesterolemia, syndrome X, hypertrophic cardiomyopathy. In these diseases, noninvasive transthoracic Doppler echocardiography allows for serial CFR evaluations to explore the effect of various pharmacological therapies.

  4. Changes in left ventricular functions after coronary artery by-pass surgery

    Directory of Open Access Journals (Sweden)

    Habib Çil

    2010-09-01

    Full Text Available Objectives: The aim of this study was to evaluate the left ventricular functions with transthoracic echocardiography after coronary bypass surgery.Methods: Sixty-four patients who underwent coronary bypass surgery between January 2008 and March 2009 were retrospectively evaluated. The diagnosis, age and gender of the patients, presence of diabetes mellitus and/or hypertension, smoking, and left ventricle functions before and after surgery were recorded.Results: The mean age of the patients was 58 ± 6,2 years. Forty-four of 64 patients were male, and 20 were female. The lowest ejection fraction was measured in two patients as 30% preoperatively. The mean preoperative and postoperative left ventricle ejection fractions were 48 ± 5.4% and 58 ± 2.4% respectively. This difference was found statistically significant. The mortality rate of by-pass surgery was 4.68% (3 patients.Conclusion: The left ventricular functions were significantly recovered after coronary by-pass surgery.

  5. Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy: a functional assessment of radial forearm versus anterolateral thigh flap.

    Science.gov (United States)

    de Vicente, Juan Carlos; de Villalaín, Lucas; Torre, Aintzane; Peña, Ignacio

    2008-11-01

    The purpose of this study was to evaluate tongue function and donor site morbidity in patients with oral cancer surgically treated and reconstructed with radial or anterolateral thigh free flaps. Twenty patients underwent primary reconstruction after hemiglossectomy between January 2002 and June 2004. Ten patients were reconstructed using a free forearm flap and the remaining with an anterolateral thigh flap. Eight patients on each group underwent postoperative radiotherapy (average, 60 Gy). All of them were followed postoperatively to determine after 6 months their functional outcome as it related to speech, deglutition, tongue mobility, and donor site morbidity. The intelligibility, deglutition, and tongue mobility were each scored on a scale ranging from 1 to 7 by an independent investigator. Data were analyzed by the 2-tail Mann-Whitney U test. No differences in mean speech intelligibility, tongue mobility, or deglutition mean scores were seen between radial forearm flap and anterolateral thigh flap (P > .05). In all anterolateral thigh flap-treated cases, the donor site was closed directly and no complications were seen. However, in all forearm flaps donor site closure was carried out with skin grafts and dorsal forearm splinting was applied for 1 week postoperatively. In 4 cases a partial skin graft failure was observed and donor sites healed for second intention. Anterolateral thigh flap, with its versatility in design, long pedicle with a suitable vessel diameter, and low donor site morbidity, could be the ideal flap for hemiglossectomy defect reconstruction.

  6. Integrating anatomical and functional imaging for the assessment of coronary artery disease.

    Science.gov (United States)

    Lee, Andrea K Y; Qutub, Mohammed A; Aljizeeri, Ahmed; Chow, Benjamin J W

    2013-10-01

    Coronary artery disease (CAD) is a leading cause of morbidity and mortality. Invasive cardiac angiography with fractional flow reserve measurement allows for the anatomical and functional assessment of CAD. Given the invasive nature of invasive cardiac angiography and the risks of procedure-related complications, research has focused upon noninvasive methods for anatomical and functional measures of CAD. As such, there is growing interest in the development of hybrid imaging because it may provide incremental diagnostic information over each imaging modality alone. We will provide an overview of the evidence to date on the anatomical and functional stratification of CAD and current hybrid techniques.

  7. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  8. Monitoring in microvascular surgery.

    Science.gov (United States)

    Furnas, H; Rosen, J M

    1991-03-01

    The importance of monitoring in microvascular surgery is underscored by the high reported salvage rates of failing free flaps and replants. In this overview, we begin by defining the physiology of ischemic tissue with emphasis given to the no-reflow phenomenon and the secondary critical ischemia times. Based on the physiological changes accompanying ischemia, several variables are defined that can be monitored to reflect the vascular state of a free flap or replant. Multifarious monitoring systems are then reviewed, including clinical observation, temperature, isotope clearance, ultrasonic Doppler, laser Doppler, transcutaneous oxygen tension, reflection plethysmography, dermofluorometry, pH, electromagnetic flowmetry, serial hematocrits, interstitial fluid pressure, and magnetic resonance imaging.

  9. The influence of cardiac function on coronary arterial enhancement at coronary computed tomography angiography: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Maryam Moradi

    2016-01-01

    Full Text Available Background: The purpose of this study was to evaluate the influence of ejection fraction (EF on peak aortic time (PAT and peak aortic enhancement (PAE during coronary computed tomography angiography (CTA. Materials and Methods: One-hundred and twenty patients (64 men, 56 women underwent measurement of coronary CTA with a measurement of EF within 3 months of coronary CTA. Pearson's correlation coefficient analysis was used to investigate the relationships between EF, PAT and PAE, and peak attenuation of all coronary arteries. Results: The range of EF was (25%–70% (mean: 55 ± 7.7. The range of PAT and PAE of ascending aorta on bolus test was 13–31 s (mean: 19.3 ± 2 and 153–435 HU (mean: 235 ± 40.6, respectively. Mean peak attenuation of ascending aorta, right coronary artery, left coronary artery, left circumflex artery, and left anterior descending were (561 ± 119, (476 ± 109, (505 ± 108, (467 ± 113, and (473 ± 104, respectively. There was a negative correlation between EF and PAT (r = −0.266, P = 0.003; however, there was no significant correlation between EF and PAE (r = −0.027, P = 0.767.In addition, there was no significant correlation between EF and the peak attenuation of coronary arteries. Conclusion: PAT was related to EF, but there was no relationship between PAE and EF. One of the explanation is that the left ventricular EF used for our study was assessed with echocardiography which is used roughly estimation of EF with interval of 5%–10% and may cause confounding results.

  10. The influence of contrast media on kidney function in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam

    2014-01-01

    AIMS: To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. METHODS AND RESULTS: A total...... patients were invited to a 6-month examination and collection of blood samples. RESULTS: A total of 19 patients (4.3%) developed CIN. CIN patients had a pre-investigation higher estimated glomerular filtration rate (eGRF), lower level of kidney failure and lower creatinine level than non-CIN patients....... Kidney function was not normalized in CIN patients 6 months after the intervention. Two patients still met the definition of CIN. CONCLUSION: With no restriction in fluid intake and supplementary infusion of saline, only a few patients with stable CAD developed early indications of CIN during elective...

  11. Executive function, but not memory, associates with incident coronary heart disease and stroke

    DEFF Research Database (Denmark)

    Rostamian, Somayeh; van Buchem, Mark A; Westendorp, Rudi G J

    2015-01-01

    from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) with Mini-Mental State Examination score ≥24 points. Scores on the Stroop Color-Word Test (selective attention) and the Letter Digit Substitution Test (processing speed) were converted to Z scores and averaged into a composite...... executive function score. Likewise, scores of the Picture Learning Test (immediate and delayed memory) were transformed into a composite memory score. Associations of executive function and memory were longitudinally assessed with risk of coronary heart disease and stroke using multivariable Cox regression...

  12. Loss-of-Function Mutations in APOC3, Triglycerides, and Coronary Disease

    Science.gov (United States)

    2014-01-01

    Background Plasma triglyceride levels are heritable and are correlated with the risk of coronary heart disease. Sequencing of the protein-coding regions of the human genome (the exome) has the potential to identify rare mutations that have a large effect on phenotype. Methods We sequenced the protein-coding regions of 18,666 genes in each of 3734 participants of European or African ancestry in the Exome Sequencing Project. We conducted tests to determine whether rare mutations in coding sequence, individually or in aggregate within a gene, were associated with plasma triglyceride levels. For mutations associated with triglyceride levels, we subsequently evaluated their association with the risk of coronary heart disease in 110,970 persons. Results An aggregate of rare mutations in the gene encoding apolipoprotein C3 (APOC3) was associated with lower plasma triglyceride levels. Among the four mutations that drove this result, three were loss-of-function mutations: a nonsense mutation (R19X) and two splice-site mutations (IVS2+1G→A and IVS3+1G→T). The fourth was a missense mutation (A43T). Approximately 1 in 150 persons in the study was a heterozygous carrier of at least one of these four mutations. Triglyceride levels in the carriers were 39% lower than levels in noncarriers (Ptriglycerides and APOC3. Carriers of these mutations were found to have a reduced risk of coronary heart disease. (Funded by the National Heart, Lung, and Blood Institute and others.) PMID:24941081

  13. Cognitive functioning and microvascular disease

    NARCIS (Netherlands)

    Heringa, S.M.

    2014-01-01

    Cognitive impairment and dementia form a major health issue, affecting a considerable proportion of the aging population. Cerebral vascular damage is increasingly recognized as one of the main causes of cognitive decline in aging and dementia. Another main cause of cognitive deterioration in older p

  14. Outcomes of anatomical vs. functional testing for coronary artery disease : Lessons from the PROMISE trial.

    Science.gov (United States)

    Shah, R; Foldyna, B; Hoffmann, U

    2016-08-01

    The development of coronary artery disease (CAD) is a major, final common pathway in heart disease worldwide. With a rise in stress testing and increased scrutiny on cost-effectiveness and radiation exposure in medical imaging, a focus on the relative merits of anatomic versus functional characterization of CAD has emerged. In this context, coronary computed tomography angiography (CCTA) is a noninvasive alternative to functional testing as a first-line test for CAD detection but is complimentary in its nature. Here, we discuss the design, results, and implications of the PROMISE trial, a randomized comparative effectiveness study of 10,003 patients across 193 sites in the United States and Canada comparing the prognostic and diagnostic power of CCTA and standard stress testing. Specifically, we discuss the safety (e. g., contrast, radiation exposure) of CCTA versus functional testing in CAD, the need for improved selection for noninvasive testing, the frequency of downstream testing after anatomic or functional imaging, the use of imaging results in clinical management, and novel modalities of CAD risk determination using CCTA. PROMISE demonstrated that in a real-world, low-to-intermediate risk patient population referred to noninvasive testing for CAD, both CCTA and functional testing approaches have similar clinical, economic, and safety-based outcomes. We conclude with open questions in CAD imaging, specifically as they pertain to the utilization of CCTA.

  15. [CARDIOREABILITATION PECULIARITIES AND CORRECTION OF VIOLATIONS OF SISTOLIC, DIASOLIC FUNCTION AND HEART RATE VARIABILITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND CORONARY ARTERY REVASCULARIZATION].

    Science.gov (United States)

    Shved, M; Tsuglevych, L; Kyrychok, I; Levytska, L; Boiko, T; Kitsak, Ya

    2017-04-01

    In patients with acute coronary syndrome (ACS) who underwent coronary arteries revascularization, violations of hemodynamics, metabolism and heart rate variability often develop in the postoperative period, therefore, the goal of the study was to establish the features of disturbances and the effectiveness of correction of left ventricular systolic and diastolic dysfunction and heart rate variability in stages of cardiorehabilitation in patients with acute coronary syndrome who underwent coronary arteries revascularization. The experimental group included 40 patients with ACS in the postoperative period who underwent balloon angioplasty and stenting of the coronary arteries (25 patients with ST-segment elevation ACS and 15 patients without ST-segment elevation ACS). The age of examined patients was 37 to 74 years, an average of 52.6±6.7 years. The control group consisted of 20 patients, comparable in age and clinico-laboratory manifestations of ACS, who underwent drug treatment with direct anticoagulants, double antiplatelet therapy, β-blockers, ACE inhibitors and statins. Clinical efficacy of cardiorespiratory process in patients of both groups was assessed by the dynamics of general clinical symptoms and parameters of natriuretic propeptide, systolic and diastolic function of the left ventricle and heart rate variability. In the initial state, clinical and laboratory-instrumental signs of myocardial ischemia disappear in patients with ACS undergoing surgical revascularization of the coronary arteries, but clinical and subclinical manifestations of heart failure were diagnosed. The use of the accelerated program of cardiac rehabilitation already during the first month of studies leads to a decreasement of the signs of systolic and diastolic dysfunction, the level of NT-proBNP and improve in the variability of the heart rhythm wich significantly improves the life quality of patients with ACS. To monitor the effectiveness and safety of cardiac rehabilitation in

  16. [Left-ventricular function and physical exertion tolerance in patients with myocardial infarction with isolated lesion of the coronary arteries].

    Science.gov (United States)

    Golikov, A P; Levshunov, S P; Belozerov, G E

    1989-01-01

    Myocardial infarction area and left-ventricular myocardial contractility, determined by sectoral scanning, and exercise tolerance were assessed in 47 myocardial infarction patients with isolated coronary arterial lesions. The area under myocardial infarction was shown to be dependent on the site of the atherosclerotic process rather than the degree of stenosis in patients with isolated coronary arterial lesions. A relationship was established between the incidence of complications developing in the acute phase of infarction and the degree of stenosis. The disease was complicated more frequently in patients with coronary arterial occlusion as compared to those with severe coronary-arterial stenosis. High stress tolerance, irrespective of the site of myocardial infarction, is an evidence of great functional potentials in this category of patients.

  17. Effects of Percutaneous Coronary Intervention on Viable Myocardium and Heart Function of Diabetic Patients With Chronic Total Occlusion.

    Science.gov (United States)

    Zhou, Guowei; Yang, Wenyi; Li, Liang

    The aim of this study was to compare the effects of percutaneous coronary intervention (PCI) on coronary chronic total occlusion patients with (DM) or without (NDM) diabetes mellitus. A total of 78 patients were divided into DM group and NDM group according to whether the patient has DM. The results of PCI were analyzed using quantitative coronary analysis. In addition, all the patients underwent Tc-MIBI (methoxyisobutylisonitrile) single-photon emission computed tomography (SPECT) and ultrasonic cardiogram in the first week and the sixth month after PCI to evaluate PCI results. During the 6-month follow-up, major adverse cardiac event (MACE) was recorded and analyzed as well. The first and second classes of collateral circulation between the 2 groups have significant differences (P coronary intervention has beneficial effects on heart functions and MACE when performed on chronic total occlusion patients with and without DM.

  18. Coronary flow reserve measurement in the coronary sinus in pre and post CABG status

    Directory of Open Access Journals (Sweden)

    M Hajaghaei

    2007-11-01

    Full Text Available Background: Coronary flow reserve (CFR is defined as a maximal(hyperemic to resting ratio of coronary blood flow. It is a physiologicparameter of coronary circulation and depends on the patency of the epicardialcoronary arteries and integrity of the microvascular circulation.CFR measurement has many clinical applications including functional assessmentof intermediate stenosis, detection of critical stenosis monitoring of coronaryflow in the post angioplasty period, assessment of post infarct blood flow andassessment of coronary graft patency. The aim of this study was to measure CFRin the coronary sinus through the transthoracic echocardiographic approach, inpatients who were candidate for coronary artery bypass graft surgery (CABGbefore and one month after operation.Patients and Methods: The present study included 19 patients (meanage=56±9.1 including 15 males and 4 females, admitted for CABG. All patientshad a sinus rhythm, normal wall thickness, normal RV systolic pressure, andtricuspid valvular regurgitation equal or less than grade 2. The antegrade phaseof coronary flow in the coronary sinus moving into the right atrium was analyzedin two phases (systolic and diastolic. Each wave was determined considering thepeak velocity and velocity time integral (VTI. The volumetric blood flow in thecoronary sinus calculated at the baseline and then in hyperemic phase was usedfor determination of CFR both before and after CABG.Results: There was a significant increase in the diameter of the coronarysinus after CABG (9.4±1.2mm compared with that of before CABG values (8.6±1.05mm. Also there was a trend of increasing the diameter in the hyperemicphase before and after CABG. The absolute increase in mean coronary sinusdiameter was 0.5 mm before and 1.5 mm after CABG. Coronary flow reserve (CFRwas significantly higher after surgery, despite a significant increase insystolic velocity ratio (hyperemic/baseline after CABG. This is also true forsystolic

  19. Acute transient coronary sinus hypertension impairs left ventricular function and induces myocardial edema.

    Science.gov (United States)

    Pratt, J W; Schertel, E R; Schaefer, S L; Esham, K E; McClure, D E; Heck, C F; Myerowitz, P D

    1996-09-01

    This study was performed to evaluate the direct and indirect effects of acute coronary sinus hypertension (CSH) on systolic and diastolic left ventricular (LV) function. Coronary sinus pressure was elevated to 25 mmHg for 3 h in eight pentobarbital-anesthetized dogs and then relieved. LV contractility was assessed by preload recruitable stroke work (PRSW) and end-systolic elastance (Ees). Diastolic function was assessed by the time constant of isovolumic relaxation (tau) and the end-diastolic pressure volume relationship (EDPVR). PRSW and Ees decreased progressively, and tau and the slope of the EDPVR increased progressively with CSH. These changes persisted after relief of CSH. beta-Adrenergic and cholinergic receptor blockade, performed in six dogs, did not alter the effects of CSH on systolic or diastolic function. The LV wet-to-dry weight ratios of the groups with CSH were significantly greater than those of a control group without CSH. We conclude that CSH results in changes in the left ventricle that depress contractility, prolong active relaxation, and increase diastolic stiffness. The dysfunction was not the direct effect of CSH or autonomic reflex activation, but may have been induced by fluid accumulation within the interstitium.

  20. Functional changes of the coronary microvasculature with aging regarding glucose tolerance, energy metabolism, and oxidative stress.

    Science.gov (United States)

    Mourmoura, Evangelia; Couturier, Karine; Hininger-Favier, Isabelle; Malpuech-Brugère, Corinne; Azarnoush, Kasra; Richardson, Melanie; Demaison, Luc

    2014-01-01

    This study was aimed at characterizing the functional progression of the endothelial (ECs) and smooth muscle cells (SMCs) of the coronary microvasculature between youth and old age, as well as at determining the mechanisms of the observed changes on the basis of the glucose tolerance, mitochondrial energy metabolism, and oxidative stress. Male rats were divided into four age groups (3, 6, 11, and 17 months for the young (Y), young adult (YA), middle-aged (MA), and old (O) animals). The cardiac mechanical function, endothelial-dependent dilatation (EDD) and endothelial-independent dilatation (EID) of the coronary microvasculature were determined in a Langendorff preparation. The mitochondrial respiration and H2O2 production were evaluated and completed by ex vivo measurements of oxidative stress. EDD progressively decreased from youth to old age. The relaxation properties of the SMCs, although high in the Y rats, decreased drastically between youth and young adulthood and stabilized thereafter, paralleling the reduction of mitochondrial oxidative phosphorylation. The ECs dilatation activity, low at youth, was stimulated in YA animals and returned to their initial level at middle age. That parameter followed faithfully the progression of the amount of active cardiac endothelial nitric oxide synthase and whole body glucose intolerance. In conclusion, the progressive decrease in EDD occurring with aging is due to different functional behaviors of the ECs and SMCs, which appear to be associated with the systemic glucose intolerance and cardiac energy metabolism.

  1. Quantitative assessment of harmonic power doppler myocardial perfusion imaging with intravenous levovist™ in patients with myocardial infarction: comparison with myocardial viability evaluated by coronary flow reserve and coronary flow pattern of infarct-related artery

    Directory of Open Access Journals (Sweden)

    Nagai Kunihiko

    2005-08-01

    Full Text Available Abstract Background Myocardial contrast echocardiography and coronary flow velocity pattern with a rapid diastolic deceleration time after percutaneous coronary intervention has been reported to be useful in assessing microvascular damage in patients with acute myocardial infarction. Aim To evaluate myocardial contrast echocardiography with harmonic power Doppler imaging, coronary flow velocity reserve and coronary artery flow pattern in predicting functional recovery by using transthoracic echocardiography. Methods Thirty patients with anterior acute myocardial infarction underwent myocardial contrast echocardiography at rest and during hyperemia and were quantitatively analyzed by the peak color pixel intensity ratio of the risk area to the control area (PIR. Coronary flow pattern was measured using transthoracic echocardiography in the distal portion of left anterior descending artery within 24 hours after recanalization and we assessed deceleration time of diastolic flow velocity. Coronary flow velocity reserve was calculated two weeks after acute myocardial infarction. Left ventricular end-diastolic volumes and ejection fraction by angiography were computed. Results Pts were divided into 2 groups according to the deceleration time of coronary artery flow pattern (Group A; 20 pts with deceleration time ≧ 600 msec, Group B; 10 pts with deceleration time Conclusion The preserved microvasculature detecting by myocardial contrast echocardiography and coronary flow velocity reserve is related to functional recovery after acute myocardial infarction.

  2. Relation of cardiac troponin I and microvascular obstruction following ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Hallén, Jonas; Jensen, Jesper K; Buser, Peter

    2011-01-01

    Presence of microvascular obstruction (MVO) following primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) confers higher risk of left-ventricular remodelling and dysfunction. Measurement of cardiac troponin I (cTnI) after STEMI reflects the extent...

  3. X-ray intravital microscopy for functional imaging in rat hearts using synchrotron radiation coronary microangiography

    Energy Technology Data Exchange (ETDEWEB)

    Umetani, K. [Japan Synchrotron Radiation Research Institute, SPring-8, Sayo-cho, Sayo-gun, Hyogo 679-5198 (Japan); Fukushima, K. [National Cerebral and Cardiovascular Center Hospital, Fujishirodai, Suita-shi, Osaka 565-8565 (Japan)

    2013-03-15

    An X-ray intravital microscopy technique was developed to enable in vivo visualization of the coronary, cerebral, and pulmonary arteries in rats without exposure of organs and with spatial resolution in the micrometer range and temporal resolution in the millisecond range. We have refined the system continually in terms of the spatial resolution and exposure time. X-rays transmitted through an object are detected by an X-ray direct-conversion type detector, which incorporates an X-ray SATICON pickup tube. The spatial resolution has been improved to 6 {mu}m, yielding sharp images of small arteries. The exposure time has been shortened to around 2 ms using a new rotating-disk X-ray shutter, enabling imaging of beating rat hearts. Quantitative evaluations of the X-ray intravital microscopy technique were extracted from measurements of the smallest-detectable vessel size and detection of the vessel function. The smallest-diameter vessel viewed for measurements is determined primarily by the concentration of iodinated contrast material. The iodine concentration depends on the injection technique. We used ex vivo rat hearts under Langendorff perfusion for accurate evaluation. After the contrast agent is injected into the origin of the aorta in an isolated perfused rat heart, the contrast agent is delivered directly into the coronary arteries with minimum dilution. The vascular internal diameter response of coronary arterial circulation is analyzed to evaluate the vessel function. Small blood vessels of more than about 50 {mu}m diameters were visualized clearly at heart rates of around 300 beats/min. Vasodilation compared to the control was observed quantitatively using drug manipulation. Furthermore, the apparent increase in the number of small vessels with diameters of less than about 50 {mu}m was observed after the vasoactive agents increased the diameters of invisible small blood vessels to visible sizes. This technique is expected to offer the potential for direct

  4. Loss-of-function mutations in APOC3, triglycerides, and coronary disease.

    Science.gov (United States)

    Crosby, Jacy; Peloso, Gina M; Auer, Paul L; Crosslin, David R; Stitziel, Nathan O; Lange, Leslie A; Lu, Yingchang; Tang, Zheng-zheng; Zhang, He; Hindy, George; Masca, Nicholas; Stirrups, Kathleen; Kanoni, Stavroula; Do, Ron; Jun, Goo; Hu, Youna; Kang, Hyun Min; Xue, Chenyi; Goel, Anuj; Farrall, Martin; Duga, Stefano; Merlini, Pier Angelica; Asselta, Rosanna; Girelli, Domenico; Olivieri, Oliviero; Martinelli, Nicola; Yin, Wu; Reilly, Dermot; Speliotes, Elizabeth; Fox, Caroline S; Hveem, Kristian; Holmen, Oddgeir L; Nikpay, Majid; Farlow, Deborah N; Assimes, Themistocles L; Franceschini, Nora; Robinson, Jennifer; North, Kari E; Martin, Lisa W; DePristo, Mark; Gupta, Namrata; Escher, Stefan A; Jansson, Jan-Håkan; Van Zuydam, Natalie; Palmer, Colin N A; Wareham, Nicholas; Koch, Werner; Meitinger, Thomas; Peters, Annette; Lieb, Wolfgang; Erbel, Raimund; Konig, Inke R; Kruppa, Jochen; Degenhardt, Franziska; Gottesman, Omri; Bottinger, Erwin P; O'Donnell, Christopher J; Psaty, Bruce M; Ballantyne, Christie M; Abecasis, Goncalo; Ordovas, Jose M; Melander, Olle; Watkins, Hugh; Orho-Melander, Marju; Ardissino, Diego; Loos, Ruth J F; McPherson, Ruth; Willer, Cristen J; Erdmann, Jeanette; Hall, Alistair S; Samani, Nilesh J; Deloukas, Panos; Schunkert, Heribert; Wilson, James G; Kooperberg, Charles; Rich, Stephen S; Tracy, Russell P; Lin, Dan-Yu; Altshuler, David; Gabriel, Stacey; Nickerson, Deborah A; Jarvik, Gail P; Cupples, L Adrienne; Reiner, Alex P; Boerwinkle, Eric; Kathiresan, Sekar

    2014-07-03

    Plasma triglyceride levels are heritable and are correlated with the risk of coronary heart disease. Sequencing of the protein-coding regions of the human genome (the exome) has the potential to identify rare mutations that have a large effect on phenotype. We sequenced the protein-coding regions of 18,666 genes in each of 3734 participants of European or African ancestry in the Exome Sequencing Project. We conducted tests to determine whether rare mutations in coding sequence, individually or in aggregate within a gene, were associated with plasma triglyceride levels. For mutations associated with triglyceride levels, we subsequently evaluated their association with the risk of coronary heart disease in 110,970 persons. An aggregate of rare mutations in the gene encoding apolipoprotein C3 (APOC3) was associated with lower plasma triglyceride levels. Among the four mutations that drove this result, three were loss-of-function mutations: a nonsense mutation (R19X) and two splice-site mutations (IVS2+1G→A and IVS3+1G→T). The fourth was a missense mutation (A43T). Approximately 1 in 150 persons in the study was a heterozygous carrier of at least one of these four mutations. Triglyceride levels in the carriers were 39% lower than levels in noncarriers (Pdisease among 498 carriers of any rare APOC3 mutation was 40% lower than the risk among 110,472 noncarriers (odds ratio, 0.60; 95% confidence interval, 0.47 to 0.75; P=4×10(-6)). Rare mutations that disrupt APOC3 function were associated with lower levels of plasma triglycerides and APOC3. Carriers of these mutations were found to have a reduced risk of coronary heart disease. (Funded by the National Heart, Lung, and Blood Institute and others.).

  5. Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

    DEFF Research Database (Denmark)

    Ong, Peter; Aziz, Ahmed; Hansen, Henrik Steen

    2015-01-01

    Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical cohere...

  6. Microvascular dysfunction as a link between obesity, insulin resistance and hypertension.

    Science.gov (United States)

    Karaca, Ü; Schram, M T; Houben, A J H M; Muris, D M J; Stehouwer, C D A

    2014-03-01

    Impaired microvascular dilatation from any cause and impaired insulin-mediated capillary recruitment in particular result in suboptimal delivery of glucose and insulin to skeletal muscle, and subsequently impairment of glucose disposal (insulin resistance). In addition, microvascular dysfunction, through functional and/or structural arteriolar and capillary drop-out, and arteriolar constriction, increases peripheral resistance and thus blood pressure. Microvascular dysfunction may thus constitute a pathway that links insulin resistance and hypertension. Overweight and obesity may be an important cause of microvascular dysfunction. Mechanisms linking overweight and obesity to microvascular dysfunction include changes in the secretion of adipokines leading to increased levels of free fatty acids and inflammatory mediators, and decreased levels of adiponectin all of which may impair endothelial insulin signaling. Microvascular dysfunction may thus constitute a new treatment target in the prevention of type 2 diabetes mellitus and hypertension. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Endothelial Function in Adolescents with a History of Premature Coronary Artery Disease in One Parent

    Directory of Open Access Journals (Sweden)

    M Hashemi

    2006-01-01

    Full Text Available Background: In young adults, a family history of premature coronary artery disease (CAD, as well as genetic and environmental factors are independent risk factors for coronary artery disease. Methods: Endothelial function was studied in 30 children (21 boys and 9 girls with mean age of 14.9 +/- 2.3 years old of patients with documented CAD (men 45 and women 50 years old. Chidren did not have any history of diabetes mellitus, dyslipidemia, hypertension, and smoking (active/passive. Using vascular ultrasound, we measured resting Basal Brachial artery Diameter (BBD and Endothelium-Dependent Dilatation (EDD in response to increased flow and sublingual glyceryltrinitrate (GTN, an Endothelium-Independent Dilation (EID. These parameters were also measured in 30 control subjects with normal parents (18 boys and 12 girls with mean age of 14.2 +/- 2/5years old and results were compared with each other. Results: Adolescents in CAD group had abnormal Endothelial Dependent Dilatation or EDD/BBD (8.5 +/- 3.4% vs 11.8 +/- 4.5% in control subjects; P= 0.003.Endothelial Independent Dilatation (EID/BBD in the positive fimily history group was significantly more than control subjects (18.5 +/- 6.7% vs 11.9 +/- 5.2%; P <0.001. EDD/EID or the index of endothelial function was significantly lower in the positive family history group (0.92 +/- 0.05 vs 1+/- 0.03; P<0.001. There was no difference in EDD/EID index between those with history of premature CAD in mother (7 cases and those with history of premature CAD in father (23 cases (0.92 +/- 0.04 vs 0.91+/- 0.05. Conclusion: Normal adolescents without any cardiovascular risk factors but a history of premature coronary artery disease in one parent may have endothelial dysfunction, and there is no difference whether the CAD is in mother or father. Keywords: Endothelial dependent dilation, family history, CAD risk factors, premature coronary artery disease

  8. A functionally significant polymorphism in ID3 is associated with human coronary pathology.

    Directory of Open Access Journals (Sweden)

    Ani Manichaikul

    Full Text Available We previously identified association between the ID3 SNP rs11574 and carotid intima-media thickness in the Diabetes Heart Study, a predominantly White diabetic population. The nonsynonymous SNP rs11574 results in an amino acid substitution in the C-terminal region of ID3, attenuating the dominant negative function of ID3 as an inhibitor of basic HLH factor E12-mediated transcription. In the current investigation, we characterize the association between the functionally significant polymorphism in ID3, rs11574, with human coronary pathology.The Multi-Ethnic Study of Atherosclerosis (MESA is a longitudinal study of subclinical cardiovascular disease, including non-Hispanic White (n = 2,588, African American (n = 2,560 and Hispanic (n = 2,130 participants with data on coronary artery calcium (CAC. The Coronary Assessment in Virginia cohort (CAVA included 71 patients aged 30-80 years, undergoing a medically necessary cardiac catheterization and intravascular ultrasound (IVUS at the University of Virginia. ID3 SNP rs11574 risk allele was associated with the presence of CAC in MESA Whites (P = 0.017. In addition, the risk allele was associated with greater atheroma burden and stenosis in the CAVA cohort (P = 0.003, P = 0.04 respectively. The risk allele remained predictive of atheroma burden in multivariate analysis (Model 1: covariates age, gender, and LDL, regression coefficient = 9.578, SE = 3.657, p = 0.0110; Model 2: covariates Model 1, presence of hypertension, presence of diabetes, regression coefficient = 8.389, SE = 4.788, p = 0.0163.We present additional cohorts that demonstrate association of ID3 SNP rs11574 directly with human coronary artery pathology as measured by CAC and IVUS: one a multiethnic, relatively healthy population with low levels of diabetes and the second a predominantly White population with a higher incidence of T2DM referred for cardiac catheterization.

  9. Ventricular function following coronary artery bypass grafting: comparison between Gated SPECT and cardiac magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Mesquita, Claudio Tinoco [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Medicina Nuclear; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Pessoa, Maria Carolina Pinheiro [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Vasconcelos, Paulo Pontes [Centro de Diagnostico por Imagens (CDPI), Rio de Janeiro, RJ (Brazil); Oliveira Junior, Amarino Carvalho [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Dohmann, Hans Fernando Rocha [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil). Servico de Radiologia; Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Reis, Adair Gomes dos [Nuclear Diagnosticos, SP (Brazil); Fonseca, Lea Mirian Barbosa da [Pro-Echo Hospital Samaritano, Rio de Janeiro, RJ (Brazil); Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil)

    2009-04-15

    Background: The assessment of left ventricular function may be impaired by the abnormal interventricular septal motion frequently found after coronary artery bypass grafting (CABG). Studies on the validation of gated SPECT as a tool for the assessment of left ventricular function in this patient group are scarce. Objective: We investigated the agreement and correlation between left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV) as obtained using electrocardiogram-gated myocardial perfusion scintigraphy (gated SPECT) and cardiac magnetic resonance imaging in 20 patients undergoing coronary artery bypass grafting. Methods: Correlation was measured using Spearman's correlation coefficient ({rho}). Agreement was assessed using Bland-Altman analysis. Results: A good correlation was found between gated SPECT and cardiac magnetic resonance imaging in patients after CABG with regard to left ventricular ejection fraction ({rho} = 0.85; p =0.0001), moderate correlation for end-diastolic volume ({rho} = 0.51; p = 0.02), and non-significant correlation for end-diastolic volume ({rho} = 0.13; p = 0.5). Agreement ranges for LVEF, ESV and EDV were: -20% to 12%; -38 to 54 ml and; -96 to 100 ml, respectively. Conclusion: A reliable correlation was found for left ventricular ejection fraction as obtained by gated SPECT and magnetic resonance imaging in patients undergoing CABG. For ventricular volumes, however, the correlation is not adequate. (author)

  10. Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease.

    Science.gov (United States)

    Liang, Y; Li, Y P; He, F; Liu, X Q; Zhang, J Y

    2015-06-01

    Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34(+) monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, Parteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

  11. Non-invasive assessment of functionally relevant coronary artery stenoses with quantitative CT perfusion: preliminary clinical experiences

    Energy Technology Data Exchange (ETDEWEB)

    So, Aaron [Lawson Health Research Institute, Imaging Program, London, Ontario (Canada); Robarts Research Institute, Imaging Research Laboratories, London, Ontario (Canada); University of Western Ontario, Medical Biophysics, London, Ontario (Canada); Wisenberg, Gerald [Lawson Health Research Institute, Imaging Program, London, Ontario (Canada); University of Western Ontario, Medical Biophysics, London, Ontario (Canada); University of Western Ontario, Medical Imaging, London, Ontario (Canada); London Health Sciences Centre, Cardiology, London, Ontario (Canada); Islam, Ali; Amann, Justin; Romano, Walter [University of Western Ontario, Medical Imaging, London, Ontario (Canada); St. Joseph' s Health Care, Radiology, London, Ontario (Canada); Brown, James; Humen, Dennis; Jablonsky, George [London Health Sciences Centre, Cardiology, London, Ontario (Canada); Li, Jian-Ying; Hsieh, Jiang [GE Healthcare, CT Engineering, Waukesha, Wisconsin (United States); Lee, Ting-Yim [Lawson Health Research Institute, Imaging Program, London, Ontario (Canada); Robarts Research Institute, Imaging Research Laboratories, London, Ontario (Canada); University of Western Ontario, Medical Biophysics, London, Ontario (Canada); University of Western Ontario, Medical Imaging, London, Ontario (Canada)

    2012-01-15

    We developed a quantitative Dynamic Contrast-Enhanced CT (DCE-CT) technique for measuring Myocardial Perfusion Reserve (MPR) and Volume Reserve (MVR) and studied their relationship with coronary stenosis. Twenty-six patients with Coronary Artery Disease (CAD) were recruited. Degree of stenosis in each coronary artery was classified from catheter-based angiograms as Non-Stenosed (NS, angiographically normal or mildly irregular), Moderately Stenosed (MS, 50-80% reduction in luminal diameter), Severely Stenosed (SS, >80%) and SS with Collaterals (SSC). DCE-CT at rest and after dipyridamole infusion was performed using 64-slice CT. Mid-diastolic heart images were corrected for beam hardening and analyzed using proprietary software to calculate Myocardial Blood Flow (MBF, in mLmin{sup -1}100 g{sup -1}) and Blood Volume (MBV, in mL100 g{sup -1}) parametric maps. MPR and MVR in each coronary territory were calculated by dividing MBF and MBV after pharmacological stress by their respective baseline values. MPR and MVR in MS and SS territories were significantly lower than those of NS territories (p < 0.05 for all). Logistic regression analysis identified MPR MVR as the best predictor of {>=}50% coronary lesion than MPR or MVR alone. DCE-CT imaging with quantitative CT perfusion analysis could be useful for detecting coronary stenoses that are functionally significant. (orig.)

  12. The effects of post coronary stenting triple antiplatelet therapies on platelet functions

    Institute of Scientific and Technical Information of China (English)

    韩雅玲

    2006-01-01

    Objective To explore the effects of triple antiplatelet therapy on platelet aggregation and activation in patients who underwent coronary stenting. Methods 120 inhospital coronary heart disease patients with coronary stenting were randomized into two groups receiving either triple antiplatelet drugs of aspirin and clopidogrel combined with cilostazol or dual antiplatelet drugs of aspirin and clopidogrel. On the first day after stenting cilostazol

  13. Invasive Evaluation of Patients with Angina in the Absence of Obstructive Coronary Artery Disease

    Science.gov (United States)

    Lee, Bong-Ki; Lim, Hong-Seok; Fearon, William F.; Yong, Andy; Yamada, Ryotaro; Tanaka, Shigemitsu; Lee, David P.; Yeung, Alan C.; Tremmel, Jennifer A.

    2017-01-01

    Background More than 20% of patients presenting to the cardiac catheterization laboratory with angina have no angiographic evidence of coronary artery disease (CAD). Despite a “normal” angiogram, these patients often have persistent symptoms, recurrent hospitalizations, a poor functional status, and adverse cardiovascular outcomes, without a clear diagnosis. Methods and Results In 139 patients with angina in the absence of obstructive CAD (no diameter stenosis >50%), endothelial function was assessed, the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and fractional flow reserve (FFR) were measured, and intravascular ultrasound (IVUS) was performed. There were no complications. The average age was 54.0±11.4 years and 107 (77%) were women. All patients had at least some evidence of atherosclerosis based on IVUS examination of the LAD. Endothelial dysfunction (a decrease in luminal diameter of >20% after intracoronary acetylcholine) was present in 61 patients (44%). Microvascular impairment (an IMR ≥25) was present in 29 patients (21%). Seven patients (5%) had an FFR ≤0.80. A myocardial bridge was present in 70 patients (58%). Overall, only 32 patients (23%) had no coronary explanation for their angina, with normal endothelial function, normal coronary physiologic assessment, and no myocardial bridging. Conclusions The majority of patients with angina in the absence of obstructive CAD have occult coronary abnormalities. A comprehensive invasive assessment of these patients at the time of coronary angiography can be performed safely and provides important diagnostic information which may affect treatment and outcomes. PMID:25712205

  14. Improving diagnosis and treatment of women with angina pectoris and microvascular disease

    DEFF Research Database (Denmark)

    Prescott, Eva; Abildstrøm, Steen Zabell; Aziz, Ahmed

    2014-01-01

    identified, 530 contacted, and 299 (56%) agreed to participate. Among the first 50 patients, Doppler CFR was successfully measured in 49 (98%). CONCLUSIONS: Among women with suspected ischemic heart disease and no obstructive coronary artery disease, non-invasive Doppler CFR is feasible as a routine......BACKGROUND: The iPOWER study aims at determining whether routine assessment of coronary microvascular dysfunction (CMD) in women with angina and no obstructive coronary artery disease is feasible and identifies women at risk. METHODS: All women with angina referred to invasive angiographic...

  15. Fractional flow reserve derived from coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Eftekhari, Ashkan; Min, James; Achenbach, Stephan

    2016-01-01

    AIMS: Fractional flow reserve (FFR) derived from coronary computed tomography (FFRCT) has high diagnostic performance in stable coronary artery disease (CAD). The diagnostic performance of FFRCT in patients with hypertension (HTN) and diabetes (DM), who are at risk of microvascular impairment, is...

  16. Transcriptional network analysis for the regulation of left ventricular hypertrophy and microvascular remodeling.

    Science.gov (United States)

    Moreno-Moral, Aida; Mancini, Massimiliano; D'Amati, Giulia; Camici, Paolo; Petretto, Enrico

    2013-12-01

    Hypertension and cardiomyopathies share maladaptive changes of cardiac morphology, eventually leading to heart failure. These include left ventricular hypertrophy (LVH), myocardial fibrosis, and structural remodeling of coronary microcirculation, which is the morphologic hallmark of coronary microvascular dysfunction. To pinpoint the complex molecular mechanisms and pathways underlying LVH-associated cardiac remodeling independent of blood pressure effects, we employed gene network approaches to the rat heart. We used the Spontaneously Hypertensive Rat model showing many features of human hypertensive cardiomyopathy, for which we collected histological and histomorphometric data of the heart and coronary vasculature, and genome-wide cardiac gene expression. Here, we provide a large catalogue of gene co-expression networks in the heart that are significantly associated with quantitative variation in LVH, microvascular remodeling, and fibrosis-related traits. Many of these networks were significantly conserved to human idiopathic and/or ischemic cardiomyopathy patients, suggesting a potential role for these co-expressed genes in human heart disease.

  17. The correlation between high sensitivity C-Reactive Protein level and the Extent of Coronary Lesion and Cardiac Systolic Function in Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Miftah Suryadipradja

    2003-12-01

    Full Text Available To determine the mean value of high sensitivity C-Reactive Protein (hs-CRP, association between plasma level of hs-CRP with extent of disease and systolic function. A cross sectional study had been conducted to 106 coronary artery disease patients (90 stable angina pectoris, 11 unstable angina pectoris and 5 acute myocardial infarction. Plasma quantitative level of hs-CRP with cor angiography to determine extent of disease and ejection fraction were measured. The mean of hs-CRP levels in patients with SVD were 5,5 ± 7,6 mg/L, DVD were 6,6 ± 21,7 mg/L and TVD were 5,5 ± 8,0 mg/L and p=0,056, respectively. There were no significant association between hs- CRP levels with extent of disease. Systolic function had negative correlation with levels of hs-CRP (p=0,015, r=-0,235. This study showed that plasma level of hs-CRP cannot reflect the extent of disease, and it had negative correlation with systolic function. (Med J Indones 2003; 12: 201-6 Keywords: high sensitivity C-Reactive Protein, extent of disease, systolic function, coronary artery diseases.

  18. Impaired cerebrovascular function in coronary artery disease patients and recovery following cardiac rehabilitation.

    Directory of Open Access Journals (Sweden)

    Udunna C Anazodo

    2016-01-01

    Full Text Available Coronary artery disease (CAD poses a risk to the cerebrovascular function of older adults and has been linked to impaired cognitive abilities. Using magnetic resonance perfusion imaging, we investigated changes in resting cerebral blood flow (CBF and cerebrovascular reactivity (CVR to hypercapnia in 34 coronary artery disease (CAD patients and 21 age-matched controls. Gray matter volume images were acquired and used as a confounding variable to separate changes in structure from function. Compared to healthy controls, CAD patients demonstrated reduced CBF in the superior frontal, anterior cingulate, insular, pre- and post-central gyri, middle temporal and superior temporal regions. Subsequent analysis of these regions demonstrated decreased CVR in the anterior cingulate, insula, postcentral and superior frontal regions. Except in the superior frontal and precentral regions, regional reductions in CBF and CVR were identified in brain areas where no detectable reductions in gray matter volume were observed, demonstrating that these vascular changes were independent of brain atrophy. Because aerobic fitness training can improve brain function, potential changes in regional CBF were investigated in the CAD patients after completion of a 6-month exercise-based cardiac rehabilitation program. Increased CBF was observed in the bilateral anterior cingulate, as well as recovery of CBF in the dorsal aspect of the right anterior cingulate, where the magnitude of increased CBF was roughly equal to the reduction in CBF at baseline compared to controls. These exercise-related improvements in CBF in the anterior cingulate is intriguing given the role of this area in cognitive processing and regulation of cardiovascular autonomic control.

  19. Functional Status, Anxiety, Cardiac Self-Efficacy, and Health Beliefs of Patients with Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Hamid Allahverdipour

    2013-12-01

    Full Text Available Background: Beliefs and emotions could effect on functional status, quality of life, and mortality amongst patients who are suffering coronary heart disease (CHD. Current study examined the role of anxiety: trait/ state, self-efficacy, health beliefs, and functional status among patient with history of CHD. Method: In this correlational study, 105 hospitalized and outpatients patients suffering CHD in Tehran Heart Center Hospital participated by using convenience sampling method in 2012. Cardiac self-efficacy, Seattle Angina, and research- designed health beliefs questionnaires were used to gather data. Results: The functional status in CHD patients showed significant relationships with gender, job, and type of medical insurance of the participants (All ps<0.05. In addition , perceived vulnerability to face again cardiac attack in the future, perceived severity of next cardiac attack, anxiety, state anxiety and trait anxiety (All ps<0.05 had significant and negative relationships with functional status. Conversely, the cardiac self-efficacy had a positive and significant relationship (P<0.001 with functional status. Conclusion: Psychological factors have important role in functional status and quality of life of patients who suffering CHD. Therefore, it is necessary to emphasize on supportive and complementary programs to promote Cardiac Rehabilitation Programs.

  20. Microvascular endothelial cell heterogeneity : general concepts and pharmacological consequences for anti-angiogenic therapy of cancer

    NARCIS (Netherlands)

    Langenkamp, Elise; Molema, Grietje

    2009-01-01

    Microvascular endothelial cells display a large degree of heterogeneity in function depending on their location in the vascular tree. The existence of organ-specific, microvascular-bed-specific, and even intravascular variations in endothelial cell gene expression emphasizes their high cell-to-cell

  1. A case of serpentine coronaries and acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Shivashankara TH

    2015-06-01

    Full Text Available Microvascular disease is a prominent feature of systemic sclerosis (SSc and leads to Raynaud's phenomenon, pulmonary arterial hypertension, and scleroderma renal crisis. The presence of macrovascular disease is less well established, and, in particular, it is not known whether the prevalence of coronary heart disease in SSc is increased. We report a case of SSc who presented with evolved myocardial infarction whose angiogram revealed tortuous coronaries and peripheral arteries. Regional wall motion abnormality was not demonstrated on echocardiography. The microvascular dysfunction and vasospasm of coronaries were responsible for the myocardial infarction. [Int J Res Med Sci 2015; 3(6.000: 1511-1513

  2. Fusion of morphological data obtained by coronary computed tomography angiography with quantitative echocardiographic data on regional myocardial function.

    Science.gov (United States)

    Lipiec, Piotr; Wejner-Mik, Paulina; Wdowiak-Okrojek, Katarzyna; Szymczyk, Ewa; Skurski, Adam; Napieralski, Andrzej; Kamiński, Marek; Szymczyk, Konrad; Kasprzak, Jarosław D

    2016-01-01

    Three-dimensional (3D) fusion of morphological data obtained by coronary computed tomography angiography (CCTA) with functional data from resting and stress echocardiography could potentially provide additional information compared to examination results analyzed separately and increase the diagnostic and prognostic value of non-invasive imaging in patients with suspected coronary artery disease (CAD). Using vendor-independent software developed in our institution, we aimed to assess the feasibility and reproducibility of 3D fusion of morphological CCTA data with echocardiographic data regarding regional myocardial function. Thirty patients with suspected CAD underwent CCTA and resting transthoracic echocardiography. From CCTA we obtained 3D reconstructions of coronary arteries and left ventricle (LV). Offline speckle-tracking analysis of the echocardiographic images provided parametric maps depicting myocardial longitudinal strain in 17 segments of the LV. Using our software, 3 independent investigators fused echocardiographic maps with CCTA reconstruc-tions in all patients. Based on the obtained fused models, each segment of the LV was assigned to one of the major coronary artery branches. Mean time necessary for data fusion was 65 ± 7 s. Complete agreement between independent investigators in assignment of LV segments to coronary branches was obtained in 94% of the segments. The average coefficient of agreement (kappa) between the investigators was 0.950 and the intra-class correlation coefficient was 0.9329 (95% CI 0.9227-0.9420). Three-dimensional fusion of morphological CCTA data with quantitative echocardiographic data on regional myocardial function is feasible and allows highly repro-ducible assignment of myocardial segments to coronary artery branches.

  3. Accuracy of 64-slice CT angiography for the detection of functionally relevant coronary stenoses as assessed with myocardial perfusion SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Gaemperli, Oliver; Schepis, Tiziano; Koepfli, Pascal; Valenta, Ines; Soyka, Jan [University Hospital Zurich NUK C 40, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); Leschka, Sebastian; Desbiolles, Lotus; Husmann, Lars; Alkadhi, Hatem [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich NUK C 40, Nuclear Cardiology, Cardiovascular Center, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (CIHP), Zurich (Switzerland)

    2007-08-15

    CT angiography (CTA) offers a valuable alternative for the diagnosis of CAD but its value in the detection of functionally relevant coronary stenoses remains uncertain. We prospectively compared the accuracy of 64-slice CTA with that of myocardial perfusion imaging (MPI) using {sup 99m}Tc-tetrofosmin-SPECT as the gold standard for the detection of functionally relevant coronary artery disease (CAD). MPI and 64-slice CT were performed in 100 consecutive patients. CTA lesions were analysed quantitatively and area stenoses {>=}50% and {>=}75% were compared with the MPI findings. In 23 patients, MPI perfusion defects were found (12 reversible, 13 fixed). A total of 399 coronary arteries and 1,386 segments was analysed. Eighty-four segments (6.1%) in 23 coronary arteries (5.8%) of nine patients (9.0%) were excluded owing to insufficient image quality. In the remaining 1,302 segments, quantitative CTA revealed stenoses {>=}50% in 57 of 376 coronary arteries (15.2%) and stenoses {>=}75% in 32 (8.5%) coronary arteries. Using a cut-off at {>=}75% area stenosis, CTA yielded the following sensitivity, specificity, negative (NPV) and positive predictive value (PPV), and accuracy for the detection of any (fixed and reversible) MPI defect: by patient, 75%, 90%, 93%, 68% and 87%, respectively; by artery, 76%, 95%, 99%, 50% and 94%, respectively. Sixty-four-slice CTA is a reliable tool to rule out functionally relevant CAD in a non-selected population with an intermediate pretest likelihood of disease. However, an abnormal CTA is a poor predictor of ischaemia. (orig.)

  4. Multimodality Imaging Evaluation of Functional and Clinical Benefits of Percutaneous Coronary Intervention in Patients with Chronic Total Occlusion Lesion

    Directory of Open Access Journals (Sweden)

    Dongdong Sun, Jing Wang, Yue Tian, Kazim Narsinh, Haichang Wang, Chengxiang Li, Xiaowei Ma, Yabing Wang, Dongjuan Wang, Chunhong Li, Joseph C Wu, Jie Tian, Feng Cao

    2012-01-01

    Full Text Available Aims: To determine the effects of percutaneous coronary intervention (PCI on cardiac perfusion, cardiac function, and quality of life in patients with chronic total occlusion (CTO lesion in left anterior descending (LAD coronary artery.Methods and Results: Patients (n=99 with CTO lesion in the LAD coronary artery who had successfully undergone PCI were divided into three groups based on the SPECT/CTCA fusion imaging: (a no severe cardiac perfusion defects (n=9; (b reversible cardiac perfusion defects (n=40; or (c fixed cardiac perfusion defects (n=50. No statistical difference of perfusion abnormality was observed at 6 months and 1 year after PCI in group (a. In group (b, SPECT/CTCA fusion imaging demonstrated that cardiac perfusion abnormality was significantly decreased 6 month and 1 year after PCI. Left ventricular ejection fraction (LVEF increased significantly at 6 months and 1 year follow up. Quality of life improved at 6 months and 1 year after PCI procedure. Moreover, patients in group (c also benefited from PCI therapy: a decrease in cardiac perfusion abnormality, an increase in LVEF, and an improvement in quality of life. PCI of coronary arteries in addition to LAD did not significantly affect cardiac function and quality of life improvement in each group.Conclusions: PCI exerts functional and clinical benefits in patients with CTO lesion in LAD coronary artery, particularly in patients with reversible cardiac perfusion defects. SPECT/CTCA fusion imaging may serve as a useful tool to evaluate the outcomes of patients with CTO lesion in LAD coronary artery.

  5. Modified Continuous Loop Technique for microvascular anastomosis

    Directory of Open Access Journals (Sweden)

    Kumar Pramod

    2001-01-01

    Full Text Available A modified method of continuous loop technique for microvascular anastomosis is described. The handling of loop is easier & even last suture is placed under vision. This makes the microvascular anastomosis easier and simpler.

  6. Systematic analysis of functional and structural changes after coronary microembolization: a cardiac magnetic resonance imaging study.

    Science.gov (United States)

    Breuckmann, Frank; Nassenstein, Kai; Bucher, Christina; Konietzka, Ina; Kaiser, Gernot; Konorza, Thomas; Naber, Christoph; Skyschally, Andreas; Gres, Petra; Heusch, Gerd; Erbel, Raimund; Barkhausen, Jörg

    2009-02-01

    Our study aimed to detect the morphological und functional effects of coronary microembolization (ME) in vivo by cardiac magnetic resonance (CMR) imaging in an established experimental animal model. Post-mortem morphological alterations of coronary ME include perifocal inflammatory edema and focal microinfarcts. Clinically, the detection of ME after successful coronary interventions identifies a population with a worse long-term prognosis. In 18 minipigs, ME was performed by intracoronary infusion of microspheres followed by repetitive in vivo imaging on a 1.5-T MR system from 30 min to 8 h after ME. Additionally, corresponding ex vivo CMR imaging and histomorphology were performed. Cine CMR imaging demonstrated a time-dependent increase of wall motion abnormalities from 9 of 18 animals after 30 min to all animals after 8 h (0.5 h, 50%; 2 h, 78%; 4 h, 75%; 8 h, 100%). Whereas T2 images were negative 30 min after ME, 4 of 18 animals showed myocardial edema at follow-up (0.5 h, 0%; 2 h, 6%; 4 h, 25%; 8 h, 17%). In vivo late gadolinium enhancement (LGE) was observed in none of the animals after 30 min, but in 33%, 50%, and 83% of animals at 2 h, 4 h, and 8 h, respectively, after ME. Ex vivo CMR imaging showed patchy areas of LGE in all but 1 animal (2 h, 83%; 4 h, 100%; 8 h, 100%). A significant correlation was seen between the maximum troponin I level and LGE in vivo (r = 0.63) and the spatial extent of ex vivo LGE (r = 0.76). Our results show that in vivo contrast-enhanced CMR imaging allows us to detect functional and structural myocardial changes after ME with a high sensitivity. Ex vivo, the pattern of LGE of high-resolution, contrast-enhanced CMR imaging is different from the well-known pattern of LGE in compact myocardial damage. Thus, improvements in spatial resolution are thought to be necessary to improve its ability to visualize ME-induced structural alterations even in vivo.

  7. ITPKC functional polymorphism associated with Kawasaki disease susceptibility and formation of coronary artery aneurysms.

    Science.gov (United States)

    Onouchi, Yoshihiro; Gunji, Tomohiko; Burns, Jane C; Shimizu, Chisato; Newburger, Jane W; Yashiro, Mayumi; Nakamura, Yoshikazu; Yanagawa, Hiroshi; Wakui, Keiko; Fukushima, Yoshimitsu; Kishi, Fumio; Hamamoto, Kunihiro; Terai, Masaru; Sato, Yoshitake; Ouchi, Kazunobu; Saji, Tsutomu; Nariai, Akiyoshi; Kaburagi, Yoichi; Yoshikawa, Tetsushi; Suzuki, Kyoko; Tanaka, Takeo; Nagai, Toshiro; Cho, Hideo; Fujino, Akihiro; Sekine, Akihiro; Nakamichi, Reiichiro; Tsunoda, Tatsuhiko; Kawasaki, Tomisaku; Nakamura, Yusuke; Hata, Akira

    2008-01-01

    Kawasaki disease is a pediatric systemic vasculitis of unknown etiology for which a genetic influence is suspected. We identified a functional SNP (itpkc_3) in the inositol 1,4,5-trisphosphate 3-kinase C (ITPKC) gene on chromosome 19q13.2 that is significantly associated with Kawasaki disease susceptibility and also with an increased risk of coronary artery lesions in both Japanese and US children. Transfection experiments showed that the C allele of itpkc_3 reduces splicing efficiency of the ITPKC mRNA. ITPKC acts as a negative regulator of T-cell activation through the Ca2+/NFAT signaling pathway, and the C allele may contribute to immune hyper-reactivity in Kawasaki disease. This finding provides new insights into the mechanisms of immune activation in Kawasaki disease and emphasizes the importance of activated T cells in the pathogenesis of this vasculitis.

  8. Microvascular Recruitment in Insulin Resistance

    DEFF Research Database (Denmark)

    Sjøberg, Kim Anker

    In this PhD work a new method for measuring microvascular recruitment was developed and evaluated, using continues real-time imaging of contrast enhanced ultrasound. Gas-filled microbubbles were infused intravenously and by taking advantage of the echogenic properties of the microbubbles the reso......In this PhD work a new method for measuring microvascular recruitment was developed and evaluated, using continues real-time imaging of contrast enhanced ultrasound. Gas-filled microbubbles were infused intravenously and by taking advantage of the echogenic properties of the microbubbles...... hormone glucagon-like-peptide-1 (GLP-1) in the microcirculation. Glucagon-like-peptide-1 analogs are drugs used for treatments of insulin resistance and type 2 diabetes but the vascular effects of GLP-1 in vivo are elusive. Here it was shown that GLP-1 rapidly increased the microvascular recruitment...

  9. Microvascular Recruitment in Insulin Resistance

    DEFF Research Database (Denmark)

    Sjøberg, Kim Anker

    the resonating sound from the microbubbles in the systemic circulation were recorded for determination of microvascular recruitment in designated muscle segments. Results showed that microvascular recruitment increased with insulin stimulation by ~30% in rats and ~40% in humans (study I). Furthermore......, it was observed that muscle contractions increased muscle perfusion rapidly by 3-4 fold and by 1-2 fold compared to basal and insulin, respectively, in both rat and human skeletal muscle (study I). The real-time contrast-enhanced ultrasound method was applied to investigate the vaso-active effect of the incretin...... hormone glucagon-like-peptide-1 (GLP-1) in the microcirculation. Glucagon-like-peptide-1 analogs are drugs used for treatments of insulin resistance and type 2 diabetes but the vascular effects of GLP-1 in vivo are elusive. Here it was shown that GLP-1 rapidly increased the microvascular recruitment...

  10. Renal and cardiac microvascular endothelium: injury and repair

    NARCIS (Netherlands)

    Oosterhuis, NR

    2016-01-01

    Injury to the capillary endothelium can be devastating for renal and cardiac function. To halt the progression of chronic kidney disease (CKD) and heart failure (HF) preservation of the microvascular endothelial cell (EC) function and structure is of great importance.1 Increasing knowledge about

  11. Renal and cardiac microvascular endothelium: injury and repair

    NARCIS (Netherlands)

    Oosterhuis, N.R.

    2016-01-01

    Injury to the capillary endothelium can be devastating for renal and cardiac function. To halt the progression of chronic kidney disease (CKD) and heart failure (HF) preservation of the microvascular endothelial cell (EC) function and structure is of great importance.1 Increasing knowledge about mic

  12. Transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound

    Institute of Scientific and Technical Information of China (English)

    Xin-Sheng Chen

    2016-01-01

    Objective:To analyze the transesophageal echocardiography evaluation of the coronary blood flow and cardiac function in laparoscopic surgery and their correlation with operative wound.Methods:A total of 80 patients undergoing laparoscopic surgery in our hospital were randomly divided into standard pneumoperitoneum pressure group (12-15 mmHg) and high pneumoperitoneum pressure group (>15 mmHg) (n=40), and the differences in the levels of coronary blood flow and cardiac function parameters under transesophageal echocardiography as well as the content of stress hormones and acute phase proteins in serum were compared between two groups of patients.Results: Coronary blood flow parameters D, Q, PDV, MDV and DAR levels of standard pneumoperitoneum pressure group were significantly higher than those of high pneumoperitoneum pressure group; cardiac function parameters COLVOT, LVEF and LVFAC levels were significantly higher than those of high pneumoperitoneum pressure group; stress hormones Cor, Ang-Ⅰ, Ang-Ⅱ, NE, Glucagon and C-peptide as well as acute phase proteins CRP, YKL-40 and HMGB1 content in serum were significantly lower than those of high pneumoperitoneum pressure group while the acute phase protein PA content was significantly higher than that of high pneumoperitoneum pressure group.Conclusions:Transesophageal echocardiography can timely detect the excessive pneumoperitoneum damage in laparoscopic surgery to the coronary blood flow and cardiac function in patients, and also prevent the occurrence of excessive operative wound.

  13. Which angiographic variable best describes functional status 6 months after successful single-vessel coronary balloon angiopasty?

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1993-01-01

    textabstractOBJECTIVES. The aim of this study was to determine which quantitative angiographic variable best describes functional status 6 months after coronary balloon angioplasty. BACKGROUND. Several angiographic restenosis criteria have been developed. These can be divided into those that describ

  14. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone

    2015-01-01

    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  15. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Science.gov (United States)

    Andreini, Daniele; Bertella, Erika; Mushtaq, Saima; Guaricci, Andrea Igoren; Pepi, Mauro

    2015-01-01

    Coronary artery disease (CAD) is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR) has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT) has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT), functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach. PMID:25692133

  16. Depressed heart rate variability is associated with events in patients with stable coronary artery disease and preserved left ventricular function

    NARCIS (Netherlands)

    van Boven, AJ; Jukema, JW; Haaksma, J; Zwinderman, AH; Crijns, HJGM; Lie, KI

    1998-01-01

    Background Little is known about the value of heart rate variability in patients with symptomatic coronary artery disease with a preserved left ventricular function. We hypothesized that in these patients heart rate variability might be a helpful adjunct to conventional parameters to predict clinica

  17. Carotid artery stiffness, digital endothelial function, and coronary calcium in patients with essential thrombocytosis, free of overt atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Vrtovec Matjaz

    2017-05-01

    Full Text Available Patients with myeloproliferative neoplasms (MPNs are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET, a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects.

  18. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Elder dos Santos Cavalcante

    2014-11-01

    Full Text Available Background: Coronary artery bypass graft (CABG is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01. Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.

  19. Predictors of cognitive function in candidates for coronary artery bypass graft surgery.

    Science.gov (United States)

    Ernest, Christine S; Elliott, Peter C; Murphy, Barbara M; Le Grande, Michael R; Goble, Alan J; Higgins, Rosemary O; Worcester, Marian U C; Tatoulis, James

    2007-03-01

    Candidates for coronary artery bypass graft surgery have been found to exhibit reduced cognitive function prior to surgery. However, little is known regarding the factors that are associated with pre-bypass cognitive function. A battery of neuropsychological tests was administered to a group of patients listed for bypass surgery (n = 109). Medical, sociodemographic and emotional predictors of cognitive function were investigated using structural equation modeling. Medical factors, namely history of hypertension and low ejection fraction, significantly predicted reduced cognitive function, as did several sociodemographic characteristics, namely older age, less education, non-English speaking background, manual occupation, and male gender. One emotional variable, confusion and bewilderment, was also a significant predictor whereas anxiety and depression were not. When significant predictors from the three sets of variables were included in a combined model, three of the five sociodemographic characteristics, namely age, non-English speaking background and occupation, and the two medical factors remained significant. Apart from sociodemographic characteristics, medical factors such as a history of hypertension and low ejection fraction significantly predicted reduced cognitive function in bypass candidates prior to surgery.

  20. Functional impairment of hematopoietic progenitor cells in patients with coronary heart disease.

    Science.gov (United States)

    Liguori, Antonio; Fiorito, Carmela; Balestrieri, Maria Luisa; Crimi, Ettore; Bruzzese, Giuseppe; Williams-Ignarro, Sharon; D'Amora, Maurizio; Sommese, Linda; Grimaldi, Vincenzo; Minucci, Pellegrino Biagio; Giovane, Alfonso; Farzati, Bartolomeo; Ignarro, Louis J; Napoli, Claudio

    2008-03-01

    The circulating form of endothelial progenitors cells (EPCs) are derived from bone marrow (BM)-derived hematopoietic stem cells (HSCs). Enhanced mobilization of EPCs was shown to be linked to cardiac diseases. This study investigated whether reduced EPC levels in advanced coronary heart disease (CHD) are secondary to a functional exhaustion of HSCs in the BM or to reduced mobilization. Number and functional properties of EPCs were assessed in 15 healthy controls, and 40 patients with CHD. The colony-forming unit (CFU) capacity of BM-derived mononuclear cells and the CD34+ HSC number were examined in four healthy volunteers, and 15 CHD patients. EPC number was reduced in CHD patients (P < 0.01 vs. controls). Moreover, the migratory capacity was significantly impaired in EPCs of CHD patients (P < 0.05 vs. controls). On multivariate analysis, CHD was an independent predictor of functional EPC impairment. CFUs were reduced in CHD patients (59.6 +/- 21.2 vs. 75.4 +/- 25.8 in controls, P < 0.05). CHD was also predictor of impaired CFU capacity. In this small clinical study, CHD is associated with selective impairment of HSC function in the BM and in the peripheral blood, which may contribute to impairment of cardiac function.

  1. Functional and anatomical measures for outflow boundary conditions in atherosclerotic coronary bifurcations.

    Science.gov (United States)

    Schrauwen, Jelle T C; Coenen, Adriaan; Kurata, Akira; Wentzel, Jolanda J; van der Steen, Antonius F W; Nieman, Koen; Gijsen, Frank J H

    2016-07-26

    The aim of this research was finding the influence of anatomy-based and functional-based outflow boundary conditions for computational fluid dynamics (CFD) on fractional flow reserve (FFR) and wall shear stress (WSS) in mildly diseased coronary bifurcations. For 10 patient-specific bifurcations three simulations were set up with different outflow conditions, while the inflow was kept constant. First, the outflow conditions were based on the diameter of the outlets. Second, they were based on the volume estimates of the myocardium that depended on the outlets. Third, they were based on a myocardial flow measure derived from computed tomography perfusion imaging (CTP). The difference in outflow ratio between the perfusion-based and the diameter-based approach was -7 p.p. [-14 p.p.:7 p.p.] (median percentage point and interquartiles), and between the perfusion-based and volume-based this was -2 p.p. [-2 p.p.:1 p.p.]. Despite of these differences the computed FFRs matched very well. A quantitative analysis of the WSS results showed very high correlations between the methods with an r(2) ranging from 0.90 to 1.00. But despite the high correlations the diameter-based and volume-based approach generally underestimated the WSS compared to the perfusion-based approach. These differences disappeared after normalization. We demonstrated the potential of CTP for setting patient-specific boundary conditions for atherosclerotic coronary bifurcations. FFR and normalized WSS were unaffected by the variations in outflow ratios. In order to compute absolute WSS a functional measure to set the outflow ratio might be of added value in this type of vessels.

  2. Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

    Directory of Open Access Journals (Sweden)

    Y. Liang

    2015-06-01

    Full Text Available Remote ischemic preconditioning (RIPre can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG surgery were assigned randomly to a RIPre group (n=20 or coronary heart disease (CHD group (n=20. Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD, CD34+ monocyte count, and endothelial nitric oxide synthase (eNOS expression. Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05 and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05. RIPre activated STAT-3 and increased CD34+ endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

  3. Long-term, regular remote ischemic preconditioning improves endothelial function in patients with coronary heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Liang, Y.; Li, Y.P.; He, F.; Liu, X.Q.; Zhang, J.Y. [Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou (China)

    2015-04-28

    Remote ischemic preconditioning (RIPre) can prevent myocardial injury. The purpose of this study was to assess the beneficial effects of long-term regular RIPre on human arteries. Forty patients scheduled for coronary artery bypass graft (CABG) surgery were assigned randomly to a RIPre group (n=20) or coronary heart disease (CHD) group (n=20). Twenty patients scheduled for mastectomy were enrolled as a control group. RIPre was achieved by occluding arterial blood flow 5 min with a mercury sphygmomanometer followed by a 5-min reperfusion period, and this was repeated 4 times. The RIPre procedure was repeated 3 times a day for 20 days. In all patients, arterial fragments discarded during surgery were collected to evaluate endothelial function by flow-mediated dilation (FMD), CD34{sup +} monocyte count, and endothelial nitric oxide synthase (eNOS expression). Phosphorylation levels of STAT-3 and Akt were also assayed to explore the underlying mechanisms. Compared with the CHD group, long-term regular RIPre significantly improved FMD after 20 days (8.5±2.4 vs 4.9±4.2%, P<0.05) and significantly reduced troponin after CABG surgery (0.72±0.31 and 1.64±0.19, P<0.05). RIPre activated STAT-3 and increased CD34{sup +} endothelial progenitor cell counts found in arteries. Long-term, regular RIPre improved endothelial function in patients with CHD, possibly due to STAT-3 activation, and this may have led to an increase in endothelial progenitor cells.

  4. Direct ink writing of microvascular networks

    Science.gov (United States)

    Wu, Willie

    Nature is replete with examples of embedded microvascular systems that enable efficient fluid flow and distribution for autonomic healing, cooling, and energy harvesting. The ability to incorporate microvascular networks in functional materials systems is therefore both scientifically and technologically important. In this PhD thesis, the direct-write assembly of planar and 3D biomimetic microvascular networks within polymer and hydrogel matrices is demonstrated. In addition, the influence of network design of fluid transport efficiency is characterized. Planar microvascular networks composed of periodic lattices of uniformal microchannels and hierarchical, branching architectures are constructed by direct-write assembly of a fugitive organic ink. Several advancements are required to facilitate their patterning, including pressure valving, dual ink printing, and dynamic pressure variation to allow tunable control of ink deposition. The hydraulic conductance is measured using a high pressure flow meter as a function of network design. For a constant vascular volume and areal coverage, 2- and 4-generation branched architectures that obey Murray's Law exhibited the highest hydraulic conductivity. These experimental observations are in good agreement with predictions made by analytic models. 3D microvascular networks are fabricated by omnidirectional printing a fugitive organic ink into a photopolymerizable hydrogel matrix that is capped with fluid filler of nearly identical composition. Using this approach, 3D networks of arbitrary design can be patterned. After ink deposition is complete, the matrix and fluid filler are chemically cross-linked via UV irradiation, and the ink is removed by liquefication. Aqueous solutions composed of a triblock copolymer of polyethylene oxide (PEO)-polypropylene oxide (PPO)-PEO constitute the materials system of choice due to their thermal- and concentration-dependent phase behavior. Specifically, the fugitive ink consists of a 23 w

  5. Relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients

    Directory of Open Access Journals (Sweden)

    Stoičkov Viktor

    2007-01-01

    Full Text Available Introduction QT dispersion (QTd is a measure of non-homogeneous repolarisation of the myocardium and is used as an indicator of arrhythmogenicity. Objective The aim of this study was to assess the relation between QT dispersion, left ventricle systolic function and frequency of ventricular arrhythmias in coronary patients. Method We studied 290 coronary patients, 72 with angina pectoris and 218 after myocardial infarction. Eighty-one coronary patients had frequent and complex ventricular arrhythmias (out of them 19 had ventricular tachycardia and 209 were without arrhythmias or with infrequent ventricular premature contractions (VPC≤10/h. In all patients, QT dispersion, exercise test, 24-hour Holter monitoring and echocardiographic examination were performed. Results Patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd (71.8±25.5 vs 55.6±21.7 ms; p<0.001, corrected QT dispersion (QTdc: 81.3±31.5 vs. 60.3±26.1 ms; p<0.001, left ventricular end-diastolic diameter (LVEDd: 56.2±6.9 vs. 53.4±6.2 mm; p<0.001 and left ventricular end-systolic diameter (LVESd: 39.5±6.2 vs. 36.0±6.3 mm; p<0.001, and significantly lower values of left ventricular ejection fraction (LVEF: 47.7±13.9 vs. 55.9±11.6%; p<0.001 in comparison to those without arrhythmias or with infrequent VPC. Patients with VT had significantly higher values of QTd and QTdc in comparison to other patients with frequent and complex ventricular arrhythmias (83.8±17.1 vs. 69.4±26.2 ms; p<0.02 for QTd; 101.1±23.9:77.6±31.4 ms; p<0.005 for QTdc. There is a significant negative correlation of QTd and QTdc with LVEF, and a significant positive correlation of QTd and QTdc with inside dimensions of the left ventricle, in patients with frequent and complex ventricular arrhythmias. Conclusion The study demonstrated that patients with frequent and complex ventricular arrhythmias had significantly higher values of QTd and QTdc, as well as a higher

  6. Pathophysiology of hypertension: interactions between macro and microvascular alterations through endothelial dysfunction.

    Science.gov (United States)

    Yannoutsos, Alexandra; Levy, Bernard I; Safar, Michel E; Slama, Gerard; Blacher, Jacques

    2014-02-01

    Hypertension is a multifactorial systemic chronic disorder through functional and structural macrovascular and microvascular alterations. Macrovascular alterations are featured by arterial stiffening, disturbed wave reflection and altered central to peripheral pulse pressure amplification. Microvascular alterations, including altered wall-to-lumen ratio of larger arterioles, vasomotor tone abnormalities and network rarefaction, lead to disturbed tissue perfusion and susceptibility to ischemia. Central arterial stiffness and microvascular alterations are common denominators of organ damages. Vascular alterations are intercorrelated, amplifying the haemodynamic load and causing further damage in the arterial network. A plausible precursor role of vascular alterations in incident hypertension provides new insights for preventive and therapeutic strategies targeting macro and microvasculature. Cumulative metabolic burden and oxidative stress lead to chronic endothelial injury, promoting structural and functional vascular alterations, especially in the microvascular network. Pathophysiology of hypertension may then be revisited, based on both macrovascular and microvascular alterations, with a precursor role of endothelial dysfunction for the latter.

  7. CMR of microvascular obstruction and hemorrhage in myocardial infarction

    Directory of Open Access Journals (Sweden)

    Wu Katherine C

    2012-09-01

    Full Text Available Abstract Microvascular obstruction (MO or no-reflow phenomenon is an established complication of coronary reperfusion therapy for acute myocardial infarction. It is increasingly recognized as a poor prognostic indicator and marker of subsequent adverse LV remodeling. Although MO can be assessed using various imaging modalities including electrocardiography, myocardial contrast echocardiography, nuclear scintigraphy, and coronary angiography, evaluation by cardiovascular magnetic resonance (CMR is particularly useful in enhancing its detection, diagnosis, and quantification, as well as following its subsequent effects on infarct evolution and healing. MO assessment has become a routine component of the CMR evaluation of acute myocardial infarction and will increasingly play a role in clinical trials of adjunctive reperfusion agents and strategies. This review will summarize the pathophysiology of MO, current CMR approaches to diagnosis, clinical implications, and future directions needed for improving our understanding of this common clinical problem.

  8. Multimodal cardiovascular magnetic resonance quantifies regional variation in vascular structure and function in patients with coronary artery disease: Relationships with coronary disease severity

    Directory of Open Access Journals (Sweden)

    Kylintireas Ilias

    2011-10-01

    Full Text Available Abstract Background Cardiovascular magnetic resonance (CMR of the vessel wall is highly reproducible and can evaluate both changes in plaque burden and composition. It can also measure aortic compliance and endothelial function in a single integrated examination. Previous studies have focused on patients with pre-identified carotid atheroma. We define these vascular parameters in patients presenting with coronary artery disease and test their relations to its extent and severity. Methods and Results 100 patients with CAD [single-vessel (16%; two-vessel (39%; and three-vessel (42% non-obstructed coronary arteries (3%] were studied. CAD severity and extent was expressed as modified Gensini score (mean modified score 12.38 ± 5.3. A majority of carotid plaque was located in the carotid bulb (CB. Atherosclerosis in this most diseased segment correlated modestly with the severity and extent of CAD, as expressed by the modified Gensini score (R = 0.251, P Conclusions Multimodal vascular CMR shows regional abnormalities of vascular structure and function that correlate modestly with the degree and extent of CAD.

  9. Functional analysis of the TRIB1 associated locus linked to plasma triglycerides and coronary artery disease.

    Science.gov (United States)

    Douvris, Adrianna; Soubeyrand, Sébastien; Naing, Thet; Martinuk, Amy; Nikpay, Majid; Williams, Andrew; Buick, Julie; Yauk, Carole; McPherson, Ruth

    2014-06-03

    The TRIB1 locus has been linked to hepatic triglyceride metabolism in mice and to plasma triglycerides and coronary artery disease in humans. The lipid-associated single nucleotide polymorphisms (SNPs), identified by genome-wide association studies, are located ≈30 kb downstream from TRIB1, suggesting complex regulatory effects on genes or pathways relevant to hepatic triglyceride metabolism. The goal of this study was to investigate the functional relationship between common SNPs at the TRIB1 locus and plasma lipid traits. Characterization of the risk locus reveals that it encompasses a gene, TRIB1-associated locus (TRIBAL), composed of a well-conserved promoter region and an alternatively spliced transcript. Bioinformatic analysis and resequencing identified a single SNP, rs2001844, within the promoter region that associates with increased plasma triglycerides and reduced high-density lipoprotein cholesterol and coronary artery disease risk. Further, correction for triglycerides as a covariate indicated that the genome-wide association studies association is largely dependent on triglycerides. In addition, we show that rs2001844 is an expression trait locus (eQTL) for TRIB1 expression in blood and alters TRIBAL promoter activity in a reporter assay model. The TRIBAL transcript has features typical of long noncoding RNAs, including poor sequence conservation. Modulation of TRIBAL expression had limited impact on either TRIB1 or lipid regulatory genes mRNA levels in human hepatocyte models. In contrast, TRIB1 knockdown markedly increased TRIBAL expression in HepG2 cells and primary human hepatocytes. These studies demonstrate an interplay between a novel locus, TRIBAL, and TRIB1. TRIBAL is located in the genome-wide association studies identified risk locus, responds to altered expression of TRIB1, harbors a risk SNP that is an eQTL for TRIB1 expression, and associates with plasma triglyceride concentrations. © 2014 The Authors. Published on behalf of the

  10. Impaired systemic tetrahydrobiopterin bioavailability and increased dihydrobiopterin in adult falciparum malaria: association with disease severity, impaired microvascular function and increased endothelial activation.

    Directory of Open Access Journals (Sweden)

    Tsin W Yeo

    2015-03-01

    Full Text Available Tetrahydrobiopterin (BH₄ is a co-factor required for catalytic activity of nitric oxide synthase (NOS and amino acid-monooxygenases, including phenylalanine hydroxylase. BH4 is unstable: during oxidative stress it is non-enzymatically oxidized to dihydrobiopterin (BH₂, which inhibits NOS. Depending on BH₄ availability, NOS oscillates between NO synthase and NADPH oxidase: as the BH₄/BH₂ ratio decreases, NO production falls and is replaced by superoxide. In African children and Asian adults with severe malaria, NO bioavailability decreases and plasma phenylalanine increases, together suggesting possible BH₄ deficiency. The primary three biopterin metabolites (BH₄, BH₂ and B₀ [biopterin] and their association with disease severity have not been assessed in falciparum malaria. We measured pterin metabolites in urine of adults with severe falciparum malaria (SM; n=12, moderately-severe malaria (MSM, n=17, severe sepsis (SS; n=5 and healthy subjects (HC; n=20 as controls. In SM, urinary BH₄ was decreased (median 0.16 ¼mol/mmol creatinine compared to MSM (median 0.27, SS (median 0.54, and HC (median 0.34]; p<0.001. Conversely, BH₂ was increased in SM (median 0.91 ¼mol/mmol creatinine, compared to MSM (median 0.67, SS (median 0.39, and HC (median 0.52; p<0.001, suggesting increased oxidative stress and insufficient recycling of BH2 back to BH4 in severe malaria. Overall, the median BH₄/BH₂ ratio was lowest in SM [0.18 (IQR: 0.04-0.32] compared to MSM (0.45, IQR 0.27-61, SS (1.03; IQR 0.54-2.38 and controls (0.66; IQR 0.43-1.07; p<0.001. In malaria, a lower BH₄/BH₂ ratio correlated with decreased microvascular reactivity (r=0.41; p=0.03 and increased ICAM-1 (r=-0.52; p=0.005. Decreased BH4 and increased BH₂ in severe malaria (but not in severe sepsis uncouples NOS, leading to impaired NO bioavailability and potentially increased oxidative stress. Adjunctive therapy to regenerate BH4 may have a role in improving NO

  11. Differential anti-ischaemic effects of muscarinic receptor blockade in patients with obstructive coronary artery disease - impaired vs normal left ventricular function

    NARCIS (Netherlands)

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

    1999-01-01

    Aims In patients with coronary artery disease acetylcholine (a muscarinic agonist) causes vasoconstriction. The effect of atropine (a muscarinic antagonist) on coronary vasotone in patients with normal or impaired left ventricular function is unknown. Methods and Results Twenty-four patients who req

  12. Skin microvascular reactivity in patients with hypothyroidism.

    Science.gov (United States)

    Mihor, Ana; Gergar, Maša; Gaberšček, Simona; Lenasi, Helena

    2016-11-04

    Hypothyroidism is associated with impaired vascular function; however, little is known about its impact on microcirculation. We aimed to determine skin microvascular reactivity in hypothyroidism focusing on endothelial function and the sympathetic response. We measured skin laser Doppler (LD) flux (LDF) on the volar forearm and the finger pulp using LD flowmetry in hypothyroid patients (N = 13) and healthy controls (N = 15). Skin microvascular reactivity was assessed by a three-minute occlusion of the brachial artery, inducing postocclusive reactive hyperaemia (PRH), and by a four-minute local cooling of the hand. An electrocardiogram (ECG), digital artery blood pressure and skin temperature at the measuring sites were recorded. Baseline LDF, the digital artery blood pressure and the heart rate were comparable between patients and controls. On the other hand, patients exhibited significantly longer PRH duration, significantly higher blood pressure during cooling (unpaired t-test, p skin microcirculation and an apparent increase in sympathetic reactivity after local cooling in hypothyroid patients. Hypothyroidism induces subtle changes of some haemodynamic parameters in skin microcirculation implying altered endothelial function and altered sympathetic reactivity.

  13. Functional polymorphism in ABCA1 influences age of symptom onset in coronary artery disease patients.

    Science.gov (United States)

    Kyriakou, Theodosios; Pontefract, David E; Viturro, Enrique; Hodgkinson, Conrad P; Laxton, Ross C; Bogari, Neda; Cooper, George; Davies, Michael; Giblett, Joel; Day, Ian N M; Simpson, Iain A; Albrecht, Christiane; Ye, Shu

    2007-06-15

    ATP-binding-cassette-transporter-A1 (ABCA1) plays a pivotal role in intracellular cholesterol removal, exerting a protective effect against atherosclerosis. ABCA1 gene severe mutations underlie Tangier disease, a rare Mendelian disorder that can lead to premature coronary artery disease (CAD), with age of CAD onset being two decades earlier in mutant homozygotes and one decade earlier in heterozygotes than in mutation non-carriers. It is unknown whether common polymorphisms in ABCA1 could influence age of symptom onset of CAD in the general population. We examined common promoter and non-synonymous coding polymorphisms in relation to age of symptom onset in a group of CAD patients (n = 1164), and also carried out in vitro assays to test effects of the promoter variations on ABCA1 promoter transcriptional activity and effects of the coding variations on ABCA1 function in mediating cellular cholesterol efflux. Age of symptom onset was found to be associated with the promoter - 407G > C polymorphism, being 2.82 years higher in C allele homozygotes than in G allele homozygotes and intermediate in heterozygotes (61.54, 59.79 and 58.72 years, respectively; P = 0.002). In agreement, patients carrying ABCA1 haplotypes containing the -407C allele had higher age of symptom onset. Patients of the G/G or G/C genotype of the -407G > C polymorphism had significant coronary artery stenosis (>75%) at a younger age than those of the C/C genotype (P = 0.003). Reporter gene assays showed that ABCA1 haplotypes bearing the -407C allele had higher promoter activity than haplotypes with the -407G allele. Functional analyses of the coding polymorphisms showed an effect of the V825I substitution on ABCA1 function, with the 825I variant having higher activity in mediating cholesterol efflux than the wild-type (825V). A trend towards higher symptom onset age in 825I allele carriers was observed. The data indicate an influence of common ABCA1 functional polymorphisms on age of symptom onset

  14. Microvascular Disease After Renal Transplantation

    Directory of Open Access Journals (Sweden)

    Qi Lun Ooi

    2015-11-01

    Full Text Available Background/Aims: Individuals who reach end-stage kidney disease (CKD5 have a high risk of vascular events that persists even after renal transplantation. This study compared the prevalence and severity of microvascular disease in transplant recipients and patients with CKD5. Methods: Individuals with a renal transplant or CKD5 were recruited consecutively from renal clinics, and underwent bilateral retinal photography (Canon CR5-45, Canon. Their retinal images were deidentified and reviewed for hypertensive/microvascular signs by an ophthalmologist and a trained grader (Wong and Mitchell classification, and for vessel caliber at a grading centre using a computer-assisted method and Knudtson's modification of the Parr-Hubbard formula. Results: Ninety-two transplant recipients (median duration 6.4 years, range 0.8 to 28.8 and 70 subjects with CKD5 were studied. Transplant recipients were younger (pConclusions: Hypertensive/microvascular disease occurred just as often and was generally as severe in transplant recipients and subjects with CKD5. Microvascular disease potentially contributes to increased cardiac events post- transplantation.

  15. Microvascular decompression for trigeminal neuralgia.

    Science.gov (United States)

    Sade, Burak; Lee, Joung H

    2014-10-01

    The microvascular decompression procedure has proven to be a safe and effective option in the surgical management of neurovascular compression syndromes in general and trigeminal neuralgia in particular. This article aims to serve as an overview of the decision-making process, application of the surgical technique, and clinical outcome pertaining to this procedure.

  16. Microvascularization on collared peccary placenta

    DEFF Research Database (Denmark)

    Santos, Tatiana Carlesso; Oliveira, Moacir Franco; Dantzer, Vibeke

    2012-01-01

    into a microvascular network wall in a basket-like fashion. At the base of these baskets venules were formed. On the fetal side, arterioles branched centrally in the fetal rugae into a capillary network in a bulbous form, complementary to the opposite maternal depressions forming the baskets. At the base...

  17. Coronary sinus-based percutaneous annuloplasty as treatment for functional mitral regurgitation: the TITAN II trial

    Science.gov (United States)

    Lipiecki, Janusz; Siminiak, Tomasz; Sievert, Horst; Müller-Ehmsen, Jochen; Degen, Hubertus; Wu, Justina C; Schandrin, Christian; Kalmucki, Piotr; Hofmann, Ilona; Reuter, David; Goldberg, Steven L; Haude, Michael

    2016-01-01

    Objective Functional (or secondary) mitral regurgitation (FMR) is associated with greater morbidity and worse outcomes in patients with congestive heart failure (CHF) and cardiomyopathy. The Carillon® Mitral Contour System® is a coronary sinus-based percutaneous therapy to reduce FMR. We evaluated the safety and efficacy of a modified version of the Carillon device in the treatment of patients with cardiomyopathy and FMR. Methods 36 patients with CHF, depressed left ventricular function (ejection fraction <40%) and at least moderate FMR underwent the Carillon device implant. Results There was 1 major adverse event within 30 days—a death (not device related)—occurring 17 days after the implant. Reductions in FMR and improvements in functional class and 6 min walk tests were seen, similar to prior studies. Device fractures in the high strain region of the proximal anchor (seen in prior studies) were not seen in this study. Conclusions The modified Carillon device was associated with improvements in clinical and echocardiographic parameters in treating patients with FMR, while successfully addressing the issue of anchor fracture. This version of the Carillon device will be used in a blinded randomised trial of symptomatic patients with FMR. PMID:27493761

  18. Anatomy and function relation in the coronary tree: from bifurcations to myocardial flow and mass.

    Science.gov (United States)

    Kassab, Ghassan S; Finet, Gerard

    2015-01-01

    The study of the structure-function relation of coronary bifurcations is necessary not only to understand the design of the vasculature but also to use this understanding to restore structure and hence function. The objective of this review is to provide quantitative relations between bifurcation anatomy or geometry, flow distribution in the bifurcation and degree of perfused myocardial mass in order to establish practical rules to guide optimal treatment of bifurcations including side branches (SB). We use the scaling law between flow and diameter, conservation of mass and the scaling law between myocardial mass and diameter to provide geometric relations between the segment diameters of a bifurcation, flow fraction distribution in the SB, and the percentage of myocardial mass perfused by the SB. We demonstrate that the assessment of the functional significance of an SB for intervention should not only be based on the diameter of the SB but also on the diameter of the mother vessel as well as the diameter of the proximal main artery, as these dictate the flow fraction distribution and perfused myocardial mass, respectively. The geometric and flow rules for a bifurcation are extended to a trifurcation to ensure optimal therapy scaling rules for any branching pattern.

  19. Expression of miR-126 and its potential function in coronary artery ...

    African Journals Online (AJOL)

    Objective: This study aimed to explore the role of miR-126 in coronary artery disease ... pectoris and acute myocardial infarction (AMI) compared with controls (both P<0.01) the miR-126 expression in AMI was ..... in acute coronary syndromes.

  20. Infuences of Previous Angina Pectoris on Coronary Collateral Circulation and Left Ventricular Function in Patients with Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    罗初凡; 杜志民; 胡承恒; 梅卫义; 伍贵富; 李怡; 马虹

    2001-01-01

    Objective To investigate the influences of previous angina pectoris on coronary collateral circulation and left ventricular function in patients with acute myocardial infarction. Methods 307 patients with a first episode acute myocardial infarction underwent selective coronary angiography and left ventriculography. The relation of previous angina pectoris to coronary collateral circulation, peak creatine kinase and left ventricular function were analyzed.Results ① In the 307 patients, there were 192(62.5 % ) with previous angina [PA ( + ) group] and 115 (37.5 % ) without [PA ( - ) group]. ②The peak creatine kinase (CK) and CK- MB were significantly higher in PA (-) group than in PA (+) group ( P < 0.05 for both comparisons) . ③ Collateral circulation to infarct- related artery was more likely to be present in PA (+) group than in PA (-) group ( P < 0.05) . ④ The left ventricular ejection fraction was significantly increased, and the left ventricular wall motion Cortina score decreased, in PA ( + ) group than in PA ( - ) group ( P < 0.01 for both comparisons) .Conclusion In patients with acute myocardial infarction, previous angina pectoris may have beneficial effects on coronary collateral circulation and left ventricular unction.

  1. No difference in acute effects of supplemental v. dietary calcium on blood pressure and microvascular function in obese women challenged with a high-fat meal: a cross-over randomised study.

    Science.gov (United States)

    Ferreira, Thaís da Silva; Leal, Priscila Mansur; Antunes, Vanessa Parada; Sanjuliani, Antonio Felipe; Klein, Márcia Regina Simas Torres

    2016-11-01

    Recent studies suggest that supplemental Ca (SC) increases the risk of cardiovascular events, whereas dietary Ca (DC) decreases the risk of cardiovascular events. Although frequently consumed with meals, it remains unclear whether Ca can mitigate or aggravate the deleterious effects of a high-fat meal on cardiovascular risk factors. This study aimed to evaluate the effects of SC or DC on blood pressure (BP) and microvascular function (MVF) in the postprandial period in obese women challenged with a high-fat meal. In this cross-over controlled trial, sixteen obese women aged 20-50 years were randomly assigned to receive three test meals (2908 kJ (695 kcal); 48 % fat): high DC (HDCM; 547 mg DC), high SC (HSCM; 500 mg SC-calcium carbonate) and low Ca (LCM; 42 mg DC). BP was continuously evaluated from 15 min before to 120 min after meals by digital photoplethysmography. Before and 120 min after meals, participants underwent evaluation of serum Ca and microvascular flow after postocclusive reactive hyperaemia (PORH) by laser speckle contrast imaging. Ionised serum Ca rose significantly only after HSCM. Systolic BP increased after the three meals, whereas diastolic BP increased after LCM and HDCM. Hyperaemia peak, hyperaemia amplitude and AUC evaluated after PORH decreased with LCM. After HDCM, there was a reduction in hyperaemia peak and hyperaemia amplitude, whereas HSCM decreased only hyperaemia peak. However, comparative analyses of the effects of three test meals on serum Ca, BP and MVF revealed no significant meal×time interaction. This study suggests that in obese women SC and DC do not interfere with the effects of a high-fat meal on BP and MVF.

  2. Effects of sevoflurane on cardiopulmonary function in patients undergoing coronary artery bypass.

    Science.gov (United States)

    Zhang, J; Wang, S

    2016-01-01

    The objective of the current study was to investigate effects of sevoflurane on cardiopulmonary function in patients undergoing coronary artery bypass grafting (CABG). In this study, 60 cases of patients with coronary heart disease (CHD) were selected and randomly divided into the sevoflurane group (group S) and the control group C (group C) with 30 cases in each group. The two groups received intravenous anesthesia. The patients of group C were only given oxygen mask and physiological saline to keep vein open; while the patients of group S were administered with 1% sevoflurane immediately after the beginning of cardiopulmonary bypass (CPB) until the end of the treatment. The cardiopulmonary functions at 30 min before operation (T0), postoperative 2 h (T1), 6h (T2), 24h (T3) and 48 (T4) were observed. The mean arterial pressure (MAP) of the group S at T1, T2, T3 was lower than that of the group C, as were the heart rate (HR) and left ventricular ejection fraction (LVEF). The creatine kinase isoenzyme (CK-MB) during T1 to T4 in the group S was less than that of the group C, and there were significant differences between the two groups (P less than 0.05). The tidal volume (Vt), vital capacity (Vc) and oxygenation index (PaO2/FiO2) of the two groups during T1 and T2 were decreased, while respiratory frequency (RR) and alveolar-arterial blood oxygen partial pressure (PA-aO2) were increased and they began to decrease during T3 and T4. Vt and Vc of the group S were higher during T1 and T2 periods than those of the group C, while RR was lower than that of the group C; PaO2 / FiO2 during T1 to T4 period of group S was higher than that of group C, while PA-aO2 was significantly lower than that of the control group (P less than 0.05). In conclusion, although LVEF was not improved in the sevoflurane group, sevoflurane may contribute to stabilizing the cardiopulmonary function and preventing from myocardial injury.

  3. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: A randomized controlled trial protocol

    Directory of Open Access Journals (Sweden)

    Daniel da Costa Torres

    2016-12-01

    Full Text Available Background: Muscle atrophy and prolonged inactivity are associated with an increased sensation of fatigue and reduced functional capacity in the postoperative period in patients undergoing coronary artery bypass grafting. Cardiac rehabilitation after hospital discharge is highly recommended and contributes to improvement in functional capacity and quality of life. However, few studies have evaluated the effectiveness of early mobilization protocols during hospitalization on the patterns of physical activity and functional capacity after coronary artery bypass grafting. Objective: To investigate the effectiveness of an early mobilization program on the functional capacity of patients undergoing coronary artery bypass grafting in the short and long term. Methods: This is a prospective, randomized, controlled, single-blind trial protocol that will evaluate 66 consecutive patients undergoing coronary artery bypass grafting. Patients will be randomized into two training groups: the control group (N = 33, which will perform breathing exercises and the intervention group (N = 33, which will perform breathing exercises and aerobic exercises. The groups will receive treatment from first to the seventh postoperative day, twice daily. In the preoperative period, the following outcomes will be assessed: physical activity level (Baecke Questionnaire, Functional Independence Measure, and functional capacity (6-min walking test. Functional capacity will be reassessed after the 7th and 60th postoperative day. Pulmonary complications and length of hospital stay will also be evaluated. Statistical analysis will be calculated using linear mixed models and will be based on intention-to-treat. The level of significance will be set at α = 5%.

  4. Correlation between senile retinal microvascular disease and acute coronary event in the old:a controlled study of 1 509 cases in communities%老年人眼底微血管病变与急性冠脉事件的相关性研究:基于社区的1743例病例对照分析

    Institute of Scientific and Technical Information of China (English)

    徐扬; 闫中瑞; 孙树印

    2015-01-01

    目的:探讨老年人眼底微血管病变与急性冠脉事件(ACE)的相关性。方法采用基于社区的病例对照方法,选择山东省济宁市兴隆庄煤矿社区1743例年龄≥60岁的居民进行问卷调查、体格检查和实验室检查。选取符合ACE诊断标准的139例患者作为观察组,1509例确定未患ACE作为对照组。采集两组性别、年龄、吸烟、饮酒、高血压、糖尿病、文化程度、体育锻炼、眼底微血管病变、空腹血糖、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、收缩压、舒张压、体质量指数(BMI)进行单因素分析,将有统计学意义的危险因素进行多因素非条件logistic回归分析,筛选出影响ACE发生的独立危险因素。结果单因素分析显示,ACE发生的危险因素包括年龄、性别、吸烟、高血压、糖尿病、LDL-C、收缩压、舒张压、BMI、眼底微血管病变(P<0.05或P<0.01)。在眼底微血管病变中,观察组动静脉交叉征〔44.6%(62/139)比27.8%(419/1509)〕、硬性渗出〔9.4%(13/139)比4.9%(74/1509)〕、棉絮斑〔19.4%(27/139)比7.3%(110/1509)〕发生率明显高于对照组(P<0.05或P<0.01)。Logistic回归分析显示,年龄〔P=0.002,优势比(OR)=1.06,95%可信区间(95%CI)=1.04~1.09〕、吸烟(P=0.032,OR=2.17,95%CI=2.04~2.30)、眼底微血管病变(P=0.010,OR=2.33,95%CI=0.97~1.27)、高血压(P<0.001,OR=5.21,95%CI=4.11~6.36)、糖尿病(P=0.021, OR=1.03,95%CI=1.01~1.05)及LDL-C(P=0.020,OR=2.80,95%CI=2.65~2.99)是发生ACE的独立危险因素。结论眼底微血管病变是发生ACE的独立危险因素,眼底血管照相检查可以作为预测ACE的检查方法。%Objective To study the relationships between retinal microvascular disease and acute coronary event (ACE) among aged

  5. Cardiovascular sex differences influencing microvascular exchange

    Science.gov (United States)

    Huxley, Virginia H.; Wang, Jianjie

    2010-01-01

    The vital role of the cardiovascular (CV) system is maintenance of body functions via the matching of exchange to tissue metabolic demand. Sex-specific differences in the regulatory mechanisms of CV function and the metabolic requirements of men and women, respectively, have been identified and appreciated. This review focuses on sex differences of parameters influencing exchange at the point of union between blood and tissue, the microvasculature. Microvascular architecture, blood pressure (hydrostatic and oncotic), and vascular permeability, therefore, are discussed in the specific context of sex in health and disorders. It is notable that when sex differences exist, they are generally subtle but significant. In the aggregate, though, they can give rise to profoundly different phenotypes. The postulated mechanisms responsible for sex differences are attributed to genomics, epigenetics, and sex hormones. Depending on specific circumstances, the effect of the combined factors can range from insignificant to lethal. Identifying and understanding key signalling mechanisms bridging genomics/sex hormones and microvascular exchange properties within the scope of this review holds significant promise for sex-specific prevention and treatment of vascular barrier dysfunction. PMID:20495187

  6. Microvascular responsiveness in obesity: implications for therapeutic intervention

    OpenAIRE

    Bagi Zsolt (1974-) (orvos); Fehér Attila (Szeged); Cassuto, James

    2012-01-01

    Obesity has detrimental effects on the microcirculation. Functional changes in microvascular responsiveness may increase the risk of developing cardiovascular complications in obese patients. Emerging evidence indicates that selective therapeutic targeting of the microvessels may prevent life-threatening obesity-related vascular complications, such as ischaemic heart disease, heart failure and hypertension. It is also plausible that alterations in adipose tissue microcirculation contribute to...

  7. Comparison of Myocardial Perfusion Scintigraphy and Coronary Angiography Results

    Directory of Open Access Journals (Sweden)

    Umut Elboga

    2017-05-01

    Full Text Available Aim: Coronary artery disease (CAD is one of the most frequent causes of mortality and morbidity worldwide. Coronary angiography is the gold standard for the anatomical diagnosis of coronary artery stenosis. Myocardial Perfusion Scintigraphy (MPS is a non-invasive imaging modality used for the diagnosis of CAD. In this study, we aimed to compare the findings of MPS and coronary angiogram. Material and Method: Eighty-one patients (37 males, 44 females; mean age 55 ± 10.95 years with angina and detected perfusion defects on MPS were included in this study. All of the patients underwent coronary angiogram. A narrowing %u2265 50% was considered pathological on the coronary angiography. Results: Findings of the coronary angiogram and MPS were compared and found consistent in 51 (63% patients. A coronary narrowing < 50% was detected by coronary angiogram in 4 (5% of the remaining patients. Coronary angiogram was found to be normal in the remaining 26 patients (32% and these patients were evaluated as cardiac syndrome X (CSX known as microvascular angina (MA. Discussion: The findings showed that MPS is superior to coronary angiogram in the early diagnosis of myocardial perfusion disorders at the microvascular level. Therefore, we concluded that MPS should be the primary diagnostic tool to begin treatment before an anatomically large narrowing occurs in the coronaries.

  8. Diagnostic probability function for acute coronary heart disease garnered from experts' tacit knowledge.

    Science.gov (United States)

    Steurer, Johann; Held, Ulrike; Miettinen, Olli S

    2013-11-01

    Knowing about a diagnostic probability requires general knowledge about the way in which the probability depends on the diagnostic indicators involved in the specification of the case at issue. Diagnostic probability functions (DPFs) are generally unavailable at present. Our objective was to illustrate how diagnostic experts' case-specific tacit knowledge about diagnostic probabilities could be garnered in the form of DPFs. Focusing on diagnosis of acute coronary heart disease (ACHD), we presented doctors with extensive experience in hospitals' emergency departments a set of hypothetical cases specified in terms of an inclusive set of diagnostic indicators. We translated the medians of these experts' case-specific probabilities into a logistic DPF for ACHD. The principal result was the experts' typical diagnostic probability for ACHD as a joint function of the set of diagnostic indicators. A related result of note was the finding that the experts' probabilities in any given case had a surprising degree of variability. Garnering diagnostic experts' case-specific tacit knowledge about diagnostic probabilities in the form of DPFs is feasible to accomplish. Thus, once the methodology of this type of work has been "perfected," practice-guiding diagnostic expert systems can be developed. Copyright © 2013 Elsevier Inc. All rights reserved.

  9. Relationship between testosterone and indexes indicating endothelial function in male coronary heart disease patients

    Institute of Scientific and Technical Information of China (English)

    Lu Fu; Qian-Ping Gao; Jing-Xia Shen

    2008-01-01

    Aim: To investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease (CHD). Methods: We registered the following data for 106 50-70-year-old men:age, weight, blood lipid, including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cho-lesterol and triglyceride, whether a smoker, sugar levels, blood pressure, free testosterone (FT), vascular cell adhe-sion molecule-1 (VCAM-1) and the intima-media thickness (IMT) of common carotid artery, common carotid diameter,maximum velocity in systolic phase, minimum velocity in diastolic phase and resistent index. Among the 106 men, 51 were patients with CHD. The relationships between FT level, VCAM-1 concentration and IMT were examined,respectively, using a stepwise linear regression technique among all the 106 men. Results: There was no statistical difference in terms of age, blood pressure, whether a smoker, sugar levels, HDL-C, minimum velocity in diastolic phase, resistent index between male CHD patients and controls; whereas results for weight, total cholesterol, low density lipoprotein cholesterol, triglyceride, VCAM-1 and IMT of male CHD patients were higher than those of controls; FT level and maximum velocity in systolic phase were lower. It was found that among all the objects, FT level was inversely correlated with IMT and VCAM-1 concentration. Conclusion: FT level was inversely correlated with VCAM-1 concentration and IMT which are indicators of endothelial function.

  10. Functional analysis LRP6 novel mutations in patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Yujun Xu

    Full Text Available BACKGROUND: Genetic architecture of coronary artery disease (CAD is still to be defined. Since low density lipoprotein receptor-related protein 6 (LRP6 gene play critical roles in Wnt signal transduction which are important for vascular development and endodermis specification, we therefore resequenced it to search for mutations in CAD patients. METHODS: We systemically sequenced all the exons and promoter region of LRP6 gene in a sample of 380 early onset CAD patients and 380 control subjects in Chinese. RESULTS: In total, we identified 5 patient-specific mutations including K82N (two patients, S488Y (one patient, P1066T (two patients, P1206H (two patients and I1264V (one patient All these mutations located at the extracellular domain of LRP6 gene. In vitro functional analysis of patient-specific mutations demonstrated that these mutations resulted in a significant reduction in both protein level transporting to cell membrane and downstream Wnt signal activity. Furthermore, we found that LRP6 novel mutations attenuated proliferation and migration of human umbilical vein endothelial cells (HUVECs when compared with wild type (WT LRP6. CONCLUSION: Our results demonstrated that these loss-of-function variants might contribute to disease liability in a subset of CAD and defects in Wnt signal activation might be important contributing factors for the onset of CAD.

  11. Investigation of gene expression profiles in coronary heart disease and functional analysis of target gene

    Institute of Scientific and Technical Information of China (English)

    YIN HuiJun; MA Xiaoduan; JIANG YueRong; SHI DaZhuo; CHEN KeJi

    2009-01-01

    The research outlined here includes constitution of the differential gene expression profile by means of oligonucleotide gene microarray and functional analysis of the target gene for coronary heart disease (CHD). In a microarray screening experiment, the predominance of inflammation-and immune-related genes is presented in the expression profile of 107 differential genes based on the analysis of gene ontology and gene pathway. IL-8, an inflammatory factor, is identified as one of the genes that were markedly up-regulated in CHD. The plasma level of IL-8 is significantly raised in patients with CHD (n = 30) compared with healthy controls (n = 40), which underscores the clinical relevance of the in vitro finding. The further functional analysis shows that IL-8 affects platelet aggregation percentage, ex-pression of CD62p and platelet aggregation morphology in 12 healthy volunteers to some extent. These findings suggest the relevance of inflammation and immune responses to CHD at the DNA level. Moreover, IL-8 may be involved in the pathogenesis of CHD through the pathway of platelet activation.

  12. Clinical implications of microvascular obstruction and intramyocardial haemorrhage in acute myocardial infarction using cardiovascular magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Bekkers, Sebastiaan C.A.M.; Smulders, Martijn W.; Waltenberger, Johannes; Gorgels, Anton P.M.; Schalla, Simon [Maastricht University Medical Center, Department of Cardiology, Maastricht (Netherlands); Passos, Valeria Lima [Maastricht University Medical Center, Department of Methodology and Statistics, Maastricht (Netherlands); Leiner, Tim [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands)

    2010-11-15

    To investigate the clinical implications of microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH) in acute myocardial infarction (AMI). Ninety patients with a first AMI undergoing primary percutaneous coronary intervention (PCI) were studied. T2-weighted, cine and late gadolinium-enhanced cardiovascular magnetic resonance imaging was performed at 5 {+-} 2 and 103 {+-} 11 days. Patients were categorised into three groups based on the presence or absence of MVO and IMH. MVO was observed in 54% and IMH in 43% of patients, and correlated significantly (r = 0.8, p < 0.001). Pre-PCI thrombolysis in myocardial infarction 3 flow was only observed in MVO(-)/IMH(-) patients. Infarct size and impairment of systolic function were largest in MVO(+)/IMH(+) patients (n = 39, 23 {+-} 9% and 47 {+-} 7%), smallest in MVO(-)/IMH(-) patients (n = 41, 8 {+-} 8% and 55 {+-} 8%) and intermediate in MVO(+)/IMH(-) patients (n = 10, 16 {+-} 7% and 51 {+-} 6%, p < 0.001). LVEF increased in all three subgroups at follow-up, but remained intermediate in MVO(+)/IMH(-) and was lowest in MVO(+)/IMH(+) patients. Using random intercept model analysis, only infarct size was an independent predictor for adverse LV remodelling. Intramyocardial haemorrhage and microvascular obstruction are strongly related. Pre-PCI TIMI 3 flow is less frequently observed in patients with MVO and IMH. Only infarct size was an independent predictor of LV remodelling. (orig.)

  13. The effect of heart rate reduction by ivabradine on collateral function in patients with chronic stable coronary artery disease.

    Science.gov (United States)

    Gloekler, Steffen; Traupe, Tobias; Stoller, Michael; Schild, Deborah; Steck, Hélène; Khattab, Ahmed; Vogel, Rolf; Seiler, Christian

    2014-01-01

    To evaluate the effect of heart rate reduction by ivabradine on coronary collateral function in patients with chronic stable coronary artery disease (CAD). This was a prospective randomised placebo-controlled monocentre trial in a university hospital setting. 46 patients with chronic stable CAD received placebo (n=23) or ivabradine (n=23) for the duration of 6 months. The main outcome measure was collateral flow index (CFI) as obtained during a 1 min coronary artery balloon occlusion at study inclusion (baseline) and at the 6-month follow-up examination. CFI is the ratio between simultaneously recorded mean coronary occlusive pressure divided by mean aortic pressure both subtracted by mean central venous pressure. During follow-up, heart rate changed by +0.2±7.8 beats/min in the placebo group, and by -8.1±11.6 beats/min in the ivabradine group (p=0.0089). In the placebo group, CFI decreased from 0.140±0.097 at baseline to 0.109±0.067 at follow-up (p=0.12); it increased from 0.107±0.077 at baseline to 0.152±0.090 at follow-up in the ivabradine group (p=0.0461). The difference in CFI between the 6-month follow-up and baseline examination amounted to -0.031±0.090 in the placebo group and to +0.040±0.094 in the ivabradine group (p=0.0113). Heart rate reduction by ivabradine appears to have a positive effect on coronary collateral function in patients with chronic stable CAD. NCT01039389.

  14. Platelet function monitoring guided antiplatelet therapy in patients receiving high-risk coronary interventions

    Institute of Scientific and Technical Information of China (English)

    Xu Li; Wang Lefeng; Yang Xinchun; Li Kuibao; Sun Hao; Zhang Dapeng; Wang Hongshi

    2014-01-01

    Background Large-scale clinical trials have shown that routine monitoring of the platelet function in patients after percutanous coronary intervention (PCI) is not necessary.However,it is still unclear whether patients received high-risk PCI would benefit from a therapy which is guided by a selective platelet function monitoring.This explanatory study sought to assess the benefit of a therapy guided by platelet function monitoring for these patients.Methods Acute coronary syndrome (ACS) patients (n=384) who received high-risk,complex PCI were randomized into two groups.PCI in the two types of lesions described below was defined as high-risk,complex PCI:lesions that could result in severe clinical outcomes if stent thrombosis occurred or lesions at high risk for stent thrombosis.The patients in the conventionally treated group received standard dual antiplatelet therapy.The patients in the platelet function monitoring guided group received an antiplated therapy guided by a modified thromboelastography (TEG) platelet mapping:If inhibition of platelet aggregation (IPA) induced by arachidonic acid (AA) was less than 50% the aspirin dosage was raised to 200 mg/d; if IPA induced by adenosine diphosphate (ADP) was less than 30% the clopidogrel dosage was raised to 150 mg/d,for three months.The primary efficacy endpoint was a composite of myocardial infarction,emergency target vessel revascularization (eTVR),stent thrombosis,and death in six months.Results This study included 384 patients; 191 and 193 in the conventionally treated group and platelet function monitoring guided group,respectively.No significant differences were observed in the baseline clinical characteristics and interventional data between the two groups.In the platelet function monitoring guided group,the mean IPA induced by AA and ADP were (69.2±24.5)% (range,4.8% to 100.0%) and (51.4±29.8)% (range,0.2% to 100.0%),respectively.The AAinduced IPA of forty-three (22.2%) patients was less

  15. Effect of anxiety and depression on endothelial function and inflammation degree of coronary heart disease patients with angina pectoris

    Institute of Scientific and Technical Information of China (English)

    Lin Ni; Xiang-Yang Xia; Ka Han; Yong-Xin Wu

    2016-01-01

    Objective:To study the effect of anxiety and depression on endothelial function and inflammation degree of coronary heart disease patients with angina pectoris.Methods: 80 cases of patients diagnosed with angina pectoris of coronary heart disease in our hospital from May 2012 to August 2014 were enrolled for study; anxiety and depression were judged by anxiety subscale (HADS-a) and depression subscale (HADS-d). Endothelial progenitor cell and endothelial microparticle contents in peripheral blood as well as serum ET-1, CGRP, IL-6, IL-6R, IL-18, ADAMTS-1 and NO contents were detected.Results:EPC, NO and CGRP contents of angina pectoris patients with anxiety were lower than those of angina pectoris patients without anxiety, and EMP, ET-1, IL-6, IL-6R, IL-18 and ADAMTS-1 contents were higher than those of angina pectoris patients without anxiety; EPC, NO and CGRP contents of angina pectoris patients with depression were lower than those of angina pectoris patients without depression, and EMP, ET-1, IL-6, IL-6R, IL-18 and ADAMTS-1 contents were higher than those of angina pectoris patients without depression.Conclusions:Angina pectoris of coronary heart disease patients complicated with anxiety and depression have endothelial dysfunction and inflammatory reaction activation; endothelial dysfunction and inflammatory reaction activation are possible pathways that anxiety and depression cause the progression of coronary heart disease.

  16. Multiple and Contemporary Coronary Thrombosis inspite of Low Platelet Function Response.

    Science.gov (United States)

    Stio, Rocco Edoardo; Calcagno, Simone; Lucisano, Luigi; Pennacchi, Mauro; Sardella, Gennaro

    2014-08-01

    We are reporting a clinical case of a 78-year-old male who had oppressive chest pain at rest, which regressed with the intake of sublingual nitrates. Coronary angiography showed a chronic total occlusion (CTO) of the left anterior descending (LAD) artery, a normal circumflex, a hypoplasic right coronary artery and a Cardiac Magnetic Resonance showing vital tissue in anterior wall. During the procedure of CTO-PCI on LAD, patient developed multiple and contemporary coronary thrombosis in spite of low platelet reactivity, which was assessed by using Multiplate. A manual thrombectomy was performed with a good final result only after drug eluting stents (DES) implantation.

  17. Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure

    DEFF Research Database (Denmark)

    Snoer, Martin; Monk-Hansen, Tea; Olsen, Rasmus Huan

    2012-01-01

    AIMS: In heart failure, a reduced exercise capacity is the prevailing symptom and an important prognostic marker of future outcome. The purpose of the study was to assess the relation of coronary flow reserve (CFR) to diastolic and systolic function in heart failure and to determine which...... are the limiting factors for exercise capacity. METHODS AND RESULTS: Forty-seven patients with left ventricular ejection fraction (LVEF)...

  18. Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

    National Research Council Canada - National Science Library

    Guizilini, Solange; Viceconte, Marcela; Esperança, Gabriel Tavares da M; Bolzan, Douglas W; Vidotto, Milena; Moreira, Rita Simone L; Câncio, Andréia Azevedo; Gomes, Walter J

    2014-01-01

    Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery...

  19. Microvascular endothelial cells of the corpus luteum

    Directory of Open Access Journals (Sweden)

    Spanel-Borowski Katherina

    2003-11-01

    Full Text Available Abstract The cyclic nature of the capillary bed in the corpus luteum offers a unique experimental model to examine the life cycle of endothelial cells, involving discrete physiologically regulated steps of angiogenesis, blood vessel maturation and blood vessel regression. The granulosa cells and theca cells of the developing antral follicle and the steroidogenic cells of the corpus luteum produce and respond to angiogenic factors and vasoactive peptides. Following ovulation the neovascularization during the early stages of corpus luteum development has been compared to the rapid angiogenesis observed during tumor formation. On the other end of the spectrum, the microvascular endothelial cells are the first cells to undergo apoptosis at the onset of corpus luteum regression. Important insights on the morphology and function of luteal endothelial cells have been gained from a combination of in vitro and in vivo studies on endothelial cells. Endothelial cells communicate with cells comprising the functional unit of the corpus luteum, i.e., other vascular cells, steroidogenic cells, and immune cells. This review is designed to provide an overview of the types of endothelial cells present in the corpus luteum and their involvement in corpus luteum development and regression. Available evidence indicates that microvascular endothelial cells of the corpus luteum are not alike, and may differ during the process of angiogenesis and angioregression. The contributions of vasoactive peptides generated by the luteal endothelin-1 and the renin-angiotensin systems are discussed in context with the function of endothelial cells during corpus luteum formation and regression. The ability of two cytokines, tumor necrosis factor alpha and interferon gamma, are evaluated as paracrine mediators of endothelial cell function during angioregression. Finally, chemokines are discussed as a vital endothelial cell secretory products that contribute to the recruitment of

  20. Expression and function of calcium-activated potassium channels following in-stent restenosis in a porcine coronary artery model

    Directory of Open Access Journals (Sweden)

    Mais F. Absi

    2012-04-01

    Functional analysis using 1-EBIO and Bradykinin produced hyperpolarization of neointimal but not medial myocytes, which indicated the expression of functional endothelial SK3 and IKCa in the former and not in the latter. The expression of IKCa and SK3 within the neointimal layer suggested that some degree of recovery of both endothelial as well as smooth muscle regeneration had occurred. Future development of selective modulators of IKCa and SK3 channels may decrease the progression of ISR and improve coronary vascular function after stent placement, and is an area for future investigation.

  1. Coronary Flow Velocity Reserve in Burn Injury: A Prospective Clinical Cohort Study.

    Science.gov (United States)

    Caliskan, Mustafa; Turk, Emin; Karagulle, Erdal; Ciftci, Ozgur; Oguz, Hakan; Kostek, Osman; Moray, Gokhan; Haberal, Mehmet

    2016-01-01

    The authors sought to evaluate coronary microvascular function and left ventricular diastolic dysfunction using transthoracic Doppler echocardiography in burn patients. In this study, 32 adult burn patients with partial or full-thickness scald burns that were hospitalized and treated were included. The control group was matched for age and sex and was composed of otherwise healthy volunteers. Transthoracic Doppler echocardiography examinations and simultaneous laboratory tests for cardiac evaluation were performed on the sixth month after burn injury as well as with the control group. High-sensitivity C-reactive protein levels were significantly higher in the burn patients than in controls (5.17 ± 3.86 vs 2.42 ± 1.78; P = .001). Lateral isovolumic relaxation time was significantly higher in the burn injury group than in the control group (92.7 ± 15.7 vs 85.5 ± 8.3; P = .03). Baseline coronary diastolic peak flow velocity of the left anterior descending artery was similar in both groups. However, hyperemic diastolic peak flow velocity and coronary flow velocity reserve (2.26 ± 0.48 vs 2.94 ± 0.47; P < .001) were significantly lower in the burn injury group than in the control group. Coronary flow velocity reserve was significantly and inversely correlated with high-sensitivity C-reactive protein, burn ratio, creatinine, and mitral A-wave max velocity. At the sixth month of treatment, burn patients had high-sensitivity C-reactive protein levels during this period, suggesting that inflammation still exists. In addition, subclinical coronary microvascular and left ventricular diastolic dysfunction can occur in burn patients without traditional cardiovascular risk factors. However, these results must be supported by additional studies.

  2. Translational informatics approach for identifying the functional molecular communicators linking coronary artery disease, infection and inflammation.

    Science.gov (United States)

    Sharma, Ankit; Ghatge, Madankumar; Mundkur, Lakshmi; Vangala, Rajani Kanth

    2016-05-01

    Translational informatics approaches are required for the integration of diverse and accumulating data to enable the administration of effective translational medicine specifically in complex diseases such as coronary artery disease (CAD). In the current study, a novel approach for elucidating the association between infection, inflammation and CAD was used. Genes for CAD were collected from the CAD‑gene database and those for infection and inflammation were collected from the UniProt database. The cytomegalovirus (CMV)‑induced genes were identified from the literature and the CAD‑associated clinical phenotypes were obtained from the Unified Medical Language System. A total of 55 gene ontologies (GO) termed functional communicator ontologies were identified in the gene sets linking clinical phenotypes in the diseasome network. The network topology analysis suggested that important functions including viral entry, cell adhesion, apoptosis, inflammatory and immune responses networked with clinical phenotypes. Microarray data was extracted from the Gene Expression Omnibus (dataset: GSE48060) for highly networked disease myocardial infarction. Further analysis of differentially expressed genes and their GO terms suggested that CMV infection may trigger a xenobiotic response, oxidative stress, inflammation and immune modulation. Notably, the current study identified γ‑glutamyl transferase (GGT)‑5 as a potential biomarker with an odds ratio of 1.947, which increased to 2.561 following the addition of CMV and CMV‑neutralizing antibody (CMV‑NA) titers. The C‑statistics increased from 0.530 for conventional risk factors (CRFs) to 0.711 for GGT in combination with the above mentioned infections and CRFs. Therefore, the translational informatics approach used in the current study identified a potential molecular mechanism for CMV infection in CAD, and a potential biomarker for risk prediction.

  3. Functional Analysis of the Coronary Heart Disease Risk Locus on Chromosome 21q22

    Directory of Open Access Journals (Sweden)

    Katherine E. Beaney

    2017-01-01

    Full Text Available Background. The coronary heart disease (CHD risk locus on 21q22 (lead SNP rs9982601 lies within a “gene desert.” The aim of this study was to assess if this locus is associated with CHD risk factors and to identify the functional variant(s and gene(s involved. Methods. A phenome scan was performed with UCLEB Consortium data. Allele-specific protein binding was studied using electrophoretic mobility shift assays. Dual-reporter luciferase assays were used to assess the impact of genetic variation on expression. Expression quantitative trait analysis was performed with Advanced Study of Aortic Pathology (ASAP and Genotype-Tissue Expression (GTEx consortium data. Results. A suggestive association between QT interval and the locus was observed (rs9982601  p=0.04. One variant at the locus, rs28451064, showed allele-specific protein binding and its minor allele showed 12% higher luciferase expression (p = 4.82 × 10−3 compared to the common allele. The minor allele of rs9982601 was associated with higher expression of the closest upstream genes (SLC5A3 1.30-fold increase p = 3.98 × 10−5; MRPS6 1.15-fold increase p = 9.60 × 10−4 in aortic intima media in ASAP. Both rs9982601 and rs28451064 showed a suggestive association with MRPS6 expression in relevant tissues in the GTEx data. Conclusions. A candidate functional variant, rs28451064, was identified. Future work should focus on identifying the pathway(s involved.

  4. Microvascular Autonomic Composites

    Science.gov (United States)

    2012-01-06

    phenanthrene (Figure 3b) showed a dramatic decrease by functionalization with electron withdrawing groups and "heavy atoms" ( Skoog et al. 1998...fluorescence. Experiments in Fluids 26: 7-15. Skoog DA, Holler FJ, Nieman TA. 1998. Principles of Instrumental Analysis, Philadelphia: Saunders

  5. Relative microvascular pressure sensing

    Science.gov (United States)

    Choi, Min; Zemp, Roger

    2016-03-01

    Microcirculation may be characterized by the vascular pressure as it is influenced by pressure-driven perfusion. Crosssections of blood vessels can be visualized by photoacoustic imaging and compressing on vessels causes deformation. The photoacoustic signals of blood, when compressed to the point of vessel collapse, may or may not vanish depending on the buckling process it undergoes. We form relative pressure images of microvessels by tracking vessel collapse as a function of externally applied pressure using photoacoustic imaging.

  6. Value of evaluating diastolic function with the single-beat E/(e’ × s) obtained by dual doppler echocardiograph in coronary heart disease patients with preserved left ventricular systolic function

    Institute of Scientific and Technical Information of China (English)

    汪晶晶

    2014-01-01

    Objective To assess the value of E/(e’×s)in estimating left ventricular diastolic dysfunction in patients with coronary heart disease by dual Doppler echocardiograph.Methods Seventy-seven consecutive coronary heart disease patients with preserved systolic function underwent echocardiographic study were included.The E,e’and s were obtained by the dual Doppler echocardio-

  7. Serum concentration of eicosapentaenoic acid is associated with cognitive function in patients with coronary artery disease.

    Science.gov (United States)

    Yagi, Shusuke; Hara, Tomoya; Ueno, Rie; Aihara, Ken-ichi; Fukuda, Daiju; Takashima, Akira; Hotchi, Junko; Ise, Takayuki; Yamaguchi, Koji; Tobiume, Takeshi; Iwase, Takashi; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Shimabukuro, Michio; Akaike, Masashi; Sata, Masataka

    2014-12-04

    Recent studies have shown that intake of n-3 polyunsaturated fatty acids (PUFAs) is associated with reduced risk of cognitive impairment and coronary artery disease (CAD); however, it is currently unknown whether reduced serum n-3 PUFA is associated with cognitive impairment in patients with CAD. We retrospectively evaluated cognitive function with the mini-mental state examination (MMSE), serum levels of PUFAs (including eicosapentaenoic acid [EPA], docosahexaenoic acid [DHA], dihomogammalinolenic acid [DGLA], and arachidonic acid [AA]), cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, cerebrovascular disease, and history of current/previous smoking), and parameters of cardiac function (left ventricular ejection fraction and brain natriuretic peptide levels) in 146 Japanese CAD patients. The associations between the MMSE scores and the other parameters were evaluated. Pearson correlation analysis showed that EPA (R = 0.25, P <0.01), EPA/AA ratio (R = 0.22, P = 0.01), and left ventricular ejection fraction (R = 0.15, P = 0.04) were positively associated with MMSE score, and that age (R = -0.20, P <0.01) and brain natriuretic peptide levels (R = -0.28, P <0.01) were inversely associated with MMSE score. Multiple regression analysis showed that age (P <0.05) was negatively associated with MMSE score, while EPA (P <0.01) and EPA/AA ratio (P <0.05) were positively associated with MMSE score; however, sex; body mass index; left ventricular ejection fraction; levels of DHA, AA, and DGLA; DHA/AA ratio; brain natriuretic peptide; and presence of hypertension, dyslipidemia, diabetes mellitus, cerebrovascular disease, and history of current/previous smoking were statistically excluded. Serum EPA concentration is associated with cognitive function in patients with CAD, suggesting that a low serum EPA level is a risk factor for cognitive impairment independent of cardiac function, including left ventricular ejection fraction. This correlation

  8. One-vessel coronary artery disease. Anatomic, functional, and prognostic considerations.

    Science.gov (United States)

    DePace, N L; Iskandrian, A S; Hakki, A H; Kimbiris, D

    1984-06-01

    Patients with one-vessel coronary artery disease (CAD) constitute a heterogenous group with regard to anatomy, pathophysiology, and prognosis. Noninvasive examination of these patients shows variation in the presence and magnitude of ST-segment depression, the presence and extent of exercise-induced thallium 201-perfusion defect, and the presence and extent of regional and global left ventricular dysfunction assessed by radionuclide angiocardiography. Further studies, however, are needed to determine whether the physiologic consequences assessed noninvasively compound the effects of coronary anatomy as defined by angiocardiography on the prognosis or whether they are independent of these effects. Percutaneous transluminal coronary angioplasty should be considered in patients with one-vessel CAD who are symptomatic or in those who have a large amount of jeopardized myocardium.

  9. Self-healing materials with microvascular networks.

    Science.gov (United States)

    Toohey, Kathleen S; Sottos, Nancy R; Lewis, Jennifer A; Moore, Jeffrey S; White, Scott R

    2007-08-01

    Self-healing polymers composed of microencapsulated healing agents exhibit remarkable mechanical performance and regenerative ability, but are limited to autonomic repair of a single damage event in a given location. Self-healing is triggered by crack-induced rupture of the embedded capsules; thus, once a localized region is depleted of healing agent, further repair is precluded. Re-mendable polymers can achieve multiple healing cycles, but require external intervention in the form of heat treatment and applied pressure. Here, we report a self-healing system capable of autonomously repairing repeated damage events. Our bio-inspired coating-substrate design delivers healing agent to cracks in a polymer coating via a three-dimensional microvascular network embedded in the substrate. Crack damage in the epoxy coating is healed repeatedly. This approach opens new avenues for continuous delivery of healing agents for self-repair as well as other active species for additional functionality.

  10. Comprehensive cardiac assessment with multislice computed tomography: evaluation of left ventricular function and perfusion in addition to coronary anatomy in patients with previous myocardial infarction

    Science.gov (United States)

    Henneman, M M; Schuijf, J D; Jukema, J W; Lamb, H J; de Roos, A; Dibbets, P; Stokkel, M P; van der Wall, E E; Bax, J J

    2006-01-01

    Objective To evaluate a comprehensive multislice computed tomography (MSCT) protocol in patients with previous infarction, including assessment of coronary artery stenoses, left ventricular (LV) function and perfusion. Patients and methods 16‐slice MSCT was performed in 21 patients with previous infarction; from the MSCT data, coronary artery stenoses, (regional and global) LV function and perfusion were assessed. Invasive coronary angiography and gated single‐photon emission computed tomography (SPECT) served as the reference standards for coronary artery stenoses and LV function/perfusion, respectively. Results 236 of 241 (98%) coronary artery segments were interpretable on MSCT. The sensitivity and specificity for detection of stenoses were 91% and 97%. Pearson's correlation showed excellent agreement for assessment of LV ejection fraction between MSCT and SPECT (49 (13)% v 53 (12)%, respectively, r  =  0.85). Agreement for assessment of regional wall motion was excellent (92%, κ  =  0.77). In 68 of 73 (93%) segments, MSCT correctly identified a perfusion defect as compared with SPECT, whereas the absence of perfusion defects was correctly detected in 277 of 284 (98%) segments. Conclusions MSCT permits accurate, non‐invasive assessment of coronary artery stenoses, LV function and perfusion in patients with previous infarction. All parameters can be assessed from a single dataset. PMID:16740917

  11. The non-invasive documentation of coronary microcirculation impairment: role of transthoracic echocardiography

    Directory of Open Access Journals (Sweden)

    Galderisi Maurizio

    2005-08-01

    Full Text Available Abstract Transthoracic Doppler echocardiographic-derived coronary flow reserve is an useful hemodynamic index to assess dysfunction of coronary microcirculation. Isolated coronary microvascular abnormalities are overt by reduced coronary flow reserve despite normal epicardial coronary arteries. These abnormalities may occur in several diseases (arterial hypertension, diabetes mellitus, hypercholesterolemia, syndrome X, aortic valve disease, hypertrophic cardiomyopathy and idiopathic dilated cardiomyopathy. The prognostic role of impaired microvascular coronary flow reserve has been shown unfavourable especially in hypertrophic or idiopathic dilated cardiomyopathies. Coronary flow reserve reduction may be reversible, for instance after regression of left ventricular hypertrophy subsequent to valve replacement in patients with aortic stenosis, after anti-hypertensive treatment or using cholesterol lowering drugs. Coronary flow reserve may increase by 30% or more after pharmacological therapy and achieve normal level >3.0. In contrast to other non invasive tools as positron emission tomography, very expensive and associated with radiation exposure, transthoracic Doppler-derived coronary flow reserve is equally non invasive but cheaper, very accessible and prone to a reliable exploration of coronary microvascular territories, otherwise not detectable by invasive coronary angiography, able to visualize only large epicardial arteries.

  12. New animal model for the study of postmenopausal coronary and cerebral artery function: the Watanabe heritable hyperlipidemic rabbit fed on a diet avoiding phytoestrogens

    DEFF Research Database (Denmark)

    Dalsgaard, T; Larsen, C R; Mortensen, A

    2002-01-01

    to treatment for 16 weeks with either 17 beta-estradiol or placebo. The chow used was semi-synthetic, thereby avoiding the influence of phytoestrogens. Ring segments of cerebral and coronary arteries were mounted for isometric tension recordings in myographs. The passive and active length-tension relationships...... in the proximal coronary arteries. No changes were observed for the passive length-tension relationships. CONCLUSIONS: Long-term treatment with 17 beta-estradiol lowered the electromechanical tonus of atherosclerotic coronary arteries proximally, where the atherosclerosis is most developed. This could be one......OBJECTIVE: To evaluate the effect of estrogen replacement therapy (ERT) on the functional characteristics of coronary and cerebral arteries in a new rabbit model for postmenopausal vascular function. METHODS: Female ovariectomized Watanabe heritable hyperlipidemic (WHHL) rabbits were randomized...

  13. [Hemodynamic effects of intracardiac diatritoic acid and their dependance on left ventricular function and severity of coronary sclerosis (author's transl)].

    Science.gov (United States)

    Kober, G; Schröder, W; Kaltenbach, M

    1978-07-01

    In 16 patients with coronary heart disease (n = 13) and cardiomyopathy (n = 3) heart rate, left ventricular pressure and contractility (max dp/dt, min dp/dt and Vpm) were measured prior during and after three consecutive left ventricular angiograms. Heart rate decreased during angiography and increased slightly but significantly after angiography. Systolic and diastolic left ventricular pressure, max dp/dt and min dp/dt increased after angiography, whereas Vpm remained unchanged. Any hemodynamic changes occuring were moderate and only of short duration. No significant differences were found a) between patients with angiographically proven normal and reduced left ventricular function, b) between patients with normal or increased left ventricular filling pressure or c) between those with slight or severe coronary heart disease. The investigations point to a good tolerance for the sodium methyl glucamine salt of diatrizoic acid (Urografin 76) even in patients with progressed coronary heart disease. Severe side-effects described in animal experiments indicate a poor comparibility between animal models and human studies. Moreover animal experiments are mostly done with high doses not used clinically.

  14. Microvascular pressure distribution in the hamster testis.

    Science.gov (United States)

    Sweeney, T E; Rozum, J S; Desjardins, C; Gore, R W

    1991-05-01

    Convective transport is a critical element in the regulation of steroidogenesis and spermatogenesis in the testis. Steroid hormones are distributed to their target cells within seminiferous tubules via interstitial fluid. The movement of interstitial fluid and lymph, which transports protein hormones and many of the substrates required for spermatogenesis and steroidogenesis, is driven by capillary filtration. Despite the importance of convective transport in testicular function, however, the mechanisms regulating transvascular exchange in the testis are unknown. As a first step in understanding this process, we measured directly the microvascular hydrostatic pressure distribution in the hamster testis (pentobarbital sodium, 70 mg/kg ip). Using a servo-null transducer, intravascular pressure was measured in all vessel types accessible beneath the surface of the testis of 19 animals. Systemic arterial pressure averaged 89 +/- 2 (SE) mmHg. The most significant observations were that mean capillary pressure was extremely low (10.1 +/- 0.8 mmHg) and remarkably constant (range 8.2-13.3 mmHg), despite a 45 mmHg range in systemic mean arterial pressure among the animals observed. The maintenance of a low hydrostatic pressure in testicular capillaries may serve to sustain fluid filtration at a rate that prevents washout of essential solutes while preserving convective transport. Unfortunately, the anatomical and functional characteristics that determine this unique microvascular environment may also expose the testis to significant pathological risks. For example, the large pre- to postcapillary resistance ratio observed suggests that testicular capillaries must be highly susceptible to increases in venous pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Blood-based biomarkers of microvascular pathology in Alzheimer's disease.

    LENUS (Irish Health Repository)

    Ewers, Michael

    2012-02-01

    Sporadic Alzheimer\\'s disease (AD) is a genetically complex and chronically progressive neurodegenerative disorder with molecular mechanisms and neuropathologies centering around the amyloidogenic pathway, hyperphosphorylation and aggregation of tau protein, and neurofibrillary degeneration. While cerebrovascular changes have not been traditionally considered to be a central part of AD pathology, a growing body of evidence demonstrates that they may, in fact, be a characteristic feature of the AD brain as well. In particular, microvascular abnormalities within the brain have been associated with pathological AD hallmarks and may precede neurodegeneration. In vivo assessment of microvascular pathology provides a promising approach to develop useful biological markers for early detection and pathological characterization of AD. This review focuses on established blood-based biological marker candidates of microvascular pathology in AD. These candidates include plasma concentration of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) that are increased in AD. Measures of endothelial vasodilatory function including endothelin (ET-1), adrenomedullin (ADM), and atrial natriuretic peptide (ANP), as well as sphingolipids are significantly altered in mild AD or during the predementia stage of mild cognitive impairment (MCI), suggesting sensitivity of these biomarkers for early detection and diagnosis. In conclusion, the emerging clinical diagnostic evidence for the value of blood-based microvascular biomarkers in AD is promising, however, still requires validation in phase II and III diagnostic trials. Moreover, it is still unclear whether the described protein dysbalances are early or downstream pathological events and how the detected systemic microvascular alterations relate to cerebrovascular and neuronal pathologies in the AD brain.

  16. Functional characterisation of polymorphisms in candidate genes for coronary heart disease

    OpenAIRE

    van't Hooft, Ferdinand M.

    1999-01-01

    Coronary heart disease (CHD) is a multifactorial disorder. Several important risk factors, in particular cigarette smoking, hypertension, hypercholesterolaemia, reduced high density lipoprotein (HDL) cholesterol concentration and hyperglycaemia, have been defined. It appears that most risk factors are influenced by genetic components, suggesting that genetic variants in candidate genes play an important role in the development of CHD. In view of the importance of transcripti...

  17. Mild Functional Ischemic Mitral Regurgitation Following Acute Coronary Syndrome: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Sadip Pant

    2011-01-01

    Conclusion: Ischemic mitral regurgitation following acute coronary syndromeare more likely in elderly diabetics and hypertensive smokers. It is a more common finding in STEMI. Although mild MR following ACS does reduce ejection fraction, the immediate (within 10 days in-hospital mortality and cardiovascular outcomes are not significantly altered.

  18. Relationship Between Serum Zinc Level and Microvascular Complications in Patients with Type 2 Diabetes

    Institute of Scientific and Technical Information of China (English)

    Ying-Ying Luo; Jie Zhao; Xue-Yao Han; Xiang-Hai Zhou; Jing Wu; Li-Nong Ji

    2015-01-01

    Background: Previous studies suggested that zinc level was related to a certain diabetic microvascular complication.However, the relationship between zinc level and all the microvascular complications in type 2 diabetic patients remains unknown.The purpose of this study was to analyze the relationship between zinc level and each diabetic microvascular complication and identify the features related to low serum zinc level.Methods: We included the hospitalized patients with type 2 diabetes (T2D) at our department from May 30, 2013 to March 31, 2014.We initially compared the serum zinc levels between patients with specific microvascular complications and those without.We then analyzed the association between zinc level and each microvascular complication.Furthermore, we identified the unique features of patients with high and low serum zinc levels and analyzed the risk factors related to low zinc level.Results: The 412 patients included 271 with microvascular complications and 141 without any microvascular complications.Serum zinc level was significantly lower in patients with diabetic retinopathy (P < 0.001), diabetic nephropathy (DN, P < 0.001), or diabetic peripheral neuropathy (P =0.002) compared with patients without that specific complication.Lower zinc level was an independent risk factor for DN (odds ratio =0.869, 95% confidence interval =0.765-0.987, P < 0.05).The subjects with lower serum zinc level had manifested a longer duration of diabetes, higher level of hemoglobin A 1 c, higher prevalence of hypertension and microvascular complications, and lower fasting and 2-h C-peptide levels.Conclusions: Lower serum zinc level in T2D patients was related to higher prevalence of diabetic microvascular complications, and represented as an independent risk factor for DN.Patients with lower zinc level were more likely to have a longer duration of diabetes, poorer glucose control, and worse β-cell function.

  19. Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery.

    Science.gov (United States)

    Cavalcante, Elder Dos Santos; Magario, Rosmeiri; Conforti, César Augusto; Cipriano Júnior, Gerson; Arena, Ross; Carvalho, Antonio Carlos C; Buffolo, Enio; Luna Filho, Bráulio

    2014-11-01

    Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.Fundamento: A cirurgia de revascularização miocárdica (CRM) é a opção cirúrgica padrão para pacientes com placas arteriais difusas e significativas. Tal procedimento, no entanto, não é desprovido de complicações pós-operatórias, especialmente distúrbios pulmonares e cognitivos. Objetivo: Comparar o impacto de duas abordagens fisioterap

  20. Angina pectoris in women: focus on microvascular disease.

    Science.gov (United States)

    Zuchi, Cinzia; Tritto, Isabella; Ambrosio, Giuseppe

    2013-02-20

    Ischemic heart disease (IHD) is the leading cause of death among women in Western countries, and it is associated with higher morbidity and mortality than in men. Nevertheless, IHD in women remains underdiagnosed and undertreated, and the misperception that females are "protected" against cardiovascular disease leads to underestimation of their cardiovascular risk; instead, women with chest pain have a high risk of cardiovascular events. Women suffering from angina pectoris tend to have different characteristics compared to men, with a high prevalence of non-significant coronary artery disease. Angina in women is more commonly microvascular in origin than in men, and therefore standard diagnostic algorithms may be suboptimal for women. This different pathophysiology impacts clinical management of IHD in women. While response to medical therapy may differ in women, they are scarcely represented in clinical trials. Therefore, solid data in terms of gender efficacy of antianginal drugs are lacking, and particularly when angina is microvascular in origin women often continue to be symptomatic despite maximal therapy with classical antianginal drugs. Recently, new molecules have shown promising results in women. In conclusion, women with angina are a group of patients in whom it seems appropriate to concentrate efforts aimed at reducing morbidity and improving quality of life.

  1. Mandibular reconstruction with composite microvascular tissue transfer

    Energy Technology Data Exchange (ETDEWEB)

    Coleman, J.J. III; Wooden, W.A. (Emory Univ. School of Medicine, Atlanta, GA (USA))

    1990-10-01

    Microvascular free tissue transfer has provided a variety of methods of restoring vascularized bone and soft tissue to difficult defects created by tumor resection and trauma. Over 7 years, 26 patients have undergone 28 free flaps for mandibular reconstruction, 15 for primary squamous cell carcinoma of the floor of the mouth or tongue, 7 for recurrent tumor, and 6 for other reasons (lymphangioma (1), infection (1), gunshot wound (1), and osteoradionecrosis (3)). Primary reconstruction was performed in 19 cases and secondary in 9. All repairs were composite flaps including 12 scapula, 5 radial forearm, 3 fibula, 2 serratus, and 6 deep circumflex iliac artery. Mandibular defects included the symphysis alone (7), symphysis and body (5), symphysis-body-ramus condyle (2), body or ramus (13), and bilateral body (1). Fourteen patients had received prior radiotherapy to adjuvant or curative doses. Eight received postoperative radiotherapy. All patients had initially successful vascularized reconstruction by clinical examination (28) and positive radionuclide scan (22 of 22). Bony stability was achieved in 25 of 26 patients and oral continence in 24 of 26. One complete flap loss occurred at 14 days. Complications of some degree developed in 22 patients including partial skin necrosis (3), orocutaneous fistula (3), plate exposure (1), donor site infection (3), fracture of reconstruction (1), and fracture of the radius (1). Microvascular transfer of bone and soft tissue allows a reliable reconstruction--despite previous radiotherapy, infection, foreign body, or surgery--in almost every situation in which mandible and soft tissue are absent. Bony union, a healed wound, and reasonable function and appearance are likely despite early fistula, skin loss, or metal plate or bone exposure.

  2. Coronary flow of the infarct artery assessed by transthoracic Doppler after primary percutaneous coronary intervention predicts final infarct size.

    Science.gov (United States)

    Trifunovic, Danijela; Sobic-Saranovic, Dragana; Beleslin, Branko; Stankovic, Sanja; Marinkovic, Jelena; Orlic, Dejan; Vujisic-Tesic, Bosiljka; Petrovic, Milan; Nedeljkovic, Ivana; Banovic, Marko; Djukanovic, Nina; Petrovic, Olga; Petrovic, Marija; Stepanovic, Jelena; Djordjevic-Dikic, Ana; Tesic, Milorad; Ostojic, Miodrag

    2014-12-01

    Coronary microcirculatory function after primary percutaneous coronary intervention (pPCI) in patients with acute myocardial infarction is important determinant of infarct size (IS). Our aim was to investigate the utility of coronary flow reserve (CFR) and diastolic deceleration time (DDT) of the infarct artery (IRA) assessed by transthoracic Doppler echocardiography after pPCI for final IS prediction. In 59 patients, on the 2nd day after pPCI for acute anterior myocardial infarction, transthoracic Doppler analysis of IRA blood flow was done including measurements of CFR, baseline DDT and DDT during adenosine infusion (DDT adeno). Killip class, myocardial blush grade, resolution of ST segment elevation, peak creatine kinase-myocardial band and conventional echocardiographic parameters were determined. Single-photon emission computed tomography myocardial perfusion imaging was done 6 weeks later to define final IS (percentage of myocardium with fixed perfusion abnormality). IS significantly correlated with CFR (r = -0.686, p 20 %), the best cut-off for CFR was <1.73 (sensitivity 65 %, specificity 96 %) and for DDT adeno ≤720 ms (sensitivity 81 %, specificity 96 %). CFR and DDT during adenosine are independent and powerful early predictors of final IS offering incremental prognostic information over conventional parameters of myocardial and microvascular damage and tissue reperfusion.

  3. Functional characteristics of coronary vasomotor function following intramyocardial gene therapy with naked DNA encoding for vascular endothelial growth factor 165

    NARCIS (Netherlands)

    Tio, RA; Wijpkema, JS; Tan, ES; Asselbergs, FW; Hospers, GAP; Jessurun, GAJ; Zijlstra, F

    2005-01-01

    Vascular endothelial growth factor (VEGF) is a potent angiogenic factor. VEGF gene therapy improves perfusion of ischemic myocardium in experimental models and possibly in patients with end-stage coronary artery disease. In addition to its proliferative and migratory effect on endothelial cells, it

  4. Effects of Aerobic Exercise Applied Early After Coronary Artery Bypass Grafting on Pulmonary Function, Respiratory Muscle Strength, and Functional Capacity: A Randomized Controlled Trial.

    Science.gov (United States)

    Borges, Daniel L; Silva, Mayara Gabrielle; Silva, Luan Nascimento; Fortes, João Vyctor; Costa, Erika Thalita; Assunção, Rebeca Pessoa; Lima, Carlos Magno; da Silva Nina, Vinícius José; Bernardo-Filho, Mário; Caputo, Danúbia Sá

    2016-09-01

    Physical activity is beneficial in several clinical situations and recommended for patients with ischemic heart disease, as well as for those undergoing cardiac surgery. In a randomized controlled trial, 34 patients underwent coronary artery bypass grafting. A randomized control group (n = 15) submitted to conventional physiotherapy. The intervention group (n = 19) received the same protocol plus additional aerobic exercise with cycle ergometer. Pulmonary function by spirometry, respiratory muscle strength by manovacuometry, and functional capacity through 6-minute walking test was assessed before surgery and at hospital discharge. There was significant reduction in pulmonary function in both groups. In both groups, inspiratory muscle strength was maintained while expiratory muscle strength significantly decreased. Functional capacity was maintained in the intervention group (364.5 [324.5 to 428] vs. 348 [300.7 to 413.7] meters, P = .06), but it decreased significantly in control group patients (320 [288.5 to 393.0] vs. 292 [237.0 to 336.0] meters, P = .01). A significant difference in functional capacity was also found in intergroup analyses at hospital discharge (P = .03). Aerobic exercise applied early on coronary artery bypass grafting patients may promote maintenance of functional capacity, with no impact on pulmonary function and respiratory muscle strength when compared with conventional physiotherapy.

  5. Effect of phentolamine on the hyperemic response to adenosine in patients with microvascular disease.

    Science.gov (United States)

    Aarnoudse, Wilbert; Geven, Maartje; Barbato, Emanuele; Botman, Kees-joost; De Bruyne, Bernard; Pijls, Nico H J

    2005-12-15

    For accurate measurement of the fractional flow reserve (FFR) of the myocardium, the presence of maximum hyperemia is of paramount importance. It has been suggested that the hyperemic effect of the conventionally used hyperemic stimulus, adenosine, could be submaximal in patients who have microvascular dysfunction and that adding alpha-blocking agents could augment the hyperemic response in these patients. We studied the effect of the nonselective alpha-blocking agent phentolamine, which was administered in addition to adenosine after achieving hyperemia, in patients who had microvascular disease and those who did not. Thirty patients who were referred for percutaneous coronary intervention were selected. Of these 30 patients, 15 had strong indications for microvascular disease and 15 did not. FFR was measured using intracoronary adenosine, intravenous adenosine, and intracoronary papaverine before and after intracoronary administration of the nonselective alpha blocker phentolamine. In patients who did not have microvascular disease, no differences in hyperemic response to adenosine were noted, whether or not alpha blockade was given before adenosine administration; FFR levels before and after phentolamine were 0.76 and 0.75, respectively, using intracoronary adenosine (p = 0.10) and 0.75 and 0.74, respectively, using intravenous adenosine (p = 0.20). In contrast, in patients who had microvascular disease, some increase in hyperemic response was observed after administration of phentolamine; FFR levels decreased from 0.74 to 0.70 using intracoronary adenosine (p = 0.003) and from 0.75 to 0.72 using intravenous adenosine (p = 0.04). Although statistically significant, the observed further decrease in microvascular resistance after addition of phentolamine was small and did not affect clinical decision making in any patient. In conclusion, when measuring FFR, routinely adding an alpha-blocking agent to adenosine does not affect clinical decision making.

  6. Four-dimensional echocardiography area strain combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis.

    Science.gov (United States)

    Deng, Yan; Peng, Long; Liu, Yuan-Yuan; Yin, Li-Xue; Li, Chun-Mei; Wang, Yi; Rao, Li

    2017-07-28

    The aim of this prospective study was to assess the diagnosis value of four-dimensional echocardiography area strain (AS) combined with exercise stress echocardiography to evaluate left ventricular regional systolic function in patients with mild single vessel coronary artery stenosis. Based on treadmill exercise load status, two-dimensional conventional echocardiography and four-dimensional echocardiography area strain were performed on patients suspected coronary artery disease before coronary angiogram. Thirty patients (case group) with mild left anterior descending coronary artery stenosis (stenosis coronary artery stenosis according to the coronary angiogram results were prospectively enrolled. All the patients had no left ventricular regional wall motion abnormality in two-dimensional echocardiography at rest and exercise stress. There was no significant difference in the 16 segmental systolic peak AS at rest between two groups. After exercise stress, the peak systolic ASrest-stress at mid anterior wall (-7.00%±10.90% vs 2.80%±23.69%) and mid anterolateral wall (-4.40%±18.81% vs 8.80%±19.16%) were decreased, while increased at basal inferolateral wall (14.00%±19.27% vs -5.60%±15.94%) in case group compared with control group (Pcoronary artery stenosis, the area strain was decreased at involved segments, while compensatory increased at noninvolved segments after exercise stress. Four-dimensional echocardiography area strain combined with exercise stress echocardiography could sensitively find left ventricular regional systolic function abnormality in patients with mild single vessel coronary artery stenosis, and locate stenosis coronary artery accordingly. © 2017, Wiley Periodicals, Inc.

  7. Association of glomerular filtration rate with slow coronary flow in patients with normal to mildly impaired renal function.

    Science.gov (United States)

    Akin, Fatih; Celik, Omer; Ayça, Burak; Yalçin, Ahmet Arif; Altun, Ibrahim; Köse, Nuri

    2014-10-01

    We evaluated the association between estimated glomerular filtration rate (eGFR) and slow coronary flow (SCF) in patients with normal to mildly impaired renal function; 211 patients with angiographically proven SCF and 219 controls were studied. Patients were categorized based on the angiographic findings as with or without SCF. We used the Modification of Diet in Renal Disease equation to calculate eGFR. The frequency of mildly decreased eGFR, serum uric acid levels, and eGFR was higher in the SCF group. Patients with mildly impaired renal function had higher thrombolysis in myocardial infarction frame counts in 3 major coronary arteries. In logistic regression analysis, uric acid (odds ratio [OR] = 1.323, 95% confidence interval [CI] = 1.109-1.572, P = .002) and eGFR (OR = 0.972, 95% CI = 0.957-0.987, P < .001) were independent correlates of SCF. In conclusion, eGFR was significantly correlated with SCF in patients with normal to mildly impaired renal function.

  8. Adipose tissue-derived microvascular fragments: natural vascularization units for regenerative medicine.

    Science.gov (United States)

    Laschke, Matthias W; Menger, Michael D

    2015-08-01

    The establishment of effective vascularization is a key challenge in regenerative medicine. To achieve this, the transplantation of native microvascular fragments has emerged as a promising novel concept. Microvascular fragments can be isolated in large amounts from fat tissue, exhibit a high angiogenic activity, and represent a rich source of mesenchymal stem cells. Originally, microvascular fragments have been used in angiogenesis research for the isolation of capillary endothelium and for functional sprouting assays. More recent studies have demonstrated that they rapidly develop into microvascular networks after transfer into tissue defects. Moreover, they are suitable for the generation of prevascularized tissue constructs. Hence, a wide range of future medical applications may benefit from the use of these natural vascularization units. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Intravascular Stenting in Microvascular Anastomoses

    DEFF Research Database (Denmark)

    Assersen, Kristine; Sørensen, Jens

    2015-01-01

    Background The effect of intravascular stenting (IVaS) on microvascular anastomoses has given adverse results. For experienced microsurgeons the benefit of IVaS is doubtful. We have investigated the potential benefit of the IVaS technique for two groups of inexperienced microsurgeons with different...... surgical levels of experience (medical students and young residents). Experienced microsurgeons acted as a control group. Materials and Methods In an experimental crossover study, 139 microsurgical anastomoses were performed on the femoral artery in 70 rats by 10 surgeons. On one side of the rat, the IVaS...... spent on the anastomosis. Results No significant difference in patency rates was seen between the stenting and conventional technique in all three groups. The experienced microsurgeons had 100% patency rate with both techniques. The medical students had 20/28 in the IVaS and 19/28 conventional group...

  10. Prognostic value of dobutamine stress myocardial perfusion echocardiography in patients with known or suspected coronary artery disease and normal left ventricular function

    Science.gov (United States)

    Mattoso, Angele A. A.; Tsutsui, Jeane M.; Kowatsch, Ingrid; Cruz, Vitória Y. L.; Sbano, João C. N.; Ribeiro, Henrique B.; Kalil Filho, Roberto; Porter, Thomas R.; Mathias, Wilson

    2017-01-01

    Objective We sought to determine the prognostic value of qualitative and quantitative analysis obtained by real-time myocardial perfusion echocardiography (RTMPE) in patients with known or suspected coronary artery disease (CAD). Background Quantification of myocardial blood flow reserve (MBFR) in patients with CAD using RTMPE has been demonstrated to further improve accuracy over the analysis of wall motion (WM) and qualitative analysis of myocardial perfusion (QMP). Methods From March 2003 to December 2008, we prospectively studied 168 patients with normal left ventricular function (LVF) who underwent dobutamine stress RTMPE. The replenishment velocity reserve (β) and MBFR were derived from RTMPE. Acute coronary events were: cardiac death, myocardial infarction and unstable angina with need for urgent coronary revascularization. Results During a median follow-up of 34 months (5 days to 6.9 years), 17 acute coronary events occurred. Abnormal β reserve in ≥2 coronary territories was the only independent predictor of events hazard ratio (HR) = 21, 95% CI = 4.5–99; p<0.001). Both, abnormal β reserve and MBFR added significant incremental value in predicting events over qualitative analysis of WM and MP (χ2 = 6.6 and χ2 = 24.6, respectively; p = 0.001 and χ2 = 6.6 and χ2 = 15.5, respectively; p = 0.012, respectively). When coronary angiographic data was added to the multivariate analysis model, β reserve remained the only predictor of events with HR of 21.0 (95% CI = 4.5–99); p<0.001. Conclusion Quantitative dobutamine stress RTMPE provides incremental prognostic information over clinical variables, qualitative analysis of WM and MP, and coronary angiography in predicting acute coronary events. PMID:28234978

  11. Improved assessment of functional severity of coronary artery stenosis by analysis of combined intracoronary pressure and flow velocity signals

    NARCIS (Netherlands)

    Nolte, F.

    2014-01-01

    Coronary artery disease (CAD) accounts for almost 2 million deaths per year within the EU. CAD is often characterized by focal narrowing of epicardial arteries, limiting coronary arterial flow and myocardial perfusion. Treatment of critical lesions by percutaneous coronary intervention (PCI) can be

  12. Microvascular Remodeling and Wound Healing: A Role for Pericytes

    Science.gov (United States)

    Dulmovits, Brian M.; Herman, Ira M.

    2012-01-01

    Physiologic wound healing is highly dependent on the coordinated functions of vascular and non-vascular cells. Resolution of tissue injury involves coagulation, inflammation, formation of granulation tissue, remodeling and scarring. Angiogenesis, the growth of microvessels the size of capillaries, is crucial for these processes, delivering blood-borne cells, nutrients and oxygen to actively remodeling areas. Central to angiogenic induction and regulation is microvascular remodeling, which is dependent upon capillary endothelial cell and pericyte interactions. Despite our growing knowledge of pericyte-endothelial cell crosstalk, it is unclear how the interplay among pericytes, inflammatory cells, glia and connective tissue elements shape microvascular injury response. Here, we consider the relationships that pericytes form with the cellular effectors of healing in normal and diabetic environments, including repair following injury and vascular complications of diabetes, such as diabetic macular edema and proliferative diabetic retinopathy. In addition, pericytes and stem cells possessing “pericyte-like” characteristics are gaining considerable attention in experimental and clinical efforts aimed at promoting healing or eradicating ocular vascular proliferative disorders. As the origin, identification and characterization of microvascular pericyte progenitor populations remains somewhat ambiguous, the molecular markers, structural and functional characteristics of pericytes will be briefly reviewed. PMID:22750474

  13. Coronary endothelial function assessment using self-gated cardiac cine MRI and k-t sparse SENSE.

    Science.gov (United States)

    Yerly, Jérôme; Ginami, Giulia; Nordio, Giovanna; Coristine, Andrew J; Coppo, Simone; Monney, Pierre; Stuber, Matthias

    2016-11-01

    Electrocardiogram (ECG)-gated cine MRI, paired with isometric handgrip exercise, can be used to accurately, reproducibly, and noninvasively measure coronary endothelial function (CEF). Obtaining a reliable ECG signal at higher field strengths, however, can be challenging due to rapid gradient switching and an increased heart rate under stress. To address these limitations, we present a self-gated cardiac cine MRI framework for CEF measurements that operates without ECG signal. Cross-sectional slices of the right coronary artery (RCA) were acquired using a two-dimensional golden angle radial trajectory. This sampling approach, combined with the k-t sparse SENSE algorithm, allows for the reconstruction of both real-time images for self-gating signal calculations and retrospectively reordered self-gated cine images. CEF measurements were quantitatively compared using both the self-gated and the standard ECG-gated approach. Self-gated cine images with high-quality, temporal, and spatial resolution were reconstructed for 18 healthy volunteers. CEF as measured in self-gated images was in good agreement (R(2)  = 0.60) with that measured by its standard ECG-gated counterpart. High spatial and temporal resolution cross-sectional cine images of the RCA can be obtained without ECG signal. The coronary vasomotor response to handgrip exercise compares favorably with that obtained with the standard ECG-gated method. Magn Reson Med 76:1443-1454, 2015. © 2015 International Society for Magnetic Resonance in Medicine. © 2015 International Society for Magnetic Resonance in Medicine.

  14. Effect of Shengmai Injection on Vascular Endothelial and Heart Functions in Patients with Coronary Heart Disease Complicated with Diabetes Mellitus

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ya-chen; LU Bao-jing; ZHAO Mei-hua; RONG Ye-zhi; CHEN Rui-ming

    2008-01-01

    Objective: To study the effect of Shengrnai injection (生脉注射液, SMI) on vascular endothelial and heart functions in coronary heart disease patients complicated with diabetes mellitus (CHD-DM). Methods: One hundred and twenty patients with CHD-DM, their diagnosis confirmed by coronary arteriography, were equally randomized into a control group treated with conventional treatment and a treated group treated with conventional treatment plus SMI. The changes in blood levels of nitric oxide (NO), endothelin-1 (ET-1) and angiotensin Ⅱ (Ang Ⅱ ), as well as endothelium-dependent vascular dilating function and heart function in the patients were observed before treatment and after the 3-week treatment. Results: After being treated with SMI for 3 weeks, in the treated group, blood level of NO was raised significantly from 69.8 ± 33.1 μ mol/L to 120.1 ± 50.8 μ mol/L, and ET-1 was lowered from 70.1 ± 32.1 ng/L to 46.2±21.3 ng/L, respectively (P<0.01); that of Ang Ⅱ was lowered from 81.3 ± 24.3 ng/L to 50.2 ± 27.3 ng/L (P<0.01); brachial arterial post-congestion blood flow increasing rate was raised from 389.4 ± 26.3% to 459.3 ± 27.8% (P<0.01); and the improvement in heart function as seen through the ejection fraction (EF) was increased from 44 ± 5% to 68 ± 6% (P<0.01), all the changes being more significant than those in the control group (all P<0.01). Conclusion: SMI can improve not only the endothelial function in CHD-DM patients, but also heart contraction significantly.

  15. Reprint of "The role of cytoskeleton in the regulation of vascular endothelial barrier function" [Microvascular Research 76 (2008) 202-207].

    Science.gov (United States)

    Bogatcheva, Natalia V; Verin, Alexander D

    2009-01-01

    The cytoskeleton is vital to the function of virtually all cell types in the organism as it is required for cell division, cell motility, endo- or exocytosis and the maintenance of cell shape. Endothelial cells, lining the inner surface of the blood vessels, exploit cytoskeletal elements to ensure the integrity of cell monolayer in quiescent endothelium, and to enable the disintegration of the formed barrier in response to various agonists. Vascular permeability is defined by the combination of transcellular and paracellular pathways, with the latter being a major contributor to the inflammation-induced barrier dysfunction. This review will analyze the cytoskeletal elements, which reorganization affects endothelial permeability, and emphasize signaling mechanisms with barrier-protective or barrier-disruptive potential.

  16. RhoA/rock signaling mediates peroxynitrite-induced functional impairment of Rat coronary vessels.

    Science.gov (United States)

    Sun, Zhijun; Wu, Xing; Li, Weiping; Peng, Hui; Shen, Xuhua; Ma, Lu; Liu, Huirong; Li, Hongwei

    2016-10-11

    Diabetes-induced vascular dysfunction may arise from reduced nitric oxide (NO) availability, following interaction with superoxide to form peroxynitrite. Peroxynitrite can induce formation of 3-nitrotyrosine-modified proteins. RhoA/ROCK signaling is also involved in diabetes-induced vascular dysfunction. The study aimed to investigate possible links between Rho/ROCK signaling, hyperglycemia, and peroxynitrite in small coronary arteries. Rat small coronary arteries were exposed to normal (NG; 5.5 mM) or high (HG; 23 mM) D-glucose. Vascular ring constriction to 3 mM 4-aminopyridine and dilation to 1 μM forskolin were measured. Protein expression (immunohistochemistry and western blot), mRNA expression (real-time PCR), and protein activity (luminescence-based G-LISA and kinase activity spectroscopy assays) of RhoA, ROCK1, and ROCK2 were determined. Vascular ring constriction and dilation were smaller in the HG group than in the NG group (P ROCK partially reversed the effects of HG. Peroxynitrite impaired vascular ring constriction/dilation; this was partially reversed by inhibition of RhoA or ROCK. Protein and mRNA expressions of RhoA, ROCK1, and ROCK2 were higher under HG than NG (P ROCK (P ROCK1, and ROCK2 activity (P ROCK1, and ROCK2 activity; these actions were partially inhibited by 100 μM urate (peroxynitrite scavenger). Exogenous peroxynitrite had no effect on the expression of the voltage-dependent K(+) channels 1.2 and 1.5. Peroxynitrite-induced coronary vascular dysfunction may be mediated, at least in part, through increased expressions and activities of RhoA, ROCK1, and ROCK2.

  17. Coronary microembolization.

    Science.gov (United States)

    Skyschally, Andreas; Leineweber, Kkirsten; Gres, Petra; Haude, Michael; Erbel, Raimund; Heusch, Gerd

    2006-09-01

    Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation. This review summarizes the present experimental pathophysiology of coronary microembolization in animal models of acute coronary syndromes and highlights the main consequences of coronary microembolization--reduced coronary reserve, microinfarction, inflammation and oxidative modification of contractile proteins, contractile dysfunction and perfusion-contraction mismatch.Furthermore, the review presents the available clinical evidence for coronary microembolization in patients and compares the clinical observations with observations in the experimental model.

  18. Coronary flow reserve in the remote myocardium predicts left ventricular remodeling following acute myocardial infarction.

    Science.gov (United States)

    Cheng, Rongchao; Wei, Guoqian; Yu, Longhao; Su, Zhendong; Wei, Li; Bai, Xiuping; Tian, Jiawei; Li, Xueqi

    2014-07-01

    Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present study was to assess whether a relationship exists between CFR and left ventricular remodeling following AMI. We enrolled 18 consecutive patients undergoing coronary intervention. Heart function was analyzed using real-time myocardial contrast echocardiography at one week and six months after coronary angioplasty. Ten subjects were enrolled as the control group and were examined using the same method at the same time to assess CFR. Cardiac troponin I (cTnI) levels were routinely analyzed to estimate peak concentration. CFR was 1.55±0.11 in the infarcted zone and 2.05±0.31 in the remote zone (p2.05). The levels of cTnI were higher in Group I compared to Group II on admission (36.40 vs. 21.38, p<0.05). Furthermore, left ventricular end diastolic volume was higher in Group I compared to Group II at six months following coronary angioplasty. Microvascular dysfunction is commonly observed in the remote myocardium. The CFR value accurately predicts adverse ventricular remodeling following AMI.

  19. Effects of Music Therapy on Endothelial Function in Patients With Coronary Artery Disease Participating in Aerobic Exercise Therapy.

    Science.gov (United States)

    Deljanin Ilic, Marina; Pavlovic, Radmila F; Kocic, Gordana; Simonovic, Dejan; Lazarevic, Gordana

    2017-02-27

    Context • Pleasant music that evokes a positive emotional response may activate brain pathways of the insular cortex, central nucleus of the amygdala, and lateral hypothalamus, which are involved in the integration of emotional and ambient sensory input, with corresponding autonomic responses. Exercise training can improve endothelium-dependent vasodilatation, both in epicardial coronary vessels and in resistance vessels, for patients with coronary heart disease. Objective • The aim of the present study was to evaluate the effects on endothelial function when patients with stable coronary artery disease (CAD) listened to their favorite music. Design • The study was a randomized controlled trial. Setting • The study occurred at the Institute of Cardiology, Niska Banja, Faculty of Medicine, University of Nis (Nis, Serbia). Participants • Participants were 74 patients with stable CAD. Intervention • Participants were randomly assigned to 1 of 3 groups: (1) exercise training only (T) group (n = 33), (2) listening to music and exercise training (MT) group (n = 31), and listening to music only (M) group (n = 10). Participants in the T and MT groups received usual medical care and underwent 3 wk of supervised aerobic exercise training. In addition to the exercise training, participants in the MT group listened to their favorite music for 1.5 h every day. Participants in the M group received the usual medical care and listened to their favorite music for 1.5 h every day. Outcome Measures • At baseline and postintervention, outcomes were assessed through measurement of the changes in circulating blood markers of endothelial function-the stable end product of nitric oxide (NOx), asymmetric dimethylarginine, symmetric dimethylarginine, and xanthine oxidase-and through the results of submaximal or symptom-limited exercise test. Results • After 3 wk, the NOx significantly increased in both in MT and T groups, with P < .001 and P < .01, respectively. The level of

  20. Insulin-resistant glucose metabolism in patients with microvascular angina--syndrome X

    DEFF Research Database (Denmark)

    Vestergaard, H; Skøtt, P; Steffensen, R

    1995-01-01

    fat-free mass [FFM]-1.min-1, P decrease in nonoxidative glucose metabolism (8.4 +/- 0.9 v 12.5 +/- 1.3 mg.kg FFM-1.min-1, P ...Studies in patients with microvascular angina (MA) or the cardiologic syndrome X have shown a hyperinsulinemic response to an oral glucose challenge, suggesting insulin resistance and a role for increased serum insulin in coronary microvascular dysfunction. The aim of the present study......, hyperinsulinemic clamp was performed in combination with indirect calorimetry. Biopsy of vastus lateralis muscle was taken in the basal state and after 4 hours of euglycemia and hyperinsulinemia (2 mU.kg-1.min-1). The fasting level of "true" serum insulin was significantly higher (43 +/- 6 v 22 +/- 3 pmol/L, P...

  1. Preventing microvascular complications in type 1 diabetes mellitus.

    Science.gov (United States)

    Viswanathan, Vijay

    2015-04-01

    Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM) by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c) level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c 20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour.

  2. Microvascular Abnormality in Schizophrenia as Shown by Retinal Imaging

    Science.gov (United States)

    Meier, Madeline H.; Shalev, Idan; Moffitt, Terrie E.; Kapur, Shitij; Keefe, Richard S.E.; Wong, Tien; Belsky, Daniel W.; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Caspi, Avshalom; Poulton, Richie

    2013-01-01

    Objective Retinal and cerebral microvessels are structurally and functionally homologous, but, unlike cerebral microvessels, retinal microvessels can be noninvasively measured in vivo via retinal imaging. Here we test the hypothesis that individuals with schizophrenia show microvascular abnormality and evaluate the utility of retinal imaging as a tool for future schizophrenia research. Methods Participants were members of the Dunedin Study, a population-representative cohort followed from birth with 95% retention. Study members underwent retinal imaging at age 38 years. We assessed retinal arteriolar and venular caliber for all members of the cohort, including individuals who developed schizophrenia. Results Study members who developed schizophrenia were distinguished by wider retinal venules, suggesting microvascular abnormality reflective of insufficient brain oxygen supply. Analyses that controlled for confounding health conditions suggested that wider retinal venules are not simply an artifact of co-occurring health problems in schizophrenia patients. Wider venules were also associated with a dimensional measure of adult psychosis symptoms and with psychosis symptoms reported in childhood. Conclusions Findings provide initial support for the hypothesis that individuals with schizophrenia show microvascular abnormality. Moreover, results suggest that the same vascular mechanisms underlie subthreshold symptoms and clinical disorder and that these associations may begin early in life. These findings highlight the promise of retinal imaging as a tool for understanding the pathogenesis of schizophrenia. PMID:24030514

  3. Preventing microvascular complications in type 1 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Vijay Viswanathan

    2015-01-01

    Full Text Available Patients with complications of diabetes such as retinopathy, nephropathy, and cardiovascular complications have increased hospital stay with greater economic burden. Prevention of complications should be started before the onset of type 1 diabetes mellitus (T1DM by working on risk factors and thereafter by intervention upon confirmatory diagnosis which can prevent further damage to β-cells. The actual risk of getting microvascular complications like microalbuminuria and retinopathy progression starts at glycated hemoglobin (HbA1c level of 7%. As per the American Diabetes Association, a new pediatric glycemic control target of HbA1c 20 years as compared to patients <10 years of age. Screening of these complications should be done regularly, and appropriate preventive strategies should be followed. Angiotensin converting enzyme inhibitors and angiotensin II receptor blocker reduce progression from microalbuminuria to macroalbuminuria and increase the regression rate to normoalbuminuria. Diabetic microvascular complications can be controlled with tight glycemic therapy, dyslipidemia management and blood pressure control along with renal function monitoring, lifestyle changes, including smoking cessation and low-protein diet. An integrated and personalized care would reduce the risk of development of microvascular complications in T1DM patients. The child with diabetes who receives limited care is more likely to develop long-term complications at an earlier age. Screening for subclinical complications and early interventions with intensive therapy is the need of the hour.

  4. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan;

    2012-01-01

    OBJECTIVESWe wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).METHODSNinety-two patients with stable angina......%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible...... in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects...

  5. Reduction in coronary and peripheral vasomotor function in patients with HIV after initiation of antiretroviral therapy: a longitudinal study with positron emission tomography and flow-mediated dilation

    DEFF Research Database (Denmark)

    Kristoffersen, Ulrik Sloth; Wiinberg, Niels; Petersen, Claus Leth;

    2010-01-01

    The mechanisms underlying the increased cardiovascular risk in patients with HIV on antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET) in patients with HIV initiating ART...

  6. Coronary and peripheral endothelial function in HIV patients studied with positron emission tomography and flow-mediated dilation: relation to hypercholesterolemia

    DEFF Research Database (Denmark)

    Lebech, Anne-Mette; Kristoffersen, Ulrik; Wiinberg, Niels

    2008-01-01

    BACKGROUND: The mechanisms underlying increased cardiovascular risk in HIV patients in antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET), in HIV patients with normal or high ch...... in hypercholesterolemic patients. Also, the increased level of plasma endothelial markers found in HIV patients was not related to hypercholesterolemia....

  7. 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.

  8. Ultrasound assessment of mitral annular displacement in patients with coronary heart disease and its correlation with left heart function and serum indexes

    Institute of Scientific and Technical Information of China (English)

    Bing-Yan Lai

    2016-01-01

    Objective:To analyze the ultrasound assessment of mitral annular displacement in patients with coronary heart disease and its correlation with left heart function and serum indexes. Methods:A total of 89 patients with coronary heart disease were divided into angina pectoris group 42 cases and myocardial infarction group 47 cases according to the illness, and 58 cases of healthy subjects were included in control group. Values of mitral annular displacement (MAD) parameters, left heart function indexes and serum illness-related indexes of three groups were detected, and the correlation between values of MAD parameters and values of cardiac function indexes and serum illness-related indexes were further analyzed.Results:MAD parameters TMAD1, TMAD2 and TMADmid values, heart function LVEF values and serum CysC level of myocardial infarction group and angina pectoris group were lower than those of control group, and cardiac function LVEDD, LVESD and A/E values as well as serum H-FABP, ICTP, Hcy and vWF levels were higher than those of control group (P<0.05); MAD parameters TMAD1, TMAD2 and TMADmid values of patients with coronary heart disease were negatively correlated with LVEDD, LVESD and A/E values as well as H-FABP, ICTP, Hcy and vWF levels, and were positively correlated with LVEF value and CysC level (P<0.05). Conclusions:Ultrasound assessment of mitral annular displacement in patients with coronary heart disease can early diagnose coronary heart disease and judge the disease severity, and it plays a positive role in optimizing disease prognosis.

  9. An evaluation of the efficacy of microvascular breast reconstruction techniques.

    Science.gov (United States)

    Dobrut, Mirosław; Maciejewski, Adam; Półtorak, Stanisław

    2013-01-01

    The aim of the study was to evaluate the efficacy of different microvascular techniques in breast reconstruction with the analysis of postoperative complications. The additional goal of the study is to analyze the quality of life of patients after microvascular breast reconstruction in comparison to the control group of patients who underwent only mastectomy without any reconstructive procedures. Also the algorithm of breast reconstruction is presented as the result of own experiences. Clinical material contain 2 groups of patients - women after surgical treatment in Department of Oncological and Reconstructive Surgery, Cancer Center in Gliwice in the year 2004-2009 where in 53 cases immediate and in 26 delayed breast microvascular reconstruction were performed. In all cases the diagnosis of cancer was proved by histopathological biopsy before the treatment. The type of radical resection (mastectomy) depended on histopathological type of cancer and its localization. The reconstruction - immediate vs delayed was carefully planned together with oncological treatment of the cases. Everywhere this plan was established based on carefully examinations of inferior epigastric vessels and theirs perforators. The choice between immediate and delayed microvascular reconstruction was based on prognosis and predictive factors. The QOL was analyzed due to own questionnaire when functional, aesthetics and social effects were evaluated. Free flap survival rate for all types of free flap was 95%. In cases where classic TRAM was used the rate was 85%, in cases where muscle sparring TRAM was chosen the survival rate was 100% and in remaining cases of DIEP reconstructions the rate was 89%. Generally the complications after microvascular reconstruction occurred in 13 cases (16%). In 9 cases the problems with flaps perfusion were notified. Total flap necrosis was observed in 2 TRAM and in 2 DIEP cases. In all those cases salvage surgery was administered in which the microanastomoses

  10. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure.

    Science.gov (United States)

    Yuniadi, Yoga; Kusnadi, Yuyus; Sandhow, Lakshmi; Erika, Rendra; Hanafy, Dicky A; Sardjono, Caroline; Kaligis, R W M; Kasim, Manoefris; Harimurti, Ganesja M

    2016-01-01

    Background. Proangiogenic Hematopoietic Cells (PHC) which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4 ± 7.40 yo) preimplant NT proBNP level is 5124.5 ± 4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87 ± 0.41, 0.63 ± 0.66, 99.00 ± 2.60, and 3.22 ± 3.79%, respectively. LVEF was improved (22 ± 5.68 versus 26.8 ± 7.93, p observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  11. The Influence of Endothelial Function and Myocardial Ischemia on Peak Oxygen Consumption in Patients with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Simon L. Bacon

    2012-01-01

    Full Text Available Impaired endothelial function has been shown to limit exercise in coronary artery disease (CAD patients and has been implicated in myocardial ischemia. However, the association of endothelial function and ischemia on peak exercise oxygen consumption (VO2 has not been previously reported. A total of 116 CAD patients underwent standard exercise stress testing, during which VO2 was measured. On a separate day, endothelial-dependent and -independent function were assessed by ultrasound using flow-mediated arterial vasodilation (FMD and sublingual glyceryl trinitrate administration (GTNMD of the brachial artery. Patients with exercise-induced myocardial ischemia had lower FMD than nonischemic patients (3.64±0.57 versus 4.98±0.36, P=.050, but there was no difference in GTNMD (14.11±0.99 versus 15.47±0.63, P=.249. Analyses revealed that both FMD (P=.006 and GTNMD (P=.019 were related to peak VO2. However, neither the presence of ischemia (P=.860 nor the interaction of ischemia with FMD (P=.382 and GTNMD (P=.151 was related to peak VO2. These data suggest that poor endothelial function, potentially via impaired NO production and smooth muscle dysfunction, may be an important determinant of exercise capacity in patients with CAD, independent of myocardial ischemia.

  12. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-01-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  13. PILOT STUDY RESULTS OF THE INFLUENCE OF CITICOLINE AND PIRIBEDIL ON COGNITIVE FUNCTION IN PATIENTS WITH ISCHEMIC HEART DISEASE AFTER CORONARY ARTERY BYPASS SURGERY

    Directory of Open Access Journals (Sweden)

    M. M. Petrova

    2015-09-01

    Full Text Available Aim. To reveal cognitive deficit after coronary artery bypass, the influence of citicoline, piribedil on the state of higher cerebral functions in the early and late periods after surgery.Material and methods. The study included 94 patients with ischemic heart disease. All patients were divided into 3 groups. Patients of the first group (n=30 were prescribed citicoline as a cerebral neuroprotective drug. Patients of the second group (n=32 had piribedil in addition to standard therapy. Patients of the control group (n=32 had only a standard treatment without any neuroprotective drugs. All patients underwent coronary artery bypass surgery. The cognitive function was assessed before, 10 days after and six months after coronary artery bypass.Results. Patients of group 1 and 2 had achieved pre-surgical levels of cognitive tests results 6 months after coronary artery bypass. The control group had achieved initial levels only in three tests: visual memory (immediate simulation; p=0.008, categorical association (p=0.002, clock drawing test (Wilcoxon test; p=0,005, while other indices were reduced in comparison with the initial ones.Conclusion. The obtained results allow considering the studied drugs as a protectors of cognitive function after surgery. Randomized controlled double-blind studies on large samples are needed to confirm these results.

  14. Myocardial scar identified by magnetic resonance imaging can predict left ventricular functional improvement after coronary artery bypass grafting.

    Directory of Open Access Journals (Sweden)

    Tao Yang

    Full Text Available BACKGROUND: Previous studies have shown that viable myocardium predicts recovery of left ventricular (LV dysfunction after revascularization. Our aim was to evaluate the prognostic value of myocardial scar assessed by late gadolinium-enhanced cardiovascular magnetic resonance imaging (LGE-CMR on functional recovery in patients undergoing coronary artery bypass grafting (CABG. METHODS: From November 2009 to September 2012, 63 patients with reduced left ventricular ejection fraction (LVEF referred for first-time isolated CABG were prospectively enrolled, 52 were included in final analysis. LV functional parameters and scar tissue were assessed by LGE-CMR at baseline and 6 months after surgery. Patency of grafts was evaluated by computed tomography angiography (CTA 6 months post-CABG. Predictors for global functional recovery were analyzed. RESULTS: The baseline LVEF was 32.7 ± 9.2%, which improved to 41.6 ± 11.0% 6 months later and 32/52 patients improved LVEF by ≥ 5%. Multivariate logistic regression analysis showed that the most significant negative predictor for global functional recovery was the number of scar segments (Odds ratio 2.864, 95% Confidence Interval 1.172-6.996, p = 0.021. Receiver-Operator-Characteristic (ROC analysis demonstrated that ≤ 4 scar segments predicted global functional recovery with a sensitivity and specificity of 85.0% and 87.5%, respectively (AUC = 0.91, p<0.001. Comparison of ROC curves also indicated that scar tissue was superior to viable myocardium in predicting cardiac functional recovery (p<0.001. CONCLUSIONS: Our findings indicated that scar tissue on LGE-CMR is an independent negative predictor of cardiac functional recovery in patients with impaired LV function undergoing CABG. These observations may be helpful for clinicians and cardiovascular surgeons to determine which patients are most likely to benefit from surgical revascularization.

  15. Early microvascular changes in the preterm neonate: a comparative study of the human and guinea pig.

    Science.gov (United States)

    Dyson, Rebecca M; Palliser, Hannah K; Lakkundi, Anil; de Waal, Koert; Latter, Joanna L; Clifton, Vicki L; Wright, Ian M R

    2014-09-17

    Dysfunction of the transition from fetal to neonatal circulatory systems may be a major contributor to poor outcome following preterm birth. Evidence exists in the human for both a period of low flow between 5 and 11 h and a later period of increased flow, suggesting a hypoperfusion-reperfusion cycle over the first 24 h following birth. Little is known about the regulation of peripheral blood flow during this time. The aim of this study was to conduct a comparative study between the human and guinea pig to characterize peripheral microvascular behavior during circulatory transition. Very preterm (≤28 weeks GA), preterm (29-36 weeks GA), and term (≥37 weeks GA) human neonates underwent laser Doppler analysis of skin microvascular blood flow at 6 and 24 h from birth. Guinea pig neonates were delivered prematurely (62 day GA) or at term (68-71 day GA) and laser Doppler analysis of skin microvascular blood flow was assessed every 2 h from birth. In human preterm neonates, there is a period of high microvascular flow at 24 h after birth. No period of low flow was observed at 6 h. In preterm animals, microvascular flow increased after birth, reaching a peak at 10 h postnatal age. Blood flow then steadily decreased, returning to delivery levels by 24 h. Preterm birth was associated with higher baseline microvascular flow throughout the study period in both human and guinea pig neonates. The findings do not support a hypoperfusion-reperfusion cycle in the microcirculation during circulatory transition. The guinea pig model of preterm birth will allow further investigation of the mechanisms underlying microvascular function and dysfunction during the initial extrauterine period.

  16. MPST but not CSE is the primary regulator of hydrogen sulfide production and function in the coronary artery.

    Science.gov (United States)

    Kuo, Maggie M; Kim, Dae Hee; Jandu, Sandeep; Bergman, Yehudit; Tan, Siqi; Wang, Huilei; Pandey, Deepesh R; Abraham, Theodore P; Shoukas, Artin A; Berkowitz, Dan E; Santhanam, Lakshmi

    2016-01-01

    Hydrogen sulfide (H2S) has emerged as an important gasotransmitter in the vasculature. In this study, we tested the hypothesis that H2S contributes to coronary vasoregulation and evaluated the physiological relevance of two sources of H2S, namely, cystathionine-γ-lyase (CSE) and 3-mercaptypyruvate sulfertransferase (MPST). MPST was detected in human coronary artery endothelial cells as well as rat and mouse coronary artery; CSE was not detected in the coronary vasculature. Rat coronary artery homogenates produced H2S through the MPST pathway but not the CSE pathway in vitro. In vivo coronary vasorelaxation response was similar in CSE knockout mice, wild-type mice (WT), and WT mice treated with the CSE inhibitor propargylglycine, suggesting that CSE-produced H2S does not have a significant role in coronary vasoregulation in vivo. Ex vivo, the MPST substrate 3-mercaptopyruvate (3-MP) and H2S donor sodium hydrosulfide (NaHS) elicited similar coronary vasoreactivity responses. Pyruvate did not have any effects on vasoreactivity. The vasoactive effect of H2S appeared to be nitric oxide (NO) dependent: H2S induced coronary vasoconstriction in the presence of NO and vasorelaxation in its absence. Maximal endothelial-dependent relaxation was intact after 3-MP and NaHS induced an increase in preconstriction tone, suggesting that endothelial NO synthase activity was not significantly inhibited. In vitro, H2S reacted with NO, which may, in part explain the vasoconstrictive effects of 3-MP and NaHS. Taken together, these data show that MPST rather than CSE generates H2S in coronary artery, mediating its effects through direct modulation of NO. This has important implications for H2S-based therapy in healthy and diseased coronary arteries.

  17. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: A cohort study of cardiac function

    Directory of Open Access Journals (Sweden)

    Reza Karbasi Afshar

    2015-01-01

    Full Text Available Introduction: Cardiac resynchronization therapy (CRT is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG, with and without CRT-defibrillator (CRT-D inserting and then measured its effects on these two groups. Patients and Methods: Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG and Group 2 ( n = 52 without receiving CRT-D. Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF, echocardiographic assessment, and New York Heart Association (NYHA class level. Results: The mean age of participants in Group 1 (48 male and in Group 2 (52 male was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF changes and NYHA class level was significant ( P > 0.05. Hospitalization ( P = 0.008, mortality rate ( P = 0.007, and AF were significantly different between these two groups. Conclusions: The results showed that the increase in LVEF and patient′s improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.

  18. IL-17A facilitates platelet function through the ERK2 signaling pathway in patients with acute coronary syndrome.

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    Shuang Zhang

    Full Text Available BACKGROUND: Platelet aggregation mediated by inflammation played a critical role in the development of coronary heart diseases (CHD. Our previous clinical researches showed that Th17 cells and their characteristic cytokine IL-17A were associated with the plaque destabilization in patients with acute coronary syndrome (ACS. However, the potent effect of IL-17A on platelets-induced atherothrombosis remains unknown. METHODS AND RESULTS: In this study, we detected the plasma IL-17A levels and platelet aggregation in patients with stable angina (SA, unstable angina (UA, acute myocardial infarction (AMI and chest pain syndrome (CPS. In addition, the markers of platelet activation (CD62P/PAC-1 and the mitogen-activated protein kinases (MAPKs pathway were detected in platelets from ACS patients. We found that plasma IL-17A levels and platelet aggregation in patients with ACS (UA and AMI were significantly higher than patients with SA and CPS, and the plasma IL-17A levels were positively correlated with the platelet aggregation (R = 0.47, P<0.01. In addition, in patients with ACS, the platelet aggregation, CD62P/PAC-1 and the phosphorylation of ERK2 signaling pathway were obviously elevated in platelets pre-stimulated with IL-17A in vitro. Furthermore, the specific inhibitor of ERK2 could attenuate platelet aggregation and activation triggered by IL-17A. CONCLUSION: Our experiment firstly proved that IL-17A could promote platelet function in patients with ACS via activating platelets ERK2 signaling pathway and may provide a novel target for antiplatelet therapies in CHD.

  19. Gene expression microarray data from human microvascular endothelial cells supplemented with a low concentration of niacin

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    Jennifer M. Hughes-Large

    2016-03-01

    Full Text Available The systemic lipid modifying drug, niacin, can directly improve human microvascular endothelial cell angiogenic function under lipotoxic conditions, possibly through activation of niacin receptors “Niacin receptor activation improves human microvascular endothelial cell angiogenic function during lipotoxicity” (Hughes-Large et al. 2014. Here we provide accompanying data collected using Affymetrix GeneChip microarrays to identify changes in gene expression in human microvascular endothelial cells treated with 10 μM niacin. Statistical analyses of robust multi-array average (RMA values revealed that only 16 genes exhibited greater than 1.3-fold differential expression. Of these 16, only 5 were identified protein coding genes, while 3 of the remaining 11 genes appeared to be small nuclear/nucleolar RNAs. Altered expression of EFCAB4B, NAP1L2, and OR13C8 was confirmed by real time quantitative PCR.

  20. The prevention of diabetic microvascular complications of diabetes: is there a role for lipid lowering?

    Science.gov (United States)

    Leiter, Lawrence A

    2005-06-01

    The role of hyperglycemia in the development of microvascular complications of diabetes, such as nephropathy, retinopathy and neuropathy, has been well documented. Evidence is accumulating to support the concept that dyslipidemia can also contribute to the development of these complications. Lipid-lowering agents, such as statins, have been shown to prevent cardiovascular events in patients with diabetes. However, in addition to preventing macrovascular diseases, statins may also be able to retard the progression of microvascular complications of diabetes. Indeed, in addition to reducing lipid levels, these agents can improve endothelial function and reduce oxidative stress, which can improve microvascular function. These findings would provide further support for the use of lipid-lowering agents in patients with diabetes.

  1. Microvascular dysfunction is associated with plasma osteoprotegerin levels in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Høfsten, Dan E; Christophersen, Thomas B

    2013-01-01

    Osteoprotegerin (OPG) is a glycoprotein that inhibits nuclear factor-κB's regulatory effects on inflammation, skeletal, and vascular systems, and is a potential biomarker of atherosclerosis and seems to be involved in vascular calcifications. The objective of this study was to assess the relation...... the relationship between OPG, left ventricular function, and microvascular function in patients with acute myocardial infarction (AMI)....

  2. Anti-inflammatory and antioxidant functions of high-density lipoprotein subclasses in patients with acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Ying TAN

    2013-02-01

    Full Text Available Objective  To assess the anti-inflammatory and antioxidant functions of high-density lipoprotein (HDL subclasses (HDL2 and HDL3 in patients with acute coronary syndrome (ACS, and to elucidate whether incapacitation of HDL subclasses occurred in ACS patients. Methods  Forty ACS patients hospitalized in Nanfang Hospital from Jan. 2011 to Jan. 2012 (ACS group, and 40 subjects simultaneously receiving health examination (control group were enrolled in present study. Plasma lipid and hypersensitive C reactive protein (hs-CRP levels, HDL subclasses inflammatory index (HII, paraoxonase-1 (PON1 activity and lipid hydroperoxide (LOOH levels in both groups were measured. Results  The low-density lipoprotein cholesterol (LDL-C and hs-CRP levels were higher in ACS group than in control group (P0.05. Conclusions  The incapacitation of HDL subclasses may occur in ACS patients, with an attenuated antioxidant ability and accentuated proinflammatory function. Mature HDL2 possesses better anti-inflammatory and antioxidant function than HDL3, thus playing a better cardioprotective effect.

  3. Accuracy of diagnosis of coronary artery disease by radionuclide management of left ventricular function during rest and exercise

    Energy Technology Data Exchange (ETDEWEB)

    Jones, R.H.; McEwan, P.; Newman, G.E.; Port, S.; Rerych, S.K.; Scholz, P.M.; Upton, M.T.; Peter, C.A.; Austin, E.H.; Leong, K.H.; Gibbons, R.J.; Cobb, F.R.; Coleman, R.E.; Sabiston, D.C. Jr.

    1981-09-01

    Rest and exercise radionuclide angiocardiographic measurements of left ventricular function were obtained in 496 patients who underwent cardiac catheterization for chest pain. Two hundred forty-eight of these patients also had an exercise treadmill test. An ejection fraction less than 50% was the abnormality of resting left ventricular function that provided the greatest diagnostic information. In patients with normal resting left ventricular function, exercise abnormalities that were optimal for diagnosis of coronary artery disease were an injection fraction at least 6% less than predicted, an increase greater than 20 ml in end-systolic volume and the appearance of an exercise-induced wall motion abnormality. The sensitivity and specificity of the test were lower in patients who were taking propranolol at the time of study and in patients who failed to achieve an adequate exercise end point. In the 387 patients with an optimal study, the test had a sensitivity of 90% and a specificity of 58%. Radionuclide angiocardiography was more sensitive and less specific than the exercise treadmill test. The high degree of sensitivity of the radionuclide test suggests that it is most appropriately applied to patient groups with a high prevalence of disease, including those considered for cardiac catheterization.

  4. Traditional Chinese Medicine Tongxinluo Improves Cardiac Function of Rats with Dilated Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Fang-Fang Shen

    2014-01-01

    Full Text Available The study aimed at testing the hypothesis that tongxinluo capsule might exert its cardioprotective effect by preventing ventricular remodeling and improving coronary microvascular function in a rat model of doxorubicin-induced dilated cardiomyopathy (DCM. Rats that survived DCM induction were randomly divided into three groups to be given 1.5 g·kg−1·day−1 (TXL-H, n=9 or 0.15 g·kg−1·day−1 (TXL-L, n=10 of tongxinluo, or normal saline at the same volume (DCM-C, n=10 intragastrically. Age matched normal rats treated with normal saline were used as normal controls (NOR-C, n=9. After four weeks of treatment, the DCM-C, TXL-H, and TXL-L groups exhibited significant cardiac dysfunction, left ventricular remodeling, and coronary microvascular dysfunction, compared with the NOR-C rats. However, myocardial functional parameters were significantly improved and microvascular density (MVD increased in the TXL-H group compared with the DCM-C group (all P<0.01. Left ventricular remodeling was prevented. There were close linear relationships between CVF and LVEF (r=-0.683, P<0.05, MVD and LVEF (r=0.895, P<0.05, and MVD and CVF (r=-0.798, P<0.05. It was indicated that high-dose tongxinluo effectively improved cardiac function in rat model of DCM.

  5. Differential regulation of functional gene clusters in overt coronary artery disease in a transgenic atherosclerosis-hypertensive rat model.

    OpenAIRE

    Herrera, Victoria M. L.; Didishvili, Tamara; Lopez, Lyle V.; Ruiz-Opazo, Nelson

    2002-01-01

    BACKGROUND: Human acute coronary syndrome refers to the spectrum of clinical manifestations of overt coronary artery (CAD) disease characterized by atherosclerotic plaque destabilization and resultant myocardial injury. Typically studied as distinct pathologies, emerging pathogenic paradigms implicate multiple processes beyond thrombosis and ischemic cell injury respectively, with significant pathway overlap involving inflammation, apoptosis, matrix degradation, and oxidative stress. However,...

  6. The diagnostic accuracy and outcomes after coronary computed tomography angiography vs. conventional functional testing in patients with stable angina pectoris

    DEFF Research Database (Denmark)

    Nielsen, Lene H; Ortner, Nino; Nørgaard, Bjarne L

    2014-01-01

    AIMS: To systematically review and perform a meta-analysis of the diagnostic accuracy and post-test outcomes of conventional exercise electrocardiography (XECG) and single-photon emission computed tomography (SPECT) compared with coronary computed tomography angiography (coronary CTA) in patients...

  7. Depth-resolved 3D visualization of coronary microvasculature with optical microangiography

    Science.gov (United States)

    Qin, Wan; Roberts, Meredith A.; Qi, Xiaoli; Murry, Charles E.; Zheng, Ying; Wang, Ruikang K.

    2016-11-01

    In this study, we propose a novel implementation of optical coherence tomography-based angiography combined with ex vivo perfusion of fixed hearts to visualize coronary microvascular structure and function. The extracorporeal perfusion of Intralipid solution allows depth-resolved angiographic imaging, control of perfusion pressure, and high-resolution optical microangiography. The imaging technique offers new opportunities for microcirculation research in the heart, which has been challenging due to motion artifacts and the lack of independent control of pressure and flow. With the ability to precisely quantify structural and functional features, this imaging platform has broad potential for the study of the pathophysiology of microvasculature in the heart as well as other organs.

  8. Increased benefit of interleukin-1 inhibition on vascular function, myocardial deformation, and twisting in patients with coronary artery disease and coexisting rheumatoid arthritis.

    Science.gov (United States)

    Ikonomidis, Ignatios; Tzortzis, Stavros; Andreadou, Ioanna; Paraskevaidis, Ioannis; Katseli, Chrysoula; Katsimbri, Pelagia; Pavlidis, George; Parissis, John; Kremastinos, Dimitrios; Anastasiou-Nana, Maria; Lekakis, John

    2014-07-01

    We investigated the effects of anakinra, an interleukin-1 receptor antagonist, on coronary and left ventricular function in coronary artery disease (CAD) patients with rheumatoid arthritis. In a double-blind crossover trial, 80 patients with rheumatoid arthritis (60 with CAD and 20 without) were randomized to a single injection of anakinra or placebo and after 48 hours to the alternative treatment. At baseline and 3 hours after treatment, we assessed (1) flow-mediated dilation of brachial artery; (2) coronary flow reserve, ejection fraction, systemic arterial compliance, and resistance by echocardiography; (3) left ventricular global longitudinal and circumferential strain, peak twisting, untwisting velocity by speckle tracking; and (4) interleukin-1β, nitrotyrosine, malondialdehyde, protein carbonyl, and Fas/Fas ligand levels. At baseline, patients with CAD had 3-fold higher interleukin-1β, protein carbonyl, higher nitrotyrosine, malondialdehyde, and Fas/Fas ligand than non-CAD (PInterleukin-1 inhibition causes a greater improvement in endothelial, coronary aortic function in addition to left ventricular myocardial deformation and twisting in rheumatoid arthritis patients with CAD than in those without. http://www.clinicaltrials.gov. Unique identifier: NCT01566201. © 2014 American Heart Association, Inc.

  9. Fat embolism syndrome and pulmonary microvascular cytology.

    Science.gov (United States)

    Castella, X; Vallés, J; Cabezuelo, M A; Fernandez, R; Artigas, A

    1992-06-01

    Pulmonary microvascular cytology consists of analysis of capillary blood sampled while a Swan-Ganz catheter is in the wedge position. This technique has proved to be useful in the diagnosis of lymphangitic spread of carcinoma in the lungs and there are case reports of their use in amniotic fluid embolism. Its usefulness in diagnosing fat embolism syndrome has been shown only rarely. We report a new case in which pulmonary microvascular cytologic study allowed a definite diagnosis of fat embolism syndrome. We suggest obtaining routinely samples of capillary blood when a pulmonary catheter is in place and fat embolism is suspected on a clinical basis.

  10. Microvascular angina in postmenopausal women.

    Directory of Open Access Journals (Sweden)

    Alexander Valdés Martín

    2011-10-01

    Full Text Available Fundamento: la angina microvascular es frecuente en mujeres posmenopáusicas. La isquemia miocárdica ha sido inducida mediante pruebas de estrés, en las que se ha comprobado una relación entre la disfunción endotelial y los defectos de perfusión miocárdica. Objetivo: determinar si la isquemia miocárdica puede evidenciarse por anormalidades de la perfusión y de la función detectadas por gammagrafía miocárdica en mujeres con angina típica, angiografía coronaria normal y disfunción endotelial. Métodos: estudio descriptivo realizado en el Instituto de Cardiología y Cirugía Cardiovascular de La Habana que incluyó 59 mujeres. Se les realizó lipidograma, se les midió función endotelial de la arteria braquial mediante ultrasonido, y estudio electrocardiográfico de 24 horas (Holter. Se aplicó un protocolo de estrés-reposo durante la gammagrafía. Las pacientes fueron divididas en dos grupos, acorde a la presencia (grupo I o ausencia (grupo II de defectos de perfusión miocárdica. Resultados: mostraron defectos de la perfusión 21 pacientes. El 57 % de las pacientes del grupo I exhibió más disfunción endotelial. Sólo doce pacientes mostraron defectos reversibles de la perfusión y en el 75 % de los casos se asoció a una reducción de la fracción de eyección ventricular izquierda postestrés mayor de un 5 % y a anormalidades regionales de la motilidad de la pared. Tres pacientes en el grupo I mostraron evidencia de isquemia comparado con cuatro en el grupo II. Conclusiones: la isquemia inducida por estrés se asocia a una reducción de la fracción de eyección ventricular izquierda postestrés y a una vasodilatación anormal dependiente del endotelio.

  11. Mitogen-activated protein kinase inhibition and cardioplegia-cardiopulmonary bypass reduce coronary myogenic tone.

    Science.gov (United States)

    Khan, Tanveer A; Bianchi, Cesario; Ruel, Marc; Voisine, Pierre; Li, Jianyi; Liddicoat, John R; Sellke, Frank W

    2003-09-09

    Cardioplegia-cardiopulmonary bypass (C/CPB) is associated with coronary microcirculatory dysfunction. Regulation of the microcirculation includes myogenic tone. Mitogen-activated protein kinases (MAPK) have been implicated in coronary vasomotor function. We hypothesized that vasomotor dysfunction of the coronary microcirculation is mediated in part by alterations in extracellular signal regulated kinase 1/2 (ERK1/2) activity following C/CPB in humans. Atrial myocardium was harvested from patients (n=15) before and after blood cardioplegia and short-term reperfusion under conditions of CPB. Myogenic tone of coronary arterioles was measured by videomicroscopy. Microvessel tone was determined post-C/CPB and after PD98059, a MAPK/ERK kinase 1/2 (MEK1/2) inhibitor. MAPK phosphatase-1 (MKP-1) and activated ERK1/2 were measured by Western blot. MKP-1 gene expression was determined by Northern blot. In situ hybridization and immunohistochemistry were used to localize myocardial MKP-1 and activated ERK1/2, respectively. Myogenic tone was reduced in coronary arterioles post-C/CPB (-10.5+/-0.9%, P<0.01 versus control/pre-C/CPB, n=5). Myogenic tone was decreased in coronary microvessels after 30 micromol/L (n=5) and 50 micromol/L (n=5) PD98059 treatment (-11.0+/-0.8% and -14.6+/-2.0%, respectively, both P<0.01 versus control/pre-C/CPB). Myocardial levels of activated ERK1/2 were reduced post-C/CPB (0.6+/-0.1, post/pre-C/CPB ratio, P<0.05, n=5) while MKP-1 levels increased (4.2+/-0.6, post/pre-C/CPB ratio, P<0.05, n=5). Myocardial MKP-1 gene expression increased post-C/CPB (3.0+/-0.8, post/pre-C/CPB ratio, P<0.05, n=5). MKP-1 and activated ERK1/2 localized to coronary arterioles in myocardial sections. Coronary myogenic tone is dependent on ERK1/2 and decreased after C/CPB. C/CPB reduces levels of activated ERK1/2, potentially by increased levels of MKP-1. The ERK1/2 signal transduction pathway in part mediates coronary microvascular dysfunction after C/CPB in humans.

  12. Impact of type 2 diabetes and the metabolic syndrome on myocardial structure and microvasculature of men with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Yii Michael

    2011-09-01

    Full Text Available Abstract Background Type 2 diabetes and the metabolic syndrome are associated with impaired diastolic function and increased heart failure risk. Animal models and autopsy studies of diabetic patients implicate myocardial fibrosis, cardiomyocyte hypertrophy, altered myocardial microvascular structure and advanced glycation end-products (AGEs in the pathogenesis of diabetic cardiomyopathy. We investigated whether type 2 diabetes and the metabolic syndrome are associated with altered myocardial structure, microvasculature, and expression of AGEs and receptor for AGEs (RAGE in men with coronary artery disease. Methods We performed histological analysis of left ventricular biopsies from 13 control, 10 diabetic and 23 metabolic syndrome men undergoing coronary artery bypass graft surgery who did not have heart failure or atrial fibrillation, had not received loop diuretic therapy, and did not have evidence of previous myocardial infarction. Results All three patient groups had similar extent of coronary artery disease and clinical characteristics, apart from differences in metabolic parameters. Diabetic and metabolic syndrome patients had higher pulmonary capillary wedge pressure than controls, and diabetic patients had reduced mitral diastolic peak velocity of the septal mitral annulus (E', consistent with impaired diastolic function. Neither diabetic nor metabolic syndrome patients had increased myocardial interstitial fibrosis (picrosirius red, or increased immunostaining for collagen I and III, the AGE Nε-(carboxymethyllysine, or RAGE. Cardiomyocyte width, capillary length density, diffusion radius, and arteriolar dimensions did not differ between the three patient groups, whereas diabetic and metabolic syndrome patients had reduced perivascular fibrosis. Conclusions Impaired diastolic function of type 2 diabetic and metabolic syndrome patients was not dependent on increased myocardial fibrosis, cardiomyocyte hypertrophy, alteration of the

  13. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

    Science.gov (United States)

    Eisele, Tom; Nunninger, Peter; Münz, Benedikt

    2017-01-01

    Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred. PMID:28409033

  14. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm

    Directory of Open Access Journals (Sweden)

    Sorin Giusca

    2017-01-01

    Full Text Available Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.

  15. [Effect of different concentrations liposomal emoxipine on coronary flow, contractive and pump function of the isolated rat heart after normotermic ischema and further reperfusion].

    Science.gov (United States)

    Toropova, Ia G; Mukhamadiiarov, R A; Golovkin, A S

    2013-07-01

    In the experiments on the isolated perfused rat heart we studied the effects of liposomes containing different concentrations (0.25 and 0.1 mg/ml) of emoxipine on coronary flow, contractive and pump function of the isolated heart, which was effected by total normothermical ischemia and reperfusion. The parameters of the contractile activity of hearts, coronary flow and pump function of the hearts were assessed. It was detected that the introduction of the liposomal emoxipine during ischemia provides a protective effect against ischemic and reperfusion myocardial damage and smaller concentration of the emoxipin (0.1 mg/ml) in composition with the liposomes promote the best recovery of contractile activity and the pumping function of the ischemic heart in the period of the reperfusion.

  16. Depression Mediates the Effect of Sexual Function on Quality of Life among Men but Not Women with Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Shervin Assari

    2014-12-01

    Full Text Available Background: Poor sexual function is associated with impaired Health-Related Quality of Life (HRQoL, and patients with Coronary Artery Disease (CAD are not exceptions. It is not known, however, if symptoms of depression mediate the effect of sexual function on HRQoL among men and women with CAD. Objectives: This study aimed to determine the mediating effect of depressive symptoms on the association between sexual function and HRQoL among men and women with CAD. Patients and Methods: This cross-sectional study was conducted on 401 men and 156 women with CAD. Sexual function, measured by the Relation and Sexuality Scale (RSS, was the independent variable. In addition, physical and mental HRQoL measured using physical and mental health summary scores of Short Form 36 (SF-36 were dependent variables. Besides, the severity of depressive symptoms measured by the Hospital Anxiety and Depression Scale (HADS was conceptualized as the mediator. Age, income, education, and medical comorbidities (Ifudu index were control variables, and gender was the moderator. Multi-group path analysis was conducted using AMOS20.0 for data analysis. Results: When the effects of age, education, income, and comorbidities were controlled, sexual function was correlated with poor mental HRQoL in both genders. However, the association between sexual function and poor physical HRQoL could be found only among men but not women. Evidence also supported partial mediation of depressive symptoms on the effect of sexual function on mental HRQoL of both men and women. Nonetheless, the results suggested partial mediation of depressive symptoms on the effect of sexual function on physical HRQoL only among men but not women. Conclusions:: Symptoms of depression may not have a similar role in explaining the effect of sexual function on physical HRQoL of men and women with CAD. Our findings suggest that only among men, depressive symptoms might be the mechanism by which sexual function

  17. Corrected thrombolysis in myocardial infarction frame counts in diabetic patients with angiographically normal coronary arteries.

    Science.gov (United States)

    Turkoglu, Sedat; Ozdemir, Murat; Tacoy, Gulten; Tavil, Yusuf; Abaci, Adnan; Timurkaynak, Timur; Cengel, Atiye

    2008-08-01

    To evaluate corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC) in patients with angiographically normal coronary arteries and diabetes mellitus, a condition known to be associated with microvascular dysfunction. Patients who underwent coronary angiography in Gazi University Hospital, Ankara, Turkey between January 2000 and January 2005 were studied. Corrected TIMI frame count was calculated over the left anterior descending (LAD), left circumflex (Cx) and right coronary arteries (RCA) in 118 diabetic and 122 non-diabetic patients with normal coronary angiogram. The mean CTFC values of the LAD, Cx, and the RCA were similar in diabetics and nondiabetics 21.0 +/= 7.5 versus 21.3 +/= 9.6, 23.3 +/= 9.7 versus 23.5 +/= 10.8, 17.9 +/= 6.7 versus 18.7 +/=7.4 respectively, p>0.05 for all comparisons. In stepwise multivariate linear regression analysis, body surface area had a significant correlation with CTFC of all the 3 coronary arteries. We conclude that CTFC in diabetics and non-diabetics with angiographically normal coronary arteries is similar. Since microvascular disease is an inherent component of diabetes, our finding may reflect the inadequacy of CTFC in predicting microvascular disease in diabetic patients with normal coronary angiograms.

  18. Microvascular and immunological studies in Raynaud's phenomenon.

    NARCIS (Netherlands)

    Houtman, Pieternella Maria

    1985-01-01

    The purpose of this thesis was to investigate the diagnostic significance of microvascular abnormalities - as observed in the nailfold - in patients with RP with respect to the presence or development of a connective tissue disease. In addition, we investigated whether the observed abnormalities wer

  19. Microvascular and immunological studies in Raynaud's phenomenon.

    NARCIS (Netherlands)

    Houtman, Pieternella Maria

    1985-01-01

    The purpose of this thesis was to investigate the diagnostic significance of microvascular abnormalities - as observed in the nailfold - in patients with RP with respect to the presence or development of a connective tissue disease. In addition, we investigated whether the observed abnormalities wer

  20. How to assess microvascular structure in humans.

    Science.gov (United States)

    Rizzoni, Damiano; Aalkjaer, Christian; De Ciuceis, Carolina; Porteri, Enzo; Rossini, Claudia; Rosei, Claudia Agabiti; Sarkar, Annamaria; Rosei, Enrico Agabiti

    2011-12-01

    Structural alterations of subcutaneous small resistance arteries, as indicated by an increased media to lumen ratio, are frequently present in hypertensive and/or diabetic patients. However, the evaluation of microvascular structure is not an easy task. Among the methods that may be applied to humans, plethysmographic evaluation of small arteries and wire or pressure micromyography were extensively used in the last decades. Media to lumen ratio of small arteries evaluated by micromyography was demonstrated to possess a strong prognostic significance; however, its extensive evaluation is limited by the invasiveness of the assessment, since a biopsy of subcutaneous fat is needed. Non-invasive approaches were then proposed, including capillaroscopy, which provides information about microvascular rarefaction. Recently, the interest of investigators has focused on the retinal microvascular bed. In particular, a non-invasive measurement of wall thickness to internal lumen ratio of retinal arterioles using scanning laser Doppler flowmetry has been recently introduced. Preliminary data suggest a fairly good agreement between this approach and micromyographic measurements, generally considered the gold standard approach. Therefore, the evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the immediate future, an evaluation to be performed in all hypertensive patients, in order to obtain a better stratification of cardiovascular risk. © 2011 Adis Data Information BV. All rights reserved.

  1. CT coronary angiography vs. invasive coronary angiography in CHD

    Directory of Open Access Journals (Sweden)

    Anja Hagen

    2012-04-01

    stenoses and two diagnostic studies using intracoronary pressure measurement as the reference standard (identification of functionally relevant stenoses were included in the medical evaluation. Meta-analysis of the nine studies of higher methodological quality showed that, CT coronary angiography with invasive coronary angiography as the reference standard, had a sensitivity of 96 % (95 % CI: 93 % to 98 %, specificity of 86 % (95 % CI: 83 % to 89 %, positive likelihood ratio of 6.38 (95 % CI: 5.18 to 7.87 and negative likelihood ratio of 0.06 (95 % CI: 0.03 to 0.10. However, due to non-diagnostic CT images approximately 3.6 % of the examined patients required a subsequent invasive coronary angiography. Using intracoronary pressure measurement as the reference standard, CT coronary angiography compared to invasive coronary angiography had a sensitivity of 80 % (95 % CI: 61 % to 92 % versus 67 % (95 % CI: 51 % to 78 %, a specificity of 67 % (95 % CI: 47 % to 83 % versus 75 % (95 % CI: 60 % to 86 %, an average positive likelihood ratio of 2.3 versus 2.6, and an average negative likelihood ratio 0.3 versus 0.4, respectively. Compared to invasive coronary angiography, the average effective radiation dose of CT coronary angiography was higher with retrospective electrocardiogram (ECG gating and relatively similar with prospective ECG gating. The health economic model using invasive coronary angiography as the reference standard showed that at a pretest probability of CHD of 50 % or lower, CT coronary angiography resulted in lower cost per patient with true positive diagnosis. At a pretest probability of CHD of 70 % or higher, invasive coronary angiography was associated with lower cost per patient with true positive diagnosis. Using intracoronary pressure measurement as the reference standard, both types of coronary angiographies resulted in substantially higher cost per patient with true positive diagnosis. Two publications dealing explicitly with ethical aspects were

  2. GLP-1 increases microvascular recruitment but not glucose uptake in human and rat skeletal muscle

    DEFF Research Database (Denmark)

    Sjøberg, Kim Anker; Holst, Jens Juul; Rattigan, Stephen

    2014-01-01

    The insulinotropic gut hormone, glucagon-like-peptide-1 (GLP-1) has been proposed to have effects on vascular function and glucose disposal. However, whether GLP-1 is able to increase microvascular recruitment (MVR) in humans has not been investigated. GLP-1 was infused in the femoral artery...... in overnight fasted healthy young men. Microvascular recruitment was measured with real time contrast-enhanced ultrasound and leg glucose uptake by the leg balance technique with and without inhibition of the insulinotropic response of GLP-1 by co-infusion of octreotide. As a positive control, MVR and leg...

  3. Increased brachial-ankle pulse wave velocity is associated with impaired endothelial function in patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    LIU Dong-hong; TAO Jun; WANG Yan; LIAO Xin-xue; XU Ming-guo; WANG Jie-mei; YANG Zhen; CHEN Long; L(U) Ming-de; LU Kun

    2006-01-01

    Background Pulse wave velocity and flow-mediated vasodilation (FMD) are widely used as noninvasive modalities for evaluating atherosclerosis. However, it is not known whether pulse wave velocity is related to FMD in patients with coronary artery disease (CAD). Therefore, the present study was designed to investigate the alteration in brachial-ankle pulse wave velocity (baPWV) and endothelial function in CAD patients.Methods Thirty-three patients with CAD and thirty control subjects were recruited for this study. baPWV was measured non-invasively using a VP 1000 automated PWV/ABI analyzer (PWV/ABI, Colin Co. Ltd., Komaki,Japan). Endothelial function as reflected by FMD in the brachial artery was assessed with a high-resolution ultrasound device.Results baPWV was increased in CAD patients compared with control subjects [(1756.1±253.1) cm/s vs(1495.3 ± 202.3) cm/s, P<0.01]. FMD was significantly reduced in CAD patients compared with control subjects[(5.2±2.1) % vs (11.1 ±4.4) %, P<0.01]. baPWV correlated with FMD (r =-0.68, P<0.001). The endothelium-independent vasodilation induced by sublingual nitroglycerin in the brachial artery was similar in the CAD group compared with the control group.Conclusions CAD is associated with increased baPWV and endothelial dysfunction. Increased baPWV parallels diminished endothelial function. Our data therefore suggest that baPWV can be used as a noninvasive surrogate index in clinical evaluation of endothelial function.

  4. Comparing Heparin-Coated and Non-Coated Oxygenators on Renal Functions in Coronary Artery Bypass Surgery

    Directory of Open Access Journals (Sweden)

    Bektaş Battaloğlu

    2011-04-01

    Full Text Available Background: Renal damage and subsequent acute renal failure is one of the most important complications in patients who had cardiac surgery. Multicenter studies with thousands of patients which exposed the risk factors for acute renal failure has been published especially in the last decade. This study is designed for evaluation of heparin-coated and non-coated oxygenators on the renal functions. Methods: This study has been performed prospectively with 50 patients who had undergone coronary bypass surgery in our clinic from March 2006 to September 2006. The patients have been divided into two groups as non-coated oxygenators (n = 25, Group 1 used and heparin-coated oxygenators (n = 25, Group 2 used. Blood samples were collected at the preoperative, and at 1st, 24th and 96th postoperative hours. The demographic data were similar in two groups. Results: There was no early mortality in both groups. Operative and postoperative parameters were similar in both groups. There were no statistical differences between the evaluated parameters like BUN, creatinine, sodium, potassium, calcium, chloride, phosphorus, urine protein, creatinine clearence, urine sodium, urine calcium and urine chloride tests at preoperative period in both groups. We did not detect renal dysfunction in any patients. There are no statistical differences in the creatinine clearance in preoperative and postoperative periods in both groups. In group one, creatinin levels were lower than group two at 24 hours after surgery and these differences were statistically important in two groups. We found no significant difference between two groups regarding the other parameters for renal function during the postoperative period. Conclusion: In this study, there were not any significant difference between coated and non-coated oxygenators’ effects over renal functions of patients whose renal functions were normal preoperatively.

  5. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2016-01-01

    Full Text Available Background. Proangiogenic Hematopoietic Cells (PHC which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4±7.40 yo preimplant NT proBNP level is 5124.5±4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87±0.41, 0.63±0.66, 99.00±2.60, and 3.22±3.79%, respectively. LVEF was improved (22±5.68 versus 26.8±7.93, p<0.001 during short and long term observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  6. Relationship between site of myocardial infarction, left ventricular function and cytokine levels in patients undergoing coronary artery surgery.

    Science.gov (United States)

    Kiris, Ilker; Kapan, Sahin; Narin, Cuneyt; Ozaydın, Mehmet; Cure, Medine Cumhur; Sutcu, Recep; Okutan, Huseyin

    The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.

  7. Identification of Risk Pathways and Functional Modules for Coronary Artery Disease Based on Genome-wide SNP Data

    Directory of Open Access Journals (Sweden)

    Xiang Zhao

    2016-12-01

    Full Text Available Coronary artery disease (CAD is a complex human disease, involving multiple genes and their nonlinear interactions, which often act in a modular fashion. Genome-wide single nucleotide polymorphism (SNP profiling provides an effective technique to unravel these underlying genetic interplays or their functional involvements for CAD. This study aimed to identify the susceptible pathways and modules for CAD based on SNP omics. First, the Wellcome Trust Case Control Consortium (WTCCC SNP datasets of CAD and control samples were used to assess the joint effect of multiple genetic variants at the pathway level, using logistic kernel machine regression model. Then, an expanded genetic network was constructed by integrating statistical gene–gene interactions involved in these susceptible pathways with their protein–protein interaction (PPI knowledge. Finally, risk functional modules were identified by decomposition of the network. Of 276 KEGG pathways analyzed, 6 pathways were found to have a significant effect on CAD. Other than glycerolipid metabolism, glycosaminoglycan biosynthesis, and cardiac muscle contraction pathways, three pathways related to other diseases were also revealed, including Alzheimer’s disease, non-alcoholic fatty liver disease, and Huntington’s disease. A genetic epistatic network of 95 genes was further constructed using the abovementioned integrative approach. Of 10 functional modules derived from the network, 6 have been annotated to phospholipase C activity and cell adhesion molecule binding, which also have known functional involvement in Alzheimer’s disease. These findings indicate an overlap of the underlying molecular mechanisms between CAD and Alzheimer’s disease, thus providing new insights into the molecular basis for CAD and its molecular relationships with other diseases.

  8. Dual-step prospective ECG-triggered 128-slice dual-source CT for evaluation of coronary arteries and cardiac function without heart rate control: a technical note

    Energy Technology Data Exchange (ETDEWEB)

    Feuchtner, Gudrun [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Innsbruck Medical University, Department of Radiology II, Innsbruck (Austria); Goetti, Robert; Marincek, Borut; Alkadhi, Hatem; Leschka, Sebastian [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); Plass, Andre; Wieser, Monika [University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland); Baumueller, Stephan; Stolzmann, Paul; Scheffel, Hans [University Hospital Zurich, Institute of Diagnostic Radiology, Zurich (Switzerland); University Hospital Zurich, Clinic for Cardiovascular Surgery, Zurich (Switzerland)

    2010-09-15

    To describe prospective ECG-triggered dual-source CT dual-step pulsing (pECG{sub dual-step}) for evaluation of coronary arteries and cardiac function. Fifty-one consecutive patients pre- or post-cardiovascular surgery were examined with adaptive sequential tube current modulated (pECG{sub dual-step}) 128-slice dual-source CT without heart rate control (main padding window: 40% RR interval >65 bpm/70% RR interval <65 bpm). Image quality of coronary arteries was graded (4-point scale), and cardiac function was evaluated. Mean HR was 68 bpm. Thirty-seven patients were in stable sinus rhythm (SR); 14 had arrhythmia. Image quality of coronary arteries was diagnostic in 804/816 (98%) of segments. The number of non-diagnostic segments was higher in patients with arrhythmia as compared to those in SR (4% vs. 0.5%; p = 0.01), and there were fewer segments with excellent image quality (79% vs. 94%; p < 0.001) and more segments with impaired image quality (p < 0.001 and p = 0.002). Global and regional LV function could be evaluated in 41 (80%) and 47 (92%) patients, and valvular function in 48 (94%). In 11/14 of patients with arrhythmia, the second step switched to full mAs, increasing radiation exposure to 8.6 mAs (p < 0.001). The average radiation dose was 3.8 mSv (range, 1.7-7.9) in patients in SR. pECG{sub dual-step}128-slice DSCT is feasible for the evaluation of coronary arteries and cardiac function without heart rate control in patients in stable sinus rhythm at a low radiation dose. (orig.)

  9. Microvascular pericytes in healthy and diseased kidneys

    Directory of Open Access Journals (Sweden)

    Pan SY

    2014-01-01

    Full Text Available Szu-Yu Pan,1,2 Yu-Ting Chang,3 Shuei-Liong Lin1,31Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 2Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan; 3Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, TaiwanAbstract: Pericytes are interstitial mesenchymal cells found in many major organs. In the kidney, microvascular pericytes are defined anatomically as extensively branched, collagen-producing cells in close contact with endothelial cells. Although many molecular markers have been proposed, none of them can identify the pericytes with satisfactory specificity or sensitivity. The roles of microvascular pericytes in kidneys were poorly understood in the past. Recently, by using genetic lineage tracing to label collagen-producing cells or mesenchymal cells, the elusive characteristics of the pericytes have been illuminated. The purpose of this article is to review recent advances in the understanding of microvascular pericytes in the kidneys. In healthy kidney, the pericytes are found to take part in the maintenance of microvascular stability. Detachment of the pericytes from the microvasculature and loss of the close contact with endothelial cells have been observed during renal insult. Renal microvascular pericytes have been shown to be the major source of scar-forming myofibroblasts in fibrogenic kidney disease. Targeting the crosstalk between pericytes and neighboring endothelial cells or tubular epithelial cells may inhibit the pericyte-myofibroblast transition, prevent peritubular capillary rarefaction, and attenuate renal fibrosis. In addition, renal pericytes deserve attention for their potential to produce erythropoietin in healthy kidneys as pericytes stand in the front line, sensing the change of oxygenation and hemoglobin concentration. Further delineation of the mechanisms underlying the

  10. Effects of allopurinol and vitamin E on renal function in patients with cardiac coronary artery bypass grafts

    Directory of Open Access Journals (Sweden)

    Nader Nouri-Majalan

    2009-05-01

    Full Text Available Nader Nouri-Majalan1, Ehsan Fotouhi Ardakani2, Khalil Forouzannia3, Hosein Moshtaghian41Department of Nephrology, 3Department of Cardiovascular Surgery, 4Department of Anesthesiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2Ali bin Abu Taleb Medical College, Yazd Azad University, Yazd, IranBackground: Acute renal failure is a common complication of cardiac surgery, with oxidants found to play an important role in renal injury. We therefore assessed whether the supplemental antioxidant vitamin E and the inhibitor of xanthine oxidase allopurinol could prevent renal dysfunction after coronary artery bypass graft (CABG surgery.Methods: Of 60 patients with glomerular filtration rate (GFR < 60 mL/min scheduled to undergo CABG surgery, 30 were randomized to treatment with vitamin E and allopurinol for 3–5 days before surgery and 30 to no treatment. Serum creatinine levels and potassium and creatinine clearances were measured preoperatively and daily until day 5 after surgery. Results: The patients consisted of 31 males and 29 females, with a mean age of 63 ± 9 years. After surgery, there were no significant differences in mean serum creatinine (1.2 ± 0.33 vs 1.2 ± 0.4 mg/dL; p = 0.43 concentrations, or creatinine clearance (52 ± 12.8 vs 52 ± 12.8 mL/min; p = 0.9. The frequency of acute renal failure did not differ in treatment group compared with control (16% vs 13%; p = 0.5. Length of stay in the intensive care unit (ICU was significantly longer in the control than in the treated group (3.9 ± 1.5 vs 2.6 ± 0.7 days; p < 0.001.Conclusion: Prophylactic treatment with vitamin E and allopurinol had no renoprotective effects in patients with pre-existing renal failure undergoing CABG surgery. Treatment with these agents, however, reduces the duration of ICU stay.Keywords: antioxidants, coronary artery bypass, prevention and control, renal function

  11. Radionuclide left ventricular dV/dt for the assessment of cardiac function in patients with coronary disease.

    Science.gov (United States)

    Bianco, J A; Makey, D G; Laskey, W K; Shafer, R B

    1979-01-01

    To investigate potential uses of left-ventricular (LV) systolic ejection rate (LV dV/dt) in the evaluation of LV function, we examined the effect of exercise, angiotensin, and leg raising on LV ejection fraction and LV dV/dt in patients with coronary-artery disease. The following observations were made: a) LV ejection fraction and dV/dt changed proportionately, but in opposite directions, during supine exercise; b) LV ejection fraction and dV/dt decreased to a similar extent during angiotensin infusions; and c) LV ejection fraction and dV/dt were unchanged by leg raising. The changes in peak and mean LV dV/dt were similar. Regardless of the physiologic state, peak LV dV/dt occurred during the first third of systole. These data imply that in this population there were no specific advantages of LV dV/dt over LV ejection fraction in the evaluation of LV performance.

  12. Does postsystolic motion or shortening predict recovery of myocardial function after primary percutanous coronary intervention?

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Poulsen, Steen Hvitfeldt; Nørgaard, Bjarne Linde;

    2007-01-01

    or shortening appears more frequently in the acute phase in myocardial segments with impaired systolic function compared with normally functioning segments. However, presence of postsystolic contraction is not associated with improvement in strain or wall-motion score at follow-up, and does not seem......OBJECTIVE: The purpose of the study was to evaluate whether presence of postsystolic motion or shortening defined by Doppler tissue imaging may predict recovery of regional myocardial function in patients with ST-elevation myocardial infarction. METHODS: Echocardiography was performed a few hours......); and normal myocardial function in the acute phase (type E, n = 759). RESULTS: There were no differences among type A, B, C, and D segments with regard to the proportion presenting postsystolic tissue velocity equal to or greater than 1.0 cm/s (0.52, 0.54, 0.60, and 0.47, respectively, P = .20...

  13. Association of low educational status with microvascular complications in type 2 diabetes: Jaipur diabetes registry

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    Niharikaa Sharma

    2015-01-01

    Full Text Available Objective: To determine the association of educational status (ES, as marker of socioeconomic status, with the prevalence of microvascular complications in diabetes.Methods: Successive patients (n = 1214 presenting to our center were evaluated for sociodemographic, anthropometric, clinical, and therapeutic variables. Subjects were classified according to ES into Group 1 (illiterate, 216; Group 2 (≤ primary, 537, Group 3 (≤ higher secondary, 312, and Group 4 (any college, 149. Descriptive statistics is reported. Results: Mean age of patients was 52 ± 10 years, duration of diabetes 7 ± 7 years and 55% were men. Prevalence of various risk factors was smoking/tobacco 25.5%, obesity body mass index ≥25 kg/m2 64.0%, abdominal obesity 63.4%, hypertension 67.5%, high fat diet 14.5%, low fruits/vegetables 31.8%, low fiber intake 60.0%, high salt diet 16.9%, physical inactivity 27.5%, coronary or cerebrovascular disease 3.0%, and microvascular disease (peripheral, ocular or renal in 20.7%. Microvascular disease was significantly greater in illiterate (25.9% and low (23.6% compared to middle (15.0% and high (14.7% ES groups (P .0% was significantly greater in illiterate (38.0%, low (46.0%, and middle (41.0% compared to high (31.5% ES subjects (P < 0.05. Conclusions: There is a greater prevalence of the microvascular disease in illiterate and low ES diabetes patients in India. This is associated with the higher prevalence of smoking/tobacco use, poor quality diet, and sub-optimal diabetes control.

  14. The influence of admission glucose on epicardial and microvascular flow after primary angioplasty

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background Patients with elevated admission glucose levels may be at increased risk of death after myocardial infarction, independent of other baseline risk factors and more severe coronary artery disease. However, data regarding admission glucose and epicardial and microvascular flow after primary angioplasty is limited.Methods Angioplasty was performed in 308 ST-segment elevated myocardial infarction patients. Patients were divided into 3 groups on the basis of admission glucose level: group 1, <7.8 mmol/L; group 2, (7.8 - 11.0) mmol/L; and group 3, ≥11.0 mmol/L. Results Compared with group 1, patients in group 2 and group 3 were more often female and older. Triglycerides (TG) in group 3 were significantly higher than group 1. At angiography, they more frequently had 2-vessel or 3-vessel disease. In the infarct-related artery, there was no relationship between hyperglycemia and thrombolysis in myocardial infarction (TIMI) 3 flow after percutaneous coronary intervention (PCI) (89.7%, 86.0% and 86.3%, P=NS). However, corrected TIMI frame count (CTFC) in group 2 and group 3 were more than group 1. TIMI myocardial perfusion grade (TMPG) 0-1 grade among patients with hyperglycemia after PCI were more frequent (30.9% and 29.0% vs 17.3%, P<0.05). There was less frequent complete ST-segment resolution (STR) and early T wave inversion among patients with hyperglycemia after PCI. Conclusion Elevated admission glucose levels in ST-segment elevation myocardial infarction patients treated with primary PCI are independently associated with impaired microvascular flow. Abnormal microvascular flow may contribute at least in part to the poor outcomes observed in patients with elevated admission glucose.

  15. A model of physical factors in the structural adaptation of microvascular networks in normotension and hypertension

    DEFF Research Database (Denmark)

    Jacobsen, Jens Christian Brings; Gustafsson, Finn; Holstein-Rathlou, N.-H.

    2003-01-01

    hemodynamic stimuli in the individual vessel. Simulated results show emanating microvascular networks with properties similar to those observed in vivo. The model points to an altered endothelial function as a key factor in the development of vascular changes characteristic of hypertension....

  16. [Relations of the duration of pre-existing angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction].

    Science.gov (United States)

    Juillière, Y; Danchin, N; Grentzinger, A; Suty-Selton, C; Perrin, O; Guenoun, P; Pernot, C; Cherrier, F

    1990-10-01

    The aim of this retrospective study was to determine the relationship between the duration of preceding angina pectoris, collateral circulation and left ventricular function after isolated coronary occlusion with or without myocardial infarction. Coronary angiography of 138 consecutive patients showed isolated and complete occlusions of the left anterior descending (58 patients) or right coronary artery (80 patients). One hundred and four patients had myocardial infarction with (Group A, n = 21) or without (Group B, n = 83) preceding angina pectoris and 34 had angina without myocardial infarction (Group C). The left ventricular ejection fraction was measured by ventriculography in the 30 degrees right anterior oblique projection. The collateral circulation was assessed by coronary angiography and evaluated as follows: no flow or flow limited to collateral branches (subgroup 1) and partial or complete filling of the epicardial arterial segment (subgroup 2). In the global population the left ventricular ejection fraction was higher and the duration of preceding angina pectoris was longer in the subgroups with a well developed collateral circulation. There was no difference in ejection fraction between Groups A and B (presence of myocardial infarction), on the other hand, within each of the groups, a good collateral circulation (subgroup 2) was associated with a significantly higher ejection fraction. Group C (without infarction) patients had better ejection fractions than Groups A or B, especially when the collateral circulation was poorly developed. Within Group C, the quality of the collateral circulation did not seem to affect the ejection fraction. The left ventricular ejection fraction is lower in patients with isolated coronary occlusion and myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. Microvascular Disease and Ischemic Heart Disease%微血管病变与缺血性心脏病

    Institute of Scientific and Technical Information of China (English)

    田骆冰; 夏岳; 刘超; 刘坤申

    2009-01-01

    冠状动脉微血管在心肌的血供中起着重要作用,冠状动脉微循环对冠心病的发生、发展、疗效及预后具有重要影响而备受人们重视.目前冠状动脉微血管病变主要分为X综合征和冠脉内慢血流现象,二者都与缺血性心脏病存在着密切的关系,但发病机制有所不同.X综合征主要是冠状动脉微血管痉挛所致,而冠脉内慢血流现象传统上被认为与微血管功能失调有关.此外慢血流现象可能是缺血性心脏病的一种新的发病机制,它可能代表了动脉粥样硬化和内皮功能失调的早期阶段.并且二者在治疗上有所不同.%Small coronary arteries play an important role in the blood supply of the myocardial tissues. Microcirculation has an important effect on the pathogenesis, development, therapy, and prognosis of coronary artery disease. At present, coronary microvascular disease mainly includes syndrome X and coronary slow flow phenomenon, which is closely related to ischemic heart disease. However, their pathogenesis differs;syndrome X is caused by a spasm of the microvessels, while coronary slow flow phenomenon is related to a microvascular disfunction. Coronary slow flow phenomenon may be a new pathogenic mechanism for ischemic heart disease.

  18. Brain volume and cognitive function in patients with revascularized coronary artery disease

    NARCIS (Netherlands)

    Ottens, Thomas H; Hendrikse, Jeroen|info:eu-repo/dai/nl/266590268; Nathoe, Hendrik M|info:eu-repo/dai/nl/267961472; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van Dijk, Diederik|info:eu-repo/dai/nl/241616301

    2017-01-01

    BACKGROUND: The pathogenesis of cognitive dysfunction in patients with CAD remains unclear. CAD is associated with brain atrophy and specific lesions. Detailed knowledge about the association of brain volume measured with MRI, and cognitive function in patients with CAD is lacking. We therefore

  19. The effects of optimism and gratitude on adherence, functioning and mental health following an acute coronary syndrome.

    Science.gov (United States)

    Millstein, Rachel A; Celano, Christopher M; Beale, Eleanor E; Beach, Scott R; Suarez, Laura; Belcher, Arianna M; Januzzi, James L; Huffman, Jeff C

    This study examined the effects of optimism and gratitude on self-reported health behavior adherence, physical functioning and emotional well-being after an acute coronary syndrome (ACS). Among 156 patients, we examined associations between optimism and gratitude measured 2 weeks post-ACS and 6-month outcomes: adherence to medical recommendations, mental and physical health-related quality of life (HRQoL), physical functioning, depressive symptoms and anxiety. Multivariable linear regression models were used, controlling for increasing levels of adjustment. Optimism [β=.11, standard error (S.E.)=.05, P=.038] and gratitude (β=.10, S.E.=.05, P=.027) at 2 weeks were associated with subsequent self-reported adherence to medical recommendations (diet, exercise, medication adherence, stress reduction) at 6 months in fully adjusted models. Two-week optimism and gratitude were associated with improvements in mental HRQoL (optimism: β=.44, S.E.=.13, P=.001; gratitude: β=.33, S.E.=.12, P=.005) and reductions in symptoms of depression (optimism: β=-.11, S.E.=.05, P=.039; gratitude: β=-.10, S.E.=.05, P=.028) and anxiety (optimism: β=-.15, S.E.=.05, P=.004; gratitude: β=-.10, S.E.=.05, P=.034) at 6 months. Optimism and gratitude at 2 weeks post-ACS were associated with higher self-reported adherence and improved emotional well-being 6 months later, independent of negative emotional states. Optimism and gratitude may help recovery from an ACS. Interventions promoting these positive constructs could help improve adherence and well-being. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Long noncoding RNA-MEG3 is involved in diabetes mellitus-related microvascular dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Qiu, Gui-Zhen [Department of Health, Linyi People' s Hospital, Shandong University, Shandong (China); Tian, Wei [Department of Nursing, Linyi Oncosurgical Hospital, Shandong (China); Fu, Hai-Tao [Department of Ophthalmology, Linyi People' s Hospital, Shandong University, Shandong (China); Li, Chao-Peng, E-mail: lcpcn@163.com [Eye Institute of Xuzhou, Jiangsu (China); Liu, Ban, E-mail: liuban@126.com [Department of Cardiology, Shanghai Tenth People' s Hospital, Tongji University School of Medicine, Shanghai (China)

    2016-02-26

    Microvascular dysfunction is an important characteristic of diabetic retinopathy. Long non-coding RNAs (lncRNAs) play important roles in diverse biological processes. In this study, we investigated the role of lncRNA-MEG3 in diabetes-related microvascular dysfunction. We show that MEG3 expression level is significantly down-regulated in the retinas of STZ-induced diabetic mice, and endothelial cells upon high glucose and oxidative stress. MEG3 knockdown aggravates retinal vessel dysfunction in vivo, as shown by serious capillary degeneration, and increased microvascular leakage and inflammation. MEG3 knockdown also regulates retinal endothelial cell proliferation, migration, and tube formation in vitro. The role of MEG3 in endothelial cell function is mainly mediated by the activation of PI3k/Akt signaling. MEG3 up-regulation may serve as a therapeutic strategy for treating diabetes-related microvascular complications. - Highlights: • LncRNA-MEG3 level is down-regulated upon diabetic stress. • MEG3 knockdown aggravates retinal vascular dysfunction in vivo. • MEG3 regulates retinal endothelial cell function in vitro. • MEG3 regulates endothelial cell function through PI3k/Akt signaling.

  1. Effect of yoga regimen on lung functions including diffusion capacity in coronary artery disease patients: A randomized controlled study.

    Science.gov (United States)

    Yadav, Asha; Singh, Savita; Singh, Kp; Pai, Preeti

    2015-01-01

    Lung functions are found to be impaired in coronary artery disease (CAD), congestive heart failure, left ventricular dysfunction, and after cardiac surgery. Diffusion capacity progressively worsens as the severity of CAD increases due to reduction in lung tissue participating in gas exchange. Pranayama breathing exercises and yogic postures may play an impressive role in improving cardio-respiratory efficiency and facilitating gas diffusion at the alveolo-capillary membrane. This study was done to see the effect of yoga regimen on lung functions particularly diffusion capacity in CAD patients. A total of 80 stable CAD patients below 65 years of age of both sexes were selected and randomized into two groups of 40 each. Group I CAD patients were given yoga regimen for 3 months which consisted of yogic postures, pranayama breathing exercises, dietary modification, and holistic teaching along with their conventional medicine while Group II CAD patients were put only on conventional medicine. Lung functions including diffusion capacity were recorded thrice in both the groups: 0 day as baseline, 22(nd) day and on 90(th) day by using computerized MS medisoft Cardio-respiratory Instrument, HYP'AIR Compact model of cardio-respiratory testing machine was manufactured by P K Morgan, India. The recorded parameters were statistically analyzed by repeated measures ANOVA followed by Tukey's test in both the groups. Cardiovascular parameters were also compared before and after intervention in both the groups. Statistically significant improvements were seen in slow vital capacity, forced vital capacity, peak expiratory flow rate, maximum voluntary ventilation, and diffusion factor/ transfer factor of lung for carbon monoxide after 3 months of yoga regimen in Group I. Forced expiratory volume in 1(st) sec (FEV1), and FEV1 % also showed a trend toward improvement although not statistically significant. HR, SBP and DBP also showed significant improvement in Group-I patients who

  2. Upregulation of SK3 and IK1 channels contributes to the enhanced endothelial calcium signaling and the preserved coronary relaxation in obese Zucker rats.

    Directory of Open Access Journals (Sweden)

    Belén Climent

    Full Text Available BACKGROUND AND AIMS: Endothelial small- and intermediate-conductance KCa channels, SK3 and IK1, are key mediators in the endothelium-derived hyperpolarization and relaxation of vascular smooth muscle and also in the modulation of endothelial Ca2+ signaling and nitric oxide (NO release. Obesity is associated with endothelial dysfunction and impaired relaxation, although how obesity influences endothelial SK3/IK1 function is unclear. Therefore we assessed whether the role of these channels in the coronary circulation is altered in obese animals. METHODS AND RESULTS: In coronary arteries mounted in microvascular myographs, selective blockade of SK3/IK1 channels unmasked an increased contribution of these channels to the ACh- and to the exogenous NO- induced relaxations in arteries of Obese Zucker Rats (OZR compared to Lean Zucker Rats (LZR. Relaxant responses induced by the SK3/IK1 channel activator NS309 were enhanced in OZR and NO- endothelium-dependent in LZR, whereas an additional endothelium-independent relaxant component was found in OZR. Fura2-AM fluorescence revealed a larger ACh-induced intracellular Ca2+ mobilization in the endothelium of coronary arteries from OZR, which was inhibited by blockade of SK3/IK1 channels in both LZR and OZR. Western blot analysis showed an increased expression of SK3/IK1 channels in coronary arteries of OZR and immunohistochemistry suggested that it takes place predominantly in the endothelial layer. CONCLUSIONS: Obesity may induce activation of adaptive vascular mechanisms to preserve the dilator function in coronary arteries. Increased function and expression of SK3/IK1 channels by influencing endothelial Ca2+ dynamics might contribute to the unaltered endothelium-dependent coronary relaxation in the early stages of obesity.

  3. The sulphydryl containing ACE inhibitor Zofenoprilat protects coronary endothelium from Doxorubicin-induced apoptosis.

    Science.gov (United States)

    Monti, Martina; Terzuoli, Erika; Ziche, Marina; Morbidelli, Lucia

    2013-10-01

    Pediatric and adult cancer patients, following the use of the antitumor drug Doxorubicin develop cardiotoxicity. Pharmacological protection of microvascular endothelium might produce a double benefit: (i) reduction of myocardial toxicity (the primary target of Doxorubicin action) and (ii) maintenance of the vascular functionality for the adequate delivery of chemotherapeutics to tumor cells. This study was aimed to evaluate the mechanisms responsible of the protective effects of the angiotensin converting enzyme inhibitor (ACEI) Zofenoprilat against the toxic effects exerted by Doxorubicin on coronary microvascular endothelium. We found that exposure of endothelial cells to Doxorubicin (0.1-1μM range) impaired cell survival by promoting their apoptosis. ERK1/2 related p53 activation, but not reactive oxygen species, was responsible for Doxorubicin induced caspase-3 cleavage. P53 mediated-apoptosis and impairment of survival were reverted by treatment with Zofenoprilat. The previously described PI-3K/eNOS/endogenous fibroblast growth factor signaling was not involved in the protective effect, which, instead, could be ascribed to cystathionine gamma lyase dependent availability of H2S from Zofenoprilat. Furthermore, considering the tumor environment, the treatment of endothelial/tumor co-cultures with Zofenoprilat did not affect the antitumor efficacy of Doxorubicin. In conclusion the ACEI Zofenoprilat exerts a protective effect on Doxorubicin induced endothelial damage, without affecting its antitumor efficacy. Thus, sulfhydryl containing ACEI may be a useful therapy for Doxorubicin-induced cardiotoxicity.

  4. Assessment of left and right ventricular diastolic and systolic functions using two-dimensional speckle-tracking echocardiography in patients with coronary slow-flow phenomenon.

    Directory of Open Access Journals (Sweden)

    Yonghuai Wang

    Full Text Available Coronary slow-flow phenomenon (CSFP is an angiographic diagnosis characterised by a low rate of flow of contrast agent in the normal or near-normal epicardial coronary arteries. Many of the patients with CSFP may experience recurrent acute coronary syndromes. However, current clinical practice tends to underestimate the impact of CSFP due to the yet unknown effect on the cardiac function. This study was performed to evaluate left ventricular (LV and right ventricular (RV diastolic and systolic functions, using two-dimensional (2D longitudinal strain and strain rate, in patients with CSFP, and to determine the relationships between the thrombolysis in myocardial infarction (TIMI frame count (TFC and LV and RV diastolic and systolic functions.Sixty-three patients with CSFP and 45 age- and sex-matched controls without CSFP were enrolled in the study. Diagnosis of CSFP was made by TFC. LV and RV diastolic and systolic functions were assessed by 2D speckle-tracking echocardiography.LV peak early diastolic longitudinal strain rate (LSRe was lower in patients with CSFP than in controls (P = 0.01. LV peak systolic longitudinal strain (LS and LV peak systolic longitudinal strain rate (LSRs were lower in patients with CSFP than in controls (P = 0.004 and P = 0.03, respectively. There was no difference in LV ejection fraction. RV peak early diastolic longitudinal strain rate (RSRe was lower in patients with CSFP than in controls (P = 0.03. There were no differences in RV peak systolic longitudinal strain (RS, RV peak systolic longitudinal strain rate (RSRs, or RV fractional area change among the groups. The mean TFC correlated negatively with LSRe and RSRe in patients with CSFP (r = -0.26, P = 0.04 and r = -0.32, P = 0.01, respectively.LV diastolic and systolic functions were impaired in patients with CSFP. CSFP also affected RV diastolic function, but not RV systolic function.

  5. Effect of intensive versus moderate lipid lowering on endothelial function and vascular responsiveness to angiotensin II in stable coronary artery disease.

    Science.gov (United States)

    van der Harst, Pim; Wagenaar, Lodewijk J; Buikema, Hendrik; Voors, Adriaan A; Plokker, H W Thijs; Morshuis, Wim J; Six, A Jacob; Boonstra, Piet W; Nickenig, Georg; Wassmann, Sven; van Veldhuisen, Dirk J; van Gilst, Wiek H

    2005-11-15

    Recent evidence has demonstrated that intensive lipid-lowering therapy with a high-dose statin provides significant clinical benefit beyond moderate lipid-lowering therapy. However, dose-dependent effects of short-term statin therapy on vascular function have not been demonstrated. We studied endothelial function and vascular responsiveness to angiotensin II in patients who had coronary artery diseased and were randomized to receive low- or high-dose atorvastatin (10 or 80 mg, respectively) or placebo. Internal thoracic artery segments were obtained during coronary bypass surgery and studied in vitro. Endothelium-dependent vasodilation was increased with atorvastatin therapy (p = 0.035) but was significantly increased further in patients who received 80 mg compared with those who received 10 mg of atorvastatin (p = 0.05). Endothelium improvement was accompanied by decreased vascular response to angiotensin II (p = 0.039). These findings suggest a mechanism for the clinical benefit of intensive lipid-lowering treatment in coronary heart disease.

  6. Structure and functioning of a multidisciplinary 'Heart Team' for patients with coronary artery disease: rationale and recommendations from a joint BCS/BCIS/SCTS working group.

    Science.gov (United States)

    Luckraz, Heyman; Norell, Michael; Buch, Mamta; James, Rachael; Cooper, Graham

    2015-10-01

    The decision-making process in the management of patients with ischaemic heart disease has historically been the responsibility of the cardiologist and encompasses medical management, percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG). Currently, there is significant geographical variability in the PCI:CABG ratio. There are now emerging recommendations that this decision-making process should be carried out through a multidisciplinary approach, namely the Heart Team. This work was carried out on behalf of The British Cardiovascular Society (BCS), Society for Cardiothoracic Surgery in Great Britain and Ireland (SCTS) and British Cardiovascular Intervention Society (BCIS). This manuscript sets out the principles for the functioning of the Heart Team. This work has been approved by the Executive Committees of BCS/BCIS/SCTS.

  7. Treatment of hemimasticatory spasm with microvascular decompression.

    Science.gov (United States)

    Wang, Yong-Nan; Dou, Ning-Ning; Zhou, Qiu-Meng; Jiao, Wei; Zhu, Jin; Zhong, Jun; Li, Shi-Ting

    2013-01-01

    Hemimasticatory spasm is a rare disorder characterized by paroxysmal involuntary contraction of the jaw-closing muscles. As the ideology and pathogenesis of the disease are still unclear, there has been no treatment that could give rise to a good outcome so far. Herein, we tried to use surgical management to cure the disease. Six patients with the disease were included in this study. These patients underwent microvascular decompression of the motor fibers of the trigeminal root. After the operation, all faces of the patients felt relaxed at varied degrees, except for 1 patient. Our study showed that microvascular decompression of the trigeminal nerve could lead to a better outcome. However, a control study with a large sample is needed before this technique is widely used.

  8. A mathematical model for the vessel recruitment in coronary microcirculation in the absence of active autoregulation.

    Science.gov (United States)

    Saracco, Alice; Bauckneht, Matteo; Verna, Edoardo; Ghiringhelli, Sergio; Repetto, Rodolfo; Sambuceti, Gianmario; Provasoli, Stefano; Storace, Marco

    2016-03-01

    This paper proposes a mathematical model for vessel recruitment in the microvascular coronary network. The model is based on microvascular network units (MVNUs), where we define a MVNU as a portion of the microvascular network comprising seven generations of identical, parallel-arranged vessels (upstream arteries, large and small arterioles, capillaries, small and large venules, and downstream veins). The model implements a new mechanism to describe the variation in the number of MVNU in response to sudden variations of the local input pressure. In particular, it describes a recruitment mechanism dependent on distal pressure which operates in the coronary microcirculatory network even in maximally dilated conditions. We apply the model to interpret data from 29 patients who underwent revascularization by percutaneous coronary intervention (PCI). Treated vessels were the left anterior descending coronary artery, the left circumflex and the right coronary artery in 26, 2 and 1 patients, respectively. Following intracoronary adenosine administration, distal coronary pressure and blood flow were 48 ± 18 mmHg and 45 ± 30 ml/min before PCI, respectively, and significantly increased afterwards to 80 ± 17 mmHg and 68 ± 32 ml/min (p<0.001). The model predicts an increase in MVNU number in patients with preserved wall motion in the myocardial region which underwent PCI. On the contrary, a decrease in MVNU number is predicted by the model in patients with regional dysfunction and implies a relatively lower response of maximal flow to revascularization.

  9. Intrinsic sex-specific differences in microvascular endothelial cell phosphodiesterases

    Science.gov (United States)

    Bingaman, Susan; Huxley, Virginia H.

    2010-01-01

    The importance of gonadal hormones in the regulation of vascular function has been documented. An alternate and essential contribution of the sex chromosomes to sex differences in vascular function is poorly understood. We reported previously sex differences in microvessel permeability (Ps) responses to adenosine that were mediated by the cAMP signaling pathway (Wang J, PhD thesis, 2005; Wang J and Huxley V, Proceedings of the VIII World Congress of Microcirculation, 2007; Wang J and Huxley VH, Am J Physiol Heart Circ Physiol 291: H3094–H3105, 2006). The two cyclic nucleotides, cAMP and cGMP, central to the regulation of vascular barrier integrity, are hydrolyzed by phosphodiesterases (PDE). We hypothesized that microvascular endothelial cells (EC) would retain intrinsic and inheritable sexually dimorphic genes with respect to the PDEs modulating EC barrier function. Primary cultured microvascular EC from skeletal muscles isolated from male and female rats, respectively, were used. SRY (a sex-determining region Y gene) mRNA expression was observed exclusively in male, not female, cells. The predominant isoform among PDE1–5, present in both XY and XX EC, was PDE4. Expression mRNA levels of PDE1A (male > female) and PDE3B (male < female) were sex dependent; PDE2A, PDE4D, and PDE5A were sex independent. Barrier function, Ps, was determined from measures of albumin flux across confluent primary cultured microvessel XY and XX EC monolayers. Consistent with intact in situ microvessels, basal monolayer Ps did not differ between XY (1.7 ± 0.2 × 10−6 cm/s; n = 8) and XX (1.8 ± 0.1 × 10−6 cm/s; n = 10) EC. Cilostazol, a PDE3 inhibitor, reduced (11%, P < 0.05) Ps in XX, not XY, cells. These findings demonstrate the presence and maintenance of intrinsic sex-related differences in gene expression and cellular phenotype by microvascular EC in a gonadal-hormone-free environment. Furthermore, intrinsic cell-sex likely contributes significantly to sexual dimorphism in

  10. Effect of danhong injection on endothelial injury, degree of inflammation and cardiac function of patients with acute coronary syndrome after interventional therapy

    Institute of Scientific and Technical Information of China (English)

    Yang Liu; Jin-Peng Xu; Wei-Ying Di; Jing Li; Zhan-Wen Xu; Xing-Zhou Zhao; Shu-Jiang Song; Fu-Lin Liu

    2016-01-01

    Objective:To analyze the effect of danhong injection on endothelial injury, degree of inflammation and cardiac function of patients with acute coronary syndrome after interventional therapy.Methods:A total of 104 patients with acute coronary syndrome who received inpatient treatment in our hospital from August 2012 to August 2015 were chosen as the research subjects and randomly divided into observation group 52 cases and control group 52 cases according to different treatment. Control group received clinical routine interventional therapy for acute coronary syndrome, the observation group received danhong injection adjuvant treatment on the basis of interventional therapy, and then endothelial injury, the degree of inflammation and cardiac function were compared between two groups.Results:After observation group received danhong injection adjuvant treatment, plasma vWF, ET-1 and NTG value were lower than those of control group while NO and FMD value were higher than those of control group (P<0.05); serum pentraxin-3, IL-18, IL-18/IL-10 and LpPLA2 value of observation group after treatment were lower than those of control group while IL-10 value was higher than that of control group (P<0.05); LVEDV, LVESV and BNP value of observation group after treatment were lower than those of control group while LVEF value was higher than that of control group (P<0.05).Conclusions: Danhong injection adjuvant therapy on the basis of interventional therapy for patients with acute coronary syndrome can reduce vascular endothelial and inflammatory injury, and play a positive role in cardiac protection.

  11. Fabrication, characterization, and modeling of microvascular composites

    Science.gov (United States)

    Ryan, Thomas J.

    Composite laminates of glass fiber and epoxy pre-preg were fabricated with microvascular channels. The channels were created using polylactic acid (PLA) filament that evaporates at a temperature of 392 °F (200 °C) above the resin cure temperature of 250 °F (121 °C). After the composite is cured, the panel was removed from the oven and allowed to cool to room temperature. The panel is then reheated to 392 °F to vaporize the filament, leaving a cylindrical channel. A microvascular channel can be used for withdrawing heat, damage detection and self-healing. However, increasing the temperatures of the laminate above the cure temperature of the resin causes excess cross linking, potentially decreasing the mechanical properties. Tensile and flexural mechanical tests were performed on composite specimens and tensile tests were performed on neat resin specimens. A three-dimensional finite element model (FEM) was developed to study the progressive deformation and damage mechanics under tensile loading. The load carrying capacity of the microvascular composite was shown to decrease by 40% from a standard composite material. This paper will present the details of the fabrication, characterization and modeling techniques that were used in this study.

  12. Microvascular structure as a prognostically relevant endpoint.

    Science.gov (United States)

    Agabiti-Rosei, Enrico; Rizzoni, Damiano

    2017-05-01

    Remodelling of subcutaneous small resistance arteries, as indicated by an increased media-to-lumen ratio, is frequently present in hypertensive, obese, or diabetic patients. The increased media-to-lumen ratio may impair organ flow reserve. This may be important in the maintenance and, probably, also in the progressive worsening of hypertensive disease. The presence of structural alterations represents a prognostically relevant factor, in terms of development of target organ damage or cardiovascular events, thus allowing us a prediction of complications in hypertension. In fact, media-to-lumen ratio of small arteries at baseline, and possibly their changes during treatment may have a strong prognostic significance. However, new, non-invasive techniques are needed before suggesting extensive application of the evaluation of remodelling of small arteries for the cardiovascular risk stratification in hypertensive patients. Some new techniques for the evaluation of microvascular morphology in the retina, currently under clinical investigation, seem to represent a promising and interesting future perspective. The evaluation of microvascular structure is progressively moving from bench to bedside, and it could represent, in the near future, an evaluation to be performed in all hypertensive patients, to obtain a better stratification of cardiovascular risk, and, possibly, it might be considered as an intermediate endpoint in the evaluation of the effects of antihypertensive therapy, provided that a demonstration of a prognostic value of non-invasive measures of microvascular structure is made available.

  13. Inability of coronary blood flow reserve measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients

    NARCIS (Netherlands)

    G-J. Laarman (GertJan); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.R. Jonkers; P.J. de Feyter (Pim)

    1991-01-01

    textabstractTo determine functional and anatomic changes in the first 24 hours after coronary angioplasty, we studied at random 15 patients (9 men, mean age 60 years) who underwent coronary angioplasty of 16 coronary arteries. Quantitative coronary angiography and coronary flow reserve measurements

  14. Inability of coronary blood flow reserve measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients

    NARCIS (Netherlands)

    G-J. Laarman (GertJan); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.R. Jonkers; P.J. de Feyter (Pim)

    1991-01-01

    textabstractTo determine functional and anatomic changes in the first 24 hours after coronary angioplasty, we studied at random 15 patients (9 men, mean age 60 years) who underwent coronary angioplasty of 16 coronary arteries. Quantitative coronary angiography and coronary flow reserve measurements

  15. Percutaneous Trans-Coronary Venous Mitral Annuloplasty in Patients With Functional Mitral Regurgitation: Analysis of Poznan Carillon Registry Data.

    Science.gov (United States)

    Kałmucki, Piotr; Jerzykowska, Olga; Dankowski, Rafał; Baszko, Artur; Kramer, Lucyna; Szyszka, Andrzej; Siminiak, Tomasz

    2016-12-01

    The purpose of our study is to verify, whether percutaneous mitral annuloplasty results in reverse remodeling in patients with functional mitral regurgitation (FMR) and impaired ejection fraction (EF) and to investigate which echo parameters may help in prediction of the efficacy of the procedure. FMR exacerbates left ventricular (LV) dilatation and contributes to both LV remodeling and heart failure. We analyzed baseline and 1 month follow-up data in 22 consecutive patients with FMR, who underwent successful percutaneous trans-coronary venous mitral annuloplasty with the Carillon device. Significant reduction of FMR echo parameters, including vena contracta (VC), effective regurgitant orifice area (EROA), and regurgitant volume (RV) were observed and maintained throughout 1 month follow up and did not correlate with baseline annular, LV or with the left atrial diameters. Baseline mitral tenting area correlated negatively with the relative improvement (% difference) of EROA (r = -0.5898) and RV (r = -0.4363), but not with VC (r = 0.1341). In addition, increased EF as well as a significant reduction in left ventricular diameters were noted. The increase in EF negatively correlated with the change in EROA (r = -0.50058), PISA (r = -0.5327), and RV (r = -0.5457). Baseline mitral tenting area significantly correlated with the 1 month change in EF (r = 0.5946) and stroke volume (r = 0.6913). The improvement of FMR after treatment with the Carillon device is associated with LV reverse remodeling and an increase in systolic performance, that correlates with the reduction in mitral regurgitation, being not dependent on baseline heart diameters. Mitral tenting area seems to be an important parameter in prediction of benefit from percutaneous mitral annuloplasty. © 2016, Wiley Periodicals, Inc.

  16. Oxidation modifies the structure and function of the extracellular matrix generated by human coronary artery endothelial cells.

    Science.gov (United States)

    Chuang, Christine Y; Degendorfer, Georg; Hammer, Astrid; Whitelock, John M; Malle, Ernst; Davies, Michael J

    2014-04-15

    ECM (extracellular matrix) materials, such as laminin, perlecan, type IV collagen and fibronectin, play a key role in determining the structure of the arterial wall and the properties of cells that interact with the ECM. The aim of the present study was to investigate the effect of peroxynitrous acid, an oxidant generated by activated macrophages, on the structure and function of the ECM laid down by HCAECs (human coronary artery endothelial cells) in vitro and in vivo. We show that exposure of HCAEC-derived native matrix components to peroxynitrous acid (but not decomposed oxidant) at concentrations >1 μM results in a loss of antibody recognition of perlecan, collagen IV, and cell-binding sites on laminin and fibronectin. Loss of recognition was accompanied by decreased HCAEC adhesion. Real-time PCR showed up-regulation of inflammation-associated genes, including MMP7 (matrix metalloproteinase 7) and MMP13, as well as down-regulation of the laminin α2 chain, in HCAECs cultured on peroxynitrous acid-treated matrix compared with native matrix. Immunohistochemical studies provided evidence of co-localization of laminin with 3-nitrotyrosine, a biomarker of peroxynitrous acid damage, in type II-III/IV human atherosclerotic lesions, consistent with matrix damage occurring during disease development in vivo. The results of the present study suggest a mechanism through which peroxynitrous acid modifies endothelial cell-derived native ECM proteins of the arterial basement membrane in atherosclerotic lesions. These changes to ECM and particularly perlecan and laminin may be important in inducing cellular dysfunction and contribute to atherogenesis.

  17. Assessment of left ventricular function and mass in dual-source computed tomography coronary angiography

    Energy Technology Data Exchange (ETDEWEB)

    Jensen, Christoph J., E-mail: c.jensen@contilia.d [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Jochims, Markus [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Hunold, Peter; Forsting, Michael; Barkhausen, Joerg [Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen (Germany); Sabin, Georg V.; Bruder, Oliver [Department of Cardiology and Angiology, Elisabeth Hospital, Essen (Germany); Schlosser, Thomas [Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Essen (Germany)

    2010-06-15

    Purpose: To quantify left ventricular (LV) function and mass (LVM) derived from dual-source computed tomography (DSCT) and the influence of beta-blocker administration compared to cardiac magnetic resonance imaging (CMR). Methods: Thirty-two patients undergoing cardiac DSCT and CMR were included, where of fifteen received metoprolol intravenously before DSCT. LV parameters were calculated by the disc-summation method (DSM) and by a segmented region-growing algorithm (RGA). All data sets were analyzed by two blinded observers. Interobserver agreement was tested by the intraclass correlation coefficient. Results.: 1. Using DSM LV parameters were not statistically different between DSCT and CMR in all patients (DSCT vs. CMR: EF 63 {+-} 8% vs. 64 {+-} 8%, p = 0.47; EDV 136 {+-} 36 ml vs. 138 {+-} 35 ml, p = 0.66; ESV 52 {+-} 21 ml vs. 52 {+-} 22 ml, p = 0.61; SV 83 {+-} 22 ml vs. 87 {+-} 19 ml, p = 0.22; CO 5.4 {+-} 0.9 l/min vs. 5.7 {+-} 1.2 l/min, p = 0.09, LVM 132 {+-} 33 g vs. 132 {+-} 33 g, p = 0.99). 2. In a subgroup of 15 patients beta-blockade prior to DSCT resulted in a lower ejection fraction (EF), stroke volume (SV), cardiac output (CO) and increase in end systolic volume (ESV) in DSCT (EF 59 {+-} 8% vs. 62 {+-} 9%; SV 73 {+-} 17 ml vs. 81 {+-} 15 ml; CO 5.7 {+-} 1.2 l/min vs. 5.0 {+-} 0.8 l/min; ESV 52 {+-} 27 ml vs. 57 {+-} 24 ml, all p < 0.05). 3. Analyzing the RGA parameters LV volumes were not significantly different compared to DSM, whereas LVM was higher using RGA (177 {+-} 31 g vs. 132 {+-} 33 g, p < 0.05). Interobserver agreement was excellent comparing DSM values with best agreement between RGA calculations. Conclusion: Left ventricular volumes and mass can reliably be assessed by DSCT compared to CMR. However, beta-blocker administration leads to statistically significant reduced EF, SV and CO, whereas ESV significantly increases. DSCT RGA reliably analyzes LV function, whereas LVM is overestimated compared to DSM.

  18. Sensitive cardiac troponins and N-terminal pro-B-type natriuretic peptide in stable coronary artery disease: correlation with left ventricular function as assessed by myocardial strain.

    Science.gov (United States)

    Smedsrud, Marit Kristine; Gravning, Jørgen; Omland, Torbjørn; Eek, Christian; Mørkrid, Lars; Skulstad, Helge; Aaberge, Lars; Bendz, Bjørn; Kjekshus, John; Edvardsen, Thor

    2015-06-01

    N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac troponins (cTns) measured with sensitive assays provide strong prognostic information in patients with stable coronary artery disease. However, the relationship between these biomarkers and myocardial contractile function, as well as infarct size, in this patient group, remains to be defined. The study population consisted of 160 patients referred to a follow-up echocardiography scheduled 1 year after coronary revascularization. Concentrations of NT-proBNP, high-sensitive cTnT (hs-cTnT) and sensitive cTnI assays were assessed. Left ventricular function was measured as global peak systolic longitudinal strain by speckle tracking echocardiography and infarct size was assessed by late-enhancement MRI. NT-proBNP and sensitive cTnI levels were significantly associated with left ventricular function by peak systolic strain (R-values 0.243 and 0.228, p = 0.002 and 0.004) as well as infarct size (R-values 0.343 and 0.366, p = 0.014 and p = 0.008). In contrast, hs-cTnT did not correlate with left ventricular function (R = 0.095, p = 0.231) and only marginally with infarct size (R = 0.237, p = 0.094). NT-proBNP and sensitive cTnI levels correlate with left ventricular function and infarct size in patients with stable coronary artery disease after revascularization. As opposed to hs-cTnT, NT-proBNP and cTnI seem to be indicators of incipient myocardial dysfunction and the extent of myocardial necrosis.

  19. Coronary artery fistula

    Science.gov (United States)

    Congenital heart defect - coronary artery fistula; Birth defect heart - coronary artery fistula ... A coronary artery fistula is often congenital, meaning that it is present at birth. It generally occurs when one of the coronary arteries ...

  20. Determinants of microvascular damage recovery after acute myocardial infarction: results from the acute myocardial infarction contrast imaging (AMICI) multi-centre study.

    Science.gov (United States)

    Funaro, Stefania; Galiuto, Leonarda; Boccalini, Francesca; Cimino, Sara; Canali, Emanuele; Evangelio, Francesca; DeLuca, Laura; Paraggio, Lazzaro; Mattatelli, Antonella; Gnessi, Lucio; Agati, Luciano

    2011-04-01

    Microvascular damage (MD) occurring soon after primary percutaneous coronary intervention (PPCI) may reverse or remain sustained within the first week after ST-elevation myocardial infarction (STEMI). We investigated the incidence, determinants, and long-term clinical relevance of MD reversal after PPCI. Serial two-dimensional echocardiograms (2DE) and a myocardial contrast study were obtained within 24 h of PPCI (T1) and at pre-discharge (T2) in 110 successfully re-perfused STEMI patients. Six months 2DE and 2-year clinical follow-up were obtained. After PPCI myocardial re-perfusion was normal at T1 only in 40 patients (36%, 'normal reflow'), recovered at T2 in 33 (30%, 'reversible MD'), and remained abnormal in 37 (34%, 'sustained MD'). At follow-up, normal reflow and reversible MD were coupled with a significant reduction in the infarct area, decrease in cardiac volumes, and a slight non-significant improvement in systolic function. Conversely, in the sustained MD group, the infarct area did not change and cardiac volumes significantly increased with a parallel worsening in systolic function. By multivariate analysis, independent predictors of reversible MD were: absence of family history of coronary artery disease (CAD), younger age, shorter time to re-perfusion, and absence of diabetes. The 2-year combined events rate was significantly lower in reversible MD (log-rank test P= 0.03) compared with sustained MD patients. In STEMI patients treated according to the current guidelines, MD frequently occurs soon after re-perfusion but it is reversible in ~50% of cases and it is associated with a favourable functional and clinical outcome. Family history of CAD, aging, time to re-perfusion, and diabetes are independent predictors of MD reversibility.

  1. Early systemic microvascular damage in pigs with atherogenic diabetes mellitus coincides with renal angiopoietin dysbalance

    NARCIS (Netherlands)

    M. Khairoun (Meriem); M.M. van den Heuvel (Mieke); B. van den Berg (Bernard); O. Sorop (Oana); De Boer, R. (Rients); N.S. van Ditzhuijzen (Nienke); I.M. Bajema (Ingeborg); H.J. Baelde; M. Zandbergen; D.J.G.M. Duncker (Dirk); T. Rabelink (Ton); M.E. Reinders (Marlies); W.J. van der Giessen (Wim); J.I. Rotmans (Joris)

    2015-01-01

    textabstractBackground: Diabetes mellitus (DM) is associated with a range of microvascular complications including diabetic nephropathy (DN). Microvascular abnormalities in the kidneys are common histopathologic findings in DN, which represent one manifestation of ongoing systemic microvascular dama

  2. Association of Rare Loss-Of-Function Alleles in HAL, Serum Histidine: Levels and Incident Coronary Heart Disease

    NARCIS (Netherlands)

    B. Yu (Bing); A.H. Li (Alexander H.); D. Muzny (Donna); N. Veeraraghavan (Narayanan); P.S. de Vries (Paul); J.C. Bis (Joshua); S. Musani (Solomon); D. Alexander (Danny); A.C. Morrison (Alanna); O.H. Franco (Oscar); A.G. Uitterlinden (Andre G.); A. Hofman (Albert); A. Dehghan (Abbas); J.G. Wilson (James); B.M. Psaty (Bruce); R. Gibbs (Richard); P. Wei (Peng); E.A. Boerwinkle (Eric)

    2015-01-01

    textabstractBackground-Histidine is a semiessential amino acid with antioxidant and anti-inflammatory properties. Few data are available on the associations between genetic variants, histidine levels, and incident coronary heart disease (CHD) in a population-based sample. Methods and Results-By cond

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

    NARCIS (Netherlands)

    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

  4. Functional COMT Val158Met polymorphism, risk of acute coronary events and serum homocysteine: the Kuopio ischaemic heart disease risk factor study.

    Directory of Open Access Journals (Sweden)

    Sari Voutilainen

    Full Text Available BACKGROUND: The role of circulating levels of total homocysteine tHcy in the development of coronary heart disease (CHD is still under debate. One reason for conflicting results between previous studies on homocysteine and heart diseases could be consequence of different interactions between homocysteine and genes in different study populations. Many genetic factors play a role in folate-homocysteine metabolism, like functional polymorphism (Val108Met in the Catechol-O-methyltransferase (COMT gene. METHODOLOGY AND FINDINGS: Our aim was to examine the role of COMT Val158Met polymorphism and interaction of this polymorphism with serum tHcy and folate concentration on the risk of acute coronary and events in middle-aged men from eastern Finland. A population-based prospective cohort of 792 men aged 46-64 years was examined as part of the Kuopio Ischaemic Heart Disease Risk Factor Study. During an average follow-up of 9.3 years, there were 69 acute coronary events in men with no previous history of CHD. When comparing the COMT low activity genotype with the others, we found an age and examination year adjusted hazard rate ratio (HRR of 1.73 (95% confidence interval (CI, 1.07-2.79, and an age, examination year, serum LDL and HDL cholesterol, and triglyceride concentration, systolic blood pressure and smoking adjusted HRR of 1.77 (95% CI, 1.05-2.77. Although serum tHcy concentration was not statistically significantly associated with acute coronary events (HRR for the highest third versus others 1.52, 95% CI, 0.93-2.49, subjects with both high serum tHcy and the COMT low activity genotype had an additionally increased adjusted risk of HRR 2.94 (95% CI 1.50-5.76 as compared with other men. CONCLUSIONS: This prospective cohort study suggests that the functional COMT Val158Met polymorphism is associated with increased risk of acute coronary events and it may interact with high serum tHcy levels.

  5. Adipose tissue-derived microvascular fragments from aged donors exhibit an impaired vascularisation capacity

    Directory of Open Access Journals (Sweden)

    MW Laschke

    2014-10-01

    Full Text Available Adipose tissue-derived microvascular fragments are promising vascularisation units for applications in the field of tissue engineering. Elderly patients are the major future target population of such applications due to an increasing human life expectancy. Therefore, we herein investigated the effect of aging on the fragments’ vascularisation capacity. Microvascular fragments were isolated from epididymal fat pads of adult (8 months and aged (16 months C57BL/6 donor mice. These fragments were seeded onto porous polyurethane scaffolds, which were implanted into dorsal skinfold chambers to study their vascularisation using intravital fluorescence microscopy, histology and immunohistochemistry. Scaffolds seeded with fragments from aged donors exhibited a significantly lower functional microvessel density and intravascular blood flow velocity. This was associated with an impaired vessel maturation, as indicated by vessel wall irregularities, constantly elevated diameters and a lower fraction of CD31/α-smooth muscle actin double positive microvessels in the implants’ border and centre zones. Additional in vitro analyses revealed that microvascular fragments from adult and aged donors do not differ in their stem cell content as well as in their release of angiogenic growth factors, survival and proliferative activity under hypoxic conditions. However, fragments from aged donors exhibit a significantly lower number of matrix metalloproteinase -9-positive perivascular cells. Taken together, these findings demonstrate that aging is a crucial determinant for the vascularisation capacity of isolated microvascular fragments.

  6. Microvascular dysfunction: an emerging pathway in the pathogenesis of obesity-related insulin resistance.

    Science.gov (United States)

    Muris, Dennis M J; Houben, Alfons J H M; Schram, Miranda T; Stehouwer, Coen D A

    2013-03-01

    The prevalence of type 2 diabetes mellitus (T2DM) and its major risk factor, obesity, has reached epidemic proportions in Western society. How obesity leads to insulin resistance and subsequent T2DM is incompletely understood. It has been established that insulin can redirect blood flow in skeletal muscle from non-nutritive to nutritive capillary networks, without increasing total blood flow. This results in a net increase of the overall number of perfused nutritive capillary networks and thereby increases insulin-mediated glucose uptake by skeletal muscle. This process, referred to as functional (nutritive) capillary recruitment, has been shown to be endothelium-dependent and to require activation of the phosphatidylinositol-kinase (PI3K) pathway in the endothelial cell. Several studies have demonstrated that these processes are impaired in states of microvascular dysfunction. In obesity, changes in several adipokines are likely candidates to influence insulin signaling pathways in endothelial cells, thereby causing microvascular dysfunction. Microvascular dysfunction, in turn, impairs the timely access of glucose and insulin to their target tissues, and may therefore be an additional cause of insulin resistance. Thus, microvascular dysfunction may be a key feature in the development of obesity-related insulin resistance. In the present review, we will discuss the evidence for this emerging role for the microcirculation as a possible link between obesity and insulin resistance.

  7. Demonstration of actin filament stress fibers in microvascular endothelial cells in situ.

    Science.gov (United States)

    Nehls, V; Drenckhahn, D

    1991-07-01

    We have developed a method for immunostaining the microvascular tree of rat mesenteric windows in situ. The procedure consists of three steps, i.e., mild fixation with formaldehyde, controlled proteolytic digestion of the mesothelial layer, and permeabilization with acetone. Discrimination between different microvascular segments was possible by double-fluorescent staining with antibodies to the smooth muscle isoform of alpha-actin and to nonmuscle myosin from platelets. Antibodies to nonmuscle myosin labeled numerous longitudinally oriented cables in endothelial cells of all microvascular segments (arterioles, metarterioles, pre-, mid-, and postcapillaries, small venules). Occasionally, the myosin-containing cables displayed the interrupted sarcomere-like staining pattern that is diagnostic for stress fibers. In contrast, staining of actin filaments with phalloidin-rhodamin resulted in a noninterrupted, continuous fluorescence of the stress fibers. A possible functional role of microvascular endothelial stress fibers is to serve as a tensile cytoskeletal scaffold that stabilizes the tubular, three-dimensional geometry of microvessels and, in addition, to help the endothelium resist the shear forces created by blood flow and by collision with red and white blood cells.

  8. Peroxynitrite mediates testosterone-induced vasodilation of microvascular resistance vessels.

    Science.gov (United States)

    Puttabyatappa, Yashoda; Stallone, John N; Ergul, Adviye; El-Remessy, Azza B; Kumar, Sanjiv; Black, Stephen; Johnson, Maribeth; Owen, Mary P; White, Richard E

    2013-04-01

    Our knowledge of how androgens influence the cardiovascular system is far from complete, and this lack of understanding is especially true of how androgens affect resistance vessels. Our aim was to identify the signaling mechanisms stimulated by testosterone (TES) in microvascular arteries and to understand how these mechanisms mediate TES-induced vasodilation. Mesenteric microvessels were isolated from male Sprague-Dawley rats. Tension studies demonstrated a rapid, concentration-dependent, vasodilatory response to TES that did not involve protein synthesis or aromatization to 17β-estradiol. Dichlorofluorescein fluorescence and nitrotyrosine immunoblot experiments indicated that TES stimulated peroxynitrite formation in microvessels, and functional studies demonstrated that TES-induced vasodilation was inhibited by scavenging peroxynitrite. As predicted, TES enhanced the production of both peroxynitrite precursors (i.e., superoxide and nitic oxide), and xanthine oxidase was identified as the likely source of TES-stimulated superoxide production. Functional and biochemical studies indicated that TES signaling involved activity of the phosphoinositide 3 (PI3) kinase-protein kinase B (Akt) cascade initiated by activation of the androgen receptor and culminated in enhanced production of cGMP and microvascular vasodilation. These findings, derived from a variety of analytical and functional approaches, provide evidence for a novel nongenomic signaling mechanism for androgen action in the microvasculature: TES-stimulated vasodilation mediated primarily by peroxynitrite formed from xanthine oxidase-generated superoxide and NO. This response was associated with activation of the PI3 kinase-Akt signaling cascade initiated by activation of the androgen receptor. We propose this mechanism could account for TES-stimulated cGMP production in microvessels and, ultimately, vasodilation.

  9. Regulation of human cerebro-microvascular endothelial baso-lateral adhesion and barrier function by S1P through dual involvement of S1P1 and S1P2 receptors.

    Science.gov (United States)

    Wiltshire, Rachael; Nelson, Vicky; Kho, Dan Ting; Angel, Catherine E; O'Carroll, Simon J; Graham, E Scott

    2016-01-27

    Herein we show that S1P rapidly and acutely reduces the focal adhesion strength and barrier tightness of brain endothelial cells. xCELLigence biosensor technology was used to measure focal adhesion, which was reduced by S1P acutely and this response was mediated through both S1P1 and S1P2 receptors. S1P increased secretion of several pro-inflammatory mediators from brain endothelial cells. However, the magnitude of this response was small in comparison to that mediated by TNFα or IL-1β. Furthermore, S1P did not significantly increase cell-surface expression of any key cell adhesion molecules involved in leukocyte recruitment, included ICAM-1 and VCAM-1. Finally, we reveal that S1P acutely and dynamically regulates microvascular endothelial barrier tightness in a manner consistent with regulated rapid opening followed by closing and strengthening of the barrier. We hypothesise that the role of the S1P receptors in this process is not to cause barrier dysfunction, but is related to controlled opening of the endothelial junctions. This was revealed using real-time measurement of barrier integrity using ECIS ZΘ TEER technology and endothelial viability using xCELLigence technology. Finally, we show that these responses do not occur simply though the pharmacology of a single S1P receptor but involves coordinated action of S1P1 and S1P2 receptors.

  10. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    OpenAIRE

    Rajendra Nehete; Anita Nehete; Sandeep Singla; Harshad Adhav

    2012-01-01

    In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally s...

  11. Diabetic microvascular complications: possible targets for improved macrovascular outcomes

    Science.gov (United States)

    D’Elia, John A; Bayliss, George; Roshan, Bijan; Maski, Manish; Gleason, Ray E; Weinrauch, Larry A

    2011-01-01

    The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes control. Are we ignoring mechanisms of vasculotoxicity (profibrosis, altered angiogenesis, hypertrophy, hyperplasia, and endothelial injury) inherent in current antihyperglycemic medications? Is the polypharmacy for lowering cholesterol, triglyceride, glucose, and systolic blood pressure producing drug interactions that are too complex to be clinically identified? We review angiotensin–aldosterone mechanisms of tissue injury that magnify microvascular damage caused by hyperglycemia and hypertension. Many studies describe interruption of these mechanisms, without hemodynamic consequence, in the preservation of function in type 1 diabetes. Possible interactions between the renin–angiotensin–aldosterone system and physiologic glycemic control (through pulsatile insulin release) suggest opportunities for further clinical investigation. PMID:21694944

  12. VASCULAR ENDOTHELIAL FUNCTION CHANGE IN ELDERLY CHINESE PATINENTS WITH OBSTRUCTIVE SLEEP APNEA AND ITS ASSOCIATION WITH CORONARY HEART DISEASE

    Institute of Scientific and Technical Information of China (English)

    王虹; 张希龙; 殷凯生; 贾恩志; 苏梅

    2004-01-01

    Objective To investigate the function change index of vascular endothelial cells (EC), plasma levelsof nitricoxide (NO) and endothelin (ET) in elderly Chinese patients with obstructive sleepapnea hypopnea syndrome(OSAHS) and its associat ion with coronary heart disease (CHD). Methods 31 elderly simple snorers with neitherOSAHSnor CHD were randomly selected as control group. 45 elderly patients with moderate or severe degree of OSAHS wererecruited as OSAHS group, which were further divided into two subgroups, CHD subgroup (16 pat ients) and non CHDsubgroup (29 pa tients). The changes of plasma concentrations of NO and ET were tested and compared from group togroup. Results Compared with control group, in OSAHS group there was a significant lower NO level (27.69±9. 17mmol/Lvs 61.90± 13.47, P<0. 01), higher ET level (58.08±14.21pg/ml vs 34. 77±8.23pg/ml, P<0. 01), and lower rate of NO/ET(0. 47±0. 18 vs 1. 72±0. 97mmol/L, P<0. 01). The incidence of CHD in OSAS group was 35.6%. Comparison between controlgroup and non-CHD OSAHS subgroup showed that the decreased NO level (35.53±9.39), increased ET level(47.78±11.13pg/ml) and declined NO/ET (0.75±0.13) in non CHD subgroup were statistically significant (P<0.05).Such a difference was more significant between conrol group and CHD OSAS subgroup (P<0. 01). Comparison between thetwo subgroups in OSAHS group indicated that there was a significantly lower NO level, higher ET level and more declinedNO/ET in OSAHS with CHD subgroup than in OSAHS without CHD subgroup (all P<0.05). Conclusion Vascular endothelialfunction was significantly impaired in elderly Chinese patients with OSAHS, especially in those with both OSAHSand CHD. Dysfunction of vascular EC may be one of the causes of complicated CHD in OSAHS patients.

  13. Influence of the amount of myocardium subtended to a coronary stenosis on the index of microcirculatory resistance. Implications for the invasive assessment of microcirculatory function in ischemic heart disease.

    Science.gov (United States)

    Echavarría-Pinto, Mauro; van de Hoef, Tim P; Nijjer, Sukhjinder; Gonzalo, Nieves; Nombela-Franco, Luis; Ibañez, Borja; Sen, Sayan; Petraco, Ricardo; Jimenez-Quevedo, Pilar; Nuñez-Gil, Ivan J; Cerrato, Enrico; Salinas, Pablo; Quirós, Alicia; Garcia-Garcia, Hector M; Fernandez-Ortiz, Antonio; Macaya, Carlos; Davies, Justin; Piek, Jan; Escaned, Javier

    2017-05-09

    The index of microcirculatory resistance (IMR) is growingly used to quantify microcirculatory function. However, in normal coronary arteries, resistance increases with the branching structure of the coronary tree, which suggest that IMR could be influenced by the amount of downstream myocardial mass (MM). We aimed to evaluate the influence of the amount of MM subtended to an intermediate stenosis on the IMR. IMR, fractional flow reserve and coronary flow reserve (CFR) were measured in 123 coronary arteries (102 patients) with intermediate stenosis. Jeopardized MM was estimated with the Myocardial Jeopardy Index (MJI). MM was inversely associated with IMR (R2=0.16, pcoronary stenosis is inversely associated with the IMR, while is not associated with the CFR.

  14. Advances in microvascular decompression for hemifacial spasm

    Institute of Scientific and Technical Information of China (English)

    Zhiqiang Cui; Zhipei Ling

    2015-01-01

    Primary hemifacial spasm (HFS) is a disorder that causes frequent involuntary contractions in the muscles on one side of the face, due to a blood vessel compressing the nerve at its root exit zone (REZ) from the brainstem. Numerous prospective and retrospective case series have confirmed the efficacy of microvascular decompression (MVD) of the facial nerve in patients with HFS. However, while MVD is effective, there are still significant postoperative complications. In this paper, recent technological advances related to MVD (such as lateral spread response, brainstem auditory evokes potential, three dimensional time of flight magnetic resonance angiography, intraoperative neuroendoscopy) are reviewed for the purposes of improving MVD treatment efficacy and reducing postoperative complications.

  15. Impairment of Coronary Flow Reserve Evaluated by Phase Contrast Cine-Magnetic Resonance Imaging in Patients With Heart Failure With Preserved Ejection Fraction.

    Science.gov (United States)

    Kato, Shingo; Saito, Naka; Kirigaya, Hidekuni; Gyotoku, Daiki; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Nakachi, Tatsuya; Fukui, Kazuki; Futaki, Masaaki; Iwasawa, Tae; Kimura, Kazuo; Umemura, Satoshi

    2016-02-23

    Phase contrast (PC) cine-magnetic resonance imaging (MRI) of the coronary sinus allows for noninvasive evaluation of coronary flow reserve (CFR), which is an index of left ventricular microvascular function. The objective of this study was to investigate coronary flow reserve in patients with heart failure with preserved ejection fraction (HFpEF). We studied 25 patients with HFpEF (mean and SD of age: 73±7 years), 13 with hypertensive left ventricular hypertrophy (LVH) (67±10 years), and 18 controls (65±15 years). Breath-hold PC cine-MRI images of the coronary sinus were obtained to assess blood flow at rest and during ATP infusion. CFR was calculated as coronary sinus blood flow during ATP infusion divided by coronary sinus blood flow at rest. Impairment of CFR was defined as CFR <2.5 according to a previous study. The majority (76%) of HFpEF patients had decreased CFR. CFR was significantly decreased in HFpEF patients in comparison to hypertensive LVH patients and control subjects (CFR: 2.21±0.55 in HFpEF vs 3.05±0.74 in hypertensive LVH, 3.83±0.73 in controls; P<0.001 by 1-way ANOVA). According to multivariable linear regression analysis, CFR independently and significantly correlated with serum brain natriuretic peptide level (β=-68.0; 95% CI, -116.2 to -19.7; P=0.007). CFR was significantly lower in patients with HFpEF than in hypertensive LVH patients and controls. These results indicated that impairment of CFR might be a pathophysiological factor for HFpEF and might be related to HFpEF disease severity. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  16. Obesity, metabolic syndrome, impaired fasting glucose, and microvascular dysfunction: a principal component analysis approach

    Directory of Open Access Journals (Sweden)

    Panazzolo Diogo G

    2012-11-01

    Full Text Available Abstract Background We aimed to evaluate the multivariate association between functional microvascular variables and clinical-laboratorial-anthropometrical measurements. Methods Data from 189 female subjects (34.0±15.5 years, 30.5±7.1 kg/m2, who were non-smokers, non-regular drug users, without a history of diabetes and/or hypertension, were analyzed by principal component analysis (PCA. PCA is a classical multivariate exploratory tool because it highlights common variation between variables allowing inferences about possible biological meaning of associations between them, without pre-establishing cause-effect relationships. In total, 15 variables were used for PCA: body mass index (BMI, waist circumference, systolic and diastolic blood pressure (BP, fasting plasma glucose, levels of total cholesterol, high-density lipoprotein cholesterol (HDL-c, low-density lipoprotein cholesterol (LDL-c, triglycerides (TG, insulin, C-reactive protein (CRP, and functional microvascular variables measured by nailfold videocapillaroscopy. Nailfold videocapillaroscopy was used for direct visualization of nutritive capillaries, assessing functional capillary density, red blood cell velocity (RBCV at rest and peak after 1 min of arterial occlusion (RBCVmax, and the time taken to reach RBCVmax (TRBCVmax. Results A total of 35% of subjects had metabolic syndrome, 77% were overweight/obese, and 9.5% had impaired fasting glucose. PCA was able to recognize that functional microvascular variables and clinical-laboratorial-anthropometrical measurements had a similar variation. The first five principal components explained most of the intrinsic variation of the data. For example, principal component 1 was associated with BMI, waist circumference, systolic BP, diastolic BP, insulin, TG, CRP, and TRBCVmax varying in the same way. Principal component 1 also showed a strong association among HDL-c, RBCV, and RBCVmax, but in the opposite way. Principal component 3 was

  17. Rapid homogeneous endothelialization of high aspect ratio microvascular networks.

    Science.gov (United States)

    Naik, Nisarga; Hanjaya-Putra, Donny; Haller, Carolyn A; Allen, Mark G; Chaikof, Elliot L

    2015-08-01

    Microvascularization of an engineered tissue construct is necessary to ensure the nourishment and viability of the hosted cells. Microvascular constructs can be created by seeding the luminal surfaces of microfluidic channel arrays with endothelial cells. However, in a conventional flow-based system, the uniformity of endothelialization of such an engineered microvascular network is constrained by mass transfer of the cells through high length-to-diameter (L/D) aspect ratio microchannels. Moreover, given the inherent limitations of the initial seeding process to generate a uniform cell coating, the large surface-area-to-volume ratio of microfluidic systems demands long culture periods for the formation of confluent cellular microconduits. In this report, we describe the design of polydimethylsiloxane (PDMS) and poly(glycerol sebacate) (PGS) microvascular constructs with reentrant microchannels that facilitates rapid, spatially homogeneous endothelial cell seeding of a high L/D (2 cm/35 μm; > 550:1) aspect ratio microchannels. MEMS technology was employed for the fabrication of a monolithic, elastomeric, reentrant microvascular construct. Isotropic etching and PDMS micromolding yielded a near-cylindrical microvascular channel array. A 'stretch - seed - seal' operation was implemented for uniform incorporation of endothelial cells along the entire microvascular area of the construct yielding endothelialized microvascular networks in less than 24 h. The feasibility of this endothelialization strategy and the uniformity of cellularization were established using confocal microscope imaging.

  18. Nighttime aircraft noise impairs endothelial function and increases blood pressure in patients with or at high risk for coronary artery disease.

    Science.gov (United States)

    Schmidt, Frank; Kolle, Kristoffer; Kreuder, Katharina; Schnorbus, Boris; Wild, Philip; Hechtner, Marlene; Binder, Harald; Gori, Tommaso; Münzel, Thomas

    2015-01-01

    Epidemiological studies suggest the existence of a relationship between aircraft noise exposure and increased risk for myocardial infarction and stroke. Patients with established coronary artery disease and endothelial dysfunction are known to have more future cardiovascular events. We therefore tested the effects of nocturnal aircraft noise on endothelial function in patients with or at high risk for coronary artery disease. 60 Patients (50p 1-3 vessels disease; 10p with a high Framingham Score of 23%) were exposed in random and blinded order to aircraft noise and no noise conditions. Noise was simulated in the patients' bedroom and consisted of 60 events during one night. Polygraphy was recorded during study nights, endothelial function (flow-mediated dilation of the brachial artery), questionnaires and blood sampling were performed on the morning after each study night. The mean sound pressure levels L eq(3) measured were 46.9 ± 2.0 dB(A) in the Noise 60 nights and 39.2 ± 3.1 dB(A) in the control nights. Subjective sleep quality was markedly reduced by noise from 5.8 ± 2.0 to 3.7 ± 2.2 (p aircraft noise markedly impairs endothelial function in patients with or at risk for cardiovascular disease. These vascular effects appear to be independent from annoyance and attitude towards noise and may explain in part the cardiovascular side effects of nighttime aircraft noise.

  19. Genome-wide association study reveals a polymorphism in the podocyte receptor RANK for the decline of renal function in coronary patients.

    Directory of Open Access Journals (Sweden)

    Andreas Leiherer

    Full Text Available Impaired kidney function is a significant health problem and a major concern in clinical routine and is routinely determined by decreased glomerular filtration rate (GFR. In contrast to single assessment of a patients' kidney function providing only limited information on patients' health, serial measurements of GFR clearly improves the validity of diagnosis. The decline of kidney function has recently been reported to be predictive for mortality and vascular events in coronary patients. However, it has not been investigated for genetic association in GWA studies. This study investigates for the first time the association of cardiometabolic polymorphisms with the decline of estimated GFR during a 4 year follow up in 583 coronary patients, using the Cardio-Metabo Chip. We revealed a suggestive association with 3 polymorphisms, surpassing genome-wide significance (p = 4.0 e-7. The top hit rs17069906 (p = 5.6 e-10 is located within the genomic region of RANK, recently demonstrated to be an important player in the adaptive recovery response in podocytes and suggested as a promising therapeutic target in glomerular diseases.

  20. Cardiovascular function during the first 24 hours after off pump coronary artery bypass grafting--a prospective, randomized study.

    Science.gov (United States)

    Vedin, Jenny; Jensen, Ulf; Ericsson, Anders; Bitkover, Catarina; Samuelsson, Sten; Bredin, Fredrik; Vaage, Jarle

    2003-12-01

    We hypothesized that cardiovascular performance during the first 24 postoperative hours would be better in patients after off pump coronary artery bypass grafting compared to conventional on pump surgery. Fifty-nine patients were randomized to on or off pump coronary artery bypass grafting. Hemodynamic parameters, including cardiac index and systemic vascular resistance index were measured before and at 1, 4, and 20 h after surgery. Troponin T and creatine kinase-MB (CK-MB) were measured before and at 1, 6, and 20 h after surgery. There was no difference in age, sex, ejection fraction or number of grafts between groups. Cardiac index was higher (p=0.05) and systemic vascular resistance index was lower (p=0.007) in the off pump group 1 h after arrival in the intensive care unit. CK-MB and troponin T were significantly lower in the off pump group after 1 h (CK-MB p<0.001, troponin T p<0.001) and after 6 h (CK-MB p=0.02, troponin T p<0.001). After 24 h there was no difference between the two groups. In conclusion, immediately after surgery there was better cardiovascular performance and less release of markers of myocardial damage after off pump coronary surgery. After 24 h all differences were eliminated.

  1. Effect of Diltiazem on Coronary Artery Flow and Myocardial Perfusion in Patients With Isolated Coronary Artery Ectasia and Either Stable Angina Pectoris or Positive Myocardial Ischemic Stress Test.

    Science.gov (United States)

    Ozcan, Ozgur Ulas; Atmaca, Yusuf; Goksuluk, Huseyin; Akbulut, Irem Muge; Ozyuncu, Nil; Ersoy, Nedret; Erol, Cetin

    2015-10-15

    Isolated coronary artery ectasia (CAE) may be associated with stable or unstable coronary events despite the absence of epicardial coronary stenosis. Impaired coronary flow dynamics and myocardial perfusion have been demonstrated in stable patients with ectatic coronary arteries. We aimed to assess whether epicardial flow and tissue-level perfusion would be improved by diltiazem in myocardial regions subtended by the ectatic coronary arteries in patients with isolated CAE. A total of 60 patients with isolated CAE were identified of 9,780 patients who underwent elective coronary angiography. Patients were randomized to 5 mg of intracoronary diltiazem or saline. Coronary blood flow of the microvascular network was assessed using myocardial blush grade (MBG) technique. The thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (TFC) were used to assess epicardial coronary flow. MBG (from 2.4 to 2.6, p = 0.02), TIMI flow grades (from 2.4 to 2.8, p flow grade; and from 35 to 33, p = 0.43 for TFC). Diltiazem provided amelioration of the altered coronary flow dynamics, which was suggested as the pathophysiological influence of CAE. In conclusion, the favorable effects of the diltiazem on myocardial perfusion were observed at both epicardial and tissue levels.

  2. Coronary anomaly: the single coronary artery

    Institute of Scientific and Technical Information of China (English)

    QIN Xu-guang; XIONG Wei-guo; LU Chun-peng; GONG Cheng-jie; SHANG Li-hua

    2010-01-01

    @@ Single coronary artery (SCA), defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the right coronary artery (RCA) originating from the middle of left descending artery (LAD), and the other is the left main coronary artery (LMCA) arising from the proximal right coronary artery.

  3. secondary Prevention of Coronary Events by Coronary Artery Bypass Surgery

    OpenAIRE

    2003-01-01

    Coronary artery bypass surgery has shown its superiority on other therapeutic options in specific but frequent indications such as left main lesions, multivessel disease with alteration of ventricular function, proximal lesions of the LAD, and multivessel diseases in diabetic patients. After reviewing the epidemiology of coronary artherosclerosis, we emphasize the efficacy of the surgical treatment compared to medical or interventional therapy for preventing ischemic events. The results deriv...

  4. Microvascular reactivity during sympathetic stimulations in Raynaud's phenomenon.

    Science.gov (United States)

    Stoyneva, Zlatka B; Dermendjiev, Svetlan M; Medjidieva, Daniela G; Vodenicharov, Vlayko E

    2016-12-01

    The objective of the study was to assess skin autonomic microvascular reactivity to sympathetic stimulations and its association with primary and secondary Raynaud's phenomenon (RP). Laser-Doppler recorded finger pulp skin blood flow was monitored during orthostatic and deep breathing tests of 4 subjects groups, each of them composed of 20 subjects: group 1, healthy controls; group 2, vibration-induced secondary RP (vRP); group 3, primary RP (pRP); group 4, systemic sclerosis-related secondary RP (sclRP). Within groups comparisons by Wilcoxon matched pairs rank test and between groups by Bonferroni's multiple test for unpaired data were done using SPSS Statistics software. Reliably lower initial perfusion values were established in all the RP patients. The local sympathetic axon-reflex mediated responses to orthostasis were reduced in all RP groups with increased perfusions in upright posture instead of decreased. The vasoconstrictor responses to deep breathing tended to increase instead of decreasing in the vRP and pRP groups, while in the sclRP group the perfusions decreased. Strong correlations between the initial finger pulp perfusions and the orthostatic and deep breathing perfusion responses were found in the control, pRP and vRP groups (P<0.0001) and a modest correlation between the initial perfusions and the deep breathing perfusion responses in the sclRP group. Abnormal cutaneous microvascular reactivity to central and local axon-reflex sympathetic stimulations was established in RP patients reflecting self-regulatory dysfunctions which might contribute to the manifestations of the ischemic microcirculatory paroxysms. Laser Doppler flowmetry with functional orthostatic and deep breathing tests contribute to the diagnosis of RP.

  5. Comparison of cardiovascular magnetic resonance of late gadolinium enhancement and diastolic wall thickness to predict recovery of left ventricular function after coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Udompunturak Suthipol

    2008-09-01

    Full Text Available Abstract Background The objective was to compare the value of late gadolinium enhancement (LGE and end-diastolic wall thickness (EDWT assessed by cardiovascular magnetic resonance (CMR in predicting recovery of left ventricular function after coronary artery bypass surgery (CABG. Methods We enrolled patients with coronary artery disease and left ventricular ejection fraction Results We studied 46 men and 4 women with an average age of 61 years. Baseline left ventricular ejection fraction was 37 ± 13%. A total of 2,020 myocardial segments were analyzed. Abnormal wall motion and the LGE area were detected in 1,446 segments (71.6% and 1,196 segments (59.2% respectively. Wall motion improvement was demonstrated in 481 of 1,227 segments (39.2% that initially had wall motion abnormalities at baseline. Logistic regression analysis showed that the LGE area, EDWT and resting wall motion grade predicted wall motion improvement. Comparison of Receiver-Operator-Characteristic (ROC curves demonstrated that the LGE area was the most important predictor (p Conclusion LGE and EDWT are independent predictors for functional recovery after revascularization. However, LGE appears to be a more important factor and independent of EDWT.

  6. Hyperglycemia in acute coronary syndromes: from mechanisms to prognostic implications.

    Science.gov (United States)

    Angeli, Fabio; Reboldi, Gianpaolo; Poltronieri, Cristina; Lazzari, Ludovico; Sordi, Martina; Garofoli, Marta; Bartolini, Claudia; Verdecchia, Paolo

    2015-12-01

    Hyperglycemia is a frequent condition in patients with acute coronary syndromes (ACS). Hyperglycemia during ACS is caused by an inflammatory and adrenergic response to ischemic stress, when catecholamines are released and glycogenolysis induced. Although the involved pathophysiological mechanisms have not yet been fully elucidated, it is believed that hyperglycemia is associated with an increase in free fat acids (which induce cardiac arrhythmias), insulin resistance, chemical inactivation of nitric oxide and the production of oxygen reactive species (with consequent microvascular and endothelial dysfunction), a prothrombotic state, and vascular inflammation. It is also related to myocardial metabolic disorders, leading to thrombosis, extension of the damaged area, reduced collateral circulation, and ischemic preconditioning. In the last few years, several observational studies demonstrated that hyperglycemia in ACS is a powerful predictor of survival, increasing the risk of immediate and long-term complications in patients both with and without previously known diabetes mellitus. Glucose management strategies in ACS may improve outcomes in patients with hyperglycemia, perhaps by reducing inflammatory and clotting mediators, by improving endothelial function and fibrinolysis and by reducing infarct size. Recent clinical trials of insulin in ACS have resulted in varying levels of benefit, but the clinical benefit of an aggressive treatment with insulin is yet unproved.

  7. Coronary collaterals

    NARCIS (Netherlands)

    Koerselman, Jeroen

    2004-01-01

    Cardiovascular diseases, in particular coronary artery disease, are the leading cause of death and disease in industrialized countries. Atherosclerotic changes of the arterial vessel wall constitute one of the major causes for the occurrence of cardiovascular disease. Important risk factors for

  8. Coronary collaterals

    NARCIS (Netherlands)

    Koerselman, Jeroen

    2004-01-01

    Cardiovascular diseases, in particular coronary artery disease, are the leading cause of death and disease in industrialized countries. Atherosclerotic changes of the arterial vessel wall constitute one of the major causes for the occurrence of cardiovascular disease. Important risk factors for card

  9. Combined use of 64-slice computed tomography angiography and gated myocardial perfusion SPECT for the detection of functionally relevant coronary artery stenoses. First results in a clinical setting concerning patients with stable angina

    Energy Technology Data Exchange (ETDEWEB)

    Hacker, M.; Hack, N.; Tiling, R. [Klinikum Grosshadern (Germany). Dept. of Nuclear Medicine; Jakobs, T.; Nikolaou, K.; Becker, C. [Klinikum Grosshadern (Germany). Dept. of Clinical Radiology; Ziegler, F. von; Knez, A. [Klinikum Grosshadern (Germany). Dept. of Cardiology; Koenig, A.; Klauss, V. [Medizinische Poliklinik-Innenstadt, Univ. of Munich (Germany). Dept. of Cardiology

    2007-07-01

    Aim: In patients with stable angina pectoris both morphological and functional information about the coronary artery tree should be present before revascularization therapy is performed. High accuracy was shown for spiral computed tomography (MDCT) angiography acquired with a 64-slice CT scanner compared to invasive coronary angiography (ICA) in detecting ''obstructive'' coronary artery disease (CAD). Gated myocardial SPECT (MPI) is an established method for the noninvasive assessment of functional significance of coronary stenoses. Aim of the study was to evaluate the combination of 64-slice CT angiography plus MPI in comparison to ICA plus MPI in the detection of hemodynamically relevant coronary artery stenoses in a clinical setting. Patients, methods: 30 patients (63 {+-} 10.8 years, 23 men) with stable angina (21 with suspected, 9 with known CAD) were investigated. MPI, 64-slice CT angiography and ICA were performed, reversible and fixed perfusion defects were allocated to determining lesions separately for MDCT angiography and ICA. The combination of MDCT angiography plus MPI was compared to the results of ICA plus MPI. Results: Sensitivity, specificity, negative and positive predictive value for the combination of MDCT angiography plus MPI was 85%, 97%, 98% and 79%, respectively, on a vessel-based and 93%, 87%, 93% and 88%, respectively, on a patient-based level. 19 coronary arteries with stenoses =50% in both ICA and MDCT angiography showed no ischemia in MPI. Conclusion: The combination of 64-slice CT angiography and gated myocardial SPECT enabled a comprehensive non-invasive view of the anatomical and functional status of the coronary artery tree. (orig.)

  10. Effects of eicosapentaenoic acid on peri-procedural (type IVa) myocardial infarction following elective coronary stenting.

    Science.gov (United States)

    Kurita, Akiyoshi; Takashima, Hiroaki; Ando, Hirohiko; Kumagai, Soichiro; Waseda, Katsuhisa; Gosho, Masahiko; Amano, Tetsuya

    2015-08-01

    The aim of this study was to assess the effect of eicosapentaenoic acid (EPA) on peri-procedural (type IVa) myocardial infarction (MI) following elective percutaneous coronary intervention (PCI). We analyzed data from 165 of 178 consecutive patients with stable angina pectoris who underwent de novo successful stent implantation in the native coronary artery. Patients were assigned to receive statin therapy in combination with 1800mg/day of EPA or statin alone. Post-procedural index of microcirculatory resistance (IMR) values were calculated for 30 patients in the EPA group and 32 controls. In the multivariate logistic model, EPA administration, low kidney function, and the presence of slow flow/no reflow were significantly and independently associated with type IVa MI. Post-procedural IMR values were significantly lower in the EPA group [19.8 (6.4, 51.1) vs. 27.8 (8.2, 89.3), p=0.003] compared to the control group. Pre-treatment with EPA in addition to statins significantly reduced the incidence of type IVa MI compared to statin therapy only, which may be attributed to the ability of EPA to reduce microvascular dysfunction induced by PCI. Copyright © 2014. Published by Elsevier Ltd.

  11. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. 冠脉造影正常患者内皮功能与冠脉血流储备能力的研究%Clinical study of Endothelial Function and Coronary Flow Reserve in Patients with Normal Coronary Arteriograms

    Institute of Scientific and Technical Information of China (English)

    张勇; 唐小霞; 曹邦明; 任淑红; 王新宇; 陈兴新

    2014-01-01

    Objective Coronary Flow Reserve ( CFR ) of patients with normal coronary arteriograms were measured by the use of angiographic digital tracking and endothelial function were evaluated by intracoronary acetyl -choline(Ach) test and high-sensitivity C-reactive protein (hsCRP) levels.The change of CFR and endothelial function in patients with different risk factors were observed and analysed .Methods In selected 118 cases ( The mean age 61 ±11 years old ) with suspected coronary artery disease were divided into 6 groups according to different risk factors:hypertension , hypercholesterolemia , obesity , smoking , type 2 diabetes mellitus and ≥2 risk factors groups while 24 healthy subjects ( The mean age 56 ±12 years old ) as matched .CFR of patients with normal coro-nary arteriograms were measured by the use of angiographic digital tracking and endothelial function were evaluated by intracoronary Ach test and hsCRP levels .The change of CFR , positive rates of Ach test , hsCRP levels were ob-served and analysed .Results CFR in group of hypertension , smoking and≥2 risk factors were lower and positive rates of Ach test ,hsCRP levels were higher than those of the control group .CFR in group of hypercholesterolemia , Obesity , Type 2 Diabetes Mellitus groups were lower and positive rates of Ach test were higher than those of the control group but there were no significant differences between them .hsCRP levels of Type 2 Diabetes Mellitus group were higher than those of the control group .Conclusion Angiography digital tracking method can be easily used in measuring CFR .Lower CFR and endothelial dysfunction in people with different risk factors were observed in this reaserch .%目的:通过常规冠脉造影,运用数字跟踪技术软件测定冠脉造影正常患者冠脉血流储备( Coro-nary Flow Reserve,CFR),冠脉内注射乙酰胆碱(Acetylcholine,Ach)并检测高敏C反应蛋白( high Sensitivi-ty,hsCRP)含量评价内皮功能,

  13. Transport and regulation mechanism of the colloidal gold liposomes in the brain microvascular endothelial cells

    Institute of Scientific and Technical Information of China (English)

    WANG Lipeng; CHANG Yanzhong

    2015-01-01

    Objective:Blood-brain barrier is the key barrier of brain in the innate immune. It can prevent the harmful substances from the blood into the brain. In order to keep the brain in a relatively stable environment and maintain the normal function of the nervous system, it can also pump harmful substances or excess substances outside the brain selectively. Among them, brain microvascular endothelial cell tissue is a key part in the blood-brain barrier's function. The number of the patients with central nervous system ( CNS) diseases increased year by year. The therapeutic drug is usually inhibited by the blood-brain barrier and is difficult to work. Therefore, how to modify the drug and to make it easier to cross the blood brain barrier is the key point to cure CNS. At present, more than 95% research focus only on how nano drugs can enter the cell, the way and efficiency to enter the cell and the research of effect of nano drug etc. For the process of drug carrier in endocytosis, intracellular transport and release and regulation of research are rarely reported. Clathrin and P-glycoprotein are related protein in endo-cytosis and exocytosis with nano drug. Clathrin is located on the plasma membrane. It participates in endocytosis of some nutrients, and maybe the entry into the cell of some drugs. P-glycoprotein is located in the membrane of cer-ebral capillary endothelial cells. It can efflux drugs relying on ATP. Although there is a certain understanding of the cell in the inner swallow and efflux. But the process of the liposome drug is not clear. To solve the above prob-lems, using colloidal gold liposome nano materials to trace liposome's transport and regulation mechanism in brain microvascular endothelial cells, and study endocytosis, release, distribution and regulation mechanism of nano lipo-somes in brain microvascular. The solution of this problem can guide to construct reasonable drug carrier, and look forward to clarifing the molecular basis and mechanism of

  14. Comparison of a Two-Lead, Computerized, Resting ECG Signal Analysis Device, the MultiFunction-CardioGramsm or MCG (a.k.a. 3DMP, to Quantitative Coronary Angiography for the Detection of Relevant Coronary Artery Stenosis (>70% - A Meta-Analysis of all Published Trials Performed and Analyzed in the US

    Directory of Open Access Journals (Sweden)

    John E. Strobeck, Joseph T. Shen, Binoy Singh, Kotaro Obunai, Charles Miceli, Howard Sacher, Franz Ritucci, Michael Imhoff

    2009-01-01

    Full Text Available Background: Accurate, non-invasive diagnosis of, and screening for, coronary artery disease (CAD and restenosis after coronary revascularization has been a challenge due to either low sensitivity/specificity or relevant morbidity associated with current diagnostic modalities. Methods: To assess sensitivity and specificity of a new computerized, multiphase, resting electrocardiogram analysis device (MultiFunction-CardioGramsm or MCG a.k.a. 3DMP for the detection of relevant coronary stenosis (>70%, a meta-analysis of three published prospective trials performed in the US on patient data collected using the US manufactured device and analyzed using the US-based software and New York data analysis center from patients in the US, Germany, and Asia was completed. A total of 1076 patients from the three trials (US - 136; Germany - 751; Asia - 189 (average age 62 ± 11.5, 65 for women, 60 for men scheduled for coronary angiography, were included in the analysis. Patients enrolled in the trials may or may not have had prior angiography and/or coronary intervention. Angiographic results in all studies were classified for hemodynamically relevant stenosis (> 70% by two US based angiographers independently. Results: Hemodynamically relevant stenosis was diagnosed in 467 patients (43.4%. The device, after performing a frequency-domain, computational analysis of the resting ECG leads and computer-database comparison, calculated a coronary ischemia “severity” score from 0 to 20 for each patient. The severity score was significantly higher for patients with relevant coronary stenosis (5.4 ± 1.8 vs. 1.7 ± 2.1. The study device (using a cut-off score for relevant stenosis of 4.0 correctly classified 941 of the 1076 patients with or without relevant stenosis (sensitivity-91.2%; specificity-84.6%; NPV 0.942, PPV 0.777. Adjusted positive and negative predictive values (PPV and NPV were 81.9% and 92.6%, respectively (ROC AUC = 0.881 [95% CI: 0

  15. Cardiac CT: coronary arteries and beyond

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H. [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany); RWTH Aachen University, Applied Medical Engineering, Aachen (Germany); Muehlenbruch, Georg; Guenther, Rolf W.; Wildberger, Joachim E. [RWTH Aachen University, Department of Diagnostic Radiology, University Hospital, Aachen (Germany)

    2007-04-15

    Multi-detector-row computed tomography (MDCT) has emerged as a rapidly developing method for non-invasive imaging of the heart. An understanding of ECG synchronization, contrast material administration, patient preparation and image post-processing is needed to optimize image quality. The basic technical principles and essentials of these technical basics are described here. Correctly applied cardiac MDCT allows imaging of the coronary arteries including coronary anatomy and stenosis detection. The same is true for evaluation of coronary artery bypass grafts and, to some extent, coronary artery stents. While quantification of total calcified plaque burden has been long established, coronary MDCT allows assessing plaque morphology and constitution. Recent approaches go beyond the coronaries and include evaluation of left ventricular function at rest and myocardial viability. In combination with experimental approaches for assessing aortic valve function and myocardial perfusion imaging, cardiac MDCT offers the potential for a comprehensive examination of the heart using a single breath-hold examination. (orig.)

  16. Quantitative analysis of coronary endothelial function with generator-produced {sup 82}Rb PET: comparison with {sup 15}O-labelled water PET

    Energy Technology Data Exchange (ETDEWEB)

    Yoshinaga, Keiichiro [Hokkaido University Graduate School of Medicine, Department of Photobiology, Division of Molecular/Cellular Imaging, Kita-Ku, Sapporo, Hokkaido (Japan); Manabe, Osamu; Tamaki, Nagara [Hokkaido University of Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Katoh, Chietsugu [Hokkaido University of Graduate School of Medicine, Department of Health Sciences, Sapporo (Japan); Chen, Li; Kemp, Robert A. de; Williams, Kathryn; Beanlands, Rob S.B. [University of Ottawa Heart Institute, National Cardiac PET Centre, Division of Cardiology, Ottawa, Ontario (Canada); Klein, Ran [Hokkaido University of Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); University of Ottawa Heart Institute, National Cardiac PET Centre, Division of Cardiology, Ottawa, Ontario (Canada); Naya, Masanao [Hokkaido University of Graduate School of Medicine, Department of Cardiology, Sapporo (Japan)

    2010-12-15

    Endothelial dysfunction is the earliest abnormality in the development of coronary atherosclerosis. {sup 82}Rb is a generator-produced positron emission tomography (PET) myocardial perfusion tracer that is becoming more widely used. We aimed to (1) develop a method for quantitative assessment of coronary endothelial function using the myocardial blood flow (MBF) response during a cold pressor test (CPT) in smokers, measured using {sup 82}Rb PET, and (2) compare the results with those measured using {sup 15}O-water PET. MBF was assessed at rest and during the CPT with {sup 82}Rb and {sup 15}O-water in nine controls and ten smokers. A one-compartment model with tracer extraction correction was used to estimate MBF with both tracers. CPT response was calculated as the ratio of MBF during the CPT to MBF at rest. At rest, measurements of MBF for smokers vs controls were not different using {sup 15}O-water (0.86 {+-} 0.18 vs 0.70 {+-} 0.13, p = 0.426) than they were using {sup 82}Rb (0.83 {+-} 0.23 vs 0.62 {+-} 0.20, p = 0.051). Both methods showed a reduced CPT response in smokers vs controls ({sup 15}O-water, 1.03 {+-} 0.21 vs 1.42 {+-} 0.29, p = 0.006; {sup 82}Rb, 1.02 {+-} 0.28 vs 1.70 {+-} 0.52, p < 0.001). There was high reliability [intraclass correlation coefficients: 0.48 (0.07, 0.75)] of MBF measurement between {sup 82}Rb and {sup 15}O-water during the CPT. Using a CPT, {sup 82}Rb MBF measurements detected coronary endothelial dysfunctions in smokers. {sup 82}Rb MBF measurements were comparable to those made using the {sup 15}O-water approach. Thus, {sup 82}Rb PET may be applicable for risk assessments or evaluation of risk factor modification in subjects with coronary risk factors. (orig.)

  17. Differentiation state determines neural effects on microvascular endothelial cells

    Energy Technology Data Exchange (ETDEWEB)

    Muffley, Lara A., E-mail: muffley@u.washington.edu [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States); Pan, Shin-Chen, E-mail: pansc@mail.ncku.edu.tw [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States); Smith, Andria N., E-mail: gnaunderwater@gmail.com [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States); Ga, Maricar, E-mail: marga16@uw.edu [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States); Hocking, Anne M., E-mail: ahocking@u.washington.edu [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States); Gibran, Nicole S., E-mail: nicoleg@u.washington.edu [University of Washington, Campus Box 359796, 300 9th Avenue, Seattle, WA 98104 (United States)

    2012-10-01

    Growing evidence indicates that nerves and capillaries interact paracrinely in uninjured skin and cutaneous wounds. Although mature neurons are the predominant neural cell in the skin, neural progenitor cells have also been detected in uninjured adult skin. The aim of this study was to characterize differential paracrine effects of neural progenitor cells and mature sensory neurons on dermal microvascular endothelial cells. Our results suggest that neural progenitor cells and mature sensory neurons have unique secretory profiles and distinct effects on dermal microvascular endothelial cell proliferation, migration, and nitric oxide production. Neural progenitor cells and dorsal root ganglion neurons secrete different proteins related to angiogenesis. Specific to neural progenitor cells were dipeptidyl peptidase-4, IGFBP-2, pentraxin-3, serpin f1, TIMP-1, TIMP-4 and VEGF. In contrast, endostatin, FGF-1, MCP-1 and thrombospondin-2 were specific to dorsal root ganglion neurons. Microvascular endothelial cell proliferation was inhibited by dorsal root ganglion neurons but unaffected by neural progenitor cells. In contrast, microvascular endothelial cell migration in a scratch wound assay was inhibited by neural progenitor cells and unaffected by dorsal root ganglion neurons. In addition, nitric oxide production by microvascular endothelial cells was increased by dorsal root ganglion neurons but unaffected by neural progenitor cells. -- Highlights: Black-Right-Pointing-Pointer Dorsal root ganglion neurons, not neural progenitor cells, regulate microvascular endothelial cell proliferation. Black-Right-Pointing-Pointer Neural progenitor cells, not dorsal root ganglion neurons, regulate microvascular endothelial cell migration. Black-Right-Pointing-Pointer Neural progenitor cells and dorsal root ganglion neurons do not effect microvascular endothelial tube formation. Black-Right-Pointing-Pointer Dorsal root ganglion neurons, not neural progenitor cells, regulate

  18. Microvascularization on collared peccary placenta: a microvascular cast study [corrected] in late pregnancy.

    Science.gov (United States)

    Santos, Tatiana Carlesso; Oliveira, Moacir Franco; Dantzer, Vibeke; Miglino, Maria Angélica

    2012-07-01

    The microvascularization of the collared peccary (Tayassu tajacu) placenta was studied by vascular casts and immunolocalization of α-smooth muscle actin and vimentin, to identify the three dimensional organization and vascular flow interrelation in the microvasculature between the maternal and fetal compartments of the placentae. The immunolocalization of vimentin in the vascular endothelium and in the smooth muscle cells of blood vessels showed indented capillaries along the uterine epithelium and the trophoblast at the sides of complementary maternal and fetal microfolds, or rugae. This confers the three-dimensional structure observed in vascular casts. On the maternal side, casts demonstrated uterine folds coated by with primary and secondary ridges, and by areolae dispersed between these ridges. The arteriole runs through the center/middle of ridges, branching at the top into a microvascular network wall in a basket-like fashion. At the base of these baskets venules were formed. On the fetal side, arterioles branched centrally in the fetal rugae into a capillary network in a bulbous form, complementary to the opposite maternal depressions forming the baskets. At the base of the bulbous protrusions, the fetal venules arise. The blood vessel orientation in the materno-fetal interface of the placentae of collared peccaries suggests a blood flow pattern of the type countercurrent to cross current. The same pattern has been reported in domestic swine demonstrating that, even after 38 million years, the Tayassuidae and Suidae families exhibit similar placental morphology, which is here characterized at the microvascular level.

  19. Phase transition of the microvascular network architecture in human pathologies.

    Science.gov (United States)

    Bianciardi, Giorgio; Traversi, Claudio; Cattaneo, Ruggero; De Felice, Claudia; Monaco, Annalisa; Tosi, Gianmarco; Parrini, Stefano; Latini, Giuseppe

    2012-01-01

    We have investigated the microvascular pattern in acquired or genetic diseases in humans. The lower gingival and vestibular oral mucosa, as well as the optic nerve head, was chosen to characterize the vascular pattern complexity due to the simple accessibility and visibility Local fractal dimensions, fractal dimension of the minimum path and Lempel-Ziv complexity have been used as operational numerical tools to characterize the microvascular networks. In the normal healthy subjects microvascular networks show nonlinear values corresponding to the complexity of a diffusion limited aggregation (DLA) model, while in several acquired or genetic diseases they are approaching the ones of an invasion percolation model.

  20. Association of Microvascular Dysfunction With Late-Life Depression

    DEFF Research Database (Denmark)

    van Agtmaal, Marnix J M; Houben, Alfons J H M; Pouwer, Frans

    2017-01-01

    Importance: The etiologic factors of late-life depression are still poorly understood. Recent evidence suggests that microvascular dysfunction is associated with depression, which may have implications for prevention and treatment. However, this association has not been systematically reviewed...... microvascular dysfunction might provide a potential target for the prevention and treatment of depression........ Objective: To examine the associations of peripheral and cerebral microvascular dysfunction with late-life depression. Data Sources: A systematic literature search was conducted in MEDLINE and EMBASE for and longitudinal studies published since inception to October 16, 2016, that assessed the associations...

  1. Reduced microvascular density in non-ischemic myocardium of patients with recent non-ST-segment-elevation myocardial infarction.

    Science.gov (United States)

    Campbell, Duncan J; Somaratne, Jithendra B; Jenkins, Alicia J; Prior, David L; Yii, Michael; Kenny, James F; Newcomb, Andrew E; Kelly, Darren J; Black, Mary Jane

    2013-08-10

    Myocardial microvascular dysfunction has been implicated in the pathogenesis of myocardial infarction (MI). We tested the hypothesis that patients with MI have lower microvasculature density in myocardium remote from the site of infarction than patients with similar extent of coronary artery disease (CAD) without MI and examined the relationship between myocardial capillary length density and plasma levels of angiogenesis-related biomarkers. We analyzed biopsies from non-ischemic left ventricular (LV) myocardium and measured plasma levels of angiogenesis-related biomarkers in patients undergoing coronary artery bypass graft surgery, 57 without previous MI (no-MI) and 27 with recent non-ST-segment-elevation MI (NSTEMI). Comparison was made with biopsies from 31 aortic stenosis (AS) patients and 6 patients with "normal" LV without CAD. Myocardial microvascular density of NSTEMI patients was approximately half the density of no-MI patients, and similar to AS patients. Whereas the reduced microvascular density of AS patients was accounted for by their cardiomyocyte hypertrophy, this was not the case for NSTEMI patients, who had higher diffusion radius/cardiomyocyte width ratio than no-MI, "normal" LV, and AS patients. NSTEMI patients had lower plasma levels of carboxymethyl lysine and low molecular weight fluorophores, higher vascular endothelial growth factor (VEGF) receptor-1/VEGF-A ratio, and higher endostatin and hepatocyte growth factor levels than no-MI patients. Recent MI was associated with reduced microvasculature density in myocardium remote from the site of infarction and alteration in plasma levels of angiogenesis-related biomarkers. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  2. Telmisartan enhances mitochondrial activity and alters cellular functions in human coronary artery endothelial cells via AMP-activated protein kinase pathway.

    Science.gov (United States)

    Kurokawa, Hirofumi; Sugiyama, Seigo; Nozaki, Toshimitsu; Sugamura, Koichi; Toyama, Kensuke; Matsubara, Junichi; Fujisue, Koichiro; Ohba, Keisuke; Maeda, Hirofumi; Konishi, Masaaki; Akiyama, Eiichi; Sumida, Hitoshi; Izumiya, Yasuhiro; Yasuda, Osamu; Kim-Mitsuyama, Shokei; Ogawa, Hisao

    2015-04-01

    Mitochondrial dysfunction plays an important role in cellular senescence and impaired function of vascular endothelium, resulted in cardiovascular diseases. Telmisartan is a unique angiotensin II type I receptor blocker that has been shown to prevent cardiovascular events in high risk patients. AMP-activated protein kinase (AMPK) plays a critical role in mitochondrial biogenesis and endothelial function. This study assessed whether telmisartan enhances mitochondrial function and alters cellular functions via AMPK in human coronary artery endothelial cells (HCAECs). In cultured HCAECs, telmisartan significantly enhanced mitochondrial activity assessed by mitochondrial reductase activity and intracellular ATP production and increased the expression of mitochondria related genes. Telmisartan prevented cellular senescence and exhibited the anti-apoptotic and pro-angiogenic properties. The expression of genes related anti-oxidant and pro-angiogenic properties were increased by telmisartan. Telmisartan increased endothelial NO synthase and AMPK phosphorylation. Peroxisome proliferator-activated receptor gamma signaling was not involved in telmisartan-induced improvement of mitochondrial function. All of these effects were abolished by inhibition of AMPK. Telmisartan enhanced mitochondrial activity and exhibited anti-senescence effects and improving endothelial function through AMPK in HCAECs. Telmisartan could provide beneficial effects on vascular diseases via enhancement of mitochondrial activity and modulating endothelial function through AMPK activation. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  3. Multi-physics optimization of three-dimensional microvascular polymeric components

    Science.gov (United States)

    Aragón, Alejandro M.; Saksena, Rajat; Kozola, Brian D.; Geubelle, Philippe H.; Christensen, Kenneth T.; White, Scott R.

    2013-01-01

    This work discusses the computational design of microvascular polymeric materials, which aim at mimicking the behavior found in some living organisms that contain a vascular system. The optimization of the topology of the embedded three-dimensional microvascular network is carried out by coupling a multi-objective constrained genetic algorithm with a finite-element based physics solver, the latter validated through experiments. The optimization is carried out on multiple conflicting objective functions, namely the void volume fraction left by the network, the energy required to drive the fluid through the network and the maximum temperature when the material is subjected to thermal loads. The methodology presented in this work results in a viable alternative for the multi-physics optimization of these materials for active-cooling applications.

  4. A focus on the prognosis and management of ischemic heart disease in patients without evidence of obstructive coronary artery disease.

    Science.gov (United States)

    Scalone, Giancarla; Niccoli, Giampaolo

    2015-01-01

    Ischemic heart disease without evidence of obstructive coronary artery disease is a common phenotype comprising different coronary syndromes with either stable or unstable clinical presentation. In this context, the clinical outcome and management appear extremely variable, due to different etiologies. Of note, coronary microvascular dysfunction is the pathogenetic mechanism linking different clinical scenarios in most of the cases. Hence, in this article, we aim to provide a systematic approach of reviewing the prognosis and management of angina or myocardial infarction without evidence of obstructive coronary artery disease. Moreover, we will propose a new scheme of classification by distinguishing between angina with normal coronary artery and myocardial infarction with normal coronary artery in order to facilitate clinicians to perform a proper management workflow.

  5. Higher CHADS2 score is associated with impaired coronary flow reserve: A study using phase contrast cine magnetic resonance imaging.

    Science.gov (United States)

    Kirigaya, Hidekuni; Kato, Shingo; Gyotoku, Daiki; Yamada, Nao; Iinuma, Naoki; Kusakawa, Yuka; Iguchi, Kohei; Miki, Yuko; Nakachi, Tatsuya; Fukui, Kazuki; Iwasawa, Tae; Kimura, Kazuo

    2016-10-15

    The presence of coronary microvascular dysfunction (CMD) is an important prognostic marker for coronary artery disease (CAD) patients. The purpose of this study was to investigate whether the CHADS2 score is associated with CMD evaluated by magnetic resonance imaging (MRI). One hundred forty three patients with known or suspected CAD (mean age 70.3±9.5years) were enrolled. All patients did not have any significant coronary stenosis on X-ray coronary angiography (CAG) at the time of MRI acquisition. By using a 1.5T MRI scanner, breath-hold phase contrast cine MRI images of coronary sinus (CS) were obtained to assess the blood flow of CS both at rest and during adenosine triphosphate (ATP) infusion. Coronary flow reserve (CFR) was calculated as CS blood flow during ATP infusion divided by CS blood flow at rest. CMD was defined as CFRcine MRI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Molecular and cellular basis of microvascular perfusion deficits induced by Clostridium perfringens and Clostridium septicum.

    Directory of Open Access Journals (Sweden)

    Michael J Hickey

    2008-04-01

    Full Text Available Reduced tissue perfusion leading to tissue ischemia is a central component of the pathogenesis of myonecrosis caused by Clostridium perfringens. The C. perfringens alpha-toxin has been shown capable of inducing these changes, but its potential synergy with perfringolysin O (theta-toxin is less well understood. Similarly, Clostridium septicum is a highly virulent causative agent of spontaneous gas gangrene, but its effect on the microcirculation has not been examined. Therefore, the aim of this study was to use intravital microscopy to examine the effects of C. perfringens and C. septicum on the functional microcirculation, coupled with the use of isogenic toxin mutants to elucidate the role of particular toxins in the resultant microvascular perfusion deficits. This study represents the first time this integrated approach has been used in the analysis of the pathological response to clostridial toxins. Culture supernatants from wild-type C. perfringens induced extensive cell death within 30 min, as assessed by in vivo uptake of propidium iodide. Furthermore, significant reductions in capillary perfusion were observed within 60 min. Depletion of either platelets or neutrophils reduced the alteration in perfusion, consistent with a role for these blood-borne cells in obstructing perfusion. In addition, mutation of either the alpha-toxin or perfringolysin O structural genes attenuated the reduction in perfusion, a process that was reversed by genetic complementation. C. septicum also induced a marked reduction in perfusion, with the degree of microvascular compromise correlating with the level of the C. septicum alpha-toxin. Together, these data indicate that as a result of its ability to produce alpha-toxin and perfringolysin O, C. perfringens rapidly induces irreversible cellular injury and a marked reduction in microvascular perfusion. Since C. septicum induces a similar reduction in microvascular perfusion, it is postulated that this function

  7. Microvascular system of anterior cruciate ligament in dogs.

    Science.gov (United States)

    Kobayashi, Shigeru; Baba, Hisatoshi; Uchida, Kenzo; Negoro, Kohei; Sato, Mituhiko; Miyazaki, Tsuyoshi; Nomura, Eiki; Murakami, Kaname; Shimizubata, Matsuyuki; Meir, Adam

    2006-07-01

    This study was done to investigate the microvascular system of anterior cruciate ligament (ACL) using dogs. The objective was to study the microvascular architecture and the status of the barrier function of the capillary wall in the ACL by using microangiogram, scanning (SEM), and transmission electron microscopy (TEM). The vascular system in the ACL has been intensively studied by a number of researchers, using several microangiographic techniques in dogs, rabbits, and humans. However, most of these microangiographic studies had significant shortcomings, including the lack of three-dimensional observations and function of the blood-joint barrier in the ACL. In this study, the microstructure of the ACL was examined using microangiogram, SEM, and TEM. We investigated the vasculature of the ACL with SEM of vascular corrosion casts. In addition, we examined the status of the barrier function of the capillary wall in the ACL using the protein tracer horseradish peroxidase (HRP). Feeding vessels of the ligament were predominantly coming from the synovial-derived vessels originating from the synovium attached to the ligament near the tibial and femoral bone insertions of the ACL. The anterior cruciate ligament was surrounded by synovium, which had abundant vessels. The branches of these synovial vessels were penetrating into the ligament and making the intrinsic vascular network. It was also ascertained under SEM that the perivascular space around the intrinsic vessels were communicating through the intrinsic ligament fiber bundles and the mesh-like synovial membrane. The capillaries in the ACL were all of the continuous type under TEM. The protein tracer that was injected into the joint space passed through the synovial membrane and entered into the capillary lumen in the ACL, but the tracer that was injected intravenously did not appear in the perivascular space. The existence of a blood-ACL barrier does not necessarily imply the existence of an ACL-blood barrier. We

  8. Different types of atrial fibrillation, renal function, and mortality in elderly Chinese patients with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Fu S

    2014-02-01

    Full Text Available Shihui Fu,1,* Tao Liu,2,* Leiming Luo,1 Ping Ye1 1Department of Geriatric Cardiology; 2Nanlou Ultrasound Department, Chinese People’s Liberation Army General Hospital, Beijing, People's Republic of China *These authors are joint first authors Background: Atrial fibrillation (AF is the most common arrhythmia in patients with chronic kidney disease (CKD, and the combined prevalence of these two disorders increases as the population ages. Both AF and CKD have risk factors for development of each other and eventual mortality. However, the relationship between different types of AF, CKD, and mortality remains unclear, especially in elderly Chinese patients with coronary artery disease. Methods: This study comprised 1,050 patients of median age 86 (60–104 years with coronary artery disease. The end point was all-cause death during a mean follow-up of 417 days. Results: Of 219 patients identified to have AF, 128 had paroxysmal type, 44 had persistent type, and 47 had permanent type. After adjusting for confounders, the estimated glomerular filtration rate was lower and the prevalence of CKD was higher in patients with permanent AF but not in those with paroxysmal or persistent AF. During follow-up, 106 non-CKD patients and 112 CKD patients died; mortality was significantly higher in CKD patients with AF than in those without AF (36 [40.9%] versus 76 [26.8%], but not in patients without CKD (17 [13.0%] versus 89 [16.3%]. In patients with CKD, paroxysmal AF was independently associated with higher mortality after adjustment but not persistent or permanent AF. No type of AF had an independent association with mortality in patients without CKD. Conclusion: All types of AF had a high prevalence. Permanent AF was independently associated with an increased prevalence of CKD and a decreased estimated glomerular filtration rate. Paroxysmal AF was an independent risk factor for survival in patients with CKD but not in those without CKD. Keywords: atrial

  9. Reduced coronary flow reserve in patients with primary hyperparathyroidism: a study by G-SPECT myocardial perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Marini, Cecilia [CNR Institute of Bioimages and Molecular Physiology Milan, Genoa (Italy); Giusti, Massimo; Vera, Lara; Minuto, Francesco [University of Genoa, Department of Endocrinological and Metabolic Sciences, Genoa (Italy); Armonino, Riccardo; Ghigliotti, Giorgio; Bezante, Gian Paolo; Morbelli, Silvia; Pomposelli, Elena; Massollo, Michela; Gandolfo, Patrizia; Sambuceti, Gianmario [University of Genoa, Department of Internal Medicine, Genoa (Italy)

    2010-12-15

    The mechanisms underlying increased cardiovascular risk in primary hyperparathyroidism (pHPT) have not been fully defined. Recently, this issue has become the subject of renewed interest due to the increasing evidence that the endothelium and vascular wall are targets for parathyroid hormone (PTH). The aim of this study was to measure regional coronary flow reserve (CFR) to determine whether the vascular damage induced by pHPT extends to affect the coronary microvascular function. A total of 22 pHPT patients without a history of coronary artery disease and 7 age-matched control subjects were recruited. Dipyridamole myocardial blood flow (MBF) was assessed using {sup 99m}Tc-sestamibi by measuring first-transit counts in the pulmonary artery and myocardial count rate from G-SPECT images. Baseline MBF was estimated 2 h later according to the same procedure. Regional CFR was defined as the ratio between dipyridamole and baseline MBF using a 17-segment left ventricular model. Three pHPT patients showed reversible perfusion defects and were excluded from the analysis. In the remaining 19, CFR was significantly lower with respect to the control subjects (1.88 {+-} 0.64 vs. 3.36 {+-} 0.66, respectively; p < 0.01). Moreover, patients studied for more than 28 months from pHPT diagnosis showed lower CFR values than the others (1.42 {+-} 0.18 vs. 2.25 {+-} 0.64, respectively; p < 0.01). Consequently, the time from diagnosis to the nuclear study showed a reasonable correlation with the degree of CFR impairment (Spearman's rho -0.667, p < 0.02). pHPT is associated with a significant dysfunction of the coronary microcirculation. This disorder might contribute to the high cardiovascular risk of conditions characterized by chronic elevations in serum PTH levels. (orig.)

  10. Clinical outcome following micro-vascular decompression for trigeminal neuralgia

    Directory of Open Access Journals (Sweden)

    Godugu Bhaskar Rao

    2015-07-01

    Conclusion: Micro-vascular decompression is safe and effective in producing good pain relief over a long term in patients with Trigeminal neuralgias refractive to medical treatment. [Int J Res Med Sci 2015; 3(7.000: 1741-1744

  11. Retinal microvascular abnormalities and stroke: a systematic review

    NARCIS (Netherlands)

    Doubal, F.N.; Hokke, P.E.; Wardlaw, J.M.

    2009-01-01

    Background: Lacunar strokes account for 25% of ischaemic strokes, but their precise aetiology is unknown. Similarities between the retinal and cerebral small vessels mean that clarification of the exact relationship between retinal microvascular abnormalities and stroke, and particularly with stroke

  12. SPY Imaging Assessment Correlates With Transesophageal Echocardiogram Assessment of Ventricular Function During Off-Pump Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Anderson, Curtis A; Kypson, Alan P; Hudson, Wes; Ferguson, Bruce; Rodriguez, Evelio

    2008-05-01

    Intraoperative assessment of graft anastomoses is commonly performed after off-pump coronary artery bypass grafting (OPCAB). The SPY imaging system allows intraoperative graft assessment. We document correlation between intraoperative SPY images and wall motion abnormality by transesophageal echocardiogram (TEE) during OPCAB. A 79-year-old female underwent OPCAB. Intraoperative graft patency assessment was performed with the SPY and left ventricular wall motion was assessed by TEE. SPY imaging demonstrated poor flow trough the distal vein graft anastomosis to the posterior descending artery, which correlated with a new posterior wall motion hypokinesis. After graft revision, SPY imaging demonstrated good distal flow and the TEE demonstrated normalization of the left ventricular posterior wall motion. SPY technology allows the surgeon to accurately assess graft patency intraoperatively and allows immediate correction of a technical problem.

  13. Coronary blood flow in patients with cardiac syndrome X.

    Science.gov (United States)

    Sen, Nihat; Tavil, Yusuf; Yazici, Hüseyin Uğur; Abacl, Adnan; Cengel, Atiye

    2007-02-01

    Epicardial coronary arteries are normal in patients with cardiac syndrome X. It is, however, unclear whether there is an abnormality at the level of microvascular circulation. In this study, our aim was to evaluate the epicardial coronary blood flow and myocardial perfusion in patients with cardiac syndrome X. Two hundred and three patients (mean age 53+/-10 years, 85 men) were included in the study. The diagnosis of cardiac syndrome X was made in patients who had a complaint of typical anginal chest pain and had ischemic findings on either myocardial perfusion scintigraphy or a treadmill exercise test, and whose coronary angiograms did not reveal any pathology. Fifty patients (mean age 54+/-11 years, 24 men) who had a complaint of typical anginal chest pain and had a normal myocardial perfusion test and normal coronary arteries were recruited as the control group. Epicardial coronary blood flow was evaluated with the thrombolysis in myocardial infarction frame count method and myocardial perfusion was evaluated with the myocardial blush grade method. A myocardial blush grade of 0.05). We found that the epicardial coronary blood flow, as assessed by thrombolysis in myocardial infarction frame count, and myocardial perfusion, as assessed by myocardial blush grade, were normal in patients with cardiac syndrome X.

  14. Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders.

    Science.gov (United States)

    Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

    2016-08-18

    Intracoronary acetylcholine provocation testing (ACH-test) is an established method for assessment of epicardial coronary artery spasm in the catheterization laboratory which was introduced more than 30 years ago. Due to the short half-life of acetylcholine it can only be applied directly into the coronary arteries. Several studies have demonstrated the safety and clinical usefulness of this test. However, acetylcholine testing is only rarely applied in the U.S. or Europe. Nevertheless, it has been shown that 62% of Caucasian patients with stable angina and unobstructed coronary arteries on coronary angiography suffer from coronary vasomotor disorders that can be diagnosed with acetylcholine testing. In recent years it has been appreciated that the ACH-test not only assesses the presence of epicardial spasm but that it can also be useful for the detection of coronary microvascular spam. In such cases no epicardial spasm is seen after injection of acetylcholine but ischemic ECG shifts are present together with a reproduction of the patient's symptoms during the test. This article describes the experience with the ACH-test and its implementation in daily clinical routine.

  15. Concomitant macro and microvascular complications in diabetic nephropathy

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    Alwakeel Jamal

    2009-01-01

    Full Text Available To determine the prevalence of concomitant microvascular and macrovascular complica-tions of diabetic nephropathy we retrospectively reviewed the medical records of all 1,952 type 2 dia-betic patients followed-up at Security Forces Hospital, Riyadh, Saudi Arabia from January 1989 to December 2004. There were 626 (32.1% patients (294 (47% were males who developed diabetic nephropathy. Their mean age was 66.9 ± 11.4 years, mean duration of diabetes was 15.4 ± 7.5 years, mean age at the onset of nephropathy was 61.5 ± 12.4 years, and mean duration of nephropathy was 3.9 ± 3.8 years. Concomitant diabetic complications included cataract (38.2%, acute coronary syndrome (36.1%, peripheral neuropathy (24.9%, myocardial infarction (24.1%, background retinopathy (22.4%, stroke (17.6%, proliferative retinopathy (11.7%, foot infection (7.3%, limb amputation (3.7% and blindness (3%. Hypertension was documented in 577 (92.2% patients, dyslipidemia in 266 (42.5% and mortality from all causes in 86 (13.7%. There were 148 (23.6% patients with one complication, 81 (12.9% with two, 83 (13.3% with three, and 61 (9.7% with four or more. Dete-rioration of glomerular filtration rate was observed in 464 (74% patients and doubling of serum creatinine in 250 (39.9%, while 95 (15.2% developed end-stage renal disease (ESRD at the end of study and 79 (12.6% required dialysis. Complications were significantly more prevalent among males with greater number reaching ESRD level than females (P< 0.05. Relative risks of developing com-plications were significant after the onset of nephropathy; ACS (1.41, MI (1.49, stroke (1.48, diabetic foot (1.6, amputation (1.58 and death (1.93. We conclude that complications of diabetes are aggre-ssive and progressive including high prevalence of diabetic nephropathy. Careful monitoring and proper institution of management protocols should be implemented to identify diabetic patients at high risk for complications and mitigate progression

  16. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation.

    Science.gov (United States)

    Nehete, Rajendra; Nehete, Anita; Singla, Sandeep; Adhav, Harshad

    2012-01-01

    In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

  17. Bilateral microvascular second toe transfer for bilateral post-traumatic thumb amputation

    Directory of Open Access Journals (Sweden)

    Rajendra Nehete

    2012-01-01

    Full Text Available In bilateral thumb amputations, the functional impairment is serious and every attempt should be made to reconstruct the thumb. We report a case of bilateral post traumatic thumb amputation, reconstructed with bilateral second toe transfer. Only two such cases have been reported in literature so far. Though there are various modalities for the reconstruction of thumb, microvascular toe transfer has its own merits. The convalescent period is minimal with excellent function. It is bilaterally symmetric and aesthetically superior to the osteoplastic reconstruction. The technical details are discussed, and the long term functional and aesthetic results are presented.

  18. Reduction of neutrophil activity decreases early microvascular injury after subarachnoid haemorrhage

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    Bi Weina

    2011-08-01

    Full Text Available Abstract Background Subarachnoid haemorrhage (SAH elicits rapid pathological changes in the structure and function of parenchymal vessels (≤ 100 μm. The role of neutrophils in these changes has not been determined. This study investigates the role of neutrophils in early microvascular changes after SAH Method Rats were either untreated, treated with vinblastine or anti-polymorphonuclear (PMN serum, which depletes neutrophils, or treated with pyrrolidine dithiocarbamate (PDTC, which limits neutrophil activity. SAH was induced by endovascular perforation. Neutrophil infiltration and the integrity of vascular endothelium and basement membrane were assessed immunohistochemically. Vascular collagenase activity was assessed by in situ zymography. Results Vinblastine and anti-PMN serum reduced post-SAH accumulation of neutrophils in cerebral vessels and in brain parenchyma. PDTC increased the neutrophil accumulation in cerebral vessels and decreased accumulation in brain parenchyma. In addition, each of the three agents decreased vascular collagenase activity and post-SAH loss of vascular endothelial and basement membrane immunostaining. Conclusions Our results implicate neutrophils in early microvascular injury after SAH and indicate that treatments which reduce neutrophil activity can be beneficial in limiting microvascular injury and increasing survival after SAH.

  19. Changes of microvascular architecture, ultrastructure and permeability of rat jejunal villi at different ages

    Institute of Scientific and Technical Information of China (English)

    Yan-Min Chen; Jin-Sheng Zhang; Xiang-Lin Duan

    2003-01-01

    AIM: To investigate the changes of microvascular architecture, ultrastructure and permeability of rat jejunal villi at different ages.METHODS: Microvascular corrosion casting, scanning electron microscopy, transmission electron microscopy and Evans blue infiltration technique were used in this study.RESULTS: The intestinal villous plexus of adult rats consisted of arterioles, capillary network and venules. The marginal capillary extended to the base part of the villi and connected to the capillary networks of adjacent villi. In newborn rats,the villous plexus was rather simple, and capillary network was not formed. The villous plexus became cone-shaped and was closely arrayed in ablactation rats. In adult rats,the villous plexus became tongue-shaped and was enlarged both in height and width. In aged rats, the villous plexus shrank in volume and became shorter and narrower. The diametral ratio of villous arteriole to villous venule increased as animals became older. The number of endothelial holes,the thickness of basal membrane and the permeability of microvasculature were increased over the entire course of development from newborn period to aged period.CONCLUSION: The digestive and absorptive functions of the rat jejunum at different ages are highly dependent upon the state of villous microvascular architecture and permeability, and blood circulation is enhanced by collateral branches such as marginal capillary, through which blood is drained to the capillary networks of adjacent villi.

  20. Clinical reference value of retinal microvascular changes in patients with cerebral microbleeds

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    Ji-Yuan Guo

    2014-12-01

    Full Text Available AIM: To study clinical reference value of retinal microvascular changes in patients with cerebral microbleeds(CMBsand discuss its clinical significance. METHODS:From January 2012 to December 2013, 125 hospitalized patients were collected, including 81 cases were male, 44 cases were female, mean age 76.3±11.2 years old. For all patients, functions of liver and kidney, blood-lipoids, blood sugar and blood biochemical examination were tested, and fundus photography and cerebral MR was done. According to the fundus camera eyes, retinal arteriolar equivalent(RAE, retinal venular equivalent(RVE, retinal vein diameter ratio(AVRand arteriovenous crossing sign(AVNwere identified, CMBs were classified with cerebral MRI. All the data were processed by SPSS statistical software. RESULTS: The central retinal arteriolar equivalent(CRAE, central retinal venular equivalent(CRVEand AVR values in the eyes were found no statistical difference(PPCOCLUSION: The results show that retinal microvascular changes, especially small retinal vein arteriovenous cross width, and arteriovenous crossing phenomenon, in which CMBs will happen more likely. After sex, age, hypertension and hyperglycemia in patients with traditional cardiovascular risk factors being ruled out, the retinal microvascular changes are still relatively factors of CMB's occurrence.

  1. Increased Angiotensin II Sensitivity Contributes to Microvascular Dysfunction in Women Who Have Had Preeclampsia.

    Science.gov (United States)

    Stanhewicz, Anna E; Jandu, Sandeep; Santhanam, Lakshmi; Alexander, Lacy M

    2017-08-01

    Women who have had preeclampsia have increased cardiovascular disease risk; however, the mechanism(s) responsible for this association remain unclear. Microvascular damage sustained during a preeclamptic pregnancy may persist postpartum. The putative mechanisms mediating this dysfunction include a reduction in NO-dependent dilation and an increased sensitivity to angiotensin II. In this study, we evaluated endothelium-dependent dilation, angiotensin II sensitivity, and the therapeutic effect of angiotensin II receptor blockade (losartan) on endothelium-dependent dilation in vivo in the microvasculature of women with a history of preeclampsia (n=12) and control women who had a healthy pregnancy (n=12). We hypothesized that preeclampsia would have (1) reduced endothelium-dependent dilation, (2) reduced NO-mediated dilation, and (3) increased sensitivity to angiotensin II. We further hypothesized that localized losartan would increase endothelium-dependent vasodilation in preeclampsia. We assessed microvascular endothelium-dependent vasodilator function by measurement of cutaneous vascular conductance responses to graded infusion of acetylcholine (acetylcholine; 10(-7)-102 mmol/L) and a standardized local heating protocol in control sites and sites treated with 15 mmol/L L-NAME (N(G)-nitro-l-arginine methyl ester; NO-synthase inhibitor) or 43 µmol/L losartan. Further, we assessed microvascular vasoconstrictor sensitivity to angiotensin II (10(-20)-10(-4) mol/L). Preeclampsia had significantly reduced endothelium-dependent dilation (-0.3±0.5 versus -1.0±0.4 logEC50; PPreeclampsia also had augmented vasoconstrictor sensitivity to angiotensin II (-10.2±1.3 versus -8.3±0.5; P=0.006). Angiotensin II type I receptor inhibition augmented endothelium-dependent vasodilation and NO-dependent dilation in preeclampsia but had no effect in healthy pregnancy. These data suggest that women who have had preeclampsia have persistent microvascular dysfunction postpartum, mediated

  2. The nociceptin/orphanin FQ receptor antagonist UFP-101 reduces microvascular inflammation to lipopolysaccharide in vivo.

    Directory of Open Access Journals (Sweden)

    Zoë L S Brookes

    Full Text Available Microvascular inflammation occurs during sepsis and the endogenous opioid-like peptide nociceptin/orphanin FQ (N/OFQ is known to regulate inflammation. This study aimed to determine the inflammatory role of N/OFQ and its receptor NOP (ORL1 within the microcirculation, along with anti-inflammatory effects of the NOP antagonist UFP-101 (University of Ferrara Peptide-101 in an animal model of sepsis (endotoxemia. Male Wistar rats (220 to 300 g were administered lipopolysaccharide (LPS for 24 h (-24 h, 1 mg kg(-1; -2 h, 1 mg kg(-1 i.v., tail vein. They were then either anesthetised for observation of the mesenteric microcirculation using fluorescent in vivo microscopy, or isolated arterioles (~200 µm were studied in vitro with pressure myography. 200 nM kg(-1 fluorescently labelled N/OFQ (FITC-N/OFQ, i.a., mesenteric artery bound to specific sites on the microvascular endothelium in vivo, indicating sparse distribution of NOP receptors. In vitro, arterioles (~200 µm dilated to intraluminal N/OFQ (10(-5M (32.6 + 8.4% and this response was exaggerated with LPS (62.0 +7.9%, p=0.031. In vivo, LPS induced macromolecular leak of FITC-BSA (0.02 g kg(-1 i.v. (LPS: 95.3 (86.7 to 97.9%, p=0.043 from post-capillary venules (<40 µm and increased leukocyte rolling as endotoxemia progressed (p=0.027, both being reduced by 150 nmol kg(-1 UFP-101 (i.v., jugular vein. Firstly, the rat mesenteric microcirculation expresses NOP receptors and secondly, NOP function (ability to induce dilation is enhanced with LPS. UFP-101 also reduced microvascular inflammation to endotoxemia in vivo. Hence inhibition of the microvascular N/OFQ-NOP pathway may have therapeutic potential during sepsis and warrants further investigation.

  3. Two-dimensional longitudinal strain for the assessment of the left ventricular systolic function as compared with conventional echocardiographic methods in patients with acute coronary syndromes.

    Science.gov (United States)

    Ryczek, Robert; Krzesiński, Paweł; Krzywicki, Paweł; Smurzyński, Paweł; Cwetsch, Andrzej

    2011-01-01

    The evaluation of the left ventricular (LV) function is one of the most important elements of diagnosis in patients with cardiovascular (CV) diseases. A low LV ejection fraction (LVEF) is a strong and independent predictor of CV events. Traditionally, echocardiography characterises the LV systolic function by the estimation of LVEF with use of the Simpson method, supported by the wall motion score index (WMSI). Speckle tracking imaging is a new method of LV function imaging based on the estimation of longitudinal peak systolic strain (LPSS), by tracing of the automatically detected myocardial speckles. To evaluate the usefulness of global longitudinal peak systolic strain (GLPSS) and regional longitudinal peak systolic strain (r-LPSS) in LV systolic function assessment and to compare LPSS with conventional parameters such as LVEF, WMSI and regional wall motion score index (r-WMSI). The study was performed in a group of 44 patients with a clinical diagnosis of acute coronary syndrome (mean age 63.6 ± 12.2 years). The LVEF, WMSI, r-WMSI were estimated by echocardiography (VIVID 7 Dimension, GE Healthcare, USA). Moreover, LPSS (GLPSS and r-LPSS) with use of automated function imaging (AFI) were also estimated. In the study group mean LVEF was 43.1 ± 12.7%, mean WMSI: 1.68 ± 0.52, and GLPSS: -13.8 ± 5.6%. A very strong linear correlation between the conventional and new parameters was observed - for GLPSS and LVEF: r = -0.86 (p < 0.00001), for GLPSS and WMSI: r = 0.88 (p < 0.00001). The results of the regional myocardial contractility assessment (r-LPSS and r-WMSI) were also in agreement, especially for LV anterior wall (r = 0.87, p < 0.00001). These results suggest a considerable usefulness of LPSS - a new method of echocardiographical imaging - in the estimation of global and regional LV function in patients with acute coronary syndrome and its agreement with conventional parameters such as LVEF and WMSI.

  4. Effect of angiopoietin-related protein 2 on coronary angiogenesis and myocardial function in a porcine model of acute myocardial ischemia

    Institute of Scientific and Technical Information of China (English)

    Shu Meng; Changqian Wang; Fei Wang; Renjian Zhou; Fangbao Ding; Fuxin Chen

    2008-01-01

    Our previous studies have suggested that angiopoietin-related protein 2 (Arp2) may improve rat cardiac function after acute myocardial infarction (AMI) by accelerating angiogenesis.We want to study the efficacy of the adenoviral vector-mediated gene transfer of Arp2 (Ad.Arp2) in inducing angiogenesis and in improving the myocardial perfusion and function in a porcine acute myocardial ischemic model.Methods The minipigs underwent ligation of the proximal circumflex coronary artery (LCx) and were randomly assigned to treatment with Ad.Arp2,adenoviral vectors with no transgene (Ad.Null) or PBS.Four weeks later,the animals were evaluated using echocardiography,cardiac perfusion imaging and pathologic observation.Results Four weeks after treatment,the Arp2 protein was revealed in the myocardium of Ad.Arp2 animals,but was not found in the Ad.Null or PBS animals.Also,a significant revival of myocardial perfusion was found in the ischemic area in Ad.Arp2-treated animals,whose global and regional myocardial function was greatly improved.The quantitation of new capillaries was much greater in the Ad.Arp2 group than in the Ad.Null or PBS groups.Conclusion Treatment with Ad.ARP2 offers the obvious advantage of greatly improving the blood supply and the heart function.(J Geriatr Cardiol 2008;5:230-234)

  5. Hemodynamic Consequences of Changes in Microvascular Structure.

    Science.gov (United States)

    Rizzoni, Damiano; Agabiti-Rosei, Claudia; Agabiti-Rosei, Enrico

    2017-10-01

    In hypertension, an increased media-to-lumen ratio of small resistance arteries might play an important role in the increase of vascular resistance, and may also be an adaptive response to the increased hemodynamic load. The presence of morphological alteration in the microvasculature may be associated to an impaired tissue perfusion and/or to the development of target organ damage. Structural alterations in the microcirculation might represent a predictor of the onset of cardio-cerebrovascular events and hypertension complications. A cross-talk between the small and large artery may exaggerate arterial damage, following a vicious circle. Therefore, in the present review, possible hemodynamic consequences of the presence of microvascular structural alterations will be considered, in terms of their time of onset, role in the development and/or maintenance of high blood pressure values, and interrelationships with structural/mechanical alterations of large conductance arteries. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  6. [Microvascular anastomoses in cervical esophageal reconstruction].

    Science.gov (United States)

    Takushima, A; Harii, K; Asato, H

    2001-09-01

    Ischemia or hemostasis in the gastric, jejunal, and colonic pedicle after esophagectomy is believed to contribute significantly to postoperative complications. With the advent of microvascular anastomoses, many surgeons have adopted vascular augmentation (supercharge) as a means of avoiding these difficulties. Microsurgical free tissue transfer represented by the free jejunum and forearm flap also plays an important role in esophageal reconstruction. In this paper, the authors introduce the technical points important for successful revascularization including the choice of recipient vessels, setting up of the reconstructive materials, and postoperative monitoring. In cases of gastric pull-up elevated via posterior mediastinum, the left gastroduodenal vessels are anastomosed to the cervical transverse or superior thyroidal vessels. In cases of duodenal or colonic pull-up elevated via the anterosternal route, the vascular pedicles are anastomosed to the internal mammary vessels which are dissected by resecting the costal cartilage. When the free jejunum flap is used, the cervical transverse or superior thyroidal vessels are most frequently used as recipients. Postoperative monitoring of free flaps is performed using Doppler ultrasound or through a small skin incision made above the transferred tissue. Although gastric or colonic pull-up is difficult to monitor, color Doppler sonography permits quantitative analysis of blood flow and may be a useful option.

  7. Coronary and peripheral endothelial function in HIV patients studied with positron emission tomography and flow-mediated dilation: relation to hypercholesterolemia

    Energy Technology Data Exchange (ETDEWEB)

    Lebech, Anne-Mette [Copenhagen University Hospital, Department of Infectious Diseases, Hvidovre (Denmark); Hvidovre University Hospital, Department of Infectious Diseases, Hvidovre (Denmark); Kristoffersen, Ulrik Sloth; Kjaer, Andreas [Rigshospitalet University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen (Denmark); University of Copenhagen, Cluster for Molecular Imaging, Copenhagen (Denmark); Wiinberg, Niels; Petersen, Claus Leth [Frederiksberg University Hospital, Department of Clinical Physiology and Nuclear Medicine, Frederiksberg (Denmark); Kofoed, Kristian; Andersen, Ove [Copenhagen University Hospital, Department of Infectious Diseases, Hvidovre (Denmark); Copenhagen University Hospital, Clinical Research Unit, Hvidovre (Denmark); Hesse, Birger [Rigshospitalet University Hospital, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen (Denmark); Gerstoft, Jan [Rigshospitalet University Hospital, Department of Infectious Diseases, Copenhagen (Denmark)

    2008-11-15

    The mechanisms underlying increased cardiovascular risk in HIV patients in antiretroviral therapy (ART) are not known. Our aim was to study the endothelial function of the coronary arteries by cardiac perfusion positron emission tomography (PET), in HIV patients with normal or high cholesterol levels. Flow mediated dilation (FMD) of the brachial artery and circulating endothelial markers were also assessed. HIV patients in ART with total cholesterol {<=} 5.5 mmol/L (215 mg/dL; n = 13) or total cholesterol {>=} 6.5 mmol/L (254 mg/dL; n = 12) and healthy controls (n = 14) were included. {sup 13}NH{sub 3} perfusion PET, FMD, and measurement of plasma levels of E-Selectin, ICAM-1, VCAM-1, tPAI-1, and hs-CRP were performed. Baseline myocardial perfusion and the coronary flow reserve measured by PET (3.2 {+-} 0.3, 3.2 {+-} 0.3 and 3.0 {+-} 0.3; ns) was similar in HIV patients with normal or high total cholesterol and controls. FMD did not differ between the groups and was 4.6 {+-} 1.1%, 5.1 {+-} 1.2%, and 4.6 {+-} 0.8%, respectively. Increased levels of plasma E-Selectin, ICAM-1, tPAI-1, and hs-CRP were found in HIV patients when compared to controls (p < 0.05). E-Selectin and ICAM-1 levels were higher in HIV patients receiving protease inhibitors (PI) compared to those not receiving PI (p < 0.05). None of the measured endothelial biomarkers differed between the normal and high cholesterol HIV groups. In ART-treated HIV patients with a low overall cardiovascular risk, no sign of endothelial dysfunction was found not even in hypercholesterolemic patients. Also, the increased level of plasma endothelial markers found in HIV patients was not related to hypercholesterolemia. (orig.)

  8. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

  9. Multifractal and lacunarity analysis of microvascular morphology and remodeling.

    Science.gov (United States)

    Gould, Daniel J; Vadakkan, Tegy J; Poché, Ross A; Dickinson, Mary E

    2011-02-01

    Classical measures of vessel morphology, including diameter and density, are employed to study microvasculature in endothelial membrane labeled mice. These measurements prove sufficient for some studies; however, they are less well suited for quantifying changes in microcirculatory networks lacking hierarchical structure. We demonstrate that automated multifractal analysis and lacunarity may be used with classical methods to quantify microvascular morphology. Using multifractal analysis and lacunarity, we present an automated extraction tool with a processing pipeline to characterize 2D representations of 3D microvasculature. We apply our analysis on four tissues and the hyaloid vasculature during remodeling. We found that the vessel networks analyzed have multifractal geometries and that kidney microvasculature has the largest fractal dimension and the lowest lacunarity compared to microvasculature networks in the cortex, skin, and thigh muscle. Also, we found that, during hyaloid remodeling, there were differences in multifractal spectra reflecting the functional transition from a space filling vasculature which nurtures the lens to a less dense vasculature as it regresses, permitting unobstructed vision. Multifractal analysis and lacunarity are valuable additions to classical measures of vascular morphology and will have utility in future studies of normal, developing, and pathological tissues. © 2011 John Wiley & Sons Ltd.

  10. Barrier stabilizing mediators in regulation of microvascular endothelial permeability

    Institute of Scientific and Technical Information of China (English)

    HUANG Qiao-bing

    2012-01-01

    Increase of microvascular permeability is one of the most important pathological events in the pathogenesis of trauma and bum injury.Massive leakage of fluid from vascular space leads to lose of blood plasma and decrease of effective circulatory blood volume,resulting in formation of severe tissue edema,hypotension or even shock,especially in severe bum injury.Fluid resuscitation has been the only valid approach to sustain patient's blood volume for a long time,due to the lack of overall and profound understanding of the mechanisms of vascular hyperpenneability response.There is an emerging concept in recent years that some so-called barrier stabilizing mediators play a positive role in preventing the increase of vascular permeability.These mediators may be released in response to proinflammatory mediators and serve to restore endothelial barrier function.Some of these stabilizing mediators are important even in quiescent state because they preserve basal vascular permeability at low levels.This review introduces some of these mediators and reveals their underlying signaling mechanisms during endothelial barrier enhancing process.

  11. Microvascular network topology of the human retinal vessels.

    Science.gov (United States)

    Schröder, S; Brab, M; Schmid-Schönbein, G W; Reim, M; Schmid-Schönbein, H

    1990-01-01

    A quantitative analysis of blood flow in the human retinal vessels requires a detailed picture of the microvascular network topology. In order to lay the foundation for a quantitative microcirculatory network analysis of the human retina, a novel technique for tissue preparation and network characterization was developed. After injection of hydrogen peroxide into the human bulb, the microvasculature was filled with oxygen produced by endothelial catalase and visualized after embedding in a mixture of cedar oil and gum damar. The vessel topology was documented in the form of photomicrographs, which permitted complete reconstruction of the microvasculature on transparent overlays. By considering the complete capillary system it was possible to divide the retinal network into dichotomous, asymmetric arteriolar and venular trees. The Strahler ordering method, which considers both dichotomous and side branching configurations, was selected and applied to analyze the retinal vascular trees, using the capillaries as the zero order reference vessels. The number of vessel segments was found to be an approximate logarithmic function of the order number, in accordance with Horton's law. Vessel lengths within each order were found to be log-normal distributed, and median lengths for different orders could be approximated by a 2nd degree polynomial curve. Diameters within each order could be approximated by a Gaussian distribution, and the mean values for different orders could be expressed by an exponential curve. These data provide the basis for conductance, pressure and flow computations within the retinal microvessels.

  12. Diabetic microvascular complications: possible targets for improved macrovascular outcomes

    Directory of Open Access Journals (Sweden)

    Bijan Roshan

    2010-12-01

    Full Text Available John A D’Elia1, George Bayliss1,2, Bijan Roshan1, Manish Maski1, Ray E Gleason1, Larry A Weinrauch11Renal Unit, Joslin Diabetes Center, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; 2Department of Medicine, Rhode Island Hospital, Alpert School of Medicine, Brown University, Providence, RI, USAAbstract: The results of recent outcome trials challenge hypotheses that tight control of both glycohemoglobin and blood pressure diminishes macrovascular events and survival among type 2 diabetic patients. Relevant questions exist regarding the adequacy of glycohemoglobin alone as a measure of diabetes control. Are we ignoring mechanisms of vasculotoxicity (profibrosis, altered angiogenesis, hypertrophy, hyperplasia, and endothelial injury inherent in current antihyperglycemic medications? Is the polypharmacy for lowering cholesterol, triglyceride, glucose, and systolic blood pressure producing drug interactions that are too complex to be clinically identified? We review angiotensin–aldosterone mechanisms of tissue injury that magnify microvascular damage caused by hyperglycemia and hypertension. Many studies describe interruption of these mechanisms, without hemodynamic consequence, in the preservation of function in type 1 diabetes. Possible interactions between the renin–angiotensin–aldosterone system and physiologic glycemic control (through pulsatile insulin release suggest opportunities for further clinical investigation.Keywords: angiotensin-converting enzyme inhibitor, pulsatile insulin, diabetic nephropathy, cardiac autonomic neuropathy, podocytes, beta cells 

  13. Modeling of cerebral oxygen transport based on in vivo microscopic imaging of microvascular network structure, blood flow and oxygenation

    Directory of Open Access Journals (Sweden)

    Louis Gagnon

    2016-08-01

    Full Text Available Oxygen is delivered to brain tissue by a dense network of microvessels, which actively control cerebral blood flow (CBF through vasodilation and contraction in response to changing levels of neural activity. Understanding these network-level processes is immediately relevant for (1 interpretation of functional Magnetic Resonance Imaging (fMRI signals, and (2 investigation of neurological diseases in which a deterioration of neurovascular and neuro-metabolic physiology contributes to motor and cognitive decline. Experimental data on the structure, flow and oxygen levels of microvascular networks are needed, together with theoretical methods to integrate this information and predict physiologically relevant properties that are not directly measurable. Recent progress in optical imaging technologies for high-resolution in vivo measurement of the cerebral microvascular architecture, blood flow, and oxygenation enables construction of detailed computational models of cerebral hemodynamics and oxygen transport based on realistic three-dimensional microvascular networks. In this article, we review state-of-the-art optical microscopy technologies for quantitative in vivo imaging of cerebral microvascular structure, blood flow and oxygenation, and theoretical methods that utilize such data to generate spatially resolved models for blood flow and oxygen transport. These bottom-up models are essential for the understanding of the processes governing brain oxygenation in normal and disease states and for eventual translation of the lessons learned from animal studies to humans.

  14. Quantitative assessment of myocardial blush grade in patients with coronary artery disease and in cardiac transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Nina; Patricia; Hofmann; Hartmut; Dickhaus; Hugo; A; Katus; Grigorios; Korosoglou

    2014-01-01

    Quantitative assessment of myocardial perfusion by myocardial blush grade(MBG) is an angiographic computer-assisted method to assess myocardial tissue-level reperfusion in patients with acute coronary syndromes and microvascular integrity in heart transplant recipients with suspected cardiac allograft vasculopathy. This review describes the ability of quantitative MBG as a simple, fast and cost effective modality for the prompt diagnosis of impaired microvascular integrity during routine cardiac catheterization. Herein, we summarize the existing evidence, its usefulness in the clinical routine, and compare this method to other techniques which can be used for the assessment of myocardial perfusion.

  15. Liraglutide prevents microvascular insulin resistance and preserves muscle capillary density in high-fat diet-fed rats.

    Science.gov (United States)

    Chai, Weidong; Fu, Zhuo; Aylor, Kevin W; Barrett, Eugene J; Liu, Zhenqi

    2016-09-01

    Muscle microvasculature critically regulates endothelial exchange surface area to facilitate transendothelial delivery of insulin, nutrients, and oxygen to myocytes. Insulin resistance blunts insulin-mediated microvascular recruitment and decreases muscle capillary density; both contribute to lower microvascular blood volume. Glucagon-like peptide 1 (GLP-1) and its analogs are able to dilate blood vessels and stimulate endothelial cell proliferation. In this study, we aim to determine the effects of sustained stimulation of the GLP-1 receptors on insulin-mediated capillary recruitment and metabolic insulin responses, small arterial endothelial function, and muscle capillary density. Rats were fed a high-fat diet (HFD) for 4 wk with or without simultaneous administration of liraglutide and subjected to a euglycemic hyperinsulinemic clamp for 120 min after an overnight fast. Insulin-mediated muscle microvascular recruitment and muscle oxygenation were determined before and during insulin infusion. Muscle capillary density was determined and distal saphenous artery used for determination of endothelial function and insulin-mediated vasodilation. HFD induced muscle microvascular insulin resistance and small arterial vessel endothelial dysfunction and decreased muscle capillary density. Simultaneous treatment of HFD-fed rats with liraglutide prevented all of these changes and improved insulin-stimulated glucose disposal. These were associated with a significantly increased AMPK phosphorylation and the expressions of VEGF and its receptors. We conclude that GLP-1 receptor agonists may exert their salutary glycemic effect via improving microvascular insulin sensitivity and muscle capillary density during the development of insulin resistance, and early use of GLP-1 receptor agonists may attenuate metabolic insulin resistance as well as prevent cardiovascular complications of diabetes. Copyright © 2016 the American Physiological Society.

  16. Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease.

    Science.gov (United States)

    Chen, Chia-Hsin; Chen, Yi-Jen; Tu, Hung-Pin; Huang, Mao-Hsiung; Jhong, Jing-Hui; Lin, Ko-Long

    2014-10-01

    Cardiopulmonary exercise training is beneficial to people with coronary artery disease (CAD). Nevertheless, the correlation between aerobic capacity, and functional mobility and quality of life in elderly CAD patients is less addressed. The purpose of the current study is to investigate the beneficial effects of exercise training in elderly people with CAD, integrating exercise stress testing, functional mobility, handgrip strength, and health-related quality of life. Elderly people with CAD were enrolled from the outpatient clinic of a cardiac rehabilitation unit in a medical center. Participants were assigned to the exercise training group (N = 21) or the usual care group (N = 15). A total of 36 sessions of exercise training, completed in 12 weeks, was prescribed. Echocardiography, exercise stress testing, the 6-minute walking test, Timed Up and Go test, and handgrip strength testing were performed, and the Short-Form 36 questionnaire (SF-36) was administered at baseline and at 12-week follow-up. Peak oxygen consumption improved significantly after training. The heart rate recovery improved from 13.90/minute to 16.62/minute after exercise training. Functional mobility and handgrip strength also improved after training. Significant improvements were found in SF-36 physical function, social function, role limitation due to emotional problems, and mental health domains. A significant correlation between dynamic cardiopulmonary exercise testing parameters, the 6-minute walking test, Timed Up and Go test, handgrip strength, and SF-36 physical function and general health domains was also detected. Twelve-week, 36-session exercise training, including moderate-intensity cardiopulmonary exercise training, strengthening exercise, and balance training, is beneficial to elderly patients with CAD, and cardiopulmonary exercise testing parameters correlate well with balance and quality of life.

  17. Intima-Media Thickness and Cognitive Function in Stroke-Free Middle-Aged Adults: Findings From the Coronary Artery Risk Development in Young Adults Study.

    Science.gov (United States)

    Zeki Al Hazzouri, Adina; Vittinghoff, Eric; Sidney, Stephen; Reis, Jared P; Jacobs, David R; Yaffe, Kristine

    2015-08-01

    The relationship between carotid artery intima-media thickness (IMT) and cognitive function in midlife remains relatively unexplored. We examined the association between IMT and cognitive function in a middle-aged epidemiological cohort of 2618 stroke-free participants. At the year 20 visit (our study baseline), participants from the Coronary Artery Risk Development in Young Adults study had IMT measured by ultrasound at the common carotid artery. Five years later, participants completed a cognitive battery consisting of the Rey Auditory-Verbal Learning Test of verbal memory, the Digit Symbol Substitution Test of processing speed, and the Stroop test of executive function. We transformed cognitive scores into standardized z scores, with negative values indicating worse performance. Mean age at baseline was 45.3 years (SD, 3.6). Greater IMT (per 1 SD difference of 0.12 mm) was significantly associated with worse performance on all cognitive tests (z scores) in unadjusted linear regression models (verbal memory, -0.16; 95% confidence interval [CI], -0.20 to -0.13; processing speed, -0.23; 95% CI, -0.27 to -0.19; and executive function, -0.17; 95% CI, -0.20 to -0.13). In models adjusted for sociodemographics and vascular risk factors that lie earlier in the causal pathway, greater IMT remained negatively associated with processing speed (-0.06; 95% CI, -0.09 to -0.02; P, 0.003) and borderline associated with executive function (-0.03; 95% CI, -0.07 to 0.00; P, 0.07) but not with verbal memory. We observed an association between greater IMT and worse processing speed-a key component of cognitive functioning-at middle age above and beyond traditional vascular risk factors. Efforts targeted at preventing early stages of atherosclerosis may modify the course of cognitive aging. © 2015 American Heart Association, Inc.

  18. Functional recovery of patien